Public District Research Articles

Bacterial etiology among diarrheal cases

Objectives The main objective of this article was to check the bacterial etiology to find out the routes of infection, which might help with control strategies. As Nalbari is one of the most common flood-affected districts in Assam, India, we chose Nalbari district as our study area. The socioeconomic factor enhances the transmission of bacteria easily, as every year during floods, pictures of water from neighboring hilly states or countries (e.g., Bhutan)—rain, waterlogging, and more—are seen. Material and Methods Stool samples or rectal swabs were collected from the patients who had reported to the District Public Health Laboratory(DPHL) with acute diarrheal disease in Nalbari. Patients or their attendant’s consent was collected prior to collecting samples. Samples were processed for culture, gram stain microscopy, and biochemical tests to isolate the organism. Results Test results showed Escherichia coli (E. coli) 40.95%, Salmonella 2.86%, Shigella 1.42%, and Campylobacter 0.48%. No other bacteria were isolated during the study period. Maximum cases were reported during the rainy season. Conclusion E. coli can transmit through fecal-oral means; Salmonella through contaminated food, water, contact with infected people/animals, and so on; Shigella through fecal-oral, contaminated food, water, oral-anal sexual routes, and more; and Campylobacter through contaminated or raw food, milk, water, and so on. This study concludes that water can easily transmit bacteria to other people. Health hygiene, economic condition, living behavior, awareness, and administration’s activities all might play an important role in minimizing this burden. Making plans prior to flood by administration and more research studies can help in controlling this disease burden.

Factors, barriers and adherence of nurses to patient education in public hospitals of Lanao del Sur, Philippines

Introduction: Patient education is a core responsibility in nursing, vital for improving patient understanding and active participation in their healthcare decisions. There are various factors that impact nurses' ability to provide patient education, but little is known about how these factors influence adherence in public hospitals, particularly in resource-limited settings. This study investigates nurses' adherence to patient education protocols in Lanao del Sur, Philippines, while evaluating facilitating factors and barriers. Methods: This study employed a quantitative, descriptive, cross-sectional correlational research design. Seventy-six nurses from two public district hospitals participated. Data were gathered through surveys on demographics, adherence to patient education, facilitators, and barriers. Correlation analyses, including Pearson’s correlation and Spearman’s rho, assessed relationships between variables, with Cramer’s V used for categorical data. Statistical significance was set at α = 0.05. Results: Most participants were married females aged 31-40, with incomes of 10,000-39,000 PHP, college-educated, and assigned to wards, with 3 months to 3 years of tenure. Nurses acknowledged the importance of patient education and identified 14 barriers. Adherence to patient education showed negative correlations with age, income, educational attainment, and tenure, but positive correlations with gender, marital status, and area of assignment. Facilitating factors positively correlated with adherence, as did barriers. Conclusions: Identifying factors affecting nurses' adherence to patient education is vital for improving these practices. Findings will support the Nursing Patient Education Development Program, enhancing patient education in Lanao del Sur's public hospitals.

Evaluation of the Use of Methylation as a New Tool for the Diagnostics and Progression of Squamous Intraepithelial Lesions.

Vaccination against human papillomavirus (HPV) significantly reduces the incidence of HPV-related lesions worldwide. Considering the increasingly young age of patients in gynecological offices and earlier sexual initiation and potential contact with the HPV virus, doctors need the tools to verify diagnoses. Currently, women plan to pursue motherhood later, so it is necessary to consider whether sexual treatment in the form of, among others, loop electrosurgical excision procedures (LEEPs) may increase the risk of premature birth or difficulty dilating the cervix during labour. For this reason, to avoid the overtreatment of low-grade squamous intraepithelial lesions (LSILs), methylation testing may be considered. In patients with histopathologically confirmed high-grade squamous intraepithelial lesions (HSILs) during biopsy and, ultimately, a lower diagnosis, i.e., LSIL or no signs of atypia, methylation was found to be a useful tool. We performed a Pap smear, HPV genotyping, a punch biopsy, LEEP-conization (if needed), and methylation tests on 108 women admitted to the District Public Hospital in Poland. Women with a negative methylation test result were significantly more likely to be ultimately diagnosed with LSIL (p = 0.013). This means that in 85.7% of the patients with HSIL, major cervical surgery could be avoided if the methylation test was negative. Methylation testing, as well as dual-staining and diagnostics detecting the mRNA transcripts of highly oncogenic types of HPV, might be used in the future in the diagnosis of pre-cancerous conditions, mainly of the cervix, and in HPV-dependent cervical cancer screening. The methylation test may also be used in the diagnosis and identification of lesions within the cervical canal, including those located deep within the frontal crypts, not visible even during a professional colposcopic evaluation of the cervix.

