Safety Procedures Research Articles

Evaluation of psychosocial factors affecting faecal sludge desludging practice compliance in Bekasi City

Desludging operators have important role in on site sanitation to achieve safe sanitation. Desludging practice have to comply with the principles of safe sanitation and regulations to maintain the health and safety of the worker, the community, and the environment. However, the implementation of desludging sometimes does not comply with safe sanitation principle and regulation. This study aims to identify the compliance of faecal sludge desludging with regulation and safe sanitation principle. Furthermore, Theoretical Domains Framework (TDF) is applied to explore psychosocial factors of the operators that affect desludging practice. Questionnaire assessing desludging practice and psychosocial factors based on TDF was given to 32 desludging operators that works in local government and private desludging services in Bekasi City. Desludging practice in Bekasi City were not comply desludging practice procedure. From desludging procedure compliance, only 56% of the respondents claimed to have carried out the desludging practice in accordance with the procedures, low percentage also found in the worker’s safety procedure especially in wearing Personal Protective Equipment (PPE) eventhough mostly do not do high risk action in emptying. Related to faecal sludge disposal procedure, high percentage (84%) of workers always discharge to Faecal Sludge Treatment Plant (FSTP), while some small amount (16%) often follow the discharge procedure. Spearman’s Rank Correlation analysis was used to determine domains in TDF that significantly affecting desludging practice compliance. From the correlation analysis, Knowledge (ρ = 0.505; P =0.003), Beliefs about consequences (ρ =0.473; P = 0.006), and Environmental context and resources (ρ =0.389; P = 0.028) are statistically significant affecting desludging practice.

Innovative Food Safety Approaches and Nutraceuticals to Promote Children's Health on Future Outbreaks with the Reflection of COVID-19.

After the COVID-19 pandemic, innovative methods have emerged for the management of food safety, child nutrition has become more important than ever, and increasing attention has been paid to the consequences of COVID-19. For instance, since SARS-CoV-2 is an animal-based zoonotic virus, there is a changing trend in consumer preferences from conventional meat products to cultured meat and vegan supplementation. Due to the effects mentioned, this chapter provides strategic guidance on novel foods, food safety innovations, and novel health and safety procedures in public places such as restaurants or bars. There are also long-term health impacts on children in the aftermath of COVID-19. Since the risk of myopia is one of the important long-term effects to be considered, trending nutritional immunology approaches are presented to reduce emerging problems in child eye health. The enhancement of immune system remains problematic for many children considering that they cannot use the COVID-19 vaccine. Therefore, this chapter also emphasizes the importance of breastfeeding on the side effects of viral infections and new supplements, such as probiotic drops, to improve children's and babies' immune health. Additionally, efforts should be undertaken to improve nanoencapsulation techniques to prepare for future epidemics and pandemics. Nanomaterial-supported nutraceuticals, nanoencapsulation of functional ingredients or their nanoparticles, and nano-combination of phytochemicals, fatty acids, or probiotics should be investigated to improve the immunity of children. In this sense, detailed further research in this area needs to be adapted to innovative technologies for the treatment of infants and children against future zoonotic viruses.

Impact of a peer-support programme to improve loneliness and social isolation due to COVID-19: does adding a secure, user friendly video-conference solution work better than telephone support alone? Protocol for a three-arm randomised clinical trial

IntroductionThe COVID-19 pandemic has forced the implementation of physical distancing and self-isolation strategies worldwide. However, these measures have significant potential to increase social isolation and loneliness. Among older people, loneliness...

Factors associated with central venous catheter infection in critically ill patients

Introduction: The study was conducted by analyzing 8 articles related to Central Venous Catheter Infections in critically ill patients in the Intensive Care Unit to analyze the factors associated with central venous catheter infection in critically ill patients. Objectives: The main objective is to determine the incidence of central venous catheter infection and related factors by these routes in patients treated in the Intensive Care Unit. Methodology: This systematic review was applied with Holly, it was carried out according to the eligibility criteria by means of the PIO question and with PRISMA methodology. Results. It was found that 70% of the results of the analysis of the studies refer to the proper use of the central venous catheter being related to insertion and maintenance and that the incidence of central venous catheter infection is based on prolonged ICU stay. Conclusion: The follow-up of general and specific protocols, with the introduction of verification routines that minimize the risk of error in a highly complex environment, must have the participation of all health personnel, including management bodies. Recommendations: Show commitment from the management, administrative, and quality areas, to adequately monitor the processes and procedures for patient safety in the central venous catheter. Avoid unnecessarily prolonging catheter life and clearly define catheter insertion indications. Among the various factors that produce infection, the environment has to do with it, maintaining an adequate temperature inside the patient's cubicle or room to reduce the proliferation of organisms.

