Quality midwifery care during the COVID-19 pandemic in Bangladesh: A focus group study with midwives, nurses, and midwifery educators.

INTRODUCTION: Bangladesh has made remarkable strides in the development of the midwifery profession. However, the COVID-19 pandemic has had profound effects on healthcare systems worldwide, including those related to reproductive, perinatal, and maternal health. Given the recent advancements in the midwifery field in Bangladesh, it is crucial to examine the pandemic's impact on existing barriers and the capacity of midwifery professionals to deliver high-quality care. The aim of this study is to describe the possibility of midwives being able to provide quality midwifery care in Bangladesh during the COVID-19 pandemic. METHODS: To gather insights, data were collected from July to October 2020 via four qualitative focus group discussions online; 23 actively practicing midwives, nurses specializing in midwifery care, and midwifery educators, participated. The data analysis employed reflexive thematic analysis. RESULTS: The COVID-19 crisis posed significant threats to women's safety and health, with lockdowns exacerbating gender inequalities in society. Midwives faced added challenges due to their relatively low professional status and increased workloads. Insufficient policy implementation further compromised midwives' safety. Fear of contracting the virus and working during their free time also raised concerns about the quality of care provided. Nevertheless, the pandemic provided opportunities for midwives to demonstrate their ability to deliver independent midwifery care in Bangladesh. CONCLUSIONS: The pandemic underscored the importance of creating respectful and dignified working conditions for midwives. It revealed that professional midwives can work independently when provided with the necessary space and a supportive work environment. This opens the door for the implementation of a midwifery-led care model. Further research is recommended to investigate the medical safety and efficacy of independent midwifery care in the context of Bangladesh.

Development and validation of Digi-MEE Instrument measuring online learning environments in medical education.

Objectives: To develop and validate Digital Medical Education Environment (Digi-MEE) Instrument for measuring online learning environment in medical education. Methods: This series of studies involved 696 participants from May 2022 to December 2022. Following scoping review, invited modified e-Delphi experts developed consensus on the components and related items for measuring online learning environments. A panel of content experts and a group of medical students carried out content and response-process validation to determine Content Validity Index (CVI) and Face Validity Index (FVI) respectively. This was followed by exploratory and confirmatory factor analysis and reliability analysis to determine Digi-MEE's factorial structure and internal consistency using SPSS version 26.0 and AMOS 26.0. Results: Delphi experts agreed upon nine components with 73 items of initial Digi-MEE version. CVI of Digi-MEE 2.0 was more than 0.90. with FVI of Digi-MEE 3.0 of 0.87. Exploratory factor analysis yielded 46 items with 57.18% variance. Confirmatory factor analysis led to the final Digi-MEE version containing 28 items within nine components with acceptable levels of goodness of fit indices. Overall Cronbach alpha of the final Digi-MEE was more than 0.90, and for the nine components ranged between 0.62 and 0.76. Conclusion: Digi-MEE is a promising valid and reliable instrument to evaluate online education environment in medical education. Content, response-process, factorial structure, and internal consistency evidence support the validity of Digi-MEE. Medical schools can use Digi-MEE as an evaluation tool for the continuous quality improvement of online learning environments.

Faculty Willingness For Continuing Online Teaching-Post COVID-19 Pandemic In Pakistan.

Objectives: To determine faculty willingness for continuing online education after coronavirus disease-2019 in Pakistan, and to correlate it with perceived gain in experience in online teaching during the pandemic. METHODS: The cross-sectional study was conducted at Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan, from January to July 2021, and comprised medical faculty with teaching experience of at least 2 years. Data was collected using an online questionnaire though Google Forms. Multiple regression analysis was done to determine faculty willingness with perceived experience levels in online education. Data was analysed using SPSS 25. RESULTS: Of the 100 subjects approached, 68(68%) responded; 51(75%) females and 17(25%) males. Of the total, 30(44.1%) participants were aged 33-40 years, 25(37%) were from Basic Sciences, 27(39.7%) from Clinical Sciences, 16(23.5%) from Allied Health Sciences, and 39(57.4%) had teaching experience <5 years.. Overall, 39 (57.4%) participants were willing to continue online education post-pandemic, 20(29.4%) agreed partially and 9 (13.2%) did not agree. A positive linear relationship was found between willingness to continue online education and increase in perceived experience level in teaching online (p=0.021). CONCLUSIONS: There was a significant difference between perceived experience level in online teaching before and after the coronavirus disease-2019 pandemic. Those with increase in perceived experience level were willing to continue online education.

