Search results for: surgical team

Authors: Yayan Harry Yadi, L. Meily Kurniawidjaja

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Work activities for MMH (Manual Material Handling) in the storage of liquid catalyst raw material workstations in chemical industries identify high-risk MSDs (Musculoskeletal Disorders). Their work is often performed frequently requires an awkward body posture, twisting, bending because of physical space limited, cold, slippery, and limited tools for transfer container and weighing the liquid chemistry of the catalyst into the container. This study aims to develop an ergonomic work system design on the transfer and weighing process of liquid catalyst raw materials at the storage warehouse. A triangulation method through an interview, observation, and detail study team with assessing the level of risk work posture and complaints. Work postures were analyzed using the RULA method, through the support of CATIA software. The study concludes that ergonomic design can make reduce 3 levels of risk scores awkward posture. CATIA Software simulation provided a comprehensive solution for a better posture of manual material handling at task weigh. An addition of manual material handling tools such as adjustable conveyors, trolley and modification tools semi-mechanical weighing with techniques based on rule ergonomic design can reduce the hazard of chemical fluid spills.

Keywords: ergonomic design, MSDs, CATIA software, RULA, chemical industry

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Authors: Parastoo Parhizkar, Jaber Yaghini, Omid Fakheran

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Background: Third molar surgery is often associated with postoperative problems which cause serious impediments on daily activities and quality of life. Steroidal anti-inflammatory drugs may decrease these common post-operative complications. The purpose of this review is evaluating the available evidence regarding the efficacy of corticosteroids used as adjunctive therapy for patients undergoing third molar surgery. Methods: PubMed, Google scholar, Scopus, web of science, clinicaltrials.gov, scirus.com, Cochrane central register for controlled trials, LILACS, OpenGrey, centerwatch, isrctn, who.int and ebsco were searched without restrictions regarding the year of publication. Randomized clinical trials assessing patient-reported outcomes in patients undergoing surgical therapy, were eligible for inclusion. Study quality was assessed using the CONSORT-checklist. No meta-analysis was performed. Results: A total of twelve Randomized Clinical Trials were included in this study. Methylprednisolone and Dexamethasone may decrease postoperative side effects such as pain, trismus and edema. Based on the results both of them could improve patients’ satisfaction, and there is no significant difference between these two types of corticosteroids regarding the patient centered outcomes (p > 0.05). Intralesional and intravenous injection of Dexamethasone showed an equivalent result, with statistically significant better results (P < 0.05) in comparison with the oral treatment. Conclusion: various types of corticosteroids can enhance the patient’s satisfaction following third molar surgery. However, there is no significant difference between Dexamethasone, Prednisolone and Methylprednisolone groups in this regard. Comparing the various administration routs, local injection of Dexamethasone is quite simple, painless and cost-effective adjunctive therapy with better drug efficacy.

Keywords: third molar surgery, corticosteroids, patient-reported outcomes, health related quality of life

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Authors: Riin Seema

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Guidance and counseling as a whole-school responsibility is a global trend. Counseling is a specific competence, that consist of cognitive, emotional, attitudinal, and behavioral components. To authors best knowledge, there are no self-assessment scales for teachers in the whole world to measure teachers’ counseling competency. In 2016 an Estonian scale on teachers counseling competence was developed during an Interdisciplinary Project at Tallinn University. The team consisted of 10 interdisciplinary students (psychology, nursery school, special and adult education) and their supervisor. In 2017 another international Interdisciplinary Project was carried out for adapting the scale in English for international students. Firstly, the Estonian scale was translated by 2 professional translators, and then a group of international Erasmus students (again from psychology, nursery school, special and adult education) selected the most suitable translation for the scale. The developed ‘Teacher’s Counselling Competence Self-Efficacy Scale’ measures teacher’s self-efficacy beliefs in their own competence to perform different counseling tasks (creating a counseling relationship, using different reflection techniques, etc.). The scale consists of 47 questions in a 5-point numeric scale. The scale is created based on counseling theory and scale development and validation theory. The scale has been used as a teaching and learning material for counseling courses by 174 Estonian and 10 international student teachers. After filling out the scale, the students also reflected on the scale and their own counseling competencies. The study showed that the scale is unidimensional and has an excellent Cronbach alpha coefficient. Student’s qualitative feedback on the scale has been very positive, as the scale supports their self-reflection. In conclusion, the developed ‘Teacher’s Counselling Competence Self-Efficacy Scale’ is a useful tool for supporting student teachers’ learning.

Keywords: competency, counseling, self-efficacy, teacher students

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Authors: Anthoni Jeorge

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Throughout the history of the world, servant leadership has been researched, and favourable results such as individual, team, and organizational have been linked to the construct. This research paper designates St. Camillus de Lellis, a practitioner of servant leadership and founder of the Ministers of the Sick as a servant leader in his approach to care for the sick. Service is the visible face of his servant leadership. First of all, despite many challenges, St. Camillus de Lellis practiced leadership by the example of compassionate service to the sick. Second, he made service to the sick the highest priority of his life. Third, Camillus displayed servant leadership such that his manner of leadership gave birth to a New School of Service to the Sick. The paper identifies the distinctive dimensions and essential elements which characterized his service-centered leadership. Furthermore, discuss the six major characteristics of a servant leader as set forth by St. Camillus’s life example. The research illustrates the transformational power of servant leadership infield healthcare in general and, in doing so, provides servant leadership seekers ways servant leadership can transform elder care in one’s own field (St. Camillus Health Systems). Thus, it ascertains that servant leadership is best-fit for humanized elder care. Supported by the review of literature, the paper ascertains that Camillus, by identifying himself with the sick, gained deeper insights concerning the pain and suffering of the population. Uniquely drawn from his true grit, Camillus’ service-centered leadership is value-based, people-oriented, and compassion-filled. His way of service to the sick is the prolongation of gestures of mercy and compassion. It is hoped that the results of this study will help health care workers and servant leadership practitioners to humanize elder care and cultivate servant leadership attitude in their health care services to the sick. By incorporating such service-oriented elements into their leadership orientation, health care workers will be true servant leaders of the sick.

