Evening Shifts Research Articles

Circadian Adaptation of Melatonin and Cortisol in Police Officers Working Rotating Shifts.

Misalignment of behavior and circadian rhythms due to night work can impair sleep and waking function. While both simulated and field-based studies suggest that circadian adaptation to a nocturnal schedule is slow, the rates of adaptation in real-world shift-work conditions are still largely unknown. The aim of this study was to evaluate the extent of adaptation of 24-h rhythms with 6-sulfatoxymelatonin (aMT6s) and cortisol in police officers working rotating shifts, with a special attention to night shifts. A total of 76 police officers (20 women; aged 32 ± 5.4 years, mean ± SD) from the province of Quebec, Canada, participated in a field study during their 28- or 35-day work cycle. Urine samples were collected for ~32 h before a series of day, evening, and night shifts to assess circadian phase. Before day, evening, and night shifts, 60%-89% of officers were adapted to a day schedule based on aMT6 rhythms, and 71%-78% were adapted based on cortisol rhythms. To further quantify the rate of circadian adaptation to night shifts, initial and final phases were determined in a subset of 37 officers with suitable rhythms for both hormones before and after 3-8 consecutive shifts (median = 7). Data were analyzed with circular and linear mixed-effects models. After night shifts, 30% and 24% of officers were adapted to a night-oriented schedule for aMT6s and cortisol, respectively. Significantly larger phase-delay shifts (aMT6s: -7.3 ± 0.9 h; cortisol: -6.3 ± 0.8 h) were observed in police officers who adapted to night shifts than in non-adapted officers (aMT6s: 0.8 ± 0.9 h; cortisol: 0.2 ± 1.1 h). Consistent with prior research, our results from both urinary aMT6s and cortisol midpoints indicate that a large proportion of police officers remained in a state of circadian misalignment following a series of night shifts in dim-light working environments.

Comparing the Effects of Acupressure and Clonazepam Tablets on Sleep Quality of Hemodialysis Patients: A Randomized Controlled Trial.

Objective: The current study aimed to compare the impact of acupressure and clonazepam tablets on the quality of sleep in hemodialysis patients in light of the rising prevalence of chronic kidney disease (CKD), the high prevalence of sleep disturbance in these patients, and the side effects of hypnotic drugs. Method : A total of 60 patients were selected for this randomized, controlled clinical trial and randomly assigned to two groups. For two weeks during the researcher's evening shift, one group received acupressure (six spots bilaterally for three minutes each day). The opposing group was administered clonazepam tablets (0.5 mg) for two weeks. The Pittsburgh Sleep Quality Index (PSQI), which measures sleep quality, was used to compare sleep in the two groups before and after the intervention. Results: There was no statistically significant difference between the two groups prior to the intervention (P = 0.75) in terms of the mean pre-intervention PSQI scores for the acupressure and clonazepam groups, which were 15.83 ± 1.51 and 16.17 ± 0.91, respectively. However, the average PSQI scores after the intervention in the clonazepam and acupressure groups were 13.25 ± 2.88 and 8.97 ± 4.29, respectively, indicating a statistically significant difference (P < 0.0001). Both the acupressure and the clonazepam groups showed improvements in their post-intervention sleep quality among the patients. However, when the percentage changed in the mean scores of the total score and all of the PSQI components were calculated for each group, it became clear that acupressure was more effective at enhancing sleep than clonazepam tablets. Conclusion: The findings of the present investigation demonstrate that acupressure has a greater impact on patients' sleep quality compared to clonazepam tablets. Depending on the circumstances, acupressure can be used as a simple, safe, and non-drug way to enhance hemodialysis patients' quality of sleep.

Association between different patterns of shift work and liver function tests: A cross-sectional analysis of Shahedieh PERSIAN cohort data, Iran, 2020.

