Search results for: provider recommendation

Authors: Kaushal Kishore, Suman Mukhopadhyay, Susovan Das, Manashi Adhikary, Sandip Bhattacharyya

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In integrated steel plants, conveyor belts are widely used for transferring raw materials from one location to another. An output pin bush coupling attached with a conveyor transferring iron ore fines and fluxes failed after two years of service life. This led to an operational delay of approximately 15 hours. This study is focused on failure analysis of the coupling and recommending counter-measures to prevent any such failures in the future. Investigation consisted of careful visual observation, checking of operating parameters, stress calculation and analysis, macro and micro-fractography, material characterizations like chemical and metallurgical analysis and tensile and impact testings. The fracture occurred from an unusually sharp double step. There were multiple corrosion pits near the step that aggravated the situation. Inner contact surface of the coupling revealed differential abrasion that created a macroscopic difference in the height of the component. This pointed towards misalignment of the coupling beyond a threshold limit. In addition to these design and installation issues, material of the coupling did not meet the quality standards. These were made up of grey cast iron having graphite morphology intermediate between random distribution (Type A) and rosette pattern (Type B). This manifested as a marked reduction in impact toughness and tensile strength of the component. These findings corroborated well with the brittle mode of fracture that might have occurred during minor impact loading while loading of conveyor belt with raw materials from height. Simulated study was conducted to examine the effect of corrosion pits on tensile and impact toughness of grey cast iron. It was observed that pitting marginally reduced tensile strength and ductility. However, there was marked (up to 45%) reduction in impact toughness due to pitting. Thus, it became evident that failure of the coupling occurred due to combination of factors like inferior material, misalignment, poor step design and corrosion pitting. Recommendation for life enhancement of coupling included the use of tougher SG 500/7 grade, incorporation of proper fillet radius for the step, correction of alignment and application of corrosion resistant organic coating to prevent pitting.

Keywords: brittle fracture, cast iron, coupling, double step, pitting, simulated impact tests

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Authors: Bollu Mounica

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Background: Nowadays drug related problems were seen very commonly within the health care practice. These could result in the medication errors, adverse events, drug interactions and harm to patients. Pharmacist has an identified role in minimizing and preventing such type of problems. Objectives: To detect the incidence of drug related problems for the hospitalized patient, and to analyze the clinical pharmacist interventions performed during the review of prescription orders of the general medicine, psychiatry, surgery, pediatrics, gynaecology units of a large tertiary care teaching hospital. Methods: It was a retrospective, observational and interventional study. The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions. For a period starting November 2012 until December 2014, the inpatient medication charts and orders were identified and rectified by ward and practicing clinical pharmacists within the inpatient pharmacy services in a tertiary care teaching hospital on routine daily activities. Data was collected and evaluated. The causes of this problem were identified. Results: A total of 360 patients were followed. Male (71.66%) predominance was noted over females (28.33%). Drug related problems were more commonly seen in patients aged in between 31-60. Most of the DRP observed in the study resulted from the dispensing errors (26.11%), improper drug selection (17.22%), followed by untreated indications (14.4%) Majority of the clinical pharmacist recommendations were on need for proper dispensing (26.11%), and drug change (18.05%). Minor significance of DRPs were noted high (41.11 %), whereas (35.27 %) were moderate and (23.61 %) were major. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high (86.66%). Conclusion: Our study showed that the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes needed in the prescriptions. In this context, routine participation of clinical pharmacists in clinical medical rounds facilitates the identification of DRPs and may prevent their occurrence.

Keywords: drug related problems, clinical pharmacist, drug prescriptions, drug related problems, intervention

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Authors: Abdul Basit Kiani

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Web development, the art of creating and maintaining websites, has witnessed remarkable advancements. The aim is to provide an overview of some of the cutting-edge developments in the field. Firstly, the rise of responsive web design has revolutionized user experiences across devices. With the increasing prevalence of smartphones and tablets, web developers have adapted to ensure seamless browsing experiences, regardless of screen size. This progress has greatly enhanced accessibility and usability, catering to the diverse needs of users worldwide. Additionally, the evolution of web frameworks and libraries has significantly streamlined the development process. Tools such as React, Angular, and Vue.js have empowered developers to build dynamic and interactive web applications with ease. These frameworks not only enhance efficiency but also bolster scalability, allowing for the creation of complex and feature-rich web solutions. Furthermore, the emergence of progressive web applications (PWAs) has bridged the gap between native mobile apps and web development. PWAs leverage modern web technologies to deliver app-like experiences, including offline functionality, push notifications, and seamless installation. This innovation has transformed the way users interact with websites, blurring the boundaries between traditional web and mobile applications. Moreover, the integration of artificial intelligence (AI) and machine learning (ML) has opened new horizons in web development. Chatbots, intelligent recommendation systems, and personalization algorithms have become integral components of modern websites. These AI-powered features enhance user engagement, provide personalized experiences, and streamline customer support processes, revolutionizing the way businesses interact with their audiences. Lastly, the emphasis on web security and privacy has been a pivotal area of progress. With the increasing incidents of cyber threats, web developers have implemented robust security measures to safeguard user data and ensure secure transactions. Innovations such as HTTPS protocol, two-factor authentication, and advanced encryption techniques have bolstered the overall security of web applications, fostering trust and confidence among users. Hence, recent progress in web development has propelled the industry forward, enabling developers to craft innovative and immersive digital experiences. From responsive design to AI integration and enhanced security, the landscape of web development continues to evolve, promising a future filled with endless possibilities.

Keywords: progressive web applications (PWAs), web security, machine learning (ML), web frameworks, advancement responsive web design

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Authors: Nivedhitha Venkatakrishnan

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Flooding in urban areas in India has become a usual ritual phenomenon and a nightmare to most cities, which is a consequence of man-made disruption resulting in disaster. The City planning in India falls short of withstanding hydro generated disasters. This has become a barrier and challenge in the process of development put forth by urbanization, high population density, expanding informal settlements, environment degradation from uncollected and untreated waste that flows into natural drains and water bodies, this has disrupted the natural mechanism of hazard protection such as drainage channels, wetlands and floodplains. The magnitude and the impact of the mishap was high because of the failure of development policies, strategies, plans that the city had adopted. In the current scenario, cities are becoming the home for future, with economic diversification bringing in more investment into cities especially in domains of Urban infrastructure, planning and design. The uncertainty of the Urban futures in these low elevated coastal zones faces an unprecedented risk and threat. The study on focuses on three major pillars of resilience such as Recover, Resist and Restore. This process of getting ready to handle the situation bridges the gap between disaster response management and risk reduction requires a shift in paradigm. The study involved a qualitative research and a system design approach (framework). The initial stages involved mapping out of the urban water morphology with respect to the spatial growth gave an insight of the water bodies that have gone missing over the years during the process of urbanization. The major finding of the study was missing links between traditional water harvesting network was a major reason resulting in a manmade disaster. The research conceptualized the ideology of a sponge city framework which would guide the growth through institutional frameworks at different levels. The next stage was on understanding the implementation process at various stage to ensure the shift in paradigm. Demonstration of the concepts at a neighborhood level where, how, what are the functions and benefits of each component. Quantifying the design decision with rainwater harvest, surface runoff and how much water is collected and how it could be collected, stored and reused. The study came with further recommendation for Water Mitigation Spaces that will revive the traditional harvesting network.

