Search results for: clinical research professionals

Authors: Zahra Salehi Shahrbabaki, Zahra Chavoshzadeh, Fahimeh Abdollahimajd, Samin Sharafian, Tolue Mahdavi, Mahnaz Jamee

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Background: Inborn errors of immunity (IEIs) are monogenic diseases of the immune the system with broad clinical manifestations. Despite the increasing genetic advancements, the diagnosis of IEIs still leans on clinical diagnosis. Dermatologic manifestations are observed in a large number of IEI patients and can lead to proper approach, prompt intervention and improved prognosis. Methods: This cross-sectional study was carried out between 2018 and 2020 on IEIs at a Children's tertiary care center in Tehran, Iran. Demographic details (including age, sex, and parental consanguinity), age at onset of symptoms and family history of IEI with were recorded. Results :212 patients were included. Cutaneous findings were reported in (95 ,44.8%) patients. and 61 of 95 (64.2%) reported skin lesions as the first clinical presentation. Skin infection (69, 72.6%) was the most frequent cutaneous manifestation, followed by an eczematous rash (24, 25 %). Conclusions: Skin manifestations are common feature in IEI patients and can be readily recognizable by healthcare providers. This study tried to provide information on prognostic consequences.

Keywords: primary immuno deficiency, inborn errror of metabolism, skin manifestation, skin infection

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Authors: Andriana E. Tran, Anna Chur-Hansen

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Sexual health is an important aspect of overall wellbeing. This study aimed to explore the sexual health experiences of men aged 50 years and over from the perspective of health care professional participants who were specializing in sexual health care and who consulted with older men. A total of ten interviews were conducted. Eleven themes were identified regarding men’s experiences with sexual health care as reported by participants. 1) Biologically focused: older male clients focus largely on the biological aspect of their sexual health without consideration of other factors which might affect their functioning. 2) Psychological concerns: there is an interaction between mental and sexual health but older male clients do not necessarily see this. 3) Medicalization of sexual functioning: advances in medicine that aid with erectile difficulties which consequently mean that older men tend to favor a medical solution to their sexual concerns. 4) Masculine identity: sexual health concerns are linked to older male clients’ sense of masculinity. 5) Penile functionality: most concerns that older male clients have center on their penile functionality. 6) Relationships: many male clients seek sexual help as they believe it improves relationships. Conversely, having supportive partners may mean older male clients focus less on the physicality of sex. 7) Grief and loss: men experience grief and loss – the loss of their sexual functioning, grief from loss of a long-term partner, and loss of intimacy and privacy when moving from independent living to residential care. 8) Social stigma: older male clients experience stigma around aging sexuality and sex in general. 9) Help-seeking behavior: older male clients will usually seek mechanistic solution for biological sexual concerns, such as medication used for penile dysfunction. 10) Dismissed by health care professionals: many older male clients seek specialist sexual health care without the knowledge of their doctors as they feel dismissed due to lack of expertise, lack of time, and the doctor’s personal attitudes and characteristics. Finally, 11) Lack of resources: there is a distinct lack of resources and training to understand sexuality for healthy older men. These findings may inform future research, professional training, public health campaigns and policies for sexual health in older men.

Keywords: ageing, biopsychosocial model, men's health, sexual health

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Authors: Guy Rubin, Ravit Shay, Nimrod Rozen

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The accuracy of a diagnostic test used to classify a patient as having disease or being disease-free is a valuable piece of information to be used by the physician when making treatment decisions. Finger laceration, suspected to have nerve injury is a challenging decision for the treating surgeon. The purpose of this study was to evaluate the sensitivity, specificity and predictive values of six clinical tests in the diagnosis of digital nerve injury. The six clinical tests included light touch, pin prick, static and dynamic 2-point discrimination, Semmes Weinstein monofilament and wrinkle test. Data comparing pre-surgery examination with post-surgery results of 42 patients with 52 digital nerve injury was evaluated. The subjective examinations, light touch, pin prick, static and dynamic 2-point discrimination and Semmes-Weinstein monofilament were not sensitive (57.6, 69.7, 42.4, 40 and 66.8% respectively) and specific (36.8, 36.8, 47.4, 42.1 and 31.6% respectively). Wrinkle test, the only objective examination, was the most sensitive (78.1%) and specific (55.6%). This result gives no pre-operative examination the ability to predict the result of explorative surgery.

Keywords: digital nerve, injury, nerve examination, Semmes-Weinstein monofilamen, sensitivity, specificity, two point discrimination, wrinkle test

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Authors: Qin-Min Ge, Shu-Ming Pan

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Emergency clinicians usually get teaching qualification after graduating from medical universities without special faculty training in China mainland. Emergency departments are overcrowded places, with large numbers of patients suffering undifferentiated illness. In the field of emergency medicine (EM), improving the faculty competencies and developing the teaching skills are important for medical education, they could enhance learners outcomes and hence affect the patients prognosis indirectly. This article highlights the necessities of faculty training in EM, illustrates the qualities a good clinical educator should qualify, advances the skills as educators in an academic setting and discusses the ways to be good clinical teachers.

Keywords: emergency education, competence, faculty training, teaching, emergency medicine

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Authors: Saleh Hayat

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Efficiency, productivity and sustainability are important factors for structure and the application of processes in green building. Various previous studies have addressed efficiency, productivity and sustainability separately. This research study aims to investigate the implications of these three factors taking together. Frequency analysis and the ranking techniques are carried out to explore the connection between these factors. The interconnection matrix has been developed and functional grouping is made based upon data from expert opinion and field professionals. The existence of a relationship, the type of relationship and the scaled impact have been drawn. Additionally, a system diagram has been developed to show the variable correlation. The results of expert opinion show that efficiency, productivity and sustainability have a stronger impact on green buildings.

