Search results for: emergency obstetric care

Authors: Bacha Zakaria

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This study aimed to investigate the reality of humane treatment and work environment problems for nurses in public hospitals and their repercussions on the patients arriving there. In this curve, our field study was based on a sample of nurses in Algiers hospitals estimated at 100 nurses. The questionnaire prepared by the two researchers was applied face to face with the nurses, and after obtaining and analyzing the data, we concluded the most important results: The presence of many problems in the work environment, such as work pressures, lack of appreciation, verbal and physical violence, risk of infection, poor salary and incentives, working during fatigue, administrative problems etc. And accordingly, The embodiment of humane dealing with patients requires providing a humane work environment for nurses and dealing with them humanely so that they embody positive behaviors while dealing with patients.

Keywords: nursing, future, family-focused care, health equity

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Authors: Madikeri Rohit

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As energy efficiency is the key concern in many aircraft manufacturing companies regenerative braking is a technique using which energy lost due to friction while braking can be regained. In the operation of an aircraft, significant energy is lost during deceleration or braking which occurs during its landing phase. This problem can be overcome using Regenerative Breaking System (RBS) in landing gear. The major problem faced is regarding the batteries and the overall efficiency gained in competence with the added weight. As the amount of energy required to store is huge we need batteries with high capacity for storage. Another obstacle by using high capacity batteries is the added weight which undermines the efficiency obtained using RBS. An approach to this problem is to either use the obtained energy immediately without storage or to store in other forms such as mechanical, pneumatic and hydraulic. Problem faced with mechanical systems is the weight of the flywheel needed to obtain required efficiency. Pneumatic and hydraulic systems are a better option at present. Using hydraulic systems for storing energy is efficient as it integrates into the overall hydraulic system present in the aircraft. Another obstacle is faced with the redundancy of this system. Conventional braking must be used along with RBS in order to provide redundancy. Major benefits obtained using RBS is with the help of the energy obtained during landing which can be used of engine less taxing. This reduces fuel consumption as well as noise and air pollution. Another added benefit of using RBS is to provide electrical supply to lighting systems, cabin pressurization system and can be used for emergency power supply in case of electric failure. This paper discusses about using RBS in landing gear, problems, prospects and new techniques being pursued to improve RBS.

Keywords: regenerative braking, types of energy conversion, landing gear, energy storage

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Authors: Wissem Abdaoui, Ilhem Mokhtari, Adel Gouri, Benouareth Djamel Eddine

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Contracted in a health facility, hospital-acquired infections are a major public health problem in recent years. The increase of nosocomial infections is partly related to diagnostic and therapeutic advances in medicine. The aim of our study was to isolate and diagnose some types of bacteria that are circulating in the hospital by performing different samples at two medical services: Pulmonary and Infectious Diseases. The antibiotic susceptibility tests were performed for bacterial isolates. The results have shown that there is a predominance of enterobacteria followed by the staphylococcus with its two species epidermidis ans saprophyticus. The study of the antibiogramme identified that some of these bacteria have a resistant profile against all the tested antibiotics. The fight against nosocomial infections is difficult because it must act on several factors: quality of care, safety of the hospital environment, hygiene, wearing gloves etc. are all areas that should be of heightened vigilance and preventive measures.

Keywords: nosocomial infection, isolation, identification, sensitivity and resistance to antibiotics

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Authors: Mebruka Mohammed, Daniel Bisrat, Asfaw Debella, Tarekegn Birhanu

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Lack of quality control standards for medicinal plants and their preparations is considered major barrier to their integration in to effective primary health care in Ethiopia. Poor quality herbal preparations led to countless adverse reactions extending to death. Denial of penetration for the Ethiopian medicinal plants in to the world’s booming herbal market is also another significant loss resulting from absence of herbal quality control system. Thus, in the present study, Gnidia stenophylla Gilg (popular antimalarial plant of south eastern Ethiopia), is standardized and a full monograph is produced that can serve as a guideline in quality control of the crude drug. Morphologically, the roots are found to be cylindrical and tapering towards the end. It has a hard, corky and friable touch with saddle brown color externally and it is relatively smooth and pale brown internally. It has got characteristic pungent odor and very bitter taste. Microscopically it has showed lignified xylem vessels, wider medullary rays with some calcium oxalate crystals, reddish brown secondary metabolite contents and slender shaped long fibres. Physicochemical standards quantified and resulted: foreign matter (5.25%), moisture content (6.69%), total ash (40.80%), acid insoluble ash (8.00%), water soluble ash (2.30%), alcohol soluble extractive (15.27%), water soluble extractive (10.98%), foaming index (100.01 ml/g), swelling index (7.60 ml/g). Phytochemically: Phenols, flavonoids, steroids, tannins and saponins were detected in the root extract; TLC and HPLC fingerprints were produced and an analytical marker was also tentatively characterized as 3-(3,4-dihydro-3,5-dihydroxy-2-(4-hydroxy-5-methylhex-1-en-2-yl)-7-methoxy-4-oxo-2H-chromen-8-yl)-5-hydroxy-2-(4-hydroxyphenyl)-7-methoxy-4H-chromen-4-one. Residue wise pesticides (i.e. DDT, DDE, g-BHC) and radiochemical levels fall below the WHO limit while Heavy metals (i.e. Co, Ni, Cr, Pb, and Cu), total aerobic count and fungal load lie way above the WHO limit. In conclusion, the result can be taken as signal that employing non standardized medicinal plants could cause many health risks of the Ethiopian people and Africans’ at large (as 80% of inhabitants in the continent depends on it for primary health care). Therefore, following a more universal approach to herbal quality by adopting the WHO guidelines and developing monographs using the various quality parameters is inevitable to minimize quality breach and promote effective herbal drug usage.

