Search results for: time-to-event outcomes

Authors: May George

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Native speakers can play a significant role in improving second language learners speaking skills through weekly interaction. Speaking is one of the important skills that second language learners need to practice in order to be able to communicate the language. This study will examine Talkaboard as an important tool to achieve better outcomes in speaking a language. The subject of the study will be 16 advanced Arabic language learners at the college level. There will be a pre-test and post-test to examine the conversation outcomes using the Talkaborad tool. The students will be asked to write a summary and talk about their weekly conversation experience with the native speaker in class. The teacher will use a check list to determine the progress made in speaking the Arabic language. The results of this study will provide language teachers with information related to the native speakers’ role in language and the progress the second language learners made after interacting with native speakers.

Keywords: speaking, language, interaction, culture

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Authors: Raman Sharma, S. K. Jain

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Aims and Objectives: Fixation of the mesh during laparoscopic total extraperitoneal (TEP) repair of inguinal hernia is thought to be necessary to prevent recurrence. However, mesh fixation may increase surgical complications and postoperative pain. Our objective was to compare the outcomes of nonfixation with fixation of polypropylene mesh by metal tacks during TEP repair of inguinal hernia. Methods: Forty patients aged 18 to72 years with inguinal hernia were included who underwent laparoscopic TEP repair of inguinal hernia with (n=20) or without (n=20) fixation of the mesh. The outcomes were operative duration, postoperative pain score, cost, in-hospital stay, time to return to normal activity, and complications. Results: Patients in whom the mesh was not fixed had shorter mean operating time (p < 0.05). We found no difference between groups in the postoperative pain score, incidence of recurrence, in-hospital stay, time to return to normal activity and complications (P > 0.05). Moreover, a net cost savings was realized for each hernia repair performed without stapled mesh. Conclusions: TEP repair without mesh fixation resulted in the shorter operating time and lower operative cost with no difference between groups in the postoperative pain score, incidence of recurrence, in-hospital stay, time to return to normal activity and complications. All this contribute to make TEP repair without mesh fixation a better choice for repair of uncomplicated inguinal hernia, especially in developing nations with scarce resources.

Keywords: postoperative pain score, inguinal hernia, nonfixation of mesh, total extra peritoneal (TEP)

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Authors: Piotr Romaniuk, Krzysztof Kaczmarek, Adam Szromek

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Background: A number of approaches to assess the performance of health system have been proposed so far. Nonetheless, they lack a consensus regarding the key components of assessment procedure and criteria of evaluation. The WHO and OECD have developed methods of assessing health system to counteract the underlying issues, but they are not free of controversies and did not manage to produce a commonly accepted consensus. The aim of the study: On the basis of WHO and OECD approaches we decided to develop own methodology to assess the performance of health systems in Central and Eastern European countries. We have applied the method to compare the effects of health systems reforms in 20 countries of the region, in order to evaluate the dynamic of changes in terms of health system outcomes.Methods: Data was collected from a 25-year time period after the fall of communism, subsetted into different post-reform stages. Datasets collected from individual countries underwent one-, two- or multi-dimensional statistical analyses, and the Synthetic Measure of health system Outcomes (SMO) was calculated, on the basis of the method of zeroed unitarization. A map of dynamics of changes over time across the region was constructed. Results: When making a comparative analysis of the tested group in terms of the average SMO value throughout the analyzed period, we noticed some differences, although the gaps between individual countries were small. The countries with the highest SMO were the Czech Republic, Estonia, Poland, Hungary and Slovenia, while the lowest was in Ukraine, Russia, Moldova, Georgia, Albania, and Armenia. Countries differ in terms of the range of SMO value changes throughout the analyzed period. The dynamics of change is high in the case of Estonia and Latvia, moderate in the case of Poland, Hungary, Czech Republic, Croatia, Russia and Moldova, and small when it comes to Belarus, Ukraine, Macedonia, Lithuania, and Georgia. This information reveals fluctuation dynamics of the measured value in time, yet it does not necessarily mean that in such a dynamic range an improvement appears in a given country. In reality, some of the countries moved from on the scale with different effects. Albania decreased the level of health system outcomes while Armenia and Georgia made progress, but lost distance to leaders in the region. On the other hand, Latvia and Estonia showed the most dynamic progress in improving the outcomes. Conclusions: Countries that have decided to implement comprehensive health reform have achieved a positive result in terms of further improvements in health system efficiency levels. Besides, a higher level of efficiency during the initial transition period generally positively determined the subsequent value of the efficiency index value, but not the dynamics of change. The paths of health system outcomes improvement are highly diverse between different countries. The instrument we propose constitutes a useful tool to evaluate the effectiveness of reform processes in post-communist countries, but more studies are needed to identify factors that may determine results obtained by individual countries, as well as to eliminate the limitations of methodology we applied.

Keywords: health system outcomes, health reforms, health system assessment, health system evaluation

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Authors: Vincent Liu

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Machine learning algorithms (ML) can achieve high accuracy in predicting outcomes compared to classical models. Metaheuristic, nature-inspired algorithms can enhance traditional ML algorithms by optimizing them such as by performing feature selection. We compare ten ML algorithms to predict 30-day hospital readmission rates for diabetes patients in the US using a dataset from UCI Machine Learning Repository with feature selection performed by Greywolf nature-inspired algorithm. The baseline accuracy for the initial random forest model was 65%. After performing feature engineering, SMOTE for class balancing, and Greywolf optimization, the machine learning algorithms showed better metrics, including F1 scores, accuracy, and confusion matrix with improvements ranging in 10%-30%, and a best model of XGBoost with an accuracy of 95%. Applying machine learning this way can improve patient outcomes as unnecessary rehospitalizations can be prevented by focusing on patients that are at a higher risk of readmission.

