Search results for: clinical quality

Authors: Jamuna Rajeswaran

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In the past two decades, with a population of more than a billion. India is passing through a major socio-demographic and epidemiological transition with consequent changes in health scenario. TBI constitute significant burden on health care resources in India The impact on a person and family can be devastating. Patients with TBI experience persistent cognitive deficits, emotional changes, which contribute to the disruption of life activities. The recovery of TBI would be maximized by appropriate rehabilitation. Neurofeedback is an emerging neuroscience-based clinical application. Sixty patients were recruited for this study after obtaining informed consent. Rivermead Head Injury Follow-up Questionnaire, Rivermead Post Concussion Symptoms Questionnaire and Visual Analog Scale were used to assess the behavioral and symptomotolgy associated with post TBI. Neuropsychological assessment was carried out using NIMHANS neuropsychological battery 2004. The Intervention group received neurofeedback training and the waitlist group did not receive any treatment during this phase. Patients were allocated to intervention and waitlist group at random. There were 30 patients in each group. Patients were given 20 sessions of NFT Patients were trained on the O1 and O2 channels for alpha theta training. Each session was of 40 minutes duration with 5-6 sessions per week. The post-training assessment was carried out for the intervention group after 20 sessions of NFT. The waitlist group underwent assessment after one month. Results showed neurofeedback training is effective in ameliorating deficits in cognitive functions and quality of life in patients with TBI. Improvements were corroborated by the clinical interview with patients and significant others post NFT.

Keywords: assessment, rehabilitation, cognition, EEG neurofeedback

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Authors: Vasiliki Markantoni, Eftychia Platsidaki, Georgios Chaidemenos, Georgios Kontochristopoulos

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Introduction: Bromhidrosis, also known as osmidrosis, is a common distressing condition with a significant negative effect on patient’s quality of life. Its etiology is multifactorial. It usually affects axilla, genital skin, breasts and soles, areas where apocrine glands are mostly distributed. Therapeutic treatments include topical antibacterial agents, antiperspirants and neuromuscular blocker agents-toxins. In this study, we aimed to evaluate the efficacy and possible complications of topical glycopyrrolate, an anticholinergic agent, for treatment of bromhidrosis. Glycopyrrolate, applied topically as a cream, solution or spray at concentrations between 0,5% and 4%, has been successfully used to treat different forms of focal hyperhidrosis. Materials and Methods: Twenty patients, six males and fourteen females, meeting the criteria for bromhidrosis were treated with topical glycopyrrolate for two months. The average age was 36. Eleven patients had bromhidrosis located to the axillae, four to the soles, four to both axillae and soles and one to the genital folds. Glycopyrrolate was applied topically as a cream at concentration 2%, formulated in Fitalite. During the first month, patients were using the cream every night and thereafter twice daily. The degree of malodor was assessed subjectively by patients and scaled averagely as ‘none’, ‘mild’, ‘moderate’, and ‘severe’ with corresponding scores of 0, 1, 2, and 3, respectively. The modified Dermatology Life Quality Index (DLQI) was used to assess the quality of life. The clinical efficacy was graded by the patient scale of excellent, good, fair and poor. In the end, patients were given the power to evaluate whether they were totally satisfied with, partially satisfied or unsatisfied and possible side effects during the treatment were recorded. Results: All patients were satisfied at the end of the treatment. No patient defined the response as no improvement. The subjectively assessed score level of bromhidrosis was remarkably improved after the first month of treatment and improved slightly more after the second month. DLQI score was also improved to all patients. Adverse effects were reported in 2 patients. In the first case, topical irritation was reported. This was classed as mild (erythema and desquamation), appeared during the second month of treatment and was treated with low-potency topical corticosteroids. In the second case, mydriasis was reported, that recovered without specific treatment, as soon as we insisted to the importance of careful hygiene after cream application so as not to contaminate the periocular skin or ocular surface. Conclusions: Dermatologists often encounter patients with bromhidrosis, therefore should be aware of treatment options. To the best of our knowledge, this is the first study to evaluate the use of topical glycopyrrolate as a therapeutic approach for bromhidrosis. Our findings suggest that topical glycopyrrolate has an excellent safety profile and demonstrate encouraging results for the management of this distressful condition.

Keywords: Bromhidrosis, glycopyrrolate, topical treatment, osmidrosis

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Authors: Kuo-C. Lo, Chung-H. Hung

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Invasion of foreign air pollutants to deteriorate local air quality has become an emerging international issue of concern. This study aimed to apply meteorological and air quality model, WRF-Chem (V3.1), for simulating and analyzing the phenomenon of forming of high-concentrated particulate matters, PM10 and PM2.5, in ambient air of Taiwan during January 17th to 19th, 2014. The foreign air pollutants were mainly from long-distance transport of air pollutants of China being transported with a strong continental cold high. It was observed that PM10 and PM2.5 peaked as high as 182~588 μg/m3 and 95~165 μg/m3, respectively, in the ambient air of west side of Taiwan. They were about 2~3 folds higher than the usual concentrations of particulate matters in these seasons.

