Search results for: care planning

Authors: Marie-Josee Lavallee

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Adorno’s reputation as an abstract and pessimistic thinker who indulged in a critic of capitalist society and culture without bothering himself with opening prospects for change, and who has no interest in political activism, recently begun to be questioned. This paper, which has a twofold objective, will push revisionist readings a step further by putting forward the thesis that revolutionary praxis has been an enduring concern for Adorno, surfacing throughout his entire work. On the other hand, it will hold that his understanding of the relationships between theory and praxis, which will be explained by referring to Ernst Bloch’s distinction between the warm and cold currents of Marxism, can help to interpret the paralysis of revolutionary practice in our own time under a new light. Philosophy and its tasks have been an enduring topic of Adorno’s work from the 1930s to Negativ Dialektik. The writings in which he develops these ideas stand among his most obscure and abstract so that their strong ties to the political have remained mainly overlooked. Adorno’s undertaking of criticizing and ‘redeeming’ philosophy and metaphysics is inseparable from a care for retrieving the capacity to act in the world and to change it. Philosophical problems are immanent to sociological problems, and vice versa, he underlines in his Metaphysik. Begriff and Problem. The issue of truth cannot be severed from the contingent context of a given idea. As a critical undertaking extracting its contents from reality, which is what philosophy should be from Adorno's perspective, the latter has the potential to fully reveal the reification of the individual and consciousness resulting from capitalist economic and cultural domination, thus opening the way to resistance and revolutionary change. While this project, according to his usual method, is sketched mainly in negative terms, it also exhibits positive contours which depict a socialist society. Only in the latter could human suffering end, and mutilated individuals experiment with reconciliation in an authentic way. That Adorno’s continuous plea for philosophy’s self-critic and renewal hides an enduring concern for revolutionary praxis emerges clearly from a careful philosophical analysis of his writings on philosophy and a selection of his sociological work, coupled with references to his correspondences. This study points to the necessity of a serious re-evaluation of Adorno’s relationship to the political, which will impact on the interpretation of his whole oeuvre, is much needed. In the second place, Adorno's dialectical conception of theory and praxis is enlightening for our own time, since it suggests that we are experiencing a phase of creative latency rather an insurmountable impasse.

Keywords: Frankfurt school, philosophy and revolution, revolutionary praxis, Theodor W. Adorno

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Authors: Meenakshi Pappu

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The terms like liveability, Sustainable Development Goals and pandemic have been widely analysed in proving sustainable cities and community living in growing urban areas by 2030. The pandemic has made us all ruminate about how we look into different fast-growing cities which vary in geographical location, climatic zones, terrains, land use and varying cultural backgrounds & traditions belong to the mother soil. India has taken up huge steps to move towards achieving UN-SDGs. Smart city missions have played a vital role in moving towards SDG. Visakhapatnam city is the executive capital in the state of Andhra Pradesh. Located on the Eastern Ghats in South India, it is surrounded by a mountain range on three sides and the Indian Ocean on one side. This unique geographical location and fast urbanization in the last two decades, has put up immense pressure on the natural environment and recourses. It's observed that a lot of investigation to address the existing and proposed land-use, spatial, natural resources, air quality, environmental challenges, and a range of socio-economic, economic challenges were identified during the assessment phase. The citizen concerns with quality and quantity of access to water, sewerage, energy, transportation (public & private) and safety for the public were found out through surveying. Urban infrastructure plays a major part in city building. These cities are occupied by people who come for a better living. This paper aims to provide off-center way of approach to citizens-oriented community habits by addressing SDG 11: Sustainable cities & community by enkindling a characteristic framework of amalgamating 1.eco-design principal, 2. three factors of liveability and 3. a local traditional planning solution. Aiming towards a sustainable development utilized with the focus on the quality of the life and experience of the people who live in urban areas integrating life with soil & water. Building strong social agenda that includes affordable housing for all levels of households, secure and place for good quality public realm for the local people with activity in green corridor, open meeting space & adding recreational places for advantage..

Keywords: livability, eco-design, smart city mission, sustainable

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Authors: Ernest Tambo, Ghislaine Madjou, Jeanne Y. Ngogang, Shenglan Tang, Zhou XiaoNong

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Implementing national to community-based 'One Health' surveillance approach for human, animal and environmental consequences mitigation offers great opportunities and value-added in sustainable development and wellbeing. 'One Health' surveillance approach global partnerships, policy commitment and financial investment are much needed in addressing the evolving threats and epidemics crises mitigation in African countries. The paper provides insights onto how China-Africa health development cooperation in promoting “One Health” surveillance approach in response advocacy and mitigation. China-Africa health development initiatives provide new prospects in guiding and moving forward appropriate and evidence-based advocacy and mitigation management approaches and strategies in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). Early and continuous quality and timely surveillance data collection and coordinated information sharing practices in malaria and other diseases are demonstrated in Comoros, Zanzibar, Ghana and Cameroon. Improvements of variety of access to contextual sources and network of data sharing platforms are needed in guiding evidence-based and tailored detection and response to unusual hazardous events. Moreover, understanding threats and diseases trends, frontline or point of care response delivery is crucial to promote integrated and sustainable targeted local, national “One Health” surveillance and response approach needs implementation. Importantly, operational guidelines are vital in increasing coherent financing and national workforce capacity development mechanisms. Strengthening participatory partnerships, collaboration and monitoring strategies in achieving global health agenda effectiveness in Africa. At the same enhancing surveillance data information streams reporting and dissemination usefulness in informing policies decisions, health systems programming and financial mobilization and prioritized allocation pre, during and post threats and epidemics crises programs strengths and weaknesses. Thus, capitalizing on “One Health” surveillance and response approach advocacy and mitigation implementation is timely in consolidating Africa Union 2063 agenda and Africa renaissance capabilities and expectations.

Keywords: Africa, one health approach, surveillance, response

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Authors: Bansal Ashwani

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Cartographic depiction and visualization of wetland changes is an important tool to map spatial-temporal information about the wetland dynamics effectively and to comprehend the response of these water bodies in maintaining the groundwater and surrounding ecosystem. This is true for the states of North Western India, i.e., J&K, Himachal, Punjab, and Haryana that are bestowed upon with several natural wetlands in the flood plains or on the courses of its rivers. Thus, the present study documents, analyses and reconstructs the lost wetlands, which existed in the flood plains of the major river basins of these states, i.e., Chenab, Jhelum, Satluj, Beas, Ravi, and Ghagar, in the beginning of the 20th century. To achieve the objective, the study has used multi-temporal datasets since the 1960s using high to medium resolution satellite datasets, e.g., Corona (1960s/70s), Landsat (1990s-2017) and Sentinel (2017). The Sentinel (2017) satellite image has been used for making the wetland inventory owing to its comparatively higher spatial resolution with multi-spectral bands. In addition, historical records, repeated photographs, historical maps, field observations including geomorphological evidence were also used. The water index techniques, i.e., band rationing, normalized difference water index (NDWI), modified NDWI (MNDWI) have been compared and used to map the wetlands. The wetland types found in the north-western states have been categorized under 19 classes suggested by Space Application Centre, India. These enable the researcher to provide with the wetlands inventory and a series of cartographic representation that includes overlaying multiple temporal wetlands extent vectors. A preliminary result shows the general state of wetland shrinkage since the 1960s with varying area shrinkage rate from one wetland to another. In addition, it is observed that majority of wetlands have not been documented so far and even do not have names. Moreover, the purpose is to emphasize their elimination in addition to establishing a baseline dataset that can be a tool for wetland planning and management. Finally, the applicability of cartographic depiction and visualization, historical map sources, repeated photographs and remote sensing data for reconstruction of long term wetlands fluctuations, especially in the northern part of India, will be addressed.

