Search results for: international medical corps (IMC)

Authors: Lynda Golea, Rachid Chebaki

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Schiff bases contain heterocyclic structural units with N and O donor atoms which plays an important role in coordination chemistry. Azomethine groups are a broad class of widely used compounds with applications in many fields, including analytical, inorganic chemistry and biological. Schiff's base is of promising research interest due to the widespread antibacterial resistance in medical science. In addition, the research is essential to generate Schiff base metal complexes with various applications. Schiff complexes have been used as drugs and have antibacterial, antifungal, antiviral, and anti-inflammatory properties. The various donor atoms they contain offer a special ability for metal binding. In this research on the physicochemical properties of azomethine groups, we synthesized and studied the Schiff base compounds by a condensation reaction of tryptamines and acetophenone in ethanol. The structure of the prepared compound was interpreted using 1H NMR, 13C NMR, UV-vis and FT-IR. A computational analysis at the level of DFT with functional B3LYP in conjunction with the base 6-311+G (d, p) was conducted to study its electronic and molecular structure. The biological study was performed on three bacterial strains usually causing infection, including Gram-positive and Gram-negative, for antibacterial activity. Results showed moderate biological activity and proportional activity with increasing concentration.

Keywords: azomethine, HOMO, LUMO, RMN, molecular docking

Procedia PDF Downloads 66

Authors: R. Domínguez, A. Castro, N. Fernandez, F. Hidalgo, F. Ortiz

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Aims: Study musculoskeletal disorders produced by excess physical exertion in marines Introduction: Musculoskeletal injuries during military training are an important medical problem faced by military organizations throughout the world. Military occupations are physically demanding, which represents a high risk of injury "and subsequent disability, these injuries represent important risk factors for hospitalization, disability, and discharge Methodology: This is a causal correlational study in which data were collected in order to find a cause-effect relationship between the physical effort in marines during their career in the Chilean Navy and the musculoskeletal disorders that occur in some from them. Results:100% had experienced musculoskeletal pain in some part of the body and 73.52% of the respondents had experienced limitations in the ability to work, as a consequence forced to change jobs due to musculoskeletal pain. The neck, shoulders and the lumbar dorsal region were the regions with the highest prevalence of pain, as well as pain that limit the ability to work. Conclusion: Musculoskeletal injuries and illnesses related to injuries are common in marines, both in those who operate in campus Charles, as in another operational unit due to the nature of the work. Many of these injuries occur during physical training and sports and various studies have dealt with the descriptive epidemiology of musculoskeletal injuries in military personnel.

Keywords: physical effort, marines, musculoskeletal disorders produced (MSD), training

Procedia PDF Downloads 178

Authors: Papazafeiropoulou Olga

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The purpose of this paper focuses on exploring the emergence of Greek tragedy on the American stage until the first half of the 20th century through the intellectual processes and contributions of Greek, Italian and Jewish community theatre. Drawing on a wide range of sources, we trace Greek tragedy on the American stage, exploring the intricate processes of community’s theatre identities. The announcement aims to analyze the distinct yet related efforts of first Americans to intersect with Greek tragedy, searching simultaneously for the identities of immigrants. Ultimately, ancient drama became a vehicle not only for great developments in the American theater. In 1903, the Greek actor Dionysios Taboularis arrived in America, while the immigrant stream from Greece to America brought his artistic heritage, presenting in “Hall House” of Chicago the play Return. In 1906, in New York, an amateur group presented the play The Alosi of Messolonghi, and the next year in Chicago, an attempt was noted with a dramatic romance. In the decade 1907-1917, Nikolaos Matsoukas founded and directed the “Arbe theater”, while Petros Kotopoulis formed a troupe. In 1930, one of the greatest Greek theatrical events was the arrival of Marika’s Kotopoulis. Also, members of Vrysoula’s Pantopoulos formed the “Athenian Operetta”, with a positive influence on Greek American theatre. Italian immigrant community, located in tenement “Little Italies” throughout the city, and soon amateur theatrical clubs evolved. The earliest was the “Circolo Filodrammatico Italo-Americano” in 1880. Fausto Malzone’s artistic direction paved the way for the professional Italian immigrant theatre. Immigrant audiences heard the plays of their homeland, representing a major transition for this ethnic theatre. In 1900, the community had produced the major forces that created the professional theatre. By l905, the Italian American theatre had become firmly rooted in its professional phase. Yiddish Theater was both an import and a home-grown phenomenon. In 1878, The Sorceress was brought to America by Boris Thomashefsky. Between 1890 and 1940, many Yiddish theater companies appeared in America, presenting adaptations of classical plays. Αmerica’s people's first encounter with ancient texts was mostly academic. The tracing of tragedy as a form and concept that follows the evolutionary course of domestic social, aesthetic, and political ferments according to the international trends and currents draws conclusions about the early Greek, Italian, and Jewish immigrant’s theatre in relationship to the American scene until the first half of 20th century. Presumably, community theater acquired identity by intersecting with the spiritual reception of tragedy in America.

Keywords: American, community, Greek, Italian, identities, intersection, Jewish, theatre, tragedy

Procedia PDF Downloads 78

Authors: Mojtaba Eshraghi Arani

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Concluding the contract for carriage of cargo with the shipper (through bill of lading or charterparty), the carrier must transport the cargo from loading port to the port of discharge and deliver it to the consignee. Unless otherwise agreed in the contract, the carrier must avoid from any deviation, transfer of cargo to another vessel or unreasonable stoppage of carriage in-transit. However, the vessel might break down in-transit for any reason and becomes unable to continue its voyage to the port of discharge. This is a frequent incident in the carriage of goods by sea which leads to important dispute between the carrier/owner and the shipper/charterer (hereinafter called “cargo interests”). It is a generally accepted rule that in such event, the carrier/owner must repair the vessel after which it will continue its voyage to the destination port. The dispute will arise in the case that temporary repair of the vessel cannot be done in the short or reasonable term. There are two options for the contract parties in such a case: First, the carrier/owner is entitled to repair the vessel while having the cargo onboard or discharged in the port of refugee, and the cargo interests must wait till the breakdown is rectified at any time, whenever. Second, the carrier/owner will be responsible to charter another vessel and transfer the entirety of cargo to the substitute vessel. In fact, the main question revolves around the duty of carrier/owner to perform transfer of cargo to another vessel. Such operation which is called “trans-shipment” or “transhipment” (in terms of the oil industry it is usually called “ship-to-ship” or “STS”) needs to be done carefully and with due diligence. In fact, the transshipment operation for various cargoes might be different as each cargo requires its own suitable equipment for transfer to another vessel, so this operation is often costly. Moreover, there is a considerable risk of collision between two vessels in particular in bulk carriers. Bulk cargo is also exposed to the shortage and partial loss in the process of transshipment especially during bad weather. Concerning tankers which carry oil and petrochemical products, transshipment, is most probably followed by sea pollution. On the grounds of the above consequences, the owners are afraid of being held responsible for such operation and are reluctant to perform in the relevant disputes. The main argument raised by them is that no regulation has recognized such duty upon their shoulders so any such operation must be done under the auspices of the cargo interests and all costs must be reimbursed by themselves. Unfortunately, not only the international conventions including Hague rules, Hague-Visby Rules, Hamburg rules and Rotterdam rules but also most domestic laws are silent in this regard. The doctrine has yet to analyse the issue and no legal researches was found out in this regard. A qualitative method with the concept of interpretation of data collection has been used in this paper. The source of the data is the analysis of regulations and cases. It is argued in this article that the paramount rule in the maritime law is “the accomplishment of the voyage” by the carrier/owner in view of which, if the voyage can only be finished by transshipment, then the carrier/owner will be responsible to carry out this operation. The duty of carrier/owner to apply “due diligence” will strengthen this reasoning. Any and all costs and expenses will also be on the account pf the owner/carrier, unless the incident is attributable to any cause arising from the cargo interests’ negligence.

