Search results for: Yuzawa family health plan

Authors: Taylor Harris

Abstract:

Gustilo-anderson grade III tibial fractures are exquisitely difficult injuries to manage as they require extensive soft tissue repair in addition to fracture fixation. These injuries are best managed collaboratively by Orthopedic and Plastic surgeons. While utilizing an Orthoplastics approach has decreased the rates of adverse outcomes in these injuries, there is a large amount of variation in exactly how an Orthoplastics team approaches complex cases such as these. It is sometimes recommended that definitive bone fixation and soft tissue coverage be completed simultaneously in a single-stage manner, but there is a paucity of large scale studies to provide evidence to support this recommendation. It is the aim of this study to report the outcomes of a single-stage "fix-and-flap" approach through a systematic review of the available literature. Hopefully, this better informs an evidence-based Orthoplastics approach to managing open tibial fractures. Systematic review of the literature was performed. Medline and Google Scholar were used and all studies published since 2000, in English were included. 103 studies were initially evaluated for inclusion. Reference lists of all included studies were also examined for potentially eligible studies. Gustilo grade III tibial shaft fractures in adults that were managed with a single-stage Orthoplastics approach were identified and evaluated with regard to outcomes of interest. Exclusion criteria included studies with patients <16 years old, case studies, systemic reviews, meta-analyses. Primary outcomes of interest were the rates of deep infections and rates of limb salvage. Secondary outcomes of interest included time to bone union, rates of non-union, and rates of re-operation. 15 studies were eligible. 11 of these studies reported rates of deep infection as an outcome, with rates ranging from 0.98%-20%. The pooled rate between studies was 7.34%. 7 studies reported rates of limb salvage with a range of 96.25%-100%. The pooled rate of the associated studies was 97.8%. 6 reported rates of non-union with a range of 0%-14%, a pooled rate of 6.6%. 6 reported time to bone union with a range of 24 to 40.3 weeks and a pooled average time of 34.2 weeks, and 4 reported rates of reoperation ranging from 7%-55%, with a pooled rate of 31.1%. A few studies that compared a single stage to a multi stage approach side-by-side unanimously favored the single stage approach. Outcomes of Gustilo grade III open tibial fractures utilizing an Orthoplastics approach that is specifically done in a single-stage produce low rates of adverse outcomes. Large scale studies of Orthoplastic collaboration that were not completed in strictly a single stage, or were completed in multiple stages, have not reported as favorable outcomes. We recommend that not only should Orthopedic surgeons and Plastic surgeons collaborate in the management of severe open tibial fracture, but they should plan to undergo definitive fixation and coverage in a single-stage for improved outcomes.

Keywords: orthoplastic, gustilo grade iii, single-stage, trauma, systematic review

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Authors: Wenhao Li, Shijun Guo

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Carbon fibre reinforced composites are progressively replacing metal structures in modern civil aircraft. This is because composite materials have large potential of weight saving compared with metal. However, the achievement to date of weight saving in composite structure is far less than the theoretical potential due to many uncertainties in structural integrity and safety concern. Unlike the conventional metallic structure, composite components are bonded together along the joints where structural integrity is a major concern. To ensure the safety, metal fasteners are used to reinforce the composite bonded joints. One of the solutions for a significant weight saving of composite structure is to develop an effective technology of on-board Structural Health Monitoring (SHM) System. By monitoring the real-life stress status of composite structures during service, the safety margin set in the structure design can be reduced with confidence. It provides a means of safeguard to minimize the need for programmed inspections and allow for maintenance to be need-driven, rather than usage-driven. The aim of this paper is to develop smart composite joint. The key technology is a multifunctional thermoplastic composite fastener (MTCF). The MTCF will replace some of the existing metallic fasteners in the most concerned locations distributed over the aircraft composite structures to reinforce the joints and form an on-board SHM network system. Each of the MTCFs will work as a unit of the AU and AE technology. The proposed MTCF technology has been patented and developed by Prof. Guo in Cranfield University, UK in the past a few years. The manufactured MTCF has been successfully employed in the composite SLJ (Single-Lap Joint). In terms of the structure integrity, the hybrid SLJ reinforced by MTCF achieves 19.1% improvement in the ultimate failure strength in comparison to the bonded SLJ. By increasing the diameter or rearranging the lay-up sequence of MTCF, the hybrid SLJ reinforced by MTCF is able to achieve the equivalent ultimate strength as that reinforced by titanium fastener. The predicted ultimate strength in simulation is in good agreement with the test results. In terms of the structural health monitoring, a signal from the MTCF was measured well before the load of mechanical failure. This signal provides a warning of initial crack in the joint which could not be detected by the strain gauge until the final failure.

Keywords: composite single-lap joint, crack propagation, multifunctional composite fastener, structural health monitoring

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Authors: Lakshmi, Yakshita Awasthi, Deepika, Lovleen Jha, Archna Kumar

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From the back of centuries, plant-parasitic nematodes (PPN) have been recognized as a major threat to agriculturalists globally. It causes 21.3% global food loss annually. The utilization of harmful chemical pesticides to minimize the nematode population may cause acute and delayed health hazards and harmful impacts on human health. In recent years, a variety of plants have been evaluated for their nematicidal properties and efficacy in the management of plant-parasitic nematodes. Several Phyto-nematicides are available, but most of them are incapable of sustainable management of PPN, especially Meloidogyne spp. Thus, there is a great need for a new eco-friendly, highly efficient, sustainable control measure for this nematode species. Keeping all these facts and after reviewing the literature, aqueous extract of Cymbopogon citratus, Tagetes erecta, and Azadirachta indica were prepared by adding distilled water (1 g sample mixed with 10ml of water). In vitro studies were conducted to evaluate the efficacious nature of targeted botanicals against PPN Meloidogyne spp. The mortality status of PPN was recorded by counting the live and dead individuals after applying 100μl of selected extract. The impact was observed at different time durations, i.e., 24h and 48h. The result showed that the highest 100% mortality was at 48h in all three extracts. Thus, these extracts, with the addition of a suitable shelf-life enhancer, may be exploited in different nematode control programs as an economical, sustainable measure.

Keywords: Meloidogyne, Cymbopogon citratus, Tagetes erecta, Azadirachta indica, nematicidal

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Authors: Mercia I. Van Der Walt, Suzan Sayegh, Izzeldin E. L. J. Ibrahim, Mohamed G. Al-Kuwari, Manaf Kamil

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Background: Increased physical activity is associated with improvements in health conditions. Walking is recognized as an easy form of physical activity and a strategy used in health promotion. Step into Health (SIH), a national community program, was established in Qatar to support physical activity promotion through the monitoring of step counts. This study aims to assess the physical activity levels of the adult population in Qatar through a pedometer-based community program over a three-year-period. Methodology: This cross-sectional longitudinal study was conducted between from January 2013 and December 2015 based on daily step counts. A total of 15,947 adults (8,551 males and 7,396 females), from different nationalities enrolled in the program and aged 18 to 64, are included. The program involves free distribution of pedometers to members who voluntarily choose to register. It is also supported by a self-monitoring online account and linked to a web-database. All members are informed about the 10,000 steps/day target and automated emails as well as text messages are sent as reminders to upload data. Daily step counts were measured through the Omron HJ-324U pedometer (Omron Healthcare Co., Ltd., Japan). Analyses are done on the data extracted from the web-database. Results: Daily average step count for the overall community increased from 4,830 steps/day (2013) to 6,124 steps /day (2015). This increase was also observed within the three age categories (18–30), (31-45) and (>45) years. Average steps per day were found to be more among males compared with females in each of the aforementioned age groups. Moreover, males and females in the age group (>45 years) show the highest average step count with 7,010 steps/day and 5,564 steps/day respectively. The 21% increase in overall step count throughout the study period is associated with well-resourced program and ongoing impact in smaller communities such as workplaces and universities, a step in the right direction. However, the average step count of 6,124 steps/day in the third year is still classified as the low active category. Although the program showed an increase step count we found, 33% of the study population are low active, 35 % are sedentary with only 32% being active. Conclusion: This study indicates that the pedometer-based intervention was effective in increasing the daily physical activity of participants. However, alternative approaches need to be incorporated within the program to educate and encourage the community to meet the physical activity recommendations in relation to step count.

