Search results for: integrated care delivery

Authors: Nuttapimon Bhirommuang, Kulapong Jayanama

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Background: Prevalence of malnutrition in hospitalized patient is higher than general population. As a result of the unawareness of consequence and the more concerning in the other aspects of care, many patients with high risk of malnutrition are unrecognized. Even if malnutrition has been identified as affecting in many patient outcomes, the impact may differ in each population and group of patients. Objectives: The aims of this study were to examine the association between the nutritional status and the length of stay and hospital costs in hospitalized patients, to investigate the factors related these outcomes and to determine the frequency of malnutrition in hospitals. Method: This retrospective cohort study enrolled all patients aged 15 years old or older and admitted in SDMC, Ramathibodi Hospital between 1st January 2016 and 30th September 2016. The nutritional status assessment by Nutrition Alert Form (NAF) was performed by well-trained nurses in all patients at admission. Baseline characteristics were recorded. Length of stay and hospital costs were collected during their hospitalization. Univariate analysis, nonparametric rank test, Kruskal-Wallis test were used to compare means in the case of nonnormally and noncontinuously distributed data. Chi-square used to analyze categorical variables, the nutritional status and the length of stay and hospital costs and identify possible confounding factors (data were analyzed using SPSS version 18.0). Result: Of the 2,906 patients, 3.9% were severe malnutrition (NAF-C score > 10) and 11.4% were moderate malnutrition (NAF-B score 6 - 10). Both length of stay and hospital costs were found significantly higher in more severe malnutrition group (p < 0.001), NAF = A: 3.21 days, 95% CI 3.06-3.35 and 111,544.25 THB, 95% CI 106,994.41 – 116,094.1; NAF = B: 7.54 days, 95% CI 6.32 – 8.76 and 162,302.4 THB, 95% CI 129,557.88 – 195,046.92; NAF =C: 14.77 days, 95% CI 11.34 – 18.2 and 323,572.11 THB, 95% CI 226,958.1 – 420,096.13 (1 THB = 0.03019 USD). Age of each nutritional status group had also significant increase from NAF A to NAF C (p < 0.001): 55.07, 67.03 and 73.88 years old, respectively. Conclusion: The prevalence of malnutrition in Ramathibodi hospital is voluminous. Severe malnutrition screening by NAF is significantly correlated with worse clinical outcome, especially higher length of stay and hospital costs. Elderly is also a significant factor which correlates with malnutrition. The results of this study could change the awareness of health personnel and the practice protocol. Moreover, the further study concerning nutritional support in high-risk group of malnutrition is ongoing to confirm this hypothesis.

Keywords: malnutrition, NAF, length of stay, hospital costs

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Authors: M. Aouimeur

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The environmental risks of a dam and particularly the security in the Valley downstream of it,, is a very complex problem. Integrated management and risk-sharing become more and more indispensable. The definition of "vulnerability “concept can provide assistance to controlling the efficiency of protective measures and the characterization of each valley relatively to the floods's risk. Security can be enhanced through the integrated land management. The social sciences may be associated to the operational systems of civil protection, in particular warning networks. The passage of extreme floods in the site of the dam causes the rupture of this structure and important damages downstream the dam. The river bed could be damaged by erosion if it is not well protected. Also, we may encounter some scouring and flooding problems in the downstream area of the dam. Therefore, the protection of the dam is crucial. It must have an energy dissipator in a specific place. The basin of dissipation plays a very important role for the security of the dam and the protection of the environment against floods downstream the dam. It allows to dissipate the potential energy created by the dam with the passage of the extreme flood on the weir and regularize in a natural manner and with more security the discharge or elevation of the water plan on the crest of the weir, also it permits to reduce the speed of the flow downstream the dam, in order to obtain an identical speed to the river bed. The problem of the dimensioning of a classic dissipation basin is in the determination of the necessary parameters for the dimensioning of this structure. This communication presents a simple graphical method, that is fast and complete, and a methodology which determines the main features of the hydraulic jump, necessary parameters for sizing the classic dissipation basin. This graphical method takes into account the constraints imposed by the reality of the terrain or the practice such as the one related to the topography of the site, the preservation of the environment equilibrium and the technical and economic side.This methodology is to impose the loss of head DH dissipated by the hydraulic jump as a hypothesis (free design) to determine all the others parameters of classical dissipation basin. We can impose the loss of head DH dissipated by the hydraulic jump that is equal to a selected value or to a certain percentage of the upstream total head created by the dam. With the parameter DH+ =(DH/k),(k: critical depth),the elaborate graphical representation allows to find the other parameters, the multiplication of these parameters by k gives the main characteristics of the hydraulic jump, necessary parameters for the dimensioning of classic dissipation basin.This solution is often preferred for sizing the dissipation basins of small concrete dams. The results verification and their comparison to practical data, confirm the validity and reliability of the elaborate graphical method.

Keywords: dimensioning, energy dissipation basin, hydraulic jump, protection of the environment

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Authors: Thanduxolo Elford Fana

