Search results for: hospital building

Authors: Qiao-Yu Warren Cai

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Due to the rise of big data, building corpora and using them to analyze ChineseL2 learners’ language output has become a trend. Various empirical research has been conducted using Chinese corpora built by different academic institutes. However, most of the research analyzed the data in the Chinese corpora usingcorpus-based qualitative content analysis with descriptive statistics. Descriptive statistics can be used to make summations about the subjects or samples that research has actually measured to describe the numerical data, but the collected data cannot be generalized to the population. Comte, a Frenchpositivist, has argued since the 19th century that human beings’ knowledge, whether the discipline is humanistic and social science or natural science, should be verified in a scientific way to construct a universal theory to explain the truth and human beings behaviors. Inferential statistics, able to make judgments of the probability of a difference observed between groups being dependable or caused by chance (Free Geography Notes, 2015)and to infer from the subjects or examples what the population might think or behave, is just the right method to support Comte’s argument in the field of TCSOL. Also, inferential statistics is a core of quantitative research, but little research has been conducted by combing corpora with inferential statistics. Little research analyzes the differences in Chinese L2 learners’ language corpus output errors by using theOne-way ANOVA so that the findings of previous research are limited to inferring the population's Chinese errors according to the given samples’ Chinese corpora. To fill this knowledge gap in the professional development of Taiwanese TCSOL, the present study aims to utilize the One-way ANOVA to analyze corpus output errors of Chinese L2 learners from America, Myanmar, and Singapore. The results show that no significant difference exists in ‘shì (是) sentence’ and word order errors, but compared with Americans and Singaporeans, it is significantly easier for Myanmar to have ‘sentence blends.’ Based on the above results, the present study provides an instructional approach and contributes to further exploration of how Chinese L2 learners can have (and use) learning strategies to lower errors.

Keywords: Chinese corpus, error analysis, one-way analysis of variance, Chinese L2 learners, Americans, myanmar, Singaporeans

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Authors: Sumiti Saharan, Pallav Patankar, Lily W. Lee

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Understanding the health-seeking behaviors and attitudes of women towards maternal health in the context of gender roles and family dynamics is tremendously crucial for designing effective and impactful interventions aimed at improving maternal and child health outcomes. Further, as the digital world becomes more accessible and affordable, it is imperative to scope the potential of digital technology in enabling access to maternal health information in different socio-economic groups (SEGs). In the summer of 2017, we conducted a study with 500 women across different SEGs in urban India who were pregnant or had had a delivery in the last year. The study was undertaken to assess their maternal health information seeking behavior with a particular focus on probing their use of digital technology for health-related information. The study also measured women's decision-making autonomy in the context of maternal health, awareness of their rights to quality and respectful maternal healthcare, and agency to voice their rights. We probed the impact of key variables including education, age, and socioeconomic status on all outcome variables. In terms of health-seeking behaviors, we found that women heavily relied on medical professionals and/or their mothers and mothers-in-law for all maternal health advice. Digital adoption was found to be high across all SEGs, with around 70% of women from all populations using the internet several times a week. On the other hand, use of the internet for both accessing maternal health information and choosing maternity hospitals were both significantly dependent on SEG. The key reasons reported for not using the internet for health purposes were lack of awareness and lack of trust on content accuracy. Decisions around health practices and type of delivery were found to be jointly made by women and other family members. Almost all women reported their husbands to play a key role in all maternal health decisions and for decisions with a clear financial implication like choice of hospital for delivery, husbands were reported to be the sole decision maker by a majority of women. The agency of women was also found to be low in interactions with maternal healthcare providers with a third of respondents not comfortable with voicing their opinions and preferences to their doctors. Interestingly, we find that this relatively low agency was prominent in both lower middle class and middle-class SEGs. Recognition of the sociocultural determinants of behavior is the first step in developing actionable strategies for improving maternal health outcomes. Our study quantifies the agency and autonomy of women in urban India and the variables that impact them. Our findings emphasize the value of gender normative approaches that factor in the key role husbands play in guiding maternal health decisions. They also highlight the power of digital approaches for catalyzing access to maternal health information. These insights into the attitude and behaviors of mothers in context of their sociocultural environments—and their relationship with digital technology—can help pave the way towards designing effective, scalable maternal and child health programs in developing nations like India.

Keywords: access to healthcare information, behavior, digital health, maternal health

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Authors: Carly Nesvat, Dominic Jarrett, Colin Thomson, Wilma Coltart, Thelma Bowers, Jan Thomson

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Introduction: Within Scotland, the Same As You strategy committed to moving people with learning disabilities out of long-stay hospital accommodation into homes in the community. Much of the focus of this movement was on the placement of people within individual homes. In order to achieve this, potentially excessive supports were put in place which created dependence, and carried significant ongoing cost primarily for local authorities. The greater focus on empowerment and community participation which has been evident in more recent learning disability strategy, along with the financial pressures being experienced across the public sector, created an imperative to re-examine that provision, particularly in relation to the use of expensive sleepover supports to individuals, and the potential for this to be appropriately scaled back through the use of telecare. Method: As part of a broader programme of redesigning overnight supports within North Ayrshire, a cluster of individuals living in close proximity were identified, who were in receipt of overnight supports, but who were identified as having the capacity to potentially benefit from their removal. In their place, a responder service was established (an individual staying overnight in a nearby service user’s home), and a variety of telecare solutions were placed within individual’s homes. Active and passive technology was connected to an Alarm Receiving Centre, which would alert the local responder service when necessary. Individuals and their families were prepared for the change, and continued to be informed about progress with the pilot. Results: 4 individuals, 2 of whom shared a tenancy, had their sleepover supports removed as part of the pilot. Extensive data collection in relation to alarm activation was combined with feedback from the 4 individuals, their families, and staff involved in their support. Varying perspectives emerged within the feedback. 3 of the individuals were clearly described as benefitting from the change, and the greater sense of independence it brought, while more concerns were evident in relation to the fourth. Some family members expressed a need for greater preparation in relation to the change and ongoing information provision. Some support staff also expressed a need for more information, to help them understand the new support arrangements for an individual, as well as noting concerns in relation to the outcomes for one participant. Conclusion: Developing a telecare response in relation to a cluster of individuals was facilitated by them all being supported by the same care provider. The number of similar clusters of individuals being identified within North Ayrshire is limited. Developing other solutions such as a response service for redesign will potentially require greater collaboration between different providers of home support, as well as continuing to explore the full range of telecare, including digital options. The pilot has highlighted the need for effective preparatory and ongoing engagement with staff and families, as well as the challenges which can accompany making changes to long-standing packages of support.

Keywords: challenges, change, engagement, telecare

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Authors: Anketa Kumar, Rajantheran Al Muniandy, Rishabh Kumar

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For centuries, Indian costumes are admired for their great aesthetics, functional and narrative qualities. The purpose of the current study is to investigate the role of costumes as visual narratives in Hindi Cinema as Filmmaking is simply one of the most recent manifestations of the human desire to tell stories in which costume acts as a tool to be read as an Intertext by the viewers watching the films. The problem that promoted this study arose when clothes become an interesting topic when examined within the social structures in which they are worn. It is this visual image of dress worn by the character that is investigated in this research through Hindi Cinema of the 1960s, which was a reflection of the society in the realistic form. This research intends to integrate the application of Roland Barthes Semiotic theory in analyzing main movie characters in the National Award-Winning Hindi movie Mughal e Azam (1960). The research helps in filling the gap between the singular level of interpretation and another level that offers a solution towards bridging the gap in viewers' manifold interpretation of a particular movie product. This study focuses on how visual appearance communicates for building up of perception and can relate to notions of realism, defining cultural identity and status in the society. The research methodology is subjected analytical technique that employs in this research is qualitative and descriptive in nature with the use of the Freeze frame technique. The portrayal of costumes is explained with Barthes' principles of Semiotics. The freeze-frame technique stops the motion of the film on a single frame and allows the chosen image to be read as a still photograph. The finding during this research into costume portrayal in the movie was that freezing the frame in midst of running the films attracted attention towards intricate costume details, leading to record the nuanced observations of this minutiae during the movie. Given that during the application of interpretation while watching K Asif’s Mughal e Azam focused on certain aspects of costumes of the king. On the same idea, further research can be employed to strengthen the relation between costumes and visual narration.

