Search results for: teaching hospital

Authors: Saziye Darendeli

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Motivation has a significant impact on a second/foreign language learning process, so it plays a vital role while achieving the learning goal. As it is defined by Simon (1967, p. 29), motivation is “a goal terminating mechanism, permitting goals to be processed serially.”AccordingtoSimon, if a learning goal is activated and enough attention is given, the learner starts learning. In connection with this view, the more attention is given on a subject, and the more activation takes place on it, the quicker learning will occur. Moreover, today almost every teacher is familiar with the term “distance education” regardless of their student's age group. As it is stated by Visser (2002), when compared to the traditional classrooms, in distance education, the rate and success of language learningdecreasesandone of the most essential reasons is that motivating students in distance education contexts, in which interaction is lower, is much more challenging than face-to-face training especially with young learners(Lim& Kim, 2003). Besides, there are limited numbers of studies conducted on motivational strategies for young learners in distance education contexts since we have been experiencing full time the online schooling process recently, yet online teaching seems to be permanent in our lives with the new technological era. Therefore, there appears to be a need for various strategies to motivate young learners in distance education, and the current study aims to find out the strategies that young learners’ teachers use to increase their students’ motivation level in distance education. To achieve this aim, a qualitative research approach and a phenomenological method with an interpretive design will be used. The participants, who are teachers of young learners, will be interviewed using a structured interview format consisting of 7 questions. As the participants are young learners’teacherswhohavebeenexperiencingteaching online, exploring thestrategiesthattheyusetoincreasetheirstudents’ motivationlevelwillprovidesomesuggestionsaboutthemotivationalstrategiesforfuture online classes. Also, in this paper, I will move beyond the traditional classrooms that have face-to-face lessons and discuss the effective motivational strategies for young learners in distance education.

Keywords: motivation, distance education, young learners, strategies

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Authors: N. Ayob, N. C. Nkosi, R. P. Burger, S. J. Piketh, F. Letlaila, O. Maphosa

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South African higher tertiary institution have been faced with high dropout rates. About 50 to 60% of first years drop out to due to various reasons one being inadequate academic support. Geography 111 (GEOG 111) module is historically known for having below 50% pass rate, high dropout rate and identified as a first year risk module. For the first time GEOG 111 (2021) on the Mahikeng Campus admitted 150 students pursuing more than 6 different qualifications (BA and BSc) from the Humanities Faculty and FNAS. First year students had difficulties transitioning from secondary to tertiary institutions as we shifted to remote learning while we navigate through the Covid-19 pandemic. The traditional method of teaching does not encourage students to help each other. With remote learning we do not have control over what the students share and perhaps this can be a learning opportunity to embrace peer learning and change the manner in which we assess the students. The purpose of this pilot study was to assist GEOG111 students with academic challenges whilst improving their University experience. This was a qualitative study open to all GEOG111, repeaters, students who are not confident in their Geographical knowledge and never did Geography at high school level. The selected 9 Golden Key International Honour Society Geography mentors attended an academic mentor training program with module lecturers. About 17.6% of the mentees did not have a geography background however, 94% of the mentees passed, 1 mentee had a mark of 38%. 11 of the participants had a mark >60% with one student that excelled 70%. It is evident that mentorship helped students reach their academic potential. Peer learning and mentoring are associated with improved academic performance and allows the students to take charge of their learning and academic experience. Thus an important element as we transform pedagogies at higher learning institutions.

Keywords: geography, risk module, peer mentoring, peer learning

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Authors: Imen Aribi Ben Amor

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The aim of the present study is to analyze the performance of requests in emails among a group of Tunisian postgraduate students. It also seeks to determine the influence of the social factors on the participants’ requests performance. For this purpose, the data were collected using a discourse completion test (DCT). Accordingly, 42 Tunisian postgraduate students were asked to respond in English to eight different situations in which they carried out the speech act of request in emails. The data were analyzed based on the degree of directness. A detailed analysis of the head acts found in the DCT revealed that Tunisian Postgraduate students use a varied repertoire of request strategies (direct, conventionally indirect and non-conventionally indirect) but at the same time rely heavily on direct request strategies. They tended to address their requestees directly except for distant superiors. DCT results suggest that the participants are to some extent aware of the influence of the ranking of imposition and social distance but fail to acknowledge the weight of social power when performing requests in emails. The preference of the participants to use direct strategies may be the result of the effect of Tunisian culture and the negative transfer of Tunisian communicative strategies. Accordingly, this study suggests some pedagogical implications and suggestions for Tunisian EFL (English as a Foreign Language) instructors. They are required to pay closer attention to the pragmalinguistic nuances of the ways in which requests in emails are realized. Teachers can also help students understand academic email etiquettes by explicitly explaining what they expect in the student email. Thus, EFL teachers and syllabus designers should devote more attention to developing EFL learners’ pragmatic competence through teaching L2 pragmatics.

Keywords: directness, ranking of imposition, request strategies, social distance, social power

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Authors: W. L. Tsang, H. Y. Li, S. L. Wong, T. Y. Kwok, S. C. Yuen, S. S. Kwok, P. S. Ko, S. Y. Lau

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Introduction: Palliative care is no doubt necessary in surgery. When one looks at studies of what patients with life-threatening illness want and compares to what they experience in surgical units, the gap is huge. Surgical nurses, being patient advocates, should engage with patients and families sooner rather than later in their illness trajectories to consider how to manage the illness, not just their capacity to survive. Objective: This clinical practice guide aims to fill the service gap of palliative care in surgery by producing a quality-driven, evidence-based yet straightforward clinical practice guide based on a focus strategy. Methodology: In line with Guide to Good Nursing Practice: End-of-Life Care recommended by Nursing Council of Hong Kong and the strategic goal of improving quality of palliative care proposed in HA Strategic Plan 2017-2022, multiple phases of work were undertaken from July 2015 to December 2017. A pragmatic clinical practice guide for surgical patients facing life-threatening conditions was developed based on assessments on knowledge of and attitudes towards end-of-life care of surgical nurses. Key domains, including preparation for bereavement, nursing care for imminently dying patients and at the dying scene were crystallized according to the results of the assessments and the palliative care checklist formulated by UCH Palliative Care Team. After a year of rollout, its content was refined through analyses of implementation in routine practice and consensus opinions from frontline nurses. Results and Outcomes: This clinical practice guide inspires surgical nurses with the art of care to provide for patients’ comfort, function, and longevity. It provides practical directions and assists nurses to master the skills on advance care planning and learn how to be clear with patients, families and themselves about the realities of the disease pictures. Through the implementation, patients and families are included in the decision process, and their wishes are honored. The delivery of explicit and high-quality palliative care maintains good nurse-to-patient relations and enhances satisfaction of hospital care of patients and families. Conclusion: Surgical nursing has always been up to the unique challenges of the era. This clinical practice guide has become an island of credibility for our nurses as they traverse the often stormy waters of life-limiting illness.

