Search results for: pregnancy outcomes

Authors: Sanchita B. Sarma, M. P. Nath

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Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of magnesium or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in patients with mild preeclampsia undergoing caesarean section. Sixty women with mild preeclampsia undergoing elective caesarean section were included in a prospective, double blind, controlled trial. Patients were randomly assigned to receive spinal anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 µg fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg) (group M) with 0.15ml preservative free distilled water. Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesic requirements were studied. Statistical comparison was carried out using the Chi-square or Fisher’s exact tests and Independent Student’s t-test where appropriate. The onset of both sensory and motor block was slower in the magnesium group. The duration of spinal anaesthesia (246 vs. 284) and motor block (186.3 vs. 210) were significantly longer in the magnesium group. Total analgesic top up requirement was less in group M. Hemodynamic parameters were similar in both the groups. Intrathecal magnesium caused minimal side effects. Since Fentanyl and other opioid congeners are not available throughout the country easily, magnesium with its easy availability and less side effect profile can be a cost effective alternative to fentanyl in managing pregnancy induced hypertension (PIH) patients given along with Bupivacaine intrathecally in caesarean section.

Keywords: analgesia, magnesium, pre eclampsia, spinal anaesthesia

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Authors: Liane J. Ioannou, Jonathan Serpell, Cino Bendinelli, David Walters, Jenny Gough, Dean Lisewski, Win Meyer-Rochow, Julie Miller, Duncan Topliss, Bill Fleming, Stephen Farrell, Andrew Kiu, James Kollias, Mark Sywak, Adam Aniss, Linda Fenton, Danielle Ghusn, Simon Harper, Aleksandra Popadich, Kate Stringer, David Watters, Susannah Ahern

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BACKGROUND: There are significant variations in the management, treatment and outcomes of thyroid cancer, particularly in the role of: diagnostic investigation and pre-treatment scanning; optimal extent of surgery (total or hemi-thyroidectomy); use of active surveillance for small low-risk cancers; central lymph node dissections (therapeutic or prophylactic); outcomes following surgery (e.g. recurrent laryngeal nerve palsy, hypocalcaemia, hypoparathyroidism); post-surgical hormone, calcium and vitamin D therapy; and provision and dosage of radioactive iodine treatment. A proven strategy to reduce variations in the outcome and to improve survival is to measure and compare it using high-quality clinical registry data. Clinical registries provide the most effective means of collecting high-quality data and are a tool for quality improvement. Where they have been introduced at a state or national level, registries have become one of the most clinically valued tools for quality improvement. To benchmark clinical care, clinical quality registries require systematic measurement at predefined intervals and the capacity to report back information to participating clinical units. OBJECTIVE: The aim of this study was to develop a core set clinical indicators that enable measurement and reporting of quality of care for patients with thyroid cancer. We hypothesise that measuring clinical quality indicators, developed to identify differences in quality of care across sites, will reduce variation and improve patient outcomes and survival, thereby lessening costs and healthcare burden to the Australian community. METHOD: Preparatory work and scoping was conducted to identify existing high quality, clinical guidelines and best practice for thyroid cancer both nationally and internationally, as well as relevant literature. A bi-national panel was invited to participate in a modified Delphi process. Panelists were asked to rate each proposed indicator on a Likert scale of 1–9 in a three-round iterative process. RESULTS: A total of 236 potential quality indicators were identified. One hundred and ninety-two indicators were removed to reflect the data capture by the Australian and New Zealand Thyroid Cancer Registry (ANZTCR) (from diagnosis to 90-days post-surgery). The remaining 44 indicators were presented to the panelists for voting. A further 21 indicators were later added by the panelists bringing the total potential quality indicators to 65. Of these, 21 were considered the most important and feasible indicators to measure quality of care in thyroid cancer, of which 12 were recommended for inclusion in the final set. The consensus indicator set spans the spectrum of care, including: preoperative; surgery; surgical complications; staging and post-surgical treatment planning; and post-surgical treatment. CONCLUSIONS: This study provides a core set of quality indicators to measure quality of care in thyroid cancer. This indicator set can be applied as a tool for internal quality improvement, comparative quality reporting, public reporting and research. Inclusion of these quality indicators into monitoring databases such as clinical quality registries will enable opportunities for benchmarking and feedback on best practice care to clinicians involved in the management of thyroid cancer.

Keywords: clinical registry, Delphi survey, quality indicators, quality of care

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Authors: Mohammad Saberian, Mohammad Ali Rahgozar, Reza Porhoseini

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Peat soil is formed naturally through the accumulation of organic matter under water and it consists of more than 75% organic substances. Peat is considered to be in the category of problematic soil, which is not suitable for construction, due to its high compressibility, high moisture content, low shear strength, and low bearing capacity. Since this kind of soil is generally found in many countries and different regions, finding desirable techniques for stabilization of peat is absolutely essential. The purpose of this paper is to review the various techniques applied for stabilizing peat soil and discuss outcomes of its improved mechanical parameters and strength properties. Recognizing characterization of stabilized peat is one of the most significant factors for architectural structures; as a consequence, various strategies for stabilization of this susceptible soil have been examined based on the depth of peat deposit.

Keywords: peat soil, stabilization, depth, strength, unconfined compressive strength (USC)

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Authors: Sarah K. Amer, Nagwa Badr, Osman Ibrahim, Ahmed Hamad

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This paper surveys the effectiveness of software process quality assurance frameworks, with some focus on Capability Maturity Model Integration (CMMI) - a framework that has become widely adopted in software organizations. The importance of quality improvement in software development, and the differences in the outcomes of quality framework implementation between Middle Eastern and North African (MENA-region) countries and non-MENA-region countries are discussed. The greatest challenges met in the MENA region are identified, with particular focus on Egypt and its rising software development industry.

