Search results for: covid-19 and mental health outcomes

Authors: Lucia Liu, Matthew Koziol

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Obsessive-compulsive disorder (OCD), a long-lasting anxiety disorder involving recurrent, intrusive thoughts, affects over 2 million adults in the United States. Transcranial magnetic stimulation (TMS) stands out as a noninvasive, cutting-edge therapy that has been shown to reduce symptoms in patients with treatment-resistant OCD. The Food and Drug Administration (FDA) approved protocol pairs TMS sessions with individualized symptom provocation, aiming to improve the susceptibility of brain circuits to stimulation. However, limited standardization or guidance exists on how to conduct symptom provocation and which methods are most effective. This study aims to compare the effect of internal versus external techniques to induce obsessional stress in a clinical setting during TMS therapy. Two symptom provocation methods, (i) Asking patients thought-provoking questions about their obsessions (internal) and (ii) Requesting patients to perform obsession-related tasks (external), were employed in a crossover design with repeated measurement. Thirty-six treatments of NeuroStar TMS were administered to each of two patients over 8 weeks in an outpatient clinic. Patient One received 18 sessions of internal provocation followed by 18 sessions of external provocation, while Patient Two received 18 sessions of external provocation followed by 18 sessions of internal provocation. The primary outcome was the level of self-reported obsessional stress on a visual analog scale from 1 to 10. The secondary outcome was self-reported OCD severity, collected biweekly in a four-level Likert-scale (1 to 4) of bad, fair, good and excellent. Outcomes were compared and tested between provocation arms through repeated measures ANOVA, accounting for intra-patient correlations. Ages were 42 for Patient One (male, White) and 57 for Patient Two (male, White). Both patients had similar moderate symptoms at baseline, as determined through the Yale-Brown Obsessive Compulsive Scale (YBOCS). When comparing obsessional stress induced across the two arms of internal and external provocation methods, the mean (SD) was 6.03 (1.18) for internal and 4.01 (1.28) for external strategies (P=0.0019); ranges were 3 to 8 for internal and 2 to 8 for external strategies. Internal provocation yielded 5 (31.25%) bad, 6 (33.33%) fair, 3 (18.75%) good, and 2 (12.5%) excellent responses for OCD status, while external provocation yielded 5 (31.25%) bad, 9 (56.25%) fair, 1 (6.25%) good, and 1 (6.25%) excellent responses (P=0.58). Internal symptom provocation tactics had a significantly stronger impact on inducing obsessional stress and led to better OCD status (non-significant). This could be attributed to the fact that answering questions may prompt patients to reflect more on their lived experiences and struggles with OCD. In the future, clinical trials with larger sample sizes are warranted to validate this finding. Results support the increased integration of internal methods into structured provocation protocols, potentially reducing the time required for provocation and achieving greater treatment response to TMS.

Keywords: obsessive-compulsive disorder, transcranial magnetic stimulation, mental health, symptom provocation

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Authors: Xu Feifei

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The prevalence of COVID-19 currently is the biggest challenge to improving people's quality of life. Its impact on the health-related quality of life (HRQoL) is highly uncertain and has not been summarized so far. The aim of the present systematic review was to assess and provide an up-to-date analysis of the impact of the COVID-19 pandemic on the HRQoL of participants who have been infected, have not been infected but isolated, frontline, with different diseases, and the general population. Therefore, an electronic search of the literature in PubMed databases was performed from 2019 to July 2022 (without date restriction). PRISMA guideline methodology was employed, and data regarding the HRQoL were extracted from eligible studies. Articles were included if they met the following inclusion criteria: (a) reports on the data collection of the health state utility values (HSUVs) related to COVID-19 from 2019 to 2021; (b) English language and peer-reviewed journals; and (c) original HSUV data; (d) using EQ-5D tool to quantify the HRQoL. To identify studies that reported the effects on COVID-19, data on the proportion of overall HSUVs of participants who had the outcome were collected and analyzed using a one-group meta-analysis. As a result, thirty-two studies fulfilled the inclusion criteria and, therefore, were included in the systematic review. A total of 45295 participants and provided 219 means of HSUVs during COVID-19 were included in this systematic review. The range of utility is from 0.224 to 1. The study included participants from Europe (n=16), North America (n=4), Asia (n=10), South America (n=1), and Africa (n=1). Twelve articles showed that the HRQoL of the participants who have been infected with COVID-19 (range of overall HSUVs from 0.6125 to 0.863). Two studies reported the population of frontline workers (the range of overall HSUVs from 0.82 to 0.93). Seven of the articles researched the participants who had not been infected with COVID-19 but suffered from morbidities during the pandemic (range of overall HSUVs from 0.5 to 0.96). Thirteen studies showed that the HRQoL of the respondents who have not been infected with COVID-19 and without any morbidities (range of overall HSUVs from 0.64 to 0.964). Moreover, eighteen articles reported the outcomes of overall HSUVs during the COVID-19 pandemic in different population groups. The estimate of overall HSUVs of direct COVID-19 experience population (n=1333) was 0.751 (95% CI 0.670 - 0.832, I2 = 98.64%); the estimate of frontline population (n=610) was 0.906 ((95% CI 0.854 – 0.957, I2 = 98.61%); participants with different disease (n=132) were 0.768 (95% CI 0.515 - 1.021, I2= 99.26%); general population without infection history (n=29,892) was 0.825 (95% CI 0.766 - 0.885, I2 =99.69%). Conclusively, taking into account these results, this systematic review might confirm that COVID-19 has a negative impact on the HRQoL of the infected population and illness population. It provides practical value for cost-effectiveness model analysis of health states related to COVID-19.

