Search results for: clinical codes

Authors: M. Abuziarov

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The designed complex is intended for the numerical simulation of fast dynamic processes of interaction of heterogeneous environments susceptible to the significant formability. The main challenges in solving such problems are associated with the construction of the numerical meshes. Currently, there are two basic approaches to solve this problem. One is using of Lagrangian or Lagrangian Eulerian grid associated with the boundaries of media and the second is associated with the fixed Eulerian mesh, boundary cells of which cut boundaries of the environment medium and requires the calculation of these cut volumes. Both approaches require the complex grid generators and significant time for preparing the code’s data for simulation. In this codes these problems are solved using two grids, regular fixed and mobile local Euler Lagrange - Eulerian (ALE approach) accompanying the contact and free boundaries, the surfaces of shock waves and phase transitions, and other possible features of solutions, with mutual interpolation of integrated parameters. For modeling of both liquids and gases, and deformable solids the Godunov scheme of increased accuracy is used in Lagrangian - Eulerian variables, the same for the Euler equations and for the Euler- Cauchy, describing the deformation of the solid. The increased accuracy of the scheme is achieved by using 3D spatial time dependent solution of the discontinuity problem (3D space time dependent Riemann's Problem solver). The same solution is used to calculate the interaction at the liquid-solid surface (Fluid Structure Interaction problem). The codes does not require complex 3D mesh generators, only the surfaces of the calculating objects as the STL files created by means of engineering graphics are given by the user, which greatly simplifies the preparing the task and makes it convenient to use directly by the designer at the design stage. The results of the test solutions and applications related to the generation and extension of the detonation and shock waves, loading the constructions are presented.

Keywords: fluid structure interaction, Riemann's solver, Euler variables, 3D codes

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Authors: Abeer Alhazmi

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Introduction: Clinical education is considered a significant part of the learning process for nurses and nursing students. However, recruiting high- caliber individuals to train them to be tomorrow’s educators/teachers has been a recurrent challenge. One of the troubling challenges in this field is the absent of proper training programmes to train educators to be future education professionals and leaders. Aim: To explore the impact of a stage 1 and stage 2 clinical instructor courses on developing leadership skills for nurses as educators.Theoretical Framework: Informed by a symbolic interactionist framework, this research explored the Impact of stage 1 and stage 2 clinical instructor courses on nurses' knowledge, attitudes, and leadership skills. Method: Using Glaserian grounded theory method the data were derived from 3 focus groups and 15 in-depth interviews with nurse educators/clinical instructors and nurses who attended stage 1 and stage 2 clinical instructor courses at King Abdu-Aziz University Hospital (KAUH). Findings: The findings of the research are represented in the core category exploring new identity as educator and its two constituent categories Accepting change, and constructing educator identity. The core and sub- categories were generated through a theoretical exploration of the development of educator’s identity throughout stage 1 and stage 2 clinical instructor courses. Conclusion: The social identity of the nurse educators was developed and changed during and after attending stage 1 and stage 2 clinical instructor courses. In light of an increased understanding of the development process of educators identity and role, the research presents implications and recommendations that may contribute to the development of nursing educators in general and in Saudi Arabia in specific.

Keywords: clinical instructor course, educators, identity work, clinical nursing

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Authors: Dries Dulsster

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This research we want to discuss the implications of the concept of ‘lalangue’ and illustrate its importance for lacanian psychoanalysis and its clinical practice. We will look at this concept through an in depth reading of Lacan’s later seminars, his lectures at the North-American universities and his study on James Joyce. We will illustrate the importance of this concept with a case study from a clinical practice. We will argue that the introduction of ‘lalangue’ has several theoretical and clinical implications that will radically change Lacans teachings. We will illustrate the distinction between language and lalangue. Language serves communication, but this is not the case with lalangue. We will claim that there is jouissance in language and will approach this by introducing the concept of ‘lalangue’. We will ask ourselves what the effect will be of this distinction and how we can use this in clinical practice. The concept of ‘lalangue’ will introduce a new way of thinking about the unconscious. It will force us to no longer view the unconscious as Symbolic, but as Imaginary or Real. Another implication will be the approach on the symptom, no longer approaching it as a formation of the unconscious. It will be renamed as ‘sinthome’, as function of the real. Last of all it will force us to rethink the lacanian interpretation and how we direct the treatment. The implications on a clinical level will be how we think about the lacanian interpretation and the direction of the treatment. We will no longer focus on language and meaning, but focus on jouissance and the ways in which the subject deals with this. We will illustrate this importance with a clinical case study. To summarize, the concept of lalangue forces us to radically rethink lacanian psychoanalysis, with major implications on a theoretical and clinical level. It introduces new concepts such as the real unconscious and the sinthome. It will also make us rethink the way we work as lacanian psychoanalysts.

