Search results for: long term care facility

Authors: Ahmad Zulfahmi Mohd Kamaruzaman, Mohd Ismail Ibrahim, Ariffin Marzuki Mokhtar, Maizun Mohd Zain, Saiful Nazri Satiman, Mohd Najib Majdi Yaacob

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Background: Aftermath any patient safety incidents, the involved healthcare providers possibly sustained second victim-related distress (second victim distress and reduced their professional efficacy), with subsequent negative work-related outcomes or vice versa cultivating resilience. This study aimed to investigate the factors affecting negative work-related outcomes and resilience, with the triad of support; colleague, supervisor, and institutional support as the hypothetical mediators. Methods: This was a cross sectional study recruiting a total of 733 healthcare providers from three tertiary care in Kelantan, Malaysia. Three steps of hierarchical linear regression were developed for each outcome; negative work-related outcomes and resilience. Then, four multiple mediator models of support triad were analyzed. Results: Second victim distress, professional efficacy, and the support triad contributed significantly for each regression model. In the pathway of professional efficacy on each negative work-related outcomes and resilience, colleague support partially mediated the relationship. As for second victim distress on negative work related outcomes, colleague and supervisor support were the partial mediator, and on resilience; all support triad also produced a similar effect. Conclusion: Second victim distress, professional efficacy, and the support triad influenced the relationship with the negative work-related outcomes and resilience. Support triad as the mediators ameliorated the effect in between and explained the urgency of having good support for recovery post encountering patient safety incidents.

Keywords: second victims, patient safety incidents, hierarchical linear regression, mediation, support

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Authors: Patti Kastanias, Wei Wang, Karyn Mackenzie, Sandra Robinson, Susan Wnuk

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Obesity is a worldwide epidemic and is recognized as a chronic disease. Pain in the obese individual is a multidimensional issue. An increase in BMI is positively correlated with pain incidence and severity, especially in central obesity where individuals are twice as likely to have chronic pain. Both obesity and chronic pain are also associated with mood disorders. Pain is worse among obese individuals with depression and anxiety. Bariatric surgery provides patients with an effective solution for long-term weight loss and associated health problems. However, not much is known about acute and chronic pain after bariatric surgery and its contributing factors, including mood disorders. Nurse practitioners (NPs) at one large multidisciplinary bariatric surgery centre led two studies to examine acute and chronic pain and pain management over time after bariatric surgery. The purpose of the initial study was to examine the incidence and severity of acute and chronic pain after bariatric surgery. The aim of the secondary study was to further examine chronic pain, specifically looking at psychological factors that influence severity or incidence of both neuropathic and somatic pain as well as changes in opioid use. The initial study was a prospective, longitudinal study where patients having bariatric surgery at one surgical center were followed up to 6 months postop. Data was collected at 7 time points using validated instruments for pain severity, pain interference, and patient satisfaction. In the second study, subjects were followed longitudinally starting preoperatively and then at 6 months and 1 year postoperatively to capture changes in chronic pain and influencing variables over time. Valid and reliable instruments were utilized for all major study outcomes. In the first study, there was a trend towards decreased acute post-operative pain over time. The incidence and severity of chronic pain was found to be significantly reduced at 6 months post bariatric surgery. Interestingly, interference of chronic pain in daily life such as normal work, mood, and walking ability was significantly improved at 6 months postop however; this was not the case with sleep. Preliminary results of the secondary study indicate that pain severity, pain interference, anxiety and depression are significantly improved at 6 months postoperatively. In addition, preoperative anxiety, depression and emotional regulation were predictive of pain interference, but not pain severity. The results of our regression analyses provide evidence for the impact of pre-existing psychological factors on pain, particularly anxiety in obese populations.

Keywords: bariatric surgery, mood disorders, obesity, pain

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Authors: Paramita Nur Kurniati, Stanislaus Riyanta

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In the midst of the heightened usage of electronic money (e-money), Indonesian government expenditure is yet governed through cash-basis transactions. This conventional system brings about a number of potential risks and obstacles to operational conduct, including state financial liquidity issue. Consequently, Ministry of Finance is currently establishing the cashless payment methods for State Budget (APBN). Included in those advance methods is credit card facility as a government expenditure payment scheme. This policy is one of the innovations within the public sector learned from other countries’ best practices. Moreover, this particular method is already prominent within the private-sector realm. Qualitative descriptive analysis technique is implemented to evaluate the contemporary innovation of using government credit card in the path towards cashless society. This approach is expected to generate several benefits for the government, particularly in minimizing corruption within the state financial management. Effective coordination among policy makers and policy implementers is essential for the success of this policy’s exercise, without neglecting prudence and public transparency aspects. Government credit card usage shall be the potent resolution for enhancing the government’s overall public service performance.

Keywords: cashless basis, cashless society, government credit card, public sector innovation

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Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team

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Authors: T. M. Samuel, O. O. Aremu, I. O. Ismaila, L. I. Onu, B. O. Adetifa, S. E. Adegbite, O. O. Olokoshe

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The imperative of anthropometry in designing to fit cannot be overemphasized. Of essence is the variability of measurements among population for which data is collected. In this paper anthropometric data were collected for the design of gari-frying facility such that work system would be designed to fit the gari-frying population in the Southwestern states of Nigeria comprising Lagos, Ogun, Oyo, Osun, Ondo, and Ekiti. Twenty-seven body dimensions were measured among 120 gari-frying processors. Statistical analysis was performed using SPSS package to determine the mean, standard deviation, minimum value, maximum value and percentiles (2nd, 5th, 25th, 50th, 75th, 95th, and 98th) of the different anthropometric parameters. One sample t-test was conducted to determine the variation within the population. The 50th percentiles of some of the anthropometric parameters were compared with those from other populations in literature. The correlation between the worker’s age and the body anthropometry was also investigated.The mean weight, height, shoulder height (sitting), eye height (standing) and eye height (sitting) are 63.37 kg, 1.57 m, 0.55 m, 1.45 m, and 0.67 m respectively.Result also shows a high correlation with other populations and a statistically significant difference in variability of data within the population in all the body dimensions measured. With a mean age of 42.36 years, results shows that age will be a wrong indicator for estimating the anthropometry for the population.

