Search results for: sustainable medical education

Authors: Yanjie Zhu, André Jesus, Irwanda Laory

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Structural Health Monitoring (SHM), involving data acquisition, data interpretation and decision-making system aim to continuously monitor the structural performance of civil infrastructures under various in-service circumstances. The main value and purpose of SHM is identifying damages through data interpretation system. Research on SHM has been expanded in the last decades and a large volume of data is recorded every day owing to the dramatic development in sensor techniques and certain progress in signal processing techniques. However, efficient and reliable data interpretation for damage detection under environmental variations is still a big challenge. Structural damages might be masked because variations in measured data can be the result of environmental variations. This research reports a novel method based on single-channel Blind Signal Separation (BSS), which extracts environmental effects from measured data directly without any prior knowledge of the structure loading and environmental conditions. Despite the successful application in audio processing and bio-medical research fields, BSS has never been used to detect damage under varying environmental conditions. This proposed method optimizes and combines Ensemble Empirical Mode Decomposition (EEMD), Principal Component Analysis (PCA) and Independent Component Analysis (ICA) together to separate structural responses due to different loading conditions respectively from a single channel input signal. The ICA is applying on dimension-reduced output of EEMD. Numerical simulation of a truss bridge, inspired from New Joban Line Arakawa Railway Bridge, is used to validate this method. All results demonstrate that the single-channel BSS-based method can recover temperature effects from mixed structural response recorded by a single sensor with a convincing accuracy. This will be the foundation of further research on direct damage detection under varying environment.

Keywords: damage detection, ensemble empirical mode decomposition (EEMD), environmental variations, independent component analysis (ICA), principal component analysis (PCA), structural health monitoring (SHM)

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Authors: Efe Mary Isike

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The variety of relationships between migrants and host communities is an enduring theme of migration studies. On one extreme, there are numerous examples of hostility towards ‘strangers’ who are either ejected from society or denied access to jobs, housing, education, healthcare and other aspects of normal life. More moderate treatments of those identified as different include expectations of assimilation in which host communities expect socially marginalized groups to conform to norms that they define. Both exclusion and assimilation attempt to manage the problem of difference by removing it. South Africa experienced great influx of African immigrants who worked in mines and farms under harsh and exploitative conditions before and after the institutionalization of apartheid. Although these labour migrants contributed a great deal to the economic development of South Africa, they were not given citizenship status. The formal democratization in 1994 came with dreams and expectations of a more inclusive South Africa, where black South Africans hoped to maximize their potential in a more free, fair and equal society. In the same vein, it also opened spaces for an influx of especially African immigrants into the country which set the stage for a new form of contest for belonging between South African citizens and African migrant settlers. One major manifestation of this contest was the violent xenophobic attacks against African immigrants which predate that of May 2008 and has continued with lower intensity across the country since then. While it is doubtless possible to find abundant evidence of antagonism in the relations between South Africans and African immigrants, the purpose of this study is to investigate the everyday realities of migrants in ordinary places who interact with a variety of people through their livelihood activities, marriages and social relationships, moving around towns and cities, in their residential areas, in faith-based organizations and other elements of everyday life. Rather than assuming all relations are hostile, this study intends to look at the breadth of everyday relationships within a specific context. Based on the foregoing, the main task of this study is to holistically examine and explain the nature of interactions between African migrants and South African citizens by analysing the social network ties that connect them in the specific case of Umhlathuze municipality. It will also investigate the variety of networks that exists between African migrants and South Africans and examine the nature of the linkages in the various networks identified between these two groups in Umhlathuze Municipality. Apart from a review of relevant literature, policies and other official documents, this paper will employ a purposive sample survey and in-depth interview of African immigrants and South Africans within their networks in selected suburbs in KwaZulu-Natal.

Keywords: migration, networks, development, host communities

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Authors: Quentin Lobbe, David Chavalarias, Alexandre Delanoe

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The ICT revolution has given birth to an unprecedented world of digital traces and has impacted a wide number of knowledge-driven domains such as science, education or policy making. Nowadays, we are daily fueled by unlimited flows of articles, blogs, messages, tweets, etc. The internet itself can thus be considered as an unsteady hyper-textual environment where websites emerge and expand every day. But there are structures inside knowledge. A given text can always be studied in relation to others or in light of a specific socio-cultural context. By way of their textual traces, human beings are calling each other out: hypertext citations, retweets, vocabulary similarity, etc. We are in fact the architects of a giant web of elements of knowledge whose structures and shapes convey their own information. The global shapes of these digital traces represent a source of collective knowledge and the question of their visualization remains an opened challenge. How can we explore, browse and interact with such shapes? In order to navigate across these growing constellations of words and texts, interdisciplinary innovations are emerging at the crossroad between fields of social and computational sciences. In particular, complex systems approaches make it now possible to reconstruct the hidden structures of textual knowledge by means of multi-scale objects of research such as semantic maps and phylomemies. The phylomemy reconstruction is a generic method related to the co-word analysis framework. Phylomemies aim to reveal the temporal dynamics of large corpora of textual contents by performing inter-temporal matching on extracted knowledge domains in order to identify their conceptual lineages. This study aims to address the question of visualizing the global shapes of online political discussions related to the French presidential and legislative elections of 2017. We aim to build phylomemies on top of a dedicated collection of thousands of French political tweets enriched with archived contemporary news web articles. Our goal is to reconstruct the temporal evolution of online debates fueled by each political community during the elections. To that end, we want to introduce an iterative data exploration methodology implemented and tested within the free software Gargantext. There we combine synchronic and diachronic axis of visualization to reveal the dynamics of our corpora of tweets and web pages as well as their inner syntagmatic and paradigmatic relationships. In doing so, we aim to provide researchers with innovative methodological means to explore online semantic landscapes in a collaborative and reflective way.

Keywords: online political debate, French election, hyper-text, phylomemy

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Authors: Sopit Tubtimhin, Chaliya Wamaloon, Anchalee Supattagorn

