Search results for: emergency medical team

Authors: Alberto Abello Moreno-Cid

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Mummification was the process through which immortality was granted to the deceased, so it was of extreme importance to the Egyptians. The techniques of embalming had evolved over the centuries, and specialists created increasingly sophisticated tools. However, due to its eminently religious nature, knowledge about everything related to this practice was jealously preserved, and the testimonies that have survived to our time are scarce. For this reason, embalming instruments found in archaeological excavations are uncommon. The tomb of the Vizier Amenhotep Huy (AT No. -28-), located in the el-Assasif necropolis that is being excavated since 2009 by the team of the Institute of Ancient Egyptian Studies, has been the scene of some discoveries of this type that evidences the existence of mummification practices in this place after the New Kingdom. The clysters or enemas are the fundamental tools in the second type of mummification described by the historian Herodotus to introduce caustic solutions inside the body of the deceased. Nevertheless, such objects only have been found in three locations: the tomb of Ankh-Hor in Luxor, where a copper enema belonged to the prophet of Ammon Uah-ib-Ra came to light; the excavation of the tomb of Menekh-ib-Nekau in Abusir, where was also found one made of copper; and the excavations in the Bucheum, where two more artifacts were discovered, also made of copper but in different shapes and sizes. Both of them were used for the mummification of sacred animals and this is the reason they vary significantly. Therefore, the object found in the tomb No. -28-, is the first known made of faience of all these peculiar tools and the oldest known until now, dated in the Third Intermediate Period (circa 1070-650 B.C.). This paper bases its investigation on the study of those parallelisms, the material, the current archaeological context and the full analysis and reconstruction of the object in question. The key point is the use of faience in the production of this item: creating a device intended to be in constant use seems to be a first illogical compared to other samples made of copper. Faience around the area of Deir el-Bahari had a strong religious component, associated with solar myths and principles of the resurrection, connected to the Osirian that characterises the mummification procedure. The study allows to refute some of the premises which are held unalterable in Egyptology, verifying the utilization of these sort of pieces, understanding its way of use and showing that this type of mummification was also applied to the highest social stratum, in which case the tools were thought out of an exceptional quality and religious symbolism.

Keywords: clyster, el-Assasif, embalming, faience enema mummification, Theban necropolis

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Authors: Qirat Naz

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The aim of this research study is to explore the perspectives of migrants and interpreters from diverse backgrounds on language barriers, their English language proficiency and access to health care facilities. A qualitative research methodology was used including in-depth interviews and focus group discussions. Data was collected from 20 migrants who have difficulty conversing in the English language and 12 interpreters including family members and friends who provide translation services as part of accessing health care. The findings seek to address three key research questions: how language is a barrier for non-national language speakers to access the health care facilities, what is the impact of various socio-cultural and linguistic backgrounds on health compliance, and what is the role of interpreters in providing access to, usage of, and satisfaction with health-care facilities. The most crucial component of providing care was found to be effective communication between patient and health care professionals. Language barrier was the major concern for healthcare professionals in providing and for migrants in accessing sufficient, suitable, and productive health care facilities. Language and sociocultural background play a significant role in health compliance as this research reported; respondents believe that patients who interact with the doctors who have same sociocultural and linguistic background benefit from receiving better medical care than those who do not. Language limitations and the socio-cultural gap make it difficult for patients and medical staff to communicate clearly with one another, which has a negative effect on quality of care and patient satisfaction. The use of qualified interpreters was found to be beneficial but there were also drawbacks such as accessibility and availability of them in a timely manner for patient needs. The findings of this research can help health care workers and policy makers working to improve health care delivery system and to create appropriate strategies to overcome this challenge.

Keywords: migration, migrants, language barrier, healthcare access

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Authors: A. T. Muruviwa

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To-date, the discourse on corporate social responsibility (CSR) has primarily centred on the actions and inactions of corporations; hence, the dominant focus on CSR has been on impacts and outcomes. The obscuring effect of this approach has, arguably, resulted in the emergence of what may be termed a ‘Northern’ agenda on CSR theory and practice, in contrast to an emergency ‘Southern’ discourse, which appears to highlight the crucial issues of poverty reduction, infrastructure development and the broader questions of social provisioning and community empowerment. Some scholars have explicitly called for a CSR research agenda that focuses on the 'reciprocal duties' of the stakeholders in the CSR process rather than fixate on the actions and inactions of business. It is against the backdrop of these contestations that this study assesses the reciprocal relationships amongst CSR stakeholders in a Zimbabwean platinum mining town, with a view to demonstrating how such relationships – and the expectations and obligations embedded in them – impact on the success or failure of CSR initiatives. The existence of mutual relations between the corporation and its stakeholders signifies the successes of CSR processes and hence the outcomes. The company is Zimplats Mining Company; the community is Mhondoro-Ngezi, and the stakeholders are clearly identified in the study. The study utilised a triangulated design, with data collected using a mini survey, focus groups, in-depth interview and observation. The key findings are that the CSR process in the study community is dominated by the mining company. Despite the existence of a CSR framework that recognises government, local leaders and community members as legitimate stakeholders, there is little evidence of concrete contributions made by these stakeholders towards the realisation of CSR objectives. As a result, the community development process – in so far as CSR is concerned – fails to address the developmental concerns of the various stakeholders. On the basis of these findings, the study concludes that there is a crisis of reciprocity in the CSR process in Mhondoro-Ngezi, and that a situation where the conceptualisation of local development needs and the deployment of specific development tools seems to be driven by one stakeholder almost to the exclusion of all others, can only present contradictory development outcomes. The significance of this study is that it allows for the development of a more nuanced and robust CSR discourse. Rather than focusing on the corporate and stakeholder perspectives and outcomes of CSR initiatives, this study examines the CSR- development nexus by interrogating the idea of reciprocal responsibility as a sin qua non to CSR success. This analytical strategy and focus allow the researcher to gain a clear understanding of how stakeholder relationships and duties influence CSR processes and also the overall outcome. At a more practical level, the findings of the study should help to shape the policy on corporate community relationships with a view to enhancing the role of mining in development.

Keywords: community development, processes, reciprocity, stakeholders

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Authors: Meshandren Naidoo, Amy Gooden

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Implantable brain-computer interface (BCI) technologies have developed to the point where brain-computer communication is possible. This has great potential in the medical field, as it allows persons who have lost capacities. However, ethicists and regulators call for a strict approach to these technologies due to the impact on personhood. This research demonstrates that the personhood debate is more nuanced and that where an African approach to personhood is used, it may produce results more favorable to the development and use of this technology.

Keywords: artificial intelligence, law, neuroscience, ethics

Procedia PDF Downloads 134

Authors: Lin Fu-Gong

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Background: As WHO announced, people with intellectual disability (ID) were vulnerable to mental health problems. And there were few custom-made mental health scales for those people to monitor their mental health. Those people with mental problems often accompanied worse prognosis and usually became to be a heavier burden on the caregivers. Purpose: In this study, we intend to develop a psychopathy scale as a practical tool for monitoring the mental health for people with ID living in institute. Methods: In this study, we adopt the Psychopathology Inventory for Mentally Retarded Adults developed by professor Matson with certified reliability and validity in Western countries with Dr. Matson’s agreement in advance. We first translated the inventory into Chinese validated version considering the domestic culture background in the past year. And the validity and reliability evaluation of mental health status using this inventory among the people with intellectual living in the institute were done. Results: The inventory includes eight psychiatric disorder scales as schizophrenic, affective, psychosexual, adjustment, anxiety, somatoform, personality disorders and inappropriate mental adjustment. Around 83% of 40 invested people, who randomly selected from the institute, were found to have at least one disorder who were recommended with medical help by two evaluators. Among the residents examined, somatoform disorder and inappropriate mental adjustment were most popular with 60% and 78% people respectively. Conclusion: The result showed the prevalence psychiatric disorders were relatively high among people with ID in institute and the mental problems need to be further cared and followed for their mental health. The results showed that the psychopathology inventory was a useful tool for institute caregiver, manager and for long-term care policy to the government. In the coming stage, we plan to extend the use of the valid Chinese version inventory among more different type institutes for people with ID to establish their dynamic mental health status including medical need, relapse and rehabilitation to promote their mental health.