Keywords: flooding, man made disaster, resilient city, traditional harvesting network, waterbodies

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Authors: Maryamsadat Habibi

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Objective: pharmaceutical errors are avoidable occurrences that can result in inappropriate pharmaceutical use, patient harm, treatment failure, increased hospital costs and length of stay, and other outcomes that affect both the individual receiving treatment and the healthcare provider. This study aimed to perform a reconciliation of medications in the cardiovascular ward of Imam Reza Hospital in Mashhad, Iran, and evaluate the prevalence of medication discrepancies between the best medication list created for the patient by the pharmacist and the medication order of the treating physician there. Materials & Methods: The 97 patients in the cardiovascular ward of the Imam Reza Hospital in Mashhad were the subject of a cross-sectional study from June to September of 2021. After giving their informed consent and being admitted to the ward, all patients with at least one underlying condition and at least two medications being taken at home were included in the study. A medical reconciliation form was used to record patient demographics and medical histories during the first 24 hours of admission, and the information was contrasted with the doctors' orders. The doctor then discovered medication inconsistencies between the two lists and double-checked them to separate the intentional from the accidental anomalies. Finally, using SPSS software version 22, it was determined how common medical discrepancies are and how different sorts of discrepancies relate to various variables. Results: The average age of the participants in this study was 57.6915.84 years, with 57.7% of men and 42.3% of women. 95.9% of the patients among these people encountered at least one medication discrepancy, and 58.9% of them suffered at least one unintentional drug cessation. Out of the 659 medications registered in the study, 399 cases (60.54%) had inconsistencies, of which 161 cases (40.35%) involved the intentional stopping of a medication, 123 cases (30.82%) involved the stopping of a medication unintentionally, and 115 cases (28.82%) involved the continued use of a medication by adjusting the dose. Additionally, the category of cardiovascular pharmaceuticals and the category of gastrointestinal medications were found to have the highest medical inconsistencies in the current study. Furthermore, there was no correlation between the frequency of medical discrepancies and the following variables: age, ward, date of visit, type, and number of underlying diseases (P=0.13), P=0.61, P=0.72, P=0.82, P=0.44, and so forth. On the other hand, there was a statistically significant correlation between the number of medications taken at home (P=0.037) and the prevalence of medical discrepancies with gender (P=0.029). The results of this study revealed that 96% of patients admitted to the cardiovascular unit at Imam Reza Hospital had at least one medication error, which was typically an intentional drug discontinuance. According to the study's findings, patients admitted to Imam Reza Hospital's cardiovascular ward have a great potential for identifying and correcting various medication discrepancies as well as for avoiding prescription errors when the medication reconciliation method is used. As a result, it is essential to carry out a precise assessment to achieve the best treatment outcomes and avoid unintended medication discontinuation, unwanted drug-related events, and drug interactions between the patient's home medications and those prescribed in the hospital.

Keywords: drug combination, drug side effects, drug incompatibility, cardiovascular department

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Authors: Mesfin Nigussie Ibido

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The study is designed to explore the effects of land certification in securing women’s land rights of two rural villages in Robe district at Arsi Zone of Oromia regional state. The land is very critical assets for human life survival and the backbone for rural women livelihood. Equal access and control power to the land have given a chance for rural women to participate in different economic activities and improve their bargaining ability for decision making on their rights. Unfortunately, women were discriminated and marginalized from access and control of land for centuries through customary practices. However, in many countries, legal reform is used as a powerful tool for eliminating discriminatory provisions in property rights. Among other equity and efficiency concerns, the land certification program in Ethiopia attempts to address gender bias concerns of the current land-tenure system. The existed rural land policy was recognizing a women land rights and benefited by strengthened wives awareness of their land rights and contribute to the strong involvement of wives in decision making. However, harmful practices and policy implementation problems still against women do not fully exercise a provision of land rights in a different area of the country. Thus, this study is carried out to examine the effect of land certification in securing women’s land rights by eliminating the discriminatory nature of cultural abuses of study areas. Probability and non-probability sampling types were used, and the sample size was determined by using the sampling distribution of the proportion method. Systematic random sampling method was applied by taking the nth element of the sample frame. Both quantitative and qualitative research methods were applied, and survey respondents of 192 households were conducted and administering questionnaires in the quantitative method. The qualitative method was applied by interviews with focus group discussions with rural women, case stories, Village, and relevant district offices. Triangulation method was applied in data collection, data presentation and in the analysis of findings. Study finding revealed that the existence of land certification is affected by rural women positively by advancing their land rights, but still, some women are challenged by unsolved problems in the study areas. The study forwards recommendation on the existed problems or gaps to ensure women’s equal access to and control over land in the study areas.

Keywords: decision making, effects, land certification, land right, tenure security

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Authors: Corbel Camille, Le Cerf Flora, Corveleyn Xavier

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Introduction: Aging is a physiological phenomenon accompanied by anatomical and cognitive changes leading to anxiety and pain. This could have significant impacts on quality of life, life expectancy, and the progression of cognitive disorders. Virtual Reality Intervention (VRI) is increasingly recognized as a non-pharmacological approach to alleviate pain and anxiety in children and young adults. However, while recent studies have explored the feasibility of applying VRI in the older population, confirmation through studies is still required to establish its benefits in various contexts. Objective: This pilot study, following a clinical trial methodology international recommendation for VRI in healthcare, aims to evaluate the feasibility and effects of using VRI with a 101-year-old woman residing in a nursing home undergoing weekly painful and anxious wound dressing changes. Methods: Following the international recommendations, this study focused on feasibility and preliminary results. A Single Case Experimental Design protocol consists of two distinct phases: control (Phase A) and personalized VRI (Phase B), each lasting for 6 sessions. Data were collected before, during and after the care, using measures of pain (Algoplus and numerical scale), anxiety (Hospital anxiety scale and numerical scale), VRI experience (semi-structured interview) and physiological measures. Results: The results suggest that the utilization of VRI is both feasible and well-tolerated by the participant. VRI contributed to a decrease in pain and anxiety during care sessions, with a more significant impact on pain compared to anxiety, which showed a gradual and slight decrease. Physiological data, particularly those related to stress, also indicate a reduction in physiological activity during VRI. Conclusion: This pilot study confirms the feasibility and benefits of using virtual reality in managing pain and anxiety in an older adult in a nursing home. In light of these results, it is essential that future studies focus on setting up randomized controlled trials (RCTs). These studies should involve a representative number of older adults to ensure generalizable data. This rigorous, controlled methodology will enable us to assess the effectiveness of virtual reality more accurately in various care settings, measure its impact on clinical parameters such as pain and anxiety, and explore the long-term implications of this intervention.

Keywords: anxiety reduction, nursing home, older adult, pain management, virtual reality

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Authors: Obiageli Helen Ezeh, Chuks Clement Ezeh

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Background: It is estimated that more than 330 million persons are living with HIV-infection globally and in Nigeria about 3.4 persons are living with the infection, with an annual death rate of 180,000. Psychological morbidity often accompany chronic illnesses and may be associated with substance abuse, poor health seeking behavior and adherence to treatment program; it may worsen existing health problems and the overall quality of life. Until the burden is effectively identified, intervention cannot be planned. Until there is a cure, the goal is to manage and cope effectively with HIV-infection. Little if any studies have been done in this area in the North West geo-political zone of Nigeria. The study would help to identify high risk groups and prevent the progression and spread of the infection. Aim: To identify HIV-infected persons with psychological morbidity, accessing HIV- clinic at Shika Hospital, Zaria, Kaduna State; and analyze their socio-demographic profile. Methods: A cross sectional descriptive study was carried out to assess and analyze the socio-demographic characteristics of HIV-infected persons attending Shika hospital Zaria Nigeria, who screened positive for psychological morbidity. A total of 109 HIV-infected persons receiving HAART at Shika clinic, Zaria, Kaduna State, Nigeria, were administered questionnaires, the General Health Questionnaire (GHQ-12)measuring psychological morbidity and socio-demographic data. The participants ranged in age between 18 and 75 years. Results: Data were analyzed using SPSS software 15. Both descriptive and inferential Statistics were performed on the data. Results indicate a total prevalent rate of psychological morbidity of 78 percent among participants. Of this, about 16.2 percent were severely distressed, 25.1 percent moderately distressed and 36.7percent were mildly distressed. More females (65 percent of those with psychological morbidity) were found to be distressed than their male (55 percent) counterparts. It was (44 percent) for patients whose HIV-infection was of relatively shorter duration(2-4 years) than those of longer duration(5-9 years; and 10 years/above). The age group (21-30 years) was the most affected (35 percent). The rate was also 55 percent for Christians and 45 percent for Muslims. For married patients with partners it was 20 percent and for singles 30 percent; for the widowed (12 percent) and divorced (38 percent). At the level of tribal/ethnic groups, it was 13 percent for Ibos, 22 percent for Yorubas, 27 percent for Hausas and 33 percent for all the other minority tribes put together. Conclusion/Recommendation: The study has been able to identify the presence of psychological morbidity among HIV-infected persons as high and analyze the socio-demographic factors associated with it as significant. Periodic screening of HIV-infected persons for psychological morbidity and psychosocial intervention was recommended.

