Search results for: comprehensive care

Authors: Aschenaki Zerihun Kea, Bernt Lindtjorn, Achamyelesh Gebretsadik, Sven Gudmund Hinderaker

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Introduction: Maternal mortality studies conducted at the national level do not provide the information needed for planning and monitoring health programs at lower administrative levels. The aim of this study was to measure maternal mortality, identify risk factors and district-level variations in Sidama National Regional State, southern Ethiopia. Methods: A cross sectional population-based survey was carried out in households where women reported pregnancy and birth outcomes in the past five years. The study was conducted in the Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. Multi-stage cluster sampling technique was employed. The outcome variable of the study was maternal mortality. Complex sample logistic regression analysis was applied to assess variables independently associated with maternal mortality. Results: We registered 10602 live births (LB) and 48 maternal deaths, yielding an overall maternal mortality ratio (MMR) of 419; 95% CI: 260-577 per 100,000 LB. Aroresa district had the highest MMR with 1142 (95% CI: 693-1591) per 100,000 LB. Leading causes of death were haemorrhage 21 (41%) and eclampsia 10 (27%). Thirty (59%) mothers died during labour, or within 24 hours after delivery, 25 (47%) died at home and 17 (38%) at a health facility. Mothers who did not have formal education had a higher risk of maternal death (AOR: 4.4; 95% CI: 1.7 – 11.0). The risk of maternal death was higher in districts with a low midwife-to-population ratio (AOR: 2.9; 95% CI: 1.0-8.9). Conclusion: The high maternal mortality with district-level variations in Sidama Region highlights the importance of improving obstetric care and employing targeted interventions in areas with high mortality rates. Due attention should be given to improving access to female education. Additional midwives have to be trained and deployed to improve maternal health services and consequently save the lives of mothers.

Keywords: maternal mortality variation, maternal death, Sidama, Ethiopia

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Authors: Isabella Lima Leite de Freitas

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The importance of astronomy for humanity is unquestionable. Despite being a robust science, capable of bringing new discoveries every day and quickly increasing the ability of researchers to understand the universe more deeply, scientific research in this area can also help in various applications outside the domain of astronomy. The objective of this study was to review and conduct a descriptive analysis of published studies that presented the importance of astronomy in the area of education. A narrative review of the literature has been performed, considering the articles published in the last five years. As astronomy involves the study of physics, chemistry, biology, mathematics and technology, one of the studies evaluated presented astronomy as the gateway to science, demonstrating the presence of astronomy in 52 school curricula in 37 countries, with celestial movement the dominant content area. Another intervention study, evaluating individuals aged 4-5 years, demonstrated that the attribution of personal characteristics to cosmic bodies, in addition to the use of comprehensive astronomy concepts, favored the learning of science in preschool-age children, considering the use of practical activities of accompaniment and free drawing. Aiming to measure scientific literacy, another study developed in Turkey, motivated the authorities of this country to change the teaching materials and curriculum of secondary schools after the term “astronomy” appeared as one of the most attractive subjects for young people aged 15 to 24. There are also reports in the literature of the use of pedagogical tools, such as the representation of the Solar System on a human scale, where students can walk along the orbits of the planets while studying the laws of dynamics. The use of this tool favored the teaching of the relationship between distance, duration and speed over the period of the planets, in addition to improving the motivation and well-being of students aged 14-16. An important impact of astronomy on education was demonstrated in the study that evaluated the participation of high school students in the Astronomical Olympiads and the International Astronomy Olympiad. The study concluded that these Olympics have considerable influence on students who pursue a career in teaching or research later on, many of whom are in the area of astronomy itself. In addition, the literature indicates that the teaching of astronomy in the digital age has facilitated the availability of data for researchers, but also for the general population. This fact can increase even more the curiosity that the astronomy area has always instilled in people and promote the dissemination of knowledge on an expanded scale. Currently, astronomy has been considered an important ally in strengthening the school curricula of children, adolescents and young adults. This has been used as teaching tools, in addition to being extremely useful for scientific literacy, being increasingly used in the area of education.

Keywords: astronomy, education area, teaching, review

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Authors: Adnan I. O. Zaid, Raghad S. Hemeimat

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Magnesium - aluminum alloys are versatile materials which are used in manufacturing a number of engineering and industrial parts in the automobile and aircraft industries due to their strength – to –weight -ratio. Against these preferable characteristics, magnesium is difficult to deform at room temperature therefore it is alloyed with other elements mainly Aluminum and Zinc to add some required properties particularly for their high strength - to -weight ratio. Mg and its alloys oxidize rapidly therefore care should be taken during melting or machining them; but they are not fire hazardous. Grain refinement is an important technology to improve the mechanical properties and the micro structure uniformity of the alloys. Grain refinement has been introduced in early fifties; when Cibula showed that the presence of Ti, and Ti+ B, produced a great refining effect in Al. since then it became an industrial practice to grain refine Al. Most of the published work on grain refinement was directed toward grain refining Al and Zinc alloys; however, the effect of the addition of rare earth material on the grain size or the mechanical behavior of Mg alloys has not been previously investigated. This forms the main objective of the research work; where, the effect of Ti addition on the grain size, mechanical behavior, ductility, and the extrusion force & energy consumed in forward extrusion of Mg-AZ31 alloy is investigated and discussed in two conditions, first in the as cast condition and the second after extrusion. It was found that addition of Ti to Mg- AZ31 alloy has resulted in reduction of its grain size by 14%; the reduction in grain size after extrusion was much higher. However the increase in Vicker’s hardness was 3% after the addition of Ti in the as cast condition, and higher values for Vicker’s hardness were achieved after extrusion. Furthermore, an increase in the strength coefficient by 36% was achieved with the addition of Ti to Mg-AZ31 alloy in the as cast condition. Similarly, the work hardening index was also increased indicating an enhancement of the ductility and formability. As for the extrusion process, it was found that the force and energy required for the extrusion were both reduced by 57% and 59% with the addition of Ti.

Keywords: cast condition, direct extrusion, ductility, MgAZ31 alloy, super - plasticity

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Authors: Uwe C. Fischer

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Mental health and well-being for employees working in the human service system are getting more and more important given the increasing rate of absenteeism at work. Besides individual capacities, social and community factors seem to be important in the working setting. Starting from a demand resource framework including the classical demand control aspects, social support systems, specific demands and resources of the client work, and work-family conflict were considered in the present study. We state hypothetically, that these factors have a meaningful association with the mental quality of life of employees working in the field of social, educational and health sectors. 1140 employees, working in human service organizations (education, youth care, nursing etc.) were asked for strains and resources at work (selected scales from Salutogenetic Subjective Work Assessment SALSA and own new scales for client work), work-family conflict, and mental quality of life from the German Short Form Health Survey. Considering the complex influences of the variables, we conducted a multiple hierarchical regression analysis. One third of the whole variance of the mental quality of life can be declared by the different variables of the model. When the variables concerning social influences were included in the hierarchical regression, the influence of work related control resource decreased. Excessive workload, work-family conflict, social support by supervisors, co-workers and other persons outside work, as well as strains and resources associated with client work had significant regression coefficients. Conclusions: Social support systems are crucial in the social, educational and health related service sector, regarding the influence on mental well-being. Especially the work-family conflict focuses on the importance of the work-life balance. Also the specific strains and resources of the client work, measured with new constructed scales, showed great impact on mental health. Therefore occupational health promotion should focus more on the social factors within and outside the working place.