Keywords: intellectual disability, psychiatric disorder, psychopathology inventory, mental health, the institute

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

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

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

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Authors: Lina María Martínez Sánchez, Juliana Molina Valencia, Esteban Vallejo Agudelo, Daniel Gallego González, María Isabel Pérez Palacio, Juan Ricardo Gaviria García, María De Los Ángeles Rodríguez Gázquez, Gloria Inés Martínez Domínguez

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Alternative and complementary therapies constitute a vast and complex combination of interventions, philosophies, approaches, and therapies that acquire a holistic healthcare point of view, becoming an alternative for the treatment of patients with chronic pain. Objective: determine the characteristics of the use of alternative and complementary therapies in patients with chronic pain who consulted in a medical institution. Methodology: cross-sectional and descriptive study, with a population of patients that assisted to the outpatient consultation and met the eligibility criteria. Sampling was not conducted. A form was used for the collection of demographic and clinical variables and the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) was validated. The analysis and processing of information was carried out using the SPSS program vr.19. Results: 220 people with chronic pain were included. The average age was 54.7±16.2 years, 78.2% were women, and 75.5% belonged to the socioeconomic strata 1 to 3. Musculoskeletal pain (77.7%), migraine (15%) and neuralgia (9.1%) were the most frequently types of chronic pain. 33.6% of participants have used some kind of alternative and complementary therapy; the most frequent were: homeopathy (14.5%), phytotherapy (12.7%), and acupuncture (11.4%). The total average HCAMQ score for the study group was 30.2±7.0 points, which shows a moderate attitude toward the use of complementary and alternative medicine. The highest scores according to the type of pain were: neuralgia (32.4±5.8), musculoskeletal pain (30.5±6.7), fibromyalgia (29.6±7.3) and migraine (28.5±8.8). The reliability of the HCAMQ was acceptable (Cronbach's α: 0.6). Conclusion: it was noted that the types of chronic pain and the clinical or therapeutic management of patients correspond to the data available in current literature. Despite the moderate attitude toward the use of these alternative and complementary therapies, one of every three patients uses them.

Keywords: chronic pain, complementary therapies, homeopathy, acupuncture analgesia

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Authors: Mohammad Ghahramani, Fahimeh Saei Manesh

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Winning a soccer game is based on thorough and deep analysis of the ongoing match. On the other hand, giant gambling companies are in vital need of such analysis to reduce their loss against their customers. In this research work, we perform deep, real-time analysis on every soccer match around the world that distinguishes our work from others by focusing on particular seasons, teams and partial analytics. Our contributions are presented in the platform called “Analyst Masters.” First, we introduce various sources of information available for soccer analysis for teams around the world that helped us record live statistical data and information from more than 50,000 soccer matches a year. Our second and main contribution is to introduce our proposed in-play performance evaluation. The third contribution is developing new features from stable soccer matches. The statistics of soccer matches and their odds before and in-play are considered in the image format versus time including the halftime. Local Binary patterns, (LBP) is then employed to extract features from the image. Our analyses reveal incredibly interesting features and rules if a soccer match has reached enough stability. For example, our “8-minute rule” implies if 'Team A' scores a goal and can maintain the result for at least 8 minutes then the match would end in their favor in a stable match. We could also make accurate predictions before the match of scoring less/more than 2.5 goals. We benefit from the Gradient Boosting Trees, GBT, to extract highly related features. Once the features are selected from this pool of data, the Decision trees decide if the match is stable. A stable match is then passed to a post-processing stage to check its properties such as betters’ and punters’ behavior and its statistical data to issue the prediction. The proposed method was trained using 140,000 soccer matches and tested on more than 100,000 samples achieving 98% accuracy to select stable matches. Our database from 240,000 matches shows that one can get over 20% betting profit per month using Analyst Masters. Such consistent profit outperforms human experts and shows the inefficiency of the betting market. Top soccer tipsters achieve 50% accuracy and 8% monthly profit in average only on regional matches. Both our collected database of more than 240,000 soccer matches from 2012 and our algorithm would greatly benefit coaches and punters to get accurate analysis.

Keywords: soccer, analytics, machine learning, database

Procedia PDF Downloads 239

Authors: Agnes Anyango Andollo, Jane Achieng Achola

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The use of Information and Communication Technologies (ICTs) has become one of the driving forces in facilitation of learning in most colleges. The ability to effectively harness the technology varies from college to college. The study objective was to determine the lecturers’, institutional attributes and policies that influence the utilization of ICT by the lecturers’. A cross sectional survey design was employed in order to empirically investigate the extent to which lecturers’ personal, institutional attributes and policies influence the utilization of ICT to facilitate learning. The target population of the study was 295 lecturers who facilitate learning at KMTC-Nairobi. Structured self-administered questionnaire was given to the lecturers. Quantitative data was scrutinized for completeness, accuracy and uniformity then coded. Data were analyzed in frequencies and percentages using Statistical Package for Social Sciences (SPSS) version 19, this was a reliable tool for quantitative data analysis. A total of 155 completed questionnaires administered were obtained from the respondents for the study that were subjected to analysis. The study found out that 93 (60%) of the respondents were male while 62 (40%) of the respondents were female. Individual’s educational level, age, gender and educational experience had the greatest impact on use of ICT. Lecturers’ own beliefs, values, ideas and thinking had moderate impact on use of ICT. And that institutional support by provision of resources for ICT related training such as internet, computers, laptops and projectors had moderate impact (p = 0.049) at 5% significant level on use of ICT. The study concluded that institutional attributes and ICT policy were keys to utilization of ICT by lecturers at KMTC Nairobi also mandatory policy on use of ICT by lecturers to facilitate learning was key. It recommended that policies should be put in place for Technical support to lecturers when in problem during utilization of ICT and also a mechanism should be put in place to make the use of ICT in teaching and learning mandatory.

