Exploring a paperless business administrative system (BAS) implementation in a K-12 school

The primary purpose of this qualitative study was to investigate how a paperless BAS can affect the overall performance of a school’s administrative activities. The research included direct observation, survey questionnaires, document review, and both structured and unstructured interviews. The selected school, a K-12 charter school, was an ideal candidate for this study as it allowed unrestricted access. The effects of the move to a paperless BAS were overwhelmingly positive. These effects included enabling employees to complete their resource requests more speedily and accurately. The implementation also incorporated “smart” forms that did not allow users to submit incomplete forms. Employees were able to track requests, ensuring that objectives were achieved effectively and in a timely manner. Continuous, rapid, and secure access to information allowed stakeholders to make quicker and better-informed decisions. One negative effect was that the user interface required a steep learning curve. Employees expressed concerns about the lack of transparency in the decision to go paperless. Finally, employees from all user groups expressed their desire for more in-depth and frequent training, including periodic refresher courses, not only to keep users abreast of system changes and updates, but also to allow them to continuously hone their skills using the system. Based on the survey data, several recommendations for change emerged. An illustrated system user guide would be an important tool for users. In addition, an online help function, along with a live Help Desk and IT staff, would decrease system issues and delays. Early involvement from stakeholders in the decision to move to a paperless system would improve the “buy-in” from all stakeholders. Future research could investigate whether different training programs yield different results. Additional quantitative research is needed to investigate the return on investment from going paperless. Finally, future research should address other aspects of school operations that could be made paperless

تأثير تعديل النظام الغذائي على تكرار الأعراض الحركية الوعائية عند السيدات في مرحلة سن الحكمة

     تمر المرأة بمرحلة انقطاع الطمث تبدأ بعد سن 45 عاماً، وتتميز بتوقف الدورة الطمثية نتيجة انخفاض إفراز الهرمونات الأنثوية، ويصاحبها العديد من الأعراض مثل الهبات الساخنة والتعرق الليلي واضطرابات النوم والمزاج وآلام الظهر والمفاصل والتعب المزمن، تعتبر الهبات الساخنة من أهم الأعراض خلال هذه المرحلة، ويعتبر انخفاض هرمون الإستروجين هو المسبب الرئيسي لها، ويوجد العديد من طرق العلاج للهبات الساخنة مثل العلاج الهرموني بالإستروجين والبروجسترون، حيث يعتبر الخيار الأكثر فاعلية إلا أنه قد يسبب بعض المضاعفات والآثار الجانبية، لذلك بدأت السيدات بالبحث عن بدائل علاجية آمنة، ويعتبر اتباع تعديل نمط الحياة باتباع نظام غذائي صحي طريقة فعالة، حيث هدفت هذه الدراسة إلى تقييم تأثير تعديل النظام الغذائي على تكرار الهبات الساخنة والتعرق الليلي، حيث أظهرت نتائج الدراسة انخفاض تكرار الأعراض الحركية الوعائية عند السيدات في المجموعة التجريبية اللواتي طبق عليهن تعديل النظام الغذائي بعد ثلاثة أشهر وبشكل هام مقارنةً بالسيدات اللواتي لم يطبق عليهن هذا التعديل في المجموعة الضابطة، وأوصت الدراسة باتباع تعديل النظام الغذائي عند السيدات اللواتي يعانين من الأعراض الحركية الوعائية وإجراء المزيد من الدراسات حول هذا الموضوع وعلى عينات أكبر من السيدات وفترات متابعة أطول

تأثير تعديل النظام الغذائي على تكرار الأعراض الحركية الوعائية عند السيدات في مرحلة سن الحكمة

     تمر المرأة بمرحلة انقطاع الطمث تبدأ بعد سن 45 عاماً، وتتميز بتوقف الدورة الطمثية نتيجة انخفاض إفراز الهرمونات الأنثوية، ويصاحبها العديد من الأعراض مثل الهبات الساخنة والتعرق الليلي واضطرابات النوم والمزاج وآلام الظهر والمفاصل والتعب المزمن، تعتبر الهبات الساخنة من أهم الأعراض خلال هذه المرحلة، ويعتبر انخفاض هرمون الإستروجين هو المسبب الرئيسي لها، ويوجد العديد من طرق العلاج للهبات الساخنة مثل العلاج الهرموني بالإستروجين والبروجسترون، حيث يعتبر الخيار الأكثر فاعلية إلا أنه قد يسبب بعض المضاعفات والآثار الجانبية، لذلك بدأت السيدات بالبحث عن بدائل علاجية آمنة، ويعتبر اتباع تعديل نمط الحياة باتباع نظام غذائي صحي طريقة فعالة، حيث هدفت هذه الدراسة إلى تقييم تأثير تعديل النظام الغذائي على تكرار الهبات الساخنة والتعرق الليلي، حيث أظهرت نتائج الدراسة انخفاض تكرار الأعراض الحركية الوعائية عند السيدات في المجموعة التجريبية اللواتي طبق عليهن تعديل النظام الغذائي بعد ثلاثة أشهر وبشكل هام مقارنةً بالسيدات اللواتي لم يطبق عليهن هذا التعديل في المجموعة الضابطة، وأوصت الدراسة باتباع تعديل النظام الغذائي عند السيدات اللواتي يعانين من الأعراض الحركية الوعائية وإجراء المزيد من الدراسات حول هذا الموضوع وعلى عينات أكبر من السيدات وفترات متابعة أطول

