Search results for: smart home healthcare

Authors: Mirjana Dokmanovic

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In recent years, the disadvantaged and marginalised position of rural women in the Republic of Serbia has been recognised in a number of national strategies and policy papers. A number of measures have been adopted by the government aimed at economic empowerment of rural women and eliminating barriers to accessing decision making and economic and social opportunities. However, their implementation pace is still slow. The aim of the paper is to indicate the necessity of a comprehensive policy approach to eliminating discrimination against rural women that would include policy and financial commitments for enhancing agricultural and rural development as a whole, instead of taking fragmented measures targeting consequences instead of causes. The paper introduces main findings of the study of challenges, constraints, and opportunities of rural women in Serbia to enjoy their economic and social rights. The research methodology included the desk research and the qualitative analysis of the available data, statistics, policy papers, studies, and reports produced by the government, ministries and other governmental bodies, independent human rights bodies, and civil society organizations (CSOs). The findings of the study reveal that rural women are at great risk of poverty, particularly in remote areas, and when getting old or widowed. Young rural women working in agriculture are also in unfavorable position, as they do not have opportunities to enjoy their rights during pregnancy and maternity leave, childcare leave and leave due to the special care of a child. The study indicates that the main causes of their unfavorable position are related to the prevalent patriarchal surrounding and economic and social underdevelopment of rural areas in Serbia. Gender inequalities have been particularly present in accessing land and property rights, inheritance, education, social protection, healthcare, and decision making. Women living in the rural areas are exposed at high risk of discrimination in all spheres of public and private life that undermine their enjoyment of basic economic, social and cultural rights. The vulnerability of rural women to discrimination increases in cases of the intersectionality of other grounds of discrimination, such as disability, ethnicity, age, health condition and sexual discrimination. If they are victims of domestic violence, their experience lack of access to shelters and protection services. Despite the State’s recognition of the marginalized position of rural women, there is still a lack of a comprehensive policy approach to improving the economic and social position of rural women.

Keywords: agricultural and rural development, care economy, discrimination against women, economic and social rights, feminization of poverty, Republic of Serbia, rural women

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Authors: Jane-Francis A. Abongdia, Thandiswa Mpiti

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There is an international concern to develop children’s literacy skills. In many parts of the world, the need to become fluent in a second language is essential for gaining meaningful access to education, the labour market and broader social functioning. In spite of these efforts, the problem still continues. The level of English language proficiency is far from satisfactory and these goals are unattainable by others. The issue is more complex in South Africa as learners are immersed in a second language (L2) curriculum. South Africa is a prime example of a country facing the dilemma of how to effectively equip a majority of its population with English as a second language or first additional language (FAL). Given the multilingual nature of South Africa with eleven official languages, and the position and power of English, the study investigates teachers’ and learners’ experiences on isiXhosa and Afrikaans background learners’ writing in English First Additional Language (EFAL). Moreover, possible causes of writing difficulties and teacher’s practices for writing are explored. The theoretical and conceptual framework for the study is provided by studies on constructivist theories and sociocultural theories. In exploring these issues, a qualitative approach through semi-structured interviews, classroom observations, and document analysis were adopted. This data is analysed by critical discourse analysis (CDA). The study identified a weak correlation between teachers’ beliefs and their actual teaching practices. Although the teachers believe that writing is as important as listening, speaking, reading, grammar and vocabulary, and that it needs regular practice, the data reveal that they fail to put their beliefs into practice. Moreover, the data revealed that learners were disturbed by their home language because when they do not know a word they would write either the isiXhosa or the Afrikaans equivalent. Code-switching seems to have instilled a sense of “dependence on translations” where some learners would not even try to answer English questions but would wait for the teacher to translate the questions into isiXhosa or Afrikaans before they could attempt to give answers. The findings of the study show a marked improvement in the writing performance of learners who used the process approach in writing. These findings demonstrate the need for assisting teachers to shift away from focusing only on learners’ performance (testing and grading) towards a stronger emphasis on the process of writing. The study concludes that the process approach to writing could enable teachers to focus on the various parts of the writing process which can give more freedom to learners to experiment their language proficiency. It would require that teachers develop a deeper understanding of the process/genre approaches to teaching writing advocated by CAPS. All in all, the study shows that both learners and teachers face numerous challenges relating to writing. This means that more work still needs to be done in this area. The present study argues that teachers teaching EFAL learners should approach writing as a critical and core aspect of learners’ education. Learners should be exposed to intensive writing activities throughout their school years.

Keywords: constructivism, English second language, language of learning and teaching, writing

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Authors: Irfan Khan, Chiemeka David Ekene Arize, Hilly Swami

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Mental health care access and stigma present global challenges, with disparities significantly influenced by economic, cultural, and societal factors. This paper focuses on the mental health care systems of South Asia and the United States, comparing how cultural norms, infrastructure, and policy affect mental health care accessibility and effectiveness in both regions. In South Asia, mental health care is hindered by a combination of underfunding, a critical shortage of professionals, and deeply ingrained cultural stigmas that deter help-seeking. Traditional beliefs often link mental disorders to supernatural causes, and women face additional barriers due to gender disparities. Despite recent policy reforms, implementation remains a challenge, particularly in rural areas. In contrast, the U.S. has a more developed healthcare infrastructure but continues to grapple with stigma, particularly within professional settings like law enforcement. Interventions such as the use of community health workers (CHWs) and collaborative care models have improved access, especially among underserved populations. However, the U.S. still faces disparities in care for minority groups, where cultural competence and stigma reduction are critical for improving outcomes. The paper’s comparative analysis identifies transferable strategies from the U.S. that could be adapted to South Asia’s context, such as integrating mental health care into primary care and using digital interventions to bridge the treatment gap in rural areas. Additionally, South Asia's community-centered approaches offer insights that could enhance the cultural adaptability of interventions in the U.S., particularly for ethnic minorities and immigrant populations. Through a systematic review, this paper examines intervention strategies, stigma, policy support, and the cultural and social determinants of mental health in both regions. The findings emphasize the need for culturally tailored mental health interventions and policy reforms that promote access and reduce stigma. Recommendations include enhancing public awareness, integrating mental health services into primary care, expanding community-based programs, and leveraging digital health interventions. This research contributes to the global discourse on mental health by highlighting culturally sensitive approaches that can be adapted to improve mental health care access and outcomes in both South Asia and the United States.

Keywords: mental health stigma South Asia, mental health care accessibility South Asia, cultural influences mental health South Asia, mental health interventions USA, cross-cultural mental health care

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Authors: Bagireanu Astrid, Bros-Williamson Julio, Duncheva Mila, Currie John

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Digital Twins (DT) are an innovative concept of cyber-physical integration of data between an asset and its virtual replica. They have originated in established industries such as manufacturing and aviation and have garnered increasing attention as a potentially transformative technology within the built environment. With the potential to support decision-making, real-time simulations, forecasting abilities and managing operations, DT do not fall under a singular scope. This makes defining and leveraging the potential uses of DT a potential missed opportunity. Despite its recognised potential in established industries, literature on DT in the built environment remains limited. Inadequate attention has been given to the implementation of DT in construction projects, as opposed to its operational stage applications. Additionally, the absence of a standardised definition has resulted in inconsistent interpretations of DT in both industry and academia. There is a need to consolidate research to foster a unified understanding of the DT. Such consolidation is indispensable to ensure that future research is undertaken with a solid foundation. This paper aims to present a comprehensive systematic literature review on the role of DT in the built environment. To accomplish this objective, a review and thematic analysis was conducted, encompassing relevant papers from the last five years. The identified papers are categorised based on their specific areas of focus, and the content of these papers was translated into a through classification of DT. In characterising DT and the associated data processes identified, this systematic literature review has identified 6 DT opportunities specifically relevant to the built environment: Facilitating collaborative procurement methods, Supporting net-zero and decarbonization goals, Supporting Modern Methods of Construction (MMC) and off-site manufacturing (OSM), Providing increased transparency and stakeholders collaboration, Supporting complex decision making (real-time simulations and forecasting abilities) and Seamless integration with Internet of Things (IoT), data analytics and other DT. Finally, a discussion of each area of research is provided. A table of definitions of DT across the reviewed literature is provided, seeking to delineate the current state of DT implementation in the built environment context. Gaps in knowledge are identified, as well as research challenges and opportunities for further advancements in the implementation of DT within the built environment. This paper critically assesses the existing literature to identify the potential of DT applications, aiming to harness the transformative capabilities of data in the built environment. By fostering a unified comprehension of DT, this paper contributes to advancing the effective adoption and utilisation of this technology, accelerating progress towards the realisation of smart cities, decarbonisation, and other envisioned roles for DT in the construction domain.

