Poor Cooperation Research Articles

A qualitative study of factors influencing evidence-based practice of blood collection by clinical nurses via central venous access devices.

Several studies have upheld the advantages of blood collection using via central venous access device (CVAD); the procedure has a high success rate and avoids painful repeated punctures. Some studies have suggested that via central venous access device (CVAD) blood collection is preferable for acute and critical care, oncology, and pediatric patients. However, there is no consensus on or standardization of this approach. To explore the facilitators of and barriers factors of evidence-based decision-making in CVAD blood collection in clinical practice. This was a qualitative study guided by phenomenological research. A purposive sampling method was used to select 13 clinical nurses from two public hospitals in China to conduct semi-structured personal interviews. The interview outline was designed based on a literature review and the i-PARIHS theoretical framework, and information was organized and analyzed using the Colaizzi 7-step analysis method. Two themes and seven sub-themes were derived from the analysis of interview data. Facilitating factors: (1) nurses' trust the evidence-based nursing decisions; (2) low rate of operational complications; (3) high success rate of blood collection; (4) nurses' sense of professional benefit; Hindering factors: (1) preparation of operational materials and time-consuming operation; (2) nursing interruptions; (3) patients' economic factors. The interview data showed that CVAD blood collection is suitable for critically ill patients, children, patients with poor venous conditions and poor cooperation. This study provides guidance for advancing the clinical application of evidence-based CVAD blood collection. Evidence-based nursing culture, operational advantages, and nurses' sense of professional benefit were effective facilitators of the evidence-based practice. Researchers need to optimize the operating materials and methods, and comprehensively consider multiple factors to promote the better application of evidence.

Mechanical properties of CFRP and shrinkage compensating concrete actively confined and strengthened short columns under freeze–thaw cycles

AbstractThis paper investigates the use of CFRP precast tubes filled with shrinkage‐compensating self‐consolidating concrete (SSCC) for strengthening columns. Compared to ordinary self‐consolidating concrete (OSCC), SSCC can address the stress hysteresis issue caused by the poor cooperation between CFRP and concrete structures, while also enhancing the mechanical properties of columns. Experimental and theoretical studies were conducted to examine the tensile mechanical properties of CFRP materials and the axial compressive mechanical properties of CFRP precast tubes strengthened with OSCC or SSCC under freeze–thaw cycles. Various variables were considered, such as freeze–thaw cycles, types of strengthening concrete, and the number of CFRP layers. The results indicate that freeze–thaw cycles do not affect the ultimate tensile strength of CFRP but significantly reduce its ultimate tensile strain. SSCC‐strengthened specimens exhibit higher load‐carrying capacity and better ductility compared to OSCC‐strengthened specimens. In addition, compared to the strengthening of two‐layer CFRP and SSCC, the strengthening of one‐layer CFRP and SSCC more effectively demonstrates the advantage of the post‐tensioning effect. However, the ductility coefficient of the columns decreases with an increase in the number of freeze–thaw cycles, regardless of the number of CFRP layers or type of strengthened concrete. Modified theoretical model accurately predicts the normalized peak stress and strain of the strengthened specimens.

СИСТЕМНІСТЬ РІШЕНЬ РОЗШИРЕННЯ ВИРОБНИЦТВА ВИСОКОЯКІСНОЇ ПРОДУКЦІЇ ЕКСПОРТООРІЄНТОВАНИМ МЕТАЛУРГІЙНИМ ПІДПРИЄМСТВОМ

The study outlines the approaches toward the rationalization of the technological process of pellet production by combining iron ore extraction in the quarry, its milling, concentrate enrichment, pellet firing. The practice of system implementation of modern technology of flotation processing of iron content into the concentrate as a strategic task of improving the quality of pellets is described. The peculiarities of involving a significant percentage of "low-grade" ores in production in case of necessity are revealed. It was concluded that the implementation and successful functioning of the quality management system are affected by engineering mistakes, poor cooperation with suppliers, the return of low-quality products to the enterprise, additional transportation expenses. The sequence of development of the fundamental documents of the quality management system regarding the implementation of the policy in the field of expansion of export supplies of pellets and improvement of the organizational structure of the company's management is covered. The iron content in pellets was predicted using the auto regression model. An improved structure of management of foreign economic activity in case of the implementation of the project on additional production of high-quality pellets is proposed. The costs for increasing the volume of production of iron ore raw materials for the project for the successful functioning of the automated management system for the entire technological process of charge preparation, pelletizing and firing of pellets are systematically defined. A risk assessment was carried out in conditions of implementation of the model for calculating the capital assets of the complex of equipment for the production of high-quality pellets of a well-known global company. Decisions regarding the positioning of the plant's pellets on the world market with determination of the pricing strategy are justified.