Keywords: socio-demographics, psychological morbidities, HIV-Infection, HAART

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Authors: Ebenezer Kwesi Armah-Ansah, Kenneth Fosu Oteng, Esther Selasi Avinu, Eugene Budu, Edward Kwabena Ameyaw

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Background: Maternal mortality, particularly in Benin, is a major public health concern in Sub-Saharan Africa. To provide a positive pregnancy experience and reduce maternal morbidities, all pregnant women must get appropriate and timely prenatal support. However, many pregnant women in developing countries, including Benin, begin antenatal care late. There is a paucity of empirical literature on the prevalence and predictors of early antenatal care visits in Benin. As a result, the purpose of this study is to investigate the prevalence and predictors of early antenatal care visits among women of productive age in Benin. Methods: This is a secondary analysis of the 2017/2018 Benin Demographic and Health Survey (BDHS) data. The study involved 6,919 eligible women. Data analysis was conducted using Stata version 14.2 for Mac OS. We adopted a multilevel logistic regression to examine the predictors of early ANC visits in Benin. The results were presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and p-value <0.05 to determine the significant associations. Results: The prevalence of early ANC visits among pregnant women in Benin was 57.03% [95% CI: 55.41-58.64]. In the final multilevel logistic regression, early ANC visit was higher among women aged 30-34 [aOR=1.60, 95% CI=1.17-2.18] compared to those aged 15-19, women with primary education [aOR=1.22, 95% CI=1.06-142] compared to the non-educated women, women who were covered by health insurance [aOR=3.03, 95% CI=1.35-6.76], women without a big problem in getting the money needed for treatment [aOR=1.31, 95% CI=1.16-1.49], distance to the health facility, not a big problem [aOR=1.23, 95% CI=1.08-1.41], and women whose partners had secondary/higher education [aOR=1.35, 95% CI=1.15-1.57] compared with those who were not covered by health insurance, had big problem in getting money needed for treatment, distance to health facility is a big problem and whose partners had no education respectively. However, women who had four or more births [aOR=0.60, 95% CI=0.48-0.74] and those in Atacora Region [aOR=0.50, 95% CI=0.37-0.68] had lower odds of early ANC visit. Conclusion: This study revealed a relatively high prevalence of early ANC visits among women of reproductive age in Benin. Women's age, educational status of women and their partners, parity, health insurance coverage, distance to health facilities, and region were all associated with early ANC visits among women of reproductive in Benin. These factors ought to be taken into account when developing ANC policies and strategies in order to boost early ANC visits among women in Benin. This will significantly reduce maternal and newborn mortality and help achieve the World Health Organization’s recommendation that all pregnant women should initiate early ANC visits within the first three months of pregnancy.

Keywords: antenatal care, Benin, maternal health, pregnancy, DHS, public health

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Authors: Vincent Andrew Cappellano

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In the early phases of critical infrastructure system design, translating distributed computing requirements to an architecture has risk given the multitude of approaches (e.g., cloud, edge, fog). In many systems, a single requirement for system uptime / availability is used to encompass the system’s intended operations. However, when architected systems may perform to those availability requirements only during normal operations and not during component failure, or during outages caused by adversary attacks on critical infrastructure (e.g., physical, cyber). System designers lack a structured method to evaluate availability requirements against candidate system architectures through deep degradation scenarios (i.e., normal ops all the way down to significant damage of communications or physical nodes). This increases risk of poor selection of a candidate architecture due to the absence of insight into true performance for systems that must operate as a piece of critical infrastructure. This research effort proposes a process to analyze critical infrastructure system availability requirements and a candidate set of systems architectures, producing a metric assessing these architectures over a spectrum of degradations to aid in selecting appropriate resilient architectures. To accomplish this effort, a set of simulation and evaluation efforts are undertaken that will process, in an automated way, a set of sample requirements into a set of potential architectures where system functions and capabilities are distributed across nodes. Nodes and links will have specific characteristics and based on sampled requirements, contribute to the overall system functionality, such that as they are impacted/degraded, the impacted functional availability of a system can be determined. A machine learning reinforcement-based agent will structurally impact the nodes, links, and characteristics (e.g., bandwidth, latency) of a given architecture to provide an assessment of system functional uptime/availability under these scenarios. By varying the intensity of the attack and related aspects, we can create a structured method of evaluating the performance of candidate architectures against each other to create a metric rating its resilience to these attack types/strategies. Through multiple simulation iterations, sufficient data will exist to compare this availability metric, and an architectural recommendation against the baseline requirements, in comparison to existing multi-factor computing architectural selection processes. It is intended that this additional data will create an improvement in the matching of resilient critical infrastructure system requirements to the correct architectures and implementations that will support improved operation during times of system degradation due to failures and infrastructure attacks.

Keywords: architecture, resiliency, availability, cyber-attack

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Authors: Bulama Alhaji Alhassan, Roselyn Odeh, Rakiya Idris Labaran, Dorcas Yemi Danladi, Faith Ochonu

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Introduction: Contraceptive use has numerous health benefits such as preventing unplanned pregnancies thereby supporting women to achieve their life goals, maintaining the ideal amount of time between pregnancies, lowering the death rate for both mothers and children and generally enhancing the lives of women and children. Despite the numerous advantages of modern contraception and numerous initiatives by the government and development partners to promote its adoption, Nigeria's use of these methods has remained persistently low. Counseling about contraception is essential to providing high-quality treatment ensuring informed choice, and voluntarism for family planning is the key. The goal of the contraceptive counseling approach known as Counseling for Choice (C4C) is to ensure that people have the agency and voice to choose the contraceptive methods that best suit their requirements by altering the way both clients and providers engage in family planning counseling sessions. Aim: To evaluate the effect of counseling for choice on Modern Contraceptive adoption and continuation among married adolescent girls aged 15-19 years in 61 health facilities, within a 6-month period in Northern Nigeria. Methodology: Data from the NDHIS was obtained from selected facilities Pre & Post commencement of C4C intervention from 36 facilities Kaduna and 25 Nasarawa Matasan Matan Arewa (MMA) core implementation states putting into consideration the specific period of initiation of intervention, six months after deployment of the C4C, data was obtained from these facilities for post analysis. Data was analyzed on SPSS using paired sample t-test. Result: C4C resulted to improved access to FP services via increasing contraceptive adoption and continued used by 15% and 27% respectively (p<0.05) in Nasarawa state. While in Kaduna state we observed 11% and 28% improvement in adoption and continued use respectively as well with statistical significance (p<0.05) depicting that the increase is highly correlated (0.99 Nasarawa and 0.75 Kaduna) with the C4C intervention where the provider uses the NORMAL AND 3Ws Rubric to explain to the client in a simplified manner what to do with chosen method, what to expect with her method of adoption and when to return for a refill. Conclusion: In Northern Nigeria, it was observed that most clients discontinue their methods due to bleeding side effect and that was related to lack of appropriate and comprehensive information during counselling about what to expect with the clients method of adoption but with the intervention of the program, through capacity strengthening of PHC providers on counselling skills using the Counselling for Choice, it has helped to improve modern contraceptive uptake among young married women in northern Nigeria.

Keywords: continuation, counselling, uptake, adolescent, modern & implementation

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Authors: Tanya Greathosue, Adrianna Taylor, Lori Darnel, Eileen Starr, Susie Ryder, Julie Clockston, Dawn Matera Bassett, Jess Retrum

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The United States has an identified need to improve the social work mental and behavioral health workforce shortage with a focus on culturally diverse and responsive mental and behavioral health practitioners to adequately serve its rapidly growing multicultural communities. The U.S. is experiencing rapid demographic changes. Ensuring that mental and behavioral health services are effective and accessible for diverse communities is essential for improving overall health outcomes. In response to this need, we developed a training program focused on interdisciplinary collaboration, evidence-based practices, and culturally responsive services. The success of the training program, funded by the Health Resource Service Administration (HRSA) Behavioral Health Workforce Education and Training (BHWET), has provided the foundation for stage two of our programming. In addition to HRSA/BHWET, we are receiving funding from Colorado Access, a state workforce development initiative, and Kaiser Permanente, a healthcare provider network in the United States. We have moved beyond improved learner outcomes to increasing recruitment of historically excluded, disproportionately mistreated learners, mentorship of students to improve retention, and successful, culturally responsive, diverse workforce development. These authors will utilize a pretest-posttest comparison group design and trend analysis to evaluate the success of the training program. Comparison groups will be matched based on age, gender identification, race, income, as well as prior experience in the field, and time in the degree program. This article describes our culturally responsive training program. Our goals are to increase the recruitment and retention of historically excluded, disproportionately mistreated learners. We achieve this by integrating cultural humility and sensitivity training into educational curricula for our scholars who participate in cohort classroom and seminar learning. Additionally, we provide our community partners who serve as internship sites with ongoing continuing education on how to promote and develop inclusive and supportive work environments for our learners. This work will be of value to mental and behavioral health care practitioners who serve historically excluded and mistreated populations. Participants will learn about culturally informed best practices to increase recruitment and retention of culturally diverse learners. Additionally, participants will hear how to create a culturally responsive training program that encourages an inclusive community for their learners through cohort learning, mentoring, community networking, and critical accountability.

