Search results for: healthcare operation management

Authors: Yasir Memon

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The complexity and challenges in the offshore industry are increasing more than the past. The oil and gas industry is expanding every day by accomplishing these challenges. More challenging wells such as longer and deeper are being drilled in today’s environment. Blowout prevention phenomena hold a worthy importance in oil and gas biosphere. In recent, so many past years when the oil and gas industry was growing drilling operation were extremely dangerous. There was none technology to determine the pressure of reservoir and drilling hence was blind operation. A blowout arises when an uncontrolled reservoir pressure enters in wellbore. A potential of blowout in the oil industry is the danger for the both environment and the human life. Environmental damage, state/country regulators, and the capital investment causes in loss. There are many cases of blowout in the oil the gas industry caused damage to both human and the environment. A huge capital investment is being in used to stop happening of blowout through all over the biosphere to bring damage at the lowest level. The objective of this study is to promote safety and good resources to assure safety and environmental integrity in all operations during drilling. This study shows that human errors and management failure is the main cause of blowout therefore proper management with the wise use of precautions, prevention methods or controlling techniques can reduce the probability of blowout to a minimum level. It also discusses basic procedures, concepts and equipment involved in well control methods and various steps using at various conditions. Furthermore, another aim of this study work is to highlight management role in oil gas operations. Moreover, this study analyze the causes of Blowout of Macondo well occurred in the Gulf of Mexico on April 20, 2010, and deliver the recommendations and analysis of various aspect of well control methods and also provides the list of mistakes and compromises that British Petroleum and its partner were making during drilling and well completion methods and also the Macondo well disaster happened due to various safety and development rules violation. This case study concludes that Macondo well blowout disaster could be avoided with proper management of their personnel’s and communication between them and by following safety rules/laws it could be brought to minimum environmental damage.

Keywords: energy, environment, oil and gas industry, Macondo well accident

Procedia PDF Downloads 159

Authors: Y. Y. Babanyara, B. A. Gana, T. Garba, M. A. Batari

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Proper management of dental waste is a crucial issue for maintaining human health and the environment. The waste generated in the dental clinics has the potential for spreading infections and causing diseases, so improper disposal of these dental wastes can cause harm to the dentist, the people in immediate vicinity of the dentist, waste handlers, general public and the environment through production of toxins or as by-products of the destruction process. Staff that provide dental healthcare ought to be aware of the proper handling and the system of management of dental waste used by different dental hospitals. The method of investigation adopted in the paper involved a desk study in which documents and records relating to dental waste handling were studied to obtain background information on existing dental waste management in Nigeria other countries of the world are also mentioned as examples. Additionally, information on generation, handling, segregation, risk associated during handling and treatment of dental medical waste were sought in order to determine the best method for safe disposal. This article provides dentists with the information they need to properly dispose of mercury and amalgam waste, and provides suggestions for managing the other wastes that result from the day-to-day activities of a dental office such as: used X-ray fixers and developers; cleaners for X-ray developer systems; lead foils, shields and aprons; chemiclave/chemical sterilant solutions; disinfectants, cleaners, and other chemicals; and, general office waste. Additionally, this study may be beneficial for authorities and researchers of developing countries to work towards improving their present dental waste management system.

Keywords: clinic, dental, disposal, environment, waste management

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Authors: Bailey Hall, Athena Hoppe, Tevyn Kagele, Anna Nichols, Breeanna Messner

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The Spokane Street Medicine (SSM) Program aims to deliver medical care to people experiencing homelessness in Spokane, Washington. Street medicine is designed to function in a non-traditional setting to help deliver healthcare to a largely underserved population. In this analysis, the SSM Program’s medical charts from street and shelter encounters in early 2021 were reviewed in order to identify illness and diseases in people experiencing homelessness in Spokane. More than half of the prescriptions written during these encounters were for either an antibacterial, an antibiotic, or an antifungal. Estimates of the cost to the local healthcare system are included. Initiating treatment for communicable diseases in people experiencing homelessness via street medicine efforts greatly reduces economic costs while improving health outcomes.

Keywords: ethical issues in public health, equity issues in public health, health economics, health disparities, healthcare costs, medical public health, public health ethics, street medicine

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Authors: Sonika Raj, Amarjeet Singh, Vijay Lakshmi Sharma

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Introduction: In 21st century, due to revolution in Information and Communication Technologies (ICTs), there has been phenomenal development in quality and quantity of knowledge in the field of medical science. So, the access to relevant information to physicians is critical to the delivery of effective healthcare services to patients. The study was conducted to assess the information needs and attitudes of the medical professionals; to determine the sources and channels of information used by them; to ascertain the current usage of ICTs and the barriers faced by them in utilization of ICTs in health information access. Methodology: This descriptive cross-sectional study was carried in 2015 on hundred medical professionals working in public and private sectors of Chandigarh. The study used both quantitative and qualitative method for data collection. A semi structured questionnaire and interview schedule was used to collect data on information seeking needs, access to ICTs and barriers to healthcare information access. Five Data analysis was done using SPSS-16 and qualitative data was analyzed using thematic approach. Results: The most preferred sources to access healthcare information were internet (85%), trainings (61%) and communication with colleagues (57%). They wanted information on new drug therapy and latest developments in respective fields. All had access to computer with but almost half assessed their computer knowledge as average and only 3% had received training regarding usage. Educational status (p=0.004), place of work (p=0.004), number of years in job (p=0.004) and sector of job (p=0.04) of doctors were found to be significantly associated with their active search for information. The major themes that emerged from in-views were need; types and sources of healthcare information; exchange of information among different levels of healthcare providers; usage of ICTs to obtain and share information; barriers to access of healthcare information and quality of health information materials and involvement in their development process Conclusion and Recommendations: The medical professionals need information in their in their due course of work. However, information needs of medical professionals were not being adequately met. There should be training of professional regarding internet skills and the course on bioinformatics should be incorporated in the curricula of medical students. The policy framework must be formulated that will encourage and promote the use of ICTs as tools for health information access and dissemination.

