Search results for: primary health care facilities

Authors: Jaleh Mohammad Aliha, Rezvan Razazi, Nasim Naderi

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Introduction: Despite the progress in new effective drugs in the treatment of heart failure, the disease still accompanied with frequent hospitalization, impaired quality of life, early mortality and significant economic burden. Patients with chronic disease and consequently patients with heart failure need the knowledge and optimal health literacy to improve the quality of life and minimize the rate of rehopitalizatio. So, considering to importance of knowledge and health literacy in this patients as well as contradictory literature, this study conducted to investigate the relationship between health literacy and Knowledge of heart failure with rehospitalization in patients with heart failure admitted to heart failure clinic in Rajai Heart center in 1394. Methods: The cross-sectional method with convenience sampling method was used in this study. After obtaining the necessary permissions from the ethics committee and the Shahid Rajai Heart center, 238 patients who were older than 18 years and had ejection fraction 35% or less with the ability to read and write and lack of psychiatric, neurological and cognitive disorders and signed the informed consent were recruited. Data collection were perfomed through demographic data questionnaire, short standard health literacy questionnaire 'Short-TOFHLA-16' and Vanderwall (2005) knowledge of heart failure questionnaire. Reliability was assessed by internal consistency method and Cronbach's alpha for both questionnaires was more than 0.7. Then data were analysed by SPSS-20 with descriptive statistic and analytical statistic such as T-test, Chi-square and ANOVA. Results: The majority of patients were male (66%), married (80%) and had age between 50 to 70 years old (42%). The majority of studied men and women have good health literacy and About half of them have adequate knowledge about heart failure. Fisher's exact test showed that there was a significant statistical correlation between health literacy and knowlegh about heart failure. In other words, higher health literacy associated with more knowledge about their condition. Also findings showed that there was no significant statistical correlation between health literacy and knowledge about heart failure and frequency of CCU and emergency admissions. Conclusion: The study results showed that the higher health literacy, associated with the greater knowledge about heart failure and patients' perception about caring recommendations and disease outcomes. Therefore, the knowledge about heart failure and factors which related to severity of the disease, is the important issue to problem identification and treatment and reduction of rehospitalization.

Keywords: health literacy, heart failure, knowlegde, rehospitalization

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Authors: Manoj Kumar Reddy Pulim, Lakshmi Muthukrishnan, Geetha Jayapathy, Radhika Raman

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Introduction: In the past two decades, noninvasive positive pressure ventilation (NIPPV) emerged as one of the most important advances in the management of both acute and chronic respiratory failure in children. In the acute setting, it is an alternative to intubation with a goal to preserve normal physiologic functions, decrease airway injury, and prevent respiratory tract infections. There is a need to determine the clinical profile and parameters which point towards the need for NIV in the pediatric emergency setting. Objectives: i) To study the clinical profile of children who required non invasive ventilation and invasive ventilation, ii) To study the clinical parameters common to children who required non invasive ventilation. Methods: All children between one month to 18 years, who were intubated in the pediatric emergency department and those for whom decision to commence Non Invasive Ventilation was made in Emergency Room were included in the study. Children were transferred to the Paediatric Intensive Care Unit and started on Non Invasive Ventilation as per our hospital policy and followed up in the Paediatric Intensive Care Unit. Clinical profile of all children which included age, gender, diagnosis and indication for intubation were documented. Clinical parameters such as respiratory rate, heart rate, saturation, grunting were documented. Parameters obtained were subject to statistical analysis. Observations: Airway disease (Bronchiolitis 25%, Viral induced wheeze 22%) was a common diagnosis in 32 children who required Non Invasive Ventilation. Neuromuscular disorder was the common diagnosis in 27 children (78%) who were Intubated. 17 children commenced on Non Invasive Ventilation who later needed invasive ventilation had Neuromuscular disease. High frequency nasal cannula was used in 32, and mask ventilation in 17 children. Clinical parameters common to the Non Invasive Ventilation group were age < 1 year (17), tachycardia n = 7 (22%), tachypnea n = 23 (72%) and severe respiratory distress n = 9 (28%), grunt n = 7 (22%), SPO2 (80% to 90%) n = 16. Children in the Non Invasive Ventilation + INTUBATION group were > 3 years (9), had tachycardia 7 (41%), tachypnea 9(53%) with a male predominance n = 9. In statistical comparison among 3 groups,'p' value was significant for pH, saturation, and use of Ionotrope. Conclusion: Invasive ventilation can be avoided in the paediatric Emergency Department in children with airway disease, by commencing Non Invasive Ventilation early. Intubation in the pediatric emergency department has a higher association with neuromuscular disorders.

Keywords: clinical parameters, indications, non invasive ventilation, paediatric emergency room

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Authors: Jiraporn Prommaha

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The purpose of this research is to study the development of Thailand Brand Identity and the perception of its image in order to find any guidelines for the identity development and the image perception of Thailand Brand in Health and Wellness Tourism. The paper is conducted through mixed methods research, both the qualitative and quantitative researches. The qualitative focuses on the in-depth interview of executive administrations from public and private sectors involved scholars and experts in identity and image issue, main 11 people. The quantitative research was done by the questionnaires to collect data from foreign tourists 800; Chinese tourists 400 and UK tourists 400. The technique used for this was the Exploratory Factor Analysis (EFA), this was to determine the relation between the structures of the variables by categorizing the variables into group by applying the Varimax rotation technique. This technique showed recognition the Thailand brand image related to the 2 countries, China and UK. The results found that guidelines for brand identity development and image perception of health and wellness tourism in Thailand; as following (1) Develop communication in order to understanding of the meaning of the word 'Health and beauty tourism' throughout the country, (2) Develop human resources as a national agenda, (3) Develop awareness rising in the conservation and preservation of natural resources of the country, (4) Develop the cooperation of all stakeholders in Health and Wellness Businesses, (5) Develop digital communication throughout the country and (6) Develop safety in Tourism.

