Search results for: private hospital.

Authors: Lizinis Cassendra Frederick Dony, Jirom Jeremy Frederick Dony, Andrew Nicholas, Dewi Binti Tajuddin

Abstract:

Starting and surviving a business is influenced by various entrepreneurship socio-economics activities. The study revealed that some of the entrepreneurs are not registered under SME but running own business as an intermediary with the private organization entrusted as “Self-Employed.” SME is known as “Small Medium Enterprise” contributes growth in Malaysia. Therefore, the entrepreneurialism business interest and entrepreneurial intention enhancing new spurring production, expanding employment opportunities, increasing productivity, promoting exports, stimulating innovation and providing new avenue in the business market place. This study has identified the unique contribution to the full understanding of complex mechanisms through entrepreneurship obstacles and education impacts on happiness and well-being to society. Moreover, “Ethnic” term has defined as a curious meaning refers to a classification of a large group of people customs implies to ancestral, racial, national, tribal, religious, linguistic and cultural origins. It is a social phenomenon.1 According to Sabah data population is amounting to 2,389,494 showed the predominant ethnic group being the Kadazan Dusun (18.4%) followed by Bajau (17.3%) and Malays (15.3%). For the year 2010, data statistic immigrants population report showed the amount to 239,765 people which cover 4% of the Sabahan’s population.2 Sabah has numerous group of talented entrepreneurs. The business environment among the minority ethnics are influenced with the business sentiment competition. The literature on ethnic entrepreneurship recognizes two main type entrepreneurships: the middleman and enclave entrepreneurs. According to Adam Smith,3 there are evidently some principles disposition to admire and maintain the distinction business rank status and cause most universal business sentiments. Due to credit barriers competition, the minority ethnics are losing the business market and since 2014, many illegal immigrants have been found to be using permits of the locals to operate businesses in Malaysia.4 The development of small business entrepreneurship among the minority ethnics in Sabah evidenced based variety of complex perception and differences concepts. The studies also confirmed the effects of heterogeneity on group decision and thinking caused partly by excessive pre-occupation with maintaining cohesiveness and the presence of cultural diversity in groups should reduce its probability.5 The researchers proposed that there are seven success determinants particularly to determine the involvement of minority ethnics comparing to the involvement of the immigrants in Sabah. Although, (SMEs) have always been considered the backbone of the economy development, the minority ethnics are often categorized it as the “second-choice.’ The study showed that illegal immigrants entrepreneur imposed a burden on Sabahan social programs as well as the prison, court and health care systems. The tension between the need for cheap labor and the impulse to protect Malaysian in Sabah workers, entrepreneurs and taxpayers, among the subjects discussed in this study. This is clearly can be advantages and disadvantages to the Sabah economic development.

Keywords: entrepreneurial firms, self-employed, immigrants, minority ethnic, economic impacts

Procedia PDF Downloads 387

Authors: Sachin Mulmi Shrestha, Xin Fang, Hui Ye, Lihua Ren, Qinghua Ji, Ruihua Shi

Abstract:

Background: Esophageal squamous cell carcinoma (ESCC) is a tumor arising from esophageal epithelial cells and is one of the major disease subtype in Asian countries, including China. Esophageal cancer is the 7th highest incidence based on the 2020 data of GLOBOCAN. The pathogenesis of cancer is still not well understood as many molecular and genetic basis of esophageal carcinogenesis has yet to be clearly elucidated. Circular RNAs are RNA molecules that are formed by back-splicing covalently joined 3′- and 5′-endsrather than canonical splicing, and recent data suggest circular RNAs could sponge miRNAs and are enriched with functional miRNA binding sites. Hence, we studied the mechanism of circular RNA, its biological function, and the relationship between microRNA in the carcinogenesis of ESCC. Methods: 4 pairs of normal and esophageal cancer tissues were collected in Zhongda hospital, affiliated to Southeast University, and high-throughput RNA sequencing was done. The result revealed that circ_0032746 was upregulated, and thus we selected circ_0032746 for further study. The backsplice junction of circRNA was validated by sanger sequence, and stability was determined by RNASE R assay. The binding site of circRNA and microRNA was predicted by circinteractome,mirandaand RNAhybrid database. Furthermore, circRNA was silenced by siRNA and then by lentivirus. The regulatory axis of circ0032746/miR4270 was validated by shRNA, mimic, and inhibitor transfection. Then, in vitro experiments were performed to assess the role of circ0032746 on proliferation (CCK-8 assay and colon formation assay), migration and invasion (Transewell assay), and apoptosis of ESCC. Results: The upregulated circ0032746 was validated in 9 pairs of tissues and 5 types of cell lines by qPCR, which showed high expression and was statistically significant (P<0.005) ). Upregulated circ0032746 was silenced by shRNA, which showed significant knockdown in KYSE 30 and TE-1 cell lines expression compared to control. Nuclear and cytoplasmic mRNA fraction experiment displayed the cytoplasmic location of circ0032746. The sponging of miR4270 was validated by co-transfection of sh-circ0032746 and mimic or inhibitor. Transfection with mimic showed the decreased expression of circ_0032746, whereas inhibitor inhibited the result. In vitro experiments showed that silencing of circ_0032746 inhibited the proliferation, migration, and invasion compared to the negative control group. The apoptosis was seen higher in a knockdown group than in the control group. Furthermore, 11 common mircoRNA target mRNAs were predicted by Targetscan, MirTarbase, and miRanda database, which may further play role in the pathogenesis. Conclusion: Our results showed that novel circ_0032746 is upregulated in ESCC and plays role in itsoncogenicity. Silencing of circ_0032746 inhibits the proliferation and migration of ESCC whereas increases the apoptosis of cancer cells. Hence, circ0032746 acts as an oncogene in ESCC by sponging with miR4270 and could be a potential biomarker in the diagnosis of ESCC in the future.

Keywords: circRNA, esophageal squamous cell carcinoma, microRNA, upregulated

Procedia PDF Downloads 86

Authors: Javier E. García-Gallo, Nelson J. Fonseca-Ruiz, John F. Duitama-Munoz

Abstract:

Sepsis is a syndrome that occurs with physiological and biochemical abnormalities induced by severe infection and carries a high mortality and morbidity, therefore the severity of its condition must be interpreted quickly. After patient admission in an intensive care unit (ICU), it is necessary to synthesize the large volume of information that is collected from patients in a value that represents the severity of their condition. Traditional severity of illness scores seeks to be applicable to all patient populations, and usually assess in-hospital mortality. However, the use of machine learning techniques and the data of a population that shares a common characteristic could lead to the development of customized mortality prediction scores with better performance. This study presents the development of a score for the one-year mortality prediction of the patients that are admitted to an ICU with a sepsis diagnosis. 5650 ICU admissions extracted from the MIMICIII database were evaluated, divided into two groups: 70% to develop the score and 30% to validate it. Comorbidities, demographics and clinical information of the first 24 hours after the ICU admission were used to develop a mortality prediction score. LASSO (least absolute shrinkage and selection operator) and SGB (Stochastic Gradient Boosting) variable importance methodologies were used to select the set of variables that make up the developed score; each of this variables was dichotomized and a cut-off point that divides the population into two groups with different mean mortalities was found; if the patient is in the group that presents a higher mortality a one is assigned to the particular variable, otherwise a zero is assigned. These binary variables are used in a logistic regression (LR) model, and its coefficients were rounded to the nearest integer. The resulting integers are the point values that make up the score when multiplied with each binary variables and summed. The one-year mortality probability was estimated using the score as the only variable in a LR model. Predictive power of the score, was evaluated using the 1695 admissions of the validation subset obtaining an area under the receiver operating characteristic curve of 0.7528, which outperforms the results obtained with Sequential Organ Failure Assessment (SOFA), Oxford Acute Severity of Illness Score (OASIS) and Simplified Acute Physiology Score II (SAPSII) scores on the same validation subset. Observed and predicted mortality rates within estimated probabilities deciles were compared graphically and found to be similar, indicating that the risk estimate obtained with the score is close to the observed mortality, it is also observed that the number of events (deaths) is indeed increasing as the outcome go from the decile with the lowest probabilities to the decile with the highest probabilities. Sepsis is a syndrome that carries a high mortality, 43.3% for the patients included in this study; therefore, tools that help clinicians to quickly and accurately predict a worse prognosis are needed. This work demonstrates the importance of customization of mortality prediction scores since the developed score provides better performance than traditional scoring systems.

Keywords: intensive care, logistic regression model, mortality prediction, sepsis, severity of illness, stochastic gradient boosting

Procedia PDF Downloads 191

Authors: Michele Paleologo, Marta Acampora, Serena Barello, Guendalina Graffigna

Abstract:

Introduction: In the face of increasing demands for higher agricultural productivity with minimal environmental impact, participatory research approaches emerge as promising means to promote innovation. However, the complexities and ambiguities surrounding these approaches in both theory and practice present challenges. This Scoping Review seeks to bridge these gaps by mapping participatory approaches in agricultural contexts, analyzing their characteristics, and identifying indicators of success. Methods: Following PRISMA guidelines, we conducted a systematic Scoping Review, searching Scopus and Web of Science databases. Our review encompassed 34 projects from diverse geographical regions and farming contexts. Thematic analysis was employed to explore the types of innovation promoted and the categories of participants involved. Results: The identified innovation types encompass technological advancements, sustainable farming practices, and market integration, forming 5 main themes: climate change, cultivar, irrigation, pest and herbicide, and technical improvement. These themes represent critical areas where participatory research drives innovation to address pressing agricultural challenges. Participants were categorized as citizens, experts, NGOs, private companies, and public bodies. Understanding their roles is vital for designing effective participatory initiatives that embrace diverse stakeholders. The review also highlighted 27 theoretical frameworks underpinning participatory projects. Clearer guidelines and reporting standards are crucial for facilitating the comparison and synthesis of findings across studies, thereby enhancing the robustness of future participatory endeavors. Furthermore, we identified three main categories of barriers and facilitators: pragmatic/behavioral, emotional/relational, and cognitive. These insights underscore the significance of participant engagement and collaborative decision-making for project success beyond theoretical considerations. Regarding participation, projects were classified as contributory (5 cases), where stakeholders contributed insights; collaborative (10 cases), with active co-designing of solutions; and co-created (19 cases), featuring deep stakeholder involvement from ideation to implementation, resulting in joint ownership of outcomes. Such diverse participation modes highlight the adaptability of participatory approaches to varying agricultural contexts. Discussion: In conclusion, this Scoping Review demonstrates the potential of participatory research in driving transformative changes in farmers' practices, fostering sustainability and innovation in agriculture. Understanding the diverse landscape of participatory approaches, theoretical frameworks, and participant engagement strategies is essential for designing effective and context-specific interventions. Collaborative efforts among researchers, practitioners, and stakeholders are pivotal in harnessing the full potential of participatory approaches and driving positive change in agricultural settings worldwide. The identified themes of innovation and participation modes provide valuable insights for future research and targeted interventions in agricultural innovation.

