Search results for: patient knowledge

Authors: Ling-Lang Huang, Yih-Jer Wu

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Empathy is crucial for a patient-physician relationship and medical professionalism. Internet activity, gaming, or even addiction, have been more and more common among medical students. However, there’s been no report showing whether internet behavior has a substantial impact on empathy in medical students to our best knowledge. All year-2 medical students taking the optional course 'Narrative, Comprehension, and Communication' were enrolled. Internet behaviors are divided into two groups, 'internet users without online gaming (IU)' and 'internet users with online gaming (IG)', each group was further divided into 3 groups according to their average online retention time each day (< 2, 2 - 6, > 6 hours). Empathy was evaluated by the scores of the reports and humanities reflection after watching indicated movies, and by self-measured empathy questionnaire. All students taking the year-2 optional course 'Narrative, Comprehension, and Communication' were enrolled. As compared with students in the IU group, those in the IG group had significantly lower scores for the reports (81.3 ± 3.7 vs. 86.4 ± 5.1, P = 0.014). If further dividing the students into 5 groups (IU < 2, IU 2-6, IG < 2, IG 2 - 6, and IG > 6 hours), the scores were significantly and negatively correlated to online gaming with longer hours (r = -0.556, P = 0.006). However, there was no significant difference between IU and IG groups (33.0 ± 5.4 vs. 34.8 ± 3.2, P = n.s.), in terms of scores in the self-measured empathy questionnaire, neither was there any significant trend of scores along with longer online hours across the 5 groups (r = -0.164, P = n.s.). To date, there has been no evidence showing whether different internet behaviors (with or without online gaming) have distinct impacts on empathy. Although all of the medical students had a similarly good self-perception for empathy, our data suggested that online gaming did have a negative impact on their actual expression of empathy. Our observation has brought up an important issue for pondering: May IT- or gaming-assisted medical learning actually harm students’ empathy? In conclusion, this data suggests that long hours of online gaming harms expression of empathy, though all medics think themselves a person of high empathy.

Keywords: empathy. Internet, medical students, online gaming

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Authors: Anuruddha Jagoda, Samiddhi Samarakoon, Anil Jasinghe

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In an emergency department ‘where every second count for patient’s management’ timely availability of X- rays play a vital role in early diagnosis and management of patients. Trauma care centers rely heavily on timely radiologic imaging for patient care and radiology plays a crucial role in the emergency department (ED) operations. A research study was carried out to assess timeliness of availability of X-rays and total turnaround time at the Accident Service of National Hospital of Sri Lanka which is the premier trauma center in the country. Digital Radiology system was implemented as an intervention to improve the timeliness of availability of X-rays. Post-implementation assessment was carried out to assess the effectiveness of the intervention. Reduction in all three aspects of waiting times namely waiting for initial examination by doctors, waiting until X –ray is performed and waiting for image availability was observed after implementation of the intervention. However, the most significant improvement was seen in waiting time for image availability and reduction in time for image availability had indirect impact on reducing waiting time for initial examination by doctors and waiting until X –ray is performed. The most significant reduction in time for image availability was observed when performing 4-5 X rays with DR system. The least improvement in timeliness was seen in patients who are categorized as critical.

Keywords: emergency department, digital radilogy, timeliness, trauma care

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Authors: Shedy Maharani Nariswari, Prima Agustia Nova, I. Made Kariasa

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Background. Heart Failure (HF) is a chronic and progressive condition associated with significant morbidity, mortality, health care expenditures, and a high readmission rate over the years. Self‐care is essential to manage chronic heart failure in the long term, and it is related to better outcomes and can enhance the quality of life. Objective. The aims of this study were to describe the relationship between self-care behavior and quality of life among heart failure patients in East Jakarta, Indonesia. Methods. This study used a correlational-descriptive design with a cross-sectional study, the sampling method used purposive sampling method. Self-care was measured using Self-care Heart Failure Index version 6.2, and quality of life was measured using The Minnesota Living with Heart Failure. Pearson correlation and Spearman-rho correlations are used to analyze the data. Results. We recruited 103 patients with HF in both outpatient and inpatient ward: mean age 59.26 ± 11.643 years, 63.1% male. Patients with higher levels of education were associated with higher self-care maintenance (p= 0.007). The patient's average quality of life is quite high, with a score of 72,07 ± 16,89. There were a significant relationship among self-care maintenance (r=0,305, p=0,001), self-care management (r=0,330, p=0,001), and self-care confidence (r=0,335, p=0,001) towards the quality of life. Most participants have inadequate self-care maintenance, self-care management, and self-care confidence (score < 70), while the score of quality of life is categorized as poor. Conclusion. The self-care behaviors were limited among patients living with HF in Indonesia yet was associated with better quality of life. It is necessary to promote health related to knowledge and adherence to self-care behavior so that it can improve the quality of life of heart failure patients. This study can be used as a reference to promote self-care among patients with heart failure, it can help to enhance their quality of life.

