Search results for: clinical quality and safety

Authors: Shalini Rankawat, Mansi Rankawat, Rahul Dubey, Mazad Zaveri

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Physiological signals such as electrocardiogram (ECG) and arterial blood pressure (ABP) in the intensive care unit (ICU) are often seriously corrupted by noise, artifacts, and missing data, which lead to errors in the estimation of heart rate (HR) and incidences of false alarm from ICU monitors. Clinical support in ICU requires most reliable heart rate estimation. Cardiac activity, because of its relatively high electrical energy, may introduce artifacts in Electroencephalogram (EEG), Electrooculogram (EOG), and Electromyogram (EMG) recordings. This paper presents a robust heart rate estimation method by detection of R-peaks of ECG artifacts in EEG, EMG & EOG signals, using energy-based function and a novel Signal Quality Index (SQI) assessment technique. SQIs of physiological signals (EEG, EMG, & EOG) were obtained by correlation of nonlinear energy operator (teager energy) of these signals with either ECG or ABP signal. HR is estimated from ECG, ABP, EEG, EMG, and EOG signals from separate Kalman filter based upon individual SQIs. Data fusion of each HR estimate was then performed by weighing each estimate by the Kalman filters’ SQI modified innovations. The fused signal HR estimate is more accurate and robust than any of the individual HR estimate. This method was evaluated on MIMIC II data base of PhysioNet from bedside monitors of ICU patients. The method provides an accurate HR estimate even in the presence of noise and artifacts.

Keywords: ECG, ABP, EEG, EMG, EOG, ECG artifacts, Teager-Kaiser energy, heart rate, signal quality index, Kalman filter, data fusion

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Authors: Nicolas Koslover, Tamara Levene

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Aims: Tonsilitis is one of the most common presentations to the A+E department. We aimed to assess whether patients presenting with tonsilitis are being managed in-line with current guidance. We then set out to educate A+E staff about tonsilitis management and then assessed for improvement in management. Methods: All patients presenting to A+E in one fortnight with a documented diagnosis of tonsilitis were included. We reviewed the notes to assess the choice of treatment in each case and whether a clinical score (CENTOR or FEVERPain score) was used to guide choice of treatment (in accordance with NICE guideline [NG84]). We designed and delivered an educational intervention for A+E staff covering tonsilitis guidelines. The audit was repeated two weeks later. Results: Over the study period, 49 patients were included; only 35% (n=17) had either a clinical score documented or had all components of a score recorded. In total, 39% (n=19) were treated with antibiotics. Of these, 63% (n=12) should not have been prescribed an antibiotic and 37% (n=7) were prescribed an inappropriate antibiotic. At re-audit, (n=50 cases), 58% (n=29) had a clinical score documented and 28% (n=14) were treated with antibiotics. Of these, 29% (n=4) should not have been prescribed antibiotics and 21% (n=3) were prescribed an inappropriate antibiotic. Thus, after this teaching session, there was a significant improvement in antibiotic prescribing practices (63% vs. 29%, p=0.026). Conclusions: A+E assessment and management of tonsilitis frequently deviated from guidelines, but a single teaching session vastly improved clinical scoring and antibiotic prescribing practices.

Keywords: tonsilitis, education, emergency medicine, ENT

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Authors: B. E. Narkhede, S. K. Mahajan, B. T. Patil, R. D. Raut

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Information quality is a major performance measure for an Enterprise Resource Planning (ERP) system of any firm. This study identifies various critical success factors of information quality. The effect of various critical success factors like project management, reengineering efforts and interdepartmental communications on information quality is analyzed using a multiple regression model. Here quantitative data are collected from respondents from various firms through structured questionnaire for assessment of the information quality, project management, reengineering efforts and interdepartmental communications. The validity and reliability of the data are ensured using techniques like factor analysis, computing of Cronbach’s alpha. This study gives relative importance of each of the critical success factors. The findings suggest that among the various factors influencing information quality careful reengineering efforts are the most influencing factor. This paper gives clear insight to managers and practitioners regarding the relative importance of critical success factors influencing information quality so that they can formulate a strategy at the beginning of ERP system implementation.

Keywords: Enterprise Resource Planning (ERP), information systems (IS), multiple regression, information quality

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Authors: Keenoo Bibi Sumera, Alsheikh Mona, Mubarak Jan Beebee Zeba Mahetaab

