Implementation of Routine In Situ Simulation in Residency Curriculum Targeting Competency in Technical and Decision-Making Skills

Abstract The European Union set out several directives and standards for governments and local authorities on environmental policy issues in the planning and management of public services. Public service provisioning is subject to both traditional expectations (such as customer-friendliness and efficiency) and new environmental stewardship and sustainability expectations. This paper analyzes public service processes, particularly the university enrolment process. Our analysis used public service models (Service Blueprinting, Business Process Modeling, Process Chain Network) and a mathematical model (P-graph). Our research aims to analyze the university enrolment process and its efficiency, considering sustainability aspects and expectations and identifying the points that can be modified and improved to make it more efficient, sustainable, qualitatively positive, and economical. According to our research, school administrators are overburdened during the enrolment process, often resulting in overtime work and a high turnover ratio. Our results clearly show the high inefficiency of this administrative process, as administrators can only partially meet their expected labor targets during their regular working hours. We found that the university enrolment process can be improved and made more efficient and sustainable. Using the P-graph, we have found the process’s optimal path and resource requirements in a way that was not feasible with previous models. Heartened by these results, we propose introducing and applying the P-graph as a new model to study other public service processes. Graphical abstract

The pandemic push: Digital technologies and workforce adjustments

Background and Objectives: Health professionals’ working schedules often do not allow them to follow a balanced way of life, and the nature of their work can affect their weight and eating habits. The aim of the present study is to shed some light on the impact of night shift working on the dietary practices of healthcare practitioners in Greece. Materials and Methods: This was a cross-sectional study. With the use of an administered questionnaire several parameters were assessed, including anthropometric characteristics, weight history, as well as nutritional habits of the same group of participants during night shifts and when at regular working hours. Moreover, nutritional beliefs of the subjects were recorded, as well as the level of adherence to the Mediterranean diet. Results: It was observed that in all food groups, including water, used to compare the nutritional patterns of the participants during night shifts and when working regular hours, statistical differences were noted (p = 0.001). Furthermore, the participants who reported a higher adherence to the Mediterranean diet and self-reported healthier nutritional habits, had a statistically lower weight compared to the participants that rarely followed the specific model or reported unhealthier eating routine (p = 0.010 and p = 0.015, respectively). Conclusions: We conclude that shift-working healthcare professionals are associated with disturbed eating behaviours leading to the high consumption of unhealthy food. The implementation of interventions that will concentrate on educating health workers on balanced nutrition and improving physical environment (i.e., food availability, healthier food choices) seems to be of great importance.

High costs associated with after-hour electroencephalography (EEG) constitute a barrier for financially constrained hospitals to provide this neurodiagnostic procedure outside regular working hours. Our study aims to deepen our understanding of the cost elements involved in delivering EEG services during after-hours. We accessed publicly available data sets and created a cost model depending on 3 most commonly seen staffing scenarios: (1) technologist on-site, (2) technologist on-call from home, and (3) a hybrid of the two. Cost of EEG depends on the volume of testing and the staffing plan. Within the various cost elements, labor cost of EEG technologists is the predominant expenditure, which varies across geographic regions and urban areas. We provide a model to explain why access to EEGs during after-hours has a substantial expense. This model provides a cost calculator tool (made available as part of this publication in eAppendix 1, links.lww.com/CPJ/A513) to estimate the cost of EEG platform based on site-specific staffing scenarios and annual volume.

Physical and mental fatigue resulting from continuous work over an extended period without sufficient rest. Work fatigue can affect workers in all sectors, both informal and formal, but several factors influence the fatigue levels in each sector. Informal sector workers typically operate in irregular conditions, without fixed working hours, and work for extended periods to meet their livelihood needs. Meanwhile, formal sector workers often have more regular working hours and definite rest periods. However, formal sector workers may also experience similar fatigue due to high job demands, pressure from superiors, or tight deadlines. The consequences of fatigue can lead to serious physical and mental health issues, such as stress, anxiety, sleep disturbances, and even depression. Therefore, it is crucial for workers in both sectors to pay attention to their health and well-being and take measures to prevent fatigue and cope with work-related stress. The research employed a quantitative method with a cross-sectional approach. There were 122 respondents, comprising 61 from the informal sector and 61 from the formal sector. The research findings indicated that the level of fatigue experienced by workers in both sectors was severe, with 78 (63.9%) of informal sector workers predominantly facing this fatigue