Keywords: Lacan's later teaching, language, Lalangue, the unconscious

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Authors: F. Abdelhamid

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Algeria is a multilingual speech community where individuals constantly mix between codes in spoken discourse. Code is used as a cover term to refer to the existing languages and language varieties which include, among others, the mother tongue of the majority Algerian Arabic, the official language Modern Standard Arabic and the foreign languages French and English. The present study explores whether Algerians mix between these codes in online communication as well. Facebook is the selected platform from which data is collected because it is the preferred social media site for most Algerians and it is the most used one. Adopting the notion of translanguaging, this study attempts explaining how users of Facebook use multilingual messages to communicate meaning. Accordingly, multilingual interactions are not approached from a pejorative perspective but rather as a creative linguistic behavior that multilingual utilize to achieve intended meanings. The study is intended as a contribution to the research on multilingualism online because although an extensive literature has investigated multilingualism in spoken discourse, limited research investigated it in the online one. Its aim is two-fold. First, it aims at ensuring that the selected platform for analysis, namely Facebook, could be a source for multilingual data to enable the qualitative analysis. This is done by measuring frequency rates of multilingual instances. Second, when enough multilingual instances are encountered, it aims at describing and interpreting some selected ones. 120 posts and 16335 comments were collected from two Facebook pages. Analysis revealed that third of the collected data are multilingual messages. Users of Facebook mixed between the four mentioned codes in writing their messages. The most frequent cases are mixing between Algerian Arabic and French and between Algerian Arabic and Modern Standard Arabic. A focused qualitative analysis followed where some examples are interpreted and explained. It seems that Algerians mix between codes when communicating online despite the fact that it is a conscious type of communication. This suggests that such behavior is not a random and corrupted way of communicating but rather an intentional and natural one.

Keywords: Algerian speech community, computer mediated communication, languages in contact, multilingualism, translanguaging

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Authors: Susan Ka Yee Chow

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Effective clinical preceptorship is affecting students’ competence and fostering their growth in applying theoretical knowledge and skills in clinical settings. Any difference between the expected and actual learning experience will reduce nursing students’ interest in clinical practices and having a negative consequence with their clinical performance. This cross-sectional study is an attempt to compare the differences between preferred and actual preceptorship experience of final year nursing students, and to examine the relationship between the actual preceptorship experience and perceived clinical competence of the students in a tertiary institution. Participants of the study were final year bachelor nursing students of a self-financing tertiary institution in Hong Kong. The instruments used to measure the effectiveness of clinical preceptorship was developed by the participating institution. The scale consisted of five items in a 5-point likert scale. The questions including goals development, critical thinking, learning objectives, asking questions and providing feedback to students. The “Clinical Competence Questionnaire” by Liou & Cheng (2014) was used to examine students’ perceived clinical competences. The scale consisted of 47 items categorized into four domains, namely nursing professional behaviours; skill competence: general performance; skill competence: core nursing skills and skill competence: advanced nursing skills. There were 193 questionnaires returned with a response rate of 89%. The paired t-test was used to compare the differences between preferred and actual preceptorship experiences of students. The results showed significant differences (p<0.001) for the five questions. The mean for the preferred scores is higher than the actual scores resulting statistically significance. The maximum mean difference was accepted goal and the highest mean different was giving feedback. The Pearson Correlation Coefficient was used to examine the relationship. The results showed moderate correlations between nursing professional behaviours with asking questions and providing feedback. Providing useful feedback to students is having moderate correlations with all domains of the Clinical Competence Questionnaire (r=0.269 – 0.345). It is concluded that nursing students do not have a positive perception of the clinical preceptorship. Their perceptions are significantly different from their expected preceptorship. If students were given more opportunities to ask questions in a pedagogical atmosphere, their perceived clinical competence and learning outcomes could be improved as a result.

Keywords: clinical preceptor, clinical competence, clinical practicum, nursing students

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Authors: Phang Moon Leng

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Automated Early Warning Scores is a newly developed clinical decision tool that is used to streamline and improve the process of obtaining a patient’s vital signs so a clinical decision can be made at an earlier stage to prevent the patient from further deterioration. This technology provides immediate update on the score and clinical decision to be taken based on the outcome. This paper aims to study the use of an automated early warning score system on whether the technology has assisted the hospital in early detection and escalation of clinical condition and improve patient outcome. The hospital adopted the Modified Early Warning Scores (MEWS) Scoring System and MEWS Clinical Response into Philips IntelliVue Guardian Automated Early Warning Score equipment and studied whether the process has been leaned, whether the use of technology improved the usage & experience of the nurses, and whether the technology has improved patient care and outcome. It was found the steps required to obtain vital signs has been significantly reduced and is used more frequently to obtain patient vital signs. The number of deaths, and length of stay has significantly decreased as clinical decisions can be made and escalated more quickly with the Automated EWS. The automated early warning score equipment has helped improve work efficiency by removing the need for documenting into patient’s EMR. The technology streamlines clinical decision-making and allows faster care and intervention to be carried out and improves overall patient outcome which translates to better care for patient.

Keywords: automated early warning score, clinical quality and safety, patient safety, medical technology

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Authors: Sukanta K. Shill, Md. M. Hoque, Md. Shaifullah

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An experiment on the punching of RC column footing, comparison of test result to established different codes for punching shear calculation of column footings is presented in the paper. The principal aim of this study is to investigate the punching shear behavior of an isolated column footing using brick aggregate as coarse aggregate. Consequence, a RC model footing was constructed on a stabilized soil and tested the footing under field condition. The test result yields that the experimental punching shear capacity is greater than all the theoretical punching shear capacities obtained by using different codes of practices. It can be stated that BNBC 1993, as well as ACI 318, 2002 code formulae are very conservative in predicting the punching shear resistance of RC footing, whereas the CEB-FIP MC, 1990 formula and Eurocode2 formula are less conservative in predicting the punching shear resistance of footing.

