Search results for: surgical training

Authors: Yung-Hui Tang, Yan-Chiou Ku, Li-Chi Huang

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Aim: The aim of this study is to explore the effect of the Humanoid Diagram Teaching (HDT) strategy on novice nurses’ care ability and retention rate. Methods: This study was a quasi-experimental study using two groups concurrently with repeat measurements sample consisted of 24 novice nurses (12 in each experimental and control group) in a medical center in southern Taiwan. Both groups all received regular training program (nursing standard techniques and practices, concept map, mini-CEX, CbD, and clinical education and training), and experimental group added the HDT program. The HDT strategy includes the contents of patients’ body humanoid drawing and discussion for 30 minutes each time, three times a week, and continually for four weeks. The effectiveness of ＨDT was evaluated by mini-CEX, CbD and clinical assessment and retention rate at the 3rd month and 6th month. Results: The novice nurses' care ability were examined, only CbD score in the control group was improved in the 3rd month and with statistical difference, p = .003. The mini-CEX and CbD in the experimental group were significantly improved in both the first and third month with statistical differences p = .00. Although mini-CEX and CbD in the experimental group were higher than the control group, but there was no significant difference p > .05. Retention rate of the experimental group in the third month and sixth month was significantly higher than the control group, and there was a statistically significant difference p < .05. Conclusions: The study reveals that HDT strategy can help novice nurses learning, enhancing their knowledge and technical capability, analytical skills in case-based caring, and retention. The HDT strategy can be served as an effective strategy for novice training for better nurse retention rate.

Keywords: humanoid diagram teaching strategy, novice nurses retention, teaching strategy of nurse retention, visual learning mode

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Authors: Natnicha Wareesamarn, Waruntorn Jongrungrotsakul, Anon Wisutthananon

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Occupational illnesses and injuries are the partial results of unsafe work behaviors. Safety training, an occupational health and safety standard, could either reduce or prevent such illnesses and injuries. This quasi-experimental research aimed to examine the effect of integrated safety training on safety work behaviors among 54 waste collectors working in the Su-ngai Kolok and Muang districts in Narathiwat Province. The workers were equally divided into an experimental or a control group (27 in each). The study was implemented from September to November 2021. The research instruments consisted of 1) an integrated safety promotion program on safety work behaviors which was developed based on the literature review, and 2) a questionnaire on safe working behaviors among waste collectors modified from a safety work behaviors questionnaire by Sitthichai Jaikhan et al. (2019). The content validity of the questionnaire was confirmed by experts with a content validity index of 0.97, while reliability was at an acceptable level (0.86 - 0.90). Data were analyzed using descriptive statistics and a t-test. The findings showed that after receiving the integrated safety promotion program on safety work behaviors, the mean scores for safety work behaviors among the experimental group (x ̅ = 73.89, S.D.=1.12) were significantly higher than those of the control group (x ̅ = 47.93, S.D.= 2.45) (p<.001). Furthermore, it was found that the mean score for safety work behaviors among the experimental group after receiving the integrated safety promotion program (x ̅=73.89, S.D.= 2.45) was significantly higher than that before receiving the program (x ̅=47.85, S.D.= 2.16) (p<.001). These findings indicate that occupational health nurses and related staff should place great concern on the application of integrated safety promotion programs into their own work. This is anticipated to enhance safe work behaviors, thereby reducing occupational illnesses and injuries, as well as enhancing the quality of working life among waste collectors.

Keywords: integrated safety promotion program, safety work behaviors, waste collectors, safety training

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Authors: Xiaohan Bookman, Xiaoyan Zhu

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Margin-Based Principle has been proposed for a long time, it has been proved that this principle could reduce the structural risk and improve the performance in both theoretical and practical aspects. Meanwhile, feed-forward neural network is a traditional classifier, which is very hot at present with a deeper architecture. However, the training algorithm of feed-forward neural network is developed and generated from Widrow-Hoff Principle that means to minimize the squared error. In this paper, we propose a new training algorithm for feed-forward neural networks based on Margin-Based Principle, which could effectively promote the accuracy and generalization ability of neural network classifiers with less labeled samples and flexible network. We have conducted experiments on four UCI open data sets and achieved good results as expected. In conclusion, our model could handle more sparse labeled and more high-dimension data set in a high accuracy while modification from old ANN method to our method is easy and almost free of work.

Keywords: Max-Margin Principle, Feed-Forward Neural Network, classifier, structural risk

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Authors: Julia A. Ermakova

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This study aimed to investigate the efficacy of a physical rehabilitation program for postpartum women. The program was developed with the purpose of restoring physical performance in women during the postpartum period. The research employed a variety of methods, including an analysis of scientific literature, pedagogical testing and experimentation, mathematical processing of study results, and physical performance assessment using a range of tests. The program recommends refraining from abdominal exercises during the first 6-8 months following a cesarean section and avoiding exercises with weights. Instead, a feasible training regimen that gradually increases in intensity several times a week is recommended, along with moderate cardio exercises such as walking, bodyweight training, and a separate workout component that targets posture improvement. Stretching after strength training is also encouraged. The necessary equipment includes comfortable sports attire with a chest support top, mat, push-ups, resistance band, timer, and clock. The motivational aspect of the program is paramount, and the mentee's positive experience with the workout regimen includes feelings of lightness in the body, increased energy, and positive emotions. The gradual reduction of body size and weight loss due to an improved metabolism also serves as positive reinforcement. The mentee's progress can be measured through various means, including an external assessment of her form, body measurements, weight, BMI, and the presence or absence of slouching in everyday life. The findings of this study reveal that the program is effective in restoring physical performance in postpartum women. The mentee achieved weight loss and almost regained her pre-pregnancy shape while her self-esteem improved. Her waist, shoulder, and hip measurements decreased, and she displayed less slouching in her daily life. In conclusion, the developed physical rehabilitation program for postpartum women is an effective means of restoring physical performance. It is crucial to follow the recommended training regimen and equipment to avoid limitations and ensure safety during the postpartum period. The motivational component of the program is also fundamental in encouraging positive reinforcement and improving self-esteem.