Keywords: culturally diverse mental health practitioners, recruitment, mentorship, workforce development, underserved clinics, professional development

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Authors: K. C. M. Wong, C. P. Y. Cheng, K. Y. Chan, G. S. C. Fung, T. F. O. Lau, K. F. C. Leung, J. P. C. Fok

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Hospital Authority (HA) is the statutory body to manage all public hospitals in Hong Kong. Occupational Care Medicine Service (OMCS) is an in-house multi-disciplinary team responsible for injury management in HA. Hospital administrative services (AS) provides essential support in hospital daily operation to facilitate the provision of quality healthcare services. An occupational health enhancement program in Tai Po Hospital (TPH) domestic service supporting unit (DSSU) was piloted in 2013 with satisfactory outcome, the keys to success were staff engagement and management support. Riding on the success, the program was rolled out to another 5 AS departments of Alice Ho Miu Ling Nethersole Hospital (AHNH) and TPH in 2015. This paper highlights the indispensable components of disability management and occupational health enhancement program in hospital settings. Objectives: 1) Facilitate workplace to support staff with health affecting work problem, 2) Enhance staff’s occupational health. Methodology: Hospital Occupational Safety and Health (OSH) team and AS departments (catering, linen services, and DSSU) of AHNH and TPH worked closely with OMCS. Focus group meetings and worksite visits were conducted with frontline staff engagement. OSH hazards were identified with corresponding OSH improvement measures introduced, e.g., invention of high dusting device to minimize working at height; tailor-made linen cart to minimize back bending at work, etc. Specific MHO trainings were offered to each AS department. A disability management workshop was provided to supervisors in order to enhance their knowledge and skills in return-to-work (RTW) facilitation. Based on injured staff's health condition, OMCS would provide work recommendation, and RTW plan was formulated with engagement of staff and their supervisors. Genuine communication among stakeholders with expectation management paved the way for realistic goals setting and success in our program. Outcome: After implementation of the program, a significant drop of 26% in musculoskeletal disorders related sickness absence day was noted in 2016 as compared to the average of 2013-2015. The improvement was postulated by innovative OSH improvement measures, teamwork, staff engagement and management support. Staff and supervisors’ feedback were very encouraging that 90% respondents rated very satisfactory in program evaluation. This program exemplified good work sharing among departments to support staff in need.

Keywords: disability management, occupational health, return to work, occupational medicine

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Authors: Rawan K. Al-Duaij, Salem A. Al-Salem

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Projects, the unique and temporary process of achieving a set of requirements have always been challenging; Planning the schedule and budget, managing the resources and risks are mostly driven by a similar past experience or the technical consultations of experts in the matter. With that complexity of Projects in Scope, Time, and execution environment, Adjustment Orders are tools to reflect changes to the original project parameters after Contract signature. Adjustment Orders are the official/legal amendments to the terms and conditions of a live Contract. Reasons for issuing Adjustment Orders arise from changes in Contract scope, technical requirement and specification resulting in scope addition, deletion, or alteration. It can be as well a combination of most of these parameters resulting in an increase or decrease in time and/or cost. Most business leaders (handling projects in the interest of the owner) refrain from using Adjustment Orders considering their main objectives of staying within budget and on schedule. Success in managing the changes results in uninterrupted execution and agreed project costs as well as schedule. Nevertheless, this is not always practically achievable. In this paper, a detailed study through utilizing Industrial Engineering & Systems Management tools such as Six Sigma, Data Analysis, and Quality Control were implemented on the organization’s five years records of the issued Adjustment Orders in order to investigate their prevalence, and time and cost impact. The analysis outcome revealed and helped to identify and categorize the predominant causations with the highest impacts, which were considered most in recommending the corrective measures to reach the objective of minimizing the Adjustment Orders impacts. Data analysis demonstrated no specific trend in the AO frequency in past five years; however, time impact is more than the cost impact. Although Adjustment Orders might never be avoidable; this analysis offers’ some insight to the procedural gaps, and where it is highly impacting the organization. Possible solutions are concluded such as improving project handling team’s coordination and communication, utilizing a blanket service contract, and modifying the projects gate system procedures to minimize the possibility of having similar struggles in future. Projects in the Oil and Gas sector are always evolving and demand a certain amount of flexibility to sustain the goals of the field. As it will be demonstrated, the uncertainty of project parameters, in adequate project definition, operational constraints and stringent procedures are main factors resulting in the need for Adjustment Orders and accordingly the recommendation will be to address that challenge.

Keywords: adjustment orders, data analysis, oil and gas sector, systems management

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Authors: Bernice Badal

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The South African English curriculum emphasizes the adoption of the Communicative Approach (CA) using Communicative Language Teaching (CLT) methodologies to develop English as a second language (ESL) learners’ communicative competence in contexts such as township schools in South Africa. However, studies indicate that the adoption of the approach largely remains a rhetoric. Poor English language proficiency among learners and poor student performance, which continues from the secondary to the tertiary phase, is widely attributed to a lack of English language proficiency in South Africa. Consequently, this qualitative study, using a mix of classroom observations and interviews, sought to investigate teacher knowledge of Communicative Competence and the methods and strategies ESL teachers used to develop their learners’ communicative competence. The success of learners’ ability to develop communicative competence in contexts such as township schools in South Africa is inseparable from materials, tasks, teacher knowledge and how they implement the approach in the classrooms. Accordingly, teacher knowledge of the theory and practical implications of the CLT approach is imperative for the negotiation of meaning and appropriate use of language in context in resource-impoverished areas like the township. Using a mix of interviews and observations as data sources, this qualitative study examined teachers’ definitions and knowledge of Communicative competence with a focus on how it influenced their classroom practices. The findings revealed that teachers were not familiar with the notion of communicative competence, the communication process, and the underpinnings of CLT. Teachers’ narratives indicated an awareness that there should be interactions and communication in the classroom, but a lack of theoretical understanding of the types of communication necessary scuttled their initiatives. Thus, conceptual deficiency influences teachers’ practices as they engage in classroom activities in a superficial manner or focus on stipulated learner activities prescribed by the CAPS document. This study, therefore, concluded that partial or limited conceptual and coherent understandings with ‘teacher-proof’ stipulations for classroom practice do not inspire teacher efficacy and mastery of prescribed approaches; thus, more efforts should be made by the Department of Basic Education to strengthen the existing Professional Development workshops to support teachers in improving their understandings and application of CLT for the development of Communicative competence in their learners. The findings of the study contribute to the field of teacher knowledge acquisition, teacher beliefs and practices and professional development in the context of second language teaching and learning with a recommendation that frameworks for the development of communicative competence with wider applicability in resource-poor environments be developed to support teacher understanding and application in classrooms.

Keywords: communicative competence, CLT, conceptual understanding of reforms, professional development

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Authors: Priyanshu Sharma

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Urban development mechanism has evolved over the years in India, and various planning models and tools have been adopted by different states. Large cities have been able to make and implement plans with the varied degree. However, it has been observed these mechanisms face challenges to gain the momentum in small and medium towns. Gujarat has a very robust legislation that empowers planning authorities to prepare development plans (DP) and town planning scheme (TPS). The DP- TPS planning methods are quite popular for large cities in Gujarat. However, it has been observed that in the smaller towns these methods of plan preparation are facing severe agitations. Recently, development authorities of many small towns like Himmatnagar, Nadiad, and Junagadh, etc. have faced serious protest from local residents. This is because of the large amount of land deduction under the provisions of DP and TPS. And this number of opposition has been increasing since 2012 in Gujarat. This study aims to understand in detail the reasons for agitation against the plans prepared by smaller towns. It will further try to see whether the current framework of urban planning (DP and TPS) are really suitable for these towns. After understanding the development concerns and background, the aim and objectives of the study were outlined: Aim: To evaluate the suitability and acceptability of the current urban development mechanism for the small and medium towns. Objectives: (i) To review the GTPUD Act and identify the provision related to small and medium towns (ii) To understand preparation process of development plan and town planning scheme and issues related to it (iii) To understand the issues raised by the different stakeholder w.r.t plan because of which the plan and authority was agitated (iv) To find out the possible option through which these plans can be made suitable and acceptable to the stakeholder. The approach of this study is more qualitative based with the intention to understand the time frame process of preparation of development plan and town planning scheme and issues related to it. On the basis of literature study, the three towns were selected, and the detailed questionnaire was prepared for the stakeholders (development authorities and local residents) which include the time process taken in the preparation of DP and TPS and what were issues faced during the process and who all were involved. Lastly, the study looks into aspects of the land value of original plots and readjusted plots by concluding the argument whether this TP scheme model really worked in small and medium towns. Because the land deduction under TP scheme is allowed up to 50% as per the act and there is no distinct provision for small and medium towns under the act, so how this could be justified to smaller towns where the market value have not changed over the years. After analyzing the issues and reason behind the agitation against the DP and TPS in these small and medium towns. The broader recommendation has been given which can make these plans acceptable and suitable for the stakeholder.