Keywords: efficiency, green building, productivity, sustainability

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Authors: Payel Saha

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Social media is playing an important role for dissemination of information in society. In 21st century most people have a smart phone and used different social media tools like Facebook, Twitter, Instagram, WhatsApp, Skype etc. in day to day life. It is rapidly growing web-based tool for everyone to share thoughts, ideas and knowledge globally using internet. The study highlights the current use of social media tools for promoting library and information services of Library and Information Professionals of India, which are working in Library. The study was conducted during November, 2017. A structured questionnaire was prepared using google docs and shared using different mailing list, sent to individual email IDs and sharing with other social media tools. Only 90 responses received from the different states of India and analyzed via MS-Excel. The data receive from 17 states and 3 union territories of India; however most of the respondents has come from the states Odisha 23, Himachal Pradesh 14 and Assam 10. The results revealed that out 90 respondents 37 Female and 53 male categories and also majority of respondents 71 have come from academic library followed by special library 15, Public library 3 and corporate library 1 respondent. The study indicates that, out of 90 respondent’s majority of 53 of respondents said that their Library have a social media account while 39 of respondents have not their Library social media account. The study also inform that Facebook, YouTube, Google+, LinkedIn, Twitter and Instagram are using by the LIS professional of India and Facebook 86 was popular social media tool among the other social media tools. Furthermore, respondent reported that they are using social media tools for sharing photos of events and programs of library 72, followed by tips for using different services 64, posting of new arrivals 56, tutorials of database 35 and send brief updates to patrons 32, announcement of library holidays 22. It was also reported by respondents that they are sharing information about scholarships training programs and marketing of library events etc. The study furthermore identify that lack of time is the major problem while using social media with 53 of respondents followed by low speed of internet 35, too many social media tools to learn 17 and some 3 respondents reported that there is no problem while using social media tools. The results also revealed that, majority of the respondents reported that they are using social media tools in daily basis 71 followed by weekly basis 16. It was followed by monthly 1 respondent and other 2 of the respondents. In summary, this study is expected to be useful in further promoting the social media for dissemination of library and information services to the general public.

Keywords: application of social media, India, promoting library services, library professionals

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Authors: Nizar Ghali, Bernard Fortin, Guy Lacroix

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In Quebec, colonoscopies volumes have continued to rise in recent years in the absence of effective monitoring mechanism for the appropriateness and the quality of these exams. In 2010, November, Quebec Government introduced the colorectal cancer-screening program in the objective to control for volume and cost imperfection. This program is based on clinical standards and was initiated for first group of institutions. One year later, Government adds financial incentives for participants institutions. In this analysis, we want to assess for the causal effect of the two components of this program: clinical pathways and financial incentives. Especially we assess for the reform effect on healthcare quality and population health in the context that medical remuneration is not directly dependent on this additional funding offered by the program. We have data on admissions episodes and deaths for 8 years. We use multistate model analog to difference in difference approach to estimate reform effect on the transition probability between different states for each patient. Our results show that the reform reduced length of stay without deterioration in hospital mortality or readmission rate. In the other hand, the program contributed to decrease the hospitalization rate and a less invasive treatment approach for colorectal surgeries. This is a sign of healthcare quality and population health improvement. We demonstrate in this analysis that physicians’ behavior can be affected by both clinical standards and financial incentives even if offered to facilities.

Keywords: multi-state and multi-episode transition model, healthcare quality, length of stay, transition probability, difference in difference

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Authors: Sanjay Saraf

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The oral cavity can be the site for early manifestations of mucocutaneous disorders (MD) or the only site for occurrence of these disorders. It can also exhibit oral lesions with simultaneous associated skin lesions. The MD involving the oral mucosa commonly presents with signs such as ulcers, vesicles and bullae. The unique environment of the oral cavity may modify these signs of the disease, thereby making the clinical diagnosis an arduous task. In addition to the unique environment of oral cavity, the overlapping of the signs of various mucocutaneous disorders, also makes the clinical diagnosis more intricate. The aim of this review is to present the oral signs of dermatological disorders having common oral involvement and emphasize their importance in early detection of the systemic disorders. The aim is also to highlight the necessity of oral examination by a dermatologist while examining the skin lesions. Prior to the oral examination, it must be imperative for the dermatologists and the dental clinicians to have the knowledge of oral anatomy. It is also important to know the impact of various diseases on oral mucosa, and the characteristic features of various oral mucocutaneous lesions. An initial clinical oral examination is may help in the early diagnosis of the MD. Failure to identify the oral manifestations may reduce the likelihood of early treatment and lead to more serious problems. This paper reviews the oral manifestations of immune mediated dermatological disorders with common oral manifestations.

Keywords: dermatological investigations, genodermatosis, histological features, oral examination

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Authors: Nabil A. A. Mohamed, Alaa A. A. Balbaa, Khaled E. Ayad

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Osteoarthritis (OA) of the knee is the most common form of arthritis and leads to more activity limitations (e.g., disability in walking and stair climbing) than any other disease, especially in the elderly. Recently, impaired proprioceptive accuracy of the knee has been proposed as a local factor in the onset and progression of radiographic knee OA (ROA). Purpose: To compare the clinical and radiological findings in healthy with that of knee OA. Also, to determine if there is a correlation between the clinical and radiological findings in patients with knee OA. Subjects: Fifty one patients diagnosed as unilateral or bilateral knee OA with age ranged between 35-70 years, from both gender without any previous history of knee trauma or surgery, and twenty one normal subjects with age ranged from 35 - 68 years. METHODS: peak torque/body weight (PT/BW) was recorded from knee extensors at isokinetic isometric mode at angle of 45 degree. Also, the Absolute Angular Error was recorded at 45O and 30O to measure joint position sense (JPS). They made anteroposterior (AP) plain X-rays from standing semiflexed knee position and their average score of Timed Up and Go test(TUG) and WOMAC were recorded as a measure of knee pain, stiffness and function. Comparison between the mean values of different variables in the two groups was performed using unpaired student t test. The P value less or equal to 0.05 was considered significant. Results: There were significant differences between the studied variables between the experimental and control groups except the values of AAE at 30O. Also, there were no significant correlation between the clinical findings (pain, function, muscle strength and proprioception) and the severity of arthritic changes in X-rays. CONCLUSION: From the finding of the current study we can conclude that there were a significant difference between the both groups in all studied parameters (the WOMAC, functional level, quadriceps muscle strength and the joint proprioception). Also this study did not support the dependency on radiological findings in management of knee OA as the radiological features did not necessarily indicate the level of structural damage of patients with knee OA and we should consider the clinical features in our treatment plan.