Keywords: brand identity, image perception, nation branding, health and wellness tourism, mixed methods research

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Authors: Tayyab Ahmad, Gerard Healey

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The potential role of higher education institutes in sustainable development cannot be undermined. In this regard, it is important to investigate the established concept of sustainability in such institutes to explore the room for further improvement. In this paper, a case study of the University of Melbourne is conducted, and the institute’s commitments towards sustainability are examined by a detailed qualitative review of its policy and design standard documents. These documents are reviewed as through these; the institute portrays its vision of building environment facilities, which it aspires to procure and use. From detailed review, it is realized that these documents are updated at different times, creating the potential for mismatch between them. The occurrence of different goals and objectives in different documents is highlighted, and the interrelationships between different goals and operational objectives are explored. The role of the university aspired goals/objectives in terms of built environment sustainability is discussed, and the gaps in the articulation of goals and operational objectives are highlighted. Recommendations are provided for enhancing the built environment sustainability at the University of Melbourne.

Keywords: university, design standards, policy, sustainability, built environment

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Authors: Abdullah Alsheddy

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This paper presents the employment of Pareto optimality as a strategy to help (single-objective) local search escaping local optima. Instead of local search, Pareto local search is applied to solve the quadratic assignment problem which is multi-objectivized by adding a helper objective. The additional objective is defined as a function of the primary one with augmented penalties that are dynamically updated.

Keywords: Pareto optimization, multi-objectivization, quadratic assignment problem, local search

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Authors: Jose Rodrigo Zubiri, Sofia Carmen Tomacruz

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Amidst an increasingly digitalized society, information and communication technologies have been seamlessly integrated into the economic, social, and political life of individuals. Information has been regarded as a primary good, essential to the wellbeing and self-respect of individuals in society. The digital engagements of an individual play a key role in a variety of life outcomes ranging from academic performance to entrepreneurial success to health service uptake. As a result of varying degrees of access to the Internet and ICTs across populations and individuals, a digital divide emerges. Education, a sector pivotal to directing individual life trajectories, has been radically transformed with regards to the learning process and access to information and thus faces the implications of the digital divide, as new waves of inequalities are introduced in the classroom. As the period of basic education is critical to transitioning into civic life or higher education, digital inequalities are capable of aggravating pre-existing social inequalities. Through survey-questionnaires, conducted on 152 high school students from a Philippine public school, the study reveals the correlation of academic performance and aspirations (for their highest academic qualification) to access to digital technologies and the Internet, according to Van Dijk’s four measurements of digital poverty, namely: motivational access, material access, skills access, and usage access. The findings reveal a positive correlation for academic performance whereas no correlation was found between aspirations and digital access. In the study, significant correlational differences were also found between genders, specifically, in terms of skills access and academic performance.

Keywords: digital divide, ICTs, inequality, education, life trajectories

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Authors: Kelsey Fortin, Susan Harvey

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The intersection between hunger and health outcomes is beginning to gain traction among the research community. With new interventions focusing on collaborations between the medical and social service sectors, this study aimed to understand the acceptability and approach of a health coaching intervention within a county-wide Midwest food pantry. Through formative research, the study used mixed methods to review secondary data and conduct surveys and semi-structured interviews with food pantry clients (n=30), staff (n=7), and volunteers (n=10). Supplemental secondary data collected and provided by pantry staff were reviewed to understand the broader pantry context of clientele health and health behaviors, annual food donations, and current pantry programming. Results from secondary data showed that the broader pantry client population reported high rates of chronic disease, low consumption of fruits and vegetables, and poor self-reported health, while annual donation data showed increases in produce availability on pantry shelves. This disconnect between produce availability, client health status, and behaviors was supported in the current study, with pantry staff and volunteers reporting lack of knowledge in produce selection and preparation being amongst the most common client inquiries and barriers to healthy food selection. Additional supports to secondary data came from pantry clients in the current study through self-reported high rates of both individual (60%, n=18) and household (43%, n=13 ) disease diagnosis, low consumption of fruits and vegetables averaging zero to one servings of vegetables (67%, n=20) and fruits (47%, n=14) per day, and low levels of physical activity averaging zero to 120 minutes per week (67%, n=20). Further, pantry clients provided health coaching programmatic recommendations through interviews with feedback such as non-judgmental coaching, accountability measures, and providing participant incentives as considerations for future program design and approach. Volunteers and staff reported the need for client education in food preparation, basic nutrition and physical activity, and the need for additional health expertise to educate and respond to diet related nutrition recommendations. All three stakeholder groups supported hosting a health coach within the pantry to focused on nutrition, physical activity, and health programming, with one client stating, 'I am hoping it really works out [the health coaching program]. I think it would be great for something like this to be offered for someone that isn’t knowledgeable like me.' In conclusion, high rates of chronic disease, partnered with low food, nutrition, and physical activity literacy among pantry clients, demonstrates the need to address health behaviors. With all three stakeholder groups showing acceptability of a health coaching program, partnered with existing literature showing health coaching success as a behavior change intervention, further research should be conducted to pilot the design and implementation of such a program in the pantry setting.