Keywords: diabetes, machine learning, 30-day readmission, metaheuristic

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Authors: John Tate

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In 2004, the French Parliament banned the “hijab” in public schools, and in 2010 it prohibited the “burqa” and “niqab” in “public places.” The result was a “secular” outcome involving the removal of these garments, often identified with Islamic religious and cultural practice, from the French public sphere. Yet in 2016, the French local council bans on the “burqini” were overruled by France’s highest administrative court, the Conseil d’État, allowing for their retention in the public sphere. Unlike the burqa and hijab bans, the burqini bans produced significant divisions at the highest echelons of the French political class, with the Prime Minister, Manuel Valls, and the President, François Hollande, finding themselves at odds on the issue. This article seeks to achieve four aims. It seeks to (a) explain the contrary outcomes between key French state institutions, such as the Conseil d’État and the French Parliament, concerning the hijab and burqa bans, and the Conseil d’État and French local councils, concerning the burqini bans; (b) to do so by identifying two qualitatively distinct, and at times incompatible, conceptions of laïcité, present within official French public discourse, and applied by these French state institutions to underwrite these respective outcomes; (c) explain why, given these contrary conceptions of laïcité, and these contrary outcomes, the widespread identification of laïcité with “secularism” is both misleading and inaccurate; and (d) provide an explanation why senior members of the French political class were divided on the burqini bans when they were not divided on the nation-wide prohibitions of the hijab in public schools and the burqa in public places. In regard to this last question, the article seeks to ask why the Burqini was “different”?

Keywords: liberalism, republicanism, laïcité, citizenship

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Authors: Shaila Rana, Wasim Alhamdani

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Effective cybersecurity learning relies on an engaging, interactive, and entertaining activity that fosters positive learning outcomes. VR cybersecurity training may promote these aforementioned variables. However, a methodological approach and framework have not yet been created to allow trainers and educators to employ VR cybersecurity training methods to promote positive learning outcomes to the author’s best knowledge. Thus, this paper aims to create an approach that cybersecurity trainers can follow to create a VR cybersecurity training module. This methodology utilizes concepts from other cybersecurity training frameworks, such as NICE and CyTrONE. Other cybersecurity training frameworks do not incorporate the use of VR. VR training proposes unique challenges that cannot be addressed in current cybersecurity training frameworks. Subsequently, this ontology utilizes concepts unique to developing VR training to create a relevant methodology for creating VR cybersecurity training modules. The outcome of this research is to create a methodology that is relevant and useful for designing VR cybersecurity training modules.

Keywords: virtual reality cybersecurity training, VR cybersecurity training, traditional cybersecurity training, ontology

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Authors: Kartina Sury Kariman

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Brand-to-customer (B2C) engagement has been well established through the traditional platform such as direct sales, advertising, customer service center, customer hotline as well as brand usage experiences. Increasingly, interest to B2C has evolved to include customer-to-customer (C2C) interaction analysis aligned with the vast growth of web 2.0. Hence, discussion on C2C interaction and brand strategy have captured social media as it enables brands and C2C interaction to be connected in various ways, providing opportunities for marketers to shape their brand engagement strategy while reaching C2C as the targeted outcomes. The objective here is to provide a preliminary review of C2C interaction consisting the antecedents and consequences while highlighting areas of research interest within the context from marketers perspective and the business outcomes. This paper discusses how C2C interaction defines marketers’ brand and communication strategy and how social media trend shapes the strategy when promoting the awareness of life insurance industry and educating the target market.

Keywords: social media, brand engagement, customer interaction, customer engagement, brand strategy, life insurance

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Authors: Sahani Rathnasiri, Pritee Ray, Sardar M. N. Isalm, Carlos A. Vega-Mejia

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This study develops a cooperative game theory-based cost-sharing contract model for a business to consumer (B2C) e-commerce supply chain to minimize the overall supply chain costs and the individual costs within an information asymmetry scenario. The objective of this study is to address the issues of strategic interactions among the key players of the e-commerce supply chain operation, which impedes the optimal operational outcomes. Game theory has been included in the field of supply chain management to resolve strategic decision-making issues; however, most of the studies are limited only to two-echelons of the supply chains. Multi-echelon supply chain optimizations based on game-theoretic models are less explored in the previous literature. This study adopts a cooperative game model to focus on the common payoff of operations and addresses the issues of information asymmetry and coordination of a three-echelon e-commerce supply chain. The cost-sharing contract model integrates operational features such as production, inventory management and distribution with the contract related constraints. The outcomes of the model highlight the importance of maintaining lower operational costs by all players to obtain benefits from the cost-sharing contract. Further, the cost-sharing contract ensures true cost revelation, and hence eliminates the information asymmetry issues among the players. Comparing the results of the contract model with the de-centralized e-commerce supply chain operation further emphasizes that the cost-sharing contract derives Pareto-improved outcomes and minimizes the costs of overall e-commerce supply chain operation.

