Search results for: healthcare operation management
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 12761

Search results for: healthcare operation management

6491 Research of Actuators of Common Rail Injection Systems with the Use of LabVIEW on a Specially Designed Test Bench

Authors: G. Baranski, A. Majczak, M. Wendeker

Abstract:

Currently, the most commonly used solution to provide fuel to the diesel engines is the Common Rail system. Compared to previous designs, as a due to relatively simple construction and electronic control systems, these systems allow achieving favourable engine operation parameters with particular emphasis on low emission of toxic compounds into the atmosphere. In this system, the amount of injected fuel dose is strictly dependent on the course of parameters of the electrical impulse sent by the power amplifier power supply system injector from the engine controller. The article presents the construction of a laboratory test bench to examine the course of the injection process and the expense in storage injection systems. The test bench enables testing of injection systems with electromagnetically controlled injectors with the use of scientific engineering tools. The developed system is based on LabView software and CompactRIO family controller using FPGA systems and a real time microcontroller. The results of experimental research on electromagnetic injectors of common rail system, controlled by a dedicated National Instruments card, confirm the effectiveness of the presented approach. The results of the research described in the article present the influence of basic parameters of the electric impulse opening the electromagnetic injector on the value of the injected fuel dose. Acknowledgement: This work has been realized in the cooperation with The Construction Office of WSK ‘PZL-KALISZ’ S.A.’ and is part of Grant Agreement No. POIR.01.02.00-00-0002/15 financed by the Polish National Centre for Research and Development.

Keywords: fuel injector, combustion engine, fuel pressure, compression ignition engine, power supply system, controller, LabVIEW

Procedia PDF Downloads 115
6490 Physiological Assessment for Straightforward Symptom Identification (PASSify): An Oral Diagnostic Device for Infants

Authors: Kathryn Rooney, Kaitlyn Eddy, Evan Landers, Weihui Li

Abstract:

The international mortality rate for neonates and infants has been declining at a disproportionally low rate when compared to the overall decline in child mortality in recent decades. A significant portion of infant deaths could be prevented with the implementation of low-cost and easy to use physiological monitoring devices, by enabling early identification of symptoms before they progress into life-threatening illnesses. The oral diagnostic device discussed in this paper serves to continuously monitor the key vital signs of body temperature, respiratory rate, heart rate, and oxygen saturation. The device mimics an infant pacifier, designed to be easily tolerated by infants as well as orthodontically inert. The fundamental measurements are gathered via thermistors and a pulse oximeter, each encapsulated in medical-grade silicone and wired internally to a microcontroller chip. The chip then translates the raw measurements into physiological values via an internal algorithm, before outputting the data to a liquid crystal display screen and an Android application. Additionally, a biological sample collection chamber is incorporated into the internal portion of the device. The movement within the oral chamber created by sucking on the pacifier-like device pushes saliva through a small check valve in the distal end, where it is accumulated and stored. The collection chamber can be easily removed, making the sample readily available to be tested for various diseases and analytes. With the vital sign monitoring and sample collection offered by this device, abnormal fluctuations in physiological parameters can be identified and appropriate medical care can be sought. This device enables preventative diagnosis for infants who may otherwise have gone undiagnosed, due to the inaccessibility of healthcare that plagues vast numbers of underprivileged populations.

Keywords: neonate mortality, infant mortality, low-cost diagnostics, vital signs, saliva testing, preventative care

Procedia PDF Downloads 142
6489 Sociocultural Context of Pain Management in Oncology and Palliative Nursing Care

Authors: Andrea Zielke-Nadkarni

Abstract:

Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: pain management, migrants, sociocultural context, palliative care

Procedia PDF Downloads 349
6488 Performance Management in Serbian Banks: Balanced Scorecard Approach

Authors: Nela Milosevic, Sladjana Barjaktarovic Rakocevic, Sladjana Benkovic, Nemanja Milanovic

Abstract:

Nowadays, performance measurement systems play a key role in evaluating the strategic performances of an organization. On the other hand, there has been a shift towards the Balanced Scorecard (BSC), which has been recognized as a valuable managerial approach. The main goal of this paper is to analyze the main performances of Serbian banks measured at the branches level, through the usage of the Balanced Scorecard framework. Although an extensive number of practitioners have an interest in the Balanced Scorecard approach, little empirical research has been conducted on the implementation of its concept in the service sector like banks, especially within developing countries. From the beginning of August till the end of September 2015, authors have been conducting in-depth interviews among a number of experts from the most successful banks in Serbia. The results show that the non-financial measures, especially, customer oriented indicators and product/ service oriented indicators, seem to be very important factors for improving not only the financial situation within the bank, but also overall business performances. Additionally, the findings prove that there is the cause-effect relationship between non-financial and financial dimensions of the Balanced Scorecard. Having in mind that the banks are still using outdated performance evaluation systems, such as annual, quarterly and monthly reports, we hope that this paper will contribute to the knowledge of how banks in Serbia may apply the Balanced Scorecard approach to evaluate their performance on the most efficient and effective way.

Keywords: balanced scorecard approach, bank management, performance measurement systems, strategic performances

Procedia PDF Downloads 323
6487 A Sustainable Energy Portfolio for Greater Kampala Metropolitan Area by the Mid-Century

Authors: Ismail Kimuli

Abstract:

With a steadfast economic development, the Greater Kampala metropolitan area (GKMA) faces increasing pressures to increasetheshare of low-carbon electricity in the energy balance, abate CO2 emissions and also restructure the transportation sector for a sustainable 2050. GKMA, is Uganda’s commercial, political, social, and industrial hub with a population of 4.1 million, contributing 60% tothe nation’s GDP and accounts for 80% of Uganda’s industrial sector.However, with the rampant anthropogenic interference that causes climate change, CO2 emissions in the metropolitan are contributing to global warming. Many economies across the globe are addressing this challengethrough development and analysis of sustainable energy portfolios.A sustainable energy portfolio is a low-carbon scenario. The study reviews the literature to establish the current energy management situation of GKMA and finds it wanting in addressing the immediate challenges associated with energy management of the metropolitan. Then, the study develops and examines a sustainable energy portfolio for GKMA using TIMES-VEDA and then presents it as an investigative low-carbon energy scenario that could propel the metropolitan sustainably towards 2050.Sustainability is plausible by optimizing the total primary energy supply, generating low-carbon electricity from hydropower and PV-solar renewables, improving heating technologies for residential & commercial sectors, and switching 90% of land passengers from road to a Kampala metro for a sustainable mid-century.