Keywords: COVID-19, health-related quality of life, meta-analysis, systematic review, utility value

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Authors: Tigist mamo, Beryl Oranga, Precious Mubanga

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High rates of child undernutrition in Ethiopia place children at significant risk, highlighting the need for low-cost, nutritious diets starting at six months of age. These diets should be diverse and rich in essential nutrients like proteins, vitamins, and minerals. However, many rural households participating in the Productive Safety Net Program (PSNP) struggle to afford fortified foods and often rely on low-protein, cereal-based diets, leading to micronutrient deficiencies. In addition, fasting practices further restrict the consumption of animal-source foods for 190 to 250 days each year, limiting dietary diversity even more. Addressing these challenges requires solutions beyond nutrition counseling, focusing on factors such as seasonality, food perishability, and safety to promote better health outcomes for children. The program's main objective is to empower caregivers with practical recipes for complementary feeding for children aged 6 to 23 months by enhancing meals with affordable ingredients like cereal, legumes, dried vegetables, and meat. The ongoing implementation research within the SPIR-II program is centered on developing a cost-effective mixed flour and exploring drying techniques to extend shelf life, ultimately addressing the delayed introduction of complementary foods and increasing nutrient-rich options in households. Saleswomen participating in the SPIR-II program have been empowered to produce easy-to-use local complementary flour and conduct door-to-door sales in their neighborhoods. Caregivers who have purchased and fed this flour to their children have reported significant improvements in their nutritional status. Additionally, SPIR-II is testing low-tech drying methods suitable for rural Ethiopian contexts to reduce food loss and promote the inclusion of nutrient-dense foods in children's diets. The paper will highlight the primary outcomes of these initiatives as they are being implemented.

Keywords: food preservation, easy-to-use mixed flour, complementary feeding, drying techniques

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Authors: Pradapet Krutchangthong, Jirawat Sudsawart

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This research aims to study the health tourism administration and factors related to health tourism promotion at Ban Nam Chieo Community, Laem Ngop, Trat Province. The sample in this research is 361 tourists who use the service and Ban Nam Chieo Community residents who provide the service. Sampling was done from a population size of 3,780 using Taro Yamane’s formula. The tools used in the study were questionnaires and interviews. The statistics used in this research are percentage, mean and standard deviation. The result of Model Development of Health Tourism at Ban Nam Chieo Community, Laem Ngop , Trat Province shows that most of them are female with bachelor degree. They are government officers with an average income between 16,001-20,000 Baht. Suggested health system activities for health tourism development are: 1) health massage, 2) herbal compress, 3) exercise in the water by walking on shell. Meanwhile, factors related to health tourism promotion at Ban Nam Chieo Community, Laem Ngop, Trat Province are: 1) understanding the context of the community and service providers, 2) cooperation from related government and private sectors.

Keywords: health tourism, health system activities, promotion, administration

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Authors: Aneena Suresh, C. S. Sidharth

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Drug related problems (DRPs) are common in chronic kidney disease (CKD) patients and end stage patients undergoing hemodialysis. To treat the co-morbid conditions of the patients, more complex therapeutic regimen is required, and it leads to development of DRPs. So, this calls for frequent monitoring of the patients. Due to the busy work schedules, physicians are unable to deliver optimal care to these patients. Addition of a clinical pharmacist in the team will improve the standard of care offered to CKD patients by minimizing DRPs. In India, the role of clinical pharmacists in the improving the health outcomes in CKD patients is poorly recognized. Therefore, this study is conducted to put an insight on the role of clinical pharmacist in improving Drug Related Problems in patients with chronic kidney disease, thereby helping them to achieve desired therapeutic outcomes in the patients. A prospective interventional study was conducted for a year in a 620 bedded tertiary care hospital in India. Data was collected using an unstructured questionnaire, medication charts, etc. DRPs were categorized using Hepler and Strand classification. Relationships between the age, weight, GFR, average no of medication taken, average no of comorbidities, and average length of hospital days with the DRPs were identified using Mann Whitney U test. The study population primarily constituted of patients above the age of 50 years with a mean age of 59.91±13.59. Our study showed that 25% of the population presented with DRPs. On an average, CKD patients are prescribed at least 8 medications for the treatment in our study. This explains the high incidence of drug interactions in patients suffering from CKD (45.65%). The least common DRPs in our study were found to be sub therapeutic dose (2%) and adverse drug reactions (2%). Out of this, 60 % of the DRPs were addressed successfully. In our study, there is an association between the DRPs with the average number of medications prescribed, the average number of comorbidities, and the length of the hospital days with p value of 0.022, 0.004, and 0.000, respectively. In the current study, 86% of the proposed interventions were accepted, and 41 % were implemented by the physician, and only 14% were rejected. Hence, it is evident that clinical pharmacist interventions will contribute significantly to diminish the DRPs in CKD patients, thereby decreasing the economic burden of healthcare costs and improving patient’s quality of life.

Keywords: chronic kidney disease, clinical pharmacist, drug related problem, intervention

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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Background: NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studiesare shortcoming on individual patient experience. The aim of this study was to assess the patient’ssatisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. Methods: For all patients managed with woodcast in our unit, we undertook a structured questionnairethat included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score, and the pain numerical score at the time of injury and six weeks after. Results: 30 patients were initially managed with woodcast.80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. Conclusion: For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Pariscasting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Nader Al-Rashidi, David Greenhalgh

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Mathematical modelling techniques are now being used by health organizations worldwide to help understand the likely impact that intervention strategies treatment options and combinations of these have on the prevalence and incidence of hepatitis C virus (HCV) in the people who inject drugs (PWID) population. In this poster, we develop a deterministic, compartmental mathematical model to approximate the spread of the HCV in a PWID population that has been divided into two groups by time since onset of injection. The model assumes that after injection needles adopt the most infectious state of their previous state or that of the PWID who last injected with them. Using analytical techniques, we find that the model behaviour is determined by the basic reproductive number R₀, where R₀ = 1 is a critical threshold separating two different outcomes. The disease-free equilibrium is globally stable if R₀ ≤ 1 and unstable if R₀ > 1. Additionally, we make some simulations where have confirmed that the model tends to this endemic equilibrium value with realistic parameter values giving an HCV prevalence.

