On-site Supervision Research Articles

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.

Remote Teleproctoring with the TEGUS System for Mechanical Thrombectomy in aNon-Comprehensive Stroke Center: Initial Preliminary Data On Clinical Experience.

Mechanical thrombectomy (MT) is typically performed by experienced neurointerventional radiologists. However, logistical and geographic limitations often hinder access to rapid MT. This study reports the first clinical experience using TEGUS teleproctoring to support MT conducted by general interventional radiologists (IR) at non-comprehensive stroke centers, compared to on-site proctoring outcomes. The Arnau de Vilanova Hospital in Spain used to transfer stroke patients requiring MT to acomprehensive Stroke Center 160 km away. To overcome COVID-19 mobility restrictions, the Tegus Teleproctoring System was installed. Before teleproctoring, the general interventional radiologist underwent six months of neurointerventional training at aprimary stroke center. From April 2021 to May 2023, general IR conducted MT either with on-site proctor supervision or teleproctoring support. We aim to compare clinical outcome of patients receiving MT according to proctoring method. During the study, 49MTs were performed: 15 with TEGUS teleproctoring and 34with on-site proctoring. Both groups had similar baseline characteristics, except for NIHSS scores (Tegus 9 [IQR 6-20] vs 18 [IQR 12-22], p = 0.034). No significant differences were found in door-to-revascularization time (82 ± 28.2 vs 84 ± 26.4) min, p = (0.895). The final mTICI distribution and 90-day mRS scores were comparable after adjusting by stroke severity. There were no reports of symptomatic intracranial hemorrhage in either group. This study shows the feasibility of Tegus remote teleproctoring during emergent cases of MT in aremote hospital. It could improve the learning curve of interventional radiologists with limited experience in MT, and lower the territorial inequity associated to MT.

Health workers’ adherence to malaria case management protocols in Northern Sudan: a qualitative study

BackgroundNonadherence to national standards for malaria diagnosis and treatment has been reported in Sudan. In this study, qualitative research examined the clinical domains of nonadherence, factors influencing nonadherent practices and health workers’ views on how to improve adherence.MethodsIn September 2023, five Focus Group Discussions (FGDs) were undertaken with 104 health workers from 42 health facilities in Sudan’s Northern State. The participants included medical assistants, doctors, nurses, laboratory personnel, pharmacists and public health officers. The FGDs followed a semi-structured guide reflecting the national malaria case management protocol. Qualitative thematic analysis was performed.ResultsNonadherent practices included disregarding parasitological test results, suboptimal paediatric artemether–lumefantrine (AL) dosing, lack of counselling, use of prohibited artemether injections for uncomplicated and severe malaria, artesunate dose approximations and suboptimal preparations, lack of AL follow on treatment for severe malaria; and rare use of primaquine for radical Plasmodium vivax treatment and dihydroartemisinin-piperaquine as the second-line treatment for uncomplicated malaria. Factors influencing nonadherence included stock-outs of anti-malarials and RDTs; staff shortages; lack of training, job aids and supervision; malpractice by specialists; distrust of malaria microscopy and RDTs; and patient pressure for diagnosis and treatment. Health workers recommended strengthening the supply chain; hiring personnel; providing in-service protocol training including specialists; establishing external quality assurance for malaria diagnosis; and providing onsite supportive supervision and public health campaigns.ConclusionsThis study revealed a broad spectrum of behavioural and systemic challenges in malaria management among frontline health workers in Northern Sudan, including nonadherence to protocols due to resource shortages, training gaps, a lack of supportive supervision and patient pressure. These insights, including health workers’ views about improvements, will inform evidence-based interventions by Sudan’s National Malaria Control Programme to improve health systems readiness and the quality of malaria case management.

Cause Analysis of Elevator Accidents Based on Complex Network

In order to excavate the key causes of elevator accidents, 70 elevator accident investigation reports from 2018 to 2023 were collected, and data mining was carried out to extract "4M" unsafe factors. On this basis, based on the complex network, the model of elevator accident causation network is constructed, and the statistical characteristics of this model are analyzed. Finally, the entropy weight-TOPSIS is used to construct a comprehensive evaluation model of network node importance, which comprehensively evaluates the causes of elevator accidents from four indicators, including degree centrality, intermediary centrality, proximity centrality and aggregation coefficient of nodes, and identifies the key factors of elevator accidents. The results show that unsafe factors such as defects of equipment and facilities, illegal operation, improper operation, weak safety awareness, inadequate implementation of safety responsibilities, and inadequate on-site supervision are the key causes of elevator accidents, which need to be controlled and controlled.

