Search results for: obstetric outcome

Authors: Harper Staples

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A necessary outcome of today’s contemporary globalised reality, current views of multilingualism hold that it no longer represents the exception, but rather the rule. As such, the simultaneous acquisition of multiple languages represents a common experience for many of today's students and therefore represents a key area of inquiry in the domain of foreign language learner identity. Second and multilingual language acquisition processes parallel each other in many ways; however, there are differences to be found in the ways in which a student may learn a third language. A multilingual repertoire will have to negotiate complex change as language competencies dynamically evolve; moreover, this process will vary according to the contextual factors attributed to a unique learner. A developing multilingual identity must, therefore, contend with an array of potential challenges specific to the individual in question. Despite an overarching recognition in the literature that pluri-language acquisition represents a unique field of inquiry within applied linguistic research, there is a paucity of empirical work which examines the ways in which individuals construct a sense of their own identity as multilingual speakers in such contexts of learning. This study explores this phenomenon via a mixed-methods, comparative case study approach at four school sites based in Finland, France, Wales, and England. It takes a strongly individual-in-context view, conceptualising each adolescent participant in dynamic terms in order to undertake a holistic exploration of the myriad factors that might impact upon, and indeed be impacted by, a learner's developing multilingual identity. Emerging themes of note thus far suggest that, beyond the expected divergences in the experience of multilinguality at the individual level, there are contradictions in the way in which adolescent students in each site 'claim' their plurilingualism. This can be argued to be linked to both meso and macro-level factors, including the foreign language curriculum and, more broadly, societal attitudes towards multilingualism. These diverse emergent identifications have implications not only for attainment in the foreign language but also for student well-being more generally.

Keywords: foreign language learning, student identity, multilingualism, educational psychology

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Authors: Mário Silva, Filipa Gomes, Filipa Oliveira, Simone Morais, Cristina Delerue-Matos

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Brown seaweeds are abundant in Portuguese coastline and represent an almost unexploited marine economic resource. One of the most common species, easily available for harvesting in the northwest coast, is Saccorhiza polyschides grows in the lowest shore and costal rocky reefs. It is almost exclusively used by local farmers as natural fertilizer, but contains a substantial amount of valuable compounds, particularly alginates, natural biopolymers of high interest for many industrial applications. Alginates are natural polysaccharides present in cell walls of brown seaweed, highly biocompatible, with particular properties that make them of high interest for the food, biotechnology, cosmetics and pharmaceutical industries. Conventional extraction processes are based on thermal treatment. They are lengthy and consume high amounts of energy and solvents. In recent years, microwave-assisted extraction (MAE) has shown enormous potential to overcome major drawbacks that outcome from conventional plant material extraction (thermal and/or solvent based) techniques, being also successfully applied to the extraction of agar, fucoidans and alginates. In the present study, acid pretreatment of brown seaweed Saccorhiza polyschides for subsequent microwave-assisted extraction (MAE) of alginate was optimized. Seaweeds were collected in Northwest Portuguese coastal waters of the Atlantic Ocean between May and August, 2014. Experimental design was used to assess the effect of temperature and acid pretreatment time in alginate extraction. Response surface methodology allowed the determination of the optimum MAE conditions: 40 mL of HCl 0.1 M per g of dried seaweed with constant stirring at 20ºC during 14h. Optimal acid pretreatment conditions have enhanced significantly MAE of alginates from Saccorhiza polyschides, thus contributing for the development of a viable, more environmental friendly alternative to conventional processes.

Keywords: acid pretreatment, alginate, brown seaweed, microwave-assisted extraction, response surface methodology

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Authors: Emma Roberts

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The Rome II Regulation has established a uniform regime of conflict of law rules across the European Union (except for Denmark) which determines the law applicable in non-contractual obligations disputes. It marks a significant development towards the Europeanization of private international law and aims to provide the most appropriate connecting factors to achieve both legal certainty and justice in individual cases. Many non-contractual obligations are recognised to present such distinct factors that, to achieve these aims, a special rule is provided for determining the applicable law in cases in respect of product liability and environmental torts, for example. Throughout the legislative process, the European Parliament sought to establish a separate rule for road traffic accidents, recognising that these cases too present such novel situations that a blanket application of a lex loci damni approach would not provide an appropriate answer. Such attempts were rejected and, as a result, cases arising out of road traffic accidents are subject to the Regulation’s general lex loci damni rule along with its escape clause and limited exception. This paper offers a critique of the Regulation’s response to cross-border road traffic accident cases. In England and Wales, there have been few cases that have applied the Regulation’s provisions to date, but significantly the majority of such cases are in respect of road traffic accidents. This paper examines the decisions in those cases and challenges the legislators’ decision not to provide a special rule for such incidences. Owing to the diversity in compensation systems globally, applying the Regulation’s general rule to cases of road traffic accidents – given the breadth of matters that are to be subject to the lex cause – cannot ensure an outcome that provides ‘justice in individual cases’ as is assured by the Regulation's recitals. Not only does this paper suggest that the absence of a special rule for road traffic accidents means that the Regulation fails to achieve one of its principal aims, but it further makes out a compelling case for the legislative body of the European Union to implement a corrective instrument.

Keywords: accidents abroad, applicable law, cross-border torts, non-contractual obligations, road traffic accidents

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Authors: Naim Izet Kajtazi

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Context: The third ventricle colloid cyst (CC) is a benign growth usually located in the third ventricle and can cause various neurological symptoms, including sudden death. Modern surgical interventions may still result in a wide range of complications and cerebral venous thrombosis (CVT) is among them. Process: A 38-year-old female with an existing diagnosis of diabetes mellitus (DM) and hypothyroidism and a six-month history of headaches, blurred vision, and vomiting presented to our clinic three days after the headaches became excessively severe. Neurological examination on admission revealed bilateral papilledema without any associated focal neurological deficits. Brain computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of a third ventricle colloid cyst and associated non-communicating hydrocephalus involving the lateral ventricles. As a result, the patient underwent emergency bilateral external ventricular drainage (EVD) insertion followed by a third ventricular CC excision under neuronavigation through a right frontal craniotomy. Twelve days post-operatively, the patient developed further headaches, followed by a generalized tonic-clonic seizure that led to no postictal neurological deficits. Nonetheless, computed tomography venography of the brain revealed extensive thrombosis of the superior sagittal sinus, inferior sagittal sinus, right sigmoid sinus, and right internal jugular vein. A newly diagnosed CVT was treated with intravenous heparin. The patient was discharged with warfarin, which was discontinued after 12 months. Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from mild chronic headaches. Outcome: Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from mild chronic headaches. Relevance: A preoperative venous study should be performed in all cases to gain a better understanding of the venous anatomy. We advocate meticulous microsurgical techniques to protect the venous system surrounding the foramen of Monro and reduce the amount of retraction during surgery.