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Background and Significance: Breast cancer is the most frequently diagnosed and leading cause of cancer death among women. This study aims to determine factors potentially predicting recurrence and long-term survival after the first recurrence in surgically treated patients between postmenopausal and younger women. Methods and Analysis: A retrospective cohort study was performed on 498 Thai women with invasive breast cancer, who had undergone mastectomy and been followed-up at Ubon Ratchathani Cancer Hospital, Thailand. We collected based on a systematic chart audit from medical records and pathology reports between January 1, 2002, and December 31, 2011. The last follow-up time point for surviving patients was December 31, 2016. A Cox regression model was used to calculate hazard ratios of recurrence and death. Findings: The median age was 49 (SD ± 9.66) at the time of diagnosis, 47% was post-menopausal women ( ≥ 51years and not experienced any menstrual flow for a minimum of 12 months), and 53 % was younger women ( ˂ 51 years and have menstrual period). Median time from the diagnosis to the last follow-up or death was 10.81 [95% CI = 9.53-12.07] years in younger cases and 8.20 [95% CI = 6.57-9.82] years in postmenopausal cases. The recurrence-free survival (RFS) for younger estimates at 1, 5 and 10 years of 95.0 %, 64.0% and 58.93% respectively, appeared slightly better than the 92.7%, 58.1% and 53.1% for postmenopausal women [HRadj = 1.25, 95% CI = 0.95-1.64]. Regarding overall survival (OS) for younger at 1, 5 and 10 years were 97.7%, 72.7 % and 52.7% respectively, for postmenopausal patients, OS at 1, 5 and 10 years were 95.7%, 70.0% and 44.5 respectively, there were no significant differences in survival [HRadj = 1.23, 95% CI = 0.94 -1.64]. Multivariate analysis identified five risk factors for negatively impacting on survival were triple negative [HR= 2.76, 95% CI = 1.47-5.19], Her2-enriched [HR = 2.59, 95% CI = 1.37-4.91], luminal B [HR = 2.29, 95 % CI=1.35-3.89], not free margin [HR = 1.98, 95%CI=1.00-3.96] and patients who received only adjuvant chemotherapy [HR= 3.75, 95% CI = 2.00-7.04]. Statistically significant risks of overall cancer recurrence were Her2-enriched [HR = 5.20, 95% CI = 2.75-9.80], triple negative [HR = 3.87, 95% CI = 1.98-7.59], luminal B [HR= 2.59, 95% CI = 1.48-4.54,] and patients who received only adjuvant chemotherapy [HR= 2.59, 95% CI = 1.48-5.66]. Discussion and Implications: Outcomes from this studies have shown that postmenopausal women have been associated with increased risk of recurrence and mortality. As the results, it provides useful information for planning the screening and treatment of early-stage breast cancer in the future.

Keywords: breast cancer, menopause status, recurrence-free survival, overall survival

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Authors: Andriana E. Tran, Anna Chur-Hansen

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

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

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Authors: Boris Bajer, Andrea Havranova, Miroslav Vlcek, Richard Imrich, Adela Penesova

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Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes, and also prevent cardiovascular diseases, as it showed many studies (the Finnish Diabetes Prevention Study, Diabetes Prevention Program (DPP), . the China Da Qing Diabetes Prevention Study, etc.) Therefore the aim of our study was to compare the effect of intensified lifestyle intervention on cardiometabolic parameters. Methods: It is an ongoing randomized interventional clinical study (NCT02325804) focused on the reduction of body weight/fat. Intervention: hypocaloric diet (30% restriction of calories) and physical activity 150 minutes/week. Before and after 8 weeks of intervention all patients underwent complete medical examination (measurement of physical fitness, resting metabolic rate (RMR), body composition analysis, oral glucose tolerance test, parameters of lipid metabolism, and other cardiometabolic risk factors. Results: So far 39 patients finished the intervention. The average reduction of body weight was 6,8 + 4,9 kg (0-15 kg; p=0,0006), accompanied with significant reduction of body fat percentage (p ≤ 0,0001), amount of fat mass (p=0,03), waist circumference (p=0.02). Amount of lean mass and RMR remained unchanged. Heart rate (p=0,02), systolic and diastolic blood pressure was reduced (p=0,01 p=0,02 resp.) as well as insulin sensitivity was improved. Lipid parameters also changed - cholesterol, LDL decreased (p=0,05, p=0,04 resp.), while triglycerides showed tendency to decrease (p=0,055). Liver function improved, alanine aminotrasnferase (ALT) were reduced (p=0,01). Physical fitness significantly improved (as measure VO2 max (p=0,02). Conclusion: Results of our study are in line with previous results about the beneficial effect of intensive lifestyle changes on the reduction of cardiometabolic risk factors and improvement of liver function. Supported by grants APVV 15-0228; VEGA 2/0161/16

Keywords: obesity, weight loss, diet lipids, blood pressure, liver enzymes

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Authors: Diane Ghanem, Oscar Covarrubias, Michael Raad, Dawn LaPorte, Babar Shafiq

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Introduction: Standardized exams have long been considered a cornerstone in measuring cognitive competency and academic achievement. Their fixed nature and predetermined scoring methods offer a consistent yardstick for gauging intellectual acumen across diverse demographics. Consequently, the performance of artificial intelligence (AI) in this context presents a rich, yet unexplored terrain for quantifying AI's understanding of complex cognitive tasks and simulating human-like problem-solving skills. Publicly available AI language models such as ChatGPT have demonstrated utility in text generation and even problem-solving when provided with clear instructions. Amidst this transformative shift, the aim of this study is to assess ChatGPT’s performance on the orthopaedic surgery in-training examination (OITE). Methods: All 213 OITE 2021 web-based questions were retrieved from the AAOS-ResStudy website. Two independent reviewers copied and pasted the questions and response options into ChatGPT Plus (version 4.0) and recorded the generated answers. All media-containing questions were flagged and carefully examined. Twelve OITE media-containing questions that relied purely on images (clinical pictures, radiographs, MRIs, CT scans) and could not be rationalized from the clinical presentation were excluded. Cohen’s Kappa coefficient was used to examine the agreement of ChatGPT-generated responses between reviewers. Descriptive statistics were used to summarize the performance (% correct) of ChatGPT Plus. The 2021 norm table was used to compare ChatGPT Plus’ performance on the OITE to national orthopaedic surgery residents in that same year. Results: A total of 201 were evaluated by ChatGPT Plus. Excellent agreement was observed between raters for the 201 ChatGPT-generated responses, with a Cohen’s Kappa coefficient of 0.947. 45.8% (92/201) were media-containing questions. ChatGPT had an average overall score of 61.2% (123/201). Its score was 64.2% (70/109) on non-media questions. When compared to the performance of all national orthopaedic surgery residents in 2021, ChatGPT Plus performed at the level of an average PGY3. Discussion: ChatGPT Plus is able to pass the OITE with a satisfactory overall score of 61.2%, ranking at the level of third-year orthopaedic surgery residents. More importantly, it provided logical reasoning and justifications that may help residents grasp evidence-based information and improve their understanding of OITE cases and general orthopaedic principles. With further improvements, AI language models, such as ChatGPT, may become valuable interactive learning tools in resident education, although further studies are still needed to examine their efficacy and impact on long-term learning and OITE/ABOS performance.

Keywords: artificial intelligence, ChatGPT, orthopaedic in-training examination, OITE, orthopedic surgery, standardized testing

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Authors: Tiffany Hollis

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Childhood trauma is well documented in mental health research, yet has received little attention in urban schools. Child trauma affects brain development and impacts cognitive, emotional, and behavioral functioning. When educators understand that some of the behaviors that appear to be aggressive in nature might be the result of a hidden diagnosis of trauma, learning can take place, and the child can thrive in the classroom setting. Traumatized children, however, do not fit neatly into any single ‘box.’ Although many children enter school each day carrying with them the experience of exposure to violence in the home, the symptoms of their trauma can be multifaceted and complex, requiring individualized therapeutic attention. The purpose of this study was to examine how prepared educators are to address the unique challenges facing children who experience trauma. Given the vast number of traumatized children in our society, it is evident that our education system must investigate ways to create an optimal learning environment that accounts for trauma, addresses its impact on cognitive and behavioral development, and facilitates mental and emotional health and well-being. The researcher describes the knowledge, attitudes, dispositions, and skills relating to trauma-informed knowledge of induction level teachers in a diverse middle school. The data for this study were collected through interviews with teachers, who are in the induction phase (the first three years of their teaching career). The study findings paint a clear picture of how ill-prepared educators are to address the needs of students who have experienced trauma and the implications for the development of a professional development workshop or series of workshops that train teachers how to recognize and address and respond to the needs of students. The study shows how teachers often lack skills to meet the needs of students who have experienced trauma. Traumatized children regularly carry a heavy weight on their shoulders. Children who have experienced trauma may feel that the world is filled with unresponsive, threatening adults, and peers. Despite this, supportive interventions can provide traumatized children with places to go that are safe, stimulating, and even fun. Schools offer an environment that potentially meets these requirements by creating safe spaces where students can feel at ease and have fun while also learning via stimulating educational activities. This study highlights the lack of preparedness of educators to address the academic, behavioral, and cognitive needs of students who have experienced trauma. These findings provide implications for the creation of a professional development workshop that addresses how to recognize and address the needs of students who have experienced some type of trauma. They also provide implications for future research with a focus on specific interventions that enable the creation of optimal learning environments where students who have experienced trauma and all students can succeed, regardless of their life experiences.

