Search results for: medical practice

Authors: Parimalakrishnan Sundararjan, Madheswaran Murugan, Dhanya Dharman, Yatindra Kumar, Sudhir Singh Gangwar, Guru Prasad Mohanta

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Antibiotic resistance AR is a global issue, India started to redress the issues of antibiotic resistance late and it plans to have: active surveillance of microbial resistance and promote appropriate use of antibiotics. The present study attempted to achieve appropriate use of antibiotics through pharmacists’ intervention at practice point. In a quasi-experimental prospective cohort study, the cases with bacteremia from four hospitals were identified during 2015 and 2016 for intervention. The pharmacists centered intervention: active screening of each prescription and comparing with the selection of antibiotics with susceptibility of the bacteria. Wherever irrationality noticed, it was brought to the notice of the treating physician for making changes. There were two groups: intervention group and control group without intervention. The active screening and intervention in 915 patients has reduced therapeutic regimen time in patients with bacteremia. The intervention group showed the decreased duration of hospital stay 3.4 days from 5.1 days. Further, multivariate modeling of patients who were in control group showed that patients in the intervention group had a significant decrease in both duration of hospital stay and infection-related mortality. Unlike developed countries, pharmacists are not active partners in patient care in India. This unique attempt of pharmacist’ invention was planned in consultation with hospital authorities which proved beneficial in terms of reducing the duration of treatment, hospital stay, and infection-related mortality. This establishes the need for a collaborative decision making among the health workforce in patient care at least for promoting rational use of antibiotics, an attempt to combat resistance.

Keywords: antibiotics resistance, intervention, bacteremia, multivariate modeling

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Authors: Coulibaly Fatoumata, Gragnon Biego, Aka N. David, Mbari K. Benjamin, Soro Y. René, Ndiaye Jean-louis

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Poultry is nowadays one of the most consumed sources of protein, and its livestock represents one of the few opportunities for savings, investment and protection against risk. It provides income for the most vulnerable sections of society, in particular, women (70%) and children who mainly practice this breeding. A study was conducted in the commune of Korhogo at the level of 52 poultry farms, the objective of which was to know the epidemiological situation of parasitism external and internal poultry in order to contribute to the improvement of the health status of modern poultry farms in the said commune. The method described by OIE (2005), consisting of using the standard formula (n = δ2*p*(1-p) *c /i2), made it possible to calculate the size of the sample. Then, samples of droppings and ectoparasites were taken from the affected farms. After analysis and identification, two (2) species of mallophagous lice, including Menopon gallinae (50%) and Menacanthus stramineus (33%) and a species of bug Cimex lectularius (17%) were highlighted. The laying hens were more infested than broilers. Regarding gastrointestinal parasites, different species (six) have been identified: Trichostrongylus tenuis (17%), Syngamus trachea (19%), Heterakis sp (10%), Ascaridia sp (17%), Raillietina sp (8%) and Eimeria sp (29%). In addition, coccidiosis (Eimeria sp) proved to be the dominant pathology representing 67% of pathologies in broiler farms and 33% in poultry farms. The presence of these parasitoses in these modern farms constitutes a constraint major contribution to productivity and their development In view of all these difficulties, proposals have been made in order to participate in the establishment of a good prophylaxis program (health and medical). In addition, the Ivorian government, with the support of veterinarians, must interfere more in the organization of the health monitoring of traditional chickens and poultry in general through supervision and training in order to preserve public health ( animal, human and environmental health).

Keywords: gastrointestinal parasites, ectoparasites, pathologies, poultry, korhogo.

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Authors: Boy Subirosa Sabarguna, Aria Kekalih, Irzan Nurman

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Introduction: Software in the form of Clinical Decision Support System could help students in understanding the mind set of decision-making in diagnosis and treatment at the stage of general practitioners. This could accelerate and ease the learning process which previously took place by using books and experience. Method: Gather 1000 members of the National Medical Multimedia Digital Community (NM2DC) who use the “flowchart of diagnosis and treatment” software, and analyse factors related to: display, speed in learning, convenience in learning, helpfulness and usefulness in the learning process, by using the Likert Scale through online questionnaire which will further be processed using percentage. Results and Discussions: Out of the 1000 members of NM2DC, apparently: 97.0% of the members use the software and 87.5% of them are students. In terms of the analysed factors related to: display, speed in learning, convenience in learning, helpfulness and usefulness of the software’s usage, the results indicate a 90.7% of fairly good performance. Therefore, the “Flowchart of Diagnosis and Treatment” software has helped students in understanding the decision-making of diagnosis and treatment. Conclusion: the use of “Flowchart of Diagnosis and Treatment” software indicates a positive role in helping students understand decision-making of diagnosis and treatment.

Keywords: usage, software, diagnosis and treatment, medical education

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Authors: Lulu Liao, Huijing Chen, Yinan Zhao, Hongting Ning, Hui Feng

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Urinary tract infection rate is an important index of care quality in nursing homes. The aim of the study is to understand the nursing assistant's current knowledge and attitudes of urinary incontinence and to explore related stakeholders' viewpoint about urinary incontinence training. This explanatory sequential study used Knowledge, Practice, and Attitude Model (KAP) and Adult Learning Theories, as the conceptual framework. The researchers collected data from 509 nursing assistants in sixteen nursing homes in Hunan province in China. The questionnaire survey was to assess the knowledge and attitude of urinary incontinence of nursing assistants. On the basis of quantitative research and combined with focus group, training demands were identified, which nurse managers should adopt to improve nursing assistants’ professional practice ability in urinary incontinence. Most nursing assistants held the poor knowledge (14.0 ± 4.18) but had positive attitudes (35.5 ± 3.19) toward urinary incontinence. There was a significant positive correlation between urinary incontinence knowledge and nursing assistants' year of work and educational level, urinary incontinence attitude, and education level (p < 0.001). Despite a general awareness of the importance of prevention of urinary tract infections, not all nurse managers fully valued the training in urinary incontinence compared with daily care training. And the nursing assistants required simple education resources to equip them with skills to address problem about urinary incontinence. The variety of learning methods also highlighted the need for educational materials, and nursing assistants had shown a strong interest in online learning. Related education material should be developed to meet the learning need of nurse assistants and provide suitable training method for planned quality improvement in urinary incontinence.

