Search results for: long term care facility
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 11408

Search results for: long term care facility

6998 Indeterminacy: An Urban Design Tool to Measure Resilience to Climate Change, a Caribbean Case Study

Authors: Tapan Kumar Dhar

Abstract:

How well are our city forms designed to adapt to climate change and its resulting uncertainty? What urban design tools can be used to measure and improve resilience to climate change, and how would they do so? In addressing these questions, this paper considers indeterminacy, a concept originated in the resilience literature, to measure the resilience of built environments. In the realm of urban design, ‘indeterminacy’ can be referred to as built-in design capabilities of an urban system to serve different purposes which are not necessarily predetermined. An urban system, particularly that with a higher degree of indeterminacy, can enable the system to be reorganized and changed to accommodate new or unknown functions while coping with uncertainty over time. Underlying principles of this concept have long been discussed in the urban design and planning literature, including open architecture, landscape urbanism, and flexible housing. This paper argues that the concept indeterminacy holds the potential to reduce the impacts of climate change incrementally and proactively. With regard to sustainable development, both planning and climate change literature highly recommend proactive adaptation as it involves less cost, efforts, and energy than last-minute emergency or reactive actions. Nevertheless, the concept still remains isolated from resilience and climate change adaptation discourses even though the discourses advocate the incremental transformation of a system to cope with climatic uncertainty. This paper considers indeterminacy, as an urban design tool, to measure and increase resilience (and adaptive capacity) of Long Bay’s coastal settlements in Negril, Jamaica. Negril is one of the popular tourism destinations in the Caribbean highly vulnerable to sea-level rise and its associated impacts. This paper employs empirical information obtained from direct observation and informal interviews with local people. While testing the tool, this paper deploys an urban morphology study, which includes land use patterns and the physical characteristics of urban form, including street networks, block patterns, and building footprints. The results reveal that most resorts in Long Bay are designed for pre-determined purposes and offer a little potential to use differently if needed. Additionally, Negril’s street networks are found to be rigid and have limited accessibility to different points of interest. This rigidity can expose the entire infrastructure further to extreme climatic events and also impedes recovery actions after a disaster. However, Long Bay still has room for future resilient developments in other relatively less vulnerable areas. In adapting to climate change, indeterminacy can be reached through design that achieves a balance between the degree of vulnerability and the degree of indeterminacy: the more vulnerable a place is, the more indeterminacy is useful. This paper concludes with a set of urban design typologies to increase the resilience of coastal settlements.

Keywords: climate change adaptation, resilience, sea-level rise, urban form

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6997 The ‘Accompanying Spouse Dependent Visa Status’: Challenges and Constraints Faced by Zimbabwean Immigrant Women in Integration into South Africa’s Formal Labour Market

Authors: Rujeko Samanthia Chimukuche

Abstract:

Introduction: Transboundary migration at both regional and continental levels has become the defining feature of the 21st century. The recent global migration crisis due to economic strife and war brings back to the fore an old age problem, but with fresh challenges. Migration and forced displacement are issues that require long-term solutions. In South Africa, for example, whilst much attention has been placed on xenophobic attacks and other issues at the nexus of immigrant and indigenous communities, the limited focus has been placed on the integration, specifically formal labour integration of immigrant communities and the gender inequalities that are prevalent. Despite noble efforts by South Africa, hosting several immigrants, several challenges arise in integrating the migrants into society as it is often difficult to harmonize the interests of indigenous communities and those of foreign nationals. This research study has aimed to fill in the gaps by analyzing how stringent immigration and visa regulations prevent skilled migrant women spouses from employment, which often results in several societal vices, including domestic abuse, minimum or no access to important services such as healthcare, education, social welfare among others. Methods: Using a qualitative approach, the study analyzed South Africa migration and labour policies in terms of mainstreaming the gender needs of skilled migrant women. Secondly, the study highlighted the migratory experiences and constraints of skilled Zimbabwean women migrant spouses in South Africa labour integration. The experiences of these women have shown the gender inequalities of the migratory policies. Thirdly, Zimbabwean women's opportunities and/or challenges in integration into the South African formal labour market were explored. Lastly, practical interventions to support the integration of skilled migrant women spouses into South Africa’s formal labour market were suggested. Findings: Key findings show that gender dynamics are pivotal in migration patterns and the mainstreaming of gender in migration policies. This study, therefore, contributed to the fields of gender and migration by examining ways in which gender rights of skilled migrant women spouses can be incorporated in labour integration policy making.

Keywords: accompanying spouse visa, gender-migration, labour-integration, Zimbabwean women

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6996 Validation of a Placebo Method with Potential for Blinding in Ultrasound-Guided Dry Needling

Authors: Johnson C. Y. Pang, Bo Peng, Kara K. L. Reeves, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding is potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26 ± 5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms, and quality of life (QOL), were analyzed by repeated measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: ultrasound-guided dry needling, dry needling, knee osteoarthritis, physiotheraphy

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6995 Agronomic Test to Determine the Efficiency of Hydrothermally Treated Alkaline Igneous Rocks and Their Potassium Fertilizing Capacity

Authors: Aaron Herve Mbwe Mbissik, Lotfi Khiari, Otmane Raji, Abdellatif Elghali, Abdelkarim Lajili, Muhammad Ouabid, Martin Jemo, Jean-Louis Bodinier

Abstract:

Potassium (K) is an essential macronutrient for plant growth, helping to regulate several physiological and metabolic processes. Evaporite-related potash salts, mainly sylvite minerals (K chloride or KCl), are the principal source of K for the fertilizer industry. However, due to the high potash-supply risk associated with its considerable price fluctuations and uneven geographic distribution for most agriculture-based developing countries, the development of alternative sources of fertilizer K is imperative to maintain adequate crop yield, reduce yield gaps, and food security. Alkaline Igneous rocks containing significant K-rich silicate minerals such as K feldspar are increasingly seen as the best alternative available. However, these rocks may require to be hydrothermally treatment to enhance the release of potassium. In this study, we evaluate the fertilizing capacity of raw and hydrothermally treated K-bearing silicate rocks from different areas in Morocco. The effectiveness of rock powders was tested in a greenhouse experiment using ryegrass (Lolium multiflorum) by comparing them to a control (no K added) and to a conventional fertilizer (muriate of potash: MOP or KCl). The trial was conducted in a randomized complete block design with three replications, and plants were grown on K-depleted soils for three growing cycles. To achieve our objective, in addition to the analysis of the muriate response curve and the different biomasses, we also examined three necessary coefficients, namely: the K uptake, then apparent K recovery (AKR), and the relative K efficiency (RKE). The results showed that based on the optimum economic rate of MOP (230 kg.K.ha⁻¹) and the optimum yield (44 000 kg.K.ha⁻¹), the efficiency of K silicate rocks was as high as that of MOP. Although the plants took up only half of the K supplied by the powdered rock, the hydrothermal material was found to be satisfactory, with a biomass value reaching the optimum economic limit until the second crop cycle. In comparison, the AKR of the MOP (98.6%) and its RKE in the 1st cycle were higher than our materials: 39% and 38%, respectively. Therefore, the raw and hydrothermal materials mixture could be an appropriate solution for long-term agronomic use based on the obtained results.