Keywords: educator preparation, induction educators, professional development, trauma-informed

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Authors: Hend Albassam, Nouf Alrumaih

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Nowadays we are in the age of technologies and communication and there is no doubt that technologies such as the Internet can offer many advantages for many business fields, and the health field is no execution. In fact, using the Internet provide us with a new path to improve the quality of health care throughout the world. The e-healthcare offers many advantages such as: efficiency by reducing the cost and avoiding duplicate diagnostics, empowerment of patients by enabling them to access their medical records, enhancing the quality of healthcare and enabling information exchange and communication between healthcare organizations. There are many problems that result from using papers as a way of communication, for example, paper-based prescriptions. Usually, the doctor writes a prescription and gives it to the patient who in turn carries it to the pharmacy. After that, the pharmacist takes the prescription to fill it and give it to the patient. Sometimes the pharmacist might find difficulty in reading the doctor’s handwriting; the patient could change and counterfeit the prescription. These existing problems and many others heighten the need to improve the quality of the healthcare. This project is set out to develop a distributed e-healthcare system that offers some features of e-health and addresses some of the above-mentioned problems. The developed system provides an electronic health record (EHR) and enables communication between separate health care organizations such as the clinic, pharmacy and laboratory. To develop this system, the Service Oriented Architecture (SOA) is adopted as a design approach, which helps to design several independent modules that communicate by using web services. The layering design pattern is used in designing each module as it provides reusability that allows the business logic layer to be reused by different higher layers such as the web service or the website in our system. The experimental analysis has shown that the project has successfully achieved its aims toward solving the problems related to the paper-based healthcare systems and it enables different health organization to communicate effectively. It implements four independent modules including healthcare provider, pharmacy, laboratory and medication information provider. Each module provides different functionalities and is used by a different type of user. These modules interoperate with each other using a set of web services.

Keywords: e-health, services oriented architecture (SOA), web services, interoperability

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Authors: Auwal Abubakar, Shazril Imran Shaukat, Noor Khairiah A. Karim, Mohammed Zakir Kassim, Gokula Kumar Appalanaido, Hafiz Mohd Zin

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Background: Voluntary deep inspiration breath-hold radiotherapy (vDIBH-RT) is an effective cardiac dose reduction technique during left breast radiotherapy. This study aimed to assess the accuracy of the implementation of the vDIBH technique among left breast cancer patients without the use of a special device such as a surface-guided imaging system. Methods: The vDIBH-RT technique was implemented among thirteen (13) left breast cancer patients at the Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia. Breath-hold monitoring was performed based on breath-hold skin marks and laser light congruence observed on zoomed CCTV images from the control console during each delivery. The initial setup was verified using cone beam computed tomography (CBCT) during breath-hold. Each field was delivered using multiple beam segments to allow a delivery time of 20 seconds, which can be tolerated by patients in breath-hold. The data were analysed using an in-house developed MATLAB algorithm. PTV margin was computed based on van Herk's margin recipe. Results: The setup error analysed from CBCT shows that the population systematic error in lateral (x), longitudinal (y), and vertical (z) axes was 2.28 mm, 3.35 mm, and 3.10 mm, respectively. Based on the CBCT image guidance, the Planning target volume (PTV) margin that would be required for vDIBH-RT using CCTV/Laser monitoring technique is 7.77 mm, 10.85 mm, and 10.93 mm in x, y, and z axes, respectively. Conclusion: It is feasible to safely implement vDIBH-RT among left breast cancer patients without special equipment. The breath-hold monitoring technique is cost-effective, radiation-free, easy to implement, and allows real-time breath-hold monitoring.

Keywords: vDIBH, cone beam computed tomography, radiotherapy, left breast cancer

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Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter

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The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.

Keywords: imaging, guidelines, emergency medicine, audit

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Authors: Deog-Gyu Seo, Jin-Soo Ahn

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Objectives: Recently, the development of adhesive primers on stable bonding between zirconia and resin cement has been on the increase. The bond strength of zirconia-resin cement can be effectively increased with the treatment of primer composed of the adhesive monomer that can chemically bond with the oxide layer, which forms on the surface of zirconia. 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) that contains phosphate ester and acidic monomer 4-methacryloxyethyl trimellitic anhydride(4-META) have been suggested as monomers that can form chemical bond with the surface oxide layer of zirconia. Also, these suggested monomers have proved to be effective zirconia surface treatment for bonding to resin cement. The purpose of this study is to evaluate the effects of primer treatment on the bond strength of Zirconia-resin cement by using three different kinds of primers on the market. Methods: Zirconia blocks were prepared into 60 disk-shaped specimens by using a diamond saw. Specimens were divided into four different groups: first three groups were treated with zirconiaLiner(Sun Medical Co., Ltd., Furutaka-cho, Moriyama, Shiga, Japan), Alloy primer (Kuraray Noritake Dental Inc., Sakaju, Kurashiki, Okayama, Japan), and Universal primer (Tokuyama dental Corp., Taitou, Taitou-ku, Tokyo, Japan) respectively. The last group was the control with no surface treatment. Dual cured resin cement (Biscem, Bisco Inc., Schaumburg, IL, USA) was luted to each group of specimens. And then, shear bond strengths were measured by universal tesing machine. The significance of the result was statistically analyzed by one-way ANOVA and Tukey test. The failure sites in each group were inspected under a magnifier. Results: Mean shear bond strength were 0.60, 1.39, 1.03, 1.38 MPa for control, Zirconia Liner (ZL), Alloy primer (AP), Universal primer (UP), respectively. Groups with application of each of the three primers showed significantly higher shear bond strength compared to the control group (p < 0.05). Among the three groups with the treatment, ZL and UP showed significantly higher shear bond strength than AP (p < 0.05), and there were no significant differences in mean shear bond strength between ZL and UP (p < 0.05). While the most specimens of control groups showed adhesive failure (80%), the most specimens of three primer-treated groups showed cohesive or mixed failure (80%).