Keywords: GKMA, sustainability, TIMES-VEDA, low-carbon scenario

Procedia PDF Downloads 88
6486 “Chasing Hope”: Parents’ Perspectives on Complementary and Alternative Interventions for Autism Spectrum Disorder Children in Kazakhstan

Authors: Sofiya An, Akbota Kanderzhanova, Assel Akhmetova, Faye Foster, Chee K. Chan

Abstract:

Healthcare, education and social support for children with autism in Kazakhstan has been evolving and transforming over the last three decades. There is still limited knowledge of the use of complementary and alternative medicine by families caring for autistic children in this post-Soviet region. An exploratory qualitative focus group study of Kazakhstani families was carried out to capture and understand their experiences of using complementary and alternative (CAM) medicine. A total of six focus groups were conducted in five cities across the country including Nur-Sultan, Almaty, Kyzylorda, Karaganda and Taraz. The perceived factors driving the availability, choice, and use of complementary and alternative medicine by families of autistic children in the country were distilled and evaluated. The data collected was analyzed using a framework analysis and themes and subthemes were developed. Two major themes stood out. The first was the “unmet needs”, which relates to the predisposing factors that motivate parents to CAM uptake, and the second was the “chasing hope”, which relates to the enabling factors that facilitate parents’ uptake of CAM. Fear of missing out (FOMO) is a latent underlying motivation underscoring these two themes as well. Parents of autism spectrum disorder (ASD) children in Kazakhstan have to deal with many challenges when seeking treatment for their children with ASD. They are prepared and resort to try out whatever CAM interventions available. The motivation and rationale of choice of use is driven by the lack of options and the hope of any potential positive outcome rather than from rational decisions based on efficacy or the evidence-based data of CAM. Parents get desperate and are willing to try CAM regardless of and independent of their cultural and belief systems and they do not want to miss out just in case it might work. This study also gives an international and cross-cultural perspective on the motives, choice and practice of parents with ASD children using CAM in Kazakhstan, a Central Asian country.

Keywords: autism spectrum disorder, Central Asia, complementary and alternative medicine, cross-cultural perspective, qualitative research

Procedia PDF Downloads 130
6485 A Framework Factors Influencing Accounting Information Systems Adoption Success

Authors: Manirath Wongsim

Abstract:

AIS plays an important role in business management, strategic and can provide assistance in all phases of decision making. Thus, many organisations needs to be seen as well adopting AIS, which is critical to a company in order to organise, manage and operate process in all sections. In order to implement AIS successfully, it is important to understand the underlying factors that influence the AIS adoption. Therefore, this research intends to study this perspective of factors influence and impact on AIS adoption’s success. The model has been designed to illustrate factors influences in AIS adoption. It also attempts to identify the critical success factors that organisations should focus on, to ensure the adoption on accounting process. This framework will be developed from case studies by collecting qualitative and quantitative data. Case study and survey methodology were adopted for this research. Case studies in two Thai- organisations were carried out. The results of the two main case studies suggested 9 factors that may have impact on in AIS adoption. Survey instrument was developed based on the findings from case studies. Two large-scale surveys were sent to selected members of Thailand Accountant, and Thailand Computer Society to further develop and test the research framework. The top three critical factors for ensuring AIS adoption were: top management commitment, steering committees, and Technical capability of AIS personnel. That is, it is now clear which factors impact in AIS adoption, and which of those factors are critical success factors for ensuring AIS adoption successes

Keywords: accounting information system, accounting information systems adoption, and inflecting AIS adoption

Procedia PDF Downloads 384
6484 Effectiveness of Jute Geotextiles for Hill Slope Stabilization in Adverse Climatic Condition

Authors: Pradip Choudhury, Tapobrata Sanyal

Abstract:

Effectiveness of Jute Geotextiles (JGT) in hill slope management now stands substantiated. The reasons of its efficacy are attributed to its bio-degradability, hygroscopic property and its thickness. Usually open weave JGT is used for slope management. Thickness of JGT helps in reducing the velocity of surface run-off, thus curbing the extent of migration of soil particles detached as a result of kinetic energy of rain-drops and also of wind effects. Initially JGT acts as cover of the surface of slope thus protect movement of loose soil particles. Hygroscopic property of jute effects overland storage of the flow. JGT acts as mulch and creates a congenial micro-climate that fosters quick growth of vegetation on bio-degradation. In fact JGT plays an important role in bio-remediation of slope-erosion problems. Considering the environmental aftermath, JGT is the preferred option in developed countries for surface soil conservation against erosion. In India JGT has not been tried in low temperature zones at high altitudes where temperature goes below the freezing point (even below - 25° Celsius). The behavior of JGT in such low-temperature zones is not precisely known. The 16th BRTF of Project Himank of Border Roads Organization (BRO) has recently taken the initiative to try two varieties of JGT , ie, 292 gsm and 500 gsm at two different places for hill slope management in Leh, a high altitude place of about 2,660 mtrs and 4900 mtrs above MSL respectively in Jammu & Kashmir where erosion is caused more as a result of rapid movement of sand particles due to high wind (wind erosion. Soil particles of the region formed naturally by weathering of fragile rocks are usually loosely bonded (non-cohesive), undergo dissociation with the rise in wind force and kinetic energy of rain drops and are blown away by wind. Open weave JGT interestingly was observed to contain the dissociated soil particles within its pores and lend stability the affected soil mass to a great extent thus preventing its movement by extraneous agents such as wind. The paper delineates about climatic factors, type of JGT used and the prevailing site conditions with an attempt to analyze the mechanism of functioning of JGT in low temperature zones.

