Search results for: long‐term care

Authors: Mariia Karizhenskaia, Tanvi Nandani, Ali Tafazoli Moghadam

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Hospice palliative care (HPC) is one of the most complicated philosophies of care in which physical, social/cultural, and spiritual aspects of human life are intermingled with an undeniably significant role in every aspect. Among these dimensions of care, culture possesses an outstanding position in the process and goal determination of HPC. This study shows the importance of cultural elements in the establishment of effective and optimized structures of HPC in the Canadian healthcare environment. Our systematic search included Medline, Google Scholar, and St. Lawrence College Library, considering original, peer-reviewed research papers published from 1998 to 2023 to identify recent national literature connecting culture and palliative care delivery. The most frequently presented feature among the articles is the role of culture in the efficiency of the HPC. It has been shown frequently that including the culturespecific parameters of each nation in this system of care is vital for its success. On the other hand, ignorance about the exclusive cultural trends in a specific location has been accompanied by significant failure rates. Accordingly, implementing a culture-wise adaptable approach is mandatory for multicultural societies. The following outcome of research studies in this field underscores the importance of culture-oriented education for healthcare staff. Thus, all the practitioners involved in HPC will recognize the importance of traditions, religions, and social habits for processing the care requirements. Cultural competency training is a telling sample of the establishment of this strategy in health care that has come to the aid of HPC in recent years. Another complexity of the culturized HPC nowadays is the long-standing issue of racialization. Systematic and subconscious deprivation of minorities has always been an adversity of advanced levels of care. The last part of the constellation of our research outcomes is comprised of the ethical considerations of culturally driven HPC. This part is the most sophisticated aspect of our topic because almost all the analyses, arguments, and justifications are subjective. While there was no standard measure for ethical elements in clinical studies with palliative interventions, many research teams endorsed applying ethical principles for all the involved patients. Notably, interpretations and projections of ethics differ in varying cultural backgrounds. Therefore, healthcare providers should always be aware of the most respectable methodologies of HPC on a case-by-case basis. Cultural training programs have been utilized as one of the main tactics to improve the ability of healthcare providers to address the cultural needs and preferences of diverse patients and families. In this way, most of the involved health care practitioners will be equipped with cultural competence. Considerations for ethical and racial specifications of the clients of this service will boost the effectiveness and fruitfulness of the HPC. Canadian society is a colorful compilation of multiple nationalities; accordingly, healthcare clients are diverse, and this divergence is also translated into HPC patients. This fact justifies the importance of studying all the cultural aspects of HPC to provide optimal care on this enormous land.

Keywords: cultural competence, end-of-life care, hospice, palliative care

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Authors: Paul M. H. J. Roekaerts

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In recent years, it became clear that much intensive care (ICU) survivors develop a post-intensive care syndrome (PICS) consisting of psychiatric, cognitive and physical problems for a prolonged period after their ICU stay. Physical inactivity and delirium during the ICU stay are the main determinants of the post-ICU PICS. This presentation will focus on delirium, its epidemiology, prevalence, effect on outcome, risk factors and the current standard of care for managing delirium. Because ICU delirium is a predictor of prolonged length-of-stay in the ICU and of death, the use of a delirium prevention bundle (DPB) becomes mandatory in every ICU. In this presentation, a DPB bundle will be discussed consisting of six components: pain, sedation, sleep, sensory and intellectual stimulation, early mobilization, and hydration. For every of the six components, what to do and what not to do will be discussed. The author will present his own institutional policy on pharmacological and non-pharmacological interventions in the management of delirium. The component ‘early mobilization’ will be discussed more in detail, as this component is extremely important in the prevention of delirium as well as in the prevention of the PICS. The author will conclude his presentation with the remaining areas of uncertainties/work and research to be done.

Keywords: delirium, delirium prevention bundle, early mobilisation in intensive care (ICU), post-intensive care syndrome (PICS)

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Authors: Alpa Mehta

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Talent acquisition, development, and retention are major issues encountered in the health care industries in any country. Recent authentic data showed that employee turnover in the field of health care is increasing day by day compare to other industrial sectors. There are many reasons behind retention issues. One of such can be the lack of involvement and engagement of health workers in day to day HRM. Health care is a noble profession and employee has to deal with the patient with the optimum level of satisfaction and productivity. So employee morale and motivation should be high. This area of concern is mostly ignored by management, and ultimately it turns into dissatisfaction and abandonment in search of other jobs. The paper analyses the HRM tools to retain healthcare employee with high moral through employee involvement. The paper includes the case study of One of the Prominent Health care institute of India has found out a way to retain talented employees in the organization with the tool of employee engagement.

Keywords: employee involvement, health care industry, human resources management, talent retention

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Authors: Eda Jazexhiu-Postoli, Gladiola Hoxha, Ada Simeoni, Sonila Biba

