Search results for: nursing record

Authors: Anketa Kumar, Rajantheran Al Muniandy, Rishabh Kumar

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For centuries, Indian costumes are admired for their great aesthetics, functional and narrative qualities. The purpose of the current study is to investigate the role of costumes as visual narratives in Hindi Cinema as Filmmaking is simply one of the most recent manifestations of the human desire to tell stories in which costume acts as a tool to be read as an Intertext by the viewers watching the films. The problem that promoted this study arose when clothes become an interesting topic when examined within the social structures in which they are worn. It is this visual image of dress worn by the character that is investigated in this research through Hindi Cinema of the 1960s, which was a reflection of the society in the realistic form. This research intends to integrate the application of Roland Barthes Semiotic theory in analyzing main movie characters in the National Award-Winning Hindi movie Mughal e Azam (1960). The research helps in filling the gap between the singular level of interpretation and another level that offers a solution towards bridging the gap in viewers' manifold interpretation of a particular movie product. This study focuses on how visual appearance communicates for building up of perception and can relate to notions of realism, defining cultural identity and status in the society. The research methodology is subjected analytical technique that employs in this research is qualitative and descriptive in nature with the use of the Freeze frame technique. The portrayal of costumes is explained with Barthes' principles of Semiotics. The freeze-frame technique stops the motion of the film on a single frame and allows the chosen image to be read as a still photograph. The finding during this research into costume portrayal in the movie was that freezing the frame in midst of running the films attracted attention towards intricate costume details, leading to record the nuanced observations of this minutiae during the movie. Given that during the application of interpretation while watching K Asif’s Mughal e Azam focused on certain aspects of costumes of the king. On the same idea, further research can be employed to strengthen the relation between costumes and visual narration.

Keywords: character portrayal, costumes, Indian cinema, semiotics, visual significance

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Authors: Poonam Goswami

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Background: The diagnosis of a serious illness like cancer can have an impact on a patient’s emotional well-being and may result in psychological symptoms, anxiety, depression, and loss of control. Advance care planning discussions ensure patients’ values and goals of care, including patients’ freedom to choose their place of death, are respected. Unfortunately, these discussions are often delayed and are not initiated early in patients’ cancer trajectory. As a result, patients’ wishes often remains unknown until the last phase of their life. Evidence suggests that many patients inappropriately receive aggressive treatment near the end of life, which does lead to higher resource utilization, decreased quality of life, and increased cost. Additionally, the novel coronavirus disease 2019 (COVID-19) pandemic challenged the health care systems worldwide and raised important ethical issues, especially regarding the potential need for rationing health care in the context of scarce resources and crisis capacity. The importance of goal concordant care is now even substantially important and is heightened in the context of this pandemic. Problem: Although there is growing evidence on the effects of the ACP on the completion of advanced directives, improved patient and family concordance for preferences for medical care, and receipt of care, there is still a lack of standardized ACP conversation strategies for patients with cancer. Methods: The Key concepts of ACP include (1) assessing patient and family readiness, (2) identifying a surrogate decision maker ( medical power of attorney), (3) exploring patient and family understanding of the disease and treatment options,(4) discussing the values and goals of care, and options for end-of-life care, (5) documenting patient preferences in the medical record, and (6) revisiting the discussions at every change in the treatment plan and /or change in clinical status, including at every hospitalization. Conclusion/Implication for practice: Advance Care Planning (ACP) and end-of-life (EOL) discussions are important for patients, families, and health care providers. Adopting the verbal and nonverbal communication strategies can help overcome the barriers to effective communication on these difficult discussions. ACP with goals of care discussions should not be delayed until the patient is hospitalized.

Keywords: advance care planning, end of life, cancer, global, pandemic

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Authors: Abhishek Oswal

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Background: Inconsistencies between the guidelines for childhood asthma can pose a diagnostic challenge to clinicians. NICE guidelines are the most commonly followed guidelines in primary care in the UK; they state that to be diagnosed with asthma, a child must be more than 5 years old and must have objective evidence of the disease. When diagnoses are coded in general practice (GP), these guidelines may be superseded by communications from secondary care. Hence it is imperative that diagnoses are correct, as per up to date guidelines and evidence, as this affects follow up and management both in primary and secondary care. Methods: A snapshot audit at a general practice surgery was undertaken of children (less than 16 years old) with a coded diagnosis of 'asthma', to review the age at diagnosis and whether any objective evidence of asthma was documented at diagnosis. 50 cases of asthma in children presenting to the emergency department (ED) were then audited to review the age at presentation, whether there was evidence of previous asthma diagnosis and whether the patient was discharged from ED. A repeat audit is planned in ED this winter. Results: In a GP surgery, there were 83 coded cases of asthma in children. 51 children (61%) were diagnosed under 5, with 9 children (11%) who had objective evidence of asthma documented at diagnosis. In ED, 50 cases were collected, of which 4 were excluded as they were referred to the other services, or for incorrect coding. Of the 46 remaining, 27 diagnoses confirmed to NICE guidelines (59%). 33 children (72%) were discharged from ED. Discussion: The most likely reason for the apparent low rate of a correct diagnosis is the significant challenge of obtaining objective evidence of asthma in children. There were a number of patients who were diagnosed from secondary care services and then coded as 'asthma' in GP, without having objective documented evidence. The electronic patient record (EPR) system used in our emergency department (ED) did not allow coding of 'suspected diagnosis' or of 'viral induced wheeze'. This may have led to incorrect diagnoses coded in primary care, of children who had no confirmed diagnosis of asthma. We look forward to the re-audit, as the EPR system has been updated to allow suspected diagnoses. In contrast to the NICE guidelines used here, British Thoracic Society (BTS) guidelines allow for a trial of treatment and subsequent confirmation of diagnosis without objective evidence. It is possible that some of the cases which have been classified as incorrect in this audit may still meet other guidelines. Conclusion: The diagnosis of asthma in children is challenging. Incorrect diagnoses may be related to clinical pressures and the provision of services to allow compliance with NICE guidelines. Consensus statements between the various groups would also aid the decision-making process and diagnostic dilemmas that clinicians face, to allow more consistent care of the patient.

Keywords: asthma, diagnosis, primary care, emergency department, guidelines, audit

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Authors: Calassandra Nwokoro

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Introduction: The nursing profession requires a lot of commitment, effort, and time to efficiently manage patients and provide them quality healthcare services, this work load may eventually cause the nurses to become burned out and experience psychological distress. This study assessed the prevalence of burnout, risk factors, and the coping strategies among nurses working in Lagos University Teaching Hospital (LUTH), Lagos state, Nigeria. Methodology: A descriptive cross-sectional study design was conducted among 308 nurses working in LUTH. Simple random sampling was used in selection of study respondents. The questionnaire comprised three parts; the sociodemographic characteristics of the respondents, the extent of burnout syndrome using the Maslach Burnout Inventory, and the coping strategies used among the respondents using the BRIEF-COPE Inventory. Results: This study revealed relatively high levels of burnout among the nurses in LUTH with a prevalence of 16.9%, 31.2% and 20.1% for high emotional exhaustion, high depersonalization and reduced professional accomplishment respectively. It also showed that burnout was significantly associated with long working hours. Religion was found to be the most commonly used coping strategy overall, while emotional support was the most frequently used coping strategy among nurses who had burnout. Conclusion: This study has revealed a relatively high prevalence of burnout among the nurses in Lagos University Teaching Hospital. In order to minimize the negative health impacts of burnout, the government should collaborate with psychologists and psychiatrists to implement regular stress management and stress inoculation programs for nurses and other health professionals in the country.

