Search results for: indicators of care quality

Authors: Seon-Young Lee, Harkiran Sagoo, Katherine Whitehurst, Georgina Wellstead, Alexander Fowler, Riaz Agha, Dennis Orgill

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Introduction: Systematic reviews attempt to answer research questions by synthesising the data within primary papers. They are an increasingly important tool within evidence-based medicine, guiding clinical practice, future research and healthcare policy. We sought to determine the reporting quality of recent systematic reviews in plastic surgery. Methods: This systematic review was conducted in line with the Cochrane handbook, reported in line with the PRISMA statement and registered at the ResearchRegistry (UIN: reviewregistry18). MEDLINE and EMBASE databases were searched in 2013 and 2014 for systematic reviews by five major plastic surgery journals. Screening, identification and data extraction was performed independently by two teams. Results: From an initial set of 163 articles, 79 met the inclusion criteria. The median PRISMA score was 16 out of 27 items (59.3%; range 6-26, 95% CI 14-17). Compliance between individual PRISMA items showed high variability. It was poorest for items related to the use of review protocol (item 5; 5%) and presentation of data on risk of bias of each study (item 19; 18%), while being the highest for description of rationale (item 3; 99%) and sources of funding and other support (item 27; 95%), and for structured summary in the abstract (item 2; 95%). Conclusion: The reporting quality of systematic reviews in plastic surgery requires improvement. ‘Hard-wiring’ of compliance through journal submission systems, as well as improved education, awareness and a cohesive strategy among all stakeholders is called for.

Keywords: PRISMA, reporting quality, plastic surgery, systematic review, meta-analysis

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Authors: Olor Obi, Ishiekwen Bridget, Ekpeyong Edom

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Even though gout is becoming more common, the role of dietary risk factors in the development and management of this condition remains unclear. Therefore, this review work will aim at clarifying the role of dietary factors in the risk and management of gout. An extensive search of literature published between 1960 and 2018 will be performed on the databases of PubMed, CINAHL, Science Direct, Cochrane, BMJ, Ann Rheum Dis, and BioMed to identify relevant cohort, prospective, population-based, or cross-sectional studies that examined the effect of diet on gout. About 19 studies will be included in this review work. The methodological quality of these studies will be evaluated using the quality assessment tool for observational and cross-sectional studies developed by the National Heart, Lungs, and Blood Institute. This work intends to reveal that a positive association exists between the intake of sugary, sweetened beverages and the risk of gout. It will also reveal the relationship between the increase in coffee consumption and the risk of gout.

Keywords: gout, dietary factors, management of gout, gouty arthritis

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Authors: Robert E. Kenney, Richard B. Aguilar, Efrain Antunez, Gregory Schor-Haskin, Rafael Rey, Catie Falcon, Luis Arce

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This study sought to explore the effect of Sarapin injections on chronic knee pain (CKP). Many adults suffer from CKP which is most often attributed to osteoarthritis. Current treatment regimens for CKP involve the use NSAIDS medications, injections with steroids/analgesic, platelet rich plasma injections, or orthopedic surgical interventions. Sarapin is a commercially available homeopathic aqueous extract from the pitcher plant. Studies on the use of Sarapin as a treatment for cervical, thoracic, and lumbosacral facet joint nerve blocks have been performed with mixed results. There is little available evidence on the use of Sarapin in CKP. This study examines the effect of a series of 3 weekly injections of aqueous Sarapin in 95 elderly patients with CKP in a primary care setting. Cano Health, a primary care group, identified 95 successive patients with CKP from its multimodal physiotherapy program for chronic pain. Patients underwent evaluation by a clinician, underwent diagnostic Xrays of the knees, and the treatment plan with three weekly Sarapin injections was discussed. A pain and functional limitation survey (a modified Lower Extremity Functional Scale (mLEFS)) was administered prior to initiating treatment (Entry Survey (ES)). Each patient received an intraarticular injection of 2 cc of aqueous Sarapin with 1cc 1% lidocaine during weeks 1, 2 and 3. The mLEFS was administered again at week 4, one week after the third Sarapin injection (Exit Survey (ExS)). Demographics: Mean Age 62 +/- 9.8; 73% female; 89% Hispanic/Latino; mean time between ES and ExS was 27.5 +/-8.2 days. Survey: The mLEFS was based on a published Lower Extremity Functional Scale and each patient rated their pain or functional limitation from 0 (no difficulty) to 5 (severe difficulty) for 10 questions. Answers were summed and compared. Maximum score for severe difficulty would be 50 points. Results: Mean pain/functional scores: ES was 30.3 +/-12.1 and ExS was 19.5 +/- 12.5. This represents a relative improvement of 35.7% (P<0.00001). A total of 81% (77/95) of the patients showed improvement in symptoms at week four as assessed by the mLEFS. There were 11 patients who reported an increase in their survey scores while 7 patients reported no change. When evaluating the cohort that reported improvement, the ES was 30.9 +/-11.4 and ExS was 16.3 +/-9.8 yielding a 47.2% relative improvement (P<0.00001). Injections were well tolerated, and no adverse events were reported. Conclusions: In this cohort of 95 elderly patients with CKP, treatment with 3 weekly injections of Sarapin significantly improved pain and function as assessed by a mLEFS survey. The majority (81%) of patients responded positively to therapy, 12% had worsening symptoms and 7% reported no change. The use of intraarticular injections of Sarapin for CKP was shown to be an effective modality of treatment. Sarapin’s low cost, tolerability, and ease of use make it an attractive alternative to NSAIDS, steroids, PRP or surgical intervention for this common debilitating condition.