Keywords: K-uptake, AKR, RKE, K-bearing silicate rock, MOP

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6994 Structural Performance Evaluation of Segmented Wind Turbine Blade Through Finite Element Simulation

Authors: Chandrashekhar Bhat, Dilifa Jossley Noronha, Faber A. Saldana

Abstract:

Transportation of long turbine blades from one place to another is a difficult process. Hence a feasibility study of modularization of wind turbine blade was taken from structural standpoint through finite element analysis. Initially, a non-segmented blade is modeled and its structural behavior is evaluated to serve as reference. The resonant, static bending and fatigue tests are simulated in accordance with IEC61400-23 standard for comparison purpose. The non-segmented test blade is separated at suitable location based on trade off studies and the segments are joined with an innovative double strap bonded joint configuration. The adhesive joint is modeled by adopting cohesive zone modeling approach in ANSYS. The developed blade model is analyzed for its structural response through simulation. Performances of both the blades are found to be similar, which indicates that, efficient segmentation of the long blade is possible which facilitates easy transportation of the blades and on site reassembling. The location selected for segmentation and adopted joint configuration has resulted in an efficient segmented blade model which proves the methodology adopted for segmentation was quite effective. The developed segmented blade appears to be the viable alternative considering its structural response specifically in fatigue within considered assumptions.

Keywords: modularization, fatigue, cohesive zone modeling, wind turbine blade

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6993 Applying Critical Realism to Qualitative Social Work Research: A Critical Realist Approach for Social Work Thematic Analysis Method

Authors: Lynne Soon-Chean Park

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Critical Realism (CR) has emerged as an alternative to both the positivist and constructivist perspectives that have long dominated social work research. By unpacking the epistemic weakness of two dogmatic perspectives, CR provides a useful philosophical approach that incorporates the ontological objectivist and subjectivist stance. The CR perspective suggests an alternative approach for social work researchers who have long been looking to engage in the complex interplay between perceived reality at the empirical level and the objective reality that lies behind the empirical event as a causal mechanism. However, despite the usefulness of CR in informing social work research, little practical guidance is available about how CR can inform methodological considerations in social work research studies. This presentation aims to provide a detailed description of CR-informed thematic analysis by drawing examples from a social work doctoral research of Korean migrants’ experiences and understanding of trust associated with their settlement experience in New Zealand. Because of its theoretical flexibility and accessibility as a qualitative analysis method, thematic analysis can be applied as a method that works both to search for the demi-regularities of the collected data and to identify the causal mechanisms that lay behind the empirical data. In so doing, this presentation seeks to provide a concrete and detailed exemplar for social work researchers wishing to employ CR in their qualitative thematic analysis process.

Keywords: critical Realism, data analysis, epistemology, research methodology, social work research, thematic analysis

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6992 Blood Oxygen Saturation Measurement System Using Broad-Band Light Source with LabVIEW Program

Authors: Myoung Ah Kim, Dong Ho Sin, Chul Gyu Song

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Blood oxygen saturation system is a well-established, noninvasive photoplethysmographic method to monitor vital signs. Conventional blood oxygen saturation measurements for the two LED light source is the ambiguity of the oxygen saturation measurement principle and the measurement results greatly influenced and heat and motion artifact. A high accuracy in order to solve these problems blood oxygen saturation measuring method has been proposed using a broadband light source that can be easily understood by the algorithm. The measurement of blood oxygen saturation based on broad-band light source has advantage of simple testing facility and easy understanding. Broadband light source based on blood oxygen saturation measuring program proposed in this paper is a combination of LabVIEW and MATLAB. Using the wavelength range of 450 nm-750 nm using a floating light absorption of oxyhemoglobin and deoxyhemoglobin to measure the blood oxygen saturation. Hand movement is to fix the probe to the motor stage in order to prevent oxygen saturation measurement that affect the sample and probe kept constant interval. Experimental results show that the proposed method noticeably increases the accuracy and saves time compared with the conventional methods.

Keywords: oxygen saturation, broad-band light source, CCD, light reflectance theory

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6991 Impact of Natural Degradation of Low Density Polyethylene on Its Morphology

Authors: Meryem Imane Babaghayou, Asma Abdelhafidi, Salem Fouad Chabira, Mohammed Sebaa

Abstract:

A challenge of plastics industries is the realization of materials that resist the degradation in its application environment, and that to guarantee a longer life time therefore an optimal time of use. Blown extruded films of low-density polyethylene (LDPE) supplied by SABIC SAUDI ARABIA blown and extruded in SOFIPLAST company in Setif ALGERIA , have been subjected to climatic ageing in a sub-Saharan facility at Laghouat (Algeria) with direct exposure to sun. Samples were characterized by X-ray diffraction (XRD) and differential scanning calorimetry (DSC) techniques after prescribed amounts of time up to 8 months. It has been shown via these two techniques the impact of UV irradiation on the morphological development of a plastic material, especially the crystallinity degree which increases with exposure time. The reason of these morphological changes is related to photooxidative reactions leading to cross linking in the beginning and to chain scissions for an advanced stage of ageing this last ones are the first responsible. The crystallinity degree change is essentially controlled by the secondary crystallization of the amorphous chains whose mobility is enhanced by the chain scission processes. The diffusion of these short segments integrates the surface of the lamellae increasing in this way their thicknesses. The results presented highlight the complexity of the involved phenomena.

Keywords: Low Density poly (Ethylene), crystallinity, ageing, XRD, DSC

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6990 A Review of the Run to Run (R to R) Control in the Manufacturing Processes

Authors: Khalil Aghapouramin, Mostafa Ranjbar

Abstract:

Run- to- Run (R2 R) control was developed in order to monitor and control different semiconductor manufacturing processes based upon the fundamental engineering frameworks. This technology allows rectification in the optimum direction. This control always had a significant potency in which was appeared in a variety of processes. The term run to run refers to the case where the act of control would take with the aim of getting batches of silicon wafers which produced in a manufacturing process. In the present work, a brief review about run-to-run control investigated which mainly is effective in the manufacturing process.