Keywords: cooperative game theory, cost-sharing contract, e-commerce supply chain, information asymmetry

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Authors: Lisa Chandler, Alistair Ward

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A significant component of design pedagogy is the need to foster design thinking in various contexts and to support students in understanding links between educational exercises and their potential application in professional design practice. It is also important that educators provide opportunities for students to engage with new technologies and encourage them to imagine applying their design skills for a range of outcomes. Problem solving is central to design so it is also essential that students understand that there can be multiple solutions to a design brief, and are supported in undertaking creative experimentation to generate imaginative outcomes. This paper presents a case study examining some innovative approaches to addressing these elements of design pedagogy. It investigates the effectiveness of the Immerse Lab, a three wall projection room at the University of the Sunshine Coast, Australia, as a learning context for design practice, for generating ideas and for supporting learning involving the comparative display of design outcomes. The project required first year design students to create a simple graphic design derived from an ordinary object and to incorporate specific design criteria. Utilizing custom-designed software, the students’ solutions were projected together onto the Immerse walls to create a large-scale, immersive grid of images, which was used to compare and contrast various responses to the same problem. The software also enabled individual student designs to be transformed, multiplied and enlarged in multiple ways and prompted discussions around the applicability of the designs in real world contexts. Teams of students interacted with their projected designs, brainstorming imaginative applications for their outcomes. Analysis of 77 anonymous student surveys revealed that the majority of students found: learning in the Immerse Lab to be beneficial; comparative review more effective than in standard tutorial rooms; that the activity generated new ideas; it encouraged students to think differently about their designs; it inspired students to develop their existing designs or create new ones. The project demonstrates that curricula involving immersive spaces can be effective in supporting engaging and relevant design pedagogy and might be utilized in other disciplinary areas.

Keywords: design pedagogy, immersive education, technology-enhanced learning, visualization

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Authors: A. A. Agbor, Jean Joel R. Bigna, Serges Clotaire Billong, Mathurin Cyrille Tejiokem, Gabriel L. Ekali, Claudia S. Plottel, Jean Jacques N. Noubiap, Hortence Abessolo, Roselyne Toby, Sinata Koulla-Shiro

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Background: Contributors to fatal outcomes in patients undergoing tuberculosis (TB) treatment in the setting of HIV co-infection are poorly characterized, especially in sub-Saharan Africa. Our study’s aim was to assess factors associated with death in TB/HIV co-infected patients during the first 6 months their TB treatment. Methods: We conducted a tertiary-care hospital-based retrospective cohort study from January 2006 to December 2013 at the Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify hospitalized co-infected TB/HIV patients aged 15 years and older. Death was defined as any death occurring during TB treatment, as per the World Health Organization’s recommendations. Logistic regression analysis identified factors associated with death. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval. A p value < 0.05 was considered statistically significant. Results: The 337 patients enrolled had a mean age of 39.3 (+/- 10.3) years and more (54.3%) were women. TB treatment outcomes included: treatment success in 60.8% (n=205), death in 29.4% (n=99), not evaluated in 5.3% (n=18), loss to follow-up in 5.3% (n=14), and failure in 0.3% (n=1) . After exclusion of patients lost to follow-up and not evaluated, death in TB/HIV co-infected patients during TB treatment was associated with: a TB diagnosis made before national implementation of guidelines regarding initiation of antiretroviral therapy (aOR = 2.50 [1.31-4.78]; p = 0.006), the presence of other AIDS-defining infections (aOR = 2.73 [1.27-5.86]; p = 0.010), non-AIDS comorbidities (aOR = 3.35 [1.37-8.21]; p = 0.008), not receiving co-trimoxazole prophylaxis (aOR = 3.61 [1.71-7.63]; p = 0.001), not receiving antiretroviral therapy (aOR = 2.45 [1.18-5.08]; p = 0.016), and CD4 cell counts < 50 cells/mm3 (aOR = 16.43 [1.05-258.04]; p = 0.047). Conclusions: The success rate of anti-tuberculosis treatment among hospitalized TB/HIV co-infected patients in our setting is low. Mortality in the first 6 months of treatment was high and strongly associated with specific clinical factors including states of greater immunosuppression, highlighting the urgent need for targeted interventions, including provision of anti-retroviral therapy and co-trimoxazole prophylaxis in order to enhance patient outcomes.

Keywords: TB/HIV co-infection, death, treatment outcomes, factors

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Authors: R. Botrugno, S Basyuni, G. Nugent, I. Jenkyn, A. Ferro, H. Bennett, C. Hjalmarsson, J. Chu, V. Santhanam

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This trainee led randomised controlled trial (RCT) aims to assess various outcomes for resorbable versus non-resorbable sutures for traumatic lacerations to the face. Within this trial of resorbable versus non-resorbable sutures for traumatic lacerations of the face (TORNFace), patient recruitment was facilitated by trainees who were employed at an NHS University Teaching Hospital in the United Kingdom. The trainees received appropriate training prior to recruiting patients for the trial. This included the completion of a national research e-learning module and face-to-face training that was provided locally. The locally delivered training provided an understanding of the eligibility criteria for the trial and the consent process. Existing trainee skills were utilised involving clinical photography to record baseline data and delivering the intervention based on the treatment arm selected. Eligible patients who required primary closure of traumatic lacerations of the face were randomised into one of two treatment arms. These comprised of resorbable (vicryl rapide) or non-resorbable sutures (ethilon). Primarily the cosmetic outcome was assessed. Secondary outcomes included: complications rates, health care economics, and patient-reported outcomes. Remote follow-up of recruited patients utilised photographs of the facial laceration which had received the intervention. These took place at 1 week, 3 months and 6 months post-intervention. This study aims to demonstrate an example of trainee-led research within the specialty of oral and maxillofacial surgery. The available data for the randomised controlled trial will also be presented.