Keywords: client interaction, human service system, mental health, social support, work-family conflict

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Authors: B. Bernabela, P. Bles, A. Bloecker, D. DeRock, M. van Es, M. Gerritse, T. de Jongh, W. Lansing, M. Martinot, J. van de Wetering

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A heated debate has been taking place concerning research and teaching at Dutch universities for the last few years. The ministry of science and education has published reports on its strategy to improve university curricula and position the Netherlands as a globally competitive knowledge economy. These reports have provoked an uproar of responses from think tanks, concerned academics, and the media. At the center of the debate is disagreement over who should determine the Dutch university curricula and how these curricula should look. Many stakeholders in the higher education system have voiced their opinion, and some have not been heard. The result is that the diversity of visions is ignored or taken for granted in the official reports. Recognizing this gap in stakeholder analysis, the aim of this paper is to bring attention to the wide range of perspectives on who should be responsible for designing higher education curricula. Based on a previous analysis by the Rathenau Institute, we distinguish five different groups of stakeholders: government, business sector, university faculty and administration, students, and the societal sector. We conducted semi-structured, in-depth interviews with representatives from each stakeholder group, and distributed quantitative questionnaires to people in the societal sector (i.e. people not directly affiliated with universities or graduates). Preliminary data suggests that the stakeholders have different target points concerning the university curricula. Representatives from the governmental sector tend to place special emphasis on the link between research and education, while representatives from the business sector rather focus on greater opportunities for students to obtain practical experience in the job market. Responses from students reflect a belief that they should be able to influence the curriculum in order to compete with other students on the international job market. On the other hand, university faculty expresses concern that focusing on the labor market puts undue pressure on students and compromises the quality of education. Interestingly, the opinions of members of ‘society’ seem to be relatively unchanged by political and economic shifts. Following a comprehensive analysis of the data, we believe that our results will make a significant contribution to the debate on university education in the Netherlands. These results should be regarded as a foundation for further research concerning the direction of Dutch higher education, for only if we take into account the different opinions and views of the various stakeholders can we decide which steps to take. Moreover, the Dutch experience offers lessons to other countries as well. As the internationalization of higher education is occurring faster than ever before, universities throughout Europe and globally are experiencing many of the same pressures.

Keywords: Dutch University curriculum, higher education, participants’ opinions, stakeholder perspectives

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Authors: Shengnan Chen, Shuhua Wang

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Successful production of hydrocarbon from unconventional tight oil reserves has changed the energy landscape in North America. The oil contained within these reservoirs typically will not flow to the wellbore at economic rates without assistance from advanced horizontal well and multi-stage hydraulic fracturing. Efficient and economic development of these reserves is a priority of society, government, and industry, especially under the current low oil prices. Meanwhile, society needs technological and process innovations to enhance oil recovery while concurrently reducing environmental impacts. Recently, big data analysis and artificial intelligence become very popular, developing data-driven insights for better designs and decisions in various engineering disciplines. However, the application of data mining in petroleum engineering is still in its infancy. The objective of this research aims to apply intelligent data analysis and data-driven models to exploit unconventional oil reserves both efficiently and economically. More specifically, a comprehensive database including the reservoir geological data, reservoir geophysical data, well completion data and production data for thousands of wells is firstly established to discover the valuable insights and knowledge related to tight oil reserves development. Several data analysis methods are introduced to analysis such a huge dataset. For example, K-means clustering is used to partition all observations into clusters; principle component analysis is applied to emphasize the variation and bring out strong patterns in the dataset, making the big data easy to explore and visualize; exploratory factor analysis (EFA) is used to identify the complex interrelationships between well completion data and well production data. Different data mining techniques, such as artificial neural network, fuzzy logic, and machine learning technique are then summarized, and appropriate ones are selected to analyze the database based on the prediction accuracy, model robustness, and reproducibility. Advanced knowledge and patterned are finally recognized and integrated into a modified self-adaptive differential evolution optimization workflow to enhance the oil recovery and maximize the net present value (NPV) of the unconventional oil resources. This research will advance the knowledge in the development of unconventional oil reserves and bridge the gap between the big data and performance optimizations in these formations. The newly developed data-driven optimization workflow is a powerful approach to guide field operation, which leads to better designs, higher oil recovery and economic return of future wells in the unconventional oil reserves.

Keywords: big data, artificial intelligence, enhance oil recovery, unconventional oil reserves

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Authors: Daniel Faraj, Arabella Raupach, Charlotte Hespe, Helen Wilcox, Kristie-Lee Anning

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Aim: International child sponsorship programs comprise a considerable proportion of global aid accessible to the general population. Team Philippines (TP), a healthcare and welfare initiative run in association with the University of Notre Dame Sydney since 2013, leads a holistic sponsorship program for thirty children from Calauan, Philippines. To date, empirical research has not been performed on the overall success and impact of the TP child sponsorship program. As such, this study aims to evaluate its effectiveness in improving pediatric outcomes. Methods: Study cohorts comprised thirty sponsored and twenty-nine age- and gender-matched non-sponsored children. Data were extracted from the TP Medical Director database and lifestyle questionnaires for July-November 2019. Outcome measures included anthropometry, markers of medical health, dental health, exercise, and diet. Statistical analyses were performed in SPSS. Results: Sponsorship resulted in fewer medical diagnoses and prescription medications, superior dental health, and improved diet. Further, sponsored children may show a clinically significant trend toward improved physical health. Sponsorship did not affect growth and development metrics or levels of physical activity. Conclusions: The TP child sponsorship program significantly impacts positive pediatric health outcomes in the Calauan community. The strength of the program lies in its holistic, sustainable, and community-based model, which is enabled by effective international child sponsorship. This study further supports the relationship between supporting early livelihood and improved health in the pediatric population.

Keywords: child health, public health, health status disparities, healthcare disparities, social determinants of health, morbidity, community health services, culturally competent care, medically underserved areas, population health management, Philippines

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Authors: Mahmoud Reza Hosseini

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The universe is in a continuous expansion process, resulting in the reduction of its density and temperature. Also, by extrapolating back from its current state, the universe at its early times has been studied known as the big bang theory. According to this theory, moments after creation, the universe was an extremely hot and dense environment. However, its rapid expansion due to nuclear fusion led to a reduction in its temperature and density. This is evidenced through the cosmic microwave background and the universe structure at a large scale. However, extrapolating back further from this early state reaches singularity which cannot be explained by modern physics and the big bang theory is no longer valid. In addition, one can expect a nonuniform energy distribution across the universe from a sudden expansion. However, highly accurate measurements reveal an equal temperature mapping across the universe which is contradictory to the big bang principles. To resolve this issue, it is believed that cosmic inflation occurred at the very early stages of the birth of the universe According to the cosmic inflation theory, the elements which formed the universe underwent a phase of exponential growth due to the existence of a large cosmological constant. The inflation phase allows the uniform distribution of energy so that an equal maximum temperature could be achieved across the early universe. Also, the evidence of quantum fluctuations of this stage provides a means for studying the types of imperfections the universe would begin with. Although well-established theories such as cosmic inflation and the big bang together provide a comprehensive picture of the early universe and how it evolved into its current state, they are unable to address the singularity paradox at the time of universe creation. Therefore, a practical model capable of describing how the universe was initiated is needed. This research series aims at addressing the singularity issue by introducing an energy conversion mechanism. This is accomplished by establishing a state of energy called a “neutral state”, with an energy level which is referred to as “base energy” capable of converting into other states. Although it follows the same principles, the unique quanta state of the base energy allows it to be distinguishable from other states and have a uniform distribution at the ground level. Although the concept of base energy can be utilized to address the singularity issue, to establish a complete picture, the origin of the base energy should be also identified. This matter is the subject of the first study in the series “A Conceptual Study for Investigating the Creation of Energy and Understanding the Properties of Nothing” which is discussed in detail. Therefore, the proposed concept in this research series provides a road map for enhancing our understating of the universe's creation from nothing and its evolution and discusses the possibility of base energy as one of the main building blocks of this universe.

