Performance in credential enhancing masters program facilitates future success in the health professions

This paper examined the critical factors and potential predictors necessary for successful admission to dental school for students participating in the credential enhancing Oral Health Sciences (OHS) master’s program at Boston University. The academic parameters of OHS-DMD and traditional (four year) college graduate DMD students were compared to determine if OHS graduates performed at a comparable academic level in dental school as DMD students who entered dental school without completing a credential enhancing master’s program. To accomplish this, we examined data from students who matriculated to the Oral Health Sciences program from 2006 to 2015 and collected demographic, undergraduate grade point average (GPA), dental admissions test (DAT) scores and Oral Health Sciences GPA from Admissions and Registrar records for our analyses. To compare dental school performance and success on national board exams we obtained data for both OHS-DMD and traditional DMD students who enter the Boston University Goldman School of Dental Medicine. We performed unpaired T-tests to evaluate differences in undergraduate GPA, DAT and OHS GPA data for those OHS students matriculating to any dental school to determine what criteria, if any, can be used to predict success. We found that two factors were significant in determining acceptance to dental school: the Oral Health Sciences GPA (3.501 ± 0.301 vs 2.914 ± 0.336, p <0.0001*) and DAT scores (18.380 ± 2.089 vs 17.231 ± 1.833, p= 0.0365*). Comparison of academic performance between DMD and OHS-DMD at BU dental school found that students perform equally as well in Year 1 but dropped lower in Year 2 when comparing GPA (3.40 ± 0.052 vs 3.290 ± 0.259*, p=0.043). Lastly, first attempt fail rates on national board examinations (8.3% + 4.78 vs 7.4% + 5.1, p=0.024) between traditional DMD and OHS-DMD students were reduced however retake pass rates were equivalent (p=0.120). These studies demonstrate that both OHS-GPA and DAT scores are significant factors in successful admission to dental school for those who had been unable to gain acceptance without the credential enhancing master’s program. Additionally, students performing well in the Oral Health Sciences program matriculate to dental school and are nearly as successful academically and on board exams as traditional four-year students DMD. Lastly, in keeping with the original mission of the OHS program, we have been largely successful in allowing underachieving and/or underrepresented minority and socioeconomically disadvantaged students to gain acceptance dental school

Calculation of Wear Rate by Weight and Volume for Aluminum Samples

&nbsp;تم التحقيق في طريقتين لحساب معدل التآكل بالوزن والحجم عمليا باستخدام عينات ألمنيوم مع حمل مختلف (500 جم، 1000 غرام، و1500 جم) ووقت اختبار مختلف (300 ثانية، 600 ثانية، و900 ثانية). تظهر النتيجة أنه عندما يزيد الحمل من 500 جم إلى 1500 جم فإن معدل التآكل بالوزن يزداد بنسبة (83٪ و80٪ و37٪) لوقت الاختبار (300s و600s و900s) على التوالي. كذلك، يزيد زمن الاختبار المتزايد من 300 إلى 900 ثانية من معدل التآكل حسب الوزن (216٪، 155٪، و136٪) للحمل (500 جرام، 1000 جرام، 1500 جرام) على التوالي. أيضا، عندما يزداد الحمل من 500 غم إلى 1500 غم معدل التآكل من خلال زيادة الحجم بنسبة (740 ٪، 612 ٪، و662 ٪) لوقت الاختبار (300s، 600s، و900 s) على التوالي. كذلك، يزيد زمن الاختبار المتزايد من 300 إلى 900 ثانية من معدل التآكل بالحجم بنسبة (152٪، 110٪، و128٪) للحمل (500 جرام، 1000 جرام، 1500 جرام) على التوالي.Two ways of calculating the wear rate was investigated experimentally by weight and volume using aluminum samples with different load (500g, 1000g, and 1500g) and different time of test (300 s, 600 s, and 900 s). The results show that, When the load increasing from 500 g to 1500 g the wear rate by weight increase by (83%, 80%, and 37%) for test time (300s, 600s, and 900s) respectively. Also, the increasing test time from 300s to 900 s causes increasing in wear rate by weight by (216%, 155%, and 136%) for load (500g, 1000g, and 1500g) respectively. Also, when the load increasing from 500 g to 1500 g the wear rate by volume increase by (740%, 612%, and 662%) for test time (300s, 600s, and 900s) respectively. Also, the increasing test time from 300s to 900 s causes increasing in wear rate by volume by (152%, 110%, and 128%) for load (500 g, 1000g, and 1500g) respectively

Nexus between energy pricing and carbon emission. A policy mix response of developing economies

The study utilised a data set of South Asian countries of energy pricing (E.P.), carbon emission, and policy mix between 1990 and 2020. A comprehensive set of models from econometric such as fixed effect (F.E.), and panel quantile regression (P.Q.R.) is used to determine the relationship between underline indicators. Furthermore, the T.O.P.S.I.S. method from operational research was applied to determine the efficiency level of these factors in the South Asian region. E.P. and carbon emission are contributing positively to the process of household consumption (H.C.). In the policy mix scenario, H.C. is positively associated with inflation while negatively with the tax rate. Furthermore, the outcomes of the T.O.P.S.I.S. indicate that Bhutan is performing efficiently in the said parameters followed by Pakistan, while India’s performance is not impressive in this regard. This study can be helpful to policymakers for effective energy demand planning, conservation, and frame policies that would ensure sustainable H.C. and serve as motivation to search for alternative energy sources to meet the growing energy demand

