Search results for: organisational outcomes

Authors: Helen Johnson-Egemba

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This paper will discuss the current effectiveness of music therapy for a range of conditions, such as depression and anxiety. Indeed, traditional forms of therapy have often been effective in treating various mental and physical health conditions. However, they are not with their limitations. Music therapy, on the other hand, is a non-invasive and cost-effective alternative that can produce similar or even better results. Music therapy can produce longer-lasting results. The research also highlights the underlying mechanisms of traditional music therapy, such as its complementary treatment. A systematic review of existing literature was conducted to gather relevant studies and establish a comprehensive understanding of the topic. Various research methods, including experimental studies, qualitative research, surveys, were utilized to explore the therapeutic potential of traditional music interventions. The findings reveal that traditional music therapy shows promise in managing anxiety and depression symptoms, with positive outcomes impacting brain activity, emotions, and stress regulation. The outcomes of this study contribute to evidence-based practice, providing insights for clinicians and therapists to incorporate traditional music therapy into their treatment approaches. Furthermore, the research promotes awareness and acceptance of traditional music as a legitimate and effective therapeutic intervention for anxiety and depression, potentially enhancing access to alternative and complementary treatment options. Overall, this study demonstrates the potential benefits of traditional music therapy in addressing anxiety and depression, offering valuable implications for mental health care and improving the well-being of individuals struggling with these conditions.

Keywords: anxiety, effectiveness, depression, traditional music, therapy, treatment

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Authors: Monika Szpringer, Mariola Wojciechowska, Robert Dutkiewicz, Grażyna Nowak-Starz, Marzena Olędzka

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The main aim of this article is to determine the phenomenon of stress among academic teachers as well as to identify the extent to which the teachers experience work-related psychological risks. It is also important to support academic teachers trade unions in scope of stress-oriented activities, including psychological dangers in the assessment of risk in the workplace (college). The authors used a method of a diagnostic survey with a polling as a technique and authors’ questionnaire as a tool. The survey was conducted between September and December of 2013 and it comprised 1890 academic teachers from five voivodeships. The study reveals that 84.0% of the respondents found the work of an academic teacher to be borne with a considerable stress. The percentage values of the most frequent causes of stress are as follows: frequent changes of both organisational and didactic matters as well as overwhelming bureaucracy (77.8 %), time pressure regarding professional development and related risk of losing job (68.2 %), difficult working conditions (45.4%), conflicts and rivalry between teachers (44.1%), excessive amount of duties as well as increasing requirements and demanding attitude of students (33.7%). Work-related stress affects or significantly affects the private life of 69 % and 66.4 % of the respondents respectively. The majority of the people surveyed deals with stress by undertaking various activities, with 40% pointing at using various substances, mostly cigarettes and alcohol (p > 0,05) Physical ailments were experienced by 81% of the respondents, in 9% they were rare and 8 % of the respondents had never experienced such disorders. The entire group of the surveyed people (100 %) claimed that they have no possibility of contacting a psychologist at their workplace (p > 0.05), and they stated that the need of contacting specialists does exist.

Keywords: stress, academic teachers, psychological risks, work-related

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Authors: Bernard Ewuoso

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Introduction: Induction of labor (IOL) usually involves the patient moving between antenatal, labor, and postnatal wards. Delay in IOL has been defined as delay in the time it takes a woman to wait for induction after her cervix is assessed to be favorable. Opinions vary on the acceptable time the patient is allowed to wait for once the cervix is adjudged ripe for induction. What has been considered a benchmark is a delay of up to 12 hours. There is evidence that delay in IOL is associated with adverse outcomes. Aim: To determine the number of women experiencing delay in induction of labor and their outcomes. Method: This audit was retrospective and observational. It included women who had induction of labor in the month of October 2023 in two hospitals. Clinical data was collected from electronic medical records into an Excel sheet for analysis. Women had cervical ripening as inpatient or outpatient. The primary objective was to determine the number of women experiencing delay in induction of labor, while the secondary objective was to outcome these women. Result: 136 women had IOL. The least percentage of data retrieved for any parameter was 80%. The mean gestational age at IOL was 278.26 days. The mean waiting time was 905.34mins. Seventy-five women had their IOL at the Royal Infirmary of Edinburgh (RIE), fifty-seven at St. John’s Hospital (SJH), and three women were transferred from RIE to SJH. The preferred method of cervical ripening was balloon closely followed by prostaglandin. Twenty-seven women did not require cervical ripening and had their process started with amniotomy. Prostaglandin was the method of choice of cervical ripening at RIE, while balloon was preferred in SJH. Of the thirty-five women found to be suitable for outpatient cervical ripening, thirteen had outpatient ripening. There was a significant increase in the number of women undergoing outpatient cervical ripening at RIE from 10.5% in April 2022 to 42.9%. The preferred method for outpatient cervical ripening at the RIE was balloon, while it was prostaglandin for SJH. These were contradictory to the preferred method of inpatient cervical ripening at both centers. The average waiting time for IOL at RIE, 1166.92mins, is more than double that of SJH, 442.93mins, and far exceed 12hours, which is the proposed benchmark. The waiting time tends to be shorter with prostaglandin. Out of the women that had outpatient cervical ripening 63.6% had to wait for more than 12hrs before being induced while it was 36.1% for women that had inpatient cervical ripening. Overall, 38.5% women waited for more than 12 hours before having their induction. A lesser proportion of the women who waited for more than 12 hours had caesarean section, assisted vaginal delivery, and postpartum hemorrhage, whereas a greater proportion had spontaneous vaginal delivery and intrapartum or postpartum infection. Conclusion: A significant number of the women included in the study experienced delay in their induction process, and this was associated with an increased occurrence of intrapartum or postpartum infection. Outpatient cervical ripening contributed to delay.

Keywords: delay in induction of labor, inpatient, outpatient, intrapartum, postpartum, infection

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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Authors: Iliana Georganta, Clare Deehan, Marysia Thomson, Miriam McDonald, Kerrie McNulty, Anna Strachan, Elizabeth Anderson, Alyaa Mostafa

