Costing of a Blended Course at the Open University of Sri Lanka: An Empirical Study

In a viable Open and Distance Learning system, providing immediate access to learning resources and fostering effective teacher-learner interactions are essential components while balancing the cost of the course without compromising quality. Owing to the advancement of ICT across the globe, the Open University of Sri Lanka has initiated integrating online components into the existing print-based courses and offering them as blended courses. The gauging costs for these blended courses are also vital to determine the various costs components. Hence, an empirical study was conducted to estimate total costs and cost per student of a blended course. In this empirical study, costing was carried out, based on five major costs categories; course materials design and development, course materials production, course delivery, student evaluation, overhead and infrastructure. Th

Practices and Perspectives in Cardiopulmonary Resuscitation Attempts and the Use of Do Not Attempt Resuscitation Orders: A Cross-sectional Survey in Sri Lanka.

Objective: The objective of this study is to describe the characteristics of in-hospital cardiopulmonary resuscitation (CPR) attempts, the perspectives of junior doctors involved in those attempts and the use of do not attempt resuscitation (DNAR) orders. Methods: A cross-sectional telephone survey aimed at intern doctors working in all medical/surgical wards in government hospitals. Interns were interviewed based on the above objective. Results: A total of 42 CPR attempts from 82 hospitals (338 wards) were reported, 3 of which were excluded as the participating doctor was unavailable for interview. 16 (4.7%) wards had at least 1 patient with an informal DNAR order. 42 deaths were reported. 8 deaths occurred without a known resuscitation attempt, of which 6 occurred on wards with an informal DNAR order in place. 39 resuscitations were attempted. Survival at 24 h was 2 (5.1%). In 5 (13%) attempts, CPR was the only intervention reported. On 25 (64%) occasions, doctors were "not at all" or "only a little bit surprised" by the arrest. Conclusions: CPR attempts before death in hospitals across Sri Lanka is prevalent. DNAR use remains uncommon

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Civil-military relations in post-conflict Sri Lanka: successful civilian consolidation in the face of political competition

The LTTE insurgency seeking a separate Tamil state in Sri Lanka was successfully eliminated by the Sri Lankan military in 2009. Toward the end of the conflict, Sri Lanka’s armed forces strength rose to approximately 375,000. The use of the military in nation-building projects was misunderstood by many as militarization of the country. Therefore, this thesis asks these questions: How are the civil authorities maintaining control and effectiveness of the country’s armed forces? And how does the civilian government constructively utilize the military and continue to assert civilian rule? These questions were examined as a comparative single case study because in recent history, no civilian government has concluded terrorism through military means. A combination of Huntington’s subjective and objective civilian control theory, Alagappa’s state coercion theory, and Matei and Bruneau’s CMR dimensions was used. This thesis finds that the civilians used heavy subjective-control mechanisms to ascertain the subordination of military due to political competition. However, the divided political setting prevented the military from entering into party politics, increasing professionalism and antithesis of subjective control, which is objective control. In this situation, Huntington’s subjective control did not happen, as the divided political setting and conflict positively contributed to ascertaining civilian control.http://archive.org/details/civilmilitaryrel1094547897Lieutenant Colonel, Sri Lanka Light Infantry, Sri Lanka ArmyApproved for public release; distribution is unlimited

Distal aphalangia, microcephaly and mental retardation

generalised convulsions. He was the third child born to consanguineous parents. The antenatal and perinatal period of this child had been normal. At 3 months of age he developed generalised convulsions and was treated with phenobarbitone at the Nawalapitiya Base Hospital. However, subtle seizures persisted at a frequency of about 1 or 2 seizures a month. At about 15 months of age the seizure frequency increased. He also had global development delay. On examination he had dysmorphic features. The occipito-frontal circumference was 46 cm (<3rd centile, [1], length of child 89 cm (< 3rd centile) and weight 13.5 kg (between 10th and 25th centile). The dysmorphic features were mainly confined to hands and feet. The distal phalanges of all the four finger