Keywords: footing, punching shear, field condition, stabilized soil, brick aggregate

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Authors: Zohra Benfodda, Valentin Duvauchelle, Chaimae Majdi, David Bénimélis, Catherine Dunyach-Remy, Patrick Meffre

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New antibiotics are necessary to treat microbial pathogens, especially ESKAPE pathogens that are becoming increasingly resistant to available treatment. Despite the medical need, the number of newly approved drugs continues to decline. The majority of antibiotics under clinical development are natural products or derivatives thereof. 43 juglone/naphthazarin derivatives were synthesized using Minisci-type direct C–H alkylation and evaluated for their antibacterial properties against various clinical and reference Gram-positive MSSA, clinical Gram-positive MRSA. Different compounds of the synthesized series showed promising activity against clinical and reference MSSA (MIC: 1–8 μg/ml) and good efficacy against clinical MRSA (MIC: 2–8 μg/ml) strains. The synergistic effects of active compounds were evaluated with reference antibiotics (vancomycin and cloxacillin), and it was found that the antibiotic combination with those active compounds efficiently enhanced the antimicrobial activity and consequently the MIC values of reference antibiotics were lowered up to 1/16th of the original MIC. These synthesized compounds did not present hemolytic activity on sheep red blood cells. In addition to the in silico prediction of ADME profile parameter which is promising and encouraging for further development.

Keywords: juglone, naphthazarin, antibacterial, clinical MRSA, synergistic studies, MIC determination

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Authors: Abdelhammid Chibane

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This study summarizes state-of-the-art knowledge in the seismic response of vertically irregular building frames. Criteria defining vertical irregularity as per the current building codes have been discussed. A review of studies on the seismic behaviour of vertically irregular structures along with their findings has been presented. It is observed that building codes provide criteria to classify the vertically irregular structures and suggest dynamic analysis to arrive at design lateral forces. Most of the studies agree on the increase in drift demand in the tower portion of set-back structures and on the increase in seismic demand for buildings with discontinuous distributions in mass, stiffness, and strength. The largest seismic demand is found for the combined-stiffness-and-strength irregularity.

Keywords: mass irregularity, set-back structure, stiffness irregularity, strength irregularity, vertical irregularity

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Authors: Hussein Yousif Aziz

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This paper discussed the design and analysis of bridge foundation subjected to load of train with three codes, namely AASHTO code, British Standard BS Code 8004 (1986), and Chinese code (TB10002.5-2005).The study focused on the design and analysis of bridge’s foundation manually with the three codes and found which code is better for design and controls the problem of high settlement due to the applied loads. The results showed the Chinese codes are costly that the number of reinforcement bars in the pile cap and piles is more than those with AASHTO code and BS code with the same dimensions. Settlement of the bridge was calculated depending on the data collected from the project site. The vertical ultimate bearing capacity of single pile for three codes is also discussed. Other analyses by using the two-dimensional Plaxis program and other programs like SAP2000 14, PROKON many parameters are calculated. The maximum values of the vertical displacement are close to the calculated ones. The results indicate that the AASHTO code is economics and safer in the bearing capacity of single pile. The purpose of this project is to study out the pier on the basis of the design of the pile foundation. There is a 32m simply supported beam of box section on top of the structure. The pier of bridge is round-type. The main component of the design is to calculate pile foundation and the settlement. According to the related data, we choose 1.0m in diameter bored pile of 48m. The pile is laid out in the rectangular pile cap. The dimension of the cap is 12m 9 m. Because of the interaction factors of pile groups, the load-bearing capacity of simple pile must be checked, the punching resistance of pile cap, the shearing strength of pile cap, and the part in bending of pile cap, all of them are very important to the structure stability. Also, checking soft sub-bearing capacity is necessary under the pile foundation. This project provides a deeper analysis and comparison about pile foundation design schemes. Firstly, here are brief instructions of the construction situation about the Bridge. With the actual construction geological features and the upper load on the Bridge, this paper analyzes the bearing capacity and settlement of single pile. In the paper the Equivalent Pier Method is used to calculate and analyze settlements of the piles.

Keywords: pile foundation, settlement, bearing capacity, civil engineering

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Authors: Jacob Nortey

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Introduction: In recent years, there has been an enormous success in discoveries of scientific knowledge in medicine coupled with the advancement of technology. Despite all these successes, diagnoses and treatment of diseases have become complex. According to the Ibero – American Study of Adverse Effects (IBEAS), about 10% of hospital patients suffer from secondary damage during the care process, and approximately 2% die from this process. Many clinical decision support systems have been developed to help mitigate some healthcare medical errors. Method: Relevant databases were searched, including ones that were peculiar to the clinical decision support system (that is, using google scholar, Pub Med and general google searches). The articles were then screened for a comprehensive overview of the functionality, consultative style and statistical usage of Dxplain Clinical decision support systems. Results: Inferences drawn from the articles showed high usage of Dxplain clinical decision support system for problem-based learning among students in developed countries as against little or no usage among students in Low – and Middle – income Countries. The results also indicated high usage among general practitioners. Conclusion: Despite the challenges Dxplain presents, the benefits of its usage to clinicians and students are enormous.