Keywords: heart failure, self-care maintenance, self-care management, self-care confidence, quality of life

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Authors: Ariane Plaisance, Holly O. Witteman, Patrick Michel Archambault

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Upon admission to an intensive care unit (ICU), all patients should discuss their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. We employed user-centered design to adapt an existing decision aid (DA) about CPR to create a novel wiki-based DA adapted to the context of a single ICU and tailored to individual patient’s risk factors. During Phase 1, we conducted three weeks of ethnography of the decision-making context in our ICU to identify clinician and patient needs for a decision aid. During this time, we observed five dyads of intensivists and patients discussing their wishes concerning life-sustaining interventions. We also conducted semi-structured interviews with the attending intensivists in this ICU. During Phase 2, we conducted three rounds of rapid prototyping involving 15 patients and 11 other allied health professionals. We recorded discussions between intensivists and patients and used a standardized observation grid to collect patients’ comments and sociodemographic data. We applied content analysis to field notes, verbatim transcripts and the completed observation grids. Each round of observations and rapid prototyping iteratively informed the design of the next prototype. We also used the programming architecture of a wiki platform to embed the GO-FAR prediction rule programming code that we linked to a risk graphics software to better illustrate outcome risks calculated. During Phase I, we identified the need to add a section in our DA concerning invasive mechanical ventilation in addition to CPR because both life-sustaining interventions were often discussed together by physicians. During Phase II, we produced a context-adapted decision aid about CPR and mechanical ventilation that includes a values clarification section, questions about the patient’s functional autonomy prior to admission to the ICU and the functional decline that they would judge acceptable upon hospital discharge, risks and benefits of CPR and invasive mechanical ventilation, population-level statistics about CPR, a synthesis section to help patients come to a final decision and an online calculator based on the GO-FAR prediction rule. Even though the three rounds of rapid prototyping led to simplifying the information in our DA, 60% (n= 3/5) of the patients involved in the last cycle still did not understand the purpose of the DA. We also identified gaps in the discussion and documentation of patients’ preferences concerning life-sustaining interventions (e.g.,. CPR, invasive mechanical ventilation). The final version of our DA and our online wiki-based GO-FAR risk calculator using the IconArray.com risk graphics software are available online at www.wikidecision.org and are ready to be adapted to other contexts. Our results inform producers of decision aids on the use of wikis and user-centered design to develop DAs that are better adapted to users’ needs. Further work is needed on the creation of a video version of our DA. Physicians will also need the training to use our DA and to develop shared decision-making skills about goals of care.

Keywords: ethnography, intensive care units, life-sustaining therapies, user-centered design

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Authors: Jonathan Kissi, Baozhen Dai, Wisdom W. K. Pomegbe, Abdul-Basit Kassim

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Protecting patient’s digital information is a growing concern for healthcare institutions as people nowadays perpetually live their lives through telemedicine services. These telemedicine services have been confronted with several determinants that hinder their successful implementations, especially in developing countries. Identifying such determinants that influence the acceptance of telemedicine services is also a problem for healthcare professionals. Despite the tremendous increase in telemedicine services, its adoption, and use has been quite slow in some healthcare settings. Generally, it is accepted in today’s globalizing world that the success of telemedicine services relies on users’ satisfaction. Satisfying health professionals and patients are one of the crucial objectives of telemedicine success. This study seeks to investigate the determinants that influence health professionals’ intention to utilize telemedicine services in clinical activities in a sub-Saharan African country in West Africa (Ghana). A hybridized model comprising of health adoption models, including technology acceptance theory, diffusion of innovation theory, and protection of motivation theory, were used to investigate these quandaries. The study was carried out in four government health institutions that apply and regulate telemedicine services in their clinical activities. A structured questionnaire was developed and used for data collection. Purposive and convenience sampling methods were used in the selection of healthcare professionals from different medical fields for the study. The collected data were analyzed based on structural equation modeling (SEM) approach. All selected constructs showed a significant relationship with health professional’s behavioral intention in the direction expected from prior literature including perceived usefulness, perceived ease of use, management strategies, financial sustainability, communication channels, patients security threat, patients privacy risk, self efficacy, actual service use, user satisfaction, and telemedicine services systems securities threat. Surprisingly, user characteristics and response efficacy of health professionals were not significant in the hybridized model. The findings and insights from this research show that health professionals are pragmatic when making choices for technology applications and also their willingness to use telemedicine services. They are, however, anxious about its threats and coping appraisals. The identified significant constructs in the study may help to increase efficiency, quality of services, quality patient care delivery, and satisfactory user satisfaction among healthcare professionals. The implantation and effective utilization of telemedicine services in the selected hospitals will aid as a strategy to eradicate hardships in healthcare services delivery. The service will help attain universal health access coverage to all populace. This study contributes to empirical knowledge by identifying the vital factors influencing health professionals’ behavioral intentions to adopt telemedicine services. The study will also help stakeholders of healthcare to formulate better policies towards telemedicine service usage.

Keywords: telemedicine service, perceived usefulness, perceived ease of use, management strategies, security threats

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Authors: Dong-Joong Kim, Sangho Choi, Woong Lim

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This paper discusses Sfard’s commognitive approach and provides an empirical study as an example to illustrate the theory as method. Traditionally, research in mathematics education focused on the acquisition of mathematical knowledge and the didactic process of knowledge transfer. Through attending to a distinctive form of language in mathematics, as well as mathematics as a discursive subject, alternative views of making meaning in mathematics have emerged; these views are therefore “critical,” as in critical discourse analysis. The commognitive discourse analysis method has the potential to bring more clarity to our understanding of students’ mathematical thinking and the process through which students are socialized into school mathematics.

Keywords: commognitive framework, discourse analysis, mathematical discourse, mathematics education

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Authors: Gabriel Montague, Max Vilgalys, Catherine H. Crawford, Jorge Ortiz, Dava Newman