Postoperative Atrial Fibrillation and Flutter in Liver Transplantation: An Important Predictor of Early and Late Morbidity and Mortality

Postoperative atrial fibrillation/flutter (POAF) is the most common perioperative arrhythmia and may be particularly problematic after liver transplantation (LT). This study is a single‐center retrospective analysis of POAF to determine its incidence following LT, to identify risk factors, to assess its impact on clinical outcomes, and to summarize management strategies. The records of all patients who underwent LT between 2010 and 2018 were reviewed. Extracted data included pre‐LT demographics and cardiac evaluation, in‐hospital post‐LT cardiac events, early and late complications, and survival. Among 1011 patients, the incidence of post‐LT POAF was 10%. Using binary logistic regression, pre‐LT history of atrial fibrillation was the strongest predictor of POAF (odds ratio [OR], 6.72; 95% confidence interval [CI], 2.00‐22.57; P < 0.001), followed by history of coronary artery disease (CAD; OR, 2.52; 95% CI, 1.10‐5.81; P = 0.03). Cardiac stress testing abnormality and CAD on cardiac catheterization were also associated with higher risk. Median time to POAF onset after LT was 3 days with 72% of cases resolving within 48 hours. POAF patients had greater hospital length of stay, death during the LT admission, and 90‐day and 1‐year mortality. POAF was an independent risk factor for post‐LT mortality (OR, 2.0; 95% CI, 1.3‐3.0; P < 0.01). Amiodarone was administered to 73% of POAF patients with no evidence of increased serum alanine aminotransferase levels. POAF occurred in 10% of post‐LT patients with early onset and rapid resolution in most affected patients. POAF patients, however, had significant morbidity and mortality, suggesting that POAF is an important marker for worse early and late post‐LT outcomes

Association of Computer Vision Syndrome with Depression/Anxiety among Lebanese Young Adults: The Mediating Effect of Stress.

peer reviewedComputers have become indispensable in daily activities. With this excess use of electronics, computer vision syndrome (CVS), a highly prevalent condition, is associated with various symptoms. Although understanding the relationship between CVS and mental health has been reported, the impact of CVS has not been explored on more than one psychological aspect. We hypothesize that higher CVS symptoms could be associated with higher levels of anxiety and depression, mediated by higher stress. Therefore, the objective of this study was to determine the association between CVS and depression and anxiety among a sample of Lebanese young adults, along with evaluating the mediating effect of stress on these associations. Between August 2020 and April 2021, 749 participants completed an online questionnaire for this cross-sectional study. Females compared to males (Beta = 3.73) and those with CVS compared to those who did not (Beta = 3.14) were significantly associated with more anxiety, whereas having a university level of education compared to secondary or less (Beta = -3.02) was significantly associated with less anxiety. Females compared to males (Beta = 2.55) and those with CVS compared to those without (Beta = 2.61) were significantly associated with more depression, whereas being of an older age (Beta = -0.18) was significantly associated with less depression. Stress partially mediated the association between CVS and anxiety and between CVS and depression. More CVS was significantly associated with more stress (Beta = 3.05). Higher stress was significantly associated with more anxiety (Beta = 0.70) and depression (Beta = 0.71), whereas more CVS was significantly and directly associated with more anxiety (Beta = 3.14) and depression (Beta = 2.61). This study is the first worldwide to evaluate an association between CVS and mental health. Our results serve as a starting point for healthcare providers (psychiatrists and psychologists, most importantly) to look deeper into CVS when looking for reasons behind mental health issues. Further studies are warranted to confirm our results and look for more factors and mediators in such associations

