Search results for: logistic objectives

Authors: Scarlet Tabot Enanga Longsti

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Community-Based Health Insurance (CBHI) schemes have been proposed as a possible means to achieve affordable health care in low-and lower-middle-income countries. The existing evidence provides mixed results on the impact of CBHI schemes on healthcare utilisation and out -of-pocket payments (OOPP) for healthcare. Over 900 CBHI schemes have been implemented in underdeveloped countries, and these schemes have undergone different modifications over the years. Prior reviews have suggested that different designs of CBHI schemes may result in different outcomes. Objectives: This review sought to determine the interventions that affect the impact of CBHI schemes on OOPP and health service utilisation. Interventions in this study referred to any action or modification in the design of a CBHI scheme that affected the impact of the scheme on OOPP and/or healthcare utilization. Methods: Any CBHI study that was done in a lower middle-income country, that used an experimental design, that included OOPP or health care utilisation as outcome variables, and that was published in either English or French was included in this study. Studies were searched for in MEDLINE, Embase, CINAHL, EconLit, IBSS, Web of Science, Cochrane Library, and Global Index Medicus from July to August 2023. Bias was assessed using Joanna Brigs Institute tools for quality assessment for randomized control trials and quasi experimental studies. A narrative synthesis was done. Results: 12 studies were included in the review, with a total of 69 villages, 13,653 households, and 62,786 participants. Average premium collection was 4.8 USD/year. Most CBHI schemes had flat rates. The study revealed that a range of interventions impact OOPP and health care utilisation. Five categories of interventions were identified. The intervention with the highest impact on OOPP and utilisation was “Audit visits”. Next in line came external funds, training scheme workers, and engaging community leaders and village heads to advertise the scheme. Free healthcare led to a significant increase in utilisation of health services, a significant reduction in Catastrophic health expenditure, but an insignificant effect on OOPP among insured compared with uninsured. Conclusions: Community-Based Health Insurance could pave the way for Universal Health Care in low and middle-income countries. However, this can only be possible if careful thought is given to how schemes are designed. Due to the heterogeneity of studies and results on CBHI schemes, there is need for further research for more effective designs to be developed.

Keywords: community based health insurance, developing countries, health service utilisation, out of pocket payment

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Authors: Nayoma Ranawaka

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The demand for the high quality internationally comparable financial information has been increased than ever with the expansion of economic activities beyond its national boundaries. Thus, the necessity of converging accounting practices across the world is now continuously discussed with greater emphasis. The global convergence to International Financial Reporting Standards has been one of the main objectives of the International Accounting Standards Setting Board (IASB) since its establishment in 2001. Accordingly, Sri Lanka has adopted IFRSs in 2012. Among the other standards as a newly introduced standard by the IASB, IFRS 13 plays a pivotal role as it deals with the Fair Value Accounting (FVA). Therefore, it is valuable to obtain knowledge about the consequences of implementing IFRS 13 in Sri Lanka and compare results across nations. According to the IFRS Jurisdictional provision of Sri Lanka, Institute of Chartered Accountants of Sri Lanka has taken official steps to adopt IFRS 13 by introducing SLFRS 13 with de jure convergence. Then this study was identified the de facto convergence of the SLFRS 13 in measuring the Fair Value of Financial Instruments in the Sri Lankan context. Accordingly, the objective of this study is to explore the consequences to financial reporting by implementing SLFRS 13 on measuring the financial instruments. In order to achieve the objective of the study expert interview and in-depth interviews with the interviewees from the selected three case studies and their independent auditor were carried out using customized three different interview guides. These three cases were selected from three different industries; Banking, Manufacturing and Finance. NVivo version 10 was used to analyze the data collected through in-depth interviews. Then the content analysis was carried out and conclusions were derived based on the findings. Contribution to the knowledge by this study can be identified in different aspects. Findings of this study facilitate accounting practitioners to get an overall picture of application of fair value standard in measuring the financial instruments and to identify the challenges and barriers to the adoption process. Further, assist auditors in carrying out their audit procedures to check the level of compliance to the fair value standard in measuring the financial instruments. Moreover, this would enable foreign investors in assessing the reliability of the financial statements of their target investments as a result of SLFRS 13 in measuring the FVs of the FIs. The findings of the study could be used to open new avenues of thinking for policy formulators to provide the necessary infrastructure to eliminate disparities exists among different regulatory bodies to facilitate full convergence and thereby growth of the economy. Further, this provides insights to the dynamics of FVA implementation that are also relevant for other developing countries.

Keywords: convergence, fair value, financial instruments, IFRS 13

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Authors: M. Sulieman, H. Arabiyat, H. Ali, K. Potiszil, I. Abbas, R. English, P. King, I. Brown, P. Drew

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Introduction: The incidence of breast ductal Carcinoma in Situ (DCIS) has been increasing; it currently represents up 20-25% of all breast carcinomas. Some aspects of DCIS management are still controversial, mainly due to the heterogeneity of its clinical presentation and of its biological and pathological characteristics. In DCIS, histological diagnosis obtained preoperatively, carries the risk of sampling error if the presence of invasive cancer is subsequently diagnosed. The mammographic extent over than 4–5 cm and the presence of architectural distortion, focal asymmetric density or mass on mammography are proven important risk factors of preoperative histological under staging. Intracystic papillary cancer (IPC) is a rare form of breast carcinoma. Despite being previously compared to DCIS it has been shown to present histologically with invasion of the basement membrane and even metastasis. SLNB – Carries the risk of associated comorbidity that should be considered when planning surgery for DCIS and IPC. Objectives: The aim of this Audit was to better define a ‘high risk’ group of patients with pre-op diagnosis of non-invasive cancer undergoing breast conserving surgery, who would benefit from sentinel node biopsy. Method: Retrospective data collection of all patients with ductal carcinoma in situ over 5 years. 636 patients identified, and after exclusion criteria applied: 394 patients were included. High risk defined as: Extensive micro-calcification >40mm OR any mass forming DCIS. IPC: Winpath search from for the term ‘papillary carcinoma’ in any breast specimen for 5 years duration;.29 patients were included in this group. Results: DCIS: 188 deemed high risk due to >40mm calcification or a mass forming (radiological or palpable) 61% of those had a mastectomy and 32% BCS. Overall, in that high-risk group - the number with invasive disease was 38%. Of those high-risk DCIS pts 85% had a SLN - 80% at the time of surgery and 5% at a second operation. For the BCS patients - 42% had SLN at time of surgery and 13% (8 patients) at a second operation. 15 (7.9%) pts in the high-risk group had a positive SLNB, 11 having a mastectomy and 4 having BCS. IPC: The provisional diagnosis of encysted papillary carcinoma is upgraded to an invasive carcinoma on final histology in around a third of cases. This has may have implications when deciding whether to offer sentinel node removal at the time of therapeutic surgery. Conclusions: We have defined a ‘high risk’ group of pts with pre-op diagnosis of non-invasive cancer undergoing BCS, who would benefit from SLNB at the time of the surgery. In patients with high-risk features; the risk of invasive disease is up to 40% but the risk of nodal involvement is approximately 8%. The risk of morbidity from SLN is up to about 5% especially the risk of lymphedema.

