Search results for: hospital costs

Authors: Sutinon Yuchomsuk, Satchachon Changthom, Pruet Areesawangvong, Monsiri Jinapen

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Background: Esophageal squamous cell carcinoma can be presented with many symptoms, such as dysphagia or weight loss. However, in some circumstances, rare presentations can be found, e.g., dyspnea, which is more common in pulmonary malignancy. And dyspnea is also one of the most common presentations of COVID-19 infection. So, in this case, we can learn from many points in patient symptoms and findings leading to the diagnosis of esophageal squamous cell carcinoma. Method: This research is a case-report study including one patient from Mahasarakham Hospital, Thailand. Data were collected during December 2021. Result: A 55-year-old Thai male patient with an unknown past medical history presented with dyspnea and shortness of breath for the duration of three days prior to admission. His symptom also included cough, fever, and sore throat. Laboratory results indicated that the patient had COVID-19 pneumonia. Further investigation showed that he had cardiac tamponade and suspected pulmonary/esophageal cancer. Lung biopsy and pericardiocentesis were done, which were positive for carcinoma from pericardial effusion but negative for malignancy from the lung biopsy. Later esophagogastroduodenoscopy was done with endoscopic tissue biopsy; the result was positive for squamous cell carcinoma of the esophagus. Conclusion: Most commonly, esophageal cancer is presented with dysphagia or weight loss. However, in some rare cases, patients can also be presented with dyspnea due to cardiac tamponade. And in recent years, COVID-19 has become a pandemic all over the world, sometimes masking symptoms of other diseases. Such as in this case, the patient didn’t improve after the pneumonia was resolved, which led to the final diagnosis of metastatic esophageal cancer.

Keywords: esophageal cancer, cardiac tamponade, metastatic squamous cell carcinoma, COVID-19 infection

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Authors: Thais Cavalheri Santos, Pedro Jose Gabriel Ferreira, Alexandre Daliberto Frugoli, Lucio Leonardo, Pedro Americo Frugoli

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This paper presents a low cost education proposal to be used in engineering courses. The engineering education in universities of a developing country that is in need of an increasing number of engineers carried out with quality and affordably, pose a difficult problem to solve. In Brazil, the political and economic scenario requires academic managers able to reduce costs without compromising the quality of education. Within this context, the elaboration of a physics principles teaching method with the construction of an electronic balance is proposed. First, a method to develop and construct a load cell through which the students can understand the physical principle of strain gauges and bridge circuit will be proposed. The load cell structure was made with aluminum 6351T6, in dimensions of 80 mm x 13 mm x 13 mm and for its instrumentation, a complete Wheatstone Bridge was assembled with strain gauges of 350 ohms. Additionally, the process involves the use of a software tool to document the prototypes (design circuits), the conditioning of the signal, a microcontroller, C language programming as well as the development of the prototype. The project also intends to use an open-source I/O board (Arduino Microcontroller). To design the circuit, the Fritizing software will be used and, to program the controller, an open-source software named IDE®. A load cell was chosen because strain gauges have accuracy and their use has several applications in the industry. A prototype was developed for this study, and it confirmed the affordability of this educational idea. Furthermore, the goal of this proposal is to motivate the students to understand the several possible applications in high technology of the use of load cells and microcontroller.

Keywords: Arduino, load cell, low-cost education, strain gauge

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Authors: Dhanashree Moghe, Roberta Bullingham, Rizwan Ahmed, Tarun Singhal

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Aim: The NHS Bowel Screening Programme recommends the use of endoscopic tattooing for suspected malignant lesions that later require surgical or endoscopic localisation, using local protocols as guidance. This is in accordance with guidance from the BSG (The British Society of Gastroenterologists). We used a well-recognised local protocol as a standard to audit current tattooing practice in a large district general hospital with no current local guidelines. Method: A retrospective quantitative analysis of 50 patients who underwent segmental colonic resection for cancer over a 6-month period in 2021. We reviewed historic electronic endoscopy reports recording relevant data on tattoo indication and placement. Secondly, we carried out an anonymous survey of 16 independent lower GI endoscopists on self-reported details of their practice. Results: In our study, 28 patients (56%) had a tattoo placed at the time of their colonoscopy. Of these, only 53% (n=15) had the tattoo distal to the lesion, with the measured distance of the tattoo from the lesion only being documented in 8 reports. Only seven patients (25%) had a circumferential (4 quadrant) placement of the tattoo. 13 patients had lesions either in the caecum or rectum, locations deemed unnecessary as per BSG guidelines. Of the survey responses collected, there were four different protocols being used to guide practice. Only 50% of respondents placed tattoos at the correct distance from the lesion, and 83% placed the correct number of tattoos. Conclusion: There is a lack of standardisation of practices in colonic tattooing demonstrated in our study with incomplete compliance to our standard. The inadequate documentation of tattoo location can contribute to confusion and inaccuracy in the intraoperative localisation of lesions. This has the potential to increase operation length and morbidity. There is a need to standardise both technique and documentation in colonoscopic tattooing practice.

Keywords: colorectal cancer, endoscopic tattooing, colonoscopy, NHS BSCP

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Authors: Thinakar Mani Balusamy, Ratnakar S. Kini, Bharat Narasimhan, Venkateswaran A. R, Pugazhendi Thangavelu, Mohammed Ali, Prem Kumar K., Kani Sheikh M., Sibi Thooran Karmegam, Radhakrishnan N., Mohammed Noufal

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Introduction: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining nine presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed nonoperatively. Nine patients had a severe injury ( > grade 3) – of which four underwent endotherapy, three had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed nonoperatively, three underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Keywords: endotherapy, non-operative management, surgery, traumatic pancreatic injury

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Authors: Angelica Gonzalez O, Leonardo Rivera Cadavid, Diego Fernando Manotas