Keywords: built environment, design, digital twins, literature review

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Authors: Huang Wei-Yi

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Objective: This article explores the intensive care nursing experience of a lung cancer patient with pulmonary embolism who was placed on ECMO. Following a sudden change in the patient’s condition and a consensus reached during a family meeting, the decision was made to withdraw life-sustaining equipment and collaborate with the palliative care team. Methods: The nursing period was from October 20 to October 27, 2023. The author monitored physiological data, observed, provided direct care, conducted interviews, performed physical assessments, and reviewed medical records. Together with the critical care team and bypass personnel, a comprehensive assessment was conducted using Gordon's Eleven Functional Health Patterns to identify the patient’s health issues, which included pain related to lung cancer and invasive devices, fear of death due to sudden deterioration, and altered tissue perfusion related to hemodynamic instability. Results: The patient was admitted with fever, back pain, and painful urination. During hospitalization, the patient experienced sudden discomfort followed by cardiac arrest, requiring multiple CPR attempts and ECMO placement. A subsequent CT angiogram revealed a pulmonary embolism. The patient's condition was further complicated by severe pain due to compression fractures, and a diagnosis of terminal lung cancer was unexpectedly confirmed, leading to emotional distress and uncertainty about future treatment. Throughout the critical care process, ECMO was removed on October 24, stabilizing the patient’s body temperature between 36.5-37°C and maintaining a mean arterial pressure of 60-80 mmHg. Pain management, including Morphine 8mg in 0.9% N/S 100ml IV drip q6h PRN and Ultracet 37.5 mg/325 mg 1# PO q6h, kept the pain level below 3. The patient was transferred to the ward on October 27 and discharged home on October 30. Conclusion: During the care period, collaboration with the medical team and palliative care professionals was crucial. Adjustments to pain medication, symptom management, and lung cancer-targeted therapy improved the patient’s physical discomfort and pain levels. By applying the unique functions of nursing and the four principles of palliative care, positive encouragement was provided. Family members, along with social workers, clergy, psychologists, and nutritionists, participated in cross-disciplinary care, alleviating anxiety and fear. The consensus to withdraw ECMO and life-sustaining equipment enabled the patient and family to receive high-quality care and maintain autonomy in decision-making. A follow-up call on November 1 confirmed that the patient was emotionally stable, pain-free, and continuing with targeted lung cancer therapy.

Keywords: intensive care, lung cancer, pulmonary embolism, ECMO

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Authors: Epaminondas G. Kyriakidis, Theodosis D. Dimitrakos, Constantinos C. Karamatsoukis

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The vehicle routing problem (VRP) is a well-known problem in Operations Research and has been widely studied during the last fifty-five years. The context of the VRP is that of delivering products located at a central depot to customers who are scattered in a geographical area and have placed orders for these products. A vehicle or a fleet of vehicles start their routes from the depot and visit the customers in order to satisfy their demands. Special attention has been given to the capacitated VRP in which the vehicles have limited carrying capacity of the goods that must be delivered. In the present work, we present a specific capacitated stochastic vehicle routing problem which has realistic applications to distributions of materials to shops or to healthcare facilities or to military units. A vehicle starts its route from a depot loaded with items of two similar but not identical products. We name these products, product 1 and product 2. The vehicle must deliver the products to N customers according to a predefined sequence. This means that first customer 1 must be serviced, then customer 2 must be serviced, then customer 3 must be serviced and so on. The vehicle has a finite capacity and after servicing all customers it returns to the depot. It is assumed that each customer prefers either product 1 or product 2 with known probabilities. The actual preference of each customer becomes known when the vehicle visits the customer. It is also assumed that the quantity that each customer demands is a random variable with known distribution. The actual demand is revealed upon the vehicle’s arrival at customer’s site. The demand of each customer cannot exceed the vehicle capacity and the vehicle is allowed during its route to return to the depot to restock with quantities of both products. The travel costs between consecutive customers and the travel costs between the customers and the depot are known. If there is shortage for the desired product, it is permitted to deliver the other product at a reduced price. The objective is to find the optimal routing strategy, i.e. the routing strategy that minimizes the expected total cost among all possible strategies. It is possible to find the optimal routing strategy using a suitable stochastic dynamic programming algorithm. It is also possible to prove that the optimal routing strategy has a specific threshold-type structure, i.e. it is characterized by critical numbers. This structural result enables us to construct an efficient special-purpose dynamic programming algorithm that operates only over those routing strategies having this structure. The findings of the present study lead us to the conclusion that the dynamic programming method may be a very useful tool for the solution of specific vehicle routing problems. A problem for future research could be the study of a similar stochastic vehicle routing problem in which the vehicle instead of delivering, it collects products from ordered customers.

Keywords: collection of similar products, dynamic programming, stochastic demands, stochastic preferences, vehicle routing problem

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Authors: Isis Ribeiro Berger

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In view of recent war conflicts between Russia and Ukraine, the government of Paraná State, in Brazil, started a program to host Ukrainian scientists in state universities in 2022. The initiative aimed at integrating these scientists into the Brazilian academic community, strengthening the role of universities in producing science and innovation even in times of war, as well as fostering Higher Education internationalization. Paraná state was a pioneer in this initiative due to the fact it has been home to the largest contingent of immigrants and descendants of Ukrainians in Brazil because of migratory processes that began at the end of the 19th century. One of the universities receiving Ukrainian scientists is in Foz do Iguaçu, a city that borders Argentina and Paraguay. It is a multilingual environment, whose majority languages are Portuguese (the official language of Brazil), Spanish (the official language of both Argentina and Paraguay), as well as Guarani (the co-official indigenous language of Paraguay). It is in such a sociolinguistic environment that two Ukrainian professors began their activities within the scope of an Interdisciplinary Postgraduate Program (master’s and doctorate degree). This case study, whose theme is the management of multilingualism, was developed within the scope of Language Policy. It aimed at identifying the attitudes of both Ukrainian professors and postgraduate students towards multilingualism in this context, given the plural linguistic repertoire of the academic community, as well as identifying the language management strategies for the construction of knowledge implemented by the program and in the classroom by these participants. Therefore, the study was conducted under a qualitative approach, for which surveys and interviews were adopted as part of its methodological procedures. Data revealed the presence of different languages in the classroom (Portuguese, Spanish, English and Ukrainian), which made pedagogical practices challenging for both professors and students, whose levels of knowledge in the different languages varied significantly. The results indicate that multilingualism was the norm as the means of instruction adopted in this context, in which bilingual Portuguese-English-Ukrainian instruction was used by the professors in their lectures. Although English has been privileged for the internationalization of Higher Education in various contexts, it was not used as an exclusive means of instruction in this case, mostly because it is a predominantly Portuguese-Spanish-speaking environment. In addition, the professors counted on the mediation of an interpreter hired by the program since not every student had sufficient knowledge of English as part of their repertoires. The findings also suggest Portuguese is the language that most of the participants of this study prefer, both because it is the mother tongue of majority, and because it is the official language of the host country to the professors, who have sought to integrate to the local culture and community. This research is inserted in the Axis: Multilingualism and Education, of the UNESCO Chair on Language Policies for Multilingualism to which this study is related.