ANALYSIS OF LABOUR PRODUCTIVITY IN THE WORK OF LIGHT STEEL ROOF FRAME STRUCTURE (CASE STUDY: CONSTRUCTION PROJECT OF THE CATHOLIC CHURCH OF St. MARIA BUNDA PENGHARAPAN BUNUT SANGGAU)

Project performance is greatly influenced by labor productivity. The productivity of each worker is different and is influenced by several factors such as work experience, age, education level, wages, site conditions, weather, coordination and planning, and leadership skills. This study examines the value and level of labor productivity, the variables that influence productivity, and the efforts to improve labor productivity. Observations in this study were conducted using the construction sampling method to observe the work scope, construction time, number of workers, adequate time, contribution time, ineffective time of lightweight steel-roof frame construction work, and direct on-site observation. Next, the level of labor productivity must be analyzed using the Labor Utilization Rate (LUR) approach. The analysis shows that the average productivity values for horse labor were 2,581 m²/OH for ironworkers and 5,197 m²/OH for manual workers. The productivity value for ironworkers in lath construction is 5,256 m²/OH. From the analysis of the average level of labor productivity (results are more than 50% of her), it can be concluded that the level of labor productivity in the construction project of the catholic church of St. Maria Bunda Pengharapan Bunut Sanggau is satisfactory. The most significant variables affecting labor productivity are control variables. As a result of interviews with stakeholders, it was found that ways to increase labor productivity include effectively using time, creating a working system that is easy to work in, ensuring that workers have specialized knowledge, and ensuring thorough on-site supervision. Improvements are needed to create a good working environment.

Outreach Training and Supportive Supervision for Quality Malaria Service Delivery: A Qualitative Evaluation in 11 Sub-Saharan African Countries.

Quality improvement of malaria services aims to ensure that more patients receive accurate diagnosis, appropriate treatment, and referral. The Outreach Training and Supportive Supervision Plus (OTSS+) approach seeks to improve health facility readiness and provider competency through onsite supportive supervision, troubleshooting, and on-the-job training. As part of a multicomponent evaluation, qualitative research was conducted to understand the value of the OTSS+ approach for malaria quality improvement. Semistructured key informant interviews, focus group discussions, and structured health facility-based interviews were used to gather stakeholder perspectives at subnational, national, and global levels. Data were collected globally and in 11 countries implementing OTSS+; in-depth data collection was done in four: Cameroon, Ghana, Niger, and Zambia. Study sites and participants were selected purposively. Verbatim transcripts were analyzed thematically, following the Framework approach. A total of 262 participants were included in the analysis; 98 (37.4%) were supervisees, 99 (37.8%) were supervisors, and 65 (24.8%) were other stakeholders. The OTSS+ approach was perceived to improve provider knowledge and skills in malaria service delivery and to improve data and supply management indirectly. Improvements were attributed to a combination of factors. Participants valued the relevance, adaptation, and digitization of supervision checklists; the quality and amount of contact with problem-solving supervisors; and the joint identification of problems and solutions, and development of action plans. Opportunities for improvement were digitized checklist refinement, assurance of a sufficient pool of supervisors, prioritization of health facilities, action plan dissemination and follow-up, and data review and use. The OTSS+ approach was perceived to be a useful quality improvement approach for malaria services.

Ethics and benefits of family participation in global surgery: a review of the One World Surgery experience

Short-term experiences in global health (STEGHs) provide the opportunity to improve individual patient care and build systemic capacity in under-resourced communities. While most STEGHs are conducted by teams of clinical practitioners and/or trainees, there are some organizations in which nonclinical family members of medical/surgical volunteers participate. One World Surgery is an example of an organization that encourages family member participation in its short-term volunteer trips to Honduras. Through careful pretrip orientation, on-site supervision, and consistent educational programs, One World Surgery has developed a program which promotes safe and effective participation of family members. A recent survey of preprofessional volunteers confirmed that participants felt appropriately supervised and well prepared for their STEGH duties; as a testament to their experience, 100% of these volunteers indicated they would like to return for another One World Surgery experience. The purpose of this paper is to highlight the benefits of family member participation in STEGHs and share the experience of one organization in which family member participation has been developed to provide ethical, beneficial, and sustainable care.