Keywords: palliative care delivery, palliative care in surgery, hospice care, end-of-life care

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Authors: Mohammed Asiri, Saleh Alsuwayt, Mohammed Bin Mugren, Abdulmalik Almufarrih, Tariq Alotaibi, Saad Almodameg

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Background: End-stage renal disease is a major public health concern with high incidence and mortality rate. Most of ESRD patients are on hemodialysis therapy which is a long-term treatment that disturbs patients’ lifestyle. As a result, he will be susceptible to develop psychiatric disorders like anxiety that may direct him to non-compliance on physician instructions and hemodialysis therapy. Although there are studies conducted on psychiatric issues in hemodialysis patients, but few studies focused on the effect of anxiety disorder and the patient’s compliance. Hence, we are interested in determining the prevalence of anxiety disorder among hemodialysis patients in Saudi Arabia, as well as in defining the correlation between anxiety disorder and compliance on physician instructions and hemodialysis therapy. We hypothesize that our study will show a higher prevalence of anxiety in hemodialysis patients than in general population. Also, we expect the anxiety to have a negative impact on their compliance. Methodology: We used a cross-sectional study design carried out at dialysis unit of four major hospitals in Riyadh, KSA. We interviewed 235 End Stage Renal Disease male and female patients who are on hemodialysis. We divided the patients into two categories according to their compliance. we used modified general questionnaire to get their demographic data, then we used a psychometric response scale called visual analog scale (VAS) to assess patient’s compliance to hemodialysis and physician’s instructions. Also, we used the Arabic validated version of the hospital anxiety and depression scale (HAD scale) used mainly for anxiety assessment. Results: The overall response rate was 54%. Respondents included 147 (62.6%) males and 88 (37.4%) females. The prevalence of anxiety among hemodialysis patients is 13.3%. According to visual analog scale, we found that 189 compliant patients and 45 non-compliant patients. For HAD scale, the mean ± standard deviation of the total score for females was (4.44 ± 4.7) and it’s higher than males which was 2.65 ± 3.08 (P-value= 0.002). The mean ± standard deviation of HAD score in the non-compliant group was (5.88  4.88) and it was higher than the compliant group (2.7  3.32) (P-value= 0.004). Among non-complaint group, 33.3% of anxious patients were males and 66.6% were females. There was a negative correlation between HAD score of anxiety and visual analog scale (R= - 0.285). Conclusion: We conclude that there is a high prevalence of anxiety among patients with End Stage Renal Disease that was higher in females with association of non-compliance to physician’s instructions and hemodialysis therapy.

Keywords: anxiety, end-stage renal disease, renal failure, anxiety disorder

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Authors: Mahnaz Seyedoshohadaee

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Background and Aims: Hospitalization of one of the family members in the hospital, especially in the emergency department, causes anxiety and psychological problems in family members and others. The way nurses interact with patients and their companions can play an important role in controlling and managing their anxiety. This study aims to determine the relationship between the anxiety of family members of patients referring to emergency departments and their views on the communication skills of nurses. Materials and Methods: The current research was a descriptive-correlation cross-sectional study on 263 family members of patients referred to the department. The emergency of two selected medical training centers affiliated with Iran University of Medical Sciences was performed. The samples were selected continuously in 2018 based on the inclusion criteria. Information was collected using the Health Communication Questionnaire (HCCQ) and Beck Anxiety Questionnaire (BAI). To analyze the data, Pearson's correlation coefficient, independent t-tests, analysis of variance, and Kruskal-Wallis were used at a significance level of 0.05. The data was analyzed using SPSS version 16 statistical software. Results: The mean score of communication skills of emergency department nurses from the point of view of patients' companions was at a low level (74.36 with a standard deviation of 3.7). 3.75% of patients' companions had anxiety at a mild level. There was no statistically significant correlation between the anxieties of the patient's companions. The anxiety of the patient's companions had a statistically significant relationship with the educational level (P=0.039), economic status (P=0.033), and family relationship with the patient (P=0.001). Also, the average anxiety score in children was significantly higher than that of patients' wives (P=0.008). The triage level of the patient also had a statistically significant relationship with the anxiety of the patient's companions (P>0.001). Conclusion: Most of the family members of the patients referred to the emergency room experienced mild anxiety. Also, from their point of view, the communication skills of emergency nurses were at a weak level. Despite the fact that there was no statistically significant relationship between the patient's family member's anxiety and their opinion about nurses' communication skills in this study, it seems that the weak communication skills of nurses from the patient's family member's point of view need special attention. The results of the present study can provide the necessary grounds for planning to improve the communication skills of nurses and also control the anxiety of patient caregivers through in-service training or other incentive mechanisms.

Keywords: anxiety, family, emergency department, communication skills, nurse

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Authors: Felix Oromena Egara, Moeketsi Mosia

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The study aimed to evaluate the impact of blended learning on mathematics retention among secondary school students. Conducted in the Isoko North Local Government Area of Delta State, Nigeria, the research involved 1,235 senior class one (SS 1) students. Employing a non-equivalent control group pre-test-post-test quasi-experimental design, a sample of 70 students was selected from two secondary schools with ICT facilities through purposive sampling. Random allocation of students into experimental and control groups was achieved through balloting within each selected school. The investigation included three assessment points: pre-Mathematics Achievement Test (MAT), post-MAT, and post-post-MAT (retention), administered systematically by the researchers. Data collection utilized the established MAT instrument, which demonstrated a high reliability score of 0.86. Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) version 28, with mean and standard deviation addressing study questions and analysis of covariance scrutinizing hypotheses at a significance level of .05. Results revealed significantly greater improvements in mathematics retention scores among students exposed to blended learning compared to those instructed through conventional methods. Moreover, noticeable differences in mean retention scores were observed, with male students in the blended learning group exhibiting notably higher performance. Based on these findings, recommendations were made, advocating for mathematics educators to integrate blended learning, particularly in geometry teaching, to enhance students’ retention of mathematical concepts.

