Search results for: elderly care facilities

Authors: Usharani Rathinam

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Although policies directing inclusion of marginalized were in effect, majority of chronically impoverished in India belonged to schedule caste and schedule tribes. Also, taking into account that poverty is gendered; destitute women belonged to lower social order whose need is not largely highlighted at policy level. This paper discusses on social relations poverty which highlights on how social order that existed structurally in the society can perpetuate chronic poverty, followed by a critical review on social inclusion policies of India, its merits and demerits in addressing chronic poverty. Multiple case study design is utilized to address this concern in four districts of India; Jhansi, Tikamgarh, Cuddalore and Anantapur. These four districts were selected by purposive sampling based on the criteria; the district should either be categorized as a backward district or should have a history of high poverty rate. Qualitative methods including eighty in-depth interviews, six focus group discussions, six social mapping procedures and three key informant interviews were conducted in 2011, at each of the locations. Analysis of the data revealed that irrespective of gender, schedule castes and schedule tribe participants were found to be chronically poor in all districts. Caste based discrimination is exhibited at both micro and macro levels; village and institutional levels. At village level, lower caste respondents had lesser access to public resources. Also, within institutional settings, due to confiscation, unequal access to resources is noticed, especially in fund distribution. This study found that half of the budget intended for schedule caste and schedule tribes were confiscated by upper caste administrative staffs. This implies that power based on social hierarchy marginalize lower caste participants from accessing better economic, social, and political benefits, that had led them to suffer long term poverty. This study also explored the traditional ties between caste, social structure and bonded labour as a cause of long-term poverty. Though equal access is being emphasized in constitutional rights, issues at micro level have not been reflected in formulation of these rights. Therefore, it is significant for a policy to consider the structural complexity and then focus on issues such as equal distribution of assets and infrastructural facilities that will reduce exclusion and foster long-term security in areas such as employment, markets and public distribution.

Keywords: caste, inclusion policies, India, social order

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Authors: Geetha Baskaran, Andrzej Barjiela, Rong Qu

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Motivation: Nurse scheduling is a complex combinatorial optimization problem. It is also known as NP-hard. It needs an efficient re-scheduling to minimize some trade-off of the measures of violation by reducing selected constraints to soft constraints with measurements of their violations. Problem Statement: In this paper, we extend our novel approach to solve the nurse scheduling problem by transforming it through Information Granulation. Approach: This approach satisfies the rules of a typical hospital environment based on a standard benchmark problem. Generating good work schedules has a great influence on nurses' working conditions which are strongly related to the level of a quality health care. Domain transformation that combines the strengths of operation research and artificial intelligence was proposed for the solution of the problem. Compared to conventional methods, our approach involves judicious grouping (information granulation) of shifts types’ that transforms the original problem into a smaller solution domain. Later these schedules from the smaller problem domain are converted back into the original problem domain by taking into account the constraints that could not be represented in the smaller domain. An Integer Programming (IP) package is used to solve the transformed scheduling problem by expending the branch and bound algorithm. We have used the GNU Octave for Windows to solve this problem. Results: The scheduling problem has been solved in the proposed formalism resulting in a high quality schedule. Conclusion: Domain transformation represents departure from a conventional one-shift-at-a-time scheduling approach. It offers an advantage of efficient and easily understandable solutions as well as offering deterministic reproducibility of the results. We note, however, that it does not guarantee the global optimum.

Keywords: domain transformation, nurse scheduling, information granulation, artificial intelligence, simulation

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Authors: R. R. Dewi Rahmawaty Aktyani Putri, Earmporn Thongkrajai, Dedy Purwito

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There were many instruments have been developed to assess social support which has the different dimension in breast cancer patients. The Issue of measurement is a challenge to determining the component of dimensional concept, defining the unit of measurement, and establishing the validity and reliability of the measurement. However, the instruments where need to know how much support which obtained and perceived among women with breast cancer who undergone chemotherapy which it can help nurses to prevent of non-adherence in chemotherapy. This study aimed to measure the reliability of BC-SSAS instrument among 30 Indonesian women with breast cancer aged 18 years and above who undergone chemotherapy for six cycles in the oncological unit of Outpatient Department (OPD), Margono Soekardjo Hospital, Central Java, Indonesia. Data were collected during October to December 2015 by using modified the Breast Cancer Social Support Assessment (BC-SSAS). The Cronbach’s alpha analysis was carried out to measure internal consistency for reliability test of BC-SSAS instrument. This study used five experts for content validity index. The results showed that for content validity, I-CVI was 0.98 and S-CVI was 0.98; Cronbach’s alpha value was 0.971 and the Cronbach’s alpha coefficients for the subscales were high, with 0.903 for emotional support, 0.865 for informational support, 0.901 for tangible support, 0.897 for appraisal support and 0.884 for positive interaction support. The results confirmed that the BC-SSAS instrument has high reliability. BC-SSAS instruments were reliable and can be used in health care services to measure the social support received and perceived among women with breast cancer who undergone chemotherapy so that preventive interventions can be developed and the quality of health services can be improved.

Keywords: BC-SSAS, women with breast cancer, chemotherapy, Indonesia

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Authors: William L. Whitehouse, Louisa H. Y. Lo, Andrew B. Kinghorn, Simon C. C. Shiu, Julian. A. Tanner

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C-reactive protein (CRP) is an acute-phase reactant and sensitive indicator for sepsis and other life-threatening pathologies, including systemic inflammatory response syndrome (SIRS). Currently, clinical turn-around times for established CRP detection methods take between 30 minutes to hours or even days from centralized laboratories. Here, we report the development of an electrochemical biosensor using redox probe-tagged DNA aptamers functionalized onto cheap, commercially available screen-printed electrodes. Binding-induced conformational switching of the CRP-targeting aptamer induces a specific and selective signal-ON event, which enables single-step and reagentless detection of CRP in as little as 1 minute. The aptasensor dynamic range spans 5-1000nM (R=0.97) or 5-500nM (R=0.99) in 50% diluted human serum, with a LOD of 3nM, corresponding to 2-orders of magnitude sensitivity under the clinically relevant cut-off for CRP. The sensor is stable for up to one week and can be reused numerous times, as judged from repeated real-time dosing and dose-response assays. By decoupling binding events from the signal induction mechanism, structure-switching electrochemical aptamer-based sensors (SS-EABs) provide considerable advantages over their adsorption-based counterparts. Our work expands on the retinue of such sensors reported in the literature and is the first instance of an SS-EAB for reagentless CRP detection. We hope this study can inspire further investigations into the suitability of SS-EABs for diagnostics, which will aid translational R&D toward fully realized devices aimed at point-of-care applications or for use more broadly by the public.

Keywords: structure-switching, C-reactive protein, electrochemical, biosensor, aptasensor.