Keywords: WRF-Chem, air pollution, PM2.5, ambient air quality

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Authors: Niloufar Yadgari

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GANs are a potent form of deep learning models that have found success in various fields. They are part of the larger group of generative techniques, which aim to produce authentic data using a probabilistic model that learns distributions from actual samples. In clinical settings, GANs have demonstrated improved abilities in capturing spatially intricate, nonlinear, and possibly subtle disease impacts in contrast to conventional generative techniques. This review critically evaluates the current research on how GANs are being used in imaging studies of different neurological conditions like Alzheimer's disease, brain tumors, aging of the brain, and multiple sclerosis. We offer a clear explanation of different GAN techniques for each use case in neuroimaging and delve into the key hurdles, unanswered queries, and potential advancements in utilizing GANs in this field. Our goal is to connect advanced deep learning techniques with neurology studies, showcasing how GANs can assist in clinical decision-making and enhance our comprehension of the structural and functional aspects of brain disorders.

Keywords: GAN, pathology, generative adversarial network, neuro imaging

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Authors: Ilirian Laçi, Alketa Spahiu

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Ageing causes an increase in the number of patients with spinal canal stenosis. Most of the patients have back pain, leg pain, numbness of the legs, as well as urinary incontinence as a very common symptoms. Urinary incontinence impairs the quality of life. Correction of the symptom of urinary incontinence is possible in the early and adequate treatment of spinal stenosis. Methods: This study observed patients with urinary incontinence and spinal canal stenosis. These patients underwent mechanical decompression of the spinal stenosis through surgery. At the same time, these patients were observed clinically with clinical consultations. Cystoscopy and urodynamic tests were conducted at intervals of 2 and 6 months. As a result of treatment, 60% of patients did recover. The patients in this group who benefit from treatment were the patients who were early diagnosed and treated. Conclusions: An important factor in the prognosis of this pathology is the early diagnosis and treatment. The proper treatment of this pathology makes it curable in most cases. An important role in this pathology is played by the neurosurgeon. Surgery accompanied by laminotomy and mechanical decompression is the best way of treatment. Other factors that played a role in this pathology are also a large number of childbirths for women, obesity, etc.

Keywords: urinary incontinence, quality of life, spinal canal stenosis, early diagnosis, treatment

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Authors: H. Zidoum, A. AlShareedah, S. Al Sawafi, A. Al-Ansari, B. Al Lawati

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Systemic lupus erythematosus (SLE) is an autoimmune disease with genetic and environmental components. SLE is characterized by a wide variability of clinical manifestations and a course frequently subject to unpredictable flares. Despite recent progress in classification tools, the early diagnosis of SLE is still an unmet need for many patients. This study proposes an interpretable disease classification model that combines the high and efficient predictive performance of CatBoost and the model-agnostic interpretation tools of Shapley Additive exPlanations (SHAP). The CatBoost model was trained on a local cohort of 219 Omani patients with SLE as well as other control diseases. Furthermore, the SHAP library was used to generate individual explanations of the model's decisions as well as rank clinical features by contribution. Overall, we achieved an AUC score of 0.945, F1-score of 0.92 and identified four clinical features (alopecia, renal disorders, cutaneous lupus, and hemolytic anemia) along with the patient's age that was shown to have the greatest contribution on the prediction.

Keywords: feature selection, classification, systemic lupus erythematosus, model interpretation, SHAP, Catboost

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Authors: Jungbin Lim, Bohee Kang, Heelim Lee, Sunjin Kim, GeumHee Choi, Jae-Suk Jung, Suk Ji

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Nonsurgical periodontal therapies have, for several decades, been the basis of periodontal treatment concepts. The aim of this paper is to investigate the effectiveness of non-surgical periodontal therapy according to the severity of periodontitis disease. Methods: Retrospective data of patients who visited Department of periodontics in Ajou University Medical Center from 2016 to 2022 were collected. Among the patients, those who took full mouth examination of clinical parameters and non-surgical periodontal therapy were chosen for this study. Selected patients were divided into initial, moderate, and severe periodontitis based on severity and complexity of management (2018 World Workshop EFP/AAP consensus). Recall visits with clinical periodontal examination were scheduled for 1,2,3 months or 1,3,6 months after the treatment. The results were evaluated by recordings of mean probing pocket depth (mean PD), mean clinical attachment levels (mean CAL), bleeding on probing (BOP%), mean gingival index (mean GI), mean regression, mean sulcus bleeding index (mean SBI), mean plaque scores (mean PI). All statistical analyses were performed with R software, version 4.3.0. A level of significance, P<0.05, was considered to be statistically significant. Results: A total of 92 patients were included in this study. 15 patients were diagnosed as initial periodontitis, 14 moderate periodontitis, and 63 severe periodontitis. The all parameters except for mean recession decreased over time in all groups. The amount of mean PD decreased were the greatest in severe periodontitis group followed by moderate and initial, which was found to be statistically significant. The changes of mean PD were 0.15±0.05 mm, 0.37±0.06 mm, and 1.01±0.07 mm (initial, moderate, and severe, respectively, P<0.001). When comparing before and after treatment, the reductions in BOP(%), mean GI, mean SBI, and mean PI were statistically significant. Conclusion: All patients who received non-surgical periodontal therapy showed periodontal healing in terms of improvements in clinical parameters, and it was greater in the severe group.