Keywords: laceration, suture, trauma, trial

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Authors: Luisa Perez-Mujica

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Traditionally, non-compliance in water regulation has been understood to be attributable to lack of information or knowledge of regulations. In other words, it is confusing behavioural change and education with communication or regulations. However, compliance is a complex response to water regulation factors including 1) knowledge and understanding of regulations; 2) perception that resources are overregulated; 3) presence of regulatory officers in the field; 4) accurate communication of what is being protected; 5) time lag between behavioral change projects and observation of outcomes and 6) how success of behavioral change is measured and evaluated. This paper presents a framework for designing education and behavioral change projects by understanding non-compliance in terms of the interaction of its factors, including a process for prioritizing projects, actions, evaluation and monitoring of outcomes. By taking a systemic approach to compliance, a more directed type of actions can be efficiently identified and prioritized, preventing the reactive nature of education and behavioral change projects.

Keywords: water regulation, compliance, behaviour change, systems thinking

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Authors: Edward Shizha, Edward Makwarimba

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Newcomer and refugee youth feel excluded in the education system in Canada, and the formal education environment does not fully cater for their learning needs. The objective of this study was to build knowledge and understanding of the educational needs and experiences of these youth in Canada and how available afterschool programs can most effectively support their learning needs and academic outcomes. The Employment and Social Development Canada (ESDC), which funded this research, enables and empowers students to advance their educational experience through targeted investments in services that are delivered by youth-serving organizations outside the formal education system through afterschool initiatives. A literature review and a provincial/territorial internet scan were conducted to determine the availability of services and programs that serve the educational needs and academic outcomes of newcomer youth in 10 provinces and 3 territories in Canada. The goal was to identify intersectional factors (e.g., gender, sexuality, culture, social class, race, etc.) that influence educational outcomes of newcomer/refugee students and to recommend ways the ESDC could complement settlement services to enhance students’ educational success. First, data was collected through a literature search of various databases, including PubMed, Web of Science, Scopus, Google docs, ACADEMIA, and grey literature, including government documents, to inform our analysis. Second, a provincial/territorial internet scan was conducted using a template that was created by ESDC staff with the input of the researchers. The objective of the web-search scan was to identify afterschool programs, projects, and initiatives offered to newcomer/refugee youth by service provider organizations. The method for the scan included both qualitative and quantitative data gathering. Both the literature review and the provincial/territorial scan revealed that there are gender disparities in educational outcomes of newcomer and refugee youth. High school completion rates by gender show that boys are at higher risk of not graduating than girls and that girls are more likely than boys to have at least a high school diploma and more likely to proceed to postsecondary education. Findings from literature reveal that afterschool programs are required for refugee youth who experience mental health challenges and miss out on significant periods of schooling, which affect attendance, participation, and graduation from high school. However, some refugee youth use their resilience and ambition to succeed in their educational outcomes. Another finding showed that some immigrant/refugee students, through ethnic organizations and familial affiliation, maintain aspects of their cultural values, parental expectations and ambitious expectations for their own careers to succeed in both high school and postsecondary education. The study found a significant combination of afterschool programs that include academic support, scholarships, bursaries, homework support, career readiness, internships, mentorship, tutoring, non-clinical counselling, mental health and social well-being support, language skills, volunteering opportunities, community connections, peer networking, culturally relevant services etc. These programs assist newcomer youth to develop self-confidence and prepare for academic success and future career development. The study concluded that advantages of afterschool programs are greatest for youth at risk for poor educational outcomes, such as Latino and Black youth, including 2SLGBTQI+ immigrant youth.

Keywords: afterschool programs, educational outcomes, newcomer youth, refugee youth, youth-serving organizations

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Authors: Wadsana Sarakarn, Pimonpan Charoensri, Baliya Chaiyara

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Objectives: To study the outcomes of the developed nursing model to prevent early postpartum hemorrhage (PPH). Materials and Methods: The analytical study was conducted in Sunpasitthiprasong Hospital during October 1st, 2015, until May 31st, 2017. After review the prevalence, risk factors, and outcomes of postpartum hemorrhage of the parturient who gave birth in Sunpasitthiprasong Hospital, the nursing model was developed under research regulation of Kemmis&McTaggart using 4 steps of operating procedures: 1) analyzing problem situation and gathering 2) creating the plan 3) noticing and performing 4) reflecting the result of the operation. The nursing model consisted of the screening tools for risk factors associated with PPH, the clinical nursing practice guideline (CNPG), and the collecting bag for measuring postpartum blood loss. Primary outcome was early postpartum hemorrhage. Secondary outcomes were postpartum hysterectomy, maternal mortality, personnel’s practice, knowledge, and satisfaction of the nursing model. The data were analyzed by using content analysis for qualitative data and descriptive statistics for quantitative data. Results: Before using the nursing model, the prevalence of early postpartum hemorrhage was under estimated (2.97%). There were 5 cases of postpartum hysterectomy and 2 cases of maternal death due to postpartum hemorrhage. During the study period, there was 22.7% prevalence of postpartum hemorrhage among 220 pregnant women who were vaginally delivered at Sunpasitthiprasong Hospital. No maternal death or postpartum hysterectomy was reported after using the nursing model. Among 16 registered nurses at the delivery room who evaluated using of the nursing model, they reported the high level of practice, knowledge, and satisfaction Conclusion: The nursing model for the prevention of early PPH is effective to decrease early PPH and other serious complications.