Keywords: hepatitis C, people who inject drugs, HCV, PWID

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Authors: Shahid Nishat, Keith Thomas

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E-government initiatives attract substantial public investments around the world. These investments are based on the premise of digital transformation of the public services, improved efficiency and transparency, and citizen participation in the social democratic processes. However, many e-Government projects, especially in developing countries, fail to achieve their intended outcomes, and a strong disparity exists between the investments made and outcomes achieved, often referred to as e-Government paradox. Further, there is lack of research on evaluating the impacts of e-Government in terms of public value it creates, which ultimately drives usage. This study aims to address these gaps by identifying key enablers of e-Government success and by proposing a public value based framework to examine impact of e-Government services. The study will extend Delone and McLean Information System (IS) Success model by integrating Technology Readiness (TR) characteristics to develop an integrated success model. Level of analysis will be mobile government applications, and the framework will be empirically tested using quantitative methods. The research will add to the literature on e-Government success and will be beneficial for governments, especially in developing countries aspiring to improve public services through the use of Information Communication Technologies (ICT).

Keywords: e-Government, IS success model, public value, technology adoption, technology readiness

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Authors: Ricardo Bragança, Tom Vinaimont

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This paper discusses the introduction of processes of self-determined learning (heutagogy) into a graduate course on financial modeling, using elements of entangled pedagogy and Biggs’ constructive alignment. To encourage learners to take control of their own learning journey and develop critical thinking and problem-solving skills, each session in the course receives tailor-made media-enhanced pedagogical assets. The design of those assets specifically supports entangled pedagogy, which opposes technological or pedagogical determinism in support of the collaborative integration of pedagogy and technology. Media assets for each of the ten sessions in this course consist of three components. The first component in this three-pronged approach is a game-cut-like cinematographic representation that introduces the context of the session. The second component represents a character from an open-source-styled community that encourages self-determined learning. The third component consists of a character, which refers to the in-person instructor and also aligns learning outcomes and assessment tasks, using Biggs’ constructive alignment, to the cinematographic and open-source-styled component. In essence, the course's metamorphosis helps students apply the concepts they've studied to actual financial modeling issues. The audio-visual media assets create a storyline throughout the course based on gamified and real-world applications, thus encouraging student engagement and interaction. The structured entanglement of pedagogy and technology also guides the instructor in the design of the in-class interactions and directs the focus on outcomes and assessments. The transformation process of this graduate course in financial modeling led to an institutional teaching award in 2021. The transformation of this course may be used as a model for other courses and programs in many disciplines to help with intended learning outcomes integration, constructive alignment, and Assurance of Learning.

Keywords: innovative education, active learning, entangled pedagogy, heutagogy, constructive alignment, project based learning, financial modeling, graduate business education

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Authors: Anshu Radha Aggarwal

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Higher Education (HE) in the India has experienced a series of remarkable changes over the last fifteen years as successive governments have sought to make the sector more efficient and more accountable for investment of public funds. Rapid expansion in student numbers and pressures to widen Participation amongst non-traditional students are key challenges facing HE. Learning outcomes can act as a benchmark for assuring quality and efficiency in HE and they also enable universities to describe courses in an unambiguous way so as to demystify (and open up) education to a wider audience. This paper examines how learning outcomes are used in HE and evaluates the implications for curriculum design and student learning. There has been huge expansion in the field of higher education, both technical and non-technical, in India during the last two decades, and this trend is continuing. It is expected that another about 400 colleges and 300 universities will be created by the end of the 13th Plan Period. This has lead to many concerns about the quality of education and training of our students. Many studies have brought the issues ailing our curricula, delivery, monitoring and assessment. Govt. of India, (via MHRD, UGC, NBA,…) has initiated several steps to bring improvement in quality of higher education and training, such as National Skills Qualification Framework, making accreditation of institutions mandatory in order to receive Govt. grants, and so on. Moreover, Outcome-based Education and Training (OBET) has also been mandated and encouraged in the teaching/learning institutions. MHRD, UGC and NBAhas made accreditation of schools, colleges and universities mandatory w.e.f Jan 2014. Outcome-based Education and Training (OBET) approach is learner-centric, whereas the traditional approach has been teacher-centric. OBET is a process which involves the re-orientation/restructuring the curriculum, implementation, assessment/measurements of educational goals, and achievement of higher order learning, rather than merely clearing/passing the university examinations. OBET aims to bring about these desired changes within the students, by increasing knowledge, developing skills, influencing attitudes and creating social-connect mind-set. This approach has been adopted by several leading universities and institutions around the world in advanced countries. Objectives of this paper is to highlight the issues concerning quality in higher education and quality frameworks, to deliberate on the various education and training models, to explain the outcome-based education and assessment processes, to provide an understanding of the NAAC and outcome-based accreditation criteria and processes and to share best-practice outcomes-based accreditation system and process.

Keywords: learning outcomes, curriculum development, pedagogy, outcome based education

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Authors: Khaled M. Alqahtani

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Copy number alterations (CNA) are variations in the structure of the genome, where certain regions deviate from the typical two chromosomal copies. These alterations are pivotal in understanding tumor progression and are indicative of patients' survival outcomes. However, effectively modeling patients' survival based on their genomic CNA profiles while identifying relevant genomic regions remains a statistical challenge. Various methods, such as the Cox proportional hazard (PH) model with ridge, lasso, or elastic net penalties, have been proposed but often overlook the inherent dependencies between genomic regions, leading to results that are hard to interpret. In this study, we enhance the elastic net penalty by incorporating an additional penalty that accounts for these dependencies. This approach yields smooth parameter estimates and facilitates variable selection, resulting in a sparse solution. Our findings demonstrate that this method outperforms other models in predicting survival outcomes, as evidenced by our simulation study. Moreover, it allows for a more meaningful interpretation of genomic regions associated with patients' survival. We demonstrate the efficacy of our approach using both real data from a lung cancer cohort and simulated datasets.

