Search results for: healthcare costs

Authors: Maria Sciammarella, Uttam M. Shrestha, Youngho Seo, Grant T. Gullberg, Elias H. Botvinick

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Background: Myocardial perfusion imaging (MPI) is typically performed with static imaging protocols and visually assessed for perfusion defects based on the relative intensity distribution. Dynamic cardiac SPECT, on the other hand, is a new imaging technique that is based on time varying information of radiotracer distribution, which permits quantification of myocardial blood flow (MBF). In this abstract, we report a progress and current status of dynamic cardiac SPECT using conventional gamma camera (Infinia Hawkeye 4, GE Healthcare) for estimation of myocardial blood flow and coronary flow reserve. Methods: A group of patients who had high risk of coronary artery disease was enrolled to evaluate our methodology. A low-dose/high-dose rest/pharmacologic-induced-stress protocol was implemented. A standard rest and a standard stress radionuclide dose of ⁹⁹ᵐTc-tetrofosmin (140 keV) was administered. The dynamic SPECT data for each patient were reconstructed using the standard 4-dimensional maximum likelihood expectation maximization (ML-EM) algorithm. Acquired data were used to estimate the myocardial blood flow (MBF). The correspondence between flow values in the main coronary vasculature with myocardial segments defined by the standardized myocardial segmentation and nomenclature were derived. The coronary flow reserve, CFR, was defined as the ratio of stress to rest MBF values. CFR values estimated with SPECT were also validated with dynamic PET. Results: The range of territorial MBF in LAD, RCA, and LCX was 0.44 ml/min/g to 3.81 ml/min/g. The MBF between estimated with PET and SPECT in the group of independent cohort of 7 patients showed statistically significant correlation, r = 0.71 (p < 0.001). But the corresponding CFR correlation was moderate r = 0.39 yet statistically significant (p = 0.037). The mean stress MBF value was significantly lower for angiographically abnormal than that for the normal (Normal Mean MBF = 2.49 ± 0.61, Abnormal Mean MBF = 1.43 ± 0. 0.62, P < .001). Conclusions: The visually assessed image findings in clinical SPECT are subjective, and may not reflect direct physiologic measures of coronary lesion. The MBF and CFR measured with dynamic SPECT are fully objective and available only with the data generated from the dynamic SPECT method. A quantitative approach such as measuring CFR using dynamic SPECT imaging is a better mode of diagnosing CAD than visual assessment of stress and rest images from static SPECT images Coronary Flow Reserve.

Keywords: dynamic SPECT, clinical SPECT/CT, selective coronary angiograph, ⁹⁹ᵐTc-Tetrofosmin

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Authors: Yi-Fung Lin, Shiow-Ching Shun, Wen-Yu Hu

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Background: A skill mix model is regarded as one of the most effective methods of reducing nursing shortages, as well as easing nursing staff workloads and labor costs. Although this model shows several benefits for the health workforce, the relationship between the optimal model of skill mix and the patient mortality rate remains to be discovered. Objectives: This review aimed to explore the relationship between the skill mix model and patient mortality rate in acute care hospitals. Data Sources: A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases and researchers retrieved studies published between January 1986 and March 2022. Review methods: Two independent reviewers screened the titles and abstracts based on selection criteria, extracted the data, and performed critical appraisals using the STROBE checklist of each included study. The studies focused on adult patients in acute care hospitals, and the skill mix model and patient mortality rate were included in the analysis. Results: Six included studies were conducted in the USA, Canada, Italy, Taiwan, and European countries (Belgium, England, Finland, Ireland, Spain, and Switzerland), including patients in medical, surgical, and intensive care units. There were both nurses and nursing assistants in their skill mix team. This main finding is that three studies (324,592 participants) show evidence of fewer mortality rates associated with hospitals with a higher percentage of registered nurse staff (range percentage of registered nurse staff 36.1%-100%), but three articles (1,122,270 participants) did not find the same result (range of percentage of registered nurse staff 46%-96%). However, based on appraisal findings, those showing a significant association all meet good quality standards, but only one-third of their counterparts. Conclusions: In light of the limited amount and quality of published research in this review, it is prudent to treat the findings with caution. Although the evidence is not insufficient certainty to draw conclusions about the relationship between nurse staffing level and patients' mortality, this review lights the direction of relevant studies in the future. The limitation of this article is the variation in skill mix models among countries and institutions, making it impossible to do a meta-analysis to compare them further.

Keywords: nurse staffing level, nursing assistants, mortality, skill mix

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Authors: Minna-Maari Harmaala, Hanna Harilainen

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Estimates of the economic value of transitioning to circular economy models vary but it has been estimated to represent $1 trillion worth of new business into the global economy. In Europe alone, estimates claim that adopting circular-economy principles could not only have environmental and social benefits but also generate a net economic benefit of €1.8 trillion by 2030. Proponents of a circular economy argue that it offers a major opportunity to increase resource productivity, decrease resource dependence and waste, and increase employment and growth. A circular system could improve competitiveness and unleash innovation. Yet, most companies are not capturing these opportunities and thus the even abundant circular opportunities remain uncaptured even though they would seem inherently profitable. Service design in broad terms relates to developing an existing or a new service or service concept with emphasis and focus on the customer experience from the onset of the development process. Service design may even mean starting from scratch and co-creating the service concept entirely with the help of customer involvement. Service design methodologies provide a structured way of incorporating customer understanding and involvement in the process of designing better services with better resonance to customer needs. A business model is a depiction of how the company creates, delivers, and captures value; i.e. how it organizes its business. The process of business model development and adjustment or modification is also called business model innovation. Innovating business models has become a part of business strategy. Our hypothesis is that in addition to linear models still being easier to adopt and often with lower threshold costs, companies lack an understanding of how circular models can be adopted into their business and how customers will be willing and ready to adopt the new circular business models. In our research, we use robust service design methodology to develop circular economy solutions with two case study companies. The aim of the process is to not only develop the service concepts and portfolio, but to demonstrate the willingness to adopt circular solutions exists in the customer base. In addition to service design, we employ business model innovation methods to develop, test, and validate the new circular business models further. The results clearly indicate that amongst the customer groups there are specific customer personas that are willing to adopt and in fact are expecting the companies to take a leading role in the transition towards a circular economy. At the same time, there is a group of indifferents, to whom the idea of circularity provides no added value. In addition, the case studies clearly show what changes adoption of circular economy principles brings to the existing business model and how they can be integrated.

Keywords: business model innovation, circular economy, circular economy business models, service design

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Authors: Rajish Shil, Mohammad Ali Houri, Mohammad Milad Ismail, Fatimah Al Kaabi

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The clinical presentation of Primary hyperparathyroidism can vary from simple asymptomatic hypercalcemia to severe life-threatening hypercalcemic crisis with multi-organ dysfunction, which can be due to parathyroid adenoma or sometimes with malignant cancer. This cascade of clinical presentation can lead to a diagnostic and therapeutic challenge for treating the disease. We are presenting a case of severe hypercalcemic crisis due to parathyroid adenoma with an emphasis on early management, diagnosis, and interventions to prevent any lifelong complications and any permanent organ dysfunction. A 30 years old female with a history of primary Infertility, admitted to Al Ain Hospital critical care unit with Acute Severe Necrotizing Pancreatitis. She initially had a 1-month history of abdominal pain on and off, for which she was treated conservatively with no much improvement, and later on, she developed life-threatening severe pancreatitis, which required her to be admitted to the critical care unit. She was transferred from a private healthcare facility, where she was found to have a very high level of calcium up to 15mmol/L. She received systemic Zoledronic Acid, which lowered her calcium level transiently and later was increased again. She went on to develop multiple end-organ damages along with multiple electrolytes disturbances. She was found to have high levels of Parathyroid hormone, which was correlated with a parathyroid mass on the neck via radiological imaging. After a long course of medical treatment to lower the calcium to a near-normal level, parathyroidectomy was done, which showed parathyroid adenoma on histology. She developed hungry bone syndrome after the surgery and pancreatic pseudocyst after resolving of pancreatitis. She required aggressive treatment with Intravenous calcium for her hypocalcemia as she received zoledronic acid at the beginning of the disease. Later on, she was discharged on long term calcium and other electrolytes supplements. In patients presenting with hypercalcemia, it is prudent to investigate and start treatment early to prevent complications and end-organ damage from hypercalcemia and also to treat the primary cause of the hypercalcemia, with conscious follow up to prevent hypocalcemic complications after treatment. It is important to follow up patients with parathyroid adenomas for a long period in order to detect any recurrence of the tumor or to make sure if the primary tumor is either benign or malignant.