Keywords: pedometer, physical activity, Qatar, step count

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Authors: Olasunkanmi Olapeju

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A large chunk of global population are not yet connected to water borne faecal management systems that rely on flush mechanisms and sewers networks that are linked with a central treatment plant. Only about 10% of sub-Saharan African countries are connected to central sewage systems. In Nigeria, majority of the population do not only depend on on-plot sanitation systems, a huge chunk do not also have access to safe and improved toilets. Apart from the organizational challenges and technical capacity, the other major factors that account for why faecal waste management is yet unimproved in developing countries are faulty planning frameworks that fail to maintain balance between urbanization dynamics and infrastructures, and misconceptions about what modern sanitation is all about. In most cases, the quest to implement developmental patterns that integrate modern sewers based sanitation systems have huge financial and political costs. Faecal waste management in poor countries largely lacks the needed political attention and budgetary prioritization. Yet, the on-plot sanitation systems being mainly relied upon the need to be managed in a manner that is sustainable and healthy, pending when development would embrace a more sustainable off-site central sewage system. This study is aimed at investigating existing strategies for managing on-plot sanitation systems’ faecal waste in Ogun state, Nigeria, with the aim of recommending sustainable sanitation management systems. The study adopted the convergent parallel variant of the mixed-mode technique, which involves the adoption of both quantitative and qualitative method of data collection. Adopting a four-level multi-stage approach, which is inclusive of all political divisions in the study area, a total of 330 questionnaires were respectively administered in the study area. Moreover, the qualitative data adopted the purposive approach in scoping down to 33 key informants. SPSS software (Version 22.0) was employed for descriptively analysis. The study shows that about 52% of households adopt the non-recovery management (NRM) means of burying their latrines with sand sludge shrinkage with chemicals such as carbides. The dominance of the non-recovery management means seriously constrains the quest for faecal resource recovery. Essentially, the management techniques adopted by households depend largely on the technology of their sanitary containments, emptying means available, the ability of households to pay for the cost of emptying, and the social acceptability of the reusability of faecal waste, which determines faecal resource recoverability. The study suggests that there is a need for municipal authorities in the study area to urgently intervene in the sanitation sector and consider it a key element of the planning process. There is a need for a comprehensive plan that would ensure a seamless transition to the adoption of a modern sanitation management system.

Keywords: faecal, management, planning, waste, sanitation, sustainability

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Authors: Indhumathi Gopal

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Undergraduate research is well documented in Science, Technology, Engineering, and Mathematics (STEM), neurosciences, and microbiology disciplines, though it is hardly part of a physical fitness & wellness discipline. However, students need experiential learning opportunities, like internships and research assistantships, to get ahead with graduate schools and be gainfully employed. The first step towards this goal is to have students do a simple research project in a semester-long course. The value of research experiences and how to integrate research activity in a physical fitness & wellness course are discussed. The investigator looks into a mini research project, “Awareness of Obesity among College Students” and explains how to guide students through the research process, including journal search, data collection, and basic statistics. Besides, students will be introduced to the statistical package program SPSS 22.0 to assist with data evaluation. The lab component of the combined lecture-physical activity course could include the measurement of student’s weight with respect to their height to obtain body mass index (BMI). Students could categorize themselves in accordance with the World Health Organization’s guidelines. Results obtained after completing the data analysis help students be aware of their own potential health risks associated with overweight and obesity. Overweight and obesity are risk factors for hypertension, hypercholesterolemia, heart disease, stroke, diabetes, and certain types of cancer. It is hoped that this experience will get students interested in scientific studies, gain confidence, think critically, and develop problem-solving and good communication skills.

Keywords: physical fitness, undergraduate research experience, obesity, BMI

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Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

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Obesity-related health conditions impose a substantial economic burden on payers due to increased healthcare use. Estimates of healthcare resource use and costs associated with obesity-related comorbidities are needed to inform policies and interventions targeting these conditions. Methods: Adults living with obesity were identified (a procedure-related body mass index code for class 2/3 obesity between 2012 and 2019 in Alberta, Canada; excluding those with bariatric surgery), and outcomes were compared over 1-year (2019/2020) between those who had and did not have specific obesity-related comorbidities. The probability of using a healthcare service (based on the odds ratio of a zero [OR-zero] cost) was compared; 95% confidence intervals (CI) were reported. Logistic regression and a generalized linear model with log link and gamma distribution were used for total healthcare cost comparisons ($CDN); cost ratios and estimated cost differences (95% CI) were reported. Potential socio-demographic and clinical confounders were adjusted for, and incremental cost differences were representative of a referent case. Results: A total of 220,190 adults living with obesity were included; 44% had hypertension, 25% had osteoarthritis, 24% had type-2 diabetes, 17% had cardiovascular disease, 12% had insulin resistance, 9% had chronic back pain, and 4% of females had polycystic ovarian syndrome (PCOS). The probability of hospitalization, ED visit, and ambulatory care was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (hospitalization: 1.8-times [OR-zero: 0.57 [0.55/0.59]] / ED visit: 1.9-times [OR-zero: 0.54 [0.53/0.56]] / ambulatory care visit: 2.4-times [OR-zero: 0.41 [0.40/0.43]]), cardiovascular disease (2.7-times [OR-zero: 0.37 [0.36/0.38]] / 1.9-times [OR-zero: 0.52 [0.51/0.53]] / 2.8-times [OR-zero: 0.36 [0.35/0.36]]), osteoarthritis (2.0-times [OR-zero: 0.51 [0.50/0.53]] / 1.4-times [OR-zero: 0.74 [0.73/0.76]] / 2.5-times [OR-zero: 0.40 [0.40/0.41]]), type-2 diabetes (1.9-times [OR-zero: 0.54 [0.52/0.55]] / 1.4-times [OR-zero: 0.72 [0.70/0.73]] / 2.1-times [OR-zero: 0.47 [0.46/0.47]]), hypertension (1.8-times [OR-zero: 0.56 [0.54/0.57]] / 1.3-times [OR-zero: 0.79 [0.77/0.80]] / 2.2-times [OR-zero: 0.46 [0.45/0.47]]), PCOS (not significant / 1.2-times [OR-zero: 0.83 [0.79/0.88]] / not significant), and insulin resistance (1.1-times [OR-zero: 0.88 [0.84/0.91]] / 1.1-times [OR-zero: 0.92 [0.89/0.94]] / 1.8-times [OR-zero: 0.56 [0.54/0.57]]). After fully adjusting for potential confounders, the total healthcare cost ratio was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (1.54-times [1.51/1.56]), cardiovascular disease (1.45-times [1.43/1.47]), osteoarthritis (1.36-times [1.35/1.38]), type-2 diabetes (1.30-times [1.28/1.31]), hypertension (1.27-times [1.26/1.28]), PCOS (1.08-times [1.05/1.11]), and insulin resistance (1.03-times [1.01/1.04]). Conclusions: Adults with obesity who have specific disease-related health conditions have a higher probability of healthcare use and incur greater costs than those without specific comorbidities; incremental costs are larger when other obesity-related health conditions are not adjusted for. In a specific referent case, hypertension was costliest (44% had this condition with an additional annual cost of $715 [$678/$753]). If these findings hold for the Canadian population, hypertension in persons with obesity represents an estimated additional annual healthcare cost of $2.5 billion among adults living with obesity (based on an adult obesity rate of 26%). Results of this study can inform decision making on investment in interventions that are effective in treating obesity and its complications.

