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Zoaib Habib Tharwani,1 Prince Kumar,1 Yumna Salman,1 Zarmina Islam,1 Shoaib Ahmad,2 Mohammad Yasir Essar3 1Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan; 2District Head Quarters Teaching Hospital, Faisalabad, Pakistan; 3Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Mohammad Yasir Essar, Email yasir.essar@gmail.comAbstract: Typhoid, and its extra drug resistant form which is highly prevalent Pakistan, is increasing the burden on healthcare through multiple factors. These range from lack of sanitation, the collapsing economy, and poor access to clean drinking water which have made it arduous for the government and various other organizations in containing it. With the COVID-19 pandemic, treatment of typhoid became a challenge as focus was driven towards limiting the COVID-19 spread, and hence preferential use of antibiotics such as azithromycin may limit future empirical antibiotic therapy for typhoid. Socioeconomic disparities and geographical as well as demographic barriers further limit access to appropriate typhoid management. Lastly, illiteracy and self-medication with antibiotics may predispose Pakistan to another outbreak of typhoid. These concerns, although largely unaddressed effectively, need immediate action. Previously, the government and international organizations have made efforts to control the spread through the introduction of TCV as a part of EPI and awareness, additional improvements are needed. These include: improving access to telemedicine in rural areas, extensive vaccination programs, and routine awareness programs especially in schools.Keywords: typhoid, COVID-19, water sanitation, healthcare, vaccine, Pakistan

الملخص: أهداف البحث: إن طرق التدريس التقليدية ليست بالكفاءة المرجوة بسبب عدم قدرتها على تعزيز التعلم النشط. وإن اعتبار المشاركة النشطة من قبل المتعلمين يساعد على تعزيز التجربة التعليمية. بالإضافة إلى ذلك، فقد ثبت أن التغذية الراجعة البناءة تحفز على التعلم النشط. تهدف هذه الدراسة إلى قياس تأثير التدخلات باستخدام التعلم النشط والتغذية الراجعة على الأداء الأكاديمي لطلاب الطب. طرق البحث: أُجريت هذه الدراسة الاستطلاعية متعددة المراحل على طلاب الطب في منهج علم الأجنة من خلال التعلم السلبي (٩٠ طالبا)، والتعلم المتكامل النشط (٨٠ طالبا)، وأخيرا بالتعلم النشط مع التغذية الراجعة الفاعلة (٨٥ طالبا) على مدى ثلاث سنوات متتالية. وقد تمت مقارنة درجات الطلاب خلال التقييمات المستمرة والختامية مع الدرجات النهائية. بالإضافة إلى ذلك، تم تحليل آراء الطلاب باستخدام استبانة. النتائج: شارك في هذا البحث ٢٥٥ طالبا. أظهرت آراء الطلاب اختلافات ملحوظة. وكان هناك اتجاه إيجابي نحو التدخلات من خلال التعلم النشط والتغذية الراجعة. زادت المشاركة النشطة للطلاب من ٢٤٪ إلى ٦٩٪ وأخيرا إلى ٧٢٪ خلال ثلاث سنوات. وكان لديهم الدافع لحضور المحاضرات كما اتضح من مشاركة ٢٨٪ و٧٠٪ و٨٢٪ على التوالي. كما كانت هناك زيادة كبيرة في الدرجات الأكاديمية خلال الثلاث سنوات. الاستنتاجات: تؤكد هذه الدراسة فاعلية التعلم النشط والتغذية الراجعة على الأداء الأكاديمي لطلاب الطب. وبالتالى يمكن إدراج نهج تعليمي للتعلم المتكامل النشط متبوعا بالتغذية الراجعة في المناهج الطبية. Abstract: Objectives: Didactic time-honoured teaching pedagogies carry a low educational impact due to their inability to foster active learning. Active participation from learners is considered to enhance their learning experience. Furthermore, constructive feedback has been found to facilitate active learning. This study aims to measure the impact of interventions via the use of active learning and feedback on the academic performance of medical students. Methods: We conducted an observational multi-stage prospective study of the medical students undertaking embryology courses via passive learning (90 students), active integrated learning (80 students), and finally, with active learning and effective feedback (85 students) over three successive years. The students' grades in the formative and summative assessments were compared with their end-of-course grades. Additionally, the students’ perceptions about the courses were analysed using a self-constructed questionnaire. Results: A total of 255 students participated in this research. The observed frequencies of the students’ responses showed significant variations in their responses to all the statements (X2, p

BackgroundNumerous clinical and experimental observations have alluded to the substantial anti-neoplastic role of vitamin D in breast cancer (BC), primarily by inducing apoptosis and affecting metastasis. Tumor progression and resistance to chemotherapy have been linked to vasculogenic mimicry (VM), which represents the endothelial-independent formation of microvascular channels by cancer cells. However, the effect of vitamin D on VM formation in BC has not been thoroughly investigated. This study examined the impact of 1α,25-dihydroxyvitamin D3 (calcitriol), the active form of vitamin D, on the expression of major factors involved in BC migration, invasion, and VM formation.Experimental MethodsPublicly available transcriptomic datasets were used to profile the expression status of the key VM markers in vitamin D-treated BC cells. The in silico data were validated by examining the expression and activity of the key factors that are involved in tumor progression and MV formation in hormone-positive MCF-7 and aggressive triple‐negative MDA-MB-231 BC cells after treatment with calcitriol.Results and DiscussionsThe bioinformatics analysis showed that tumor VM formation-enriched pathways were differentially downregulated in vitamin D-treated cells when compared with control counterparts. Treatment of BC cells with calcitriol resulted in increased expression of tissue inhibitors of metalloproteinases (TIMPs 1 and 2) and decreased content and gelatinolytic activity of matrix metalloproteinases (MMPs 2 and 9). Furthermore, calcitriol treatment reduced the expression of several pro-MV formation regulators including vascular endothelial growth factor (VEGF), tumor growth factor (TGF-β1), and amphiregulin. Eventually, this process resulted in a profound reduction in cell migration and invasion following the treatment of BC cells with calcitriol when compared to the controls. Finally, the formation of VM was diminished in the aggressive triple‐negative MDA-MB-231 cancer cell line after calcitriol treatment.ConclusionOur findings demonstrate that vitamin D mediates its antitumor effects in BC cells by inhibiting and curtailing their potential for VM formation.