Keywords: hypercalcemia, pancreatitis, hypocalcemia, hyperparathyroidism

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Authors: Wayne Tarrant, Ethan Petersen

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The concept of a flat tax goes back to at least the Biblical tithe. A progressive income tax was first vociferously espoused in a small, but famous, pamphlet in 1848 (although England had an emergency progressive tax for war costs prior to this). Within a few years many countries had adopted the progressive structure. The flat tax was only reinstated in some small countries and British protectorates until Mart Laar was elected Prime Minister of Estonia in 1992. Since Estonia’s adoption of the flat tax in 1993, many other formerly Communist countries have likewise abandoned progressive income taxes. Economists had expectations of what would happen when a flat tax was enacted, but very little work has been done on actually measuring the effect. With a testbed of 21 countries in this region that currently have a flat tax, much comparison is possible. Several countries have retained progressive taxes, giving an opportunity for contrast. There are also the cases of Czech Republic and Slovakia, which have adopted and later abandoned the flat tax. Further, with over 20 years’ worth of economic history in some flat tax countries, we can begin to do some serious longitudinal study. In this paper we consider many economic variables to determine if there are statistically significant differences from before to after the adoption of a flat tax. We consider unemployment rates, tax receipts, GDP growth, Gini coefficients, and market data where the data are available. Comparisons are made through the use of event studies and time series methods. The results are mixed, but we draw statistically significant conclusions about some effects. We also look at the different implementations of the flat tax. In some countries there are equal income and corporate tax rates. In others the income tax has a lower rate, while in others the reverse is true. Each of these sends a clear message to individuals and corporations. The policy makers surely have a desired effect in mind. We group countries with similar policies, try to determine if the intended effect actually occurred, and then report the results. This is a work in progress, and we welcome the suggestion of variables to consider. Further, some of the data from before the fall of the Iron Curtain are suspect. Since there are new ruling regimes in these countries, the methods of computing different statistical measures has changed. Although we first look at the raw data as reported, we also attempt to account for these changes. We show which data seem to be fictional and suggest ways to infer the needed statistics from other data. These results are reported beside those on the reported data. Since there is debate about taxation structure, this paper can help inform policymakers of change the flat tax has caused in other countries. The work shows some strengths and weaknesses of a flat tax structure. Moreover, it provides beginnings of a scientific analysis of the flat tax in practice rather than having discussion based solely upon theory and conjecture.

Keywords: flat tax, financial markets, GDP, unemployment rate, Gini coefficient

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Authors: Ricardo Torcato, Helder Morais

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The manufacture of crystal glass parts is based on obtaining the rough geometry by blowing and/or injection, generally followed by a set of manual finishing operations using cutting and grinding tools. The forming techniques used do not allow the obtainment, with repeatability, of parts with complex shapes and the finishing operations use intensive specialized labor resulting in high cycle times and production costs. This work aims to explore the digital manufacture of crystal glass parts by investigating new subtractive techniques for the automated, flexible finishing of these parts. Finishing operations are essential to respond to customer demands in terms of crystal feel and shine. It is intended to investigate the applicability of different computerized finishing technologies, namely milling and grinding in a CNC machining center with or without ultrasonic assistance, to crystal processing. Research in the field of grinding hard and brittle materials, despite not being extensive, has increased in recent years, and scientific knowledge about the machinability of crystal glass is still very limited. However, it can be said that the unique properties of glass, such as high hardness and very low toughness, make any glass machining technology a very challenging process. This work will measure the performance improvement brought about by the use of ultrasound compared to conventional crystal grinding. This presentation is focused on the mechanical characterization and analysis of the cutting forces in CNC machining of superior crystal glass (Pb ≥ 30%). For the mechanical characterization, the Vickers hardness test provides an estimate of the material hardness (Hv) and the fracture toughness based on cracks that appear in the indentation. Mechanical impulse excitation test estimates the Young’s Modulus, shear modulus and Poisson ratio of the material. For the cutting forces, it a dynamometer was used to measure the forces in the face grinding process. The tests were made based on the Taguchi method to correlate the input parameters (feed rate, tool rotation speed and depth of cut) with the output parameters (surface roughness and cutting forces) to optimize the process (better roughness using the cutting forces that do not compromise the material structure and the tool life) using ANOVA. This study was conducted for conventional grinding and for the ultrasonic grinding process with the same cutting tools. It was possible to determine the optimum cutting parameters for minimum cutting forces and for minimum surface roughness in both grinding processes. Ultrasonic-assisted grinding provides a better surface roughness than conventional grinding.

Keywords: CNC machining, crystal glass, cutting forces, hardness

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Authors: Katsue Edo, Yu Hiroi

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T Increasing attention has been paid to using pictures and photographs in research since the beginning of the 21th century in social sciences. Meanwhile we have been studying the usefulness of Picture mining, which is one of the new ways for a these picture using researches. Picture Mining is an explorative research analysis method that takes useful information from pictures, photographs and static or moving images. It is often compared with the methods of text mining. The Picture Mining concept includes observational research in the broad sense, because it also aims to analyze moving images (Ochihara and Edo 2013). In the recent literature, studies and reports using pictures are increasing due to the environmental changes. These are identified as technological and social changes (Edo et.al. 2013). Low price digital cameras and i-phones, high information transmission speed, low costs for information transferring and high performance and resolution of the cameras of mobile phones have changed the photographing behavior of people. Consequently, there is less resistance in taking and processing photographs for most of the people in the developing countries. In these studies, this method of collecting data from respondents is often called as ‘participant-generated photography’ or ‘respondent-generated visual imagery’, which focuses on the collection of data and its analysis (Pauwels 2011, Snyder 2012). But there are few systematical and conceptual studies that supports it significance of these methods. We have discussed in the recent years to conceptualize these picture using research methods and formalize theoretical findings (Edo et. al. 2014). We have identified the most efficient fields of Picture mining in the following areas inductively and in case studies; 1) Research in Consumer and Customer Lifestyles. 2) New Product Development. 3) Research in Fashion and Design. Though we have found that it will be useful in these fields and areas, we must verify these assumptions. In this study we will focus on the field of fashion and design, to determine whether picture mining methods are really reliable in this area. In order to do so we have conducted an empirical research of the respondents’ attitudes and behavior concerning pictures and photographs. We compared the attitudes and behavior of pictures toward fashion to meals, and found out that taking pictures of fashion is not as easy as taking meals and food. Respondents do not often take pictures of fashion and upload their pictures online, such as Facebook and Instagram, compared to meals and food because of the difficulty of taking them. We concluded that we should be more careful in analyzing pictures in the fashion area for there still might be some kind of bias existing even if the environment of pictures have drastically changed in these years.