Keywords: joint position sense, peak torque, proprioception, radiological knee osteoarthritis

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Authors: Joy Cao, Min Zhou

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Purpose: Acute Type A aortic dissection is a well-known cause of extremely high mortality rate. A highly accurate and cost-effective non-invasive predictor is critically needed so that the patient can be treated at earlier stage. Although various CFD approaches have been tried to establish some prediction frameworks, they are sensitive to uncertainty in both image segmentation and boundary conditions. Tedious pre-processing and demanding calibration procedures requirement further compound the issue, thus hampering their clinical applicability. Using the latest physics informed deep learning methods to establish an accurate and cost-effective predictor framework are amongst the main goals for a better Type A aortic dissection treatment. Methods: Via training a novel physics-informed deep residual network, with non-invasive 4D MRI displacement vectors as inputs, the trained model can cost-effectively calculate all these biomarkers: aortic blood pressure, WSS, and OSI, which are used to predict potential type A aortic dissection to avoid the high mortality events down the road. Results: The proposed deep learning method has been successfully trained and tested with both synthetic 3D aneurysm dataset and a clinical dataset in the aortic dissection context using Google colab environment. In both cases, the model has generated aortic blood pressure, WSS, and OSI results matching the expected patient’s health status. Conclusion: The proposed novel physics-informed deep residual network shows great potential to create a cost-effective, non-invasive predictor framework. Additional physics-based de-noising algorithm will be added to make the model more robust to clinical data noises. Further studies will be conducted in collaboration with big institutions such as Cleveland Clinic with more clinical samples to further improve the model’s clinical applicability.

Keywords: type-a aortic dissection, deep residual networks, blood flow modeling, data-driven modeling, non-invasive diagnostics, deep learning, artificial intelligence.

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Authors: Irfan Anjum Manarvi, Fawzi Aljassir

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Human bones have been a keen area of research over a long time in the field of biomechanical engineering. Medical professionals, as well as engineering academics and researchers, have investigated various bones by using medical, mechanical, and materials approaches to discover the available body of knowledge. Their major focus has been to establish properties of these and ultimately develop processes and tools either to prevent fracture or recover its damage. Literature shows that mechanical professionals conducted a variety of tests for hardness, deformation, and strain field measurement to arrive at their findings. However, they considered these results accuracy to be insufficient due to various limitations of tools, test equipment, difficulties in the availability of human bones. They proposed the need for further studies to first overcome inaccuracies in measurement methods, testing machines, and experimental errors and then carry out experimental or theoretical studies. Finite Element analysis is a technique which was developed for the aerospace industry due to the complexity of design and materials. But over a period of time, it has found its applications in many other industries due to accuracy and flexibility in selection of materials and types of loading that could be theoretically applied to an object under study. In the past few decades, the field of biomechanical engineering has also started to see its applicability. However, the work done in the area of Tarsals, metatarsals and phalanges using this technique is very limited. Therefore, present research has been focused on using this technique for analysis of these critical bones of the human body. This technique requires a 3-dimensional geometric computer model of the object to be analyzed. In the present research, a 3d laser scanner was used for accurate geometric scans of individual tarsals, metatarsals, and phalanges from a typical human foot to make these computer geometric models. These were then imported into a Finite Element Analysis software and a length refining process was carried out prior to analysis to ensure the computer models were true representatives of actual bone. This was followed by analysis of each bone individually. A number of constraints and load conditions were applied to observe the stress and strain distributions in these bones under the conditions of compression and tensile loads or their combination. Results were collected for deformations in various axis, and stress and strain distributions were observed to identify critical locations where fracture could occur. A comparative analysis of failure properties of all the three types of bones was carried out to establish which of these could fail earlier which is presented in this research. Results of this investigation could be used for further experimental studies by the academics and researchers, as well as industrial engineers, for development of various foot protection devices or tools for surgical operations and recovery treatment of these bones. Researchers could build up on these models to carryout analysis of a complete human foot through Finite Element analysis under various loading conditions such as walking, marching, running, and landing after a jump etc.

Keywords: tarsals, metatarsals, phalanges, 3D scanning, finite element analysis

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Authors: Yash Bingi, Yiqiao Yin

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Reduction of child mortality is an ongoing struggle and a commonly used factor in determining progress in the medical field. The under-5 mortality number is around 5 million around the world, with many of the deaths being preventable. In light of this issue, Cardiotocograms (CTGs) have emerged as a leading tool to determine fetal health. By using ultrasound pulses and reading the responses, CTGs help healthcare professionals assess the overall health of the fetus to determine the risk of child mortality. However, interpreting the results of the CTGs is time-consuming and inefficient, especially in underdeveloped areas where an expert obstetrician is hard to come by. Using a support vector machine (SVM) and oversampling, this paper proposed a model that classifies fetal health with an accuracy of 99.59%. To further explain the CTG measurements, an algorithm based on Randomized Input Sampling for Explanation ((RISE) of Black-box Models was created, called Feature Alteration for explanation of Black Box Models (FAB), and compared the findings to Shapley Additive Explanations (SHAP) and Local Interpretable Model Agnostic Explanations (LIME). This allows doctors and medical professionals to classify fetal health with high accuracy and determine which features were most influential in the process.