Keywords: burnout, nurses, coping strategies, healthcare

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Authors: Amir Mukhtar, Habib Nasir

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To achieve an enhanced range of large calibre artillery a base bleed unit equipped with ammonium perchlorate and hydroxyl-terminated polybutadiene (AP/HTPB) based composite propellant grain is installed at the bottom of a projectile which produces jet of hot gasses and reduces base drag during flight of the projectile. Upon leaving the muzzle at very high muzzle velocity, due to sudden pressure drop, the propellant grain gets quenched. Therefore, base-bleed unit is equipped with an igniter to ensure ignition as well as reignition of the propellant grain. Pyrotechnic compositions based on Zr/NH₄ClO₄ and Zr/KClO₄ mixtures have been studied for the effect of fuel/oxidizer ratio and oxidizer type on ballistic properties. Calorific values of mixtures were investigated by bomb calorimeter, the average burning rate was measured by fuse wire technique at ambient conditions, and high-pressure closed vessel was used to record pressure-time profile, maximum pressure achieved (Pmax), time to achieve Pmax and differential pressure (dP/dt). It was observed that the 30, 40, 50 and 60 wt.% of Zr has a very significant effect on ballistic properties of mixtures. Compositions with NH₄ClO₄ produced higher values of Pmax, dP/dt and Calorific value as compared to Zr/KClO₄ based mixtures. Composition containing KClO₄ comparatively produced higher burning rate and maximum burning rate was recorded at 8.30 mm/s with 60 wt.% Zr in Zr/KClO₄ pyrotechnic mixture. Zr/KClO₄ with 50 wt. % of Zr was tests fired in igniter assembly by electric initiation method. Igniter assembly was test fired several times and average burning time of 3.5 sec with igniter mass burning rate of 6.85 g/sec was recorded. Igniter was finally fired on static and dynamic level with base bleed unit which gave successful ignition to the base bleed grain and extended range was achieved with 155 mm artillery projectile.

Keywords: base bleed, closed vessel, igniter, zirconium

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Authors: Nanyombi Lubimbi, Josette Niyokindi

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Background: As in many other developing countries in Africa, Rwanda suffers from a chronic shortage of skilled Health Care professionals including Clinical Instructors. This shortage negatively affects the clinical instruction quality therefore impacting student-learning outcomes. Due to poor clinical supervision, it is often noted that students have no structure or consistent guidance in their learning process. The Clinical Educators and the Rwandan counterparts identified the need to create a favorable environment for learning. Description: During orientation the expectations of the student learning process, collaboration of the clinical instructors with the nurses and Clinical Educators is outlined. The ward managers facilitate structured learning by helping the students identify a maximum of two patients using the school’s objectives to guide the appropriate selection of patients. Throughout the day, Clinical Educators with collaboration of Clinical Instructors when present conduct an ongoing assessment of learning and provide feedback to the students. Post-conference is provided once or twice a week to practice critical thinking skills of patient cases that they have been taking care of during the day. Lessons Learned: The students are found to be more confident with knowledge and skills gained during rotations. Clinical facility evaluations completed by students at the end of their rotations highlight the student’s satisfaction and recommendation for continuation of structured learning. Conclusion: Based on the satisfaction of both students and Clinical Instructors, we have identified need for structured learning during clinical rotations. We acknowledge that more evidence-based practice is necessary to effectively address the needs of nursing and midwifery students throughout the country.

Keywords: Rwanda, clinical rotation, structured learning, critical thinking skills, post-conference

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Authors: Nihar Bheda

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Protecting digital assets such as networks, systems, and data from advanced cyber threats is the aim of Digital Immunity Systems (DIS), which are a subset of cybersecurity. With features like continuous monitoring, coordinated reactions, and long-term adaptation, DIS seeks to mimic biological immunity. This minimizes downtime by automatically identifying and eliminating threats. Traditional security measures, such as firewalls and antivirus software, are insufficient for enterprises, such as healthcare providers, given the rapid evolution of cyber threats. The number of medical record breaches that have occurred in recent years is proof that attackers are finding healthcare data to be an increasingly valuable target. However, obstacles to enhancing security include outdated systems, financial limitations, and a lack of knowledge. DIS is an advancement in cyber defenses designed specifically for healthcare settings. Protection akin to an "immune system" is produced by core capabilities such as anomaly detection, access controls, and policy enforcement. Coordination of responses across IT infrastructure to contain attacks is made possible by automation and orchestration. Massive amounts of data are analyzed by AI and machine learning to find new threats. After an incident, self-healing enables services to resume quickly. The implementation of DIS is consistent with the healthcare industry's urgent requirement for resilient data security in light of evolving risks and strict guidelines. With resilient systems, it can help organizations lower business risk, minimize the effects of breaches, and preserve patient care continuity. DIS will be essential for protecting a variety of environments, including cloud computing and the Internet of medical devices, as healthcare providers quickly adopt new technologies. DIS lowers traditional security overhead for IT departments and offers automated protection, even though it requires an initial investment. In the near future, DIS may prove to be essential for small clinics, blood banks, imaging centers, large hospitals, and other healthcare organizations. Cyber resilience can become attainable for the whole healthcare ecosystem with customized DIS implementations.

Keywords: digital immunity system, cybersecurity, healthcare data, emerging technology

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Authors: Igor A. Bessmertny, Bidru C. Enkomaryam

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Active involving patients and communities in health decisions can improve both people’s health and the healthcare system. Adopting artificial intelligence can lead to more accurate and complete patient record management. This review aims to identify the current state of researches conducted using artificial intelligence techniques to improve patient engagement and wellbeing, medical domains used in patient engagement context, and lastly, to assess opportunities and challenges for patient engagement in the wellness process. A search of peer-reviewed publications, reviews, conceptual analyses, white papers, author’s manuscripts and theses was undertaken. English language literature published in 2013– 2022 period and publications, report and guidelines of World Health Organization (WHO) were also assessed. About 281 papers were retrieved. Duplicate papers in the databases were removed. After application of the inclusion and exclusion criteria, 41 papers were included to the analysis. Patient counseling in preventing adverse drug events, in doctor-patient risk communication, surgical, drug development, mental healthcare, hypertension & diabetes, metabolic syndrome and non-communicable chronic diseases are implementation areas in healthcare where patient engagement can be implemented using artificial intelligence, particularly machine learning and deep learning techniques and tools. The five groups of factors that potentially affecting patient engagement in safety are related to: patient, health conditions, health care professionals, tasks and health care setting. Active involvement of patients and families can help accelerate the implementation of healthcare safety initiatives. In sub-Saharan Africa, using digital technologies like artificial intelligence in patient engagement context is low due to poor level of technological development and deployment. The opportunities and challenges available to implement patient engagement strategies vary greatly from country to country and from region to region. Thus, further investigation will be focused on methods and tools using the potential of artificial intelligence to support more simplified care that might be improve communication with patients and train health care professionals.

