Search results for: early mobilisation in intensive care (ICU)

Authors: Emmanuel A. David, Rebecca O. Soremekun, Roseline I. Aderemi-Williams

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Background: The complexities involved in the management of diabetes mellitus require a multi-dimensional, multi-professional collaborative and continuous care by health care providers and a substantial self-care by the patients in order to achieve desired treatment outcomes. The effect of pharmacists’ care in the management of diabetes in resource-endowed nations is well documented in literature, but randomised-controlled assessment of the impact of pharmacist-led care among patients with diabetes in resource-limited settings like Nigeria and sub-Saharan Africa countries is scarce. Objective: To evaluate the impact of Pharmacist-led care on glycaemic control in patients with uncontrolled type 2 diabetes, using a randomised-controlled study design Methods: This study employed a prospective randomised controlled design, to assess the impact of pharmacist-led care on glycaemic control of 108 poorly controlled type 2 diabetic patients. A total of 200 clinically diagnosed type 2 diabetes patients were purposively selected using fasting blood glucose ≥ 7mmol/L and tested for long term glucose control using Glycated haemoglobin measure. One hundred and eight (108) patients with ≥ 7% Glycated haemoglobin were recruited for the study and assigned unique identification numbers. They were further randomly allocated to intervention and usual care groups using computer generated random numbers, with each group containing 54 subjects. Patients in the intervention group received pharmacist-structured intervention, including education, periodic phone calls, adherence counselling, referral and 6 months follow-up, while patients in usual care group only kept clinic appointments with their physicians. Data collected at baseline and six months included socio-demographic characteristics, fasting blood glucose, Glycated haemoglobin, blood pressure, lipid profile. With an intention to treat analysis, Mann-Whitney U test was used to compared median change from baseline in the primary outcome (Glycated haemoglobin) and secondary outcomes measure, effect size was computed and proportion of patients that reached target laboratory parameter were compared in both arms. Results: All enrolled participants (108) completed the study, 54 in each study. Mean age was 51±11.75 and majority were female (68.5%). Intervention patients had significant reduction in Glycated haemoglobin (-0.75%; P<0.001; η2 = 0.144), with greater proportion attaining target laboratory parameter after 6 months of care compared to usual care group (Glycated haemoglobin: 42.6% vs 20.8%; P=0.02). Furthermore, patients who received pharmacist-led care were about 3 times more likely to have better glucose control (AOR 2.718, 95%CI: 1.143-6.461) compared to usual care group. Conclusion: Pharmacist-led care significantly improved glucose control in patients with uncontrolled type 2 diabetes mellitus and should be integrated in the routine management of diabetes patients, especially in resource-limited settings.

Keywords: glycaemic control , pharmacist-led care, randomised-controlled trial , type 2 diabetes mellitus

Procedia PDF Downloads 115

Authors: Ezgi Yurdakul, Klaus-Alexander Rieder, Richard Sibbick

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Most of the shotcrete projects require compliance with meeting a specified early-age strength target (e.g., reaching 1 MPa in 1 hour) that is selected based on the underground conditions. To meet the desired early-age performance characteristics, accelerators are commonly used as they increase early-age strength development rate and accelerate the setting thereby reducing sagging and rebound. The selection of accelerator type and its dosage is made by the setting time and strength required for the shotcrete application. While alkaline and alkali-free accelerators are the two main types used in wet-mix shotcrete; alkali-free admixtures increasingly substitute the alkaline accelerators to improve the performance and working safety. This paper aims to evaluate the impact of alkali-free accelerators in wet-mix on various tests including set time, early and later-age compressive strength, boiled absorption, and electrical resistivity. Furthermore, the comparison between accelerated and non-accelerated samples will be made to demonstrate the interaction between cement and accelerators. Scanning electron microscopy (SEM), fluorescent resin impregnated thin section and cut and polished surface images will be used to understand the microstructure characterization of mixes in the presence of accelerators.

Keywords: accelerators, chemical admixtures, shotcrete, sprayed concrete

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Authors: Haoqi Gao, Koichi Ogawara

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Retinal vascular segmentation of color fundus is the basis of ophthalmic computer-aided diagnosis and large-scale disease screening systems. Early screening of fundus diseases has great value for clinical medical diagnosis. The traditional methods depend on the experience of the doctor, which is time-consuming, labor-intensive, and inefficient. Furthermore, medical images are scarce and fraught with legal concerns regarding patient privacy. In this paper, we propose a new Generative Adversarial Network based on CycleGAN for retinal fundus images. This method can generate not only synthetic fundus images but also generate corresponding segmentation masks, which has certain application value and challenge in computer vision and computer graphics. In the results, we evaluate our proposed method from both quantitative and qualitative. For generated segmented images, our method achieves dice coefficient of 0.81 and PR of 0.89 on DRIVE dataset. For generated synthetic fundus images, we use ”Toy Experiment” to verify the state-of-the-art performance of our method.