Keywords: machine learning, fetal health, gradient boosting, support vector machine, Shapley values, local interpretable model agnostic explanations

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Authors: Anita Burgund Isakov, Cristina Nunes, Nevenka Zegarac, Ana Antunes

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Contemporary societies are facing a noticeable shift in family realities, urging to need for the development of new policies, service, and practice orientation that has application across different sectors who serves families with children across the world. A challenge for the field of family support is diversity in conceptual assumptions and epistemological frameworks. Since many disciplines and professionals are working in the family support field, there is a need to map and gain a deeper insight into the skills for the workforce in this field. Under the umbrella of the COST action 'The Pan-European Family Support Research Network: A bottom-up, evidence-based and multidisciplinary approach', a review of the current state of knowledge published from the European studies on family support workforce skills standards is performed. Contributing to the aim of mapping and catalogization of skills standards, key stages of literature review were identified in order to extract and systematize the data. We have considered inclusion and exclusion criteria for this literature review. Inclusion criteria were: a) families living with their children and families using family support services; different methodological approaches were included: qualitative, quantitative, mix method, literature review and theoretical reflections various topic appeared in journals like working with families that are facing difficulties or culturally sensitive practice and relationship-based approaches; b) the dates ranged from 1995 to February 2020. Articles published prior to 1995 were excluded due to modernization of family support services across world; c) the sources and languages included peer-reviewed articles published in scientific journals in English. Six databases were searched and once we have extracted all the relevant papers (n=29), we searched the list of reference in each and we found 11 additional papers. In total 40 papers have been extracted from six data basis. Findings could be summarized in: 1) only five countries emerged with production in the specific topic, that is, workforce skills to family support (UK, USA, Canada, Australia, and Spain), 2) studies revealed that diverse skills support family topics were investigated, namely the professional support skills to help families of neglected/abused children or in care; the professional support skills to help families with children who suffer from behavioral problems and families with children with disabilities; and the professional support skills to help minority ethnic parents, 3) social workers were the main targeted professionals' studies albeit other child protection workers were studied too, 4) the workforce skills to family support were grouped in three topics: the qualities of the professionals (attitudes and attributes); technical skills, and specific knowledge. The framework of analyses, literature strategy and findings with study limitations will be further discussed. As an implication, this study contributes and advocates for the structuring of a common base for cross-sectoral and interdisciplinary qualification standards for the family support workforce.

Keywords: family support, skill standards, systemic review, workforce

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Authors: Yi-Fan Lin, Peter P. Howley, Frank A. Tuyl

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Quality measurement and reporting systems are used in healthcare internationally. In Australia, the Australian Council on Healthcare Standards records and reports hundreds of clinical indicators (CIs) nationally across the healthcare system. These CIs are measures of performance in the clinical setting, and are used as a screening tool to help assess whether a standard of care is being met. Existing analysis and reporting of these CIs incorporate Bayesian methods to address sampling variation; however, such assessments are retrospective in nature, reporting upon the previous six or twelve months of data. The use of Bayesian methods within statistical process control for monitoring systems is an important pursuit to support more timely decision-making. Our research has developed and assessed a new graphical monitoring tool, similar to a control chart, based on the beta-binomial posterior predictive (BBPP) distribution to facilitate the real-time assessment of health care organizational performance via CIs. The BBPP charts have been compared with the traditional Bernoulli CUSUM (BC) chart by simulation. The more traditional “central” and “highest posterior density” (HPD) interval approaches were each considered to define the limits, and the multiple charts were compared via in-control and out-of-control average run lengths (ARLs), assuming that the parameter representing the underlying CI rate (proportion of cases with an event of interest) required estimation. Preliminary results have identified that the BBPP chart with HPD-based control limits provides better out-of-control run length performance than the central interval-based and BC charts. Further, the BC chart’s performance may be improved by using Bayesian parameter estimation of the underlying CI rate.

Keywords: average run length (ARL), bernoulli cusum (BC) chart, beta binomial posterior predictive (BBPP) distribution, clinical indicator (CI), healthcare organization (HCO), highest posterior density (HPD) interval

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Authors: Izabela Nowicka, Jacek Dworzecki

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The paper will be presented to selected legal and organizational solutions for the prevention and combating of terrorism by the police in Poland. Development will include information on the organization and functioning of the police anti-terrorist sub-units, whose officers are on the front line of the fight against terrorism. They will be presented to the conditions and cases of use of firearms by police officers in the course of special operations aimed against organizations and terrorist groups, and the perpetrators of criminal acts of terrorism as well as the legal foundation for the Polish police to take immediate counterterrorism operations. Article will be prepared in the context of an international research project entitled. Understand the Dimensions of Organised Crime and Terrorist Networks for Developing Effective and Efficient Security Solutions for First-line-practitioners and Professionals [Project: H2020-FCT-2015, No: 700688].

Keywords: the fight against terrorism, police, Poland, takedown

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Authors: Ruth Green, Samantha Milton, Rinal Desai