Keywords: climate, erosion, jutegeotextile, stabilize

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6483 Machine Learning-Based Techniques for Detecting and Mitigating Cyber-attacks on Automatic Generation Control in Smart Grids

Authors: Sami M. Alshareef

Abstract:

The rapid growth of smart grid technology has brought significant advancements to the power industry. However, with the increasing interconnectivity and reliance on information and communication technologies, smart grids have become vulnerable to cyber-attacks, posing significant threats to the reliable operation of power systems. Among the critical components of smart grids, the Automatic Generation Control (AGC) system plays a vital role in maintaining the balance between generation and load demand. Therefore, protecting the AGC system from cyber threats is of paramount importance to maintain grid stability and prevent disruptions. Traditional security measures often fall short in addressing sophisticated and evolving cyber threats, necessitating the exploration of innovative approaches. Machine learning, with its ability to analyze vast amounts of data and learn patterns, has emerged as a promising solution to enhance AGC system security. Therefore, this research proposal aims to address the challenges associated with detecting and mitigating cyber-attacks on AGC in smart grids by leveraging machine learning techniques on automatic generation control of two-area power systems. By utilizing historical data, the proposed system will learn the normal behavior patterns of AGC and identify deviations caused by cyber-attacks. Once an attack is detected, appropriate mitigation strategies will be employed to safeguard the AGC system. The outcomes of this research will provide power system operators and administrators with valuable insights into the vulnerabilities of AGC systems in smart grids and offer practical solutions to enhance their cyber resilience.

Keywords: machine learning, cyber-attacks, automatic generation control, smart grid

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6482 Examining Postcolonial Corporate Power Structures through the Lens of Development Induced Projects in Africa

Authors: Omogboyega Abe

Abstract:

This paper examines the relationships between socio-economic inequalities of power, race, wealth engendered by corporate structure, and domination in postcolonial Africa. The paper further considers how land as an epitome of property and power for the locals paved the way for capitalist accumulation and control in the hands of transnational corporations. European colonization of Africa was contingent on settler colonialism, where properties, including land, were re-modified as extractive resources for primitive accumulation. In developing Africa's extractive resources, transnational corporations (TNCs) usurped states' structures and domination over native land. The usurpation/corporate capture that exists to date has led to remonstrations and arguably a counter-productive approach to development projects. In some communities, the mention of extractive companies triggers resentment. The paradigm of state capture and state autonomy is simply inadequate to either describe or resolve the play of forces or actors responsible for severe corporate-induced human rights violations in emerging markets. Moreover, even if the deadly working conditions are conceived as some regulatory failure, it is tough to tell whose failure. The analysis in this paper is that the complexity and ambiguity evidenced by the multiple regimes and political and economic forces shaping production, consumption, and distribution of socio-economic variables are not exceptional in emerging markets. Instead, the varied experience in developing countries provides a window for seeing what we face in understanding and theorizing the structure and operation of the global economic and regulatory order in general.

Keywords: colonial, emerging markets, business, human rights, corporation

Procedia PDF Downloads 54
6481 3+3 Regional Cooperation Format and the South Caucasus

Authors: Eka Darbaidze

Abstract:

Due to its important geopolitical location and strategic economic situation, the South Caucasus has been a region that has been a crossroads of interests between different states and empires since ancient times. Over the centuries, the forms of international relations with regard to the South Caucasus region have been constantly changing, however, the national interests of the Caucasian nations as well as the interests of the regional hegemonic powers in relation to the countries of the South Caucasus have remained almost unchanged. The conflict-ridden South Caucasus's attempt to create a new format of regional cooperation has a rather rich history, dating back to the collapse of the Soviet Union. However, despite the diversity of initiatives, they do not deviate from the format of political statements and it is natural that the case was never settled before their implementation, as none of the previous cooperation initiatives was able to reach all members of the region. The current regional co-operation platform is linked to the name of Turkish President Recep Tayyip Erdogan, who spoke out about the initiative during a visit to Azerbaijan. The so-called 3 + 3 platform for regional cooperation involves cooperation between three countries in the South Caucasus (Armenia, Azerbaijan and Georgia) and three "big neighbors" - Russia, Turkey and Iran. Very soon, the initiative received a positive response from the authorities of Azerbaijan, Iran and Armenia. According to them, this cooperation platform will strengthen cooperation between the countries involved in the regional platform and will focus on security, economic and transport issues. Our goal is to determine the interests of the main regional actors involved in the South Caucasus Cooperation Platform (3 + 3): Iran, Russia and Turkey. Our goal is also to determine what threats, risks or benefits may be associated with the involvement of the three countries of the South Caucasus: Azerbaijan, Armenia and Georgia in this platform and what will be the consequences for Georgia, whose 20% of its internationally recognized borders are still occupied by Russia and whose territory is still under creeping occupation.

Keywords: South Caucasus, Georgia's interest, the interests of Iran, the interests of Turkey, Russian interests, Georgia's occupation

Procedia PDF Downloads 188
6480 Workforce Optimization: Fair Workload Balance and Near-Optimal Task Execution Order

Authors: Alvaro Javier Ortega

Abstract:

A large number of companies face the challenge of matching highly-skilled professionals to high-end positions by human resource deployment professionals. However, when the professional list and tasks to be matched are larger than a few dozens, this process result is far from optimal and takes a long time to be made. Therefore, an automated assignment algorithm for this workforce management problem is needed. The majority of companies are divided into several sectors or departments, where trained employees with different experience levels deal with a large number of tasks daily. Also, the execution order of all tasks is of mater consequence, due to some of these tasks just can be run it if the result of another task is provided. Thus, a wrong execution order leads to large waiting times between consecutive tasks. The desired goal is, therefore, creating accurate matches and a near-optimal execution order that maximizes the number of tasks performed and minimizes the idle time of the expensive skilled employees. The problem described before can be model as a mixed-integer non-linear programming (MINLP) as it will be shown in detail through this paper. A large number of MINLP algorithms have been proposed in the literature. Here, genetic algorithm solutions are considered and a comparison between two different mutation approaches is presented. The simulated results considering different complexity levels of assignment decisions show the appropriateness of the proposed model.

Keywords: employees, genetic algorithm, industry management, workforce

Procedia PDF Downloads 156
6479 Uncommon Presentation of Iscahemic Heart Disease with Sheehan’s Syndrome at Mid-Level Private Hospital of Bangladesh and Its Management- A Case Report

Authors: Nazmul Haque, Syeda Tasnuva Maria

Abstract:

Sheehan's Syndrome (SS), also known as postpartum hypopituitarism, is a rare but potentially serious condition resulting from ischemic necrosis of the pituitary gland, often occurring during or after childbirth. This syndrome is characterized by hypopituitarism, leading to deficiencies in various hormones produced by the pituitary gland. The primary cause is typically severe postpartum hemorrhage, leading to inadequate blood supply and subsequent necrosis of the pituitary tissue. This chronic hypopituitarism sometimes plays the role of premature atherosclerosis, which may lead to cardiovascular disease. This abstract provides a comprehensive overview of Sheehan's Syndrome with ischaemic heart disease, encompassing its pathophysiology, clinical manifestations, and current management strategies. The disorder presents a wide spectrum of symptoms, including chest pain, fatigue, amenorrhea, lactation failure, hypothyroidism, and adrenal insufficiency. Timely diagnosis is crucial, as delayed recognition can lead to complications and long-term health consequences. We herein report a patient complaining of chronic fatigue symptoms, aggressiveness, chest pain, and breathlessness with repeated LOC that were diagnosed with SS with IHD. The patient was treated with antiplatelet, antianginal, steroids, and hormone replacement with marked improvement in his overall condition.

