Search results for: hospital safety
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 5339

Search results for: hospital safety

1019 Effects of α-IFN –SingleWalled Carbon NanoTube and α-IFN-PLGA Encapsulated on Breast Cancer in Rats Induced by DMBA by Using CA15-3 Tumor Marker

Authors: Anoosh Eghdami

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Background and aim: Conventional anticancer drugs display significant shortcomings which limit their use in cancer therapy. For this reason, important progress has been achieved in the field of nanotechnology to solve these problems and offer a promising and effective alternative for cancer treatment. Tumor markers may also be measured periodically during cancer therapy. Tumor markers may also be measured after treatment has ended to check for recurrence the return of cancer. The aim of this study was to evaluate the effect of nano drug delivery in induced breast cancer with DMBA by using CA15-3 tumor marker. Material and method: the rats were divided into five groups. The first group (control n=15) were fed only sesame oil as a gavage. In the second group n=15,10 mg DMBA was dissolved in 5ml of sesame oil and were fed as a gavage. In addition to DMBA treatment as the second group, in the 3,4and 5 groups after cancer creation, respectively affected by alpha interferon (α-IFN),alpha interferon conjugated with single walled carbon nano tube (α-IFN-SWNT) and encapsulated in poly lactic poly glycolic acid (α-IFN-PLGA). Tumor marker was measured in recent three groups. Results: The ANOVA test was used to determine the differences among the groups. Cancer inducing in rats (group 2) caused a significant increase in blood levels of CA15-3 (P<0.05). Administration of α-IFN, α-IFN –SWNT and α-IFN-PLGA in 3 groups of cancerous rats caused a significant decrease in blood levels of CA15-3 only the group that treated with α-IFN-PLGA (p<0.05). Conclusion: the results of this study indicate that nano drugs more effective than traditional drug in cancer treatment, although further work is needed to elucidate the safety and side effect of these compound in human.

Keywords: breast cancer, nano drug, tumor markers, CA15-3, α-IFN-PLGA, -IFN –SWNT

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1018 A Case Study on Re-Assessment Study of an Earthfill Dam at Latamber, Pakistan

Authors: Afnan Ahmad, Shahid Ali, Mujahid Khan

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This research presents the parametric study of an existing earth fill dam located at Latamber, Karak city, Pakistan. The study consists of carrying out seepage analysis, slope stability analysis, and Earthquake analysis of the dam for the existing dam geometry and do the same for modified geometry. Dams are massive as well as expensive hydraulic structure, therefore it needs proper attention. Additionally, this dam falls under zone 2B region of Pakistan, which is an earthquake-prone area and where ground accelerations range from 0.16g to 0.24g peak. So it should be deal with great care, as the failure of any dam can cause irreparable losses. Similarly, seepage as well as slope failure can also cause damages which can lead to failure of the dam. Therefore, keeping in view of the importance of dam construction and associated costs, our main focus is to carry out parametric study of newly constructed dam. GeoStudio software is used for this analysis in the study in which Seep/W is used for seepage analysis, Slope/w is used for Slope stability analysis and Quake/w is used for earthquake analysis. Based on the geometrical, hydrological and geotechnical data, Seepage and slope stability analysis of different proposed geometries of the dam are carried out along with the Seismic analysis. A rigorous analysis was carried out in 2-D limit equilibrium using finite element analysis. The seismic study began with the static analysis, continuing by the dynamic response analysis. The seismic analyses permitted evaluation of the overall patterns of the Latamber dam behavior in terms of displacements, stress, strain, and acceleration fields. Similarly, the seepage analysis allows evaluation of seepage through the foundation and embankment of the dam, while slope stability analysis estimates the factor of safety of the upstream and downstream of the dam. The results of the analysis demonstrate that among multiple geometries, Latamber dam is secure against seepage piping failure and slope stability (upstream and downstream) failure. Moreover, the dam is safe against any dynamic loading and no liquefaction has been observed while changing its geometry in permissible limits.

Keywords: earth-fill dam, finite element, liquefaction, seepage analysis

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1017 The Use of Spirulina during Aerobic Exercise on the Performance of Immune and Consumption Indicators (A Case Study: Young Men After Physical Training)

Authors: Vahab Behmanesh

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One of the topics that has always attracted the attention of sports medicine and sports science experts is the positive or negative effect of sports activities on the functioning of the body's immune system. In the present research, a course of aerobic running with spirulina consumption has been studied on the maximum oxygen consumption and the performance of some indicators of the immune system of men who have trained after one session of physical activity. In this research, 50 trained students were studied randomly in four groups, spirulina- aerobic, spirulina, placebo- aerobic, and control. In order to test the research hypotheses, one-way statistical method of variance (ANOVA) was used considering the significance level of a=0.005 and post hoc test (LSD). A blood sample was taken from the participants in the first stage test in fasting and resting state immediately after Bruce's maximal test on the treadmill until complete relaxation was reached, and their Vo2max value was determined through the aforementioned test. The subjects of the spirulina-aerobic running and placebo-aerobic running groups took three 500 mg spirulina and 500 mg placebo pills a day for six weeks and ran three times a week for 30 minutes at the threshold of aerobic stimulation. The spirulina and placebo groups also consumed spirulina and placebo tablets in the above method for six weeks. Then they did the same first stage test as the second stage test. Blood samples were taken to measure the number of CD4+, CD8+, NK, and the ratio of CD4+ to CD8+ on four occasions before and after the first and second stage tests. The analysis of the findings showed that: aerobic running and spirulina supplement alone increase Vo2max. Aerobic running and consumption of spirulina increases Vo2max more than other groups (P<0.05), +CD4 and hemoglobin of the spirulina-aerobic running group was significantly different from other groups (P=0.002), +CD4 of the groups together There was no significant difference, NK increased in all groups, the ratio of CD4+ to CD8+ between the groups had a significant difference (P=0.002), the ratio of CD4+ to CD8+ in the spirulina- aerobic group was lower than the spirulina and placebo groups. All in all, it can be concluded that the supplement of spirulina and aerobic exercise may increase Vo2max and improve safety indicators.

Keywords: spirulina (Q2), hemoglobin (Q3), aerobic exercise (Q3), residual activity (Q2), CD4+ to CD8+ ratio (Q3)

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1016 The Effects of Physician-Family Communication from the Point View of Clinical Staff

Authors: Lu-Chiu Huang, Pei-Pei Chen, Li-Chin Yu, Chiao-Wen Kuo, Tsui-Tao Liu, Rung-Chuang Feng

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Purpose: People put increasing emphasis on demands of medical quality and protecting their interests. Patients' or family's dissatisfaction with medical care may easily lead to medical dispute. Physician-family communication plays an essential role in medical care. A sound communication cannot only strengthen patients' belief in the medical team but make patient have definite insight into treatment course of the disease. A family meeting provides an effective platform for communication between clinical staff, patients and family. Decisions and consensuses formed in family meetings can promote patients' or family's satisfaction with medical care. Clinical staff's attitudes toward family meeting may determine behavioral intentions to hold family meeting. This study aims to explore clinical staff's difficulties in holding family meeting and evaluate how their attitudes and behavior influence the effect of family meetings. Methods: This was a cross-sectional study. It was conducted at a regional teaching hospital in Taipei city. The research team developed its own structural questionnaires, whose expert validity was checked by the nursing experts. Participants filled in the questionnaires online. Data were collected by convenience sampling. A total of 568 participants were invited. They included doctors, nurses, social workers, and so on. Results: 1) The average score of ‘clinical staff’s attitudes to family meetings’ was 5.15 (SD=0.898). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It indicated that clinical staff had positive attitudes toward family meetings, 2) The average score of ‘clinical staff’s behavior to family meetings’ was 5.61 (SD=0.937). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It meant clinical staff tended to have positive behavior at the family meeting, and 3) The average score of ‘Difficulty in conducting family meetings’ was 5.15 (SD=0.897). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. The higher the score was, the less difficulty the clinical staff felt. It demonstrated clinical staff felt less difficulty in conducting family meetings. Clinical staff's identification with family meetings brought favored effects. Persistent and active promotion for family meetings can bring patients and family more benefits. Implications for practice: Understanding clinical staff's difficulty in participating family meeting and exploring their attitudes or behavior toward physician-family communication are helpful to develop modes of interaction. Consequently, quality and satisfaction of physician-family communication can be increased.