Keywords: health information, ICTs, medical professionals, qualitative

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Authors: Mostafa Dastori, Sirus Mohammadi

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While plug-in electric vehicles (PEVs) potentially have the capability to fulfill the energy storage needs of the electric grid, the degradation on the battery during this operation makes it less preferable by the auto manufacturers and consumers. On the other hand, the on-board chargers can also supply energy storage system applications such as reactive power compensation, voltage regulation, and power factor correction without the need of engaging the battery with the grid and thereby preserving its lifetime. It presents the design motives of single-phase on-board chargers in detail and makes a classification of the chargers based on their future vehicle-to-grid usage. The pros and cons of each different ac–dc topology are discussed to shed light on their suit- ability for reactive power support. This paper also presents and analyzes the differences between charging-only operation and capacitive reactive power operation that results in increased demand from the dc-link capacitor (more charge/discharge cycles and in- creased second harmonic ripple current). Moreover, battery state of charge is spared from losses during reactive power operation, but converter output power must be limited below its rated power rating to have the same stress on the dc-link capacitor.

Keywords: energy storage system, battery unit, cost, optimal sizing, plug-in electric vehicles (PEVs), smart grid

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Authors: Rita Magdalena, N. K. Caecar Pratiwi, Yunendah Nur Fuadah, Sofia Saidah, Bima Sakti

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Vessel segmentation of retinal fundus is important for biomedical sciences in diagnosing ailments related to the eye. Segmentation can simplify medical experts in diagnosing retinal fundus image state. Therefore, in this study, we designed a software using MATLAB which enables the segmentation of the retinal blood vessels on retinal fundus images. There are two main steps in the process of segmentation. The first step is image preprocessing that aims to improve the quality of the image to be optimum segmented. The second step is the image segmentation in order to perform the extraction process to retrieve the retina’s blood vessel from the eye fundus image. The image segmentation methods that will be analyzed in this study are Morphology Operation, Discrete Wavelet Transform and combination of both. The amount of data that used in this project is 40 for the retinal image and 40 for manually segmentation image. After doing some testing scenarios, the average accuracy for Morphology Operation method is 88.46 % while for Discrete Wavelet Transform is 89.28 %. By combining the two methods mentioned in later, the average accuracy was increased to 89.53 %. The result of this study is an image processing system that can segment the blood vessels in retinal fundus with high accuracy and low computation time.

Keywords: discrete wavelet transform, fundus retina, morphology operation, segmentation, vessel

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Authors: Manan’Iarivo Rasolonjanahary, Chris Bingham, Nigel Schofield, Masoud Bazargan

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This paper presents the research and application of model predictive scheduled charging of electric vehicles (EV) subject to limited available power resource. To focus on algorithm and operational characteristics, the EV interface to the source is modelled as a battery state equation during the charging operation. The researched methods allow for the priority scheduling of EV charging in a multi-vehicle regime and when subject to limited source power availability. Priority attribution for each connected EV is described. The validity of the developed methodology is shown through the simulation of different scenarios of charging operation of multiple connected EVs including non-scheduled and scheduled operation with various numbers of vehicles. Performance of the developed algorithms is also reported with the recommendation of the choice of suitable parameters.

Keywords: model predictive control, non-scheduled, power limited sources, scheduled and stop-start battery charging

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Authors: Anita D. Adamu, Winston M. W. Shakantu

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Maintenance management is no longer a stand-alone activity. It has now assumed a strategic position in many organisations that have recognised its importance in achieving primary goals and a key aspect of effective management of facilities. This paper aims at providing an understanding of the role and function of strategic management in creating and sustaining an effective maintenance management system in an organisation. The background provides an articulated concept and principles of strategic management. The theoretical concepts paved way for a conceptual framework for which strategic management can be integrated into the maintenance management system of an organisation to improve effectiveness in the maintenance of facilities.

Keywords: facilities, maintenance management, organisations, strategic management

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Authors: Guo Cyuan Deng

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This study represents how the Soviet-occupied dark memory in Baltic countries were interpreted and represented by examining the way of management of prison heritage. Based on the formulation of a dark-tourism spectrum which Philip Stone proposed, the Patarei prison in Estonia and the Karosta prison in Latvia are compared, and it is thought that both prisons, which had experienced similar colonial history, face different tourism operation in the present. The former is being run by NGO and remain the situation of “empty" by art intervening. However, the Estonia government attempt to get the operation of museum and transform it to anti-Soviet museum in order show national identity. By contrast, the latter is being managed by private company, whom transformed the prison to "dark fun factories" by entertainment activities in order to private capital accumulation. Moreover, it is not only indicated that both prisons exclude the minority's memory, but also the flaws of dark-tourism spectrum which divide the dark and light are discussed. Finally, given the nature and function of dark heritage, the concept "le métro" is used to supplement Stone's spectrum.