Keywords: Gnidia stenophylla Gilg, standardization/monograph, pharmacognostic, residue/impurity, quality

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Authors: Fatma Koksal Çakirlar, Si̇nem Ozdemir, Selcan Akyol, Revazi̇ye Gulesen, Murat Gunaydin, Nevri̇ye Gonullu, Belkis Levent, Nuri̇ Kiraz

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Vibrio cholerae O1 and O139 are the causative agent of epidemic or pandemic cholera. V. cholerae O1 is generally accepted as a non-invasive enterotoxigenic organism causing gastroenteritis of various severities. Non-O1 V. cholerae can cause small outbreaks of diarrhea due to consumption of contaminated food and water. Particularly, the patients with achlorydria have a risk for vibrio infections. There are numerous case reports of bacteremia caused by vibrio in patients with predisposing conditions like cirrhosis, nephrotic syndrome, diabetes, hematologic malignancy, gastrectomy, and AIDS. We described in this study the first case of nontoxigenic, non-01/non-O139 V. cholerae isolated from the blood culture of a 77-year-old female patient with hipertension, diabetes, coronary artery disease, gout and about 9 years ago migrated breast cancer history. The patient with complaints of shortness of breath, fever and malaise admitted to our emergency clinic were evaluated. There was no diarrhea or abdominal symptoms in the patient. No growth in her urine culture, but blood culture (BACTEC 9120 system, Becton Dickinson, USA) was positive for non-01/non-O139 V. cholerae that was identified by conventional methods and Phoenix automated system (BD Diagnostic Systems, Sparks, MD). It does not secrete the cholera toxin. The agglutination test was negative with polyvalent O1 antisera and O139 antiserum. Empirically ceftriaxone was administered to the patient and she was discharged with improvement in general condition. In this study we report bacteremia by non-01/non-O139 V. cholerae that is rare in the worldwide and first in Turkey.

Keywords: bacteremia, blood culture, immunocompromised patient, Non-O1 vibrio cholerae

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Authors: Onyia Comfort Ngozi, Iketaku Ifeoma Roseline

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Inspite of the laudable goals and objectives in education, Nigerian women, still face a lot of challenges that hinder the personal and national development. There are unbalances between males and females at all levels of the science education sector in Nigeria. Educate a woman, and you educate a nation, and if you educate a man, you educate an individual. It is on this note that the paper focuses on bridging the gender gap as it concerns science education in Nigeria. Suggestions were made as measures of bridging the gender gap in Nigerian education sector. The researchers concluded that achieving gender equality will promote greater equality in employment, help postpone early marriages, reduce infant mortality rates and improve health and education for a future generation. Thus, the paper recommended that government should involve women in policy making to take care of any gender issue and bias that may be included either consciously or not, during formulation stage.

Keywords: education, gender, science education, women, equality

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Authors: Mary A. Lindell

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Adults with intellectual disabilities (ID) are increasingly attending postsecondary institutions, including inclusive residential programs at four-year universities. The legislation, national organizations, and researchers support developing postsecondary education (PSE) options for this historically underserved population. Simultaneously, researchers are assessing the quality of life indicators (QOL) for people with ID. This study explores the quality of life characteristics for individuals with ID entering a two-year PSE program. A survey aligned with the PSE program was developed and administered to participants before they began their college program (in future studies, the same survey will be administered 6 months and 1 year after graduating). Employment, income, and housing are frequently cited QOL measures. People with disabilities, and especially people with ID, are more likely to experience unemployment and low wages than people without disabilities. PSE improves adult outcomes (e.g., employment, income, housing) for people with and without disabilities. Similarly, adults with ID who attend PSE are more likely to be employed than their peers who do not attend PSE; however, adults with ID are least likely among their typical peers and other students with disabilities to attend PSE. There is increased attention to providing individuals with ID access to PSE and more research is needed regarding the characteristics of students attending PSE. This study focuses on the participants of a fully residential two-year program for individuals with ID. Students earn an Applied Skills Certificate while focusing on five benchmarks: self-care, home care, relationships, academics, and employment. To create a QOL measure, the goals of the PSE program were identified, and possible assessment items were initially selected from the National Core Indicators (NCI) and the National Transition Longitudinal Survey 2 (NTLS2) that aligned with the five program goals. Program staff and advisory committee members offered input on potential item alignment with program goals and expected value to students with ID in the program. National experts in researching QOL outcomes of people with ID were consulted and concurred that the items selected would be useful in measuring the outcomes of postsecondary students with ID. The measure was piloted, modified, and administered to incoming students with ID. Research questions: (1) In what ways are students with ID entering a two-year PSE program similar to individuals with ID who complete the NCI and NTLS2 surveys? (2) In what ways are students with ID entering a two-year PSE program different than individuals with ID who completed the NCI and NTLS2 surveys? The process of developing a QOL measure specific to a PSE program for individuals with ID revealed that many of the items in comprehensive national QOL measures are not relevant to stake-holders of this two-year residential inclusive PSE program. Specific responses of students with ID entering an inclusive PSE program will be presented as well as a comparison to similar items on national QOL measures. This study explores the characteristics of students with ID entering a residential, inclusive PSE program. This information is valuable for, researchers, educators, and policy makers as PSE programs become more accessible for individuals with ID.

Keywords: intellectual disabilities, inclusion, post-secondary education, quality of life

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Authors: Hareem Kausar

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Women of today’s world are energetic, enthusiastic and high-spirited. They tend to be the best in whatever they do and strive to accept and fulfil each challenge with utmost liveliness. The aim of the research was about studying the impact of Maternal Employment on the Child’s Behavioral Development. It was conducted as an initiative to study the impact factor in Pakistani culture and for deep insight to the subject using qualitative research methodology. The samples were interviewed through semi-structured interview method in three phases including two working mothers, two children and a day care center official and the data was collected and analyzed through content analysis. Further, it was linked with the literature from the west and the results show that children of working mothers tend to be sound mentally and physically but at some points they face the inner feeling of solitude. Overall, develop the mechanism in independence in their nature and behavior but maternal employment definitely affects the overall behavioral development of the children.