Keywords: breast ductal carcinoma in Situ (DCIS), intracystic papillary carcinoma (IPC), sentinel node biopsy (SLNB), high-risk, non-invasive, cancer disease

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Authors: Aisling Davies, Ciara Greene

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Over the past decade the phenomenon of mind-wandering in cognitive tasks has attracted widespread scientific attention. Research indicates that mind-wandering occurrences can be detected through behavioural responses in the Sustained Attention to Response Task (SART) and several studies have attributed a specific pattern of responding around an error in this task to an observable effect of a mind-wandering state. SART behavioural responses are also widely accepted as indices of sustained attention and of general attention lapses. However, evidence suggests that these same patterns of responding may be attributable to other factors associated with more focused states and that it may also be possible to distinguish the two states within the same task. To use behavioural responses in the SART to study mind-wandering, it is essential to establish both the SART parameters that would increase the likelihood of errors due to mind-wandering, and exactly what type of responses are indicative of mind-wandering, neither of which have yet been determined. The aims of this study were to compare different versions of the SART to establish which task would induce the most mind-wandering episodes and to determine whether mind-wandering related errors can be distinguished from errors during periods of focus, by behavioural responses in the SART. To achieve these objectives, 25 Participants completed four modified versions of the SART that differed from the classic paradigm in several ways so to capture more instances of mind-wandering. The duration that trials were presented for was increased proportionately across each of the four versions of the task; Standard, Medium Slow, Slow, and Very Slow and participants intermittently responded to thought probes assessing their level of focus and degree of mind-wandering throughout. Error rates, reaction times and variability in reaction times decreased in proportion to the decrease in trial duration rate and the proportion of mind-wandering related errors increased, until the Very Slow condition where the extra decrease in duration no longer had an effect. Distinct reaction time patterns around an error, dependent on level of focus (high/low) and level of mind-wandering (high/low) were also observed indicating four separate attention states occurring within the SART. This study establishes the optimal duration of trial presentation for inducing mind-wandering in the SART, provides evidence supporting the idea that different attention states can be observed within the SART and highlights the importance of addressing other factors contributing to behavioural responses when studying mind-wandering during this task. A notable finding in relation to the standard SART, was that while more errors were observed in this version of the task, most of these errors were during periods of focus, raising significant questions about our current understanding of mind-wandering and associated failures of attention.

Keywords: attention, mind-wandering, trial duration rate, Sustained Attention to Response Task (SART)

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Authors: B. Bricklin Zeff

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This research explores the development and application of a specialized chatbot tailored for a nursing English course, with a primary objective of augmenting student engagement through situational content and responsiveness to key expressions and vocabulary. Introducing the chatbot, elucidating its purpose, and outlining its functionality are crucial initial steps in the research study, as they provide a comprehensive foundation for understanding the design and objectives of the specialized chatbot developed for the nursing English course. These elements establish the context for subsequent evaluations and analyses, enabling a nuanced exploration of the chatbot's impact on student engagement and language learning within the nursing education domain. The subsequent exploration of the intricate language model development process underscores the fusion of scientific methodologies and artistic considerations in this application of artificial intelligence (AI). Tailored for educators and curriculum developers in nursing, practical principles extending beyond AI and education are considered. Some insights into leveraging technology for enhanced language learning in specialized fields are addressed, with potential applications of similar chatbots in other professional English courses. The overarching vision is to illuminate how AI can transform language learning, rendering it more interactive and contextually relevant. The presented chatbot is a tangible example, equipping educators with a practical tool to enhance their teaching practices. Methodologies employed in this research encompass surveys and discussions to gather feedback on the chatbot's usability, effectiveness, and potential improvements. The chatbot system was integrated into a nursing English course, facilitating the collection of valuable feedback from participants. Significant findings from the study underscore the chatbot's effectiveness in encouraging more verbal practice of target expressions and vocabulary necessary for performance in role-play assessment strategies. This outcome emphasizes the practical implications of integrating AI into language education in specialized fields. This research holds significance for educators and curriculum developers in the nursing field, offering insights into integrating technology for enhanced English language learning. The study's major findings contribute valuable perspectives on the practical impact of the chatbot on student interaction and verbal practice. Ultimately, the research sheds light on the transformative potential of AI in making language learning more interactive and contextually relevant, particularly within specialized domains like nursing.

Keywords: chatbot, nursing, pragmatics, role-play, AI

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Authors: Florence Ibeh, David Oyewmi Oyekunle, David Boohene

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The continuous advancement of information technology has completely transformed how businesses and organizations operate on a global scale. The widespread availability of virtual communication tools enables individuals to opt for remote work. While remote employment offers various benefits, such as facilitating corporate growth and enhancing customer support, it also presents distinct challenges. Therefore, investigating the intricacies of virtual team morale is crucial for ensuring the achievement of project objectives. For this study, content analysis of pre-existing secondary data was employed to examine the phenomenon. Essential elements vital for improving the success of projects within virtual teams were identified. These factors include technology adoption, creating a distraction-free work environment, effective leadership, trust-building, clear communication channels, well-defined task allocation, active team participation, and motivation. Furthermore, the study established a substantial correlation between morale levels and the participation and productivity of virtual team members. Higher levels of morale were associated with optimal performance among virtual teams. The study determined that the key factors for enhancing project performance in virtual teams are the adoption of technology, a focused environment, effective leadership, trust, communication, well-defined tasks, collaborative teamwork, and motivation. Additionally, the study discovered that modifying the optimal strategies employed by in-office teams can enhance the diminished morale prevalent in remote teams to sustain a high level of team morale for virtual teams. The findings of this study are highly significant in the dynamic field of project management. Currently, there is limited information regarding strategies that address challenges arising from external factors in virtual teams, such as ambient noise and disruptions caused by family members. The findings underscore the significance of selecting appropriate communication technologies, delineating distinct roles and responsibilities for virtual team members, and nurturing a culture of accountability and trust. Promoting seamless collaboration and instilling motivation among virtual team members are deemed highly effective in augmenting employee engagement and performance within virtual team setting.

Keywords: virtual teams, morale, project performance, distract-free environment, technology adaptation

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Authors: Mahadehe Hassan

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In most countries manufacturing, trading and distribution of gasoline and diesel fuels belongs to the most important sectors of national economy. For Bangladesh, a robust, well-functioning, secure and smartly managed national fuel distribution chain is an essential precondition for achieving Government top priorities in development and modernization of transportation infrastructure, protection of national environment and population health as well as, very importantly, securing due tax revenue for the State Budget. Bangladesh is a developing country with complex fuel supply network, high fuel taxes incidence and – till now - limited possibilities in application of modern, automated technologies for Government national fuel market control. Such environment allows dishonest physical and legal persons and organized criminals to build and profit from illegal fuel distribution schemes and fuel illicit trade. As a result, the market transparency and the country attractiveness for foreign investments, law-abiding economic operators, national consumers, State Budget and the Government ability to finance development projects, and the country at large suffer significantly. Research shows that over 50% of retail petrol stations in major agglomerations of Bangladesh sell adulterated fuels and/or cheat customers on the real volume of the fuel pumped into their vehicles. Other forms of detected fuel illicit trade practices include misdeclaration of fuel quantitative and qualitative parameters during internal transit and selling of non-declared and smuggled fuels. The aim of the study is to recommend the implementation of a National Fuel Distribution Integrity Program (FDIP) in Bangladesh to address and resolve fuel adulteration and illicit trade problems. The program should be customized according to the specific needs of the country and implemented in partnership with providers of advanced technologies. FDIP should enable and further enhance capacity of respective Bangladesh Government authorities in identification and elimination of all forms of fuel illicit trade swiftly and resolutely. FDIP high-technology, IT and automation systems and secure infrastructures should be aimed at the following areas (1) fuel adulteration, misdeclaration and non-declaration; (2) fuel quality and; (3) fuel volume manipulation at retail level. Furthermore, overall concept of FDIP delivery and its interaction with the reporting and management systems used by the Government shall be aligned with and support objectives of the Vision 2041 and Smart Bangladesh Government programs.

