Search results for: referral adequacy

Authors: Mahmoudi Marwa, Bahim Nadhem, Aydi Abdelwaheb, Issaoui Wissal, S. Najet

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This work represents a coupling between the geographic information system (GIS) and the multicriteria analysis aiming at the selection of an artificial recharge site by the treated wastewater for the Ariana governorate. On regional characteristics, bibliography and available data on artificial recharge, 13 constraints and 5 factors were hierarchically structured for the adequacy of an artificial recharge. The factors are subdivided into two main groups: environmental factors and economic factors. The adopted methodology allows a preliminary assessment of a recharge site, the weighted linear combination (WLC) and the analytical hierarchy process (AHP) in a GIS. The standardization of the criteria is carried out by the application of the different membership functions. The form and control points of the latter are defined by the consultation of the experts. The weighting of the selected criteria is allocated according to relative importance using the AHP methodology. The weighted linear combination (WLC) integrates the different criteria and factors to delineate the most suitable areas for artificial recharge site selection by treated wastewater. The results of this study showed three potential candidate sites that appear when environmental factors are more important than economic factors. These sites are ranked in descending order using the ELECTRE III method. Nevertheless, decision making for the selection of an artificial recharge site will depend on the decision makers in force.

Keywords: artificial recharge site, treated wastewater, analytical hierarchy process, ELECTRE III

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Authors: Soo Hong Da, Ng Zheng Yao, Burra Venkata Durga Kumar

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The Healthcare sector is a business that consists of providing medical services, manufacturing medical equipment and drugs as well as providing medical insurance to the public. Most of the time, the data stored in the healthcare database is to be related to patient’s information which is required to be accurate when it is accessed by authorized stakeholders. In distributed systems, one important issue is concurrency in the system as it ensures the shared resources to be synchronized and remains consistent through multiple read and write operations by multiple clients. The problems of concurrency in the healthcare sector are who gets the access and how the shared data is synchronized and remains consistent when there are two or more stakeholders attempting to the shared data simultaneously. In this paper, a framework that is beneficial to distributed healthcare sector concurrent environment is proposed. In the proposed framework, four different level nodes of the database, which are national center, regional center, referral center, and local center are explained. Moreover, the frame synchronization is not symmetrical. There are two synchronization techniques, which are complete and partial synchronization operation are explained. Furthermore, when there are multiple clients accessed at the same time, synchronization types are also discussed with cases at different levels and priorities to ensure data is synchronized throughout the processes.

Keywords: resources, healthcare, concurrency, synchronization, stakeholders, database

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Authors: M. Ridwanul Hassan, Samuel George

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Aims: Steroid injections are commonly used as a diagnostic tool or an alternative to surgical management of carpal tunnel syndrome (CTS) and are generally safe. Ischaemia is a rare complication with very few cases reported in the literature. Methods: We report a case of a 50-year-old female that presented with a necrotic wound to her left palm one month after a steroid injection into the carpal tunnel. She had a 2-year history of CTS in her left hand that was treated with six previous steroid injections in primary care during this period. The wound evolved from a blister to a necrotic ulcer which led to a painful, hollow defect in the centre of her palm. She did not report any history of trauma, nor did she have any co-morbidities. Clinical photographs were taken. Results: On examination, she had a 0.5 cmx1 cm defect in the palm of her left hand down to aponeurosis. There was purulent discharge in the wound with surrounding erythema but no spreading cellulitis. She had full function of her fingers but was very tender on movements and at rest. She was admitted for intravenous antibiotics and underwent a debridement, washout, and carpal tunnel release the next day. The defect was packed to heal by secondary intention and has now fully healed one month following her operation. Conclusions: This is an extremely rare complication of steroid injections to the carpal tunnel and may have been avoided by earlier referral for surgery rather than treatment using multiple steroid injections.

Keywords: hand surgery, complication, rare, carpal tunnel syndrome

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Authors: Margarida Maria Cabugueira Csutódio dos Santos, Joana Filipa Pintéus Pereira

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The way children understand the concept of health and illness influences their reaction in contexts where these concepts are present (e.g.,illness; vaccination). The recognition of the importance of children's beliefs/representations about health and disease has led to the development of models that seek to explain the development process of these concepts. In the construction of their representations, children are influenced not only by their cognitive competence but also by their life experiences. In the last 3 years, children have experienced a pandemic health crisis that has exposed them to anomalous and stressful situations. Objective: the aim of this study was (1) to identify children’s representations about disease (including symptoms, causes, control/treatment) and prevention (including health procedures and vaccines) and (2) whether COVID19 is mentioned and influences their representations. Methodology: a qualitative study in which 67 children with 7 to 10 years old (mean 8,8) participated. A semi-structured interview was used following the Bibace and Walsh model, focusing on the representation of the disease and its prevention. Results show a marked influence of the lived experience with regard to causes of the disease, disease control and treatment, and adherence to vaccination. Age-dependent differences were found with older children being able to talk about illness and contamination process and younger displaying more basic, concrete and rigid representations. Conclusions: The results of this study bring clues to the adequacy of communication with the child in the context of health and illness and discriminately in a future health pandemic crisis.