Keywords: policy, computers education, medical training institutions, ICTs

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Authors: Alaa Ashraf Khaleel Abdallah

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Background: The global landscape has witnessed an alarming rise in armed conflicts, further devastating populations through enforced displacement, compromised infrastructure, and strained healthcare systems. In Sudan, the situation is particularly dire, with conflict exacerbating shortages in medical supplies and personnel, pushing the already fragile healthcare system into crisis, especially affecting surgical care. Initially, war impacts were significant in conflict zones like Khartoum, but since mid-April 2023, the entire country has descended into chaos. Weak monitoring and health information systems hinder accurate assessment of surgical care in conflict zones, leading to inadequate resource allocation, suboptimal care, and missed opportunities for global learning. This study investigates the impact of the Sudanese conflict on postoperative complications, exploring prevalence, types, outcomes, and psychological effects in conflict and safe areas. Methods: Conducted across 10 Sudanese states—5 in conflict zones such as Khartoum and West Darfur, and 5 in safer regions like River Nile and Kassala—this study analyzed data from 1,457 patients who underwent surgery post-April 2023. Data were collected using a pretested, mixed-mode questionnaire that incorporated elements from validated frameworks and tailored questions specific to the study's context. Hospital records and surgical logs were also used, with data analyzed via SPSS. Results: The overall prevalence of postoperative complications was 35.89%, with a higher rate in conflict zones (57.5%) compared to safe areas (26.4%). Surgical site infections predominated in conflict zones (24.7%) and higher than its prevalence in safe areas, and while fever was prevalent in safer regions even though much less compared to conflict areas, bleeding from surgical site was very frequent in conflict areas. Most patients recovered within two months at a rate higher in safe areas, but most of them required further medical or surgical management within the first month, but psychological impacts were more pronounced in conflict zones with 22.22% reported anxiety among injuries patients, and 20.6% experienced depression, 13.5% and 16.9% respectively, in those had surgeries for other medical conditions, compared to 0.22%anxiety rates and 8.1%for depression in safer regions. Risk factors included age, travel to conflict zones, access to care, delays, and comorbidities. Conclusion: Strengthening healthcare systems and ensuring accessible surgical care are critical in both conflict and safe areas. Specific attention must be given to addressing patient suffering and demographic shifts caused by armed conflict. Further research is needed to refine the predictive model for postoperative complications in conflict zones.

Keywords: postoperative complications, conflict zones, risk factors, surgical outcomes, Sudan

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Authors: Isabell Koinig, Sandra Diehl

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In recent years, the health-care context has not been left unaffected by technological developments. In recent years, the Internet of Medical Things (IoMT)has not only led to a collaboration between disease management and advanced care coordination but also to more personalized health care and patient empowerment. With more than 40 % of all health technology being IoMT-related by 2020, questions regarding privacy become more prevalent, even more so during COVID-19when apps allowing for an intensive tracking of people’s whereabouts and their personal contacts cause privacy advocates to protest and revolt. There is a widespread tendency that even though users may express concerns and fears about their privacy, they behave in a manner that appears to contradict their statements by disclosing personal data. In literature, this phenomenon is discussed as a privacy paradox. While there are some studies investigating the privacy paradox in general, there is only scarce research related to the privacy paradox in the health sector and, to the authors’ knowledge, no empirical study investigating young people’s attitudes toward data security when using wearables and health apps. The empirical study presented in this paper tries to reduce this research gap by focusing on the area of digital and mobile health. It sets out to investigate the degree of importance individuals attribute to protecting their privacy and individual privacy protection strategies. Moreover, the question to which degree individuals between the ages of 20 and 30 years are willing to grant commercial parties access to their private data to use digital health services and apps are put to the test. To answer this research question, results from 6 focus groups with 40 participants will be presented. The focus was put on this age segment that has grown up in a digitally immersed environment. Moreover, it is particularly the young generation who is not only interested in health and fitness but also already uses health-supporting apps or gadgets. Approximately one-third of the study participants were students. Subjects were recruited in August and September 2019 by two trained researchers via email and were offered an incentive for their participation. Overall, results indicate that the young generation is well informed about the growing data collection and is quite critical of it; moreover, they possess knowledge of the potential side effects associated with this data collection. Most respondents indicated to cautiously handle their data and consider privacy as highly relevant, utilizing a number of protective strategies to ensure the confidentiality of their information. Their willingness to share information in exchange for services was only moderately pronounced, particularly in the health context, since health data was seen as valuable and sensitive. The majority of respondents indicated to rather miss out on using digital and mobile health offerings in order to maintain their privacy. While this behavior might be an unintended consequence, it is an important piece of information for app developers and medical providers, who have to find a way to find a user base for their products against the background of rising user privacy concerns.

Keywords: digital health, privacy, privacy paradox, IoMT

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Authors: V. I. Kozyavkin, L. F. Shestopalova, T. B. Voloshyn

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Introduction: Rehabilitation of children with Autism is the issue of the day in psychiatry and neurology. It is attributed to constantly increasing quantity of autistic children - Autistic Spectrum Disorders (ASD) Existing rehabilitation approaches in treatment of children with Autism improve their medico- social and social- psychological adjustment. Experience of treatment for different kinds of Autistic disorders in International Clinic of Rehabilitation (ICR) reveals the necessity of complex intensive approach for healing this malady and wider implementation of a Kozyavkin method for treatment of children with ASD. Methods: 19 children aged from 3 to 14 years were examined. They were diagnosed ‘Autism’ (F84.0) with comorbid neurological pathology (from pyramidal insufficiency to para- and tetraplegia). All patients underwent rehabilitation in ICR during two weeks, where INRS approach was used. INRS included methods like biomechanical correction of the spine, massage, physical therapy, joint mobilization, wax-paraffin applications. They were supplemented by art- therapy, ergotherapy, rhythmical group exercises, computer game therapy, team Olympic games and other methods for improvement of motivation and social integration of the child. Estimation of efficacy was conducted using parent’s questioning and done twice- on the onset of INRS rehabilitation course and two weeks afterward. For efficacy assessment of rehabilitation of autistic children in ICR standardized tool was used, namely Autism Treatment Evaluation Checklist (ATEC). This scale was selected because any rehabilitation approaches for the child with Autism can be assessed using it. Results: Before the onset of INRS treatment mean score according to ATEC scale was 64,75±9,23, it reveals occurrence in examined children severe communication, speech, socialization and behavioral impairments. After the end of the rehabilitation course, the mean score was 56,5±6,7, what indicates positive dynamics in comparison to the onset of rehabilitation. Generally, improvement of psychoemotional state occurred in 90% of cases. Most significant changes occurred in the scope of speech (16,5 before and 14,5 after the treatment), socialization (15.1 before and 12,5 after) and behavior (20,1 before and 17.4 after). Conclusion: As a result of INRS rehabilitation course reduction of autistic symptoms was noted. Particularly improvements in speech were observed (children began to spell out new syllables, words), there was some decrease in signs of destructiveness, quality of contact with the surrounding people improved, new skills of self-service appeared. The prospect of the study is further, according to evidence- based medicine standards, deeper examination of INRS and assessment of its usefulness in treatment for Autism and ASD.

Keywords: intensive neurophysiological rehabilitation system (INRS), international clinic od rehabilitation, ASD, rehabilitation

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Authors: Fernando Araujo, Sandra Cardoso, Fátima Fonseca, Sandra Cavaca