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Rationale and Purpose: Performance management and development system are central to effective and efficient service delivery, especially in highly labour intensive sectors such as South African public health. Performance management and development systems seek to ensure that good employee performance is rewarded accordingly, while those who underperform are developed so that they can reach their full potential. An effective and efficiently implemented performance management system motivates and improves employee engagement. The purpose of this study is to examine the implementation of the performance management and development system and the challenges that are encountered during its implementation in the Eastern Cape Provincial Department of Health. Methods: A qualitative research approach and a case study design was adopted in this study. The primary data were collected through observations, focus group discussions with employees, a group interview with shop stewards, and in-depth interviews with supervisors and managers, from April 2019 to September 2019. There were 45 study participants. In-depth interviews were held with 10 managers at facility level, which included chief executive officer, chief medical officer, assistant director’s in human resources management, patient admin, operations, finance, and two area manager and two operation managers nursing. A group interview was conducted with five shop stewards and an in-depth interview with one shop steward from the group. Five focus group discussions were conducted with clinical and non-clinical staff. The focus group discussions were supplemented with an in-depth interview with one person from each group in order to counter the group effect. Observations included moderation committee, contracting, and assessment meetings. Findings: The study shows that the performance management and development system was not properly implemented. There was non-compliance to performance management and development system policy guidelines in terms of time lines for contracting, evaluation, payment of incentives to good performers, and management of poor performance. The study revealed that the system is ineffective in raising the performance of employees and unable to assist employees to grow. The performance bonuses were no longer paid to qualifying employees. The study also revealed that lack of capacity and commitment, poor communication, constant policy changes, financial constraints, weak and highly bureaucratic management structures, union interference were challenges that were encountered during the implementation of the performance management and development system. Lastly, employees and supervisors were rating themselves three irrespective of how well or bad they performed. Conclusion: Performance management is regarded as vital to improved performance of the health workforce and healthcare service delivery among populations. Effective implementation of performance management and development system depends on well-capacitated and unbiased management at facility levels. Therefore, there is an urgent need to improve communication, link performance management to rewards, and capacitate staff on performance management and development system, as it is key to improved public health sector outcomes or performance.

Keywords: challenges, implementation, performance management and development system, public hospital

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Authors: Anand R. Nair, Markus Trenker

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Lifting body concepts were conceived as early as 1917 and patented by Roy Scroggs. It was an idea of using the fuselage as a lift producing body with no or small wings. Many of these designs were developed and even flight tested between 1920’s to 1970’s, but it was not pursued further for commercial flight as at lower airspeeds, such a configuration was incapable to produce sufficient lift for the entire aircraft. The concept presented in this contribution is combining the lifting body design along with a fixed wing to maximise the lift produced by the aircraft. Conventional aircraft fuselages are designed to be aerodynamically efficient, which is to minimise the drag; however, these fuselages produce very minimal or negligible lift. For the design of an unmanned fixed wing transport aircraft, many of the restrictions which are present for commercial aircraft in terms of fuselage design can be excluded, such as windows for the passengers/pilots, cabin-environment systems, emergency exits, and pressurization systems. This gives new flexibility to design fuselages which are unconventionally shaped to contribute to the lift of the aircraft. The two lifting body concepts presented in this contribution are targeting different applications: For a fast cargo delivery drone, the fuselage is based on a scaled airfoil shape with a cargo capacity of 500 kg for euro pallets. The aircraft has a span of 14 m and reaches 1500 km at a cruising speed of 90 m/s. The aircraft could also easily be adapted to accommodate pilot and passengers with modifications to the internal structures, but pressurization is not included as the service ceiling envisioned for this type of aircraft is limited to 10,000 ft. The next concept to be investigated is called a multi-purpose drone, which incorporates a different type of lifting body and is a much more versatile aircraft as it will have a VTOL capability. The aircraft will have a wingspan of approximately 6 m and flight speeds of 60 m/s within the same service ceiling as the fast cargo delivery drone. The multi-purpose drone can be easily adapted for various applications such as firefighting, agricultural purposes, surveillance, and even passenger transport. Lifting body designs are not a new concept, but their effectiveness in terms of cargo transportation has not been widely investigated. Due to their enhanced lift producing capability, lifting body designs enable the reduction of the wing area and the overall weight of the aircraft. This will, in turn, reduce the thrust requirement and ultimately the fuel consumption. The various designs proposed in this contribution will be based on the general aviation category of aircrafts and will be focussed on unmanned methods of operation. These unmanned fixed-wing transport drones will feature appropriate cargo loading/unloading concepts which can accommodate large size cargo for efficient time management and ease of operation. The various designs will be compared in performance to their conventional counterpart to understand their benefits/shortcomings in terms of design, performance, complexity, and ease of operation. The majority of the performance analysis will be carried out using industry relevant standards in computational fluid dynamics software packages.

Keywords: lifting body concept, computational fluid dynamics, unmanned fixed-wing aircraft, cargo drone

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Authors: Spanova Yerkezhan, Amantay Ayan, Alimzhanova Laura

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This article discusses the concept of rebranding and its relationship to cybersecurity. Rebranding is the process of changing the appearance and image of a company or organization in order to appeal to new customers or change the perception of a company. It can be a powerful tool for businesses looking to renew their reputation or expand into new markets. In today's digital age, companies increasingly rely on technology and the internet to conduct business; rebranding can also present significant cybersecurity risks. This is because a rebranding effort can create new vulnerabilities for companies, particularly in terms of their online presence. This article explores the potential hazards associated with rebranding and provides recommendations for mitigating those risks. It also highlights the importance of considering cybersecurity in the rebranding process and how it can be integrated into the overall strategy for a successful and secure rebranding.

Keywords: rebranding, cybersecurity, cyberattack, logo, vulnerability

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Authors: Tamara Vagg, Cathy Shortt, Claire Hickey, Joseph A. Eustace, Barry J. Plant, Sabin Tabirca

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Introduction: Paper-based patient passports have been used advantageously for older patients, patients with diabetes, and patients with learning difficulties. However, these passports can experience issues with data security, patients forgetting to bring the passport, patients being over encumbered, and uncertainty with who is responsible for entering and managing data in this passport. These issues could be resolved by transferring the paper-based system to a convenient platform such as a smartphone application (app). Background: Life expectancy for some Cystic Fibrosis (CF) patients are rising and as such new complications and procedures are predicted. Subsequently, there is a need for education and management interventions that can benefit CF adults. This research proposes a CF patient passport to record basic medical information through a smartphone app which will allow CF adults access to their basic medical information. Aim: To provide CF patients with their basic medical information via mobile multimedia so that they can receive care when traveling abroad or between CF centres. Moreover, by recording their basic medical information, CF patients may become more aware of their own condition and more active in their health care. Methods: This app is designed by a CF multidisciplinary team to be a lightweight reflection of a hospital patient file. The passport app is created using PhoneGap so that it can be deployed for both Android and iOS devices. Data entered into the app is encrypted and stored locally only. The app is password protected and includes the ability to set reminders and a graph to visualise weight and lung function over time. The app is introduced to seven participants as part of a stress test. The participants are asked to test the performance and usability of the app and report any issues identified. Results: Feedback and suggestions received via this testing include the ability to reorder the list of clinical appointments via date, an open format of recording dates (in the event specifics are unknown), and a drop down menu for data which is difficult to enter (such as bugs found in mucus). The app is found to be usable and accessible and is now being prepared for a pilot study with adult CF patients. Conclusions: It is anticipated that such an app will be beneficial to CF adult patients when travelling abroad and between CF centres.