Keywords: dxplain, clinical decision support sytem, diagnosis, support systems

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Authors: Roy Y. C. Huang, J. S. Kuang, Hamdolah Behnam

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Beam-column connections play an important role in the reinforced concrete moment resisting frame (RCMRF), which is one of the most commonly used structural systems around the world. The premature failure of such connections would severely limit the seismic performance and increase the vulnerability of RCMRF. In the past decades, researchers primarily focused on investigating the structural behaviour and failure mechanisms of conventional beam-column joints, the beam width of which is either smaller than or equal to the column width, while studies in wide beam-column joints were scarce. This paper presents the preliminary experimental results of two full-scale exterior wide beam-column connections, which are mainly designed and detailed according to ACI 318-14 and ACI 352R-02, under reversed cyclic loading. The ratios of the design shear force to the nominal shear strength of these specimens are 1.0 and 1.7, respectively, so as to probe into differences of the joint shear strength between experimental results and predictions by design codes of practice. Flexural failure dominated in the specimen with ratio of 1.0 in which full-width plastic hinges were observed, while both beam hinges and post-peak joint shear failure occurred for the other specimen. No sign of premature joint shear failure was found which is inconsistent with ACI codes’ prediction. Finally, a modification of current codes of practice is provided to accurately predict the joint shear strength in wide beam-column joint.

Keywords: joint shear strength, reversed cyclic loading, seismic vulnerability, wide beam-column joints

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Authors: David Pettitt, Benjamin Davies, Georg Holländer, David Brindley

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Cellular based therapies, whose origins can be traced from the intertwined concepts of tissue engineering and regenerative medicine, have the potential to transform the current medical landscape and offer an approach to managing what were once considered untreatable diseases. However, despite a large increase in basic science activity in the cell therapy arena alongside a growing portfolio of cell therapy trials, the number of industry products available for widespread clinical use correlates poorly with such a magnitude of activity, with the number of cell-based therapeutics in mainstream use remaining comparatively low. This research serves to quantitatively assess the barriers to the clinical adoption of cell-based therapeutics through identification of unique barriers, specific challenges and opportunities facing the development and adoption of such therapies.

Keywords: cell therapy, clinical adoption, commercialization, translation

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Authors: Irfan Ameer

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Bribery control in developing countries is the biggest challenge for multinational enterprises (MNEs). Bribery practices are socially embedded and institutionalized, and therefore may achieve collective legitimacy in the society. MNEs often have better and strict norms, codes and standards about such corrupt practices. Bribery in B2B sales relationships has been researched but studies focusing on the role of firm in controlling bribery are scarce. The main objective of this paper is to explore MNEs strategies to control bribery in an environment where bribery is institutionalized. This qualitative study uses narrative approach and focuses on key events, actors and their role in controlling bribery in B2B sales relationships. The context of this study is pharmaceutical industry of Pakistan and data is collected through 23 episodic interviews supported by secondary data. The Corporate social responsibility (CSR) literature e.g. CSR three domain model and CSR pyramid is used to make sense of MNEs strategies to control bribery in developing countries. Results show that MNEs’ bribery control strategies are rather emerging based on the role of some key stakeholders and events which shape bribery strategies. Five key bribery control strategies were found through which MNEs can control both demand and supply side of bribery: bribery related codes development; bribery related codes implementation; focusing on competitive advantage; find mutually beneficial ethical solution; and collaboration with ethical stakeholders. The results also highlight the problems associated with each strategy. Study is unique in a sense that it focuses on stakeholders having unethical interests and provides guidelines to MNEs in controlling bribery practices in B2B sales relationships.

Keywords: bribery, developing countries, CSR, narrative research, B2B sales, MNEs

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Authors: Sau Kam Adeline Chan