Keywords: mixed methods, nursing assistants, nursing homes, urinary incontinence

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Authors: Ismaila Oladunni Muhammed, Adegbenga Raphael Ashiru

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Construction industry has been attributed to be the engine growth of Nigerian economic and infrastructural development. It promotes infrastructural development and grows an average output of Nigerian Gross Domestic Profit. However, from this great prospect, yearly reports show that consistent accidents on construction sites in Zamfara State has affected a substantial number of workers as they become temporarily or permanently disabled, thereby making many construction sites a death trap. This posed a great threat to the industry’s sustainability, de- motivate workers from working in the industry, and further have negative impact on the economy as well. It is as a result of high construction site accident currently experiencing in Zamfara state that this research was carried out to appraise the sustainability of health and safety of construction workers on sites. The proper practice and compliance to Construction Health and safety laws are very vital to the output and growth of Zamfara State construction sector. However, a quantitative approach was adopted to justify the aforesaid statement which will provide a broader understanding of the study. Descriptive statistical analysis was obtained through Statistical Package for the Social Sciences (SPSS Version 20). Furthermore, the findings from the research highlighted that the performance and output of construction workers on construction sites depends on the proper practice of health and safety. The research findings also recommended ways to enhance employers and employee’s compliance with existing laws guiding health and safety on Zamfara State construction sites. Nevertheless, the purpose of the paper is to appraise the sustainability of Health and Safety on Zamfara State construction sites. This study further provided thorough information for resolving challenges of construction sites accidents to improve construction firm productivity and also ensured construction worker’s safety on site.

Keywords: construction industry, health and safety regulations, causes of accident, construction safety practices

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Authors: Corlia van der Walt, Michele K. Havenga

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The study considers corporate governance regulation and practice in South African higher education institutions and makes recommendations for the improvement of current governance practices in this sector. The development of corporate governance principles and practices in South Africa, culminating in the King IV Report on Corporate Governance which was launched in November 2016, is discussed. King IV enjoys international recognition as a progressive corporate governance instrument. It was necessitated by the fundamental changes in business and society nationally and globally, as well as by the significant changes to South African company law introduced by new legislation. Corporate governance and the corporate form are narrowly associated, but there is general recognition that the principles of ethical and effective leadership are not restricted to corporations. Thus King IV was drafted with the express aim that it should apply to all organisations, regardless of their form of incorporation, and the report includes specific sector supplements in support of this aspiration. The South African higher education sector has of late been under intense scrutiny, and a few universities have been placed under administration because of poor governance practices. Universities have also been severely impacted by the consequences of what is generally known as ‘#FeesmustFall’, a student led protest movement initially aimed against the increase of fees at public universities, but which rapidly expanded to also include other concerns. It was clearly necessary to revisit corporate governance policy and practice in the sector. The review of the current higher education governance regime in light of the King IV recommendations, lessons from company law regarding the entrenchment and enforcement of corporate governance principles, and a comparison of higher education governance practices in selected other jurisdictions led to recommendations for the improvement of governance practices in South African higher education. It is further suggested that a sector supplement for higher education institutions may provide additional clarity. Some of the recommendations may be of comparative value for international higher education governance.

Keywords: committees, corporate governance, ethical leadership, higher education institutions, integrated reporting, King IV, sector supplements, sustainability

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Authors: L. S. Zavodna, J. Zavodny Pospisil

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The aim of this paper is to identify the factors for sustainability in the accommodation sector. Although sustainability is a current trend in tourism, not many facilities know how to apply the concept in practice. This paper presents a model for the implementation of sustainability in hotels, hostels, campgrounds, or other facilities. First, there are identified sections of each accommodation facility, which can contribute to sustainability. Furthermore, concrete steps are presented to transfer this model into reality.

Keywords: accommodation sector, model, sustainable tourism, sustainability

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Authors: Amr Sultan, Sara Elgazzar, Breksal Elmiligy

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The airline industry nowadays is becoming a more growing industry facing a severe competition. It is an influential issue in this context to utilize revenue management (RM) concept and practice in order to develop the pricing strategy. There is an unfathomable necessity for RM to assist the airlines and their associates to disparage the cost and recuperate their revenue, which in turn will boost the airline industry performance. The complexity of RM imposes enormous challenges on the airline industry. Several studies have been proposed on the RM adaptation in airlines industry while there is a limited availability of implementing RM and its complexity in the developing countries such as Egypt. This research represents a research schema about the implementation of the RM to the Egyptian airline industry. The research aims at investigating and demonstrating the complexities face implementing RM in the airline industry, up on which the research provides a comprehensive understanding of how to overcome these complexities while adapting RM in the Egyptian airline industry. An empirical study was conducted on the Egyptian airline sector based on a sample of four airlines (Egyptair, Britishair, KLM, and Lufthansa). The empirical study was conducted using a mix of qualitative and quantitative approaches. First, in-depth interviews were carried out to analyze the Egyptian airline sector status and the main challenges faced by the airlines. Then, a structured survey on the three different parties of airline industry; airlines, airfreight forwarders, and passengers were conducted in order to investigate the main complexity factors from different parties' points of view. Finally, a focus group was conducted to develop a best practice framework to overcome the complexities faced the RM adaptation in the Egyptian airline industry. The research provides an original contribution to knowledge by creating a framework to overcome the complexities and challenges in adapting RM in the airline industry generally and the Egyptian airline industry particularly. The framework can be used as a RM tool to increase the effectiveness and efficiency of the Egyptian airline industry performance.

