Proper Compliance Research Articles

CYTOLOGICAL DIAGNOSTICS OF THYROID DISEASES: BASIC PRINCIPLES AND FEATURES OF APPLICATION IN MODERN CONDITIONS

Introduction. Cytological diagnostics of thyroid diseases widely used in medical practice today. The standards and guidelines used in this examination ensure close cooperation between doctors of different specialties. Aim of research: To determine the methodological and organizational features of cytological examination of the thyroid gland, which can improve the use of this diagnostic method in Ukraine. The effectiveness of cytological examination depends on many factors. First of all, it is important to use this method in cases where the test result can be sufficiently informative and help identify thyroid diseases, choose further diagnostic and appropriate treatment tactics. Important stages in the actual cytological examination of thyroid diseases are: sampling, fixation and staining of cytological specimens, evaluation of microscopic changes, formulation of a cytological conclusion, and, if necessary, the use of immunocytochemical and molecular genetic methods. Compared to other countries, Ukraine has a higher incidence of uninformative reports in cytological diagnostics of thyroid diseases. The reasons for this are most likely more frequent violations of the technique of puncture, fixation and transportation of the material. It should be noted that cytologic examination in Ukraine is performed by a laboratory doctors, while in most countries of the world this examination is performed by a pathologist. Conclusions. In order to improve the effectiveness of the method of cytological diagnostics of thyroid diseases in Ukraine, it is necessary to ensure proper compliance with the relevant norms, standards and rules at all stages of its implementation. Taking into account the current regulatory norms and rules for cytological examinations in Ukraine, it is necessary to improve the qualifications of laboratory doctors in the field of cytological diagnostics of thyroid diseases, officially to include the method of cytological diagnostics into the work of a pathologist and to actively implement in medical practice The Bethesda System for Reporting Thyroid Cytopathology, 2023.

Is Bangladesh’s people aware of “diabetes mellitus: the disease of prosperity” health care management?

Introduction: Diabetes mellitus is an increasing threat to the world, which is also considered a “disease of prosperity”. The manifest of demographic changes, cultural transition, modernization, and population aging, etc. make it a “developing countries problem”. The incidence of type 2 diabetes mellitus is increasing so rapidly and it is estimated by 2030 this number will almost double. Around 387 million people have diabetes which is equal to 8.3% people. It is projected that there will be a 42% increase in the number of individuals with diabetes, from 51 to 72 million in the developed countries and a 170% increase, from 84 to 228 million, in the developing countries. Diabetes mellitus is a chronic disease once thought to be uncommon in Bangladesh, but now it has emerged as an important public health problem. About 3.6 million people are affected throughout the country. In Bangladesh around 4% of adults aged 25 years or more have type 2 diabetes mellitus, and 80 lakh people in Bangladesh suffer from diabetes. It causes 6.4 percent of total deaths in the country. Awareness of diabetes is not up to the mark due to health education about diabetes, announcement, and an overall lack of awareness of the disease and its effectiveness makes it more complicated to manage. Objectives: This study aimed to assess the knowledge and awareness status on health care management of type 2 diabetes mellitus in Bangladesh. Methods: This is a cross-sectional study followed by descriptive methods and mixed methods in design among Dhaka and Manikgonj districts. Results: Findings reveal that a very significant relationship exists between compliances and complications. Compliances are influenced by various factors like sex, education, occupation, treatment facilities, etc. But who follow the proper compliances face fewer complications? Also, in addition to anti-diabetic medication and another method of compliance to an herbal method which was familiar to diabetic patients. Most compliance the respondents preferred are diet, exercise, weight control over the medication. Conclusion: Overall, a positive outcome was that the patients of type 2 diabetics who maintained proper compliance faced fewer complications than those who didn’t follow them properly.