Keywords: Cystic Fibrosis, digital patient passport, mHealth, self management

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Authors: Shubham Tandon, Rajni Goel

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The prime objective of our review paper is to study the quantitative psychology impact on our daily life. Quantitative techniques have been studied with the aim of discovering solutions in an advanced way. To get the unbiased and correct results, statistics and other useful mathematical aspects have been reviewed. So, many psychologists use quantitative techniques while working in the area of psychology with the aim of discovering solutions in an advanced way. This ensures their accurate outcomes as those will make use of precise criteria in knowing the minds and conditions of any person. Also, proper experimentation and observational tools are taken care of to avoid some possibilities of invalid data.

Keywords: quantitative psychology, psychologists, statistics, person, results, minds

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Authors: Ararat Khachatryan, Davit Mirzoyan

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In sub micrometer technology, the aging phenomenon starts to have a significant impact on the reliability of integrated circuits by bringing performance degradation. For that reason, it is important to have a capability to evaluate the aging effects accurately. This paper presents an accurate aging measurement approach based on phase-locked loop (PLL) and voltage-controlled oscillator (VCO) circuit. The architecture is rejecting the circuit self-aging effect from the characteristics of PLL, which is generating the frequency without any aging phenomena affects. The aging monitor is implemented in low power 32 nm CMOS technology, and occupies a pretty small area. Aging simulation results show that the proposed aging measurement circuit improves accuracy by about 2.8% at high temperature and 19.6% at high voltage.

Keywords: aging effect, HCI, NBTI, nanoscale

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Authors: Memnun Seven, Aygül Akyüz

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Having a baby, giving birth and being a mother are generally considered happy events, especially for women who have had a history of infertility and may have suffered emotionally, physically and financially. Although the transition from the prenatal period to the postnatal period is usually desired and planned, it is a developmental and cognitive transition period full of complex emotional reactions. During this period, common mood disorders for women include maternity blues, postpartum depression and postpartum psychosis. Postpartum depression is a common and serious mood disorder which can jeopardize the health of the mother, baby and family within the first year of delivery. Knowing the risks factors is an important issue for the early detection and early intervention of postpartum depression. However, knowing that a history of infertility may contribute to the development of postpartum depression, there are few studies assessing the effects of infertility during the diagnosis and treatment of depression. In this review, the effects of infertility on the development of postpartum depression and nurse/midwives’ roles in this issue are discussed in light with the literature.

Keywords: infertility, postpartum depression, risk factors, mood disorder

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Authors: Sachin Sharma

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A wireless sensor network (WSN) consists of a large number of sensor nodes which are deployed over an area to perform local computations based on information gathered from the surroundings. With the increasing demand for real-time applications in WSN, real-time critical events anticipate an efficient quality-of-service (QoS) based routing for data delivery from the network infrastructure. Hence, maximizing the lifetime of the network through minimizing the energy is an important challenge in WSN; sensors cannot be easily replaced or recharged due to their ad-hoc deployment in a hazardous environment. Considerable research has been focused on developing robust energy efficient QoS based routing protocols. The main focus of this article is primarily on periodical cycling schemes which represent the most compatible technique for energy saving and we also focus on the data-driven approaches that can be used to improve the energy efficiency. Finally, we will make a review on some communication protocols proposed for sensor networks.

Keywords: energy efficient, quality of service, wireless sensor networks, MAC

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Authors: Julio Kauss, Miguel Cadillo, David Mauricio

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E-commerce is a business model that allows companies to optimize the processes of buying, selling, transferring goods and exchanging services through computer networks or the Internet. In Peru, the electronic commerce is used infrequently. This situation is due, in part to the fact that there is no model that allows companies to implement an e-commerce solution, which means that most SMEs do not have adequate knowledge to adapt to electronic commerce. In this work, a reference model is proposed for the implementation of an e-commerce solution in Peruvian SMEs in the retail sector. It consists of five phases: Business Analysis, Business Modeling, Implementation, Post Implementation and Results. The present model was validated in a SME of the Peruvian retail sector through the implementation of an electronic commerce platform, through which the company increased its sales through the delivery channel by 10% in the first month of deployment. This result showed that the model is easy to implement, is economical and agile. In addition, it allowed the company to increase its business offer, adapt to e-commerce and improve customer loyalty.

Keywords: e-commerce, retail, SMEs, reference model

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Authors: Azza Taha Zaki

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Technology-enhanced teaching has been in the limelight since the 90s when educators started investigating and experimenting with using computers in the classroom as a means of building 21^st. century skills and motivating students. The concept of technology-enhanced strategies in education is kaleidoscopic! It has meant different things to different educators. For the purpose of this paper, however, it will be used to refer to the diverse technology-based strategies used to support and enrich the flipped learning process, in the classroom and outside. The paper will investigate how technology is put in the service of teaching and learning to improve the students’ learning experience as manifested in students’ attendance and engagement, achievement rates and finally, students’ projects at the end of the semester. The results will be supported by a student survey about relevant specific aspects of their learning experience in the modules in the study.