Keywords: big bang, cosmic inflation, birth of universe, energy creation

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Authors: Rajlakshmi Banerjee, Sujoy Banerjee

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The prevalence of malnutrition, as the most common cause of morbidity and mortality increases with old age, especially in developing countries like India, because of many factors out of which dentate status is one. It affects diet, nutritional status and general health due to reduced chewing ability and poor food choices. Aim and Objective: This study aimed to evaluate the effect of nutritional status, dietary intake on the Oral Health-related Quality of life (OHRQoL) of elderly edentulous complete denture wearing patients and to know whether they are at a higher risk of malnutrition. The objective was to assess the need to include dietary and nutritional counselling during Prosthodontic rehabilitation of elderly edentulous patients. Materials and method: A cross-sectional study was conducted among 200 elderly denture wearing patients above 60 yrs of age from Nagpur, Maharashtra. The majority of study subjects (60%) were between the age group 60 and 75 years. Mini-Nutritional Assessment (MNA) Questionnaire was used to assess nutritional status and General Oral Health Assessment Index (GOHAI) questionnaire was used to determine the Oral health related Quality of life of these patients.Descriptive statistics was used to analyze data using SPSS version 21. Results: Among the assessed subjects, nearly 80% of them had total scores of GOHAI between 12 and 57 which require ‘needed dental care.’ As per MNA, 10.5% had adequate nutrition, 70 % were at risk of malnutrition, and remaining 19.5 % of subjects were malnourished. There was a significant correlation between GOHAI and MNA scores. A strong association was found between mean GOHAI and MNA scores and thereby nutritional status and OHRQOL.Conclusion: The use of conventional dentures increases the risk of malnutrition in the elderly due to inability to eat and chew food properly and therefore severely affecting the quality of life. Dietary analysis and counselling should be strictly incorporated into geriatric treatment planning during Prosthetic rehabilitation.

Keywords: general oral health assessment index, General Oral Health Assessment Index (GOHAI), nutritional assessment, mini-nutritional assessment, Mini-Nutritional Assessment (MNA), quality of life

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Authors: Suhaib Radi, Ibrahim Basem Nafadi, Abdullah Ahmed Alsulami, Nawaf Faisal Halabi, Abdulrhman Abdullah Alsubhi, Sami Wesam Maghrabi, Waleed Saad Alshehri

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Background: Kidney stones greatly affect individuals. The range of these effects regarding multiple kidney stone factors (size, presence of obstruction, and modality of treatment) in stone formers with and without diabetes has not been well explored in the literature to the best of the author's knowledge. Our goal is to investigate this unexplored correlation between diabetes and kidney stones by conducting a Cohort retrospective study to precisely evaluate the effects of this condition and the existence of complications in adult individuals with diabetes in Saudi Arabia in comparison to a non-diabetic control group. Methodology: This is a retrospective cohort study aiming to evaluate the range of effects of kidney stones in stone formers in a group of adults diagnosed with type 2 diabetes mellitus and adults without diabetes between 2017 and 2019 in Jeddah, Saudi Arabia. An IRB approval has been granted for this study. The data was analyzed using SPSS. The data was collected from the 1st of December 2022 until the 1st of March 2023. Results: A total of 254 individuals diagnosed with kidney stones were included, 127 of whom were adult individuals with type 2 diabetes, and 127 were non-diabetics. Our study shows that the individuals affected with diabetes were more likely to have larger kidney stones in comparison to individuals without diabetes (13.12 mm vs. 10.53 mm, p-value = 0.03). Moreover, individuals with hypertension and dyslipidemia also had significantly larger stones. On the other hand, no significant difference was found in the presence of obstruction and modality of treatment between the two groups. Conclusion: This study done in Saudi Arabia found that individuals with kidney stones who concurrently had diabetes formed larger kidney stones, and they were also found to have other comorbidities such as HTN, dyslipidemia, obesity, and renal disease. The significance of these findings could assist in the future of primary and secondary prevention of renal stones.

Keywords: kidney stone, type 2 DM, metabolic syndrome, lithotripsy

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Authors: Francisco Fernandez de Castro

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The Conditional Cash Transfer (CCT) model gives monetary transfers to beneficiary families on the condition that they take specific education and health actions. According to the economic rationale of CCTs the poor need incentives to invest in their human capital because they are trapped by a lack of information and misleading beliefs. If left to their own decision, the poor will not be able to choose what is in their best interests. The basic assumption of the CCT model is that the poor need incentives to take care of their own education and health-nutrition. Due to the incentives (income cash transfers and conditionalities), beneficiary families are supposed to attend doctor visits and health talks. Children would stay in the school. These incentivized behaviors would produce outcomes such as better health and higher level of education, which in turn will reduce poverty. Based on a grounded theory approach to conduct a two-year period of qualitative data collection in northern Mexico, this study shows that this explanation is incomplete. In addition to the information failure and inadequate beliefs, there are structural barriers in everyday life of households that make health-nutrition and education investments difficult. In-depth interviews and observation work showed that the program takes for granted local conditions in which beneficiary families should fulfill their co-responsibilities. Data challenged the program’s assumptions and unveiled local obstacles not contemplated in the program’s design. These findings have policy and research implications for the CCT agenda. They bring elements for late programming due to the gap between the CCT strategy as envisioned by policy designers, and the program that beneficiary families experience on the ground. As for research consequences, these findings suggest new avenues for scholarly work regarding the causal mechanisms and social processes explaining CCT outcomes.

Keywords: conditional cash transfers, incentives, poverty, structural barriers

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Authors: Gabriela Rivadeneyra-Romero, Claudia del C. Gutierrez Torres, Sergio A. Martinez-Delgadillo, Victor X. Mendoza-Escamilla, Alejandro Alonzo-Garcia

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Ultrasonic degradation is currently being used in sonochemical reactors to degrade pollutant compounds from aqueous media, as emerging contaminants (e.g. pharmaceuticals, drugs and personal care products.) because they can produce possible ecological impacts on the environment. For this reason, it is important to develop appropriate water and wastewater treatments able to reduce pollution and increase reuse. Pollutants such as textile dyes, aromatic and phenolic compounds, cholorobenzene, bisphenol-A and carboxylic acid and other organic pollutants, can be removed from wastewaters by sonochemical oxidation. The effect on the removal of pollutants depends on the type of the ultrasonic frequency used; however, not much studies have been done related to the behavior of the fluid into the sonoreactors operated at different ultrasonic frequencies. Based on the above, it is necessary to study the hydrodynamic behavior of the liquid generated by the ultrasonic irradiation to design efficient sonoreactors to reduce treatment times and costs. In this work, it was studied the hydrodynamic behavior of the fluid in sonochemical reactors at different frequencies (250 kHz, 500 kHz and 1000 kHz). The performances of the sonoreactors at those frequencies were simulated using computational fluid dynamics (CFD). Due to there is great sound speed gradient between piezoelectric and fluid, k-e models were used. Piezoelectric was defined as a vibration surface, to evaluate the different frequencies effect on the fluid into sonochemical reactor. Structured hexahedral cells were used to mesh the computational liquid domain, and fine triangular cells were used to mesh the piezoelectric transducers. Unsteady state conditions were used in the solver. Estimation of the dissipation rate, flow field velocities, Reynolds stress and turbulent quantities were evaluated by CFD and 2D-PIV measurements. Test results show that there is no necessary correlation between an increase of the ultrasonic frequency and the pollutant degradation, moreover, the reactor geometry and power density are important factors that should be considered in the sonochemical reactor design.