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Background/Aims: Eye pain/swelling/redness is a common presentation to Barnet General Hospital (a district general hospital), pediatric emergency department, and is managed by both the pediatric and emergency teams. The management of each child differs dramatically depending on the healthcare professional who reviews them. There also appears to be confusion in diagnosis between periorbital cellulitis, pre-septal cellulitis, and orbital cellulitis. Pre septal cellulitis refers to an inflammation of the eyelids and soft tissue anterior to the orbital septum. In contrast, orbital cellulitis is a serious, rapidly progressive infection of soft tissues located posterior to the orbital septum. Pre-septal cellulitis is more prevalent and less serious than orbital cellulitis, although it may be part of a continuous spectrum if untreated. Pre-septal cellulitis should there be diagnosed and treated urgently to prevent spread to the septum. For the purpose of the audit, the term periorbital cellulitis has been used as an umbrella term for all spectrums of this infection. The audit aimed to look at, how as a whole, the department is diagnosing and managing orbital and pre-septal cellulitis. Gold Standard: Patients of the same age and diagnosis should be treated with the same medication, advice, and follow-up. Method: Data was collected retrospectively from pediatric patients ( < 18years) who attended the emergency department from June 2019 to February 2020 who had been coded as pre-septal cellulitis, periorbital cellulitis, orbital cellulitis, or eye pain/swelling/redness. Demographics, signs and symptoms, management, and follow-up were recorded for all patients with any of the diagnoses of pre-septal, periorbital, or orbital cellulitis. A Microsoft Excel spreadsheet was used to record the anonymised data. Results: There were vast discrepancies in the diagnosis, management, and follow-up of patients with periorbital cellulitis. Conclusion/Discussion: The audit concluded there is no uniform approach to managing periorbital cellulitis in Barnet General Hospital Paediatric Emergency Department. Healthcare professionals misdiagnosed conjunctivitis as periorbital cellulitis, and adequate steps did not appear to be documented on excluding red flag signs and symptoms of patients presenting. There was no consistency in follow-up, with some patients having timely phone reviews or clinical reviews for mild symptoms. Advice given by the staff was appropriate, and patients did return when symptoms got worse and were treated accordingly. Plan: Given the inconsistency, a gold standard care pathway or local easily accessible clinical guideline can be developed to help with the diagnosis and management of periorbital cellulitis. Along with this, a teaching session can be carried out for the staff of the pediatric team and emergency department to disseminate the teaching. Following the introduction of a guideline and teaching sessions, patients notes can be re-reviewed to check improvement in patient care.

Keywords: periorbital cellulitis, preseptal cellulitis, orbital cellulitis, erythematous eyelid

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Authors: Abdulrahman Algaeed

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The Ophthalmic Ultrasound is the easiest method of early diagnosing Retinoblastoma after clinical examination. It can be done with ease without sedation. King Khaled Eye Specialist Hospital is a tertiary care center where Retinoblastoma patients are often seen and treated there. The first modality to rule out the disease is Ophthalmic Ultrasound. Classic Retinoblastoma is easily diagnosed by using the conventional 10MHz Ophthalmic Ultrasound probe in the regular clinic setup. Retinal lesion with multiple, very highly reflective surfaces within lesion typical of Calcium deposits. The use of Standardized A-scan is very useful where internal reflectivity is classified as very highly reflective. Color Doppler is extremely useful as well to show the blood flow within lesion/s. In conclusion: Ophthalmic Ultrasound should be the first tool to be used to diagnose Retinoblastoma after clinical examination. The accuracy of the Exam is very high.

Keywords: doppler, retinoblastoma, reflectivity, ultrasound

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Authors: Aneta Nitsch-Osuch, Katarzyna Zycinska, Ewa Gyrczuk, Agnieszka Topczewska-Cabanek, Kazimierz Wardyn

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Introduction: Influenza is an important clinical and epidemiological problem and should be considered as a possible nosocomial infection. The aim of the study was to determine the influenza vaccine coverage rates among Polish nurses and to find out drivers and barriers for influenza vaccination among this group of health care workers (HCWs). Material and methods: The self- fulfilled survey with 26 questions about the knowledge, perception, and influenza coverage rates was distributed among 461 nurses. Results: Only 15% of nurses were vaccinated against influenza in the consecutive seasons. The majority (75%) of the regularly vaccinated nurses were ambulatory careworkers. The difference between the number of vaccinated hospitals and ambulatory care nurses was statistically significant (p < 0.05). The main motivating factors for an influenza vaccination were: a fear of the illness and its complications (97%) and a free of charge vaccine available at the workplace (87%). Ambulatory care nurses more often declared that they were vaccinated mainly to protect themselves while hospital care nurses more often declared the will to protect their patients, these differences in the perception and attitudes to an influenza vaccination among hospital and ambulatory care nurses were statistically significant (p < 0.05). The main barriers for an influenza vaccination among the nursing staff were: a lack of reimbursement of the vaccine (95%), a lack of insufficient knowledge about the effectiveness, and safety of the influenza vaccine (54%). The ambulatory care nurses more often found influenza vaccination as the ethical duty compared to hospital care nurses (p < 0.05). Conclusions: The influenza vaccine coverage rates among the Polish nurses are low and must be improved in the future. More educational activities dedicated to HCWs may result in the increased awareness of influenza vaccination benefits for both medical professionals and patients.

Keywords: influenza, vaccination, nurses, ambulatory careworkers

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Authors: Natalie Tyldesley-Marshall, Janette Parr, Anna Brown, Yen-Fu Chen, Amy Grove

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It is widely recognised in policy and research that the provision of services for children and young people (CYP) with Special Educational Needs and Disabilities (SEND) is enhanced when health and social care, and education services collaborate and interact effectively. In the UK, there have been significant changes to policy and provisions which support and improve collaboration. However, professionals responsible for implementing these changes face multiple challenges, including a lack of specific implementation guidance or framework to illustrate how effective multi-agency working could or should work. This systematic review will identify the key components of effective multi-agency working in services for CYP with SEND; and the most effective forms of partnership working in this setting. The review highlights interventions that lead to service improvements; and the conditions in the local area that support and encourage success. A protocol was written and registered with PROSPERO registration: CRD42022352194. Searches were conducted on several health, care, education, and applied social science databases from the year 2012 onwards. Citation chaining has been undertaken, as well as broader grey literature searching to enrich the findings. Qualitative, quantitative, mixed methods studies and systematic reviews were included, assessed independently, and critically appraised or assessed for risk of bias using appropriate tools based on study design. Data were extracted in NVivo software and checked by a more experienced researcher. A convergent segregated approach to synthesis and integration was used in which the quantitative and qualitative data were synthesised independently and then integrated using a joint display integration matrix. Findings demonstrate the key ingredients for effective partnership working for services delivering SEND. Interventions deemed effective are described, and lessons learned across interventions are summarised. Results will be of interest to educators and health and social care professionals that provide services to those with SEND. These will also be used to develop policy recommendations for how UK healthcare, social care, and education services for CYP with SEND aged 0-25 can most effectively collaborate and achieve service improvement. The review will also identify any gaps in the literature to recommend areas for future research. Funding for this review was provided by the Department for Education.