Keywords: cargo, STS, transshipment, vessel, voyage

Procedia PDF Downloads 125

Authors: Wasmi Woishi

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Smart card technology is a secure and safe technology that is expanding its capabilities day by day in terms of holding important information without alteration. It is readily available, and its ease of portability makes it more efficient in terms of its usage. The smart card is in use by many industries such as financial, insurance, governmental industries, personal identification, to name a few. Smart card technology is popular for its wide familiarity, adaptability, accessibility, benefits, and portability. This research aims to find out the perception toward the application of a cloud-based healthcare system through a smart card in KSA. The research has compiled the countries using a smart card or smart healthcare card and indicated the potential benefits of implementing smart healthcare cards. 120 participants from Riyadh city were surveyed by the means of a closed-ended questionnaire. Data were analyzed through SPSS. This research extends the research body in the healthcare system. Empirical evidence regarding smart healthcare cards is scarce and hence undertaken in this study. The study provides a useful insight into collecting, storing, analyzing, manipulating, and accessibility of medical information regarding smart healthcare cards. Research findings can help achieve KSA's Vision 2030 goals in terms of the digitalization of healthcare systems in improving its efficiency and effectiveness in storing and accessing healthcare data.

Keywords: smart card technology, healthcare using smart cards, smart healthcare cards, KSA healthcare information system, cloud-based healthcare cards

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Authors: Natasha Mandal, Rakesh Singh Moirangthem

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The present work reports a theoretical model to develop a plasmonic biosensor for the detection of glucose concentrations in human blood and urine as the abnormality of glucose label is the major cause of diabetes which becomes a life-threatening disease worldwide. This study is based on the surface plasmon resonance (SPR) sensor applications which is a well-established, highly sensitive, label-free, rapid optical sensing tool. Here we have introduced a sandwich assay of two dielectric spacer layers of MgF2 and BaTiO3which gives better performance compared to commonly used SiO2 and TiO2 dielectric spacers due to their low dielectric loss and higher refractive index. The sensitivity of our proposed sensor was found as 3242 nm/RIU approximately, with an excellent linear response of 0.958, which is higher than the conventional single-layer Au SPR sensor. Further, the sensitivity enhancement is also optimized by coating a few layers of two-dimensional (2D) nanomaterials (e.g., Graphene, h-BN, MXene, MoS2, WS2, etc.) on the sensor chip. Hence, our proposed SPR sensor has the potential for the detection of glucose concentration in blood and urine with enhanced sensitivity and high affinity and could be utilized as a reliable platform for the optical biosensing application in the field of medical diagnosis.

Keywords: biosensor, surface plasmon resonance, dielectric spacer, 2D nanomaterials

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Authors: Seyed Aliasghar Mosavi, Mostafa Naderi, Khosrow Jadidi, Amir Hashem Mohammadi

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To study the measurement of intraocular pressure (IOP) before and after implantation of intrastromal corneal ring (MyoRing) in patients with keratoconus. Setting: Baqiyatallah University of Medical Sciences, Tehran, Iran. Methods: We compared the IOP of 13 eyes which underwent MyoRing implantation prior and six months post operation using Goldman applanation (as gold standard), Icare, and Corvis ST (uncorrected, corrected and corrected with cornea biomechanics). Results: The resulting intraocular pressure measurements prior to surgery, Icare, Corvis (corrected with cornea biomechanics) overestimated the IOP, however measurements by Corvis uncorrected underestimate the IOP. The resulting intraocular pressure measurements after surgery, Icare, Corvis (corrected with cornea biomechanics) overestimated the IOP but measurements by Corvis uncorrected underestimate the IOP. Conclusion: Consistent intraocular pressure measurements on eyes with Myoring in keratoconus can be obtained with the Goldman applanation tonometer as the gold standard measurement. We were not able to obtain consistent results when we measured the IOP by Icare and Corvis prior and after surgery.

Keywords: intraocular pressure, MyoRing, Keratoconus, Goldmann applanation, Icare, Corvis ST

Procedia PDF Downloads 249

Authors: Ravisinh Solanki, Ravi Patel, Chhaganbhai Patel

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Purpose: The purpose of this study is to develop a methodology for the risk assessment and evaluation of nitrosamine impurities in Glipizide antidiabetic formulations. Nitroso compounds, including nitrosamines, have emerged as significant concerns in drug products, as highlighted by the ICH M7 guidelines. This study aims to identify known and potential sources of nitrosamine impurities that may contaminate Glipizide formulations and assess their presence. By determining observed or predicted levels of these impurities and comparing them with regulatory guidance, this research will contribute to ensuring the safety and quality of combination antidiabetic drug products on the market. Factors contributing to the presence of genotoxic nitrosamine contaminants in glipizide medications, such as secondary and tertiary amines, and nitroso group-complex forming molecules, will be investigated. Additionally, conditions necessary for nitrosamine formation, including the presence of nitrosating agents, and acidic environments, will be examined to enhance understanding and mitigation strategies. Method: The methodology for the study involves the implementation of the N-Nitroso Acid Precursor (NAP) test, as recommended by the WHO in 1978 and detailed in the 1980 International Agency for Research on Cancer monograph. Individual glass vials containing equivalent to 10mM quantities of Glipizide is prepared. These compounds are dissolved in an acidic environment and supplemented with 40 mM NaNO2. The resulting solutions are maintained at a temperature of 37°C for a duration of 4 hours. For the analysis of the samples, an HPLC method is employed for fit-for-purpose separation. LC resolution is achieved using a step gradient on an Agilent Eclipse Plus C18 column (4.6 X 100 mm, 3.5µ). Mobile phases A and B consist of 0.1% v/v formic acid in water and acetonitrile, respectively, following a gradient mode program. The flow rate is set at 0.6 mL/min, and the column compartment temperature is maintained at 35°C. Detection is performed using a PDA detector within the wavelength range of 190-400 nm. To determine the exact mass of formed nitrosamine drug substance related impurities (NDSRIs), the HPLC method is transferred to LC-TQ-MS/MS with the same mobile phase composition and gradient program. The injection volume is set at 5 µL, and MS analysis is conducted in Electrospray Ionization (ESI) mode within the mass range of 100−1000 Daltons. Results: The samples of NAP test were prepared according to the protocol. The samples were analyzed using HPLC and LC-TQ-MS/MS identify possible NDSRIs generated in different formulations of glipizide. It was found that the NAP test generated a various NDSRIs. The new finding, which has not been reported yet, discovered contamination of Glipizide. These NDSRIs are categorised based on the predicted carcinogenic potency and recommended its acceptable intact in medicines. The analytical method was found specific and reproducible.