Keywords: attendance, British University, Egypt, flipped, student achievement, student-centred, student engagement, students’ projects

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Authors: Meisam Moghadasi, Hassan Ali Ozgoli, Foad Farhani

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In this research, firstly, a commercial gas sweetening unit with methyl-di-ethanol-amine (MDEA) solution is simulated and comprised in an integrated model in accordance with Aspen HYSYS software. For evaluation purposes, in the second step, the results of the simulation are compared with operating data gathered from South Pars Gas Complex (SPGC). According to the simulation results, the considerable energy potential contributed to the pressure difference between absorber and regenerator columns causes this energy driving force to be applied in power recovery turbine (PRT). In the last step, the amount of waste hydraulic energy is calculated, and its recovery methods are investigated.

Keywords: gas sweetening unit, simulation, MDEA, power recovery turbine, waste-to-energy

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Authors: Hanan Anwar

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All systems recycle. The construction industry has not only become a major consumer of natural materials along with a source of pollution. Environmental integrated production, reusing and recycling is of great importance in Egypt nowadays. Governments should ensure that the technical, environmental and economic feasibility of alternative systems is considered and is taken into account before construction starts. Hereby this paper focuses on the recycle of building materials as a way for environment protection and sustainable development. Environmental management integrates the requirements of sustainable development. There are many methods used to reduce waste and increase profits through salvage, reuse, and the recycling of construction waste. Sustainable development as a tool to continual improvement cycle processes innovations to save money.

Keywords: environment, management, reuse, recycling, sustainable development

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Authors: Basma Hassabo, Sarah Ahmed, Aisha Hameed

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Aims and Objectives: To determine the incidence of maternal mortality amongst pregnant women with sickle cell disease (SCD) in the United Kingdom and to determine exact cause of death in these women. Background: SCD is caused by the ‘sickle’ gene and is characterized by episodes of severe bone pain and other complications like acute chest syndrome, chronic pulmonary hypertension, stroke, retinopathy, chronic renal failure, hepato-splenic crises, avascular bone necrosis, sepsis and leg ulcers. SCD is a continual cause of maternal mortality and fetal complications, and it comprises 1.5% of all Direct and Indirect deaths in the UK. Sepsis following premature rupture of membranes with ascending infection, post-partum infection and pre-labour overwhelming septic shock is one of its leading causes of death. Over the last fifty years of maternal mortality reports in UK, between 1 to 4 pregnant women died in each triennium. Material and Method: This is a retrospective study that involves pregnant women who died from SCD complications in the UK between 1952-2012. Data were collected from the UK Confidential Enquiries into Maternal Death and its causes between 1952–2012. Prior to 1985, exact cause of death in this cohort was not recorded. Results: 33 deaths reported between 1964 and 1984. 17 deaths were reported due to sickle cell disease between 1985 and 2012. Five women in this group died of sickle cell crisis, one woman had liver sequestration crisis, two women died of venous thromboembolism, two had myocardial fibrosis and three died of sepsis. Remaining women died of amniotic fluid embolism, SUDEP, myocardial ischemia and intracranial haemorrhage. Conclusion: The leading causes of death in sickle cell sick pregnant women are sickle cell crises, sepsis, venous thrombosis and thromboembolism. Prenatal care for women with SCD should be managed by a multidisciplinary team that includes an obstetrician, nutritionist, primary care physician, and haematologist. In every sick Sickle Cell woman Sickle Cell crises should be on the top of the list of differential diagnosis. Aggressive treatment of complications with low threshold to commence broad-spectrum antibiotics and LMWH contribute to better outcomes.

Keywords: incidence, maternal mortality, sickle cell disease (SCD), uk

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Authors: Shu-Hui Chuang, Shao-Chun Chiu, Shu-Hsin Chuang

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While the marketing management literature is regarding the direct benefits of market orientation (MO) on firm value, the impact of such MO-based value co-creation remains largely an unexplored area of research. Thus, the primary objective of this study is to provide some new perspectives in examining how MO can enhance value co-creation for customers and sellers. In particular, drawing from the relational view of the firm and IT literature, we propose that the chain of MO-based co-creation of value and how adopt e-marketing systems between partners can facilitate this chain. Using data on use of the e-marketing system, we empirically validate that the sellers’ integrated MO is critical in increasing the e-marketing adoption, which in turn helps to creation co-creation value for both parties.

Keywords: market orientation, value co-creation, e-marketing system, relational view of the firm

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Authors: Matsobane Mosetja, Nehemiah Mavetera, Ernest Mnkandla

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Local governments in South Africa are responsible for the provision of basic services. There are countless benefits that come with e-Government platforms if they are properly implemented to help local governments deliver these basic services to citizens. This study investigates factors influencing the adoption and use of e-Government platforms by citizens in the North West Province, South. The study is set against a background of significant change in South Africa where government services are electronically delivered. The outcome of the study revealed that: 1) decisions on the development of e-Government platforms are made based on a series of consultative forums; 2) the municipalities are open to constructive criticism on their online platform; 3) the municipalities have room for dialogue on how best to improve service delivery; 4) the municipalities are accessible to the citizens all the time; 5) the municipalities are making means and ways to empower them to be part of the collective and lastly e-Government provides room for online discussion.