Keywords: CFD, reactor, ultrasound, wastewater

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Authors: Leonore Robieux, Franck Zenasni, Marc Pocard, Clarisse Eveno

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Empirical data in health psychology studies show the necessity to consider the doctor-patient communication and its positive impact on outcomes such as patients’ satisfaction, treatment adherence, physical and psychological wellbeing. In this line, the present research aims to define the role and determinants of an effective doctor–patient communication during the treatment of patients with serious illness (peritoneal carcinomatosis). We carried out a prospective longitudinal study including patients treated for peritoneal carcinomatosis of various origins. From November 2016, to date, data were collected using validated questionnaires at two times of evaluation: one month before the surgery (T0) and one month after (T1). Thus, patients reported their (a) anxiety and depression levels, (b) standardized and individualized quality of life and (c) how they perceived communication, attitude and empathy of the surgeon. 105 volunteer patients (Mean age = 58.18 years, SD = 10.24, 62.2% female) participated to the study. PC arose from rare diseases (14%), colorectal (38%), eso-gastric (24%) and ovarian (8%) cancer. Three groups are defined according to the severity of their pathology and the treatment offered to them: (1) important surgical treatment with the goal of healing (53%), (2) repeated palliative surgical treatment (17%), and (3) the patients recused for surgical treatment, only palliative approach (30%). Results are presented according to Baron and Kenny recommendations. The regressions analyses show that only depression and anxiety are sensitive to the communication and empathy of surgeon. The main results show that a good communication and high level of empathy at T0 and T1 limit depression and anxiety of the patients in T1. Results also indicate that the severity of the disease modulates this positive impact of communication: better is the communication the less are the level of depression and anxiety of the patients. This effect is higher for patients treated for the more severe disease. These results confirm that, even in the case severe disease a good communication between patient and physician remains a significant factor in promoting the well-being of patients. More specific training need to be developed to promote empathic care.

Keywords: clinical empathy, determinants, healthcare, psychological wellbeing

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Authors: Chaudhary Itisha, Shankar Manu

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Patient satisfaction represents a crucial aspect in the evaluation of health care services. Preoperative teaching provides the patient with pertinent information concerning the surgical process and the intended surgical procedure as well as anticipated patient behavior (anxiety, fear), expected sensation, and the probable outcomes. Although patient education is part of Accreditation protocols, it is not uniform at most places. The aim of this study was to try to assess the benefit of preoperative patient education on selected post-operative outcome parameters; mainly, post-operative pain scores, requirement of additional analgesia, return to activity of daily living and overall patient satisfaction, and try to standardize few education protocols. Dependent variables were measured before and after the treatment on a study population of 302 volunteers. Educational intervention was provided by the Investigator in the preoperative period to the study group through personal counseling. An information booklet contained detailed information was also provided. Statistical Analysis was done using Chi square test, Mann Whitney u test and Fischer Exact Test on a total of 302 subjects. P value <0.05 was considered as level of statistical significance and p<0.01 was considered as highly significant. This study suggested that patients who are given a structured, individualized and elaborate preoperative education and counseling have a better ability to cope up with postoperative pain in the immediate post-operative period. However, there was not much difference when the patients have had almost complete recovery. There was no difference in the requirement of additional analgesia among the two groups. There is a positive effect of preoperative counseling on expected return to the activities of daily living and normal work schedule. However, no effect was observed on the activities in the immediate post-operative period. There is no difference in the overall satisfaction score among the two groups of patients. Thus this study concludes that there is a positive benefit as suggested by the results for pre-operative patient education. Although the difference in various parameters studied might not be significant over a long term basis, they definitely point towards the benefits of preoperative patient education. 

Keywords: patient education, post-operative pain, postoperative outcomes, patient satisfaction

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Authors: Arlinda Memetaj

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Building up of a well-functioning administrative justice system is one of the key prerequisites for ensuring the existence of an accountable and efficient public administration in Kosovo as well. To this aim, the country has already established an almost comprehensive legislative and institutional frameworks. The latter derives from (among others) the Kosovo`s Stabilisation and Association Agreement with the EU of 2016. A series of efforts are being presently still undertaken by all relevant domestic and international stakeholders being active in both the Kosovo`s public administration reform and the country` s system of a local self-government. Both systems are thus under a constant state of reform. Despite the aforesaid, there is still a series of shortcomings in the country in above context. There is a lot of backlog of administrative cases in the Prishtina Administrative court; there is a public lack in judiciary; the public administration is organized in a fragmented way; the administrative laws are still not properly implemented at local level; the municipalities` legislative and executive branches are not sufficiently transparent for the ordinary citizens ... Against the above short background, the full paper firstly outlines the legislative and institutional framework of the Kosovo's systems of an administrative justice and local self-government (on the basis of the fact that public administration and local government are not separate fields). It then illustrates the key specific shortcomings in those fields, as seen from the perspective of the citizens' right to good administration. It finally claims that the current status quo situation in the country may be resolved (among others) by granting Kosovo a status of full member state of the Council of Europe or at least granting it with a temporary status of a contracting party of (among others) the European Human Rights Convention. The later would enable all Kosovo citizens (regardless their ethnic or other origin whose human rights are violated by the Kosovo`s relative administrative authorities including the administrative courts) to bring their case/s before the respective well-known European Strasbourg-based Human Rights Court. This would consequently put the State under permanent and full monitoring process, with a view to obliging the country to properly implement the European Court`s decisions (as adopted by this court in those cases). This would be a benefit first of all for the very Kosovo`s ordinary citizens regardless their ethnic or other background. It would provide for a particular positive input in the ongoing efforts being undertaken by Kosovo and Serbia states within the EU-facilitated Dialogue, with a view to building up of an integral administrative justice system at central and local level in the whole Kosovo` s territory. The main method used in this paper is the descriptive, analytical and comparative one.

Keywords: administrative courts, administrative justice, administrative procedure, benefit, European Human Rights Court, human rights, monitoring, reform.

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Authors: B. Bricklin Zeff

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This research explores the development and application of a specialized chatbot tailored for a nursing English course, with a primary objective of augmenting student engagement through situational content and responsiveness to key expressions and vocabulary. Introducing the chatbot, elucidating its purpose, and outlining its functionality are crucial initial steps in the research study, as they provide a comprehensive foundation for understanding the design and objectives of the specialized chatbot developed for the nursing English course. These elements establish the context for subsequent evaluations and analyses, enabling a nuanced exploration of the chatbot's impact on student engagement and language learning within the nursing education domain. The subsequent exploration of the intricate language model development process underscores the fusion of scientific methodologies and artistic considerations in this application of artificial intelligence (AI). Tailored for educators and curriculum developers in nursing, practical principles extending beyond AI and education are considered. Some insights into leveraging technology for enhanced language learning in specialized fields are addressed, with potential applications of similar chatbots in other professional English courses. The overarching vision is to illuminate how AI can transform language learning, rendering it more interactive and contextually relevant. The presented chatbot is a tangible example, equipping educators with a practical tool to enhance their teaching practices. Methodologies employed in this research encompass surveys and discussions to gather feedback on the chatbot's usability, effectiveness, and potential improvements. The chatbot system was integrated into a nursing English course, facilitating the collection of valuable feedback from participants. Significant findings from the study underscore the chatbot's effectiveness in encouraging more verbal practice of target expressions and vocabulary necessary for performance in role-play assessment strategies. This outcome emphasizes the practical implications of integrating AI into language education in specialized fields. This research holds significance for educators and curriculum developers in the nursing field, offering insights into integrating technology for enhanced English language learning. The study's major findings contribute valuable perspectives on the practical impact of the chatbot on student interaction and verbal practice. Ultimately, the research sheds light on the transformative potential of AI in making language learning more interactive and contextually relevant, particularly within specialized domains like nursing.