Keywords: blended learning, flipped classroom model, secondary school students, station rotation model

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Authors: Yasmine Aridi, Lara Nasreddine, Maya Khalil, Arafat Tfayli, Anas Mugharbel, Farah Naja

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Breast cancer is the most commonly diagnosed cancer site among women worldwide and the second most common cause of cancer mortality. Breast cancer rates differ vastly between geographical areas, countries, and within the same country. In Lebanon, the proportion of breast cancer to all other sites of tumor is 38.2%; these rates are still lower than those observed worldwide, but remain the highest among Arab countries. Studies and evidence based reviews show a strong association between breast cancer development and prognosis and dietary habits, specifically the Mediterranean diet (MD). As such, the aim of this study is to examine dietary patterns and adherence to the MD among a sample of 182 breast cancer female patients in Beirut, Lebanon. Subjects were recruited from two major hospitals; a private medical center and a public hospital. All subjects were administered two questionnaires: socio- demographics and Mediterranean diet adherence. Five Mediterranean scores were calculated: MS, MSDPS, PMDI, PREDIMED and DDS. The mean age of the participants was 53.78 years. The overall adherence to the Mediterranean diet (MD) was low since the sample means of 3 out of the 5 calculated scores were less than the scores’ medians. Given that 4 out of the 5 Mediterranean scores significantly varied between the recruitment sites, women in the private medical center were found to adhere more to the MD. Our results also show that the majority of the sample population’s intakes are exceeding the recommendations for total and saturated fat, while meeting the requirements for fiber, EPA, DHA and Linolenic Acid. Participants in the private medical center were consuming significantly more calories, carbohydrates, fiber, sugar, Lycopene, Calcium, Iron and Folate and less fat. After conducting multivariate linear regression analyses, the following significant results were observed: positive associations between MD (CPMDI, PREDIMED) and monthly income & current state of health, while negative associations between MD (MSDPS, PREDIMED) and age & employment status. Our findings indicated a low overall adherence to the MD and identified factors associated with it; which suggests a need to address dietary habits among BC patients in Lebanon, specifically encouraging them to adhere to their traditional Mediterranean diet.

Keywords: Adherence, Breast cancer, Dietary patterns, Mediterranean diet, Nutrition

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Authors: Ewelina Zdebska

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A social worker is an integral part of an interdisciplinary team working with the child and his family in a terminal state. Social support is an integral part of the medical procedure in the care of hospice. This is the basis and prerequisite of full treatment and good care of the child - patient, whose illness often finds at least the expected period of his life when his personal and legal issues are not regulated, and the family burdened with the problem requires care and support specialists - professionals. Hospice for Children in Krakow: a palliative care team operating in the province of Krakow and Malopolska, conducts specialized care for terminally ill children in place of their residence from the time when parents and doctors decided to end of treatment in hospital, allows parents to carry out medical care at home, provides parents social and legal assistance and provides care, psychological support and friendship to families throughout the life of the child's illness and after his death, as long as it is needed. The social worker in a hospice does not bear the burden of solving social problems, which is the responsibility of other authorities, but provides support possible and necessary at the moment. The most common form of assistance is to provide information on benefits, which for the child and his family may be subject to any treatment and fight for the life and health of a child. Employee assists in the preparation and completion of documents, requests to increase the degree of disability because of progressive disease or Allowance care because of the inability to live independently. It works in settling all the issues with the Department of Social Security, as well as with the Municipal and District Team Affairs of disability. Seeking help and support using multi-faceted childcare. With the Centres for Social Welfare contacts are also often on the organization of additional respite care for the sick at home (care), especially in the work of the other members of the family or if the family can not cope with the care and needs extra help. Hospice for Children in Cracow completing construction of Poland's first Respite Care Centre for chronically and terminally ill children, will be an open house where children suffering from chronic and incurable diseases and their families can get professional help, whenever - when they need it. The social worker has to pick up a very important role in caring for a terminally ill child. His presence gives a little patient and family the opportunity to be at this difficult time together while organizing assistance and support.

Keywords: social worker, care, terminal care, hospice

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Authors: Biki Sarmah, Priyanko Raj Mudiar

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In the modern world of remotely interactive virtual reality-based learning and teaching, including professional skill-building training and acquisition practices, as well as data acquisition and robotic systems, the revolutionary application or implementation of field-programmable neurostimulator aids and first-hand interactive sensitisation techniques into 3D holographic audio-visual platforms have been a coveted dream of many scholars, professionals, scientists, and students. Integration of 'kinaesthetic vibrotactile haptic perception' along with an actuated step magnitude contact profiloscopy in augmented reality-based learning platforms and professional training can be implemented by using an extremely calculated and well-coordinated image telemetry including remote data mining and control technique. A real-time, computer-aided (PLC-SCADA) field calibration based algorithm must be designed for the purpose. But most importantly, in order to actually realise, as well as to 'interact' with some 3D holographic models displayed over a remote screen using remote laser image telemetry and control, all spatio-physical parameters like cardinal alignment, gyroscopic compensation, as well as surface profile and thermal compositions, must be implemented using zero-order type 1 actuators (or transducers) because they provide zero hystereses, zero backlashes, low deadtime as well as providing a linear, absolutely controllable, intrinsically observable and smooth performance with the least amount of error compensation while ensuring the best ergonomic comfort ever possible for the users.

Keywords: haptic feedback, kinaesthetic vibrotactile 3D design, medical simulation training, piezo diaphragm based actuator

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Authors: Angela Mathias Kavishe

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Sexual harassment directed at women is reported in many societies, including in Tanzania. The advent of ICT technology, especially in universities, seems to aggravate the situation by extending harassment to cyberspace in various forms, including cyberstalking. Evidence shows that online violence is more dangerous than physical one due to the ability to access multiple private information, attack many victims, mask the perpetrator's identity, suspend the threat for a long time and spread over time and space. The study aimed to measure the magnitude of cyber harassment in Tanzanian higher learning institutions and to assess institutional sensitivity to ICT-mediated gender-based violence. It was carried out in 4 higher learning institutions in Tanzania: Mwalimu Nyerere Memorial Academy and Institute of Finance Management in Dar es Salaam and SAUT, and the University of Dodoma, where a survey questionnaire was distributed to 400 students and 40 key informants were interviewed. It was found that in each institution, the majority of female students experienced online harassment on social media perpetrated by ex-partners, male students, and university male teaching staff. The perpetrators compelled the female students to post nude pictures, have sexual relations with them, or utilize the posted private photographs to force female students to practice online or offline sexual relations. These threats seem to emanate from social-cultural beliefs about the subordinate position of women in society and that women's bodies are perceived as sex objects. It is therefore concluded that cyberspace provides an alternative space for perpetrators to exercise violence towards women.

Keywords: cyberstalking, embodiment, gender-based violence, internet

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Authors: Shima Nikanjam, Badiossadat Hassanpour, Adi Irfan Che Ani

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The design process in architecture education is based upon the Learning-by-Doing method, which leads students to understand how to design by practicing rather than studying. First-year design studios, as starting educational stage, provide integrated knowledge and skills of design for newly jointed architecture students. Within the basic design studio environment, students are guided to transfer their abstract thoughts into visual concrete decisions under the supervision of design educators for the first time. Therefore, introductory design studios have predominant impacts on students’ operational thinking and designing. Architectural design thinking is quite different from students’ educational backgrounds and learning habits. This educational challenge at basic design studios creates a severe need to study the reality of design education at foundation year and define appropriate educational methods with convenient project types with the intention of enhancing architecture education quality. Material for this study has been gathered through long-term direct observation at a first year second semester design studio at the faculty of architecture at EMU (known as FARC 102), fall and spring academic semester 2014-15. Distribution of a questionnaire among case study students and interviews with third and fourth design studio students who passed through the same methods of education in the past 2 years and conducting interviews with instructors are other methodologies used in this research. The results of this study reveal a risk of a mismatch between the implemented teaching method, project type and scale in this particular level and students’ learning styles. Although the existence of such risk due to varieties in students’ profiles could be expected to some extent, recommendations can support educators to reach maximum compatibility.