Keywords: copy number alterations, cox proportional hazard, lung cancer, regression, sparse solution

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Authors: Husain A. Murad, Ali A. Dashti, Ali Al-Kandari

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The outbreak of Coronavirus during the Spring semester of 2020 brought new challenges for the teaching of vocational mass communication courses at universities in Kuwait. Using the Media Richness Theory (MRT), this study examines the response of 252 university students on mass communication programs. A questionnaire regarding their perceptions and preferences concerning modes of instruction on vocational courses online, focusing on the four factors of MRT: immediacy of feedback, capacity to include personal focus, conveyance of multiple cues, and variety of language. The outcomes show that immediacy of feedback predicted all criterion variables: suitability of distance learning (DL) for teaching vocational courses, sentiments of students toward DL, perceptions of easiness of evaluation of DL coursework, and the possibility of retaking DL courses. Capacity to include personal focus was another positive predictor of the criterion variables. It predicted students’ sentiments toward DL and the possibility of retaking DL courses. The outcomes are discussed in relation to implications for using DL, as well as constructing an agenda for DL research.

Keywords: distance learning, media richness theory, traditional learning, vocational media courses

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Authors: Salam Abukhadrah

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This research advocates for the use of feminist evaluation (FE) as a tool of great potential in policy and program assessment in relation to women’s empowerment. This research explores the journey of women’s place into the evaluation and international development. Moreover, this research presents a case example of the use of FE on the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), in Ganaparthi village in rural India, in Andhra Pradesh state (AP). This evaluation is formed on the basis of women’s empowerment framework that seeks to examine empowerment as a process and an end in itself rather than as just simplified quantifiable outcomes. This framework is used to conduct in-depth semi-structured interviews that are later cross-validated by a focus group discussion. In addition, this evaluation draws on secondary data from the MGNREGA website and on extracted data from the National Family Health Survey of AP.

Keywords: feminist evaluation, MGNREGA, women’s empowerment, case example, India

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Authors: Darius Danesh, Michael J. Ryan, Alireza Abbasi

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Project Portfolio Management (PPM) is an essential component of an organisation’s strategic procedures, which requires attention of several factors to envisage a range of long-term outcomes to support strategic project portfolio decisions. To evaluate overall efficiency at the portfolio level, it is essential to identify the functionality of specific projects as well as to aggregate those findings in a mathematically meaningful manner that indicates the strategic significance of the associated projects at a number of levels of abstraction. PPM success is directly associated with the quality of decisions made and poor judgment increases portfolio costs. Hence, various Multi-Criteria Decision Making (MCDM) techniques have been designed and employed to support the decision-making functions. This paper reviews possible option to improve the decision-making outcomes in the organisational portfolio management processes using the Analytic Hierarchy Process (AHP) both from academic and practical perspectives and will examine the usability, certainty and quality of the technique. The results of the study will also provide insight into the technical risk associated with current decision-making model to underpin initiative tracking and strategic portfolio management.

Keywords: analytic hierarchy process, decision support systems, multi-criteria decision making, project portfolio management

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Authors: Ali Rashash Alzahrani, Elizabeth Stojanovski

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Data on various aspects of education are collected at the institutional and government level regularly. In Australia, for example, students at various levels of schooling undertake examinations in numeracy and literacy as part of NAPLAN testing, enabling longitudinal assessment of such data as well as comparisons between schools and states within Australia. Another source of educational data collected internationally is via the PISA study which collects data from several countries when students are approximately 15 years of age and enables comparisons in the performance of science, mathematics and English between countries as well as ranking of countries based on performance in these standardised tests. As well as student and school outcomes based on the tests taken as part of the PISA study, there is a wealth of other data collected in the study including parental demographics data and data related to teaching strategies used by educators. Overall, an abundance of educational data is available which has the potential to be used to help improve educational attainment and teaching of content in order to improve learning outcomes. A multivariate assessment of such data enables multiple variables to be considered simultaneously and will be used in the present study to help develop profiles of students based on performance in mathematics using data obtained from the PISA study.

Keywords: cluster analysis, education, mathematics, profiles

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Authors: Chizzoniti Domenico, Beggiora Klizia, Cattani Letizia, Moscatelli Monica

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This paper concerns the study of sustainable construction materials applied on the "Health Post", a prototype for the primary health care situated in alienated areas of the world. It's suitable for social and climatic Sub-Saharan context; however, it could be moved in other countries of the world with similar urgent needs. The idea is to create a Health Post with local construction materials that have a low environmental impact and promote the local workforce allowing reuse of traditional building techniques lowering production costs and transport. The aim of Primary Health Care Centre is to be a flexible and expandable structure identifying a modular form that can be repeated several times to expand its existing functions. In this way it could be not only a health care centre but also a socio-cultural facility.