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Background: Due to the busy schedule of the practicing clinicians at the hospitals, students may not always be attended to, which is to their detriment. The clinicians at the hospitals are also not always acquainted with teaching and/or supervising students on their placements. Additionally, there is a high student-patient ratio. Since they are the prospective clinical doctors under training, they need to reach the competence levels in clinical decision-making skills to be able to serve the healthcare system of the country and to be safe doctors. Aims and Objectives: A reflective portfolio was used to provide a means for students to learn by reflecting on their experiences and obtaining continuous feedback. This practice is an attempt to compensate for the scarcity of lack of resources, that is, clinical placement supervisors and patients. It is also anticipated that it will provide learners with a continuous monitoring and learning gap analysis tool for their clinical skills. Methodology: A hardcopy reflective portfolio was designed and validated. The portfolio incorporated a mini clinical evaluation exercise (mini-CEX), direct observation of procedural skills and reflection sections. Workshops were organized for the stakeholders, that is the management, faculty and students, separately. The rationale of reflection was emphasized. Students were given samples of reflective writing. The portfolio was then implemented amongst the undergraduate medical students of years four, five and six during clinical clerkship. After 16 weeks of implementation of the portfolio, a survey questionnaire was introduced to explore how undergraduate students perceive the educational value of the reflective portfolio and its impact on their deep information processing. Results: The majority of the respondents are in MD Year 5. Out of 52 respondents, 57.7% were doing the internal medicine clinical placement rotation, and 42.3% were in Otorhinolaryngology clinical placement rotation. The respondents believe that the implementation of a reflective portfolio helped them identify their weaknesses, gain professional development in terms of helping them to identify areas where the knowledge is good, increase the learning value if it is used as a formative assessment, try to relate to different courses and in improving their professional skills. However, it is not necessary that the portfolio will improve the self-esteem of respondents or help in developing their critical thinking, The portfolio takes time to complete, and the supervisors are not useful. They had to chase supervisors for feedback. 53.8% of the respondents followed the Gibbs reflective model to write the reflection, whilst the others did not follow any guidelines to write the reflection 48.1% said that the feedback was helpful, 17.3% preferred the use of written feedback, whilst 11.5% preferred oral feedback. Most of them suggested more frequent feedback. 59.6% of respondents found the current portfolio user-friendly, and 28.8% thought it was too bulky. 27.5% have mentioned that for a mobile application. Conclusion: The reflective portfolio, through the reflection of their work and regular feedback from supervisors, has an overall positive impact on the learning process of undergraduate medical students during their clinical clerkship.

Keywords: Portfolio, Reflection, Feedback, Clinical Placement, Undergraduate Medical Education

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Authors: Elisa Maître

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The redeployment of tram networks in French cities has considerably modified public spaces and the way citizens use them. Above and beyond the image that trams have of contributing to the sustainable urban development, the question of safety for users in these spaces has not been studied much. This study is based on an analysis of use of public spaces laid out for trams, from the standpoint of legibility and safety concerns. The study also examines to what extent the complexity of the design process, with many interactions between numerous and varied players in this process has a role in the genesis of these problems. This work is mainly based on the analysis of links between the uses of these re-designed public spaces (through observations, interviews of users and accident studies) and the analysis of the design conditions and processes of the projects studied (mainly based on interviews with the actors of these projects). Practical analyses were based three points of view: that of the planner, that of the user (based on observations and interviews) and that of the road safety expert. The cities of Montpellier, Marseille and Nice are the three fields of study on which the demonstration of this thesis is based. On part, the results of this study allow showing that the insertion of tram poses some problems complication of public areas of French cities. These complications related to the restructuring of public spaces for the tram, create difficulties of use and safety concerns. On the other hand, interviews depth analyses, fully transcribed, have led us to develop particular dysfunction scenarios in the design process. These elements lead to question the way the legibility and safety of these new forms of public spaces are taken into account. Then, an in-depth analysis of the design processes of public spaces with trams systems would also be a way of better understanding the choices made, the compromises accepted, and the conflicts and constraints at work, weighing on the layout of these spaces. The results presented concerning the impact that spaces laid out for trams have on the difficulty of use, suggest different possibilities for improving the way in which safety for all users is taken into account in designing public spaces.

Keywords: public spaces, road layout, users, design process of urban projects

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Authors: Noel Paolo Domingo, James Paul Menina, Laurente Ferrer

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Most people were forced to stay at home and limit their physical contact during the COVID-19 pandemic. Due to the situation, strict implementation of government policies and safety protocols encouraged consumers to utilize cashless or digital transactions through e-wallets. In this study, the researchers aim to investigate the efficiency of using e-wallets as a payment method during the COVID-19 pandemic in Marikina City. The study examined the efficiency of e-wallets in terms of Usefulness, Convenience, and Safety and Security based on respondents’ assessment. Questionnaires developed by the researchers were distributed to a total of 400 e-wallet users in Marikina City aged 15 years old and above to gather data by using a purposive sampling technique. The data collected was processed using SPSS version 26. Frequency, percentage, and mean were utilized to describe the profile of respondents and their assessment of e-wallets in terms of the three constructs. ANOVA and t-tests were also employed to test the significant differences in the respondent’s assessment when the demographic profile was considered. The study revealed that when it comes to usefulness, e-wallet is efficient while in terms of convenience, and safety and security, e-wallet has been proven to be very efficient. During the COVID-19 pandemic, utilizing e-wallets has been embraced by most consumers. By enhancing its features, more people will be satisfied with using e-wallets.

Keywords: efficiency of e-wallets, usefulness, convenience, safety and security

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Authors: Samart Homthong, Wutthipong Moungnoi

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Critical success factors (CSFs) and the criteria to measure project success have received much attention over the decades and are among the most widely researched topics in the context of project management. However, although there have been extensive studies on the subject by different researchers, to date, there has been little agreement on the CSFs. The aim of this study is to identify the CSFs that influence the performance of construction projects, and determine their relative importance for different objectives across five stages in the project life cycle. A considerable literature review was conducted that resulted in the identification of 179 individual factors. These factors were then grouped into nine major categories. A questionnaire survey was used to collect data from three groups of respondents: client representatives, consultants, and contractors. Out of 164 questionnaires distributed, 93 were returned, yielding a response rate of 56.7%. Using the mean score, relative importance index, and weighted average method, the top 10 critical factors for each category were identified. The agreement of survey respondents on those categorised factors were analysed using Spearman’s rank correlation. A one-way analysis of variance was then performed to determine whether the mean scores among the various groups of respondents were statistically significant. The findings indicate the most CSFs in each category in procurement phase are: proper procurement programming of materials (time), stability in the price of materials (cost), and determining quality in the construction (quality). They are then followed by safety equipment acquisition and maintenance (health and safety), budgeting allowed in a contractual arrangement for implementing environmental management activities (environment), completeness of drawing documents (productivity), accurate measurement and pricing of bill of quantities (risk management), adequate communication among the project team (human resource), and adequate cost control measures (client satisfaction). An understanding of CSFs would help all interested parties in the construction industry to improve project performance. Furthermore, the results of this study would help construction professionals and practitioners take proactive measures for effective project management.

