Search results for: programme outcome

Authors: J. Niyitegeka, G. Nshimirimana, A. Silverstein, J. Odhiambo, Y. Lin, T. Nkurunziza, R. Riviello, S. Rulisa, P. Banguti, H. Magge, M. Macharia, J. P. Dushime, R. Habimana, B. Hedt-Gauthier

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In low-resource settings, women needing an emergency cesarean section experiences various delays in both reaching and receiving care that is often linked to poor neonatal outcomes. In this study, we quantified different measures of delays and assessed the association between these delays and neonatal outcomes at three rural district hospitals in Rwanda. This retrospective study included 441 neonates and their mothers who underwent emergency cesarean sections in 2015 at Butaro, Kirehe and Rwinkwavu District Hospitals. Four possible delays were measured: Time from start of labor to district hospital admission, travel time from a health center to the district hospital, time from admission to surgical incision, and time from the decision for the emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR < 7 or death) and favorable (APGAR ≥ 7). We assessed the relationship between each type of delay and neonatal outcomes using multivariate logistic regression. In our study, 38.7% (108 out of 279) of neonates’ mothers labored for 12 to 24 hours before hospital admission and 44.7% (159 of 356) of mothers were transferred from health centers that required 30 to 60 minutes of travel time to reach the district hospital. 48.1% (178 of 370) of caesarean sections started within five hours after admission and 85.2% (288 of 338) started more than thirty minutes after the decision for the emergency cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 minutes of travel time from the health center to the district hospital compared to health centers attached to the hospital (OR = 5.12, p = 0.02). Neonatal outcomes were also significantly different depending on decision to incision intervals; neonates with cesarean deliveries starting more than thirty minutes after decision had better outcomes than those started immediately (OR = 0.32, p = 0.04). Interventions that decrease barriers to access to maternal health care services can improve neonatal outcome after emergency cesarean section. Triaging could explain the inverse relationship between time from decision to incision and neonatal outcome; this must be studied more in the future.

Keywords: Africa, emergency obstetric care, rural health delivery, maternal and child health

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Authors: Sema Şenoğlu, Sevgi Karakuş

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Hydrazone scaffold is important to design new drug groups and is found to possess numerous uses in pharmaceutical chemistry. Besides, hydrazone derivatives are also known for biological activities such as anticancer, antimicrobial, antiviral, and antifungal. Hydrazone derivatives are promising anticancer agents because they inhibit cancer proliferation and induce apoptosis. Human carbonic anhydrase IX has a high potential to be an antiproliferative drug target, and targeting this protein is also important for obtaining potential anticancer inhibitors. The protein construct was retrieved as a PDB file from the RCSB protein database. This binding interaction of proteins and ligands was performed using Discovery Studio Visualizer. In vitro inhibitory activity of hydrazone derivatives was tested against enzyme carbonic anhydrase IX on the PyRx programme. Most of these molecules showed remarkable human carbonic anhydrase IX inhibitory activity compared to the acetazolamide. As a result, these compounds appear to be a potential target in drug design against human carbonic anhydrase IX.

Keywords: cancer, carbonic anhydrase IX enzyme, docking, hydrazone

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Authors: Rosina U. Ndukwe, Diane Crone, Nick Cavill

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Active transport (i.e. walking to school, cycle to work schemes etc.) is an effective approach with multiple social and environmental benefits for transforming urban environments into active urban environments. Although walking and cycling often remain on the margins of urban planning and infrastructure, there are new approaches emerging, along with policy intervention relevant for the creation of sustainable urban active environments conductive to active travel, increasing physical activity levels of involved communities and supporting social inclusion through more active participation. SPAcE - Supporting Policy and Action for Active Environments is a 3 year Erasmus+ project that aims to integrate active transport programmes into public policy across the EU. SPAcE focuses on cities/towns with recorded low physical activity levels to support the development of active environments in 5 sites: Latvia [Tukums], Italy [Palermo], Romania [Brasov], Spain [Castilla-La Mancha] and Greece [Trikala]. The first part of the project involved a review of good practice including case studies from across the EU and project partner countries. This has resulted in the first output from the project, an evidence of good practice summary with case study examples. In the second part of the project, working groups across the 5 sites have carried out co-production to develop Urban Active Environments (UActivE) Action Plans aimed at influencing policy and practice for increasing physical activity primarily through the use of cycling and walking. Action plans are based on international evidence and guidance for healthy urban planning. Remaining project partners include Universities (Gloucestershire, Oxford, Zurich, Thessaly) and Fit for Life programme (National physical activity promotion program, Finland) who provide support and advice incorporating current evidence, healthy urban planning and mentoring. Cooperation and co-production with public health professionals, local government officers, education authorities and transport agencies has been a key approach of the project. The third stage of the project has involved training partners in the WHO HEAT tool to support the implementation of the Action Plans. Project results show how multi-agency, transnational collaboration can produce real-life Action Plans in five EU countries, based on published evidence, real-life experience, consultation and collaborative working with other organisations across the EU. Learning from the processes adopted within this project will demonstrate how public health, local government and transport agencies across the EU, can work together to create healthy environments that have the aim of facilitating active behaviour, even in times of constrained public budgets. The SPAcE project has captured both the challenges and solutions for increasing population physical activity levels, health and wellness in urban spaces and translating evidence into policy and practice ensuring innovation at policy level. Funding acknowledgment: SPAcE (www.activeenvironments.eu) is co-funded by the Sport action of the ERASMUS+ programme.