Keywords: participatory research, co-creation, agricultural innovation, stakeholders' engagement

Procedia PDF Downloads 34

Authors: A. Coetzee, C. F. Kelly, E. Even-Zahav

Abstract:

Dominant approaches to livestock production are harmful to the environment, human health and animal welfare, yet global meat consumption is rising. Sustainable alternative production approaches are therefore urgently required, and ‘free range’ is the main alternative for chicken meat offered in South Africa (and globally). Although the South African Poultry Association provides non-binding guidelines, there is a lack of formal definition and regulation of free range chicken production, meaning it is unclear what this alternative entails and if it is consistently practised (a trend observed globally). The objective of this exploratory qualitative case study is therefore to investigate who and what determines free range chicken. The case study, conducted from a social constructivist worldview, uses semi-structured interviews, photographs and document analysis to collect data. Interviews are conducted with those involved with bringing free range chicken to the market - farmers, chefs, retailers, and regulators. Data is analysed using thematic analysis to establish dominant patterns in the data. The five major themes identified (based on prevalence in data and on achieving the research objective) are: 1) free range means a bird reared with good animal welfare in mind, 2) free range means quality meat, 3) free range means a profitable business, 4) free range is determined by decision makers or by access to markets, and 5) free range is coupled with concerns about the lack of regulation. Unpacking the findings in the context of the literature reveals who and what determines free range. The research uncovers wide-ranging interpretations of ‘free range’, driven by the absence of formal regulation for free range chicken practices and the lack of independent private certification. This means that the term ‘free range’ is socially constructed, thus varied and complex. The case study also shows that whether chicken meat is free range is generally determined by those who have access to markets. Large retailers claim adherence to the internationally recognised Five Freedoms, also include in the South African Poultry Association Code of Good Practice, which others in the sector say are too broad to be meaningful. Producers describe animal welfare concerns as the main driver for how they practice/view free range production, yet these interpretations vary. An additional driver is a focus on human health, which participants achieve mainly through the use of antibiotic-free feed, resulting in what participants regard as higher quality meat. The participants are also strongly driven by business imperatives, with most stating that free range chicken should carry a higher price than conventionally-reared chicken due to increased production costs. Recommendations from this study focus on, inter alia, a need to understand consumers’ perspectives on free range chicken, given that those in the sector claim they are responding to consumer demand, and conducting environmental research such as life cycle assessment studies to establish the true (environmental) sustainability of free range production. At present, it seems the sector mostly responds to social sustainability: human health and animal welfare.

Keywords: chicken meat production, free range, socially constructed, sustainability

Procedia PDF Downloads 132

Authors: Samira Hamiditehrani

Abstract:

Automated vehicles (AVs) are emerging technologies that could potentially offer a wide range of opportunities and challenges for the transportation sector. The advent of AV technology has also resulted in new business models in shared mobility services where many ride hailing and car sharing companies are developing on-demand AVs including shared automated vehicles (SAVs) and pooled automated vehicles (Pooled AVs). SAVs and Pooled AVs could provide alternative shared mobility services which encourage sustainable transport systems, mitigate traffic congestion, and reduce automobile dependency. However, the success of on-demand AVs in addressing major transportation policy issues depends on whether and how the public adopts them as regular travel modes. To identify conditions under which individuals may adopt on-demand AVs, previous studies have applied human behavior and technology acceptance theories, where Theory of Planned Behavior (TPB) has been validated and is among the most tested in on-demand AV research. In this respect, this study has three objectives: (a) to propose and validate a theoretical model for behavioral intention to use SAVs and Pooled AVs by extending the original TPB model; (b) to identify the characteristics of early adopters of SAVs, who prefer to have a shorter and private ride, versus prospective users of Pooled AVs, who choose more affordable but longer and shared trips; and (c) to investigate Canadians’ intentions to adopt on-demand AVs for regular trips. Toward this end, this study uses data from an online survey (n = 3,622) of workers or adult students (18 to 75 years old) conducted in October and November 2021 for six major Canadian metropolitan areas: Toronto, Vancouver, Ottawa, Montreal, Calgary, and Hamilton. To accomplish the goals of this study, a base bivariate ordered probit model, in which both SAV and Pooled AV adoptions are estimated as ordered dependent variables, alongside a full structural equation modeling (SEM) system are estimated. The findings of this study indicate that affective motivations such as attitude towards AV technology, perceived privacy, and subjective norms, matter more than sociodemographic and travel behavior characteristic in adopting on-demand AVs. Also, the results of second objective provide evidence that although there are a few affective motivations, such as subjective norms and having ample knowledge, that are common between early adopters of SAVs and PooledAVs, many examined motivations differ among SAV and Pooled AV adoption factors. In other words, motivations influencing intention to use on-demand AVs differ among the service types. Likewise, depending on the types of on-demand AVs, the sociodemographic characteristics of early adopters differ significantly. In general, findings paint a complex picture with respect to the application of constructs from common technology adoption models to the study of on-demand AVs. Findings from the final objective suggest that policymakers, planners, the vehicle and technology industries, and the public at large should moderate their expectations that on-demand AVs may suddenly transform the entire transportation sector. Instead, this study suggests that SAVs and Pooled AVs (when they entire the Canadian market) are likely to be adopted as supplementary mobility tools rather than substitutions for current travel modes

Keywords: automated vehicles, Canadian perception, theory of planned behavior, on-demand AVs

Procedia PDF Downloads 49

Authors: K. Power, M. White, B. Dunleavey, E. Comerford, C. Doherty, N. Delanty, R. Corbridge, M. Fitzsimons

Abstract:

Introduction: Providing people with access to their own healthcare information and engaging them as co-authors of their health record can promote better transparency, trust, and inclusivity in the healthcare system. With the advent of electronic health records, there is a move towards involving patients as partners in their healthcare by providing them with access to their own health data via electronic patient portals (ePortal). For example, a recently developed ePortal to the Irish National Epilepsy Electronic Patient Record (EPR) provides access to summary medical records, tools for Patient Reported Outcomes (PROM), health goal-setting and preparation for clinical appointments. Aim: To determine what people with epilepsy (their families/carers) value about the Irish epilepsy ePortal. Methods: A socio-technical process was employed recruiting 30 families of people with epilepsy who also have an intellectual disability (ID). Family members who are a care partner of the person with epilepsy (PWE) were invited to co-design, develop and implement the ePortal. Family members engaged in usability and utility testing which involved a face to face meeting to learn about the ePortal, register for a user account and evaluate its structure and content. Family members were instructed to login to the portal on at least two separate occasions following the meeting and to complete a self-report evaluation tool during this time. The evaluation tool, based on a Usability Questionnaire (Lewis, 1993), consists of a short assessment of comfort using technology, instructions for using the ePortal and some tasks to complete. Tasks included validating summary record details, assessing ePortal ease of use, evaluation of information presented. Participants were asked for suggestions on how to improve the portal and make it more applicable to PWE who also have an ID. Results: Family members responded positively to the ePortal and valued the ability to share information between clinicians and care partners; use the ePortal as a passport between different healthcare settings (e.g., primary care to hospital). In the context of elderly parents of PWE, the ePortal is valued as a tool for supporting shared care between family members. Participants welcomed the facility to log lists of questions and goals to discuss with the clinician at the next clinical appointment as a means of improving quality of care. Participants also suggested further enhancements to the ePortal such as access to clinic letters which can provide an aide memoir in terms of the careplan agreed with the clinical team. For example, through the ePortal, people could see what investigations or therapies are scheduled. Conclusion: The Epilepsy Patient Portal is accessible via a range of devices such as smartphones and tablets. ePortals have the potential to help personalise care, improve patient involvement in clinical decision making, engage them as quality and safety partners, and help clinicians be more responsive to patient needs. Acknowledgement: The epilepsy ePortal project is part of PISCES, a Lighthouse Project funded by eHealth Ireland and HSE to help build an understanding of the benefits of eHealth technologies in the Irish Healthcare System.

Keywords: electronic patient portal, electronic patient record, epilepsy, intellectual disability, usability testing

Procedia PDF Downloads 317

Authors: Igor Peraza Curiel, Suzanne Strum

Abstract:

Today, when many foreign architects are receiving commissions in the United Arab Emirates, it is essential to analyze how their designs are influenced by the region's culture, environment, and building traditions. This study examines the approach to siting, geometry, construction methods, and material choices in two private homes for a family in Dubai, a project being constructed on adjacent sites by the acclaimed Spanish team of RCR Architects. Their third project in Dubai, the houses mark a turning point in their design approach to the desert. The Pritzker Prize-winning architects of RCR gained renown for building works deeply responsive to the history, landscape, and customs of their hometown in a volcanic area of the Catalonia region of Spain. Key formative projects and their entry to practice in UAE will be analyzed according to the concepts of place identity, the poetics of construction, and material imagination. The poetics of construction, a theoretical position with a long practical tradition, was revived by the British critic Kenneth Frampton. The idea of architecture as a constructional craft is related to the concepts of material imagination and place identity--phenomenological concerns with the creative engagement with local matter and topography that are at the very essence of RCR's way of designing, detailing, and making. Our study situates RCR within the challenges of building in the region, where western forms and means have largely replaced the ingenious responsiveness of indigenous architecture to the climate and material scarcity. The dwellings, iterations of the same steel and concrete vaulting system, highlight the conceptual framework of RCR's design approach to offer a study in contemporary critical regionalism. The Kama House evokes Bedouin tents, while the Alwah House takes the form of desert dunes in response to the temporality of the winds. Metal mesh screens designed to capture the shifting sands will complete the forms. The original research draws on interviews with the architects and unique documentation provided by them and collected by the authors during on-site visits. By examining the two houses in-depth, this paper foregrounds a series of timely questions: 1) What is the impact of the local climatic, cultural, and material conditions on their project in the UAE? 2) How does this work further their experiences in the region? 3) How has RCR adapted their construction techniques as their work expands beyond familiar settings? The investigation seeks to understand how the design methodology developed for more than 20 years and enmeshed in the regional milieu of their hometown can transform as the architects encounter unique characteristics and values in the Middle East. By focusing on the contemporary interpretation of Arabic geometry and elements, the houses reveal the role of geometry, tectonics, and material specificity in the realization from conceptual sketches to built form. In emphasizing the importance of regional responsiveness, the dynamics of international construction practice, and detailing this study highlights essential issues for professionals and students looking to practice in an increasingly global market.