Keywords: leadership, service, healthcare, compassion

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Authors: Aisha M. Khairat

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Community education in the Arab Republic of Egypt is a model that provides education to remote, underprivileged villages and hamlets where children have no access to public education. The community education model is based on the philosophy of transforming individuals to reach their full potential and on instilling the seeds of empowerment and citizenship to induce societal transformation. This research aims at investigating the degree to which the leadership style and organizational culture of the Egyptian community schools demonstrates an empowering approach. Nile Valley NGO, an Egyptian Non-Governmental Organization (NGO) leading hundreds of Egyptian community schools was studied to investigate the perceptions of empowerment amongst its leadership. This in turn will have serious implications on the level of empowerment the communities managed by Nile Valley NGO are experiencing, and will serve as an indicator to the degree to which community schools are achieving their goals in transforming individuals and empowering communities and reforming Egyptian education – and not just a tool to reach literacy. This mixed-methods research utilized surveys and semi-structured interviews to capture the perceptions of empowerment in the views of a sample of 380 community schools facilitators (teachers) spanning 8 Egyptian governorates and Nile Valley NGO’s community education project team and leadership. The findings demonstrate interesting leadership approaches with traits from transformational and servant leadership theoretical models. The organizational culture at Nile Valley NGO reflects the universal dichotomy between market-oriented and humanitarian orientations. The perceptions of empowerment were positive, and several success stories were uncovered in spite of the many challenges faced on the national level and despite the scarcity or resources.

Keywords: community education, community schools in Egypt, empowerment, organizational culture, leadership

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Authors: Thomas Trouton, Sebastian Tanner, Manvir Sandher

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The use of simulation in undergraduate and postgraduate medical curricula is ever-growing, is a useful addition to the traditional apprenticeship model of learning within medical education, and better prepares graduates for the team-based approach to healthcare seen in real-life clinical practice. As a learning tool, however, undergraduate medical students often have little understanding of the theory behind the use of medical simulation and have little experience in planning and delivering their own simulated teaching sessions. We designed and implemented a student-selected component (SSC) as part of the undergraduate medical curriculum at the University of Buckingham Medical School to introduce students to the concepts behind the use of medical simulation in education and allow them to plan and deliver their own simulated medical scenario to their peers. The SSC took place over a 2-week period in the 3rd year of the undergraduate course. There was a mix of lectures, seminars and interactive group work sessions, as well as hands-on experience in the simulation suite, to introduce key concepts related to medical simulation, including technical considerations in simulation, human factors, debriefing and troubleshooting scenarios. We evaluated the success of our SSC using “Net Promotor Scores” (NPS) to assess students’ confidence in planning and facilitating a simulation-based teaching session, as well as leading a debrief session. In all three domains, we showed an increase in the confidence of the students. We also showed an increase in confidence in the management of common medical emergencies as a result of the SSC. Overall, the students who chose our SSC had the opportunity to learn new skills in medical education, with a particular focus on the use of simulation-based teaching, and feedback highlighted that a number of students would take these skills forward in their own practice. We demonstrated an increase in confidence in several domains related to the use of medical simulation in education and have hopefully inspired a new generation of medical educators.

Keywords: simulation, SSC, teaching, medical students

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Authors: Jayant Balaji Athavale, Sean Clarke

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Background: According to the WHO, every year, more than 700,000 people die by suicide, which is one person around every 45 seconds. Suicide is the fourth leading cause of death among 15 to 29-year-olds globally. The most common situations or life events that might cause suicidal thoughts are financial problems/unemployment, rejections, relationship breakups, sexual/substance abuse and mental illnesses. Mental/psychological weakness caused due to defects in one’s personality is one of the main reasons why people feel they cannot cope in such situations and contemplate suicide. A WHO Mental Health Action Plan 2013–2020 lists a 4-point strategy to enhance mental health by ‘implementing strategies for promotion and prevention in mental health.’ Methodology: With 40 years of spiritual research background, the team at the Maharshi University of Spirituality has studied the spiritual root causes that can significantly affect one’s mental health and the solutions to improve it. Results/Findings: According to spiritual science, the time and nature of death are mostly due to spiritual reasons. A person would mostly contemplate and attempt suicide when he is spiritually most vulnerable. Spiritual practice, as per universal principles, helps in protecting a person spiritually and prevents him from getting such thoughts of self-harm or acting upon them by controlling such impulses. The University has had much success in helping people to overcome the defects in their personalities, including those with suicidal thoughts, through spiritual practices such as chanting the Name of God and the Personality Defect Removal (PDR) process developed by the Author. Conclusion: If such techniques were taught in educational institutions, they could be simple yet effective self-help tools to prevent thoughts of suicide and enhance mental health and well-being.

Keywords: suicide, mental health, abuse, suicide prevention, personality defect removal

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Authors: Kjellgren Maria, Lilliehorn Sara, Markström Urban

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This article describes the counselling practice of school social workers (SSWs) with individual children. SSWs work in the school system’s pupil health team, whose primary task is health promotion and prevention. The work of SSWs is about helping children and adolescents who, for various reasons, suffer from mental ill-health, school absenteeism, or stress that make them unable to achieve their intended goals. SSWs preferably meet these children in individual counselling sessions. The aim of this article is to describe and analyse SSWs’ experience of counselling with children and to examine the characteristics of counselling practice. The data collection was conducted through four semi-structured focus group interviews with a total of 22 SSWs in four different regions in Sweden. SSWs provide counselling to children in order to bring about improved feelings or behavioural changes. It can be noted that SSWs put emphasis on both the counselling process and the alliance with the child. The interviews showed a common practice among SSWs regarding the structure of the counselling sessions, with certain steps and approaches being employed. However, the specific interventions differed and were characterised by an eclectic standpoint in which SSWs utilise a broad repertoire of therapeutic schools and techniques. Furthermore, a relational perspective emerged as a most prominent focus for the SSWs by re-emerging throughout the material. We believe that SSWs could benefit from theoretical perspectives on ‘contextual model’ and ‘attachment theory’ as ‘models of the mind’. Being emotionally close to the child and being able to follow their development requires a lot from SSWs, as both professional caregivers and as “safe havens”.