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Background Neonatal hypotonia represents a commonly encountered issue in the Neonatal Intensive Care Unit and newborn nursery. The differential diagnosis is broad, encompassing chromosome abnormalities, primary muscular dystrophies, neuropathies and inborn errors of metabolism. Aim of study Our study describes some of the main clinical features of hypotonia in newborns and presents clinical cases of neonatal hypotonia we treated in our Neonatal unit in the last 3 years. Case reports Four neonates born in our hospital presented with hypotonia after birth, one preterm newborn 35-36 weeks of gestational age and three other term newborns (38-39 weeks of gestational age). Prenatal data revealed a decrease in fetal movements in both cases. Intrapartum meconium-stained amniotic fluid was found in 75% of our hypotonic newborns. Clinical features included inability to establish effective respiratory movements and need for resuscitation in the delivery room, respiratory distress syndrome, feeding difficulties and need for oro-gastric tube feeding, dysmorphic features, hoarse voice and moderate to severe muscular hypotonia. The genetic workup revealed the diagnosis of Autosomal Recessive Congenital Myasthenic Syndrome 1-B, Sotos Syndrome, Spinal Muscular Atrophy Type 1 and Transient Hypotonia of the Newborn. Two out of four hypotonic neonates were transferred to the Pediatric Intensive Care Unit and died at the age of three to five months old. Conclusion Hypotonia is a concerning finding in neonatal care and it is suggested by decreased intrauterine fetal movements, failure to establish first breaths, respiratory distress and feeding difficulties in the neonate. Prognosis is determined by its etiology and time of diagnosis and intervention.

Keywords: hypotonic neonate, respiratory distress, feeding difficulties, fetal movements

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Authors: Khalid Al Saleh, Najlaa AlSayed

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Background: Palliative care is changing from just ‘end of life care’ to care delivered earlier in the disease course. Metanalysis showed that Palliative Performance Scale (PPS) is associated with increased length of survival. The Palliative Care Center (PCC) in Kuwait is the only stand-alone center in Eastern Mediterranean Region with a capacity of 92 beds. We compared clinical characteristics between patients referred from the Specialized Cancer Center and general hospitals in Kuwait to PCC. Method: A cross Sectional survey was conducted since the opening of PCC in January 2011 to June 2013. Patients’ data on demographics, type of the cancer, PPS score and referring hospital were collected and analyzed. Results: Total number of the patients was 142. Mean age was 61.05±14.79 years, 66 patients (47.1%) were males and 74 (52.9%) were females. The most common cancers in males were lung (n=18, 27.3%) followed by head and neck cancers (n=8, 12.1%) and brain tumors (n=7, 10.6%) while in females, the most common cancers were breast cancer (n=12, 16.7%) followed by ovarian cancer (n=10, 13.9%) and Cancer Colon (n=8, 11.1%). Patients with PPS score 30% were 27.9% (n=39), 40% in 40.7% (n=57), and 50% in 17.1% (n=24) respectively. Patients referred from the Specialized Cancer Center had significantly higher portion of patients with PPS score > 30% (73.4%, n=94), compared to patients coming from general hospitals (33.3%, n=4), P value= 0.007. Conclusion: There is significant difference in PPS scores between patients referred from the Specialized Cancer Center compared to patients referred from general hospitals. We encourage that all cancer patients should be treated in Specialized Cancer Centers and earlier involvement of Palliative Care Centers to achieve better survival. Training workshops are needed for health care professionals working in general hospitals to raise awareness about earlier referral of patients to palliative care services.

Keywords: palliative care, kuwait, performance scale differences, pps score, specialized hospitals

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Authors: Priscila Vitorino, Jeeziane Rezende, Edison Pereira, Adrielly Silva, Weimar Barroso

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Body composition insight during physical activity is relevant to follow up sports income since it can be important and actuate in velocity, resistance, potency, and has an effect on force and agility. The purpose of this study was to identify anthropometric profile, evaluate and correlate body mass index and bioimpedance behavior during the days of Caminhada Ecológica de Goiás - Brasil. A longitudinal study was performed with 25 male participants, with an average age of 45.6±9.1 years. All patients were actives. Body composition was evaluated by body mass index (BMI) measurement and bioimpedance procedures. Both were collected 20 days before walking beginning (A0) and in the four days along the same (A1, A2, A3 e A4). Data were collected in the end of each walking day at athletes accommodations. Final distance during walking route was 308 km in five days, with an average of 62km/day and 7,6 km/hour, and an average temperature of 30°C. Data are represented with mean and standard deviation. ANOVA (Bonferroni pos test) was used to compare frequent measurements between the days. Pearson's correlation test was used to correlate BMI with lean mass, fat mass, and water. BMI decreased from A0 to A1, A2 and A3 (p < 0,01) and increased on A4 (p < 0,01). No changes were observed concerning fat percentage (p=0,60), lean mass (p=0,10) and body water composition (p=0,09). A positive and moderate correlation between BMI and fat percentage was observed; an inverse and moderate correlation between BMI, lean mass and body water composition occurred. Total body mass increased during high intensity and long term walking distance. However, the values of body fat, lean mass and water were maintained.

Keywords: aerobic exercise, body composition, metabolism, sports

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Authors: Abdessamad Dali-Ali, Houaria Beldjillali, Fouzia Agag, Asmaa Oukebdane, Ramzi Tidjani, Arslane Bettayeb, Khadidja Meddeber, Radia Dali-Yahia, Nori Midoun

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Healthcare-associated infections are a real public health problem, especially in intensive care units. The aim of our study was to describe the epidemiological profile and to estimate the incidence of these infections at the intensive care unit of our teaching hospital. A prospective study was conducted, from June 2012 to December 2013. During this period, 305 patients having a duration of hospitalization equal or more than 48 hours were included in the study. In terms of the incidence of healthcare associated infections, nosocomial pneumonia occupied the first position with a cumulative incidence rate of 20.0%, followed by bacteremia (5.6%), central venous catheter infections (4%), and urinary tract infections (3%). In the case of isolated microorganisms, Gram-negative bacilli not enterobacteriaceae occupied the first place with 48.5%, followed by enterobacteria (32.1%). Acinetobacter baumannii was the most common germ (27.6%). Our study showed that the rate of health-care-associated infections was relatively high in the intensive care unit. A control program to reduce all infections is a priority for the Infection Control Associated Committee.