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Energy poverty considers a population that does not have access to modern energy service. In particular, an area of a country that is not connected to the national electricity grid is known as a Non-Interconnected Zone (NIZ). Access to electricity has a significant impact on the welfare and development opportunities of the population. Different studies have shown that most health problems have an empirical cause and effect relationship with multidimensional energy poverty. Likewise, research has been carried out to review the consequences of not having access to electricity, and its results have concluded a statistically significant relationship between energy poverty and sources of drinking water, access to clean water, risks of mosquito bites, obesity, sterilization, marital status, occupation, and residence. Therefore, extensive research has been conducted in the construction of an energy poverty measure based on an index. Some of these studies introduce a Multidimensional Energy Poverty Index (MEPI), Compose Energy Poverty Index (CEPI), Low Income High Costs indicator (LIHC), among others. For this purpose, this study analyzes the energy poverty index using a multicriteria analysis determining the set of feasible alternatives - for which Colombia's ZNI will be used as a case study - to be considered in the problem and the set of relevant criteria in the characterization of the ZNI, from which the prioritization is obtained to determine the level of adjustment of each alternative with respect to the performance in each criterion. Additionally, this study considers the installation of Micro-Grids (MG). This is considered a straightforward solution to this problem because an MG is a local electrical grid, able to operate in grid-connected and island mode. Drawing on those insights, this study compares an energy poverty index considering an MG installation and calculates the impacts of different criterias in an energy poverty index in NIZ.

Keywords: multicirteria, energy poverty, rural, microgrids, non-interconnect zones

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Authors: Sahar Iqrar, Malik Adeel Anwar, Zain Akram, Maria Noor

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Introduction: Oral lichen planus is a chronic inflammatory condition of unknown etiology. Oral lichen planus may be related with several other diseases. Grinspan's Syndrome is characterized by a triad of oral lichen planus, hypertension, and diabetes mellitus. Other associations reported in the literature are with chronic liver disease and, with dyslipidemia. The nature of these associations is still not fully understood. Material and methods: Study was conducted in Department of Oral Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan. A total of n=89 clinically diagnosed patients of oral lichen planus of both gender and all age groups were recruited and detailed history were recorded in the designed performs. Results: A total of n=89 patients were taken with male to female ratio of 3:8 in which 24 were male and 65 females. Mean age was 48.8 ± 13.8 years. Age range of 10-74 years was seen. Among these patients suffering from oral lichen planus, 41.6% (n=37) had a positive history for hypertension with 59.5% (n=22) of these patients were taking different medication for their condition. Whereas Diabetes Mellitus was found in 24.7% (n=22) patients with 72.7% (n=16) of these patients using the hypoglycemic drug (oral or injectable) to control their blood glucose levels. Out of these n=89 lichen planus patients 21.3% had both hypertension and diabetes mellitus (fulfilling the criteria for Grinspan's Syndrome). Out of this Grinspan's Syndrome pool 94.7% (n=19) were taking drug atleast for one of the two conditions. Conclusion: As noticed form the medical history of the patients, most of them were using hypoglycemic drugs for diabetes mellitus and beta blockers, diuretics and calcium channel blockers for hypertension. These drugs are known for lichenoid reaction. Therefore, it should be ruled out at histopathological/ immunological and molecular level whether these patients are suffering from lichen planus or lichenoid drug reaction to truly declare them as patients with Grinspan’s Syndrome.

Keywords: diabetes mellitus, grinspan's syndrome, lichenoid drug reaction, oral lichen planus

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Authors: Meghan Biallas, Amanda Hoffman, Tamara Miller, Kimmy Schnibben, Janaina Siegler

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This paper assesses Walmart’s supply chain resiliency amidst continuous supply chain disruptions. It aims to evaluate how Walmart can use supply chain resiliency theory to retain its status as a global supply chain leader. The Bloomberg terminal was used to organize Walmart’s 754 Tier-1 suppliers by the size of their relationship to Walmart. Additional data from IBISWorld and Statista was also used in the analysis. This research focused on the top ten Tier-1 suppliers, with the greatest percentage of their revenue attributed to Walmart. This paper also applied the firm’s information to the Supply Chain Resilience Assessment and Management (SCRAM) framework for supply chain resiliency to evaluate the firm’s capabilities, vulnerabilities, and gaps. A rubric was created to quantify Walmart’s risks using four pillars: flexibility, velocity, visibility, and collaboration. Information and examples were reported from Walmart’s 10k filing. For each example, a rating of 1 indicated “high” resiliency, 0 indicated “medium” resiliency, and -1 indicated “low” resiliency. Findings from this study include the following: (1) Walmart has maintained its leadership through its ability to remain resilient with regard to visibility, efficiency, capacity, and collaboration. (2) Walmart is experiencing increases in supply chain costs due to internal factors affecting the company and external factors affecting its suppliers. (3) There are a number of emerging supply chain risks with Walmart’s suppliers, which could cause issues for Walmart to remain a supply chain leader in the future. Using the SCRAM framework, this paper assesses how Walmart measures up to the Supply Chain Resiliency Theory, identifying areas of strength as well as areas where Walmart can improve in order to remain a global supply chain leader.

Keywords: supply chain resiliency, zone of balanced resilience, supply chain resilience assessment and management, supply chain theory.