Keywords: NDSRI, nitrosamine impurities, antidiabetic, glipizide, LC-MS/MS

Procedia PDF Downloads 41

Authors: Oswaldo Otero, Eduardo A. Orozco, Ana M. Herrera

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In this work, we present results from analytical and numerical studies of the electron acceleration by a TE₀₁₁ cylindrical microwave mode in a static homogeneous magnetic field under electron cyclotron resonance (ECR) condition. The stability of the orbits is analyzed using the particle orbit theory. In order to get a better understanding of the interaction wave-particle, we decompose the azimuthally electric field component as the superposition of right and left-hand circular polarization standing waves. The trajectory, energy and phase-shift of the electron are found through a numerical solution of the relativistic Newton-Lorentz equation in a finite difference method by the Boris method. It is shown that an electron longitudinally injected with an energy of 7 keV in a radial position r=Rc/2, being Rc the cavity radius, is accelerated up to energy of 90 keV by an electric field strength of 14 kV/cm and frequency of 2.45 GHz. This energy can be used to produce X-ray for medical imaging. These results can be used as a starting point for study the acceleration of electrons in a magnetic field changing slowly in time (GYRAC), which has some important applications as the electron cyclotron resonance ion proton accelerator (ECR-IPAC) for cancer therapy and to control plasma bunches with relativistic electrons.

Keywords: Boris method, electron cyclotron resonance, finite difference method, particle orbit theory, X-ray

Procedia PDF Downloads 161

Authors: M. Khaledi Pour, P. Akbartehrani, M. Amini, M. Khani, M. Mohajeri Tehrani, R. Radi, B. Shokri

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Diabetic Foot Ulcer (DFU) is one of the costly severe complications of diabetes. Neuropathy and Peripheral Arterial Disease (PAD) due to diabetes are significant causes of this complication. In 10 years the patients with DFUs are twice as likely to die as patients without DFUs. Cold Atmospheric Plasma (CAP) is a promising tool for medical purposes. CAP generate reactive species at room temperature and are effective in killing bacteria and fibroblast proliferation. These CAP-based tools produce NO, which has bactericidal and angiogenesis properties. It also showed promising effects in the DFUs surface reduction and the time to wound closure. In this paper, we evaluated the effect of the Argon Plasma Jet (APJ) on the healing process of the Wagner Grade 2 DFUs in a randomized clinical trial. The 20 kHz sinusoidal voltage frequency derives the APJ. Patients (n=20) were randomly double-blinded assigned into two groups. These groups receive the standard care (SC, n=10) and the standard care with APJ treatment (SC+APJ, n=10) for five sessions in four weeks. The results showed that the APJ treatment along standard care could reduce the wound surface by 20 percent more than the standard care. Also, It showed a more influential role in controlling wound infection.

Keywords: argon plasma jet, cold atmospheric plasma, diabetes, diabetic foot ulcer

Procedia PDF Downloads 205

Authors: Stephanie A. Schauder, Gosia Sylwestrzak

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Overweight and obese women report avoiding preventive care due to fear of weight-related bias from medical professionals. Gynecological exams, due to their sensitive and personally invasive nature, are especially susceptible to avoidance. This research investigates the association between body mass index (BMI) and screening rates for breast and cervical cancer using claims data from 1.3 million members of a large health insurance company. Because obesity is associated with increased cancer risk, screenings for these cancers should increase as BMI increases. However, this paper finds that the distribution of cancer screening rates by BMI take an inverted U-shape with underweight and obese members having the lowest screening rates. For cervical cancer screening, those in the target population with a BMI of 23 have the highest screening rate at 68%, while Obese Class III members have a screening rate of 50%. Those in the underweight category have a screening rate of 58%. This relationship persists even after controlling for health and demographic covariates in regression analysis. Interestingly, there is no association between BMI and BRCA (BReast CAncer gene) genetic testing. This is consistent with the narrative that stigma causes avoidance because genetic testing does not involve any assessment of a person’s body. More work must be done to determine how to increase cancer screening rates in those who may feel stigmatized due to their weight.

Keywords: cancer screening, cervical cancer, breast cancer, weight stigma, avoidance of care

Procedia PDF Downloads 206

Authors: Gokcen Ogruk-Maz, Sinan Yildirim

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Introduction: Exchange rate forecasting is pivotal for informed financial decision-making, encompassing risk management, investment strategies, and international trade planning. However, traditional forecasting models often fail to capture the complexity and volatility of currency markets. This study explores the potential of ensemble learning techniques such as Random Forest, Gradient Boosting, and AdaBoost to enhance the accuracy and robustness of exchange rate predictions. Research Objectives The primary objective is to evaluate the performance of ensemble methods in comparison to traditional econometric models such as Uncovered Interest Rate Parity, Purchasing Power Parity, and Monetary Models. By integrating advanced machine learning techniques with fundamental macroeconomic indicators, this research seeks to identify optimal approaches for predicting exchange rate movements across major currency pairs. Methodology: Using historical exchange rate data and economic indicators such as interest rates, inflation, money supply, and GDP, the study develops forecasting models leveraging ensemble techniques. Comparative analysis is performed against traditional models and hybrid approaches incorporating Facebook Prophet, Artificial Neural Networks, and XGBoost. The models are evaluated using statistical metrics like Mean Squared Error, Theil Ratio, and Diebold-Mariano tests across five currency pairs (JPY to USD, AUD to USD, CAD to USD, GBP to USD, and NZD to USD). Preliminary Results: Results indicate that ensemble learning models consistently outperform traditional methods in predictive accuracy. XGBoost shows the strongest performance among the techniques evaluated, achieving significant improvements in forecast precision with consistently low p-values and Theil Ratios. Hybrid models integrating macroeconomic fundamentals into machine learning frameworks further enhance predictive accuracy. Discussion: The findings show the potential of ensemble methods to address the limitations of traditional models by capturing non-linear relationships and complex dynamics in exchange rate movements. While Random Forest and Gradient Boosting are effective, the superior performance of XGBoost suggests that its capacity for handling sparse and irregular data offers a distinct advantage in financial forecasting. Conclusion and Implications: This research demonstrates that ensemble learning techniques, particularly when combined with traditional macroeconomic fundamentals, provide a robust framework for improving exchange rate forecasting. The study offers actionable insights for financial practitioners and policymakers, emphasizing the value of integrating machine learning approaches into predictive modeling for monetary economics.

