Search results for: Objective correlative
Commenced in January 2007
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Edition: International
Paper Count: 6771

Search results for: Objective correlative

1071 Human Resource Management Functions; Employee Performance; Professional Health Workers In Public District Hospitals

Authors: Benjamin Mugisha Bugingo

Abstract:

Healthcare staffhas been considered as asignificant pillar to the health care system. However, the contest of human resources for health in terms of the turnover of health workers in Uganda has been more distinct in the latest years. The objective of the paper, therefore, were to investigate the influence Role Human resource management functions in on employeeperformance of professional health workers in public district hospitals in Kampala. The study objectives were: to establish the effect of performance management function, financialincentives, non-financial incentives, participation, and involvement in the decision-making on the employee performance of professional health workers in public district hospitals in Kampala. The study was devised in the social exchange theory and the equity theory. This study adopted a descriptive research design using quantitative approaches. The study used a cross-sectional research design with a mixed-methods approach. With a population of 402 individuals, the study considered a sample of 252 respondents, including doctors, nurses, midwives, pharmacists, and dentists from 3 district hospitals. The study instruments entailed a questionnaire as a quantitative data collection tool and interviews and focus group discussions as qualitative data gathering tools. To analyze quantitative data, descriptive statistics were used to assess the perceived status of Human resource management functions and the magnitude of intentions to stay, and inferential statistics were used to show the effect of predictors on the outcome variable by plotting a multiple linear regression. Qualitative data were analyzed in themes and reported in narrative and verbatim quotes and were used to complement descriptive findings for a better understanding of the magnitude of the study variables. The findings of this study showed a significant and positive effect of performance management function, financialincentives, non-financial incentives, and participation and involvement in decision-making on employee performance of professional health workers in public district hospitals in Kampala. This study is expected to be a major contributor for the improvement of the health system in the country and other similar settings as it has provided the insights for strategic orientation in the area of human resources for health, especially for enhanced employee performance in relation with the integrated human resource management approach

Keywords: human resource functions, employee performance, employee wellness, profecial workers

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1070 Study on the Effects of Indigenous Biological Face Treatment

Authors: Saron Adisu Gezahegn

Abstract:

Commercial cosmetic has been affecting human health due to their contents and dosage composition. Chemical base cosmetics exposes users to unnecessary health problems and financial cost. Some of the cosmetics' interaction with the environment has negative impacts on health such as burning, cracking, coloring, and so on. The users are looking for a temporary service without evaluating the side effects of cosmetics that contain chemical compositions that result in irritation, burning, allergies, cracking, and the nature of the face. Every cosmetic contains a heavy metal such as lead, zinc, cadmium, silicon, and other heavy cosmetics materials. The users may expose at the end of the day to untreatable diseases like cancer. The objective of the research is to study the effects of indigenous biological face treatment without any additives like chemicals. In ancient times this thought was highly tremendous in the world but things were changing bit by bit and reached chemical base cosmetics to maintain the beauty of hair, skin, and faces. The side effects of the treatment on the face were minimum and the side effects with the interaction of the environment were almost nil. But this thought is changed and replaces the indigenous substances with chemical substances by adding additives like heavy chemical lead and cadmium in the sense of preservation, pigments, dye, and shining. Various studies indicated that cosmetics have dangerous side effects that expose users to health problems and expensive financial loss. This study focuses on a local indigenous plant called Kulkual. Kulkual is available everywhere in a study area and sustainable products can harvest to use as indigenous face treatment materials.25 men and 25 women were selected as a sample population randomly to conduct the study effectively.The plant is harvested from the guard in the productive season. The plant was exposed to the sun dry for a week. Then the peel was removed from the plant fruit and the peels were taken to a bath filled with water to soak for three days. Then the flesh of the peel was avoided from the fruit and ready to use as a face treatment. The fleshy peel was smeared on each sample for almost a week and continued for a week. The result indicated that the effects of the treatment were a positive response with minimum cost and minimum side effects due to the environment. The beauty shines, smoothness, and color are better than chemical base cosmetics. Finally, the study is recommended that all users prefer a biological method of treatment with minimum cost and minimums side effects on health with the interaction of the environment.

Keywords: cosmetic, indigneous, heavymetals, toxic

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1069 Development of a Test Plant for Parabolic Trough Solar Collectors Characterization

Authors: Nelson Ponce Jr., Jonas R. Gazoli, Alessandro Sete, Roberto M. G. Velásquez, Valério L. Borges, Moacir A. S. de Andrade

Abstract:

The search for increased efficiency in generation systems has been of great importance in recent years to reduce the impact of greenhouse gas emissions and global warming. For clean energy sources, such as the generation systems that use concentrated solar power technology, this efficiency improvement impacts a lower investment per kW, improving the project’s viability. For the specific case of parabolic trough solar concentrators, their performance is strongly linked to their geometric precision of assembly and the individual efficiencies of their main components, such as parabolic mirrors and receiver tubes. Thus, for accurate efficiency analysis, it should be conducted empirically, looking for mounting and operating conditions like those observed in the field. The Brazilian power generation and distribution company Eletrobras Furnas, through the R&D program of the National Agency of Electrical Energy, has developed a plant for testing parabolic trough concentrators located in Aparecida de Goiânia, in the state of Goiás, Brazil. The main objective of this test plant is the characterization of the prototype concentrator that is being developed by the company itself in partnership with Eudora Energia, seeking to optimize it to obtain the same or better efficiency than the concentrators of this type already known commercially. This test plant is a closed pipe system where a pump circulates a heat transfer fluid, also calledHTF, in the concentrator that is being characterized. A flow meter and two temperature transmitters, installed at the inlet and outlet of the concentrator, record the parameters necessary to know the power absorbed by the system and then calculate its efficiency based on the direct solar irradiation available during the test period. After the HTF gains heat in the concentrator, it flows through heat exchangers that allow the acquired energy to be dissipated into the ambient. The goal is to keep the concentrator inlet temperature constant throughout the desired test period. The developed plant performs the tests in an autonomous way, where the operator must enter the HTF flow rate in the control system, the desired concentrator inlet temperature, and the test time. This paper presents the methodology employed for design and operation, as well as the instrumentation needed for the development of a parabolic trough test plant, being a guideline for standardization facilities.

Keywords: parabolic trough, concentrated solar power, CSP, solar power, test plant, energy efficiency, performance characterization, renewable energy

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1068 The Association between C-Reactive Protein and Hypertension with Different US Participants Ethnicity-Findings from National Health and Nutrition Examination Survey 1999-2010

Authors: Ghada Abo-Zaid

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The main objective of this study was to examine the association between the elevated level of CRP and incidence of hypertension before and after adjusting by age, BMI, gender, SES, smoking, diabetes, cholesterol LDL and cholesterol HDL and to determine whether the association were differ by race. Method: Cross sectional data for participations from age 17 to age 74 years who included in The National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010 were analysed. CRP level was classified into three categories ( > 3mg/L, between 1mg/LL and 3mg/L, and < 3 mg/L). Blood pressure categorization was done using JNC 7 algorithm Hypertension defined as either systolic blood pressure (SBP) of 140 mmHg or more and disystolic blood pressure (DBP) of 90mmHg or greater, otherwise a self-reported prior diagnosis by a physician. Pre-hypertension was defined as (139 > SBP > 120 or 89 > DPB > 80). Multinominal regression model was undertaken to measure the association between CRP level and hypertension. Results: In univariable models, CRP concentrations > 3 mg/L were associated with a 73% greater risk of incident hypertension compared with CRP concentrations < 1 mg/L (Hypertension: odds ratio [OR] = 1.73; 95% confidence interval [CI], 1.50-1.99). Ethnic comparisons showed that American Mexican had the highest risk of incident hypertension (odds ratio [OR] = 2.39; 95% confidence interval [CI], 2.21-2.58).This risk was statistically insignificant, however, either after controlling by other variables (Hypertension: OR = 0.75; 95% CI, 0.52-1.08,), or categorized by race [American Mexican: odds ratio [OR] = 1.58; 95% confidence interval [CI], 0,58-4.26, Other Hispanic: odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.19-4.42, Non-Hispanic white: odds ratio [OR] = 0.90; 95% confidence interval [CI], 0.50-1.59, Non-Hispanic Black: odds ratio [OR] = 0.44; 95% confidence interval [CI], 0.22-0,87]. The same results were found for pre-hypertension, and the Non-Hispanic black showed the highest significant risk for Pre-Hypertension (odds ratio [OR] = 1.60; 95% confidence interval [CI], 1.26-2.03). When CRP concentrations were between 1.0-3.0 mg/L, in an unadjusted models prehypertension was associated with higher likelihood of elevated CRP (OR = 1.37; 95% CI, 1.15-1.62). The same relationship was maintained in Non-Hispanic white, Non-Hispanic black, and other race (Non-Hispanic white: OR = 1.24; 95% CI, 1.03-1.48, Non-Hispanic black: OR = 1.60; 95% CI, 1.27-2.03, other race: OR = 2.50; 95% CI, 1.32-4.74) while the association was insignificant with American Mexican and other Hispanic. In the adjusted model, the relationship between CRP and prehypertension were no longer available. In contrary, Hypertension was not independently associated with elevated CRP, and the results were the same after grouped by race or adjusted by the confounder variables. The same results were obtained when SBP or DBP were on a continuous measure. Conclusions: This study confirmed the existence of an association between hypertension, prehypertension and elevated level of CRP, however this association was no longer available after adjusting by other variables. Ethic group differences were statistically significant at the univariable models, while it disappeared after controlling by other variables.