Keywords: attitudes, border region, multilingualism management, Ukrainian professors

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Authors: Peter R. Alfieri

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The principal aim of this research and presentation is to give global and personal perspective of the migratory diaspora and how it is perceived by a substantial majority that relies on the media’s portrayal of migratory movements. Since its Greek origins the word “diaspora” has taken on several connotations, but none has surpassed its use in regard to the human element; because since before the dawn of history, man has had to struggle for survival. That survival was a struggle against the elements and other natural enemies, but none as tenacious and relentless as other men. Many have used the term diaspora to describe the spread of certain ethnic groups resulting in new generations in new places; but has the human diaspora been as haphazard as that of spores? The quest for survival has spawned migrations that are not quite that simple, even though it has several similarities to plant spores or dandelion seeds flying throughout the atmosphere. Man kind has constantly migrated in search of food, shelter, and safety. When they were able to find food and shelter, they would inform others who would venture to the new place. Information, whether through word of mouth, written material, or visual communications, has been a moving force in man’s life; and it spurred migrants in their quest for better environments. Today we pride ourselves in being able to communicate instantly with anyone anywhere in the world, and we are privileged to see most of what is happening in the world thanks to the highly developed modern media. Is Media a “wind/force” instrumental in propelling the diaspora throughout the world? The media has been the tool that has incentive many migratory, but unfortunately it is also the means responsible for many misconceptions regarding migrants and their hosts. Has the Media presented an unbiased view of the migrant or has it been the means that generated negative or prejudiced views of the migrant and, perhaps, the host environment? Some examples were easily seen in 19th century the United States where they advertised the following, “Help needed, Irish need not apply”. How do immigrants circumvent latent barriers that are not as obvious as the ones just mentioned? Some immigrants return home and have children that decide to emigrate. It is a perpetual cycle in the search for self-improvement. The stories that are brought back might be inspiration for the new generation of emigrants. Poverty, hunger, and political turmoil spur most migrations. The majority learn from others or through the media about certain destinations that will provide one or several opportunities to improve their existence. Many of those migrants suffer untold hardships to succeed. When they succeed, they provide a great incentive for their children to obtain an education or skill that will insure them a better life. Although the new environment may contribute greatly to a successful career, most immigrants do not forget their own struggle. They see the media’s portrayal of other migrants from all over the globe. Some try to communicate to others the true feelings of despair felt by immigrants, because they are all brothers and sisters in the perennial struggle for a better life. “HOPE” for a better life drives the immigrant toward the unknown and it has helped overcome the obstacles that present themselves challenging every newcomer. Hope and perseverance strengthen the resolve of the migrant in his struggle to survive.

Keywords: media, migration, heath, education, obstacles

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Authors: Ye Sun, Han-Youl Lee, Kathy Musa-Veloso, Nabil Bosco

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Japan has been experiencing global ageing of population with the World’s leading life expectancy (80.8 y for men and 86.9 y for women) and among the lowest birth rate. Preventive nutrition-based approaches have been identified by the health authorities as one of the strategies to increase the healthy life expectancy and reduce the healthcare costs. However, the nutritional needs and status of the senior population have not been well characterized to provide targeted solutions. This study aims to describe the age- and gender-specific prevalence of inadequacy of macro- and micronutrients intake based on the latest Japan National Health and Nutrition Survey (JNHNS) 2014. JNHNS collected data on the consumption of foods and beverages using 1-day semi-weight household dietary record. Nutrient intake levels were then calculated using the Japanese standard tables of food composition. Where applicable, Japanese population-specific estimated average requirements (EAR) were used as a benchmark to determine the prevalence of potential nutrient intake inadequacy, and adequate intake (AI) were used for nutrients with no available EARs. In all, 3403 senior adults aged 60 y and above and 3324 young adults aged 19 to 59 y were included in the 2014 JNHNS. Age- and gender-specific differences were observed in the mean nutrient intakes as well as the prevalence of inadequacy. Among the 22 nutrients examined, the prevalence of inadequacy for iron, vitamin C, magnesium, potassium, and folic acid in the senior adults was significantly lower than young adults, suggesting potentially healthier dietary choices by the seniors. However, there was still a considerable proportion of seniors who did not meet the requirement for key nutrients like vitamin B1 (67%), calcium (57%), vitamin A (48%), magnesium (47%), vitamin E (44%), and vitamin B6 (41%). Inadequate nutrient intake is generally more prevalent among elderly males than females for many nutrients, with the exception of iron (prevalence of inadequacy: 21% versus 42%) which could partly be explained by the higher intake recommendations for the females. In conclusion, high prevalence of nutrient inadequacy exists in older adults, with a potentially worsened picture for men. Such inadequacies could have multiple health implications including physical frailty and mental health. Further study is warranted to investigate the food consumption patterns that could explain the observed nutrient inadequacies, and to eventually develop nutrition-based solutions tailored to the needs of specific subgroups of the population.

Keywords: ageing, national health and nutrition survey, nutrients, nutrition

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Authors: Jacklyn Yek, Clara Tong, Shin Yuet Chong, Yee Yian Ong

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Background: While emergency manuals and cognitive aids (CA) have been used in high-hazard industries for decades, this has been a nascent field in healthcare. CAs can potentially offset the large cognitive load involved in crisis resource management and possibly facilitate the efficient performance of key steps in treatment. A crisis manual was developed based on local guidelines and the latest evidence-based information and introduced to a tertiary hospital setting in Singapore. Hence, the objective of this study is to evaluate the effectiveness of the crisis manual in guiding response and management of critical events. Methods: 7 surgical teams were recruited to participate in a series of simulated emergencies in high-fidelity operating room simulator over the period of April to June 2018. All teams consisted of a surgical consultant and medical officer/registrar, anesthesia consultant and medical officer/registrar; as well as a circulating, scrub and anesthetic nurse. Each team performed a simulated operation in which 1 or more of the crisis events occurred. The teams were randomly assigned to a scenario of the crisis manual and all teams were deemed to be equal in experience and knowledge. Before the simulation, teams were instructed on proper checklist use but the use of the checklist was optional. Results: 7 simulation sessions were performed, consisting of the following scenarios: Airway fire, Massive Transfusion Protocol, Malignant Hyperthermia, Eclampsia, and Difficult Airway. Out of the 7 surgical teams, 2 teams made use of the crisis manual – of which both teams had encountered a ‘Malignant Hyperthermia’ scenario. These team members reflected that the crisis manual assisted allowed them to work in a team, especially being able to involve the surgical doctors who were unfamiliar with the condition and management. A run chart plotted showed a possible upward trend, suggesting that with increasing awareness and training, staff would become more likely to initiate the use of the crisis manual. Conclusion: Despite the high volume load in this tertiary hospital, certain crises remain rare and clinicians are often caught unprepared. A crisis manual is an effective tool and easy-to-use repository that can improve patient outcome and encourage teamwork. With training, familiarity would allow clinicians to be increasingly comfortable with reaching out for the crisis manual. More simulation training would need to be conducted to determine its effectiveness.

Keywords: crisis resource management, high fidelity simulation training, medical errors, visual aids

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Authors: Sneha Shankar, Orlando Buendia, Will Evans

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Alpha-1 antitrypsin deficiency (AATD) is a rare, genetic, and multisystemic condition. Underdiagnosis is common, leading to chronic pulmonary and hepatic complications, increased resource utilization, and additional costs to the healthcare system. Currently, there is limited evidence of the direct medical costs of AATD diagnosis in the UK. This study explores the economic impact of AATD patients during the 3 years before diagnosis and to identify the major cost drivers using primary and secondary care electronic health record (EHR) data. The 3 years before diagnosis time period was chosen based on the ability of our tool to identify patients earlier. The AATD algorithm was created using published disease criteria and applied to 148 known AATD patients’ EHR found in a primary care database of 936,148 patients (413,674 Biobank and 501,188 in a single primary care locality). Among 148 patients, 9 patients were flagged earlier by the tool and, on average, could save 3 (1-6) years per patient. We analysed 101 of the 148 AATD patients’ primary care journey and 20 patients’ Hospital Episode Statistics (HES) data, all of whom had at least 3 years of clinical history in their records before diagnosis. The codes related to laboratory tests, clinical visits, referrals, hospitalization days, day case, and inpatient admissions attributable to AATD were examined in this 3-year period before diagnosis. The average cost per patient was calculated, and the direct medical costs were modelled based on the mean prevalence of 100 AATD patients in a 500,000 population. A deterministic sensitivity analysis (DSA) of 20% was performed to determine the major cost drivers. Cost data was obtained from the NHS National tariff 2020/21, National Schedule of NHS Costs 2018/19, PSSRU 2018/19, and private care tariff. The total direct medical cost of one hundred AATD patients three years before diagnosis in primary and secondary care in the UK was £3,556,489, with an average direct cost per patient of £35,565. A vast majority of this total direct cost (95%) was associated with inpatient admissions (£3,378,229). The DSA determined that the costs associated with tier-2 laboratory tests and inpatient admissions were the greatest contributors to direct costs in primary and secondary care, respectively. This retrospective study shows the role of EHRs in calculating direct medical costs and the potential benefit of new technologies for the early identification of patients with AATD to reduce the economic burden in primary and secondary care in the UK.