Keywords: anthropometry, cassava processing, design to fit, gari-frying, workstation design

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Authors: Jennifer E Simpson

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Background and purpose: The ubiquitous use of the Internet and social media by children and young people has had a dual effect. The first is to open a world of possibilities and promise that is characterized by the ability to consume and create content, connect with friends, explore and experiment. The second relates to risks such as unsolicited requests, sexual exploitation, cyberbullying and commercial exploitation. This duality poses significant difficulties for a generation of foster carers and social workers who have no childhood experience to draw on in terms of growing up using the Internet, social media and digital devices. This presentation is concerned with the findings of a small qualitative study about the use of digital devices and the Internet by care-experienced young people to stay in touch with their families and the way this was managed by foster carers and social workers using specific parental mediation strategies. The findings highlight that restrictive strategies were used by foster carers and endorsed by social workers. An argument is made for an approach that develops a series of balanced solutions that move foster carers from such restrictive approaches to those that are grounded in co-use and are interpretive in nature. Methods: Using a purposive sampling strategy, 12 triads consisting of care-experienced young people (aged 13-18 years), their foster carers and allocated social workers were recruited. All respondents undertook a semi-structured interview, with the young people detailing what social media apps and other devices they used to contact their families via an Ecomap. The foster carers and social workers shared details of the methods and approaches they used to manage digital devices and the Internet in general. Data analysis was performed using a Framework analytic method to explore the various attitudes, as well as complementary and contradictory perspectives of the young people, their foster carers and allocated social workers. Findings: The majority of foster carers made use of parental mediation strategies that erred on the side of typologies that included setting rules and regulations (restrictive), ad-hoc checking of a young person’s behavior and device (monitoring), and software used to limit or block access to inappropriate websites (technical). It was noted that minimal use was made by foster carers of parental mediation strategies that included talking about content (active/interpretive) or sharing Internet activities (co-use). Amongst the majority of the social workers, they also had a strong preference for restrictive approaches. Conclusions and implications: Trepidations on the part of both foster carers and social workers about the use of digital devices and the Internet meant that the parental strategies used were weighted more towards restriction, with little use made of approaches such as co-use and interpretative. This lack of balance calls for solutions that are grounded in co-use and an interpretive approach, both of which can be achieved through training and support, as well as wider policy change.

Keywords: parental mediation strategies, risk, children in state care, online safety

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Authors: Deepthy Ann Joy, N. Sreedevi

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Hearing impairment (HI) at an early age, identified before the onset of language development can reduce the negative effect on speech and language development of children. Early rehabilitation is very important in the improvement of speech production in children with HI. Other than conventional hearing aids, Cochlear Implants are being used in the rehabilitation of children with HI. However, delay in acquisition of speech and language milestones persist in children with Cochlear Implant (CI). Delay in speech milestones are reflected through speech sound errors. These errors reflect the temporal and spectral characteristics of speech. Hence, acoustical analysis of the speech sounds will provide a better representation of speech production skills in children with CI. The present study aimed at investigating the acoustic characteristics of vowels in Malayalam speaking children with a cochlear implant. The participants of the study consisted of 20 Malayalam speaking children in the age range of four and seven years. The experimental group consisted of 10 children with CI, and the control group consisted of 10 typically developing children. Acoustic analysis was carried out for 5 short (/a/, /i/, /u/, /e/, /o/) and 5 long vowels (/a:/, /i:/, /u:/, /e:/, /o:/) in word-initial position. The responses were recorded and analyzed for acoustic parameters such as Vowel duration, Ratio of the duration of a short and long vowel, Formant frequencies (F₁ and F₂) and Formant Centralization Ratio (FCR) computed using the formula (F₂u+F₂a+F₁i+F₁u)/(F₂i+F₁a). Findings of the present study indicated that the values for vowel duration were higher in experimental group compared to the control group for all the vowels except for /u/. Ratio of duration of short and long vowel was also found to be higher in experimental group compared to control group except for /i/. Further F₁ for all vowels was found to be higher in experimental group with variability noticed in F₂ values. FCR was found be higher in experimental group, indicating vowel centralization. Further, the results of independent t-test revealed no significant difference across the parameters in both the groups. It was found that the spectral and temporal measures in children with CI moved towards normal range. The result emphasizes the significance of early rehabilitation in children with hearing impairment. The role of rehabilitation related aspects are also discussed in detail which can be clinically incorporated for the betterment of speech therapeutic services in children with CI.

Keywords: acoustics, cochlear implant, Malayalam, vowels

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Authors: Khaled M. Ali, Ayman A. Mostafa, Soliman M. Soliman

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Objectives: To describe the most common clinical and endoscopic findings associated with complicated corneal ulcers in cats, and to determine the short-term outcomes after surgical treatment of these cats. Animals Eighteen client-owned cats of different breeds (52 females and 28 males), ranging in age from 3 months to 6 years, with corneal ulcers. Procedures: Cats were clinically evaluated to initially determine the concurrent corneal abnormalities. Endoscopic examination was performed to determine the anterior and posterior segments abnormalities. Superficial and deep stromal ulcers were treated using conjunctival flap. Corneal sequestrum was treated by partial keratectomy and conjunctival flap. Anterior synechia was treated via peripheral iridectomy and separation of the adhesion between the iris and the inner cornea. Symblepharon was treated by removal of the adhered conjunctival membrane from the cornea. Incurable endophthalmitis was treated surgically by extirpation. Short-term outcomes after surgical managements of selected corneal abnormalities were then assessed clinically and endoscopically. Results: Deep stromal ulcer with descemetocele, endophthalmitis, symblepharon, corneal sequestration and anterior synechia with secondary glaucoma and corneal scarring were the most common complications of corneal ulcer. FHV-1 was a common etiologic factor of corneal ulceration. Persistent corneal scars of varying shape and size developed in cats with deep stromal ulcer, anterior synechia, and corneal sequestration. Conclusions: Domestic shorthaired and Persian cats were the most predisposed breeds to FHV-1 infection and subsequent corneal ulceration. Immediate management of patients with corneal ulcer would prevent serious complications. No age or sex predisposition to complicated corneal ulceration in cats.