Keywords: low costs building, sustainable construction materials, green construction system, prototype, health care, emergency

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Authors: Ghiwa Dandach

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By challenging the anti-failure bias and contributing to the theoretical territory of the attribution theory, this thesis develops a comprehensive process for entrepreneurial learning from failure. The practical implication of the findings suggests assisting entrepreneurs (current, failing, and nascent) in effectively anticipating and reflecting upon failure. Additionally, the process is suggested to enhance the level of institutional and private (accelerators and financers) support provided to entrepreneurs, the implications of which may improve future opportunities for entrepreneurial success. Henceforth, exploring learning from failure is argued to impact the potential survival of future ventures, subsequently revitalizing the economic contribution of entrepreneurship. This learning process can be enhanced with the cognitive development of causal ascriptions for failure, which eventually impacts learning outcomes. However, the mechanism with which entrepreneurs make sense of failure, reflect on the journey, and transform experience into knowledge is still under-researched. More specifically, the cognitive process of failure attribution is under-explored, majorly in the context of developing economies, calling for a more insightful understanding on how entrepreneurs ascribe failure. Responding to the call for more thorough research in such cultural contexts, this study expands the understanding of the dimensions of failure attributions as perceived by entrepreneurs and the impact of these dimensions on learning outcomes in the Lebanese context. The research adopted the exploratory interpretivism paradigm and collected data from interviews with industry experts first, followed by narratives of entrepreneurs using the qualitative multimethod approach. The holistic and categorical content analysis of narratives, preceded by the thematic analysis of interviews, unveiled how entrepreneurs ascribe failure by developing minor and major dimensions of each failure attribution. The findings have also revealed how each dimension impacts the learning from failure when accompanied by emotional resilience. The thesis concludes that exploring in-depth the dimensions of failure attributions significantly determines the level of learning generated. They are moving beyond the simple categorisation of ascriptions as primary internal or external unveiled how learning may occur with each attribution at the individual, venture, and ecosystem levels. This has further accentuated that a major internal attribution of failure combined with a minor external attribution generated the highest levels of transformative and double-loop learning, emphasizing the role of personal blame and responsibility on enhancing learning outcomes.

Keywords: attribution, entrepreneurship, reflection, sense-making, emotions, learning outcomes, failure, exit

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Authors: Nevila Bardhi, Joanna Magda, Kolapo Alex-Oni, Slavenka Sedlar, Paromita Hore

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The New York City Department of Health and Mental Hygiene (NYC DOHMH) receives blood lead test results for NYC residents and conducts lead poisoning case investigations for individuals with elevated blood lead levels exposed to lead occupationally and non-occupationally. To (1) improve participant engagement, (2) aid the identification of potential lead sources, and (3) better tailor recommendations to reduce lead exposure, Motivational Interviewing (MI) techniques were incorporated during risk assessment interviews of non-pregnant adults by DOHMH’s Adult Lead Poisoning Prevention (ALP) Program. MI is an evidence-based counselling method used in clinical settings that have been effective in promoting behavior change by resolving ambivalence and enhancing motivation in treating both physiological and psychological health conditions. The incorporation of MI techniques in the ALP risk assessment interview was effective in improving the identification of lead sources for non-pregnant adult cases, thus, allowing for the opportunity to better tailor lead poisoning prevention recommendations. The embedding of MI cues in the ALP risk assessment interview also significantly increased engagement in the interview process, resulting in approximately 50 more interviews conducted per year and a decrease in interview refusals during case investigations. Additionally, the pre-MI interview completion rate was 57%, while the post-MI Interview completion rate was 68%. We recommend MI techniques to be used by other lead poisoning prevention programs during lead poisoning investigations in similar diverse populations.

Keywords: lead poisoning prevention, motivational interviewing, behavior change, lead poisoning risk factors, self-efficacy

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Authors: Nicholas Bayfield, Liam Bibo, Charley Budgeon, Robert Larbalestier, Tom Briffa

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Introduction: Stress hyperglycaemia is common following cardiac surgery. Its optimal management is uncertain and may differ by diabetic status. This study assesses the in-hospital glycaemic management of cardiac surgery patients and associated postoperative outcomes. Methods: A retrospective cohort analysis of all patients undergoing cardiac surgery at Fiona Stanley Hospital from February 2015 to May 2019 was undertaken. Management and outcomes of hyperglycaemia following cardiac surgery were assessed. Follow-up was assessed to 1 year postoperatively. Multivariate regression modelling was utilised. Results: 1050 non-diabetic patients and 689 diabetic patients were included. In the non-diabetic cohort, patients with mild (peak blood sugar level [BSL] < 14.3), transient stress hyperglycaemia managed without insulin were not at an increased risk of wound-related morbidity (P=0.899) or mortality at 1 year (P=0.483). Insulin management was associated with wound-related readmission to hospital (P=0.004) and superficial sternal wound infection (P=0.047). Prolonged or severe stress hyperglycaemia was predictive of hospital re-admission (P=0.050) but not morbidity or mortality (P=0.546). Diabetes mellitus was an independent risk factor 1-year mortality (OR; 1.972 [1.041–3.736], P=0.037), graft harvest site wound infection (OR; 1.810 [1.134–2.889], P=0.013) and wound-related readmission (OR; 1.866 [1.076–3.236], P=0.026). In diabetics, postoperative peak BSL > 13.9mmol/L was predictive of graft harvest site infections (OR; 3.528 [1.724-7.217], P=0.001) and wound-related readmission OR; 3.462 [1.540-7.783], P=0.003) regardless of modality of management. A peak BSL of 10.0-13.9 did not increase the risk of morbidity/mortality compared to a peak BSL of < 10.0 (P=0.557). Diabetics with a peak BSL of 13.9 or less did not have significantly increased morbidity/mortality outcomes compared to non-diabetics (P=0.418). Conclusion: In non-diabetic patients, transient mild stress hyperglycaemia following cardiac surgery does not uniformly require treatment. In diabetic patients, postoperative hyperglycaemia with peak BSL exceeding 13.9mmol/L was associated with wound-related morbidity and hospital readmission following cardiac surgery.

