Search results for: clinical advice services

Authors: Wanwadee Neamsakul

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VARK learning style is an effective method of learning that could enhance all skills of the students like visual (V), auditory (A), read/write (R), and kinesthetic (K). This learning style benefits the students in terms of professional competencies, critical thinking and lifelong learning which are the desirable characteristics of the nursing students. This study aimed to develop a model of teaching and learning clinical practicum at postpartum ward for nursing students by using VARK learning styles, and evaluate the nursing students’ opinions about the developmental model. A methodology used for this study was research and development (R&D). The model was developed by focus group discussion with five obstetric nursing instructors who have experiences teaching Maternal Newborn and Midwifery I subject. The activities related to practices in the postpartum (PP) ward including all skills of VARK were assigned into the matrix table. The researcher asked the experts to supervise the model and adjusted the model following the supervision. Subsequently, it was brought to be tried out with the nursing students who practiced on the PP ward. Thirty third year nursing students from one of the northern Nursing Colleges, Academic year 2015 were purposive sampling. The opinions about the satisfaction of the model were collected using a questionnaire which was tested for its validity and reliability. Data were analyzed using descriptive statistics. The developed model composed of 27 activities. Seven activities were developed as enhancement of visual skills for the nursing students (25.93%), five activities as auditory skills (18.52%), six activities as read and write skills (22.22%), and nine activities as kinesthetic skills (33.33%). Overall opinions about the model were reported at the highest level of average satisfaction (mean=4.63, S.D=0.45). In the aspects of visual skill (mean=4.80, S.D=0.45) was reported at the highest level of average satisfaction followed by auditory skill (mean=4.62, S.D=0.43), read and write skill (mean=4.57, S.D=0.46), and kinesthetic skill (mean=4.53, S.D=0.45) which were reported at the highest level of average satisfaction, respectively. The nursing students reported that the model could help them employ all of their skills during practicing and taking care of the postpartum women and newborn babies. They could establish self-confidence while providing care and felt proud of themselves by the benefits of the model. It can be said that using VARK learning style to develop the model could enhance both nursing students’ competencies and positive attitude towards the nursing profession. Consequently, they could provide quality care for postpartum women and newborn babies effectively in the long run.

Keywords: model, nursing students, postpartum ward, teaching and learning clinical practicum

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Authors: Inci Aksu Kargin

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The civil war which began in the Daraa province of Syria in March 2011, has caused thousands of Syrians to die and millions more to seek refuge in other countries such as Turkey, Lebanon, Jordan, Iraq, and Egypt. In order to understand the Syrian refugees’ living conditions and the problems they have experienced in Turkey in-depth, and to analyze how the arrival of the Syrian refugees in Turkey has affected the local people who live in Turkish-Syrian border, this study employed interviews, which were conducted with three different groups. First, 60 Syrian refugees, who have settled in Hatay and Gaziantep, were interviewed. Then, the Turkish government institutions, and NGOs, which are responsible for assisting the refugees, were interviewed. These interviews revealed that many Syrian refugees have encountered with several issues such as access to labor and housing markets as well as free healthcare and public education services. Second, 60 Turkish citizens living in Hatay and Gaziantep provinces were interviewed. These interviews shed light on the many issues (e.g., increase of unemployment, increase in the rental and sale prices of the houses, decrease in the quality of healthcare services, increase in traffic problems, problems with regard to the usage of parks and gardens) that Turkish citizens began experiencing after mass asylum claim of the Syrian refugees to Turkey. In addition to these, the existing social problems in Turkey such as child labor, begging, child brides, and illegal marriages (religious marriages) worsen.

Keywords: migration, refugees, Syrian civil war, Turkey

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Authors: Welawat Tienpratarn, Chaiyaporn Yuksen, Rungrawin Promkul, Chetsadakon Jenpanitpong, Pajit Bunta, Suthap Jaiboon

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Supraventricular tachycardia (SVT) is an abnormally fast atrial tachycardia characterized by narrow (≤ 120 ms) and constant QRS. Adenosine was the drug of choice; the first dose was 6 mg. It can be repeated with the second and third doses of 12 mg, with greater than 90% success. The study found that patients observed at 4 hours after normal sinus rhythm was no recurrence within 24 hours. The objective of this study was to investigate the factors that influence the recurrence of SVT after adenosine in the emergency department (ED). The study was conducted retrospectively exploratory model, prognostic study at the Emergency Department (ED) in Faculty of Medicine, Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand. The study was conducted for ten years period between 2010 and 2020. The inclusion criteria were age > 15 years, visiting the ED with SVT, and treating with adenosine. Those patients were recorded with the recurrence SVT in ED. The multivariable logistic regression model developed the predictive model and prediction score for recurrence PSVT. 264 patients met the study criteria. Of those, 24 patients (10%) had recurrence PSVT. Five independent factors were predictive of recurrence PSVT. There was age>65 years, heart rate (after adenosine) > 100 per min, structural heart disease, and dose of adenosine. The clinical risk score to predict recurrence PSVT is developed accuracy 74.41%. The score of >6 had the likelihood ratio of recurrence PSVT by 5.71 times. The clinical predictive score of > 6 was associated with recurrence PSVT in ED.

Keywords: supraventricular tachycardia, recurrance, emergency department, adenosine

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Authors: Pumela Msweli, Dexter L. Ryneveldt

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This paper seeks to shed light on institutional logics and institutionalization processes that influence the successful implementation of financial sector regulations. We use the neo-institutional theory lens to interrogate how the newly promulgated Financial Sector Regulations Act (FSRA) provides for the institutionalisation of the Twin Peaks Model. With the enactment of FSRA, previous financial regulatory institutions were dismantled, and new financial regulators established. In point, the Financial Services Conduct Authority (FSCA) replaced the Financial Services Board (FSB), and accordingly, the Prudential Authority (PA) was established. FSRA is layered with complexities that make it mandatory to co-exist, cooperate, and collaborate with other institutions to fulfill FSRA’s overall financial stability objective. We use content analysis of the financial regulations that established the Twin Peaks Models (TPM) in South Africa and in the Netherlands, to map out the three-stage institutionalization processes: (1) habitualisation, (2) objectification and (3) sedimentation. This allowed for a comparison of how South Africa, as a developing country and Netherlands as a developed country, have institutionalized the Twin Peak model. We provide valuable insights into how differences in the institutional and societal logics of the developing and developed contexts shape the institutionalization of financial regulations.