Keywords: periodontology, clinical periodontology, oral treatment, comprehensive preventive dentistry, non-surgical periodontal therapy

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Authors: Jae Ni Jang, Young Uk Kim

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Background: Chat Generative Pre-training Transformer-3 (ChatGPT; San Francisco, California, Open Artificial Intelligence) is an artificial intelligence chatbot based on a large language model designed to generate human-like text. As the usage of ChatGPT is increasing among less knowledgeable patients, medical students, and anesthesia and pain medicine residents or trainees, we aimed to evaluate the accuracy of ChatGPT-3 responses to questions about the American Society of Anesthesiologists (ASA) classification based on patients’ underlying diseases and assess the quality of the generated responses. Methods: A total of 47 questions were submitted to ChatGPT using textual prompts. The questions were designed for ChatGPT-3 to provide answers regarding ASA classification in response to common underlying diseases frequently observed in adult patients. In addition, we created 18 questions regarding the ASA classification for pediatric patients and pregnant women. The accuracy of ChatGPT’s responses was evaluated by cross-referencing with Miller’s Anesthesia, Morgan & Mikhail’s Clinical Anesthesiology, and the American Society of Anesthesiologists’ ASA Physical Status Classification System (2020). Results: Out of the 47 questions pertaining to adults, ChatGPT -3 provided correct answers for only 23, resulting in an accuracy rate of 48.9%. Furthermore, the responses provided by ChatGPT-3 regarding children and pregnant women were mostly inaccurate, as indicated by a 28% accuracy rate (5 out of 18). Conclusions: ChatGPT provided correct responses to questions relevant to the daily clinical routine of anesthesiologists in approximately half of the cases, while the remaining responses contained errors. Therefore, caution is advised when using ChatGPT to retrieve anesthesia-related information. Although ChatGPT may not yet be suitable for clinical settings, we anticipate significant improvements in ChatGPT and other large language models in the near future. Regular assessments of ChatGPT's ASA classification accuracy are essential due to the evolving nature of ChatGPT as an artificial intelligence entity. This is especially important because ChatGPT has a clinically unacceptable rate of error and hallucination, particularly in pediatric patients and pregnant women. The methodology established in this study may be used to continue evaluating ChatGPT.

Keywords: American Society of Anesthesiologists, artificial intelligence, Chat Generative Pre-training Transformer-3, ChatGPT

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Authors: Shahbaz G. Hassan

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Water quality models are very important to predict the changes in surface water quality for environmental management. The aim of this paper is to give an overview of the water qualities, and to provide directions for selecting models in specific situation. Water quality models include one kind of model based on a mechanistic approach, while other models simulate water quality without considering a mechanism. Mechanistic models can be widely applied and have capabilities for long-time simulation, with highly complexity. Therefore, more spaces are provided to explain the principle and application experience of mechanistic models. Mechanism models have certain assumptions on rivers, lakes and estuaries, which limits the application range of the model, this paper introduces the principles and applications of water quality model based on the above three scenarios. On the other hand, mechanistic models are more easily to compute, and with no limit to the geographical conditions, but they cannot be used with confidence to simulate long term changes. This paper divides the empirical models into two broad categories according to the difference of mathematical algorithm, models based on artificial intelligence and models based on statistical methods.

Keywords: empirical models, mathematical, statistical, water quality

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Authors: Karl Owen L. Suan, Juliet Marie S. Lambayan, Floramay P. Salo-Curato

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Objective: To predict the outcome among patients admitted with community-acquired pneumonia (ages 3 months to 59 months old) admitted in Visayas Community Medical Center using the Respiratory Index of Severity in Children (RISC). Design: A cross-sectional study design was used. Setting: The study was done in Visayas Community Medical Center, which is a private tertiary level in Cebu City from January-June 2013. Patients/Participants: A total of 72 patients were initially enrolled in the study. However, 1 patient transferred to another institution, thus 71 patients were included in this study. Within 24 hours from admission, patients were assigned a RISC score. Statistical Analysis: Cohen’s kappa coefficient was used for inter-rater agreement for categorical data. This study used frequency and percentage distribution for qualitative data. Mean, standard deviation and range were used for quantitative data. To determine the relationship of each RISC score parameter and the total RISC score with the outcome, a Mann Whitney U Test and 2x2 Fischer Exact test for testing associations were used. A p value less of than 0.05 alpha was considered significant. Results: There was a statistical significance between RISC score and clinical outcome. RISC score of greater than 4 was correlated with intubation and/or mortality. Conclusion: The RISC scoring system is a simple combination of clinical parameters and a reliable tool that will help stratify patients aged 3 months to 59 months in predicting clinical outcome.