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World Health Organization had listed ‘Communication during Patient Care Handovers’ as one of its highest 5 patient safety initiatives. Clinical handover means transfer of accountability and responsibility of clinical information from one health professional to another. The main goal of clinical handover is to convey patient’s current condition and treatment plan accurately. Ineffective communication at point of care is globally regarded as the main cause of the sentinel event. Situation, Background, Assessment and Recommendation (SBAR), a communication tool, is extensively regarded as an effective communication tool in healthcare setting. Nonetheless, just by scenario-based program in nursing school or attending workshops on SBAR would not be enough for freshly graduated nurses to apply it competently in a complex clinical practice. To what extend and in-depth of information should be conveyed during handover process is not easy to learn. As such, on-site coaching is essential to upgrade their expertise on the usage of SBAR and ultimately to avoid any clinical error. On-site coaching for all freshly graduated nurses on the usage of SBAR in clinical handover was commenced in August 2014. During the preceptorship period, freshly graduated nurses were coached by the preceptor. After that, they were gradually assigned to take care of a group of patients independently. Nurse leaders would join in their shift handover process at patient’s bedside. Feedback and support were given to them accordingly. Discrepancies on their clinical handover process were shared with them and documented for further improvement work. Owing to the constraint of manpower in nurse leader, about coaching for 30 times were provided to a nurse in a year. Staff satisfaction survey was conducted to gauge their feelings about the coaching and look into areas for further improvement. Number of clinical error avoided was documented as well. The nurses reported that there was a significant improvement particularly in their confidence and knowledge in clinical handover process. In addition, the sense of empowerment was developed when liaising with senior and experienced nurses. Their proficiency in applying SBAR was enhanced and they become more alert to the critical criteria of an effective clinical handover. Most importantly, accuracy of transferring patient’s condition was improved and repetition of information was avoided. Clinical errors were prevented and quality patient care was ensured. Using SBAR as a communication tool looks simple. The tool only provides a framework to guide the handover process. Nevertheless, without on-site training, loophole on clinical handover still exists, patient’s safety will be affected and clinical error still happens.

Keywords: freshly graduated nurse, competency of clinical handover, quality, clinical error

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Authors: Samad Lotfollahzadeh

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Escherichia coli (E.coli) is the most isolated bacteria from blood circulation of septicemic calves. Given the prevalence of septicemia in animals and its economic importance in veterinary practice, better understanding of changes in clinical signs following disease, may contribute to early detection of the disorder. The present study has been carried out to detect changes of clinical signs in induced sepsis in calves with E.coli. Colisepticemia has been induced in 10 twenty-day old healthy Holstein- Frisian calves with intravenous injection of 1.5 X 109 colony forming units (cfu) of O111: H8 strain of E.coli. Clinical signs including rectal temperature, heart rate, respiratory rate, shock, appetite, sucking reflex, feces consistency, general behavior, dehydration and standing ability were recorded in experimental calves during 24 hours after induction of colisepticemia. Blood culture was also carried out from calves four times during the experiment. ANOVA with repeated measure is used to see changes of calves’ clinical signs to experimental colisepticemia, and values of P≤ 0.05 was considered statistically significant. Mean values of rectal temperature and heart rate as well as median values of respiratory rate, appetite, suckling reflex, standing ability and feces consistency of experimental calves increased significantly during the study (P<0.05). In the present study, median value of shock score was not significantly increased in experimental calves (P> 0.05). The results of present study showed that total score of clinical signs in calves with experimental colisepticemia increased significantly, although the score of some clinical signs such as shock did not change significantly.

Keywords: calves, clinical signs scoring, E. coli O111:H8, experimental colisepticemia

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Authors: Hui-Yi Wang, Shu-Mei Chen, Mei-Fang Liu

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Background and purpose: Providing clinical experience in medical education is an important discipline method where students can gradually apply their academic knowledge to clinical situations. The purpose of this study was to establish self-assessment questionnaires for students to assess their learning outcomes for two fields of physical therapy, orthopedic physical therapy, and pediatric physical therapy, in a clinical fieldwork course. Methods: The questionnaires were developed based on the core competence dimensions of the course. The content validity of the questionnaires was evaluated and established by expert meetings. Among the third-year undergraduate students who took the clinical fieldwork course, there were 49 students participated in this study. Teachers arranged for the students to study two professional fields, and each professional field conducted a three-week clinical lesson. The students filled out the self-assessment questionnaires before and after each three-week lesson. Results: The self-assessment questionnaires were established by expert meetings that there were six core competency dimensions in each of the two fields, with 20 and 21 item-questions, respectively. After each three-week clinical fieldwork, the self-rating scores in each core competency dimension were higher when compared to those before the course, indicating having better clinical abilities after the lessons. The best self-rating scores were the dimension of attitude and humanistic literacy, and the two lower scores were the dimensions of professional knowledge and skills and problem-solving critical thinking. Conclusions: This study developed questionnaires for clinical fieldwork courses to reflect students' learning outcomes, including the performance of professional knowledge, practice skills, and professional attitudes. The use of self-assessment of learning performance can help students build up their reflective competencies. Teachers can guide students to pay attention to the performance of abilities in each core dimension to enhance the effectiveness of learning through self-reflection and improvement.

Keywords: physical therapy, clinical fieldwork course, learning outcomes assessment, medical education, self-reflection ability

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Authors: Yeimis Milton, Palomino Pichihua

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The city, like living organisms, originates from codes, structured information in the form of rules that condition the physical form and performance of urban space. Usually, the so-called urban codes clash with the spontaneous nature of the city, with the urban Kháos that contextualizes the free creation (poiesis) of human collectives. This contradiction is especially evident in Latin America, which, like other developing regions, lacks adequate instruments to guide urban growth. Thus constructing a hybrid between the formal and informal city, categories that are difficult to separate one from the other. This is a comparative study focusing on the urban codes created to address the pandemic. The objective is to build an overview of these innovations in the region. The sample is made up of official norms published in pandemic, directly linked to urban planning and building control (urban form). The countries analyzed are Brazil, Mexico, Argentina, Peru, Colombia, and Chile. The study uncovers a shared interest in facing future urban problems, in contrast to the inconsistency of proposed legal instruments. Factors such as the lack of articulation, validity time, and ambiguity, among others, accentuate this problem. Likewise, it evidences that the political situation of each country has a significant influence on the development of these norms and the possibility of their long-term impact. In summary, the global emergency has produced opportunities to transform urban systems from their internal rules; however, there are very few successful examples in this field. Therefore, Latin American cities have the task of learning from this defeat in order to lay the foundations for a more resilient and sustainable urban future.