Keywords: physical rehabilitation, postpartum, methodology, postpartum recovery, rehabilitation

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Authors: Jane E. Mullen, Kevin Kelloway, Ann Rhéaume-Brüning

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The purpose of this study is to examine the effects of perceived leader word-action alignment on subordinate extra-role safety behavior. Using survey data gathered from a sample of nurses employed in health care facilities located in Eastern Canada (n = 192), the effects of perceived word-action alignment (measured as the cross product of leaders speaking positively about safety and acting safely) on nurse safety participation was examined. Moderated regression analysis resulted in the significant (p < .01) prediction of nurse safety participation by the interaction term. Analysis of the simple slopes comprising the interaction term suggests that positively speaking about safety only predicted safety participation when leaders were also perceived by subordinates as acting safely. The results provide empirical support for the importance of the perceived alignment between leaders’ words, or espoused safety values and priorities, and their actions. Practical implications for safety leadership training are discussed.

Keywords: leadership, safety participation, safety performance, safety training

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Authors: Mahboobeh Sadeghi, Zahra Izadi Khah, Mansour Hakim Javadi, Masoud Gholamali Lavasani

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Background: Since there is a relation between psychological and physiological factors, the aim of this study was to examine the effect of Emotion Regulation training on cognitive emotion regulation problem in patients with Multiple Sclerosis(MS) Method: In a randomized clinical trial thirty patients diagnosed with Multiple Sclerosis referred to state welfare organization were selected. The sample group was randomized into either an experimental group or a nonintervention control group. The subjects participated in 75-minute treatment sessions held three times a week for 4weeks (12 sessions). All 30 individuals were administered with Cognitive Emotion Regulation questionnaire (CERQ). Participants completed the questionnaire in pretest and post-test. Data obtained from the questionnaire was analyzed using Mancova. Results: Emotion Regulation significantly decreased the Cognitive Emotion Regulation problems patients with Multiple sclerosis (p < 0.001). Conclusions: Emotion Regulation can be used for the treatment of cognitive-emotion regulation problem in Multiple sclerosis.

Keywords: Multiple Sclerosis, cognitive-emotion regulation, emotion regulation, MS

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

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

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

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Authors: Dohun Kim

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Technological innovations have stimulated flipped learning in many disciplines, including language teaching. It is a specific type of blended learning, which combines onsite (i.e. face-to-face) with online experiences to produce effective, efficient and flexible learning. Flipped learning literally ‘flips’ conventional teaching and learning activities upside down: it leverages technologies to deliver a lecture and direct instruction—other asynchronous activities as well—outside the classroom to reserve onsite time for interaction and activities in the upper cognitive realms: applying, analysing, evaluating and creating. Unlike the conventional flipped approaches, which focused on video lecture, followed by face-to-face or on-site session, new innovative methods incorporate various means and structures to serve the needs of different academic disciplines and classrooms. In the light of such innovations, this study adopted ‘student-engaged’ approaches to interpreter training and contrasts them with traditional classrooms. To this end, students were also encouraged to engage in asynchronous activities online, and innovative technologies, such as Telepresence, were employed. Based on the class implementation, a thorough examination was conducted to examine how we can structure and implement flipped classrooms for language and interpreting training while actively engaging learners. This study adopted a quantitative research method, while complementing it with a qualitative one. The key findings suggest that the significance of the instructor’s role does not dwindle, but his/her role changes to a moderator and a facilitator. Second, we can apply flipped learning to both theory- and practice-oriented modules. Third, students’ integration into the community of inquiry is of significant importance to foster active and higher-order learning. Fourth, cognitive presence and competence can be enhanced through strengthened and integrated teaching and social presences. Well-orchestrated teaching presence stimulates students to find out the problems and voices the convergences and divergences, while fluid social presence facilitates the exchanges of knowledge and the adjustment of solutions, which eventually contributes to consolidating cognitive presence—a key ingredient that enables the application and testing of the solutions and reflection thereon.

Keywords: blended learning, Community of Inquiry, flipped learning, interpreter training, student-centred learning

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Authors: R. Pardo, P. Menendez, MA Gil-Olarte, S. Sanchez, E. García, R. Quintana, J. Martín