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Context: A meta-analysis of randomized controlled trials (RCTs) comparing hysterectomy versus endometrial ablation and resection in the management of heavy menstrual bleeding. Objective: To evaluate the clinical efficacy, satisfaction rates and adverse events of hysterectomy compared to more minimally invasive techniques in the treatment of HMB. Evidence Acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing hysterectomy with either endometrial ablation endometrial resection of both. The search had no language restrictions and was last updated in June 2020 using MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, PubMed, Google Scholar, PsycINFO, Clinicaltrials.gov and Clinical trials. EU. In addition, a manual search of the abstract databases of the European Haemophilia Conference on women's health was performed and further studies were identified from references of acquired papers. The primary outcomes were patient-reported and objective reduction in heavy menstrual bleeding up to 2 years and after 2 years. Secondary outcomes included satisfaction rates, pain, adverse events short and long term, quality of life and sexual function, further surgery, duration of surgery and hospital stay and time to return to work and normal activities. Data were analysed using RevMan software. Evidence synthesis: 12 studies and a total of 2028 women were included (hysterectomy: n = 977 women vs endometrial ablation or resection: n = 1051 women). Hysterectomy was compared with endometrial ablation only in five studies (Lin, Dickersin, Sesti, Jain, Cooper) and endometrial resection only in five studies (Gannon, Schulpher, O’Connor, Crosignani, Zupi) and a mixture of the Ablation and Resection in two studies (Elmantwe, Pinion). Of the 1² studies, 10 reported women’s perception of bleeding symptoms as improved. Meta-analysis showed that women in the hysterectomy group were more likely to show improvement in bleeding symptoms when compared with endometrial ablation or resection up to 2-year follow-up (RR 0.75, 95% CI 0.71 to 0.79, I² = 95%). Objective outcomes of improvement in bleeding also favored hysterectomy. Patient satisfaction was higher after hysterectomy within the 2 years follow-up (RR: 0.90, 95%CI: 0.86 to 0.94, I²:58%), however, there was no significant difference between the two groups at more than 2 years follow up. Sepsis (RR: 0.03, 95% CI 0.002 to 0.56; 1 study), wound infection (RR: 0.05, 95% CI: 0.01 to 0.28, I²: 0%, 3 studies) and Urinary tract infection (UTI) (RR: 0.20, 95% CI: 0.10 to 0.42, I²: 0%, 4 studies) all favoured hysteroscopic techniques. Fluid overload (RR: 7.80, 95% CI: 2.16 to 28.16, I² :0%, 4 studies) and perforation (RR: 5.42, 95% CI: 1.25 to 23.45, I²: 0%, 4 studies) however favoured hysterectomy in the short term. Conclusions: This meta-analysis has demonstrated that endometrial ablation and endometrial resection are both viable options when compared with hysterectomy for the treatment of heavy menstrual bleeding. Hysteroscopic procedures had better outcomes in the short term with fewer adverse events including wound infection, UTI and sepsis. The hysterectomy performed better when measuring more long-term impacts such as recurrence of symptoms, overall satisfaction at two years and the need for further treatment or surgery.

Keywords: menorrhagia, hysterectomy, ablation, resection

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Authors: Robinson, E. L., Freeman, E. E.

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Over the last few decades, the social movement of involved fatherhood has stimulated a research focus on fathers, leading to an increase in the body of evidence into the paternal contributions to child development. Past research has suggested that rough-and-tumble play, which involves wrestling, chasing and tumbling, is the preferred play type of western fathers. This type of play remains underutilized and underrepresented in child developmental research as it’s perceived to be dangerous or too aggressive. The limited research available has shown a relationship between high quality rough-and-tumble play interactions, lower childhood aggression and improved child emotional regulation. The aim of this study was to examine father-child rough-and-tumble play and assess the impact on cognitive development in children aged 4-7 years. Father-child dyads completed a 10-minute rough-and-tumble play interaction, which consisted of 2 games, at the University of Newcastle. Children then completed the Wechsler Preschool & Primary Scale of Intelligence - Fourth Edition Australian and New Zealand Standardized Edition (WPPSI-IV A&NZ). Fathers reported on their involvement in various caregiving activities and on their child’s development. Analyses revealed that fathers-child play quality was positively related to working memory outcomes in children. Furthermore, the amount of rough-and-tumble play father and child did together on a regular basis was also related to working memory outcomes. While father-child play interactions remain an understudied area of research, this study outlines the importance of examining the paternal play role in children’s cognitive development.

Keywords: children, development, father, executive function

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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Background: Medical knowledge continuously evolves and to help health care providers to stay up-to-date, evidence-based medicine (EBM) has emerged as a model. The practice of EBM requires new skills of the health care provider, including directed literature searches, the critical evaluation of research studies, and the direct application of the findings to patient care. This paper describes the integration and evaluation of an evidence-based medicine course sequence into a Physician Assistant curriculum. This course sequence teaches students to manage and use the best clinical research evidence to competently practice medicine. A survey was developed to assess the outcomes of the EBM course sequence. Methodology: The cornerstone of the three-semester sequence of EBM are interactive small group discussions that are designed to introduce students to the most clinically applicable skills to identify, manage and use the best clinical research evidence to improve the health of their patients. During the three-semester sequence, the students are assigned each semester to participate in small group discussions that are facilitated by faculty with varying background and expertise. Prior to the start of the first EBM course in the winter semester, PA students complete a knowledge-based survey that was developed by the authors to assess the effectiveness of the course series. The survey consists of 53 Likert scale questions that address the nine objectives for the course series. At the end of the three semester course series, the same survey was given to all students in the program and the results from before, and after the sequence of EBM courses are compared. Specific attention is paid to overall performance of students in the nine course objectives. Results: We find that students from the Class of 2016 and 2017 consistently improve (as measured by percent correct responses on the survey tool) after the EBM course series (Class of 2016: Pre- 62% Post- 75%; Class of 2017: Pre- 61 % Post-70%). The biggest increase in knowledge was observed in the areas of finding and evaluating the evidence, with asking concise clinical questions (Class of 2016: Pre- 61% Post- 81%; Class of 2017: Pre- 61 % Post-75%) and searching the medical database (Class of 2016: Pre- 24% Post- 65%; Class of 2017: Pre- 35 % Post-66 %). Questions requiring students to analyze, evaluate and report on the available clinical evidence regarding diagnosis showed improvement, but to a lesser extend (Class of 2016: Pre- 56% Post- 77%; Class of 2017: Pre- 56 % Post-61%). Conclusions: Outcomes identified that students did gain skills which will allow them to apply EBM principles. In addition, the outcomes of the knowledge-based survey allowed the faculty to focus on areas needing improvement, specifically the translation of best evidence into patient care. To address this area, the clinical faculty developed case scenarios that were incorporated into the lecture and discussion sessions, allowing students to better connect the research studies with patient care. Students commented that ‘class discussion and case examples’ contributed most to their learning and that ‘it was helpful to learn how to develop research questions and how to analyze studies and their significance to a potential client’. As evident by the outcomes, the EBM courses achieved the goals of the course and were well received by the students. 

Keywords: evidence-based medicine, clinical education, assessment tool, physician assistant

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Authors: Zena Ebrahim, Susan Woodhouse

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Previous research shows that mothers’ experiences of trauma are linked to their child’s later socioemotional functioning. However, the mechanisms involved are not well understood. One potential mediator is maternal insensitive responses to child distress. This study examined the link between maternal trauma, mothers’ responses to toddler distress, and toddlers’ socioemotional outcomes among a socioeconomically diverse sample of 110 mothers and their 12- to 35-month-old toddlers. It was hypothesized that a mother’s difficulty in responding sensitively to her child’s distress would mediate the relations between maternal trauma and child internalizing and externalizing behaviors. Two mediational models were tested to examine non-supportive responses to distress as a potential mediator of the relation between maternal trauma and toddler mental health outcomes; one model focused on predicting child internalizing symptoms and the other focused on predicting child externalizing symptoms. Measures included assessment of maternal trauma (Life Stressor Checklist-Revised), mothers’ responses to child distress (Coping with Toddlers’ Negative Emotions Scale), and toddler socioemotional functioning (Infant-Toddler Social and Emotional Assessment). Results revealed that the relations between maternal trauma and toddler symptoms (internalizing and externalizing symptoms) were mediated by maternal non-supportive response to child distress for both internalizing and externalizing domains of child mental health. Findings suggest the importance of early intervention for trauma-exposed mothers and target areas for parenting interventions.

