Search results for: maternal and child healthcare

Authors: Naridchaya Aberdour, Joanna Kao, Anne Miller, Timothy Shore, Richard Maher, Zhixin Liu

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Background: COVID-19 has and continues to be a strain on healthcare globally, with the number of patients requiring hospitalization exceeding the level of medical support available in many countries. As chest x-rays are the primary respiratory radiological investigation, the Radiological Assessment of Lung Edema (RALE) score was used to quantify the extent of pulmonary infection on baseline imaging. Assessment of RALE score's reproducibility and associations with clinical outcome parameters were then evaluated to determine implications for patient management and prognosis. Methods: A retrospective study was performed with the inclusion of patients testing positive for COVID-19 on nasopharyngeal swab within a single Local Health District in Sydney, Australia and baseline x-ray imaging acquired between January to June 2020. Two independent Radiologists viewed the studies and calculated the RALE scores. Clinical outcome parameters were collected and statistical analysis was performed to assess RALE score reproducibility and possible associations with clinical outcomes. Results: A total of 78 patients met inclusion criteria with the age range of 4 to 91 years old. RALE score concordance between the two independent Radiologists was excellent (interclass correlation coefficient = 0.93, 95% CI = 0.88-0.95, p<0.005). Binomial logistics regression identified a positive correlation with hospital admission (1.87 OR, 95% CI= 1.3-2.6, p<0.005), oxygen requirement (1.48 OR, 95% CI= 1.2-1.8, p<0.005) and invasive ventilation (1.2 OR, 95% CI= 1.0-1.3, p<0.005) for each 1-point increase in RALE score. For each one year increased in age, there was a negative correlation with recovery (0.05 OR, 95% CI= 0.92-1.0, p<0.01). RALE scores above three were positively associated with hospitalization (Youden Index 0.61, sensitivity 0.73, specificity 0.89) and above six were positively associated with ICU admission (Youden Index 0.67, sensitivity 0.91, specificity 0.78). Conclusion: The RALE score can be used as a surrogate to quantify the extent of COVID-19 infection and has an excellent inter-observer agreement. The RALE score could be used to prognosticate and identify patients at high risk of deterioration. Threshold values may also be applied to predict the likelihood of hospital and ICU admission.

Keywords: chest radiography, coronavirus, COVID-19, RALE score

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Authors: Satabdi Das

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Background:The abortion debate has polarized women, pitting them against each other in the binary of pro-choice and pro-life. While the followers of pro-choice views the right to an abortion as inherent to a women's right to sovereignty, the latter believes that it is unethical to kill a unborn baby as it is in a way denying the foetus' right to life. So there are innumerable arguments and counter arguments without hyphenation and the dilemma remains that which one is more significant – the mother's right to terminate pregnancy or the foetus' right to life. This pro-life and pro-choice debate has an western root which is more about reproductive freedom. But the Western standard of looking at abortion debate is not fully relevant in the Indian context. The situation is entirely different here. Sex selective foeticide is a social ill in India which cannot be explained through the prism of abortion debate only. It must take into account the problems of forced female foeticide. Objectives: Against this backdrop the study sheds light on the following issues: -How the Reproductive debate has been evolved? -How it is relevant in the Indian Context where female foeticide is a harsh reality? -How one should address the dilemma between life and death in the context of pro life-pro choice debate? Methodology: The study employs historical analytical and descriptive analytical methods and uses primary documents like governmental documents and secondary sources like analytical articles in books, journals, and relevant websites. Findings: -Fertility control is not a modern day phenomenon. It has its roots throughout ancient, medieval and present epochs. However, there existed debates over the rights of the foetus and the question of ethics pertaining to the act of abortion. -Pre-natal sex determination for sex selective abortion is a common phenomenon in India because of the wish for male heirs. The cultural preferences for male child over female ones have resulted in the disappearance of girl children. -When does the life begin has not been recognized by any law. Considering Indian case, it can be said that the Pro life/ pro choice is not that relevant as it is in the US. Here the women are often denied the basic human rights. They are murdered at the womb in many places. Their right to lives are jeopardised in that way. In the liberal abortion regime of India, women's choice to end a pregnancy is limited among very few enlightened families. In many cases, it is the decision of the family to end a pregnancy for boy preference. For that pre natal sex determination plays a crucial role. Conclusion: In India, we can be pro life only when the right to life of the unborn can be secured irrespective of its sex. Similarly we belong to pro-choice group only when the choice to terminate a baby is entirely decided by the mother for her own reasons.

Keywords: female foeticide, India, prolife/pro choice, right to abortion

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Authors: Khushboo Shah

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Categorical bans on the death penalty and life-without-parole sentences for juvenile offenders in a growing number of countries have established a new era in juvenile jurisprudence. This has been brought about by integration of the growing knowledge in cognitive neuroscience and appreciation of the inherent differences between adults and adolescents over the last ten years. This evolving understanding of being a child in the criminal system can be aptly reflected through policies that incorporate the mitigating traits of youth. First, the presentation will delineate the structures in cognitive neuroscience and in particular, focus on the prefrontal cortex, the amygdala, and the basal ganglia. These key anatomical structures in the brain are linked to three mitigating adolescent traits—an underdeveloped sense of responsibility, an increased vulnerability to negative influences, and transitory personality traits—that establish why juveniles have a lessened culpability. The discussion will delve into the details depicting how an underdeveloped prefrontal cortex results in the heightened emotional angst, high-energy and risky behavior characteristic of the adolescent time period or how the amygdala, the emotional center of the brain, governs different emotional expression resulting in why teens are susceptible to negative influences. Based on this greater understanding, it is incumbent that policies adequately reflect the adolescent physiology and psychology in the criminal system. However, it is important to ensure that these views are appropriately weighted while considering the jurisprudence for the treatment of children in the law. To ensure this balance is appropriately stricken, policies must incorporate the distinctive traits of youth in sentencing and legal considerations and yet refrain from the potential fallacies of absolving a juvenile offender of guilt and culpability. Accordingly, three policies will demonstrate how these results can be achieved: (1) eliminate housing of juvenile offenders in the adult prison system, (2) mandate fitness hearings for all transfers of juveniles to adult criminal court, and (3) use the post-disposition review as a type of rehabilitation method for juvenile offenders. Ultimately, this interdisciplinary approach of science and law allows for a better understanding of adolescent psychological and social functioning and can effectuate better legal outcomes for juveniles tried as adults.