Recent studies suggest that shift work may cause liver dysfunction. This study aimed to examine the relationship between different patterns of shift work and elevated level of liver enzymes. In this cross-sectional study, 1910 workers aged 35 to 70 years were selected with simple random sampling from 9978 participants of the recruitment phase of Shahedieh PERSIAN cohort study. Level of serum liver enzymes (ALT, AST, ALP, and GGT) and ALT/AST ratio was compared between shift workers and non-shift workers, and among employees working in different patterns of shift work. Data were analyzed by SPSS (version 21.0) using Student's T test, Mann-Whitney U test, chi-square test, Kruskal Wallis test, and logistic regression. Among 1347 males (71%) and 563 females (29%) with a mean age of 40.4±7.4 years, 469 were shift workers. Fixed evening type shift was the most common (30.3%) and fixed night-shift was the least common (0.9%) type of shift work. The mean blood levels of liver enzymes was not significantly different between shift workers and non-shift workers. In comparison between different patterns of shift work, the mean serum level of GGT was significantly higher in individuals with slow rotating shifts than those with fixed evening shifts, rapid rotating, split and fixed 24 hour shifts (p≤0.001). After adjusting for confounding factors only elevated AST was significantly higher in shift workers. There was only a significant association between shift work and elevated AST, and no relationship was found with ALT, ALP, GGT, and ALT/AST ratio.

Time Waster in Nursing Career Field Study in Medical Baghdad City

In the various periods of human life time have a high value and it plays a definitive role to accomplish goals, duties and wishes either individual or organization. Time in the sector of healthcare hand chance for physicians and nurses to help and remedy patients beside it conduces to build a sound healthy system. Thus, time waster becomes as worst losses because it related to human life. The purpose of this research is to restrict the nurses&amp;rsquo; actions which it prompts to lost time from a workday as well as to estimate the amount of time spent in each act. Data were collected from three groups of nurses sample worked in the morning and evening shifts in Medical Baghdad City by survey questionnaire that involved (47) items. The outcomes of accumulated data from the samples were underline three groups of acts have varying influence lead in lost time during a workday of nurses in the Iraqi context. In addition, the finding resulted that the amount of time lost is nearby to other lands, such as Iran, Australia, United State and&amp;nbsp;&amp;nbsp; South America. At last the present study confirms that there is no an universal tool suitable to determine all deeds cause to deprive time and measure the amount of time lost whereof incite us to create and construct a local convenient instrument almost fit with domestic environment and culture.

Workplace bullying and violence in health sector in Saudi Arabia.

Workplace bullying violence (BV), with psychological and physical impacts, is increasing globally. However, studies from Saudi Arabia investigating which specialties are most exposed, and linking them with other factors, such as sociodemographic conditions, are scarce. This study aimed to estimate the prevalence of workplace BV over a 12-month period and determine the circumstances related to the event, consequences for the attacker, and targeted personnel among all healthcare providers in the Kingdom of Saudi Arabia (KSA). This analytical cross-sectional study included all health providers registered with the Saudi Commission for Health Specialties who worked for more than 1 year in the healthcare sector (governmental or private) in the KSA until May 2019. In total, 7398 healthcare workers were electively enrolled in the study; 51.3% were men, and 48.7% were women, with a mean age of 40 ± 8.62 years. They were mostly (60%) non-Saudi. Overall, 26.6% encountered BV. Those who worked in the private sector, in shifts, especially evening shifts, were significantly more exposed. Furthermore, pharmacists had the highest prevalence of workplace violence. The prevalence of BV is moderately high; however, it is a serious issue faced by healthcare workers, especially those working night shifts. Pharmacists were more likely to experience bullying. This demonstrates that more support, specific strategies, and policies are required to reduce the occurrence of workplace BV, protect healthcare providers, and prevent attacks. Underreporting these situations may give an incorrect indication of the magnitude of the problem; thus, more education and further studies in the KSA are needed.