Keywords: action plans, active transport, SPAcE, UActivE urban active environments, walking and cycling

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Authors: Sam J. Cooley, Mary L. Quinton, Benjamin J. Parry, Mark J. G. Holland, Richard J. Whiting, Jennifer Cumming

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Practitioners draw attention to people’s character strengths to promote empowerment and well-being. This paper explores the possibility that existing approaches for assessing character strengths (e.g., the Values in Action survey; VIA-IS) could be even more autonomy supportive and empowering when combined with strengths profiling, an ideographic tool informed by personal construct theory (PCT). A PCT approach ensures that: (1) knowledge is co-created (i.e., the practitioner is not seen as the ‘expert’ who leads the process); (2) individuals are not required to ‘fit’ within a prescribed list of characteristics; and (3) individuals are free to use their own terminology and interpretations. A combined Strengths Profiling and VIA approach was used in a sample of homeless youth (aged 16-25) who are commonly perceived as ‘hard-to-engage’ through traditional forms of assessment. Strengths Profiling was completed face-to-face in small groups. Participants (N = 116) began by listing a variety of personally meaningful characteristics. Participants gave each characteristic a score out of ten for how important it was to them (1 = not so important; 10 = very important), their ideal competency, and their current competency (1 = poor; 10 = excellent). A discrepancy score was calculated for each characteristic (discrepancy score = ideal score - current score x importance), whereby a lower discrepancy score indicated greater satisfaction. Strengths Profiling was used at the beginning and end of a 10-week positive youth development programme. Experiences were captured through video diary room entries made by participants and through reflective notes taken by the facilitators. Participants were also asked to complete a pre-and post-programme questionnaire, measuring perceptions of well-being, self-worth, and resilience. All of the young people who attended the strengths profiling session agreed to complete a profile, and the majority became highly engaged in the process. Strengths profiling was found to be an autonomy supportive and empowering experience, with each participant identifying an average of 10 character strengths (M = 10.27, SD = 3.23). In total, 215 different character strengths were identified, each with varying terms and definitions used, which differed greatly between participants and demonstrated the value in soliciting personal constructs. Using the participants’ definitions, 98% of characteristics were categorized deductively into the VIA framework. Bravery, perseverance, and hope were the character strengths that featured most, whilst temperance and courage received the highest discrepancy scores. Discrepancy scores were negatively correlated with well-being, self-worth, and resilience, and meaningful improvements were recorded following the intervention. These findings support the use of strengths profiling as a theoretically-driven and novel way to engage disadvantaged youth in identifying and monitoring character strengths. When young people are given the freedom to express their own characteristics, the resulting terminologies extend beyond the language used in existing frameworks. This added freedom and control over the process of strengths identification encouraged youth to take ownership over their profiles and apply their strengths. In addition, the ability to transform characteristics post hoc into the VIA framework means that strengths profiling can be used to explore aggregated/nomothetic hypotheses, whilst still benefiting from its ideographic roots.

Keywords: ideographic, nomothetic, positive youth development, VIA-IS, assessment, homeless youth

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Authors: Rajashekhar K. Patil, Martin J. Babu

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Weaver ants-Oecophylla smaragdina live in colonies that have polymorphic castes. The females which include the queen, major and minor workers are haploid. The individuals of castes are dependent on olfactory cues for carrying out caste-specific behaviour. In an effort to understand whether organizational differences exist to support these behavioural differences, we studied the olfactory system at the level of the sensilla on the antennae, olfactory glomeruli and the Kenyon cells in the mushroom bodies (MB). The MB differ in major and minor workers in terms of their size, with the major workers having relatively larger calyces and peduncle. The morphology of different types of Kenyon cells as revealed by Golgi-rapid staining was studied and the major workers had more dendritic arbors than minor workers. This suggests a greater degree of olfactory processing in major workers. Differences in caste-specific arrangement of sensilla, olfactory glomeruli and celluar architecture of MB indicate a developmental programme that forms basis of differential behaviour.

Keywords: ant, oecophylla, caste, mushroom body

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Authors: Montserrrat Dopico Gonzalez, Ramon Lopez Facal

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The development of a critical, open and plural citizenship constitutes one of the main challenges of the school institution in the present multicultural societies. Didactics in Social Sciences has conducted important contributions to the development of active methodologies to promote the development of the intercultural competencies of the student body. Research in intercultural education has demonstrated the efficiency of the cooperative learning techniques to improve the intercultural relations in the classroom. Our study proposes to check the effect that, concerning the development of intercultural competencies of the student body, the emotional education can have in the context of the use of active methodologies such as the learning by projects and the cooperative learning. To that purpose, a programme of intervention based on activities focussed on controversial issues related to cultural diversity has been implemented in several secondary schools. Through a methodology which combines intercultural competence scales with interviews and also with the analysis of the school body’s productions, the persistence of stereotypes against immigration and the efficacy of the introduction of emotional education elements in the development of intercultural competencies have both been observed.

Keywords: active methodologies, didactics in social sciences, intercultural competences, intercultural education

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Authors: Jeena R. S., Sukesh Kumar A.

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Stroke is one of the major reasons of adult disability and morbidity in many of the developing countries like India. Early diagnosis of stroke is essential for timely prevention and cure. Various conventional statistical methods and computational intelligent models have been developed for predicting the risk and outcome of stroke. This research work focuses on a multilevel approach for predicting the occurrence of stroke based on various risk factors and invasive techniques like retinal imaging. This risk prediction model can aid in clinical decision making and help patients to have an improved and reliable risk prediction.