Keywords: critical success factors, procurement phase, project life cycle, project performance

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Authors: Spira A., Marabelle A., Kientop D., Moser E., Mumm J.

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Background: Both interleukin-2 (IL-2) and interleukin-10 (IL-10) have been extensively studied for their stimulatory function on T cells and their potential to obtain sustainable tumor control in RCC, melanoma, lung, and pancreatic cancer as monotherapy, as well as combination with PD-1 blockers, radiation, and chemotherapy. While approved, IL-2 retains significant toxicity, preventing its widespread use. The significant efforts undertaken to uncouple IL-2 toxicity from its anti-tumor function have been unsuccessful, and early phase clinical safety observed with PEGylated IL-10 was not met in a blinded Phase 3 trial. Deka Biosciences has engineered a novel molecule coupling wild-type IL-2 to a high affinity variant of Epstein Barr Viral (EBV) IL-10 via a scaffold (scFv) that binds to epidermal growth factor receptors (EGFR). This patented molecule, termed DK210 (EGFR), is retained at high levels within the tumor microenvironment for days after dosing. In addition to overlapping and non-redundant anti-tumor function, IL-10 reduces IL-2 mediated cytokine release syndrome risks and inhibits IL-2 mediated T regulatory cell proliferation. Methods: DK210 (EGFR) is being evaluated in an open-label, dose-escalation (Phase 1) study with 5 (0.025-0.3 mg/kg) monotherapy dose levels and (expansion cohorts) in combination with PD-1 blockers, or radiation or chemotherapy in patients with advanced solid tumors overexpressing EGFR. Key eligibility criteria include 1) confirmed progressive disease on at least one line of systemic treatment, 2) EGFR overexpression or amplification documented in histology reports, 3) at least a 4 week or 5 half-lives window since last treatment, and 4) excluding subjects with long QT syndrome, multiple myeloma, multiple sclerosis, myasthenia gravis or uncontrolled infectious, psychiatric, neurologic, or cancer disease. Plasma and tissue samples will be investigated for pharmacodynamic and predictive biomarkers and genetic signatures associated with IFN-gamma secretion, aiming to select subjects for treatment in Phase 2. Conclusion: Through successful coupling of wild-type IL-2 with a high affinity IL-10 and targeting directly to the tumor microenvironment, DK210 (EGFR) has the potential to harness IL-2 and IL-10’s known anti-cancer promise while reducing immunogenicity and toxicity risks enabling safe concomitant cytokine treatment with other anti-cancer modalities.

Keywords: cytokine, EGFR over expression, interleukine-2, interleukine-10, clinical trial

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Authors: Baskar Kotte

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Many organizations are constantly striving to implement numerous techniques for long-term sustainability, for food related organizations it is imperative to conceptualize the critical concepts which constitute food safety sustainability. This presentation provides three critical pillars to develop a sustainable organization. Financial sustainability, regulatory sustainability and excellence standards sustainability are the three components which practiced and implemented effectively with process performance metrics defined objectives and targets lead to sustainable and safe food organizations. The participants take away a well-developed concept diagram with all elements impacting sustainability. Proven disciplined path which worked to achieve desired results is presented for effective implementation. Effective implementation of this proven disciplined path positions organizations to achieve world class status with bottomline improvement. Additionally, this presentation highlights critical terms, principles and implementation difficulties related to using the proven disciplined path. This presentation is beneficial for business leaders, food safety compliance managers, food safety practitioners, financial managers, Lean & Six sigma continual improvement managers, BRC/SQF/ IFS / FSSC 22000 practitioners and food manufacturing personnel.

Keywords: food safety, sustainability, regulatory, lean, six sigma, bottom-line improvement disciplined path

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Authors: Petar Dobrev

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There is no agreed-upon definition of firm quality. While profitability and stock performance often qualify as popular proxies of quality, in this project, we aim to identify quality without relying on a firm’s financial statements or stock returns as selection criteria. Instead, we use firm-level data on management practices across small to medium-sized U.S. manufacturing firms from the World Management Survey (WMS) to measure firm quality. Each firm in the WMS dataset is assigned a mean management score from 0 to 5, with higher scores identifying better-managed firms. This management score serves as our proxy for firm quality and is the sole criteria we use to separate firms into portfolios comprised of high-quality and low-quality firms. We define high-quality (low-quality) firms as those firms with a management score of one standard deviation above (below) the mean. To study whether this proxy for firm quality can identify better-performing firms, we link this data to Compustat and The Center for Research in Security Prices (CRSP) to obtain firm-level data on financial performance and monthly stock returns, respectively. We find that from 1999 to 2019 (our sample data period), firms in the high-quality portfolio are consistently more profitable — higher operating profitability and return on equity compared to low-quality firms. In addition, high-quality firms also exhibit a lower risk of bankruptcy — a higher Altman Z-score. Next, we test whether the stocks of the firms in the high-quality portfolio earn superior risk-adjusted excess returns. We regress the monthly excess returns on each portfolio on the Fama-French 3-factor, 4-factor, and 5-factor models, the betting-against-beta factor, and the quality-minus-junk factor. We find no statistically significant differences in excess returns between both portfolios, suggesting that stocks of high-quality (well managed) firms do not earn superior risk-adjusted returns compared to low-quality (poorly managed) firms. In short, our proxy for firm quality, the WMS management score, can identify firms with superior financial performance (higher profitability and reduced risk of bankruptcy). However, our management proxy cannot identify stocks that earn superior risk-adjusted returns, suggesting no statistically significant relationship between managerial quality and stock performance.