Keywords: CRP, hypertension, ethnicity, NHANES, blood pressure

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1067 Possibilities to Evaluate the Climatic and Meteorological Potential for Viticulture in Poland: The Case Study of the Jagiellonian University Vineyard

Authors: Oskar Sekowski

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Current global warming causes changes in the traditional zones of viticulture worldwide. During 20th century, the average global air temperature increased by 0.89˚C. The models of climate change indicate that viticulture, currently concentrating in narrow geographic niches, may move towards the poles, to higher geographic latitudes. Global warming may cause changes in traditional viticulture regions. Therefore, there is a need to estimate the climatic conditions and climate change in areas that are not traditionally associated with viticulture, e.g., Poland. The primary objective of this paper is to prepare methodology to evaluate the climatic and meteorological potential for viticulture in Poland based on a case study. Moreover, the additional aim is to evaluate the climatic potential of a mesoregion where a university vineyard is located. The daily data of temperature, precipitation, insolation, and wind speed (1988-2018) from the meteorological station located in Łazy, southern Poland, was used to evaluate 15 climatological parameters and indices connected with viticulture. The next steps of the methodology are based on Geographic Information System methods. The topographical factors such as a slope gradient and slope exposure were created using Digital Elevation Models. The spatial distribution of climatological elements was interpolated by ordinary kriging. The values of each factor and indices were also ranked and classified. The viticultural potential was determined by integrating two suitability maps, i.e., the topographical and climatic ones, and by calculating the average for each pixel. Data analysis shows significant changes in heat accumulation indices that are driven by increases in maximum temperature, mostly increasing number of days with Tmax > 30˚C. The climatic conditions of this mesoregion are sufficient for vitis vinifera viticulture. The values of indicators and insolation are similar to those in the known wine regions located on similar geographical latitudes in Europe. The smallest threat to viticulture in study area is the occurrence of hail and the highest occurrence of frost in the winter. This research provides the basis for evaluating general suitability and climatologic potential for viticulture in Poland. To characterize the climatic potential for viticulture, it is necessary to assess the suitability of all climatological and topographical factors that can influence viticulture. The methodology used in this case study shows places where there is a possibility to create vineyards. It may also be helpful for wine-makers to select grape varieties.

Keywords: climatologic potential, climatic classification, Poland, viticulture

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1066 Management in the Transport of Pigs to Slaughterhouses in the Valle De Aburrá, Antioquia

Authors: Natalia Uribe Corrales, María Fernanda Benavides Erazo, Santiago Henao Villegas

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Introduction: Transport is a crucial link in the porcine chain because it is considered a stressful event in the animal, due to it is a new environment, which generates new interactions, together with factors such as speed, noise, temperature changes, vibrations, deprivation of food and water. Therefore, inadequate handling at this stage can lead to bruises, musculoskeletal injuries, fatigue, and mortality, resulting in canal seizures and economic losses. Objective: To characterize the transport and driving practices for the mobilization of standing pigs directed to slaughter plants in the Valle de Aburrá, Antioquia, Colombia in 2017. Methods: A descriptive cross-sectional study was carried out with the transporters arriving at the slaughterhouses approved by National Institute for Food and Medicine Surveillance (INVIMA) during 2017 in the Valle de Aburrá. The process of obtaining the samples was made from probabilistic sampling. Variables such as journey time, mechanical technical certificate, training in animal welfare, driving speed, material, and condition of floors and separators, supervision of animals during the trip, load density and mortality were analyzed. It was approved by the ethics committee for the use and care of animals CICUA of CES University, Act number 14 of 2015. Results: 190 trucks were analyzed, finding that 12.4% did not have updated mechanical technical certificate; the transporters experience in pig’s transportation was an average of 9.4 years (d.e.7.5). The 85.8% reported not having received training in animal welfare. Other results were that the average speed was 63.04km/hr (d.e 13.46) and the 62% had floors in good condition; nevertheless, the 48% had bad conditions on separators. On the other hand, the 88% did not supervise their animals during the journey, although the 62.2% had an adequate loading density, in relation to the average mortality was 0.2 deaths/travel (d.e. 0.5). Conclusions: Trainers should be encouraged on issues such as proper maintenance of vehicles, animal welfare, obligatory review of animals during mobilization and speed of driving, as these poorly managed indicators generate stress in animals, increasing generation of injuries as well as possible accidents; also, it is necessary to continue to improve aspects such as aluminum floors and separators that favor easy cleaning and maintenance, as well as the appropriate handling in the density of load that generates animal welfare.

Keywords: animal welfare, driving practices, pigs, truck infrastructure

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1065 Cardiac Pacemaker in a Patient Undergoing Breast Radiotherapy-Multidisciplinary Approach

Authors: B. Petrović, M. Petrović, L. Rutonjski, I. Djan, V. Ivanović

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Objective: Cardiac pacemakers are very sensitive to radiotherapy treatment from two sources: electromagnetic influence from the medical linear accelerator producing ionizing radiation- influencing electronics within the pacemaker, and the absorption of dose to the device. On the other hand, patients with cardiac pacemakers at the place of a tumor are rather rare, and single clinic hardly has experience with the management of such patients. The widely accepted international guidelines for management of radiation oncology patients recommend that these patients should be closely monitored and examined before, during and after radiotherapy treatment by cardiologist, and their device and condition followed up. The number of patients having both cancer and pacemaker, is growing every year, as both cancer incidence, as well as cardiac diseases incidence, are inevitably growing figures. Materials and methods: Female patient, age 69, was diagnozed with valvular cardiomyopathy and got implanted a pacemaker in 2005 and prosthetic mitral valve in 1993 (cancer was diagnosed in 2012). She was stable cardiologically and came to radiation therapy department with the diagnosis of right breast cancer, with the tumor in upper lateral quadrant of the right breast. Since she had all lymph nodes positive (28 in total), she had to have irradiated the supraclavicular region, as well as the breast with the tumor bed. She previously received chemotherapy, approved by the cardiologist. The patient was estimated to be with the high risk as device was within the field of irradiation, and the patient had high dependence on her pacemaker. The radiation therapy plan was conducted as 3D conformal therapy. The delineated target was breast with supraclavicular region, where the pacemaker was actually placed, with the addition of a pacemaker as organ at risk, to estimate the dose to the device and its components as recommended, and the breast. The targets received both 50 Gy in 25 fractions (where 20% of a pacemaker received 50 Gy, and 60% of a device received 40 Gy). The electrode to the heart received between 1 Gy and 50 Gy. Verification of dose planned and delivered was performed. Results: Evaluation of the patient status according to the guidelines and especially evaluation of all associated risks to the patient during treatment was done. Patient was irradiated by prescribed dose and followed up for the whole year, with no symptoms of failure of the pacemaker device during, or after treatment in follow up period. The functionality of a device was estimated to be unchanged, according to the parameters (electrode impedance and battery energy). Conclusion: Patient was closely monitored according to published guidelines during irradiation and afterwards. Pacemaker irradiated with the full dose did not show any signs of failure despite recommendations data, but in correlation with other published data.