Keywords: administrative data, healthcare cost, obesity-related comorbidities, real world evidence

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Authors: Janis E. Campbell

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Most of what is known about complementary, alternative or traditional medicine (CATM) in the United States today is known from either the National Health Interview Survey a cross-sectional survey with a few questions or from small cross-sectional or cohort studies with specific populations. The broad geographical distribution in CATM use or providers is not known. For this project, we used geospatial cluster analysis to determine if there were clusters of CATM provider by county in the US. In this analysis, we used the National Provider Index to determine the geographic distribution of providers in the US. Of the 215,769 CAMT providers 211,603 resided in the contiguous US: Acupuncturist (26,563); Art, Poetry, Music and Dance Therapist (2,752); Chiropractor (89,514); Doula/Midwife (3,535); Exercise (507); Homeopath (380); Massage Therapist (36,540); Mechanotherapist (1,888); Naprapath (146); Naturopath (4,782); Nutrition (42,036); Reflexologist (522); Religious (2,438). ESRI® spatial autocorrelation was used to determine if the geographic location of CATM providers were random or clustered. For global analysis, we used Getis-Ord General G and for Local Indicators of Spatial Associations with an Optimized Hot Spot Analysis using an alpha of 0.05. Overall, CATM providers were clustered with both low and high. With Chiropractors, focusing in the Midwest, religious providers having very small clusters in the central US, and other types of CAMT focused in the northwest and west coast, Colorado and New Mexico, the great lakes areas and Florida. We will discuss some of the implications of this study, including associations with health, economic, social, and political systems.

Keywords: complementary medicine, alternative medicine, geospatial, United States

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Authors: Hugo Reis, Isabel Rabiais

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The main purpose of the present study is to understand the nurse’s responsibility in preventing the septic shock in an oncological patient with febrile neutropenia submitted to chemotherapy. In order to do it, an integrative review of literature has been conducted. In the research done in many databases, it was concluded that only 7 out of 5202 articles compiled the entire inclusion standard present in the strict protocol of research, being this made up by all different methodologies. On the research done in the 7 articles it has resulted 8 text macro-units associated to different nursing interventions: ‘Health Education’; ‘Prophylactic Therapy Administration’; ‘Scales Utilization’; ‘Patient Evaluation’; ‘Environment Control’; ‘Performance of Diagnostic Auxiliary Exams’; ‘Protocol Enforcement/Procedure Guidelines’; ‘Antibiotic Therapy Administration’. Concerning the prevalence/result’s division there can be identified many conclusions: the macro-units ‘Patient Evaluation’, ‘Performance of Diagnostic Auxiliary Exams’, and ‘Antibiotic Therapy Administration’ present themselves to be the most prevalent in the research – 6 in 7 occurrences (approximately 85.7%). Next, the macro-unit ‘Protocol Enforcement/Procedure Guidelines’ presents itself as an important expression unit – being part of 5 out of the 7 analyzed studies (approximately 71.4%). The macro-unit ‘Health Education’, seems to be in the same way, an important expression unit – 4 out of the 7 (or approximately 57%). The macro-unit ‘Scales Utilization’, represents a minor part in the research done – it’s in only 2 out of the 7 cases (approximately 28.6%). On the other hand, the macro-units ‘Prophylactic Therapy Administration’ and ‘Environment Control’ are the two categories with fewer results in the research - 1 out of the 7 cases, the same as approximately 14.3% of the research results. Every research done to the macro-unit ‘Antibiotic Therapy Administration’ agreed to refer that the intervention should be strictly done, in a period of time less than one hour after diagnosing the fever, with the purpose of controlling the quick spread of infection – minimizing its seriousness. Identifying these interventions contributes, concluding that, to adopt strategies in order to prevent the phenomenon that represents a daily scenario responsible for the cost´s increase in health institutions, being at the same time responsible for the high morbidity rates and mortality increase associated with this specific group of patients.

Keywords: febrile neutropenia, oncology nursing, patient, septic shock

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Authors: Saeed Rezaeian, M. Rezaee Boroon

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Nitrogen accumulates in soils during the process of fertilizer addition to promote the plant growth. When the organic matter decomposes, the form of available nitrogen produced is in the form of nitrate, which is highly mobile. The most significant health effect of nitrate ingestion is methemoglobinemia in infants under six months of age (blue baby syndrome). The mobile nutrients, like nitrate nitrogen, are not stored in the soil as the available forms for the long periods and in large amounts. It depends on the needs for the crops such as vegetables. On the other hand, the vegetables will compete actively for nitrate nitrogen as a mobile nutrient and water. The mobile nutrients must be shared. The fewer the plants, the larger this share is for each plant. Also, this nitrate nitrogen is poisonous for the people who use these vegetables. Nitrate is converted to nitrite by the existing bacteria in the stomach and the Gastro-Intestinal (GI) tract. When nitrite is entered into the blood cells, it converts the hemoglobin to methemoglobin, which causes the anoxemia and cyanosis. The increasing use of pesticides and chemical fertilizers, especially the fertilizers with nitrates compounds, which have been common for the increased production of agricultural crops, has caused the nitrate pollution in the (soil, water, and environment). They have caused a lot of damage to humans and animals. In this research, the nitrate accumulation in different kind of vegetables such as; green pepper, tomatoes, egg plants, watermelon, cucumber, and red pepper were observed in the suburbs of Mashhad, Neisabour, and Sabzevar cities. In some of these cities, the information forms of agronomical practices collected were such as; different vegetable crops fertilizer recommendations, varieties, pesticides, irrigation schedules, etc., which were filled out by some of our colleagues in the research areas mentioned above. Analysis of the samples was sent to the soil and water laboratory in our department in Mashhad. The final results from the chemical analysis of samples showed that the mean levels of nitrates from the samples of the fruit crops in the mentioned cities above were all lower than the critical levels. These fruit crop samples were in the order of: 35.91, 8.47, 24.81, 6.03, 46.43, 2.06 mg/kg dry matter, for the following crops such as; tomato, cucumber, eggplant, watermelon, green pepper, and red pepper. Even though, this study was conducted with limited samples and by considering the mean levels, the use of these crops from the nutritional point of view will not cause the poisoning of humans.