Keywords: material imagination, regional responsiveness, place identity, poetics of construction

Procedia PDF Downloads 106

Authors: Emmanuel Maiyanga

Abstract:

Access to sufficiently good quality freshwater has been a global challenge, but more notably in low-income countries, particularly in the Sub-Saharan countries, which Nigeria is one. Urban population is soaring, especially in many low-income countries, the existing centralised water supply infrastructures are ageing and inadequate, moreover in households peoples’ lifestyles have become more water-demanding. So, people mostly device coping strategies where municipal supply is perceived to have failed. This development threatens the futures of groundwater and calls for a review of management strategy and research approach. The various issues associated with water demand management in low-income countries and Nigeria, in particular, are well documented in the literature. However, the way people use water daily in households and the reasons they do so, and how the situation is constructing demand among the middle-class population in Abuja Nigeria is poorly understood. This is what this research aims to unpack. This is achieved by using the social practices research approach (which is based on the Theory of Practices) to understand how this situation impacts on the shared groundwater resource. A qualitative method was used for data gathering. This involved audio-recorded interviews of householders and water professionals in the private and public sectors. It also involved observation, note-taking, and document study. The data were analysed thematically using NVIVO software. The research reveals the major household practices that draw on the water on a domestic scale, and they include water sourcing, body hygiene and sanitation, laundry, kitchen, and outdoor practices (car washing, domestic livestock farming, and gardening). Among all the practices, water sourcing, body hygiene, kitchen, and laundry practices, are identified to impact most on groundwater, with impact scale varying with household peculiarities. Water sourcing practices involve people sourcing mostly from personal boreholes because the municipal water supply is perceived inadequate and unreliable in terms of service delivery and water quality, and people prefer easier and unlimited access and control using boreholes. Body hygiene practices reveal that every respondent prefers bucket bathing at least once daily, and the majority bathe twice or more every day. Frequency is determined by the feeling of hotness and dirt on the skin. Thus, people bathe to cool down, stay clean, and satisfy perceived social, religious, and hygiene demand. Kitchen practice consumes water significantly as people run the tap for vegetable washing in daily food preparation and dishwashing after each meal. Laundry practice reveals that most people wash clothes most frequently (twice in a week) during hot and dusty weather, and washing with hands in basins and buckets is the most prevalent and water wasting due to soap overdose. The research also reveals poor water governance as a major cause of current inadequate municipal water delivery. The implication poor governance and widespread use of boreholes is an uncontrolled abstraction of groundwater to satisfy desired household practices, thereby putting the future of the shared aquifer at great risk of total depletion with attendant multiplying effects on the people and the environment and population continues to soar.

Keywords: boreholes, groundwater, household water practices, self-supply

Procedia PDF Downloads 101

Authors: M. Fry, L. Fitzpatrick, Julie Considine, R. Z. Shaban, Kate Curtis

Abstract:

Introduction: The vast majority of older Australians lives independently and are self-managing at home, despite a growing number living with a chronic illness that requires health intervention. Evidence shows that between 50% and 80% of people presenting to the emergency department (ED) are in pain. Australian EDs manage 7.2 million attendances every year and 1.4 million of these are people aged 65 years or more. Research shows that 28% of ED patients aged 65 years or more have Cognitive impairment (CI) associated with dementia, delirium and neurological conditions. Background: Traditional ED service delivery may not be suitable for older people who present with multiple, complex and ongoing illnesses. Likewise, ED clinical staff often perceive that their role should be focused more on immediate and potential lifethreatening illness and conditions which are episodic in nature. Therefore, the needs of older people and their family/carers may not be adequately addressed in the context of an ED presentation. Aim: We aimed to explore the utilisation and characteristics of older people presenting to four metropolitan EDs. Method: The findings being presented are part of a program of research exploring pain management practices for older persons with long bone fractures. The study was conducted across four metropolitan emergency departments of older patients (65years and over) and involved a 12-month randomised medical record audit (n=255). Results: ED presentations across four ED sites in 2012 numbered 168021, with 44778 (26.6%) patients aged 65 and over. Of the 44778 patients, the average age was 79.1 years (SD 8.54). There were more females 23932 (53.5%). The majority (26925: 85.0%) of older persons self-referred to the ED and lived independently. The majority arrived by ambulance (n=18553: 41.4%) and were allocated triage category was 3 (n=19,507:43.65%) or Triage category 4 at (n=15,389: 34.43%). The top five triage symptom presentations involved pain (n=8088; 18.25%), dyspnoea (n=4735; 10.7%), falls (n=4032; 9.1%), other (n=3984; 9.0%), cardiac (n=2987; 6.7%). The top five system based diagnostic presentations involved musculoskeletal (n=8902; 20.1%), cardiac (n=6704:15.0%), respiratory (n=4933; 11.0%), neurological (n=4909; 11.0%), gastroenterology (n=4321; 9.7%). On review of one tertiary hospital database the vital signs on average at time triage: Systolic Blood Pressure 143.6mmHg. Heart Rate 83.4 beats/minute; Respiratory Rate 18.5 breaths/ minute; Oxygen saturation 97.0% and Tympanic temperature 36.7 and Blood Glucose Level 7.4mmols/litre. The majority presented with a Glasgow Coma Score of 14 or higher. On average the older person stayed in the ED 4:56 (SD 3:28minutes).The average time to be seen was 39 minutes (SD 48 minutes). The majority of older persons were admitted (n=27562: 61.5%), did not wait for treatment (n= 8879: 0.02%) discharged home (n=16256: 36.0%). Conclusion: The vast majority of older persons are living independently, although many require admission on arrival to the ED. Many arrived in pain and with musculoskeletal injuries and or conditions. New models of care need to be considered, which may better support self-management and independent living of the older person and the National Emergency Access Targets.

Keywords: chronic, older person, aged care, emergency department

Procedia PDF Downloads 211

Authors: Yusuf Berkay Metinal, Gulden Gumusburun Ayalp

Abstract:

Architectural education is characterized by its distinctive amalgamation of studio-based pedagogy and theoretical instruction. It offers students a comprehensive learning experience that blends practical skill development with critical inquiry and conceptual exploration. Design studios are central to this educational paradigm, which serve as dynamic hubs of creativity and innovation, providing students with immersive environments for experimentation and collaborative engagement. The physical presence and interactive dynamics inherent in studio-based learning underscore the indispensability of face-to-face instruction and interpersonal interaction in nurturing the next generation of architects. However, architectural education underwent a seismic transformation in response to the global COVID-19 pandemic, precipitating an abrupt transition from traditional, in-person instruction to online education modalities. While this shift introduced newfound flexibility in terms of temporal and spatial constraints, it also brought many challenges to the fore. Chief among these challenges was maintaining effective communication and fostering meaningful collaboration among students in virtual learning environments. Besides these challenges, lack of peer learning emerged as a vital issue of the educational experience, particularly crucial for novice students navigating the intricacies of architectural practice. Nevertheless, the pivot to online education also laid bare a discernible decline in educational efficacy, prompting inquiries regarding the enduring viability of online education in architectural pedagogy. Moreover, as educational institutions grappled with the exigencies of remote instruction, discernible disparities between different institutional contexts emerged. While state universities often contended with fiscal constraints that shaped their operational capacities, private institutions encountered challenges from a lack of institutional fortification and entrenched educational traditions. Acknowledging the multifaceted nature of these challenges, this study endeavored to undertake a comprehensive inquiry into the dynamics of online education within architectural pedagogy by interrogating variables such as class level and type of university; the research aimed to elucidate demographic critical success factors that underpin the effectiveness of online education initiatives. To this end, a meticulously constructed questionnaire was administered to architecture students from diverse academic institutions across Turkey, informed by an exhaustive review of extant literature and scholarly discourse. The resulting dataset, comprising responses from 232 participants, underwent rigorous statistical analysis, including independent samples t-test and one-way ANOVA, to discern patterns and correlations indicative of overarching trends and salient insights. In sum, the findings of this study serve as a scholarly compass for educators, policymakers, and stakeholders navigating the evolving landscapes of architectural education. By elucidating the intricate interplay of demographical factors that shape the efficacy of online education in architectural pedagogy, this research offers a scholarly foundation upon which to anchor informed decisions and strategic interventions to elevate the educational experience for future cohorts of aspiring architects.

Keywords: architectural education, COVID-19, distance education, online education

Procedia PDF Downloads 22

Authors: Nitika Sharma, Yogesh Jain

Abstract:

Introduction: An efficient Information System helps in improving the service delivery as well provides the foundation for policy and regulation of other building blocks of Health System. Health care organizations require an integrated working of its various sub-systems. An efficient EMR software boosts the teamwork amongst the various sub-systems thereby resulting in improved service delivery. Although there has been a huge impetus to EMR under the Digital India initiative, it has still not been mandated in India. It is generally implemented in huge funded public or private healthcare organizations only. Objective: The study was conducted to understand the factors that lead to the successful adoption of an affordable EMR in the low level healthcare organization. It intended to understand the design of the EMR and address the solutions to the challenges faced in adoption of the EMR. Methodology: The study was conducted in a non-profit registered Healthcare organization that has been providing healthcare facilities to more than 2500 villages including certain areas that are difficult to access. The data was collected with help of field notes, in-depth interviews and participant observation. A total of 16 participants using the EMR from different departments were enrolled via purposive sampling technique. The participants included in the study were working in the organization before the implementation of the EMR system. The study was conducted in one month period from 25 June-20 July 2018. The Ethical approval was taken from the institute along with prior approval of the participants. Data analysis: A word document of more than 4000 words was obtained after transcribing and translating the answers of respondents. It was further analyzed by focused coding, a line by line review of the transcripts, underlining words, phrases or sentences that might suggest themes to do thematic narrative analysis. Results: Based on the answers the results were thematically grouped under four headings: 1. governance of organization, 2. architecture and design of the software, 3. features of the software, 4. challenges faced in adoption and the solutions to address them. It was inferred that the successful implementation was attributed to the easy and comprehensive design of the system which has facilitated not only easy data storage and retrieval but contributes in constructing a decision support system for the staff. Portability has lead to increased acceptance by physicians. The proper division of labor, increased efficiency of staff, incorporation of auto-correction features and facilitation of task shifting has lead to increased acceptance amongst the users of various departments. Geographical inhibitions, low computer literacy and high patient load were the major challenges faced during its implementation. Despite of dual efforts made both by the architects and administrators to combat these challenges, there are still certain ongoing challenges faced by organization. Conclusion: Whenever any new technology is adopted there are certain innovators, early adopters, late adopters and laggards. The same pattern was followed in adoption of this software. He challenges were overcome with joint efforts of organization administrators and users as well. Thereby this case study provides a framework of implementing similar systems in public sector of countries that are struggling for digitizing the healthcare in presence of crunch of human and financial resources.