Keywords: cardiac pacemaker, breast cancer, radiotherapy treatment planning, complications of treatment

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1064 Retrospective Analysis of 142 Cases of Incision Infection Complicated with Sternal Osteomyelitis after Cardiac Surgery Treated by Activated PRP Gel Filling

Authors: Daifeng Hao, Guang Feng, Jingfeng Zhao, Tao Li, Xiaoye Tuo

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Objective: To retrospectively analyze the clinical characteristics of incision infection with sternal osteomyelitis sinus tract after cardiac surgery and the operation method and therapeutic effect of filling and repairing with activated PRP gel. Methods: From March 2011 to October 2022, 142 cases of incision infection after cardiac surgery with sternal osteomyelitis sinus were retrospectively analyzed, and the causes of poor wound healing after surgery, wound characteristics, perioperative wound management were summarized. Treatment during operation, collection and storage process of autologous PRP before debridement surgery, PRP filling repair and activation method after debridement surgery, effect of anticoagulant drugs on surgery, postoperative complications and average wound healing time, etc.. Results: Among the cases in this group, 53.3% underwent coronary artery bypass grafting, 36.8% underwent artificial heart valve replacement, 8.2% underwent aortic artificial vessel replacement, and 1.7% underwent allogeneic heart transplantation. The main causes of poor incision healing were suture reaction, fat liquefaction, osteoporosis, diabetes, and metal allergy in sequence. The wound is characterized by an infected sinus tract. Before the operation, 100-150ml of PRP with 4 times the physiological concentration was collected separately with a blood component separation device. After sinus debridement, PRP was perfused to fill the bony defect in the middle of the sternum, activated with thrombin freeze-dried powder and calcium gluconate injection to form a gel, and the outer skin and subcutaneous tissue were sutured freely. 62.9% of patients discontinued warfarin during the perioperative period, and 37.1% of patients maintained warfarin treatment. There was no significant difference in the incidence of postoperative wound hematoma. The average postoperative wound healing time was 12.9±4.7 days, and there was no obvious postoperative complication. Conclusions: Application of activated PRP gel to fill incision infection with sternal osteomyelitis sinus after cardiac surgery has a less surgical injury and satisfactory and stable curative effect. It can completely replace the previously used pectoralis major muscle flap transplantation operation scheme.

Keywords: platelet-rich plasma, negative-pressure wound therapy, sternal osteomyelitis, cardiac surgery

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1063 Social Skills as a Significant Aspect of a Successful Start of Compulsory Education

Authors: Eva Šmelová, Alena Berčíková

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The issue of school maturity and readiness of a child for a successful start of compulsory education is one of the long-term monitored areas, especially in the context of education and psychology. In the context of the curricular reform in the Czech Republic, the issue has recently gained importance. Analyses of research in this area suggest a lack of a broader overview of indicators informing about the current level of children’s school maturity and school readiness. Instead, various studies address partial issues. Between 2009 and 2013 a research study was performed at the Faculty of Education, Palacký University Olomouc (Czech Republic) focusing on children’s maturity and readiness for compulsory education. In this study, social skills were of marginal interest; the main focus was on the mental area. This previous research is smoothly linked with the present study, the objective of which is to identify the level of school maturity and school readiness in selected characteristics of social skills as part of the adaptation process after enrolment in compulsory education. In this context, the following research question has been formulated: During the process of adaptation to the school environment, which social skills are weakened? The method applied was observation, for the purposes of which the authors developed a research tool – record sheet with 11 items – social skills that a child should have by the end of preschool education. The items were assessed by first-grade teachers at the beginning of the school year. The degree of achievement and intensity of the skills were assessed for each child using an assessment scale. In the research, the authors monitored a total of three independent variables (gender, postponement of school attendance, participation in inclusive education). The effect of these independent variables was monitored using 11 dependent variables. These variables are represented by the results achieved in selected social skills. Statistical data processing was assisted by the Computer Centre of Palacký University Olomouc. Statistical calculations were performed using SPSS v. 12.0 for Windows and STATISTICA: StatSoft STATISTICA CR, Cz (software system for data analysis). The research sample comprised 115 children. In their paper, the authors present the results of the research and at the same time point to possible areas of further investigation. They also highlight possible risks associated with weakened social skills.

Keywords: compulsory education, curricular reform, educational diagnostics, pupil, school curriculum, school maturity, school readiness, social skills

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1062 Electronic Waste Analysis And Characterization Study: Management Input For Highly Urbanized Cities

Authors: Jilbert Novelero, Oliver Mariano

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In a world where technological evolution and competition to create innovative products are at its peak, problems on Electronic Waste (E-Waste) are now becoming a global concern. E-waste is said to be any electrical or electronic devices that have reached the terminal of its useful life. The major issue are the volume and the raw materials used in crafting E-waste which is non-biodegradable and contains hazardous substances that are toxic to human health and the environment. The objective of this study is to gather baseline data in terms of the composition of E-waste in the solid waste stream and to determine the top 5 E-waste categories in a highly urbanized city. Recommendations in managing these wastes for its reduction were provided which may serve as a guide for acceptance and implementation in the locality. Pasig City was the chosen beneficiary of the research output and through the collaboration of the City Government of Pasig and its Solid Waste Management Office (SWMO); the researcher successfully conducted the Electronic Waste Analysis and Characterization Study (E-WACS) to achieve the objectives. E-WACS that was conducted on April 2019 showed that E-waste ranked 4th which comprises the 10.39% of the overall solid waste volume. Out of 345, 127.24kg which is the total daily domestic waste generation in the city, E-waste covers 35,858.72kg. Moreover, an average of 40 grams was determined to be the E-waste generation per person per day. The top 5 E-waste categories were then classified after the analysis. The category which ranked first is the office and telecommunications equipment that contained the 63.18% of the total generated E-waste. Second in ranking was the household appliances category with 21.13% composition. Third was the lighting devices category with 8.17%. Fourth on ranking was the consumer electronics and batteries category which was composed of 5.97% and fifth was the wires and cables category where it comprised the 1.41% of the average generated E-waste samples. One of the recommendations provided in this research is the implementation of the Pasig City Waste Advantage Card. The card can be used as a privilege card and earned points can be converted to avail of and enjoy services such as haircut, massage, dental services, medical check-up, and etc. Another recommendation raised is for the LGU to encourage a communication or dialogue with the technology and electronics manufacturers and distributors and international and local companies to plan the retrieval and disposal of the E-wastes in accordance with the Extended Producer Responsibility (EPR) policy where producers are given significant responsibilities for the treatment and disposal of post-consumer products.

Keywords: E-waste, E-WACS, E-waste characterization, electronic waste, electronic waste analysis

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1061 Method for Controlling the Groundwater Polluted by the Surface Waters through Injection Wells

Authors: Victorita Radulescu

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Introduction: The optimum exploitation of agricultural land in the presence of an aquifer polluted by the surface sources requires close monitoring of groundwater level in both periods of intense irrigation and in absence of the irrigations, in times of drought. Currently in Romania, in the south part of the country, the Baragan area, many agricultural lands are confronted with the risk of groundwater pollution in the absence of systematic irrigation, correlated with the climate changes. Basic Methods: The non-steady flow of the groundwater from an aquifer can be described by the Bousinesq’s partial differential equation. The finite element method was used, applied to the porous media needed for the water mass balance equation. By the proper structure of the initial and boundary conditions may be modeled the flow in drainage or injection systems of wells, according to the period of irrigation or prolonged drought. The boundary conditions consist of the groundwater levels required at margins of the analyzed area, in conformity to the reality of the pollutant emissaries, following the method of the double steps. Major Findings/Results: The drainage condition is equivalent to operating regimes on the two or three rows of wells, negative, as to assure the pollutant transport, modeled with the variable flow in groups of two adjacent nodes. In order to obtain the level of the water table, in accordance with the real constraints, are needed, for example, to be restricted its top level below of an imposed value, required in each node. The objective function consists of a sum of the absolute values of differences of the infiltration flow rates, increased by a large penalty factor when there are positive values of pollutant. In these conditions, a balanced structure of the pollutant concentration is maintained in the groundwater. The spatial coordinates represent the modified parameters during the process of optimization and the drainage flows through wells. Conclusions: The presented calculation scheme was applied to an area having a cross-section of 50 km between two emissaries with various levels of altitude and different values of pollution. The input data were correlated with the measurements made in-situ, such as the level of the bedrock, the grain size of the field, the slope, etc. This method of calculation can also be extended to determine the variation of the groundwater in the aquifer following the flood wave propagation in envoys.