Keywords: collaboration, joint commissioning, service delivery, service improvement

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Authors: Ben Clapperton, Daniel Stahl, Kimberley Goldsmith, Trudie Chalder

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Chronic fatigue syndrome (CFS) is a condition characterised by chronic disabling fatigue and other symptoms that currently can't be explained by any underlying medical condition. Although clinical trials support the effectiveness of cognitive behaviour therapy (CBT), the success rate for individual patients is modest. Patients vary in their response and little is known which factors predict or moderate treatment outcomes. The aim of the project is to develop a prediction model from baseline characteristics of patients, such as demographics, clinical and psychological variables, which may predict likely treatment outcome and provide guidance for clinical decision making and help clinicians to recommend the best treatment. The project is aimed at identifying subgroups of patients with similar baseline characteristics that are predictive of treatment effects using modern cluster analyses and data mining machine learning algorithms. The characteristics of these groups will then be used to inform the types of individuals who benefit from a specific treatment. In addition, results will provide a better understanding of for whom the treatment works. The suitability of different clustering methods to identify subgroups and their response to different treatments of CFS patients is compared.

Keywords: chronic fatigue syndrome, latent class analysis, prediction modelling, self-organizing maps

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Authors: Tris Kee

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As the urban design discipline develops renewed interests in participatory design and collaborative place-making, it becomes critical to review the potential and limitations in current processes to ensure a sustainable method for future development.This paper explores how collaborative design can be a key to future sustainable urban development through two case studies from Asia.The process involves a multi-disciplinary collaboration and an innovative learning process by sharing ideas as well as careful consideration on social, economic and political circumstances among government and district stakeholders.This intrinsic proposition of innovative participatory planning implies interdisciplinary collaboration between professionals and local residents to integrate knowledge into new urban place-making thinking.Design innovation in contemporary society can manifest itself in the discourse sustainable urban development by bottom-up planning and community driven design. This paper examines the emerging design pedagogy which promotes interdisciplinary coalition of professionals and local stakeholders in community development as an innovative design rubric to create a sustainable urban approach.Through two case studies in Hong Kong, this paper reviews and critically evaluates the process of how the notion of sustainable development in contemporary urban planning theory is underpinned by the collaborative design practice.

Keywords: collaborative design, design innovation, sustainable development, urban development

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Authors: Chaliya Wamaloon, Malee Chaisaena, Nusara Prasertsri

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Informal caregivers providing home-based palliative and end-of-life (EOL) care to people with advanced cancer is needed, however, there has not been develop caregiver skills for the EOL in cancer patients. The aim of this research was to study the model development of caregiver skills for the EOL in cancer patients. Mixed methods research was conducted in 3 phases. All subjects were in Ubon Rathchathani Cancer Hospital including 30 EOL cancer patient caregivers, 30 EOL cancer patients, and 111 health care professionals who provided care for the EOL cancer patients and 30 EOL target participants who had been trained to be cancer patient caregivers. The research tools were questionnaires, semi structured interviews, and caregiver skills questionnaires. Data were analyzed by using percentage, mean, standard deviation, pair t-test, and content analysis. The result from this study showed the model development of caregiver skills for cancer patients consisted of 9 domains skills: 1. monitoring, 2. interpreting, 3. making decisions, 4. taking action, 5. making adjustments, 6. providing hands-on care, 7. accessing resources, 8. working together with the ill patients, and 9. navigating the healthcare system. The model composed of skills development curriculum for cancer patient caregivers, Manual of palliative care for caregivers, diary of health care records for cancer patients, and the evaluation model of development of caregiver skills for EOL cancer patients. The results of the evaluation in the development model of caregiver skills for EOL cancer patients showed that the caregivers were satisfied with the model of development for caregiver skills at a high level. The comparison of the caregiver skills before and after obtaining the development of caregivers skills revealed that it improved at a statistically significant level (p < 0.05).

Keywords: caregiver, caregiver skills, cancer patients, end of life

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Authors: Jaseel C. K., Surya M.

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The study explored the post-traumatic growth experiences among divorcees. Although research studies on post-traumatic growth (PTG) are not few in number, the ones conducted in the population are quite rare and lack depth as most of them were solely dependent on the post-traumatic growth inventory scale and its statistical analyses. A total of 10 participants were interviewed (telephonic) using a semi-structured interview schedule prepared based on the research questions and the theoretical framework of post traumatic growth. The interviews were analyzed using thematic analysis, which generated five major themes and 17 subthemes. From the analysis, it was found that enhanced interpersonal relationships, changed perceptions about love and marriage, better management of emotions, prioritization of self, increased pro-social behavior, better character strengths, etc., are the most prominent positive shifts in the lives of divorcees. It was also found that factors like good relationships, professional support, work engagement, response to social stigma, and time facilitated post-traumatic growth in the population. Another interesting finding that came out of the study was that socio-economic status, educational background, and occupational status all have a positive impact on the PTG experiences among the divorced. The results of the study can hopefully help professionals working with divorcees to impart positivity to them and facilitate post-traumatic growth.