Keywords: school social conselling, school social workers, contextual model, attachment thory

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Authors: Katarína Čurová, Leonard Siegfried, Radka Vargová, Marta Kmeťová, Vladimír Hrabovský

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Introduction: Cytolethal distending toxins (CDTs) represent intracellular acting proteins which interfere with cell cycle of eukaryotic cells. They are produced by Gram-negative bacteria with afinity to mucocutaneous surfaces and could play a role in the pathogenesis of various diseases. CDTs induce DNA damage probably through DNAse activity, which causes cell cycle arrest and leads to further changes (cell distension and death, apoptosis) depending on the cell type. Five subtypes of CDT (I to V) were reported in E. coli. Methods: We examined 252 E. coli strains belonging to four different groups. Of these strains, 57 were isolated from patients with diarrhea, 65 from patients with urinary tract infections (UTI), 65 from patients with sepsis and 65 from patients with other extraintestinal infections (mostly surgical wounds, decubitus ulcers and respiratory tract infections). Identification of these strains was performed by MALDI-TOF analysis and detection of genes encoding CDTs and determination of the phylogenetic group was performed by PCR. Results: In this study, we detected presence of cdt genes in 11 of 252 E. coli strains tested (4,4 %). Four cdt positive E. coli strains were confirmed in group of UTI (6,15 %), three cdt positive E. coli strains in groups of diarrhea (5,3 %) and other extraintestinal infections (4,6 %). The lowest incidence, one cdt positive E. coli strain, was observed in group of sepsis (1,5 %). All cdt positive E. coli strains belonged to phylogenetic group B2. Conclusion: CDT-producing E. coli are isolated in a low percentage from patients with intestinal and extraintestinal infections, including sepsis and our results correspond with these studies. A weak prevalence of cdt genes suggests that CDTs are not major virulence factors but in combination with other virulence factors may increase virulence potential of E. coli. We suppose that all 11 cdt positive E. coli strains represent real pathogens because they belong to the phylogenetic group B2 which is pathogenic lineage for bacteria E. coli.

Keywords: cytolethal distending toxin, E. coli, phylogenetic group, extraintestinal infection, diarrhea

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Authors: Pedro Gomes, Lia Ferreira, Sofia Garcia, Jaime Babulal, Luís Costa, Luís Castelo, José Muras, Isabel Gonçalves, Rui Carvalho

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Introduction: Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. Objectives: The present study aims to evaluate the outcomes in terms of need for hospitalization, amputation, healing time and mortality in patients with new-onset diabetic foot ulcers in subgroups stratified by etiology. Methods: A retrospective study based on clinical assessment of patients presenting with new ulcers to a multidisciplinary diabetic foot consult during 2012. Outcomes were determined until September 2014, from hospital registers. Baseline clinical examination was done to classify ulcers as neuropathic, ischemic or neuroischemic. Results: 487 patients with new diabetic foot ulcers were observed; 36%, 15% and 49% of patients had neuropathic, ischemic and neuroischemic ulcers, respectively. For analysis, patients were classified as having predominantly neuropathic (36%) or ischemic foot (64%). The mean age was significantly higher in the group with ischemic foot (70±12 vs 63±12 years; p <0.001), as well as the duration of diabetes (18±10 vs 16 ± 10years, p <0.05). A history of previous amputation was also significantly higher in this group (24.7% vs 15.6%, p <0.05). The evolution of ischemic ulcers was significantly worse, with a greater need for hospitalization (27.2% vs 18%, p <0.05), amputation (11.5% vs 3.6% p <0.05) mainly major amputation (3% vs. 0%; p <0.001) and higher mean healing time (151 days vs 89 days, p <0.05). The mortality rate at 18 months, was also significantly higher in the ischemic foot group (7.3% vs 1.8%, p <0.05). Conclusions: All types of diabetic foot ulcers are associated with high morbidity and mortality, however, the presence of arterial disease confers a poor prognosis. Diabetic foot can be successfully treated only by the multidisciplinary team which can provide more comprehensive and integrated care.

Keywords: diabetes, foot ulcers, etiology, outcome

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Authors: Jacky Liu, Dulani Jayasuriya, Ryan Elmore

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Match fixing and anomalous sports events have increasingly threatened the integrity of professional sports, prompting concerns about existing detection methods. This study addresses prior research limitations in match fixing detection, improving the identification of potential fraudulent matches by incorporating advanced anomaly detection techniques. We develop a novel method to identify anomalous matches and player performances by examining series of matches, such as playoffs. Additionally, we investigate bettors' potential profits when avoiding anomaly matches and explore factors behind unusual player performances. Our literature review covers match fixing detection, match outcome forecasting models, and anomaly detection methods, underscoring current limitations and proposing a new sports anomaly detection method. Our findings reveal anomalous series in the 2022 NBA playoffs, with the Phoenix Suns vs Dallas Mavericks series having the lowest natural occurrence probability. We identify abnormal player performances and bettors' profits significantly decrease when post-season matches are included. This study contributes by developing a new approach to detect anomalous matches and player performances, and assisting investigators in identifying responsible parties. While we cannot conclusively establish reasons behind unusual player performances, our findings suggest factors such as team financial difficulties, executive mismanagement, and individual player contract issues.

Keywords: anomaly match detection, match fixing, match outcome forecasting, problematic players identification

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Authors: Hardisiswo Soedjana, Inne Caroline

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Deep dermal or full thickness burns are inevitably lead to post-burn contractures. These contractures remain to be one of the most concerning late complications of burn injuries. Surgical management includes releasing the contracture followed by resurfacing the defect accompanied by post-operative rehabilitation. Optimal treatment of post-burn contractures depends on the characteristics of the contractures. This study is aimed to describe clinical characteristics, problems, and management of post-burn contractures in adults and children. A retrospective analysis was conducted from medical records of patients suffered from contractures after burn injuries admitted to Hasan Sadikin general hospital between January 2016 and January 2018. A total of 50 patients with post burn contractures were included in the study. There were 17 adults and 33 children. Most patients were male, whose age range within 15-59 years old and 5-9 years old. Educational background was mostly senior high school among adults, while there was only one third of children who have entered school. Etiology of burns was predominantly flame in adults (82.3%); whereas flame and scald were the leading cause of burn injury in children (11%). Based on anatomical regions, hands were the most common affected both in adults (35.2%) and children (48.5%). Contractures were identified in 6-12 months since the initial burns. Most post-burn hand contractures were resurfaced with full-thickness skin graft (FTSG) both in adults and children. There were 11 patients who presented with recurrent contracture after previous history of contracture release. Post-operative rehabilitation was conducted for all patients; however, it is important to highlight that it is still challenging to control splinting and exercise when patients are discharged and especially the compliance in children. In order to improve quality of life in patients with history of deep burn injuries, prevention of contractures should begin right after acute care has been established. Education for the importance of splinting and exercise should be administered as comprehensible as possible for adult patients and parents of pediatric patients.

