Search results for: risk behaviors

Authors: Gokulan Vethanayakam, Daniel Aston

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Introduction: The ReSPECT process supports healthcare professionals when making patient-centered decisions in the event of an emergency. It has been widely adopted by the NHS in England and allows patients to express thoughts and wishes about treatments and outcomes that they consider acceptable. It includes (but is not limited to) cardiopulmonary resuscitation decisions. ReSPECT conversations should ideally occur prior to ICU admission and should be documented in the eight sections of the nationally-standardised ReSPECT form. This audit evaluated the use of ReSPECT on a busy cardiothoracic ICU in an NHS Trust where established policies advocating its use exist. Methods: This audit was a retrospective review of ReSPECT forms for a sample of high-risk patients admitted to ICU at the Royal Papworth Hospital between January 2021 and March 2022. Patients all received one of the following interventions: Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) for severe respiratory failure (retrieved via the national ECMO service); cardiac or pulmonary transplantation-related surgical procedures (including organ transplants and Ventricular Assist Device (VAD) implantation); or elective non-transplant cardiac surgery. The quality of documentation on ReSPECT forms was evaluated using national standards and a graded ranking tool devised by the authors which was used to assess narrative aspects of the forms. Quality was ranked as A (excellent) to D (poor). Results: Of 230 patients (74 VV-ECMO, 104 transplant, 52 elective non-transplant surgery), 43 (18.7%) had a ReSPECT form and only one (0.43%) patient had a ReSPECT form completed prior to ICU admission. Of the 43 forms completed, 38 (88.4%) were completed due to the commencement of End of Life (EoL) care. No non-transplant surgical patients included in the audit had a ReSPECT form. There was documentation of balance of care (section 4a), CPR status (section 4c), capacity assessment (section 5), and patient involvement in completing the form (section 6a) on all 43 forms. Of the 34 patients assessed as lacking capacity to make decisions, only 22 (64.7%) had reasons documented. Other sections were variably completed; 29 (67.4%) forms had relevant background information included to a good standard (section 2a). Clinical guidance for the patient (section 4b) was given in 25 (58.1%), of which 11 stated the rationale that underpinned it. Seven forms (16.3%) contained information in an inappropriate section. In a comparison of ReSPECT forms completed ahead of an EoL trigger with those completed when EoL care began, there was a higher number of entries in section 3 (considering patient’s values/fears) that were assessed at grades A-B in the former group (p = 0.014), suggesting higher quality. Similarly, forms from the transplant group contained higher quality information in section 3 than those from the VV-ECMO group (p = 0.0005). Conclusions: Utilisation of the ReSPECT process in high-risk patients is yet to be well-adopted in this trust. Teams who meet patients before hospital admission for transplant or high-risk surgery should be encouraged to engage with the ReSPECT process at this point in the patient's journey. VV-ECMO retrieval teams should consider ReSPECT conversations with patients’ relatives at the time of retrieval.

Keywords: audit, critical care, end of life, ICU, ReSPECT, resuscitation

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Authors: Mario C. Nierras

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This study aimed to determine the extension services’ needs of small farmers in Biliran province, Philippines. It also sought to find out other issues/concerns of the small farmers. Extension services’ needs of small farmers were gathered through personal interviewing and observational analysis of randomly-selected small farmers in Biliran, Philippines. Biliran small farmers extension services’ needs include: raising fruits, raising legumes, raising vegetables, raising swine, raising cattle, and raising chicken (as priority broad skills). For the specific skills, diagnosing symptoms on fertilizer deficiencies, controlling plant pests and diseases, diagnosing signs on specific pest and disease damage, controlling animal pests and diseases, and doing artificial insemination were the priority skills. They considered an on-farm trial of new technology as most needed to be coupled with industry and quality-orientedness, as positive behaviors needed in farming success. The farmers still adhere to the so-called wait-and-see attitude, thus they are more convinced to follow a particular technology if they see a concrete result of the introduced changes. Technical needs prioritization of Biliran small farmers showed that they have a real need for crop and animal production skills to include the other issues/concerns. Extension service program planning for small farmers should be patterned after their technical needs giving due attention to some issues/concerns so that extension work could deliver the right skills for the right needs of the farmers.

Keywords: extension, extension service, extension service needs, extension service program, farmers, small farmers, marginal farmers

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Authors: Aditya Sharma

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Profits earned from relative strength strategy of zero-cost portfolio i.e. taking long position in winner stocks and short position in loser stocks from recent past are termed as momentum profits. In recent times, there has been lot of controversy and concern about sources of momentum profits, since the existence of these profits acts as an evidence of earning non-normal returns from publicly available information directly contradicting Efficient Market Hypothesis. Literature review reveals conflicting theories and differing evidences on sources of momentum profits. This paper aims at re-examining the sources of momentum profits in Indian capital markets. The study focuses on assessing the effect of fundamental as well as behavioral sources in order to understand the role of investor behavior in stock returns and suggest (if any) improvements to existing behavioral asset pricing models. This Paper adopts calendar time methodology to calculate momentum profits for 6 different strategies with and without skipping a month between ranking and holding period. For each J/K strategy, under this methodology, at the beginning of each month t stocks are ranked on past j month’s average returns and sorted in descending order. Stocks in upper decile are termed winners and bottom decile as losers. After ranking long and short positions are taken in winner and loser stocks respectively and both portfolios are held for next k months, in such manner that at any given point of time we have K overlapping long and short portfolios each, ranked from t-1 month to t-K month. At the end of period, returns of both long and short portfolios are calculated by taking equally weighted average across all months. Long minus short returns (LMS) are momentum profits for each strategy. Post testing for momentum profits, to study the role market risk plays in momentum profits, CAPM and Fama French three factor model adjusted LMS returns are calculated. In the final phase of studying sources, decomposing methodology has been used for breaking up the profits into unconditional means, serial correlations, and cross-serial correlations. This methodology is unbiased, can be used with the decile-based methodology and helps to test the effect of behavioral and fundamental sources altogether. From all the analysis, it was found that momentum profits do exist in Indian capital markets with market risk playing little role in defining them. Also, it was observed that though momentum profits have multiple sources (risk, serial correlations, and cross-serial correlations), cross-serial correlations plays a major role in defining these profits. The study revealed that momentum profits do have multiple sources however, cross-serial correlations i.e. the effect of returns of other stocks play a major role. This means that in addition to studying the investors` reactions to the information of the same firm it is also important to study how they react to the information of other firms. The analysis confirms that investor behavior does play an important role in stock returns and incorporating both the aspects of investors’ reactions in behavioral asset pricing models help make then better.