Keywords: architecture education, basic design studio, educational method, forms creation skill

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Authors: Mashaal Hooda

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The rationale for conducting this action research was to increase students' Academic Achievement (AA) contexts of studying/researching by employing the Goal Setting intervention (GS). The purposive sample consisted of 10 female undergraduate students at a university in Dubai. The intervention was introduced through workshop classes conducted online. The pre-intervention consisted of discussions concentrating on participants' research contexts amidst a pandemic. The GS moderators were implemented in the class, followed by scaffolding and mentoring interactions and self-reflective accounts of students' actions and feelings of using the intervention to better plan and structure their dissertation tasks. The research incorporated a Mixed Methods Methodology (MMM). Quantitative data collection took place through surveys, while qualitative data were collected using semi-structured interviews. Triangulation of the emergent themes showed a positive increase in students achievable GS, self-regulatory study skills, feedback-seeking behaviours, research organisation and synthesis, self-reflection and Academic Resilient (AR) attitudes amalgamate to enhance students' AA outcomes. Though, students' intrinsic motivational levels to study and research observed minor changes only. Nonetheless, the pebble in the shoe was removed as students AA contexts improved in undertaking better actionable steps for their research. Therefore, the GS intervention enabled students to set, balance, and achieve academic goals while catering to their academic anxieties, mental health concerns, and adaptability to the e-learning platforms amidst the COVID-19 pandemic. Despite the wide-scale changes the pandemic brought to the teaching and learning communities, the GS intervention served as a targeted intervention to help students maintain their achievement contexts in a goal-oriented way.

Keywords: academic achievement, acadeic resilience, COVID-19, goal setting

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Authors: Thais Cavalheri Santos, Pedro Jose Gabriel Ferreira, Alexandre Daliberto Frugoli, Lucio Leonardo, Pedro Americo Frugoli

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This paper presents a low cost education proposal to be used in engineering courses. The engineering education in universities of a developing country that is in need of an increasing number of engineers carried out with quality and affordably, pose a difficult problem to solve. In Brazil, the political and economic scenario requires academic managers able to reduce costs without compromising the quality of education. Within this context, the elaboration of a physics principles teaching method with the construction of an electronic balance is proposed. First, a method to develop and construct a load cell through which the students can understand the physical principle of strain gauges and bridge circuit will be proposed. The load cell structure was made with aluminum 6351T6, in dimensions of 80 mm x 13 mm x 13 mm and for its instrumentation, a complete Wheatstone Bridge was assembled with strain gauges of 350 ohms. Additionally, the process involves the use of a software tool to document the prototypes (design circuits), the conditioning of the signal, a microcontroller, C language programming as well as the development of the prototype. The project also intends to use an open-source I/O board (Arduino Microcontroller). To design the circuit, the Fritizing software will be used and, to program the controller, an open-source software named IDE®. A load cell was chosen because strain gauges have accuracy and their use has several applications in the industry. A prototype was developed for this study, and it confirmed the affordability of this educational idea. Furthermore, the goal of this proposal is to motivate the students to understand the several possible applications in high technology of the use of load cells and microcontroller.

Keywords: Arduino, load cell, low-cost education, strain gauge

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Authors: Siddharth Jain, Abhenil Mittal, Surendra Kumar Sharma

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Background: With its recent emergence and re-emergence, dengue has become a major international public health concern, imposing significant financial burden especially in developing countries. Despite aggressive control measures in place, India experienced one of its largest outbreaks in 2015 with Delhi being most severely affected. There is a lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak. Methods: This prospective observational study conducted at an apex tertiary care center in Delhi, India included confirmed adult dengue patients admitted between August-November 2015. Patient demographics, clinical details, and laboratory findings were recorded in a predesigned proforma. Appropriate statistical tests were used to summarize and compare the clinical and laboratory characteristics and derive predictors of mortality and severe disease, while developing a clinical risk score for mortality. Serotype analysis was also done for 75 representative samples to identify the dominant serotypes. Results: Data of 369 patients were analyzed (mean age 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (DHF Grade 1,2)and 46 (12%) developed dengue shock syndrome (DSS). Twenty two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnoea at rest were identified as independent predictors of severe disease. Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnoea) which, if ≥ 22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were DENV-2 and DENV-4. Conclusion: Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine the outcome in dengue patients. Timely referral/access to health care is important. Development and use of validated predictors of disease severity and simple clinical risk scores, which can be applied in all healthcare settings, can help minimize mortality and morbidity, especially in resource limited settings.

Keywords: dengue, mortality, predictors, severity

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Authors: Gunay Imanguliyeva

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Burnout is one of the concerning issues in education. The present paper aimed to explore the concept of burnout among program directors and faculty working in three higher education institutions (HEIs) in Azerbaijan and identify the factors contributing to burnout and the possible consequences of this syndrome on research participants’ professional and personal life. The researcher believed that if the concept of burnout was defined precisely and explored among more faculty, administration, and educational institutions, university leadership may have looked for the ways to support program directors and faculty, which would increase job satisfaction and decrease turnover. An exploratory qualitative research design was chosen for this study. The conceptual framework of this study was based on the Maslach Burnout Inventory. The instruments of the research were semi-structured interviews, observation, and document review. Three EFL (Teaching English as a Foreign Language) instructors and three program directors of the English Language Department working in three higher educational institutions in Azerbaijan participated in this study. The major findings of this study showed that both program directors and faculty suffered from burnout. Though they were aware of the factors that caused burnout, they did not know how to deal with this feeling. While research participants had high feeling of Emotional Exhaustion and Depersonalization, they had a low feeling of Personal Accomplishment. The researcher suggests that further research is important to measure the level of burnout and to enable HEIs to increase the productivity of program directors’ and faculty’s work as well as decrease the rate of retention in future. Also, in order to help program directors and faculty to cope with burnout, the research recommends the university leadership to meet their psycho-social needs, emotional-physical needs, and personal-intellectual needs. Keywords: burnout, emotional exhaustion, factors, well-being, higher education

Keywords: burnout, well-being, higher education, factors

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Authors: Thanooja Naushad, Meena Natarajan, Tushar Vasant Kulkarni