Keywords: burn, contracture, education, exercise, splinting

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Authors: Anshu Bahl, Saroj Kaler, Shivani Gupta, S B Ray

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Background: Somatostatin is an endogenous regulatory neuropeptide. Somatostatin and its analogues play an important role in neuropathic and inflammatory pain. Neuropeptide Y is extensively distributed in the mammalian nervous system. NPY has an important role in blood pressure, circadian rhythm, obesity, appetite and memory. The purpose was to investigate somatostatin and NPY expression in dorsal root ganglia during pain. The plantar incision model in rats is similar to postoperative pain in humans. Methods: 24 adult male Sprague dawley rats were distributed randomly into two groups – Control (n=6) and incision (n=18) groups. Using Hargreaves apparatus, thermal hyperalgesia behavioural test for nociception was done under basal condition and after surgical incision in right hind paw at different time periods (day 1, 3 and 5). The plantar incision was performed as per standard protocol. Perfusion was done using 4% paraformaldehyde followed by extraction of dorsal root ganglia at L4 level. The tissue was processed for immunohistochemical localisation for somatostatin and neuropeptide Y. Results: Post incisional groups (day 1, 3 and 5) exhibited significant decrease of paw withdrawal latency as compared to control groups. Somatostatin expression was noted under basal conditions. It decreased on day 1, but again gradually increased on day 3 and further on day five post incision. The expression of Neuropeptide Y was noted in the cytoplasm of dorsal root ganglia under basal conditions. Compared to control group, expression of neuropeptide Y decreased on day one after incision, but again gradually increased on day 3. Maximum expression was noted on day five post incision. Conclusion: Decrease in paw withdrawal latency indicated nociception, particularly on day 1. In comparison to control, somatostatin and NPY expression was decreased on day one post incision. This could be correlated with increased axoplasmic flow towards the spinal cord. Somatostatin and NPY expression was maximum on day five post incision. This could be due to decreased migration from the site of synthesis towards the spinal cord.

Keywords: dorsal root ganglia, neuropeptide y, postoperative pain, somatostatin

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Authors: Chukwudalu C. Nwazojie, Wole W. Soboyejo, John Obayemi, Ali Salifu Azeko, Sandra M. Jusu, Chinyerem M. Onyekanne

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The conventional methods for the diagnosis and treatment of breast cancer include bulk systematic mammography, ultrasound, dynamic contrast-enhanced fast 3D gradient-echo (GRE) magnetic resonance imaging (MRI), surgery, chemotherapy, and radiotherapy. However, nanoparticles and drug-loaded polymer microspheres for disease (cancer) targeting and treatment have enormous potential to enhance the approaches that are used today. The goal is to produce an implantable biomedical device for localized breast cancer drug delivery within Africa and the world. The main advantage of localized delivery is that it reduces the amount of drug that is needed to have a therapeutic effect. Polymer blends of poly (D,L-lactide-co-glycolide) (PLGA) and polycaprolactone (PCL), which are biodegradable, is used as a drug excipient. This work focuses on the development of PLGA-PCL (poly (D,L-lactide-co-glycolide) (PLGA) blended with based injectable drug microspheres and are loaded with anticancer drugs (prodigiosin (PG), and paclitaxel (PTX) control) and also the conjugated forms of the drug functionalized with LHRH (luteinizing hormone-releasing hormone) (PG-LHRH, and PTX- LHRH control), using a single-emulsion solvent evaporation technique. The encapsulation was done in the presence of PLGA-PCL (as a polymer matrix) and poly-(vinyl alcohol) (PVA) (as an emulsifier). Comparative study of the various drugs release kinetics and degradation mechanisms of the PLGA-PCL with an encapsulated drug is achieved, and the implication of this study is for the potential application of prodigiosin PLGA-PCL loaded microparticles for controlled delivery of cancer drug and treatment to prevent the regrowth or locoregional recurrence, following surgical resection of triple-negative breast tumor.

Keywords: cancer, polymers, drug kinetics, nanoparticles

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Authors: Usman Dutse, Eldah Ephraim Buba, Dalhatu Sa’idu

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The popularity of foreign football leagues are getting a soaring in Africa. Nigerian youths are following these leagues with high sense of dedication and devotion. The paper examines the factors behind the growing popularity of foreign football league in Nigeria and its socio economic implications on the country. Primary data were largely used for the study and collected through the use of questionnaire and interview. The data collected were analysed with the use of descriptive and qualitative methods of analysis. The findings made from the analysis indicates that the reasons why foreign league is popular in Nigeria is because the quality of national league in Nigeria is poor, the matches are not mostly televised, corruption/match fixing is common; for the above mentioned reasons national football league become uninteresting compared to foreign leagues. It was also confirmed that the overwhelming popularity of foreign league has the following social effects: friendship and acquaintance are created between supporters of the same club via social media and viewing centres, it has increased the knowledge and awareness of youth about the economics and politics of international sports. However, it has also brewed rivalry between supporters of clubs, drugs are sold in viewing centres and it sometimes serves as a meeting point for miscreants and criminals. Some of the economic effects were also identified as follows: small entrepreneurs establish commercial viewing centres and they employ other supporting staff to operate. On the strength of the above findings, the following were recommended: There is the urgent need to reform our national league to an acceptable standard; improve the quality of the team, the facilities and media coverage of the matches. This might make Nigerians to channel some of the love for foreign leagues to the local leagues.