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Authors: Amel Osman, Stewart McKenna

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Aim: Fever may present as the sole sign of a serious underlying infection in young infants. Febrile Infants aged less than 90 days are at an elevated susceptibility to invasive bacterial infections, thus presenting a challenge in ensuring the appropriate management of these cases. This study aims to ensure strict adherence to NICE guidelines for the management of fever in infants between 0 and 90 days presenting to Tallaght Hospital ED. A comprehensive audit, followed by a re-audit, was conducted to enhance the quality of care delivered to these patients. In accordance with NICE guidelines, all febrile infants should undergo blood tests. Additionally, LP should be performed in all neonates under 28 days, infants displaying signs of illness, and those with WCC below 5 or above 15. Method: A retrospective case review was performed, encompassing all patients aged between 0 to 90 days who presented with fever at Tallaght ED. Data retrieval was conducted from electronic records on two separate occasions, six months apart. The evaluation encompassed the assessment of body temperature as well as both partial and full septic workups. Results: Over the study period, 150 infants presented to the ED with fever in the initial audit, and 120 in the re-audit. In the first study, 81 patients warranted a full septic workup as per NICE, but only 48 received it. Conversely, 40 patients met criteria for a partial septic workup, with 12 undergoing blood tests. In the second study, 73 patients qualified for a full septic workup, of which 52 were completed. Additionally, 27 patients were indicated for a partial workup, with 20 undergoing blood tests. Conclusion: Managing febrile infants under three months of age presenting to Tallaght ED remains a persistent challenge, underscoring the need for continuous educational initiatives to guarantee that these patients receive the requisite assessments and treatments.

Keywords: infants, fever, septic workup, tallaght

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Authors: Maria Del Mar Maira Vidal, Alvaro Briales

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In this paper, we will conduct an analysis of the results of the I+D+i research project “New types of socio-existential vulnerability, support and care in Spain” (VULSOCU) (2016-20). This project had the objective to analyze the new types of vulnerability that are the result of the combination of several factors as the economic crisis, the unemployment, the transformations of the Welfare State, the individualization, etc. We have, therefore, analyzed the way that Spanish long-term unemployed over 45 years experience vulnerability and its consequences on their lives. We have focused on long-term unemployed over 45 that had previously developed stable career paths and have been looking for a job for two years or more. In order to carry out this analysis, we will try to break the dichotomy between the social and the individual, between the socio-historical and the subjectivity, to overcome some of the limits of the research on unemployment. The fieldwork consisted of more than ten focus groups and fifty in-depth interviews. The work and life ethics completely changed at the turn of the nineteenth and twentieth centuries. In the nineteenth century, companies had trouble maintaining their staff, but in the 21st century, unemployed workers feel that they are useless people. Workers value themselves if they have a job. This unveils that labor is a comprehensive social relationship in capitalist societies. In general, unemployed workers are not able to analyze their unemployment as a social problem. They analyze their unemployment as an individual problem. They blame themselves for their unemployment; instead of taking into account that there are millions of unemployed, they talk about themselves as if they were on their own. And the problems caused by unemployment are explained as psychological problems and are medicalized. Anyway, it is important to highlight that this is the result of an ideology and a social relationship that is part of our historical time.

Keywords: life ethics, work ethics, unemployment, unemployed over 45 years old

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Authors: I. L. Kim, J. Y. Lee, A. K. Tekile

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In consequence of the very high urbanization rate of Korea, the number of traffic noise damages in areas congested with population and facilities is steadily increasing. The current environmental noise levels data in major cities of the country show that the noise levels exceed the standards set for both day and night times. This research was about comparative analysis in search for optimal soundproof panel shape and design factor that can minimize sound reflection noise. In addition to the normal flat-type panel shape, the reflection noise reduction of swelling-type, combined swelling and curved-type, and screen-type were evaluated. The noise source model Nord 2000, which often provides abundant information compared to models for the similar purpose, was used in the study to determine the overall noise level. Based on vehicle categorization in Korea, the noise levels for varying frequency from different heights of the sound source (directivity heights of Harmonize model) have been calculated for simulation. Each simulation has been made using the ray-tracing method. The noise level has also been calculated using the noise prediction program called SoundPlan 7.2, for comparison. The noise level prediction was made at 15m (R1), 30 m (R2) and at middle of the road, 2m (R3) receiving the point. By designing the noise barriers by shape and running the prediction program by inserting the noise source on the 2nd lane to the noise barrier side, among the 6 lanes considered, the reflection noise slightly decreased or increased in all noise barriers. At R1, especially in the cases of the screen-type noise barriers, there was no reduction effect predicted in all conditions. However, the swelling-type showed a decrease of 0.7~1.2 dB at R1, performing the best reduction effect among the tested noise barriers. Compared to other forms of noise barriers, the swelling-type was thought to be the most suitable for reducing the reflection noise; however, since a slight increase was predicted at R2, further research based on a more sophisticated categorization of related design factors is necessary. Moreover, as swellings are difficult to produce and the size of the modules are smaller than other panels, it is challenging to install swelling-type noise barriers. If these problems are solved, its applicable region will not be limited to other types of noise barriers. Hence, when a swelling-type noise barrier is installed at a downtown region where the amount of traffic is increasing every day, it will both secure visibility through the transparent walls and diminish any noise pollution due to the reflection. Moreover, when decorated with shapes and design, noise barriers will achieve a visual attraction than a flat-type one and thus will alleviate any psychological hardships related to noise, other than the unique physical soundproofing functions of the soundproof panels.

Keywords: reflection noise, shaped noise barriers, sound proof panel, traffic noise

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Authors: Igor Pejic

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The main focus of this research will be on analyzing correlative links between terrorism as an asymmetrical threat and the consequences it leaves on conventional security forces. The methodology behind the research will include qualitative research methods focusing on comparative analysis of books, scientific papers, documents and other sources, in order to deduce, explore and formulate the results of the research. With the coming of the 21^st century and the rising multi-polar, new world threats quickly emerged. The realistic approach in international relations deems that relations among nations are in a constant state of anarchy since there are no definitive rules and the distribution of power varies widely. International relations are further characterized by egoistic and self-orientated human nature, anarchy or absence of a higher government, security and lack of morality. The asymmetry of power is also reflected on countries' security capabilities and its abilities to project power. With the coming of the new millennia and the rising multi-polar world order, the asymmetry of power can be also added as an important trait of the global society which consequently brought new threats. Among various others, terrorism is probably the most well-known, well-based and well-spread asymmetric threat. In today's global political arena, terrorism is used by state and non-state actors to fulfill their political agendas. Terrorism is used as an all-inclusive tool for regime change, subversion or a revolution. Although the nature of terrorist groups is somewhat inconsistent, terrorism as a security and social phenomenon has a one constant which is reflected in its political dimension. The state's security apparatus, which was embodied in the form of conventional armed forces, is now becoming fragile, unable to tackle new threats and to a certain extent outdated. Conventional security forces were designed to defend or engage an exterior threat which is more or less symmetric and visible. On the other hand, terrorism as an asymmetrical threat is a part of hybrid, special or asymmetric warfare in which specialized units, institutions or facilities represent the primary pillars of security. In today's global society, terrorism is probably the most acute problem which can paralyze entire countries and their political systems. This problem, however, cannot be engaged on an open field of battle, but rather it requires a different approach in which conventional armed forces cannot be used traditionally and their role must be adjusted. The research will try to shed light on the phenomena of modern day terrorism and to prove its correlation with the state conventional armed forces. States are obliged to adjust their security apparatus to the new realism of global society and terrorism as an asymmetrical threat which is a side-product of the unbalanced world.