Keywords: revenue management, airline industry, revenue management complexity, Egyptian airline industry

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Authors: Robyn L. Curran, Joanne R. Naidoo, Gugu Mchunu

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Along with the increasing awareness of human trafficking, is the acknowledgement that it is no longer just a social problem but also a significant public health problem that requires both increased knowledge and the specialist equipping of aftercare providers such as nurses who care for human trafficking survivors. Current discourse regarding aftercare of human trafficking survivors, is that approaches do not clearly explain the function or content of aftercare and what aftercare entails. Although psychological and medical aftercare are emphasized as important components, little practical attention is devoted to what these components actually involve and the effectiveness of current practice in aftercare. Review of the literature on the processes that take place from aftercare to empowerment, revealed the need for emphasis to be placed on the voices of survivors concerning their liberation from oppression. The aim of the study was to develop a theory for aftercare of human trafficking survivors, through analyzing the experiences of survivors and aftercare providers in shelters in three provinces in South Africa. Through using a Straussian grounded theory approach, the researcher developed a theory to inform care of human trafficking survivors in low resource settings using the voice of the survivors and those experienced in direct care of human trafficking survivors. Four human trafficking survivors and three aftercare providers from three shelters in three provinces in South Africa were individually interviewed in order for the theory to emerge. The findings of the study elicited a theoretical model of the renewed self, and the conditions that facilitate this process in care of human trafficking survivors. The process that human trafficking survivors navigate to empowerment require mutual collaboration of the aftercare provider and survivor as the survivor awakens vision, confronts reality, re-salvages autonomy and liberates self. Psychological resilience of the survivor facilitates the transition to renewed self. The recommendations of this study may improve the nursing care provided to human trafficking survivors and equip professionals with knowledge and skills to promote the process of renewing self for survivors.

Keywords: aftercare, aftercare providers, grounded theory, human trafficking survivors

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Authors: K. Malak, A. Nourah, S.Liyakathunisa

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Nowadays, healthcare services are facing many challenges since they are becoming more complex and more needed. Every detail of a patient’s interactions with health care providers is maintained in Electronic Health Records (ECR) and Healthcare information systems (HIS). However, most of the existing systems are often focused on documenting what happens in manual health care process, rather than providing the highest quality patient care. Healthcare business processes and stakeholders can no longer rely on manual processes, to provide better patient care and efficient utilization of resources, Healthcare processes must be automated wherever it is possible. In this research, a detail survey and analysis is performed on the existing health care systems in Saudi Arabia, and an automated smart medical healthcare business process model is proposed. The business process management methods and rules are followed in discovering, collecting information, analysis, redesign, implementation and performance improvement analysis in terms of time and cost. From the simulation results, it is evident that our proposed smart medical records system can improve the quality of the service by reducing the time and cost and increasing efficiency

Keywords: business process management, electronic health records, efficiency, cost, time

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Authors: Sinead Impey, Gaye Stephens, Lucy Hederman, Declan O'Sullivan

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Continued paper use in the clinical area post-Electronic Health Record (EHR) adoption is regularly linked to hardware and software usability challenges. Although paper is used as a workaround to circumvent challenges, including limited availability of a computer, this perspective does not consider the important role paper, such as the nurses’ handover sheet, play in practice. The purpose of this study is to confirm the hypothesis that paper use post-EHR adoption continues as paper provides both a cognitive tool (that assists with workflow) and a compensation tool (to circumvent usability challenges). Distinguishing the different motivations for continued paper-use could assist future evaluations of electronic record systems. Methods: Qualitative data were collected from three clinical care environments (ICU, general ward and specialist day-care) who used an electronic record for at least 12 months. Data were collected through semi-structured interviews with 22 nurses. Data were transcribed, themes extracted using an inductive bottom-up coding approach and a thematic index constructed. Findings: All nurses interviewed continued to use paper post-EHR adoption. While two distinct motivations for paper use post-EHR adoption were confirmed by the data - paper as a cognitive tool and paper as a compensation tool - further finding was that there was an overlap between the two uses. That is, paper used as a compensation tool could also be adapted to function as a cognitive aid due to its nature (easy to access and annotate) or vice versa. Rather than present paper persistence as having two distinctive motivations, it is more useful to describe it as presenting on a continuum with compensation tool and cognitive tool at either pole. Paper as a cognitive tool referred to pages such as nurses’ handover sheet. These did not form part of the patient’s record, although information could be transcribed from one to the other. Findings suggest that although the patient record was digitised, handover sheets did not fall within this remit. These personal pages continued to be useful post-EHR adoption for capturing personal notes or patient information and so continued to be incorporated into the nurses’ work. Comparatively, the paper used as a compensation tool, such as pre-printed care plans which were stored in the patient's record, appears to have been instigated in reaction to usability challenges. In these instances, it is expected that paper use could reduce or cease when the underlying problem is addressed. There is a danger that as paper affords nurses a temporary information platform that is mobile, easy to access and annotate, its use could become embedded in clinical practice. Conclusion: Paper presents a utility to nursing, either as a cognitive or compensation tool or combination of both. By fully understanding its utility and nuances, organisations can avoid evaluating all incidences of paper use (post-EHR adoption) as arising from usability challenges. Instead, suitable remedies for paper-persistence can be targeted at the root cause.

Keywords: cognitive tool, compensation tool, electronic record, handover sheet, nurse, paper persistence

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Authors: Qi En Han, Si En Wai, Eugene Quek

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As one of the two Academic Medical Centres (AMCs) in Singapore, SingHealth Duke-NUS AMC strives to improve patients’ lives through excellent clinical care, research and education. These efforts are enhanced with the establishment of Academic Clinical Programmes (ACPs). Each ACP brings together specialists in a particular discipline from different institutions to maximize the power of shared knowledge and resources. Initiated by Surgery ACP, the student research mentorship programme is a programme designed to facilitate engagement between medical students and the surgical faculty. The programme offers mentors not only the opportunity to supervise research but also to nurture future clinician scientists. In turn, medical students acquire valuable research experience which may be useful in their future careers. The programme typically lasts one year, depending on the students’ commitment. Surgery ACP matches students’ research interests with the mentor's area of expertise whenever possible. Surgery ACP organizes informal tea sessions to bring students and prospective mentors together. Once a match is made, the pair is required to submit a project proposal which includes the title, proposed start and end dates, ethical and biosafety considerations and project details. The mentees either think of their own research question with guidance from the mentors or join an existing project. The mentees may participate in data collection, data analysis, manuscript writing and conference presentation. The progress of each research project is monitored through half-yearly progress report. The mentees report problems encountered or changes made to existing proposal on top of the progress made. A total of 18 mentors were successfully paired with 36 mentees since 2013. Currently, there are 23 on-going and 13 completed projects. The mentees are encouraged to present their projects at conferences and to publish in peer-reviewed journals. Six mentees have presented their completed projects at local or international conferences and one mentee has her work published. To further support student research, Surgery ACP organized a Research Day in 2015 to recognize their research efforts and to showcase their wide-range of research. Surgery ACP recognizes that early exposure of medical students to research is important in developing them into clinician scientists. As interest in research take time to develop and are usually realized during various research attachments, it is crucial that programmes such as the student research mentorship programme exist. Surgery ACP will continue to build on this programme.