Keywords: the development of a nursing model, prevention of postpartum hemorrhage, pregnant women, postpartum hemorrhage

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Authors: Parastoo Vasli

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In today's society, more and more people work during ‘non-standard’ working hours, including shift and night work, which are perceived danger factors for health, safety, and social prosperity. Appropriate preventive and protective measures are needed to reduce side effects and ensure that the worker can adapt sufficiently. Of the many health effects associated with shift work, sleep disorders are the most widely recognized. The most troubling acute symptoms are difficulty falling asleep, short sleep, and drowsiness during working hours that last for days on end. The outcomes checked on plainly exhibit that shift work is related to expanded mental, social, and physiological drowsiness. Apparently, the effects are due to circadian and hemostatic compounds (sleep loss). Drowsiness is especially evident during night shifts and may lead to drowsiness in real workplace accidents. In some occupations, this is clearly a risk that could endanger human lives and has enormous financial outcomes. These dangers clearly affect a large number of people and should be of great importance to society. In particular, safety on night shifts is consistently reduced.

Keywords: shift work, night work, safety, health, drowsiness

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Authors: Mohamed Abdelmongy

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Autologous Blood for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Systematic Review and Meta-analysis Hossam Zein1,2, Ammar Ismail1,3, Mohamed Abdelmongy1,4, Sherif Elsherif1,5,6, Ahmad Hassanen1,4, Basma Muhammad2, Fathy Assaf1,3, Ahmed Elsehili1,7, Ahmed Negida1,7, Shin Yamane9, Mohamed M. Abdel-Daim8,9 and Kazuaki Kadonosono9 https://www.ncbi.nlm.nih.gov/pubmed/30277146 BACKGROUND: Pterygium is a benign ocular lesion characterized by triangular fibrovascular growth of conjunctival tissue over the cornea. Patients complain of the bad cosmetic appearance, ocular surface irritation and decreased visual acuity if the pterygium is large enough to cause astigmatism or encroach on the pupil. The definitive treatment of pterygium is surgical removal. However, outcomes are compromised by recurrence . The aim of the current study is to systematically review the current literature to explore the efficacy and safety of fibrin glue, suture and autologous blood coagulum for conjunctivalautograft fixation in primary pterygium surgery. OBJECTIVES: To assess the effectiveness of fibrin glue compared to sutures and autologous blood coagulum in conjunctival autografting for the surgical treatment of pterygium. METHODS: During preparing this manuscript, we followed the steps adequately illustrated in the Cochrane Handbook for Systematic Reviews of Interventions version 5.3, and reported it according to the preferred reporting of systematic review and meta-analysis (PRISMA) statement guidelines. We searched PubMed, Ovid (both through Medline), ISI Web of Science, and Cochrane Central Register of Controlled Trials (Central) through January 2017, using the following keywords “Pterygium AND (blood OR glue OR suture)” SELECTION CRITERIA: We included all randomized controlled trials (RCTs) that met the following criteria: 1) comparing autologous blood vs fibrin glue for conjunctivalautograft fixation in primary pterygium surgery 2) comparing autologous blood vs sutures for conjunctivalautograft fixation in primary pterygium surgery DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, assessed trial quality, and extracted data using standard methodological procedures expected by Cochrane. The extracted data included A) study design, sample size, and main findings, B) Baseline characteristics of patients included in this review including their age, sex, pterygium site and grade, and graft size. C) Study outcomes comprising 1) primary outcomes: recurrence rate 2) secondary outcomes: graft stability outcomes (graft retraction, graft displacement), operation time (min) and postoperative symptoms (pain, discomfort, foreign body sensation, tearing) MAIN RESULTS: We included 7 RCTs and The review included662eyes (Blood: 293; Glue: 198; Suture: 171). we assess the 1) primary outcomes: recurrence rate 2) secondary outcomes: graft stability outcomes (graft retraction, graft displacement), operation time (min) and postoperative symptoms (pain, discomfort, foreign body sensation, tearing) CONCLUSIONS: Autologous blood for conjunctivalautograft fixation in pterygium surgery is associated with lower graft stability than fibrin glue or sutures. It was not inferior to fibrin glue or sutures regarding recurrence rate. The overall quality of evidence is low. Further well designed RCTs are needed to fully explore the efficacy of this new technique.

Keywords: pterygium, autograft, ophthalmology, cornea

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Authors: Mohand Yaghi, O. Kehinde

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Background: For the diagnosis of prostate cancer Trans-rectal prostate biopsy (TRPB) is used commonly, the procedure is associated with infective complications. There is evidence that antibiotics (ABx) decrease infective events after TRPB, but different regimens are used. Aim: To systematically review different regimens of prophylactic oral antibiotics in TRPB. Design: Medline, Embase, Clinical trials site, and Cochrane library were searched, experts were consulted about relevant studies. Randomized clinical trials (RCT) conducted in the last twenty years, which investigated different oral antibiotic regimens in TRPB, and compared their efficacy to reduce infectious complications were analyzed. Measurements: Primary outcomes were bacteriuria, urinary tract infection (UTI), fever, bacteremia, sepsis. Secondary outcomes were hospitalization rate, and the prevalence of ABx-resistant bacteria. Results: Nine trials were eligible with 3012 patients. Antibiotics prevented bacteriuria (3.5% vs. 9.88%), UTI (4.46% vs. 9.75%), and hospitalization (0.21% vs. 2.13%) significantly in comparison with placebo or no treatment. No significant difference was found in all outcomes of the review between the single dose regimen and the 3 days. The single dose regimen was as effective as the multiple dose except in Bacteriuria (6.75% vs. 3.25%), and the prevalence of ABx-resistant bacteria (1.57% vs. 0.27%). Quinolones reduced only UTI significantly in comparison with other antibiotics. Lastly, Ciprofloxacin is the best Quinolone to prevent UTI, and hospitalization. Conclusion: it is essential to prescribe prophylactic Antibiotics in TRPB. No conclusive evidence could be claimed about the superiority of the multiple or the 3 days regimens to the single dose regimen. Unexpectedly, ABx-resistant bacteria was identified more often in the single dose cohorts.