Keywords: investor behavior, momentum effect, sources of momentum, stock returns

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Authors: Velly Kapadia, Reenu Singh

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This report identifies the long-term driving forces behind urbanization and the impact of compact living on both society and the home and proposes a concept to create smarter and more sustainable homes. Compact living has been trending across India as a sustainable housing solution, and the reality is that India is currently facing a housing shortage in urban areas of around 10 million units. With the rising demand for housing, urban land prices have been rising and the cost of homes. The paper explores how and why the interior design of the homes can be improved to relieve the housing demand in an environmentally, socially and economically sustainable manner. A questionnaire survey was conducted to determine living patterns, area requirements, ecological footprints, energy consumption, purchasing patterns, and various pro-environmental behaviors of people who downsize to compact homes. Quantitative research explores sustainable material choices, durability, functionality, cost, and reusability of furniture. Besides addressing the need for smart and sustainable designed compact homes, a conceptual model is proposed, including options of ideal schematic layouts for homes in urban areas. In the conclusions, suggestions to improve space planning and suitable interior entities have been made to support the fact that compact homes are an eminently practical and sensible solution for the urban citizen.

Keywords: compact living, housing shortage, lifestyle, sustainable interior design

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Authors: Herdina Indrijati

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This research aims to describe teenager delinquency behavior (Juvenile Delinquency) of senior high school students in Surabaya, Indonesia. Juvenile Delinquency is a broad range of behaviors start from socially unacceptable behavior (overreact in school), violation (escape from home) to crimes (like stealing). This research uses quantitative descriptive method using 498 students who come from 8 different schools in Surabaya as subjects. Juvenile Delinquency behavior form questionnaire has been completed by subjects and was used to measure and describe the behavior. The result of this research is presented in statistic descriptive forms. Result shows that 169 subjects skip school, 55 subjects get out of home without parent’s permission, 110 subjects engage in smoking behavior, 74 subjects damage other people properties, 32 subjects steal, 16 subjects exploit others and 7 subjects engage in drug abuse. Frequency of the top five mentioned behavior are 1-10 times. It is also found that subject’s peers are most likely to be the victim of Juvenile Delinquency. The reasons teenagers engage in Juvenile Delinquency include (1) feeling tired, bored or lazy – that contributes to their skip school behavior (2) Having a lot of problem with parents - contrives them to run away from home, (3) accidentally damage other people’s properties, (4) financial problems – force them to steal and exploit, (5) feeling like having a lot of life problems – that makes them do drugs (6) trying smoking for experience.

Keywords: juvenile delinquency, senior high school, student

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Authors: Vahidreza Mahmoudabadi, Omid Bahar, Mohammad Kazem Jafari

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In many applied engineering problems, structural analysis is usually conducted by assuming a rigid bed, while imposing the effect of structure bed flexibility can affect significantly on the structure response. This article focuses on investigation and evaluation of the effects arising from considering a soil-structure system in evaluation of dynamic characteristics of a steel structure with respect to elastic and inelastic behaviors. The recorded structure acceleration during Taiwan’s strong Chi-Chi earthquake on different floors of the structure was our evaluation criteria. The respective structure is an eight-story steel bending frame structure designed using a displacement-based direct method assuring weak beam - strong column function. The results indicated that different identification methods i.e. reverse Fourier transform or transfer functions, is capable to determine some of the dynamic parameters of the structure precisely, rather than evaluating all of them at once (mode frequencies, mode shapes, structure damping, structure rigidity, etc.). Response evaluation based on the input and output data elucidated that the structure first mode is not significantly affected, even considering the soil-structure interaction effect, but the upper modes have been changed. Also, it was found that the response transfer function of the different stories, in which plastic hinges have occurred in the structure components, provides similar results.

Keywords: bending steel frame structure, dynamic characteristics, displacement-based design, soil-structure system, system identification

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Authors: Kottaridi Klimentia, Demopoulos Vasilis, Sidiropoulos Anastasios, Ihara Diego, Nikolaidis Vasileios, Antonopoulos Dimitrios

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Aflatoxins are highly poisonous and carcinogenic compounds produced by species of the genus Aspergillus spp. that can infect a variety of agricultural foods, including dried figs. Biological and environmental factors, such as population, pathogenicity, and aflatoxinogenic capacity of the strains, topography, soil, and climate parameters of the fig orchards, are believed to have a strong effect on aflatoxin levels. Existing methods for aflatoxin detection and measurement, such as high performance liquid chromatography (HPLC), and enzyme-linked immunosorbent assay (ELISA), can provide accurate results, but the procedures are usually time-consuming, sample-destructive, and expensive. Predicting aflatoxin levels prior to crop harvest is useful for minimizing the health and financial impact of a contaminated crop. Consequently, there is interest in developing a tool that predicts aflatoxin levels based on topography and soil analysis data of fig orchards. This paper describes the development of a risk assessment tool for the contamination of aflatoxin on dried figs, based on the location and altitude of the fig orchards, the population of the fungus Aspergillus spp. in the soil, and soil parameters such as pH, saturation percentage (SP), electrical conductivity (EC), organic matter, particle size analysis (sand, silt, clay), the concentration of the exchangeable cations (Ca, Mg, K, Na), extractable P, and trace of elements (B, Fe, Mn, Zn and Cu), by employing machine learning methods. In particular, our proposed method integrates three machine learning techniques, i.e., dimensionality reduction on the original dataset (principal component analysis), metric learning (Mahalanobis metric for clustering), and k-nearest neighbors learning algorithm (KNN), into an enhanced model, with mean performance equal to 85% by terms of the Pearson correlation coefficient (PCC) between observed and predicted values.