Keywords: epidemiological profile, healthcare associated infections, intensive care units, teaching hospital of Oran, Algeria

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Authors: Hilal Al Shamsi, Abdullah Almutairi

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Introduction: As primary healthcare centres play an important role in implementing Saudi Arabia’s health strategy, this paper offers a review of publications on the quality of the country’s primary health care. With the aim of deciding on solutions for improvement, it provides an overview of healthcare quality in this context and indicates barriers to quality. Method: Using two databases, ProQuest and Scopus, data extracted from published articles were systematically analysed for determining the care quality in Saudi primary health centres and obstacles to achieving higher quality. Results: Twenty-six articles met the criteria for inclusion in this review. The components of healthcare quality were examined in terms of the access to and effectiveness of interpersonal and clinical care. Good access and effective care were identified in such areas as maternal health care and the control of epidemic diseases, whereas poor access and effectiveness of care were shown for chronic disease management programmes, referral patterns (in terms of referral letters and feedback reports), health education and interpersonal care (in terms of language barriers). Several factors were identified as barriers to high-quality care. These included problems with evidence-based practice implementation, professional development, the use of referrals to secondary care and organisational culture. Successful improvements have been implemented by other systems, such as mobile medical units, electronic referrals, online translation tools and mobile devices and their applications; these can be implemented in Saudi Arabia for improving the quality of the primary healthcare system in this country. Conclusion: The quality of primary health care in Saudi Arabia varies among the different services. To improve quality, management programmes and organisational culture must be promoted in primary health care. Professional development strategies are also needed for improving the skills and knowledge of healthcare professionals. Potential improvements can be implemented to improve the quality of the primary health system.

Keywords: quality, primary health care, Saudi Arabia, health centres, general medical

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Authors: Cinzia Valente

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Over the last few years, national legislators have been forced to deal with social changes that have had important repercussions in family law and children’s law. This growing focus on minors has provoked important reforms, specifically on issues relating to the welfare and protection of children. My presentation focuses on the issue of migrant children in particular I refer to unaccompanied children, or ‘children on the move’, or separate children or any other term defining migrant minors who cross national borders seeking protection or better opportunities. They arrive often illegally, on the European territory without a responsible adult who take care of them. There is a common assumption that migrants are running away from conflicts, poverty and human rights abuse and they arrive in a foreign country hoping a better life; children without persons who takes care of them encounter some difficulties in their integration in the host country. The migration flows recorded in recent decades towards EU countries, and Italy in particular, have imposed an intense pressure to modernize institutions, services and specific legal frameworks, with the aim of responding adequately to the needs of foreign individuals, as well as ensuring a good level of living standards and facilitating integration, especially for migrant children. The object of my paper is the analysis of the Italian rules, practices and services existing in favor of unaccompanied children (foster care, reunification, acquisition of citizenship and other) in comparison with other European legal systems on the same thematic with a comparative method. Highlighting European standards to find common principles for the best solution to children's problems is the conclusive aim of my presentation.

Keywords: Children , Family Law, Migration , Uniform Law

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Authors: Nathen A. Spitz, Dennis Martin Kivlighan III, Arwa Aburizik

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Background and Purpose: Presently, there is a paucity of naturalistic studies that directly compare the effectiveness of psychotherapy versus concurrent psychotherapy and psychiatric care for the treatment of depression and anxiety in cancer patients. Informed by previous clinical trials examining the efficacy of concurrent approaches, this study sought to test the hypothesis that a combined approach would result in the greatest reduction of depression and anxiety symptoms. Methods: Data for this study consisted of 433 adult cancer patients, with 252 receiving only psychotherapy and 181 receiving concurrent psychotherapy and psychiatric care at the University of Iowa Hospitals and Clinics. Longitudinal PHQ9 and GAD7 data were analyzed between both groups using latent growth curve analyses. Results: After controlling for treatment length and provider effects, results indicated that concurrent care was more effective than psychotherapy alone for depressive symptoms (γ₁₂ = -0.12, p = .037). Specifically, the simple slope for concurrent care was -0.25 (p = .022), and the simple slope for psychotherapy alone was -0.13 (p = .006), suggesting that patients receiving concurrent care experienced a greater reduction in depressive symptoms compared to patients receiving psychotherapy alone. In contrast, there were no significant differences between psychotherapy alone and concurrent psychotherapy and psychiatric care in the reduction of anxious symptoms. Conclusions: Overall, as both psychotherapy and psychiatric care may address unique aspects of mental health conditions, in addition to potentially providing synergetic support to each other, a combinatorial approach to mental healthcare for cancer patients may improve outcomes.

Keywords: psychiatry, psychology, psycho-oncology, combined care, psychotherapy, behavioral psychology

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Authors: J. Luché-Thayer, C. Perronne, C. Meseko

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We reviewed how certain institutional policies and practices, as well as questionable research, are creating obstacles to care and informed consent for Lyme and relapsing fever Borreliosis patients. The interference is denying access to treatments that meet the internationally accepted standards as set by the Institute of Medicine. This obstruction to care contributes to significant human suffering, disability and negative economic effect across many nations and in many regions of the world. We note how evidence based medicine emphasizes the importance of clinical experience and patient-centered care and how these patients benefit significantly when their rights to choose among treatment options are upheld.  