Keywords: alpha-1 antitrypsin deficiency, costs, digital health, early diagnosis

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Authors: Tetyana Kendzerska, David T. Zhu, Michael Pugliese, Douglas Manuel, Mohsen Sadatsafavi, Marcus Povitz, Therese A. Stukel, Teresa To, Shawn D. Aaron, Sunita Mulpuru, Melanie Chin, Claire E. Kendall, Kednapa Thavorn, Rebecca Robillard, Andrea S. Gershon

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The impact of the COVID-19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown. To compare observed and expected (projected based on previous years) trends in all-cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 - March 2021). A population-based study using provincial health administrative data.General adult population (Ontario, Canada). Monthly all-cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at-risk) for seven combined ACSCs (asthma, COPD, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016-2019) by fitting monthly time series auto-regressive integrated moving-average models. Compared to previous years, all-cause mortality rates increased at the beginning of the pandemic (observed rate in March-May 2020 of 79.98 vs. projected of 71.24 [66.35-76.50]) and then returned to expected in June 2020—except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 vs. projected of 52.07 (47.84-56.68); observed ED visit rate of 92.55 vs. projected of 134.72 (124.89-145.33). ACSC outpatient visit rates decreased initially (observed rate of 4,299.57 vs. projected of 5,060.23 [4,712.64-5,433.46]) and then returned to expected in June 2020. Reductions in outpatient visits for ACSCs at the beginning of the pandemic combined with reduced hospital admissions may have been associated with temporally increased mortality—disproportionately experienced by immigrants and those with mental health conditions. The Ottawa Hospital Academic Medical Organization

Keywords: COVID-19, chronic disease, all-cause mortality, hospitalizations, emergency department visits, outpatient visits, modelling, population-based study, asthma, COPD, angina, heart failure, hypertension, diabetes, epilepsy

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Authors: Julio Jesus Salazar, Julio Jesus De Lama

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the fundamental objective of hydrological studies applied to the engineering field is to determine the statistically consistent volumes or water flows that, in each case, allow us to size or design a series of elements or structures to effectively manage and develop a river basin. To determine these values, there are several ways of working within the framework of traditional hydrology: (1) Study each of the factors that influence the hydrological cycle, (2) Study the historical behavior of the hydrology of the area, (3) Study the historical behavior of hydrologically similar zones, and (4) Other studies (rain simulators or experimental basins). Of course, this range of studies in a certain basin is very varied and complex and presents the difficulty of collecting the data in real time. In this complex space, the study of variables can only be overcome by collecting and transmitting data to decision centers through the Internet of things and artificial intelligence. Thus, this research work implemented the learning project of the sub-basin of the Shullcas river in the Andean basin of the Mantaro river in Peru. The sensor firmware to collect and communicate hydrological parameter data was programmed and tested in similar basins of the European Union. The Machine Learning applications was programmed to choose the algorithms that direct the best solution to the determination of the rainfall-runoff relationship captured in the different polygons of the sub-basin. Tests were carried out in the mountains of Europe, and in the sub-basins of the Shullcas river (Huancayo) and the Yauli river (Jauja) with heights close to 5000 m.a.s.l., giving the following conclusions: to guarantee a correct communication, the distance between devices should not pass the 15 km. It is advisable to minimize the energy consumption of the devices and avoid collisions between packages, the distances oscillate between 5 and 10 km, in this way the transmission power can be reduced and a higher bitrate can be used. In case the communication elements of the devices of the network (internet of things) installed in the basin do not have good visibility between them, the distance should be reduced to the range of 1-3 km. The energy efficiency of the Atmel microcontrollers present in Arduino is not adequate to meet the requirements of system autonomy. To increase the autonomy of the system, it is recommended to use low consumption systems, such as the Ashton Raggatt McDougall or ARM Cortex L (Ultra Low Power) microcontrollers or even the Cortex M; and high-performance direct current (DC) to direct current (DC) converters. The Machine Learning System has initiated the learning of the Shullcas system to generate the best hydrology of the sub-basin. This will improve as machine learning and the data entered in the big data coincide every second. This will provide services to each of the applications of the complex system to return the best data of determined flows.

Keywords: hydrology, internet of things, machine learning, river basin

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Authors: Abdullah Mohammadi

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Years of prolong war in Afghanistan has led to one of the largest refugee and migrant populations in the contemporary world. During this continuous unrest which began in 1970s (by military coup, Marxist revolution and the subsequent invasion of USSR), over one-third of the population migrated to neighboring countries, especially Pakistan and Iran. After the Soviet Army withdrawal in 1989, a new wave of conflicts emerged between rival Afghan groups and this led to new refugees. Taliban period, also, created its own refugees. During all these years, I.R. of Iran has been one of the main destinations of Afghan refugees and migrants. At first, due to the political situation after Islamic Revolution, Iran government didn’t restrict the entry of Afghan refugees. Those who came first in Iran received ID cards and had access to education and healthcare services. But in 1990s, due to economic and social concerns, Iran’s policy towards Afghan refugees and migrants changed. The government has tried to identify and register Afghans in Iran and limit their access to some services and jobs. Unfortunately, there are few studies on Afghan refugees and migrants’ situation in Iran and we have a dim and vague picture of them. Of the few studies done on this group, none of them focus on the illegal Afghan migrants’ situation in Iran. Here, we tried to study the social and economic aspects of illegal Afghan migrants’ living in Iran. In doing so, we interviewed 24 illegal Afghan migrants in Iran. The method applied for analyzing the data is thematic analysis. For the interviews, we chose family heads (17 men and 7 women). According to the findings, illegal Afghan migrants’ socio-economic situation in Iran is very undesirable. Its main cause is the marginalization of this group which is resulted from government policies towards Afghan migrants. Most of the illegal Afghan migrants work in unskilled and inferior jobs and live in rent houses on the margins of cities and villages. None of them could buy a house or vehicle due to law. Based on their income, they form one of the lowest, unprivileged groups in the society. Socially, they face many problems in their everyday life: social insecurity, harassment and violence, misuse of their situation by police and people, lack of education opportunity, etc. In general, we may conclude that illegal Afghan migrant have little adaptation with Iran’s society. They face severe limitations compared to legal migrants and refugees and have no opportunity for upward social mobility. However, they have managed some strategies to face these difficulties including: seeking financial and emotional helps from family and friendship networks, sending one of the family members to third country (mostly to European countries), establishing self-administered schools for children (schools which are illegal and run by Afghan educated youth).

Keywords: illegal Afghan migrants, marginalization, social insecurity, upward social mobility

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Authors: Mariyan Tomov

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Bulgarian working class immigrants are increasingly concerned with UK’s recent immigration policies in the context of Brexit. The new ID system would exclude many people currently working in Britain and would break the usual immigrant travel patterns. Post-Brexit Britain would aim to repeal seasonal immigrants. Measures for keeping long-term and life-long immigrants have been implemented and migrants that aim to remain in Britain and establish a household there would be more privileged than temporary or seasonal workers. The results of such regulating mechanisms come at the expense of migrants’ longings for a ‘normal’ existence, especially for those coming from Central and Eastern Europe. Based on in-depth interviews with Bulgarian working class immigrants, the study found out that their major concerns following the decision of the UK to leave the EU are related with the freedom to travel, reside and work in the UK. Furthermore, many of the interviewed women are concerned that they could lose some of the EU's fundamental rights, such as maternity and protection of pregnant women from unlawful dismissal. The soar of commodity prices and university fees and the limited access to public services, healthcare and social benefits in the UK, are also subject to discussion in the paper. The most serious problem, according to the interview, is that the attitude towards Bulgarians and other immigrants in the UK is deteriorating. Both traditional and social media in the UK often portray the migrants negatively by claiming that they take British job positions while simultaneously abuse the welfare system. As a result, the Bulgarian migrants often face social exclusion, which might have negative influence on their health and welfare. In this sense, some of the interviewed stress on the fact that the most important changes after Brexit must take place in British society itself. The aim of the proposed study is to provide a better understanding of the Bulgarian migrants’ economic, health and sociocultural experience in the context of Brexit. Methodologically, the proposed paper leans on: 1. Analysing ethnographic materials dedicated to the pre- and post-migratory experiences of Bulgarian working class migrants, using SPSS. 2. Semi-structured interviews are conducted with more than 50 Bulgarian working class migrants [N > 50] in the UK, between 18 and 65 years. The communication with the interviewees was possible via Viber/Skype or face-to-face interaction. 3. The analysis is guided by theoretical frameworks. The paper has been developed within the framework of the research projects of the National Scientific Fund of Bulgaria: DCOST 01/25-20.02.2017 supporting COST Action CA16111 ‘International Ethnic and Immigrant Minorities Survey Data Network’.