Keywords: asymmetrical warfare, conventional forces, security, terrorism

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Authors: Opara Monica, Suriani Ismail, Ahmad Iqmer Nashriq Mohd Nazan

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The true magnitude of the mortality and morbidity attributable to malaria worldwide is, at best, a scientific guess, although it is not disputable that the greatest burden is in sub-Saharan Africa. Those at highest risk are children younger than 5 years and pregnant women, particularly primigravidae. Nationally, malaria remains the third leading cause of death and is still considered a major public health problem. Therefore, this study is aimed to assess the effectiveness of health education intervention on insecticide-treated net use and its practices among pregnant women attending antenatal clinics. Materials and Methods: This study will be an intervention study with two arms double parallel randomized controlled trial (blinded) to be conducted in 3 stages. The first stage will develop health belief model (HBM) program, while in the second stage, pregnant women will be recruited, assessed (baseline data), randomized into two arms of the study, and follow-up for six months. The third stage will evaluate the impact of the intervention on HBM and disseminate the findings. Data will be collected with the use of a structured questionnaire which will contain validated tools. The main outcome measurement will be the treatment effect using HBM, while data will be analysed using SPSS, version 22. Discussion: The study will contribute to the existing knowledge on hospital-based care programs for pregnant women in developing countries where the literature is scanty. It will generally give insight into the importance of HBM measurement in interventional studies on malaria and other related infectious diseases in this setting.

Keywords: malaria, health education, insecticide-treated nets, sub-Saharan Africa

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Authors: Artitaya Sabangbal, Darawan Augsornwan, Palakorn Surakunprapha, Lalida Petphai

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Background: Srinagarind Hospital Ward 3C has about 180 cases of patients with head and neck cancer per year. Almost all of these patients suffer with pain, fatigue, low self image, swallowing problem and when the tumor is larger they will have breathing problem. Many of them have complication after operation such as pressure sore, pneumonia, deep vein thrombosis. Nursing activity is very important to prevent the complication especially promoting patients early ambulation. The objective of this study was to develop early ambulation protocol for patients with head and neck cancer undergoing operation. Method: this study is one part of nursing system development in patients undergoing operation in Ward 3C. It is a participation action research divided into 3 phases Phase 1 Situation review: In this phase we review the clinical outcomes, process of care, from document such as nurses note and interview nurses, patients and family about early ambulation. Phase 2 Searching nursing intervention about early ambulation from previous study then establish protocol . This phase we have picture package of early ambulation. Phase 3 implementation and evaluation. Result: Patients with head and neck cancer after operation can follow early ambulation protocol 100%, 85 % of patients can follow protocol within 2 days after operation and 100% can follow protocol within 3 days. No complications occur. Patients satisfaction in very good level is 58% and in good level is 42% Length of hospital stay is 6 days in patients with wide excision and 16 day in patients with flap coverage. Conclusion: The early ambulation protocol is appropriate for patients with head and neck cancer who undergo operation. This can restore physical health, reduce complication and increase patients satisfaction.

Keywords: nursing system, early ambulation, head and neck cancer, operation

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Authors: Ayesha Iftikhar, Faisal Hafeez, Muhammad Jawad Saleem, Afifa Naeem, Muhammad Sohaib

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To further develop integrated pest management (IPM) tactics against insect pests, demographic toxicology is considered important and efficient to evaluate the long-term effects of pesticides on biological control agents. In this study, lethal and sub-lethal effects of Pyriproxyfen (insect growth regulator) two concentrations of LC10 and LC30 were tested on second instar larvae of convergent lady beetle, Hippodamia convergens (Goeze) in order to evaluate the effect of insecticide on demographic parameters of the predator under laboratory conditions. The life table parameters were analysed statistically by using age-stage, two sex life table procedure. The results of this study show that developmental time for immature was prolonged in treated population (LC30 and LC10) rather than in control. Similarly, male and female longevity was also longer in the control group as compared to the treated population. Adult pre-oviposition period and fecundity were also greater in control as compared to the treated population. In addition, population parameters such as net reproductive rate (R0), intrinsic rate of increase (r) and finite rate of increase (λ) were also greater in control group rather than treated population. However, mean generation time (T) was greater in the treated group. The results revealed that pyriproxyfen, even at low concentrations, has potential to greatly affect the population growth of predatory lady beetle, therefore care should be taken when insect growth regulators are used within an IPM framework.

Keywords: ladybird beetle, IGR, integrated pest management, population inhibition

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Authors: Asmamaw Yehun

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The name “TANA” is one of International Geodetic Service (IGS) Global Positioning System (GPS) station which is found in Bahir Dar University in Institute of Land Administration. The station name taken from one of big Lakes in Africa ,Lake Tana. The Institute of Land Administration (ILA) is part of Bahir Dar University, located in the capital of the Amhara National Regional State, Bahir Dar. The institute is the first of its kind in East Africa. The station is installed by cooperation of ILA and Sweden International Development Agency (SIDA) fund support. The Continues Operating Reference Station (CORS) is a network of stations that provide global satellite system navigation data to help three dimensional positioning, meteorology, space, weather, and geophysical applications throughout the globe. TANA station was as CORS since 2013 and sites are independently owned and operated by governments, research and education facilities and others. The data collected by the reference station is downloadable through Internet for post processing purpose by interested parties who carry out GNSS measurements and want to achieve a higher accuracy. We made a first observation on TANA, monitor stations on May 29th 2013. We used Leica 1200 receivers and AX1202GG antennas and made observations from 11:30 until 15:20 for about 3h 50minutes. Processing of data was done in an automatic post processing service CSRS-PPP by Natural Resources Canada (NRCan) . Post processing was done June 27th 2013 so precise ephemeris was used 30 days after observation. We found Latitude (ITRF08): 11 34 08.6573 (dms) / 0.008 (m), Longitude (ITRF08): 37 19 44.7811 (dms) / 0.018 (m) and Ellipsoidal Height (ITRF08): 1850.958 (m) / 0.037 (m). We were compared this result with GAMIT/GLOBK processed data and it was very closed and accurate. TANA station is one of the second IGS station for Ethiopia since 2015 up to now. It provides data for any civilian users, researchers, governmental and nongovernmental users. TANA station is installed with very advanced choke ring antenna and GR25 Leica receiver and also the site is very good for satellite accessibility. In order to test hydrostatic and wet zenith delay for positional data quality, we used GAMIT/GLOBK and we found that TANA station is the most accurate IGS station in East Africa. Due to lower tropospheric zenith and ionospheric delay, TANA and ADIS IGS stations has 2 and 1.9 meters 3D positional accuracy respectively.

