Interaction and cognitive engagement in online discussions in professional development leadership and management course at a private nursing institution

In the Post RN BScN curriculum, one of the courses “Professional Development and Leadership (PDLM)” was offered as blended mode for the first time. In order to explore the students’ interactions and Cognitive Engagement (CE) in Online Discussion Forums (ODFs), the research team conducted a retrospective study for the first time at a private nursing institution of Karachi-Pakistan. The study was conducted by utilizing the retrospective qualitative paradigm of discourse analysis to understand student’s CE in ODFs. The study has addressed the following one main and three subsidiary research questions: How do threaded discussions (in the part of online forums) enable or hinder the student’s level of cognitive engagement in a blended learning course (PDLM course)? All the course enrollees were invited to participate in the study; 24 of 81 students provided the written consent to participate in the study. The participants of the research study were both males and females; of which males were (20.8%) whereas females were (79.2%). However, only (92.3%) of the participants’ completed the Online Monkey Survey tool for demographic details. The data was collected after the university’s ethical review committee’s clearance. The scripts of ODFs from two online modules (named as Module A & B) were used for this study, which were triangulated through Focus Group Discussions (FGDs). The researcher used discourse analysis to explore the interrelations between words and the context in which the words are used. This assisted in establishing the links to determine the patterns of interaction and the levels of CE of the learners. Levels and categories of CE defined by Zhu (2006) were used as a guideline for discourse analysis of the discussion forums of two modules. Categories were assigned various levels to understand the specific kinds of interactions as explained within the selected analytical framework. The categories and levels include question type I and II, statements type I-VI, reflection type I and II, mentoring and scaffolding. It is observed from the results that majority of the participants used statements type I which is responding to the direct questions, whereas, seeking clarifications (either question type I or II) was not much observed. Mentoring and Scaffolding are higher levels of CE, however, only less number of responses observed in both the modules A and B. Moreover, study participants reported high level of engagement with the positive role of faculty facilitation and felt more comfortable in participating through a virtual learning environment. It was recommended to set netiquettes, to have sound training to those learners whose ICT skills need improvement and to consider in-depth key informant interviews with each research participant soon after they posted a comment on ODF, will bring more insight in understanding CE

Discrimination Indices for Diagnosis of Beta(β) Thalassemia Trait

Background: To determine the reliability ofhematological indices and derived formulas indiagnosing beta thalassemia trait.Methods: In this observational cohort study,patients diagnosed as beta thalassaemia minor wereincluded. All hematological indices wererecorded.Haemoglobin electrophoresis wasperformed using capillarys 2 flex piercing system.An HbA2 value > 3.5% was considered as a cut-offpoint for beta-thalassemia trait. Fourteenhaematological indices were then applied accordingto the formulae and cut off values. Percentage ofpositive cases accurately identified along with themean, median and mode were calculated for eachdiscrimination index.Results: The study cohort constituted of total 493patients, out of which 246 (49.9%) were male and 247(50.1%) were females. The mean age of all thepatients was 20.34 +12.835, with range of 6-50 years.The mean haemoglobin level of all patients was10.82+1.64 and ranged between 4.60 and 16.30. A redblood cell count more than 4.9 X 10 12/l and a MCHless that 25 pg were the most consistent findings.Srivastava index was more near to predicting betathalassaemia minor .Conclusion: Red cell indices and discriminationfactors have a potential utility in screening for βthalassaemia trait , keeping in view their sensitivityand specificit

Outcome & Complications of Decompressive Craniectomy with Expansion Duroplasty in Severe Head Injury

Objective:  A descriptive case series was conducted to find the frequency of complications and complications of decompressive craniectomy with expansion duraplasty in severe head injury. Material and Methods:  189 patients fulfilling the selection criteria were included. All patients had TBI which was confirmed by CT scan. Surgery was performed on the day of admission under general anesthesia and a large trauma flap. Patients were monitored daily by evaluators from the date of surgery until hospital discharge or death. Patients were followed up for 3 months and the outcome was assessed using the Glasgow outcome scale (GOS). Results:  Mean age of the patients was 36.57 years. There were 61.4% (116) males and 38.6% (73) females. 3.7% had CSF leakage. 1.6% had meningitis. Wound infection was seen in 7.4% of patients. Forty percent had a favorable outcome and 60% had a poor outcome. Fifty patients out of 111 patients between 18 – 40 years showed good outcomes. Twenty-six out of 78 from the 41 – 60 years age group showed good outcomes. Out of 189 total, 76 patients had a good outcome. The outcome was good in 63 patients out of 148 patients with GCS 5 – 8, whereas 13 (out of 41) patients had a good outcome with GCS below 5. Conclusion:  We discovered that the result was good in 40% of patients, with 11 percent of complications recorded. Therefore, we concluded that decompressive craniectomy with expansion duraplasty is an effective procedure for the treatment of the severe head injury