Keywords: primer, resin cement, shear bond strength, zirconia

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Authors: Rafiqul Hasan, A. S. M. Tanim Anwar, Mohammad Azizul Hakim

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Background: Chronic kidney disease (CKD) is a major public health problem that continues to increase in prevalence globally. The prevalence of chronic kidney disease is increasing day by day in low to middle income countries (LMICs). People living in LMICs have the highest need for renal replacement therapy (RRT) despite they have lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, very much infrastructure, dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. To authors knowledge there was scarcity of data regarding CAPD performance in remote area of Bangladesh. This study was aimed to report the characteristics and outcomes of CAPD in ESRD patients lived in least developed area of Bangladesh. Methods: This prospective study was conducted in Cox’sbazar Medical College Hospital, Cox’sbazar and Parkview hospital Ltd, Chattogram, Bangladesh. Data were collected by questionnaire from the patients of any age with end-stage renal disease (ESRD) who underwent CAPD in 2018–2021. The baseline characteristics, PD-related complication as well as patient and technique survivals were analyzed. Results: Out of 31 patients who underwent CAPD, 18 (58%) were male on the age range of 15–79 years. The mean follow-up duration was 18 months. Mortality was inversely related with the EF of echocardiography. The peritonitis rate was 0.48 episodes per patient per year. The 1, 3 and 4-year patient survival rates were 64.34% (95% CI = 52.5–81.5), 23.79% (95% CI = 17.9 – 57.4) and 3.22% (95% CI = 31.2–77.5) respectively. Conclusions: In this study, CAPD performance was poorer than usual reference. Cardiac compromised patient and inappropriate dwell might be the main contributing factors behind this scenario. The peritonitis rate was nearly similar to that of developed countries. CAPD was cost effective than HD in remote area. Some accessible measures may be taken to make CAPD a more acceptable RRT modality with improved outcomes in poor socioeconomic backgrounds.

Keywords: dialysis cost, peritoneal dialysis, peritonitis, CAPD, least developed area, remote area, Bangladesh

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Authors: Anna Mirczak

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Introduction: In connection with the aging of the population and the increase in the number of people with chronic illnesses, the priority objective for public health has become not only lengthening life, but also improving quality of life in older persons, as well as maintenance of their relative independence and active participation in social life. The most important determinant of a person’s quality of life is health. According to the literature, older people with chronic illness who live in rural settings are at greater risk for poor outcomes than their urban counterparts. Furthermore research characterizes the rural elderly as having a higher incidence of sickness, dysfunction, disability, restricted mobility, and acute and chronic conditions than their urban citizens. It is dictated by the overlapping certain specific socio-economic factors typical for rural areas which include: social and geography exclusion, limited access to health care centers, and low socioeconomic status. Aim of the study: The objective of this study was to recognize health status and needs of older people living in selected rural areas in Poland and evaluate the impacts of working in the farm on their health status. Material and methods: The study was performed personally, using interviews based on the structural questionnaires, during the period from March 2011 to October 2012. The group of respondents consisted 203 people aged 65 years and over living in selected rural areas in Poland. The analysis of collected research material was performed using the statistical package SPSS 19 for Windows. The level of significance for the tested the hypotheses assumed value of 0.05. Results: The mean age of participants was 75,5 years (SD=5,7) range from 65 to 94 years. Most of the interviewees had children (89.2%) and grandchildren (83.7) and lived mainly with family members (75.9%) mostly in double (46.8%) and triple (20.8%) household. The majority of respondents (71,9%) were physical working on the farm. At the time of interview, each of the respondents reported that they had been diagnosed with at least one chronic diseases by their GP. The most common were: hypertension (67,5%), osteoarthritis (44,8%), atherosclerosis (43,3%), cataract (40,4%), arrhythmia (28,6%), diabetes mellitus (19,7%) and stomach or duodenum ulcer diseases (17,2%).The number of diseases occurring of the sample was dependent on gender and age. Significant associations were observed between working on the farm and frequency of occurrence cardiovascular diseases, the gastrointestinal tract dysfunction and sensory disorders. Conclusions: The most common causes of disability among older citizens were: chronic diseases, malnutrition and complaints about access to health services (especially to cardiologist and an ophthalmologist). Health care access and health status are a particular concern in rural areas where the population is older, has lower education and income levels, and is more likely to be living in medically underserved areas than is the case in urban areas.

Keywords: ageing, health status, older people, rural

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Authors: Farah Naja, Mohamad Alameddine

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Background: The difficulty of compliance to therapeutic and lifestyle management of type 2 diabetes mellitus (T2DM) encourages patients to use complementary and alternative medicine (CAM) therapies. Little is known about the prevalence and mode of CAM use among diabetics in the Eastern Mediterranean Region in general and Lebanon in particular. Objective: To assess the prevalence and modes of CAM use among patients with T2DM residing in Beirut, Lebanon. Methods: A cross-sectional survey of T2DM patients was conducted on patients recruited from two major referral centers - a public hospital and a private academic medical center in Beirut. In a face-to-face interview, participants completed a survey questionnaire comprised of three sections: socio-demographic, diabetes characteristics and types and modes of CAM use. Descriptive statistics, univariate and multivariate logistic regression analyses were utilized to assess the prevalence, mode and correlates of CAM use in the study population. The main outcome in this study (CAM use) was defined as using CAM at least once since diagnosis with T2DM. Results: A total of 333 T2DM patients completed the survey (response rate: 94.6%). Prevalence of CAM use in the study population was 38%, 95% CI (33.1-43.5). After adjustment, CAM use was significantly associated with a “married” status, a longer duration of T2DM, the presence of disease complications, and a positive family history of the disease. Folk foods and herbs were the most commonly used CAM followed by natural health products. One in five patients used CAM as an alternative to conventional treatment. Only 7 % of CAM users disclosed the CAM use to their treating physician. Health care practitioners were the least cited (7%) as influencing the choice of CAM among users. Conclusion: The use of CAM therapies among T2DM patients in Lebanon is prevalent. Decision makers and care providers must fully understand the potential risks and benefits of CAM therapies to appropriately advise their patients. Attention must be dedicated to educating T2DM patients on the importance of disclosing CAM use to their physicians especially patients with a family history of diabetes, and those using conventional therapy for a long time.

Keywords: nutritional supplements, type 2 diabetes mellitus, complementary and alternative medicine (CAM), conventional therapy

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Authors: Ahmed Sami Hammami, Mohamed Jellazi