Keywords: character portrayal, costumes, Indian cinema, semiotics, visual significance

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Authors: Seyed Reza Aghili, Tahereh Shokohi, Shirin Sadat Hashemi Fesharaki, Mohammad Ali Boroumand, Bahar Salmanian

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Introduction: Intravenous catheter-associated fungal infection as nosocomial infection continue to be a deep problem among hospitalized patients, decreasing quality of life and adding healthcare costs. The capacity of catheters in the spread of candidemia in heart failure patients is obvious. The aim of this study was to evaluate the prevalence and genetic identification of Candida species in heart disorder patients. Material and Methods: This study was conducted in Tehran Hospital of Cardiology Center (Tehran, Iran, 2014) during 1.5 years on the patients hospitalized for at least 7 days and who had central or peripheral vein catheter. Culture of catheters, blood and skin of the location of catheter insertion were applied for detecting Candida colonies in 223 patients. Identification of Candida species was made on the basis of a combination of various phenotypic methods and confirmed by sequencing the ITS1-5.8S-ITS2 region amplified from the genomic DNA using PCR and the NCBI BLAST. Results: Of the 223 patients samples tested, we identified totally 15 Candida isolates obtained from 9 (4.04%) catheter cultures, 3 (1.35%) blood cultures and 2 (0.90%) skin cultures of the catheter insertion areas. On the base of ITS region sequencing, out of nine Candida isolates from catheter, 5(55.6%) C. albicans, 2(22.2%) C. glabrata, 1(11.1%) C. membranifiaciens and 1 (11.1%) C. tropicalis were identified. Among three Candida isolates from blood culture, C. tropicalis, C. carpophila and C. membranifiaciens were identified. Non-candida yeast isolated from one blood culture was Cryptococcus albidus. One case of C. glabrata and one case of Candida albicans were isolated from skin culture of the catheter insertion areas in patients with positive catheter culture. In these patients, ITS region of rDNA sequence showed a similarity between Candida isolated from the skin and catheter. However, the blood samples of these patients were negative for fungal growth. We report two cases of catheter-related candidemia caused by C. membranifiaciens and C. tropicalis on the base of genetic similarity of species isolated from blood and catheter which were treated successfully with intravenous fluconazole and catheter removal. In phenotypic identification methods, we could only identify C. albicans and C. tropicalis and other yeast isolates were diagnosed as Candida sp. Discussion: Although more than 200 species of Candida have been identified, only a few cause diseases in humans. There is some evidence that non-albicans infections are increasing. Many risk factors, including prior antibiotic therapy, use of a central venous catheter, surgery, and parenteral nutrition are considered to be associated with candidemia in hospitalized heart failure patients. Identifying the route of infection in candidemia is difficult. Non-albicans candida as the cause of candidemia is increasing dramatically. By using conventional method, many non-albicans isolates remain unidentified. So, using more sensitive and specific molecular genetic sequencing to clarify the aspects of epidemiology of the unknown candida species infections is essential. The positive blood and catheter cultures for candida isolates and high percentage of similarity of their ITS region of rDNA sequence in these two patients confirmed the diagnosis of intravenous catheter-associated candidemia.

Keywords: catheter-associated infections, heart failure patient, molecular genetic sequencing, ITS region of rDNA, Candidemia

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Authors: Hailemikael Negussie, Sebla Arın Ensarioğlu

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In February 2023 Southeastern Türkiye and Northwestern Syria were hit by two consecutive earthquakes with high magnitude leaving thousands dead and thousands more homeless. The housing crisis in the affected areas has resulted in the need for a fast and qualified solution. There are a number of solutions, one of which is the use of modular designs to rebuild the cities that have been affected. Modular designs are prefabricated building components that can be quickly and efficiently assembled on-site, making them ideal to build structures with faster speed and higher quality. These structures are flexible, adaptable, and can be customized to meet the specific needs of the inhabitants, in addition to being more energy-efficient and sustainable. The prefabricated nature also assures that the quality of the products can be easily controlled. The reason for the collapse of most of the buildings during the earthquakes was found out to be the lack of quality during the construction stage. Using modular designs allows a higher control over the quality of the construction materials being used. The use of modular designs for a project of this scale presents some challenges, including the high upfront cost to design and manufacture components. However, if implemented correctly, modular designs can offer an effective and efficient solution to the urgent housing needs. The aim of this paper is to explore the potential of modular housing for mid- and long-term earthquake-resistant housing needs in the affected disaster zones after the earthquakes of February 2023. In the scope of this paper the adaptability of modular, prefabricated housing designs for the post-disaster environment, the advantages and disadvantages of this system will be examined. Elements such as; the current conditions of the region where the destruction happened, climatic data, topographic factors will be examined. Additionally, the paper will examine; examples of similar local and international modular post-earthquake housing projects. The region is projected to enter a rapid reconstruction phase in the following periods. Therefore, this paper will present a proposal for a system that can be used to produce safe and healthy urbanization policies without causing new aggrievements while meeting the housing needs of the people in the affected regions.

Keywords: post-disaster housing, earthquake-resistant design, modular design, housing, Türkiye

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Authors: Dahna Alkahtani, Faryal Suraya, Fadah Alanazi

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Background: Buccal mucosal graft for urethral augmentation has surpassed other grafting options, and is now considered the standard of choice for substitution Urethroplasty. The graft has gained its popularity due to its excellent short and long-term results, easy harvesting as well as its ability in withstanding wet environments. However, although Buccal mucosal grafts are an excellent option, it is not free of complications, potential intraoral complications are bleeding, pain, swelling, injury to the nerve resulting in numbness, lip deviation or retraction. Objectives: The current study aims to evaluate the intraoral complications of buccal mucosa grafts harvested from one cheek, and used in Augmentation Urethroplasty. Methodology: The study was conducted retrospectively using the medical records of patients who underwent open augmentation urethroplasty with a buccal mucosa graft at King Khalid University Hospital, Saudi Arabia. Data collection of demographics included the type of graft used, presence or absence of strictures and its etiological factors. Pre-operative and post-operative evaluations were carried out on the subjects including the medical history, physical examination, uroflowmetry, retrograde urethrography, voiding cystourethrography and urine cultures were also noted. Further, the quality of life and complications of the procedure including the presence or occurrence of bleeding within 3-days post-procedure, the severity of pain, oral swelling after grafting, length of return to normal daily diet, painful surgical site, intake of painkillers, presence or absence of speech disturbance, numbness in the cheeks and lips were documented. Results: Thirty-two male subjects with ages ranging from 15 years to 72 years were included in the current study. Following the procedure, a hundred percent of the subjects returned to their normal daily diet by the sixth postoperative day. Further, the majority of the patients reported experiencing mild pain accounting for 61.3%, and 90.3% of the subjects reported using painkillers to control the pain. Surgical wound Pain was reportedly more common at the perineal site as 48.4% of the subjects experienced it; on the other hand, 41.9% of the patients experienced pain in the oral mucosa. The presence of speech disorders, as assessed through medical history, was found to be present in 3.2% of patients. The presence of numbness in the cheeks and lips was found in 3.2% of patients. Other complications such as parotid duct injury, delayed wound healing, non-healing wound and suture granuloma were rare as 90.3% of the subjects denied experiencing any of them, there were nonetheless reports of parotid duct injury by 6.5% of the patients, and non-healing wound by the 3.2% of patients. Conclusion: Buccal Mucosa Graft in Augmentation Urethroplasty is an ideal source of allograft, although not entirely painless; it is considerably safe with minimal intra-oral complication and undetectable strain on the patients’ quality of life.