Keywords: atmosphere, GNSS, neutral atmosphere, precipitable water vapour

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Authors: Angalabiri-Owei E. Bekekeme, Brambaifa Nelson

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In view of the peculiar environment of the Niger Delta, access to modern health care is limited, hence the inhabitants especially those in the swampy areas resorts to sourcing for alternatives cure for their ailments using plants commonly found in this area without scientific evaluation. Rhizophora racemosa, G. F. Meyer (Rhizophoraceae) is the most abundant mangrove plant in the Niger Delta Area of Nigeria. The plant has been observed to be used for relief of a toothache and dysmenorrhoea among some Ijaw communities in the region. This work has revealed the likely potential of the plant in drug discovery and development. The crude methanol extract at doses of 300 mg/kg and 600 mg/kg (intraperitoneal) were tested for analgesic effect using fresh egg albumin induced inflammatory pain and Randall–Sellito method to assess the pain threshold. The anti-inflammatory effect was also evaluated with the extract at doses of 300 mg/kg and 600 mg/kg (intraperitoneal) using acute inflammatory model; fresh egg albumin induced paw oedema and assessed using Plethysmometer in rats. The methanol extracts 300 mg/kg and 600 mg/kg exhibited a significant (P < 0.001) and dose-dependent analgesic activity compared with the negative control and a standard drug diclofenac using ANOVA with Least Significant Difference post hoc test as evidenced by increased pain threshold. Also, the extract significantly (P < 0.001) reduced the rat paw oedema induced by the sub plantar injection of fresh egg albumin when compared with the negative control and a standard diclofenac using above statistical methods. This study revealed that the plant possesses analgesic and anti-inflammatory activities hence provide scientific bases for use as medicine.

Keywords: analgesic, anti-inflammatory, plethysmometer, Rhizophora racemosa

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Authors: Kevin Henry

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Introduction: This research identifies the main struggles of non-binary people in an organizational setting using the ZMET – method of in-depth interviews. The research was done in Iceland, a country that is repeatedly listed in the top countries for gender equality and found three main categories of non-binary struggles in organizations. These categories can be used to improve organizational non-binary inclusion. Aim: The main questions this paper will answer are: Which unique obstacles are non-binary people facing in their daily organizational life? Which organizational and individual measures help with more inclusion of non-binary people? How can organizational gender equality measures be made more inclusive of non-binary issues? Background: Even though gender equality is a much-researched topic, the struggles of non-binary people are often overlooked in gender equality research. Additionally, non-binary and transgender people are frequently researched together, even though their struggles can be very different. Research focused on non-binary people is, in many cases, done on a more structural or organizational level with quantitative data such as salary or position within an organization. This research focuses on the individual and their struggles with qualitative data to derive measures for non-binary inclusion and equality. Method: An adapted approach of the ZMET-Method (Zaltman Metaphor Elicitation Technique) will be used, during which in-depth interviews are held with individuals, utilizing pictures as a metaphorical starting point to discuss their main thoughts and feelings on being non-binary in an organizational setting. Interviewees prepared five pictures, each representing one key thought or feeling about their organizational life. The interviewer then lets the interviewee describe each picture and asks probing questions to get a deeper understanding of each individual topic. This method helps with a mostly unbiased data collection process by only asking probing questions during the interview and not leading the interviewee in any certain direction. Results: This research has identified three main categories of struggles non-binary people are facing in an organizational setting: internal (personal) struggles, external struggles and structural struggles. Internal struggles refer to struggles that originate from the person themselves (e.g., struggles with their own identity). External struggles refer to struggles from the outside (e.g. harassment from coworkers, exclusion). Structural struggles refer to struggles that are built into the organizational policy or facilities (e.g. restrooms, gendered language). Conclusion: This study shows that there are many struggles for non-binary people in organizations and that even in countries that pride themselves on being progressive and having a high level of gender equality, there is still much to be done for non-binary inclusion. Implications for Organizations: Organizations that strive to improve the inclusion of all genders should pay attention to how their structures are built, how their training is conducted, and how their policies affect people of various genders. Simple changes like making restrooms gender-neutral and using neutral language in company communications are good examples of small structural steps for more inclusion.

Keywords: gender equality, non-binary, organizations, ZMET

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Authors: Noof Eid Al Shammari

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Background: Living with haemodialysis (HD) can impose several physical and social restrictions on the lives of individuals. Usually, the patient has three dialysis sessions per week that each run for three to four hours. This limits the social life of patients and causes a lower quality of life, in conjunction with the fact that people with chronic kidney disease must follow strict fluid and food regimens and use multiple medications. Given these factors, patients undergoing HD generally need psychological support. Objective: This scoping review study aims to evaluate the effectiveness of physical and breathing exercises on quality of life (QOL) and psychophysical status in patients undergoing HD. Methodology: Searches for relevant studies were performed in four databases (MEDLINE, CINAHL, Google Scholar, and PubMed) for articles published between 2011 and 2021. Out of all the searched literature, ten studies met the inclusion criteria (8 randomised controlled trials, one quasi-experimental study, and one pilot study), with a total of 588 patients. Different types of physical and breathing exercises were used (breathing, cardiopulmonary, and physical exercises). Results: All included studies in this scoping review revealed that most of the aerobic or anaerobic exercises, as well as breathing exercises, had a positive effect and significantly improved patients’ QOL, physical functioning, and psychological status. Conclusions: In this review, most of the articles demonstrated a positive effect of physical and breathing exercises on the QOL and psychophysical status of HD patients. Based on the findings of these studies, physical and breathing exercises were shown to improve muscle strength and other health-related aspects of QOL, including sexual, social, cognitive, and physical functions. However, more studies will need to be conducted with a larger sample to determine the best intervention that could be implemented and standardised in nursing care for patients undergoing HD.