Keywords: cartographic depiction and visualization, wetland changes, NDWI/MDWI, geomorphological evidence and remote sensing

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Authors: David A. Scott, Michelle G. Scott

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The problem of juvenile crime, school suspensions and oppositional behaviors indicates a need for a wide range of intervention programs for at-risk youth. Juvenile court systems and mental health agencies are examining alternative ways to deal with at-risk youth that will allow the adolescent to live within their home community. The previous trend that treatment away from home is more effective than treatment near one's community has shifted. Research now suggests that treatment be close to home for several reasons, such as increased treatment success, parental involvement, and reduced costs. Treatment options consist of a wide range of interventions, including outpatient, inpatient, and community-based services (therapeutic group homes, foster care and in-home preservation services). The juvenile justice system, families and other mental health agencies continue to seek the most effective treatment for at-risk youth in their communities. This research examines two possible treatment modalities, a multi-systemic outpatient program and a residential program. Research examining effective, evidence- based counseling will be discussed during this presentation. The presenter recently completed a three-year research grant examining effective treatment modalities for at-risk youth participating in a multi-systemic program. The presenter has also been involved in several research activities gathering data on effective techniques used in residential programs. The data and discussion will be broken down into two parts, each discussing one of the treatment modalities mentioned above. Data on the residential programs was collected on both a sample of 740 at- risk youth over a five-year period and also a sample of 63 participants during a one-year period residing in a residential programs. The effectiveness of these residential services was measured in three ways: services are evaluated by primary referral sources; follow-up data is obtained at various intervals after program participation to measure recidivism (what percentage got back into trouble with the Department of Juvenile Justice); and a more sensitive, "Offense Seriousness Score", has been computed and analyzed prior to, during and after treatment in the residential program. Data on the multi-systemic program was gathered over the past three years on 190 participants. Research will discuss pre and post test results, recidivism rates, academic performance, parental involvement, and effective counseling treatment modalities.

Keywords: at-risk youth, group homes, therapeutic group homes, recidivism rates

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Authors: H. M. Alfrihidi, H.A. Albarakaty

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Flattening filter-free (FFF) photon beam radiotherapy has increased in the last decade, which is enabled by advancements in treatment planning systems and radiation delivery techniques like multi-leave collimators. FFF beams have higher dose rates, which reduces treatment time. On the other hand, FFF beams have a higher surface dose, which is due to the loss of beam hardening effect caused by the presence of the flatting filter (FF). The possibility of improving FFF beam quality using filters from low-z materials such as steel and aluminium (Al) was investigated using Monte Carlo (MC) simulations. The attenuation coefficient of low-z materials for low-energy photons is higher than that of high-energy photons, which leads to the hardening of the FFF beam and, consequently, a reduction in the surface dose. BEAMnrc user code, based on Electron Gamma Shower (EGSnrc) MC code, is used to simulate the beam of a 6 MV True-Beam linac. A phase-space (phosphor) file provided by Varian Medical Systems was used as a radiation source in the simulation. This phosphor file was scored just above the jaws at 27.88 cm from the target. The linac from the jaw downward was constructed, and radiation passing was simulated and scored at 100 cm from the target. To study the effect of low-z filters, steel and Al filters with a thickness of 1 cm were added below the jaws, and the phosphor file was scored at 100 cm from the target. For comparison, the FF beam was simulated using a similar setup. (BEAM Data Processor (BEAMdp) is used to analyse the energy spectrum in the phosphorus files. Then, the dose distribution resulting from these beams was simulated in a homogeneous water phantom using DOSXYZnrc. The dose profile was evaluated according to the surface dose, the lateral dose distribution, and the percentage depth dose (PDD). The energy spectra of the beams show that the FFF beam is softer than the FF beam. The energy peaks for the FFF and FF beams are 0.525 MeV and 1.52 MeV, respectively. The FFF beam's energy peak becomes 1.1 MeV using a steel filter, while the Al filter does not affect the peak position. Steel and Al's filters reduced the surface dose by 5% and 1.7%, respectively. The dose at a depth of 10 cm (D10) rises by around 2% and 0.5% due to using a steel and Al filter, respectively. On the other hand, steel and Al filters reduce the dose rate of the FFF beam by 34% and 14%, respectively. However, their effect on the dose rate is less than that of the tungsten FF, which reduces the dose rate by about 60%. In conclusion, filters from low-z material decrease the surface dose and increase the D10 dose, allowing for a high-dose delivery to deep tumors with a low skin dose. Although using these filters affects the dose rate, this effect is much lower than the effect of the FF.

Keywords: flattening filter free, monte carlo, radiotherapy, surface dose

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Authors: Hasan Topacoglu

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The Meiji Restoration was a chain of events that restored Japan in 1868 and considered as the beginning of Japanese Modernization by many scholars. In 1968, to honor its modern incarnation, Japan celebrated Meiji Centennial as one of the biggest Media Events in the country after the World War II. It was celebrated all around the country throughout the year following with a central event in Tokyo. Meanwhile, Japanese scholars started an opposition movement and claimed that Government was using this event to raise nationalism, pointing at Government’s statement on the meaning of Meiji. Most of the scholars, unfortunately, were hooked into the ideological problem of the Government’s way of planning and evaluated it as a failure. However, scholars missed out an important point that apart from the central event in Tokyo, each city planned its own event and celebrated it on a different date, also with a different theme. For example, Kyoto showed a regional characteristic and focused on Kyoto’s own culture, tradition etc., and highlighted a further past than 100 years. This was mainly because some areas/cities had a different ‘memory’ for Meiji Restoration than Tokyo which was reflected through the way they celebrated Meiji Centennial. On the other hand, 2023 will be the year of Turkish Republic Centennial. A year which will be marked by national and maybe even international events. Although an official committee has not been announced yet, The 2023 Vision, a list of goals has been released by the Government to coincide with the centenary of the Republic of Turkey in 2023 and there are some ongoing projects that are planned to be completed by then. By looking at the content of these projects, it is possible to say that Government is aiming to focus on Modernization through the Centennial. However, some of the projects are already showing some interesting characteristics such as the Istanbul New Airport whose design is inspired by Selimiye Mosque’s Islamic-Ottoman figure. It is true that Turkey and Japan have different historical backgrounds and the timeline of the Meiji Restoration and Foundation of Turkish Republic are different. Therefore, a particular comparison between these two events is not justified. However, they may have more in common than we are up to think because, each country marked the start of a new nation conceived on modern principles. For that reason, it is important to understand the similarities or differences between Meiji Centennial and Turkish Republic Centennial as a media event. This study introduces Meiji Centennial as a media event and analyses opposition movement along with the meaning of Meiji Centennial. Additionally, it explains regional characteristic differences and gives Kyoto as an example. Moreover, it introduces some of the ongoing Centennial projects in Turkey and analyses the meaning of the Turkish Republic Centennial through these projects. Without comparing Japan and Turkey, it explains the case of Japan but the discussion centers on deepening our understanding of Centennial as a Media Event and remarks some important aspects for Turkey’s upcoming Centennial events.

Keywords: media events, Meiji centennial, the 2023 vision, Turkish republic centennial

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Authors: Louise Ödlund, Danica Djuric Ilic

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From a system perspective, there are several benefits of DH. A possibility to utilize the excess heat from waste incineration and biomass-based combined heat and power (CHP) production (e.g. possibility to utilize the excess heat from electricity production) are two examples. However, in a future sustainable society, the benefits of DH may be less obvious. Due to the climate changes and increased energy efficiency of buildings, the demand for space heating is expected to decrease. Due to the society´s development towards circular economy, a larger amount of the waste will be material recycled, and the possibility for DH production by the energy recovery through waste incineration will be reduced. Furthermore, the benefits of biomass-based CHP production will be less obvious since the marginal electricity production will no longer be linked to high greenhouse gas emissions due to an increased share of renewable electricity capacity in the electricity system. The purpose of the study is (1) to provide an overview of the possible development of other sectors which may influence the DH in the future and (2) to detect new business strategies which would enable for DH to adapt to the future conditions and remain competitive to alternative heat production in the future. A system approach was applied where DH is seen as a part of an integrated system which consists of other sectors as well. The possible future development of other sectors and the possible business strategies for DH producers were searched through a systematic literature review In order to remain competitive to the alternative heat production in the future, DH producers need to develop new business strategies. While the demand for space heating is expected to decrease, the space cooling demand will probably increase due to the climate changes, but also due to the better insulation of buildings in the cases where the home appliances are the heat sources. This opens up a possibility for applying DH-driven absorption cooling, which would increase the annual capacity utilization of the DH plants. The benefits of the DH related to the energy recovery from the waste incineration will exist in the future since there will always be a need to take care of materials and waste that cannot be recycled (e.g. waste containing organic toxins, bacteria, such as diapers and hospital waste). Furthermore, by operating central controlled heat pumps, CHP plants, and heat storage depending on the intermittent electricity production variation, the DH companies may enable an increased share of intermittent electricity production in the national electricity grid. DH producers can also enable development of local biofuel supply chains and reduce biofuel production costs by integrating biofuel and DH production in local DH systems.