Keywords: Run-to-Run (R2R) control, manufacturing, process in engineering, manufacturing controls

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6989 Coping with the Stress and Negative Emotions of Care-Giving by Using Techniques from Seneca, Epictetus, and Marcus Aurelius

Authors: Arsalan Memon

Abstract:

There are many challenges that a caregiver faces in average everyday life. One such challenge is coping with the stress and negative emotions of caregiving. The Stoics (i.e. Lucius Annaeus Seneca [4 B.C.E. - 65 C.E.], Epictetus [50-135 C.E.], and Marcus Aurelius [121-180 C.E.]) have provided coping techniques that are useful for dealing with stress and negative emotions. This paper lists and explains some of the fundamental coping techniques provided by the Stoics. For instance, some Stoic coping techniques thus follow (the list is far from exhaustive): a) mindfulness: to the best of your ability, constantly being aware of your thoughts, habits, desires, norms, memories, likes/dislikes, beliefs, values, and of everything outside of you in the world (b) constantly adjusting one’s expectations in accordance with reality, c) memento mori: constantly reminding oneself that death is inevitable and that death is not to be seen as evil, and d) praemeditatio malorum: constantly detaching oneself from everything that is so dear to one so that the least amount of suffering follows from the loss, damage, or ceasing to be of such entities. All coping techniques will be extracted from the following original texts by the Stoics: Seneca’s Letters to Lucilius, Epictetus’ Discourses and the Encheiridion, and Marcus Aurelius’ Meditations. One major finding is that the usefulness of each Stoic coping technique can be empirically tested by anyone in the sense of applying it one’s own life especially when one is facing real-life challenges. Another major finding is that all of the Stoic coping techniques are predicated upon, and follow from, one fundamental principle: constantly differentiate what is and what is not in one’s control. After differentiating it, one should constantly habituate oneself in not controlling things that are beyond one’s control. For example, the following things are beyond one’s control (all things being equal): death, certain illnesses, being born in a particular socio-economic family, etc. The conclusion is that if one habituates oneself by practicing to the best of one’s ability both the fundamental Stoic principle and the Stoic coping techniques, then such a habitual practice can eventually decrease the stress and negative emotions that one experiences by being a caregiver.

Keywords: care-giving, coping techniques, negative emotions, stoicism, stress

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6988 Designing and Implementation of MPLS Based VPN

Authors: Muhammad Kamran Asif

Abstract:

MPLS stands for Multi-Protocol Label Switching. It is the technology which replaces ATM (Asynchronous Transfer Mode) and frame relay. In this paper, we have designed a full fledge small scale MPLS based service provider network core network model, which provides communication services (e.g. voice, video and data) to the customer more efficiently using label switching technique. Using MPLS VPN provides security to the customers which are either on LAN or WAN. It protects its single customer sites from being attacked by any intruder from outside world along with the provision of concept of extension of a private network over an internet. In this paper, we tried to implement a service provider network using minimum available resources i.e. five 3800 series CISCO routers comprises of service provider core, provider edge routers and customer edge routers. The customers on the one end of the network (customer side) is capable of sending any kind of data to the customers at the other end using service provider cloud which is MPLS VPN enabled. We have also done simulation and emulation for the model using GNS3 (Graphical Network Simulator-3) and achieved the real time scenarios. We have also deployed a NMS system which monitors our service provider cloud and generates alarm in case of any intrusion or malfunctioning in the network. Moreover, we have also provided a video help desk facility between customers and service provider cloud to resolve the network issues more effectively.

Keywords: MPLS, VPN, NMS, ATM, asynchronous transfer mode

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6987 The Impact of Centralisation on Radical Prostatectomy Outcomes: Our Outcomes

Authors: Jemini Vyas, Oluwatobi Adeyoe, Jenny Branagan, Chandran Tanabalan, John Beatty, Aakash Pai

Abstract:

Introduction: The development of robotic surgery has accelerated centralisation to tertiary centres, where robotic radical prostatectomy (RP) is offered. The purpose of concentrating treatment in high volume specialist centres is to improve the quality of care and patient outcomes. The aim of this study was to assess the impact on clinical outcomes of centralisation for locally diagnosed patients undergoing RP. Methods: Clinical outcomes for 169 consecutive laparoscopic & open RP pre-centralisation were retrospectively compared with 50 consecutive robotic RP conducted over a similar period post-centralisation. Preoperative risk stratification and time to surgery were collected. Perioperative outcomes, including length of stay (LOS) and complications, were collated. Post-operative outcomes, including erectile dysfunction (ED), biochemical recurrence (BCR), and urinary continence, were assessed. Results: Preoperative risk stratification showed no difference between the two groups. The median time from diagnosis to treatment was similar between the two groups (pre-centralisation, 121 days, post-centralisation, 117 days). The mean length of stay (pre-centralisation, 2.1 days, post-centralisation, 1.6 days) showed no significant difference (p=0.073). Proportion of overall complications (pre-centralisation, 11.4%, post-centralisation, 8.7%) and complications, above Clavien-Dindo 2, were similar between the two groups (pre-centralisation1.2%, post-centralisation 2.2%). Post operative functional parameters, including continence and ED, were comparable. Five-year BCR free rate was 78% for the pre-centralisation group and 79% for the post centralisation group. Conclusion: For our cohort of patients, clinical outcomes have remained static during centralisation. It is imperative that centralisation is accompanied by increased capacity, streamlining of pathways, and training to ensure that improved quality of care is achieved. Our institution has newly acquired a robot, and prospectively studying this data may support the reversal of centralisation for RP surgery.

Keywords: prostate, cancer, prostatectomy, clinical

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6986 Nutrition Intervention for Spinal Cord Injury in Critical Care

Authors: Dina Muharib

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Specific metabolic challenges are present following spinal cord injury. The acute stage is characterized by a reduction in metabolic activity, as well as a negative nitrogen balance that cannot be corrected, even with aggressive nutritional support. Metabolic demands need to be accurately monitored to avoid overfeeding. Enteral feeding is the optimal route following SCI. When oral feeding is not possible, nasogastric, followed by nasojejunal, then by percutaneous endoscopic gastrostomy, if necessary, is suggested.