Keywords: augmentation, buccal, graft, oral

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Authors: Christabel Ihedike, John Mooney, Monica Price

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Summary: This study aims to critically evaluate effect of photochemical smog on respiratory health in Nigeria. Cohort of chronic obstructive pulmonary disease (COPD) patients was recruited from two large hospitals in Abuja Nigeria. Respiratory health questionnaires, daily diaries, dyspnoea scale and lung function measurement were used to obtain health data and investigate the relationship with air quality data (principally ozone, NOx and particulate pollution). Concentrations of air pollutants were higher than WHO and Nigerian air quality standard. The result suggests a correlation between measured air quality and exacerbation of respiratory illness. Introduction: Photochemical smog is a significant health challenge in most cities and its effect on respiratory health is well acknowledged. This type of pollution is most harmful to the elderly, children and those with underlying respiratory disease. This study aims to investigate impact of increasing temperature and photo-chemically generated secondary air pollutants on respiratory health in Abuja Nigeria. Method and Result: Health data was collected using spirometry to measure lung function on routine attendance at the clinic, daily diaries kept by patients and information obtained using respiratory questionnaire. Questionnaire responses (obtained using an adapted and internally validated version of St George’s Hospital Respiratory Questionnaire), shows that ‘time of wheeze’ showed an association with participants activities: 30% had worse wheeze in the morning: 10% cannot shop, 15% take long-time to get washed, 25% walk slower, 15% if hurry have to stop and 5% cannot take-bath. There was also a decrease in Forced expiratory volume in the first second and Forced Vital Capacity, and daily change in the afternoon–morning may be associated with the concentration level of pollutants. Also, dyspnoea symptoms recorded that 60% of patients were on grade 3, 25% grade 2 and 15% grade 1. Daily frequency of the number of patients in the cohort that cough /brought sputum is 78%. Air pollution in the city is higher than Nigerian and WHO standards with NOx and PM10 concentrations of 693.59ug/m-3 and 748ugm-3 being measured respectively. The result shows that air pollution may increase occurrence and exacerbation of respiratory disease. Conclusion: High temperature and local climatic conditions in urban Nigeria encourages formation of Ozone, the major constituent of photochemical smog, resulting also in the formation of secondary air pollutants associated with health challenges. In this study we confirm the likely potency of the pattern of secondary air pollution in exacerbating COPD symptoms in vulnerable patient group in urban Nigeria. There is need for better regulation and measures to reduce ozone, particularly when local climatic conditions favour development of photochemical smog in such settings. Climate change and likely increasing temperatures add impetus and urgency for better air quality standards and measures (traffic-restrictions and emissions standards) in developing world settings such as Nigeria.

Keywords: Abuja-Nigeria, effect, photochemical smog, respiratory health

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Authors: Rupali Bhatia, Deepthi Nair, Geetika Khanna, Seema Singhal

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Introduction: Genital tract tuberculosis is a chronic disease (caused by reactivation of organisms from systemic distribution of Mycobacterium tuberculosis) that often presents with low grade symptoms and non-specific complaints. Patients with genital tuberculosis are usually young women seeking workup and treatment for infertility. Infertility is the commonest presentation due to involvement of the fallopian tubes, endometrium and ovarian damage with poor ovarian volume and reserve. The diagnosis of genital tuberculosis is difficult because of the fact that it is a silent invader of genital tract. Since tissue cannot be obtained from fallopian tubes, the diagnosis is made by isolation of bacilli from endometrial tissue obtained by endometrial biopsy curettage and/or aspiration. Problems are associated with sampling technique as well as diagnostic modality due to lack of adequate sample volumes and the segregation of the sample for various diagnostic tests resulting in non-uniform distribution of microorganisms. Moreover, lack of an efficient sampling technique universally applicable for all specific diagnostic tests contributes to the diagnostic challenges. Endometrial sampling plays a key role in accurate diagnosis of female genital tuberculosis. It may be done by 2 methods viz. endometrial curettage and endometrial aspiration. Both endometrial curettage and aspirate have their own limitations as curettage picks up strip of the endometrium from one of the walls of the uterine cavity including tubal osteal areas whereas aspirate obtains total tissue with exfoliated cells present in the secretory fluid of the endometrial cavity. Further, sparse and uneven distribution of the bacilli remains a major factor contributing to the limitations of the techniques. The sample that is obtained by either technique is subjected to histopathological examination, AFB staining, culture and PCR. Aim: Comparison of the sampling techniques viz. endometrial biopsy curettage and endometrial aspiration using different laboratory methods of histopathology, cytology, microbiology and molecular biology. Method: In a hospital based observational study, 75 Indian females suspected of genital tuberculosis were selected on the basis of inclusion criteria. The women underwent endometrial tissue sampling using Novaks biopsy curette and Karmans cannula. One part of the specimen obtained was sent in formalin solution for histopathological testing and another part was sent in normal saline for acid fast bacilli smear, culture and polymerase chain reaction. The results so obtained were correlated using coefficient of correlation and chi square test. Result: Concordance of results showed moderate agreement between both the sampling techniques. Among HPE, AFB and PCR, maximum sensitivity was observed for PCR, though the specificity was not as high as other techniques. Conclusion: Statistically no significant difference was observed between the results obtained by the two sampling techniques. Therefore, one may use either EA or EB to obtain endometrial samples and avoid multiple sampling as both the techniques are equally efficient in diagnosing genital tuberculosis by HPE, AFB, culture or PCR.

Keywords: acid fast bacilli (AFB), histopatholgy examination (HPE), polymerase chain reaction (PCR), endometrial biopsy curettage

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Authors: Ochuko K. Overen, Edson L. Meyer

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Uncontrolled heat transfer between the inner and outer space of low-cost housings through the thermal envelope result in indoor thermal discomfort. As a result, an excessive amount of energy is consumed for space heating and cooling. Thermo-optical properties are the ability of paints to reduce the rate of heat transfer through the thermal envelope. The aim of this study is to analyze the thermal performance of a low-cost house with its walls inner surface coated with transparent infrared reflective paint. The thermo-optical properties of the paint were analyzed using Scanning Electron Microscopy/ Energy Dispersive X-ray spectroscopy (SEM/EDX), Fourier Transform Infra-Red (FTIR) and thermal photographic technique. Meteorological indoor and ambient parameters such as; air temperature, relative humidity, solar radiation, wind speed and direction of a low-cost house in Golf-course settlement, South Africa were monitored. The monitoring period covers both winter and summer period before and after coating. The thermal performance of the coated walls was evaluated using time lag and decrement factor. The SEM image shows that the coat is transparent to light. The presence of Al as Al2O and other elements were revealed by the EDX spectrum. Before coating, the average decrement factor of the walls in summer was found to be 0.773 with a corresponding time lag of 1.3 hours. In winter, the average decrement factor and corresponding time lag were 0.467 and 1.6 hours, respectively. After coating, the average decrement factor and corresponding time lag were 0.533 and 2.3 hour, respectively in summer. In winter, an average decrement factor of 1.120 and corresponding time lag of 3 hours was observed. The findings show that the performance of the coats is influenced by the seasons. With a 74% reduction in decrement factor and 1.4 time lag increase in winter, it implies that the coatings have more ability to retain heat within the inner space of the house than preventing heat flow into the house. In conclusion, the results have shown that transparent infrared reflective paint has the ability to reduce the propagation of heat flux through building walls. Hence, it can serve as a remedy to the poor thermal performance of low-cost housings in South Africa.

Keywords: energy efficiency, decrement factor, low-cost housing, paints, rural development, thermal comfort, time lag

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Authors: Carmen W. H. Chan, Helen Y. L. Chan, Kai Chow Choi, Ka Ming Chow, Cecilia W. M. Kwan, Nancy H. Y. Ng, Jackie Robinson

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Introduction: In Hong Kong, a significant number of deaths occur in acute care wards, which requires nurses in these settings to provide end-of-life care and lead ACP implementation. However, nurses in these settings, in fact, have very low-level involvement in ACP discussions because of limited training in ACP conversations. Objective: This study aims to assess the impact of a multi-media experiential ACP (MEACP) training program, which is guided by the experiential learning model and theory of planned behaviour, on nurses' knowledge and confidence in assisting patients with ACP. Methodology: The study utilizes a cluster randomized controlled trial with a 12-week follow-up. Eligible nurses working in acute care hospital wards are randomly assigned at the ward level, in a 1:1 ratio, to either the control group (no ACP education) or the intervention group (4-week MEACP training program). The training programme includes training through a webpage and mobile application, as well as a face-to-face training workshop with enhanced lectures and role play, which is based on the Theory of Planned Behavior and Kolb's Experiential Learning Model. Questionnaires were distributed to assess nurses' knowledge (a 10-item true/false questionnaire) and level of confidence (five-point Likert scale) in ACP at baseline (T0), four weeks after the baseline assessment (T1), and 12 weeks after T1 (T2). In this interim report, data analysis was mainly descriptive in nature. Result: The interim report focuses on the preliminary results of 165 nurses at T0 (Control: 74, Intervention: 91) over a 5-month period, 69 nurses from the control group who completed the 4-week follow-up and 65 nurses from the intervention group who completed the 4-week MEACP training program at T1. The preliminary attrition rate is 6.8% and 28.6% for the control and intervention groups, respectively, as some nurses did not complete the whole set of online modules. At baseline, the two groups were generally homogeneous in terms of their years of nursing practice, weekly working hours, working title, and level of education, as well as ACP knowledge and confidence levels. The proportion of nurses who answered all ten knowledge questions correctly increased from 13.8% (T0) to 66.2% (T1) for the intervention group and from 13% (T0) to 20.3% (T1) for the control group. The nurses in the intervention group answered an average of 7.57 and 9.43 questions correctly at T0 and T1, respectively. They showed a greater improvement in the knowledge assessment at T1 with respect to T0 when compared with their counterparts in the control group (mean difference of change score, Δ=1.22). They also exhibited a greater gain in level of confidence at T1 compared to their colleagues in the control group (Δ=0.91). T2 data is yet available. Conclusion: The prevalence of nurses engaging in ACP and their level of knowledge about ACP in Hong Kong is low. The MEACP training program can enrich nurses by providing them with more knowledge about ACP and increasing their confidence in conducting ACP.