Keywords: district heating, sustainable business strategies, sustainable development, system approach

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Authors: Liang Zhang, Gang Xu, Yue Wang, Chen Li, Shao Chong Zhou

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Presently, more and more nuclear power plants are facing the issue of life extension. When a nuclear power plant applies for an extension of life, its condition needs to meet the current design standards, which is not fine for all old reactors, typically for seismic design. Seismic-grade equipment in nuclear power plants are now generally placed separately from the non-seismic-grade equipment, but it was not strictly required before. Therefore, it is very important to study whether non-seismic-grade equipment will affect the seismic-grade equipment when dropped down in an earthquake situation, which is related to the safety of nuclear power plants and future life extension applications. This research was based on the cooling water system with the seismic and non-seismic grade equipment installed together, as an example to study whether the non-seismic-grade equipment such as DN50 fire pipes and ventilation pipes arranged above will damage the DN300 pipes and valves arranged below when earthquakes occur. In the study, the simulation was carried out by ANSYS / LY-DYNA, and Johnson-Cook was used as the material model and failure model. For the experiments, the relative positions of objects in the room were restored by 1: 1. In the experiment, the pipes and valves were filled with water with a pressure of 0.785 MPa. The pressure-holding performance of the pipe was used as a criterion for damage. In addition to the pressure-holding performance, the opening torque was considered as well for the valves. The research results show that when the 10-meter-long DN50 pipe was dropped from the position of 8 meters height and the 8-meter-long air pipe dropped from a position of 3.6 meters height, they do not affect the integrity of DN300 pipe below. There is no failure phenomenon in the simulation as well. After the experiment, the pressure drop in two hours for the pipe is less than 0.1%. The main body of the valve does not fail either. The opening torque change after the experiment is less than 0.5%, but the handwheel of the valve may break, which affects the opening actions. In summary, impacts of the upper pipes and ventilation pipes dropdown on the integrity of the DN300 pipes and valves below in a cooling water system of a typical second-generation nuclear power plant under an earthquake was studied. As a result, the functionality of the DN300 pipeline and the valves themselves are not significantly affected, but the handwheel of the valve or similar articles can probably be broken and need to take care.

Keywords: cooling water system, earthquake, integrity, pipe and valve

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Authors: Mahmood Naghizadeh, Maryam Memarian, Hourshad Irvash

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Following the rise in the world population and the upward growth of urbanization, the design, planning, and management of the site scenery for the purpose of presentation and expansion of sustainable site scenery has turned to be the greatest concern to experts. Since the fundamental principles of the site scenery change more and less haphazardly over time, sustainable site scenery can be viewed as an ideal goal because both sustainability and dynamism come into view in urban site scenery and it wouldn’t be designed according to a set of pre-determined principles. Sustainable site scenery, as the ongoing interaction between idealism and pragmatism with sustainability factors, is a dynamic phenomenon created by bringing cultural, historical, social and natural scenery together. Such an interaction is not to subdue other factors but to reinforce the aforementioned factors. The sustainable site scenery is a persistently occurring event not only has attenuated over time but has gained strength. The sustainability of a site scenery or an event over time depends on its site identity which grows out of its continuous association with the past. The sustainability of a site scene or an event in a time frame intertwined with the identity of the place from past to present. This past history supports the present and future of the scene. The result of such a supportive role is the sustainability of site scenery. Isfahan Naqsh-e-Jahan Square is one of the most outstanding squares in the world and the best embodiment of Iranian site scenery architecture. This square is an arena that brings people together and a dynamic city center comprising various urban and religious complexes, spaces and facilities and is considered as one of the most favorable traditional urban space of Iran. Such a place can illustrate many factors related to sustainable site scenery. One the other hand, there are still no specific principles concerning sustainability in the architecture of site scenery. Meanwhile, sustainability is recognized as a rather modern view in architecture. The purpose of this research is to identify factors involved in sustainability in general and to examine their effects on site scenery architecture in particular. Finally, these factors will be studied with taking Naqsh-e-Jahan Square into account. This research adopts an analytic-descriptive approach that has benefited from the review of literature available in library studies and the documents related to sustainability and site scenery architecture. The statistical population used for the purpose of this research includes square constructed during the Safavid dynasty and Naqsh-e-Jahan Square was picked out as the case study. The purpose of this paper is to come up with a rough definition of sustainable site scenery and demonstrate this concept by analyzing it and recognizing the social, economic and ecological aspects of this project.

Keywords: Naqsh-e-Jahan Square, site scenery architecture, sustainability, sustainable site scenery

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Authors: Sawsan Domi

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Khartoum is considering as one of the hottest cities all over the world, the mean monthly outdoor temperature remains above 30 ºC. Solar Radiation on Building Surfaces considered within the world highest values. Buildings in Khartoum is receiving huge amounts of watts/m2. Northern, eastern and western facades always receive a greater amount than the south ones. Therefore, these facades of the building must be better protected than the others. One of the most important design limits affecting indoor thermal comfort and energy conservation are building envelope design, self-efficiency in building materials and optical and thermo-physical properties of the building envelope. A small sun-facing glazing area is very important to provide thermal comfort in hot dry climates because of the intensive sunshine. This study aims to propose a work plan to help minimize the negative environmental effect of the climate on buildings taking the intensive use of glazing. In the last 15 years, there was a rapid growth in building sector in Khartoum followed by many of wrong strategies getting away of being environmental friendly. The intensive use of glazing on facades increased to commercial, industrial and design aspects, while the glass envelope led to quick increase in temperature by the reflection affects the sun on faces, cars and bodies. Logically, being transparent by using glass give a sense of open spaces, allowing natural lighting and sometimes natural ventilation keeping dust and insects away. In the other hand, it costs more and give more overheated. And this is unsuitable for a hot dry climate city like Khartoum. Many huge projects permitted every year from the Ministry of Planning in Khartoum state, with a design based on the intensive use of glazing on facades. There are no Laws or Regulations to control using materials in construction, the last building code -building code 2008- Khartoum state- only focused in using sustainable materials with no consider to any environmental aspects. Results of the study will help increase the awareness for architects, engineers and public about this environmentally problem. Objectives vary between Improve energy performance in buildings and Provide high levels of thermal comfort in the inner environment. As a future project, what are the changes that can happen in building permits codes and regulations. There could be recommendations for the governmental sector such as Obliging the responsible authorities to version environmental friendly laws in building construction fields and Support Renewable energy sector in buildings.

Keywords: building envelope, building regulations, glazed facades, solar radiation

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Authors: Liane J. Ioannou, Jonathan Serpell, Joanne Dean, Cino Bendinelli, Jenny Gough, Dean Lisewski, Julie Miller, Win Meyer-Rochow, Stan Sidhu, Duncan Topliss, David Walters, John Zalcberg, Susannah Ahern

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Background: The occurrence of thyroid cancer is increasing throughout the developed world, including Australia and New Zealand, and since the 1990s has become the fastest increasing malignancy. Following the success of a number of institutional databases that monitor outcomes after thyroid surgery, the Australian and New Zealand Endocrine Surgeons (ANZES) agreed to auspice the development of a bi-national thyroid cancer registry. Objectives: To establish a bi-national population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. Patients and Methods: The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) captures clinical data for all patients, over the age of 18 years, diagnosed with thyroid cancer, confirmed by histopathology report, that have been diagnosed, assessed or treated at a contributing hospital. Data is collected by endocrine surgeons using a web-based interface, REDCap, primarily via direct data entry. Results: A multi-disciplinary Steering Committee was formed, and with operational support from Monash University the ANZTCR was established in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 30 sites expected to come on board across Australia and New Zealand in 2018. A modified-Delphi process was undertaken to determine the key quality indicators to be reported by the registry, and a minimum dataset was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery, and 30-day follow up. Conclusion: There are very few established thyroid cancer registries internationally, yet clinical quality registries have shown valuable outcomes and patient benefits in other cancers. The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand the current practice in the treatment of thyroid cancer and reasons for variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer-term outcome data particularly for patients with the poor prognostic disease will add significant further value to the registry.