Keywords: trauma, parenting, child mental health, transgenerational effects of trauma

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Authors: Brooke Sweeney, David White, Felix Amparano, Nick A. Clark, Amy R. Beck, Mathew Lindquist, Lora Edwards, Julie Vandal, Jennifer Lisondra, Katie Cox, Renee Arensberg, Allen Cummins, Jazmine Cedeno, Jason D. Fraser, Kelsey Dean, Helena H. Laroche, Cristina Fernandez

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Background: National organizations call for standardized pre-surgical requirements and education to optimize postoperative outcomes. Since 2017 our surgery program has used defined protocols and educational curricula pre- and post-surgery. In response to patient outcomes, our educational content was refined to include quizzes to assess patient knowledge and surgical preparedness. We aim to optimize adolescent pre-bariatric surgery preparedness by improving overall aggregate pre-surgical assessment performance from 68% to 80% within 12 months. Methods: A multidisciplinary improvement team was developed within the weight management clinic (WMC) of our tertiary care, free-standing children’s hospital. A manual has been utilized since 2017, with limitations in consistent delivery and patient uptake of information. The curriculum has been improved to include quizzes administered during WMC visits prior to bariatric surgery. The initial outcome measure is the pre-surgical quiz score of adolescents preparing for bariatric surgery. Process measure was the number of questions answered correctly to test the questions. Baseline performance was determined by a patient assessment survey of pre-surgical preparedness at patient visits. Plan-Do-Study-Act cycles (PDSA) included: 1) creation and implementation of a refined curriculum, 2) development of 5 new quizzes based upon learning objectives, and 3) improving provider-lead teaching and quiz administration within clinic workflow. Run charts assessed impact over time. Results: A total of 346 quiz questions were administered to 34 adolescents. The outcome measure improved from a baseline mean of 68% to 86% following PDSA 2 cycles, and it was sustained. Conclusion/Implication: Patient/family comprehension of surgical preparedness improved with standardized education via team member-led teaching and assessment using quizzes during pre-surgical clinic visits. The next steps include launching redesigned teaching materials with modules correlated to quizzes and assessment of comprehension and outcomes post-surgically.

Keywords: bariatric surgery, adolescent, clinic, pre-bariatric training

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Authors: K. M. Wong

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Engineering education is crucial to technological innovation and advancement worldwide by generating young talents who are able to integrate scientific principles and design practical solutions for real-world problems. Graduates of engineering curriculums are expected to demonstrate an extensive set of learning outcomes as required in international accreditation agreements for engineering academic qualifications, such as the Washington Accord and the Sydney Accord. On the other hand, students have different learning preferences of receiving, processing and internalizing knowledge and skills. If the learning environment is advantageous to the learning styles of the students, there is a higher chance that the students can achieve the intended learning outcomes. With proper identification of the learning styles of the students, corresponding teaching strategies can then be developed for more effective learning. This research was an investigation of learning styles of tertiary students studying higher diploma programmes in Hong Kong. Data from over 200 students in engineering programmes were collected and analysed to identify the learning characteristics of students. A small-scale longitudinal study was then started to gather academic results of the students throughout their two-year engineering studies. Preliminary results suggested that the sample students were reflective, sensing, visual, and sequential learners. Observations from the analysed data not only provided valuable information for teachers to design more effective teaching strategies, but also provided data for further analysis with the students’ academic results. The results generated from the longitudinal study shed light on areas of improvement for more effective engineering curriculum design for better teaching and learning.

Keywords: learning styles, learning characteristics, engineering education, vocational education, Hong Kong

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Authors: Harini Atturu, Divyani Byagari, Bindhu Rani Thumkunta, Sahitya Bammidi, Manasa Badveli

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Introduction: Biological, psychological and social domains influence the outcomes of pregnancy. The COVID19 pandemic had a significant effect on the psychological and social domains of pregnant women all over the world. Everyone has inherent coping mechanisms which ultimately determine the actual impact of such external stimulus on outcomes of pregnancy. This study aims to understand the coping strategies used by pregnant women to overcome the psychological impact of the first wave of the COVID 19 pandemic. Methods: Institutional ethics permission was sought. All pregnant women attending antenatal clinics in the institution during September 2020 were included in the study. Brief-COPE, a self-rated questionnaire, was provided to understand the coping strategies used by them. The Questionnaire consists of 28 questions that fall into 14 themes. These 14 themes were mapped into four domains consisting of Approaching coping (APC) styles, Avoidant Coping (AVC) styles, Humor and Religion. The results were analyzed using univariate and multivariate analysis. Factor analysis was performed to identify themes that are most frequently used. Results: 162 pregnant women were included in the study. The majority of the women were aged between 18 and 30 (90.1%). 60.9% of the respondents were having their first pregnancy and were in the 2nd trimester (59.6%). The majority of them were living in the city (74%), belonged to the middle class (77.6%) and were not working (70.1%). 56 respondents (34.6%) reported that they had contact with suspected or Covid positive patients. Many were worried that their pregnancy might be complicated (43%), their baby may contract COVID (45%) and their family members could get COVID during the hospital visits for antenatal check-ups. 33.6% of women admitted missing their regular antenatal check-ups because of the above concerns. All respondents used various coping strategies to overcome the psychological impact of COVID 19. Out of the 4 coping strategies, participants scored high on Religion with a mean of 5.471.45 followed by Approaching Coping (APC) styles (5.131.25), Humor (4.592.07) and Avoidant Coping (AVC) styles (4.130.88). Religion as a coping strategy scored high for all respondents irrespective of age, parity, trimester, social and employment status. Exploratory Factor analysis revealed two cluster groups that explained 68% of the variance, with Component 1 contributing to 58.9% and component 2 contributing 9.13% of the variance. Humor, Acceptance, Planning, and Religion were the top 4 factors that showed strong loadings. Conclusion: Most of the pregnant women were worried about the negative impact of COVID 19 on the outcomes of their pregnancy. Religion and Approaching coping styles seem to be the predominant coping strategies used by them. Interventionists and policymakers should consider these factors while providing support to such women.

Keywords: coping strategies, pregnancy, COVID-19, brief-COPE

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Authors: Ben J. Lippe

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Consult Liaison Psychology services are overgrowing, given the robust empirical support of the utility of this service in hospital settings. These psychological services, including clinical assessment, applied psychotherapy, and consultation with other healthcare providers, have been shown to improve health outcomes for patients and bolster important areas of administrative interest such as decreased length of patient admission. However, there is little descriptive literature outlining the process and mechanisms of building or developing a Consult Liaison Psychology service. The main findings of this current conceptual work are intended to be clear in nature to elucidate the essential methods involved in developing consult liaison psychology programs, including thorough reviews of relevant behavioral health literature and inclusion of experiential outcomes. The diverse range of hospital settings and healthcare systems makes a “blueprint” method of program development challenging to define, yet important structural frameworks presented here based on the relevant literature and applied practice can help lay critical groundwork for program development in this growing area of psychological service. This conceptual approach addresses the prominent processes, as well as common programmatic and clinical pitfalls, involved in the event of a Consult Liaison Psychology service. This paper, including a systematic review of relevant literature, is intended to serve as a key program development reference for the development of Consult Liaison Psychology services, other related behavioral health programs, and to help inform further research efforts.