Keywords: software quality, software process improvement, software development methodologies, capability maturity model integration

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Authors: Y. Salfati, D. Sharef Bussel, J. Zamir

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In this paper, we present an Evaluation Case Study implementing the eight principles of Collaborative Approaches to Evaluation (CAE) as designed by Brad Cousins in the past decade. The focus of this paper is sharing a rich experience in which we achieved two main goals. The first was the development of a valuable and meaningful new teacher training program, and the second was a successful implementation of the CAE principles. The innovative teacher training program is based on the idea of including physical movement during the process of teaching and learning academic themes. The program is called Learning through Movement. This program is a response to a call from the Ministry of Education, claiming that today children sit in front of screens and do not exercise any physical activity. In order to contribute to children’s health, physical, and cognitive development, the Ministry of Education promotes learning through physical activities. Research supports the idea that sports and physical exercise improve academic achievements. The Learning through Movement program is operated by Kaye Academic College. Students in the Elementary School Training Program, together with students in the Physical Education Training Program, implement the program in collaboration with two mentors from the College. The program combines academic learning with physical activity. The evaluation began at the beginning of the program. During the evaluation process, data was collected by means of qualitative tools, including interviews with mentors, observations during the students’ collaborative planning, class observations at school and focus groups with students, as well as the collection of documentation related to the teamwork and to the program itself. The data was analyzed using content analysis and triangulation. The preliminary results show outcomes relating to the Teacher Training Programs, the student teachers, the pupils in class, the role of Physical Education teachers, and the evaluation. The Teacher Training Programs developed a collaborative approach to lesson planning. The students' teachers demonstrated a change in their basic attitudes towards the idea of integrating physical activities during the lessons. The pupils indicated higher motivation through full participation in classes. These three outcomes are indicators of the success of the program. An additional significant outcome of the program relates to the status and role of the physical education teachers, changing their role from marginal to central in the school. Concerning evaluation, a deep sense of trust and confidence was achieved, between the evaluator and the whole team. The paper includes the perspectives and challenges of the heads and mentors of the two programs as well as the evaluator’s conclusions. The evaluation unveils challenges in conducting a CAE evaluation in such a complex setting.

Keywords: collaborative evaluation, training teachers, learning through movement

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Authors: Khanday Pervaiz Ahmad

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It was in 19th century when the Indian educated class started to reform their socio-religious set up as an imperative to respond to the challenges put forward by the colonial empire. The colonial discourse on India from the very beginning was gendered, as the colonized society was feminized and its ‘effeminate’ character, as opposed to ‘colonial masculinity’ was held to be a justification for its loss of independence. The ‘women health figure’ is prominently in these gender discourses. The women’s health received a much place in the colonial discourse. Lack of health consciousness, illiteracy, and belief in myths, rituals and superstitions were deemed the main factors taken as an indicator of miserable condition of Indian women’s health. As the low position of women caused shame to the natives, reforming the condition of women, its health occupied a major place in their intellectual as well as activist engagements. Magazines (journals) for women began to appear in various Indian languages in the mid to late 19th century with Bengal leading the front. These sources (Magazines) like Harm, Tehzib un Niswan, Saheli, Khatoon etc. are essential for the study of the emergence of an ideology of respectable domesticity in Indian Muslim upper middle class. Similarly for the study of development of Women’s health consciousness, women’s magazines are very essential. These earliest women Urdu magazines were first started by men, and then followed by the women’s own magazines. Various health issues, like pregnancy, child-rearing, menstruation, midwives training, Pardah, and health etc. were discussed at a time when it was impossible to discuss them in public sphere. These women magazines were brave pioneers, expanding the frontiers of women’s roles, and consciousness at a time when those frontiers were severely limited. This paper will try to focus on how women responded to the question of colonial discourse about their bodies. How health consciousness developed among Indian Muslim women and in what way it contributed in the development of feminist consciousness in South Asian Muslim Women community.

Keywords: Ashraf class, khatoon, haram women, feminism

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Authors: Stephen Rulisa, Aimee Nyiramahirwe

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Background: Strategies to increase the uptake of contraception services have been adopted in Rwanda, but the unmet need for family planning remains high. Women in the postpartum period are at higher risk for unintended pregnancy due to the silent conversion from lactational amenorrhea to reactivation of ovulatory cycles. The purpose of this study was to explore the role of male partners in the uptake of postpartum contraception. Methods: A prospective cross-sectional study was conducted among women who delivered at the University Teaching Hospital of Kigali for a period of 3 months with random sampling. A questionnaire was used to collect socio-demographic and antenatal data, information on male companionship, and intent to use postpartum contraception at admission. Participants were contacted six weeks later to collect data on contraceptive use. The outcome variables were uptake of postpartum contraception and types of contraceptives taken (long-acting vs. short-acting), controlling for male companionship during the antenatal period. A Chi-square test was used and a p-value ≤0.05 was considered significant. Results: A total of 209 women were recruited with a mean age of 30.8±5.2 years. The majority (60.9%) were multigravida, and 66.5% were multiparous. More than half (55%) had male partner companionship, 18.3% had companionship for four antenatal visits, and 28.2% had education on contraception with their male partner. Factors significantly associated with uptake of postpartum contraception were: age above 30 years, owning or heading a business, multigravidity, multiparity, antenatal care at a health center or district hospital, cesarean delivery, and previous utilization of contraception. Male companionship significantly increased the intent to use contraception, uptake of modern contraception in general, and uptake of long active contraceptives but did not predict the uptake of short-acting contraceptives. Conclusions: Our study demonstrates a positive association between male companionship during antenatal care, labor and delivery with the uptake of postpartum family planning. Our study suggests more sensitization to involve the male partners, improving the education on contraception during antenatal care and further research to assess the sustained uptake of contraception beyond the postpartum period.

Keywords: postpartum, family planning, contraception, male partner, uptake

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Authors: Winai Rungrittidetch

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This paper investigated the operational system, procedures, outcomes, and obstacles during the application of the Corporate Social Responsibility by the small enterprises and other involved groups in the anchor production business of the core firm, Jatura Charoen Chai Company Limited. The paper also aimed to discover ways to improve the stakeholders who participated in the CSR training and advisory programme. The paper utilized the qualitative methodology which included documentary review and semi- structured interview. The interviews were made with 8 respondents as the representative of different groups of the company’s stakeholder. The findings drew out the lessons learned from the participation of the selected small manufacturing enterprises in the CSR training and advisory programme. Some suggestions were also made, addressing the significance of the Philosophy of Sufficiency Economy.