Thermoset plastic waste from garment button industry as a novel solid state curing agent for epoxy resin system

Garment button industry uses unsaturated polyester based on ethylene glycol and maleic acid to produce thermoset plastic sheets using styrene (31-34 w/w%) as a cross-linking agent. Buttons are produced by casting process and remaining part of the sheet becomes an inherent waste. This research study evaluated the curing behaviour of the powdered thermoset polyester waste (PTPW) of garment button industry as an alternative for amine hardener in epoxy resin systems. Particle size distribution was analysed using the standard sieve analysis method. It indicated that majority (83 w/w%) of the particles were in the range of 125 – 500 µm. Set-to-touch drying time of the epoxy resin system was significantly improved when PTPW was blended with amine hardener. The fastest drying was observed with 30-70% of powdered waste in the blend of amine hardener and PTPW. When an amine molecule reacts with an epoxy ring, it combines to one end of the epoxy resin molecule. Since PTPW particle has more than one reactive and accessible COOH and OH group, each particle can chemically combine with a number of epoxy rings to initiate the cross-linking process. However the effect on set to touch drying time was marginal with the increase of PTPW above 70% and may be due to the initiation of ring opening reactions of epoxy resin with carboxylic groups and hydroxyl groups.PTPW was kept overnight in alkali medium to break the ester links and was acidified with sulphuric acid to generate –COOH and –OH groups. Hydrolysed powder was thoroughly washed to remove sulphuric residues and dried at 105 °C. FTIR spectra of PTPW before and after the hydrolysis reaction indicated the presence of hydrogen-bonded O-H stretching after hydrolysis. Matrix of PTPW particle is hydrophobic in nature since the chains are cross-linked by styrene units. The –COOH and –OH groups which are formed in the hydrolysis tend to form hydrogen-bonds with each other within the matrix itself. Set-to-touch drying characteristics of PTPW and hydrolysed PTPW were very similar to amine hardener when used in the epoxy resin system. When hydrolysed PTPW was blended in proportion with amine hardener, no significant improvement of set to touch drying time was observed. Even though the hydrolysis generated more hydroxyl groups and carboxyl groups within the matrix of particles, number of freely accessible carboxylic and hydroxyl groups without steric hindrance to the epoxy ring structure may not be significant. Therefore the presence of excess number of functional groups per particle is not an advantage by means of drying characteristics.Keywords : Epoxy resin system / Plastic waste / Garment button industry / Hardener / Epoxy groutAcknowledgement : T and S Buttons Lanka (Pvt) Ltd provided a sample of waste in powder form

Pakistan registry of intensive carE (PRICE): Expanding a lower middle-income, clinician-designed critical care registry in south Asia

Introduction: In resource-limited settings - with inequalities in access to and outcomes for trauma, surgical and critical care - intensive care registries are uncommon.Aim: The Pakistan Society of Critical Care Medicine, Intensive Care Society (UK) and the Network for Improving Critical Care Systems and Training (NICST) aim to implement a clinician-led real-time national intensive care registry in Pakistan: the Pakistan Registry of Intensive CarE (PRICE).Method: This was adapted from a successful clinician co-designed national registry in Sri Lanka; ICU information has been linked to real-time dashboards, providing clinicians and administrators individual patient and service delivery activity respectively.Output: Commenced in August 2017, five ICU\u27s (three administrative regions - 104 beds) were recruited and have reported over 1100 critical care admissions to PRICE.Impact and future: PRICE is being rolled out nationally in Pakistan and will provide continuous granular healthcare information necessary to empower clinicians to drive setting-specific priorities for service improvement and research

Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka

Lack of investment in low-income and middle-income countries (LMICs) in systems capturing continuous information regarding care of the acutely unwell patient is hindering global efforts to address inequalities, both at facility and national level. Furthermore, this of lack of data is disempowering frontline staff and those seeking to support them, from progressing setting-relevant research and quality improvement. In contrast to high-income country (HIC) settings, where electronic surveillance has boosted the capability of governments, clinicians and researchers to engage in service-wide healthcare evaluation, healthcare information in resource-limited settings remains almost exclusively paper based. In this practice paper, we describe the efforts of a collaboration of clinicians, administrators, researchers and healthcare informaticians working in South Asia, in addressing the inequality in access to patient information in acute care. Harnessing a clinician-led collaborative approach to design and evaluation, we have implemented a national acute care information platform in Sri Lanka that is tailored to priorities of frontline staff. Iterative adaptation has ensured the platform has the flexibility to integrate with legacy paper systems, support junior team members in advocating for acutely unwell patients and has made information captured accessible to diverse stakeholders to improve service delivery. The same platform is now empowering clinicians to participate in international research and drive forwards improvements in care. During this journey, we have also gained insights on how to overcome well-described barriers to implementation of digital information tools in LMIC. We anticipate that this north–south collaborative approach to addressing the challenges of health system implementation in acute care may provide learning and inspiration to other partnerships seeking to engage in similar work

Applicability of the APACHE II model to a lower middle income country

To determine the utility of APACHE II in a low-and middle-income (LMIC) setting and the implications of missing data.Patients meeting APACHE II inclusion criteria admitted to 18 ICUs in Sri Lanka over three consecutive months had data necessary for the calculation of APACHE II, probabilities prospectively extracted from case notes. APACHE II physiology score (APS), probabilities, Standardised (ICU) Mortality Ratio (SMR), discrimination (AUROC), and calibration (C-statistic) were calculated, both by imputing missing measurements with normal values and by Multiple Imputation using Chained Equations (MICE).From a total of 995 patients admitted during the study period, 736 had APACHE II probabilities calculated. Data availability for APS calculation ranged from 70.6% to 88.4% for bedside observations and 18.7% to 63.4% for invasive measurements. SMR (95% CI) was 1.27 (1.17, 1.40) and 0.46 (0.44, 0.49), AUROC (95% CI) was 0.70 (0.65, 0.76) and 0.74 (0.68, 0.80), and C-statistic was 68.8 and 156.6 for normal value imputation and MICE, respectively.An incomplete dataset confounds interpretation of prognostic model performance in LMICs, wherein imputation using normal values is not a suitable strategy. Improving data availability, researching imputation methods and developing setting-adapted and simpler prognostic models are warranted

A retrospective study of physiological observation-reporting practices and the recognition, response, and outcomes following cardiopulmonary arrest in a low-to-middle-income country

Background and Aims In Sri Lanka, as in most low‑to‑middle‑income countries (LMICs), early warning systems (EWSs) are not in use. Understanding observation‑reporting practices and response to deterioration is a necessary step in evaluating the feasibility of EWS implementation in a LMIC setting. This study describes the practices of observation reporting and the recognition and response to presumed cardiopulmonary arrest in a LMIC. Patients and Methods This retrospective study was carried out at District General Hospital Monaragala, Sri Lanka. One hundred and fifty adult patients who had cardiac arrests and were reported to a nurse responder were included in the study. Results Availability of six parameters (excluding mentation) was significantly higher at admission (P &lt; 0.05) than at 24 and 48 h prior to cardiac arrest. Patients had a 49.3% immediate return of spontaneous circulation (ROSC) and 35.3% survival to hospital discharge. Nearly 48.6% of patients who had ROSC did not receive postarrest intensive care. Intubation was performed in 46 (62.2%) patients who went on to have ROSC compared with 28 (36.8%) with no ROSC (P &lt; 0.05). Defibrillation, performed in eight (10.8%) patients who had ROSC and eight (10.5%) in whom did not, was statistically insignificant (P = 0.995). Conclusions Observations commonly used to detect deterioration are poorly reported, and reporting practices would need to be improved prior to EWS implementation. These findings reinforce the need for training in acute care and resuscitation skills for health‑care teams in LMIC settings as part of a program of improving recognition and response to acute deterioration.</p