Keywords: maternal employment, child behavior- development, childhood, impact

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Authors: Esra Yuksel, Dilek Duman, Levent Yeniay, Sezgin Ulukaya

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Sentinel lymph node biopsy (SLNB) is a minimal invasive technique with lower morbidity in axillary staging of breast cancer. Isosulfan blue stain is frequently used in SLNB and regarded as safe. The present case report aimed to report severe decrement in SpO2 following isosulfan blue administration, as well as skin and urine signs and inconsistency with clinical picture in a 67-year-old ,77 kg, ASA II female case that underwent SLNB under general anesthesia. Ten minutes after subcutaneous administration of 10 ml 1% isosulfan blue by the surgeons into the patient, who were hemodynamically stable, SpO2 first reduced to 87% from 99%, and then to 75% in minutes despite 100% oxygen support. Meanwhile, blood pressure and EtCO2 monitoring was unremarkable. After specifying that anesthesia device worked normally, airway pressure did not increase and the endotracheal tube has been placed accurately, the blood sample was taken from the patient for arterial gas analysis. A severe increase was thought in MetHb concentration since SpO2 persisted to be 75% although the concentration of inspired oxygen was 100%, and solution of 2500 mg ascorbic acid in 500 ml 5% Dextrose was given to the patient via intravenous route until the results of arterial blood gas were obtained. However, arterial blood gas results were as follows: pH: 7.54, PaCO2: 23.3 mmHg, PaO2: 281 mmHg, SaO2: %99, and MetHb: %2.7. Biochemical analysis revealed a blood MetHb concentration of 2%.However, since arterial blood gas parameters were good, hemodynamics of the patient was stable and methemoglobin concentration was not so high, the patient was extubated after surgery when she was relaxed, cooperated and had adequate respiration. Despite the absence of respiratory or neurological distress, SpO2 value was increased only up to 85% within 2 hours with 5 L/min oxygen support via face mask in the surgery room as the patient was extubated. At that time, the skin of particularly the upper part of her body has turned into blue, more remarkable on the face. The color of plasma of the blood taken from the patient for biochemical analysis was blue. The color of urine coming throughout the urinary catheter placed in intensive care unit was also blue. Twelve hours after 5 L/min. oxygen inhalation via a mask, the SpO2 reached to 90%. During monitoring in intensive care unit on the postoperative 1st day, facial color and urine color of the patient was still blue, SpO2 was 92%, and arterial blood gas levels were as follows: pH: 7.44, PaO2: 76.1 mmHg, PaCO2: 38.2 mmHg, SaO2: 99%, and MetHb 1%. During monitoring in clinic on the postoperative 2nd day, SpO2 was 95% without oxygen support and her facial and urine color turned into normal. The patient was discharged on the 3rd day without any problem.In conclusion, SLNB is a less invasive alternative to axillary dissection. However, false pulse oximeter reading due to pigment interference is a rare complication of this procedure. Arterial blood gas analysis should be used to confirm any fall in SpO2 reading during monitoring.

Keywords: isosulfan blue, pulse oximetry, SLNB, methemoglobinemia

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Authors: Julia Córdoba

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People are not completely autonomous, as we live in society; therefore, people could be defined as relationally dependent. The lack, decrease or loss of physical, psychological and/or social interdependence due to a disability situation is known as dependence. This is related to the need for help from another person in order to carry out activities of daily living. This population group lives with major social limitations that significantly reduce their participation and autonomy. They have high levels of stigma and invisibility from private environments (family and close networks), as well as from the public order (environment, community). The importance of this study lies in the fact that the lack of support and adjustments leads to what authors call the circle of exclusion. This circle describes how not accessing services - due to the difficulties caused by the disability situation impacts biological, social and psychological levels. This situation produces higher levels of exclusion and vulnerability. This study will focus on the process of autonomy and dependence of adults with disability from the model of disability proposed by the International Classification of Functioning, Health and Disability (ICF). The objectives are: i) to write down the relationship between autonomy and dependence based on socio-health variables and ii) to determine the relationship between the situation of autonomy and dependence and the expectations and interests of the participants. We propose a study that will use a survey technique through a previously validated virtual questionnaire. The data obtained will be analyzed using quantitative and qualitative methods for the details of the profiles obtained. No less than 200 questionnaires will be administered to people between 18 and 64 years of age who self-identify as having some degree of dependency due to disability. For the analysis of the results, the two main variables of autonomy and dependence will be considered. Socio-demographic variables such as age, gender identity, area of residence and family composition will be used. In relation to the biological dimension of the situation, the diagnosis, if any, and the type of disability will be asked. For the description of these profiles of autonomy and dependence, the following variables will be used: self-perception, decision-making, interests, expectations and life project, care of their health condition, support and social network, and labor and educational inclusion. The relationship between the target population and the variables collected provides several guidelines that could form the basis for the analysis of other research of interest in terms of self-perception, autonomy and dependence. The areas and situations where people state that they have greater possibilities to decide and have a say will be obtained. It will identify social (networks and support, educational background), demographic (age, gender identity and residence) and health-related variables (diagnosis and type of disability, quality of care) that may have a greater relationship with situations of dependency or autonomy. It will be studied whether the level of autonomy and/or dependence has an impact on the type of expectations and interests of the people surveyed.