Keywords: physical exercise, breathing exercises, quality of life, depression, hemodialysis

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Authors: Orapan Thosingha, Tassana Boontong, Prapa Yuttatri, Vilaivan Thongcharoen, Soparn Potaya, Mattika Chaichan, Chanin Chakkrapopyodhin, Khwanthida Phimphakarn, Taddao Nabnean

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This research aimed to explore symptom experiences among Thai adults with chronic illnesses living in an urban community area of Bangkok. The sample was 670 adults with ages ranging from 20-59 years. The majority of them (65.2%) had more than one disease. Hypertension, dyslipidemia, and diabetes were the first three diseases among them. About 58% were female, and 51.1 % stayed with their couples. The studied sample had relatively low socioeconomic status; 33.7% were wage workers, 15.2% were street vendors, and 10.4% were unemployed. About 54 % had family incomes less than 10,000 baht (300 US Dollars) per month, and 41.6% addressed that their incomes were not adequate for daily living. Although the majority of them (63.7%) did not have to pay for hospital visits, they still had to pay for public transportation and could not earn a wage or any income on the hospital visit day. The first three physical symptoms they experienced were knee pain (60.5%) due to being overweight, headache (47.0%), and insomnia (44.6%). About 45% stated that their incomes decreased after having chronic illnesses and 37.2% expressed that having lower incomes affected their living, 34.5% perceived being a burden, and 34.3% regret about depending on others. It can be concluded that adults with low socioeconomic status who experienced chronic illnesses and resided in an urban community area had complex needs. While caring for them, nurses should pay attention not only to a disease-related domain but also to a social-related domain. Reached-out clinics led by professional nurses who are well-prepared for primary medical care and home visit are strongly recommended. National Health Security Office should adopt this policy and develop an action plan to serve the needs of chronically ill adults with low socioeconomic status.

Keywords: chronic illnesses, urban community, socioeconomic status, symptom experiences, low incomes

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Authors: Mohammad Nazri Mustafa, Sh Norliza Sy Salim, Pedram Hatami Abdullah

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Civil and structural assets normally have an average of more than 30 years of design life. Adding to this advantage, the assets are normally subjected to slow degradation process. Due to the fact that repair and strengthening work for these assets are normally not dependent on plant shut down, the maintenance and integrity restoration of these assets are mostly done based on “as required” and “run to failure” basis. However unlike other industries, the exposure in oil and gas environment is harsher as the result of corrosive soil and groundwater, chemical spill, frequent wetting and drying, icing and de-icing, steam and heat, etc. Due to this type of exposure and the increasing level of structural defects and rectification in line with the increasing age of plants, assets integrity assessment requires a more defined scope and procedures that needs to be based on risk and assets criticality. This leads to the establishment of risk based inspection and proactive maintenance procedure for civil and structural assets. To date there is hardly any procedure and guideline as far as integrity assessment and systematic inspection and maintenance of civil and structural assets (onshore) are concerned. Group Technical Solutions has developed a procedure and guideline that takes into consideration credible failure scenario, assets risk and criticality from process safety and structural engineering perspective, structural importance, modeling and analysis among others. Detailed inspection that includes destructive and non-destructive tests (DT & NDT) and structural monitoring is also being performed to quantify defects, assess severity and impact on integrity as well as identify the timeline for integrity restoration. Each defect and its credible failure scenario is assessed against the risk on people, environment, reputation and production loss. This technical paper is intended to share on the established procedure and guideline and their execution in oil & gas plants. In line with the overall roadmap, the procedure and guideline will form part of specialized solutions to increase production and to meet the “Operational Excellence” target while extending service life of civil and structural assets. As the result of implementation, the management of civil and structural assets is now more systematically done and the “fire-fighting” mode of maintenance is being gradually phased out and replaced by a proactive and preventive approach. This technical paper will also set the criteria and pose the challenge to the industry for innovative repair and strengthening methods for civil & structural assets in oil & gas environment, in line with safety, constructability and continuous modification and revamp of plant facilities to meet production demand.

Keywords: assets criticality, credible failure scenario, proactive and preventive maintenance, risk based inspection

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Authors: Nannapus Saramad, Rewwadee Petsirasan, Jom Suwanno

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Background: This retrospective study design was to describe average blood pressure, blood pressure level, target blood pressure control rate post-stroke BP control in the year following discharge from Sichon hospital, Sichon District, Nakhon Si Thammarat province. The secondary data analysis was employed from the patient’s health records with patient or caregiver interview. A total of 232 eligible post-acute ischemic strokes in the year following discharge (2017-2018) were recruited. Methods: Data analyses were applied to identify the relationship values of single variables were determined through univariate analyses: The Chi-square test, Fisher exact test, the variables found to have a p-value < 0.2 were analyzed by the binary logistic regression Results: Most of the patients in this study were men 61.6%, an average age of 65.4 ± 14.8 years. Systolic blood pressure levels were in the grade 1-2 hypertension and diastolic pressure at optimal and normal at all times during the initial treatment through the present. The results revealed 25% among the groups under the age of 60 achieved BP control; 36.3% for older than 60 years group; and 27.9% for diabetic group. The multivariate analysis revealed the final relationship of four significant variables: 1) receiving calcium-channel blocker (p =.027); 2) medication adherence of antihypertensive (p = .024) 3) medication adherence of antiplatelet ( p = .020); and 4) medication behavior ( p = . 010) . Conclusion: The medical nurse and health care provider should promote their adherence to behavior to improve their blood pressure control.

Keywords: acute ischemic stroke, target blood pressure control, medication adherence, recurrence stroke

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Authors: Catarina Ramos Pereira, Jorge Rodrigues, Natália Oliveira, Jorge Machado, Maria Begoña Criado, Jorge Machado, Henri J. Greten

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Background: Parkinson's disease is a multi-system neurodegenerative disorder characterized by motor and non-motor symptoms. To slow disorder progression, different treatment options are now available, but in most cases, these therapeutic strategies also involve the presence of important side effects. This has led many patients to pursue complementary therapies, such as acupuncture, to alleviate PD symptoms. Therefore, an update on the efficacy of this treatment for patients of PD is of great value. This work presents a systematic review of the efficacy of acupuncture treatments in relieving PD symptoms. Methods: EMBASE, Medline, Pubmed, Science Direct, The Cochrane Library, Cochrane Central Register of Controlled Trials (Central), and Scielo databases were systematically searched from January 2011 through July 2021. Randomized controlled trials (RCTs) published in English with all types of acupuncture treatment were included. The selection and analysis of the articles were conducted by two blinding authors through the Rayyan application. Results: 720 potentially relevant articles were identified; 52 RCTs met our inclusion criteria. After the exclusion of 35, we found 17 eligible. The included RCTs reported positive effects for acupuncture plus conventional treatment compared with conventional treatment alone in the UPDRS score. Conclusions: Additional evidence should be supported by rigorous methodological strategies. Although firm conclusions cannot be drawn, acupuncture treatment, in the framework of an interdisciplinary care team, appears to have positive effects on PD symptoms.