Keywords: SCI, energy, protein, nutrition assessment, eneral feeding, nitrogen balance

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6985 Posterior Acetabular Fractures-Optimizing the Treatment by Enhancing Practical Skills

Authors: Olivera Lupescu, Taina Elena Avramescu, Mihail Nagea, Alexandru Dimitriu

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Acetabular fractures represent a real challenge due to their impact upon the long term function of the hip joint, and due to the risk of intra- and peri-operative complications especially that they affect young, active people. That is why treating these fractures require certain skills which must be exercised, regarding the pre-operative planning, as well as the execution of surgery.The authors retrospectively analyse 38 cases with acetabular fractures operated using the posterior approach in our hospital between 01.01.2013- 01.01.2015 for which complete medical records ensure a follow-up of 24 months, in order to establish the main causes of potential errors and to underline the methods for preventing them. This target is included in the Erasmus + project ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery COR-skills’. This paper analyses the pitfalls revealed by these cases, as well as the measures necessary to enhance the practical skills of the surgeons who perform acetabular surgery. Pre-op planning matched the intra and post-operative outcome in 88% of the analyzed points, from 72% at the beginning to 94% in the last case, meaning that experience is very important in treating this injury. The main problems detected for the posterior approach were: nervous complications - 3 cases, 1 of them a complete paralysis of the sciatic nerve, which recovered 6 months after surgery, and in other 2 cases intra-articular position of the screws was demonstrated by post-operative CT scans, so secondary screw removal was necessary in these cases. We analysed this incident, too, due to lack of information about the relationship between the screws and the joint secondary to this approach. Septic complications appeared in 3 cases, 2 superficial and 1 profound (requiring implant removal). The most important problems were the reduction of the fractures and the positioning of the screws so as not to interfere with the the articular space. In posterior acetabular fractures, pre-op complex planning is important in order to achieve maximum treatment efficacy with minimum of risk; an optimal training of the surgeons insisting on the main points of potential mistakes ensure the success of the procedure, as well as a favorable outcome for the patient.

Keywords: acetabular fractures, articular congruency, surgical skills, vocational training

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6984 Lessons from Implementation of a Network-Wide Safety Huddle in Behavioral Health

Authors: Deborah Weidner, Melissa Morgera

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The model of care delivery in the Behavioral Health Network (BHN) is integrated across all five regions of Hartford Healthcare and thus spans the entirety of the state of Connecticut, with care provided in seven inpatient settings and over 30 ambulatory outpatient locations. While safety has been a core priority of the BHN in alignment with High Reliability practices, safety initiatives have historically been facilitated locally in each region or within each entity, with interventions implemented locally as opposed to throughout the network. To address this, the BHN introduced a network wide Safety Huddle during 2022. Launched in January, the BHN Safety Huddle brought together internal stakeholders, including medical and administrative leaders, along with executive institute leadership, quality, and risk management. By bringing leaders together and introducing a network-wide safety huddle into the way we work, the benefit has been an increase in awareness of safety events occurring in behavioral health areas as well as increased systemization of countermeasures to prevent future events. One significant discussion topic presented in huddles has pertained to environmental design and patient access to potentially dangerous items, addressing some of the most relevant factors resulting in harm to patients in inpatient and emergency settings for behavioral health patients. The safety huddle has improved visibility of potential environmental safety risks through the generation of over 15 safety alerts cascaded throughout the BHN and also spurred a rapid improvement project focused on standardization of patient belonging searches to reduce patient access to potentially dangerous items on inpatient units. Safety events pertaining to potentially dangerous items decreased by 31% as a result of standardized interventions implemented across the network and as a result of increased awareness. A second positive outcome originating from the BHN Safety Huddle was implementation of a recommendation to increase the emergency Narcan®(naloxone) supply on hand in ambulatory settings of the BHN after incidents involving accidental overdose resulted in higher doses of naloxone administration. By increasing the emergency supply of naloxone on hand in all ambulatory and residential settings, colleagues are better prepared to respond in an emergency situation should a patient experience an overdose while on site. Lastly, discussions in safety huddle spurred a new initiative within the BHN to improve responsiveness to assaultive incidents through a consultation service. This consult service, aligned with one of the network’s improvement priorities to reduce harm events related to assaultive incidents, was borne out of discussion in huddle in which it was identified that additional interventions may be needed in providing clinical care to patients who are experiencing multiple and/ or frequent safety events.

Keywords: quality, safety, behavioral health, risk management

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6983 A Prototype of an Information and Communication Technology Based Intervention Tool for Children with Dyslexia

Authors: Rajlakshmi Guha, Sajjad Ansari, Shazia Nasreen, Hirak Banerjee, Jiaul Paik

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Dyslexia is a neurocognitive disorder, affecting around fifteen percent of the Indian population. The symptoms include difficulty in reading alphabet, words, and sentences. This can be difficult at the phonemic or recognition level and may further affect lexical structures. Therapeutic intervention of dyslexic children post assessment is generally done by special educators and psychologists through one on one interaction. Considering the large number of children affected and the scarcity of experts, access to care is limited in India. Moreover, unavailability of resources and timely communication with caregivers add on to the problem of proper intervention. With the development of Educational Technology and its use in India, access to information and care has been improved in such a large and diverse country. In this context, this paper proposes an ICT enabled home-based intervention program for dyslexic children which would support the child, and provide an interactive interface between expert, parents, and students. The paper discusses the details of the database design and system layout of the program. Along with, it also highlights the development of different technical aids required to build out personalized android applications for the Indian dyslexic population. These technical aids include speech database creation for children, automatic speech recognition system, serious game development, and color coded fonts. The paper also emphasizes the games developed to assist the dyslexic child on cognitive training primarily for attention, working memory, and spatial reasoning. In addition, it talks about the specific elements of the interactive intervention tool that makes it effective for home based intervention of dyslexia.

Keywords: Android applications, cognitive training, dyslexia, intervention

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6982 Creatine Associated with Resistance Training Increases Muscle Mass in the Elderly

Authors: Camila Lemos Pinto, Juliana Alves Carneiro, Patrícia Borges Botelho, João Felipe Mota

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Sarcopenia, a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, currently affects over 50 million people and increases the risk of adverse outcomes such as physical disability, poor quality of life and death. The aim of this study was to examine the efficacy of creatine supplementation associated with resistance training on muscle mass in the elderly. A 12-week, double blind, randomized, parallel group, placebo controlled trial was conducted. Participants were randomly allocated into one of the following groups: placebo with resistance training (PL+RT, n=14) and creatine supplementation with resistance training (CR + RT, n=13). The subjects from CR+RT group received 5 g/day of creatine monohydrate and the subjects from the PL+RT group were given the same dose of maltodextrin. Participants were instructed to ingest the supplement on non-training days immediately after lunch and on training days immediately after resistance training sessions dissolved in a beverage comprising 100 g of maltodextrin lemon flavored. Participants of both groups undertook a supervised exercise training program for 12 weeks (3 times per week). The subjects were assessed at baseline and after 12 weeks. The primary outcome was muscle mass, assessed by dual energy X-ray absorptiometry (DXA). The secondary outcome included diagnose participants with one of the three stages of sarcopenia (presarcopenia, sarcopenia and severe sarcopenia) by skeletal muscle mass index (SMI), handgrip strength and gait speed. CR+RT group had a significant increase in SMI and muscle (p<0.0001), a significant decrease in android and gynoid fat (p = 0.028 and p=0.035, respectively) and a tendency of decreasing in body fat (p=0.053) after the intervention. PL+RT only had a significant increase in SMI (p=0.007). The main finding of this clinical trial indicated that creatine supplementation combined with resistance training was capable of increasing muscle mass in our elderly cohort (p=0.02). In addition, the number of subjects diagnosed with one of the three stages of sarcopenia at baseline decreased in the creatine supplemented group in comparison with the placebo group (CR+RT, n=-3; PL+RT, n=0). In summary, 12 weeks of creatine supplementation associated with resistance training resulted in increases in muscle mass. This is the first research with elderly of both sexes that show the same increase in muscle mass with a minor quantity of creatine supplementation in a short period. Future long-term research should investigate the effects of these interventions in sarcopenic elderly.