Keywords: exchange rate forecasting, ensemble learning, financial modeling, machine learning, monetary economics, XGBoost

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Authors: Rosa Amalia Safitri, Ine van der Fels-Klerx, Henk Hogeveen

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Halal is a dietary law observed by people following Islamic faith. It is considered as a type of credence food quality which cannot be easily assured by consumers even upon and after consumption. Therefore, Halal certification takes place as a practical tool for the consumers to make an informed choice particularly in a non-Muslim majority country, including the Netherlands. Discrete choice experiment (DCE) was employed in this study for its ability to assess the importance of attributes attached to Halal beef in the Dutch market and to investigate consumer utilities. Furthermore, willingness to pay (WTP) for the desired Halal certification was estimated. Four most relevant attributes were selected, i.e., the slaughter method, traceability information, place of purchase, and Halal certification. Price was incorporated as an attribute to allow estimation of willingness to pay for Halal certification. There were 242 Muslim respondents who regularly consumed Halal beef completed the survey, from Dutch (53%) and non-Dutch consumers living in the Netherlands (47%). The vast majority of the respondents (95%) were within the age of 18-45 years old, with the largest group being student (43%) followed by employee (30%) and housewife (12%). Majority of the respondents (76%) had disposable monthly income less than € 2,500, while the rest earned more than € 2,500. The respondents assessed themselves of having good knowledge of the studied attributes, except for traceability information with 62% of the respondents considered themselves not knowledgeable. The findings indicated that slaughter method was valued as the most important attribute, followed by Halal certificate, place of purchase, price, and traceability information. This order of importance varied across sociodemographic variables, except for the slaughter method. Both Dutch and non-Dutch subgroups valued Halal certification as the third most important attributes. However, non-Dutch respondents valued it with higher importance (0,20) than their Dutch counterparts (0,16). For non-Dutch, the price was more important than Halal certification. The ideal product preferred by the consumers indicated the product serving the highest utilities for consumers, and characterized by beef obtained without pre-slaughtering stunning, with traceability info, available at Halal store, certified by an official certifier, and sold at 2.75 € per 500 gr. In general, an official Halal certifier was mostly preferred. However, consumers were not willing to pay for premium for any type of Halal certifiers, indicated by negative WTP of -0.73 €, -0.93 €, and -1,03€ for small, official, and international certifiers, respectively. This finding indicated that consumers tend to lose their utility when confronted with price. WTP estimates differ across socio-demographic variables with male and non-Dutch respondents had the lowest WTP. The unfamiliarity to traceability information might cause respondents to perceive it as the least important attribute. In the context of Halal certified meat, adding traceability information into meat packaging can serve two functions, first consumers can justify for themselves whether the processes comply with Halal requirements, for example, the use of pre-slaughtering stunning, and secondly to assure its safety. Therefore, integrating traceability info into meat packaging can help to make informed decision for both Halal status and food safety.

Keywords: consumer utilities, discrete choice experiments, Halal certification, willingness to pay

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Authors: Papali Maqalika

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Lesotho farmers produce significant quantities of Merino wool of a quality competitive on the global market and make a substantial impact on the economy of Lesotho. However, even with the economic contribution, the production and quality information and trends of this fibre has been recognised nor documented. This is a sombre shortcoming as Lesotho wool is unknown on international markets. The situation is worsened by the fact that Lesotho wool is auction together with South African wool, trading and benchmarking Lesotho wool are difficult not to mention attempts to advance its production and quality. Based on the information above, available data on Lesotho wool for 10 years were collected and analysed for trends to used in benchmarking where applicable. The fibre properties analysed include fibre diameter (fineness), vegetable matter and yield, application and price. These were selected because they are fundamental in determining fibre quality and price. Production of wool in Lesotho has increased slightly over the ten years covered by this study. It also became apparent that production and quality trends of Lesotho wool are greatly influenced by the farming practices, breed of sheep and climatic conditions. Greater adoption of the merino sheep breed, sheds/barns and sheep coats are suggested as ways to reduce mortality rate (due to extremely cold temperatures), to reduce the vegetable matter on the fibre thus improving the quality and increase yield per sheep and production as a whole. Some farming practices such as the lack of barns, supplementary feeding and veterinary care present constraints in wool production. The districts in the Highlands region were found to have the highest production of mostly wool, this being ascribed to better pastures, climatic, social and other conditions conducive to wool production. The production of Lesotho wool and its quality can be improved further, possibly because of the interventions the Ministry of Agriculture introduced through the Small Agricultural and Development Project (SADP) and other appropriate initiatives by the National Wool and Mohair Growers Association (NWMGA). The challenge however, remains the lack of direct involvement of the wool growers (farmers) in decisions making and policy development, this potentially influences and may lead to the reluctance to adopt the strategies. In some cases, the wool growers do not receive the benefits associated with the interventions immediately. Based on these discoveries; it is recommended that the relevant educators and researchers in wool and textile science, as well as the local wool farmers in Lesotho, be represented in policy and other decision making forums relating to these interventions. In this way, educational campaigns and training workshops will be demand driven with a better chance of adoption and success. This is because the direct beneficiaries will have been involved at inception and they will have a sense of ownership as well as intent to see them through successfully.

Keywords: lesotho wool, wool quality, wool production, lesotho economy, global market, apparel wool, database, textile science, exports, animal farming practices, intimate apparel, interventions

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Authors: Nutthan Inkhong, Sutthiphong Ruangchante