Keywords: chatbot, nursing, pragmatics, role-play, AI

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Authors: Danna Jia, Bin Li

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Background: Atopic dermatitis (AD) is a chronic and refractory inflammatory skin disease characterized by relapsing eczematous and pruritic skin lesions. The global prevalence of AD ranges from 1~ 20%, and its incidence rates are increasing. It affects individuals from infancy to adulthood, significantly impacting their daily lives and social activities. Despite its major health burden, the precise mechanisms underlying AD remain unknown. Understanding the genetic differences associated with AD is crucial for advancing diagnosis and targeted treatment development. This study aims to identify candidate genes of AD by using bioinformatics analysis. Methods: We conducted a comprehensive analysis of four pooled transcriptomic datasets (GSE16161, GSE32924, GSE130588, and GSE120721) obtained from the Gene Expression Omnibus (GEO) database. Differential gene expression analysis was performed using the R statistical language. The differentially expressed genes (DEGs) between AD patients and normal individuals were functionally analyzed using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. Furthermore, a protein-protein interaction (PPI) network was constructed to identify candidate genes. Results: Among the patient-level gene expression datasets, we identified 114 shared DEGs, consisting of 53 upregulated genes and 61 downregulated genes. Functional analysis using GO and KEGG revealed that the DEGs were mainly associated with the negative regulation of transcription from RNA polymerase II promoter, membrane-related functions, protein binding, and the Human papillomavirus infection pathway. Through the PPI network analysis, we identified eight core genes: CD44, STAT1, HMMR, AURKA, MKI67, and SMARCA4. Conclusion: This study elucidates key genes associated with AD, providing potential targets for diagnosis and treatment. The identified genes have the potential to contribute to the understanding and management of AD. The bioinformatics analysis conducted in this study offers new insights and directions for further research on AD. Future studies can focus on validating the functional roles of these genes and exploring their therapeutic potential in AD. While these findings will require further verification as achieved with experiments involving in vivo and in vitro models, these results provided some initial insights into dysfunctional inflammatory and immune responses associated with AD. Such information offers the potential to develop novel therapeutic targets for use in preventing and treating AD.

Keywords: atopic dermatitis, bioinformatics, biomarkers, genes

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Authors: Soheila Sadeghi

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In the dynamic landscape of project management, scope changes are an inevitable reality that can significantly impact project performance. These changes, whether initiated by stakeholders, external factors, or internal project dynamics, can lead to cost overruns and schedule delays. Accurately predicting the consequences of these changes is crucial for effective project control and informed decision-making. This study aims to develop predictive models to estimate the impact of scope changes on project cost and schedule using machine learning techniques. The research utilizes a comprehensive dataset containing detailed information on project tasks, including the Work Breakdown Structure (WBS), task type, productivity rate, estimated cost, actual cost, duration, task dependencies, scope change magnitude, and scope change timing. Multiple machine learning models are developed and evaluated to predict the impact of scope changes on project cost and schedule. These models include Linear Regression, Decision Tree, Ridge Regression, Random Forest, Gradient Boosting, and XGBoost. The dataset is split into training and testing sets, and the models are trained using the preprocessed data. Cross-validation techniques are employed to assess the robustness and generalization ability of the models. The performance of the models is evaluated using metrics such as Mean Squared Error (MSE) and R-squared. Residual plots are generated to assess the goodness of fit and identify any patterns or outliers. Hyperparameter tuning is performed to optimize the XGBoost model and improve its predictive accuracy. The feature importance analysis reveals the relative significance of different project attributes in predicting the impact on cost and schedule. Key factors such as productivity rate, scope change magnitude, task dependencies, estimated cost, actual cost, duration, and specific WBS elements are identified as influential predictors. The study highlights the importance of considering both cost and schedule implications when managing scope changes. The developed predictive models provide project managers with a data-driven tool to proactively assess the potential impact of scope changes on project cost and schedule. By leveraging these insights, project managers can make informed decisions, optimize resource allocation, and develop effective mitigation strategies. The findings of this research contribute to improved project planning, risk management, and overall project success.

Keywords: cost impact, machine learning, predictive modeling, schedule impact, scope changes

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Authors: Fatih Topaloğlu

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Although philosophy is inherently a theoretical and intellectual activity, it should not be denied that environmental conditions influence the formation and shaping of philosophical thought. In this context, it should be noted that the Philosophy of Religion has been influential in the debates in the West, especially since the beginning of the 20th century, and that this influence has dimensions that cannot be limited to academic or intellectual fields. The issues and problems that fall within the field of interest of Philosophy of Religion are followed with interest by a significant proportion of society through popular publications. Philosophy of Religion has its share in many social, economic, cultural, scientific, political and ethical developments. Philosophy of Religion, in the most general sense, can be defined as a philosophical approach to religion or a philosophical way of thinking and discussing religion. Philosophy of Religion tries to explain the epistemological foundations of concepts such as belief and faith that shape religious life by revealing their meaning for the individual. Thus, Philosophy of Religion tries to evaluate the effect of beliefs on the individual's values, judgments and behaviours with a comprehensive and critical eye. The Philosophy of Religion, which tries to create new solutions and perspectives by applying the methods of philosophy to religious problems, tries to solve these problems not by referring to the holy book or religious teachings but by logical proofs obtained through the possibilities of reason and evidence filtered through the filter of criticism. Although there is no standard method for doing Philosophy of Religion, it can be said that an approach that can be expressed as thinking about religion in a rational, objective, and consistent way is generally accepted. The evaluations made within the scope of Philosophy of Religion have two stages. The first is the definition stage, and the second is the evaluation stage. In the first stage, the data of different scientific disciplines, especially other religious sciences, are utilized to define the issues objectively. In the second stage, philosophical evaluations are made based on this foundation. During these evaluations, the issue of how the relationship between religion and philosophy should be established is extremely sensitive. The main thesis of this paper is that the Philosophy of Religion, as a branch of philosophy, has been affected by the conditions caused by the historical experience through which it has passed and has differentiated its subjects and the methods it uses to realize its philosophical acts over time under the influence of these conditions. This study will attempt to evaluate the validity of this study based on the "Introduction to Philosophy of Religion" literature, which we assume reflects this differentiation. As a result of this examination will aim to reach some factual conclusions about the nature of both philosophical and religious thought, to determine the phases that the Philosophy of Religion as a discipline has gone through since the day it emerged, and to investigate the possibilities of a holistic view of the field.

Keywords: content analysis, culture, history, philosophy of religion, method

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Authors: Balasooriya B. M. C. M., Sujeeva N., Thowfeek Z., Siddiqa Omo, Liyanagunawardana J. E., Jayawardana Saiu, Manathunga S. S., Katulanda G. W.