Keywords: conflicts of interest, obstacles to healthcare accessibility, patient-centered care, the right to informed consent

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Authors: Lee Boudreau, Ash Kumar Khaitu, Laura A. S. MacDonald

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In April 2015, a magnitude 7.8 earthquake struck Nepal, killing, injuring, and displacing thousands of people. The earthquake also damaged water and sanitation service networks, leading to a high risk of diarrheal disease and the associated negative health impacts. In response to the disaster, the Environment and Public Health Organization (ENPHO), a Kathmandu-based non-governmental organization, worked with the Centre for Affordable Water and Sanitation Technology (CAWST), a Canadian education, training and consulting organization, to develop two training programs to educate volunteers on water, sanitation, and hygiene (WASH) needs. The first training program was intended for acute response, with the second focusing on longer term recovery. A key focus was to equip the volunteers with the knowledge and skills to formulate useful WASH advice in the unanticipated circumstances they would encounter when working in affected areas. Within the first two weeks of the disaster, a two-day acute response training was developed, which focused on enabling volunteers to educate those affected by the disaster about local WASH issues, their link to health, and their increased importance immediately following emergency situations. Between March and October 2015, a total of 19 training events took place, with over 470 volunteers trained. The trained volunteers distributed hygiene kits and liquid chlorine for household water treatment. They also facilitated health messaging and WASH awareness activities in affected communities. A three-day recovery phase training was also developed and has been delivered to volunteers in Nepal since October 2015. This training focused on WASH issues during the recovery and reconstruction phases. The interventions and recommendations in the recovery phase training focus on long-term WASH solutions, and so form a link between emergency relief strategies and long-term development goals. ENPHO has trained 226 volunteers during the recovery phase, with training ongoing as of April 2016. In the aftermath of the earthquake, ENPHO found that its existing pool of volunteers were more than willing to help those in their communities who were more in need. By training these and new volunteers, ENPHO was able to reach many more communities in the immediate aftermath of the disaster; together they reached 11 of the 14 earthquake-affected districts. The collaboration between ENPHO and CAWST in developing the training materials was a highly collaborative and iterative process, which enabled the training materials to be developed within a short response time. By training volunteers on basic WASH topics during both the immediate response and the recovery phase, ENPHO and CAWST have been able to link immediate emergency relief to long-term developmental goals. While the recovery phase training continues in Nepal, CAWST is planning to decontextualize the training used in both phases so that it can be applied to other emergency situations in the future. The training materials will become part of the open content materials available on CAWST’s WASH Resources website.

Keywords: water and sanitation, emergency response, education and training, building resilience

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Authors: Leoba Nyathi, Augustine K. Tugli, Takalani G. Tshitangano

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Use of health care services is an effective way of improving maternal and child health outcomes, especially in the rural areas. The study aimed to find out the perceptions of women on factors that affect the utilisation of antenatal care services (ANC) in Mangwe Rural District, Zimbabwe. The study was conducted in Mabunga village which is situated in Mangwe Rural District, Matabeleland South Province, Zimbabwe. A qualitative approach using explorative and descriptive design was adopted for the study. A sample of ten women were chosen from the target population by means of convenience sampling and data was collected through semi-structured interviews. Interviews and discussions were audio-taped, transcribed and coded into themes and subthemes. The study results showed that access factors, socio-cultural factors, demographic factors, quality of care and knowledge about antenatal care services were the major factors affecting utilisation of ANC services in Mangwe Rural District. It was discovered that the geographical location of the village to the health care centres has a great impact on utilisation of services. All the women did not initiate ANC services as recommended and they also did not adhere to the number of times they were supposed to visit the health care centres. The findings concluded that women have the knowledge about ANC and they all attended at least once during their last pregnancy. However, inconsistencies in attendance were shown due to access, socio-cultural and demographic factors.

Keywords: antenatal care services, women, utilisation, affect, factors, perceptions

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Authors: Stacie Nelson Colling, Adele Cummings

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The United States Supreme Court recently announced that it is unconstitutional to sentence a child to life without parole for non-homicide offenses, and that each child so situated must be afforded a meaningful opportunity for release from prison in his lifetime. The Court also declared that it is unconstitutional to impose a mandatory sentence of life without parole on a child for homicide offenses. Across the United States, attorneys and advocates continue to litigate issues surrounding the implementation of these legal principles. Some states have held that any sentence to a finite term of years, no matter how long, is not the same as ‘life’ and therefore does not violate the constitution. Other states have held that a sentence to a term of years that is less than the expected life of that particular child is not unconstitutional. In Colorado, the courts have routinely looked to life expectancy estimates from governmental organizations to determine how long a particular child is expected to live. They then compare that the date that the child is expected to be eligible for parole, and if the child is expected to still be living when he is eligible for parole, the sentence is deemed constitutional. This paper argues that it is inappropriate, reckless, unconstitutional and not scientifically sound to use such estimates in determining whether a child will have a meaningful opportunity for release from prison and life outside of prison before he dies. This paper argues that the opportunity for release must mean more than a probability that a child will be released before his death, and that it must include an opportunity for a meaningful life outside of prison (not just the opportunity to be released and then die on the outside). The paper further argues that life expectancy estimates cannot guide a court or a legislature in determining whether a sentence is or is not constitutional.

