Step Forward Research Articles

Effectiveness of early clinical exposure in competency-based curriculum – A step forward

Background: Early clinical exposure (ECE), a newer concept introduced by the national medical council provide students with early exposure to clinical settings and patients, which can help them develop a better understanding of the health-care system and their role as future health-care providers. Aims and Objectives: This study aimed to compare the effectiveness of ECE with the traditional method of teaching in physiology practicals, using blood pressure (BP) measurement as an example, among 1st-year medical students in India. Materials and Methods: A quasi-experimental study was conducted with two groups of 75 students each, with one group receiving ECE and the other group receiving traditional teaching. Both groups received theoretical lectures and demonstrations on BP measurement before the practical sessions. The students’ knowledge, skills, and attitudes were assessed using a pretested and validated checklist. Results: The results showed that ECE was more effective than the traditional method in improving the students’ performance in BP measurement and communication skills. Moreover, feedback from the participants revealed that ECE improved their academic strength, clinical correlation to pre-clinical learning, sociocultural context of understanding the diseases, attitude, ethics, professionalism, and recognition of the need to learn clinical skills properly during preclinical practical sessions. Conclusion: Medical schools should incorporate the ECE as much as possible to enhance students’ clinical and communication skills and to make them recognize the relevance of basic sciences to clinical subjects in the upcoming years.

One Step Forward, Half Step Back: the Still Long Way to Go to End Statelessness in Madagascar

This work sheds light on the still unresolved plight of statelessness in Madagascar, a country that has a long history of stateless communities, above all among Karana, of Indian origin and Muslim religion. In spite of several important steps undertaken in order to eradicate stateslessness in the country (see, for example, the adoption of the 2016 Law on Nationality that partially amendended the 1960 Code on Nationality) the path for the complete eradication of statelessness in the country seems still quite long because of the lack of will by local authorities who seem to ignore the conditions of thousands of people, born and bred in Madagascar that, apparently for no specific reason, still do not hold Malagasy citizenship, bringing them to be deprived of several basic rights which citizens are normally entitled to. In this respect, the fact that Madagascar is still not a party of several important international legal instruments adopted to eradicate statelessness, does not facilitate the situation of the thousands of stateless people in Madagascar.

A Step Forward and Two Steps Back Towards the Centralization of Russian State Statistics in the Context of the International Statistical Congress

A Step Forward and Two Steps Back Towards the Centralization of Russian State Statistics in the Context of the International Statistical Congress

Adjusted calcium equation: a step forward

Adjusted calcium equation: a step forward

Individualized chemotherapy and immunotherapy for rectal cancer: the next step forward

Individualized chemotherapy and immunotherapy for rectal cancer: the next step forward

European Union Cost Caps: One Step Forward Two Steps Sideways to Substantive Harmonisation of Consumer Credit Law

European Union Cost Caps: One Step Forward Two Steps Sideways to Substantive Harmonisation of Consumer Credit Law

Disaster risk reduction and G20: A major step forward

Disaster risks are increasing and changing their nature. The global risk landscape is evolving as new risks – many of them arising from cascading and inter-connected hazards – are arising. While significant achievements have been made to reduce loss of lives, economic and asset damages are still on the increasing trend. G20, which started as the major economic group meeting, has emerged over years as an influential political forum. While there have been several attempts to bring disaster risk reduction agenda to G20, the issue has not been addressed in a comprehensive and sustained manner. A new working group on Disaster Risk Reduction has been established under India's Presidency. This paper analyzes G20 and DRR risk reduction agenda's evolution, provides insights on India's contribution to the thematic area, and suggest future interventions required at G20. While Indian Prime Minister's 10-points agenda sets the future DRR interventions targets, India's leadership in DRR can be seen in terms of local level risk management framework, resilient infrastructure, financing of disaster risk management, social protection, people's engagement, and resource management. In addition to that, response to COVID-19 through the Disaster Management Act has set up a new milestone for multi hazards and all hazards risk management, including complex and cascading risks. Five specific areas that are urgently required are: 1) investment in resilient infrastructure, 2) digital infra and data management protocol, including open data, open governance, 3) use of disruptive and emerging technologies, 4) enhancement of technology transfer and market creation through private sector involvement, and 5) fostering youth innovation and entrepreneurship in DRR. This will help not only the G20 nations, but also contribute to other vulnerable countries and communities.