Keywords: artificial intelligence, patient engagement, machine learning, patient involvement

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Authors: Petcharat  Kerdonfag, Surasak Taneepanichskul, Winai Wadwongtham

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Industrial noise is usually considered as the main impact of the environmental health and safety because its exposure can cause permanently serious hearing damage. Despite providing strictly hearing protection standards and campaigning extensively encouraging public health awareness among industrial workers in Thailand, hazard noise-induced hearing loss has dramatically been massive obstacles for workers’ health. The aims of the study were to explore and specify the hearing threshold levels among steel industrial workers responsible in which higher noise levels of work zone and to examine the relationships of hearing loss and workers’ age and the length of employment in Samut Prakan province, Thailand. Cross-sectional study design was done. Ninety-three steel industrial workers in the designated zone of higher noise (> 85dBA) with more than 1 year of employment from two factories by simple random sampling and available to participate in were assessed by the audiometric screening at regional Samut Prakan hospital. Data of doing screening were collected from October to December, 2016 by the occupational medicine physician and a qualified occupational nurse. All participants were examined by the same examiners for the validity. An Audiometric testing was performed at least 14 hours after the last noise exposure from the workplace. Workers’ age and the length of employment were gathered by the developed occupational record form. Results: The range of workers’ age was from 23 to 59 years, (Mean = 41.67, SD = 9.69) and the length of employment was from 1 to 39 years, (Mean = 13.99, SD = 9.88). Fifty three (60.0%) out of all participants have been exposing to the hazard of noise in the workplace for more than 10 years. Twenty-three (24.7%) of them have been exposing to the hazard of noise less than or equal to 5 years. Seventeen (18.3%) of them have been exposing to the hazard of noise for 5 to 10 years. Using the cut point of less than or equal to 25 dBA of hearing thresholds, the average means of hearing thresholds for participants at 4, 6, and 8 kHz were 31.34, 29.62, and 25.64 dB, respectively for the right ear and 40.15, 32.20, and 25.48 dB for the left ear, respectively. The more developing age of workers in the work zone with hazard of noise, the more the hearing thresholds would be increasing at frequencies of 4, 6, and 8 kHz (p =.012, p =.026, p =.024) for the right ear, respectively and for the left ear only at the frequency 4 kHz (p =.009). Conclusion: The participants’ age in the hazard of noise work zone was significantly associated with the hearing loss in different levels while the length of participants’ employment was not significantly associated with the hearing loss. Thus hearing threshold levels among industrial workers would be regularly assessed and needed to be protected at the beginning of working.

Keywords: hearing threshold levels, hazard of noise, hearing loss, audiometric testing

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Authors: Jitaree Tantiyasawatdikul, Bantita Jadnok, Sarunya Tijana

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Background: Nutritional status is an important factor before, during, and after an operation. It can help wound healing. If the patients have good nutritional status before and after an operation, wound healing can occur more easily. It can strengthen the immune system leading to decreased infection, reduced length of stay, and reducing the cost to patients and caregivers. Therefore, screening to evaluate the nutritional status of patients in 3B becomes the database for further developing the treatment and also will lead to excellent service from the interdisciplinary team. Objective: To study the nutritional status of patients in surgical ward 3B at Surgical and Orthopedics Nursing Division, Srinagarind Hospital. Method: A descriptive study, to evaluate the nutritional status of 86 patients admitted in 3B between October 2014 and March 2015.The instruments used in this study consisted of two parts: 1) personal data, 2) Screening nutritional status. The data were analyzed by percentage and mean. Results: A sample population of 86 patients aged 22-81 years old, mean age 52.59years, 90.69% are married, female were 55.81%, regular diet 70.93%, patients with no problem oral cavity was 87.21%.The sample population had high incidence of CA 47.67% and secondly cardiovascular disease 36.05 %. Patients with high-risk nutrition was 12.79 % including 45.45% cardiovascular disease and 36.36% CA. Screening of nutritional status of high-risk nutrition was 39.36% severe triceps skinfold (TSF), severe mid-arm muscle circumference(MAMC) 9.09% and severe total lymphocyte 39.36%. Conclusion: The result of nutritional status screening of surgical ward 3B found 12.79% patients with high-risk nutrition including 45.45% with cardiovascular disease .There was no problem with oral cavity and eating.

Keywords: nutritional status, screening, surgical patients, 3B ward, Srinagarind Hospital

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Authors: Beeto W. C. Leung, Nicole C. Y. Lee

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It was well known that college students experienced a high level of stress and anxiety. College athletes, a special group of college students, may even encounter a higher level of pressure and distress due to their dual endeavors in academic and athletic settings. Due to the high demands and costs of mental health services, easily accessible, web-based self-help interventions are getting more popular. The aim of the present experimental study was to examine the potential intervention effect of a mindfulness-based self-help mobile App, called 'Smiling Mind', on mindfulness and psychological well-being. Forty-six college athletes, recruited from athletic teams of two local universities in Hong Kong, were randomly assigned to the Mindfulness App Group (MAG) and the Control Group (CG). All participants were administered the Mindful Attention Awareness Scale, Geriatric Depression Scale, and Perceived Stress Scale-10 before the study (Time 1, T1) and after the 4-week intervention (Time 2, T2). MAG was requested to use the app and follow the instructions every day for at least 5 days per week. Participants were also asked to record their daily app usage time. Results showed that, for MAG, from T1 to T2, mindfulness has been increased from 3.25 to 3.92; depressive symptoms and stress has been significantly decreased from 8.6 to 5.1 and 24.8 to 13.5 respectively while for the CG, mindfulness has been decreased slightly from 3.29 to 3.13; depressive symptoms and stress has been slightly increased from 7.1 to 7.3 and 24.1 to 27.1 respectively. Three mixed-design ANOVAs with time (T1, T2) as the within-subjects factor and intervention group (MAG, CG) as the between-subjects factor revealed a main effect of time on mindfulness, F(1, 41) = 10.28, p < 0.01, depressive symptoms, F(1, 41) = 6.55, p < 0.02 and stress, F(1, 41) = 16.96, p < 0.001 respectively. Both predicted interaction between time and intervention group on mindfulness, F(1, 41) = 26.6, p < 0.001, ηp 2 =0.39, depressive symptoms, F(1, 41) = 8.00, p < 0.01, ηp 2 =0.16 and Stress F(1, 41) = 49.3, p < 0.001, ηp 2 =0.55 were significant meaning that participants using the Mindfulness Mobile App in the intervention did experienced a significant increase in mindfulness and significant decrease in depressive symptoms and perceived level of stress after the 4-week intervention when compared with the control group. The present study provided encouraging empirical support for using Smiling Mind, a self-help mobile app, to promote mindfulness and mental health in a cost-effective way. Further studies should examine the potential use of Smiling Mind in different samples, including children and adolescence, as well as, investigate the lasting effects of using the app on other psychosocial outcomes such as emotional regulations.