Keywords: clinical staff, communication, family meeting, physician-family

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1015 Electrospun NaMnPO₄/CNF as High-Performance Cathode Material for Sodium Ion Batteries

Authors: Concetta Busacca, Leone Frusteri, Orazio Di Blasi, Alessandra Di Blasi

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The large-scale extension of renewable energy led, recently, to the development of efficient and low-cost electrochemical energy storage (EES) systems such as batteries. Although lithium-ion battery (LIB) technology is relatively mature, several issues regarding safety, cyclability, and high costs must be overcome. Thanks to the availability and low cost of sodium, sodium-ion batteries (NIB) have the potential to meet the energy storage needs of the large-scale grid, becoming a valid alternative to LIB in some energy sectors, such as the stationary one. However, important challenges such as low specific energy and short cyclic life due to the large radius of Na+ must be faced to introduce this technology into the market. As an important component of SIBs, cathode materials have a significant effect on the electrochemical performance of SIBs. Recently, sodium layer transition metal oxides, phosphates, and organic compounds have been investigated as cathode materials for SIBs. In particular, phosphate-based compounds such as NaₓMPO₄ (M= Fe, Co, Mn) have been extensively studied as cathodic polyanion materials due to their long cycle stability and appropriate operating voltage. Among these, an interesting cathode material is the NaMnPO₄ based one, thanks to the stability and the high redox potential of the Mn²⁺/Mn³⁺ ion pair (3÷4 V vs. Na+/Na), which allows reaching a high energy density. This work concerns with the synthesis of a composite material based on NaMnPO₄ and carbon nanofibers (NaMnPO₄-CNF) characterized by a mixed crystalline structure between the maricite and olivine phases and a self-standing manufacture obtained by electrospinning technique. The material was tested in a Na-ion battery coin cell in half cell configuration, and showed outstanding electrocatalytic performances with a specific discharge capacity of 125 mAhg⁻¹ and 101 mAhg⁻¹ at 0.3C and 0.6C, respectively, and a retention capacity of about 80% a 0.6C after 100 cycles.

Keywords: electrospinning, self standing materials, Na ion battery, cathode materials

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1014 DNA of Hibiscus sabdariffa Damaged by Radiation from 900 MHz GSM Antenna

Authors: A. O. Oluwajobi, O. A. Falusi, N. A. Zubbair, T. Owoeye, F. Ladejobi, M. C. Dangana, A. Abubakar

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The technology of mobile telephony has positively enhanced human life and reports on the bio safety of the radiation from their antennae have been contradictory, leading to serious litigations and violent protests by residents in several parts of the world. The crave for more information, as requested by WHO in order to resolve this issue, formed the basis for this study on the effect of the radiation from 900 MHz GSM antenna on the DNA of Hibiscus sabdariffa. Seeds of H. sabdariffa were raised in pots placed in three replicates at 100, 200, 300 and 400 metres from the GSM antennae in three selected test locations and a control where there was no GSM signal. Temperature (˚C) and the relative humidity (%) of study sites were measured for the period of study (24 weeks). Fresh young leaves were harvested from each plant at two, eight and twenty-four weeks after sowing and the DNA extracts were subjected to RAPD-PCR analyses. There were no significant differences between the weather conditions (temperature and relative humidity) in all the study locations. However, significant differences were observed in the intensities of radiations between the control (less than 0.02 V/m) and the test (0.40-1.01 V/m) locations. Data obtained showed that DNA of samples exposed to rays from GSM antenna had various levels of distortions, estimated at 91.67%. Distortions occurred in 58.33% of the samples between 2-8 weeks of exposure while 33.33% of the samples were distorted between 8-24 weeks exposure. Approximately 8.33% of the samples did not show distortions in DNA while 33.33% of the samples had their DNA damaged twice, both at 8 and at 24 weeks of exposure. The study showed that radiation from the 900 MHz GSM antenna is potent enough to cause distortions to DNA of H. sabdariffa even within 2-8 weeks of exposure. DNA damage was also independent of the distance from the antenna. These observations would qualify emissions from GSM mast as environmental hazard to the existence of plant biodiversities and all life forms in general. These results will trigger efforts to prevent further erosion of plant genetic resources which have been threatening food security and also the risks posed to living organisms, thereby making our environment very safe for our existence while we still continue to enjoy the benefits of the GSM technology.

Keywords: damage, DNA, GSM antenna, radiation

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1013 Tracheal Stenting to Relieve Respiratory Distress in Patient with Advanced Esophageal Malignancy and Its Anaesthetic Management

Authors: Aarti Agarwal, Ajmal Khan

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Background and Objective: Breathing difficulty is most distressing symptom for the patient and their caregivers providing palliative care to individuals with advanced malignancy. It needs to be tackled effectively and sometimes preemptively to provide relief from respiratory obstruction. Interventional procedures like tracheal stenting are becoming increasingly popular as a part of palliation for respiratory symptoms. We present a case of esophageal tumor earlier stented by Gastroenterologist to maintain esophageal patency, but the tumor outgrew to produce tracheal infiltration and thereby causing airway obstruction. Method and Result: 62-year-old man presented with unresectable Carcinoma oesophagus with inability to swallow. A metallic stent was placed by the gastroenterologist, to maintain esophageal patency and enable patient to swallow. Two months later, the patient returned to hospital in emergency with respiratory distress. CT neck and thorax revealed tumor infiltration through posterior tracheal wall. Lower extent of the tumor was till 1 cm above the carina. Airway stenting with Tracheo bronchial stent with Y configuration was planned under general anaesthesia with airway blocks. Superior Laryngeal Nerve Block, Glossopharyngeal block and Trans tracheal infiltration of local anaesthetics were performed. The patient was sedated with Fentanyl, Midazolam and propofol infusion but was breathing spontaneously. Once the rigid bronchoscope was placed inside trachea, breathing was supported with oxygen and sevoflurane. Initially, the trachea was cleared of tumor by coring. After creating space, tracheal stent was positioned and deployed. After stent placement patient was awakened, suctioned and nebulized. His respiratory stridor relieved instantaneously and was shifted to recovery. Conclusion: Airway blocks help in decreasing the incidence and severity of coughing during airway instrumentation thereby help in proper stent placement. They also reduce the requirement of general anaesthetics and hasten the post stenting recovery. Airway stent provided immediate relief to patient from symptoms of respiratory difficulty. Decision for early tracheal stenting may be taken for a select group of patients with high propensity for local spread, thereby avoiding respiratory complications and providing better quality of life in patients with inoperable malignancy.