6765 Surveillance For Side Effects Of Glycemic Control: Von Gierke Disease And Recurrent Diarrhea With Hospitalized Approach

Abstract Disclosure: J. Gone: None. E. Fegahli: None. T. Thompson: None. Background: Von Gierke disease is an autosomal recessive disorder leading to the inability to break down glycogen. Clinical features manifest at 3-6 months including symptoms of hypoglycemia, short stature, thin legs, round face, protruding abdomen, muscular hypotonia, and psychomotor retardation. Workup shows hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia, anemia, hepatomegaly, and renomegaly. Patients may develop inflammatory bowel disease, osteopenia, renal failure, hepatic tumors, and pulmonary hypertension. Molecular sequencing confirms the diagnosis. Feeding glucose at regular intervals prevents hypoglycemia. One should avoid fructose, lactose, sucrose, and galactose. Oral citrate or bicarbonate is used to treat lactic acidosis. Gout, hyperlipidemia, anemia, IBD and osteoporosis are managed accordingly. Regular screening for osteoporosis, renal failure, hepatic tumors, and pulmonary hypertension is recommended. Liver transplantation results in optimal management. Gene therapy clinical trials are underway. Clinical Case: We present a case of von Gierke disease in a 20-year-old male presenting to the Emergency Department for recurrent nausea, emesis, poor oral intake, water diarrhea and subjective fever. Inpatient workup showed lactic acidosis, hyperuricemia, hypertriglyceridemia, transaminitis, and fibrofatty hepatomegaly. Intravenous fluids, antiemetics and cornstarch were given. Symptoms including nausea, emesis, and diarrhea improved, most notably after adjustments made to cornstarch dosage and frequency. The patient was discharged with an antiemetic and an antidiarrheal and with recommendations to continue scheduled cornstarch. Patient was educated about the importance of proper diet compliance and close outpatient follow up. Hence, management of von Gierke disease should include not only strict glycemic control but also close surveillance for possible side effects, such as diarrhea. Moreover, future studies are necessary to support empiric modifications in management despite a basis of a hypothetical rationale. Conclusion: An essential goal of managing GSD-1 is not only strict glycemic control but also close surveillance for possible side effects, such as diarrhea. Adjustments to maintaining normoglycemia may be mandatory by manipulating factors including dosage and frequency of oral carbohydrates, such as cornstarch, to reduce the recurrence of side effects as much as possible. Treatment regimens should be individualized to each case because the initial presentation and response to treatment in every patient can be different, whether it is minor or major. Future studies about the mechanisms regarding possible side effects of treatment, such as diarrhea, are warranted to corroborate empiric changes in management, like adjusting dosage and frequency or medications, despite having a hypothetical rationale. Presentation: 6/1/2024

B-299 Comparison of a Recently FDA-Cleared Urine Benzodiazepine Screening Assay with β-Glucuronidase Hydrolysis to Liquid Chromatography-Mass Spectrometry

Abstract Background Benzodiazepines are a class of prescribed psychoactive drugs that act as a depressant on the central nervous system. Over the last decade, the fast-acting sedative effects of these drugs have led to misuse, therefore making detection important for monitoring proper drug compliance. Immunoassays on urine samples are commonly used as a screening method and the results are confirmed using high-performance liquid chromatography/tandem mass spectrometry (LC-MS/MS). The metabolites of benzodiazepine in urine are predominantly excreted as glucuronides which may lead to false negative results when utilizing immunoassay-based methods. The purpose of this study was to compare a new generation of benzodiazepine reagent, that includes a β-glucuronidase enzyme to increase sensitivity, to LC-MS/MS. Secondly, the positivity rate was compared before and after the increased sensitivity screening assay was implemented. Methods Validation of benzodiazepine II assay was performed on an automated chemistry analyzer (Roche Diagnostics, cobas c502), utilizing a kinetic interaction of microparticles in a solution (KIMS) method. A total of thirty urine samples that screened positive on the benzodiazepine II assay and thirty samples that screened negative, were compared with LC-MS/MS. The LC-MS/MS panel included α- hydroxytriazolam, 7- aminoclonazepam, nordiazepam, temazepam, oxazepam, lorazepam, and α-hydroxyalprazolam. The lower limit of quantitation was 40 ng/mL for all compounds except α-hydroxyalprazolam which was 60 ng/mL. The cutoff concentration for the benzodiazepine II assay was 200 ng/mL. Three months of data was also collected before and after converting to the new generation of benzodiazepine assay. Results Conclusions The addition of β-glucuronidase to the benzodiazepine II assay allowed for high sensitivity when detecting urine benzodiazepine metabolites. With the increased sensitivity, almost a doubling of positivity rate was observed. The overall high diagnostic accuracy of the test makes it a reliable screening method for urine benzodiazepine detection.