Possibility of Integrated Planning for Parks, Greenbelts and Street Space in South Korea

Background and objective: Planning for parks and greenbelts is crucial in public housing district plans. This study was conducted to explore the possibility of expanding parks and greenbelts by adjusting street space according to legal bases and suggest a model for expanding parks and greenbelts by reducing the area of roads in new town planning.Methods: The research site, Public Housing District ‘Wangsuk 2’ near Seoul City, is part of the 3rd Phase New Towns. It is being developed according to the government’s policy to expand the housing supply in the Seoul metropolitan area. The legal possibilities related to land, housing, and roads were reviewed, the site was analyzed through the land use plan of Wangsuk 2, and an integration model was developed, applied, and evaluated.Results: An integrated street park model was designed, which integrates sidewalks, bicycle lanes, and planting strips planned as part of road facilities with adjacent parks or greenbelts. The road sections of the site that require the improvement of street space were selected for the model application. As a result of the simulation, the total length of the integrated street parks was about 4 km, the area of parks and greenbelts expanded by 15,901 m², increasing the ratio of park and greenbelt area by 0.7%, and the ratio of road area decreased from 17.1% to 16.4%.Conclusion: Integrated street parks expand green space in new town development while providing a safe and comfortable passage for visitors, pedestrians, bicycle/PM users, and drivers. This study is significant in that it presents an alternative to expanding green space that can improve street space and urban environment, which residents can experience daily.

INFLUENCE OF UTILIZATION OF INFORMATION AND COMMUNICATION TECHNOLOGY TOOLS IN TEACHING PHYSICS ON STUDENT COMPETENCES IN PUBLIC DAY LOWER SECONDARY SCHOOL IN RWANDA A CASE OF KICUKIRO DISTRICT

The adoptions of ICT tools in education have gained significant attention globally due to their potential to enhance teaching and learning experiences. This study aims to examine the influence of ICT tools in teaching Physics on student competence in public day schools in Kicukiro District, Rwanda. The study has three specific objectives which are to assess the influence of multimedia on students competences in Physics in lower secondary schools of Kicukiro district, to evaluate the influence of computer based simulation on students competences in Physics in public lower secondary schools in Kicukiro district and to determine the influence of virtual experiment on students competence in Physics on lower public secondary school of Kicukiro district. The finding of this study was offered insight to teachers, school administrators, education policies makers and ICT industry for working better in globalized digital age. The study was also provided valuable insights for policymakers and educators to enhance the teaching and learning of Physics in public schools through the effective use of ICT tools. The selection of participants for this study were employed various methods including both simple random and purposive sampling techniques. The study gathered data through questionnaire with Likert scale statements and interview guide. Specifically, thequestionnaire were made for students while interview guides were designed for head teacher and teachers of Physics. The studys population was 11994 people consist of 26 head teachers, 38 teachers of Physics and 11930 Students from all of the Kicukiro Districts lower public secondary school. The study utilized descriptive survey design to analyses data and examines relationship between ICT tool and student competence. A sample size of 387were chosen by using Yamane formula. The selection of participants for this study were employed various methods including both simple random for 387 students and purposive sampling techniques for 24 head teachers and 34 teachers of Physics. The analysis procedure involved the use of descriptive statistics. Each item from questionnaire and interview were systematically categorized.Theresultsshowedthatthereisastatisticallysignificantrelationship(r=.865, p < .01) between use of multimedia and conceptual understanding and retention of knowledge in public lower secondary schoolsofKicukiro District. Furthermore, according to the findings, there is a strong positivecorrelation (r = .802, p < .01) between simulation and engagement in learning experiences. Finally, the results indicate that there is a moderate to strong positive correlation(r = .735, p < .01) use of virtual experiment and improved score in examination. The findings revealed that simulation and multimedia were prevalent with high participation rate among students. Researcher recommend several key included student to utilize simulation and multimedia as new tools especially STEM will enhance engagement and a standardized evaluation framework based on the discoveries that every student felt that ICT tools improved their competence in Physics. This framework would enable a systematic assessment of the impact of utilize ICT tools in teaching. Based on findings that students highly valued their using ICT tools and perceived them as beneficial, organizing a national curriculum can further incentivize schools to invest in high-quality program.