Keywords: environmental protection, infiltrations, numerical modeling, pollutant transport through soils

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1060 Communication Training about Depression and Suicide Prevention for Pharmacists: A Hungarian Pilot Study

Authors: Mónika Ditta Tóth, Ádám Fritz, Balázs Hankó, György Purebl

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Communication training about depression and suicide prevention for pharmacists – A Hungarian pilot study Mónika Ditta Tóth1, Ádám Fritz2, Balázs Hankó2, György Purebl1 1: Semmelweis University, Institute of Behavioural Sciences 2: Semmelweis University, University Pharmacy Department of Pharmacy Administration Background: Suicide rates in Hungary have been one of the highest in the European Union. Depression is one of the main risk factors for suicide and recognizing and treating depression is an effective way to prevent suicidal behaviour. In their daily practice, pharmacists meet patients with high risk of mental health problems. Therefore they have a key role in the prevention of depression and suicide. Aim: The main aim of this study is to raise pharmacists’ awareness about depression and suicide to enable better recognation of verbal and non-verbal signs of these deseases. Another important objective is to reduce their stigma about depression and increase their confidence in communication with depressed and/or suicidal patients. Methods: A 3-hour communication workshop has been delivered in this pilot study about the reasons, trigger factors, verbal and non-verbal signs of depression and suicide. The training includes communication techniques which have been developed to patients needs, as well as role-playing scenarios. Depression Stigma and Morris Confidence Scales were applied before, after and 6 weeks following the training. The results of the training group are then compared with two of the following pharmacist groups: 1. written material only (N=15), 2. no material (N=15). Results: One-way ANOVA revealed significant differences in the training group regarding the level of confidence in treating and communicating with patients with depression and/or suicide following the training, and after 6 weeks (F(2, 24)= 7,135, p=,004; baseline: 20,37, after training: 30,00, follow up: 27,66). After the 3-hour workshop the personal stigma about depression decreased (baselin: 19,75 after training: 17,00, p=0,075) in the training group (N=9), whilst the perceived stigma did not change (before: 33.54, after: 33,44, p=NS). Trainees assessed the workshop as ‘useful’ and ‘gap filling’. No significant differences was found in the group of pharmacisists who got written material only. Conclusions: Despite the high rates of depression and suicide in Hungary, pharmacists do not receive lectures or seminars about mental health during their university studies. Such half-day workshops could fill this gap and give practical help to recognize and communicate with depressed and/or suicidal patients in a more effective way. This way pharmacists, as community gate-keepers, could contribute to a more effective suicide prevention program in Hungary.

Keywords: communication training, pharmacists, depression, suicide

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1059 Psychological Consultation of Married Couples at Various Stages of Formation of the Young Family

Authors: Gulden Aykinbaeva, Assem Umirzakova, Assel Makhadiyeva

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The problem of studying of young married couples in connection with a change of social institute of a family and marriage is represented very actual for family consultation, considering a family role in the development of modern society. Results of numerous researchs say that one of difficult in formation and stabilization of a matrimony is the period of a young family. This period is characterized by various processes of integration, adaptation and emotional compatibility of spouses. The young family in it the period endures the first standard crisis which postpones a print for the further development of the family scenario. Emergence new, earlier not existing, systems of values render a huge value on the process of formation of a young family and each of spouses separately. Possibly to solve the set family tasks at the development of the uniform system of the family relations in which socially mature persons capable to consider a family as the creativity of each other act as subjects. Due to the research objective in work the following techniques were used: a questionnaire of satisfaction with V. V. Stolin's marriage and A. N. Volkova's technique directed on detection of coherence of family values and role installations in a married couple, and also content – the analysis. Development of an internal basis of a family on mutual clearing of values is important during the work with married couples. 'The mature view' of the partner in the marriage union provides coherence between the expected and real behavior of the partner that is important for the realization of the purposes of adaptation in a family. For research of communication of the data obtained by means of A. N. Volkova's techniques, V. V. Stolina and content – the analysis, the correlation analysis, with the application of the criterion of Spirmen was used. The analysis of results of the conducted research allowed us to determine the number of consistent patterns: 1. Nature of change of satisfaction with marriage at spouses testifies that the matrimonial relations undergo high-quality changes at different stages of formation of a young family. 2. The matrimonial relations in the course of their development, formation and functioning in young marriage undergo considerable changes on psychological, social and psychological and insignificant — at the psychophysiological and sociocultural levels. The material received by us allows to plan ways of further detailed researches of the development of the matrimonial relations not only in the young marriage but also at further stages of development of a matrimony. We believe that the results received in this research can be almost applied at creation of algorithms of selection of marriage partners, at diagnostics of character and the maintenance of matrimonial disharmonies, at the forecast of stability of marriage and a family.

Keywords: married couples, formation of the young family, psychological consultation, matrimony

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1058 An Experimental Study on the Influence of Brain-Break in the Classroom on the Physical Health and Academic Performance of Fourth Grade Students

Authors: Qian Mao, Xiaozan Wang, Jiarong Zhong, Xiaolin Zou

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Introduction: As a result of the decline of students' physical health level and the increase of study pressure, students’ academic performance is not so good. Objective: This study aims to verify whether the Brain-Break intervention in the fourth-grade classroom of primary school can improve students' physical health and academic performance. Methods: According to the principle of no difference in pre-test data, students from two classes of grade four in Fuhai Road Primary School, Fushan district, Yantai city, Shandong province, were selected as experimental subjects, including 50 students in the experimental class (25 males and 25 females) and 50 students in the control class (24 males and 26 females). The content of the experiment was that the students were asked to perform a 4-minute Brain-Berak program designed by the researcher in the second class in the morning and the afternoon, and the intervention lasted for 12 weeks. In addition, the lung capacity, 50-meter run, sitting body forward bend, one-minute jumping rope and one-minute sit-ups stipulated in the national standards for physical fitness of students (revised in 2014) were selected as the indicators of physical health. The scores of Chinese, Mathematics, and English in the unified academic test of the municipal education bureau were selected as the indicators of academic performance. The independent-sample t-test was used to compare and analyze the data of each index between the two classes. The paired-sample t-test was used to compare and analyze the data of each index in the two classes. This paper presents only results with significant differences. Results: in terms of physical health, lung capacity (P=0.002, T= -2.254), one-minute rope skipping (P=0.000, T=3.043), and one-minute sit-ups (P=0.045, T=6.153) were significantly different between the experimental class and the control class. In terms of academic performance, there is a significant difference between the Chinese performance of the experimental class and the control class (P=0.009, T=4.833). Conclusion: Adding Brain-Berak intervention in the classroom can effectively improve the cardiorespiratory endurance (lung capacity), coordination (jumping rope), and abdominal strength (sit-ups) of fourth-grade students. At the same time, it can also effectively improve their Chinese performance. Therefore, it is suggested to promote micro-sports in the classroom of primary schools throughout the country so as to help students improve their physical health and academic performance.

Keywords: academic performance, brain break, fourth grade, physical health

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1057 Creating Futures: Using Fictive Scripting Methods for Institutional Strategic Planning

Authors: Christine Winberg, James Garraway

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Many key university documents, such as vision and mission statements and strategic plans, are aspirational and future-oriented. There is a wide range of future-oriented methods that are used in planning applications, ranging from mathematical modelling to expert opinions. Many of these methods have limitations, and planners using these tools might, for example, make the technical-rational assumption that their plans will unfold in a logical and inevitable fashion, thus underestimating the many complex forces that are at play in planning for an unknown future. This is the issue that this study addresses. The overall project aim was to assist a new university of technology in developing appropriate responses to its social responsibility, graduate employability and research missions in its strategic plan. The specific research question guiding the research activities and approach was: how might the use of innovative future-oriented planning tools enable or constrain a strategic planning process? The research objective was to engage collaborating groups in the use of an innovative tool to develop and assess future scenarios, for the purpose of developing deeper understandings of possible futures and their challenges. The scenario planning tool chosen was ‘fictive scripting’, an analytical technique derived from Technology Forecasting and Innovation Studies. Fictive scripts are future projections that also take into account the present shape of the world and current developments. The process thus began with a critical diagnosis of the present, highlighting its tensions and frictions. The collaborative groups then developed fictive scripts, each group producing a future scenario that foregrounded different institutional missions, their implications and possible consequences. The scripts were analyzed with a view to identifying their potential contribution to the university’s strategic planning exercise. The unfolding fictive scripts revealed a number of insights in terms of unexpected benefits, unexpected challenges, and unexpected consequences. These insights were not evident in previous strategic planning exercises. The contribution that this study offers is to show how better choices can be made and potential pitfalls avoided through a systematic foresight exercise. When universities develop strategic planning documents, they are looking into the future. In this paper it is argued that the use of appropriate tools for future-oriented exercises, can help planners to understand more fully what achieving desired outcomes might entail, what challenges might be encountered, and what unexpected consequences might ensue.