Keywords: cardiac surgery, pulmonary embolism, pulmonary embolectomy, cardiopulmonary bypass

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Authors: Beatrix Faragó, Zsolt Szakály, Ágnes Kovácsné Tóth, Csaba Konczos, Norbert Kovács, Zsófia Pápai, Tamás Kertész

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The future of the nation is the embodiment of a healthy society. A key segment of government policy is the development of health and a health-oriented environment. As a result, sport as an activator of health is an important area for development. In Hungary, sport is a strategic sector with the aim of developing a sports nation. The function of sport in the global society is multifaceted, which is manifested in both social and economic terms. The economic importance of sport is gaining ground in the world, with implications for Central and Eastern Europe. Smaller states, such as Hungary, cannot ignore the economic effects of exploiting the effects of sport. The relationship between physical activity and health is driven by the health economy towards the nation's economic factor. In our research, we analyzed sport as a national strategy sector and its impact on age groups. By presenting the current state of health behavior, we get an idea of the directions where development opportunities require even more intervention. The foundation of the health of a nation is the young age group, whose shaping of health will shape the future generation. Our research was attended by university students from the Faculty of Health and Sports Sciences who will be experts in the field of health in the future. The other group is the elderly, who are a growing social group due to demographic change and are a key segment of the labor market and consumer society. Our study presents the health behavior of the two age groups, their differences, and similarities. The survey also identifies gaps in the development of a health management strategy that national strategies should take into account.

Keywords: competitiveness, health behavior, health economy, health management, sports nation

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Authors: Shraddha Acharya, Sharad Kumar Sharma, Ratna Bhattarai, Bhagwan Maharjan, Deepak Dahal, Serpahine Kaminsa

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Background: Drug-resistant (DR) tuberculosis (TB) continues to be a threat in Nepal, with an estimated 2800 new cases every year. The treatment of DR-TB with second line TB drugs is complex and takes longer time with comparatively lower treatment success rate than drug-susceptible TB. Delay in treatment initiation for DR-TB patients might further result in unfavorable treatment outcomes and increased transmission. This study thus aims to determine median time taken to initiate second-line treatment among Rifampicin Resistant (RR) diagnosed TB patients and to assess the proportion of treatment delays among various type of DR-TB cases. Method: A retrospective cohort study was done using national routine electronic data (DRTB and TB Laboratory Patient Tracking System-DHIS2) on drug resistant tuberculosis patients between January 2020 and December 2022. The time taken for treatment initiation was computed as– days from first diagnosis as RR TB through Xpert MTB/Rif test to enrollment on second-line treatment. The treatment delay (>7 days after diagnosis) was calculated. Results: Among total RR TB cases (N=954) diagnosed via Xpert nationwide, 61.4% were enrolled under shorter-treatment regimen (STR), 33.0% under longer treatment regimen (LTR), 5.1% for Pre-extensively drug resistant TB (Pre-XDR) and 0.4% for Extensively drug resistant TB (XDR) treatment. Among these cases, it was found that the median time from diagnosis to treatment initiation was 6 days (IQR:2-15.8). The median time was 5 days (IQR:2.0-13.3) among STR, 6 days (IQR:3.0-15.0) among LTR, 30 days (IQR:5.5-66.8) among Pre-XDR and 4 days (IQR:2.5-9.0) among XDR TB cases. The overall treatment delay (>7 days after diagnosis) was observed in 42.4% of the patients, among which, cases enrolled under Pre-XDR contributed substantially to treatment delay (72.0%), followed by LTR (43.6%), STR (39.1%) and XDR (33.3%). Conclusion: Timely diagnosis and prompt treatment initiation remain fundamental focus of the National TB program. The findings of the study, however suggest gaps in timeliness of treatment initiation for the drug-resistant TB patients, which could bring adverse treatment outcomes. Moreover, there is an alarming delay in second line treatment initiation for the Pre-XDR TB patients. Therefore, this study generates evidence to identify existing gaps in treatment initiation and highlights need for formulating specific policies and intervention in creating effective linkage between the RR TB diagnosis and enrollment on second line TB treatment with intensified efforts from health providers for follow-ups and expansion of more decentralized, adequate, and accessible diagnostic and treatment services for DR-TB, especially Pre-XDR TB cases, due to the observed long treatment delays.

Keywords: drug-resistant, tuberculosis, treatment initiation, Nepal, treatment delay

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Authors: Mohammadreza Mohebbi, Masoumeh Sanagou

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The ability to predict clinical outcomes is of great importance to physicians and clinicians. A number of different methods have been used in an effort to accurately predict these outcomes. These methods include the development of scoring systems based on multivariate statistical modelling, and models involving the use of classification and regression trees. The process usually consists of two consecutive phases, namely model development and external validation. The model development phase consists of building a multivariate model and evaluating its predictive performance by examining calibration and discrimination, and internal validation. External validation tests the predictive performance of a model by assessing its calibration and discrimination in different but plausibly related patients. A motivate example focuses on prediction modeling using a sample of patients undergone coronary artery bypass graft (CABG) has been used for illustrative purpose and a set of primary considerations for evaluating prediction model studies using specific quality indicators as criteria to help stakeholders evaluate the quality of a prediction model study has been proposed.

Keywords: clinical prediction models, clinical decision rule, prognosis, external validation, model calibration, biostatistics

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Authors: Alper Tolga Kumtepe, Erdem Erdogdu, M. Recep Okur, Eda Kaypak, Ozlem Kaya, Serap Ugur, Deniz Dincer, Hakan Yildirim