Analysis of the types of death before and after public prosecutor's investigations in Baden-Württemberg

Difficulties in diagnosing the cause of death have been widely discussed in the literature. However, studies on the quality assurance of the determination of the manner of death and the results of public prosecutor investigations are rare. In this study, data from six public health departments in Baden-Württemberg on all deaths from 2016-2018 were analyzed. Significant differences were found between the individual public prosecutor's districts with regard to the type of death determined during the medical post-mortem examination. In 6.3 [4.5-7.4]% of all deaths, the public prosecutor's offices initiated investigations. In 6.0 [4.3-8.5]% of these investigations, an autopsy was performed. A significant difference between the public prosecutor's districts could not be demonstrated in this regard.

The Role of Nursing Guidelines on Successful License Renewal for Nurses and Midwives in Ubungo District Public Hospitals in Tanzania

In the recent years, nurses and mid wives are struggling to keep their knowledge current knowledge and skills current and relevant through to changing requirements and situations. Through engaging in continuing professional development (CPD), care givers become updated knowledge and practice to provide quality care to patients. This study sought to unveil the role of CPD on license renewal of midwives and nurses with a special focus on Ubungo district as Ubungo has more health Centres as compared to other districts in Dar es Salaam. Specifically, the study sought to determine the role of nursing guidelines on successful license renewal for Nurses and Midwives in Ubungo District Public Hospitals, The study was guided by the Kirkpatrick Model as the theoretical framework. The study used descriptive research design while simple random and purposive sampling techniques were used to select members of sample size who were 99 respondents. The target population of the study included all public hospitals, dispensaries and health centres located in the Ubungo district. The data was collected using documents review, in-depth interview, and structured interviews, and then analyzed using content analysis, narrative analysis, and descriptive analysis. Findings revealed that the CPD acquisition and license renewal guidelines are available at the Tanzania nursing and midwifery council(TNMC) website, however, they require registration and login to access them. The license acquisition process was through paper document submission at the TNMC office and later on changed to online in 2022. Apart from insufficient computers and limited internet access, some challenges result from nurses and midwives negative attitude towards license renewal as they tend to not renew them until there is a tactical advantage such as a promotion. Management staff at the hospitals also does not focus on license renewal as they focus more on accomplishment of daily tasks, and only care when a malpractice occurs. CPD points determine the eligibility of the license renewal applicant. The study concludes that the online availability of CPD guidelines is a good way of reaching all stakeholders. The study recommends awareness raising activities regarding access to the guidelines, raise more awareness regarding the online license renewal system, and design more effective and efficient means of stakeholder outreach.

Changes of Organizational Culture at the Public Health Center in Cilincing District, North Jakarta, Indonesia

The empirical problem in this research is that in the working area of the Cilincing District Public Health Center, they have never carried out health education or monitoring activities in fisheries areas, including how to make salted fish. The study aims (1) to measure responsive culture, awareness management, organizational commitment, and identification of formalin in salted fish before and after implementing responsive culture. Furthermore, the study analyzes the influence of awareness management and organizational commitment on responsive culture and formalization in salted fish. It also aims to determine the best influence path model. The design used is to provide a responsive culture module and pre-post observational. Descriptive analysis was used to determine the distribution of respondents regarding responsive culture; awareness management; organizational commitment; and identification of formalin in salted fish. SEM SmartPLS is used to test the influence between variables. The results showed that the best model of influence path is (1) awareness management has a direct effect on organizational commitment; (2) organizational commitment influences responsive culture and responsive culture influences formalin content in salted fish. It is proven that a responsive culture plays an important role in overcoming health center performance problems. After implementing the responsive culture module, and a formalin test was carried out on making salted fish, the results showed that there was no formaline in salted fish.