Keywords: fuel adulteration, octane, kerosene, diesel, petrol, pollution, carbon emissions

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Authors: Ayelet Hersch, Corrine Serfaty, Sigal Portnoy

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Stroke survivors commonly report persistent fatigue and sleep disruptions during rehabilitation and post-recovery. While limited research has explored the impact of stroke on a patient's chronotype, there is a gap in understanding the differences in cognitive performance based on treatment timing. Study objectives: (a) To characterize the sleep chronotype in sub-acute post-stroke individuals. (b) Explore cognitive task performance differences during preferred and non-preferred hours. (c) Examine the relationships between sleep quality and cognitive performance. For this intra-subject study, twenty participants (mean age 60.2±8.6) post-first stroke (6-12 weeks post stroke) underwent assessments at preferred and non-preferred chronotypic times. The assessment included demographic surveys, the Munich Chronotype Questionnaire, Montreal Cognitive Assessment (MoCA), Rivermead Behavioral Memory Test (RBMT), a fatigue questionnaire, and 4-5 days of actigraphy (wrist-worn wGT3X-BT, ActiGraph) to record sleep characteristics. Four sleep quality indices were extracted from actigraphy wristwatch recordings: The average of total sleep time per day (minutes), the average number of awakenings during the sleep period per day, the efficiency of sleep (total hours of sleep per day divided by hours spent in bed per day, averaged across the days and presented as percentage), and the Wake after Sleep Onset (WASO) index, indicating the average number of minutes elapsed from the onset of sleep to the first awakening. Stroke survivors exhibited an earlier sleep chronotype post-injury compared to pre-injury. Enhanced attention, as indicated by higher RBMT scores, occurred during preferred hours. Specifically, 30% of the study participants demonstrated an elevation in their final scores during their preferred hours, transitioning from the category of "mild memory impairment" to "normal memory." However, no significant differences emerged in executive functions, attention tasks, and MoCA scores between preferred and non-preferred hours. The Wake After Sleep Onset (WASO) index correlated with MoCA/RBMT scores during preferred hours (r=0.53/0.51, p=0.021/0.027, respectively). The number of awakenings correlated with MoCA letter task performance during non-preferred hours (r=0.45, p=0.044). Enhanced attention during preferred hours suggests a potential relationship between chronotype and cognitive performance, highlighting the importance of personalized rehabilitation strategies in stroke care. Further exploration of these relationships could contribute to optimizing the timing of cognitive interventions for stroke survivors.

Keywords: sleep chronotype, chronobiology, circadian rhythm, rehabilitation timing

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Authors: Muhammad Yasir Tarar

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Background: Intraarticular steroid injections are an effective option in alleviating the symptoms of conditions like osteoarthritis, rheumatoid arthritis, crystal arthropathy, and rotator cuff tendinopathy. Most of these injections are conducted in the elderly who are on polypharmacy, including anticoagulants at times. Up to 6% of patients aged 80-84 years have been reported to be taking Warfarin. The literature availability on safety quotient for patients undergoing intraarticular injections on Warfarin is scarce. It has remained debatable over the years which approach is safe for these patients. Continuing warfarin has a theoretical bleeding risk, and stopping it can lead to even severe life-threatening thromboembolic events in high-risk patients. Objectives: To evaluate the risk of bleeding complications in patients on warfarin undergoing intraarticular injections or arthrocentesis. Study Design & Methods: A literature search of MEDLINE (1946 to present), EMBASE (1974 to present), and Cochrane CENTRAL (1988 to present) databases were conducted using any combination of the keywords, Injection, Knee, Shoulder, Joint, Intraarticular, arthrocentesis, Warfarin, and Anticoagulation in November 2020 for articles published in any language with no publication year limit. The study inclusion criteria included reporting on the rate of bleeding complications following injection of the knee or shoulder in patients on warfarin treatment. Randomized control trials and prospective and retrospective study designs were included. An electronic standardized Performa for data extraction was made. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) the methodology was used. The articles were appraised using the methodological index for nonrandomized studies. The Cochrane Risk of Bias Tool used to assess the risk of bias in included RCTs and the MINORS tool for assessment of bias in observational studies. Results: The search of databases resulted in a total of 852 articles. Relevant articles as per the inclusion criteria were shortlisted, 7 articles deemed suitable to be include. A total of 1033 joints sample size was undertaken with specified knee and shoulder joints of a total of 820. Only 6 joints had bleeding complications, 5 early bleeding at the time of injection or aspiration, and one late bleeding complication with INR of 5, additionally, 2 patients complained of bruising, 3 of pain, and 1 managed for infection. Conclusions: The results of the metanalysis show that it is relatively safe to perform intraarticular injections in patients on Warfarin regardless of the INR range.

Keywords: arthrocentesis, warfarin, bleeding, injection

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Authors: Ibrahim Umar, Ashiru Rajab, Sumayya Chindo, Emmanuel Olashore

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INTRODUCTION: Kano is the most populous state in Nigeria and one of the two states with the highest TB burden in the country. The state notifies an average of 8,000+ TB cases quarterly and has the highest yearly notification of all the states in Nigeria from 2020 to 2022. The contribution of the state TB program to the National TB notification varies from 9% to 10% quarterly between the first quarter of 2022 and second quarter of 2023. The Kano State TB Situation Room is an innovative platform for timely data collection, collation and analysis for informed decision in health system. During the 2023 second National TB Testing week (NTBTW) Kano TB program aimed at early TB detection, prevention and treatment. The state TB Situation room provided avenue to the state for coordination and surveillance through real time data reporting, review, analysis and use during the NTBTW. OBJECTIVES: To assess the role of innovative information and communication technology platform for real-time TB reporting during second National TB Testing week in Nigeria 2023. To showcase the NTBTW data cascade analysis using TSR as innovative ICT platform. METHODOLOGY: The State TB deployed a real-time virtual dashboard for NTBTW reporting, analysis and feedback. A data room team was set up who received realtime data using google link. Data received was analyzed using power BI analytic tool with statistical alpha level of significance of <0.05. RESULTS: At the end of the week-long activity and using the real-time dashboard with onsite mentorship of the field workers, the state TB program was able to screen a total of 52,054 people were screened for TB from 72,112 individuals eligible for screening (72% screening rate). A total of 9,910 presumptive TB clients were identified and evaluated for TB leading to diagnosis of 445 TB patients with TB (5% yield from presumptives) and placement of 435 TB patients on treatment (98% percentage enrolment). CONCLUSION: The TB Situation Room (TBSR) has been a great asset to Kano State TB Control Program in meeting up with the growing demand for timely data reporting in TB and other global health responses. The use of real time surveillance data during the 2023 NTBTW has in no small measure improved the TB response and feedback in Kano State. Scaling up this intervention to other disease areas, states and nations is a positive step in the right direction towards global TB eradication.

Keywords: tuberculosis (tb), national tb testing week (ntbtw), tb situation rom (tsr), information communication technology (ict)

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Authors: Jonalee Das Bajpai, Sandeep Shastri

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The Indian Textile and Garment Industry is one of the major contributors to the country’s economy. This industry is also one of the largest labour intensive industries after agriculture and livestock. This Indian garment industry caters to both the domestic and international market. Although this industry comes under the purview of Indian Labour Laws and other voluntary work place standards yet, this industry is often criticized for the undue exploitation of the workers. This paper explored the status of forced labour and discrimination at work place in the garment manufacturing units in Bengaluru. This study is conducted from the perspective of women sewing operators as majority of operators in Bengaluru are women. The research also explored to study the impact of social compliance certification in abolishing forced labour and discrimination at work place. Objectives of the Research: 1. To study the impact of 'Social Compliance Certification' on abolition of forced labour among the women workforce. 2. To study the impact of 'Social Compliance Certification' on abolition of discrimination at workplace among the women workforce. Sample Size and Data Collection Techniques: The main backbone of the data which is the primary data was collected through a structured questionnaire. The questionnaire attempted to explore the extent of prevalence of forced labour and discrimination against women workers from the perspective of women workers themselves. The sample size for the same was 600 (n) women sewing operators from the garment industry with minimum one year of work experience. Three hundred samples were selected from units with Social Compliance Certification like SA8000, WRAP, BSCI, ETI and so on. Other three hundred samples were selected from units without Social Compliance Certification. Out of these three hundred samples, one hundred and fifty samples were selected from units with Buyer’s Code of Conduct and another one hundred and fifty were from domestic units that do not come under the purview of any such certification. The responses of the survey were further authenticated through on sight visit and personal interactions. Comparative analysis of the workplace environment between units with Social Compliance certification, units with Buyer’s Code of Conduct and domestic units that do not come under the purview of any such voluntary workplace environment enabled to analyze the impact of Social Compliance certification on abolition of workplace environment and discrimination at workplace. Correlation analysis has been conducted to measure the relationship between impact of forced labour and discrimination at workplace on the level of job satisfaction. The result displayed that abolition of forced labour and abolition of discrimination at workplace have a higher level of job satisfaction among the women workers.