Keywords: childen, health beliefs, pediatrics, covid19, vaccines

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Authors: Felipa de Mello-Sampayo

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The aim of this study is to undertake, from patient’s perspective, the timing and probability of using teledermatology, comparing it with a conventional referral system. The dynamic stochastic model’s main value-added consists of the concrete application to patients waiting for dermatology surgical intervention. Patients with low health level uncertainty must use teledermatology treatment as soon as possible, which is precisely when the teledermatology is least valuable. The results of the model were then tested empirically with the teledermatology network covering the area served by the Hospital Garcia da Horta, Portugal, links the primary care centers of 24 health districts with the hospital’s dermatology department via the corporate intranet of the Portuguese healthcare system. Health level volatility can be understood as the hazard of developing skin cancer and the trend of health level as the bias of developing skin lesions. The results of the survival analysis suggest that the theoretical model can explain the use of teledermatology. It depends negatively on the volatility of patients' health, and positively on the trend of health, i.e., the lower the risk of developing skin cancer and the younger the patients, the more presurgical teledermatology one expects to occur. Presurgical teledermatology also depends positively on out-of-pocket expenses and negatively on the opportunity costs of teledermatology, i.e., the lower the benefit missed by using teledermatology, the more presurgical teledermatology one expects to occur.

Keywords: teledermatology, wait time, uncertainty, opportunity cost, survival analysis

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Authors: Emma Carr, Jennifer Morrison, Peter Walker

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Background: Due to COVID-19, there was a significant reduction in the number of children being treated under general anaesthetic (GA) within the health board, which led to a backlog of referrals. The referrals were being triaged and added to a waiting list in order of priority -determined by the information given. By implementing a checklist, it is anticipated that at least 70% of referrals will have the majority of the information required to effectively prioritise patients. The gold standard, as defined in ‘Guidelines For The Management Of Children Referred For Dental Extractions Under General Anaesthesia’, indicates that all referrals should mention: (i) Inability of the child to cooperate, (ii) Previously tried anxiety management techniques, (iii) Existence of psychological disorders, (iv) Presence of acute dental infection, (v) Requirement for extractions in multiple quadrants. Method: 130 referrals were examined over three months and compared to the recommended standard. A letter was emailed to referring dentists within Ayrshire & Arran outlining the recommended information to be included within the referral. The second round of data collection was then carried out, which involved an examination of 105 referrals. Results: The first round revealed that only 28% of referrals mentioned at least four defined standards outlined above. Following issuing a checklist to all dentists, this increased to 72%. Conclusion: As many of the children referred for extractions under GA have suffered pain and infection because of dental caries, it is important that delay of treatment is minimised, where possible. The implementation of a standardised checklist has enabled more effective prioritisation of patients.

Keywords: caries, dentistry, general anaesthetic, paediatrics

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Authors: Sonam Kelzang

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Background: Penetrating injuries as a result of traditional sports (Archery and Khuru) are commonly seen in Bhutan. To our knowledge, there is no study carried out looking into the data of penetrating injuries due to traditional sports. Aim: This is a retrospective analysis of cases of penetrating injuries as a result of traditional sports admitted to JDWNRH over the last 3 years to draw an inference on the pattern of injury and associated morbidity and mortality. Method: Data on penetrating injuries related to traditional sports (Archery and Khuru) were collected and reviewed over the period of 3 years. Assault cases were excluded. For each year we analysed age, sex, parts of the body affected, agent of injury and whether admission was required or not. Results: Out of the total 44 victims of penetrating injury by traditional sports (Archery and Khuru) between 2013 and 2015 (average of 15 cases of penetrating injuries per year). Eighty-five percent were male and 15% were female. Their age ranged from 4 yrs to 62 years. Sixty-one percent of the victims were in the working age group of 19-58 years; 30% of the victims were referred from various district hospitals; 38% of the victims needed admission; 42 % of the victims suffered injury to the head; and 54% of the injuries were caused by Khuru. Conclusion: Penetrating injuries due to traditional sports admitted to JDWNRH, Thimphu, remained same over the three years period despite safety regulations in place. Although there were no deaths during the last three years, morbidity still remains high.

Keywords: archery, Bhutan, Khuru, darts

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Authors: Majid Khan

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Introduction: In this era of microsurgery, free flap holds a remarkable spot in reconstructive surgery. A free flap is well suited for composite defects as it provides sufficient and well-vascularized tissue for coverage. We report our experience with the use of the free flaps for the reconstruction of composite defects. Methods: This is a retrospective case series (chart review) of patients who underwent reconstruction of composite defects with a free flap at Aga Khan University Hospital, Karachi (Pakistan) from January 01, 2015, to December 31, 2019. Data were collected for patient demographics, size of the defect, size of flap, recipient vessels, postoperative complications, and outcome of the free flap. Results: Over this period, 532 free flaps are included in this study. The overall success rate is 95.5%. The mean age of the patient was 44.86 years. In 532 procedures, there were 448 defects from tumor ablation of head and neck cancer. The most frequent free flap was the anterolateral thigh flap in 232 procedures. In this study, the risk factor hypertension (p=0.004) was found significant for wound dehiscence, preop radiation/chemotherapy (p=0.003), and malnutrition (p=0.005) were found significant for fistula formation. Malnutrition (p=0.02) and use of vein grafts (p=0.025) were significant factors for flap failure. Conclusion: Free tissue transfer is a reliable option for the reconstruction of large and composite defects. Hypertension, malnutrition, and preoperative radiotherapy can cause significant morbidity.