Keywords: empirical research, fashion and design, Picture Mining, qualitative research

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Authors: Tolulope Aremu

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This paper is based on the idea of using deep learning methodology for optimizing production yield by tuning a few key process parameters in a manufacturing environment. The study was explicitly on how to maximize production yield and minimize operational costs by utilizing advanced neural network models, specifically Long Short-Term Memory and Convolutional Neural Networks. These models were implemented using Python-based frameworks—TensorFlow and Keras. The targets of the research are the precision molding processes in which temperature ranges between 150°C and 220°C, the pressure ranges between 5 and 15 bar, and the material flow rate ranges between 10 and 50 kg/h, which are critical parameters that have a great effect on yield. A dataset of 1 million production cycles has been considered for five continuous years, where detailed logs are present showing the exact setting of parameters and yield output. The LSTM model would model time-dependent trends in production data, while CNN analyzed the spatial correlations between parameters. Models are designed in a supervised learning manner. For the model's loss, an MSE loss function is used, optimized through the Adam optimizer. After running a total of 100 training epochs, 95% accuracy was achieved by the models recommending optimal parameter configurations. Results indicated that with the use of RSM and DOE traditional methods, there was an increase in production yield of 12%. Besides, the error margin was reduced by 8%, hence consistent quality products from the deep learning models. The monetary value was annually around $2.5 million, the cost saved from material waste, energy consumption, and equipment wear resulting from the implementation of optimized process parameters. This system was deployed in an industrial production environment with the help of a hybrid cloud system: Microsoft Azure, for data storage, and the training and deployment of their models were performed on Google Cloud AI. The functionality of real-time monitoring of the process and automatic tuning of parameters depends on cloud infrastructure. To put it into perspective, deep learning models, especially those employing LSTM and CNN, optimize the production yield by fine-tuning process parameters. Future research will consider reinforcement learning with a view to achieving further enhancement of system autonomy and scalability across various manufacturing sectors.

Keywords: production yield optimization, deep learning, tuning of process parameters, LSTM, CNN, precision manufacturing, TensorFlow, Keras, cloud infrastructure, cost saving

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Authors: Abuzar Baloach

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Spinal cord stimulators (SCS) are increasingly used for managing chronic pain, but their presence requires careful anesthetic planning. This review explores critical anesthetic considerations for patients with SCS, encompassing preoperative, intraoperative, and acute pain management, as well as specific considerations for obstetric and out-of-operating-room procedures. Preoperative Evaluation: Thorough assessment is essential, including a detailed medical history of the SCS device, such as type, manufacturer, and settings. Additionally, a complete pain history and a physical exam are necessary to understand the patient’s baseline neurological function and assess mobility, which can impact anesthesia management. Intraoperative Considerations: Electrocautery poses a risk for patients with SCS due to potential interference. Monopolar electrocautery is discouraged, but if needed, the grounding pad should be positioned away from the device, and the device itself should be turned off. The SCS device can introduce ECG artifacts and potentially interfere with pacemakers and defibrillators (ICD), which may result in inappropriate pacing or shocks. Precautions, including baseline ECG and interrogation, are recommended if both devices are present. Furthermore, lithotripsy, though generally avoided, can be performed under certain conditions with caution. Obstetric Anesthesia: While SCS devices are generally turned off during pregnancy, they have shown no interference with fetal cardiotocography, and epidural placement can be safely achieved with a sterile technique below the SCS leads. Acute Pain Considerations: SCS placement is taken into account in pain management plans, especially with neuraxial anesthesia, as potential risks include infection, limited spread due to fibrous sheaths, and damage to the SCS leads. Out-of-Operating Room Procedures: MRI, previously contraindicated, is now conditionally safe with SCS devices, depending on manufacturer specifications. CT scans are generally safe, though radiation should be minimized to prevent device malfunction. For radiation therapy, specific safety measures are recommended, such as keeping the beam at least 1 cm away from the device and limiting the dose to prevent damage. In conclusion, anesthetic management for SCS patients requires meticulous planning across all stages of care. By understanding the unique interactions and potential risks associated with SCS and other devices, healthcare providers can enhance patient safety and improve outcomes. Further research and the establishment of standardized guidelines are essential to optimize perioperative care for this growing patient population.

Keywords: anesthesia, chronic pain, spinal cord stimulator, SCS

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Authors: Tsu-Yun Chiu, Tsung-Hsueh Lu, Tain-Junn Cheng

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Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.

Keywords: catchment area of healthcare, chronic disease management, Geographic information system, quality of diabetes care

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Authors: RAJ KUMAR G.C.

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There are tremendous opportunities to maximize smallholder farmers’ income from small-scale water resource development through micro irrigation and multiple-use water systems (MUS). MUS are an improved water management approach, developed and tested successfully by iDE that pipes water to a community both for domestic use and for agriculture using efficient micro irrigation. Different MUS models address different landscape constraints, water demand, and users’ preferences. MUS are complemented by micro irrigation kits, which were developed by iDE to enable farmers to grow high-value crops year-round and to use limited water resources efficiently. Over the last 15 years, iDE’s promotion of the MUS approach has encouraged government and other key stakeholders to invest in MUS for better planning of scarce water resources. Currently, about 60% of the cost of MUS construction is covered by the government and community. Based on iDE’s experience, a gravity-fed MUS costs approximately $125 USD per household to construct, and it can increase household income by $300 USD per year. A key element of the MUS approach is keeping farmers well linked to input supply systems and local produce collection centers, which helps to ensure that the farmers can produce a sufficient quantity of high-quality produce that earns a fair price. This process in turn creates an enabling environment for smallholders to invest in MUS and micro irrigation. Therefore, MUS should be seen as an integrated package of interventions –the end users, water sources, technologies, and the marketplace– that together enhance technical, financial, and institutional sustainability. Communities are trained to participate in sustainable water resource management as a part of the MUS planning and construction process. The MUS approach is cost-effective, improves community governance of scarce water resources, helps smallholder farmers to improve rural health and livelihoods, and promotes gender equity. MUS systems are simple to maintain and communities are trained to ensure that they can undertake minor maintenance procedures themselves. All in all, the iDE Nepal MUS offers multiple benefits and represents a practical and sustainable model of the MUS approach. Moreover, there is a growing national consensus that rural water supply systems should be designed for multiple uses, acknowledging that substantial work remains in developing national-level and local capacity and policies for scale-up.

Keywords: multiple-use water systems , small scale water resources, rural livelihoods, practical and sustainable model

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Authors: Samantha Meyerholz

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MSKCC offers patients cutting edge cancer care with the highest quality standards. However, many patients and industry members do not realize that the operations of the Immunology Histology Lab (IHC) are the backbone for carrying out this mission. The IHC lab manufactures blocks and slides containing critical tissue samples that will be read by a Pathologist to diagnose and dictate a patient’s treatment course. The lab processes 200 requests daily, leading to the generation of approximately 2,000 slides and 1,100 blocks each day. Lab material is transported through labeling, cutting, staining and sorting manufacturing stations, while being managed by multiple techs throughout the space. The quality of the stain as well as wait times associated with processing requests, is directly associated with patients receiving rapid treatments and having a wider range of care options. This project aims to improve slide request turnaround time for rush and non-rush cases, while increasing the quality of each request filled (no missing slides or poorly stained items). Rush cases are to be filled in less than 24 hours, while standard cases are allotted a 48 hour time period. Reducing turnaround times enable patients to communicate sooner with their clinical team regarding their diagnosis, ultimately leading faster treatments and potentially better outcomes. Additional project goals included streamlining tech and material workflow, while reducing waste and increasing efficiency. This project followed a DMAIC structure with emphasis on lean and ergonomic principles that could be integrated into an evolving lab culture. Load times and batching processes were analyzed using process mapping, FMEA analysis, waste analysis, engineering observation, 5S and spaghetti diagramming. Reduction of lab technician movement as well as their body position at each workstation was of top concern to pathology leadership. With new equipment being brought into the lab to carry out workflow improvements, screen and tool placement was discussed with the techs in focus groups, to reduce variation and increase comfort throughout the workspace. 5S analysis was completed in two phases in the IHC lab, helping to drive solutions that reduced rework and tech motion. The IHC lab plans to continue utilizing these techniques to further reduce the time gap between tissue analysis and cancer care.