Keywords: life without parole, life expectancy, juvenile sentencing, meaningful opportunity for release from prison

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Authors: Srinivas Peri, Siva Abhishek Sirivella, Tejaswini Kallakuri, Uzair Ahmad

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Smart cities and intelligent transportation systems rely heavily on effective traffic management and infrastructure planning. This research tackles the data scarcity challenge by generating realistically synthetic traffic data from the PeMS-Bay dataset, enhancing predictive modeling accuracy and reliability. Advanced techniques like TimeGAN and GaussianCopula are utilized to create synthetic data that mimics the statistical and structural characteristics of real-world traffic. The future integration of Spatial-Temporal Generative Adversarial Networks (ST-GAN) is anticipated to capture both spatial and temporal correlations, further improving data quality and realism. Each synthetic data generation model's performance is evaluated against real-world data to identify the most effective models for accurately replicating traffic patterns. Long Short-Term Memory (LSTM) networks are employed to model and predict complex temporal dependencies within traffic patterns. This holistic approach aims to identify areas with low vehicle counts, reveal underlying traffic issues, and guide targeted infrastructure interventions. By combining GAN-based synthetic data generation with LSTM-based traffic modeling, this study facilitates data-driven decision-making that improves urban mobility, safety, and the overall efficiency of city planning initiatives.

Keywords: GAN, long short-term memory (LSTM), synthetic data generation, traffic management

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Authors: Kankurize Josiane, Nizigama Mediatrice

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Introduction: Burundi records a still high infant mortality rate. Despite efforts to reduce it, prematurity is still the leading cause of death in the neonatal period. The objective of this study was to assess the quality of care for premature babies hospitalized in the neonatology unit of the Centre Hospitalier Universitaire de Kamenge. Method: This was a descriptive and evaluative prospective carried out in the neonatology unit of the CHUK (Centre Hospitalier Universitaire de Kamenge) from December 1, 2016, to May 31, 2017, including 70 premature babies, 65 mothers of premature babies and 15 providers including a pediatrician and 14 nurses. Using a tool developed by the World Health Organization and adapted to the local context by national experts, the quality of care for premature babies was assessed. Results: Prematurity accounted for 44.05% of hospitalizations in neonatology at the University Hospital of Kamenge. The assessment of the quality of care for premature babies was of low quality, with an average global score of 2/5 (50%), indicating that there is a considerable need for improvement to reach the standards. Conclusion: Efforts must be made to have infrastructures, materials, and human resources sufficient in quality and quantity so that the neonatology unit of the CHUK can be efficient and optimize the care of premature babies.

Keywords: quality of care, evaluation, premature, standards

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Authors: Peter Boyes, Sarah Sharples, Paul Tennent, Gary Priestnall, Jeremy Morley

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Significant long-term investment projects can involve complex decisions. These are often described as capital projects, and the factors that contribute to their complexity include budgets, motivating reasons for investment, stakeholder involvement, interdependent projects, and the delivery phases required. The complexity of these projects often requires management groups to be established involving stakeholder representatives; these teams are inherently multidisciplinary. This study uses two university campus capital projects as case studies for this type of management group. Due to the interaction of projects with wider campus infrastructure and users, decisions are made at varying spatial granularity throughout the project lifespan. This spatial-related context brings complexity to the group decisions. Sensemaking is the process used to achieve group situational awareness of a complex situation, enabling the team to arrive at a consensus and make a decision. The purpose of this study is to understand the role of people and data in the complex spatial related long-term decision and sensemaking processes. The paper aims to identify and present issues experienced in practical settings of these types of decision. A series of exploratory semi-structured interviews with members of the two projects elicit an understanding of their operation. From two stages of thematic analysis, inductive and deductive, emergent themes are identified around the group structure, the data usage, and the decision making within these groups. When data were made available to the group, there were commonly issues with the perception of veracity and validity of the data presented; this impacted the ability of group to reach consensus and, therefore, for decisions to be made. Similarly, there were different responses to forecasted or modelled data, shaped by the experience and occupation of the individuals within the multidisciplinary management group. This paper provides an understanding of further support required for team sensemaking and decision making in complex capital projects. The paper also discusses the barriers found to effective decision making in this setting and suggests opportunities to develop decision support systems in this team strategic decision-making process. Recommendations are made for further research into the sensemaking and decision-making process of this complex spatial-related setting.

Keywords: decision making, decisions under uncertainty, real decisions, sensemaking, spatial, team decision making

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Authors: Cassey Younghans

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Background: Current health care trends demonstrate that there is an increasing number of patients being hospitalized with complex comorbidities. These complex needs require advanced therapies, and treatment goals often focus on doing everything possible to prolong life rather than focusing on the individual patient’s quality of life which is the goal of palliative care efforts. Patients benefit from palliative care in the early stages of the illness rather than after the disease progressed or the state of acuity has advanced. The clinical problem identified was that palliative care was not being implemented early enough in the disease process with patients who had complex medical conditions and who would benefit from the philosophy and skills of palliative care professionals. Purpose: The purpose of this quality improvement study was to increase the number of palliative care screenings and consults completed on adults after being admitted to one Non-ICU and Non-COVID hospital unit. Methods: A retrospective chart review assessing for possible missed opportunities to introduce palliation was performed for patients with six primary diagnoses, including heart failure, liver failure, end stage renal disease, chronic obstructive pulmonary disease, cerebrovascular accident, and cancer in a population of adults over the ago of 19 on one medical-surgical unit over a three-month period prior to the intervention. An educational session with the nurses on the benefits of palliative care was conducted by the researcher, and a screening tool was implemented. The expected outcome was to have an increase in early palliative care consultation with patients with complex comorbid conditions and a decrease in missed opportunities for the implementation of palliative care. Another retrospective chart review was completed following completion of the three month piloting of the tool. Results: During the retrospective chart review, 46 patients were admitted to the medical-surgical floor with the primary diagnoses identified in the inclusion criteria. Six patients had palliative care consults completed during that time. Twenty-two palliative care screening tools were completed during the intervention period. Of those, 15 of the patients scored a 7 or higher, suggesting that a palliative care consultation was warranted. The final retrospective chart review identified that 4 palliative consults were implemented during that time of the 31 patients who were admitted over the three month time frame. Conclusion: Educating nurses and implementing a palliative care screening upon admission can be of great value in providing early identification of patients who might benefit from palliative care. Recommendations – It is recommended that this screening tool should be used to help identify the patents of whom would benefit from a palliative care consult, and nurses would be able to initiated a palliative care consultation themselves.