Intelligent Control System for Wood Drying: Scalable Architecture, Predictive Analytics, and Future Enhancements

This article explores the research and development undertaken as part of a Master’s degree in Computer Engineering, with a primary focus on enhancing control mechanisms for natural wood drying. While this method is known for its cost-effectiveness in terms of labor and energy, it suffers from slower and unstable drying cycles. The project’s objective is to implement an intelligent control system that significantly improves monitoring and recording of humidity levels in each wooden stack. Additionally, the system incorporates the capability to predict humidity based on data sourced from a weather forecasting API. The proposed solution entails a three-layer system: data collection, relay, and analysis. In the data collection layer, low-computing devices, utilizing a Raspberry Pi, measure humidity levels in individual wood stacks. These devices then transmit the data via Low Power Bluetooth to the subsequent layer. The data relay layer incorporates an Android application designed to aggregate, normalize, and transmit collected data. Furthermore, it provides users with visualization tools for comprehensive data understanding. The data storage and analysis layer, developed with Django, serves as the back-end, offering management functionalities for stacks, sensors, overall data, and analysis capabilities. This layer can generate humidity forecasts based on real-time weather information. The implementation of this intelligent control system enables accurate insights into humidity levels, triggering alerts for any anomalies during the drying process. This reduces the necessity for constant on-site supervision, optimizes work efficiency, lowers costs, and eliminates repetitive tasks.

Corportae Governance Issues in Nepalese Banks and Financial Insti-tutions and Legal Settelement at the Supreme Court of Nepal

Corporate governance includes a set of relationships among Board of Directors, management team, employees, and other stakeholders of an organization. Corporate governance is a mechanism that determines the setting of goals, attainment of objectives, and monitoring of the performance of an entity. Banks and financial institutions (BFIs.) in Nepal have been under great concern regarding good corporate governance from the regulatory body, Nepal Rastra Bank (NRB), a central bank of Nepal. After back-to-back off-site supervision and on-site supervision, issues of corporate governance have come to the surface. Issues of corporate governance at Nepalese BFIs go beyond the picture reflected in the books of accounts and financial indicators. Hence, issues of corporate governance have been raised in the courtrooms of Nepal. Thus, the paper conducted a case study on the issues of corporate governance within Nepalese BFIs. In such a scenario, the Supreme Court of Nepal, in most cases, gave verdicts in favor of the central bank, found the top managerial personnel to be the main culprit, and ordered it to settle the issues as corporate governance comes under the jurisdiction of NRB.

Curbing customer-to-customer misbehavior contagion in the sharing economy

The sharing economy has fundamentally transformed customers’ lives. Providing short-term access to resources, however, creates environments in which customers regularly become the target of other customers’ misbehavior, either personally or toward shared resources. Although this customer-to-customer (C2C) misbehavior is known to be contagious, the reasons for its spread and the effectiveness of containment measures across sharing economy markets remain unclear. Three experiments reveal the moderating role of on-site supervision: platform-provider-directed blame attributions drive C2C misbehavior contagion in settings with formal on-site supervision, while social norms underlie contagion when on-site supervision is absent. Perpetrator-directed blame attributions reverse contagion irrespective of on-site supervision. More intrusive platform and peer-provider measures (in-person reprimands, in-app messages, and photo features) are most effective at curbing contagion by reducing social norms to misbehave and shifting blame to the perpetrator. However, these measures are only effective at certain C2C misbehavior severity levels for different sharing economy market types.

Safety risk analysis of high-rise steel structure building construction

At present, in the construction of high-rise steel structures, many construction companies have inaccurate grasp of the key technologies of steel structure construction, and in specific construction, they still follow past construction experience, resulting in the lack of guarantee for the quality of steel structure construction. In the construction of steel structures, there is a great correlation between various sub items, processes, and before processes. In addition, there is a close relationship between the progress, quality, cost and safety of the project. If there is a problem in any node or link, it will have a chain reaction, affect the realization of other goals and expand losses. This paper first expounds the characteristics of building steel structure, then analyzes the safety risks of high-rise steel structure construction, and finally puts forward the safety management strategies of high-rise steel structure construction, including innovating steel bar welding technology, risk control of environmental factors, strengthening on-site supervision of construction projects and increasing the application of BIM technology.

