Search results for: Darmawan Salman

Authors: Salman Imran, Chris Healey

Abstract:

Traditionally, medical care of children in England and Wales starts from primary care with a referral to secondary care paediatricians who may not investigate further. Many primary care doctors do not undergo a paediatric rotation/exposure in training. As a result, there are many who have not acquired the necessary skills to manage children hence increasing hospital referral. With the current demand on hospitals in the National Health Service managing more problems in the community is needed. One way of handling this is to set up clinics, meetings and huddles in GP surgeries where professionals involved (general practitioner, paediatrician, health visitor, community nurse, dietician, school nurse) come together and share information which can help improve communication and care. The increased awareness and education that paediatricians can impart in this way will help boost confidence for primary care professionals to be able to be more self-sufficient. This has been tried successfully in other regions e.g., St. Mary’s Hospital in London but is crucial for a more rural setting like ours. The primary aim of this project would be to educate specifically GP’s and generally all other health professionals involved. Additional benefits would be providing care nearer home, increasing patient’s confidence in their local surgery, improving communication and reducing unnecessary patient flow to already stretched hospital resources. Methods: This was done as a plan do study act cycle (PDSA). Three clinics were delivered in different practices over six months where feedback from staff and patients was collected. Designated time for teaching/discussion was used which involved some cases from the actual clinics. Both new and follow up patients were included. Two clinics were conducted by a paediatrician and nurse whilst the 3rd involved paediatrician and local doctor. The distance from hospital to clinics varied from two miles to 22 miles approximately. All equipment used was provided by primary care. Results: A total of 30 patients were seen. All patients found the location convenient as it was nearer than the hospital. 70-90% clearly understood the reason for a change in venue. 95% agreed to the importance of their local doctor being involved in their care. 20% needed to be seen in the hospital for further investigations. Patients felt this to be a more personalised, in-depth, friendly and polite experience. Local physicians felt this to be a more relaxed, familiar and local experience for their patients and they managed to get immediate feedback regarding their own clinical management. 90% felt they gained important learning from the discussion time and the paediatrician also learned about their understanding and gaps in knowledge/focus areas. 80% felt this time was valuable for targeted learning. Equipment, information technology, and office space could be improved for the smooth running of any future clinics. Conclusion: The acute paediatric outpatient clinic can be successfully established in primary care facilities. Careful patient selection and adequate facilities are important. We have demonstrated a further step in the reduction of patient flow to hospitals and upskilling primary care health professionals. This service is expected to become more efficient with experience.

Keywords: clinics, education, paediatricians, primary care

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Authors: Sibawu Witness Siyepu

Abstract:

This study explores the effects of instructional design using blended learning in the learning of radian measures among Engineering students. Blended learning is an education programme that combines online digital media with traditional classroom methods. It requires the physical presence of both lecturer and student in a mathematics computer laboratory. Blended learning provides element of class control over time, place, path or pace. The focus was on the use of Khan Academy to supplement traditional classroom interactions. Khan Academy is a non-profit educational organisation created by educator Salman Khan with a goal of creating an accessible place for students to learn through watching videos in a computer assisted computer. The researcher who is an also lecturer in mathematics support programme collected data through instructing students to watch Khan Academy videos on radian measures, and by supplying students with traditional classroom activities. Classroom activities entails radian measure activities extracted from the Internet. Students were given an opportunity to engage in class discussions, social interactions and collaborations. These activities necessitated students to write formative assessments tests. The purpose of formative assessments tests was to find out about the students’ understanding of radian measures, including errors and misconceptions they displayed in their calculations. Identification of errors and misconceptions serve as pointers of students’ weaknesses and strengths in their learning of radian measures. At the end of data collection, semi-structure interviews were administered to a purposefully sampled group to explore their perceptions and feedback regarding the use of blended learning approach in teaching and learning of radian measures. The study employed Algebraic Insight Framework to analyse data collected. Algebraic Insight Framework is a subset of symbol sense which allows a student to correctly enter expressions into a computer assisted systems efficiently. This study offers students opportunities to enter topics and subtopics on radian measures into a computer through the lens of Khan Academy. Khan academy demonstrates procedures followed to reach solutions of mathematical problems. The researcher performed the task of explaining mathematical concepts and facilitated the process of reinvention of rules and formulae in the learning of radian measures. Lastly, activities that reinforce students’ understanding of radian were distributed. Results showed that this study enthused the students in their learning of radian measures. Learning through videos prompted the students to ask questions which brought about clarity and sense making to the classroom discussions. Data revealed that sense making through reinvention of rules and formulae assisted the students in enhancing their learning of radian measures. This study recommends the use of Khan Academy in blended learning to be introduced as a socialisation programme to all first year students. This will prepare students that are computer illiterate to become conversant with the use of Khan Academy as a powerful tool in the learning of mathematics. Khan Academy is a key technological tool that is pivotal for the development of students’ autonomy in the learning of mathematics and that promotes collaboration with lecturers and peers.