Keywords: CVT, seizures, third ventricle colloid cyst, MRI of brain

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Authors: Nicolas M. Beleski, Gustavo A. G. Lugo

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Robotic agents are taking more and increasingly important roles in society. In order to make these robots and agents more autonomous and efficient, their systems have grown to be considerably complex and convoluted. This growth in complexity has led recent researchers to investigate forms to explain the AI behavior behind these systems in search for more trustworthy interactions. A current problem in explainable AI is the inner workings with the logic inference process and how to conduct a sensibility analysis of the process of valuation and alteration of beliefs. In a social HRI (human-robot interaction) setup, theory of mind is crucial to ease the intentionality gap and to achieve that we should be able to infer over observed human behaviors, such as cases of cognitive dissonance. One specific case inspired in human cognition is the role emotions play on our belief system and the effects caused when observed behavior does not match the expected outcome. In such scenarios emotions can make a person wrongly assume the antecedent P for an observed consequent Q, and as a result, incorrectly assert that P is true. This form of cognitive dissonance where an unproven cause is taken as truth induces changes in the belief base which can directly affect future decisions and actions. If we aim to be inspired by human thoughts in order to apply levels of theory of mind to these artificial agents, we must find the conditions to replicate these observable cognitive mechanisms. To achieve this, a computational architecture is proposed to model the modulation effect emotions have on the belief system and how it affects logic inference process and consequently the decision making of an agent. To validate the model, an experiment based on the prisoner's dilemma is currently under development. The hypothesis to be tested involves two main points: how emotions, modeled as internal argument strength modulators, can alter inference outcomes, and how can explainable outcomes be produced under specific forms of cognitive dissonance.

Keywords: cognitive architecture, cognitive dissonance, explainable ai, sensitivity analysis, theory of mind

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Authors: A. H. Nanher, N. P. Singh, Shashidhar Yadav, Sachin Tyagi

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Agricultural production system is an outcome of a complex interaction of seed, soil, water and agro-chemicals (including fertilizers). Therefore, judicious management of all the inputs is essential for the sustainability of such a complex system. Precision agriculture gives farmers the ability to use crop inputs more effectively including fertilizers, pesticides, tillage and irrigation water. More effective use of inputs means greater crop yield and/or quality, without polluting the environment the focus on enhancing the productivity during the Green Revolution coupled with total disregard of proper management of inputs and without considering the ecological impacts, has resulted into environmental degradation. To evaluate a new approach for site-specific nutrient management (SSNM). Large variation in initial soil fertility characteristics and indigenous supply of N, P, and K was observed among Field- and season-specific NPK applications were calculated by accounting for the indigenous nutrient supply, yield targets, and nutrient demand as a function of the interactions between N, P, and K. Nitrogen applications were fine-tuned based on season-specific rules and field-specific monitoring of crop N status. The performance of SSNM did not differ significantly between high-yielding and low-yielding climatic seasons, but improved over time with larger benefits observed in the second year Future, strategies for nutrient management in intensive rice systems must become more site-specific and dynamic to manage spatially and temporally variable resources based on a quantitative understanding of the congruence between nutrient supply and crop demand. The SSNM concept has demonstrated promising agronomic and economic potential. It can be used for managing plant nutrients at any scale, i.e., ranging from a general recommendation for homogenous management of a larger domain to true management of between-field variability. Assessment of pest profiles in FFP and SSNM plots suggests that SSNM may also reduce pest incidence, particularly diseases that are often associated with excessive N use or unbalanced plant nutrition.

Keywords: nutrient, pesticide, crop, yield

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Authors: Avrokomi Zavitsanou, Spiros Papadopoulos, Theofanis Alexandridis

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This paper presents the research project ‘Colour & Travel’, which is co-funded by the European Union and national resources through the Operational Programme “Competitiveness, Entrepreneurship and Innovation” 2014-2020, under the Single RTDI State Aid Action "RESEARCH - CREATE - INNOVATE". The research project proposes the design of an innovative, playful framework for exploring a variety of travel destinations and creating personalised travel narratives, aiming to entertain, educate, and promote culture and tourism. Gamification of the cultural and touristic environment can enhance its experiential, multi-sensory aspects and broaden the perception of the traveler. The latter's involvement in creating and shaping his personal travel narrations and the possibility of sharing it with others can offer him an alternative, more binding way of getting acquainted with a place. In particular, the paper presents the design of an infrastructure: (a) for the development of interactive travel guides for mobile devices, where sites with specific points of interest will be recommended, with which the user can interact in playful ways and then create his personal travel narratives, (b) for the development of innovative games within virtual reality environment, where the interaction will be offered while the user is moving within the virtual environment; and (c) for an online application where the content will be offered through the browser and the modern 3D imaging technologies (WebGL). The technological products that will be developed within the proposed project can strengthen important sectors of economic and social life, such as trade, tourism, exploitation and promotion of the cultural environment, creative industries, etc. The final applications delivered at the end of the project will guarantee an improved level of service for visitors and will be a useful tool for content creators with increased adaptability, expansibility, and applicability in many regions of Greece and abroad. This paper aims to present the research project by referencing the state of the art and the methodological scheme, ending with a brief reflection on the expected outcome in terms of results.

Keywords: gamification, culture, tourism, AR, VR, applications

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Authors: William Thomas Worster

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This paper will highlight the failure of international adjudication to prevent a state from evading an order of provisional measures by simply issuing a diplomatic assurance to the court. This practice changes the positions of the litigants as equals before a court, prevents the court from inquiring into the reliability of the political pledge as it would with assurances from a state to an individual, and diminishes the court’s ability to control its own proceedings in the face of concerns over sovereignty. Both the European Court of Human Rights (ECtHR) and International Court of Justice (ICJ) will entertain these kinds of unilateral pledges, but they consider them differently when the declaration is made between states or between a state and an individual, and when made directly to the court. In short, diplomatic assurances issued between states or to individuals are usually considered not to be legally binding and are essentially questions of fact, but unilateral assurances issued directly to an international court are questions of law, and usually legally binding. At the same time, orders for provisional measures are now understood also to be legally binding, yet international courts will sometimes permit a state to substitute an assurance in place of an order for provisional measures. This emerging practice has brought the nature of a state as a sovereign capable of creating legal obligations into the forum of adjudication where the parties should have equality of arms and permitted states to create legal obligations that escape inquiry into the reliability of the outcome. While most recent practice has occurred at the ICJ in state-to-state litigation, there is some practice potentially extending the practice to human rights courts. Especially where the litigants are factually unequal – a state and an individual – this practice is problematic since states could more easily overcome factual failings in their pledges and evade the control of the court. Consider, for example, the potential for evading non-refoulement obligations by extending the current diplomatic assurances practice from the state-to-state context to the state-to-court context. The dual nature of assurances, as both legal and factual instruments, should be considered as addressed to distinct questions, each with its own considerations, and that we need to be more demanding about their precise legal and factual effects.