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Introduction : Within oncoplastic breast techniques there is increased interest in immediate partial breast reconstruction. The volume resected is greater than that of conventional conservative techniques. Central tumours of the breast have classically been treated with a mastectomy with regard to oncological safety and cosmetic secondary effects after wide central resection of the nipple and breast tissue beneath. Oncological results for central quadrantectomy have a recurrence level, disease- free period and survival identical to mastectomy. Grissoti flap is an oncoplastic surgical technique that allows the surgeon to perform a safe central quadrantectomy with excellent cosmetic results. Material and methods: The Grissoti flap is a glandular cutaneous advancement rotation flap that can fill the defect in the central portion of the excised breast. If the inferior border is affected by tumour and further surgery is decided upon at the Multidisciplinary Team Meeting, it will be necessary to perform a mastectomy. All patients with a Grisotti flap undergoing surgery since 2009 were reviewed obtaining the following data: age, hystopathological diagnosis, size, operating time, volume of tissue resected, postoperative admission time, re-excisions due to positive margins affected by tumour, wound dehiscence, complications and recurrence. Analysis and results of sentinel node biopsy were also obtained. Results: 12 patients underwent surgery between 2009-2015. The mean age was 54 years (34-67) . All had a preoperative diagnosis of ductal infiltrative carcinoma of less than 2 cm,. Diagnosis was made with Ultrasound, Mamography or both . Magnetic resonance was used in 5 cases. No patients had preoperative positive axilla after ultrasound exploration. Mean operating time was 104 minutes (84-130). Postoperative stay was 24 hours. Mean volume resected was 159 cc (70-286). In one patient the surgical border was affected by tumour and a further procedure with resection of the affected border was performed as ambulatory surgery. The sentinel node biopsy was positive for micrometastasis in only two cases. In one case lymphadenectomy was performed in 2009. In the other, treated in 2015, no lymphadenectomy was performed as the patient had a favourable histopathological prognosis and the multidisciplinary team meeting agreed that lymphadenectomy was not required. No recurrence has been diagnosed in any of the patients who underwent surgery and they are all disease free at present. Conclusions: Conservative surgery for retroareolar central tumours of the breast results in good local control of the disease with free surgical borders, including resection of the nipple areola complex and pectoral major muscle fascia. Reconstructive surgery with the inferior Grissoti flap adequately fills the defect after central quadrantectomy with creation of a new cutaneous disc where a new nipple areola complex is reconstructed with a local flap or micropigmentation. This avoids the need for contralateral symmetrization. Sentinel Node biopsy can be performed without added morbidity. When feasible, the Grissoti flap will avoid skin-sparing mastectomy for central breast tumours that will require the use of an expander, prosthesis or myocutaneous flap, with all the complications of a more complex operation.

Keywords: Grisotti flap, oncoplastic surgery, central tumours, breast

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Authors: Jana Tchekalarova, Milena Atanasova, Katerina Georgieva

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Melatonin deficit can cause a disturbance in emotional status and circadian rhythms of the endocrine system in the body. Both pharmacological and alternative approaches are applied for correction of dysfunctions driven by changes in circadian dynamics of many physiological indicators. In the present study, we tested and compare the beneficial effect of agomelatine (40 mg/kg, i.p. for 3 weeks) and endurance training on depressive behavior in two models of melatonin deficit in rat. The role of disturbed circadian rhythms of plasma melatonin and corticosterone secretion in the mechanism of these treatments was also explored. The continuous exercise program attenuated depressive responses associated with disrupted diurnal rhythm of home-cage motor activity, anhedonia in the sucrose preference test, and despair-like behavior in the forced swimming test were attenuated by agomelatine exposed to chronic constant light (CCL) and long-term exercise in pinealectomized rats. Parallel to the observed positive effect on the emotional status, agomelatine restored CCL-induced impairment of circadian patterns of plasma melatonin but not that of corticosterone. In opposite, exercise training diminished total plasma corticosterone levels and corrected its flattened pattern while it was unable to correct melatonin deficit in pinealectomy. These results suggest that the antidepressant-like effect of pharmacological and alternative approach might be mediated via two different mechanism, correction of the disturbed circadian rhythm of melatonin and corticosterone, respectively. Therefore, these treatment approaches might have a potential therapeutic application in different subpopulations of people characterized by a melatonin deficiency. This work was supported by the National Science Fund of Bulgaria (research grant # № DN 03/10; DN# 12/6).

Keywords: agomelatine, exercise training, melatonin deficit, corticosterone

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Authors: Marwa Sahnoun, Chokri Abdennadher

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This article comes, very timely, to look at the effectiveness of active labor market policies (ALMP) in improving labor market outcomes. Using panel data estimates for 19 European countries during the period 2000-2012, this article showed the role of institutional factors, especially the role of employment policies implementation based on three variables: the allocation of resources for the implementation of policies, continuity and timing in the implementation of policies to capture their effectiveness on the labor market. Empirical results shows favor effect of training, employment incentives, sheltered employment and rehabilitation and direct job creation on the entire population employment growth. Results shows also that start-up incentives seems to be more effective in increasing employment than other types of policies. Importantly, two aspects are important in terms of implementation: public expenditure on program administration, e.g. (PES) watches the most favorable aspect and the continuity of policies implemented.

Keywords: active labor market policies, implementation, public expenditure on program administration, start-up incentives, training

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Authors: Chia-Chi Chen, Tai-Sheng Huang

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Ageing society has been spread around the world. The global population is not only ageing but also declining. The structure of population has changed, which has a significant impact on both the economies and industries. Thus, how to be a healthy senior citizen to relieve the burden to the family and society will be a popular issue. Although fitness equipment manufacturing industry has been mature, the ageing population is still increasing. Therefore, this study aims to design an innovative style of fitness equipment for senior citizens, based on BMLT presented by Dr. Koyama Hirofumi. The analysis of current fitness equipment on the market and the future trend will be applied in the study. With the coming of information age, senior citizens in the future are the users of information product for sure, and the new style of fitness equipment will be combined with information technology as well. Through this study, it is believed to design an innovative style of fitness equipment for seniors and help them live heartier and happier lives.