Keywords: dark tourism, prison heritage, Post-Soviet, Baltic countries, national identities

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Authors: Van Truong Pham

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Background: Self-management was described as a potential strategy for blood pressure control in patients with hypertension. However, the effects of self-management interventions on blood pressure, self-efficacy, medication adherence, and body mass index (BMI) in older adults with hypertension have not been systematically evaluated. We evaluated the effects of self-management interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP), self-efficacy, medication adherence, and BMI in hypertensive older adults. Methods: We followed the recommended guidelines of preferred reporting items for systematic reviews and meta-analyses. Searches in electronic databases including CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science, and other sources were performed to include all relevant studies up to April 2019. Studies selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized intervention effects as Hedges' g values and 95% confidence intervals (CI) using a random-effects model. Data were analyzed using Comprehensive Meta-Analysis software 2.0. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly improved blood pressure control, self-efficacy, medication adherence, whereas the effect of self-management on BMI was not significant in older adult patients with hypertension. The following Hedges' g (effect size) values were obtained: SBP, -0.34 (95% CI, -0.51 to -0.17, p < 0.001); DBP, -0.18 (95% CI, -0.30 to -0.05, p < 0.001); self-efficacy, 0.93 (95%CI, 0.50 to 1.36, p < 0.001); medication adherence, 1.72 (95%CI, 0.44 to 3.00, p=0.008); and BMI, -0.57 (95%CI, -1.62 to 0.48, p = 0.286). Conclusions: Self-management interventions significantly improved blood pressure control, self-efficacy, and medication adherence. However, the effects of self-management on obesity control were not supported by the evidence. Healthcare providers should implement self-management interventions to strengthen patients' role in managing their health care.

Keywords: self-management, meta-analysis, blood pressure control, self-efficacy, medication adherence, body mass index

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Authors: Elkington S. Mnguni

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Water and sanitation services in South Africa are characterized by both achievements and challenges. After the end of apartheid in 1994 the newly elected government faced the challenge of eradicating backlogs with respect to access to basic services, including water and sanitation. Capital investment made in the development of new water and sanitation infrastructure to provide basic services to previously disadvantaged communities has grown, to a certain extent, at the expense of investment in the operation and maintenance of new and existing infrastructure. Challenges resulting from aging infrastructure and poor plant performance highlight the need for investing in the maintenance, rehabilitation, and replacement of existing infrastructure to optimize the return on investment. Advanced water infrastructure asset management (IAM) is key to achieving adequate levels of service, particularly with regard to reliable and high quality drinking water supply, prevention of urban flooding, efficient use of natural resources and prevention of pollution and associated risks. Against this backdrop, this paper presents an appraisal of water and sanitation IAM systems in South Africa’s three utilities, being metropolitan cities in the Gauteng Province. About a quarter of the national population lives in the three rapidly urbanizing cities of Johannesburg, Ekurhuleni and Tshwane, located in a semi-arid region. A literature review has been done and field visits to some of the utility facilities are being conducted. Semi-structured interviews will be conducted with the three utilities. The following critical factors are being analysed in terms of compliance with the national Water Services IAM Strategy (2011) and other applicable legislation: asset registers; capacity of assets; current and predicted demand; funding availability / budget allocations; plans: operation & maintenance, renewal & replacement, and risk management; no-drop status (non-revenue water levels); blue drop status (water quality); green drop status (effluent quality); and skills availability. Some of the key challenges identified in the literature review include: funding constraints, Skills shortage, and wastewater treatment plants operating beyond their design capacities. These challenges will be verified during field visits and research interviews. Gaps between literature and practice will be identified and relevant recommendations made if necessary. The objective of this study is to contribute to the resolution of the challenges brought about by the backlogs in the operation and maintenance of water and sanitation assets in the country in general, and in the three cities in particular, thus improving the sustainability thereof.

Keywords: asset management, backlogs, levels of service, sustainability, water and sanitation infrastructure

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Authors: Yongqi Dong, Zuo Zhang, Rui Fu, Li Li

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The records generated by taxicabs which are equipped with GPS devices is of vital importance for studying human mobility behavior, however, here we are focusing on taxi drivers' operation strategies between workdays and weekends temporally and spatially. We identify a group of valuable characteristics through large scale drivers' behavior in a complex metropolis environment. Based on the daily operations of 31,000 taxi drivers in New York City, we classify drivers into top, ordinary and low-income groups according to their monthly working load, daily income, daily ranking and the variance of the daily rank. Then, we apply big data analysis and visualization methods to compare the different characteristics among top, ordinary and low income drivers in selecting of working time, working area as well as strategies between workdays and weekends. The results verify that top drivers do have special operation tactics to help themselves serve more passengers, travel faster thus make more money per unit time. This research provides new possibilities for fully utilizing the information obtained from urban taxicab data for estimating human behavior, which is not only very useful for individual taxicab driver but also to those policy-makers in city authorities.

Keywords: big data, operation strategies, comparison, revenue, temporal, spatial

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Authors: Sreejith Gopinath, Aspen Olmsted

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This paper is based on our previous work that proposed a risk-transference-based architecture for healthcare systems to store sensitive data outside the system boundary, rendering the system unattractive to would-be bad actors. This architecture also allows a compromised system to be abandoned and a new system instance spun up in place to ensure business continuity without paying a ransom or engaging with a bad actor. This paper delves into the details of various attacks we simulated against the prototype system. In the paper, we discuss at length the time and computational costs associated with storing and retrieving data in the prototype system, abandoning a compromised system, and setting up a new instance with existing data. Lastly, we simulate some analytical workloads over the data stored in our specialized data storage system and discuss the time and computational costs associated with running analytics over data in a specialized storage system outside the system boundary. In summary, this paper discusses the total costs of data storage, access, and analytics incurred with the proposed architecture.