Introduction: A compassionate and patient-centered care leads to improved clinical outcomes. Promoting empathy and compassion of medical students is a forerunner of their well-being, emotional stability, and a patient-centered care. However, there is slender evidence about best educational interventions that can inculcate empathy and compassion skills. Our objective was to conduct a systematic review of research evaluating the associations between spectrum, effectiveness, frequency of teaching modalities and their outcomes on compassion and empathy to highlight best practices.Methods: We searched the Web of Science, PubMed, Scopus, and EBSCO Host on 22nd July 2020. We adapted our search strategy from a previously published systematic review on education for compassion and empathy. Selected studies were required to have used unique educational interventions for promoting empathy and compassion of medical students. The research questions were based on Participants (medical students), Intervention (empathy and/or compassion related teaching), Comparison, and Outcome.Results: We analyzed 24 articles from the initial yield of 2,861. Twenty-two were quantitative studies with a mean of 12.8 on MERSQI. Twelve were randomized controlled trials while 5 measured outcomes with single group pre- and post-tests. There was no association found between duration, frequency and complexity of an educational intervention and its effectiveness. Twenty used multimodality curricula, and of those 18 reported statistically significant positive improvement in empathy, while 3 of 4 single modality were effective. Only three studies looked for long-term effects of educational interventions. Fourteen studies evaluated Kirkpatrick's level one (self-reported knowledge), 2 level three (behavior), and 6 level four (patient outcomes). We identified six major educational constructs of teaching empathy and compassion; communication, mindfulness, early clinical exposure, technology-enhanced learning, comics and arts and culture.Discussion: Our review couldn't identify a standard teaching construct in place and highlighted that different teaching tools carry similar impact in promoting compassion and empathy and a sustainable program rather than a single training activity is essential.

Background: Vitamin D deficiency associates with high risk of breast cancer (BRCA) and increased cellular iron. Vitamin D exerts some of its anti-cancer effects by regulating the expression of key iron regulatory genes (IRGs). The association between vitamin D and cellular iron content in BRCA remains ambiguous. Herein, we addressed whether vitamin D signaling exerts a role in cellular iron homeostasis thereby affecting survival of breast cancer cells.Methods: Expression profile of IRGs in vitamin D-treated breast cancer cells was analyzed using publicly available transcriptomic datasets. After treatment of BRCA cell lines MCF-7 and MDA-MB-231 with the active form of vitamin D, labile iron content, IRGs protein levels, oxidative stress, and cell survival were evaluated.Results: Bioinformatics analysis revealed several IRGs as well as cellular stress relates genes were differentially expressed in BRCA cells. Vitamin D treatment resulted in cellular iron depletion and differentially affected the expression of key IRGs protein levels. Vitamin D treatment exerted oxidative stress induction and alteration in the cellular redox balance by increasing the synthesis of key stress-related markers. Collectively, these effects resulted in a significant decrease in BRCA cell survival.Conclusion: These findings suggest that vitamin D disrupts cellular iron homeostasis leading to oxidative stress induction and cell death.

Abstract Background Empathy is an essential core competency for future doctors. Unfortunately, the medical curriculum is infamously known to burn out aspiring doctors, which may potentially lead to a decline in empathy among medical students. This research was planned to understand the evolution of empathic approaches among students across the curriculum using the Interpersonal reactivity index (IRI) as a benchmark at the Royal College of Surgeons in Ireland - Medical University of Bahrain (RCSI-MUB) and University of Sharjah (UoS). Methods We adopted a cross-sectional design and administered an online survey to the medical students of RCSI-MUB and UoS using a modified version of the IRI along with its three subscales of empathic concern (EC), perspective taking (PT), and personal distress (PD). To identify intra- and inter-institutional variations in empathy scores, the Analysis of Variance (ANOVA) was performed separately for each institution and with both institutions combined. A two-way ANOVA was conducted for the comparison between years and institutions. For the subscale analysis of EC, PT, and PD, we used one-way ANOVA for significant differences between years at both institutions. For the gender-effect analysis, t-test was performed to examine the differences in total IRI scores at both institutions combined and at each institution separately. Additionally, an Analysis of Covariance (ANCOVA) was done to identify the influence of gender on empathy scores. Results A total of 140 students from both institutions participated in this study. We found a fluctuating pattern of empathy scores without a clear trend across the years. The sub-scales of EC, PD, and PT across academic years at both institutions showed significant differences within the EC at RCSI-MUB (p = 0.003). No significant differences were identified across other years from both institutions. There were significant differences between empathy scores from RCSI-MUB and UoS for EC (p = 0.011). Additionally, a pronounced interaction effect between year and institution was observed for PT (p = 0.032). The gender-wise analysis showed that female students had higher empathy scores than males (p = 0.004). The ANCOVA for IRI score results revealed a p-value of 0.023, indicating that gender plays a crucial role in empathy levels among medical students. The ANCOVA results revealed a p-value of 0.022 in the EC subscale. Conclusion Our study unveiled intricate patterns in empathy development among medical students across years and genders at RCSI-MUB and UoS. These congruences and dissimilarities in empathy scores signal a subjective understanding of empathy by medical students. The disparities in understanding may encourage medical educators to embed empathy in standard medical curricula for better healthcare outcomes.

Securing computers is crucial to prevent data breaches, identity theft, and financial losses. Virus incursions disrupt operations, causing downtime and costly repairs. Protective measures, including anti-virus software and cybersecurity practices, maintain network integrity and reduce the spread of malware. Combining robust cybersecurity with green computing strategies ensures efficient energy usage and sustainable network environments, safeguarding against viruses while contributing to both security and environmental goals In this study, we explore the dynamic behaviors of a modified version of the computer virus model and elucidate the connection between its parameters and network attributes. We employ Banach’s and Schaefer’s fixed-point theorems to assess the existence and uniqueness of solutions of the suggested model. Furthermore, we establish sufficient conditions for Ulam–Hyers stability within the envisioned computer virus model. To analyze solution trajectories and the impact of various input factors on computer virus dynamics, we utilize an efficient numerical technique, providing insight into the relationships between model parameters and enabling the design of networks that minimize the risk of virus outbreaks under various bifurcation conditions.