Keywords: environmental pollution, human health, nitrate accumulations, nitrate fertilizers

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Authors: M. Walmsley, S. Elmatarri, S. Mannion

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Introduction: Self-inflicted injury is a recognised cause of major trauma in adults and is an independent indicator of a reduced functional outcome compared to non-intentional major trauma. There is little literature available on the inpatient mental health (MH) management of this vulnerable group. A retrospective review was conducted of inpatient MH management of major trauma patients admitted to a UK regional Major Trauma Centre (MTC). Their outcomes were compared to all major trauma patients. This group of patients required multiple MH interventions whilst on the Major Trauma Ward (MTW) and a had worse functional outcome compared to non-intentional trauma. Method: The national TARN (Trauma Audit and Research Network) database was used to identify patients admitted to a regional MTC over a 2-year period from June 2018 to July 2020. Patients with an ISS (Injury Severity Score) of greater than 15 with a mechanism of either self-harm or high-risk behavior were included for further analysis. Inpatient medical notes were reviewed for MH interventions on the MTW. Further outcomes, including mortality, length of stay (LOS) and Glasgow Outcome Score (GOS) were compared with all major trauma patients for the same time period. Results: A total of 60 patients were identified in the time period and of those, 27 spent time on the MTW. A total of 23 (85%) had a prior MH diagnosis, with 11 (41%) under the care of secondary MH services. Adequate inpatient records for review were available for 24 patients. During their inpatient stay, 8 (33%) were reviewed on the ward by the inpatient MH team. There were 10 interventions required for 6 (25%) patients on the MTW including, sections under the Mental Health Act, transfer to specialist MH facility, pharmacological sedation and security being called to the MTW. When compared to all major trauma patients, those admitted due to self-harm or high-risk behavior had a statistically significantly higher ISS (31.43 vs 24.22, p=0.0001) and LOS (23.51d vs 16.06d, p=0.002). Functional outcomes using the GOS were reduced in this group of patients, GOS 5 (low disability) (51.66% vs. 61.01%) and they additionally had a higher level of mortality, GOS 1 (15.00% vs 11.67%). Discussion: Intentional self-harm is a recognised cause of major trauma in adults and this patient group sustains more severe injuries, requiring a longer hospital stay with worse outcomes compared to all major trauma patients. Inpatient MH interventions are required for a significant proportion of these patients and therefore, there needs to be a close relationship with MH services. There is limited available evidence for how this patient group is best managed as an inpatient to aid their recovery and further work is needed on how outcomes in this vulnerable group can be improved.

Keywords: adult major trauma, attempted suicide, self-inflicted major trauma, inpatient management

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Authors: Xiaolian Jiang, Dongling Liu, Kun Liu

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Aims: To examine the prevalence of POST-TRAUMATIC STRESS DISORDER (PTSD) symptoms among Tibetan adolescents in heavily-hit disaster area three years after Yushu earthquake, and to explore the interactions of the psycho-social-genetic risk factors. Methods: This was a three-stage study. Firstly, demographic variables，PTSD Checklist-Civilian Version （PCL-C），the Internality、Powerful other、Chance Scale，（IPC），Coping Style Scale（CSS），and the Social Support Appraisal（SSA）were used to explore the psychosocial factors of PTSD symptoms among adolescent survivors. PCL-C was used to examine the PTSD symptoms among 4072 Tibetan adolescents，and the Structured Clinical Interview for DSM-IV Disorders（SCID）was used by psychiatrists to make the diagnosis precisely. Secondly，a case-control trial was used to explore the relationship between PTSD and gene polymorphisms. 287adolescents diagnosed with PTSD were recruited in study group, and 280 adolescents without PTSD in control group. Polymerase chain reaction-restriction fragment length polymorphism technology（PCR-RFLP）was used to test gene polymorphisms. Thirdly，SPSS 22.0 was used to explore the interactions of the psycho-social-genetic risk factors of PTSD on the basis of the above results. Results and conclusions: 1．The prevalence of PTSD was 9.70%. 2．The predictive psychosocial factors of PTSD included earthquake exposure, support from others, imagine, abreact, tolerant, powerful others and family support. 3．Synergistic interactions between A1 gene of DRD2 TaqIA and the external locus of control, negative coping style, severe earthquake exposure were found. Antagonism interactions between A1 gene of DRD2 TaqIA and poor social support was found. Synergistic interactions between A1/A1 genotype and the external locus of control, negative coping style were found. Synergistic interactions between 12 gene of 5-HTTVNTR and the external locus of control, negative coping style, severe earthquake exposure were found. Synergistic interactions between 12/12 genotype and the external locus of control, negative coping style, severe earthquake exposure were also found.

Keywords: adolescents, earthquake, PTSD, risk factors

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Authors: Ruth Muturi Wanjiku

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HIV/AIDS in Kenya for unborn and young kids. HIV/AIDS is a significant health concern in Kenya, with an estimated 1.5 million people living with the disease. Unfortunately, many of these individuals are unaware of their HIV status, and the disease continues to spread among the population or unborn kids. HIV/AIDS can be transmitted from an infected mother during pregnancy, childbirth, or breastfeeding. However, with early testing and treatment, the risk of mother-to-child transmission can be significantly reduced. Therefore, it is crucial for pregnant women to get tested and receive appropriate medical care. For young kids, HIV/AIDS education is critical to preventing the spread of the disease. It is essential to teach children about the importance of safe sex practices, avoiding risky behaviors such as sharing needles and getting tested regularly. Additionally, children should be taught about the stigma surrounding HIV/AIDS and encouraged to treat individuals living with the disease with compassion and respect. In conclusion, HIV/AIDS is a significant health concern in Kenya that affects individuals of all ages. For unborn kids, early testing and treatment are critical to reducing the risk of mother-to-child transmission. For young kids, education about HIV/AIDS and safe sex practices is essential to preventing the spread of the disease and reducing stigma. It is essential to promote awareness and encourage individuals to get tested and seek medical care if they believe they may be infected with HIV/AIDS.

Keywords: AIDS, HIV, children, pregnant

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Authors: Abdelbaset M. Elghriani, Abdelsalam M. Maatuk, Isam Denna, Amira Abdulla Werfalli

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Electronic prescription software (e-prescribing) benefits patients and physicians by preventing handwriting errors and giving accurate prescriptions. E-prescribing allows prescriptions to be written and sent to pharmacies electronically instead of using handwritten notes. Significant factors that may affect the adoption of e-prescription systems include lacking technical support, financial resources to operate the systems, and change resistance from some clinicians, which have been identified as barriers to the implementation of e-prescription systems. This study aims to explore the trends and opinions of physicians and pharmacists about e-prescriptions and to identify the obstacles and benefits of the application of e-prescriptions in the health care system. A cross-sectional descriptive study was conducted at three Libyan public hospitals. Data were collected through a self-constructed questionnaire to assess the opinions regarding potential constraining factors and benefits of implementing an e-prescribing system in hospitals. Data presented as mean, frequency distribution table, cross-tabulation, and bar charts. Data analysis was performed, and the results show that technical, financial, and organizational obstacles are the most important obstacles that prevent the application of e-prescribing systems in Libyan hospitals. In addition, there was awareness of the benefits of e-prescribing, especially reducing medication dispensing errors, and a desire of physicians and pharmacists to use electronic prescriptions.