Keywords: cybersecurity, healthcare, ransomware, resilience, risk transference

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Authors: Ganbat Danaa, Chuluundorj Puntsag

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The steel structures of the Oyu-Tolgoi mining Concentrator plant are corroded during operation, which raises doubts about the continued use of some important structures of the plant, which is one of the problems facing the plant's regular operation. As a part of the main operation of the plant, the bottom part of the pressure vessel, which plays an important role in the reliable operation of the concentrate filter-drying unit, was heavily corroded, so it was necessary to study by engineering calculations, modeling, and simulation using modern advanced engineering programs and methods. The purpose of this research is to investigate whether the corroded part of the pressure vessel can be used normally in the future using advanced engineering software and to predetermine the remaining life of the time of the pressure vessel based on engineering calculations. When the thickness of the bottom part of the pressure vessel was thinned by 0.5mm due to corrosion detected by non-destructive testing, finite element analysis using ANSYS WorkBench software was used to determine the mechanical stress, strain and safety factor in the wall and bottom of the pressure vessel operating under 2.2 MPa working pressure, made conclusions on whether it can be used in the future. According to the recommendations, by using sand-blast cleaning and anti-corrosion paint, the normal, continuous and reliable operation of the Concentrator plant can be ensured, such as ordering new pressure vessels and reducing the installation period. By completing this research work, it will be used as a benchmark for assessing the corrosion condition of steel parts of pressure vessels and other metallic and non-metallic structures operating under severe conditions of corrosion, static and dynamic loads, and other deformed steels to make analysis of the structures and make it possible to evaluate and control the integrity and reliable operation of the structures.

Keywords: corrosion, non-destructive testing, finite element analysis, safety factor, structural reliability

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Authors: Raed El-Khalil, Hussein Zeaiter

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Managing and improving efficiency in the current highly competitive global automotive industry demands that companies adopt leaner and more flexible systems. During the past 20 years the domestic automotive industry in North America has been focusing on establishing new management strategies in order to meet market demands. 98The lean management process also known as Toyota Manufacturing Process (TPS) or lean manufacturing encompasses tools and techniques that were established in order to provide the best quality product with the fastest lead time at the lowest cost. The following paper presents a study that focused on improving labor efficiency at one of the Big Three (Ford, GM, Chrysler LLC) domestic automotive facility in North America. The objective of the study was to utilize several lean management tools in order to optimize the efficiency and utilization levels at the “Pre-Marriage” chassis area in a truck manufacturing and assembly facility. Utilizing three different lean tools (i.e. Standardization of work, 7 Wastes, and 5S) this research was able to improve efficiency by 51%, utilization by 246%, and reduce operations by 14%. The return on investment calculated based on the improvements made was 284%.

Keywords: lean manufacturing, standardized work, operation efficiency, utilization

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Authors: Priscila M. Lima, Corine A. P. de Almeida, Muriele R. de Lima, Fernando J. C. Magalhães Filho

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This work characterized the preliminary treatment in WWTPs in the state of Mato Grosso Do Sul (Brazil) and analyzed aspects of operation and maintenance of solid waste retained, and was evaluated the interference of this step in treatment efficiency beyond the relationship between solid waste generation with rainfall and seasonality in the region of each WTPs. The results shown that the standard setting in the preliminary treatment consists of grid along with Sand Trap, followed by Parshall that is used in 94.12% of WWTPs analyzed, and in 5.88% of WWTPs it was added the air-lift to the Sand Trap. Was concluded that the influence of rainfall, flow and seasonality associated with the rate of waste generation in the preliminary treatment, had little relation to the operation and maintenance of the primary treatment. But in some cases, precipitation data showed increased rainfall converging with increased flow and solid waste generation.

Keywords: pretreatment, sewage, solid waste, wastewater

Procedia PDF Downloads 441

Authors: Sitti Rahmawati

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Payment system of cataract surgery implemented by professional attendant of doctor and nurse has been increasing, through health insurance program and this has become one of the factors that affects a lot of government in the budget establishment. This system has been implemented in purpose of quality and expenditure control, i.e., controlling health overpayment to obtain benefit (moral hazard) by the user of insurance or health service provider. The increasing health cost becomes the main issue that hampers the society to receive required health service in cash payment-system. One of the efforts that should be taken by the government in health payment is by securing health insurance through society's health insurance. The objective of the study is to learn the capability of a patient to pay cataract eye operation for the elders. Method of study sample population in this study was patients who obtain health insurance board card for the society that was started in the first of tri-semester (January-March) 2015 and claimed in Indonesian software-Case Based Group as a purposive sampling of 40 patients. Results of the study show that total unit cost analysis of surgery service unit was obtained $75 for unit cost without AFC and salary of nurse and doctor. The operation tariff that has been implemented today at Anutapura hospitals in eye department is tariff without AFC and the salary of the employee is $80. The operation tariff of the unit cost calculation with double distribution model at $65. Conclusion, the calculation result of actual unit cost that is much greater causes incentive distribution system provided to an ophthalmologist at $37 and nurse at $20 for one operation. The surgery service tariff is still low; consequently, the hospital receives low revenue and the quality of health insurance in eye operation department is relatively low. In purpose of increasing the service quality, it requires adequately high cost to equip medical equipment and increase the number of professional health attendant in serving patients in cataract eye operation at hospital.

Keywords: economic evaluation, cataract operation, health attendant, health insurance system

Procedia PDF Downloads 146

Authors: Mohammad Al-Mousawi

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This academic article explores the indispensable role of critical thinking in the process of diagnosing diseases. Employing a multidisciplinary approach, we delve into the cognitive skills and analytical mindset that clinicians, researchers, and healthcare professionals must employ to navigate the complexities of disease identification. By examining the integration of critical thinking within the realms of medical education, diagnostic decision-making, and technological advancements, this article aims to underscore the significance of cultivating and applying critical thinking skills in the ever-evolving landscape of healthcare.

