Critical-Sized Bone Defects: Sequence and Planning.

Bone defects associated with open fractures require a careful approach and planning. At initial presentation, an emergent irrigation and debridement is required. Immediate definitive fixation is frequently safe, with the exception of those injuries that normally require staged management or very severe type IIIB and IIIC injuries. Traumatic wounds that can be approximated primarily should be closed at the time of initial presentation. Wounds that cannot be closed should have a negative pressure wound therapy dressing applied. The need for subsequent debridements remains a clinical judgment, but all nonviable tissue should be removed before definitive coverage. Cefazolin remains the standard of care for all open fractures, and type III injuries also require gram-negative coverage. Both induced membrane technique with staged bone grafting and distraction osteogenesis are excellent options for bony reconstruction. Soft tissue coverage within 1 week of injury seems critical

COMMUNICATIVE ASPECTS OF MULTILINGUAL CODE SWITCHING IN COMPUTER-MEDIATED COMMUNICATION

The quintessential role of language has been punctiliously studied relative to intercultural communication, cultural heritage, social development, education, identity construction and many more domains. One forum wherein language is investigated is the Computer-mediated Communication (CMC) which provides a fertile ground for linguistic and sociolinguistic analyses. The present study aims at investigating the preferred codes used in code switching (CS), functions of CS, and the motives of users for employing CS in CMC. The present study was based on the investigation of 200 status updates and 100 wall posts of 50 Facebook accounts of students who are enrolled in a leading state university in Mindanao and professionals who graduated from the same university. Besides English and Filipino, these Facebook users speak various regional languages such as Chavacano, Cebuano, and Tausug. Their posts were analyzed employing eclectic approaches in analyzing inter-sentential and intra-sentential code switching. The findings reveal that the preferred code in their online communication is Taglish. It implies that Taglish is an equalizer, non-privileging, non-discriminating, and more unifying. The primary reason for CS is because of real lexical need. Besides the given categories, the study determined four other reasons for CS, namely: to express ideas spontaneously, to retain native terminology, to express disappointment, and to promote relationship. The findings vouch for the viability of regional languages to co-exist with English and other languages in the gamut of human interactions in the internet

Behavioural Interventions delivered to people in Rural areas via Telehealth: A narrative systematic review of studies from the last 12 years

People who live in rural areas have historically experienced a disparity when receiving behavioural health services. Specialty treatment providers are often located in cities and require people who need help to travel great distances. The recent advent of COVID 19 has highlighted this issue but has also pushed forward the necessity of developing alternative means of service delivery which can be beneficial for people in rural areas. One such alternative is telehealth, which utilises telecommunications technologies in place of traditional media. Clients could receive much needed treatment via synchronous telehealth using videoconferencing technology, asynchronous telehealth, which could be an effective consultation tool, patient monitoring with the help of fitness trackers or diaries and mobile health which makes use of applications on mobile devices. This review seeks to answer the following questions: A.) What behavioural interventions are currently being adapted to be delivered via telehealth to people in rural areas? B.) What types and methods of telehealth delivery is most used? C.) How effectively are these interventions being applied? D.) What elements make them effective? E.) What are the challenges of delivering ABA interventions via telehealth technologies to rural areas? F.) What solutions have the studies presented to overcome these challenges

Investigation on Tourism Trends Using K-means Clustering and Regression Analysis

Purpose: The purpose of this study was to analyze tourism trends by determining the clusters of tourists based on common factors. Three (3) characteristics were explored using k-means clustering namely tourists’ demographics, travel patterns and travel preferences. These clusters were based on individual’s age, gender, country of origin, frequency of travel, travel destinations and seasons. Regression analysis was also performed to determine the factors that influence the length of stay of tourists in their travel destinations. Methodology: This research conducted a survey from 150 respondents of different age groups, gender, and nationalities. Frequency of travel in a year, length of stay per travel, seasons, destinations, purpose of travel and preferred booking method were the parameters inquired in the survey. The collected dataset was utilized to characterize the clusters of tourists with common considerations. Additionally, regression analysis was used to forecast predictors influencing tourists’ length of stay. Findings: Three (3) parameters were considered in performing k-means clustering such as tourists’ demographic profiles, travel patterns and preferences. Regression analysis likewise was employed to predict visitors’ length of stay using age, gender, purpose of travel, travel season, and preferred destination as independent variables. In participants’ demographics, number of clusters generated was k=5. Gender and nationalities were found to be randomly clustered while other parameters were categorized according to various age groups and frequency of travel. Consequently, for tourists’ travel patterns, age, gender, country of origin, frequency of stay, purpose of travel, length of stay and travel seasons were used as parameters. The elbow method knee-point revealed (k=6) as the optimal number of clusters. Moreover, travel preferences parameter was also considered for clustering where predictors like gender, age, country of origin, frequency of travel, purpose of travel, travel season and length of stay were utilized. The optimal number of clusters for this category generated K=5. Regression analysis revealed gender, age and purpose of travel as significant factors influencing tourists’ average length of stay. The combination of these variables generated the lowest value of MSE=0.64. Research limitations/implications: A limited dataset of 150 respondents mainly from Asia and Middle East were utilized in performing preliminary initiatives in analyzing tourism trends. The predictors used in the analysis were restricted to gender, age, country of origin, travel frequency, length of stay, travel season and travel destinations. Supplementary parameters ca be considered in a big data setting for similar studies in the future. K-means clustering was selected among other algorithms with attributes commonality while regression analysis was employed to determine the factors influencing tourists’ length of stay in their destinations. Social Implications: Results of this study will greatly support individual tourists in determining trends in various travel destinations. Similarly, business owners gain benefit forecasting travellers’ requirements such as accommodation, food, services, etc. Research findings likewise provide informed decisions for stakeholders Originality / Value: The dataset used were participants from different countries and nationalities which include Philippines, Saudi Arabia, United Arab Emirates, Oman, USA, Portugal, Germany, Malaysia, Thailand, Qatar, Finland, Denmark, Spain Taiwan, South Korea, Singapore, Australia, Austria, England, UK, India and China. The presented codes were programmed in python where analyses and interpretations were based on formulated objectives. K-means clustering, and regression analysis were both employed to present varied clusters according to tourists’ demographic profiles, travel patterns and preferences. Different factors were identified and used to predict tourists’ length of stay in their preferred destinations