Women's safety and protection are frequently their top concerns due to the rising tide of issues regarding Women's harassment in today's society. The seductive notion that she will be able to wander around freely on the streets even during regular working hours without worrying about being protected plagues every woman. This piece of writing serves as an example of how to use technology to safeguard Women. We present an idea that modifies the way everyone views on Women's safety. It's a success on a day when the media celebrates additional female harassment victories! Our concept addresses the need for a system that frequently detects victims and rescues them because people are unable to react appropriately in critical situations. In this research, a smart device for girls' protection is proposed that automates the emergency alarm system by routinely detecting a possible atrocity using outlier detection utilizing a heart-rate sensor. The device can deliver information at critical times without the woman's input due to her physical coordinates and its capacity to spot symptoms in pricey ones. When a crisis occurs, it immediately alerts the family and the local police station.

In accordance with articles 31 and 32 of the 1945 Constitution, as amended in Chapter XIII, it is stipulated that every citizen has the right to education because through education, every citizen can prepare themselves to play a role in society. This right extends to migrant workers, including all members of their families working in Taiwan, who are entitled to the same educational opportunities. Recognizing the awareness and responsibility of Indonesian students pursuing undergraduate (S1), master (S2), and doctoral (S3) studies in Taiwan to assist migrant workers in furthering their education, in 2015, they established an educational institution promoting equality in the form of a non-formal education programs, later known as the Community Learning Activity Center of the Indonesian Student Association (PKBM-PPI) Taiwan. The available programs include Package A (Elementary School), Package B (Junior High School), and Package C (Senior High School). The participants are migrant workers employed in Taiwan as caregivers for the elderly, aged between 20-50 years, predominantly female. Despite the PKBM activities commencing after their regular working hours, from 21:00 to 23:00 local time or 20:00 to 22:00 Western Indonesia Time (WIB), participants remain enthusiastic about attending the PKBM initiated and conducted by Indonesian students. This enthusiasm extends to participating in the Basic English Conversation Program, organized through collaboration between PKBM-PPI Taiwan and the Community Service Cluster of the English Language Program, Faculty of Humanities, Widyatama University, spanning one month (8 sessions).

BackgroundDietary practices are one of the most common modifiable risk factors for cancers. Foods rich in dietary fibers are considered protective, meanwhile fast & junk foods are risk for common cancers. Adolescence period is marked by habit formation and is thus suited for delivering behavioral intervention. Schools offer an optimal setting for planning and executing these interventions to a large number of adolescents.ObjectiveTo assess the effectiveness of a teacher-delivered cancer-prevention education in changing dietary behaviors of school going adolescents.MethodsA cluster randomized trial was conducted in government secondary and senior secondary schools with schools as clusters. A minimum required sample of 1032 students was estimated from 16 schools with 1:1 allocation in intervention and non-intervention groups. Dietary behaviors were recorded as dichotomous variable. The determinants were recorded as per theory of planned behavior framework using Likert-scale. Two teachers from each intervention school were trained to deliver cancer prevention education with focus on role of dietary behavior. Pre-post training assessment of teachers’ knowledge towards common cancers was done using a self-administered questionnaire. Gender adjusted difference-in-difference analysis was done to assess intervention effect on both healthy and unhealthy behaviors.ResultsIn selected schools all students from classes 8 to 10 were approached and a total of 1224 students were enrolled, of whom 1096 completed the study. The study recorded significant improvement in scores of students from intervention group compared to non-intervention group for their attitude, subjective norms, perceived behavioral control and intention towards consuming healthy and avoiding unhealthy foods. The intervention was effective in significantly improving the proportion of students limiting fried/fast/packed food & sugar sweetened beverages (OR:1.51, 95%CI:1.08,2.12,p:0.017), and consuming fruits & vegetables daily (OR:1.55, 95%CI:1.08,2.22, p:0.017) while adjusting effect of gender.ConclusionClassroom-based cancer prevention education delivered through teachers during regular working hours is effective in improving dietary behaviors and its determinants among adolescent students. Thus, we recommend integrating a section focusing on the role of diet in cancer prevention and other lifestyle diseases in the existing school curriculum.Trial RegistrationThe trial was registered under Clinical Trial Registry-India with registration number CTRI/2018/12/016586, dated-10/12/2018.