Keywords: Bulgarian migrants in UK, economic experiences, sociocultural experiences, Brexit

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Authors: Magdalena Hasplova, Katerina Ivanova

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Perinatal palliative care is a relatively young and developing field that includes the care of a fetus or newborn with a life-threatening or limiting defect and his family. However, the training of midwives in perinatal palliative care is insufficient and midwives do not feel prepared for this aspect of their work. This fact can affect the barriers to communication with the mother or family of the endangered child. The main aim was to analyze the awareness of midwifery students on the issue of perinatal palliative care in the Czech Republic. Based on the analysis, draw attention to possible communication barriers that may be caused by insufficient information. The research was carried out using a qualitative method, the method of data collection was a semi-structured interview. Eleven female students took part in the research, and the respondents were selected using the Snowballing method. Some methods of grounded theory (open coding and category creation) were used to analyze the data. Based on the results of the research, questions were set in a questionnaire focused on communication barriers between mothers (family) and health care professionals in the care of newborns with life-threatening or limiting disabilities. Based on the analysis of data, categories 1 were determined. Knowledge of perinatal palliative care 2. Education 3. Practical experience 4. Readiness and concerns in the provision of perinatal palliative care 6. Supervision. The questions in the questionnaire were then derived taking into account the data obtained, and the operationalization of health literacy in the field of perinatal palliative care was performed. The analysis of the interviews revealed that the education of midwives in the Czech Republic in the issue of perinatal palliative care is not uniform. The research confirmed the insufficient knowledge and skills of midwifery students preparing to provide perinatal palliative care. Respondents reported feelings of unpreparedness in the areas of communication with a woman after perinatal loss, psychological support for a woman and her family, the care of a stillborn or dying child, or self-coping with death. The questions in the questionnaire then develop these areas. We assumed that by analyzing and interpreting the data obtained from our research, we will help to better understand the concerns and motivations of students in providing holistic perinatal palliative care. We came to the conclusion that it would be appropriate to set up a unified and comprehensive education on this issue in the Czech Republic. Healthcare professionals are in a unique position that can positively or negatively affect the intensity of perinatal loss. Already properly set up education of health professionals leads to overcoming barriers in communication between health professionals and the family, experiencing perinatal loss.

Keywords: midwife, perinatal loss, perinatal palliative care, communication, barriers, mothers, family

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Authors: Papazafeiropoulou Olga

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The purpose of this paper focuses on exploring the emergence of Greek tragedy on the American stage until the first half of the 20th century through the intellectual processes and contributions of Greek, Italian and Jewish community theatre. Drawing on a wide range of sources, we trace Greek tragedy on the American stage, exploring the intricate processes of community’s theatre identities. The announcement aims to analyze the distinct yet related efforts of first Americans to intersect with Greek tragedy, searching simultaneously for the identities of immigrants. Ultimately, ancient drama became a vehicle not only for great developments in the American theater. In 1903, the Greek actor Dionysios Taboularis arrived in America, while the immigrant stream from Greece to America brought his artistic heritage, presenting in “Hall House” of Chicago the play Return. In 1906, in New York, an amateur group presented the play The Alosi of Messolonghi, and the next year in Chicago, an attempt was noted with a dramatic romance. In the decade 1907-1917, Nikolaos Matsoukas founded and directed the “Arbe theater”, while Petros Kotopoulis formed a troupe. In 1930, one of the greatest Greek theatrical events was the arrival of Marika’s Kotopoulis. Also, members of Vrysoula’s Pantopoulos formed the “Athenian Operetta”, with a positive influence on Greek American theatre. Italian immigrant community, located in tenement “Little Italies” throughout the city, and soon amateur theatrical clubs evolved. The earliest was the “Circolo Filodrammatico Italo-Americano” in 1880. Fausto Malzone’s artistic direction paved the way for the professional Italian immigrant theatre. Immigrant audiences heard the plays of their homeland, representing a major transition for this ethnic theatre. In 1900, the community had produced the major forces that created the professional theatre. By l905, the Italian American theatre had become firmly rooted in its professional phase. Yiddish Theater was both an import and a home-grown phenomenon. In 1878, The Sorceress was brought to America by Boris Thomashefsky. Between 1890 and 1940, many Yiddish theater companies appeared in America, presenting adaptations of classical plays. Αmerica’s people's first encounter with ancient texts was mostly academic. The tracing of tragedy as a form and concept that follows the evolutionary course of domestic social, aesthetic, and political ferments according to the international trends and currents draws conclusions about the early Greek, Italian, and Jewish immigrant’s theatre in relationship to the American scene until the first half of 20th century. Presumably, community theater acquired identity by intersecting with the spiritual reception of tragedy in America.

Keywords: American, community, Greek, Italian, identities, intersection, Jewish, theatre, tragedy

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Authors: Ripudaman S. Minhas, Pardeep K. Benipal, Aisha K. Yousafzai

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Background: Children of refugee or asylum-seeking background have multiple, complex needs (e.g. trauma, mental health concerns, separation, relocation, poverty, etc.) that places them at an increased risk for developing learning problems. Families encounter challenges accessing support during resettlement, preventing children from achieving their full developmental potential. There are very few studies in literature that examine the unique parenting challenges refugee families’ face. Providing appropriate support services and educational resources that address these distinctive concerns of refugee parents, will alleviate these challenges allowing for a better developmental outcome for children. Objective: To identify the characteristics of effective parenting interventions that address the unique needs of refugee families. Methods: English-language articles published from 1997 onwards were included if they described or evaluated programmes or interventions for parents of refugee or asylum-seeking background, globally. Data were extracted and analyzed according to Arksey and O’Malley’s descriptive analysis model for scoping reviews. Results: Seven studies met criteria and were included, primarily studying families settled in high-income countries. Refugee parents identified parenting to be a major concern, citing they experienced: alienation/unwelcoming services, language barriers, and lack of familiarity with school and early years services. Services that focused on building the resilience of parents, parent education, or provided services in the family’s native language, and offered families safe spaces to promote parent-child interactions were most successful. Home-visit and family-centered programs showed particular success, minimizing barriers such as transportation and inflexible work schedules, while allowing caregivers to receive feedback from facilitators. The vast majority of studies evaluated programs implementing existing curricula and frameworks. Interventions were designed in a prescriptive manner, without direct participation by family members and not directly addressing accessibility barriers. The studies also did not employ evaluation measures of parenting practices or the caregiving environment, or child development outcomes, primarily focusing on parental perceptions. Conclusion: There is scarce literature describing parenting interventions for refugee families. Successful interventions focused on building parenting resilience and capacity in their native language. To date, there are no studies that employ a participatory approach to program design to tailor content or accessibility, and few that employ parenting, developmental, behavioural, or environmental outcome measures.

Keywords: asylum-seekers, developmental pediatrics, parenting interventions, refugee families

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Authors: Benedict Ofori, Kwabena Sarpong, Stephen Antwi

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Background: Medicinal plants are utilized all around the world and are becoming increasingly important economically. The WHO notes that ‘inappropriate use of traditional medicines or practices can have negative or dangerous effects and that future research is needed to ascertain the efficacy and safety of such practices and medicinal plants used by traditional medicine systems. The poor around the world have limited access to palliative care or pain relief. Pharmacologists have been focused on developing safe and effective anti-inflammatory drugs. Most of the issues related to their use have been linked to the fact that numerous traditional and herbal treatments are classified in different nations as meals or dietary supplements. As a result, there is no need for evidence of the quality, efficacy, or safety of these herbal formulations before they are marketed. The fact that access to drugs meant for pain relief is limited in low-income countries means advanced studies should be done on home drugs meant for inflammation to close the gap. Methods: The ethanolic extracts of the plant were screened for the presence of 10 phytochemicals. The Pierce BCA Protein Assay Kit was used for the determination of the protein concentration of the egg white. The rats were randomly selected and put in 6 groups. The egg white was sub-plantar injected into the right-hand paws of the rats to induce inflammation. The animals were treated with the three plant extracts obtained from the root bark, stem, and leaves of the plant. The control groups were treated with normal saline, while the standard groups were treated with standard drugs indomethacin and celecoxib. Plethysmometer was used to measure the change in paw volume of the animals over the course of the experiment. Results: The results of the phytochemical screening revealed the presence of reducing sugars and saponins. Alkaloids were present in only R.L.S (1:1:1), and phytosterols were found in R.L(1:1) and R.L.S (1:1:1). The estimated protein concentration was found to be 103.75 mg/ml. The control group had an observable increase in paw volume, which indicated that inflammation was induced during the 5 hours. The increase in paw volume for the control group peaked at the 1st hour and decreased gradually throughout the experiment, with minimal changes in the paw volumes. The 2nd and 3rd groups were treated with 20 mg/kg of indomethacin and celecoxib. The anti-inflammatory activities of indomethacin and celecoxib were calculated to be 21.4% and 4.28%, respectively. The remaining 3 groups were treated with 2 dose levels of 200mg/kg plant extracts. R.L.S, R.L, and S.R.L had anti-inflammatory activities of 22.3%, 8.2%, and 12.07%, respectively. Conclusions: Egg albumin-induced paw model in rats can be used to evaluate the anti-inflammatory activity of herbs that might have potential anti-inflammatory activity. Herbal medications have potential anti-inflammatory activities and can be used to manage various inflammatory conditions if their efficacy and side effects are well studied. The three extracts all possessed anti-inflammatory activity, with R.L.S having the highest anti-inflammatory activity.