Mitigating the Problem of Local Extinction through Pilot Operation of the Gyeongbuk Theme City: Focusing on a comparative analysis between Kawaba Village and the Bu-Ul-Gyeong megacity†

As of 2023, over half of South Korea's 228 regions face population extinction, despite substantial local government efforts. This study examines why the "Busan-Ulsan-Gyeongnam (Bu-Ul-Gyeong) Megacity" initiative failed to address this issue. By analyzing the successful revitalization of Kawaba village in Japan, which attracted more than 2.5 million tourists, this study proposes an innovative solution tailored to South Korea—the "Gyeongbuk Four Seasons Theme Park." This project aims to revitalize the Gyeongbuk region's economy and reverse population decline, contributing to Sustainable Development Goal 11: "Sustainable Cities and Communities."This study uses a comparative case study methodology to analyze the Bu-Ul-Gyeong Megacity initiative and Kawaba Village. Data collection involved a review of policy documents and academic literature for the former and fieldwork, including interviews and observations, for the latter. The key participants included local government officials and employees in Kawaba Village. Insights from Kawaba were applied to design the "Gyeongbuk Four Seasons Theme Park," which integrates successful elements from Kawaba's model while addressing the shortcomings of the Bu-Ul-Gyeong initiative.The Bu-Ul-Gyeong initiative failed because of a lack of economic revitalization planning, insufficient community engagement, and poor cooperation between governments. Kawaba village succeeded in establishing partnerships, fostering local enterprises, and maintaining effective government communication. These factors are critical in overcoming challenges in regional development.This study proposes the "Gyeongbuk Four Seasons Theme Park," a rotating, seasonal attraction across four cities, emphasizing local specialties and resident participation. This project aims to increase population inflow and establish sustainable agricultural enterprises, contributing to the economic revitalization of the Gyeongbuk region.

Striving for Quality Higher Education: The Quandaries of Academic Planning and Quality Assurance Directorate at the University for Development Studies

The study examined the quandaries of the Directorate of Academic Planning and Quality Assurance (DAPQA) of the University for Development Studies. The study adopted a mixed research approach using purposive sampling to select two staff members from the Directorate and fourteen DAPQA representatives from all the various schools and faculties in the university. The researchers personally administered the questionnaires and conducted the interviews. Descriptive statistics and frequencies were employed to analyze the quantitative data, while the qualitative data were transcribed and coded for easy identification. The study revealed that the directorate is faced with poor cooperation from the university's academic and non-academic staff. It also came to light that there were inadequate personnel and limited office space and funds to carry out their activities. The study, therefore, recommends recruiting qualified staff and continuing workshops for existing staff of the university to appreciate the role of DAPQA and the need to avail themselves whenever needed. Again, university management should organize in-service training for the staff of DAPQA and provide enough office space and funds to carry out its activities.

Injectable polypeptide-polysaccharide depot for preventing postoperative tumor recurrence by concurrent in situ chemotherapy and brachytherapy