Nourishing Farm to School Practice With Data to Inform Program Needs: An Evaluation of Participation Among California Public Districts During the 2018-2019 School Year

BackgroundThe US Department of Agriculture promotes farm to school (F2S) as an evidence-based approach to help school meals meet updated nutrition standards that promote health. California is a key agricultural state with strong support for F2S to promote local agriculture and equitable access to nutritious food for all students. ObjectiveExamine district characteristics associated with F2S participation among California public districts during the 2018-2019 school year. DesignCross-sectional evaluation of 2019 US Department of Agriculture Farm to School Census data. Participants/settingCalifornia public districts responding to the 2019 US Department of Agriculture F2S Census (N = 572). Main outcome measureReported participation in F2S activities in 2018-2019. Covariates included district size, annual per-pupil spending, urbanicity, racial/ethnic composition, and percent free and reduced-price meal (% FRPM) eligibility. Statistical analysisDescriptive statistics (unweighted frequency and weighted percent) were reported for demographic characteristics. Weighted, multiple logistic regression assessed associations between demographic characteristics and F2S participation, reported as odds ratios (95% CI). ResultsNearly 78% of California respondents reported F2S participation. Top activities were serving local food in school lunch (73%) and breakfast (65%) and local food promotion at school (45.5%). The odds of participation among districts with enrollments ≥1000 were 1.79 (95% CI 1.15 to 2.79) times higher than smaller districts and 1.57 (95% CI 1.08 to 2.28) times higher in districts with lower annual per-pupil spending (≤$13 707). No significant differences were found by racial/ethnic composition, % FRPM eligibility, or urbanicity. ConclusionsDisparities in F2S participation exist for small districts and those with high annual per-pupil spending that may lack the advantages of economies of scale. Grant incentives and support networks for these groups are recommended along with increased monitoring focused on the quality of F2S engagement. Administration of a brief annual state F2S Census could support more timely monitoring and accountability to align with state goals and improve opportunities for data sharing and community engagement.

Abstract A147: A ten-year overview of cancer genetic family history screening in Georgia’s Latina population

Abstract Introduction: Population-based cancer genetic family history screening to identify families at high risk for BRCA-associated cancers has been endorsed by national public health policies. This report aimed to describe the utilization of family history screening services from 2013 to 2022 according to rurality and socioeconomic deprivation among the Latina community in the state of Georgia. Methods: Self-identified Latina women who attended a medical appointment at participating Georgia Public Health Clinics were invited to utilize the cancer genetic family history screening services. Screening results and participant zip code were reviewed. Area deprivation index (ADI) was measured at the census block group level and assessed as a dichotomous variable (more deprived and less deprived). Rurality was measured through Rural-Urban Commuting Area (RUCA) codes and was assessed dichotomously (urban and rural). The ADI and RUCA codes were linked to participant data by zip code to characterize genetic service access among the Latina community. Results: We found 9,330 (3.31%) adult Latinas in Georgia completed cancer genetic family history screening from 2013-2022. In this sample, 9,066 (97.17%) women screened negative, and 264 (2.83%) women screened positive (i.e., family history suggestive of higher risk for carrying BRCA1/2 mutations compared to the general population). The family history screening program reached Latinas in 16 of 18 public health districts in Georgia. However, family history screening completion varied significantly across the 16 districts (mean=327 women, range: 2 - 1,337). FH screening completion was higher among Latinas in urban areas (n=7,871) than Latinas in rural areas (n=1,459). Latinas who lived in more socially deprived areas appeared to have a higher number of screening completion (n=5,207) than those living in less socially deprived areas (n=4,123) due to interaction with urbanicity. Conclusions: Georgia’s family history screening program was able to reach Latina women across the state of Georgia, particularly those living in urban, socially deprived areas. To ensure equitable cancer genetic screening dissemination, future efforts should prioritize tailored outreach in rural regions and a comprehensive evaluation to identify key determinants of screening trends among Georgia’s Latina population. Citation Format: Dayanna A. Ramírez León, Lauren E. Barber, Sheryl Gabram-Mendola, Cindy Snyder, Susan Vadaparampil, Lindsay Fuzzell, Lauren E. McCullough, Lynn Durham, Yue Guan. A ten-year overview of cancer genetic family history screening in Georgia’s Latina population [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A147.