Those who opt to leave: Comparison by triage acuity of emergency patients who leave prior to seeing a medical practitioner

BackgroundPeople who present to an emergency department but leave before seeing a medical practitioner (LWBS) pose a potential risk, especially those triaged with higher acuity care needs. ObjectiveTo describe and compare characteristics of emergency patients who LWBS by triage acuity. MethodRetrospective review of administrative data for a 1-year period. Chi-square and logistic regression analyses conducted to investigate differences in characteristics specific to individual and the timing of presentation between patients who LWBS and were triaged as higher acuity compared to those who left but were triaged as less- or non-urgent. ResultsDuring study period, 12.6 % of patients LWBS with 30.0 % of these cases triaged as higher acuity. Number triaged as higher acuity who LWBS tended to be higher during days with a higher volume of higher acuity cases. The likelihood of LWBS for those triaged as higher acuity was higher among older age groups and those with a primary care provider who presented on weekdays, during evening and night shifts, and in the winter months. ConclusionsFindings highlight differences in LWBS cases by triage acuity and raise questions about emergency nurses’ professional responsibility to follow-up with those who LWBS if they have been triaged as higher acuity based on an assessment of their presenting complaint and risk for complications or deterioration. While continuing to work to reduce wait times and improve patient flow, it is important to identify factors affecting patients’ decision to LWBS, especially for those triaged with higher acuity healthcare needs.

Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman.

Multiple factors contribute to decision fatigue experienced by emergency physicians (EPs). This study examines the association between decision fatigue and the frequency of computed tomographic (CT) scan requests and inpatient referrals among EPs. This retrospective database analysis was done for 3 months. Scans and inpatient referral requests were coded and analyzed to assess the impact of physician fatigue on decision-making. Subsequently, the outcomes were evaluated. The majority of patients (n = 481; 51.1%) had a CT brain request. Among these requests, the morning shift (8:00 a.m.-3:00 p.m.) accounted for the highest number (n = 400; 42.5%), followed by the evening shift (3:00-11:00 p.m.) (n = 345; 36.7%). Approximately one-third of the patients (n = 301; 31.9%) had positive CT scan findings. Statistical analysis comparing the first and the second halves of each shift did not reveal significant variations in the percentage of negative CT results (p-value: 0.093). Inpatient referral was necessary for over half of the patients (n = 1,048; 52.7%), and the majority of these referrals (n = 778; 74.2%) were deemed necessary for treatment under various surgical or medical specialties. There was a statistically significant difference in the proportion of negative inpatient referrals between the first and the second halves of the afternoon shift (p-value < 0.001). Fatigue among EPs was observed, leading to more frequent consultations without inpatient admission during the latter half of the afternoon shift. However, the study found no significant impact of decision fatigue on CT scan decision-making. Al-Arimi AH, Hazra D, Al-Alawi AKA. Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman. Indian J Crit Care Med 2023;27(9):620-624.

Hospitalization for acute heart failure during non-working hours impacts on long-term mortality: the REPORT-HF registry.

Hospital admission during nighttime and off hours may affect the outcome of patients with various cardiovascular conditions due to suboptimal resources and personnel availability, but data for acute heart failure remain controversial. Therefore, we studied outcomes of acute heart failure patients according to their time of admission from the global International Registry to assess medical practice with lOngitudinal obseRvation for Treatment of Heart Failure. Overall, 18553 acute heart failure patients were divided according to time of admission into 'morning' (7:00-14:59), 'evening' (15:00-22:59), and 'night' (23:00-06:59) shift groups. Patients were also dichotomized to admission during 'working hours' (9:00-16:59 during standard working days) and 'non-working hours' (any other time). Clinical characteristics, treatments, and outcomes were compared across groups. The hospital length of stay was longer for morning (odds ratio: 1.08; 95% confidence interval: 1.06-1.10, P<0.001) and evening shift (odds ratio: 1.10; 95% confidence interval: 1.07-1.12, P<0.001) as compared with night shift. The length of stay was also longer for working vs. non-working hours (odds ratio: 1.03; 95% confidence interval: 1.02-1.05, P<0.001). There were no significant differences in in-hospital mortality among the groups. Admission during working hours, compared with non-working hours, was associated with significantly lower mortality at 1year (hazard ratio: 0.88; 95% confidence interval: 0.80-0.96, P=0.003). Acute heart failure patients admitted during the night shift and non-working hours had shorter length of stay but similar in-hospital mortality. However, patients admitted during non-working hours were at a higher risk for 1year mortality. These findings may have implications for the health policies and heart failure trials.