Keywords: e-government, e-government platforms, user acceptance, local government

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Authors: Shrestha Sharma, Jasjeet K. Sahni, Javed Ali, Sanjula Baboota

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Introduction: Rutin is a naturally occurring strong antioxidant molecule belonging to bioflavonoid category. Due to its free radical scavenging properties, it has been found to be beneficial in the treatment of various diseases including inflammation, cancer, diabetes, allergy, cardiovascular disorders and various types of microbial infections. Despite its beneficial effects, it suffers from the problem of low aqueous solubility which is responsible for low oral bioavailability. The aim of our study was to optimize and characterize self-nanoemulsifying drug delivery system (SNEDDS) of rutin using Box-Behnken design (BBD) combined with a desirability function. Further various antioxidant, pharmacokinetic and pharmacodynamic studies were performed for the optimized rutin SNEDDS formulation. Methodologies: Selection of oil, surfactant and co-surfactant was done on the basis of solubility/miscibility studies. Sefsol+ Vitamin E, Solutol HS 15 and Transcutol P were selected as oil phase, surfactant and co-surfactant respectively. Optimization of SNEDDS formulations was done by a three-factor, three-level (33)BBD. The independent factors were Sefsol+ Vitamin E, Solutol HS15, and Transcutol P. The dependent variables were globule size, self emulsification time (SEF), % transmittance and cumulative percentage drug released. Various response surface graphs and contour plots were constructed to understand the effect of different factor, their levels and combinations on the responses. The optimized Rutin SNEDDS formulation was characterized for various parameters such as globule size, zeta potential, viscosity, refractive index , % Transmittance and in vitro drug release. Ex vivo permeation studies and pharmacokinetic studies were performed for optimized formulation. Antioxidant activity was determined by DPPH and reducing power assays. Anti-inflammatory activity was determined by using carrageenan induced rat paw oedema method. Permeation of rutin across small intestine was assessed using confocal laser scanning microscopy (CLSM). Major findings:The optimized SNEDDS formulation consisting of Sefsol+ Vitamin E - Solutol HS15 -Transcutol HP at proportions of 25:35:17.5 (w/w) was prepared and a comparison of the predicted values and experimental values were found to be in close agreement. The globule size and PDI of optimized SNEDDS formulation was found to be 16.08 ± 0.02 nm and 0.124±0.01 respectively. Significant (p˂0.05) increase in percentage drug release was achieved in the case of optimized SNEDDS formulation (98.8 %) as compared to rutin suspension. Furthermore, pharmacokinetic study showed a 2.3-fold increase in relative oral bioavailability compared with that of the suspension. Antioxidant assay results indicated better efficacy of the developed formulation than the pure drug and it was found to be comparable with ascorbic acid. The results of anti-inflammatory studies showed 72.93 % inhibition for the SNEDDS formulation which was significantly higher than the drug suspension 46.56%. The results of CLSM indicated that the absorption of SNEDDS formulation was considerably higher than that from rutin suspension. Conclusion: Rutin SNEDDS have been successfully prepared and they can serve as an effective tool in enhancing oral bioavailability and efficacy of Rutin.

Keywords: rutin, oral bioavilability, pharamacokinetics, pharmacodynamics

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Authors: Abdelghafour Galadi

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In this paper, accurate power MOSFET models including quasi-saturation effect are presented. These models have no internal node voltages determined by the circuit simulator and use one JFET or one depletion mode MOSFET transistors controlled by an “effective” gate voltage taking into account the quasi-saturation effect. The proposed models achieve accurate simulation results with an average error percentage less than 9%, which is an improvement of 21 percentage points compared to the commonly used standard power MOSFET model. In addition, the models can be integrated in any available commercial circuit simulators by using their analytical equations. A description of the models will be provided along with the parameter extraction procedure.

Keywords: power MOSFET, drift layer, quasi-saturation effect, SPICE model

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Authors: Chia-Jung Chen, Yu-Chi Hsu, June-Dong Lin, Kun-Chen Chan, Chieh-Tien Wang, Li-Ching Wu, Chung-Feng Liu

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With fast advances in healthcare technology, various total laboratory automation (TLA) processes have been proposed. However, adopting TLA needs quite high funding. This study explores an early adoption experience by Taiwan’s large-scale hospital group, the Chimei Hospital Group (CMG), which owns three branch hospitals (Yongkang, Liouying and Chiali, in order by service scale), based on the five stages of Everett Rogers’ Diffusion Decision Process. 1.Knowledge stage: Over the years, two weaknesses exists in laboratory department of CMG: 1) only a few examination categories (e.g., sugar testing and HbA1c) can now be completed and reported within a day during an outpatient clinical visit; 2) the Yongkang Hospital laboratory space is dispersed across three buildings, resulting in duplicated investment in analysis instruments and inconvenient artificial specimen transportation. Thus, the senior management of the department raised a crucial question, was it time to process the redesign of the laboratory department? 2.Persuasion stage: At the end of 2013, Yongkang Hospital’s new building and restructuring project created a great opportunity for the redesign of the laboratory department. However, not all laboratory colleagues had the consensus for change. Thus, the top managers arranged a series of benchmark visits to stimulate colleagues into being aware of and accepting TLA. Later, the director of the department proposed a formal report to the top management of CMG with the results of the benchmark visits, preliminary feasibility analysis, potential benefits and so on. 3.Decision stage: This TLA suggestion was well-supported by the top management of CMG and, finally, they made a decision to carry out the project with an instrument-leasing strategy. After the announcement of a request for proposal and several vendor briefings, CMG confirmed their laboratory automation architecture and finally completed the contracts. At the same time, a cross-department project team was formed and the laboratory department assigned a section leader to the National Taiwan University Hospital for one month of relevant training. 4.Implementation stage: During the implementation, the project team called for regular meetings to review the results of the operations and to offer an immediate response to the adjustment. The main project tasks included: 1) completion of the preparatory work for beginning the automation procedures; 2) ensuring information security and privacy protection; 3) formulating automated examination process protocols; 4) evaluating the performance of new instruments and the instrument connectivity; 5)ensuring good integration with hospital information systems (HIS)/laboratory information systems (LIS); and 6) ensuring continued compliance with ISO 15189 certification. 5.Confirmation stage: In short, the core process changes include: 1) cancellation of signature seals on the specimen tubes; 2) transfer of daily examination reports to a data warehouse; 3) routine pre-admission blood drawing and formal inpatient morning blood drawing can be incorporated into an automatically-prepared tube mechanism. The study summarizes below the continuous improvement orientations: (1) Flexible reference range set-up for new instruments in LIS. (2) Restructure of the specimen category. (3) Continuous review and improvements to the examination process. (4) Whether installing the tube (specimen) delivery tracks need further evaluation.