Keywords: behavioral health, consult liaison, health psychology, psychology program development

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Authors: Vasti Oelofse, Niekie van der Merwe, Dorita du Toit

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This study addresses the need for a unified best practice model for Physical Education across BRICS nations, as current research primarily offers individual country recommendations. Drawing on relevant literature within the framework of Bronfenbrenner’s Ecological Systems Theory, as well as data from open-ended questionnaires completed by Physical Education experts from the BRICS countries, , the study develops a best practice model based on identified challenges and effective practices in Physical Education. A model is proposed that incorporates flexible and resource-efficient strategies tailored to address PE challenges specific to these countries, enhancing outcomes for learners, empowering teachers, and fostering systemic collaboration among BRICS members. The proposed model comprises six key areas: “Curriculum and policy requirements”, “General approach”, “Theoretical basis”, “Strategies for presenting content”, “Teacher training”, and “Evaluation”. The “Strategies for presenting program content” area addresses both well-resourced and poorly resourced schools, adapting curriculum, teaching strategies, materials, and learner activities for varied socio-economic contexts. The model emphasizes a holistic approach to learner development, engaging environments, and continuous teacher training. A collaborative approach among BRICS countries, focusing on shared best practices and continuous improvement, is vital for the model's successful implementation, enhancing Physical Education programs and outcomes across these nations.

Keywords: BRICS countries, physical education, best practice model, ecological systems theory

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Authors: Oluwaseun Adeleke, Samuel O. Ikani, Simeon Christian Chukwu, Fidelis Edet, Anthony Nwala, Mopelola Raji, Simeon Christian Chukwu

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Background: Health service providers are offered in-service training periodically to strengthen their ability to deliver services that are ethical, quality, timely and safe. Not all capacity-building courses have successfully resulted in intended service delivery outcomes because of poor training content, design, approach, and ambiance. The Delivering Innovations in Selfcare (DISC) project developed a Moment of Truth innovation, which is a proven training model focused on improving consumer/provider interaction that leads to an increase in the voluntary uptake of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) self-injection among women who opt for injectable contraception. Methodology: Six months after training on a moment of truth (MoT) training manual, the project conducted two intensive rounds of qualitative data collection and triangulation that included provider, client, and community mobilizer interviews, facility observations, and routine program data collection. Respondents were sampled according to a convenience sampling approach, and data collected was analyzed using a codebook and Atlas-TI. Providers and clients were interviewed to understand their experience, perspective, attitude, and awareness about the DMPA-SC self-inject. Data were collected from 12 health facilities in three states – eight directly trained and four cascades trained. The research team members came together for a participatory analysis workshop to explore and interpret emergent themes. Findings: Quality-of-service delivery and performance outcomes were observed to be significantly better in facilities whose providers were trained directly trained by the DISC project than in sites that received indirect training through master trainers. Facilities that were directly trained recorded SI proportions that were twice more than in cascade-trained sites. Direct training comprised of full-day and standalone didactic and interactive sessions constructed to evoke commitment, passion and conviction as well as eliminate provider bias and misconceptions in providers by utilizing human interest stories and values clarification exercises. Sessions also created compelling arguments using evidence and national guidelines. The training also prioritized demonstration sessions, utilized job aids, particularly videos, strengthened empathetic counseling – allaying client fears and concerns about SI, trained on positioning self-inject first and side effects management. Role plays and practicum was particularly useful to enable providers to retain and internalize new knowledge. These sessions provided experiential learning and the opportunity to apply one's expertise in a supervised environment where supportive feedback is provided in real-time. Cascade Training was often a shorter and abridged form of MoT training that leveraged existing training already planned by master trainers. This training was held over a four-hour period and was less emotive, focusing more on foundational DMPA-SC knowledge such as a reorientation to DMPA-SC, comparison of DMPA-SC variants, counseling framework and skills, data reporting and commodity tracking/requisition – no facility practicums. Training on self-injection was not as robust, presumably because they were not directed at methods in the contraceptive mix that align with state/organizational sponsored objectives – in this instance, fostering LARC services. Conclusion: To achieve better performance outcomes, consideration should be given to providing training that prioritizes practice-based and emotive content. Furthermore, a firm understanding and conviction about the value training offers improve motivation and commitment to accomplish and surpass service-related performance outcomes.

Keywords: training, performance outcomes, innovation, family planning, contraception, DMPA-SC, self-care, self-injection.

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Authors: Sharma Aseem, Dhurat Rachita, Pawar Varsha, Khalse Manisha

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Introduction: Androgenetic alopecia (AGA) is a prevalent condition characterized by progressive hair thinning driven by genetic and androgen-related factors. The current FDA-approved treatments include oral finasteride and topical minoxidil, though many patients seek combination therapies to enhance results. This study aims to evaluate the effectiveness of a combination therapy involving Minoxidil, Finasteride, and Capixyl™ based on feedback from dermatologists. Methodology: A survey, validated by experts, was distributed to 29 leading dermatologists across India (in Tier 1 and 2 cities). The survey examined real-world clinical experiences, focusing on patient outcomes and the overall effectiveness of the mentioned formulation. Results: Among the surveyed dermatologists, 41.4% identified women aged 35-40 as the most frequently diagnosed with female pattern hair loss. The combination therapy with Minoxidil, Finasteride, and Capixyl™ was utilized by 34.5% of dermatologists for over 60 patients per month. The majority highlighted the benefits of this combination therapy, which acts via multiple mechanisms, such as vasodilation and dihydrotestosterone (DHT) receptor blockade, resulting in improved hair regrowth. Additionally, patients demonstrated better clinical outcomes, enhanced compliance, and fewer side effects. Demographically, younger patients, particularly those with AGA for less than 10 years, responded more positively to the treatment. Early intervention led to quicker and more significant results. Overall satisfaction among dermatologists was high, with 86.2% expressing positive feedback on the therapy. In terms of treatment outcomes, 51.7% of dermatologists observed visible results within 4-6 months, while 34.5% noticed a significant reduction in hair fall within 8-12 weeks. Improvements in scalp health were reported by 48.3%, and 51.7% saw an increased hair density within 3-4 months. Despite mild side effects such as scalp irritation, dryness, flaking, and occasional issues like folliculitis, headaches, itching, and redness, patient satisfaction remained high. Dermatologists reported that 93.1% of patients experienced faster and better hair regrowth with Capixyl™ compared to Minoxidil alone. Suggestions for improving the formulation included incorporating peptides like Saw Palmetto and enhancing product packaging to better meet patient needs. Discussion: The combination of Minoxidil, Finasteride, and Capixyl™ yielded positive clinical outcomes, especially in improving hair density, scalp health, and overall patient satisfaction. Dermatologists found that Capixyl™ peptides enhanced the therapeutic effect, promoting hair regrowth and improving compliance. While side effects were generally mild, there were suggestions to further improve the formulation by adding additional peptides like Saw Palmetto. Conclusion: The combination of Minoxidil and Finasteride fortified with Capixyl™ presents a promising therapeutic option for managing AGA. Dermatologists reported significant improvements in hair density, scalp health, and patient satisfaction. With its favorable efficacy and manageable side effects, this formulation proves to be a valuable addition to the treatment landscape for AGA.