Keywords: aflatoxins, Aspergillus spp., dried figs, k-nearest neighbors, machine learning, prediction

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Authors: Siti Rahmawati

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Indonesia has had long period of monetary economic crisis and it is followed by an upward trend in the price of fuel oil. This situation impacts all aspects of tuna fishermen community. For instance, the basic needs of fishing communities increase and the lower purchasing power then lead to economic and social instability as well as the health of fishermen household. To understand this AHP method is applied to acknowledge the model of tuna fisheries management priorities and cold chain marketing channel and the utilization levels that impact on human health. The study is designed as a development research with the number of 180 respondents. The data were analyzed by Analytical Hierarchy Process (AHP) method. The development of tuna fishery business can improve productivity of production with economic empowerment activities for coastal communities, improving the competitiveness of products, developing fish processing centers and provide internal capital for the development of optimal fishery business. From economic aspects, fishery business is more attracting because the benefit cost ratio of 2.86. This means that for 10 years, the economic life of this project can work well as B/C> 1 and therefore the rate of investment is economically viable. From the health aspects, tuna can reduce the risk of dying from heart disease by 50%, because tuna contain selenium in the human body. The consumption of 100 g of tuna meet 52.9% of the selenium in the body and activating the antioxidant enzyme glutathione peroxidaxe which can protect the body from free radicals and stimulate various cancers. The results of the analytic hierarchy process that the quality of tuna products is the top priority for export quality as well as quality control in order to compete in the global market. The implementation of the policy can increase the income of fishermen and reduce the poverty of fishermen households and have impact on the human health whose has high risk of disease.

Keywords: management of tuna, social, economic, health

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Authors: Joelle Fong

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Older persons are at greatest risk of becoming frail. As survival to the age of 80 and beyond continues to increase, the health and frailty of older Americans has garnered much recent attention among policy makers and healthcare administrators. This paper examines patterns in old-age frailty within a multistate actuarial model that characterizes the stochastic process of biological ageing. Using aggregate population-level U.S. mortality data, we implement a stochastic aging model to examine cohort trends and gender differences in frailty distributions for older Americans born 1865 – 1894. The stochastic ageing model, which draws from the fields of actuarial science and gerontology, is well-established in the literature. The implications for public health insurance programs are also discussed. Our results suggest that, on average, women tend to be frailer than men at older ages and reveal useful insights about the magnitude of the male-female differential at critical age points. Specifically, we note that the frailty statuses of males and females are actually quite comparable from ages 65 to 80. Beyond age 80, however, the frailty levels start to diverge considerably implying that women are moving quicker into worse states of health than men. Tracking average frailty by gender over 30 successive birth cohorts, we also find that frailty levels for both genders follow a distinct peak-and-trough pattern. For instance, frailty among 85-year old American survivors increased in years 1954-1963, decreased in years 1964-1971, and again started to increase in years 1972-1979. A number of factors may have accounted for these cohort differences including differences in cohort life histories, differences in disease prevalence, differences in lifestyle and behavior, differential access to medical advances, as well as changes in environmental risk factors over time. We conclude with a discussion on the implications of our findings on spending for long-term care programs within the broader health insurance system.

Keywords: actuarial modeling, cohort analysis, frail elderly, health

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Authors: Hsin-Hsin Chang, Jann-Tay Wang, Wang-Huei Sheng

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Background: Hospital-associated infections (HAIs) have significant medical and social resource consumption. In view of medical technology change rapidly and the prolonged average life expectancy, the patients' chances of receiving invasive medical devices have also increased. As well as the potential disease of the patients, the aging, and immune dysfunction makes the disease more serious, raising the risk of HAIs. In our adult intensive care units, catheter-associated urinary tract infections (CAUTIs) have an average of 4.6% in 2014, which is much higher than that of the National Healthcare Safety Network (NHSN). Therefore, we started the intervention of CAUTI bundle care. Methods: This 3-year intervention was conducted in adults’ intensive care units (ICUs) during January 2015 to December 2017. The implementation of CAUTI bundle care in order to reduce invasive catheter-associated infections were built on evidence-based infection control measures. Prospective surveillance was performed on all patients admitted to hospital. The four major directions are 'Leader Engagement', 'Educate Personnel', 'Executive Multidisciplinary Teamwork', 'Innovation and Improvement of Tools'. Results: During the intervention period, there were 167,024 patient-days with a total of 508 episodes of CAUTIs in the entire adult ICUs identified. The incidence of CAUTIs in adult ICU was significantly decreased in the intervention period (from 2015 to 2017), from 4.6 to 3.6 per 1000 catheter days (p=0.05). Conclusion: The necessity for the implementation of CAUTI bundle care in the health care system plays an important role in the quality and policy of infection control. Multidisciplinary teamwork, education, a comprehensive checklist and from time to time audit feedback to improve healthcare workers’ compliance are the keys to success.

Keywords: bundle care, hospital-associated infections, leader engagement, multidisciplinary team work

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Authors: Mi Yuan

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Employment issues have become increasingly severe in contemporary society, with job seekers' criteria for work environments becoming more complex. However, most studies lack an analysis from the perspective of employment spatial environment. This study employs qualitative research methods such as interviews and thematic analysis, focusing on spatial environment behavior research. By analyzing the behaviors and preferences of key employment groups in China (college graduates, migrant workers, and reemployed laid-off workers) from the perspectives of physical and socio-cultural environments, this study identifies the consistencies and differences in personal viewpoints during job selection and their impact on employment decisions. The findings indicate that college graduates tend to emphasize the macro spatial environment, while migrant workers and reemployed laid-off workers are more concerned with micro spatial environment factors. Additionally, college graduates have higher requirements for the diversity of space types and the distinction between public and private spaces. Furthermore, aside from salary considerations, key employment groups generally place less importance on the socio-cultural environment compared to the physical environment. This study aims to highlight the significance of spatial environment in job selection decisions from the perspective of diverse job seekers, providing insights for policy-making and corporate recruitment strategies.

Keywords: job-seeking populations, spatial environment behavior, micro, macro, qualitative research, physical environment, socio-cultural environment

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Authors: Werner Grommes

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The institute of occupational safety and health works in a working group for building a normative standard for illuminated warning vests and did a lot of experiments and measurements as basic work (cooperation). Intelligent car headlamps are able to suppress conventional warning vests with retro-reflective stripes as a disturbing light. Illuminated warning vests are therefore required for occupational safety. However, they must not pose any danger to the wearer or other persons. Here, the risks of the batteries (lithium types), the maximum brightness (glare) and possible interference radiation from the electronics on the implant carrier must be taken into account. The all-around visibility, as well as the required range, play an important role here. For the study, many luminance measurements of already commercially available LEDs and electroluminescent warning vests, as well as their electromagnetic interference fields and aspects of electrical safety, were measured. The results of this study showed that LED lighting is all far too bright and causes strong glare. The integrated controls with pulse modulation and switching regulators cause electromagnetic interference fields. Rechargeable lithium batteries can explode depending on the temperature range. Electroluminescence brings even more hazards. A test method was developed for the evaluation of visibility at distances of 50, 100, and 150 m, including the interview of test persons. A measuring method was developed for the detection of glare effects at close range with the assignment of the maximum permissible luminance. The electromagnetic interference fields were tested in the time and frequency ranges. A risk and hazard analysis were prepared for the use of lithium batteries. The range of values for luminance and risk analysis for lithium batteries were discussed in the standards working group. These will be integrated into the standard. This paper gives a brief overview of the topics of illuminated warning vests, which takes into account the risks and hazards for the vest wearer or others