Keywords: creatine, dietetic supplement, elderly, resistance training

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6981 A Qualitative Study of Parents' Recommendations for Improving the Notification Process and Communication between Health Professionals and Families for New Diagnosis of Cystic Fibrosis

Authors: Mohammad S. Razai, Jan Williams, Rachel Nestel, Dermot Dalton

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Purpose: This descriptive qualitative study aimed to obtain parents recommendations for improving the notification process and communication of positive newborn screening result for cystic fibrosis (CF). Methods: Thematic analysis of semi-structured open-ended interviews with 11 parents of 7 children with confirmed diagnosis of CF between 2 months — 2 years of age. Results: Parents preferred face to face disclosure of positive NBS results by a pediatrician with CF professional qualification. They trusted a pediatrician more than any other professional in providing accurate, credible and comprehensive information about the diagnosis and its implications. Parents recommended that health professionals be knowledgeable and provide clear, succinct and understandable information. Providers should also explore parents concerns and acknowledge feelings and emotions. Most parents reported that they preferred to be notified immediately as soon as the results were available. Several parents preferred to be told once the diagnosis was certain. Most parents regarded open access to CF team as the most significant part of care coordination. In addition to health professionals, most parents used internet as an important source of information, interaction and exchange of experiences. Most parents also used social networking sites such as Facebook groups and smart phone apps. Conclusion: This study provides significant new evidence from parental perspective in emphasizing the pivotal role of good communication skills deployed by a knowledgeable CF specialist in person. Parents use of social media and internet has replaced some traditional methods of information exchange and may reduce the need for professional input for newly diagnosed CF patients.

Keywords: care coordination, cystic fibrosis, newborn screening, notification process, parental preferences, professional-paren communication

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6980 Paper-Like and Battery Free Sensor Patches for Wound Monitoring

Authors: Xiaodi Su, Xin Ting Zheng, Laura Sutarlie, Nur Asinah binte Mohamed Salleh, Yong Yu

Abstract:

Wound healing is a dynamic process with multiple phases. Rapid profiling and quantitative characterization of inflammation and infection remain challenging. We have developed paper-like battery-free multiplexed sensors for holistic wound assessment via quantitative detection of multiple inflammation and infection markers. In one of the designs, the sensor patch consists of a wax-printed paper panel with five colorimetric sensor channels arranged in a pattern resembling a five-petaled flower (denoted as a ‘Petal’ sensor). The five sensors are for temperature, pH, trimethylamine, uric acid, and moisture. The sensor patch is sandwiched between a top transparent silicone layer and a bottom adhesive wound contact layer. In the second design, a palm-like-shaped paper strip is fabricated by a paper-cutter printer (denoted as ‘Palm’ sensor). This sensor strip carries five sensor regions connected by a stem sampling entrance that enables rapid colorimetric detection of multiple bacteria metabolites (aldehyde, lactate, moisture, trimethylamine, tryptophan) from wound exudate. For both the “\’ Petal’ and ‘Palm’ sensors, color images can be captured by a mobile phone. According to the color changes, one can quantify the concentration of the biomarkers and then determine wound healing status and identify/quantify bacterial species in infected wounds. The ‘Petal’ and ‘Palm’ sensors are validated with in-situ animal and ex-situ skin wound models, respectively. These sensors have the potential for integration with wound dressing to allow early warning of adverse events without frequent removal of the plasters. Such in-situ and early detection of non-healing condition can trigger immediate clinical intervention to facilitate wound care management.

Keywords: wound infection, colorimetric sensor, paper fluidic sensor, wound care

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6979 An Exploration of the Emergency Staff’s Perceptions and Experiences of Teamwork and the Skills Required in the Emergency Department in Saudi Arabia

Authors: Sami Alanazi

Abstract:

Teamwork practices have been recognized as a significant strategy to improve patient safety, quality of care, and staff and patient satisfaction in healthcare settings, particularly within the emergency department (ED). The EDs depend heavily on teams of interdisciplinary healthcare staff to carry out their operational goals and core business of providing care to the serious illness and injured. The ED is also recognized as a high-risk area in relation to service demand and the potential for human error. Few studies have considered the perceptions and experiences of the ED staff (physicians, nurses, allied health professionals, and administration staff) about the practice of teamwork, especially in Saudi Arabia (SA), and no studies have been conducted to explore the practices of teamwork in the EDs. Aim: To explore the practices of teamwork from the perspectives and experiences of staff (physicians, nurses, allied health professionals, and administration staff) when interacting with each other in the admission areas in the ED of a public hospital in the Northern Border region of SA. Method: A qualitative case study design was utilized, drawing on two methods for the data collection, comprising of semi-structured interviews (n=22) with physicians (6), nurses (10), allied health professionals (3), and administrative members (3) working in the ED of a hospital in the Northern Border region of SA. The second method is non-participant direct observation. All data were analyzed using thematic analysis. Findings: The main themes that emerged from the analysis were as follows: the meaningful of teamwork, reasons of teamwork, the ED environmental factors, the organizational factors, the value of communication, leadership, teamwork skills in the ED, team members' behaviors, multicultural teamwork, and patients and families behaviors theme. Discussion: Working in the ED environment played a major role in affecting work performance as well as team dynamics. However, Communication, time management, fast-paced performance, multitasking, motivation, leadership, and stress management were highlighted by the participants as fundamental skills that have a major impact on team members and patients in the ED. It was found that the behaviors of the team members impacted the team dynamics as well as ED health services. Behaviors such as disputes among team members, conflict, cooperation, uncooperative members, neglect, and emotions of the members. Besides that, the behaviors of the patients and their accompanies had a direct impact on the team and the quality of the services. In addition, the differences in the cultures have separated the team members and created undesirable gaps such the gender segregation, national origin discrimination, and similarity and different in interests. Conclusion: Effective teamwork, in the context of the emergency department, was recognized as an essential element to obtain the quality of care as well as improve staff satisfaction.