Keywords: palliative care, screening, early, palliative care consult

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Authors: Karina Lõbus, Silver Muld, Kadri Kööp, Mare Tupits

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Aim: The aim of the research is to describe the experiences and needs of fathers’ of children with cancer in coping with the child's disease. Background: Today, about 80% of children diagnosed with malignancy in developed countries survive. Despite the positive statistics, recovery is not always certain, treatment is often very intensive and long-term. Cancer is affecting an increasing number of the population, which is increasing the demand for quality care, but the nature of expected care is currently unclear. This topic is important for the development of professional practice, as nurses complain that their knowledge to deal with the relatives of a patient with a difficult diagnosis is limited and would therefore like additional information to deal with the situation. Design: Qualitative, empirical, descriptive research. Method: The data were collected through semi-structured interviews and analysed by inductive content analysis method. Interviews were conducted during Autumn 2020. 4 subjects participated in the research. Results and Conclusions: The thesis revealed that fathers had different experiences and needs in dealing with the child's illness. Fathers' experiences of coping with child's diseases encompassed experiences with information, social relationships, healthcare, changes in personal health and experiences regarding the child. Regarding information, the respondents pointed out bad experiences with the availability of information and the ability to convey the necessary information. Experiences regarding social relationships included experiences with relatives and strangers. Regarding healthcare, fathers mentioned experiences related to the child's health and healthcare professionals. In regards to personal health, fathers pointed out negative changes in their mental and physical health. In relation to the child, the subjects revealed experiences regarding changed values, way of life and raising the child. According to the research, fathers’ needs in relation to dealing with child's cancer included material, social, and spiritual needs. In regard to material needs, fathers pointed out the need for state assistance and the needs related to the surrounding environment. The needs concerning social belonging involved needs for a driving force and involvement in the treatment process. Regarding spiritual needs, fathers expressed mixed feelings towards the need for outside and professional help.

Keywords: father, coping, cancer, child, experience, need

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Authors: Syed Ahmed Salman

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Ethicality is essential in our daily activities, including personal and commercial activities. This is evidenced by referring to the historical development of the corporate governance and ethical guidelines. The first corporate governance guideline, i.e. Cadbury Report from U.K. focuses the responsibility of board members towards the shareholders only. Gradually, realising the need to take care of the society and community, stakeholders are now concerns of business entities. Consequently, later codes of corporate governance started extending the responsibility to the other stakeholders in addition to the shareholders. One prevailing corporate governance theory, i.e. stakeholder theory, has been widely used in the research to explore the effects of business entities on society. In addition, the Global Reporting Initiative (GRI) is the leading organisation which promotes social care from businesses for sustainable development. Conventionally, history shows that ethics is key to the long term success of businesses. Many organisations, societies, and regulators give full attention and consideration to ethics. Several countries have introduced ethical codes of conduct to direct trade activities. Similarly, Islam and other religions prohibit the practice of interest, uncertainty, and gambling because of its unethical nature. These prohibited practices are not at all good for the society, business, and any organisation especially as it is detrimental to the well-being of society. In order to avoid unethicality in the finance industry, Shari’ah scholars come out with the idea of Islamic finance which is free from the prohibited elements from the Islamic perspective. It can also be termed ethical finance. This paper highlights how Takaful as one of the Islamic finance products offers fair and just products to the contracting parties and the society. Takaful is framed based on ethical guidelines which are extracted from Shari’ah principles and divine sources such as the Quran and Sunnah. Takaful products have been widely offered all over the world, including in both Muslim and non-Muslim countries. It seems that it is gaining acceptance regardless of religion. This is evidence that Takaful is being accepted as an ethical financial product.

Keywords: ethics, insurance, Islamic finance, religion and takaful

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Authors: Dan Richard D. Fernandez

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This study determined the perspectives of community health workers’ perspectives in the sustainability of primary health care. Eight community health workers, two community officials and a rural health midwife in a rural community in the in the Philippines were enjoined to share their perspectives in the sustainability of primary health care. The study utilized the critical research method. The critical research assumes that there are ‘dominated’ or ‘marginalized’ groups whose interests are not best served by existing societal structures. Their experiences highlighted that the challenges of their role include unkind and uncooperative patients, the lack of institutional support mechanisms and conflict of their roles with their family responsibilities. Their most revealing insight is the belief that primary health care is within their grasp. Finally, they believe that the burden to sustain primary health care rests on their shoulders alone. This study establishes that Multi-stakeholder participation is and Gender-sensitivity is integral to the sustainability of Primary Health Care. It also observed that the ingrained Expert-Novice or Top-down Management Culture and the marginalisation of BHWs within the system is a threat to PHC sustainability. This study also recommends to expand the study and to involve the local government units and academe in lobbying the integration of gender-sensitivity and multi-stake participatory approaches to health workforce policies. Finally, this study recognised that the CHWs’ role is indispensable to the sustainability of primary health care.