Keywords: systematic review, Parkinson disease, acupuncture, traditional Chinese medicine

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Authors: Ahmed Borg, Elsa Aristodemou, Attia Attia

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Well control involves managing the circulating drilling fluid within the wells and avoiding kicks and blowouts as these can lead to losses in human life and drilling facilities. Current practices for good control incorporate predictions of pressure losses through computational models. Developing a realistic hydraulic model for a good control problem is a very complicated process due to the existence of a complex multiphase region, which usually contains a non-Newtonian drilling fluid and the miscibility of formation gas in drilling fluid. The current approaches assume an inaccurate flow fluid model within the well, which leads to incorrect pressure loss calculations. To overcome this problem, researchers have been considering the more complex two-phase fluid flow models. However, even these more sophisticated two-phase models are unsuitable for applications where pressure dynamics are important, such as in managed pressure drilling. This study aims to develop and implement new fluid flow models that take into consideration the miscibility of fluids as well as their non-Newtonian properties for enabling realistic kick treatment. furthermore, a corresponding numerical solution method is built with an enriched data bank. The research work considers and implements models that take into consideration the effect of two phases in kick treatment for well control in conventional drilling. In this work, a corresponding numerical solution method is built with an enriched data bank. Software STARCCM+ for the computational studies to study the important parameters to describe wellbore multiphase flow, the mass flow rate, volumetric fraction, and velocity of each phase. Results showed that based on the analysis of these simulation studies, a coarser full-scale model of the wellbore, including chemical modeling established. The focus of the investigations was put on the near drill bit section. This inflow area shows certain characteristics that are dominated by the inflow conditions of the gas as well as by the configuration of the mud stream entering the annulus. Without considering the gas solubility effect, the bottom hole pressure could be underestimated by 4.2%, while the bottom hole temperature is overestimated by 3.2%. and without considering the heat transfer effect, the bottom hole pressure could be overestimated by 11.4% under steady flow conditions. Besides, larger reservoir pressure leads to a larger gas fraction in the wellbore. However, reservoir pressure has a minor effect on the steady wellbore temperature. Also as choke pressure increases, less gas will exist in the annulus in the form of free gas.

Keywords: multiphase flow, well- control, STARCCM+, petroleum engineering and gas technology, computational fluid dynamic

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Authors: Laid Fekih

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Background: Depression affects people in all communities across the world and in all aspects of their lives. Its spread varies from one country to another, can happen at any age and get rid of it is not easy. There is no clear policy in Algeria's higher education institutions to detect and treat these disorders or pay particular attention to those at risk. Identifying the prevalence of depression among Algerian students, its correlation with different variables, and studying gender differences in the light of a range of variables is necessary to develop an appropriate plan to raise the level of hope and love of life among students. Method: Random samples of 1500 University of Tlemcen students (967 girls and 533 boys), aged 19 to 24 years completed a self-administered questionnaire that included Beck's Depression Inventory ®-II (BDI®-II), (School Health Promotion: The Mood part), Other questions included in this survey focused on demographic characteristics including gender, age and year of study, academic performance (Annual Average Score (0-20) AAS), were examined. Results: The rate of depression (moderate, severe and extreme) varied from 03% to 13% among university students in Tlemcen University. There was no difference in the rates of depression in male and female students, which means that male and female students do have similar rates of depression. The rate of depression in the first-year of the study shows a higher score relative to students of other years. Depression has a negative relationship with academic performance, which means that depressed students have many difficulties in academic tasks at university. Conclusion: Depression among university students is an important center of interest in the world, not only because of the ease with which they can be followed, or the difficulties encountered during their studies and their technical courses but for the link between the level of depression and the quality of care of mental health services, especially if many students with mood and emotional problems don't meet the criteria for psychotherapy.

Keywords: depression, epidemiology, university students, academic performance

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Authors: Farhana Nosheen, Maleeha Fatima

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This study on Afghan refugee women living in Punjab, Pakistan, shows a strong relationship between poor socio-economic status and lower nutritional health status. Pakistan is one of the significant countries accepting refugees from the Afghan war. Universally, refugees are vulnerable to food security and basic life necessities. The in-hand study aimed to investigate food insecurity among afghan refugees who recently migrated to Pakistan. Purposive sampling technique was employed to collect the data from afghan women refugees settled in refugee camp settled in Capital city Islamabad, Pakistan. Data was collected through an interview tool. It revealed from data that the majority of women were underweight, about 74.7% in their reproductive years, which is an alarming situation for the forthcoming children and families. It is also shown that There’s a strong impact of their income level, education, dietary habits and food insecurity on their overall health status. It can also be observed in their Body Mass Index and in their physical appearance; they also show extremely poor levels of hemoglobin which is directly indicated anemic condition, especially iron deficiency anemia among the young Afghan refugee women. The illiteracy rate is about 93.33% among the selected participants as well as a majority of this population has 10-12 family size in comparison with their income level of about 10,000-15,000 Pakistani rupees per month, which can hardly meet their daily food expenditure. Adequate food is rarely accessible to young girls and women due to fewer national and international food aids program available in Pakistan. The majority have pale yellowish skin color (due to low iron content) along with clear white eyes (low hemoglobin level), thin hairs (protein deficiency) and spoon-shaped nails (a direct indicator of low iron level). Data showed a significant relation between appetite and BMI as their appetite is very low, which is directly indicated in their underweight body condition. About 56.67% of the participants had Urinary Tract Infections. The main causes included personal unhygienic conditions and lack of washrooms as well as drinking water facilities in their refugee camps. It is suggested that National and international food aid programs should cater to the nutritional demands of women refugees in the world to protect them from food insecurities as well as future researchers should find out better ways of analysis and treatment plans for such kind of communities who are highly prone to nutritional deficiencies and lack of basic supplies.

Keywords: food insecurity, refugees, women, vulnerable

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Authors: Bryce Benson, Sooin Lee, Ashwin Belle

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Unrecognized or delayed identification of patient deterioration is a key cause of in-hospitals adverse events. Clinicians rely on vital signs monitoring to recognize patient deterioration. However, due to ever increasing nursing workloads and the manual effort required, vital signs tend to be measured and recorded intermittently, and inconsistently causing large gaps during patient monitoring. Additionally, during deterioration, the body’s autonomic nervous system activates compensatory mechanisms causing the vital signs to be lagging indicators of underlying hemodynamic decline. This study analyzes the predictive efficacy of the Analytic for Hemodynamic Instability (AHI) system, an automated tool that was designed to help clinicians in early identification of deteriorating patients. The lead time analysis in this retrospective observational study assesses how far in advance AHI predicted deterioration prior to the start of an episode of hemodynamic instability (HI) becoming evident through vital signs? Results indicate that of the 362 episodes of HI in this study, 308 episodes (85%) were correctly predicted by the AHI system with a median lead time of 57 minutes and an average of 4 hours (240.5 minutes). Of the 54 episodes not predicted, AHI detected 45 of them while the episode of HI was ongoing. Of the 9 undetected, 5 were not detected by AHI due to either missing or noisy input ECG data during the episode of HI. In total, AHI was able to either predict or detect 98.9% of all episodes of HI in this study. These results suggest that AHI could provide an additional ‘pair of eyes’ on patients, continuously filling the monitoring gaps and consequently giving the patient care team the ability to be far more proactive in patient monitoring and adverse event management.