Keywords: free flap, free flap failure, risk factors for flap failure, free flap outcome

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Authors: Libena Cernohorska

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The goal of this paper is to specify factors influencing the profitability of selected banks. Next, a model will be created to help establish variables that have a demonstrable influence on the development of the selected banks' profitability ratios. Czech banks and their international parent companies were selected for analyzing profitability. Banks categorized as large banks (according to the Czech National Bank's system, which ranks banks according to balance sheet total) were selected to represent the Czech banks. Two ratios, the return on assets ratio (ROA) and the return on equity ratio (ROE) are used to assess bank profitability. Six endogenous and four external indicators were selected from among other factors that influence bank profitability. The data analyzed were for the years 2001 – 2013. First, correlation analysis, which was supposed to eliminate correlated values, was conducted. A large number of correlated values were established on the basis of this analysis. The strongly correlated values were omitted. Despite this, the subsequent regression analysis of profitability for the individual banks that were selected did not confirm that the selected variables influenced their profitability. The studied factors' influence on bank profitability was demonstrated only for Československá Obchodní Banka and Société Générale using regression analysis. For Československá Obchodní Banka, it was demonstrated that inflation level and the amount of the central bank's interest rate influenced the return on assets ratio and that capital adequacy and market concentration influenced the return on equity ratio for Société Générale.

Keywords: banks, profitability, regression analysis, ROA, ROE

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Authors: Ruby Ann L. Ayo

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As cultural heritage reflects the historical origin of a certain group of people, it reveals their customs, traits, beliefs, practices and even values they hold on for years. One of the tangible examples of cultural heritage is the physical structures including the old churches. The study looked-into the existing historical narratives of the century Old Catholic churches in the Province of Albay, Bikol Region, Philippines: NuestraSeñora de Salvacion in Joroan, Tiwi, Albay; the Our Lady of the Gate in Daraga, Albay; the San Juan de Bautista in Tabaco City and the St. John the Baptist in Camalig, Albay. The historical narratives were analysed in terms of validity and reliability of the secondary documents with reference to the elements of history revealing consistency and adequacy of historical facts. The contents were examined using a modified Checklist of Historical Documents. The historical narratives were likewise submitted to the content expert for validation as regards historical authenticity and accuracy. The contents of the narratives were scrutinized according to the following codes: (1.1) the Patron Saints;(1.2) factors that paved to their constructions; (1.3) the people responsible for their constructions; (1.4) the misconceptions about their constructions; and (1.5) their contributions to Bikol heritage. Based on the codes, themes were identified as: (2.1) Marian Devotees and Christ-centered Patron Saints; (2.2) geographical, socio-political and cultural factors; (2.3) church and government officials; (2.4) misconceptions on the dates of constructions and original sites; and (2.5) popular pilgrim sites and well-admired architectural designs.

Keywords: historical narratives, old churches, cultural heritage, historical validity and reliability, elements of history

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Authors: Okhee Woo, Hye Seon Shin

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Purpose: To investigate the diagnostic power of digital breast tomosynthesis (DBT) in evaluation of breast microcalcifications and usefulness as a pre-procedural study for stereotactic biopsy in comparison with full-field digital mammogram (FFDM) and FFDM plus magnification image (FFDM+MAG). Methods and Materials: An IRB approved retrospective observer performance study on DBT, FFDM, and FFDM+MAG was done. Image quality was rated in 5-point scoring system for lesion clarity (1, very indistinct; 2, indistinct; 3, fair; 4, clear; 5, very clear) and compared by Wilcoxon test. Diagnostic power was compared by diagnostic values and AUC with 95% confidence interval. Additionally, procedural report of biopsy was analysed for patient positioning and adequacy of instruments. Results: DBT showed higher lesion clarity (median 5, interquartile range 4-5) than FFDM (3, 2-4, p-value < 0.0001), and no statistically significant difference to FFDM+MAG (4, 4-5, p-value=0.3345). Diagnostic sensitivity and specificity of DBT were 86.4% and 92.5%; FFDM 70.4% and 66.7%; FFDM+MAG 93.8% and 89.6%. The AUCs of DBT (0.88) and FFDM+MAG (0.89) were larger than FFDM (0.59, p-values < 0.0001) but there was no statistically significant difference between DBT and FFDM+MAG (p-value=0.878). In 2 cases with DBT, petit needle could be appropriately prepared; and other 3 without DBT, patient repositioning was needed. Conclusion: DBT showed better image quality and diagnostic values than FFDM and equivalent to FFDM+MAG in the evaluation of breast microcalcifications. Evaluation with DBT as a pre-procedural study for breast stereotactic biopsy can lead to more accurate localization and successful biopsy and also waive the need for additional magnification images.

Keywords: DBT, breast cancer, stereotactic biopsy, mammography

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Authors: Alpha Bolinao, Francine Rose De Castro, Jessie Kate Lumba, Raztine Mae Paeste, Hannah Grace Tosio

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The present study aimed to know the role of verbal bullying in the lives of obese teenagers exposed to it. The study employed a qualitative design specifically the phenomenological approach that focuses on the obese teenagers’ verbal bullying experiences. The study also used the social constructivism approach wherein it described the obese teenagers’ verbal bullying experiences as they interact with the social world. Through purposive and referral sampling technique, the researchers were able to choose twelve (12) respondents from different schools around the City of Manila, enrolled in the School Year 2015-2016, ages 16-21 years old, has experienced verbal bullying for the last ten (10) years and with the Body Mass Index (BMI) of equal to or greater than 30. Upon the consent of the respondents, ethical considerations were ensured. In-depth one (1) hour interviews were guided by the researchers’ aide memoir. The recorded interviews were transcribed into a field text and the responses were thoroughly analyzed through Thematic Analysis and Kelly’s Repertory Grid. It was found that the role of verbal bullying in the lives of obese teenagers exposed to it is a process and is best described through a syringe, or the 5S Responses of Obese Teenagers in Bullying, with five conceptual themes which also signify the experiences and the process that obese teenagers have gone through after experiencing verbal bullying. The themes conceptualized were: Suffering, self-doubt, suppression, self-acceptance and sanguineness. This paper may serve as a basis for a counseling program to help the obese teenagers cope with their bullying experiences.