Keywords: tracheal stent, respiratory difficulty, esophageal tumor, anaesthetic management

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1012 “Towards Creating a Safe Future”: An Assessment of the Causes of Flooding in Nsanje District, Lower Shire Malawi

Authors: Davie Hope Moyo

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The environment is a combination of two things: resources and hazards. One of the hazards that is a result of environmental changes is the occurrence of flooding. Floods are one of the disasters that are highly feared by people because they have a huge impact on the human population and their environment. In recent years, flooding disasters in the Nsanje district are increasing in both frequency and magnitude. This study aims to understand the root causes of this phenomenon. To understand the causes of flooding, this study focused on the case of TA Ndamera in the Nsanje district, southern Malawi. People in the Nsanje district face disruption in their day-to-day life because of floods that affect their communities. When floods happen, people lose their property, land, livestock, and even lives. The study was carried out in order to have a better understanding of the root causes of floods. The findings of this study may help the government and other development agencies to put in place mitigation measures that will make Nsanje District resilient to the occurrence of future flood hazards. Data was collected from the area of TA Ndamera in order to assess the causes of flooding in the district. Interviews, transect walks, and researcher observation was done to appreciate the topography of the district and evaluate other factors that are making the people become vulnerable to the impacts of flooding in the district. It was found that flooding in the district is mainly caused by heavy rainfall in the upper shire, settlements along river banks, deforestation, and the topography of the district in general. The research study ends by providing recommendation strategies that need to be put in place to increase the resilience of the communities to future flood hazards. The research recommends the development of indigenous knowledge systems to alert people of incoming floods, construction of evacuation centers to ease pressure on schools, savings, and insurance schemes, construction of dykes, desilting rivers, and afforestation.

Keywords: disaster causes, mitigation, safety measures, Nsanje Malawi

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1011 Exploring Health-Related Inequalities between Private, Public and Active Transport Users, Using Relative Importance Index: Case Study on Santiago de Chile

Authors: Beatriz Mella Lira, Karla Yohannessen, Robin Hickman

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The aim of the paper is recognising inequalities through the self-assessment of health-related factors, in the context of daily mobilities in Santiago de Chile. Human capabilities will be used as the theoretical basis for the recognition and assessment of these factors regarding the functioning (what people are currently able to do) and capabilities (what people want to achieve and what is valuable for them), reflecting differences across social groups and among types of transport users. The self-assessment of health-related factors considers perceptions of stress, physical effort, proximity to other transport users, pollution, safety, and comfort. The types of transport users are classified as: private (cars, taxis, colectivos, motos), public (buses and metro) and active (bicycles and walking). The methodology follows a capability-based questionnaire, which was applied in different areas of Santiago de Chile, considering concepts extracted from the human capabilities list. The self-assessment of these health-related factors examines the context of peoples’ mobilities for performing their daily activities, considering socioeconomic differences as income, age, gender, disabilities, residence location and primary mode choice. The paper uses Relative Importance Index (RII) for weighting the relative influence or valuation of the factors. The respondents were asked to rate the importance of each factor on a scale from 1 to 5, in an ascending order of importance. The results suggest that these health-related factors impact not just the perceptions of users, but their well-being and their propensity for achieving their capabilities and the things they value in life. The paper is focused on the development of an applicable approach, measuring factors that should be included in transport project appraisal, as a more comprehensive and complementary method.

Keywords: active transport, health, human capabilities, Santiago de Chile, transport inequalities, transportation planning, urban planning

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1010 Study of the Prevalence, Associated Factors and Impact of Maternal Perinatal Depression in Women Alexandria 2022

Authors: Nermeen Saad Elbeltagy, Hoda Ghareeb, Hesham Adel Elsheshtawy, Nadim Hamed, Amany Ibrahim Mostafa, Sara Hazem Hassan

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Introduction: Depression is one of the most common mental health problems occurring in women during their child bearing years. Perinatal depression refers to major and minor depressive episodes that occur either during pregnancy or aer delivery. Although perinatal depression is common in developing countries, it is under-recognized in low and middle income countries making a substantial contribution to maternal and infant morbidity and mortality. About 12.5 - 42% of pregnant women and, 12 - 50% of post natal mothers in low and middle income countries such as Ethiopia had depression AIM OF THE WORK: To study prevalence, associated factors and impact of maternal perinatal depression in Alexandria. Patients and method: This study was conducted on 300 mothers at the postnatal ward in ElShatby Maternity Hospital from April 2022 unl October 2022. Females with past history of depression before pregnancy or females who receive medications inducing depression were excluded. The participants were asked to complete the questionnaire that includes the Edinburgh Postnatal Depression Scale (EPDS) as a screening test to obtain information concerning the current frame of mind at antepartum, partum and postpartum periods Results: The prevalence of perinatal depression was 22.3%. It was found that there is a significant negave moderate correlation between socioeconomic status and perinatal depression(r=-0.42). The present study revealed that about two thirds (60.7%) of postpartum women had low socioeconomic level. Also, less than one fourth (20%) of parents had high education and only one fourth (25.3%) of postpartum women were working. There was a statically significance difference between the number of previous abortions and perinatal depression (p=0.04). There was a significant moderate correlation between the amount of blood lost during delivery and an increased risk of developing postpartum depression. The prevalence of perinatal depression was high in cases of female neonates more than male ones. Conclusion: the prevalence of perinatal depression among the studied women was 22.3% of studied group. The significant factors identified in this study can be targeted to reduce the occurrence of perinatal depression among pregnant women in Alexandria through appropriate health interventions which includes perinatal depression screening, counseling, and the provision of support for pregnant women during antenatal care as well as lifestyle modification.

Keywords: mental health, depression in pregnancy, mental disorders, psychology in pregnancy

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1009 Just a Heads Up: Approach to Head Shape Abnormalities

Authors: Noreen Pulte

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Prior to the 'Back to Sleep' Campaign in 1992, 1 of every 300 infants seen by Advanced Practice Providers had plagiocephaly. Insufficient attention is given to plagiocephaly and brachycephaly diagnoses in practice and pediatric education. In this talk, Nurse Practitioners and Pediatric Providers will be able to: (1) identify red flags associated with head shape abnormalities, (2) learn techniques they can teach parents to prevent head shape abnormalities, and (3) differentiate between plagiocephaly, brachycephaly, and craniosynostosis. The presenter is a Primary Care Pediatric Nurse Practitioner at Ann & Robert H. Lurie Children's Hospital of Chicago and the primary provider for its head shape abnormality clinics. She will help participants translate key information obtained from birth history, review of systems, and developmental history to understand risk factors for head shape abnormalities and progression of deformities. Synostotic and non-synostotic head shapes will be explained to help participants differentiate plagiocephaly and brachycephaly from synostotic head shapes. This knowledge is critical for the prompt referral of infants with craniosynostosis for surgical evaluation and correction. Rapid referral for craniosynostosis can possibly direct the patient to a minimally invasive surgical procedure versus a craniectomy. As for plagiocephaly and brachycephaly, this timely referral can also aid in a physical therapy referral if necessitated, which treats torticollis and aids in improving head shape. A well-timed referral to a head shape clinic can possibly eliminate the need for a helmet and/or minimize the time in a helmet. Practitioners will learn the importance of obtaining head measurements using calipers. The presenter will explain head calculations and how the calculations are interpreted to determine the severity of the head shape abnormalities. Severity defines the treatment plan. Participants will learn when to refer patients to a head shape abnormality clinic and techniques they should teach parents to perform while waiting for the referral appointment. The purpose, mechanics, and logistics of helmet therapy, including optimal time to initiate helmet therapy, recommended helmet wear-time, and tips for helmet therapy compliance, will be described. Case scenarios will be incorporated into the presenter's presentation to support learning. The salient points of the case studies will be explained and discussed. Practitioners will be able to immediately translate the knowledge and skills gained in this presentation into their clinical practice.