Keywords: fictive scripts, scenarios, strategic planning, technological forecasting

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1056 Common Health Problems of Filipino Overseas Household Service Workers: Implications for Wellness

Authors: Veronica Ramirez

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For over 40 years now, the Philippines has been supplying Household Service Workers (HSWs) globally. As a requirement of the Philippine Overseas Employment Agency (POEA), all Filipinos applying for overseas work undergo medical examination and a certificate of good health is submitted to the foreign employer before hiring. However, there are workplace-related health problems that develop during employment such as musculoskeletal strain or injury, back pain, hypertension and other illnesses. Some workers are in good working conditions but are on call more than 12 hours per day. There are also those who experience heavy physical work with short rest periods or time off. They can also be easily exposed to disease outbreaks and epidemics. It was the objective of this study to determine the common health problems of Filipino Overseas Service Workers and analyze their implications to wellness in the workplace. Specifically, it sought to describe the work conditions of HSWs and determine the work-related factors affecting their health. It also identified the medical care they avail of and how they perceive their health and wellness as determinants of well-being. Finally, it proposes ways to promote wellness among HSWs. This study focused on physical illnesses and does not include mental problems experienced by HSWs. Using a questionnaire, primary data were gathered online and through survey of HSW rehires who were retaking Pre-Departure Orientation Seminar at recruitment agencies. The 2010 Health Benefit Availment data from the Overseas Workers Welfare Administration (OWWA) was also utilized. Descriptive analysis was employed on the data gathered. Key stakeholders in the migration industry were also interviewed. Previous research studies, reports and literature on migration and wellness were used as secondary data. The study found that Filipino overseas HSWs are vulnerable to physical injury and experience body pains such as back, hip and shoulder pain. Long hours of work, work hazards and lack of rest due to poor accommodations can aggravate their physical condition. Although health insurance and health care are available, HSWs are not aware how to avail them. On the basis of the findings, a Wellness Program can be designed that include health awareness, health care availment, occupational ergonomics, safety and health, work and leisure balance, developing emotional intelligence, anger management and spirituality.

Keywords: health, household service worker, overseas, wellness

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1055 Functional Neurocognitive Imaging (fNCI): A Diagnostic Tool for Assessing Concussion Neuromarker Abnormalities and Treating Post-Concussion Syndrome in Mild Traumatic Brain Injury Patients

Authors: Parker Murray, Marci Johnson, Tyson S. Burnham, Alina K. Fong, Mark D. Allen, Bruce McIff

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Purpose: Pathological dysregulation of Neurovascular Coupling (NVC) caused by mild traumatic brain injury (mTBI) is the predominant source of chronic post-concussion syndrome (PCS) symptomology. fNCI has the ability to localize dysregulation in NVC by measuring blood-oxygen-level-dependent (BOLD) signaling during the performance of fMRI-adapted neuropsychological evaluations. With fNCI, 57 brain areas consistently affected by concussion were identified as PCS neural markers, which were validated on large samples of concussion patients and healthy controls. These neuromarkers provide the basis for a computation of PCS severity which is referred to as the Severity Index Score (SIS). The SIS has proven valuable in making pre-treatment decisions, monitoring treatment efficiency, and assessing long-term stability of outcomes. Methods and Materials: After being scanned while performing various cognitive tasks, 476 concussed patients received an SIS score based on the neural dysregulation of the 57 previously identified brain regions. These scans provide an objective measurement of attentional, subcortical, visual processing, language processing, and executive functioning abilities, which were used as biomarkers for post-concussive neural dysregulation. Initial SIS scores were used to develop individualized therapy incorporating cognitive, occupational, and neuromuscular modalities. These scores were also used to establish pre-treatment benchmarks and measure post-treatment improvement. Results: Changes in SIS were calculated in percent change from pre- to post-treatment. Patients showed a mean improvement of 76.5 percent (σ= 23.3), and 75.7 percent of patients showed at least 60 percent improvement. Longitudinal reassessment of 24 of the patients, measured an average of 7.6 months post-treatment, shows that SIS improvement is maintained and improved, with an average of 90.6 percent improvement from their original scan. Conclusions: fNCI provides a reliable measurement of NVC allowing for identification of concussion pathology. Additionally, fNCI derived SIS scores direct tailored therapy to restore NVC, subsequently resolving chronic PCS resulting from mTBI.

Keywords: concussion, functional magnetic resonance imaging (fMRI), neurovascular coupling (NVC), post-concussion syndrome (PCS)

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1054 Flexural Properties of Typha Fibers Reinforced Polyester Composite

Authors: Sana Rezig, Yosr Ben Mlik, Mounir Jaouadi, Foued Khoffi, Slah Msahli, Bernard Durand

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Increasing interest in environmental concerns, natural fibers are once again being considered as reinforcements for polymer composites. The main objective of this study is to explore another natural resource, Typha fiber; which is renewable without production cost and available abundantly in nature. The aim of this study was to study the flexural properties of composite resin with and without reinforcing Typha leaf and stem fibers. The specimens were made by the hand-lay-up process using polyester matrix. In our work, we focused on the effect of various treatment conditions (sea water, alkali treatment and a combination of the two treatments), as a surface modifier, on the flexural properties of the Typha fibers reinforced polyester composites. Moreover, weight ratio of Typha leaf or stem fibers was investigated. Besides, both fibers from leaf and stem of Typha plant were used to evaluate the reinforcing effect. Another parameter, which is reinforcement structure, was investigated. In fact, a first composite was made with air-laid nonwoven structure of fibers. A second composite was with a mixture of fibers and resin for each kind of treatment. Results show that alkali treatment and combined process provided better mechanical properties of composites in comparison with fiber treated by sea water. The fiber weight ratio influenced the flexural properties of composites. Indeed, a maximum value of flexural strength of 69.8 and 62,32 MPa with flexural modulus of 6.16 and 6.34 GPawas observed respectively for composite reinforced with leaf and stem fibers for 12.6 % fiber weight ratio. For the different treatments carried out, the treatment using caustic soda, whether alone or after retting seawater, show the best results because it improves adhesion between the polyester matrix and the fibers of reinforcement. SEM photographs were made to ascertain the effects of the surface treatment of the fibers. By varying the structure of the fibers of Typha, the reinforcement used in bulk shows more effective results as that used in the non-woven structure. In addition, flexural strength rises with about (65.32 %) in the case of composite reinforced with a mixture of 12.6% leaf fibers and (27.45 %) in the case of a composite reinforced with a nonwoven structure of 12.6 % of leaf fibers. Thus, to better evaluate the effect of the fiber origin, the reinforcing structure, the processing performed and the reinforcement factor on the performance of composite materials, a statistical study was performed using Minitab. Thus, ANOVA was used, and the patterns of the main effects of these parameters and interaction between them were established. Statistical analysis, the fiber treatment and reinforcement structure seem to be the most significant parameters.

Keywords: flexural properties, fiber treatment, structure and weight ratio, SEM photographs, Typha leaf and stem fibers

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1053 Geochemical Study of Natural Bitumen, Condensate and Gas Seeps from Sousse Area, Central Tunisia

Authors: Belhaj Mohamed, M. Saidi, N. Boucherab, N. Ouertani, I. Bouazizi, M. Ben Jrad

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Natural hydrocarbon seepage has helped petroleum exploration as a direct indicator of gas and/or oil subsurface accumulations. Surface macro-seeps are generally an indication of a fault in an active Petroleum Seepage System belonging to a Total Petroleum System. This paper describes a case study in which multiple analytical techniques were used to identify and characterize trace petroleum-related hydrocarbons and other volatile organic compounds in groundwater samples collected from Sousse aquifer (Central Tunisia). The analytical techniques used for analyses of water samples included gas chromatography-mass spectrometry (GC-MS), capillary GC with flame-ionization detection, Compund Specific Isotope Analysis, Rock Eval Pyrolysis. The objective of the study was to confirm the presence of gasoline and other petroleum products or other volatile organic pollutants in those samples in order to assess the respective implication of each of the potentially responsible parties to the contamination of the aquifer. In addition, the degree of contamination at different depths in the aquifer was also of interest. The oil and gas seeps have been investigated using biomarker and stable carbon isotope analyses to perform oil-oil and oil-source rock correlations. The seepage gases are characterized by high CH4 content, very low δ13CCH4 values (-71,9 ‰) and high C1/C1–5 ratios (0.95–1.0), light deuterium–hydrogen isotope ratios (-198 ‰) and light δ13CC2 and δ13CCO2 values (-23,8‰ and-23,8‰ respectively) indicating a thermogenic origin with the contribution of the biogenic gas. An organic geochemistry study was carried out on the more ten oil seep samples. This study includes light hydrocarbon and biomarkers analyses (hopanes, steranes, n-alkanes, acyclic isoprenoids, and aromatic steroids) using GC and GC-MS. The studied samples show at least two distinct families, suggesting two different types of crude oil origins: the first oil seeps appears to be highly mature, showing evidence of chemical and/or biological degradation and was derived from a clay-rich source rock deposited in suboxic conditions. It has been sourced mainly by the lower Fahdene (Albian) source rocks. The second oil seeps was derived from a carbonate-rich source rock deposited in anoxic conditions, well correlated with the Bahloul (Cenomanian-Turonian) source rock.