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Background: The aim of the study is to evaluate the magnitude of different psychological outcomes among Tunisian health care professionals (HCP) during the COVID-19 pandemic and to identify the associated factors. Methods: HCP completed a cross-sectional questionnaire from April 4th to April, 28th 2020. The survey collected demographic information, factors that may interfere with the psychological outcomes, behavior changes and mental health measurements. The latter was assessed through 3 scales; the 7-item questions Insomnia Severity Index, the 2-item Patient Health Questionnaire and the 2-item Generalized Anxiety Disorder. Multivariable logistic regression was conducted to identify factors associated with psychological outcomes. Results: A total of 503 HCP successfully completed the survey; among those, n=493 consented to enroll in the study, 411 [83.4%] were physicians, 323 [64.2%] were women and 271 [55%] had a second-line working position. A significant proportion of HCP had anxiety 35.7%, depression 35.1% and insomnia 23.7%. Females, those with psychiatric history and those using public transport exhibited the highest proportions for overall symptoms compared to other groups e.g., depression among females vs. males: 44,9% vs. 18,2%, P=0.00. Those with a previous medical history and nurses, had more anxiety and insomnia compared to other groups e.g. anxiety among nurses vs. interns/residents vs. attending 45,1% vs 36,1% vs 27,5%; p=0.04. Multivariable logistic regression showed that female gender was a risk factor for all psychological outcomes e.g. female sex increased the odds of anxiety by 2.86; 95% confidence interval [CI], 1, 78-4, 60; P=0.00, whereas having a psychiatric history was a risk factor for both anxiety and insomnia. (e.g. for insomnia OR=2,86; 95% [CI], 1,78-4,60; P=0.00), Having protective equipment was associated with lower risk for depression (OR=0,41; 95% CI, 0,27-0,62; P=0.00) and anxiety. Physical activity was also protective against depression and anxiety (OR=0,41, 95% CI, 0,25-0,67, P=0.00). Conclusion: Psychological symptoms are usually undervalued among HCP, though the COVID-19 pandemic played a major role in exacerbating this burden. Prompt psychological support should be endorsed and simple measures such as physical activity and ensuring the necessary protection are paramount to improve mental health outcomes and the quality of care provided to patients.

Keywords: COVID-19 pandemic, health care professionals, mental health, protective factors, psychological symptoms, risk factors

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Authors: Shende Suraj Balu, A. B. Deoghare, K. M. Pandey

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The human middle ear (ME) is a delicate and vital organ. It has a complex structure that performs various functions such as receiving sound pressure and producing vibrations of eardrum and propagating it to inner ear. It consists of Tympanic Membrane (TM), three auditory ossicles, various ligament structures and muscles. Incidents such as traumata, infections, ossification of ossicular structures and other pathologies may damage the ME organs. The conditions can be surgically treated by employing prosthesis. However, the suitability of the prosthesis needs to be examined in advance prior to the surgery. Few decades ago, this issue was addressed and analyzed by developing an equivalent representation either in the form of spring mass system, electrical system using R-L-C circuit or developing an approximated CAD model. But, nowadays a three-dimensional ME model can be constructed using micro X-Ray Computed Tomography (μCT) scan data. Moreover, the concern about patient specific integrity pertaining to the disease can be examined well in advance. The current research work emphasizes to develop the ME model from the stacks of μCT images which are used as input file to MIMICS Research 19.0 (Materialise Interactive Medical Image Control System) software. A stack of CT images is converted into geometrical surface model to build accurate morphology of ME. The work is further extended to understand the dynamic behaviour of Harmonic response of the stapes footplate and umbo for different sound pressure levels applied at lateral side of eardrum using finite element approach. The pathological condition Cholesteatoma of ME is investigated to obtain peak to peak displacement of stapes footplate and umbo. Apart from this condition, other pathologies, mainly, changes in the stiffness of stapedial ligament, TM thickness and ossicular chain separation and fixation are also explored. The developed model of ME for pathologies is validated by comparing the results available in the literatures and also with the results of a normal ME to calculate the percentage loss in hearing capability.

Keywords: computed tomography (μCT), human middle ear (ME), harmonic response, pathologies, tympanic membrane (TM)

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Authors: Swarkar Sharma, Ekta Rai, Ankit Mahajan, Parvinder Kumar, Manoj K Dhar, Sushil Razdan, Kumarasamy Thangaraj, Carol Wise, Shiro Ikegawa M.D., K.K. Pandita M.D.

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Rare disorders are poorly understood hence, remain uncharacterized or patients are misdiagnosed and get poor medical attention. A rare mysterious skeletal disorder that remained unidentified for decades and rendered many people physically challenged and disabled for life has been reported in an isolated remote village ‘Arai’ of Poonch district of Jammu and Kashmir. This village is located deep in mountains and the population residing in the region is highly consanguineous. In our survey of the region, 70 affected people were reported, showing similar phenotype, in the village with a population of approximately 5000 individuals. We were able to collect samples from two multi generational extended families from the village. Through Whole Exome sequencing (WES), we identified a rare variation NM_003880.3:c.156C>A NP_003871.1:p.Cys52Ter, which results in introduction of premature stop codon in WISP3 gene. We found this variation perfectly segregating with the disease in one of the family. However, this variation was absent in other family. Interestingly, a novel splice site mutation at position c.643+1G>A of WISP3 gene, perfectly segregating with the disease was observed in the second family. Thus, exploiting WES and putting different evidences together (familial histories and genetic data, clinical features, radiological and biochemical tests and findings), the disease has finally been diagnosed as a very rare recessive hereditary skeletal disease “Progressive Pseudorheumatoid Arthropathy of Childhood” (PPAC) also known as “Spondyloepiphyseal Dysplasia Tarda with Progressive Arthropathy” (SEDT-PA). This genetic characterization and identification of the disease causing mutations will aid in genetic counseling, critically required to curb this rare disorder and to prevent its appearance in future generations in the population. Further, understanding of the role of WISP3 gene the biological pathways should help in developing treatment for the disorder.

Keywords: whole exome sequencing, Next Generation Sequencing, rare disorders

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Authors: Florence Awde

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In 2023, it was expected 350 parents in Arizona would have a child receive a cancer diagnosis (Welcome Arizona Cancer Foundation For Children, n.d.). The news of a child’s diagnosis with cancer can be overwhelming and confusing, especially for those lucky enough to lack a personal tie to the disease that takes approximately 1800 children’s lives each year in the United States (Deegan et al., n.d.). A parent’s beliefs, attitudes, and understandings surrounding cancer are vital for medical staff to provide adequate and culturally competent care for each patient, especially across cultural and ethnic lines in regions housing multicultural populations. Arizona's cultural/linguistic mosaic houses many White and Latino populations and English and Spanish speakers. Variations in insurance coverage, from those insured through public insurance programs (e.g., Medicaid) or private insurance plans (e.g., employee-sponsored insurance) versus those uninsured, also factor into health-seeking attitudes and behaviors. To further understand parental attitudes, understandings, and beliefs towards childhood cancer, 22 parents (11 of Latino ethnicity, 11 of White ethnicity) were interviewed on these facets of childhood cancer, despite 21 of the 22 never having a child receive a cancer diagnosis. The exploration of these perceptions across ethnic lines revealed a higher report of fear-orientated beliefs amongst Latino parents--hypothesized to be rooted in the starkly contrasting lack of belief in the possibility of recovering for children with cancer, compared to their white counterparts who displayed more optimism in the recovery process. Further, this study’s results lay the foundation for future scholarship to explore avenues of information dispersal to Latino parents that correct misconceptions of health outcomes and enable earlier intervention to be possible, ultimately correlating to better health and treatment outcomes by increasing parental health literacy rates for childhood cancer in the Phoenix Metropolitan.