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Interaction is one of the most important components of open and distance learning. According to Moore, who proposed one of the keystones on interaction types, there are three basic types of interaction: learner-teacher, learner-content, and learner-learner. From these interaction types, learner-content interaction, without doubt, can be identified as the most fundamental one on which all education is based. Efficacy, efficiency, and attraction of open and distance learning systems can be achieved by the practice of effective learner-content interaction. With the development of new technologies, interactive e-learning materials have been commonly used as a resource in open and distance learning, along with the printed books. The intellectual engagement of the learners with the content that is course materials may also affect their satisfaction for the open and distance learning practices in general. Learner satisfaction holds an important place in open and distance learning since it will eventually contribute to the achievement of learning outcomes. Using the learner-content interaction activities in course materials, Anadolu University, by its Open Education system, tries to involve learners in deep and meaningful learning practices. Especially, during the e-learning material design and production processes, identifying appropriate learner-content interaction activities within the context of learning outcomes holds a big importance. Considering the lack of studies adopting this approach, as well as its being a study on the use of e-learning materials in Open Education system, this research holds a big value in open and distance learning literature. In this respect, the present study aimed to investigate a) which learner-content interaction activities included in interactive courses are the most effective in learners’ achievement of verbal information learning outcomes and b) to what extent distance learners are satisfied with these learner-content interaction activities. For this study, the quasi-experimental research design was adopted. The 120 participants of the study were from Anadolu University Open Education Faculty students living in Eskişehir. The students were divided into 6 groups randomly. While 5 of these groups received different learner-content interaction activities as a part of the experiment, the other group served as the control group. The data were collected mainly through two instruments: pre-test and post-test. In addition to those tests, learners’ perceived learning was assessed with an item at the end of the program. The data collected from pre-test and post-test were analyzed by ANOVA, and in the light of the findings of this approximately 24-month study, suggestions for the further design of e-learning materials within the context of learner-content interaction activities will be provided at the conference. The current study is planned to be an antecedent for the following studies that will examine the effects of activities on other learning domains.

Keywords: interaction, distance education, interactivity, online courses

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Authors: Tharaki S. Hettiarachchi

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Sustainable construction has gained massive attention in the present world as the construction industry is highly responsible for carbon emissions and other types of unsustainable practices. Yet, the construction industry has not been able to completely attain sustainable goals. Therefore, the present study aims to identify the extent to which sustainability has been considered within the scope of construction project management and to analyze the challenges, gaps, and constraints associated. Accordingly, this study develops a sustainable framework to integrate in construction project management. In accomplishing the research aim, this research integrates a qualitative approach while relying on secondary data sources. The data shall be then analyzed with the use of a systematic literature review (SLR) method while following the PRISMA (2020) guideline and represented in a statistical form. The outcomes of this study may become highly significant in identifying the nature of the existing sustainable frameworks associated with construction project management scopes and to develop a new framework to integrate in order to enhance the effectiveness of sustainable applications in construction management. The outcomes of this research may benefit present and future construction professionals and academicians to organize sustainable construction-related knowledge in a useful way to apply in practical implementation for effective project management. Overall, this study directs present and future construction professionals toward an advanced construction project management mechanism.

Keywords: construction, framework development, project management, sustainability

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Authors: Liberata Borralho, Saúl N. de Jesus, Adelinda Candeias, Victória Fernández-Puig

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In the last decades, we have witnessed a deterioration in the health of teachers worldwide, reflecting the constant social, political and economic changes. The quality of teaching and the success of students depends on the health status of the teachers, which justifies the importance of periodically evaluating their health. With this purpose, the Teacher’s Health Questionnaire was applied to 15.394 teachers teaching in Portugal and Spain (6.208 Spanish and 9.186 Portuguese) of primary and secondary education (3.482 men, 11.911 women). This questionnaire is specific and includes both the main risks of the teaching profession and the manifestations of teacher well-being, according to the definition recommended by the World Health Organization. A descriptive analysis of the results was carried out, including a study of the dimensions and the differences according to some sociodemographic and professional variables, from an analysis of variance ANOVA, applying the Bonferroni correction. Cluster analysis (K-means) allowed us to obtain cutoff scores to assess health status. The results allow concluding that Portuguese teachers perceive a poor well-being in the performance of their professional activity and that more than half present manifestations in the various dimensions of health deterioration, highlighting the exhaustion and cognitive disorders. In turn, Spanish teachers demonstrate a high level of well-being, being the musculoskeletal dimensions and cognitive disorders the main manifestations of deterioration of health.

Keywords: job prevention, occupational health, teacher’s health, teachers work risks, teacher’s well-being

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Authors: Ceyda Sensin

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Chios Island in Greece hosts many refugees from the Middle East since the Turkey-EU Refugee Deal. Thus, it has become commonplace for non-governmental organizations (NGO) to provide help for refugees in various ways. The purpose of this research is to identify ways in which improvements can be made in the educational services offered to young adult refugees (age group 14-22) by the NGO’s. To meet this aim, an unstructured observational technique was used in this qualitative study. The data was collected as a participant observer in February 2018. According to the observations made in this study, it came out that international NGOs may utilize volunteering team members on an urgent basis since they are a free resource from all around the world. In this study, it was observed that the volunteering team members without any teaching qualifications or teaching experience have struggled with reaching refugee students with or without potential mental health problems from exposure to stress, turmoil and trauma. Therefore, this study highly recommends the use of more relevantly trained professionals, alongside the volunteer staff. Alternatively, the volunteer staffs need to have teacher training and periodical refresher training.

Keywords: ethnographic study, non-governmental organizations, refugees, qualitative research method

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Authors: Dercan Gencbas, Hatice Bebis, Sue Moorhead