Keywords: prediction, retinal imaging, risk factors, stroke

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Authors: Ryotaro Ishikawa

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INTRODUCTION: Post-traumatic stress disorder (PTSD) is a psychiatric label for a collection of psychological symptoms following a traumatic event. PTSD is as a result of a traumatic experience such as rape or sexual assault. A victim may have PTSD if she/he has experienced the following symptoms for at least a month: a) Stressor, b) Intrusion symptoms, c) Avoidance, d) Negative alterations in cognitions and mood, e) Alterations in arousal and reactivity. Studies on the cognitive theory of PTSD emphasized the roles of (a) negative appraisals of trauma memories in maintaining the symptomatology of PTSD, and (b) disorganized trauma memories in the development of PTSD. Mental contamination is primarily caused by experiences involving humans (e.g. violators or perpetrators) as opposed to substances (e.g. dirt or bodily fluids). Feelings of mental contamination may evoke following experiences of ill-treatment, sexual assault, domination, degradation, manipulation, betrayal, or humiliation. Some studies have demonstrated that traumatic thoughts related to sexual assault are particularly strong predictors of mental contamination. Treatment protocols based on cognitive-behavioral therapy appear to be beneficial in reducing the severity of PTSD and mental contamination. Studies on the cognitive theory of PTSD emphasized the roles of (A) negative appraisals of trauma memories in maintaining the symptomatology of PTSD, and (B) disorganized trauma memories in the development of PTSD. We will demonstrate a feasibility study of individual CBT for PTSD and mental contamination in Japanese clinical settings. METHOD: The single-arm trial is a group setting CBT intervention. The primary outcome is the self-rated Posttraumatic Stress Diagnostic Scale, with secondary measurements of depressive severity and mental pollution questionnaire. Assessments are conducted at baseline, after a waiting period before CBT, during CBT, and after CBT. RESULTS: Participants are eligible for the study and complete the outcome measures at all assessment points. In our hypothesis, receiving CBT would lead to improvements in primary and secondary PTSD severity. CONCLUSION: We will demonstrate a feasibility study of individual CBT for PTSD and mental contamination in Japanese clinical settings. Our treatment would achieve favorable treatment outcomes for PTSD with mental contamination in Japanese clinical settings.

Keywords: CBT, cognitive theory, PTSD, mental pollution

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Authors: Shri Krishna Mishra, Badri Yadav

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India is a democratic country requires creative dynamic citizen for its development. And it will be possible only when school produce creative prosperous students. In this aspect, researcher find out that curricular and other curricular activities of Ramkrishna Mission School is unique up to some extent because it gives emphasis on value education and holistic development of students. It giving the emphasis on self-realization, standing on their own feet and community work. Most of the teacher of this school are competent to organize classrooms and manage the behavior of their students so, outcome of this school is very effective and impressive to other school.

Keywords: Ramakrishna Mission School, analysis of curricular, other curricular activities of R. M. School, teachers

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Authors: Akinyemi Eyitayo Oufunmilayo

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In every society, it is expected that adult education will help in meeting the needs of people in terms of economic and social lives and reveal their talents, culture, and political abilities. Participation in adult education programmes could be the ones offered by the Federal, state, and local governments or non-governmental organisations. This study, therefore, investigated how people’s participation in adult education programmes could change their social lives. A quantitative method was employed for the study. The study population consisted of 210 people randomly selected from the three Senatorial Districts in Ondo State. Data obtained was analysed using frequency counts and percentages and chi-square analysis. Findings revealed that members of the society responded to the benefits of adult education programmes made available, and there were positive changes to their social lives. It could be concluded that people’s participation in adult education programmes improved every aspect of their lives for better living. It is recommended that members of the society respond and make good use of any adult education programme made available in their community, while stakeholders and other opportune members of the society come to the aid of less privileged people in their society.

Keywords: adult education programmes, social change, participation, society

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Authors: N. Fusun Oyman Serteller

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In this paper, the techniques to solve time dependent electromagnetic wave propagation equations based on the Finite Difference Method (FDM) are proposed by comparing the results with Finite Element Method (FEM) in 2D while discussing some special simulation examples.  Here, 2D dynamical wave equations for lossy media, even with a constant source, are discussed for establishing symbolic manipulation of wave propagation problems. The main objective of this contribution is to introduce a comparative study of two suitable numerical methods and to show that both methods can be applied effectively and efficiently to all types of wave propagation problems, both linear and nonlinear cases, by using symbolic computation. However, the results show that the FDM is more appropriate for solving the nonlinear cases in the symbolic solution. Furthermore, some specific complex domain examples of the comparison of electromagnetic waves equations are considered. Calculations are performed through Mathematica software by making some useful contribution to the programme and leveraging symbolic evaluations of FEM and FDM.

Keywords: finite difference method, finite element method, linear-nonlinear PDEs, symbolic computation, wave propagation equations

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Authors: Marie-Helena Docherty, Sion Edryd Williams