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Background: The Lacey Assessment of Preterm Infants (LAPI) is used in clinical practice to identify premature babies at risk of neuromotor impairments, especially cerebral palsy. This study attempted to find the validity of the Lacey assessment of preterm infants to predict neuromotor outcomes of premature babies at 12 months corrected age and to compare its predictive ability with the brain ultrasound. Methods: This prospective cohort study included 89 preterm infants (45 females and 44 males) born below 35 weeks gestation who were admitted to the neonatal intensive care unit of a government hospital in Dubai. Initial assessment was done using the Lacey assessment after the babies reached 33 weeks postmenstrual age. Follow up assessment on neuromotor outcomes was done at 12 months (± 1 week) corrected age using two standardized outcome measures, i.e., infant neurological international battery and Alberta infant motor scale. Brain ultrasound data were collected retrospectively. Data were statistically analyzed, and the diagnostic accuracy of the Lacey assessment of preterm infants (LAPI) was calculated -when used alone and in combination with the brain ultrasound. Results: On comparison with brain ultrasound, the Lacey assessment showed superior specificity (96% vs. 77%), higher positive predictive value (57% vs. 22%), and higher positive likelihood ratio (18 vs. 3) to predict neuromotor outcomes at one year of age. The sensitivity of Lacey assessment was lower than brain ultrasound (66% vs. 83%), whereas specificity was similar (97% vs. 98%). A combination of Lacey assessment and brain ultrasound results showed higher sensitivity (80%), positive (66%), and negative (98%) predictive values, positive likelihood ratio (24), and test accuracy (95%) than Lacey assessment alone in predicting neurological outcomes. The negative predictive value of the Lacey assessment was similar to that of its combination with brain ultrasound (96%). Conclusion: Results of this study suggest that the Lacey assessment of preterm infants can be used as a supplementary assessment tool for premature babies in the neonatal intensive care unit. Due to its high specificity, Lacey assessment can be used to identify those babies at low risk of abnormal neuromotor outcomes at a later age. When used along with the findings of the brain ultrasound, Lacey assessment has better sensitivity to identify preterm babies at particular risk. These findings have applications in identifying premature babies who may benefit from early intervention services.

Keywords: brain ultrasound, lacey assessment of preterm infants, neuromotor outcomes, preterm

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Authors: Magdalena Korytowska, Gunnar Lengstrand, Cecilia Larsson Wexell

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Background: Breast cancer (BC) is the most common cancer among women worldwide, and cases are continuing to increase in Sweden. Bone is the most common metastatic site in breast cancer patients, where > 65-75% of women with advanced breast cancer develop bone metastases during their disease. To prevent the skeletal-related events of metastases (e.g., pathological fractures, bone loss, cancer-induced bone pain, and hypercalcemia bone), two different classes of antiresorptive medications (AR), bisphosphonate and denosumab are typically administered every 3 to 4 weeks. Since 2015, adjuvant bisphosphonate treatment has been used every six months for three to five years in postmenopausal women for the prevention of skeletal metastases and improved survival. Methods: A case-control study was conducted to test the hypotheses that patients treated with high-dose AR are at higher risk of developing MRONJ than breast cancer patients with adjuvant bisphosphonate treatment at a lower dose. Medical and odontological data was collected between 2015-2020. Assessment of oral health and dental care before and during oncological treatment took place at the specialist clinic for Orofacial medicine linked to the specific hospital. Results: In total, 220 patients were included, 101 patients in the high-dose group and 119 patients in the adjuvant BP-treatment group. MRONJ was diagnosed in 13 patients (14%) in the high-dose group. The mandible was affected in most of the cases (84.6%), with a mean duration of high-dose treatment of 19.7 months. In 46.2% of cases, no dental cause of MRONJ could be identified. Overall, estrogen receptor-positive (ER+) BC was the most representative type in 172 patients (78.2%). However, this was 83.9% in the high-dose cases group. The most used drug was denosumab. Twenty-five patients (26.9%) switched their medication from ZOL to denosumab during their oncological treatment. Patients with ER+ breast cancer were reported in 88 patients (87.8%) in the adjuvant group that was treated with ZOL. Conclusions: MRONJ was diagnosed only in the high-dose AR group. Dental assessment and care of patients in the adjuvant group should be considered, with a recommendation to potentially prolong ZOL treatment from 3 to 5 years, with concomitant use of hormonal therapy in patients diagnosed with ER+ breast cancer to prevent bone loss induced by oncological treatment. A new referral for dental assessment is very important in the case of bone metastases when treatment with high dose AR will be required since it is associated with a higher risk of MRONJ.

Keywords: antiresorptive therapy, breast cancer, dental care, MRONJ

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Authors: Belkis L. Cabrera

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Contemporary technological innovations have reshaped possibility, interaction, communication, engagement, education, and training. Indeed, today, a high-quality technology enhanced learning experience can be transformative as much for the learner as for the educator-trainer. As innovative technologies continue to facilitate, support, foster, and enhance collaboration, problem-solving, creativity, adaptiveness, multidisciplinarity, and communication, the field of instructional design (ID) also continues to develop and expand. Shifting its focus from media to the systematic design of instruction, or rather from the gadgets and devices themselves to the theories, models, and impact of implementing educational technology, the evolution of ID marks a restructuring of the teaching, learning, and training paradigms. However, with all of its promise, this latter component of ID remains underdeveloped. The majority of ID models are crafted and guided by learning theories and, therefore, most models are constructed around student and educator roles rather than trainer roles. Thus, when these models or systems are employed for training purposes, they usually have to be re-fitted, tweaked, and stretched to meet the training needs. This paper is concerned with the training or professional development (PD) facet of instructional design and how ID models built on teacher-to-teacher interaction and dialogue can support the creation of professional learning communities (PLCs) or communities of practice (CoPs), which can augment learning and PD experiences for all. Just as technology is changing the face of education, so too can it change the face of PD within the educational realm. This paper not only provides a new ID model but using innovative technologies such as Padlet and Thinkbinder, this paper presents a concrete example of how a traditional body-to-body, brick, and mortar learning community can be transferred and transformed into the online context.

Keywords: communities of practice, e-learning, educational reform, instructional design, professional development, professional learning communities, technology, training

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Authors: Hung Tran

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This interpretive qualitative study employed three theoretical lenses: Bronfenbrenner’s (1979) Ecological System of Human Development, Vygotsky’s (1978) Sociocultural Theory of Development, and Knowles’s (1970) Adult Learning Theory as the theoretical framework in connection with the constructivist research paradigm to investigate into positive and negative aspects of the extant English as a Foreign Language (EFL) faculty mentoring programs at four higher education institutions (HEIs) in the Mekong River Delta (MRD) of Vietnam. Four apprentice faculty members (mentees), four experienced faculty members (mentors), and two associate deans (administrators) from these HEIs participated in two tape-recorded individual interviews in the Vietnamese language. Twenty interviews were transcribed verbatim and translated into English with verification. The initial analysis of data reveals that the mentoring program, which is mandated by Vietnam’s Ministry of Education and Training, has been implemented differently at these HEIs due to a lack of officially-documented mentoring guidance. Other general themes emerging from the data include essentials of the mentoring program, approaches of the mentoring practice, the mentee – mentor relationship, and lifelong learning beyond the mentoring program. Practically, this study offers stakeholders in the mentoring cycle description of benefits and best practices of tertiary EFL mentorship and a suggested mentoring program that is metaphorically depicted as “a lifebuoy” for its current and potential administrators and mentors to help their mentees survive in the first years of teaching. Theoretically, this study contributes to the world’s growing knowledge of post-secondary mentorship by enriching the modest literature on Asian tertiary EFL mentorship.