Keywords: academic clinical programme, clinician scientist, medical student, mentoring

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Authors: F. A. Gberindyer, M. O.Abatan, A. B. Saba

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Background: Gentamicin is an aminoglycoside antibiotic used in the treatment of infections caused by Gram-negative aerobic bacteria organisms in human and animals. In Nigeria, there are arrays of multisource generic versions of injectable gentamicin sulphate in the drug markets. There is a high prevalence of counterfeit and substandard drugs in the third world countries with consequent effect on their therapeutic efficacy and safety. Aim: The aim of this study was to investigate pharmaceutical equivalence of some of these generics used in veterinary practice in Nigeria. Methodology: About 20 generics of injectable gentamicin sulphate were sampled randomly across Nigeria but 15 were analyzed for identity and potency. Identity test was done using Fourier transform infra red spectroscopy and the spectral for each product compared with that of the USP reference standard for similarity. Microbiological assay using agar diffusion method with E. coli as a test organism on nutrient agar was employed and the respective diameters of bacterial inhibition zones obtained after 24 hour incubation at 37°C. The percent potency for each product was thereafter calculated and compared with the official specification. Result And Discussion: None of the generics is produced in any African country. About 75 % of the products are imported from China whereas 60 % of the veterinary generics are manufactured in Holland. Absorption spectra for the reference and test samples were similar. Percent potencies of all test products were within the official specification of 95-115 %. Nigeria relies solely on imported injectable gentamicin sulphate products. All sampled generic versions passed both identity and potency tests. Clinicians should ensure that drugs are used rationally since the converse could be contributing to the therapeutic failures reported for most of these generics. Bioequivalence study is recommended to ascertain their interchangeability when parenteral extra venous routes are indicated.

Keywords: generics, gentamicin, identity, multisource, potency

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Authors: Meinrad Haule Lembuka

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Ubuntu is an African philosophy and model with the meaning of 'humanity to others' or 'care for other’s needs because of the guiding principle of interdependence’ that embraces collective and holistic efforts in development through the human face. The study uses a literature review method reflecting Julius Nyerere’s contributions in realizing Ubuntu and social work practice. Nyerere strived to restore Africa development in the lens of humanism through the values of solidarity, communal participation, compassion, care, justice etc; He later founded developmental social work through Ujamaa model, educational for self reliance and African dignity. Nyerere was against post-colonial syndromes through African socialism that envisioned values and principles of social work to provide social justice, human dignity, social change and social development. Also, he managed to serve the primary mission of the social work profession to enhance human wellbeing and help meet basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty with African Ubuntu practice of equal distribution of resources. Nyerere further endorsed social work legal framework that embraced universal human rights: service, equality, social justice, and human dignity, Importance of human relationship, integrity and competence. Nyerere proved that Indigenous model can work with formal system like Social work profession. In 2014 the National Heritage Council of South Africa (NHC) honored him an Award of African Ubuntu champion. Nyerere strongly upheld to be an ambassador of social work through his remarkably contributions in developmental social work (Ujamaa model), social change, human dignity, equality, social unity and social justice in Africa and globe at large.

Keywords: ubuntu, Indiginious knowledge, Indiginious social work, ubuntu social work

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Authors: Armenio Lopes, Carlos Ferreira

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In the specific context of the Iberian Union between 1580 and 1640, characteristics emerged in Portuguese architecture that stood out from the main architectural production of the period. Recognised and identified aspects that had begun making their appearance decades before (1521) became significantly more marked during the Hapsburg-Spanish occupation. Distinctive even from the imperialist language of Spain, this trend would endure even after the restoration of independence (1706), continuing through to the start of the age of absolutism. Or perhaps not. This trend, recognised as Plain Style (Kubler), associated with a certain scarcity of resources, involved a certain formal and decorative simplification, as well as a particular set of conventions that would subsequently mark the landscape. This expression could also be seen as a means of asserting a certain spirit of independence as the Iberian Union breathed its last. The image of a simple, bare-bones architecture with purer design lines is associated by various authors –most notably Kubler– with the narratives of modernism, to whose principles it is similar, in a context-specific to the period. There is a contrast with some of the exuberance of the baroque or its expression in the Manueline period, in a similar fashion to modernism's responses to nineteenth-century eclecticism. This assertion and practice of simple architecture, drafted from the interpretation of the treaties, and highlighting a certain classical inspiration, was to become a benchmark in the theory of architecture, spanning the Baroque and Mannerism, until achieving contemporary recognition within certain originality and modernity. At a time when the baroque and its scenography became generally very widespread, it is important also to recognise the role played by plain style architecture in the construction of a rather complex and contradictory waterfront landscape, featuring promises of exuberance and more discrete practices.

Keywords: Carlos Mardel, Lisbon's waterfront, plain style, urban image on the waterfront

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Authors: Israel Oguche

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Journalism practice has faced several challenges across the globe, particularly in developing countries such as Nigeria. While Nigeria has thrived under democratic experiment for twenty years since the return to democracy in 1999, there is still a great lacuna in freedom of expression, such that the presidents, though elected democratically, have had the tendencies to use military might in clamping down on journalism practices across the country. Under Muhammadu Buhari, it seems Nigeria has returned to the military era when powers were used against who says what, on a media, so today, in Nigeria, there are obvious cases of outright human rights violations and detention of journalists whose offenses were not spelled out. From Abiri Jones to Abba Jalingo and Omoyele Sowore, Nigeria journalists have been placed under the cocoon of the tyrannical administration of Muhammadu Buhari, the president, with subsequent clamping down on the instruments of freedoms such as access to justice and fair hearing. This paper gave vivid analytical and empirical perspectives of journalism practice under the dark days of Muhammadu Buhari as Nigeria’s president. The objectives include; examining the core cases of attacks on journalists since 2015 to date, determining the burden of practicing journalism in a tyrannical government, reeling out the effects of restrictive practices of journalism on freedom of expression among Nigerians and proffering solutions for improvement in the years ahead. Using the cognitive dissonance theory, the survey method was used for the study, with qualitative research analysis as a tool for data presentation. In the findings, the number of journalists in jail for publishing objectively under the Buhari administration remains high while the government has clamped down on freedom of expression among the people. The study concluded that there is a need for repelling of laws made by the Nigeria government in order to save the Nigerian journalism industry from total collapse.