Keywords: college athletes, experimental study, mindfulness mobile apps, psychological well-being

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Authors: Jeanne Grace, Jacqueline Naiker

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Background: Longevity is increasing, accompanied by a rise in disability and chronic diseases with physical activity (PA) delaying disability, ensuring successful aging (SA) and independent living in older adults. Aim: This study aimed to determine objectively measured PA levels, health-related quality of life (HRQoL), life-space mobility, and successful aging (SA) of older adults in KwaZulu-Natal province, South Africa, as well as their mutual associations. Methods: A total of 210 older adults aged 65–92 years were purposively sampled and completed the Medical Outcomes Study 36-Item Short-Form Health Survey, the Life-Space Mobility, and Successful Aging questionnaires. PA levels were measured using an Omron Pedometer, which the participants wore for seven consecutive days. Results: The average number of steps taken per day for the seven days was 2025, with 98.6% of the entire study population classified as sedentary. The Vitality domain (one of 8 categorized) reflected the best health status (M = 59.9, SD ± 18.8), with a significant 93% of the participants indicating that they had not visited places outside their immediate neighborhood (P < 0.0005). A significant, negative association between the average number of steps taken in 7 days and all three SA variables – namely, the physical (r = –0.152, P = 0.027), sociological (r = –0.148, P = 0.032) and psychological (r = –0.176, P = 0.010), and a significant, positive association with life-space mobility (r = 0.224, P = 0.001) was noted. Conclusion: The majority of the elderly were sedentary, affecting their HRQoL, life-space mobility, and SA negatively.

Keywords: active life expectancy, geriatrics, nursing homes, well-being

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Authors: Maggie Hui

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Risk management is not a new concept; however, it is an uncharted area as applied to the translation process and translator training. Serving as one of the self-discovery activities in their practicum course, a two-cycle experiment was carried out with a class of 13 MA translation students with an attempt to explore their risk management while translating in a simulated setting that involves translator-client relations. To test the effects of the main variable of translators’ interaction with the simulated clients, the researcher employed control-group translators and two experiment groups (with Group A being the translator in Cycle 1 and the client in Cycle 2, and Group B on the client position in Cycle 1 and the translator position in Cycle 2). Experiment cycle 1 aims to explore if there would be any behavioral difference in risk management between translators with interaction with the simulated clients, i.e. experiment group A, and their counterparts without such interaction, i.e. control group. Design of Cycle 2 concerns the order of playing different roles of the translator and client in the experiment, and provides information to compare behavior of translators of the two experiment groups. Since this is process-oriented research, it is necessary to hypothesize what was happening in the translators’ minds. The researcher made use of a user-friendly screen-voice recording freeware to record subjects’ screen activities, including every word the translator typed and every change they made to the rendition, the websites they browsed and the reference tools they used, in addition to the verbalization of their thoughts throughout the process. The research observes the translation procedures subjects considered and finally adopted, and looks into the justifications for their procedures, in order to interpret their risk management. The qualitative and quantitative results of this study have some implications for translator training: (a) the experience of being a client seems to reinforce the translator’s risk aversion; (b) the use of role-playing simulation can empower students’ learning by enhancing their attitudinal or psycho-physiological competence, interpersonal competence and strategic competence; and (c) the screen-voice recordings serve as a helpful tool for learners to reflect on their rendition processes, i.e. what they performed satisfactorily and unsatisfactorily while translating and what they could do for improvement in future translation tasks.

Keywords: risk management, screen-voice recordings, simulated translator-client relations, translation pedagogy, translation process-oriented research

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Authors: Omkar More, Isha Saini, Gracy Mathai

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To study whether there is any clinical correlation between pterygium and dry eye and to evaluate the status of the tear film in patients with pterygium. Methods: 100 eyes with pterygium were compared with 100 control eyes without pterygium. Patients between 20 – 70 years were included in the study. A detailed history was taken and Schirmer’s test and TBUT were performed on all to evaluate the status of dry eye. Schirmer’s test ˂ 10 mm and TBUT ˂10 seconds was considered abnormal. Results: Maximum number (52) of patients affected by dry eye in both the groups were in the age group 31-40 years which statistically showed age as a significant factor of association for both pterygium and dry eye (P < 0.01).Schirmer’s test was slightly reduced in patients with pterygium(18.73±5.69 mm). TBUT was significantly reduced in the case group (12.26±2.24sec).TBUT decreased maximally in 51-60 yrs age group (13.00±2.77sec) with pterygium showing a tear film instability. On comparison of pterygia and controls with normal and abnormal tear film, Odd’s Ratio was 1.14 showing a risk of dry eye in pterygia patients to be 1.14 times higher than controls. Conclusion: Whether tear dysfunction is a precursor to pterygium growth or pterygium causes tear dysfunction is still not clear. Research and clinical evidence, however, suggest that there is a relationship between the two. This study is, therefore, undertaken to investigate the correlation between pterygium and dry eye. The patients with pterygia were compared with normals to evaluate their status regarding dryness. A close relationship exists between ocular irritation symptoms and functional evidence of tear instability. Schirmer’s test and TBUT should routinely be used in the outpatient department to diagnose dry eye in patients with pterygium and these patients should be promptly treated to prevent any sight-threatening complications.

Keywords: footfall, nursing assessment, quality improvement, six sigma

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Authors: Sung Hyun Kim

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Introduction: Sleep disturbance is common in children with developmental disorders (D.D.). Sleep disturbance has a variety of negative effects, such as behavior problems, medical problems, and even developmental problems in children with D.D. However, to our best knowledge, there has been no proper treatment for sleep disorders in children with D.D. Therefore, we conduct this study to know the positive effects of intensive rehabilitation therapy in children with D.D. on the degree of sleep disturbance. Method: We prospectively recruited 22 patients with a diagnosis of D.D. during the period of January 2022 through May 2022. The inclusion criteria were as follows: 1) a patient who would participate in the intensive rehabilitation therapy of our institution; 2) the age participant under 18 years at the time of assessment; 3) a child who has consented to participate in the study by signing the consent form by the legal guardian. We investigated the clinical characteristics of participants by the medical record, including sex, age, underlying diagnosis of D.D., and Gross Motor Function Measures (GMFM). Before starting the intensive rehabilitation therapy, we conducted a Sleep disturbance scale for children (SDSC). It contains 26 questions about children’s sleep, and those questions are grouped into six subscales, such as Disorders of initiating and maintaining sleep (DIMS), Sleep Breathing Disorders(SBD), Disorders of arousal(DOA), Sleep-Wake Transition Disorders(SWTD), Disorders of excessive somnolence(DOES) and Sleep Hyperhydrosis(SHY). We used the t-score, which was calculated by comparing the scores of normal children. Twenty two patients received 8 weeks of intensive rehabilitation, including daily physical and occupational therapy. After that, we did follow up with SDSC. The comparison between SDSC before and after intensive rehabilitation was calculated using the paired t-test, and P< 0.05 was considered statistically significant. Results: Demographic data and clinical characteristics of 22 patients are enrolled. Patients were 4.03 ± 2.91 years old, and of the total 22 patients, 14 (64%) were male, and 8 (36%) were female. Twelve patients(45%) were diagnosed with Cerebral palsy(C.P.), and the mean value of participants’ GMFM was 47.82 ± 20.60. Each mean value of SDSC’s subscales was also calculated. DIMS was 62.36 ± 13.72, SBD was 54.18 ± 8.39, DOA was 49.59 ± 7.01, SWTD was 58.95 ± 9.20, DOES was 53.09 ± 15.15, SHY was 52.14 ± 8.82, and the total was 59.86 ± 13.18. These values suggest that children with D.D. have sleep disorders. After 8 weeks of intensive rehabilitation treatment, the score of DIMS showed improvement(p=0.016), but not the other subscale and total score of SDSC. Conclusion: This result showed that intensive rehabilitation could be helpful to patients of D.D. with sleep disorders. Especially intensive rehabilitation therapy itself can be a meaningful treatment in inducing and maintaining sleep.