The Influence of Physical Work Environment and Non-Physical Work Environment and Work Culture on Teacher Performance With Discipline as an Intervening Variable in High Schools of Paser District

This research aims to determine the influence of the physical work environment and non-physical work environment as well as work culture on teacher performance with discipline as an intervening variable at the Paser District Public School. The research design used in this research is descriptive quantitative. The population in this study were all teachers who taught at Paser Regency State High Schools in the Batu Sopang District area with a total of 133 people. The sampling technique used in this research used a purposive sampling technique. The results of the research show that there is an influence of the physical work environment on teacher performance with a P Value of 0.003, there is no influence of the non-physical work environment on teacher performance with a P Value of 0.028, there is a significant influence of work culture on teacher performance with a P Value of 0.023, there is a significant influence between work discipline on teacher performance with a P Value of 0.000, there is a significant influence between the physical work environment on performance through work discipline with a P Value of 0.007, there is a significant influence between the non-physical work environment on performance through work discipline and P value is 0.042, there is a significant influence between work culture on performance through work discipline with a P value of 0.023

Preliminary image evaluation performance of radiographers in one New Zealand District: a 6-month prospective study.

Preliminary image evaluation (PIE) is a system where radiographers alert emergency department referrers to the presence or absence of abnormalities on acute extremity X-ray examinations. PIE and similar systems have been utilised in the United Kingdom (UK) and Australia due to a shortage of radiologists to provide a timely report. As New Zealand (NZ) faces a similar shortage, PIE should be considered to address the negative impact this has on patients. The aim of this study was to determine the effect of regular feedback and education on radiographers' performance when detecting and describing acute abnormalities on extremity X-ray examinations in ED. A prospective longitudinal study design was utilised for this study. The sensitivity, specificity, accuracy, and accuracy of PIEs performed by seven radiographers at a public provincial district in NZ were assessed over a 6-month period, with the participants provided monthly results along with regular e-mailed feedback on common errors. The mean for sensitivity, specificity, and accuracy calculated with a 95% confidence interval over the 6-month period were 92.8% (89.9, 95.8), 94.9 (93.1, 96.8), and 94.2 (91.9, 96.5), respectively. When the month-to-month results were analysed, the results demonstrated an improvement in participants' sensitivity, specificity, and accuracy over the 6-month period. The results of this study demonstrated that radiographers who participated in the study can perform PIE to a high standard that is comparable with the findings from international studies and demonstrated an improvement over 6 months. Therefore, PIE may be useful in NZ to aid ED clinicians in their clinical decisions when a radiology report is unavailable.

PENGARUH KOMPETENSI GURU DAN MOTIVASI INSTRINSIK TERHADAP KINERJA GURU DI SMA NEGERI KECAMATAN SEMBAWA KABUPATEN BANYUASIN

The purpose of carrying out this research is 1) To determine the effect of competency on teacher performance at State High School, Sembawa District, Banyuasin Regency; 2) To determine the effect of intrinsic motivation on teacher performance at State High School, Sembawa District, Banyuasin Regency; 3) To determine the influence of competency and intrinsic motivation on teacher performance at State High School, Sembawa District, Banyuasin Regency. This research was carried out at Sembawa District Public High School with a research sample of 97 teachers. Data collection techniques were carried out through observation, documentation studies and distributing questionnaires. The validity test uses construct validity, while the reliability test uses Cronbach's Alpha. Linearity Test and Normality Test. The results of this research are that: 1) There is a partially significant influence between teacher competency on teacher performance in Sembawa District Public High School, Banyuasin Regency, where t = 3.284 > from t table 1.671; 2) There is a partially significant influence between intrinsic motivation on teacher performance at SMA Negeri Sembawa District, Banyuasin Regency, where t = 3.151 > from t table 1.671; 3) There is a simultaneous influence between teacher competence and intrinsic motivation on teacher performance in Sembawa District Public High School, Banyuasin Regency where the calculated f value = 6.112 > more than f Table 2.74

Impact of the Korea Early Childhood Home-visiting Intervention (KECHI) on child health and development and maternal health: a randomised controlled trial protocol

IntroductionRandomised controlled trials (RCTs) of early childhood home-visiting interventions led by nurses have been conducted mainly in Western countries, whereas such trials have been limited in non-Western cultures, including Asia....