Keywords: thyroid cancer, clinical registry, population health, quality improvement

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Authors: Hsiao-Ting Huang, Chang Hsueh-Sheng

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Taiwan is an island country which is affected by the monsoon deeply. Under the climate change, the frequency of extreme rainstorm by typhoon becomes more and more often Since 2000. When the extreme rainstorm comes, it will cause serious damage in Taiwan, especially in urban area. It is suffered by the flooding and the government take it as the urgent issue. On the past, the land use of urban planning does not take flood-detention into consideration. With the development of the city, the impermeable surface increase and most of the people live in urban area. It means there is the highly vulnerability in the urban area, but it cannot deal with the surface runoff and the flooding. However, building the detention pond in hydraulic engineering way to solve the problem is not feasible in urban area. The land expropriation is the most expensive construction of the detention pond in the urban area, and the government cannot afford it. Therefore, the management strategy of flooding in urban area should use the existing resource, public facilities land. It can archive the performance of flood-detention through providing the public facilities land with the detention function. As multi-use public facilities land, it also can show the combination of the land use and water agency. To this purpose, this research generalizes the factors of multi-use for public facilities land as flood-detention space with literature review. The factors can be divided into two categories: environmental factors and conditions of public facilities. Environmental factors including three factors: the terrain elevation, the inundation potential and the distance from the drainage system. In the other hand, there are six factors for conditions of public facilities, including area, building rate, the maximum of available ratio etc. Each of them will be according to it characteristic to given the weight for the land use suitability analysis. This research selects the rules of combination from the logical combination. After this process, it can be classified into three suitability levels. Then, three suitability levels will input to the physiographic inundation model for simulating the evaluation of flood-detention respectively. This study tries to respond the urgent issue in urban area and establishes a model of multi-use for public facilities land as flood-detention through the systematic research process of this study. The result of this study can tell which combination of the suitability level is more efficacious. Besides, The model is not only standing on the side of urban planners but also add in the point of view from water agency. Those findings may serve as basis for land use indicators and decision-making references for concerned government agencies.

Keywords: flooding management strategy, land use suitability analysis, multi-use for public facilities land, physiographic inundation model

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Authors: H. Shahid

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Due to Ozone layer depletion on earth, the incoming ultraviolet (UV) radiation is recorded at its high index levels such as 25 in South Peru (13.5° S, 3360 m a.s.l.) Also, the planning of human inhabitation on Mars is under discussion where UV radiations are quite high. The exposure to UV is health hazardous and is avoided by UV filters. On the other hand, artificial UV sources are in use for water thermolysis to generate Hydrogen and Oxygen, which are later used as fuels. This paper presents the utility of employing UVA (315-400nm) and UVB (280-315nm) electromagnetic radiation from the solar spectrum to design and implement an optically active, Hydrogen and Oxygen generation system via thermolysis of desalinated seawater. The proposed system finds its utility on earth and can be deployed in the future on Mars (UVB). In this system, by using Fresnel lens arrays as an optical filter and via active tracking, the ultraviolet light from the sun is concentrated and then allowed to fall on two sub-systems of the proposed system. The first sub-system generates electrical energy by using UV based tandem photovoltaic cells such as GaAs/GaInP/GaInAs/GaInAsP and the second elevates temperature of water to lower the electric potential required to electrolyze the water. An empirical analysis is performed at 30 atm and an electrical potential is observed to be the main controlling factor for the rate of production of Hydrogen and Oxygen and hence the operating point (Q-Point) of the proposed system. The hydrogen production rate in the case of the commercial system in static mode (650ᵒC, 0.6V) is taken as a reference. The silicon oxide electrolyzer cell (SOEC) is used in the proposed (UV) system for the Hydrogen and Oxygen production. To achieve the same amount of Hydrogen as in the case of the reference system, with minimum chamber operating temperature of 850ᵒC in static mode, the corresponding required electrical potential is calculated as 0.3V. However, practically, the Hydrogen production rate is observed to be low in comparison to the reference system at 850ᵒC at 0.3V. However, it has been shown empirically that the Hydrogen production can be enhanced and by raising the electrical potential to 0.45V. It increases the production rate to the same level as is of the reference system. Therefore, 850ᵒC and 0.45V are assigned as the Q-point of the proposed system which is actively stabilized via proportional integral derivative controllers which adjust the axial position of the lens arrays for both subsystems. The functionality of the controllers is based on maintaining the chamber fixed at 850ᵒC (minimum operating temperature) and 0.45V; Q-Point to realize the same Hydrogen production rate as-is for the reference system.

Keywords: hydrogen, oxygen, thermolysis, ultraviolet

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Authors: Anis Al-Yakhiri

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Introduction: The World Health Organization (WHO) classifies malignant epithelial thyroid tumors into four major groups (papillary, follicular, medullar and undifferentiated) . Papillary thyroid carcinoma (PTC) is the most common type, for about eight out of ten thyroid cancers belong to this histological type. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. War conditions forced us to study alternative methods of using radioactive iodine in the treatment of patients with PTC. Material and methods: Between January 2014 and June 2021, in Al-Yakhiri hospital, 57 Total Thyroidectomy with Radical BilateralNeckDissection (RBND) were performed, 50 for malignant disease,7 for false positive cytology.RBND involves surgical clearance of Levels II-VI. Mean age was 40.7 years old and 92% of the patients were female. 7(14%) patients had hypothyroidism which required preoperative thyroid hormone treatment. The Thyroid Stimulating Hormone- Suppression Therapy (TSH-ST) immediately started after RBND for mostpatients on the first day. It consisted in reducing the level of TSH< 0.1 mIU/L. Results: The Apron flap was used on most operations (40)80% and with lateral extensions had 10(20%). RBND involves surgical clearance of Levels II-VI performed in all operated patients, besides that, 4(8%) of them had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV) withclearance of Levels IB. The PTC was the most common 80.9% (38 patients from 47)by histopathological report. and 4(8%) patients of 50 had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV). The postoperative mortality rate not observed (0%). The postoperative morbidity rate was 22.8% (n =13).Seroma(8.7%),Hypocalcimia(7%), Wound infection(5.3%), Bleeding(1.8%). To suppress TSH and growth of any residual thyroid theTSH-ST (levothyroxine150 – 600mcg)was performed in all patients 57(100%) on the first day afterRBND. We tracked the results of treatment for two years in 30 patients with PTC, only 3 of them received radioactive iodine abroad. Biennial Recurrence rate for PTC appeared in one woman (2%), who had RAI postoperatively in the form of neck lymph nodes metastasis. Conclusion: For patients with PTC, thyroidectomy plus prophylacticRBND is a safe and efficient procedure and it results in lower recurrence rate. Postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress TSH (not less than 150mcg), decreases incidence of recurrence. Total Thyroidectomy with RBND followed by TSH-ST, in our opinion, applicable optimal treatment scheme care for this patient population.

Keywords: thyroid cancer, Yemen war, absence of radioactive iodine, neck dissection, surgery results

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Authors: Navid Nasrolah Mazandarani, Faezeh Mohammadi Tahrodi, Jr., Norshida Ujang, Richard Jan Pech

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Human evolution has designed us to be dependent on social and natural settings, but designed of our modern cities often ignore this fact. It is evident that high-rise buildings dominate most metropolitan city centers. As a result urban parks are very limited and in many cases are not socially responsive to our social needs in these urban ‘jungles’. This paper emphasizes the functions of urban morphology in supporting socialization in Lake Garden, one of the main urban parks in Kuala Lumpur, Malaysia. It discusses two relevant theories; first the concept of users’ experience coined by Kevin Lynch (1960) which states that way-finding is related to the process of forming mental maps of environmental surroundings. Second, the concept of social activity coined by Jan Gehl (1987) which holds that urban public spaces can be more attractive when they provide welcoming places in which people can walk around and spend time. Until recently, research on socio-spatial behavior mainly focused on social ties, place attachment and human well-being; with less focus on the spatial dimension of social behavior. This paper examines the socio-spatial behavior within the spatial structure of the urban park by exploring the relationship between way-finding and social activity. The urban structures defined by the paths and nodes were analyzed as the fundamental topological structure of space to understand their effects on the social engagement pattern. The study uses a photo questionnaire survey to inspect the spatial dimension in relation to the social activities within paths and nodes. To understand the legibility of the park, spatial cognition was evaluated using sketch maps produced by 30 participants who visited the park. The results of the sketch mapping indicated that a spatial image has a strong interrelation with socio-spatial behavior. Moreover, an integrated spatial structure of the park generated integrated use and social activity. It was found that people recognized and remembered the spaces where they engaged in social activities. They could experience the park more thoroughly, when they found their way continuously through an integrated park structure. Therefore, the benefits of both perceptual and social dimensions of planning and design happened simultaneously. The findings can assist urban planners and designers to redevelop urban parks by considering the social quality design that contributes to clear mental images of these places.