Understanding the Functional Components of Technology-Enhanced Learning Environment in Medical Education: A Scoping Review.

Increasing use of technology in medical education has caused concerns to medical teachers pertaining to the quality of digital learning environments. Thus, this review aimed to unearth the functional components of effective technology-enhanced learning environment in the undergraduate medical education context. The revised Arksey and O'Malley protocol was utilized that include identification of research question and relevant studies, selection of studies, data charting and collection, and collating, summarizing, and reporting results after consultation. We discovered nine components with 25 subcomponents of 74 functional elements found to be present in effective online learning environments. The nine components include cognitive enhancement, content curation, digital capability, technological usability, pedagogical practices, learner characteristics, learning facilitator, social representations, and institutional support. There is an interplay between these components, influencing each other in online learning platforms. A technology-enhanced learning in medical education (TELEMEd) model is proposed which can be used as a framework for evaluating online learning environment in medical education. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01747-6.

Pediatric Neck Swelling: A Case Report of Fourth Branchial Cleft Cyst.

Pediatric neck masses present a diagnostic challenge, encompassing various etiologies, including rare entities like branchial cleft anomalies. Branchial cleft cysts, resulting from incomplete embryonic cleft obliteration, may become symptomatic. This case report describes a seven-year-old boy who presented with a week-long history of fever and progressively enlarging left anterior cervical swelling. Physical examination revealed a fluctuant, non-tender mass, prompting diagnostic investigations. Laboratory results indicated an elevated white blood cell count and inflammatory markers. Computed tomography identified a hypodense, rim-enhancing mass consistent with an abscess secondary to a fourth branchial cleft cyst. Ultrasound-guided aspiration yielded purulent material, confirming Staphylococcus aureus infection. This case highlights the clinical significance of fourth branchial cleft cysts as rare inflammatory neck masses in pediatric patients. The embryological context informs their diverse anatomical manifestations. Surgical excision remains the primary treatment, demanding consideration of anatomical complexities.

Observation of ionic conductivity on PUA-TBAI-I2 gel polymer electrolyte.

Jatropha oil-based polyurethane acylate gel polymer electrolyte was mixed with different concentrations of tetrabutylammonium iodide salt (TBAI). The temperature dependences of ionic conductivity, dielectric modulus and relaxation time were studied in the range of 298 to 393 K. The highest ionic conductivity of (1.88 ± 0.020) × 10-4 Scm-1 at 298 K was achieved when the gel contained 30 wt% of TBAI and 2.06 wt% of I2. Furthermore, the study found that conductivity-temperature dependence followed the Vogel-Tammann Fulcher equation. From that, it could be clearly observed that 30 wt% TBAI indicated the lowest activation energy of 6.947 kJ mol-1. By using the fitting method on the Nyquist plot, the number density, mobility and diffusion coefficient of the charge carrier were determined. The charge properties were analysed using the dielectric permittivity, modulus and dissipation factor. Apart from this, the stoke drag and capacitance were determined.

A narrative study on work place based conflicts in Obstetrics and Gynaecology Department.