Keywords: illuminated warning vest, optical tests and measurements, risks, hazards, optical glare effects, LED, E-light, electric luminescent

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Authors: Naydelis Brito Suárez, Deni Librado Torres Román, Fernando Hermosillo Reynoso

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Automatic detection and generation of a dynamic ROI (Region of Interest) in vehicle traffic surveillance videos based on a static camera in Intelligent Transportation Systems is challenging for computer vision-based systems. The dynamic ROI, being a changing ROI, should capture any other moving object located outside of a static ROI. In this work, the video is represented by a Tensor model composed of a Background and a Foreground Tensor, which contains all moving vehicles or objects. The values of each pixel over a time interval are represented by time series, and some pixel rows were selected. This paper proposes a pixel entropy-based algorithm for automatic detection and generation of a dynamic ROI in traffic videos under the assumption of two types of theoretical pixel entropy behaviors: (1) a pixel located at the road shows a high entropy value due to disturbances in this zone by vehicle traffic, (2) a pixel located outside the road shows a relatively low entropy value. To study the statistical behavior of the selected pixels, detecting the entropy changes and consequently moving objects, Shannon, Tsallis, and Approximate entropies were employed. Although Tsallis entropy achieved very high results in real-time, Approximate entropy showed results slightly better but in greater time.

Keywords: convex hull, dynamic ROI detection, pixel entropy, time series, moving objects

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Authors: Mohamed Ghoz, Hala Alsabeh

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Context: Macroscopic Nose Macroneedling (MNM) is a new non-surgical procedure for lifting and tightening the nose. It is a tissue-non-invasive technique that uses a needle to create micro-injuries in the skin. These injuries stimulate the production of collagen and elastin, which results in the tightening and lifting of the skin. Research Aim: The research aim of this study was to investigate the efficacy and safety of MNM for the treatment of nasal deformities. Methodology A total of 100 patients with nasal deformities were included in this study. The patients were randomly assigned to either the MNM group or the control group. The MNM group received a single treatment of MNM, while the control group received no treatment. The patients were evaluated at baseline, 6 months, and 12 months after treatment. Findings: The results of this study showed that MNM was effective in improving the appearance of the nose in patients with nasal deformities. At 6 months after treatment, the patients in the MNM group had significantly improved nasal tip projection, nasal bridge height, and nasal width compared to the patients in the control group. The improvements in nasal appearance were maintained at 12 months after treatment. Theoretical Importance: The findings of this study provide support for the use of MNM as a safe and effective treatment for nasal deformities. MNM is a non-surgical procedure that is associated with minimal downtime and no risk of scarring. This makes it an attractive option for patients who are looking for a minimally invasive treatment for their nasal deformities. Data Collection: Data was collected from the patients using a variety of methods, including clinical assessments, photographic assessments, and patient-reported outcome measures. Analysis Procedures: The data was analyzed using a variety of statistical methods, including descriptive statistics, inferential statistics, and meta-analysis. Question Addressed: The research question addressed in this study was whether MNM is an effective and safe treatment for nasal deformities. Conclusion: The findings of this study suggest that MNM is an effective and safe treatment for nasal deformities. MNM is a non-surgical procedure that is associated with minimal downtime and no risk of scarring. This makes it an attractive option for patients who are looking for a minimally invasive treatment for their nasal deformities.

Keywords: nose, surgery, tie, suture

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Authors: Deepak Raj Bhat, Akihiko Wakai, Shigeru Ogita, Yorihiro Tanaka, Kazushige Hayashi, Shinro Abe

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In this study, the newly developed finite element methods are used for numerical analysis ofa landslide triggered by the fluctuations of ground-water levels in different cases I-IV. In case I, the ground-water level is fixed in such a way that the overall factor of safety (Fs) would be greater or equal to 1 (i.e., stable condition). Then, the ground-water level is gradually increased up to 1.0 m for, making the overall factor of safety (Fs) less than one (i.e., stable or moving condition). Then, the newly developed finite element model is applied for numerical simulation of the slope for each case. Based on the numerical analysis results of each Cases I-IV, the details of the deformation pattern and shear strain pattern are compared to each other. Moreover, the change in mobilized shear strength and local factor of safety along the slip surface of the landslide for each case are discussed to understand the triggering behaviors of a landslide due to the increased in ground water level. It is expected that this study will help to better understand the role of groundwater fluctuation for triggering of a landslide or slope failure disasters, and it would be also helpful for the judgment of the countermeasure works for the prevention and mitigation of landslide and slope failure disasters in near future.

Keywords: finite element method, ground water fluctuations, constitutive model, landslides, long-term disaster management system

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Authors: Matthew Cameron, Stephen Yang, Latifa Al Kharusi, Adam Gosselin, Anissa Chirico, Pouya Gholipour Baradari

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Background: Iron supplementation has been evaluated in several randomized controlled trials (RCTs) for the potential to increase baseline hemoglobin and decrease the incidence of red blood cell (RBC) transfusion during cardiac surgery. This study's main objective was to evaluate the evidence for iron administration in cardiac surgery patients for its effect on the incidence of perioperative RBC transfusion. Methods: This systematic review protocol was registered with PROSPERO (CRD42020161927) on Dec. 19th, 2019, and was prepared as per the PRISMA guidelines. MEDLINE, EMBASE, CENTRAL, Web of Science databases, and Google Scholar were searched for RCTs evaluating perioperative iron administration in adult patients undergoing cardiac surgery. Each abstract was independently reviewed by two reviewers using predefined eligibility criteria. The primary outcome was perioperative RBC transfusion, with secondary outcomes of the number of RBC units transfused, change in ferritin level, reticulocyte count, hemoglobin, and adverse events, after iron administration. The risk of bias was assessed with the Cochrane Collaboration Risk of Bias Tool, and the primary and secondary outcomes were analyzed with a random-effects model. Results: Out of 1556 citations reviewed, five studies (n = 554 patients) met the inclusion criteria. The use of iron demonstrated no difference in transfusion incidence (RR 0.86; 95% CI 0.65 to 1.13). There was a low heterogeneity between studies (I²=0%). The trial sequential analysis suggested an optimal information size of 1132 participants, which the accrued information size did not reach. Conclusion: The current literature does not support the routine use of iron supplementation before cardiac surgery; however, insufficient data is available to draw a definite conclusion. A critical knowledge gap has been identified, and more robust RCTs are required on this topic.