Keywords: development plans, medium towns, small towns, town planning schemes

Procedia PDF Downloads 151

Authors: Amirah Azzeri, Fatiha H. Shabaruddin, Scott A. McDonald, Rosmawati Mohamed, Maznah Dahlui

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Objective: A scaled-up treatment cascade with direct-acting antiviral (DAA) therapy is necessary to achieve global WHO targets for hepatitis C virus (HCV) elimination in Malaysia. Recently, limited access to Sofosbuvir/Daclatasvir (SOF/DAC) is available through compulsory licensing, with future access to Sofosbuvir/Velpatasvir (SOF/VEL) expected through voluntary licensing due to recent agreements. SOF/VEL has superior clinical outcomes, particularly for cirrhotic stages, but has higher drug acquisition costs compared to SOF/DAC. It has been proposed that a stratified treatment cascade might be the most cost-efficient approach for Malaysia whereby all HCV patients are treated with SOF/DAC except for patients with cirrhosis who are treated with SOF/VEL. This study aimed to conduct a five-year budget impact analysis from the provider perspective of the proposed stratified treatment cascade for HCV treatment in Malaysia. Method: A disease progression model that was developed based on model-predicted HCV epidemiology data in Malaysia was used for the analysis, where all HCV patients in scenario A were treated with SOF/DAC for all disease stages while in scenario B, SOF/DAC was used only for non-cirrhotic patients and SOF/VEL was used for the cirrhotic patients. The model projections estimated the annual numbers of patients in care and the numbers of patients to be initiated on DAA treatment nationally. Healthcare costs associated with DAA therapy and disease stage monitoring was included to estimate the downstream cost implications. For scenario B, the estimated treatment uptake of SOF/VEL for cirrhotic patients were 25%, 50%, 75%, 100% and 100% for 2018, 2019, 2020, 2021 and 2022 respectively. Healthcare costs were estimated based on standard clinical pathways for DAA treatment described in recent guidelines. All costs were reported in US dollars (conversion rate US$1=RM4.09, the price year 2018). Scenario analysis was conducted for 5% and 10% reduction of SOF/VEL acquisition cost anticipated from the competitive market pricing of generic DAA in Malaysia. Results: The stratified treatment cascade with SOF/VEL in Scenario B was found to be cost-saving compared to Scenario A. A substantial portion of the cost reduction was due to the costs associated with DAA therapy which resulted in USD 40 thousand (year 1) to USD 443 thousand (year 5) savings annually, with cumulative savings of USD 1.1 million after 5 years. Cost reductions for disease stage monitoring were seen in year three onwards which resulted in cumulative savings of USD 1.1 thousand. Scenario analysis estimated cumulative savings of USD 1.24 to USD 1.35 million when the acquisition cost of SOF/VEL was reduced. Conclusion: A stratified treatment cascade with SOF/VEL was expected to be cost-saving and can results in a budget impact reduction in overall healthcare expenditure in Malaysia compared to treatment with SOF/DAC. The better clinical efficacy with SOF/VEL is expected to halt patients’ HCV disease progression and may reduce downstream costs of treating advanced disease stages. The findings of this analysis may be useful to inform healthcare policies for HCV treatment in Malaysia.

Keywords: Malaysia, direct acting antiviral, compulsory licensing, voluntary licensing

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Authors: P. T. Collett, M. Kershaw

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Introduction: The discussion regarding which method of anesthesia provides better results for lower limb arthroplasty is a continuing debate. Multiple meta-analysis has been performed with no clear consensus. The current recommendation is to use neuraxial anesthesia for lower limb arthroplasty; however, the evidence to support this decision is weak. The Enhanced Recovery After Surgery (ERAS) society has recommended, either technique can be used as part of a multimodal anesthetic regimen. A local study was performed to see if the current anesthetic practice correlates with the current recommendations and to evaluate the efficacy of the different techniques utilized. Method: 90 patients who underwent total hip or total knee replacements at Nevill Hall Hospital between February 2019 to July 2019 were reviewed. Data collected included the anesthetic technique, day one opiate use, pain score, and length of stay. The data was collected from anesthetic charts, and the pain team follows up forms. Analysis: The average of patients undergoing lower limb arthroplasty was 70. Of those 83% (n=75) received a spinal anaesthetic and 17% (n=15) received a general anaesthetic. For patients undergoing knee replacement under general anesthetic the average day, one pain score was 2.29 and 1.94 if a spinal anesthetic was performed. For hip replacements, the scores were 1.87 and 1.8, respectively. There was no statistical significance between these scores. Day 1 opiate usage was significantly higher in knee replacement patients who were given a general anesthetic (45.7mg IV morphine equivalent) vs. those who were operated on under spinal anesthetic (19.7mg). This difference was not noticeable in hip replacement patients. There was no significant difference in length of stay between the two anesthetic techniques. Discussion: There was no significant difference in the day one pain score between the patients who received a general or spinal anesthetic for either knee or hip replacements. The higher pain scores in the knee replacement group overall are consistent with this being a more painful procedure. This is a small patient population, which means any difference between the two groups is unlikely to be representative of a larger population. The pain scale has 4 points, which means it is difficult to identify a significant difference between pain scores. Conclusion: There is currently little standardization between the different anesthetic approaches utilized in Nevill Hall Hospital. This is likely due to the lack of adherence to a standardized anesthetic regimen. In accordance with ERAS recommends a standard anesthetic protocol is a core component. The results of this study and the guidance from the ERAS society will support the implementation of a new health board wide ERAS protocol.

Keywords: anaesthesia, orthopaedics, intensive care, patient centered decision making, treatment escalation

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Stephen Bahooshy

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Co-producing services with the people that access them is considered best practice in the United Kingdom, with the Care Act 2014 arguing that people who access services and their carers should be involved in the design, commissioning and delivery of services. Co-production is a way of working with the community, breaking down barriers of access and providing meaningful opportunity for people to engage. Unfortunately, owing to a number of reported factors such as time constraints, practitioner experience and departmental budget restraints, this process is not always followed. In 2019, in a south London borough, d/Deaf people who access services were engaged in the design, commissioning and delivery of an information and advice service that would support their community to access local government services. To do this, sensory impairment social workers and commissioners collaborated to host a series of engagement events with the d/Deaf community. Interpreters were used to enable communication between the commissioners and d/Deaf participants. Initially, the community’s opinions, ideas and requirements were noted. This was then summarized and fed back to the community to ensure accuracy. Subsequently, a service specification was developed which included performance metrics, inclusive of qualitative and quantitative indicators, such as ‘I statements’, whereby participants respond on an adapted Likert scale how much they agree or disagree with a particular statement in relation to their experience of the service. The service specification was reviewed by a smaller group of d/Deaf residents and social workers, to ensure that it met the community’s requirements. The service was then tendered using the local authority’s e-tender process. Bids were evaluated and scored in two parts; part one was by commissioners and social workers and part two was a presentation by prospective providers to an evaluation panel formed of four d/Deaf residents. The internal evaluation panel formed 75% of the overall score, whilst the d/Deaf resident evaluation panel formed 25% of the overall tender score. Co-producing the evaluation panel with social workers and the d/Deaf community meant that commissioners were able to meet the requirements of this community by developing evaluation questions and tools that were easily understood and use by this community. For example, the wording of questions were reviewed and the scoring mechanism consisted of three faces to reflect the d/Deaf residents’ scores instead of traditional numbering. These faces were a happy face, a neutral face and a sad face. By making simple changes to the commissioning and tender evaluation process, d/Deaf people were able to have meaningful involvement in the design and commissioning process for a service that would benefit their community. Co-produced performance metrics means that it is incumbent on the successful provider to continue to engage with people accessing the service and ensure that the feedback is utilized. d/Deaf residents were grateful to have been involved in this process as this was not an opportunity that they had previously been afforded. In recognition of their time, each d/Deaf resident evaluator received a £40 gift voucher, bringing the total cost of this co-production to £160.