Keywords: food insecurity, formative research, food pantries, health coaching, hunger and health

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Authors: Qiang Ren

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In the past 20 years, under the high standard of international investment protection, there have been numerous cases of investors ignoring the host country's measures to protect human health. Examples include investment disputes triggered by the Argentine government's measures related to human health, quality, and price of drinking water under the North American Free Trade Agreement. Examples also include Philip Morris v. Australia, in which case the Australian government announced the passing of the Plain Packing of Cigarettes Act to address the threat of smoking to public health in 2010. In order to take advantage of the investment treaty protection between Hong Kong and Australia, Philip Morris Asia acquired Philip Morris Australia in February 2011 and initiated investment arbitration under the treaty before the passage of the Act in July 2011. Philip Morris claimed the Act constitutes indirect expropriation and violation of fair and equitable treatment and claimed 4.16 billion US dollars compensation. Fortunately, the case ended at the admissibility decision stage and did not enter the substantive stage. Generally, even if the host country raises a human health defense, most arbitral tribunals will rule that the host country revoke the corresponding policy and make huge compensation in accordance with the clauses in the bilateral investment treaty to protect the rights of investors. The significant imbalance in the rights and obligations of host states and investors in international investment treaties undermines the ability of host states to act in pursuit of human health and social interests beyond economic interests. This squeeze on the nation's public policy space and disregard for the human health costs of investors' activities raises the need to include human health in investment rulemaking. The current international investment law system that emphasizes investor protection fails to fully reflect the requirements of the host country for the healthy development of human beings and even often brings negative impacts to human health. At a critical moment in the reform of the international investment law system, in order to achieve mutual enhancement of investment returns and human health development, human health should play a greater role in influencing and shaping international investment rules. International investment agreements should not be limited to investment protection tools but should also be part of national development strategies to serve sustainable development and human health. In order to meet the requirements of the new sustainable development goals of the United Nations, human health should be emphasized in the formulation of international investment rules, and efforts should be made to shape a new generation of international investment rules that meet the requirements of human health and sustainable development.

Keywords: human health, international investment law, Philip Morris v. Australia, investor protection

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Authors: Victor Kang, Sirene Bellahnid, Amy Al-Simaani

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Efficient documentation and completion of clerical tasks are pillars of efficient patient-centered care in acute settings such as the emergency department (ED). Medical scribes aid physicians with documentation, navigation of electronic health records, results gathering, and communication coordination with other healthcare teams. However, the use of medical scribes is not widespread, with some hospitals even continuing to discontinue their programs. One reason for this could be the lack of studies that have outlined concrete improvements in efficiency and patient and provider satisfaction in emergency departments before and after incorporating scribes. Methods: We conducted a review of the literature concerning the implementation of a medical scribe program and emergency department performance. For this review, a narrative synthesis accompanied by textual commentaries was chosen to present the selected papers. PubMed was searched exclusively. Initially, no date limits were set, but seeing as the electronic medical record was officially implemented in Canada in 2013, studies published after this date were preferred as they provided insight into the interplay between its implementation and scribes on quality improvement. Results: Throughput, efficiency, and cost-effectiveness were the most commonly used parameters in evaluating scribes in the Emergency Department. Important throughput metrics, specifically door-to-doctor and disposition time, were significantly decreased in emergency departments that utilized scribes. Of note, this was shown to be the case in community hospitals, where the burden of documentation and clerical tasks would fall directly upon the attending physician. Academic centers differ in that they rely heavily on residents and students; so the implementation of scribes has been shown to have limited effect on these metrics. However, unique to academic centers was the provider’s perception of incrased time for teaching was unique to academic centers. Consequently, providers express increased work satisfaction in relation to time spent with patients and in teaching. Patients, on the other hand, did not demonstrate a decrease in satisfaction in regards to the care that was provided, but there was no significant increase observed either. Of the studies we reviewed, one of the biggest limitations was the lack of significance in the data. While many individual studies reported that medical scribes in emergency rooms improved relative value units, patient satisfaction, provider satisfaction, and increased number of patients seen, there was no statistically significant improvement in the above criteria when compiled in a systematic review. There is also a clear publication bias; very few studies with negative results were published. To prove significance, data from more emergency rooms with scribe programs would need to be compiled which also includes emergency rooms who did not report noticeable benefits. Furthermore, most data sets focused only on scribes in academic centers. Conclusion: Ultimately, the literature suggests that while emergency room physicians who have access to medical scribes report higher satisfaction due to lower clerical burdens and can see more patients per shift, there is still variability in terms of patient and provider satisfaction. Whether or not this variability exists due to differences in training (in-house trainees versus contractors), population profile (adult versus pediatric), setting (academic versus community), or which shifts scribe work cannot be determined based on the studies that exist. Ultimately, more scribe programs need to be evaluated to determine whether these variables affect outcomes and prove whether scribes significantly improve emergency room efficiency.

Keywords: emergency medicine, medical scribe, scribe, documentation

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Authors: Alexandra McKinzie, Lucy Brown, Sarah Komanapalli, Sarah Swiezy, Caitlin Bernard

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Background: While 25% of US women will seek an abortion before age 45, targeted laws have led to a decline in abortion clinics, subsequently leaving 96% of Indiana counties and the 70% of Hoosier women residing in these counties without access to services they desperately need.1,2 Despite the need for a physician workforce that is educated and able to provide full-spectrum reproductive health care, few medical institutions have a standardized family planning and abortion pre-clinical curriculum. Methods: A Qualtrics survey was disseminated to students from Indiana University School of Medicine (IUSM) to evaluate (1) student interest in curriculum reform, (2) self-assessed preparedness to counsel on contraceptive and pregnancy options, and (3) preferred modality of instruction for family planning and abortion topics. Based on the pre-panel survey feedback, a case-based pregnancy options counseling panel will be implemented in the students’ pre-clinical, didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) in February 2022. A Qualtrics post-panel survey will be disseminated to evaluate students’ perceived efficacy and quality of the panel, as well as their self-assessed preparedness to counsel on pregnancy options. Results: Participants in the pre-panel survey (n=303) were primarily female (61.72%) and White (74.43%). Across all class levels, many (60.80%) students expected to learn about family planning and abortion in their pre-clinical education. While most (84-88%) participants felt prepared to counsel about common, non-controversial pharmacotherapies (e.g. beta-blockers and diuretics), only 20% of students felt prepared to counsel on abortion options. Overall, 85.67% of students believed that IUSM should enhance its reproductive health coverage in pre-clinical, didactic courses. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. Expected Results: The authors predict that following the panel, students will indicate improved confidence in providing pregnancy options counseling. Additionally, students will provide constructive feedback on the structure and content of the panel for incorporation into future years’ curriculum. Conclusions: IUSM students overwhelmingly expressed interest in expanding their pre-clinical curriculum’s coverage of family planning and abortion topics. To specifically improve students’ self-assessed preparedness to provide pregnancy options counseling and address students’ self-cited learning gaps, a case-based provider panel session will be implemented in response to students’ preferred modality feedback.