Keywords: corporate, social, responsibility, enterprises

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Authors: Ning Chang, Zelong Yuan, Yunpeng Wang, Jianchun Wang

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The utilization of Large Eddy Simulation (LES) has been extensive in turbulence research. LES concentrates on resolving the significant grid-scale motions while representing smaller scales through subfilter-scale (SFS) models. The deconvolution model, among the available SFS models, has proven successful in LES of engineering and geophysical flows. Nevertheless, the thorough investigation of how sub-filter scale dynamics and filter anisotropy affect SFS modeling accuracy remains lacking. The outcomes of LES are significantly influenced by filter selection and grid anisotropy, factors that have not been adequately addressed in earlier studies. This study examines two crucial aspects of LES: Firstly, the accuracy of direct deconvolution models (DDM) is evaluated concerning sub-filter scale (SFS) dynamics across varying filter-to-grid ratios (FGR) in isotropic turbulence. Various invertible filters are employed, including Gaussian, Helmholtz I and II, Butterworth, Chebyshev I and II, Cauchy, Pao, and rapidly decaying filters. The importance of FGR becomes evident as it plays a critical role in controlling errors for precise SFS stress prediction. When FGR is set to 1, the DDM models struggle to faithfully reconstruct SFS stress due to inadequate resolution of SFS dynamics. Notably, prediction accuracy improves when FGR is set to 2, leading to accurate reconstruction of SFS stress, except for cases involving Helmholtz I and II filters. Remarkably high precision, nearly 100%, is achieved at an FGR of 4 for all DDM models. Furthermore, the study extends to filter anisotropy and its impact on SFS dynamics and LES accuracy. By utilizing the dynamic Smagorinsky model (DSM), dynamic mixed model (DMM), and direct deconvolution model (DDM) with anisotropic filters, aspect ratios (AR) ranging from 1 to 16 are examined in LES filters. The results emphasize the DDM’s proficiency in accurately predicting SFS stresses under highly anisotropic filtering conditions. Notably high correlation coefficients exceeding 90% are observed in the a priori study for the DDM’s reconstructed SFS stresses, surpassing those of the DSM and DMM models. However, these correlations tend to decrease as filter anisotropy increases. In the a posteriori analysis, the DDM model consistently outperforms the DSM and DMM models across various turbulence statistics, including velocity spectra, probability density functions related to vorticity, SFS energy flux, velocity increments, strainrate tensors, and SFS stress. It is evident that as filter anisotropy intensifies, the results of DSM and DMM deteriorate, while the DDM consistently delivers satisfactory outcomes across all filter-anisotropy scenarios. These findings underscore the potential of the DDM framework as a valuable tool for advancing the development of sophisticated SFS models for LES in turbulence research.

Keywords: deconvolution model, large eddy simulation, subfilter scale modeling, turbulence

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Authors: Caitlin Bailey, Marian Frattarola Saulino, Beth Steinberg

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Today, virtually all programs offered to people with intellectual and developmental disabilities tout themselves as person-centered, community-based and inclusive, yet there is a vast range in type and quality of services that use these similar descriptors. The issue is exacerbated by the fields’ measurement practices around quality, inclusion, independent living, choice and person-centered outcomes. For instance, community inclusion for people with disabilities is often measured by the number of times person steps into his or her community. These measurement approaches set standards for quality too low so that agencies supporting group home residents to go bowling every week can report the same outcomes as an agency that supports one person to join a book club that includes people based on their literary interests rather than disability labels. Ultimately, lack of delineation in measurement contributes to the confusion between face value “quality” and true quality services and supports for many people with disabilities and their families. This exploratory study adopts alternative approaches to quality measurement including co-production methods and systems theoretical framework in order to identify the factors that 1) lead to high-quality supports and, 2) differentiate high-quality services. Project researchers have partnered with community practitioners who are all committed to providing quality services and supports but vary in the degree to which they are actually able to provide them. The study includes two parts; first, an online survey distributed to more than 500 agencies that have demonstrated commitment to providing high-quality services; and second, four in-depth case studies with agencies in three United States and Israel providing a variety of supports to children and adults with disabilities. Results from both the survey and in-depth case studies were thematically analyzed and coded. Results show that there are specific factors that differentiate service quality; however meaningful quality measurement practices also require that researchers explore the contextual factors that contribute to quality. These not only include direct services and interactions, but also characteristics of service users, their environments as well as organizations providing services, such as management and funding structures, culture and leadership. Findings from this study challenge researchers, policy makers and practitioners to examine existing quality service standards and measurements and to adopt alternate methodologies and solutions to differentiate and scale up evidence-based quality practices so that all people with disabilities have access to services that support them to live, work, and enjoy where and with whom they choose.

Keywords: co-production, inclusion, independent living, quality measurement, quality supports

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Authors: Francisco Toledo-Castillo, María Josefa Sospedra-Baeza, Sergio Hidalgo-Fuentes

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Motorcycles constitute about 9% of all motorized vehicles in Spain and are generally overrepresented in traffic accidents, accounting for 21% of total accidents. Six years of motorcycle accident data were obtained through the national accident database of Spain (Dirección General de Tráfico). Some of the studied factors are age, gender, helmet wearing, alcohol consumption, speeding, subject’s driving license and for how long it has been held, the trip purpose, and the presence of a passenger on the vehicle. Key findings show helmet use, unsafe speed, the trip purpose, weather, distraction, collision type and other variables play significant roles in crash-injury outcomes. Finally, we examine evolution of mortality and severity from 2006 to 2011.

Keywords: motorcycle accidents, risk factors, statistics, Spain

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Authors: Zahara Abdulhussan Al-Awadai

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In recent years, serious games have started to gain an increasing interest as a tool to support learning across different educational and training fields. It began to serve as a powerful educational tool for improving learning outcomes. In this research, we discuss the potential of virtual experiences and games research outside of the games industry and explore the multifaceted impact of serious games and related technologies on various aspects of our lives. We highlight the usage of serious games as a tool to improve education and other applications with a purpose beyond the entertainment industry. One of the main contributions of this research is proposing a model that facilitates the design and development of serious games in a flexible and easy-to-use way. This is achieved by exploring different requirements to develop a model that describes a serious game structure with a focus on both aspects of serious games (educational and entertainment aspects).