Keywords: criminal law, Juvenile Justice, interdisciplinary, neuroscience

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Authors: Ajit Brindhaban

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Background and Purpose: Computed Tomography (CT) scans have become the largest source of radiation in radiological imaging. The purpose of this study was to compare the quality of pediatric Computed Tomography (CT) images reconstructed using Filtered Back Projection (FBP) with images reconstructed using different strengths of Iterative Reconstruction (IR) technique, and to perform a feasibility study to assess the use of IR techniques as a dose reduction tool. Materials and Methods: An anthropomorphic phantom representing a 5-year old child was scanned, in two stages, using a Siemens Somatom CT unit. In stage one, scans of the head, chest and abdomen were performed using standard protocols recommended by the scanner manufacturer. Images were reconstructed using FBP and 5 different strengths of IR. Contrast-to-Noise Ratios (CNR) were calculated from average CT number and its standard deviation measured in regions of interest created in the lungs, bone, and soft tissues regions of the phantom. Paired t-test and the one-way ANOVA were used to compare the CNR from FBP images with IR images, at p = 0.05 level. The lowest strength value of IR that produced the highest CNR was identified. In the second stage, scans of the head was performed with decreased mA(s) values relative to the increase in CNR compared to the standard FBP protocol. CNR values were compared in this stage using Paired t-test at p = 0.05 level. Results: Images reconstructed using IR technique had higher CNR values (p < 0.01.) in all regions compared to the FBP images, at all strengths of IR. The CNR increased with increasing IR strength of up to 3, in the head and chest images. Increases beyond this strength were insignificant. In abdomen images, CNR continued to increase up to strength 5. The results also indicated that, IR techniques improve CNR by a up to factor of 1.5. Based on the CNR values at strength 3 of IR images and CNR values of FBP images, a reduction in mA(s) of about 20% was identified. The images of the head acquired at 20% reduced mA(s) and reconstructed using IR at strength 3, had similar CNR as FBP images at standard mA(s). In the head scans of the phantom used in this study, it was demonstrated that similar CNR can be achieved even when the mA(s) is reduced by about 20% if IR technique with strength of 3 is used for reconstruction. Conclusions: The IR technique produced better image quality at all strengths of IR in comparison to FBP. IR technique can provide approximately 20% dose reduction in pediatric head CT while maintaining the same image quality as FBP technique.

Keywords: filtered back projection, image quality, iterative reconstruction, pediatric computed tomography imaging

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Authors: Atitallah Sofien, Bouyahia Olfa, Krifi farah, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir

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Introduction: Subcutaneous fat necrosis of the newborn (SCFN) is a rare acute hypodermatitis characterized by skin lesions in the form of infiltrated, hard plaques and subcutaneous nodules, with a purplish-red color, occurring between the first and sixth week of life. SCFN is generally a benign condition that spontaneously regresses without sequelae, but it can be complicated by severe hypercalcemia. Methodology: This is a retrospective case report of neonatal subcutaneous fat necrosis complicated with severe hypercalcemia and nephrocalcinosis. Results: This is a case of a female newborn with a family history of a hypothyroid mother on Levothyrox, born to non-consanguineous parents and from a well-monitored pregnancy. The newborn was delivered by cesarean section at 39 weeks gestation due to severe preeclampsia. She was admitted to the Neonatal Intensive Care Unit at 1 hour of life for the management of grade 1 perinatal asphyxia and immediate neonatal respiratory distress related to transient respiratory distress. Hospitalization was complicated by a healthcare-associated infection, requiring intravenous antibiotics for ten days, with a good clinical and biological response. On the 20th day of life, she developed skin lesions in the form of indurated purplish-red nodules on the back and on both arms. A SCFN was suspected. A calcium level test was conducted, which returned a result of 3 mmol/L. The rest of the phosphocalcic assessment was normal, with early signs of nephrocalcinosis observed on renal ultrasound. The diagnosis of SCFN complicated by nephrocalcinosis associated with severe hypercalcemia was made, and the condition improved with intravenous hydration and corticosteroid therapy. Conclusion: SCFN is a rare and generally benign hypodermatitis in newborns with an etiology that is still poorly understood. Despite its benign nature, SCFN can be complicated by hypercalcemia, which can sometimes be life-threatening. Therefore, it is important to conduct a thorough skin examination of newborns, especially those with risk factors, to detect and correct any potential hypercalcemia.

Keywords: subcutaneous fat necrosis, newborn, hypercalcemia, nephrocalcinosis

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Authors: Caroline Selai, Sushrut Jadhav

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Background: University College London (UCL), the first secular university in England to admit students regardless of their religion and gender, has nearly 29,000 students of which approximately 30% are international students. The UCL Cultural Consultation Service (CCS) for staff and students is a unique service that provides assistance to staff and students experiencing challenges in their teaching, enabling, support work or studies which they believe may have a cultural component. The service provides one-to-one and group consultations, lectures, seminars, ‘grand rounds’, interactive workshops and bespoke interventions. Data: This paper presents a content analysis of CCS referrals over the last 36 months. We focus on the experience of international students, many of whom experience not only a challenge to their academic identity but also a profound challenge to their personal cultural identity. We also present 3 vignettes to illustrate how students interpret, accept, contest and resist changes in their cultural and academic identity. Discussion: This paper highlights (i) how students from collectivist cultures attempt to assimilate within an individualistic, highly competitive western university that is bound by its own institutional norms; (ii) problems in negotiating challenges at the interface of culture and gender (iii) the impact of culturally different hierarchies of power, discrimination and authority and (iv) the significance of earlier traumatic and kinship conflicts. Many international students’ social identities are shaped by their cultural and family scripts. A large number have been taught that their teachers are to be revered and their teachings unchallenged. This is at odds with quintessential goal of the western university to encourage healthy scepticism and hone students’ critical thinking skills. Conclusions: Pupil-teacher ‘cultural transference’ and shifts in cultural academic identities of students underscore critical aspects of developmental and learning challenges for students. Staff-student cultural conflict requires a broader, systemic analysis of students, staff and the wider organisation. Our findings challenge Eurocentric psychodynamic concepts such as the nature of parent-child relationship in Western Europe. We argue for a broader, more inclusive approach to develop both effective pedagogic skills in euro-american academic institutions and culturally- appropriate psychodynamic theory to underpin counselling international students.

Keywords: academic identity, cultural transference, cultural consultation in higher education, cultural formulation, cultural identity.

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Authors: Masoud Swalehe, Semra Günay

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Developed countries are losing many lives to non-communicable diseases as compared to their developing counterparts. The effects of these diseases are mostly sudden and manifest at a very short time prior to death or a dangerous attack and this has consolidated the significance of emergency medical system (EMS) as one of the vital areas of healthcare service delivery. The primary objective of this research is to reduce ambulance response times (RT) of Eskişehir province EMS since a number of studies have established a relationship between ambulance response times and survival chances of patients especially out of hospital cardiac arrest (OHCA) victims. It has been found out that patients who receive out of hospital medical attention in few (4) minutes after cardiac arrest because of low ambulance response times stand higher chances of survival than their counterparts who take longer times (more than 12 minutes) to receive out of hospital medical care because of higher ambulance response times. The study will make use of geographic information systems (GIS) technology to dynamically reallocate ambulance resources according to demand and time so as to reduce ambulance response times. Geospatial-time distribution of ambulance calls (demand) will be used as a basis for optimal ambulance deployment using system status management (SSM) strategy to achieve much demand coverage with the same number of ambulance resources to cause response time reduction. Drive-time polygons will be used to come up with time specific facility coverage areas and suggesting additional facility candidate sites where ambulance resources can be moved to serve higher demands making use of network analysis techniques. Emergency Ambulance calls’ data from 1st January 2014 to 31st December 2014 obtained from Eskişehir province health directorate will be used in this study. This study will focus on the reduction of ambulance response times which is a key Emergency Medical Services performance indicator.