Loss of control eating exhibits an evening diurnal shift among females with bulimia nervosa and binge-eating disorder.

Loss of control (LOC) is a hallmark feature of binge eating that is associated with significant distress and impairment. Despite the central role diurnal rhythms may play in the development and maintenance of LOC eating, diurnal patterns of LOC remain understudied and poorly characterised. We assessed the diurnal timing of LOC in a sample of females with bulimia nervosa and binge-eating disorder who participated in a study assessing the impact of bright light exposure on binge eating, hypothesising that higher ratings of LOC would be more likely to occur later in the day. Participants (N=34) completed a 22-day protocol during which they provided LOC ratings six times daily. Kernel density estimates describing LOC ratings across times of day were compared using permutation tests of equality. Results demonstrated an evening shift in LOC, wherein higher LOC was more likely to occur later in the day and lower LOC was more likely to occur earlier in the day. This study is the first to clearly depict the phenomenon that the likelihood of experiencing higher LOC increases throughout the day, pointing to the potential role diurnal rhythms, such as disrupted appetitive rhythms or mood variations, may play in maintaining binge eating.

Comparing the Effect of Foot Reflexology Massage and Familiar Sensory Stimulation on the Level of Consciousness of Trauma Patients Admitted to Intensive Care Units: A Clinical Trial Study

Background: Traumatic brain injury (TBI) is an acquired brain tissue injury with different severities that leads to a change in the patient’s level of consciousness. Objectives: The present study aimed to compare the impact of foot reflexology massage and familiar sensory stimulation on the level of consciousness of trauma patients admitted to the intensive care units (ICUs) of Khatam Al-Anbia Hospital in Zahedan in 2021. Methods: This quasi-experimental study was conducted with a pretest-posttest design on 135 trauma patients with an altered level of consciousness admitted to the ICUs of Khatam Al-Anbia Hospital in Zahedan in 2021. The participants were selected using convenience sampling from the patients who met the inclusion criteria and were randomly assigned to 3 groups: Foot reflexology massage, familiar sensory stimulation, and control groups (each with 45 patients). The foot reflexology massage group received reflex massage on both feet for 30 minutes, the familiar sensory stimulation group received familiar sensory stimulation for 45 minutes, and the control group received ICU routine care. The interventions were carried out for 1 week in 2 morning and evening shifts. The patient’s consciousness level was measured and recorded using the Glasgow Coma Scale (GCS) 5 minutes before and 30 minutes after the intervention. The data were analyzed using SPSS version 22, as well as using analysis of variance (ANOVA), paired samples t-test, independent samples t-test, and analysis of covariance (ANCOVA) at a significance level of 0.05 (P &lt; 0.05). Results: The data showed that the average consciousness score for the patients in both foot reflexology massage and familiar sensory stimulation groups increased significantly after the intervention compared to the control group (P = 0.001), but the 2 interventions were not significantly different in improving the level of consciousness of the patients. Conclusions: Foot reflexology massage and familiar sensory stimulation were both equally effective in increasing the level of consciousness of trauma patients with an altered level of consciousness, and none of them was superior to the other. Thus, nurses can use these 2 complementary medicine methods to speed up the improvement of consciousness of patients with TBI.

Characterization of sound pressure levels and sound sources in the intensive care unit: a 1 week observational study.