Keywords: inflammation, capparis erythrocarpos, anti-inflammatory activity, herbal medicine, paw volume, egg albumin

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Authors: Federica Marangio

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This study looks at the triangle of knowledge: research-education-innovation as growth engine of an inclusive and sustainable society, where the research is the strategic process which allows the acquisition of knowledge, innovation appraises the knowledge acquired and the education is the enabling factor of the human capital to create entrepreneurial capital. Where does Italy and China stand in the global geography of innovation? Europe is calling on a smart, inclusive and sustainable growth through a specializing process that looks at the social and economic challenges, able to understand the characteristics of specific geographic areas. It is easily questionable why it is not as simple as it looks to come up with entrepreneurial ideas in all the geographic areas. Seen that the technology plus the human capital should be the means through which is possible to innovate and contribute to the boost of innovation culture, then the young educated people can be seen as the society changing agents and it becomes clear the importance of investigating the skills and competencies that lead to innovation. By starting innovation-based activities, other countries on an international level, are able now to be part of an healthy innovative ecosystem which is the result of a strong growth policy which enables innovation. Analyzing the geography of the innovation on a global scale, comes to light that the innovative entrepreneurship is the process which portrays the competitiveness of the regions in the knowledge-based economy as strategic process able to match intellectual capital and market opportunities. The level of innovative entrepreneurship is not only the result of the endogenous growth ability of the enterprises, but also by significant relations with other enterprises, universities, other centers of education and institutions. To obtain more innovative entrepreneurship is necessary to stimulate more synergy between all these territory actors in order to create, access and value existing and new knowledge ready to be disseminate. This study focuses on individual’s lived experience and the researcher believed that she can’t understand the human actions without understanding the meaning that they attribute to their thoughts, feelings, beliefs and so given she needed to understand the deeper perspectives captured through face-to face interaction. A case study approach will contribute to the betterment of knowledge in this field. This case study will represent a picture of the innovative ecosystem and the entrepreneurial mindset as a key ingredient of endogenous growth and a must for sustainable local and regional development and social cohesion. The case study will be realized analyzing two Chinese companies. A structured set of questions will be asked in order to gain details on what generated success or failure in the different situations with the past and at the moment of the research. Everything will be recorded not to lose important information during the transcription phase. While this work is not geared toward testing a priori hypotheses, it is nevertheless useful to examine whether the projects undertaken by the companies, were stimulated by enabling factors that, as result, enhanced or hampered the local innovation culture.

Keywords: Entrepreneurship, education, geography of innovation, education.

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Authors: Desjardin, Michaels, Martinez, Ulmann

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Copper IUD is one of the most efficient and cost-effective contraception. However, pain at insertion hampers the use of this method. This is especially unfortunate in nulliparous women, often younger, who are excellent candidates for this contraception, including Emergency Contraception. Standard insertion procedure of a copper IUD usually involves measurement of uterine cavity with an hysterometer and the use of a tenaculum in order to facilitate device insertion. Both procedures lead to patient pain which often constitutes a limitation of the method. To overcome these issues, we have developed a modified insertor combined with a copper IUD. The singular design of the inserter includes a flexible inflatable membrane technology allowing an easy access to the uterine cavity even in case of abnormal uterine positions or narrow cervical canal. Moreover, this inserter makes possible a direct IUD insertion with no hysterometry and no need for tenaculum. To assess device effectiveness and patient-reported pain, a study was conducted at two clinics in Fance with 31 individuals who wanted to use a copper IUD as contraceptive method. IUD insertions have been performed by four healthcare providers. Operators completed questionnaire and evaluated effectiveness of the procedure (including IUD correct fundal placement and other usability questions) as their satisfaction. Patient also completed questionnaire and pain during procedure was measured on a 10-cm Visual Analogue Scale (VAS). Analysis of the questionnaires indicates that correct IUD placement took place in more than 93% of women, which is a standard efficacy rate. It also demonstrates that IUD insertion resulted in no, light or moderate pain predominantly in nulliparous women. No insertion resulted in severe pain (none above 6cm on a 10-cm VAS). This translated by a high level of satisfaction from both patients and practitioners. In addition, this modified inserter allowed a simplification of the insertion procedure: correct fundal placement was ensured with no need for hysterometry (100%) prior to insertion nor for cervical tenaculum to pull on the cervix (90%). Avoidance of both procedures contributed to the decrease in pain during insertion. Taken together, the results of the study demonstrate that this device constitutes a significant advance in the use of copper IUDs for any woman. It allows a simplification of the insertion procedure: there is no need for pre-insertion hysterometry and no need for traction on the cervix with tenaculum. Increased comfort during insertion should allow a wider use of the method for nulliparous women and for emergency contraception. In addition, pain is often underestimated by practitioners, but fear of pain is obviously one of the blocking factors as indicated by the analysis of the questionnaire. This evaluation brings interesting information on the use of this modified inserter for standard copper IUD and promising perspectives to set up a changement in the standard of IUD insertion procedure.

Keywords: contraceptio, IUD, innovation, pain

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Authors: Ezekiel Olukayode Akintunde

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There is a high level of inadequate methods at all levels of food supply in the global food industry. The inadequacies have led to vast wastages of food. Hence there is a need to curb the wastages that can later affect natural resources, water resources, and energy to avoid negative impacts on the climate and the environment. There is a need to engage multifaceted engineering packaging approaches for a sustainable food chain to ensure active packaging, intelligent packaging, new packaging materials, and a sustainable packaging system. Packaging can be regarded as an indispensable component approach that can be applied to solve major problems of sustainable food consumption globally; this is about controlling the environmental impact of packed food. The creative innovation will ensure that packaged foods are free from food-borne diseases and food chemical pollution. This paper evaluates the key shortcomings that must be addressed by innovative food packaging to ensure a safe, natural environment that will preserve energy and sustain water resources. Certain solutions, including fabricating microbial biodegradable chemical compounds/polymers from agro-food waste remnants, appear a bright path to ensure a strong and innovative waste-based food packaging system. Over the years, depletion in the petroleum reserves has brought about the emergence of biodegradable polymers as a proper replacement for traditional plastics; moreover, the increase in the production of traditional plastics has raised serious concerns about environmental threats. Biodegradable polymers have proven to be biocompatible, which can also be processed for other useful applications. Therefore, this study will showcase a workable guiding framework for designing a sustainable food packaging system that will not constitute a danger to our present society and that will surely preserve natural water resources. Various assessment methods will be deployed at different stages of the packaging design to enhance the package's sustainability. Every decision that will be made must be facilitated with methods that will be engaged per stage to allow for corrective measures throughout the cycle of the design process. Basic performance appraisal of packaging innovations. Food wastage can result in inimical environmental impacts, and ethical practices must be carried out for food loss at home. An examination in West Africa quantified preventable food wastage over the entire food value chain at almost 180kg per person per year. That is preventable food wastage, 35% of which originated at the household level. Many food losses reported, which happened at the harvesting, storage, transportation, and processing stages, are not preventable and are without much environmental impact because such wastage can be used for feeding. Other surveys have shown that 15%-20% of household food losses can be traced to food packaging. Therefore, new innovative packaging systems can lessen the environmental effect of food wastage to extend shelf‐life to lower food loss in the process distribution chain and at the household level.