Keywords: spatial structure, social activities, sketch map, urban park, way-finding

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Authors: M. Beheshti, S. Saegrov, T. M. Muthanna

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Separated sewer systems are designed to transfer the wastewater from houses and industrial sections to wastewater treatment plants. Unwanted water in the sewer systems is a well-known problem, i.e. storm-water inflow is around 50% of the foul sewer, and groundwater infiltration to the sewer system can exceed 50% of total wastewater volume in deteriorated networks. Infiltration and inflow of non-sewer water (I/I) into sewer systems is unfavorable in separated sewer systems and can trigger overloading the system and reducing the efficiency of wastewater treatment plants. Moreover, I/I has negative economic, environmental, and social impacts on urban areas. Therefore, for having sustainable management of urban sewer systems, I/I of unwanted water into the urban sewer systems should be considered carefully and maintenance and rehabilitation plan should be implemented on these water infrastructural assets. This study presents a methodology to identify and quantify the level of I/I into the sewer system. Amount of I/I is evaluated by accurate flow measurement in separated sewer systems for specified isolated catchments in Trondheim city (Norway). Advanced information about the characteristics of I/I is gained by CCTV inspection of sewer pipelines with high I/I contribution. Achieving enhanced knowledge about the detection and localization of non-sewer water in foul sewer system during the wet and dry weather conditions will enable the possibility for finding the problem of sewer system and prioritizing them and taking decisions for rehabilitation and renewal planning in the long-term. Furthermore, preventive measures and optimization of sewer systems functionality and efficiency can be executed by maintenance of sewer system. In this way, the exploitation of sewer system can be improved by maintenance and rehabilitation of existing pipelines in a sustainable way by more practical cost-effective and environmental friendly way. This study is conducted on specified catchments with different properties in Trondheim city. Risvollan catchment is one of these catchments with a measuring station to investigate hydrological parameters through the year, which also has a good database. For assessing the infiltration in a separated sewer system, applying the flow rate measurement method can be utilized in obtaining a general view of the network condition from infiltration point of view. This study discusses commonly used and advanced methods of localizing and quantifying I/I in sewer systems. A combination of these methods give sewer operators the possibility to compare different techniques and obtain reliable and accurate I/I data which is vital for long-term rehabilitation plans.

Keywords: flow rate measurement, infiltration and inflow (I/I), non-sewer water, separated sewer systems, sustainable management

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Authors: Soroush Pakniyat-Jahromi, Jessica Bucciarelli, Souparno Mitra, Neda Motamedi, Ralph Amazan, Samuel Rothman, Jose Tiburcio, Douglas Reich, Vicente Liz

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Violence is defined as an act of physical force that is intended to cause harm and may lead to physical and/or psychological damage. Violence toward healthcare workers (HCWs) is more common in psychiatric settings, emergency departments, and nursing homes; however, healthcare workers in medical setting are not spared from such events. Workplace violence has a huge burden in the healthcare industry and has a major impact on the physical and mental wellbeing of staff. The purpose of this study is to compare the prevalence of patient agitation and violence in medical-surgical settings in BronxCare Hospital (BCH) Bronx, New York, one year before and during the COVID-19 pandemic. Data collection occurred between June 2021 and August 2021, while the sampling time was from 2019 to 2021. The data were separated into two separate time categories: pre-COVID-19 (03/2019-03/2020) and COVID-19 (03/2020-03/2021). We created frequency tables for 19 variables. We used a chi-square test to determine a variable's statistical significance. We tested all variables against “restraint type”, determining if a patient was violent or became violent enough to restrain. The restraint types were “chemical”, “physical”, or both. This analysis was also used to determine if there was a statistical difference between the pre-COVID-19 and COVID-19 timeframes. Our data shows that there was an increase in incidents of violence in COVID-19 era (03/2020-03/2021), with total of 194 (62.8%) reported events, compared to pre COVID-19 era (03/2019-03/2020) with 115 (37.2%) events (p: 0.01). Our final analysis, completed using a chi-square test, determined the difference in violence in patients between pre-COVID-19 and COVID-19 era. We then tested the violence marker against restraint type. The result was statistically significant (p: 0.01). This is the first paper to systematically review the prevalence of violence in medical-surgical units in a hospital in New York, pre COVID-19 and during the COVID-19 era. Our data is in line with the global trend of increased prevalence of patient agitation and violence in medical settings during the COVID-19 pandemic. Violence and its management is a challenge in healthcare settings, and the COVID-19 pandemic has brought to bear a complexity of circumstances, which may have increased its incidence. It is important to identify and teach healthcare workers the best preventive approaches in dealing with patient agitation, to decrease the number of restraints in medical settings, and to create a less restrictive environment to deliver care.

Keywords: COVID-19 pandemic, patient agitation, restraints, violence

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Authors: Sarah Atalla, Shubham Gupta, Kim Alipio, Tanya Maric

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Background: Chelsea and Westminster Hospital have introduced the Birmingham Symptom Specific Obstetric Triage System (BSOTS) for patients who present acutely to the Maternity Assessment Suite (MAS) to prioritise care by urgency. The primary objective was to evaluate whether BSOTS was used appropriately to assess patients (defined as a 90% threshold). The secondary objective was to assess whether patients were seen within their designated triaged timeframe (defined as a 90% threshold). Methodology: MAS records were retrospectively reviewed for a randomly selected one-week period of data from 2020 (21/09/2020 - 27/09/2020). 189 patients presented to MAS during this time. Data were collected on the presenting complaint, time of attendance (divided into four time categories), and triage colour code for the urgency of a review by a doctor (red: immediately, orange: within 15 minutes, yellow: within 1 hour, green: within 4 hours). The number of triage waiting times that were breached and the outcome of the attendance was noted. Results: 49% of patients presenting to MAS during this time period were triaged, which therefore did not meet the 90% target. 67% of patients who were triaged were seen within their allocated timeframe as designated by their triage colour code, which therefore did not meet the 90% target. The most frequent reason for patient attendance was reduced fetal movements (30.5% of attendances). The busiest time of day (when most patients presented) was between 06:01-12:00, and this was also when the highest number of patients were not triaged (26 patients or 54% of patients presenting in this time category). The most used triage category (59%) was the green colour code (to be seen by a doctor within 4 hours), followed by orange (24%), yellow (14%), and red (3%). 45% of triaged patients were admitted, whilst 55% were discharged. 62% of patients allocated to the green triage category were discharged, as compared to 56% of yellow category patients, 27% of orange category patients, and 50% of red category patients. The time of patient presentation to the hospital was also associated with the level of urgency and outcome. Patients presenting from 12:01 to 18:00 were more likely to be discharged (72% discharged) compared to 00:01-06:00 where only 12.5% of patients were discharged. Conclusion: The triage system for assessing the urgency of acutely presenting obstetric patients is only being effectively utilised for 49% of patients. There is potential for enhancing the employment of the triage system to enable further efficiency and boost the promotion of patient safety. It is noted that MAS was busiest at 06:01 - 12:00 when there was also the highest number of non-triaged patients – this highlights some areas where we can improve, including higher levels of staffing, better use of BSOTS to triage patients, and patient education.

