Search results for: group outcomes

Authors: K. D. Candido, A. Lissounov, I. Knezevic, N. Knezevic

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Background: The most commonly performed pain procedures in the USA is Lumbar Epidural Steroid Injections (LESI). There are three main types of these procedures: transforaminal (TF), interlaminar (IL) and caudal injections. It is expected for TF injections to have better outcomes than IL injections, based on the recently published systematic review. The studies presented in that review used a midline IL approach, but those with parasagittal IL approach were not taken into consideration. Our aim is to emphasize the efficacy of the lateral parasagittal (paramedian) IL approach in this review. Methods: We included five studies in this systematic review, which compared Parasagittal-IL (PIL) with either Midline-IL (MIL) or TF LESI. Total of 296 patients who had undergone different types of LESI were observed across the five studies, and the average pain and functional improvements were calculated and compared among groups. Results: Pain and function improvements with PIL approach is superior on 12 months follow up to MIL approach (53.4% vs. 14.7%) and (55% vs. 27.7%), respectively. A 12 months follow-up results between PIL and TF shows a near equivalent effectiveness for pain (58.9% vs. 63.2%) and function improvement (47.3% vs. 48.1%). An average follow-up of 17.1 days have shown better short-term pain relief for PIL than TF approach (45.8% vs. 19.2%), respectively. Number of repeated injections is lower for PIL injections than MIL. Number of weeks between 1st and 2nd injections: PIL averaged 15.8 weeks and MIL averaged 9.7 weeks. Third LESI injection is more common in TF group (30%) than PIL group (18.8%). Conclusion: Higher complication rates are associated with TF injections for which FDA7 issued an official warning. We have recorded better outcomes in pain and function improvement of Parasagittal-IL LESI as compared to midline-IL injection, in the presented systematic review. Parasagittal and TF injections have equivalent efficacy in Pain and Function improvements thus we advocate for Parasagittal-IL approach consideration as an alternative for TF injections.

Keywords: parasagital approach, lumbar, back pain, epidural steroid injection

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Authors: Sheila Santharamohana, Susan Bennett

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Historically, the attrition rates in secondary schools of Indigenous people or Orang Asli of Malaysia have been a cause for nationwide concern. Efforts to increase student engagement focusing on curriculum re-design and aid have not had the targeted impact. The scope of the research explored a change model incorporating project-based learning and wrap-around support through school-community partnerships to increase Orang Asli engagement, student outcomes and improve cultural connectedness. The evaluation methodology was mixed-method comprising a student questionnaire, interviews, and document analysis. Data and evidence were gathered from school staff, community, the Orang Asli governmental authority (JAKOA) and external agencies. Findings from the year-long research suggests shared values and goals in school-community partnerships foster responsive leadership and is key to safeguarding vulnerable Orang Asli, resulting in improved student outcomes. The research highlighted the barriers to the recognition and distinct needs and unique values of the Orang Asli that impact their educational equity and outcomes.

Keywords: Indigenous Education, Cultural Connectedness, School-Community Partnership, Student Outcomes

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Authors: Min Woo Lee, Kyoung Seok Kim

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We made an effort to resolve a research question, which is about the relationship between employees’ corporate social responsibility (CSR) participation and their organizational citizenship behavior (OCB), and an effect of profiles of job characteristics. To test the question, we divided sample into two groups that have the profiles of each job characteristic. One group had high level on the five dimensions of job characteristic (D group), whereas another group had low level on the dimensions (R group). As a result, regression analyses showed that the relationship between CSR participation and OCB is positive in the D group, but the relationship is not significant in the R group. The results raise a question to the argument of recent studies showing that there is positive relationship between the CSR and the OCB. Implications and limitations are demonstrated in the conclusion.

Keywords: CSR, OCB, job characteristics, cluster analysis

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Authors: José Ramón López-Mínguez, Estrella Suárez-Corchuelo, Sergio López-Tejero, Luis Nombela-Franco, Xavier Freixa-Rofastes, Guillermo Bastos-Fernández, Xavier Millán-Álvarez, Raúl Moreno-Gómez, José Antonio Fernández-Díaz, Ignacio Amat-Santos, Tomás Benito-González, Fernando Alfonso-Manterola, Pablo Salinas-Sanguino, Pedro Cepas-Guillén, Dabit Arzamendi, Ignacio Cruz-González, Juan Manuel Nogales-Asensio

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Background and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P = .008) and 6.37% vs 1.91% (HR, 3.34; P = .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group.

Keywords: stents, atrial fibrillation, anticoagulants, left atrial appendage occlusion

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Authors: A. Barratt, M. H. Granat, S. Buttress, B. Roy

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Introduction: Physiotherapy is an essential part of the treatment of patients with shoulder problems. The focus of treatment is usually centred on addressing specific physiotherapy goals, ultimately resulting in the improvement in pain and function. This study investigates if computerised physiotherapy using gamification principles are as effective as standard physiotherapy. Methods: Physiotherapy exergames were created using a combination of commercially available hardware, the Microsoft Kinect, and bespoke software. The exergames used were validated by mapping physiotherapy goals of physiotherapy which included; strength, range of movement, control, speed, and activation of the kinetic chain. A multicenter, randomised prospective controlled trial investigated the use of exergames on patients with Shoulder Impingement Syndrome who had undergone Arthroscopic Subacromial Decompression surgery. The intervention group was provided with the automated sensor-based technology, allowing them to perform exergames and track their rehabilitation progress. The control group was treated with standard physiotherapy protocols. Outcomes from different domains were used to compare the groups. An important metric was the assessment of shoulder range of movement pre- and post-operatively. The range of movement data included abduction, forward flexion and external rotation which were measured by the software, pre-operatively, 6 weeks and 12 weeks post-operatively. Results: Both groups show significant improvement from pre-operative to 12 weeks in elevation in forward flexion and abduction planes. Results for abduction showed an improvement for the interventional group (p < 0.015) as well as the test group (p < 0.003). Forward flexion improvement was interventional group (p < 0.0201) with the control group (p < 0.004). There was however no significant difference between the groups at 12 weeks for abduction (p < 0.118067) , forward flexion (p < 0.189755) or external rotation (p < 0.346967). Conclusion: Exergames may be used as an alternative to standard physiotherapy regimes; however, further analysis is required focusing on patient engagement.