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The prevalence of diabetes mellitus is increasing worldwide. In Sub-Saharan Africa, type 2 diabetes represents over 90% of all types of diabetes with the number of diabetic patients expected to rise. This represents a huge economic burden in an area already contending with high rates of other significant diseases, including the highest worldwide prevalence of HIV. Diabetic complications considerably impact on morbidity and mortality. The epidemiological data for the region quotes high rates of retinopathy (7-63%), neuropathy (27-66%) and microalbuminuria (10-83%). It is therefore imperative that diabetic screening programmes are established. It is recognised that in many parts of the developing world the implementation and management of such programmes is limited by a lack of available resources. The International Diabetes Federation produced guidelines in 2012 taking these limitations into account suggesting that all diabetic patients should have access to basic screening. These guidelines are consistent with the national diabetic guidelines produced by the Lesotho Medical Council. However, diabetic care in Lesotho is delivered at the local level, with variable levels of quality. A cross sectional study was performed in the outpatient department of Maluti Hospital in Mapoteng, Lesotho, a busy rural hospital in the Berea district. Demographic data on gender, age and modality of treatment were collected over a six-week time period. Information regarding 3 basic screening parameters was obtained. These parameters included eye screening (defined as a documented ophthalmology review within the last 12 months), foot screening (defined as a documented foot health assessment by any health care professional within the last 12 months) and secondary prevention (defined as a documented blood pressure and lipid profile reading within the last 12 months). These parameters were selected on the basis of the absolute minimum level of resources in Maluti Hospital. Renal screening was excluded, as the hospital does not have access to reliable renal profile checks or urinalysis. There is however a fully functioning on-site ophthalmology department run by a senior ophthalmologist with the ability to provide retinal photography, retinal surgery and photocoagulation therapy. Data was collected on 183 type 2 diabetics. 112 patients were male and 71 were female. The average age was 43 years. 4 patients were diet controlled, 140 patients were on oral hypoglycaemic agents (metformin and/or glibenclamide), and 39 patients were on a combination of insulin and oral hypoglycaemics. In the preceding 12 months, 5 patients had undergone eye screening (3%), 24 patients had undergone foot screening (13%), and 31 patients had lipid profile testing (17%). All patients had a documented blood pressure reading (100%). Our results show that screening is poorly performed in the basic indicators suggested by the IDF and the Lesotho Medical Council. On the basis of these results, a screening programme was developed using the mnemonic SaFE; secondary prevention, foot and eye care. This is simple, memorable and transferable between healthcare professionals. In the future, the expectation would be to expand upon this current programme to include renal screening, and to further develop screening pertaining to secondary prevention.

Keywords: Africa, complications, rural, screening

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Authors: Despina Yiakoumi, Agathe Rouaix

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Laboratory experiments were run to investigate the impact of different design characteristics of the auctions, which have been implemented to procure capacity in the UK’s reformed electricity markets. The experiment studies competition among bidders in procurement multi-unit discrete descending clock auctions under different feedback policies and pricing rules. Theory indicates that feedback policy in combination with the two common pricing rules; last-accepted bid (LAB) and first-rejected bid (FRB), could affect significantly the auction outcome. Two information feedback policies regarding the bidding prices of the participants are considered; with feedback and without feedback. With feedback, after each round participants are informed of the number of items still in the auction and without feedback, after each round participants have no information about the aggregate supply. Under LAB, winning bidders receive the amount of the highest successful bid and under the FRB the winning bidders receive the lowest unsuccessful bid. Based on the theoretical predictions of the alternative auction designs, it was decided to run three treatments. First treatment considers LAB with feedback; second treatment studies LAB without feedback; third treatment investigates FRB without feedback. Theoretical predictions of the game showed that under FRB, the alternative feedback policies are indifferent to the auction outcome. Preliminary results indicate that LAB with feedback and FRB without feedback achieve on average higher clearing prices in comparison to the LAB treatment without feedback. However, the clearing prices under LAB with feedback and FRB without feedback are on average lower compared to the theoretical predictions. Although under LAB without feedback theory predicts the clearing price will drop to the competitive equilibrium, experimental results indicate that participants could still engage in cooperative behavior and drive up the price of the auction. It is showed, both theoretically and experimentally, that the pricing rules and the feedback policy, affect the bidding competitiveness of the auction by providing opportunities to participants to engage in cooperative behavior and exercise market power. LAB without feedback seems to be less vulnerable to market power opportunities compared to the alternative auction designs. This could be an argument for the use of LAB pricing rule in combination with limited feedback in the UK capacity market in an attempt to improve affordability for consumers.

Keywords: descending clock auctions, experiments, feedback policy, market design, multi-unit auctions, pricing rules, procurement auctions

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Authors: Ravi P. Agrahari

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The present study was undertaken with the objective of evaluating kitchen waste as an alternative organic material for biogas production in community level biogas plant. The field study was carried out for one month (January 19, 2012– February 17, 2012) at Centre for Energy Studies, IIT Delhi, New Delhi, India. This study involves the uses of greenhouse canopy to increase the temperature for the production of biogas in winter period. In continuation, a semi-continuous study was conducted for one month with the retention time of 30 days under batch system. The gas generated from the biogas plant was utilized for cooking (burner) and lighting (lamp) purposes. Gas productions in the winter season registered lower than other months. It can be concluded that the solar greenhouse assisted biogas plant can be efficiently adopted in colder region or in winter season because temperature plays a major role in biogas production. 

Keywords: biogas, green house chamber, organic material, solar intensity, batch system

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Authors: R. S. Mehta, G. N. Mandal

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Hepatitis-B is the major infectious disease of mankind. In Nepal it is reported that more than 4.3% of Nepalese population at any time in their life has been infected with Hepatitis-B virus (HBV). The objective of this study was to evaluate the effectiveness of planned educational programme regarding knowledge and practice of hepatitis-B among the nurses working at medical units of BPKIHS. Pre-experimental research design was used to conduct the study among the nurses working in medical units of BPKIHS. Total 40 nurses were included in the pre-test and 34 in the post-test. The education intervention was arranged on 24th May 2012 from 2:15 pm to 4:45 pm i.e. two and half hours. After two weeks of education intervention post-test was conducted. Most of the participants (60%) were of the age group of 18-22 years, Hindu (82.5%), and unmarried (65%). After education intervention there is significant differences in knowledge on the components of Hepatitis-B at 0.05 level of significance. There is no difference in the attitude components after post-test except the component patient contaminated with Hepatitis-B must be called as the last patient (p=0.035). It can conclude that hepatitis-B educational program improved knowledge and practice among the nurses.