Keywords: financial industry, financial regulation, financial stability, institutionalisation, habitualization, objectification, sedimentation, twin peaks model

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Authors: Monika Bansal

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Background: Placement of dental implant in narrow alveolar ridge is challenging to be treated. GBR procedure is currently most widely used to augment the deficient alveolar ridges and to treat the fenestration and dehiscence around dental implants. Thus, the objectives of the present study were to evaluate as well as compare the clinical performance of collagen membrane and titanium mesh for horizontal bone augmentation at dehisced implant sites. Methods and material: Total 12 single edentulous implant sites with buccal bone deficiency in 8 subjects were equally divided and treated simultaneously with either of the two membranes and DBBM(Bio-Oss) bone graft. Primary outcome measurements in terms of defect height and defect width were made using a calibrated plastic periodontal probe. Re-entry surgery was performed to remeasure the augmented site and to remove Ti-mesh at 6th month. Independent paired t-tests for the inter-group comparison and student-paired t-tests for the intra-group comparison were performed. The differences were considered to be significant at p ≤ 0.05. Results: Mean defect fill with respect to height and width was 3.50 ± 0.54 mm (87%) and 2.33 ± 0.51 mm (82%) for collagen membrane and 3.83 ± 0.75 mm (92%) and 2.50 ± 0.54 mm (88%) for Ti-mesh group respectively. Conclusions: Within the limitation of the study, it was concluded that mean defect height and width after 6 months were statistically significant within the group without significant difference between them, although defect resolution was better in Ti-mesh.

Keywords: collagen membrane, dehiscence, dental implant, horizontal bone, augmentation, ti-mesh

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Authors: Shaghayegh Rafatpanah, Mehrnaz Rad, Ahmad Reza Movassaghi, Javad Khoshnegah

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The purpose of the present study was to investigate the prevalence of isolation, antimicrobial susceptibility and ERIC-PCR typing of staphylococci species from dogs with pyoderma. The study animals were 61 clinical cases of Iranian domestic dogs with the first-time pyoderma. The prevalence of pyoderma was significantly higher amongst adult (odds Ratio: 0.21; p=0.001) large breed (odds Ratio: 2.42; p=0.002)dogs. There was no difference in prevalence of pyoderma in male and females (odds Ratio: 1.27; p= 0.337). The 'head, face and pinna' and 'trunk' were the most affected lesion regions, each with 19 cases (26.76%). An identifiable underlying disease was present in 52 (85.24%) of the dogs. Bacterial species were recovered from 43 of the 61 (70.49%) studied animals. No isolates were recovered from 18 studied dogs. The most frequently recovered bacterial genus was Staphylococcus (32/43 isolates, 74.41%) including S. epidermidis (22/43 isolates, 51.16%), S. aureus (7/43 isolates, 16.27%) and S. pseudintermedius (3/43 isolates, 6.97%). Staphylococci species resistance was most commonly seen against amoxicillin (94.11%), penicillin (83.35%), and ampicillin (76.47%). Resistant to cephalexin and cefoxitin was 5.88% and 2.94%, respectively. A total of 27 of the staphylococci isolated (84.37 %) were resistant to at least one antimicrobial agent, and 19 isolates (59.37%) were resistant to three or more antimicrobial drugs. There were no significant differences in the prevalence of resistance between the staphylococci isolated from cases of superficial and deep pyoderma. ERIC-PCR results revealed 19 different patterns among 22 isolates of S. epidermidis and 7 isolates of S. aureus.

Keywords: dog, pyoderma, Staphylococcus, Staphylococcus epidermidis, Iran

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Authors: Ashir Ahmed

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Peacekeeping is a collective responsibility of governments, law enforcement agencies, communities, families, and individuals. Moreover, the complex nature of peacekeeping activities requires a holistic and collaborative approach where various community sectors work together to form collective strategies that are likely to be more effective than strategies designed and delivered in isolation. Similarly, it is important to learn from past programs to evaluate the initiatives that have worked well and the areas that need further improvement. Review of recent peacekeeping initiatives suggests that there have been tremendous efforts and resources put in place to deal with the emerging threat of terrorism, radicalization and violent extremism through number of de-radicalization programs. Despite various attempts in designing and delivering successful programs for deradicalization, the threat of people being radicalized is growing more than ever before. This research reviews the prominent de-radicalization programs to draw an understanding of their strengths and weaknesses. Some of the weaknesses in the existing programs include. Inaccessibility: Limited resources, geographical location of potential participants (for offline programs), inaccessibility or inability to use various technologies (for online programs) makes it difficult for people to participate in de-radicalization programs. Timeliness: People might need to wait for a program on a set date/time to get the required information and to get their questions answered. This is particularly true for offline programs. Lack of trust: The privacy issues and lack of trust between participants and program organizers are another hurdle in the success of de-radicalization programs. The fear of sharing participants information with organizations (such as law enforcement agencies) without their consent led them not to participate in these programs. Generalizability: Majority of these programs are very generic in nature and do not cater the specific needs of an individual. Participants in these programs may feel that the contents are irrelevant to their individual situations and hence feel disconnected with purpose of the programs. To address the above-mentioned weaknesses, this research developed a framework that recommends some improvements in de-radicalization programs. One of the recommendations is to offer 24/7, secure, private and online hotline (also referred as helpline) for the people who have any question, concern or situation to discuss with someone who is qualified (a counsellor) to deal with people who are vulnerable to be radicalized. To make these hotline services viable and sustainable, the existing organizations offering support for depression, anxiety or suicidal ideation could additionally host these services. These helplines should be available via phone, the internet, social media and in-person. Since these services will be embedded within existing and well-known services, they would likely to get more visibility and promotion. The anonymous and secure conversation between a person and a counsellor would ensure that a person can discuss the issues without being afraid of information sharing with any third party – without his/her consent. The next stage of this project would include the operationalization of the framework by collaborating with other organizations to host de-radicalization hotlines and would assess the effectiveness of such initiatives.