Keywords: pandemic, regulation, urban planning, latin America

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Authors: R. Tariq, R. Lee

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Background: Additional demands placed on senior clinical teams with ongoing COVID-19 management has accelerated the need to harness the wider healthcare professional resources and upskill them to take on greater clinical responsibility safely. The UK NHS Long Term Plan (2019)¹ emphasises the importance of expanding Advanced Practitioners’ (APs) roles to take on more clinical diagnostic responsibilities to cope with increased demand. In acute settings, APs are often the first point of care for patients and require training to take on initial triage responsibilities efficiently and safely. Critically, their roles include determining which onward services the patients may require, and assessing whether they can be treated at home, avoiding unnecessary admissions to the hospital. Dem Dx is a Clinical Reasoning Platform (CRP) that claims to help frontline healthcare professionals independently assess and triage patients. It guides the clinician from presenting complaints through associated symptoms to a running list of differential diagnoses, media, national and institutional guidelines. The objective of this study was to compare the clinical referral rates and guidelines adherence registered by the HMR Urgent Community Care Team (UCCT)² and Dem Dx recommendations using retrospective cases. Methodology: 192 cases seen by the UCCT were anonymised and reassessed using Dem Dx clinical pathways. We compared the UCCT’s performance with Dem Dx regarding the appropriateness of onward referrals. We also compared the clinical assessment regarding adherence to NICE guidelines recorded on the clinical notes and the presence of suitable guidance in each case. The cases were audited by two medical doctors. Results: Dem Dx demonstrated appropriate referrals in 85% of cases, compared to 47% in the UCCT team (p<0.001). Of particular note, Dem Dx demonstrated an almost 65% (p<0.001) improvement in the efficacy and appropriateness of referrals in a highly experienced clinical team. The effectiveness of Dem Dx is in part attributable to the relevant NICE and local guidelines found within the platform's pathways and was found to be suitable in 86% of cases. Conclusion: This study highlights the potential of clinical decision support, as Dem Dx, to improve the quality of onward clinical referrals delivered by a multidisciplinary team in primary care. It demonstrated that it could support healthcare professionals in making appropriate referrals, especially those that may be overlooked by providing suitable clinical guidelines directly embedded into cases and clear referral pathways. Further evaluation in the clinical setting has been planned to confirm those assumptions in a prospective study.

Keywords: advanced practitioner, clinical reasoning, clinical decision-making, management, multidisciplinary team, referrals, triage

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Authors: Irum Matloob, Shoab Ahmad Khan, Fahim Arif

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As Indo-Pak has been the victim of heart diseases since many decades. Many surveys showed that percentage of cardiac patients is increasing in Pakistan day by day, and special attention is needed to pay on this issue. The framework is proposed for performing detailed analysis of ECG survey data which is conducted for measuring prevalence of heart diseases statistics in Pakistan. The ECG survey data is evaluated or filtered by using automated Minnesota codes and only those ECGs are used for further analysis which is fulfilling the standardized conditions mentioned in the Minnesota codes. Then feature selection is performed by applying proposed algorithm based on discernibility matrix, for selecting relevant features from the database. Clustering is performed for exposing natural clusters from the ECG survey data by applying spectral clustering algorithm using fuzzy c means algorithm. The hidden patterns and interesting relationships which have been exposed after this analysis are useful for further detailed analysis and for many other multiple purposes.

Keywords: arrhythmias, centroids, ECG, clustering, discernibility matrix

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Authors: Vandita Mishra

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From the management of patients, reception, record, and assistants in a clinical practice; to the management of ongoing research, clinical cases and department profile in an academic setup, the healthcare provider has to deal with all of it. The victory lies in smooth running of the show in both the above situations with an apt solution of problems encountered and smooth management of crisis faced. Thus this paper amalgamates dental science with health administration by means of introduction of a concept for practice management and problem-solving called 'Quality Circles'. This concept uses various tools for problem solving given by experts from different fields. QC tools can be applied in both clinical and academic settings in dentistry for better productivity and for scientifically approaching the process of continuous improvement in both the categories. When approached through QC, our organization showed better patient outcomes and more patient satisfaction. Introduced in 1962 by Kaoru Ishikawa, this tool has been extensively applied in certain fields outside dentistry and healthcare. By exemplification of some clinical cases and virtual scenarios, the tools of Quality circles will be elaborated and discussed upon.