Keywords: teamwork, barrier, facilitator, emergencydepartment

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6978 Translation of the Bible into the Yoruba Language: A Functionalist Approach in Resolving Cultural Problems

Authors: Ifeoluwa Omotehinse Oloruntoba

Abstract:

Through comparative and causal models of translation, this paper examined the translation of ‘bread’ into the Yoruba language in three Yoruba versions of the Bible: Bibeli Yoruba Atoka (YBA), Bibeli Mimo ni Ede Yoruba Oni (BMY) and Bibeli Mimo (BM). In biblical times, bread was a very important delicacy that it was synonymous with food in general and in the Bible, bread sometimes refers to a type of food (a mixture of flour, water, and yeast that is baked) or food in general. However, this is not the case in the Yoruba culture. In fact, some decades ago, bread was not known in Nigeria and had no name in the Yoruba language until the 1900s when it was codified as burẹdi in Yoruba, a term borrowed from English and transliterated. Nevertheless, in Nigeria presently, bread is not a special food and it is not appreciated or consumed like in the West. This makes it difficult to translate bread in the Bible into Yoruba. From an investigation on the translation of this term, it was discovered that bread which has 330 occurrences in the English Bible translation (King James) has few occurrences in the three Yoruba Bible versions. In the first version (YBA) published in the 1880s, where bread is synonymous with food in general, it is mostly translated as oúnjẹ (food) or the verb jẹ (to eat), revealing that something is eaten but not indicating what it is. However, when the bread is a type of food, it is rendered as akara, a special delicacy of the Yoruba people made from beans flour. In the later version (BMY) published in the 1990s, bread as food, in general, is also mainly translated as oúnjẹ or the verb jẹ, but when it is a type of food, it is translated as akara with few occurrences of burẹdi. In the latest edition (BM), bread as food is either rendered as ounje or literally translated as burẹdi. Where it is a type of food in this version, it is mainly rendered as burẹdi with few occurrences of akara, indicating the assimilation of bread into the Yoruba culture. This result, although limited, shows that the Bible was translated into Yoruba to make it accessible to Yoruba speakers in their everyday language, hence the application of both domesticating and foreignising strategies. This research also emphasizes the role of the translator as an intermediary between two cultures.

Keywords: translation, Bible, Yoruba, cultural problems

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6977 Nanorods Based Dielectrophoresis for Protein Concentration and Immunoassay

Authors: Zhen Cao, Yu Zhu, Junxue Fu

Abstract:

Immunoassay, i.e., antigen-antibody reaction, is crucial for disease diagnostics. To achieve the adequate signal of the antigen protein detection, a large amount of sample and long incubation time is needed. However, the amount of protein is usually small at the early stage, which makes it difficult to detect. Unlike cells and DNAs, no valid chemical method exists for protein amplification. Thus, an alternative way to improve the signal is through particle manipulation techniques to concentrate proteins, among which dielectrophoresis (DEP) is an effective one. DEP is a technique that concentrates particles to the designated region through a force created by the gradient in a non-uniform electric field. Since DEP force is proportional to the cube of particle size and square of electric field gradient, it is relatively easy to capture larger particles such as cells. For smaller ones like proteins, a super high gradient is then required. In this work, three-dimensional Ag/SiO2 nanorods arrays, fabricated by an easy physical vapor deposition technique called as oblique angle deposition, have been integrated with a DEP device and created the field gradient as high as of 2.6×10²⁴ V²/m³. The nanorods based DEP device is able to enrich bovine serum albumin (BSA) protein by 1800-fold and the rate has reached 180-fold/s when only applying 5 V electric potential. Based on the above nanorods integrated DEP platform, an immunoassay of mouse immunoglobulin G (IgG) proteins has been performed. Briefly, specific antibodies are immobilized onto nanorods, then IgG proteins are concentrated and captured, and finally, the signal from fluorescence-labelled antibodies are detected. The limit of detection (LoD) is measured as 275.3 fg/mL (~1.8 fM), which is a 20,000-fold enhancement compared with identical assays performed on blank glass plates. Further, prostate-specific antigen (PSA), which is a cancer biomarker for diagnosis of prostate cancer after radical prostatectomy, is also quantified with a LoD as low as 2.6 pg/mL. The time to signal saturation has been significantly reduced to one minute. In summary, together with an easy nanorod fabrication and integration method, this nanorods based DEP platform has demonstrated highly sensitive immunoassay performance and thus poses great potentials in applications for early point-of-care diagnostics.

Keywords: dielectrophoresis, immunoassay, oblique angle deposition, protein concentration

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6976 The Spiritual Distress of Women Coping with the End of Life and Death of Their Spouses

Authors: Szu-Mei Hsiao

Abstract:

Many nurses have concerns about the difficulties of providing spiritual care for ethnic-Chinese patients and family members within their cultural context. This is due to a lack of knowledge and training. Most family caregivers are female. There has been little research exploring the potential impact of Chinese cultural values on the spiritual distress of couple dyadic participants in Taiwan. This study explores the spiritual issues of Taiwanese women coping with their husband’s advanced cancer during palliative care to death. Qualitative multiple case studies were used. Data was collected through participant observation and in-depth face-to-face interviews. Transcribed interview data was analyzed by using qualitative content analysis. Three couples were recruited from a community-based rural hospital in Taiwan where the husbands were hospitalized in a medical ward. Four spiritual distress themes emerged from the analysis: (1) A personal conflict in trying to come to terms with love and forgiveness; the inability to forgive their husband’s mistakes; and, lack of their family’s love and support. (2) A feeling of hopelessness due to advanced cancer, such as a feeling of disappointment in their destiny and karma, including expressing doubt on survival. (3) A feeling of uncertainty in facing death peacefully, such as fear of facing the unknown world; and, (4) A feeling of doubt causing them to question the meaning and values in their lives. This research has shown that caregivers needed family support, friends, social welfare, and the help of their religion to meet their spiritual needs in coping within the final stages of life and death. The findings of this study could assist health professionals to detect the spiritual distress of ethnic-Chinese patients and caregivers in the context of their cultural or religious background as early as possible.