Keywords: communication, developing democracy, press freedom, journalism practices

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Authors: Saeko Toyoshima

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This research will discuss if performance tasks with technology would enhance students' willingness to communicate. The present study investigated how Japanese learners of English would change their attitude to communication in their target language by experiencing a performance task, called 'digital portfolio', in the classroom, applying the concepts of action research. The study adapted questionnaires including four-Likert and open-end questions as mixed-methods research. There were 28 students in the class. Many of Japanese university students with low proficiency (A1 in Common European Framework of References in Language Learning and Teaching) have difficulty in communicating in English due to the low proficiency and the lack of practice in and outside of the classroom at secondary education. They should need to mediate between themselves in the world of L1 and L2 with completing a performance task for communication. This paper will introduce the practice of CALL class where A1 level students have made their 'digital portfolio' related to the topics of TED® (Technology, Entertainment, Design) Talk materials. The students had 'Portfolio Session' twice in one term, once in the middle, and once at the end of the course, where they introduced their portfolio to their classmates and international students in English. The present study asked the students to answer a questionnaire about willingness to communicate twice, once at the end of the first term and once at the end of the second term. The four-Likert questions were statistically analyzed with a t-test, and the answers to open-end questions were analyzed to clarify the difference between them. They showed that the students had a more positive attitude to communication in English and enhanced their willingness to communicate through the experiences of the task. It will be the implication of this paper that making and presenting portfolio as a performance task would lead them to construct themselves in English and enable them to communicate with the others enjoyably and autonomously.

Keywords: action research, digital portfoliio, computer-assisted language learning, ELT with CALL system, mixed methods research, Japanese English learners, willingness to communicate

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Authors: Girish Chandran, Milu Tigi

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Brian O'Doherty's seminal essay, Inside the white Cube theorized and named the dominant mode of display and exhibition of Modern Art museums. Ever since the advent of Biennales and other site-specific public art projects we have seen a departure from the white cube mode of exhibition. The physicality, materiality and context within which an artwork is framed has a role in the production of meaning of public art. Equally, artworks contribute to the meaning and identity of a place. This to and fro relationship between the site and artwork and its influence on the sense of place and production of meaning is being explored in this paper in the context of Kochi Muziris Biennale (KMB). Known as the Peoples biennale with over 5 lakh visitors, it is India's first Biennale and its largest art exhibition of contemporary art. The paper employs place theory and contemporary curatorial theories to present the case. The KMB has an interesting mix of exhibition spaces which includes existing galleries and halls, site-specific projects in public spaces, infill developments and adaptive reuse of heritage and other unused architecture. The biennale was envisioned as an event connecting to the history, socio-political peculiarities of the cultural landscape of Kerala and more specifically Kochi. The paper explains the role of spatial elements in forming a curatorial narrative connected to the above mentioned ambitions.The site-specific nature of exhibition and its use of unused architecture helps in the formation of exhibition spaces unique in type and materiality. The paper argues how this helps in the creation of an 'archeology of the place'. The research elucidates how a composite nature of experience helps connect with the thematic ambitions of the Biennale and how it brings about an aesthetics distinct to KMB.

Keywords: public art, curatorial practice, architecture, place, contemporary art, site specificity

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Authors: Henry Prihanto Nugroho

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This paper suggests education tourism as an option into developing more sustainable mass tourism. Identifying the potential of education tourism and developing a sustainable packages will have an impact on social economic development in the area. Indonesia especially Yogyakarta can increase their tourism earnings by tapping into this growing market phenomenon. Educational tourism, a growing part in the world tourism market, has attracted great attention because of its direct impact on the community and as an alternative strategy for poverty alleviation. Tourism is considered as one of the main industries and sectors highly contributing to economic development in Indonesia especially in Yogyakarta, this region can be an ideal case for studying the issue of educational tourism in Universitas Gadjah Mada. This paper tries to introduce the educational tourism as an important alternative source of the economy accelerator in the context of Yogyakarta Indonesia. This paper also aims to discuss the education tourism potential at the University of Gadjah Mada, Yogyakarta Indonesia then to create and established an Education Tourism package at Gadjah Mada University. Education Tourism is a means to empower academics, local community, local businesses, and to improve the economic welfare. Methods: Focus group discussions, direct observation, survey and best practice method. Conclusion: There is a positive relationship between attitude, environmental impact, economic impact, and socio-cultural impacts and practice in the field when the potential is seized. The findings incorporate insights into the socio-cultural and economic potential of education tourism and practices related to community development at the University of Gadjah Mada, Yogyakarta Indonesia by creating an Education Tourism Packages that will suit the needs of the tourist. Educational tourism can create sustainable development for local communities, academic society, universities, and stakeholders.

Keywords: education tourism, Gadjah Mada, sustainable, tourism

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Authors: Luigi Iannacci

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This study critically explores how disability and disability are presently and problematically configured within education. As such, pedagogies, discourses, and practices that shape this configuration are examined to forward a reconceptualization of disability as it relates to education and the inclusion of students with special needs in mainstream classroom contexts. The study examines how the dominant medical/deficit model of disability positions students with special needs and advocates for a shift towards a social/critical model of disability as applied to education and classrooms. This is demonstrated through a critical look at how language, processes, and ‘interventions’ name and address deficits people who have a disability are presumed to have and, as such, conceptualize these deficits as inherent flaws that are in need of ‘fixing.’ The study will demonstrate the necessary shifts in thinking, language and practice required to forward a critical/social model of disability. The ultimate aim of this research is to offer a much-needed reconceptualization of inclusion that recognizes disability as epistemology, identity, and diversity through a critical exploration of dominant discourses that impact language, policy, instruction and ultimately, the experiences students with disabilities have within mainstream classrooms. The presentation seeks to explore disability as neurodiversity and therefore elucidate how people with disabilities can demonstrate these ways of knowing within inclusive education that avoids superficial approaches that are not responsive to their needs. This research is, therefore, of interest and use to educators teaching at the elementary, secondary, and in-service levels as well as graduate students and scholars working in the areas of inclusion, special education, and literacy. Ultimately the presentation attempts to foster a social justice and human rights-focused approach to inclusion that is responsive to students with disabilities and, as such ensures a reconceptualization of present language, understandings and practices that continue to configure disability in problematic ways.