Keywords: plagiocephaly, brachycephaly, craniosynostosis, red flags

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1008 Sociological Enquiry into Occupational Risks and Its Consequences among Informal Automobile Artisans in Osun State, Nigeria

Authors: Funmilayo Juliana Afolabi, Joke Haafkens, Paul De Beer

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Globally, there is a growing concern on reducing workplace accidents in the informal sector. However, there is a dearth of study on the perception of the informal workers on occupational risks they are exposed to. The way a worker perceives the workplace risk will influence his/her risk tolerance and risk behavior. The aim of this paper, therefore, is to have an in-depth understanding of the way the artisans perceive the risks at their workplace and how it influences their risk tolerance and risk behavior. This will help in designing meaningful intervention for the artisans and it will assist the policy makers in formulating a policy that will help them. Methods: Forty-three artisans were purposely selected for the study; data were generated through observation of the workplace and work practices of the artisans and in-depth interview from automobile artisans (Panel beater, Mechanic, Vulcanizer, and Painters) in Osun State, Nigeria. The transcriptions were coded and analyzed using MAXQDA software. Results: The perceived occupational risks among the study groups are a danger of being run over by oncoming vehicles while working by the roadside, a risk of vehicle falling on workers while working under the vehicle, cuts, and burns, fire explosion, falls from height and injuries from bursting of tires. The identified risk factors are carelessness of the workers, pressure from customers, inadequate tools, preternatural forces, God’s will and lack of apprentices that will assist them in the workplace. Furthermore, the study revealed that artisans engage in risky behavior like siphoning fuel with mouth because of perception that fuel is good for expelling worms and will make them free from any stomach upset. Conclusions: The study concluded that risky behaviors are influenced by culture, beliefs, and perception of the artisans. The study, therefore, suggested proper health and safety education for the artisans.

Keywords: automobile artisans, informal, occupational risks, Nigeria, sociological enquiry

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1007 Determination of Identification and Antibiotic Resistance Rates of Serratia marcescens and Providencia Spp. from Various Clinical Specimens by Using Both the Conventional and Automated (VITEK2) Methods

Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

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Objective: Serratia species are identified as aerobic, motile Gram negative rods. The species Serratia marcescens (S. marcescens) causes both opportunistic and nosocomial infections. The genus Providencia is Gram-negative bacilli and includes urease-producing that is responsible for a wide range of human infections. Although most Providencia infections involve the urinary tract, they are also associated with gastroenteritis, wound infections, and bacteremia. The aim of this study was evaluate the antimicrobial resistance rates of S. marcescens and Providencia spp. strains which had been isolated from various clinical materials obtained from different patients who belongs to intensive care units (ICU) and inpatient clinics. Methods: A total of 35 S. marcescens and Providencia spp. strains isolated from various clinical samples admitted to Medical Microbiology Laboratory, ANS Research and Practice Hospital, Afyon Kocatepe University between October 2013 and September 2015 were included in the study. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bio-Merieux, Marcy l’etoile, France) was used additionally. Antibacterial resistance tests were performed by using Kirby Bauer disc (Oxoid, Hampshire, England) diffusion method following the recommendations of CLSI. Results: The distribution of clinical samples were as follows: upper and lower respiratory tract samples 26, 74.2 % wound specimen 6, 17.1 % blood cultures 3, 8.5%. Of the 35 S. marcescens and Providencia spp. strains; 28, 80% were isolated from clinical samples sent from ICU. The resistance rates of S. marcescens strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 8.5 %, 22.8 %, 11.4 %, 2.8 %, 17.1 %, 40 %, 28.5 % and 5.7 % respectively. Resistance rates of Providencia spp. strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 10.2 %, 33,3 %, 18.7 %, 8.7 %, 13.2 %, 38.6 %, 26.7%, and 11.8 % respectively. Conclusion: S. marcescens is usually resistant to ampicillin, amoxicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefuroxime, cephamycins, nitrofurantoin, and colistin. The most effective antibiotic on the total of S. marcescens strains was found to be gentamicin 2.8 %, of the totally tested strains the highest resistance rate found against to ceftazidime 40 %. The lowest and highest resistance rates were found against gentamiycin and ceftazidime with the rates of 8.7 % and 38.6 % for Providencia spp.

Keywords: Serratia marcescens, Providencia spp., antibiotic resistance, intensive care unit

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1006 Self-Reliant Peer Learning for Nursing Students

Authors: U.-B. Schaer, M. Wehr, R. Hodler

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Background: Most nursing students require more training time for necessary nursing skills than defined by nursing schools curriculum to acquire basic nursing skills. Given skills training lessons are too brief to enable effective student learning, meaning in-depth skills practice and repetition various learning steps. This increases stress levels and the pressure to succeed for a nursing student with slower learning capabilities. Another possible consequence is that nursing students are less prepared in the required skills for future clinical practice. Intervention: The Bern College of Higher Education of Nursing, Switzerland, started the independent peer practice learning program in 2012. A concept was developed which defines specific aims and content as well as student’s rights and obligations. Students enlist beforehand and order the required materials. They organize themselves and train in small groups in allocated training location in the area of Learning Training and Transfer (LTT). During the peer practice, skills and knowledge can be repeatedly trained and reflected in the peer groups without the presence of a tutor. All invasive skills are practiced only on teaching dummies. This allows students to use all their potential. The students may access learning materials as literature and their own student notes. This allows nursing students to practice their skills and to deepen their knowledge on corresponding with their own learning rate. Results: Peer group discussions during the independent peer practice learning support the students in gaining certainty and confidence in their knowledge and skills. This may improve patient safety in future daily care practice. Descriptive statics show that the number of students who take advantage of the independent peer practice learning increased continuously (2012-2018). It has to be mentioned that in 2012, solely students of the first semester attended the independent peer practice learning program, while in 2018 over one-third of the participating students were in their fifth semester and final study year. It is clearly visible that the demand for independent peer practice learning is increasing. This has to be considered in the development of future teaching curricula.

Keywords: learning program, nursing students, peer learning, skill training

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1005 Safety Assessment of Tuberous Roots of Boerhaavia diffusa Root Extract: Acute and Sub-Acute Toxicity Studies

Authors: Surender Singh, Yogendra Kumar Gupta

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Boerhaavia diffusa (BD) Linn. belonging to family Nyctaginaceae is a herbaceous plant and known as ‘punarnava’ in Hindi, used as herbal medicine for pain relief and various ailments. It is widely used as a green leafy vegetable in many Asian and African countries. The objective of present study was to investigate potential adverse effects, if any, of standardized root extract of Boerhaavia diffusa in rats following subchronic administration. In acute toxicity study, no mortality was found at a dose of 2000mg/kg which indicates that oral LD50 of Boerhaavia diffusa root extract is more than 2000mg/kg. The chronic administration of Boerhaavia diffusa for 28 days at a dose of 1000mg/kg body weight did not produce any significant changes in hematological (RBC, WBC, platelets, hemoglobin, bleeding time, clotting time) and biochemical (triglycerides, blood glucose, high density lipoprotein, serum creatinine, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase) parameters of male and female rats as compared to normal control group. All the animals survived until the scheduled necropsy, and their physical and behavioral examinations did not reveal any treatment-related adverse effects. No pathological changes were observed in histological section of heart, kidney, liver, testis, ovaries and brain of Boerhaavia diffusa treated male and female rats as compared to normal control animals.These observations from oral acute toxicitystudy suggest that the extract is practically non-toxic. Thus, it can be inferred that the Boerhaavia diffusa root extract at levels up to 1000 mg/kg/day was found to be safe and does not cause adverse effects in rats. So, the no-observed effect level (NOAEL) of the extract was found to be 1000mg/kg/day.