Keywords: biomarkers, oil and gas seeps, organic geochemistry, source rock

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1052 Surface Modified Core–Shell Type Lipid–Polymer Hybrid Nanoparticles of Trans-Resveratrol, an Anticancer Agent, for Long Circulation and Improved Efficacy against MCF-7 Cells

Authors: M. R. Vijayakumar, K. Priyanka, Ramoji Kosuru, Lakshmi, Sanjay Singh

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Trans resveratrol (RES) is a non-flavonoid poly-phenolic compound proved for its therapeutic and preventive effect against various types of cancer. However, the practical application of RES in cancer treatment is limited because of its higher dose (up to 7.5 g/day in humans), low biological half life, rapid metabolism and faster elimination in mammals. PEGylated core-shell type lipid polymer hybrid nanoparticles are the novel drug delivery systems for long circulation and improved anti cancer effect of its therapeutic payloads. Therefore, the main objective of this study is to extend the biological half life (long circulation) and improve the therapeutic efficacy of RES through core shell type of nanoparticles. D-α-tocopheryl polyethylene glycol 1000 succinate (vitamin E TPGS), a novel surfactant is applied for the preparation of PEGylated lipid polymer hybrid nanoparticles. The prepared nanoparticles were evaluated by various state of the art techniques such as dynamic light scattering (DLS) technique for particle size and zeta potential, TEM for shape, differential scanning calorimetry (DSC) for interaction analysis and XRD for crystalline changes of drug. Entrapment efficiency and invitro drug release were determined by ultracentrifugation method and dialysis bag method, respectively. Cancer cell viability studies were performed by MTT assay, respectively. Pharmacokinetic studies after i.v administration were performed in sprague dawley rats. The prepared NPs were found to be spherical in shape with smooth surfaces. Particle size and zeta potential of prepared NPs were found to be in the range of 179.2±7.45 to 266.8±9.61 nm and -0.63 to -48.35 mV, respectively. DSC revealed absence of potential interaction. XRD study revealed presence of amorphous form in nanoparticles. Entrapment efficiency was found to be 83.7 % and drug release was found to be in controlled manner. MTT assay showed low MEC and pharmacokinetic studies showed higher AUC of nanoformulaition than its pristine drug. All these studies revealed that the RES loaded PEG modified core-shell type lipid polymer hybrid nanoparticles can be an alternative tool for chemopreventive and therapeutic application of RES in cancer.

Keywords: trans resveratrol, cancer nanotechnology, long circulating nanoparticles, bioavailability enhancement, core shell nanoparticles, lipid polymer hybrid nanoparticles

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1051 Integration Process and Analytic Interface of different Environmental Open Data Sets with Java/Oracle and R

Authors: Pavel H. Llamocca, Victoria Lopez

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The main objective of our work is the comparative analysis of environmental data from Open Data bases, belonging to different governments. This means that you have to integrate data from various different sources. Nowadays, many governments have the intention of publishing thousands of data sets for people and organizations to use them. In this way, the quantity of applications based on Open Data is increasing. However each government has its own procedures to publish its data, and it causes a variety of formats of data sets because there are no international standards to specify the formats of the data sets from Open Data bases. Due to this variety of formats, we must build a data integration process that is able to put together all kind of formats. There are some software tools developed in order to give support to the integration process, e.g. Data Tamer, Data Wrangler. The problem with these tools is that they need data scientist interaction to take part in the integration process as a final step. In our case we don’t want to depend on a data scientist, because environmental data are usually similar and these processes can be automated by programming. The main idea of our tool is to build Hadoop procedures adapted to data sources per each government in order to achieve an automated integration. Our work focus in environment data like temperature, energy consumption, air quality, solar radiation, speeds of wind, etc. Since 2 years, the government of Madrid is publishing its Open Data bases relative to environment indicators in real time. In the same way, other governments have published Open Data sets relative to the environment (like Andalucia or Bilbao). But all of those data sets have different formats and our solution is able to integrate all of them, furthermore it allows the user to make and visualize some analysis over the real-time data. Once the integration task is done, all the data from any government has the same format and the analysis process can be initiated in a computational better way. So the tool presented in this work has two goals: 1. Integration process; and 2. Graphic and analytic interface. As a first approach, the integration process was developed using Java and Oracle and the graphic and analytic interface with Java (jsp). However, in order to open our software tool, as second approach, we also developed an implementation with R language as mature open source technology. R is a really powerful open source programming language that allows us to process and analyze a huge amount of data with high performance. There are also some R libraries for the building of a graphic interface like shiny. A performance comparison between both implementations was made and no significant differences were found. In addition, our work provides with an Official Real-Time Integrated Data Set about Environment Data in Spain to any developer in order that they can build their own applications.

Keywords: open data, R language, data integration, environmental data

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1050 Enhancing Nursing Students’ Communication Using TeamSTEPPS to Improve Patient Safety

Authors: Stefanie Santorsola, Natasha Frank

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Improving healthcare safety necessitates examining current trends and beliefs about safety and devising strategies to improve. Errors in healthcare continue to increase and be experienced by patients, which is preventable and directly correlated to a breakdown in healthcare communication. TeamSTEPPS is an evidence-based process designed to improve the quality and safety of healthcare by improving communication and team processes. Communication is at the core of effective team collaboration and is vital for patient safety. TeamSTEPPS offers insights and strategies for improving communication and teamwork and reducing preventable errors to create a safer healthcare environment for patients. The academic, clinical, and educational environment for nursing students is vital in preparing them for professional practice by providing them with foundational knowledge and abilities. This environment provides them with a prime opportunity to learn about errors and the importance of effective communication to enhance patient safety, as nursing students are often unprepared to deal with errors. Proactively introducing and discussing errors through a supportive culture during the nursing student’s academic beginnings has the potential to carry key concepts into practice to improve and enhance patient safety. TeamSTEPPS has been used globally and has collectively positively impacted improvements in patient safety and teamwork. A workshop study was introduced in winter 2023 of registered practical nurses (RPN) students bridging to the baccalaureate nursing program; the majority of the RPNs in the bridging program were actively employed in a variety of healthcare facilities during the semester. The workshop study did receive academic institution ethics board approval, and participants signed a consent form prior to participating in the study. The premise of the workshop was to introduce TeamSTEPPS and a variety of strategies to these students and have students keep a reflective journal to incorporate the presented communication strategies in their practicum setting and keep a reflective journal on the effect and outcomes of the strategies in the healthcare setting. Findings from the workshop study supported the objective of the project, resulting in students verbalizing notable improvements in team functioning in the healthcare environment resulting from the incorporation of enhanced communication strategies from TeamSTEPPS that they were introduced to in the workshop study. Implication for educational institutions is the potential of further advancing the safety literacy and abilities of nursing students in preparing them for entering the workforce and improving safety for patients.

Keywords: teamstepps, education, patient safety, communication

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1049 Lean Implementation in a Nurse Practitioner Led Pediatric Primary Care Clinic: A Case Study

Authors: Lily Farris, Chantel E. Canessa, Rena Heathcote, Susan Shumay, Suzanna V. McRae, Alissa Collingridge, Minna K. Miller

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Objective: To describe how the Lean approach can be applied to improve access, quality and safety of care in an ambulatory pediatric primary care setting. Background: Lean was originally developed by Toyota manufacturing in Japan, and subsequently adapted for use in the healthcare sector. Lean is a systematic approach, focused on identifying and reducing waste within organizational processes, improving patient-centered care and efficiency. Limited literature is available on the implementation of the Lean methodologies in a pediatric ambulatory care setting. Methods: A strategic continuous improvement event or Rapid Process Improvement Workshop (RPIW) was launched with the aim evaluating and structurally supporting clinic workflow, capacity building, sustainability, and ultimately improving access to care and enhancing the patient experience. The Lean process consists of five specific activities: Current state/process assessment (value stream map); development of a future state map (value stream map after waste reduction); identification, quantification and prioritization of the process improvement opportunities; implementation and evaluation of process changes; and audits to sustain the gains. Staff engagement is a critical component of the Lean process. Results: Through the implementation of the RPIW and shifting workload among the administrative team, four hours of wasted time moving between desks and doing work was eliminated from the Administrative Clerks role. To streamline clinic flow, the Nursing Assistants completed patient measurements and vitals for Nurse Practitioners, reducing patient wait times and adding value to the patients visit with the Nurse Practitioners. Additionally, through the Nurse Practitioners engagement in the Lean processes a need was recognized to articulate clinic vision, mission and the alignment of NP role and scope of practice with the agency and Ministry of Health strategic plan. Conclusions: Continuous improvement work in the Pediatric Primary Care NP Clinic has provided a unique opportunity to improve the quality of care delivered and has facilitated further alignment of the daily continuous improvement work with the strategic priorities of the Ministry of Health.