Keywords: educational program, Hepatitis-B, pre-experimental design, medical units

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Authors: Carl Ashworth, Matthys Campher

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Spinal anaesthesia has been identified as the “gold standard” for primary elective total hip and knee arthroplasty, which is most commonly performed using longer-acting local anaesthetics, such as hyperbaric bupivacaine, to prolong the duration of anaesthesia and analgesia suitable for these procedures. Ketamine is known to have local anaesthetic effects with potent analgesic properties and has been evaluated as a sole anaesthetic agent via intrathecal administration; however, the use of intrathecal ketamine as an adjunct to intrathecal hyperbaric bupivacaine, morphine, and fentanyl has not been extensively studied. The objective of this study was to identify the potential analgesic effects of the addition of intrathecal ketamine to spinal anaesthesia and to compare the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine. The medical records of patients who underwent elective hip- or knee arthroplasty under spinal anaesthesia performed by an individual anaesthetist with either intrathecal hyperbaric bupivacaine, morphine and fentanyl or intrathecal hyperbaric bupivacaine, morphine, fentanyl and ketamine between June 4, 2020, and June 4, 2022, were retrospectively reviewed. These encounters were reviewed and analyzed from a perioperative pain perspective, with the primary outcome measure as the oral morphine equivalent (OME) usage in the 48 hours post-spinal anaesthesia, and secondary outcome measures including time to breakthrough analgesia, self-reported pain scores at rest and during movement at 24 and 48 hours after surgery, adverse effects of analgesia, complications, and length of stay. There were 26 patients identified who underwent TKR between June 4, 2020, and June 4, 2022, and 25 patients who underwent THR with the same conditions. It was identified that patients who underwent traditional spinal anaesthesia with the addition of ketamine for elective hip- or knee arthroplasty had a lower mean total OME in the 48 hours immediately post-spinal anaesthesia yet had a shorter time to breakthrough analgesia administration. The proposed mechanism of action for intrathecal ketamine as an additive to traditional spinal anaesthesia for elective hip- or knee arthroplasty is that it may prolong and attenuate the analgesic effect of traditional spinal anaesthesia. There were no significant differences identified in comparing the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine.

Keywords: anaesthesia, spinal, intra-thecal, ketamine, spinal-morphine, bupivacaine

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Authors: Narottam Puri, Bishnu Panigrahi, Narayan Pendse

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Background: Clinical Outcomes are the globally agreed upon, evidence-based measurable changes in health or quality of life resulting from the patient care. Reporting of outcomes and its continuous monitoring provides an opportunity for both assessing and improving the quality of patient care. In 2012, International Consortium Of HealthCare Outcome Measurement (ICHOM) was founded which has defined global Standard Sets for measuring the outcome of various treatments. Method: Monitoring of Clinical Outcomes was identified as a pillar of Fortis’ core value of Patient Centricity. The project was started as an in-house developed Clinical Outcomes Reporting Portal by the Fortis Medical IT team. Standard sets of Outcome measurement developed by ICHOM were used. A pilot was run at Fortis Escorts Heart Institute from Aug’13 – Dec’13.Starting Jan’14, it was implemented across 11 hospitals of the group. The scope was hospital-wide and major clinical specialties: Cardiac Sciences, Orthopedics & Joint Replacement were covered. The internally developed portal had its limitations of report generation and also capturing of Patient related outcomes was restricted. A year later, the company provisioned for an ICHOM Certified Software product which could provide a platform for data capturing and reporting to ensure compliance with all ICHOM requirements. Post a year of the launch of the software; Fortis Healthcare has become the 1st Healthcare Provider in Asia to publish Clinical Outcomes data for the Coronary Artery Disease Standard Set comprising of Coronary Artery Bypass Graft and Percutaneous Coronary Interventions) in the public domain. (Jan 2016). Results: This project has helped in firmly establishing a culture of monitoring and reporting Clinical Outcomes across Fortis Hospitals. Given the diverse nature of the healthcare delivery model at Fortis Network, which comprises of hospitals of varying size and specialty-mix and practically covering the entire span of the country, standardization of data collection and reporting methodology is a huge achievement in itself. 95% case reporting was achieved with more than 90% data completion at the end of Phase 1 (March 2016). Post implementation the group now has one year of data from its own hospitals. This has helped identify the gaps and plan towards ways to bridge them and also establish internal benchmarks for continual improvement. Besides the value created for the group includes: 1. Entire Fortis community has been sensitized on the importance of Clinical Outcomes monitoring for patient centric care. Initial skepticism and cynicism has been countered by effective stakeholder engagement and automation of processes. 2. Measuring quality is the first step in improving quality. Data analysis has helped compare clinical results with best-in-class hospitals and identify improvement opportunities. 3. Clinical fraternity is extremely pleased to be part of this initiative and has taken ownership of the project. Conclusion: Fortis Healthcare is the pioneer in the monitoring of Clinical Outcomes. Implementation of ICHOM standards has helped Fortis Clinical Excellence Program in improving patient engagement and strengthening its commitment to its core value of Patient Centricity. Validation and certification of the Clinical Outcomes data by an ICHOM Certified Supplier adds confidence to its claim of being leaders in this space.