Accountability, Donor Funding and Non-Governmental Organisations in Kisumu County in Kenya

Accountability is an important aspect of all organisations today. Accountable NGOs have been found to receive large funding from donors and thus undertake development programs that alleviate human suffering. This study is set to establish the accountability of donor funding by non-governmental organisations in Kisumu County. The study adopted a descriptive survey design. The target population was the NGOs located in Kisumu County- Kenya. The population was made up of all the 187 NGOs in the region. The use of open-ended questions was justified because some of the information concerned sensitive matters of the NGOs, particularly those involving finances and governance. The study established that donor funding was dependent on the accountability mechanisms put in place by the implementing NGOs. The study revealed that NGOs were expected to keep a minimum set of financial statements, e.g. Statements of comprehensive income, statements of financial position and cash flow statements. The study revealed that community involvement in the oversight of NGOs was still not adequately practised and that satisfaction of the employees with their pay perks could not be established. Donors were keen on compliance with the laws of the country and involved the oversight bodies in checking the compliance and legitimacy of the NGOs before funding and partnering with them. It was established that donors expected performance measurements to be done and that NGOs prepared specific reports. The donors also demanded that the authenticity of the financial statements be verified by independent auditors. Therefore, this study recommends that NGOs develop proper and effective accountability mechanisms to measure performance and enhance legitimacy and accountability. This will include using proper performance measurement tools and compliance with donor and government regulations to secure sustained financing and ensure that the County's development agenda is achieved. The study further recommends that the NGOs procure the services of recognised audit firms that will offer value-adding audits, which, in effect, will boost donor confidence.

TRANSPORTATION OF DANGEROUS GOODS

Transportation of dangerous goods is one of the main directions of logistics, which requires special attention and experience. Professionals working in this field must have a thorough knowledge of chemical products, their properties and classification, as well as the laws and regulations governing their transportation. The safety of the transportation of dangerous goods also includes strict observance of the rules of conduct in an emergency situation. Prompt response to emerging problems and the use of appropriate tools and equipment to eliminate leaks or incidents are an integral part of the work of professionals in this field. Regular training of personnel and continuous improvement of safety systems are key factors for minimizing risks during the transportation of dangerous goods. Special attention is paid to highlighting the difficulties associated with the transportation of such goods, using the example of individual subjects of the Russian Federation. As a result, comprehensive information on this topic will be obtained, which will allow for a better understanding and management of the risks associated with the organization of transportation of dangerous goods. Purpose. The purpose is to determine the specifics of the transportation of dangerous goods on the territory of the Russian Federation. Methodology. In this article, methods of economic, mathematical and statistical analysis were used to achieve the purpose of the study. Results. This article discusses in detail the key principles and features of the transportation of dangerous goods, which all logistics companies operating in the Russian Federation must follow. Proper compliance with these regulations is a safe and efficient part of the transportation process. Practical implications. The data obtained can be effectively used by logistics companies specializing in the transportation of dangerous goods to comply with the rules and ensure safety.

Common Reporting Standard as a model for tax information exchange: mechanism of operation and implementation status in Ukraine

The article studies the Common Reporting Standard (CRS), an information standard for the automatic exchange of tax information between states that are parties to the Multilateral Competent Authority Agreement (MCAA). It also explores the prospects of Ukraine’s participation in the exchange under this standard. The study analyzes the information subject to international exchange, types of financial institutions required to collect and submit tax-relevant information to authorities for international exchange, account types, tax residents, and methods of verifying client integrity when opening accounts. The article aims to systematize knowledge about the prerequisites for creating, the mechanism of intergovernmental tax cooperation within the CRS framework, current results achieved under this standard, Ukraine’s accession status, steps taken by Ukraine towards implementing automatic exchange of tax information, and recommendations for accountable entities and account holders on complying with CRS rules. The study employed a comprehensive research methodology, including a literature review, analysis of normative documents, and comparative analysis. The conclusions emphasize the crucial importance of Ukraine’s accession to the CRS standard for ensuring proper tax compliance and budgetary revenues, particularly amid full-scale Russian aggression. The study also describes the challenges, especially regarding compliance with tax data exchange requirements by financial institutions and account holders. It underscores the need for strong political will from Ukrainian authorities to overcome obstacles and ensure effective CRS implementation. Overall, the study highlights the significant role of CRS in improving tax collection while acknowledging the hurdles ahead. The research perspective on this topic is extensive, given that automatic tax information exchange, particularly under the investigated standard, is currently being established and is relatively underexplored by researchers.