Official Political Institutions and Party System in the Kingdom of Belgium

استطاعت مملكة بلجيكا أن تحقق استقراراً سياسياً على الرغم من وجود تنوع وتعدد معقد جداً (ديني وثقافي وعرقي واثني ولغوي واقليمي)، إنّ أخذ المملكة بالنموذج الفيدرالي كأسلوب في الادارة &nbsp;والعمل بالنظام اللا مركزي وتوزيع السلطات عزّز من مبدأ المشاركة في صنع القرار وتحقيق التوازنات بين الأقاليم والتجمعات والعمل ضمن كيان سياسي موحد، قضت من خلالها على الانشقاقات والصراعات التي عرفت بها بلجيكا منذ بداية نشأتها، فضلاً عن الأخذ بمبدأ الديمقراطية التوافقية الذي ساعد بشكل كبير في وجود تحالفات واسعة وتوازن سياسي أدى إلى احتواء الأزمات اللغوية والقومية التي طالما هدّدت استقرارها ووحدتها الوطنية، ومع الأخذ بمبدأ التمثيل النسبي للأقلّيات والعرقيات أسهم بشكل اساس على التداول السلمي للسلطة التي كانت أحد الأسس المهمة في الاستقرار السياسي للنظام السياسي في مملكة بلجيكا.The Kingdom of Belgium was able to achieve political stability despite the existence of a very complex diversity (religious, ethnic, and linguistic). The Kingdom's adoption of the federal model as a method of administration and the decentralization of the authorities strengthened the principle of participation in decision-making and balancing between regions, Political process, through which it resolved the splits and conflicts that have been known to Belgium since the beginning of its inception, as well as the principle of democratic consensus, which helped significantly in the existence of alliances and wide led to contain crises language and nationalism, which has long threatened the stability and unity And taking into account the principle of proportional representation of minorities and ethnic groups, was based mainly on the peaceful transfer of power, which was one of the important foundations for the political stability of the political system in the Kingdom of Belgium

A systematic review on intervention programs to improve activity of daily living status and health related quality of life

Background: Health related quality of life is gaining importance in examining people’s health outcomes. It is related to how good or bad people’s lives are, and to the degree of their overall wellbeing and life satisfaction level. Independency in self-care and basic activity of daily living is among the most crucial elements that could potentially affect people’s health related quality of life. The objectives of this review are to determine related studies that examined various interventions to improve the functional ability of patients with chronic diseases or injuries on health related quality of life and to identify the most common types of interventions, instruments, as well as studies designs. Materials and Methods: Literature review was performed through an electronic search of the related studies using the words “Activity of Daily Living”, and “Intervention”. Different electronic search engines were utilized, including PubMed, Science Direct, CINHAL and Medline. A specific search criterion were applied to include scientific journal articles with experimental design, written in English language and published from 2010 to 2016. Those articles that did not measure activity of daily living and health related quality of life together using standardized measures, pilot study or still in proposal stage, were excluded. Result: Thirty six experimental studies were eligible for inclusion. Twelve studies conducted on elderly, 7 for stroke, 6 for dementia whereas 9 studies for different kind of health conditions. Among those 36 studies, 26 studies were Randomized Control Trial design while 10 studies were quasi or other type of experimental design. Conclusion: Randomized Control Trials was used more frequently as an experimental design. Most of the interventions were rehabilitation and physiotherapy in nature. Barthel index was identified to be the most common instrument used to measure activity of daily living, whereas SF36 and EQ5D instruments were most commonly used for health related quality of life

Prevalence of Aflatoxicosis in Broiler Chickens in Quetta, Pakistan

Abstract.-A base line study was conducted to determine the prevalence of aflatoxicosis in broiler chickens in and around Quetta district during the period June 2009 to May 2010. The study was based on the examination of sick and dead birds (n=1105 broiler chickens). Congested and oedematous carcass, hemorrhages, yellowish brown or pale liver; swollen kidneys; atrophy of bursa and thymus were the common necropsy findings. Thin layer Chromatographic analysis of liver samples of suspected birds was carried out for the confirmation of aflatoxin. Aflatoxin contents of analyzed samples ranged between 3.0 -11.7 µg/kg. It was recorded that 8.78% (n=97) birds were aflatoxicosis positive. The highest season wise prevalence was recorded in autumn (13.29%) and the lowest in winter (5.1%). It is concluded that existing situation of aflatoxicosis need strict surveillance to monitor the problem. There should be a campaign among public to create awareness about toxicological effects of aflatoxins and development of good laboratory facilities for confirmation of disease. Further use of aflatoxin ameliorators should be promoted to limit the problem

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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