Keywords: ischaemic heart disease, Sheehan's syndrome, post-partum haemorrhage, pituitary gland

Procedia PDF Downloads 35
6478 Intervention Program for Emotional Management in Disruptive Situations Through Self-Compassion and Compassion

Authors: M. Bassas, J. Grané-Morcillo, J. Segura, J.M. Soldevila

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Mental health prevention is key in a society where, according to the World Health Organization, the fourth leading cause of death worldwide is suicide. Compassion is closely linked to personal growth. It shows once again that therapies based on prevention remain an urgent and social need. In this sense, a growing body of research demonstrates how cultivating a compassionate mind can help alleviate and prevent a variety of psychological problems. In the early 21st century, there has been a boom in third-generation compassion-based therapies, although there is a lack of empirical evidence of their efficacy. This study proposes a psychotherapy method (‘Being Method’), whose central axis revolves around emotional management through the cultivation of compassion. Therefore, the objective of this research was to analyze the effectiveness of this method with regard to the emotional changes experienced when we focus on what we are concerned about through the filter of compassion. The Being Method was born from the influence of Buddhist philosophy and contemporary psychology based mainly on Western rationalist currents. A quantitative cross-sectional study has been carried out in a sample of women between 18 and 53 years old (n=47; Mage=36.02; SDage= 11.86) interested in personal growth in which the following 6 measuring instruments were administered: Peace of mind Scale (PoM), Rosenberg Self-Esteem Scale (RSES), Subjective Happiness Scale (SHS), 2 Sacles of the Compassionate Action and Engagement Scales (CAES), Coping Response Inventory for Adults (CRI-A) and Cognitive-Behavioral Strategies Evaluation Scale (MOLDES). Following an experimental method approach, participants were divided into an experimental and control group. Longitudinal analysis was also carried out through a pre-post program comparison. Pre-post comparison outcomes indicated significant differences (p<.05) between before and after the therapy in the variables Peace of Mind, Self-esteem, Happiness, Self-compassion (A-B), Compassion (A-B), in several mental molds, as well as in several coping strategies. Also, between-groups tests proved significantly higher means obtained in the experimental group. Thus, these outcomes highlighted the effectiveness of the therapy, improving all the analyzed dimensions. The social, clinical and research implications are discussed.

Keywords: being method, compassion, effectiveness, emotional management, intervention program, personal growth therapy

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6477 Synthesis of Electrospun Polydimethylsiloxane (PDMS)/Polyvinylidene Fluoriure (PVDF) Nanofibrous Membranes for CO₂ Capture

Authors: Wen-Wen Wang, Qian Ye, Yi-Feng Lin

Abstract:

Carbon dioxide emissions are expected to increase continuously, resulting in climate change and global warming. As a result, CO₂ capture has attracted a large amount of research attention. Among the various CO₂ capture methods, membrane technology has proven to be highly efficient in capturing CO₂, because it can be scaled up, low energy consumptions and small area requirements for use by the gas separation. Various nanofibrous membranes were successfully prepared by a simple electrospinning process. The membrane contactor combined with chemical absorption and membrane process in the post-combustion CO₂ capture is used in this study. In a membrane contactor system, the highly porous and water-repellent nanofibrous membranes were used as a gas-liquid interface in a membrane contactor system for CO₂ absorption. In this work, we successfully prepared the polyvinylidene fluoride (PVDF) porous membranes with an electrospinning process. Afterwards, the as-prepared water-repellent PVDF porous membranes were used for the CO₂ capture application. However, the pristine PVDF nanofibrous membranes were wetted by the amine absorbents, resulting in the decrease in the CO₂ absorption flux, the hydrophobic polydimethylsiloxane (PDMS) materials were added into the PVDF nanofibrous membranes to improve the solvent resistance of the membranes. To increase the hydrophobic properties and CO₂ absorption flux, more hydrophobic surfaces of the PDMS/PVDF nanofibrous membranes are obtained by the grafting of fluoroalkylsilane (FAS) on the membranes surface. Furthermore, the highest CO₂ absorption flux of the PDMS/PVDF nanofibrous membranes is reached after the FAS modification with four times. The PDMS/PVDF nanofibrous membranes with 60 wt% PDMS addition can be a long and continuous operation of the CO₂ absorption and regeneration experiments. It demonstrates the as-prepared PDMS/PVDF nanofibrous membranes could potentially be used for large-scale CO₂ absorption during the post-combustion process in power plants.

Keywords: CO₂ capture, electrospinning process, membrane contactor, nanofibrous membranes, PDMS/PVDF

Procedia PDF Downloads 264
6476 Animal-Assisted Therapy: A Perspective From Singapore

Authors: Julia Wong, Hua Beng Lim, Petrina Goh, Johanna Foo, Caleb Ng, Nurul ‘Aqilah Bte Mohd Taufek

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Animal-assisted therapy (AAT) utilizes human-animal interaction to achieve specific therapeutic goals, and its efficacy has been demonstrated across various settings overseas. The use of AAT in Singapore, however, is still limited. Ang Mo Kio-Thye Hua Kwan (AMKH) is one of the first community hospitals in Singapore to use AAT to complement its occupational therapy services with elderly patients. This study explored the perspectives of AMKH’s occupational therapists (OTs) in relation to AAT to understand barriers and enablers in implementing and practising AAT. We also examined how OTs at-large across practice settings perceive AAT. A mixed method design was used. 64 OTs at-large participated in on online survey, and 7 AMKH OTs were interviewed individually via Zoom. Survey results were analysed with descriptive and Mann-Whitney U tests. Interviews were thematically analysed. AMKH OTs perceived various benefits of AAT articulated in overseas studies in domains such as motivation and participation, emotional, social interaction, sensory tactile stimulation, and cognition. Interestingly, this perception was also supported by 67% of OTs who had responded to the survey, even though most of the OTs who had participated in the survey had no experience in AAT. Despite the perceived benefits of AAT, both OTs from AMKH and those at-large articulated concerns on risks pertaining to AAT (e.g., allergies, unexpected animal behaviour, infections, etc). However, AMKH OTs shared several ways to mitigate these risks, demonstrating their ability to develop a safe program. For e.g., volunteers and their dogs must meet specific recruitment criteria, stringent protocols are used to screen and match dogs with patients, and there are strict exclusion criteria for patients participating in AAT. AMKH OTs’ experience suggests that additional skills and knowledge are required to implement AAT, therefore, healthcare institutions should first consider improving their staff training and risk mitigation knowledge before implementing AAT. They can also refer to AMKH’s AAT protocols and those found in overseas studies, but institutions must adapt the protocols to fit their institutional settings and patients’ profiles.