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There has never been so much publicly accessible atmospheric and environmental data. The possibilities of these data are exciting, but the sheer volume of available datasets represents a new challenge for researchers. The task of identifying and working with a new dataset has become more difficult with the amount and variety of available data. Datasets are often documented in ways that differ substantially from the common English used to describe the same topics. This presents a barrier not only for new scientists, but for researchers looking to find comparisons across multiple datasets or specialists from other disciplines hoping to collaborate. This paper proposes a method for addressing this obstacle: creating a knowledge graph to bridge the gap between everyday English language and the technical language surrounding these datasets. Knowledge graph generation is already a well-established field, although there are some unique challenges posed by working with Earth data. One is the sheer size of the databases – it would be infeasible to replicate or analyze all the data stored by an organization like The National Aeronautics and Space Administration (NASA) or the European Space Agency. Instead, this approach identifies topics from metadata available for datasets in NASA’s Earthdata database, which can then be used to directly request and access the raw data from NASA. By starting with a single metadata standard, this paper establishes an approach that can be generalized to different databases, but leaves the challenge of metadata harmonization for future work. Topics generated from the metadata are then linked to topics from a collection of English queries through a variety of standard and custom natural language processing (NLP) methods. The results from this method are then compared to a baseline of elastic search applied to the metadata. This comparison shows the benefits of the proposed knowledge graph system over existing methods, particularly in interpreting natural language queries and interpreting topics in metadata. For the research community, this work introduces an application of NLP to the ecological and environmental sciences, expanding the possibilities of how machine learning can be applied in this discipline. But perhaps more importantly, it establishes the foundation for a platform that can enable common English to access knowledge that previously required considerable effort and experience. By making this public data accessible to the full public, this work has the potential to transform environmental understanding, engagement, and action.

Keywords: earth metadata, knowledge graphs, natural language processing, question-answer systems

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Authors: Cholpassorn Sitthiwarongchai, Chutikarn Sriviboon

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The two primary objectives of this research were (1) to examine the current knowledge and actual circumstance of agricultural workers about mangosteen product processing; and (2) to analyze and evaluate ways to develop capacity of mangosteen product processing. The population of this study was 15,125 people who work in the agricultural sector, in this context, mangosteen production, in the eastern part of Thailand that included Chantaburi Province, Rayong Province, Trad Province and Pracheenburi Province. The sample size based on Yamane’s calculation with 95% reliability was therefore 392 samples. Mixed method was employed included questionnaire and focus group discussion with Connoisseurship Model used in order to collect quantitative and qualitative data. Key informants were used in the focus group including agricultural business owners, academic people in agro food processing, local academics, local community development staff, OTOP subcommittee, and representatives of agro processing industry professional organizations. The study found that the majority of the respondents agreed with a high level (in five-rating scale) towards most of variables of knowledge management in agro food processing. The result of the current knowledge and actual circumstance of agricultural human resource in an arena of mangosteen product processing revealed that mostly, the respondents agreed at a high level to establish 7 variables. The guideline to developing the body of knowledge in order to enhance the capacity of the agricultural workers in mangosteen product processing was delivered in the focus group discussion. The discussion finally contributed to an idea to produce manuals for mangosteen product processing methods, with 4 products chosen: (1) mangosteen soap, (2) mangosteen juice, (3) mangosteen toffee, and (4) mangosteen preserves or jam.

Keywords: capacity enhancement, agricultural workers, mangosteen product processing, marketing management

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Authors: Mike Wei, Nebu Koshy, Koen van Besien, Giorgio Inghirami, Steven M. Horwitz

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T-cell prolymphocytic leukemia (T-PLL) is a rare hematologic disease characterized by a T-cell phenotype, rapid progression, and poor prognosis with median survival of less than a year. Alemtuzumab-based chemotherapy has increased the rate of complete remissions but these are often short-lived, and allogeneic transplant is considered the only curative therapy. In recent studies, JAK3 activating mutations have been identified in T-cell cancers, with T-PLL having the highest rate of JAK3 mutations (30 – 42%). As such, T-PLL is a model disease for evaluating the utility of JAK3 inhibitors. We present a case of a 64-year-old man with relapsed-refractory T-PLL. He was initially treated with alemtuzumab and obtained complete response and was consolidated with matched unrelated donor stem cell transplant. His disease stayed in remission for approximately 1.5 years before relapse, which was then treated with a clinical trial of romidepsin-lenalidomide (partial responses then progression at 6 months) and later alemtuzumab. Due to complications of myelosuppression and CMV reactivation, his treatment was interrupted leading to disease progression. The doubling time of lymphocyte count was approximately 20 days and over a span of 60 days the lymphocyte count rose from 8 x 109/L to 68 x 109/L. Exon sequencing showed a JAK3 mutation. The patient consented to and was treated with FDA-approved tofacitinib (initially 5 mg BID, increased to 10 mg BID after 15 days of treatment). An initial decrease in lymphocyte count was followed by progression. In vitro treatment of the patient’s cells showed modest effects of tofacitinib and ruxolitinib as single agents, in the range of doxorubicin, but synergy between the agents. After 40 days of treatment with tofacitinib and with a lymphocyte count of 150 x 109/L, ruxolitinib (5mg BID) was added. Over the 60 days since dual inhibition was started, the lymphocyte count has stabilized. The patient has remained completely asymptomatic during treatment with tofacitinib and ruxolitinib. Neutrophil count has remained normal. Platelet count and hemoglobin have however declined from ~50 x109/L to ~30 x109/L and from 11 g/dL to 8.1 g/dL respectively, since the introduction of ruxolitinib. The stabilization in lymphocyte count confirms the clinical activity of JAK inhibitors in T-PLL as suggested by the presence of JAK3 mutations and by in-vitro assays. It also suggests clinical synergy between ruxolitinib and tofacitinib in this setting. Prospective studies of JAK inhibitors in PLL patients with formal dose-finding studies are needed.