Keywords: life project, disability, inclusion, autonomy

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Authors: Jacqueline A. G. Sachett, Cláudia S. Nogueira, Diana C. P. Lima, Jessica T. S. Oliveira, Guilherme K. M. Salazar, Lílian K. Aguiar

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The Polo Amazon Telehealth offers several tools for professionals working in Primary Health Care as a second formative opinion, teleconsulting and training between the different areas, whether medicine, dentistry, nursing, physiotherapy, among others. These activities have a monthly schedule of free access to the municipalities of Amazonas registered. With this premise, and in partnership with the University of the State of Amazonas (UEA), is promoting the practice of the triad; teaching-research-extension in order to collaborate with the enrichment and acquisition of knowledge through educational practices carried out through teleconferences. Therefore, nursing is to join efforts and inserts as a collaborator of this project running, contributing to the education and training of these professionals who are part of the health system in full Amazon. The aim of this study is to report the experience of academic of Amazonas State University nursing course, about the experience in the extension project underway in Polo Telemedicine Amazon. This was a descriptive study, the experience report type, about the experience of nursing academic UEA, by extension 'Telenursing: teleconsulting and second formative opinion for FHS professionals in the state of Amazonas' project, held in Polo Telemedicine Amazon, through an agreement with the UEA and funded by the Foundation of Amazonas Research from July / 2012 to July / 2016. Initially developed active search of members of the Family Health Strategy professionals, in order to provide training and training teams to use the virtual clinic, as well as the virtual environment is the focus of this tool design. The election period was an aggravating factor for the implementation of teleconsulting proposal, due to change of managers in each municipality, requiring the stoppage until they assume their positions. From this definition, we established the need for new training. The first video conference took place on 03.14.2013 for learning and training in the use of Virtual Learning Environment and Virtual Clinic, with the participation of municipalities of Novo Aripuanã, São Paulo de Olivença and Manacapuru. During the whole project was carried out literature about what is being done and produced at the national level about the subject. By the time the telenursing project has received twenty-five (25) consultancy requests. The consultants sent by nursing professionals, all have been answered to date. Faced with the lived experience, particularly in video conferencing, face to cause difficulties issues, such as the fluctuation in the number of participants in activities, difficulty of participants to reconcile the opening hours of the units with the schedule of video conferencing, transmission difficulties and changes schedule. It was concluded that the establishment of connection between the Telehealth points is one of the main factors for the implementation of Telenursing and that this feature is still new for nursing. However, effective training and updating, may provide to these professional category subsidies to quality health care in the Amazon.

Keywords: Amazon, teleconsulting, telehealth, telenursing

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Authors: Amel M. A. Osman, Roy Mahony, Lisa Dann, McKenna S.

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Background: Computed Tomography (CT) is a significant source of radiation in the pediatric population. A new head injury (HI) pathway was introduced in 2021, which altered the previous process of HI being jointly admitted with general pediatrics and surgery to admit these patients under the Emergency Medicine Team. Admitted patients included those with positive CT findings not requiring immediate neurosurgical intervention and those who did not meet current criteria for urgent CT brain as per NICE guidelines but were still symptomatic for prolonged observations. This approach aims to decrease the number of CT scans performed. The main aim is to assess the variation in CT scanning rates since the change in the admitting process. A retrospective review of patients presenting to CHI PECU with HI over 6-month period (01/01/19-31/05/19) compared to a 6-month period post introduction of the new pathway (01/06/2022-31/12/2022). Data was collected from the electronic record databases, symphony, and PACS. Results: In 2019, there were 869 presentations of HI, among which 32 (3.68%) had CT scans performed. 2 (6.25%) of those scanned had positive findings. In 2022, there were 1122 HI presentations, with 47 (4.19%) CT scans performed and positive findings in 5 (10.6%) cases. 57 patients were admitted under the new pathway for observation, with 1 having a CT scan following admission. Conclusion: Quantitative lifetime radiation risks for children are not negligible. While there was no statistically significant reduction in CTs performed amongst HIs presenting to our department, a significant group met the criteria for admission under the PECU consultant for prolonged monitoring. There was also a greater proportion of abnormalities on CT scans performed in 2022, demonstrating improved patient selection for imaging. Further data analysis is ongoing to determine if those who were admitted would have previously been scanned under the old pathway.

Keywords: head injury, CT, admission, guidline

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Authors: Syeda Mahnaz Hassan

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Social work as a specialized field, grounded in scientific knowledge and skills, is more inclined towards problem-solving process rather than charity focused approach. Medical social work, as a primary method, deals with the bio-psychosocial-spiritual elements of an individual with a problem and assesses the pliability and strength of the patients, social support systems, and their families, to assist the patients to resolve their problems independently. The medical social worker, also known as case-worker or care-worker, has to play a substantial role in the rehabilitation and retrieval of an affected person. This paper examines the roles played and responsibilities discharged by the Medical Social Workers internationally and specifically concerning Pakistan. The capacity constraints and challenges confronted by Medical Social Workers in hospitals have also been highlighted, and some policy implications have been suggested to enhance the capabilities of Medical Social Workers for serving the patients in a befitting manner.

Keywords: medical social work, Pakistan, patients, rehabilitation

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Authors: Maria Medrano, Cristina Cadenas-Sanchez, Maddi Oses, Lide Arenaza, Maria Amasene, Idoia Labayen

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The COVID-19 outbreak began in December 2019 in China and was rapidly expanded globally. Emergency measures, such as social distance or home confinement, were adopted by many country governments to prevent its transmission. In Spain, one of the most affected countries, the schools were closed, and one of the most severe mandatory home confinement was established for children from 14th March to 26th April 2020. The hypothesis of this study was that the measures adopted during the COVID-19 pandemic may have negatively affected physical activity and screen time of children. However, few studies have examined the effects of COVID-19 pandemic on lifestyle behaviours. Thus, the aim of the current work was to analyse the effects of the COVID-19 confinement on physical activity and screen time in Spanish children. For the current purpose, a total of 113 children and adolescents (12.0 ± 2.6 yr., 51.3% boys, 24.0% with overweight/obesity according to the World Obesity Federation) of the MUGI project were included in the analyses. Physical activity and screen time were longitudinally assessed by 'The Youth Activity Profile' questionnaire (YAP). Differences in physical activity and screen time before and during the confinement were assessed by dependent t-test. Before the confinement, 60% did not meet physical activity recommendations ( ≥ 60/min/day of moderate to vigorous physical activity), and 61% used screens ≥ 2 h/day. During the COVID-19 confinement, children decreased their physical activity levels (-91 ± 55 min/day, p < 0.001) and increased screen time ( ± 2.6 h/day, p < 0.001). The prevalence of children that worsened physical activity and screen time during the COVID-19 confinement were 95.2% and 69.8%, respectively. The current study evidence the negative effects of the COVID-19 confinement on physical activity and screen time in Spanish children. These findings should be taken into account to develop and implement future public health strategies for preserving children's lifestyle behaviours and health during and after the COVID-19 pandemic.