Hyperhomocysteinemia - An unidentified risk factor for stroke in our population

Introduction: Various studies show that moderate elevation of plasma homocysteine level has been associated with increased risk for cardiovascular and cerebrovascular disease. Objective: To observe the frequency of increased homocysteine level in ischemic stroke patients; and its association with other risk factors. Methodology: Observational pilot study was conducted on a sample of 75 ischemic stroke patients, enrolled regardless of their age, gender and comorbidities, at Ziauddin university hospital, Karachi. Fasting serum homocysteine, folate and vitamin B12 levels were measured. Results were interpreted using spss 20.0. Results and Discussion: Mean homocysteine level in our population was 19.51 (SD: 11.47)micromol/l. It was higher in groups with vitamin B12 and folic acid deficiency, difference being statistically significant (p=0.013 and 0.017, respectively). Males had greater propensity to hyperhomocysteinemia; the mean homocysteine value being higher, and the difference, statistically significant (p=0.010). Other factors that affect homocysteine levels were also evaluated, that is hypertension, increased cholesterol levels and smoking. There was no significant statistical difference in the homocysteine value between the groups of patients who had these risk factors and the groups that did not (p=0.747, 0.252 and 0.565, respectively). Conclusion: It was speculated that hyperhomocysteinemia is an imperative risk factor for stroke

Sound Waves in Complex (Dusty) Plasmas

Wave properties of strongly coupled complex dusty (SCCD) plasmas evaluated using the equilibrium molecular dynamics (EMD) simulation technique. In this work, the plasma normalized longitudinal current correlation function CL(k,t) and transverse current CT(k,t) are calculated for a large range of plasma parameters of Coulomb coupling parameter (Γ) and screening strength (κ) with varying wave’s number (k). In EMD simulations, we have analysed different modes of wave propagation in SCCD plasmas with increasing and decreasing sequences of different combinations of plasmas parameters (κ, Γ) at varying simulation time step (Δt). Our simulation results show that the fluctuation of waves increases with an increase of Γ and decreases with increasing κ. Additional test shows that the presented results for waves are slightly dependent on number of particles (N). The amplitude and time period of CL(k,t) and CT(k,t) also depend on different influenced parameters of κ, Γ, k and N. The new results obtained through the presented EMD method for complex dusty plasma discussed and compared with earlier simulation results based on different numerical methods. It is demonstrated that the presented model is the best tool for estimating the behaviour of waves in strongly coupled complex system (dusty plasmas) over a suitable range of parameters

Women experiences of using external breast prosthesis after mastectomy.

Objective: The aim of this study was to identify the experiences of breast cancer patients using external breast prostheses (EBP) in the context of the Pakistani society. Methods: A qualitative descriptive exploratory design was used in the study. In-depth individual interviews were conducted with 15 postmastectomy women using EBP. A semi-structured interview guide with open-ended questions was used for the interviews. The analysis of the data was organized into four categories according to the study questions including reasons for using EBP, feeling about EBP, challenges for using EBP, and coping with lost breast. Each category was further divided into subcategories. Results: Women used EBP because they felt strange, incomplete, and embarrassed in front of other people, due to the asymmetrical shape of the chest after mastectomy. They faced several challenges with regard to obtaining and using the EBP. While EBP was used as an alternative of their lost breast, they experienced sadness and embarrassment. They found it challenging to take care of the EBP and were required to make changes in their lifestyle. However, they accepted living with their lost breast, either through rationalization, family support, or faith and prayers, which helped them to cope. Conclusions: The study findings have given insight into some real experiences of mastectomy patients. Mastectomy not only affects women\u27s physical health but also their psychological health, as a result of which they become reluctant to socialize. Using EBP can help them to improve their body image and body posture. Health-care providers\u27 support is very important to the families of the patients specifically where patients are very shy to openly seek information due to cultural constraints

Fat embolism syndrome: a case series and review of literature

Fat embolism and fat embolism syndrome (FES) is a clinical spectrum characterized by dissemination of fat emboli into the systematic circulation usually as a result of orthopedic trauma and related surgical procedures. we present a case series of three patients who had FES of variable presentation and severity. In our first case patient initially developed FES pre operatively which was complicated by acute pulmonary thromboembolism in the post operative period. In our third case patient developed FES after intra medullary nail fixation of femoral shaft fracture. Fat embolism is relatively rare but fatal complication in orthopedic trauma and during long bone fracture manipulations. In addition, fat embolism is a risk factor for pulmonary thromboembolism as was evident in our first case. So, patients of fat embolism should be closely monitored for the later. Gurd and Wilson are the most commonly used criteria for the diagnosis of FES. Treatment is largely supportive and some preventive measures include early fixation of long bone fractures. Prophylactic use of steroids in a meta-analysis has been found to prevent occurrence of FES in nearly two third of patients. There is no proven role of hypertonic dextrose infusion, heparin or corticosteroids in the treatment of FES and therefore are not routinely recommended. In case of fulminant FES steroids should be considered

Cushing's ulcer: Further reflections

BACKGROUND: Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve. As a result, increased secretion of gastric acid may occur which leads to gastro-duodenal ulcer formation known as Cushing's ulcer. METHODS: A review of original records of Dr. Harvey Cushing's patients suffering from gastro-duodenal ulcers was performed followed by a discussion of the available literature. We also reviewed the clinical records of the patients never reported by Cushing to gain his perspective in describing this phenomenon. Dr. Cushing was intrigued to investigate gastro-duodenal ulcers as he lost patients to acute gastrointestinal perforations following successful brain tumor operations. It is indeed ironic that Harvey Cushing developed a gastro-duodenal ulcer in his later years with failing health. RESULTS: Clinically shown by Cushing's Yale Registry, a tumor or lesion can disrupt this circuitry, leading to gastroduodenal ulceration. Cushing said that it was "reasonable to believe that the perforations following posterior fossa cerebellar operations were produced in like fashion by an irritative disturbance either of fiber tracts or vagal centers in the brain stem." CONCLUSION: Harvey Cushing's pioneering work depicted in his Yale registry serves as a milestone for continuing research that can further discern this pathway