Using the Canonical Correlation Analysis Method to Study Students’ Levels in Face-to-Face and Online Education in Jordan

The study aims to identify the existing correlations between the two sets of variables by finding the linear combinations of the two sets of variables with the highest correlation and test the strength of the relationship between the levels of students face-to-face education and online business students at Al-Balqa Applied University by using the canonical correlation test, The study was applied to a sample of students from Al-Balqa Applied University, specifically the faculty of Business, and for the purposes of analysis and extraction of results, (SPSS ver.26), and (Stata graphics ver.11) programs were used. The study reached the following results the first, second, and third Canonical correlations are statistically significant at the level of significance (α ≤ 0.05), and the first, second, and third canonical correlation between canonical variables independents and dependents is equal (0.98, 0.965, 0.907) respectively, and the variance explained between independent and dependent canonical variable is equal (93.24%, 4.7%, 2.047%) for first, second, and third Canonical correlations respectively. The study recommends using the canonical correlation to evaluate Jordans experience in online education in schools and universities

Massive pulmonary embolism in patients with extreme bleeding risk: a case series on the successful use of ultrasound-assisted, catheter directed thrombolysis in a district general hospital

This is the final version. Available from the publisher via the DOI in this record.Massive pulmonary embolism (PE), characterised by profound arterial hypotension, is a life-threatening emergency with a 90-day mortality of over 50%. Systemic thrombolysis can signifcantly reduce the risk of death or cardiovascular collapse in these patients, by around 50%, but these benefts are ofset by a fvefold increased risk of intracranial haemorrhage and major bleeding, which may limit its use in patients at high risk of catastrophic haemorrhage. We describe a case series of 3 patients presenting with massive PE, each with extreme risk of bleeding and contra-indication to systemic thrombolysis, treated successfully with ultrasound-assisted, catheter directed thrombolysis (U-ACDT). Our experience of this novel technique using the EkoSonic Endovascular System (Ekos, BTG, London, UK) on carefully selected patients has demonstrated the potential to improve clinical status in shocked patients, with minimal bleed risk. There have been several clinical studies evaluating the Ekos system. Both the ULTIMA and SEATTLE II studies have shown signifcant reductions in RV/LV ratio by CT scanning when compared to standard anticoagulation in patients with intermediate-risk PE, with minimal bleeding complications. However, there is a pressing need for a randomised trial demonstrating improvement in robust clinical outcomes when comparing U-ACDT to simple anticoagulation. We believe that this case series adds new insight and highlights the potential of catheter directed thrombolysis in this high-risk patient cohort and consideration should be made to its use in cases where systemic thrombolysis is felt to be too high ris

Proactive risk assessment of vincristine use process in a teaching and referral hospital in Kenya

Background: The chemotherapy use process is considered as potentially risky for cancer patients due to its complex process, use of agents with narrow therapeutic indeces, multiple drug use and use of potentially toxic compounds adding to morbidity and mortality for patients with cancer. Vincristine, a "High Alert" medicine, has been associated with fatal but preventable medication errors. Objective: To determine hazards associated with vincristine use process by performing proactive risk assessments using Healthcare Failure Mode Effect Analysis (HFMEA). Methods: A multidisciplinary health team identified and evaluated potential failure modes based on vincristine use process flow diagram using a hazard scoring matrix in a leading referral hospital in Kenya treating patients with cancer. The hazard score matrix was based on the published literature. Failure modes were prioritized using decision tree analysis in which recommendations to counteract the risks were determined. Results: The processes evaluated were; prescribing, preparation and dispensing, transportation and storage, administration and monitoring of use. A total of 77 failure modes were identified over the 3 months period of the study, April to June 2017, of which 25 were classified as high risk. Thirteen were adequately covered by existing control measures while the other 12 required the development of mitigation strategies. Two of the 12 failure modes were single-point weaknesses. Conclusions: Multiple medication errors, some with serious consequences, can occur at each stage of the chemotherapy use process making it a high-risk process. HFMEA is a useful tool to identify improvements to medication safety and reduce patient harm. The HFMEA process brings together the multidisciplinary team involved in patient care in actively identifying potential failure modes and therefore owning the recommendations made. This is now being followed up

Development of a web-based application to improve data collection for antimicrobial point prevalence surveys in the public health care system in South Africa; findings and implications

Background: Surveillance of antimicrobial use is one of the main recommended strategies in combating growing antimicrobial resistance (AMR) rates and a key part of developing pertinent policies and initiatives to reduce growing AMR rates in South Africa and wider. However, determining antimicrobial utilisation at a patient-level among public hospitals in South Africa can be a challenge given personnel and resource constraints. There are also currently no standardized data collection tools. Most countries in Africa currently undertake antimicrobial utilisation surveillance using paper-based data collection tools including point prevalence surveys (PPS). Unfortunately, paper-based systems have disadvantages including the time taken to complete the forms and analyse the findings, increasing costs and manpower hurdles. Electronic tools offer many advantages including mobile and real time data collection and also the opportunity for rapid analytics. Objectives: Develop and test a web-based application (APP) for future PPS studies to successfully address identified challenges. Methods: A web based application (APP) was developed based on previous PPS in Botswana and South Africa using a paper-based data collection tool and tested during July 2017 in a leading public hospital in South Africa. The developed APP was also evaluated for data quality by measuring the number of errors, work flow, and time taken for the survey versus the previous paper-based system. User acceptance was also measured via a questionnaire to the data collectors. Results: A total of 187 patients' files were surveyed in this leading hospital using the APP whilst also documenting the challenges and areas of improvement for the APP. The identified areas of improvement have now been incorporated into the revised APP for future studies. The data collectors agreed that surveying the patients' files took appreciably less time with the APP compared to the paper based tool, and should be used in the future. In addition, data analysis was hastened using the APP. Conclusions: The APP development process has been successful and the APP is a potential tool for future PPS in South Africa and wider. The APP methodology is now being tested in new studies across South Africa to help instigate pertinent educational and other interventions to improve the future use of antimicrobials among public hospitals in South Africa