Keywords: inclusion, disability, critical approach, social justice

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Authors: Raneem O. Salem, Najwa Al-Mously, Nihal Mohamed Nabil, Abdulmohsen H. Al-Zalabani, Abeer F. Al-Dhawi, Nasser Al-Hamdan

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Objective: There are various demographic and educational factors that affect the academic performance of undergraduate medical students. The objective of this study is to identify these factors and correlate them to the GPA of the students. Methods: A cross-sectional study design utilizing grade point averages (GPAs) of two cohorts of students in both levels of the pre-clinical phase. In addition, self-administered questionnaire was used to evaluate the effect of these factors on students with poor and good cumulative GPA. Results: Among the various factors studied, gender, marital status, and the transportation used to reach the faculty significantly affected academic performance of students. Students with a cumulative GPA of 3.0 or greater significantly differed than those with a GPA of less than 3.0 being higher in female students, in married students, and type of transportation used to reach the college. Factors including age, educational factors, and type of transportation used have shown to create a significant difference in GPA between male and females. Conclusion: Factors such as age, gender, marital status, learning resources, study time, and the transportation used have been shown to significantly affect medical student GPA as a whole batch as well as when they are tested for gender.

Keywords: academic performance, educational factors, learning resources, study time, gender, socio-demographic factors

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Authors: Rachael Ojima Agarry, Raheemat Opeyemi Omosidi

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Over-schooling children is an abuse of the fundamental provisions of the National Policy on Education in Nigeria. The practice overburdens or places unwarranted academic demands on children, particularly preschoolers. This study was carried out to ascertain the prevalence of over-schooling preschoolers as perceived by teachers in the Kwara Central Senatorial District. One research question and two null hypotheses were formulated to guide the study. A descriptive survey design was employed. The population of the study consists of all preschool teachers in both private and public schools in Kwara Central. A validated instrument tagged “Questionnaire on Prevalence of Over-schooling of Preschoolers (QPOP)” with a reliability index of 0.76 was used for data collection. The questionnaire consists of sections A and B. Section A solicited the respondents’ demographic information, and Section B sought the prevalence of over-schooling as perceived by teachers. Data collected were analyzed using descriptive statistics of frequency and percentage. Mean and standard deviation were used to analyze the demographic information and the research question. The two research hypotheses were analyzed using a t-test and Analysis of Variance (ANCOVA) at a 0.05 level of significance. The results revealed that there is a high level of prevalence of over-schooling of preschoolers in Kwara Central. Also, there is a significant difference in teachers' perception of the prevalence of over-schooling preschoolers based on school type and school location. It was concluded that both private and public schools in Kwara Central practice over-schooling of preschoolers at a high level. Hence, it was recommended that the government, through the State and/or Federal Ministry of Education, should enact and enforce a law that would ensure children in this category spend only the stipulated time in school as well as strict adherence to the recommended curriculum contents by proprietors and teachers.

Keywords: over-schooling, preschoolers, school type, school location

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Authors: Gabrielle O'Donoghue

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Background: Pre-operative radiographs facilitate assessment and treatment planning in minor oral surgery. Quality assurance for dental radiography advocates the As Low As Reasonably Achievable (ALARA) principle in collecting accurate diagnostic information. Aims: To audit the quality of digital intraoral periapicals (IOPAs) taken prior to dental extractions in a metropolitan general dental practice setting. Standards: The National Radiological Protection Board (NRPB) guidance outlines three grades of radiograph quality: excellent (Grade 1 > 70% of total exposures), diagnostically acceptable (Grade 2 <20%), and unacceptable (Grade 3 <10%). Methodology: A study of pre-operative radiographs taken prior to dental extractions across 12 private general dental practices in a large metropolitan area by 44 practitioners. A total of 725 extractions were assessed, allowing 258 IOPAs to be reviewed in one audit cycle. Results: First cycle: Of 258 IOPAs: 223(86.4%) scored Grade 1, 27(10.5%) Grade 2, and 8(3.1%) Grade 3. The standard was met. 35 dental extractions were performed without an available pre-operative radiograph. Action Plan & Recommendations: Results were distributed to all staff and a continuous professional development evening organized to outline recommendations to improve image quality. A second audit cycle is proposed at a six-month interval to review the recommendations and appraise results. Conclusion: The overall standard of radiographs met the published guidelines. A significant improvement in the number of procedures undertaken without pre-operative imaging is expected at a six-month interval period. An investigation into undiagnostic imaging and associated adverse patient outcomes is being considered. Maintenance of the standards achieved is predicted in the second audit cycle to ensure consistent high quality imaging.

Keywords: audit, oral radiology, oral surgery, periapical radiographs, quality assurance

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Authors: Katherine van Kampen, Reva Qiu, Patricia Farrugia

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Orthopedic surgery has fallen behind when it comes to gender diversity despite medical school classes reaching gender parity. Studies have shown that orthopedic surgery would require 117 years to reach gender parity with the trainee population, the longest time than any other specialty, including neurosurgery, urology, and otolaryngology. The barriers that face women in orthopedic surgery have been well researched, with contributing factors being on-going stereotypes of the field, lack of women mentors, and gender roles outside of the hospital. Furthermore, women in orthopedic surgery face barriers to achieve promotion, publications, and leadership roles leading to a “leaky pipeline,” resulting in less and less women in key academic roles in the field. It is a complex topic with barriers and challenges faced in medical school, residency, and throughout employment. Our scoping review seeks to understand these challenges across a temporal timeline and to further characterize such barriers and the driving factors behind them. To this date, authors did not find a scoping review that seeks to look broadly at factors impacting the decreased amount of women entering orthopedics and the factors that cause women to hit a “glass ceiling”, the idea that women will not achieve the same success as men despite the same qualifications, upon entering the field. This scoping review is the first of its kind to attempt to summarize the large body of research focusing on women in orthopedic surgery from the preconceptions in medical school impacting their desire to pursue orthopedics all the way to employment, including challenges to academic success and financial success. Literature databases will be searched with the following key terms: women, gender inequity, workforce, orthopedics, and citations will be hand searched and collected. Articles included will discuss gender inequality within orthopedics with non-english, patient related articles excluded. Full-text review will seek to characterize the specific barriers faced by women across medical school, residency, and employment. Themes that are expected to be highlighted are workforce data, women in orthopedic leadership, medical student perspectives on the specialty, and gender bias and discrimination in the field.