Keywords: tofacitinib, ruxolitinib, T-cell prolymphocytic leukemia, JAK3

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Authors: Hadas Sopher, Davide Schaumann, Yehuda E. Kalay

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This paper addresses the shortcomings of architectural computation tools in representing human behavior in built environments, prior to construction and occupancy of those environments. Evaluating whether a design fits the needs of its future users is currently done solely post construction, or is based on the knowledge and intuition of the designer. This issue is of high importance when designing complex buildings such as hospitals, where the quality of treatment as well as patient and staff satisfaction are of major concern. Existing computational pre-occupancy human behavior evaluation methods are geared mainly to test ergonomic issues, such as wheelchair accessibility, emergency egress, etc. As such, they rely on Agent Based Modeling (ABM) techniques, which emphasize the individual user. Yet we know that most human activities are social, and involve a number of actors working together, which ABM methods cannot handle. Therefore, we present an event-based model that manages the interaction between multiple Actors, Spaces, and Activities, to describe dynamically how people use spaces. This approach requires expanding the computational representation of Actors beyond their physical description, to include psychological, social, cultural, and other parameters. The model presented in this paper includes cognitive abilities and rules that describe the response of actors to their physical and social surroundings, based on the actors’ internal status. The model has been applied in a simulation of hospital wards, and showed adaptability to a wide variety of situated behaviors and interactions.

Keywords: agent based modeling, architectural design evaluation, event modeling, human behavior simulation, spatial cognition

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Authors: Bolormaa Dalanbayar, Batsaikhan Ulaankhuu, Bayarmaa Tsogtbaatar

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In this study, we surveyed employers and students to identify compliance between employers' needs and student self-assessment of skills. Employers' survey consisted of fifteen questions to determine employers' assessment of the knowledge and skills of graduates in heavy equipment repairer's programs from four TVET schools. We also compared a survey questionnaire with Liebherr brands' job duty requirements, which determines the training needs and qualification level of their new workers. The study shows more than 76% of employers assessed professional knowledge as sufficient, more than 47% of employers assessed vocational skills as sufficient and more than 43% of employers rated attitudes as sufficient. Therefore, we can state there is a skill mismatch between the employer's assessment and students' self-assessment.

Keywords: skill mismatch, employers needs, competence-based curriculum

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Authors: Vishweshwar V. Dixit

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Kannudi is a reference editor introducing a method of input for Kannada, called OHOK!, that is, Ottu Hāku Ottu Koḍu!. This is especially suited for pressure-sensitive input devices, though the current online implementation uses the regular mechanical keyboard. OHOK! has three possible modes, namely, sva-ottu (self-conjunct), kandante (as you see), and andante (as you say). It may be noted that kandante mode does not follow the phonetic order. However, this model may work well for those who are inclined to visualize as they type rather than vocalize the sounds. Kannudi also demonstrates how domain knowledge can be effectively used to potentially increase speed, accuracy, and user-friendliness. For example, selection of a default vowel, automatic shunyification, and arkification. Also implemented are four types of Deletes that are necessary for phono-syllabic languages like Kannada.

Keywords: kannada, conjunct, reference editor, pressure input

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Authors: Hailemariam Getachew, John Sandi, Isata Dumbuya, Patricia Efe.Azikiwe, Evaline Nginge, Moses Mugisha, Eseoghene Dase, Foday Mandaray, Grace Moore

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Enhanced recovery after cesarean section (ERAC) is a standardized peri- operative care program that comprises the multidisciplinary team's collective efforts working in collaboration throughout the peri-operative period with the principal goal to improve quality of surgical care, decrease surgical related complications, and increasing patient satisfaction. Objective: The main objective of this project is to improve the implementation of enhanced recovery after cesarean section at Koidu Government hospital. Identified gap: Even though the hospital is providing comprehensive maternal and child care service, there are gaps in the implementation of ERAC. According to our survey, we found that there is low (13.3%) utilization of WHO surgical safety checklist, only limited (15.9%) patients get opioid free analgesia, pain was not recorded as a vital sign, there is no standardized checklist for hand over to and from Post Anesthesia care Unit(PACU). Furthermore, there is inconsistent evidence based post-operative care and there is no local consensus protocol and guideline as well. Implementation plan: we aimed at designing standardized protocol, checklist and guideline, provide training, build staff capacity, document pain as vital sign, perform regional analgesia, and provide evidence based post-operative care, monitoring and evaluation. Result: Data from 389 cesarean mothers showed that, Utilization of the WHO surgical safety check list found to be 95%, and pain assessment and documentation was done for all surgical patients. Oral feeding, ambulation and catheter removal was performed as per the ERAC standard for all patients. Postoperative complications drastically decreased from 13.6% to 8.1%. While, the rate of readmission was kept below 1%. Furthermore, the duration of hospital stay decreased from 4.64 days to 3.12 days. Conclusion The successful implementation of ERAC protocols demonstrates through this Quality Improvement Project that, the effectiveness of the protocols in improving recovery and patient outcome following cesarean section.

Keywords: cesarean delivery, enhanced recovery, quality improvement, patient outcome

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Authors: J. Zhang, K. Agyapong-Kodua

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Digital factory based on visual design and simulation has emerged as a mainstream to reduce digital development life cycle. Some basic industrial systems are being integrated via semantic modelling, and products (P) matching process (P)-resource (R) requirements are designed to fulfill current customer demands. Nevertheless, product design is still limited to fixed product models and known knowledge of product engineers. Therefore, this paper presents a rapid reconfiguration method based on semantic technologies with PPR ontologies to reuse known and unknown knowledge. In order to avoid the influence of big data, our system uses a cloud manufactory and distributed database to improve the efficiency of querying meeting PPR requirements.

Keywords: semantic technologies, factory system, digital factory, cloud manufactory

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Authors: Yang Zhuo

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This study explores the integration of MIDI technology as one of the important digital technologies in music teaching, from the perspective of teaching practice, into the process of cultivating students' teaching skills. At the same time, the framework elements of the learning environment for music education students are divided into four aspects: digital technology supported learning space, new knowledge learning, teaching methods, and teaching evaluation. In teaching activities, more attention should be paid to students' subjectivity and interaction between them so as to enhance their emotional experience in teaching practice simulation. In the process of independent exploration and cooperative interaction, problems should be discovered and solved, and basic knowledge of music and teaching methods should be exercised in practice.