Activities across Africa to improve antimicrobial utilisation and reduce AMR

There are concerns with current prescribing and dispensing of antimicrobials in Africa. Point prevalence studies in hospitals shown variable rates with high rates HIV in some. Variable ASPs, extended prophylaxis and high rates self purchasing in some

The seed laser system of the FERMI free-electron laser: design, performance and near future upgrades

Abstract An important trend in extreme ultraviolet and soft X-ray free-electron laser (FEL) development in recent years has been the use of seeding by an external laser, aimed to improve the coherence and stability of the generated pulses. The high-gain harmonic generation seeding technique was first implemented at FERMI and provided FEL radiation with high coherence as well as intensity and wavelength stability comparable to table-top ultrafast lasers. At FERMI, the seed laser has another very important function: it is the source of external laser pulses used in pump–probe experiments allowing one to achieve a record-low timing jitter. This paper describes the design, performance and operational modes of the FERMI seed laser in both single- and double-cascade schemes. In addition, the planned upgrade of the system to meet the challenges of the upgrade to echo-enabled harmonic generation mode is presented

Optimizing quality and efficiency of respiratory medicines in Scotland

Increasing prevalence of asthma and COPD has increased use of long acting inhalers. Different inhalers with patented delivery systems have kept costs high and inhalers among the highest expenditure items in ambulatory care in Scotland. There was a 136.8% increase in their utilisation between 2001 - 2017 alongside a 195.7% increase in expenditure. This is being addressed with brande

Recent initiatives in the Republic of Srpska to enhance appropriate use of antibiotics in ambulatory care : their influence and implications

Introduction:There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilisation principally assessed according to ESAC, ECDC and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as versus neighbouring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 DIDs to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighbouring countries. Amoxicillin and the penicillins accounted for 29%-40% and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7% - 11%), cephalosporins, macrolides and quinolones, as well as low use of third and fourth generation cephalosporins versus first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilisation of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilisation of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities

Cost Effectiveness Analysis (CEA) Program Pengelolaan Penyakit Kronis (PROLANIS) Diabetes Melitus Tipe 2 Peserta JKN di Kota Serang Banten

Data BPJS Kesehatan menunjukkan  terjadi kenaikan jumlah penderita DM peserta JKN yang berkunjung ke Rumah Sakit sebesar 40% pada tahun 2015 dibandingkan tahun sebelumnya, sementara kenaikan Biaya yang dikeluarkan untuk penyakit DM dan komplikasinya sebesar 41%. Salah satu upaya BPJS Kesehatan untuk mengendalikan penyakit DM dan komplikasinya adalah melaksanakan program pengelolaan penyakit kronis (PROLANIS). Tujuan dari studi ini adalah untuk melakukan analisa efektivitas biaya antara PROLANIS dengan Non PROLANIS menggunakan pendekatan cross sectional design. Penelitian ini membandingkan 21 pasien DM Tipe 2 yang mengikuti PROLANIS dan 85 pasien Non PROLANIS di RSUD dr. Drajat Prawira  Serang Banten. Kualitas hidup pasien diukur menggunakan kuisoner WHOQOL-BREF. Beban ekonomi untuk biaya langsung medis menggunakan tarif INA CBGs dan biaya lainnya menggunakan kuisoner beban ekonomi. Hasil penelitian ini menunjukkan terjadi perbedaan signifikan (nilai p0,044)antara rata-rata biaya total perawatan setahun DM Tipe 2 yang mengikuti PROLANIS (Rp. 2.405.536,) dibandingkan pasien Non PROLANIS (Rp 4.799.878). Pasien DM Tipe 2 PROLANIS yang memiliki kualitas hidup baik sebesar 61.9% dan pasien Non PROLANIS 25.9%. Analisa bivariat menunjukkan bahwa kualitas hidup pasien PROLANIS terbukti signifikan pada domain hubungan sosial (nilai p 0.03). Terdapat hubungan yang signifikan antara domain hubungan sosial dan lingkungan dengan domain kualitas hidup lainnya pada uji korelasi. PROLANIS lebih cost efektif dibandingkan Non PROLANIS dengan nilai ICER adalah Rp.625.155,- untuk setiap ekstra domain hubungan sosial  lebih baik dan Rp 969.369,- untuk setiap ekstra domain lingkungan lebih baik serta dominan untuk biaya dan kualitas hidup pada CE Plane