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A debureaucratization strategy for the Portuguese Health Service was assumed by the Executive Board of the SNS, in deep articulation with the Shared Services of the Ministry of Health. Two of the main dimensions were focused on sick leaves (SL), that transform primary health care (PHC) in administrative institutions, limiting access to patients. The self-declaration of illness (SDI) project, through the National Health Service Contact Centre (SNS24), began on May 1, 2023, and has already resulted in the issuance of more than 300,000 SDI without the need to allocate resources from the National Health Service (NHS). This political decision allows each citizen, in a maximum 2 times/year, and 3 days each time, if ill, through their own responsibility, report their health condition in a dematerialized way, and by this way justified the absence to work, although by Portuguese law in these first three days, there is no payment of salary. Using a digital approach, it is now feasible without the need to go to the PHC and occupy the time of the PHC only to obtain an SL. Through this measure, bureaucracy has been reduced, and the system has been focused on users, improving the lives of citizens and reducing the administrative burden on PHC, which now has more consultation times for users who need it. The second initiative, which began on March 1, 2024, allows the SL to be issued in emergency departments (ED) of public hospitals and in the health institutions of the social and private sectors. This project is intended to allow the user who has suffered a situation of acute urgent illness and who has been observed in an ED of a public hospital or in a private or social entity no longer need to go to PHC only to apply for the respective SL. Since March 1, 54,453 SLs have been issued, 242 in private or social sector institutions and 6,918 in public hospitals, of which 134 were in ED and 47,292 in PHC. This approach has proven to be technically robust, allows immediate resolution of problems and differentiates the performance of doctors. However, it is important to continue to qualify the proper functioning of the ED, preventing non-urgent users from going there only to obtain SL. Thus, in order to make better use of existing resources, it was operationalizing this extension of its issuance in a balanced way, allowing SL to be issued in the ED of hospitals only to critically ill patients or patients referred by INEM, SNS24, or PHC. In both cases, an intense public campaign was implemented to explain the way it works and the benefits for patients. In satisfaction surveys, more than 95% of patients and doctors were satisfied with the solutions, asking for extensions to other areas. The administrative simplification agenda of the NHS continues its effective development. For the success of this debureaucratization agenda, the key factors are effective communication and the ability to reach patients and health professionals in order to increase health literacy and the correct use of NHS.

Keywords: debureaucratization strategy, self-declaration of illness, sick leaves, SNS24

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Authors: Yi Shan Cheng, Ya Hui Yeh, Hsiao Wen Hsu

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Delirium is an acute state of confusion, which is mainly the result of the interaction of many factors, including: age>65 years, comorbidity, cognitive function and visual/auditory impairment, dehydration, pain, sleep disorder, pipeline retention, general anesthesia and major surgery… etc. Researches show the prevalence of delirium in hospitalized elderly patients over 50%. If it doesn't improve in time, may cause cognitive decline or impairment, not only prolong the length of hospital stay but also increase mortality. Some studies have shown that multiple nonpharmacological interventions are the most effective and common strategies, which are reorientation, early mobility, promoting sleep and nutritional support (including water intake), could improve or prevent delirium in the hospitalized elderly. In Taiwan, only one research to compare the delirium incidence of the older patients who have received orthopedic surgery between multi-nonpharmacological interventions and general routine care. Therefore, the purpose of this study is to address the prevention or improvement of delirium incidence density in medical hospitalized elderly, provide clinical nurses as a reference for clinical implementation, and develop follow-up related research. This study is a quasi-experimental design using purposive sampling. Samples are from two wards: the geriatric ward and the general medicine ward at a medical center in central Taiwan. The sample size estimated at least 100, and then the data will be collected through a self-administered structured questionnaire, including: demographic and professional evaluation items. Case recruiting from 5/13/2023. The research results will be analyzed by SPSS for Windows 22.0 software, including descriptive statistics and inferential statistics: logistic regression、Generalized Estimating Equation(GEE)、multivariate analysis of variance(MANOVA).

Keywords: multiple nonpharmacological interventions, hospitalized elderly, delirium incidence, delirium

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Authors: Glenn Auld Knierim

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Automated robotic winding of high-temperature superconductors (HTS) addresses precision, efficiency, and reliability critical to the commercialization of products. Today’s HTS materials are mature and commercially promising but require manufacturing attention. In particular to the exaggerated rectangular cross-section (very thin by very wide), winding precision is critical to address the stress that can crack the fragile ceramic superconductor (SC) layer and destroy the SC properties. Damage potential is highest during peak operations, where winding stress magnifies operational stress. Another challenge is operational parameters such as magnetic field alignment affecting design performance. Winding process performance, including precision, capability for geometric complexity, and efficient repeatability, are required for commercial production of current HTS. Due to winding limitations, current HTS magnets focus on simple pancake configurations. HTS motors, generators, MRI/NMR, fusion, and other projects are awaiting robotic wound solenoid, planar, and spherical magnet configurations. As with conventional power cables, full transposition winding is required for long length alternating current (AC) and pulsed power cables. Robotic production is required for transposition, periodic swapping of cable conductors, and placing into precise positions, which allows power utility required minimized reactance. A full transposition SC cable, in theory, has no transmission length limits for AC and variable transient operation due to no resistance (a problem with conventional cables), negligible reactance (a problem for helical wound HTS cables), and no long length manufacturing issues (a problem with both stamped and twisted stacked HTS cables). The Infinity Physics team is solving manufacturing problems by developing automated manufacturing to produce the first-ever reliable and utility-grade commercial SC cables and magnets. Robotic winding machines combine mechanical and process design, specialized sense and observer, and state-of-the-art optimization and control sequencing to carefully manipulate individual fragile SCs, especially HTS, to shape previously unattainable, complex geometries with electrical geometry equivalent to commercially available conventional conductor devices.

Keywords: automated winding manufacturing, high temperature superconductor, magnet, power cable

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Authors: Dong Jiang

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Turnout is the essential equipment on the railway, which also belongs to one of the strongest demanded infrastructural facilities of railway on account of the more seriously frog rail failures. In cooperation with Germany Company (DB Systemtechnik AG), our research team focuses on the quantitative analysis about the frog rails to predict their lifetimes. Moreover, the suggestions for the timely and effective maintenances are made to improve the economy of the frog rails. The lifetime of the frog rail depends strongly on the internal damage of the running surface until the breakages occur. On the basis of Hertzian theory of the contact mechanics, the dynamic loads of the running surface are calculated in form of the contact pressures on the running surface and the equivalent tensile stress inside the running surface. According to material mechanics, the strength of the frog rail is determined quantitatively in form of the Stress-cycle (S-N) curve. Under the interaction between the dynamic loads and the strength, the internal damage of the running surface is calculated by means of the linear damage hypothesis of the Miner’s rule. The emergence of the first Breakage on the running surface is to be defined as the failure criterion that the damage degree equals 1.0. From the microscopic perspective, the running surface of the frog rail is divided into numerous segments for the detailed analysis. The internal damage of the segment grows slowly in the beginning and disproportionately quickly in the end until the emergence of the breakage. From the macroscopic perspective, the internal damage of the running surface develops simply always linear along the lifetime. With this linear growth of the internal damages, the lifetime of the frog rail could be predicted simply through the immediate introduction of the slope of the linearity. However, the superficial abrasion plays an essential role in the results of the internal damages from the both perspectives. The influences of the superficial abrasion on the lifetime are described in form of the abrasion rate. It has two contradictory effects. On the one hand, the insufficient abrasion rate causes the concentration of the damage accumulation on the same position below the running surface to accelerate the rail failure. On the other hand, the excessive abrasion rate advances the disappearance of the head hardened surface of the frog rail to result in the untimely breakage on the surface. Thus, the relationship between the abrasion rate and the lifetime is subdivided into an initial phase of the increased lifetime and a subsequent phase of the more rapid decreasing lifetime with the continuous growth of the abrasion rate. Through the compensation of these two effects, the critical abrasion rate is discussed to reach the optimal lifetime.