Keywords: cats, complicated corneal ulceration, clinical, endoscopic diagnosis, FHV-1

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Authors: Adi Sharabi, Dafna Marom-Golan

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Parents’ involvement in the care of their children with Autism Spectrum Disorder (ASD) and its beneficial effect on the children’s developmental and educational outcomes is well documented. At the same time, parents of children with ASD tend to experience greater psychological distress than parents of children with other developmental disabilities or with typical development. Positive social support is an important resource used by parents to reduce their psychological distress. The goal of the current research was to examine the contribution of formal and informal social support in explaining mothers’ and fathers’ involvement with their young children with ASD. The sample consisted of 107 parents who live in Israel (61 mothers and 46 fathers) of children aged between 2 and 7, all diagnosed with ASD and attending special kindergartens or special day care for children with ASD. Parental involvement and social support perception were assessed. Initial analysis focused on the relations between involvement, support, and demographic variables. In addition, analysis of variance (ANOVA) was conducted to test differences between mothers and fathers. Two hierarchical multiple regression analyses were performed to examine the predicted factors in the involvement model while controlling for group (mothers/fathers). Results indicate that mothers reported significantly higher levels of parenting involvement than fathers. Mothers reported higher levels of general involvement and all sub-types of involvement. For example, mothers reported that they were more interested in and have higher levels of attendance in their child’s educational program. They were also more collaborative in their child’s educational therapeutic program, and socialized with other parents of children from their child’s kindergarten than fathers. Mothers’ involvement was found to be related to their informal support (non-formal relatives). Findings also reveal significant differences between mothers and fathers on the formal support subscale measure of specializes services. Fathers, more than mothers, reported more specializes services support such as social workers or professional therapists. Separate hierarchical multiple regression analyses revealed a unique gender difference in the factors that explained parental involvement. Specifically, informal support only had a unique positive contribution in explaining mothers’, but not fathers’ involvement. This study highlights the central role of mothers in maintaining constant contact with the educational system and the professionals who help care for their child with ASD. At the same time, this research emphasizes the crucial role of both mothers and fathers in their child's development and well-being at every development stage, particularly in early development. Further, different kinds of social support seem to relate to the different kinds of parental involvement. It is in the best interest of educators and family therapists who work with families with children with ASD to support the cohesiveness of the family and the collaboration of the parents by understanding and respecting the way each member addresses the responsibilities of parenting a child with ASD, and her or his need for different types of social support.

Keywords: parental differences, parental involvement, social support, specialized support services

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Authors: M. Manohari, Himanshu Gupta, S. Priyadharshini, R. Santhanam, S. Chandrasekaran, B. Venkatraman

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Injection is one of the potential routes of intake in a radioactive facility. The internal dose due to this intake is monitored at the radiation emergency medical centre, IGCAR using a portable planar HPGe detector. The contaminated wound may be having different shapes. In a reprocessing potential of wound contamination with actinide is more. Efficiency is one of the input parameters for estimation of internal dose. Estimating these efficiencies experimentally would be tedious and cumbersome. Numerical estimation can be a supplement to experiment. As an initial step in this study 241Am contamination of different shapes are studied. In this study portable planar HPGe detector was modeled using Monte Carlo code FLUKA and the effect of different parameters like distance of the contamination from the detector, radius of the circular contamination were studied. Efficiency values for point and surface contamination located at different distances were estimated. The effect of efficiency on the radius of the surface source was more predominant when the source is at 1 cm distance compared to when the source to detector distance is 10 cm. At 1 cm the efficiency decreased quadratically as the radius increased and at 10 cm it decreased linearly. The point source efficiency varied exponentially with source to detector distance.

Keywords: Planar HPGe, efficiency value, injection, surface source

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Authors: Mehdi Ghatei, Masoomeh Lorestani

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Upstream Tailings Storage Facilities (TSFs) may experience slope instabilities due to soil liquefaction, especially in regions known to be seismically active. In this study, liquefaction susceptibility of an upstream-raised TSF in Western Australia was assessed using two different approaches. The first approach assessed liquefaction susceptibility using Cone Penetration Tests with pore pressure measurement (CPTu) as described by the National Centre for Earthquake Engineering Research (NCEER). This assessment was based on the four CPTu tests that were conducted on the perimeter embankment of the TSF. The second approach used the Finite Element (FE) method with application of an equivalent linear model to predict the undrained cyclic behavior, the pore water pressure and the liquefaction of the materials. The tailings parameters were estimated from the CPTu profiles and from the laboratory tests. The cyclic parameters were estimated from the literature where test results of similar material were available. The results showed that there was a good agreement, in the liquefaction susceptibility of the tailings material, between the NCEER and FE methods with equivalent linear model.

Keywords: liquefaction , CPTU, NCEER, finite element method, equivalent linear model

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Authors: Abeer N. Alshukairi, Abdulrahman A. Alrajhi, Abdulfattah W. Alamri, Adel F. Alothman

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We described the nosocomial transmission of a pre-XDR or an MDR case of pulmonary tuberculosis in a HIV negative health care worker in an area endemic for MDR & XDR tuberculosis. With inadequate therapy and non-compliance, his strain developed acquired resistance and he presented with extra-pulmonary XDR tuberculosis in the form of multi-focal osteomyelitis and encysted pleural effusion. He was cured after 2 years of therapy with various anti-tuberculous drugs in addition to interferon gamma.