Keywords: aging society, BMLT (Beginning Movement Load Training), seniors, new style of fitness equipment

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

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Background: While delays to care exist in resource rich settings, greater delays are seen along the care continuum in low- and middle-income countries (LMICs) largely due to limited healthcare capacity to address the disproportional rates of traumatic brain injury (TBI) in Sub Saharan Africa (SSA). While many LMICs have government subsidized systems to offset surgical costs, the burden of securing funds by the patients for medications, supplies, and CT diagnostics poses a significant challenge to timely surgical interventions. In Kampala Uganda, the challenge of obtaining timely CT scans is twofold. First, due to a lack of a functional CT scanner at the tertiary hospital, patients need to arrange their own transportation to the nearby private facility for CT scans. Second, self-financing for the private CT scans ranges from $80 - $130, which is near the average monthly income in Kampala. These bottlenecks contribute significantly to the care continuum delays and are associated with poor TBI outcomes. Objective: The objectives of this study are to 1) describe the temporal delays through a modified three delays model that fits the context of neurosurgical interventions for TBI patients in Kampala and 2) investigate the association between delays and mortality. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Four time intervals were constructed along five time points: injury, hospital arrival, neurosurgical evaluation, CT results, and definitive surgery. Time interval differences among mild, moderate and severe TBI and their association with mortality were analyzed. Results: The mortality rate of all TBI patients presenting to MNRH was 9.6%, which ranged from 4.7% for mild and moderate TBI patients receiving surgery to 81.8% for severe TBI patients who failed to receive surgery. The duration from injury to surgery varied considerably across TBI severity with the largest gap seen between mild TBI (174 hours) and severe TBI (69 hours) patients. Further analysis revealed care continuum differences for interval 3 (neurosurgical evaluation to CT result) and 4 (CT result to surgery) between severe TBI patients (7 hours for interval 3 and 24 hours for interval 4) and mild TBI patients (19 hours for interval 3, and 96 hours for interval 4). These post-arrival delays were associated with mortality for mild (p=0.05) and moderate TBI (p=0.03) patients. Conclusions: To our knowledge, this is the first analysis using a modified ‘three delays’ framework to analyze the care continuum of TBI patients in Uganda from injury to surgery. We found significant associations between delays and mortality for mild and moderate TBI patients. As it currently stands, poorer outcomes were observed for these mild and moderate TBI patients who were managed non-operatively or failed to receive surgery while surgical services were shunted to more severely ill patients. While well intentioned, high mortality rates were still observed for the severe TBI patients managed surgically. These results suggest the need for future research to optimize triage practices, understand delay contributors, and improve pre-hospital logistical referral systems.

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

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Authors: Ersumo Tessema, Bogale Girmaye Tamrat, Mohammed Burka

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Background: Hyperthyroidism is a common thyroid disorder especially in women and characterized by increased thyroid hormone synthesis and secretion. The disorder manifests predominantly as Graves’ disease in iodine-sufficient areas and has increasing prevalence in iodine-deficient countries in patients with nodular thyroid disease and following iodine fortification. In Ethiopia, the magnitude of the disorder is unknown and, in Africa, due to scarcity of resources, its management remains suboptimal. Objective: The aim of this study was to analyze the pattern and management of patients with hyperthyroidism at the United Vision Medical Services Center, Addis Ababa between August 30, 2013, and February 1, 2018. Patients and methods: The study was a retrospective analysis of medical records of all patients with hyperthyroidism at the United Vision Private Medical Services Center, Addis Ababa. A questionnaire was filled out; the collected data entered into a computer and statistically analyzed using the SPSS package. The results were tabulated and discussed with literature review. Results: A total of 589 patients were included in this study. The median age was 40 years, and the male to female ratio was 1.0:7.9. Most patients (93%) presented with goiter and the associated features of toxic goiter except weight loss, sweating and tachycardia were uncommon. Majority of patients presented more than two years after the onset of their presenting symptoms. The most common physical finding (91%), as well as diagnosis, was toxic nodular goiter. The most frequent (83%) derangement in the thyroid function tests was a low thyroid-stimulating hormone, and the most commonly (94%) used antithyroid drug was a propylthiouracil. The most common (96%) surgical procedure in 213 patients was a near-total thyroidectomy with a postoperative course without incident in 92% of all the patients. Conclusion: The incidence and prevalence of hyperthyroidism are apparently on the increase in Addis Ababa, which may be related to the existing severe iodine-deficiency and or the salt iodation program (iodine-induced hyperthyroidism). Hyperthyroidism predominantly affects women and, in surgical services, toxic nodular goiter is more common than diffuse goiter, and the treatment of choice in experienced hands is a near-total thyroidectomy.

Keywords: Ethiopia, grave’s disease, hyperthyroidism, toxic nodular goiter

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Authors: Merle Talvik, Taimi Tulva, Kristi Puusepp, Ülle Ernits