Keywords: breakage, critical abrasion rate, frog rail, internal damage, optimal lifetime

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Authors: Deinzel R. Uezono, Vivien Fe F. Fadrilan-Camacho, Bianca Margarita L. Medina, Antonio Domingo R. Reario, Trisha M. Salcedo, Luke Wesley P. Borromeo

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The environment of health care workers is considered one of the most hazardous settings due to the nature of their work. In developing countries especially, the Philippines, this continues to be overlooked in terms of programs and services on occupational health and safety (OHS). One possible reason for this is the existing information gap on OHS which limits data comparability and impairs effective monitoring and assessment of interventions. To address this gap, there is a need to determine the current conditions of Filipino health care workers in their workplace. This descriptive cross-sectional study assessed the occupational health and safety conditions of health care workers in barangay health centers in a selected city in Metro Manila, Philippines by: (1) determining the hazards present in the workplace; (2) determining the most common self-reported medical problems; and (3) describing the elements of an OHS system based on the six building blocks of health system. Assessment was done through walkthrough survey, self-administered questionnaire, and key informant interview. Data analysis was done using Epi Info 7 and NVivo 11. Results revealed different health hazards present in the workplace particularly biological hazards (exposure to sick patients and infectious specimens), physical hazards (inadequate space and/or lighting), chemical hazards (toxic reagents and flammable chemicals), and ergonomic hazards (activities requiring repetitive motion and awkward posture). Additionally, safety hazards (improper capping of syringe and lack of fire safety provisions) were also observed. Meanwhile, the most commonly self-reported chronic diseases among health care workers (N=336) were hypertension (20.24%, n=68) and diabetes (12.50%, n=42). Top commonly self-reported symptoms were colds (66.07%, n=222), coughs (63.10%, n=212), headache (55.65%, n=187), and muscle pain (50.60%, n=170) while other diseases were influenza (16.96%, n=57) and UTI (15.48%, n=52). In terms of the elements of the OHS system, a general policy on occupational health and safety was found to be lacking and in effect, an absence of health and safety committee overseeing the implementing and monitoring of the policy. No separate budget specific for OHS programs and services was also found to be a limitation. As a result, no OHS personnel and trainings/seminar were identified. No established information system for OHS was in place. In conclusion, health and safety hazards were observed to be present across the barangay health centers visited in a selected city in Metro Manila. Medical conditions identified as most commonly self-reported were hypertension and diabetes for chronic diseases; colds, coughs, headache, and muscle pain for medical symptoms; and influenza and UTI for other diseases. As for the elements of the occupational health and safety system, there was a lack in the general components of the six building blocks of the health system.

Keywords: health hazards, occupational health and safety, occupational health and safety system, safety hazards

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Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: According to the World Health Organization, caesarean section delivery rates of more than 10-15% caesarean section deliveries in any specific geographic region in the world are not justifiable. The aim of the study was to describe the level and analyse determinants of caesarean section delivery in Addis Ababa. Methods: Data was collected in Addis Ababa using a structured questionnaire administered to 901 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary logistic regression model was employed to identify predictors of caesarean section delivery. Results: Among the 835 women who delivered their last birth at healthcare facilities, 19.2% of them gave birth by caesarean section. About 9.0% of the caesarean section births were due to mother’s request or service provider’s influence without any medical indication. The caesarean section delivery rate was much higher than the recommended rate particularly among the non-slum residents (27.2%); clients of private healthcare facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women belonging to the highest wealth quintile household (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery by service providers. The logistic regression model shows that older age (30-49), secondary and above education, non-slum residence, high-risk pregnancy and receiving adequate antenatal care were significantly positively associated with caesarean section delivery. Conclusion: Despite the unreserved effort towards achieving MDG 5 through safe skilled delivery assistance among others, the high caesarean section rate beyond the recommend limit, and the finding that caesarean sections done without medical indications were also alarming. The government and city administration should take appropriate measures before the problems become setbacks in healthcare provision. Further investigations should focus on the effect of caesarean section delivery on maternal and child health outcomes in the study area.

Keywords: Addis Ababa, caesarean section, mode of delivery, slum residence

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Authors: Ayman M. Mansour, Bilal Hawashin, Hesham Alsalem

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Faster delivery of laboratory test results is one of the most noticeable signs of good laboratory service and is often used as a key performance indicator of laboratory performance. Despite the availability of technology, the delivery time of clinical laboratory test results continues to be a cause of customer dissatisfaction which makes patients feel frustrated and they became careless to get their laboratory test results. The Medical Clinical Laboratory test results are highly sensitive and could harm patients especially with the severe case if they deliver in wrong time. Such results affect the treatment done by physicians if arrived at correct time efforts should, therefore, be made to ensure faster delivery of lab test results by utilizing new trusted, Robust and fast system. In this paper, we proposed a distributed Multi-Agent System to enhance and faster the process of laboratory test results delivery using SMS. The developed system relies on SMS messages because of the wide availability of GSM network comparing to the other network. The software provides the capability of knowledge sharing between different units and different laboratory medical centers. The system was built using java programming. To implement the proposed system we had many possible techniques. One of these is to use the peer-to-peer (P2P) model, where all the peers are treated equally and the service is distributed among all the peers of the network. However, for the pure P2P model, it is difficult to maintain the coherence of the network, discover new peers and ensure security. Also, security is a quite important issue since each node is allowed to join the network without any control mechanism. We thus take the hybrid P2P model, a model between the Client/Server model and the pure P2P model using GSM technology through SMS messages. This model satisfies our need. A GUI has been developed to provide the laboratory staff with the simple and easy way to interact with the system. This system provides quick response rate and the decision is faster than the manual methods. This will save patients life.

Keywords: multi-agent system, delivery process, GSM technology, clinical laboratory results

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Authors: Maryam Beiranvand, Sajad Yaghoubi

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Background: Some microbes can colonize plants’ inner tissues without causing obvious damage and can even produce useful bioactive substances. In the present study, the diversity of the endophytic bacteria associated with medicinal plants from Iran was investigated by culturing techniques, molecular gene identification, as well as measuring them for antibacterial activity. Results: In the spring season from 2013 to 2014, 35 herb pharmacology samples were collected, sterilized, meshed, and then cultured on selective media culture. A total of 199 endophytic bacteria were successfully isolated from 35 tissue cultures of medical plants, and sixty-seven out of 199 bacterial isolates were subjected to identification by the 16S rRNA gene sequence analysis method. Based on the sequence similarity gene and phylogenetic analyses, these isolates were grouped into five classes, fourteen orders, seventeen families, twenty-one genera, and forty strains. The most abundant group of endophytic bacteria was actinobacterial, consisting of thirty-two (47%) out of 67 bacterial isolates. Ten (22.3%) out of 67 bacterial isolates remained unidentified and classified at the genus level. The signature of the 16S rRNA gene formed a distinct line in a phylogenetic tree showing that they might be new species of bacteria. One (5.2%) out of 67 bacterial isolates was still not well categorized. Forty-two out of 67 strains were candidates for antimicrobial activity tests. Nineteen (45%) out of 42 strains showed antimicrobial activity multidrug-resistance (MDR); thirteen (68%) out of 19 strains were allocated to classes actinobacteria. Four (21%) out of 19 strains belonged to the Bacillaceae family, one (5.2%) out of 19 strains was the Paenibacillaceae family, and one (5.2%) out of 19 strains belonged to the Pseudomonadaceae family. The other twenty-three strains did not show inhibitory activities. Conclusions: Our research showed a high-level phylogenetic diversity and the intoxicating antibiotic activity of endophytic bacteria in the herb pharmacology of Iran.