Keywords: COVID-19, lifestyle changes, paediatric, physical activity, screen time

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Authors: Nasreen Abdulmannan

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Fetal abnormalities are categorized as a structural abnormality, non-structural abnormality, or a combination of both. Fetal structural abnormalities (FSA) include, but are not limited, to Down syndrome, congenital diaphragmatic hernia, and cleft lip and palate. These abnormalities can be detected in the first weeks of pregnancy, which is almost around 9 - 20 weeks gestational. Etiological factors for FSA are unknown; however, transmitted genetic risk can be one of these factors. Consanguineous marriage often referred to as inbreeding, represents a significant risk factor for FSA due to the increased likelihood of deleterious genetic traits shared by both biological parents. In a country such as the Kingdom of Saudi Arabia (KSA), consanguineous marriage is high, which creates a significant risk of children being born with congenital abnormalities. Historically, the practice of consanguinity occurred commonly among European royalty. For example, Great Britain’s Queen Victoria married her German first cousin, Prince Albert of Coburg. Although a distant blood relationship, the United Kingdom’s Queen Elizabeth II married her cousin, Prince Philip of Greece and Denmark—both of them direct descendants of Queen Victoria. In Middle Eastern countries, a high incidence of consanguineous unions still exists, including in the KSA. Previous studies indicated that a significant gap exists in understanding the lived experiences of Saudi women dealing with an FSA-complicated pregnancy. Eleven participants were interviewed using a semi-structured interview format for this qualitative phenomenological study investigating the lived experiences of pregnant Saudi women carrying a child with FSA. This study explored the gaps in current literature regarding the lived experiences of pregnant Saudi women whose pregnancies were complicated by FSA. In addition, the researcher acquired knowledge about the available support and resources as well as the Saudi cultural perspective on FSA. This research explored the lived experiences of pregnant Saudi women utilizing Giorgi’s (2009) approach to data collection and data management. Findings for this study cover five major themes: (1) initial maternal reaction to the FSA diagnosis per ultrasound screening; (2) strengthening of the maternal relationship with God; (3) maternal concern for their child’s future; (4) feeling supported by their loved ones; and (5) lack of healthcare provider support and guidance. Future research in the KSA is needed to explore the network support for these mothers. This study recommended further clinical nursing research, nursing education, clinical practice, and healthcare policy/procedures to provide opportunities for improvement in nursing care and increase awareness in KSA society.

Keywords: fetal structural abnormalities, psychological distress, health provider, health care

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Authors: R. Unnikrishnan, K. Shankar

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In the case of high-speed fighter aircrafts, seat ejection is designed mainly for the safety of the pilot in case of an emergency. Strong windblast due to the high velocity of flight is one main difficulty in clearing the tail of the aircraft. Excessive G-forces generated, immobilizes the pilot from escape. In most of the cases, seats are ejected out of the aircrafts by explosives or by rocket motors attached to the bottom of the seat. Ejection forces are primarily in the vertical direction with the objective of attaining the maximum possible velocity in a specified period of time. The safe ejection parameters are studied to estimate the critical time of ejection for various geometries and velocities of flight. An equivalent analytical 2-dimensional biomechanical model of the human spine has been modelled consisting of vertebrae and intervertebral discs with a lumped mass approach. The 24 vertebrae, which consists of the cervical, thoracic and lumbar regions, in addition to the head mass and the pelvis has been designed as 26 rigid structures and the intervertebral discs are assumed as 25 flexible joint structures. The rigid structures are modelled as mass elements and the flexible joints as spring and damper elements. Here, the motions are restricted only in the mid-sagittal plane to form a 26 degree of freedom system. The equations of motions are derived for translational movement of the spinal column. An ejection force with a linearly increasing acceleration profile is applied as vertical base excitation on to the pelvis. The dynamic vibrational response of each vertebra in time-domain is estimated.

Keywords: biomechanical model, lumped mass, seat ejection, vibrational response

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Authors: Y. Atilgan Şengül

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Health information technologies promise higher quality, safer care and much more for both patients and professionals. Despite their promise, they are costly to develop and difficult to implement. On the other hand, user acceptance and usage determine the success of implemented information technology in healthcare. This study provides a model to understand health professionals’ perception and expectation of health information technology. Extensive literature review has been conducted to determine the main factors to be measured. A questionnaire has been designed as a measurement model and submitted to the personnel of an in vitro fertilization clinic. The respondents’ degree of agreement according to five-point Likert scale was 72% for convenient access to data and 69.4% for the importance of data security. There was a significant difference in acceptance of electronic data storage for female respondents. Also, other significant differences between professions were obtained.