Keywords: academics, dentistry, healthcare, quality

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Authors: Umut Arslan, John Sommers Flanagan

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The purpose of this study was to investigate qualifications of ethics training in counselor education programs in Turkey. The survey data were collected from 251 Turkish counseling students to examine differences in ethical judgments between freshmen and seniors. Chi-square analysis was used to analyze the data from an ethical practice and belief survey. This survey was used to assess counselor candidates’ ethical judgments regarding Turkish counseling ethical codes and sources of ethics information. Statistically significant differences were found between university seniors and freshmen on items that are related to confidentiality, dual relationships, and professional relationships. Furthermore, patterns based on demographic information showed significant differences as a result of gender, economic status, and parents’ educational level. Participants gave the highest rating of information sources to Turkish counseling ethical codes.

Keywords: ethics, training, Turkey, counselor, education

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Authors: Peyman Amini Motlagh, Ali Pak

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Seismic retrofitting of important structures is essential in seismological active zones. The importance is doubled when it comes to some buildings like schools, hospitals, bridges etc. because they are required to continue their serviceability even after a major earthquake. Generally, seismic retrofitting codes have paid little attention to retrofitting of foundations due to its construction complexity. In this paper different methods for seismic retrofitting of tall buildings’ foundations will be discussed and evaluated. Foundations are considered in three different categories. First, foundations those are in danger of liquefaction of their underlying soil. Second, foundations located on slopes in seismological active regions. Third, foundations designed according to former design codes and may show structural defects under earthquake loads. After describing different methods used in different countries for retrofitting of the existing foundations in seismological active regions, comprehensive comparison between these methods with regard to the above mentioned categories is carried out. This paper gives some guidelines to choose the best method for seismic retrofitting of tall buildings’ foundations in retrofitting projects.

Keywords: existing foundation, landslide, liquefaction, seismic retrofitting

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Authors: Irum Matloob, Shoab Ahmad Khan, Fahim Arif

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As Indo-pak has been the victim of heart diseases since many decades. Many surveys showed that percentage of cardiac patients is increasing in Pakistan day by day, and special attention is needed to pay on this issue. The framework is proposed for performing detailed analysis of ECG survey data which is conducted for measuring the prevalence of heart diseases statistics in Pakistan. The ECG survey data is evaluated or filtered by using automated Minnesota codes and only those ECGs are used for further analysis which is fulfilling the standardized conditions mentioned in the Minnesota codes. Then feature selection is performed by applying proposed algorithm based on discernibility matrix, for selecting relevant features from the database. Clustering is performed for exposing natural clusters from the ECG survey data by applying spectral clustering algorithm using fuzzy c means algorithm. The hidden patterns and interesting relationships which have been exposed after this analysis are useful for further detailed analysis and for many other multiple purposes.

Keywords: arrhythmias, centroids, ECG, clustering, discernibility matrix

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Authors: Awole Seid, Yosef Zenebe, Hadgu Gerensea, Kebede Haile Misgina

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Background: Clinical competence is one of the ultimate goals of nursing education. Clinical skills are more than successfully performing tasks; it incorporates client assessment, identification of deficits and the ability to critically think to provide solutions. Assessment of clinical competence, particularly identifying gaps that need improvement and determining the educational needs of nursing students have great importance in nursing education. Thus this study aims determining clinical self-efficacy of final year school of nursing students in three universities of Tigray Region. Methods: A cross-sectional study was conducted on 224 final year school of nursing students from department of nursing, psychiatric nursing, and midwifery on three universities of Tigray region. Anonymous self-administered questionnaire was administered to generate data collected on June, 2017. The data were analyzed using SPSS version 20. The result is described using tables and charts as required. Logistic regression was employed to test associations. Result: The mean age of students was 22.94 + 1.44. Generally, 21% of students have been graduated in the department in which they are not interested. The study demonstrated 28.6% had poor and 71.4% had good perceived clinical self-efficacy. Beside this, 43.8% of psychiatric nursing and 32.6% of comprehensive nursing students have poor clinical self-efficacy. Among the four domains, 39.3% and 37.9% have poor clinical self- efficacy with regard to ‘Professional development’ and ‘Management of care’. Place of the institution [AOR=3.480 (1.333 - 9.088), p=0.011], interest during department selection [AOR=2.202 (1.045 - 4.642), p=.038], and theory-practice gap [AOR=0.224 (0.110 - 0.457), p=0.000] were significantly associated with perceived clinical self-efficacy. Conclusion: The magnitude of students with poor clinically self efficacy was high. Place of institution, theory-practice gap, students interest to the discipline were the significant predictors of clinical self-efficacy. Students from youngest universities have good clinical self-efficacy. During department selection, student’s interest should be respected. The universities and other stakeholders should improve the capacity of surrounding affiliate teaching hospitals to set and improve care standards in order to narrow the theory-practice gap. School faculties should provide trainings to hospital staffs and monitor standards of clinical procedures.

Keywords: clinical self-efficacy, nursing students, Tigray, northern Ethiopia

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Authors: J. R. Wang, Y. Chiang, W. S. Hsu, H. C. Chen, S. H. Chen, J. H. Yang, S. W. Chen, C. Shih

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In this study, the RASCAL and ALOHA codes are used to establish an analysis methodology for hydrogen fluoride (HF) evaluation. There are three main steps in this study. First, the UF₆ data were collected. Second, one postulated case was analyzed by using the RASCAL and UF₆ data. This postulated case assumes that fire occurring and UF₆ is releasing from a building. Third, the results of RASCAL for HF mass were as the input data of ALOHA. Two postulated cases of HF were analyzed by using ALOHA code and the results of RASCAL. These postulated cases assume fire occurring and HF is releasing with no raining (Case 1) or raining (Case 2) condition. According to the analysis results of ALOHA, the HF concentration of Case 2 is smaller than Case 1. The results can be a reference for the preparing of emergency plans for the release of HF.