Keywords: emergency medical services, system status management, ambulance response times, geographic information system, geospatial-time distribution, out of hospital cardiac arrest

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Authors: Chan Yan Nok

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The present study is a qualitative study based on the coping experiences of six Hong Kong Chinese mothers who had childhood trauma from their first-person perspective. Expanding the perspective beyond the dominant discourse of “inter-generation transmission of trauma”, this study explores the experiences and meanings of child trauma embedded in their narratives through the process of thematic analysis and narrative analysis. The interviewees painted a nuanced picture of their process of coping and trauma resolution. First, acknowledgement; second, feel safe and start to tell the story of trauma; third, feel the feelings and expression of emotions; fourth, clarifying and coping with the impacts of trauma; fifth, integration and transformation; and sixth, using their new understanding of experience to have a better life. It was seen that there was no “end” within the process of trauma resolution. Instead, this is an ongoing process with positive healing trajectory. Analysis of the stories of the mothers revealed recurrent themes around continuous self-reflective awareness in the process of trauma coping. Rather than being necessarily negative and detrimental, childhood trauma could highlight the meanings of being a mother and reveal opportunities for continuous personal growth and self-enhancement. Utilizing the sense of inadequacy as a core driver in the trauma recovery process while developing a heightened awareness of the unfinished business embedded in their “automatic pattern” of behaviors, emotions, and thoughts can help these mothers become more flexible to formulate new methods in facing future predicaments. Future social work and parent education practices should help mothers deal with unresolved trauma, make sense of their impacts of childhood trauma and discover the growth embedded in the past traumatic experience. They should be facilitated in “acknowledging the reality of the trauma”, including understanding their complicated emotions arising from the traumatic experiences and voicing their struggles. In addition, helping these mothers to be aware of short-term and long-term trauma impacts (i.e., secondary responses to the trauma) and explore their effective coping strategies in “overcoming secondary responses to the trauma” are crucial for their future positive adjustment and transformation. Through affirming their coping abilities and lessons learnt from past experiences, mothers can reduce feelings of shame and powerlessness and enhance their parental capacity.

Keywords: childhood trauma, coping, mothers, self-awareness, self-reflection, trauma resolution

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Authors: Isomar Lima da Silva, Alcilene Batalha Pontes, Aristeu Jonatas Leite de Oliveira, Roberto Maia Augusto

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Context: Mechanical ventilators are medical devices that help provide oxygen and ventilation to patients with respiratory difficulties. This equipment consists of a manual breathing unit that can be operated by a doctor or nurse and a mechanical ventilator that controls the airflow and pressure in the patient's respiratory system. This type of ventilator is commonly used in emergencies and intensive care units where it is necessary to provide breathing support to critically ill or injured patients. Objective: In this context, this work aims to develop a reliable and low-cost mechanical ventilator to meet the demand of hospitals in treating people affected by Covid-19 and other severe respiratory diseases, offering a chance of treatment as an alternative to mechanical ventilators currently available in the market. Method: The project presents the development of a low-cost auxiliary ventilator with a controlled ventilatory system assisted by integrated hardware and firmware for respiratory cycle control in non-invasive mechanical ventilation treatments using a manual artificial respiration unit. The hardware includes pressure sensors capable of identifying positive expiratory pressure, peak inspiratory flow, and injected air volume. The embedded system controls the data sent by the sensors. It ensures efficient patient breathing through the operation of the sensors, microcontroller, and actuator, providing patient data information to the healthcare professional (system operator) through the graphical interface and enabling clinical parameter adjustments as needed. Results: The test data of the developed mechanical ventilator presented satisfactory results in terms of performance and reliability, showing that the equipment developed can be a viable alternative to commercial mechanical ventilators currently available, offering a low-cost solution to meet the increasing demand for respiratory support equipment.

Keywords: mechanical fans, breathing, medical equipment, COVID-19, intensive care units

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Authors: Wipakon Sonsnam, Kanya Napapongsa

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The quantitative aim of the study; 1) health conditions, to examine the state of health of the aging, 2) perceived of self-efficacy, self-care of aging ,3) perceived of social support of the aging, 4) to examine factors associated with self-efficacy in enhancing the health and self-care when illness. 100 samples selected from communities in Dusit, Bangkok, 2014 by random sampling. The questionnaires were used to collect data have 5-point rating scale, consisting of strongly agree, agree, undecided, disagree, and strongly disagree; approved content valid by 3 experts, reliability coefficients alpha was .784 for perceived of self-efficacy, self-care of aging and .827 for perceived of social support of the aging. ST-5, 2Q used for collect mental health. The ability to engage in a daily routine was collected by Barthel ADL index. Founding, the sample group were female (68%). (33%) of them were in the age of 60-65. Most of them were married and still live with their spouse (55%) and do not work (38%). The average annual income was less than 10,000 baht supported by child. Most people think that income was adequate (49.0%) and Satisfaction (61.0%). Most of aging caring them-self, followed by them spouse (26%). Welfare of the public had supported, living for the aging (100%), followed by Join and health volunteers in communities (23%). In terms of health, (53%) of the sample group feels health was fair, hypertension was the most common health condition among sample group (68%), following by diabetes (55%). About eyesight, (42%) have visual acuity. (59.0%) do not need hearing aids. 84% have more than 20 teeth remaining, and have no problem with chewing (61%). In terms of Ability to engage in a daily routine, most of people (84%) in sample group are in type 1. (91%) of the participants don’t have bladder incontinence. For mental condition, (82%) do not have insomnia. (87%) do not have anxiety. (96%) do not have depression. However, (77%) of the sample group is facing stress. In terms of environment in home, bathroom in the home (90.0%) and floor of bathroom was slippery (91.0%). (48%) of the sample group has the skills of how to look after themselves while being sick, and how to keep up healthy lifestyle. Besides, some other factors, such as gender, age and educational background are related to the health perception. The statistical significance was <0.05. Suggestion: The instruments available to national standards such as ST-5, 2Q and Barthel ADL index. Reliability coefficients alpha was .784 for perceived of self-efficacy, self-care of aging and .827 for perceived of social support of the aging. The instrument used to collect perceived of social support must be further developed to study level of influence of social support that affect the health of elderly.

Keywords: ้health status, perception of aging, self-efficacy, social support

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Authors: Chan Hui-Ya, Ding Shin-Tan

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Background and Aim: The discharge planning is considered helpful to reduce the hospital length of stay and readmission rate, and then increased satisfaction with healthcare for patients and professionals. In order to decrease the waiting time of long-term care and boost the care quality of patients after discharge from the hospital, the Ministry of Health and Welfare department in Taiwan initiates a program “discharge planning connects with long-term care 2.0 services” in 2017. The purpose of this study is to investigate the outcome of the pilot of this program in a medical center. Methods: By purpose sampling, the study chose five wards in a medical center as pilot units. The researchers compared the beds of service, the numbers of cases which were transferred to the long-term care center and transferred rates per month between the pilot units and the other units, and analyze the basic data, the long-term care service needs and the approval service items of cases transfer to the long-term care center in pilot units. Results: From June to September 2017, a total of 92 referrals were made, and 51 patients were enrolled into the pilot program. There is a significant difference of transferring rate between the pilot units and the other units (χ = 702.6683, p < 0.001). Only 20 cases (39.2% success rate) were approved to accept the parts of service items of long-term care in the pilot units. The most approval item was respite care service (n = 13; 65%), while it was third at needs ranking of service lists during linking services process. Among the reasons of patients who cancelled the request, 38.71% reasons were related to the services which could not match the patients’ needs and expectation. Conclusion: The results indicate there is a requirement to modify the long-term care services to fit the needs of cases. The researchers suggest estimating the potential cases by screening data from hospital informatics systems and to hire more case manager according the service time of potential cases. Meanwhile, the strategies shortened the assessment scale and authorized hospital case managers to approve some items of long-term care should be considered.