Keywords: unilateral, diplomacy, assurances, undertakings, provisional measures, interim measures

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Authors: Ammar Asma, Bouafia Nabiha, Ghammam Rim, Ezzi Olfa, Ben Cheikh Asma, Mahjoub Mohamed, Helali Radhia, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Central venous catheter associated infections (CVC-AI) are among the serious hospital-acquired infections. The aims of this study are to determine the incidence of CVC-AI, and their risk factors among patients followed in a Tunisian medical intensive care unit (ICU). Materials / Methods: A prospective cohort study conducted between September 15th, 2015 and November 15th, 2016 in an 8-bed medical ICU including all patients admitted for more than 48h. CVC-AI were defined according to CDC of ATLANTA criteria. The enrollment was based on clinical and laboratory diagnosis of CVC-AI. For all subjects, age, sex, underlying diseases, SAPS II score, ICU length of stay, exposure to CVC (number of CVC placed, site of insertion and duration catheterization) were recorded. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: Among 192 eligible patients, 144 patients (75%) had a central venous catheter. Twenty-eight patients (19.4%) had developed CVC-AI with density rate incidence 20.02/1000 CVC-days. Among these infections, 60.7% (n=17) were systemic CVC-AI (with negative blood culture), and 35.7% (n=10) were bloodstream CVC-AI. The mean SAPS II of patients with CVC-AI was 32.76 14.48; their mean Charlson index was 1.77 1.55, their mean duration of catheterization was 15.46 10.81 days and the mean duration of one central line was 5.8+/-3.72 days. Gram-negative bacteria was determined in 53.5 % of CVC-AI (n= 15) dominated by multi-drug resistant Acinetobacter baumani (n=7). Staphylococci were isolated in 3 CVC-AI. Fourteen (50%) patients with CVC-AI died. Univariate analysis identified men (p=0.034), the referral from another hospital department (p=0.03), tobacco (p=0.006), duration of sedation (p=0.003) and the duration of catheterization (p=0), as possible risk factors of CVC-AI. Multivariate analysis showed that independent factors of CVC-AI were, male sex; OR= 5.73, IC 95% [2; 16.46], p=0.001, Ramsay score; OR= 1.57, IC 95% [1.036; 2.38], p=0.033, and duration of catheterization; OR=1.093, IC 95% [1.035; 1.15], p=0.001. Conclusion: In a monocenter cohort, CVC-AI had a high density and is associated with poor outcome. Identifying the risk factors is necessary to find solutions for this major health problem.

Keywords: central venous catheter associated infection, intensive care unit, prospective cohort studies, risk factors

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Authors: Farah Naja, Mohamad Alameddine

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

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

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Authors: Katie Emerson, Sara Perez-Ojalvo, Jim Komorowski, Danielle Greenberg

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The purpose of this study was to evaluate arginase activity levels in response to combinations of an inositol-stabilized arginine silicate (ASI; Nitrosigine®), L-arginine, and Inositol. Arginine acts as a vasodilator that promotes increased blood flow resulting in enhanced delivery of oxygen and nutrients to the brain and other tissues. ASI alone has been shown to improve performance on cognitive tasks. Arginase, found in human serum, catalyzes the conversion of arginine to ornithine and urea, completing the last step in the urea cycle. Decreasing arginase levels maintains arginine and results in increased nitric oxide production. This study aimed to determine the most effective combination of ASI, L-arginine and inositol for minimizing arginase levels and therefore maximize ASI’s effect on cognition. Serum was taken from untreated healthy donors by separation from clotted factors. Arginase activity of serum in the presence or absence of test products was determined (QuantiChrom™, DARG-100, Bioassay Systems, Hayward CA). The remaining ultra-filtrated serum units were harvested and used as the source for the arginase enzyme. ASI alone or combined with varied levels of Inositol were tested as follows: ASI + inositol at 0.25 g, 0.5 g, 0.75 g, or 1.00 g. L-arginine was also tested as a positive control. All tests elicited changes in arginase activity demonstrating the efficacy of the method used. Adding L-arginine to serum from untreated subjects, with or without inositol only had a mild effect. Adding inositol at all levels reduced arginase activity. Adding 0.5 g to the standardized amount of ASI led to the lowest amount of arginase activity as compared to the 0.25g 0.75g or 1.00g doses of inositol or to L-arginine alone. The outcome of this study demonstrates an interaction of the pairing of inositol with ASI on the activity of the enzyme arginase. We found that neither the maximum nor minimum amount of inositol tested in this study led to maximal arginase inhibition. Since the inhibition of arginase activity is desirable for product formulations looking to maintain arginine levels, the most effective amount of inositol was deemed preferred. Subsequent studies suggest this moderate level of inositol in combination with ASI leads to cognitive improvements including reaction time, executive function, and concentration.

Keywords: arginine, inositol, arginase, cognitive benefits

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Authors: Kholoud Abdulaziz, Kholoud Al-Najdi, Abdullah Kadri, Konstantinos E. Kakosimos

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The Middle East area is highly affected by air pollution induced by anthropogenic and natural phenomena. There is evidence that air pollution, especially particulates, greatly affects the population health. Many studies have raised a warning of the high concentration of particulates and their affect not just around industrial and construction areas but also in the immediate working and living environment. One of the methods to study air quality is continuous and periodic monitoring using active or passive samplers. Active monitoring and sampling are the default procedures per the European and US standards. However, in many cases they have been inefficient to accurately capture the spatial variability of air pollution due to the small number of installations; which eventually is attributed to the high cost of the equipment and the limited availability of users with expertise and scientific background. Another alternative has been found to account for the limitations of the active methods that is the passive sampling. It is inexpensive, requires no continuous power supply, and easy to assemble which makes it a more flexible option, though less accurate. This study aims to investigate and evaluate the use of passive sampling for particulate matter pollution monitoring in dry tropical climates, like in the Middle East. More specifically, a number of field measurements have be conducted, both indoors and outdoors, at Qatar and the results have been compared with active sampling equipment and the reference methods. The samples have been analyzed, that is to obtain particle size distribution, by applying existing laboratory techniques (optical microscopy) and by exploring new approaches like the white light interferometry to. Then the new parameters of the well-established model have been calculated in order to estimate the atmospheric concentration of particulates. Additionally, an extended literature review will investigate for new and better models. The outcome of this project is expected to have an impact on the public, as well, as it will raise awareness among people about the quality of life and about the importance of implementing research culture in the community.