Keywords: discrimination, garment industry, forced labour, social compliance certification

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Authors: J. A. Marañón, L. Lozano C. De Los Santos, L. Martínez-Campesino, E. Caballero-Garrido, F. Galán-Estella

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Urinary incontinence (UI) is a significant health problem with considerable social and economic impact. An estimated 30% of women aged 30 to 60 years old have urinary incontinence (UI), while more than 50% of community-dwelling older women have the condition. Stress urinary incontinence and overactive bladder are the common types of incontinence The prevalence of stress and mixed (stress and urge) incontinence is higher than urge incontinence, but the latter is more likely to require treatment. In women, moderate and severe have a prevalence ranging from about 12% to 17% The objectives of this study was to examine the effect of the supplementation of tablets containing Dropsordry in women with urge urinary incontinence (UUI). Dropsordry is a novel active containing phytoestrogens from SOLGEN, the high genistin soy bean extract and pyrogallol plus polyphenols from standarized pumpkin seed extract,. The study was a single-center, not randomiized open prospective, study. 28 women with urinary incontinence ≥45 years were enrolled in this study (45-62 y. old age . Mean 52 y old). Items related to UI symptoms, were previously collected (T0) and these ítems were reviewed at the final of the study – 8 weeks. (T2). The presence of UI was previously diagnosed using the International Continence Society standards (ICS). Relationships between presence of UI and potential related factors as diabetes were also explored. Daily urinary test control was performed during the 8 weeks of treatment. Daily dosage was 1 g/ day (500 mg twice per day) from 0 to 4 week (T1), following a 500 mg/day daily intake from 4 to 8 week (T2). After eight weeks of treatment, the urgency grade score was reduced a 24,7%. The total urge episodes was reduced a 46%. Surprisingly there was no a significant change in daytime urinations (< 5%), however nocturia was reduced a 69,35%. Strenght Urinary Incontinence (SUI) was also tested showing a remarkably 52,17% reduction. Moreover the use of daily pantyliners was reduced a 66,25%. In addition, it was performed a panel test survey with quests when subjects of the study were enrolled (T0) and the same quests was performed after 8 weeks of supplementation (T2). 100% of the enrolled women fullfilled the ICIQ-SF quest (Spanish versión) and they were also questioned about the effects they noticed in response to taking the supplement and the change in quality of life. Interestingly no side effects were reported. There was a 96,2% of subjective satisfaction and a 85,8% objective score in the improvement of quality of life. CONCLUSION: the combination of High genistin isoflavones and pumpkin seed pyrogallol in Dropsordry tablets seems to be a safe and highly effective supplementation for the relieve of the urinary incontinence symptoms and a better quality of life in perimenopause women .

Keywords: isoflavones, pumpkin, menopause, incontinence, genistin

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Authors: Vilas Warudkar, Dinkar Janghel, Siraj Ahmed

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Rapid development experienced by India requires huge amount of energy. Actual supply capacity additions have been consistently lower than the targets set by the government. According to World Bank 40% of residences are without electricity. In 12th five year plan 30 GW grid interactive renewable capacity is planned in which 17 GW is Wind, 10 GW is from solar and 2.1 GW from small hydro project, and rest is compensated by bio gas. Renewable energy (RE) and energy efficiency (EE) meet not only the environmental and energy security objectives, but also can play a crucial role in reducing chronic power shortages. In remote areas or areas with a weak grid, wind energy can be used for charging batteries or can be combined with a diesel engine to save fuel whenever wind is available. India according to IEC 61400-1 belongs to class IV Wind Condition; it is not possible to set up wind turbine in large scale at every place. So, the best choice is to go for small scale wind turbine at lower height which will have good annual energy production (AEP). Based on the wind characteristic available at MANIT Bhopal, rotor for small scale wind turbine is designed. Various Aero foil data is reviewed for selection of airfoil in the Blade Profile. Airfoil suited of Low wind conditions i.e. at low Reynold’s number is selected based on Coefficient of Lift, Drag and angle of attack. For designing of the rotor blade, standard Blade Element Momentum (BEM) Theory is implanted. Performance of the Blade is estimated using BEM theory in which axial induction factor and angular induction factor is optimized using iterative technique. Rotor performance is estimated for particular designed blade specifically for low wind Conditions. Power production of rotor is determined at different wind speeds for particular pitch angle of the blade. At pitch 15o and velocity 5 m/sec gives good cut in speed of 2 m/sec and power produced is around 350 Watts. Tip speed of the Blade is considered as 6.5 for which Coefficient of Performance of the rotor is calculated 0.35, which is good acceptable value for Small scale Wind turbine. Simple Load Model (SLM, IEC 61400-2) is also discussed to improve the structural strength of the rotor. In SLM, Edge wise Moment and Flap Wise moment is considered which cause bending stress at the root of the blade. Various Load case mentioned in the IEC 61400-2 is calculated and checked for the partial safety factor of the wind turbine blade.

Keywords: annual energy production, Blade Element Momentum Theory, low wind Conditions, selection of airfoil

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Authors: Hussein M. H. Mohamed, Hamdy M. B. Zaki

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Fresh sausage is one of the cheapest and delicious meat products that are gaining popularity all over the world. It is considered as a practice of adding value to low-value meat cuts of high fat and connective tissue contents. One of the most important characteristics of fresh sausage is the distinctive marbling appearance between lean and fatty portions, which can be achieved by using animal fat. For achieving the marbling appearance of fresh sausage, a lager amount of fat needs to be used. The use of animal fat may represent a health concern due to its content of saturated fatty acids and trans-fats, which increase the risk of heart diseases. There is a need for reducing the fat content of fresh sausage to obtain a healthy product. However, fat is responsible for the texture, flavor, and juiciness of the product. Therefore, developing reduced-fat products is a challenging process. The main objectives of the current study were to incorporate chicken skin based products (chicken skin emulsion, gelatinized chicken skin, and gelatinized chicken skin emulsion) during the formulation of fresh sausage as fat replacers and to study the effect of these products on the nutritional quality, physicochemical properties, and sensory attributes of the processed product. Three fresh sausage formulae were prepared using chicken skin based fat replacers (chicken skin emulsion, gelatinized chicken skin, and gelatinized chicken skin emulsion) beside one formula prepared using mesenteric beef fat as a control. The proximate composition, fatty acid profiles, Physico-chemical characteristics, and sensory attributes of all formulas were assessed. The results revealed that the use of chicken skin based fat replacers resulted in significant (P < 0.05) reduction of fat contents from 17.67 % in beef mesenteric fat formulated sausage to 5.77, 8.05 and 8.46 in chicken skin emulsion, gelatinized chicken skin, and gelatinized chicken skin emulsion formulated sausages, respectively. Significant reduction in the saturated fatty acid contents and a significant increase in mono-unsaturated, poly-unsaturated, and omega-3 fatty acids have been observed in all formulae processed with chicken skin based fat replacers. Moreover, significant improvements in the physico-chemical characteristics and non-significant changes in the sensory attributes have been obtained. From the obtained results, it can be concluded that the chicken skin based products can be used safely to improve the nutritional quality and physico chemical properties of beef fresh sausages without changing the sensory attributes of the product. This study may encourage meat processors to utilize chicken skin based fat replacers for the production of high quality and healthy beef fresh sausages.

Keywords: chicken skin emulsion, fresh sausage, gelatinized chicken skin, gelatinized chicken skin emulsion

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Authors: Anshu Radha Aggarwal

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Higher Education (HE) in the India has experienced a series of remarkable changes over the last fifteen years as successive governments have sought to make the sector more efficient and more accountable for investment of public funds. Rapid expansion in student numbers and pressures to widen Participation amongst non-traditional students are key challenges facing HE. Learning outcomes can act as a benchmark for assuring quality and efficiency in HE and they also enable universities to describe courses in an unambiguous way so as to demystify (and open up) education to a wider audience. This paper examines how learning outcomes are used in HE and evaluates the implications for curriculum design and student learning. There has been huge expansion in the field of higher education, both technical and non-technical, in India during the last two decades, and this trend is continuing. It is expected that another about 400 colleges and 300 universities will be created by the end of the 13th Plan Period. This has lead to many concerns about the quality of education and training of our students. Many studies have brought the issues ailing our curricula, delivery, monitoring and assessment. Govt. of India, (via MHRD, UGC, NBA,…) has initiated several steps to bring improvement in quality of higher education and training, such as National Skills Qualification Framework, making accreditation of institutions mandatory in order to receive Govt. grants, and so on. Moreover, Outcome-based Education and Training (OBET) has also been mandated and encouraged in the teaching/learning institutions. MHRD, UGC and NBAhas made accreditation of schools, colleges and universities mandatory w.e.f Jan 2014. Outcome-based Education and Training (OBET) approach is learner-centric, whereas the traditional approach has been teacher-centric. OBET is a process which involves the re-orientation/restructuring the curriculum, implementation, assessment/measurements of educational goals, and achievement of higher order learning, rather than merely clearing/passing the university examinations. OBET aims to bring about these desired changes within the students, by increasing knowledge, developing skills, influencing attitudes and creating social-connect mind-set. This approach has been adopted by several leading universities and institutions around the world in advanced countries. Objectives of this paper is to highlight the issues concerning quality in higher education and quality frameworks, to deliberate on the various education and training models, to explain the outcome-based education and assessment processes, to provide an understanding of the NAAC and outcome-based accreditation criteria and processes and to share best-practice outcomes-based accreditation system and process.