Keywords: androgenetic alopecia, combination therapy, minoxidil, finasteride, capixyl

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Authors: Evgenia Papathanasiou, Georgios Kokkotis, Georgios Axiaris, Theodoros Argyropoulos, Nikos Viazis, Olga Giouleme, Konstantinos Gkoumas, Αnthia Gatopoulou, Αggelos Theodoulou, Georgios Theocharis, Αngeliki Theodoropoulou, Μaria Κalogirou, Pantelis Karatzas, Κonstantinos Κatsanos, Theodora Kafetzi, Κonstantinos Κarmiris, Αnastasia Κourikou, Ιoannis E Κoutroubakis, Christos Liatsos, Gerassimos J. Mantzaris, Νicoletta Μathou, Georgia Bellou, George Michalopoulos Αikaterini Μantaka, Penelope Nikolaou, Μichael Oikonomou, Dimitrios Polymeros, George Papatheodoridis, Εvdoxia Stergiou, Κonstantinos Soufleris, Εpameinondas Skouloudis, Μaria Tzouvala, Georgia Tsiolakidou, Εftychia Tsironi, Styliani Tsafaraki, Kalliopi Foteinogiannopoulou, Konstantina Chalakatevaki, Αngeliki Christidou, Dimitrios K. Christodoulou, Giorgos Bamias, Spyridon Michopoulos, Εvanthia Zampeli

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Background: Inflammatory bowel disease (IBD) commonly affects female patients of reproductive age, making the interaction between fertility, pregnancy and IBD an important issue in disease management. The effect of disease activity on the outcome of pregnancy and its impact on neonatal growth is a field of intense research. Close follow-up of pregnant IBD patients by a multidisciplinary team improves maternal and neonatal outcomes. Aim – Methods: Α national retrospective study of pregnancies in women with IBD between 2010-2020 was carried out in 22 IBD reference centers in Greece. Patient characteristics such as disease profile, type of treatment, and disease activity during gestation were analyzed in correlation to the method of delivery, pregnancy outcomes, as well as breastfeeding and offspring health. Results: Two-hundred and twenty-three pregnancies in 175 IBD patients were registered in the study. 122 with Crohn’s disease (CD). Median age during diagnosis was 25.6 years (12-44), with median disease duration of 7.4 years (0-23). One-hundred and twenty-nine patients (58%) were recorded during their first pregnancy. Early pregnancy termination was reported by 48 patients (22%). Pregnancy as a result of in vitro fertilization (IVF) occurred in 15 cases (6.7%). At the beginning of gestation, 165 patients (74%) were under treatment: 48 with anti-TNF agents (29%), 43 with azathioprine (26%), 101 with 5-aminosalicylic acid formulations (61%) and 12 with steroids (7%). We recorded 49 cases of IBD flares (22%) during pregnancy. Two-thirds of them (n=30) were in remission at the onset of the pregnancy. Almost half of them (n=22) required corticosteroid treatment. Patients with ulcerative colitis (UC) were in greater risk of disease flare during pregnancy (p<0.001). All but 3 pregnancies (99.1%) resulted in uncomplicated delivery. In 147 cases (67.1%), cesarean delivery was performed. Two late fetal deaths (0.9%) were reported, both in patients with continuously active disease since the beginning of pregnancy. After delivery, 75 patients (34%) presented with a disease flare, which was associated with active disease at the beginning of pregnancy (p <0.001). Conclusion: The majority of female, Greek IBD patients, had a favorable pregnancy outcome. Active inflammation during gestation and UC diagnosis were associated with a negative impact on pregnancy outcomes. The results of this study are in favor of the continuation of IBD treatment during pregnancy.

Keywords: pregnancy, ulcerative colitis, Crohn disease, flare

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Authors: Pongsakorn Komutpol, Pravej Serichetaphongse, Soontra Panmekiate, Atiphan Pimkhaokham

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Statement of Problem: The important parameter of esthetic assessment in anterior maxillary implant include pink esthetic of gingiva and white esthetic of restoration. While the 3 dimensional (3D) implant position are recently concerned as a key for succeeding in implant treatment. However, to our knowledge, the authors did not come across any publication that demonstrated the relations of esthetic outcome and 3D implant position. Objectives: To investigate the correlation between positional accuracy of single-tooth implant restoration (STIR) in all 3 dimensions and their esthetic outcomes. Materials and Methods: 17 patients’ data who had a STIR at central incisor with pristine contralateral tooth were included in this study. Intraoral photographs, dental models, and cone beam computed tomography (CBCT) images were retrieved. The esthetic outcome was assessed in accordance with pink esthetic score and white esthetic score (PES/WES). While the number of correct position in each dimension (mesiodistal, labiolingual, apicocoronal) of the implant were evaluated and defined as 'right' or 'wrong' according to ITI consensus conference by one investigator using CBCT data. The different mean score between right and wrong position in all dimensions was analyzed by Mann-Whitney U test with 0.05 was the significant level of the study. Results: The average score of PES/WES was 15.88 ± 1.65 which was considered as clinically acceptable. The average PES/WES score in 1, 2 and 3 right dimension of the implant position were 16.71, 15.75 and 15.17 respectively. None of the implants placed wrongly in all three dimensions. Statistically significant difference of the PES/WES score was found between the implants that placed right in 3 dimensions and 1 dimension (p = 0.041). Conclusion: This study supported the principle of 3D position of implant. The more properly implant was placed, the higher esthetic outcome was found.

Keywords: accuracy, dental implant, esthetic, 3D implant position

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Authors: Asrarul Fikri Abu Hassan, Muhammad Hafiz bin Hanafi, Jafri Malin Abdullah

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This study is to compare the motor evoked potential (MEP) changes using different settings of repetitive transcranial magnetic stimulation (rTMS) in the post-haemorrhagic stroke patient which treated conservatively. The goal of the study is to determine changes in corticomotor excitability and functional outcome after repetitive transcranial magnetic stimulation (rTMS) therapy regime. 20 post-stroke patients with upper limb hemiparesis were studied due to haemorrhagic stroke. One of the three settings; (I) Inhibitory setting, or (II) facilitatory setting, or (III) control group, no excitatory or inhibitory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. Functional outcomes were evaluated using the Barthel index score. We found pre-treatment MEP values of the lesional side were lower compared to post-treatment values in both settings. In contrast, we found that the pre-treatment MEP values of the non-lesional side were higher compared to post-treatment values in both settings. Interestingly, patients with treatment, either facilitatory setting and inhibitory setting have faster motor recovery compared to the control group. Our data showed both settings might improve the MEP of the upper extremity and functional outcomes in the haemorrhagic stroke patient.