In this study we present an in-depth bibliometric analysis of Sci-Hub downloads by Egyptian researchers based on the 2017 download log file. The study reveals that Egyptian researchers heavily rely on Sci-Hub, generating a substantial 1,357,526 download requests in 2017, with 65% of these occurring outside regular working hours. Cairo emerges as a central hub for this activity, contributing 81.58% of total downloads. Journal articles constitute the majority of downloads at 82.36%, followed by conference papers (12.89%). A discernible trend shows a preference for recent papers published between 2012 and 2017, highlighting the demand for up-to-date research. The analysis also highlights prominent publishers, including IEEE, Elsevier, Wiley, and Springer, as preferred sources for Egyptian researchers. “Journal of the American Chemical Society” and “Journal of Applied Physics” stand out among accessed journals, while IEEE-associated conferences, notably “IEEE Power and Energy Society General Meeting,” dominate conference paper downloads. Examining journal accessibility via the Egyptian Knowledge Bank (EKB) reveals that 62.84% of journals are accessible, with Science Direct as the leading provider (28.37%). However, a significant gap emerges as 87.39% of downloaded conference papers remain inaccessible through EKB. Furthermore, a semantic analysis highlights recurring themes such as “systems,” “review,” “analysis,” “treatment,” “power,” and “energy,” reflecting the key research areas of Egyptian researchers. Overall, this study offers valuable insights into Sci-Hub’s role in supplementing Egyptian researchers’ resource access and underscores the need for comprehensive resource coverage and accessibility enhancements.

ObjectivesIdentify university-aged students and contrast their healthcare provision and outcomes with other patients in the same age group attending emergency departments for deliberate self-harm.DesignRetrospective cross-sectional observational study.SettingPatients visiting 129 public...

Introduction: The use of laparoscopy in emergency abdominal surgery is considered high-risk due to its elevated morbidity, requiring expertise in laparoscopic surgery. Objective: Assessing the feasibility, reproducibility, and safety of laparoscopy in non-traumatic acute abdominal surgery. Methods: Descriptive, prospective and evaluative study, conducted between February 2018 and October 2021. We have included in this study: acute appendicitis and its complications, lithiasis acute cholecystitis (LAC), peritonitis by perforation of peptic ulcer, adhesive acute intestinal obstruction, adnexal torsion, extra-uterine pregnancies, and non-specific acute abdominal pain. Results: We operated on 337 patients laparoscopically, with an average of 02 surgeries per medical shift. In 62.6%, surgeries were performed outside of regular working hours. We encountered temporary, material, and human difficulties in 10.8% of the cases. Average age of the patients is 38 years ±15 years. F/H sex ratio =1.29. Diagnostic accuracy of laparoscopy was 100 %. Intraoperative laparoscopic scanning corrected the preoperative diagnosis in 15.73% of cases. Average operative time was 52.09 min ± 24.14 min. One conversion recorded (0.3%). Rate of postoperative complications was 6.2%. These complications are classified at grade I according to the Clavien-Dindo classification in 85.71%. Only one patient (0.3%) required a second operation. Average length of overall hospitalization was 1.5 days. Conclusion: Our results suggest that emergency laparoscopy is feasible, safe, and reproducible. So it can claim to replace laparotomy in the management of acute, non-traumatic abdominal emergencies.

Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours. In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology. The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Children's Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists. Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain.