Can Facebook's community standards keep up with legal certainty? Content moderation governance under the pressure of the Digital Services Act

AbstractContent moderation by social media companies is a challenge for regulators around the world. The European Union is trying to tackle this challenge with its Digital Services Act (DSA). Notably, Article 14 DSA aims to impose language requirements based on the principle of legal certainty to social media companies' terms and conditions, of which community standards (CS) are a part. The principle of legal certainty is one of the building blocks of international human rights law, and its inclusion in the DSA illustrates the human rights‐based approach anchored in this European regulation. Based on a content analysis of Facebook's CS, this paper shows that their standards do not meet European requirements for legal certainty and argues that important changes in content moderation governance would be needed for proper compliance. Such changes could generate a domino effect beyond the European Union and on Facebook's content moderation governance itself. At the same time, the DSA could also generate a boomerang effect on the legal certainty principle as such. From this perspective, the paper contributes to the literature on regulatory governance studies, and on international human rights law in social media studies from a European Union perspective.

Evaluation of the Efficacy of Magnetic Resonance Imaging for Feminizing Gender Affirmation Genital Surgery: A Novel Approach.

Background Gender dysphoria is treated with gender affirmation surgery (GAS) for assigned male at birth (AMAB) individuals. This study aimed to evaluate the postoperative anatomical changes in AMAB individuals who underwent GAS using magnetic resonance imaging (MRI) and to compare it with cis-females, thereby assessing the efficacy of the surgical technique in achieving pelvic anatomy similar to cis-females. Methodology This was a prospective observational study done in a tertiary care hospital. AMAB individuals who underwent gender affirmation genital surgery using single-stage solely penile skin inversion vaginoplasty were included after informed consent and approval by the Institutional Human Ethics Committee. Patients with complications such as deep space surgical site infection (SSI) and neo-vaginal prolapse were excluded. All the study participants were advised a vaginal self-dilatation regimen, reviewed three months after the surgery, and subjected to an MRI of the pelvis with a vaginal tutor. Parameters such as neo-vaginal depth, alpha (α) angle, rectovaginal thickness, and remnant of corpora cavernosa were measured and compared with cis-female parameters measured from images in the archives from the Department of Radiology. Result A total of 21 patients were included in the study, with a mean age of 27±4.7. Between the study group and cis-females, no significant difference was seen in vaginal depth, and cis-females had significantly higher values in other parameters. There was a significant difference between the subgroups, i.e., defaulters and non-defaulters in soft tissue parameters such as vaginal depth (p=0.001), αangle (p=0.002), and rectovaginal thickness (p=0.002) with the non-defaulter patients having higher values. Conclusion Single-stage penile skin inversion vaginoplasty is capable of producing anatomical parameters, importantly neo-vaginal depth, which is fairly comparable with cis-female, as evident in the non-defaulter subgroup patients. Proper compliance with the vaginal dilatation regimen plays a significant role in the maintenance of soft tissue pelvic anatomical parameters.

IJCM_306A: Patient compliance towards Post exposure Prophylaxis with Anti Rabies Vaccine - Hospital based study