The Whole Theory of This Universe—A Step Forward to Einstein, Part-3<sup>rd</sup>: “The Universal Theory of Visible and Invisible Universe”

We believe that the universe is of two types: visible and invisible. Nothing is at rest between the invisible and visible universes. All microscopic bodies as well as all macroscopic bodies are in motion along curved paths (i.e. in circles). The universe inside an atom is as vast as the visible universe. An atom consists of millions of particles or particle galaxies which contain central energy pools or central energy cores. Energy pools present in the centre of the invisible universe inside atomic or subatomic particles from which particles and energy are continuously interconverting. In a dense central energy pool, two opposite charges are created due to the swirling motion of microscopic energy droplets. Small microscopic energy droplets may swirl either clockwise or anti-clockwise to produce microscopic tornadoes which are non-superimposable mirror images of each other and gain the property of positive and negative charges. Hence, the electrostatic force is originated between these two opposite charges, which are then changed into a pair of particles, i.e. catitron, which carries a positive charge, and anitron which carries a negative charge. All the other millions of subatomic particles or particle galaxies are produced in the same way. So, the electrostatic force is the basic force, and all other forces originate from this basic electrostatic force of attraction. When charged particles move, they produce an oscillating electric field, and the spinning of these particles produces oscillating magnetic fields. These oscillating electric and magnetic fields are perpendicular to each other and, by their interaction, an oscillating gravitational field is produced which is also perpendicular to both the oscillating electric field and the oscillating magnetic field. The Earth’s axial tilt, which causes the Earth’s precessional motion, is caused by the parallel alignment of the Earth’s magnetic field with the magnetic field of the Sun. Gravity is not a cause of space-time curvature, but gravity causes space-time curvature. Space-time curvature is nothing but a curved path around a heavy object. The Universal Theory of Visible and Invisible Universe—The Whole Theory of This Universe—A Step Forward to Einstein, opens new windows in the challenging fields of science and research, i.e. visible and invisible universe, universe inside an atom, what is the stuff of the entire universe? What will happen at the end of this whole universe?

Interpretation of Body Temperature and Oxygen Saturation based on Individual Normal Ranges in Habitual Condition: A Step Forward for Applied Precision Medicine

Background: Precision medicine aims to provide patients with care and treatment based on the individual's unique conditions. Current reference ranges for vital parameters are based on healthy reference populations at group level, usually male, individuals excluding long-term medical conditions and daily medication. This entails a risk of misinterpretation on each measurement occasion because a deviant value for the individual may be camouflaged by a normal value at group level. We believe that precision medicine in practice requires that values for vital parameters are interpreted in relation to the individual's normal range in habitual condition. Aim: To investigate body temperature and oxygen saturation in healthy and frail individuals, based on individual normal range in habitual condition. Methods: The sample consisted of 70 healthy individuals, 27 to 80y, 20 nursing home residents, 70 to 100y, and 32 patients in hospital-affiliated home care, 60 to 95y. Age, gender, physical ability, chronic disease, medication was documented. Ear temperature and oxygen saturation were performed for five mornings before getting out of bed and taking medicine, food or drink. Results: The range for body temperature in healthy subjects was 34.3°C to 37.7 °C and in frail elderly 34.5°C to 37.7 °C. No differences in the variation of normal range in body temperature was found between healthy and frail individuals, 0.7°C + 0.4°C, though the variation between min and max temperature were large; 2.4°C vs 2.7°C and 2.9°C vs 2.3°C in healthy and frail subjects, respectively. A max temperature of < 36.2°C was more frequent in healthy subjects. The range for oxygen saturation varied between 85% to 99%, in healthy subjects and 75% to 100% in frail elderly. No healthy subjects had a max oxygen saturation value <94%. Inflammatory processes influenced body temperature and oxygen saturation in frail elderly. Conclusion: To promote precision medicine and health our results show that it is necessary to interpret body temperature and oxygen saturation based on individual normal ranges in habitual condition. By interpreting deviations from the individual's normal interval, the possibility of necessary care efforts increases without delay, which can be decisive before further deterioration.