Keywords: co-production, community engagement, deaf and hearing impaired, service design

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Authors: Stavros T. Ponis, George D. Plakas-Koumadorakis, Sotiris P. Gayialis

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Augmented Reality (AR) can be defined as a technology, which takes the capabilities of computer-generated display, sound, text and effects to enhance the user's real-world experience by overlaying virtual objects into the real world. By doing that, AR is capable of providing a vast array of work support tools, which can significantly increase employee productivity, enhance existing job training programs by making them more realistic and in some cases introduce completely new forms of work and task executions. One of the most promising AR industrial applications, as literature shows, is the use of Head Worn, monocular or binocular Displays (HWD) to support logistics and production operations, such as order picking, part assembly and maintenance. This paper presents the initial results of an ongoing research project for the introduction of a dedicated AR-HWD solution to the picking process of a Distribution Center (DC) in Greece operated by a large Telecommunication Service Provider (TSP). In that context, the proposed research aims to determine whether gamification elements should be integrated in the functional requirements of the AR solution, such as providing points for reaching objectives and creating leaderboards and awards (e.g. badges) for general achievements. Up to now, there is a an ambiguity on the impact of gamification in logistics operations since gamification literature mostly focuses on non-industrial organizational contexts such as education and customer/citizen facing applications, such as tourism and health. To the contrary, the gamification efforts described in this study focus in one of the most labor- intensive and workflow dependent logistics processes, i.e. Customer Order Picking (COP). Although introducing AR in COP, undoubtedly, creates significant opportunities for workload reduction and increased process performance the added value of gamification is far from certain. This paper aims to provide insights on the suitability and usefulness of AR-enhanced gamification in the hard and very demanding environment of a logistics center. In doing so, it will utilize a review of the current state-of-the art regarding gamification of production and logistics processes coupled with the results of questionnaire guided interviews with industry experts, i.e. logisticians, warehouse workers (pickers) and AR software developers. The findings of the proposed research aim to contribute towards a better understanding of AR-enhanced gamification, the organizational change it entails and the consequences it potentially has for all implicated entities in the often highly standardized and structured work required in the logistics setting. The interpretation of these findings will support the decision of logisticians regarding the introduction of gamification in their logistics processes by providing them useful insights and guidelines originating from a real life case study of a large DC operating more than 300 retail outlets in Greece.

Keywords: augmented reality, technology acceptance, warehouse management, vision picking, new forms of work, gamification

Procedia PDF Downloads 145

Authors: Folajinmi Oluwasina, Towolawi Adetayo, Kate Ssamula, Penninah Iutung, Daniel Reijer

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Objective: Routine HIV screening has been promoted as an essential component of efforts to reduce incidence, morbidity, and mortality. The objectives of this study were to identify the optimal annual volume needed to realize the public health goals of HIV screening in the AIDS Healthcare Foundation supported hospitals and establish an implementation process to realize that optimal annual volume. Methods: Starting in 2011 a program was established to routinize HIV screening within communities and government hospitals. In 2016 Five-years of HIV screening data were reviewed to identify the optimal annual proportions of age-eligible patients screened to realize the public health goals of reducing new diagnoses and ending late-stage diagnosis (tracked as concurrent HIV/AIDS diagnosis). Analysis demonstrated that rates of new diagnoses level off when 42% of age-eligible patients were screened, providing a baseline for routine screening efforts; and concurrent HIV/AIDS diagnoses reached statistical zero at screening rates of 70%. Annual facility based targets were re-structured to meet these new target volumes. Restructuring efforts focused on right-sizing HIV screening programs to align and transition programs to integrated HIV screening within standard medical care and treatment. Results: Over one million patients were screened for HIV during the five years; 16, 033 new HIV diagnoses and access to care and treatment made successfully for 82 % (13,206), and concurrent diagnosis rates went from 32.26% to 25.27%. While screening rates increased by 104.7% over the 5-years, volume analysis demonstrated that rates need to further increase by 62.52% to reach desired 20% baseline and more than double to reach optimal annual screening volume. In 2011 facility targets for HIV screening were increased to reflect volume analysis, and in that third year, 12 of the 19 facilities reached or exceeded new baseline targets. Conclusions and Recommendation: Quantifying targets against routine HIV screening goals identified optimal annual screening volume and allowed facilities to scale their program size and allocate resources accordingly. The program transitioned from utilizing non-evidence based annual volume increases to establishing annual targets based on optimal volume analysis. This has allowed efforts to be evaluated on the ability to realize quantified goals related to the public health value of HIV screening. Optimal volume analysis helps to determine the size of an HIV screening program. It is a public health tool, not a tool to determine if an individual patient should receive screening.

Keywords: HIV screening, optimal volume, HIV diagnosis, routine

Procedia PDF Downloads 258

Authors: A. Rahim Baharudin, Nor Arinee binti Mat Saaud, Muhammad Afiq Azman, Farah Adiba A. Sani

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Objectives: This paper shares the case study on the engineering analysis, data analysis, and real-time data comparison for qualifying the stand wires' minimum breaking load and safe working load upon loadout operation for a new project and, at the same time, eliminate the risk due to discrepancies and unalignment of COMPANY Technical Standards to Industry Standards and Practices. This paper demonstrates “Lean Construction” for COMPANY’s Project by sustaining fit-for-purpose Technical Requirements of Loadout Strand Wire Factor of Safety (F.S). The case study utilizes historical engineering data from a few loadout operations by skidding methods from different projects. It is also demonstrating and qualifying the skidding wires' minimum breaking load and safe working load used for loadout operation for substructure and other facilities for the future. Methods: Engineering analysis and comparison of data were taken as referred to the international standard and internal COMPANY standard requirements. Data was taken from nine (9) previous projects for both topsides and jacket facilities executed at the several local fabrication yards where load out was conducted by three (3) different service providers with emphasis on four (4) basic elements: i) Industry Standards for Loadout Engineering and Operation Reference: COMPANY internal standard was referred to superseded documents of DNV-OS-H201 and DNV/GL 0013/ND. DNV/GL 0013/ND and DNVGL-ST-N001 do not mention any requirements of Strand Wire F.S of 4.0 for Skidding / Pulling Operations. ii) Reference to past Loadout Engineering and Execution Package: Reference was made to projects delivered by three (3) major offshore facilities operators. Strand Wire F.S observed ranges from 2.0 MBL (Min) to 2.5 MBL (Max). No Loadout Operation using the requirements of 4.0 MBL was sighted from the reference. iii) Strand Jack Equipment Manufacturer Datasheet Reference: Referring to Strand Jack Equipment Manufactured Datasheet by different loadout service providers, it is shown that the Designed F.S for the equipment is also ranging between 2.0 ~ 2.5. Eight (8) Strand Jack Datasheet Model was referred to, ranging from 15 Mt to 850 Mt Capacity; however, there are NO observations of designed F.S 4.0 sighted. iv) Site Monitoring on Actual Loadout Data and Parameter: Max Load on Strand Wire was captured during 2nd Breakout, which is during Static Condition of 12.9 MT / Strand Wire (67.9% Utilization). Max Load on Strand Wire for Dynamic Conditions during Step 8 and Step 12 is 9.4 Mt / Strand Wire (49.5% Utilization). Conclusion: This analysis and study demonstrated the adequacy of strand wires supplied by the service provider were technically sufficient in terms of strength, and via engineering analysis conducted, the minimum breaking load and safe working load utilized and calculated for the projects were satisfied and operated safely for the projects. It is recommended from this study that COMPANY’s technical requirements are to be revised for future projects’ utilization.