Managing Occupational Health and Safety Risks in Construction Projects to Achieve Social Sustainability – A Review of Literature

This systematic literature review aims to thoroughly examine the relationship between Occupational Health and Safety (OHS) and project management in construction projects. The construction industry is known for its high accident rates among workers, and it is important to understand the factors that contribute to these accidents to develop effective OHS management practices. The review highlights the significance of legal compliance in OHS management and the challenges and opportunities presented by the integration of OHS laws in construction project management. One of the main factors that contribute to high accident rates among construction workers is inadequate training and a lack of proper safety equipment. The review also identifies common types of accidents and their factors on construction sites, such as falls from heights, electrical hazards, and heavy machinery accidents. Additionally, it suggests measures for improving OHS management practices, such as regular safety inspections and training programs, implementing safety policies and procedures, and providing proper personal protective equipment to workers. Overall, the research indicates that OHS is an essential aspect of construction project management, and effective OHS management can improve project performance by reducing accidents and injuries, improving worker morale and productivity, and enhancing the project’s reputation. The review provides insights on how to develop, implement and continuously improve OHS management practices in construction projects.

Behavior-Based Safety, the Right Long-term approach to address Workplace Safety

Until the present, addressing the behavioral aspects of work-related accidents and occupational diseases in Romania has been very sporadic. Most companies have adopted various programs and initiatives to enhance compliance with Occupational Safety and Health procedures. All these procedures are important for a successful safety process. Done correctly, they contribute to good safety performance. But today, these elements define the average safety effort, representing what everyone else is doing. If a company performs them well, it will achieve an average level of safety for their industry. While the injury rate will be affected by the consistency of these efforts, the result will basically be a normal variation above and below the industry average: some years better than average, some years worse. In this context, the paper presents some tools developed worldwide to improve consistently the safety and health of the employees. The basic objective of this study is to explore the human dynamics of occupational health and safety and to show how these can be managed to significantly improve performance. The principles and practical procedures are not based on common sense or intuition, but rather on reliable scientific investigations. Many recommendations seem different from traditional approaches to occupational safety.

ASSESSMENT OF SAFETY AND HEALTH MANAGEMENT PRACTICES AT SELECTED SITES IN ABUJA

This study aims to assess the safety and health management practices in some selected sites in Abuja. The objectives of the study are to evaluate the existing safety and health protocols and procedures at construction sites in Abuja, identify the challenges and shortcomings in the implementation of safety and health measures in the construction industry in Abuja, and explore improvement strategies for safety and health management practices in the construction sector in Abuja. The study hypothesizes that there is a significant relationship between safety and health management practices and the occurrence of accidents in construction sites in Abuja. The study used a mixed-methods approach, including questionnaires and observation checklists, to collect data from regulatory bodies, construction companies, and laborers at five construction sites in Abuja. The study also identified that the individual, organizational, and institutional system influence risks assessment, communication, and control at construction sites. The study recommends frequent staff training on health and safety work procedures, improvement of internal communication channels to be carried out by the safety managers and officers, and reinforcement of positive employee attitude towards safety. Effective communication is an integral component of an efficient and safe workplace. There are skills and some kind of knowledge base that are critical to the safe and proper execution of any job. The Cronbach Alpha value gotten is 0.942879065 falls under the 0.8-0.9 range which means that the value gotten for the Cronbach alpha is good. The decision rule is to reject the null hypothesis and accept the alternative if the sig. value of the variables under study is lower than 0.05 level of significance. The alpha value gotten was 0.77 and the p-value to be 0.000511605 which means and signifies that the null hypothesis is rejected and there is indeed a significant difference. In conclusion, the research is accepting the alternative hypothesis which states that A meaningful correlation exists between safety and health management practices and the incidence of accidents at construction sites.