Keywords: options counseling, family planning, abortion, curriculum reform, case-based panel

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Authors: Zicheng Zhang, Linli Zhang

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As China's biggest social media platform, Weibo has taken on essential health communication responsibilities during the pandemic. This research takes 105 posters in 15 health-related official Weibo accounts as the analysis objects to explore COVID19 health information communication and visualisation. First, the interaction between the audiences and Weibo, including forwarding, comments, and likes, is statistically analysed. The comments about the information design are extracted manually, and then the sentiment analysis is carried out to verdict audiences' views about the poster's design. The forwarding and comments are quantified as the attention index for a reference to the degree of likes. In addition, this study also designed an evaluation scale based on the standards of Health Literacy Resource by the Centers for Medicare& Medicaid Services (US). Then designers scored all selected posters one by one. Finally, combining the data of the two parts, concluded that: 1. To a certain extent, people think that the posters do not deliver substantive and practical information; 2. Non-knowledge posters(i.e., cartoon posters) gained more Forwarding and Likes, such as Go, Wuhan poster; 3. The analysis of COVID posters is still mainly picture-oriented, mainly about encouraging people to overcome difficulties; 4. Posters for pandemic prevention usually contain more text and fewer illustrations and do not clearly show cultural differences. In conclusion, health communication usually involves a lot of professional knowledge, so visualising that knowledge in an accessible way for the general public is challenging. The relevant posters still have the problems of lack of effective communication, superficial design, and insufficient content accessibility.

Keywords: weibo, visualisation, covid posters, poster design

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Authors: Azadeh Bashiri

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Introduction: In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. Background: This study, provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. Methods: This is a cross-sectional study that was conducted in 2013. The student community was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also, Visual Paradigm software was used to design a conceptual model. Result: Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. Conclusion: According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, provide the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate.

Keywords: structured radiology report, information needs, minimum data set, electronic health record system in Iran

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Authors: Ankita Jadon, Sidi Souvi, Nathalie Girault, Denis Petitprez

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Safety requirements for Generation IV nuclear reactor designs, especially the new generation sodium-cooled fast reactors (SFR) require a risk-informed approach to model severe accidents (SA) and their consequences in case of outside release. In SFRs, aerosols are produced during a core disruptive accident when primary system sodium is ejected into the containment and burn in contact with the air; producing sodium aerosols. One of the key aspects of safety evaluation is the in-containment sodium aerosol behavior and their interaction with fission products. The study of the effects of sodium fires is essential for safety evaluation as the fire can both thermally damage the containment vessel and cause an overpressurization risk. Besides, during the fire, airborne fission product first dissolved in the primary sodium can be aerosolized or, as it can be the case for fission products, released under the gaseous form. The objective of this work is to study the interactions between sodium aerosols and fission products (Iodine, toxic and volatile, being the primary concern). Sodium fires resulting from an SA would produce aerosols consisting of sodium peroxides, hydroxides, carbonates, and bicarbonates. In addition to being toxic (in oxide form), this aerosol will then become radioactive. If such aerosols are leaked into the environment, they can pose a danger to the ecosystem. Depending on the chemical affinity of these chemical forms with fission products, the radiological consequences of an SA leading to containment leak tightness loss will also be affected. This work is split into two phases. Firstly, a method to theoretically understand the kinetics and thermodynamics of the heterogeneous reaction between sodium aerosols and fission products: I2 and HI are proposed. Ab-initio, density functional theory (DFT) calculations using Vienna ab-initio simulation package are carried out to develop an understanding of the surfaces of sodium carbonate (Na2CO3) aerosols and hence provide insight on its affinity towards iodine species. A comprehensive study of I2 and HI adsorption, as well as bicarbonate formation on the calculated lowest energy surface of Na2CO3, was performed which provided adsorption energies and description of the optimized configuration of adsorbate on the stable surface. Secondly, the heterogeneous reaction between (I2)g and Na2CO3 aerosols were investigated experimentally. To study this, (I2)g was generated by heating a permeation tube containing solid I2, and, passing it through a reaction chamber containing Na2CO3 aerosol deposit. The concentration of iodine was then measured at the exit of the reaction chamber. Preliminary observations indicate that there is an effective uptake of (I2)g on Na2CO3 surface, as suggested by our theoretical chemistry calculations. This work is the first step in addressing the gaps in knowledge of in-containment and atmospheric source term which are essential aspects of safety evaluation of SFR SA. In particular, this study is aimed to determine and characterize the radiological and chemical source term. These results will then provide useful insights for the developments of new models to be implemented in integrated computer simulation tool to analyze and evaluate SFR safety designs.

Keywords: iodine adsorption, sodium aerosols, sodium cooled reactor, DFT calculations, sodium carbonate