Keywords: EMR, healthcare technology, e-health, EHR

Procedia PDF Downloads 85

Authors: Atin Adhikari, Sushma Kurella, Pratik Banerjee, Nabanita Mukherjee, Yamini M. Chandana Gollapudi, Bushra Shah

Abstract:

Different sharp instruments, drilling machines, and high speed rotary instruments are routinely used in dental clinics during dental cleaning. Therefore, these cleaning procedures release a lot of oral microorganisms including bacteria in clinic air and may cause significant occupational bioaerosol exposure risks for dentists, dental hygienists, patients, and dental clinic employees. Two major goals of this study were to quantify volumetric airborne concentrations of bacteria and to assess overall microbial activity in this type of occupational environment. The study was conducted in several dental clinics of southern Georgia and 15 dental cleaning procedures were targeted for sampling of airborne bacteria and testing of overall microbial activity in settled dusts over clinic floors. For air sampling, a Biostage viable cascade impactor was utilized, which comprises an inlet cone, precision-drilled 400-hole impactor stage, and a base that holds an agar plate (Tryptic soy agar). A high-flow Quick-Take-30 pump connected to this impactor pulls microorganisms in air at 28.3 L/min flow rate through the holes (jets) where they are collected on the agar surface for approx. five minutes. After sampling, agar plates containing the samples were placed in an ice chest with blue ice and plates were incubated at 30±2°C for 24 to 72 h. Colonies were counted and converted to airborne concentrations (CFU/m3) followed by positive hole corrections. Most abundant bacterial colonies (selected by visual screening) were identified by PCR amplicon sequencing of 16S rRNA genes. For understanding overall microbial activity in clinic floors and estimating a general cleanliness of the clinic surfaces during or after dental cleaning procedures, ATP levels were determined in swabbed dust samples collected from 10 cm2 floor surfaces. Concentration of ATP may indicate both the cell viability and the metabolic status of settled microorganisms in this situation. An ATP measuring kit was used, which utilized standard luciferin-luciferase fluorescence reaction and a luminometer, which quantified ATP levels as relative light units (RLU). Three air and dust samples were collected during each cleaning procedure (at the beginning, during cleaning, and immediately after the procedure was completed (n = 45). Concentrations at the beginning, during, and after dental cleaning procedures were 671±525, 917±1203, and 899±823 CFU/m3, respectively for airborne bacteria and 91±101, 243±129, and 139±77 RLU/sample, respectively for ATP levels. The concentrations of bacteria were significantly higher than typical indoor residential environments. Although an increasing trend for airborne bacteria was observed during cleaning, the data collected at three different time points were not significantly different (ANOVA: p = 0.38) probably due to high standard deviations of data. The ATP levels, however, demonstrated a significant difference (ANOVA: p <0.05) in this scenario indicating significant change in microbial activity on floor surfaces during dental cleaning. The most common bacterial genera identified were: Neisseria sp., Streptococcus sp., Chryseobacterium sp., Paenisporosarcina sp., and Vibrio sp. in terms of frequencies of occurrences, respectively. The study concluded that bacterial exposure in dental clinics could be a notable occupational biohazard, and appropriate respiratory protections for the employees are urgently needed.

Keywords: bioaerosols, hospital hygiene, indoor air quality, occupational biohazards

Procedia PDF Downloads 291

Authors: George Kyriakopoulos, Photini Pazartzis, Anthi Koskina, Crystalie Bourcha

Abstract:

The need for securing safe access to and return from outer space, as well as ensuring the viability of outer space operations, maintains vivid the debate over the promotion of organization of space traffic through a Space Traffic Management System (STM). The proliferation of outer space activities in recent years as well as the dynamic emergence of the private sector has gradually resulted in a diverse universe of actors operating in outer space. The said developments created an increased adverse impact on outer space sustainability as the case of the growing number of space debris clearly demonstrates. The above landscape sustains considerable threats to outer space environment and its operators that need to be addressed by a combination of scientific-technological measures and regulatory interventions. In this context, recourse to recent technological advancements and, in particular, to Artificial Intelligence (AI) and machine learning systems, could achieve exponential results in promoting space traffic management with respect to collision avoidance as well as launch and re-entry procedures/phases. New technologies can support the prospects of a successful space traffic management system at an international scale by enabling, inter alia, timely, accurate and analytical processing of large data sets and rapid decision-making, more precise space debris identification and tracking and overall minimization of collision risks and reduction of operational costs. What is more, a significant part of space activities (i.e. launch and/or re-entry phase) takes place in airspace rather than in outer space, hence the overall discussion also involves the highly developed, both technically and legally, international (and national) Air Traffic Management System (ATM). Nonetheless, from a regulatory perspective, the use of AI for the purposes of space traffic management puts forward implications that merit particular attention. Key issues in this regard include the delimitation of AI-based activities as space activities, the designation of the applicable legal regime (international space or air law, national law), the assessment of the nature and extent of international legal obligations regarding space traffic coordination, as well as the appropriate liability regime applicable to AI-based technologies when operating for space traffic coordination, taking into particular consideration the dense regulatory developments at EU level. In addition, the prospects of institutionalizing international cooperation and promoting an international governance system, together with the challenges of establishment of a comprehensive international STM regime are revisited in the light of intervention of AI technologies. This paper aims at examining regulatory implications advanced by the use of AI technology in the context of space traffic management operations and its key correlating concepts (SSA, space debris mitigation) drawing in particular on international and regional considerations in the field of STM (e.g. UNCOPUOS, International Academy of Astronautics, European Space Agency, among other actors), the promising advancements of the EU approach to AI regulation and, last but not least, national approaches regarding the use of AI in the context of space traffic management, in toto. Acknowledgment: The present work was co-funded by the European Union and Greek national funds through the Operational Program "Human Resources Development, Education and Lifelong Learning " (NSRF 2014-2020), under the call "Supporting Researchers with an Emphasis on Young Researchers – Cycle B" (MIS: 5048145).

Keywords: artificial intelligence, space traffic management, space situational awareness, space debris

Procedia PDF Downloads 222

Authors: Dmitriy Chernov, Maria Karavassilis, Suhyoun Youn, Amna Izhar, Devasenan Devendra

Abstract:

Introduction and Background: A well-structured and comprehensive departmental induction improves patient safety and job satisfaction amongst doctors. The aims of our Project were as follows: 1. Assess the perceived preparedness of junior doctors starting their rotation in Acute Medicine at Watford General Hospital. 2. Develop a supplemental Induction Guide and Pocket reference in the form of an iOS mobile application. 3. To collect feedback after implementing the mobile application following a trial period of 8 weeks with a small cohort of junior doctors. Materials and Methods: A questionnaire was distributed to all new junior trainees starting in the department of Acute Medicine to assess their experience of current induction. A mobile Induction application was developed and trialled over a period of 8 weeks, distributed in addition to the existing didactic induction session. After the trial period, the same questionnaire was distributed to assess improvement in induction experience. Analytics data were collected with users’ consent to gauge user engagement and identify areas of improvement of the application. A feedback survey about the app was also distributed. Results: A total of 32 doctors used the application during the 8-week trial period. The application was accessed 7259 times in total, with the average user spending a cumulative of 37 minutes 22 seconds on the app. The most used section was Clinical Guidelines, accessed 1490 times. The App Feedback survey revealed positive reviews: 100% of participants (n=15/15) responded that the app improved their overall induction experience compared to other placements; 93% (n=14/15) responded that the app improved overall efficiency in completing daily ward jobs compared to previous rotations; and 93% (n=14/15) responded that the app improved patient safety overall. In the Pre-App and Post-App Induction Surveys, participants reported: a 48% improvement in awareness of practical aspects of the job; a 26% improvement of awareness on locating pathways and clinical guidelines; a 40% reduction of feelings of overwhelmingness. Conclusions and recommendations: This study demonstrates the importance of technology in Medical Education and Clinical Induction. The mobile application average engagement time equates to over 20 cumulative hours of on-the-job training delivered to each user, within an 8-week period. The most used and referred to section was clinical guidelines. This shows that there is high demand for an accessible pocket guide for this type of material. This simple mobile application resulted in a significant improvement in feedback about induction in our Department of Acute Medicine, and will likely impact workplace satisfaction. Limitations of the application include: post-app surveys had a small number of participants; the app is currently only available for iPhone users; some useful sections are nested deep within the app, lacks deep search functionality across all sections; lacks real time user feedback; and requires regular review and updates. Future steps for the app include: developing a web app, with an admin dashboard to simplify uploading and editing content; a comprehensive search functionality; and a user feedback and peer ratings system.