Keywords: construction, load out, minimum breaking load, safe working load, strand jacking, skidding

Procedia PDF Downloads 101

Authors: Anastasia Tsakiridi

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Geographic information systems (GIS) have been utilized in numerous spatial problems, such as site research, land suitability, and demographic analysis. Besides, GIS has been applied in scientific fields like geography, health, and economics. In business studies, GIS has been used to provide insights and spatial perspectives in demographic trends, spending indicators, and network analysis. To date, the information regarding the available usages of GIS in supply chain management (SCM) and how these analyses can benefit businesses is limited. A systematic literature review (SLR) of the last 5-year peer-reviewed academic literature was conducted, aiming to explore the existing usages of GIS in SCM. The searches were performed in 3 databases (Web of Science, ProQuest, and Business Source Premier) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The analysis resulted in 79 papers. The results indicate that the existing GIS applications used in SCM were in the following domains: a) network/ transportation analysis (in 53 of the papers), b) location – allocation site search/ selection (multiple-criteria decision analysis) (in 45 papers), c) spatial analysis (demographic or physical) (in 34 papers), d) combination of GIS and supply chain/network optimization tools (in 32 papers), and e) visualization/ monitoring or building information modeling applications (in 8 papers). An additional categorization of the literature was conducted by examining the usage of GIS in the supply chain (SC) by the business sectors, as indicated by the volume of the papers. The results showed that GIS is mainly being applied in the SC of the biomass biofuel/wood industry (33 papers). Other industries that are currently utilizing GIS in their SC were the logistics industry (22 papers), the humanitarian/emergency/health care sector (10 papers), the food/agro-industry sector (5 papers), the petroleum/ coal/ shale gas sector (3 papers), the faecal sludge sector (2 papers), the recycle and product footprint industry (2 papers), and the construction sector (2 papers). The results were also presented by the geography of the included studies and the GIS software used to provide critical business insights and suggestions for future research. The results showed that research case studies of GIS in SCM were conducted in 26 countries (mainly in the USA) and that the most prominent GIS software provider was the Environmental Systems Research Institute’s ArcGIS (in 51 of the papers). This study is a systematic literature review of the usage of GIS in SCM. The results showed that the GIS capabilities could offer substantial benefits in SCM decision-making by providing key insights to cost minimization, supplier selection, facility location, SC network configuration, and asset management. However, as presented in the results, only eight industries/sectors are currently using GIS in their SCM activities. These findings may offer essential tools to SC managers who seek to optimize the SC activities and/or minimize logistic costs and to consultants and business owners that want to make strategic SC decisions. Furthermore, the findings may be of interest to researchers aiming to investigate unexplored research areas where GIS may improve SCM.

Keywords: supply chain management, logistics, systematic literature review, GIS

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Authors: Birgit Rasmussen, Thomas Maribo, Bente S. Toft

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BACKGROUND: Cardiac rehabilitation is the standard treatment for ischemic heart disease. Cardiac rehabilitation improves quality of life, reduces mortality and the risk of readmission, and provides patients with valuable knowledge and encouragement from peers and staff. Still, less than half of eligible patients enroll. Face-to-face interventions have the potential to support patients' decision-making and increase enrolment in cardiac rehabilitation. However, we lack knowledge of the content and characteristics of interventions. AIM: The aim was to outline and evaluate the content and characteristics of studies that have reported on face-to-face interventions to encourage enrolment in cardiac rehabilitation in patients with ischemic heart disease. METHOD: This scoping review followed the Joanne Briggs Institute methodology. Based on an a-priori protocol that defined the systematic search criteria, six databases were searched for studies published between 2001 and 2023. Two reviewers independently screened and selected studies. All authors discussed the summarized data prior to the narrative presentation. RESULTS: After screening and full text review of 5583 records, 20 studies of heterogeneous design and content were included. Four studies described the key contents in face-to-face interventions to be education, support of autonomy, addressing reasons for change, and emotional and cognitive support while showing understanding. Two studies used motivational interviewing to target patients' experiences and address worries and anticipated difficulties. Four quantitative studies found associations between enrolment and intention to attend, cardiac rehabilitation barriers, exercise self-efficacy, and perceived control. When patients asked questions, enrolment rates were higher, while providing reassurance and optimism could lead to non-attendance if patients had a high degree of worry. In qualitative studies, support to overcome barriers and knowledge about health benefits from participation in cardiac rehabilitation facilitated enrolment. Feeling reassured that the cardiac condition was good could lead to non-attendance. DISCUSSION AND CONCLUSION: To support patients' enrolment in cardiac rehabilitation, it is recommended that interventions integrate a person-centered dialogue. Individual worries and barriers to cardiac rehabilitation should be jointly explored. When talking with patients for whom worries predominate, the recommendation is to focus on the patients' perspectives and avoid too much focus on reassurance and problem-solving. The patients' perspectives, the mechanisms of change, and the process evaluation of the intervention including person-centeredness are relevant to include in future studies.

Keywords: ischemic heart disease, cardiac rehabilitation, enrolment, person-centered, in-hospital interventions

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Authors: Mohd Suhaizan Shamsuddin

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Urbanization exacerbates the environment quality and pressures of matured urban trees' growth and development in changing environment. The growth of struggled matured urban tree-roots by spreading within the existences of infrastructures, resulting in large damage to the structured and declined growth. Many physiological growths declined or damages by the present and installations of infrastructures within and nearby root zone. Afford to remain both matured urban tree and infrastructures as a service provider causes damage and death, respectively. Inasmuch, spending more expenditure on fixing both or removing matured urban trees as risky to the future environment as the mitigation methods to reduce the problems are unconcerned. This paper aims to explain mitigation method practices of reducing the encountered problems of matured urban tree-roots settling and infrastructures while modified urban soil to sustain at an optimum level. Three categories capturing encountered conflicts growth of matured urban tree-roots growth within and nearby infrastructures by mitigating the problems of limited soil spaces, poor soil structures and soil space barrier installations and maintenance. The limited soil space encountered many conflicts and identified six methods that mitigate the survival tree-roots, such as soil volume/mounding, soil replacement/amendment for the radial trench, soil spacing-root bridge, root tunneling, walkway/pavement rising/diverted, and suspended pavement. The limited soil spaces are mitigation affords of inadequate soil-roots and spreading root settling and modification of construction soil media since the barrier existed and installed in root trails or zones. This is the reason for enabling tree-roots spreading and finds adequate sources (nutrients, water uptake and oxygen), spaces and functioning to stability stand of root anchorage since the matured tree grows larger. The poor soil structures were identified as three methods to mitigate soil materials' problems, and fewer soil voids comprise skeletal soil, structural soil, and soil cell. Mitigation of poor soil structure is altering the existing and introducing new structures by modifying the quantities and materials ratio allowing more voids beneath for roots spreading by considering the above structure of foot and vehicle traffics functioning or load-bearing. The soil space barrier installations and maintenance recognized to sustain both infrastructures and tree-roots grown in limited spaces and its benefits, the root barrier installations and root pruning are recommended. In conclusion, these recommended methods attempt to mitigate the present problems encountered at a particular place and problems among tree-roots and infrastructures exist. The combined method is the best way to alleviates the conflicts since the recognized conflicts are between tree-roots and man-made while the urban soil is modified. These presenting methods are most considered to sustain the matured urban trees' lifespan growth in the urban environment.

Keywords: urban tree-roots, limited soil spaces, poor soil structures, soil space barrier and maintenance

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Authors: Maximilian Engelhardt, Stephan Seeck

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The COVID-19 pandemic is accelerating the already growing field of e-commerce. The resulting urban freight transport volume leads to traffic and negative environmental impact. Furthermore, the service level of parcel logistics service provider is lacking far behind the expectations of consumer. These challenges can be solved by radically reorganize the urban last mile distribution structure: parcels could be consolidated in a micro hub within the inner city and delivered within time windows by cargo bike. This approach leads to a significant improvement of consumer satisfaction with their overall delivery experience. However, this approach also leads to significantly increased costs per parcel. While there is a relevant share of online shoppers that are willing to pay for such a delivery service there are no deeper insights about this target group available in the literature. Being aware of the importance of knowing target groups for businesses, the aim of this paper is to elaborate the most important factors that determine the willingness to pay for sustainable and service-oriented parcel delivery (factor analysis) and to derive customer segments (cluster analysis). In order to answer those questions, a data set is analyzed using quantitative methods of multivariate statistics. The data set was generated via an online survey in September and October 2020 within the five largest cities in Germany (n = 1.071). The data set contains socio-demographic, living-related and value-related variables, e.g. age, income, city, living situation and willingness to pay. In a prior work of the author, the data was analyzed applying descriptive and inference statistical methods that only provided limited insights regarding the above-mentioned research questions. The analysis in an exploratory way using factor and cluster analysis promise deeper insights of relevant influencing factors and segments for user behavior of the mentioned parcel delivery concept. The analysis model is built and implemented with help of the statistical software language R. The data analysis is currently performed and will be completed in December 2021. It is expected that the results will show the most relevant factors that are determining user behavior of sustainable and service-oriented parcel deliveries (e.g. age, current service experience, willingness to pay) and give deeper insights in characteristics that describe the segments that are more or less willing to pay for a better parcel delivery service. Based on the expected results, relevant implications and conclusions can be derived for startups that are about to change the way parcels are delivered: more customer-orientated by time window-delivery and parcel consolidation, more environmental-friendly by cargo bike. The results will give detailed insights regarding their target groups of parcel recipients. Further research can be conducted by exploring alternative revenue models (beyond the parcel recipient) that could compensate the additional costs, e.g. online-shops that increase their service-level or municipalities that reduce traffic on their streets.