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Chiang Rai province is located at the northern border of Thailand. Most of the geography there is the northern continental highlands, and the population has many types of inhabitants, including Thai people, immigrants and ethnic groups such as Akha, Lahu, Lisu, Yao, etc. Most of these ethnic groups migrated from neighbouring countries such as Myanmar, Laos, China, etc. and settled in the mountains. Each ethnic group has their unique traditions, culture, and ways of life, including the musical culture that the ancestors of each ethnic group brought with them. In the present, the Akha have the largest population in the region and still live together in numerous villages in many districts. Thus, Akha musical culture still appears in the community traditions and cultural events of Chiang Rai province regularly. This article presents the situations of Akha musical culture in the present and the predictions for the future. The study method involves the analysis of music information and the related social contexts, which were collected from the fieldwork of ethnomusicological methodology by in-depth interviews, observations, audio and visual recordings, and related documents. The results found that the important persons who are related with Akha musical culture include (1) a musical instrument maker (lives in Mae Chan district) who produces various Akha musical instruments, including gourd mouth organs, Akha drums, two-way flutes, three-hole flutes, Jew’s harps (the sound of teenage love), buffalo horns (the sound symbol of hunting) and bird call instruments (the imitation of bird sounds), (2) a folk philosopher (lives in Mae Pha Luang district) who can teach music to the new generation of Akha people as well as lecture and demonstrate music to academics and tourists, and (3) a community leader (lives in Mae Chan district) who conserves Akha performances, singing and music through various activities of the students in an informal school. Because of the changes to the social contexts and ways of life of the Akha people, such as the educational system, religion, social media, etc., including the popularity of both Thai and international popular music among the new generation of Akha people, changes to and the fading away of Akha musical culture in the future may likely occur. Therefore, the conservation and inheritance of Akha music is an issue that should be resolved quickly. This primary study leads to the next step of the ethnomusicological work and plays a part in preventing or reducing the problems impacting Akha musical culture survival by the recording of Akha music in all of its dimensions, such as producing musical instruments, playing musical instruments, analysis of tuning systems, recording Akha music as musical notation using symbols, researching related social contexts, etc. and the transcription of this information to create lessons that can be returned to the Akha community.

Keywords: Akha music, Chiang Rai, ethnic music in Thailand, ethnomusicology

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Authors: Katarina Revocati Mteule

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The background of this research arises from global demands for fair business opportunities. As one of responses to these demands, nations embarked on reforms in commercial laws. In 1990s Tanzania resorted to economic transformation through liberalization to attract more investments included reform in commercial laws enforcement. This research scrutinizes the effectiveness of reforms in Tanzania in comparison with Canada and Singapore and the role of technology. The methodology to be used is doctrinal legal research mixed with international comparative legal research. It involves comparative analysis of library, online, and internet resources as well as Case Laws and Statutory Laws. Tanzania, Canada and Singapore are sampled comparators basing on their distinct level of economic development. The criteria of analysis includes the nature of reforms, type of technology, technological infrastructure and human resource technical competence in each country. As the world progresses towards reforms in commercial laws, improvements in law, policy, and regulatory frameworks are paramount. Specifically, commercial laws are essential in contract enforcement and dispute resolution and how it copes with modern technologies is a concern. Harnessing the best technology is necessary to cope with the modernity in world businesses. In line with this, Tanzania is improving its business environment, including law enforcement mechanisms that are supportive to investments. Reforms such as specialized commercial law enforcement coupled with alternative dispute resolutions such as arbitration, mediation, and reconciliation are emphasized. Court technology as one of the reform tools given high priority. This research evaluates the progress and the effectiveness of the reforms in Commercial Laws towards friendly business environment in Tanzania in comparison with Canada and Singapore. The experience of Tanzania is compared with Canada and Singapore to see what to improve for each country to enhance quick and fair enforcement of commercial law. The research proposes necessary global standards of procedures and in national laws to offer a business-friendly environment and the use of appropriate technology. Solutions are proposed in tackling the challenges of delays in enforcing Commercial Laws such as case management, funding, legal and procedural hindrances, laxity among staff, and abuse of Court process among litigants, all in line with modern technology. It is the finding of the research that proper use of technology has managed to reduce case backlogs and time taken to resolve a commercial dispute, to increase court integrity by minimizing human contacts in commercial law enforcement which may lead to solicitation of favors and saving of parties’ time due to online service. Among the three countries, each one is facing a distinct challenge due to the level of poverty and remoteness from online service. How solutions are found in one country is a lesson to another. To conclude, this paper is suggesting solutions for improving the commercial law enforcement mechanisms in line with modern technology. The call for technological transformation is essential for the enforcement of commercial laws.

Keywords: commercial law, enforcement, technology

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Authors: Jun Hong Lee

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Background: Many dementia patients complain insomnia and depressive mood, and hypnotics and antidepressants are being prescribed. As prevalence of dementia is increasing, insomnia and depressive mood are becoming more important. Objective: We evaluated insomnia and depression in outpatients of dementia center. Patients and Methods/Material and Methods: We reviewed medical records of the patients who visited outpatients clinic of NHIS Ilsan Hospital Dementia Center during 2016. Results: Total 716 patients are included; Subjective Memory Impairment (SMI) : 143 patients (20%), non-amnestic Mild Cognitive Impairment (MCI): single domain 70 (10%), multiple domain 34 (5%), amnestic MCI: single domain 74 (10%), multiple domain 159 (22%), Early onset Alzheimer´s disease (AD): 9 (1%), AD 121 (17%), Vascular dementia: 62 (9%), Mixed dementia 44 (6%). Hypnotics and antidepressants are prescribed as follows; SMI : hypnotics 14 patients (10%), antidepressants 27 (19%), non-amnestic MCI: single domain hypnotics 9 (13%), antidepressants 12 (17%), multiple domain hypnotics 4 (12%), antidepressants 6 (18%), amnestic MCI: single domain hypnotics 10 (14%), antidepressants 16 (22%), multiple domain hypnotics 22 (14%), antidepressants 24 (15%), Early onset Alzheimer´s disease (AD): hypnotics 1 (11%), antidepressants 2 (22%), AD: hypnotics 10 (8%), antidepressants 36 (30%), Vascular dementia: hypnotics 8 (13%), antidepressants 20 (32%), Mixed dementia: hypnotics 4 (9%), antidepressants 17 (39%). Conclusion: Among the outpatients of Dementia Center, MCI and SMI are majorities, and the number of MCI patients are almost half. Depression is more prevalent in AD, and Vascular dementia than MCI and SMI, and about 22% of patients are being prescribed by antidepressants and 11% by hypnotics.