Keywords: discharge planning, long-term care, case manager, patient care

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Authors: Lancer Scott

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Purpose: High quality clinical disaster medicine requires providers working collaboratively to care for multiple patients in chaotic environments; however, many providers lack adequate training. To address this deficit, we created a competency-based, 5-hour Emergency Preparedness Training (EPT) curriculum using didactics, small-group discussion, and kinetic learning. The goal was to evaluate the effect of a short course on improving provider knowledge, confidence and skills in disaster scenarios. Methods: Diverse groups of medical university students, health care professionals, and community members were enrolled between 2011 and 2014. The course consisted of didactic lectures, small group exercises, and two live, multi-patient mass casualty incident (MCI) scenarios. The outcome measures were based on core competencies and performance objectives developed by a curriculum task force and assessed via trained facilitator observation, pre- and post-testing, and a course evaluation. Results: 708 participants completed were trained between November 2011 and August 2014, including 49.9% physicians, 31.9% medical students, 7.2% nurses, and 11% various other healthcare professions. 100% of participants completed the pre-test and 71.9% completed the post-test, with average correct answers increasing from 39% to 60%. Following didactics, trainees met 73% and 96% of performance objectives for the two small group exercises and 68.5% and 61.1% of performance objectives for the two MCI scenarios. Average trainee self-assessment of both overall knowledge and skill with clinical disasters improved from 33/100 to 74/100 (overall knowledge) and 33/100 to 77/100 (overall skill). The course assessment was completed by 34.3% participants, of whom 91.5% highly recommended the course. Conclusion: A relatively short, intensive EPT course can improve the ability of a diverse group of disaster care providers to respond effectively to mass casualty scenarios.

Keywords: clinical disaster medicine, training, hospital preparedness, surge capacity, education, curriculum, research, performance, training, student, physicians, nurses, health care providers, health care

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Authors: Emanuela Zilli, Antonio Madia, Milvia Marchiori, Paola Anello, Chiara Cabbia, Emanuela Velo, Delia Campagnolo, Michele Scomazzon, Emanuela Salvatico, S. Tikvina, Antonio Miotti

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Hepatitis C is an inflammation of the liver caused by the hepatitis C virus (HCV). Antiviral medicines can cure more than 95% of cases of hepatitis C infection, but access to diagnosis and treatment remains low. The ULSS 6 Euganea – Health Trust has implemented a campaign to eradicate hepatitis C in the province of Padua (North-East of Italy), which can be subdivided into three areas: North (300.000 inhabitants), Centre (400.000) and South (300.000). In September 2021, the project was launched in the Northern area; a set of brochures was distributed in outpatient services, general practitioners’ clinics and offices, community pharmacy services, social health districts, and through social networks. The Hepatology Service contacted 460 patients selected by the Clinical Laboratory (positivity for HCV antibodies): 83 patients (18.0%) had been already cured of HCV infection, missing or deceased; 377 patients (82.0%) met the criteria to be eligible for HCV eradication therapy and were therefore included in a Day Service specific agenda and followed by a multidisciplinary team of healthcare professionals, with a dedicated telephone line. Haemato-chemical tests, general medical check-ups and ultrasound tests with fibroscan were performed. Patients were tested for Sars-CoV-2 positivity; those not yet vaccinated against Covid-19 were encouraged to complete the vaccination scheme. All 377 patients (100%) received HCV eradication therapy at the community pharmacy service; a detailed explanation of how to take their medication was provided. At the end of the first phase, Covid-19 vaccination rate was 100% (377/377), including patients already vaccinated and new-vaccinated. Check-up appointments were arranged after 2 or 3 months, according to the treatment plan. The awareness campaign and the organization of HCV eradication therapy service by ULSS 6 Euganea are proving to be effective; the project is now going to be applied to Central and Southern areas of the province (1.132 patients).

Keywords: public health, HCV-eradication, Covid-19 emergency, health communication strategies

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Authors: Iram Zahair, Tanith Rose, Oyinlola Oyebode, Stephen Clayton, Iman Ghosh, Michelle Maden, Ben Barr

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Background: Gastrointestinal infections exert a significant public health burden on UK healthcare services and the community. However, there are conflicting findings on where ethnic inequalities are likely to persist. This systematic review aimed to identify studies that ascertain differences in the incidence and prevalence of gastrointestinal infections within and between UK ethnic groups and explore possible explanations for heterogeneity observed within the literature. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, a systematic review methodology was used. Medline, Web of Science, CINAHL Plus, and grey literature were searched from 1980 to 2021 for studies reporting an association between ethnicity and gastrointestinal infections in UK population samples. Two reviewers independently screened the articles and conducted quality appraisals; data extraction was undertaken by one reviewer and verified by two reviewers (PROSPERO CRD 42021240714). A narrative synthesis was undertaken to synthesise the study findings. Results: The searches identified 8134 studies; 13 met the inclusion criteria. 12 out of 13 studies found a difference in the prevalence of gastrointestinal infections between different ethnic groups. UK ethnic minorities, predominantly men and children of Asian ethnicity, had an increased risk of infection than the white British majority in 12 studies; the Pakistani ethnic group had a higher risk of infection in three out of 13 studies. Studies reported that age and sex confounded the relationship between ethnicity and gastrointestinal infections. At the same time, the country of birth, socioeconomic status, and geographical location of ethnic groups mediated this association and significantly explained the heterogeneity observed across the studies. Harvest plots supported the textual synthesis. Conclusion: This systematic review elucidates the lack of extensive UK quantitative evidence examining the association between ethnicity and gastrointestinal infections. Insights into gastrointestinal infections and ethnicity's association can help address policy actions to mitigate the inequalities identified within and between UK ethnic groups.

Keywords: ethnic and racial populations, public health, public health policy, systematic review

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Authors: Gobinathan Devathasan, Kezia Devathasan

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Objective: To improve the current modified Broca-Wernicke-Lichtheim-Kussmaul speech schema and provide insight into autism. Methods: We reviewed the pertinent literature. Current findings, involving Brodmann areas 22, 46, 9,44,45,6,4 are based on neuropathology and functional MRI studies. However, in primary autism, there is no lucid explanation and changes described, whether neuropathology or functional MRI, appear consequential. Findings: We forward an enhanced model which may explain the enigma related to autism. Vowel output is subcortical and does need cortical representation whereas consonant speech is cortical in origin. Left lateralization is needed to commence the circuitry spin as our life have evolved with L-amino acids and left spin of electrons. A fundamental species difference is we are capable of three syllable-consonants and bi-syllable expression whereas cetaceans and songbirds are confined to single or dual consonants. The 4 key sites for speech are superior auditory cortex, Broca’s two areas, and the supplementary motor cortex. Using the Argand’s diagram and Reimann’s projection, we theorize that the Euclidean three dimensional synaptic neuronal circuits of speech are quantized to coherent waves, and then decoherence takes place at area 6 (spherical representation). In this quantum state complex, 3-consonant languages are instantaneously integrated and multiple languages can be learned, verbalized and differentiated. Conclusion: We postulate that evolutionary human speech is elevated to quantum interaction unlike cetaceans and birds to achieve the three consonants/bi-syllable speech. In classical primary autism, the sudden speech switches off and on noted in several cases could now be explained not by any anatomical lesion but failure of coherence. Area 6 projects directly into prefrontal saccadic area (8); and this further explains the second primary feature in autism: lack of eye contact. The third feature which is repetitive finger gestures, located adjacent to the speech/motor areas, are actual attempts to communicate with the autistic child akin to sign language for the deaf.