Keywords: RISC, clinical outcome, community-acquired pneumonia, patients

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Authors: Eimar Yadir Quintero Tapias

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Background: Science is not generally self-correcting; many clinical studies end with the same conclusion "more research is needed." This study hypothesizes that first, we need a better appraisal of the available (and unavailable) evidence instead of creating more of the same false inquiries. Methods: Systematic review of ClinicalTrials.gov study records using the following Boolean operators: (food OR nut OR milk OR egg OR shellfish OR wheat OR peanuts) AND (allergy OR allergies OR hypersensitivity OR hypersensitivities). Variables included the status of the study (e g., active and completed), availability of results, sponsor type, sample size, among others. To determine the rates of non-publication in journals indexed by PubMed, an advanced search query using the specific Number of Clinical Trials (e.g., NCT000001 OR NCT000002 OR...) was performed. As a prophylactic measure to prevent P-hacking, data analyses only included descriptive statistics and not inferential approaches. Results: A total of 2092 study records matched the search query described above (date: September 13, 2019). Most studies were interventional (n = 1770; 84.6%) and the remainder observational (n = 322; 15.4%). Universities, hospitals, and research centers sponsored over half of these investigations (n = 1208; 57.7%), 308 studies (14.7%) were industry-funded, and 147 received NIH grants; the remaining studies got mixed sponsorship. Regarding completed studies (n = 1156; 55.2%), 248 (21.5%) have results available at the registry site, and 417 (36.1%) matched NCT numbers of journal papers indexed by PubMed. Conclusions: The internal and external validity of human research is critical for the appraisal of medical evidence. It is imperative to analyze the entire dataset of clinical studies, preferably at a patient-level anonymized raw data, before rushing to conclusions with insufficient and inadequate information. Publication bias and non-registration of clinical trials limit the evaluation of the evidence concerning therapeutic interventions for food allergy, such as oral and sublingual immunotherapy, as well as any other medical condition. Over half of the food allergy human research remains unpublished.

Keywords: allergy, clinical trials, immunology, systematic reviews

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Authors: Sonia Alberti

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The Regional Conference to Restructure Psychiatric Care in Latin America, convened by the Pan American Health Organization (PAHO) in 1990, oriented the Brazilian Federal Act in 2001 that stipulated the psychiatric reform which requires deinstitutionalization and community-based treatment. Since then, the 15 years’ experience of different working teams in mental health led an academic working group – supervisors from personal practices, professors and researchers – to discuss certain clinical issues, as well as supervisions, and to organize colloquia in different cities as a methodology. These colloquia count on the participation of different working teams from the cities in which they are held, with team members with different levels of educational degrees and prior experiences, in order to increase dialogue right where it does not always appear to be possible. The principal aim of these colloquia is to gain interlocution between practitioners and academics. Working with the theory of case constructions, this methodology revealed itself helpful in unfolding new solutions. The paper also observes that there is not always harmony between what the psychiatric reform demands and clinical ethics.

Keywords: mental health, supervision, clinical cases, Brazilian experience

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Authors: Shara Toibayeva, Irbulat Utepbergenov, Lyazzat Issabekova, Aidana Bodesova

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The article discusses the importance of quality assessment as a strategic tool in business and emphasizes the significance of the effectiveness of quality management systems (QMS) for enterprises. The evaluation of these systems takes into account the specificity of quality indicators, the multilevel nature of the system, and the need for optimal selection of the number of indicators and evaluation of the system state, which is critical for making rational management decisions. Methods and models of automated enterprise quality management are proposed, including an intelligent automated quality management system integrated with the Management Information and Control System. These systems make it possible to automate the implementation and support of QMS, increasing the validity, efficiency, and effectiveness of management decisions by automating the functions performed by decision makers and personnel. The paper also emphasizes the use of recurrent neural networks to improve automated quality management. Recurrent neural networks (RNNs) are used to analyze and process sequences of data, which is particularly useful in the context of document quality assessment and non-conformance detection in quality management systems. These networks are able to account for temporal dependencies and complex relationships between different data elements, which improves the accuracy and efficiency of automated decisions. The project was supported by a grant from the Ministry of Education and Science of the Republic of Kazakhstan under the Zhas Galym project No. AR 13268939, dedicated to research and development of digital technologies to ensure consistency of QMS regulatory documents.

Keywords: automated control system, quality management, document structure, formal language

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Authors: Abbos Utkirov

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Total Quality Management (TQM) in the context of educational institutions requires careful planning and the implementation of an annual quality program to achieve its vision effectively. By applying TQM concepts, the higher education system can experience significant improvements. This study aims to examine TQM in higher education, focusing on Critical Success Factors (CSF) and their implementation across all areas. The study ultimately concludes that CSF and their execution play a crucial role in higher education institutions. Some institutions have already benefited from TQM methods by dedicating themselves to the system and using it to achieve their objectives. Through this review, recent studies shed light on how the TQM system can employ various strategies and hypotheses to empower employees, foster a positive and supportive environment, and emphasize the importance of enabling students to unleash their full potential.

Keywords: total quality management (TQM), critical success factor (CSF), organizational performance, quality management practices

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Authors: Rahma Abed, Sahbi Bahroun, Ezzeddine Zagrouba

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Due to the huge amount of data in videos, extracting the relevant frames became a necessity and an essential step prior to performing face recognition. In this context, we propose a method for extracting keyframes from videos based on face quality and deep learning for a face recognition task. This method has two steps. We start by generating face quality scores for each face image based on the use of three face feature extractors, including Gabor, LBP, and HOG. The second step consists in training a Deep Convolutional Neural Network in a supervised manner in order to select the frames that have the best face quality. The obtained results show the effectiveness of the proposed method compared to the methods of the state of the art.