Keywords: learning outcomes, curriculum development, pedagogy, outcome based education

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Authors: Usman Asif, Klaus Schmidt

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In recent years, the development of alternate fuel vehicles has helped to reduce carbon emissions worldwide. As the number of vehicles will continue to increase in the future, the energy demand will also increase. Therefore, we must consider automotive technologies that are efficient and less harmful to the environment in the long run. Battery Electric Vehicles (BEVs) have gained popularity in recent years because of their lower maintenance, lower fuel costs, and lower carbon emissions. Nevertheless, BEVs show several disadvantages, such as slow charging times and lower range than traditional combustion-powered vehicles. These factors keep many people from switching to BEVs. The authors of this research believe that these limitations can be overcome by using fuel cell technology. Fuel cell technology converts chemical energy into electrical energy from hydrogen power and therefore serves as fuel to power the motor and thus replacing heavy lithium batteries that are expensive and hard to recycle. Also, in contrast to battery-powered electric vehicle technology, Fuel Cell Electric Vehicles (FCEVs) offer higher ranges and lower fuel-up times and therefore are more competitive with electric vehicles. However, FCEVs have not gained the same popularity as electric vehicles due to stringent legal frameworks, underdeveloped infrastructure, high fuel transport, and storage costs plus the expense of fuel cell technology itself. This research will focus on the legal frameworks for hydrogen-powered vehicles, and how a change in these policies may affect and improve hydrogen fueling infrastructure and lower hydrogen transport and storage costs. These policies may also facilitate reductions in fuel cell technology costs. In order to attain a better framework, a number of countries have developed conceptual roadmaps. These roadmaps have set out a series of objectives to increase the access of FCEVs to their respective markets. This research will specifically focus on policies in Japan, Europe, and the USA in their attempt to shape the automotive industry of the future. The researchers also suggest additional policies that may help to accelerate the advancement of FCEVs to mass-markets. The approach was to provide a solid literature review using resources from around the globe. After a subsequent analysis and synthesis of this review, the authors concluded that in spite of existing legal challenges that have hindered the advancement of fuel-cell technology in the automobile industry in the past, new initiatives that enhance and advance the very same technology in the future are underway.

Keywords: fuel cell electric vehicles, fuel cell technology, legal frameworks, policies and regulations

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Authors: Keith T. S. Tung, Frederick K. Ho, Rosa S. Wong, Camilla K. M. Lo, Wilfred H. S. Wong, C. B. Chow, Patrick Ip

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Objectives: Underage drinking is an important public health problem both locally and globally. Conventional prevention/intervention relies on unidirectional knowledge transfer such as mail leaflets or health talks which showed mixed results in changing the target behaviour. Previously, we conducted a school internet-based intervention which was found to be effective in reducing alcohol use among adolescents, yet the underlying mechanisms have not been properly investigated. This study, therefore, examined the mechanisms that explain how the intervention produced a change in alcohol drinking behaviours among Chinese adolescent as observed in our previous clustered randomised controlled trial (RCT) study. Methods: This is a cluster randomised controlled trial with parallel group design. Participating schools were randomised to the Internet intervention or the conventional health education group (control) with a 1:1 allocation ratio. Secondary 1–3 students of the participating schools were enrolled in this study. The Internet intervention was a web-based quiz game competition, in which participating students would answer 1,000 alcohol-related multiple-choice quiz questions. Conventional health education group received a promotional package on equivalent alcohol-related knowledge. The participants’ alcohol-related attitude, knowledge, and perceived behavioural control were self-reported before the intervention (baseline) and one month and three months after the intervention. Results: Our RCT results showed that participants in the Internet group were less likely to drink (risk ratio [RR] 0.79, p < 0.01) as well as in lesser amount (β -0.06, p < 0.05) compared to those in the control group at both post-intervention follow-ups. Within the intervention group, regression analyses showed that high quiz scorer had greater improvement in alcohol-related knowledge (β 0.28, p < 0.01) and attitude (β -0.26, p < 0.01) at 1 month after intervention, which in turn increased their perceived behavioural control against alcohol use (β 0.10 and -0.26, both p < 0.01). Attitude, compared to knowledge, was found to be a stronger contributor to the intervention effect on perceived behavioural control. Conclusions: Our internet-based intervention has demonstrated effectiveness in reducing the risk of underage drinking when compared with conventional health education. Our study results further showed an attitude to be a more important factor than knowledge in changing health-related behaviour. This has an important implication for future prevention/intervention on an underage drinking problem.

Keywords: adolescents, internet-based intervention, randomized controlled trial, underage drinking

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Authors: Hooriya Sadr Dadras, Shiva Seyed Erfani

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Speaking skills merit meticulous attention both on the side of the learners and the teachers. In particular, accuracy is a critical component to guarantee the messages to be conveyed through conversation because a wrongful change may adversely alter the content and purpose of the talk. Different types of tasks have served teachers to meet numerous educational objectives. Besides, negotiation of meaning and the use of different strategies have been areas of concern in socio-cultural theories of SLA. Negotiation of meaning is among the conversational processes which have a crucial role in facilitating the understanding and expression of meaning in a given second language. Conversational strategies are used during interaction when there is a breakdown in communication that leads to the interlocutor attempting to remedy the gap through talk. Therefore, this study was an attempt to investigate if there was any significant difference between the effect of reasoning gap tasks and information gap tasks on the frequency of conversational strategies used in negotiation of meaning in classrooms on one hand, and on the accuracy in speaking of Iranian intermediate EFL learners on the other. After a pilot study to check the practicality of the treatments, at the outset of the main study, the Preliminary English Test was administered to ensure the homogeneity of 87 out of 107 participants who attended the intact classes of a 15 session term in one control and two experimental groups. Also, speaking sections of PET were used as pretest and posttest to examine their speaking accuracy. The tests were recorded and transcribed to estimate the percentage of the number of the clauses with no grammatical errors in the total produced clauses to measure the speaking accuracy. In all groups, the grammatical points of accuracy were instructed and the use of conversational strategies was practiced. Then, different kinds of reasoning gap tasks (matchmaking, deciding on the course of action, and working out a time table) and information gap tasks (restoring an incomplete chart, spot the differences, arranging sentences into stories, and guessing game) were manipulated in experimental groups during treatment sessions, and the students were required to practice conversational strategies when doing speaking tasks. The conversations throughout the terms were recorded and transcribed to count the frequency of the conversational strategies used in all groups. The results of statistical analysis demonstrated that applying both the reasoning gap tasks and information gap tasks significantly affected the frequency of conversational strategies through negotiation. In the face of the improvements, the reasoning gap tasks had a more significant impact on encouraging the negotiation of meaning and increasing the number of conversational frequencies every session. The findings also indicated both task types could help learners significantly improve their speaking accuracy. Here, applying the reasoning gap tasks was more effective than the information gap tasks in improving the level of learners’ speaking accuracy.