Keywords: animal-assisted therapy, dog-assisted therapy, occupational therapy, complementary therapy

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6475 Crowdsensing Project in the Brazilian Municipality of Florianópolis for the Number of Visitors Measurement

Authors: Carlos Roberto De Rolt, Julio da Silva Dias, Rafael Tezza, Luca Foschini, Matteo Mura

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The seasonal population fluctuation presents a challenge to touristic cities since the number of inhabitants can double according to the season. The aim of this work is to develop a model that correlates the waste collected with the population of the city and also allow cooperation between the inhabitants and the local government. The model allows public managers to evaluate the impact of the seasonal population fluctuation on waste generation and also to improve planning resource utilization throughout the year. The study uses data from the company that collects the garbage in Florianópolis, a Brazilian city that presents the profile of a city that attracts tourists due to numerous beaches and warm weather. The fluctuations are caused by the number of people that come to the city throughout the year for holidays, summer time vacations or business events. Crowdsensing will be accomplished through smartphones with access to an app for data collection, with voluntary participation of the population. Crowdsensing participants can access information collected in waves for this portal. Crowdsensing represents an innovative and participatory approach which involves the population in gathering information to improve the quality of life. The management of crowdsensing solutions plays an essential role given the complexity to foster collaboration, establish available sensors and collect and process the collected data. Practical implications of this tool described in this paper refer, for example, to the management of seasonal tourism in a large municipality, whose public services are impacted by the floating of the population. Crowdsensing and big data support managers in predicting the arrival, permanence, and movement of people in a given urban area. Also, by linking crowdsourced data to databases from other public service providers - e.g., water, garbage collection, electricity, public transport, telecommunications - it is possible to estimate the floating of the population of an urban area affected by seasonal tourism. This approach supports the municipality in increasing the effectiveness of resource allocation while, at the same time, increasing the quality of the service as perceived by citizens and tourists.

Keywords: big data, dashboards, floating population, smart city, urban management solutions

Procedia PDF Downloads 273
6474 Assessment of the Standard of Referrals for Extraction of Carious Primary Teeth under General Anaesthetic

Authors: Emma Carr, Jennifer Morrison, Peter Walker

Abstract:

Background: Due to COVID-19, there was a significant reduction in the number of children being treated under general anaesthetic (GA) within the health board, which led to a backlog of referrals. The referrals were being triaged and added to a waiting list in order of priority -determined by the information given. By implementing a checklist, it is anticipated that at least 70% of referrals will have the majority of the information required to effectively prioritise patients. The gold standard, as defined in ‘Guidelines For The Management Of Children Referred For Dental Extractions Under General Anaesthesia’, indicates that all referrals should mention: (i) Inability of the child to cooperate, (ii) Previously tried anxiety management techniques, (iii) Existence of psychological disorders, (iv) Presence of acute dental infection, (v) Requirement for extractions in multiple quadrants. Method: 130 referrals were examined over three months and compared to the recommended standard. A letter was emailed to referring dentists within Ayrshire & Arran outlining the recommended information to be included within the referral. The second round of data collection was then carried out, which involved an examination of 105 referrals. Results: The first round revealed that only 28% of referrals mentioned at least four defined standards outlined above. Following issuing a checklist to all dentists, this increased to 72%. Conclusion: As many of the children referred for extractions under GA have suffered pain and infection because of dental caries, it is important that delay of treatment is minimised, where possible. The implementation of a standardised checklist has enabled more effective prioritisation of patients.

Keywords: caries, dentistry, general anaesthetic, paediatrics

Procedia PDF Downloads 94
6473 Reduction of Plutonium Production in Heavy Water Research Reactor: A Feasibility Study through Neutronic Analysis Using MCNPX2.6 and CINDER90 Codes

Authors: H. Shamoradifar, B. Teimuri, P. Parvaresh, S. Mohammadi

Abstract:

One of the main characteristics of Heavy Water Moderated Reactors is their high production of plutonium. This article demonstrates the possibility of reduction of plutonium and other actinides in Heavy Water Research Reactor. Among the many ways for reducing plutonium production in a heavy water reactor, in this research, changing the fuel from natural Uranium fuel to Thorium-Uranium mixed fuel was focused. The main fissile nucleus in Thorium-Uranium fuels is U-233 which would be produced after neutron absorption by Th-232, so the Thorium-Uranium fuels have some known advantages compared to the Uranium fuels. Due to this fact, four Thorium-Uranium fuels with different compositions ratios were chosen in our simulations; a) 10% UO2-90% THO2 (enriched= 20%); b) 15% UO2-85% THO2 (enriched= 10%); c) 30% UO2-70% THO2 (enriched= 5%); d) 35% UO2-65% THO2 (enriched= 3.7%). The natural Uranium Oxide (UO2) is considered as the reference fuel, in other words all of the calculated data are compared with the related data from Uranium fuel. Neutronic parameters were calculated and used as the comparison parameters. All calculations were performed by Monte Carol (MCNPX2.6) steady state reaction rate calculation linked to a deterministic depletion calculation (CINDER90). The obtained computational data showed that Thorium-Uranium fuels with four different fissile compositions ratios can satisfy the safety and operating requirements for Heavy Water Research Reactor. Furthermore, Thorium-Uranium fuels have a very good proliferation resistance and consume less fissile material than uranium fuels at the same reactor operation time. Using mixed Thorium-Uranium fuels reduced the long-lived α emitter, high radiotoxic wastes and the radio toxicity level of spent fuel.