Keywords: advance directive, advance care planning, confidence, knowledge, multi-media experiential, randomised control trial

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Authors: Amna B. Medani, M. A. Elbadwi Samia, Hassan A. Khalid

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In our study, nine Nubian goat kids were obtained, allotted into three groups, and healthily adapted in pens within the premises of the Veterinary Teaching Hospital, University of Khartoum to be given the oral doses of the dried herb shoots at daily doses of 1 and 5 gm/kg/day with drinking water, while the kids of the control group were left undosed. All goats were slaughtered,if not died, after 35 days. S. argel at the given doses caused signs of arched posture, ruffled hair, shivering and paralysis of limbs. On post mortem, lesions were seen to be hepatic fatty changes, renal necrosis, congested lungs and inflamed intestines. Serum chemistry investigations revealed significant increase (P< 0.05-0.01) in the activities of ALP(alkaline phosphates) and AST( aspartate-aminotransferase) in goats dosed with 5 gm /kg/ day. Also observed were significant increases in inorganic phosphorus and urea concentrations (P < 0.05-0.01) in both dosed goat groups. .Other investigations including the activity of GGT( gamma glutamyltransferase), creatinine, calcium, total protein and albumin illustrated no significant difference from that of the undosed controls. On haematological evaluation , the goat kids dosed with 5 gm/kg/dayshowed a decrease in haemoglobin concentration and red blood cells count of (P < 0.05-0.01).Both groups of dosed goats showed a higher packed cell volume values of (P < 0.05) when compared to the control goats .Mean corpuscular haemoglobin values were not different from those of the control kids. S. argel at the given doses caused signs of arched posture, ruffled hair, shivering and paralysis of limbs. On post mortem, lesions were seen to be hepatic fatty changes, renal necrosis, congested lungs and inflamed intestines. Serum chemistry investigations revealed significant increase (P < 0.05-0.01) in the activities of ALP(alkaline phosphates) and AST( aspartate-aminotransferase) in goats dosed with 5 gm /kg/ day. Also observed were significant increases in inorganic phosphorus and urea concentrations (P < 0.05-0.01) in both dosed goat groups. .Other investigations including the activity of GGT( gamma-glutamyltransferase), creatinine, calcium, total protein and albumin illustrated no significant difference from that of the undosed controls. calcium, total protein and albumin illustrated no significant difference from that of the undosed controls. On haematological evaluation , the goat kids dosed with 5 gm/kg/dayshowed a decrease in haemoglobin concentration and red blood cells count of (P < 0.05-0.01).Both groups of dosed goats showed a higher packed cell volume values of (P < 0.05) when compared to the control goats .Mean corpuscular haemoglobin values were not different from those of the control kids. Data obtained were then discussed to find S. argel irritable to intestines , toxic to the kidney and liver and a haematological mild toxin.Suggestions for future were forwarded.

Keywords: hargal, nubian goats, solenstemma argel, toxicity

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Authors: Kuo-Kai Lin, Po-Lun Chang

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Research Background and Purpose: Following the development of the Internet and multimedia, the Internet and information technology have become crucial avenues of modern communication and knowledge acquisition. The advantages of using mobile devices for learning include making learning borderless and accessible. Mobile learning has become a trend in disease management and health promotion in recent years. End-stage renal disease (ESRD) is an irreversible chronic disease, and patients who do not receive kidney transplants can only rely on hemodialysis or peritoneal dialysis to survive. Due to the complexities in caregiving for patients with ESRD that stem from their advanced age and other comorbidities, the patients’ incapacity of self-care leads to an increase in the need to rely on their families or primary caregivers, although whether the primary caregivers adequately understand and implement patient care is a topic of concern. Therefore, this study explored whether primary caregivers’ health care provisions can be improved through the intervention of an automatic speech intelligent system, thereby improving the objective health outcomes of patients undergoing long-term dialysis. Method: This study developed an automatic speech intelligent system with healthcare functions such as health information voice prompt, two-way feedback, real-time push notification, and health information delivery. Convenience sampling was adopted to recruit eligible patients from a hemodialysis center at a regional teaching hospital as research participants. A one-group pretest-posttest design was adopted. Descriptive and inferential statistics were calculated from the demographic information collected from questionnaires answered by patients and primary caregivers, and from a medical record review, a health care scale (recorded six months before and after the implementation of intervention measures), a subjective health assessment, and a report of objective physiological indicators. The changes in health care behaviors, subjective health status, and physiological indicators before and after the intervention of the proposed automatic speech intelligent system were then compared. Conclusion and Discussion: The preliminary automatic speech intelligent system developed in this study was tested with 20 pretest patients at the recruitment location, and their health care capacity scores improved from 59.1 to 72.8; comparisons through a nonparametric test indicated a significant difference (p < .01). The average score for their subjective health assessment rose from 2.8 to 3.3. A survey of their objective physiological indicators discovered that the compliance rate for the blood potassium level was the most significant indicator; its average compliance rate increased from 81% to 94%. The results demonstrated that this automatic speech intelligent system yielded a higher efficacy for chronic disease care than did conventional health education delivered by nurses. Therefore, future efforts will continue to increase the number of recruited patients and to refine the intelligent system. Future improvements to the intelligent system can be expected to enhance its effectiveness even further.

Keywords: automatic speech intelligent system for health care, primary caregiver, long-term hemodialysis, health care capabilities, health outcomes

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Authors: Liang Zhao, Chongquan Zhong

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Introduction: According to statistics, people spend 80% to 90% of time indoor, so indoor air quality, either at home or in the office, greatly impacts the quality of life, health and work efficiency. Therefore, indoor air quality is very important to human activities. With the acceleration of urbanization, people are spending more time in indoor activity. The time in indoor environment, the living space, and the frequency interior decoration are all increasingly increased. However, housing decoration materials contain formaldehyde and other harmful substances, causing environmental and air quality problems, which have brought serious damage to countless families and attracted growing attention. According to World Health Organization statistics, the indoor environments in more than 30% of buildings in China are polluted by poisonous and harmful gases. Indoor pollution has caused various health problems, and these widespread public health problems can lead to respiratory diseases. Long-term inhalation of low-concentration formaldehyde would cause persistent headache, insomnia, weakness, palpitation, weight loss and vomiting, which are serious impacts on human health and safety. On the other hand, as for offices, some surveys show that good indoor air quality helps to enthuse the staff and improve the work efficiency by 2%-16%. Therefore, people need to further understand the living and working environments. There is a need for easy-to-use indoor environment monitoring instruments, with which users only have to power up and monitor the environmental parameters. The corresponding real-time data can be displayed on the screen for analysis. Environment monitoring should have the sensitive signal alarm function and send alarm when harmful gases such as formaldehyde, CO, SO2, are excessive to human body. System design: According to the monitoring requirements of various gases, temperature and humidity, we designed a portable, light, real-time and accurate monitor for various environmental parameters, including temperature, humidity, formaldehyde, methane, and CO. This monitor will generate an alarm signal when a target is beyond the standard. It can conveniently measure a variety of harmful gases and provide the alarm function. It also has the advantages of small volume, convenience to carry and use. It has a real-time display function, outputting the parameters on the LCD screen, and a real-time alarm function. Conclusions: This study is focused on the research and development of a portable parameter monitoring instrument for indoor environment. On the platform of an STM32 development board, the monitored data are collected through an external sensor. The STM32 platform is for data acquisition and processing procedures, and successfully monitors the real-time temperature, humidity, formaldehyde, CO, methane and other environmental parameters. Real-time data are displayed on the LCD screen. The system is stable and can be used in different indoor places such as family, hospital, and office. Meanwhile, the system adopts the idea of modular design and is superior in transplanting. The scheme is slightly modified and can be used similarly as the function of a monitoring system. This monitor has very high research and application values.