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Authors: Kimberly Samaha

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In order to attract new types of investors into the emerging Bio-Economy, new methodologies to analyze investment risk are needed. The Bio-Hub Ecosystem model was developed to address a critical area of concern within the global energy market regarding the use of biomass as a feedstock for power plants. This study looked at repurposing existing biomass-energy plants into Circular Zero-Waste Bio-Hub Ecosystems. A Bio-Hub model that first targets a ‘whole-tree’ approach and then looks at the circular economics of co-hosting diverse industries (wood processing, aquaculture, agriculture) in the vicinity of the Biomass Power Plants facilities. This study modeled the economics and risk strategies of cradle-to-cradle linkages to incorporate the value-chain effects on capital/operational expenditures and investment risk reductions using a proprietary techno-economic model that incorporates investment risk scenarios utilizing the Monte Carlo methodology. The study calculated the sequential increases in profitability for each additional co-host on an operating forestry-based biomass energy plant in West Enfield, Maine. Phase I starts with the base-line of forestry biomass to electricity only and was built up in stages to include co-hosts of a greenhouse and a land-based shrimp farm. Phase I incorporates CO2 and heat waste streams from the operating power plant in an analysis of lowering and stabilizing the operating costs of the agriculture and aquaculture co-hosts. Phase II analysis incorporated a jet-fuel biorefinery and its secondary slip-stream of biochar which would be developed into two additional bio-products: 1) A soil amendment compost for agriculture and 2) A biochar effluent filter for the aquaculture. The second part of the study applied the Monte Carlo risk methodology to illustrate how co-location derisks investment in an integrated Bio-Hub versus individual investments in stand-alone projects of energy, agriculture or aquaculture. The analyzed scenarios compared reductions in both Capital and Operating Expenditures, which stabilizes profits and reduces the investment risk associated with projects in energy, agriculture, and aquaculture. The major findings of this techno-economic modeling using the Monte Carlo technique resulted in the masterplan for the first Bio-Hub to be built in West Enfield, Maine. In 2018, the site was designated as an economic opportunity zone as part of a Federal Program, which allows for Capital Gains tax benefits for investments on the site. Bioenergy facilities are currently at a critical juncture where they have an opportunity to be repurposed into efficient, profitable and socially responsible investments, or be idled and scrapped. The Bio-hub Ecosystems techno-economic analysis model is a critical model to expedite new standards for investments in circular zero-waste projects. Profitable projects will expedite adoption and advance the critical transition from the current ‘take-make-dispose’ paradigm inherent in the energy, forestry and food industries to a more sustainable Bio-Economy paradigm that supports local and rural communities.

Keywords: bio-economy, investment risk, circular design, economic modelling

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Authors: Chu-Tzu Chen, Angela S. Huang, Yu-Min Chou, Chin-Hui Yang

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Dengue is a major public health concern throughout tropical and sub-tropical regions. Taiwan is located in the Pacific Ocean and overlying the tropical and subtropical zones. The island remains humid throughout the year and receives abundant rainfall, and the temperature is very hot in summer at southern Taiwan. It is ideal for the growth of dengue vectors and would be increasing the risk on dengue outbreaks. During the first half of the 20th century, there were three island-wide dengue outbreaks (1915, 1931, and 1942). After almost forty years of dormancy, a DEN-2 outbreak occurred in Liuchiu Township, Pingtung County in 1981. Thereafter, more dengue outbreaks occurred with different scales in southern Taiwan. However, there were more than ten thousands of dengue cases in 2014 and in 2015. It did not only affect human health, but also caused widespread social disruption and economic losses. The study would like to reveal the epidemiology of dengue on Taiwan, especially the severe outbreak in 2015, and try to find the effective interventions in dengue control including dengue vaccine development for the elderly. Methods: The study applied the Notifiable Diseases Surveillance System database of the Taiwan Centers for Disease Control as data source. All cases were reported with the uniform case definition and confirmed by NS1 rapid diagnosis/laboratory diagnosis. Results: In 2014, Taiwan experienced a serious DEN-1 outbreak with 15,492 locally-acquired cases, including 136 cases of dengue hemorrhagic fever (DHF) which caused 21 deaths. However, a more serious DEN-2 outbreak occurred with 43,419 locally-acquired cases in 2015. The epidemic occurred mainly at Tainan City (22,760 cases) and Kaohsiung City (19,723 cases) in southern Taiwan. The age distribution for the cases were mainly adults. There were 228 deaths due to dengue infection, and the case fatality rate was 5.25 ‰. The average age of them was 73.66 years (range 29-96) and 86.84% of them were older than 60 years. Most of them were comorbidities. To review the clinical manifestations of the 228 death cases, 38.16% (N=87) of them were reported with warning signs, while 51.75% (N=118) were reported without warning signs. Among the 87 death cases reported to dengue with warning signs, 89.53% were diagnosed sever dengue and 84% needed the intensive care. Conclusion: The year 2015 was characterized by large dengue outbreaks worldwide. The risk of serious dengue outbreak may increase significantly in the future, and the elderly is the vulnerable group in Taiwan. However, a dengue vaccine has been licensed for use in people 9-45 years of age living in endemic settings at the end of 2015. In addition to carry out the research to find out new interventions in dengue control, developing the dengue vaccine for the elderly is very important to prevent severe dengue and deaths.

Keywords: case fatality rate, dengue, dengue vaccine, the elderly

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Authors: Amber Shahi, Ayesha Tazeen, Abdus Samad, Shama Parveen

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Nanoparticles (NPs) are tiny particles. According to the International Organization for Standardization, the size range of NPs is in the nanometer range (1-100 nm). They show distinct properties that are not shown by larger particles of the same material. NPs are currently being used in different fields due to their unique physicochemical nature. NPs are a boon for medical sciences, environmental sciences, electronics, and textile industries. However, there is growing concern about their potential adverse effects on human health. This poster presents a comprehensive review of the current literature on the pros and cons of NPs on human health. The poster will discuss the various types of interactions of NPs with biological systems. There are a number of beneficial uses of NPs in the field of health and environmental welfare. NPs are very useful in disease diagnosis, antimicrobial action, and the treatment of diseases like Alzheimer’s. They can also cross the blood-brain barrier, making them capable of treating brain diseases. Additionally, NPs can target specific tumors and be used for cancer treatment. To treat environmental health, NPs also act as catalytic converters to reduce pollution from the environment. On the other hand, NPs also have some negative impacts on the human body, such as being cytotoxic and genotoxic. They can also affect the reproductive system, such as the testis and ovary, and sexual behavior. The poster will further discuss the routes of exposure of NPs. The poster will conclude with a discussion of the current regulations and guidelines on the use of NPs in various applications. It will highlight the need for further research and the development of standardized toxicity testing methods to ensure the safe use of NPs in various applications. When using NPs in diagnosis and treatment, we should also take into consideration their safe concentration in the body. Overall, this poster aims to provide a comprehensive overview of the pros and cons of NPs on human health and to promote awareness and understanding of the potential risks and benefits associated with their use.