Keywords: medical plant, endophytic bacteria, antimicrobial activity, whole genome sequencing analysis

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Authors: Shilpa Balan

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Radio Frequency Identification, also popularly known as RFID is used to automatically identify and track tags attached to items. This study focuses on the application of RFID in healthcare. The adoption of RFID in healthcare is a crucial technology to patient safety and inventory management. Data from RFID tags are used to identify the locations of patients and inventory in real time. Medical errors are thought to be a prominent cause of loss of life and injury. The major advantage of RFID application in healthcare industry is the reduction of medical errors. The healthcare industry has generated huge amounts of data. By discovering patterns and trends within the data, big data analytics can help improve patient care and lower healthcare costs. The number of increasing research publications leading to innovations in RFID applications shows the importance of this technology. This study explores the current state of research of RFID in healthcare using a text mining approach. No study has been performed yet on examining the current state of RFID research in healthcare using a data mining approach. In this study, related articles were collected on RFID from healthcare journal and news articles. Articles collected were from the year 2000 to 2015. Significant keywords on the topic of focus are identified and analyzed using open source data analytics software such as Rapid Miner. These analytical tools help extract pertinent information from massive volumes of data. It is seen that the main benefits of adopting RFID technology in healthcare include tracking medicines and equipment, upholding patient safety, and security improvement. The real-time tracking features of RFID allows for enhanced supply chain management. By productively using big data, healthcare organizations can gain significant benefits. Big data analytics in healthcare enables improved decisions by extracting insights from large volumes of data.

Keywords: RFID, data mining, data analysis, healthcare

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Authors: Razvan Mercut, Mihaela Ionescu, Vlad Parvanescu, Razvan Ghita, Tudor-Gabriel Caragea, Cristina Simionescu, Marius-Eugen Ciurea

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Introduction: Over the past years, the incidence of non-melanoma skin cancer (NMSC) has continuously increased, being one of the most commonly diagnosed carcinomasofthe cephalic extremity. NMSC regroups basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Merkel cell carcinoma, cutaneous lymphoma, and sarcoma. The most common forms are BCC and SCC, both still implying a significant level of morbidity due to local invasion (especially BCC), even if the overall death rates are declining. The objective of our study was the evaluation of clinical and histological aspects of NMSC for a group of patients with BCC and SCC, from Craiova, a south-western major city in Romania. Materialand method: Our study lot comprised 65 patients, with an almost equal distribution of sexes, and ages between 23-91 years old (mean value±standard deviation62.61±16.67), all treated within the Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency County Hospital Craiova, Romania, between 2019-2020. In order to determine the main morphological characteristics of both studied cancers, we used paraffin embedding techniques, with various staining methods:hematoxylin-eosin, Masson's trichrome stain with aniline blue, and Periodic acid-schiffAlcian Blue. The statistical study was completed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA), with XLSTAT (Addinsoft SARL, Paris, France). Results: The overall results of our study indicate that BCC accounts for 67.69% of all NMSC forms; SCC covers 27.69%, while 4.62% are representedby other forms. The most frequent site is the nose for BCC (27.69%, 18 patients), being followed by preauricular regions, forehead, and periorbital areas. For patients with SCC, tumors were mainly located at lips level (66.67%, 12 patients). The analysis of NMSC histological forms indicated that nodular BCC is predominant (45.45%, 20 patients), as well as ulcero-vegetant SCC (38.89%, 7 patients). We have not identified any topographic characteristics or NMSC forms significantly related to age or sex. Conclusions: The most frequent NMSC form identified for our study lot was BCC. The preferred location was the nose for BCC. For SCC, the oral cavity is the most frequent anatomical site, especially the lips level. Nodular BCC and ulcero-vegetant SCC were the most commonly identified histological types. Our findings emphasize the need for periodic screening, in order to improve prevention and early treatment for these malignancies.

Keywords: non-melanoma skin cancer, basal cell carcinoma, squamous cell carcinoma, histological

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Authors: David Lynch, Jake Madden

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There exists a body of literature that reports on the many benefits of partnerships between universities and schools, especially in terms of teaching improvement and school reform. This is because such partnerships can build significant teaching capital, by deepening and expanding the skillsets and mindsets needed to create the connections that support ongoing and embedded teacher professional development and career goals. At the same time, this literature is critical of such initiatives when the partnership outcomes are short- term or one-sided, misaligned to fundamental problems, and not expressly focused on building the desired teaching capabilities. In response to this situation, research conducted by Professor David Lynch and his TeachLab research team, has begun to shed light on the strengths and limitations of school/university partnerships, via the identification of key conceptual elements that appear to act as critical partnership success factors. These elements are theorised as an inter-play between professional knowledge acquisition, readiness, talent management and organisational structure. However, knowledge of how these elements are established, and how they manifest within the school and its teaching workforce as an overall system, remains incomplete. Therefore, research designed to more clearly delineate these elements in relation to their impact on school/university partnerships is thus required. It is within this context that this paper reports on the development and testing of a Professional Learning (PL) model for schools and their teachers that incorporates school-university research partnering within a systematic, whole-of-school PL strategy that is underpinned and structured by a micro-credentialing (MC) regime. MC involves learning a narrow-focused certificate (a micro-credential) in a specific topic area (e.g., 'How to Differentiate Instruction for English as a second language Students') and embedded in the teacher’s day-to-day teaching work. The use of MC is viewed as important to the efficacy and sustainability of teacher PL because it (1) provides an evidence-based framework for teacher learning, (2) has the ability to promote teacher social capital and (3) engender lifelong learning in keeping professional skills current in an embedded and seamless to work manner. The associated research is centred on a primary school in Australia (P-6) that acted as an arena to co-develop, test/investigate and report on outcomes for teacher PL that uses MC to support a whole-of-school partnership with a university.

Keywords: teaching improvement, teacher professional learning, talent management, education partnerships, school-university research

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Authors: Aparajita Bhattacharya, Mousumi Dutta, Zakir Husain, Dionne Sequeira, Asima Mukhopadhyay

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Background: Tata Medical Centre (TMC), Kolkata is a major cancer referral centre in Eastern India and neighbouring countries providing state of the art facilities; however, it is a non-profit organisation with patients requiring to pay at subsidised rates. Although a system for social assessment and applying for governmental/ non-governmental (NGO) funds is in place, access is challenging. Amongst gynaecological cancers (GC), ovarian cancer (OC) is associated with the highest treatment cost; majority of which is required at the beginning when complex surgery is performed and funding arrangements cannot be made in time. We therefore appointed a dedicated Medical Social Worker (MSW) in 2016, supported by NGO for GC patients in order to assist patients/family members to access/avail these funds more readily and assist in economic evaluation for both direct and opportunity costs. Objectives: To reflect on our experience and challenges in collecting data on economic evaluation of cancer patients and compare success rates in achieving fund mobilization after introduction of MSW. Methods: A Retrospective survey. Patients with OC and their relatives were seen by the MSW during the initial outpatients department visit and followed though till discharge from the hospital and during follow-up visits. Assistance was provided in preparing the essential documents/paperwork/contacts for the funding agencies including both governmental (Chief-Minister/Prime-Minister/President) and NGO sources. In addition, a detailed questionnaire was filled up for economic assessment of direct/opportunity costs during the entire treatment and 12 months follow up period which forms a part of the study called HEPTROC (Health economic evaluation of primary treatment for ovarian cancer) developed in collaboration with economics departments of Universities. Results: In 2015, 102 patients were operated for OC; only 16 patients (15.68 %) had availed funding of a total sum of INR 1640000 through the hospital system for social assessment. Following challenges were faced by majority of the relatives: 1. Gathering important documents/proper contact details for governmental funding bodies and difficulty in following up the current status 3. Late arrival of funds. In contrast in 2016, 104 OC patients underwent surgery; the direct cost of treatment was significantly higher (median, INR 300000- 400000) compared to other GCs (n=274). 98/104 (94.23%) OC patients could be helped to apply for funds and 90/104(86.56%) patients received funding amounting to a total of INR 10897000. There has been a tenfold increase in funds mobilized in 2016 after the introduction of dedicated MSW in GC. So far, in 2017 (till June), 46/54(85.18%) OC patients applied for funds and 37/54(68.51%) patients have received funding. In a qualitative survey, all patients appreciated the role of the MSW who subsequently became the key worker for patient follow up and the chief portal for patient reported outcome monitoring. Data collection quality for the HEPTROC study was improved when questionnaires were administered by the MSW compared to researchers. Conclusion: Introduction of cancer specific MSW can expedite the availability of funds required for cancer patients and it can positively impact on patient satisfaction and outcome reporting. The economic assessment will influence fund allocation and decision for policymaking in ovarian cancer. Acknowledgement: Jivdaya Foundation Dallas, Texas.