Keywords: Heavy Water Reactor, Burn up, Minor Actinides, Neutronic Calculation

Procedia PDF Downloads 235
6472 The Effectiveness of High-Frequency Repetitive Transcranial Magnetic Stimulation in Persistent Somatic Symptoms Disorder: A Case Report Study

Authors: Mohammed Khamis Albalushi

Abstract:

Background: Somatic symptoms disorders are usually comorbid with depressive disorders despite the fact that there is little evidence for effective treatment for it. Repetitive transcranial magnetic stimulation (rTMS) has been approved by the FDA for mildly resistant depression. From this point, we hypothesized that rTMS delivered over the prefrontal cortex (PFC) may be useful in somatic symptoms disorder. Therefore, in our case report, we want to shed light on the potential effectiveness of rTMS in somatic symptoms disorder. Case Report: A 65-year-old Omani female with multiple medical comorbidities on multiple medications. She presented complaining of multiple somatic complaints in the last 2 years after visiting multiple clinics and underwent several specialists’ examinations, investigations and procedures for somatic treatments; all of them were normal. Then patient was seen by a different psychiatric clinic; multiple anti-depressant and adjuvant anti-psychotic medications were tried, patient still did not improve. The patient was admitted to the hospital for observation and management. Initially, she was preoccupied with her somatic complaint and kept on Fluoxetine and Olanzapine along with that, topiramate was added, but still with minimal improvement. Then rTMS was added to her management plan following Intermittent theta burst (iTBS) rTMS protocol. After completing all sessions of rTMS, the patient was recovering from all her symptoms, and no complaints were reported from her. Conclusion: Our case highlights the importance of investigating more thoroughly in rTMS as a treatment option for Persistent Somatic symptoms Disorder.

Keywords: rTMS, somatic symptoms disorder, resistive cases, TMS

Procedia PDF Downloads 48
6471 The Relationship between the Use of Social Networks with Executive Functions and Academic Performance in High School Students in Tehran

Authors: Esmail Sadipour

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The use of social networks is increasing day by day in all societies. The purpose of this research was to know the relationship between the use of social networks (Instagram, WhatsApp, and Telegram) with executive functions and academic performance in first-year female high school students. This research was applied in terms of purpose, quantitative in terms of data type, and correlational in terms of technique. The population of this research consisted of all female high school students in the first year of district 2 of Tehran. Using Green's formula, the sample size of 150 people was determined and selected by cluster random method. In this way, from all 17 high schools in district 2 of Tehran, 5 high schools were selected by a simple random method and then one class was selected from each high school, and a total of 155 students were selected. To measure the use of social networks, a researcher-made questionnaire was used, the Barclay test (2012) was used for executive functions, and last semester's GPA was used for academic performance. Pearson's correlation coefficient and multivariate regression were used to analyze the data. The results showed that there is a negative relationship between the amount of use of social networks and self-control, self-motivation and time self-management. In other words, the more the use of social networks, the fewer executive functions of students, self-control, self-motivation, and self-management of their time. Also, with the increase in the use of social networks, the academic performance of students has decreased.

Keywords: social networks, executive function, academic performance, working memory

Procedia PDF Downloads 72
6470 Non-Destructive Testing of Carbon Fiber Reinforced Plastic by Infrared Thermography Methods

Authors: W. Swiderski

Abstract:

Composite materials are one answer to the growing demand for materials with better parameters of construction and exploitation. Composite materials also permit conscious shaping of desirable properties to increase the extent of reach in the case of metals, ceramics or polymers. In recent years, composite materials have been used widely in aerospace, energy, transportation, medicine, etc. Fiber-reinforced composites including carbon fiber, glass fiber and aramid fiber have become a major structural material. The typical defect during manufacture and operation is delamination damage of layered composites. When delamination damage of the composites spreads, it may lead to a composite fracture. One of the many methods used in non-destructive testing of composites is active infrared thermography. In active thermography, it is necessary to deliver energy to the examined sample in order to obtain significant temperature differences indicating the presence of subsurface anomalies. To detect possible defects in composite materials, different methods of thermal stimulation can be applied to the tested material, these include heating lamps, lasers, eddy currents, microwaves or ultrasounds. The use of a suitable source of thermal stimulation on the test material can have a decisive influence on the detection or failure to detect defects. Samples of multilayer structure carbon composites were prepared with deliberately introduced defects for comparative purposes. Very thin defects of different sizes and shapes made of Teflon or copper having a thickness of 0.1 mm were screened. Non-destructive testing was carried out using the following sources of thermal stimulation, heating lamp, flash lamp, ultrasound and eddy currents. The results are reported in the paper.

Keywords: Non-destructive testing, IR thermography, composite material, thermal stimulation

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6469 The Impact of Supply Chain Strategy and Integration on Supply Chain Performance: Supply Chain Vulnerability as a Moderator

Authors: Yi-Chun Kuo, Jo-Chieh Lin

Abstract:

The objective of a supply chain strategy is to reduce waste and increase efficiency to attain cost benefits, and to guarantee supply chain flexibility when facing the ever-changing market environment in order to meet customer requirements. Strategy implementation aims to fulfill common goals and attain benefits by integrating upstream and downstream enterprises, sharing information, conducting common planning, and taking part in decision making, so as to enhance the overall performance of the supply chain. With the rise of outsourcing and globalization, the increasing dependence on suppliers and customers and the rapid development of information technology, the complexity and uncertainty of the supply chain have intensified, and supply chain vulnerability has surged, resulting in adverse effects on supply chain performance. Thus, this study aims to use supply chain vulnerability as a moderating variable and apply structural equation modeling (SEM) to determine the relationships among supply chain strategy, supply chain integration, and supply chain performance, as well as the moderating effect of supply chain vulnerability on supply chain performance. The data investigation of this study was questionnaires which were collected from the management level of enterprises in Taiwan and China, 149 questionnaires were received. The result of confirmatory factor analysis shows that the path coefficients of supply chain strategy on supply chain integration and supply chain performance are positive (0.497, t= 4.914; 0.748, t= 5.919), having a significantly positive effect. Supply chain integration is also significantly positively correlated to supply chain performance (0.192, t = 2.273). The moderating effects of supply chain vulnerability on supply chain strategy and supply chain integration to supply chain performance are significant (7.407; 4.687). In Taiwan, 97.73% of enterprises are small- and medium-sized enterprises (SMEs) focusing on receiving original equipment manufacturer (OEM) and original design manufacturer (ODM) orders. In order to meet the needs of customers and to respond to market changes, these enterprises especially focus on supply chain flexibility and their integration with the upstream and downstream enterprises. According to the observation of this research, the effect of supply chain vulnerability on supply chain performance is significant, and so enterprises need to attach great importance to the management of supply chain risk and conduct risk analysis on their suppliers in order to formulate response strategies when facing emergency situations. At the same time, risk management is incorporated into the supply chain so as to reduce the effect of supply chain vulnerability on the overall supply chain performance.