Keywords: osteomyelitis, treatment, XDR tuberculosis, successful treatment

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Authors: Prashant Verma, Prafulla K. Swain, K. K. Singh, Mukti Khetan

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Objective: In India, around 20,000 women die every year due to abortion-related complications. In the modelling of count variables, there is sometimes a preponderance of zero counts. This article concerns the estimation of various count regression models to predict the average number of spontaneous abortion among women in the Punjab state of India. It also assesses the factors associated with the number of spontaneous abortions. Materials and methods: The study included 27,173 married women of Punjab obtained from the DLHS-4 survey (2012-13). Poisson regression (PR), Negative binomial (NB) regression, zero hurdle negative binomial (ZHNB), and zero-inflated negative binomial (ZINB) models were employed to predict the average number of spontaneous abortions and to identify the determinants affecting the number of spontaneous abortions. Results: Statistical comparisons among four estimation methods revealed that the ZINB model provides the best prediction for the number of spontaneous abortions. Antenatal care (ANC) place, place of residence, total children born to a woman, woman's education and economic status were found to be the most significant factors affecting the occurrence of spontaneous abortion. Conclusions: The study offers a practical demonstration of techniques designed to handle count variables. Statistical comparisons among four estimation models revealed that the ZINB model provided the best prediction for the number of spontaneous abortions and is recommended to be used to predict the number of spontaneous abortions. The study suggests that women receive institutional Antenatal care to attain limited parity. It also advocates promoting higher education among women in Punjab, India.

Keywords: count data, spontaneous abortion, Poisson model, negative binomial model, zero hurdle negative binomial, zero-inflated negative binomial, regression

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Authors: Zhao Yang Liu, Jing Tao

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The Asian long-horned beetle, Anoplophora glabripennis (Motschulsky) (Coleoptera: Cerambycidae: Lamiinae), is a wood-borer and polyphagous xylophages native to Asia and killing healthy trees. As it causes serious danger to trees, the beetle has been paid close attention in the world. However, the genetic markers limited, especially microsatellite. In this study, 24 novel simple sequence repeat (SSR) molecular markers, a powerful tool for genetic diversity studies and linkage map construction, were developed and characterized from whole genome shotgun sequences. We developed SSR loci of 2 to 6 repeated and perfect units including 9895 points, the density of SSRs was found one SSR per 56.57 kb and the abundance of SSR was 0.02/kb, besides 140 types of repeats motifs were found. Half of the 48 pairs SSR primers (containing 4 di-, 7 tri-, 2 tetra- and 11 hexamers SSRs) we selected randomly from 1222 pairs of primers were polymorphism. The number of alleles for these markers in 48 individuals varied from 3 to 21 with an average of 7.71, the number of effective alleles ranged from 1.22 to 9.97 with an average of 3.54. Besides this, the polymorphic information content (PIC) ranged from 0.18 to 0.89 with a mean of 0.65, And Shannon's Information index (I) ranged from 0.46 to 2.62 with an average of 1.44. The results suggest that the method for screening of SSR in the whole genome is feasible and efficient. SSR markers developed in this study can be used for population genetic studies of A. glabripennis. Moreover, they may also be helpful for the development of microsatellites for other Coleoptera.

Keywords: SSR markers, Anoplophora glabripennis, genetic diversity, whole genome

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Authors: Khadijeh Abhari, Seyed Shahram Shekarforoush, Saeid Hosseinzadeh

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An in vivo trial was conducted to evaluate the effects of Bacillus coagulans, and inulin, either separately or in combination, on lipid profile using a rat model. Thirty-two male Wistar rats were randomly divided into four groups (n=8) and fed as follows: standard diet (control), standard diet with 5% w/w long chain inulin (prebiotic), standard diet with 109 spores/day spores of B. coagulans by orogastric gavage (probiotic), and standard diet with 5% w/w long chain inulin and 109 spores/day of B. coagulans (synbiotic). Rats were fed the treatments for 30 days. Serum samples were collected 10, 20 and 30 days following onset of treatment. Total cholesterol, HDL and LDL cholesterol and triglycerides concentrations were analyzed. Results of this study showed that inulin potentially affected the lipid profile. An obvious decrease in serum total cholesterol and LDL-cholestrol of rats fed with inulin in synbiotic and prebiotic groups was seen in all sampling days. Inulin fed rats also demonstrated higher levels of HDL-cholesterol concentration; however this value in probiotic and control fed rats remains without significant change. According to the results of this study, B. coagulans did not contribute to any lipid profile changes after 30 days. Thus, further in vitro investigations on the characteristic of these bacteria could be useful to gain insights into understanding the treatment of probiotics in order to achieve the maximum beneficial effect.

Keywords: bacillus coagulans, inulin, rat, lipid profile, synbiotic diet

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Authors: Mohd Aftar Abu Bakar, Noratiqah Mohd Ariff, Abdul Aziz Jemain

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Storm Event Analysis (SEA) provides a method to define rainfalls events as storms where each storm has its own amount and duration. By modelling daily probability of different types of storms, the onset, offset and cycle of rainfall seasons can be determined and investigated. Furthermore, researchers from the field of meteorology will be able to study the dynamical characteristics of rainfalls and make predictions for future reference. In this study, four categories of storms; short, intermediate, long and very long storms; are introduced based on the length of storm duration. Daily probability models of storms are built for these four categories of storms in Peninsular Malaysia. The models are constructed by using Bernoulli distribution and by applying linear regression on the first Fourier harmonic equation. From the models obtained, it is found that daily probability of storms at the Eastern part of Peninsular Malaysia shows a unimodal pattern with high probability of rain beginning at the end of the year and lasting until early the next year. This is very likely due to the Northeast monsoon season which occurs from November to March every year. Meanwhile, short and intermediate storms at other regions of Peninsular Malaysia experience a bimodal cycle due to the two inter-monsoon seasons. Overall, these models indicate that Peninsular Malaysia can be divided into four distinct regions based on the daily pattern for the probability of various storm events.

