Continuous Supervision Research Articles

Ethical and Regulatory Challenges of Generative Artificial Intelligence in Healthcare: A Chinese Perspective.

To provide practical insights that delve into the ethical issues and regulatory implications of generative artificial intelligence (GenAI) in healthcare. Ethical Challenges and Regulatory Impact in China is used as an example. Despite China's efforts to strike a delicate balance between protecting public welfare and promoting technological advancement, numerous unresolved issues persist in the practical integration of generative artificial intelligence into healthcare settings. Key issues such as data application, privacy protection, cost-effectiveness and regulatory remain areas of ambiguity that require clarification. Stringent ethical guidelines, data privacy protection measures and continuous supervision and evaluation of artificial intelligence decisions will help enhance the expected benefits of GenAI in healthcare. The potential use of GenAI in healthcare has garnered widespread attention, emerging as a significant global research topic. However, its application in this domain presents substantial ethical and regulatory challenges. Compared to other fields, GenAI's role in healthcare is more sensitive and complex, necessitating an urgent assessment of its ethical implications for future development and deployment. Challenges and ethical considerations are particularly pronounced in developing countries with limited healthcare resources.

Iatrogenic Female Genitourinary Fistula in Uganda: Etiology, Twelve-Year Trends, and Risk Factors for Development Following Cesarean Section.

To describe the magnitude and trend of the iatrogenic genitourinary fistula in Uganda, and the risk factors for development following the Cesarean Section (CS). A retrospective review of charts of women with a confirmed diagnosis of genitourinary fistula at four regional fistula repair sites in Uganda between 2010 and 2021 was conducted. A fistula was classified as iatrogenic if it was; ureteric, vesico-cervical, vesico-uterine, or vaginal vault fistula that followed an obstetric or gynecological surgery. The annual proportions for the ischemic and iatrogenic fistula over the study period were compared. A sub group analysis of women with genitourinary fistula delivered by CS was done to determine the factors associated with iatrogenic fistula. Multivariable log binomial regression was performed to determine the independent risk factors. There were 521 women who presented with genito-urinary fistula of which, 169 (32.4%) were iatrogenic. Most of the iatrogenic fistulae followed CS (71%). The proportions of iatrogenic fistulae increased from 8/52 (9.6%) in 2010 to 38/88 (43.2%) in 2020. The risk factors for iatrogenic fistula following CS were; Grand-multiparity (OR = 5.8; 95% CI: 2.1-15.4), Repeat CS (OR = 4.1; 95% CI: 1.8-9.3), CS performed by an intern doctor (OR = 4.8; 95% CI: 1.5-15.5) and CS done at a Health Centre IV (OR = 4.5; 95% CI: 1.2-16.7). The magnitude of the iatrogenic genitourinary fistula in Uganda is high and most follow CS. There is an observed rising trend in iatrogenic fistula. The risk factors for iatrogenic fistula following CS are grandmultiparity, repeat CS, CS performed by intern doctors and CS performed at lower health facilities. There is a need for continuous training and supervision of lower cadre doctors involved in CS to reduce on the rising trend of iatrogenic fistula.

Hospital waste management system in Kermanshah: challenges, future and sustainable management with circular economy

Proper hospital waste management poses important concerns due to the risk capacity of hospital waste to health and the environment. Healthcare management approaches have changed in recent years, motivated by the desire to minimize the environmental impact. The review aims to examine the current HCW and considers the local challenges associated with establishing a circular economy (CE) to improve hospital waste management regarding training along Plan, Do, Check, and Act (PDCA). The study found that mean medical and general waste segregation rates in public hospitals were 50.15 and 49.85, respectively. On average, 3.6 kg of waste was generated per bed per day. Analysis revealed a significant correlation between total waste and infectious waste with the number of occupied beds in the hospital (p < 0.05). Updating national laws by the CE approach is necessary. Our insights into circular hospital waste urge establishing a green management team, new training methods, and continuous supervision. Using PDCA to enhance waste segregation, training, and other aspects of hospital waste management is vital.

Feasibility of Employing mHealth in Delivering Preventive Nutrition Interventions Targeting the First 1000 Days of Life: Experiences from a Community-Based Cluster Randomised Trial in Rural Bangladesh.