Background: Rabies is a deadly viral disease that affects the nervous system. The components of rabies post-exposure prophylaxis involve wound treatment, Rabies Immune Globulin, and the anti-rabies vaccine. Proper compliance with the rabies vaccination schedule is crucial to prevent development of Rabies Objectives: 1) To assess prevalence of non-compliance and delayed compliance towards post-exposure prophylaxis of the anti-rabiess vaccine of GMC, Jammu 2) To study factors associated with and reasons of delayed compliance and non-compliance towards post-exposure prophylaxis of the anti-rabies vaccine of GMC, Jammu Methodology: A cross- sectional study was carried out from September 2022 to July 2023 on 594 animal bite victims presenting to OPD of the anti-rabies clinic of GMC, Jammu for the first time, with category 2 and 3 bites were included Results: Males were about 76.9%, and females, 23.1%. Graduates were 29.3%. Animal bites were mainly from stray dogs (58.2%), with category three wounds (93.8%). Wound washing practices were done by 540 (90.9%), about 58 (9.8%) had used only water and about 482 (81.1%) had used only soap and water for wound washing. 71.7% completed the full course of Anti-Rabies Vaccine (ARV), 24.6% showed delayed compliance, and 3.7% were non-compliant or dropouts. Delayed compliance was observed on the second (35%), third (42.4%), and fourth doses (22.6%). Reasons for delayed compliance included distant residence, loss of wages, and forgetfulness. Non-compliance reasons included negligence and health issues. No socio- demographic factors showed an association with compliance with ARV. Conclusion: The urgent need to increase awareness and counseling for individuals bitten by animals. Special attention is crucial for promptly administering Anti-Rabies Immunoglobulin in severe cases (category 3 bites) to prevent rabies

Reaching the limits of antipsychotic treatment: the upper end of severe schizophrenia in forensic institutions - a case report

IntroductionSevere schizophrenia is often closely related to delinquency resulting in relative overrepresentation of these manifestations of disease in forensic institutions.ObjectivesThe aim of the present work is to report the therapeutic challenges in a case of severe schizophrenia in a forensic institution from a clinical viewpoint as a basis for discussion.MethodsThe case report is based on the available clinical documentation, exploratory interviews as well as a structured clinical interview (PANSS).ResultsPresenting a case of a 41-year-old, male Caucasian inpatient suffering from a catatonic schizophrenia, we report the challenges in treatment of chronic, major schizophrenic disease resistant to antipsychotic medication. Without any previous criminal convictions, he has been instutionalized in a forensic psychiatry after a bodily harm to a random stranger about three years ago. Regarding medical history, information is limited to a few inpatient admissions prior to detention documenting intravenous opioid and cocaine abuse. Initially, the patient presented sexual disinhibition and ongoing endangerment of others with frequent assaults to other patients and prison guards. From a psychopathological viewpoint several phenomenona such as delusional intuition, acoustic, tactile and coenaesthetic hallucinations, echolalia, mannerisms and thought diffusions reflect the severe course of the disease (PANSS: P 34/49, N 38/49, G 73/112; total 145/210). Therapeutic attempts with an antipsychotic combination of risperidone, olanzapine and quetiapine as well as valproic acid resulted in insufficient recovery with persistent physical assaults and florid psychosis. In reaction to that zuclopenthixol for impulse control was added. As from the beginning of this year a switch of medication by gradually replacing risperidone and zuclopenthixol with haloperidol and clozapine showed modest success. Under the current medication and therapeutic drug levels the patient does not pose endangerment to others. However, regular tonic-eye fits require supplementary treatment with biperiden, and the patient still presents frequent periods of self-harm punching himself, verbal lack of impulse control and the psychopathological phenomenona described before. In addition to pharmacological treatment the patient receives psychotherapeutic one-on-one conversations. Despite approaching all limits of the available antipsychotic repertoire, psychopathology is only insufficiently controlled leading considerations to electroconvulsive therapy as a treatment of last resort.ConclusionsCertainly, the present case is exemplary for a severely ill population of patients reaching – after a long and untreated course of disease - a chronic stage that does not sufficiently respond to a multitude of treatment attempts despite proper compliance raising the urgent need for further treatment options.Disclosure of InterestNone Declared