High voltage in nuclear applications: Occupational safety aspects and standards

High voltage (HV) plays diverse and critical roles that in both nuclear power generation and nuclear instrumentation, contributing to the efficiency, safety, and precision of various processes within the nuclear domain. The basic detection component of nuclear instruments is the nuclear detector, which needs direct current HV power supply. Exposure to HV electrical systems can cause serious injuries, fatalities, and damage to equipment if proper safety measures are not followed. Comprehensive safety measures, such as proper training, adherence to safety procedures, use of personal protective equipment, equipment maintenance, regular inspections, and compliance with relevant safety standards and regulations, are essential to mitigate hazards arising from HV applications. HV safety and standards are critical aspects of HV occupational practices as they ensure the protection of personnel, machine, and workplace safety. A close study points to certain inadequacies and weaknesses in the existing standards. These include a lack of universal standards, insufficient coverage of nonelectric hazards or indirect safety hazards, deficient or no focus on human factors, and limited consideration of evolving and new technologies. In the last portion of this article, the standards followed at the High Voltage Pulsed Power Lab, Control Instrumentation Division, BARC are discussed along with the safety practices that are observed in the routine operation of different high voltage systems.

Safety of GMP-compliant iPSC lines generated by Sendai virus transduction is dependent upon clone identity and sex of the donor.

Human induced pluripotent stem cells (hiPSCs) are a potential source of somatic cells for cell therapies due to their ability to self-renew and differentiate into various cells of the body. To date, the clinical application of hiPSCs has been limited due to safety issues. The present study aims to standardize the safety procedure of the derivation of GMP-compliant induced pluripotent stem cell (iPSC) lines from human fibroblasts. The hiPSC lines were generated using the nonintegrative Sendai virus method to incorporate Yamanaka reprogramming factors (OCT3/4, SOX2, KLF4 and c-MYC) into cells. A constant temperature was maintained during the cell culture, including all stages of the culture after transduction with Sendai virus. Pluripotency was proved in six independently generated hiPSC lines from adult female (47 years old) and male (57 years old) donors' derived fibroblasts via alkaline phosphatase live (ALP) staining, qPCR, and immunocytochemistry. The hiPSC lines showed a gradual decrease in the presence of the virus with each subsequent passage, and this reduction was specific to the hiPSC line. The frequency and probability of chromosomal aberrations in hiPSCs were dependent on both the iPSC clone identity and sex of the donor. In summary, the generation of hiPSC for clinical applications requires safety standards application (biosafety protocol, quality control of hiPSC lines, viral and genetic integrity screening) from the first stages of the clonal selection of hiPSC from the same donor.

On the Issue of Ensuring the Durability of Products and Structures Made of High-Strength Concrete to Explosive Destruction

Fire safety procedures are an integral part of the design process of civil and industrial construction facilities. When carrying out design calculations, up-to-date reference data on the resistance of known types of building materials to the effects of open fire and elevated temperatures are used. However, modification of the compositions and properties of such materials may cause changes in their behavior in fire conditions. Thus, new types of high-strength concretes based on Portland cement in practice have shown a tendency to explosive destruction, which significantly affects the reliability of the simulation results of their resistance to prolonged and short-term exposure to elevated temperatures. The presented work provides an overview and assessment of the current state of the issue of ensuring fire safety of structures made of high-strength concrete, additional measures are proposed to improve the existing algorithms for determining their fire resistance.

Assessment of Hepato-Renal Biomarkers in Petrol Pump Attendants: Impact of Protective Gear Usage

Background: Petrol Pump attendants (PPA) in India wear a variety of safety gear, including as overalls, masks, and gloves. It is still entirely unknown if they can effectively protect vulnerable organs like the liver and kidney. The study's objective is to examine the hepato-renal axis' biochemical characteristics in PPA employees who wore protective gear while on duty and those who did not.
 Methods: The research population was divided into three Groups. Group A consisted of 15 adults male PPAs who had consistently implemented protective measures when administering petroleum products. 32 PPA who did not wear protective gear made up Group B. A total of twenty-eight male adults who had not been exposed to petroleum products made up Group C, the control Group. For PPA selected for the research, a minimum of five years of exposure was required. Through the administration of a questionnaire, data on worker safety was gathered about the usage of self-protective gear as a standard safety procedure for personal protection. To evaluate biochemical indicators of hepato-renal functioning, serum was used. Both the Student's t test and the analysis of variance were used to find statistical differences. It was deemed significant at p 0.05.
 Results: ALP, AST, ALT, creatinine, urea, albumin, and total protein activities or levels in both Group A and Group B were substantially different from control (Group C), suggesting liver impairment.
 Conclusion: Data from this study indicate that none of the three protective gear options employed by PPA in Group B significantly decreased exposure.