Keywords: disease diagnosis, human health, nanoparticles, toxicity testing

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Authors: G. Nadirova, B. Aktaulova

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The main question of the research is- how did the Kazakhs manage to keep their religious thinking in the period of active propaganda of Soviet atheism, for seventy years of struggle against religion with the involvement of the scientific worldview as the primary means of proving the absence of the divine nature and materiality of the world? Our hypothesis is that In case of Kazakhstan the conservative female religious consciousness seems to have been a factor that helped to preserve the “everyday” religiousness of Kazakhs, which was far from deep theological contents of Islam, but able to revive in a short time after the decennia of proclaimed atheism.

Keywords: woman, religious thinking, Kazakhstan, soviet ideology, rituals, family

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Authors: Nishu Atrey, Priyanka Singh, G. P. Talwar, Jagdish Gupta, Alka Kriplani, Rohini Sehgal, Indrani Ganguli, Soni Sinha

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Background: Vaginosis is a widely prevalent syndrome in India and elsewhere. Recurrence is frequent in women treated with antibiotics, whose vagina pH remains above 5.0 indicative of the loss of resident lactobacilli. The objective of the present trial was to determine whether a Polyherbal microbicide BASANT can regress Vaginosis. Another objective was to determine whether the three selected strains of Probiotics endowed with making high amounts of lactic acid can colonise and restore the pH of the vagina to the acidic healthy range. Materials and Procedure: BASANT, was employed in powder form in veg (cellulose) capsules. TRF#36 strain of Lactobacillus fermentum, TRF#8 strain of L.gasseri, and TRF#30 strain of L.salivarius (combination termed as Pro-vag-Health) were employed at 3x109 bacilli lyophilized, packaged in capsules. The trials were conducted in women suffering from vaginosis with vaginal pH above 5.0. Women were given intravaginally either BASANT, Pro-vag-Health or a combination of the two intravaginally for seven days and thereafter once weekly as a maintenance dose. Results: BASANT cleared vaginosis in 14/20 women and Pro-vag-Health in 13/20 women. Interestingly, the combination of BASANT plus Pro-vag-Health was effective in 19/20 women, in contrast to Placebo capsules effective only in 1/20 women. Interpretation and Conclusion: The combination of BASANT and Pro-veg-Health Probiotics taken together intravaginally for seven days relieves 19 out of 20 women from vaginosis to restore acidic pH and healthy vagina. Extension of trial with this combination in larger number is indicated.

Keywords: microbicide, probiotics, vaginal pH, vaginosis

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Authors: B. Rusyidi

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Since 2009, the Indonesian Ministry of Social Affairs has been implementing Program Kesejahteraan Sosial Anak (PKSA) (Child Welfare Program) a conditional cash transfer program that targets neglected children, children with disabilities, street children, children in conflict with the law, and children in need of special protection, all from poor households. PKSA integrates three elements: Transfer of cash, care and social services through social workers, and institutional childcare assistance. This qualitative study analyzed the roles and the challenges of social workers in implementing PKSA and lays out recommendations to inform policy changes. Data were collected in late 2014 from national and local government and non-government child welfare agencies, social workers, and childcare institution representatives through interviews and Focused Group Discussions (FGDs). Field work took place in six districts in the provinces of Jakarta, Central Java and South Sulawesi. The study found that the social workers’ role was significant in facilitating cash transfer, providing education and guidance, and linking children and families to basic social services. This improved utilization of basic social services enhanced children and families’ behaviors and contributed to the well being of the children. However, only a small number of childcare institutions have social workers, leaving many children and families without care and social service linkages, depriving them of rehabilitative components to help them regain their social functions. Some social workers reported their struggles with heavy workloads, lack of professional competencies and training, limited job security, and inadequate professional acknowledgment from other professions. Parts of those challenges were due to the centralized nature of the program and the lack of shared vision and commitment about the child protection system among related government agencies both at the national and local levels. The study highlights the necessity to implement an integrated child protection system, decentralize the PKSA program, and increase the number, competence, case management, and management and monitoring of social workers. The most recent progress of the program and its impacts on social workers are also discussed.

Keywords: child protection, conditional cash transfer, program decentralization, social worker, working conditions

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Authors: Chueh Chi-An, Chan Hui-Ya

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Background and Aim: National Health Insurance (NHI) Administration released a new reimbursement policy for hospital patients who received a superior discharge plan on April 1, 2016. Each case could be claimed 1,500 points for fee-of service with related documents. The policy is considered a solution to help reducing the crowding in the emergency department, the length of stay of hospital, unplanned readmission rate and unplanned ER visit. This study aim is to explore the effect of the new reimbursement policy for discharge planning service in a medical center. Methods: The discharge team explained to general wards the new policy and encouraged early assessment, communication and connecting to community care for patients. They stated the benefit from the policy and asked documenting for reimbursement claiming from April to May 2016. The imbursement fee of NHI declaration from June 2015 to October 2017 was collected. The indicators included hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction were analyzed after the policy implemented. Results: The results showed that the amount of service declaration was increasing from 2 cases in February 2016 to 110 cases in October 2017, the application rate was increasing from 0.029% to 1.576% of all inpatient cases, and the average payment from NHI was around 148,500 NT dollars per month in 2017. There are no significant differences in the indicators among hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction. Conclusion: To provide a good discharge plan require a specialized case manager, the new reimbursement policy is too complicated and the total fee-of-service hospital could claim is too limited to hiring one. The results suggest more strategies combine with the new reimbursement policy will be needed.