OBJECTIVE: To explore the patterns in research and underlying factors of conflicts in obstetrics and gynaecology and its effect on restricting the quality of education and training of residents. METHODS: The narrative study was conducted at the Obstetrics and Gynaecology Department, Lady Aitchison Hospital, King Edward Medical University, Lahore, Pakistan, from October 2018 to January 2019, and comprised narrative essays by residents associated with the department. Data was subjected to thematic analysis. RESULTS: Of the 27 residents, 26(96.3%) were females and 1(3.7%) was male. Overall, 19(70.3%) were aged 25-30 years and 8(29.6%) were aged 30-35 years. Three levels of conflict were identified: organisational, interpersonal and individual. Causes of organisational conflict included inadequate facilities, poor security and unclear duty appointments. Interpersonal factors included lack of communication, lack of patient autonomy, non-cooperative co-workers, illiteracy of attendants and unprofessional behaviour. Individual factors were overburdening duty hours and duty negligence. CONCLUSIONS: There was found to be a need to design education programmes, like workshops, that may enable post-graduate residents in obstetrics and gynaecology to handle conflicts at workplace.

Stuck in the blend: Challenges faced by students enrolled in blended programs of Masters in Health Professions Education.

OBJECTIVES: The advent of computer technology and widespread use of internet has given rise to e-learning and blended programs all over the world. The aim of this study was to explore problems faced by students enrolled in blended program of MHPE in Pakistan. METHODS: This was a qualitative exploratory study done between October 2017 and February 2018. Data included semi-structured individual interviews of eighteen students and four facilitators involved in blended MHPE programs of three leading Universities of Pakistan. Nine hundred and two students' reflective essays were also included for data triangulation. Data was organized in Atlas-ti and analyzed through thematic analysis using Revised Community of Inquiry framework. RESULTS: Seventy open codes were condensed to fifteen sub-themes and five themes. Learner related problems comprised difficulty in self-regulation and self-directed learning as emphasized by the facilitators whereas students quoted teacher related problems focusing on feedback provision. Cognitive issues included huge cognitive load with engagement issues. Students also highlighted issues with social interaction encompassed difficulties in interacting with facilitators and managing group dynamics. Both students and facilitators agreed on institutional issues focused on limited resource provision, unsatisfactory administrative support and financial issues. CONCLUSION: Students of MHPE are challenged with variety of issues in blended learning program relating to self-regulation, heavy cognitive load with engagement, social interaction especially with facilitators and managing group dynamics Addressing these issues can improve the experience of these students in blended programs.

Temperature-dependent development of Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) and its larval parasitoid, Habrobracon hebetor (Say) (Hymenoptera: Braconidae): implications for species interactions.

Habrobracon hebetor (Say) is a parasitoid of various Lepidoptera including Helicoverpa armigera (Hübner), a key pest of different crops and vegetables. The development of both H. armigera and H. hebetor were simultaneously evaluated against a wide range of constant temperatures (10, 15, 17.5, 20, 25, 27.5, 30, 35, 37.5 and 40 °C). Helicoverpa armigera completed its development from egg to adult within a temperature range of 17.5-37.5 °C and H. hebetor completed its life cycle from egg to adult within a temperature range of 15-40 °C. Based on the Ikemoto and Takai model the developmental threshold (To) and thermal constant (K) to complete the immature stages, of H. armigera were calculated as 11.6 °C and 513.6 DD, respectively, and 13 °C and 148 DD, respectively, for H. hebetor. Analytis/Briere-2 and Analytis/Briere-1 were adjudged the best non-linear models for prediction of phenology of H. armigera and H. hebetor, respectively and enabled estimation of the optimum (Topt) and maximum temperature (Tmax) for development with values of 34.8, 38.7, 36.3, and 43 °C for host and the parasitoid, respectively. Parasitisation by H. hebetor was maximal at 25 °C but occurred even at 40 °C. This study suggests although high temperature is limiting to insects, our estimates of the upper thermal limits for both species are higher than previously estimated. Some biological control of H. armigera by H. hebetor may persist in tropical areas, even with increasing temperatures due to climate change.

Cross-cultural measurement invariance of the Revised Child Anxiety and Depression Scale across 11 world-wide societies.