Keywords: music education, educational technology, MIDI, teacher training

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Authors: Abdelrahman Mohamed

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Copyright law is a branch of the Intellectual Property Law that gives authors exclusive rights to copy, display, perform, and distribute copyrightable works. In theory, copyright law aims to promote the welfare of society by granting exclusive rights to the creators in exchange for the works that these creators produce for society. Thus, there are two different types of rights that a just regime should balance between them which are owners' rights and users' rights. The paper argues that there is a conflict between the current international copyright regime and the Islamic Social Justice Theory. This regime is unjust from the Islamic Social Justice Theory's perspective regarding access to educational materials because this regime was unjustly established by the colonizers to protect their interests, starting from the Berne Convention for the Protection of Literary and Artistic Works 1886 and reaching to the Trade-Related Aspects of Intellectual Property Rights 1994. Consequently, the injustice of this regime was reflected in the regulations of these agreements and led to an imbalance between the owners' rights and the users' rights in favor of the former at the expense of the latter. As a result, copyright has become a barrier to access to knowledge and educational materials. The paper starts by illustrating the concept of justice in Islamic sources such as the Quran, Sunnah, and El-Maslha-Elmorsalah. Then, social justice is discussed by focusing on the importance of access to knowledge and the right to education. The theory assumes that the right to education and access to educational materials are necessities; thus, to achieve justice in this regime, the users' rights should be granted regardless of their region, color, and financial situation. Then, the paper discusses the history of authorship protection under the Islamic Sharia and to what extent this right was recognized even before the existence of copyright law. According to this theory, the authors' rights should be protected, however, this protection should not be at the expense of the human's rights to education and the right to access to educational materials. Moreover, the Islamic Social Justice Theory prohibits the concentration of wealth among a few numbers of people, 'the minority'. Thus, if knowledge is considered an asset or a good, the concentration of knowledge is prohibited from the Islamic perspective, which is the current situation of the copyright regime where a few countries control knowledge production and distribution. Finally, recommendations will be discussed to mitigate the injustice of the current international copyright regime and to fill the gap between the current international copyright regime and the Islamic Social Justice Theory.

Keywords: colonization, copyright, intellectual property, Islamic sharia, social justice

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Authors: Okhee Woo, Hye Seon Shin

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

Keywords: DBT, breast cancer, stereotactic biopsy, mammography

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Authors: Sonia Lachowska, Agnieszka Antonczyk, Joanna Tunikowska, Pawel Kucharski, Bartlomiej Liszka

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Isoflurane is one of the most commonly used anaesthetic gases in veterinary medicine. Due to its numerous side effects, intravenous anaesthesia is more often used. The combination of tiletamine with zolazepam has proved to be a safe and pharmacologically beneficial combination. Analgesic effect, fast induction time, effective myorelaxation, and smooth recovery are the main advantages of this combination of drugs. In the following study, the authors verified the necessity of isoflurane to maintain anaesthesia in dogs after the use of tiletamine-zolazepam for induction. 12 dogs were selected to the group with the inclusion criteria: ASA (American Society of Anaesthesiology) I or II. Each dog received premedication intramuscularly with medetomidine-butorfanol (10 μg/kg, 0,1 mg/kg respectively). 15 minutes from premedication, preoxygenation lasting 5 minutes was started. Anaesthesia was induced with tiletamine-zolazepam at the dose of 5 mg/kg. Then the dogs were intubated and anaesthesia was maintained with isoflurane. Initially, MAC (Minimum Alveolar Concentration) was set to 0.7 vol.%. After 15 minutes equilibration, MAC was determined using Dixon’s up-and-down method. Painful stimulation including compressions of paw pad, phalange, groin area, and clamping Backhaus on skin. Hemodynamic and ventilation parameters were measured and noted in 2 minutes intervals. In this method, the positive or negative response to the noxious stimulus is estimated and then used to determine the concentration of isoflurane for next patient. The response is only assessed once in each patient. The results show that isoflurane is not necessary to maintain anaesthesia after tiletamine-zolazepam induction. This is clinically important because the side effects resulting from using isoflurane are eliminated.

Keywords: anaesthesia, dog, Isoflurane, The Dixon's up-and-down method, Tiletamine, Zolazepam

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Authors: Joel S. Mtebe, Aron Kondoro, Mussa M. Kissaka, Elia Kibga

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Sub-Saharan Africa is described as the second fastest growing mobile phone penetration in the world more than in the United States or the European Union. Mobile phones have been used to provide a lot of opportunities to improve people’s lives in the region such as in banking, marketing, entertainment, and paying various bills such as water, TV, and electricity. However, the potential of using mobile phones to enhance teaching and learning has not been explored. This study presents an experience of developing and delivering SMS quizzes questions that were used to assess mastery of the subject content knowledge of science and mathematics secondary school teachers in Tanzania. The SMS quizzes were used as a follow up support mechanism to 500 teachers who participated in a project to upgrade subject content knowledge of science and mathematics subjects. Quizzes of 10-15 questions were sent to teachers each week for 8 weeks and the results were analyzed using SPSS. The results showed that chemistry and biology had better performance compared to mathematics and physics. Teachers reported some challenges that led to poor performance, invalid answers, and non-responses and they are presented. This research has several practical implications for those who are implementing or planning to use mobile phones for teaching and learning especially in rural secondary schools in sub-Saharan Africa.