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Authors: Elham Sharif, Nasser Rizk, Sirin Abu Aqel, Ofelia Masoud

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Background: Previous studies have investigated the association of rs1544410, rs7975232 and rs731236 polymorphisms in vitamin D receptor gene and its impact on diseases such as cancer, diabetes and hypertension in different ethnic backgrounds. Aim: The aim of this study is to investigate the association between VDR polymorphisms using three SNP’s (rs1544410, rs7975232 and rs731236) and the severity of the significant lesion in coronary arteries among angiographically diagnosed CAD. Methods: A prospective-retrospective study was conducted on 192 CAD patients enrolled from the cardiology department-Heart Hospital HMC, grouped in 96 subjects with significant stenosis and 96 with non-significant stenosis with a mean age between 30 and 75 years old. Genotyping was performed for the following SNPs rs1544410, rs7975232 and rs731236 using TaqMan assay by the Real Time PCR, ABI 7500 in Health Sciences Labs at Qatar University Biomedical Research Center. Results: The results showed that both groups have matched age and gender distribution but patients with the significant stenosis have significantly higher; BMI (p=0.047); smoking status (p=0.039); FBS (p= 0.031); CK-MB (p=0.025) and Troponin (p=0.002) than the patients with non–significant lesion. Among the traditional risk factors, smoking increases the odds of the severe stenotic lesion in CAD patients by 1.984, with 95% CI between 1.024 – 7.063, with p= 0.042.HWE showed deviations of the rs1544410 and rs731236 among the study subjects. The most frequent genotype in distribution of rs7975232 is the AA among the significant stenosis patients, while the heterozygous AC was the frequent genotype in distribution among the non-significant stenosis group. The carriers of CC genotype in rs7975232 increased the risk of having significant coronary arteries stenotic lesion by 1.83 with 95% CI (1.020 – 3.280), p=0.043. No association was found between the rs7975232 with vitamin D and VDBP. Conclusion: There is a significant association between rs7975232 and the severity of CAD lesion. The carrier of CC genotype in rs7975232 increased the risk of having significant coronary arteries atherosclerotic lesion especially in patients with smoking history independent of vitamin D.

Keywords: vitamin D, vitamin D receptor, polymorphism, coronary harat disease

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Authors: Vered Shenaar-Golan, Nava Wald, Uri Yatzkar

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Background: Parenting children with mental health problems poses multiple challenges, including coping with difficult behavior and negative child emotions. The impact on parents includes financial strain, negative social stigma, and negative feelings of guilt or blame, resulting in significant stress and lower levels of well-being. Given findings that self-compassion plays a significant role in reducing stress and improving well-being, the current study examined the role of self-compassion in the experience of parents raising a child with mental health problems. The study tested (1) whether child behavioral/emotional problem severity is associated with higher parental stress and lower parental well-being; (2) whether self-compassion is associated with lower parental stress and higher parental well-being; and (3) whether self-compassion is a stronger predictor of parental stress and well-being than child behavioral/emotional problem severity. Methods: Three hundred and six mothers and two hundred and fifty-six fathers of children attending a hospital child and adolescent psychiatric center were assessed at admission. Consenting parents completed four questionnaires: Child Strength and Difficulty – parent version, Self-compassion, Parent Feeling Inventory, and Well-Being. Results: Child behavioral/emotional problem severity was associated with higher parental stress and lower parental well-being, and self-compassion was a stronger predictor of parental stress and well-being levels than child behavioral/emotional problem severity. For children with internalizing but not externalizing behavioral/emotional problems, parental self-compassion was the only predictor of parental well-being beyond the severity of child behavioral/emotional problems. Conclusions: Cultivating self-compassion is important in reducing parental stress and increasing parental well-being, particularly with internalizing presentations, and should be considered when designing therapeutic interventions for parents.

Keywords: parenting children with mental health problems, self-compassion, parental stress, feelings, well-being

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Authors: Omolara Lade, David Oloke

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The approach to water management worldwide is currently in transition, with a shift from centralised infrastructures to greater consideration of decentralised technologies, such as rainwater harvesting (RWH). However, in Nigeria, implementation of sustainable water management, such as RWH systems, is inefficient and social, environmental and technical barriers, concerns and knowledge gaps exist, which currently restrict its widespread utilisation. This inefficiency contributes to water scarcity, water-borne diseases, and loss of lives and property due to flooding. Meanwhile, several RWH technologies have been developed to improve SWM through both demand and storm-water management. Such technologies involve the use of reinforced concrete cement (RCC) storage tanks, surface water reservoirs and ground-water recharge pits as storage systems. A framework was developed to assess the significance and extent of water management problems, match the problems with existing RWH-based solutions and develop a robust ready-to-use decision support tool that can quantify the costs and benefits of implementing several RWH-based storage systems. The methodology adopted was the mixed method approach, involving a detailed literature review, followed by a questionnaire survey of household respondents, Nigerian Architects and Civil Engineers and focus group discussion with stakeholders. 18 selection attributes have been defined and three alternatives have been identified in this research. The questionnaires were analysed using SPSS, excel and selected statistical methods to derive weightings of the attributes for the tool. Following this, three case studies were modelled using RainCycle software. From the results, the MDA model chose RCC tank as the most appropriate storage system for RWH.

Keywords: rainwater harvesting, modelling, hydraulic assessment, whole life cost, decision support system

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Authors: Mohammad Ansari, Satinder Mann, Ahmed Ismail

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Primary care patients in Emergency Departments (ED) have been the topic of discussion since 1998 in the United Kingdom. Numerous studies have analysed attendances in EDs retrospectively and suggest that at least one third to fifty percent patients attending ED with problems which could be managed appropriately in General Practice or minor injuries units. The pattern of ED Usage seems to be International. In Australia and many departments in the United States include walk in facilities staffed by physicians on family practice residency programme. It clearly appears in the United Kingdom that EDs have to accept that such patients with primary care problems will attend the ED and facilities will have to be provided to see and treat such patients. Urgent care centres were introduced in the United Kingdom nearly a decade ago to reduce the pressure on EDs. Most of these were situated near pre-existing EDs. Unfortunately these centres failed to have the desired effect of reducing the number of patients visiting EDs, it has been noticed that when more patients were seen in Urgent Care centres there were increased attendances in ED as well. A new model of Urgent Care centre was started in the ED of George Eliot Hospital, Nuneaton, UK. We looked at the working of the centre by looking at the number of patients seen daily against the number of total attendances in the ED. We studied the number and type of patients seen by the Urgent Care Doctor. All the medical records of the patients were seen and the time patients spent in the Urgent Care centre was recorded. The total number of patients seen during this study were 1532. 219 (14.3% ) were seen within our Urgent Care centre. None of the patients waited over four hours to be seen. It has been recognised that primary care patients in the ED are a major part of attendances of the department and unless these patients are seen in Urgent Care centres, overcrowding and long waits cannot been avoided. It has been shown that employing primary care Physicians in Urgent Care centres reduces overall cost because they do not carry out as many investigations as Junior Doctors. In our study over 14% patients were seen by Urgent Care Physicians and none of the patients waited for more than four hours and we feel that care provided to the patients by Urgent Care centre was highly effective and satisfying for the patient.