Keywords: physicians, e-prescribing, health care system, pharmacists

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Authors: Chaliya Wamaloon, Malee Chaisaena, Nusara Prasertsri

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Informal caregivers providing home-based palliative and end-of-life (EOL) care to people with advanced cancer is needed, however, there has not been develop caregiver skills for the EOL in cancer patients. The aim of this research was to study the model development of caregiver skills for the EOL in cancer patients. Mixed methods research was conducted in 3 phases. All subjects were in Ubon Rathchathani Cancer Hospital including 30 EOL cancer patient caregivers, 30 EOL cancer patients, and 111 health care professionals who provided care for the EOL cancer patients and 30 EOL target participants who had been trained to be cancer patient caregivers. The research tools were questionnaires, semi structured interviews, and caregiver skills questionnaires. Data were analyzed by using percentage, mean, standard deviation, pair t-test, and content analysis. The result from this study showed the model development of caregiver skills for cancer patients consisted of 9 domains skills: 1. monitoring, 2. interpreting, 3. making decisions, 4. taking action, 5. making adjustments, 6. providing hands-on care, 7. accessing resources, 8. working together with the ill patients, and 9. navigating the healthcare system. The model composed of skills development curriculum for cancer patient caregivers, Manual of palliative care for caregivers, diary of health care records for cancer patients, and the evaluation model of development of caregiver skills for EOL cancer patients. The results of the evaluation in the development model of caregiver skills for EOL cancer patients showed that the caregivers were satisfied with the model of development for caregiver skills at a high level. The comparison of the caregiver skills before and after obtaining the development of caregivers skills revealed that it improved at a statistically significant level (p < 0.05).

Keywords: caregiver, caregiver skills, cancer patients, end of life

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Authors: Georges Ghazi, Magali Gelhaye, Ruxandra Botez

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Over the years, the Flight Management System (FMS) has experienced a continuous improvement of its many features, to the point of becoming the pilot’s primary interface for flight planning operation on the airplane. With the assistance of the FMS, the concept of distance and time has been completely revolutionized, providing the crew members with the determination of the optimized route (or flight plan) from the departure airport to the arrival airport. To accomplish this function, the FMS needs an accurate Aircraft Performance Model (APM) of the aircraft. In general, APMs that equipped most modern FMSs are established before the entry into service of an individual aircraft, and results from the combination of a set of ordinary differential equations and a set of performance databases. Unfortunately, an aircraft in service is constantly exposed to dynamic loads that degrade its flight characteristics. These degradations endow two main origins: airframe deterioration (control surfaces rigging, seals missing or damaged, etc.) and engine performance degradation (fuel consumption increase for a given thrust). Thus, after several years of service, the performance databases and the APM associated to a specific aircraft are no longer representative enough of the actual aircraft performance. It is important to monitor the trend of the performance deterioration and correct the uncertainties of the aircraft model in order to improve the accuracy the flight management system predictions. The basis of this research lies in the new ability to continuously update an Aircraft Performance Model (APM) during flight using an adaptive lookup table technique. This methodology was developed and applied to the well-known Cessna Citation X business aircraft. For the purpose of this study, a level D Research Aircraft Flight Simulator (RAFS) was used as a test aircraft. According to Federal Aviation Administration the level D is the highest certification level for the flight dynamics modeling. Basically, using data available in the Flight Crew Operating Manual (FCOM), a first APM describing the variation of the engine fan speed and aircraft fuel flow w.r.t flight conditions was derived. This model was next improved using the proposed methodology. To do that, several cruise flights were performed using the RAFS. An algorithm was developed to frequently sample the aircraft sensors measurements during the flight and compare the model prediction with the actual measurements. Based on these comparisons, a correction was performed on the actual APM in order to minimize the error between the predicted data and the measured data. In this way, as the aircraft flies, the APM will be continuously enhanced, making the FMS more and more precise and the prediction of trajectories more realistic and more reliable. The results obtained are very encouraging. Indeed, using the tables initialized with the FCOM data, only a few iterations were needed to reduce the fuel flow prediction error from an average relative error of 12% to 0.3%. Similarly, the FCOM prediction regarding the engine fan speed was reduced from a maximum error deviation of 5.0% to 0.2% after only ten flights.

Keywords: aircraft performance, cruise, trajectory optimization, adaptive lookup tables, Cessna Citation X

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Authors: Sabina Ampon-Wireko

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Purpose: The study explores the influence of the organizational climate of silence on job performance through the mediating effects of work engagement (WE). Further, the degree to which supervisor support (SS) and work engagement moderate job performance are examined. Method: Using a questionnaire, the study collected 565 valid responses from frontline nurses in Ghana. The hierarchical regression technique was employed in estimating the relationship between the variables. Findings: The results showed a significant negative influence of top managers' and supervisors' attitudes to silence on both contextual and task performance. Communication opportunities, however, revealed positive and significant effects on contextual and task performance. Work engagement had no role in mediating top managers' and supervisors’ attitudes toward silence, communication opportunities, and task performance. Supervisor support acted as a moderating factor in the relationship between job engagement and task performance. In contrast, despite the direct positive relationship between supervisor support and contextual performance, it failed to moderate the relationship between work engagement and contextual performance. Practical implications: The study's findings demonstrate the need for health managers and supervisors to become more conscious of silence. The findings offer diverse recommendations for encouraging the sharing of relevant ideas, facts, and opinions within the health sector.

Keywords: organizational climate of silence, job performance, work engagement, supervisor support, frontline nurses

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Authors: Yogita Tulsian, R. S. Gupta, K. F. Laserson

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Background: Delays in the diagnosis and treatment of TB facilitates disease transmission in the community, so we conducted a study to evaluate the burden of and risk factors for delay in TB diagnosis and initiation of TB treatment among patients in the private and public sectors in Udaipur district, Rajasthan, India. Methods: A retrospective cohort study was conducted among 100 new sputum-positive TB. Patients were interviewed in the intensive phase of treatment September 2013-November 2013 Long total diagnosis delay (TDD) was defined as a time interval between first symptom to confirmed diagnosis > 30 days. Long health treatment delay (HTD) was defined as a time interval between confirmed diagnosis to treatment initiation > 7 days. Results: We observed a median TDD of 55 days (range: 7-136 days) in the public sector and of 92 days (11-380 days) in the private sector. Long TDD in the private sector was significantly associated with middle-higher socio-economic status (Risk Ratio (RR): 2;95% CI: 1.3-3). The reasons reported from the private sector for long TDD were suspect TB patients not advised for sputum examination (RR: 42; 95% CI:2.6-660), practise of self-medication (RR: 17.4; 95% CI: 1.1-267), or lack of awareness (RR: 9.7;95% CI: 0.6-145). The median HTD in the public sector was 3 days (range: 0-14 days), and in the private sector, 2 days (range: 0-11 days) (non-significant difference). Conclusions: Long TDD in private sector may be improved through sputum referral for all suspect TB cases and better education to all regarding TB.

Keywords: diagnosis delay, treatment delay, privatesector, public sector

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Authors: Idoia Landa Oregi, Itsaso Gonzalez Ochoantesana, Olatz Nicolas Buxens, Carlo Ferretti