Keywords: mobile learning, elearning, educational technolgies, SMS, secondary education, assessment

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Authors: Maniyarasan Rajendran

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Every design has a process, and every architect deals in the ways best known to them. The design translation from the concept to completion change in accordance with their design philosophies, their tools, availability of resources, and at times the clients and the context of the design as well. The approach to understanding the design process requires formalisation of the design intents. The design process is characterised by change, with the time and the technology. The design flow is just indicative and never exhaustive. The knowledge and experience of stakeholders remain limited to the part they played in the project, and their ability to remember, and is through the Photographs. These artefacts, when circulated can hardly tell what the project is. They can never tell the narrative behind. In due course, the design processes are lost. The Design junctions are lost in the journey. Photographs acted as major source materials, along with its importance in architectural revivalism in the 19th century. From the history, we understand that it has been photographs, that act as the dominant source of evidence. The idea of recording is also followed with the idea of getting inspired from the records and documents. The design concept, the architectural firms’ philosophies, the materials used, the special needs, the numerous ‘Trial-and-error’ methods, design methodology, experience of failures and success levels, and the knowledge acquired, etc., and the various other aspects and methods go through in every project, and they deserve/ought to be recorded. The knowledge can be preserved and passed through generations, by documenting the design processes involved. This paper explores the idea of a process documentation as a tool of self-reflection, creation of architectural firm’ repository, and these implications proceed with the design evolution of the team.

Keywords: architecture, design, documentation, records

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Authors: Thea Werkhoven, Wayne Cotton

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Adult and childhood rates of obesity in Australia are health concerns of high national priority, retaining epidemic status in the populations affected. Attempts to prevent further increases in prevalence of childhood obesity in the population aged below eighteen years have had varied success. A multidisciplinary approach has been used, employing strategies in schools, through established health care system usage and public health campaigns. Over the last decade a plateau in prevalence has been reached in the youth population afflicted by obesity and interest has peaked in school based strategies to prevent and treat overweight and obesity. Of interest to this study is the importance of the tertiary training of future health educators or health professionals destined to be involved in obesity prevention and treatment strategies. Health educators and health professionals are considered instrumental to the success of prevention and treatment strategies, required to possess sufficient and accurate knowledge in order to be effective in their positions. A common influence on the success of school based health promoting activities are the weight based attitudes possessed by health educators, known to be negative and biased towards overweight or obese children during training and practice. Whilst the tertiary training of future health professionals includes minimal nutrition education, there is no mandatory training in health education or nutrition for pre-service health educators in Australian tertiary institutions. This study aimed to assess the impact of a pedagogical intervention on pre-service health educators and health professionals enrolled in a health and wellbeing elective. The intervention aimed to increase nutrition knowledge and decrease weight bias and was embedded in the twelve week elective. Participants (n=98) were tertiary students at a major Australian University who were enrolled in health (47%) and non-health related degrees (53%). A quantitative survey using four valid and reliable instruments was conducted to measured nutrition knowledge, antifat attitudes and weight stereotyping attitudes at baseline and post-intervention. Scores on each instrument were compared between time points to check if they had significantly changed and to determine the effect of the intervention on attitudes and knowledge. Antifat attitudes at baseline were considered low and decreased further over the course of the intervention. Scores representing weight bias did decrease but the change was not significant. Fat stereotyping attitudes became stronger over the course of the intervention and this change was significant. Nutrition knowledge significantly improved from baseline to post-intervention. The design of the nutrition knowledge and attitude amelioration content of the intervention was semi-successful in achieving its outcomes. While the level of nutrition knowledge was improved over the course of the intervention, an unintentional increase was observed in weight based prejudice which is known to occur in interventions that employ stigma reduction methodologies. Further research is required into a structured methodology that increases level of nutrition knowledge and ameliorates weight bias at the tertiary level. In this way training provided would help prepare future health educators with the knowledge, skills and attitudes required to be effective and bias free in their practice.

Keywords: education, intervention, nutrition, obesity

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Authors: Mahesh Chandra Paliwal, Ajay Kumar Jain

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Supervisors working in the industries must have the knowledge and skills for performing their job for environmental protection and sustainable development. A survey of thirty industries was conducted to know the roles of supervisors related to environmental protection and sustainable development. A questionnaire was prepared based on the discussion with the environmental experts. The findings of the study show that supervisors must be aware of practices followed for good housekeeping, water management, waste management, maintenance of effluent treatment plants, monitoring pollution control level to perform their job to save the environment. These aspects must be incorporated in diploma curriculum so that the diploma pass outs may use this knowledge and skills in the industries.

Keywords: environmental protection, sustainable development, water management, waste management, curriculum

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Authors: Karla Lebedoff, Susan Walsh, Michelle Bain

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Eczema is a chronic atopy condition requiring long-term daily management in children. Written action plans for other chronic atopic conditions, such as asthma and food allergies, are widely recommended and distributed to pediatric patients' parents and caregivers, seeking to improve clinical outcomes and become empowered to manage the patient's ever-changing symptoms. Written action plans for eczema, referred to as "asthma of the skin," are not routinely used in practice. Parents of children suffering from eczema rarely receive a written action plan to follow, and commendations supporting eczema action plans are inconsistent. Pediatric patients between birth and 18 years old who were followed for eczema at an urban Midwest community hospital were eligible to participate in this quality improvement project. At the initial visit, parents received instructions on individualized eczema action plans for their child and completed two validated surveys: Health Confidence Score (HCS) and Patient-Oriented Eczema Measure (POEM). Pre- and post-survey responses were collected, and clinical symptom presentation at follow-up were outcome determinants. Project implementation was guided by Institute for Healthcare Improvement's Step-up Framework and the Plan-Do-Study-Act cycle. This project measured clinical outcomes and parent confidence in self-management of their child's eczema symptoms with the responses from 26 participant surveys. Pre-survey responses were collected from 36 participants, though ten were lost to follow-up. Average POEM scores improved by 53%, while average HCS scores remained unchanged. Of seven completed in-person follow-up visits, six clinical progress notes documented improvement. Individualized eczema action plans can be seamlessly incorporated into primary and specialty care visits for pediatric patients suffering from eczema. Following a patient-specific eczema action plan may lessen the daily physical and mental burdens of uncontrolled eczema for children and parents, managing symptoms that chronically flare and recede. Furthermore, incorporating eczema action plans into practice potentially reduces the likely underestimated $5.3 billion economic disease burden of eczema on the U.S. healthcare system.