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In the nursing process, many of the nursing classification systems were created to be used in international. From these, NANDA-I, Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC). In this direction, the main objective of this study is to establish a model for caregivers in hospitals and communities in Turkey and to ensure that nursing outputs are assessed by NOC-based measures. There are many scales to measure Urinary Incontinence (UI), which is very common in children, in old age, vaginal birth, NOC scales are ideal for use in the nursing process for comprehensive and holistic assessment, with surveys available. For this reason, the purpose of this study is to evaluate the validity of the NOC outputs and indicators used for UI NANDA-I. This research is a methodological study. In addition to the validity of scale indicators in the study, how much they will contribute to recovery after the nursing intervention was assessed by experts. Scope validations have been applied and calculated according to Fehring 1987 work model. According to this, nursing inclusion criteria and scores were determined. For example, if experts have at least four years of clinical experience, their score was 4 points or have at least one year of the nursing classification system, their score was 1 point. The experts were a publication experience about nursing classification, their score was 1 point, or have a doctoral degree in nursing, their score was 2 points. If the expert has a master degree, their score was 1 point. Total of 55 experts rated Fehring as a “senior degree” with a score of 90 according to the expert scoring. The nursing interventions to be applied were asked to what extent these indicators would contribute to recovery. For coverage validity tailored to Fehring's model, each NOC and NOC indicator from specialists was asked to score between 1-5. Score for the significance of indicators was from 1=no precaution to 5=very important. After the expert opinion, these weighted scores obtained for each NOC and NOC indicator were classified as 0.8 critical, 0.8 > 0.5 complements, > 0.5 are excluded. In the NANDA-I / NOC / NIC system (guideline), 5 NOCs proposed for nursing diagnoses for UI were proposed. These outputs are; Urinary Continence, Urinary Elimination, Tissue Integrity, Self CareToileting, Medication Response. After the scales are translated into Turkish, the weighted average of the scores obtained from specialists for the coverage of all 5 NOCs and the contribution of nursing initiatives exceeded 0.8. After the opinions of the experts, 79 of the 82 indicators were calculated as critical, 3 of the indicators were calculated as supplemental. Because of 0.5 > was not obtained, no substance was removed. All NOC outputs were identified as valid and usable scales in Turkey. In this study, five NOC outcomes were verified for the evaluation of the output of individuals who have received nursing knowledge of UI and variant types. Nurses in Turkey can benefit from the outputs of the NOC scale to perform the care of the elderly incontinence.

Keywords: nursing outcomes, content validity, nursing diagnosis, urinary incontinence

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Authors: Aliakbar Hafezi, Jalal Taherian, Mahsa Elahi, Jamshid Abedi

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Background: Patients with breast cancer with different molecular subtypes may have different pathological responses to neoadjuvant chemotherapy (NAC). The aim of this study was to evaluate the pathological response to NAC in patients with locally advanced breast cancer based on molecular subtypes. Method: In this retrospective cohort study, 210 female patients with breast cancer candidate for NAC referred to the radiation oncology departments in southern Iran between August 2019 and September 2024 were evaluated in terms of pathologic complete response (pCR) based on immunohistochemical molecular markers (estrogen and progesterone receptors, Her-2/neu and Ki-67), overall survival (OS) and disease-free survival (DFS). Results: The mean age of the patients was 38.22 ± 10.34 years, and 68 patients (32.4%) had a positive family history of breast cancer. The pCR rate was 17.6% (37 patients), which in the subtypes of luminal A, luminal B, Her-2/neu positive and triple negative was 7.7%, 16.9%, 26.5% and 21.05%, respectively. Patients with pCR had significantly better OS (78.4% vs. 49.1%, P = 0.014) and DFS (83.8% vs. 51.4%, P = 0.020) than patients with partial/no pathological response. Conclusion: It seems that the molecular subtype plays a decisive role in the clinical outcome and the pathological response to NAC in patients with locally advanced breast cancer.

Keywords: locally advanced breast cancer, neoadjuvant chemotherapy, pathologic complete response, clinical outcomes

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Authors: Zeinab Aliyas

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Walking is known as the most common type of physical activity that helps mental and physical health of people. In the recent years, promoting walking activity in neighborhood areas and cities become as one of the important issues in terms of sustainable cities. Therefore the study aimed to investigate the influence of fear of crime and personal barriers as social and personal factor respectively on neighborhood walking. 464 questionnaires in Bandar Baru Bangi in Malaysia was distributed to collect data, and finally, 424 questionnaires were qualified to be used in the study. The Smart-PLS was used to analyze the data. The findings of the study revealed that individual barriers and fear of crime both have significant influence on the level of walking behavior in the neighborhood area. It was found that fear of crime has higher influence on walking behavior in comparison to individual factors. The finding of this study can help urban researcher and planner to know the significant influence of crime safety and individual attitudes on the level of walking activity.

Keywords: fear of crime, neighborhood walking, personal barriers, residential neighborhood

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Authors: Muncharee Phaobthip

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In this research, the researcher re-examine the mediating effect of employee engagement between its antecedents and consequences for investigates the relation of leadership practices, employment branding and employee engagement based on social exchange theory. As such the researcher has four objectives as follows: First, to study the effects of leadership practices on employment branding, employee engagement and work intention; second, to examine the effects of employer brand perception on employee engagement and work intention; third, to examine the effects of employee engagement on work intention; and last, forth, the researcher inquires into the respondence of work intention. The researcher constituted a sample population of 535 employees of a Thai hotel chain located in four regions of the Kingdom of Thailand (Thailand). The researcher utilized a mixed-methods approach divided into quantitative and qualitative research investigatory phases, respectively. In the quantitative phase of research investigation, the researcher collected germane data from the 535 members of the sample population through the use of a questionnaire as a research instrument. In the qualitative phase of research investigation, relevant data were obtained through carrying out in-depth interviews with three subgroups of members of the sample population. These three subgroups consisted of twelve hotelier experts, six employees at the administrator level, and operational level employees. Focus group discussions were held with discussants from these three subgroups. Findings are as follows: Leadership practices showed positive effects on employment branding, employee engagement, and work intention. Employment branding displayed positive effects on employee engagement and work intention. Employee engagement had positive effects on work intention. However, in the analysis of the equation, the researcher confirmed that the important role of employee engagement is mediator factor between its antecedent and consequence factors. This provides benefits, in that it augments the body of knowledge devoted to the fostering of employee engagement in respect to psychological conditions. In conclusion, the researcher found that the value co-creation between leaders, employers and employees had positive effects on employee outcomes for lead to business outcomes according to reciprocal rule.

Keywords: antecedents, employee engagement, psychological conditions, work intention

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