Chemotherapy and radiotherapy in combination with sequence regimens are recognized as the current major strategy for suppressing postoperative tumor recurrence. However, systemic side effects and poor in-field cooperation of the two therapies seriously impair the therapeutic efficacy of patients. The combination of brachytherapy and chemotherapy through innovative biomaterials has proven to be an important strategy to achieve synergistic effects of radiotherapy and chemotherapy in-time and in-field. However, for postoperative chemoradiotherapy, as far as we know, there are few relevant reports. Herein, an injectable pH-responsive polypeptide-polysaccharide depot for concurrent in situ chemotherapy and brachytherapy was developed by encapsulating vincristine into iodine-125 radionuclide labeled hydrogel. This depot hydrogel was prepared by dynamic covalent bonds of Schiff base between aldehydeated hyaluronic acid and polyethylene glycol-polytyrosine. Therefore, this hydrogel enables smart response to tumor acidic microenvironment, rapid release of the encapsulated vincristine and an enhanced uptake effect by tumor cells, which significantly reduces IC50 of vincristine for the anaplasia Wilms' tumor cells in vitro. This depot hydrogel shows excellent stability and biocompatibility, and maintains for 14 days after in situ injection in a postoperative model of anaplasia Wilms' tumor. After injection at the cavity of tumor excision, responsively-released vincristine and the radioactive iodine-125 exerted excellent killing effects on residual tumor cells, inhibiting tumor relapse and liver metastasis of the recurrent tumor. Hence, this study proposes an effective therapeutic strategy for inhibiting anaplasia Wilms’ tumor recurrence, which provides a new approach for concurrent postoperative chemo-radiotherapy and a desirable guidance in regimen execution of pediatric refractory tumors.

A systematic review and meta-synthesis of the barriers of offsite construction projects

Offsite construction (OSC) has been increasingly adopted in the construction industry, especially with increased practical interest in digital transformation in construction, automated production, assembly, and delivery. The uptake of OSC has not however been consistent internationally, and the adoption rate of modular and prefabricated construction is still poor in many developing and developed countries. This review aims to detect and classify the barriers for adopting OSC by assimilating previous research studies. This paper systematically analyses 75 research articles, published in the past decade spanning between 2012 and 2022 inclusive. A total of 47 barriers were identified through this review and the five most frequent barriers were: lack of skills and expertise in OSC within the organization, poor cooperation and integration between stakeholders in the value chain, higher project costs, higher capital cost, and lack of a national standards and design codes for prefabricated components. The analysis offers insights into gaps that exist that could support greater OSC activity globally. Barrier trends by publication year and country are reported to highlight changes in research activity to delineate recommendations for future work to ensure greater uptake.

EFL teachers’ perceptions of emotional exhaustion and associated regulation strategies: a phenomenological analysis

ABSTRACT Teaching, particularly in a second/foreign language (L2) context, is an emotionally demanding profession, often leading to negative outcomes for educators. Teaching, particularly in a second/foreign language (L2) context, is an emotionally demanding profession, often leading to negative outcomes for educators. To fill the gap, this phenomenological study examined the causes, consequences, and regulation strategies of Chinese EFL teachers’ emotional exhaustion. A semi-structured interview was held with 58 teachers. The results of thematic analysis revealed that this emotional state had different causes and consequences. The most frequent causes were ‘occupational pressures’, ‘identity conflicts and mismatches’, ‘stressful classroom climate’, ‘high expectations’, and ‘students’ poor performance and cooperation’. Additionally, it was found that teachers’ emotional exhaustion can mostly lead to ‘poor teaching quality’, ‘job burnout’, ‘low work engagement’, ‘low teaching enthusiasm’, and ‘various other negative emotions and outcomes’. To regulate such an aversive feeling, the participants used a range of preventive and responsive strategies before and after its occurrence. The study discusses the findings and presents some conclusions and implications for Chinese L2 teachers, teacher trainers, and policy-makers to raise their understanding of the nature and mechanism of emotional exhaustion in teaching English and its regulation.

Nurses’ attitude towards patient advocacy and its associated factor in East Gojjam Zone Public hospitals, Northwest Ethiopia, 2023