Keywords: engineering, ergonomics, healthcare, lean

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Authors: Matthew Sedgwick

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Introduction: Social media continues to grow in popularity and Instagram is one of the largest platforms available. It provides an invaluable method of communication between health care professionals and patients. Both patients and dentists can benefit from seeing clinical cases posted by other members of the profession. It can prompt discussion about how the outcome was achieved and showcases what is possible with the right techniques and planning. This study aimed to identify what people were posting about the topic ‘veneers’ and inform health care professionals as to what content had the most engagement and make recommendations as to how to improve the quality of social media posts. Design: 150 consecutive posts for the search term ‘veneers’ were analyzed retrospectively between 21st October 2021 to 31st October 2021. Non-English language posts duplicated posts, and posts not about dental veneers were excluded. After exclusions were applied, 80 posts were included in the study for analysis. The content of the posts was analyzed and coded and the main themes were identified. The number of comments, likes and views were also recorded for each post. Results: The themes were: before and after treatment, cost, dental training courses, treatment process and trial smiles. Dentists were the most common posters of content (82.5%) and it was interesting to note that there were no patients who posted about treatment in this sample. The main type of media was photographs (93.75%) compared to video (6.25%). Videos had an average of 45,541 views and more comments and likes than the average for photographs. The average number of comments and likes per post were 20.88 and 761.58, respectively. Conclusion: Before and after photographs were the most common finding as this is how dentists showcase their work. The study showed that videos showing the treatment process had more engagement than photographs. Dentists should consider making video posts showing the patient journey, including before and after veneer treatment, as this can result in more potential patients and colleagues viewing the content. Video content could help dentists distinguish their posts from others as it can also be used across other platforms such as TikTok or Facebook reaching a wider audience. More informative posts about how the result has shown are achieved required, including potential costs. This will help increase transparency regarding this treatment method, including the financial and potential biological cost to teeth. As a result, this will improve patient understanding and become an invaluable adjunct in informed consent.

Keywords: content analysis, dental veneers, Instagram, social media

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Authors: T. Elrazaz

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This paper examines accrual and real earnings management by publicly listed targets around mergers and acquisitions. Prior literature shows that earnings management around mergers and acquisitions can have a significant economic impact because of the associated wealth transfers among stakeholders. More importantly, acting on behalf of their shareholders or pursuing their self-interests, managers of both targets and acquirers may be equally motivated to manipulate earnings prior to an acquisition to generate higher gains for their shareholders or themselves. Building on the grounds of information asymmetry, agency conflicts, stewardship theory, and the revelation principle, this study addresses the question of whether takeover targets employ accrual and real earnings management in the periods prior to the announcement of Mergers and Acquisitions (M&A). Additionally, this study examines whether acquirers are able to detect targets’ earnings management, and in response, adjust the acquisition premium paid in order not to face the risk of overpayment. This study uses an aggregate accruals approach in estimating accrual earnings management as proxied by estimated abnormal accruals. Additionally, real earnings management is proxied for by employing widely used models in accounting and finance literature. The results of this study indicate that takeover targets manipulate their earnings using accruals in the second year with an earnings release prior to the announcement of the M&A. Moreover, in partitioning the sample of targets according to the method of payment used in the deal, the results are restricted only to targets of stock-financed deals. These results are consistent with the argument that targets of cash-only or mixed-payment deals do not have the same strong motivations to manage their earnings as their stock-financed deals counterparts do additionally supporting the findings of prior studies that the method of payment in takeovers is value relevant. The findings of this study also indicate that takeover targets manipulate earnings upwards through cutting discretionary expenses the year prior to the acquisition while they do not do so by manipulating sales or production costs. Moreover, in partitioning the sample of targets according to the method of payment used in the deal, the results are restricted only to targets of stock-financed deals, providing further robustness to the results derived under the accrual-based models. Finally, this study finds evidence suggesting that acquirers are fully aware of the accrual-based techniques employed by takeover targets and can unveil such manipulation practices. These results are robust to alternative accrual and real earnings management proxies, as well as controlling for the method of payment in the deal.

Keywords: accrual earnings management, acquisition premium, real earnings management, takeover targets

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Authors: Elenice Maria Schons Silva, Andre Carlos Silva

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The crescent demand for raw material has increased mining activities. Mineral industry faces the challenge of process more complexes ores, with very small particles and low grade, together with constant pressure to reduce production costs and environment impacts. Froth flotation deserves special attention among the concentration methods for mineral processing. Besides its great selectivity for different minerals, flotation is a high efficient method to process fine particles. The process is based on the minerals surficial physicochemical properties and the separation is only possible with the aid of chemicals such as collectors, frothers, modifiers, and depressants. In order to use sustainable and eco-friendly reagents, oils extracted from three different vegetable species (pequi’s pulp, macauba’s nut and pulp, and Jatropha curcas) were studied and tested as apatite collectors. Since the oils are not soluble in water, an alkaline hydrolysis (or saponification), was necessary before their contact with the minerals. The saponification was performed at room temperature. The tests with the new collectors were carried out at pH 9 and Flotigam 5806, a synthetic mix of fatty acids industrially adopted as apatite collector manufactured by Clariant, was used as benchmark. In order to find a feasible replacement for cornstarch the flour and starch of a graniferous variety of sorghum was tested as depressant. Apatite samples were used in the flotation tests. XRF (X-ray fluorescence), XRD (X-ray diffraction), and SEM/EDS (Scanning Electron Microscopy with Energy Dispersive Spectroscopy) were used to characterize the apatite samples. Zeta potential measurements were performed in the pH range from 3.5 to 12.5. A commercial cornstarch was used as depressant benchmark. Four depressants dosages and pH values were tested. A statistical test was used to verify the pH, dosage, and starch type influence on the minerals recoveries. For dosages equal or higher than 7.5 mg/L, pequi oil recovered almost all apatite particles. In one hand, macauba’s pulp oil showed excellent results for all dosages, with more than 90% of apatite recovery, but in the other hand, with the nut oil, the higher recovery found was around 84%. Jatropha curcas oil was the second best oil tested and more than 90% of the apatite particles were recovered for the dosage of 7.5 mg/L. Regarding the depressant, the lower apatite recovery with sorghum starch were found for a dosage of 1,200 g/t and pH 11, resulting in a recovery of 1.99%. The apatite recovery for the same conditions as 1.40% for sorghum flour (approximately 30% lower). When comparing with cornstarch at the same conditions sorghum flour produced an apatite recovery 91% lower.

Keywords: collectors, depressants, flotation, mineral processing

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Authors: Ergham Al Bachir

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This study adopts strategic leadership (Upper Echelons) as the core theory and contextual leadership theory as the research lens. This research asks how the external context impacts strategic leadership effectiveness to achieve the outcomes in pluralistic organizations (PO). The study explores how the context influences the selection of CEOs, top management teams (TMT), and their leadership effectiveness. POs are characterized by the multiple objectives of their top management teams, divergent objectives, multiple strategies, and multiple governing authorities. The research question is explored by means of a qualitative multiple-case study focusing on healthcare, real estate, and financial services organizations. The data sources are semi-structured interviews, documents, and direct observations. The data analysis strategy is inductive and deploys thematic analysis and cross-case synthesis. The findings differentiate between national and international CEOs' delegation of authority and relationship with the Board of Directors. The findings identify the elements of the dynamic context that influence TMT and PO outcomes. The emergent hybrid strategic and contextual leadership framework shows how the different contextual factors influence strategic direction, PO context, selection of CEOs and TMT, and the outcomes in four pluralistic organizations. The study offers seven theoretical contributions to Upper Echelons, strategic leadership, and contextual leadership research. (1) The integration of two theories revealed how CEO’s impact on the organization is complementary to the contextual impact. (2) Conducting this study in the Middle East contributes to strategic leadership and contextual leadership research. (3) The demonstration of the significant contextual effects on the selection of CEOs. (4 and 5) Two contributions revealed new links between the context, the Board role, internal versus external CEOs, and national versus international CEOs. (6 and 7) This study offered two definitions: what accounts for CEO leadership effectiveness and organizational outcomes. Two methodological contributions were also identified: (1) Previous strategic leadership and Upper Echelons research are mainly quantitative, while this study adopts qualitative multiple-case research with face-to-face interviews. (2) The extrication of the CEO from the TMT advanced the data analysis in strategic leadership research. Four contributions are offered to practice: (1) The CEO's leadership effectiveness inside and outside the organization. (2) Rapid turnover of predecessor CEOs signifies the need for a strategic and contextual approach to CEOs' succession. (3) TMT composition and education impact on TMT-CEO and TMT-TMT interface. (4) Multilevel strategic contextual leadership development framework.