Keywords: Boerhaavia diffusa, histology, toxicity, sub-acute

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1004 Improvements in Transient Testing in The Transient REActor Test (TREAT) with a Choice of Filter

Authors: Harish Aryal

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The safe and reliable operation of nuclear reactors has always been one of the topmost priorities in the nuclear industry. Transient testing allows us to understand the time-dependent behavior of the neutron population in response to either a planned change in the reactor conditions or unplanned circumstances. These unforeseen conditions might occur due to sudden reactivity insertions, feedback, power excursions, instabilities, and accidents. To study such behavior, we need transient testing, which is like car crash testing, to estimate the durability and strength of a car design. In nuclear designs, such transient testing can simulate a wide range of accidents due to sudden reactivity insertions and helps to study the feasibility and integrity of the fuel to be used in certain reactor types. This testing involves a high neutron flux environment and real-time imaging technology with advanced instrumentation with appropriate accuracy and resolution to study the fuel slumping behavior. With the aid of transient testing and adequate imaging tools, it is possible to test the safety basis for reactor and fuel designs that serves as a gateway in licensing advanced reactors in the future. To that end, it is crucial to fully understand advanced imaging techniques both analytically and via simulations. This paper presents an innovative method of supporting real-time imaging of fuel pins and other structures during transient testing. The major fuel-motion detection device that is studied in this dissertation is the Hodoscope which requires collimators. This paper provides 1) an MCNP model and simulation of a Transient Reactor Test (TREAT) core with a central fuel element replaced by a slotted fuel element that provides an open path between test samples and a hodoscope detector and 2) a choice of good filter to improve image resolution.

Keywords: hodoscope, transient testing, collimators, MCNP, TREAT, hodogram, filters

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1003 Dependence of Androgen Status in Men with Primary Hypothyroidism on Duration and Condition of Compensation

Authors: Krytskyy T.

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Introduction: The role of androgen deficiency in men as a factor in the pathogenesis of many somatic diseases is unmistakable. The interaction of thyroid and sex hormones with hypothyroidism in men is still the subject of discussions. The purpose of the study is to assess the androgen status of men with primary hypothyroidism, depending on its duration and the state of compensation. Materials and methods: 45 men with primary hypothyroidism aged 35 to 60 years, as well as 25 healthy men, who formed a control group, were under supervision. A selection of men for examination was conducted in the process of outpatient and in-patient treatment at the endocrinology department of the University Hospital in Ternopil. The functional state of the pituitary-gonadal system was evaluated in order to characterize the androgen status of patients. The concentration of follicle stimulating hormone, luteinizing hormone, prolactin, thyroid-stimulating hormone was determined in blood with the help of enzyme-linked method. Also, the content of hormones: total testosterone, linking sex hormones globulin were determined. Results: Reduced total testosterone (TT) content was found in 42.2% of patients with hypothyroidism. Herewith in 17.8% of patients, blood TT levels were lower than 8.0 nmol / L, and in 11 (24.4%) men, the rate was in the range of 8.0 to 12.0 nmol / L. Based on the results of the determination of the content of free testosterone (FT), the frequency of laboratory hypogonadism in men with hypothyroidism was higher than the results of the determination of TT. The degree of compensation of hypothyroidism probably did not affect the average levels of gonadotropic and sex hormones. Conclusions: Reduced total testosterone content was found in 42.2% of patients with primary hypothyroidism. Herewith, in 17.8% of patients blood TT levels were lower than 8.0 nmol / L, which is a sign of absolute deficiency of testosterone, and in 24.4% of men the rate ranged from 8.0 to 12.0 nmol / l , indicating partial androgen deficiency. Linking sex hormones globulin levels were believed to be lower in 46.7% of patients with hypothyroidism compared to control group. The average levels of E2 in the examined patients did not significantly differ from the mean of control group. FSH, LH, and prolactin levels in men with hypothyroidism were within the normal age limits and probably did not differ from those of control group. The degree of compensation of hypothyroidism probably did not affect the average levels of gonadotropic and sex hormones. The mean LH content in the blood was significantly increased in men with a duration of hypothyroidism up to 5 years and did not differ from that of the control group and in men with a duration of hypothyroidism over 5 years. In men with hypothyroidism, a probable reduction in T / LH coefficient is found. The obtained data may indicate a combined lesion of the central and peripheral parts of the pituitary-gonadal system in men with hypothyroidism.

Keywords: androgenic status, hypothyroidism, testosterone, linking sex hormones globulin

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1002 Human Factors Integration of Chemical, Biological, Radiological and Nuclear Response: Systems and Technologies

Authors: Graham Hancox, Saydia Razak, Sue Hignett, Jo Barnes, Jyri Silmari, Florian Kading

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In the event of a Chemical, Biological, Radiological and Nuclear (CBRN) incident rapidly gaining, situational awareness is of paramount importance and advanced technologies have an important role to play in improving detection, identification, monitoring (DIM) and patient tracking. Understanding how these advanced technologies can fit into current response systems is essential to ensure they are optimally designed, usable and meet end-users’ needs. For this reason, Human Factors (Ergonomics) methods have been used within an EU Horizon 2020 project (TOXI-Triage) to firstly describe (map) the hierarchical structure in a CBRN response with adapted Accident Map (AcciMap) methodology. Secondly, Hierarchical Task Analysis (HTA) has been used to describe and review the sequence of steps (sub-tasks) in a CBRN scenario response as a task system. HTA methodology was then used to map one advanced technology, ‘Tag and Trace’, which tags an element (people, sample and equipment) with a Near Field Communication (NFC) chip in the Hot Zone to allow tracing of (monitoring), for example casualty progress through the response. This HTA mapping of the Tag and Trace system showed how the provider envisaged the technology being used, allowing for review and fit with the current CBRN response systems. These methodologies have been found to be very effective in promoting and supporting a dialogue between end-users and technology providers. The Human Factors methods have given clear diagrammatic (visual) representations of how providers see their technology being used and how end users would actually use it in the field; allowing for a more user centered approach to the design process. For CBRN events usability is critical as sub-optimum design of technology could add to a responders’ workload in what is already a chaotic, ambiguous and safety critical environment.