Keywords: Barthel index, corticomotor excitability, motor evoked potential, repetitive transcranial magnetic stimulation, stroke

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Authors: Rosita Kanapeckaite

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The modern operational military environment is a combination of factors such as change, uncertainty, complexity and ambiguity. Stiehm (2002) refers to such situations as VUCA situations. VUCA is an acronym commonly used to describe the volatility, uncertainty, complexity and ambiguity of various situations and conditions. Increasingly fast-paced military operations require military personnel to demonstrate readiness and resilience under stressful conditions in order to maintain the optimum cognitive and physical performance necessary to achieve success. Military resilience can be defined as the ability to cope with the negative effects of setbacks and associated stress on military performance and combat effectiveness. In the volatile, uncertain, complex and ambiguous modern operational environment, both current and future operations require and place a higher priority on enhancing and maintaining troop readiness and resilience to win decisively in multidimensional combat. This paper explores the phenomenon of soldiers' psychological resilience, theories of leadership, and commitment to the organisation. The aim of the study is to examine the relationship between soldiers' psychological resilience, leadership style and commitment to the organisation. The study involved 425 professional soldiers, the research method was a questionnaire survey. The instruments used were measures of psychological resilience, leadership styles and commitment to the organisation. Results: transformational leadership style predicts higher psychological resilience, and psychologically resilient professional servicemen are more committed to the organisation. The study confirms the importance of soldiers' psychological resilience for their commitment to the organisation. The paper also discusses practical applications.

Keywords: resilience, commitment, solders, leadership style

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Authors: Monika Jurkeviciute, Amia Enam, Johanna Torres Bonilla, Henrik Eriksson

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Introduction: Many evaluations of eHealth interventions conclude that the evidence for improved clinical outcomes is limited, especially when the intervention is short, such as one year. Often, evaluation design does not address the feasibility of achieving clinical outcomes. Evaluations are designed to reflect upon clinical goals of intervention without utilizing the opportunity to illuminate effects on organizations and cost. A comprehensive design of evaluation can better support decision-making regarding the effectiveness and potential transferability of eHealth. Hence, the purpose of this paper is to present a feasible and comprehensive design of evaluation for eHealth intervention, including the design process in different contexts. Methodology: The situation of limited feasibility of clinical outcomes was foreseen in the European Union funded project called “DECI” (“Digital Environment for Cognitive Inclusion”) that is run under the “Horizon 2020” program with an aim to define and test a digital environment platform within corresponding care models that help elderly people live independently. A complex intervention of eHealth implementation into elaborate care models in four different countries was planned for one year. To design the evaluation, a participative approach was undertaken using Pettigrew’s lens of change and transformations, including context, process, and content. Through a series of workshops, observations, interviews, and document analysis, as well as a review of scientific literature, a comprehensive design of evaluation was created. Findings: The findings indicate that in order to get evidence on clinical outcomes, eHealth interventions should last longer than one year. The content of the comprehensive evaluation design includes a collection of qualitative and quantitative methods for data gathering which illuminates non-medical aspects. Furthermore, it contains communication arrangements to discuss the results and continuously improve the evaluation design, as well as procedures for monitoring and improving the data collection during the intervention. The process of the comprehensive evaluation design consists of four stages: (1) analysis of a current state in different contexts, including measurement systems, expectations and profiles of stakeholders, organizational ambitions to change due to eHealth integration, and the organizational capacity to collect data for evaluation; (2) workshop with project partners to discuss the as-is situation in relation to the project goals; (3) development of general and customized sets of relevant performance measures, questionnaires and interview questions; (4) setting up procedures and monitoring systems for the interventions. Lastly, strategies are presented on how challenges can be handled during the design process of evaluation in four different countries. The evaluation design needs to consider contextual factors such as project limitations, and differences between pilot sites in terms of eHealth solutions, patient groups, care models, national and organizational cultures and settings. This implies a need for the flexible approach to evaluation design to enable judgment over the effectiveness and potential for adoption and transferability of eHealth. In summary, this paper provides learning opportunities for future evaluation designs of eHealth interventions in different national and organizational settings.

Keywords: ehealth, elderly, evaluation, intervention, multi-cultural

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Authors: Akbar Ali

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The aim of this study is to explore the academic performance of adolescents who are living with their single parents. Living with single parents is challenging experience especially when children are in adolescence phase. The core aim of study was to investigate how family environment, social status and parental support affect adolescents’ academic performance. This study is carried out in Punjab, Pakistan on adolescents who are experiencing the single family environment either my divorce or natural parental marital transition. Qualitative methodology was employed to evaluate the different aspects of aspects of academic performance. A sample of 40 students in-between age 14 to 18 years was selected from different institutions coming from different socio cultural backgrounds and having different family situations comprising different types of single family structure. Data was collected through semi structured interviews to explore the academics performance and family dynamics. Findings of the study indicated that adolescents living with single parents show poor academic performance due to lack of interest, absentees, poor social and economic support, less parental involvement. Students were showing less or no interest in extracurricular activities and less social interaction with fellows. Parental economic status , Parenting style, parental involvement and academic support are the key factors which directly academic outcomes. Research experience was challenging because students were reluctant to share family issues. Proper academic and counselling centre should be established to provide emotional and academic counselling for such students. Longitudinal research should be carried out to trace the academic outcomes and social adjustments.

Keywords: academic counselling, marital transitions, parenting style, parental involvement

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Authors: A. Sewell

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The paper reports a research project which investigated the social interactions of nine to ten-year-olds in a mainstream primary school. The project implemented an adaption of a whole class, behavioural intervention known as 'The Good Behaviour Game (TGBG)'. TGBG is an evidence-based intervention traditionally used to reduce low-level disruptive behaviours in a classroom setting. TGBG was adapted to encourage pupil’s engagement in pro-social behaviour during lessons. A mixed methods research design was employed to evaluate intervention effects and pupil’s perceptions of their social interactions and relationships with others. Single-case research design was used to evaluate behaviour change, and Personal Construct Psychology (PCP) repertory grids were used to explore pupil’s perceptions. The findings demonstrated that TGBG could be successfully adapted to positively influence pupil’s engagement in pro-social behaviours. The findings from the PCP repertory grid interviews revealed the complexities of how children construct their social interactions and relationships with others, and how an understanding of these could be used to design better social skills interventions. It is concluded that TGBG is a cost-effective, simple to implement intervention for promoting positive social interactions and relationships at the whole class level. The paper presents the aims, design, findings, and conclusions of the study in further detail and relates limitations and potential future extensions of the research. The outcomes have direct application and relevance for practitioners interested in children’s social development and how to promote positive outcomes in this critical aspect of childhood.