Hubungan Latihan Keselamatan, Peraturan dan Prosedur Keselamatan terhadap Prestasi Keselamatan Anggota Kerja GIATMARA

Safety performance holds a vital role in developing safety management in the workplace, aiming to ensure both safety compliance and safety participation in the organization. Safety performance also contributes to and determines the success of accident prevention program implementation. This study was conducted to identify the relationship between safety training, safety rules and procedures, and the safety performance of employees at GIATMARA. This study is a quantitative study that uses a survey research design. The research instrument is a questionnaire and involves 128 respondents among GIATMARA workers in the state of Perak. The results of the Pearson correlation statistical analysis show that there is a significant and positive relationship between safety training (r = .496, p ≤ 0.01), as well as safety rules and procedures (r = .593 **, p ≤ 0.01) on safety performance. The results of this study prove that safety training and safety rules and procedures affect the safety performance of an organization. Therefore, every organization needs to ensure that each employee receives adequate safety training and is provided with well-organized and clear safety rules and procedures.

Establishing Occupational Health and Safety Management System in a Libya Oil Company According to ISO 45001:2018 Case Study: Waha Oil Company

The main aim of the paper is to identify the level of Occupational Health and Safety (OHS) systems application in the Waha Oil Company. This study also examines the employee’s perspective (PE) regarding the application level of the systems of occupational health and safety. The study has shown that the majority of employees are satisfied with the level of occupational health and safety means and procedures in their workplace, also the employees agreed that the company holds training programs and sessions on occupational health and safety affairs, and the results have shown that employees are satisfied with the insurance and compensation policies in the company. The study has adopted a quantitative approach with deductive reasoning based on a case study model to test for a correlation between two main variables which are (OHS and EP). Also, this approach allows analysis of the numerical primary data generated from the questionnaire using the statistical software SPSS. According to the results of this study, it was concluded that there is a statistically significant linear correlation between the two variables and that this relationship is positive, meaning that OHS as an independent variable can predict EP as a dependent variable.

Efficiency and perceived safety of foot and ankle procedures performed on the preoperative stretcher versus operating room table.

Foot and ankle surgeons often perform minor surgeries on the preoperative stretcher instead of the operating room table. We examined whether stretcher-based and operating room table-based procedures differed with respect to operating room efficiency and staff perceptions. We retrospectively reviewed medical records of patients undergoing minor foot and ankle surgery at an ambulatory surgery centre. We collected 'time to start', the duration between patient arrival in the operating room and incision time, and 'time to exit', the duration between procedure end time and patient exit from the operating room. Staff were surveyed regarding their perceptions of stretcher-based and operating room table-based procedures. 'Time to start' was significantly shorter for stretcher-based procedures, but 'time to exit' was not. Seventeen (81%) staff members thought stretcher-based procedures increased operating room efficiency. Thirteen (62%) thought stretcher-based procedures bettered staff safety. Nineteen (91%) thought stretcher-based procedures were equivalent to or better than operating room table-based procedures for patient safety. Most (67%) would recommend stretcher-based procedures. We found small but significant time savings associated with stretcher-based procedures. Without adapting surgical scheduling practices, the impact of stretcher-based procedures on overall operating room efficiency is questionable. Nevertheless, the majority of OR staff think stretcher-based procedures increase OR efficiency and are safer for staff. Level IV, Retrospective case series.

Challenges and innovations during the COVID-19 pandemic: An international survey of music therapy educators