Keywords: keyframe extraction, face quality assessment, face in video recognition, convolution neural network

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Authors: Amina Aquil, Abdeljalil El Got

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Background: Sleep quality is one of the most important indicators related to the quality of life of patients suffering from cancer. Many factors could affect this quality of sleep and then be considered as associated predictors. Methods: The aim of this study was to assess the prevalence of sleep disorders and the associated factors with impaired sleep quality in Moroccan women with gynecological cancer. A cross-sectional study was carried out within the oncology department of the Ibn Rochd University Hospital, Casablanca, on Moroccan women who had undergone radical surgery for gynecological cancer (n=100). Translated and validated Arabic versions of the following international scales were used: Pittsburgh sleep quality index (PSQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg's self-esteem scale (RSES), and Body image scale (BIS). Results: 78% of participants were considered poor sleepers. Most of the patients exhibited very poor subjective quality, low sleep latency, a short period of sleep, and a low rate of usual sleep efficiency. The vast majority of these patients were in poor shape during the day and did not use sleep medication. Waking up in the middle of the night or early in the morning and getting up to use the bathroom were the main reasons for poor sleep quality. PSQI scores were positively correlated with anxiety, depression, body image dissatisfaction, and lower self-esteem (p < 0.001). Conclusion: Sleep quality and its predictors require a systematic evaluation and adequate management to prevent sleep disturbances and mental distress as well as to improve the quality of life of these patients.

Keywords: body image, gynecological cancer, self esteem, sleep quality

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Authors: Kevin Wongleedee

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Food quality and risks are major concerns for inbound senior tourists when visiting tourist destinations in Thailand. The purposes of this study were to investigate food quality and risks perceived by inbound senior tourists. This paper drew upon data collection from an inbound senior tourist survey conducted in Thailand during summer 2013. Summer time in Thailand is a high season for inbound tourists. It is also a high risk period in which a variety food safety issues and incidents have often occurred. The survey was structured primarily to obtain inbound senior tourists’ concerns toward a variety of food quality and risks they encountered during their trip in Thailand. A total of 400 inbound senior tourists were elicited as data input for mean and standard deviation. The findings revealed that inbound tourists rated the overall food quality at a high level and the three most important perceived food risks were 1) unclean physical cooking facility, 2) toxic chemical handling, and 3) unclean water.

Keywords: food quality, inbound senior tourists, risks, Thailand

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Authors: Darshani Premaratne, Afshin Kandampath Puthiyadath

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The Government of Qatar is taking active steps in improving quality of health care industry in the state of Qatar. In this initiative development and market introduction of Clinical Information System and Electronic Health Record (EHR) system are proved to be a highly challenging process. Along with an organization specialized on EHR system development and with the blessing of Health Ministry of Qatar the process of introduction of EHR system in Qatar healthcare industry was undertaken. Initially a market survey was carried out to understand the requirements. Secondly, the available government regulations, needs and possible upcoming regulations were carefully studied before deployment of resources for software development. Sufficient flexibility was allowed to cater for both the changes in the market and the regulations. As the first initiative a system that enables integration of referral network where referral clinic and laboratory system for all single doctor (and small scale) clinics was developed. Setting of isolated single doctor clinics all over the state to bring in to an integrated referral network along with a referral hospital need a coherent steering force and a solid top down framework. This paper discusses about the lessons learned in developing, in obtaining approval of the health ministry and in introduction to the industry of the single doctor referral network along with an EHR system. It was concluded that development of this nature required continues balance between the market requirements and upcoming regulations. Further accelerating the development based on the emerging needs, implementation based on the end user needs while tallying with the regulations, diffusion, and uptake of demand-driven and evidence-based products, tools, strategies, and proper utilization of findings were equally found paramount in successful development of end product. Development of full scale Clinical Information System and EHR system are underway based on the lessons learned. The Government of Qatar is taking active steps in improving quality of health care industry in the state of Qatar. In this initiative development and market introduction of Clinical Information System and Electronic Health Record (EHR) system are proved to be a highly challenging process. Along with an organization specialized on EHR system development and with the blessing of Health Ministry of Qatar the process of introduction of EHR system in Qatar healthcare industry was undertaken. Initially a market survey was carried out to understand the requirements. Secondly the available government regulations, needs and possible upcoming regulations were carefully studied before deployment of resources for software development. Sufficient flexibility was allowed to cater for both the changes in the market and the regulations. As the first initiative a system that enables integration of referral network where referral clinic and laboratory system for all single doctor (and small scale) clinics was developed. Setting of isolated single doctor clinics all over the state to bring in to an integrated referral network along with a referral hospital need a coherent steering force and a solid top down framework. This paper discusses about the lessons learned in developing, in obtaining approval of the health ministry and in introduction to the industry of the single doctor referral network along with an EHR system. It was concluded that development of this nature required continues balance between the market requirements and upcoming regulations. Further accelerating the development based on the emerging needs, implementation based on the end user needs while tallying with the regulations, diffusion, and uptake of demand-driven and evidence-based products, tools, strategies, and proper utilization of findings were equally found paramount in successful development of end product. Development of full scale Clinical Information System and EHR system are underway based on the lessons learned.