BACKGROUND: In order to compare estimates by one assessment scale across various cultures/ethnic groups, an important aspect that needs to be demonstrated is that its construct across these groups is invariant when measured using a similar and simultaneous approach (i.e., demonstrated cross-cultural measurement invariance). One of the methods for evaluating measurement invariance is testing for differential item functioning (DIF), which assesses whether different groups respond differently to particular items. The aim of this study was to evaluate the cross-cultural measurement invariance of the Revised Child Anxiety and Depression Scale (RCADS) in societies with different socioeconomic, cultural, and religious backgrounds. METHODS: The study was organised by the International Child Mental Health Study Group. Self-reported data were collected from adolescents residing in 11 countries: Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestinian Territories, the Philippines, Portugal, Romania and Serbia. The multiple-indicators multiple-causes model was used to test the RCADS items for DIF across the countries. RESULTS: Ten items exhibited DIF considering all cross-country comparisons. Only one or two items were flagged with DIF in the head-to-head comparisons, while there were three to five items flagged with DIF, when one country was compared with the others. Even with all cross-culturally non-invariant items removed from nine language versions tested, the original factor model representing six anxiety and depressive symptoms subscales was not significantly violated. CONCLUSIONS: There is clear evidence that relatively small number of the RCADS items is non-invariant, especially when comparing two different cultural/ethnic groups, which indicates on its sound cross-cultural validity and suitability for cross-cultural comparisons in adolescent anxiety and depressive symptoms.

Phalangeal Osteosarcoma Mistaken for Tuberculosis: A Case Report.

We report a 21-year old female patient who presented with an 18-month history of a swelling in the distal phalanx of her right little finger. Although the history, clinical features and MRI were suggestive of a benign tumour or a tuberculous lesion, the histo-pathological examination of the swelling was reported as a conventional osteosarcoma. Osteosarcoma of the hand is very rare. This article highlights the possibility of a seemingly benign lesion seen in a routine clinic could well turn out to be malignant, and the need to maintain a high index of suspicion.

A method based on impedance spectroscopy to determine transport properties of polymer electrolytes.

In this work, we introduce a method based on impedance spectroscopy and the equations developed to evaluate, with a good degree of accuracy, the number density, mobility and diffusion coefficient of mobile ions. Nyquist plots of electrolytes based on poly(acrylonitrile) or PAN and methyl cellulose (MC) incorporated with lithium bis(oxalato)borate have been established from impedance measurements. Equivalent circuits based on a resistor and "leaky capacitor(s)" have been determined and the relevant impedance equations derived. The values of the parameters required in the equation are obtained from the Nyquist plots and the parameters that cannot be obtained from the respective plots have been obtained by trial and error in order to fit the Nyquist plots. The transport parameters are calculated using the developed equations and the results have been compared with those obtained from the broadband dielectric response (BDR) method. Finally, Fourier transform infrared (FTIR) spectroscopy has been used to verify the results obtained from the two approaches at room and elevated temperatures.

Non-Hodgekin's lymphoma of female genital tract: a case report.

Non-Hodgkin lymphoma (NHL) causes many deaths worldwide with increasing incidence. Non-Hodgkin's lymphoma (NHL) may involve the gynecologic tract, and the ovary to be one of the commoner anatomic sites as reported. Ovarian involvement by NHL is usually secondary, occurring as a part of systemic disease. The diagnosis is often made incidentally while investigating for gynecological symptoms. We report an interesting case of NHL in a 35 year old female, who primarily presented with acute abdomen disease with secondary ovarian and cervical involvement and occult extra-ovarian disease.

Scanning electron microscopic evaluation of the successful sterilization of Lucilia cuprina (Wiedemann) utilized in maggot debridement therapy (mdt).