Keywords: shoulder, physiotherapy, exergames, gamification

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Authors: Mariam Shah

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Strict liability is frequently used in magistrate’s courts for TV license and driving offences.There is existing research suggesting that the strict liability approach to criminal offences can result in ‘absurd’ judicial outcomes, or potentially ‘injustice’.This paper will discuss the potential merits of strict liability as a method for dealing with shoplifting offences.Currently, there is disparity in sentencing outcomes in the UK, particularly in relation to shoplifting offences.This paper will question whether ‘injustice’ is actually in the differentiation of defendants based upon their ‘perceived’ circumstances, which could be resulting in arbitrary judicial decision making.

Keywords: arbitrary, decision making, judicial decision making, shoplifting, stereotypes, strict liability

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Authors: Alimohamad Asghari, Ahmad Daneshi, Mohammad Farhadi, Arash Bayat, Mohammad Ajalloueyan, Marjan Mirsalehi, Mohsen Rajati, Seyed Basir Hashemi, Nader Saki, Ali Omidvari

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Evidence suggests that Cochlear Implantation (CI) is a beneficial approach for auditory and speech skills improvement in children with severe to profound hearing loss. However, it remains controversial if implantation in children <12 months is safe and effective compared to older children. The present study aimed to determine whether children's ages affect surgical complications and auditory and speech development. The current multicenter study enrolled 86 children who underwent CI surgery at <12 months of age (group A) and 362 children who underwent implantation between 12 and 24 months of age (group B). The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were determined pre-impanation, and "one-year" and "two-year" post-implantation. Four complications (overall rate: 4.65%; three minor) occurred in group A and 12 complications (overall rate: 4.41%; nine minor) occurred in group B. We found no statistically significant difference in the complication rates between the groups (p>0.05). The mean SIR and CAP scores improved over time following CI activation in both groups. However, we did not find significant differences in CAP and SIR scores between the groups across different time points. Cochlear implantation is a safe and efficient procedure in children younger than 12 months, providing substantial auditory and speech benefits comparable to children undergoing implantation at 12 to 24 months of age. Furthermore, surgical complications in younger children are similar to those of children undergoing the CI at an older age.

Keywords: cochlear implant, Infant, complications, outcome

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Authors: Yi-Ting Chen, Yu-Fang Huang, Pei-Wei Wang, Hai-Wei Liang, Chun-Hao Lai, Mei-Lien Chen

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Background: Bisphenol A (BPA) is commonly used in consumer products, such as inner coatings of cans and polycarbonated bottles. BPA is considered to be an endocrine disrupting substance (EDs) that affects normal human hormones and may cause adverse effects on human health. Pregnant women and fetuses are susceptible groups of endocrine disrupting substances. Prenatal exposure to BPA has been shown to affect the fetus through the placenta. Therefore, it is important to evaluate the potential health risk of fetal exposure to BPA during pregnancy. The aims of this study were (1) to determine the urinary concentration of BPA in pregnant women, and (2) to investigate the association between BPA exposure during pregnancy and birth outcomes. Methods: This study recruited 117 pregnant women and their fetuses from 2012 to 2014 from the Taiwan Maternal- Infant Cohort Study (TMICS). Maternal urine samples were collected in the third trimester and questionnaires were used to collect socio-demographic characteristics, eating habits and medical conditions of the participants. Information about birth outcomes of the fetus was obtained from medical records. As for chemicals analysis, BPA concentrations in urine were determined by off-line solid-phase extraction-ultra-performance liquid chromatography coupled with a Q-Tof mass spectrometer. The urinary concentrations were adjusted with creatinine. The association between maternal concentrations of BPA and birth outcomes was estimated using the logistic regression model. Results: The detection rate of BPA is 99%; the concentration ranges (μg/g) from 0.16 to 46.90. The mean (SD) BPA levels are 5.37(6.42) μg/g creatinine. The mean ±SD of the body weight, body length, head circumference, chest circumference and gestational age at birth are 3105.18 ± 339.53 g, 49.33 ± 1.90 cm, 34.16 ± 1.06 cm, 32.34 ± 1.37 cm and 38.58 ± 1.37 weeks, respectively. After stratifying the exposure levels into two groups by median, pregnant women in higher exposure group would have an increased risk of lower body weight (OR=0.57, 95%CI=0.271-1.193), smaller chest circumference (OR=0.70, 95%CI=0.335-1.47) and shorter gestational age at birth newborn (OR=0.46, 95%CI=0.191-1.114). However, there are no associations between BPA concentration and birth outcomes reach a significant level (p < 0.05) in statistics. Conclusions: This study presents prenatal BPA profiles and infants in northern Taiwan. Women who have higher BPA concentrations tend to give birth to lower body weight, smaller chest circumference or shorter gestational age at birth newborn. More data will be included to verify the results. This report will also present the predictors of BPA concentrations for pregnant women.

Keywords: bisphenol A, birth outcomes, biomonitoring, prenatal exposure

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Authors: Sandipika Gupta

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Objective: Due to admirably low 30-day mortality rates for paediatric cardiac surgery, it is now pertinent to turn towards more intermediate-length outcomes such as morbidities closely associated with these surgeries. One such morbidity, major adverse events (MAE) comprises a group of adverse outcomes associated with paediatric cardiac surgery (e.g. cardiac arrest, major haemorrhage). Methods: This is a retrospective study that analysed the incidence and impact of MAE which was the primary outcome in the UK population. The data was collected in 5 centres between October 2015 and June 2017, amassing 3090 surgical episodes. The incidence and risk factors for MAE, were assessed through descriptive statistical analyses and multivariate logistic regression. The secondary outcomes of life status at 6 months and the length of hospital stay were also evaluated to understand the impact of MAE on patients. Results: Out of 3090 episodes, 134 (4.3%) had a postoperative MAE. The majority of the episodes were in: neonates (47%, P<0.001), high-risk cardiac diagnosis groups (20.1%, P<0.001), episodes with longer 5mes on the bypass (72.4%, P<0.001) and urgent surgeries (57.9%, P<0.001). Episodes reporting MAE also reported longer lengths of stay in hospital (29 days vs 9 days, P<0.001). Furthermore, patients experiencing MAE were at a higher risk of mortality at the 6-month life status check (mortality rates: 29.2% vs 2%, P<0.001).Conclusions: Key risk factors were identified. An important negative impact of MAE was found for patients. The identified risk factors could be used to profile and flag at-risk patients. Monitoring of MAE rates and closer investigation into the care pathway before and after individual MAEs in children’s heart units may lead to a reduction in these terrible events.