Keywords: foreign, league, socioeconomic, implications

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Authors: Priscilla Akua Agyapong

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Background: In a country of nearly 34 million people, Ghana suffers from rapidly growing pediatric CHD cases and not enough pediatric specialists to attend to the burgeoning needs of these children. Most of the cases are either missed or diagnosed late, resulting in increased mortality. According to the National Cardiothoracic Centre, 1 in every 100,000 births in Ghana has CHD; however, there is limited data on the clinical presentation and its management, one of the many reasons I decided to do this case study coupled with the loss my 2 month old niece to multiple Ventricular Septal Defect 3 years ago due late diagnoses. Method: A retrospective cohort study was performed at the child health clinic of one of Ghana’s public tertiary Institutions using data from their electronic health record (EHR) from February 2021 to April 2022. All suspected or provisionally diagnosed cases were included in the analysis. Results: Records of over 3000 children were reviewed with an approximate male to female ratio of 1:1.53 cases diagnosed during the period of study, most of whom were less than 5 years of age. 25 cases had complete clinical records, with acyanotic septal defects being the most diagnosed. 62.5% of the cases were ventricular septal defects, followed by Patent Ductus Arteriosus (23%) and Atrial Septal Defects (4.5%). Tetralogy of Fallot was the most predominant and complex cyanotic CHD with 10%. Conclusion: The indeterminate coronary anatomy of infants makes it difficult to use only echocardiography and other conventional clinical methods in screening for CHDs. There are rising modernizations and new innovative ways that can be employed in Ghana for early detection, hence preventing the delay of a potential surgical repair. It is, therefore, imperative to create the needed awareness about these “SILENT CRISES” and help save the Ghanaian child’s life.

Keywords: congenital heart defect(CHD), ventricular septal defect(VSD), atrial septal defect(ASD), patent ductus arteriosus(PDA)

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Authors: Antonio Marco Miotti, Antonella Ruffatto, Giampaola Basso, Antonio Madia, Giulia Zavatta, Emanuela Salvatico, Emanuela Zilli

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A National Action Plan to fight antimicrobial resistance was launched in Italy in 2017. In order to reduce inappropriate exposure to antibiotics and infections from multi-drug resistant bacteria, it is essential to set up a structured system of surveillance and monitoring of the implementation of National Action Plan standards, including antimicrobial consumption, with a special focus on quinolones, third generation cephalosporins and carbapenems. A quantitative estimate of antibiotic consumption (defined daily dose - DDD - consumption per 100 days of hospitalization) has been provided by the Pharmaceutical Service to the Hospital of Cittadella, ULSS 6 Euganea – Health Trust (District of Padua) for the years 2019 (before the pandemic), 2020 and 2021 for all classes of antibiotics. Multidisciplinary meetings have been organized monthly by the local Antimicrobial Stewardship Group. Between 2019 and 2021, an increase in the consumption of carbapenems in the Intensive Care Unit (from 12.2 to 18.2 DDD, + 49.2%) and a decrease in Medical wards (from 5.3 to 2.6 DDD, - 50.9%) was reported; a decrease in the consumption of quinolones in Intensive Care Unit (from 17.2 to 10.8 DDD, - 37.2%), Medical wards (from 10.5 to 6.6 DDD, - 37.1%) and Surgical wards (from 10.2 to 9.3 DDD, - 8.8%) was highlighted; an increase in the consumption of third generation cephalosporins in Medical wards (from 18.1 to 22.6 DDD, + 24,1%) was reported. Finally, after an increase in the consumption of macrolides between 2020 and 2019, in 2021, a decrease was reported in the Intensive Care Unit (DDD: 8.0 in 2019, 18.0 in 2020, 6.4 in 2021) and Medical wards (DDD: 9.0 in 2019, 13.7 in 2020, 10.9 in 2021). Constant monitoring of antimicrobial consumption and timely identifying of warning situations that may need a specific intervention are the cornerstone of Antimicrobial Stewardship programs, together with analysing data on bacterial resistance rates and infections from multi-drug resistant bacteria.

Keywords: carbapenems, quinolones, antimicrobial, stewardship

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Authors: Bushra Jamil, Nudrat Baqri, Muhammad Hassan Saeed

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Entrepreneurship is creating or setting up a business not only for the purpose of generating profit but also for providing job opportunities. Entrepreneurs are problem solvers and product developers. They use their financial asset for hiring a professional team and combine the innovation, knowledge, and leadership leads to a successful startup or a business. To be a successful entrepreneur, one should be people-oriented and have perseverance. One must have the ability to take risk, believe in his/her potential, and have the courage to move forward in all circumstances. Most importantly, have the ability to take risk and can assess the risk. For STEM students, entrepreneurship is of specific importance and relevance as it helps them not just to be able to solve real life existing complications but to be able to recognize and identify emerging needs and glitches. It is becoming increasingly apparent that in today’s world, there is a need as well as a desire for STEM and entrepreneurship to work together. In Pakistan, entrepreneurship is slowly emerging, yet we are far behind. It is high time that we should introduce modern teaching methods and inculcate entrepreneurial initiative in students. A course on entrepreneurship can be included in the syllabus, and we must invite businessmen and policy makers to motivate young minds for entrepreneurship. This must be pitching competitions, opportunities to win seed funding, and facilities of incubation centers. In Pakistan, there are many good public sector research institutes, yet there is a void gap in the private sector. Only few research institute are meant for research and development. BJ Micro Lab is one of them. It is SECP registered company and is working in academia to promote and facilitate research in STEM. BJ Micro Lab is a women led initiative, and we are trying to promote research as a passion, not as an arduous burden. For this, we are continuously arranging training workshops and sessions. More than 100 students have been trained in ten different workshops arranged at BJ Micro Lab.

Keywords: entrepreneurship, STEM, challenges, oppurtunties

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Authors: Megat Zuhairy, Megat Tajuddin, Hadijah Iberahim, Noraini Ismail

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This paper aims to discuss the impact of external networking on innovation and organizational performance in the construction industry. In Malaysia, the construction industry is known to be one of the industries that contribute significantly towards her economic growth. The construction industry is described as a fragmented and complex product system as construction projects implementation requires involvement of varying combination of large and small organizations across the supply chain spectrum. The innovation and performance of Malaysian construction industry are reported to be at underachieving and efforts for its improvement have inspired this study initiative. External networking among industry players is capable in bringing them to work together as a team, reducing the adversarial relationships among them for innovation effort and greater performance. The instrument in measuring innovation and organizational performance specific to the construction industry was developed by adapting measures introduced by several scholars in these fields. Contractors and consulting companies were the sampling frames of this study representing the construction industry in Malaysia. The population lists were developed from the lists provided by CIDB, BEM, BOA and BQSM. The samples were selected based on a stratified sampling method to gauge representation of the different groups in the population. Regression analysis was performed in this quantitative study to assess relationships amongst variables. The results revealed that principally, external networking is significant in influencing both innovation and organizational performance. Nevertheless, external networking with different industry players has a different impact on innovation and organizational performance. The study revealed that external networking with project players is significant on project performance but not on innovation. On the other hand, external networking with government agencies, academic institutions and professional bodies is significant in influencing innovation but not on organizational performance.