Keywords: algebraic insight framework, blended learning, Khan Academy, radian measures

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Authors: Omair Anas

Abstract:

The Persian Gulf has been in turmoil for a long time since the colonial administration has handed over the role to the small and weak kings and emirs who were assured of protection in return of many economic and security promises to them. The regional order, Saudi Arabia evolved was a rentier regional order secured by an expansion of rentier economy and taking responsibility for much of the expenses of the regional order on behalf of relatively poor countries. The two oil booms helped the Saudi state to expand the 'rentier order' driven stability and bring the countries like Egypt, Jordan, Syria, and Palestine under its tutelage. The disruptive misadventure, however, came with Iran's proclamation of the Islamic Revolution in 1979 which it wanted to be exported to its 'un-Islamic and American puppet' Arab neighbours. For Saudi Arabia, even the challenge presented by the socialist-nationalist Arab dictators like Gamal Abdul Nasser and Hafez Al-Assad was not that much threatening to the Saudi Arabia’s then-defensive realism. In the Arab uprisings, the Gulf monarchies saw a wave of insecurity and Iran found it an opportune time to complete the revolutionary process it could not complete after 1979. An alliance of convenience and ideology between Iran and Islamist groups had the real potential to challenge both Saudi Arabia’s own security and its leadership in the region. The disruptive threat appeared at a time when the Saudi state had already sensed an impending crisis originating from the shifts in the energy markets. Low energy prices, declining global demands, and huge investments in alternative energy resources required Saudi Arabia to rationalize its economy according to changing the global political economy. The domestic Saudi reforms remained gradual until the death of King Abdullah in 2015. What is happening now in the region, the Qatar crisis, the Lebanon crisis and the Saudi-Iranian proxy war in Iraq, Syria, and Yemen has combined three immediate objectives, rationalising Saudi economy and most importantly, the resetting the Saudi royal power for Saudi Arabia’s longest-serving future King Mohammad bin Salman. The Saudi King perhaps has no time to wait and watch the power vacuum appearing because of Iran’s expansionist foreign policy. The Saudis appear to be employing an offensive realism by advancing a pro-active regional policy to counter Iran’s threatening influence amid disappearing Western security from the region. As the Syrian civil war is coming to a compromised end with ceding much ground to Iran-controlled militias, Hezbollah and Al-Hashad, the Saudi state has lost much ground in these years and the threat from Iranian proxies is more than a reality, more clearly in Bahrain, Iraq, Syria, and Yemen. This paper attempts to analyse the changing Saudi behaviour in the region, which, the author understands, is shaped by an offensive-realist approach towards finding a favourable security environment for the Saudi-led regional order, a post-rentier order perhaps.