Keywords: Childhood Cancer, Parental Beliefs, Parental Attitudes, Parental Understandings, Phoenix Metropolitan, Culturally Competent Care, Health Disparities, Health Inequities

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Authors: Thomas J. Bell III

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This paper explores the value of assimilating certification training within a traditional course curriculum. This innovative approach is believed to increase stakeholder value within the Computer Information System program at Texas Wesleyan University. Stakeholder value is obtained from increased job marketability and critical thinking skills that create employment-ready graduates. This paper views value as first developing the capability to earn an industry-recognized certification, which provides the student with more job placement compatibility while allowing the use of critical thinking skills in a liberal arts business program. Graduates with industry-based credentials are often given preference in the hiring process, particularly in the information technology sector. And without a pioneering curriculum that better prepares students for an ever-changing employment market, its educational value is dubiously questioned. Since certifications are trending in the hiring process, academic programs should explore the viability of incorporating certification training into teaching pedagogy and courses curriculum. This study will examine the use of the balanced scorecard across four performance dimensions (financial, customer, internal process, and innovation) to measure the stakeholder value of certification training within a traditional course curriculum. The balanced scorecard as a strategic management tool may provide insight for leveraging resource prioritization and decisions needed to achieve various curriculum objectives and long-term value while meeting multiple stakeholders' needs, such as students, universities, faculty, and administrators. The research methodology will consist of quantitative analysis that includes (1) surveying over one-hundred students in the CIS program to learn what factor(s) contributed to their certification exam success or failure, (2) interviewing representatives from the Texas Workforce Commission to identify the employment needs and trends in the North Texas (Dallas/Fort Worth) area, (3) reviewing notable Workforce Innovation and Opportunity Act publications on training trends across several local business sectors, and (4) analyzing control variables to identify specific correlations between industry alignment and job placement to determine if a correlation exists. These findings may provide helpful insight into impactful pedagogical teaching techniques and curriculum that positively contribute to certification credentialing success. And should these industry-certified students land industry-related jobs that correlate with their certification credential value, arguably, stakeholder value has been realized.

Keywords: certification exam teaching pedagogy, exam preparation, testing techniques, exam study tips, passing certification exams, embedding industry certification and curriculum alignment, balanced scorecard performance evaluation

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Authors: Joelle Fong

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Older persons are at greatest risk of becoming frail. As survival to the age of 80 and beyond continues to increase, the health and frailty of older Americans has garnered much recent attention among policy makers and healthcare administrators. This paper examines patterns in old-age frailty within a multistate actuarial model that characterizes the stochastic process of biological ageing. Using aggregate population-level U.S. mortality data, we implement a stochastic aging model to examine cohort trends and gender differences in frailty distributions for older Americans born 1865 – 1894. The stochastic ageing model, which draws from the fields of actuarial science and gerontology, is well-established in the literature. The implications for public health insurance programs are also discussed. Our results suggest that, on average, women tend to be frailer than men at older ages and reveal useful insights about the magnitude of the male-female differential at critical age points. Specifically, we note that the frailty statuses of males and females are actually quite comparable from ages 65 to 80. Beyond age 80, however, the frailty levels start to diverge considerably implying that women are moving quicker into worse states of health than men. Tracking average frailty by gender over 30 successive birth cohorts, we also find that frailty levels for both genders follow a distinct peak-and-trough pattern. For instance, frailty among 85-year old American survivors increased in years 1954-1963, decreased in years 1964-1971, and again started to increase in years 1972-1979. A number of factors may have accounted for these cohort differences including differences in cohort life histories, differences in disease prevalence, differences in lifestyle and behavior, differential access to medical advances, as well as changes in environmental risk factors over time. We conclude with a discussion on the implications of our findings on spending for long-term care programs within the broader health insurance system.

Keywords: actuarial modeling, cohort analysis, frail elderly, health

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Authors: Aneta Daniel

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The subject of the study is the exploration of the origins and dynamics of the development of language studies, which have been labelled as neurolinguistics. It is worth mentioning that the origins of neurolinguistics are to be found in the research conducted by German scientists before the Second World War in Breslau Universität (presently Wroclaw). The dominant figure in these studies was professor Carl Wernicke, whose students continued and creatively developed projects of their master within this area. Professor Carl Wernicke, a German physician, anatomist, psychiatrist, and neuropathologist, is primarily known for his influential research on aphasia. His research, as well as those conducted by professor Paul Broca, has led to breakthroughs in the location of brain functions, particularly speech. Years later the theses of the pioneers of cognitive neurology (Carl Wernicke and Paul Broca) were developed by other neurolinguists. The main objective of the investigation is the reconstruction of the group of scientists –the students of Carl Wernicke– who contributed to the development of neurolinguistics. The scholars were mainly neurologists and psychiatrists and dealt with the branch of science that had not been named neurolinguistics at that time. The profiles of the scholars will be analysed and presented as the members of the group of researchers who have contributed to the breakthroughs in psychology and neuroscience. The research material consists of archival records documenting the research of professor Carl Wernicke and the researchers from Breslau (presently Wroclaw) which is one of the fastest growing cities in Europe. In 1870, when Carl Wernicke became the medical doctor, Breslau was full of cultural events: festivals and circus shows were held in the city center. Today we can come back to these events due to 'Breslauer Zeitung (1870)', which precisely describes all the events that took place on particular days. It is worth noting that those were the beginnings of antisemitism in Breslau. Many theses and articles that have survived in the libraries in Wroclaw and all over the world contribute to the development of neuroscience. The history of research on the brain and speech analysis, including the history of psychology and neuroscience, areas from which neurolinguistics is derived, will be presented.

Keywords: Aphasia, brain injury, Carl Wernicke, language, neurolinguistics

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Authors: Mary H Moen, Lauren H. Mandel

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Creating a sense of community in online learning is important for student engagement and success. The integration of discussion forums within online learning environments presents an opportunity to explore how this computer mediated communications format can cultivate a sense of community among students in accelerated master’s degree programs. This research has two aims, to delve into the ways instructors utilize this communications technology to create community and to understand the feelings and experiences of graduate students participating in these forums in regard to its effectiveness in community building. This study is a two-phase approach encompassing qualitative and quantitative methodologies. The data will be collected at an online accelerated Master of Library and Information Studies program at a public university in the northeast of the United States. Phase 1 is a content analysis of the syllabi from all courses taught in the 2023 calendar year, which explores the format and rules governing discussion forum assignments. Four to six individual interviews of department faculty and part time faculty will also be conducted to illuminate their perceptions of the successes and challenges of their discussion forum activities. Phase 2 will be an online survey administered to students in the program during the 2023 calendar year. Quantitative data will be collected for statistical analysis, and short answer responses will be analyzed for themes. The survey is adapted from the Classroom Community Scale Short-Form (CSS-SF), which measures students' self-reported responses on their feelings of connectedness and learning. The prompts will contextualize the items from their experience in discussion forums during the program. Short answer responses on the challenges and successes of using discussion forums will be analyzed to gauge student perceptions and experiences using this type of communication technology in education. This research study is in progress. The authors anticipate that the findings will provide a comprehensive understanding of the varied approaches instructors use in discussion forums for community-building purposes in an accelerated MLIS program. They predict that the more varied, flexible, and consistent student uses of discussion forums are, the greater the sense of community students will report. Additionally, students’ and instructors’ perceptions and experiences within these forums will shed light on the successes and challenges faced, thereby offering valuable recommendations for enhancing online learning environments. The findings are significant because they can contribute actionable insights for instructors, educational institutions, and curriculum designers aiming to optimize the use of discussion forums in online accelerated graduate programs, ultimately fostering a richer and more engaging learning experience for students.