Keywords: de-radicalization, framework, hotlines, peacekeeping

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Authors: Mohammad H. Yarmohammadian, Fatemeh Rezaei

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Introduction: Improving patient safety in health systems is one of the main priorities in healthcare systems, so clinical risk management in organizations has become increasingly significant. Although several tools have been developed for clinical risk management, each has its own limitations. Aims: This study aims to develop a comprehensive tool that can complete the limitations of each risk assessment and management tools with the advantage of other tools. Methods: Procedure was determined in two main stages included development of an initial model during meetings with the professors and literature review, then implementation and verification of final model. Subjects and Methods: This study is a quantitative − qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment of the two parts of the fourth phase and seven phases of the research was conducted. Purposive and stratification sampling of various responsible teams for the selected process was conducted in the operating room. Final model verified in eight phases through application of activity breakdown structure, failure mode and effects analysis (FMEA), healthcare risk priority number (RPN), root cause analysis (RCA), FT, and Eindhoven Classification model (ECM) tools. This model has been conducted typically on patients admitted in a day-clinic ward of a public hospital for surgery in October 2012 to June. Statistical Analysis Used: Qualitative data analysis was done through content analysis and quantitative analysis done through checklist and edited RPN tables. Results: After verification the final model in eight-step, patient's admission process for surgery was developed by focus discussion group (FDG) members in five main phases. Then with adopted methodology of FMEA, 85 failure modes along with its causes, effects, and preventive capabilities was set in the tables. Developed tables to calculate RPN index contain three criteria for severity, two criteria for probability, and two criteria for preventability. Tree failure modes were above determined significant risk limitation (RPN > 250). After a 3-month period, patient's misidentification incidents were the most frequent reported events. Each RPN criterion of misidentification events compared and found that various RPN number for tree misidentification reported events could be determine against predicted score in previous phase. Identified root causes through fault tree categorized with ECM. Wrong side surgery event was selected by focus discussion group to purpose improvement action. The most important causes were lack of planning for number and priority of surgical procedures. After prioritization of the suggested interventions, computerized registration system in health information system (HIS) was adopted to prepare the action plan in the final phase. Conclusion: Complexity of health care industry requires risk managers to have a multifaceted vision. Therefore, applying only one of retrospective or prospective tools for risk management does not work and each organization must provide conditions for potential application of these methods in its organization. The results of this study showed that the integrated clinical risk management model can be used in hospitals as an efficient tool in order to improve clinical governance.

Keywords: failure modes and effective analysis, risk management, root cause analysis, model

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Authors: Alaa Tag-Eldin Mohamed

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The environmental, cultural, social, and technological changes have led higher education institutes to question their traditional roles. Many declarations and frameworks highlight the importance of fulfilling social responsibility of higher education institutes. The study aims at developing a framework of university social responsibility and sustainability (USR&S) with focus on South Valley University (SVU) as a case study of Egyptian Universities. The study used meetings with 12 vice deans of community services and environmental affairs on social responsibility and environmental issues. The proposed framework integrates social responsibility with strategic management through the establishment and maintenance of the vision, mission, values, goals and management systems; elaboration of policies; provision of actions; evaluation of services and development of social collaboration with stakeholders to meet current and future needs of the community and environment. The framework links between different stakeholders internally and externally using communication and reporting tools. The results show that SVU integrates social responsibility and sustainability in its strategic plans. It has policies and actions however fragmented and lack of appropriate structure and budgeting. The proposed framework could be valuable for researchers and decision makers of the Egyptian Universities. The study proposed recommendations and highlighted building on the results and conducting future research.

Keywords: corporate social responsibility (CSR), south valley university, sustainable university, university social responsibility and sustainability (USR&S)

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Authors: Firdaous Zair, Zoubir Elfelsoufi, Mohammed Fourka

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The allocation of resources is an issue that is needed on the tactical and operational strategic plan. This work considers the allocation of resources in the case of pure players, manufacturers and Click & Mortars that have launched online sales. The aim is to improve the level of customer satisfaction and maintaining the benefits of e-retailer and of its cooperators and reducing costs and risks. Our contribution is a decision support system and tool for improving the allocation of resources in logistics chains e-commerce B2C context. We first modeled the B2C chain with all operations that integrates and possible scenarios since online retailers offer a wide selection of personalized service. The personalized services that online shopping companies offer to the clients can be embodied in many aspects, such as the customizations of payment, the distribution methods, and after-sales service choices. In addition, every aspect of customized service has several modes. At that time, we analyzed the optimization problems of supply chain resource allocation in customized online shopping service mode, which is different from the supply chain resource allocation under traditional manufacturing or service circumstances. Then we realized an optimization model and algorithm for the development based on the analysis of the allocation of the B2C supply chain resources. It is a multi-objective optimization that considers the collaboration of resources in operations, time and costs but also the risks and the quality of services as well as dynamic and uncertain characters related to the request.

Keywords: e-commerce, supply chain, B2C, optimisation, resource allocation

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Authors: Choon Seong Ng, P. Petrick, C. L. Lau