Keywords: orthopedics, gender equity, workforce, women in surgery

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Authors: Bei Shan Lin, Chun Mei Lu, Ya Ping Chen, Li Chen Lu

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This study explores the ethical issues concerning the use of physical restraint in geriatric care. Physical restraint use in a medical care setting is seen as a controversial form of treatment that has occurred over decades. There is no doubt that people nowadays are living longer than previous generations. The ageing process is inevitable. Common disease such as impaired comprehension, memory loss, and trouble expressing one’s self contribute to the difficulty that these older patients have in adapting to medical institution. For these reasons, physical restraint is often used in reducing the risk of falling, managing wandering behaviour, preventing agitation, and promoting patient compliance in geriatric care. It can mean that physical restraints are considered as a common practice that is used in the care of older patients. It is most commonly used for three specific purposes, including procedural restraint, restraint to prevent falls, and behavioural restraints. Although there have been well documented instances of morbidity and mortality recognised as being potential risks associated with physical restraint use, it continues to be permitted and used in healthcare, often in the name of safety. However, there is insufficient evidence supporting the effectiveness of physical restraint use reducing injuries from falls and controlling challenging behaviour in geriatric care settings. There is barely any empirical evidence of either a scientific basis or clinical trials have evaluated the improvement in patient safety following physical restraint. In difficult clinical situations, guidelines and practical suggestions for Healthcare professionals to comply requirements can help those making appropriate decisions and to facilitate better judgement regarding physical restraint use. The following recommendations are given for physical restraint use in long-term care settings: an interdisciplinary team approach to assess, evaluate, and treat underlying diseases to determine if treatment can ease issues precipitating physical restraint use; a clearly stated purpose of treatment plan should be made after weighing up the risk of physical restraint use against the risk of without physical restraint use; a care plan for physical restraint has to include individualised treatment planning, informed consent, identification and remedial action to avoid negative consequences, regular assessment and modification, reduction and removal of risks; patients and their families must have the opportunity to consider and give voluntary informed consent prior to physical restraint utilisation; patients, family members, and Healthcare professionals should be educated on use and adverse consequences of physical restraints in order to make raise awareness of potential risks and to take appropriate steps to prevent unnecessary harm; after physical restraint removal, Healthcare professionals should discuss with patients and family members about their experience, feelings, and any anxieties regarding the treatment. Physical restraint should always be considered a last resort as deprive patient’s freedom, control, and individuality. Healthcare professionals should emphasise on providing individualized care, interdisciplinary decision-making process, and creative and collaborative alternatives to promote older patient’s rights, dignity and overall well-being as much as possible.

Keywords: ethics healthcare, geriatric care, healthcare, physical restraint

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Authors: Feras Darwish Elhajji, Alberto Berardi, Manal Ayyash, Iman Basheti

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The concept of the use of probiotics for humans now has been known for decades however, their intake by the Jordanian population seems to be less common when compared to population in the developed countries. Community pharmacy is the main supplier of probiotics, however, after conducting an extensive literature review, not any published research article could be found talking about the role, knowledge, and practice of the pharmacists in the area of probiotics. The main aim of this study was to evaluate the level of knowledge about probiotics and their dispensing practice in community pharmacies in Jordan. Community pharmacy staff (pharmacists and technicians) in Amman and north of Jordan were randomly selected to complete an anonymous questionnaire that had been pre-tested and validated. Ethical approval was obtained from the university ethics committee. The questionnaire included the following sections: demographics, knowledge and perceptions about probiotics, and role of the pharmacist Pharmacists and technicians were visited and interviewed in 281 community pharmacies. Asking about probiotics, 90.4% of them said that they know what probiotics are, although only 29.5% agreed that pharmacy staff in Jordan have good knowledge about probiotics, and 88.3% agreed that pharmacy staff in Jordan need more training and knowledge about probiotics. Variables that were significantly related to knowledge about probiotics were being a pharmacist (ρ= 0.012), area of the community pharmacy (ρ= 0.019), and female staff (ρ= 0.031) after conducting logistic regression statistical analysis. More than two-thirds of the participants thought that probiotics are classified as dietary supplements by Jordan Food and Drug Administration (JFDA). Of those who knew probiotics, the majority of them – 76.8% and 91.7% – agreed that probiotics are effective and safe, respectively. Believing in efficacy of the probiotics was significantly associated with answering their use to be with or after antibiotic administration and to increase normal flora gut population (ρ= 0.007). Efficacy was also significantly associated with recommending probiotics to consumers by the pharmacist (ρ< 0.001) and by the doctor (ρ= 0.041). At the same time, the concept of safety was mainly associated with their use for flatulence and gases (ρ= 0.048). Level of knowledge about probiotics and their uses, efficacy and safety amongst community pharmacy staff in Jordan is found to be good. However, this level can be raised in the future, especially knowledge about uses of probiotics.

Keywords: community pharmacy, Jordan, prebiotics, probiotics

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Authors: Liang Wang, Wei Zhang

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Nowadays, sustainable development has increasingly become an important research topic of engineering education. Existing research on Engineering Education for Sustainable Development (EESD) has highlighted the importance of perceptions for ethical responsibility to address sustainable development in practice. However, whether and how the professional engineering experience affects those perceptions has not been proved, especially in a Chinese context. Our study fills this gap by investigating the perceptions bias of EESD between experienced engineers and engineering students. We specifically examined what EESD means for experienced engineers and engineering students using a triple-dimensional model to understand if there are obvious differences between the two groups. Our goal is to make the benefits of these experiences more accessible in school context. The data (n=438) came from a questionnaire created and adapted from previously published studies containing 288 students from mechanical or civil engineering and 150 civil engineers with rich working experience, and the questionnaire was distributed during Fall 2020. T-test was used to find the difference in different dimensions between the two groups. The statistical results show that there is a significant difference in the perceptions of EESD between experienced engineers and inexperienced engineering students in China. Experienced engineers tend to consider sustainable development from ecological, economic, and social perspectives, while engineering students' answers focus more on ecology and ignore economic and social dimensions to some extend. The findings provide empirical evidence that professional experience is helpful to cultivate the cognition and ability of sustainable development in engineering education. The results of this work indicate that more practical content should be added to engineering education to promote sustainable development. In addition, for the design of engineering courses and professional practice systems for sustainable development, we should not only pay attention to the ecological aspects but also emphasize the coordination of ecological, economic, and socially sustainable development (e.g., engineer's ethical responsibility).