Keywords: urgent care centres, primary care physicians, overcrowding, cost

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Authors: Stephanie Nihan, Jayson M. Fadrigalan, Pyay P. San, Steven M. Santos, Weihui Li

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People of all ages who use wheelchairs are left with the inconvenience of not having an easy way to take their vital signs. Typically, patients are required to visit the hospital in order to take the vital signs. VitalGO is a wheel chair system that equipped with medical devices to take vital signs and then transmit data to a mobile application for convenient, long term health monitoring. The vital signs include oxygen saturation, heart rate, and blood pressure, breathing rate and body temperature. Oxygen saturation and heart rate are monitored through pulse oximeter. Blood pressure is taken through a radar sensor. Breathing rate is derived through thoracic impedance while body temperature is measured through an infrared thermometer. The application receives data through bluetooth and stores in a database for review in a simple graphical interface. The application will have the ability to display this data over various time intervals such as a day, week, month, 3 months, 6 months and a year. The final system for the mobile app can also provide an interface for both the user and their physician(s) to record notes or keep record of daily symptoms that a patient might be having. The user’s doctor will be granted access by the user to view the patient information for assistance with a more accurate diagnosis. Also, this wheelchair accessory conveniently includes a foldable table/desk as somewhere to place an electronic device that may be used to access the app. The foldable table will overall contribute to the wheelchair user’s increased comfort and will give them somewhere to place food, a book, or any other form of entertainment that would normally be hard to juggle on their lap.

Keywords: wheel chair, vital sign, mobile application, telemedicine

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Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

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Authors: Kamyar Maleki Bagherabadi, Torstein Aarseth Bø, Truls Flatberg, Olve Mo

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Hydrogen fuel cells and batteries are one of the promising solutions aligned with carbon emission reduction goals for the marine sector. However, the higher installation and operation costs of hydrogen-based systems compared to conventional diesel gensets raise questions about the appropriate hydrogen tank size, energy, and fuel consumption estimations. Ship designers need methodologies and tools to calculate energy and fuel consumption for different component sizes to facilitate decision-making regarding feasibility and performance for retrofits and design cases. The aim of this work is to compare three alternative modeling approaches for the estimation of energy and fuel consumption with various hydrogen tank sizes, battery capacities, and load-sharing strategies. A fishery vessel is selected as an example, using logged load demand data over a year of operations. The modeled power system consists of a PEM fuel cell, a diesel genset, and a battery. The methodologies used are: first, an energy-based model; second, considering load variations during the time domain with a rule-based Power Management System (PMS); and third, a load variations model and dynamic PMS strategy based on optimization with perfect foresight. The errors and potentials of the methods are discussed, and design sensitivity studies for this case are conducted. The results show that the energy-based method can estimate fuel and energy consumption with acceptable accuracy. However, models that consider time variation of the load provide more realistic estimations of energy and fuel consumption regarding hydrogen tank and battery size, still within low computational time.

Keywords: fuel cell, battery, hydrogen, hybrid power system, power management system

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Authors: A. Aldawsari

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The complex issue of women working in a mixed-gender work environment has its roots in social and cultural factors. This research was done to identify and explore the social and cultural challenges Saudi women face in a mixed-gender work environment in Saudi Arabia. Over the years, Saudi women in mixed-gender work environments in Saudi Arabia have been of interest in various research areas, especially within the context of a hospital work environment. This research, which involves a female researcher interacting one-on-one with Saudi women, will address this issue as well as the effect of the 2030 Vision in Saudi Arabia, and it will aim to include several new fields of work environments for women in Saudi Arabia. The aim of this research is to examine the perceptions of Saudi women who work in a mixed gender environment regarding the general empowerment of women in these settings. The objective of this research is to explore the cultural and social challenges that influence Saudi women's rights to work in a mixed-gender environment in Saudi Arabia. The significance of this research lies in the fact that there is an urgency to resolve issue of female employment in Saudi Arabia, where Saudi women still suffer from inequality in employment opportunity. Although the Saudi government is seeking to empower women by integrating them into a mixed-gender work environment, which is a key goal and prominent social change advocated for in the 2030 Vision, this same goal is one of the main challenges in the face of achieving female empowerment. The methodology section focuses on appropriate methods that can be used to study the effect of social and cultural challenges on the employment of women. It then determines the conditions and limitations of the research by applying a qualitative research approach to the investigation and analysing the data collected from the interviews. A statistical analysis tool, such as NVivo, will be used for the qualitative analysis of the interviews. The study found that the factor most responsible for creating social and cultural challenges is family—whether close family or distant family—more so than tribe or community.

Keywords: women, work, mixed-gender, environment

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Authors: Anamika A. Sharma, Arezou Ahmadi R. A., Narendra B. Parihar, Manjusha Sajith