Keywords: birmingham, BSOTS, maternal, obstetric, pregnancy, specific, symptom, triage

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Authors: Brooke Sweeney, David White, Felix Amparano, Nick A. Clark, Amy R. Beck, Mathew Lindquist, Lora Edwards, Julie Vandal, Jennifer Lisondra, Katie Cox, Renee Arensberg, Allen Cummins, Jazmine Cedeno, Jason D. Fraser, Kelsey Dean, Helena H. Laroche, Cristina Fernandez

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Background: National organizations call for standardized pre-surgical requirements and education to optimize postoperative outcomes. Since 2017 our surgery program has used defined protocols and educational curricula pre- and post-surgery. In response to patient outcomes, our educational content was refined to include quizzes to assess patient knowledge and surgical preparedness. We aim to optimize adolescent pre-bariatric surgery preparedness by improving overall aggregate pre-surgical assessment performance from 68% to 80% within 12 months. Methods: A multidisciplinary improvement team was developed within the weight management clinic (WMC) of our tertiary care, free-standing children’s hospital. A manual has been utilized since 2017, with limitations in consistent delivery and patient uptake of information. The curriculum has been improved to include quizzes administered during WMC visits prior to bariatric surgery. The initial outcome measure is the pre-surgical quiz score of adolescents preparing for bariatric surgery. Process measure was the number of questions answered correctly to test the questions. Baseline performance was determined by a patient assessment survey of pre-surgical preparedness at patient visits. Plan-Do-Study-Act cycles (PDSA) included: 1) creation and implementation of a refined curriculum, 2) development of 5 new quizzes based upon learning objectives, and 3) improving provider-lead teaching and quiz administration within clinic workflow. Run charts assessed impact over time. Results: A total of 346 quiz questions were administered to 34 adolescents. The outcome measure improved from a baseline mean of 68% to 86% following PDSA 2 cycles, and it was sustained. Conclusion/Implication: Patient/family comprehension of surgical preparedness improved with standardized education via team member-led teaching and assessment using quizzes during pre-surgical clinic visits. The next steps include launching redesigned teaching materials with modules correlated to quizzes and assessment of comprehension and outcomes post-surgically.

Keywords: bariatric surgery, adolescent, clinic, pre-bariatric training

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Authors: Chandra Shekhar Majumder, Orin Sultana Jamie

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Background: Dacryocystorhinostomy (DCR) has been a widely accepted surgical intervention for nasolacrimal duct obstructions. Some previous studies demonstrated the potential benefits of the peroperative application of agents like Mitomycin-C (MMC) with DCR to improve surgical outcomes. Relevant studies are rare in Bangladesh, and there are controversies about the dose, duration of MMC, and outcome. Therefore, the present study aimed to investigate the comparative efficacy of DCR with and without MMC in a tertiary hospital in Bangladesh. Objective: The study aims to determine the outcome of a dacryocystorhinostomy with preoperative local use of mitomycin–C. Methods: An analytical study was conducted in the Department of Ophthalmology, Sir Salimullah Medical College & Mitford Hospital, Dhaka, from January 2023 to September 2023. Seventy patients who were admitted for DCR operation were included according to the inclusion and exclusion criteria. Patients were divided into two groups: those who underwent DCR with peroperative administration of 0.2 mg/ml Mitomycin-C for 5 minutes (Group I) and those who underwent DCR alone (Group II). All patients were subjected to detailed history taking, clinical examination, and relevant investigations. All patients underwent DCR according to standard guidelines and ensured the highest peroperative and postoperative care. Then, patients were followed up at 7th POD, 1-month POD, 3 months POD, and 6 months POD to observe the success rate between the two groups by assessing tearing condition, irrigation, height of tear meniscus, and FDDT- test. Data was recorded using a pre-structured questionnaire, and collected data were analyzed using SPSS 23. Results: The mean age of the study patients was 42.17±6.7 (SD) years and 42.29±7.1 (SD) years in Groups I and II, respectively, with no significant difference (p=0.945). At the 6th month’s follow-up, group I patients were observed with 94.3% frequency of symptom-free, 85.6% patency of lacrimal drainage system, 68.6% had tear meniscus <0.1mm and 88.6% had positive Fluorescence Dye Disappearance Test (FDDT test). In group II, 91.4% were symptom-free, 68.6% showed patency, 57.1% had a height of tear meniscus < 0.1 mm, and 85.6% had FDDT test positive. But no statistically significant difference was observed (p<.05). Conclusion: The use of Mitomycin-C preoperatively during DCR offers better postoperative outcomes, particularly in maintaining patency and achieving symptom resolution with more FDDT test positive and improvement of tear meniscus in the MMC group than the control group. However, this study didn’t demonstrate a statistically significant difference between the two groups. Further research with larger sample sizes and longer follow-up periods would be beneficial to corroborate these findings.

Keywords: dacryocystorhinostomy, mitomycin-c, dacryocystitis, nasolacrimal duct obstruction

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Authors: Spencer Liu, William Chan, Marlena Komatz, Tommy Ramos, Mark Trentalange, Faye Rim, Dae Kim, Mary Kelly, Samuel Schuessler, Roberta Stack, Justas Lauzadis, Kathryn DelPizzo, Seth Waldman, Alexandra Sideris

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Background & Significance: The increasing prevalence of cannabis use in the United States has important safety considerations in the perioperative setting, as chronic or heavy preoperative cannabis use may increase the risk of intraoperative complications, postoperative nausea and vomiting (PONV), increased postoperative pain levels, and acute side effects associated with cannabis use cessation. In this retrospective chart review study, we sought to determine the prevalence of self-reported cannabis use in the past 5-years at a single institution in New York City. We hypothesized that there is an increasing prevalence of preoperative self-reported cannabis use among adult and adolescent patients undergoing orthopedic surgery. Methods: After IRB approval for this retrospective study, surgical cases performed on patients 12 years of age and older at the hospital’s main campus and two ambulatory surgery centers between January 1st, 2018, and December 31st, 2023, with preoperatively self-disclosed cannabis use entered in the social history intake form were identified using the tool SlicerDicer in Epic. Case and patient characteristics were extracted, and trends in utilization over time were assessed by the Cochran-Armitage trend test. Results: Overall, the prevalence of self-reported cannabis use increased from 6.6% in 2018 to 10.6% in 2023. By age group, the prevalence of self-reported cannabis use among adolescents remained consistently low (2018: 2.6%, 2023: 2.6%) but increased with significant evidence for a linear trend (p < 0.05) within every adult age group. Among adults, patients who were 18-24 years old (2018: 18%, 2023: 20.5%) and 25-34 years old (2018: 15.9%, 2023: 24.2%) had the highest prevalences of disclosure, whereas patients who were 75 years of age or older had the lowest prevalence of disclosure (2018: 1.9%, 2023: 4.6%). Patients who were 25-34 years old had the highest percent difference in disclosure rates of 8.3%, which corresponded to a 52.2% increase from 2018 to 2023. The adult age group with the highest percent change was patients who were 75 years of age or older, with a difference of 2.7%, which corresponded to a 142.1% increase from 2018 to 2023. Conclusions: These trends in preoperative self-reported cannabis use among patients undergoing orthopedic surgery have important implications for perioperative care and clinical outcomes. Efforts are underway to refine and standardize cannabis use data capture at our institution.

Keywords: orthopedic surgery, cannabis, postoperative pain, postoperative nausea

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Authors: Binaya Tamang, Buddhi R. Pokharel, Narayan Gautam, Puspa R. Dhakal, Yuresh Twayana