Keywords: strategic leadership, contextual leadership, upper echelons, pluralistic organizations, cross-cultural leadership

Procedia PDF Downloads 95

Authors: Raveendranath Veeramani, Sunil Jonathan Holla, Parkash Chand, Sunil Chumber

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Gray’s Anatomy for Students has been a well-appreciated book among undergraduate students of anatomy in Asia. However, the current curricular requirements of anatomy require a more focused and organized approach. The editors of the first South Asia edition of Gray’s Anatomy for Students hereby highlight the modifications and importance of this edition. There is an emphasis on active learning by making the clinical relevance of anatomy explicit. Learning anatomy in context has been fostered by the association between anatomists and clinicians in keeping with the emerging integrated curriculum of the 21st century. The language has been simplified to aid students who have studied in the vernacular. The original illustrations have been retained, and few illustrations have been added. There are more figure numbers mentioned in the text to encourage students to refer to the illustrations while learning. The text has been made more student-friendly by adding generalizations, classifications and summaries. There are useful review materials at the beginning of the chapters which include digital resources for self-study. There are updates on imaging techniques to encourage students to appreciate the importance of essential knowledge of the relevant anatomy to interpret images, due emphasis has been laid on dissection. Additional importance has been given to the cranial nerves, by describing their relevant details with several additional illustrations and flowcharts. This new edition includes innovative features such as set inductions, outlines for subchapters and flowcharts to facilitate learning. Set inductions are mostly clinical scenarios to create interest in the need to study anatomy for healthcare professions. The outlines are a modern multimodal facilitating approach towards various topics to empower students to explore content and direct their learning and include learning objectives and material for review. The components of the outline encourage the student to be aware of the need to create solutions to clinical problems. The outlines help students direct their learning to recall facts, demonstrate and analyze relationships, use reason to explain concepts, appreciate the significance of structures and their relationships and apply anatomical knowledge. The 'structures to be identified in a dissection' are given as Level I, II and III which represent the 'must know, desirable to know and nice to know' content respectively. The flowcharts have been added to get an overview of the course of a structure, recapitulate important details about structures, and as an aid to recall. There has been a great effort to balance the need to have content that would enable students to understand concepts as well as get the basic material for the current condensed curriculum.

Keywords: Grays anatomy, South Asia, human anatomy, students anatomy

Procedia PDF Downloads 202

Authors: Sau Kam Adeline Chan

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World Health Organization had listed ‘Communication during Patient Care Handovers’ as one of its highest 5 patient safety initiatives. Clinical handover means transfer of accountability and responsibility of clinical information from one health professional to another. The main goal of clinical handover is to convey patient’s current condition and treatment plan accurately. Ineffective communication at point of care is globally regarded as the main cause of the sentinel event. Situation, Background, Assessment and Recommendation (SBAR), a communication tool, is extensively regarded as an effective communication tool in healthcare setting. Nonetheless, just by scenario-based program in nursing school or attending workshops on SBAR would not be enough for freshly graduated nurses to apply it competently in a complex clinical practice. To what extend and in-depth of information should be conveyed during handover process is not easy to learn. As such, on-site coaching is essential to upgrade their expertise on the usage of SBAR and ultimately to avoid any clinical error. On-site coaching for all freshly graduated nurses on the usage of SBAR in clinical handover was commenced in August 2014. During the preceptorship period, freshly graduated nurses were coached by the preceptor. After that, they were gradually assigned to take care of a group of patients independently. Nurse leaders would join in their shift handover process at patient’s bedside. Feedback and support were given to them accordingly. Discrepancies on their clinical handover process were shared with them and documented for further improvement work. Owing to the constraint of manpower in nurse leader, about coaching for 30 times were provided to a nurse in a year. Staff satisfaction survey was conducted to gauge their feelings about the coaching and look into areas for further improvement. Number of clinical error avoided was documented as well. The nurses reported that there was a significant improvement particularly in their confidence and knowledge in clinical handover process. In addition, the sense of empowerment was developed when liaising with senior and experienced nurses. Their proficiency in applying SBAR was enhanced and they become more alert to the critical criteria of an effective clinical handover. Most importantly, accuracy of transferring patient’s condition was improved and repetition of information was avoided. Clinical errors were prevented and quality patient care was ensured. Using SBAR as a communication tool looks simple. The tool only provides a framework to guide the handover process. Nevertheless, without on-site training, loophole on clinical handover still exists, patient’s safety will be affected and clinical error still happens.

Keywords: freshly graduated nurse, competency of clinical handover, quality, clinical error

Procedia PDF Downloads 150

Authors: Priscila A. Bernardes, Marcos E. Buzanskas, Luciana C. A. Regitano, Ricardo V. Ventura, Danisio P. Munari

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Genotype imputation has been used to reduce genomic selections costs. In order to increase haplotype detection accuracy in methods that considers the linkage disequilibrium, another approach could be used, such as combined genotype data from different panels. Therefore, this study aimed to evaluate the linkage disequilibrium and haplotype blocks in two high-density panels before and after the imputation to a combined panel in Nelore beef cattle. A total of 814 animals were genotyped with the Illumina BovineHD BeadChip (IHD), wherein 93 animals (23 bulls and 70 progenies) were also genotyped with the Affymetrix Axion Genome-Wide BOS 1 Array Plate (AHD). After the quality control, 809 IHD animals (509,107 SNPs) and 93 AHD (427,875 SNPs) remained for analyses. The combined genotype panel (CP) was constructed by merging both panels after quality control, resulting in 880,336 SNPs. Imputation analysis was conducted using software FImpute v.2.2b. The reference (CP) and target (IHD) populations consisted of 23 bulls and 786 animals, respectively. The linkage disequilibrium and haplotype blocks studies were carried out for IHD, AHD, and imputed CP. Two linkage disequilibrium measures were considered; the correlation coefficient between alleles from two loci (r²) and the |D’|. Both measures were calculated using the software PLINK. The haplotypes' blocks were estimated using the software Haploview. The r² measurement presented different decay when compared to |D’|, wherein AHD and IHD had almost the same decay. For r², even with possible overestimation by the sample size for AHD (93 animals), the IHD presented higher values when compared to AHD for shorter distances, but with the increase of distance, both panels presented similar values. The r² measurement is influenced by the minor allele frequency of the pair of SNPs, which can cause the observed difference comparing the r² decay and |D’| decay. As a sum of the combinations between Illumina and Affymetrix panels, the CP presented a decay equivalent to a mean of these combinations. The estimated haplotype blocks detected for IHD, AHD, and CP were 84,529, 63,967, and 140,336, respectively. The IHD were composed by haplotype blocks with mean of 137.70 ± 219.05kb, the AHD with mean of 102.10kb ± 155.47, and the CP with mean of 107.10kb ± 169.14. The majority of the haplotype blocks of these three panels were composed by less than 10 SNPs, with only 3,882 (IHD), 193 (AHD) and 8,462 (CP) haplotype blocks composed by 10 SNPs or more. There was an increase in the number of chromosomes covered with long haplotypes when CP was used as well as an increase in haplotype coverage for short chromosomes (23-29), which can contribute for studies that explore haplotype blocks. In general, using CP could be an alternative to increase density and number of haplotype blocks, increasing the probability to obtain a marker close to a quantitative trait loci of interest.