Keywords: obesity, obese teenagers, bullying, experiences

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Authors: Niyada Naksuk, Thoetchai Peeraphatdit, Vitaly Herasevich, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham

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Introduction: Little is known about the safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. Methods: Pre-study Confusion Assessment Method-Intensive Care Unit (CAM–ICU) criteria were implemented in screening consecutive patients admitted to Mayo Clinic, Rochester, the USA from 2004 through 2013. Death status was prospectively ascertained. Results: Of 11,079 study patients, the incidence of delirium was 8.3% (n=925). Delirium was associated with an increased risk of in-hospital mortality (adjusted OR 1.49; 95% CI, 1.08-2.08; P=.02) and one-year mortality among patients who survived from CCU admission (adjusted HR 1.46; 95% CI, 1.12-1.87; P=.005). A total of 792 doses of haloperidol (5 IQR [3-10] mg/day) or quetiapine (25 IQR [13-50] mg/day) were given to 244 patients with delirium. The clinical characteristics of patients with delirium who did and did not receive antipsychotic therapy were not different (baseline corrected QT [QTc] interval 460±61 ms vs. 457±58 ms, respectively; P = 0.57). In comparison to baseline, mean QTc intervals after the first and third doses of the antipsychotics were not significantly prolonged in haloperidol (448±56, 458±57, and 450±50 ms, respectively) or quetiapine groups (459±54, 467±68, and 462±46 ms, respectively) (P > 0.05 for all). Additionally, in-hospital mortality (adjusted OR 0.67; 95% CI, 0.42-1.04; P=.07), ventricular arrhythmia (adjusted OR 0.87; 95% CI, 0.17-3.62; P=.85) and one-year mortality among the hospital survivors (adjusted HR 0.86; 95% CI 0.62-1.17; P = 0.34) were not different in patients with delirium irrespective of whether or not they received antipsychotics. Conclusions: In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.

Keywords: arrhythmias, haloperidol, mortality, qtc interval, quetiapine

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Authors: Mahmoud Y. Shokry, Rami M. El-Sherbiny

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This paper aims to highlight the role of some parameters that may be of a noticeable impact on numerical analysis/design of embankments. It presents the results of a three-dimensional (3-D) finite element analysis of a monitored earth embankment that was constructed on soft clay formation stabilized by cast in-situ piles using software PLAXIS 3D. A comparison between the predicted and the monitored responses is presented to assess the adequacy of the adopted numerical model. The model was used in the targeted parametric study. Moreover, a comparison was performed between the results of the 3-D analyses and the analytical solutions. This paper concluded that the effect of using mono pile caps led to decrease both the total and differential settlement and increased the efficiency of the piled embankment system. The study of using geogrids revealed that it can contribute in decreasing the settlement and maximizing the part of the embankment load transferred to piles. Moreover, it was found that increasing the stiffness of the geogrids provides higher values of tensile forces and hence has more effective influence on embankment load carried by piles rather than using multi-number of layers with low values of geogrid stiffness. The efficiency of the piled embankments system was also found to be greater when higher embankments are used rather than the low height embankments. The comparison between the numerical 3-D model and the theoretical design methods revealed that many analytical solutions are conservative and non-accurate rather than the 3-D finite element numerical models.

Keywords: efficiency, embankment, geogrids, soft clay

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Authors: I. V. Pinto, M. R. Sooriyarachchi

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It can be frequently observed that the data arising in our environment have a hierarchical or a nested structure attached with the data. Multilevel modelling is a modern approach to handle this kind of data. When multilevel modelling is combined with a binary response, the estimation methods get complex in nature and the usual techniques are derived from quasi-likelihood method. The estimation methods which are compared in this study are, marginal quasi-likelihood (order 1 & order 2) (MQL1, MQL2) and penalized quasi-likelihood (order 1 & order 2) (PQL1, PQL2). A statistical model is of no use if it does not reflect the given dataset. Therefore, checking the adequacy of the fitted model through a goodness-of-fit (GOF) test is an essential stage in any modelling procedure. However, prior to usage, it is also equally important to confirm that the GOF test performs well and is suitable for the given model. This study assesses the suitability of the GOF test developed for binary response multilevel models with respect to the method used in model estimation. An extensive set of simulations was conducted using MLwiN (v 2.19) with varying number of clusters, cluster sizes and intra cluster correlations. The test maintained the desirable Type-I error for models estimated using PQL2 and it failed for almost all the combinations of MQL. Power of the test was adequate for most of the combinations in all estimation methods except MQL1. Moreover, models were fitted using the four methods to a real-life dataset and performance of the test was compared for each model.