Keywords: game development, requirements, serious games, serious game model

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Authors: Dalia Bhattacharjee

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Motherhood as an institution is considered as sacred. Reproduction and motherhood have always been a concern of the private space of home. However, with the emergence of technologies like the Assisted Reproductive Technologies (ARTs), this intimate area has moved into the public. A woman can now become a mother with artificial insemination done by expert medical professionals in a hospital. With this development, the meanings of motherhood and childrearing have altered. Mothers have been divided into ‘ovarian mothers’ (those who provide the eggs), ‘uterine mothers’ (those who carry out the pregnancy and give birth), and ‘social mothers’ (those who raise the child). Thus, the ART business deconstructs motherhood by defining who the biological mother is and who the social mother is and who – despite contributing parts or processes of her body to the life of the child is not a mother, but merely the donor of a product, be it the egg or the womb, which is owned by those who are favoured by the contract. The industry of commercial surrogacy in India has been estimated to be of $2.3 billion as of 2012. There are many women who work as surrogate mothers in this industry for the exchange of money. It runs like a full-fledged business guided by a highly profit oriented capitalist market. The reproductive labourers are identified as mere womb renters or victims and not as active agents in such arrangements. Such a discourse undercuts the agency exercised by the women. The present study is an ethnography into the commercial surrogacy industry in India. This journey furthers the understanding of the dilemmas faced by the reproductive labourers. The paper emphasizes on the experiences of reproduction and motherhood outside the private space of the home in the commercial surrogacy industry in India, and, argues that this multiplicity of experiences need much focus and attention, where, the consumer becomes ‘the’ citizen and the women workers continue to be victims. The study draws on the narratives of the reproductive labourers, who remain at the center, and yet, at the periphery of such arrangements. This feminist ethnography is informed by the feminist standpoint theory to account for and analyse these varied experiences which further the understanding of the dilemmas faced by the reproductive labourers.

Keywords: commercial surrogacy, ethnography, motherhood, standpoint theory

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Authors: Ozge Gurcanli

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Recent studies in active-learning focus on how student experience varies based on the content (e.g. STEM versus Humanities) and the medium (e.g. in-class exercises versus off-campus activities) of experiential learning. However, little is known whether the variation in classroom time and space within the same active learning context affects student experience. This study manipulated the use of classroom time for the active learning component of a developmental psychology course that is offered at a four-year university in the South-West Region of United States. The course uses a blended model: traditional and active learning. In the traditional learning component of the course, students do weekly readings, listen to lectures, and take midterms. In the active learning component, students make a documentary on a developmental topic as a final project. Students used the classroom time and space for the documentary in two ways: regular classroom time slots that were dedicated to the making of the documentary outside without the supervision of the professor (Classroom-time Outside) and lectures that offered basic instructions about how to make a documentary (Documentary Lectures). The study used the public teaching evaluations that are administered by the Office of Registrar’s. A total of two hundred and seven student evaluations were available across six semesters. Because the Office of Registrar’s presented the data separately without personal identifiers, One-Way ANOVA with four groups (Traditional, Experiential-Heavy: 19% Classroom-time Outside, 12% for Documentary Lectures, Experiential-Moderate: 5-7% for Classroom-time Outside, 16-19% for Documentary Lectures, Experiential Light: 4-7% for Classroom-time Outside, 7% for Documentary Lectures) was conducted on five key features (Organization, Quality, Assignments Contribution, Intellectual Curiosity, Teaching Effectiveness). Each measure used a five-point reverse-coded scale (1-Outstanding, 5-Poor). For all experiential conditions, the documentary counted towards 30% of the final grade. Organization (‘The instructors preparation for class was’), Quality (’Overall, I would rate the quality of this course as’) and Assignment Contribution (’The contribution of the graded work that made to the learning experience was’) did not yield any significant differences across four course types (F (3, 202)=1.72, p > .05, F(3, 200)=.32, p > .05, F(3, 203)=.43, p > .05, respectively). Intellectual Curiosity (’The instructor’s ability to stimulate intellectual curiosity was’) yielded a marginal effect (F (3, 201)=2.61, p = .053). Tukey’s HSD (p < .05) indicated that the Experiential-Heavy (M = 1.94, SD = .82) condition was significantly different than all other three conditions (M =1.57, 1.51, 1.58; SD = .68, .66, .77, respectively) showing that heavily active class-time did not elicit intellectual curiosity as much as others. Finally, Teaching Effectiveness (’Overall, I feel that the instructor’s effectiveness as a teacher was’) was significant (F (3, 198)=3.32, p <.05). Tukey’s HSD (p <.05) showed that students found the courses with moderate (M=1.49, SD=.62) to light (M=1.52, SD=.70) active class-time more effective than heavily active class-time (M=1.93, SD=.69). Overall, the findings of this study suggest that within the same active learning context, the time and the space dedicated to active learning results in different outcomes in intellectual curiosity and teaching effectiveness.

Keywords: active learning, learning outcomes, student experience, learning context

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Authors: Brian Carey Sims

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The current study examines psychological factors relevant to child custody litigation among African American fathers. Thirty-seven fathers engaged in various stages of custody litigation involving their children were surveyed about their perceptions of racial stereotypes, parental motivations, and racialized dynamics of the court/ legal process. Data were analyzed using a Critical Race Theory model designed to statistically isolate fathers’ perceptions of the existence and maintenance of structural racism through the legal process. Results indicate significant correlations between fathers’ psychological measures and structural outcomes of their cases. Findings are discussed in terms of ethical implications for family court judicial systems and attorney practice.