Abstract Simulation in healthcare, empowered by big data analytics and artificial intelligence (AI), has the potential to drive transformative innovations towards enhanced interprofessional collaboration (IPC). This convergence of technologies revolutionizes medical education, offering healthcare professionals (HCPs) an immersive, iterative, and dynamic simulation platform for hands-on learning and deliberate practice. Big data analytics, integrated in modern simulators, creates realistic clinical scenarios which mimics real-world complexities. This optimization of skill acquisition and decision-making with personalized feedback leads to life-long learning. Beyond clinical training, simulation-based AI, virtual reality (VR), and augmented reality (AR) automated tools offer avenues for quality improvement, research and innovation, and team working. Additionally, the integration of VR and AR enhances simulation experience by providing realistic environments for practicing high-risk procedures and personalized learning. IPC, crucial for patient safety and quality care, finds a natural home in simulation-based education, fostering teamwork, communication, and shared decision-making among diverse HCP teams. A thoughtful integration of simulation-based medical education into curricula requires overcoming its barriers such as professional silos and stereo-typing. There is a need for a cautious implantation of technology in clinical training without overly ignoring the real patient-based medical education.

OBJECTIVES Leadership within medical academic institutions often adheres to hierarchical structures, relying on factors like seniority and context, with limited focus on leadership development. This study aims to develop a structured framework by examining the traits, aspirations, and pre-requisites of academic leaders within medical school faculties. METHODS A cross-sectional study collected input from regular medical faculty and those in leadership roles through an online questionnaire, followed by quantitative and qualitative analyses. Data was curated, analyzed, and triangulated to establish subdomains, domains, and themes for the framework. RESULTS Among 229 respondents, 121 held formal academic leadership roles, the remaining 108 were regular medical faculty. And 92% of regular faculty cited lack of experience and training as significant barriers to effective leadership. Both groups agreed on the need for intensive leadership training, as 85% of leaders and 66% of regular faculty lacked formal academic leadership training. The concept of affiliative leadership was favored by 45% of leaders. Qualitative analysis and subtheme triangulation led to the development of the 6 Es Framework for Leadership in Academic Medicine (FLAM). This framework encompasses: ethics (accountability and role modeling), education (structured curriculum and training), envision (clear path and talent identification), engagement (structural foundation and attainable goals), empowerment (fostering passion), and encouragement (financial incentives). CONCLUSION This research reinforces the necessity of structured leadership development in academic medicine. The unique attributes of the 6Es FLAM have the potential to enhance leadership in this field.

Abstract Background Healthcare systems rely on well-trained family medicine physicians who can offer continuous quality services to their communities and beyond. The American Academy of Family Physicians and the World Organization of Family Doctors recommend that medical curricula should have adequately supervised education and training of the learners in family medicine during their preclinical and clinical placements. However, some medical schools don’t have a comprehensive family medicine program to prepare graduates who can meet the community needs. This work aims to report the essential steps for the development, implementation, and evaluation of the family medicine program at the College of Medicine at the University of Sharjah in United Arab Emirates. Methods We used the Kern’s 6-step model to describe the development, implementation, and evaluation of the family medicine program. This includes problem identification, needs assessment, goals setting, educational strategies, implementation, and evaluation. During 2014–2022, we longitudinally collected essential information about the family medicine program from different stakeholders including the feedback of clinical coordinators, adjunct clinical faculty, and medical students at the end-of-clerkship. All responses were analysed to determine the effective implementation and evaluation of the family medicine program. Results Over the course of 8 academic years, 804 medical students, 49 adjunct clinical faculty and three College of Medicine faculty participated in the evaluation of the family medicine program. The majority of respondents were satisfied with various aspects of the family medicine program, including the skills gained, the organisation of program, and the variety of clinical encounters. The medical students and adjunct clinical faculty suggested the inclusion of e-clinics, faculty development program, and the expansion of more clinical sites for the effectiveness of the family medicine program. Conclusions We report a successful development, implementation, and evaluation of the family medicine program in United Arab Emirates with a positive and impactful learning experience. More attention should be paid towards a suitable representation of family medicine program in the medical curriculum with focused and targeted educational plans for medical students.

Existing public sector management literature requires an empirical examination of the relationship between change readiness, organizational agility, and public value-driven innovation performance. Moreover, how organizational structure moderates these relationships in the public sector context is still being determined. This study aims to address this gap by collecting data from 421 top management respondents working in public services in the United Arab Emirates. The hypotheses are tested using a structural equation model. The study's findings confirm that change readiness positively influences organizational agility and reveals the positive effects of organizational agility on public value-driven innovation performance in public service organizations. Additionally, this study highlights that change readiness directly affects public value-driven innovation performance. Simultaneously, organizational structure (formalization and centralization) affects the relationships between change readiness and public value-driven innovation performance, and organizational agility and public value-driven innovation performance. Finally, this study shows that organizational structure (centralized and formalized) impacts the relationship between change readiness and organizational agility. This study contributes substantially to the existing knowledge on the relationships between change readiness, organizational agility, organizational structure, and public value-driven innovation performance.

The hybrid LiFi/WiFi communication networks have demonstrated their efficacy and advantages in terms of data transmission rates. Multiple difficulties were identified in these networks, including the access point assignment (APA) and the process of handover (HO). These troubles (criteria) are influenced by multiple elements, including optical gain at the recipient, mobility, distance, blockage, shadowing, and other variables. It is crucial to evaluate multiple criteria when making-decisions in order to attain more precise results. However, as far, limited studies employing the multicriteria decision-making (MCDM) technique for a hybrid LiFi/WiFi network has been discovered. Nevertheless, although the MCDM technique is highly accurate, it involves long process to achieve the optimal access point (AP). This results in heightened complexity of the system, leading to longer AP transfer times and higher HO rates. In order to address the aforementioned constraints, this paper introduces a novel approach termed as card-flipping decision making (CFDM). CFDM enables swift and precise decision-making while minimizing computational complexity. Additionally, it incorporates HO rates that involve bypassing HOs and selecting the most optimal AP. The analytic hierarchy process (AHP) is adopted to estimate the subjective weights of each criterion and establish their level of priority. The proposed method provided in this study is combined with the AHP, referred to as the merged AHP-CFDM. This integration is considered a new MCDM technique. The proposed method consists of an algorithm that performs i) criteria segmentation based on criteria values, ii) criteria sortation based on AHP results, and iii) criteria grouping based on network type. The classification of criteria is also taken into account including cost and benefit criteria. The proposed algorithm treats each criterion as a card, and each card is flipped (computed) when necessary. The outcome of the AHP-CFDM decisions are SKIP, FLIP, and ASSIGN. The proposed AHP-CFDM is a new MCDM technique and can be utilized in other networks and/or applications for decision-making. The investigation demonstrates improvements in total system efficiency in terms of computational complexity and HO rates when compared to both standard approaches and benchmark techniques. The simulation results demonstrate that the proposed strategy outperforms other methods significantly when compared to the most relevant studies.