Keywords: air pollution, passive samplers, interferometry, indoor, outdoor

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Authors: Hanna Gulema, Meaza Demissie, Alemayehu Worku, Tesfaye Assebe Yadeta, Yemane Berhane

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Background: In patriarchal societies, female caregivers decide on food allocation within a family based on prevailing gender and age norms, which may lead to inequality that does not favor young adolescent girls. This study evaluated the effect of a community-based social norm intervention involving female caregivers in West Hararghe, Ethiopia. The intervention was engaging female caregivers along with other adult influential community members to deliberate and act on food allocation social norms in a process referred to as Social Analysis and Action (SAA). Method: We used data from a large quasi-experimental study to compare family eating practices between those who participated in the Social Analyses and Action intervention and those who did not. The respondents were female caregivers in households with young adolescent girls (ages 13 and 14 years). The study’s outcome was the practice of family eating together from the same dish. The difference in difference (DID) analysis with the Mixed effect logistic regression model was used to examine the effect of the intervention. Result: The results showed improved family eating practices in both groups, but the improvement was greater in the intervention group. The DID analysis showed an 11.99 percentage points greater improvement in the intervention arm than in the control arm. The mixed-effect regression produced an adjusted odds ratio of 2.08 (95% CI [1.06–4.09]) after controlling selected covariates, p-value 0.033. Conclusions: The involvement of influential adult community members significantly improves the family practice of eating together in households where adolescent girls are present in our study. The intervention has great potential to minimize household food allocation inequalities and thus improve the nutritional status of young adolescents. Further studies are necessary to evaluate the effectiveness of the intervention in different social norm contexts to formulate policy and guidelines for scale-up.

Keywords: family eating practice, social norm intervention, adolescence girls, caregiver

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Authors: Arlene Caney, Linda Fellag

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To counter the adverse effect of Covid-19 on college student success, two faculty members at a US community college have used web-based assessment data to improve curricula and, thus, student outcomes. This case study exemplifies how “closing the loop” by analyzing outcome assessments in real time can improve student learning for academically underprepared students struggling during the pandemic. The purpose of the study was to develop ways to mitigate the negative impact of Covid-19 on student success of underprepared college students. Using the Assessment, Evaluation, Feedback and Intervention System (AEFIS) and other assessment tools provided by the college’s Office of Institutional Research, an English professor and a Music professor collected data in skill areas related to their curricula over four semesters, gaining insight into specific course sections and learners’ performance across different Covid-driven course formats—face-to-face, hybrid, synchronous, and asynchronous. Real-time data collection allowed faculty to shorten and close the assessment loop, and prompted faculty to enhance their curricula with engaging material, student-centered activities, and a variety of tech tools. Frequent communication, individualized study, constructive criticism, and encouragement were among other measures taken to enhance teaching and learning. As a result, even while student success rates were declining college-wide, student outcomes in these faculty members’ asynchronous and synchronous online classes improved or remained comparable to student outcomes in hybrid and face-to-face sections. These practices have demonstrated that even high-risk students who enter college with remedial level language and mathematics skills, interrupted education, work and family responsibilities, and language and cultural diversity can maintain positive outcomes in college across semesters, even during the pandemic.

Keywords: AEFIS, assessment, distance education, institutional research center

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Authors: Kristin Thooft

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

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

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Authors: Mohamed Ghoz, Hala Alsabeh

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Context: Macroscopic Nose Macroneedling (MNM) is a new non-surgical procedure for lifting and tightening the nose. It is a tissue-non-invasive technique that uses a needle to create micro-injuries in the skin. These injuries stimulate the production of collagen and elastin, which results in the tightening and lifting of the skin. Research Aim: The research aim of this study was to investigate the efficacy and safety of MNM for the treatment of nasal deformities. Methodology A total of 100 patients with nasal deformities were included in this study. The patients were randomly assigned to either the MNM group or the control group. The MNM group received a single treatment of MNM, while the control group received no treatment. The patients were evaluated at baseline, 6 months, and 12 months after treatment. Findings: The results of this study showed that MNM was effective in improving the appearance of the nose in patients with nasal deformities. At 6 months after treatment, the patients in the MNM group had significantly improved nasal tip projection, nasal bridge height, and nasal width compared to the patients in the control group. The improvements in nasal appearance were maintained at 12 months after treatment. Theoretical Importance: The findings of this study provide support for the use of MNM as a safe and effective treatment for nasal deformities. MNM is a non-surgical procedure that is associated with minimal downtime and no risk of scarring. This makes it an attractive option for patients who are looking for a minimally invasive treatment for their nasal deformities. Data Collection: Data was collected from the patients using a variety of methods, including clinical assessments, photographic assessments, and patient-reported outcome measures. Analysis Procedures: The data was analyzed using a variety of statistical methods, including descriptive statistics, inferential statistics, and meta-analysis. Question Addressed: The research question addressed in this study was whether MNM is an effective and safe treatment for nasal deformities. Conclusion: The findings of this study suggest that MNM is an effective and safe treatment for nasal deformities. MNM is a non-surgical procedure that is associated with minimal downtime and no risk of scarring. This makes it an attractive option for patients who are looking for a minimally invasive treatment for their nasal deformities.