Keywords: quantum neuronal paradigm, cetaceans and human speech, autism and rapid magnetic stimulation, coherence and decoherence of speech

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Authors: Ambika Perisamy, Asyriawati binte Mohd Hamzah

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The focus of this presentation is to discuss teacher professional development (TPD) through the use of technology. TPD is necessary to prepare teachers for future challenges they will face throughout their careers and to develop new skills and good teaching practices. We will also be discussing current issues in embracing technology in the field of early childhood education and the impact on the professional development of teachers. Participants will also learn to apply teaching and learning practices through the use of technology. One major objective of this presentation is to coherently fuse practical, technology and theoretical content. The process begins by concretizing a set of preconceived ideas which need to be joined with theoretical justifications found in the literature. Technology can make observations fairer and more reliable, easier to implement, and more preferable to teachers and principals. Technology will also help principals to improve classroom observations of teachers and ultimately improve teachers’ continuous professional development. Video technology allows the early childhood teachers to record and keep the recorded video for reflection at any time. This will also provide opportunities for her to share with her principals for professional dialogues and continuous professional development plans. A total of 10 early childhood teachers and 4 principals were involved in these efforts which identified and analyze the gaps in the quality of classroom observations and its co relation to developing teachers as reflective practitioners. The methodology used involves active exploration with video technology recordings, conversations, interviews and authentic teacher child interactions which forms the key thrust in improving teaching and learning practice. A qualitative analysis of photographs, videos, transcripts which illustrates teacher’s reflections and classroom observation checklists before and after the use of video technology were adopted. Arguably, although PD support can be magnanimously strong, if teachers could not connect or create meaning out of the opportunities made available to them, they may remain passive or uninvolved. Therefore, teachers must see the value of applying new ideas such as technology and approaches to practice while creating personal meaning out of professional development. These video recordings are transferable, can be shared and edited through social media, emails and common storage between teachers and principals. To conclude the importance of reflective practice among early childhood teachers and addressing the concerns raised before and after the use of video technology, teachers and principals shared the feasibility, practical and relevance use of video technology.

Keywords: early childhood education, reflective, improve teaching and learning, technology

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Authors: Mohamad Shamsuri Juhari

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Fathers who positively involve themselves in their children’s lives will have had a constructive influence on the latter’s social, behavioural, and psychological development. This paper will share the preliminary findings of an ongoing research project which investigates Singaporean fathers from the nation’s minority Malay-Muslim community who commit the reverse, that is, it intends to study the reasons behind these fathers’ non-involvement during the period of their children’s developing years be it through absence, disinterest or ignorance. For instance, children from homes with absentee fathers are more likely to develop deficiencies in attitude and conduct. A father’s negative show of parental skills can also cause setbacks in the child’s education, economic instability in the latter’s future family life, as well as the likelihood of an ensuing intergenerational transmission of criminal behaviour. In the context of the minority Singaporean Malay-Muslim community, the need to investigate the challenges faced by fathers from the ethnic group in carrying out their parental roles arose due to the perceptible rise in statistics reflecting delinquency among its youths. This has resulted in other associated issues such as teenage pregnancies (and the subsequent cyclical patterns of divorce and single motherhood), over-representation in the data for drug offences, and under-representation in statistics reflecting academic achievement. While other factors are known to be involved, these negative outcomes have also been attributed to the lack of fatherly guidance in the affected Malay families. This still-ongoing research project is being carried out in two phases: The first by means of secondary research as well as exploratory data collection via roundtable and focus group discussions with fathers from diverse socio-economic backgrounds. This sets the way for the second phase in which a survey will be undertaken, followed by a series of in-depth face-to-face interviews. The research findings will then be translated into intervention initiatives to overcome the identified challenges. Based on the results collated from Phase 1 of the research, this paper will share a ‘first look’ on the challenges to effective parenting faced by Malay-Muslim fathers in Singapore specifically those relating to the socio-cultural domains of attitude, knowledge, and practice.

Keywords: Malay fathers, socio-cultural domains, attitude, knowledge, practice

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Authors: Ali Alshumrani, Nathan Clarke, Bogdan Ghite, Stavros Shiaeles

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Digital forensics has become an essential tool in the investigation of cyber and computer-assisted crime. Arguably, given the prevalence of technology and the subsequent digital footprints that exist, it could have a significant role across almost all crimes. However, the variety of technology platforms (such as computers, mobiles, Closed-Circuit Television (CCTV), Internet of Things (IoT), databases, drones, cloud computing services), heterogeneity and volume of data, forensic tool capability, and the investigative cost make investigations both technically challenging and prohibitively expensive. Forensic tools also tend to be siloed into specific technologies, e.g., File System Forensic Analysis Tools (FS-FAT) and Network Forensic Analysis Tools (N-FAT), and a good deal of data sources has little to no specialist forensic tools. Increasingly it also becomes essential to compare and correlate evidence across data sources and to do so in an efficient and effective manner enabling an investigator to answer high-level questions of the data in a timely manner without having to trawl through data and perform the correlation manually. This paper proposes a Unified Forensic Analysis Tool (U-FAT), which aims to establish a common language for electronic information and permit multi-source forensic analysis. Core to this approach is the identification and development of forensic analyses that automate complex data correlations, enabling investigators to investigate cases more efficiently. The paper presents a systematic analysis of major crime categories and identifies what forensic analyses could be used. For example, in a child abduction, an investigation team might have evidence from a range of sources including computing devices (mobile phone, PC), CCTV (potentially a large number), ISP records, and mobile network cell tower data, in addition to third party databases such as the National Sex Offender registry and tax records, with the desire to auto-correlate and across sources and visualize in a cognitively effective manner. U-FAT provides a holistic, flexible, and extensible approach to providing digital forensics in technology, application, and data-agnostic manner, providing powerful and automated forensic analysis.

Keywords: digital forensics, evidence correlation, heterogeneous data, forensics tool

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Authors: Sang Wook Park, Jun Su Park, Byung Kwan Oh, Yousok Kim, Hyo Seon Park

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This study suggests the estimation method of stress distribution for the beam structures based on TLS (Terrestrial Laser Scanning). The main components of method are the creation of the lattices of raw data from TLS to satisfy the suitable condition and application of CSSI (Cubic Smoothing Spline Interpolation) for estimating stress distribution. Estimation of stress distribution for the structural member or the whole structure is one of the important factors for safety evaluation of the structure. Existing sensors which include ESG (Electric strain gauge) and LVDT (Linear Variable Differential Transformer) can be categorized as contact type sensor which should be installed on the structural members and also there are various limitations such as the need of separate space where the network cables are installed and the difficulty of access for sensor installation in real buildings. To overcome these problems inherent in the contact type sensors, TLS system of LiDAR (light detection and ranging), which can measure the displacement of a target in a long range without the influence of surrounding environment and also get the whole shape of the structure, has been applied to the field of structural health monitoring. The important characteristic of TLS measuring is a formation of point clouds which has many points including the local coordinate. Point clouds is not linear distribution but dispersed shape. Thus, to analyze point clouds, the interpolation is needed vitally. Through formation of averaged lattices and CSSI for the raw data, the method which can estimate the displacement of simple beam was developed. Also, the developed method can be extended to calculate the strain and finally applicable to estimate a stress distribution of a structural member. To verify the validity of the method, the loading test on a simple beam was conducted and TLS measured it. Through a comparison of the estimated stress and reference stress, the validity of the method is confirmed.