Keywords: cardiac surgery, iron, iron supplementation, perioperative medicine, meta-analysis, systematic review, randomized controlled trial

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Authors: Bharat Kumar, Deepak Kumar, Vijay Chaudhry

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Zirconium alloys are widely used for the core components of a pressurized heavy water reactor (PHWR) or Canada deuterium (CANDU) reactor due to their low neutron absorption cross-section and excellent mechanical properties. The components made of Zirconium alloys are subjected to flow-induced vibrations, resulting in fretting wear at the interface of; pressure tubes and bearing pads, pressure tubes and calandria tubes, and calandria tubes and Liquid injection shutdown system (LISS) nozzles. There is a need to explore the tribological response under such conditions. Present work simulates the contact between calandria tube and LISS nozzle of PHWR/CANDU reactor as cylinder-on-cylinder contact configuration. Reciprocating tribo-tests were conducted on Zircaloy-4 (Zr-4) under the self-mated condition at varying amplitude, frequency, and sliding time. To understand the active wear mechanism, worn surfaces were analyzed using Scanning Electron Microscopy (SEM) and Energy Dispersive Spectroscopy (EDS). The change in amplitude severely affects the wear than other factors. The wear mechanism transits from adhesion to abrasion with increasing test amplitude. The dominant wear mechanisms are micro-cutting and micro-plowing followed by delamination in some areas. However, the coefficient of friction has indifferent behaviors.

Keywords: zircaloy-4, tribology, calandria tube, LISS nozzle, PHWR

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Authors: Qian You, Ibrahim Hassan, Lyes Kadem

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An experiment is conducted to fundamentally investigate flow oscillation characteristics in different sizes of single microtubes in vertical upward flow direction. Three microtubes have 0.889 mm, 0.533 mm, and 0.305 mm hydraulic diameters with 100 mm identical heated length. The mass flux of the working fluid FC-72 varies from 700 kg/m2•s to 1400 kg/m2•s, and the heat flux is uniformly applied on the tube surface up to 9.4 W/cm2. The subcooled inlet temperature is maintained around 24°C during the experiment. The effect of hydraulic diameter and mass flux are studied. The results showed that they have interactions on the flow oscillations occurrence and behaviors. The onset of flow instability (OFI), which is a threshold of unstable flow, usually appears in large microtube with diversified and sustained flow oscillations, while the transient point, which is the point when the flow turns from one stable state to another suddenly, is more observed in small microtube without characterized flow oscillations due to the bubble confinement. The OFI/transient point occurs early as hydraulic diameter reduces at a given mass flux. The increased mass flux can delay the OFI/transient point occurrence in large hydraulic diameter, but no significant effect in small size. Although the only transient point is observed in the smallest tube, it appears at small heat flux and is not sensitive to mass flux; hence, the smallest microtube is not recommended since increasing heat flux may cause local dryout.

Keywords: flow boiling instability, hydraulic diameter effect, a single microtube, vertical upward flow

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Authors: Andres Pinilla Palacios, Ricardo Tamayo

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Emotional contagion is characterized as an automatic tendency to synchronize behaviors that facilitate emotional convergence among humans. It might thus play a pivotal role to understand the dynamics of key social interactions. However, a few research has investigated its potential mechanisms. We suggest two complementary but independent processes that may underlie emotional contagion. The efficient contagion hypothesis, based on fast and implicit bottom-up processes, modulated by familiarity and spread of activation in the emotional associative networks of memory. Secondly, the emotional contrast hypothesis, based on slow and explicit top-down processes guided by deliberated appraisal and hypothesis-testing. In order to assess these two hypotheses, an experiment with 39 participants was conducted. In the first phase, participants were induced (between-groups) to an emotional state (positive, neutral or negative) using a standardized video taken from the FilmStim database. In the second phase, participants classified and rated (within-subject) the emotional state of 15 faces (5 for each emotional state) taken from the POFA database. In the third phase, all participants were returned to a baseline emotional state using the same neutral video used in the first phase. In a fourth phase, participants classified and rated a new set of 15 faces. The accuracy in the identification and rating of emotions was partially explained by the efficient contagion hypothesis, but the speed with which these judgments were made was partially explained by the emotional contrast hypothesis. However, results are ambiguous, so a follow-up experiment is proposed in which emotional expressions and activation of the sympathetic system will be measured using EMG and EDA respectively.

Keywords: electromyography, emotional contagion, emotional valence, identification of emotions, imitation

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Authors: Hyeon-Kyo Lim, Tong-Il Jang, Yong-Hee Lee

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For an operator in a nuclear power plant, human error is one of the most dreaded factors that may result in unexpected accidents. The possibility of human errors may be low, but the risk of them would be unimaginably enormous. Thus, for accident prevention, it is quite indispensable to analyze the influence of any factors which may raise the possibility of human errors. During the past decades, not a few research results showed that performance of human operators may vary over time due to lots of factors. Among them, stress is known to be an indirect factor that may cause human errors and result in mental illness. Until now, not a few assessment tools have been developed to assess stress level of human workers. However, it still is questionable to utilize them for human performance anticipation which is related with human error possibility, because they were mainly developed from the viewpoint of mental health rather than industrial safety. Stress level of a person may go up or down with work time. In that sense, if they would be applicable in the safety aspect, they should be able to assess the variation resulted from work time at least. Therefore, this study aimed to compare their applicability for safety purpose. More than 10 kinds of work stress tools were analyzed with reference to assessment items, assessment and analysis methods, and follow-up measures which are known to close related factors with work stress. The results showed that most tools mainly focused their weights on some common organizational factors such as demands, supports, and relationships, in sequence. Their weights were broadly similar. However, they failed to recommend practical solutions. Instead, they merely advised to set up overall counterplans in PDCA cycle or risk management activities which would be far from practical human error prevention. Thus, it was concluded that application of stress assessment tools mainly developed for mental health seemed to be impractical for safety purpose with respect to human performance anticipation, and that development of a new assessment tools would be inevitable if anyone wants to assess stress level in the aspect of human performance variation and accident prevention. As a consequence, as practical counterplans, this study proposed a new scheme for assessment of work stress level of a human operator that may vary over work time which is closely related with the possibility of human errors.