Keywords: community health workers, multi-stakeholder participation, sustainability, gender-sensitivity

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Authors: Tewelde Gebreslassie Gebreanenia, Frie Ayalew Yimam, Seada Hussen Adem

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Patient safety and quality of care are essential goals of health care delivery, but they are often compromised by human errors, system failures, or resource constraints. In a variety of healthcare contexts, artificial intelligence (AI), a quickly developing field, can provide fresh approaches to enhancing patient safety and treatment quality. Artificial Intelligence (AI) has the potential to decrease errors and enhance patient outcomes by carrying out tasks that would typically require human intelligence. These tasks include the detection and prevention of adverse events, monitoring and warning patients and clinicians about changes in vital signs, symptoms, or risks, offering individualized and evidence-based recommendations for diagnosis, treatment, or prevention, and assessing and enhancing the effectiveness of health care systems and services. This study examines the state-of-the-art and potential future applications of AI-based technologies for enhancing patient safety and care quality, as well as the opportunities and problems they present for patients, policymakers, researchers, and healthcare providers. In order to ensure the safe, efficient, and responsible application of AI in healthcare, the paper also addresses the ethical, legal, social, and technical challenges that must be addressed and regulated.

Keywords: artificial intelligence, health care, human intelligence, patient safty, quality of care

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Authors: R. Mahmoodi, A. R. Zolfaghari

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In nuclear power plants, loss of coolant from the primary system is the type of reduced removed capacity that is given most attention; such an accident is referred as Loss of Coolant Accident (LOCA). In the current study, investigation of shell and tube THTL heat exchanger behavior during LOCA is implemented by ANSYS CFX simulation software in both steady state and transient mode of turbulent fluid flow according to experimental conditions. Numerical results obtained from ANSYS CFX simulation show good agreement with experimental data of THTL heat exchanger. The results illustrate that in large break LOCA as short term accident, heat exchanger could not fast response to temperature variables but in the long term, the temperature of shell side of heat exchanger will be increase.

Keywords: shell-and-tube heat exchanger, shell-side, CFD, flow and heat transfer, LOCA

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Authors: Amaraporn Puraya, Roongtiva Boonpracom, Somsak Thojampa, Sirikanok Klankhajhon, Kittisak Kumpeera

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The objective of this qualitative research was to study the elderly health care process by community participation. Data were collected by quality research methods, including secondary data study, observation, in-depth interviews, and focus group discussions and analyzed by content analysis, reflection and review of information. The research results pointed out that the important elderly health care process by community participation consisted of 2 parts, namely the community participation development process in elderly health care and the outcomes from the participation development process. The community participation development process consisted of 4 steps as follows: 1) Building the leadership team, an important social capital of the community, which started from searching for both formal and informal leaders by giving the opportunity for public participation and creating clear agreements defining roles, duties and responsibilities; 2) investigating the problems and the needs of the community, 3) designing the elderly health care activities under the concept of self-care potential development of the elderly through participation in community forums and meetings to exchange knowledge with common goals, plans and operation and 4) the development process of sustainable health care agreement at the local level, starting from opening communication channels to create awareness and participation in various activities at both individual and group levels as well as pushing activities/projects into the community development plan consistent with the local administration policy. The outcomes from the participation development process were as follows. 1) There was the integration of the elderly for doing the elderly health care activities/projects in the community managed by the elderly themselves. 2) The service system was changed from the passive to the proactive one, focusing on health promotion rather than treating diseases or illnesses. 3) The registered nurses / the public health officers can provide care for the elderly with chronic illnesses through the implementation of activities/projects of elderly health care so that the elderly can access the services more. 4) The local government organization became the main mechanism in driving the elderly health care process by community participation.

Keywords: elderly health care process, community participation, elderly, Thailand

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Authors: Akram Alfantazi, Tirdad Nickchi

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Magnesium galvanic corrosion plays an important role in the commercialization of Mg alloys in the automobile industry. This study aims at visualizing the electrochemical activity of the magnesium surface being coupled with pure iron in sulfate-chloride solutions. Scanning electrochemical microscopy was used to monitor the chemical activity of the surface and the data was compared with the conventional corrosion results such as potentiodynamic polarization, linear polarization, and immersion tests. The SECM results showed that the chemical reactivity of Mg is higher than phosphate-permanganate-coated Mg. Regions in the vicinity of the galvanic couple boundary are very active in the magnesium phase and fully protected in the iron phase. Scanning electrochemical microscopy results showed that the conversion coating provided good corrosion resistance for magnesium in the short-term but fails at long-term testing.

Keywords: corrosion, galvanic corrosion, magnesium, scanning electrochemical microscopy

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Authors: Chao Fang

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Due to the Confucian emphasis on filial piety and an undeveloped social welfare system in mainland China, adult children are both socially and legally obliged to care for their parents, including financial assistance and physical care as well as emotional and social support. Thus a family-centred care pattern for elderly people has been firmly established in China. However, because of the nationwide ‘One Child Policy’, over one million parents are excluded from such care because of the death of their only child and, therefore, their primary caregiver. Without their child’s support, these parents must manage the day to day challenges of growing old alone, with little support from society. By overturning established expectations of a ‘good’ elderly life, the loss of an only child may be accompanied by social and self-stigmatization, pushing these bereaved parents to the margin of society and threatening their economic, physical, emotional and social well-being. More importantly, since the One Child Policy was implemented from the late 1970s and early 1980s, the first generation of bereaved or ‘Shidu’ parents has reached an age at which those parents need elderly care. However, their predicament has been largely ignored. This paper reports on a qualitative interview study that found elderly care to be the main concern for Shidu parents’ everyday life. The paper identifies and discusses the concerns these bereaved parents raised about the prospect of having nowhere to turn at a time of increased need for financial, physical, social and emotional support in old age. The paper also identifies how Shidu parents have been coming together in grief and negotiate to make their predicament known to the government and wider society and to re-define their elderly life by rebuilding a sense of ‘family’.