Keywords: excess stock returns, management, profitability, quality

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Authors: Khawla Hlel

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Purpose: This study aims to examine whether critical audit matters (CAM) affect financial information quality. We also investigate the moderating role of the audit committee on the association between CAM and financial information quality. Design/Methodology/Approach: The analysis is based on GLS and GMM regressions explaining the absolute value of discretionary accruals by using 52 Tunisian listed firms on the Tunisia Stock Exchange (TSE) for the period 2017-2020. Findings: We find evidence that managers react to the CAM by increasing the quality of financial disclosures. This study provides insights into how a change in the auditor’s report model might impact the quality of financial information. It suggests that external auditors and audit committees serve as a beneficial mechanism for enhancing financial information quality by reducing information asymmetry. In addition, our results indicate that CAM is an efficient monitoring mechanism that increases financial reporting quality and supervises managers. Originality: This study is important for potential investors who should assess CAM when evaluating firms. Furthermore, the authors expect the findings to be interesting to firms, as this study highlights the effectiveness of the auditor in reducing managerial opportunistic behavior and improving information quality. The results could encourage audit regulators to ameliorate the standards, as this research reinforces the role of the auditor in increasing the quality of financial disclosure by offering the required information for shareholders.

Keywords: critical audit matters, audit committee, information quality, Tunisian firms

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Authors: Moshiur Rahman, Tahmida Jakia

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Bangladesh, a densely populated South Asian country is home to more than 160 million people. In two decades ago, the people of this developing nation drank heavily contaminated surface water. Over the past thirty years, the country, and its development partners, has undertaken extensive efforts to provide microbiologically safe groundwater based drinking water through the use of tube-wells. About 85% of the people now drink tube-well water from about 11 million tube-wells/hand pumps. However, diarrhoeal and other water-related diseases are still reported among the major causes of morbidity and mortality among Bangladeshi children. This implies that the mode of transmission of pathogens through water and/or other modes continue. In addition, massive scale arsenic contamination has been recently reported in the ground water. Thirty five million people may be at risk of consuming arsenic contaminated water exceeding 0.05 mg/l in Bangladesh. Drinking of arsenic contaminated water has been linked with skin problems, cancer, cardiovascular diseases, neurological diseases, eye problems, cancer of the internal organs, and other diseases. In the study area, Narail district, recent investigations about existing water quality situations indicated presence of low to high levels of arsenic, salinity, iron, manganese and bacteriological contamination risks. As challenges for safe water exist; it is likely that sanitation and food hygiene practices are poor which lead threat to ensure food security.The main attempt of this study is to find out the challenges to ensure food security andprovide probable solutions to ensure food safety towards 0.7 million of people in study area. A survey has been conducted at Lohagara and Kalia sub district of Narail district with a pretested questionnaire. Primary data are collected through a questionnaire, while secondary data are collected from pertinent offices as well as academic journals. FGD has also been done to know the knowledge regarding water, sanitation as well as food preparation and consumption practice of community people in study area. The major focus of this study is to assess the state of sanitation and food hygiene condition of rural people. It is found that most of the villagers have lack of knowledge about food safety. Open defecation rate is high which lead threat to ensure food security.

Keywords: food safety, challenges, hygiene, Bangladesh

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Authors: Priti Saha, Biswajit Paul

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Rapid urbanization and industrialization have increased the demand of groundwater. However, the present era has evident an enormous level of groundwater pollution. Therefore, water quality assessment is paramount importance to evaluate its suitability for drinking, irrigation and industrial use. This study focus to evaluate the groundwater quality of an industrial city in eastern India through interdisciplinary techniques. The multi-purpose Water Quality Index (WQI) assess the suitability for drinking as well as irrigation of forty sampling locations, where 2.5% and 15% of sampling locations have excellent water quality (WQI:0-25) as well as 15% and 40% have good quality (WQI:25-50), which represents its suitability for drinking and irrigation respectively. However, the industrial water quality was assessed through Ryznar Stability Index (LSI), which affirmed that only 2.5% of sampling locations have neither corrosive nor scale forming properties (RSI: 6.2-6.8). These techniques with the integration of geographical information system (GIS) for spatial assessment indorsed its effectiveness to identify the regions where the water bodies are suitable to use for drinking, irrigation as well as industrial activities. Further, the sources of these contaminants were identified through factor analysis (FA), which revealed that both the geogenic as well as anthropogenic sources were responsible for groundwater pollution. This research demonstrates the effectiveness of statistical and GIS techniques for the analysis of environmental contaminants.