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Background: Carbapenem-resistant isolates have been increasingly reported recently. Carbapenem stewardship is designed to optimize its usage particularly among medical wards with high prevalence of carbapenem prescriptions to combat such emerging resistance. Carbapenem stewardship programmes (CSP) can reduce antibiotic use but clinical outcome of such measures needs further evaluation. We examined this in a prospective manner using feedback mechanism. Methods: Our single-center prospective cohort study involved all carbapenem prescriptions across the medical wards (including medical patients admitted to intensive care unit) in a tertiary university hospital setting. The impact of such stewardship was analysed according to the accepted and the rejected groups. The primary endpoint was safety. Safety measure applied in this study was the death at 1 month. Secondary endpoints included length of hospitalisation and readmission. Results: Over the 19 months’ period, input from 144 carbapenem prescriptions was analysed on the basis of acceptance of our CSP recommendations on the use of carbapenems. Recommendations made were as follows : de-escalation of carbapenem; stopping the carbapenem; use for a short duration of 5-7 days; required prolonged duration in the case of carbapenem-sensitive Extended Spectrum Beta-Lactamases bacteremia; dose adjustment; and surgical intervention for removal of septic foci. De-escalation, shorten duration of carbapenem and carbapenem cessation comprised 79% of the recommendations. Acceptance rate was 57%. Those who accepted CSP recommendations had no increase in mortality (p = 0.92), had a shorter length of hospital stay (LOS) and had cost-saving. Infection-related deaths were found to be higher among those in the rejected group. Moreover, three rejected cases (6%) among all non-indicated cases (n = 50) were found to have developed carbapenem-resistant isolates. Lastly, Pitt’s bacteremia score appeared to be a key element affecting the carbapenem prescription’s behaviour in this trial. Conclusions: Carbapenem stewardship program in the medical wards not only saves money, but most importantly it is safe and does not harm the patients with added benefits of reducing the length of hospital stay. However, more time is needed to engage the primary clinical teams by formal clinical presentation and immediate personal feedback by senior Infectious Disease (ID) personnel to increase its acceptance.

Keywords: audit and feedback, carbapenem stewardship, medical wards, university hospital

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Authors: Mohhamed El Habib Labdouni

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Introduction: Co-infection with VIH and tuberculosis poses one of the major ongoing challenges for global TB and AIDS prevention and control. The objective of this study is to raise the issue of the resurgence of TB, in People living with VIH supported in a referent center in western Algeria. Its epidemiological, clinical, biological and radiological new trends, and to compare the mortality rate between early and delayed ART. Methods: It was a prospective study, during 36 months from the 01st/01/2012 to 31st/12/2014, by identifying and analyzing cases of TB-VIH co-infection. Our population was devised in two groups/ early ART and delayed ART. The primary and secondary endpoints were analyzed with Kaplan-Meier curves and log-rank test the period of follow up, which was fixed at 300 weeks. Results: Sixty cases of co-infection TB -VIH were enrolled in our study: 78.3% had pulmonary tuberculosis associated with extra-pulmonary, 13.3% had only pulmonary tuberculosis and 08.3% presented strictly extra-pulmonary TB. The clinical particularity of this co-infection is the frequency of serious localization such us: pleural 23.3%, peritoneal 31.7%, and meningeal suffusion 13.3%.y-.biologicaly we notice the predominance both of pancytopenia and leucoanemia, hyponatremia in 38,6% and hypokalemia in 19,3%. By analyzing Kaplan-Meier survival curves, we notice that early ART initiation is associated with a significant reduction of all-cause mortality (p = 0,000), and we have identified several prognostic factors such as hypokalemia hyponatremia, leukocytosis thrombopenemia leucothrombopenia (p = 0,005). Conclusion: Our study confirms most of the results reported in the literature. Early ART initiation reduces the rate of all-cause mortality, despite the probability of the occurrence of TB-IRIS.

Keywords: TB-HIV co-infection, early ART, hyponatremia, extrapulmonary tuberculosis

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Authors: Michael Dimmer, Holger Flederer

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The basis of realizing a construction project is a technically flawless concept which satisfies conditions regarding environment and costs, as well as static-constructional terms. The presented software system actively supports civil engineers during the setup of optimal designs, by giving advice regarding durability, life-cycle costs, sustainability and much more. A major part of the surrounding conditions of a design process is gathered and assimilated by experienced engineers subconsciously. It is a question about eligible building techniques and their practicability by considering emerging costs. Planning engineers have acquired many of this experience during their professional life and use them for their daily work. Occasionally, the planning engineer should disassociate himself from his experience to be open for new and better solutions which meet the functional demands, as well. The developed expert system gives planning engineers recommendations for preferred design options of new constructions as well as for existing bridge constructions. It is possible to analyze construction elements and techniques regarding sustainability and life-cycle costs. This way the software provides recommendations for future constructions. Furthermore, there is an option to design existing road bridges especially for heavy duty transport. This implies a route planning tool to get quick and reliable information as to whether the bridge support structures of a transport route have been measured sufficiently for a certain heavy duty transport. The use of this expert system in bridge planning companies and building authorities will save costs massively for new and existent bridge constructions. This is achieved by consequently considering parameters like life-cycle costs and sustainability for its planning recommendations.

Keywords: expert system, planning process, road bridges, software system

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Authors: Josef Voracek, Jan Sima

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The main purpose of our study is to state the basic types of fitness customers. This paper aims to create a specific customer typology in today’s fitness centres in the region of Prague. Our suggested typology of Prague fitness centres customers is based on answers to the questions: What are the customers like, what are their preferences, and what kinds of services do they use more often in Prague fitness centres? These are the main aspects of the presented typology. A survey was conducted on a sample of 1004 respondents from 48 fitness centres, which ran during May 2012. We used questionnaires and latent class analysis for the assessment and interpretation of data. Gender was especially the main filter criterion. In the population, there were 522 males and 482 females. Data were analysed using the LCA method. We identified 6 segments of typical customers, of which three are male and three are female. Each segment is influenced primarily by the age of customers, from which we can develop further characteristics, such as education, income, marital status, etc. Male segments use the main workout area above all, whilst female segments use a much wider range of services offered, for example, group exercises, personal training, and cardio theatres. LCA method was found to be the most suitable tool, because cluster analysis is very limited in the forms and numbers of variables and indicators. Models of 3 latent classes for each gender are optimal, as it is demonstrated by entropy indices and matrices of the likelihood of the membership to the classes. A probable weak point of the survey is the selection of fitness centres, because of the market in Prague is really specific.