Keywords: ethics, family, legal psychology, policy, race

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Authors: Farman Ali, Asif Mahmood

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The utilization of genetic markers in prostate cancer management represents a significant advance in personalized medicine, offering the potential for more precise diagnosis and tailored treatment strategies. This paper explores the pivotal role of genetic markers in the diagnosis and treatment of prostate cancer, emphasizing their contribution to the identification of individual risk profiles, tumor aggressiveness, and response to therapy. By integrating current research findings, we discuss the application of genetic markers in developing targeted therapies and the implications for patient outcomes. Despite the promising advancements, challenges such as accessibility, cost, and the need for further validation in diverse populations remain. The paper concludes with an outlook on future directions, underscoring the importance of genetic markers in revolutionizing prostate cancer care.

Keywords: prostate cancer, genetic markers, personalized medicine, BRCA1 and BRCA2

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Authors: Shikhar Shrivastava, Varun Khare

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Background: We are confronted by a society that is becoming more complex, more mobile, and more dysfunctional. Teen pregnancy, suicide, elopement, and the perusal of dangerous drugs have become commonplace. In addition, children do not settle their disputes as they once did. Guns and knives are quotidian. Therefore, it has been an exigent to have a "Juvenile Code" that would provide specific substantive and procedural rules for juveniles in the justice system. However, until the twentieth century, there was little difference between how the justice system treated adults and children. Age was considered only in terms of appropriate punishment and juveniles were eligible for the same punishment as adults. Findings: The increased prevalence and legislative support for specialized courts, Juvenile Justice Boards, including juvenile drug, mental health and truancy court programs, as well as diversion programs and evidence-based approaches into the fabric of juvenile justice are just a few examples of recent advances. In India, various measures were taken to prosecute young offenders who committed violent crimes as adults. But it was argued that equating juveniles with adult criminals was neither scientifically correct nor normatively defensible. It would defeat the very purpose of the justice system. Methodology and Conclusion: This paper attempts to bring forth the results of analytical and descriptive research that examined changing trends in juvenile justice legislation. It covers the investigative and inspective practices of police, the various administrative agencies who have roles in implementing the legislation, the courts, and the detention centers. In this paper we shall discuss about how the juvenile justice system is the dumping ground for many of a youths’ problem. The changing notions of justice, from retributive to restorative and rehabilitative shall be discussed. A comparative study of the Juvenile act in India and that of the U.S has been discussed. Specific social institutions and forces that explain juvenile delinquency are identified. In addition, various influences on juvenile delinquency are noted, such as families, schools, peer groups and communities. The text concludes by addressing socialization, deterrence, imprisonments, alternatives, restitution and preventions.

Keywords: juvenile, justice system, retributive, rehabilitative, delinquency

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Authors: Maria Reichenber Arcilla

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Objective: To determine the risk factors for maternal and neonatal complications associated with operative vaginal deliveries. Methods: A retrospective chart review of 435 patients who underwent operative vaginal deliveries was done. Patient profiles – age, parity, AOG, duration of labor – and outcomes – birthweight, maternal and neonatal complications - were tabulated and multivariable analysis and logistic regression were performed using SPSS® Statistics Base. Results and Conclusion: There was no significant difference in the incidence of maternal and neonatal complications between those that underwent vacuum and forceps extraction. Among the variables analysed, parity and duration of labor reached statistical significance. The odds of maternal complications were 3 times higher among nulliparous patients. Neonatal complications were seen in those whose labor lasted more than 9 hours.

Keywords: operative vaginal deliveries, maternal, neonatal, morbidity

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Authors: Sahar Heidary

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Radiography and radiotherapy have emerged as crucial pillars of modern medical practice, revolutionizing diagnostics and treatment for a myriad of health conditions. This abstract highlights the pivotal role of radiography and radiotherapy in favor of healthcare and society. Radiography, a non-invasive imaging technique, has significantly advanced medical diagnostics by enabling the visualization of internal structures and abnormalities within the human body. With the advent of digital radiography, clinicians can obtain high-resolution images promptly, leading to faster diagnoses and informed treatment decisions. Radiography plays a pivotal role in detecting fractures, tumors, infections, and various other conditions, allowing for timely interventions and improved patient outcomes. Moreover, its widespread accessibility and cost-effectiveness make it an indispensable tool in healthcare settings worldwide. On the other hand, radiotherapy, a branch of medical science that utilizes high-energy radiation, has become an integral component of cancer treatment and management. By precisely targeting and damaging cancerous cells, radiotherapy offers a potent strategy to control tumor growth and, in many cases, leads to cancer eradication. Additionally, radiotherapy is often used in combination with surgery and chemotherapy, providing a multifaceted approach to combat cancer comprehensively. The continuous advancements in radiotherapy techniques, such as intensity-modulated radiotherapy and stereotactic radiosurgery, have further improved treatment precision while minimizing damage to surrounding healthy tissues. Furthermore, radiography and radiotherapy have demonstrated their worth beyond oncology. Radiography is instrumental in guiding various medical procedures, including catheter placement, joint injections, and dental evaluations, reducing complications and enhancing procedural accuracy. On the other hand, radiotherapy finds applications in non-cancerous conditions like benign tumors, vascular malformations, and certain neurological disorders, offering therapeutic options for patients who may not benefit from traditional surgical interventions. In conclusion, radiography and radiotherapy stand as indispensable tools in modern medicine, driving transformative improvements in patient care and treatment outcomes. Their ability to diagnose, treat, and manage a wide array of medical conditions underscores their favor in medical practice. As technology continues to advance, radiography and radiotherapy will undoubtedly play an ever more significant role in shaping the future of healthcare, ultimately saving lives and enhancing the quality of life for countless individuals worldwide.