Keywords: indoor air quality, gas concentration detection, embedded system, sensor

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Authors: Luís M. João, Patrício Langa

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The article reviews the literature on quality assurance (QA) in African higher education studies (HES) conducted through a bibliometric mapping of published papers between 1999 and 2019. Specifically, the article highlights the nuances of knowledge production in four scientific databases: Scopus, Web of Science (WoS), African Journal Online (AJOL), and Google Scholar. The analysis included 531 papers, of which 127 are from Scopus, 30 are from Web of Science, 85 are from African Journal Online, and 259 are from Google Scholar. In essence, 284 authors wrote these papers from 231 institutions and 69 different countries (i.e., Africa=54 and outside Africa=15). Results indicate the existing knowledge. This analysis allows the readers to understand the growth and development of the field during the two-decade period, identify key contributors, and observe potential trends or gaps in the research. The paper employs bibliometric mapping as its primary analytical lens. By utilizing this method, the study quantitatively assesses the publications related to QA in African HES, helping to identify patterns, collaboration networks, and disparities in research output. The bibliometric approach allows for a systematic and objective analysis of large datasets, offering a comprehensive view of the knowledge production in the field. Furthermore, the study highlights the lack of shared resources available to enhance quality in higher education institutions (HEIs) in Africa. This finding underscores the importance of promoting collaborative research efforts, knowledge exchange, and capacity building within the region to improve the overall quality of higher education. The paper argues that despite the growing quantity of QA research in African higher education, there are challenges related to citation impact and access to high-impact publication avenues for African researchers. It emphasises the need to promote collaborative research and resource-sharing to enhance the quality of HEIs in Africa. The analytical lenses of bibliometric mapping and the examination of publication players' scenarios contribute to a comprehensive understanding of the field and its implications for African higher education.

Keywords: Africa, bibliometric research, higher education studies, quality assurance, scientific database, systematic review

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Authors: Mochamad Nuruz Zaman, Mangatur Rudolf Nababan, M. A. Djatmika

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Both society and education areas teach to have good communication for building the interpersonal skills up. Everyone has the capacity to understand something new, either well comprehension or worst understanding. Worst understanding makes the language errors when the interactions are done by someone in the first meeting, and they do not know before it because of distance area. “The Space between Us” movie delivers the love-adventure story between Mars Boy and Earth Girl. They are so many missing conversations because of the different climate and environment. As the moviegoer also must be focused on the subtitle in order to enjoy well the movie. Furthermore, Indonesia subtitle and English conversation on the movie still have overlapping understanding in the translation. Translation hereby consists of source language -SL- (English conversation) and target language -TL- (Indonesia subtitle). These research gap above is formulated in research question by how the language errors happened in that movie and their effects on translation quality which is deepest analyzed by translation study toward discourse analysis approach. The research goal is to expand the language errors and their translation qualities in order to create a good atmosphere in movie media. The research is studied by embedded research in qualitative design. The research locations consist of setting, participant, and event as focused determined boundary. Sources of datum are “The Space between Us” movie and informant (translation quality rater). The sampling is criterion-based sampling (purposive sampling). Data collection techniques use content analysis and questioner. Data validation applies data source and method triangulation. Data analysis delivers domain, taxonomy, componential, and cultural theme analysis. Data findings on the language errors happened in the movie are referential, register, society, textual, receptive, expressive, individual, group, analogical, transfer, local, and global errors. Data discussions on their effects to translation quality are concentrated by translation techniques on their data findings; they are amplification, borrowing, description, discursive creation, established equivalent, generalization, literal, modulation, particularization, reduction, substitution, and transposition.

Keywords: discourse analysis, language errors, The Space between Us movie, translation techniques, translation quality instruments

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Authors: Yasemin Ilkay

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Urban spatial pattern interacts with the minds and bodies of citizens and influences their perception and attitudes, which leads to a two-folded map of the same space: physical and Psychogeographic maps. Psychogeography is a field of inquiry (rooted in literature and fiction) investigating how the environment affects the feelings and behaviors of individuals. This term was posed by Situationist International Movement in the 1950s by Guy Debord; in the course of time, the artistic framework evolved into a political issue, especially with the term Dérive, which indicates ‘deviation’ and ‘resistance’ to the existing spatial reality. The term Dérive appeared on the track of Flânéur after one hundred years; and turned out to be a political tool to transform everyday urban life. The three main concepts of psychogeography [walking, dérive, and palimpsest] construct the epistemological framework for a psychogeographic spatial analysis. Mental representations investigating this framework would provide a designer to capture the invisible layers of the gap between ‘how a space is conceived’ and ‘how the same space is perceived and experienced.’ This gap is a neglected but critical issue to discuss in the planning discipline, and psychogeography provides methodological inputs to cover the interrelation among top-down designs of urban patterning and bottom-up reproductions of ‘the soul’ of urban space at the intersection of geography and psychology. City centers and university campuses exemplify opposite poles of spatial organization and walking practice, which may result in differentiated spatial appropriation forms. There is a traditional city center in Van, located at the core of the city with a dense population and several activities, but not connected to Van Lake, which is the largest lake in the country. On the other hand, the university campus is located at the periphery, and although it has a promenade along the lake’s coast and a regional hospital, it presents a limited walking experience with ambiguous forms of spatial appropriation. The city center draws a vivid urban everyday life; however, the campus presents a relatively natural life far away from the center. This paper aims to reveal the differentiated psychogeographic maps of spatial appropriation at the city center vs. the university campus, which is located at the periphery of the city and along the coast of the largest lake in Turkey. The main question of the paper is, “how do the psychogeographic maps of spatial appropriation differentiate at the city center and university campus in Van within the walking experience with reference to the two-folded map assumption.” The experiential maps of a core group of 15 planning students will be created with the techniques of mental mapping, photographing, and narratives through attentive walks conducted together on selected routes; in addition to these attentive walks, 30 more in-depth interviews will be conducted by the core group. The narrative of psychogeographic mapping of spatial appropriation at the two spatial poles would display the conflicting soul of the city with reference to sub-behavioural regions of walking, differentiated forms of derive and layers of palimpsest.

Keywords: attentive walk, body, cognitive geography, derive, experiential maps, psychogeography, Van, Turkey

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Authors: Po-Ching Wang

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Considering the notable effects of natural resource consumption and impacts on fragile ecosystems, reflection on contemporary sustainable design is critical. Nevertheless, the idea of ‘green’ has been misapplied and even abused, and, in fact, much damage to the environment has been done in its name. In 1996’s popular science fiction film Independence Day, an alien species, having exhausted the natural resources of one planet, moves on to another —a fairly obvious irony on contemporary human beings’ irresponsible use of the Earth’s natural resources in modern times. In fact, the human ambition to master nature and freely access the world’s resources has long been inherent in manifestos evinced by productions of the environmental design professions. Ron Herron’s Walking City, an experimental architectural piece of 1964, is one example that comes to mind here. For this design concept, the architect imagined a gigantic nomadic urban aggregate that by way of an insect-like robotic carrier would move all over the world, on land and sea, to wherever its inhabitants want. Given the contemporary crisis regarding natural resources, recently ideas pertinent to structuring a sustainable environment have been attracting much interest in architecture, a field that has been accused of significantly contributing to ecosystem degradation. Great art, such as Fallingwater building, has been regarded as nature-friendly, but its notion of ‘green’ might be inadequate in the face of the resource demands made by human populations today. This research suggests a more conservative and scrupulous attitude to attempting to modify nature for architectural settings. Designs that pursue spiritual or metaphysical interconnections through anthropocentric aesthetics are not sufficient to benefit ecosystem integrity; though high-tech energy-saving processes may contribute to a fine-scale sustainability, they may ultimately cause catastrophe in the global scale. Design with frugality is proposed in order to actively reduce environmental load. The aesthetic taste and ecological sensibility of design professions and the public alike may have to be reshaped in order to make the goals of environmental sustainability viable.