Keywords: Sarapin, intraarticular, chronic knee pain, osteoarthritis

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Authors: Peng Guo

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Objective: This study investigates the clinical characteristics of sleep disorders (SD) in patients with Alzheimer's disease (AD) and their relationship with cognitive impairment. Methods: According to the inclusion and exclusion criteria of AD, 460 AD patients were consecutively included in Beijing Tiantan Hospital from January 2016 to April 2022. Demographic data, including gender, age, age of onset, course of disease, years of education and body mass index, were collected. The Pittsburgh sleep quality index (PSQI) scale was used to evaluate the overall sleep status. AD patients with PSQI ≥7 was divided into AD with SD (AD-SD) group, and those with PSQI < 7 were divided into AD with no SD (AD-nSD) group. The overall cognitive function of AD patients was evaluated by the scales of Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA), memory was evaluated by the AVLT-immediate recall, AVLT-delayed recall and CFT-delayed memory scales, the language was evaluated by BNT scale, visuospatial ability was evaluated by CFT-imitation, executive function was evaluated by Stroop-A, Stroop-B and Stroop-C scales, attention was evaluated by TMT-A, TMT-B, and SDMT scales. The correlation between cognitive function and PSQI score in AD-SD group was analyzed. Results: Among the 460 AD patients, 173 cases (37.61%) had SD. There was no significant difference in gender, age, age of onset, course of disease, years of education and body mass index between AD-SD and AD-nSD groups (P>0.05). The factors with significant difference in PSQI scale between AD-SD and AD-nSD groups include sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleeping medication and daytime dysfunction (P<0.05). Compared with AD-nSD group, the total scores of MMSE, MoCA, AVLT-immediate recall and CFT-imitation scales in AD-SD group were significantly lower（P＜0.01，P＜0.01，P＜0.01，P＜0.05）. In AD-SD group, subjective sleep quality was significantly and negatively correlated with the scores of MMSE, MoCA, AVLT-immediate recall and CFT-imitation scales (r=-0.277，P=0.000; r=-0.216，P=0.004; r=-0.253，P=0.001; r=-0.239, P=0.004), daytime dysfunction was significantly and negatively correlated with the score of AVLT-immediate recall scale (r=-0.160，P=0.043). Conclusion The incidence of AD-SD is 37.61%. AD-SD patients have worse subjective sleep quality, longer time to fall asleep, shorter sleep time, lower sleep efficiency, severer nighttime SD, more use of sleep medicine, and severer daytime dysfunction. The overall cognitive function, immediate recall and visuospatial ability of AD-SD patients are significantly impaired and are closely correlated with the decline of subjective sleep quality. The impairment of immediate recall is highly correlated with daytime dysfunction in AD-SD patients.

Keywords: Alzheimer's disease, sleep disorders, cognitive impairment, correlation

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Authors: Nebojsa Stefanovic, Sasa Milijic, Natasa Danilovic Hristic

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Spatial plan of the special purpose area constitutes a basic tool in the planning of infrastructure corridor of a highway. The aim of the plan is to define the planning basis and provision of spatial conditions for the construction and operation of the highway, as well as for developing other infrastructure systems in the corridor. This paper presents a methodology and approach to the preparation of the Spatial Plan for the special purpose area for the infrastructure corridor of the highway E-80, Section Niš-Merdare in Serbia. The applied methodological approach is based on the combined application of the integrative and participatory method in the decision-making process on the sustainable development of the highway corridor. It was found that, for the planning and management of the infrastructure corridor, a key problem is coordination of spatial and urban planning, strategic environmental assessment and sectoral traffic planning and designing. Through the development of the plan, special attention is focused on increasing the accessibility of the local and regional surrounding, reducing the adverse impacts on the development of settlements and the economy, protection of natural resources, natural and cultural heritage, and the development of other infrastructure systems in the corridor of the highway. As a result of the applied methodology, this paper analyzes the basic features such as coverage, the concept, protected zones, service facilities and objects, the rules of development and construction, etc. Special emphasis is placed to methodology and results of the Strategic Environmental Assessment of the Spatial Plan, and to the importance of protection measures, with the special significance of air and noise protection measures. For evaluation in the Strategic Environmental Assessment, a multicriteria expert evaluation (semi-quantitative method) of planned solutions was used in relation to the set of goals and relevant indicators, based on the basic set of indicators of sustainable development. Evaluation of planned solutions encompassed the significance and size, spatial conditions and probability of the impact of planned solutions on the environment, and the defined goals of strategic assessment. The framework of the implementation of the Spatial Plan is presented, which is determined for the simultaneous elaboration of planning solutions at two levels: the strategic level of the spatial plan and detailed urban plan level. It is also analyzed the relationship of the Spatial Plan to other applicable planning documents for the planning area. The effects of this methodological approach relate to enabling integrated planning of the sustainable development of the infrastructure corridor of the highway and its surrounding area, through coordination of spatial, urban and sectoral traffic planning and design, as well as the participation of all key actors in the adoption and implementation of planned decisions. By the conclusions of the paper, it is pointed to the direction for further research, particularly in terms of harmonizing methodology of planning documentation and preparation of technical-design documentation.

Keywords: corridor, environment, highway, impact, methodology, spatial plan, urban

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Authors: Toshanlal Meenpal, Ankita Meenpal

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A very important technique in reversible data hiding field is Difference expansion. Secret message as well as the cover image may be completely recovered without any distortion after data extraction process due to reversibility feature. In general, in any difference expansion scheme embedding is performed by integer transform in the difference image acquired by grouping two neighboring pixel values. This paper proposes an improved reversible difference expansion embedding scheme. We mainly consider edge direction for embedding by modifying the difference of two neighboring pixels values. In general, the larger difference tends to bring a degraded stego image quality than the smaller difference. Image quality in the range of 0.5 to 3.7 dB in average is achieved by the proposed scheme, which is shown through the experimental results. However payload wise it achieves almost similar capacity in comparisons with previous method.