Keywords: sleep disorder, developmental delay, intensive rehabilitation therapy, cerebral palsy

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Authors: Adedeji S. Adegoke, Olakunle N. Popoola

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Promotion is indispensible and inestimable property of marketing through which different organizations persuade their prospective customers. The idea of passing information about a product to the consumer at outside the world is known as promotional activities. A study was determined whether there was relationship between promotional mix and consumer buying decision, that is may be customers were influenced by promotion. It was investigated to determine whether promotion can be used to influence competitors’ activities in the market and also research was conducted to determine if there was any problem encountered by Nigeria bottling company plc, in promoting its beverages products. The various forms of promotional mix available for an organization were examined and recommended the appropriate promotional mix that company can adopt to boost the company sales. The research design was depended on the primary and secondary data. The primary data were information collected from the subjects using methods of data collection, that is through the use of questionnaire, interview, direct observation, etc. The secondary data consist of information that already exists having been collected for another purpose by some researchers. These include internal and external sources. The questionnaire was designed and administered to the staff of production and marketing department of Nigeria bottling company plc., which served as the population of this study, out of which sample was drawn randomly from the population, using sample random technique. It was deduced that 90% of the respondents opined that advertising influenced competition in the market and that there was a good sale after they started advert while 10% of them were not sure. At advertising level, 85% of the respondents chose 81-100% as the increase in the percentage recorded in their sales level, while 10% of them agreed that increase in the percentage recorded in their sales was within 61-80% and 5% of them chose 45-60% as the percentage increase in their sales record. Due to unstable economic condition of the Nigeria, many business organizations adopted the promotional strategies. Apart from advertising, it was discovered through research that sales promotion served as an incentive to consumers of Nigeria bottling company plc at a time offer gifts and prizes to consumers which drastically increased their level of sales. Since advertising and sales promotion increased the level of sales, more money should be allocated for this purpose to maintain market share and thereby increase profit.

Keywords: consumer, marketing, organization, promotional mix

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Authors: Altab Hossain, Shakerul Islam, Golamur R. Khan, Abu Zafar M. Salahuddin

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An effective identification of breakdowns is of premier importance for the safe and reliable operation of Nuclear Power Plants (NPP) and its associated facilities. A great number of monitoring and diagnosis methodologies are applied and used worldwide in areas such as industry, automobiles, hospitals, and power plant to detect and reduce human disasters. The potential consequences of several hazardous activities may harm the society using nuclear and its associated facilities. Hence, one of the most popular and effective methods to ensure safety and monitor the entire nuclear facility and imply risk-free operation without human interference during the hazardous situation is using a robot. Therefore, in this study, an advanced autonomous robot has been designed and developed that can monitor several parameters in the NPP to ensure the safety and do some risky job in case of nuclear disaster. The robot consisted of autonomous track following unit, data processing and transmitting unit can follow a straight line and take turn as the bank greater than 90 degrees. The developed robot can analyze various parameters such as temperature, altitude, radiation, obstacle, humidity, detecting fire, measuring distance, ultrasonic scan and taking the heat of any particular object. It has an ability to broadcast live stream and can record the document to its own server memory. There is a separate control unit constructed with a baseboard which processes the recorded data and a transmitter which transmits the processed data. To make the robot user-friendly, the code is developed such a way that a user can control any of robotic arm as per types of work. To control at any place and without the track, there is an advanced code has been developed to take manual overwrite. Through this process, administrator who has logged in permission to Dynamic Host Client Protocol (DHCP) can make the handover of the control of the robot. In this process, this robot is provided maximum nuclear security from being hacked. Not only NPP, this robot can be used to maximize the real-time monitoring system of any nuclear facility as well as nuclear material transportation and decomposition system.

Keywords: nuclear power plant, radiation, dynamic host client protocol, nuclear security

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Authors: S. Haider, B. Bhushan

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Eye Gaze behaviour of individuals with and without intellectual disability are investigated in an eye tracking study in terms of sensitivity to Nonaccidental (NAPs) and Metric (MPs) shape properties. Total fixation time is used as an indirect measure of attention allocation. Studies have found Mean reaction times for non accidental properties (NAPs) to be shorter than for metric (MPs) when the MP and NAP differences were equalized. METHODS: Twenty-five individuals with intellectual disability (mild and moderate level of Mental Retardation) and twenty-seven normal individuals were compared on mean total fixation duration, accuracy level and mean reaction time for mild NAPs, extreme NAPs and metric properties of images. 2D images of cylinders were adapted and made into forced choice match-to-sample tasks. Tobii TX300 Eye Tracker was used to record total fixation duration and data obtained from the Areas of Interest (AOI). Variable trial duration (total reaction time of each participant) and fixed trail duration (data taken at each second from one to fifteen seconds) data were used for analyses. Both groups did not differ in terms of fixation times (fixed as well as variable) across any of the three image manipulations but differed in terms of reaction time and accuracy. Normal individuals had longer reaction time compared to individuals with intellectual disability across all types of images. Both the groups differed significantly on accuracy measure across all image types. Normal individuals performed better across all three types of images. Mild NAPs vs. Metric differences: There was significant difference between mild NAPs and metric properties of images in terms of reaction times. Mild NAPs images had significantly longer reaction time compared to metric for normal individuals but this difference was not found for individuals with intellectual disability. Mild NAPs images had significantly better accuracy level compared to metric for both the groups. In conclusion, type of image manipulations did not result in differences in attention allocation for individuals with and without intellectual disability. Mild Nonaccidental properties facilitate better accuracy level compared to metric in both the groups but this advantage is seen only for normal group in terms of mean reaction time.