Keywords: food packaging, biodegradable polymer, intelligent packaging, shelf-life

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Authors: Rosemary Saunders, Courtney Glass, Karla Seaman, Karen Gullick, Julie Andrew, Anne Wilkinson, Ashwini Davray

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Current literature demonstrates that most Australians receive end-of-life care in a hospital setting, despite most hoping to die within their own home. The necessity for high quality end-of-life care has been emphasised by the Australian Commission on Safety and Quality in Health Care and the National Safety and Quality in Health Services Standards depict the requirement for comprehensive care at the end of life (Action 5.20), reinforcing the obligation for continual organisational assessment to determine if these standards are suitably achieved. Limited research exploring clinical staff perspectives of end-of-life care delivery has been conducted within an Australian private health context. This study aimed to investigate clinical staff member perceptions of end-of-life care delivery at a private hospital in Western Australia. The study comprised of a multi-faceted mixed-methods methodology, part of a larger study. Data was obtained from clinical staff utilising surveys and focus groups. A total of 133 questionnaires were completed by clinical staff, including registered nurses (61.4%), enrolled nurses (22.7%), allied health professionals (9.9%), non-palliative care consultants (3.8%) and junior doctors (2.2%). A total of 14.7% of respondents were palliative care ward staff members. Additionally, seven staff focus groups were conducted with physicians (n=3), nurses (n=26) and allied health professionals including social workers (n=1), dietitians (n=2), physiotherapists (n=5) and speech pathologists (n=3). Key findings from the surveys highlighted that the majority of staff agreed it was part of their role to talk to doctors about the care of patients who they thought may be dying, and recognised the importance of communication, appropriate training and support for clinical staff to provide quality end-of-life care. Thematic analysis of the qualitative data generated three key themes: creating the setting which highlighted the importance of adequate resourcing and conducive physical environments for end-of-life care and to support staff and families; planning and care delivery which emphasised the necessity for collaboration between staff, families and patients to develop care plans and treatment directives; and collaborating in end-of-life care, with effective communication and teamwork leading to achievable care delivery expectations. These findings contribute to health professionals better understanding of end-of-life care provision and the importance of collaborating with patients and families in care delivery. It is crucial that health care providers implement strategies to overcome gaps in care, so quality end-of-life care is provided. Findings from this study have been translated into practice, with the development and implementation of resources, training opportunities, support networks and guidelines for the delivery of quality end-of-life care.

Keywords: clinical staff, end-of-life care, mixed-methods, private hospital.

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Authors: Irene Kretchy, Frances Owusu-Daaku, Samuel Danquah

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Hypertension is the leading risk factor for cardiovascular diseases, and a major cause of death and disability worldwide. This study examined whether psychosocial variables influenced patients’ perception and experience of side effects of their medicines, how they coped with these experiences and the impact on mental health and medication adherence to conventional hypertension therapies. Methods: A hospital-based mixed methods study, using quantitative and qualitative approaches was conducted on hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms, and coping mechanisms with the aid of standard questionnaires. Information from the quantitative phase was analyzed with the Statistical Package for Social Sciences (SPSS) version 20. The interviews from the qualitative study were audio-taped with a digital audio recorder, manually transcribed and analyzed using thematic content analysis. The themes originated from participant interviews a posteriori. Results: The experiences of side effects – such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion - were categorized as no/low (39.75%), moderate (53.0%) and high (7.25%). Significant relationships between depression (x 2 = 24.21, P < 0.0001), anxiety (x 2 = 42.33, P < 0.0001), stress (x 2 = 39.73, P < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association are reported – depression [OR = 1.9 (1.03 – 3.57), p = 0.04], anxiety [OR = 1.5 (1.22 – 1.77), p = < 0.001], and stress [OR = 1.3 (1.02 – 1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95% CI 1.07 – 1.85), p = 0.04] with social factors, media influences and attitudes of primary caregivers further explaining this relationship. The personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments, and interventions made by clinicians were the main forms of coping with side effects. Conclusions: Results from this study show that contrary to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The result offers more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care. Additionally, medication side effects should be considered as a possible cause of non-adherence among hypertensive patients, thus addressing this problem from a Biopsychosocial perspective in any intervention may improve adherence and invariably control blood pressure.

Keywords: biopsychosocial, hypertension, medication adherence, psychological disorders

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Authors: Elidrissi Laila, El Rhaoussi Fatima-Zahra, Haddad Fouad, Tahiri Mohamed, Hliwa Wafaa, Bellabah Ahmed, Badre Wafaa

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Introduction: Metabolic Dysfunction Associated with Non-Alcoholic Fatty Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), is the leading cause of chronic liver disease. The cardiometabolic risk factors associated with MASLD represent common health issues and significant public health challenges. Medical students, being active participants in the healthcare system and a young demographic, are particularly relevant for understanding this entity to prevent its occurrence on a personal and collective level. The objective of our study is to assess the level of knowledge among medical students regarding MASLD, its risk factors, and its long-term consequences. Materials and Methods: We conducted a descriptive cross-sectional study using an anonymous questionnaire distributed through social media over a period of 2 weeks. Medical students from various faculties in Morocco answered 22 questions about MASLD, its etiological factors, diagnosis, complications, and principles of treatment. All responses were analyzed using the Jamovi software. Results: A total of 124 students voluntarily provided complete responses. 59% of our participants were in their 3rd year, with a median age of 21 years. Among the respondents, 27% were overweight, obese, or diabetic. 83% correctly answered more than half of the questions, and 77% believed they knew about MASLD. However, 84% of students were unaware that MASLD is the leading cause of chronic liver disease, and 12% even considered it a rare condition. Regarding etiological factors, overweight and obesity were mentioned in 93% of responses, and type 2 diabetes in 84%. 62% of participants believed that type 1 diabetes could not be implicated in MASLD. For 83 students, MASLD was considered a diagnosis of exclusion, while 41 students believed that a biopsy was mandatory for diagnosis. 12% believed that MASLD did not lead to long-term complications, and 44% were unaware that MASLD could progress to hepatocellular carcinoma. Regarding treatment, 85% included weight loss, and 19% did not consider diabetes management as a therapeutic approach for MASLD. At the end of the questionnaire, 89% of the students expressed a desire to learn more about MASLD and were invited to access an informative sheet through a hyperlink. Conclusion: MASLD represents a significant public health concern due to the prevalence of its risk factors, notably the obesity pandemic, which is widespread among the young population. There is a need for awareness about the seriousness of this emerging and long-underestimated condition among young future physicians.

Keywords: MASLD, medical students, obesity, diabetes

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Authors: Ashima Sharma, Tapan K. Chaudhuri

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Human Serum Albumin (HSA) is one of the most demanded therapeutic protein with immense biotechnological applications. The current source of HSA is human blood plasma. Blood is a limited and an unsafe source as it possesses the risk of contamination by various blood derived pathogens. This issue led to exploitation of various hosts with the aim to obtain an alternative source for the production of the rHSA. But, till now no host has been proven to be effective commercially for rHSA production because of their respective limitations. Thus, there exists an indispensable need to promote non-animal derived rHSA production. Of all the host systems, Escherichia coli is one of the most convenient hosts which has contributed in the production of more than 30% of the FDA approved recombinant pharmaceuticals. E. coli grows rapidly and its culture reaches high cell density using inexpensive and simple substrates. The fermentation batch turnaround number for E. coli culture is 300 per year, which is far greater than any of the host systems available. Therefore, E. coli derived recombinant products have more economical potential as fermentation processes are cheaper compared to the other expression hosts available. Despite of all the mentioned advantages, E. coli had not been successfully adopted as a host for rHSA production. The major bottleneck in exploiting E. coli as a host for rHSA production was aggregation i.e. majority of the expressed recombinant protein was forming inclusion bodies (more than 90% of the total expressed rHSA) in the E. coli cytosol. Recovery of functional rHSA form inclusion body is not preferred because it is tedious, time consuming, laborious and expensive. Because of this limitation, E. coli host system was neglected for rHSA production for last few decades. Considering the advantages of E. coli as a host, the present work has targeted E. coli as an alternate host for rHSA production through resolving the major issue of inclusion body formation associated with it. In the present study, we have developed a novel and innovative method for enhanced soluble and functional production of rHSA in E.coli (~60% of the total expressed rHSA in the soluble fraction) through modulation of the cellular growth, folding and environmental parameters, thereby leading to significantly improved and enhanced -expression levels as well as the functional and soluble proportion of the total expressed rHSA in the cytosolic fraction of the host. Therefore, in the present case we have filled in the gap in the literature, by exploiting the most well studied host system Escherichia coli which is of low cost, fast growing, scalable and ‘yet neglected’, for the enhancement of functional production of HSA- one of the most crucial biomolecule for clinical and biotechnological applications.