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The impact of citizens in urban transformations has become increasingly important in the pursuit of creating citizen-centered cities. Citizens at the forefront of the urban transformation process are key to establishing resilient, sustainable, and inclusive cities that cater to the needs of all residents. Therefore, collecting data and information directly from citizens is crucial for the sustainable development of cities. Within this context, public participation becomes a pillar for acquiring the necessary information from citizens. Public participation in urban transformation processes establishes a more responsive, equitable, and resilient urban environment. This approach cultivates a sense of shared responsibility and collective progress in building cities that truly serve the well-being of all residents. However, the implementation of public participation practices often overlooks strategies to effectively engage citizens in the processes, resulting in non-successful participatory outcomes. Therefore, this research focuses on identifying and analyzing the critical aspects of citizen engagement during the same participatory urban transformation process in different European contexts: Ermua (Spain), Elva (Estonia) and Matera (Italy). The participatory neighborhood regeneration process is divided into three main stages, to turn social districts into inclusive and smart neighborhoods: (i) the strategic level, (ii) the design level, and (iii) the implementation level. In the initial stage, the focus is on diagnosing the neighborhood and creating a shared vision with the community. The second stage centers around collaboratively designing various action plans to foster inclusivity and intelligence while pushing local economic development within the district. Finally, the third stage ensures the proper co-implementation of the designed actions in the neighborhood. To this date, the presented results critically analyze the key aspects of engagement in the first stage of the methodology, the strategic plan, in the three above-mentioned contexts. It is a multifaceted study that incorporates three case studies to shed light on the various perspectives and strategies adopted by each city. The results indicate that despite of the various cultural contexts, all cities face similar barriers when seeking to enhance engagement. Accordingly, the study identifies specific challenges within the participatory approach across the three cities such as the existence of discontented citizens, communication gaps, inconsistent participation, or administration resistance. Consequently, key learnings of the process indicate that a collaborative sphere needs to be cultivated, educating both citizens and administrations in the aspects of co-governance, giving these practices the appropriate space and their own communication channels. This study is part of the DROP project, funded by the European Union, which aims to develop a citizen-centered urban renewal methodology to transform the social districts into smart and inclusive neighborhoods.

Keywords: citizen-centred cities, engagement, public participation, urban transformation

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Authors: Maria Tagarelli De Monte

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In 2021, the passage of the law recognizing Italian Sign Language (LIS) as the language of the Italian deaf minority was the input for including this visual-gestural language in the curricula of interpreters and translators choosing the academic setting for their training. Yet, a gap remains concerning LIS education of teachers and communication assistants as referring figures for people who are deaf or hard of hearing in mainstream education. As well documented in the related scientific literature, deaf children often experience severe difficulties with the languages spoken in the country where they grow up, manifesting in all levels of literacy competence. In the research introduced here, the experience of deaf students (and their teachers) attending schools is explored in areas that are characterized by strong native bilingualism, such as Friuli-Venezia Giulia (FVG), facing Italian Northeast borders. This region is peculiar as the native population may be bilingual Italian and Friulian (50% of the local population), German, and/or Slovenian. The research involved all schools of all levels in Friuli to understand the relationship between the language skills expressed by teachers and those shown by deaf learners with a background in sign language. In addition to collecting specific information on the degree of preparation of teachers in deaf-related matters and LIS, the research has allowed to highlight the role, often poorly considered, covered by the communication assistants who work alongside deaf students. On several occasions, teachers and assistants were unanimous in affirming the importance of mutual collaboration and adequate consideration of the educational-rehabilitative history of the deaf child and her family. The research was based on a mixed method of structured questionnaires and semi-structured interviews with the referring teachers. As a result, a varied and complex framework emerged, showing an asymmetry in preparing personnel dedicated to the deaf learner. Considering how Italian education has long invested in creating an inclusive and accessible school system (i.e. with the "Ten Theses for Democratic Language Education"), a constructive analysis will complete the discussion in an attempt to understand how linguistic (and modal) differences can become levers of inclusion.

Keywords: FVG, LIS, linguistic needs, deafness, teacher education, bilingual bimodal children, communication assistants, inclusion model

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Authors: Imalka Wasana Rathnayaka, Rasheda Khanam, Mohammad Mafizur Rahman

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TheCOVID-19 pandemic has created unprecedented challenges to both the health and economic states in countries around the world. This study aims to evaluate the effectiveness of governments' decisions to mitigate the risks of COVID-19 through proposing policy directions to reduce its magnitude. The study is motivated by the ongoing coronavirus outbreaks and comprehensive policy responses taken by countries to mitigate the spread of COVID-19 and reduce death rates. This study contributes to filling the knowledge by exploiting the long-term efficacy of extensive plans of governments. This study employs a Panel autoregressive distributed lag (ARDL) framework. The panels incorporate both a significant number of variables and fortnightly observations from22 countries. The dependent variables adopted in this study are the fortnightly death rates and the rates of the spread of COVID-19. Mortality rate and the rate of infection data were computed based on the number of deaths and the number of new cases per 10000 people.The explanatory variables are fortnightly values of indexes taken to investigate the efficacy of government interventions to control COVID-19. Overall government response index, Stringency index, Containment and health index, and Economic support index were selected as explanatory variables. The study relies on the Oxford COVID-19 Government Measure Tracker (OxCGRT). According to the procedures of ARDL, the study employs (i) the unit root test to check stationarity, (ii) panel cointegration, and (iii) PMG and ARDL estimation techniques. The study shows that the COVID-19 pandemic forced immediate responses from policymakers across the world to mitigate the risks of COVID-19. Of the four types of government policy interventions: (i) Stringency and (ii) Economic Support have been most effective and reveal that facilitating Stringency and financial measures has resulted in a reduction in infection and fatality rates, while (iii) Government responses are positively associated with deaths but negatively with infected cases. Even though this positive relationship is unexpected to some extent in the long run, social distancing norms of the governments have been broken by the public in some countries, and population age demographics would be a possible reason for that result. (iv) Containment and healthcare improvements reduce death rates but increase the infection rates, although the effect has been lower (in absolute value). The model implies that implementation of containment health practices without association with tracing and individual-level quarantine does not work well. The policy implication based on containment health measures must be applied together with targeted, aggressive, and rapid containment to extensively reduce the number of people infected with COVID 19. Furthermore, the results demonstrate that economic support for income and debt relief has been the key to suppressing the rate of COVID-19 infections and fatality rates.

Keywords: COVID-19, infection rate, deaths rate, government response, panel data

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Authors: Atul Khurana, Rajul Rastogi, Hans-Joachim Gamperl

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The pharmaceutical companies are getting more inclined towards patient support programs (PSPs) which assist patients and/or healthcare professionals (HCPs) in more desirable disease management and cost-effective treatment. The utmost objective of these programs is patient care. The PSPs may include financial assistance to patients, medicine compliance programs, access to HCPs via phone or online chat centers, etc. The PSP has a crucial role in terms of customer acquisition and retention strategies. During the conduct of these programs, Marketing Authorisation Holder (MAH) may receive information related to concerned medicinal products, which is usually reported by patients or involved HCPs. This information may include suspected adverse reaction(s) during/after administration of medicinal products. Hence, the MAH should design PSP to comply with regulatory reporting requirements and avoid non-compliance during PV inspection. The emergence of wireless health devices is lowering the burden on patients to manually incorporate safety data, and building a significant option for patients to observe major swings in reference to drug safety. Therefore, to enhance the adoption of these programs, MAH not only needs to aware patients about advantages of the program, but also recognizes the importance of time of patients and commitments made in a constructive manner. It is indispensable that strengthening the public health is considered as the topmost priority in such programs, and the MAH is compliant to Pharmacovigilance (PV) requirements along with regulatory obligations.