Keywords: eye gaze fixations, eye movements, intellectual disability, stimulus properties

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Authors: Jiyeon Kang, Yeon Jin Jeong, Hoon Heo

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Purpose: Bullying in nursing workplace has been a serious problem that increases the turnover of nurses. Few studies have examined the effects of communication training on workplace bullying for nurses, and all used a single-group design and a small sample size. Thus, more rigorous research has been needed to evaluate the effects properly. This research was aimed to identify the effects of the mobile type communication training of responses on bullying behaviors among nurses. Methods: A randomized controlled trial was performed. Subjects were 62 critical care nurses working in university hospitals in Busan, South Korea. We developed a mobile phone application to train nurses to deal with bullying situation. This application includes 6 common bullying situations and appropriate empathetic communication (non-violent communication) samples in the form of webtoons. The experimental group used this application for 4 weeks, and we measured interpersonal relationship, workplace bullying, symptom experience, and intention to leave before, post, and 8 weeks after the intervention from both experimental and control groups. The effect of the intervention was analyzed using repeated measures ANOVA. Results: The mobile type communication training developed in this study was effective for decreasing nurses’ intention to leave workplace (F = 5.11, p = .027). However, it had no effect on interpersonal relationship (F = 2.54, p = .116), workplace bullying (F = 2.99, p = .089) or symptom experience (F = 2.81, p = .099). The beneficial effects on intention to leave lasted at least up to 4 weeks after the training. Conclusion: The mobile type communication training can be utilized as an effective personal coping strategy for workplace bullying among nurses. Further studies on the long-term effects of the communication training are necessary.

Keywords: bullying, communication, mobile applications, nurses, training, workplace

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Authors: Chiou-Shiue Ko

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As is explicitly stipulated in Article 7 of the Enforcement Rules of the Special Education Act as amended in 1998, "in principle, children with disabilities should be integrated with normal children for preschool education". Since then, all cities and counties have been committed to promoting preschool inclusive education. The Education Department, New Taipei City Government, has been actively recruiting advisory groups of professors to assist in the implementation of inclusive education in preschools since 2001. Since 2011, the author of this study has been guiding Preschool Rainbow to implement inclusive education. Through field observations, meetings, and teaching demonstration seminars, this study explored the process of how inclusive education has been successfully implemented in collaboration with teachers of special education classes and regular classes in Preschool Rainbow. The implementation phases for inclusive education in a single academic year include the following: 1) Preparatory stage. Prior to implementation, teachers in special education and regular classes discuss ways of conducting inclusive education and organize reading clubs to read books related to curriculum modifications that integrate the eight education strategies, early treatment and education, and early childhood education programs to enhance their capacity to implement and compose teaching plans for inclusive education. In addition to the general objectives of inclusive education, the objective of inclusive education for special children is also embedded into the Individualized Education Program (IEP). 2) Implementation stage. Initially, a promotional program for special education is implemented for the children to allow all the children in the preschool to understand their own special qualities and those of special children. After the implementation of three weeks of reverse inclusion, the children in the special education classes are put into groups and enter the regular classes twice a week to implement adjustments to their inclusion in the learning area and the curriculum. In 2013, further cooperation was carried out with adjacent hospitals to perform development screening activities for the early detection of children with developmental delays. 3) Review and reflection stage. After the implementation of inclusive education, all teachers in the preschool are divided into two groups to record their teaching plans and the lessons learned during implementation. The effectiveness of implementing the objective of inclusive education is also reviewed. With the collaboration of all teachers, in 2015, Preschool Rainbow won New Taipei City’s “Preschool Light” award as an exceptional model for inclusive education. Its model of implementing inclusive education can be used as a reference for other preschools.

Keywords: collaboration, inclusive education, preschool, teachers, special education classes, regular classes

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Authors: Pei-Fan Mu

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Background: Lung cancer is the most common cancer with the highest mortality rate. Patients with lung cancer under chemotherapy treatment experience life-threatening uncertainty. This study was based on the broaden-and-build theory using intentionality reflection of the body and internalization of positive prioritization strategies to enhance positive emotions of patients with lung cancer. Purpose: The purpose of this study was to use a quasi-experimental research design to examine the effectiveness of the enhancing positive emotion program. Method: Data were collected from a medical center in Taiwan. Fifty-four participants with lung cancer were recruited. Thirty participants were in the experiential group receiving the two weeks program. The content of the program includes awareness and understanding of the symptom experience, co-existing with illness and establishing self-identity, cognitive-emotion adjustment and establishing a new body schema, and symptom management to reach spiritual well-being. Twenty-four participants were in the control group receiving regular nursing care. Baseline, one month later and two months later, programmed measurements of symptoms of distress, positive emotion, and psychological well-being. Results: These two weeks of enhancing the positive emotion program resulted in a significantly improved positive emotion score for the experimental group compared to the control group. The findings of this study indicated that the positive emotion had significant differences between the two groups. There were no differences in symptom distress between the two groups. Discussion: The findings indicated that the enhancing positive emotion program could help patients enhance their life-threatening facing conditions.

Keywords: positive emotion, lung cancer, experimental design, symptom distress

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Authors: Maggie Hui

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Risk management is not a new concept; however, it is an uncharted area as applied to the translation process and translator training. Risk managers are responsible for managing risk, i.e. adopting strategies with the intention to minimize loss and maximize gains in spite of uncertainty. Which risk strategy to use often depends on the frequency of an event (i.e. probability) and the severity of its outcomes (i.e. impact). This is basically the way translation/localization project managers handle risk management. Although risk management could involve both positive and negative impacts, impact seems to be always negative in professional translators’ management models, e.g. how many days of project time are lost or how many clients are lost. However, for analysis of translation performance, the impact should be possibly positive (e.g. increased readability of the translation) or negative (e.g. loss of source-text information). In other words, the straight business model of risk management is not directly applicable to the study of risk management in the rendition process. This research aims to explore trainee translators’ risk managing while translating in a simulated setting that involves translator-client relations. A two-cycle experiment involving two roles, the translator and the simulated client, was carried out with a class of translation students to test the effects of the main variable of peer-group interaction. The researcher made use of a user-friendly screen-voice recording freeware to record subjects’ screen activities, including every word the translator typed and every change they made to the rendition, the websites they browsed and the reference tools they used, in addition to the verbalization of their thoughts throughout the process. The research observes the translation procedures subjects considered and finally adopted, and looks into the justifications for their procedures, in order to interpret their risk management. The qualitative and quantitative results of this study have some implications for translator training: (a) the experience of being a client seems to reinforce the translator’s risk aversion; (b) there is a wide gap between the translator’s internal risk management and their external presentation of risk; and (c) the use of role-playing simulation can empower students’ learning by enhancing their attitudinal or psycho-physiological competence, interpersonal competence and strategic competence.