Keywords: information hiding, wedge direction, difference expansion, integer transform

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Authors: Sorayya Malek, Mogeeb Mosleh, Sharifah M. Syed

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In this study, Support Vector Machine (SVM) technique was applied to predict the dichotomized value of Dissolved oxygen (DO) from two freshwater lakes namely Chini and Bera Lake (Malaysia). Data sample contained 11 parameters for water quality features from year 2005 until 2009. All data parameters were used to predicate the dissolved oxygen concentration which was dichotomized into 3 different levels (High, Medium, and Low). The input parameters were ranked, and forward selection method was applied to determine the optimum parameters that yield the lowest errors, and highest accuracy. Initial results showed that pH, water temperature, and conductivity are the most important parameters that significantly affect the predication of DO. Then, SVM model was applied using the Anova kernel with those parameters yielded 74% accuracy rate. We concluded that using SVM models to predicate the DO is feasible, and using dichotomized value of DO yields higher prediction accuracy than using precise DO value.

Keywords: dissolved oxygen, water quality, predication DO, support vector machine

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Authors: Moatlhodi Wise Letshwenyo, Lesedi Lebogang

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Botswana is an arid country that needs to start reusing wastewater as part of its water security plan. Pilot scale slow sand filtration in combination with roughing filter was investigated for the treatment of effluent from Botswana International University of Science and Technology to meet Botswana irrigation standards. The system was operated at hydraulic loading rates of 0.04 m/hr and 0.12 m/hr. The results show that the system was able to reduce turbidity from 262 Nephelometric Turbidity Units to a range between 18 and 0 Nephelometric Turbidity Units which was below 30 Nephelometric Turbidity Units threshold limit. The overall efficacy ranged between 61% and 100%. Suspended solids, Biochemical Oxygen Demand, and Chemical Oxygen Demand removal efficiency averaged 42.6%, 45.5%, and 77% respectively and all within irrigation standards. Other physio-chemical parameters were within irrigation standards except for bicarbonate ion which averaged 297.7±44 mg L^-1 in the influent and 196.22±50 mg L^-1 in the effluent which was above the limit of 92 mg L^-1, therefore averaging a reduction of 34.1% by the system. Total coliforms, fecal coliforms, and Escherichia coli in the effluent were initially averaging 1.1 log counts, 0.5 log counts, and 1.3 log counts respectively compared to corresponding influent log counts of 3.4, 2.7 and 4.1, respectively. As time passed, it was observed that only roughing filter was able to reach reductions of 97.5%, 86% and 100% respectively for faecal coliforms, Escherichia coli, and total coliforms. These organism numbers were observed to have increased in slow sand filter effluent suggesting multiplication in the tank. Water quality index value of 22.79 for the physio-chemical parameters suggests that the effluent is of excellent quality and can be used for irrigation purposes. However, the water quality index value for the microbial parameters (1820) renders the quality unsuitable for irrigation. It is concluded that slow sand filtration in combination with roughing filter is a viable option for the treatment of secondary effluent for reuse purposes. However, further studies should be conducted especially for the removal of microbial parameters using the system.

Keywords: irrigation, slow sand filter, turbidity, wastewater reuse

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Authors: Chao-Linag Hsieh, Zheng-Wei Ye, Chen-Kang Huang, Yeun-Chung Lee, Chih-Hong Sun, Tzai-Hung Wen, Jehn-Yih Juang, Joe-Air Jiang

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Air pollution and climate warming become more and more intensified in many areas, especially in urban areas. Environmental parameters are critical information to air pollution and weather monitoring. Thus, it is necessary to develop a suitable air pollution and weather monitoring system for urban areas. In this study, a vehicle monitoring system (VMS) based on the IoT technique is developed. Cars are selected as the research tool because it can reach a greater number of streets to collect data. The VMS can monitor different environmental parameters, including ambient temperature and humidity, and air quality parameters, including PM2.5, NO₂, CO, and O₃. The VMS can provide other information, including GPS signals and the vibration information through driving a car on the street. Different sensor modules are used to measure the parameters and collect the measured data and transmit them to a cloud server through the LoRa protocol. A user interface is used to show the sensing data storing at the cloud server. To examine the performance of the system, a researcher drove a Nissan x-trail 1998 to the area close to the Da’an District office in Taipei to collect monitoring data. The collected data are instantly shown on the user interface. The four kinds of information are provided by the interface: GPS positions, weather parameters, vehicle information, and air quality information. With the VMS, users can obtain the information regarding air quality and weather conditions when they drive their car to an urban area. Also, government agencies can make decisions on traffic planning based on the information provided by the proposed VMS.

Keywords: LoRa, monitoring system, smart city, vehicle

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Authors: Naeemeh Silvari

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The tourism industry is important for different nations in two ways. Apart from economic benefits, it provides a basis for getting acquainted with the culture of different regions of the world. Depending on the capacities and contexts of their geography, countries try to attract more people to their country in different ways. Health tourism has been an important branch of the tourism industry in recent years, and many countries around the world are trying to make progress in this field and attract many tourists from around the world. Iran, like many developing countries in the Middle East and East Asia, is trying to improve and develop tourist attractions in the field of health. Due to the cheapness of providing medical services to tourists, many people have traveled to Iran for medical and health care. However, there is a long way to go before recognizing and reaching the desired position in this field. Due to the direct relationship between tourism and culture, the negative attitude towards the context of Iran has caused foreign travelers not to choose this country as their tourist destination. In this article, we tried to study the change in their attitude towards Iran by using semi-structured interviews of foreign travelers who traveled to Iran for treatment and medical services. The text of the interviews was coded and analyzed by MAX QDA software. Many of the people in the sample were from Middle Eastern and Arabic-speaking countries. Influenced by the media, they felt rejected by the Iranians before the trip. During their stay in Iran and in connection with the health care staff, in the first stage, they pointed out that many of their anxieties about the kind of treatment of Iranians have been allayed. In addition to the satisfaction with the medical services provided, they considered the atmosphere of Iranians' interaction with foreign travelers to be relatively appropriate, and some stated that Iran would be the destination of their leisure trip in the future. At the end of the research, policymakers were suggested that in order to resolve cultural contradictions rooted in values, they should first be recognized and seek to use other opportunities to resolve contradictions and form interactions with other cultures.