Keywords: economic evaluation, funding, medical social worker, ovarian cancer

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Authors: Yaou Zhang

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Background: Relatively little scholarly attention has been paid to the production of Benjamin Britten’s chamber opera The Turn of the Screw. As one of Britten’s most remarkable operas. The story of the libretto was from Henry James’s novella of the same name. The novella was created in 1898 and one of the primary questions addressed to people in the story is “how real the ghosts are,” which leads the story to a huge ambiguity in readers’ minds. Aims: This research focuses on the experience of seeing the opera on stage over several decades. This study of opera productions over time not only provides insight into how stage performances can alter audience members' perceptions of the opera in the present but also reveals a landscape of shifting aesthetics and receptions. Methods: To examine the hypotheses in interpretation and reception, the qualitative analysis is used to examine the figures of ghosts in different productions across the time from 1954 to 2021 in the UK: by accessing recordings, newspapers, and reviews for the productions that are sourced from online and physical archives. For instance, the field research is conducted on the topic by arranging interviews with the creative team and visiting Opera North in Leeds and Britten-Pears Foundation. The collected data reveals the “hidden identity” in creative teams’ interpretations, social preferences, and rediscover that have previously remained unseen. Results: This research presents an angle of Britten’s Screw by using the third position; it shows how the attention moved from the stage of “do the ghosts really exist” to “traumatised children.” Discussion: Critics and audiences have debated whether the governess hallucinates the ghosts in the opera for decades. While, in recent years, directors of new productions have given themselves the opportunity to go deeper into Britten's musical structure and offer the opera more space to be interpreted, rather than debating if "ghosts actually exist" or "the psychological problems of the governess." One can consider and reflect that the questionable actions of the children are because they are suffering from trauma, whether the trauma comes from the ghosts, the hallucinating governess, or some prior experiences: various interpretations cause one result that children are the recipients of trauma. Arguably, the role of the supernatural is neither simply one of the elements of a ghost story nor simply one of the parts of the ambiguity between the supernatural and the hallucination of the governess; rather, the ghosts and the hallucinating governess can exist at the same time - the combination of the supernatural’s and the governess’s behaviours on stage generates a sharper and more serious angle that draws our attention to the traumatized children.

Keywords: benjamin britten, chamber opera, production, reception, staging, the turn of the screw

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Authors: Tamar Arieli

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Cross-border cooperation has long been hailed as a means for stabilizing and normalizing relations between former enemies. Cooperation in problem-solving and realizing of local interests in post-conflict environments can indeed serve as a basis for developing dialogue and meaningful relations between neighbors across borders. Hence the potential for formerly sealed borders to serve as a basis for generating local and national perceptions of interdependence and as a buffer against the resume of conflict. Central questions which arise for policy-makers and third parties are how to facilitate cross-border cooperation and which areas of cooperation best serve to normalize post-conflict border regions. The Israel-Jordan border functions as a post-conflict border, in that it is a peaceful border since the 1994 Israel-Jordan peace treaty yet cross-border relations are defined but the highly securitized nature of the border region and the ongoing Arab-Israel regional conflict. This case study is based on long term qualitative research carried out in the border regions of both Israel and Jordan, which mapped and analyzed cross-border in a wide range of activities – social interactions sponsored by peace-facilitating NGOs, government sponsored agricultural cooperation, municipal initiated emergency planning in cross-border continuous urban settings, private cross-border business ventures and various environmental cooperative initiatives. These cooperative initiatives are evaluated through multiple interviews carried out with initiators and partners in cross-border cooperation as well as analysis of documentation, funding and media. These cooperative interactions are compared based on levels of cross-border local and official awareness and involvement as well as sustainability over time. This research identifies environmental cooperation as the most sustainable area of cross- border cooperation and as most conducive to generating perceptions of regional interdependence. This is a variation to the ‘New Middle East’ vision of business-based cooperation leading to conflict amelioration and regional stability. Environmental cooperation serving the public good rather than personal profit enjoys social legitimization even in the face of widespread anti-normalization sentiments common in the post-conflict environment. This insight is examined in light of philosophical and social aspects of the natural environment and its social perceptions. This research has theoretical implications for better understanding dynamics of cooperation and conflict, as well as practical ramifications for practitioners in border region policy and management.

Keywords: borders, cooperation, post-conflict, security

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Authors: Shantala Herlekar

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Introduction: Entrainment effect of music on cardiovascular parameters is well established. Music is being used in the background by medical students while studying. However, does it really help them relax faster and concentrate better? Objectives: This study was done to compare the effects of classical instrumental background music versus no music on blood pressure response over time and on successively performed divided attention test in Indian and Malaysian 1st-year medical students. Method: 60 Indian and 60 Malaysian first year medical students, with an equal number of girls and boys were randomized into two groups i.e music group and control group thus creating four subgroups. Three different forms of Symbol Digit Modality Test (to test concentration ability) were used as a pre-test, during music/control session and post-test. It was assessed using total, correct and error score. Simultaneously, multiple Blood Pressure recordings were taken as pre-test, during 1, 5, 15, 25 minutes during music/control (+SDMT) and post-test. The music group performed the test with classical instrumental background music while the control group performed it in silence. Results were analyzed using students paired t test. p value < 0.05 was taken as statistically significant. A drop in BP recording was indicative of relaxed state and a rise in BP with task performance was indicative of increased arousal. Results: In Symbol Digit Modality Test (SDMT) test, Music group showed significant better results for correct (p = 0.02) and total (p = 0.029) scores during post-test while errors reduced (p = 0.002). Indian music group showed decline in post-test error scores (p = 0.002). Malaysian music group performed significantly better in all categories. Blood pressure response was similar in music and control group with following variations, a drop in BP at 5minutes, being significant in music group (p < 0.001), a steep rise in values till 15minutes (corresponding to SDMT test) also being significant only in music group (p < 0.001) and the Systolic BP readings in controls during post-test were at lower levels compared to music group. On comparing the subgroups, not much difference was noticed in recordings of Indian student’s subgroups while all the paired-t test values in the Malaysian music group were significant. Conclusion: These recordings indicate an increased relaxed state with classical instrumental music and an increased arousal while performing a concentration task. Music used in our study was beneficial to students irrespective of their nationality and preference of music type. It can act as an “active coping” strategy and alleviate stress within a very short period of time, in our study within a span of 5minutes. When used in the background, during task performance, can increase arousal which helps the students perform better. Implications: Music can be used between lectures for a short time to relax the students and help them concentrate better for the subsequent classes, especially for late afternoon sessions.