Keywords: clinical information system, electronic health record, state regulations, integrated referral network of clinics

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Authors: M. Nasri Nasrabadi, A. A. Hassani

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Karoon is one of the greatest and longest rivers of Iran, which because of the existence of numerous industrial, agricultural centers and drinking usage, has a strategic situation in the west and southwest parts of Iran, and the optimal monitoring of its water quality is an essential and indispensable national issue. Due to financial constraints, water quality monitoring network design is an efficient way to manage water quality. The most crucial part is to find appropriate locations for monitoring stations. Considering the objectives of water usage, we evaluate existing water quality sampling stations of this river. There are several methods for assessment of existing monitoring stations such as Sanders method, multiple criteria decision making and dynamic programming approach (DPA) which DPA opted in this study. The results showed that due to the drinking water quality index out of 20 existing monitoring stations, nine stations should be retained on the river, that include of Gorgor-Band-Ghir of A zone, Dez-Band-Ghir of B zone, Teir, Pole Panjom and Zargan of C zone, Darkhoein, Hafar, Chobade, and Sabonsazi of D zone. In additional, stations of Dez river have the best conditions.

Keywords: DPA, karoon river, network monitoring, water quality, sampling site

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Authors: Joel Carlos Vieira Reinhardt, Mariana de Freitas Dewes, Odair Lelis Gonçalez

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This paper proposes a method to implement a strategic framework for the quality management system that considers the analysis of prospective scenarios in the determination of policy, mission, vision, objectives, processes, monitoring, and goals. Semantic categorization of qualitative testimonial research on employee perception shows it was possible to implement an effective change in the organizations at the Department of Aerospace Science and Technology through the focus on the organization's needs management, producing a rupture with the historical managerial practice.

Keywords: management of company needs, mission, prospective scenarios, quality management, quality policy, vision

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Authors: Kwok W. Mui, Ling T. Wong, Chin T. Cheung, Ho C. Yu

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Based on an indoor environmental quality (IEQ) index established by previous work that indicates the overall IEQ acceptance from the prospect of an occupant in residential buildings in terms of four IEQ factors - thermal comfort, indoor air quality, visual and aural comforts, this study develops a user-friendly IEQ calculator for iOS and Android users to calculate the occupant acceptance and compare the relative performance of IEQ in apartments. The calculator allows the prediction of the best IEQ scenario on a quantitative scale. Any indoor environments under the specific IEQ conditions can be benchmarked against the predicted IEQ acceptance range. This calculator can also suggest how to achieve the best IEQ acceptance among a group of residents.

Keywords: calculator, indoor environmental quality (IEQ), residential buildings, 5-star benchmarks

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Authors: Azadeh Yaraghchi, Reza Bagherian Sararoodi, Niknaz Salehi Moghadam, Mohammad Hossein Mandegar, Adis Kraskian Mujembari, Omid Rezaei

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Background: Quality of life is one of the most important consequences of disease in psychosomatic disorders. Many psychological factors are considered in predicting quality of life in patients with coronary artery bypass graft (CABG). The present study was aimed to determine the relationship between perceived social support and quality of life in patients with coronary artery bypass graft (CABG). Methods: The population included 82 patients who had undergone CABG from October 2014 to May 2015 in four different hospitals in Tehran. The patients were evaluated with Multi-dimension scale of perceived social support (MSPSS) and after three months follow up were evaluated by Short-Form quality of life questionnaire (SF-36). The obtained data were analyzed through Pearson correlation test and multiple variable regression models. Findings: A relationship between perceived social support and quality of life in patients with CABG was observed (r=0.374, p<0.01). The results showed that 22.4% of variation in quality of life is predicted by perceived social support components (p<0.01, R2 =0.224). Conclusion: Based on the results, perceived social support is one of the predictors of quality of life in patients with coronary artery bypass graft. Accordingly, these results can be useful in conceiving proactive policies, detecting high risk patients and planning for psychological interventions.

Keywords: coronary artery bypass graft, perceived social support, psychological factors, quality of life

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Authors: Yas Barzegar, Atrin Barzegar

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Drinking water quality assessment is a major issue today; technology and practices are continuously improving; Artificial Intelligence (AI) methods prove their efficiency in this domain. The current research seeks a hierarchical fuzzy model for predicting drinking water quality in Rome (Italy). The Mamdani fuzzy inference system (FIS) is applied with different defuzzification methods. The Proposed Model includes three fuzzy intermediate models and one fuzzy final model. Each fuzzy model consists of three input parameters and 27 fuzzy rules. The model is developed for water quality assessment with a dataset considering nine parameters (Alkalinity, Hardness, pH, Ca, Mg, Fluoride, Sulphate, Nitrates, and Iron). Fuzzy-logic-based methods have been demonstrated to be appropriate to address uncertainty and subjectivity in drinking water quality assessment; it is an effective method for managing complicated, uncertain water systems and predicting drinking water quality. The FIS method can provide an effective solution to complex systems; this method can be modified easily to improve performance.