Keywords: clinical outcomes, healthcare delivery, patient centricity, ICHOM

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Authors: Revaz Gvelesiani

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Nowadays, social inequality increasingly strengthens the trend from business entrepreneurship to social entrepreneurship. It can be said that business entrepreneurs, according to their interests, move towards social entrepreneurship. Effectively operating markets create mechanisms, which lead to 'good' behavior. This is the most important feature of the rationally functioning society. As for the prospects of social entrepreneurship, expansion of entrepreneurship concept at the social arena may lead to such an outcome, when people who are skeptical about business, become more open towards entrepreneurship as a type of activity. This is the way which by means of increased participation in entrepreneurship promotes fair distribution of wealth. Today 'entrepreneurship for all' is still a dream, although the one, which may come true.

Keywords: social entrepreneurship, business entrepreneurship, functions of entrepreneurship, social inequality, social interests, interest groups, interest conflicts

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Authors: Chalise Kiran

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The learning difficulties of children with disabilities are always a matter of concern when we talk about educational needs and quality education of children with disabilities. This paper is the outcome of the review of the literatures based on the literatures on the educational needs and learning difficulties of children with disabilities. For the paper, different studies written on children with disabilities and their education were collected through search engines. The literature put together was analyzed from the angle of learning difficulties faced by children with disabilities and the same were used as a precursor to arrive at the findings on the learning of the children. The analysis showed that children with disabilities face learning difficulties. The reasons for these difficulties could be attributed to factors in terms of authority, structure, school environment, and behaviors of teachers and parents, and the society as a whole.

Keywords: children with disabilities, learning difficulties, education, disabled children

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Authors: Malgorzata Bartoszewicz, Grzegorz Krzysko

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Chemistry students plan a career path based on their interests, predispositions, and preferences. This study aims to determine what percentage of all chemistry students selected teaching as a career. There is a lack of science teachers (especially physics and chemistry) in Poland, and there is limited research on students' choices and professional preferences. At the Faculty of Chemistry of the Adam Mickiewicz University in the academic year 2019/2020, changes were introduced to the study program resulting from legal regulations and as part of the funds raised from the project "Teacher - competent practitioner, supervisor, expert", No. POWR.03.01.00-00-KN40/18. The aim of the study was to determine how many first-cycle and second-cycle studies students declare the teaching profession as a career. In the case of first-cycle studies students, 9.5% of respondents choose the teaching profession and 9.2% of second-cycle studies students. It was found that the number of students who chose the teacher preparation programme at Faculty of Chemistry of the Adam Mickiewicz University has decreased since 5 years.

Keywords: faculty of chemistry, Adam Mickiewicz University, professional ambitions, students, teacher

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Authors: Sara Ataei, Molouk Hadjibabaie, Amirhossein Moslehi, Maryam Taghizadeh-Ghehi, Asieh Ashouri, Elham Amini, Kheirollah Gholami, Alireza Hayatshahi, Mohammad Vaezi, Ardeshir Ghavamzadeh

Abstract:

Acute kidney injury (AKI) is one of the complications of hematopoietic stem cell transplantation and is associated with increased mortality. N-acetylcysteine (NAC) is a thiol compound with antioxidant and vasodilatory properties that has been investigated for the prevention of AKI in several clinical settings. In the present study, we evaluated the effects of intravenous NAC on the prevention of AKI in allogeneic hematopoietic stem cell transplantation patients. A double-blind randomized placebo-controlled trial was conducted, and 80 patients were recruited to receive 100 mg/kg/day NAC or placebo as intermittent intravenous infusion from day -6 to day +15. AKI was determined on the basis of the Risk-Injury-Failure-Loss-Endstage renal disease and AKI Network criteria as the primary outcome. We assessed urine neutrophil gelatinase-associated lipocalin (uNGAL) on days -6, -3, +3, +9, and +15 as the secondary outcome. Moreover, transplant-related outcomes and NAC adverse reactions were evaluated during the study period. Statistical analysis was performed using appropriate parametric and non-parametric methods including Kaplan–Meier for AKI and generalized estimating equation for uNGAL. At the end of the trial, data from 72 patients were analyzed (NAC: 33 patients and placebo: 39 patients). Participants of each group were not different considering baseline characteristics. AKI was observed in 18% of NAC recipients and 15% of placebo group patients, and the occurrence pattern was not significantly different (p = 0.73). Moreover, no significant difference was observed between groups for uNGAL measures (p = 0.10). Transplant-related outcomes were similar for both groups, and all patients had successful engraftment. Three patients did not tolerate NAC because of abdominal pain, shortness of breath and rash with pruritus and were dropped from the intervention group before transplantation. However, the frequency of adverse reactions was not significantly different between groups. In conclusion, our findings could not show any clinical benefits from high-dose NAC particularly for AKI prevention in allogeneic hematopoietic stem cell transplantation patients.

Keywords: acute kidney injury, N-acetylcysteine, hematopoietic stem cell transplantation, urine neutrophil gelatinase-associated lipocalin, randomized controlled trial

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Authors: Vignesh Pechiappan Ayyathurai, Mukesh Limbachiya, Hsein Kew

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There is a growing interest in using recycled, secondary use and industrial by product materials in high value commercial applications. Potential high volume applications include use of fine aggregate in flowable fill or as a component in manufactured aggregates. However, there is much scientific, as well as applied research needed in this area due to lack to availability of data on the mechanical and environmental properties of elements or products produced using fine recycled aggregates. The principle objectives of this research are to synthesize existing data on the beneficial reuse of fine recycled materials and to develop extensive testing programme for assessing and establishing engineering and long term durability properties of concrete and other construction products produced using such material for use in practical application widely. This paper is a research proposal for PhD admission. The proposed research aims to supply the necessary technical, as well as practical information on fine recycled aggregate concrete to the construction industry for promoting its wider use within the construction industry. Furthermore, to disseminate research outcomes to the local authorities for consideration of use of fine recycled aggregate concrete in various applications.