Keywords: advanced cancer, Buddhism, Confucianism, Taoism, qualitative research, spiritual distress

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6975 Economics of Precision Mechanization in Wine and Table Grape Production

Authors: Dean A. McCorkle, Ed W. Hellman, Rebekka M. Dudensing, Dan D. Hanselka

Abstract:

The motivation for this study centers on the labor- and cost-intensive nature of wine and table grape production in the U.S., and the potential opportunities for precision mechanization using robotics to augment those production tasks that are labor-intensive. The objectives of this study are to evaluate the economic viability of grape production in five U.S. states under current operating conditions, identify common production challenges and tasks that could be augmented with new technology, and quantify a maximum price for new technology that growers would be able to pay. Wine and table grape production is primed for precision mechanization technology as it faces a variety of production and labor issues. Methodology: Using a grower panel process, this project includes the development of a representative wine grape vineyard in five states and a representative table grape vineyard in California. The panels provided production, budget, and financial-related information that are typical for vineyards in their area. Labor costs for various production tasks are of particular interest. Using the data from the representative budget, 10-year projected financial statements have been developed for the representative vineyard and evaluated using a stochastic simulation model approach. Labor costs for selected vineyard production tasks were evaluated for the potential of new precision mechanization technology being developed. These tasks were selected based on a variety of factors, including input from the panel members, and the extent to which the development of new technology was deemed to be feasible. The net present value (NPV) of the labor cost over seven years for each production task was derived. This allowed for the calculation of a maximum price for new technology whereby the NPV of labor costs would equal the NPV of purchasing, owning, and operating new technology. Expected Results: The results from the stochastic model will show the projected financial health of each representative vineyard over the 2015-2024 timeframe. Investigators have developed a preliminary list of production tasks that have the potential for precision mechanization. For each task, the labor requirements, labor costs, and the maximum price for new technology will be presented and discussed. Together, these results will allow technology developers to focus and prioritize their research and development efforts for wine and table grape vineyards, and suggest opportunities to strengthen vineyard profitability and long-term viability using precision mechanization.

Keywords: net present value, robotic technology, stochastic simulation, wine and table grapes

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6974 Land Cover Mapping Using Sentinel-2, Landsat-8 Satellite Images, and Google Earth Engine: A Study Case of the Beterou Catchment

Authors: Ella Sèdé Maforikan

Abstract:

Accurate land cover mapping is essential for effective environmental monitoring and natural resources management. This study focuses on assessing the classification performance of two satellite datasets and evaluating the impact of different input feature combinations on classification accuracy in the Beterou catchment, situated in the northern part of Benin. Landsat-8 and Sentinel-2 images from June 1, 2020, to March 31, 2021, were utilized. Employing the Random Forest (RF) algorithm on Google Earth Engine (GEE), a supervised classification categorized the land into five classes: forest, savannas, cropland, settlement, and water bodies. GEE was chosen due to its high-performance computing capabilities, mitigating computational burdens associated with traditional land cover classification methods. By eliminating the need for individual satellite image downloads and providing access to an extensive archive of remote sensing data, GEE facilitated efficient model training on remote sensing data. The study achieved commendable overall accuracy (OA), ranging from 84% to 85%, even without incorporating spectral indices and terrain metrics into the model. Notably, the inclusion of additional input sources, specifically terrain features like slope and elevation, enhanced classification accuracy. The highest accuracy was achieved with Sentinel-2 (OA = 91%, Kappa = 0.88), slightly surpassing Landsat-8 (OA = 90%, Kappa = 0.87). This underscores the significance of combining diverse input sources for optimal accuracy in land cover mapping. The methodology presented herein not only enables the creation of precise, expeditious land cover maps but also demonstrates the prowess of cloud computing through GEE for large-scale land cover mapping with remarkable accuracy. The study emphasizes the synergy of different input sources to achieve superior accuracy. As a future recommendation, the application of Light Detection and Ranging (LiDAR) technology is proposed to enhance vegetation type differentiation in the Beterou catchment. Additionally, a cross-comparison between Sentinel-2 and Landsat-8 for assessing long-term land cover changes is suggested.

Keywords: land cover mapping, Google Earth Engine, random forest, Beterou catchment

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6973 Association between Cholesterol Levels and Atopy among Adolescents with and without Sufficient Amount of Physical Activity

Authors: Keith T. S. Tung, H. W. Tsang, Rosa S. Wong, Frederick K. Ho, Patrick Ip

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Objectives: Atopic diseases are increasingly prevalent among children and adolescents, both locally and internationally. One of the possible contributing factors could be the hypercholesterolemia which leads to cholesterol accumulation in macrophages and other immune cells that would eventually promote inflammatory responses, including augmentation of toll-like receptor (TLR). Meanwhile, physical activity is well known for its beneficial effects against the condition of hypercholesterolemia and incidence of atopic diseases. This study, therefore, explored whether atopic diseases were associated with increased cholesterol levels and whether physical activity habit influenced this association. Methods: This is a sub-study derived from the longitudinal cohort study which recruited a group of children at five years of age in Kindergarten 3 (K3) to investigate the long-term impact of family socioeconomic status on child development. In 2018/19, adolescents (average age: 13 years old) were asked to report their physical activity habit and history of any atopic diseases. During health assessment, peripheral blood samples were collected from the adolescents to study their lipid profile [total cholesterol, high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol]. Regression analyses were performed to test the relationships between variables of interest. Results: Among the 315 adolescents, 99 (31.4%) reported to have allergic rhinitis. There were 45 (14.3%) with eczema, 17 (5.4%) with a food allergy, and 12 (3.8%) with asthma. Regression analyses showed that adolescents with a history of any type of atopic diseases had significantly higher total cholesterol (B=13.3, p < 0.01) and LDL cholesterol (B=7.9, p < 0.05) levels. Further subgroup analyses were conducted to examine the effect of physical activity level on the association between atopic diseases and cholesterol levels. We found stronger associations among those who did not meet the World Health Organization recommendation of at least 60 minutes of moderate-to-vigorous activities each day (total cholesterol: B=15.5, p < 0.01; LDL cholesterol: B=10.4, p < 0.05). For those who met this recommendation, the associations between atopic diseases and cholesterol levels became insignificant. Conclusion: Our study results support the current research evidence on the relationship between an elevated level of cholesterol and atopic diseases. More importantly, our results provide preliminary support for the protective effect of regular exercises against elevated cholesterol level due to atopic diseases. The findings highlight the importance of a healthy lifestyle for keeping cholesterol levels in the normal range, which can bring benefits to both physical and mental health.

Keywords: atopic diseases, Chinese adolescents, cholesterol level, physical activity

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6972 A Longitudinal Examination of the Impact of Treatment Modality on Relationship Satisfaction and Mental Health Quality of Life Outcomes among Prostate Cancer Survivors

Authors: Gabriela Ilie, Robert D. H. Rutledge

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A review of the literature reveals a need for longitudinal studies to properly understand the quality of life of prostate cancer survivors during their prostate cancer journey in order to identify opportunities for patient support and care during prostate cancer survivorship. In this study, mental health and relationship satisfaction were assessed longitudinally and by treatment modality among a population-based sample of Canadian adult men with a history of prostate cancer diagnosis. A total of 98 men, aged 51 or older with a history of prostate cancer completed an on-line 15-minute survey between May 2017 and February 2018, assessing mental health (Kessler Psychological Distress Scale) and relationship satisfaction (Dyadic Adjustment Scale) at baseline and at three months post-treatment with either active or nonactive prostate cancer treatment. Almost 1 in 6 men in this sample screened positive for mental health issues (17.34%, n=17) irrespective of treatment modality and most (n=11) were not currently on medication for depression, anxiety or both. Mental health outcomes were poorer for men with multimorbidity. For every instance of screening positive for mental health issues, 2.021 (95% CI:1.1 to 3.8) times more comorbidities were recorded. Relationship satisfaction and dyadic cohesion were statistically significantly lower from first assessment to 3 months for men who underwent multiple treatment modalities (surgery and radiation with hormonal therapy). Relationship satisfaction was also lower at 3 months for men who underwent radiation therapy. Almost 1 in 2 men in this sample (74%) indicated they did not attend a prostate cancer support group. Results suggest that treatment for mental health is underutilized in men with prostate cancer. Men who undergo multiple forms of active treatment appear more vulnerable to relationship dissatisfaction and feeling disconnected from their partner. Data points to important opportunities for patient education and care support during survivorship.