Keywords: mobile app, doctor induction, medical education, acute medicine

Procedia PDF Downloads 63

Authors: C. Fernandez-Plaza, I. Abad, E. Diaz, I. Diaz

Abstract:

Births occurring before the 37th week of gestation are considered preterm births. A threat of preterm is defined as the beginning of regular uterine contractions, dilation and cervical effacement between 23 and 36 gestation weeks. To author's best knowledge, the factors that determine the beginning of the birth are not completely defined yet. In particular, the incidence of sleep habits on preterm births is weekly studied. The aim of this study is to develop a model to predict the factors affecting premature delivery on pregnancy, based on the above potential risk factors, including those derived from sleep habits and light exposure at night (introduced as 12 variables obtained by a telephone survey using two questionnaires previously used by other authors). Thus, three groups of variables were included in the study (maternal, fetal and sleep habits). The study was approved by Research Ethics Committee of the Principado of Asturias (Spain). An observational, retrospective and descriptive study was performed with 481 births between January 1, 2015 and May 10, 2016 in the University Central Hospital of Asturias (Spain). A statistical analysis using SPSS was carried out to compare qualitative and quantitative variables between preterm and term delivery. Chi-square test qualitative variable and t-test for quantitative variables were applied. Statistically significant differences (p < 0.05) between preterm vs. term births were found for primiparity, multi-parity, kind of conception, place of residence or premature rupture of membranes and interruption during nights. In addition to the statistical analysis, machine learning methods to look for a prediction model were tested. In particular, tree based models were applied as the trade-off between performance and interpretability is especially suitable for this study. C5.0, recursive partitioning, random forest and tree bag models were analysed using caret R-package. Cross validation with 10-folds and parameter tuning to optimize the methods were applied. In addition, different noise reduction methods were applied to the initial data using NoiseFiltersR package. The best performance was obtained by C5.0 method with Accuracy 0.91, Sensitivity 0.93, Specificity 0.89 and Precision 0.91. Some well known preterm birth factors were identified: Cervix Dilation, maternal BMI, Premature rupture of membranes or nuchal translucency analysis in the first trimester. The model also identifies other new factors related to sleep habits such as light through window, bedtime on working days, usage of electronic devices before sleeping from Mondays to Fridays or change of sleeping habits reflected in the number of hours, in the depth of sleep or in the lighting of the room. IF dilation < = 2.95 AND usage of electronic devices before sleeping from Mondays to Friday = YES and change of sleeping habits = YES, then preterm is one of the predicting rules obtained by C5.0. In this work a model for predicting preterm births is developed. It is based on machine learning together with noise reduction techniques. The method maximizing the performance is the one selected. This model shows the influence of variables related to sleep habits in preterm prediction.

Keywords: machine learning, noise reduction, preterm birth, sleep habit

Procedia PDF Downloads 122

Authors: Nafiah Solikhah Thoha

Abstract:

One area that has spatial character as Heritage area is Kauman Villages. Kauman village in The City of Surakarta, Central Java, Indonesia was formed in 1757 by Paku Buwono III as the King of Kasunanan kingdom (Mataram Kingdom) for Kasunanan kingdom courtiers and scholars of Madrasa. Spatial character of Kauman village influenced by Islamic planning and socio-cultural rules of Kasunanan Kingdom. As traditional settlements influenced by Islamic planning, the Grand Mosque is a binding part of the whole area. Circulation pattern forming network (labyrinth) with narrow streets that ended at the Grand Mosque. The outdoor space can be used for circulation. Social activity is dominated by step movement from one place to a different place. Stalemate (the fina/cul de sac) generally only passable on foot, bicycles, and motorcycles. While the pass (main and branch) can be traversed by motor, vehicles. Kauman village has an area that can not be used as a public road that penetrates and serves as a liaison between the outside world to the other. Hierarchy of hall in Kauman village shows that the existence of a space is getting into more important. Firstly, woman in Kauman make the handmade batik for themself. In 2005 many people improving batik tradisional into commercial, and developed program named "Batik Tourism village of Kauman". That program affects the spatial transformations. This study aimed to explore the influence of tourism program towards spatial transformations. The factors that studied are the organization of space, circulation patterns, hierarchical space, and orientation through the descriptive-evaluation approach methods. Based on the study, tourism activity engenders transformations on the spatial scale (macro), residential block (mezo), homes (micro). First, the Grand Mosque and madrasa (religious school) as a binding zoning; tangle of roads as forming the structure of the area developed as a liaison with outside Kauman; organization of space in the residential of batik entrepreneurs firstly just a residential, then develop into residential, factory of batik including showroom. Second, the circulation pattern forming network (labyrinth) and ends at the Grand Mosque. Third, the hierarchy in the form of public space (the shari), semi-public, and private (the fina/culdesac) is no longer to provide protection to women, only as hierarchy of circulation path. Fourth, cluster building orientation does not follow the kiblat direction or axis oriented to cosmos, but influence by the new function as the showroom. It was need the direction of the main road. Kauman grow as an appropriate area for the community. During its development, the settlement function changes according to community activities, especially economic activities. The new function areas as tourism area affect spatial pattern of Kauman village. Spatial existence and activity as a local wisdom that has been done for generations have meaning of holistic, encompassing socio-cultural sustainability, economics, and the heritage area. By reviewing the local wisdom and the way of life of that society, we can learn how to apply the culture as education for sustainable of heritage area.

Keywords: impact of tourism, Kauman village, spatial transformation, sustainable of heritage area

Procedia PDF Downloads 406

Authors: Freya Harding, Anne Gatuguta, Chi Eziefula

Abstract:

Introduction Research shows the quality of experiences of pregnancy, birth, and postpartum impacts the health and well-being of the mother and baby. This is recognised by the WHO in their recommendations ‘Intrapartum care for a positive childbirth experience’. The COVID-19 pandemic saw the transformation of the NHS Maternity services to prevent the transmission of COVID-19. Physical and social isolation may have affected women’s experiences of pregnancy, birth and postpartum; especially those of healthcare. Examples of such changes made to the NHS include both the reduction in volume of face-to-face consultations and restrictions to visitor time in hospitals. One notable detriment due to these changes was the absence of a partner during certain stages of birth. The aim of this study was to explore women’s experiences of pregnancy, birth, and postnatal period during the COVID-19 pandemic in the UK. Methods We collected qualitative data from women who had given birth during the COVID-19 pandemic. In-depth, semi-structured interviews were conducted with twelve participants recruited from mother and baby groups in Southeast England. Data were audio-recorded, transcribed verbatim, and analysed thematically using both inductive and deductive approaches. Ethics permission was granted from Brighton and Sussex Medical School (ER/BSMS9A83/1). Results Interviews were conducted with 12 women who gave birth between May 2020 and February 2021. Ages of the participants ranged between 28 and 42 years, most of which were white British, with one being Asian British. All participants were heterosexual and either married or co-habiting with their partner. Five participants worked in the NHS, and all participants had professional occupations. Women felt inadequately supported both socially and medically. An appropriate sense of control over their own birthing experience was lacking. Safety mechanisms, such as in-person visits from the midwife, had no suitable alternatives in place. Serious health issues were able to “slip through the net.” Mental health conditions in some of those interviewed worsened or developed. Similarly, reduced support from partners during birth and during the immediate postpartum period at the hospital, coupled with reduced ward staffing, resulted in some traumatic experiences; particularly for women who had undergone caesarean section. However, some unexpected positive effects were reported; one example being that partners were able to spend more time with their baby due to furlough schemes and working from home. Similarly, emergency care was not felt to have been compromised. Overall, six themes emerged: (1) Self-reported traumatic experiences, (2) Challenges of caring for a baby with reduced medical and social support, (3) Unexpected benefits to the parenting experience, (4) The effects of a sudden change in medical management (5) Poor communication from healthcare professionals (6) Social change; with subthemes of support accessing medical care, the workplace, family and friends, and antenatal & baby groups. Conclusions The results indicate that the healthcare system was unable to adequately deliver maternity care to facilitate positive pregnancy, birth, and postnatal experiences during the heights of the pandemic. The poor quality of such experiences has been linked an increased risk of long-term health complications in both the mother and child.

Keywords: pregnancy, birth, postpartum, postnatal, COVID-19, maternity, social support, qualitative, pandemic

Procedia PDF Downloads 116

Authors: Jacqueline Eleonora Ek, Michael Spiteri, Chris Giordimaina, Pierre Agius

Abstract:

Background: Malta is known for being a key player as a frontline country with regard to irregular immigration from Africa to Europe. Every year the island experiences an influx of migrants as boat movement across the Mediterranean continues to be a humanitarian challenge. Irregular immigration and applying for asylum is both a lengthy and mentally demanding process. Those doing so are often faced with multiple challenges, which can adversely affect their mental health. Between January and August 2020, Malta disembarked 2 162 people rescued at sea, 463 of them between July & August. Given the small size of the Maltese islands, this regulation places a disproportionately large burden on the country, creating a backlog in the processing of asylum applications resulting in increased time periods of detention. These delays reverberate throughout multiple management pathways resulting in prolonged periods of detention and challenging access to health services. Objectives: To better understand the spatial dimensions of this humanitarian crisis, this study aims to assess disparities in the acute medical management of migrants presenting to the emergency department (ED) with acute mental health presentations as compared to that of local and non-local residents. Method: In this retrospective study, 17795 consecutive ED attendances were reviewed to look for acute mental health presentations. These were further evaluated to assess discrepancies in transportation routes to hospital, nature of presenting complaint, effects of language barriers, use of CT brain, treatment given at ED, availability of psychiatric reviews, and final admission/discharge plans. Results: Of the ED attendances, 92.3% were local residents, and 7.7% were non-locals. Of the non-locals, 13.8% were migrants, and 86.2% were other-non-locals. Acute mental health presentations were seen in 1% of local residents; this increased to 20.6% in migrants. 56.4% of migrants attended with deliberate self-harm; this was lower in local residents, 28.9%. Contrastingly, in local residents, the most common presenting complaint was suicidal thought/ low mood 37.3%, the incidence was similar in migrants at 33.3%. The main differences included 12.8% of migrants presenting with refused oral intake while only 0.6% of local residents presented with the same complaints. 7.7% of migrants presented with a reduced level of consciousness, no local residents presented with this same issue. Physicians documented a language barrier in 74.4% of migrants. 25.6% were noted to be completely uncommunicative. Further investigations included the use of a CT scan in 12% of local residents and in 35.9% of migrants. The most common treatment administered to migrants was supportive fluids 15.4%, the most common in local residents was benzodiazepines 15.1%. Voluntary psychiatric admissions were seen in 33.3% of migrants and 24.7% of locals. Involuntary admissions were seen in 23% of migrants and 13.3% of locals. Conclusion: Results showed multiple disparities in health management. A meeting was held between entities responsible for migrant health in Malta, including the emergency department, primary health care, migrant detention services, and Malta Red Cross. Currently, national quality-improvement initiatives are underway to form new pathways to improve patient-centered care. These include an interpreter unit, centralized handover sheets, and a dedicated migrant health service.