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Introduction: Hemodialysis is the most effective therapeutic technique for patient with ESRD second to renal transplantation. However it is a lifelong therapy which requires frequent hospital, or dialysis centers visits mainly twice and thrice weekly, thus considerably changes the normal way of patient’s living. So this study aimed to Assess Health-Related Quality of life in End-Stage Renal Disease (ESRD) Undergoing Twice and Thrice weekly Hemodialysis. Method: A prospective observational, cross-sectional study was carried out from September 2016 to April 2017 in end-stage renal disease patients undergoing hemodialysis. Socio-demographic and clinical details of patients were obtained from the medical records. WHOQOL-BREF questionnaire was used to Access Health-Related Quality Of Life. Quality of Life scores of Twice weekly and Thrice weekly hemodialysis was analyzed by Kruskal Wallis Test. Results: Majority of respondents were male (72.55%), married (89.31%), employed (58.02%), belong to middle class (71.00%) and resides in rural area (58.78%). The mean ages in the patient undergoing twice weekly and thrice weekly hemodialysis were 51.89 ± 15.64 years and 51.33 ± 15.70 years respectively. Average Quality of Life scores observed in twice weekly and thrice weekly hemodialysis was 52.07 ± 13.30 (p=0.0037) and 52.87 ± 13.47 (p=0.0004) respectively. The hemoglobin of thrice weekly dialysis patients (10.28 gm/dL) was high as compared to twice weekly dialysis (9.23 gm/dL). Patients undergoing thrice weekly dialysis had improved serum urea, serum creatinine values (95.85 mg/dL, 8.32 mg/dL) as compared to twice weekly hemodialysis ( 104.94 mg/dL, 8.68 mg/dL). Conclusion: Our study concluded that there was no significant difference between overall Health-Related Quality Of Life in twice weekly and thrice weekly hemodialysis. Frequent hemodialysis was associated with improved control of hypertension, serum urea, serum creatinine levels.

Keywords: end stage renal disease, health related quality of life, twice weekly hemodialysis, thrice weekly hemodialysis

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Authors: Lim Poh Im

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This paper examines the current strategic and planning issues in the provision of affordable housing in urban centres in Malaysia from the perspective of sustainability. Sustainability here refers to social sustainability such as the need to address urban poverty and ensure better quality of life; economic sustainability in ensuring that the financial mechanisms are healthy and stable in the long-run, and to a lesser extent, environmental sustainability in reducing pollution related problems and building footprint. The Malaysian affordable housing sector has undergone tremendous transformations since the sixties, transcending from the earlier social housing catering to the poorer strata of the society, to the current state of housing woes plaguing the young urban middle class. The increase in urban land prices and construction costs, coupled with rampant property speculative and manipulative activities have resulted in situations of housing that are largely unaffordable even to the middle income sector of the urban populations. To overcome such scenario, the public as well as private sectors in the recent years, have came up with various intermediate, as well as medium-term policies aimed to curb the burning housing needs of the urban populations. Key strategies include financial intervention in regulating the interests rates, imposing property gain taxes; loosening the requirement for density and other planning requirements, faster approval of projects, compulsory contribution from developers, etc. Some of the policies are commendable, while others are ad-hoc by nature, and are not able to resolve the long-term socio-economic challenges. This paper discusses and examines the issues from the ‘sustainability’ perspective, focusing on key fiscal, land use and planning policies, as well as the more subtle (but important) political and institutional factors shaping the provision of mass housing for the urban populations in Malaysia.

Keywords: affordable housing, urban housing, sustainable housing, planning for urban housing

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Authors: Victor Prevost, Solene Landerneau, Michel Duhamel, Joel Sternheimer, Olivier Gallet, Pedro Ferrandiz, Marwa Mokni

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The search for homologous proteins is one of the ongoing challenges in biology and bioinformatics. Traditionally, a pair of proteins is thought to be homologous when they originate from the same ancestral protein. In such a case, their sequences share similarities, and advanced scientific research effort is spent to investigate this question. On this basis, we propose the Protein-Wave Alignment Tool (”P-WAT”) developed within the framework of the France Relance 2030 plan. Our work takes into consideration the mass-related wave aspect of protein biosynthesis, by associating specific frequencies to each amino acid according to its mass. Amino acids are then regrouped within their mass category. This way, our algorithm produces specific alignments in addition to those obtained with a common amino acid coding system. For this purpose, we develop the ”P-WAT” original algorithm, able to address large protein databases, with different attributes such as species, protein names, etc. that allow us to align user’s requests with a set of specific protein sequences. The primary intent of this algorithm is to achieve efficient alignments, in this specific conceptual frame, by minimizing execution costs and information loss. Our algorithm identifies sequence similarities by searching for matches of sub-sequences of different sizes, referred to as primers. Our algorithm relies on Boolean operations upon a dot plot matrix to identify primer amino acids common to both proteins which are likely to be part of a significant alignment of peptides. From those primers, dynamic programming-like traceback operations generate alignments and alignment scores based on an adjusted PAM250 matrix.

Keywords: protein, alignment, homologous, Genodic

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Authors: Elucir Gir, Laelson Rochelle Milanês Sousa, Pedro Henrique Tertuliano Leoni, Carla Aparecida Arena Ventura, Ana Cristina de Oliveira e Silva, Renata Karina Reis

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Context and significance: Resilience is a protective agent for the physical and mental well-being of nursing professionals. Team members are constantly subjected to high levels of work stress that can negatively impact care performance and users of health services. Stress levels have been exacerbated with the COVID-19 pandemic. Objective: The aim of this study was to analyze the resilience of nursing professionals in Brazil during the COVID-19 pandemic. Method: Cross-sectional study with a quantitative approach carried out with professionals from nursing teams from all regions of Brazil. Data collection took place in the first year of the pandemic between October and December 2020. Data were obtained through an online questionnaire posted on social networks. The information collected included the sociodemographic characterization of the nursing professionals and the Brief Resilient Coping Scale was applied. Student's t-test for independent samples and analysis of variance (ANOVA) were used to compare resilience scores with sociodemographic variables. Results: 8,792 nursing professionals participated in the study, 5,767 (65.6%) were nurses, 7,437 (84.6%) were female and 2,643 (30.1%) were from the Northeast region of Brazil, 5,124 (58.8% ) had low levels of resilience. The results showed a statistically significant difference between the resilience score and the variables: professional category (p<0.001); sex (p = 0.003); age range (p<0.001); region of Brazil (p<0.001); marital status (p=0.029) and providing assistance in a field hospital (p<0.001). Conclusion: Participants in this study had, in general, low levels of resilience. There is an urgent need for actions aimed at promoting the psychological health of nursing professionals inserted in pandemic contexts. Descriptors: Psychological Resilience; Nursing professionals; COVID-19; SARSCoV-2.