In Malaysia, maggot debridement therapy (MDT) utilizes maggots of Lucilia cuprina (Wiedemann) to debride necrotic tissue from wound surface, reduce bacterial infection and therefore, enhance wound healing process. To evaluate the sterility of the sterile maggots produced after sterilization process before delivering onto patient wounds. Sterility of sterile maggots is crucial in ensuring the safe usage of MDT and patient's health. Eggs of L. cuprina collected from a laboratory colony were divided into treated group (sterilized) and control group (non-sterilized). Treated group underwent sterilization while eggs from control group were allowed to hatch without sterilization. Sodium hypochlorite and formaldehyde were the main disinfectants used in this sterilization process. Scanning electron microscope (SEM) was used to examine and ascertain the sterility of sterile maggots. SEM results showed that all sterilized L. cuprina eggs and maggots achieved sterility and all were cleared from bacterial contamination. In contrast, all non-sterilized eggs and maggots were found to be colonized by microorganisms. Sterilization method employed to sterilize eggs and maggots used in Malaysia MDT was proven successful and MDT is safe to be used as wound management tools.

Scanning electron microscopic evaluation of the successful sterilization of Lucilia cuprina (Wiedemann) utilized in maggot debridement therapy (mdt)

In Malaysia, maggot debridement therapy (MDT) utilizes maggots of Lucilia cuprina (Wiedemann) to debride necrotic tissue from wound surface, reduce bacterial infection and therefore, enhance wound healing process. To evaluate the sterility of the sterile maggots produced after sterilization process before delivering onto patient wounds. Sterility of sterile maggots is crucial in ensuring the safe usage of MDT and patient’s health. Eggs of L. cuprina collected from a laboratory colony were divided into treated group (sterilized) and control group (non-sterilized). Treated group underwent sterilization while eggs from control group were allowed to hatch without sterilization. Sodium hypochlorite and formaldehyde were the main disinfectants used in this sterilization process. Scanning electron microscope (SEM) was used to examine and ascertain the sterility of sterile maggots. SEM results showed that all sterilized L. cuprina eggs and maggots achieved sterility and all were cleared from bacterial contamination. In contrast, all non-sterilized eggs and maggots were found to be colonized by microorganisms. Sterilization method employed to sterilize eggs and maggots used in Malaysia MDT was proven successful and MDT is safe to be used as wound management tools.

Habitat characterization and mapping of Anopheles maculatus (Theobald) mosquito larvae in malaria endemic areas in Kuala Lipis, Pahang, Malaysia.

In Peninsular Malaysia, a large proportion of malaria cases occur in the central mountainous and forested parts of the country. As part of a study to assess remote sensing data as a tool for vector mapping, we conducted entomological surveys to determine the type of mosquitoes, their characteristics and the abundance of habitats of the vector Anopheles maculatus in malaria endemic areas in Pos Senderot. An. maculatus mosquitoes were collected from 49 breeding sites in Pos Senderot. An. maculatus preferred to breed in water pockets formed on the bank of rivers and waterfalls. The most common larval habitats were shallow pools 5.0-15.0 cm deep with clear water, mud substrate and plants or floatage. The mosquito also preferred open or partially shaded habitats. Breeding habitats were generally located at 100-400 m from the nearest human settlement. Changes in breeding characteristics were also observed. Instead of breeding in slow flowing streams, most larvae bred in small water pockets along the river margin.

AK-2123 (Sanazol) as a radiation sensitizer in the treatment of stage III cervical cancer: results of an IAEA multicentre randomised trial.