Keywords: cultural conflict, health tourism, cultural prejudice, advertising and media

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Authors: Jana Atteah, Wid Jan, Yara AlHibshi, Rahaf AlRougi

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Anyword is an AI copywriting tool that helps marketers create effective campaigns for specific audiences. It offers a wide range of templates for various platforms, brand voice guidelines, and valuable analytics insights. Anyword is used by top global companies and has been recognized as one of the "Fastest Growing Products" in the 2023 software awards. A recent study examined the utilization and impact of AI-powered writing tools, specifically focusing on the adoption of AI in writing pursuits and the use of the Anyword platform. The results indicate that a majority of respondents (52.17%) had not previously used Anyword, but those who had were generally satisfied with the platform. Notable productivity improvements were observed among 13% of the participants, while an additional 34.8% reported a slight increase in productivity. A majority (47.8%) maintained a neutral stance, suggesting that their productivity remained unaffected. Only a minimal percentage (4.3%) claimed that their productivity did not improve with the usage of Anyword AI. In terms of the quality of written content generated, the participants responded positively. Approximately 91% of participants gave Anyword AI a score of 5 or higher, with roughly 17% giving it a perfect score. A small percentage (approximately 9%) gave a low score between 0-2. The mode result was a score of 7, indicating a generally positive perception of the quality of content generated using Anyword AI. These findings suggest that AI can contribute to increased productivity and positively influence the quality of written content. Further research and exploration of AI tools in writing pursuits are warranted to fully understand their potential and limitations.

Keywords: artificial intelligence, marketing platforms, productivity, user interface

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Authors: Aneta Nitsch-Osuch, Sylwia Dyk, Izabela Gołebiak

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Background. Since 2014 the pertussis vaccine is recommended to Polish health care workers who have close contacts with infants. Although this recommendation is implemented into the National Immunization Programme, its realization has remained unknown. The Purpose: The aim of the study, conducted at the department of Social Medicine and Public Health (Medical University of Warsaw, Poland), was to describe a perception, knowledge and coverage rates regarding pertussis vaccination among nursing staff. According to the authors' knowledge, it was the first study related to this topic in our country. Material and Methods: A total number of 543 nurses who work at pediatric or neonatal wards was included into the study (501 women and 42 men), average age was 47 years. All nurses were asked to fulfill the anonymous survey, previously validated. Results: 1. Coverage rates: The analysis of results revealed that only 4% of responders reported they were vaccinated with Tdpa within past 10 years, while 8% declared they would plan the vaccine in the future. 35% of responders would consider the Tdpa vaccine whether there is some kind of the reimbursement. 2. Perception and knowledge of the disease and vaccination: The majority (82%) of nurses did not recognize pertussis as a re-emerging infectious disease. 54% of them believed that obligatory vaccinations in the childhood protect against the disease and the protection is a life-long one. Only 15% of nurses considered pertussis as a possible nosocomial infection. The current epidemiology of the disease was known to 6% of responders, while 24% of them were familiar with pertussis vaccination schedules for infants, children and adolescents, but only 9% of responders knew that adults older than 19 years are recommended to be vaccinated with Tdpa every 10 years. Many nurses (82%) would expect more educational activities related to pertussis and methods of its prophylaxis. Conclusions: The pertussis vaccine coverage rate among Polish nurses is extremely low. This is a result of not enough knowledge about the disease and its prevention. Educational activities addressed to health care workers and reimbursement of the pertussis vaccine are required to improve awareness and increase of vaccine coverage rates in the future.

Keywords: coverage, nurse, pertussis, vaccine

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Authors: Christina Y. P. Ting

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Migration is a global phenomenon with movements of migrants from developed and developing countries to the host societies. Migrants have changed the host countries’ demography – its population structure and also its ethnic cultural diversity. Acculturation of migrants in terms of their adoption of the host culture is seen as important to ensure that they ‘fit into’ their adopted country so as to participate in everyday public life. However, this research found that the increase of the China-born migrants’ post-migration consumption level had impact on Australia’s environment reflected not only because of their adoption of elements of the host culture, but also retention of aspects of Chinese culture – indicating that the influence of bi-culturalism was in operation. This research, which was based on the face-to-face interview with 61 China-born migrants in the suburb of Box Hill, Melbourne, investigated the pattern of change in the migrants’ consumption upon their settlement in Australia. Using an ecological footprint calculator, their post-migration footprints were found to be larger than pre-migration footprint. The uniquely-derived CALD (Culturally and Linguistically Diverse) Index was used to measure individuals’ strength of connectedness to ethnic culture. Multi-variant analysis was carried out to understand which independent factors that influence consumption best explain the change in footprint (which is the difference between pre-and post-migration footprints, as a dependent factor). These independent factors ranged from socio-economic and demographics to the cultural context, that is, the CALD Index and indicators of acculturation. The major findings from the analysis were: Chinese culture (as measured by the CALD Index) and indicators of acculturation such as length of residency and using English in communications besides the traditional factors such as age, income and education level made significant contributions to the large increase in the China-born group’s post-migration consumption level. This paper as part of a larger study found that younger migrants’ large change in their footprint were related to high income and low level of education. This group of migrants also practiced bi-cultural consumption in retaining ethnic culture and adopting the host culture. These findings have importantly highlighted that for a host society to tackle environmental crisis, governments need not only to understand the relationship between age and consumption behaviour, but also to understand and embrace the migrants’ ethnic cultures, which may act as bridges and/or fences in relationships. In conclusion, for governments to deal with national issues such as environmental crisis within a cultural diverse population, it necessitates an understanding of age and aspects of ethnic culture that may act as bridges and fences. This understanding can aid in putting in place policies that enable the co-existence of a hybrid of the ethnic and host cultures in order to create and maintain a harmonious and secured living environment for population groups.