Keywords: ambulatory care, lean, pediatric primary care, system efficiency

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1048 Exploring the Potential of Mobile Learning in Distance Higher Education: A Case Study of the University of Jammu, Jammu, and Kashmir

Authors: Darshana Sharma

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Distance Education has emerged as a viable alternative to serve the higher educational needs of the socially and economically disadvantaged people of the remote, rural areas of Jammu region. The University of Jammu is a National Accreditation, and Assessment Council accredited, A+ university and has been accorded graded autonomy by the University Grants Commission. It is a dual mode university offering academic programmes through the regular departments and through the Directorate of Distance Education. The Directorate of Distance Education, University of Jammu still uses printed study material as a mode of instructional delivery. The development of technologies has assured increased interaction and communication for distance learners throughout the distance open learning institutions. Though it is tempting and convenient to adopt technology already being used by others, it may not prove effective for the simple reason that two institutions may be unlike in some respect. The use of technology must be conceived in view of the needs of the learners; geographical socio-economic-cultural and technological contexts and financial, administrative and academic resources of the institution. Mobile learning (m-learning) is a novel approach to knowledge acquisition and dissemination and is gaining global attention. It has evolved as one of the useful channels of distance learning promoting interaction between learners and teachers. It is felt that the Directorate of Distance Education, University of Jammu also needs to adopt new technologies to provide more effective academic and information support to distance learners in order to keep them motivated and also to develop self-learning skills. The chief objective of the research on which this paper is based was to measure the opinion of the distance learners of the DDE, the University of Jammu about the merits of mobile learning. It also explores their preferences for implementing mobile learning. The survey research design of descriptive research has been used. The data was collected from 400 distance learners enrolled with undergraduate and post-graduate programmes using self-constructed questionnaire containing five-point Likert scale items arranging from strongly agree, agree, indifferent, disagree and strongly disagree. Percentages were used to analyze the data. The findings lead to conclude that mobile learning has a great potential for the DDE for reaching out to the rural, remotely located distance learners of the Jammu region and also to improve the teaching-learning environment. The paper also finds out the challenges in the implementation of mobile learning in the region and further makes suggestions for effective implementation of mobile learning in DDE, University of Jammu.

Keywords: directorate of distance education, mobile learning, national accreditation and assessment council, university of Jammu

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1047 A Quantitative Study on the “Unbalanced Phenomenon” of Mixed-Use Development in the Central Area of Nanjing Inner City Based on the Meta-Dimensional Model

Authors: Yang Chen, Lili Fu

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Promoting urban regeneration in existing areas has been elevated to a national strategy in China. In this context, because of the multidimensional sustainable effect through the intensive use of land, mixed-use development has become an important objective for high-quality urban regeneration in the inner city. However, in the long period of time since China's reform and opening up, the "unbalanced phenomenon" of mixed-use development in China's inner cities has been very serious. On the one hand, the excessive focus on certain individual spaces has led to an increase in the level of mixed-use development in some areas, substantially ahead of others, resulting in a growing gap between different parts of the inner city; On the other hand, the excessive focus on a one-dimensional element of the spatial organization of mixed-use development, such as the enhancement of functional mix or spatial capacity, has led to a lagging phenomenon or neglect in the construction of other dimensional elements, such as pedestrian permeability, green environmental quality, social inclusion, etc. This phenomenon is particularly evident in the central area of the inner city, and it clearly runs counter to the need for sustainable development in China's new era. Therefore, a rational qualitative and quantitative analysis of the "unbalanced phenomenon" will help to identify the problem and provide a basis for the formulation of relevant optimization plans in the future. This paper builds a dynamic evaluation method of mixed-use development based on a meta-dimensional model and then uses spatial evolution analysis and spatial consistency analysis with ArcGIS software to reveal the "unbalanced phenomenon " in over the past 40 years of the central city area in Nanjing, a China’s typical city facing regeneration. This study result finds that, compared to the increase in functional mix and capacity, the dimensions of residential space mix, public service facility mix, pedestrian permeability, and greenness in Nanjing's city central area showed different degrees of lagging improvement, and the unbalanced development problems in each part of the city center are different, so the governance and planning plan for future mixed-use development needs to fully address these problems. The research methodology of this paper provides a tool for comprehensive dynamic identification of mixed-use development level’s change, and the results deepen the knowledge of the evolution of mixed-use development patterns in China’s inner cities and provide a reference basis for future regeneration practices.

Keywords: mixed-use development, unbalanced phenomenon, the meta-dimensional model, over the past 40 years of Nanjing, China

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1046 Characterization of Polymorphic Forms of Rifaximin

Authors: Ana Carolina Kogawa, Selma Gutierrez Antonio, Hérida Regina Nunes Salgado

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Rifaximin is an oral antimicrobial, gut - selective and not systemic with adverse effects compared to placebo. It is used for the treatment of hepatic encephalopathy, travelers diarrhea, irritable bowel syndrome, Clostridium difficile, ulcerative colitis and acute diarrhea. The crystalline form present in the rifaximin with minimal systemic absorption is α, being the amorphous form significantly different. Regulators are increasingly attention to polymorphisms. Polymorphs can change the form by altering the drug characteristics compromising the effectiveness and safety of the finished product. International Conference on Harmonization issued the ICH Guidance Q6A, which aim to improve the control of polymorphism in new and existing pharmaceuticals. The objective of this study was to obtain polymorphic forms of rifaximin employing recrystallization processes and characterize them by thermal analysis (thermogravimetry - TG and differential scanning calorimetry - DSC), X-ray diffraction, scanning electron microscopy and solubility test. Six polymorphic forms of rifaximin, designated I to VI were obtained by the crystallization process by evaporation of the solvent. The profiles of the TG curves obtained from polymorphic forms of rifaximin are similar to rifaximin and each other, however, the DTG are different, indicating different thermal behaviors. Melting temperature values of all the polymorphic forms were greater to that shown by the rifaximin, indicating the higher thermal stability of the obtained forms. The comparison of the diffractograms of the polymorphic forms of rifaximin with rifaximin α, β and γ constant in patent indicate that forms III, V and VI are formed by mixing polymorph β and α and form III is formed by polymorph β. The polymorphic form I is formed by polymorph β, but with a significant amount of amorphous material. Already, the polymorphic form II consists of polymorph γ, amorphous. In scanning electron microscope is possible to observe the heterogeneity of morphological characteristics of crystals of polymorphic forms among themselves and with rifaximin. The solubility of forms I and II was greater than the solubility of rifaximin, already, forms III, IV and V presented lower solubility than of rifaximin. Similarly, the bioavailability of the amorphous form of rifaximin is considered significantly higher than the form α, the polymorphic forms obtained in this work can not guarantee the excellent tolerability of the reference medicine. Therefore, studies like these are extremely important and they point to the need for greater requirements by the regulatory agencies competent about polymorphs analysis of the raw materials used in the manufacture of medicines marketed globally. These analyzes are not required in the majority of official compendia. Partnerships between industries, research centers and universities would be a viable way to consolidate researches in this area and contribute to improving the quality of solid drugs.