Keywords: radiology, radiotherapy, medical imaging, cancer treatment

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Authors: Kim Katherine Castillo, Nelson John Datubatang, Terrence Phillip Dy, Norelie Hampac, Reichen Crismark Martinez, Nina Faith Pantinople, Jose Dante Santos II, Marchel Ann Santos, Sophia Abigail Santiago, Zyrill Xsar San Juan, Aira Mae Tagao, Crystal Kylla Viagedor

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The Work Immersion Program was implemented to help students gain abundant work-related experiences while on-site; additionally, the program aims to help students improve their competencies and interpersonal skills as they are given the option to join the workforce if they ever choose to do so after senior high school. The work immersion experience posed diverse challenges for students, spanning personal, financial, engagement, environmental, and equipment-related domains. These included the need for assistance in time management, transportation expenses, and procurement of materials. Furthermore, students faced difficulties in independent task completion and encountered suboptimal work environments. Addressing these multifaceted obstacles is crucial to optimize the educational outcomes of work immersion programs. In addition to the challenges, several other issues have been identified, including the absence of standardized work immersion programs across schools and industries, the challenges in securing appropriate work immersion placements, the necessity for enhanced monitoring and evaluation of program effectiveness, and the limited availability of field programs aligned with students' chosen courses. Furthermore, there is a lack of comprehensive information regarding the attitudes of Senior High School students toward work immersion programs within their respective schools. This study aims to investigate the attitudes of senior high school students at Nazareth School of National University towards work immersion programs, with a focus on identifying factors that influence their perception and participation, including collegiality and expectations. By exploring the students' attitudes, the research endeavors to enhance the school's work immersion programs and contribute to the overall educational experience of the students. This study addresses challenges related to work immersion programs, focusing on six subtopics: Work Immersion, Work Immersion in the Philippines, Students' Attitudes, Factors Affecting Students' Attitudes, Effectiveness of Work Immersion for Senior High School Students, and Students' Perception and Willingness to Participate. Using a descriptive research design, the study examines the attitudes of senior high school students at Nazareth School of National University in Manila. Data was collected from 100 students, representing different academic strands, through a 35-item researcher-made survey. Descriptive statistics, including measures of central tendency and variability, will be used to analyze the data using JASP, providing valuable insights into the students' attitudes toward work immersion.

Keywords: attitudes, challenges, educational outcomes, work immersion programs

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Authors: Laura Southgate

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The Association of Southeast Asian Nations (ASEAN), as well as much of the scholarship on the organisation, celebrates its ability to uphold the principle of regional autonomy, understood as upholding the norm of non-intervention by external powers in regional affairs. Yet, in practice, this has been repeatedly violated. This dichotomy between rhetoric and practice suggests an interesting avenue for further study. The East Timor crisis (1975-1999) has been selected as a case-study to test the dynamics of ASEAN state resistance to sovereignty violation in two distinct timeframes: Indonesia’s initial invasion of the territory in 1975, and the ensuing humanitarian crisis in 1999 which resulted in a UN-mandated, Australian-led peacekeeping intervention force. These time-periods demonstrate variation on the dependent variable. It is necessary to observe covariation in order to derive observations in support of a causal theory. To establish covariation, my independent variable is therefore a continuous variable characterised by variation in convergence of interest. Change of this variable should change the value of the dependent variable, thus establishing causal direction. This paper investigates the history of ASEAN’s relationship to the norm of non-intervention. It offers an alternative understanding of ASEAN’s history, written in terms of the relationship between a key ASEAN state, which I call a ‘vanguard state’, and selected external powers. This paper will consider when ASEAN resistance to sovereignty violation has succeeded, and when it has failed. It will contend that variation in outcomes associated with vanguard state resistance to sovereignty violation can be best explained by levels of interest convergence between the ASEAN vanguard state and designated external actors. Evidence will be provided to support the hypothesis that in 1999, ASEAN’s failure to resist violations to the sovereignty of Indonesia was a consequence of low interest convergence between Indonesia and the external powers. Conversely, in 1975, ASEAN’s ability to resist violations to the sovereignty of Indonesia was a consequence of high interest convergence between Indonesia and the external powers. As the vanguard state, Indonesia was able to apply pressure on the ASEAN states and obtain unanimous support for Indonesia’s East Timor policy in 1975 and 1999. However, the key factor explaining the variance in outcomes in both time periods resides in the critical role played by external actors. This view represents a serious challenge to much of the existing scholarship that emphasises ASEAN’s ability to defend regional autonomy. As these cases attempt to show, ASEAN autonomy is much more contingent than portrayed in the existing literature.

Keywords: ASEAN, east timor, intervention, sovereignty

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Authors: Xiao Yang, Ji Zhang, Yingli Song, Hui Huang, Jing Zhang, Yan Wang, Rongrong Han, Zhixuan Xiang, Lu Chen, Lingling Gao

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Aim and Objectives: To examine physical activity self-efficacy, identify its predictors, and further explore the mechanism of action among the predictors in mainland Chinese pregnant women with high risk for gestational diabetes mellitus (GDM). Background: Physical activity could protect pregnant women from developing GDM. Physical activity self-efficacy was the key predictor of physical activity. Design: A cross-sectional study was conducted from October 2021 to May 2022 in Zhengzhou, China. Methods: 252 eligible pregnant women completed the Pregnancy Physical Activity Self-efficacy Scale, the Social Support for Physical Activity Scale, the Knowledge on Physical Activity Questionnaire, the 7-item Generalized Anxiety Disorder scale, the Edinburgh Postnatal Depression Scale, and a socio-demographic data sheet. Multiple linear regression was applied to explore the predictors of physical activity self-efficacy. Structural equation modeling was used to explore the mechanism of action among the predictors. Results: Chinese pregnant women with a high risk for GDM reported a moderate level of physical activity self-efficacy. The best-fit regression analysis revealed four variables explained 17.5% of the variance in physical activity self-efficacy. Social support for physical activity was the strongest predictor, followed by knowledge of the physical activity, intention to do physical activity, and anxiety symptoms. The model analysis indicated that knowledge of physical activity could release anxiety and depressive symptoms and then increase physical activity self-efficacy. Conclusion: The present study revealed a moderate level of physical activity self-efficacy. Interventions targeting pregnant women with high risk for GDM need to include the predictors of physical activity self-efficacy. Relevance to clinical practice: To facilitate pregnant women with high risk for GDM to engage in physical activity, healthcare professionals may find assess physical activity self-efficacy and intervene as soon as possible on their first antenatal visit. Physical activity intervention programs focused on self-efficacy may be conducted in further research.