An Android platform-based customised app and web-linked system was developed to aid in implementing selected nutrition interventions by community health workers (CHWs) in a community-based cluster randomised trial (c-RCT) in rural Bangladesh. Here, we describe the architecture of the intervention delivery system, and explore feasibility of employing mHealth as CHWs' job aid, employing a mixed-method study design covering 17 visits per mother-child dyad. We analysed CHWs' real-time visit information from monitoring and documentation data, and CHWs' qualitative interviews to explore the advantages and barriers of using mHealth as a job aid. Intervention coverage was high across the arms (>90%), except around the narrow perinatal period (51%) due to mothers' cultural practice of moving to their parents' homes and/or hospitals for childbirth. CHWs mentioned technical and functional advantages of the job aid including device portability, easy navigability of content, pictorial demonstration that improved communication, easy information entry, and automated daily scheduling of tasks. Technical challenges included charging tablets, especially in power cut-prone areas, deteriorated battery capacity over continuous device usage, unstable internet network in unsupportive weather conditions, and device safety. Nevertheless, onsite supervision and monitoring by expert supervisors remained important to ensure intervention quality. With appropriate training and supervision, CHWs utilised the tablet-based app proficiently, attaining high coverage of long-term visits. mHealth was thus useful for designing, planning, scheduling, and delivering nutrition interventions through CHWs, and for monitoring and supervision by supervisors. Therefore, this application and job aid can be adopted or replicated into the currently developing national health systems platform for improving coverage and quality of preventive maternal and child nutrition services. In addition, continuous supportive supervision by skilled supervisors must be accompanied to ensure CHWs' task quality. Finally, future studies should rigorously assess undesirable health and environmental effects of mHealth before and after mainstreaming, effective interventions addressing device-induced health hazards should be designed and scaled up, and effective e-waste management must be ensured.

A-331 Monitoring Operators Proficiency at Point of Care is Crucial for Reliable Patient Values. A Practical Example with Patient Blood Chloride, Potassium and Sodium Measurands Assayed with i-STAT®

Abstract Background While i-STAT® cartridges offer the Physician a spectrum of analytical methods at the point of care for prompt diagnosis and interventions, these methods have to be harmonized with the laboratory methods in order to reliably detect shifts and trends. With this practical example we illustrate the importance of a program of routine comparisons between the i-STAT® and laboratory methods to detect analytical differences exceeding the CLIA’s criterion and potentially having adverse clinical implications. Methods Patient blood chloride (Cl), potassium (K) and sodium (Na) values as obtained by nurses with i-STAT Chem 8 ™ cartridges (Abbott Laboratories) at the point of care, where daily compared with the values as obtained with the Laboratory method (two cobas 6000®, Roche Diagnostics) using green top BD® lithium heparin tubes (Becton Dickinson) collected within thirty minutes of the i-STAT assay. The data were electronically stored in RALS™ (RALS Informatics) and transferred to Minitab® (Version 21, Minitab Inc.) statistical software. The two analytical methods were compared using the orthogonal and the polynomial ordinary least squares (POLS) regression models and their graphic representations. The aptness of the methods was evaluated with the standardized residuals diagnostics for normality, independence, outliers (Standardized residual &amp;gt;|3|) and influential observations (Hi&amp;gt;0.5). For acceptance of the differences the CLIA’s total error criterion was employed. (CI: target value ± 5%; K: target value ± 0.5 mmol/L; Na: target value ± 4 mmol/L). Results In the first four months of the study the number of differences exceeding the CLIA’s criterion was not acceptable. [Cl: 10% (165/1564); K: 7% (109/1593); Na: 4% (66/1586)]. These differences were occurring throughout the analytical range (AMR). Consequently, the operator’s technique was suspected and the POCT senior technologists (CA, FA) adopted operator specific interventions. This strategy was effective in the following month and the improvements were maintained for seven consecutive months. Monthly differences exceeding the CLIA’s criterion decreased significantly [Cl:1.9% (52/2777): K:0.9% (25/2868): Na:0.5% (15/2896)]. This was clearly illustrated with the dot plot by date and the parallel box plots by month. Regression analysis showed that the orthogonal and the OLS models were equivalent. Cl: Orthogonal y=1.7+0.99x, OLS y=12+0.88x. K; Orthogonal y=0.2+1.2x, OLS y=0.1+0.96x. Na: orthogonal y=3+0.98x, OLS y=14+0.9x. Additionally, the POLS model showed a linear relationship within the AMR intervals with few outliers (Cl=11; K=7; Na=9), no influential observations (Hi&amp;lt;0.5) and equality of monthly regression lines (P&amp;gt;0.05). Conclusions The implementation of daily comparisons between patient values as obtained with the i-STAT method and those as obtained by the Laboratory method in the interval of thirty minutes, allowed the identification of individual operators requiring additional training. This strategy ensured reliable performance for eight consecutive months. This study clearly showed that the addition of continuous supervision and training of operators to quality control and quality assurance practices, ensured the interchangeability of patient values as obtained with i-STAT and those as obtained with the Laboratory method. Electronic collection of data and analysis with appropriate statistical software, such as Minitab, was crucial for the implementation of this program.