Keywords: critical thinking, medical education, diagnostic decision-making, fostering critical thinking

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Authors: John Pomerat, Aviv Segev

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Recently, deep learning has had many theoretical breakthroughs. For deep learning to be successful in the industry, however, there need to be practical algorithms capable of handling many real-world hiccups preventing the immediate application of a learning algorithm. Although AI promises to revolutionize the healthcare industry, getting access to patient data in order to train learning algorithms has not been easy. One proposed solution to this is data- sharing. In this paper, we propose an alternative protocol, based on multi-party computation, to train deep learning models while maintaining both the privacy and security of training data. We examine three methods of training neural networks in this way: Transfer learning, average ensemble learning, and series network learning. We compare these methods to the equivalent model obtained through data-sharing across two different experiments. Additionally, we address the security concerns of this protocol. While the motivating example is healthcare, our findings regarding multi-party computation of neural network training are purely theoretical and have use-cases outside the domain of healthcare.

Keywords: neural network aggregation, multi-party computation, transfer learning, average ensemble learning

Procedia PDF Downloads 137

Authors: K. W. Lee, C. M. Choi, H. C. Tsang, W. K. Fong, Y. K. Cheng, L. Y. Chan, C. K. Yuen, P. W. Lau, Y. L. To, K. C. Chow

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QR (Quick Response) Code is a matrix barcode. It enables users to open websites, photos and other information with mobile devices by just snapping the code. In usual Long Term Oxygen Therapy arrangement, piles of LTOT related information like leaflets from different oxygen service providers are given to patients to choose an appropriate plan according to their needs. If these printed materials are transformed into electronic format (QR Code), it would be more environmentally-friendly. More importantly, electronic materials including LTOT equipment operation and dyspnoea relieving techniques also empower patients in long-term disease management. The objective to this study is to investigate the effect of QR code in patient education on new LTOT users. This study was carried out in medical wards of North District Hospital. Adult patients and relatives who followed commands, were able to use smartphones with internet services and required LTOT arrangement on hospital discharge were recruited. In LTOT arrangement, apart from the usual LTOT education booklets which included patients’ personal information (e.g. oxygen titration and six-minute walk test results etc.), extra leaflets consisted of 1. QR codes of LTOT plans from different oxygen service providers, 2. Education materials of dyspnoea management and 3. Instructions on LTOT equipment operation were given. Upon completion of LTOT arrangement, a questionnaire about the use of QR code on patient education was filled in by patients or relatives. A total of 10 new LTOT users were recruited from November 2017 to January 2018. Initially, 70% of them did not know anything about the QR code, but all of them understood its operation after a simple demonstration. 70% of them agreed that it was convenient to use (20% strongly agree, 40% agree, 10% somewhat agree). 80% of them agreed that QR code could facilitate the retrieval of more LTOT related information (10% strongly agree, 70% agree) while 90% agreed that we should continue delivering QR code leaflets to new LTOT users in the future (30% strongly agree, 40% agree, 20% somewhat agree). It is proven that QR code is a convenient and environmentally-friendly tool to deliver information. It is also relatively easy to be introduced to new users. It has received welcoming feedbacks from current users.

Keywords: long-term oxygen therapy, physiotherapy, patient education, QR code

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Authors: Nam Kyu Kim, Hee Jun Cha, Jae Jin Seo, Dong Jun Won

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Output power of a photovoltaic (PV) generator depends on incident solar irradiance. If the clouds pass or the climate condition is bad, the PV output fluctuates frequently. When PV generator is connected to the grid, these fluctuations adversely affect power quality. Thus, ramp rate control with battery energy storage system (BESS) is needed to reduce PV output fluctuations. At the same time, for effective BESS operation and sizing the optimal BESS capacity, managing state of charge (SOC) is the most important part. In addition, managing SOC helps to avoid violating the SOC operating range of BESS when performing renewable integration (RI) continuously. As PV and BESS increase, the SOC management of BESS will become more important in the future. This paper presents the SOC management algorithm which helps to operate effectively BESS, and has focused on method to manage SOC while reducing PV output fluctuations. A simulation model is developed in PSCAD/EMTDC software. The simulation results show that the SOC is maintained within the operating range by adjusting the output distribution according to the SOC of the BESS.

Keywords: battery energy storage system, ramp rate control, renewable integration, SOC management

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Authors: Ezinne K. Okoro, Takahiko Katoh, Yoko Kawamura, Stanley C. Meribe

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HIV infection in children is largely as a result of vertical transmission (mother to child transmission [MTCT]). Thus, elimination of mother to child transmission of HIV/AIDS is critical in eliminating HIV infection in children. In Nigeria, drawbacks such as; limited pediatric screening, limited human capital, insufficient advocacy and poor understanding of ART guidelines, have impacted efforts at combating the disease, even as treatment services are free. Prevention of Mother to Child Transmission (PMTCT) program relies on health workers who not only counsel pregnant women on first contact but can competently provide HIV-positive pregnant women with accurate information about the PMTCT program such as feeding techniques and drug adherence. In developing regions like Nigeria where health care delivery faces a lot of drawbacks, it becomes paramount to address these issues of poor PMTCT coverage by conducting a baseline assessment of the knowledge, practices and perceptions related to HIV prevention amongst healthcare workers in Nigeria. A descriptive cross-sectional study was conducted amongst 250 health workers currently employed in health facilities in Abuja, Nigeria where PMTCT services were offered with the capacity to carry out early infant diagnosis testing (EID). Data was collected using a self-administered, pretested, structured questionnaire. This study showed that the knowledge of PMTCT of HIV was poor (30%) among healthcare workers who offer this service day-to-day to pregnant women. When PMTCT practices were analyzed in keeping with National PMTCT guidelines, over 61% of the respondents reported observing standard practices and the majority (58%) had good attitudes towards caring for patients with HIV/AIDS. Although 61% of the respondents reported being satisfied with the quality of service being rendered, 63% reported not being satisfied with their level of knowledge. Predictors of good knowledge were job designation and level of educational attainment. Health workers who were more satisfied with their working conditions and those who had worked for a longer time in the PMTCT service were more likely to observe standard PMTCT practices. With over 62% of the healthcare workers suggesting that more training would improve the quality of service being rendered, this is a strong pointer to stakeholders to consider a ‘healthcare worker-oriented approach’ when planning and conducting PMTCT training for healthcare workers. This in turn will increase pediatric ARV coverage, the knowledge and effectiveness of the healthcare workers in carrying out appropriate PMTCT interventions and culminating in the reduction/elimination of HIV transmission to newborns.