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Background and Objective: Microalbuminuria is often regarded as a sign of end-organ damage due to hypertension, with an increased risk for renal diseases. The present study was designed to find the prevalence of microalbuminuria in hypertensive patients by determining albumin creatinine ratio (ACR) and the association of ACR and microalbuminuria status with different stages and duration of hypertension (HTN). Also, to establish the correlation of systolic and diastolic blood pressure (SBP and DBP) with various parameters viz; ACR, urinary microalbumin (UMA), estimated glomerular filtration rate (eGFR), urinary creatinine (Ucreat), serum creatinine (Screat), and find out their significance among HTN and ACR status. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Internal Medicine, UCMS, Bhairahawa, Nepal from April 2019 to September 2019 after obtaining ethical approval from institutional review committee (IRC), UCMS. A total of 120 hypertensive patients were enrolled whose blood, and spot urine samples were taken. eGFR was calculated by using Cockcroft-Gault formula after determining Screat while ACR was calculated after measuring Ucreat and UMA from the spot urine sample. Creatinine was estimated from modified jaffes’ reaction, whereas urinary micro albumin was done by Mispa i3 analyzer. Data were analyzed by using SPSS. 20 using p-value ≤ 0.05 as statistically significant. Results: In our study, the highest enrolled were grade II HTN (36.7%) followed by normal (33.3%), grade I (20.8%) and grade III (9.2%). Evaluating the ACR status, 19.2% were microalbuminuria, and the rest were normal. Though the ACR status (normal and microalbuminuria) was not statistically significant with HTN status (P=0.860) and the duration of HTN status (P=0.165), 5 (45.5%) out of 11 grade III HTN were microalbuminuria and the prevalence was also higher for longer duration .i.e., more than 10 years. In microalbuminuria, both the SBP (p=0.023, r=0.471) and DBP (P=0.034, r= 0.444) were strongly and positively correlated with Screat, in contrast to eGFR, which was negatively but weakly correlated. With the significant difference between the HTN group, the mean ACR (P=0.047) and UMA (P=0.02) were found to be highest among grade III patients, i.e., 84.3 ± 113.3 mg/gm. and 88.4 ± 83.9 mg/l respectively. The mean eGFR (64.2 ± 24.8 vs 77.2 ± 18.1 ml/min) was considerably lower in microalbuminuria ( p=0.026) than the normal in contrast to the SBP (160 ± 33.7 vs. 146.6 ± 19.5 mm of Hg) which was significantly higher (P=0.008). Among the different BMI category, the mean ACR was found to be significantly different (P= 0.01) with the highest value in underweight (115.2 ± 51.5 mg/gm.) and lowest in overweight (31.8 ± 4.3 mg/gm.). Conclusion: The study recommends that the microalbuminuria can be a very useful and imperative predictor of deranged kidney functions in hypertensive patients. The high value of ACR and UMA in hypertensive patients along with significant increased Screat, SBP whereas decreased eGFR in microalbuminuria patients explicitly supports the above statement.

Keywords: albumin creatinine ratio, hypertension, microalbuminuria, renal disease

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Authors: Cledinaldo A. Dias, Isabela C. Santos, Marcus V. S. Siqueira

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In the contemporary globalization, the competitiveness generated in the search of new markets aiming at the growth of productivity and, consequently, of profits, implies the redefinition of productive processes and new forms of work organization. As a result of this structuring, unemployment, labor force turnover and the increase in outsourcing and informal work occur. Considering the different relationships and working conditions of outsourced employees, this study aims to identify the most present stressors among outsourced service providers from a Federal Institution of Higher Education in Brazil. To reach this objective, a descriptive exploratory study with a quantitative approach was carried out. The qualitative approach was chosen to provide an in-depth analysis of the occupational conditions of outsourced workers since this method seeks to focus on the social as a world of investigated meanings and the language or speech of each subject as the object of this approach. The survey was conducted in the city of Montes Claros - Minas Gerais (Brazil) and involved eighty workers from companies hired by the institution, including armed security guards, porters, cleaners, drivers, gardeners, and administrative assistants. The choice of professionals obeyed non-probabilistic criteria for convenience or accessibility. Data collection was performed by means of a structured questionnaire composed of sixty questions, in a Likert-type frequency interval scale format, in order to identify potential organizational stressors. The results obtained evidence that the stress factors pointed out by the workers are, in most cases, a determining factor due to the low productive performance at work. Amongst the factors associated with stress, the ones that stood out most were those related to organizational communication failures, the incentive to competition, lack of expectations of professional growth, insecurity and job instability. Based on the results, the need for greater concern and organizational responsibility with the well-being and mental health of the outsourced worker and the recognition of their physical and psychological limitations, and care that goes beyond the functional capacity for the work. Specifically for the preservation of mental health, physical and quality of life, it is concluded that it is necessary for the professional to be inserted in the external world that favors it internally since this set is complemented so that the individual remains in balance and obtain satisfaction in your work.

Keywords: occupational health, outsourced, organizational studies, stressors

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Authors: Li-Jia Chiu

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The purpose of this study is to integrate the content of professional ethics curriculum into life education. This course is a required course for the third-year students of the university. The curriculum is based on professional ethics, which can help students gain insights into a conceptual understanding of professional theory, learning the meaning and the value of life. This study enhances students' attitude toward learning through multi-teaching methods. It takes ‘professionalism’ as the subject of discussion. Additionally, the course combines the connotation and issues of the student's career development. Using the world cafe discussion method, students can think about the role of the future career, and inspire students to integrate their career development and life value reflection and connection. This study recruited the third-year undergraduate students as samples to collect data. This study was conducted in the course of the fall semester in 2016 for thematic discussions, classroom observations, course study forms, coursework, and results in publication reports, etc. The researcher conducted induction data analysis to reflect the practice and reflection of the course. The subjects included 117 students from two classes, including 54 male and 63 female students. The findings of this study comprised the following two parts: the student’s learning and teacher’s teaching reflection. The students’ gains were that: 1) The curriculum design is different from that of other subjects; 2) The curriculum is highly interactive with teachers and classmates; 3) These students are willing to actively participate and share ideas in group discussions; 4 ) They thought the possibility of further discussions with other groups of students through table-to-table discussions; 5) They experienced the respect from other students in the learning process and their appreciation of other students in the same group. The instruction reflections were as follows: 1) Students learned to get link to the value of life and future development through topical discussions; 2) After the main course design guided through gradual guidance, the students’ psychology reached a certain degree of cognition, and further themes then added would cause more sensuous learning effects; 3) Combining students’ expertise in drawing in this department (digital media design department) into curriculum design is effective in stimulating learning motivation and sense of accomplishment; 4) In order to compare and explore learning benefits, future researches are recommended to conduct the similar studies with different departments. Finally, the researcher looks forward to providing research results and findings to the related curriculum teachers as a reference for practical curriculum planning and teaching methods.

Keywords: life education, World Cafe, professional ethics, professionalism

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Authors: Teagan Fink, Lynn Chong, Michael Hii, Brett Knowles

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Background: Telemedicine is a rapidly advancing field providing healthcare to patients at a distance from their treating clinician. There is a paucity of high-quality evidence detailing the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial – conducted prior to the COVID 19 pandemic – aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) of telephone compared to face-to-face clinic follow-up after uncomplicated general surgical procedures. Methods: Patients following uncomplicated laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic follow-up. Data points including patient demographics, perioperative details and postoperative outcomes (eg. wound healing complications, pain scores, unplanned readmission to hospital and return to daily activities) were compared between groups. Patients also completed a Likert patient satisfaction survey following their consultation. Results: 103 patients were recruited over a 12-month period (21 laparoscopic appendicectomies, 65 laparoscopic cholecystectomies, nine open umbilical hernia repairs, six laparoscopic inguinal hernia repairs and two laparoscopic umbilical hernia repairs). Baseline patient demographics and operative interventions were the same in both groups. Patient or clinician-reported concerns on postoperative pain, use of analgesia, wound healing complications and return to daily activities at clinic follow-up were not significantly different between the two groups. Of the 58 patients randomized to the telemedicine arm, 40% reported high and 60% reported very high patient satisfaction. Telemedicine clinic mean consultation times were significantly shorter than face-to-face consultation times (telemedicine 10.3 +/- 7.2 minutes, face-to-face 19.2 +/- 23.8 minutes, p-value = 0.014). Rates of failing to attend clinic were not significantly different (telemedicine 3%, control 6%). There was no increased rate of postoperative complications in patients followed up by telemedicine compared to in-person. There were no unplanned readmissions, return to theatre, or mortalities in this study. Conclusion: Telemedicine follow-up of patients undergoing uncomplicated general surgery is safe and does not result in any missed diagnosis or higher rates of complications. Telemedicine provides high patient satisfaction and steps to implement this modality in inpatient care should be undertaken.