Keywords: human error, human performance, work stress, assessment tool, time-variant, accident prevention

Procedia PDF Downloads 673

Authors: Allison Herlene Du Plessis, Dalena (R.M.) Van Rooyen, Wilma Ten Ham-Baloyi, Sihaam Jardien-Baboo

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Introduction: Women die in pregnancy and childbirth for five main reasons—severe bleeding, infections, unsafe abortions, hypertensive disorders (pre-eclampsia and eclampsia), and medical complications including cardiac disease, diabetes, or HIV/AIDS complicated by pregnancy. In 2015, WHO classified sepsis as the third highest cause for maternal mortalities in the world. Chorioamnionitis is a clinical syndrome of intrauterine infection during any stage of the pregnancy and it refers to ascending bacteria from the vaginal canal up into the uterus, causing infection. While the incidence rates for chorioamnionitis are not well documented, complications related to chorioamnionitis are well documented and midwives still struggle to identify this condition in time due to its complex nature. Few diagnostic methods are available in public health services, due to escalated laboratory costs. Often the affordable biomarkers, such as C-reactive protein CRP, full blood count (FBC) and WBC, have low significance in diagnosing chorioamnionitis. A lack of screening impacts on effective and timeous management of chorioamnionitis, and early identification and management of risks could help to prevent neonatal complications and reduce the subsequent series of morbidities and healthcare costs of infants who are health foci of perinatal infections. Objective: This integrative literature review provides an overview of current best research evidence on the screening of women at risk for chorioamnionitis. Design: An integrative literature review was conducted using a systematic electronic literature search through EBSCOhost, Cochrane Online, Wiley Online, PubMed, Scopus and Google. Guidelines, research studies, and reports in English related to chorioamnionitis from 2008 up until 2020 were included in the study. Findings: After critical appraisal, 31 articles were included. More than one third (67%) of the literature included ranked on the three highest levels of evidence (Level I, II and III). Data extracted regarding screening for chorioamnionitis was synthesized into four themes, namely: screening by clinical signs and symptoms, screening by causative factors of chorioamnionitis, screening of obstetric history, and essential biomarkers to diagnose chorioamnionitis. Key conclusions: There are factors that can be used by midwives to identify women at risk for chorioamnionitis. However, there are a paucity of established sociological, epidemiological and behavioral factors to screen this population. Several biomarkers are available to diagnose chorioamnionitis. Increased Interleukin-6 in amniotic fluid is the better indicator and strongest predictor of histological chorioamnionitis, whereas the available rapid matrix-metalloproteinase-8 test requires further testing. Maternal white blood cells count (WBC) has shown poor selectivity and sensitivity, and C-reactive protein (CRP) thresholds varied among studies and are not ideal for conclusive diagnosis of subclinical chorioamnionitis. Implications for practice: Screening of women at risk for chorioamnionitis by health care providers providing care for pregnant women, including midwives, is important for diagnosis and management before complications arise, particularly in resource-constraint settings.

Keywords: chorioamnionitis, guidelines, best evidence, screening, diagnosis, pregnant women

Procedia PDF Downloads 123

Authors: Mustafa Gulsen, Nihan Pekyavas, Emine Atıcı

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Purpose: The aim of this study is to investigate the effects of Kinesio taping on postural stability and in young soccer players. Subjects and Methods: 62 volunteered soccer players from Cayyolu Sports Club were included in our study. Permissions were also taken from the club directors about the inclusion of their players to our study. Soccer players between the age of 12 and 16 were included in our study. Players that had previous injury on lower extremities were excluded from the study. Players were randomly divided into two groups: Kinesio taping (KT) (n=31), and control group (n = 31). KT application including gastrocnemius and quadriceps femoris muscle facilitation techniques were applied to the first group. A rest time for 45 minutes was given in order to see the best effectiveness of the tape. The second group was set as the control group and no application was made. All participants were assessed before the application and 45 minutes later. In order to provide the double-blind design of the study, an experienced physiotherapist has done the assessments and another experienced physiotherapist has done the taping. The patients were randomly assigned to one of the two groups using an online random allocation software program. Postural stability was assessed by using Tetrax Interactive Balance System. Thermographic assessment was done by using FLIR E5 (FLIR Systems AB, Sweden) thermal camera in order to see which muscles have the most thermal activity while maintaining postural stability. Results: Statistically significant differences were found in all assessment parameters in both Kinesio Taping and control groups (all p<0.05) except thermal imaging of dominant gastrocnemius muscle results (p=0.668) (Table 1). In comparison of the two groups, statistically significant differences were found in all parameters (all p<0.05). Conclusion: In this study, we investigated the effects of Kinesio taping on postural stability in young soccer players and found that KT application on Quadriceps and Gastrocnemius muscles may have decreased the risk of falling more than the control group. According to thermal imaging assessments, both Quadriceps and Gastrocnemius muscles may be active in maintaining postural stability but in KT group, the temperature of these muscles are higher which leads us to think that they are more activated.

Keywords: Kinesio taping, fall risk, muscle temperature, postural stability

Procedia PDF Downloads 241

Authors: Mona Isazad Mashinchi, Davood Roshan Sangachin, Francis J. Sullivan, Dietrich Rebholz-Schuhmann