Keywords: bicultural consumer, CALD index, consumption, ethnic culture, migrants

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Authors: Kristine D. de Leon, Junifer A. Abatayo, Jose Cristina M. Pariña

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The current study is a comparative analysis of the use of shell nouns as a cohesive device (CD) in an English for Second Language (ESL) setting in order to identify their use and relationship in the quality of second language (L2) writing. As these nouns were established to anticipate the meaning within, across or outside the text, their use has fascinated writing researchers. The corpus of the study included published articles from reputable journals and graduate students’ papers in order to analyze the frequency of shell nouns using “highly prevalent” nouns in the academic community, to identify the different lexicogrammatical patterns where these nouns occur and to the functions connected with these patterns. The result of the study implies that published authors used more shell nouns in their paper than graduate students. However, the functions of the different lexicogrammatical patterns for the frequently occurring shell nouns are somewhat similar. These results could help students in enhancing the cohesion of their text and in comprehending it.

Keywords: anaphoric, cataphoric, lexico-grammatical, shell nouns

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Authors: Lucia Billeci, Gennaro Tartarisco, Maurizio Varanini

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Fetal cardiac monitoring by fetal electrocardiogram (fECG) can provide significant clinical information about the healthy condition of the fetus. Despite this potentiality till now the use of fECG in clinical practice has been quite limited due to the difficulties in its measuring. The recovery of fECG from the signals acquired non-invasively by using electrodes placed on the maternal abdomen is a challenging task because abdominal signals are a mixture of several components and the fetal one is very weak. This paper presents an approach for fECG extraction from abdominal maternal recordings, which exploits the characteristics of pseudo-periodicity of fetal ECG. It consists of devising a quality index (fQI) for fECG and of finding the linear combinations of preprocessed abdominal signals, which maximize these fQI (quality index optimization - QIO). It aims at improving the performances of the most commonly adopted methods for fECG extraction, usually based on maternal ECG (mECG) estimating and canceling. The procedure for the fECG extraction and fetal QRS (fQRS) detection is completely unsupervised and based on the following steps: signal pre-processing; maternal ECG (mECG) extraction and maternal QRS detection; mECG component approximation and canceling by weighted principal component analysis; fECG extraction by fQI maximization and fetal QRS detection. The proposed method was compared with our previously developed procedure, which obtained the highest at the Physionet/Computing in Cardiology Challenge 2013. That procedure was based on removing the mECG from abdominal signals estimated by a principal component analysis (PCA) and applying the Independent component Analysis (ICA) on the residual signals. Both methods were developed and tuned using 69, 1 min long, abdominal measurements with fetal QRS annotation of the dataset A provided by PhysioNet/Computing in Cardiology Challenge 2013. The QIO-based and the ICA-based methods were compared in analyzing two databases of abdominal maternal ECG available on the Physionet site. The first is the Abdominal and Direct Fetal Electrocardiogram Database (ADdb) which contains the fetal QRS annotations thus allowing a quantitative performance comparison, the second is the Non-Invasive Fetal Electrocardiogram Database (NIdb), which does not contain the fetal QRS annotations so that the comparison between the two methods can be only qualitative. In particular, the comparison on NIdb was performed defining an index of quality for the fetal RR series. On the annotated database ADdb the QIO method, provided the performance indexes Sens=0.9988, PPA=0.9991, F1=0.9989 overcoming the ICA-based one, which provided Sens=0.9966, PPA=0.9972, F1=0.9969. The comparison on NIdb was performed defining an index of quality for the fetal RR series. The index of quality resulted higher for the QIO-based method compared to the ICA-based one in 35 records out 55 cases of the NIdb. The QIO-based method gave very high performances with both the databases. The results of this study foresees the application of the algorithm in a fully unsupervised way for the implementation in wearable devices for self-monitoring of fetal health.

Keywords: fetal electrocardiography, fetal QRS detection, independent component analysis (ICA), optimization, wearable

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Authors: Abdullah Almusharraf, Andrew Whyte

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The sub-task pattern in terms of the deviations and defects should be identified and understand in order to improve the quality practices in construction projects. Therefore, the sub-task susceptibility to exposure to deviations and defects have been evaluated and classified via six classifications that have proposed in this study. 34 case studies on specific sub-task (from compression member in construction concrete structure) have been collected from seven construction projects in order to examined study’s classifications. The study revealed that the sub-task has high sensitive to deviation where (91%) of the cases recorded as deviations, however, only (19%) of cases recorded as defects. Another findings were that the actual work during the execution process has high source of deviation for this sub-task (74%) while only (26%) of the deviation source was due to both design documentations with the actual work. These findings significantly imply that it could be used the study’s classifications to determine the pattern of each sub-task and develop the proactive actions to overcome issues of the sub-task deviations and defects.

Keywords: sub-tasks, deviations, defects, quality, construction projects

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Authors: A. Kaeotawee, N. Bunmas, W. Chomthong

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Background: The cancellation of elective surgery is a major indicator of poor operating room efficiency. Furthermore, it is recognized as a major cause of emotional trauma to patients as well as their families. This study was carried out to assess the incidence and causes of elective surgery cancellation in our setting and to find the appropriate solutions for better quality management. Objective: To determine the incidence and causes of elective surgery cancellations in Songklanagarind Hospital. Material and Method: A prospective survey was conducted from September to November 2012. All patients who had their scheduled elective operations cancelled were assessed. Data was collected on the following 2 components: (1) patient demographics;(2) main reasons for cancellations, which were grouped into patient-related factors and organizational-related factors. Data are reported as a percentage of patients whose operations were cancelled. The association between cancellation status and patient demographics was assessed using univariate logistic regression. Results: 2,395 patients were scheduled for elective surgery and of these 343 (14.3%) had their operations cancelled. Cardiothoracic surgery had the highest rate of cancellations (28.7%) while the least number of cancellations occurred in ophthalmology (10.1%). The main reasons for cancellations were related to the unit's organization (53.6%), due to the surgeon (48.4%). Patient related causes (46.4%), due to non medical reasons (32.1%). The most common cause of cancellation by the surgeon was lack of theater time (21.3%), by patients due to the patient’s nonappearance (25.1%). Cancellation was significantly associated with type of patient, health insurance, type of anesthesia and specialties (p<0.05). Conclusion: Surgery cancellations by surgeons relating to a lack of theater time was a significant problem in our setting. Appropriate solutions for better quality improvement are needed.