Keywords: water quality, fuzzy logic, smart cities, water attribute, fuzzy inference system, membership function

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Authors: Ijaz Ahamad Tatlah

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The justification of this study was to identify about physical facilities as encouragement to Quality Assurance Practices (QAP) in the Universities of Pakistan concerning the views of students, teachers and Directors of Quality Enhancement Cells’ (QEC’s) and to differentiate the views of students, teachers and Directors of QECs in relation to physical facilities about quality assurance practices in the universities of Pakistan. It was a quantitative and qualitative research study. This study was conducted on a sample of 28 universities (public and private sector) of Pakistan by using random and purposive sampling technique. Questionnaires and semi-structured interviews were planned to gather information from students, teachers and Directors of QECs in relation to physical facilities about quality assurance practices in the universities of Pakistan. The data was analyzed by using Descriptive, inferential statistics, and thematic coding. The study revealed that students, teachers and Directors of QEC’s faced a lot of problems and issues without physical facilities. Quality assurance Agency (QAA), Quality Assurance Department (QAD) and Higher Education commission (HEC) all are relevant Pakistani Agencies, which are working consistently of both sectors i.e. public and private to supervise, guide and facilitate the universities of Pakistan for developing quality assurance practices. Majority of the students teachers and Directors’ of QECs opined that books, research journals, manuals for use of science laboratories, equipment for experiments and update computers were available for teachers and students’ in the universities. It was suggested by the students teachers and Directors of QECs of universities that Quality Assurance Practices (QAP) can be accelerated by thinking the following steps: provision of sufficient resources, add the latest software for computers laboratories and new edition of books.

Keywords: physical facilities, quality assurance practices, library, laboratory

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Authors: Shadab Bahreini

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Public transportation is one of the most important aspects of cities, which impacts various factors of the Quality of Life (QoL) of citizens. A passenger's experience is influenced by a variety of indicators in addition to the cost and safety of the trip. This article intends to investigate how QoL is affected by public transport in an urban environment by introducing a literature review of QoL and Quality of Urban Life (QoUL), investigating the intersection of QoL and public transport, and reviewing the background theory for Transport Quality of Life (TQoL). The article proposes a Public Transport Quality of Life (PTQoL) framework comprised of a set of indicators that measure how public transport impacts QoL across personal (physical and mental), socioeconomic, and environmental dimensions. The study proposes using the framework to evaluate objective or subjective factors affecting a person's QoL regarding public transport. Finally, it concludes that public transport is a key component in shaping QoL in urban environments and that policymakers and urban planners should use the PTQoL framework to make evidence-based decisions to improve public transport systems and their impact on QoL.

Keywords: public transport, quality of life, subjective and objective indicators, urban environment

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Authors: Subhash Nerella, Ziyuan Guan, Azra Bihorac, Parisa Rashidi

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Intensive care units (ICUs) provide care to critically ill patients in severe and life-threatening conditions. However, patient monitoring in the ICU is limited by the time and resource constraints imposed on healthcare providers. Many critical care indices such as mobility are still manually assessed, which can be subjective, prone to human errors, and lack granularity. Other important aspects, such as environmental factors, are not monitored at all. For example, critically ill patients often experience circadian disruptions due to the absence of effective environmental “timekeepers” such as the light/dark cycle and the systemic effect of acute illness on chronobiologic markers. Although the occurrence of delirium is associated with circadian disruption risk factors, these factors are not routinely monitored in the ICU. Hence, there is a critical unmet need to develop systems for precise and real-time assessment through novel enabling technologies. We have developed the mobility and circadian disruption quantification system (Mobi-DiQ) by augmenting biomarker and clinical data with pervasive sensing data to generate mobility and circadian cues related to mobility, nightly disruptions, and light and noise exposure. We hypothesize that Mobi-DiQ can provide accurate mobility and circadian cues that correlate with bedside clinical mobility assessments and circadian biomarkers, ultimately important for delirium risk assessment and prevention. The collected multimodal dataset consists of depth images, Electromyography (EMG) data, patient extremity movement captured by accelerometers, ambient light levels, Sound Pressure Level (SPL), and indoor air quality measured by volatile organic compounds, and the equivalent CO₂ concentration. For delirium risk assessment, the system recognizes mobility cues (axial body movement features and body key points) and circadian cues, including nightly disruptions, ambient SPL, and light intensity, as well as other environmental factors such as indoor air quality. The Mobi-DiQ system consists of three major components: the pervasive sensing system, a data storage and analysis server, and a data annotation system. For data collection, six local pervasive sensing systems were deployed, including a local computer and sensors. A video recording tool with graphical user interface (GUI) developed in python was used to capture depth image frames for analyzing patient mobility. All sensor data is encrypted, then automatically uploaded to the Mobi-DiQ server through a secured VPN connection. Several data pipelines are developed to automate the data transfer, curation, and data preparation for annotation and model training. The data curation and post-processing are performed on the server. A custom secure annotation tool with GUI was developed to annotate depth activity data. The annotation tool is linked to the MongoDB database to record the data annotation and to provide summarization. Docker containers are also utilized to manage services and pipelines running on the server in an isolated manner. The processed clinical data and annotations are used to train and develop real-time pervasive sensing systems to augment clinical decision-making and promote targeted interventions. In the future, we intend to evaluate our system as a clinical implementation trial, as well as to refine and validate it by using other data sources, including neurological data obtained through continuous electroencephalography (EEG).