IntroductionOne of the most important but underappreciated roles of nurses is patient advocacy. To advocate for patients effectively, the nurses should have a favorable attitude towards patient advocacy. Despite this fact, the nurses’ attitude towards patient advocacy was not known in Ethiopia. Thus, this study aimed to assess nurses’ attitude towards patient advocacy and its associated factors in East Gojjam Zone Public Hospitals, Northwest in 2023.MethodsInstitutional-based cross-sectional study design was conducted among 385 nurses in East Gojjam Zone Public Hospitals from March 1 to April 30, 2023. Nurses were selected using simple random sampling techniques from 11 public hospitals. The data were collected in a self-administered way. Binary logistic regression was used for data analysis. All independent variables having a P value of < 0.25 in the bivariable logistic regression were fitted into a multivariable logistic regression. The AOR at a 95% confidence interval was used to identify the strength of the association, and a p value of 0.05 was used to declare it statistically significant at the final model.ResultA total of 385 nurses participated in the study, for a 91% response rate. Among these, 49.9% of nurses had an unfavorable attitude. Being working in a primary hospital [AOR = 2.3; 95% CI: (1.4–3.8)], poor cooperation of nurses [AOR = 1.7; 95% CI: (1.1–2.8)], being unsatisfied with the job [AOR = 1.7; 95% CI: (1.1–2.7)], and poor perceived supervision of work [AOR = 6.2; 95% CI: (3.7–9.8)] were factors associated with nurses’ attitudes towards patient advocacy.ConclusionThe number of nurses who had an unfavorable attitude towards patient advocacy was high. Working in a primary hospital, poor cooperation with others, being dissatisfied with the job, and having an unfavorable perception towards the supervision of work were the factors associated with the unfavorable attitude of nurses towards patient advocacy. It is recommended that all hospitals better support the nurses to increase their job satisfaction and have good supervision of the nurses’ activities.

Factors influencing the continuity of evidence-based practice in perioperative airway management for elderly patients with fractures: A qualitative study.

More and more evidence-based practices are emerging, but researchers mostly focus on short-term effects, resulting in evidence-based practices not being applied in the clinic in the long term. In this study, we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic. To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures. This study was qualitative research. Nine nurses who implemented evidence-based practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects. Semi-structured interviews were conducted with them, and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model. Three main themes and ten subthemes were identified: Process aspects (benefits to patients, benefits to nurses, lack of follow-up, complex processes); staff aspects (insufficient human resources, inadequate training and education, lack of leadership support); and organizational environment aspects (inadequate infrastructure, poor patient compliance, poor doctor cooperation). Human resources, training and education, leadership support, infrastructure, and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.

Evaluation of the extent of plaque removal and users' experience of alternative toothbrushes: A randomized single-blind crossover study.

In residential care, tooth brushing with a manual toothbrush can be challenging because of technical difficulties, time consumption and poor patient cooperation, resulting in a sub-optimal cleaning. The study aimed at comparing the efficiency in plaque removal, brushing time and users' experience between three toothbrushes: a single-headed conventional manual toothbrush, a triple-headed manual toothbrush and a U-shaped electric toothbrush. This was a single-blind crossover study with three pre-post-test conditions. Participants were 26 dental students divided into fixed pairs to play the role of caregivers and care receivers. Pre/post plaque scores were determined by two independent investigators according to the Quigley-Hein Plaque Index (QHI). Questionnaires evaluated participants' experiences. Statistical tests of significances of differences and ANOVA were performed. Results showed that plaque removal was more effective for the manual toothbrush and the triple-headed toothbrush compared to the U-shaped electric toothbrush (p < 0.001). Brushing time was the longest for the single manual toothbrush (149 s). The U-shaped electric toothbrush showed significantly better results for aspects related to comfort and salivation. The manual and triple-headed toothbrush showed better results for aspects related to cleanliness and motivation to use. Notwithstanding its favourable comfort, tooth plaque removal is not enhanced by a U-shaped electric toothbrush. The triple-headed and single-headed toothbrushes reduced plaque more substantially than the U-shaped toothbrush. In addition, the triple-headed manual toothbrush was not only effective in plaque removal, but also had a shorter brushing time and was easy to use, being an adequate alternative for care-dependent patient groups.

Ophthalmology Residents' Experience in Cataract Surgery: Preoperative Risk Factors, Intraoperative Complications, and Surgical Outcomes.