Keywords: general surgery, telemedicine, patient satisfaction, patient safety

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Authors: Kaddour Fellague Mohammed

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The world has seen in recent years, significant developments affected various aspects of life and influenced the different types of institutions, thus was born a new world is a world of globalization, which dominated the scientific revolution and the tremendous technological developments, and that contributed to the re-formation of human resources in contemporary organizations, and made patterns new regulatory and at the same time raised and strongly values and new ideas, the organizations have become more flexible, and faster response to consumer and environmental conditions, and exceeded the problem of time and place in the framework of communication and human interaction and use of advanced information technology and adoption mainly mechanism in running its operations , focused on performance and based strategic thinking and approach in order to achieve its strategic goals high degrees of superiority and excellence, this new reality created an increasing need for a new type of human resources, quality aims to renew and aspire to be a strategic player in managing the organization and drafting of various strategies, think globally and act locally, to accommodate local variables in the international markets, which began organizations tend to strongly as well as the ability to work under different cultures. Human resources management of the most important management functions to focus on the human element, which is considered the most valuable resource of the Department and the most influential in productivity at all, that the management and development of human resources Tattabra a cornerstone in the majority of organizations which aims to strengthen the organizational capacity, and enable companies to attract and rehabilitation of the necessary competencies and are able to keep up with current and future challenges, human resources can contribute to and strongly in achieving the objectives and profit organization, and even expand more than contribute to the creation of new jobs to alleviate unemployment and achieve full operation, administration and human resources mean short optimal use of the human element is available and expected, where he was the efficiency and capabilities, and experience of this human element, and his enthusiasm for the work stop the efficiency and success in reaching their goals, so interested administration scientists developed the principles and foundations that help to make the most of each individual benefit in the organization through human resources management, these foundations start of the planning and selection, training and incentives and evaluation, which is not separate from each other, but are integrated with each other as a system systemic order to reach the efficient functioning of the human resources management and has been the organization as a whole in the context of development sustainable.

Keywords: configuration, training, development, human resources, operating

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Authors: Neeraj Vij, Christian Leber, Kenneth Schmidt

Abstract:

Introduction: Total knee arthroplasty is a common procedure. It is well known that the biomechanics of the knee do not fully return to their normal state. Motion analysis has been used to study the biomechanics of the knee after total knee arthroplasty. The purpose of this scoping review is to summarize the current use of gait analysis in total knee arthroplasty and to identify the preoperative motion analysis parameters for which a systematic review aimed at determining the reliability and validity may be warranted. Materials and Methods: This IRB-exempt scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist strictly. Five search engines were searched for a total of 279 articles. Articles underwent a title and abstract screening process followed by full-text screening. Included articles were placed in the following sections: the role of gait analysis as a research tool for operative decisions, other research applications for motion analysis in total knee arthroplasty, gait analysis as a tool in predicting radiologic outcomes, gait analysis as a tool in predicting clinical outcomes. Results: Eleven articles studied gait analysis as a research tool in studying operative decisions. Motion analysis is currently used to study surgical approaches, surgical techniques, and implant choice. Five articles studied other research applications for motion analysis in total knee arthroplasty. Other research applications for motion analysis currently include studying the role of the unicompartmental knee arthroplasty and novel physical therapy protocols aimed at optimizing post-operative care. Two articles studied motion analysis as a tool for predicting radiographic outcomes. Preoperative gait analysis has identified parameters than can predict postoperative tibial component migration. 15 articles studied motion analysis in conjunction with clinical scores. Conclusions: There is a broad range of applications within the research domain of total knee arthroplasty. The potential application is likely larger. However, the current literature is limited by vague definitions of ‘gait analysis’ or ‘motion analysis’ and a limited number of articles with preoperative and postoperative functional and clinical measures. Knee adduction moment, knee adduction impulse, total knee range of motion, varus angle, cadence, stride length, and velocity have the potential for integration into composite clinical scores. A systematic review aimed at determining the validity, reliability, sensitivities, and specificities of these variables is warranted.

Keywords: motion analysis, joint replacement, patient-reported outcomes, knee surgery

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Authors: Dali Nikolaishvili, Nino Khareba, Mariam Tsitsagi

Abstract:

Tbilisi has been a capital of Georgia since the 5ᵗʰ century. City area was covered by forest in historical past. Nowadays the situation has been changing dramatically. Dozens of problems are caused by damages/destruction of green cover and solution, at one glance, seems to be uncomplicated (planting trees and creating green quarters), but on the other hand, according to the increasing tendency, the built up of areas still remains unsolved. Finding out the ways to overcome such obstacles is important even for protecting the health of society. Making of Retrospective cartography of the forest area of Tbilisi with use of GIS technology and remote sensing was the main aim of the research. Research about the dynamic of forest-cover in Tbilisi and its surroundings included the following steps: assessment of the dynamic of forest in Tbilisi and its surroundings. The survey was mainly based on the retrospective mapping method. Using of GIS technology, studying, comparing and identifying the narrative sources was the next step. And the last one was analyzed of the changes from the 80s to the present days on the basis of decryption of remotely sensed images. After creating a unified cartographic basis, the mapping and plans of different periods have been linked to this geodatabase. Data about green parks, individual old plants existing in the private yards and respondents' Information (according to a questionnaire created in advance) was added to the basic database, the general plan of Tbilisi and Scientific works as well. On the basis of analysis of historic, including cartographic sources, forest-cover maps for different periods of time were made. In addition, was made the catalog of individual green parks (location, area, typical composition, name and so on), which was the basis of creating several thematic maps. Areas with a high rate of green area degradation were identified. Several maps depicting the dynamics of forest cover of Tbilisi were created and analyzed. The methods of linking the data of the old cartographic sources to the modern basis were developed too, the result of which may be used in Urban Planning of Tbilisi. Understanding, perceiving and analyzing the real condition of green cover in Tbilisi and its problems, in turn, will help to take appropriate measures for the maintenance of ancient plants, to develop forests and to plan properly parks, squares, and recreational sites. Because the healthy environment is the main condition of human health and implies to the rational development of the city.

Keywords: catalogue of green area, GIS, historical cartography, cartography, remote sensing, Tbilisi

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Authors: Rohit Kothari

Abstract:

Background: Leprosyis a chronic granulomatous diseasecaused by Mycobacterium leprae (M. Lepra). Reactions may interrupt its usual chronic course.Type-1 (T1R)and type-2 lepra reaction(T2R) are acute events and signifytype-IV and type-III hypersensitivity responses, respectively. Various chemokines like CCL3, 5, 11, and CCL24 may be increased during the course of leprosy or during reactions and may serve as markers of early diagnosis, response to therapy, and prognosis. Objective: To find correlation of CCL3, 5, 11, and CCL24 in leprosy patients on multidrug therapy and their family contacts after ruling out active disease during leprosy treatment and during periods of lepra reactions. Methodology: This randomized control trial was conducted in 50 clinico-histopathologically diagnosed cases of leprosy in a tertiary care hospital in Bengaluru, India. 50 of their family contacts were adequately examined and investigated should the need be to rule out active disease. The two study-groups comprised of leprosy cases, and the age, sex, and area of residence matched healthy contactswho were given single-dose rifampicin prophylaxis, respectively. Blood samples were taken at baseline, six months, and after one yearin both the groups (on completion of MDT in leprosy cases)and also during periods of reaction if occurred in leprosy cases. Results: Our study found that at baseline, CCL5, 11, and 24 were higher in leprosy cases as compared to the healthy contacts, and the difference was statistically significant.CCL3 was also found to be higherat baseline in leprosy cases, however, the difference was not statistically significant. At six months and one year, the levels of CCL 5, 11, and 24 reduced, and the difference was statistically significant in leprosy cases, whereas it remained almost static in all the healthy contacts. Twenty patients of leprosy developed lepra reaction during the course of one year, and during reaction, the increase in CCL11 and 24 was statistically significant from baseline, whereas CCL3 and 5 did not rise significantly. One of the healthy contacts developed signs of leprosy in the form of hypopigmented numb patch and was clinico-histopathologically, and CCL11 and 24 were found to be higher with a statistically significant difference from the baseline values. Conclusion: CCL5, 11, and 24 are sensitive markers of diagnosing leprosy, response to MDT, and prognosis and are not increased in healthy contacts. CCL11 and 24 are sensitive markers of lepra reactions and may serve as one of the early diagnostic modalities for identifying lepra reaction and also leprosy in healthy contacts. To the best of our knowledge, this is the first study to evaluate these biomarkers in leprosy cases and their healthy contacts with a follow-up of upto one year with one of them developing the disease, and the same was confirmed based on these biomarkers as well.

Keywords: chemokine profile, healthy contacts, leprosy, lepra reactions

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