Keywords: groundwater, water quality analysis, water quality index, WQI, factor analysis, FA, spatial assessment

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Authors: Salwa M. Almomen, Mona A. Almaghrabi, Saja M. Alhabardi, Adel A. Alrwisan

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Background: Hepatotoxicity is a major reason for medication withdrawal from the markets. Unfortunately, serious adverse hepatic effects can occur after marketing with limited indicators during clinical development. Therefore, finding possible predictors for hepatotoxicity might guide the monitoring program of various stakeholders. Methods: We examined the clinical review documents for drugs approved in the US from 2011 to 2016 to evaluate their hepatic safety profile. Predictors: we assessed whether these medications meet Hy’s Law with hepatotoxicity grade ≥ 3, labeled hepatic adverse effects at approval, or accelerated approval status. Outcome: post-marketing regulatory action related to hepatotoxicity, including product withdrawal or updates to warning, precaution, or adverse effects sections. Statistical analysis: drugs were included in the analysis from the time of approval until the end of 2019 or the first post-marketing regulatory action related to hepatotoxicity, whichever occurred first. The hazard ratio (HR) was estimated using Cox-regression analysis. Results: We included 192 medications in the study. We classified 48 drugs as having grade ≥ 3 hepatotoxicities, 43 had accelerated approval status, and 74 had labeled information about hepatotoxicity prior to marketing. The adjusted HRs for post-marketing regulatory action for products with grade ≥ 3 hepatotoxicity was 0.61 (95% confidence interval [CI], 0.17-2.23), 0.92 (95%CI, 0.29-2.93) for a drug approved via accelerated approval program, and was 0.91 (95%CI, 0.33-2.56) for drugs with labeled hepatotoxicity information at approval time. Conclusion: This study does not provide conclusive evidence on the association between post-marketing regulatory action and grade ≥ 3 hepatotoxicity, accelerated approval status, or availability of labeled information at approval due to sampling size and channeling bias.

Keywords: accelerated approvals, hepatic adverse effects, drug-induced liver injury, hepatotoxicity predictors, post-marketing withdrawal

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Authors: Naufal Ahmad Rijalul Alam

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This article presents a quality of education for the poor people in Indonesia and the offering of strategy to be done. It also investigates the influence of Islamic Education which stands behind the religious values in developing effort of government to respond the problem with using humanities approaches in medium society. The offering strategy resulted in four agenda: 1) building a shared commitment, 2) encouraging the improvement of the quality of public and private schools, 3) encouraging the use of 'the indicator of disaffection' for gifted children, and 4) encouraging the enlargement of vocational training centers and polytechnics. The conclusion is that the quality of education can be increased with these four agenda, although they are not too easy because it deals with other factors such as the economy, politics, and culture which is happening in the country.

Keywords: quality education, poor people, strategy of Islamic education, medium community

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Authors: Vivian Isaac, A. T. Joteeshwaran, Craig McLachlan

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The University of New South Wales (UNSW) Rural Clinical School has a strategic collaborative focus on chronic disease and public health. Our objectives are to understand rural environmental and biological interactions in vulnerable community populations. The UNSW Rural Clinical School translational model is a spoke and hub network. This spoke and hub model connects rural data and biological specimens with city based collaborative public health research networks. Similar spoke and hub models are prevalent across research centers in India. The Australia-India Council grant was awarded so we could establish sustainable public health and community research collaborations. As part of the collaborative network we are developing strategies around data and biological sharing platforms between Indian Institute of Public Health, Public Health Foundation of India (PHFI), Hyderabad and Rural Clinical School UNSW. The key objective is to understand how research collaborations are conducted in India and also how data can shared and tracked with external collaborators such as ourselves. A framework to improve data sharing for research collaborations, including DNA was proposed as a project outcome. The complexities of sharing biological data has been investigated via a visit to India. A flagship sustainable project between Rural Clinical School UNSW and PHFI would illustrate a model of data sharing platforms.

Keywords: data sharing, collaboration, public health research, chronic disease

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Authors: Omar Masaud Almrhag, Frage Lhadi Abookleesh

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Different types of food like banana, potato and chicken affect the quality of oil during deep fat frying. The changes in the quality of oil were evaluated and compared. Four different types of edible oils, namely, corn oil, soybean, canola, and palm oil were used for deep fat frying at 180°C ± 5°C for 5 h/d for six consecutive days. A potato was sliced into 7-8 cm length wedges and chicken was cut into uniform pieces of 100 g each. The parameters used to assess the quality of oil were total polar compound (TPC), iodine value (IV), specific extinction E1% at 233 nm and 269 nm, fatty acid composition (FAC), free fatty acids (FFA), viscosity (cp) and changes in the thermal properties. Results showed that, TPC, IV, FAC, Viscosity (cp) and FFA composition changed significantly with time (P< 0.05) and type of food. Significant differences (P< 0.05) were noted for the used parameters during frying of the above mentioned three products.

Keywords: frying potato, chicken, frying deterioration, quality of oil

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Authors: Rafael Andres Rincon Barrera