Keywords: attitudes, HIV/AIDS, healthcare workers, knowledge, mother to child transmission, Nigeria, perceptions

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Authors: Hsin-Yueh Chang, Pin-Chen Liao, Jo-Shu Chang, Chun-Yen Chen

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Biofuel has drawn much attention as a potential substitute to fossil fuels. However, biodiesel from waste oil, oil crops or other oil sources can only satisfy partial existing demands for transportation. Due to the feature of being clean, green and viable for mass production, using microalgae as a feedstock for biodiesel is regarded as a possible solution for a low-carbon and sustainable society. In particular, Thraustochytrium sp. BM2, an indigenous heterotrophic microalga, possesses the potential for metabolizing glycerol to produce lipids. Hence, it is being considered as a promising microalgae-based oil source for biodiesel production and other applications. This study was to optimize the culture pH, scale up, assess the feasibility of producing microalgal lipid from crude glycerol and apply operation strategies following optimal results from shake flask system in a 5L stirred-tank fermenter for further enhancing lipid productivities. Cultivation of Thraustochytrium sp. BM2 without pH control resulted in the highest lipid production of 3944 mg/L and biomass production of 4.85 g/L. Next, when initial glycerol and corn steep liquor (CSL) concentration increased five times (50 g and 62.5 g, respectively), the overall lipid productivity could reach 124 mg/L/h. However, when using crude glycerol as a sole carbon source, direct addition of crude glycerol could inhibit culture growth. Therefore, acid and metal salt pretreatment methods were utilized to purify the crude glycerol. Crude glycerol pretreated with acid and CaCl₂ had the greatest overall lipid productivity 131 mg/L/h when used as a carbon source and proved to be a better substitute for pure glycerol as carbon source in Thraustochytrium sp. BM2 cultivation medium. Engineering operation strategies such as fed-batch and semi-batch operation were applied in the cultivation of Thraustochytrium sp. BM2 for the improvement of lipid production. In cultivation of fed-batch operation strategy, harvested biomass 132.60 g and lipid 69.15 g were obtained. Also, lipid yield 0.20 g/g glycerol was same as in batch cultivation, although with poor overall lipid productivity 107 mg/L/h. In cultivation of semi-batch operation strategy, overall lipid productivity could reach 158 mg/L/h due to the shorter cultivation time. Harvested biomass and lipid achieved 232.62 g and 126.61 g respectively. Lipid yield was improved from 0.20 to 0.24 g/g glycerol. Besides, product costs of three kinds of operation strategies were also calculated. The lowest product cost 12.42 $NTD/g lipid was obtained while employing semi-batch operation strategy and reduced 33% in comparison with batch operation strategy.

Keywords: heterotrophic microalga Thrasutochytrium sp. BM2, microalgal lipid, crude glycerol, fermentation strategy, biodiesel

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Authors: Jaishree Ellis

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The United States Centers for Disease Control tells us that many women with disabilities will not receive regular health screenings, including Pap Smears and mammograms. This article was comprised and written to recognize the barriers to care, gaps in existing healthcare implementation, and viable methodologies for the provision of comprehensive and robust gynecologic care for women with disabilities. According to the World Health Organization, 15% of the world's population, or approximately 1 billion people, have disabilities, most of whom are identified as women. Women with disabilities are described as being multi-disabled, as in some places, they suffer exclusion because of their disabilities as well as their gender. The paucity of information regarding how to create a healthcare system that is inclusive of every woman, regardless of her type of disability (physical, mental, intellectual or medical), has made it challenging to establish an environment that makes it possible for individuals to access care in an equitable, respectful and comprehensive way. A review of the current literature, institutional websites within the United States and American resource guides was implemented to determine where comprehensive models of care for women with disabilities exist, as well as the modalities that are being employed to meet their healthcare needs. The many barriers to care that women with disabilities face were also extracted from various sources within the literature to provide an exhaustive list that can be tackled, one by one. Of the 637 Hospital Systems in the United States, only 7 provide website documentation of health care services that address the unique needs of women with disabilities. The presumption is that if institutions have not marketed such interventions to the community, then it is likely that they do not have a robust suite of services with which to make gynecologic care available to patients with disabilities. Through this review, 7 main barriers to comprehensive gynecologic care were identified, with more than 20 sub-categories existing within those. As with many other areas of community life, inclusion remains lacking in the delivery of healthcare for women with disabilities. There are at least 7 barriers that must be overcome in order to provide equity in the medical office, the exam room, the hospital and the operating room. While few institutions have prioritized this, those few have provided blueprints that can easily be adopted by others. However, as the general population lives longer and ages, the incidence of disabilities increases, as do the healthcare disparities surrounding them. Further compounded by this is a lack of formal education for medical providers in the United States.