ABSTRACT Introduction The COVID-19 pandemic affected educational institutions and clinical organizations, with universities and clinical sites experiencing a complete lock down with unexpected changes to meeting students’ and clients’ needs within this new landscape. Consequently, music therapy educators had to pivot from their current teaching and practicum format to comply with university and governmental restrictions. Study aims This manuscript explores how COVID-19 impacted music therapy teaching practices and learning delivery, identifying resources and tools implemented by music therapy educators, explicating changes in assessment of student learning, compliance with required guidelines and approvals, and innovations used or discovered during this time. Method International music therapy educators completed an online survey about their music therapy education and teaching practices, including questions about their teaching practices during the COVID-19 pandemic. Results Sixty-one music therapy educators from 19 countries completed a 55-question survey, including 6 questions specifically about the impact of the COVID-19 pandemic on their teaching practices. Majority of respondents reported that COVID-19 had a significant impact on their teaching practices, sharing the various changes implemented and tools and resources integrated into their online teaching platforms. Two exemplars further illustrate detailed processes necessitated by educators from two different universities. Discussion Clearly, the pandemic impacted music therapy education and training, including integration and adaptation of new and existing tools into their teaching and assessment practices, plus changes to safety procedures in implementing guidelines. Lastly, innovative teaching practices introduced during the pandemic that educators plan to retain as a part of their teaching portfolio are explored.

Evaluation of the effect of ozone disinfection on forensic identification of blood, saliva, and semen stains

Good laboratory practice minimizes the biological hazard posed by potentially infectious casework samples. In certain scenarios, when the casework sample is contaminated with highly contagious pathogens, additional safety procedures such as disinfection might be advised. It was previously proven that ozone gas treatment does not hamper STR analysis, but there is no data on how the disinfection affects other steps of the forensic analysis.In this study, we aimed to assess the interference of ozone disinfection with forensic tests used to identify biological stains.A dilution series of blood, saliva, and semen samples were pipetted onto cotton fabric and let completely dry. Half of the samples were subjected to ozone treatment, while the rest served as controls. All the samples were tested with specific lateral flow immunochromatographic assays and for specific RNA markers with quantitative real-time PCR. Additionally, luminol test was carried out on blood spots, Phadebas® Amylase Test on saliva stains, and semen stains were examined with STK Lab kit and light microscope following Christmas Tree or Hematoxylin-Eosin staining.Ozone treatment had no detrimental effect on the microscopic identification of sperm cells. Undiluted blood samples were detected with luminol and immunoassay, but at higher dilution, the sensitivity of the test decreased after disinfection. The same decrease in sensitivity was observed in the detection of semen stains using STK Lab kit from STK® Sperm Tracker, and in the case of the immunoassay specific for prostate-specific antigen (PSA). Ozone treatment almost completely inhibited the enzymatic activity of amylase. The sensitivity of antibody-based detection of amylase was also greatly reduced. RNA markers showed degradation but remained detectable in blood and semen samples after incubation in the presence of ozone. In saliva, the higher Ct values of the mRNA markers were close to the detection limit, even before ozone treatment.

Assessment of Handling Practices of Fresh Vegetable Salads in Restaurants and Street Vendors: A Case of Mwanza City, Tanzania

Food safety is crucial for promoting public health and economic development. Food service establishments (FSE) provide a wide range of foods, including raw, mild and well-heat treated. Raw or mild-heat treated foods like fresh vegetable salads, Kachumbari, are potentially risky if not well handled. The objective of this study was to assess handling practices of operators involved in the preparation and serving of Kachumbari in various FSE in Mwanza City, Tanzania. A cross sectional study involving thirty food handlers from 10 restaurants and 20 street food vending sites was conducted in April 2023. A semi-structured questionnaire and observation checklist were used to collect data. Results indicated that 93.3% lacked formal food handling training, and 66.7% did not prioritize clean-as-you-go practices for food safety. Moreover, 53.3% felt that wearing clean clothes when handling food was not important, and only 26.6% underwent annual medical checkups. Moreover, the majority of the handlers (66.7%) demonstrated a poor understanding of food safety principles and procedures. Based on these findings, we recommend regular trainings on best handling practices among food handlers, coupled with inspections and supervision by relevant government authorities, to ensure that food prepared in FSE in Mwanza City and Tanzania as a whole is safe for human consumption.