Keywords: innovation, external networking, organizational performance, construction industry

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Authors: Aline Valverde Arroteia, Tatiana Gondim do Amaral, Silvio Burrattino Melhado

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During the last twenty years, the construction field in Brazil has evolved significantly in response to its market growing and competitiveness. However, this evolving path has faced many obstacles such as cultural barriers and the lack of efforts to achieve quality at the construction site. At the same time, the greatest amount of information generated on the designing or construction phases is lost due to the lack of an effective coordination of these activities. Face this problem, the aim of this research was to implement a French method named PEO which means preparation for building construction (in Portuguese) seeking to understand the design management process and its interface with the building construction phase. The research method applied was qualitative, and it was carried out through two case studies in the city of Goiania, in Goias, Brazil. The research was divided into two stages called pilot study at Company A and implementation of PEO at Company B. After the implementation; the results demonstrated the PEO method's effectiveness and feasibility while a booster on the quality improvement of design management. The analysis showed that the method has a purpose to improve the design and allow the reduction of failures, errors and rework commonly found in the production of buildings. Therefore, it can be concluded that the PEO is feasible to be applied to real estate and building companies. But, companies need to believe in the contribution they can make to the discovery of design failures in conjunction with other stakeholders forming a construction team. The result of PEO can be maximized when adopting the principles of simultaneous engineering and insertion of new computer technologies, which use a three-dimensional model of the building with BIM process.

Keywords: communication, design and construction interface management, preparation for building construction (PEO), proactive coordination (CPA)

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Authors: Nesengani Elelwani Clinton

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This paper presents reflective learning as an opportunity commonly available and used for food waste learning in a food processing company in the transition to sustainable and just food systems. In addressing how employees learn about food waste during food processing, the opportunities available for food waste learning were investigated. Reflective learning appeared to be the most used approach to learning about food waste. In the case of food waste learning, reflective learning was a response after employees wasted a substantial amount of food, where process controllers and team leaders would highlight the issue to employees who wasted food and explain how food waste could be reduced. This showed that learning about food waste is not proactive, and there continues to be a lack of structured learning around food waste. Several challenges were highlighted around reflective learning about food waste. Some of the challenges included understanding the language, lack of interest from employees, set times to reach production targets, and working pressures. These challenges were reported to be hindering factors in understanding food waste learning, which is not structured. A need was identified for proactive learning through structured methods. This is because it was discovered that in the plant, where food processing activities happen, the signage and posters that are there are directly related to other sustainability issues such as food safety and health. This indicated that there are low levels of awareness about food waste. Therefore, this paper argues that food waste learning should be proactive. The proactive learning approach should include structured learning materials around food waste during food processing. In the structuring of the learning materials, individual trainers should be multilingual. This will make it possible for those who do not understand English to understand in their own language. And lastly, there should be signage and posters in the food processing plant around food waste. This will bring more awareness around food waste, and employees' behaviour can be influenced by the posters and signage in the food processing plant. Thus, will enable a transition to a just and sustainable food system.

Keywords: sustainable and just food systems, food waste, food waste learning, reflective learning approach

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Authors: Fabiha Tanzeem

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BACKGROUND: Osteoporosis is a skeletal disease that is associated with a reduction in bone mass and microstructures of the bone and deterioration of bone tissue. Fragility fracture due to osteoporosis is the most significant complication of osteoporosis. The increasing prevalence of fragility fractures presents a growing burden on the global economy. There is a rapidly evolving need to improve awareness of the costs associated with these types of fractures and to review current policies and practices for the prevention and management of the disease. This systematic review will identify and describe the direct and indirect costs associated with osteoporotic fragility fractures from a global perspective from the included studies. The review will also find out whether the costs required for the treatment of fragility fractures due to osteoporosis impose an economic burden on the global healthcare system. METHODS: Four major databases were systematically searched for direct and indirect costs of osteoporotic fragility fracture studies in the English Language. PubMed, Cochrane Library, Embase and Google Scholar were searched for suitable articles published between 1990 and July 2020. RESULTS: The original search yielded 1166 papers; from these, 27 articles were selected for this review according to the inclusion and exclusion criteria. In the 27 studies, the highest direct costs were associated with the treatment of pelvic fractures, with the majority of the expenditure due to hospitalization and surgical treatments. It is also observed that most of the articles are from developed countries. CONCLUSION: This review indicates the significance of the economic burden of osteoporosis globally, although more research needs to be done in developing countries. In the treatment of fragility fractures, direct costs were the main reported expenditure in this review. The healthcare costs incurred globally can be significantly reduced by implementing measures to effectively prevent the disease. Raising awareness in children and adults by improving the quality of the information available and standardising policies and planning of services requires further research.

Keywords: systematic review, osteoporosis, cost of illness

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Authors: Rona Lee Suelo-Calanao, Mahmoud Loubani

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Objective: Sternal wound infection (SWI) following cardiac operation has a significant impact on patient morbidity and mortality. It also contributes to longer hospital stays and increased treatment costs. SWI management is mainly focused on treatment rather than prevention. This study looks at the effect of closed incision negative pressure therapy (ciNPT) dressing to help reduce the incidence of superficial SWI in high-risk patients after cardiac surgery. The ciNPT dressing was evaluated at 3 cardiac hospitals in the United Kingdom". Methods: All patients who had cardiac surgery from 2013 to 2021 were included in the study. The patients were classed as high risk if they have two or more of the recognised risk factors: obesity, age above 80 years old, diabetes, and chronic obstructive pulmonary disease. Patients receiving standard dressing (SD) and patients using ciNPT were propensity matched, and the Fisher’s exact test (two-tailed) and unpaired T-test were used to analyse categorical and continuous data, respectively. Results: There were 766 matched cases in each group. Total SWI incidences are lower in the ciNPT group compared to the SD group (43 (5.6%) vs 119 (15.5%), P=0.0001). There are fewer deep sternal wound infections (14(1.8%) vs. 31(4.04%), p=0.0149) and fewer superficial infections (29(3.7%) vs. 88 (11.4%), p=0.0001) in the ciNPT group compared to the SD group. However, the ciNPT group showed a longer average length of stay (11.23 ± 13 days versus 9.66 ± 10 days; p=0.0083) and higher mean logistic EuroSCORE (11.143 ± 13 versus 8.094 ± 11; p=0.0001). Conclusion: Utilization of ciNPT as an approach to help reduce the incidence of superficial and deep SWI may be effective in high-risk patients requiring cardiac surgery.