Keywords: daily probability model, monsoon seasons, regions, storm events

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Authors: Priyanka Patil, Logan Manikam

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Background: The first 1000 days of life are a critical window and can result in adverse health consequences due to inadequate nutrition. South-Asian (SA) communities face significant health disparities, particularly in maternal and child health. Community-based interventions, often employing Participatory-Learning and Action (PLA) approaches, have effectively addressed health inequalities in lower-income nations. The aim of this study was to assess the feasibility of implementing a PLA intervention to improve infant feeding and care practices in SA communities living in London. Methods: Comprehensive analyses were conducted to assess the feasibility/fidelity of this pilot randomized controlled trial. Summary statistics were computed to compare key metrics, including participant consent rates, attendance, retention, intervention support, and perceived effectiveness, against predefined progression rules guiding toward a definitive trial. Secondary outcomes were analyzed, drawing insights from multiple sources, such as The Children’s-Eating-Behaviour Questionnaire (CEBQ), Parental-Feeding-Style Questionnaires (PFSQ), Food-diary, and the Equality-Impact-Assessment (EIA) tool. A video analysis of children's mealtime behavior trends was conducted. Feedback interviews were collected from study participants. Results: Process-outcome measures met predefined progression rules for a definitive trial, which deemed the intervention as feasible and acceptable. The secondary outcomes analysis revealed no significant changes in children's BMI z-scores. This could be attributed to the abbreviated follow-up period of 6 months, reduced from 12 months, due to COVID-19-related delays. CEBQ analysis showed increased food responsiveness, along with decreased emotional over/undereating. A similar trend was observed in PFSQ. The EIA tool found no potential discrimination areas, and video analysis revealed a decrease in force-feeding practices. Participant feedback revealed improved awareness and knowledge sharing. Conclusion: This study demonstrates that a co-adapted PLA intervention is feasible and well-received in optimizing infant-care practices among South-Asian community members in a high-income country. These findings highlight the potential of community-based interventions to enhance health outcomes, promoting health equity.

Keywords: child health, childhood obesity, community-based, infant nutrition

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Authors: Ho-Hsin Lee, Yue-Min Jiang, Shu-Hui Tsai, Jian-Ren Chen, Mei-Yu XU, Wen-Tien Wu

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This project presents an AI-based method and system for wound status analysis. The system uses a three-in-one sensor device to analyze wound status, including color, temperature, and a 3D sensor to provide wound information up to 2mm below the surface, such as redness, heat, and blood circulation information. The system has a 90% accuracy rate, requiring only one manual correction in 70% of cases, with a one-second delay. The system also provides an offline application that allows for manual correction of the wound bed range using color-based guidance to estimate wound bed size with 96% accuracy and a maximum of one manual correction in 96% of cases, with a one-second delay. Additionally, AI-assisted wound bed range selection achieves 100% of cases without manual intervention, with an accuracy rate of 76%, while AI-based wound tissue type classification achieves an 85.3% accuracy rate for five categories. The AI system also includes similar case search and expert recommendation capabilities. For AI-assisted wound range selection, the system uses WIFI6 technology, increasing data transmission speeds by 22 times. The project aims to save up to 64% of the time required for human wound record keeping and reduce the estimated time to assess wound status by 96%, with an 80% accuracy rate. Overall, the proposed AI method and system integrate multiple sensors to provide accurate wound information and offer offline and online AI-assisted wound bed size estimation and wound tissue type classification. The system decreases delay time to one second, reduces the number of manual corrections required, saves time on wound record keeping, and increases data transmission speed, all of which have the potential to significantly improve wound care and management efficiency and accuracy.

Keywords: wound status analysis, AI-based system, multi-sensor integration, color-based guidance

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Authors: Freda Sinclair

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The purpose of this paper is to examine the impact of IPV on the family and how to best provide services for this population who suffer in silence from PTSD, medical and mental health issues and living in fear of their partner who is causing them harm. Although this is a societal issue, those in the underserved communities face even greater implications due to lack of education, language barriers, housing and financial insecurity, and overall fear of systems that seem to punish and re-traumatize them when seeking help. This paper examines the systems that treat the underserved and fail them due to their lack of knowledge, implicit biases, and failure to provide adequate time and patience to observe and provide what the family needs when they come to service providers seeking assistance and support. The methodology used examines a qualitative and quantitative study of homeless women and their families seeking safe shelter away from their partners who are causing harm. The study examines ways in which they became known to the system by way of medical, mental health, substance abuse or child welfare authorities. Found that due to the myriad of families facing countless needs, research has found that using trained therapists along with promising practice and/or evidence-based practice models best supports the needs of the families while addressing their trauma and meeting their concrete needs. The implications are that we need more trained clinicians who are sympathetic to this population and are willing to maintain up to date information to help them best serve their community and provide the best possible care. The findings give insight into how this study can be examined on a broader scale and give policy implications of how to serve best all people who are exposed to IPV, trauma, and PTSD and feel as if they are overlooked by society. There are greater implications for needed research to better support all people who live in fear of the people who harm them and best practice, support and outreach that can give best practice care to those who are in need at the most vulnerable times of their lives.