Does Facilitative Supervision Made Difference in PHC Readiness to Provide Emergency Maternal and Newborn Care: an Operational Research at Primary Health Centre of Ende District, Eastern Indonesia

Purpose: Government of Indonesia (GOI) has commitment to ensure that basic obstetric and newborn care is provided as to standard of care, through a pilot project of facilitative supervision conducted at 5 Primary Health Centre (PHC) of Ende district, in a series of combined online and onsite supervision during a period of 7 months, ended in December 2021. This operational research examined PHC’ readiness in providing emergency obstetric and newborn care, comparing intervened and control PHC.
 Methods: This present study used quasi experimental method, with Post-test Only Control Group design. Intervention of facilitative supervision only provided in one group, and assessment conducted in those 2 groups, comparing results between those groups. Unit analysis was PHC, 2 PHCs selected as intervened PHC, and 2 PHCs as control. Data were collected through direct observation using check list, assessment of patient’s records, and interview with several health workers.
 Results: In this operational study we compared the service coverage and readiness in providing emergency obstetric neonatal care, between PHC that received and not received intensive facilitative supervision in the previous 7 months. PHC in urban area handling very few obstetric complications but referred more cases to District Hospital (>90). However, intervened PHC provide obstetric complication care two times higher (8.33%) than control PHC (4.17%). Both intervened and control PHC in rural area, provide far more obstetric complication care (>60%) compared to those in urban area, with the coverage of referral case around 30-35% from total obstetric complication cases. Intervened PHC in rural area managing all neonatal complication cases, and shows the lowest percentage of neonatal death (1,2%) compare to other PHCs. Control PHC in rural area also managed 88.89% of neonatal complication cases, but has the highest percentage of neonatal death (4.17%). The significant difference between intervened and control PHC in the input side, lies in the availability of emergency team which should be minimal of 3 health workers consist of doctor, midwife and nurse; and availability of neonatal emergency kit. In the process side, the difference between intervened and control PHC is more obvious in rural area, the main difference lies in the unavailability of algorithm and SOP for post-partum bleeding, pre/eclampsia, and neonatal resuscitation at control PHC
 Conclusions: There is difference in the readiness of providing emergency maternal neonatal between intervened and control PHC only in rural area, indicate by higher compliance level value in the intervened PHC (77.14%) compared to control PHC (40%). The difference in the quality of care only obvious in rural area and in emergency neonatal care, indicate by 3,5x lower percentage of neonatal death in intervened PHC compared to the control PHC

Development of Construction Site Safety Monitoring Techniques Using Worker Positioning and BIM

Construction site accidents have been an ongoing concern, resulting in property damage and significant loss of life. Since the implementation of the Serious Accidents Punishment Act, the importance of preventing human casualties in industrial accidents has been increasingly emphasized, and safety management is being carried out through on-site supervision. However, safety management personnel are insufficient in expansive construction sites. In this study, we developed a technique that determines a worker’s position wearing a wearable sensor and manages the worker’s safety around a hazardous zone defined in the digital twin environment. By converging IMU and UWB sensors with the Kalman Filter, the worker’s positioning limit was improved, and BIM was utilized as a digital twin method. The findings demonstrate that it is possible to systematically manage worker-centered safety on construction sites by proposing preventive measures against the weakness of field supervisors as safety management personnel.

Health Professions Education Strategies for Enhancing Capacity for Task-Shifting and Task-Sharing Implementation in Africa: A Scoping Review.