Keywords: AcciMap, CBRN, ergonomics, hierarchical task analysis, human factors

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1001 Obstacles and Ways-Forward to Upgrading Nigeria Basic Nursing Schools: A Survey of Perception of Teaching Hospitals’ Nurse Trainers and Stakeholders

Authors: Chijioke Oliver Nwodoh, Jonah Ikechukwu Eze, Loretta Chika Ukwuaba, Ifeoma Ndubuisi, Ada Carol Nwaneri, Ijeoma Lewechi Okoronkwo

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Presence of nursing workforce with unequal qualification and status in Nigeria has undermined the growth of nursing profession in the country. Upgrading of the existing basic and post-basic nursing schools to degree-awarding institutions in Nigeria is a way-forward to solving this inequality problem and Nigeria teaching hospitals are in vantage position for this project due to the already existing supportive structure and manpower in those hospitals. What the nurse trainers and the stakeholders of the teaching hospitals may hold for or against the upgrading is a determining factor for the upgrading project, but that is not clear and has not been investigated in Nigeria. The study investigated the perception of nurse trainers and stakeholders of teaching hospitals in Enugu State of Nigeria on the obstacles and ways-forward to upgrading nursing schools to degree-awarding institutions in Nigeria. The study specifically elicited what the subjects may view as obstacles to upgrading basic and post-basic nursing schools to degree-awarding institutions in Nigeria and ascertained their suggestions on the possible ways of overcoming the obstacles. By utilizing cross-sectional descriptive design and a purposive sampling procedure, 78 accessible subjects out of a total population of 87 were used for the study. The generated data from the subjects were analyzed using frequencies, percentages and mean for the research questions and Pearson’s chi-square for the hypotheses, with the aid of Statistical Package for Social Sciences Version 20.0. The result showed that lack of extant policy, fund, and disunity among policy makers and stakeholders of nursing profession are the main obstacles to the upgrading. However, the respondents did not see items like: stakeholders and nurse trainers of basic and post-basic schools of nursing; fear of admitting and producing poor quality nurses; and so forth, as obstacles to the upgrading project. Institution of the upgrading policy by Nursing and Midwifery Council of Nigeria, funding, awareness creation for the upgrading and unison among policy makers and stakeholders of nursing profession are the major possible ways to overcome the obstacles. The difference in the subjects’ perceptions between the two hospitals was found to be statistically insignificant (p > 0.05). It is recommended that the policy makers and stakeholders of nursing in Nigeria should unite and liaise with Federal Ministries of Health and Education for modalities and actualization of upgrading nursing schools to degree-awarding institutions in Nigeria.

Keywords: nurse trainers, obstacles, perception, stakeholders, teaching hospital, upgrading basic nursing schools, ways-forward

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1000 Clinical Outcomes and Symptom Management in Pediatric Patients Following Eczema Action Plans: A Quality Improvement Project

Authors: Karla Lebedoff, Susan Walsh, Michelle Bain

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Eczema is a chronic atopy condition requiring long-term daily management in children. Written action plans for other chronic atopic conditions, such as asthma and food allergies, are widely recommended and distributed to pediatric patients' parents and caregivers, seeking to improve clinical outcomes and become empowered to manage the patient's ever-changing symptoms. Written action plans for eczema, referred to as "asthma of the skin," are not routinely used in practice. Parents of children suffering from eczema rarely receive a written action plan to follow, and commendations supporting eczema action plans are inconsistent. Pediatric patients between birth and 18 years old who were followed for eczema at an urban Midwest community hospital were eligible to participate in this quality improvement project. At the initial visit, parents received instructions on individualized eczema action plans for their child and completed two validated surveys: Health Confidence Score (HCS) and Patient-Oriented Eczema Measure (POEM). Pre- and post-survey responses were collected, and clinical symptom presentation at follow-up were outcome determinants. Project implementation was guided by Institute for Healthcare Improvement's Step-up Framework and the Plan-Do-Study-Act cycle. This project measured clinical outcomes and parent confidence in self-management of their child's eczema symptoms with the responses from 26 participant surveys. Pre-survey responses were collected from 36 participants, though ten were lost to follow-up. Average POEM scores improved by 53%, while average HCS scores remained unchanged. Of seven completed in-person follow-up visits, six clinical progress notes documented improvement. Individualized eczema action plans can be seamlessly incorporated into primary and specialty care visits for pediatric patients suffering from eczema. Following a patient-specific eczema action plan may lessen the daily physical and mental burdens of uncontrolled eczema for children and parents, managing symptoms that chronically flare and recede. Furthermore, incorporating eczema action plans into practice potentially reduces the likely underestimated $5.3 billion economic disease burden of eczema on the U.S. healthcare system.

Keywords: atopic dermatitis, eczema action plan, eczema symptom management, pediatric eczema

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999 An Experience of HIV Testing and Counseling Services at a Tertiary Care Center of Bangladesh

Authors: S. M. Rashed Ul Islam, Shahina Tabassum, Afsana Anwar Miti

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Objective: HIV testing and counseling center (HTC) is an important component of the HIV/AIDS detection, prevention and control interventions. The service was first initiated at the Department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU) since the first case detection in 1989. The present study aimed to describe the demographic profile among the attendees tested HIV positive. Methods: The present study was carried out among 219 HIV positive cases detected through screening at the Department of Virology of BSMMU during the year of 2012-2016. Data were collected through pre-structured written questionnaire during the counseling session. Data were expressed as frequency and percentages and analyzed using SPSS v20.0 program. Results: Out of 219 HIV cases detected, 77.6% were males, and 22.4% were females with a mean age (mean±SD) of 35.46±9.46 years. Among them, 70.7% belonged to the 26-45 age groups representing the sexually active age. The majority of the cases were married (86.3%) and 49.8% had primary level of education whereas, 8.7% were illiterate. Nearly 42% of cases were referred from Chittagong division (south-east part of the country) followed by Dhaka division (35.6%). The bulk of study population admitted to involvement in high-risk behaviour (90%) in the past and 42% of them had worked overseas. The Pearson Chi-square (χ2) analysis revealed significant relationship of gender with marital (χ2=7.88 at 2% level) and occupation status (χ2=120.48 at 6% level); however, no association was observed with risk behaviour and educational status. Recommendations: HIV risk behavior was found to be a prime source for HIV infection among the study population. So, there is need for health education and awareness program to bring about behavioral changes to halt the yearly increase of new cases in the country with special attention to our overseas workers on HIV/AIDS risk and safety.

Keywords: Bangladesh, health education, HIV testing and counseling (HTC), HIV/AIDS, risk behavior

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998 Creation of Computerized Benchmarks to Facilitate Preparedness for Biological Events

Authors: B. Adini, M. Oren

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Introduction: Communicable diseases and pandemics pose a growing threat to the well-being of the global population. A vital component of protecting the public health is the creation and sustenance of a continuous preparedness for such hazards. A joint Israeli-German task force was deployed in order to develop an advanced tool for self-evaluation of emergency preparedness for variable types of biological threats. Methods: Based on a comprehensive literature review and interviews with leading content experts, an evaluation tool was developed based on quantitative and qualitative parameters and indicators. A modified Delphi process was used to achieve consensus among over 225 experts from both Germany and Israel concerning items to be included in the evaluation tool. Validity and applicability of the tool for medical institutions was examined in a series of simulation and field exercises. Results: Over 115 German and Israeli experts reviewed and examined the proposed parameters as part of the modified Delphi cycles. A consensus of over 75% of experts was attained for 183 out of 188 items. The relative importance of each parameter was rated as part of the Delphi process, in order to define its impact on the overall emergency preparedness. The parameters were integrated in computerized web-based software that enables to calculate scores of emergency preparedness for biological events. Conclusions: The parameters developed in the joint German-Israeli project serve as benchmarks that delineate actions to be implemented in order to create and maintain an ongoing preparedness for biological events. The computerized evaluation tool enables to continuously monitor the level of readiness and thus strengths and gaps can be identified and corrected appropriately. Adoption of such a tool is recommended as an integral component of quality assurance of public health and safety.