Keywords:

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Authors: Gali Moritz, Jacqueline H. Becker, Jyoti V. Ankam, Kimberly Arcoleo, Matthew Wysocki, Roee Holtzer, Juan Wisnivesky, Paula J. Busse, Alex D. Federman, Sunit P. Jariwala, Jonathan M. Feldman

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Objective: Cognitive impairment (CI), whose incidence is greater among ethnic/racial minorities, is a significant barrier to asthma self-management (SM) behaviors and outcomes in older adults. The aim of this study was to examine the relationships between CI, assessed using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Hispanic participants. Additionally, we evaluated whether using two different MoCA cutoff scores influenced the association between CI and study outcomes. Methods: Baseline cross-sectional data were extracted from a longitudinal study of older adults with asthma (N=165) age≥ 60 years and used for analysis. Cognition was assessed using the MoCA. Asthma control, asthma-related quality of life (QOL), inhaled corticosteroid (ICS) dosing, and ICS adherence were assessed using self-report. The inhaler technique was observed and rated. Results: Using established MoCA cutoff scores of 23 and 26 yielded 45% and 74% CI rates, respectively. CI, defined using the 23 cutoff score, was significantly associated with worse asthma control (p=.04) and worse ICS adherence (p=.01). With a cutoff score of 26, only asthma-related QOL was significantly associated with CI (p=.03). Race/ethnicity and education did not moderate the relationships between CI and asthma SM behaviors and outcomes. Conclusions: CI in older adults with asthma is associated with important clinical outcomes, but this relationship is influenced by the cutoff score used to define CI.

Keywords: cognition, respiratory, elderly, testing, adherence, validity

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Authors: Shamshuddin K., Nagaraj Vannal, Diwakar Kulkarni

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This paper presents details of teaching and learning pedagogical techniques attempted for the undergraduate engineering program to improve the concentration span of students in a classroom. The details of activities such as valid statement, quiz competition, classroom paper, group work and product marketing to make the students remain active for the entire class duration and to improve presentation skills are presented. These activities shown tremendous improvement in student’s performance in academics, also in asking questions, concept understanding and interaction with the course instructor. With these pedagogical activities we are able to achieve Program outcome elements and ABET Program outcomes such as d, i, g and h which are difficult to achieve through the conventional teaching methods.

Keywords: activities, pedagogy, interactive learning, valid statement, quiz competition, classroom papers, group work, product marketing

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Authors: Jacob Dangerfield, Jacob Pollard, Jennifer DeCou

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Introduction: Burnout, anxiety, and depression are three conditions that are prevalent in medical providers. This is especially the case in the field of anesthesia, which has a high number of providers suffering from burnout and burnout syndrome. A major contributor to this issue is isolation in the workplace, with a perceived lack of peer support as a major risk factor for burnout. Two organizational interventions that can be done to help improve this issue are small group sessions and providing affordable mental health services. Per American College of Graduate Medical Education (ACGME) Guidelines, these affordable mental health services are a requirement of all residency programs, but for a variety of reasons, many residents do not access them. As physicians, we are often not good at asking for help. With this in mind, we hypothesized that carrying out small group resiliency sessions facilitated by Graduate Medical Education (GME) Wellness Counselors would improve both resident peer support as well as the likelihood that a resident will reach out to GME Wellness in a time of need. Methods: We held small group resiliency sessions with the GME Wellness Mental Health Professionals during protected didactic time. These sessions were small groups, including the members of one’s class (i.e., first-year residents on their own), and were facilitated by 1-2 mental health professionals. After these sessions, we surveyed residents who attended using a short Google Forms survey and using a 5-point Likert Scale, asked residents about some outcomes from the session. A “strongly agree” or “agree” was considered a positive response. Results: Results from our survey showed that the resident sessions had multiple positive outcomes. This survey was sent to 29 residents, and we had a 62% response rate. We found out through this survey that these small group sessions had a perceived positive impact on resident personal well-being, increased perceived peer support from classmates, and made residents more likely to reach out to GME Wellness in the future. Perceived positive impact on well-being was found in 83% of resident respondents, improved perceived peer support in 83% of respondents, and 78% of resident respondents stated that this session increased their likelihood of reaching out to mental health professionals. Conclusions: Through this study, we can conclude that our hypothesis was correct in that Small Group Resiliency Sessions that are facilitated by GME Wellness Counselors improve both resident peer support as well as the likelihood a resident reaches out to these mental health professionals in time of need. We believe these findings are very important as they address two important factors that can aid in decreasing a provider’s risk of experiencing burnout. Through this simple means, we believe other residency programs can help the well-being of their residents, and together, we can decrease the number of cases of burnout in anesthesia.

Keywords: anesthesiology, burnout, wellness, depression, residents, trainees, mental health

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Authors: Yangming Zhu, Mingming Guo, Xiaozan Wang

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Introduction: The purpose of this study is to integrate functional training into physical education to test the effectiveness of functional training in improving the physical fitness (PF) and sport skills (SS) of female college students. Methods: A total of 54 female college students from East China Normal University were selected for this study (27 in the experimental group and 27 in the control group), and 13 weeks of the experimental intervention was conducted during the semester. During the experimental period, the experimental group was functionally trained for 1 hour per week. The control group performed one-hour weekly sports (such as basketball, football, etc.) as usual. Before and after the experiment, the national students' physical fitness test was used to test the PF of the experimental group and the control group, and the SS of the experimental group and the control group were tested before and after the intervention. Then using SPSS and Excel to organize and analyze the data. Results: The independent sample T-test showed that there was no significant difference in the PF and SS between the experimental group and the control group before the experiment (T PF=71.86, p PF> 0.05, Tₛₛ=82.41,pₛₛ > 0.05); After the experiment, the PF of the experimental group was significantly higher than that of the control group (T Improve=71.86, p Improve < 0.05); after the experiment, the SS of the experimental group was significantly higher than that of the control group (Tₛₛ = 1.31, pₛₛ <0.01) Conclusions: Integrating functional training into physical education can improve the PF of female college students. At the same time, the integration of functional training into physical education can also effectively improve the SS of female college students. Therefore, it is suggested that functional training be integrated into the daily physical education of female college students so as to improve their PF and SS.