Keywords: nose, surgery, tie, suture

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Authors: Matthew Cameron, Stephen Yang, Latifa Al Kharusi, Adam Gosselin, Anissa Chirico, Pouya Gholipour Baradari

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Background: Iron supplementation has been evaluated in several randomized controlled trials (RCTs) for the potential to increase baseline hemoglobin and decrease the incidence of red blood cell (RBC) transfusion during cardiac surgery. This study's main objective was to evaluate the evidence for iron administration in cardiac surgery patients for its effect on the incidence of perioperative RBC transfusion. Methods: This systematic review protocol was registered with PROSPERO (CRD42020161927) on Dec. 19th, 2019, and was prepared as per the PRISMA guidelines. MEDLINE, EMBASE, CENTRAL, Web of Science databases, and Google Scholar were searched for RCTs evaluating perioperative iron administration in adult patients undergoing cardiac surgery. Each abstract was independently reviewed by two reviewers using predefined eligibility criteria. The primary outcome was perioperative RBC transfusion, with secondary outcomes of the number of RBC units transfused, change in ferritin level, reticulocyte count, hemoglobin, and adverse events, after iron administration. The risk of bias was assessed with the Cochrane Collaboration Risk of Bias Tool, and the primary and secondary outcomes were analyzed with a random-effects model. Results: Out of 1556 citations reviewed, five studies (n = 554 patients) met the inclusion criteria. The use of iron demonstrated no difference in transfusion incidence (RR 0.86; 95% CI 0.65 to 1.13). There was a low heterogeneity between studies (I²=0%). The trial sequential analysis suggested an optimal information size of 1132 participants, which the accrued information size did not reach. Conclusion: The current literature does not support the routine use of iron supplementation before cardiac surgery; however, insufficient data is available to draw a definite conclusion. A critical knowledge gap has been identified, and more robust RCTs are required on this topic.

Keywords: cardiac surgery, iron, iron supplementation, perioperative medicine, meta-analysis, systematic review, randomized controlled trial

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Authors: Migena Mana, Ahmed Khalid Syed, Abdul Malik, Nikhil Cherian

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In recent years, advancements in deep learning enabled researchers to tackle the problem of self-driving cars. Car companies use huge datasets to train their deep learning models to make autonomous cars a reality. However, this approach has certain drawbacks in that the state space of possible actions for a car is so huge that there cannot be a dataset for every possible road scenario. To overcome this problem, the concept of reinforcement learning (RL) is being investigated in this research. Since the problem of autonomous driving can be modeled in a simulation, it lends itself naturally to the domain of reinforcement learning. The advantage of this approach is that we can model different and complex road scenarios in a simulation without having to deploy in the real world. The autonomous agent can learn to drive by finding the optimal policy. This learned model can then be easily deployed in a real-world setting. In this project, we focus on three RL algorithms: Q-learning, Deep Deterministic Policy Gradient (DDPG), and Proximal Policy Optimization (PPO). To model the environment, we have used TORCS (The Open Racing Car Simulator), which provides us with a strong foundation to test our model. The inputs to the algorithms are the sensor data provided by the simulator such as velocity, distance from side pavement, etc. The outcome of this research project is a comparative analysis of these algorithms. Based on the comparison, the PPO algorithm gives the best results. When using PPO algorithm, the reward is greater, and the acceleration, steering angle and braking are more stable compared to the other algorithms, which means that the agent learns to drive in a better and more efficient way in this case. Additionally, we have come up with a dataset taken from the training of the agent with DDPG and PPO algorithms. It contains all the steps of the agent during one full training in the form: (all input values, acceleration, steering angle, break, loss, reward). This study can serve as a base for further complex road scenarios. Furthermore, it can be enlarged in the field of computer vision, using the images to find the best policy.

Keywords: autonomous driving, DDPG (deep deterministic policy gradient), PPO (proximal policy optimization), reinforcement learning

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Authors: Jameelah Omolara Yaqub

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One of the main reasons for the existence of central bank is that it is believed that central banks have some influence on private sector decisions which will enable the Central Bank to achieve some of its objectives especially that of stable price and economic growth. By the assumption of the New Keynesian theory that prices are fully flexible in the short run, the central bank can temporarily influence real interest rate and, therefore, have an effect on real output in addition to nominal prices. There is, therefore, the need for the Central Bank to monitor, respond to, and influence private sector decisions appropriately. This thus shows that the Central Bank and the private sector will both affect and be affected by each other implying considerable interdependence between the sectors. The interdependence may be simultaneous or not depending on the level of information, readily available and how sensitive prices are to agents’ expectations about the future. The aim of this paper is, therefore, to determine whether the interdependence between asset prices and monetary policy are simultaneous or not and how important is this relationship. Studies on the effects of monetary policy have largely used VAR models to identify the interdependence but most have found small effects of interaction. Some earlier studies have ignored the possibility of simultaneous interdependence while those that have allowed for simultaneous interdependence used data from developed economies only. This study, therefore, extends the literature by using data from a developing economy where information might not be readily available to influence agents’ expectation. In this study, the direction of relationship among variables of interest will be tested by carrying out the Granger causality test. Thereafter, the interaction between asset prices and monetary policy in Nigeria will be tested. Asset prices will be represented by the NSE index as well as real estate prices while monetary policy will be represented by money supply and the MPR respectively. The VAR model will be used to analyse the relationship between the variables in order to take account of potential simultaneity of interdependence. The study will cover the period between 1980 and 2014 due to data availability. It is believed that the outcome of the research will guide monetary policymakers especially the CBN to effectively influence the private sector decisions and thereby achieve its objectives of price stability and economic growth.

Keywords: asset prices, granger causality, monetary policy rate, Nigeria

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Authors: Hong Wu, Naiji Lu

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Improvement of health behavior among people with chronic diseases is vital for increasing longevity and enhancing quality of life. This paper researched the causal effects of informal care on the compliance with doctor’s health advices – smoking control, dietetic regulation, weight control and keep exercising – among older people with chronic diseases in China, which is facing the challenge of aging. We addressed the selection bias by using propensity score matching in the estimation process. We used the 2011-2012 national baseline data of the China Health and Retirement Longitudinal Study. Our results showed informal care can help improve health behavior of older people. First, informal care improved the compliance of smoking controls: whether smoke, frequency of smoking, and the time lag between wake up and the first cigarette was all lower for these older people with informal care; Second, for dietetic regulation, older people with informal care had more meals every day than older people without informal care; Third, three variables: BMI, whether gain weight and whether lose weight were used to measure the outcome of weight control. There were no significant difference between group with informal care and that without for BMI and the possibility of losing weight. Older people with informal care had lower possibility of gain weight than that without; Last, for the advice of keeping exercising, informal care increased the probability of walking exercise, however, the difference between groups for moderate and vigorous exercise were not significant. Our results indicate policy makers who aim to decrease accidents should take informal care to elders into account and provide an appropriate policy to meet the demand of informal care. Our birth policy and postponed retirement policy may decrease the informal caregiving hours, so adjustments of these policies are important and urgent to meet the current situation of aged tendency of population. In addition, government could give more support to develop organizations to provide formal care, such as nursing home. We infer that formal care is also useful for health behavior improvements.