Legal regulation of obligations in international agreements

The law of international treaties is one of the key branches of international law. It is international agreements, as a source of international law, that govern states, since the contractual regulation of international activity is able to ensure civilized interstate cooperation, such as: trade, investment, create appropriate conditions for the development of the economies of the contracting parties, and guarantee security processes in the country. The obligations of states assumed during the conclusion of international agreements, their proper formulation, agreement and compliance are the primary basis of quality international relations. Accordingly, this paper is devoted to the analysis of the normatively determined characteristics of an international agreement and the presence of obligations in them, methods of revival of obligations in the agreement, comparison of agreements with different subjects and obligations in them. Emphasis is made separately on the existing problems of the implementation of current international agreements. The study shows that security agreements usually contain negative obligations, while trade agreements include both positive and negative types of obligations. The above demonstrates that an international agreement is an expression of the will of the parties, their intentions, and also demonstrates the nature of the relationship dictated by the subject of the agreement. Thus, security agreements provide for compliance with the principle of non-interference and refraining from actions that could harm another country. Instead, trade agreements aim at active cooperation between states, which emphasizes the need for positive commitments by countries. The issues of appropriateness of the formation of obligations are equally important, both in international private and in international public law. However, researchers, unfortunately, pay little attention to the specifics of states’ obligations. It is the latter that are important, complex and lengthy to negotiate and affect a wide range of individuals. Undoubtedly, they differ significantly among themselves in the specifics of multilateral international agreements, which provide for accession itself, and not participation in the formation of the texts of agreements. All of the above emphasizes the complexity and multifacetedness of the researched issue. Accordingly, as modern international agreement law develops, it needs new views, the proper formulation of obligations in agreements, and guarantees of the latter’s fulfillment.

Impact of Covid -19 incidence rate and government-initiated risk communication measures on individual's NPI practices.

Non-pharmaceutical interventions (NPI) are the most widely recognized public health measures recognized globally to prevent the spread of Covid-19. NPIs' effectiveness may depend on the type, combination of applied interventions, and the level of proper public compliance with the NPIs. The expected outcome of behavioural practices varies relative to the intervention duration. This study aimed to assess the trend of community compliance to NPI with Covid-19 incidence and government-initiated interventions, and its variation by residence and sociodemographic characteristics of people. A weekly non-participatory field survey on individuals' NPI practices was observed from the 41st epidemiological week of October 5th, 2020, to the 26th epidemiological week of July 4th, 2021, a total of 39 weeks. The survey covered all 14 regional and national capital cities in Ethiopia. Data collection for the three NPI behaviours (i.e., respiratory hygiene, hand hygiene, and physical distance) was managed weekly at eight public service locations using the Open Data Kit (ODK) tool. The Covid- 19 incidence data and public health measures information from August 3rd, 2020 to July 4th, 2021 were obtained from the Ethiopian Public Health Institute (EPHI). More than 180,000 individuals were observed for their NPI practice, with an average of 5,000 observations in a week. About 43% of the observations were made in Addis Ababa, 56% were male and 75% were middle age group (18-50 years). The overall level of NPI compliance was high at the beginning of the observation then peaked around the 13th- 15th epidemiological weeks then declined during the rest of the weeks. The peak NPI compliance periods followed the high Covid-19 death incidence and government-initiated intensive public health measures weeks. Respiratory hygiene had the highest compliance above 41% whereas hand hygiene was the lowest (4%). There was a significant difference between residents of the capital city and regional cities in their level of compliance with NPI. Females comply more than males, and individuals had increased NPI compliance at the bank service and workplaces compared to those in the transport services at P = 0.000. An increased level of compliance with NPI was observed following intensive government-initiated Covid-19 prevention measures and an increased Covid-19 death incidence. Therefore, the intensity of government-initiated risk communication and public advocacy programs should be strengthened, possibly for similar respiratory disease pandemics in the future.

Refractory hypothyroidism: True malabsorption or pseudo-malabsorption?

Hypothyroidism is one of the most common endocrinopathies. Its treatment consists of hormonal supplementation with levothyroxine. Despite the simplicity and accessibility of this treatment, cases of refractory hypothyroidism have been reported despite high doses. Our case is a new observation exposing this problem while discussing the modalities of its management. Patient aged 34, followed for 6 months for hypothyroidism post total thyroidectomy. She was taking 300 μg/day of levothyroxine. The patient reported compliance with her treatment. She did not report taking any other medications. Clinical examination revealed that the patient was profoundly hypothyroid. Biological tests showed TSH > 100 μUI/mL (0.35-4.94), FT4 less than 0.40 (0.7-1.48) and FT3< 1.07 pg/mL (1.71-3.71). After eliminating all obvious causes, an oral thyroid hormone absorption test was performed in hospital, with FT4 measurements at H0, H2, H4 and H6 after levothyroxine intake. The results showed increasing FT4 elevation, eliminating the diagnosis of malabsorption and testifying to our patient's poor compliance with treatment. We report on a case that highlights the value of the thyroid hormone absorption test, which can help distinguish between true malabsorption and pseudo-malabsorption, in which case re- education on proper compliance and possible psychological follow-up are required.