Keywords: enhanced functional production of rHSA in E. coli, recombinant human serum albumin, recombinant protein expression, recombinant protein processing

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Authors: Syue-Wen Lin

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Objective: This article discusses the nursing experience of caring for a uterine cancer patient who experienced cardiogenic shock and was weaned off ECMO. The patient was placed on ECMO due to cardiogenic shock and initially struggled with anxiety caused by the physical discomfort from the disease and multiple medical devices, as well as the isolation in the ICU and restrictions on physical activity. Over time, the patient was able to wean off ECMO and perform daily activities and rehabilitation independently. Methods: The nursing period was from January 6 to January 9. Through observation, direct care, interviews, physical assessments, and case reviews, the intensive care team and bypass personnel conducted a comprehensive assessment using Gordon's 11 functional health patterns. The assessment identified three main nursing health problems: pain, anxiety, and decreased cardiac tissue perfusion. Results: The author consulted a psychologist to employ open communication techniques and empathetic care to build a trusting nurse-patient relationship. A patient-centered intensive cancer care plan was developed. Pain was assessed using a pain scale, and pain medications were adjusted in consultation with a pharmacist. Lavender essential oil therapy, light music, and pillows were used to distract and alleviate pain. The patient was encouraged to express feelings and family members were invited to increase visits and provide companionship to reduce the uncertainty caused by cancer and illness. Vital signs were closely monitored, and nursing interventions were provided to maintain adequate myocardial perfusion. Post-ECMO, the patient was encouraged to engage in rehabilitation and cardiopulmonary training. Conclusion: A key takeaway from the care process is the importance of observing not only the patient's vital signs but also their psychological state, especially when dealing with cancer patients on ECMO. The patient's greatest source of comfort was the presence of family, which helped alleviate anxiety. Healthcare providers play multiple critical roles as advocates, coordinators, educators, and counselors, listening to and accepting the patient’s emotional responses. The report aims to provide clinical cancer nurses with a reference to improve the quality of care and alleviate cancer-related discomfort.

Keywords: ECMO, uterine cancer, palliative care, Gordon's 11 functional health patterns

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Authors: Gideon Abagna Azunre

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Informal urbanism is perhaps the most ubiquitous urban phenomenon in sub-Saharan Africa (SSA) and Ghana specifically. Estimates suggest that about two-fifths of urban dwellers (37.9%) in Ghana live in informal settlements, while two-thirds of the working labour force are within the informal economy. This makes Ghana invariably an ‘informal country.’ Informal urbanism involves economic and housing activities that are – in law or in practice – not covered (or insufficiently covered) by formal regulations. Many urban folks rely on informal urbanism as a survival strategy due to limited formal waged employment opportunities or rising home prices in the open market. In an era of globalizing neoliberalism, this struggle to survive in cities resonates with several people globally. For years now, there have been intense debates on the utility of informal urbanism – both its economic and housing dimensions – in developing sustainable cities. While some scholars believe that informal urbanism is beneficial to the sustainable city development agenda, others argue that it generates unbearable negative consequences and it symbolizes lawlessness and squalor. Consequently, the main aim of this research was to dig below the surface of the narratives to locate the role of informal urbanism in the quest for sustainable cities. The research geographically focused on Ghana and its burgeoning informal sector. Also, both primary and secondary data were utilized for the analysis; Secondary data entailed a synthesis of the fragmented literature on informal urbanism in Ghana, while primary data entailed interviews with informal stakeholders (such as informal settlement dwellers), city authorities, and planners. These two data sets were weaved together to discover the nexus between informal urbanism and the tripartite dimensions of sustainable cities – economic, social, and environmental. The results from the research showed a two-pronged relationship between informal urbanism and the three dimensions of sustainable city development. In other words, informal urbanism was identified to both positively and negatively affect the drive for sustainable cities. On the one hand, it provides employment (particularly to women), supplies households’ basic needs (shelter, health, water, and waste management), and enhances civic engagement. However, on the other hand, it perpetuates social and gender inequalities, insecurity, congestion, and pollution. The research revealed that a ‘black and white’ interpretation and policy approach is incapable of capturing the complexities of informal urbanism. Therefore, trying to eradicate or remove it from the urbanscape because it exhibits some negative consequences means cities will lose their positive contributions. The inverse also holds true. A careful balancing act is necessary to maximize the benefits and minimize the costs. Overall, the research presented a de-colonial theorization of informal urbanism and thus followed post-colonial scholars’ clarion call to African cities to embrace the paradox of informality and find ways to integrate it into the city-building process.

Keywords: informal urbanism, sustainable city development, economic sustainability, social sustainability, environmental sustainability, Ghana

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Authors: Md. S. Sabuz

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Bangladesh, a South Asian developing country, has achieved a remarkable breakthrough in health indicators during the last four decades despite immense income inequality. This phenomenon results in the mystical exclusion of marginalized people from obtaining health care facilities. However, the persistence of exclusion of the disadvantaged remains troubling. Exclusion occurs from occupational inferiority, pay and wage differences, educational backwardness, gender disparity to urban-rural complexity and eliminate the unprivileged from seeking and availing the health services. Evidence from Bangladesh shows that many sick people prefer to die at home without securing medical services because in previous times they were not treated well, not because the medical facilities were inadequate or antediluvian but the socio-economic class allows them to receive obdurate treatment. Furthermore, government and policymakers have given enormous emphasis on infrastructural development and achieving health indicators instead of ensuring quality services and inclusiveness of people from all spheres. Therefore, it is high time to address the issues concerning this and highlight the impact of economic status on health status in a sociological perspective. The objective of this study is to consider ways of assessing and exploring the impact of economic status for instance: occupational status, pay and wage variable, on health status in the context of Bangladesh. The hypotheses are that there are a significant number of factors affecting economic status which are impactful for health status eventually, but acute income inequality is a prominent factor. Illiteracy, gender disparity, remoteness, incredibility on services, superior costs, superstition etc. are the dominant indicators behind the economic factors influencing the health status. The chosen methodologies are a qualitative and quantitative approaches to accomplish the research objectives. Secondary sources of data will be used to conduct the study. Surveys will be conducted on the people who have ever been through the health care facilities and people from the different socio-economic and cultural backgrounds. Focus group discussions will be conducted to acquire the data from different cultural and regional citizens. The findings show that 48% of people who are from disadvantaged communities have been deprived of proper health care facilities. The general reasons behind this are the higher cost of medicines and other equipment. A significant number of people are unaware of the appropriate facilities. It was found that the socio-economic variables are the main influential factors that work as the driving force for both economic dimension and health status. Above all regional variables and gender, dimensions have an enormous effect on determining the health status of an individual or community. Amidst many positive achievements for example decrease in the child mortality rate, an increase in the immunization programs of the child etc., the inclusiveness of all classes of people in health care facilities has been overshadowed in Bangladesh. However, this phenomenon along with the socio-economic and cultural phenomena significantly demolishes the quality and inclusiveness of the health status of people.

Keywords: cultural context of health, economic status, gender and health, rural health care

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Authors: Deanne McArthur, Melinda Wall, Claire Hanlon, Dana Agnolin, Krista Davis, Melanie Dennis, Elizabeth Glidden, Anne Marie Smith, Claudette Thomson

Abstract:

Background and significance: Patients with eating disorders have traditionally been an underserviced population within the publicly-funded Canadian healthcare system. This situation was worsened by the COVID-19 pandemic and accompanying public health measures, such as “lockdowns” which led to increased isolation, changes in routine, and other disruptions. Illness severity and prevalence rose significantly with corresponding increases in patient suffering and poor outcomes. In Ontario, Canada, the provincial government responded by increasing funding for the treatment of eating disorders, including the launch of a new day program at an intermediate, regional health centre that already housed an outpatient treatment service. The funding was received in March 2022. The care team sought to optimize this opportunity by designing a program that would fit well within the resource-constrained context in Ontario. Methods: This case study will detail how the team consulted the literature and sought patient and family input to design a program that optimizes patient outcomes and supports for patients and families while they await treatment. Early steps include a review of the literature, expert consultation and patient and family focus groups. Interprofessional consensus was sought at each step with the team adopting a shared leadership and patient-centered approach. Methods will include interviews, observations and document reviews to detail a rich description of the process undertaken to design the program, including evaluation measures adopted. Interim findings pertaining to the early stages of the program-building process will be detailed as well as early lessons and ongoing evolution of the program and design process. Program implementation and outcome evaluation will continue throughout 2022 and early 2023 with further publication and presentation of study results expected in the summer of 2023. The aim of this study is to contribute to the body of knowledge pertaining to the design and implementation of eating disorder treatment services that combine outpatient and day treatment services in a resource-constrained context.

Keywords: eating disorders, day program, interprofessional, outpatient, adolescents, transitional aged youth

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