Keywords: healthcare, health informatics, medical record system, questionnaire

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Authors: Tali Capua, Karin Hermon, Miguel Glatstein, Oren Tavor, Ayelet Rimon

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Background: Electric bicycles (E-bikes) are one of a wide range of light electric vehicles that provide convenient local transportation and attractive recreational opportunities. Along with their growing use worldwide, the E-bike related injury rate increases. To the best of our knowledge, this study is the first to specifically compare E-bike with classic bicycle related injuries in children. Methods: Data of all pediatric ( < 16 years of age) bicycle related injuries presenting to an urban level I trauma center between 2014 and 2015 were collected and analyzed. The recorded data included age, gender, details of the accident, as well severity of injury, medical diagnosis, and the outcome. Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) were calculated for each patient. Data of E-bike related injuries and classic bicycle were then compared. Results: A total of 124 bicycle related injuries and 97 E-bike related injuries presented to the emergency department. Once pedestrians and bicycle passengers were removed, the groups of riders consisted of 111 bikers and 85 E-bikers. The mean age of bikers was 9.9 years (range 3-16 years) and of E-bikers was 13.7 years (range 7.5-16 years). Injuries to the head and the extremities were common in both groups. Compared to bikers, E-bikers had significantly more injuries to intra-abdominal organs (p = 0.04). Twenty patients (16%) with bicycle related injuries were admitted, and 13 (15%) patients with E-bike related injuries, of the latter group four underwent surgical intervention. ISS scores were low overall, but the injuries of higher severity (ISS > 9) were among the E-bikers. Conclusions: This study provides unique information which suggests that injuries in E-bikers tend to be more severe than in classic bikers. There is a need for regulation regarding the use of E-bikes to enhance the safety of both bikers and other road and pavement users.

Keywords: bicycle, electric bicycle, injury, pediatric, trauma

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Authors: Miriam Schiff, Hadas Rosenne, Ran Nir-Paz, Shiri Shinan Altman

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To examine (1) the level, predictors, and subjective perception of professional quality of life (PRoQL), posttraumatic growth, roles, task changes during the pandemic, and perceived preparedness for the next pandemic. These variables were added as part of an international study on social workers in healthcare stress, resilience, and perceived preparedness we took part in, along with Australia, Canada, China, Hong Kong, Singapore, and Taiwan. (2) The extent to which background variables, rate of exposure to the virus, working in COVID wards, profession, personal resilience, and resistance to organizational change predict posttraumatic growth, perceived preparedness, and PRoQL (the latter was examined among social workers only). (3) The teams' perceptions of how the pandemic impacted them at the personal, professional, and organizational levels and what assisted them. Methodologies: Mixed quantitative and qualitative methods were used. 1039 hospital healthcare workers from various professions participated in the quantitative study while 32 participated in in-depth interviews. The same methods were used in six other countries. Findings: The level of PRoQL was moderate, with higher burnout and secondary traumatization level than during routine times. Differences between countries in the level of PRoQL were found as well. Perceived preparedness for the next pandemic at the personal level was moderate and similar among the different health professions. Higher exposure to the virus was associated with lower perceived preparedness of the hospitals. Compared to other professions, doctors and nurses perceived hospitals as significantly less prepared for the next pandemic. The preparedness of the State of Israel for the next pandemic is perceived as low by all healthcare professionals. A moderate level of posttraumatic growth was found. Staff who worked at the COVID ward reported a greater level of growth. Doctors reported the lowest level of growth. The staff's resilience was high, with no differences among professions or levels of exposure. Working in the COVID ward and resilience predicted better preparedness, while resistance to organizational change predicted worse preparedness. Findings from the qualitative part of the study revealed that healthcare workers reported challenges at the personal, professional and organizational level during the different waves of the pandemic. They also report on internal and external resources they either owned or obtained during that period. Conclusion: Exposure to the COVID-19 virus is associated with secondary traumatization on one hand and personal posttraumatic growth on the other hand. Personal and professional discoveries and a sense of mission helped cope with the pandemic that was perceived as a historical event, war, or mass casualty event. Personal resilience, along with the support of colleagues, family, and direct management, were seen as significant components of coping. Hospitals should plan ahead and improve their preparedness to the next pandemic.

Keywords: covid-19, health-care, social workers, burnout, preparedness, international perspective

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Authors: Launcelot McGrath

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The Coronavirus disease 2019 (COVID-19) has spread rapidly around the world, resulting in high mortality rates and very large numbers of people requiring medical treatment in ICU. Management of patient hospitalisation is a critical aspect to control this disease and reduce chaos in the healthcare systems. Remote monitoring provides a solution to protect vulnerable and elderly high-risk patients. Continuous remote monitoring of oxygen saturation, respiratory rate, heart rate, and temperature, etc., provides medical systems with up-to-the-minute information about their patients' statuses. Remote monitoring also limits the spread of infection by reducing hospital overcrowding. This paper examines the potential of remote monitoring for Covid-19 to assist in the rapid identification of patients at risk, facilitate the detection of patient deterioration, and enable early interventions.

Keywords: remote monitoring, patient care, oxygen saturation, Covid-19, hospital management

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Authors: Amany ElShazly, Lubna A. Sherif

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The entanglement of humans with the environment has always been inevitable and often causes destruction. In this respect, ‘Ecolinguistics’ helps humans to understand the link between languages and the environment. Stibbe (2014a) has indicated that ‘linguistics’, particularly, Critical Discourse Studies (CDS), provides an interpretation of language which shapes world views, while the ‘eco’ side maintains the life-sustaining interactions of humans and the physical environment. This paper considers two key ecological instances, namely: The Grand Ethiopian Renaissance Dam (GERD) as a focal point of political dispute and THE LINE project as well as Etthadar lel Akhdar (Go Green Initiative) as two examples of combating ecological degradation. ‘Ecosophy’ as explained by Naess (1996) is used to describe the ecolinguistic framework, which assesses discourse where the linguistic lens focuses on the use of metaphor, and ‘Positive Discourse’ framework, which resonates with respect and care for the natural world.