Keywords: discharge planning, reimbursement, unplanned ER visit, readmission rate

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Authors: Rossana Taravella, Gilberto M. Cellura, Giuseppe Cirrincione, Salvatore Asciutto, Marco Caruso, Massimo Benedetto, Renato Ciofalo, Giuliana Pace, Salvatore Novo

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Objectives: This retrospective analysis sought to evaluate 1-month outcomes and therapy effectiveness of a population of patients treated with MitraClip therapy. We describe in this article the preliminary results of primary effectiveness endpoint. Background: Percutaneous Mitral Repair is being developed to treat severe mitral regurgitation (MR), with increasing real-world cases of functional MR (FMR). In the EVEREST (Endovascular Valve Edge-to-Edge Repair Study)II trial, the percutaneous device showed superior safety but less reduction in MR at 1year. 4-year outcomes from EVEREST II trial showed no difference in the prevalence of moderate-severe and severe MR or mortality at 4years between surgical mitral repair and percutaneous approach. Methods: We analysed retrospectively collected data from one center experience in Italy enrolled from January 2011 to December 2016. The study included 62 patients [mean age 74±11years, 43 men (69%)] with MR of at least grade3+. Most of the patients had functional MR, were in New York Heart Association (NYHA) functional class III or IV, with a large portion (78%) of mild-to-moderate Tricuspid Regurgitation (TR). One or more clips were implanted in 67 procedures (62 patients). Results and Conclusions: Severity of MR was reduced in all successfully treated patients,54(90%) were discharged with MR≤2+ (primary effectiveness endpoint). Clinical 1-month follow-up data showed an improvement in NYHA functional class (42 patients (70%) in NYHA class I-II). 60 of 62 (97 %) successfully treated patients were free from death and mitral valve surgery at 1-month follow-up. MitraClip therapy reduces functional MR with acute MR reduction to <2+ in the great majority of patients, with a large freedom from death, surgery or recurrent MR in a great portion of patients.

Keywords: MitraClip, mitral regurgitation, heart valves, catheter-based therapy

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Authors: Milena M. Melo, Jane M. Santos, Severine Frere, Valderio A. Reisen, Neyval C. Reis Jr., Mariade Fátima S. Leite

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Although there had been a many studies that shows the impact of air pollution on physical health, comparatively less was known of human behavioral responses and annoyance impacts. Annoyance caused by air pollution is a public health problem because it can be an ambient stressor causing stress and disease and can affect quality of life. The objective of this work is to evaluate the annoyance caused by air pollution in two different industrialized urban areas, Dunkirk (France) and Vitoria (Brazil). The populations of these cities often report feeling annoyed by dust. Surveys were conducted, and the collected data were analyzed using statistical analyses. The results show that sociodemographic variables, importance of air quality, perceived industrial risk, perceived air pollution and occurrence of health problems play important roles in the perceived annoyance. These results show the existence of a common problem in geographically distant areas and allow stakeholders to develop prevention strategies.

Keywords: air pollution, annoyance, industrial risks, public health, perception of pollution, settled dust

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Authors: Haythem A. Nakkas, Philip J. Scott, Jim S. Briggs

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This paper reports a structured literature review of the application of Health Information Technology in developing countries, defined as the World Bank categories Low-income countries, Lower-middle-income, and Upper-middle-income countries. The aim was to identify and classify the various applications of health information technology to assess its current state in developing countries and explore potential areas of research. We offer specific analysis and application of HIT in Libya as one of the developing countries. Method: A structured literature review was conducted using the following online databases: IEEE, Science Direct, PubMed, and Google Scholar. Publication dates were set for 2000-2013. For the PubMed search, publications in English, French, and Arabic were specified. Using a content analysis approach, 159 papers were analyzed and a total number of 26 factors were identified that affect the adoption of health information technology. Results: Of the 2681 retrieved articles, 159 met the inclusion criteria which were carefully analyzed and classified. Conclusion: The implementation of health information technology across developing countries is varied. Whilst it was initially expected financial constraints would have severely limited health information technology implementation, some developing countries like India have nevertheless dominated the literature and taken the lead in conducting scientific research. Comparing the number of studies to the number of countries in each category, we found that Low-income countries and Lower-middle-income had more studies carried out than Upper-middle-income countries. However, whilst IT has been used in various sectors of the economy, the healthcare sector in developing countries is still failing to benefit fully from the potential advantages that IT can offer.

Keywords: developing countries, developed countries, factors, failure, health information technology, implementation, libya, success

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Authors: Nattapong Techarattanased

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This survey research aimed to study the influence of attitude in services, product, and marketing mix affected intention to revisit in boutique hotel of foreign travelers in Bangkok, Thailand. The total 400 sets of closed-ended questionnaires were utilized for conducting data from foreign tourists who come to boutique hotel and can communicate in English. The descriptive statistics and multiple regression analysis were used to analyze data. The research found that tourists’ attitude towards the service of check in and check out process, food and beverage, guest room and other facilities affected in opportunity of revisiting, recommending to others and possibility of revisiting in the future at 0.05 statistically significant levels. Tourists’ attitude towards service and marketing mix in term of people, physical evidence, price, process and channel of distribution could forecast intention to revisit in term of recommending to others and intention to revisit in the future at 0.05 statistically significant levels.

Keywords: boutique hotel, foreign tourists, intention to revisit, service marketing mix

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Authors: Mohan Kotamrazu

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Cyclone Hudhud which battered the city of Visakhapatnam on 12^th October, 2014, damaged many buildings, public amenities and infrastructure facilities along the Visakha- Bheemili coastal corridor. More than half the green cover of the city was wiped out. Majority of the trees along the coastal corridor suffered from complete or partial damage. In order to understand the different ways that trees incurred damage during the cyclone, a damage assessment study was carried out by the author. The areas covered by this study included two university campuses, several parks and residential colonies which bore the brunt of the cyclone. Post disaster attempts have been made to restore many of the trees that have suffered from partial or complete damage from the effects of extreme winds. This paper examines the various ways that trees incurred damage from the cyclone Hudhud and presents some examples of the restoration efforts carried out by educational institutions, public parks and religious institutions of the city of Visakhapatnam in the aftermath of the devastating cyclone.