Keywords: physical activity, gestational diabetes, self-efficacy, predictors

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Authors: Jacob Dangerfield, Jacob Pollard, Jennifer DeCou

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Introduction: Burnout, anxiety, and depression are three conditions that are prevalent in medical providers. This is especially the case in the field of anesthesia, which has a high number of providers suffering from burnout and burnout syndrome. A major contributor to this issue is isolation in the workplace, with a perceived lack of peer support as a major risk factor for burnout. Two organizational interventions that can be done to help improve this issue are small group sessions and providing affordable mental health services. Per American College of Graduate Medical Education (ACGME) Guidelines, these affordable mental health services are a requirement of all residency programs, but for a variety of reasons, many residents do not access them. As physicians, we are often not good at asking for help. With this in mind, we hypothesized that carrying out small group resiliency sessions facilitated by Graduate Medical Education (GME) Wellness Counselors would improve both resident peer support as well as the likelihood that a resident will reach out to GME Wellness in a time of need. Methods: We held small group resiliency sessions with the GME Wellness Mental Health Professionals during protected didactic time. These sessions were small groups, including the members of one’s class (i.e., first-year residents on their own), and were facilitated by 1-2 mental health professionals. After these sessions, we surveyed residents who attended using a short Google Forms survey and using a 5-point Likert Scale, asked residents about some outcomes from the session. A “strongly agree” or “agree” was considered a positive response. Results: Results from our survey showed that the resident sessions had multiple positive outcomes. This survey was sent to 29 residents, and we had a 62% response rate. We found out through this survey that these small group sessions had a perceived positive impact on resident personal well-being, increased perceived peer support from classmates, and made residents more likely to reach out to GME Wellness in the future. Perceived positive impact on well-being was found in 83% of resident respondents, improved perceived peer support in 83% of respondents, and 78% of resident respondents stated that this session increased their likelihood of reaching out to mental health professionals. Conclusions: Through this study, we can conclude that our hypothesis was correct in that Small Group Resiliency Sessions that are facilitated by GME Wellness Counselors improve both resident peer support as well as the likelihood a resident reaches out to these mental health professionals in time of need. We believe these findings are very important as they address two important factors that can aid in decreasing a provider’s risk of experiencing burnout. Through this simple means, we believe other residency programs can help the well-being of their residents, and together, we can decrease the number of cases of burnout in anesthesia.

Keywords: anesthesiology, burnout, wellness, depression, residents, trainees, mental health

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Authors: Cosmas Maphosa, Ndileleni P. Mudzielwana, Lufuno Netshifhefhe

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Core business in a university centers on a curriculum. Teaching, learning, assessment and university products all have a bearing on the curriculum. In this discussion paper, the researchers engage in theoretical underpinnings of curriculum development in universities in South Africa. The paper is hinged on the realization that meaningful curriculum development is only possible if academic staff member has a thorough understanding of curriculum, curriculum design principles, and processes. Such understanding should be informed by theory. In this paper, the researchers consider curriculum, curriculum orientations, and the role of learning outcomes in curriculum development. Important and key considerations in module/course design are discussed and relevant examples given. The issue of alignment, as an important aspect of module/course design, is also explained and exemplified. Conclusions and recommendations are made.

Keywords: curriculum, curriculum development, knowledge, graduate attributes, competencies, teaching and learning

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Authors: Marndarath Suksanga

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The purposes and policies applied to sabbatical leave, along with the cost of using sabbatical leave. The potential benefits of the use of sabbatical leave to enhance organizational commitment are then examined. The focuses on the role of the sabbatical leave in the development, satisfaction, and productivity of faculty in institutions. An examination of the origin, definition, purposes, and outcomes of sabbatical leaves reviewed in the literature clarifies the role and benefits of the sabbatical leave. The result of this review can be used to determine the need for further study of how sabbatical leave might be used in higher education in universities level to the benefit of the faculty, students and organizations. The result of this review can be used to determine the need for further study of how sabbatical leave might be used in professional-technical and community colleges to the benefit of the faculty, students and organizations.

Keywords: return on investment, ROI, sabbatical leave, higher education

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Authors: Ben-Fred Ohia

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Code-switching and code-mixing are linguistic behaviours that arise in a bilingual situation. They limit speakers in a conversation to decide which code they should use to utter particular phrases or words in the course of carrying out their utterance. Every human society is characterized by the existence of diverse linguistic varieties. The speakers of these varieties at some points have various degrees of contact with the non-speakers of their variety, which one of the outcomes of the linguistic contact is code-switching or code-mixing. The work discusses the nature of code-switching and code-mixing in Ogba-English bilinguals’ speeches. It provides a detailed explanation of the concept of code-switching and code-mixing and explains the typology of code-switching and code-mixing and their manifestation in Ogba-English bilingual speakers’ speeches. The findings reveal that code-switching and code-mixing are functionally motivated and being triggered by various conversational contexts.

Keywords: bilinguals, code-mixing, code-switching, Ogba

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Authors: Linda Weinberg, Miriam Symon

Abstract:

While few institutions of higher education in Israel offer international programs taught entirely in English, many Israeli students today can study at least one content course taught in English during their degree program. In particular, with the growth of international partnerships and opportunities for student mobility, English medium instruction is a growing phenomenon. There are however no official guidelines in Israel for how to develop and implement content courses in English and no training to help lecturers prepare for teaching their materials in a foreign language. Furthermore, the implications for the students and the nature of the courses themselves have not been sufficiently considered. In addition, the institution must have lecturers who are able to teach these courses effectively in English. An international project funded by the European Union addresses these issues and a set of guidelines which provide guidance for lecturers in adapting their courses for delivery in English have been developed. A train-the-trainer approach is adopted in order to cascade knowledge and experience in English medium instruction from experts to language teachers and on to content teachers thus maximizing the scope of professional development. To accompany training, a model English medium course has been created which serves the dual purpose of highlighting alternatives to the frontal lecture while integrating language learning objectives with content goals. This course can also be used as a standalone content course. The development of the guidelines and of the course utilized backwards, forwards and central design in an iterative process. The goals for combined language and content outcomes were identified first after which a suitable framework for achieving these goals was constructed. The assessment procedures evolved through collaboration between content and language specialists and subsequently were put into action during a piloting phase. Feedback from the piloting teachers and from the students highlight the need for clear channels of communication to encourage frank and honest discussion of expectations versus reality. While much of what goes on in the English medium classroom requires no better teaching skills than are required in any classroom, the understanding of students' abilities in achieving reasonable learning outcomes in a foreign language must be rationalized and accommodated within the course design. Concomitantly, preparatory language classes for students must be able to adapt to prepare students for specific language and cognitive skills and activities that courses conducted in English require. This paper presents findings from the implementation of a purpose-designed English medium instruction course arrived at through an iterative backwards, forwards and central design process utilizing feedback from students and lecturers alike leading to suggested guidelines for English medium instruction in higher education.