This retrospective study explores the connection between preoperative patient risk factors, the experience of ophthalmology residents, and the outcomes of cataract surgeries performed at Hadassah Medical Center. It is hypothesized that with increased experience, residents may demonstrate greater proficiency in handling surgeries on higher-risk patients, potentially leading to improved surgical outcomes overall. Data were examined from 691 consecutive cataract surgeries in 590 patients, conducted by ophthalmology residents at Hadassah Medical Center (January 2018 to February 2022). Demographics, surgeon experience, preoperative cataract risk assessment score, and pre- and postoperative corrected distance visual acuity (CDVA) were analyzed. The risk score was based on cataract density, previous vitrectomy, presence of phacodonesis, small pupil, extreme axial length (> 30mm or < 21.5mm) or abnormal axial length (26-30mm), shallow anterior chamber (< 2.5mm), poor patient cooperation, oral alpha-1 blocker use, diabetic retinopathy (DR), Fuchs endothelial dystrophy, and having one functioning eye. This study focused on the correlation of risk scores with residents' surgical experience and surgical outcomes. As residents gained experience, surgeries on patients with at least one risk factor increased from 54% (first year) to 75% (second year; p < 0.001) and fluctuated between 75%, 82%, and 77% (third, fourth, and fifth years, respectively), with initial preoperative CDVA declining progressively. Despite handling more complex cases over time, the percentage of intraoperative complications per patient decreased with each year of residents' experience (17%, 13%, 11%, 17%, 6%; respectively). Patients without any risk factor had higher postoperative CDVA than those with one or more risk factors (mean ± standard deviation [SD] in logMAR, 0.16 ± 0.26 vs. 0.27 ± 0.35; p < 0.001) and a higher percentage of CDVA improvement (63% vs. 57%, p = 0.016). The use of a preoperative risk assessment scoring system to allocate surgeries to residents at varying experience levels may reduce the risk for surgical complications, thereby ensuring patient safety and providing residents with a gradual learning experience.

Preoperative Anxiolytic and Sedative Effects of Intranasal Remimazolam and Dexmedetomidine: A Randomized Controlled Clinical Study in Children Undergoing General Surgeries.

Remimazolam, anultra-short-acting and fast-metabolized sedative, has only been sporadically investigated in children. This study was performed to determine the beneficial effects of intranasal remimazolam or dexmedetomidine on preoperative anxiety in children undergoing general surgeries. Ninety children were randomly and equally assigned to Group R (intranasal remimazolam 1.5mg kg-1), Group D (intranasal dexmedetomidine 2 mcg kg-1), and Group C (intranasal distilled water). The primary outcomes were the preoperative anxiety scores using the modified Yale preoperative anxiety scale (m-Ypas). The secondary outcomes included the cooperation behaviour of intranasal drug application, preoperative sedation levels, parental separation anxiety scores (PSAS), and mask acceptance scores (MAS). Group R showed a significant low anxiety at 10 min after intranasal premedication (vs group C, P=0.010; vs group D, P = 0.002) and at anaesthesia induction (vs group C, P = 0.004). Group D showed a significantly low anxiety score only prior to anaesthesia induction (vs group C, P = 0.005). Most children in group R achieved mild sedation at 10 min (vs group C, P < 0.001; vs group D, P < 0.001), with a few progressing to deep sedation afterwards, while group D tended toward deep sedation. Compared to Group C, patients in Group R performed significantly better on the MAS (P = 0.014) and PSAS (P = 0.008). However, remimazolam did cause poor cooperation behavior to the intranasal application due to its mucosal irritation (vs group C, P = 0.001; vs group D, P = 0.010). Both intranasal remimazolam and dexmedetomidine can effectively alleviate preoperative anxiety in children. While intranasal remimazolam has a rapid onset, it produces only mild sedation and causes substantial nasal irritation. NCT04720963, January 22, 2021, ClinicalTrials.Gov.