Keywords: drug safety, good pharmacovigilance practice, patient support program, pharmacovigilance

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Authors: Chiung-Hua Chan, Fang-Yuan Chang, Li-Chi Huang

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Stroke patients received regular rehabilitation therapy have measurable advancement in muscle strength, balance, control upper and lower physical activity, walking speed and endurance. This study aimed to investigate the relationship between increases in bedside rehabilitation time and the function of activities and daily living (ADL) in stroke patients. The study was quasi-experimental research design and randomized sampling. The researcher collected 12 stroke patients of stroke patients transferred to rehabilitation ward unit of a medical center during 1 January to 31 March 2017. All participants then were assigned to case group and control group. Data collection was through direct observation of assessment ADL of stroke patients by researchers on Day 1. Case group received regular rehabilitation, exercises in increase of bedside rehabilitation schedules exercise programs by ward nurses. Bedside rehabilitation exercise content with physical, functional and linguistic frequency and time, Control group only give routine rehabilitation schedule care. This was a randomized study performed in 12 patients who were stroke patients and transferred to rehabilitation ward unit of a medical center during 1 January to 31 March 2017. First, the researcher explained the purpose and method of the study to the patients or the family members. All participants completed a consent informed before participation. Patients were randomly assigned to a ‘bedside rehabilitation program’ (BRP) group and a control (C) group. The BRP group received bedside rehabilitation schedules exercise programs by ward nurses. while the C group did not. Both groups received routine rehabilitation schedule. The Functional Independence Measure was used to measure outcome at the first, 14th and the 28th day of rehabilitation ward admitted. Data were analyzed using SPSS 22.0. After implementation of standardized ‘‘bedside rehabilitation program’, the results were: (1) the increasing of bedside rehabilitation had significant difference (p<.05) in promotion ADL function of stroke patients (2) the extend time of the bedside rehabilitation has significant difference (p<.05) in promotion ADL function of stroke patients compared with the control group. This study demonstrated that the ‘bedside rehabilitation program’ enhanced the ADL function in stroke patients. The nurses and rehabilitation ward managers need to understand that the extend time and frequency of rehabilitation provide a chance to enhanced the ADL function of stroke patients.

Keywords: stroke, bedside rehabilitation, functional activity, ADL

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Authors: Shweh Fern Loo, Jun Yin Ong, Than Zaw Oo

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Acute respiratory distress syndrome (ARDS) is a common serious condition of bilateral lung infiltrates that develops secondary to various underlying conditions such as diseases or injuries. ARDS with severe hypercapnia is associated with higher ICU mortality and morbidity. Venovenous Extracorporeal membrane oxygenation (VV-ECMO) support has been established to avert life-threatening hypoxemia and hypercapnic respiratory failure despite optimal conventional mechanical ventilation. However, VV-ECMO is relatively not advisable in particular groups of patients, especially in multi-organ failure, advanced age, hemorrhagic complications and irreversible central nervous system pathology. We presented a case of a 79-year-old Chinese lady without any pre-existing lung disease admitted to our hospital intensive care unit (ICU) after acute presentation of breathlessness and chest pain. After extensive workup, she was diagnosed with rapidly progressing acute interstitial pneumonia with ARDS and hypercapnia respiratory failure. The patient received lung protective strategies of mechanical ventilation and neuromuscular blockage therapy as per clinical guidelines. However, hypercapnia respiratory failure was refractory, and she was deemed not a good candidate for VV-ECMO support given her advanced age and high vasopressor requirements from shock. Alternative therapy with extracorporeal CO2 removal (ECCO2R) was considered and implemented. The patient received 12 days of ECCO2R paired with muscle paralysis, optimization of lung-protective mechanical ventilation and dialysis. Unfortunately, the patient still had refractory hypercapnic respiratory failure with dual vasopressor support despite prolonged therapy. Given failed and futile medical treatment, the family opted for withdrawal of care, a conservative approach, and comfort care, which led to her demise. The effectivity of extracorporeal CO2 removal may depend on disease burden, involvement and severity of the disease. There is insufficient data to make strong recommendations about its benefit-risk ratio for ECCO2R devices, and further studies and data would be required. Nonetheless, ECCO2R can be considered an alternative treatment for refractory hypercapnic respiratory failure patients who are unsuitable for initiating venovenous ECMO.

Keywords: extracorporeal CO2 removal (ECCO2R), acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), hypercapnic respiratory failure

Procedia PDF Downloads 56

Authors: Stamatis Zoras, Vasilis Evagelopoulos, Theodoros Staurakas

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The association between elevated air pollution levels and extreme climate conditions (temperature, particulate matter, ozone levels, etc.) and mental consequences has been, recently, the focus of significant number of studies. It varies depending on the time of the year it occurs either during the hot period or cold periods but, specifically, when extreme air pollution and weather events are observed, e.g. air pollution episodes and persistent heatwaves. It also varies spatially due to different effects of air quality and climate extremes to human health when considering metropolitan or rural areas. An air pollutant concentration and a climate extreme are taking a different form of impact if the focus area is countryside or in the urban environment. In the built environment the climate extreme effects are driven through the formed microclimate which must be studied more efficiently. Variables such as biological, age groups etc may be implicated by different environmental factors such as increased air pollution/noise levels and overheating of buildings in comparison to rural areas. Gridded air quality and climate variables derived from the land surface observations network of West Macedonia in Greece will be analysed against mortality data in a spatial format in the region of West Macedonia. Artificial intelligence (AI) tools will be used for data correction and prediction of health deterioration with climatic conditions and air pollution at local scale. This would reveal the built environment implications against the countryside. The air pollution and climatic data have been collected from meteorological stations and span the period from 2000 to 2009. These will be projected against the mortality rates data in daily, monthly, seasonal and annual grids. The grids will be operated as AI-based warning models for decision makers in order to map the health conditions in rural and urban areas to ensure improved awareness of the healthcare system by taken into account the predicted changing climate conditions. Gridded data of climate conditions, air quality levels against mortality rates will be presented by AI-analysed gridded indicators of the implicated variables. An Al-based gridded warning platform at local scales is then developed for future system awareness platform for regional level.

Keywords: air quality, artificial inteligence, climatic conditions, mortality

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Authors: E. Njuguna, S. Ilovi, P. Muiruri, K. Mutai, J. Kinuthia, P. Njoroge

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Introduction: Cervical cancer is the commonest cause of cancer-related morbidity and mortality among women in developing countries in Sub Saharan Africa. Screening for cervical cancer in all women regardless of HIV status is crucial for the early detection of cancer of the cervix when treatment is most effective in curing the disease. It is particularly more important to screen HIV infected women as they are more at risk of developing the disease and progressing faster once infected with HPV (Human Papilloma Virus). We aimed to determine the factors affecting the utilization of cervical cancer screenings among HIV infected women above 18 years of age at Kenyatta National Hospital (KNH) Comprehensive Care Center (CCC). Materials and Methods: A cross-sectional mixed quantitative and qualitative study involving randomly and purposefully selected HIV positive female respectively was conducted. Qualitative data collection involved 4 focus group discussions of eligible female participants while quantitative data were acquired by one to one interviewer administered structured questionnaires. The outcome variable was the utilization of cervical cancer screening. Data were entered into Access data base and analyzed using Stata version 11.1. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising. Results: We enrolled a total of 387 patients, mean age (IQ range) 40 years (36-44). Cervical cancer screening utilization was 46% despite a health care provider recommendation of 85%. The screening results were reported as normal in 72 of 81 (88.9%) and abnormal 7 of 81(8.6%) of the cases. Those who did not know their result were 2 of 81(2.5%). Patients were less likely to utilize the service with increasing number of years attending the clinic (OR 0.9, 95% CI 0.86-0.99, p-value 0.02), but more likely to utilize the service if recommendation by a staff was made (OR 10, 95% CI 4.2-23.9, p<0.001), and if cervical screening had been done before joining KNH CCC (OR 2.9, 95% CI 1.7-4.9, p < 0.001). Similarly, they were more likely to rate the services on cervical cancer screening as good (OR 5.0, 95% CI 1.7-3.4, p <0.001) and very good (OR 8.1, 95% CI 2.5-6.1, p<0.001) if they had utilized the service. The main barrier themes emerging from qualitative data included fear of screening due to excessive pain or bleeding, lack of proper communication on screening procedures and increased waiting time. Conclusions: Utilization of cervical cancer screening services was low despite health care recommendation. Patient socio-demographic characteristics did not influence whether or not they utilized the services, indicating the important role of the health care provider in the referral and provision of the service.