Keywords: psychological resilience, nursing professionals, COVID-19, SARS-CoV-2

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Authors: Fuad Alzahrani, Yiannis Kyratsis

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Although emergency nurses, being the frontline workers in mass-gatherings, are essential for providing an effective public health response, little is known about the skills that emergency nurses have, or require, in order to respond effectively to a disaster event. This paper is designed to address this gap in the literature by conducting an empirical study on emergency nurses’ preparedness at the mass-gathering event of Hajj in Mecca city. To achieve this aim, this study conducted a cross-sectional survey among 106 emergency department nurses in all the public hospitals in Mecca in 2014. The results revealed that although emergency nurses’ role understanding is high; they have limited knowledge and awareness of how to respond appropriately to mass-gathering disaster events. To address this knowledge gap, the top three most beneficial types of education and training courses suggested are: hospital education sessions, the Emergency Management Saudi Course and workshop; and short courses in disaster management. Finally, recommendations and constructive strategies are developed to provide the best practice in enhancing disaster preparedness. This paper adds to the body of knowledge regarding emergency nurses and mass gathering disasters. This paper measures the level of disaster knowledge, previous disaster response experience and disaster education and training amongst emergency nurses in Mecca, Saudi Arabia. It is anticipated that this study will provide a foundation for future studies aimed at better preparing emergency nurses for disaster response. This paper employs new strategies to improve the emergency nurses’ response during mass gatherings for the Hajj. Increasing the emergency nurses’ knowledge will develop their effective responses in mass-gathering disasters.

Keywords: emergency nurses, mass-gatherings, hajj, disaster preparedness, disaster knowledge, perceived role, disaster training, previous disaster response experience

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Ahmed A. Khamis, Abeer Kharshid, Nor Azizah Aziz

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The effect of statins dose intensity (SDI) on glycemic control in patients with existing diabetes is unclear. Also, there are many contradictory findings were reported in the literature; thus, it is limiting the possibility to draw conclusions. This project was designed to compare the effect of SDI on glycated hemoglobin (HbA1c%) control in outpatients with Type 2 diabetes in the endocrine clinic at Hospital Pulau Pinang, Malaysia, between July 2015 and August 2016. A prospective cohort study was conducted, where records of 345 patients with Type 2 diabetes (Moderate-SDI group 289 patients and high-SDI cohort 56 patients) were reviewed to identify demographics and laboratory tests. The target of glycemic control (HbA1c < 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, and the results were presented as descriptive statistics. From 289 moderate-SDI cohorts with a mean age of 57.3 ± 12.4 years, only 86 (29.8%) cases were shown to have controlled glycemia, while there were 203 (70.2%) cases with uncontrolled glycemia with confidence interval (CI) of 95% (6.2–10.8). On the other hand, the high-SDI group of 56 patients with Type 2 diabetes with a mean age 57.7±12.4 years is distributed among 11 (19.6%) patients with controlled diabetes, and 45 (80.4%) of them had uncontrolled glycemia, CI: 95% (7.1–11.9). The study has demonstrated that the relative risk (RR) of uncontrolled glycemia in patients with Type 2 diabetes that used high-SDI is 1.15, and the excessive relative risk (ERR) is 15%. The absolute risk (AR) is 10.2%, and the number needed to harm (NNH) is 10. Outpatients with Type 2 diabetes who use high-SDI of statin have a higher risk of uncontrolled glycemia than outpatients who had been treated with a moderate-SDI.

Keywords: cohort study, diabetes control, dose intensity, HbA1c, Malaysia, statin, type 2 diabetes mellitus, uncontrolled glycemia

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Authors: Eric Yi-Hsiu Huang, Meng-Chun Kao, Wen-Chuan Kuo

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For every laparoscopic surgery, a safe pneumoperitoneumcreation (gaining access to the peritoneal cavity) is the first and essential step. However, closed pneumoperitoneum is usually obtained by blind insertion of a Veress needle into the peritoneal cavity, which may carry potential risks suchas bowel and vascular injury.Until now, there remains no definite measure to visually confirm the position of the needle tip inside the peritoneal cavity. Therefore, this study established an image-guided Veress needle method by combining a fiber probe with optical coherence tomography (OCT). An algorithm was also proposed for determining the exact location of the needle tip through the acquisition of OCT images. Our method not only generates a series of “live” two-dimensional (2D) images during the needle puncture toward the peritoneal cavity but also can eliminate operator variation in image judgment, thus improving peritoneal access safety. This study was approved by the Ethics Committee of Taipei Veterans General Hospital (Taipei VGH IACUC 2020-144). A total of 2400 in vivo OCT images, independent of each other, were acquired from experiments of forty peritoneal punctures on two piglets. Characteristic OCT image patterns could be observed during the puncturing process. The ROC curve demonstrates the discrimination capability of these quantitative image features of the classifier, showing the accuracy of the classifier for determining the inside vs. outside of the peritoneal was 98% (AUC=0.98). In summary, the present study demonstrates the ability of the combination of our proposed automatic identification method and OCT imaging for automatically and objectively identifying the location of the needle tip. OCT images translate the blind closed technique of peritoneal access into a visualized procedure, thus improving peritoneal access safety.