Keywords: anthropocentric aesthetic, aquarium sustainability, biosphere 2, ecological aesthetic, ecological footprint, frugal design

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Authors: Nilanthi Ratnayake, Wen-Ling Liu

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Prior research indicates an increasing gap between the skills and capabilities of graduates in the contemporary workplace across the globe. The challenge of addressing this issue primarily lies on the hands of higher education institutes/universities. In particular, surveys of UK employers and retailers found that soft skills including communication, numeracy, teamwork, confidence, analytical ability, digital/IT skills, business sense, language, and social skills are highly valued by graduate employers, and in achieving this, there are various assessed and non-assessed learning exercises have already been embedded into the university curriculum. To this end, this research study aims to explore the reflections of postgraduate student participation in a live commercial project (i.e. designing an advertising campaign for open days, summer school etc.) implemented with the intention of offering a transformative experience by deploying this project. Qualitative research methodology has been followed in this study, collecting data from three types of target audiences; students, academics and employers via a series of personal interviews and focus group discussions. Recorded data were transcribed, entered into NVIVO, and analysed using meaning condensation and content analysis. Students reported that they had a very positive impact towards improving self-efficacy, especially in relation to soft skills and confidence in seeking employment opportunities. In addition, this project has reduced cultural barriers for international students in general communications. Academic staff and potential employers who attended on the presentation day expressed their gratitude for offering a lifelong experience for students, and indeed believed that these type of projects contribute significantly to enhance skills and capabilities of students to cater the demands of employers. In essence, key findings demonstrate that an integration of knowledge-based skills into a live commercial project facilitate individuals to make the transition from education to employment in terms of skills, abilities and work behaviours more effectively in comparison to some other activities/assuagements that are currently in place in higher education institutions/universities.

Keywords: soft skills, commercially live project, higher education, student participation

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Authors: Sami W. Tabsh

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The strength of reinforced concrete depends on the member dimensions and material properties. The properties of concrete and steel materials are not constant but random variables. The variability of concrete strength is due to batching errors, variations in mixing, cement quality uncertainties, differences in the degree of compaction and disparity in curing. Similarly, the variability of steel strength is attributed to the manufacturing process, rolling conditions, characteristics of base material, uncertainties in chemical composition, and the microstructure-property relationships. To account for such uncertainties, codes of practice for reinforced concrete design impose resistance factors to ensure structural reliability over the useful life of the structure. In this investigation, the effects of reductions in concrete and reinforcing steel strengths from the nominal values, beyond those accounted for in the structural design codes, on the structural reliability are assessed. The considered limit states are flexure, shear and axial compression based on the ACI 318-11 structural concrete building code. Structural safety is measured in terms of a reliability index. Probabilistic resistance and load models are compiled from the available literature. The study showed that there is a wide variation in the reliability index for reinforced concrete members designed for flexure, shear or axial compression, especially when the live-to-dead load ratio is low. Furthermore, variations in concrete strength have minor effect on the reliability of beams in flexure, moderate effect on the reliability of beams in shear, and sever effect on the reliability of columns in axial compression. On the other hand, changes in steel yield strength have great effect on the reliability of beams in flexure, moderate effect on the reliability of beams in shear, and mild effect on the reliability of columns in axial compression. Based on the outcome, it can be concluded that the reliability of beams is sensitive to changes in the yield strength of the steel reinforcement, whereas the reliability of columns is sensitive to variations in the concrete strength. Since the embedded target reliability in structural design codes results in lower structural safety in beams than in columns, large reductions in material strengths compromise the structural safety of beams much more than they affect columns.

Keywords: code, flexure, limit states, random variables, reinforced concrete, reliability, reliability index, shear, structural safety

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Authors: Asinguza P. Allan

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The Advocacy for Better Health aims to equip citizens with enabling environment and systems to effectively advocate for strong action plans to improve health services. This is because the 2020 Government target for Uganda to transform into a middle income country will be achieved if investment is made in keeping the population healthy and productive. Citizen participation as an important foundation for change has been emphasized to gather data through participatory rural appraisal and inform evidence-based advocacy for recruitment and motivation of human resources. Citizens conduct problem ranking during advocacy forums on staffing levels and health worker absenteeism. Citizens prioritised inadequate number of midwives and absenteeism. On triangulation, health worker to population ratio in Uganda remains at 0.25/1,000 which is far below the World Health Organization (WHO) threshold of 2.3/1,000. Working with IntraHealth, the project advocated for recruitment of critical skilled staff (doctors and midwives) and scale up health workers motivation strategy to reduce Uganda’s Neonatal Mortality Rate of 22/1,000 and Maternal Mortality Ratio of 320/100,000. Government has committed to increase staffing to 80% by 2018 (10 districts have passed ordinances and revived use of duty rosters to address health worker absenteeism. On the other hand, the better health advocacy debate has been elevated with need to increase health sector budget allocations from 8% to 10%. The project has learnt that building a body of evidence from citizens enhances the advocacy agenda. Communities will further monitor government commitments to reduce Neonatal Mortality Rate and Maternal Mortality Ratio. The project has learnt that interface meeting between duty bearers and the community allows for immediate feedback and the process is a strong instrument for empowerment. It facilitates monitoring and performance evaluation of services, projects and government administrative units (like district assemblies) by the community members themselves. This, in turn, makes the human resources in health to be accountable, transparent and responsive to communities where they work. This, in turn, promotes human resource performance.

Keywords: advocacy, empowerment, evidence, human resources

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Authors: Jamie E. Banker

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For many families, pregnancy and the postpartum time are filled with both anticipation and change. For some pregnant or postpartum women, this time is marked by the onset of a mood or anxiety disorder. Experiencing a mood or anxiety disorders during this time of life differs from depression or anxiety at other times of life. Not only because of the physical changes occurring in the mother’s body but also the mental and physical preparation necessary to redefine family roles, responsibilities, and develop new identities in the life transition. The presence of a mood or anxiety disorder can influence the way in which a mother defines herself and can complicate her understanding of her abilities and competencies as a mother. The complexity of experiencing a mood or anxiety disorder in the midst of these changes necessitates specific treatment interventions to match both the symptomatology and psychological adjustments. This study explores the use of narrative family therapy techniques when treating a mother who is experiencing postpartum depression. Externalization is a common technique used in narrative family therapy and can help client’s separate their identity from the problems they are experiencing. This is crucial to a new mom who is in the middle of defining her identity during her transition to parenthood. The goal of this study is to examine how the use of externalization techniques help postpartum women separate their mood and anxiety symptoms from their identity as a mother. An exploratory case study design was conducted in a single setting, private practice therapy office, and explored how a narrative family therapy approach can be used to treat perinatal mood and anxiety disorders. The therapy sessions were audio recorded and transcribed. Constructivism and narrative theory are used as theoretical frameworks and data from the therapy sessions, and a follow-up survey was triangulated and analyzed. During the course of the treatment, the participant reports using the new externalizing labels for her symptoms. Within one month of treatment, the participant reports that she could stop herself from thinking the harmful thoughts faster, and within three months, the harmful thoughts went away. The main themes in this study were building courage and less self-blame. This case highlights the role narrative family therapy can play in the treatment of perinatal mood and anxiety disorders and the importance of separating a women’s mood from her identity as a mother. This conceptual framework was beneficial to the postpartum mother when treating perinatal mood and anxiety disorder symptoms.

Keywords: externalizing techniques, narrative family therapy, perinatal mood and anxiety disorders, postpartum depression

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Authors: Tomokazu Nagata, Jawid Ahmad Baktash

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The goal of this paper is to explore the use of formal methods for Electronic Identity Card System. Nowadays, one of the core research directions in a constantly growing distributed environment is the improvement of the communication process. The responsibility for proper verification becomes crucial. Formal methods can play an essential role in the development and testing of systems. The thesis presents two different methodologies for assessing correctness. Our first approach employs abstract interpretation techniques for creating a trace based model for Electronic Identity Card System. The model was used for building a semi decidable procedure for verifying the system model. We also developed the code for the eID System and can cover three parts login to system sending of Acknowledgment from user side, receiving of all information from server side and log out from system. The new concepts of impasse and spawned sessions that we introduced led our research to original statements about the intruder’s knowledge and eID system coding with respect to secrecy. Furthermore, we demonstrated that there is a bound on the number of sessions needed for the analysis of System.Electronic identity (eID) cards promise to supply a universal, nation-wide mechanism for user authentication. Most European countries have started to deploy eID for government and private sector applications. Are government-issued electronic ID cards the proper way to authenticate users of online services? We use the eID project as a showcase to discuss eID from an application perspective. The new eID card has interesting design features, it is contact-less, it aims to protect people’s privacy to the extent possible, and it supports cryptographically strong mutual authentication between users and services. Privacy features include support for pseudonymous authentication and per service controlled access to individual data items. The article discusses key concepts, the eID infrastructure, observed and expected problems, and open questions. The core technology seems ready for prime time and government projects deploy it to the masses. But application issues may hamper eID adoption for online applications.