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Background data. In 1940–1941 and 1945–1991 Estonia was occupied by Soviet Union. Paternalism was a common principle in Soviet social policy, including health care. The Soviet government, not the individuals themselves, decided on achieving a person’s quality of life. With the help of Soviet ideology, the work culture of nurses was constructed and the education system was also reshaped according to the ideology. The “new period of awakening” was initiated under Gorbachev’s perestroika and glasnost (1985–1991), leading to democratization. Aim. The qualitative study aimed to analyze nursing education in Soviet Estonia in the conditions of paternalistic orientation and ideological pressure. Method. The research was conducted in 2021 and 2023. Senior nurses (aged 69–87) who had worked for at least 20 years during the Soviet era were surveyed. Thematic interviews were conducted in written form and orally (13 interviewees), followed by a focus group interview (8 interviewees). A thematic content analysis was performed. Results. Nursing is part of society’s culture and in this sense, in - terviews with nurses provide us with critical information about the functioning of society and cultural identity at a given time. During the Soviet era the training of nurses occured within vocational training institutions. The curricula underwent a shift towards a Soviet-oriented approach. A significant portion of lessons were dedicated to imparting knowledge on the principles and tenets of Communist-Marxist ideology. Therefore, practical subjects and nursing theory were frequently allocated limited space. A paternalistic orientation prevailed in health care: just as the state regulated how to cure, spread hygiene, and healthy lifestyles propaganda, training was also determined by the management of the institution, thereby limiting the person´s autonomy to decide what kind of training was needed. The research is of significant value in the context of the history of nursing, as it helps to understand the difficulties and complexity of the development of nursing on the timeline. The Soviet era still affects Estonian society today and will continue to do so in the future. The same type of developments occurred in other post-Soviet countries.

Keywords: Estonian SSR, nursing education, paternalism, senior nurse, Soviet ideology

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Authors: Suehyun Cho, Darrell Harrington, Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Alex Kiselyov, Michael Shpigelmacher

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Bionaut Labs, LLC is developing a minimally invasive robotic microdevice designed to treat non-communicating hydrocephalus in both adult and pediatric patients. The device utilizes biocompatible microsurgical particles (Bionaut™) that are specifically designed to safely and reliably perform accurate fenestration(s) in the 3rd ventricle, aqueduct of Sylvius, and/or trapped intraventricular cysts of the brain in order to re-establish normal cerebrospinal fluid flow dynamics and thereby balance and/or normalize intra/intercompartmental pressure. The Bionaut™ is navigated to the target via CSF or brain tissue in a minimally invasive fashion with precise control using real-time imaging. Upon reaching the pre-defined anatomical target, the external driver allows for directing the specific microsurgical action defined to achieve the surgical goal. Notable features of the proposed protocol are i) Bionaut™ access to the intraventricular target follows a clinically validated endoscopy trajectory which may not be feasible via ‘traditional’ rigid endoscopy: ii) the treatment is microsurgical, there are no foreign materials left behind post-procedure; iii) Bionaut™ is an untethered device that is navigated through the subarachnoid and intraventricular compartments of the brain, following pre-designated non-linear trajectories as determined by the safest anatomical and physiological path; iv) Overall protocol involves minimally invasive delivery and post-operational retrieval of the surgical Bionaut™. The approach is expected to be suitable to treat pediatric patients 0-12 months old as well as adult patients with obstructive hydrocephalus who fail traditional shunts or are eligible for endoscopy. Current progress, including platform optimization, Bionaut™ control, and real-time imaging and in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of ovine models, will be discussed.

Keywords: Bionaut™, cerebrospinal fluid, CSF, fenestration, hydrocephalus, micro-robot, microsurgery

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Authors: Maciej Zasuwa, Grzegorz Ptasinski, Antoni Kopyt

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Nowadays flight simulators offer tremendous possibilities for safe and cost-effective pilot training, by utilization of powerful, computational tools. Due to technology outpacing methodology, vast majority of training related work is done by human instructors. It makes assessment not efficient, and vulnerable to instructors’ subjectivity. The research presents an Objective Assessment Tool (gOAT) developed at the Warsaw University of Technology, and tested on SW-4 helicopter flight simulator. The tool uses database of the predefined manoeuvres, defined and integrated to the virtual environment. These were implemented, basing on Aeronautical Design Standard Performance Specification Handling Qualities Requirements for Military Rotorcraft (ADS-33), with predefined Mission-Task-Elements (MTEs). The core element of the gOAT enhanced algorithm that provides instructor a new set of information. In details, a set of objective flight parameters fused with report about psychophysical state of the pilot. While the pilot performs the task, the gOAT system automatically calculates performance using the embedded algorithms, data registered by the simulator software (position, orientation, velocity, etc.), as well as measurements of physiological changes of pilot’s psychophysiological state (temperature, sweating, heart rate). Complete set of measurements is presented on-line to instructor’s station and shown in dedicated graphical interface. The presented tool is based on open source solutions, and flexible for editing. Additional manoeuvres can be easily added using guide developed by authors, and MTEs can be changed by instructor even during an exercise. Algorithm and measurements used allow not only to implement basic stress level measurements, but also to reduce instructor’s workload significantly. Tool developed can be used for training purpose, as well as periodical checks of the aircrew. Flexibility and ease of modifications allow the further development to be wide ranged, and the tool to be customized. Depending on simulation purpose, gOAT can be adjusted to support simulator of aircraft, helicopter, or unmanned aerial vehicle (UAV).