Climatic Factors and Its Effect on Chili Production: One Step Forward Combating Climate Change

The impacts of climate change are increasingly visible from time to time, where it’s also arisen in the agricultural sector, including chili cultivation. In order to solve this problem, we need to know how climate factors actually impacts chili production. This study aimed to find out which and how climate factors impacted chili production, also the optimum point of each factor in regard of its impact on chili production. In this study, we used secondary data from the Food and Agriculture Organization (FAO) and the Climate Change Knowledge Portal (World Bank) with data ranging from 1961 to 2021 (61 years). Regression analysis using a quadratic model is used to determine the impact of climatic factors on chili production. The analysis shows that the mean and minimum temperatures, followed by rainfall have a significant impact on chili production with an optimum point of 25.20°C; 20.95°C; and 2,751.54 mm respectively.

ETwinning And Activities of Daily Living İn Special Education

ITCs are considered necessary and positive, but in special education it is necessary to take a step forward that allows students to communicate with other students from different cities, show their work and at the same time learn together with the help of their teachers. This study aims to improve communication between schools and special education students and to know the effect it generates on the learning of life skills through the eTwinning platform. In addition, an initial and final survey of parents and teachers working with the group is conducted. A total of 80 teachers from special education schools in different cities of Turkey and from a Spanish university participate together with their primary education teachers. Working with the Etwinning platform has been found to improve communication between schools and special education students. In this research, students with special educational needs have overcome communication barriers by interacting with others outside of their everyday environments by demonstrating that they can achieve anything, when given the opportunity to create, learn, know and develop digital skills. There is a greater knowledge of web 2.0 tools, such as canva, wordart, ingpss learning, KineMaster, Pixiz, vivavideo, meitu, phinsh to publicize the work done, assuming responsibility for their own learning, in addition, parents of students consider that the activities carried out within the framework of the eTwinning program have had an impact on their children's daily life skills.

One Step Back or One Step Forward? Effects of Grade Retention and School Retention Composition on Portuguese Students’ Psychosocial Outcomes Using PISA 2018 Data

Grade retention is a common practice applied to academically struggling students within the Portuguese context. Studies investigating the psychological experiences of grade-retained students are still scarce. In addition, most studies tend to neglect the multilevel nature of the school context. This study examines the effects of grade retention in grades 1–9 on Portuguese students’ psychosocial outcomes by the age of 15, using PISA 2018 data. Using a quasi-experimental design through full matching, we reduced the bias between 1362 retained and 4189 promoted students in relevant background variables. Results from the multilevel models showed that retained students, by the age of 15, present lower task orientation and school belonging. In addition, we found that the high retention rates negatively relate to students’ reading self-concept, task orientation, and school valuing and that school retention rates moderate the relationship between students’ retention and the psychosocial variables considered. Overall, these findings suggest detrimental effects of grade retention and that grade retention also affects the promoted peers of retained students.

Widening access for minoritised ethnic communities in the Liverpool Step Forward psychological service

Step Forward, an NHS Primary Care Mental Health Service in Liverpool, endeavours to make their service more accessible to minoritised ethnic communities. This article outlines some important considerations in developing a more culturally responsive service and describes the initiatives Step Forward has implemented to achieve this aim.

A Step Forward for Intensive Care Unit Patients: Early Mobility Interventions and Associated Outcome Measures

Critical illness survivors have impairments across physical, psychological, and cognitive health domains known as post-intensive care syndrome. Although physical activity can improve outcomes across all health domains, most intensive care unit early mobility studies focus solely on physical outcomes. To explore the role of early mobility for adult patients in the intensive care unit by analyzing early mobility intervention studies with physical, psychological, or cognitive outcome measures. This integrative review used Whittemore and Knafl's methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, Embase, PubMed, PsycINFO, and Scopus databases were searched for primary research articles published from 2005 through 2021 on adult intensive care unit early mobility interventions evaluated by physical, cognitive, or psychological outcome measures during or after intervention delivery. Interventions comprising only passive mobility were excluded. Of 1009 articles screened, 20 were included. Variations in outcome measures, measurement timing, instruments, and control groups made synthesis difficult. No study evaluated an intervention using outcome measures from all 3 health domains. Five studies measured physical and cognitive outcomes; 6 studies measured physical and psychological outcomes. Early mobility is primarily addressed objectively and unidimensionally, limiting understanding of the implications of early mobility for patients. Post-intensive care syndrome prevention begins in the intensive care unit; early mobility is a promising intervention for targeting multiple risk factors. Studies that measure outcomes in all health domains during or after early mobility are needed to better evaluate the comprehensive effects of early mobility.