Keywords: emergency department, communication, health, migration

Procedia PDF Downloads 87

Authors: Christoph Opperer

Abstract:

The rapid urbanization of modern societies and the need for sustainable urban development demand innovative solutions that meet both individual and collective needs while addressing environmental concerns. To address these challenges, this paper presents a study that explores the potential of spatial and energetic/ecological optimization to enhance the performance of urban settlements, focusing on both architectural and urban scales. The study focuses on the application of biological principles and self-organization processes in urban planning and design, aiming to achieve a balance between ecological performance, architectural quality, and individual living conditions. The research adopts a case study approach, focusing on a 10-hectare brownfield site in the south of Vienna. The site is surrounded by a small-scale built environment as an appropriate starting point for the research and design process. However, the selected urban form is not a prerequisite for the proposed design methodology, as the findings can be applied to various urban forms and densities. The methodology used in this research involves dividing the overall building mass and program into individual small housing units. A computational model has been developed to optimize the distribution of these units, considering factors such as solar exposure/radiation, views, privacy, proximity to sources of disturbance (such as noise), and minimal internal circulation areas. The model also ensures that existing vegetation and buildings on the site are preserved and incorporated into the optimization and design process. The model allows for simultaneous optimization at two scales, architectural and urban design, which have traditionally been addressed sequentially. This holistic design approach leads to individual and collective benefits, resulting in urban environments that foster a balance between ecology and architectural quality. The results of the optimization process demonstrate a seemingly random distribution of housing units that, in fact, is a densified hybrid between traditional garden settlements and allotment settlements. This urban typology is selected due to its compatibility with the surrounding urban context, although the presented methodology can be extended to other forms of urban development and density levels. The benefits of this approach are threefold. First, it allows for the determination of ideal housing distribution that optimizes solar radiation for each building density level, essentially extending the concept of sustainable building to the urban scale. Second, the method enhances living quality by considering the orientation and positioning of individual functions within each housing unit, achieving optimal views and privacy. Third, the algorithm's flexibility and robustness facilitate the efficient implementation of urban development with various stakeholders, architects, and construction companies without compromising its performance. The core of the research is the application of global and local optimization strategies to create efficient design solutions. By considering both, the performance of individual units and the collective performance of the urban aggregation, we ensure an optimal balance between private and communal benefits. By promoting a holistic understanding of urban ecology and integrating advanced optimization strategies, our methodology offers a sustainable and efficient solution to the challenges of modern urbanization.

Keywords: sustainable development, self-organization, ecological performance, solar radiation and exposure, daylight, visibility, accessibility, spatial distribution, local and global optimization

Procedia PDF Downloads 42

Authors: Chiara Cosentino, Carlo Pruneti, Carla Merisio, Domenico Sgromo

Abstract:

Introduction – Psychoneuroimmunology as approach clearly showed how psychological features can influence health through specific physiological pathways linked to the stress reaction. This can be true also in cancer, in its latter conceptualization seen as a chronic disease. Therefore, it is still not clear how the psychological features can combine with a physiological specific path, for a better adjustment to cancer. The aim of this study is identifying how in Italian survivors, perceived social support, body image, coping and quality of life correlate with or influence Heart Rate Variability (HRV), the physiological parameter that can mirror a condition of chronic stress or a good relaxing capability. Method - The study had an exploratory transversal design. The final sample was made of 38 ovarian cancer survivors aged from 29 to 80 (M= 56,08; SD=12,76) following a program for Ovarian Cancer at the Oncological Clinic, University Hospital of Parma, Italy. Participants were asked to fill: Multidimensional Scale of Perceived Social Support (MSPSS); Derridford Appearance Scale-59 (DAS-59); Mental Adjustment to Cancer (MAC); Quality of Life Questionnaire (EORTC). For each participant was recorded Short-Term HRV (5 minutes) using emWavePro. Results– Data showed many interesting correlations within the psychological features. EORTC scores have a significant correlation with DAS-59 (r =-.327 p <.05), MSPSS (r =.411 p<.05), and MAC scores, in particular with the strategy Fatalism (r =.364 p<.05). A good social support improves HRV (F(1,33)= 4.27 p<.05). Perceiving themselves as effective in their environment, preserving a good role functioning (EORTC), positively affects HRV (F(1,33)=9.810 p<.001). Women admitting concerns towards body image seem prone to emotive disclosure, reducing emotional distress and improving HRV (β=.453); emotional avoidance worsens HRV (β=-.391). Discussion and conclusion - Results showed a strong relationship between body image and Quality of Life. These data suggest that higher concerns on body image, in particular, the negative self-concept linked to appearance, was linked to the worst functioning in everyday life. The relation between the negative self-concept and a reduction in emotional functioning is understandable in terms of possible distress deriving from the perception of body appearance. The relationship between a high perceived social support and a better functioning in everyday life was also confirmed. In this sample fatalism, was associated with a better physical, role and emotional functioning. In these women, the presence of a good support may activate the physiological Social Engagement System improving their HRV. Perceiving themselves effective in their environment, preserving a good role functioning, also positively affects HRV, probably following the same physiological pathway. A higher presence of concerns about appearance contributes to a higher HRV. Probably women admitting more body concerns are prone to a better emotive disclosure. This could reduce emotional distress improving HRV and global health. This study reached preliminary demonstration of an ‘Integrated Model of Defense’ in these cancer survivors. In these model, psychological features interact building a better quality of life and a condition of psychological well-being that is associated and influence HRV, then the physiological condition.

Keywords: cancer survivors, heart rate variability, ovarian cancer, psychophysiological adjustment

Procedia PDF Downloads 165

Authors: Peregrine James Dalziel, Philip Vu Tran

Abstract:

Objective / Introduction: Demand for radiology services from Emergency Departments (ED) continues to increase with greater demands placed on radiology staff providing reports for the management of complex cases. Queuing theory indicates that wide variability of process time with the random nature of request arrival increases the probability of significant queues. This can lead to delays in the time-to-availability of radiology reports (TTA-RR) and potentially impaired ED patient flow. In addition, greater “cognitive workload” of greater volume may lead to reduced productivity and increased errors. We sought to quantify the potential ED flow improvements obtainable from increased radiology providers serving 3 public hospitals in Melbourne Australia. We sought to assess the potential productivity gains, quality improvement and the cost-effectiveness of increased labor inputs. Methods & Materials: The Western Health Medical Imaging Department moved from single resident coverage on weekend days 8:30 am-10:30 pm to a limited period of 2 resident coverage 1 pm-6 pm on both weekend days. The TTA-RR for weekend CT scans was calculated from the PACs database for the 8 month period symmetrically around the date of staffing change. A multivariate linear regression model was developed to isolate the improvement in TTA-RR, between the two 4-months periods. Daily and hourly scan volume at the time of each CT scan was calculated to assess the impact of varying department workload. To assess any improvement in report quality/errors a random sample of 200 studies was assessed to compare the average number of clinically significant over-read addendums to reports between the 2 periods. Cost-effectiveness was assessed by comparing the marginal cost of additional staffing against a conservative estimate of the economic benefit of improved ED patient throughput using the Australian national insurance rebate for private ED attendance as a revenue proxy. Results: The primary resident on call and the type of scan accounted for most of the explained variability in time to report availability (R2=0.29). Increasing daily volume and hourly volume was associated with increased TTA-RR (1.5m (p<0.01) and 4.8m (p<0.01) respectively per additional scan ordered within each time frame. Reports were available 25.9 minutes sooner on average in the 4 months post-implementation of double coverage (p<0.01) with additional 23.6 minutes improvement when 2 residents were on-site concomitantly (p<0.01). The aggregate average improvement in TTA-RR was 24.8 hours per weekend day This represents the increased decision-making time available to ED physicians and potential improvement in ED bed utilisation. 5% of reports from the intervention period contained clinically significant addendums vs 7% in the single resident period but this was not statistically significant (p=0.7). The marginal cost was less than the anticipated economic benefit based assuming a 50% capture of improved TTA-RR inpatient disposition and using the lowest available national insurance rebate as a proxy for economic benefit. Conclusion: TTA-RR improved significantly during the period of increased staff availability, both during the specific period of increased staffing and throughout the day. Increased labor utilisation is cost-effective compared with the potential improved productivity for ED cases requiring CT imaging.

Keywords: workflow, quality, administration, CT, staffing

Procedia PDF Downloads 90

Authors: Nurkhairul Bariyah Baharun, Afzan Adam, Reena Rahayu Md Zin

Abstract:

Tumor microenvironment (TME) in breast cancer is mainly composed of cancer cells, immune cells, and stromal cells. The interaction between cancer cells and their microenvironment plays an important role in tumor development, progression, and treatment response. The TME in breast cancer includes tumor-infiltrating lymphocytes (TILs) that are implicated in killing tumor cells. TILs can be found in tumor stroma (sTILs) and within the tumor (iTILs). TILs in triple negative breast cancer (TNBC) have been demonstrated to have prognostic and potentially predictive value. The international Immune-Oncology Biomarker Working Group (TIL-WG) had developed a guideline focus on the assessment of sTILs using hematoxylin and eosin (H&E)-stained slides. According to the guideline, the pathologists use “eye balling” method on the H&E stained- slide for sTILs assessment. This method has low precision, poor interobserver reproducibility, and is time-consuming for a comprehensive evaluation, besides only counted sTILs in their assessment. The TIL-WG has therefore recommended that any algorithm for computational assessment of TILs utilizing the guidelines provided to overcome the limitations of manual assessment, thus providing highly accurate and reliable TILs detection and classification for reproducible and quantitative measurement. This study is carried out to develop a TNBC digital whole slide image (WSI) dataset from H&E-stained slides and IHC (CD4+ and CD8+) stained slides. TNBC cases were retrieved from the database of the Department of Pathology, Hospital Canselor Tuanku Muhriz (HCTM). TNBC cases diagnosed between the year 2010 and 2021 with no history of other cancer and available block tissue were included in the study (n=58). Tissue blocks were sectioned approximately 4 µm for H&E and IHC stain. The H&E staining was performed according to a well-established protocol. Indirect IHC stain was also performed on the tissue sections using protocol from Diagnostic BioSystems PolyVue™ Plus Kit, USA. The slides were stained with rabbit monoclonal, CD8 antibody (SP16) and Rabbit monoclonal, CD4 antibody (EP204). The selected and quality-checked slides were then scanned using a high-resolution whole slide scanner (Pannoramic DESK II DW- slide scanner) to digitalize the tissue image with a pixel resolution of 20x magnification. A manual TILs (sTILs and iTILs) assessment was then carried out by the appointed pathologist (2 pathologists) for manual TILs scoring from the digital WSIs following the guideline developed by TIL-WG 2014, and the result displayed as the percentage of sTILs and iTILs per mm² stromal and tumour area on the tissue. Following this, we aimed to develop an automated digital image scoring framework that incorporates key elements of manual guidelines (including both sTILs and iTILs) using manually annotated data for robust and objective quantification of TILs in TNBC. From the study, we have developed a digital dataset of TNBC H&E and IHC (CD4+ and CD8+) stained slides. We hope that an automated based scoring method can provide quantitative and interpretable TILs scoring, which correlates with the manual pathologist-derived sTILs and iTILs scoring and thus has potential prognostic implications.