Keywords: customer, fitness, latent class analysis, typology

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Authors: Umamaheswari Shanmugam, Silvia Ronchi

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Software, artificial intelligence, and machine learning can improve healthcare through innovative and advanced technologies that can use the large amount and variety of data generated during healthcare services every day; one of the significant advantages of these new technologies is the ability to get experience and knowledge from real-world use and to improve their performance continuously. Healthcare systems and institutions can significantly benefit because the use of advanced technologies improves the efficiency and efficacy of healthcare. Software-defined as a medical device, is stand-alone software that is intended to be used for patients for one or more of these specific medical intended uses: - diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of a disease, any other health conditions, replacing or modifying any part of a physiological or pathological process–manage the received information from in vitro specimens derived from the human samples (body) and without principal main action of its principal intended use by pharmacological, immunological or metabolic definition. Software qualified as medical devices must comply with the general safety and performance requirements applicable to medical devices. These requirements are necessary to ensure high performance and quality and protect patients' safety. The evolution and the continuous improvement of software used in healthcare must consider the increase in regulatory requirements, which are becoming more complex in each market. The gap between these advanced technologies and the new regulations is the biggest challenge for medical device manufacturers. Regulatory requirements can be considered a market barrier, as they can delay or obstacle the device's approval. Still, they are necessary to ensure performance, quality, and safety. At the same time, they can be a business opportunity if the manufacturer can define the appropriate regulatory strategy in advance. The abstract will provide an overview of the current regulatory framework, the evolution of the international requirements, and the standards applicable to medical device software in the potential market all over the world.

Keywords: artificial intelligence, machine learning, SaMD, regulatory, clinical evaluation, classification, international requirements, MDR, 510k, PMA, IMDRF, cyber security, health care systems

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Authors: A. Mukrimah, M. Mohd Parid, H. F. Lim

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Wetland ecosystem has valuable resources that contribute to national income generation and public well-being, either directly by resources that have a market value or indirectly by resources that have no market value. Economic approach is used to evaluate the resources to determine the best use of wetland resources and should be emphasized in policy development planning. This approach is to prevent imbalance in the allocation of resources and welfare benefits. A case study was conducted in 2016 to assess the economic value of wetland ecosystem services at Pulau Kukup National Parks (PKNP). This study has applied dichotomous choice survey design Contingent Valuation Method (CVM) to investigate empirically the willingness-to-pay (WTP) by the public. The study interviewed 400 household respondents at Pontian, Johor. Analysis showed 81% of household interviewed were willing to contribute to the Wetland Conservation Trust Fund. The results also indicated that on average a household was willing to pay RM87 annually. By taking into account 21,664 households in Pontian district in 2016, public’s contribution to conserves wetland ecosystem at PKNP was calculated to be RM1, 884,334. From the public’s interest to contribute to the conservation of wetland ecosystem services at PKNP, it indicates that more concerted effort is needed by both the federal and state governments to conserve and rehabilitate the mangrove ecosystem in Malaysia.

Keywords: environmental economy, economic valuation, choice experiment, Pulau Kukup national parks

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Authors: Richard Okyere Boadu, Judith Obiri-Yeboah, Kwame Adu Okyere Boadu, Nathan Kumasenu Mensah, Grace Amoh-Agyei

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Routine health information system (RHIS) quality assurance has become an important issue, not only because of its significance in promoting a high standard of patient care but also because of its impact on government budgets for the maintenance of health services. A routine health information system comprises healthcare data collection, compilation, storage, analysis, report generation, and dissemination on a routine basis in various healthcare settings. The data from RHIS give a representation of health status, health services, and health resources. The sources of RHIS data are normally individual health records, records of services delivered, and records of health resources. Using reliable information from routine health information systems is fundamental in the healthcare delivery system. Quality assurance practices are measures that are put in place to ensure the health data that are collected meet required quality standards. Routine health information system quality assurance practices ensure that data that are generated from the system are fit for use. This study considered quality assurance practices in the RHIS processes. Methods: A cross-sectional study was conducted in eight health facilities in Tarkwa Sub-Municipal Health Service in the western region of Ghana. The study involved routine quality assurance practices among the 90 health staff and management selected from facilities in Tarkwa Sub-Municipal who collected or used data routinely from 24th December 2019 to 20th January 2020. Results: Generally, Tarkwa Sub-Municipal health service appears to practice quality assurance during data collection, compilation, storage, analysis and dissemination. The results show some achievement in quality control performance in report dissemination (77.6%), data analysis (68.0%), data compilation (67.4%), report compilation (66.3%), data storage (66.3%) and collection (61.1%). Conclusions: Even though the Tarkwa Sub-Municipal Health Directorate engages in some control measures to ensure data quality, there is a need to strengthen the process to achieve the targeted percentage of performance (90.0%). There was a significant shortfall in quality assurance practices performance, especially during data collection, with respect to the expected performance.

Keywords: quality assurance practices, assessment of routine health information system quality, routine health information system, data quality

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Authors: Wooseok Byon, Eunyoung Kim, Junseong Kwon, Byung Joo Song, Chan Heun Park

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Background/Purpose: Previous preclinical and clinical data suggest that increased lymphocytic infiltration would be associated with good prognosis and benefit from immunogenic chemotherapy especially in triple-negative breast cancer (TNBC). We investigated a single-center experience of TNBC and relationship with lymphocytic infiltration. Methods: From January 2004 to December 2012, at the Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, we retrospectively reviewed 897 breast cancer patients-clinical outcomes, clinicopathological characteristics, breast cancer subtypes. And we reviewed lymphocytic infiltration of TNBC specimens by two pathologists. Statistical analysis of risk factors associated with recurrence was performed. Results: A total of 897 patients, 76 were TNBC (8.47%). Mean age of TNBC patients were 50.95 (SD10.42) years, mean follow-up periods was 40.06 months. We reviewed 49 slides, and there were 8 recurrent breast cancer patients (16.32%), and 4 patients were expired (8.16%). There were 9 lymphocytic predominant breast cancers (LPBC)-carcinomas with either intratumoral lymphocytes in >60% of tumor cell nests. 1 patient of LPBC was recurred and 8 were not. In multivariate logistic regression, the odds ratio of lymphocytic infiltration was 0.59 (p=0.643). Conclusion: In a single-center experience of TNBC, the lymphocytic infiltration in tumor cell nest might be a good trend on the prognosis but there was not statistically significant.