Keywords: functional training, physical fitness, sport skills, female college students

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Authors: Ibrahim Turfanda, Soniya Rai, Karan Vadher

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Objectives— The study aims to compare real-world adherence to and persistence with dulaglutide and liraglutide in patients with type 2 diabetes (T2D) initiating treatment in UAE. Methods— This was a retrospective, non-interventional study (observation period: 01 March 2017–31 August 2019) using the UAE Dubai e-Claims database. Included: adult patients initiating dulaglutide/liraglutide 01 September 2017–31 August 2018 (index period) with: ≥1 claim for T2D in the 6 months before index date (ID); ≥1 claim for dulaglutide/liraglutide during index period; and continuous medical enrolment for ≥6 months before and ≥12 months after ID. Key endpoints, assessed 3/6/12 months after ID: adherence to treatment (proportion of days covered [PDC; PDC ≥80% considered ‘adherent’], per-group mean±standard deviation [SD] PDC); and persistence (number of continuous therapy days from ID until discontinuation [i.e., >45 days gap] or end of observation period). Patients initiating dulaglutide/liraglutide were propensity score matched (1:1) based on baseline characteristics. Between-group comparison of adherence was analysed using the McNemar test (α=0.025). Persistence was analysed using Kaplan–Meier estimates with log-rank tests (α=0.025) for between-group comparisons. This study presents 12-month outcomes. Results— Following propensity score matching, 263 patients were included in each group. Mean±SD PDC for all patients at 12 months was significantly higher in the dulaglutide versus the liraglutide group (dulaglutide=0.48±0.30, liraglutide=0.39±0.28, p=0.0002). The proportion of adherent patients favored dulaglutide (dulaglutide=20.2%, liraglutide=12.9%, p=0.0302), as did the probability of being adherent to treatment (odds ratio [97.5% CI]: 1.70 [0.99, 2.91]; p=0.03). Proportion of persistent patients also favoured dulaglutide (dulaglutide=15.2%, liraglutide=9.1%, p=0.0528), as did the probability of discontinuing treatment 12 months after ID (p=0.027). Conclusions— Based on the UAE Dubai e-Claims database data, dulaglutide initiators exhibited significantly greater adherence in terms of mean PDC versus liraglutide initiators. The proportion of adherent patients and the probability of being adherent favored the dulaglutide group, as did treatment persistence.

Keywords: adherence, dulaglutide, effectiveness, liraglutide, persistence

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Authors: Ismail Seçer, Kerime Meryem Dereli̇oğlu

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This study is conducted to determine the effects of group counseling program on secondary school 9th grade students’ assertiveness skills. The study group was formed of 100 students who have received education in Erzurum Kültür Elementary School in 2015-2016 education years. RAE-Rathus Assertiveness Schedule developed by Voltan Acar was applied on this group to gather data. 40 students who got lower grades from the inventory were divided randomly into experimental and control groups. Each group is formed of 20 students. Group counseling program was carried out on the experimental group to improve the students’ assertiveness skills for 8 weeks. Single-way and two-way analysis of covariance (ANCOVA) were used in the analysis of the data. The data was analyzed by using the SPSS 19.00. The results of the study show that assertiveness skills of the students who participate in the group counseling program increased meaningfully compared to the control group and pre-experiment. Besides, it was determined that the change observed in the experimental group occurred separately from the age and socio-economic level variables, and it was determined with the monitoring test applied after four months that this affect was continued. According to this result, it can be said that the applied group counseling program is an effective means to improve the assertiveness skills of secondary school students.

Keywords: high school, assertiveness, assertiveness inventory, assertiveness education

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Authors: Maria Vargas Hernandez, Jose Rojas Suarez, Carmelo Dueñas Castell, Sandra Contreras, Camilo Bello, Diana Borre, Walter Anichiarico, Harold Vasquez, Eduard Perez, Jose Santacruz

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In the last two decades, there have been outbreaks of emerging infectious diseases, with an impact on both the general population and the obstetric population. These infections, which affect the general population, pose a high risk for adverse maternal and perinatal outcomes, taking into account that physiological and immunological changes that occur during pregnancy can increase their risk or severity. Among these, the pandemics of viral infections, Influenza A/H1N1 and SARS-CoV-2/COVID-19, stand out. In 2009, Influenza A/H1N1 infection (H1N1 2009pdm) affected approximately 3,110 obstetric patients, with data reported from 29 countries, including 1,625 (52.3%) cases that were hospitalized, 378 (23.3%) admissions to ICU and 130 (8%) deaths; and since the end of 2019, the Severe Acute Respiratory Syndrome - 2 (SARS-CoV-2) has been identified, causing the COVID-19 pandemic, with global mortality that is around 2-4% for the general population, and higher mortality in patients requiring admission to the intensive care unit. Its impact on the obstetric population is still unknown. Objectives: To evaluate the impact on maternal and perinatal outcomes of COVID-19 infection in reference to influenza A/H1N1 infection in the obstetric population. Methodology: Systematic review of the literature and meta-analysis. Results: Mortality from maternal infection with influenza A/H1N1 appears to be higher (8%) than mortality due to maternal infection with COVID-19 (3%). The rates of ICU admission, hospitalization, the requirement for invasive mechanical ventilation, and fetal death also appear to be higher in the maternal population with A/H1N1 infection, in reference to the maternal population with COVID-19 infection. Within perinatal outcomes, the admission to the neonatal ICU appears to be higher in the infants born to mothers with COVID-19 infection (28% vs. 15% for COVID-19 and A/H1N1, respectively). Conclusion: A/H1N1 infection in the obstetric population seems to be associated with a higher proportion of adverse outcomes in relation to COVID-19 infection. The actual impact of maternal influenza A/H1N1 infection on perinatal outcomes is unknown. More COVID-19 studies are needed to understand the impact of maternal infection on perinatal outcomes in this population.