Keywords: FRA, fine aggregate, recycling, concrete

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Authors: Saira Soroya, Khalid Mahmood

Abstract:

Library catalogs open the door to the library collection. OPAC (Online Public Access Catalog) are one of the services offered by automated libraries. The present study aims to explore user’s awareness, the level of use and their searching behavior of OPAC with a purpose to give suggestions and ways to improve user-friendly features of library OPAC. The population consisted of OPAC users of Lahore University of Management Sciences (LUMS). Convenient sampling technique was carried out. Total sample size was 100 OPAC users. Quantitative research design, based on survey method used to carry out the study. The data collection instrument was adopted. Data was analyzed using SPSS. Results revealed that a considerable number of users were not aware of OPAC i.e. (30%); however, those who were aware were using basic features of the OPAC. It was found that lack of knowledge was considered the frequent reason for not using all features of OPAC. In this regard, it is strongly recommended that compulsory information literacy programme should be established.

Keywords: catalog, OPAC, library automation, usability study, university library

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Authors: A. S. V Polgampala, F. Huang

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This is an overview of what is entailed in an evaluation and issues to be aware of when class observation is being done. This study examined the effects of evaluating teaching practice of a 7-day ‘block teaching’ session in a pre -service science teacher training program at a reputed National College of Education in Sri Lanka. Effects were assessed in three areas: evaluation of the training process, evaluation of the training impact, and evaluation of the training procedure. Data for this study were collected by class observation of 18 teachers during 9th February to 16th of 2017. Prospective teachers of science teaching, the participants of the study were evaluated based on newly introduced format by the NIE. The data collected was analyzed qualitatively using the Miles and Huberman procedure for analyzing qualitative data: data reduction, data display and conclusion drawing/verification. It was observed that the trainees showed their confidence in teaching those competencies and skills. Teacher educators’ dissatisfaction has been a great impact on evaluation process.

Keywords: evaluation, perceptions & perspectives, pre-service, science teachering

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Authors: Wei-Po Wu, Wen-Yu Liu, Wei−Ting Lin, Hen-Yu Lien

Abstract:

Introduction: Improving balance function for individuals after stroke is a crucial target in physiotherapy. Aquatic therapy which challenges individual’s postural control in an unstable fluid environment may be beneficial in enhancing balance functions. The purposes of the systematic review with meta-analyses were to validate the effects of aquatic therapy in improving balance functions for individuals with strokes in contrast to conventional physiotherapy. Method: Available studies were explored from three electronic databases: PubMed, Scopus, and Web of Science. During literature search, the published date of studies was not limited. The study design of the included studies should be randomized controlled trials (RCTs) and the studies should contain at least one outcome measurement of balance function. The PEDro scale was adopted to assess the quality of included studies, while the 'Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence' was used to evaluate the level of evidence. After the data extraction, studies with same outcome measures were pooled together for meta-analysis. Result: Ten studies with 282 participants were included in analyses. The research qualities of the studies were ranged from fair to good (4 to 8 points). Levels of evidence of the included studies were graded as level 2 and 3. Finally, scores of Berg Balance Scale (BBS), Eye closed force plate center of pressure velocity (anterior-posterior, medial-lateral axis) and Timed up and Go test were pooled and analyzed separately. The pooled results shown improvement in balance function (BBS mean difference (MD): 1.39 points; 95% confidence interval (CI): 0.05-2.29; p=0.002) (Eye closed force plate center of pressure velocity (anterior-posterior axis) MD: 1.39 mm/s; 95% confidence interval (CI): 0.93-1.86; p<0.001) (Eye closed force plate center of pressure velocity (medial-lateral) MD: 1.48 mm/s; 95% confidence interval (CI): 0.15-2.82; p=0.03) and mobility (MD: 0.9 seconds; 95% CI: 0.07-1.73; p=0.03) of stroke individuals after aquatic therapy compared to conventional therapy. Although there were significant differences between two treatment groups, the differences in improvement were relatively small. Conclusion: The aquatic therapy improved general balance function and mobility in the individuals with stroke better than conventional physiotherapy.

Keywords: aquatic therapy, balance function, meta-analysis, stroke, systematic review

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Authors: Johnson C. Y. Pang, Bo Peng, Kara K. L. Reeves, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding is potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26 ± 5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms, and quality of life (QOL), were analyzed by repeated measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: ultrasound-guided dry needling, dry needling, knee osteoarthritis, physiotheraphy

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Authors: B. E. Weber, N. Vrielink, M. G. Rietbergen

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This paper explores the long-term effects of the Energy Box trajectory on households in the private rental sector, specifically households experiencing energy poverty. The concept of energy poverty has been getting increasing attention among policymakers over the past few years. In the Netherlands, as far as we know, there are no national policies on alleviating energy poverty, which negatively impacts energy-poor households. The Energy Box can help households experiencing energy poverty by stimulating them to improve the energy efficiency of their home by changing their energy-saving behavior. Important long-term effects are that respondents indicate that they live in a more environmentally friendly way and that they save money on their energy bills. Households feel engaged with the concept of energy-saving and can see the benefits of changing their energy-saving behavior. Respondents perceived the Energy Box as a means to live more environmentally friendly, instead of it solely being a means to save money on energy bills. The findings show that most respondents signed up for the Energy Box are interested in energy-saving as a lifestyle choice instead of a financial choice, which would likely be the case for households experiencing energy poverty.