Keywords: clinical deterioration prediction, decision support system, early warning system, hemodynamic status, physiologic monitoring

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Authors: Karin Eines, Riki Tesler

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Introduction: The Mamanet Cachibol League (MCL) is a community-based model developed in Israel to promote physical activity (PA) and amateur team sports among women. team sports are not just groups in the context of specific sport activity but also incorporated into a person’s sense of self and become influencing factor on sport-related behavior among the players. While in the non-Arabic sector, sport venues are available for the local authority population, the Arabic sector authorities face limited access sport facilities, with 168 sport venues and authorities with no venues at all. Within the Arab community, women participation in sports has traditionally been limited and, even more so for participation in team sports. Aims: The purpose of the study was to explore attributes of women MCL activity via: (1) assess differences between participants in the MCL and non-participants among Arab women regarding well-being level; (2) to examine among MCL participants the relationship between health maintenance characteristics and the likelihood of participating in the MCL; and (3) Use qualitative approach to shed light over the question why Arabic women participate in MCL and continue their engagement in PA. Methods: An explanatory sequential mixed-method design was employed to gain a deeper understanding of the advantages and motivations among women participating in community-based team sports. A cross-sectional survey was conducted among Israeli Arab women aged 25–59. Demographic characteristics, well-being (SRH and psychosomatic symptoms), eating habits, and social support were analyzed using two-way analyses of covariance and multiple regression models with a sequential entry of the variables. Quantitative results were further explored in qualitative in-depth interviews among 30 of the MCL participants, which shed light on additional reasons for participation in PA. Results: MCL participants reported better self-reported health (p < 0.001) and lower rates of psychosomatic symptoms (p < 0.001) compared to non-participants. Participation in MCL was also related to higher levels of well-being and healthy eating habits. Women who participated also experienced a profound sense of belonging, leading to enhanced social interactions and positivity in their personal and professional lives. They were dedicated to the group and felt empowered by the reciprocal commitment. The group promoted equality, making the women feel valued and respected, resulting in community admiration. Their involvement positively impacted their families, justifying their time commitment.

Keywords: wellbeing, obesity, community based sports, healthy eating habits, arab women

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Authors: F. Longo, G. Granello, G. Tecchio, F. Da Porto

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Unreinforced masonry (URM) infill walls are widely used throughout the world, also in seismic prone regions, as partitions in reinforced concrete building frames. Even if they do not represent structural elements, they can dramatically affect both strength and stiffness of RC structures by acting as a diagonal strut, modifying shear and displacements distribution along the building height, with uncertain consequences on structural safety. In the last decades, many refined models have been developed to describe infill walls effect on frame structural behaviour, but generally restricted to in-plane actions. Only very recently some new approaches were implemented to consider in-plane/out-of-plane interaction of URM infill walls in progressive collapse simulations. In the present work, a particularly promising macro-model was adopted for the progressive collapse analysis of infilled RC frames. The model allows to consider the bi-directional interaction in terms of displacement and strength capacity for URM infills, and to remove the infill contribution when the URM wall is supposed to fail during the analysis process. The model was calibrated on experimental data regarding two different URM panels thickness, modelling with particular care the post-critic softening branch. A frame specimen set representing the most common Italian structures was built considering two main normative approaches: a traditional design philosophy, corresponding to structures erected between 50’s-80’s basically designed to support vertical loads, and a seismic design philosophy, corresponding to current criteria that take into account horizontal actions. Non-Linear Static analyses were carried out on the specimen set and some preliminary evaluations were drawn in terms of different performance exhibited by the RC frame when the contemporary effect of the out-of-plane damage is considered for the URM infill.

Keywords: infill Panels macromodels, in plane-out of plane interaction, RC frames, URM infills

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Authors: Sabah Yasin, Anum Obaid

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Abstract—Working women in Pakistan should not be neglected, as women make up to half of the population, and are highly educated and diversified in their skills and capabilities. With a shift in global economic and social demands the obligations of a women have altered significantly, impacted by the dual pressures of career and personal life. Despite global efforts to improve economic empowerment and health of women, through Sustainable Development Goals, they suffer from social, economic, psychological and physiological challenges. A sound understanding of working women’s nutrition and health-related stress is a prompt necessity, in areas like Faisalabad, thus leading to a public health issue. The current qualitative study is grounded under the paradigm of in-depth interviews with working women, currently working full time in Faisalabad. Participants collected through snowball sampling were women ages 30-40. This study explores the perceptions and experiences as well as barriers and factors effecting the overall wellbeing of working women, regarding nutrition and health-related stress. Findings of the current study disclosed that the nutritional and health well-being of working women in Faisalabad suffers from the impact of various stressors, like long working hours, excessive workload, low income, poor work place culture, unavailability of healthy food choices at work, lack of time, lack of self-care, unattended nutritional deficiencies and overburdened share of responsibilities. Hence, these findings highlight the need for effective strategies and support systems that will address the unique stressors faced by working women and also by educating them in changing their attitudes and understanding psychosocial barriers that impede their ability to maintain nutrition and overall well-being.

Keywords: health triangle, lifestyle behaviors, nutrition-related, professional life, stress, working women

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Authors: Jie Ji, Jing Xu, Yuehong Zhuang, Xiangqing Kang, Ying Qian, Ping Zhou, Di Xue

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Background: In 2014, there were 28,341 health professionals in Pudong new area of Shanghai and the number per 1000 population was 5.199, 55.55% higher than that in 2006. But it was always less than the average number of health professionals per 1000 population in Shanghai from 2006 to 2014. Therefore, allocation planning for the health professionals in Pudong new area has become a high priority task in order to meet the future demands of health care. In this study, we constructed an objective-based system dynamics model to forecast the number of health professionals in Pudong new area of Shanghai in 2020. Methods: We collected the data from health statistics reports and previous survey of human resources in Pudong new area of Shanghai. Nine experts, who were from health administrative departments, public hospitals and community health service centers, were consulted to estimate the current and future status of nine variables used in the system dynamics model. Based on the objective of the number of health professionals per 1000 population (8.0) in Shanghai for 2020, the system dynamics model for health professionals in Pudong new area of Shanghai was constructed to forecast the number of health professionals needed in Pudong new area in 2020. Results: The system dynamics model for health professionals in Pudong new area of Shanghai was constructed. The model forecasted that there will be 37,330 health professionals (6.433 per 1000 population) in 2020. If the success rate of health professional recruitment changed from 20% to 70%, the number of health professionals per 1000 population would be changed from 5.269 to 6.919. If this rate changed from 20% to 70% and the success rate of building new beds changed from 5% to 30% at the same time, the number of health professionals per 1000 population would be changed from 5.269 to 6.923. Conclusions: The system dynamics model could be used to simulate and forecast the health professionals. But, if there were no significant changes in health policies and management system, the number of health professionals per 1000 population would not reach the objectives in Pudong new area in 2020.