Keywords: automated assessment, flight simulator, human factors, pilot training

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Authors: Tatiana Belmonte dos Santos Rodrigues

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This is a comparative study between the training process of teachers of English as a foreign language in a Brazilian institution and an Italian institution, analyzing the academic curriculum, which includes courses mandatory internship activities, among other curricular aspects, and investigating the motivations that lead pre-service teachers to pursue a teaching career. The two institutions involved in this research are considered the oldest in Brazil, the Federal University of Amazonas, created in 1909, and the oldest in Italy, the University of Bologna, created in 1088. The general problem, or guiding question of this research, therefore, is: What is the role of the academic curriculum in motivating and consolidating the teaching of English as a Foreign Language (EFL) as a professional career? The hypothesis be investigated is that the degree courses of the two institutions apply in their curricula the pedagogical contours described in Shulman (2005), essential for the consolidation of the specificities of professional teacher training, which would lead to the strengthening of motivation pre-service professors to remain in this professional career plan, both for those who have already entered the course with pre-established external or internal motivations and for those who entered without apparent motivation. This is qualitative research (CRESWELL, 2007), with the application of field research, where documental analysis of the academic curriculum was carried out together with interviews with preservice teachers of the two institutions and analysis through interpretivism (MERTENS, 2010). The curriculum was analyzed in the light of Shulman (2005) and the interviewees' motivational discourse were analyzed from the perspective of Lovely (2012)'s discoveries. At the end, the data was crossed to answer the guiding question of the research, generating the proposed comparative study.

Keywords: preservice teachers, academic curriculum, motivation, english as a foreign language

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Authors: R. K. Yadav, S. Baral, H. R. Paudel, R. Basnet

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The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public healthcare providers in the fight against tuberculosis using international healthcare standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal. A total of 20 respondents participated in the study. Barriers to PPM were identified in the following three themes: 1) Obstacles related to TB case detection, 2) Obstacles related to patients, and 3) Obstacles related to the healthcare system. PPM implementation was challenged by following subthemes that included staff turnover, low private sector participation in workshops, a lack of training, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies. The study concludes that numerous barriers exist in the way of effective implementation of the PPM approach, including TB cases detection barriers such as knowledge of TB diagnosis and treatment, HW attitude, workload, patient-related barriers such as knowledge of TB, self-medication practice, stigma and discrimination, financial status, and health system-related barriers such as staff turnover and poor engagement of the private sector in workshops, training, recording, and re-evaluation. Government stakeholders must work together with private sector stakeholders to perform joint monitoring and supervision. Private practitioners should receive training and orientation, and presumptive TB patients should be given adequate time and counseling as well as motivation to visit a government health facility.

Keywords: barrier, tuberculosis, case finding, PPM, nepal

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Authors: A. Belayadi, A. Mougari, L. Ait-Gougam, F. Mekideche-Chafa

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The artificial neural network is one of the interesting techniques that have been advantageously used to deal with modeling problems. In this study, the computing with artificial neural network (CANN) is proposed. The model is applied to modulate the information processing of one-dimensional task. We aim to integrate a new method which is based on a new coding approach of generating the input-output mapping. The latter is based on increasing the neuron unit in the last layer. Accordingly, to show the efficiency of the approach under study, a comparison is made between the proposed method of generating the input-output set and the conventional method. The results illustrated that the increasing of the neuron units, in the last layer, allows to find the optimal network’s parameters that fit with the mapping data. Moreover, it permits to decrease the training time, during the computation process, which avoids the use of computers with high memory usage.

Keywords: neural network computing, continuous functions generating the input-output mapping, decreasing the training time, machines with big memories

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Authors: Maserapelo Gladys Serapelwane, Eva Mofatiki Manyedi

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Background: Unfair labour practices on staff is a worldwide concern, which creates conflicts and disharmony among health workers. It is found that nursing staff members are unfairly treated without a valid reason in primary health care (PHC) facilities and predominantly in developing countries, and South Africa is not excluded. Objectives: The purpose of the study was to explore and describe the experiences of operational managers regarding unfair labour practices on staff by their local area managers and describe the perceptions of operational managers towards such treatment. Methods: A qualitative, descriptive, exploratory, and contextual research approach was considered appropriate for the study. In this study, the population comprised operational managers working in the PHC facilities of Northwest Province, South Africa. Purposive sampling was used to select participants for the study and focus group interviews were used to interview 23 operational managers. Ethical measures were applied throughout the study. Findings: The six phases of thematic analysis were used to analyze data collected for the study. Two themes that emerged are experiences of factors related to unfair labour practices in the PHC facilities and perceptions regarding how to improve their working conditions. The categories that were found in the first themes were favouritism and discrimination. In the second theme, in-service training and transparency regarding staff training and development emerged. Recommendations comprised, among others, training on the concepts of quality in the workplace and reinforcement of transparency regarding granting of study leave and attending workshops. Conclusion: Operational managers in the PHC facilities experienced unfair labour practices as evidenced by favouritism.

Keywords: unfair labour practices, primary health care facilities, operational managers, North West Province

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Authors: Sait Ozsoy, Asude Gokmen, Mehtap Yondem, Hanife A. Alkan, Gulnaz T. Javan

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Deep neck infection often develops due to upper respiratory tract and odontogenic infections. Gastrointestinal System perforation can occur for many reasons and is in need of the early diagnosis and prompt surgical treatment. In both cases late or incorrect diagnosis may lead to increase morbidity and high mortality. A patient with a diagnosis of deep neck abscess died while under treatment due to sepsis and multiple organ failure. Autopsy finding showed duodenal ulcer and this is reported in the literature.

Keywords: peptic ulcer perforation, peritonitis, retropharyngeal abscess, sepsis

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Authors: T. O. Adeoye

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In Nigeria prior to the arrival of the colonial masters, there used to be good family relationship, things were done through cooperation and community effort, even training and upbringing of a child was the responsibility of every member of the community. The advent of western education and civilization brought about movement of youths from rural to urban areas. Hence the tie that binds the village life is broken, community as a whole is no more responsible for the upbringing or home training of her children any more. The study investigates adoption of home nursing as a remedy for child labour in Nigeria, considered challenges like poverty, broken homes and illiteracy among others. For the purpose of verification, a survey in form of an opinion poll was conducted by means of interview using questionnaires for about 3000 respondents. However, out of the respondents that were interviewed as regard parental poverty and its resultant effect on a child only 14.2% of the respondent strongly disagreed that children work on the street because their parents are poor. The study shows that possible solutions of effective ways of controlling child labour is home nursing and also promoting and advocating for the policies against child labour in Nigeria.