Individual and organizational factors associated with injury history and patient handling behaviors: Results from a nationwide survey of healthcare workers

With proper compliance, safe patient handling and mobility (SPHM) programs reduce musculoskeletal disorders (MSDs). To better understand individual, environmental, and organizational factors associated with both the adoption of SPHM and prevalence of MSDs, a nationwide online survey was administered. 973 healthcare workers (HCWs) completed the survey, for which 59.6% reported past work-related MSDs or pain. Among those with pain or injury, 33.3% changed roles, 79.7% worked while injured, and only 30.9% reported workers’ compensation claims. Less than half of HCWs agreed that SPHM equipment is readily available, and most considered manually handling patients weighing over 91 kg acceptable. Equipment availability, ceiling lift availability, supervisor encouragement, and annual training were associated with increased use of SPHM equipment. Availability of SPHM equipment reduced the likelihood of injured nurses changing roles. Despite overall agreement that SPHM programs are beneficial, common clinical practice remains insufficient to adequately protect HCWs from risk of injury.

Delayed prandial insulin boluses are an important determinant of blood glucose control and relate to fear of hypoglycemia in people with type 1 diabetes on advanced technologies

AimsAutomated insulin delivery systems improve blood glucose control in patients with type 1 diabetes (T1D). However, optimizing their performance requires patient's proper compliance to meal insulin bolus administration. We explored real-life prevalence of delayed prandial boluses (DBs) in adults with T1D on advanced technologies, and their association with glycemic control and fear of hypoglycemia (FH). MethodsIn the last two-week web-based reports of 152 adults with T1D on Hybrid Closed Loop Systems (HCLS) or Sensor Augmented Pump (SAP), DBs were identified when a steep increase in blood glucose occurred at CGM before the prandial bolus, and CGM metrics were evaluated. All participants completed an online questionnaire on FH. ResultsMean DBs over two weeks were 10.2 ± 4.7 (M ± SD, range 1–23) and more frequent in women than men (11.0 ± 4.6 vs. 9.4 ± 4.7, p = 0.036). Participants with more DBs (>12) showed significantly lower Time-In-Range (62.4 ± 13.8 vs. 76.6 ± 9.0 %) than those with less DBs (<7.7), along with higher Time-Above-Range, GMI, and Coefficient-of-Variation (ANOVA, p < 0.001 for all). Participants with higher FH score showed more DBs (11.6 ± 5.0) than those in lower tertiles (9.57 ± 4.59 and 9.47 ± 4.45, ANOVA p = 0.045). ConclusionsIn patients on advanced technologies, delayed boluses are extremely common, and associate with significantly worse glycemic control. Utmost attention is needed to bolus timing, mainly tackling fear of hypoglycemia.

Transnational Law and Criminal Justice System: Highlighting Legislative and Procedural Challenges to combat Cyber Crime in the wake of CPEC

World Justice Project’s (WJP) Rule of Law Index 2022 ranked Pakistan globally at 129th out of 140 countries while on regional level Pakistan is ranked 5th out of 6 countries. Where Pakistan’s justice system is hitting the bottom in rule-of-law index, at the same time, the entire nation is celebrating China-Pakistan Economic Corridor (CPEC), which is a flagship project of Belt and Road Initiative (BRI) also known as OBOR. This is a Chinese master stroke in the cross-continental geo-economics of the world. With a heavy influx of Chinese businesses and Chinese nationals arriving in the country, the markets and Pakistani citizens are vulnerable to criminal activities including more sophisticated types of crimes such as crimes involving ICT. In particular, incidents of ATM skimming are rising in Karachi among other crimes. Foreign nationals are arrested include Chinese nationals; however, legislative and procedural lacunasand prosecution related defects eventually cause the prosecution version to collapse during trial. Therefore, this research study proposes strong legislative and judicial framework, human resource development including need for prompt initiatives in the subordinate judiciary. This research also highlights the need for having proper compliance of environmental and labor laws regulations. The research is based on mixed methodology. Quantitative analysis is conducted on the data collected through questionnaires from the sample of 50 respondents that include advocates, FIA investigation officers and public prosecutors.In addition, qualitative analysis is done through interviews of senior officers from NR3C as well as I.Os, students, academics and research economists from academia.