Lived Experiences of Novice Secondary School English Teachers in the Implementation of Modular Distance Learning in the Philippines

As COVID-19 forced schools to shift to distance learning, the modular approach, in particular, became the most viable option for the continuity of learning. However, these sudden changes also brought unique experiences to novice teachers. This study explored the lived experiences of novice secondary school English teachers (NSSET) in Tagum City in implementing modular distance learning (MDL) in the context of the pandemic. Phenomenological inquiry based on Bronfenbrenner's ecological theory was used to explain the experiences of the eight (8) participants. Using validated researcher-made interview questions, virtual in-depth interviews were conducted. Through Braun and Clarke’s (2006) six-step framework, themes that emerged, categorized into five echelons, are as follows: poor cooperation of parents and students, and productive collaboration with colleagues and immediate heads; overwhelming pressure from external sources, and taking direction from others’ influence; perpetual communication breakdown, and confronting challenges in the delivery of modular learning; meeting society’s expectations; abrupt adjustment to the new normal. These shape the experiences of the NSSET in conducting MDL in the new normal. However, the poor cooperation of parents and students poses the most significant experience for the NSSET. Notwithstanding, novice teachers navigated successfully through these experiences brought about by implementing MDL amid the pandemic.

Analysis of acupoint massage combined with touch on relieving anxiety and pain in patients with oral implant surgery.

Oral implant surgery is an effective procedure for artificial implants in missing tooth areas under local anesthesia. Because patients under local anesthesia are conscious during this procedure, compared with general anesthesia-related operations, they are more likely to experience negative emotions, such as anxiety and tension. These emotional reactions result in shivering and chills in the limbs, leading to poor doctor-patient cooperation and even avoidance of treatment. In traditional Chinese medicine, it is believed that acupoint massage regulates blood and Qi, dredge menstruation, and relieve pain, which is beneficial for patients' emotional adjustment; however, there are few related clinical studies. To observe the changes in anxiety and pain in patients with oral implant after acupoint massage combined with touch therapy. One hundred patients undergoing oral implantation in our hospital between May 2020 and May 2023 were randomly divided into control and study groups, according to a random number table, with 50 patients in each group. The control group received routine intervention, and the study group received acupoint massage combined with touch on the basis of the control group. Anxiety [assessed using the Modified Dental Anxiety Scale (MDAS)], pain severity, blood pressure, heart rate, and satisfaction were compared between the two groups. Before intervention, the difference in MDAS score between the two groups was not significant (P > 0.05), while after the intervention, the MDAS scores decreased in both groups compared with those before the intervention (P < 0.05); the MDAS score of the study group was lower than that of the control group, with a statistically significant difference (P < 0.05). The degree of pain in the intervention group was significantly lower than that in the control group (P < 0.05). Before the intervention, there were no significant differences in systolic and diastolic blood pressures or heart rate between the two groups (P > 0.05). The systolic and diastolic blood pressures and heart rate in the intervention group, during and after the intervention, were significantly lower than those in the control group (P < 0.05). The total degree of satisfaction in the study group was significantly higher than that in the control group (P < 0.05). Acupoint massage combined with touch better relieves anxiety and pain in patients undergoing dental implant surgery, improving the perioperative comfort of these patients and ensuring safety and a smooth operation.

Challenges Facing Secondary School Teachers in Achieving Effective Job Performance: A Case Study of Meru District Council, Arusha Region

This study examines the challenges facing secondary school teachers in executing their duties for effective job performance through a qualitative case study design. The study participants were secondary school teachers, heads of schools, and the District Education Officer. A total of 111 respondents were involved, including 100 teachers, 10 heads of schools, and 1 District Education Officer. In collecting data, interview and focus group discussion (FGD) methods of data collection were used for the purpose of this study. The data were analyzed through content and thematic analysis. The study found teachers are burdened with several challenges, including but not limited to an unfriendly working environment, a shortage of teaching and learning materials, low achievement of students in science subjects, poor cooperation between parents and teachers, poor cooperation accorded by employers, a lack of overtime and/or housing allowances, and political influences on teaching and learning processes. The study concluded that teaching, apart from being a noble profession that prepares not only leaders but also champions of various fields, has grown to be forgotten. Thus, it is recommended that there are significant needs to shift priorities and attention towards the teaching profession. One key aspect highlighted is the need for better compensation and entitlements for teachers, including salaries, subsistence allowances, extra-time allowances, and access to teaching and learning materials. Moreover, addressing these challenges requires comprehensive support and tailored interventions from educational institutions, policymakers, and other stakeholders in the education sector.