Keywords: faculty mentorship, mentees, mentors, administrator, the MRD, Vietnam

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Authors: C. M. Choi, H. C. Tsang, W. K. Fong, Y. K. Cheng, T. K. Chui, L. Y. Chan, K. W. Lee, C. K. Yuen, P. W. Lau, Y. L. To, K. C. Chow

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Six-minute walk test (6MWT) is a sub-maximal exercise test to assess aerobic capacity and exercise tolerance of patients with chronic respiratory disease and heart failure. This has been proven to be a reliable and valid tool and commonly used in clinical situations. Traditional 6MWT is labour-intensive and time-consuming especially for patients who require assistance in ambulation and oxygen use. When performing the test with these patients, one staff will assist the patient in walking (with or without aids) while another staff will need to manually record patient’s oxygen saturation, heart rate and walking distance at every minute and/or carry oxygen cylinder at the same time. Physiotherapist will then have to document the test results in bed notes in details. With the use of electronic 6MWT (E-6MWT), patients wear a wireless oximeter that transfers data to a tablet PC via Bluetooth. Real-time recording of oxygen saturation, heart rate, and distance are displayed. No manual work on recording is needed. The tablet will generate a comprehensive report which can be directly attached to the patient’s bed notes for documentation. Data can also be saved for later patient follow up. This study was carried out in North District Hospital. Patients who followed commands and required 6MWT assessment were included. Patients were assigned to study or control groups. In the study group, patients adopted the E-6MWT while those in control group adopted the traditional 6MWT. Manpower and time consumed were recorded. Physiotherapists also completed a questionnaire about the use of E-6MWT. Total 12 subjects (Study=6; Control=6) were recruited during 11-12/2017. An average number of staff required and time consumed in traditional 6MWT were 1.67 and 949.33 seconds respectively; while in E-6MWT, the figures were 1.00 and 630.00 seconds respectively. Compared to traditional 6MWT, E-6MWT required 67.00% less manpower and 50.10% less in time spent. Physiotherapists (n=7) found E-6MWT is convenient to use (mean=5.14; satisfied to very satisfied), requires less manpower and time to complete the test (mean=4.71; rather satisfied to satisfied), has better data management (mean=5.86; satisfied to very satisfied) and is recommended to be used clinically (mean=5.29; satisfied to very satisfied). It is proven that E-6MWT requires less manpower input with higher efficiency and better data management. It is welcomed by the clinical frontline staff.

Keywords: electronic, physiotherapy, six-minute walk test, 6MWT

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Authors: Kelechi E. Ezeji

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The inclusion of relevant content in curricula of architecture schools is vital for attainment of Computer Aided Design (CAD) proficiency by graduates. Implementing this content involves, among other variables, the presence of competent tutors. Consequently, this study sought to investigate the importance of personnel recruitment for inclusion of content vital to the implementation of CAD in the curriculum for architecture education. This was with a view to developing a framework for appropriate implementation of CAD curriculum. It was focused on departments of architecture in universities in south-east Nigeria which have been accredited by National Universities Commission. Survey research design was employed. Data were obtained from sources within the study area using questionnaires, personal interviews, physical observation/enumeration and examination of institutional documents. A multi-stage stratified random sampling method was adopted. The first stage of stratification involved random sampling by balloting of the departments. The second stage involved obtaining respondents’ population from the number of staff and students of sample population. Chi Square analysis tool for nominal variables and Pearson’s product moment correlation test for interval variables were used for data analysis. With ρ < 0.5, the study found significant correlation between the number of CAD literate academic staff and use of CAD in design studio/assignments; that increase in the overall number of teaching staff significantly affected total CAD credit units in the curriculum of the department. The implications of these findings were that for successful implementation leading to attainment of CAD proficiency to occur, CAD-literacy should be a factor in the recruitment of staff and a policy of in-house training should be pursued.

Keywords: computer-aided design, education, personnel recruitment, curriculum

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Authors: Bharat Rawat, Shekhar Rajbhandari, Yadav Bhatta, Jay Prakash Jaiswal, Shivaji Bikram Silwal, Rajiv Shrestha, Shova Sunuwar

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Introduction: The honey produced by the bees fed on Rhobdodendron species containing grayanotoxin is known as mad honey. Grayanotoxin is found in honey obtained from the nectar of Rhododendron species growing on the mountains of the Black Sea region of Turkey and also in Japan, Nepal, Brazil, parts of North America, and Europe. Although the incidence of grayanotoxin poisoning is rare, there is concern that the number of cases per year will rise with the increasing demand for organic products. Mad honey intoxication might present with mild symptoms of cardiovascular, gastrointestinal and neurological systems or might also present with a life-threatening form with AV block and cardiovascular collapse. In this article, we describe the summary of five cases, which came to our hospital with mad honey related cardiac complications. Findings: In last one year, five cases presented in the emergency department with sudden onset of Loss of consciousness, dizziness, shortness of breath. They felt difficulty after the consumption of 1-3 teaspoonful of wild honey. The honey was brought from most of the rural parts of Nepal like khotang. Some of them also came with vomiting, dizziness, and loose stool. On examination, most of them had severe bradycardia and low blood pressure. No abnormalities were detected on systemic examinations. In one patient, ECG and cardiac enzymes showed features of the acute coronary syndrome, but his treadmill test done few days later was normal. All patients were managed with inj. Atropine, I/V normal saline, and other supportive measures and discharged in a stable condition within one or two days. Conclusions: Rhododendrons is the national flower of Nepal. The specific species of rhododendron found in Nepal which contains the toxin is not known. Bees feeding on these rhododendrons are known to transfer the grayanotoxin to the honey they produce. Most symptoms are mild and resolve themselves without medical intervention. Signs and symptoms of grayanotoxin poisoning rarely last more than 24 hours and are usually not fatal. Some signs of mad honey poisoning include Bradycardia, Cardiac arrhythmia, Hypotension, Nausea and Vomiting. They respond to close monitoring and appropriate supportive treatment. Normally, patients recover completely with no residual damage to the heart or its conduction system.