Keywords: prostate cancer survivorship, mental health, quality of life, relationship satisfaction

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6971 Analyzing the Impact of the COVID-19 Pandemic on Clinicians’ Perceptions of Resuscitation and Escalation Decision-Making Processes: Cross-Sectional Survey of Hospital Clinicians in the United Kingdom

Authors: Michelle Hartanto, Risheka Suthantirakumar

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Introduction Staff redeployment, increased numbers of acutely unwell patients requiring resuscitation decision-making conversations, visiting restrictions, and varying guidance regarding resuscitation for patients with COVID-19 disrupted clinicians’ management of resuscitation and escalation decision-making processes. While it was generally accepted that the COVID-19 pandemic disturbed numerous aspects of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process in the United Kingdom, a process which establishes a patient’s CPR status and treatment escalation plans, the impact of the pandemic on clinicians’ attitudes towards these resuscitation and decision-making conversations was unknown. This was the first study to examine the impact of the COVID-19 pandemic on clinicians’ knowledge, skills, and attitudes towards the ReSPECT process. Methods A cross-sectional survey of clinicians at one acute teaching hospital in the UK was conducted. A questionnaire with a defined five-point Likert scale was distributed and clinicians were asked to recall their pre-pandemic views on ReSPECT and report their current views at the time of survey distribution (May 2020, end of the first COVID-19 wave in the UK). Responses were received from 171 clinicians, and self-reported views before and during the pandemic were compared. Results Clinicians reported they found managing ReSPECT conversations more challenging during the pandemic, especially when conducted over the telephone with relatives, and they experienced an increase in negative emotions before, during, and after conducting ReSPECT conversations. Our findings identified that due to the pandemic there was now a need for clinicians to receive training and support in conducting resuscitation and escalation decision-making conversations over the telephone with relatives and managing these processes.

Keywords: cardiopulmonary resuscitation, COVID-19 pandemic, DNACPR discussion, education, recommended summary plan for emergency care and treatment, resuscitation order

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6970 Human Identification Using Local Roughness Patterns in Heartbeat Signal

Authors: Md. Khayrul Bashar, Md. Saiful Islam, Kimiko Yamashita, Yano Midori

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Despite having some progress in human authentication, conventional biometrics (e.g., facial features, fingerprints, retinal scans, gait, voice patterns) are not robust against falsification because they are neither confidential nor secret to an individual. As a non-invasive tool, electrocardiogram (ECG) has recently shown a great potential in human recognition due to its unique rhythms characterizing the variability of human heart structures (chest geometry, sizes, and positions). Moreover, ECG has a real-time vitality characteristic that signifies the live signs, which ensure legitimate individual to be identified. However, the detection accuracy of the current ECG-based methods is not sufficient due to a high variability of the individual’s heartbeats at a different instance of time. These variations may occur due to muscle flexure, the change of mental or emotional states, and the change of sensor positions or long-term baseline shift during the recording of ECG signal. In this study, a new method is proposed for human identification, which is based on the extraction of the local roughness of ECG heartbeat signals. First ECG signal is preprocessed using a second order band-pass Butterworth filter having cut-off frequencies of 0.00025 and 0.04. A number of local binary patterns are then extracted by applying a moving neighborhood window along the ECG signal. At each instant of the ECG signal, the pattern is formed by comparing the ECG intensities at neighboring time points with the central intensity in the moving window. Then, binary weights are multiplied with the pattern to come up with the local roughness description of the signal. Finally, histograms are constructed that describe the heartbeat signals of individual subjects in the database. One advantage of the proposed feature is that it does not depend on the accuracy of detecting QRS complex, unlike the conventional methods. Supervised recognition methods are then designed using minimum distance to mean and Bayesian classifiers to identify authentic human subjects. An experiment with sixty (60) ECG signals from sixty adult subjects from National Metrology Institute of Germany (NMIG) - PTB database, showed that the proposed new method is promising compared to a conventional interval and amplitude feature-based method.

Keywords: human identification, ECG biometrics, local roughness patterns, supervised classification

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6969 Campaigns of Youth Empowerment and Unemployment In Development Discourses: In the Case of Ethiopia

Authors: Fentie, Belay, Mulat

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In today’s high decrement figure of the global economy, nations are facing many economic, social and political challenges; universally, there is high distress of food and other survival insecurity. Further, as a result of conflict, natural disasters, and leadership influences, youths are existentially less empowered and unemployed, especially in developing countries. With this situation to handle well challenges, it’s important to search, investigate and deliberate about youth, unemployment, empowerment and possible management fashions, as youths have the potential to carry and fight such battles. The method adopted is a qualitative analysis of secondary data sources in youth empowerment, unemployment and development as an inclusive framework. Youth unemployment is a major development headache for most African countries. In Ethiopia, following weak youth empowerment, youth unemployment has increased from time to time, and quality education and organization linkage matter as an important constraint. As a management challenge, although accessibility of quality education for Ethiopian youths is an important constraint, the country's youths are fortified deceptively and harassed in a vicious political challenge in their struggle to fetch social and economic changes in the country. Further, thousands of youths are inactivated, criminalized and lost their lives and this makes youths hopeless anger in their lives and pushes them further to be exposed for addictions, prostitution, violence, and illegitimate migrations. This youth challenge wasn’t only destined for African countries; rather, indeed, it was a global burden and headed as a global agenda. As a resolution, the construction of a healthy education system can create independent youths who acquire success and accelerate development. Developing countries should ensue development in the cultivation of empowerment tools through long and short-term education, implementing policy in action, diminishing wide-ranging gaps of (religion, ethnicity & region), and take high youth population as an opportunity and empower them. Further managing and empowering youths to be involved in decision-making, giving political weight and building a network of organizations to easily access job opportunities are important suggestions to save youths in work, for both increasing their income and the country's food security balance.

Keywords: development, Ethiopia, management, unemployment, youth empowerment

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