Keywords: English medium instruction, higher education, iterative design process, train-the-trainer

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Authors: Rik van Leeuwen, Ger Koole

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Within hospitality, marketing departments use segmentation to create tailored strategies to ensure personalized marketing. This study provides a data-driven approach by segmenting guest profiles via hierarchical clustering based on an extensive set of features. The industry requires understandable outcomes that contribute to adaptability for marketing departments to make data-driven decisions and ultimately driving profit. A marketing department specified a business question that guides the unsupervised machine learning algorithm. Features of guests change over time; therefore, there is a probability that guests transition from one segment to another. The purpose of the study is to provide steps in the process from raw data to actionable insights, which serve as a guideline for how hospitality companies can adopt an algorithmic approach.

Keywords: hierarchical cluster analysis, hospitality, market segmentation

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Authors: Sundaresan Soundararajan, Chor Ngee Tan

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Introduction: Pyogenic spondylitis, otherwise treated conservatively with long term antibiotics, would require surgical debridement and reconstruction in about 10% to 20% of cases. The classical approach adopted many surgeons have always been anterior approach in ensuring thorough and complete debridement. This, however, comes with high rates of morbidity due to the nature of its access. Direct lateral retroperitoneal approach, which has been growing in usage in degenerative lumbar diseases, has the potential in treating pyogenic spondylitis with its ease of approach and relatively low risk of complications. Aims/Objectives: The objective of this study was to evaluate the effectiveness and clinical outcome of using lateral approach surgery in the surgical management of pyogenic spondylitis of the lumbar spine. Methods: Retrospective chart analysis was done on all patients who presented with pyogenic spondylitis (lumbar discitis/vertebral osteomyelitis) and had undergone direct lateral retroperitoneal lumbar vertebral debridement and posterior instrumentation between 2014 and 2016. Data on blood loss, surgical operating time, surgical complications, clinical outcomes and fusion rates were recorded. Results: A total of 6 patients (3 male and 3 female) underwent this procedure at a single institution by a single surgeon during the defined period. One patient presented with infected implant (PLIF) and vertebral osteomyelitis while the other five presented with single level spondylodiscitis. All patients underwent lumbar debridement, iliac strut grafting and posterior instrumentation (revision of screws for infected PLIF case). The mean operating time was 308.3 mins for all 6 cases. Mean blood loss was reported at 341cc (range from 200cc to 600cc). Presenting symptom of back pain resolved in all 6 cases while 2 cases that presented with lower limb weakness had improvement of neurological deficits. One patient had dislodged strut graft while performing posterior instrumentation and needed graft revision intraoperatively. Infective markers normalized for all patients subsequently. All subjects also showed radiological evidence of fusion on 6 months follow up. Conclusions: Lateral approach in treating pyogenic spondylitis is a viable option as it allows debridement and reconstruction without the risk that comes with other anterior approaches. It allows efficient debridement, short surgical time, moderate blood loss and low risk of vascular injuries. Clinical outcomes and fusion rates by this approach also support its use as practical MIS option surgery for such infection cases.

Keywords: lateral approach, minimally invasive, pyogenic spondylitis, XLIF

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Authors: Noreen Noreen, Aamir Ijaz, Hamza Akhtar

Abstract:

Background: Screening plays a major role to detect chromosomal abnormalities, Down syndrome, neural tube defects and other inborn diseases of the newborn. Serum biomarkers in the second trimester are useful in determining risk of most common chromosomal anomalies; these test include Alpha-fetoprotein (AFP), Human chorionic gonadotropin (hCG), Unconjugated Oestriol (UEȝ)and inhibin-A. Quadruple biomarkers are worth test in diagnosing the congenital pathology during pregnancy, these procedures does not form a part of routine health care of pregnant women in Pakistan, so the median value is lacking for population in Pakistan. Objective: To determine median values of biochemical maternal serum markers in local population during second trimester maternal screening. Study settings: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP) Rawalpindi. Methods: Cross-Sectional study for estimation of reference values. Non-probability consecutive sampling, 155 healthy pregnant women, of 30-40 years of age, will be included. As non-parametric statistics will be used, the minimum sample size is 120. Result: Total 155 women were enrolled into this study. The age of all women enrolled ranged from 30 to39 yrs. Among them, 39 per cent of women were less than 34 years. Mean maternal age 33.46±2.35 SD and maternal body weight were 54.98±2.88. Median value of quadruple markers calculated from 15-18th week of gestation that will be used for calculation of MOM for screening of trisomy21 in this gestational age. Median value at 15 week of gestation were observed hCG 36650 mIU/ml, AFP 23.3 IU/ml, UEȝ 3.5 nmol/L, InhibinA 198 ng/L, at 16 week of gestation hCG 29050 mIU/ml, AFP 35.4 IU/ml, UEȝ 4.1 nmol/L, InhibinA 179 ng/L, at 17 week of gestation hCG 28450 mIU/ml, AFP 36.0 IU/ml, UEȝ 6.7 nmol/L, InhibinA 176 ng/L and at 18 week of gestation hCG 25200 mIU/ml, AFP 38.2 IU/ml, UEȝ 8.2 nmol/L, InhibinA 190 ng/L respectively.All the comparisons were significant (p-Value <0.005) with 95% confidence Interval (CI) and level of significance of study set by going through literature and set at 5%. Conclusion: The median values for these four biomarkers in Pakistani pregnant women can be used to calculate MoM.

Keywords: screening, down syndrome, quadruple test, second trimester, serum biomarkers

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