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Background: Decision-making processes are nowadays driven by data, data analytics and Business Intelligence (BI). BI as a software platform can provide a wide variety of capabilities such as organization memory, information integration, insight creation and presentation capabilities. Visualizing data through dashboards is one of the BI solutions (for a variety of areas) which helps managers in the decision making processes to expose the most informative information at a glance. In the healthcare domain to date, dashboard presentations are more frequently used to track performance related metrics and less frequently used to monitor those quality parameters which relate directly to patient outcomes. Providing effective and timely care for patients and improving the health outcome are highly dependent on presenting and visualizing data and information. Objective: In this research, the focus is on the presentation capabilities of BI to design a dashboard for prostate cancer (PC) data that allows better decision making for the patients, the hospital and the healthcare system related to a cancer dataset. The aim of this research is to customize a retrospective PC dataset in a dashboard interface to give a better understanding of data in the categories (risk factors, treatment approaches, disease control and side effects) which matter most to patients as well as other stakeholders. By presenting the outcome in the dashboard we address one of the major targets of a value-based health care (VBHC) delivery model which is measuring the value and presenting the outcome to different actors in HC industry (such as patients and doctors) for a better decision making. Method: For visualizing the stored data to users, three interactive dashboards based on the PC dataset have been developed (using the Tableau Software) to provide better views to the risk factors, treatment approaches, and side effects. Results: Many benefits derived from interactive graphs and tables in dashboards which helped to easily visualize and see the patients at risk, better understanding the relationship between patient's status after treatment and their initial status before treatment, or to choose better decision about treatments with fewer side effects regarding patient status and etc. Conclusions: Building a well-designed and informative dashboard is related to three important factors including; the users, goals and the data types. Dashboard's hierarchies, drilling, and graphical features can guide doctors to better navigate through information. The features of the interactive PC dashboard not only let doctors ask specific questions and filter the results based on the key performance indicators (KPI) such as: Gleason Grade, Patient's Age and Status, but may also help patients to better understand different treatment outcomes, such as side effects during the time, and have an active role in their treatment decisions. Currently, we are extending the results to the real-time interactive dashboard that users (either patients and doctors) can easily explore the data by choosing preferred attribute and data to make better near real-time decisions.

Keywords: business intelligence, dashboard, decision making, healthcare, prostate cancer, value-based healthcare

Procedia PDF Downloads 141

Authors: Ashenafi Ayele, Shewit Haftu, Tesfalem Araya

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Background: “Post-psychotic depression”, “post schizophrenic depression”, and “secondary depression” have been used to describe the occurrence of depressive symptoms during the chronic phase of schizophrenia. Post-psychotic depression is the most common cause of death due to suicide in schizophrenia patients. Overall lifetime risk for patients with schizophrenia is 50% for suicide attempts and 9-13% lifetime risk for completed suicide and also it is associated with poor prognosis and poor quality of life. Objective: To assess determinant of post psychotic depression in schizophrenia patients ACSH and Mekelle General Hospital, Tigray Ethiopia 2019. Methods: An institutional based unmatched case control study was conducted among 69 cases and 138 controls with the ratio of case to control 1 ratio 2. The sample is calculated using epi-info 3.1 to assess the determinant factors of post-psychotic depression in schizophrenia patients. The cases were schizophrenia patients who have been diagnosed at least for more than one-year stable for two months, and the controls are any patients who are diagnosed as schizophrenia patients. Study subjects were selected using a consecutive sampling technique. The Calgary depression scale for schizophrenia self-administered questionnaire was used. Before the interview, it was assessed the client’s capacity to give intended information using a scale called the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC). Bivariant and multiple Logistic regression analysis was performed to determine between the independent and dependent variables. The significant independent predictor was declared at 95% confidence interval and P-value of less than 0.05. Result: Females were affected by post psychotic depression with the (AOR=2.01, 95%CI: 1.003- 4.012, P= 0.49).Patients who have mild form of positive symptom of schizophrenia affected by post psychotic depression with (AOR =4.05, 95%CI: 1.888- 8.7.8, P=0001).Patients who have minimal form of negative symptom of schizophrenia are affected by post psychotic depression with (AOR =4.23, 95%CI: 1.081-17.092, P=.038). Conclusion: In this study, sex (female) and presence of positive and negative symptoms of schizophrenia were significantly associated. It is recommended that the post psychotic depression should be assessed in every schizophrenia patient to decrease the severity of illness, and to improve patient’s quality of life.

Keywords: determinants, post-psychotic depression, Mekelle city

Procedia PDF Downloads 122

Authors: Bilge Aydın Er, Yuksel Ardalı

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In Ayvacık village, 80-90% of the population is engaged in agriculture. The pollution was adversely affecting the properties of agricultural origin of the lake. This study is to determine pollution caused by unwanted changes in the Suat Ugurlu Dam Lake has been launched to monitor. Yesilirmak basin is located in the proximal part of the Black Sea. Therefore it was exposed to impact many pollution. In this study, sediment samples from selected points along the lake was made on the analysis. This work was supported by the results of water analyzes. It is clear that urgent measures should be taken to the area of water management

Keywords: eutrophication, Black sea, lake, pollution

Procedia PDF Downloads 399

Authors: Athena Nguyen, Rojin Belganeh

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In recycling plastics industries, waste plastics are converted into monomers and other useful molecules by chemical reactions. Thermal energy generated by incineration is recovered when waste plastics melt. During the process, Flame retardants containing products get in, and brominated flame retardants (BFRs) are often used to reduce the flammability of products. Some of the originally formulated brominated flame retardants additives are restricted by the RoHS Directive, such as PBDE and PBB. The determination of BFRs other than those restricted by the RoHS directive is required. Frontier Lab developed a pyrolyzer based on the vertical micro-furnace design. The multi-mode pyrolyzer with different modes of operations, including evolve gas analysis (EGA), flash pyrolysis, thermal desorption, heart cutting, allows users to choose among the techniques for their analysis purposes. The method requires very little sample preparation. The first step is to perform an EGA using temperature programs. This technique provides information about the thermal temperature behaviors of the sample. The EGA thermogram is then used to determine the next steps in the analysis process. In this presentation, with an Optimal thermal temperature zone identified based on EGA thermogram, thermal desorption GC/MS is a chosen technique for the determination of brominated flame retardants in recycled plastic toys. Five types of general-purpose brominated flame retardants other than those restricted by the RoHS Directive are determined by the standard addition method.