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Introduction and objectives: Adrenal venous sampling (AVS) is the gold standard to discriminate unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and only performed in a limited number of centers worldwide. To the best of our knowledge, Except for one study conducted in India, no other research studies on this area have been conducted in South Asia. This study aimed to evaluate the effectiveness of AVS in the management of primary aldosteronism. Methods: A total of 32 patients who underwent AVS at the National Hospital of Sri Lanka from April 2021 to April 2023 were enrolled. Demographic, clinical and laboratory data were obtained retrospectively. A procedure was considered successful when adequate cannulation of both adrenal veins was demonstrated. Cortisol gradient across the adrenal vein (AV) and the peripheral vein was used to establish the success of venous cannulation. Lateralization was determined by the aldosterone gradient between the two sides. Continuous and categorical variables were summarized with mean, SD, and proportions, respectively. The mean and standard deviation of the contralateral suppression index (CSI) were estimated with an intercept-only Bayesian inference model. Results: Of the 32 patients, the average age was 52.47 +26.14 and 19 (59.4%) were males. Both AVs were successfully cannulated in 12 (37.5%). Among them, lateralization was demonstrated in 11(91.7%), and one was diagnosed as a bilateral disease. There were no total failures. Right AV cannulation was unsuccessful in 18 (56.25%), of which lateralization was demonstrated in 9 (50%), and others were inconclusive. Left AV cannulation was unsuccessful only in 2 (6.25%); one was lateralized, and the other remained inconclusive. The estimated mean of the CSI was 0.33 (89% credible interval 0.11-0.86). Seven patients underwent unilateral adrenalectomy and demonstrated significant improvement in blood pressure during follow-up. Two patients await surgery. Others were treated medically. Conclusions: Despite failure due to procedural difficulties, AVS remained useful in the management of patients with PA. Moreover, the success of the procedure needs experienced hands and advanced equipment to achieve optimal outcomes in PA.

Keywords: adrenal venous sampling, lateralization, contralateral suppression index, primary aldosteronism

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Authors: Haiu-Lan Chin, Yu-Fen Hsiao, Hua-Ying Chuang, Wei Lee

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An adult with intellectual disability generally has insufficient physical activity which is an important factor leading to premature weakness. Studies in recent years on frailty syndrome have accumulated substantial data about indicators of human aging, including unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity. Of these indicators, hand-grip strength can be seen as a predictor of mortality, disability, complications, and increased length of hospital stay. Hand-grip strength in fact provides a comprehensive overview of one’s vitality. The research is about the investigation on hand-grip strength of adults with intellectual disabilities in facilities, institutions and workshops. The participants are 197 male adults (M=39.09±12.85 years old), and 114 female ones (M=35.80±8.2 years old) so far. The aim of the study is to figure out the performance of their hand-grip strength, and initiate the setting of training on hand-grip strength in their daily life which will decrease the weakening on their physical condition. Test items include weight, bone density, basal metabolic rate (BMR), static body balance except hand-grip strength. Hand-grip strength was measured by a hand dynamometer and classified as normal group ( ≧ 30 kg for male and ≧ 20 kg for female) and weak group ( < 30 kg for male, < 20 kg for female)The analysis includes descriptive statistics, and the indicators of grip strength fo the adults with intellectual disability. Though the research is still ongoing and the participants are increasing, the data indicates: (1) The correlation between hand-grip strength and degree of the intellectual disability (p ≦. 001), basal metabolic rate (p ≦ .001), and static body balance (p ≦ .01) as well. Nevertheless, there is no significant correlation between grip strength and basal metabolic rate which had been having significant correlation with hand-grip strength. (2) The difference between male and female subjects in hand-grip strength is significant, the hand-grip strength of male subjects (25.70±12.81 Kg) is much higher than female ones (16.30±8.89 Kg). Compared to the female counterparts, male participants indicate greater individual differences. And the proportion of weakness between male and female subjects is also different. (3) The regression indicates the main factors related to grip strength performance include degree of the intellectual disability, height, static body balance, training and weight sequentially. (4) There is significant difference on both hand-grip and static body balance between participants in facilities and workshops. The study supports the truth about the sex and gender differences in health. Nevertheless, the average hand-grip strength of left hand is higher than right hand in both male and female subjects. Moreover, 71.3% of male subjects and 64.2% of female subjects have better performance in their left hand-grip which is distinctive features especially in low degree of the intellectual disability.

Keywords: adult with intellectual disability, frailty syndrome, grip strength, physical condition

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Authors: Marta Blavia

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Magiciens de la terre, organized in 1989 by the Centre Pompidou, became 'the first worldwide exhibition of contemporary art' by presenting artists from Western and non-Western countries, including three Chinese artists. For the first time, West turned its eyes to other countries not as exotic sources of inspiration, but as places where contemporary art was also being created. One year later, Chine: demain pour hier was inaugurated as the first Chinese avant-garde group-exhibition in Occident. Among the artists included was Cai Guo-Qiang who, like many other Chinese artists, had left his home country in the eighties in pursuit of greater creative freedom. By exploring artistic non-Western perspectives, both landmark exhibitions questioned the predominance of the Eurocentric vision in the construction of history art. But more than anything else, these exhibitions laid the groundwork for the rise of the so-called phenomenon 'global contemporary art'. All the same time, 1989 also was a turning point in Chinese art history. Because of the Tiananmen student protests, The Chinese government undertook a series of measures to cut down any kind of avant-garde artistic activity after a decade of a relative openness. During the eighties, and especially after the Tiananmen crackdown, some important artists began to leave China to move overseas such as Xu Bing and Ai Weiwei (USA); Chen Zhen and Huang Yong Ping (France); or Cai Guo-Qiang (Japan). After emigrating abroad, Chinese overseas artists began to develop projects in accordance with their new environments and audiences as well as to appear in numerous international exhibitions. With their creations, that moved freely between a variety of Eastern and Western art sources, these artists were crucial agents in the emergence of global contemporary art. As other Chinese artists overseas, Cai Guo-Qiang’s career took off during the 1990s and early 2000s right at the same moment in which Western art world started to look beyond itself. Little by little, he developed a very personal artistic language that redefines Chinese ideas, symbols, and traditional materials in a new world order marked by globalization. Cai Guo-Qiang participated in many of the exhibitions that contributed to shape global contemporary art: Encountering the Others (1992); the 45th Venice Biennale (1993); Inside Out: New Chinese Art (1997), or the 48th Venice Biennale (1999), where he recreated the Chinese monumental social realist work Rent Collection Courtyard that earned him the Golden Lion Award. By examining the different stages of Cai Guo-Qiang’s artistic path as well as the transnational dimensions of his creations, this paper aims at offering a comprehensive survey on the construction of the discourse of global contemporary art.

Keywords: Cai Guo-Qiang, Chinese artists overseas, emergence global art, transnational art

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Authors: Jeh Patel, Chandrahas Paidi, Ahmed Hambaba

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Traditional methods for analyzing athlete movement often lack the detail and immediacy required for optimal training. This project aims to address this limitation by developing a Real-time human pose estimation system specifically designed to enhance athlete training across various sports. This system leverages the power of convolutional neural networks (CNNs) to provide a comprehensive and immediate analysis of an athlete’s movement patterns during training sessions. The core architecture utilizes dilated convolutions to capture crucial long-range dependencies within video frames. Combining this with the robust encoder-decoder architecture to further refine pose estimation accuracy. This capability is essential for precise joint localization across the diverse range of athletic poses encountered in different sports. Furthermore, by quantifying movement efficiency, power output, and range of motion, the system provides data-driven insights that can be used to optimize training programs. Pose estimation data analysis can also be used to develop personalized training plans that target specific weaknesses identified in an athlete’s movement patterns. To overcome the limitations posed by outdoor environments, the project employs strategies such as multi-camera configurations or depth sensing techniques. These approaches can enhance pose estimation accuracy in challenging lighting and occlusion scenarios, where pose estimation accuracy in challenging lighting and occlusion scenarios. A dataset is collected From the labs of Martin Luther King at San Jose State University. The system is evaluated through a series of tests that measure its efficiency and accuracy in real-world scenarios. Results indicate a high level of precision in recognizing different poses, substantiating the potential of this technology in practical applications. Challenges such as enhancing the system’s ability to operate in varied environmental conditions and further expanding the dataset for training were identified and discussed. Future work will refine the model’s adaptability and incorporate haptic feedback to enhance the interactivity and richness of the user experience. This project demonstrates the feasibility of an advanced pose detection model and lays the groundwork for future innovations in assistive enhancement technologies.