Keywords: structural healthcare monitoring, terrestrial laser scanning, estimation of stress distribution, coordinate transformation, cubic smoothing spline interpolation

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Authors: Kumar Gular, Viswanathan S., Mastour Saeed Alshahrani, Ravi Shankar Reddy, Jaya Shanker Tedla, Snehil Dixit, Ajay Prasad Gautam, Venkata Nagaraj Kakaraparthi, Devika Rani Sangadala

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Background: Despite trunk control’s significant contribution to improving various functional activity components, the independent effect of trunk performance on quality of life is yet to be estimated in stroke survivors. Ascertaining the correlation between trunk control and self-reported quality of life while evaluating the effect of demographic and clinical characteristics on their relationship will guide concerned healthcare professionals in designing ideal rehabilitation protocols during the late sub-acute stroke stage of recovery. The aims of the present research were to (1) investigate the associations of trunk performance with self-rated quality of life and (2) evaluate if age, body mass index (BMI), and clinical characteristics mediate the relationship between trunk motor performance and perceived quality of life in the sub-acute stroke population. Methods: Trunk motor functions and quality of life among the late sub-acute stroke population aged 57.53 ± 6.42 years were evaluated through the trunk Impairment Scale (TIS) and Stroke specific quality of life (SSQOL) questionnaire, respectively. Pearson correlation coefficients and mediation analysis were performed to elucidate the relationship of trunk motor function with quality of life and determine the mediation impact of demographic and clinical characteristics on their association, respectively. Results: The current study observed significant correlations between trunk motor functions (TIS) and quality of life (SSQOL) with r=0.68 (p<0.001). Age, BMI, and type of stroke were detected as potential mediating factors in the association between trunk performance and quality of life. Conclusion: Validated associations between trunk motor functions and perceived quality of life among the late sub-acute stroke population emphasize the importance of comprehensive evaluation of trunk control. Rehabilitation specialists should focus on appropriate strategies to enhance trunk performance anticipating the potential effects of age, BMI, and type of stroke to improve health-related quality of life in stroke survivors.

Keywords: sub-acute stroke, quality of life, functional independence, trunk control

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Authors: Mark Davies, Carolyn Wallace, Christina Lloydwin, Tom Powell

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Background: Frailty is increasingly recognized as a public health problem within an aging population. It is often characterized as an accumulation of clinical symptoms with progressive decline. We contend that dehydration is potentially the missing link driving the cycle of frailty; it contributes to malnutrition and cognitive decline and is a risk factor for other conditions. Frailty may also impact on fluid intake in cognitively intact older adults, indicating the cyclical nature of dehydration contributing to increasing frailty. Aim: To examine the relationships between fluid, hydration, and frailty in older adults in order to determine what works, for whom, how, why, and in what circumstances. Methods: A Realist Synthesis was first undertaken with n=50 studies, leading to the development of a Refined Programme Theory (RPT) articulating what hydration interventions work, for whom, to what degree, in what contexts, and how & why. Within the subsequent evaluation, the RPT was further confirmed/refuted/refined following semi-structured interviews with n=8 participants (healthcare professionals and patients). The RAMESES Quality Standards were followed throughout the study. Results: The Refined Programme Theory (RPT) highlighted three factors that result in optimized hydration for frail older people, i.e., Developing an Understanding Around Hydration, Empowering Participation, and System Reconfiguration. Our RPT indicates that hydration interventions work by developing an understanding of the importance of hydration, mitigating physical & cognitive barriers, increasing the agency of the patient, using a prompting process to reinforce drinking behavior, and routinizing hydration as a dimension of overall care. Conclusion: The study indicates that a greater understanding of the importance of hydration is required for all parties. Patients also require physical and psychological support if they are to be active agents in meeting their hydration needs. At a wider ‘system’ level, organizations must work in an integrated manner introducing processes that enable continuing professional development (CPD), encourage ongoing holistic assessment, and routinize hydration support.

Keywords: frailty, dehydration, older adults, realist review, realist evaluation

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Authors: Susan Scott, Dina Hanna, Bassel Zebian, Gary Ruiz, Sreena Das

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Although the number of cases of TB in England has fallen over the last 4 years, it remains an important public health burden with 1 in 20 cases dying annually. The vast majority of cases present in non-UK born individuals with social risk factors. We present a case of non-pulmonary TB presenting in a healthy child born in the UK to professional parents. We present a case of a healthy 10 year old boy who developed acute back pain during school PE. Over the next 5 months, he was seen by various health and allied professionals with worsening back pain and kyphosis. He became increasing unsteady and for the 10 days prior to admission to our hospital, he developed fevers. He was admitted to his local hospital for tonsillitis where he suffered two falls on account of his leg weakness. A spinal X-ray revealed a pathological fracture and gibbus formation. He was transferred to our unit for further management. On arrival, the patient had lower motor neurone signs of his left leg. He underwent spinal fixture, laminectomy and decompression. Microbiology samples taken intra-operatively confirmed Mycobacterium Tuberculosis. He had a positive Mantoux and T-spot and treatment were commenced. There was no evidence of immune compromise. The patient was born in the UK, had a BCG scar and his only travel history had been two years prior to presentation when he travelled to the Phillipines for a short holiday. The patient continues to have issues around neuropathic pain, mobility, pill burden and mild liver side effects from treatment. Discussion: There is a paucity of case reports on spinal TB in paediatrics and diagnosis is often difficult due to the non-specific symptomatology. Although prognosis on treatment is good, a delayed diagnosis can have devastating consequences. This case highlights the continued need for higher index of suspicion and diagnosis in a world with changing patterns of migration and increase global travel. Surgical intervention is limited to the most serious cases to minimise further neurological damage and improve prognosis. There remains the need for a multi-disciplinary approach to deal with challenges of treatment and rehabilitation.