Keywords: risk management, role-playing simulation, translation pedagogy, translator-client relations

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Authors: Sujatha Shanmugasundaram

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Background: It has been since one year that COVID-19 has emerged into the world. Since then, healthcare professionals facing a great challenge in to fight against this deadly virus. According to World Health Organization (WHO) 2021, it is estimated that more than 131 million confirmed cases and 2million deaths around the world due to this pandemic. Nurses are the frontline workers who play a major role in safeguarding the lives of the people in acute care settings. Evidence suggests that there are numbers of research have been carried out on nurses' and healthcare provider’s experiences during the pandemic. But, unfortunately, there are no or little evidence available on Muslim nurse’s perspective. Hence, this research will investigate the experiences of Muslim nurses working in an acute care setting during the pandemic. Purpose: The purpose of the study is to explore the experiences of Muslim nurses working in an acute setting during the COVID-19 pandemic. Research Methods: A qualitative research approach will be utilized for the study. Semi-structured interview schedule will be used to collect the data. Face to face interviews will be conducted. All interviews will be conducted in Arabic, and it will be audio recorded. Verbatim will be noted. Muslim nurses working in an acute setting will be included in the study. Convenient sampling technique will be used to recruit the participants. Ethical approval will be obtained from the study sites. Strauss and Corbin's thematic analysis will be used to analyze the data. Conclusion: Considering that nurses are the frontline workers, they have a significant role in dealing with this COVID-19. It is a great challenge for the nurses working in an acute care setting. Thus, this study will bring out significant findings that will impact the nursing practice.

Keywords: acute care, COVID-19, experiences, muslim nurses

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Authors: Tekalign Gidi Kure

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This paper addresses a range of serious problems involving higher education in Ethiopia. In spite of increased enrollment in higher education, educational quality is deteriorating afterwards. Thus, this paper tried to assess the role of social infrastructure in education for economic development of the country and examined major critical problems in higher education of Ethiopia such as higher education finance, curriculum development, and instructor’s career development. Primarily the paper discusses the fundamental contributions of social infrastructure in higher education to economic development; namely development of human capital, improved health, life expectancy, increased productivity, and personal saving, then, the paper examines critically higher education in three regimes of Ethiopia (Emperor Regime, Derg Regime and EPDRF/current government). Thus, four main questions were raised during this research: "What are the antecedents of Ethiopia Higher Education System under three regimes?", " what are the current and emerging higher educational needs in Ethiopia economic development?", " what are the role of private sector in addressing the gaps in the higher education of the country and its adverse effect on quality issues? ", and "what improvements are needed in higher education system of Ethiopia?". Documents from Ministry of Education in Ethiopia, National Statistical Abstracts, and Reports from the World Bank and other recognized institutions were used in addition to recent empirical researches conducted in the country. In doing so, care had been taken to reduce prejudiced reports by involving different reports from multiple sources. The paper concludes that during emperor system higher education enrollment was among the very lowest in the world, therefore, the skilled human resource available to guide development were little, but the cost was very high. During the Derg regime where an ideological change in the system penetrated into higher education resulted with the lack of a large amount of resources to support higher education; the war inside and outside the country diverts resources from the sector. The main purpose of this paper is not only to discuss the problems and issues of higher education in the past, but it also investigates the influence that the current expansion of higher education has on the finance, staff, and other resources for the quality of education. The paper concludes that higher education in Ethiopia are financed by government, outdated curriculum and lagging behind the standard regarding qualified staff. Finally, it provided inevitable solutions if the country wants to gain well record in quality of education as well.

Keywords: social infrastructure, higher education, ethiopia, education quality

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Authors: Canapi Patricia Joy, Canlas Tracy Gabriella, Canseco Teresa, Capistrano Reena Marie, Carandang Vernon, Carbonel Khiara Claudine

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Research problem: The main problem of the study was to determine the effect of Projecting the Reflection of the Individual’s Self-esteem (PRIDE) therapy on the level of self-esteem of physically challenged adolescents. Objectives of the Study: The study determined the effect of PRIDE (Projecting the Reflection of the Individuals Self-esteem) therapy on the level of self-esteem among physically challenged adolescents. Methodology: A quasi-experimental study was used which involved 30 randomly-assigned subjects, 15 in the experimental group and 15 in the control group. The Projecting the reflection of the Individuals’ Self-Esteem (PRDIE) therapy was administered to the experimental group. The researchers utilized the Sorensen Self-Esteem test tool as a pretest and posttest questionnaire and yielded a Cronbach’s alpha of .912. Paired T-test was used to analyze the gathered data. Results: The results showed that after the administration of PRIDE therapy, there was an increase on the level of self-esteem. The experimental group had a value of 3.590, which was significant and meant that the level of self-esteem is significantly increased. On the other hand, the control group, had a value of -2.207 which was also significant, therefore, the level of self esteem significantly decreased. Conclusion: the PRIDE Therapy is effective in increasing the level of self-esteem among physically challenged adolescent. Recommendations: The researchers recommend the use of PRIDE Therapy as an intervention in handling physically challenged patients, especially adolescents, in order to enhance their self-esteem. Also, the researchers recommend that nursing students be informed on the efficacy of PRIDE Therapy in enhancing the self-esteem of physically challenged patients. Furthermore, the inclusion of a psychologist during the implementation of PRIDE Therapy, specifically art therapy, to be able to have a more focused interpretation of the drawings and really be able to see the projection of their self-esteem is also recommended.

Keywords: adolescents, PRIDE therapy, physically challenged, self-esteem

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Authors: Priscilla Adoley Moffat

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This study explored perceptions rooted in and acquired from the cultures of many developing countries and how they impact applicants’ preferences and choices of STEM programs. The context of developing countries was chosen for this study because gender role socialization continues to maintain an important place in most of these cultures. This study’s relevance rests in the fact that, as the world takes steps to encourage and promote the choice and study of STEM programs, especially among females, there is a need for efforts towards understanding various cultural perceptions towards some programs of study, particularly STEM programs, which have diverse gender attributions in many developing cultures. Also, as the world strives to achieve gender equity in education, such a study comes in handy, as it provides a useful understanding of the underlying cultural factors that affect study program preferences of applicants, particularly in developing countries like Ghana as well as others in Africa. The study analyzed the admission application data of five public universities in Ghana. 1600 randomly-sampled final-year students of 32 randomly-selected senior high schools from the 16 regions of Ghana were interviewed. Since parents and teachers often guide and influence the study program choices of applicants, the study examined the perceptions of 180 teachers and 360 parents. The study found, among other things, that STEM programs are commonly perceived to pose much more difficulty to females than they do to males. As a result, many female applicants are discouraged from choosing these programs. While nursing programs are perceived more as programs for females, with the justification that females are better caregivers, males are perceived to be better medical doctors, engineers, and computer technicians. Thus, many females are less encouraged to choose Technology and Engineering programs.