Keywords: goodness-of-fit test, marginal quasi-likelihood, multilevel modelling, penalized quasi-likelihood, power, quasi-likelihood, type-I error

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Authors: Babu Shersad, Partha Banerjee

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Reduction in haemoglobin levels has been implicated to be a cause for reduced exercise tolerance and cardiovascular complications of chronic renal diseases. Trends of hemoglobin levels in patients on haemodialysis could be an indicator of efficacy of hemodialysis and an indicator of quality of life in haemodialysis patients. In the UAE, the rate of growth (of patients on dialysis) is 10 to 15 per cent per year. The primary mode of haemodialysis in the region is based on in-patient hospital-based hemodialysis units. The increase in risk of cardiovascular and cerebrovascular morbidity as well as mortality in pre-dialysis Chronic Renal Disease has been reported. However, data on the health burden on haemodialysis in standalone dialysis facilities is very scarce. This is mainly due to the paucity of ambulatory centres for haemodialysis in the region. AMSA is the first center to offer standalone dialysis in the UAE and a study over a one year period was performed. Patient data was analyzed using a questionnaire for 45 patients with an average of 2.5 dialysis sessions per week. All patients were on chronic haemodialysis as outpatients. The trends of haemoglobin levels as an independent variable were evaluated. These trends were interpreted in comparison with other parameters of renal function (creatinine, uric acid, blood pressure and ferritin). Trends indicate an increase in hemoglobin levels with increased supplementation of iron and erythropoietin over time. The adequacy of hemodialysis shows improvement concomitantly. This, in turn, correlates with better patient outcomes and has a direct impact on morbidity and mortality. This study is a pilot study and further studies are indicated so that objective parameters can be studied and validated for hemodialysis in the region.

Keywords: haemodialysis, haemoglobin in haemodialysis, haemodialysis parameters, erythropoietic agents in haemodialysis

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Authors: Su Sin Chong, Abdul Aziz Abdul Raman, Sulaiman Wadi Harun, Hamzah Arof

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Chemical Oxygen Demand (COD) plays a vital role determination of an appropriate strategy for wastewater treatment including the control of the quality of an effluent. In this study, a new sensing method was introduced for the first time and developed to investigate chemical oxygen demand (COD) using a Mach-Zehner Interferometer (MZI)-based dye sensor. The sensor is constructed by bridging two single mode fibres (SMF1 and SMF2) with a short section (~20 mm) of multimode fibre (MMF) and was formed by tapering the MMF to generate evanescent field which is sensitive to perturbation of sensing medium. When the COD concentration increase takes effect will induce changes in output intensity and effective refractive index between the microfiber and the sensing medium. The adequacy of decisions based on COD values relies on the quality of the measurements. Therefore, the dual output response can be applied to the analytical procedure enhance measurement quality. This work presents a detailed assessment of the determination of COD values in synthetic wastewaters. Detailed models of the measurement performance, including sensitivity, reversibility, stability, and uncertainty were successfully validated by proficiency tests where supported on sound and objective criteria. Comparison of the standard method with the new proposed method was also conducted. This proposed sensor is compact, reliable and feasible to investigate the COD value.

Keywords: chemical oxygen demand, environmental sensing, Mach-Zehnder interferometer sensor, online monitoring

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Authors: Mutshinye Manguvhewa, Maria Florence, Mansoo Yu, Elize Koch, Kamal Kamaloodien

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Substance use among pregnant women is a perennial problem in the Western Cape Province of South Africa. There are many influential factors are associated with substance use among women of childbearing age. The study explored factors associated with substance use among pregnant women using a qualitative research design and the bio-ecological theoretical framework to explore and guide the researcher throughout the study. Participants were selected using purposive sampling. Only participants accessed from the Department of Social Development meeting the inclusion criteria of the study were interviewed using semi structured interviews. Immediate referral for psychological intervention during the interview was available for participants who needed it. Braun and Clarke's six phases of thematic analysis were utilised to analyse the data. The study adheres to ethical guidelines for the participants' protection. Participants were informed about the study before the initiation of the interviews and the details of their voluntary participation were explained. The key findings from this study illustrate that socio-cultural factors, personal factors, emotional response and intimate relationships are the major contributing factors to substance use among pregnant women in this sample. The results outline the preventative measures that pregnant women implement. Lastly, the study reveals the positive and negative perceptions of substance use programmes that participants share. Some of the study findings are similar to the existing literature and some of the findings differed. Recommendations emanating from the study include that the stakeholders, rehabilitation centres, Department of Health and future researchers should act proactively against substance use during pregnancy.

Keywords: substance addiction, antenatal care, pregnancy, substance use

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Authors: Jamaludin Tarkim, Yoga Teguh Guntara, Maftuhah

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Islamic leadership style is model of leadership style applied by the Prophet Muhammad SAW. Islamic leadership style is applied, namely Syura (deliberation), ‘Adl bil qisth (justice, with equality), and Hurriyyah al-kalam (freedom of expression) and along with the values of Islam in the Islamic leadership style. This research aims to gain an overview of the experience of Head Nurse in the implementation of Islamic leadership style. This research is a qualitative one with descriptive phenomenology design through in-depth interviews. Participants were occupied as Head Nurse at the Hospital room Syarif Hidayatullah, set directly (purposive) with the principle of suitability (appropriateness) and sufficiency (adequacy). Retrieval of data and research conducted during the month of June 2014. Data collected in the form of recording in-depth interviews and analysis with Collazi method. This research identified four themes Syura (deliberation);‘Adl bil qisth (justice, with equality); Hurriyyah al-kalam (freedom of expression) and along with the values of Islam in the Islamic leadership style. The results of this research can provide a review of the Head Room experience in the application of Islamic leadership style at Syarif Hidayatullah Hospital already skilled leadership during the process, but the application is still not maximized. Required further research on in-depth exploration of how to get more comprehensive results from room Head Nurse experience in the application of Islamic leadership style, as well as subsequent researchers can choose a wider scope and complex so get more complete data.