Keywords: ecosophy, critical discourse studies, metaphor, positive discourse, social semiotics, ecolinguistics

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Authors: Liliana Gomez Cardona, Mary McComber, Kristyn Brown, Arlene Laliberté, Outi Linnaranta

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The history of colonialism and more contemporary political issues have resulted in the exposure of Kanien'kehá:ka: non (Kanien'kehá:ka of Kahnawake) to challenging and even traumatic experiences. Colonization, religious missions, residential schools as well as economic and political marginalization are the factors that have challenged the wellbeing and mental health of these populations. In psychiatry, screening for mental illness is often done using questionnaires with which the patient is expected to respond to how often he/she has certain symptoms. However, the Indigenous view of mental wellbeing may not fit well with this approach. Moreover, biomedical treatments do not always meet the needs of Indigenous people because they do not understand the culture and traditional healing methods that persist in many communities. Assess whether the questionnaires used to measure symptoms, commonly used in psychiatry are appropriate and culturally safe for the Mohawk in Quebec. Identify the most appropriate tool to assess and promote wellbeing and follow the process necessary to improve its cultural sensitivity and safety for the Mohawk population. Qualitative, collaborative, and participatory action research project which respects First Nations protocols and the principles of ownership, control, access, and possession (OCAP). Data collection based on five focus groups with stakeholders working with these populations and members of Indigenous communities. Thematic analysis of the data collected and emerging through an advisory group that led a revision of the content, use, and cultural and conceptual relevance of the instruments. The questionnaires measuring psychiatric symptoms face significant limitations in the local indigenous context. We present the factors that make these tools not relevant among Mohawks. Although the scale called Growth and Empowerment Measure (GEM) was originally developed among Indigenous in Australia, the Mohawk in Quebec found that this tool comprehends critical aspects of their mental health and wellbeing more respectfully and accurately than questionnaires focused on measuring symptoms. We document the process of cultural adaptation of this tool which was supported by community members to create a culturally safe tool that helps in growth and empowerment. The cultural adaptation of the GEM provides valuable information about the factors affecting wellbeing and contributes to mental health promotion. This process improves mental health services by giving health care providers useful information about the Mohawk population and their clients. We believe that integrating this tool in interventions can help create a bridge to improve communication between the Indigenous cultural perspective of the patient and the biomedical view of health care providers. Further work is needed to confirm the clinical utility of this tool in psychological and psychiatric intervention along with social and community services.

Keywords: cultural adaptation, cultural safety, empowerment, Mohawks, mental health, Quebec

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Authors: Temitope L. A. Leshoro

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This study explored several variables that enhance economic growth in South Africa, based on different growth theories while using the vector error correction model (VECM) technique. The impacts and contributions of each of these variables on GDP in South Africa were investigated. The motivation for this study was as a result of the weak economic growth that the country has been experiencing lately, as well as the continuous increase in unemployment rate and deteriorating health care system. Annual data spanning over the period 1974 to 2013 was employed. The results showed that the major determinants of GDP are trade openness, government spending, and health indicator; as these variables are not only economically significant but also statistically significant in explaining the changes in GDP in South Africa. Policy recommendations for economic growth enhancement are suggested based on the findings of this study.

Keywords: economic growth, GDP, investment, health indicator, VECM

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Authors: Osama Zayed

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Aim of the work: The aim of this study is to assess the predictors of pelvic vascular injuries in patients with pelvic fractures from major blunt trauma. Methods: This study was conducted as a tool-assessment study. Forty six patients with pelvic fractures from major blunt trauma will be recruited to the study arriving to department of emergency, Suez Canal University Hospital. Data were collected from questionnaire including; personal data of the studied patients and full medical history, clinical examinations, outcome measures (The Physiological and Operative Severity Score for enumeration of Mortality and morbidity (POSSUM), laboratory and imaging studies. Patients underwent surgical interventions or further investigations based on the conventional standards for interventions. All patients were followed up during conservative, operative and post-operative periods in the hospital for interpretation the predictive scores of vascular injuries. Results: Significant predictors of vascular injuries according to computed tomography (CT) scan include age, male gender, lower Glasgow coma (GCS) scores, occurrence of hypotension, mortality rate, higher physical POSSUM scores, presence of ultrasound collection, type of management, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) POSSUM scores, presence of abdominal injuries, and poor outcome. Conclusions: There was higher frequency of males than females in the studied patients. There were high probability of morbidity and low probability of mortality among patients. Our study demonstrates that POSSUM score can be used as a predictor of vascular injury in pelvis fracture patients.

Keywords: predictors, pelvic vascular injuries, pelvic fractures, major blunt trauma, POSSUM

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Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah

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Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.

Keywords: ambulance offload, district general hospital, handover, quality improvement

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Authors: A. Chenafa, S. Boulenouar, M. Zitouni, M. Boukouria

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The sterilization of medical devices constitutes for all the medical professions, an inescapable obligation. It has for objective to prevent the infectious risk, both for the patient and for the medical team. The Dental surgeon as every healthcare professional has to master perfectly this subject and to train his staff to the various techniques of sterilization. It is the only way to assure the patients all the security for which they are entitled to wait when they undergo a dental care. It’s for it, that we undertook to lead an investigation aiming at estimating the sterilization practice at the dental surgeon of Sidi bel Abbes. The survey result showed a youth marked with the profession with a majority use of autoclave with cycle B and an almost total absence of the sterilization controls (test of Bowie and Dick). However, the majority of the dentists control and validate their sterilizers. Finally, our survey allowed us to describe some practices which must be improved regarding control, regarding qualification and regarding staff training. And suggestions were made in this sense.

Keywords: dental surgeon, medical devices, sterilization, survey

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Authors: Manish Kumar

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Reinforced cement concrete is getting extensively used for construction of different type of structures for the last one century. During this period, we have constructed many structures like buildings, bridges, industrial structures, pavement, water tanks etc. using this construction material. These structures have been created with huge investment of resources. It is essential to maintain those structures in functional condition. Since deterioration in RCC Structures is a common and natural phenomenon it is required to have a detailed plan, methodology for structural repair and rehabilitation shall be in place for dealing such issues. It is important to know exact reason of distress, type of distress and correct method of repair concrete structures. The different methods of repair are described in paper according to distress category which can be refereed for repair. Major finding of the study is that to protect our structure we need to have maintenance frequency and correct material to be chosen for repair. Also workmanship during repair needs to be taken utmost care for quality repair.