EFFECT OF CONTINUOUS PROFESSIONAL DEVELOPMENT ON STUDENTS ACADEMIC PERFORMANCE IN NINE YEARS BASIC EDUCATION SCHOOLS OF RWANDAA CASE OF NYARUGURU DISTRICT

Background: This study investigated the effect of continuous professional development on students Academic performance in nine-year basic education schools in Nyaruguru district, Rwanda. The specific objectives were to identify continuous professional development Programmes practiced in nine years basic education in Rwandan schools, to analyze the students academic performance due to continuous professional development in Rwandan schools and to assess the influence of continuous professional development on students performance in nine-year basic education schools in Rwanda. This study is useful to all stakeholders in education sector such as public institutions, decision makers, district authorities, head teachers, teachers, learners and scholars. The researcher applied a descriptive correlational study, targeting 5 head teachers, 150 teachers and 88 School based mentors. This study selected respondents and key informants purposively and randomly. A study sample of 243 respondents was obtained by use of Yamanes formula. Materials and Methods: Information was analyzed using statistical package for social sciences version 26.0 to generate descriptive statistics in terms of frequency, percentage, mean and standard deviation. Inferential statistics were produced in terms of correlation and regression coefficient for determining size effect between variables. Results:English proficiency factors indicated that 79.2% strongly agree that Educational document preparation, and 82.6% strongly agreed that Teaching techniques, 79.9% strongly agreed that Course content, 77.2% strongly agreed that Classroom management show continuous professional development Programmes in Nyaruguru District, Rwanda, Results on the students academic performance 79.4% strongly agreed that improved academic performance, 82.6% Strongly agreed that high national examination. Additionally, 77.9% Strongly agreed that improved personality development 68.5%. Strongly agreed that improved personal development, 78.5% strongly agreed that improved academic performance indicates student academic performance. Results from objective three reveal a strong positive correlation between academic performance improvement, educational document preparation, teaching techniques, course content, and slow learners treatment, suggesting effective policies and professional development time, and that they were positively and statistically correlated since most of their levels of significance were greater than 0.05 in association. Conclusion: It is advised that the Ministry of Education and the REB (Rwanda Education Board) develop effective policies and devote adequate time for CPD in schools. They should also organize school principals to enhance CPD practice. To offer effective, ongoing professional support for teachers, it is strongly suggested that certified CPD facilitators be recruited and principals skilled in educational leadership and management be hired throughout all secondary schools across different districts. Relevant professional training programs should be developed in response to the unique training requirements of professors. To do this, competent authorities at all levels must pay close attention to this issue. To improve their abilities, school principals should emphasize CPD and actively involve themselves in peer learning. There is a need to carry out a research on The study recommends more research into the effects of continuous profession development on teachers performance in teaching career.

Appendicectomy pathway: Insights from electronic medical records of a local health district in Australia

BackgroundThis study aims to identify the common pathways of appendicectomy, the most common emergency surgery in Australia’s public hospitals and any variations within a regional public health district in New South Wales, Australia. MethodsWe analyzed the electronic medical records of 3,943 patients who underwent appendicectomy between January 2014 and July 2020 at 2 hospitals in the Illawarra Shoalhaven Local Health District, New South Wales, Australia, using the PM2 approach for surgical pathway identification and subsequent statistical analyses. ResultsAmong 3,943 patients, 3,606 (91.5%) followed an 11-step main pathway: (1) emergency department admission, (2) surgery booking, (3) anesthesia start, (4) operating room entry, (5) surgery start, (6) surgery end, (7) anesthesia end, (8) operating room discharge, (9) postanesthesia care unit admission, (10) postanesthesia care unit discharge, and (11) hospital discharge. The median length of stay was 48.13 hours (interquartile range 32.74). The main pathway differed from either variation 1 (n = 246, 6.2%) or variation 2 (n = 30, 0.8%) only in the timing and location of anesthesia administration or conclusion. Variation 3 (n = 26, 0.7%) included patients who underwent appendicectomy twice, whereas variation 4 (n = 25, 0.6%) included patients booked for surgery before emergency department admission through community doctor referrals. Thirteen exceptional cases experienced combinations of the aforementioned pathways. The length of stay and phase durations varied between the main pathway and these variations. ConclusionThe appendicectomy pathway was largely standardized across the studied hospitals, with the location of anesthesia administration or conclusion affecting specific stages but not the overall length of stay. Only a complex 2-surgery pathway increased length of stay.

An Effective Health System Approach to End TB: Implementing the Double X Strategy in Vietnam.