Keywords: infection, prostate cancer, sepsis, TRPB

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Authors: Danielle Klassen, Reiko Yeap, Margo Schmitt-Boshnick, Scott Oddie

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The development of the 7-week Alberta Happiness Basics program was initiated in 2010 in response to the need for community mental health programming. This provincial wide program aims to increase overall happiness and reduce negative thoughts and feelings through a positive psychology intervention. While the 7-week program has proven effective, a shortened 4-week program has additionally been developed to address client needs. In this study, participants were interviewed to determine if the 4- and 7-week programs had similar success of producing lasting behavior change at 3, 6, and 9 months post-program. A health quality of life (HQOL) measure was also used to compare the two programs and examine patient outcomes. Quantitative and qualitative analysis showed significant improvements in HQOL and sustainable behavior change for both programs. Findings indicate that the shorter, patient-centered program was effective in increasing happiness and reducing negative thoughts and feelings.

Keywords: primary care, mental health, depression, short duration

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Authors: Shahan Waheed, Muhammad Waqas, Asher Feroz

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Objectives: To determine the utility of base deficit in traumatic brain injury in assessing the severity and to correlate with the conventional computed tomography scales in grading the severity of head injury. Methodology: Observational cross-sectional study conducted in a tertiary care facility from 1st January 2010 to 31st December 2012. All patients with isolated traumatic brain injury presenting within 24 hours of the injury to the emergency department were included in the study. Initial Glasgow Coma Scale and base deficit values were taken at presentation, the patients were followed during their hospital stay and CT scan brain findings were recorded and graded as per the Rotterdam scale, the findings were cross-checked by a radiologist, Glasgow Outcome Scale was taken on last follow up. Outcomes were dichotomized into favorable and unfavorable outcomes. Continuous variables with normal and non-normal distributions are reported as mean ± SD. Categorical variables are presented as frequencies and percentages. Relationship of the base deficit with GCS, GOS, CT scan brain and length of stay was calculated using Spearman`s correlation. Results: 154 patients were enrolled in the study. Mean age of the patients were 30 years and 137 were males. The severity of brain injuries as per the GCS was 34 moderate and 109 severe respectively. 34 percent of the total has an unfavorable outcome with a mean of 18±14. The correlation was significant at the 0.01 level with GCS on presentation and the base deficit 0.004. The correlation was not significant between the Rotterdam CT scan brain findings, length of stay and the base deficit. Conclusion: The base deficit was found to be a good predictor of severity of brain injury. There was no association of the severity of injuries on the CT scan brain as per the Rotterdam scale and the base deficit. Further studies with large sample size are needed to further evaluate the associations.

Keywords: base deficit, traumatic brain injury, Rotterdam, GCS

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Authors: Inas S. Khayal, Weiping Zhou, Jonathan Skinner

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Healthcare delivery systems around the world are in crisis. The need to improve health outcomes while decreasing healthcare costs have led to an imminent call to action to transform the healthcare delivery system. While Bioinformatics and Biomedical Engineering have primarily focused on biological level data and biomedical technology, there is clear evidence of the importance of the delivery of care on patient outcomes. Classic singular decomposition approaches from reductionist science are not capable of explaining complex systems. Approaches and methods from systems science and systems engineering are utilized to structure healthcare delivery system data. Specifically, systems architecture is used to develop a multi-scale and multi-dimensional characterization of the healthcare delivery system, defined here as the Healthcare Delivery System Knowledge Base. This paper is the first to contribute a new method of structuring and visualizing a multi-dimensional and multi-scale healthcare delivery system using systems architecture in order to better understand healthcare delivery.

Keywords: health informatics, systems thinking, systems architecture, healthcare delivery system, data analytics

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Authors: Deepika Faugoo

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Gender equality stands as the cornerstone of societal progress, intricately woven into the very essence of the 2030 Sustainable Development Goals (SDGs). Yet, the gender leadership gap remains a formidable obstacle hindering global equality. Despite women's educational advancements, their underrepresentation in senior roles persists as a baffling anomaly. Drawing from contemporary research, empirical evidence, and secondary data, this paper underscores the imperative of advancing women in leadership to drive SDGs related to empowerment and gender equality by 2030. It highlights the undeniable link between women leaders and sustainable outcomes, citing case studies and examples of their contributions to financial performance, prosperity, economic growth, and societal well-being. Exploring persistent barriers and emerging challenges, it offers actionable strategies to enhance women's representation in leadership, promising transformative benefits for organizations and societies. Amidst societal upheavals, gender equality emerges as a potent solution, catalyzing change toward a future where every voice resonates, ensuring no one is left behind.