Keywords: Bos taurus indicus, decay, genotype imputation, single nucleotide polymorphism

Procedia PDF Downloads 281

Authors: Obaid AlOtaibi, Salman Hussain

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Wind energy is associated with many geographical factors including wind speed, climate change, surface topography, environmental impacts, and several economic factors, most notably the advancement of wind technology and energy prices. It is the fastest-growing and least economically expensive method for generating electricity. Wind energy generation is directly related to the characteristics of spatial wind. Therefore, the feasibility study for the wind energy conversion system is based on the value of the energy obtained relative to the initial investment and the cost of operation and maintenance. In Kuwait, wind energy is an appropriate choice as a source of energy generation. It can be used in groundwater extraction in agricultural areas such as Al-Abdali in the north and Al-Wafra in the south, or in fresh and brackish groundwater fields or remote and isolated locations such as border areas and projects away from conventional power electricity services, to take advantage of alternative energy, reduce pollutants, and reduce energy production costs. The study covers the State of Kuwait with an exception of metropolitan area. Climatic data were attained through the readings of eight distributed monitoring stations affiliated with Kuwait Institute for Scientific Research (KISR). The data were used to assess the daily, monthly, quarterly, and annual available wind energy accessible for utilization. The researchers applied the Suitability Model to analyze the study by using the ArcGIS program. It is a model of spatial analysis that compares more than one location based on grading weights to choose the most suitable one. The study criteria are: the average annual wind speed, land use, topography of land, distance from the main road networks, urban areas. According to the previous criteria, the four proposed locations to establish wind farm projects are selected based on the weights of the degree of suitability (excellent, good, average, and poor). The percentage of areas that represents the most suitable locations with an excellent rank (4) is 8% of Kuwait’s area. It is relatively distributed as follows: Al-Shqaya, Al-Dabdeba, Al-Salmi (5.22%), Al-Abdali (1.22%), Umm al-Hayman (0.70%), North Wafra and Al-Shaqeeq (0.86%). The study recommends to decision-makers to consider the proposed location (No.1), (Al-Shqaya, Al-Dabdaba, and Al-Salmi) as the most suitable location for future development of wind farms in Kuwait, this location is economically feasible.

Keywords: Kuwait, renewable energy, spatial analysis, wind energy

Procedia PDF Downloads 151

Authors: Vaikunthan Rajaratnam

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Maintaining continuous professional development among clinicians has been a challenge. Hand surgery is a unique speciality with the coming together of orthopaedics, plastics and trauma surgeons. The requirements for a team-based approach to care with the inclusion of other experts such as occupational, physiotherapist and orthotic and prosthetist provide the impetus for the creation of communities of practice. This study analysed the community of practice in hand surgery that was created through a social networking website for professionals. The main objectives were to discover the usefulness of this community of practice created in the platform of the group function of LinkedIn. The second objective was to determine the usability of this platform for the purposes of continuing professional development among members of this community of practice. The methodology used was one of mixed methods which included a quantitative analysis on the usefulness of the social network website as a community of practice, using the analytics provided by the LinkedIn platform. Further qualitative analysis was performed on the various postings that were generated by the community of practice within the social network website. This was augmented by a respondent driven survey conducted online to assess the usefulness of the platform for continuous professional development. A total of 31 respondents were involved in this study. This study has shown that it is possible to create an engaging and interactive community of practice among hand surgeons using the group function of this professional social networking website LinkedIn. Over three years the group has grown significantly with members from multiple regions and has produced engaging and interactive conversations online. From the results of the respondents’ survey, it can be concluded that there was satisfaction of the functionality and that it was an excellent platform for discussions and collaboration in the community of practice with a 69 % of satisfaction. Case-based discussions were the most useful functions of the community of practice. This platform usability was graded as excellent using the validated usability tool. This study has shown that the social networking site LinkedIn’s group function can be easily used as a community of practice effectively and provides convenience to professionals and has made an impact on their practice and better care for patients. It has also shown that this platform was easy to use and has a high level of usability for the average healthcare professional. This platform provided the improved connectivity among professionals involved in hand surgery care which allowed for the community to grow and with proper support and contribution of relevant material by members allowed for a safe environment for the exchange of knowledge and sharing of experience that is the foundation of a community practice.

Keywords: community of practice, online community, hand surgery, lifelong learning, LinkedIn, social media, continuing professional development

Procedia PDF Downloads 317

Authors: Amira Mabrouk

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This paper deals with the acceptability of urban toll in Tunisia. The price-based regulation, i.e. urban toll, is the outcome of a political process hampered by three-fold objectives: effectiveness, equity and social acceptability. This produces both economic interest groups and functions that are of incongruent preferences. The plausibility of this speculation goes hand in hand with the fact that these economic interest groups are also taxpayers who undeniably perceive urban toll as an additional charge. This wariness is coupled with an inquiry about the conditions of usage, the redistribution of the collected tax revenue and the idea of the leviathan state completes the picture. In a nutshell, if researches related to road congestion proliferate, no de facto legitimacy can be pleaded. Nonetheless, the theory on urban tolls engenders economists’ questioning of ways to reduce negative external effects linked to it. Only then does the urban toll appear to bear an answer to these issues. Undeniably, the urban toll suggests inherent conflicts due to the apparent no-payment principal of a public asset as well as to the social perception of the new measure as a mere additional charge. However, when the main concern is effectiveness is its broad sense and the social well-being, the main factors that determine the acceptability of such a tariff measure along with the type of incentives should be the object of a thorough, in-depth analysis. Before adopting this economic role, one has to recognize the factors that intervene in the acceptability of a congestion toll which brought about a copious number of articles and reports that lacked mostly solid theoretical content. It is noticeable that nowadays uncertainties float over the exact nature of the acceptability process. Accepting a congestion tariff could differ from one era to another, from one region to another and from one population to another, etc. Notably, this article, within a convenient time frame, attempts at bringing into focus a link between the social acceptability of the urban congestion toll and the value of time through a survey method barely employed in Tunisia, that of stated preference method. How can the urban toll, as a tax, be defined, justified and made acceptable? How can an equitable and effective tariff of congestion toll be reached? How can the costs of this urban toll be covered? In what way can we make the redistribution of the urban toll revenue visible and economically equitable? How can the redistribution of the revenue of urban toll compensate the disadvantaged while introducing such a tariff measure? This paper will offer answers to these research questions and it follows the line of contribution of JULES DUPUIT in 1844.

Keywords: congestion charge, social perception, acceptability, stated preferences

Procedia PDF Downloads 287

Authors: M. A. Okezue, K. L. Clase, S. R. Byrn

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The requirement for maintaining data integrity in laboratory operations is critical for regulatory compliance. Automation of procedures reduces incidence of human errors. Quality control laboratories located in low-income economies may face some barriers in attempts to automate their processes. Since data from quality control tests on pharmaceutical products are used in making regulatory decisions, it is important that laboratory reports are accurate and reliable. Zinc Sulphate (ZnSO₄) tablets is used in treatment of diarrhea in pediatric population, and as an adjunct therapy for COVID-19 regimen. Unfortunately, zinc content in these formulations is determined titrimetrically; a manual analytical procedure. The assay for ZnSO4 tablets involves time-consuming steps that contain mathematical formulae prone to calculation errors. To achieve consistency, save costs, and improve data integrity, validated spreadsheets were developed to simplify the two critical steps in the analysis of ZnSO4 tablets: standardization of 0.1M Sodium Edetate (EDTA) solution, and the complexometric titration assay procedure. The assay method in the United States Pharmacopoeia was used to create a process flow for ZnSO₄ tablets. For each step in the process, different formulae were input into two spreadsheets to automate calculations. Further checks were created within the automated system to ensure validity of replicate analysis in titrimetric procedures. Validations were conducted using five data sets of manually computed assay results. The acceptance criteria set for the protocol were met. Significant p-values (p < 0.05, α = 0.05, at 95% Confidence Interval) were obtained from students’ t-test evaluation of the mean values for manual-calculated and spreadsheet results at all levels of the analysis flow. Right-first-time analysis and principles of data integrity were enhanced by use of the validated spreadsheet calculators in titrimetric evaluations of ZnSO₄ tablets. Human errors were minimized in calculations when procedures were automated in quality control laboratories. The assay procedure for the formulation was achieved in a time-efficient manner with greater level of accuracy. This project is expected to promote cost savings for laboratory business models.