Pre‐Liver Transplant Cardiac Catheterization is Associated with Low Rate of Myocardial Infarction and Cardiac Mortality

Background A previous study at Indiana University demonstrated a reduction in myocardial infarction (MI) incidence with increased frequency of cardiac catheterization (CATH) in liver transplant (LT) candidates. A strict protocol for performing CATH based upon predefined risk factors, rather than non‐invasive testing alone, was applied to a subgroup (2009‐2010) from that study. CATH was followed by percutaneous coronary intervention (PCI) in cases of significant coronary artery disease (CAD; ≥50% stenosis). The current study applies this screening protocol to a larger cohort (2010‐2016) to assess post‐LT clinical outcomes. Results Among 811 LT patients, 766 underwent stress testing (94%), and 559 underwent CATH (69%) of whom 10% had CAD requiring PCI. The sensitivity of stress echocardiography in detecting significant CAD was 37%. Predictors of PCI included increasing age, male gender and personal history of CAD (p<0.05 for all). Compared to patients who had no CATH, patients who underwent CATH had higher mortality (p=0.07), and the hazard rates (HR) for mortality increased with CAD severity [normal CATH (HR: 1.35 [95% CI: 0.79, 2.33], p=0.298); non‐obstructive CAD (HR: 1.53 [95% CI: 0.84, 2.77], p=0.161); and significant CAD (HR: 1.96 [95% CI: 0.93, 4.15], p=0.080)]. Post‐LT outcomes were compared to the 2009‐2010 subgroup from the previous study and showed similar 1‐year overall mortality (8% and 6%, p=0.48); 1‐year MI incidence (<1% and <1%, p=0.8); and MI deaths as portion of all deaths (3% and 9%, p=0.35). Conclusion Stress echocardiography alone is not reliable in screening LT patients for CAD. Aggressive CAD screening with CATH is associated with low rate of MI and cardiac mortality and validates the previously published protocol when extrapolated over a larger sample and longer follow‐up period

Life in Health 2019: Research and Practice

This proceedings contains a selection of papers from the internacional interdisciplinary conference Life in Health 2019, which took place from 5 to 6 September 2019 in the Czech Republic at the Faculty of Education, Masaryk University. The papers focus on general as well as specific approaches to public health protection and promotion. The findings presented are based on research data and are applicable in health education and general education of children and the whole population

CAD-LT score effectively predicts risk of significant coronary artery disease in liver transplant candidates

Background & Aims Patients with cirrhosis and significant coronary artery disease (CAD) are at risk of peri-liver transplantation (LT) cardiac events. The coronary artery disease in liver transplantation (CAD-LT) score and algorithm aim to predict the risk of significant CAD in LT candidates and guide pre-LT cardiac evaluation. Methods Patients who underwent pre-LT evaluation at Indiana University (2010-2019) were studied retrospectively. Stress echocardiography (SE) and cardiac catheterization (CATH) reports were reviewed. CATH was performed for predefined CAD risk factors, irrespective of normal SE. Significant CAD was defined as CAD requiring percutaneous or surgical intervention. A multivariate regression model was constructed to assess risk factors. Receiver-operating curve analysis was used to compute a point-based risk score and a stratified testing algorithm. Results A total of 1,771 pre-LT patients underwent cardiac evaluation, including results from 1,634 SE and 1,266 CATH assessments. Risk-adjusted predictors of significant CAD at CATH were older age (adjusted odds ratio 1.05; 95% CI 1.03–1.08), male sex (1.69; 1.16–2.50), diabetes (1.57; 1.12–2.22), hypertension (1.61; 1.14–2.28), tobacco use (pack years) (1.01; 1.00–1.02), family history of CAD (1.63; 1.16–2.28), and personal history of CAD (6.55; 4.33–9.90). The CAD-LT score stratified significant CAD risk as low (≤2%), intermediate (3% to 9%), and high (≥10%). Among patients who underwent CATH, a risk-based testing algorithm (low: no testing; intermediate: non-invasive testing vs. CATH; high: CATH) would have identified 97% of all significant CAD and potentially avoided unnecessary testing (669 SE [57%] and 561 CATH [44%]). Conclusions The CAD-LT score and algorithm (available at www.cad-lt.com) effectively stratify pre-LT risk for significant CAD. This may guide more targeted testing of candidates with fewer tests and faster time to waitlist. Lay summary The coronary artery disease in liver transplantation (CAD-LT) score and algorithm effectively stratify patients based on their risk of significant coronary artery disease. The CAD-LT algorithm can be used to guide a more targeted cardiac evaluation prior to liver transplantation

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care