Keywords: accelerated online learning, discussion forums, LIS programs, sense of community, g

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Authors: Md, MCS, MPH Munyangi Wa Nkola Jerome

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The pandemic of COVID-19, a recently discovered contagious respiratory disease called SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus 2 Majority of people infected with SARS-CoV-2: Asymptomatic or mildly ill 14% of patients will develop severe illness requiring hospitalization and oxygen support, and 5% of these will be transferred to an intensive care unit, Urgent need for new treatments that can be used quickly to avoid transfer of patients to intensive care and death. Objective: To evaluate the clinical activity (efficacy) of ArtiCovid Hypothesis: Administration of 3 times a teaspoon per day by COVID patients (symptomatic, mild, or moderate forms) results in the disappearance of symptoms and improvement of biological parameters (including viral suppression). Clinical efficacy: the disappearance of clinical signs after seven days of treatment; reduction in the rate of patients transferred to intensive care units for mechanical ventilation and a decrease in mortality related to this infection Paraclinical efficacy: improvement of biological parameters (mainly d-dimer, CRP) Virological efficacy: suppression of the viral load after seven days of treatment (control test on the seventh day is negative) Pilot study using a standardized solution based on Artemisia annua (ARTICOVID) Obtaining authorization from the health authorities of the province of Central Kongo Recruitment of volunteer patients, mainly in the Kinkanda HospitalCarrying out tests before and after treatment as well as analyses before and after treatment. The protocol obtained the approval of the ethics committee 50 patients who completed the treatment were aged between 2 and 70 years, with an average age of 36 yearsMore half were male (56%). One in four patients was a health professional (25%) Of the 12 health professionals, 4 were physicians. For those who reported the date of onset of the disease, the average duration between the appearance of the first symptoms and the medical consultation was 5 days. The 50 patients put on ARTICOVID were discharged alive with CRP levels substantially normalizedAfter seven to eight days, the control test came back negative. This pilot study suggests that ARTICOVID may be effective against COVID-19 infection.

Keywords: artiCovid, DRC, Covid-19, SARS_COV_2

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Authors: Jae Ni Jang, Young Uk Kim

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Background: Chat Generative Pre-training Transformer-3 (ChatGPT; San Francisco, California, Open Artificial Intelligence) is an artificial intelligence chatbot based on a large language model designed to generate human-like text. As the usage of ChatGPT is increasing among less knowledgeable patients, medical students, and anesthesia and pain medicine residents or trainees, we aimed to evaluate the accuracy of ChatGPT-3 responses to questions about the American Society of Anesthesiologists (ASA) classification based on patients’ underlying diseases and assess the quality of the generated responses. Methods: A total of 47 questions were submitted to ChatGPT using textual prompts. The questions were designed for ChatGPT-3 to provide answers regarding ASA classification in response to common underlying diseases frequently observed in adult patients. In addition, we created 18 questions regarding the ASA classification for pediatric patients and pregnant women. The accuracy of ChatGPT’s responses was evaluated by cross-referencing with Miller’s Anesthesia, Morgan & Mikhail’s Clinical Anesthesiology, and the American Society of Anesthesiologists’ ASA Physical Status Classification System (2020). Results: Out of the 47 questions pertaining to adults, ChatGPT -3 provided correct answers for only 23, resulting in an accuracy rate of 48.9%. Furthermore, the responses provided by ChatGPT-3 regarding children and pregnant women were mostly inaccurate, as indicated by a 28% accuracy rate (5 out of 18). Conclusions: ChatGPT provided correct responses to questions relevant to the daily clinical routine of anesthesiologists in approximately half of the cases, while the remaining responses contained errors. Therefore, caution is advised when using ChatGPT to retrieve anesthesia-related information. Although ChatGPT may not yet be suitable for clinical settings, we anticipate significant improvements in ChatGPT and other large language models in the near future. Regular assessments of ChatGPT's ASA classification accuracy are essential due to the evolving nature of ChatGPT as an artificial intelligence entity. This is especially important because ChatGPT has a clinically unacceptable rate of error and hallucination, particularly in pediatric patients and pregnant women. The methodology established in this study may be used to continue evaluating ChatGPT.

Keywords: American Society of Anesthesiologists, artificial intelligence, Chat Generative Pre-training Transformer-3, ChatGPT

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Authors: Uliana N. Tumanova, Viacheslav M. Lyapin, Vladimir G. Bychenko, Alexandr I. Shchegolev, Gennady T. Sukhikh

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It is well known that the gas formed as a result of postmortem decomposition of tissues can be detected already 24-48 hours after death. In addition, the conditions of keeping and storage of the corpse (temperature and humidity of the environment) significantly determine the rate of occurrence and development of posthumous changes. The presence of sepsis is accompanied by faster postmortem decomposition and decay of the organs and tissues of the body. The presence of gas in the vessels and cavities can be revealed fully at postmortem CT. Radiologists must certainly report on the detection of intraorganic or intravascular gas, wich was detected at postmortem CT, to forensic experts or pathologists before the autopsy. This gas can not be detected during autopsy, but it can be very important for establishing a diagnosis. To explore the possibility of postmortem CT for the evaluation of gas accumulations in the newborns' vessels, who died from congenital sepsis. Researched of 44 newborns bodies (25 male and 19 female sex, at the age from 6 hours to 27 days) after 6 - 12 hours of death. The bodies were stored in the refrigerator at a temperature of +4°C in the supine position. Grouped 12 bodies of newborns that died from congenital sepsis. The control group consisted of 32 bodies of newborns that died without signs of sepsis. Postmortem CT examination was performed at the GEMINI TF TOF16 device, before the autopsy. The localizations of gas accumulations in the vessels were determined on the CT tomograms. The sepsis diagnosis was on the basis of clinical and laboratory data and autopsy results. Gases in the vessels were detected in 33.3% of cases in the group with sepsis, and in the control group - in 34.4%. A group with sepsis most often the gas localized in the heart and liver vessels - 50% each, of observations number with the detected gas in the vessels. In the heart cavities, aorta and mesenteric vessels - 25% each. In control most often gas was detected in the liver (63.6%) and abdominal cavity (54.5%) vessels. In 45.5% the gas localized in the cavities, and in 36.4% in the vessels of the heart. In the cerebral vessels and in the aorta gas was detected in 27.3% and 9.1%, respectively. Postmortem CT has high diagnostic capabilities to detect free gas in vessels. Postmortem changes in newborns that died from sepsis do not affect intravascular gas production within 6-12 hours. Radiation methods should be used as a supplement to the autopsy, including as a kind of ‘guide’, with the indication to the forensic medical expert of certain changes identified during CT studies, for better definition of pathological processes during the autopsy. Postmortem CT can be recommend as a first stage of autopsy.