Keywords: tuberculosis, non-pulmonary TB, public health burden, diagnostic challenge

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Authors: Polina Prokopovich

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Despite the well-established dependence of cartilage mechanical properties on the frequency of the applied load, most research in the field is carried out in either load-free or constant load conditions because of the complexity of the equipment required for the determination of time-dependent properties. These simpler analyses provide a limited representation of cartilage properties thus greatly reducing the impact of the information gathered hindering the understanding of the mechanisms involved in this tissue replacement, development and pathology. More complex techniques could represent better investigative methods, but their uptake in cartilage research is limited by the highly specialised training required and cost of the equipment. There is, therefore, a clear need for alternative experimental approaches to cartilage testing to be deployed in research and clinical settings using more user-friendly and financial accessible devices. Frequency dependent material properties can be determined through rheometry that is an easy to use requiring a relatively inexpensive device; we present how a commercial rheometer can be adapted to determine the viscoelastic properties of articular cartilage. Frequency-sweep tests were run at various applied normal loads on immature, mature and trypsinased (as model of osteoarthritis) cartilage samples to determine the dynamic shear moduli (G*, G′ G″) of the tissues. Moduli increased with increasing frequency and applied load; mature cartilage had generally the highest moduli and GAG depleted samples the lowest. Hydraulic permeability (KH) was estimated from the rheological data and decreased with applied load; GAG depleted cartilage exhibited higher hydraulic permeability than either immature or mature tissues. The rheometer-based methodology developed was validated by the close comparison of the rheometer-obtained cartilage characteristics (G*, G′, G″, KH) with results obtained with more complex testing techniques available in literature. Rheometry is relatively simpler and does not require highly capital intensive machinery and staff training is more accessible; thus the use of a rheometer would represent a cost-effective approach for the determination of frequency-dependent properties of cartilage for more comprehensive and impactful results for both healthcare professional and R&D.

Keywords: tissue, rheometer, biomaterial, cartilage

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Authors: Muhandiram Rallage Ruvini Nisansala Yatigammana, Anuruddhika Kumudu Kumari Rajakaruna Jayathilaka

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Sports injuries are common among teenagers and children engaged in organized sports. While most sports injuries are typical, some rare occurrences involve conditions such as eye, dental, cervical, and rare internal organ injuries, such as pancreatic injuries. These injuries, especially traumatic pancreatitis, require prompt attention due to their potential for severe and sometimes fatal complications. This case revolves around a real accident involving a 12-year-old girl, Piyumi, who suffered a face-to-face collision during netball practice, resulting in severe abdominal pain. After a medical examination, she was diagnosed with a rare pancreatic injury, uncommon in children compared to adults. In Piyumi’s case, she had a grade 3 pancreatic injury and underwent non-surgical management, successfully healing her wound without surgery. The study attempts to fill empirical and population gaps, addressing a rarely discussed injury experienced by a 12-year-old female netball player. The paper will also provide an in-depth understanding of pancreatic injury, which is a rare sports injury. The study’s main objective was to investigate the incidence and characteristics of pancreatic injury, particularly focusing on pancreatic trauma, among children and adolescents engaged in high-impact sports, such as netball. This research adopted a case study strategy, employing interviews as the primary data collection method. Interviews were conducted with Piyumi, her parents, and the two specialist doctors directly involved in her treatment, providing firsthand accounts and insights. By examining the case, the paper arrives at three main conclusions. Firstly, pancreatic damage is uncommon, especially in the sports world, and proper diagnosis is essential to avoiding health concerns, particularly for minors. Secondly, CT (Computed Tomography) was useful in locating the injury, as injuries can be diagnosed very well with Computed Tomography (CT) images. Finally, and most importantly, pancreatic injuries are infrequent, but trauma can still occur, particularly in high-impact sports or accidents involving extreme force or falls. These injuries should be accurately diagnosed and treated promptly.

Keywords: child athlete, pancreatic injury, rare sports injuries, sportswoman

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Authors: Tsu-Yin Wu, Jenni Hoffman, Lydia McMurrows, Sarah Lally

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Recent events of the Flint Water Crisis and elevated lead levels in Detroit public school water have highlighted a specific public health disparity and shown the need for better education of healthcare providers on lead education. Identifying children and pregnant women with a high risk for lead poisoning and ensuring lead testing is completed is critical. The purpose of this study is to explore the impact of an educational intervention on knowledge and confidence levels among nursing students enrolled in the prelicensure Bachelor of Science in Nursing (BSN) and Registered Nurse to BSN program (R2B). The study used both quantitative and qualitative research methods to assess the impact of multi-modal pedagogy on knowledge and confidence of lead screening and prevention among prelicensure and R2B nursing students. The students received lead poisoning and prevention content in addition to completing an e-learning module developed by the Pediatric Environmental Health Specialty Units. A total of 115 students completed the pre-and post-test instrument that consisted of demographic, lead knowledge, and confidence items. Despite the increase of total knowledge, three dimensions of lead poisoning, and confidence from pre- to post-test scores for both groups, there was no statistical significance on the increase between prelicensure and R2B students. Thematic analysis of qualitative data showed five themes from participants' learning experiences: lead exposure, signs and symptoms of lead poisoning, screening and diagnosis, prevention, and policy and statewide issues. The study is limited by a small sample and participants recalling some correct answers from the pretest, thus, scoring higher on the post-test. The results contribute to the minimally existent literature examining a critical public health concern regarding lead health exposure and prevention education of nursing students. Incorporating such content area into the nursing curriculum is essential in ensuring that such public health disparities are mitigated.

Keywords: lead poisoning, emerging public health issue, community health, nursing edducation

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Authors: Camille Alexis-Garsee, Nicola Payne

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One consequence of the pandemic has been the debilitating health impact that some people experience over a longer period of time, known as long-COVID. This has been predominately researched in adults; however, there is emerging evidence on the effects of long-COVID in children. Research has indicated over half of children who contracted COVID-19 experienced persistent symptoms four months after a confirmed diagnosis. There is little research on the impact of this on children and their families. This study aimed to explore the experiences of children with long-COVID, to enable further understanding of the impacts and needs within this group. Semi-structured interviews, facilitated by children’s drawings, were conducted with 15 children (aged 9-16, 9 females). Inductive thematic analysis was used to analyze the data. The findings tell a story of loss, change and of resilience. Many children were unable to engage in normal daily activities and were unable to attend school, however, all employed self-management techniques to cope with symptoms and were positive for the future. Four main themes were identified: (1) Education challenges: although some schools tried to accommodate the child’s new limitations with provision of flexi-attendance, online classes and a reduced timetable, children struggled to keep up with their schoolwork and needed more support; (2) Disrupted relationships: children felt socially isolated; they were forced to give up co and extra-curricular activities, were no longer in contact with friendship groups and missed out on key experiences with friends and family; (3) Diverse health-related challenges: children’s symptoms affected daily functioning but were also triggers for changes in thoughts and mood; (4) Coping and resilience: children actively engaged in symptom management and were able to ‘self-pace’ and/or employ distraction activities to cope. They were also focused on living a ‘normal’ life and looked to the future with great positivity. A key challenge of the long-term effects of COVID is recognizing and treating the illness in children and the subsequent impact on multiple aspects of their lives. Even though children described feeling disconnected in many ways, their life goals were still important. A multi-faceted approach is needed for management of this illness, with a focus on helping these children successfully reintegrate into society and achieve their dreams.