Keywords: customer segmentation, e-commerce, last mile delivery, parcel service, urban logistics, willingness-to-pay

Procedia PDF Downloads 103

Authors: Theresa Bacon-Baguley, Martina Reinhold

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Introduction: The purpose of this paper is to discuss the importance of both formative and summative evaluation of a Physician Assistant (PA) program with a distant campus delivered through Interactive Television (ITV) to assure equity of educational experiences. Methodology: A needs assessment utilizing a case-control design determined the need and interest in expanding the existing PA program to northern Michigan. A federal grant was written and funded, which supported the hiring of two full-time faculty members and support staff at the distant site. The strengths and weaknesses of delivering a program through ITV were evaluated using weekly formative evaluation, and bi-semester summative evaluation. Formative evaluation involved discussion of lecture content to be delivered, special ITV needs, orientation of new lecturers to the system, student concerns, support staff updates, and scheduling of student/faculty traveling between the two campuses. The summative evaluation, designed from a literature review of barriers to ITV, included 19 statements designed to evaluate the following items: quality of technology (audio, video, etc.), confidence in the ITV system, quality of instruction and instructor interaction between the two locations, and availability of resources at each location. In addition, students were given the opportunity to write qualitative remarks for each course delivered between the two locations. This summative evaluation was given to all students at mid-semester and at the end of the semester. The goal of the summative evaluation was to have 80% or greater of the students respond favorably (‘Very Good’ or ‘Good’) to each of the 19 statements. Results: Prior to the start of the first cohort at the distant campus, the technology was tested. During this time period, the formative evaluations identified key components needing modification, which were rapidly addressed: ability to record lectures, lighting, sound, and content delivery. When the mid-semester summative survey was given to the first cohort of students, 18 of the 19 statements in the summative evaluation met the goal of 80% or greater in the favorable category. When the summative evaluation statements were stratified by the two cohorts, the summative evaluation identified that students at the home location responded that they did not have adequate access to printers, and students at the expansion location responded that they did not have adequate access to library resources. These results allowed the program to address the deficiencies through contacting informational technology for additional printers, and to provide students with knowledge on how to access library resources. Conclusion: Successful expansion of programs to a distant site utilizing ITV technology requires extensive monitoring using both formative and summative evaluation. The formative evaluation allowed for quick identification of issues that could immediately be addressed, both at the planning and developing stage, as well as during implementation. Through use of the summative evaluation the program is able to monitor the success/ effectiveness of the expansion and identify specific needs of students at each location.

Keywords: assessment, distance learning, formative feedback, interactive television (ITV), student experience, summative feedback, support

Procedia PDF Downloads 236

Authors: Mary Jane Suarez

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A massive educational overhaul has taken place at the onset of the 21st century addressing the mismatches of employability skills with that of scholastic skills taught in schools. For a community to thrive in an ever-developing economy, the teaching of the necessary skills for job competencies should be realized by every educational institution. However, in harnessing 21st-century skills amongst learners, teachers, who often lack familiarity and thorough insights into the emerging 21st-century skills, are chained with the restraint of the need to comprehend the physiognomies of 21st-century skills learning and the requisite to implement the tenets of 21st-century skills teaching. With the endeavor to espouse 21st-century skills learning and teaching, a United States-based national coalition called Partnership 21st Century Skills (P21) has identified the four most important skills in 21st-century learning: critical thinking, communication, collaboration, and creativity and innovation with an established framework for 21st-century skills standards. Assessment of skills is the lifeblood of every teaching and learning encounter. It is correspondingly crucial to look at the 21st century standards and the assessment guides recognized by P21 to ensure that learners are 21st century ready. This mixed-method study sought to discover and describe what classroom assessments were used by English teachers in a public secondary school in the Philippines with course offerings on science, technology, engineering, and mathematics (STEM). The research evaluated the assessment tools implemented by English teachers and how these assessment tools were congruent to the 21st assessment standards of P21. A convergent parallel design was used to analyze assessment tools and practices in four phases. In the data-gathering phase, survey questionnaires, document reviews, interviews, and classroom observations were used to gather quantitative and qualitative data simultaneously, and how assessment tools and practices were consistent with the P21 framework with the four Cs as its foci. In the analysis phase, the data were treated using mean, frequency, and percentage. In the merging and interpretation phases, a side-by-side comparison was used to identify convergent and divergent aspects of the results. In conclusion, the results yielded assessments tools and practices that were inconsistent, if not at all, used by teachers. Findings showed that there were inconsistencies in implementing authentic assessments, there was a scarcity of using a rubric to critically assess 21st skills in both language and literature subjects, there were incongruencies in using portfolio and self-reflective assessments, there was an exclusion of intercultural aspects in assessing the four Cs and the lack of integrating collaboration in formative and summative assessments. As a recommendation, a harmonized assessment scheme of P21 skills was fashioned for teachers to plan, implement, and monitor classroom assessments of 21st-century skills, ensuring the alignment of such assessments to P21 standards for the furtherance of the institution’s thrust to effectively integrate 21st-century skills assessment standards to its curricula.

Keywords: 21st-century skills, 21st-century skills assessments, assessment standards, congruency, four Cs

Procedia PDF Downloads 188

Authors: Elaine Crable, Amit Sen

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Short-term study abroad programs have become a mainstay of MBA programs. The benefits of international business experiences, along with its exposure to global cultures, are well documented. However, developing a rewarding study, abroad program at the graduate level can be challenging for Faculty, especially when devising such a program for a group of part-time MBA students who come with a wide range of experiences and demographic characteristics. Each student has individual expectations for the study abroad experience. This study provides suggestions and considerations for Faculty that are planning to design a short-term study abroad program, especially for part-time MBA students. Insights are based on a recent experience leading a group of twenty-one students on a ten-day program to Morocco. The trip was designed and facilitated by two faculty members and a local Moroccan facilitator. This experience led to a number of insights and recommendations. First, the choice of location is critical. The choice of Morocco was very deliberate, owing to its multi-faceted cultural landscape and international business interest. It is an Islamic State with close ties to Europe both culturally and geographically and Morocco is a multi-lingual country with some combination of three languages spoken by most – English, Arabic, and French. Second, collaboration with a local ‘academic’ partner allowed the level of instruction to be both rigorous and significantly more engaging. Third, allowing students to participate in the planning of the trip enabled the trip participants to collaborate, negotiate, and share their own experiences and strengths. The pre-trip engagement was structured by creating four sub-groups, each responsible for an assigned city. Each student sub-group had to provide a historical background of the assigned city, plan the itinerary including sites to visit, cuisine to experience, industries to explore, markets to visit, plus provide a budget for that city’s expenses. The pre-planning segment of the course was critical for the success of the program as students were able to contribute to the design of the program through collaboration and negotiation with their peers. Fourth, each student sub-group was assigned industry to study within Morocco. The student sub-group prepared a presentation and a group paper with their analysis of the chosen industries. The pre-planning activities created strong bonds among the trip participants, which was evident when faced with on-ground challenges, especially when it was necessary to quickly evacuate due to a surprise USA COVID evacuation notice. The entire group supported each other when quickly making their way back to the United States. Unfortunately, the trip was cut short by two days due to this emergency exit, but the feedback regarding the program was very positive all around. While the program design put pressure on the Faculty leads regarding planning and coordination upfront, the outcome in terms of student engagement, student learning, collaboration and negotiation were all favorable and worth the effort. Finally, an added value, the cost of the program for the student was significantly lower compared to running a program with a professional provider.

Keywords: business education, experiential learning, international education, study abroad

Procedia PDF Downloads 164