Occupational Health Hazards among Petrol Station Workers in Ibadan, Oyo State, Nigeria

When a consumer comes to the gas station to buy fuel, the attendants are their initial point of contact. Petrol station employees deal with a variety of risks and health issues on the job. This study was carried out to ascertain the health risks, occupational safety practices, and health issues among gas station workers in Ibadan, Oyo State. Africa.
 This intervention study was conducted with all willing attendants that operate at Ibadan's filling stations. A semi-structured interviewer-administered English-language questionnaire was used to gather data. STATA 12.1 software was used for data analysis after structured interviewer-administered questionnaires were used to gather data. Both descriptive and inferential statistics were used in the analysis. A 5% threshold for significance was used.
 The study involved 620 respondents in total for both genders, the mean age of the responders was 29.4 ± 4.6 years. The inhalation of petrol fumes, customer confrontation, and noise exposure were among the hazards that were reported. Dust-related chronic cough; heat stress that frequently leads to heat exhaustion and heat stroke; hearing loss; hypertension from excessive equipment noise; back and general body ache from bending over repeatedly at work; robbery; fire; harsh weather; and exhaust fume incidence. Health problems reported included headache, blurry vision, vomiting, drowsiness, vertigo, heartburn, slurred speech, weakness, staggering, facial flushing, itching, loss of consciousness, heart failure, convulsion, irritability, memory loss, nausea, tremor, involuntary eye movement, cough, muscle spasms, hallucination, altered vision, insomnia, poor appetite and stomach upset factor associated with health problem. The results, which have a p-value of 0.29, demonstrate that there is no meaningful correlation between occupational safety practices and health issues. Occupation-related health hazards, work environment, and health problems are significantly correlated, with p-values of less than 0.01. Additionally, there is no significant correlation (p-value of 0.12), between understanding of safety procedures and health issues.
 In conclusion, the study found that attendants at fiilling stations were subjected to a variety of risks and health issues. Poor hand washing techniques, first aid box availability, PPE awareness and use, and medical assessment procedures were all present. The Independent Petroleum Marketers Association and other relevant parties should endeavor to guarantee that filling station owners assume accountability for the well-being and security of their employees.

The restricted SAR protocol: A method to assess MRI coil prototypes in an unconditionally safe manner.

Testing an RF coil prototype on subjects involves laborious verifications to ensure its safety. In particular, it requires preliminary electromagnetic simulations and their validations on phantoms to accurately predict the specific absorption rate (SAR). For coil design validation with a simpler safety procedure, the restricted SAR (rS) mode is proposed, enabling representative first experiments in vivo. The goal of the developed approach is to accelerate the transition of a custom coil system from prototype to clinical use. The restricted specific absorption rate (SAR) (rS) mode imposes a radical limitation on the transmitted RF power based on a worst-case scenario of local RF power absorption. The limitations used are independent of the SAR spatial distribution, making this approach unconditionally safe. The developed rS protocol contains the sequences required for coil evaluation and satisfies the imposed rS conditions. It provides a quantitative characterization of the coil transmission and reception profiles and a qualitative evaluation of the anatomical images. Protocol validation was performed on commercial and pre-industrial prototype coils on a small cohort of healthy volunteers. The proposed rS protocol enables coil evaluation within an acquisition time compatible with common clinical protocol duration. The total time of all evaluation steps does not exceed 17 min. At the same time, the global SAR remains 100 times less than the International Electrotechnical Commission safety limit for played sequences. The rS protocol allows characterizing and comparing coil prototypes on volunteers without extensive electromagnetic calculations and phantom validations in an unconditionally safe way.

Integrating Virtual Reality into Work Zone Flagger Training: Usability Analysis and Behavioral Assessment

Virtual reality (VR) has found increased use in transportation workforce development. VR offers an immersive and interactive approach to training. This study presents the development and implementation of an interactive VR training module designed for a work zone flagger training course. The module allows up to two trainees to perform the following flagging activities using a pair of VR controllers: (1) turn the STOP/SLOW paddle; (2) teleport to a specific location; and (3) pick up and move traffic cones to direct traffic. A pilot test was first conducted to obtain feedback from course instructors and 12 staff of the Missouri Department of Transportation (MoDOT). The revised module was then implemented at two MoDOT flagger training courses, with 28 MoDOT staff participating. The developed module was evaluated using three instruments—a system usability scale, self-reported engagement, and trainee behavioral measures. The results showed that the VR flagger training module achieved the majority of the intended outcomes. Over 82% of participants strongly agreed or agreed that the VR module helped them focus more during the overall work zone training and 93% of participants stated that VR made them feel more positive about their overall training experience. The behavioral analysis helps instructors evaluate whether trainees accurately followed the safety procedures and guidelines and offer individualized feedback. The evaluation also gathered additional feedback from participants and instructors, leading to further refinements in the VR training module development and implementation.