Keywords: innovation decision process, total laboratory automation, health care

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Authors: Alejandra Ben-Aissa, Martina Moreno, Luciano Sappia, Paul Lacharmoise, Ana Moya

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Organ-on-Chip (OoC) stands out as a highly promising approach for drug testing, presenting a cost-effective and ethically superior alternative to conventional in vivo experiments. These cutting-edge devices emerge from the integration of tissue engineering and microfluidic technology, faithfully replicating the physiological conditions of targeted organs. Consequently, they offer a more precise understanding of drug responses without the ethical concerns associated with animal testing. When addressing the limitations of OoC due to conventional and time-consuming techniques, Lab-On-Chip (LoC) emerge as a disruptive technology capable of providing real-time monitoring without compromising sample integrity. This work develops LoC platforms that can be integrated within OoC platforms to monitor essential culture media parameters, including glucose, oxygen, and pH, facilitating the straightforward exchange of sensing units within a dynamic and controlled environment without disrupting cultures. This approach preserves the experimental setup, minimizes the impact on cells, and enables efficient, prolonged measurement. The LoC system is fabricated following the patented methodology protected by EU patent EP4317957A1. One of the key challenges of integrating sensors in a biocompatible, feasible, robust, and scalable manner is addressed through fully printed sensors, ensuring a customized, cost-effective, and scalable solution. With this technique, sensor reliability is enhanced, providing high sensitivity and selectivity for accurate parameter monitoring. In the present study, LoC is validated measuring a complete culture media. The oxygen sensor provided a measurement range from 0 mgO2/L to 6.3 mgO2/L. The pH sensor demonstrated a measurement range spanning 2 pH units to 9.5 pH units. Additionally, the glucose sensor achieved a measurement range from 0 mM to 11 mM. All the measures were performed with the sensors integrated in the LoC. In conclusion, this study showcases the impactful synergy of OoC technology with LoC systems using fully printed sensors, marking a significant step forward in ethical and effective biomedical research, particularly in drug development. This innovation not only meets current demands but also lays the groundwork for future advancements in precision and customization within scientific exploration.

Keywords: organ on chip, lab on chip, real time monitoring, biosensors

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Authors: Wing Chi Wong

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Globally, studying parents caring for children with attention deficit/ hyperactivity disorder (ADHD) is valuable in order to design measures in supporting those parents by health care providers and government. Such parents in Hong Kong seem to encounter detrimental stress and enormous difficulties which are exacerbated by the traditional Chinese culture, exclusion from social members and fiercely competitive educational system. However, seldom studies scrutinize this issue in Hong Kong. This article aims to review the literature regarding parents caring offsprings with ADHD in Hong Kong. Criteria were set for searching among published studies listed in various databases, including MEDLINE, CINCAHL, PsycINFO, ProQuest, Embase, Cochrane Library and Springer Link. Articles with words 'Attention Deficit Hyperactivity Disorder', 'parenting', 'parent', 'family', 'father', 'mother', 'care' in titles and abstracts were identified. Articles with all types of research designs and methods, regardless in English or Chinese, were included. They were limited to years between January 2008 and September 2018. Four relevant studies have resulted. Of them, two were exploratory studies, one was a qualitative study, and one was a survey. Samples were recruited from child psychiatric clinic, Child and Adolescent Mental Health Unit, or multiple family group therapy centres. Authors proclaimed that quality of life of those parents was usually low; particularly mothers perceived a higher stress than fathers; parenting barriers existed; conflicts were commonly raised in parent-child relationship resulting in probable maltreatment to children. Previous studies generally suggested the potential negative outcomes of parents caring children with ADHD. The types and effectiveness of interventions to those parents on relieving their tortures under Hong Kong context had not been explored and systematically evaluated. The scanty studies and existing understanding could not give a promising conclusion pertaining to the appropriate family intervention to parents living with children with ADHD. A stringent research design is necessary to establish evidence on the effectiveness of interventions for those families.

Keywords: attention deficit/ hyperactivity disorder, Hong Kong, parents, interventions

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Authors: Beverley Gallimore

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The Individuals with Disabilities Education Act of 2004 (IDEA) has helped to improve outcomes for students with special education needs. Through IDEA, students with Special Education Needs (SEN) have opportunities for more equitable education within the General Education classroom. However, students with disabilities lack access to instructions that can help them to maximize their fullest learning potential. Recently, educational stakeholders have emphasized Integrated Co-teaching as a tool to increase engagement and learning outcomes for students with disabilities in general education classrooms. As a result of this new approach, general and special education teachers are working collaboratively to teach students with disabilities. However, co-teaching models are not properly designed and structured to effectively benefit students with disabilities. Teachers must be oriented correctly in the co-teaching models if it is to be beneficial for students.

Keywords: CO-teaching, differentiation, equitable, collaborative

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Authors: Badryah Alshehri, Kevin Gormley, Gillian Prue, Karen McCutcheon