Keywords: biological events, emergency preparedness, bioterrorism, natural biological events

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997 The Effectiveness of a Self-Efficacy Psychoeducational Programme to Enhance Outcomes of Patients with End-Stage Renal Disease

Authors: H. C. Chen, S. W. C. Chan, K. Cheng, A. Vathsala, H. K. Sran, H. He

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Background: End-stage renal disease (ESRD) is the last stage of chronic kidney disease. The numbers of patients with ESRD have increased worldwide due to the growing number of aging, diabetes and hypertension populations. Patients with ESRD suffer from physical illness and psychological distress due to complex treatment regimens, which often affect the patients’ social and psychological functioning. As a result, the patients may fail to perform daily self-care and self-management, and consequently experience worsening conditions. Aims: The study aims to examine the effectiveness of a self-efficacy psychoeducational programme on primary outcome (self-efficacy) and secondary outcomes (psychological wellbeing, treatment adherence, and quality of life) in patients with ESRD and haemodialysis in Singapore. Methodology: A randomised controlled, two-group pretest and repeated posttests design will be carried out. A total of 154 participants (n=154) will be recruited. The participants in the control group will receive a routine treatment. The participants in the intervention group will receive a self-efficacy psychoeducational programme in addition to the routine treatment. The programme is a two-session of educational intervention in a week. A booklet, two consecutive sessions of face-to-face individual education, and an abdominal breathing exercise are adopted in the programme. Outcome measurements include Dialysis Specific Self-efficacy Scale, Kidney Disease Quality of Life- 36 Hospital Anxiety and Depression Scale, Renal Adherence Attitudes Questionnaire and Renal Adherence Behaviour Questionnaire. The questionnaires will be used to measure at baseline, 1- and 3- and 6-month follow-up periods. Process evaluation will be conducted with a semi-structured face to face interview. Quantitative data will be analysed using SPSS21.0 software. Qualitative data will be analysed by content analysis. Significance of the study: This study will identify a clinically useful and potentially effective approach to help patients with end-stage renal disease and haemodialysis by enhancing their self-efficacy in self-care behaviour, and therefore improving their psychological well-being, treatment adherence and quality of life. This study will provide information to develop clinical guidelines to improve patients’ disease self-management and to enhance health-related outcomes and it will help reducing disease burden.

Keywords: end-stage renal disease (ESRD), haemodialysis, psychoeducation, self-efficacy

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996 An Exploration of Cyberspace Security, Strategy for a New Era

Authors: Laxmi R. Kasaraneni

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The Internet connects all the networks, including the nation’s critical infrastructure that are used extensively by not only a nation’s government and military to protect sensitive information and execute missions, but also the primary infrastructure that provides services that enable modern conveniences such as education, potable water, electricity, natural gas, and financial transactions. It has become the central nervous system for the government, the citizens, and the industries. When it is attacked, the effects can ripple far and wide impacts not only to citizens’ well-being but nation’s economy, civil infrastructure, and national security. As such, these critical services may be targeted by malicious hackers during cyber warfare, it is imperative to not only protect them and mitigate any immediate or potential threats, but to also understand the current or potential impacts beyond the IT networks or the organization. The Nation’s IT infrastructure which is now vital for communication, commerce, and control of our physical infrastructure, is highly vulnerable to attack. While existing technologies can address some vulnerabilities, fundamentally new architectures and technologies are needed to address the larger structural insecurities of an infrastructure developed in a more trusting time when mass cyber attacks were not foreseen. This research is intended to improve the core functions of the Internet and critical-sector information systems by providing a clear path to create a safe, secure, and resilient cyber environment that help stakeholders at all levels of government, and the private sector work together to develop the cybersecurity capabilities that are key to our economy, national security, and public health and safety. This research paper also emphasizes the present and future cyber security threats, the capabilities and goals of cyber attackers, a strategic concept and steps to implement cybersecurity for maximum effectiveness, enabling technologies, some strategic assumptions and critical challenges, and the future of cyberspace.

Keywords: critical challenges, critical infrastructure, cyber security, enabling technologies, national security

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995 Impacts of Public Insurance on Health Access and Outcomes: Evidence from India

Authors: Titir Bhattacharya, Tanika Chakraborty, Prabal K. De

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Maternal and child health continue to be a significant policy focus in developing countries, including India. An emerging model in health care is the creation of public and private partnerships. Since the construction of physical infrastructure is costly, governments at various levels have tried to implement social health insurance schemes where a trust calculates insurance premiums and medical payments. Typically, qualifying families get full subsidization of the premium and get access to private hospitals, in addition to low cost public hospitals, for their tertiary care needs. We analyze one such pioneering social insurance scheme in the Indian state of Andhra Pradesh (AP). The Rajiv Aarogyasri program (RA) was introduced by the Government of AP on a pilot basis in 2007 and implemented in 2008. In this paper, we first examine the extent to which access to reproductive health care changed. For example, the RA scheme reimburses hospital deliveries leading us to expect an increase in institutional deliveries, particularly in private hospitals. Second, we expect an increase in institutional deliveries to also improve child health outcomes. Hence, we estimate if the program improved infant and child mortality. We use District Level Health Survey data to create annual birth cohorts from 2000-2015. Since AP was the only state in which such a state insurance program was implemented, the neighboring states constituted a plausible control group. Combined with the policy timing, and the year of birth, we employ a difference-indifference strategy to identify the effects of RA on the residents of AP. We perform several checks against threats to identification, including testing for pre-treatment trends between the treatment and control states. We find that the policy significantly lowered infant and child mortality in AP. We also find that deliveries in private hospitals increased, and government hospitals decreased, showing a substitution effect of the relative price change. Finally, as expected, out-of-pocket costs declined for the treatment group. However, we do not find any significant effects for usual preventive care such as vaccination, showing that benefits of insurance schemes targeted at the tertiary level may not trickle down to the primary care level.

Keywords: public health insurance, maternal and child health, public-private choice

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994 Analytical Model of Multiphase Machines Under Electrical Faults: Application on Dual Stator Asynchronous Machine

Authors: Nacera Yassa, Abdelmalek Saidoune, Ghania Ouadfel, Hamza Houassine

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The rapid advancement in electrical technologies has underscored the increasing importance of multiphase machines across various industrial sectors. These machines offer significant advantages in terms of efficiency, compactness, and reliability compared to their single-phase counterparts. However, early detection and diagnosis of electrical faults remain critical challenges to ensure the durability and safety of these complex systems. This paper presents an advanced analytical model for multiphase machines, with a particular focus on dual stator asynchronous machines. The primary objective is to develop a robust diagnostic tool capable of effectively detecting and locating electrical faults in these machines, including short circuits, winding faults, and voltage imbalances. The proposed methodology relies on an analytical approach combining electrical machine theory, modeling of magnetic and electrical circuits, and advanced signal analysis techniques. By employing detailed analytical equations, the developed model accurately simulates the behavior of multiphase machines in the presence of electrical faults. The effectiveness of the proposed model is demonstrated through a series of case studies and numerical simulations. In particular, special attention is given to analyzing the dynamic behavior of machines under different types of faults, as well as optimizing diagnostic and recovery strategies. The obtained results pave the way for new advancements in the field of multiphase machine diagnostics, with potential applications in various sectors such as automotive, aerospace, and renewable energies. By providing precise and reliable tools for early fault detection, this research contributes to improving the reliability and durability of complex electrical systems while reducing maintenance and operation costs.