Keywords: congenital sepsis, gas, newborn, postmortem CT

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Authors: Sitti Rahmawati

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Payment system of cataract surgery implemented by professional attendant of doctor and nurse has been increasing, through health insurance program and this has become one of the factors that affects a lot of government in the budget establishment. This system has been implemented in purpose of quality and expenditure control, i.e., controlling health overpayment to obtain benefit (moral hazard) by the user of insurance or health service provider. The increasing health cost becomes the main issue that hampers the society to receive required health service in cash payment-system. One of the efforts that should be taken by the government in health payment is by securing health insurance through society's health insurance. The objective of the study is to learn the capability of a patient to pay cataract eye operation for the elders. Method of study sample population in this study was patients who obtain health insurance board card for the society that was started in the first of tri-semester (January-March) 2015 and claimed in Indonesian software-Case Based Group as a purposive sampling of 40 patients. Results of the study show that total unit cost analysis of surgery service unit was obtained $75 for unit cost without AFC and salary of nurse and doctor. The operation tariff that has been implemented today at Anutapura hospitals in eye department is tariff without AFC and the salary of the employee is $80. The operation tariff of the unit cost calculation with double distribution model at $65. Conclusion, the calculation result of actual unit cost that is much greater causes incentive distribution system provided to an ophthalmologist at $37 and nurse at $20 for one operation. The surgery service tariff is still low; consequently, the hospital receives low revenue and the quality of health insurance in eye operation department is relatively low. In purpose of increasing the service quality, it requires adequately high cost to equip medical equipment and increase the number of professional health attendant in serving patients in cataract eye operation at hospital.

Keywords: economic evaluation, cataract operation, health attendant, health insurance system

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Authors: Stella Chioma Nwizu

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The National Commission for Adult and Non Formal Education (NMEC) in Nigeria is charged with the reduction of illiteracy rate through the development, monitoring, and supervision of literacy programmes in Nigeria. In spite of various efforts by NMEC to reduce illiteracy, literature still shows that the illiteracy rate is still high. According to NMEC/UNICEF, about 60 million Nigerians are non-literate, and nearly two thirds of them are women. This situation forced the government to search for innovative and better approaches to literacy promotion and delivery. The literacy by radio project was adopted as an innovative intervention to literacy delivery in Nigeria because the radio is the cheapest and most easily affordable medium for non-literates. The project aimed at widening access to literacy programmes for the non-literate marginalized and disadvantaged groups in Nigeria by taking literacy programmes to their door steps. The literacy by radio has worked perfectly well in non-literacy reduction in Cuba. This innovative intervention of literacy by radio is anchored on the diffusion of innovation theory by Rogers. The literacy by radio has been going on for fifteen years and the efficacy and contributions of this innovation need to be investigated. Thus, the purpose of this research is to review the contributions of the literacy by radio in Nigeria. The researcher adopted the survey research design for the study. The population for the study consisted of 2,706 participants and 47 facilitators of the literacy by radio programme in the 10 pilot states in Nigeria. A sample of four states made up of 302 participants and eight facilitators were used for the study. Information was collected through Focus Group Discussion (FGD), interviews and content analysis of official documents. The data were analysed qualitatively to review the contributions of literacy by radio project and determine the efficacy of this innovative approach in facilitating literacy in Nigeria. Results from the field experience showed, among others, that more non-literates have better access to literacy programmes through this innovative approach. The pilot project was 88% successful; not less than 2,110 adults were made literate through the literacy by radio project in 2017. However, lack of enthusiasm and commitment on the part of the technical committee and facilitators due to non-payment of honorarium, poor signals from radio stations, interruption of lectures with adverts, low community involvement in decision making in the project are challenges to the success rate of the project. The researcher acknowledges the need to customize all materials and broadcasts in all the dialects of the participants and the inclusion of more civil rights, environmental protection and agricultural skills into the project. The study recommends among others, improved and timely funding of the project by the Federal Government to enable NMEC to fulfill her obligations towards the greater success of the programme, setting up of independent radio stations for airing the programmes and proper monitoring and evaluation of the project by NMEC and State Agencies for greater effectiveness. In an era of the knowledge-driven economy, no one should be allowed to get saddled with the weight of illiteracy.

Keywords: innovative approach, literacy, project, radio, survey

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Authors: Kristin Thooft

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— Increasing pressure to manage healthcare costs has resulted in shifting care towards ambulatory settings and is driving a focus on cost transparency. There are few nurse staffing to workload models developed for ambulatory settings, less for multi-specialty clinics. Of the existing models, few have been evaluated against outcomes to understand any impact. This evaluation took place after the AWARD model for nurse staffing to workload was implemented in a multi-specialty clinic at a regional healthcare system in the Midwest. The multi-specialty clinic houses 26 medical and surgical specialty practices. The AWARD model was implemented in two specialty practices in October 2020. Donabedian’s Structure-Process-Outcome (SPO) model was used to evaluate outcomes based on changes to the structure and processes of care provided. The AWARD model defined and quantified the processes, recommended changes in the structure of day-to-day nurse staffing. Cost of care per patient visit, total visits, a total nurse performed visits used as structural and process measures, influencing the outcomes of cost of care and access to care. Independent t-tests were used to compare the difference in variables pre-and post-implementation. The SPO model was useful as an evaluation tool, providing a simple framework that is understood by a diverse care team. No statistically significant changes in the cost of care, total visits, or nurse visits were observed, but there were differences. Cost of care increased and access to care decreased. Two weeks into the post-implementation period, the multi-specialty clinic paused all non-critical patient visits due to a second surge of the COVID-19 pandemic. Clinic nursing staff was re-allocated to support the inpatient areas. This negatively impacted the ability of the Nurse Manager to utilize the AWARD model to plan daily staffing fully. The SPO framework could be used for the ongoing assessment of nurse staffing performance. Additional variables could be measured, giving a complete picture of the impact of nurse staffing. Going forward, there must be a continued focus on the outcomes of care and the value of nursing

Keywords: ambulatory, clinic, evaluation, outcomes, staffing, staffing model, staffing to workload

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Authors: Christopher S. Perez, Kendal C. Boyd

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global suicide rates have decreased in recent decades, rates in the United States have increased by 35.2 percent since 1999.American Indians and Alaska Natives (AI/AN) have the highest rates of suicide in the U.S., with approximately 22 suicides per 100,000 people as of 2019. AI/AN have experienced significant historical trauma resulting in disproportionate rates of substance abuse and mental disorders. This literature review aimed to identify the demographic and clinical risk and protective factors for American Indians and Alaska Natives and provide an overview of suicidality in this population. The literature reflected varying definitions of suicidality depending on region, with some AI/AN tribesconceptualizing suicide through a spiritual framework, while others defined suicide in the biomedical sense. Furthermore, AI/AN adults and adolescents experienced higher rates of suicidal ideation when compared to other racial groups. Religious preference, sexual orientation, prior suicidal behavior, psychiatric admission, history of abuse, substance abuse, family history of mental illness, family history of substance abuse, family history of suicidal behaviors, domestic violence, and trauma were discussed as factors related to suicidality. Recommendations included increasing access to and utilization of mental health and medical services, culturally adapting suicide prevention programs to AI/AN communities, increasing support for LGBTQ+ AI/AN, providing opportunities that reinforce ethnic identity, and post-hospitalization follow-up care. The following databases were utilized to obtain peer-reviewed articles for this literature review: Complementary Index, Academic Search Premier, Science Direct, PsycInfo, Social Sciences Citation Index, PsycArticles, PubMed, EbscoHost, and PsycBooks. Articles that examined Native populations outside of the United States did not cite a primary source and/or were published before 1990 were excluded.

Keywords: alaska native, american indian, protective factors, risk factors, suicidality, suicide

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