Keywords: A/H1N1, COVID-19, maternal outcomes, perinatal outcomes

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Authors: Anju Rani, Geeta, Sudha Rani, Choudhary, Puhal

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Method- A total of 300 patients were studied, with 100 patients in each group. Patients aged 16-60 years, ASA grade I and II undergoing elective general surgical, urology and orthopedic procedures were included in the study. The patients were randomly allocated to any of the three groups by Using Sealed envelopes. 1. Group A: EMLA (eutectic mixture of 2.5% lidocaine with 2.5% prilocaine) - Patients receiving eutectic Lidocaine/ Prilocaine cream (2gm/10cm2) of Prilox cream), for 60- 70 min under occlusive dressing. 2. Group B - Patients receiving topical diclofenac 4 % spray gel for 60- 70 min, covering an absorption area of 50 cm2 3. Group C: control – Direct cannulation was done without any intervention. Results - Group B showed significantly least number of patients complaining pain on IV cannulation in comparison to group A and group C. The Mean VAS scores were found to be maximum in GROUP C: control-8.76 ± 4.14, then in GROUP A: EMLA- 2.54 ± 4.21.and least in GROUP B: Diclofenac 4% spray-1.13 ± 3.05. Erythema, induration and edema were significantly reported to be higher for the control group. Also group A patients reported adverse skin reactions more than patients in group B. Conclusion - It can be concluded that diclofenac spray 4 % and EMLA cream are effective in reducing the incidence and severity of venous cannulation pain as compared to the control group. However, a higher incidence of skin blanching, erythema, and oedema associated with EMLA cream and a lower incidence of these adverse effects favours the use of diclofenac spray 4%. They are promising agents for the treatment of venous cannulation pain.

Keywords: diclofenac spray, EMLA, intravenous, pain

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Authors: Kanu Priya Mohan

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Innovation in education is one of the essential pathways to achieve both educational, and development goals in today’s dynamically changing world. Over the last decade, coaching and mentoring have been applied in the field of education as positive intervention techniques for fostering teaching and learning reforms in the developed countries. The context of this research was Thailand’s educational reform process, wherein a project on coaching and mentoring (C&M) was launched in 2014. The C&M project endeavored to support the professional development of the school teachers in the various provinces of Thailand, and to also enable them to apply C&M for teaching innovative instructional techniques. This research aimed to empirically investigate the learning outcomes for the master trainers, who trained for coaching and mentoring as the first step in the process to train the school teachers. A mixed method study was used for evaluating the learning outcomes of training in terms of cognitive- behavioral-affective dimensions. In the first part of the research a quantitative research design was incorporated to evaluate the effects of learner characteristics and instructional techniques, on the learning outcomes. In the second phase, a qualitative method of in-depth interviews was used to find details about the training outcomes, as well as the perceived barriers and enablers of the training process. Sample size constraints were there, yet these exploratory results, integrated from both methods indicated the significance of evaluating training outcomes from the three dimensions, and the perceived role of other factors in the training. Findings are discussed in terms of their implications for the training of C&M, and also their impact in fostering positive education through innovative educational techniques in the developing countries.

Keywords: cognitive-behavioral-affective learning outcomes, mixed method research, teachers in Thailand, training evaluation

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Authors: Ana Ferraz, Martim Santos, M. Graça Pereira

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Distress among parents of children with acute lymphoblastic leukemia (ALL) is common during treatment and can persist several years post-diagnosis, impacting the adjustment of children and parents themselves. Current evidence is needed to examine the scope and nature of parental distress in childhood ALL. This review focused on associated variables, predictors, and outcomes of parental distress following their ALL diagnosis of their child. PubMed, Web of Science, and PsycINFO databases were searched for English and Spanish papers published from 1983 to 2021. PRISMA statement was followed, and papers were evaluated through a standardized methodological quality assessment tool (NHLBI). Of the 28 papers included, 16 were evaluated as fair, eight as good, and four as poor. Regarding results, 11 papers reported subgroup differences, and 15 found potential predictors of parental distress, including sociodemographic, psychosocial, psychological, family, health, and ALL-specific variables. Significant correlations were found between parental distress, social support, illness cognitions, and resilience, as well as contradictory results regarding the impact of sociodemographic variables on parental distress. Family cohesion and caregiver burden were associated with distress, and the use of healthy coping strategies was associated with less anxiety. Caregiver strain contributed to distress, and the overall impact of illness positively predicted anxiety in mothers and somatization in fathers. Differences in parental distress were found regarding group risk, time since diagnosis, and treatment phases. Thirteen papers explored the outcomes of parental distress on psychological, family, health, and social/education outcomes. Parental distress was the most important predictor of family strain. Significant correlations were found between parental distress at diagnosis and further psychological adjustment of parents themselves and their children. Most papers reported correlations between parental distress on children’s adjustment and quality of life, although few studies reported no association. Correlations between maternal depression and child participation in education and social life were also found. Longitudinal studies are needed to better understand parental distress and its consequences on health outcomes, in particular. Future interventions should focus mainly on parents on distress reduction and psychological adjustment, both in parents and children over time.

Keywords: childhood acute lymphoblastic leukemia, family, parental distress, psychological adjustment, quality of life

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Authors: Haruna Modibbo Usman, Mustapha Muktar, Nasiru Inuwa

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This paper examined the long run relationship between health outcomes and economic growth in Nigeria from 1961 to 2012. Using annual time series data, Augmented Dickey-Fuller (ADF) test is conducted to check the stochastic properties of the variables. Also, the long run relationship among the variables is confirmed based on Johansen Multivariate Cointegration approach whereas the long run and short run dynamics are observed using Vector Error Correction Mechanism (VECM). In addition, VEC Granger causality test is employed to examine the direction of causality among the variables. On the whole, the results obtained revealed the existence of a long run relationship between health outcomes and economic growth in Nigeria and that both life expectancy and crude death rate as measures of health are found to have a long run negative and statistically significant impact on the economic growth over the study period. This is further buttressed by the results of Granger causality test which indicated the existence of unidirectional causality running from life expectancy and crude death rate to economic growth. The study therefore, calls for governments at various levels to create preconditions for health improvements in Nigeria in order to boost the level of health outcomes.