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Safety in global aviation plays a preponderant role in organizations that seek to avoid accidents in an attempt to preserve their most precious assets (the people and the machines). Human factors-based programs have shown to be effective in managing human-generated risks. The importance of training on human factors in maintenance has not been indifferent to the Colombian Air Force (COLAF). This research, which has a mixed quantitative, qualitative and descriptive approach, deals with its absence of structuring an instruction program in Human Factors in Aeronautical Maintenance, which serves as a tool to improve Operational Safety in the military air units of the COLAF. Research shows the trends and evolution of human factors programs in aeronautical maintenance through the analysis of a data matrix with 33 sources taken from different databases that are about the incorporation of these types of programs in the aeronautical industry in the last 20 years; as well as the improvements in the operational safety process that are presented after the implementation of these ones. Likewise, it compiles different normative guides in force from world aeronautical authorities for training in these programs, establishing a matrix of methodologies that may be applicable to develop a training program in human factors in maintenance. Subsequently, it illustrates the design, validation, and development of a human factors knowledge measurement instrument for maintenance at the COLAF that includes topics on Human Factors (HF), Safety Management System (SMS), and aeronautical maintenance regulations at the COLAF. With the information obtained, it performs the statistical analysis showing the aspects of knowledge and strengthening the staff for the preparation of the instruction program. Performing data triangulation based on the applicable methods and the weakest aspects found in the maintenance people shows a variable crossing from color coding, thus indicating the contents according to a training program for human factors in aeronautical maintenance, which are adjusted according to the competencies that are expected to be developed with the staff in a curricular format established by the COLAF. Among the most important findings are the determination that different authors are dealing with human factors in maintenance agrees that there is no standard model for its instruction and implementation, but that it must be adapted to the needs of the organization, that the Safety Culture in the Companies which incorporated programs on human factors in maintenance increased, that from the data obtained with the instrument for knowledge measurement of human factors in maintenance, the level of knowledge is MEDIUM-LOW with a score of 61.79%. And finally that there is an opportunity to improve Operational Safety for the COLAF through the implementation of the training program of human factors in maintenance for the technicians working in this area.

Keywords: Colombian air force, human factors, safety culture, safety management system, triangulation

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Authors: Isa Usman Balan, Umar Aliyu, Ahmad Tijjani Muhammed

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The laboratory scale experiment was conducted to determine the phytochemical constituents and antibacterial activities of epiphytic neem leaves (Tapinanthusdodoneifolius) extracts on some selected clinical isolates. The samples were collected using polythene bags to avoid unnecessary contamination of the plants, and they were collected from the old site garden of the BUK. The phytochemical screening and antibacterial test were carried out in the Chemistry and Biology laboratory, respectively at Bayero University Kano (BUK). The result obtained showed that carbohydrates, glycosides, steroids, alkaloids, phenol, saponins and flavonoids are present in the ethanolic extract. However, chloroform extract showed only glycosides, phenols, and carbohydrates. Furthermore, there was no significant difference between the ethanolic extracts and bacterial isolates (p<0.05).

Keywords: phytochemical screening, antibacterial, clinical isolates, epiphytic neem leaves, Tapinanthus dodoneifolius

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Authors: Malki Fatima Zahra Nadia, Kellal Cheiimaa, Brahimi Houria

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Total Quality Management (TQM) is one of the most important modern management systems in marketing, that help organizations to survive and remain competitive in the dynamic market with frequent changes. It assists them in gaining a competitive advantage, growth, and excellence compared to their competitors. To understand the impact of TQM on competitive advantage in economic companies, a study was conducted in Ooredoo Telecommunications Company. A questionnaire was designed and distributed to OOredoo' 75 employees in each of the departments of leadership, quality assurance, quality control, research and development, production, customer service, Similarly, resulting in the retrieval of 72 questionnaires. To analyze the descriptive results of the study, the SPSS software version 25 was used. Additionally, Structural Equation Modeling (SEM) with the help of Smart Pls4 software was utilized to test the study's hypotheses. The study concluded that there is an impact between total quality management and competitive advantage in Ooredoo company to different degrees. On this basis, the study recommended the need to implement the total quality management system at the level of all organizations and in various fields.

Keywords: total quality management, ISO system, competitive advantage, competitive strategies

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Authors: M. Saba, A. Iaaly, E. Carlier, N. Georges

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This research focuses on assessing the ground water quality of Northern Lebanon affected by saline water intrusion. The chemical, physical and microbiological parameters were collected in various seasons spanning over the period of two years. Results were assessed using Geographic Information System (GIS) due to its visual capabilities in presenting the pollution extent in the studied region. Future projections of the excessive pumping were also simulated using GIS in order to assess the extent of the problem of saline intrusion in the near future.

Keywords: GIS, saline water, quality control, drinkable water quality standards, pumping

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Authors: Anastasia Constantinou, Stephen Morris