Keywords: accuracy in speaking, conversational strategies, information gap tasks, reasoning gap tasks

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Authors: Rajib Husain, Munirujzaman Osmani, Mohammad Shamsal Islam

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Purpose: To compare the safety, efficacy and visual outcome of phacoemulsification vs. manual small-incision cataract surgery (SICS) for the treatment of cataract in Bangladesh. Objectives: 1. To assess the Visual outcome after cataract surgery 2. To understand the post-operative complications and early rehabilitation 3. To identified which surgical procedure more attractive to the patients 4. To identify which surgical procedure is occurred fewer complications. 5. To find out the socio-economic and demographic characteristics of study patients Setting: Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh. Design: Retrospective, randomised comparison of 300 patients with visually significant cataracts. Method: The present study was designed as a retrospective hospital-based research. The sample size was 300 and study period was from July, 2012 to July, 2013 and assigned randomly to receive either phacoemulsification or manual small-incision cataract surgery (SICS). Preoperative and post-operative data were collected through a well designed collection format. Three follow-up were done; i) during discharge ii) 1-3 weeks & iii) 4-11 weeks post operatively. All preoperative and surgical complications, uncorrected and best-corrected visual acuity (BCVA) and astigmatism were taken into consideration for comparison of outcome Result: Nearly 95% patients were more than 40 years of age. About 52% patients were female, and 48% were male. 52% (N=157) patients came to operate their first eye where 48% (N=143) patients were visited again to operate their second eye. Postoperatively, five eyes (3.33%) developed corneal oedema with >10 Descemets folds, and six eyes (4%) had corneal oedema with <10 Descemets folds for Phacoemulsification surgeries. For SICS surgeries, seven eyes (4.66%) developed corneal oedema with >10 Descemets folds and eight eyes (5.33%) had corneal oedema with < 10 descemets folds. However, both the uncorrected and corrected (4-11 weeks) visual acuities were better in the eyes that had phacoemulsification (p=0.02 and p=0.03), and there was less astigmatism (p=0.001) at 4-11 weeks in the eye that had phacoemulsification. Best-corrected visual acuity (BCVA) of final follow-up 95% (N=253) had a good outcome, borderline 3.10% (N=40) and poor outcome was 1.6% (N=7). The individual surgeon outcome were closer, 95% (BCVA) in SICS and 96% (BCVA) in Phacoemulsification at 4-11 weeks follow-up respectively. Conclusion: outcome of cataract surgery both Phacoemulsification and SICS in CEITC was more satisfactory according to who norms. Both Phacoemulsification and manual small-incision cataract surgery (SICS) shows excellent visual outcomes with low complication rates and good rehabilitation. Phacoemulsification is significantly faster, and modern technology based surgical procedure for cataract treatment.

Keywords: phacoemulsification, SICS, cataract, Bangladesh, visual outcome of SICS

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Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser

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Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.

Keywords: adverse events, global trigger tool, patient safety, record review

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Authors: Dorit Alt, Nirit Raichel

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Educational practice is continually subjected to renewal needs, due mainly to the growing proportion of information communication technology, globalization of education, and the pursuit of quality. These types of renewal needs require developing updated instructional and assessment practices that put a premium on adaptability to the emerging requirements of present society. However, university instruction is criticized for not coping with these new challenges while continuing to exemplify the traditional instruction. In order to overcome this critical inadequacy between current educational goals and instructional methods, the LLAF consortium (including 16 members from 8 countries) is collaborating to create a curricular reform for lifelong learning (LLL) in teachers' education, health care and other applied fields. This project aims to achieve its objectives by developing, and piloting models for training students in LLL and promoting meaningful learning activities that could integrate knowledge with the personal transferable skills. LLAF has created a practical guide for teachers containing updated pedagogical strategies and assessment tools based on the constructivist approach for learning. This presentation will be limited to teachers' education only and to the contribution of a pre-pilot research aimed at providing a scale designed to measure constructivist activities in higher education learning environments. A mix-method approach was implemented in two phases to construct the scale: The first phase included a qualitative content analysis involving both deductive and inductive category applications of students' observations. The results foregrounded eight categories: knowledge construction, authenticity, multiple perspectives, prior knowledge, in-depth learning, teacher- student interaction, social interaction and cooperative dialogue. The students' descriptions of their classes were formulated as 36 items. The second phase employed structural equation modeling (SEM). The scale was submitted to 597 undergraduate students. The goodness of fit of the data to the structural model yielded sufficient fit results. This research elaborates the body of literature by adding a category of in-depth learning which emerged from the content analysis. Moreover, the theoretical category of social activity has been extended to include two distinctive factors: cooperative dialogue and social interaction. Implications of these findings for the LLAF project are discussed.

Keywords: constructivist learning, higher education, mix-methodology, lifelong learning

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Authors: Corbel Camille, Le Cerf Flora, Capriz Françoise, Vaillant-Ciszewicz Anne-Julie, Breaud Jean, Guerin Olivier, Corveleyn Xavier

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Background: The medical environment can generate stressful and anxiety-provoking situations for patients, particularly during painful care procedures for the older population. These stressful environments have deleterious effects on the quality of care and can even put the patient at risk and set the care team up for failure. The search for a solution is, therefore, imperative. The development of new technologies, such as virtual reality (VR), seems to be an answer to this problem. Objectives: The objective of this study is to compare the effects of virtual reality on pain and anxiety when caring for older hospitalized people with the effects of usual care. More precisely, different individual factors (age, cognitive level, individual preferences, etc.) and different virtual reality universes (personalized or non-personalized) are studied to understand the role of these factors in reducing pain and anxiety during care procedures. The aim of this study is to improve the quality of life of patients and caregivers in their work environment. Method: This mono-centered, randomized, controlled study was conducted from September 2023 to September 2024 on 120 participants recruited from the geriatric departments of the Cimiez Hospital, Nice, France. Participants are randomized into three groups: a control group, a personalized VR group and a non-personalized VR group. Each participant is followed during a painful care session. Data are collected before, during and after the care, using measures of pain (Algoplus and numerical scale) and anxiety (Hospital anxiety scale and numerical scale). Physiological assessments with an oximeter are also performed to collect both heart and respiratory rate measurements. The implementation of the care will be assessed among healthcare providers to evaluate its effects on the difficulty and fatigue associated with the care. Additionally, a questionnaire (System Usability Scale) will be administered at the conclusion of the study to determine the willingness of healthcare providers to integrate VR into their daily care practices. Result: The preliminary results indicate significant effects on anxiety (p=.001) and pain (p=<.001) following the VR intervention during care, as compared to the control group. Conclusion: The preliminary results suggest that VRI appears to be a suitable and effective method for reducing anxiety and pain among older hospitalized individuals compared with standard care. Finally, the experiences of healthcare professionals involved will also be considered to assess the impact of these interventions on working conditions and patient support.

Keywords: anxiety, care, pain, older adults, virtual reality

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Authors: Ledi Neçaj

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Objectives: The target of this paper is (1) to explain objectively physical activity model throughout three chronic cardiopulmonary conditions, and (2) to study the connection among physical activity dimensions with disease severity, self-reported physical and emotional functioning, and exercise performance. Material and Methods: This is a cross-sectional study of patients in their domestic environment. Patients with cardiopulmonary diseases were: chronic obstructive pulmonary disease (COPD), (n-63), coronary heart failure (n=60), and patients with implantable cardioverter defibrillator (n=60). Main results measures: Seven ambulatory physical activity dimensions (total steps, percentage time active, percentage time ambulating at low, medium, and hard intensity, maximum cadence for 30 non-stop minutes, and peak performance) have been measured with an accelerometer. Results: Subjects with COPD had the lowest amount of ambulatory physical activity compared with topics with coronary heart failure and cardiac dysrhythmias (all 7 interest dimensions, P<.05); total step counts have been: 5319 as opposed to 7464 as opposed to 9570, respectively. Six-minute walk distance becomes correlated (r=.44-.65, P<.01) with all physical activity dimensions inside the COPD pattern, the most powerful correlations being with total steps and peak performance. In topics with cardiac impairment, maximal oxygen intake had the most effective small to slight correlations with five of the physical activity dimensions (r=.22-.40, P<.05). In contrast, correlations among 6-minute walk test distance and physical activity have been higher (r=.48-.61, P<.01) albeit in a smaller pattern of most effective patients with coronary heart failure. For all three samples, self-reported physical and mental health functioning, age, frame mass index, airflow obstruction, and ejection fraction had both exceptionally small and no significant correlations with physical activity. Conclusions: Findings from this study present a profitable benchmark of physical activity patterns in individuals with cardiopulmonary diseases for comparison with future studies. All seven dimensions of ambulatory physical activity have disfavor between subjects with COPD, heart failure, and cardiac dysrhythmias. Depending on the research or clinical goal, the use of one dimension, such as total steps, may be sufficient. Although physical activity had high correlations with performance on a six-minute walk test relative to other variables, accelerometers-based physical activity monitoring provides unique, important information about real-world behavior in patients with cardiopulmonary not already captured with existing measures.