WhatsApp: A Blessing or Bane for Communication between Emergency Physicians and Vascular Surgeons?

Abstract The integration of WhatsApp (WhatsApp Inc., Mountain View, CA, USA) into the health-care sector is transforming the dynamics of medical communication. Launched in 2009 and incorporated into the Facebook suite of companies in 2014, WhatsApp has become a pivotal platform for health-care professionals. It allows for quick, personal, and group messaging, which is increasingly used to exchange patient information, discuss cases, and make timely decisions. The app’s end-to-end encryption is critical for maintaining patient confidentiality, ensuring that sensitive data are only accessible to the intended recipients. This security feature and the group sharing format enable health-care teams to communicate confidentially and efficiently, bolstering the oversight capabilities of attending senior consultants or physicians over their junior peers. The real-time exchange of information is crucial in providing continuous supervision and facilitating immediate feedback, which is indispensable in clinical training and patient care. However, the widespread adoption of WhatsApp also comes with challenges and potential drawbacks, which have been the focus of past research. These studies assessed the impact of WhatsApp on health-care delivery, considering both the enhancement of communication it offers and the issues it may present, such as data security beyond encryption and the blurring of professional and personal boundaries. In this “medical opinion” from an academic tertiary care center in Muscat, we explored how emergency medicine physicians can effectively use WhatsApp to expedite or bypass referral processes for emergency cases, particularly those involving vascular and other surgical emergencies.

Machine learning approaches for improving atomic force microscopy instrumentation and data analytics

Atomic force microscopy (AFM) is a part of the scanning probe microscopy family. It provides a platform for high-resolution topographical imaging, surface analysis as well as nanomechanical property mapping for stiff and soft samples (live cells, proteins, and other biomolecules). AFM is also crucial for measuring single-molecule interaction forces and important parameters of binding dynamics for receptor-ligand interactions or protein-protein interactions on live cells. However, performing AFM measurements and the associated data analytics are tedious, laborious experimental procedures requiring specific skill sets and continuous user supervision. Significant progress has been made recently in artificial intelligence (AI) and deep learning (DL), extending into microscopy. In this review, we summarize how researchers have implemented machine learning approaches so far to improve the performance of atomic force microscopy (AFM), make AFM data analytics faster, and make data measurement procedures high-throughput. We also shed some light on the different application areas of AFM that have significantly benefited from applications of machine learning frameworks and discuss the scope and future possibilities of these crucial approaches.

Bariatric and metabolic surgery, different surgical techniques and their implications