Keywords: supply chain integration, supply chain performance, supply chain vulnerability, structural equation modeling

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6468 Helicoverpa armigera Hubner (Lepidoptera: Noctuidae) Susceptibility to Bacillus thuringiensis Crystal Toxins

Authors: Muhammad Jawad Saleem, Faisal Hafeez, Muhammad Arshad, Afifa Naeem, Ayesha Iftekhar

Abstract:

Bacillus thuringiensis is a gram-positive spore-forming bacterium that belongs to the Bacillus cereus group of Bacilli and it produces ICP (insecticidal crystal protein) Cry toxins or Cysts toxins. Spores are produced as parasporal crystalline inclusions bodies (also known as endotoxins) at the onset of sporulation during the stationary growth phase. During vegetative growth that does not form crystals and is called vegetative insecticidal proteins (VIP) and secreted an insecticidal protein (SIP). Bacillus thuringiensis (Bt) is important for pest management either in the form of insecticides or through incorporated in the gene of the crop. Bioassays were conducted on the F2 generation of 1st instar larvae of H. armigera by the diet incorporation method to determine the susceptibility to Bt Cry toxins (Cry1Ac, Cry2Ab, Cry2A). The median lethal concentration (LC₅₀) of Cry1Ac, Cry2Ab, Cry2A ranged from 0.11 to 1.06 µg/ml and moult inhibitory concentration (MIC₅₀) of Cry1Ac, Cry2Ab, Cry2A ranged from 0.05 to 0.25 µg/ml. Cry1Ac was found most toxic to 1st instar larvae of H. armigera as compared to other Bt Cry toxins (Cry1Ac, Cry2Ab, Cry2A). The experimental results are important to policy-makers and technology providers to develop strategies for the exploitation of transgenic Bt cotton varieties as a component of integrated pest management.

Keywords: Bt toxin, Cry1Ac, Cry2Ab, Cry2A, susceptibility, Helicoverpa armigera

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6467 Critical Assessment of Herbal Medicine Usage and Efficacy by Pharmacy Students

Authors: Anton V. Dolzhenko, Tahir Mehmood Khan

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An ability to make an evidence-based decision is a critically important skill required for practicing pharmacists. The development of this skill is incorporated into the pharmacy curriculum. We aimed in our study to estimate perception of pharmacy students regarding herbal medicines and their ability to assess information on herbal medicines professionally. The current Monash University curriculum in Pharmacy does not provide comprehensive study material on herbal medicines and students should find their way to find information, assess its quality and make a professional decision. In the Pharmacy course, students are trained how to apply this process to conventional medicines. In our survey of 93 undergraduate students from year 1-4 of Pharmacy course at Monash University Malaysia, we found that students’ view on herbal medicines is sometimes associated with common beliefs, which affect students’ ability to make evidence-based conclusions regarding the therapeutic potential of herbal medicines. The use of herbal medicines is widespread and 95.7% of the participated students have prior experience of using them. In the scale 1 to 10, students rated the importance of acquiring herbal medicine knowledge for them as 8.1±1.6. More than half (54.9%) agreed that herbal medicines have the same clinical significance as conventional medicines in treating diseases. Even more, students agreed that healthcare settings should give equal importance to both conventional and herbal medicine use (80.6%) and that herbal medicines should comply with strict quality control procedures as conventional medicines (84.9%). The latter statement also indicates that students consider safety issues associated with the use of herbal medicines seriously. It was further confirmed by 94.6% of students saying that the safety and toxicity information on herbs and spices are important to pharmacists and 95.7% of students admitting that drug-herb interactions may affect therapeutic outcome. Only 36.5% of students consider herbal medicines as s safer alternative to conventional medicines. The students use information on herbal medicines from various sources and media. Most of the students (81.7%) obtain information on herbal medicines from the Internet and only 20.4% mentioned lectures/workshop/seminars as a source of such information. Therefore, we can conclude that students attained the skills on the critical assessment of therapeutic properties of conventional medicines have a potential to use their skills for evidence-based decisions regarding herbal medicines.

Keywords: evidence-based decision, pharmacy education, student perception, traditional medicines

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6466 Transforming Data Science Curriculum Through Design Thinking

Authors: Samar Swaid

Abstract:

Today, corporates are moving toward the adoption of Design-Thinking techniques to develop products and services, putting their consumer as the heart of the development process. One of the leading companies in Design-Thinking, IDEO (Innovation, Design, Engineering Organization), defines Design-Thinking as an approach to problem-solving that relies on a set of multi-layered skills, processes, and mindsets that help people generate novel solutions to problems. Design thinking may result in new ideas, narratives, objects or systems. It is about redesigning systems, organizations, infrastructures, processes, and solutions in an innovative fashion based on the users' feedback. Tim Brown, president and CEO of IDEO, sees design thinking as a human-centered approach that draws from the designer's toolkit to integrate people's needs, innovative technologies, and business requirements. The application of design thinking has been witnessed to be the road to developing innovative applications, interactive systems, scientific software, healthcare application, and even to utilizing Design-Thinking to re-think business operations, as in the case of Airbnb. Recently, there has been a movement to apply design thinking to machine learning and artificial intelligence to ensure creating the "wow" effect on consumers. The Association of Computing Machinery task force on Data Science program states that" Data scientists should be able to implement and understand algorithms for data collection and analysis. They should understand the time and space considerations of algorithms. They should follow good design principles developing software, understanding the importance of those principles for testability and maintainability" However, this definition hides the user behind the machine who works on data preparation, algorithm selection and model interpretation. Thus, the Data Science program includes design thinking to ensure meeting the user demands, generating more usable machine learning tools, and developing ways of framing computational thinking. Here, describe the fundamentals of Design-Thinking and teaching modules for data science programs.