Keywords: experience, Islamic leadership style, head nurse, nursing management

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Authors: Akintayo Opawole, Godwin O. Jagboro

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Research efforts on infrastructure development in Nigeria had not provided adequate assessment of issues essential for policy response by the government to address infrastructure deficiency. One major gap existing in previous studies is the assessment of challenges facing the budgetary financing model. Based on a case study of Osun State in Southwestern Nigeria, factors affecting budgetary financing of public infrastructure were identified from literature and brainstorming. Respondents were: 6 architects, 4 quantity surveyors, 6 town planners, 5 estate surveyors, 4 builders, 21 engineers and 26 economists/accountants ranging from principal to director who have been involved in policy making process with respect to infrastructure development in the public service of Osun state. The identified variables were subjected to factor analysis. The Kaiser-Meyer-Olkin measure of sampling adequacy tests carried out (KMO, 0.785) showed that the data collected were adequate for the analysis and the Bartlett’s test of sphericity (0.000) showed the data upon which the analysis was carried out was reliable. Results showed that factors such as poor collaboration between the state and local government establishments, absence of credible database system and inadequate funding of maintenance were the most significant to infrastructure development in the State. Policy responses to address challenges of infrastructure development in the state were identified to focus on creation of legal framework for liberation policy, enforcement of ‘due process’ in the procurement and establishment of monitoring system for project delivery.

Keywords: development, infrastructure, financing, procurement

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Authors: Yogita Tulsian, R. S. Gupta, K. F. Laserson

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Background: Delays in the diagnosis and treatment of TB facilitates disease transmission in the community, so we conducted a study to evaluate the burden of and risk factors for delay in TB diagnosis and initiation of TB treatment among patients in the private and public sectors in Udaipur district, Rajasthan, India. Methods: A retrospective cohort study was conducted among 100 new sputum-positive TB. Patients were interviewed in the intensive phase of treatment September 2013-November 2013 Long total diagnosis delay (TDD) was defined as a time interval between first symptom to confirmed diagnosis > 30 days. Long health treatment delay (HTD) was defined as a time interval between confirmed diagnosis to treatment initiation > 7 days. Results: We observed a median TDD of 55 days (range: 7-136 days) in the public sector and of 92 days (11-380 days) in the private sector. Long TDD in the private sector was significantly associated with middle-higher socio-economic status (Risk Ratio (RR): 2;95% CI: 1.3-3). The reasons reported from the private sector for long TDD were suspect TB patients not advised for sputum examination (RR: 42; 95% CI:2.6-660), practise of self-medication (RR: 17.4; 95% CI: 1.1-267), or lack of awareness (RR: 9.7;95% CI: 0.6-145). The median HTD in the public sector was 3 days (range: 0-14 days), and in the private sector, 2 days (range: 0-11 days) (non-significant difference). Conclusions: Long TDD in private sector may be improved through sputum referral for all suspect TB cases and better education to all regarding TB.

Keywords: diagnosis delay, treatment delay, privatesector, public sector

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Authors: Ragy Raafat Gaber Attaalla

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Background: We looked at acute poisonings brought on by illegal drugs and pharmaceuticals that influence the nervous system at Assiut University Hospitals. Methods: Between January 2010 and December 2015, we conducted a retrospective examination of patient records from the largest tertiary toxicology referral center in Assiut. We examined the frequency, pattern, and distribution of ages and genders of acute nervous system agent poisoning. Results: 29,083 individuals total—16,657 (57.27%) males and 12,426 (42.73%) females—were included in the current study. Men's and women's median ages were 29 and 26, respectively (p < 0.0001). 10,326 (83.10%) women and 12,071 (72.47%) men under 40 were present (p < 0.001). 44.10% of cases had a history of poisoning, and the majority of cases (69.38% in men and 79.00% in women, p<0.001) were purposeful. Between various age groups and nervous system agents, there were notable variations in the ratios of men and women. The most often used agent for women was alprazolam, whereas methadone was more popular for men. Overall, there was a rising tendency in acute poisoning associated with alcohol and opioids used to treat addiction disorders, but a declining trend with benzodiazepines and antidepressants. Conclusion: Addiction to methadone was widespread, particularly in young males, and the majority of these cases were self-inflicted. Alprazolam and clonazepam poisoning most commonly affect women and males in the 20–29 age range, respectively. Opium was utilized by men over 30 and women over 60. Over half of the deaths were related to illicit narcotics, with opium being the most common. This research could raise awareness and lead to the development of gender- and age-specific local programs for education and prevention.

Keywords: acute poisonings, illegal drugs, pharmaceuticals, nerve system

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Authors: Katie-Beth Webster

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Mucormycosis is a rare opportunistic fungal infection that, if left untreated, can cause large scale tissue necrosis and death. There are a number of cases of this in the literature, most commonly in the head and neck region arising from sinuses. It is also usually found in immunocompromised patient subgroups. This study reviewed a number of cases of mucormycosis in previously fit and healthy young trauma patients to assess predisposing factors for infection and adequacy of current treatment paradigms. These trauma patients likely contracted the fungal infection from the soil at the site of the incident. Despite early washout and debridement of the wounds at the scene of the injury and on arrival in hospital, both these patients contracted mucormycosis. It was suspected that inadequate early debridement of soil contaminated limbs was one of the major factors that can lead to catastrophic tissue necrosis. In both cases, this resulted in the patients having a higher level of amputation than would have initially been required based on the level of their injury. This was secondary to cutaneous and soft tissue necrosis secondary to the fungal infiltration leading to osteomyelitis and systemic sepsis. In the literature, it appears diagnosis is often protracted in this condition secondary to inadequate early treatment and long processing times for fungal cultures. If fungal cultures were sent at the time of first assessment and adequate debridements are performed aggressively early, it could lead to these critically unwell trauma patients receiving appropriate antifungal and surgical treatment earlier in their episode of care. This is likely to improve long term outcomes for these patients.