Keywords: trauma, PTSD, IPV, EBP

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Authors: Panwad Wongthong, Thanan Apivantanaporn, Sutthiwan Amattayakul

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Nature-based tourism is one of the fastest growing industries that can bring in economic benefits, improve quality of life and promote conservation of biodiversity and habitats. As tourism develops, substantial socio-economic and environmental costs become more explicit. Particularly in island destinations, the dynamic system and geographical limitations makes the intensity of tourism development and severity of the negative environmental impacts greater. The current contribution of the tourism sector to global climate change is established at approximately 5% of global anthropogenic CO2 emissions. In all scenarios, tourism is anticipated to grow substantially and to account for an increasingly large share of global greenhouse gas emissions. This has prompted an urgent call for more sustainable alternatives. This study selected a small island of Koh Mak in Thailand as a case study because of its reputation of being laid back, family oriented and rich in biodiversity. Importantly, it is a test platform for low carbon tourism development project supported by the Designated Areas for Sustainable Tourism Administration (DASTA) in collaboration with the Institute for Small and Medium Enterprises Development (ISMED). The study explores strategies for low carbon tourism management and assesses challenges and opportunities for Koh Mak to become a low carbon tourism destination. The goal is to identify suitable management approaches applicable for Koh Mak which may then be adapted to other small islands in Thailand and the region. Interventions/initiatives to increase energy efficiency in hotels and resorts; cut carbon emissions; reduce impacts on the environment; and promote conservation will be analyzed. Ways toward long-term sustainability of climate-friendly tourism will be recommended. Recognizing the importance of multi-stakeholder involvement in the tourism sector, findings from this study can reward Koh Mak tourism industry with a triple-win: cost savings and compliance with higher standards/markets; less waste, air emissions and effluents; and better capabilities of change, motivation of business owners, staff, tourists as well as residents. The consideration of climate change issues in the planning and implementation of tourism development is of great significance to protect the tourism sector from negative impacts.

Keywords: climate change, CO2 emissions, low carbon tourism, sustainable tourism management

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Authors: Muuz Abraha Meshesha

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Illegal Migration, specifically Trafficking in person is one of the primary issues of the day affecting all states of the world with variation on the extent of the root causes and consequences that led people to migrate irregularly and the consequences it is costing on humanity. This paper intends to investigate the root causes and consequences of illegal migration in Ethiopia’s Tigray Regional state and come up with alternative intervening strategy. To come up with pertinent and robust research finding, this study employed mixed research approach involving qualitative and quantitative data in line with purposive and snow ball sampling selection technique. The study revealed that, though poverty is the most commonly sensed pushing factor for people to illegally migrate, the issue of psycho-social orientation and attitudinal immersion of the local community for illegal migration, both in thinking and action is the most pressing problem that urges serious intervention. Trafficking in persons and Illegal migration in general, is becoming the norm of the day in the study area that overtly reveal illegal migration is an issue beyond livelihood securing demand in practice. Basically, parties engaged in illegal migration and the accomplice with human traffickers these days in the study area are found to be more than urgency for food security and a need to escape from livelihood impoverishment. Therefore, this study come up with a new paradigm insight indicating that illegal migration is believed by the local community members as an optional path way of doing business in illegal way while the attitude of the community and officials authorized to regulate is being part of the channel or to the least tolerant of this grave global danger. The study also found that the effect of illegal migration is significantly manifested in long run than in short term periods. Therefore, a need for critical consideration on attitudinal based intervention and youth oriented and enforceable legal and policy framework accountability framework is required to face and control illegal migration by international, national, local stakeholders. Besides this, economy based development interventions that could engage and reorient the youth, as primary victims of trafficking, and expansion of large scale projects that can employ large number of youths at a time.

Keywords: human traficking, illegal migration, migration, tigray region

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Authors: Alokananda Ghosh, Shraban Sarkar

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The study aims to identify suitable sites for new hospitals with critical obstetric care facilities in Birbhum, one of the vulnerable and underserved districts of Eastern India, considering six main and 14 sub-criteria, using GIS-based Analytic Hierarchy Process (AHP) and Multi-Attribute Utility Theory (MAUT) approach. The criteria were identified through field surveys and previous literature. After collecting expert decisions, a pairwise comparison matrix was prepared using the Saaty scale to calculate the weights through AHP. On the contrary, objective weighting methods, i.e., Entropy and Criteria Importance through Interaction Correlation (CRITIC), were used to perform the MAUT. Finally, suitability maps were prepared by weighted sum analysis. Sensitivity analyses of AHP were performed to explore the effect of dominant criteria. Results from AHP reveal that ‘maternal death in transit’ followed by ‘accessibility and connectivity’, ‘maternal health care service (MHCS) coverage gap’ were three important criteria with comparatively higher weighted values. Whereas ‘accessibility and connectivity’ and ‘maternal death in transit’ were observed to have more imprint in entropy and CRITIC, respectively. While comparing the predictive suitable classes of these three models with the layer of existing hospitals, except Entropy-MAUT, the other two are pointing towards the left-over underserved areas of existing facilities. Only 43%-67% of existing hospitals were in the moderate to lower suitable class. Therefore, the results of the predictive models might bring valuable input in future planning.

Keywords: hospital site suitability, analytic hierarchy process, multi-attribute utility theory, entropy, criteria importance through interaction correlation, multi-criteria decision analysis

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Authors: Hanjun Hu, Jinxiang Zhang

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With the decline of "growthism", China's urbanization process has shifted from the stage of spatial expansion to the stage of optimization of built-up spaces, and urban renewal has gradually become a new wave of China's urban movement in recent years. The ongoing urban renewal movement in China not only needs to generate new motivation for urban development but also solve the backlog of social problems caused by rapid urbanization, which provides an opportunity for the transformation of China's urban governance model. Unlike previous approaches that focused on physical space and functional renewal, such as urban reconstruction, redevelopment, and reuse, the key challenge of urban renewal in the post-growth era lies in coordinating the complex interest relationships between multiple stakeholders. The traditional theoretical frameworks that focus on the structural relations between social groups are insufficient to explain the behavior logic and mutual cooperation mechanism of various groups and individuals in the current urban renewal practices. Therefore, based on the long-term tracking of the urban renewal practices in the Old City of Nanjing (OCN), this paper introduces the "collective action" theory to deeply analyze changes in the urban renewal governance model in OCN and tries to summarize the governance strategies that promote the formation of collective action within recent practices from a micro-scale. The study found that the practice in OCN experienced three different stages "government-led", "growth coalition" and "asymmetric game". With the transformation of government governance concepts, the rise of residents' consciousness of rights, and the wider participation of social organizations in recent years, the urban renewal in OCN is entering a new stage of "collective renewal action". Through the establishment of the renewal organization model, incentive policies, and dynamic negotiation mechanism, urban renewal in OCN not only achieves a relative balance between individual interests and collective interests but also makes the willingness of residents the dominant factor in formulating urban renewal policies. However, the presentation of "collective renewal action" in OCN is still mainly based on typical cases. Although the government is no longer the dominant role, a large number of resident-led collective actions have not yet emerged, which puts forward new research needs for a sustainable governance policy innovation in this action.