Keywords: chronic diseases, compliance, CHARLS, health advice, informal care, older people, propensity score matching

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Authors: Geeta Goyal

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Teaching-learning of English as a second language is a challenge for the learner as well as the teacher. Whereas a student may find it hard and get demotivated while communicating in a language other than mother tongue, a teacher, too, finds it difficult to integrate necessary teaching material in lesson plans to maximize the outcome. Studies reveal that task-based teaching can be useful in diverse contexts in a second language classroom as it helps in creating opportunities for language exposure as per learners' interest and capability levels, which boosts their confidence and learning efficiency. The present study has analysed the impact of various activities carried out in a heterogenous group of second language learners at tertiary level in a semi-urban area in Haryana state of India. Language tasks were specifically planned with a focus on engaging groups of twenty-five students for a period of three weeks. These included language games such as spell-well, cross-naught besides other communicative and interactive tasks like mock-interviews, role plays, sharing experiences, storytelling, simulations, scene-enact, video-clipping, etc. Tools in form of handouts and cue cards were also used as per requirement. This experiment was conducted for ten groups of students taking bachelor’s courses in different streams of humanities, commerce, and sciences. Participants were continuously supervised, monitored, and guided by the respective teacher. Feedback was collected from the students through classroom observations, interviews, and questionnaires. Students' responses revealed that they felt comfortable and got plenty of opportunities to communicate freely without being afraid of making mistakes. It was observed that even slow/timid/shy learners got involved by getting an experience of English language usage in friendly environment. Moreover, it helped the teacher in establishing a trusting relationship with students and encouraged them to do the same with their classmates. The analysis of the data revealed that majority of students demonstrated improvement in their interest and enthusiasm in the class. The study revealed that task-based teaching was an effective method to improve the teaching-learning process under the given conditions.

Keywords: communication skills, English, second language, task-based teaching

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Authors: Edward A. Osifodunrin, Jose Manuel Dias Lopes

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In Nigeria, enormous efforts/resources had, over the years, been expended on promoting financial inclusion (FI); however, it is seemingly discouraging that many of its self-declared targets on FI remained unachieved, especially amongst the Rural Dwellers and Actors in the Informal Sectors (RDAIS). Expectedly, many reasons had been earmarked for these failures: low literacy level, huge informal/rural sectors, etc. This study posits that in spite of these truly-debilitating factors, these FI policy failures could have been avoided or mitigated if the principles of active and better-managed citizens’ participation had been strictly followed in the (re)design/implementation of its FI policies. In other words, in a bid to mitigate the prevalent FE in Nigeria, this study hypothesizes the positive impact of increased/active citizens’ participation on FI outcome(s), backed by a preliminary empirical validation. Also, the study introduces the RDAIS-focused participatory financial inclusion policy (PFIP) as a major FI policy regeneration/improvement tool. The three categories of respondents that served as research subjects are FI experts in Nigeria (n = 72), RDAIS from the very rural/remote village of Unguwar Dogo in Northern Nigeria (n = 43), and RDAIS from another rural village of Sekere (n = 56) in the Southern region of Nigeria. Using survey design (5-point Likert scale questionnaires), random/stratified sampling, and descriptive/inferential statistics, the study often recorded independent consensus (amongst these three categories of respondents) that RDAIS’s active participation in iterative FI policy initiation, (re)design, implementation, (re)evaluation could indeed give improved FI outcomes. However, some questionnaire items also recorded divergent opinions and various statistically significant differences in the mean scores of these three categories. The PFIP (or any customized version of it) should then be carefully integrated into the NFIS of Nigeria (and possibly in the NFIS of other developing countries) to truly/fully provide FI policy integration for these excluded RDAIS and arrest the prevalence of FE.

Keywords: citizens’ participation, development, financial inclusion, formal financial services, national financial inclusion strategy, participatory financial inclusion policy, rural dwellers and actors in the informal sectors

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Authors: Juntip Kanjanasilp, Ratree Sawangjit, Kanokporn Meelap, Kwanchanok Kruthakool

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Depression is a common mental health disorder. Antidepressants are effective pharmacological treatments, but most patients have low medication adherence. This study aims to systematic review and meta-analysis what method increase the antidepressants adherence efficiently and improve clinical outcome. Systematic review of articles of randomized controlled trials obtained by a computerized literature search of The Cochrane, Library, Pubmed, Embase, PsycINFO, CINAHL, Education search, Web of Science and ThaiLIS (28 December 2017). Twenty-three studies were included and assessed the quality of research by ROB 2.0. The results reported that printing media improved in number of people who had medication adherence statistical significantly (p= 0.018), but education, phone call, and program utilization were no different (p=0.172, p=0.127, p=0.659). There was no significant difference in pharmacist’s group, health care team’s group and physician’s group (p=0.329, p=0.070, p=0.040). Times of intervention at 1 month and 6 months improved medication adherence significantly (p= 0.0001, p=0.013). There was significantly improved adherence in single intervention (p=0.027) but no different in multiple interventions (p=0.154). When we analyzed medication adherence with the mean score, no improved adherence was found, not relevant with who gives the intervention and times to intervention. However, the multiple interventions group was statistically significant improved medication adherence (p=0.040). Phone call and the physician’s group were statistically significant improved clinical outcomes in number of improved patients (0.025 and 0.020, respectively). But in the pharmacist’s group and physician’s group were not found difference in the mean score of clinical outcomes (p=0.993, p=0.120, respectively). Times to intervention and number of intervention were not significant difference than usual care. The overall intervention can increase antidepressant adherence, especially the printing media, and the appropriate timing of the intervention is at least 6 months. For effective treatment, the provider should have experience and expert in caring for patients with depressive disorders, such as a psychiatrist. Medical personnel should have knowledge in caring for these patients also.