Keywords: social skills, social development, social competency, the good behaviour game

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Authors: Nadeem Akhtar, An Ran, Cornelius B. Pratt

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China’s President Xi' vision of Belt and Road Initiative, an infrastructural project of development and connectivity, is attracting international students to Chinese universities, with Pakistan and India among the top-10 countries of origin of those students (Ministry of Education China, 2018). An additional factor in international students’ interest in Chinese universities is their improving global rankings of Chinese universities. Against that backdrop, this study addresses two overarching questions: (a) What factors explain South Asian students’ study-away experiences, particularly in their multicultural environments? and (b) What role do new media play in their adaptation to that environment? This study is guided by Stephen’s (2011) theoretical model, which suggests that social networks influence immigrants’ interactions with host and home culture. The present study used a structured questionnaire distributed through both WeChat and other online platforms to international students studying in Chinese universities. Preliminary results are threefold: (a) that the frequency of use of social media is a predictor of the level of adjustment of the students to their multicultural environment; (b) that social engagement with their international-student peers is a moderating factor in their experiential outcomes; and (c) length of stay in Chinese universities, surprisingly, was not a predictor of adaptation. A major implication of these findings is that, even though social media tend to be criticized for contributing to anomie and to diminishing social capital among youths and millennials, they can be poignant tools for cultural adaptation, particularly among international students in China. It remains to be seen if such outcomes occur among international students in other countries or world regions.

Keywords: adaptation, China's Belt and Road Initiative, international students, social media

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Authors: Samira K. Al-Nasser, Siamak Noroozi, Roya Haratian, Adrian Harvey

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A total knee replacement (TKR) is a surgical procedure necessary when there is severe pain and/or loss of function in the knee. Surgeons balance the load in the knee and the surrounding soft tissue by feeling the tension at different ranges of motion. This method can be unreliable and lead to early failure of the joint. The ideal kinematics and load distribution have been debated significantly based on previous biomechanical studies surrounding both TKRs and normal knees. Intraoperative sensors like VERASENSE and eLibra have provided a method for the quantification of the load indicating a balanced knee. A review of the literature written about intraoperative sensors and tension/stability of the knee was done. Studies currently debate the quantification of the load in medial and lateral compartments specifically. However, most research reported that following a TKR the medial compartment was loaded more heavily than the lateral compartment. In several cases, these results were shown to increase the success of the surgery because they mimic the normal kinematics of the knee. In conclusion, most research agrees that an intercompartmental load differential of between 10 and 20 pounds, where the medial load was higher than the lateral, and an absolute load of less than 70 pounds was ideal. However, further intraoperative sensor development could help improve the accuracy and understanding of the load distribution on the surgical outcomes in a TKR. A reduction in early revision surgeries for TKRs would provide an improved quality of life for patients and reduce the economic burden placed on both the National Health Service (NHS) and the patient.

Keywords: intraoperative sensors, joint load forces, kinematics, load balancing, and total knee replacement

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Authors: Haripriya Chakraborty

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The healthcare system in the United States is considered to be one of the most inefficient and expensive systems when compared to other developed countries. Consequently, there are persistent concerns regarding the overall functioning of this system. For instance, the large number of uninsured individuals and high premiums are pressing issues that are shown to have a negative effect on health outcomes with possible life-threatening consequences. The Affordable Care Act (ACA), which was signed into law in 2010, was aimed at improving some of these inefficiencies. This paper aims at providing a computational mechanism to examine some of these inefficiencies and the effects that policy proposals may have on reducing these inefficiencies. Agent-based modeling is an invaluable tool that provides a flexible framework to model complex systems. It can provide an important perspective into the nature of some interactions that occur and how the benefits of these interactions are allocated. In this paper, we propose a novel and versatile agent-based model with realistic assumptions to simulate the dynamics of a health insurance marketplace that contains a mixture of private and public insurers and individuals. We use this model to analyze the characteristics, motivations, payoffs, and strategies of these agents. In addition, we examine the effects of certain policies, including some of the provisions of the ACA, aimed at reducing the uninsured rate and the cost of premiums to move closer to a system that is more equitable and improves health outcomes for the general population. Our test results confirm the usefulness of our agent-based model in studying this complicated issue and suggest some implications for public policies aimed at healthcare reform.

Keywords: agent-based modeling, healthcare reform, insurance markets, public policy

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Authors: Pratima Tatke, Archana Avhad, Bhanu Duggal, Meeta Rajivlochan, Sujata Saunik, Pradip Vyas, Nidhi Pandey, Aditee Dalvi, Jyothi Subramanian

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Background: Smoking is well established risk factor for the development and progression of coronary artery disease. It is strongly related to morbidity and mortality from cardiovascular causes. The aim of this study is to observe effect of smoking status on percutaneous coronary intervention(PCI) after 1 year. Methods: 2527 patients who underwent PCI at different hospital of Maharashtra(India) from 2012 to 2015 under the health insurance scheme which is launched by Health department, Government of Maharashtra for below poverty line(BPL) families which covers cardiology. Informed consent of patients was taken .They were followed by telephonic survey after 6months to 1year of PCI . Outcomes of interest included myocardial infarction, restenosis, cardiac rehospitalization, death, and a composite of events after PCI. Made group of two non smokers-1861 and smokers (including patients who quit at time of PCI )-659. Results: Statistical Analysis using Pearson’s chi square test revealed that there was trend seen of increasing incidence of death, Myocardial infarction and Restenosis in smokers than non smokers .Smokers had a greater death risk compared to nonsmoker; 5.7% and 5.1% respectively p=0.518. Also Repeat procedures (2.1% vs. 1.5% p=0.222), breathlessness (17.8% vs. 18.20% p=0.1) and Myocardial Infarction (7.3% vs. 10%) high in smoker than non smokers. Conclusion: Major adverse cardiovascular events (MACE) were observed even after successful PCI in smokers. Patients undergoing percutaneous coronary intervention should be encouraged to stop smoking.

Keywords: coronary artery diseases, major adverse cardiovascular events, percutaneous coronary intervention, smoking

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Authors: Jamil Ahmed, Li P. Wong, Yan P. Chua

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The United Nation's sustainable development goals include the target to ensure access to water and sanitation for all; however, very few studies have assessed school-based drinking water in Pakistan. The purpose of this study was to characterize water quality in primary schools of Pakistan and to characterize how recent WASH interventions were associated with school water quality. We conducted a representative cross-sectional study of primary schools in the Sindh province of Pakistan. We used structured observations and structured interviews to ascertain the school’s WASH conditions. Our primary exposures of interest were the implementation of previous WASH interventions in the school and the water source type. Outcomes of interest included water quality (measured by various chemical and microbiological indicators) and water availability at the school’s primary drinking water source. We used log-binomial regression to characterize how WASH exposures were associated with water quality outcomes. We collected data from 256 schools. Groundwater was the primary drinking water source at most schools (87%). Water testing showed that 14% of the school’s water had arsenic above the WHO recommendations, and over 50% of the water samples exceeded recommendations for both lead and cadmium. A majority of the water sources (52%) had fecal coliform contamination. None of the schools had nitrate contamination (0%), and few had fluoride contamination (5%). Regression results indicated that having a recent WASH intervention at the school was not associated with either arsenic contamination (prevalence ratio=0.97; 95% CI: 0.46-2.1) or with fecal coliform contamination (PR=0.88; 95% CI: 0.67-1.17). Our assessment unveiled several water quality gaps that exist, including high heavy metal and fecal contamination. Our findings will help various stakeholders to take suitable action to improve water quality in Pakistani schools.