Keywords: terrorism, Saudi Arabia, Rentier State, gulf crisis

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Authors: Khlood F. Salman, Richard Zoucha, Hani Nawafleh

Abstract:

Introduction: Jordan ranks the fourth highest breast cancer prevalence after Lebanon, Bahrain, and Kuwait. Considerable evidence showed that cultural, ethnic, and economic differences influence a woman’s practice to early detection and prevention of breast cancer. Objectives: To understand women’s health beliefs and values in relation to early detection of breast cancer; and to explore the impact of these beliefs on their decisions regarding reluctance or acceptance of early detection measures such as mammogram screening. Design: A qualitative focused ethnography was used to collect data for this study. Settings: The study was conducted in the second largest city surrounded by a large rural area in Ma’an- Jordan. Participants: A total of twenty seven women, with no history of breast cancer, between the ages of 18 and older, who had prior health experience with health providers, and were willing to share elements of personal health beliefs related to breast health within the larger cultural context. The participants were recruited using the snowball method and words of mouth. Data collection and analysis: A short questionnaire was designed to collect data related to socio demographic status (SDQ) from all participants. A Semi-structured interviews guide was used to elicit data through interviews with the informants. Nvivo10 a data manager was utilized to assist with data analysis. Leininger’s four phases of qualitative data analysis was used as a guide for the data analysis. The phases used to analyze the data included: 1) Collecting and documenting raw data, 2) Identifying of descriptors and categories according to the domains of inquiry and research questions. Emic and etic data is coded for similarities and differences, 3) Identifying patterns and contextual analysis, discover saturation of ideas and recurrent patterns, and 4) Identifying themes and theoretical formulations and recommendations. Findings: Three major themes were emerged within the cultural and religious context; 1. Fear, denial, embarrassment and lack of knowledge were common perceptions of Ma’anis’ women regarding breast health and screening mammography, 2. Health care professionals in Jordan were not quick to offer information and education about breast cancer and screening, and 3. Willingness to learn about breast health and cancer prevention. Conclusion: The study indicated the disparities between the infrastructure and resourcing in rural and urban areas of Jordan, knowledge deficit related to breast cancer, and lack of education about breast health may impact women’s decision to go for a mammogram screening. Cultural beliefs, fear, embarrassments as well as providers lack of focus on breast health were significant contributors against practicing breast health. Health providers and policy makers should provide resources for the establishment health education programs regarding breast cancer early detection and mammography screening. Nurses should play a major role in delivering health education about breast health in general and breast cancer in particular. A culturally appropriate health awareness messages can be used in creating educational programs which can be employed at the national levels.

Keywords: breast health, beliefs, cultural context, ethnography, mammogram screening

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Authors: Roshanak Afrakhteh, Abdolrasoul Salman Mahini, Mahdi Motagh, Hamidreza Kamyab

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Urban Heat Islands (UHIs) are distinctive urban areas characterized by densely populated central cores surrounded by less densely populated peripheral lands. These areas experience elevated temperatures, primarily due to impermeable surfaces and specific land use patterns. The consequences of these temperature variations are far-reaching, impacting the environment and society negatively, leading to increased energy consumption, air pollution, and public health concerns. This paper emphasizes the need for simplified approaches to comprehend UHI temperature dynamics and explains how urban development patterns contribute to land surface temperature variation. To illustrate this relationship, the study focuses on the Guilan Plain, utilizing techniques like principal component analysis and generalized additive models. The research centered on mapping land use and land surface temperature in the low-lying area of Guilan province. Satellite data from Landsat sensors for three different time periods (2002, 2012, and 2021) were employed. Using eCognition software, a spatial unit known as a "city block" was utilized through object-based analysis. The study also applied the normalized difference vegetation index (NDVI) method to estimate land surface radiance. Predictive variables for urban land surface temperature within residential city blocks were identified categorized as intrinsic (related to the block's structure) and neighboring (related to adjacent blocks) variables. Principal Component Analysis (PCA) was used to select significant variables, and a Generalized Additive Model (GAM) approach, implemented using R's mgcv package, modeled the relationship between urban land surface temperature and predictor variables.Notable findings included variations in urban temperature across different years attributed to environmental and climatic factors. Block size, shared boundary, mother polygon area, and perimeter-to-area ratio were identified as main variables for the generalized additive regression model. This model showed non-linear relationships, with block size, shared boundary, and mother polygon area positively correlated with temperature, while the perimeter-to-area ratio displayed a negative trend. The discussion highlights the challenges of predicting urban surface temperature and the significance of block size in determining urban temperature patterns. It also underscores the importance of spatial configuration and unit structure in shaping urban temperature patterns. In conclusion, this study contributes to the growing body of research on the connection between land use patterns and urban surface temperature. Block size, along with block dispersion and aggregation, emerged as key factors influencing urban surface temperature in residential areas. The proposed methodology enhances our understanding of parameter significance in shaping urban temperature patterns across various regions, particularly in Iran.