Keywords: depression, medication adherence, clinical outcomes, systematic review, meta-analysis

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Authors: Mark P. Mayala, Henry Mayala, Khuzeima Khanbhai

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Background: Heart failure has been a rising concern in Tanzania. New drugs have been introduced, including the group of drugs called Angiotensin receptor Neprilysin Inhibitor (ARNI), but due to their high cost, angiotensin-converting enzymes inhibitors (ACEIs) and Angiotensin receptor blockers (ARBs) have been mostly used in Tanzania. However, according to our knowledge, the efficacy comparison of the two groups is yet to be studied in Tanzania. The aim of this study was to compare the efficacy of ACEIs and ARBs among patients with heart failure. Methodology: This was a hospital-based prospective cohort study done at Jakaya Kikwete Cardiac Institution (JKCI), Tanzania, from June to December 2020. Consecutive enrollment was done until fulfilling the inclusion criteria. Clinical details were measured at baseline. We assessed the relationship between ARBs and ACEIs users with N-terminal pro-brain natriuretic peptide (NT pro-BNP) levels at admission and at 1-month follow-up using a chi-square test. A Kaplan-Meier curve was used to estimate the survival time of the two groups. Results: 155 HF patients were enrolled, with a mean age of 48 years, whereby 52.3% were male, and their mean left ventricular ejection fraction (LVEF) was 37.3%. 52 (33.5%) heart failure patients were on ACEIs, 57 (36.8%) on ARBs, and 46 (29.7%) were neither using ACEIs nor ARBs. At least half of the patients did not receive a guideline-directed medical therapy (GDMT), with only 82 (52.9%) receiving a GDMT. A drop in NT pro-BNP levels was observed during admission and at 1-month follow-up on both groups, from 6389.2 pg/ml to 4000.1 pg/ml for ARB users and 5877.7 pg/ml to 1328.2 pg/ml for the ACEIs users. There was no statistical difference between the two groups when estimated by the Kaplan-Meier curve, though more deaths were observed in those who were neither on ACEIs nor ARBs, with a calculated P value of 0.01. Conclusion: This study demonstrates that ACEIs have more efficacy and overall better clinical outcome than ARBs, but this should be taken under the patient-based case, considering the side effects of ACEIs and patients’ adherence.

Keywords: angiotensin converting enzymes inhibitors, angiotensin receptor blockers, guideline direct medical therapy, N-terminal pro-brain natriuretic peptide

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Authors: Sofiya Rao, Sagnik Dey

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Aerosol-cloud-precipitation interaction continues to be one of the largest sources of uncertainty in quantifying the aerosol climate forcing. The uncertainty is increasing from global to regional scale. This problem remains unresolved due to the large discrepancy in the representation of cloud processes in the climate models. Most of the studies on aerosol-cloud-climate interaction and aerosol-cloud-precipitation over Indian Ocean (like INDOEX, CAIPEEX campaign etc.) are restricted to either particular to one season or particular to one region. Here we developed a theoretical framework to quantify aerosol indirect radiative forcing using Moderate Resolution Imaging Spectroradiometer (MODIS) aerosol and cloud products of 15 years (2000-2015) period over the Indian Ocean. This framework relies on the observationally constrained estimate of the aerosol-induced change in cloud albedo. We partitioned the change in cloud albedo into the change in Liquid Water Path (LWP) and Effective Radius of Clouds (Reff) in response to an aerosol optical depth (AOD). Cloud albedo response to an increase in AOD is most sensitive in the range of LWP between 120-300 gm/m² for a range of Reff varying from 8-24 micrometer, which means aerosols are most sensitive to this range of LWP and Reff. Using this framework, aerosol forcing during a transition from indirect to semi-direct effect is also calculated. The outcome of this analysis shows best results over the Arabian Sea in comparison with the Bay of Bengal and the South Indian Ocean because of heterogeneity in aerosol spices over the Arabian Sea. Over the Arabian Sea during Winter Season the more absorbing aerosols are dominating, during Pre-monsoon dust (coarse mode aerosol particles) are more dominating. In winter and pre-monsoon majorly the aerosol forcing is more dominating while during monsoon and post-monsoon season meteorological forcing is more dominating. Over the South Indian Ocean, more or less same types of aerosol (Sea salt) are present. Over the Arabian Sea the Aerosol Indirect Radiative forcing are varying from -5 ± 4.5 W/m² for winter season while in other seasons it is reducing. The results provide observationally constrained estimates of aerosol indirect forcing in the Indian Ocean which can be helpful in evaluating the climate model performance in the context of such complex interactions.

Keywords: aerosol-cloud-precipitation interaction, aerosol-cloud-climate interaction, indirect radiative forcing, climate model

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Authors: Pajaree Naramitpanich, Natchanok Jansawang, Panwilai Chomchid

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The aims of this are compared between the students’ logical thinking abilities of their learning for designing the 5-lesson instructional plans of the 2-instructional methods, namely; the STEM Education and the Creative Learning Process (CLP) for developing students’ logical thinking abilities that a sample consisted of 90 students from two chemistry classes of different learning outcomes in Wapi Phathum School with the cluster random sampling technique was used at the 11th grade level. To administer of their learning environments with the 45-experimenl student group by the STEM Education method and the 45-controlling student group by the Creative Learning Process. These learning different groups were obtained using the 5 instruments; the 5-lesson instructional plans of the STEM Education and the Creative Learning Process to enhance the logical thinking tests on Mineral issue were used. The efficiency of the Creative Learning Processes (CLP) Model and the STEM Education’s innovations of these each five instructional lesson plans based on criteria are higher than of 80/80 standard level with the IOC index from the expert educators. The averages mean scores of students’ learning achievement motives were assessed with the Pre and Post Techniques and Logical Thinking Ability Test (LTAT) and dependent t-test analysis were differentiated between the CLP and the STEM, significantly. Students’ perceptions of their chemistry classroom environment inventories with the MCI with the CLP and the STEM methods also were found, differently. Associations between students’ perceptions of their chemistry classroom learning environment inventories on the CLP Model and the STEM Education learning designs toward their logical thinking abilities toward chemistry, the predictive efficiency of R2 values indicate that 68% and 76% of the variances in students’ logical thinking abilities toward chemistry to their controlling and experimental chemistry classroom learning environmental groups with the MCI were correlated at .05 levels, significantly. Implementations of this result are showed the students’ learning by the CLP of the potential thinking life-changing roles in most their logical thinking abilities that it is revealed that the students perceive their abilities to be highly learning achievement in chemistry group are differentiated with the STEM education of students’ outcomes.