Keywords: tumor-infiltrating lymphocytes, triple negative breast cancer, medical and health sciences

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Authors: Seda Muftugil-Yalcin

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With the proliferation of the number of social enterprises worldwide, there is now a whole ecosystem full of different organisational actors revolving around social enterprises. Impact hubs, incubation centers, and organisations (profit or non-profit) that offer consultancy services to social enterprises can be said to constitute one such cluster in the eco-system. These organisations offer a variety of services to social enterprises which desire to maximize their positive social impact. Especially with regards to impact measurement, there are numerous systems/guides/approaches/tools developed that claim to benefit social enterprises. Many organisations choose one of the existing tools and craft programs that help social enterprises to measure and to manage their social impacts. However, empirical evidence with regards to how the services of these consultancy organisations are precisely utilized on the field is scarce. This inevitably casts doubt on the impact of these organisations themselves. This research dwells on four case studies from the Netherlands and Turkey. In each country, two university-affiliated impact centers and two independent consultancy agencies that work with social entrepreneurs in the area of social impact measurement are closely examined. The overarching research question has been 'With regards to impact measurement, how do the founders/managers of these organisations perceive and make sense of their contribution to social enterprises and to the social entrepreneurship eco-system at large?' As for methodology, in-depth interviews were carried out with the managers/founders of these organisations and discourse analysis method has been used for data analysis together with grounded theory. The comparison between Turkey and Netherlands elucidate common denominators of impact measurement hype and discourses that are currently existing worldwide. In addition, it also reveals differing priorities of social enterprises in these different settings, which shape the expectations of social enterprises of consultancy organisations. Comparison between university affiliated impact hubs and independent consultancy organisations also give away important data about how different forms of consultancy organisations (in this case university based and independent) position themselves in relation to alike organisations with similar aims. The overall aim of the research is to reveal the contribution of the consultancy organisations that work with social enterprises to the social entrepreneurship field as perceived by them through a cross cultural study. The findings indicate that in both settings, the organisations that were claiming to bring positive social impact on the social entrepreneurship eco-system through their impact measurement trainings were themselves having a hard time in concretizing their own contributions; which indicated that these organisations were in need of a different impact measurement discourse than the ones they were championing.

Keywords: consultancy organisations, social entrepreneurship, social impact measurement, social impact discourse

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Authors: Md. S. Sabuz

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Bangladesh, a South Asian developing country, has achieved a remarkable breakthrough in health indicators during the last four decades despite immense income inequality. This phenomenon results in the mystical exclusion of marginalized people from obtaining health care facilities. However, the persistence of exclusion of the disadvantaged remains troubling. Exclusion occurs from occupational inferiority, pay and wage differences, educational backwardness, gender disparity to urban-rural complexity and eliminate the unprivileged from seeking and availing the health services. Evidence from Bangladesh shows that many sick people prefer to die at home without securing medical services because in previous times they were not treated well, not because the medical facilities were inadequate or antediluvian but the socio-economic class allows them to receive obdurate treatment. Furthermore, government and policymakers have given enormous emphasis on infrastructural development and achieving health indicators instead of ensuring quality services and inclusiveness of people from all spheres. Therefore, it is high time to address the issues concerning this and highlight the impact of economic status on health status in a sociological perspective. The objective of this study is to consider ways of assessing and exploring the impact of economic status for instance: occupational status, pay and wage variable, on health status in the context of Bangladesh. The hypotheses are that there are a significant number of factors affecting economic status which are impactful for health status eventually, but acute income inequality is a prominent factor. Illiteracy, gender disparity, remoteness, incredibility on services, superior costs, superstition etc. are the dominant indicators behind the economic factors influencing the health status. The chosen methodologies are a qualitative and quantitative approaches to accomplish the research objectives. Secondary sources of data will be used to conduct the study. Surveys will be conducted on the people who have ever been through the health care facilities and people from the different socio-economic and cultural backgrounds. Focus group discussions will be conducted to acquire the data from different cultural and regional citizens. The findings show that 48% of people who are from disadvantaged communities have been deprived of proper health care facilities. The general reasons behind this are the higher cost of medicines and other equipment. A significant number of people are unaware of the appropriate facilities. It was found that the socio-economic variables are the main influential factors that work as the driving force for both economic dimension and health status. Above all regional variables and gender, dimensions have an enormous effect on determining the health status of an individual or community. Amidst many positive achievements for example decrease in the child mortality rate, an increase in the immunization programs of the child etc., the inclusiveness of all classes of people in health care facilities has been overshadowed in Bangladesh. However, this phenomenon along with the socio-economic and cultural phenomena significantly demolishes the quality and inclusiveness of the health status of people.

Keywords: cultural context of health, economic status, gender and health, rural health care

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Authors: Rahmi Yetri Kasri, Paulus Wirutomo

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Citizen engagement approach has become increasingly important in the rural water sector. However, the question remains as to what exactly is meant by citizen engagement and how this approach can lead to sustainable service delivery. To understand citizen engagement, this paper argues that we need to understand basic elements of social life that consist of social structure, process, and culture within the realm of community’s living environment. Extracting from empirical data from Pamsimas villages in rural West Java, Indonesia, this paper will identify basic elements of social life and environment that influence and form the engagement of citizen and government in delivering and sustaining rural water supply services in Indonesia. Pamsimas or the Water Supply and Sanitation for Low Income Communities project is the biggest rural water program in Indonesia, implemented since 1993 in more than 27,000 villages. The sustainability of this sector is explored through a rural water supply service delivery life-cycle, starts with capital investment, operational and maintenance, asset expansion or renewal, strategic planning for future services and matching cost with financing. Using mixed-method data collection in case study research, this paper argues that increased citizen engagement contributes to a more sustainable rural water service delivery.