Keywords: insomnia, depression, dementia, antidepressants, hypnotics

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Authors: Eric Morettin

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Cybersecurity and digital literacy are pressing issues among Canadian citizens, yet formal education does not provide today’s students with the necessary knowledge and skills needed to adapt to these challenging issues within the physical and digital labor-market. Canada’s current education systems do not highlight the importance of these respective fields, aside from using technology for learning management systems and alternative methods of assignment completion. Educators are not properly trained to integrate technology into the compulsory courses within public education, to better prepare their learners in these topics and Canada’s digital economy. ICTC addresses these gaps in education and training through cross-Canadian educational programming in digital literacy and competency, cybersecurity and coding which is bridged with Canada’s provincially regulated K-12 curriculum guidelines. After analyzing Canada’s provincial education, it is apparent that there are gaps in learning related to technology, as well as inconsistent educational outcomes that do not adequately represent the current Canadian and global economies. Presently only New Brunswick, Nova Scotia, Ontario, and British Columbia offer curriculum guidelines for cybersecurity, computer programming, and digital literacy. The remaining provinces do not address these skills in their curriculum guidelines. Moreover, certain courses across some provinces not being updated since the 1990’s. The three territories respectfully take curriculum strands from other provinces and use them as their foundation in education. Yukon uses all British Columbia curriculum. Northwest Territories and Nunavut respectfully use a hybrid of Alberta and Saskatchewan curriculum as their foundation of learning. Education that is provincially regulated does not allow for consistency across the country’s educational outcomes and what Canada’s students will achieve – especially when curriculum outcomes have not been updated to reflect present day society. Through this, ICTC has aligned Canada’s provincially regulated curriculum and created opportunities for focused education in the realm of technology to better serve Canada’s present learners and teachers; while addressing inequalities and applicability within curriculum strands and outcomes across the country. As a result, lessons, units, and formal assessment strategies, have been created to benefit students and teachers in this interdisciplinary, cross-curricular, practice - as well as meeting their compulsory education requirements and developing skills and literacy in cyber education. Teachers can access these lessons and units through ICTC’s website, as well as receive professional development regarding the assessment and implementation of these offerings from ICTC’s education coordinators, whose combines experience exceeds 50 years of teaching in public, private, international, and Indigenous schools. We encourage you to take this opportunity that will benefit students and educators, and will bridge the learning and curriculum gaps in Canadian education to better reflect the ever-changing public, social, and career landscape that all citizens are a part of. Students are the future, and we at ICTC strive to ensure their futures are bright and prosperous.

Keywords: cybersecurity, education, curriculum, teachers

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Authors: Maylen Villamanan Alba

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Latin America is marked by its history: conquest, colonialism, and slavery left deep footprints in most Latin American countries. Also, the past century has been affected by wars, military dictatorships, and political violence, which profoundly influenced Latin American popular culture. Consequently, reminiscences of historical crimes are frequently present in daily life, media, public opinion, and arts. This legacy is remembered in novels, paintings, songs, and films. In fact, Latin American cinema has a trend which refers to the verisimilitude with reality in fiction films. These films about historical violence are narrated as fictional characters, but their stories are based on real historical contexts. Therefore, cultural criminology has considered films as a significant field to understand social representations of violence related to historical crimes. The aim of the present contribution is to analyze the legacy of past and historical memory in social representations of violence in Latin American cinema as a critical approach to historical crimes. This qualitative research is based on content analysis. The sample is seven multi-award winning films of the International Festival of New Latin American Cinema of Havana. The films selected are Kamchatka, Argentina (2002); Carandiru, Brazil (2003); Enlightened by fire, Argentina (2005); Post-mortem, Chile (2010); No, Chile (2012) Wakolda; Argentina (2013) and The Clan, Argentina (2015). Cultural criminology highlights that cinema shapes meanings of social practices such as historical crimes. Critical criminology offers a critical theory framework to interpret Latin American cinema. This analysis reveals historical conditions deeply associated with power relationships, policy, and inequality issues. As indicated by this theory, violence is characterized as a structural process based on social asymmetries. These social asymmetries are crossed by social scopes, including institutional and personal dimensions. Thus, institutions of the states are depicted through personal stories of characters involved with human conflicts. Intimacy and social background are linked in the personages who simultaneously perform roles such as soldiers, policemen, professionals or inmates and they are at the same time depict as human beings with family, gender, racial, ideological or generational issues. Social representations of violence related to past legacy are a portrait of historical crimes perpetrated against Latin American citizens. Thereby, they have contributed to political positions, social behaviors, and public opinion. The legacy of these historical crimes suggests a path that should never be taken again. It means past legacy is a reminder, a warning, and a historic lesson for Latin American people. Social representations of violence are permeated by historical memory as denunciation under a critical approach.

Keywords: Latin American cinema, historical memory, social representation, violence

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Authors: Leonardo Ramirez Lopez, Edward Guillen Pinto, Carlos Ramos Linares

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The controversy brought about by the increasing use of mHealth apps and their effectiveness for disease prevention and diagnosis calls for immediate control. Although a critical topic in research areas such as medicine, engineering, economics, among others, this issue lacks reliable implementation models. However, projects such as Open Web Application Security Project (OWASP) and various studies have helped to create useful and reliable apps. This research is conducted under a quality model to optimize two mHealth apps for older adults. Results analysis on the use of two physical activity monitoring apps - AcTiv (physical activity) and SMCa (energy expenditure) - is positive and ideal. Through a theoretical and practical analysis, precision calculations and personal information control of older adults for disease prevention and diagnosis were performed. Finally, apps are validated by a physician and, as a result, they may be used as health monitoring tools in physical performance centers or any other physical activity. The results obtained provide an effective validation model for this type of mobile apps, which, in turn, may be applied by other software developers that along with medical staff would offer digital healthcare tools for elderly people.

Keywords: model, validation, effective, healthcare, elderly people, mobile app

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Authors: Thomas C. Nash

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New Zealand has a small, yet racially diverse, population of only 4.6 million people, consisting of a majority European immigrant population and a large indigenous Maori population. Because disparities in healthcare often exist among minority populations, it could be expected that the White and Maori populations of New Zealand would have unequal access to healthcare. In order to understand the ways these disparities may present themselves, it became important to travel to New Zealand in order to interview both Western and natural healthcare professionals, public health officials, health activists and Maori people. In observing the various mechanisms within the New Zealand healthcare system, some stand out as effective ways of alleviating the racial disparities often seen in healthcare. These include the efficiency of regional District Health Boards, the benefits of individuals making decisions regarding their treatment plans and the importance of cohesion among the Maori and White populations. In forming a conclusion around these observations, it is evident that the integration of Maori culture into contemporary New Zealand has benefited the healthcare system. This unity has generated support for non-Western medical treatments, in turn forming a healthcare system that creates low barriers to entry for non-traditional forms of healthcare. These low barriers allow individuals to allocate available healthcare resources in ways that are most beneficial for them and are consistent with their tastes and preferences, maximizing efficiency.