Keywords: cointegration, economic growth, Granger causality, health outcomes, VECM

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Authors: Saniya Ablatt, Matthew Jacobsson, Jamie Whisler, Austin Forbes

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Postoperative pancreatic fistula (POPF) is a complication that occurs in up to 41% of patients after pancreaticoduodenectomy. Although certain characteristics such as individual patient anatomy are known risk factors for POPF, the effect of barbed suture techniques remains underexplored. This study examines whether the use of Stratafix barbed suture versus PDS impacts the risk of developing POPF. After obtaining IRB exemption, a retrospective chart review was initiated involving patients who underwent pancreaticoduodenectomy for the treatment of malignant or premalignant lesions of the pancreas at our institution between April 1st 2020 and April 30th 2022. Patients were stratified into 2 groups respective to the technique used to suture the pancreatico-jejunal anastomosis: Group 1 was composed to patients in which 4.0 Stratafix® suture was used n=41. Group 1 was composed to patients in which 4.0 PDS suture was used n=42. Data regarding patient age, sex, BMI, presence or absence of biochemical leak, presence or absence of grade B & C postoperative pancreatic fistulas, rate and type of in hospital complication, rate of reoperation, 30 day readmission rate, 90 day mortality, and total mortality were compared between groups. 83 patients were included in our study with 42 receiving Stratafix and 41 receiving PDS (50.6% vs 49.4%). Stratafix patients had less biochemical leaks (0.0% vs 4.8%, p=0.19) and higher rates of POPF but this was not statistically significant (7.2% vs 2.4%, p=0.26). Additionally, there was no difference between the use of stratafix versus PDS on the risk of clinically relevant grade B or C POPF (p=0.26, OR=3.25 [CI= 0.74-16.43]). Of the independent variables including age, race, sex, BMI, and ASA class, BMI greater than 25 increased the risk of clinically relevant POPF by 7.7 times compared to patients with BMI less than 25 (p=0.03, OR=7.79 [1.04-88.51]). Despite no significant difference in primary outcomes, the Stratafix group had lower rates of secondary outcomes including 90-day mortality; bleeding, cardiac, and infectious complications; reoperation; and 30-day readmission. On statistical analysis, Stratafix decreased the risk of 30-day readmission (p=0.04, OR=0.21, CI=0.04-0.97) and had a marginally significant effect on the risk of reoperation (p=0.08, OR=0.24, CI=0.04-1.26). There was no difference between the use of Stratafix versus PDS on the risk of POPF (p=0.26). However, Stratafix decreased the risk of 30-day readmission (p=0.04) and BMI greater than 25 increased the risk of clinically relevant POPF (p=0.03).

Keywords: pancreas, hepatobiliary surgery, hepatobiliary, pancreatic leak, biochemical leak, fistula, pancreatic fistula

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Authors: S. Priya

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A project based learning assignment in English for Specific Purposes (ESP) context based on Communicative English as prescribed in the university syllabus for engineering students and its learning outcome from ESP context is the focus of analysis through this paper. The task based on Project Based Learning (PBL) was conducted in the digital language lab which had audio visual aids to support the team presentation. The total strength of 48 students of Mechanical Branch were divided into 6 groups, each consisting of 8 students. The group members were selected on random numbering basis. They were given a group task to represent a power point presentation on a topic related to their core branch. They had to discuss the issue and choose their topic and represent in a given format. It provided the individual role of each member in the presentation. A brief overview of the project and the outcome of its technical aspects were also had to be included. Each group had to highlight the contributions of that innovative technology through their presentation. The power point should be provided in a CD format. The variations in the choice of subjects, their usage of digital technologies, co-ordination for competition, learning experience of first time stage presentation, challenges of team cohesiveness were some criteria observed as their learning experience. For many other students undergoing the stages of planning, preparation and practice as steps for presentation had been the learning outcomes as given through their feedback form. The evaluation pattern is distributed for individual contribution and group effectiveness which promotes quality of presentation. The evaluated skills are communication skills, group cohesiveness, and audience response, quality of technicality and usage of technical terms. This paper thus analyses how project based learning improves the communication, life skills and technical skills in English for Specific learning context through PBL.

Keywords: language lab, ESP context, communicative skills, life skills

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Authors: Florge Francis A. Sy

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Physicians develop emotional and psychological distress after facing a patient’s death. This can result in stress or burnout. Coping mechanisms in dealing with these deaths may be maladaptive. Determining grief, emotional impact, and coping strategies in physicians is necessary to identify those needing intervention. This can be done by employing validated assessment tools such as the Texas Revised Inventory of Grief (TRIG) scale, Impact of Events Scale (IES), and BriefCOPE tool, respectively. This prospective, observational study was done in a private hospital in Cebu City. Fifty-five internal medicine residents were included and tasked to answer a survey based on their most memorable patient death encounter. The TRIG, IES, and BriefCOPE scores were determined. Participants were divided into severe grief and non-severe grief based on TRIG scores, low-impact, moderate-impact, and high-impact based on IES, and low-use, moderate-use, and high-use based on the BriefCOPE. The differences in the groups’ characteristics were statistically determined, and a p-value of < 0.05 was significant. The participants’ average age was 28.45 years. Most were female and single. Most belonged to the non-severe group based on TRIG, a moderate-impact group based on the IES, and high-use group based on the BriefCOPE. However, 21.8% reported severe grief, 27.3% reported high-impact, and 10.9% had low use of coping strategies. The proportion of residents who encountered CPR prior to the patient’s death was greater in the severe group. Proportions of both high-impact and non-high impact groups were comparable. The proportion of female residents was higher in the high-use group. There were a number of residents who reported severe grief, high emotional impact, and low coping strategies. This highlights the need for interventions such as debriefing after CPR or formal training in residency programs in dealing with emotional burden to counteract maladaptive coping behaviors and prevent negative outcomes.