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In a disaster event, sharing patient information between the pre-hospital Emergency Medical Services (EMS) and Emergency Department (ED) hospitals is a complex process during which important information may be altered or lost due to poor communication. The aim of this study was to critically discuss the current evidence base in relation to communication between pre- EMS hospital and ED hospital professionals by the use of Information and Communication Systems (ICT). This study followed the systematic approach; six electronic databases were searched: CINAHL, Medline, Embase, PubMed, Web of Science, and IEEE Xplore Digital Library were comprehensively searched in January 2018 and a second search was completed in April 2020 to capture more recent publications. The study selection process was undertaken independently by the study authors. Both qualitative and quantitative studies were chosen that focused on factors that are positively or negatively associated with coordinated communication between pre-hospital EMS and ED teams in a disaster event. These studies were assessed for quality, and the data were analyzed according to the key screening themes which emerged from the literature search. Twenty-two studies were included. Eleven studies employed quantitative methods, seven studies used qualitative methods, and four studies used mixed methods. Four themes emerged on communication between EMTs (pre-hospital EMS and ED staff) in a disaster event using the ICT. (1) Disaster preparedness plans and coordination. This theme reported that disaster plans are in place in hospitals, and in some cases, there are interagency agreements with pre-hospital and relevant stakeholders. However, the findings showed that the disaster plans highlighted in these studies lacked information regarding coordinated communications within and between the pre-hospital and hospital. (2) Communication systems used in the disaster. This theme highlighted that although various communication systems are used between and within hospitals and pre-hospitals, technical issues have influenced communication between teams during disasters. (3) Integrated information management systems. This theme suggested the need for an integrated health information system that can help pre-hospital and hospital staff to record patient data and ensure the data is shared. (4) Disaster training and drills. While some studies analyzed disaster drills and training, the majority of these studies were focused on hospital departments other than EMTs. These studies suggest the need for simulation disaster training and drills, including EMTs. This review demonstrates that considerable gaps remain in the understanding of the communication between the EMS and ED hospital staff in relation to response in disasters. The review shows that although different types of ICTs are used, various issues remain which affect coordinated communication among the relevant professionals.

Keywords: emergency medical teams, communication, information and communication technologies, disaster

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Authors: Mohammad Saraj Sharifzai, Keisuke Kitagawa, Mohammad Kamil Halimee, Javid Habib, Daishi Sakaguchi

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The overall goal of this paper is to examine the suitability and potential of the policies addressing the sustainability and affordability of housing for returnees, and to determine the impact of this policy on housing delivery for Afghan refugees. Housing is a central component of the settlement experience of refugees. A positive housing situation can facilitate many aspects of integration. Unaffordable, and unsafe housing, however, can cause disruptions in the entire settlement process. This paper aims to identify a suite of built forms for housing that is both affordable and environmentally sustainable for Afghan refugees. The result was the development of a framework that enables the assessment of the overall performance of various types of housing development in all zones of the country. There is very little evidence that the present approach of housing provision to the vagaries of market forces has provided affordable housing, especially for Afghan refugees. There is a need to incorporate social housing into the policy to assist people who cannot afford to have their own houses.

Keywords: Afghan refugees, housing policy, affordability, social housing, housing provision, environmental sustainability principles, resettlement

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Authors: Santiago Quesada-García, María Lozano-Gómez, Pablo Valero-Flores

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The recent digital revolution, together with modern technologies, is changing the environment and the way people interact with inhabited space. However, in society, the elderly are a very broad and varied group that presents serious difficulties in understanding these modern technologies. Outpatients with cognitive disabilities, such as those suffering from Alzheimer's disease (AD), are distinguished within this cluster. This population group is in constant growth, and they have specific requirements for their inhabited space. According to architecture, which is one of the health humanities, environments are designed to promote well-being and improve the quality of life for all. Buildings, as well as the tools and technologies integrated into them, must be accessible, inclusive, and foster health. In this new digital paradigm, artificial intelligence (AI) appears as an innovative resource to help this population group improve their autonomy and quality of life. Some experiences and solutions, such as those that interact with users through chatbots and voicebots, show the potential of AI in its practical application. In the design of healthy spaces, the integration of AI in architecture will allow the living environment to become a kind of 'exo-brain' that can make up for certain cognitive deficiencies in this population. The objective of this paper is to address, from the discipline of neuroarchitecture, how modern technologies can be integrated into everyday environments and be an accessible resource for people with cognitive disabilities. For this, the methodology has a mixed structure. On the one hand, from an empirical point of view, the research carries out a review of the existing literature about the applications of AI to build space, following the critical review foundations. As a unconventional architectural research, an experimental analysis is proposed based on people with AD as a resource of data to study how the environment in which they live influences their regular activities. The results presented in this communication are part of the progress achieved in the competitive R&D&I project ALZARQ (PID2020-115790RB-I00). These outcomes are aimed at the specific needs of people with cognitive disabilities, especially those with AD, since, due to the comfort and wellness that the solutions entail, they can also be extrapolated to the whole society. As a provisional conclusion, it can be stated that, in the immediate future, AI will be an essential element in the design and construction of healthy new environments. The discipline of architecture has the compositional resources to, through this emerging technology, build an 'exo-brain' capable of becoming a personal assistant for the inhabitants, with whom to interact proactively and contribute to their general well-being. The main objective of this work is to show how this is possible.

Keywords: Alzheimer’s disease, artificial intelligence, healthy architecture, neuroarchitecture, architectural design

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Authors: Anisa Suraya Ab Razak, Izza Hayat