Multiple studies have provided evidence that the hospitality and tourism sector is experiencing a growing reliance on information and communication technology (ICT). Consequently, employees in this industry are facing an escalating expectation to stay connected and address work-related communication even outside their regular working hours. Little is known about how using ICTs during off-job can raise employee unfairness perceptions and job overload and how managers can control this. The primary focus of the current study is to examine the association between work-related ICT use after hours and employees' perceived injustice and the mediating role of work-role overload and the moderating role of psychological detachment in this relationship within the hospitality and tourism industry. By convenient sampling method, 400 employee responses were collected. The collected data were analyzed using structural equation modeling (SEM) with the "Partial least squares (PLS)" technique, employing SmartPLS-4 software. The empirical findings demonstrate a positive association between work-related ICT use after hours and employees' perceived injustice (EPI) and work role overload (WRO). Similarly, the mediating role of work-role overload and the moderating role of psychological detachment were supported. The study concludes by providing theoretical and practical implications and discusses how these findings can be applied within the tourism and hospitality industry.

BackgroundRecent reports have demonstrated promising results regarding the use of ketamine sedation for reducing pediatric intussusception without an associated elevated risk of bowel perforation. However, data on direct intraluminal pressure are still lacking. This study aimed to investigate sedation safety, primarily by comparing intraluminal pressure.MethodsThis retrospective study included patients aged 10 years or younger, diagnosed with intussusception at a university‐affiliated pediatric emergency department (ED) between July 2021 and February 2023. These patients were categorized into two groups: sedation and non‐sedation. During regular working hours (from 9:00 a.m. to 5:00 p.m. on weekdays), patients were administered 1 mg/kg of intravenous ketamine for sedation during air enema reduction. Patients within non‐working hours did not receive sedative interventions.ResultsIn a study of 114 patients with intussusception (median age: 25 months), 29 (25.4%) received sedatives, and 85 (74.6%) did not. Maximum intraluminal pressure during the procedure showed no significant difference between the groups (sedation: 64 mmHg, non‐sedation: 83 mmHg, p = 0.091). Bowel perforation was not observed in the overall cohort. No difference was observed in the failure rate or recurrence rate within 24 h between the two groups. Sedation with a median dose of 1 mg/kg ketamine did not cause delays in the ED process and demonstrated no adverse events while maintaining appropriate sedation depth with sequential dosing.ConclusionsThe utilization of ketamine sedation during fluoroscopy‐guided air enema reduction for pediatric intussusception was not associated with increased intraluminal pressure, increased rate of reduction failure, or bowel perforation.

Objective: This study aimed to assess the response time of the emergency medical services (EMS) at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Methods: This cross-sectional study was conducted at KSUMC emergency department. The study included all records of emergency calls that required ambulance dispatch during the study period. Data on the times they received the call, dispatched the ambulance, arrived at the scene, left the scene, and arrived at the hospital were collected. Each call was examined to assess if it took place during normal working hours (08:00-16:00) or within 30 minutes of shift changes (08:00, 16:00, and 00:00). Results: Of all the calls received, 288 (61.7%) were made during regular working hours (08:00-16:00), while 47 (10.1%) were made during the turning shifts (30 minutes before or after the shift). The median time from receiving the call to dispatch, from receiving the call to arrival at the scene, from dispatch to hospital arrival, and the scene time was 1 minute, 7 minutes, 24 minutes, and 10 minutes, respectively. The response and transportation times for emergency responders were consistent whether the calls were received during shift changes or at other times. The differences in mean rank were not statistically significant (P-values = 0.404 and 0.262, respectively). Conclusion: The EMS team at KSUMC in Riyadh, Saudi Arabia, responded quickly. The median times between receiving a call and arriving at the scene, as well as the median scene time, were found to be adequate.

Urban green spaces (UGSs), such as parks and gardens, are vital for the health and well-being of city residents. However, unequal access to and utilization of UGS can impede social cohesion and sustainable development of cities. While many studies have investigated inequalities in accessibility to UGSs across various demographic groups, gender inequality in actual utilization of UGSs has received little attention largely due to the lack of data to reliably track UGS utilization by urban residents. Here, we leveraged the capacity of mobile phone data to track the movement of a large population and assessed the gender disparities in the utilization of UGSs among more than 77,000 residents residing in 2 populous communities in Beijing. We found that men spent 11% more time in UGSs and visited them 6% more frequently than women. This gender disparity varied across different socioeconomic groups. The middle-aged group exhibited an up to 46.4% greater disparity than other age groups, while the higher-income group showed a 12.4% larger disparity than the lower-income group. Additionally, the resident group with normal commuting distances had a 52.8% higher gender disparity, and the resident group with regular working hours had a 110% greater disparity compared to their respective counterpart groups. These findings contributed to environmental justice research by revealing the complex gender disparity in UGS utilization. The approach developed in the study provides an efficient way for identifying disparities in the utilization of UGS and designing effective strategies accordingly to alleviate inequalities in our study area and beyond.