Keywords: eID, event-B, Pro-B, formal method, message passing

Procedia PDF Downloads 219

Authors: Thanduxolo Elford Fana

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Rationale and Purpose: Performance management and development system are central to effective and efficient service delivery, especially in highly labour intensive sectors such as South African public health. Performance management and development systems seek to ensure that good employee performance is rewarded accordingly, while those who underperform are developed so that they can reach their full potential. An effective and efficiently implemented performance management system motivates and improves employee engagement. The purpose of this study is to examine the implementation of the performance management and development system and the challenges that are encountered during its implementation in the Eastern Cape Provincial Department of Health. Methods: A qualitative research approach and a case study design was adopted in this study. The primary data were collected through observations, focus group discussions with employees, a group interview with shop stewards, and in-depth interviews with supervisors and managers, from April 2019 to September 2019. There were 45 study participants. In-depth interviews were held with 10 managers at facility level, which included chief executive officer, chief medical officer, assistant director’s in human resources management, patient admin, operations, finance, and two area manager and two operation managers nursing. A group interview was conducted with five shop stewards and an in-depth interview with one shop steward from the group. Five focus group discussions were conducted with clinical and non-clinical staff. The focus group discussions were supplemented with an in-depth interview with one person from each group in order to counter the group effect. Observations included moderation committee, contracting, and assessment meetings. Findings: The study shows that the performance management and development system was not properly implemented. There was non-compliance to performance management and development system policy guidelines in terms of time lines for contracting, evaluation, payment of incentives to good performers, and management of poor performance. The study revealed that the system is ineffective in raising the performance of employees and unable to assist employees to grow. The performance bonuses were no longer paid to qualifying employees. The study also revealed that lack of capacity and commitment, poor communication, constant policy changes, financial constraints, weak and highly bureaucratic management structures, union interference were challenges that were encountered during the implementation of the performance management and development system. Lastly, employees and supervisors were rating themselves three irrespective of how well or bad they performed. Conclusion: Performance management is regarded as vital to improved performance of the health workforce and healthcare service delivery among populations. Effective implementation of performance management and development system depends on well-capacitated and unbiased management at facility levels. Therefore, there is an urgent need to improve communication, link performance management to rewards, and capacitate staff on performance management and development system, as it is key to improved public health sector outcomes or performance.

Keywords: challenges, implementation, performance management and development system, public hospital

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Authors: Golson Mohamed, Yasmine Gamasy, Khaled EL-Khatib, Anas Al-Natour, Shady Fadel, Haytham Rashwan, Haytham Badawy, Nadia Farghaly

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Introduction: Wilm's tumor is the most common malignant renal tumor in children. Much progress has been made in the management of patients with this malignancy over the last 3 decades. Today treatments are based on several trials and studies conducted by the International Society of Pediatric Oncology (SIOP) in Europe and National Wilm's Tumor Study Group (NWTS) in the USA. It is necessary for us to understand why do we follow either of the protocols, NWTS which follows the upfront surgery principle or the SIOP which follows the upfront chemotherapy principle in all stages of the disease. Objective: The aim of is to assess outcome in patients treated with preoperative chemotherapy and patients treated with upfront surgery to compare their effect on overall survival. Study design: to decide which protocol to follow, study was carried out on records for patients aged 1 day to 18 years old suffering from Wilm's tumor who were admitted to Alexandria University Hospital, pediatric oncology, pediatric urology and pediatric surgery departments, with a retrospective survey records from 2010 to 2015, Design and editing of the transfer sheet with a (PRISMA flow study) Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (11) Qualitative data were described using number and percent. Quantitative data were described using Range (minimum and maximum), mean, standard deviation and median. Comparison between different groups regarding categorical variables was tested using Chi-square test. When more than 20% of the cells have expected count less than 5, correction for chi-square was conducted using Fisher’s Exact test or Monte Carlo correction. The distributions of quantitative variables were tested for normality using Kolmogorov-Smirnov test, Shapiro-Wilk test, and D'Agstino test, if it reveals normal data distribution, parametric tests were applied. If the data were abnormally distributed, non-parametric tests were used. For normally distributed data, a comparison between two independent populations was done using independent t-test. For abnormally distributed data, comparison between two independent populations was done using Mann-Whitney test. Significance of the obtained results was judged at the 5% level. Results: A significantly statistical difference was observed for survival between the two studied groups favoring the upfront chemotherapy(86.4%)as compared to the upfront surgery group (59.3%) where P=0.009. As regard complication, 20 cases (74.1%) out of 27 were complicated in the group of patients treated with upfront surgery. Meanwhile, 30 cases (68.2%) out of 44 had complications in patients treated with upfront chemotherapy. Also, the incidence of intraoperative complication (rupture) was less in upfront chemotherapy group as compared to upfront surgery group. Conclusion: Upfront chemotherapy has superiority over upfront surgery.As the patient who started with upfront chemotherapy shown, higher survival rate, less percent in complication, less percent needed for radiotherapy, and less rate in recurrence.

Keywords: Wilm's tumor, renal tumor, chemotherapy, surgery

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Authors: Salima R. Rajwani, Tazeen Ali, Rubina Barolia, Yasmin Parpio, Nasreen Alwani, Salima B. Virani

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Introduction: Nurses and physicians have a critical role in initiating lifesaving interventions during cardiac arrest. It is important that timely delivery of high quality Cardio Pulmonary Resuscitation (CPR) with advanced resuscitation skills and management of cardiac arrhythmias is a key dimension of code during cardiac arrest. It will decrease the chances of patient survival if the healthcare professionals are unable to initiate CPR timely. Moreover, traditional training will not prepare physicians and nurses at a competent level and their knowledge level declines over a period of time. In this regard, simulation training has been proven to be effective in promoting resuscitation skills. Simulation teaching learning strategy improves knowledge level, and skills performance during resuscitation through experiential learning without compromising patient safety in real clinical situations. The purpose of the study is to evaluate the effectiveness of simulation training in Advanced Cardiac Life Support Courses by using the selfefficacy tool. Methods: The study design is a quantitative research design and non-randomized quasi-experimental study design. The study examined the effectiveness of simulation through self-efficacy in two instructional methods; one is Medium Fidelity Simulation (MFS) and second is Traditional Training Method (TTM). The sample size was 220. Data was compiled by using the SPSS tool. The standardized simulation based training increases self-efficacy, knowledge, and skills and improves the management of patients in actual resuscitation. Results: 153 students participated in study; CG: n = 77 and EG: n = 77. The comparison was done between arms in pre and post-test. (F value was 1.69, p value is <0.195 and df was 1). There was no significant difference between arms in the pre and post-test. The interaction between arms was observed and there was no significant difference in interaction between arms in the pre and post-test. (F value was 0.298, p value is <0.586 and df is 1. However, the results showed self-efficacy scores were significantly higher within experimental group in post-test in advanced cardiac life support resuscitation courses as compared to Traditional Training Method (TTM) and had overall (p <0.0001) and F value was 143.316 (mean score was 45.01 and SD was 9.29) verses pre-test result showed (mean score was 31.15 and SD was 12.76) as compared to TTM in post-test (mean score was 29.68 and SD was 14.12) verses pre-test result showed (mean score was 42.33 and SD was 11.39). Conclusion: The standardized simulation-based training was conducted in the safe learning environment in Advanced Cardiac Life Suport Courses and physicians and nurses benefited from self-confidence, early identification of life-threatening scenarios, early initiation of CPR, and provides high-quality CPR, timely administration of medication and defibrillation, appropriate airway management, rhythm analysis and interpretation, and Return of Spontaneous Circulation (ROSC), team dynamics, debriefing, and teaching and learning strategies that will improve the patient survival in actual resuscitation.