Keywords: health equity, inclusion, healthcare disparities, education

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Authors: Noorulain Khalid, Unsaar Hayat, Muhammad Chaudhary, Christos Iosifidis, Felipe Dhawahir-Scala, Fiona Carley

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Dry eye disease (DED) is a common condition seen in the emergency eye department (EED) at Manchester Royal Eye Hospital (MREH). However, there is variability in the prescription of lubricating eye drops among different healthcare providers. The aim of this study was to develop an up-to-date, standardized algorithm for the prescription of lubricating eye drops in the EED at MREH based on international and national guidelines. The study also aimed to assess the impact of implementing the guideline on the rate of inappropriate lubricant prescriptions. Primarily, the impact was to be assessed in the form of the appropriateness of prescriptions for patients’ DED. The impact was secondary to be assessed through analysis of the cost to the hospital. Data from 845 patients who attended the EED over a 3-month period were analyzed, and 157 patients met the inclusion and exclusion criteria. After conducting a review of the literature and collaborating with the corneal team, an algorithm for the prescription of lubricants in the EED was developed. Three plan-do-study-act (PDSA) cycles were conducted, with interventions such as emails, posters, in-person reminders, and education for incoming trainees. The appropriateness of prescriptions was evaluated against the guidelines. Data were collected from patient records and analyzed using statistical methods. The appropriateness of prescriptions was assessed by comparing them to the guidelines and by clinical correlation with a specialized registrar. The study found a substantial improvement in the number of appropriate prescriptions, with an increase from 55% to 93% over the three PDSA cycles. There was additionally a 51% reduction in expenditure on lubricant prescriptions, resulting in cost savings for the hospital (approximate saving of £50/week). Theoretical importance: Appropriate prescription of lubricating eye drops improves disease management for patients and reduces costs for the hospital. The development and implementation of a standardized guideline facilitate the achievement of these goals. Conclusion: This study highlights the inconsistent management of DED in the EED and the potential lack of training in this area for healthcare providers. The implementation of a standardized, easy-to-follow guideline for lubricating eye drops can help to improve disease management while also resulting in cost savings for the hospital.

Keywords: lubrication, dry eye disease, guideline, prescription

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Authors: Mahmoud A. Amin, Essam Taman, Ahmed Omran, Mahmoud Shawky, Ahmed Mekawy, Abdallah M. Kotkat, Saber Younes, Nehad N. Ghonemy, Amin Saad, Ezz-Aleslam, Abdullah M. Elosh

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Introduction: TMJ is a one-of-a-kind, complicated synovial joint that helps with masticatory function by allowing the mandible to open and close the mouth. True ankylosis is a situation in which condylar movement is limited by a mechanical defect in the joint, whereas false ankylosis is a condition in which there is a restriction in mandibular movement due to muscular spasm myositis ossificans, and coronoid process hyperplasia. Ankylosis is characterized by the inability to open the mouth due to fusion of the TMJ condyle to the base of the skull as a result of trauma, infection, or systemic diseases such as rheumatoid arthritis (the most common) and psoraisis. Ankylosis causes facial asymmetry and affects the patient psychologically as well as speech, difficult mastication, poor oral hygiene, malocclusion, and other factors. TMJ is a technically challenging joint; hence TMJ ankylosis management is complicated. Case presentation: this case is a male patient 25 years old reported to our maxillofacial clinic in Damietta faculty of medicine, Al-Azhar University with the inability to open the mouth at all, with a history of difficulty of mouth breathing and eating foods, there was a history of falling from height at 2006, and the patient underwent corrective surgery before with no improvement because the ankylosis was relapsed short period after the previous operations with that done out of our hospital inter-incisor distant ZERO so, this condition need mandatory management. Clinical examination and radiological investigations were done after complete approval from the patient and his brother; tracheostomy was done for our patient before the operation. The patient entered the operation in our hospital and drastic improvement in mouth opening was noticed, helping to restore the physical psychological health of the patient.

Keywords: temporomandibular joint, TMJ, Ankylosis, mouth opening, physiotherapy, condylar plate

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Authors: Nigina Toktasynova, Sholpan Sagyndykova, Zhanat Kenzhebayeva, Maksat Kalimoldayev, Mariya Ishimova, Irbulat Utepbergenov

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Any business needs a stable operation and continuous improvement, therefore it is necessary to constantly interact with the environment, to analyze the work of the enterprise in terms of employees, executives and consumers, as well as to correct any inconsistencies of certain types of processes and their aggregate. In the case of heat supply organizations, in addition to suppliers, local legislation must be considered which often is the main regulator of pricing of services. In this case, the process approach used to build a functional organizational structure in these types of businesses in Kazakhstan is a challenge not only in the implementation, but also in ways of analyzing the employee's salary. To solve these problems, we investigated the management system of heating enterprise, including strategic planning based on the balanced scorecard (BSC), quality management in accordance with the standards of the Quality Management System (QMS) ISO 9001 and analysis of the system based on expert judgment using fuzzy inference. To carry out our work we used the theory of fuzzy sets, the QMS in accordance with ISO 9001, BSC according to the method of Kaplan and Norton, method of construction of business processes according to the notation IDEF0, theory of modeling using Matlab software simulation tools and graphical programming LabVIEW. The results of the work are as follows: We determined possibilities of improving the management of heat-supply plant-based on QMS; after the justification and adaptation of software tool it has been used to automate a series of functions for the management and reduction of resources and for the maintenance of the system up to date; an application for the analysis of the QMS based on fuzzy inference has been created with novel organization of communication software with the application enabling the analysis of relevant data of enterprise management system.