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Introduction: The diagnosis and management of severe hyponatremia in neuropsychiatric patients present a significant challenge to physicians. Several factors contribute, including diagnostic shadowing and attributing abnormal behavior to intellectual disability or psychiatric conditions. Hyponatraemia is the commonest electrolyte abnormality in the inpatient population, ranging from mild/asymptomatic, moderate to severe levels with life-threatening symptoms such as seizures, coma and death. There are several documented fatal case reports in the literature of severe hyponatremia secondary to psychogenic polydipsia, often diagnosed only in autopsy. This paper presents a case study of acute severe hyponatremia in a neuropsychiatric patient with early diagnosis and admission to intensive care. Case study: A 21-year old Caucasian male with known epilepsy and learning disability was admitted from residential living with generalized tonic-clonic self-terminating seizures after refusing medications for several weeks. Evidence of superficial head injury was detected on physical examination. His laboratory data demonstrated mild hyponatremia (125 mmol/L). Computed tomography imaging of his brain demonstrated no acute bleed or space-occupying lesion. He exhibited abnormal behavior - restlessness, drinking water from bathroom taps, inability to engage, paranoia, and hypersexuality. No collateral history was available to establish his baseline behavior. He was loaded with intravenous sodium valproate and leveritircaetam. Three hours later, he developed vomiting and a generalized tonic-clonic seizure lasting forty seconds. He remained drowsy for several hours and regained minimal recovery of consciousness. A repeat set of blood tests demonstrated profound hyponatremia (117 mmol/L). Outcomes: He was referred to intensive care for peripheral intravenous infusion of 2.7% sodium chloride solution with two-hourly laboratory monitoring of sodium concentration. Laboratory monitoring identified dangerously rapid correction of serum sodium concentration, and hypertonic saline was switched to a 5% dextrose solution to reduce the risk of acute large-volume fluid shifts from the cerebral intracellular compartment to the extracellular compartment. He underwent urethral catheterization and produced 8 liters of urine over 24 hours. Serum sodium concentration remained stable after 24 hours of correction fluids. His GCS recovered to baseline after 48 hours with improvement in behavior -he engaged with healthcare professionals, understood the importance of taking medications, admitted to illicit drug use and drinking massive amounts of water. He was transferred from high-dependency care to ward level and was initiated on multiple trials of anti-epileptics before achieving seizure-free days two weeks after resolution of acute hyponatremia. Conclusion: Psychogenic polydipsia is often found in young patients with intellectual disability or psychiatric disorders. Patients drink large volumes of water daily ranging from ten to forty liters, resulting in acute severe hyponatremia with mortality rates as high as 20%. Poor outcomes are due to challenges faced by physicians in making an early diagnosis and treating acute hyponatremia safely. A low index of suspicion of water intoxication is required in this population, including patients with known epilepsy. Monitoring urine output proved to be clinically effective in aiding diagnosis. Early referral and admission to intensive care should be considered for safe correction of sodium concentration while minimizing risk of fatal complications e.g. central pontine myelinolysis.

Keywords: epilepsy, psychogenic polydipsia, seizure, severe hyponatremia

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Authors: Yen Ling Liu, Shu-Fen Wu, Chen-Fuh Lam, I-Ling Tsai, Chia-Yu Chen

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Purpose: Nurse anesthetists are confronting extraordinarily high job stress in their daily practice, deriving from the fast-track anesthesia care, risk of perioperative complications, routine rotating shifts, teaching programs and interactions with the surgical team in the operating room. This study investigated the influence of work stress on the burnout and turnover intention of nurse anesthetists in a regional general hospital in Southern Taiwan. Methods: This was a descriptive correlational study carried out in 66 full-time nurse anesthetists. Data was collected from March 2017 to June 2017 by in-person interview, and a self-administered structured questionnaire was completed by the interviewee. Outcome measurements included the Practice Environment Scale of the Nursing Work Index (PES-NWI), Maslach Burnout Inventory (MBI) and nursing staff turnover intention. Numerical data were analyzed by descriptive statistics, independent t test, or one-way ANOVA. Categorical data were compared using the chi-square test (x²). Datasets were computed with Pearson product-moment correlation and linear regression. Data were analyzed by using SPSS 20.0 software. Results: The average score for job burnout was 68.7916.67 (out of 100). The three major components of burnout, including emotional depletion (mean score of 26.32), depersonalization (mean score of 13.65), and personal(mean score of 24.48). These average scores suggested that these nurse anesthetists were at high risk of burnout and inversely correlated with turnover intention (t = -4.048, P < 0.05). Using linear regression model, emotional exhaustion and depersonalization were the two independent factors that predicted turnover intention in the nurse anesthetists (19.1% in total variance). Conclusion/Implications for Practice: The study identifies that the high risk of job burnout in the nurse anesthetists is not simply derived from physical overload, but most likely resulted from the additional emotional and psychological stress. The occurrence of job burnout may affect the quality of nursing work, and also influence family harmony, in turn, may increase the turnover rate. Multimodal approach is warranted to reduce work stress and job burnout in nurse anesthetists to enhance their willingness to contribute in anesthesia care.

Keywords: anesthesia nurses, burnout, job, turnover intention

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Authors: R. S. Fisca, Y. R. Elox, L. Umi, U. Z. Luttfia, Kun Harismah

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Petai (Parkia speciosa) is a plant indigenous to Southeast Asia. It is consumed either raw or cooked. It has been used in folk medicine to treat diabetes, hypertension, and kidney problems. It contains minerals and vitamins. Petai contains a lot of chemical compounds that are beneficial for health, including antioxidants, Vitamin B6 0,9mg, energy 142 g. cal, 10.4 g protein. 2 g fat, 22 g carbohydrates, 95 mg calcium, phosphorus 115 mg, 1 mg iron, 200 IU of vitamin A, vitamin B1 0.17 mg, 36 mg of vitamin C that can resolve various health problems. These chips are the result of innovation from petai packaged in such a way becomes a tasty snack chips and can be enjoyed by many people to relax and also nutritious for health. In the manufacture of petai chips require several steps of them start by boiling, flating, drying and the last frying. In introducing the products widely we sell petai chips with several methods. Some of these methods include direct sales, delivery order, online/social media, and open some booth at a few places and the car free day in Solo every sunday. Opportunity in selling petai chips is very wide because there is no competitors with similar business. With the innovation of petai chips become healthy snacks can be introduced to the public and can even be exported out of the country as one of the extraordinary snacks from Indonesia.

Keywords: antioxidants, chips, healty, petai

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Authors: Prozorkevitch D., Mishurov A., Sokolov K., Karsakov L., Pestrikova L.

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The current body of knowledge about the marine environment and the dynamics of marine ecosystems includes a huge amount of heterogeneous data collected over decades. It generally includes a wide range of hydrological, biological and fishery data. Marine researchers collect these data and analyze how and why the ecosystem changes from past to present. Based on these historical records and linkages between the processes it is possible to predict future changes. Multivariate analysis of trends and their interconnection in the marine ecosystem may be used as an instrument for predicting further ecosystem evolution. A wide range of information about the components of the marine ecosystem for more than 50 years needs to be used to investigate how these arrays can help to predict the future.

Keywords: barents sea ecosystem, abiotic, biotic, data sets, trends, prediction

Procedia PDF Downloads 117