Exposure to elevated sound pressure levels within the intensive care unit is known to negatively affect patient and staff health. In the past, interventions to address this problem have been unsuccessful as there is no conclusive evidence on the severity of each sound source and their role on the overall sound pressure levels. Therefore, the goal of the study was to perform a continuous 1 week recording to characterize the sound pressure levels and identify negative sound sources in this setting. In this prospective, systematic, and quantitative observational study, the sound pressure levels and sound sources were continuously recorded in a mixed medical-surgical intensive care unit over 1 week. Measurements were conducted using four sound level meters and a human observer present in the room noting all sound sources arising from two beds. The mean 8 h sound pressure level was significantly higher during the day (52.01 ± 1.75 dBA) and evening (50.92 ± 1.66 dBA) shifts than during the night shift (47.57 ± 2.23; F(2, 19) = 11.80, p < 0.001). No significant difference was found in the maximum and minimum mean 8 h sound pressure levels between the work shifts. However, there was a significant difference between the two beds in the based on location during the day (F(3, 28) = 3.91, p = 0.0189) and evening (F(3, 24) = 5.66, p = 0.00445) shifts. Cleaning of the patient area, admission and discharge activities, and renal interventions (e.g., dialysis) contributed the most to the overall sound pressure levels, with staff talking occurring most frequently. Our study was able to identify that continuous maintenance of the patient area, patient admission and discharge, and renal interventions were responsible for the greatest contribution to the sound pressure levels. Moreover, while staff talking was not found to significantly contribute to the sound pressure levels, it was found to be the most frequently occurring activity which may indirectly influence patient wellbeing. Overall, identifying these sound sources can have a meaningful impact on patients and staff by identifying targets for future interventions, thus leading to a healthier environment.

Forest conservation maximises açaí palm pollination services and yield in the Brazilian Amazon

Abstract Agricultural expansion is one of the main drivers of global pollinator loss. Paradoxically, this occurs while agriculture is becoming increasingly dependent on biotic pollination, raising concerns about food production. Integrated Crop Pollination (ICP), the use of both wild and managed pollinators in crop fields, can help conserve pollinator diversity while ensuring effective pollination services for growers. However, given the context‐dependent nature of this approach, there is an urgent need to evaluate its application across different landscapes and crops. We apply the ICP approach to açaí palm (Euterpe oleracea Mart.) production in the eastern Brazilian Amazon to explore effects of a native stingless bee, Scaptotrigona aff. postica (Apidae: Meliponini), and landscape‐level forest conservation on yield and socioeconomic outcomes for açaí fruit growers. We assessed flower visitor assemblages and fruit production on 18 plantations across a landscape forest cover gradient, with bee colonies introduced on nine plantations. Field data were combined with information from semistructured interviews of growers to estimate yield and profit per hectare under different pollinator management scenarios. Bee colonies and forest cover enhanced flower visitor abundance on palm inflorescences, but abundance increases attributed to managed bees were associated with shifts in flower visitor evenness and diversity (species richness), due to reduced visitation of wild bees near managed colonies. Fruit production on inflorescences was positively related to bee abundance and bee diversity. Consequently, overall pollination performance was lower in plantations with bee colonies. This was repeated at the hectare scale, where yield and profit were associated with surrounding forest cover and not bee colonies. Synthesis and applications. Managed bees can increase pollinator densities and fruit production, but the increased environmental and socioeconomic risks associated with this activity means açaí growers should prioritise forest conservation to safeguard pollination services and improve overall sustainability of açaí production in the eastern Brazilian Amazon.

Portrait of Montréal healthcare workers infected with SARS-CoV-2 during the first wave of the pandemic: a cross-sectional study.

During the first wave of COVID-19 in Québec, healthcare workers (HCWs) represented 25% of the cases in Montréal. A study was conducted to describe SARS-CoV-2-infected HCWs in Montréal, and certain workplace and household characteristics. Secondary objectives included estimating the associations between having had access to personal protective equipment (PPE) and training, and following self-isolation recommendations, and certain sociodemographic and workplace characteristics. A cross-sectional study was conducted, based on a stratified random sample, among Montréal HCWs who tested positive for SARS-CoV-2 between March and July 2020. A total of 370 participants answered a telephone-administered questionnaire. Descriptive statistics were conducted, followed by log binomial regressions to estimate the associations. Study participants were mostly female (74%), born outside of Canada (65%), and identified as Black, Indigenous, and People of Colour (BIPOC; 63%). In terms of healthcare positions, most were orderlies (40%) or registered nurses (20%). Half (52%) of the participants reported having had insufficient access to PPE and 30% reported having received no training related to SARS-CoV-2 infection prevention, with large proportions being BIPOC women. Working evening or night shifts decreased chances of having had sufficient access to PPE (OR 0.50; 0.30-0.83). This study describes the profile of the HCWs who were infected during the first wave of the pandemic in Montréal. Recommendations include collecting comprehensive sociodemographic data on SARS-CoV-2 infections and ensuring equitable access to infection prevention and control training and PPE during health crises, particularly those at highest risk of exposure.