Keywords: elective cases, surgery cancellation, quality management, appropriate solutions

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Authors: Leonore Robieux, Franck Zenasni, Marc Pocard, Clarisse Eveno

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Empirical data in health psychology studies show the necessity to consider the doctor-patient communication and its positive impact on outcomes such as patients’ satisfaction, treatment adherence, physical and psychological wellbeing. In this line, the present research aims to define the role and determinants of an effective doctor–patient communication during the treatment of patients with serious illness (peritoneal carcinomatosis). We carried out a prospective longitudinal study including patients treated for peritoneal carcinomatosis of various origins. From November 2016, to date, data were collected using validated questionnaires at two times of evaluation: one month before the surgery (T0) and one month after (T1). Thus, patients reported their (a) anxiety and depression levels, (b) standardized and individualized quality of life and (c) how they perceived communication, attitude and empathy of the surgeon. 105 volunteer patients (Mean age = 58.18 years, SD = 10.24, 62.2% female) participated to the study. PC arose from rare diseases (14%), colorectal (38%), eso-gastric (24%) and ovarian (8%) cancer. Three groups are defined according to the severity of their pathology and the treatment offered to them: (1) important surgical treatment with the goal of healing (53%), (2) repeated palliative surgical treatment (17%), and (3) the patients recused for surgical treatment, only palliative approach (30%). Results are presented according to Baron and Kenny recommendations. The regressions analyses show that only depression and anxiety are sensitive to the communication and empathy of surgeon. The main results show that a good communication and high level of empathy at T0 and T1 limit depression and anxiety of the patients in T1. Results also indicate that the severity of the disease modulates this positive impact of communication: better is the communication the less are the level of depression and anxiety of the patients. This effect is higher for patients treated for the more severe disease. These results confirm that, even in the case severe disease a good communication between patient and physician remains a significant factor in promoting the well-being of patients. More specific training need to be developed to promote empathic care.

Keywords: clinical empathy, determinants, healthcare, psychological wellbeing

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Authors: Ivana Tadic, Snjezana Pivac

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Although human resources are recognized as the crucial companies’ resources and their positive influence on companies’ performances has been confirmed through different researches, scientists are still debating it. In order to contribute this debate, this paper firstly discusses the most important human resource management elements and practices and its influence on companies’ success. Afterwards it defines human resource “bundles” – interrelated and internally consistent human resource practices, complementary to each other, or the most important human resource practices and elements regarding Croatian companies and its human resource management activities. Finally, the paper provides empirical results; more precisely it reveals the relation of the level of development of human resource management function (“bundles”) and companies’ financial performances (using profitability ratios, liquidity ratios, solvency ratios and a group of additional ratios related to employees’ indicators).

Keywords: companies’ performances, human resource bundles, multivariate statistical analysis, marketing

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Authors: Changfeng Fu

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Sustainable urban development has been widely accepted a common sense in the modern urban planning and design. However, the measurement and assessment of urban sustainability, especially the quantitative assessment have been always an issue obsessing planning and design professionals. This paper will present an on-going research on the principles and technologies to develop a quantitative urban sustainability assessment principles and techniques which aim to integrate indicators, geospatial and geo-reference data, and assessment techniques together into a mechanism. It is based on the principles and techniques of geospatial analysis with GIS and statistical analysis methods. The decision-making technologies and methods such as AHP and SMART are also adopted to address overall assessment conclusions. The possible interfaces and presentation of data and quantitative assessment results are also described. This research is based on the knowledge, situations and data sources of UK, but it is potentially adaptable to other countries or regions. The implementation potentials of the mechanism are also discussed.

Keywords: urban sustainability assessment, quantitative analysis, sustainability indicator, geospatial data, big data

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Authors: Mona Rezaei, Habib Honari, Mehrzad Hamidi, Fatemeh Kiani

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Make strong brands has become a priority for many organizations in marketing. Brand is an important indicator of marketing status. Brand Strength is in kept customer, profit, brand development and gain competitive advantage and In fact it is a concept that was created from a consumer perspective. It is assumed that the creation of a strong brand is creating numerous marketing benefits. The purpose of this study was to evaluate the psychometric characteristics of the questionnaire the most strong sports brands in the consumer society. Questionnaire was conducted to a sample of 340 customers of sports brands. Psychometric parameters were determined by using appropriate statistical methods. The results of the factor analysis and Varimax rotation revealed five factors of strong brands. The results confirms that questionnaire structure have acceptable associated to the data and confirmed all indicators of the model. Reliability (859/0) was satisfactory. According to calculated psychometric indices, this questionnaire could be appropriate to assess the most strong sports brands.

Keywords: reliability, strong brand, sport brands, psychometric

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Authors: Lv Shizeng, Han Xiao, Zhang Yi, Ding Wenjing

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The lunar sample storage device is mainly used for the preparation of the lunar samples, observation, physical analysis and other work. The lunar samples and operating equipment are placed directly inside the storage device. The inside of the storage device is a high purity nitrogen environment to ensure that the sample is not contaminated by the Earth's environment. In order to ensure that the water and oxygen indicators in the storage device meet the sample requirements, a dynamic gas cycle is required between the storage device and the external purification equipment. However, the internal gas disturbance in the storage device can affect the operation of the sample. In this paper, the storage device model is established, and the tetrahedral mesh is established by Tetra/Mixed method. The influence of different inlet position and gas flow on the internal flow field disturbance is calculated, and the disturbed flow area should be avoided during the sampling operation.