Keywords: senior leadership, empowerment, SDGs, gender equality

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Authors: Atma Sahu

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After 9/11, there will only be cyberwars. The cyberwars increase in intensity the country's cybersecurity workforce's hiring and retention issues. Currently, many organizations have unfilled cybersecurity positions, and to a lesser degree, their cybersecurity teams are understaffed. Therefore, there is a critical need to develop a new program to help meet the market demand for cybersecurity engineers (CYSE) and personnel. Coppin State University in the United States was responsible for developing a cybersecurity engineering BS degree program. The CYSE curriculum design methodology consisted of three parts. First, the ACM Cross-Cutting Concepts standard's pervasive framework helped curriculum designers and students explore connections among the core courses' knowledge areas and reinforce the security mindset conveyed in them. Second, the core course context was created to assist students in resolving security issues in authentic cyber situations involving cyber security systems in various aspects of industrial work while adhering to the NIST standards framework. The last part of the CYSE curriculum design aspect was the institutional student learning outcomes (SLOs) integrated and aligned in content courses, representing more detailed outcomes and emphasizing what learners can do over merely what they know. The CYSE program's core courses express competencies and learning outcomes using action verbs from Bloom's Revised Taxonomy. This aspect of the CYSE BS degree program's design is based on these three pillars: the ACM, NIST, and SLO standards, which all CYSE curriculum designers should know. This unique CYSE curriculum design methodology will address how students and the CYSE program will be assessed and evaluated. It is also critical that educators, program managers, and students understand the importance of staying current in this fast-paced CYSE field.

Keywords: cyber security, cybersecurity engineering, systems engineering, NIST standards, physical systems

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Authors: M. Johnson, R. Faggian, V. Sposito

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A participatory and engaged approach is key in connecting agricultural managers to sustainable agricultural systems to support and optimize production in Victoria’s food bowl. A sustainable intensification (SI) approach is well documented globally, but participation rates amongst Victorian farmers is fragmentary, and key outcomes and implementation strategies are poorly understood. Improvement in decision-support management tools and a greater understanding of the productivity gains available upon implementation of SI is necessary. This paper reviews the current understanding and uptake of SI practices amongst farmers in one of Victoria’s premier food producing regions, the Goulburn Broken; and it spatially analyses the potential for this region to adapt to climate change and optimize food production. A Geographical Information Systems (GIS) approach is taken to develop an interactive decision-support tool that can be accessible to on-ground agricultural managers. The tool encompasses multiple criteria analysis (MCA) that identifies factors during the construction phase of the tool, using expert witnesses and regional knowledge, framed within an Analytical Hierarchy Process. Given the complexities of the interrelations between each of the key outcomes, this participatory approach, in which local realities and factors inform the key outcomes and help to strategies for a particular region, results in a robust strategy for sustainably intensifying production in key food producing regions. The creation of an interactive, locally embedded, decision-support management and education tool can help to close the gap between farmer knowledge and production, increase on-farm adoption of sustainable farming strategies and techniques, and optimize farm productivity.

Keywords: agriculture, decision-support management tool, Geographic Information System, GIS, sustainable intensification

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Authors: Leila Goosen, Dalize van Heerden

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The performance outcomes of first year Computer Science and Information Technology students across the world are of great concern, whether they are being taught in a face-to-face environment or via distance education. In the face-to-face environment, it is, however, somewhat easier to teach and support students than it is in a distance education environment. The face-to-face academic can more easily gauge the level of understanding and participation of students and implement interventions to address issues, which may arise. With the inroads that Web 2.0 and Web 3.0 technologies are making, the world of online teaching and learning are rapidly expanding, bringing about technologies, which allows for similar interactions between online academics and their students as available to their face-to-face counter parts. At the University of South Africa (UNISA), the Learning Management System (LMS) is called myUNISA and it is deployed on a SAKAI platform. In this paper, we will take a look at some of the myUNISA technologies implemented in the teaching of a first year programming course, how they are implemented and, in some cases, we will indicate how this affects the performance outcomes of students.

Keywords: computer science, Distance Education Technologies, Learning Management System, face-to-face environment

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Authors: Manal Ahmed, Amal Shehata, Shereen Deeb

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The study's purpose was to determine the effect of the perioperative protocol of care on clinical outcomes among patients undergoing coronary artery bypass graft. Subjects: A sample of 100 adult patients who were planned for coronary artery bypass graft, were selected and divided alternatively and randomly into two equal groups (50 study -50 control).The study was carried out at National heart Institute in Cairo and open heart surgical intensive care unit in Shebin El-Kom Teaching Hospital. Instruments: Four instruments were used for data collection: Interviewing questionnaire, dyspnea analogue scale, Biophysiological measurement instrument, and Compliance assessment sheet. Results: There were statistically significant differences between both groups regarding most respiratory system assessment findings at discharge. More than two-thirds of the study group of the current study had a continuous and regular commitment to diet regimen, which ranked first followed by the compliance of daily living activities then quitting smoking. Conclusions: The perioperative protocol of care has a significant improving effect on respiratory findings, dyspnea degree, duration of mechanical ventilation, length of hospital stay, compliance to diet, therapeutic regimen, daily living activities, and quit smoking among study group undergoing CABG. Recommendations: Perioperative protocol of care should be carried out for CABG patients at open-heart surgical units as well as an illustrative colored booklet about CAD, CABG and perioperative care should be available and distributed to all CABG patients.

Keywords: perioperative, effect, clinical outcomes, coronary artery, bypass graft, protocol of care

Procedia PDF Downloads 111

Authors: Jawaher F. Alsharef, Abdullah A. Ghaddaf, Mohammed S. Alomari, Abdullah A. Al Qurashi, Ahmed S. Abdulhamid, Mohammed S. Alshehri, Majed Alosaimi

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Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD=–0.28, 95% CI –0.53 to –0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR= 0.77, 95% CI –0.58 to 1.03). Conclusions: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events.