Keywords: atopic dermatitis, eczema action plan, eczema symptom management, pediatric eczema

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Authors: Mahmoud Eladl, Bahaaeldeen Hesham, Saryia Adra, Ahmad Addasi, Mohammad Al Tahawi, Musa’Ab Omair, Nafe Alhariri, Mohamed Eladl, Hiba J. Barqawi

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Introduction: Prostate cancer is the second most common cancer in men globally and the fifth greatest cause of cancer-related mortality. In the United Arab Emirates (UAE), prostate cancer has been on the rise due to population aging. However, knowledge deficits and screening barriers do exist because of cultural, social, and psychological factors. The objective of this study is to assess the knowledge, practices, and attitudes of prostate cancer and its screening among men aged 40 years and above in the UAE. Methodology: A cross-sectional study was conducted between September 5 and October 31, 2024, using a self-administered online questionnaire distributed through social media platforms. Data collected from the questionnaire were analyzed using SPSS version 26 (IBM Corp., Armonk, NY). Results: A total of 471 responses were analyzed. The median age of participants was 51 ± 12. Most of the respondents were non-healthcare workers with at least a bachelor's degree. Most of the participants were moderately aware of prostate cancer risk factors and symptoms. However, there was a severe lack of awareness of genetic predisposition and racial risk factors. While 80.3% of participants were aware of the role of prostate-specific antigen tests in prostate screening, 62.8% recognized the role of a digital rectal examination. The most important barriers to screening were lack of perceived risk, time constraints, and fear of diagnosis. Conclusion: Significant knowledge gaps and barriers to prostate screening exist. Health education initiatives targeting cultural stigma with the use of culturally appropriate and accurate information through credible online platforms are necessary.

Keywords: male health awareness, prostate cancer, PSA, screening, UAE

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Authors: Vidya Pratap, Seena Biju, A. Keshavdev

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The ever-increasing quantity and variety of domestic solid waste pose a major challenge to both households as well as to municipal authorities. In keeping with the Indian Prime Minister’s mission of Swachh Bharat (Clean India), the local municipal administration distributed 2 buckets to each household in a residential colony in Manipal (an educational town in southern India). Households were instructed to segregate their waste into wet and dry waste and keep these buckets at their gate for daily collection. This paper captures the knowledge, attitude, and behavior of 145 households along with the challenges they face in segregating their wastes. Survey representatives self-administered a questionnaire based on 107 variables that gathered demographic details, attitude and behavior constructs, knowledge about waste segregation and method of disposal for organic, recyclable and hazardous wastes. The study used descriptive tools to explore the data. While 95% of the respondents preferred good segregation practices, only 86% of them exhibited such behavior. 88% of the families observed had members who were either graduates or post-graduates whereas only 37% of the families had women who were working. In both attitude and behavior, 63% of the households did not have working women. Also, among those who practiced segregation, 7% were observed to not practice segregation in spite of the lady member being at home (The authors of this study in no way intend to name women as responsible for waste segregation at home; this thought is based on the fact that while in conversation with households, all respondents opined that women lead this activity). The findings of the study are intended to add value to the existing perceptions of the municipality regarding citizen behavior towards policy implementation/improvement. India as a country faces roadblocks at many levels of policy implementation. The findings of this study are meant to contribute/clarify about the Clean India drive.

Keywords: attitude, behavior, knowledge, segregation of domestic waste

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Authors: Rodolfo Alfonso, David Alonso, Albin Garcia, Jose Luis Alonso

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Recently a new kilovoltage radiotherapy unit model Xstrahl 200 - donated to the INOR´s Department of Radiotherapy (DR-INOR) in the framework of a IAEA's technical cooperation project- has been commissioned. This unit is able to treat shallow and low deep laying lesions, as it provides 8 discrete beam qualities, from 40 to 200 kV. As part of the patient-specific quality assurance program established at DR-INOR for external beam radiotherapy, it has been recommended to implement in vivo dose measurements (IVD), as they allow effectively discovering eventual errors or failures in the radiotherapy process. For that purpose a radio-photoluminescence (RPL) dosimetry system, model XXX, -also donated to DR-INOR by the same IAEA project- has been studied and commissioned. Main dosimetric parameters of the RPL system, such as reproducibility, linearity, and filed size influence were assessed. In a similar way, the response of radiochromic EBT3 type film was investigated for purposes of IVD. Both systems were calibrated in terms of entrance surface dose. Results of the dosimetric commissioning of RPL and EBT3 for IVD, and their pre-clinical implementation through end-to-end test cases are presented. The RPL dosimetry seems more recommendable for hyper-fractionated schemes with larger fields and curved patient contours, as those in chest wall irradiations, where the use of more than one dosimeter could be required. The radiochromic system involves smaller corrections with field size, but it sensibility is lower; hence it is more adequate for hypo-fractionated treatments with smaller fields.