Introduction: The global increase in obesity has generated an increasing prevalence of this health condition, associated with various clinical conditions. Obesity management may include lifestyle changes, medication use or surgical intervention, such as bariatric surgery. Among the surgical techniques most used in this context, the gastric bypass procedure stands out, recognized for its effectiveness in reducing weight and improving associated comorbidities. Methodology: A bibliographic review was carried out in the PubMed database, covering articles published between 2010 and 2022. The search used key terms such as "gastric bypass", "obesity", "comorbidities" and "effects". Results and Discussion: The analyzes carried out in the studies showed that the gastric bypass procedure proves to be an effective strategy in the management of obesity, promoting a significant reduction in weight and contributing to the improvement of coexisting conditions such as diabetes, high blood pressure, dyslipidemia and sleep apnea. Additionally, gastric bypass has favorable effects on quality of life and reduced mortality rates. Although its effectiveness is notable, the indication for gastric bypass requires careful evaluation, taking into account the severity of obesity and the presence of coexisting conditions. Raising patients' awareness of the risks and benefits of this procedure is imperative, as is the need for post-surgery follow-up by a multidisciplinary team. Conclusion: The gastric bypass procedure emerges as a safe and effective option in the treatment of obesity, having a positive impact on weight reduction, improving coexisting conditions and the quality of life of patients. However, the importance of careful selection for the indication of this technique is highlighted, as well as continuous supervision by a multidisciplinary post-surgery team.

Pelaksanaan Manajemen Kurikulum dalam Meningkatkan Mutu Pendidikan di MIS Al-Hikmah Namorambe

This research aims to evaluate the implementation of curriculum management in improving the quality of education at MIS Al-Hikmah Namorambe. This study uses a qualitative descriptive method, with data collection techniques through observation, interviews, and documentation. The results show that well-planned curriculum planning, regular teacher training, and effective supervision significantly contribute to improving the quality of education. Supporting factors such as students, social, political, economic, and technological aspects as well as challenges such as limited facilities and lack of teacher supervision were also identified. In conclusion, good curriculum management implementation, supported by internal and external meetings as well as continuous training and supervision, is effective in improving the quality of education at MIS Al-Hikmah Namorambe.

Implementation of Evacuation Training in Emergency Situations to Improve Ship Passenger Safety on KMP Jatra 2

The incidence of accidents and occupational diseases is still quite high. Various ship incidents include sinking, collision, fire, aground, people falling overboard, steering damage, and pollution at sea. as well as work accidents during duty on the ship, generally caused by human factors or human error. The purpose of this study is to find out the emergency drills on the ship, based on SOLAS on the KMP Jatra 2 ship and to find out how to handle problems in maximizing job training to each crew member according to SOLAS and SOP regulations. The results of this study found that emergency training on board KMP Jatra 2 is not running properly due to lack of consistency in following the SOP and SOLAS standards that have been set. To deal with this problem, several steps need to be taken, namely good HR policies, implementation of a punishment system for undisciplined crew members, regular training and realistic simulation of emergency situations, continuous supervision and evaluation of training implementation.

Prevalence and outcome of puerperal sepsis among mothers in Nigeria: A five-year retrospective study

BackgroundPuerperal sepsis is one of the leading causes of maternal illness and mortality in low- and middle-income countries, despite advances in diagnosis, antimicrobial therapy, and medical management. AimThis study aimed to assess the prevalence and outcomes of puerperal sepsis in tertiary hospitals in Ondo State, Nigeria. MethodsThis retrospective cross-sectional study was conducted at a tertiary hospital in Ondo State. Total enumerative sampling was used to select patients diagnosed with puerperal sepsis between 2016 and 2020. An adapted structured checklist was used to retrieve data from patients’ medical records. Data analysis was performed using SPSS version 25. Descriptive and inferential statistics were used to analyze the results. FindingsOut of 7980 obstetric cases managed during the study period, 156 patients had puerperal sepsis with a prevalence rate of 2%. The majority of patients were unregistered and were referred from other health facilities (94.2%). Other significant risk factors identified were postpartum hemorrhage (60.9%), prolonged labor (14.1%), premature rupture of membranes (19.9%), and lacerations (5.1%). Of the 156 patients diagnosed with puerperal sepsis, 151 (96.8%) were treated and discharged, while five (3.2%) died due to complications. Furthermore, a strong correlation was found between the mode of delivery and outcomes of puerperal sepsis (P ​= ​0.03). ConclusionsPuerperal sepsis remains a major public health concern. Therefore, there is a need to promote prenatal care and ensure continuous supervision and monitoring of birthplaces/delivery centers in Nigeria.