Keywords: divorcees, meaning making, positive changes, post traumatic growth, trauma

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Authors: Mohammad Qasim Mohammadi, Mohammad Arif Rohman

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Although socially sustainable building is becoming increasingly popular worldwide, past studies indicate that when policymakers support sustainable building development, the social dimension is often given insufficient attention or entirely disregarded. There are not many studies that focus on the problems of socially sustainable buildings in Afghanistan. This research investigates the factors that may hinder social sustainability implementation in residential building construction. The study will gather data from construction professionals by purposive sampling and employ Exploratory Factor Analysis (EFA) and Varimax for analysis. The results will undergo rigorous examination and thorough discussion. The expected results in this research will analyze the underlying barrier structure (factors) that hinder social sustainability, and each of these factors will represent a set of observed variables. In addition, the factor loadings show which barriers pose the greatest challenges. The primary goal of this study is to provide valuable insights into the impediment factors of social sustainability within the residential building environment, aiming to inform decision-making in the industry and encourage the adoption of more socially sustainable construction practices.

Keywords: social sustainability, residential building, barriers, drivers, afghanistan, factor analysis

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Authors: Poh Im. Lim, Hillary Yee Qin. Tan

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Nowadays, going green has become a trend, and being emphasized in the construction industry. In Malaysia, there are several green rating tools available in the industry and among these, GBI and GreenRE are considered as the most common tools adopted for residential buildings. However, being green is not equal to or making something sustainable. Being sustainable is to take economic, environmental and social aspects into consideration. This is particularly essential in the affordable housing sector as the end-users belong to lower-income and places importance on many socio-economic needs beyond the environmental criteria. This paper discusses the arguments in proposing a sustainability framework that is tailor-made for high-rise affordable housing. In-depth interviews and observation mapping methods were used in gathering inputs from the end-users, non-governmental organisations (NGOs) as well as the professionals. ‘Bottom-up’ approach was applied in this research to show the significance of participation from the local community in the decision-making process. The proposed sustainability framework illustrates the discrepancies between user priorities and what the industry is providing. The outcome of this research suggests that integrating sustainability into high-rise affordable housing is achievable and beneficial to the industry, society, and the environment.

Keywords: green building rating tools, high-rise affordable housing, sustainability framework, sustainable development

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Authors: Peter Collett, Mike Pynn, Haseeb Ur Rahman

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For the last few years across the UK there has been a push towards implementing treatment escalation plans (TEP) for every patient admitted to hospital. This is a paper form which is completed by a junior doctor then countersigned by the consultant responsible for the patient's care. It is designed to address what level of care is appropriate for the patient in question at point of entry to hospital. It helps decide whether the patient would benefit for ward based, high dependency or intensive care. They are completed to ensure the patient's best interests are maintained and aim to facilitate difficult decisions which may be required at a later date. For example, a frail patient with significant co-morbidities, unlikely to survive a pathology requiring an intensive care admission is admitted to hospital the decision can be made early to state the patient would not benefit from an ICU admission. This decision can be reversed depending on the clinical course of the patient's admission. It promotes discussions with the patient regarding their wishes to receive certain levels of healthcare. This poster describes the steps taken in the Aneurin Bevan University Health Board (ABUHB) when implementing the TEP form. The team implementing the TEP form campaigned for it's use to the board of directors. The directors were eager to hear of experiences of other health boards who had implemented the TEP form. The team presented the data produced in a number of health boards and demonstrated the proposed form. Concern was raised regarding the legalities of the form and that it could upset patients and relatives if the form was not explained properly. This delayed the effectuation of the TEP form and further research and discussion would be required. When COVID 19 reached the UK the National Institute for Health and Clinical Excellence issued guidance stating every patient admitted to hospital should be issued a TEP form. The TEP form was accelerated through the vetting process and was approved with immediate effect. The TEP form in ABUHB has now been in circulation for a month. An audit investigating it's uptake and a survey gathering opinions have been conducted.

Keywords: acute medicine, clinical governance, intensive care, patient centered decision making

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Authors: Mani Venkatesh, Catarina Delgado, Purvishkumar Patel

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The sustainable supply chain is gaining popularity among practitioners because of increased environmental degradation and stakeholder awareness. On the other hand supply chain, risk management is very crucial for the practitioners as it potentially disrupts supply chain operations. Prediction and addressing the risk caused by social issues in the supply chain is paramount importance to the sustainable enterprise. More recently, the usage of Big data analytics for forecasting business trends has been gaining momentum among professionals. The aim of the research is to explore the application of big data, predictive analytics in successfully mitigating supply chain social risk and demonstrate how such mitigation can help in achieving sustainability (environmental, economic & social). The method involves the identification and validation of social issues in the supply chain by an expert panel and survey. Later, we used a case study to illustrate the application of big data in the successful identification and mitigation of social issues in the supply chain. Our result shows that the company can predict various social issues through big data, predictive analytics and mitigate the social risk. We also discuss the implication of this research to the body of knowledge and practice.

Keywords: big data, sustainability, supply chain social sustainability, social risk, case study

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Authors: Anastasia V. Lazareva

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Nowadays in the light of the evolving multifocal challenges in the sphere of environmental and social difficulties and despite the strong opposition of globalist and anti-globalist movements, we are facing the urgent need of the creation of a vast pool of educated environmentalists through the implementation of relevant university faculties and programs. Considering the threats humanity has tackled these years portrayed in every tiny detail in AGENDA – 2030 –namely, poverty, biodiversity loss, marine and terrestrial pollution, lack of sanitation, and equal rights for all, we must admit that professionals are required to address them all. With this purpose, we have conducted research based on the questionnaires of students, faculty members, and companies’ chief executives and human resources managers on what particular disciplines should be incorporated into the programs in universities and higher institutions to meet the millennium goals and tests. The research is based on the Linkert scale and covers various age groups of students. The topicality of this issue is predetermined by modern reality. The subject of the research is a questionnaire database filled in by 97 students, 17 faculty members of MGIMO University, and 14 companies’ representatives concerning their attitudes towards the implementation of environmental programs of studies in universities and the choice of disciplines required. The study has a limitation -it is based only on one university students' and faculty members’ questionnaires. The methods applied are a questionnaire, content analysis, sampling, and categorization. The findings of this survey imply that all three groups of respondents admit the necessity of implementing environmental programs for studies in higher education. Nevertheless, different groups favor various programs and disciplines to be incorporated into the curriculum.