Keywords: botulinum toxin type A, limb lengthening, distraction osteogenesis, deformity correction, pain management

Procedia PDF Downloads 114

Authors: Hisyam Hidayatullah

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Utilization game on a lesson needs to be done in order to provide proper motoric learning model to improve students' skills. Approach to the game, as one of the models of a motoric learning, is intended to improve student learning outcomes math trigonometry materials generally that prioritize a Memory or rote. The purpose of this study is producting innovation to improve a cognitive abilities of students in the field, to improve student performance, and ultimately to improve student understanding in determining a value of trigonometry in various quadrants, and it apply a approach to the game Domino "Cassava H154M" who is adopted from cassava game and it has made total revised in cassava content. The game is divided into 3 sessions: sine cassava, cosine cassava and cassava tangent. Researchers using action of research method, which consists of several stages such as: planning, implementation, observation, reporting and evaluation. Researchers found that a game approaches can improve student learning outcomes, enhance students' creativity in terms of their motoric learning, and creating a supportive learning environment.

Keywords: cassava "H154M", motoric, value of trigonometry, quadrant

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Authors: Jo Kuys, Kirsten Day

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Improving urban transportation systems requires an emphasis on users’ end-to-end journey experience, from the moment the user steps out of their home to when they arrive at their destination. In considering such end-to-end experiences, human centred design (HCD) must be integrated from the very beginning to generate viable outcomes for the public. An HCD approach will encourage innovative outcomes while acknowledging all factors that need to be understood along the journey. We provide evidence to show that when designing for public transportation, it is not just about the physical manifestation of a particular outcome; moreover, it’s about the context and human behaviours that need to be considered throughout the design process. Humans and their behavioural factors are vitally important to successful implementation of sustainable public transport systems. Through an in-depth literature review of HCD approaches for urban transportation systems, we provide a base to exploit the benefits and highlight the importance of including HCD in public transportation projects for greater patronage, resulting in more sustainable cities. An HCD approach is critical to all public transportation projects to understand different levels of transportation design, from the setting of transport policy to implementation to infrastructure, vehicle, and interface design.

Keywords: human centred design, public transportation, urban planning, user experience

Procedia PDF Downloads 154

Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

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Background: DCIS accounts for 20% of malignancies diagnosed by the breast screening programme and is primarily managed by surgical excision. There is variable guidance on defining excision margins, and adjuvant treatments vary widely. This study aimed to investigate the clinical outcomes for patients following surgical excision of small volume DCIS. Methods: This single-centreretrospective cohort study of 101 consecutive breast screened patients diagnosed with DCIS who underwent surgical excision. All patients diagnosed with DCIS had radiological abnormalities <15mm. Clinical, radiological, and histological data were collected from patients who had been diagnosed within a 5 year period, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Outcomes included re-excision rates, radiotherapy usage, and the presence of invasive cancer. Results: Breast conservation surgery was performed in 94.1% (n=95). Following surgical excision, 74(73.27%)patients had complete DCIS excision (>2mm margin), 4(4.0%) had margins 1-2mm, and 17(16.84%)had margins <1mm. The median size of DCIS in the specimen sample was 4mm. In 86% of patients with involved margins (n=18), the mammogram underestimated the DCIS size by a median of 12.5mm (range: 1-42mm). Of the patients with involved margins, 11(10.9%)had a re-excision, and 6 of these (50%) required two re-excisions to completely excise the DCIS. Post-operative radiotherapy was provided to 53(52.48%)patients. Four (3.97%) patients were found to have invasive ductal carcinoma on surgical excision, which was not present on core biopsy – all had high-grade DCIS. Recurrence of DCIS was seen in the same site during follow-up in 1 patient (1%), 1 year after their first DCIS diagnosis. Conclusion: Breast conservation surgery is safe in patients with DCIS, with low rates of re-excision, recurrence, and upstaging to invasive cancer. Furthermore, the median size of DCIS found in the specimens of patients who had DCIS fully removed in surgery was low, suggesting it may be possible that total removal through VAE was possible for these patients.

Keywords: surgical excision, breast conservation surgery, DCIS, Re-excision, radiotherapy, invasive cancer

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Authors: Svetlana Bialkova, Marnix van Gisbergen

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Advanced Virtual Reality (VR) technologies offer compelling multisensory and interactive experiences applicable in various fields from education to entertainment. However, serious VR applications within the financial sector are scarce, and managing ‘real’ business services with(in) VR is a challenge inviting further investigation. The current research addresses this challenge, by exploring the key parameters influencing the VR business power and the development of appropriate VR applications in real financial business. We conducted profound investigation of both B2B and B2C needs, and how these could be met. In three studies, we have approached experts from leading international banks (finance to computer specialists), and their (potential) customers. Study 1 included focus group discussions with experts. First, participants could experience different VR devices such as Samsung Gear VR, then a structured discussion was held. The outcomes are analyzed and summarized in a portfolio. Study 2 further used the portfolio analyzer to profile the management of real business services with(in) VR. Again experts participated, where first being introduced with Samsung Gear, then experiencing it and being interviewed. Based on the outcomes, a survey was developed to interview (potential) customers and test ideas created (Study 3). The results suggest that developing proper system architectures to connect people and to connect devices is crucial for building up powerful business with(in) VR. From one side, connecting devices, e.g., pairing mobile Head Mounted Displays for VR with smart-phones and/or wearable technologies would be appropriate way “to have” customers anywhere, anytime with a brand and/or business. Developing VR Apps, providing detailed real time visualization of performance and infrastructure types could enable 3D VR navigation, 3D contents viewing, but also being opportunity for connecting people in collaborative platforms. The outcomes of the current research are summarized in a model which could be applied to unlock the real business power of VR.

Keywords: business power, B2B, B2C, VR applications

Procedia PDF Downloads 264