Keywords: rhobdodendron, honey, grayanotoxin, bradycardia

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Authors: Pernille K. Christiansen, Mette Maria Skjøth, Line Lorenzen, Eva Draborg, Christina Anne Vinter, Trine Kjær, Mette Juel Rothmann

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Background and aims: Overweight and obesity are an increasing challenge on a global level. In Denmark, more than one-third of all pregnant women are overweight or obese, and many women exceed the gestational weight gain recommendations from the Institute of Medicine. Being overweight or obese, is associated with a higher risk of adverse maternal and fetal outcomes, including gestational diabetes and childhood obesity. Thus, it is important to focus on the women’s lifestyles between their pregnancies to lower the risk of gestational weight retention in the long run. The objective of this study was to explorer what barriers and challenges postpartum women experience with respect to healthy lifestyles during the postpartum period and to access whether an Information Technology based intervention might be a supportive tool to assist and motivate postpartum women to a healthy lifestyle. Materials and methods: The method is inspired by participatory design. A systematic text condensation was applied to semi-structured focus groups. Five focus group interviews were carried out with a total of 17 postpartum women and two interviews with a total of six health professionals. Participants were recruited through the municipality in Svendborg, Denmark, and at Odense University Hospital in Odense, Denmark, during a four-month period in early 2018. Results: From the women’s perspective, better assistance is needed from the health professionals to obtain or maintain a healthy lifestyle. The women need tools that inform and help them understand and prioritise their own health-related risks, and to motivate them to plan and take care of their own health. As the women use Information Technology on a daily basis, the solution could be delivered through Information Technology. Finally, there is room for engaging the partner more in the communication related to the baby and family’s lifestyle. Conclusion: Postpartum women need tools that inform and motivate a healthy lifestyle postpartum. The tools should allow access to high-quality information from health care professionals, when the information is needed, and also allow engagement from the partner. Finally, Information Technology is a potential tool for delivering tools.

Keywords: information technology, lifestyle, overweight, postpartum

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Authors: Sepideh Nikounejad, Mostafa Ghaderi, Nematollah Azizi, Per-Olof Thang, Mohamad Reza Neyestani

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From an educational perspective, an effective and efficient relationship between university and industry can be considered as an important means by which not only both sides are improved but also it brings many advantages and benefits for both parties. It means more specifically, mutual collaboration between universities and industry can not only reduce youth unemployment, but it can improve the quality of teaching and learning in higher education settings while providing more qualified people to industrial enterprises. Indeed the lack of effective interaction between Iranian universities and industry has confronted the country and created many challenges include in increasing number of unskillful and unemployed graduates. However, in order to suggest appropriate practical strategies, it is very important to see how this issue has been tackled by Swedish universities, which have had a good background in this collaboration and how they are connected to the industry in particular and labour market in general. The research aims to study and compare the mechanisms, processes, and policies of the current model in the relationships between university and industry in Iran and Sweden. As a qualitative study, grounded theory was applied. Data were collected via semi-structured interviews. Participants were selected purposefully and by the snowball sampling method. The findings indicate that despite reported needs from both sides for close collaborations between universities and industries in Iran, current policies and practices, including internship, laboratory, and financial support, need to be revised critically. However, in light of our findings on the Swedish policies and practices for linking universities and industries, some practical strategies will be suggested for the Iranian higher education context. In conclusion, cooperation models between universities and industries in Iran and Sweden will be described.

Keywords: cooperation, higher education, industry, comparative

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Authors: Ruiyuan Wang, Jing Han, Bruno Di Biase, Mark Antoniou

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The purpose of this study is to explore the relationship between working memory (WM) capacity and Chinese-English consecutive interpreting (CI) performance in interpreting learners with different study abroad experience (SAE). Such relationship is not well understood. This study also examines whether Chinese interpreting learners with SAE in English-speaking countries, demonstrate a better performance in inflectional morphology and agreement, notoriously unstable in Chinese speakers of English L2, in their interpreting output than learners without SAE. Fifty Chinese university students, majoring in Chinese-English Interpreting, were recruited in Australia (n=25) and China (n=25). The two groups matched in age, language proficiency, and interpreting training period. Study abroad (SA) group has been studying in an English-speaking country (Australia) for over 12 months, and none of the students recruited in China (the no study abroad = NSA group) had ever studied or lived in an English-speaking country. Data on language proficiency and training background were collected via a questionnaire. Lexical retrieval performance and working memory (WM) capacity data were collected experimentally, and finally, interpreting data was elicited via a direct CI task. Main results of the study show that WM significantly correlated with participants' CI performance independently of learning context. Moreover, SA outperformed NSA learners in terms of subject-verb number agreement. Apart from that, WM capacity was also found to correlate significantly with their morphosyntactic accuracy. This paper sheds some light on the relationship between study abroad, WM capacity, and CI performance. Exploring the effect of study abroad on interpreting trainees and how various important factors correlate may help interpreting educators bring forward more targeted teaching paradigms for participants with different learning experiences.

Keywords: study abroad experience, consecutive interpreting, working memory, inflectional agreement

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Authors: K. O. Ogbedeh, C. P. Ekwe, G. O. Ihejirika, S. A. Dialoke, O. P. Onyewuchi, C. P. Anyanwu, I. E. Kalu

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As one of the major pests of field crops, termites attack groundnut at all stages of its development, especially during prolonged dry spell. Effect of palm bunch ash and neem(Azardirachta indica A. Juss) leaf powder on termite infestation in groundnut field in Owerri, Nigeria was investigated in this study. The field trial was carried out in 2016 at the Teaching and Research Farm of the Federal University of Technology, Owerri, Nigeria. The experiment was laid out in a 3x3 Factorial fitted into a Randomized Complete Block Design (RCBD) with three replications. The treatments include three rates of palm bunch ash at 0.0 (control), 1.0 and 2.0tons/ha and three rates of neem leaf powder at 0.0(control), 1.0, 2.0 tons/ha respectively. Data were collected on percentage emergence, termite incidence and termite severity. These were subjected to analysis of variance (ANOVA), and means were separated using least significant difference at 5% level of probability. The result shows that there were no significant (P= 0.05) differences in percentage emergence amongst treatment means due to palm bunch ash and neem leaf powder applications. Contrarily, palm bunch ash at 2.0 tons/ha recorded the least termite incidence especially at twelve weeks after planting (12WAP) with a value of 22.20% while control plot maintained highest values at 6WAP (48.70%) and 12WAP (48.30%) respectively. Also palm bunch ash at 2.0tons/ha depressed termite severity more than other treatments especially at 2 and 4 WAP (0.56) respectively. Control plots on the other hand consistently maintained highest termite severity throughout the trial with the highest value at 2 and 12WAP (1.56). Conclusively, palm bunch ash exhibited highest depressive action against termite on groundnut especially at higher application value (2.0tons/ha).