Keywords: ambulatory physical activity, walking, monitoring, COPD, heart failure, implantable defibrillator, exercise performance

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Authors: Esam Roshdy, Saleh AlRashdi, Turki Alharbi, Rawan Eskandarani, Zurina Cabilo

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Introduction/ background: Consultation in the Emergency Department constitute a major part of the work flow every day. Any delay in the consultation process have a major impact on the length of stay and patient disposition and thus affect the total waiting time of patients in the ED. King Fahad medical City in Riyadh City, Saudi Arabia is considered a major Tertiary hospital where there is high flow of patients of different categories visiting the ED. The importance of decreasing consultation time and decision for final disposition of patients was recognized and interpreted in this project to find ways to improve the patient flow in the department and thus the total patient disposition and outcome. Aim / Objectives: 1. To monitor the time of consultation for patients in the Emergency department and its impact on the length of stay of patients in the ED. 2. To detect and assess the problems that lead to long consultation times in the ED, and reach a targeted time of 2 hours for final disposition of patients, according to recognized international and our institutional consultation policy, to reach the final goal of decreasing total length of stay and thus improve the patient flow in the ED. Methods: Data was collected retrospectively for a 92 charts of consultations done in the ED over 2 month’s period. The data was analyzed to get the median of Total Consultation Time. A survey was conducted among all ED staff to determine the level of knowledge about the total consultation time and the compliance to the institutional policy target of 2 hours. A second Data sample of 168 chart was collected after awareness campaign and education of all ED staff about the importance of reaching the target consultation time and compliance to the institutional policy. Results: We have found that there is room for improvement in our overall consultation time. This was found to be more frequent with certain specialties. Our surveys have showed that many ED staff are not familiar or not compliant with our consultation policy which was not clear for everyone. Post-intervention data have showed that awareness of the importance to decrease the total consultation time and compliance alone to the targeted goal have had a huge impact on overall improvement and decreasing the time of final decision and disposition of the patient and the overall patient length of stay in the ED. Conclusion: Working on improving Consultation time in the Emergency Department is a major factor in improving overall length of stay and patient flow. This improvement helps in the overall patient disposition and satisfaction. Plan: As a continuation of our project we are planning to focus on the conflict of admission cases where more than one specialty is involved in the care of patients. We are planning to collect data on the time it takes to resolve and reach final disposition of those patients, and its impact on the length of stay and our department flow and the overall patient outcome and satisfaction.

Keywords: consultation time, impact, length of stay, in the ED

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Authors: Scott Snyder

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Grading approaches in higher education have not changed meaningfully in over 100 years. While there is variation in the types of grades assigned across countries, most use approaches based on simple ordinal scales (e.g, letter grades). While grades are generally viewed as an indication of a student's performance, challenges arise regarding the clarity, validity, and reliability of letter grades. Research about grading in higher education has primarily focused on grade inflation, student attitudes toward grading, impacts of grades, and benefits of plus-minus letter grade systems. Little research is available about alternative approaches to grading, varying approaches used by faculty within and across colleges, and faculty attitudes toward grades and alternative approaches to grading. To begin to address these gaps, a survey was conducted of faculty in a sample of departments at three diverse colleges in a southeastern state in the US. The survey focused on faculty experiences with and attitudes toward grading, the degree to which faculty innovate in teaching and grading practices, and faculty interest in alternatives to the point system approach to grading. Responses were received from 104 instructors (21% response rate). The majority reported that teaching accounted for 50% or more of their academic duties. Almost all (92%) of respondents reported using point and percentage systems for their grading. While all respondents agreed that grades should reflect the degree to which objectives were mastered, half indicated that grades should also reflect effort or improvement. Over 60% felt that grades should be predictive of success in subsequent courses or real life applications. Most respondents disagreed that grades should compare students to other students. About 42% worried about their own grade inflation and grade inflation in their college. Only 17% disagreed that grades mean different things based on the instructor while 75% thought it would be good if there was agreement. Less than 50% of respondents felt that grades were directly useful for identifying students who should/should not continue, identify strengths/weaknesses, predict which students will be most successful, or contribute to program monitoring of student progress. Instructors were less willing to modify assessment than they were to modify instruction and curriculum. Most respondents (76%) were interested in learning about alternative approaches to grading (e.g., specifications grading). The factors that were most associated with willingness to adopt a new grading approach were clarity to students and simplicity of adoption of the approach. Follow-up studies are underway to investigate implementations of alternative grading approaches, expand the study to universities and departments not involved in the initial study, examine student attitudes about alternative approaches, and refine the measure of attitude toward adoption of alternative grading practices within the survey. Workshops about challenges of using percentage and point systems for determining grades and workshops regarding alternative approaches to grading are being offered.

Keywords: alternative approaches to grading, grades, higher education, letter grades

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Authors: Muhammad Naveed Babur, Maria Liaqat

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Background & Objective: People with disabilities especially neurological disabilities have many unmet health and rehabilitation needs, face barriers in accessing mainstream health-care services, and consequently have poor health. There are not sufficient epidemiological studies from Pakistan which assess barriers to neurorehabilitation and ways to counter it. Objectives: The objective of the study was to determine the challenges and to evaluate the barriers for neuro-rehabilitation services in developing countries. Methods: This is Exploratory sequential qualitative study based on the Panel discussion forum in International rehabilitation sciences congress and national rehabilitation conference 2017. Panel group discussion has been conducted in February 2017 with a sample size of eight professionals including Rehabilitation medicine Physician, Physical Therapist, Speech Language therapist, Occupational Therapist, Clinical Psychologist and rehabilitation nurse working in multidisciplinary/Interdisciplinary team. A comprehensive audio-videography have been developed, recorded, transcripted and documented. Data was transcribed and thematic analysis along with characteristics was drawn manually. Data verification was done with the help of two separate coders. Results: After extraction of two separate coders following results are emerged. General category themes are disease profile, demographic profile, training and education, research, barriers, governance, global funding, informal care, resources and cultural beliefs and public awareness. Barriers identified at the level are high cost, stigma, lengthy course of recovery. Hospital related barriers are lack of social support and individually tailored goal setting processes. Organizational barriers identified are lack of basic diagnostic facilities, lack of funding and human resources. Recommendations given by panelists were investment in education, capacity building, infrastructure, governance support, strategies to promote communication and realistic goals. Conclusion: It is concluded that neurorehabilitation in developing countries need attention in following categories i.e. disease profile, demographic profile, training and education, research, barriers, governance, global funding, informal care, resources and cultural beliefs and public awareness. This study also revealed barriers at the level of patient, hospital, organization. Recommendations were also given by panelists.

Keywords: disability, neurorehabilitation, telerehabilitation, disability

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Authors: K. C. M. Wong, C. P. Y. Cheng, K. Y. Chan, G. S. C. Fung, T. F. O. Lau, K. F. C. Leung, J. P. C. Fok

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Hospital Authority (HA) is the statutory body to manage all public hospitals in Hong Kong. Occupational Care Medicine Service (OMCS) is an in-house multi-disciplinary team responsible for injury management in HA. Hospital administrative services (AS) provides essential support in hospital daily operation to facilitate the provision of quality healthcare services. An occupational health enhancement program in Tai Po Hospital (TPH) domestic service supporting unit (DSSU) was piloted in 2013 with satisfactory outcome, the keys to success were staff engagement and management support. Riding on the success, the program was rolled out to another 5 AS departments of Alice Ho Miu Ling Nethersole Hospital (AHNH) and TPH in 2015. This paper highlights the indispensable components of disability management and occupational health enhancement program in hospital settings. Objectives: 1) Facilitate workplace to support staff with health affecting work problem, 2) Enhance staff’s occupational health. Methodology: Hospital Occupational Safety and Health (OSH) team and AS departments (catering, linen services, and DSSU) of AHNH and TPH worked closely with OMCS. Focus group meetings and worksite visits were conducted with frontline staff engagement. OSH hazards were identified with corresponding OSH improvement measures introduced, e.g., invention of high dusting device to minimize working at height; tailor-made linen cart to minimize back bending at work, etc. Specific MHO trainings were offered to each AS department. A disability management workshop was provided to supervisors in order to enhance their knowledge and skills in return-to-work (RTW) facilitation. Based on injured staff's health condition, OMCS would provide work recommendation, and RTW plan was formulated with engagement of staff and their supervisors. Genuine communication among stakeholders with expectation management paved the way for realistic goals setting and success in our program. Outcome: After implementation of the program, a significant drop of 26% in musculoskeletal disorders related sickness absence day was noted in 2016 as compared to the average of 2013-2015. The improvement was postulated by innovative OSH improvement measures, teamwork, staff engagement and management support. Staff and supervisors’ feedback were very encouraging that 90% respondents rated very satisfactory in program evaluation. This program exemplified good work sharing among departments to support staff in need.