The coronavirus (COVID-19) has emerged as one of the most serious issues. Researchers and officials are considering the implementation of several social distancing methods to detect potentially contaminated individuals. Nevertheless, limited social distancing methods have been discovered for tracking, scheduling, and monitoring vehicles for smart buildings. In these methods, people are tested on a regular basis in testing facilities every few days. This suggests that there may be untested infected individuals exhibiting active symptoms. Furthermore, since pandemics comparable to COVID may exhibit a range of symptoms that fluctuate throughout the day. For this reason, each time a vehicle requests entry into the facility, a real-time test or check must be performed. This study proposes a real-time vehicle social distancing decision system for managing the number of vehicles (RT-VSDD) that adds an additional testing method besides the traditional testing phase (test reports from test centers) which is a real-time vital health check during the building access request phase in order to reduce the risk of unidentified infected individuals. The concept of low-risk area and high-risk area in the building is introduced in this study where the method classifies the vehicles based on the risk levels and sends them to the targeted area. The system proposed in this study is identified as vehicle social distancing (VSD) system and is designed specifically for COVID pandemic. The performance evaluation of the proposed work has been performed using MATLAB simulations. 100 vehicles were assumed in the presented scenario with 5% untested, 20% positive, 75% negative, 30% high temperature, and 70% low temperature. When compared with the benchmark work, 40% of vehicles were classified as high risk and 55% were low risk by the proposed system, and 20% and 75% by the benchmark work. Only 5% of vehicles were denied access using the proposed system and 25% by the benchmark work. The total waiting vehicles rate was 25% and 11% in favour of the proposed work for a total waiting time of 100 minutes. The threshold value for the maximum vehicle allowed was reached 26 times by the proposed work against 13 times only by the benchmark work. 95% of vehicles were allowed access using the proposed technique, while only 75% were able to access the building using the benchmark technique. It is anticipated that the suggested system design will facilitate a reduction in the infection rate within buildings, reduces the negative economic impact, and manage the building access effectively for various industries and government sectors.

Abstract Background Regardless of a proliferation of interest in reducing unsafe practices in healthcare, threats to patient safety (PS) remain high. Moreover, little attention has been paid towards the role of interprofessional education (IPE) in enhancing PS. This qualitative study was conducted to unfold the insights of the senior medical, dental and health sciences students at the University of Sharjah (UoS) in the United Arab Emirates (UAE) about PS in an online IPE-based workshop. Methods This inductive thematic analysis study was conducted on senior medical and health students at the Colleges of Medicine, Dental Medicine, Health Sciences, and Pharmacy of UoS. During an online workshop, students discussed plausible solutions for four real practice-based clinical scenarios with elements of unsafe healthcare practices. During the breakout rooms, the students exhibited high level of articulation and proactively participated in discussions. The data from the online workshop were transcribed and then coding, categorizing, and labelling of recurrent themes were carried out. Multiple individual deliberations, consolidation, incorporation of the identified preliminary themes, and merging and reorganizing sub-themes led to a final thematic framework. Results This work delved into the perspectives of 248 students regarding teamwork, communication, problem-solving, and other aspects concerning PS in interprofessional settings in an online workshop. The iterative process of data transcription, curating and qualitative analysis surfaced 32 codes. Later, the inductive themaric analysis yielded five themes with distinct yet interconnected nested subthemes in the context of PS in IPE settings. These themes of information sharing and grounding (problem-solving, social skills), maintaining communication (clinical reasoning, shared mental model), executing interprofessional activities (collaborative practice, collaboration scripts), professional cognitive abilities (cognitive maturity, metacognition), and negotiating professional identities (systematic change, socio-economic scaffolding) emerged as fundamental pillars for enhancing PS in healthcare. Conclusion Our study demonstrated the outcome of an innovative and team-based workshop which embedded PS within a scaffold of IPE environment. This research calls for incorporation of the emerging areas of clinical reasoning, problem solving, collaborative practice, and shared mental model into medical curricula for structured IPE in improving PS domains in medical education. These findings underscore the need for multifaceted dimensions of IPE imperatives for cultivating collaborative competence.

IntroductionTeaching professionalism is a fundamental aspect of medical undergraduate education, delivering important domains of professional attitudes, ethics, and behaviors. The effects of educational interventions can be assessed by measuring the change in such domains, but validated assessment tools for these professionalism domains are lacking. In this study, we constructed and conducted expert validation of a modified theory of planned behavior (TPB) questionnaire to assess changes in professional behaviors (PBs) in medical students.MethodsTo validate that, we modified an existing TPB questionnaire, and an 18-item questionnaire was subjected to expert panel evaluation using the content validation method. The clarity and relevance of items were assessed using a four-point rating scale (i.e., 1 = not relevant to 4 = highly relevant). Ratings of experts and free-text comments were analyzed. Quantitative evaluation of relevance and clarity was undertaken through analyses of the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index (S-CVI). A qualitative assessment of the comments of experts was conducted to refine items, any disagreements were discussed, and a consensus decision was developed among authors for item changes.ResultsQuantitative evaluation of the Item-level Content Validity Index (I-CVI) scored 0.9–1 for relevance and 0.7–1 for clarity. Qualitative evaluation resulted in (i) changes to the wording of items (e.g., choices such as “worthless/worthwhile” were replaced with “not important/important”); and (ii) suggestion of the addition of social media in the construct of subjective norms.DiscussionThe proposed tool exhibits content validity and can assess TPB constructs in professionalism education. This study of content validity may help to ensure the modified TPB questionnaire accurately measures the TPB constructs, ensuring its effectiveness in accurately measuring the TPB constructs for PB in diversified educational medical institutions.