Keywords: ecology, university studies, environmentalists, education, global challenges

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Authors: Richard Okyere Boadu, Godwin Adzakpah, Nathan Kumasenu Mensah, Kwame Adu Okyere Boadu, Jonathan Kissi, Christiana Dziyaba, Rosemary Bermaa Abrefa

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Information and communication technology (ICT) has significantly advanced global healthcare, with electronic health (e-Health) applications improving health records and delivery. These innovations, including electronic health records, strengthen healthcare systems. The study investigates healthcare professionals' perceptions of health information applications and their associated factors in the Cape Coast Metropolis of Ghana's health facilities. Methods: We used a descriptive cross-sectional study design to collect data from 632 healthcare professionals (HCPs), in the three purposively selected health facilities in the Cape Coast municipality of Ghana in July 2022. Shapiro-Wilk test was used to check the normality of dependent variables. Descriptive statistics were used to report means with corresponding standard deviations for continuous variables. Proportions were also reported for categorical variables. Bivariate regression analysis was conducted to determine the factors influencing the Benefits of Information Technology (BoIT); Barriers to Information Technology Use (BITU); and Motives of Information Technology Use (MoITU) in healthcare delivery. Stata SE version 15 was used for the analysis. A p-value of less than 0.05 served as the basis for considering a statistically significant accepting hypothesis. Results: Healthcare professionals (HCPs) generally perceived moderate benefits (Mean score (M)=5.67) from information technology (IT) in healthcare. However, they slightly agreed that barriers like insufficient computers (M=5.11), frequent system downtime (M=5.09), low system performance (M=5.04), and inadequate staff training (M=4.88) hindered IT utilization. Respondents slightly agreed that training (M=5.56), technical support (M=5.46), and changes in work procedures (M=5.10) motivated their IT use. Bivariate regression analysis revealed significant influences of education, working experience, healthcare profession, and IT training on attitudes towards IT utilization in healthcare delivery (BoIT, BITU, and MoITU). Additionally, the age of healthcare providers, education, and working experience significantly influenced BITU. Ultimately, age, education, working experience, healthcare profession, and IT training significantly influenced MoITU in healthcare delivery. Conclusions: Healthcare professionals acknowledge moderate benefits of IT in healthcare but encounter barriers like inadequate resources and training. Motives for IT use include staff training and support. Bivariate regression analysis shows education, working experience, profession, and IT training significantly influence attitudes toward IT adoption. Targeted interventions and policies can enhance IT utilization in the Cape Coast Metropolis, Ghana.

Keywords: health information application, utilization of information application, information technology use, healthcare

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Authors: Mary Farrell, Maria Soubra, Sandra Vega, Dorothy Kakraba, Joanne Fontanilla, Moira Kendra, Danielle Tonzola, Stephanie Chiu

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Pneumonia is the most common infectious cause of hospitalizations in the United States, with more than one million admissions annually and costs of $10 billion every year, making it the 8th leading cause of death. Aspiration pneumonia is an aggressive type of pneumonia that results from inhalation of oropharyngeal secretions and/or gastric contents and is preventable. The authors hypothesized that an evidence-based aspiration pneumonia clinical care pathway could reduce 30-day hospital readmissions and mortality rates, while improving the overall care of patients. We conducted a retrospective chart review on 979 patients discharged with aspiration pneumonia from January 2021 to December 2022 at Overlook Medical Center. The authors identified patients who were coded with aspiration pneumonia and/or stable sepsis. Secondarily, we identified 30-day readmission rates for aspiration pneumonia from a SNF. The Aspiration Pneumonia Clinical Care Pathway starts in the emergency department (ED) with the initiation of antimicrobials within 4 hours of admission and early recognition of aspiration. Once this is identified, a swallow test is initiated by the bedside nurse, and if the patient demonstrates dysphagia, they are maintained on strict nothing by mouth (NPO) followed by a speech and language pathologist (SLP) referral for an appropriate modified diet recommendation. Aspiration prevention techniques included the avoidance of straws, 45-degree positioning, no talking during meals, taking small bites, placement of the aspiration wrist band, and consuming meals out of the bed in a chair. Nursing education was conducted with a newly created online learning module about aspiration pneumonia. The authors identified 979 patients, with an average age of 73.5 years old, who were diagnosed with aspiration pneumonia on the index hospitalization. These patients were reviewed for a 30-day readmission for aspiration pneumonia or stable sepsis, and mortality rates from January 2021 to December 2022 at Overlook Medical Center (OMC). The 30-day readmission rates were significantly lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011). When evaluating the mortality rates in the pre and post intervention cohort the authors discovered the mortality rates were lower in the post intervention cohort (23.7% vs 22.4%, p = 0.61) Mortality among non-white (self-reported as non-white) patients were lower in the post intervention cohort (34.4% vs. 21.0% , p = 0.05). Patients who reported as a current smoker/vaper in the pre and post cohorts had increased mortality rates (5.9% vs 22%). There was a decrease in mortality for the male population but an increase in mortality for women in the pre and post cohorts (19% vs. 25%). The authors attributed this increase in mortality in the post intervention cohort to more active smokers, more former smokers, and more being admitted from a SNF. This research identified that implementation of an Aspiration Pneumonia Clinical Care Pathway showed a statistically significant decrease in readmission rates and mortality rates in non-whites. The 30-day readmission rates were lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011).

Keywords: aspiration pneumonia, mortality, quality improvement, 30-day pneumonia readmissions

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