Keywords: deterioration, functional condition, reinforced cement concrete, resources

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Authors: A. Kherraf, M. Bouziane, A. Drighil, L. Azzouzi, R. Habbal

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Objective: Myxomas are rare heart tumors most commonly found in the left atrium. The purpose of this observation is to report a rare case of myxoma of the right atrium revealed by pulmonary embolism. Observation: A 34-year-old patient with no history presented to the emergency room with sudden onset dyspnea. Clinical examination showed arterial pressure at 110/70mmHg, tachycardia at 110bpm, and 90% oxygen saturation. The ECG enrolled in incomplete right bundle branch block. The radio-thorax was normal. Echocardiography revealed the presence of a large homogeneous intra-OD mass, contiguous to the inter-atrial septum, prolapsing through the tricuspid valve, and causing mild tricuspid insufficiency, with dilation of the right ventricle and retained systolic function with PAPs estimated at 45mmHg. A chest scan was performed, revealing the presence of right segmental pulmonary embolism. The patient was put under anticoagulant and underwent surgical resection of the mass; its pathological examination concluded to a myxoma. The post-operative consequences were simple, without recurrence of the mass after one year follow-up. Discussion: Myxomas represent 50% of heart tumors. Most often, they originate in the left atrium, and more rarely in the right atrium or the ventricles. Myxoma of the right atrium can be responsible for life-threatening pulmonary embolism. The most predictive factor for embolization remains the morphology of the myxomas; papillary or villous myxomas are the most friable. Surgery is the standard treatment, with regular postoperative follow-up to detect recurrence. Conclusion: Myxomas of the right atrium are a rare location for these tumors. Pulmonary embolism is the main complication and should routinely involve careful study of the right chambers on echocardiography.

Keywords: pulmonary embolism, myxoma, right atrium, heart tumors

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Authors: Paola Montenegro, Maria de los Angeles Balaguera Villa

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Contraceptive methods play a fundamental role in preventing unwanted pregnancies and protecting users from sexually transmitted infections (STIs). Despite being known to almost the entire population of reproductive age living in Colombia, there are barriers, practices and complex notions about contraceptives that affect their desired mass use and effectiveness. This work aims to analyse some of the perceptions and practices discussed with young people (13-28 years old) living in Colombia regarding the use of contraceptives in their daily lives, preferences, needs and perceived side effects. This research also examines the perceived paradox in autonomy that young people experience regarding contraceptive use: in one hand, its use (or lack of it) is interpreted as an act of self-determination and primary example of reproductive agency, on the other hand, it was frequently associated with coercion and limited autonomy derived from the gaps in reliable information available for young people, the difficulty of accessing certain preferred methods, and sometimes the experienced coercion exercise by doctors, partners and/or family members. The data and analysis discussed in this work stems from a research project whose objective was to provide information about needs and preferences in sexual and reproductive health of young people living in Colombia in relation to a possible telehealth service that could close the gap in access to quality care and safe information. Through a mixed methods approach, this study collected 5.736 responses to a virtual survey disseminated nationwide in Colombia and 47 inperson interviews (24 of them with people who were assigned female at birth and 21 with local key stakeholders in the abortion ecosystem). Quantitative data was analyzed using Stata SE Version 16.0 and qualitative analysis was completed through NVivo using thematic analysis. Key findings on contraception use in young people living in Colombia reveal that 85,8% of participants had used a contraceptive method in the last two years, and that the most commonly used methods were condoms, contraceptive pills, the morning-after pill and the method of interruption. The remaining 14,2% of respondents who declared to not have used contraceptives in the last two years expressed that the main four barriers to access were: "Lack of knowledge about contraceptive methods and where to obtain information and/or access them (13.9%)", "Have had sex with people who have vaginas (10.2%)", "Cost of contraceptive method (8.4%)" and "Difficulties in obtaining medical authorisations (7.6%)". These barriers coincided with the ones used to explain the non-use of contraceptives in young people, which reveals that limitations in information, cost, and quality care represent structural issues that need to be address in programmes, services, and public policy. Finally, interviews showed that young people perceive contraceptive use and non-use as an example of reaffirming reproductive agency and limitations to this can be explained through the widespread incomplete knowledge about how methods work and the prevalence of other social representations of contraception associated with trust, fidelity, and partner preferences, that in the end create limitations to young people’s autonomy.

Keywords: contraception, family planning, premarital fertility, unplanned pregnancy

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Authors: Kodo Sektani, Apostolos Tsouvalas, Andrei Metrikine

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The reassessment of existing movable bridges in The Netherlands has created the need for acceptance/rejection criteria to assess whether the machineries are meet certain design demands. However, the existing design code defines a different limit state design, meant for new machineries which is based on a simple linear spring-mass model. Observations show that existing bridges do not confirm the model predictions. In fact, movable bridges are nonlinear systems consisting of mechanical components, such as, gears, electric motors and brakes. Next to that, each movable bridge is characterized by a unique set of parameters. However, in the existing code various variables that describe the physical characteristics of the bridge are neglected or replaced by partial factors. For instance, the damping ratio ζ, which is different for drawbridges compared to bascule bridges, is taken as a constant for all bridge types. In this paper, a model is developed that overcomes some of the limitations of existing modelling approaches to capture the dynamics of the powertrain of a class of bridge machineries First, a semidefinite dynamic model is proposed, which accounts for stiffness, damping, and some additional variables of the physical system, which are neglected by the code, such as nonlinear braking torques. The model gives an upper bound of the peak forces/torques occurring in the powertrain during emergency braking. Second, a discrete nonlinear dynamic model is discussed, with realistic motor torque characteristics during normal operation. This model succeeds to accurately predict the full time history of the occurred stress state of the opening and closing cycle for fatigue purposes.

Keywords: Dynamics of movable bridges, Bridge machinery, Powertrains, Torque measurements

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