Precision medicine for infants with BPD: A baby step forward

Although many studies have sought strategies to prevent BPD, there is relatively little evidence on how best to treat BPD once it is established. The use of inhaled bronchodilators remains controversial: although they are commonly used due to their theoretical benefit of dilating small airways with muscular hypertrophy, it is not clear which babies benefit and how consistent and durable that benefit is. The problem is further compounded by a lack of bedside measurements to easily and objectively assess the degree of their physiologic effect.

A Step Forward for Smart Clothes─Fabric-Based Microfluidic Sensors for Wearable Health Monitoring.

We report the first demonstration of fabric-based microfluidics for wearable sensing. A new technology to develop microfluidics on fabrics, as a part of an undergarment, is described here. Compared to conventional microfluidics from polydimethylsiloxane, fabric-based microfluidics are simple to make, robust, and suitable for efficient sweat delivery. Specifically, acrylonitrile butadiene styrene (ABS) films with precut microfluidic patterns were infused through fabrics to form hydrophobic areas in a specially controlled sandwich structure. Experimental tests and simulations confirmed the sweat delivery efficiency of the microfluidics. Electrodes were screen-printed onto the fabric-based microfluidic. A novel wearable potentiometer based on Arduino was also developed as the transducer and signal readouts, which was low-cost, standardized, open-source, and capable of wireless data transfer. We applied the sensor system as a standalone or as a module of a T-shirt to quantify [Ca2+] in a wearer's sweat, with physiological and accurate results generated. Overall, this work represents a critical step in turning regular undergarments into biochemically smart platforms for health monitoring, which will broadly benefit human healthcare.

Continuous monitoring of neonatal cortical activity: A major step forward

Montazeri Moghadam etal.1 report an automated algorithm to visually convert EEG recordings to real-time quantified interpretations of EEG in neonates. The resulting measure of the brain state of the newborn (BSN) bridges several gaps in neurocritical care monitoring.

Toward Understanding Cardiovascular Risk Burden in South Asians: A Major Step Forward.

Toward Understanding Cardiovascular Risk Burden in South Asians: A Major Step Forward.

Integrating Real Tree Skeleton Reconstruction Based on Partial Computational Virtual Measurement (CVM) with Actual Forest Scenario Rendering: A Solid Step Forward for the Realization of the Digital Twins of Trees and Forests

Digital twins of forests (trees) are computational virtual recreations of forests (trees) in which the entity distributions and physical processes in real-world forests (trees) are duplicated. It is expected that conventional forest science and management can be undertaken in a digital twin of forests (trees) if the recreation of a real-world forest (tree) has accurate and comprehensive enough information. However, due to the various differences between the current tree model and the real tree, these envisioned digital twins of the forests (trees) stay a theoretical concept. In this study, we developed a processing strategy that partially integrated computational virtual measurement (CVM) process into the tree modeling workflow. Owing to the feature of CVM, partial tree skeleton reconstruction procedures were considered to have higher mechanical objectivity compared to conventional mathematical modeling methods. The reason was that we developed a novel method called virtual diameter tape (VDT), which could provide a certain percentage of modeling elements using CVM. Technically, VDT was able to virtually measure diameters and spatial distribution of cross-sectional area of trees, including the basal area, from point clouds. VDT simulated the physical scenario of diameter tapes, observing point clouds of trees. Diameter and the cross-sectional area of stem and branches were obtained by two consecutive physical measurement processes, one in the forest sample site and another in the virtual space. At the same time, VDT obtained better or a similar accuracy compared to the mathematical methods, i.e., Hough transform-based methods, using the same data sets. The root-mean-square deviation (RMSE) of retrieval of diameter at breast height (DBH) using VDT was 1.02 cm, while DBH obtained from three conventional methods varied from 1.29 cm to 1.73 cm. Based on VDT measurement results, tree skeleton reconstruction and actual forest scenario rendering of our sample plots were further implemented. Beyond the visual consistency, we believe that our work might be a small and solid step in the technological evolution from tree models to the digital twin of forests (trees).

Mental health nurses at GP practices: a step forward

Mental health nurses at GP practices: a step forward