Keywords: residents, grief, emotional impact, coping, patient death

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Authors: Liuyao Chai, Colin Clark

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Analysis of 574 participants in a simulated two-person distributive negotiation revealed that the first price 245 (42.7%) of these participants actually asked/offered for the item under negotiation (a used car) differed from the first price they previously stated they intended to ask/offer during their negotiation. This discrepancy between a negotiator’s intended first asking/offer price and his/her actual first asking/offer price had a significant and economically consequential impact on both the course and the outcomes of the negotiations studied. Participants whose actual first price remained the same as their intended first price tended to secure better negotiation outcomes. Moreover, participants who changed their intended first price tended to obtain relatively lower outcomes regardless of whether their modified first announced price had created a negotiating position that was ‘stronger’ or ‘weaker’ than if they had opened with their intended first price. Subsequent investigation of over twenty negotiation behaviours and pre-negotiation perceptual variables within this dataset indicated that the three types of first price announcers—i.e. intended first asking/offer price ‘weakeners’, ‘maintainers’ and ‘strengtheners’— comprised persons who tended to have significantly different pre-negotiation perceptions and behaved in systematically different ways during their negotiation. Typically, the most negative, outcome-compromising consequences of changing, weakening or strengthening an intended first price occurred at the very beginning of a negotiation when participants exchanged their actual first asking/offer prices.

Keywords: business communication, negotiation, persuasion, intended first asking/offer prices, bargaining

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Authors: Jaylo Abalos, Sophia Zamora

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BACKGROUND: Various gastrointestinal (GI) symptoms, including diarrhea, nausea/vomiting and abdominal pain, have been reported in patients with Coronavirus disease 2019 (COVID-19). In this context, the presence of GI symptoms is variably associated with poor clinical outcomes in COVID-19. We aim to determine the outcomes of hospitalized COVID-19 patients with gastrointestinal symptoms. METHODOLOGY: This is a retrospective cohort study that used medical records of admitted COVID-19 patients from March 2020- March 2021 in a tertiary hospital in Pangasinan. Data records were evaluated for the presence of gastrointestinal manifestations, including diarrhea, nausea, vomiting and abdominal pain at the time of admission. Comparison between cases or COVID-19 patients presenting with GI manifestations to controls or COVID-19 patients without GI manifestation was made. RESULTS: Four hundred three patients were included in the study. Of these, 22.3% presented with gastrointestinal symptoms, while 77.7% comprised the study controls. Diarrhea was the most common GI symptom (10.4%). No statistically significant difference was observed in comorbidities and laboratory findings. Mortality was the primary outcome of the study that did not reach statistical significance between cases and controls (13.33% vs. 16.30%, p =0.621). There were also no significant differences observed in the secondary outcomes, mean length of stay, (14 [12-18 days] in cases vs 14 [12- 17.5 days] in controls, p = 0.716) and need for mechanical ventilation (12.22% vs 16.93%, p = 0.329). CONCLUSION: The results of the study revealed no association of the GI symptoms to poor outcomes, including a high rate of mortality, prolonged length of stay and increased need for mechanical ventilation.

Keywords: gastrointestinal symptoms, COVID-19, outcomes, mortality, length of stay

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Authors: Agnieszka Nowogrodzka

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Objectives: ADHD is a neurodevelopmental disorder in which symptoms are most prominent throughout childhood. In the longer term, these symptoms, as well as the behaviour of the child, the experiences arising from the response of the community to the child's symptoms, as well as the functioning of the community itself, all contribute to the onset of secondary symptoms and subsequent outcomes of the disorder, such as crime or mental disorders. The purpose of this study is to estimate the prevalence of ADHD among Polish convicts serving a prison sentence. To that end, the study will focus on the relationship between the severity of ADHD and early childhood trauma, family relations, maladaptive cognitive schemas, as well as mental disorders. It is an attempt to assess the interdependence between ADHD, childhood experiences, and secondary outcomes. Methods: The study enrolled two groups of first-time convicts and repeat offenders aged between 21 and 65 –each of the study groups comprised 120 participants; 240 participants in total took part in the study. Participants were recruited in semi-open penal institutions in Poland (Poznań Custody Suite, Wronki Penal Institution, Iława Penal Institution). The control group comprised 110 men without criminal records aged 21 to 65. The DIVA 5.0 questionnaire was employed to identify the severity of ADHD symptoms. Other questionnaires employed in the course of the study included the Childhood Trauma Questionnaire (CTQ), The Family Adaptability and Cohesion Scale IV (FACES-IV), Young Schema Questionnaire (YSQ), and the General Health Questionnaire (GHQ-30). Results: The findings of the study in question are currently still being compiled and will be shared during the conference. The findings of a pilot study involving two cohorts of convicts (each numbering 20 men) and a control group (20 men with no criminal records) indicate a significant correlation between ADHD and the experience of early childhood trauma. The severity of ADHD also shows a correlation with the assessment of the functioning of the family, with the subjects assessing the relationships in their families more negatively than the control group. Furthermore, the severity of ADHD is also correlated with maladaptive emotional schemas manifesting in the participants. The findings also show a correlation between selected dimensions and the severity of offenses.