Keywords: pneumoperitoneum, optical coherence tomography, automatic identification, veress needle

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Authors: Gulcin Yildiz, Gokcen Izli

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Drying (dehydration) is the process of removing water from food in order to preserve the food. Drying is one of the oldest methods known for the preservation of agricultural products such as fruits and vegetables. Drying of agricultural products enhances their storage life, minimizes losses during storage, and save shipping and transportation costs. Apples are considered excellent candidates for drying. The objective of this research was to investigate the effects of microwave and oven processing on the quality of selected apple products. Red delicious and golden delicious apples were washed, peeled, and sliced. Drying experiments were performed in an oven at 50, 75 and 100 °C and in a microwave at 140 W and 210 W. Quality attributes such as color, total phenolic content and antioxidant capacity of dried samples with different methods were compared with the fresh sample. A Minolta CR-300 Chroma Meter was used to examine color changes in the apples. Total phenolic content was determined using the Folin-Ciocalteu reagent. The free radical scavenging activity of the extract was determined using 1,1-diphenyl-2-picrylhydrazyl (DPPH). It was found that the phenolic contents and antioxidant capacities of dried samples under all drying conditions were decreased compared to the fresh samples. The phenolic contents of microwave dried samples at 140 W and 210 W for both red and golden delicious apples were higher than those of the oven drying at 50, 75 and 100 °C. Similarly, the antioxidant activities of microwave dried samples at 140 W and 210 W were higher than those of the oven drying at 50, 75 and 100 °C for both types of apples. All color parameters (L*, a*, b*) were changed significantly depending on the drying methods and temperatures. The closest color values to the fresh sample were found for the microwave dried samples at 140 W. Microwave drying was proven to be more effective than oven drying.

Keywords: antioxidant capacity, color, golden delicious, microwave, red delicious, total phenolic content

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Authors: Anwaar Anwar Tayel

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Background: Rheumatic arthritis (RA) affect all aspects of patients' life, lead to various degrees of disability, and ultimately has a profound impact on the social, economic, psychological, and sexual aspects of the patient's life. Aim of the study: Identify physical, psychological, and sexual implications of rheumatoid arthritis among women in reproductive age. In addition to investigating the correlations between physical functional disability, psychological problems, and sexual dysfunction.Settings: The study was conducted at Rheumatology Clinic at the Main University Hospital of Alexandria. Subjects: Purposive sample was chosen from women patients with rheumatoid arthritis to be subjects of this study (n=250). Tools: Four tools were used to collect data. Tool I: Socio-demographic questionnaire. Tool II: Stanford Health Assessment Questionnaire Disability Index (HAQ- DI). Tool III: Depression Anxiety Stress Scale (DASS). Tool IV: The Sexual Dysfunction Questionnaire (SDQ) Results: The majority of the studied women suffer from severe physical disability, extreme level of depression, anxiety, and about half of them had an extreme level of stress. Also, the majority of the studied women had a severe level of sexual dysfunction. Also, statistically significant correlations between women's physical disability index, psychological problems, and sexual dysfunction were detected. Conclusion: The findings from this study confirm that women patients with RA suffer from multiple negative implications on the physical, psychological and sexual functions. Recommendations: Provide ongoing support to the patients from the time of diagnosis throughout their care and management. To help them to manage their pain and disabilities, improve their sexual function, promote their mental health, and optimize psychosocial functioning

Keywords: pysical, spycholgical, sexual, implication, rheumatic arthritis

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Authors: Supabhorn Yimthiang, Wiyada Khanwian

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Cadmium is a heavy metal that is important in the environment because it is highly toxic. The incidence and severity of type 2 diabetes mellitus are known to be associated with cadmium. The purpose of this study was to investigate the cadmium levels in patients with type 2 diabetes mellitus at diabetes mellitus clinic, Thasala hospital, Nakhon Si Thummarat, Thailand. The study population was composed of forty five subjects. Among them, twenty two were diabetic patients and twenty three were apparently healthy non-diabetic individual subjects. After an overnight fasting, blood and morning urine samples were collected from each subject to determine fasting blood sugar and cadmium levels in urine, respectively. Systolic and diastolic blood pressure values were measured by aneroid sphygmomanometer. Study approval was taken from the human subject ethics committee of Walailak University. Verbal and written informed consent was taken from all participants. In the study samples, there were 31.8% males and 68.2% females with mean age of 47+10.53 years. The geometric mean of urine cadmium was significantly higher in diabetic patients (1.015 + 0.79 µg/g creatinine) when compared with the healthy subjects (0.395 + 0.53 µg/g creatinine) (P<0.05). This result also showed that urine cadmium excretion in diabetic patients was higher than in healthy subjects by 2.6 times. Moreover, fasting blood sugar (153+47.86 μg/dl) and systolic blood pressure (183.26+17.15 mmHg) of diabetic patients was significantly different when compared with healthy subjects (79+5.38 μg/dl and 112.78+11.32 mmHg, respectively) (P<0.05). Meanwhile, the concentration of cadmium in urine showed positive correlation with fasting plasma glucose (r=0.616) and systolic blood pressure (r=0.487). This preliminary study showed that cadmium might play an important role in the development and pathogenesis of diabetes mellitus in general population. However, these findings require confirmation through additional epidemiological and biological research.

Keywords: blood pressure, cadmium, fasting blood sugar, type 2 diabetes mellitus

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Authors: Salman Al-Alyani

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In line with the Kingdom’s Vision 2030, the Saudi Green initiative was announced aimed at reducing carbon emissions by more than 4% of the global contribution. The initiative included plans to generate 50% of its energy from renewables by 2030. The geographical location of Saudi Arabia makes it among the best countries in terms of solar irradiation and has good wind resources in many areas across the Kingdom. Saudi Arabia is a wide country and has many remote locations where it is not economically feasible to connect those loads to the national grid. With the improvement of battery innovation and reduction in cost, different renewable technologies (primarily wind and solar) can be integrated to meet the need for energy in a more effective and cost-effective way. Saudi Arabia is famous for high solar irradiations in which solar power generation can extend up to six (6) hours per day (25% capacity factor) in some locations. However, the net present value (NPV) falls down to negative in some locations due to distance and high installation costs. Wind generation in Saudi Arabia is a promising technology. Hybrid renewable generation will increase the net present value and lower the payback time due to additional energy generated by wind. The infrastructure of the power system can be capitalized to contain solar generation and wind generation feeding the inverter, controller, and load. Storage systems can be added to support the hours that have an absence of wind or solar energy. Also, the smart controller that can help integrate various renewable technologies primarily wind and solar, to meet demand considering load characteristics. It could be scalable for grid or off-grid applications. The objective of this paper is to study the feasibility of introducing a hybrid renewable system in remote locations and the concept for the development of a smart controller.