Keywords: closed incision negative pressure therapy, surgical wound infection, cardiac surgery complication, high risk cardiac patients

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Authors: Mohd Said Nurumal, Sarah Sheikh Abdul Karim

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Information regarding out of hospital cardiac arrest incidence include outcome in Malaysia is limited and fragmented. This study aims to identify incidence and adherence to protocol of out of hospital cardiac arrest and also to explore the issues faced by the pre-hospital personnel in regards managing cardiac arrest victim in Kuala Lumpur, Malaysia. A mixed method approach combining the qualitative and quantitative study design was used. The 285 pre-hospital care data sheet of out of hospital cardiac arrest during the year of 2011 were examined by using checklists for identify the incidence and adherence to protocol. Nine semi-structured interviews and two focus group discussions were performed. For the incidence based on the overall out of hospital cardiac arrest cases that occurred in 2011 (n=285), the survival rates were 16.8%. For adherence to protocol, only 89 (41.8%) of the cases adhered to the given protocol and 124 did not adhere to such protocol. The qualitative information provided insight about the issues related to out of hospital cardiac arrest in every aspect. All the relevant qualitative data were merged into few categories relating issues that could affect the management of out of hospital cardiac arrest performed by pre-hospital care team. One of the essential elements in the out of hospital cardiac arrest handling by pre-hospital care is to ensure increase of survival rates and excellent outcomes by adhering to given protocols based on international standard benchmarks. Measures are needed to strengthen the quick activation of the pre-hospital care service, prompt bystander cardiopulmonary resuscitation, early defibrillation and timely advanced cardiac life support and also to tackle all the issues highlighted in qualitative results.

Keywords: pre-hospital care, out of hospital cardiac arrest, incidence, protocol, mixed method research

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Authors: Anuj Kumar, Kummara M. Rao, Sung S. Han

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Bone tissue engineering has emerged as a potentially alternative method for localized bone defects or diseases, congenital deformation, and surgical reconstruction. The designing and the fabrication of the ideal scaffold is a great challenge, in restoring of the damaged bone tissues via cell attachment, proliferation, and differentiation under three-dimensional (3D) biological micro-/nano-environment. In this case, hydrogel system composed of high hydrophilic 3D polymeric-network that is able to mimic some of the functional physical and chemical properties of the extracellular matrix (ECM) and possibly may provide a suitable 3D micro-/nano-environment (i.e., resemblance of native bone tissues). Thus, this proposed hydrogel system is highly permeable and facilitates the transport of the nutrients and metabolites. However, the use of hydrogels in bone tissue engineering is limited because of their low mechanical properties (toughness and stiffness) that continue to posing challenges in designing and fabrication of tough and stiff hydrogels along with improved bioactive properties. For this purpose, in our lab, polyacrylamide-based hybrid hydrogels were synthesized by involving sodium alginate, cellulose nanocrystals and silica-based glass using one-step free-radical polymerization. The results showed good in vitro apatite-forming ability (biomineralization) and improved mechanical properties (under compression in the form of strength and stiffness in both wet and dry conditions), and in vitro osteoblastic (MC3T3-E1 cells) cytocompatibility. For in vitro cytocompatibility assessment, both qualitative (attachment and spreading of cells using FESEM) and quantitative (cell viability and proliferation using MTT assay) analyses were performed. The obtained hybrid hydrogels may potentially be used in bone tissue engineering applications after establishment of in vivo characterization.

Keywords: bone tissue engineering, cellulose nanocrystals, hydrogels, polyacrylamide, sodium alginate

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Authors: V. Santamarina Campos, M. de Miguel Molina, B. de Miguel Molina, M. Á. Carabal Montagud

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With this contribution, we want to show a successful example of the application of the Design Thinking methodology, in the European project 'Technology transfer of Remotely Piloted Aircraft Systems (RPAS) for the creative industry'. The use of this methodology has allowed us to design and build a drone, based on the real needs of prospective users. It has demonstrated that this is a powerful tool for generating innovative ideas in the field of robotics, by focusing its effectiveness on understanding and solving real user needs. In this way, with the support of an interdisciplinary team, comprised of creatives, engineers and economists, together with the collaboration of prospective users from three European countries, a non-linear work dynamic has been created. This teamwork has generated a sense of appreciation towards the creative industries, through continuously adaptive, inventive, and playful collaboration and communication, which has facilitated the development of prototypes. These have been designed to enable filming and photography in interior spaces, within 13 sectors of European creative industries: Advertising, Architecture, Fashion, Film, Antiques and Museums, Music, Photography, Televison, Performing Arts, Publishing, Arts and Crafts, Design and Software. Furthermore, it has married the real needs of the creative industries, with what is technologically and commercially viable. As a result, a product of great value has been obtained, which offers new business opportunities for small companies across this sector.

Keywords: design thinking, design for effectiveness, methodology, active toolkit, storyboards, PAR, focus group, innovation, RPAS, indoor drone, aerial film, creative industry, end users, stakeholder

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Authors: Julie M. Novak, Simone K. Brennan, Lacey Brim