To compensate for the shortage of health workers and effectively use the available health workforce to provide access to health services at various levels of the health system, several countries are implementing task-shifting and task-sharing (TSTS). This scoping review was conducted to synthesize evidence on health professions education (HPE) strategies applied to enhance capacities for TSTS implementation in Africa. This scoping review was conducted using the enhanced Arksey and O'Malley's framework for scoping reviews. The sources of evidence included CINAHL, PubMed, and Scopus. Thirty-eight studies conducted in 23 countries provided insights on the strategies implemented in various health services contexts including general health, cancer screenings, reproductive, maternal, newborn, child and adolescent health, HIV/AIDS, emergency care, hypertension, tuberculosis, eye care, diabetes, mental health, and medicines. The HPE strategies applied were in-service training, onsite clinical supervision and mentoring, periodic supportive supervision, provision of job aides, and preservice education. Scaling up HPE based on the evidence from this study will contribute immensely to enhancing the capacity of health workers in contexts where TSTS are being implemented or planned to provide quality health services based on the population's health needs.

Terrorism and economic governance in Africa: analysis of the impact of Boko-Haram on banking administration in Nigeria

Purpose Using system theory, this paper aims to interrogate the impact of Boko-Haram on bank administration. The paper explains how death, injury and property destruction caused by terrorism affect banking supervision and structures. Design/methodology/approach With the aid of a mixed research method, this paper conducted 47 interviews. It extracted secondary data from the Central Bank of Nigeria database, the National Deposit Insurance Corporation publications, Enhancing Financial Innovation and Access Survey, the World Bank database and the Global Terrorism Index. Descriptive, content and regression analysis was used in this research. Findings With a significant regression model (p-value < 0.05), the analysis shows that terrorism accounts for 84.02% variation in banking administration. The impact of Boko-Haram on banking administration is negatively significant, especially in the areas like on-site supervision of Money Deposit Banks/Micro-finance Institutions and citizens’ accessibility to financial systems. Originality/value This paper generates new knowledge in the thematic area, which is still grey. The influence of terrorism on financial institutions as an element of economic governance is less researched. Hence, the strategic linkage of the impact of Boko-Haram on banking administration as a component of financial institutions. Therefore, this paper contributes to the existing body of literature on terrorism and economic governance.

Post introduction evaluation of the malaria vaccine implementation programme in Ghana, 2021

BackgroundMalaria remains a public health challenge in Sub-Saharan Africa with the region contributing to more than 90% of global cases in 2020. In Ghana, the malaria vaccine was piloted to assess the feasibility, safety, and its impact in the context of routine use alongside the existing recommended malaria control measures. To obtain context-specific evidence that could inform future strategies of introducing new vaccines, a standardized post-introduction evaluation (PIE) of the successes and challenges of the malaria vaccine implementation programme (MVIP) was conducted.MethodsFrom September to December 2021, the WHO Post-Introduction Evaluation (PIE) tool was used to conduct a mixed methods evaluation of the MVIP in Ghana. To ensure representativeness, study sites and participants from the national level, 18 vaccinating districts, and 54 facilities from six of the seven pilot regions were purposively selected. Quantitative and qualitative data were collected using data collection tools that were adapted based on the WHO PIE protocol. We performed summary descriptive statistics on quantitative data, thematic analysis on qualitative data, and triangulation of the results from both sets of analyses.ResultsAbout 90.7% (49/54) of health workers stated that the vaccine introduction process was smooth and contributed to an overall improvement of routine immunisation services. About 87.5% (47/54) of healthcare workers, and 95.8% (90/94) of caregivers accepted RTS,S malaria vaccine. Less than half [46.3%; (25/54)] of the healthcare workers participated in the pre-vaccine introduction training but almost all [94.4%; (51/54)] were able to constitute and administer the vaccine appropriately. About 92.5% (87/94) of caregivers were aware of the RTS,S introduction but only 44.0% (44/94) knew the number of doses needed for maximum protection. Health workers believed that the MVIP has had a positive impact on under five malaria morbidity.ConclusionsThe malaria vaccine has been piloted successfully in Ghana. Intensive advocacy; community engagement, and social mobilization; and regular onsite supportive supervision are critical enablers for successful introduction of new vaccines. Stakeholders are convinced of the feasibility of a nationwide scale up using a phased subnational approach taking into consideration malaria epidemiology and global availability of vaccines.

Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial

Family involvement is part of the evidence-based treatment for persons with psychotic disorders, yet is under-implemented despite guideline recommendations. This study assessed whether an implementation support programme increased the adherence to guidelines on family involvement, compared to guideline/manual only. In a cluster randomised design, community mental health centre units in South-East Norway went through stratified allocation to the experimental (n = 7) or control (n = 7) arm. Experimental clusters received an implementation support programme including clinical training and supervision, appointing a family coordinator and an implementation team, a toolkit, and fidelity measurements at baseline, 12, 18, and 24 months with on-site feedback and supervision. Control clusters received no such support and had fidelity measurements at baseline and 24 months without feedback. During fidelity measurements, adherence to the guidelines was measured with the basic family involvement and support scale, the general organizational index, and the family psychoeducation fidelity scale, the latter being the primary outcome. The scales consist of 12–14 items rated from 1 to 5. Data was analysed with an independent samples t-test, linear mixed models, and a tobit regression model. At 24 months, the mean scores were 4.00 or higher on all scales in the experimental arm, and the increase in adherence to the guidelines was significantly greater than in the control arm with p-values < 0.001. Large-scale implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres may be accomplished, with substantial implementation support.Trial Registration: ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study

BackgroundThere is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically.MethodsThis prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees’ knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians . The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees’ clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees.ResultsPre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8, P < 0.0001). At 6 months, 62% of trainees were performing PoCUS that had assisted in patient management and clinical diagnosis, and 46% reported earlier diagnosis and changes to patient management. 74% of trainees had increased scanning frequency and 93% reported improved scanning confidence.ConclusionThis study demonstrated intensive 2-day workshops can equip clinicians with valuable antenatal PoCUS skills, offering a viable solution to assist in the assessment and management of pregnant women in the rural/resource-poor setting where access to ultrasound services is limited or non-existent. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the continuing professional development of remote trainees and the implementation of PoCUS.

Further refinements of a continuous radon monitor for surface ocean water measurements

Radon is an excellent natural tracer for studying various geophysical processes. In the past centuries, radon isotopes measurement approaches for marine research have been fully developed but still suffer limitations. Here we present the setup and validation of an improved continuous online measurement system (PIC-ORn) to measure dissolved radon in the surface ocean and other water bodies. We demonstrated that the PIC measurement efficiency is ~2 times higher than a RAD7 and is less affected by relative humidity and produces reliable results. Laboratorial measurements indicated that the new PIC-ORn system responded timely to the change of radon activities in water. The new system was successfully deployed during a cruise to the northwest Pacific Ocean in June 2021. Despite low radon-in-water activities, the results obtained by the new PIC-ORn system matched the traditional measurement systems within the estimated uncertainties. The PIC-ORn detector takes advantage of higher efficiency, lower cost, and power consumption, and is less affected by air moisture. The new system does not rely on drying units, further reducing on-site supervision, which would benefit the researches in submarine groundwater advection and diffusion and ocean-atmosphere gas exchange.

Analysis of the most frequent nonconformance aspects related to Good Manufacturing Practices (GMP) among small and medium enterprises (SMEs) in the food industry and their main factors

Despite the increasing evidence that small processors have a low rate of food safety compliance, primarily due to the lack of Good Manufacturing Practice (GMP) implementation, only a limited number of research studies have been conducted to understand their challenges. The aims of this review were twofold, namely 1) to analyse the GMP’s most frequent nonconformance aspects in small food processing and (2) to elucidate the key factors that lead to the nonconformance aspects. The review was carried out based on twenty peer-reviewed publications between the years 2012 to 2021, which collected studies related to GMP and small-scale processors. Inadequate sanitary design and facilities were identified as the most frequent GMP nonconformance aspect (85% of the total number of publications), followed by poor personal hygiene (55%), inadequate or absence of documentation (55%), poor cleaning and maintenance programs (50%), lack of operation control (50%), lack of training (35%), inadequate product information (15%) and lack of workers’ health control (15%). Such nonconformances were found to result in incidences of foodborne diseases, unacceptable microbial growth in products and ambient areas, quality degradation as well as findings of filthy matters. The factors that led to nonconformance were the lack of on-site supervision, financial constraints, lack of knowledge, lack of managerial support, the gap in authority's enforcement and workers' resistance to food safety practices. The review concludes with a suggestion for future work to formulate a cohesive program that integrates multiple strategies in addressing the identified key factors and subsequently, enabling GMP adoption among SMEs.