Keywords: lunar samples, gas disturbance, storage device, characteristic analysis

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Authors: Diana Flores Galindo, Richard Gil Herrera

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Nowadays, Lean Manufacturing and Industry 4.0 are very important in every country. One of the main benefits is continued market presence. It has been identified that there is a need to change existing educational programs, as well as update the knowledge and skills of existing employees. It should be borne in mind that behind each technological improvement, there is a human being. Human talent cannot be neglected. The main objectives of this article are to review the link between Lean Manufacturing, the incorporation of Industry 4.0 and the steps to follow to implement it; analyze the current situation and study the implications and benefits of this new trend, with a particular focus on Mexico. Lean Manufacturing and Industry 4.0 implementation waves must always take care of the most important capital – intellectual capital. The methodology used in this article comprised the following steps: reviewing the reality of the fourth industrial revolution, reviewing employees’ skills on the journey to become world-class, and analyzing the situation in Mexico. Lean Manufacturing and Industry 4.0 were studied not as exclusive concepts, but as complementary ones. The methodological framework used is focused on motivating companies’ collaborators to guarantee common results, innovate, and remain in the market in the face of new requirements from company stakeholders. The key findings were that both trends emphasize the need to improve communication across the entire company and incorporate new technologies into everyday work, from the shop floor to administrative staff, to help improve processes. Taking care of people, activities and processes will bring a company success. In the specific case of Mexico, companies in all sectors need to be aware of and implement technological improvements according to their specific needs. Low-cost labor represents one of the most typical barriers. In conclusion, companies must build a roadmap according to their strategy and needs to achieve their short, medium- and long-term goals.

Keywords: lean management, lean manufacturing, industry 4.0, motivation, SWOT analysis, Hoshin Kanri

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Authors: Carmen E. Zapata, Juan Bautista, Olga Montoya, Claudia Moreno, Marisol Suarez, Alejandra Betancur, Duvan Nanclares, Natalia A. Cano

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This study aims to evaluate the diversity of microorganisms in filters PM2.5 and PM10; and determine the genotoxic and cytotoxic activity of the complex mixture present in PM2.5 filters used in the Aburrá Valley Air Quality Monitoring Network (Colombia). The research results indicate that particulate matter PM2.5 of different monitoring stations are bacteria; however, this study of detection of bacteria and their phylogenetic relationship is not complete evidence to connect the microorganisms with pathogenic or degrading activities of compounds present in the air. Additionally, it was demonstrated the damage induced by the particulate material in the cell membrane, lysosomal and endosomal membrane and in the mitochondrial metabolism; this damage was independent of the PM2.5 concentrations in almost all the cases.

Keywords: cytotoxic, genotoxic, microbiological analysis, PM10, PM2.5

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Authors: Astghik R. Sukiasyan

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The semidental sweet maize of Armenian population under drought stress and pollution by some heavy metals (HMs) in sites along the river Debet was studied. Accordingly, the objective of this work was to investigate the antioxidant status of maize plant in order to identify simple and reliable criteria for assessing the degree of adaptation of plants to abiotic stress of drought and HMs. It was found that in the case of removal from the mainstream of the river, the antioxidant status of the plant varies. As parameters, the antioxidant status of the plant has been determined by the activity of malondialdehyde (MDA) and Ferric Reducing Ability of Plasma (FRAP), taking into account the characteristics of natural drought of this region. The possibility of using some indicators which characterized the antioxidant status of the plant was concluded. The criteria for assessing the extent of environmental pollution could be HMs. This fact can be used for the early diagnosis of diseases in the population who lives in these areas and uses corn as the main food.

Keywords: antioxidant status, maize corn, drought stress, heavy metal

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Authors: Milda A. Cruz-Huaranga, Natalí Carbo-Bustinza, Javier Linkolk López-Gonzales, K. Depaz, Gina M. Tito T., Soledad Torres-Calderón

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The objective of this study was to improve water quality in the “La Mansión” pond in order to irrigate green spaces on the Peruvian Union University campus (Lima, Peru) using the aquatic species Eichhornia Crassipes. Furthermore, tree trimming and cleaning activities were performed that reduced water pollution caused by organic deposits and feathers from wild birds. The impaired waterbody is located on the campus of the Peruvian Union University, 580 meters above sea level, with a volume of 6,405.336 m3, an area of 3,050.16 m2, 256.81 m perimeter, and 0.12 m3/s input flow. Seven 1.8 m2 floating systems were implemented, with 12 common water hyacinth plants in each system. Before implementing this system, a water quality analysis was performed to analyse the physical-chemical, microbiological, and organoleptic parameters. The pre-analysis revealed the pond’s critical condition, with electrical conductivity: 556 mg/l; phosphate: < 0.5; pH: 7.06; total solids: 412 mg/l; arsenic: <0.01; lead: 0.115; BOD5: 14; COD: 16.94; dissolved oxygen: 13; total coliforms: 24000 MCL/100 ml; and thermo-tolerant coliforms: 11000 MCL/100 ml. After implementing the system, the following results were obtained: EC: 495 mg/l; DO:9.2 mg/l; TS: 235 mg/l; BOD5: 7.7; COD: 8.47; Pb: 0.001 mg/l; TC: 460 MCL/100 ml; FC: 240 MCL/100 ml. Thus, we confirmed that the system is 78.79% efficient regarding the Peruvian ECA (Environmental Quality Standards) established for water according to DS #015-2015-MINAM. Therefore, the water is suitable for plant irrigation. Finally, we concluded that treating wastewater with the species Eichhornia Crassipes is efficient since an improvement was achieved in the impaired waterbody.