Keywords: culture, perceptions, STEM, choice, preference

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Authors: Mehrdad Akbarzadeh, Afsaneh Abrisham

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Introduction: Critical thinking skills are crucial for nurses, particularly those working in neonatal care, where quick and informed decision-making is essential. This study aims to evaluate the effectiveness of critical thinking skills on job performance among neonatal nurses. Methods: A cross-sectional study was conducted with 450 neonatal nurses from a hospital in Mashhad. Participants were assessed using the Critical Thinking Questionnaire (CThQ) to measure their critical thinking abilities across various subscales, including Analyzing, Evaluating, Creating, Remembering, Understanding, and Applying. Additionally, a custom Job Performance Checklist completed by supervising nurses, was used to evaluate job performance across several dimensions. Data were collected and analyzed using SPSS V.23. Correlation analysis was conducted to determine the relationship between critical thinking skills and job performance. Results: The mean age of the nurses was 33.46 ± 14.2 years, with 79.15% being female. The nurses demonstrated high proficiency in critical thinking, with notable scores in the Creating (23.98 ± 4.8), Applying (17.35 ± 3.2), and Evaluating (16.67 ± 3.4) subscales. The results indicate a significant positive correlation between several critical thinking subscales and job performance. The Creating subscale exhibited the strongest correlation (R = 0.79, p < 0.001), followed by Overall CThQ (R = 0.68, p = 0.039) and Evaluating (R = 0.67, p = 0.041). Analyzing (R = 0.45, p = 0.013) and Understanding (R = 0.41, p = 0.015) also showed significant correlations with job performance. Remembering (R = 0.29, p = 0.061) and Applying (R = 0.43, p = 0.057) were not significantly correlated with job performance. Conclusion: The findings indicate that critical thinking skills, especially in creating and evaluating, are strongly associated with job performance in neonatal nurses. Enhancing these skills through targeted training programs could improve job performance, particularly in decision-making and time management. This study underscores the importance of critical thinking in neonatal care and its impact on nursing efficacy and patient outcomes.

Keywords: critical thinking, job performance, neonatal nurses, healthcare quality

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Authors: Arunas Burinskas, Aurelija Burinskiene

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On average, ten percent of drugs - commercial products are not available in pharmacies due to shortage. The shortage event disbalance sales and requires a recovery period, which is too long. Therefore, one of the critical issues that pharmacies do not record potential sales transactions during shortage and recovery periods. The authors suggest estimating outliers during shortage and recovery periods. To shorten the recovery period, the authors suggest using average sales per sales day prediction, which helps to protect the data from being downwards or upwards. Authors use the outlier’s visualization method across different drugs and apply the Grubbs test for significance evaluation. The researched sample is 100 drugs in a one-month time frame. The authors detected that high demand variability products had outliers. Among analyzed drugs, which are commercial products i) High demand variability drugs have a one-week shortage period, and the probability of facing a shortage is equal to 69.23%. ii) Mid demand variability drugs have three days shortage period, and the likelihood to fall into deficit is equal to 34.62%. To avoid shortage events and minimize the recovery period, real data must be set up. Even though there are some outlier detection methods for drug data cleaning, they have not been used for the minimization of recovery period once a shortage has occurred. The authors use Grubbs’ test real-life data cleaning method for outliers’ adjustment. In the paper, the outliers’ adjustment method is applied with a confidence level of 99%. In practice, the Grubbs’ test was used to detect outliers for cancer drugs and reported positive results. The application of the Grubbs’ test is used to detect outliers which exceed boundaries of normal distribution. The result is a probability that indicates the core data of actual sales. The application of the outliers’ test method helps to represent the difference of the mean of the sample and the most extreme data considering the standard deviation. The test detects one outlier at a time with different probabilities from a data set with an assumed normal distribution. Based on approximation data, the authors constructed a framework for scaling potential sales and estimating outliers with Grubbs’ test method. The suggested framework is applicable during the shortage event and recovery periods. The proposed framework has practical value and could be used for the minimization of the recovery period required after the shortage of event occurrence.

Keywords: drugs, Grubbs' test, outlier, shortage event

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Authors: Tamara Vagg, Cathy Shortt, Claire Hickey, Joseph A. Eustace, Barry J. Plant, Sabin Tabirca

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Introduction: Paper-based patient passports have been used advantageously for older patients, patients with diabetes, and patients with learning difficulties. However, these passports can experience issues with data security, patients forgetting to bring the passport, patients being over encumbered, and uncertainty with who is responsible for entering and managing data in this passport. These issues could be resolved by transferring the paper-based system to a convenient platform such as a smartphone application (app). Background: Life expectancy for some Cystic Fibrosis (CF) patients are rising and as such new complications and procedures are predicted. Subsequently, there is a need for education and management interventions that can benefit CF adults. This research proposes a CF patient passport to record basic medical information through a smartphone app which will allow CF adults access to their basic medical information. Aim: To provide CF patients with their basic medical information via mobile multimedia so that they can receive care when traveling abroad or between CF centres. Moreover, by recording their basic medical information, CF patients may become more aware of their own condition and more active in their health care. Methods: This app is designed by a CF multidisciplinary team to be a lightweight reflection of a hospital patient file. The passport app is created using PhoneGap so that it can be deployed for both Android and iOS devices. Data entered into the app is encrypted and stored locally only. The app is password protected and includes the ability to set reminders and a graph to visualise weight and lung function over time. The app is introduced to seven participants as part of a stress test. The participants are asked to test the performance and usability of the app and report any issues identified. Results: Feedback and suggestions received via this testing include the ability to reorder the list of clinical appointments via date, an open format of recording dates (in the event specifics are unknown), and a drop down menu for data which is difficult to enter (such as bugs found in mucus). The app is found to be usable and accessible and is now being prepared for a pilot study with adult CF patients. Conclusions: It is anticipated that such an app will be beneficial to CF adult patients when travelling abroad and between CF centres.

Keywords: Cystic Fibrosis, digital patient passport, mHealth, self management

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Authors: Noman Shahzad, Amyn Pardhan, Hasnain Zafar

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Introduction: Though short term survival advantage of damage control laparotomy in management of critically ill trauma patients is established, there is little known about the long-term quality of life of these patients. Facial closure rate after damage control laparotomy is reported to be 20-70 percent. Abdominal wall reconstruction in those who failed to achieve facial closure is challenging and can potentially affect quality of life of these patients. Methodology: We conducted retrospective matched cohort study. Adult patients who underwent damage control laparotomy from Jan 2007 till Jun 2013 were identified through medical record. Patients who had concomitant disabling brain injury or limb injuries requiring amputation were excluded. Age, gender and presentation time matched non exposure group of patients who underwent laparotomy for trauma but no damage control were identified for each damage control laparotomy patient. Quality of life assessment was done via telephonic interview at least one year after the operation, using Urdu version of EuroQol Group Quality of Life (QOL) questionnaire EQ5D after permission. Wilcoxon signed rank test was used to compare QOL scores and McNemar test was used to compare individual parameters of QOL questionnaire. Study was approved by institutional ethical review committee. Results: Out of 32 patients who underwent damage control laparotomy during study period, 20 fulfilled the selection criteria for which 20 matched controls were selected. Median age of patients (IQ Range) was 33 (26-40) years. Facial closure rate in damage control laparotomy group was 40% (8/20). One third of those who did not achieve facial closure (4/12) underwent abdominal wall reconstruction. Self-reported QOL score of damage control laparotomy patients was significantly worse than non-damage control group (p = 0.032). There was no statistically significant difference in two groups regarding individual QOL measures. Significantly, more patients in damage control group were requiring use of abdominal binder, and more patients in damage control group had to either change their job or had limitations in continuing previous job. Our study was not adequately powered to detect factors responsible for worse QOL in damage control group. Conclusion: Quality of life of damage control patients is worse than their age and gender matched patients who underwent trauma laparotomy but not damage control. Adequately powered studies need to be conducted to explore factors responsible for this finding for potential improvement.

Keywords: damage control laparotomy, laparostomy, quality of life

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