Keywords: urban renewal, collective action theory, governance, cooperation mechanism, China

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Authors: Karimeh Alnuaimi, Manal Kassab, Reem Ali, Khitam Mohammad, Kholoud Shattnawi

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Aim: To compare pregnancy outcomes of Syrian refugee women and Jordanian women. Background and introduction: The current conflict in Syria continues to displace thousands to neighboring countries, including Jordan. Pregnant refugee women are therefore facing many difficulties are known to increase the prevalence of poor reproductive health outcomes and antenatal complications. However, there is very little awareness of whether Syrian refugee women have different risks of pregnancy outcomes than Jordanian women. Methods: Using a retrospective cohort design, we examined pregnancy outcomes for Syrian refugee (N = 616) and Jordanian women (N = 644) giving birth at two governmental Hospitals in the north of Jordan, between January 1, 2014, and December 31, 2014. A checklist of 13 variables was utilized. The primary outcome measures were delivery by Caesarean section, maternal complications, low birth weight (< 2500 g), Apgar score and preterm delivery (< 37 weeks' gestational age). Results: Statistical analysis revealed that refugee mothers had a significant increase in the rate of cesarean section and the higher rate of anemia, a lower neonates’ weight, and Apgar scores when compared to their Jordanian counterparts. Discussion and Conclusion: Results were congruent with findings from other studies in the region and worldwide. Minimizing inequalities in pregnancy outcomes between Syrian refugees and Jordan women is a healthcare priority. Implications for nursing and health policy: The findings could guide the planning and development of health policies in Jordan that would help to alleviate the situation regarding refugee populations. The action is required by the policy makers, specifically targeting public and primary health care services, to address the problem of adequately meeting the need for antenatal care of this vulnerable population.

Keywords: pregnancy, Syrian refugee, Jordanian women, comparative study

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Authors: Muhammad Umar

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Safety and Assets management is considering a backbone of every department. GIS in the Railway become very important to Manage Assets and Security through Digital Maps and Web based GIS Maps. It provides a complete frame of work to the organization for the management of assets. Pakistan Railway is the most common and safest mode of traveling in Pakistan. Due to ever-increasing demand of transporting huge amount of information generated from various sources and this information must be accurate. This creates problems for Passengers and Administration that causes finical and time loss. GIS Solve this problem by Digital Maps & Database. It provides you a real time Spatial and Statistical analysis that helps you to communicate and exchange the information in a sophisticated way to the users. GIS Based Web system provides a facility to different end user to make query at a time as per requirements. This GIS System provides an advancement in an organization for a complete Monitoring, Safety and Decision System for tracks, Stations and Junctions that further use for the Analysis of different areas i.e. analysis of tracks, junctions and Stations in case of reconstruction, Rescue for rail accidents and Natural disasters .This Research work helps to reduce the financial loss and reduce human mistakes helps you provide a complete security and Management system of assets.

Keywords: Geographical Information System (GIS) for assets management, geo spatial database, railway assets management, Pakistan

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Authors: Hassan Alsada

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Tank overfill accidents are major concerns for industries handling large volumes of hydrocarbons. Buncefield, Jaipur, Puerto Rico, and West Virginia are just a few accidents with catastrophic consequences. Thus, it is very important for any industry to take the right safety measures for overfill prevention. Moreover, one of the main causative factors in the overfill accidents was inadequate risk analysis and, subsequently, inadequate design. This study aims to provide a full assessment in accordance with the Functional safety standard: “IEC 615 11 – Safety instrumented systems for the process industry” to the tank overfill scenario according to the standard’s Safety Life Cycle (SLC), which includes: the analysis phase, the implementation phase, and the operation phase. The paper discusses in depth the tank overfills Independent Protection Layers (IPLs) with systematic analysis to avoid the safety risks of under-design and the financial risk of facility overdesign. The result shows a clear and systematic assessment in compliance with the standards that can help to assist existing tank overfilling setup or a guide to support designing new storage facilities overfill protection.

Keywords: IEC 61511, PHA, LOPA, process safety, safety, health, environment, safety instrumented systems, safety instrumented function, functional safety, safety life cycle

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Authors: F. Lazzeri, I. Reiter

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Energy production optimization has been traditionally very important for utilities in order to improve resource consumption. However, load forecasting is a challenging task, as there are a large number of relevant variables that must be considered, and several strategies have been used to deal with this complex problem. This is especially true also in microgrids where many elements have to adjust their performance depending on the future generation and consumption conditions. The goal of this paper is to present a solution for short-term load forecasting in microgrids, based on three machine learning experiments developed in R and web services built and deployed with different components of Cortana Intelligence Suite: Azure Machine Learning, a fully managed cloud service that enables to easily build, deploy, and share predictive analytics solutions; SQL database, a Microsoft database service for app developers; and PowerBI, a suite of business analytics tools to analyze data and share insights. Our results show that Boosted Decision Tree and Fast Forest Quantile regression methods can be very useful to predict hourly short-term consumption in microgrids; moreover, we found that for these types of forecasting models, weather data (temperature, wind, humidity and dew point) can play a crucial role in improving the accuracy of the forecasting solution. Data cleaning and feature engineering methods performed in R and different types of machine learning algorithms (Boosted Decision Tree, Fast Forest Quantile and ARIMA) will be presented, and results and performance metrics discussed.