Keywords: mucormycosis, plastic surgery, osteomyelitis, trauma

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Authors: Mohd Dahlan Abdul Malek, Muhamad Idris, Adi Fahrudin, Ida Shafinaz Mohamed Kamil, Husmiati Yusuf, Edeymend Reny Japil, Wan Anor Wan Sulaiman, Lailawati Madlan, Alfred Chan, Nurfarhana Adillah Aftar, Mahirah Masdin

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This research intended to develop a valid and reliable instrument of the Satisfaction with Life Scale (SWLS) to measure satisfaction with life (SWL) constructs among public and private university students in Sabah, Malaysia, through the exploratory factor analysis (EFA) procedure. The pilot study obtained a sample of 108 students from public and private education institutions in Sabah, Malaysia, through an online survey using a self-administered questionnaire. The researchers performed the EFA procedure on SWL construct using IBM SPSS 25. The Bartletts' Test of Sphericity is highly significant (Sig. = .000). Furthermore, the sampling adequacy by Kaiser-Meyer-Olkin (KMO = 0.839) is excellent. Using the extraction method of Principal Component Analysis (PCA) with Varimax Rotation, a component of the SWL construct is extracted with an eigenvalue of 3.101. The variance explained for this component is 62.030%. The construct of SWL has Cronbach's alpha value of .817. The development scale and validation confirmed that the instrument is consistent and stable with both private and public college and university student samples. It adds a remarkable contribution to the measurement of SWLS, mainly in the context of higher education institution students. The EFA outcomes formed a configuration that extracts a component of SWL, which can be measured by the original five items established in this research. This research reveals that the SWL construct is applicable to this study.

Keywords: satisfaction, university students, measurement, scale development

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Authors: Daud Muhammad

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Introduction: Ankle radiographs are frequently requested in Emergency Departments (ED) for patients presenting with traumatic ankle pain. The Ottawa Ankle Rules (OAR) serve as a clinical guideline to determine the necessity of these radiographs, aiming to reduce unnecessary imaging. This audit was conducted to evaluate the adequacy of clinical information provided in radiograph requests in relation to the OAR. Methods: A retrospective analysis was performed on 50 consecutive ankle radiograph requests under ED clinicians' names for patients aged above 5 years, specifically excluding follow-up radiographs for known fractures. The study assessed whether the provided clinical information met the criteria outlined by the OAR. Results: The audit revealed that none of the 50 radiograph requests contained sufficient information to satisfy the Ottawa Ankle Rules. Furthermore, 10 out of the 50 radiographs (20%) identified fractures. Discussion: The findings indicate a significant lack of adherence to the OAR, suggesting potential overuse of radiography and unnecessary patient exposure to radiation. This non-compliance may also contribute to increased healthcare costs and resource utilization, as well as possible delays in diagnosis and treatment. Recommendations: To address these issues, the following recommendations are proposed: (1) Education and Training: Enhance awareness and training among ED clinicians regarding the OAR. (2) Standardised Request Forms: Implement changes to imaging request forms to mandate relevant information according to the OAR. (3) Scan Vetting: Promote awareness among radiographers to discuss the appropriateness of scan requests with clinicians. (4) Regular re-audits should be conducted to monitor improvements in compliance.

Keywords: Ottawa ankle rules, ankle radiographs, emergency department, traumatic pain

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Authors: Shang-Sin Shiu, Shu-I Chin, Hsiu-Ju Chen, Ru-Yu Lien

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The Hospice and Palliative Care Act has undergone three revisions, making it less challenging for terminal patients to withdraw life support systems. However, the adequacy of care before withdraw is a crucial factor in end-of-life medical treatment. The author observed that intensive care unit (ICU) nursing staff often rely on simple flowcharts or word of mouth, leading to inadequate preparation and failure to meet patient needs before withdraw. This results in confusion or hesitation among those executing the process. Therefore, there is a motivation to improve the withdraw of patient care processes, establish standardized procedures, ensure the accuracy of removal execution, enhance end-of-life care self-efficacy for nursing staff, and improve the overall quality of care. The investigation identified key issues: the lack of applicable guidelines for ICU care for withdraw from life-sustaining, insufficient education and training on withdraw and end-of-life care, scattered locations of withdraw-related tools, and inadequate self-efficacy in withdraw from life-sustaining care. Solutions proposed include revising withdraw care processes and guidelines, integrating tools and locations, conducting educational courses, and forming support groups. After the project implementation, the accuracy of removal cognition improved from 78% to 96.5%, self-efficacy in end-of-life care after removal increased from 54.7% to 93.1%, and the correctness of care behavior progressed from 27.7% to 97.8%. It is recommended to regularly conduct courses on removing life support system care and grief consolation to enhance the quality of end-of-life care.