Keywords: energy-saving behavior, energy poverty, poverty, private rental sector

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Authors: Olivera Lupescu, Taina Elena Avramescu, Mihail Nagea, Alexandru Dimitriu

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Acetabular fractures represent a real challenge due to their impact upon the long term function of the hip joint, and due to the risk of intra- and peri-operative complications especially that they affect young, active people. That is why treating these fractures require certain skills which must be exercised, regarding the pre-operative planning, as well as the execution of surgery.The authors retrospectively analyse 38 cases with acetabular fractures operated using the posterior approach in our hospital between 01.01.2013- 01.01.2015 for which complete medical records ensure a follow-up of 24 months, in order to establish the main causes of potential errors and to underline the methods for preventing them. This target is included in the Erasmus + project ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery COR-skills’. This paper analyses the pitfalls revealed by these cases, as well as the measures necessary to enhance the practical skills of the surgeons who perform acetabular surgery. Pre-op planning matched the intra and post-operative outcome in 88% of the analyzed points, from 72% at the beginning to 94% in the last case, meaning that experience is very important in treating this injury. The main problems detected for the posterior approach were: nervous complications - 3 cases, 1 of them a complete paralysis of the sciatic nerve, which recovered 6 months after surgery, and in other 2 cases intra-articular position of the screws was demonstrated by post-operative CT scans, so secondary screw removal was necessary in these cases. We analysed this incident, too, due to lack of information about the relationship between the screws and the joint secondary to this approach. Septic complications appeared in 3 cases, 2 superficial and 1 profound (requiring implant removal). The most important problems were the reduction of the fractures and the positioning of the screws so as not to interfere with the the articular space. In posterior acetabular fractures, pre-op complex planning is important in order to achieve maximum treatment efficacy with minimum of risk; an optimal training of the surgeons insisting on the main points of potential mistakes ensure the success of the procedure, as well as a favorable outcome for the patient.

Keywords: acetabular fractures, articular congruency, surgical skills, vocational training

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Authors: Camila Lemos Pinto, Juliana Alves Carneiro, Patrícia Borges Botelho, João Felipe Mota

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Sarcopenia, a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, currently affects over 50 million people and increases the risk of adverse outcomes such as physical disability, poor quality of life and death. The aim of this study was to examine the efficacy of creatine supplementation associated with resistance training on muscle mass in the elderly. A 12-week, double blind, randomized, parallel group, placebo controlled trial was conducted. Participants were randomly allocated into one of the following groups: placebo with resistance training (PL+RT, n=14) and creatine supplementation with resistance training (CR + RT, n=13). The subjects from CR+RT group received 5 g/day of creatine monohydrate and the subjects from the PL+RT group were given the same dose of maltodextrin. Participants were instructed to ingest the supplement on non-training days immediately after lunch and on training days immediately after resistance training sessions dissolved in a beverage comprising 100 g of maltodextrin lemon flavored. Participants of both groups undertook a supervised exercise training program for 12 weeks (3 times per week). The subjects were assessed at baseline and after 12 weeks. The primary outcome was muscle mass, assessed by dual energy X-ray absorptiometry (DXA). The secondary outcome included diagnose participants with one of the three stages of sarcopenia (presarcopenia, sarcopenia and severe sarcopenia) by skeletal muscle mass index (SMI), handgrip strength and gait speed. CR+RT group had a significant increase in SMI and muscle (p<0.0001), a significant decrease in android and gynoid fat (p = 0.028 and p=0.035, respectively) and a tendency of decreasing in body fat (p=0.053) after the intervention. PL+RT only had a significant increase in SMI (p=0.007). The main finding of this clinical trial indicated that creatine supplementation combined with resistance training was capable of increasing muscle mass in our elderly cohort (p=0.02). In addition, the number of subjects diagnosed with one of the three stages of sarcopenia at baseline decreased in the creatine supplemented group in comparison with the placebo group (CR+RT, n=-3; PL+RT, n=0). In summary, 12 weeks of creatine supplementation associated with resistance training resulted in increases in muscle mass. This is the first research with elderly of both sexes that show the same increase in muscle mass with a minor quantity of creatine supplementation in a short period. Future long-term research should investigate the effects of these interventions in sarcopenic elderly.

Keywords: creatine, dietetic supplement, elderly, resistance training

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Authors: Ruwan Gunawardane

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Second language teaching and learning is a complex process in which various factors are identified as having a negative impact on the competency in English among undergraduates of Sri Lanka. One such issue is the lack of intrinsic motivation among them to learn English despite the fact that they all know the importance of English. This study attempted to ascertain how the intrinsic motivation of undergraduates to learn English can be improved through reading out of curiosity. Humans are curious by nature, and cognitive psychology says that curiosity facilitates learning, memory, and motivation. The researcher carried out this study during the closure of universities due to the outbreak of the coronavirus through ‘Online Reading Café’, an online reading programme introduced by himself. He invited 1166 students of the Faculty of Science, University of Ruhuna, to read 50 articles taken from CNN and the BBC and posted at least two to three articles on the LMS of the faculty almost every day over a period of 23 days. The themes of the articles were based on the universe, exploration of planets, scientific experiments, evolution, etc., and the students were encouraged to collect as many words, phrases, and sentence structures as possible while reading and to form meaningful sentences using them. The data obtained through the students’ feedback was qualitatively analyzed. It was found that these undergraduates were interested in reading something out of curiosity, due to which intrinsic motivation is enhanced, and it facilitates competence in L2.

Keywords: English, competence, reading, curiosity

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