Summary: Pakistan, among the top five most water-stressed nations globally, grapples with water scarcity owing to inadequate treatment infrastructure and groundwater overextraction. We demonstrate a successful nature-based closed-loop system to treat wastewater from urban vehicle-washing facilities, previously reliant on groundwater. An eco-friendly integrated system containing floating treatment wetlands (FTWs), subsurface flow constructed wetlands (SSF-CWs), and sand filtration (SF) was designed and installed at three vehicle-washing facilities for wastewater treatment and reuse in a loop. While the system is still operational after years, a consistent and significant reduction in water quality indicators is recorded, successfully meeting the national environmental quality standards of Pakistan. By reducing per unit water treatment costs to as low as $0.0163/m³ and achieving payback periods under a year, the embrace of these closed-loop strategies vividly underscores the imperative of transitioning to a circular economy in the domains of wastewater treatment and resource conservation.

In this paper, we propose an effective numerical method to solve the one- and two-dimensional time-fractional convection-diffusion equations based on the Caputo derivative. The presented approach employs a hybrid method that combines Lucas and Fibonacci polynomials with the Caputo derivative definition. The main objective is to transform the problem into a time-discrete form utilizing the Caputo derivative technique and then approximate the function's derivative using Fibonacci polynomials. To evaluate the efficiency and accuracy of the proposed technique, we apply it to one- and two-dimensional problems and compare the results with the exact as well as with existing methods in recent literature. The comparison demonstrates that the proposed approach is highly efficient, accurate and ease to implement.

Medical professionalism education intends to produce virtuous and humanistic healthcare professionals who demonstrate perseverance and professional integrity. However, today's medicine has embodied a mammoth transformation of medical practice towards sns and the digital realm. Such paradigm shift has challenged the medical professional's values, behaviors, and identities, and the distinct boundaries between personal and professional lives are blurred. This study aims to develop a framework for healthcare professionals coping with the challenges of medical professionalism in the digital realm. We followed a systematic approach for the development of a framework about e-professionalism. Qualitative data was collected from a systematic review and a delphi study, while quantitative data was collected by administering a validated questionnaire social networking sites for medical education (snsme). Subsequently, categorization of the selected data and identifying concepts, deconstruction and further categorizing concepts (philosophical triangulation), integration of concepts (theoretical triangulation), and synthesis and resynthesis of concepts were performed. The initial process yielded six overlapping concepts from personal, professional, character (implicit) and characteristic (explicit) domains: environment, behavior, competence, virtues, identity, and mission. Further integration of data was done for the development of the medical education e-professionalism (meep) framework with a central concept of a commitment to mission. The mission showed deep connections with values (conformity, beneficence, universalism, and integrity), behaviours (communication, self-awareness, tolerance, power), and identity (reflection, conscientiousness, self-directed, self-actualization). The data demonstrated that all medical professionals require updated expertise in sns participation. The meep framework recognises a mission-based social contract by the medical community. This mission is largely driven by professional values, behaviors and identity. Adherence to digital standards, accountability, empathy, sensitivity, and commitment to society are essential elements of the meep framework. [ABSTRACT FROM AUTHOR]

ABSTRACTMedical Professionalism (MP) defined as values, behaviours and attitudes that promote professional relationships, public trust and patient safety is a vital competency in health profession education. MP has a distinctive uniqueness due to cultural, contextual, conceptual, and generational variations. There is no standard instructional strategy to probe the understanding of MP in a cohesive, structured, interactive manner. This study aimed to investigate undergraduate medical students’ understanding of MP using express team-based learning (e-TBL) at both campuses of Royal College of Surgeons Ireland (RCSI). Using the key principles of a sociocultural theoretical lens in adult learning theory, we designed e-TBL as a context-learning-based educational strategy. We conducted three e-TBL sessions on cross-cultural communication and health disparities, a reflective report on clinical encounters, and professionalism in practice. We collected, collated, and analyzed the student experiences qualitatively using data gathered from team-based case discussions during e-TBL sessions. A dedicated working group developed very short-answer questions for the individual readiness assurance test (IRAT) and MP-based case scenarios for team discussions. In this adapted 4-step e-TBL session, pre-class material was administered, IRAT was undertaken, and team-based discussions were facilitated, followed by facilitator feedback. A qualitative inductive thematic analysis was performed, which generated subthemes and themes illustrated in excerpts. Our thematic analysis of data from 172 students (101 from Bahrain and 71 from Dublin) yielded four unique themes: incoming professional attitudes, transformative experiences, sociological understanding of professionalism, and new professional identity formation. This qualitative study provides a deeper understanding of medical students’ perceptions of medical professionalism. The generated themes resonated with divergent and evolving elements of MP in an era of socioeconomic and cultural diversity, transformative experiences, and professional identity formation. The core elements of these themes can be integrated into the teaching of MP to prepare fit-to-practice future doctors.

Abstract Background In healthcare practice, ethical challenges are inevitable and their optimal handling may potentialy improve patient care. Ethical development in medical education is critical for the transition from a medical and health sciences student to an ethical healthcare practitioner. Understanding the health professions students’ approaches towards practice-driven ethical dilemmas could harness i the effective ethical development in their medical education. This study attempts to identify the health professions students’ approaches towards practice-driven ethical dilemmas. Methods An inductive qualitative evaluation was conducted on six recorded videos of health professions students’ case-based online group discussions, followed by a one-hour online ethics workshop. The online ethics workshop was organized with students from the College of Medicine, College of Dental Medicine and College of Pharmacy at the University of Sharjah, and the College of Medicine at the United Arab Emirates University. . The recorded videos were transcribed verbatim and imported to the qualitative data analysis software of MAXQDA 2022. Data were analyzed applying four stages of review, reflect, reduce and retrieve and two different coders triangulated the findings. Results Six themes emerged from the qualitative analysis of the health professions students’ approaches to the practice-based ethical dilemmas; (1) emotions, (2) personal experiences, (3) law and legal system, (4) professional background, (5) knowledge of medical research and (6) inter-professional education. In addition, during the case-based group discussions in the ethics workshop, students efficiently applied the relevant ethical principles of autonomy, beneficence, non-maleficence and justice in their reasoning process to reach an ethical decision. Conclusion The findings of this study explained how health professions students resolve ethical dilemmas in their ethical reasoning process. This work sheds light on ethical development in medical education by gaining students’ perspectives in dealing with complex clinical scenarios. The findings from this qualitative evaluation will aid academic medical institutions in developing medical and research-based ethics curriculum to transform students to ethical leaders.