Keywords: engineering education, sustainable development, experienced engineers, engineering students

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Authors: Mattia Testuzza

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Public health is a social endeavour, which involves many different actors: from extremely stratified, structured health systems to unofficial networks of people and knowledge. Health and diseases are an intertwined individual and social experiences. Both patients and health workers navigate this public space through relations of trust. Trust in healthcare goes from the personal trust between a patient and her/his doctor to the trust of both the patient and the health worker in the medical knowledge and the healthcare system. Trust it is not a given, but it is continuously negotiated, given and gained. The key to understand these essential relations of trust in health is to recognise them as a social practice, which therefore implies agency and power. In these terms, health is constantly public and made public, as trust emerges as a meaningfully political phenomenon. Trust as a power relation can be observed at play in the implementation of public health policies such as the WHO’s Directly-Observed Theraphy Short-course (DOTS), and with the increasing concern for drug-resistance that tuberculosis pose, looking at the role of trust in the healthcare delivery system and implementation of public health policies becomes significantly relevant. The ethnographic fieldwork was carried out in four months through observation of the daily practices at the National Tuberculosis Center of Nepal, and semi-structured interviews with MultiDrug-Resistant Tuberculosis (MDR-TB) patients at different stages of the treatment, their relatives, MDR-TB specialised nurses, and doctors. Throughout the research, the role which trust plays in tuberculosis treatment emerged as one fundamental ax that cuts through all the different factors intertwined with drug-resistance development, unfolding a tension between the DOTS policy, which undermines trust, and the day-to-day healthcare relations and practices which cannot function without trust. Trust also stands out as a key component of the solutions to unforeseen issues which develop from the overall uncertainty of the context - for example, political instability and extreme poverty - in which tuberculosis treatment is carried out in Nepal.

Keywords: trust, tuberculosis, drug-resistance, politics of health

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Authors: Indujeeva Keerthila Peiris

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The secular view of mindfulness has some connotation to the original meaning of mindfulness mentioned in the Theravada Buddhist texts (Pāli Canon), but there is a substantial difference in the meaning of the two. Secular Mindfulness Based Interventions (MBI) focus on stilling the mind, which may provide short-term benefits and help individuals to deal with physical pain, grief, and distress. However, as with many popular educational innovations, the foundational values of mindfulness strategies have been distorted and subverted in a number of instances in which ‘McMindfulness’ programmes have been implemented with a view to reducing mindfulness mediation as a self-help technique that is easily misappropriated for the exclusive pursuit of corporate objectives, employee pacification, and commercial profit. The intention of this paper is not to critique the misappropriations of mindfulness. Instead, to go back to the root source and bring insights from the Buddhist Pāli Canon and its associated teachings on mindfulness in its own terms. In the Buddha’s discourses, as preserved in the Pāli Canon, there is nothing more significant than the understanding and practice of ‘Satipatthãna’. The Satipatthāna Sutta , the ‘Discourse on the Establishment of Mindfulness,’ opens with a proclamation highlighting both the purpose of this training and its methodology. The right practice of mindfulness is the gateway to understanding the Buddha’s teaching. However, although this concept is widely discussed among the Dhamma practitioners, it is the least understood one of them all. The purpose of this paper is to understand deeper meaning of mindfulness as it was originally intended by the Teacher. The natural state of mind is that it wanders. It wanders into the past, the present, and the future. One’s ability to hold attention to a mind object (emotion, thought, feeling, sensation, sense impression) called ‘concentration’. The intentional concentration process does not lead to wisdom. However, the development of wisdom starts when the mind is calm, concentrated, and unified. The practice of insight contemplation aims at gaining a direct understanding of the real nature of phenomena. According to the Buddha’s teaching, there are three basic facts of all existence: 1) impermanence (anicca in Pāli) ; 2) fabrication (also commonly known as suffering, unsatisfactoriness, sankhara or dukka in Pāli); 3) not-self (insubstantiality or impersonality, annatta in Pāli ). The entire Buddhist doctrine is based on these three facts. The problem is our ignorance covers reality. It is not that a person sees the emptiness of them or that we try to see the emptiness of our experience by conceptually thinking that they are empty. It is an experiential outcome that happens when the cause-and- effect overrides the self-view (sakkaya dhitti), and ignorance is known as ignorance and eradicated once and for all. Therefore, the right view (samma dhitti) is the starting point of the path, not ethical conduct (sila) or samadhi (jhana). In order to develop the right view, we need to first listen to the correct Dhamma and possess Yoniso manasikara (right comprehension) to know the five aggregates as five aggregates.

Keywords: mindfulness, spirituality, buddhism, pali canon

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Authors: Arun Dhakal, Geoff Cockfield, Tek Narayan Maraseni

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This paper attempts to fulfil the gap in measuring adoption in agroforestry studies. It explains the derivation of an index of adoption rate in a Nepalese context and examines the factors affecting adoption of agroforestry-based land management practice (AFLMP) in the Dhanusha District of Nepal. Data about the different farm practices and the factors (bio-physical, socio-economic) influencing adoption were collected during focus group discussion and from the randomly selected households using a household survey questionnaire, respectively. A multivariate regression model was used to determine the factors. The factors (variables) found to significantly affect adoption of AFLMP were: farm size, availability of irrigation water, education of household heads, agricultural labour force, frequency of visits by extension workers, expenditure on farm inputs purchase, household’s experience in agroforestry, and distance from home to government forest. The regression model explained about 75% of variation in adoption decision. The model rejected ‘erosion hazard’, ‘flood hazard’ and ‘gender’ as determinants of adoption, which in case of single agroforestry practice were major variables and played positive role. Out of eight variables, farm size played the most powerful role in explaining the variation in adoption, followed by availability of irrigation water and education of household heads. The results of this study suggest that policies to promote the provision of irrigation water, extension services and motivation to obtaining higher education would probably provide the incentive to adopt agroforestry elsewhere in the terai of Nepal.

Keywords: agroforestry, adoption index, determinants of adoption, step-wise linear regression, Nepal

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