ACCELERATING STUDENT COMPETENCY IN ENGLISH THROUGH EFFECTIVE LEARNING MANAGEMENT: INSIGHTS FROM MAN 2 MATARAM

This study examines the implementation of an English learning management system aimed at accelerating student competency at MAN 2 Mataram. This study analyzes aspects of planning, organizing, implementing, and controlling in the English learning process in an accelerated program tailored for language track students. Using a qualitative approach, data were collected through observation, interviews, and document analysis at MAN 2 Mataram, a leading Islamic high school in Mataram. The findings indicate that effective planning and organizing are essential to adapting the curriculum to the needs of diverse students, especially those with high cognitive abilities. The English curriculum is tailored to emphasize essential materials, allowing students to learn in an accelerated manner without being distracted by less relevant content. The implementation is supported by motivated and well-trained teachers, who use a variety of teaching methods to encourage active learning. However, this study identified several challenges, including limited resources and varying levels of student readiness, which were addressed through targeted interventions and continuous teacher supervision. This study concludes that a well-managed learning system, supported by a strong curriculum and effective teaching strategies, can significantly improve students' competency in English, especially in an accelerated learning environment. These findings provide valuable insights for educators and policy makers aiming to improve educational outcomes in similar contexts.

The effect of the antibiotic stewardship program (ASP) on community-acquired pneumonia (CAP): a before-after study.

Background: Community-acquired pneumonia (CAP) is one of the leading causes of death worldwide. Antibiotic stewardship program (ASP) has been implemented to improve rational and responsible antibiotic use by encouraging guideline adherence. Objective: This retrospective observational before-after study aimed to evaluate whether the ASP may improve guideline adherence, antibiotic exposure, and clinical outcomes in patients hospitalized due to CAP in Hungary. Methods: The study was conducted at a pulmonology department of a tertiary care medical center in Hungary. The ASP implementation consisted of written and published guidelines available to all professionals, continuous supervision, and counseling services on antibiotic therapies at an individual level, with the aim of ensuring compliance with CAP guidelines. Overall guideline adherence (agent selection, route of administration, and dose), clinical outcomes (length of stay and 30-day mortality), antibiotic exposure, and direct costs were compared between the two periods. Fisher's exact test and t-test were applied to compare categorical and continuous variables, respectively. P-values below 0.05 were defined as significant. Results: Significant improvement in overall CAP guideline adherence (30.2%), sequential therapy (10.5%), and a significant reduction in the total duration of antibiotic therapy (13.5%) were observed. Guideline non-adherent combination therapies with metronidazole decreased significantly by 28.1%. Antibiotic exposure decreased by 7.2%, leading to a significant decrease in direct costs (23.6%). Moreover, the ASP had benefits for clinical outcomes, and length of stay decreased by 13.5%. Conclusion: The ASP may play an important role in optimizing empirical antibiotic therapy in CAP having a sustained long-term effect.

Case of vector-borne coinfection in a dog

Vector-borne diseases (VBD) in dogs, such as babesiosis, ehrlichiosis, anaplasmosis, and dirofilariasis, pose a significant threat to animal health in many regions worldwide, including Ukraine. These diseases are transmitted through the bites of ectoparasites, such as ticks and mosquitoes. With increasing urbanization, climate change, and population migration, the risk of spreading these diseases is significantly heightened. This article is dedicated to the case analysis of a dog in Ukraine diagnosed with two vector-borne diseases simultaneously, focusing on the clinical manifestations and diagnostic approaches for these conditions. Currently, the prevalence of VBD in dogs in Ukraine is insufficiently studied. There are only sporadic reports of isolated pathogens, with comprehensive information needing to be included. A case of concurrent dirofilariasis and babesiosis in a dog is presented. In the spring of 2024, an 8-year-old intact male German shepherd was brought to a veterinary clinic in Kamianets-Podilskyi due to general weakness. Clinical signs included fever, vomiting, slightly pale mucous membranes, and a mild cough. Following abdominal ultrasound and blood sample collection, anti-inflammatory and antiemetic medications were prescribed. A blood smear revealed Babesia canis and treatment with imidocarb was initiated. However, after a week, the dog's condition did not improve. A repeat blood test detected live microfilariae, and the CaniV-4 test identified antibodies to D. immitis, confirming dirofilariasis. Molecular studies corroborated the diagnosis. Follow-up echocardiography and radiography did not reveal visible adult worms in the heart. The dog was treated with melarsomine and a combination of imidacloprid and moxidectin. Two months later, follow-up blood tests showed no presence of microfilariae, and all blood and biochemical parameters were within normal ranges. The dog was under continuous veterinary supervision for the following months. Overall, there is a noticeable trend in the increase of VBD among dogs in Ukraine, necessitating heightened attention from veterinary services and pet owners. Regular preventive measures, such as ectoparasite control and health monitoring, are crucial for managing the spread of these diseases.