Appropriate addition power for aphakic infants determined by a smart wearable device Clouclip

ABSTRACT Clinical relevance It is particularly important to perform reasonable and effective optical correction to enable visual development after primary lens removal surgery for congenital cataracts. Aphakic infants need a suitable addition power of prescription (ADD) to help them focus on close visual objects. Background It is challenging to obtain appropriate ADD power for infants due to poor cooperation and lack of subjective feedback. We aimed to determine the appropriate ADD for aphakic infants using a recently developed smart wearable device called Clouclip. Methods The study was a cross-sectional, observational pilot study. Twenty-three aphakic infants (aged from 6 months to 3.5 years) were invited to wear a smart wearable device for 7 days consecutively to monitor the near viewing distance in real life. Viewing habits and its associations with the possible influencing factors were investigated based on the data obtained from the device. Results The average proportion of near viewing time was 77.9% (95% confidence interval (CI) 72.1–83.7%). The average of the median near viewing distance was 23.8 cm (95% CI 20.6 cm-27.0 cm), which corresponded to an ADD of +4.25 D (95% CI + 3.75 D – +4.75 D) spectacle prescription. The height of the child was found to be positively correlated with the median of near viewing distance (r = 0.646, p = 0.001). Age, current ADD, age of cataract extraction surgery and bilaterality or monocularity of the aphakic eyes showed no significant correlation with the aforementioned viewing habits (all p > 0.05). Conclusion By using the novel wearable device, we found the suitable ADD of spectacle prescription for aphakic infants is about +4.25 D. The height of the child was an influencing factor for ADD.

Standard technical specifications for methacholine chloride (Methacholine) bronchial challenge test (2023)

Standard technical specifications for methacholine chloride (Methacholine) bronchial challenge test (2023)

Challenges of Clinical Education: From the Perspective of Clinical Instructors and Clinical Staffs at Dire Dawa University, Dire Dawa, Ethiopia, Qualitative Study.

To explore the challenges of clinical education from the perspective of clinical instructors and clinical staff at Dire Dawa University College of Health Science. An institutional-based phenomenological qualitative study was conducted. Clinical instructors and staff provided data through in-depth interviews and key informant discussions, which were facilitated by a semistructured tool and a voice recorder. A total of 17 participants, including 11 in-depth interviews (IDIs) with clinical instructors (including two key informants) and six IDIs with clinical staff were included in this study. A purposive sampling method was used to select study participants, and the data were analyzed thematically using the computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with an inductive approach involves six steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing. Clinical instructors and clinical staff noted a number of challenges in clinical education, including insufficient medical equipment, low incentives, clinical site repetition, unfavorable clinical practice sites, lack of communication from instructors, skill attrition, lack of orientation for instructors and students, client/patient unwelcomingness, uncooperative healthcare workers, and poor university cooperation. The aforementioned issues contributed to the quality of clinical education and its desired impact, as outlined in this research. A multidisciplinary and collaborative effort is needed to address these challenges.

Newborn and infant vision screening in primary care: A clinical review.

Newborn and infant vision screening is an essential component of the health promotion visit, where the provider screens for ocular risk factors and abnormalities that may cause future impairment or vision loss. Providers may underestimate the importance of screening or find neonatal vision assessments difficult due to poor patient cooperation or time-consuming exams, but the reversibility of vision impairment in infants makes early detection paramount to proper treatment. This article provides a clinical review of evidence-based, practical guidance to providers who care for infants from birth through 6 months of age in the primary care setting. The comprehensive eye exam in infants should include a thorough history and physical examination of eye structures, visual acuity, evaluation of extraocular movements and alignment, and assessment of the red reflex. Recommended exam maneuvers differ with age as visual acuity improves and development advances through infancy. Early detection of ocular pathology is critical to avoid permanent vision loss, serious morbidity, and even mortality. The seemingly complex vision screening exam can be completed with little to no cooperation from the patient when a competent pediatric healthcare provider prioritizes opportunistic exam maneuvers. The opportunistic exam allows providers to maximize efficiency while maintaining thorough technique during vision exams and screenings.