Keywords: data integrity, spreadsheets, titrimetry, validation, zinc sulphate tablets

Procedia PDF Downloads 170

Authors: Louise Penzenstadler, Tiphaine Robet, Radu Iuga, Daniele Zullino

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Context: The outpatient clinic of the psychiatric addiction service of Geneva University Hospital has been providing support to individuals affected by various narcotics for 30 years. However, the increasing consumption of crack cocaine in Geneva has presented a new challenge for the healthcare system. Research Aim: The aim of this research is to evaluate the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder. Methodology: The research utilizes a combination of quantitative and qualitative retrospective data analysis to evaluate the effectiveness of the outreach intervention. Findings: The data collected from October 2023 to December 2023 show that the outreach program successfully made 1,071 contacts with drug users and led to 15 new requests for care and enrollment in treatment. Patients expressed high satisfaction with the intervention, citing easy and rapid access to treatment and social support. Theoretical Importance: This research contributes to the understanding of the challenges and specific needs of a complex group of drug users who face severe health problems. It highlights the importance of outreach interventions in establishing trust, connecting users with care, and facilitating medication-assisted treatment for opioid addiction. Data Collection: Data was collected through the outreach program's interactions with drug users, including street outreach interventions and presence at locations frequented by users. Patient satisfaction surveys were also utilized. Analysis Procedures: The collected data was analyzed using both quantitative and qualitative methods. The quantitative analysis involved examining the number of contacts made, new requests for care, and treatment enrollment. The qualitative analysis focused on patient satisfaction and their perceptions of the intervention. Questions Addressed: The research addresses the following questions: What is the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder? How effective is the outreach program in connecting drug users with care and initiating medication-assisted treatment? Conclusion: The outreach program has proven to be an effective intervention in establishing trust with crack users, connecting them with care, and initiating medication-assisted treatment for opioid addiction. It has also highlighted the importance of addressing the specific challenges faced by this group of drug users.

Keywords: crack addiction, outreach treatment, peer intervention, polydrug use

Procedia PDF Downloads 64

Authors: Teagan Fink, Lynn Chong, Michael Hii, Brett Knowles

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Background: Telemedicine is a rapidly advancing field providing healthcare to patients at a distance from their treating clinician. There is a paucity of high-quality evidence detailing the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial – conducted prior to the COVID 19 pandemic – aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) of telephone compared to face-to-face clinic follow-up after uncomplicated general surgical procedures. Methods: Patients following uncomplicated laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic follow-up. Data points including patient demographics, perioperative details and postoperative outcomes (eg. wound healing complications, pain scores, unplanned readmission to hospital and return to daily activities) were compared between groups. Patients also completed a Likert patient satisfaction survey following their consultation. Results: 103 patients were recruited over a 12-month period (21 laparoscopic appendicectomies, 65 laparoscopic cholecystectomies, nine open umbilical hernia repairs, six laparoscopic inguinal hernia repairs and two laparoscopic umbilical hernia repairs). Baseline patient demographics and operative interventions were the same in both groups. Patient or clinician-reported concerns on postoperative pain, use of analgesia, wound healing complications and return to daily activities at clinic follow-up were not significantly different between the two groups. Of the 58 patients randomized to the telemedicine arm, 40% reported high and 60% reported very high patient satisfaction. Telemedicine clinic mean consultation times were significantly shorter than face-to-face consultation times (telemedicine 10.3 +/- 7.2 minutes, face-to-face 19.2 +/- 23.8 minutes, p-value = 0.014). Rates of failing to attend clinic were not significantly different (telemedicine 3%, control 6%). There was no increased rate of postoperative complications in patients followed up by telemedicine compared to in-person. There were no unplanned readmissions, return to theatre, or mortalities in this study. Conclusion: Telemedicine follow-up of patients undergoing uncomplicated general surgery is safe and does not result in any missed diagnosis or higher rates of complications. Telemedicine provides high patient satisfaction and steps to implement this modality in inpatient care should be undertaken.

Keywords: general surgery, telemedicine, patient satisfaction, patient safety

Procedia PDF Downloads 119

Authors: Rebecca Greenberg, Nipa Chauhan, Rashad Rehman

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Paternalism, in its traditional form, seems largely incompatible with Western medicine. In contrast, Family-Centred Care, a partial response to historically authoritative paternalism, carries its own challenges, particularly when operationalized as family-directed care. Specifically, in neonatology, decision-making is left entirely to Substitute Decision Makers (most commonly parents). Most models of shared decision-making employ both the parents’ and medical team’s perspectives but do not recognize the inherent asymmetry of information and experience – asking parents to act like physicians to evaluate technical data and encourage physicians to refrain from strong medical opinions and proposals. They also do not fully appreciate the difficulties in adjudicating which perspective to prioritize and, moreover, how to mitigate disagreement. Introducing a mild form of paternalism can harness the unique skillset both parents and clinicians bring to shared decision-making and ultimately work towards decision-making in the best interest of the child. The notion expressed here is that within the model of shared decision-making, mild paternalism is prioritized inasmuch as optimal care is prioritized. This mild form of paternalism is known as Beneficent Paternalism and justifies our encouragement for physicians to root down in their own medical expertise to propose treatment plans informed by medical expertise, standards of care, and the parents’ values. This does not mean that we forget that paternalism was historically justified on ‘beneficent’ grounds; however, our recommendation is that a re-integration of mild paternalism is appropriate within our current Western healthcare climate. Through illustrative examples from the NICU, this paper explores the appropriateness and merits of Beneficent Paternalism and ultimately its use in promoting family-centered care, patient’s best interests and reducing moral distress. A distinctive feature of the NICU is the fact that communication regarding a patient’s treatment is exclusively done with substitute decision-makers and not the patient, i.e., the neonate themselves. This leaves the burden of responsibility entirely on substitute decision-makers and the clinical team; the patient in the NICU does not have any prior wishes, values, or beliefs that can guide decision-making on their behalf. Therefore, the wishes, values, and beliefs of the parent become the map upon which clinical proposals are made, giving extra weight to the family’s decision-making responsibility. This leads to why Family Directed Care is common in the NICU, where shared decision-making is mandatory. However, the zone of parental discretion is not as all-encompassing as it is currently considered; there are appropriate times when the clinical team should strongly root down in medical expertise and perhaps take the lead in guiding family decision-making: this is just what it means to adopt Beneficent Paternalism.

