Impact of a Disaster Educational Program on Knowledge and Practices of Teachers among Primary Governmental Schools, Cairo Governorate

Disaster is an extreme event that causes loss of life, property, essential services and means of livelihood. Aim of this study; was to assess the impact of a disaster educational program on knowledge and practices of teachers. Research design; A (pre-post) quasi-experimental design was adopted in this research. Setting; the study was conducted at three primary governmental schools in Cairo governorate. Three educational departments were assigned randomly from total thirty two departments. One school from each educational department was selected randomly (3 schools). These schools were El-Sayida Sakina, Ahmed Lotfy El-Said and El-Kasr Elaini primary governmental schools. The study sample; consisted of 50 teachers were included from three selected school in the research. Teachers number was; 17 teachers in El-Sayida Sakina School, 18 teachers in Ahmed Lotfy El-Said school and 15 in El-Kasr Elaini. Tools for data collection; three tools were used in this study; 1) Demographic characteristics for teachers; 2) Pre/ post knowledge questionnaire sheet. 3) Pre/post observational checklist. Study results; results revealed that, 70 % of teachers were females, 54% aged from 35-55 years.  Nearly all teachers (94%) didn't have any experience in disaster management before the educational program compared to less than half (42%) of the teachers who had unsatisfactory knowledge about disaster management. While 96%, 100% respectively had good knowledge scores about disaster management immediately and 2 months after the educational program. Regarding to teacher's practices, 100% and 84% had good practice scores immediately and 2 months after the educational program respectively while 90% had unsatisfactory practice scores about disaster management before the educational program. A highly statistically significance differences were found between all practice subscales about dealing with injured personnel in disaster among teachers before, immediately and 2 months after the educational program.  The study concluded that, educational program implicated changes in teaches' knowledge, and practices regarding disaster management in primary governmental schools. The study recommended periodic training programs for teachers in primary governmental schools Key words: Teachers, disaster management, primary governmental school

A calcineurin–Hoxb13 axis regulates growth mode of mammalian cardiomyocytes

10.1038/s41586-020-2228-6Nature5827811271-27

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

MRI evaluation of the knee post double bundle ACL reconstruction: Association of graft findings and comparison with arthroscopy

Purpose: To determine the association of graft complications after anterior cruciate ligament reconstruction using double bundle graft by magnetic resonance imaging using arthroscopy/surgery as a gold standard. Patient and methods: A total of 126 patients (130 knees) with complete ACL tears were recruited for this prospective study, and all patients subsequently underwent an MRI examination to evaluate graft integrity and signal intensity. Results: Out of 130 knees with ACL reconstruction, partial tears of the AM bundle were seen in 25 knees (19.2%) and complete tear of the AM bundle was seen in 26 (20%). Partial tears of the PL bundle were seen in 35 knees (26.9%), and complete tears of the PL bundle in 31 knees (23.8%). These patients’ signs of instability were noted in 2 patients with partial tear of PL bundle and in 9 patients with complete tear of PL bundle. Conclusion: Increased signal intensity within the anteromedial or posterolateral bundles of a double bundle ACL reconstruction is frequently associated with a partial tear. Impingement of the anteromedial graft is frequently associated with partial tear and increased signal intensity which is proved by arthroscopy/surgery. A low incidence of other complications is seen

Mixture model in high-order statistics for peak factor estimation on low-rise building

peer reviewedTo design reliable structures, extreme pressures and peak factors are required. In many applications of Wind Engineering, their statistical analysis has to be performed taking into account the non-Gaussianity of the wind pressures. With the increasing precision and sampling frequency of pressure sensors, large short and local peak events are more usually captured. Their relevance is naturally questioned in the context of a structural design. Furthermore, the increasing computational power allows for accumulation and analysis of larger data sets revealing the detailed nature of wind flows around bluff bodies. In particular, in the shear layers and where local vortices form, it is commonly admitted that the Probability Density Function (PDF) of measured pressures might exhibit two or more significant components. These mixed flows can be modelled with mixture models [Cook (2016)]. Whenever several processes coexist, and when one of them is leading in the tail of the statistical distribution, as will be seen next in the context of corner vortices over a flat roof, it is natural to construct the extreme value model with this leading process and not with the mixed observed pressures. It is therefore important to separate the different processes that can be observed in the pressure histories. Once this is done, specific analytical formulations of non-Gaussian peak factors can be used to evaluate the statistics of extreme values [Kareem and Zhao (1994), Chen (2009)]. The separation of mixed processes is usually done by means of the PDF of the signals [Cook (2016)]. This information is of course essential to perform an accurate decomposition but it might be facilitated by considering higher rank information like auto-correlations and higher correlations like the triple or quadruple correlation. Indeed, the two phenomena that need to be separated and identified might be characterized by significantly different timescales, which are not reflected in the PDF. In this paper, the large negative pressures measured on a flat roof are analyzed and decomposed into two elementary processes, namely, the flapping corner vortex and the turbulent flow detaching from the sharp upstream edge. The full paper will finally show that an accurate decomposition of the recorded pressures into their underlying modes provides a more meaningful evaluation of the extreme pressures