Keywords: blood pressure, classical instrumental background music, ethnicity, symbol digit modality test

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Authors: Shanza Akram, Sameen Toor, Heba Harb Abu Alkass, Zainab Abdulsalam Altaha, Sara Taha Abdulla, Saleem Imran

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Acute pulmonary embolism (PE) is a common disease and can be fatal. The clinical presentation is variable and nonspecific, making accurate diagnosis difficult. Testing patients with suspected acute PE has increased dramatically. However, the overuse of some tests, particularly CT and D-dimer measurement, may not improve care while potentially leading to patient harm and unnecessary expense. CTPA is the investigation of choice for PE. Its easy availability, accuracy and ability to provide alternative diagnosis has lowered the threshold for performing it, resulting in its overuse. Guidelines have recommended the use of clinical pretest probability tools such as ‘Wells score’ to assess risk of suspected PE. Unfortunately, implementation of guidelines in clinical practice is inconsistent. This has led to low risk patients being subjected to unnecessary imaging, exposure to radiation and possible contrast related complications. Aim: To study the diagnostic yield of CT PA, clinical pretest probability of patients according to wells score and to determine whether or not there was an overuse of CTPA in our service. Methods: CT scans done on patients with suspected P.E in our hospital from 1st January 2014 to 31st December 2014 were retrospectively reviewed. Medical records were reviewed to study demographics, clinical presentation, final diagnosis, and to establish if Wells score and D-Dimer were used correctly in predicting the probability of PE and the need for subsequent CTPA. Results: 100 patients (51male) underwent CT PA in the time period. Mean age was 57 years (24-91 years). Majority of patients presented with shortness of breath (52%). Other presenting symptoms included chest pain 34%, palpitations 6%, collapse 5% and haemoptysis 5%. D Dimer test was done in 69%. Overall Wells score was low (<2) in 28 %, moderate (>2 - < 6) in 47% and high (> 6) in 15% of patients. Wells score was documented in medical notes of only 20% patients. PE was confirmed in 12% (8 male) patients. 4 had bilateral PE’s. In high-risk group (Wells > 6) (n=15), there were 5 diagnosed PEs. In moderate risk group (Wells >2 - < 6) (n=47), there were 6 and in low risk group (Wells <2) (n=28), one case of PE was confirmed. CT scans negative for PE showed pleural effusion in 30, Consolidation in 20, atelactasis in 15 and pulmonary nodule in 4 patients. 31 scans were completely normal. Conclusion: Yield of CT for pulmonary embolism was low in our cohort at 12%. A significant number of our patients who underwent CT PA had low Wells score. This suggests that CT PA is over utilized in our institution. Wells score was poorly documented in medical notes. CT-PA was able to detect alternative pulmonary abnormalities explaining the patient's clinical presentation. CT-PA requires concomitant pretest clinical probability assessment to be an effective diagnostic tool for confirming or excluding PE. . Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being considered. Combining Wells scores with clinical and laboratory assessment may reduce the need for CTPA.

Keywords: CT PA, D dimer, pulmonary embolism, wells score

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Authors: Y. Teterin, S. Suleymanova, I. Dmitriev, P. Yartcev

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Introduction: One of the most common complications after pancreas transplantation are pancreatic fluid collections (PFCs), which are often complicated not only by infection and subsequent disfunction of the pancreatoduodenal graft (PDG), but also with a rather high mortality rate of recipients. Drainage is not always effective and often requires repeated open surgical interventions, which worsens the outcome of the surgery. Percutaneous drainage of PFCs combined with endoscopic stenting of the main pancreatic duct of the pancreatoduodenal graft (MPDPDG) showed high efficiency in the treatment of PFCs. Aims & Methods: From 01.01.2012 to 31.12.2021 at the Sklifosovsky Research Institute for Emergency Medicine were performed 64 transplantations of PDG. In 11 cases (17.2%), the early postoperative period was complicated by the formation of PFCs. Of these, 7 patients underwent percutaneous drainage of pancreonecrosis with high efficiency and did not required additional methods of treatment. In the remaining 4 patients, drainage was ineffective and was an indication for endoscopic stenting of the MPDPDG. They were the ones who made up the study group. Among them were 3 men and 1 woman. The mean age of the patients was 36,4 years.PFCs in these patients formed on days 1, 12, 18, and 47 after PDG transplantation. We used a gastroscope to stent the MPDPDG, due to anatomical features of the location of the duodenoduodenal anastomosis after PDG transplantation. Through the endoscope channel was performed selective catheterization of the MPDPDG, using a catheter and a guidewire, followed by its contrasting with a water-soluble contrast agent. Due to the extravasation of the contrast, was determined the localization of the defect in the PDG duct system. After that, a plastic pancreatic stent with a diameter of 7 Fr. and a length of 7 cm. was installed along guidewire. The stent was installed in such a way that its proximal edge completely covered the defect zone, and the distal one was determined in the intestinal lumen. Results: In all patients PDG pancreaticography revealed extravasation of a contrast in the area of the isthmus and body of the pancreas, which required stenting of the MPDPDG. In 1 (25%) case, the patient had a dislocation of the stent into the intestinal lumen (III degree according to Clavien-Dindo (2009)). This patient underwent repeated endoscopic stenting of the MPDPDG. On average 23 days after endoscopic stenting of the MPDPDG, the drainage tubes were removed and after approximately 40 days all patients were discharged in a satisfactory condition with follow-up endocrinologist and surgeon consultation. Pancreatic stents were removed after 6 months ± 7 days. Conclusion: Endoscopic stenting of the main pancreatic duct of the donor pancreas is by far the most highly effective and minimally invasive method in the treatment of PFCs after transplantation of the pancreatoduodenal complex.

Keywords: pancreas transplantation, endoscopy surgery, diabetes, stenting, main pancreatic duct

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Authors: Preethy Mary Donald, Renjith George

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Oral tori are localized non-neoplastic protuberances of maxilla and mandible. Torus palatinus (TP) is found on the midline of the roof of mouth existing as single growth or in clusters. Torus mandibularis(TM) is located on the lingual aspect of the mandible commonly between canine and premolar region. Etiology of their presence was not clear and was found to be multifactorial. Their variations in relation to age, gender, ethnicity and also the characteristics of TP and TM have become the interest of multiple studies. The objectives of this study were to determine the prevalence of torus palatinus (TP) and torus mandibularis (TM) among patients who have visited outpatient department, Faculty of Dentistry, Melaka Manipal Medical College. 108 patients were examined for the presence of oral tori at the outpatient department, Faculty of Dentistry, Melaka-Manipal Medical College. Factors such as age, gender, ethnicity of the patients and size, shape, location of the oral tori were studied. For TP, Malays (62.96%) have been found to have the highest prevalence than Chinese (43.3%) and Indians (35.71%). For TM, Chinese (7.46%) had predominated compared to Malays (7.41%) and Indians (0%). There is no significant association between occurrence of TP and TM with age, gender and ethnicity. For Torus palatinus, the most common size was Grade 1(1-3mm), most common location was molar region, and the most common shape was spindle. For Torus mandibularis, the most frequent location was canine premolar region and exists in unilateral single or bilateral single fashion. The overall prevalence rates were 47.2% for TP and 6.48% for TM. However, there is no significant association between occurrence of TP and TM with age, gender and ethnicity. The results showed variations in clinical characteristics and support the findings that occurrence of tori is a dynamic phenomenon which is multifactorial owing to the environmental factors such as stress from occlusion and dietary habits. It could be due to the genetic make-up of the individual.

Keywords: torus palatinus, torus mandibularis, age, gender

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