Keywords: allocation planning, forecast, health professional, system dynamics

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Authors: Md. Rafiul Biswas, Uzair Shah, Mohammad Alkayal, Zubair Shah, Othman Althawadi, Kamila Swart

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Background: Social media platforms play a significant role in the mediated consumption of sport, especially so for sport mega-event. The characteristics of Twitter data (e.g., user mentions, retweets, likes, #hashtag) accumulate the users in one ground and spread information widely and quickly. Analysis of Twitter data can reflect the public attitudes, behavior, and sentiment toward a specific event on a larger scale than traditional surveys. Qatar is going to be the first Arab country to host the mega sports event FIFA World Cup 2022 (Q22). Qatar has hosted the FIFA Arab Cup 2021 (FAC21) to serve as a preparation for the mega-event. Objectives: This study investigates public sentiments and experiences about FAC21 and provides an insight to enhance the public experiences for the upcoming Q22. Method: FCA21-related tweets were downloaded using Twitter Academic research API between 01 October 2021 to 18 February 2022. Tweets were divided into three different periods: before T1 (01 Oct 2021 to 29 Nov 2021), during T2 (30 Nov 2021 -18 Dec 2021), and after the FAC21 T3 (19 Dec 2021-18 Feb 2022). The collected tweets were preprocessed in several steps to prepare for analysis; (1) removed duplicate and retweets, (2) removed emojis, punctuation, and stop words (3) normalized tweets using word lemmatization. Then, rule-based classification was applied to remove irrelevant tweets. Next, the twitter-XLM-roBERTa-base model from Huggingface was applied to identify the sentiment in the tweets. Further, state-of-the-art BertTopic modeling will be applied to identify trending topics over different periods. Results: We downloaded 8,669,875 Tweets posted by 2728220 unique users in different languages. Of those, 819,813 unique English tweets were selected in this study. After splitting into three periods, 541630, 138876, and 139307 were from T1, T2, and T3, respectively. Most of the sentiments were neutral, around 60% in different periods. However, the rate of negative sentiment (23%) was high compared to positive sentiment (18%). The analysis indicates negative concerns about FAC21. Therefore, we will apply BerTopic to identify public concerns. This study will permit the investigation of people’s expectations before FAC21 (e.g., stadium, transportation, accommodation, visa, tickets, travel, and other facilities) and ascertain whether these were met. Moreover, it will highlight public expectations and concerns. The findings of this study can assist the event organizers in enhancing implementation plans for Q22. Furthermore, this study can support policymakers with aligning strategies and plans to leverage outstanding outcomes.

Keywords: FIFA Arab Cup, FIFA, Twitter, machine learning

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Authors: Melvin Ouma

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Language is one of the most crucial tools in medical interaction. Its importance is as great today as it was many decades ago. Difficulty in openly discussing certain diseases and body parts is one of the challenges in language use in medical contexts. Guided by H. P. Grice’s Cooperative Principle, this paper explores the flouting of the cooperative principles in Swahili speaking medical setting. The paper examines how men flout the maxims using the Swahili language when reporting reproductive health problems to the doctor. The data used was gathered from a qualitative study carried out in a reproductive health clinic in a public facility in Nakuru County, Kenya. All the research protocols were observed by acquiring all the research permits. Respondents' ethical considerations of consent, privacy, and confidentiality were observed. The respondents recruited were men who visited the reproductive health clinic and voluntarily agreed to participate in the study without coercion or compensation. Participant observation was the key data collection tool, with the doctor and patient conversation digitally recorded. The researcher was allowed into the clinic in a socially acceptable role. Male patients flouted the maxims of quantity, quality, relation, and manner in order to describe their reproductive health problems without embarrassment using the Swahili language. The flouting was done through the discursive strategies of narration and circumlocution. Flouting of the maxims was acceptable to the doctor and patient due to the fact that sexual intercourse and private body parts are taboo topics and uncomfortable to talk about. The quality of health care received by the patient depended on the doctor’s patience when all the maxims were flouted. In the reproductive health clinic, flouting of maxims hindered communication and, at the same time, enhanced communication between the doctor and patient.

Keywords: cooperative principle, doctor, men, reproductive health

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Authors: Roaa Al Sharif, Salsabil Abo Al-Azayem, Nimah Alsomali, Wjoud Alsaeed, Nawal Alshammari, Abdulaziz Alwatban, Yaseen Alrabae, Razan Orfali, Faisal Alqarni, Ahmad Alrasheedi

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from various countries have revealed that nurses possess only a basic understanding of the GCS. Regarding this matter, limited knowledge is available about the situation in Saudi Arabia. Overall, the available research suggests that there is room for improvement in the knowledge of the GCS among nurses in Saudi Arabia. Further training and education programs may be beneficial in enhancing nurses' understanding and application of the GCS in clinical practice. Objective: To determine the level of knowledge and competence in assessing the GCS among staff nurses and to identify factors that might influence their knowledge at King Fahd Medical City in Riyadh, Saudi Arabia. Methods: A descriptive, cross-sectional survey involving 199 KFMC staff nurses was conducted. Nurses were provided with a structured questionnaire, and data were collected and analyzed using SPSS version 16, employing descriptive statistics and Chi-square tests. Results: The majority, 81.4% of nurses, had an average level of knowledge in assessing the Glasgow Coma Scale (GCS). The mean score for measuring the level of knowledge among staff nurses in GCS assessment was 8.8 ± 1.826. Overall, 13.6% of respondents demonstrated good knowledge of the GCS, scoring between 11 and 15 points, while only 5% of nurses exhibited poor knowledge of the GCS assessment. There was a significant correlation between knowledge and nurses' departments (χ2(2) = 19.184, p < 0.001). χ2(2) = 19.184," representing a Chi-square statistic with 2 degrees of freedom used to test the association between categorical variables in the data analysis. Conclusion: The findings indicate that knowledge of GCS assessment among staff nurses in a single center in Saudi Arabia is moderate. Therefore, there is a need for continuous education programs to enhance their competence in using this assessment.

Keywords: Glasgow Coma Scale, brain injury, nurses’ knowledge assessment, continuous education programs

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