PURPOSE: AK-2123, a nitrotriazole hypoxic cell sensitizer, has reportedly improved results in head and neck cancers, uterine cervical cancers and other solid tumours when added to radical radiotherapy. A prospectively randomised trial was initiated by the International Atomic Energy Agency (IAEA) evaluating AK-2123 and radiotherapy in treatment of uterine cervical cancer stage III and IV. PATIENTS AND METHODS: A total of 462 patients were randomised from 8 centres. Patients from four centres were excluded due to lack of accrual, closing of the centre and insufficient documentation and reporting. The final study population consisted of 333 patients who were randomised between May 1995 and December 1998. Patients were randomised to either standard radical treatment (radiation therapy alone, RT) or standard radical radiotherapy and additional administration of AK-2123 (RT+AK-2123). The total dose of 45-50.8 Gy was delivered by 20-28 fractions in an overall time of 4-5 1/2 weeks, with further dose escalation by brachytherapy or external beam. In the study arm, patients received 0.6 g/sqm AK-2123 by intravenous administration before external beam radiotherapy, treating with AK-2123 on alternate days (e.g. Monday-Wednesday-Friday) during the entire course of external beam therapy. Following exclusion of 7 patients who did not undergo treatment, a total of 326 patients remained for evaluation. RESULTS: The rate of local tumour control was significantly higher in the group after radiotherapy and additional administration of AK-2123. Local tumour control was 61% (95/155) after AK-2123 and 46% (79/171) after radiotherapy alone (p=0.006). The actuarial survival at 60 months was 57% after RT+AK-2123, compared to 41% after RT (Log Rank p=0.01). AK-2123 did neither increase gastro-intestinal toxicity nor was it attributed to any haematological toxicity. A mild peripheral toxicity (Grade 1: 13% and Grade 2: 2%) usually completely reversible was infrequently seen after AK-2123 administration. CONCLUSION: We conclude that the addition of AK-2123 to radical radiotherapy significantly increases local tumour control and survival in advanced squamous cell cancer of the uterine cervix without the addition of any major toxicity.

Distribution and abundance of diurnal and nocturnal dipterous flies in the Federal Territory, Putrajaya.

A study of diurnal and nocturnal distribution of flies was conducted in Putrajaya. Six different ecological habitats were selected, namely: botanical garden, lake-area, administration building, wetland, jungle fringes and housing areas. Two different type of traps, cylinderical and rectangular in shape were used in the study. Baits used in these traps were yeast, sugar, salted fish, shrimp paste and fresh liver. Traps were placed at the sites throughout the diurnal and nocturnal periods. The time for sunrise and sunset was determined using a Geographical Positioning System gadget (GARMIN) at the sites. Both type of traps were equally effective in trapping flies. There was no significant difference between both types of traps in their ability to trap flies (p > 0.05). A total of 1,534 flies were collected and identified from both types of trap using the multiple baits and habitats. The collection consisted of 23 species of flies classified under 6 families. The highest number of flies were caught from the lake-area followed by botanical garden, administration building, housing areas, wetland and jungle fringes. The most dominant species was Chrysomya megacephala, followed by species of Sarcophagidae and Musca domestica. Diurnal period had more numbers of flies (81.55%) compared to the nocturnal periods (18.45%). Some species of flies were strictly diurnal, some exibited both diurnal and nocturnal activities while only one species was strictly nocturnal.

Field bioefficacy of deltamethrin residual spraying against dengue vectors.

Field bioefficacy of residual-sprayed deltamethrin against Aedes vectors was evaluated in an urban residential area in Kuala Lumpur. The trial area consisted of single storey wood-brick houses and a block of flat. The houses were treated with outdoor residual spraying while the flat was used as an untreated control. Initial pre-survey using ovitrap surveillance indicated high Aedes population in the area. Deltamethrin WG was sprayed at a dosage of 25mg/m2 using a compression sprayer. The effectiveness of deltamethrin was determined by wall bioassay and ovitrap surveillance. The residual activity of 25mg/m2 deltamethrin was still effective for 6 weeks after treatment, based on biweekly bioassay results. Bioassay also indicated that both Aedes aegypti and Aedes albopictus were more susceptible on the wooden surfaces than on brick. Aedes aegypti was more susceptible than Ae. albopictus against deltamethrin. Residual spraying of deltamethrin was not very effective against Aedes in this study since the Aedes population in the study area did not reduce as indicated by the total number of larvae collected using the ovitrap (Wilcoxon Sign Test, p> 0.05). Further studies are required to improve the effectiveness of residual spraying against Aedes vectors.