Keywords: alternative and complementary healthcare, low barriers to entry, Maori populations, racial cohesion

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Authors: Zo Hasina Rabemananjara

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The North-East of Madagascar is the pillar of Madagascar's foreign trade, providing 41% and 80% of world exports of cloves and vanilla, respectively, in 2016. For Madagascar, the north-eastern escarpment is home to the last massifs of humid forest in large scale of the island, surrounded by a small scale agricultural mosaic. In the sites where this study is taking place, located in the peripheral zones of protected areas, the production of rent aims to supply international markets. In fact, importers of the cash crops produced in these areas are located mainly in India, Singapore, France, Germany and the United States. Recently, the price of these products has increased significantly, especially from the year 2015. For vanilla, the price has skyrocketed, from an approximate price of 73 USD per kilo in 2015 to more than 250 USD per kilo in 2016. The value of clove exports increased sharply by 49.4% in 2017, largely to Singapore and India due to the sharp increase in exported volume (+47, 6%) in 2017. If the relationship between the rise in prices of rented products and the change in physical environments is known, the evolution of the behavior of land users linked to this aspect was not yet addressed by research. In fact, the consequence of this price increase in the organization of the use of space at the local level still raises questions. Hence, the research question is: to what extent does this improvement in the price of imported products affect user behavior linked to the local organization of access to the factor of soil production? To fully appreciate this change in behavior, surveys of 144 land user households were carried out, and group interviews were also carried out. The results of this research showed that the rise in the prices of annuity products from the year 2015 caused significant changes in the behavior of land users in the study sites. Young people, who have not been attracted to farming for a long time, have started to show interest in it since the period of rising vanilla and clove prices. They have set up their own fields of vanilla and clove cultivation. This revival of interest conferred an important value on the land and caused conflicts especially between family members because the acquisition of the cultivated land was done by inheritance or donation. This change in user behavior has also affected the farmers' life strategy since the latter have decided to abandon rain-fed rice farming, which has long been considered a guaranteed subsistence activity for cash crops. This research will contribute to nourishing scientific reflection on the management of land use and also to support political decision-makers in decision-making on spatial planning.

Keywords: behavior of land users, North-eastern Madagascar, price of export products, spatial planning

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Authors: Neeraj Malhotra

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Background: Bioreactors in tissue engineering are used as devices that apply mechanical means to influence biological processes. They are commonly employed for stem cell culturing, growth and expansion as well as in 3D tissue culture. Contemporarily there use is well established and is tested extensively in the medical sciences, for tissue-regeneration and tissue engineering of organs like bone, cartilage, blood vessels, skin grafts, cardiac muscle etc. Methodology: Literature search, both electronic and hand search, was done using the following MeSH and keywords: bioreactors, bioreactors and dentistry, bioreactors & dental tissue engineering, bioreactors and regenerative dentistry. Articles published only in English language were included for review. Results: Bioreactors like, spinner flask-, rotating wall-, flow perfusion-, and micro-bioreactors and in-vivo bioreactor have been employed and tested for the regeneration of dental and like-tissues. These include gingival tissue, periodontal ligament, alveolar bone, mucosa, cementum and blood vessels. Based on their working dynamics they can be customized in future for regeneration of pulp tissue and whole tooth regeneration. Apart from this, they have been successfully used in testing the clinical efficacy and biological safety of dental biomaterials. Conclusion: Bioreactors have potential use in testing dental biomaterials and tissue engineering approaches aimed at regenerative dentistry.

Keywords: bioreactors, biological process, mechanical stimulation, regenerative dentistry, stem cells

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Authors: Lukasz Grzegorz Broda, Taiwo Oseni, Andrew Stranieri, Rodrigo Marino, Ronelle Welton, Mark Yates

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The oral health of residents in aged care centres in Australia is poor, contributing to infections, hospital admissions, and increased suffering. Although the use of electric toothbrushes has been deployed in many centres, smartbrushes that record and transmit information about brushing patterns and duration are not routinely deployed. Yet, the use of smartbrushes for aged care residents promises better oral care. Thus, a study aimed at investigating the appropriateness and suitability of a smartbrush for aged care residents is currently underway. Due to the peculiarity of the aged care setting, the incorporation of smartbrushes into residents’ care does require careful planning and design considerations. This paper describes an initial design process undertaken through the use of an actor to understand the important elements to be incorporated whilst installing a smartbrush for use in aged care settings. The design covers the configuration settings of the brush and app, including ergonomic factors related to brush and smartphone placement. A design science approach led to an installation re-design and a revised protocol for the planned study, the ultimate aim being to design installations to enhance perceived usefulness, ease of use, and attitudes towards the incorporation of smartbrushes for improving oral health care for aged care residents.

Keywords: smartbrush, applied computing, life and medical sciences, health informatics

Procedia PDF Downloads 176

Authors: T. L. Granzyk, S. Scarborough, J. DeCosmo

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The use of health-related or medical narratives has gained increasing anecdotal and research-based support as a successful device for changing health behavior and outcomes. These narratives, in the form of oral storytelling, short films, and educational documentaries, for example, are most effective when including empathetic characters that transport viewers into the story and command both their attention and emotional response. This case study outlines how and why one large health system created a short narrative film for their internal Sepsis Awareness campaign, which told the dramatic story of a patient recovering from a missed sepsis diagnosis, leaving her a quad-amputee. Results include positive global anecdotal response to the film from healthcare professionals and patients, as well as use of the film to support legislation, ultimately passed in favor of the formation of Sepsis Awareness Workgroups in Maryland. Authors conclude that narrative films can be used successfully to initiate healthcare legislation and to increase internal and external awareness of health-related areas in need of greater improvement and support. As such, healthcare leaders and stakeholders would benefit from learning how to intentionally create, cultivate, and curate narratives from within their own health systems that elicit an empathetic response.

Keywords: healthcare policy, healthcare narratives, sepsis awareness, short films

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Authors: Mehdi Modabberifar, Sanaz Jabary, Mojtaba Ghodsi

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Stiffness sensing is an important issue in medical diagnostic, robotics surgery, safe handling, and safe grasping of objects in production lines. Detecting and obtaining the characteristics in dwelling lumps embedded in a soft tissue and safe removing and handling of detected lumps is needed in surgery. Also in industry, grasping and handling an object without damaging in a place where it is not possible to access a human operator is very important. In this paper, a method for object handling is presented. It is based on the use of an intelligent gripper to detect the object stiffness and then setting a programmable force for grasping the object to move it. The main components of this system includes sensors (sensors for measuring force and displacement), electrical (electrical and electronic circuits, tactile data processing and force control system), mechanical (gripper mechanism and driving system for the gripper) and the display unit. The system uses a rotary potentiometer for measuring gripper displacement. A microcontroller using the feedback received by the load cell, mounted on the finger of the gripper, calculates the amount of stiffness, and then commands the gripper motor to apply a certain force on the object. Results of Experiments on some samples with different stiffness show that the gripper works successfully. The gripper can be used in haptic interfaces or robotic systems used for object handling.