Tanta stroke chain performance during era of COVID-19 pandemic: how to minimize the real/expectation gap

BackgroundDuring the coronavirus disease of 2019 (COVID-19) pandemic, it would be so difficult to keep the balance between time-saving best stroke care and medical staff safety which obliges healthcare decision-makers to think extraordinarily. The objectives of this study were to evaluate the performance of the Tanta stroke chain (TSC) during the period of the study as well as to identify areas of strength and disparities of the system while dealing with the COVID-19 pandemic measures. The study was conducted on 492 acute ischemic stroke (AIS) patients who were divided into COVID-19 suspected (115 patients) and COVID-19 non-suspected (377 patients). The former group was further COVID-19 confirmed and COVID-19 negative patients. The latter group was subdivided according to the timing of the patient’s arrival at the hospital in the morning, evening, and night shifts group while the fourth group constitute those reached during shifting hours. Patients received early stroke management regarding the 2018 AHA/ASA guideline and its 2019 update.ResultsSuspected COVID-19 patients represented 23.37% of studied patients. Onset to needle time was significantly prolonged in suspected COVID-19 patients with little chance of utilizing IV thrombolysis (IVT) and consecutive higher morbidity and mortality rates. For COVID-19 non-suspected patients group, a higher rate of IVT utilization was noticed in those reached during the morning shift with a lower chance of utilization in those reached during the shifting hours.ConclusionCOVID-19 measures had an inverse effect on TSC logistics which needed upgrading of the service to better cope with the pandemic and to improve AIS patients’ functional outcomes.

Challenging Organizational Factors Associated With Admission Delay to Intensive Care Unit-A Novel Quality Indicator.

Delays in admitting patients to the intensive care unit (ICU) can defer the timely initiation of life-sustaining therapies and invasive monitoring, jeopardizing the success of the treatment. Nevertheless, the availability of research on interventions that reduce or minimize admission delays is limited. The current study aimed to assess the factors related to delays in admission times of critically ill patients transferred to the ICU. A software was designed to follow-up, compare and measure the defined intervals of the time to admission, implemented at the ICU for 6 months. Measurements included 5 time intervals, referral department, and work shift at admission. Data from 1004 patients admitted to the ICU between July 2017 and January 2020 were analyzed in a retrospective observational study. Precisely, 53.9% of total patients were referred from the hospital emergency department, and 44% were admitted during the evening shift. Significant differences were found in time intervals between shifts, showing the morning round had the longer total admission time (median: 67.8 min). Analysis showed that admission time was longer at times of full capacity compared to times of available bed (mean: 56.4 and 40.2 min, respectively; U = 68,722, p < .05). Findings demonstrated a significant shortening of time to admission after implementing a new time monitoring software by the Institutional Quality Control Commission (U = 5072, p < .001). Our study opens doors for potential studies on applying effective initiatives in critical care settings to improve patient care and outcomes. Additionally, it generates new insights regarding how clinicians and nursing teams can jointly develop and promote multidisciplinary interventions in intensive care work environments.