Keywords: cervical, cancer, HIV, women, comprehensive care center

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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Background: NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studiesare shortcoming on individual patient experience. The aim of this study was to assess the patient’ssatisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. Methods: For all patients managed with woodcast in our unit, we undertook a structured questionnairethat included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score, and the pain numerical score at the time of injury and six weeks after. Results: 30 patients were initially managed with woodcast.80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. Conclusion: For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Pariscasting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Kamal Agrawal, Ved Prakash Nayak, Akshay Patil

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Raipur is known as a city of water bodies. The city had around 200 man-made and natural lakes of varying sizes. These structures were constructed to collect rainwater and control flooding in the city. Due to the transition from community participation to state government, as well as rapid urbanisation, Raipur now has only about 80 lakes left. Rapid and unplanned growth has resulted in pollution, encroachment, and eutrophication of the city's lakes. The state government keeps these lakes in good condition by cleaning them and proposing lakefront developments. However, maintaining individual lakes is insufficient because urban lakes are not distinct entities. It is a system comprised of the lake, shore, catchment, and other components. While Urban lake system (ULS) is a combination of multiple such lake systems interacting in a complex urban setting. Thus, the project aims to propose a co-evolution model for urban lake systems (ULS) and rapid urbanization in Raipur. The goals are to comprehend the ULS and to identify elements and dimensions of urbanization that influence the ULS. Evaluate the impact of rapid urbanization on the ULS & vice versa in the study area. Determine how to maximize the positive impact while minimizing the negative impact identified in the study area. Propose short-, medium-, and long-term planning interventions to support the ULS's co-evolution with rapid urbanization. A complexity approach is used to investigate the ULS. It is a technique for understanding large, complex systems. A complex system is one with many interconnected and interdependent elements and dimensions. Thus, elements of ULS and rapid urbanization are identified through a literature study to evaluate statements of their impacts (Beneficial/ Adverse) on one another. Rapid urbanization has been identified as having elements such as demography, urban legislation, informal settlement, urban infrastructure, and tourism. Similarly, the catchment area of the lake, the lake's water quality, the water spread area, and lakefront developments are all being impacted by rapid urbanisation. These nine elements serve as parameters for the subsequent analysis. Elements are limited to physical parameters only. The city has designated a study area based on the definition provided by the National Plan for the Conservation of Aquatic Ecosystems. Three lakes are discovered within a one-kilometer radius, establishing a tiny urban lake system. Because the condition of a lake is directly related to the condition of its catchment area, the catchment area of these three lakes is delineated as the study area. Data is collected to identify impact statements, and the interdependence diagram generated between the parameters yields results in terms of interlinking between each parameter and their impact on the system as a whole. The planning interventions proposed for the ULS and rapid urbanisation co-evolution model include spatial proposals as well as policy recommendations for the short, medium, and long term. This study's next step will be to determine how to implement the proposed interventions based on the availability of resources, funds, and governance patterns.

Keywords: urban lake system, co-evolution, rapid urbanization, complex system

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Authors: Ioannis N. Sergentanis, Stavroula Papadodima, Maria Tsellou, Dimitrios Vlachodimitropoulos, Sotirios Athanaselis, Chara Spiliopoulou

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Introduction: The aim of this study is the investigation of characteristics of suicide, as documented in autopsies during a five-year interval in the greater area of Attica, including the city of Athens. This could reveal possible protective or aggravating factors for suicide risk during a period strongly associated with the Greek debt crisis. Materials and Methods: Data was obtained following registration of suicide cases among autopsies performed in the Forensic Medicine and Toxicology Department, School of Medicine, National and Kapodistrian University of Athens, Greece, during the time interval from January 2011 to December 2015. Anonymity and medical secret were respected. A series of demographic and social factors in addition to special characteristics of suicide were entered into a specially established pre-coded database. These factors include social data as well as psychiatric background and certain autopsy characteristics. Data analysis was performed using descriptive statistics and Fisher’s exact test. The software used was STATA/SE 13 (Stata Corp., College Station, TX, USA). Results: A total of 162 cases were studied, 128 men and 34 women. Age ranged from 14 to 97 years old with an average of 53 years, presenting two peaks around 40 and 60 years. A 56% of cases were single/ divorced/ widowed. 25% of cases occurred during the weekend, and 66% of cases occurred in the house. A predominance of hanging as the leading method of suicide (41.4%) followed by jumping from a height (22.8%) and firearms (19.1%) was noted. Statistical analysis showed an association was found between suicide method and gender (P < 0.001, Fisher’s exact test); specifically, no woman used a firearm while only one man used medication overdose (against four women). Discussion: Greece has historically been one of the countries with the lowest suicide rates in Europe. Given a possible change in suicide trends during the financial crisis, further research seems necessary in order to establish risk factors. According to our study, suicide is more frequent in men who are not married, inside their house. Gender seems to be a factor affecting the method of suicide. These results seem in accordance with the international literature. Stronger than expected predominance in male suicide can be associated with failure to live up to social and family expectations for financial reasons.

Keywords: autopsy, Greece, risk factors, suicide

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Authors: Fereshteh Ganjavi, Rachel Schaffer, Varsha Jorawar

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Elena’s Light is a non-profit organization focused on building brighter futures for refugees, especially women and children. Our mission is to empower refugee women and children by addressing social, legal, and public health issues that predominantly concern them. Elena’s Light offers a range of services that support refugees from structural disadvantages, cultural and social stress, marginalization, and other stressors related to migration. Using a three-pronged approach, our programs focus on legal advocacy, English language acquisition, and health and wellness. Following the Afghan humanitarian crisis, Elena’s Light has developed and intensified advocacy efforts in the legal realm to address the influx of refugees who desperately need assistance. We developed and hosted a Know Your Rights presentation with local immigration lawyers and professionals in February 2022 on the Afghan Humanitarian Parole, which was very successful with over 100 attendees. Elena’s Light is hosting the second Know Your Rights session in early August 2022 on immigration options for Afghans, including Temporary Protected Status (TPS), asylum, Special Immigrant Visa (SIV), and humanitarian parole. Lastly, EL is also leading the local initiative to develop a pro-bono committee to respond to the overwhelming need for lawyers to work on legal cases for Afghan during this crisis. Furthermore, through our other services, we provide free, in-home customizable ESL tutoring sessions to refugee women with a focus on driver’s education, facilitating acculturation, and improving employment opportunities. We also provide in-home maternal, pediatric, and mental health education and wellness services that are aimed at addressing the explicit and implicit barriers to healthcare for refugee populations. Elena’s Light’s diverse community aims to counter the structural disadvantages and anxiety-inducing emotions and experiences related to being a refugee. We would like to join this International Conference on Refugee Law since protecting refugee rights is our mission. We would like to share what we have learned from our legal initiatives for refugee rights. We would also like to listen, learn from, and discuss with experts and researchers how to better understand and advocate for refugee rights. We hope to improve our understanding of how to provide better legal aid for our clients through this conference.

Keywords: legal, advocacy, Afghan humanitarian crisis, policy, pro-bono

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