Keywords: advanced cardiac life support, cardio pulmonary resuscitation, return of spontaneous circulation, simulation

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Authors: Renzhi Qi, Zhaoping Zhong

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Under the dual pressure of the global energy crisis and environmental pollution, avoiding the consumption of non-renewable fossil fuels based on carbon as the energy carrier and developing and utilizing non-carbon energy carriers are the basic requirements for the future new energy economy. Electrocatalyst for water splitting plays an important role in building sustainable and environmentally friendly energy conversion. The oxygen evolution reaction (OER) is essentially limited by the slow kinetics of multi-step proton-electron transfer, which limits the efficiency and cost of water splitting. In this work, CeO₂@NiCo-NRGO/NF hybrid materials were prepared using nickel foam (NF) and nitrogen-doped reduced graphene oxide (NRGO) as conductive substrates by multi-step hydrothermal method and were used as highly efficient catalysts for OER. The well-connected nanosheet array forms a three-dimensional (3D) network on the substrate, providing a large electrochemical surface area with abundant catalytic active sites. The doping of CeO₂ in NiCo-NRGO/NF electrocatalysts promotes the dispersion of substances and its synergistic effect in promoting the activation of reactants, which is crucial for improving its catalytic performance against OER. The results indicate that CeO₂@NiCo-NRGO/NF only requires a lower overpotential of 250 mV to drive the current density of 10 mA cm-2 for an OER reaction of 1 M KOH, and exhibits excellent stability at this current density for more than 10 hours. The double layer capacitance (Cdl) values show that CeO₂@NiCo-NRGO/NF significantly affects the interfacial conductivity and electrochemically active surface area. The hybrid structure could promote the catalytic performance of oxygen evolution reaction, such as low initial potential, high electrical activity, and excellent long-term durability. The strategy for improving the catalytic activity of NiCo-LDH can be used to develop a variety of other electrocatalysts for water splitting.

Keywords: CeO₂, reduced graphene oxide, NiCo-layered double hydroxide, oxygen evolution reaction

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Authors: Ewa Kicko Walczak, Grazyna Rymarz

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In recent years, nanotechnology has been successfully applied for flame retardancy of polymers, in particular for construction materials. The consumption of thermoset resins as a construction polymers materials is approximately over one million tone word wide. Excellent mechanical, relatively high heat and thermal stability of their type of polymers are proven for variety applications, e.g. transportation, electrical, electronic, building part industry. Above applications in addition to the strength and thermal properties also requires -referring to the legal regulation or recommendation - an adequate level of flammability of the materials. This publication present the evaluation was made of effectiveness of flame retardancy of halogen-free hybrid flame retardants(FR) as compounds nitric/phosphorus modifiers that act with nanofillers (nano carbons, organ modified montmorillonite, nano silica, microsphere) in relation to unsaturated polyester/epoxy resins and glass-reinforced on base this resins laminates(GRP) as a final products. The analysis of the fire properties provided proof of effective flame retardancy of the tested composites by defining oxygen indices values (LOI), with the use of thermogravimetric methods (TGA) and combustion head (CH). An analysis of the combustion process with Cone Calorimeter (CC) method included in the first place N/P units and nanofillers with the observed phenomenon of synergic action of compounds. The fine-plates, phase morphology and rheology of composites were assessed by SEM/ TEM analysis. Polymer-matrix glass reinforced laminates with modified resins meet LOI over 30%, reduced in a decrease by 70% HRR (according to CC analysis), positive description of the curves TGA and values CH; no adverse negative impact on mechanical properties. The main objective of our current project is to contribute to the general understanding of the flame retardants mechanism and to investigate the corresponding structure/properties relationships. We confirm that nanotechnology systems are successfully concept for commercialized forms for non-flammable GRP pipe, concrete composites, and flame retardant tunnels constructions.

Keywords: fire retardants, FR, halogen-free FR nanofillers, non-flammable pipe/concrete, thermoset resins

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Authors: Bianca Maria Rulli, Lenny Valentino Schiaretti

Abstract:

The considerable recent urbanization has increasingly sharpened environmental and social problems all over the world. During the recent years, many answers to the alarming attitudes in modern cities have emerged: a drastic reduction in the rate of growth is becoming essential for future generations and small scale economies are considered more adaptive and sustainable. According to the concept of degrowth, cities should consider surpassing the centralization of urban living by redefining the relationship between rural and urban knowledge; growing food in cities fundamentally contributes to the increase of social and ecological resilience. Through an innovative approach, this research combines the benefits of urban agriculture (increase of biological diversity, shorter and thus more efficient supply chains, food security) and temporary land use. They stimulate collaborative practices to satisfy the changing needs of communities and stakeholders. The concept proposes a coherent strategy to create a sustainable development of urban spaces, introducing a productive green-network to link specific areas in the city. By shifting the current relationship between architecture and landscape, the former process of ground consumption is deeply revised. Temporary modules can be used as concrete tools to create temporal areas of innovation, transforming vacant or marginal spaces into potential laboratories for the development of the city. The only permanent ground traces, such as foundations, are minimized in order to allow future land re-use. The aim is to describe a new mindset regarding the quality of space in the metropolis which allows, in a completely flexible way, to bring back the green and the urban farming into the cities. The wide possibilities of the research are analyzed in two different case-studies. The first is a regeneration/connection project designated for social housing, the second concerns the use of temporary modules to answer to the potential needs of social structures. The intention of the productive green-network is to link the different vacant spaces to each other as well as to the entire urban fabric. This also generates a potential improvement of the current situation of underprivileged and disadvantaged persons.

Keywords: degrowth, green network, land use, temporary building, urban farming

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Authors: Iliana Georganta, Clare Deehan, Marysia Thomson, Miriam McDonald, Kerrie McNulty, Anna Strachan, Elizabeth Anderson, Alyaa Mostafa

Abstract:

Context: A meta-analysis of randomized controlled trials (RCTs) comparing hysterectomy versus endometrial ablation and resection in the management of heavy menstrual bleeding. Objective: To evaluate the clinical efficacy, satisfaction rates and adverse events of hysterectomy compared to more minimally invasive techniques in the treatment of HMB. Evidence Acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing hysterectomy with either endometrial ablation endometrial resection of both. The search had no language restrictions and was last updated in June 2020 using MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, PubMed, Google Scholar, PsycINFO, Clinicaltrials.gov and Clinical trials. EU. In addition, a manual search of the abstract databases of the European Haemophilia Conference on women's health was performed and further studies were identified from references of acquired papers. The primary outcomes were patient-reported and objective reduction in heavy menstrual bleeding up to 2 years and after 2 years. Secondary outcomes included satisfaction rates, pain, adverse events short and long term, quality of life and sexual function, further surgery, duration of surgery and hospital stay and time to return to work and normal activities. Data were analysed using RevMan software. Evidence synthesis: 12 studies and a total of 2028 women were included (hysterectomy: n = 977 women vs endometrial ablation or resection: n = 1051 women). Hysterectomy was compared with endometrial ablation only in five studies (Lin, Dickersin, Sesti, Jain, Cooper) and endometrial resection only in five studies (Gannon, Schulpher, O’Connor, Crosignani, Zupi) and a mixture of the Ablation and Resection in two studies (Elmantwe, Pinion). Of the 1² studies, 10 reported women’s perception of bleeding symptoms as improved. Meta-analysis showed that women in the hysterectomy group were more likely to show improvement in bleeding symptoms when compared with endometrial ablation or resection up to 2-year follow-up (RR 0.75, 95% CI 0.71 to 0.79, I² = 95%). Objective outcomes of improvement in bleeding also favored hysterectomy. Patient satisfaction was higher after hysterectomy within the 2 years follow-up (RR: 0.90, 95%CI: 0.86 to 0.94, I²:58%), however, there was no significant difference between the two groups at more than 2 years follow up. Sepsis (RR: 0.03, 95% CI 0.002 to 0.56; 1 study), wound infection (RR: 0.05, 95% CI: 0.01 to 0.28, I²: 0%, 3 studies) and Urinary tract infection (UTI) (RR: 0.20, 95% CI: 0.10 to 0.42, I²: 0%, 4 studies) all favoured hysteroscopic techniques. Fluid overload (RR: 7.80, 95% CI: 2.16 to 28.16, I² :0%, 4 studies) and perforation (RR: 5.42, 95% CI: 1.25 to 23.45, I²: 0%, 4 studies) however favoured hysterectomy in the short term. Conclusions: This meta-analysis has demonstrated that endometrial ablation and endometrial resection are both viable options when compared with hysterectomy for the treatment of heavy menstrual bleeding. Hysteroscopic procedures had better outcomes in the short term with fewer adverse events including wound infection, UTI and sepsis. The hysterectomy performed better when measuring more long-term impacts such as recurrence of symptoms, overall satisfaction at two years and the need for further treatment or surgery.

Keywords: menorrhagia, hysterectomy, ablation, resection

Procedia PDF Downloads 146