Keywords: RASCAL, ALOHA, UF₆, hydrogen fluoride

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Authors: Ibraheem Husain, Abul Kalam Najmi, Karishma Chester

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First-in-human (FIH) studies are a critical step in clinical development of any molecule that has shown therapeutic promise in preclinical evaluations, since preclinical research and safety studies into clinical development is a crucial step for successful development of monoclonal antibodies for guidance in pharmaceutical industry for the treatment of human diseases. Therefore, comparison between USFDA and nine pharmacologically guided approaches (PGA) (simple allometry, maximum life span potential, brain weight, rule of exponent (ROE), two species methods and one species methods) were made to determine maximum recommended starting dose (MRSD) for first in human clinical trials using four drugs namely Denosumab, Bevacizumab, Anakinra and Omalizumab. In our study, the predicted pharmacokinetic (pk) parameters and the estimated first-in-human dose of antibodies were compared with the observed human values. The study indicated that the clearance and volume of distribution of antibodies can be predicted with reasonable accuracy in human and a good estimate of first human dose can be obtained from the predicted human clearance and volume of distribution. A pictorial method evaluation chart was also developed based on fold errors for simultaneous evaluation of various methods.

Keywords: clinical pharmacology (CPH), clinical research (CRE), clinical trials (CTR), maximum recommended starting dose (MRSD), clearance and volume of distribution

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Authors: Ji-Chan Jang

Abstract:

Tuberculosis is still major health problem because there is an increase of multidrug-resistant and extensively drug-resistant forms of the disease. Therefore, the most urgent clinical need is to discover potent agents and develop novel drug combination capable of reducing the duration of MDR and XDR tuberculosis therapy. Three reference strains H37Rv, CDC1551, W-Beijing GC1237 and six clinical isolates of MDRTB were tested to daptomycin in the range of 0.013 to 256 mg/L. Daptomycin is resistant to all tested M. tuberculosis strains not only laboratory strains but also clinical MDR strains that were isolated at different source. Daptomycin will not be an antibiotic of choice for treating infection of Gram positive atypical slowly growing M. tuberculosis.

Keywords: tuberculosis, daptomycin, resistance, Mycobacterium tuberculosis

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Authors: Mostefa Mimoune

Abstract:

Test results on concrete-filled steel tubular stub columns under axial compression are presented. The study was mainly focused on square hollow section SHS columns; 27 columns were tested. The main experimental parameters considered were the thickness of the tube, columns length and cross section sizes. Existing design codes and theoretical model were used to predict load-carrying capacities of composite section to compare the accuracy of the predictions by using the recommendations of DTR-BC (Algerian code), CSA (Canadian standard), AIJ, EC4, DBJ, AISC, BS and EC4. Experimental results indicate that the studied parameters have significant influence on both the compressive load capacity and the column failure mode. All codes used in the comparison, provide higher resistance compared to those of tests. Equation method has been suggested to evaluate the axial capacity of the composite section seem to be in agreement with tests.

Keywords: axial loading, composite section, concrete-filled steel tubes, square hollow section

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Authors: Maria Pratt, Lynn Martin

Abstract:

Context: In nursing education, clinical instructors are crucial in assessing and evaluating students' performance in clinical courses. However, instructors often struggle when assigning failing grades to students at risk of failing. Research Aim: This qualitative study aims to understand clinical instructors' experiences evaluating students with unsatisfactory performance, including how reflection and collegial support impact this evaluation process. Methodology, Data Collection, and Analysis Procedures: This study employs Gadamer's Hermeneutic Inquiry as the research methodology. A purposive maximum variation sampling technique was used to recruit eight clinical instructors from a collaborative undergraduate nursing program in Southwestern Ontario. Semi-structured, open-ended, and audio-taped interviews were conducted with the participants. The hermeneutic analysis was applied to interpret the interview data to allow for a thorough exploration and interpretation of the instructors' experiences evaluating failing students. Findings: The main findings of this qualitative research indicate that evaluating failing students was emotionally draining for the clinical instructors who experienced multiple challenges, uncertainties, and negative feelings associated with assigning failing grades. However, the analysis revealed that ongoing reflection and collegial support played a crucial role in mitigating the challenges they experienced. Conclusion: This study contributes to the theoretical understanding of nursing education by shedding light on clinical instructors' challenges in evaluating failing students. It emphasizes the emotional toll associated with this process and the role that reflection and collegial support play in alleviating those challenges. The findings underscore the need for ongoing professional development and support for instructors in nursing education. By understanding and addressing clinical instructors' experiences, nursing education programs can better equip them to effectively evaluate struggling students and provide the necessary support for their professional growth.

Keywords: clinical instructor, student evaluation, nursing, reflection, support

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