Keywords: child abuse, child labour, psychological problem, Street children

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Authors: Monique Somma

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As special education service delivery models are shifting in order to better meet the academic and social rights of students with exceptionalities, teaching practices must also align with these goals. This phenomenological case study explored the change experiences of special education teachers who have transitioned from teaching in a self-contained special education class to an inclusive class setting. Ten special educators who had recently changed their teaching roles to inclusive classrooms, completed surveys and participated in a focus group. Of the original ten educators, five chose to participate further in individual interviews. Data collected from the three methods was examined and compared for common themes. Emergent themes included, support and training, attitudes and perceptions, inclusive practice, growth and change, and teaching practice. The overall findings indicated that despite their special education training, these educators were challenged by their own beliefs and expectations, the attitudes of others and systematic barriers in the education system. They were equally surprised by the overall social and academic performance of students with exceptionalities in inclusive classes, as well as, the social and academic growth and development of the other students in the class. Over the course of their careers, they all identified an overall personal pedagogical shift, to some degree or another, which they contributed to the successful experiences of inclusion they had. They also recognized that collaborating with others was essential for inclusion to be successful. The findings from this study suggest several implications for professional development and training needs specific to special education teachers moving into inclusive settings. Maximizing the skills of teachers with special education experience in a Professional Learning Community (PLC) and mentorship opportunities would be beneficial to all staffs working toward creating inclusive classrooms and schools.

Keywords: attitudes and perceptions, inclusion of students with exceptionalities, special education teachers, teacher change

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Authors: Tim J. Walsh, Lindsay E. Young, John A. Schneider

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Background: The disproportionate rate of HIV infection among Black men who have sex with men (BMSM) in the United States suggest the importance of Preexposure Prophylaxis (PrEP) interventions for this population. As such, there is an urgent need for innovative outreach strategies that extend beyond the traditional patient-provider relationship to reach at-risk populations. Training members of the BMSM community as peer change agents (PCAs) is one such strategy. An important piece of this training is goal-setting. Goal-setting not only encourages PCAs to define the parameters of the intervention according to their lived experience, it also helps them plan courses of action. Therefore, the aims of this mixed methods study are: (1) Characterize the goals that BMSM set at the end of their PrEP training and (2) Assess the relationship between goal types and PCA engagement. Methods: Between March 2016 and July 2016, preliminary data were collected from 68 BMSM, ages 18-33, in Chicago as part of an ongoing PrEP intervention. Once enrolled, PCAs participate in a half-day training in which they learn about PrEP, practice initiating conversations about PrEP, and identify strategies for supporting at-risk peers through the PrEP adoption process. Training culminates with a goal-setting exercise, whereby participants establish a goal related to their role as a PCA. Goals were coded for features that either emerged from the data itself or existed in extant goal-setting literature. The main outcomes were (1) number of PrEP conversations PCAs self-report during booster conversations two weeks following the intervention and (2) number of peers PCAs recruit into the study that completed the PrEP workshop. Results: PCA goals (N=68) were characterized in terms of four features: Specificity, target population, personalization, and purpose defined. To date, PCAs report a collective 52 PrEP conversations. 56, 25, and 6% of PrEP conversations occurred with friends, family, and sexual partners, respectively. PCAs with specific goals had more PrEP conversations with at-risk peers compared to those with vague goals (58% vs. 42%); PCAs with personalized goals had more PrEP conversations compared to those with de-personalized goals (60% vs. 53%); and PCAs with goals that defined a purpose had more PrEP conversations compared to those who did not define a purpose (75% vs. 52%). 100% of PCAs with goals that defined a purpose recruited peers into the study compared to 45 percent of PCAs with goals that did not define a purpose. Conclusion: Our preliminary analysis demonstrates that BMSM are motivated to set and work toward a diverse set of goals to support peers in PrEP adoption. PCAs with goals involving a clearly defined purpose had more PrEP conversations and greater peer recruitment than those with goals lacking a defined purpose. This may indicate that PCAs who define their purpose at the outset of their participation will be more engaged in the study than those who do not. Goal-setting may be considered as a component of future HIV prevention interventions to advance intervention goals and as an indicator of PCAs understanding of the intervention.

Keywords: HIV prevention, MSM, peer change agent, preexposure prophylaxis

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Authors: Fuad Alzahrani, Yiannis Kyratsis

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Although emergency nurses, being the frontline workers in mass-gatherings, are essential for providing an effective public health response, little is known about the skills that emergency nurses have, or require, in order to respond effectively to a disaster event. This paper is designed to address this gap in the literature by conducting an empirical study on emergency nurses’ preparedness at the mass-gathering event of Hajj in Mecca city. To achieve this aim, this study conducted a cross-sectional survey among 106 emergency department nurses in all the public hospitals in Mecca in 2014. The results revealed that although emergency nurses’ role understanding is high; they have limited knowledge and awareness of how to respond appropriately to mass-gathering disaster events. To address this knowledge gap, the top three most beneficial types of education and training courses suggested are: hospital education sessions, the Emergency Management Saudi Course and workshop; and short courses in disaster management. Finally, recommendations and constructive strategies are developed to provide the best practice in enhancing disaster preparedness. This paper adds to the body of knowledge regarding emergency nurses and mass gathering disasters. This paper measures the level of disaster knowledge, previous disaster response experience and disaster education and training amongst emergency nurses in Mecca, Saudi Arabia. It is anticipated that this study will provide a foundation for future studies aimed at better preparing emergency nurses for disaster response. This paper employs new strategies to improve the emergency nurses’ response during mass gatherings for the Hajj. Increasing the emergency nurses’ knowledge will develop their effective responses in mass-gathering disasters.