Keywords: Eichhornia crassipes, plantlets, cleaning, impaired waterbody, pond

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Authors: Gyan Kashyap, Shri Kant Singh

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Improved mental health can be articulated as a good physical health and quality of life. Mental health plays an important role in survival of any one’s life. In today’s time people living with stress in life due to their personal matters, health problems, unemployment, work environment, living environment, substance use, life style and many more important reasons. Many studies confirmed that the significant proportion of mental health people increasing in India. This study is focused on mental well-being of male leather tannery workers in Kanpur city, India. Environment at work place as well as living environment plays an important health risk factors among leather tannery workers. Leather tannery workers are more susceptible to many chemicals and physical hazards, just because they are liable to be affected by their exposure to lots of hazardous materials and processes during tanning work in very hazardous work environment. The aim of this study to determine the level of mental health disorder and quality of life among male leather tannery and non-tannery workers in Kanpur city, India. This study utilized the primary data from the cross- sectional household study which was conducted from January to June, 2015 on tannery and non-tannery workers as a part of PhD program from the Jajmau area of Kanpur city, India. The sample of 286 tannery and 295 non-tannery workers has been collected from the study area. We have collected information from the workers of age group 15-70 those who were working at the time of survey for at least one year. This study utilized the general health questionnaire (GHQ-12) and work related stress scale to test the mental wellbeing of male tannery and non-tannery workers. By using GHQ-12 and work related stress scale, Polychoric factor analysis method has been used for best threshold and scoring. Some of important question like ‘How would you rate your overall quality of life’ on Likert scale to measure the quality of life, their earnings, education, family size, living condition, household assets, media exposure, health expenditure, treatment seeking behavior and food habits etc. Results from the study revealed that around one third of tannery workers had severe mental health problems then non-tannery workers. Mental health problem shown the statistically significant association with wealth quintile, 56 percent tannery workers had severe mental health problem those belong to medium wealth quintile. And 42 percent tannery workers had moderate mental health problem among those from the low wealth quintile. Work related stress scale found the statistically significant results for tannery workers. Large proportion of tannery and non-tannery workers reported they are unable to meet their basic needs from their earnings and living in worst condition. Important result from the study, tannery workers who were involved in beam house work in tannery (58%) had severe mental health problem. This study found the statistically significant association with tannery work and mental health problem among tannery workers.

Keywords: GHQ-12, mental well-being, factor analysis, quality of life, tannery workers

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Authors: Rasouli Divkalaee Zeinab, Kalteh Safa, Roudbari Aliakbar

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Introduction: Medical waste can lead to the generation and transmission of many infectious and contagious diseases due to the presence of pathogenic agents, thereby necessitating the need for special management to collect, decontaminate, and finally dispose of such products. This study aimed to design a centralized health care (medical) waste management program for the cities of Semnan, Mahdishahr, and Shahmirzad. Methods: This descriptive-analytical study was conducted for six months in the cities of Semnan, Mahdishahr, and Shahmirzad. In this study, the quantitative and qualitative characteristics of the generated wastes were determined by taking samples from all medical waste production centers. Then, the equipment, devices, and machines required for separate collection of the waste from the production centers and for their subsequent decontamination were estimated. Next, the investment costs, current costs, and working capital required for collection, decontamination, and final disposal of the wastes were determined. Finally, the payment for proper waste management of each category of medical waste-producing centers was determined. Results: 1021 kilograms of medical waste are produced daily in the cities of Semnan, Mahdishahr, and Shahmirzad. It was estimated that a 1000-liter autoclave, a machine for collecting medical waste, four 60-liter bins, four 120-liter bins, and four 1200-liter bins were required for implementing the study plan. Also, the estimated total annual medical waste management costs for Semnan City were determined (23,283,903,720 Iranian Rials). Conclusion: The study results showed that establishing a proper management system for medical wastes generated in the three studied cities will cost between 334,280 and 1,253,715 Iranian Rials in fees for the medical centers. The findings of this study provided comprehensive data regarding medical wastes from the generation point to the landfill site, which is vital for the government and the private sector.

Keywords: clinics, decontamination, management, medical waste

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Authors: Jafar Ahmadi

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This research has been done as a discourse analysis of the concept of citizenship in textbooks in Iran. The purpose of this study is to identify the dominant citizenship discourse in textbooks in the content of textbooks. The research method in this research is qualitative and qualitative content analysis. The statistical sample was selected in a purposeful manner and according to the research topic of books related to Persian literature, religious education and social education. The selected theoretical framework of this research is the three theories of citizenship (pre-modern, modern and postmodern). For each of these discourses, components and indicators have been extracted that are the basis of data analysis. The research findings show that the dominant citizenship discourse on the content of Iranian textbooks is pre-modern discourse and is the basis of this type of religious citizenship discourse. Finally, the findings show that the government uses the institution of education to reproduce its power.

Keywords: citizenship, textbooks, discourse analysis, religious citizenship, representation

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Authors: Shahid Hussain Abro, F. Mufadi, A. Boodi

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Microstructural study and phase transformation in steels is a basic and important step during the design of structural steel. There are huge efforts and study has been done so far on phase transformations, due to so many steel grades available commercially the phase development in steel has different consequences. In the present work an effort has been made to study the effect of heating rate on microstructural features of cold heading quality steel. The SEM, optical microscopy, and heat treatment techniques have been applied to observe the microstructural features in the experimental steel. It was observed that heating rate has the strong influence on phase transformation of CHQ steel under investigation. Heating rate increases the austenite formation kinetics with respect to holding time, and this austenite has been transformed to martensite upon cooling. Heating rate also plays a vital role on nucleation sites of austenite formation in the experimental steel.

Keywords: CHQ steel, austenite formation, heating rate, nucleation

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