Keywords: time-series, features engineering methods for forecasting, energy demand forecasting, Azure Machine Learning

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Authors: Nambiar Ritu, Ali Ban, Munawar Farida, Israell Imelda, T. Farouk Eman Rasheeda, Jangalgi Renuka, S. Boma Nellie

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Aim: To define the ultrasonographic endometrial thickness (USG ET) cutoff for evacuation of retained pieces of conception (ERPC). Background: Studies of conservative management of 1st trimester miscarriage have questioned the need for post miscarriage curettage. Therapeutic decision making with transvaginal scan post miscarriage endometrial thickness in patients clinically thought to be incomplete miscarriage is often not clear. Method: Retrospective analysis of all 1ST trimester ERPC at Al Rahba Hospital from June 2012 to July 2013 was done. Total of 164 patients underwent ERPC. All cases were reviewed for pre-operative USG ET and post ERPC histopathological examination. TVS was done to evaluate the maximum ET of the uterine cavity along the long axis of the uterus and features of retained products was noted. All cases without preoperative USG ET measurement were excluded from the study, therefore only 62 out of 164 cases were included in the study. The patients were divided into three groups: o Group A: have retained products within endometrial cavity. o Group B: endometrial thickness equal or more than 20 mm. o Group C: endometrial thickness equal or less than 19.9 mm. o Post ERPC product was sent for HPE and the results were compared. Transvaginal sonographic findings can be used as a deciding factor in the management of patients with 1st trimester miscarriage who need ERPC. Our proposed cutoff in clinically stable patients requiring ERPC is more than 20 mm.

Keywords: ERPC, histopathological examination, long axis of the uterus, USG ET

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Authors: Jamila Fakchich, Mostafa Jamila Lazaar Elachouri, Lakhder Fakchich, Fatna Ouali, Abd Errazzak Belkacem

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Diabetes is a chronic metabolic disease that has a significant impact on the health, quality of life, and life expectancy of patients as well as the health care system. By its nature diabetes, is a multisystem disease with wide-ranging complication that span nearly all region of the body. This epidemic problem, however, is not unique to the industrialized society, but has also hardly struck the developing countries. In Morocco, as developing country, there is an epidemic rise in diabetes, with ensuing concern about the management and control of this disease; it began a chronic burdensome disease of largely middle-aged and elderly people, with a long course and serious complications often resulting in high death-rate, the treatment of diabetes spent vast amount of resources including medicines, diets, physical training. Treatment of this disease is considered problematic due to the lack of effective and safe drugs capable of inducing sustained clinical, biochemical, and histological cure. In Moroccan society, the phytoremedies are some times the only affordable sources of healthcare, particularly for the people in remote areas. In this paper, we present a synthesis work obtained from the ethnobotanical data reported in different specialized journals. A Synthesis of four published ethnobotanical studies that have been carried out in different region of Morocco by different team seekers during the period from 1997 to 2015. Medicinal plants inventoried by different seekers in four Moroccan’s areas have been regrouped and codified, then, Factorial Analysis (FA) and Principal Components Analysis (PCA) are used to analyse the aggregated data from the four studies and plants are classified according to their frequency of use by population. Our work deals with an attempt to gather information on some traditional uses of medicinal plants from different regions of Morocco, also, it was designed to give a set of medicinal plants commonly used by Moroccan people in the treatment of diabetes; In this paper, we intended to provide a basic knowledge about plant species used by Moroccan society for treatment of diabetes. One of the most interesting aspects of this type of works is to assess the relative cultural importance of medicinal plants for specific illnesses and exploring its usefulness in the context of diabetes.

Keywords: Morocco, medicinal plants, ethnobotanical, diabetes, phytoremedies

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Authors: A. F. Jaber, E. Dean, M. Liu, J. He, D. Sabata, J. Radel

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Background: Stroke is a serious health care concern and a major cause of disability in the United States. This condition impacts the individual’s functional ability to perform daily activities. Predicting functional performance of people with stroke assists health care professionals in optimizing the delivery of health services to the affected individuals. The purpose of this study was to identify significant predictors of Motor FIM and of Cognitive FIM subscores among individuals with stroke after discharge from inpatient rehabilitation (typically 4-6 weeks after stroke onset). A second purpose is to explore the relation among personal characteristics, health status, and functional performance of daily activities within 2 weeks of stroke onset. Methods: This study used a retrospective chart review to conduct a secondary analysis of data obtained from the Healthcare Enterprise Repository for Ontological Narration (HERON) database. The HERON database integrates de-identified clinical data from seven different regional sources including hospital electronic medical record systems of the University of Kansas Health System. The initial HERON data extract encompassed 1192 records and the final sample consisted of 207 participants who were mostly white (74%) males (55%) with a diagnosis of ischemic stroke (77%). The outcome measures collected from HERON included performance scores on the National Institute of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), and the Functional Independence Measure (FIM). The data analysis plan included descriptive statistics, Pearson correlation analysis, and Stepwise regression analysis. Results: significant predictors of discharge Motor FIM subscores included age, baseline Motor FIM subscores, discharge NIHSS scores, and comorbid electrolyte disorder (R2 = 0.57, p <0.026). Significant predictors of discharge Cognitive FIM subscores were age, baseline cognitive FIM subscores, client cooperative behavior, comorbid obesity, and the total number of comorbidities (R2 = 0.67, p <0.020). Functional performance on admission was significantly associated with age (p < 0.01), stroke severity (p < 0.01), and length of hospital stay (p < 0.05). Conclusions: our findings show that younger age, good motor and cognitive abilities on admission, mild stroke severity, fewer comorbidities, and positive client attitude all predict favorable functional outcomes after inpatient stroke rehabilitation. This study provides health care professionals with evidence to evaluate predictors of favorable functional outcomes early at stroke rehabilitation, to tailor individualized interventions based on their client’s anticipated prognosis, and to educate clients about the benefits of making lifestyle changes to improve their anticipated rate of functional recovery.

Keywords: functional performance, predictors, stroke, recovery

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