Keywords: deep learning, delirium, healthcare, pervasive sensing

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Authors: Bency Ann Massinello, Nancy Day, Janet Fellini

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Background: The use of an appropriate mode of communication among the multidisciplinary care team members regarding coordination of care is an extremely complicated yet important patient safety initiative. Effective communication among the team members(nursing staff, medical staff, respiratory therapists, rehabilitation therapists, patient-family services team…) become essential to develop a culture of trust and collaboration to deliver the highest quality care to patients are their families. The inpatient post-acute pediatrics, where children and their caregivers come for continuity of care, is no exceptions to the increasing use of text messages as a means to communication among clinicians. One such platform is the Vocera Communications (Vocera Smart Mobile App called Vocera Edge) allows the teams to use the application and share sensitive patient information through an encrypted platform using IOS company provided shared and assigned mobile devices. Objective: This paper discusses the quality initiative of implementing the transition from Vocera Smartbage to Vocera Edge Mobile App, technology advantage, use case expansion, and lessons learned about a secure alternative modality that allows sending and receiving secure text messages in a pediatric post-acute setting using an IOS device. This implementation process included all direct care staff, ancillary teams, and administrative teams on the clinical units. Methods: Our institution launched this transition from voice prompted hands-free Vocera Smartbage to Vocera Edge mobile based app for secure care team texting using a big bang approach during the first PDSA cycle. The pre and post implementation data was gathered using a qualitative survey of about 500 multidisciplinary team members to determine the ease of use of the application and its efficiency in care coordination. The technology was further expanded in its use by implementing clinical alerts and alarms notification using middleware integration with patient monitoring (Masimo) and life safety (Nurse call) systems. Additional use of the smart mobile iPhone use include pushing out apps like Lexicomp and Up to Date to have it readily available for users for evident-based practice in medication and disease management. Results: Successful implementation of the communication system in a shared and assigned model with all of the multidisciplinary teams in our pediatric post-acute setting. In just a 3-monthperiod post implementation, we noticed a 14% increase from 7,993 messages in 6 days in December 2020 to 9,116messages in March 2021. This confirmed that all clinical and non-clinical teams were using this mode of communication for coordinating the care for their patients. System generated data analytics used in addition to the pre and post implementation staff survey for process evaluation. Conclusion: A secure texting option using a mobile device is a safe and efficient mode for care team communication and collaboration using technology in real time. This allows for the settings like post-acute pediatric care areas to be in line with the widespread use of mobile apps and technology in our mainstream healthcare.

Keywords: nursing informatics, mobile secure texting, multidisciplinary communication, pediatrics post acute care

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Authors: Catherine Heyjung Sonu

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This paper examines the effect of accounting quality on the process in which stock price is determined by focusing on contribution-in-kind valuations using Korean setting. In Korea, a number of chaebol firms have transformed into holding company system starting in 2003. With an attempt to gain as much voting right, management sold shares of subsidiaries to purchase shares of the holding company. In so doing, management of these firms received share issues for the contribution in kind that has been made to obtain additional shares of the holding company. The price of these share issues against contribution in kind is allowed to be discounted up to 30%. Using this interesting setting in Korea, this paper examines whether accounting quality affects the extent of the discount applied to the share issues. If the accounting quality of the firm for which the management is receiving share issues is poor, the extent of discount is likely to be high. The extent of discount is likely lower for firms with superior accounting quality. Using 24 cases, we find that, on average, the extent of discount is larger for share issues in which the accounting quality, proxied by the absolute value of discretionary accruals, is poor. This paper provides insight by examining the effect of accounting quality on the stock market. It sheds light on the intersection between finance and accounting research and should be of interest to researchers and practitioners.

Keywords: Accounting quality, Contribution-in-kind, discount, holding company

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Authors: Ibrahim Auwalu

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The main thrust of this paper is the examination of Quality Education as opposed to low level knowledge acquisition in the promotion of quality of life, health, individual and national growth and development. The paper reviews the role education plays in developed, developing and third world economies. It further explores the real meaning of poverty in the context it exists. That is poverty in terms of its dimensions– shortened lives, illiteracy, social exclusion and lack of material means to improve family circumstances. The paper concludes that education not only helps individuals escape poverty by developing the skills needed to improve their livelihoods, but also generates productivity gains that fuel economic growth.

Keywords: quality, education, global, poverty alleviation

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Authors: T. S. Sowmya Bhaskaran, Shekhar Seshadri

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This study aims to study the clinical features of with a history of Child Sexual Abuse (CSA). A chart review of 40 children (<16 years) with history of CSA evaluated at the Department of Child and Adolescent Psychiatry of NIMHANS during a two year period was performed. Results:The most common form of abuse was contact penetrative abuse (65%) followed by non-contact penetrative abuse (32.5%). 75% (N=30) had a psychiatric diagnosis at baseline. 50% of these children had one or more psychiatric comorbidities. Anxiety disorder was the most common diagnosis (27.5%) which included PTSD (11%) followed by Depressive disorder (25.2%). Children abused by multiple perpetrators were found to be more likely to have depression, to having a comorbid psychiatric disorder and more prone to exhibit sexualized behaviour. Children who also experienced physical violence at home were more likely to develop psychiatric illness following child sexual abuse. Psychiatric morbidity is high in clinic population of children with history of CSA. It is important to increase the awareness regarding the consequences of CSA in order to increase help seeking.

Keywords: child sexual abuse, India, tertiary care centre, clinical characteristics

Procedia PDF Downloads 457