Keywords: emergency nurses, mass-gatherings, hajj, disaster preparedness, disaster knowledge, perceived role, disaster training, previous disaster response experience

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Authors: Sean Paulsen, Michael Casey

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In this work we present a self-supervised pretraining framework for transformers on functional Magnetic Resonance Imaging (fMRI) data. First, we pretrain our architecture on two self-supervised tasks simultaneously to teach the model a general understanding of the temporal and spatial dynamics of human auditory cortex during music listening. Our pretraining results are the first to suggest a synergistic effect of multitask training on fMRI data. Second, we finetune the pretrained models and train additional fresh models on a supervised fMRI classification task. We observe significantly improved accuracy on held-out runs with the finetuned models, which demonstrates the ability of our pretraining tasks to facilitate transfer learning. This work contributes to the growing body of literature on transformer architectures for pretraining and transfer learning with fMRI data, and serves as a proof of concept for our pretraining tasks and multitask pretraining on fMRI data.

Keywords: transfer learning, fMRI, self-supervised, brain decoding, transformer, multitask training

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Authors: Marwin M. Dela Cruz

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Aviation as a transport sector is supportive of the seventeen (17) Sustainable Goals espoused by the United Nations. Air Transport Action Group (ATAG) states that over 18.1 million indirect jobs globally were sustained through the purchase of goods and services by companies in the aviation industry. This supply chain activity contributed approximately $816.4 billion to global GDP. This was achieved through numerous actions to lessen economic uncertainty and challenges. Its impact is not just a by-product of economic activity but of the facilities it generates. As the aviation industry is unifying its efforts, education and training should also come with it. The need for aviation education and training and a well-crafted regulatory policy initiated by lawmakers can provide a better aviation education. The Philippine State College of Aeronautics (PhilSCA), being the only government Higher Education Institution (HEI) in the Philippines, is given a very distinct congressional mandate to offer aviation-related courses to afford those in the aviation industry the opportunity to pursue studies. Having this, the industry has become the precursor and venue of present-day communities. In addition, it becomes an essential measure of a better life.

Keywords: Philippine state college of aeronautics, aviation industry, sustainable goals, aviation education

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Authors: Chu Shi Wei

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Supported employment in Malaysia is in the early stages of development. The development of supported employment in Malaysia is an important step towards the inclusion of individuals with disabilities who have previously lacked the necessary support for employment in the open labour market as they were confined to sheltered workshops. There is a paradigm shift from sheltered to supported employment as the sheltered workshop is based on the medical model of disability, which focuses on the disability of the individual and segregated training institutions. The paradigm shift revolves around the social model of disability, which emphasizes the abilities of the individual and the removal of the barriers in the environment by the provision of support. This study explores the development of supported employment by utilizing a mixed methods approach which consists of collecting quantitative data through a survey and interviewing participants to collect qualitative data. Job coaches from six employment sectors participated in the survey and interview. The findings of the study indicate that the role of job coaches is integral to the development of supported employment. The role of job coaches includes job matching, on-the-job training, and developing natural supports to foster greater diversity and inclusion in the workplace.

Keywords: supported employment, disabilities, diversity, development

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Authors: Amira A. A. Abdallah, Amir A. Beltagi

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Background: Core stability training has recently attracted attention for improving muscle balance and optimizing performance in healthy and unhealthy individuals. Purpose: This study investigated the effect of beginner’s core stability exercises on trunk flexors’/extensors’ peak torque ratio and trunk flexors’ and extensors’ peak torques. Methods: Thirty five healthy individuals participated in the study. They were randomly assigned to two groups; experimental “group I, n=20” and control “group II, n=15”. Their mean age, weight and height were 20.7±2.4 vs. 20.3±0.61 years, 66.5±12.1 vs. 68.57±12.2 kg and 166.7±7.8 vs. 164.28 ±7.59 cm. for group I vs. group II. Data were collected using the Biodex Isokinetic system. The participants were tested twice; before and after a 6-week period during which group I performed a core stability training program. Results: The 2x2 Mixed Design ANOVA revealed that there were no significant differences (p>0.025) in the trunk flexors’/extensors’ peak torque ratio between the pre-test and post-test conditions for either group. Moreover, there were no significant differences (p>0.025) in the trunk flexion/extension ratios between both groups at either condition. However, the 2x2 Mixed Design MANOVA revealed significant increases (p<0.025) in the trunk flexors’ and extensors’ peak torques in the post-test condition compared with the pre-test in group I with no significant differences (p>0.025) in group II. Moreover, there was a significant increase (p<0.025) in the trunk flexors’ peak torque only in group I compared with group II in the post-test condition with no significant differences in the other conditions. Interpretation/Conclusion: The improvement in muscle performance indicated by the increase in the trunk flexors’ and extensors’ peak torques in the experimental group recommends including core stability training in the exercise programs that aim to improve muscle performance.

Keywords: core stability, isokinetic, trunk muscles, muscle balance

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