Abstract Background Despite innovations in surgical techniques, major complications following colorectal surgery still lead to a significant morbidity and mortality. There is no standard protocol for perioperative management of patients with colorectal cancer. This study evaluates the effectiveness of a multimodal fail-safe model in minimizing severe surgical complications following colorectal resections. Methods We compared major complications in patients with colorectal cancers who underwent surgical resections with anastomosis during 2013–2014 (control group) with patients treated during 2015–2019 (fail-safe group). The fail-safe group had preoperative bowel preparation and a perioperative single dose of antibiotics, on-table bowel irrigation and early sigmoidoscopic assessment of anastomosis in rectal resections. A standard surgical technique for tension-free anastomosis was adapted in the fail-safe approach. The chi-square test measured relationships between categorical variables, t-test estimated the probability of differences, and the multivariate regression analysis determined the linear correlation among independent and dependent variables. Results A total of 924 patients underwent colorectal operations during the study period; however, 696 patients had surgical resections with primary anastomoses. There were 427 (61.4%) laparoscopic and 230 (33.0%) open operations, while 39 (5.6%) laparoscopic procedures were converted. Overall, the rate of major complications (Dindo-Clavien grade IIIb–V) significantly reduced from 22.6% for the control group to 9.8% for the fail-safe group (p

In order to ensure a strong research design, literature stresses the adoption of a research paradigm that is consistent with the researcher’s beliefs about the nature of reality. In this article we provide an overview of research paradigm choices in relation to the creation of a Medical Education e-Professionalism (MEeP) framework discussing the research design, research methods, data collection and analysis to enhance the transparency of our previously published research. The MEeP framework was conceived to help Health Care Professionals (HCPs) safeguard the construct of professionalism in the digital context. This entire process was heavily informed by wider readings and deliberations of published literature on e-professionalism. Although the MEeP framework research journey has been published, the paradigms approach was not discussed in any detail. Considering that one of the duties of medical educator is to balance the service and science by bringing the theoretical underpinnings of one’s research to public attention and scrutiny so as to nullify the notion of ‘weak’ research. We were compelled to unfold this paradigm story of the MEeP framework in a detailed manner. In an effort to make our research both robust and effective, this study portrays a philosophical approach to guide future research designs and methodological choices by detailing our rationale for pragmatism as a choice of paradigm.

La leucemia mieloide aguda (AML, por sus siglas en inglés) es una enfermedad muy heterogénea. Aunque se puede clasificar a los pacientes en grupos de riesgo según sus mutaciones genéticas, el pronóstico dentro de cada categoría varía sustancialmente. Es perentorio identificar nuevos marcadores moleculares de la AML. Recientemente, se ha descrito la elevación del inhibidor de la serina peptidasa Kazal tipo 2 (SPINK2) en la AML, habiendo sido relacionada con peores resultados clínicos en metaanálisis, así como en un número limitado de pacientes con AML.

Acute myeloid leukemia (AML) is a highly heterogeneous disease. Although patients can be classified into risk groups based on their genetic changes, the prognosis of disease within these categories varies widely. This situation raises the need to search for new molecular markers related to AML. Serine peptidase inhibitor Kazal type 2 (SPINK2) has recently been reported to be upregulated in AML and associated with poor outcomes by meta-analysis and in a limited number of AML patients.

Sclerosing encapsulating peritonitis (SEP) is a rare clinical condition that occurs secondary to a triggering factor such as peritoneal dialysis. The condition entails the encasement of a part of or entire small bowel in a fibro-collagenous membrane, causing subacute, acute, or chronic bowel obstruction. This case report presents a middle-aged man with recurring episodes of vague abdominal pain. The clinical examination and investigations showed small-bowel obstruction mostly focused around the previous area of mesh placement for umbilical hernia repair. The abdominal exploration showed a fibrous sac encasing the small-bowel loops, which necessitated adhesiolysis. Most of the fibrous encapsulating membrane was removed. The patient made an uneventful recovery. The treating surgeons for patients with vague manifestations of small obstruction should have a high index suspicion for rare causes of abdominal pain such as SEP.

Abstract Worldwide, buildings consume about 40 percent of the overall energy resources and contribute to an average of 30 percent of the global carbon emission. Hence, technologies for improving the energy efficiency of buildings play an essential role in the global fight against climate change. The CELSIUS project aims to improve the energy efficiency and indoor climate of medium to large sized commercial and public buildings by developing an integrated system solution that consists of (1) an IoT-enabled and cloud-based platform for monitoring and diagnostics of building energy performance and indoor climate quality, (2) a middleware software platform for cost-effective large-scale deployment of wireless sensors and gateways, and (3) an IoT network management platform for cost-efficient life-cycle maintenance of sensors and gateways. The integrated system solution will be deployed and demonstrated in a 6000 m2 building in Aarhus, Denmark, and an 18,000 m2 building in Kuala Lumpur, Malaysia. By choosing buildings located in different climate zones on different continents allows the developed system solution to be tested under realistic conditions for the international export market.

Background Gap years following medical school graduation have become more common, but research into their tangible career benefit is lacking. Examining the impact of gap years on resident scholarly productivity in ophthalmology may provide insight generalizable to all specialties.

In the contemporary era, smart buildings, characterized by their integration of advanced technologies to enhance energy efficiency and user experience, are becoming increasingly prevalent. While these advancements offer notable benefits in terms of operational efficiency and sustainability, they concurrently introduce a myriad of privacy concerns. This review article delves into the multifaceted realm of privacy issues associated with energy-efficient smart buildings. We commence by elucidating the potential risks emanating from data collection, storage, and analysis, highlighting the vulnerability of the personal and behavioral information of inhabitants. The article then transitions into discussing the rights of occupants, emphasizing the necessity for informed consent and the ability to opt-out of invasive data collection practices. Lastly, we provide an overview of existing regulations governing the intersection of smart buildings and privacy. We evaluate their effectiveness and present gaps that necessitate further legislative action. By offering a holistic perspective on the topic, this review underscores the pressing need to strike a balance between harnessing the benefits of technology in smart buildings and safeguarding the privacy of their occupants.