The Role of Academic Supervision in Controlling the Curriculum

Academic supervision plays a crucial role in controlling and ensuring the quality of the curriculum in educational institutions. The main purpose of academic supervision is to monitor, evaluate, and improve the implementation of the curriculum so that it can meet the educational standards that have been set. This supervision process involves various activities such as classroom observation, teacher performance assessment, analysis of student learning outcomes, and constructive feedback to teaching staff. Through effective supervision, educational institutions can identify strengths and weaknesses in curriculum implementation, as well as develop relevant improvement strategies. In addition, academic supervision also serves as a quality control mechanism that ensures that the curriculum remains relevant to the development of science and the needs of society. The results of the study show that structured and continuous academic supervision can improve the quality of teaching, motivate.

Pentingnya Membangun Hubungan Antar Kualitas Pribadi Konselor Dan Kualitas Pribadi Konseling

This research aims to explore the importance of building a relationship between the personal qualities of a counselor and the personal qualities of counseling in the context of counseling services. Through a qualitative approach, data was collected through in-depth interviews with counselors who have experience in the field of counseling. Data analysis was conducted using content analysis method. The results of the study indicate that the relationship between the personal qualities of the counselor and the personal qualities of counseling has a significant impact on the effectiveness of counseling services. The personal qualities of the counselor, such as empathy, patience, and honesty, contribute to the creation of a positive relationship with clients, which in turn enhances counseling outcomes. The implications of this research highlight the importance of developing the personal qualities of counselors through continuous training and supervision to improve the effectiveness of counseling services

Comprehensive Pulmonary Rehabilitation for Patients with Malignant Pleural Mesothelioma: A Feasibility Pilot Study.

Malignant pleural mesothelioma (MPM) represents a significant health burden, with limited treatment options and poor prognosis. Despite advances in pharmacological and surgical interventions, the role of rehabilitation in MPM management remains underexplored. This study aims to assess the feasibility of a tailored pulmonary rehabilitation intervention addressing physical and respiratory function in MPM patients. A prospective pilot study was conducted on surgically treated MPM patients referred to a cardiopulmonary rehabilitation service. The intervention comprised multidisciplinary educational sessions, physical rehabilitation, and respiratory physiotherapy. Feasibility was evaluated based on dropout rates, adherence to the rehabilitation program, safety, and patient-reported outcomes. Twelve patients were initially enrolled, with seven completing the study. High adherence to physical (T1: 93.43%, T2: 82.56%) and respiratory (T1: 96.2%, T2: 92.5%) rehabilitation was observed, with minimal adverse events reported. Patient satisfaction remained high throughout the study (GPE scores at T1: 1.83 ± 1.17; T2: 2.0 ± 1.15), with improvements noted in physical function, pain management, and health-related quality of life. However, some issues, such as time constraints and lack of continuous supervision, were reported by participants. This pilot study demonstrates the feasibility and potential benefits of a tailored pulmonary rehabilitation intervention in MPM patients. Despite its promising outcomes, further research with larger samples is warranted to validate its efficacy and integrate rehabilitation as a component into the multidisciplinary management of MPM.

Dual Education: A methodology Used in the Professional Secretariat School for developing workplace competencies during 2023

The Dual Professional Training Project of the Professional Secretarial School (ESP) of the National University since 2000 and is implemented in the diploma program of the two careers Commercial Education and Office Administration, which provide work spaces for students to acquire certified professional experience and, at the same time, develop labor and social competencies, through the combination of theory and practice. Continuous supervision of the participants is carried out, as well as interviews and focus groups to learn about the experiences of this modality in the year 2023, which were the acquisition of knowledge in the area of technology with the use of platforms, programs and databases; the execution of techniques through the development of document types and file management; and participation in areas complementary to their training, such as training and handling of confidential information, in addition to the skills put into practice, for example, teamwork, assertive communication and creativity. The teaching staff of the ESP has pedagogical training and experience in the technical area, necessary to complement the work developed by the tutors within the companies, which have the disposition and resources to participate in this modality.

Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design

BackgroundIntegrated Community Case Management (ICCM) of common childhood illness is one of the global initiatives to reduce mortality among under-five children by two-thirds. It is also implemented in Ethiopia to improve community access and coverage of health services. However, as per our best knowledge the implementation status of integrated community case management in the study area is not well evaluated. Therefore, this study aimed to evaluate the implementation status of the integrated community case management program in Gondar City, Northwest Ethiopia.MethodsA single case study design with mixed methods was employed to evaluate the process of integrated community case management for common childhood illness in Gondar town from March 17 to April 17, 2022. The availability, compliance, and acceptability dimensions of the program implementation were evaluated using 49 indicators. In this evaluation, 484 mothers or caregivers participated in exit interviews; 230 records were reviewed, 21 key informants were interviewed; and 42 observations were included. To identify the predictor variables associated with acceptability, we used a multivariable logistic regression analysis. Statistically significant variables were identified based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value. The qualitative data was recorded, transcribed, and translated into English, and thematic analysis was carried out.ResultsThe overall implementation of integrated community case management was 81.5%, of which availability (84.2%), compliance (83.1%), and acceptability (75.3%) contributed. Some drugs and medical equipment, like Cotrimoxazole, vitamin K, a timer, and a resuscitation bag, were stocked out. Health care providers complained that lack of refreshment training and continuous supportive supervision was the common challenges that led to a skill gap for effective program delivery. Educational status (primary AOR = 0.27, 95% CI:0.11–0.52), secondary AOR = 0.16, 95% CI:0.07–0.39), and college and above AOR = 0.08, 95% CI:0.07–0.39), prescribed drug availability (AOR = 2.17, 95% CI:1.14–4.10), travel time to the to the ICCM site (AOR = 3.8, 95% CI:1.99–7.35), and waiting time (AOR = 2.80, 95% CI:1.16–6.79) were factors associated with the acceptability of the program by caregivers.Conclusion and recommendationThe overall implementation status of the integrated community case management program was judged as good. However, there were gaps observed in the assessment, classification, and treatment of diseases. Educational status, availability of the prescribed drugs, waiting time and travel time to integrated community case management sites were factors associated with the program acceptability. Continuous supportive supervision for health facilities, refreshment training for HEW’s to maximize compliance, construction clean water sources for HPs, and conducting longitudinal studies for the future are the forwarded recommendation.

Performance evaluation of deep learning approaches for fault diagnosis of rotational mechanical systems using vibration, sound, and acoustic emission signals

The present study emphasizes an optimized deep learning algorithm for gearbox fault detection using vibration, sound, and acoustic emission signals. Statistical and acoustic features are extracted from these signals, and various neural network algorithms are explored. The supervised deep feed forward neural network (DFFNN) demonstrates excellent performance with vibration signals but limited accuracy with sound and acoustic emission signals. To address this, unsupervised algorithms are optimized and compared with vibration-based classification. The findings show that unsupervised neural networks, particularly the auto-encoder and stacked auto-encoder architectures, achieve improved classification accuracy by leveraging the unique characteristics of acoustic emission signals. The unsupervised models also effectively overcome the vanishing gradient problem via regularization, enhancing their training efficiency. The stacked auto-encoder, with multiple layers of encoders and decoders, reduces computation time by 40% and memory consumption. These optimized algorithms hold promise for automated fault detection systems. The auto-encoder and stacked auto-encoder, utilizing vibration, sound, and acoustic emission signals, offer enhanced classification accuracy and can facilitate real-time monitoring of rotating mechanical systems. However, further optimization is needed to maximize their performance. In a nutshell, the supervised DFFNN excels in utilizing vibration signals for fault detection, while the unsupervised models exploit the distinctive characteristics of acoustic emission signals. Future research will focus on refining these algorithms to enhance their effectiveness. Implementing these optimized deep learning approaches can lead to autonomous fault detection systems, eliminating the need for continuous human supervision.