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Background: The adoption of synchronous and asynchronous telemedicine modalities for primary care consultations has exponentially increased since the COVID-19 pandemic. However, there is limited understanding of how virtual consultations influence healthcare resource utilization and other quality measures including safety, timeliness, efficiency, patient and provider satisfaction, cost-effectiveness and environmental impact. Aim: Quantify the rate of follow-up visits, emergency department visits, hospitalizations, request for investigations and prescriptions and comment on the effect on different quality measures associated with different telemedicine modalities used for primary care services and primary care referrals to secondary care Design and setting: Systematic review in primary care Methods: A systematic search was carried out across three databases (Medline, PubMed and Scopus) between August and November 2023, using terms related to telemedicine, general practice, electronic referrals, follow-up, use and efficiency and supported by citation searching. This was followed by screening according to pre-defined criteria, data extraction and critical appraisal. Narrative synthesis and metanalysis of quantitative data was used to summarize findings. Results: The search identified 2230 studies; 50 studies are included in this review. There was a prevalence of asynchronous modalities in both primary care services (68%) and referrals from primary care to secondary care (83%), and most of the study participants were females (63.3%), with mean age of 48.2. The average follow-up for virtual consultations in primary care was 28.4% (eVisits: 36.8%, secure messages 18.7%, videoconference 23.5%) with no significant difference between them or F2F consultations. There was an average annual reduction of primary care visits by 0.09/patient, an increase in telephone visits by 0.20/patient, an increase in ED encounters by 0.011/patient, an increase in hospitalizations by 0.02/patient and an increase in out of hours visits by 0.019/patient. Laboratory testing was requested on average for 10.9% of telemedicine patients, imaging or procedures for 5.6% and prescriptions for 58.7% of patients. When looking at referrals to secondary care, on average 36.7% of virtual referrals required follow-up visit, with the average rate of follow-up for electronic referrals being higher than for videoconferencing (39.2% vs 23%, p=0.167). Technical failures were reported on average for 1.4% of virtual consultations to primary care. When using carbon footprint estimates, we calculate that the use of telemedicine in primary care services can potentially provide a net decrease in carbon footprint by 0.592kgCO2/patient/year. When follow-up rates are taken into account, we estimate that virtual consultations reduce carbon footprint for primary care services by 2.3 times, and for secondary care referrals by 2.2 times. No major concerns regarding quality of care, or patient satisfaction were identified. 5/7 studies that addressed cost-effectiveness, reported increased savings. Conclusions: Telemedicine provides quality, cost-effective, and environmentally sustainable care for patients in primary care with inconclusive evidence regarding the rates of subsequent healthcare utilization. The evidence is limited by heterogeneous, small-scale studies and lack of prospective comparative studies. Further research to identify the most appropriate telemedicine modality for different patient populations, clinical presentations, service provision (e.g. used to follow-up patients instead of initial diagnosis) as well as further education for patients and providers alike on how to make best use of this service is expected to improve outcomes and influence practice.

Keywords: telemedicine, healthcare utilisation, digital interventions, environmental impact, sustainable healthcare

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Authors: Jinan Fiaidhi, Hashmath Shaik

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Breaking the barrier for practicing evidence-based medicine relies on effective methods for rapidly identifying relevant evidence from the body of biomedical literature. An important challenge confronted by medical practitioners is the long time needed to browse, filter, summarize and compile information from different medical resources. Deep learning can help in solving this based on automatic question answering (Q&A) and transformers. However, Q&A and transformer technologies are not trained to answer clinical queries that can be used for evidence-based practice, nor can they respond to structured clinical questioning protocols like PICO (Patient/Problem, Intervention, Comparison and Outcome). This article describes the use of deep learning techniques for Q&A that are based on transformer models like BERT and GPT to answer PICO clinical questions that can be used for evidence-based practice extracted from sound medical research resources like PubMed. We are reporting acceptable clinical answers that are supported by findings from PubMed. Our transformer methods are reaching an acceptable state-of-the-art performance based on two staged bootstrapping processes involving filtering relevant articles followed by identifying articles that support the requested outcome expressed by the PICO question. Moreover, we are also reporting experimentations to empower our bootstrapping techniques with patch attention to the most important keywords in the clinical case and the PICO questions. Our bootstrapped patched with attention is showing relevancy of the evidence collected based on entropy metrics.

Keywords: automatic question answering, PICO questions, evidence-based medicine, generative models, LLM transformers

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Authors: Yoftahe Nigussie Worku

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This research focuses on advancing fire tube boiler technology by systematically optimizing design parameters to achieve efficient saturated steam production. The main objective is to design a high-performance boiler with a production capacity of 2000kg/h at a 12-bar design pressure while minimizing costs. The methodology employs iterative analysis, utilizing relevant formulas, and considers material selection and production methods. The study successfully results in a boiler operating at 85.25% efficiency, with a fuel consumption rate of 140.37kg/hr and a heat output of 1610kW. Theoretical importance lies in balancing efficiency, safety considerations, and cost minimization. The research addresses key questions on parameter optimization, material choices, and safety-efficiency balance, contributing valuable insights to fire tube boiler design.

Keywords: safety consideration, efficiency, production methods, material selection

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Authors: Ishmael Ntlhamu

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In Limpopo Province, the use of herbal concoctions is becoming very popular. These concoctions are claimed to be capable of treating ulcers, diabetes, certain STDs, blood cleansing, and many more types of diseases. The aim of this study was to evaluate the phytochemical composition, evaluate the pharmacological effects and consumption safety in herbal concoctions to treat various kinds of ailments in Limpopo. The concoctions were extracted with 80% acetone. Microorganisms in the concoctions were identified using the Vitek 2 compact system. Qualitative phytochemical analysis was determined using standard chemical tests and thin layer chromatography (TLC). Total polyphenol content was quantified. Antioxidant activity was quantified using 2, 2-diphenyl-1-picrylhydrazyl (DPPH) assay and ferric reducing power. Antimicrobial activities were determined using a broth micro-dilution assay and bioautography. Cell viability assay was used to determine the cytotoxicity. Results showed that concoctions had antioxidant activity. Presence of different phytoconstituents was observed. Isolated microorganisms were identified as Burkholderia pseudomallei, Staphylococcus vitulimus, Enterococcus columbae, Kocuria kristanae, Staphylococcus intermedius, Cryptococcus laurenti. and Burkholderia pseudomallei (highly pathogenic). Therefore, phytochemicals prove that the concoctions can heal as the antimicrobial tests also displayed activity. Moreover, the concoctions did not exhibit cytotoxic effects. However, contaminants raise concerns, not only for consumer safety but also the quality of herbal concoctions available as part of the traditional medicinal practice in Limpopo.