Abstract Background In recent years, social networking sites (SNSs) have evolved beyond connection and networking to become a powerful instructional tool. There is still a dearth of knowledge on the professional use of SNSs for education particularly among students from diverse backgrounds. This study examined the extent and pattern of SNSs usage for education across six institutions and then conducted an interventional workshop to fortify and regulate the educational use of SNSs. Methods This multicenter study was done in two phases. In the first phase, an online cross-sectional survey using a validated inventory was administered to determine the prevalence, extent, and preferences of SNSs usage by undergraduate students in medicine, health sciences and dentistry across five centers. Later, the second phase of the study was undertaken in a 75-min guided live workshop about the appropriate use of SNSs in academia. Additionally, pre- and post-test surveys were conducted to assess the impact and outcome of workshop. Results Of the 1722 respondents, 1553 (90%) reported using SNSs with the frequency of once a month to three to five times per day for education and to stay in touch with others. Most students agreed with the benefits of SNSs for education mainly in terms of information gathering, networking and collaboration. Twitter, Instagram, and Pinterest were noted as the most preferred SNSs for education. Nevertheless, 63% perceived that proper instruction was required for the efficient use of SNSs. Following the guided workshop, there was a significant improvement in web technology understanding, digital professionalism, skills and knowledge on the productive use of SNSs. Students rated the efficient for conceptual learning, connection to community practice, e-portfolio, and collaborative learning as the top four major teaching and learning strategies, respectively, in the post-workshop survey. Conclusion Our study demonstrates that SNSs can be used as learning tools in medical education. However, SNSs usage should be regulated and guided for a more collegial and coherent learning climate in the digital realm. We urge medical educators to integrate SNSs into their courses for a technologically advanced and impactful curriculum.

BackgroundCOVID-19 has endangered healthcare systems at multiple levels worldwide. Published data suggests that moral dilemmas faced during these unprecedented times have placed physicians at the intersections of ethical and unethical considerations. This phenomenon has questioned the physicians' morality and how that has affected their conduct. The purpose of our review is to tap into the spectrum of the transforming optics of patient care during the pandemic and its impact on psychological wellbeing of physicians.MethodsWe adopted the Arksey and O'Malley's framework, defining research questions, identifying relevant studies, selecting the studies using agreed inclusion and exclusion criteria, charting the data, and summarizing and reporting results. Databases of PubMed/Medline, Web of Science, Scopus, Science Direct, CINAHL, and PsycInfo were searched using a predefined search string. The retrieved titles and abstracts were reviewed. Later, a detailed full-text analysis of the studies which matched our inclusion criteria was performed.ResultsOur first search identified 875 titles and abstracts. After excluding duplicates, irrelevant, and incomplete titles, we selected 28 studies for further analysis. The sample size in 28 studies was 15,509 with an average size of 637 per study. Both quantitative and qualitative approaches were used, with cross-sectional surveys being utilized in all 16 quantitative studies. Using the data from semi-structured interviews, several discrete codes were generated, which led to the identification of five main themes; mental health, individual challenges, decision-making, change in patient care, and support services.ConclusionThis scoping review reports an alarming rise in psychological distress, moral injury, cynicism, uncertainty, burnout, and grief among physicians during the pandemic. Decision-making and patient care were mostly regulated by rationing, triaging, age, gender, and life expectancy. Poor professional controls and institutional services potentially led to physicians' crumbling wellbeing. This research calls for the remediation of the deteriorating mental health and a restoration of medical profession's advocacy and equity.

Abstract Background The outbreak of coronavirus disease 2019 (COVID-19) and its quick progression to a global pandemic has urged medical schools to shift from didactic to distance learning and assessment approaches. The quality of clinical training and assessment have been jeopardized due to the regulatory restrictions and potential hazards to human lives. The aim of this paper is to evaluate the utility and efficacy of an electronic Objective Structured Clinical Examination (e-OSCE), which attempted to transform the format of a face-to-face OSCE to an e-OSCE. Methods We conducted three end of clerkship e-OSCEs for final year medical students in Surgery, Medicine and Family Medicine using the teleconferencing application of Microsoft Teams (MST). The e-OSCE blueprint included the assessment of all clinical skills except physical examination and procedural skills. Examiners supervised e-OSCE from the college campus, while all students were remotely assessed through the MST channels. During the exam, the students stayed in their specified MST channel and examiners rotated across all students. The utility and efficacy of e-OSCE was evaluated using a self-administered questionnaire for students, examiners and e-OSCE team. Results The data analysis showed that 93.4% students and 92.2% examiners agreed with the quality and process of e-OSCE. Similarly, 83.6% students and 98% examiners agreed with the seamless organization of e-OSCE. As many as 45.9% students and 74.5% examiners agreed that e-OSCE was close to real life practice. Approximately one fifth of students and one third of examiners preferred e-OSCE over the face-to-face OSCE. The analysis of qualitative data generated the themes of e-OSCE structure and technology. While majority of participants were satisfied with e-OSCE, students were concerned about examiners’ training and e-OSCE contents. Examiners and e-OSCE team recognized the paper-less, tech-savy, fast and reliable format of e-OSCE. Conclusion During and beyond COVID- 19 era, e-OSCE is a strong substitute to standard OSCE for assessing clinical competence except for physical examination and procedural skills. The planning and implementation of e-OSCE reflects an ingenuity in the assessment of clinical competencies of medical students.