Keywords: gripper, haptic, stiffness, robotic

Procedia PDF Downloads 362

Authors: Adeniyi Onasanya, Maher Elshakankiri

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In recent years, the Internet of Things (IoT) has constituted a driving force of modern technological advancement, and it has become increasingly common as its impacts are seen in a variety of application domains, including healthcare. IoT is characterized by the interconnectivity of smart sensors, objects, devices, data, and applications. With the unprecedented use of IoT in industrial, commercial and domestic, it becomes very imperative to harness the benefits and functionalities associated with the IoT technology in (re)assessing the provision and positioning of healthcare to ensure efficient and improved healthcare delivery. In this research, we are focusing on two important services in healthcare systems, which are cancer care services and business analytics/cloud services. These services incorporate the implementation of an IoT that provides solution and framework for analyzing health data gathered from IoT through various sensor networks and other smart devices in order to improve healthcare delivery and to help health care providers in their decision-making process for enhanced and efficient cancer treatment. In addition, we discuss the wireless sensor network (WSN), WSN routing and data transmission in the healthcare environment. Finally, some operational challenges and security issues with IoT-based healthcare system are discussed.

Keywords: IoT, smart health care system, business analytics, (wireless) sensor network, cancer care services, cloud services

Procedia PDF Downloads 180

Authors: Yu-Chih Wang, Chia-Yu Lai, Hsiao-Tien Liu, Yi-Ju Chen, Shao-Bin Cheng

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Liver transplant has been one of the curative treatment options for hepatocellular carcinomaunder certain oncological conditions. Two of the most validated criteria are from Milan in1996 and USCF in 2001, suggesting number and size limits of tumor without vascularinvasion or distant metastasis. We performed a retrospective cohort study of hepatocellular carcinoma patients undergoing livertransplant between August 2003 and December 2020 in our institute. Clinical andpathological characteristic, survival outcome, and recurrent pattern were analysed.UCSF criteria was applied for living donor transplantation, and Milan criteria was applied for deceased donor transplantation. Of 180 total patients, 52 cases(28.8%) with diagnosis of hepatocellular carcinoma, including26 living donor(LD) and 26 deceased donor(DD) liver transplant. Complete pathologicalremission was significantly more in the DD group(p=0.009). Pathological reports showed that30.8% of DD group exceeded Milan criteria, and 19.2% of LD group exceeded UCSFcriteria.After a median follow-up of 52.2 months, the 1-year, 3-year and 5-year overall survival was 87.6%, 74.1%, and 71.8%, respectively.Meanwhile, progression-free survival was 93.1%, 85.7%, and 81.6% for 1, 3, and 5-year, respectively, similar to that in Mazzaferro et al, 1996. We concluded that Liver transplant could be applied cautiously in expanded criteria for patent withhepatocellular carcinoma.

Keywords: liver transplant, milan criteria, UCSF criteria, living donor transplantation, deceased donor transplantation

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Authors: Jayprakash Yadav, Nivedita Patra

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Polyhydroxybutyrate (PHB) is an interesting material in the field of medical science, pharmaceutical industries, and tissue engineering because of its properties such as biodegradability, biocompatibility, hydrophobicity, and elasticity. PHB is naturally accumulated by several microbes in their cytoplasm during the metabolic process as energy reserve material. PHB can be extracted from cell biomass using halogenated hydrocarbons, chemicals, and enzymes. In this study, a cheaper and non-toxic solvent, acetone, was used for the extraction process. The different parameters like acetone percentage, and solvent pH, process temperature, and incubation periods were optimized using the Response Surface Methodology (RSM). RSM was performed and the determination coefficient (R2) value was found to be 0.8833 from the quadratic regression model with no significant lack of fit. The designed RSM model results indicated that the fitness of the response variable was significant (P-value < 0.0006) and satisfactory to denote the relationship between the responses in terms of PHB recovery and purity with respect to the values of independent variables. Optimum conditions for the maximum PHB recovery and purity were found to be solvent pH 7, extraction temperature - 43 °C, incubation time - 70 minutes, and percentage acetone – 30 % from this study. The maximum predicted PHB recovery was found to be 0.845 g/g biomass dry cell weight and the purity was found to be 97.23 % using the optimized conditions.

Keywords: acetone, PHB, RSM, halogenated hydrocarbons, extraction, bacillus subtilis.

Procedia PDF Downloads 442

Authors: Robert E. Kenney, Efrain Antunez, Samuel Nodal, Ameer Malik, Richard B. Aguilar

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Physician burnout has gained much attention during the COVID pandemic. After-hours workload, HCC coding, HEDIS metrics, and clinical documentation negatively impact career satisfaction. These and other influences have increased the rate of physicians leaving the workforce. In addition, roughly 1% of the entire physician workforce will be retiring earlier than expected based on pre-pandemic trends. The two Medical Specialties with the highest rates of burnout are Family Medicine and Primary Care. With a predicted shortage of primary care physicians looming, the need to address physician burnout is crucial. Commonly reported issues leading to clinician burnout are clerical documentation requirements, increased time working on Electronic Health Records (EHR) after hours, and a decrease in work-life balance. Clinicians experiencing burnout with physical and emotional exhaustion are at an increased likelihood of providing lower quality and less efficient patient care. This may include a lack of suitable clinical documentation, medication reconciliation, clinical assessment, and treatment plans. While the annual baseline turnover rates of physicians hover around 6-7%, the COVID pandemic profoundly disrupted the delivery of healthcare. A report found that 43% of physicians switched jobs during the initial two years of the COVID pandemic (2020 and 2021), tripling the expected average annual rate to 21.5 %/yr. During this same time, an average of 4% and 1.5% of physicians retired or left the workforce for a non-clinical career, respectively. The report notes that 35.2% made career changes for a better work-life balance and another 35% reported the reason as being unhappy with their administration’s response to the pandemic. A physician-led primary care-focused health organization, Cano Health (CH), based out of Florida, sought to preemptively address this problem by implementing several supportive measures. Working with >120 clinics and >280 PCPs from Miami to Tampa and Orlando, managing nearly 120,000 Medicare Advantage lives, CH implemented a number of changes to assist with the clinician’s workload. Supportive services such as after hour and home visits by APRNs, in-clinic care managers, and patient educators were implemented. In 2021, assistive Artificial Intelligence Software (AIS) was integrated into the EHR platform. This AIS converts free text within PDF files into a usable (copy-paste) format facilitating documentation. The software also systematically and chronologically organizes clinical data, including labs, medical records, consultations, diagnostic images, medications, etc., into an easy-to-use organ system or chronic disease state format. This reduced the excess time and documentation burden required to meet payor and CMS guidelines. A clinician Documentation Support team was employed to improve the billing/coding performance. The effects of these newly designed workflow interventions were measured via analysis of clinician turnover from CH’s hiring and termination reporting software. CH’s annualized average clinician turnover rate in 2020 and 2021 were 17.7% and 12.6%, respectively. This represents a 30% relative reduction in turnover rate compared to the reported national average of 21.5%. Retirement rates during both years were 0.1%, demonstrating a relative reduction of >95% compared to the national average (4%). This model successfully promoted the retention of clinicians in a Value-Based Care setting.

Keywords: clinician burnout, COVID-19, value-based care, burnout, clinician retirement

Procedia PDF Downloads 85