Keywords: citizen engagement, rural water supply, sustainability, Indonesia

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Authors: Asm Habibullah Choudhury

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Background: This study is an investigation into medical care, ethics, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in the context of Bangladesh. The low prevalence of HIV and high prevalence of STDs in Bangladesh, in common with the global experience of HIV epidemics, has been characterized by tremendous stigmatization of those affected. Stigmatization has resulted in an extraordinary degree of unjust discrimination and in numerous human rights violations of PLWHA. Methodology: This will be a cross-sectional descriptive study and will be conducted at different points of Bangladesh. Result: PLWHA will be identified as many as possible and will be interviewed. Medical care providers will be interviewed to assess their attitude and will be observed for stigma while providing medical services. Some of the religious leaders, local influential people will be interviewed to assess their attitude towards PLWHA. Conclusion: If effective responses to HIV/AIDS-related stigma and discrimination are to be promoted in the region, work has to occur simultaneously on several fronts: Legal challenge, where necessary, to bring to account governments, employers, institutions and individuals. To create enabling environment in which PLWHA and their families, women, boys, and girls are able to access prevention and care services. Access to quality and comprehensive care. The fundamental objective, however, is to strive for action based on this understanding—action that will promote egalitarian and gender-progressive role models, and that will help guide the manner in which we interact with one another.

Keywords: HIV, AIDS, Bangladesh, human rights

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Authors: Selena Ferrian, Erin Mccaffrey, Toshie Saito, Aiqin Cao, Noah Greenwald, Mark Robert Nicolls, Trevor Bruce, Roham T. Zamanian, Patricia Del Rosario, Marlene Rabinovitch, Michael Angelo

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Recent experimental and clinical observations are advancing immunotherapies to clinical trials in pulmonary arterial hypertension (PAH). However, comprehensive mapping of the immune landscape in pulmonary arteries (PAs) is necessary to understand how immune cell subsets interact to induce pulmonary vascular pathology. We used multiplexed ion beam imaging by time-of-flight (MIBI-TOF) to interrogate the immune landscape in PAs from idiopathic (IPAH) and hereditary (HPAH) PAH patients. Massive immune infiltration in I/HPAH was observed with intramural infiltration linked to PA occlusive changes. The spatial context of CD11c+DCs expressing SAMHD1, TIM-3 and IDO-1 within immune-enriched microenvironments and neutrophils were associated with greater immune activation in HPAH. Furthermore, CD11c-DC3s (mo-DC-like cells) within a smooth muscle cell (SMC) enriched microenvironment were linked to vessel score, proliferating SMCs, and inflamed endothelial cells. Experimental data in cultured cells reinforced a causal relationship between neutrophils and mo-DCs in mediating pulmonary arterial SMC proliferation. These findings merit consideration in developing effective immunotherapies for PAH.

Keywords: pulmonary arterial hypertension, vascular remodeling, indoleamine 2-3-dioxygenase 1 (IDO-1), neutrophils, monocyte-derived dendritic cells, BMPR2 mutation, interferon gamma (IFN-γ)

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Authors: Pitchaporn Purngpiputtrakul, Suttasinee Petsakul, Sunisa Chatmongkolchart

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Nasogastric tube (NGT) insertion in anaesthetized and intubated patients can be challenging even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between the GlideScope visualization and neck flexion with lateral neck pressure techniques. This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery under relaxant general anaesthesia who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of first and second attempts, duration of insertion, and complications were recorded. The total success rate was 79.1% in Group G compared with 76.7% in Group F (P=1) The median time required for NGT insertion was significantly longer in Group G, for both first and second attempts (97 vs 42 seconds P<0.001) and (70 vs 48.5 seconds P=0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications in both techniques. Using GlideScope visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique in degree of success rate of insertion, while neck flexion with lateral neck pressure technique had fewer complications and was less time-consuming.

Keywords: anaesthesia, nasogastric tube, GlideScope, intubation

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Authors: Dorsa Rahi, Arghavan Tonkanbonbi, Soheila Manifar, Behzad Jafvarnejad

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Background and Aim: Intraoral manipulation is performed during endotracheal intubation for general anesthesia, which can traumatize the soft and hard tissue in the oral cavity and cause postoperative pain and discomfort. Dental trauma is the most common complication of intubation. This study aimed to assess the prevalence of dental complications due to intubation in patients hospitalized in Imam Khomeini Hospital during 2018-2019. Materials and Methods: A total of 805 patients presenting to the Cancer Institute of Imam Khomeini Hospital for preoperative anesthesia consultation were randomly enrolled. A dentist interviewed the patients and performed a comprehensive clinical oral examination preoperatively. The patients underwent clinical oral examination by another dentist postoperatively. Results: No significant correlation was found between dental trauma (tooth fracture, tooth mobility, or soft tissue injury) after intubation with the age or gender of patients. According to the Wilcoxon test and McNemar-Bowker Test, the rate of mobility before the intubation was significantly different from that after the intubation (P=0.000). Maxillary central incisors, maxillary left canine and mandibular right and left central incisors had the highest rate of fracture. Conclusion: Mobile teeth before the intubation are at higher risk of avulsion and aspiration during the procedure. Patients with primary temporomandibular joint disorders are more susceptible to post-intubation trismus.

Keywords: oral trauma, dental trauma, intubation, anesthesia

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Authors: Kristen Erekson, Sarah Spendlove Caswell

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Nurse educators have the challenge of training future nurses that will provide compassionate care to an increasingly diverse population of patients in a culturally sensitive way. One approach to this challenge is an immersive public and global health experience as part of the nursing program curriculum. Undergraduate nursing students at our institution are required to participate in a Public and Global Health course. They participate in a didactic preparatory course followed by a 3-to-4-week program in one of the following locations: The Czech Republic, Ecuador, Finland/Poland, Ghana, India, Spain, Taiwan, Tonga, an Honor Flight to Washington D.C. with Veterans, or in local (Utah) communities working with marginalized populations (including incarcerated individuals, refugees, etc.). The students are required to complete 84 clinical hours and 84 culture hours (which involve exposure to local history, art, architecture, customs, etc.). As Faculty, we feel strongly that these public and global health experiences help cultivate cultural awareness in our students and prepare nurses who are better prepared to serve a diverse population of patients throughout their careers. This presentation will highlight our experiences and provide ideas for other nurse educators who have an interest in developing similar programs in their schools but do not know where to start. Suggestions about how to start building relationships that can lead to these opportunities, along with logistics for continuing the programs, will be highlighted.