Keywords: culture, bereavement, China, elderly care

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Authors: Muhammad Zubair Khan, Yugyung Lee

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Deep learning has recently achieved enormous response in semantic image segmentation. The previously developed U-Net inspired architectures operate with continuous stride and pooling operations, leading to spatial data loss. Also, the methods lack establishing long-term pixels connection to preserve context knowledge and reduce spatial loss in prediction. This article developed encoder-decoder architecture with bi-directional LSTM embedded in long skip-connections and densely connected convolution blocks. The network non-linearly combines the feature maps across encoder-decoder paths for finding dependency and correlation between image pixels. Additionally, the densely connected convolutional blocks are kept in the final encoding layer to reuse features and prevent redundant data sharing. The method applied batch-normalization for reducing internal covariate shift in data distributions. The empirical evidence shows a promising response to our method compared with other semantic segmentation techniques.

Keywords: deep learning, semantic segmentation, image analysis, pixels connection, convolution neural network

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Authors: Gloria Chen

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When offering conventional level-appropriate ESL classes for adults is not feasible, a multilevel adult ESL class can be formed to benefit those who need to learn English for daily function. This paper examines the rationale, the process, the contents, and the outcomes of a multilevel ESL class for adults. The action research discusses a variety of assessments, lesson plans, teaching strategies that facilitate lifelong language learning. In small towns where adult ESL learners are only a handful, often advanced students and inexperienced students have to be placed in one class. Such class might not be viewed as desirable, but with on-going assessments, careful lesson plans, and purposeful strategies, a multilevel ESL class for adults can overcome the obstacles and help learners to reach a higher level of English proficiency. This research explores some hand-on strategies, such as group rotating, cooperative learning, and modifying textbook contents for practical purpose, and evaluate their effectiveness. The data collected in this research include Needs Assessment (beginning of class term), Mid-term Self-Assessment (5 months into class term), End-of-term Student Reflection (10 months into class), and End-of-term Assessment from the Instructor (10 months into class). A descriptive analysis of the data explains the practice of this particular learning community, and reveal the areas for improvement and enrichment. This research answers the following questions: (1) How do the assessments positively help both learners and instructors? (2) How do the learning strategies prepare students to become independent, life-long English learners? (3) How do materials, grouping, and class schedule enhance the learning? The result of the research contributes to the field of teaching and learning in language, not limited in English, by (a) examining strategies of conducting a multilevel adult class, (b) involving adult language learners with various backgrounds and learning styles for reflection and feedback, and (c) improving teaching and learning strategies upon research methods and results. One unique feature of this research is how students can work together with the instructor to form a learning community, seeking and exploring resources available to them, to become lifelong language learners.

Keywords: adult language learning, assessment, multilevel, teaching strategies

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Authors: Mohamed Amine Aiche, Elkhansa Yahia, Leila Mallem, Mohamed Salah Boulakoud

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Exposure to endocrine disrupting (ED) during life may cause long-term health effects, the population is exposed to chemicals present in air, water, food and in a variety of consumer and personal care products. Previous research indicates that a wide range of pesticides may act as endocrine disrupters. The azole fungicides propiconazole and propineb have been shown to react through several endocrine disrupting mechanisms, and to induce various endocrine disrupting effects. The purpose of this study was to evaluate the effects of two fungicides; propiconazole and propineb tested separately and in combination, on liver function. The experimental was applied on male Wistar rats dosed orally with Propiconazole 60 mg/kg/day, Propineb 100 mg/kg/day and their mixture 30 mg Propiconazole/kg/day + 50 mg Propineb /kg/day for 4 weeks, for result, a significant increase in liver weights in both treated groups with propineb, propiconazole and their mixture by reference with controls group. Also, highly significant mean values of markers of liver function such as transaminases (ALT/AST) and the activity of alkaline phosphatase (ALP) in all treated groups. The antioxidant activity showed a significant decrease in the hepatic glutathione content (GSH) and glutathione peroxidase (GPX) in all treated groups.

Keywords: endocrine disrupting, pesticide mixture, propineb, propiconazole, liver, oxidative stress

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Authors: Thuraya Ahmed Hamood Al Shidhani

Abstract:

Sports Medicine injuries are very common in primary health care. It is not necessary related to direct trauma, but it could be because of repetitive stress and overuse injuries. Knowledge of Primary Health care providers about the common sports medicine injuries and when to refer to a specialist is essential. Common sports injuries are muscle strain, joint sprain, bone bruise, Patellofemoral pain syndrome, Anterior cruciate ligament injuries, meniscal injuries, ankle ligaments injuries, concussion, Rotator cuff tendinosis/impingement syndrome, lateral and medial epicondylitis and fractures. Systematic approach is very useful in evaluation of sports injuries. RICE is important in initial management. Physiotherapy is essential for rehabilitation. Definitive Management is dependent on patient’s condition and function.

Keywords: common, sports medicine injuries, primary health care, injuries

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