Enhancing Curriculum Implementation in Nkowankowa Circuit Secondary Schools: A Qualitative Analysis of Educators' Perceptions in Limpopo-South Africa

Curriculum implementation in South Africa, particularly in Limpopo Province has many challenges that ultimately affect the quality of education. This study sought to address educators’ perceptions on curriculum implementation in Nkowankowa Circuit secondary schools. Qualitative methods were employed where 16 educators from all eight public schools in Nkowankowa Circuit were purposively sampled on the basis of knowledge and experience on curriculum issues. Face-to-face interviews were conducted to collect data on educator’s perceptions on curriculum implementation. Data collected were analysed by means of thematic data analysis method. The study was conducted from an interpretivist point of view. Findings revealed that proper monitoring enforces effective curriculum implementation, which will improve academic performance. Provision of extra classes also boosts learners’ academic performance. Lack of necessary resources seem to hamper effective implementation. Managing and monitoring curriculum implementation by School Management Teams (SMTs) ensures proper implementation and compliance to policy and improves academic performance. In conclusion, the researcher advanced recommendations that could be implemented at school and circuit level to assist improve implementation of curriculum which will ultimately uplift quality of education and academic performance in schools.

Introduction to Rectal Cancer and the Importance of Nerve Preservation

Introduction: Rectal cancer is an increasingly common and worrying disease that affects the rectum, the terminal part of the large intestine. Early detection and treatment are crucial to improving patient outcomes. Methods: We conducted a narrative review of the scientific literature to examine nerve preservation in rectal cancer surgery. Previous studies were analyzed and relevant findings related to the preservation of autonomic and pelvic nerves, as well as the prevention of sphincter dysfunction, were identified. Results: Rectal surgeries may be associated with various complications, which can have a significant impact on patients' quality of life. The preservation of the autonomic and pelvic nerves plays a crucial role in reducing postoperative urinary and sexual dysfunction. Studies have shown that nerve-sparing surgical techniques improve functional outcomes and patient satisfaction. Discussion: Nerve preservation in rectal cancer surgery requires a meticulous surgical approach and a thorough understanding of the anatomical structures involved. By preserving nerve function, not only urinary and sexual function are improved, but also overall quality of life. In addition, nerve preservation plays a critical role in preventing sphincter dysfunction after pelvic exenteration surgery. Conclusions: The preservation of autonomic and pelvic nerves in rectal cancer surgery is essential to minimize complications and improve patients' quality of life. Proper patient selection and compliance with oncology criteria contribute to the preservation of sphincter function without compromising survival rates. Preoperative radiation therapy may also increase the likelihood of sphincter sparing in patients with rectal cancer

Awareness on and Compliance with the Food Act in Sri Lanka: An Analysis of the Present Status&amp;nbsp;

Purpose: In Sri Lanka, legislative regulation of food safety and hygiene issues is mainly done under the Food Act No. 26 of 1980. Proper awareness and compliance to the Food Act are necessary for food safety. This cross-sectional analysis was done to assess the present status of awareness and compliance with the prohibitions and regulations of the Food Act by stakeholders.Research Method: Litigations done by Public Health Inspectors (PHIs) from 7 districts and data from a field survey of 30 PHIs (from same districts), 50 traders and 70 consumers (from 5 districts) were collected. Findings: According to the litigations analyzed, “Food (labeling and advertising) regulation” was the highest violated regulation in Sri Lanka (p&lt;0.05). However, “Food (Packaging materials and articles) regulation” had significantly higher ranking (p&lt;0.05) according to the PHIs’ survey. According to the traders’ ranking, their highest and least compliance (p&lt;0.05) were on “Packaging materials and articles” and “Bread standards” regulations respectively. Consumers’ highest and least awareness were on “Coloring agents” and “Flavoring agents” respectively and their highest and least compliances (p&lt;0.05) were on “Adoption for standards” regulation and “Labeling and advertising” regulation respectively. Originality/Value: This study gives an overall idea about the current awareness and compliance of the stakeholders on Food Act. It is vital for future policy development.