Transitioning experiences of middle-level nurse managers in Iloilo City

Abstract onlyThe nursing profession had been responsive to transition and the changing technological and social forces. Nurse Managers are one of the organization’s significant members. They are the one who plans, organize, direct and control the activities of the organization. Transitioning can cause different concern in an individual because there will be changes in the job that he or she is performing. Hence, this study aimed to understand the different experiences and to elucidate those experiences that the nurse managers had faced in their transition from first level management to middle-level management. The participants were chosen purposively and saturation principles were applied in which six participants who are in the middle-level management position were interviewed. Data were analyzed using the Colazzi's descriptive phenomenological strategy and computerized qualitative data management program to categorize and discern patterns. In-depth interview was used to collect data. All interviews were audio taped and transcribed by the researcher. There were four major themes that emerged. These Major Themes are: 1. There are Trials in Transitioning; 2. There are Negative Effects in Transitioning; 3. There are Positive Effects in Transitioning; and, 4. Transitioning is Challenging. These experiences are true to themselves who have experienced such phenomenon. These findings cannot be generalized to all nurse managers who transitioned from first level going to middle-level management. The identified themes formed the basis for the formulation of recommendation guidelines on transitioning experience of middle-level nurse managers. It was recommended that they may consider hiring professionals that could help their middle-level nurse managers that oversees and gives an update of the current trends in management of people, time and resources. They may formulate or create a committee that help and control those situations that gave difficulty to their nurse managers. They may help them by having a proper orientation to the different nurse managers before they assume their position. They may conduct certain seminars and workshops that cater the conflicts and struggles within the organization. They may also provide team building activities for their staff and nurse managers to improve their interaction with each other. The Middle-Level Nurse Managers and Staff Nurses may help themselves by engaging in activities that would continually develop their knowledge, skills and attitude. These activities may include attending in trainings, workshops, research forums or by having a formal continuing professional education like going back to school. Lastly, this study may be used as basis for other studies to help us understand more of the transitioning experiences that different person especially middle-level nurse managers are going through.Includes bibliographic referencesMaster of Arts in Nursin

Monitoring and evaluation case studies of the Academy of ICT Essentials for Government Leaders

The rapid uptake of the Academy programme across Asia and the Pacific region called for a comprehensive and streamlined approach to monitoring and evaluating the progress and achievements of the Academy programme, so as to better manage outputs and outcomes and improve future programme implementation. In response to this need, APCICT developed a Monitoring and Evaluation (M&amp;E) framework in 2010, and subsequently, the Academy M&amp;E Toolkit in 2013. The Toolkit aims to provide national and sub-regional partners with practical, step-by-step guidelines for monitoring and evaluating the Academy programme by helping the partners map out, customize and strengthen M&amp;E plans and systems in their organizations. The &lsquo;M&amp;E Case Studies&rsquo;, the latest addition to M&amp;E resources for the Academy, represents continued efforts by APCICT to enhance monitoring and evaluation of the Academy programme and improve its delivery at the national level. It documents the field testing experience of the M&amp;E Toolkit by partners implementing the Academy programme in Indonesia, the Philippines, and Tajikistan. The field tests were undertaken by select implementing partners to assess the practical application of the Toolkit at the national level. Each case study introduces the status of the Academy programme roll-out, key M&amp;E activities undertaken, challenges, and suggested M&amp;E strategies and recommendations in the respective countries. The case study exercise enabled the partners to fine-tune the M&amp;E Toolkit by tailoring it to their own contexts, and to share lessons learned and insights from the field.</p

tRNAdb 2009: compilation of tRNA sequences and tRNA genes

One of the first specialized collections of nucleic acid sequences in life sciences was the ‘compilation of tRNA sequences and sequences of tRNA genes’ (http://www.trna.uni-bayreuth.de). Here, an updated and completely restructured version of this compilation is presented (http://trnadb.bioinf.uni-leipzig.de). The new database, tRNAdb, is hosted and maintained in cooperation between the universities of Leipzig, Marburg, and Strasbourg. Reimplemented as a relational database, tRNAdb will be updated periodically and is searchable in a highly flexible and user-friendly way. Currently, it contains more than 12 000 tRNA genes, classified into families according to amino acid specificity. Furthermore, the implementation of the NCBI taxonomy tree facilitates phylogeny-related queries. The database provides various services including graphical representations of tRNA secondary structures, a customizable output of aligned or un-aligned sequences with a variety of individual and combinable search criteria, as well as the construction of consensus sequences for any selected set of tRNAs