Keywords: design, the lesson instructional plans, the stem education, the creative learning process, logical thinking ability, different, learning outcome, student, chemistry class

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Authors: Chan Hui-Ya, Ding Shin-Tan

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Background and Aim: The discharge planning is considered helpful to reduce the hospital length of stay and readmission rate, and then increased satisfaction with healthcare for patients and professionals. In order to decrease the waiting time of long-term care and boost the care quality of patients after discharge from the hospital, the Ministry of Health and Welfare department in Taiwan initiates a program “discharge planning connects with long-term care 2.0 services” in 2017. The purpose of this study is to investigate the outcome of the pilot of this program in a medical center. Methods: By purpose sampling, the study chose five wards in a medical center as pilot units. The researchers compared the beds of service, the numbers of cases which were transferred to the long-term care center and transferred rates per month between the pilot units and the other units, and analyze the basic data, the long-term care service needs and the approval service items of cases transfer to the long-term care center in pilot units. Results: From June to September 2017, a total of 92 referrals were made, and 51 patients were enrolled into the pilot program. There is a significant difference of transferring rate between the pilot units and the other units (χ = 702.6683, p < 0.001). Only 20 cases (39.2% success rate) were approved to accept the parts of service items of long-term care in the pilot units. The most approval item was respite care service (n = 13; 65%), while it was third at needs ranking of service lists during linking services process. Among the reasons of patients who cancelled the request, 38.71% reasons were related to the services which could not match the patients’ needs and expectation. Conclusion: The results indicate there is a requirement to modify the long-term care services to fit the needs of cases. The researchers suggest estimating the potential cases by screening data from hospital informatics systems and to hire more case manager according the service time of potential cases. Meanwhile, the strategies shortened the assessment scale and authorized hospital case managers to approve some items of long-term care should be considered.

Keywords: discharge planning, long-term care, case manager, patient care

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Authors: Lancer Scott

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Purpose: High quality clinical disaster medicine requires providers working collaboratively to care for multiple patients in chaotic environments; however, many providers lack adequate training. To address this deficit, we created a competency-based, 5-hour Emergency Preparedness Training (EPT) curriculum using didactics, small-group discussion, and kinetic learning. The goal was to evaluate the effect of a short course on improving provider knowledge, confidence and skills in disaster scenarios. Methods: Diverse groups of medical university students, health care professionals, and community members were enrolled between 2011 and 2014. The course consisted of didactic lectures, small group exercises, and two live, multi-patient mass casualty incident (MCI) scenarios. The outcome measures were based on core competencies and performance objectives developed by a curriculum task force and assessed via trained facilitator observation, pre- and post-testing, and a course evaluation. Results: 708 participants completed were trained between November 2011 and August 2014, including 49.9% physicians, 31.9% medical students, 7.2% nurses, and 11% various other healthcare professions. 100% of participants completed the pre-test and 71.9% completed the post-test, with average correct answers increasing from 39% to 60%. Following didactics, trainees met 73% and 96% of performance objectives for the two small group exercises and 68.5% and 61.1% of performance objectives for the two MCI scenarios. Average trainee self-assessment of both overall knowledge and skill with clinical disasters improved from 33/100 to 74/100 (overall knowledge) and 33/100 to 77/100 (overall skill). The course assessment was completed by 34.3% participants, of whom 91.5% highly recommended the course. Conclusion: A relatively short, intensive EPT course can improve the ability of a diverse group of disaster care providers to respond effectively to mass casualty scenarios.

Keywords: clinical disaster medicine, training, hospital preparedness, surge capacity, education, curriculum, research, performance, training, student, physicians, nurses, health care providers, health care

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Authors: Debrah Mtshelwane, Alewyn Nel, Lizelle Brink

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Social desirability is an important topic to study. It may be possible that different cultures experience social desirability in different ways. Different cultural groups exist within South Africa, however the focus of this study is specifically in the Zulu culture. This research aims to explore social desirability from an emic perspective within the social constructivist paradigm among individuals within the Zulu culture. The researcher intended to identify those features Zulu individuals deem as socially desirable and undesirable from their cultural viewpoint. The research was conducted using a qualitative research design and the constructivism paradigm was utilised in this study. Combined purposive and quota non-probability sampling was employed for this study. A sample of 30 employees (N = 30) working in various organisations from the provinces of Gauteng and KwaZulu-Natal formed part of this study and data were collected through semi-structured interviews. Thematic analysis was used to analyse the data. The main findings showed that Zulu people regard certain behaviours and actions as socially desirable and others as undesirable. The following are considered socially desirable: Conscientiousness, dominance, subjective expectations and positive relations, these are the themes that were reported on the most. These are positive features in the Zulu culture, and they reflect on behaviour patterns, attitudes and manners that people display, which are also seen as acceptable and good in the Zulu culture. The following are regarded as socially undesirable features that were identified by people who belong to the Zulu culture, the themes that were identified as undesirable are: non-conscientiousness, non-dominance (male), dominance (females), tradition, negative relations and subjective expectations. This study creates awareness on social desirability in the workplace and provides basic tools to management on how to deal with such behaviours relating to this phenomenon in the workplace. This knowledge informs employees on the concept of socially desirable behaviour, and provide more insight into behaviours and/or emotions Zulu individuals. The outcome of this study provided new indigenous, empirical knowledge on the phenomenon of social desirability within the South African context.

Keywords: cultural diversity, emic perspective, social constructivism paradigm, social desirability, Zulu culture

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Authors: Muhammad Asim

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Background: Less than half of women in South Asia (SA) use any modern contraceptive method which leads to a huge burden of unintended pregnancies, unsafe abortions, maternal deaths, and socioeconomic loss. Women empowerment plays a pivotal role in improving various health seeking behaviours, including contraceptive use. The objective of this study to explore the association between women's empowerment and modern contraceptive, among rich and poor segment of population in SA. Methods: We used the most recent, large-scale, demographic health survey data of five South Asian countries, namely Afghanistan, Pakistan, Bangladesh, India, and Nepal. The outcome variable was the current use of modern contraceptive methods. The main exposure variable was a combination (interaction) of socio-economic status (SES) and women’s level of empowerment (low, medium, and high), where SES was bifurcated into poor and rich; and women empowerment was divided into three categories: decision making, attitude to violence and social independence. Moreover, overall women empowerment indicator was also created by using three dimensions of women empowerment. We applied both descriptive statistics and multivariable logistic regression techniques for data analyses. Results: Most of the women possessed ‘medium’ level of empowerment across South Asian Countries. The lowest attitude to violence empowerment was found in Afghanistan, and the lowest social independence empowerment was observed in Bangladesh across SA. However, Pakistani women have the lowest decision-making empowerment in the region. The lowest modern contraceptive use (22.1%) was found in Afghanistan and the highest (53.2%) in Bangladesh. The multivariate results depict that the overall measure of women empowerment does not affect modern contraceptive use among poor and rich women in most of South Asian countries. However, the decision-making empowerment plays a significant role among both poor and rich women to use modern contraceptive methods across South Asian countries. Conclusions: The effect of women’s empowerment on modern contraceptive use is not consistent across countries, and among poor and rich segment of population. Of the three dimensions of women’s empowerment, the autonomy of decision making in household affairs emerged as a stronger determinant of mCPR as compared with social independence and attitude towards violence against women.

Keywords: women empowerment, contraceptive use, South Asia, women autonomy

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