Keywords: balanced scorecard, heat supply, quality management system, the theory of fuzzy sets

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Authors: Ruyang Ren, Yaohua Zhao, Yanhua Diao

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The intermittent and unstable characteristics of renewable energy such as solar energy can be effectively solved through battery energy storage system. Lithium-ion battery is widely used in battery energy storage system because of its advantages of high energy density, small internal resistance, low self-discharge rate, no memory effect and long service life. However, the performance and service life of lithium-ion battery is seriously affected by its operating temperature. Thus, the safety operation of the lithium-ion battery module is inseparable from an effective thermal management system (TMS). In this study, a new type of TMS based on micro heat pipe array (MHPA) for lithium-ion battery is established, and the TMS is applied to a battery energy storage box that needs to operate at a high temperature environment of 40 °C all year round. MHPA is a flat shape metal body with high thermal conductivity and excellent temperature uniformity. The battery energy storage box is composed of four battery modules, with a nominal voltage of 51.2 V, a nominal capacity of 400 Ah. Through the excellent heat transfer characteristics of the MHPA, the heat generated by the charge and discharge process can be quickly transferred out of the battery module. In addition, if only the MHPA cannot meet the heat dissipation requirements of the battery module, the TMS can automatically control the opening of the external fan outside the battery module according to the temperature of the battery, so as to further enhance the heat dissipation of the battery module. The thermal management performance of lithium-ion battery TMS based on MHPA is studied experimentally under different ambient temperatures and the condition to turn on the fan or not. Results show that when the ambient temperature is 40 °C and the fan is not turned on in the whole charge and discharge process, the maximum temperature of the battery in the energy storage box is 53.1 °C and the maximum temperature difference in the battery module is 2.4 °C. After the fan is turned on in the whole charge and discharge process, the maximum temperature is reduced to 50.1 °C, and the maximum temperature difference is reduced to 1.7 °C. Obviously, the lithium-ion battery TMS based on MHPA not only could control the maximum temperature of the battery below 55 °C, but also ensure the excellent temperature uniformity of the battery module. In conclusion, the lithium-ion battery TMS based on MHPA can ensure the safe and stable operation of the battery energy storage box in high temperature environment.

Keywords: heat dissipation, lithium-ion battery thermal management, micro heat pipe array, temperature uniformity

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Authors: Mohsin Shahab, Shagufta Rehmat, Faisal F. Khan

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Background: The global COVID-19 pandemic has generated health problems worldwide. Health care workers are the front-line warriors against the pandemic. The aim of this study was to find out the prevalence of COVID-19 (7th May 2021 to 3rd August 2021) amongst Health Care Workers (HCWs) and to assess the complications associated with it and its effects on their quality of life. Material and Method: The study was conducted in healthcare facilities which serve as pandemic hospitals in district Swat. A total of 140 healthcare workers, who were employed in the COVID-19 health care facilities, including the department of Pulmonology, Intensive Care Unit (ICU), and COVID-19 wards. Participants were tested for COVIID-19 using RT PCR test. A Case Report Form (CRF) for conditions during and post COVID-19 was filled to assess the complications and quality of life of health care workers. Results: A total of 140 Health Care Workers were studied, out of which 40% were doctors, 22% nursing staff, 17% paramedic staff, 9% cleaning staff, lab technologist 6%, 2% operation theater staff, administration staff, and pharmacist. The respondents were also investigated for pre-existing illness prior to SARS-CoV-2 infection, hypertension was the most prevalent, followed by chronic heart diseases and neurological disorders. Fever was the most common symptom, recorded 76.42% in the participants, while 55.71% of participants had dry cough, 55% had a sore throat, following by chest pain 43.56%. Reinfection rate was 10%, with chest pain being recorded in 85.71%. Post disease complication analysis showed that 47.14% of the participants were diagnosed with a new diagnosis after the COVID-19 recovery. Pulmonological diseases were recorded the most as a new diagnosis in, followed by gastrointestinal and psychological problems. Conclusions: The results of the study illustrates how COVID-19 has affected the overall health and quality of life of HCWs in District Swat of Khyber Pakhtunkhwa, Pakistan.

Keywords: SARS-CoV-2, COVID-19, HCW's, symptoms, questionnaire, post COVID-19

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Authors: Marina Chavleishvili

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Introduction: Today, the study of monopolies, including natural monopolies, is topical. In real life, pure monopolies are natural monopolies. Natural monopolies are used widely and are regulated by the state. In particular, the prices and rates are regulated. The paper considers the problems associated with the operation of natural monopolies in Georgia, in particular, their microeconomic analysis, pricing mechanisms, and legal mechanisms of their operation. The analysis was carried out on the example of the power industry. The rates of natural monopolies in Georgia are controlled by the Georgian National Energy and Water Supply Regulation Commission. The paper analyzes the positive role and importance of the regulatory body and the issues of improving the legislative base that will support the efficient operation of the branch. Methodology: In order to highlight natural monopolies market tendencies, the domestic and international markets are studied. An analysis of monopolies is carried out based on the endogenous and exogenous factors that determine the condition of companies, as well as the strategies chosen by firms to increase the market share. According to the productivity-based competitiveness assessment scheme, the segmentation opportunities, business environment, resources, and geographical location of monopolist companies are revealed. Main Findings: As a result of the analysis, certain assessments and conclusions were made. Natural monopolies are quite a complex and versatile economic element, and it is important to specify and duly control their frame conditions. It is important to determine the pricing policy of natural monopolies. The rates should be transparent, should show the level of life in the country, and should correspond to the incomes. The analysis confirmed the significance of the role of the Antimonopoly Service in the efficient management of natural monopolies. The law should adapt to reality and should be applied only to regulate the market. The present-day differential electricity tariffs varying depending on the consumed electrical power need revision. The effects of the electricity price discrimination are important, segmentation in different seasons in particular. Consumers use more electricity in winter than in summer, which is associated with extra capacities and maintenance costs. If the price of electricity in winter is higher than in summer, the electricity consumption will decrease in winter. The consumers will start to consume the electricity more economically, what will allow reducing extra capacities. Conclusion: Thus, the practical realization of the views given in the paper will contribute to the efficient operation of natural monopolies. Consequently, their activity will be oriented not on the reduction but on the increase of increments of the consumers or producers. Overall, the optimal management of the given fields will allow for improving the well-being throughout the country. In the article, conclusions are made, and the recommendations are developed to deliver effective policies and regulations toward the natural monopolies in Georgia.

Keywords: monopolies, natural monopolies, regulation, antimonopoly service

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