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Undergraduate medical education (UME) curriculum notably addresses micro-level communications (e.g., patient-provider, intercultural, inter-professional), yet frequently under-examines the role and impact of organizational communication, a more macro-level. Organizational communication, however, functions as foundation and through systemic structures of an organization and thereby serves as hidden curriculum and influences learning experiences and outcomes. Yet, little available research exists fully examining how students experience organizational communication while in medical school. Extant literature and best practices provide insufficient guidance for UME programs, in particular. The purpose of this study was to map and examine current organizational communication systems and processes in a UME program. Employing a phenomenology-grounded and participatory approach, this study sought to understand the organizational communication system from medical students' perspective. The research team consisted of a core team and 13 medical student co-investigators. This research employed multiple methods, including focus groups, individual interviews, and two surveys (one reflective of focus group questions, the other requesting students to submit ‘examples’ of communications). To provide context for student responses, nonstudent participants (faculty, administrators, and staff) were sampled, as they too express concerns about communication. Over 400 students across all cohorts and 17 nonstudents participated. Data were iteratively analyzed and checked for triangulation. Findings reveal the complex nature of organizational communication and student-oriented communications. They reveal program-impactful strengths, weaknesses, gaps, and tensions and speak to the role of organizational communication practices influencing both climate and culture. With regard to communications, students receive multiple, simultaneous communications from multiple sources/channels, both formal (e.g., official email) and informal (e.g., social media). Students identified organizational strengths including the desire to improve student voice, and message frequency. They also identified weaknesses related to over-reliance on emails, numerous platforms with inconsistent utilization, incorrect information, insufficient transparency, assessment/input fatigue, tacit expectations, scheduling/deadlines, responsiveness, and mental health confidentiality concerns. Moreover, they noted gaps related to lack of coordination/organization, ambiguous point-persons, student ‘voice-only’, open communication loops, lack of core centralization and consistency, and mental health bridges. Findings also revealed organizational identity and cultural characteristics as impactful on the medical school experience. Cultural characteristics included program size, diversity, urban setting, student organizations, community-engagement, crisis framing, learning for exams, inefficient bureaucracy, and professionalism. Moreover, they identified system structures that do not always leverage cultural strengths or reduce cultural problematics. Based on the results, opportunities for productive change are identified. These include leadership visibly supporting and enacting overall organizational narratives, making greater efforts in consistently ‘closing the loop’, regularly sharing how student input effects change, employing strategies of crisis communication more often, strengthening communication infrastructure, ensuring structures facilitate effective operations and change efforts, and highlighting change efforts in informational communication. Organizational communication and communications are not soft-skills, or of secondary concern within organizations, rather they are foundational in nature and serve to educate/inform all stakeholders. As primary stakeholders, students and their success directly affect the accomplishment of organizational goals. This study demonstrates how inquiries about how students navigate their educational experience extends research-based knowledge and provides actionable knowledge for the improvement of organizational operations in UME.

Keywords: medical education programs, organizational communication, participatory research, qualitative mixed methods

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Authors: Ejeh Benjamin Ijuo

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The purpose of this study was to investigate the influence of social, economic, political, and legal environment of sport organizations on sport development in zone ten (10) national zonal sport offices in Nigeria (Plateau, Nasarawa, Benue and F.C.T Abuja). To achieve this purpose, a structured 26 item questionnaire (ISEPLESOQ) designed by the researcher was used for this study. Related literature to this study was reviewed. 311 copies of questionnaire were administered to randomly selected respondents. Out of this number, 306 was dully completed and returned representing 98.4%. The respondents included: Athletes, games masters/ mistresses, coaches in state sport councils, zonal sport coordinators, team managers, directors of state sports council. Four research questions were answered using the mean and standard deviation, while the inferential statistics of chi-square(x2) test of goodness of fit was used to test the four hypotheses at 0.05 alpha levels. The findings of this study revealed that the social, economic, political and legal environment of sport organizations significantly influenced sport development in zone ten (10) national zonal sport offices in Nigeria. It was also established that the general environment of sport organizations influences people’s participation in sport, funding and sponsorship of sports, sitting of equipment and facilities at different locations, selection of athletes. It was therefore, recommended among other things that government should privatize and commercialized sport programmes to enable corporate organizations and individuals participation. Lt was further suggested that the federal government should harness her social, economic, political and legal environment to improve sport development in Nigeria.

Keywords: sport organization, sport development, sport environment, zonal sport offices

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Authors: Laila Niklasson

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The aim of the study is to critically discuss how partner schools are engaged during Initial teacher education, ITE. The background is an experiment in Sweden where the practicum organization is reorganized due to a need to enhance quality during practicum. It is a national initiative from the government, supported by the National Agency of Education and lasts 2014-2019. The main features are concentration of students to school with a certain amount of mentors, mentors who have a mentor education and teachers with relevant subject areas and where there could be a mentor team with a leader at the school. An expected outcome is for example that the student teachers should be engaged in peer-learning. The schools should be supported by extra lectures from university teachers during practicum and also extra research projects where the schools should be engaged. A case study of one university based ITE was carried out to explore the consequences for the schools not selected. The result showed that from engaging x schools in a region, x was engaged. The schools are both in urban and rural areas, mainly in the latter. There is also a tendency that private schools are not engaged. On a unit level recruitment is perceived as harder for schools not engaged. In addition they cannot market themselves as ´selected school´ which can affect parent´s selection of school for their children. Also, on unit level, but with consequences for professional development, they are not selected for research project and thereby are not fully supported during school development. The conclusion is that from an earlier inclusive approach concerning professions where all teachers were perceived as possible mentors, there is a change to an exclusive approach where selected schools and selected teachers should be engaged. The change could be perceived as a change in governance mentality, but also in how professions are perceived, and development work is pursued.

Keywords: initial teacher education, practicum schools, profession, quality development

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Authors: Komal Fizza

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Irrational and non-judicious use of antibiotics pave the way for an upsurge in antibiotic resistance, diminished effectiveness of different therapeutic regimens and as well as impounding effect on disease management leading to further morbidities. In the backdrop of this the current research is aimed to assess whether antimicrobial prescribing is in accordance with the Infectious Disease Society of America Guidelines in hospitalized patients at Shifa International Hospital, Islamabad, Pakistan. Shifa International Hospital, Islamabad is a 500 bed hospital. With the help of MIS team a form wad developed that gave the information about medical records number, name of the patient, day of start of antibiotic, the day antibiotic is supposed to be stopped and as well as the diagnosis of the patient. A ward pharmacist was employed to generate this report on a daily basis. The therapeutic regiment was reviewed by the pharmacist by monitoring the clinical progress, laboratory report and diagnosis. On the basis of this information, pharmacist made suggestions and forwarded to the hospital doctors responsible for prescribing antibiotics. If desired, changes were made regularly. In the current research our main focus was to implement this action and therefore, started monitoring patients who were on antibiotic regimens for more than 10-15 days. We took this initiative since November, 2013. At the start of the program a maximum 19 patients/day were reported to be on antibiotic regimen for more than 10-15 days. After the implementation of the initiative, the number of patients was decreased to fifteen patients per day in December, further decreased to 7 in the month of January and 9 and 6 in February and March respectively. The average patient census was 350. The current pilot study highlighted the role of pharmacist in initiating antibiotic stewardship programs in hospital settings.

Keywords: stewardship, antibiotics, resistance, clinical process

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