BackgroundSince the introduction of various vaccines against SARS-CoV-2 at the end of 2020, infection rates have continued to climb worldwide. This led to the establishment of a third dose vaccination in several countries, known as a booster. To date, there has been little real-world data about the immunological effect of this strategy.MethodsWe compared the humoral- and cellular immune response before and after the third dose of BioNTech/Pfizer vaccine BNT162b2, following different prime-boost regimen in a prospective observational study. Humoral immunity was assessed by determining anti-SARS-CoV-2 binding antibodies using a standardized quantitative assay. In addition, neutralizing antibodies were measured using a commercial surrogate ELISA-assay. Interferon-gamma release was measured after stimulating blood-cells with SARS-CoV-2 specific peptides using a commercial assay to evaluate the cellular immune response.ResultsWe included 243 health-care workers who provided blood samples and questionnaires pre- and post- third vaccination. The median antibody level increased significantly after the third vaccination dose to 2663.1 BAU/ml vs. 101.4 BAU/ml (p < 0.001) before administration of the booster dose. This was also detected for neutralizing antibodies with a binding inhibition of 99.68% ± 0.36% vs. 69.06% ± 19.88% after the second dose (p < 0.001). 96.3% of the participants showed a detectable T-cell-response after the booster dose with a mean interferon-gamma level of 2207.07 mIU/ml ± 1905 mIU/ml.ConclusionThis study detected a BMI-dependent antibody increase after the third dose of BNT162b2 following different vaccination protocols. All participants showed a significant increase in their immune response. This, in combination with the low rate of post-vaccination-symptoms underlines the potential beneficial effect of a BNT162b2-booster dose.

AimRegardless the technological developments in surgery, the anastomotic leakage (AL) rate of low rectal anastomosis remains high. Though various perioperative protocols have been tested to reduce the risk for AL, there is no standard peri-operative management approach in rectal surgery. We aim to assess the short-term outcome of a multidisciplinary approach to reduce the rates of ALs using a fail-safe-model using preoperative and intraoperative colonic irrigation in low rectal resections with primary anastomosis.MethodsBetween January 2015 and December 2020, 92 patients received low rectal resections for rectal cancer with primary anastomosis and diverting ileostomy. All these patients received pre-operative mechanical bowel preparation (MBP) without antibiotics as well as intraoperative colonic irrigation. The intraoperative colonic irrigation was performed via the efferent loop of the ileostomy. All data were analyzed by SPSS for descriptive and inferential analyses.ResultsIn the study period, 1.987 colorectal surgical procedures were performed. This study reports AL in 3 (3.3%) of 92 recruited patients. Other postoperative complications (Dindo-Clavien I-IV) were reported in 25 patients (27.2%), which occurred mainly due to non-surgical reasons such as renal dysfunction and sepsis. According to the fail-safe model, AL was treated by endoscopic or re-do surgery. The median postoperative length of hospitalization was 8 days (4–45) days.ConclusionThis study validates the effectiveness of a multi-disciplinary fail-safe model with a pre-operative MBP and an intraoperative colonic irrigation in reducing AL rates. Intraoperative colonic irrigation is a feasible approach that lowers the AL rates by reducing fecal load and by decontamination of the colon and anastomotic region. Our study does not recommend a pre-operative administration of oral antibiotics for colorectal decontamination.

BackgroundThe mRNA-based vaccine BNT162b2 of BioNTech/Pfizer has shown high efficacy against SARS-CoV-2 infection and a severe course of the COVID-19 disease. However, little is known about the long-term durability of the induced immune response resulting from the vaccination.MethodsIn a longitudinal observational study in employees at a German hospital we compared the humoral and cellular immune response in 184 participants after two doses of the BioNTech/Pfizer vaccine (BNT162b2) with a mid-term follow-up after 9 months. Anti-SARS-CoV-2 binding antibodies were determined using both a quantitative and a semi-quantitative assay. For a qualitative assessment of the humoral immune response, we additionally measured neutralizing antibodies. Cellular immune response was evaluated by measuring Interferon-gamma release after stimulating blood-cells with SARS-CoV-2 specific peptides using a commercial assay.ResultsIn the first analysis, a 100% humoral response rate was described after two doses of BNT162b2 vaccine with a mean antibody ratio of 8.01 ± 1.00. 9 months after the second dose of BNT162b2, serological testing showed a significant decreased mean antibody ratio of 3.84 ± 1.69 (p < 0.001). Neutralizing antibodies were still detectable in 96% of all participants, showing an average binding inhibition value of 68.20% ± 18.87%. Older age (p < 0.001) and obesity (p = 0.01) had a negative effect on the antibody persistence. SARS-CoV-2 specific cellular immune response was proven in 75% of individuals (mean Interferon-gamma release: 579.68 mlU/ml ± 705.56 mlU/ml).ConclusionOur data shows a declining immune response 9 months after the second dose of BNT162b2, supporting the potentially beneficial effect of booster vaccinations, the negative effect of obesity and age stresses the need of booster doses especially in these groups.

Background:There is increasing evidence on the exponential use of technology-based social media in medical field that has led to a proliferation of unprofessional behaviors in digital realm. Educating, training, and changing the behaviors of healthcare professionals are essential elements to restrain the rising unprofessional incidents. Therefore, this research was designed to determine the impact of an interventional workshop on the medical and dental students in improving their professional behaviors in the digital world using the newly developed medical Education e-Professionalism (MEeP) framework.MethodsWe adopted the Theory of Planned Behavior (TPB) as a benchmark reference which explores constructs intertwined with the mission-based MEeP framework; values (whistleblowing-raising concerns), behaviors (being responsible in the digital world) and identity (reflective practice in the digital world). A multicentre 3-phased mixed-method study was conducted using a pre-workshop survey, an online interventional workshop, and a post-workshop survey. SPSS and NVivo were the tools used for the data analysis.ResultsA total of 130 students registered for workshop out of which 120 completed the pre-workshop survey, 62 joined the workshop and 59 completed the workshop and post-workshop survey. From the whistleblowing – raising concern perspective, we found that attitudes and perceived behavioral control had a significant relationship. While for responsible in digital world category, attitude and perceived behavioral control had a significant bearing on the intentions. Third, for reflective practice, attitude and subjective norms significantly enhanced the intention of participants. A multi layered thematic analysis yielded four overarching themes of attitudes, subjective norms, perceived behavioral control and intentions. Most students showed positive attitudes of being reflective, self-directed, and humane. Students realized the subjective norms had made them conscientious, self-aware and conformative. While perceived behavioural control manifested as identity and Intentions were heavily reliant on self-actualization.ConclusionOur mixed method study found that the interventional workshop using MEeP framework significantly improved attitudes, subjective norms, perceived behavioral control, and intentions. This study provides valuable evidence of MEeP framework evaluation using the theoretical underpinning of TPB by reporting positive changes in professional values, behaviors, and identities of undergraduate medical and dental students.