Countries that are high burden for TB must reverse the COVID-19 pandemic's devastating effects to accelerate progress toward ending TB. Vietnam's Double X (2X) strategy uses chest radiography (CXR) and GeneXpert (Xpert) rapid diagnostic testing to improve early detection of TB disease. Household contacts and vulnerable populations (e.g., individuals aged 60 years and older, smokers, diabetics, those with alcohol use disorders, and those previously treated for TB) with and without TB symptoms were screened in community campaigns using CXRs, followed by Xpert for those with a positive screen. In public non-TB district facilities, diabetics, respiratory outpatients, inpatients with lung disease, and other vulnerable populations underwent 2X evaluation. During COVID-19 restrictions in Vietnam, the 2X strategy improved access to TB services by decentralization to commune health stations, the lowest level of the health system, and enabling self-screening using a quick response mobile application. The number needed to screen (NNS) with CXRs to diagnose 1 person with TB disease was calculated for all 2X models and showed the highest yield among self-screeners (11 NNS with CXR), high yield for vulnerable populations in communities (60 NNS) and facilities (19 NNS), and moderately high yield for household contacts in community campaigns (154 NNS). Computer-aided diagnosis for CXRs was incorporated into community and facility implementation and improved physicians' CXR interpretations and Xpert referral decisions. Integration of TB infection and TB disease evaluation increased eligibility for TB preventive treatment among household contacts, a major challenge during implementation. The 2X strategy increased the rational use of Xpert, employing a health system-wide approach that reached vulnerable populations with and without TB symptoms in communities and facilities for early detection of TB disease. This strategy was effectively adapted to different levels of the health system during COVID-19 restrictions and contributed to post-pandemic TB recovery in Vietnam.

Ecological study of the reach of congregate vs. grab-and-go summer meals in New York City

Participation in school meals is associated with many benefits. However, participation in school meals served in the summer through the Summer Food Service Program (SFSP) is low due to many barriers, including program requirements such as congregate feeding. During COVID-19, these requirements were waived, allowing grab-and-go meals. The purpose of this study is to compare the number of SFSP breakfast and lunch meals served during the summers of grab-and-go meals (2020 and 2021) to prior summers of congregate feeding (2014–2019) in New York City (NYC). This study is an ecological study of NYC public school geographic districts (n = 32). The primary outcome is the total number of SFSP meals served per student. Using the repeated-measures ANOVA, the results show a significant increase in the number of SFSP meals served per student during the first summer (2020) of grab-and-go meals compared to summers 2016–2019 (p ≤ 0.01) but no significant differences during the second summer (2021) of grab-and-go meals compared to summers 2014–2019. However, there was a significant increase in the number of breakfast meals served in August per student during both the first and second summer of grab-and-go meals compared to summers 2014–2019 (p < 0.05). Among NYC public schools, the waivers may increase the reach of breakfast meals served in August, when there are fewer summer school activities. While there is a need for more research, policymakers may consider making waivers that allow grab-and-go meals permanent flexibilities for the SFSP to increase access to summer meals.

Problem-Based Learning in Blended Classrooms: An Approach in Covid 19 Emergency Situation

This research paper, reports the findings of using problem-based learning approach in Blended Learning (BL) environment, while practicing grade 9 mathematical problems by fifty grade 9 students. This three week program was framed in contrast of traditional schooling, intending as enrichment and not remediation, for science group students’ practices in mathematics. The study was framed through formative experiment research method and practiced at public sector Higher Secondary School Jehangira district Swabi, aiming to explore the advantages and hazards of PBL model when applied in BL environment. The data was collected through an open ended self-developed questionnaire and was analyzed by using simple frequency distribution. The results achieved were mostly positive such as students found productive PBL approach through WhatsApp application like solving examples helped them in solving other problems, course work was completed timely, and using smart phone with peers in groups helped in better understanding the problems. But showed some concerns such as poor availability of network/internet services or non-affordability of having smart phone or internet packages, and parents showed unwillingness for using smart phone/internet. On the basis conclusion, it was suggested that these issues can be resolved by teaming up with parents alongside convincing head of the institute.

The lived experiences of providing nursing care in coastal areas: A qualitative study.

To explore nurses' experiences in providing care in coastal areas. The phenomenological study was conducted from July to September 2020 in two coastal areas located in the Riau province of Indonesia, and comprised nurses working in public health centers, hospitals and district health offices. Data was collected using in-depth interviews. Data was subjected to thematic analysis. Of the 13 nurses, 10(77%) were females and 3(23%) were males. The overall age range was 24-44 years. Four themes that emerged were health problems in coastal areas, obstacles in nursing care delivery, irrelevant duty, and procedures in delivering nursing care. There were a total of 10 sub-themes as well. Despite the challenged faced by the nurses, communities in coastal areas deserve to get due healthcare services.