Determination of the degree of burnout syndrome in engineering student-workers of the UTCH

The aim of the following article is to identify the degree of burnout syndrome in engineering students from the evening shift, who work full time in the morning. The objective is to obtain accurate data to improve the tutorial action plan from UTCH. The research starts from the hypothesis that engineer students from the evening shift, who work, experience a high degree of emotional exhaustion, depersonalization and difficulty in personal fulfillment (Burnout). To achieve this, 175 Test «Maslach Burnout Inventory» (MBI), were administered and analyzed using the categorization by summation of classes to determine the level of burnout among students. The categories are validated individually using Cronbach Alfa, resulting in scores above 70%. The items are analyzed individually and in groups according to their category and dispersion in respect to normality. Finding validity in the research generates significant contributions to improve the strategies of the Tutorial Action Program and therefore address the socioemotional necessities of the students

IOT Based Health Monitoring System

Abstract: In India, close to regarding two hundredth of the whole population loses their lives because of interrupted health observance system i.e., in most of the hospitals, doctor visits patients either in morning shift or in evening shift or in each shift. What happens if patient's health becomes important in between that interval or once a doctor isn't on the market with a patient. the solution is a patient could lose her\his life. thus, to avoid this important situation; we tend to area unit proposing a sensible embedded system device that monitors patients’ health ceaselessly. This project introduces the structure and usage of an IoT based patient observing framework, utilizing different sensors and NodeMCU as the MCU (Master Control Unit). The framework can be utilized to constantly screen the wellbeing parameters of a patient. ECG Monitoring with AD8232 ECG Sensor and MAX30102 BPM sensor is used forsensing temperature and heartbeat rate can be measured from anyplace on the globe utilizing IoT (Internet of Things). IoT is executed, utilizing an ESP-8266, which enables the data to be transmitted flawlessly over the web and mobile app

Motivation and academic performance in adolescents

Adolescence is the period of growth between childhood and adulthood. This period of development, which goes from 13 to 18 years, is usually presented as critical, due to the profound modifications of physiological and psychological order in this research we worked with a sample of 60 students, from Secondary School No. 8, morning and evening shift. An instrument was made with 45 variables, 5 of them signalytic: age, gender, an average of the previous cycle, performing some extracurricular activity, and shift. The information was processed in the SPSS and STATISTIC programs. The conclusions showed that the student, by showing a need to learn, is able to develop different academic skills through different factors, such as motivation, thus improving their school performance. Thus proposes the development of an intervention model, for training teachers, on motivation methods in the classroom; As well as conferences on the importance of the topic of adolescent motivation and the factors involved in improving academic performance, teachers and parents will be taught and publicity will be developed on the importance of school motivation in adolescents and how it intervenes from home, at school and how this influences academic results.

A Spatial Variation Analysis of In-Hospital Stroke Mortality Based on Integrated Pre-Hospital and Hospital Data in Mashhad, Iran.

Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors. This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019. Using emergency mission IDs, the pre-hospital emergency data were integrated with the patient medical records in the hospital. We used the Bayesian approach for estimating the model parameters. Out of 301 patients (142 (47.2%) females vs. 159 (52.8%) males) with a final diagnosis of stroke, 61 (20.3%) cases had in-hospital mortality. Results from Bayesian spatial log-logistic proportional odds (PO) model showed that age (PO=1.07), access rate to EMS (PO=0.78), arrival time (evening shift vs. day shift, PO=0.09), and sequelae variables (PO=9.20) had a significant association with the odds of in-hospital stroke mortality (P<0.05). Furthermore, the odds of in-hospital stroke mortality were higher in central urban areas compared to suburban areas. Marked regional variations were found in the odds of in-hospital stroke mortality in Mashhad. There was a direct association between age and odds of in-hospital stroke mortality. Hence, the prognosis of in-hospital stroke mortality could be improved by better control of hypertension, prevention of the occurrence of sequelae, increasing the access rate to EMS, and optimizing shift work schedule.

How would you respond? Insight into the administrative supervisor role.

In Brief Working to ensure that patients and staff get safely through evening, night, and weekend shifts, a key role of the administrative supervisor is to manage crises and deal with unexpected emergencies. In this article, four administrative supervisors share a challenging or unusual situation and their response.