Keywords: the intensive care unit (ICU) patients, nursing staff, withdraw life support systems, self-efficacy

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Authors: Solomon Gebremariam, Mulugeta Naizigi, Aregawi Haileselassie

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Background: Knowledge of the pattern of bacterial isolates and their antimicrobial susceptibility is crucial for guiding empirical treatment and infection prevention and control measures. Objective: The aim of this study was to analyze the pattern of bacterial isolates and their susceptibility patterns from various specimens. Methods: Retrospectively, a total of 1067 microbiological culture results that were isolated, characterized, and identified by standard microbiological methods and whose antibiotic susceptibility was determined using CLSI guidelines between 2017 and 2019 were retrieved and analyzed. Data were entered and analyzed using the Stata release 10.1 statistical package. Result: The positivity rate of culture was 26.04% (419/1609). The most common bacteria isolated were S. aureus 23.8% (94), E. coli 15.1% (60), Klebsiella pneumonia 14.1% (56), Pseudomonas aeruginosa 8.5% (34), and CONS 7.3% (29). S. aureus and CONS showed a high (58.1% - 96.2%) rate of resistance to most antibiotics tested. They were less resistant to Vancomycin which is 18.6% (13/70) and 11.8% (2/17), respectively. Similarly, the resistance of E. coli, Klebsella pneumonia, and Pseudomonas aeruginosa was high (69.4% - 100%) to most antibiotics. They were less resistant to Ciprofloxacilin, which is 41.1% (23/56), 19.2% (10/52), and 16.1% (5/31), respectively. Conclusion: This study has shown that there is a high rate of antibiotic resistance among bacterial isolates in this hospital. A combination of Vancomycin and Ciprofloxacin should be considered in the choice of antibiotics for empirical treatment of suspected infections due to S. aureus, CONS, E. coli, Klebsiella pneumonia, Pseudomonas such as in infections within hospital setup.

Keywords: antimicrobial, resistance, bacteria, hospital

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Authors: Bernard Igoche Igoche, Olumuyiwa Matthew, Peter Bednar, Alexander Gegov

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This study presents an ontology-driven approach for knowledge discovery and validation from admission databases in Nigerian polytechnic institutions. The research aims to address the challenges of extracting meaningful insights from vast amounts of admission data and utilizing them for decision-making and process improvement. The proposed methodology combines the knowledge discovery in databases (KDD) process with a structural causal model (SCM) ontological framework. The admission database of Benue State Polytechnic Ugbokolo (Benpoly) is used as a case study. The KDD process is employed to mine and distill knowledge from the database, while the SCM ontology is designed to identify and validate the important features of the admission process. The SCM validation is performed using the conditional independence test (CIT) criteria, and an algorithm is developed to implement the validation process. The identified features are then used for machine learning (ML) modeling and prediction of admission status. The results demonstrate the adequacy of the SCM ontological framework in representing the admission process and the high predictive accuracies achieved by the ML models, with k-nearest neighbors (KNN) and support vector machine (SVM) achieving 92% accuracy. The study concludes that the proposed ontology-driven approach contributes to the advancement of educational data mining and provides a foundation for future research in this domain.

Keywords: admission databases, educational data mining, machine learning, ontology-driven knowledge discovery, polytechnic education, structural causal model

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Authors: Benhammadi Hocine, Djamel Boubaya, Chaffai Hicham

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Meskiana Area is characterized by a semi-arid climate where the water supply for irrigation and industry is not sufficient as the priority goes for domestic use. To meet the increasing population growth and development, the authorities have considered building a new water retaining structure on some major temporary water streams. For this purpose Chebabta site on Oued Meskiana was chosen as the future dam site. It is large enough to store the desired volume of water. This study comes to investigate the conditions of the site and the adequacy of the ground as a foundation for the projected dam. The conditions of the site include the geological structure and mainly the presence of discontinuities in the formation on which the dam will be built, the nature of the lithologies under the foundation and the future lake, and the presence of any hazard. This site characterization is usually carried out using different methods in order to highlight any underground buried problematic structure. In this context, the different geophysical technics remain the most used ones. Three geophysical methods were used in the case of the Chebabta dam site, namely, electric survey, seismic refraction, and tomography. The choice of the technics and the location of the scan line was made on the basis of the available geological data. In this sense, profiles have been established on both banks of Oued Meskiana. The obtained results have allowed a better characterization of the geological structure, defining the limit between the surface cover and the bedrock, which is, in other words, the limit between the weathered zone and the bedrock. Their respective thicknesses were also determined by seismic refraction and electrical resistivity sounding. However, the tomography imaging technic has succeeded in positioning a fault structure passing through the right bank of the wadi.

Keywords: dam site, fault, geophysic, investigation, Meskiana

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Authors: Joleen L. H. Lee, K. F. Yen, Janette W. P. Ng, D. Woon, Mandy M. Y. Lau, Ivan M. H. Woo, S. N. Goh

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Case assignment systems are created to meet a need for equity in work distribution and better match between medical social workers' (MSWs) competencies and patients' problems. However, there is no known study that has explored how MSWs in Singapore assign cases to achieve equity in work distribution. Focus group discussions were conducted with MSWs from public hospitals to understand their perception on equitable workload and case allocation. Three approaches to case allocation were found. First is the point system where points are allocated to cases based on a checklist of presenting issues identified most of the time by non-MSWs. Intensity of case is taken into consideration, but allocation of points is often subject to variation in appreciation of roles of MSWs by the source of referral. Second is the round robin system, where all MSWs are allocated cases based on a roster. This approach resulted in perceived equity due to element of luck, but it does not match case complexity with competencies of MSWs. Third approach is unit-based allocation, where MSWs are assigned to attend to cases from specific unit. This approach helps facilitate specialization among MSWs but may result in MSWs having difficulty providing transdisciplinary care due to narrow set of knowledge and skills. Trade-offs resulted across existing approaches for case allocation by MSWs. Conversations are needed among Singapore MSWs to decide on a case allocation system that comes with trade-offs that are acceptable for patients and other key stakeholders of the care delivery system.

Keywords: case allocation, equity, medical social worker, work distribution

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