The research aims to identify the vision of male and female physical education teachers for the role of the school principal in activating school sports activity. This study also aimed to identify differences in the role of school administrations in activating school sports activity according to the variables (experience, gender). The researcher for this study used the method Descriptive in the style of survey studies. The research community was composed of physical education teachers, both male and female, regular working hours within the Al-Qadisiyah Education Directorate for the academic year (2022-2023), who numbered (362) male and female physical education teachers. The percentage of the research sample that was selected was (28.72%). Accordingly, the number of the sample reached (104) physical education teachers, with (72) teachers constituting (19.88%) and (32) schools constituting (8.83%). They were chosen randomly. Appropriate statistical methods were used for the current research, and it showed the results of this study are that the school administration has an effective and positive role in activating school sports activity. The results indicated that there were no statistically significant differences according to the variable (experience), while the results indicated that there were statistically significant differences in the variable (gender) in favor of females.

Association between Work-related Communication Devices Use during Work Outside of Regular Working Hours and Depressive Symptoms in Wage Workers

Abstract Background In-hospital cardiac arrest is a life-threatening event, often leading to poor outcomes and high mortality rates. There is limited research investigating how the time and day of arrest might impact long-term outcomes, such as mortality and functional status. Purpose To investigate the relationship between time and day of arrest and long-term outcomes in patients who experience in-hospital cardiac arrest. Methods This study included all patients who experienced an in-hospital cardiac arrest between January 1st, 2013 and December 31st, 2019, and who had a clinical indication for resuscitation. Data was obtained from the Danish in-hospital cardiac arrest registry, which was linked to other national registries to gather information on patient characteristics, such as survival, anoxic brain damage, and nursing home admission. The patients were stratified into three groups (A-C) based on time and day of the week: Group A included patients who were resuscitated during regular working hours (Monday to Friday from 08:00 to 15:59), Group B included patients who were resuscitated during off-hours (Monday to Sunday from 16:00 to 23:59 and Saturday to Sunday from 08:00 to 15:59), and Group C included patients who were resuscitated during off-hours at night (Monday to Sunday from 00:00 to 07:59). Standardized average probability of outcomes was estimated using logistic regression. Results The study population consisted of 9,225 patients, median age was 74 (1st-3rd quartile [Q1-Q3] 65-81 years) and 63.3% were men. In total, 53.6% (n = 4,909) of the patients achieved return of spontaneous circulation (ROSC). The standardized absolute chance of 30-day survival was 32.7% (95% CI 30.9%-34.5%) for group A, 27.2% (95% CI 25.7%-28.7%) for group B, and 23.6% (95% CI 22.0%-25.3%) for group C. Similarly, the chance of 1-year survival was highest for group A (27.6%; 95% CI 25.9%-29.3%) gradually decreasing to 18.9% (95% CI 17.4%-20.4%) in group C (Fig. 1). For patients who survived at least 30 days following an in-hospital cardiac arrest, the standardized absolute chance of surviving without anoxic brain damage or admission to a nursing home within one year was greatest among those in group A (81.1%; 95% CI 78.3%-83.8%), but decreased to 75.1% (95% CI 72.2%-78.1%) for those in group B, and 72.2% (95% CI 68.3%-76.1%) for those in group C (Fig. 1D). Conclusion In conclusion, this study found that patients who experience in-hospital cardiac arrest during off-hours at night have significantly lower chances of survival at both 30 days and 1 year compared to those experiencing an arrest during on-hours or off-hours. Additionally, among patients who survive the initial 30 days, those resuscitated during off-hours at night have the poorest outcomes, with lower chances of 1-year survival without anoxic brain damage or nursing home admission.Figure 1