Keywords: automated quantification, digital pathology, triple negative breast cancer, tumour infiltrating lymphocytes

Procedia PDF Downloads 91

Authors: Jun Byung Joon, Seo Seok Hyun, Lee Seo Young

Abstract:

As carbon dioxide emissions increase due to rapid industrialization and reckless development, abnormal climates such as floods and droughts are occurring. In order to respond to such climate change, the use of existing fossil fuels is reduced, and the proportion of eco-friendly renewable energy is gradually increasing. Korea is an energy resource-poor country that depends on imports for 93% of its total energy. As the global energy supply chain instability experienced due to the Russia-Ukraine crisis increases, countries around the world are resetting energy policies to minimize energy dependence and strengthen security. Seawater thermal energy is a renewable energy that replaces the existing air heat energy. It uses the characteristic of having a higher specific heat than air to cool and heat main spaces of buildings to increase heat transfer efficiency and minimize power consumption to generate electricity using fossil fuels, and Carbon dioxide emissions can be minimized. In addition, the effect on the marine environment is very small by using only the temperature characteristics of seawater in a limited way. K-water carried out a demonstration project of supplying cooling and heating energy to spaces such as the central control room and presentation room in the management building by acquiring the heat source of seawater circulated through the power plant's waterway by using the characteristics of the tidal power plant. Compared to the East Sea and the South Sea, the main system was designed in consideration of the large tidal difference, small temperature difference, and low-temperature characteristics, and its performance was verified through operation during the demonstration period. In addition, facility improvements were made for major deficiencies to strengthen monitoring functions, provide user convenience, and improve facility soundness. To spread these achievements, the basic concept was to expand the seawater heating and cooling system with a scale of 200 USRT at the Tidal Culture Center. With the operational experience of the demonstration system, it will be possible to establish an optimal seawater heat cooling and heating system suitable for the characteristics of the west coast ocean. Through this, it is possible to reduce operating costs by KRW 33,31 million per year compared to air heat, and through industry-university-research joint research, it is possible to localize major equipment and materials and develop key element technologies to revitalize the seawater heat business and to advance into overseas markets. The government's efforts are needed to expand the seawater heating and cooling system. Seawater thermal energy utilizes only the thermal energy of infinite seawater. Seawater thermal energy has less impact on the environment than river water thermal energy, except for environmental pollution factors such as bottom dredging, excavation, and sand or stone extraction. Therefore, it is necessary to increase the sense of speed in project promotion by innovatively simplifying unnecessary licensing/permission procedures. In addition, support should be provided to secure business feasibility by dramatically exempting the usage fee of public waters to actively encourage development in the private sector.

Keywords: seawater thermal energy, marine energy, tidal power plant, energy consumption

Procedia PDF Downloads 76

Authors: Dina Farran, Mark Ashworth, Fiona Gaughran

Abstract:

Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, is associated with an increased risk of stroke, contributing to heart failure and death. In this project, we aim to improve patient safety by screening for stroke risk among people with AF and co-morbid mental illness. To do so, we started by conducting a systematic review and meta-analysis on prevalence, management, and outcomes of AF in people with Serious Mental Illness (SMI) versus the general population. We then evaluated oral anticoagulation (OAC) prescription trends in people with AF and co-morbid SMI in King’s College Hospital. We also evaluated the association between mental illness severity and OAC prescription in eligible patients in South London and Maudsley (SLaM) NHS Foundation Trust. Next, we implemented an electronic clinical decision support system (eCDSS) consisting of a visual prompt on patient electronic Personal Health Records to screen for AF-related stroke risk in three Mental Health of Older Adults wards at SLaM. Finally, we assessed the feasibility and acceptability of the eCDSS by qualitatively investigating clinicians’ perspectives of the potential usefulness of the eCDSS (pre-intervention) and their experiences and their views regarding its impact on clinicians and patients (post-intervention). The systematic review showed that people with SMI had low reported rates of AF. AF patients with SMI were less likely to receive OAC than the general population. When receiving warfarin, people with SMI, particularly bipolar disorder, experienced poor anticoagulation control compared to the general population. Meta-analysis showed that SMI was not significantly associated with an increased risk of stroke or major bleeding when adjusting for underlying risk factors. The main findings of the first observational study were that among AF patients having a high stroke risk, those with co-morbid SMI were less likely than non-SMI to be prescribed any OAC, particularly warfarin. After 2019, there was no significant difference between the two groups. In the second observational study, patients with AF and co-morbid SMI were less likely to be prescribed any OAC compared to those with dementia, substance use disorders, or common mental disorders, adjusting for age, sex, stroke, and bleeding risk scores. Among AF patients with co-morbid SMI, warfarin was less likely to be prescribed to those having alcohol or substance dependency, serious self-injury, hallucinations or delusions, and activities of daily living impairment. In the intervention, clinicians were asked to confirm the presence of AF, clinically assess stroke and bleeding risks, record risk scores in clinical notes, and refer patients at high risk of stroke to OAC clinics. Clinicians reported many potential benefits for the eCDSS, including improving clinical effectiveness, better identification of patients at risk, safer and more comprehensive care, consistency in decision making and saving time. Identified potential risks included rigidity in decision-making, overreliance, reduced critical thinking, false positive recommendations, annoyance, and increased workload. This study presents a unique opportunity to quantify AF patients with mental illness who are at high risk of severe outcomes using electronic health records. This has the potential to improve health outcomes and, therefore patients' quality of life.

Keywords: atrial fibrillation, stroke, mental health conditions, electronic clinical decision support systems

Procedia PDF Downloads 26

Authors: Eric Spruth, Lindsey Herbert, Danielle DiCristofano, Isis Violet Spruth, Drake Von Spruth

Abstract:

Turning dreams into reality, the lifelong passion of Mr. Spruth and the company is to transform garbage-filled courtyards into flourishing flower and vegetable gardens, bringing light, hope, and wellness to not just the space but to the populations served within these public and private spaces. As an Expressive Art Therapist at Cook County Jail, Eric Spruth has implemented gardening projects, mobile radish carts, plant fostering systems, and large-scale murals. Lindsey Herbert, the Manager of Operations and Events at the International Museum of Surgical Science, supports gardening projects with Mr. Spruth along the front lawn of the museum, which will eventually accumulate into a community wellness garden. Mr. Spruth and Ms. Herbert both have dedicated efforts towards fostering awareness of hope and help and accountability for physical and mental wellbeing. Medicinal plants can rightfully be called one of nature’s wonderful healing tools with therapeutic powers. They can inhibit and kill bacteria, lower blood pressure, blood cholesterol, and blood sugar, prevent blood clotting, boost the immune system, and serve as a digestive aid. Some plants have the ability to stimulate the lymphatic system, which expedites the removal of waste products from the body to fight off evil toxins. Many plants are considered effective antioxidants to protect cells against free radical damage, serving to prevent some forms of cancer, heart disease, strokes, and viral infections. Garlic alone can provide us with over two hundred unusual chemicals that have the capability of protecting the human body from a wide variety of diseases. Besides the medicinal qualities of plants, plant and vegetable gardens also have an echoing effect on non-participants to look at something beautiful rather than a concrete courtyard or an unkempt lawn in front of a beautiful building. Plants also purify spaces and affect mood with color therapy. Collective gardening can foster a sense of community and purpose. Additionally, by recognizing the ever-evolving planet with global warming, horticulture therapy teaches important lessons in responsibility, accountability, and sustainability. Growing local food provides an opportunity to be involved in your own mental and physical health and gives you a chance for your own self-resilience, combating depression and a lack of nutrition. In adolescents, the process of watering and caring for plants can teach important life lessons that transcend beyond the garden by providing knowledge on how to care for yourself and how to be an active member of society. It also gives a sense of purpose and pride in transforming a small seed into a plant that can be consumed or enjoyed by others. Mr. Spruth and Ms. Herbert recognize the importance of bringing more green spaces to urban areas, both to serve a nutritional benefit and provide a beautiful transformation to underutilized areas. Gardens can bring beauty, wellness, and hope to dark spaces and provide immeasurable benefits for all.