Keywords: gas chromatography/mass spectrometry, pyrolysis, pyrolyzer, thermal desorption-GC/MS

Procedia PDF Downloads 193

Authors: Fedili Benamar, Belloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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Introduction: Perioperative blood loss is a frequent cause of complications in total hip replacement (THR). The present prospective study assessed the efficacy of tranexamic acid (Exacyl(®)) in reducing blood loss in primary THR. Hypothesis: Tranexamic acid reduces blood loss in THR. Material and method: -This is a prospective randomized study on the effectiveness of Exacyl (tranexamic acid) in total hip replacement surgery performed on a standardized technique between 2019 and September 2022. -It involved 154 patients, of which 84 received a single injection of Exacyl (group 1) at a dosage of 10 mg/kg over 20 minutes during the perioperative period. -All patients received postoperative thromboprophylaxis with enoxaparin 0.4 ml subcutaneously. -All patients were admitted to the post-interventional intensive care unit for a duration of 24 hours for monitoring and pain management as per the service protocol. Results: 154 patients, of which 84 received a single injection of Exacyl (group 1) and 70 patients patients who did not receive Exacyl perioperatively : (Group 2 ) The average age is 57 +/- 15 years The distribution by gender was nearly equal with 56% male and 44% female; "The distribution according to the ASA score was as follows: 20.2% ASA1, 82.3% ASA2, and 17.5% ASA3. "There was a significant difference in the average volume of intraoperative and postoperative bleeding during the 48 hours." The average bleeding volume for group 1 (received Exacyl) was 614 ml +/- 228, while the average bleeding volume for group 2 was 729 +/- 300, with a chi-square test of 6.35 and a p-value < 0.01, which is highly significant. The ANOVA test showed an F-statistic of 7.11 and a p-value of 0.008. A Bartlett test revealed a chi-square of 6.35 and a p-value < 0.01." "In Group 1 (patients who received Exacyl), 73% had bleeding less than 750 ml (Group A), and 26% had bleeding exceeding 750 ml (Group B). In Group 2 (patients who did not receive Exacyl perioperatively), 52% had bleeding less than 750 ml (Group A), and 47% had bleeding exceeding 750 ml (Group B). "Thus, the use of Exacyl reduced perioperative bleeding and specifically decreased the risk of severe bleeding exceeding 750 ml by 43% with a relative risk (RR) of 1.37 and a p-value < 0.01. The transfusion rate was 1.19% in the population of Group 1 (Exacyl), whereas it was 10% in the population of Group 2 (no Exacyl). It can be stated that the use of Exacyl resulted in a reduction in perioperative blood transfusion with an RR of 0.1 and a p-value of 0.02. Conclusions: The use of Exacyl significantly reduced perioperative bleeding in this type of surgery.

Keywords: acid tranexamic, blood loss, anesthesia, total hip replacement, surgery

Procedia PDF Downloads 77

Authors: Yuan-Lin Liu, Ye Li, Tian Xia

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Taxi-calling APPs have been used widely, while brought both benefits and a variety of issues for the taxi market. Many countries do not know whether the benefits are remarkable than the issues or not. This paper established a comparison between the basic scenario (2009-2012) and a taxi-calling software usage scenario (2012-2015) to explain the impact of taxi-calling APPs. The impacts of taxi-calling APPs illustrated by the comparison results are: 1) The supply and demand distribution is more balanced, extending from the city center to the suburb. The availability of taxi service has been improved in low density areas, thin market attribute has also been improved; 2)The ratio of short distance taxi trip decreased, long distance service increased, the utilization of mileage increased, and the rate of empty decreased; 3) The popularity of taxi-calling APPs was able to reduce the average empty distance, cruise time, empty mileage rate and average times of loading passengers, can also enhance the average operating speed, improve the taxi operating level, and reduce social cost although there are some disadvantages. This paper argues that the taxi industry and government can establish an integrated third-party credit information platform based on credit evaluated by the data of the drivers’ driving behaviors to supervise the drivers. Taxi-calling APPs under fully covered supervision in the mobile Internet environment will become a new trend.

Keywords: taxi, taxi-calling APPs, credit, scenario comparison

Procedia PDF Downloads 254

Authors: Warunpun Kongsom, Chaiwat Kongsom

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The objective of this study was to investigate the awareness, knowledge and consumer behavior towards organic products in Thailand. For this study, a purposive sampling technique was used to identify a sample group of 2,575 consumers over the age of 20 years who intended or made purchases from 1) green shops; 2) supermarkets with branches; and, 3) green markets. A questionnaire was used for data collection across the country. Descriptive statistics were used for data analysis. The results showed that more than 92% of consumers were aware of organic agriculture, but had less knowledge about it. More than 60% of consumers knew that organic agriculture production and processing did not allow the use of chemicals. And about 40% of consumers were confused between the food safety logo and the certified organic logo, and whether GMO was allowed in organic agriculture practice or not. In addition, most consumers perceived that organic agricultural products, good agricultural practice (GAP) products, agricultural chemicals free products, and hydroponic vegetable products had the same standard. In the view of organic consumers, the organic Thailand label was the most seen and reliable among various organic labels. Less than 3% of consumers thought that the International Federation of Organic Agriculture Movements (IFOAM) Global Organic Mark (GOM) was the most seen and reliable. For the behaviors of organic consumers, they purchased organic products mainly at the supermarket and green shop (55.4%), one to two times per month, and with a total expenditure of about 200 to 400 baht each time. The main reason for buying organic products was safety and free from agricultural chemicals. The considered factors in organic product selection were price (29.5%), convenience (22.4%), and a reliable certification system (21.3%). The demands for organic products were mainly rice, vegetables and fruits. Processed organic products were relatively small in quantity.

Keywords: consumer behavior, consumer knowledge, organic products, Thailand

Procedia PDF Downloads 296

Authors: Lida Moghaddam-Banaem, Mahmood Tavoosi, Soheila Khalili

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Objective: The main objective of this study was designing a breast cancer health literacy questionnaire and assess its psychometric properties. Methods: A comprehensive literature review was performed to develop a primary questionnaire consisting of five domains. Qualitative and quantitative content validity were assessed by relevant experts, and after some modifications, the content validity index (CVI) and content validity ratio (CVR) were calculated. Qualitative and quantitative face validity were evaluated by a number of patients, and the impact score for each item was calculated. 225 women with breast cancer were asked to fill out the questionnaire and construct validity was determined by using exploratory factor analysis. The reliability was tested by Cronbach's alpha coefficient. Results: A 36-item questionnaire with five domains of reading, having access, understanding, assessing/judgment, and decision making/behavior was designed. 2 items were omitted in the qualitative content validity process. All items achieved optimum values in CVI, CVR and impact scores. Content and face validity of the questionnaire were confirmed too. According to the exploratory factor analysis, the five-factor solution accounted for 64.98 percent of the observed variance. Conclusion: Due to the obtained satisfactory validity and reliability, this tool can be used to assess health literacy in women with breast cancer. Health policy makers can use these findings for improving health-related behaviors in breast cancer patients.

Keywords: health literacy, breast cancer, questionnaire, psychometric properties

Procedia PDF Downloads 235