Keywords: computer vision, deep learning, human pose estimation, U-NET, CNN

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Authors: Maria Vargas Hernandez, Jose Rojas Suarez, Carmelo Dueñas Castell, Sandra Contreras, Camilo Bello, Diana Borre, Walter Anichiarico, Harold Vasquez, Eduard Perez, Jose Santacruz

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In the last two decades, there have been outbreaks of emerging infectious diseases, with an impact on both the general population and the obstetric population. These infections, which affect the general population, pose a high risk for adverse maternal and perinatal outcomes, taking into account that physiological and immunological changes that occur during pregnancy can increase their risk or severity. Among these, the pandemics of viral infections, Influenza A/H1N1 and SARS-CoV-2/COVID-19, stand out. In 2009, Influenza A/H1N1 infection (H1N1 2009pdm) affected approximately 3,110 obstetric patients, with data reported from 29 countries, including 1,625 (52.3%) cases that were hospitalized, 378 (23.3%) admissions to ICU and 130 (8%) deaths; and since the end of 2019, the Severe Acute Respiratory Syndrome - 2 (SARS-CoV-2) has been identified, causing the COVID-19 pandemic, with global mortality that is around 2-4% for the general population, and higher mortality in patients requiring admission to the intensive care unit. Its impact on the obstetric population is still unknown. Objectives: To evaluate the impact on maternal and perinatal outcomes of COVID-19 infection in reference to influenza A/H1N1 infection in the obstetric population. Methodology: Systematic review of the literature and meta-analysis. Results: Mortality from maternal infection with influenza A/H1N1 appears to be higher (8%) than mortality due to maternal infection with COVID-19 (3%). The rates of ICU admission, hospitalization, the requirement for invasive mechanical ventilation, and fetal death also appear to be higher in the maternal population with A/H1N1 infection, in reference to the maternal population with COVID-19 infection. Within perinatal outcomes, the admission to the neonatal ICU appears to be higher in the infants born to mothers with COVID-19 infection (28% vs. 15% for COVID-19 and A/H1N1, respectively). Conclusion: A/H1N1 infection in the obstetric population seems to be associated with a higher proportion of adverse outcomes in relation to COVID-19 infection. The actual impact of maternal influenza A/H1N1 infection on perinatal outcomes is unknown. More COVID-19 studies are needed to understand the impact of maternal infection on perinatal outcomes in this population.

Keywords: A/H1N1, COVID-19, maternal outcomes, perinatal outcomes

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Authors: Fatemeh Abdollahi, Munn-Sann Lye, Jamshid Yazdani Charati, Mehran Zarghami

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Fathers are at risk of depression during the postpartum period. Some studies have been reported maternal depression is the key predictor of paternal postpartum depression (PPD). This study aimed to estimate the prevalence and predictors of parental PPD and its association with maternal PPD. In a cross-sectional study, via a stratified random and convenience sampling method, participants referring to health centers during 2-8 weeks postpartum were recruited from March to October 2017. Paternal PPD and its relation to maternal PPD and other related factors were assessed using multiple logistic regression. Participants were 591 literate couples who referred to Mazandaran province primary health centers during to study period. Couples were screened for depression using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ) as well. Data on mothers ‘demographic characteristics and obstetrics factors was also gathered. Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age [OR=1.20, (95%CI: 1.05- 1.36)], maternal depressive symptoms [OR=1.15, (95%CI: 1.04-1.27)], higher GHQ scores [OR=1.21, (95%CI: 1.11-1.33)] and increased recent life events [OR=1.42, (95%CI: 1.01-1.2.00)] were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD [OR=0.20, (95%CI: 0.07-0.53)]. Depressive symptoms, especially in first-time fathers following the birth of a child, are not uncommon. Maternal depressive symptoms and paternal well-being were strong predictors of parental PPD. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease the suffering of depression for both depressed parents are recommended.

Keywords: depression, men, postpartum, risk factors, women

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Authors: Shubham Gogri, Lucia Florescu

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Medical diagnosis and radiotherapy treatment planning using Computed Tomography (CT) rely on the quantitative accuracy and quality of the CT images. At the same time, requirements for CT imaging include reducing the radiation dose exposure to patients and minimizing scanning time. A solution to this is the sparse-view CT technique, based on a reduced number of projection views. This, however, introduces a new problem— the incomplete projection data results in lower quality of the reconstructed images. To tackle this issue, deep learning methods have been applied to enhance the quality of the sparse-view CT images. A first approach involved employing Mir-Net, a dedicated deep neural network designed for image enhancement. This showed promise, utilizing an intricate architecture comprising encoder and decoder networks, along with the incorporation of the Charbonnier Loss. However, this approach was computationally demanding. Subsequently, a specialized Generative Adversarial Network (GAN) architecture, rooted in the Pix2Pix framework, was implemented. This GAN framework involves a U-Net-based Generator and a Discriminator based on Convolutional Neural Networks. To bolster the GAN's performance, both Charbonnier and Wasserstein loss functions were introduced, collectively focusing on capturing minute details while ensuring training stability. The integration of the perceptual loss, calculated based on feature vectors extracted from the VGG16 network pretrained on the ImageNet dataset, further enhanced the network's ability to synthesize relevant images. A series of comprehensive experiments with clinical CT data were conducted, exploring various GAN loss functions, including Wasserstein, Charbonnier, and perceptual loss. The outcomes demonstrated significant image quality improvements, confirmed through pertinent metrics such as Peak Signal-to-Noise Ratio (PSNR) and Structural Similarity Index (SSIM) between the corrected images and the ground truth. Furthermore, learning curves and qualitative comparisons added evidence of the enhanced image quality and the network's increased stability, while preserving pixel value intensity. The experiments underscored the potential of deep learning frameworks in enhancing the visual interpretation of CT scans, achieving outcomes with SSIM values close to one and PSNR values reaching up to 76.