Keywords: antimicrobials, concoctions, cytotoxicity, phytochemicals

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Authors: Luziane De Fatima Kirchner, Maria De Jesus Dutra Dos Reis, Francine Nathalie Ferraresi Rodrigues Queluz

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This study evaluated the effect of two components of analytic-behavioral intervention (1-management of conditions of the physical environment, 2-management of the interpersonal relationship) of women with fibromyalgia (FM), besides Clinical Significance and Reliable Change at the end of the intervention. Self-report instruments were used to evaluate stress, anxiety, depression, social skills and disability due to pain and Cortisol Awakening Response (CAR). Four women with a medical diagnosis of FM (mean age 52.7; sd = 6.65), participated of the following procedures: initial evaluation, 10 sessions of component 1, intermediate evaluation, 10 sessions of component 2, and final evaluation. The 20 sessions were effective, with positive changes in the scores of all the self-report instruments, highlighting the results of the stress symptoms that had improvement in the intermediate evaluation. There was, however, no change in the cortisol response on awakening. The Clinical Significance or Reliable Change observed, according to the scores of the stress, anxiety, depression and social skills instruments, corroborated the reports of the participants in the session and the objectives of the treatment. Implications for future studies are discussed, above all, the importance in conducting evaluations with the use of direct measures together with self-report measures.

Keywords: behavioral intervention, clinical significance, fibromyalgia, reliable change

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Authors: Temitayo Olaitan

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There is a growing concern about the quality of Nigerian tertiary education. This paper maintains that quality in tertiary education relates to the development of intellectual independence, which sharpens the minds of the individual and helps transform the society economically, socially and politically. However, the paper underscores underfunding as a critical challenge to the quality of teaching and learning in tertiary education. To this end, this paper emphasizes the role of internally generated revenue (IGR) and other alternative funding strategies (public-private partnership) as inevitable for quality tertiary education. This paper hinges on stakeholders approach as a means of ensuring quality teaching and learning in tertiary education. This paper recommends that school managers should seek professional and more efficient ways of developing their revenue generating systems. It also recommends that institutions should restructure to accommodate an alternative funding strategy such as private/corporate sponsorship to ensure that sustainable initiatives are created. The paper concludes that Nigerian government should come up with a policy on how private sectors should support in improving the quality of tertiary education through active participation in funding and physical facilities development in Nigerian higher institutions of learning.

Keywords: alternative funding, budgetary allocation, quality education, tertiary education

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Authors: Ramya Rathan, Miral N. F. Salama

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The variations in the arteries have been drawing attention of anatomists for a long time because of their clinical significance. The brachial artery is the principal artery of the arm which is the continuation of the axillary artery from the lower border of the Teres Major. It terminates into the radial and ulnar arteries below the elbow joint at the neck radius. The present study aims at exploring the clinical significance of the high termination of the brachial artery. During the routine cadaveric dissection of the arm, for the undergraduate students of medicine at our university, we observed a high bifurcation of the radial and the ulnar artery at the midshaft of the humerus. The median nerve was seen passing between these two junctions. Further, the course and the relations of this artery were studied. The accurate knowledge regarding these kinds of variation in the blood vessels is mandatory for planning of designing. General physicians, surgeons and radiologists should keep in mind the variations in the branching pattern of the arteries in their daily medical, diagnostic and therapeutic procedures to avoid complications in diagnostic and surgical procedures.

Keywords: brachial artery, high termination, radial artery, ulnar artery

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Authors: Ulrica Pettersson

Abstract:

Collection of information on incidents is regularly done through pre-printed incident report forms. These tend to be incomplete and frequently lack essential information. ne consequence is that reports with inadequate information, that do not fulfil analysts’ requirements, are transferred into the analysis process. To improve an incident reporting form, theory in design science, witness psychology and interview and questionnaire research has been used. Previously three experiments have been conducted to evaluate the form and shown significant improved results. The form has proved to capture knowledge, regardless of the incidents’ character or context. The aim in this paper is to describe how design science, in more detail a design hierarchy can be used to construct a collection form for improvements in safety science.

Keywords: data collection, design science, incident reports, safety science

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Authors: Fadwa Chtioui

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Vital Pulp Therapy (VPT) is nowadays challenging the deep-rooted dogma of root canal treatment, being the only therapeutic option for permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure. Histologic and clinical research has shown that compromised dental pulp can be treated without the full removal or excavation of all healthy pulp, and the outcome of the partial or full pulpotomy followed by a Tricalcium-Silicate-based dressing seems to show promising results in maintaining pulp vitality and preserving affected teeth in the long term. By reviewing recent advances in the techniques of VPT and their clinical effectiveness and safety in permanent teeth with irreversible Pulpitis, this work provides a new understanding of pulp pathophysiology and defense mechanisms and will reform dental practitioners' decision-making in treating irreversible pulpits from root canal therapy to vital pulp therapy by taking advantage of the biological effects of Tricalcium Silicate materials. Biography of presenting author: Fadwa Chitoui graduated from the school of Dental Medicine of Monastir, Tunisia, in 2015. After getting her DDS degree with honors, she earned her Postgraduate master's Degree in Endodontics and Restorative Dentistry from her Faculty. Since 2021, she has Started her own private and specialized practice based in the capital Tunis. She enjoys the sphere of associative life, worked with national and international associations, and got engaged in scientific dental research, whereby she tailored her passion for her field of specialty towards broadening her knowledge and ambitions, holding conferences and workshops nationally and internationally and publishing scientific articles in several journals.

Keywords: irreversible pulpitis, permanenet teeth, vital pulp therapy, pulpotomy

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