Keywords: groundnut, incidence, neem, palm, severity, termites

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Authors: Guler Duru Asiret, Cemile Kutmec Yilmaz, Gulcan Bagcivan, Tugce Turten Kaymaz

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This descriptive study was conducted to determine the relationship between caregiver burden and life satisfaction who give home care to elderly individuals. The sample was recruited from the internal medicine unit and palliative unit of a state hospital located in Turkey on June 2016-2017. The study sample consisted of 231 primary caregiver family member, who met the eligibility criteria and agreed to participate in the study. The inclusion criteria were as follows: inpatient’s caregiver, primary caregiver for at least 3 months, at least 18 years of age, no communication problem or mental disorder. Data were gathered using an Information Form prepared by the researchers based on previous literature, the Zarit Burden Interview (ZBI), and the Satisfaction with Life Scale (SWLS). The data were analyzed using IBM SPSS Statistics software version 20.0 (SPSS, Chicago, IL). The descriptive characteristics of the participant were analyzed using number, percentage, mean and standard deviation. The suitability of normal distribution of scale scores was analyzed using Kolmogorov-Smirnov and Shapiro-Wilk test. Relationships between scales were analyzed using Spearman’s rank-correlation coefficient. P values less than 0.05 were considered to be significant. The average age of the caregivers was 50.11±13.46 (mean±SD) years. Of the caregivers, 76.2% were women, 45% were primary school graduates, 89.2% were married, 38.1% were the daughters of their patients. Among these, 52.4% evaluated their income level to be good. Of them, 53.6% had been giving care less than 2 years. The patients’ average age was 77.1±8.0 years. Of the patients, 55.8% were women, 56.3% were illeterate, 70.6% were married, and 97.4% had at least one chronic disease. The mean Zarit Burden Interview score was 35.4±1.5 and the Satisfaction with Life Scale score was 20.6±6.8. A negative relationship was found between the patients’ score average on the ZBI, and on the SWLS (r= -0.438, p=0.000). The present study determined that the caregivers have a moderate caregiver burden and the life satisfaction. And the life satisfaction of caregivers decreased as their caregiver burden increase. In line with the results obtained from the research, it is recommended that to increase the effectiveness of discharge training, to arrange training and counseling programs for caregivers to cope with the problems they experienced, to monitor the caregivers at regular intervals and to provide necessary institutional support.

Keywords: caregiver burden, family caregivers, nurses, satisfaction

Procedia PDF Downloads 176

Authors: Tan Xin Zhong Timothy, Chang Chen Jie Victor, Yew Kwan Tong, Lim Geok Peng Sandy

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Background: Leaders in crisis response teams such as Trauma Teams in hospitals are essential to the effective coordination and direction of the team. The response to emergency trauma situations must be accurate, rapid, and well executed. To this end, the team leader’s social, technical and leadership skills are essential factors that implicate the success of an emergency trauma intervention. While each emergency trauma case varies in severity and complexity, and the experience and expertise of team leaders may vary, it would be productive to identify certain coordinative and directive functions that improve the capacity for leading a team. Methods: This qualitative study of Trauma Team physicians in Singapore General Hospital (SGH) involved 50 in-depth interviews with doctors and nurses involved in Trauma Team activations, observations of Trauma Teams managing emergency patients, and reviews of audio/video recordings of 65 trauma activations. The interviews were conducted with doctors of various ranks across the relevant departments, 12 from the Emergency Department (ED), 11 from General Surgery (GS) and 8 from Orthopaedics, while the 6 nurses were from ED. In accordance with the grounded theory approach, the content of the interviews was coded and analysed in order to derive broad leadership themes that corresponded with certain behavioural traits exhibited by trauma team leaders, supplemented with the observational and audio/video data. Results: The leadership behaviours of the team leaders could be typified into three broad categories: team orientation, engagement and activeness. Team orientation corresponds with the source and form of cognitive responsibility, decision-making and informational contributions, divisible into individualistic and consultative sub-categories. Engagement refers to the type of activity that leaders prefer to engage in, and which implicates their attentional focus, divisible into participatory and supervisory sub-categories. Activeness is a function of the leader’s attitudes towards the behavioural regulation of the team, which manifests in inactivity or activity to augment or merely align with protocol. These factors are not exhaustive and are contextually sensitive, but collectively implicate a significant portion of the leadership activity observed in trauma teams.

Keywords: trauma team activations, critical event management, leadership, teamwork

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Authors: Akterono Budiyati, Gita Kusumo, Teguh Putra, Fritzie Rexana, Antonius Kurniawan, Aru Sudoyo, Ahmad Utomo, Andi Utama

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The presence of the programmed death ligand-1 (PD-L1) has been used in multiple clinical trials and approved as biomarker for selecting patients more likely to respond to immune checkpoint inhibitors. However, the expression of PD-L1 is regulated in different ways, which leads to a different significance of its presence. Positive PD-L1 within tumors may result from two mechanisms, induced PD-L1 expression by T-cell presence or genetic mechanism that lead to constitutive PD-L1 expression. Amplification of PD-L1 genes was found as one of genetic mechanism which causes an increase in PD-L1 expression. In case of colorectal cancer (CRC), targeting immune checkpoint inhibitor has been recommended for patients with microsatellite instable (MSI). Although the correlation between PD-L1 expression and MSI status has been widely studied, so far the precise mechanism of PD-L1 gene activation in CRC patients, particularly in MSI population have yet to be clarified. In this present study we have profiled 61 archived formalin fixed paraffin embedded CRC specimens of patients from Medistra Hospital, Jakarta admitted in 2010 - 2016. Immunohistochemistry was performed to measure expression of PD-L1 in tumor cells as well as MSI status using antibodies against PD-L1 and MMR (MLH1, MSH2, PMS2 and MSH6), respectively. PD-L1 expression was measured on tumor cells with cut off of 1% whereas loss of nuclear MMR protein expressions in tumor cells but not in normal or stromal cells indicated presence of MSI. Subset of PD-L1 positive patients was then assessed for copy number variations (CNVs) using single Tube TaqMan Copy Number Assays Gene CD247PD-L1. We also observed KRAS mutation to profile possible genetic mechanism leading to the presence or absence of PD-L1 expression. Analysis of 61 CRC patients revealed 15 patients (24%) expressed PD-L1 on their tumor cell membranes. The prevalence of surface membrane PD-L1 was significantly higher in patients with MSI (87%; 7/8) compared to patients with microsatellite stable (MSS) (15%; 8/53) (P=0.001). Although amplification of PD-L1 gene was not found among PD-L1 positive patients, low-level amplification of PD-L1 gene was commonly observed in MSS patients (75%; 6/8) than in MSI patients (43%; 3/7). Additionally, we found 26% of CRC patients harbored KRAS mutations (16/61), so far the distribution of KRAS status did not correlate with PD-L1 expression. Our data suggest genetic mechanism through amplification of PD-L1 seems not to be the mechanism underlying upregulation of PD-L1 expression in CRC patients. However, further studies are warranted to confirm the results.

Keywords: colorectal cancer, gene amplification, microsatellite instable, programmed death ligand-1

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