Keywords: data science, design thinking, AI, currculum, transformation

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6465 A Framework for University Social Responsibility and Sustainability: The Case of South Valley University, Egypt

Authors: Alaa Tag-Eldin Mohamed

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The environmental, cultural, social, and technological changes have led higher education institutes to question their traditional roles. Many declarations and frameworks highlight the importance of fulfilling social responsibility of higher education institutes. The study aims at developing a framework of university social responsibility and sustainability (USR&S) with focus on South Valley University (SVU) as a case study of Egyptian Universities. The study used meetings with 12 vice deans of community services and environmental affairs on social responsibility and environmental issues. The proposed framework integrates social responsibility with strategic management through the establishment and maintenance of the vision, mission, values, goals and management systems; elaboration of policies; provision of actions; evaluation of services and development of social collaboration with stakeholders to meet current and future needs of the community and environment. The framework links between different stakeholders internally and externally using communication and reporting tools. The results show that SVU integrates social responsibility and sustainability in its strategic plans. It has policies and actions however fragmented and lack of appropriate structure and budgeting. The proposed framework could be valuable for researchers and decision makers of the Egyptian Universities. The study proposed recommendations and highlighted building on the results and conducting future research.

Keywords: corporate social responsibility (CSR), south valley university, sustainable university, university social responsibility and sustainability (USR&S)

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6464 A Semidefinite Model to Quantify Dynamic Forces in the Powertrain of Torque Regulated Bascule Bridge Machineries

Authors: Kodo Sektani, Apostolos Tsouvalas, Andrei Metrikine

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The reassessment of existing movable bridges in The Netherlands has created the need for acceptance/rejection criteria to assess whether the machineries are meet certain design demands. However, the existing design code defines a different limit state design, meant for new machineries which is based on a simple linear spring-mass model. Observations show that existing bridges do not confirm the model predictions. In fact, movable bridges are nonlinear systems consisting of mechanical components, such as, gears, electric motors and brakes. Next to that, each movable bridge is characterized by a unique set of parameters. However, in the existing code various variables that describe the physical characteristics of the bridge are neglected or replaced by partial factors. For instance, the damping ratio ζ, which is different for drawbridges compared to bascule bridges, is taken as a constant for all bridge types. In this paper, a model is developed that overcomes some of the limitations of existing modelling approaches to capture the dynamics of the powertrain of a class of bridge machineries First, a semidefinite dynamic model is proposed, which accounts for stiffness, damping, and some additional variables of the physical system, which are neglected by the code, such as nonlinear braking torques. The model gives an upper bound of the peak forces/torques occurring in the powertrain during emergency braking. Second, a discrete nonlinear dynamic model is discussed, with realistic motor torque characteristics during normal operation. This model succeeds to accurately predict the full time history of the occurred stress state of the opening and closing cycle for fatigue purposes.

Keywords: Dynamics of movable bridges, Bridge machinery, Powertrains, Torque measurements

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6463 Endometrial Thickness Cut-Off for Evacuation of Retained Product of Conception

Authors: Nambiar Ritu, Ali Ban, Munawar Farida, Israell Imelda, T. Farouk Eman Rasheeda, Jangalgi Renuka, S. Boma Nellie

Abstract:

Aim: To define the ultrasonographic endometrial thickness (USG ET) cutoff for evacuation of retained pieces of conception (ERPC). Background: Studies of conservative management of 1st trimester miscarriage have questioned the need for post miscarriage curettage. Therapeutic decision making with transvaginal scan post miscarriage endometrial thickness in patients clinically thought to be incomplete miscarriage is often not clear. Method: Retrospective analysis of all 1ST trimester ERPC at Al Rahba Hospital from June 2012 to July 2013 was done. Total of 164 patients underwent ERPC. All cases were reviewed for pre-operative USG ET and post ERPC histopathological examination. TVS was done to evaluate the maximum ET of the uterine cavity along the long axis of the uterus and features of retained products was noted. All cases without preoperative USG ET measurement were excluded from the study, therefore only 62 out of 164 cases were included in the study. The patients were divided into three groups: o Group A: have retained products within endometrial cavity. o Group B: endometrial thickness equal or more than 20 mm. o Group C: endometrial thickness equal or less than 19.9 mm. o Post ERPC product was sent for HPE and the results were compared. Transvaginal sonographic findings can be used as a deciding factor in the management of patients with 1st trimester miscarriage who need ERPC. Our proposed cutoff in clinically stable patients requiring ERPC is more than 20 mm.

Keywords: ERPC, histopathological examination, long axis of the uterus, USG ET

Procedia PDF Downloads 201
6462 Determinants of Hospital Obstetric Unit Closures in the United States 2002-2013: Loss of Hospital Obstetric Care 2002-2013

Authors: Peiyin Hung, Katy Kozhimannil, Michelle Casey, Ira Moscovice

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Background/Objective: The loss of obstetric services has been a pressing concern in urban and rural areas nationwide. This study aims to determine factors that contribute to the loss of obstetric care through closures of a hospital or obstetric unit. Methods: Data from 2002-2013 American Hospital Association annual surveys were used to identify hospitals providing obstetric services. We linked these data to Medicare Healthcare Cost Report Information for hospital financial indicators, the US Census Bureau’s American Community Survey for zip-code level characteristics, and Area Health Resource files for county- level clinician supply measures. A discrete-time multinomial logit model was used to determine contributing factors to obstetric unit or hospital closures. Results: Of 3,551 hospitals providing obstetrics services during 2002-2013, 82% kept units open, 12% stopped providing obstetrics services, and 6% closed down completely. State-level variations existed. Factors that significantly increased hospitals’ probability of obstetric unit closures included lower than 250 annual birth volume (adjusted marginal effects [95% confidence interval]=34.1% [28%, 40%]), closer proximity to another hospital with obstetric services (per 10 miles: -1.5% [-2.4, -0.5%]), being in a county with lower family physician supply (-7.8% [-15.0%, -0.6%), being in a zip code with higher percentage of non-white females (per 10%: 10.2% [2.1%, 18.3%]), and with lower income (per $1,000 income: -0.14% [-0.28%, -0.01%]). Conclusions: Over the past 12 years, loss of obstetric services has disproportionately affected areas served by low-volume urban and rural hospitals, non-white and low-income communities, and counties with fewer family physicians, signaling a need to address maternity care access in these communities.

Keywords: access to care, obstetric care, service line discontinuation, hospital, obstetric unit closures

Procedia PDF Downloads 208