Keywords: growth, hope, mental health, sustainability, transformation, wellness

Procedia PDF Downloads 67

Authors: Tatiana Butkova, Nikolai Kibrik, Kristina Malsagova, Alexander Izotov, Alexander Stepanov, Anna Kaysheva

Abstract:

Relevance. The genetic risk of developing schizophrenia is determined by two factors: single nucleotide polymorphisms and gene copy number variations. The search for serological markers for early diagnosis of schizophrenia is driven by the fact that the first five years of the disease are accompanied by significant biological, psychological, and social changes. It is during this period that pathological processes are most amenable to correction. The aim of this study was to analyze single nucleotide polymorphisms (SNPs) that are hypothesized to potentially influence the onset and development of the endogenous process. Materials and Methods It was analyzed 73 single nucleotide polymorphism variants. The study included 48 patients undergoing inpatient treatment at "Psychiatric Clinical Hospital No. 1" in Moscow, comprising 23 females and 25 males. Inclusion criteria: - Patients aged 18 and above. - Diagnosis according to ICD-10: F20.0, F20.2, F20.8, F21.8, F25.1, F25.2. - Voluntary informed consent from patients. Exclusion criteria included: - The presence of concurrent somatic or neurological pathology, neuroinfections, epilepsy, organic central nervous system damage of any etiology, and regular use of medication. - Substance abuse and alcohol dependence. - Women who were pregnant or breastfeeding. Clinical and psychopathological assessment was complemented by psychometric evaluation using the PANSS scale at the beginning and end of treatment. The duration of observation during therapy was 4-6 weeks. Total DNA extraction was performed using QIAamp DNA. Blood samples were processed on Illumina HiScan and genotyped for 652,297 markers on the Infinium Global Chips Screening Array-24v2.0 using the IMPUTE2 program with parameters Ne=20,000 and k=90. Additional filtration was performed based on INFO>0.5 and genotype probability>0.5. Quality control of the obtained DNA was conducted using agarose gel electrophoresis, with each tested sample having a volume of 100 µL. Results. It was observed that several SNPs exhibited gender dependence. We identified groups of single nucleotide polymorphisms with a membership of 80% or more in either the female or male gender. These SNPs included rs2661319, rs2842030, rs4606, rs11868035, rs518147, rs5993883, and rs6269.Another noteworthy finding was the limited combination of SNPs sufficient to manifest clinical symptoms leading to hospitalization. Among all 48 patients, each of whom was analyzed for deviations in 73 SNPs, it was discovered that the combination of involved SNPs in the manifestation of pronounced clinical symptoms of schizophrenia was 19±3 out of 73 possible. In study, the frequency of occurrence of single nucleotide polymorphisms also varied. The most frequently observed SNPs were rs4849127 (in 90% of cases), rs1150226 (86%), rs1414334 (75%), rs10170310 (73%), rs2857657, and rs4436578 (71%). Conclusion. Thus, the results of this study provide additional evidence that these genes may be associated with the development of schizophrenia spectrum disorders. However, it's impossible cannot rule out the hypothesis that these polymorphisms may be in linkage disequilibrium with other functionally significant polymorphisms that may actually be involved in schizophrenia spectrum disorders. It has been shown that missense SNPs by themselves are likely not causative of the disease but are in strong linkage disequilibrium with non-functional SNPs that may indeed contribute to disease predisposition.

Keywords: gene polymorphisms, genotyping, single nucleotide polymorphisms, schizophrenia.

Procedia PDF Downloads 46

Authors: Carolyn Hatch, Laurent Simon

Abstract:

Urban mobility and the transportation industry are undergoing a transformation, shifting from an auto production-consumption model that has dominated since the early 20th century towards new forms of personal and shared multi-modality [1]. This is shaped by key forces such as climate change, which has induced a shift in production and consumption patterns and efforts to decarbonize and improve transport services through, for instance, the integration of vehicle automation, electrification and mobility sharing [2]. Advanced innovation practices and platforms for experimentation and validation of new mobility products and services that are increasingly complex and multi-stakeholder-oriented are shaping this new world of mobility. Transportation hubs – such as airports - are emblematic of these disruptive forces playing out in the mobility industry. Airports are emerging as the core of innovation ecosystems on and around contemporary mobility issues, and increasingly recognized as complex public/private nodes operating in many societal dimensions [3,4]. These include urban development, sustainability transitions, digital experimentation, customer experience, infrastructure development and data exploitation (for instance, airports generate massive and often untapped data flows, with significant potential for use, commercialization and social benefit). Yet airport innovation practices have not been well documented in the innovation literature. This paper addresses this gap by proposing a model of airport innovation that aims to equip airport stakeholders to respond to these new and complex innovation needs in practice. The methodology involves: 1 – a literature review bringing together key research and theory on airport innovation management, open innovation and innovation ecosystems in order to evaluate airport practices through an innovation lens; 2 – an international benchmarking of leading airports and their innovation practices, including such examples as Aéroports de Paris, Schipol in Amsterdam, Changi in Singapore, and others; and 3 – semi-structured interviews with airport managers on key aspects of organizational practice, facilitated through a close partnership with the Airport Council International (ACI), a major stakeholder in this research project. Preliminary results find that the most successful airports are those that have shifted to a multi-stakeholder, platform ecosystem model of innovation. The recent entrance of new actors in airports (Google, Amazon, Accor, Vinci, Airbnb and others) have forced the opening of organizational boundaries to share and exchange knowledge with a broader set of ecosystem players. This has also led to new forms of governance and intermediation by airport actors to connect complex, highly distributed knowledge, along with new kinds of inter-organizational collaboration, co-creation and collective ideation processes. Leading airports in the case study have demonstrated a unique capacity to force traditionally siloed activities to “think together”, “explore together” and “act together”, to share data, contribute expertise and pioneer new governance approaches and collaborative practices. In so doing, they have successfully integrated these many disruptive change pathways and forced their implementation and coordination towards innovative mobility outcomes, with positive societal, environmental and economic impacts. This research has implications for: 1 - innovation theory, 2 - urban and transport policy, and 3 - organizational practice - within the mobility industry and across the economy.

Keywords: airport management, ecosystem, innovation, mobility, platform, transport hubs

Procedia PDF Downloads 160

Authors: May Bazzi, Shafik Tokmaj, Younes Saberi, Mats Geijer, Tony Jurkiewicz, Patrik Sund, Anna Bjällmark

Abstract:

Mobile radiography, employing portable X-ray equipment, has become a routine procedure within hospital settings, with chest X-rays in intensive care units standing out as the most prevalent mobile X-ray examinations. This approach is not limited to hospitals alone, as it extends its benefits to imaging patients in various settings, particularly those too frail to be transported, such as elderly care residents in nursing homes. Moreover, the utility of mobile X-ray isn't confined solely to traditional healthcare recipients; it has proven to be a valuable resource for vulnerable populations, including the homeless, drug users, asylum seekers, and patients with multiple co-morbidities. Mobile X-rays reduce patient stress, minimize costly hospitalizations, and offer cost-effective imaging. While studies confirm its reliability, further research is needed, especially regarding image quality. Recent advancements in lightweight equipment with enhanced battery and detector technology provide the potential for nearly handheld radiography. The main aim of this study was to evaluate a new lightweight mobile X-ray system with two different detectors and compare the image quality with a modern stationary system. Methods: A total of 74 images of the chest (chest anterior-posterior (AP) views and chest lateral views) and pelvic/hip region (AP pelvis views, hip AP views, and hip cross-table lateral views) were acquired on a whole-body phantom (Kyotokagaku, Japan), utilizing varying image parameters. These images were obtained using a stationary system - 18 images (Mediel, Sweden), a mobile X-ray system with a second-generation detector - 28 images (FDR D-EVO II; Fujifilm, Japan) and a mobile X-ray system with a third-generation detector - 28 images (FDR D-EVO III; Fujifilm, Japan). Image quality was assessed by visual grading analysis (VGA), which is a method to measure image quality by assessing the visibility and accurate reproduction of anatomical structures within the images. A total of 33 image criteria were used in the analysis. A panel of two experienced radiologists, two experienced radiographers, and two final-term radiographer students evaluated the image quality on a 5-grade ordinal scale using the software Viewdex 3.0 (Viewer for Digital Evaluation of X-ray images, Sweden). Data were analyzed using visual grading characteristics analysis. The dose was measured by the dose-area product (DAP) reported by the respective systems. Results: The mobile X-ray equipment (both detectors) showed significantly better image quality than the stationary equipment for the pelvis, hip AP and hip cross-table lateral images with AUCVGA-values ranging from 0.64-0.92, while chest images showed mixed results. The number of images rated as having sufficient quality for diagnostic use was significantly higher for mobile X-ray generation 2 and 3 compared with the stationary X-ray system. The DAP values were higher for the stationary compared to the mobile system. Conclusions: The new lightweight radiographic equipment had an image quality at least as good as a fixed system at a lower radiation dose. Future studies should focus on clinical images and consider radiographers' viewpoints for a comprehensive assessment.

Keywords: mobile x-ray, visual grading analysis, radiographer, radiation dose

Procedia PDF Downloads 42

Authors: Jawaad Saleem, Hannah Wright, Peter Sommerville, Adrian Hopper

Abstract:

Introduction: Inpatient falls are the most commonly reported patient safety incidents, and carry a significant burden on resources, morbidity, and mortality. Ensuring adequate post falls management of patients by staff is therefore paramount to maintaining patient safety especially in out of hours and resource stretched settings. Aims: This quality improvement project aims to improve the current practice of falls management at Guys St Thomas Hospital, London as compared to our 2016 Quality Improvement Project findings. Furthermore, it looks to increase current junior doctors confidence in managing falls and their use of new guidance protocols. Methods: Multifaceted Interventions implemented included: the development of new trust wide guidelines detailing management pathways for patients post falls, available for intranet access. Furthermore, the production of 2000 lanyard cards distributed amongst junior doctors and staff which summarised these guidelines. Additionally, a ‘safety signal’ email was sent from the Trust chief medical officer to all staff raising awareness of falls and the guidelines. Formal falls teaching was also implemented for new doctors at induction. Using an established incident database, 189 consecutive falls in 2017were retrospectively analysed electronically to assess and compared to the variables measured in 2016 post interventions. A separate serious incident database was used to analyse 50 falls from May 2015 to March 2018 to ascertain the statistical significance of the impact of our interventions on serious incidents. A similar questionnaire for the 2017 cohort of foundation year one (FY1) doctors was performed and compared to 2016 results. Results: Questionnaire data demonstrated improved awareness and utility of guidelines and increased confidence as well as an increase in training. 97% of FY1 trainees felt that the interventions had increased their awareness of the impact of falls on patients in the trust. Data from the incident database demonstrated the time to review patients post fall had decreased from an average of 130 to 86 minutes. Improvement was also demonstrated in the reduced time to order and schedule X-ray and CT imaging, 3 and 5 hours respectively. Data from the serious incident database show that ‘the time from fall until harm was detected’ was statistically significantly lower (P = 0.044) post intervention. We also showed the incidence of significant delays in detecting harm ( > 10 hours) reduced post intervention. Conclusions: Our interventions have helped to significantly reduce the average time to assess, order and schedule appropriate imaging post falls. Delays of over ten hours to detect serious injuries after falls were commonplace; since the intervention, their frequency has markedly reduced. We suggest this will lead to identifying patient harm sooner, reduced clinical incidents relating to falls and thus improve overall patient safety. Our interventions have also helped increase clinical staff confidence, management, and awareness of falls in the trust. Next steps include expanding teaching sessions, improving multidisciplinary team involvement to aid this improvement.

Keywords: patient safety, quality improvement, serious incidents, falls, clinical care

Procedia PDF Downloads 105