Keywords: glass dosimetry, in vivo dosimetry, kilovotage radiotherapy, radiochromic dosimetry

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Authors: Ezzi Olfa, Bouafia Nabiha, Ammar Asma, Ben Cheikh Asma, Mahjoub Mohamed, Bannour Wadiaa, Achour Bechir, Khelif Abderrahim, Njah Mansour

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Background: In hematology/oncology, health care improvement has allowed increasingly aggressive management in diagnostic and therapeutic procedures. Nevertheless, these intensified procedures have been associated with higher risk of healthcare associated infections (HAIs). We undertook this study to estimate the burden of HAIs in the cancer patients in an onco -hematology unit in a Tunisian university hospital. Materials/Methods: A prospective, observational study, based on active surveillance for a period of 06 months from Mars through September 2016, was undertaken in the department of onco-hematology in a university hospital in Tunisia. Patients, who stayed in the unit for ≥ 48 h, were followed until hospital discharge. The Centers for Disease Control and Prevention criteria (CDC) for site-specific infections were used as standard definitions for HAIs. Results: One hundred fifty patients were included in the study. The gender distribution was 33.3% for girls and 66.6% boys. They have a mean age of 23.12 years (SD = 18.36 years). The main patient’s diagnosis is: Acute Lymphoblastic Leukemia (ALL): 48.7 %( n=73). The mean length of stay was 21 days +/- 18 days. Almost 8% of patients had an implantable port (n= 12), 34.9 % (n=52) had a lumber puncture and 42.7 % (n= 64) had a medullary puncture. Chemotherapy was instituted in 88% of patients (n=132). Eighty (53.3%) patients had neutropenia at admission. The incidence rate of HAIs was 32.66 % per patient; the incidence density was 15.73 per 1000 patient-days in the unit. Mortality rate was 9.3% (n= 14), and 50% of cases of death were caused by HAIs. The most frequent episodes of infection were: infection of skin and superficial mucosa (5.3%), pulmonary aspergillosis (4.6%), Healthcare associated pneumonia (HAP) (4%), Central venous catheter associated infection (4%), digestive infection (5%), and primary bloodstream infection (2.6%). Finally, fever of unknown origin (FUO) incidence rate was 14%. In case of skin and superficial infection (n= 8), 4 episodes were documented, and organisms implicated were Escherichia.coli, Geotricum capitatum and Proteus mirabilis. For pulmonary aspergillosis, 6 cases were diagnosed clinically and radiologically, and one was proved by positive aspergillus antigen in bronchial aspiration. Only one patient died due this infection. In HAP (6 cases), four episodes were diagnosed clinically and radiologically. No bacterial etiology was established in these cases. Two patients died due to HAP. For primary bloodstream infection (4 cases), implicated germs were Enterobacter cloacae, Geotricum capitatum, klebsiella pneumoniae, and Streptococcus pneumoniae. Conclusion: This type of prospective study is an indispensable tool for internal quality control. It is necessary to evaluate preventive measures and design control guides and strategies aimed to reduce the HAI’s rate and the morbidity and mortality associated with infection in a hematology/oncology unit.

Keywords: cohort prospective studies, healthcare associated infections, hematology oncology department, incidence

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Authors: Ragea Alqahtani

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The purpose of the study was to measure the effectiveness of the Goldstein’s social skill streaming model based on the special and general pre-service teachers’ knowledge about controlling their emotions in conflict situations. A review of previous pieces of literature guided the design and measurement of the effectiveness of the approach to the control of emotions. The teachers were assessed using the coping strategy, adult anger, and Goldstein’s skill streaming inventories. Lastly, the paper provides various recommendations on the sensitization of the Goldstein’s Social Skill streaming model to both the special and pre-service teachers to promote their knowledge about controlling emotions in conflicts.

Keywords: emotional control, Goldstein social skill streaming model, modeling technique, self- as-a-model, self-efficacy, self-regulation

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Authors: Aida Abd El-Razek, Alyaa Salman Madian, Gamila Gaber Ayoub

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Background: Electronic fetal monitoring is an obstetric technology that helps to record any changes in fetal heart rate and uterine activity. The aim of this study was to determine the efficacy of educational programs on the performance of internship nursing students regarding electronic fetal monitoring in obstetrics and gynecology departments. Design: A quasi-experimental research design (pre- and post-test) was used. Sample: A convenient sample of all internship nursing students (180 internship nursing students) from the Faculty of Nursing at Menoufia University during the academic year 2022-2023). The instruments of this study were a structured, self-administered interview questionnaire consisting of two parts: the socio-demographic characteristics of the study participants and an assessment of internship nursing students’ knowledge regarding electronic fetal monitoring (pre- and post-test). Observational checklist to assess internship nursing students’ performance regarding EFM. Results: There were highly statistically significant differences between the internship nurses' students’ knowledge and performance on the pretest and posttest. Conclusion: An educational program on electronic fetal monitoring carries a vital value for enhancing internship nursing students’ knowledge and performance, which ultimately leads to improved maternal and fetal outcomes. Recommendation: Regular educational programs and workshops about electronic fetal monitoring should be encouraged for all maternity nurses and internship nursing students.

Keywords: educational program, internship nursing students, performance, efficacy

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Authors: Khajeerat Phumpurk

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This research aims to study the knowledge, attitude toward household accounting of people in Bangkeaw Samutsongkhram. The sample use in this study was the people in tambol bangkeao Mueang Samut songkhram province. The Sample size for 100 household by using the accidental sampling and data collection was a questionnaire. Statistical analysis for frequency, percentage, mean, minimum, maximum value and standard deviation. It was found that the most of the respondent are farmers for 63.4. Most of them are male, with average of age 49.54 years. The education is vocational. The average household income is 60,873.74 per year. The respondent has the debt with the bank for 64.4 percent. The greatest influence to do the household accounting of farmers is the bank expertise. All the advice about doing household accounts get it from the staff of the bank for agriculture and agricultural cooperatives. The farmers for 57.3 do household accounting during the night time.

Keywords: Bangkeaw Samutsongkhram, household accounting, knowledge, sufficiency economy

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