Keywords: electronic microscopy, polymorphism, rifaximin, solubility, X-ray diffraction

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1045 Tuning the Emission Colour of Phenothiazine by Introduction of Withdrawing Electron Groups

Authors: Andrei Bejan, Luminita Marin, Dalila Belei

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Phenothiazine with electron-rich nitrogen and sulfur heteroatoms has a high electron-donating ability which promotes a good conjugation and therefore low band-gap with consequences upon charge carrier mobility improving and shifting of light emission in visible domain. Moreover, its non-planar butterfly conformation inhibits molecular aggregation and thus preserves quite well the fluorescence quantum yield in solid state compared to solution. Therefore phenothiazine and its derivatives are promising hole transport materials for use in organic electronic and optoelectronic devices as light emitting diodes, photovoltaic cells, integrated circuit sensors or driving circuits for large area display devices. The objective of this paper was to obtain a series of new phenothiazine derivatives by introduction of different electron withdrawing substituents as formyl, carboxyl and cyanoacryl units in order to create a push pull system which has potential to improve the electronic and optical properties. Bromine atom was used as electrono-donor moiety to extend furthermore the existing conjugation. The understudy compounds were structural characterized by FTIR and 1H-NMR spectroscopy and single crystal X-ray diffraction. Besides, the single crystal X-ray diffraction brought information regarding the supramolecular architecture of the compounds. Photophysical properties were monitored by UV-vis and photoluminescence spectroscopy, while the electrochemical behavior was established by cyclic voltammetry. The absorption maxima of the studied compounds vary in a large range (322-455 nm), reflecting the different electronic delocalization degree, depending by the substituent nature. In a similar manner, the emission spectra reveal different color of emitted light, a red shift being evident for the groups with higher electron withdrawing ability. The emitted light is pure and saturated for the compounds containing strong withdrawing formyl or cyanoacryl units and reach the highest quantum yield of 71% for the compound containing bromine and cyanoacrilic units. Electrochemical study show reversible oxidative and reduction processes for all the compounds and a close correlation of the HOMO-LUMO band gap with substituent nature. All these findings suggest the obtained compounds as promising materials for optoelectronic devices.

Keywords: electrochemical properties, phenothiazine derivatives, photoluminescence, quantum yield

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1044 Development of a Process Method to Manufacture Spreads from Powder Hardstock

Authors: Phakamani Xaba, Robert Huberts, Bilainu Oboirien

Abstract:

It has been over 200 years since margarine was discovered and manufactured using liquid oil, liquified hardstock oils and other oil phase & aqueous phase ingredients. Henry W. Bradley first used vegetable oils in liquid state and around 1871, since then; spreads have been traditionally manufactured using liquified oils. The main objective of this study was to develop a process method to produce spreads using spray dried hardstock fat powders as a structing fats in place of current liquid structuring fats. A high shear mixing system was used to condition the fat phase and the aqueous phase was prepared separately. Using a single scraped surface heat exchanger and pin stirrer, margarine was produced. The process method was developed for to produce spreads with 40%, 50% and 60% fat . The developed method was divided into three steps. In the first step, fat powders were conditioned by melting and dissolving them into liquid oils. The liquified portion of the oils were at 65 °C, whilst the spray dried fat powder was at 25 °C. The two were mixed using a mixing vessel at 900 rpm for 4 minutes. The rest of the ingredients i.e., lecithin, colorant, vitamins & flavours were added at ambient conditions to complete the fat/ oil phase. The water phase was prepared separately by mixing salt, water, preservative, acidifier in the mixing tank. Milk was also separately prepared by pasteurizing it at 79°C prior to feeding it into the aqueous phase. All the water phase contents were chilled to 8 °C. The oil phase and water phase were mixed in a tank, then fed into a single scraped surface heat exchanger. After the scraped surface heat exchanger, the emulsion was fed in a pin stirrer to work the formed crystals and produce margarine. The margarine produced using the developed process had fat levels of 40%, 50% and 60%. The margarine passed all the qualitative, stability, and taste assessments. The scores were 6/10, 7/10 & 7.5/10 for the 40%, 50% & 60% fat spreads, respectively. The success of the trials brought about differentiated knowledge on how to manufacture spreads using non micronized spray dried fat powders as hardstock. Manufacturers do not need to store structuring fats at 80-90°C and even high in winter, instead, they can adapt their processes to use fat powders which need to be stored at 25 °C. The developed process method used one scrape surface heat exchanger instead of the four to five currently used in votator based plants. The use of a single scraped surface heat exchanger translated to about 61% energy savings i.e., 23 kW per ton of product. Furthermore, it was found that the energy saved by implementing separate pasteurization was calculated to be 6.5 kW per ton of product produced.

Keywords: margarine emulsion, votator technology, margarine processing, scraped sur, fat powders

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1043 Testing a Motivational Model of Physical Education on Contextual Outcomes and Total Moderate to Vigorous Physical Activity of Middle School Students

Authors: Arto Grasten

Abstract:

Given the rising trend in obesity in children and youth, age-related decline in moderate- to- vigorous-intensity physical activity (MVPA) in several Western, African, and Asian countries in addition to limited evidence of behavioral, affective, cognitive outcomes in physical education, it is important to clarify the motivational processes in physical education classes behind total MVPA engagement. The present study examined the full sequence of the Hierarchical Model of Motivation in physical education including motivational climate, basic psychological needs, intrinsic motivation, contextual behavior, affect, cognition, total MVPA, and associated links to body mass index (BMI) and gender differences. A cross-sectional data comprised self-reports and objective assessments of 770 middle school students (Mage = 13.99 ± .81 years, 52% of girls) in North-East Finland. In order to test the associations between motivational climate, psychological needs, intrinsic motivation, cognition, behavior, affect, and total MVPA, a path model was implemented. Indirect effects between motivational climate and cognition, behavior, affect and total MVPA were tested by setting basic needs and intrinsic motivation as mediators into the model. The findings showed that direct and indirect paths for girls and boys associated with different contextual outcomes and girls’ indirect paths were not related with total MVPA. Precisely, task-involving climate-mediated by physical competence and intrinsic motivation related to enjoyment, importance, and graded assessments within girls, whereas task-involving climate associated with enjoyment and importance via competence and autonomy, and total MVPA via autonomy, intrinsic motivation, and importance within boys. Physical education assessments appeared to be essential in motivating students to participate in greater total MVPA. BMI was negatively linked with competence and relatedness only among girls. Although, the current and previous empirical findings supported task-involving teaching methods in physical education, in some cases, ego-involving climate should not be totally avoided. This may indicate that girls and boys perceive physical education classes in a different way. Therefore, both task- and ego-involving teaching practices can be useful ways of driving behavior in physical education classes.

Keywords: achievement goal theory, assessment, enjoyment, hierarchical model of motivation, physical activity, self-determination theory

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1042 A Lower Dose of Topiramate with Enough Antiseizure Effect: A Realistic Therapeutic Range of Topiramate

Authors: Seolah Lee, Yoohyk Jang, Soyoung Lee, Kon Chu, Sang Kun Lee

Abstract:

Objective: The International League Against Epilepsy (ILAE) currently suggests a topiramate serum level range of 5-20 mg/L. However, numerous institutions have observed substantial drug response at lower levels. This study aims to investigate the correlation between topiramate serum levels, drug responsiveness, and adverse events to establish a more accurate and tailored therapeutic range. Methods: We retrospectively analyzed topiramate serum samples collected between January 2017 and January 2022 at Seoul National University Hospital. Clinical data, including serum levels, antiseizure regimens, seizure frequency, and adverse events, were collected. Patient responses were categorized as "insufficient" (reduction in seizure frequency <50%) or "sufficient" (reduction ≥ 50%). Within the "sufficient" group, further subdivisions included seizure-free and tolerable seizure subgroups. A population pharmacokinetic model estimated serum levels from spot measurements. ROC curve analysis determined the optimal serum level cut-off. Results: A total of 389 epilepsy patients, with 555 samples, were reviewed, having a mean dose of 178.4±117.9 mg/day and a serum level of 3.9±2.8 mg/L. Out of the samples, only 5.6% (n=31) exhibited insufficient response, with a mean serum level of 3.6±2.5 mg/L. In contrast, 94.4% (n=524) of samples demonstrated sufficient response, with a mean serum level of 4.0±2.8 mg/L. This difference was not statistically significant (p = 0.45). Among the 78 reported adverse events, logistic regression analysis identified a significant association between ataxia and serum concentration (p = 0.04), with an optimal cut-off value of 6.5 mg/L. In the subgroup of patients receiving monotherapy, those in the tolerable seizure group exhibited a significantly higher serum level compared to the seizure-free group (4.8±2.0 mg/L vs 3.4±2.3 mg/L, p < 0.01). Notably, patients in the tolerable seizure group displayed a higher likelihood of progressing into drug-resistant epilepsy during follow-up visits compared to the seizure-free group. Significance: This study proposed an optimal therapeutic concentration for topiramate based on the patient's responsiveness to the drug and the incidence of adverse effects. We employed a population pharmacokinetic model and analyzed topiramate serum levels to recommend a serum level below 6.5 mg/L to mitigate the risk of ataxia-related side effects. Our findings also indicated that topiramate dose elevation is unnecessary for suboptimal responders, as the drug's effectiveness plateaus at minimal doses.

Keywords: topiramate, therapeutic range, low dos, antiseizure effect

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