Keywords: WASH interventions, water quality, primary school children, heavy metals

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Authors: Piret Pernik

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Based on strategic, operational, and technical analysis of the ongoing armed conflict in Ukraine, this paper will examine the opportunities and risks of using small commercial drones (dual-use unmanned aerial vehicles, UAV) for military purposes. The paper discusses the opportunities and risks in the information domain, encompassing both cyber and electromagnetic interference and attacks. The paper will draw conclusions on a possible strategic impact to the battlefield outcomes in the modern armed conflicts by the widespread use of dual-use UAVs. This article will contribute to filling the gap in the literature by examining based on empirical data cyberattacks and electromagnetic interference. Today, more than one hundred states and non-state actors possess UAVs ranging from low cost commodity models, widely are dual-use, available and affordable to anyone, to high-cost combat UAVs (UCAV) with lethal kinetic strike capabilities, which can be enhanced with Artificial Intelligence (AI) and Machine Learning (ML). Dual-use UAVs have been used by various actors for intelligence, reconnaissance, surveillance, situational awareness, geolocation, and kinetic targeting. Thus they function as force multipliers enabling kinetic and electronic warfare attacks and provide comparative and asymmetric operational and tactical advances. Some go as far as argue that automated (or semi-automated) systems can change the character of warfare, while others observe that the use of small drones has not changed the balance of power or battlefield outcomes. UAVs give considerable opportunities for commanders, for example, because they can be operated without GPS navigation, makes them less vulnerable and dependent on satellite communications. They can and have been used to conduct cyberattacks, electromagnetic interference, and kinetic attacks. However, they are highly vulnerable to those attacks themselves. So far, strategic studies, literature, and expert commentary have overlooked cybersecurity and electronic interference dimension of the use of dual use UAVs. The studies that link technical analysis of opportunities and risks with strategic battlefield outcomes is missing. It is expected that dual use commercial UAV proliferation in armed and hybrid conflicts will continue and accelerate in the future. Therefore, it is important to understand specific opportunities and risks related to the crowdsourced use of dual-use UAVs, which can have kinetic effects. Technical countermeasures to protect UAVs differ depending on a type of UAV (small, midsize, large, stealth combat), and this paper will offer a unique analysis of small UAVs both from the view of opportunities and risks for commanders and other actors in armed conflict.

Keywords: dual-use technology, cyber attacks, electromagnetic warfare, case studies of cyberattacks in armed conflicts

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Authors: Yasar Samet Gokceoglu, Ayse Nur Incesu, Furkan Okatar, Berk Nimetoglu, Serkan Bayram, Turgut Akgul

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Ankle syndesmosis injuries pose a significant challenge in orthopedic practice due to their potential for prolonged recovery and chronic ankle dysfunction. Accurate diagnosis and management of these injuries are essential for achieving optimal patient outcomes. The use of radiological methods, such as X-ray, computed tomography (CT), and magnetic resonance imaging (MRI), plays a vital role in the accurate diagnosis of syndesmosis injuries in the context of ankle fractures. Treatment options for ankle syndesmosis injuries vary, with surgical interventions such as screw fixation and suture-button implantation being commonly employed. The choice of treatment is influenced by the severity of the injury and the presence of associated fractures. Additionally, the mechanism of injury, such as pure syndesmosis injury or specific fracture types, can impact the stability and management of syndesmosis injuries. Ankle fractures with syndesmosis injury present a complex clinical scenario, requiring accurate diagnosis, appropriate reduction, and tailored management strategies. The interplay between the mechanism of injury, associated fractures, and treatment modalities significantly influences the outcomes of these challenging injuries. The long-term outcomes and patient satisfaction following ankle fractures with syndesmosis injury are crucial considerations in the field of orthopedics. Patient-reported outcome measures, such as the Foot and Ankle Outcome Score (FAOS), provide essential information about functional recovery and quality of life after these injuries. When diagnosing syndesmosis injuries, standard measurements, such as the medial clear space, tibiofibular overlap, tibiofibular clear space, anterior tibiofibular ratio (ATFR), and the anterior-posterior tibiofibular ratio (APTF), are assessed through radiographs and computed tomography (CT) scans. These parameters are critical in evaluating the presence and severity of syndesmosis injuries, enabling clinicians to choose the most appropriate treatment approach. Despite advancements in diagnostic imaging, challenges remain in accurately diagnosing and treating ankle syndesmosis injuries. Traditional diagnostic parameters, while beneficial, may not capture the full extent of the injury or provide sufficient information to guide therapeutic decisions. This gap highlights the need for exploring additional diagnostic parameters that could enhance the accuracy of syndesmosis injury diagnoses and inform treatment strategies more effectively. The primary goal of this research is to evaluate the usefulness of traditional radiographic measurements in comparison to new CT-based measurements for diagnosing ankle syndesmosis injuries. Specifically, this study aims to assess the accuracy of conventional parameters, including medial clear space, tibiofibular overlap, tibiofibular clear space, ATFR, and APTF, in contrast with the recently proposed CT-based measurements such as the delta and gamma angles. Moreover, the study intends to explore the relationship between these diagnostic parameters and functional outcomes, as measured by the Foot and Ankle Outcome Score (FAOS). Establishing a correlation between specific diagnostic measurements and FAOS scores will enable us to identify the most reliable predictors of functional recovery following syndesmosis injuries. This comparative analysis will provide valuable insights into the accuracy and dependability of CT-based measurements in diagnosing ankle syndesmosis injuries and their potential impact on predicting patient outcomes. The results of this study could greatly influence clinical practices by refining diagnostic criteria and optimizing treatment planning for patients with ankle syndesmosis injuries.

Keywords: ankle syndesmosis injury, diagnostic accuracy, computed tomography, radiographic measurements, Tibiofibular syndesmosis distance

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Authors: Shankar Dhakal, Andrew Jones, Geoffrey W. Lummis

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The Federal Democratic Republic of Nepal is a linguistically, culturally, and ethnically diverse country with approximately 123 different spoken languages that represent several ethnic, cultural, and religious groups of people. With a population of about 30 million, long-standing disparities and inequalities in access and achievement in education have constantly been challenging to provide equitable educational opportunities for all students. While the new constitution of federal Nepal (2015) stipulates that all schools serve the interests of diverse communities, leadership practices have failed to adopt local contextual sensitivities, leading to traditional, authoritarian approaches and entrenched inequalities. However, little is known about how Nepali secondary school principals can adapt and implement context-responsive and equitable strategies to ensure equity and inclusiveness in its enormously diverse socio-cultural contexts. To fill this gap, this study explores how educational leadership approaches and philosophies are transformed using a multi-case automated/ethnographic research methodology underpinned by the paradigm of critical constructivism. This paper reconstructs to see if school leadership in Nepal can produce more equitable and contextual outcomes. The results of this study highlight the need for a paradigm shift and the adoption of innovative leadership approaches that foster humility, empathy, and compassion in school leaders to achieve better school outcomes. This research provides valuable insights into existing literary gaps and provides guidance for future school leadership policies and practices at the personal, cultural, and political levels.

Keywords: school leadership, auto/ethnography, equitable and context-responsive leadership, Nepal

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