Keywords: disability management, occupational health, return to work, occupational medicine

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Authors: Anupriya Sharma, Sapna Narula

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Over the past decade, sustainability has gone mainstream as more people are worried about environment-related issues than ever before. These issues are of even more concern for industries which leave a significant impact on the environment. Following these ecological issues, corporates are beginning to comprehend the impact on their business. Many such initiatives have been made to address these emerging issues in the consumer-driven textile industry. Demand from customers, local communities, government regulations, etc. are considered some of the major factors affecting environmental decision-making. Research also shows that motivations to go green are inevitably determined by the way top managers perceive environmental issues as managers personal values and ethical commitment act as a motivating factor towards corporate social responsibility. Little empirical research has been conducted to examine the relationship between top managers’ personal environmental attitudes and corporate environmental behaviors for the textile industry in the Indian context. The primary purpose of this study is to determine the current state of environmental management in textile industry and whether the attitude of textile firms’ top managers is significantly related to firm’s response to environmental issues and their perceived benefits of environmental management. To achieve the aforesaid objectives of the study, authors used structured questionnaire based on literature review. The questionnaire consisted of six sections with a total length of eight pages. The first section was based on background information on the position of the respondents in the organization, annual turnover, year of firm’s establishment and so on. The other five sections of the questionnaire were based upon (drivers, attitude, and awareness, sustainable business practices, barriers to implementation and benefits achieved). To test the questionnaire, a pretest was conducted with the professionals working in corporate sustainability and had knowledge about the textile industry and was then mailed to various stakeholders involved in textile production thereby covering firms top manufacturing officers, EHS managers, textile engineers, HR personnel and R&D managers. The results of the study showed that most of the textile firms were implementing some type of environmental management practice, even though the magnitude of firm’s involvement in environmental management practices varied. The results also show that textile firms with a higher level of involvement in environmental management were more involved in the process driven technical environmental practices. It also identified that firm’s top managers environmental attitudes were correlated with perceived advantages of environmental management as textile firm’s top managers are the ones who possess managerial discretion on formulating and deciding business policies such as environmental initiatives.

Keywords: attitude and awareness, Environmental management, sustainability, textile industry

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Authors: Anette Alén

Abstract:

Intellectual property (IP) regimes have traditionally been designed to integrate various conflicting elements stemming from private entitlement and the public good. In IP laws and regulations, this design takes the form of specific uses of protected subject-matter without the right-holder’s consent, or exhaustion of exclusive rights upon market release, and the like. More recently, the pursuit of ‘balance’ has gained ground in the conceptualization of these conflicting elements both in terms of IP law and related policy. This can be seen, for example, in European Union (EU) copyright regime, where ‘balance’ has become a key element in argumentation, backed up by fundamental rights reasoning. This development also entails an ever-expanding dialogue between the IP regime and the constitutional safeguards for property, free speech, and privacy, among others. This study analyses the concept of ‘balance’ in EU copyright law: the research task is to examine the contents of the concept of ‘balance’ and the way it is operationalized and pursued, thereby producing new knowledge on the role and manifestations of ‘balance’ in recent copyright case law and regulatory instruments in the EU. The study discusses two particular pieces of legislation, the EU Digital Single Market (DSM) Copyright Directive (EU) 2019/790 and the finalized EU Artificial Intelligence (AI) Act, including some of the key preparatory materials, as well as EU Court of Justice (CJEU) case law pertaining to copyright in the digital era. The material is examined by means of document analysis, mapping the ways ‘balance’ is approached and conceptualized in the documents. Similarly, the interaction of fundamental rights as part of the balancing act is also analyzed. Doctrinal study of law is also employed in the analysis of legal sources. This study suggests that the pursuit of balance is, for its part, conducive to new battles, largely due to the advancement of digitalization and more recent developments in artificial intelligence. Indeed, the ‘balancing act’ rather presents itself as a way to bypass or even solidify some of the conflicting interests in a complex global digital economy. Indeed, such a conceptualization, especially when accompanied by non-critical or strategically driven fundamental rights argumentation, runs counter to the genuine acknowledgment of new types of conflicting interests in the copyright regime. Therefore, a more radical approach, including critical analysis of the normative basis and fundamental rights implications of the concept of ‘balance’, is required to readjust copyright law and regulations for the digital era. Notwithstanding the focus on executing the study in the context of the EU copyright regime, the results bear wider significance for the digital economy, especially due to the platform liability regime in the DSM Directive and with the AI Act including objectives of a ‘level playing field’ whereby compliance with EU copyright rules seems to be expected among system providers.

Keywords: balance, copyright, fundamental rights, platform liability, artificial intelligence

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Authors: Khadija Al-Hosni, Moon Fai Chan, Mohammed Al-Azri

Abstract:

Background: Several studies suggest that most school-age adolescents are poorly informed on cancer warning signs and risk factors. Providing adolescents with sufficient knowledge would increase their awareness in adulthood and improve seeking behaviors later. Significant: The results will provide a clear vision in assisting key decision-makers in formulating policies on the students' awareness programs towards cancer. So, the likelihood of avoiding cancer in the future will be increased or even promote early diagnosis. Objectives: to evaluate the effectiveness of an education program designed to increase awareness of cancer signs and symptoms risk factors, improve the behavior of seeking help among school students in Oman, and address the barriers to obtaining medical help. Methods: A randomized controlled trial with two groups was conducted in Oman. A total of 1716 students (n=886/control, n= 830/education), aged 15-17 years, at 10th and 11th grade from 12 governmental schools 3 in governorates from 20-February-2022 to 12-May-2022. Basic demographic data were collected, and the Cancer Awareness Measure (CAM) was used as the primary outcome. Data were collected at baseline (T0) and 4 weeks after (T1). The intervention group received an education program about cancer's cause and its signs and symptoms. In contrast, the control group did not receive any education related to this issue during the study period. Non-parametric tests were used to compare the outcomes between groups. Results: At T0, the lamp was the most recognized cancer warning sign in control (55.0%) and intervention (55.2%) groups. However, there were no significant changes at T1 for all signs in the control group. In contrast, all sign outcomes were improved significantly (p<0.001) in the intervention group, the highest response was unexplained pain (93.3%). Smoking was the most recognized risk factor in both groups: (82.8% for control; 84.1% for intervention) at T0. However, there was no significant change in T1 for the control group, but there was for the intervention group (p<0.001), the highest identification was smoking cigarettes (96.5%). Too scared was the largest barrier to seeking medical help by students in the control group at T0 (63.0%) and T1 (62.8%). However, there were no significant changes in all barriers in this group. Otherwise, being too embarrassed (60.2%) was the largest barrier to seeking medical help for students in the intervention group at T0 and too scared (58.6%) at T1. Although there were reductions in all barriers, significant differences were found in six of ten only (p<0.001). Conclusion: The intervention was effective in improving students' awareness of cancer symptoms, warning signs (p<0.001), and risk factors (p<0.001 reduced the most addressed barriers to seeking medical help (p<0.001) in comparison to the control group. The Ministry of Education in Oman could integrate awareness of cancer within the curriculum, and more interventions are needed on the sociological part to overcome the barriers that interfere with seeking medical help.

Keywords: adolescents, awareness, cancer, education, intervention, student

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