Keywords: children’s illness experience, COVID-19, long-COVID in children, long-COVID kids, qualitative research

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Authors: Guna Raj Dhungana, Roshan Nepal, Apshara Parajuli, , Archana Maharjan, Shyam K. Mishra, Pramod Aryal, Rajani Malla

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Introduction: Klebsiella pneumoniae is a well-known opportunistic human pathogen, primarily causing healthcare-associated infections. The global emergence of carbapenemase-producing K. pneumoniaeis a major public health burden, which is often extensively multidrug resistant.Thus, because of the difficulty to treat these ‘superbug’ and menace and some term as ‘apocalypse’ of post antibiotics era, an alternative approach to controlling this pathogen is prudent and one of the approaches is phage mediated control and/or treatment. Objective: In this study, we aimed to isolate novel bacteriophage against carbapenemase-producing K. pneumoniaeand characterize for potential use inphage therapy. Material and Methods: Twenty lytic phages were isolated from river water using double layer agar assay and purified. Biological features, physiochemical characters, burst size, host specificity and activity spectrum of phages were determined. One most potent phage: Phage TU_Kle10O was selected and characterized by electron microscopy. Whole genome sequences of the phage were analyzed for presence/absence of virulent factors, and other lysin genes. Results: Novel phage TU_Kle10O showed multiple host range within own genus and did not induce any BIM up to 5th generation of host’s life cycle. Electron microscopy confirmed that the phage was tailed and belonged to Caudovirales family. Next generation sequencing revealed its genome to be 166.2 Kb. bioinformatical analysis further confirmed that the phage genome ‘did not’ contain any ‘bacterial genes’ within phage genome, which ruled out the concern for transfer of virulent genes. Specific 'lysin’ enzyme was identified phages which could be used as 'antibiotics'. Conclusion: Extensively multidrug resistant bacteria like carbapenemase-producing K. pneumoniaecould be treated efficiently by phages.Absence of ‘virulent’ genes of bacterial origin and presence of lysin proteins within phage genome makes phages an excellent candidate for therapeutics.

Keywords: bacteriophage, Klebsiella pneumoniae, MDR, phage therapy, carbapenemase,

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Authors: Filiz Celik, Rachel Harrad, Rob Keasley, Paul Bennett

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The COVID-19 pandemic has posed a significant challenge to many, with some groups with particular vulnerability to adverse psychological impacts. These include those disadvantaged by mental ill health, either pre-existing or occurring during pregnancy or post-partum. Using a qualitative approach, the research aimed to identify the challenges posed by COVID-19 to women, their infants and families during the perinatal period and to suggest what further support can help alleviate the adverse mental health impact of COVID-19. 21 expectant and new mothers who were currently receiving support via a peri-natal mental health service participated in semi-structured interviews. In these interviews, participants explored the impact of changes in social circumstances and healthcare providers as a result of COVID-19 restrictions, with the resultant audio recordings transcribed and analyzed using Reflexive Thematic Analysis (RTA). Based on these accounts, it was concluded that women, their partners and potentially their infants experienced heightened peri-natal distress, and their experience at this time increased their risk for future mental health problems. Women described emerging as more vulnerable, owing to their role as primary caregivers during the perinatal period and also explained how social isolation and limited access to services meant protective buffers against mental health deterioration were reduced and the resources they needed in order to develop resilience were weakened. Although partners were invited to take part in the research, a sizeable volume of data could not be generated to fully assess the impact of the pandemic on a partner’s mental well-being. However, women expressed concerns about the paternal mental health of partners and husbands which invites us to be further vigilant to paternal mental health and associated experiences. Overall, these interviews serve to highlight and provide a voice to these women and their families who describe experiencing disadvantage at an already vulnerable time in their lives, as well as illustrating the need for services to prioritize the needs of this population when acute events strike, be those future pandemics or other disasters.

Keywords: patient experience, perinatal mental health, covid-19 pandemic, heightened anxiety, birth trauma, post-natal well-being

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Authors: Nivedita Paul

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The changing character of marriage be it arranged marriage, love marriage, polygamy, informal unions, all signify different gender relations in everyday lives. Marriages in India are part and parcel of the kinship and cultural practices. Arranged marriage is still the dominant form of marriage where spouse selection is the initiative and decision of the parents; but its form is changing, as women are now actively participating in spouse selection but with parental consent. Spouse selection related decision making is important because marriage as an institution brings social change and gender inequality; especially in a women’s life as marriages in India are mostly patrilocal. Moreover, the amount of say in spouse selection can affect a woman’s reproductive rights, domestic violence issues, household resource allocation, communication possibilities with the spouse/husband, marital life, etc. The present study uses data from Indian Human Development Survey II (2011-12) which is a nationally representative multitopic survey that covers 41,554 households. Currently, married women of age group 15-49 in their first marriage; whose year of marriage is from 1970s to 2000s have been taken for the study. Based on spouse selection experiences, the sample of women has been divided into three marriage categories-self, semi and family arranged. Women in self arranged or love marriage is the sole decision maker in choosing the partner, in semi arranged marriage or arranged marriage with consent both parents and women together take the decision, whereas in family arranged or arranged marriage without consent only parents take the decision. The main aim of the study is to find the relationship between spouse selection experiences and women’s autonomy in India. Decision making in economic matters, child and health related decision making, mobility and access to resources are taken to be proxies of autonomy. Method of ordinal regression has been used to find the relationship between spouse selection experiences and autonomy after marriage keeping other independent variables as control factors. Results show that women in semi arranged marriage have more decision making power regarding financial matters of the household, health related matters, mobility and accessibility to resources, when compared to women in family, arranged marriages. For freedom of movement and access to resources women in self arranged marriage have the highest say or exercise greatest power. Therefore, greater participation of women (even though not absolute control) in spouse selection may lead to greater autonomy after marriage.

Keywords: arranged marriage, autonomy, consent, spouse selection

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Authors: Tsung Chin Wu, Yu Chen Tsai, Rhay Hung Weng, Weir Sen Lin

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In recent years, nursing staff’s lower job satisfaction has led to higher turnover rates, and high turnover rates not only cause medical institution costs to increase but also the quality of medical care to decrease. From the perspective of internal marketing, institution staffs are internal customers, and institutions should focus and meet the needs of staff, so that staff will strive to meet the needs of external customers and provide them with the required care. However, few previous studies have investigated the impact of internal staff satisfaction on external customers. Therefore, this study aimed to conduct job satisfaction surveys on internal staff to investigate the relationship between job satisfaction and quality of medical care through statistical analysis of the study results. The related study results may serve as a reference for healthcare managers. This study was conducted using a questionnaire and the subjects were nursing staff from four hospitals. A total of 600 questionnaires were distributed and 577 valid questionnaires were returned with a response rate of 96.1%. After collecting the data, the reliability and validity of the study variables were confirmed by confirmatory factor analysis. The impact of internal marketing and job satisfaction on turnover intention of nursing staff was analyzed using descriptive analysis, one-way ANOVA, Pearson correlation analysis and multiple regression analysis. The study results showed that there was a significant difference between nursing staff’s job title and ‘professional participation’ and ‘shifts’. There was a significant difference between salary and ‘shifts’ and ‘turnover intention’, as well as between marriage and ‘remuneration’ and ‘turnover intention’. A significant difference was found between professional advancement and ‘professional growth’ and ‘type of leave’, as well as between division of service and ‘shifts’ and ‘turnover intention’. Pearson correlation analysis revealed a significant negative correlation between turnover intention and ‘internal marketing’, ‘interaction’, ‘professional participation’, ‘grasp of environment’, ‘remuneration’ and ‘shifts’, meaning that the higher the satisfaction, the lower the turnover intention. It is recommended that hospitals establish a comprehensive internal marketing mechanism to enhance staff satisfaction and in turn, reduce intention to resign, and the key to increasing job satisfaction is by establishing effective methods of internal communication.

Keywords: internal marketing, job satisfaction, turnover intention, nursing staff

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