Keywords: care, ethics, expertise, NICU, paternalism

Procedia PDF Downloads 146

Authors: Karolina Porada

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Over the last 40 years, there has been a trend in landscape architecture which supporters do not perceive the role of pro-ecological or postmodern solutions in the design of public green spaces as an essential goal, shifting their attention to the 'sculptural' shaping of areas with the use of slopes, hills, embankments, and other forms of terrain. This group of designers can be considered avant-garde, which in its activities refers to land art. Initial research shows that such applications are particularly frequent in places of former post-industrial sites and landfills, utilizing materials such as debris and post-mining waste in their construction. Due to the high degradation of the environment surrounding modern man, the brownfields are a challenge and a field of interest for the representatives of landscape architecture avant-garde, who through their projects try to recover lost lands by means of transformations supported by engineering and ecological knowledge to create places where nature can develop again. The analysis of a dozen or so facilities made it possible to come up with an important conclusion: apart from the cultural aspects (including artistic activities), the green areas formally referring to the land are important in the process of remediation of post-industrial sites and waste recycling (e. g. from construction sites). In these processes, there is also a potential for applying the concept of Natural Based Solutions, i.e. solutions allowing for the natural development of the site in such a way as to use it to cope with environmental problems, such as e.g.  air pollution, soil phytoremediation and climate change. The paper presents examples of modern parks, whose compositions are based on shaping the surface of the terrain in a way referring to the land art, at the same time providing an example of brownfields reuse and application of waste recycling.  For the purposes of object analysis, research methods such as historical-interpretation studies, case studies, qualitative research or the method of logical argumentation were used. The obtained results provide information about the role that landscape architecture can have in the process of remediation of degraded areas, at the same time guaranteeing the benefits, such as the shaping of landscapes attractive in terms of visual appearance, low costs of implementation, and improvement of the natural environment quality.

Keywords: brownfields, contemporary parks, landscape architecture, remediation

Procedia PDF Downloads 153

Authors: Paola Leon, Hugo Garcia, Adan Leon, Samuel Munoz

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The enhanced oil recovery by steam injection was considered a process that only generated physical recovery mechanisms. However, there is evidence of the occurrence of a series of chemical reactions, which are called aquathermolysis, which generates hydrogen sulfide, carbon dioxide, methane, and lower molecular weight hydrocarbons. These reactions can be favored by the addition of a catalyst during steam injection; in this way, it is possible to generate the original oil in situ upgrading through the production increase of molecules of lower molecular weight. This additional effect could increase the oil recovery factor and reduce costs in transport and refining stages. Therefore, this research has focused on the experimental evaluation of the catalytic aquathermolysis on a Colombian heavy oil with 12,8°API. The effects of three different catalysts, reaction time, and temperature were evaluated in a batch microreactor. The changes in the Colombian heavy oil were quantified through nuclear magnetic resonance 1H-NMR. The relaxation times interpretation and the absorption intensity allowed to identify the distribution of the functional groups in the base oil and upgraded oils. Additionally, the average number of aliphatic carbons in alkyl chains, the number of substituted rings, and the aromaticity factor were established as average structural parameters in order to simplify the samples' compositional analysis. The first experimental stage proved that each catalyst develops a different reaction mechanism. The aromaticity factor has an increasing order of the salts used: Mo > Fe > Ni. However, the upgraded oil obtained with iron naphthenate tends to form a higher content of mono-aromatic and lower content of poly-aromatic compounds. On the other hand, the results obtained from the second phase of experiments suggest that the upgraded oils have a smaller difference in the length of alkyl chains in the range of 240º to 270°C. This parameter has lower values at 300°C, which indicates that the alkylation or cleavage reactions of alkyl chains govern at higher reaction temperatures. The presence of condensation reactions is supported by the behavior of the aromaticity factor and the bridge carbons production between aromatic rings (RCH₂). Finally, it is observed that there is a greater dispersion in the aliphatic hydrogens, which indicates that the alkyl chains have a greater reactivity compared to the aromatic structures.

Keywords: catalyst, upgrading, aquathermolysis, steam

Procedia PDF Downloads 111

Authors: Geng Cui, Naoto Imura, Katsuhiro Nishinari, Takahiro Ezaki

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The bullwhip effect, which refers to the amplification of demand variance as one moves up the supply chain, has been observed in various industries and extensively studied through analytic approaches. Existing methods to mitigate the bullwhip effect, such as decentralized demand information, vendor-managed inventory, and the Collaborative Planning, Forecasting, and Replenishment System, rely on the willingness and ability of supply chain participants to share their information. However, in practice, information sharing is often difficult to realize due to privacy concerns. The purpose of this study is to explore new ways to mitigate the bullwhip effect without the need for information sharing. This paper proposes a 'bullwhip absorption strategy' (BAS) to alleviate the bullwhip effect by absorbing it downstream in the supply chain. To achieve this, a two-stage supply chain system was employed, consisting of a single retailer and a single manufacturer. In each time period, the retailer receives an order generated according to an autoregressive process. Upon receiving the order, the retailer depletes the ordered amount, forecasts future demand based on past records, and places an order with the manufacturer using the order-up-to replenishment policy. The manufacturer follows a similar process. In essence, the mechanism of the model is similar to that of the beer game. The BAS is implemented at the retailer's level to counteract the bullwhip effect. This strategy requires the retailer to reduce the uncertainty in its orders, thereby absorbing the bullwhip effect downstream in the supply chain. The advantage of the BAS is that upstream participants can benefit from a reduced bullwhip effect. Although the retailer may incur additional costs, if the gain in the upstream segment can compensate for the retailer's loss, the entire supply chain will be better off. Two indicators, order variance and inventory variance, were used to quantify the bullwhip effect in relation to the strength of absorption. It was found that implementing the BAS at the retailer's level results in a reduction in both the retailer's and the manufacturer's order variances. However, when examining the impact on inventory variances, a trade-off relationship was observed. The manufacturer's inventory variance monotonically decreases with an increase in absorption strength, while the retailer's inventory variance does not always decrease as the absorption strength grows. This is especially true when the autoregression coefficient has a high value, causing the retailer's inventory variance to become a monotonically increasing function of the absorption strength. Finally, numerical simulations were conducted for verification, and the results were consistent with our theoretical analysis.

Keywords: bullwhip effect, supply chain management, inventory management, demand forecasting, order-to-up policy

Procedia PDF Downloads 76

Authors: Susana Gonçalves, Joana Lencart, Anabela Gregório Dias

Abstract:

Introduction: In combination with chemotherapy, Total Body Irradiation (TBI) is most used as part of the conditioning regimen prior to allogeneic hematopoietic stem cell transplantation. Conventional TBI techniques have a long application time but non-conformality of beam-application with the inability to individually spare organs at risk. Our institution’s intention is to start using Volumetric Modulated Arc Therapy (VMAT) techniques to increase homogeneity of delivered radiation. As a first approach, a dosimetric plan was performed on a computed tomography (CT) scan of a Rando Alderson antropomorfic phantom (head and torso), using a set of six arcs distributed along the phantom. However, a full body anthropomorphic phantom is essential to carry out technique validation and implementation. Our aim is to define the physical and chemical characteristics and the ideal manufacturing procedure of upper and lower limbs to our anthropomorphic phantom, for later validate TBI using VMAT. Materials and Methods: To study the better fit between our phantom and limbs, a CT scan of Rando Alderson anthropomorphic phantom was acquired. CT was performed on GE Healthcare equipment (model Optima CT580 W), with slice thickness of 2.5 mm. This CT was also used to access the electronic density of soft tissue and bone through Hounsfield units (HU) analysis. Results: CT images were analyzed and measures were made for the ideal upper and lower limbs. Upper limbs should be build under the following measures: 43cm length and 7cm diameter (next to the shoulder section). Lower limbs should be build under the following measures: 79cm length and 16.5cm diameter (next to the thigh section). As expected, soft tissue and bone have very different electronic density. This is important to choose and analyze different materials to better represent soft tissue and bone characteristics. The approximate HU values of the soft tissue and for bone shall be 35HU and 250HU, respectively. Conclusion: At the moment, several compounds are being developed based on different types of resins and additives in order to be able to control and mimic the various constituent densities of the tissues. Concurrently, several manufacturing techniques are being explored to make it possible to produce the upper and lower limbs in a simple and non-expensive way, in order to finally carry out a systematic and appropriate study of the total body irradiation. This preliminary study was a good starting point to demonstrate the feasibility of TBI with VMAT.

Keywords: TBI, VMAT, anthropomorphic phantom, tissue equivalent materials

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