Keywords: urban heat island, land surface temperature, LST modeling, GAM, Gilan province

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Authors: Swati Gautam, Salman Akhtar, S. P. Jaiswar, Amita Jain

Abstract:

Background: FGTB is now a major global health problem mostly in developing countries including India. In humans, Mycobacterium Tuberculosis (M.tb) is a causating agent of infection. High index of suspicion is required for early diagnosis due to asymptomatic presentation of FGTB disease. In macrophages Toll Like Receptor-2 (TLR-2) is one which mediated host’s immune response to M.tb. The expression of TLR-2 on macrophages is important to determine the fate of innate immune responses to M.tb. TLR-2 have two work. First its high expression on macrophages worsen the outer of infection and another side, it maintains M.tb to its dormant stage avoids activation of M.tb from latent phase. Single Nucleotide Polymorphism (SNP) of TLR-2 gene plays an important role in susceptibility to TB among different populations and subsequently, in the development of infertility. Methodology: This Case-Control study was done in the Department of Obs and Gynae and Department of Microbiology at King George’s Medical University, U.P, Lucknow, India. Total 300 subjects (150 Cases and 150 Controls) were enrolled in the study. All subjects were enrolled only after fulfilling the given inclusion and exclusion criteria. Inclusion criteria: Age 20-35 years, menstrual-irregularities, positive on Acid-Fast Bacilli (AFB), TB-PCR, (LJ/MGIT) culture in Endometrial Aspiration (EA). Exclusion criteria: Koch’s active, on ATT, PCOS, and Endometriosis fibroid women, positive on Gonococal and Chlamydia. Blood samples were collected in EDTA tubes from cases and healthy control women (HCW) and genomic DNA extraction was carried out by salting-out method. Genotyping of TLR2 genetic variants (Arg753Gln and Arg677Trp) were performed by using single amplification refractory mutation system (ARMS) PCR technique. PCR products were analyzed by electrophoresis on 1.2% agarose gel and visualized by gel-doc. Statistical analysis of the data was performed using the SPSS 16.3 software and computing odds ratio (OR) with 95% CI. Linkage Disequiliribium (LD) analysis was done by SNP stats online software. Results: In TLR-2 (Arg753Gln) polymorphism significant risk of FGTB observed with GG homozygous mutant genotype (OR=13, CI=0.71-237.7, p=0.05), AG heterozygous mutant genotype (OR=13.7, CI=0.76-248.06, p=0.03) however, G allele (OR=1.09, CI=0.78-1.52, p=0.67) individually was not associated with FGTB. In TLR-2 (Arg677Trp) polymorphism a significant risk of FGTB observed with TT homozygous mutant genotype (OR= 0.020, CI=0.001-0.341, p < 0.001), CT heterozygous mutant genotype (OR=0.53, CI=0.33-0.86, p=0.014) and T allele (OR=0.463, CI=0.32-0.66, p < 0.001). TT mutant genotype was only found in FGTB cases and frequency of CT heterozygous more in control group as compared to FGTB group. So, CT genotype worked as protective mutation for FGTB susceptibility group. In haplotype analysis of TLR-2 genetic variants, four possible combinations, i.e. (G-T, A-C, G-C, and A-T) were obtained. The frequency of haplotype A-C was significantly higher in FGTB cases (0.32). Control group did not show A-C haplotype and only found in FGTB cases. Conclusion: In conclusion, study showed a significant association with both genetic variants of TLR-2 of FGTB disease. Moreover, the presence of specific associated genotype/alleles suggest the possibility of disease severity and clinical approach aimed to prevent extensive damage by disease and also helpful for early detection of disease.

Keywords: ARMS, EDTA, FGTB, TLR

Procedia PDF Downloads 306