Keywords: faults, diagnosis, modelling, multiphase machine

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993 In Exile but Not at Peace: An Ethnography among Rwandan Army Deserters in South Africa

Authors: Florence Ncube

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This paper examines the military and post-military experiences of soldiers who deserted from the Rwanda Defence Force (RDF) and tried to make a living in South Africa. Because they are deserters, they try to hide their military identity, yet it is simultaneously somewhat coercively ascribed to them by the Rwandan state and can put them in potential danger. The paper attends to the constructions, experiences, practices, and subjective understanding of the deserters’ being in exile to examine how, under circumstances of perceived threat, these men navigate real or perceived state-sponsored surveillance and threat in non-military settings in South Africa where they have become potential political and disciplinary targets. To make sense of the deserters’ experiences in these circumstances, the paper stitches together a number of useful theoretical concepts, including Bourdieu’s (1992) theory of practice and Vigh’s (2009; 2018) concept of social navigation because no single approach can coherently analyze the specificity of this study. Conventional post-military literature privileges an understanding of army desertion as a malignancy and somewhat problematic. Little is known about the military and post-military experiences of deserters who believe that army desertion is in fact a building block towards achieving subjective peace, even in the context of exile. The paper argues that the presence of Rwandan state agents in South Africa strips the context of the exile of its capacity to provide the deserters with peace, safety, and security. This paper recenters army desertion in analyses of militarism, soldiering, and transition in African contexts and complicates commonsense understandings of army desertion which assume that it is entirely problematic. This paper is drawn from an ethnography conducted among 30 junior-rank Rwandan army deserters exiled in Johannesburg and Cape Town. The researcher employed life histories, in-depth interviews, and deep hangouts to collect data.

Keywords: army deserter, military, identity, exile, peacebuilding, South Africa

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992 Studying the Photodegradation Behavior of Microplastics Released from Agricultural Plastic Products to the Farmland

Authors: Maryam Salehi, Gholamreza Bonyadinejad

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The application of agricultural plastic products like mulch, greenhouse covers, and silage films is increasing due to their economic benefits in providing an early and better-quality harvest. In 2015, the 4 million tons (valued a 10.6 million USD) global market for agricultural plastic films was estimated to grow by 5.6% per year through 2030. Despite the short-term benefits provided by plastic products, their long-term sustainability issues and negative impacts on soil health are not well understood. After their removal from the field, some plastic residuals remain in the soil. Plastic residuals in farmlands may fragment to small particles called microplastics (d<5mm). The microplastics' exposure to solar radiation could alter their surface chemistry and make them susceptible to fragmentation. Thus, this study examined the photodegradation of low density polyethylene as the model microplastics that are released to the agriculture farmland. The variation of plastic’s surface chemistry, morphology, and bulk characteristics were studied after accelerated UV-A radiation experiments and sampling from an agricultural field. The Attenuated Total Reflectance Fourier Transform Spectroscopy (ATR-FTIR) and X-ray Photoelectron Spectroscopy (XPS) demonstrated the formation of oxidized surface functional groups onto the microplastics surface due to the photodegradation. The Differential Scanning Calorimetry (DSC) analysis revealed an increased crystallinity for the photodegraded microplastics compared to the new samples. The gel permeation chromatography (GPC) demonstrated the reduced molecular weight for the polymer due to the photodegradation. This study provides an important opportunity to advance understanding of soil pollution. Understanding the plastic residuals’ variations as they are left in the soil is providing a critical piece of information to better estimate the microplastics' impacts on environmental biodiversity, ecosystem sustainability, and food safety.

Keywords: soil health, plastic pollution, sustainability, photodegradation

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991 The Study of Periodontal Health Status in Menopausal Women with Osteoporosis Referred to Rheumatology Clinics in Yazd and Healthy People

Authors: Mahboobe Daneshvar

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Introduction: Clinical studies on the effect of systemic conditions on periodontal diseases have shown that some systemic deficiencies may provide grounds for the onset of periodontal diseases. One of these systemic problems is osteoporosis, which may be a risk factor for the onset and exacerbation of periodontitis. This study tends to evaluate periodontal indices in osteoporotic menopausal women and compare them with healthy controls. Materials and Methods: In this case-control study, participants included 45-75-year-old menopausal women referred to rheumatology wards of the Khatamolanbia Clinic and Shahid Sadoughi Hospital in Yazd; Their bone density was determined by DEXA-scan and by imaging the femoral-lumbar bone. Thirty patients with osteoporosis and 30 subjects with normal BMD were selected. Then, informed consent was obtained for participation in the study. During the clinical examinations, tooth loss (TL), plaque index (PI), gingival recession, pocket probing depth (PPD), clinical attachment loss (CAL), and tooth mobility (TM) were measured to evaluate the periodontal status. These clinical examinations were performed to determine the periodontal status by catheter, mirror and probe. Results: During the evaluation, there was no significant difference in PPD, PI, TM, gingival recession, and CAL between case and control groups (P-value>0.05); that is, osteoporosis has no effect on the above factors. These periodontal factors are almost the same in both healthy and patient groups. In the case of missing teeth, the following results were obtained: the mean of missing teeth was 22.173% of the total teeth in the case group and 18.583% of the total teeth in the control group. In the study of the missing teeth in the case and control groups, there was a significant relationship between case and control groups (P-value = 0.025). Conclusion: In fact, since periodontal disease is multifactorial and microbial plaque is the main cause, osteoporosis is considered a predisposing factor in exacerbation or persistence of periodontal disease. In patients with osteoporosis, usually pathological fractures, hormonal changes, and aging lead to reduced physical activity and affect oral health, which leads to the manifestation of periodontal disease. But this disease increases tooth loss by changing the shape and structure of bone trabeculae and weakening them. Osteoporosis does not seem to be a deterministic factor in the incidence of periodontal disease, since it affects bone quality rather than bone quantity.

Keywords: plaque index, Osteoporosis, tooth mobility, periodontal packet

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990 Coordination of Traffic Signals on Arterial Streets in Duhok City

Authors: Dilshad Ali Mohammed, Ziyad Nayef Shamsulddin Aldoski, Millet Salim Mohammed

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The increase in levels of traffic congestion along urban signalized arterials needs efficient traffic management. The application of traffic signal coordination can improve the traffic operation and safety for a series of signalized intersection along the arterials. The objective of this study is to evaluate the benefits achievable through actuated traffic signal coordination and make a comparison in control delay against the same signalized intersection in case of being isolated. To accomplish this purpose, a series of eight signalized intersections located on two major arterials in Duhok City was chosen for conducting the study. Traffic data (traffic volumes, link and approach speeds, and passenger car equivalent) were collected at peak hours. Various methods had been used for collecting data such as video recording technique, moving vehicle method and manual methods. Geometric and signalization data were also collected for the purpose of the study. The coupling index had been calculated to check the coordination attainability, and then time space diagrams were constructed representing one-way coordination for the intersections on Barzani and Zakho Streets, and others represented two-way coordination for the intersections on Zakho Street with accepted progression bandwidth efficiency. The results of this study show great progression bandwidth of 54 seconds for east direction coordination and 17 seconds for west direction coordination on Barzani Street under suggested controlled speed of 60 kph agreeable with the present data. For Zakho Street, the progression bandwidth is 19 seconds for east direction coordination and 18 seconds for west direction coordination under suggested controlled speed of 40 kph. The results show that traffic signal coordination had led to high reduction in intersection control delays on both arterials.

Keywords: bandwidth, congestion, coordination, traffic, signals, streets

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