Keywords: generative adversarial networks, sparse view computed tomography, CT image correction, Mir-Net

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Authors: Jiyoung Kim, Chae Weon Chung

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Labor pain is one of the most common concerns of pregnant women, thus women are in need of possible options they could take to control the pain. So, this study aimed to explore maternal perception of epidural anesthesia and to compare the childbirth outcomes according to the use of epidural anesthesia. For this descriptive study, women who were over 36 weeks of pregnancy were recruited from an out-patient obstetric clinic in a public hospital in Seoul. Women were included in the study if agreed to participate, were pregnant singleton, without pregnancy complication, and expecting a natural birth. Data collection was done twice, the first one at the prenatal care visit and the second one at an in-patient ward on 2nd day postpartum. The instrument of the beliefs about epidural anesthesia, one item of asking intention to use epidural anesthesia, demographics, and obstetrical characteristics were incorporated into a questionnaire. One nurse researcher performed data collection with the structured questionnaire after the approval of the institutional review board. At the initial data collection 133 women were included, while 117 were retained at the second point after excluded 13 women due to the occurrence of complications. Analyses were done by chi-square, t-test, and ANOVA using the SPSS program. Women were aged 32.5 years old, 22.2% were over 35 years old. The average gestational age was 38.5 weeks, and 67.5% were nulliparous. Out of 38 multiparous women, 20 women (52.6%) had received epidural anesthesia in the previous delivery. At the initial interview, 62.6% (n=73) of women wanted to receive epidural anesthesia while 22.4% answered not decided and 15.4% did not want to take the procedure. However, there were changes in proportions between women’s intention to take it and actual procedures done, particularly, two-thirds of women (n=26) who had been undecided were found to receive epidural anesthesia during labor. There was a significant difference in the perception of epidural anesthesia measured before delivery between women who received and not received it (t=3.68, p < .001). Delivery outcomes were statistically different between the two groups in delivery mode (chi-square=8.64, p=.01), O₂ supply during labor (chi-square =5.01, p=.03), duration of 2nd stage of labor (t=3.70, p < .001), and arterial cord blood pH (t=2.64, p=.01). Interestingly, there was no difference in labor pain perceived between women with and without epidural anesthesia. Considering the preference and use of epidural anesthesia, health professionals need to assess coping ability of women undergoing delivery and to provide accurate information about pain control to support their decision making and eventually to enhance delivery outcomes for mothers and neonates.

Keywords: epidural anesthesia, delivery outcomes, labor pain, perception

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Authors: Andy S.K. Cheng, Samuel Leung, Cindy Kwok, Hector Tsang

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Background: Telephone counselling is one of the essential interventions that can be found in most of the Employee Assistance Programs (EAP). The purposes of this study were to (1) explore the trend of the telephone counselling from 2003-2016 in Hong Kong; (2) explore which EAP issue requires more follow-up; and 3) examine the relationship between the EAP issues and demographic data such as gender and job ranking. Method: Date of EAP services usage was collected from EAP providers in Hong Kong during 2003-2016. EAP issues were categorized into two domains, namely workplace issues and personal issues. Each domain has 12 sub-categories. Two hypotheses were formulated in this study (1) there was a gender difference in EAP issues and the follow-up hours; and (2) there was a significant difference between job ranking, EAP issues and follow-up hours. Results: A total of eight hundred and ninety-three valid cases were identified for analysis. Of them, three hundred and forty-three cases sought for follow-up. The duration of follow-up by hours was calculated for each of the follow-up cases. The results of the study shows that the top three workplace issues that required the longest duration of follow-up were (1) workload, (2) supervisor-subordinate relationship; and (3) team member’s relationship. On the other hand, the top three personal issues that required the longest duration of follow-up were (1) parenting/parent-child relationship, (2) family care, and (3) marital relationship. Two-way ANOVA was performed to compare the total follow-up hours (excluding first intake) between gender and EAP issues. There was no statistical significance for gender (p =.891), but a statistically significant main effect for EAP issues (p <.001) was found. Post-hoc analysis (Tukey’s test) showed that total follow-up hour in personal issues was statistically significant higher than that in handling workplace issues (p <.001). However, there was no statistically significant interaction effect between gender and EAP issues (p=.879) and between job ranking and EAP issues (p=.843). Conclusion: Telephone counselling is a very common intervention in addressing EAP issues arising from workplace and personal level in Hong Kong. It was frequently used to handle interpersonal relationships and the service usage was independent of gender and job ranking.

Keywords: employee assistance program, follow-up time, interpersonal relationships, telephone counselling

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Authors: Semaw A., Awet H., Yohannes M.

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Background: Hepatitis B Virus (HBV) is a major global public health problem. Individuals living in Sub-Sahara Africa have 60% lifetime risk of acquiring HBV infection. Evidences showed that 80-90% of those born from infected mothers developed chronic HBV. Perinatal HBV transmission is a major determinant of HBV carrier status, its chronic squeal and maintains HBV transmission across generations. Method: Institution based cross-sectional study was conducted among 406 pregnant mothers attending Antenatal clinics at Mekelle and Ayder referral hospital from January 30 to April 1/2014. Epidata version 3.1 was used for data entry and SPSS version 21 statistical software was used for data cleaning, management and finally determine associated factors of hepatitis B surface antigen adjusting important confounders using multivariable logistic regression analysis at 5% level of significance. Result: The overall prevalence of hepatitis B surface antigen among pregnant women was 33 (8.1%). The socio-demographic characteristic of the study population showed that there is high positivity among secondary school 189 (46.6%). In the multivariable logistic regression analysis, history of a contact with individuals who had history of hepatitis B infection or jaundice and lifetime number of multiple sexual partners were found to be significantly associated with HBsAg positivity at AOR = 3.73 95%C.I (1.373-10.182) and AOR = 2.57 95%C.I (1.173-5.654), respectively. Moreover, Human Immunodeficiency Virus (HIV) and HBV confection rate was found 3.6%. Conclusion: This study has shown that HBV prevalence in pregnant women is highly prevalent (8.1%) in the study area. Contact with individuals who had a history of hepatitis or have jaundice and report of multiple lifetime sexual partnership were associated with hepatitis B infection. Education about HBV transmission and prevention as well as screening all pregnant mothers shall be sought to reduce the serious public health crisis of HBV.

Keywords: HBsAg, hepatitis B, pregnant women, prevalence

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Authors: Nyimas Annissa Mutiara Andini

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There are 325,000 children younger than age 15 in the U.S. have epilepsy. In Indonesia, 40% of 3,5 millions cases of epilepsy happens in children. The most common type of epilepsy, which affects 6 out of 10 people with the disorder, is called idiopathic epilepsy and which has no identifiable cause. One of the most commonly used medications in the treatment of this childhood epilepsy is sodium valproate. Administration of sodium valproat in children has a problem to fail. Nearly 60% of pediatric patients known were mildly, moderately, or severely non-adherent with therapy during the first six months of treatment. Many parents or caregiver took far less medication than prescribed, and the treatment-adherence pattern for the majority of patients was established during the first month of treatment. 42% of the patients were almost always given their medications as prescribed but 13% had very poor adherence even in the early weeks and months of treatment. About 7% of patients initially gave the medication correctly 90% of the time, but adherence dropped to around 20% within six months of starting treatment. Over the six months of observation, the total missing of administration is about four out of 14 doses in any given week. This fail can cause the epilepsy to relapse. Whereas, current reported epilepsy disorder were significantly more likely than those never diagnosed to experience depression (8% vs 2%), anxiety (17% vs 3%), attention-deficit/hyperactivity disorder (23% vs 6%), developmental delay (51% vs 3%), autism/autism spectrum disorder (16% vs 1%), and headaches (14% vs 5%) (all P< 0.05). They had a greater risk of limitation in the ability to do things (relative risk: 9.22; 95% CI: 7.56–11.24), repeating a school grade (relative risk: 2.59; CI: 1.52–4.40), and potentially having unmet medical and mental health needs. In the other side, technology can help to make our life easier. One of the technology, that we can use is a mobile application. A mobile app is a software program we can download and access directly using our phone. Indonesians are highly mobile centric. They use, on average, 6.7 applications over a 30 day period. This paper is aimed to describe an application that could help to control a sodium valproat administration in children; we call it as D-Epi app. D-Epi app is a downloadable application that can help parents or caregiver alert by a timer-related application to warn whether it is the time to administer the sodium valproat. It works not only as a standard alarm, but also inform important information about the drug and emergency stuffs to do to children with epilepsy. This application could help parents and caregiver to take care a child with epilepsy in Indonesia.

Keywords: application, children, D-Epi, epilepsy

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