Keywords: global health nursing, nursing education, clinical education, public health nursing

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Authors: Christopher S. Perez, Kendal C. Boyd

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global suicide rates have decreased in recent decades, rates in the United States have increased by 35.2 percent since 1999.American Indians and Alaska Natives (AI/AN) have the highest rates of suicide in the U.S., with approximately 22 suicides per 100,000 people as of 2019. AI/AN have experienced significant historical trauma resulting in disproportionate rates of substance abuse and mental disorders. This literature review aimed to identify the demographic and clinical risk and protective factors for American Indians and Alaska Natives and provide an overview of suicidality in this population. The literature reflected varying definitions of suicidality depending on region, with some AI/AN tribesconceptualizing suicide through a spiritual framework, while others defined suicide in the biomedical sense. Furthermore, AI/AN adults and adolescents experienced higher rates of suicidal ideation when compared to other racial groups. Religious preference, sexual orientation, prior suicidal behavior, psychiatric admission, history of abuse, substance abuse, family history of mental illness, family history of substance abuse, family history of suicidal behaviors, domestic violence, and trauma were discussed as factors related to suicidality. Recommendations included increasing access to and utilization of mental health and medical services, culturally adapting suicide prevention programs to AI/AN communities, increasing support for LGBTQ+ AI/AN, providing opportunities that reinforce ethnic identity, and post-hospitalization follow-up care. The following databases were utilized to obtain peer-reviewed articles for this literature review: Complementary Index, Academic Search Premier, Science Direct, PsycInfo, Social Sciences Citation Index, PsycArticles, PubMed, EbscoHost, and PsycBooks. Articles that examined Native populations outside of the United States did not cite a primary source and/or were published before 1990 were excluded.

Keywords: alaska native, american indian, protective factors, risk factors, suicidality, suicide

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Authors: Elena K. Schneider, Johnny X. Huang, Vincenzo Carbone, Mark Baker, Mohammad A. K. Azad, Matthew A. Cooper, Jian Li, Tony Velkov

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Ivacaftor is a novel CF trans-membrane conductance regulator (CFTR) potentiator that improves the pulmonary function for cystic fibrosis patients bearing a G551D CFTR-protein mutation. Because ivacaftor is highly bound (>97%) to plasma proteins, there is the strong possibility that co-administered CF drugs that compete for the same plasma protein binding sites and impact the free drug concentration. This in turn could lead to drastic changes in the in vivo efficacy of ivacaftor and therapeutic outcomes. This study compares the binding affinity of ivacaftor and co-administered CF drugs for human serum albumin (HSA) and α1-acid glycoprotein (AGP) using surface plasmon resonance and fluorimetric binding assays that measure the displacement of site selective probes. Due to their high plasma protein binding affinities, drug-drug interactions between ivacaftor are to be expected with ducosate, montelukast, ibuprofen, dicloxacillin, omeprazole and loratadine. The significance of these drug-drug interactions is interpreted in terms of the pharmacodynamic/pharmacokinetic parameters and molecular docking simulations. The translational outcomes of the data are presented as recommendations for a staggered treatment regimen for future clinical trials which aims to maximize the effective free drug concentration and clinical efficacy of ivacaftor.

Keywords: human α-1-acid glycoprotein, binding affinity, human serum albumin, ivacaftor, cystic fibrosis

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Authors: Hwang Kwon

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Objective: To assess the efficacy of embryo transfer (ET) of accumulated vitrified embryos and compare pregnancy outcomes between ET of thawed embryos following accumulation of vitrified embryos (frozen ET) and ET of fresh and thawed frozen embryos following accumulation of vitrified embryos (fresh ET + frozen ET). Study design: Patients were poor ovarian responders defined according to the Bologna criteria as well as a subgroup of women whose previous IVF-ET cycle through controlled ovarian stimulation (COS) yielded one or no embryos. Sixty-four frozen ETs were performed following accumulation of vitrified embryos (ACCE )(ACCE Frozen) and 51 fresh + frozen ETs were performed following accumulation of vitrified embryos (ACCE Fresh + Frozen). Positive βhCG rate, clinical pregnancy rate, ongoing pregnancy rate, and good quality embryos (%, ±SD) were compared between two groups. Results: There were more good quality embryos in the ACCE Fresh + Frozen group than in the ACCE Frozen group: 60±34.7 versus 42.9±28.9, respectively (p=0.03). Positive βhCG rate [18/64(28.2%) vs. 13/51(25.5%); p=0.75] and clinical pregnancy rate [12/64 (18.8%) vs. 11/51 (10.9%); p=0.71] were comparable between the two groups. Conclusion: Accumulation of vitrified embryos is an effective method in patients with poor ovarian response who fulfill the Bologna criteria. Pregnancy outcomes were comparable between the two groups.

Keywords: accumulation of embryos, frozen embryo transfer, poor responder, Bologna criteria

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Authors: Noor Ayuni Che Zakaria, Takashi Komeda, Cheng Yee Low, Kaoru Inoue, Fazah Akhtar Hanapiah

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Previous studies have shown that there are arguments regarding the reliability and validity of the Ashworth and Modified Ashworth Scale towards evaluating patients diagnosed with upper limb disorders. These evaluations depended on the raters’ experiences. This initiated us to develop an upper limb disorder part-task trainer that is able to simulate consistent upper limb disorders, such as spasticity and rigidity signs, based on the Modified Ashworth Scale to improve the variability occurring between raters and intra-raters themselves. By providing consistent signs, novice therapists would be able to increase training frequency and exposure towards various levels of signs. A total of 22 physiotherapists and occupational therapists participated in the study. The majority of the therapists agreed that with current therapy education, they still face problems with inter-raters and intra-raters variability (strongly agree 54%; n = 12/22, agree 27%; n = 6/22) in evaluating patients’ conditions. The therapists strongly agreed (72%; n = 16/22) that therapy trainees needed to increase their frequency of training; therefore believe that our initiative to develop an upper limb disorder training tool will help in improving the clinical education field (strongly agree and agree 63%; n = 14/22).

Keywords: upper limb disorder, clinical education tool, inter/intra-raters variability, spasticity, modified Ashworth scale

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