Keywords: battery storage systems, hybrid power generation, solar energy, wind energy

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Authors: Ágota Ladó

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Miercurea Ciuc is a town in the historical region of Szeklerland in Transylvania, Romania, with a predominantly Hungarian population (its name in Hungarian being Csíkszereda) having an urban landscape and environment that has been shaped dramatically by different perceptions of urbanization during the history. The town has been part of Hungary and the Austro-Hungarian Empire before the First World War. It even got an important role, becoming in 1876 the seat and administrative center of the historical Csík county. This marks the beginning of the first urbanization process: new administrative buildings, railways, a railway station, a hospital, a Redoute and new schools have been built, new streets have been opened. However, not only the public facilities have changed: the center of the town with its private houses has also transformed, new, modern decorative and lifestyle elements have appeared. One of the streets from the town center, Kossuth street, has been featured on many postcards of the time; even a novel has mentioned it as a symbol of modern urbanization. Right after the First World War, the town became part of Romania and aside from a short interruption (between 1940 and 1944), it is still part of it. The beginning of the second major urbanization process – exactly one hundred years later - is marked by the visit of the communist leader Nicolae Ceaușescu in Miercurea Ciuc on the 6th of October 1976. In the upcoming years, he decided and started to demolish the old Kossuth street and to construct a new avenue with tall blocks of flats according to the principles of socialist urbanization. No other Transylvanian settlement has gone through such systematic abolition of its historical center and urban history during the Communist era. Not only the urban landscape has been affected. The collective memory and contemporary identity of the locals are also violated by this recent transformation of the town: important spaces, buildings, venues of activities and events simply cannot be localized, thus understood - by the younger generations.

Keywords: communist era, historical urban landscape, urban identity, urbanization

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Authors: Samar Mousa, Galini Mavromatidou, Rebecca Shirley

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Surgeons carry out numerous operations in the busy burns and plastic surgery department daily. Writing an accurate operation note with all the essential information is crucial for communication not only within the plastics team but also to the multi-disciplinary team looking after the patient, including other specialties, nurses and GPs. The Royal college of surgeons of England, in its guidelines of good surgical practice, mentioned that the surgeon should ensure that there are clear (preferably typed) operative notes for every procedure. The notes should accompany the patient into recovery and to the ward and should give sufficient detail to enable continuity of care by another doctor. The notes should include the Date and time, Elective/emergency procedure, Names of the operating surgeon and assistant, Name of the theatre anesthetist, Operative procedure carried out, Incision, Operative diagnosis, Operative findings, Any problems/complications, Any extra procedure performed and the reason why it was performed, Details of tissue removed, added or altered, Identification of any prosthesis used, including the serial numbers of prostheses and other implanted materials, Details of closure technique, Anticipated blood loss, Antibiotic prophylaxis (where applicable), DVT prophylaxis (where applicable), Detailed postoperative care instructions and Signature. Fourteen random days were chosen in December 2021 to assess the accuracy of operative notes and post-operative care. A total of 163 operative notes were examined. The average completion rates in all domains were 85.4%. An electronic operative note template was designed to cover all domains mentioned in the Royal College of surgeons' good surgical practice. It is kept in the hospital drive for all surgeons to use.

Keywords: operative notes, plastic surgery, documentation, electronic

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Authors: Thea Freese

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Environmental legislation to protect North and Baltic Sea areas from harmful vessel-source emissions has received increased political attention in recent years. Legislative measures are expected to show positive effects on the health of the marine environment and society. At the same time, compliance might increase the costs to industry and have effects on freight rates and volumes shipped with potential negative repercussions on the environment. Building on an exploratory sequential mixed methods approach, this research project will study the economic effects of maritime environmental legislation in two phases. In Phase I, exploratory in-depth interviews were conducted with 12 experts from various stakeholder groups aiming at identifying variables influencing the relationship between environmental legislation, freight rates and volumes shipped. Influencing factors like compliance, enforcement and modal shift were identified and studied. Phase II will comprise of a quantitative study conducted with the aim of verifying the theory build in Phase I and quantifying economic effects of rules on shipping pollution. Research in this field might inform policy-makers about determinants of behaviour of ship operators in the face of the law and might further the development of a comprehensive legal system for marine environmental protection. At the present stage of research, first tentative results from the qualitative phase may be examined and open research questions to be addressed in the quantitative phase as well as possible research designs for phase II may be discussed. Input from other researchers will be highly valuable at this point.

Keywords: clean shipping operations, compliance, maritime environmental legislation, maritime law and economics, mixed methods research, North and Baltic Sea area

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Authors: Arsalan Salahi

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Today, the number of changes in the construction industry and urban mass house building is increasing, which makes you need to pay more attention to targeted planning for human resource management and training. The human resources working in the construction industry have various problems and deficiencies, and in order to solve these problems, there is a need for basic management and training of these people in order to lower the construction costs and increase the quality of the projects, especially in mass house building projects. The success of any project in reaching short and long-term professional goals depends on the efficient combination of work tools, financial resources, raw materials, and most importantly, human resources. Today, due to the complexity and diversity of each project, specialized management fields have emerged to maximize the potential benefits of each component of that project. Human power is known as the most important resource in construction projects for its successful implementation, but unfortunately, due to the low cost of human power compared to other resources, such as materials and machinery, little attention is paid to it. With the correct management and training of human resources, which depends on its correct planning and development, it is possible to improve the performance of construction projects. In this article, the training and motivation of construction industry workers and their effects on the effectiveness of projects in this industry have been researched. In this regard, some barriers to the training and motivation of construction workers and personnel have been identified and solutions have been provided for construction companies. Also, the impact of workers and unskilled people on the efficiency of construction projects is investigated. The results of the above research show that by increasing the use of correct and basic training for human resources, we will see positive results and effects on the performance of construction projects.

Keywords: human resources, construction industry, principled training, skilled and unskilled workers

Procedia PDF Downloads 92