Keywords: ADHD, social impairments, mental disorders, early childhood traumas, criminality

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Authors: Hala Demerdash, Ola M. Zanaty, Emad Eldin Arida

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Background: This study investigated the micoRNA expression changes induced by Sevoflurane and Propofol and their effects on liver functions. Patients and methods: The study was designed as randomized controlled study, carried out on 200 adult patients, scheduled for major surgeries under general anesthesia (GA). Patients were randomly divided into four groups; groups SC and PC included chronic hepatitis C (CHC) patients where SC group are patients receiving Sevoflurane, and PC group are patients receiving Propofol anesthesia. While S and P groups included non- hepatitis patients; S group are patients receiving Sevoflurane and P group are patients receiving Propofol. Anesthesia in Group S and SC patients was maintained by sevoflurane, while anesthesia in Group P and PC patients was maintained by propofol infusion. Blood samples were analyzed for PT, PTT and liver enzymes. Serum samples were analyzed for microRNA before and after surgery. Results: Results show miRNA-122 and miRNA-21 were absent in serum of S and P groups in pre-operative samples. However, they were expressed in SC and PC groups. In post-operative samples; miRNA-122 revealed an increased expression in all groups; with more exaggerated response in SC group. On the other hand miRNA-21 revealed increased expression in both SC and PC groups; a slight expression in S group with absent expression in P group. There was a post-operative negative correlation between miR-122 and ALT (r=-0.46) in SC group and (r=-0.411) in PC group and positive correlation between ALT and miR-21 (r=0.335) in SC group and (r=0.379) in PC group. The amount of blood loss was positively correlated with miR-122 (r=0.366) in SC group and (r=0.384) in PC group. Conclusion: Propofol anesthesia is safer than Sevoflurane anesthesia in patients with CHC. Sevoflurane and Propofol anesthesia affect miRNA expression in both CHC and non-hepatitis patients.

Keywords: anesthesia, chronic hepatitis C, micoRNA, propofol, sevoflurane

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Authors: Zohre Shahhosseini, Mehdi Pourasghar, AliReza Khalilian, Fariba Salehi

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Objective: The prevalence of anxiety during pregnancy, particularly in developing countries, and its adverse effects on mother and baby, can make pregnancy unpleasant for pregnant women. The effect of anxiety during pregnancy on birth outcomes and children can be a justification for screening of anxious pregnant women in periodic pregnancy care and helping them. In this study, researchers have investigated effects and comparison of group counseling (Cognitive therapy) and interactive lectures on anxiety during pregnancy of primiparas. Methods: The population studied in this semi-experimental trail was nulliparous pregnant women with backgrounds in health care centers in Sari city .They were studied during a period of 3 months from early March to end May 2016. Sample size in this study was 91 patients, who were randomly assigned to three groups: group counseling, interactive lecture, and control group. Demographic questionnaire and Speilberger State –Trait Anxiety Inventory (SPAI) was completed for all three groups after obtaining letter of consent and completing the initial checklist. Then interventions included 4 sessions for group counseling and 4 sessions for interactive lecture which were implemented in two sessions a week. 4 weeks after interventions, Speilberger State – Trait Anxiety Inventory (SPAI), completed by both group counseling and interactive lectures groups again. In control group, the second questionnaire was also completed 4 weeks after completing the initial questionnaire. Data analysis was performed using spss software version 18. At first, the Kalmogorov-Smiranov test was carried out and then chi square tests, Independent t-test, paired t-test, ANOVA test, and Dunnett's post hoc test were applied. Results: Findings show that group counseling and interactive lecture with reducing state and trait anxiety in significant level of P=0/000 contribute to reduction of anxiety in nulliparous pregnant mothers. However, in this study, group counseling was more effective than an interactive lecture in reducing participants' anxiety, but this difference was not significant (P≥0/05). Conclusions: According to the results of this study, it is suggested that by screening of psychological - mental problems of pregnant women in periodic care during pregnancy be considered by revised prenatal care plans and creation of counseling and training units at health centers. Besides owing to the fact that both interactive lecture and group counseling method were effective in reducing anxiety, these methods should be used proportionate to situations and facilities.

Keywords: anxiety, group counseling, cognitive therapy, interactive lecture, nulliparous

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Authors: Elias Kodjo Kekesi

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This study seeks to investigate a critical but neglected area in disaster and emergency management in Ghana. It explores aspects of work within one of the safety-critical work environments that expose workers to psychological, social and physical harm. With much attention to crises’ survivors, deceased and their families, this research attempts to answer a key question: ‘What happens to the rescuer’? Emergency response is associated with immense and unprecedented pressure that puts responders’ physical, mental and social well-being at risk. Despite the negative psychological outcomes, scholars argue that being in a traumatic situation may trigger positive outcomes for some people. Thus, the study also focuses on the positive impact of working in a risky crisis environment. Additionally, people’s interpretation of negative experiences or exposure to adverse conditions differ owing to their personal resources which explains why some people may be negatively affected whiles others are positively impacted. To examine these complex nuances, an exploratory sequential mixed method design is adopted. This paper will highlight the findings of study one, which explores the underlying themes emerging from the Ghanaian disaster and emergency response environment regarding psychosocial hazard exposures and the corresponding outcomes.

Keywords: psychosocial hazards, organisational outcomes, qualitative research, Ghana

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Authors: Luz Janeth Ospina M.

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The fourth industrial revolution is changing the role of education substantially and, therefore, the role of instructors and learners at all levels. Education 4.0 is an imminent response to the needs of a globalized world where humans and technology are being aligned to enable endless possibilities, among them the need for students, as digital natives, to communicate effectively in at least one language besides their mother tongue, and also the requirement of developing theirs. This is an exploratory study in which a control group (N = 21), all of the students of Spanish as a foreign language at the university level, after taking a Spanish class, responded to an online questionnaire about the engagement, atmosphere, and environment in which their course was delivered. These aspects considered in the survey were relative to the instructor’s teaching style, including: (a) active, hands-on learning; (b) flexibility for in-class activities, easily switching between small group work, individual work, and whole-class discussion; and (c) integrating technology into the classroom. Strongly believing in these principles, the instructor deliberately taught the course in a SCALE-UP room, as it could facilitate such a positive and encouraging learning environment. These aspects are trends related to Education 4.0 and have become integral to the instructor’s pedagogical stance that calls for a constructive-affective role, instead of a transmissive one. As expected, with a learning environment that (a) fosters student engagement and (b) improves student outcomes, the subjects were highly engaged, which was partially due to the learning environment. An overwhelming majority (all but one) of students agreed or strongly agreed that the atmosphere and the environment were ideal. Outcomes of this study are relevant and indicate that it is about time for teachers to build up a meaningful correlation between humans and technology. We should see the trends of Education 4.0 not as a threat but as practices that should be in the hands of critical and creative instructors whose pedagogical stance responds to the needs of the learners in the 21st century.

Keywords: active learning, education 4.0, higher education, pedagogical stance

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