Keywords: defoliaton, salt spray damage, uprooting and wind throw, restoration

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Authors: Somdech Rungsrisawat

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The objective of this research was to investigate how to develop an appropriate management and administration model for the College of Film, Television, Multimedia and Performing Arts at Suan Sunandha Rajabhat University. A combination of qualitative and quantitative data collection and analysis methods was employed. The data collection was from the 8 experts who were the academic staff and entrepreneurs in films, television, multimedia and performing arts, and from 471 students studying in the communication arts field. The findings of this research paper presented the appropriate management and administration model for the College of Film, Television, Multimedia and Performing Arts, which depended on 3 factors: [i] the marketing management and the supporting facilities such as buildings, equipments and accessibility for students to the college; [ii] the competency of academic staff or lecturers and supporting staff; and [iii] career opportunities after graduation.

Keywords: educational institution management, educational management, learning resources, non-formal education, Thai qualifications framework for higher education

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Authors: Farhana Tarannum

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Ambient (outdoor) air pollution is now recognized as an important problem, both nationally and worldwide. The concentrations of gaseous pollutants (SOx, NOx, CO and O3) have been determined from samples collected at Kallyanpur along Shamoli corridor in Dhaka city. Pollutants were determined in a sample collected at ground level and a roof of a 7-storied building. These pollutants are emitted largely from stationary sources like fossil fuel fired power plants, industrial plants, and manufacturing facilities as well as mobile sources. The incomplete combustion of fuel, wood and the Sulphur containing fuel used in the vehicles are one of the main causes of CO and SOx respectively in our natural environment. When the temperature of combustion in high enough and some of that nitrogen reacts with oxygen in the air, various nitrogen oxides (NOx) are then formed. The VOCs react with NOx in the presence of sunlight to form O3. UV Visible spectrophotometric method has been used for the determination of SOx, NOx and O3. The sensor type device was used for the estimation of CO. It was found that the air pollutants (CO, SOx, NOx and O3) of a sample collected at the roof of a building were lower compared to the ground level; it indicated that ground level people are mostly affected by the gaseous pollutants.

Keywords: gaseous pollutants, UV-visible spectrophotometry, ambient air quality, Dhaka city

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Authors: Thananyada Buapian

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Overnutrition is emerging as a morbid disease in developing and Westernized countries. Because of its comorbidity diseases, it is cost-effective to prevent and manage this disease earlier. In Thailand, this alarming disease has long been studied, but the prevalence is still higher than that in the past. Physicians should recognize it well and have a definite direction to face and combat this dangerous disease. Rapid changes in the tremendous figure of overnutrition students indicate that genetic factors are not the primary determinants since human genes have remained unchanged for a century. This study aims to assess the prevalence of overnutrition students and to investigate the non-genetic factors affecting over nutrition students. A cross-sectional school-based survey was conducted. A two-stage sampling was adopted. Respondents included 1,850 students in grades 4 to 6 in Ayutthaya Province. An anthropometric measurement and questionnaire were developed. Childhood over nutrition was defined as a weight-for-height Z-score above +2SD of NCHS/WHO references. About thirty three percent of the children were over nutrition in Ayutthaya province. Stepwise multiple logistic regression analysis showed that 8 statistically significant non genetic factors explain the variation of childhood over nutrition by 18 percent. Sex is the prime factor to explain the variation of childhood over nutrition, followed by duration of light physical activities, duration of moderate physical activities, having been breastfed, the presence of a healthy role model of the caregiver, number of siblings, birth order, and occupation of the caregiver, respectively. Non genetic factors, especially the subjects’ demographic and physical activities, as well as the caregivers’ background and family environment, should be considered in viable approach to remedy this health imbalance in children.

Keywords: non genetic factors, non-genetic, over nutrition, over nutrition students

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Authors: Naima Bilal

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The contemporary Anthropocene novel, with all the atrocities, man-made and inflicted by Nature (and Supernature), differs from the Horror novel in one main characteristic, that being naively lingering to hope and the notion that all evils, days and people come to an end. The current article explores the psychological dimensions of this optimistic ending that Climate fiction novelists uphold and how does this 'hope' functions as a bait for the reader to act. The primary sources for the research are The Ministry for the Future by Kim Stanley Robinson, Parable of the Sower by Octivia Butller and Amtiv Ghosh’s Gun Island.

Keywords: hope in contemporary anthroprocene literature, Pakistani science fiction novels, science fiction as a remedy to contemporary climate problems, science the new religion

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Authors: Seyed Reza Mirmahdi, Seyedeh Maryam Hashemi Jabali

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This research was conducted to evaluate the effects of group spiritual therapy on increasing the life expectancy and mental health among the elderlies. This was a quasi-experimental research using a pretest-posttest design with a control group conducted over a population including all the elderly people of Tehran in 2012-13. A randomized sampling method was used to select 30 elderly people living in Parham nursing home that were then randomly assigned into two control and experimental groups of 15 people each. The instruments used were Miller’s life expectancy and mental health test (SCL.90.R) standard questionnaires. Individuals in experimental group received 12 sessions of group spiritual therapy while those in control group did not receive any kind of therapy. The tests were performed again for all the subjects (30 individuals) at the end of the experiment. To test the hypotheses, the data collected by questionnaires were analyzed using descriptive methods through relevant tables and charts and also inferential methods through the analysis of covariance using the SPSS software. Results showed that group spiritual therapy leads to a significant increase in both mental health and life expectancy in the experimental group of elderlies living in Parham nursing home compared to those in the control group.

Keywords: spiritual therapy, life expectancy, mental health, elderlies

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