Keywords: retinal vascular segmentations, generative ad-versarial network, cyclegan, fundus images

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Authors: Miroslava Marković, Renata Gagić, Serdar, Aleksandar Lučić, Ljubinko Rakonjac

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Forest dieback that comes in waves since the early 20th century has lately grown into an epidemic, in particular in oak stands. For this reason, research was conducted of the population dynamics of early oak defoliators, which represent a grave danger in oak stands due to their gradogenic attributes. The research was carried out over a 5-year period in oak forests in the area of forest administrations Kragujevac and Gornji Milanovac. The samples used in the research were collected from bottom branches, where Geometridae were found in the largest numbers, as well as from the mid and upper parts of the crowns, where other species were found. Population levels of these pests were presented in laboratory conditions on winter branch samples and in newly foliated stands on site, depending on the basic parameters of the climatic conditions. The greatest deviation of the population level of early oak defoliators was noted in 2018 on all 6 presented localities through the analysis of winter branches and the analysis of their presence in newly foliated stands on site, and it was followed by the highest average air temperature.

Keywords: defoliators, oak, population level, population dynamics

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Authors: Luiz Ernani Meira Jr., Antônio Prates Caldeira, Gilson Gabriel Viana Veloso, Jackson Andrade

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Background: In Brazil, primary health care (PHC) system has developed with multidisciplinary teams in facilities located in peripheral areas, as the entrance doors for all patients. So, professionals must be prepared to deal with patients with simple and complex problems. Objective: To evaluate the knowledge and the skills of physicians and nurses of PHC on cardiorespiratory arrest (CRA) and cardiopulmonary resuscitation (CPR) before and after training in Basic Life Support. Methods: This is a before-and-after study developed in a Simulation Laboratory in Montes Claros, Brazil. We included physicians and nurses randomly chosen from PHC services. Written tests on CRA and CPR were carried out and performances in a CPR simulation were evaluated, based on the American Heart Association recommendations. Training practices were performed using special manikins. Statistical analysis included Wilcoxon’s test to compare before and after scores. Results: Thirty-two professionals were included. Only 38% had previous courses and updates on emergency care. Most of professionals showed poor skills to attend to CRA in a simulated situation. Subjects showed an increased in knowledge and skills about CPR after training (p-value=0.003). Conclusion: Primary health care professionals must be continuously trained to assist urgencies and emergencies, like CRA.

Keywords: primary health care, professional training, cardiopulmonary resuscitation, cardiorespiratory, emergency

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Authors: Farida Habib, Haya Alfozan, Eman Miligi, Najla Alotaibi

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Background: Women’s satisfaction with maternity services, especially care during labor and birth, has become highly significant to healthcare providers, administrators, and policymakers. Purpose: The aims of this study were to assess maternal satisfaction regarding the quality of care during labor and to compare the level of maternal satisfaction between women who delivered by physicians and those delivered by midwives. Methodology: A descriptive, cross-sectional, correlational design was used. A convenient sample of 180 low-risk cases of immediate postpartum women who delivered at King Abdul-Aziz medical city was recruited. Women whose babies were diagnosed with serious health problems were excluded from the study. Data were collected using a self-administered questionnaire. The validity and reliability of the questionnaire were ensured. The questionnaire included three parts, namely: demographics data, medical history, and obstetrical history, and the last part is the satisfaction assessment tool. Ethical confederations were ensured. Maternal satisfaction during labor was classified in terms of health care, health workers' communication, and the environment. Results: Regarding health care, women were highly satisfied with care received from nurse (M = 4.21 + 0.88), medical care received (M = 4.17 + 0.79), and comfort techniques (M = 4.04 + 0.91). Regarding health workers' communication, women were highly satisfied with the provider to treat with dignity and respect (M = 4.03 + 0.91) and orientation to the toilet, bathroom, washing area (M = 4.00 + 0.93). Regarding the environment, women were highly satisfied with the experience of their baby's birth (M = 4.18 + 0.98) and supplies with drugs and supplies (M = 4.09 + 0.97). There was no statistically significant difference in maternal satisfaction between women who delivered by physicians and those delivered by midwives. Conclusion: Women were generally satisfied with their labor and delivery experience. There was no difference in maternal satisfaction on the labor process between women who delivered by physicians and those delivered by midwives.

Keywords: maternity, satisfaction, labor, delivery

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Authors: Nermin Sökmen

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An effort estimation model is needed for software-intensive projects that consist of hardware, embedded software or some combination of the two, as well as high level software solutions. This paper first focuses on functional decomposition techniques to measure functional complexity of a computer system and investigates its impact on system development effort. Later, it examines effects of technical difficulty and design team capability factors in order to construct the best effort estimation model. With using traditional regression analysis technique, the study develops a system development effort estimation model which takes functional complexity, technical difficulty and design team capability factors as input parameters. Finally, the assumptions of the model are tested.

Keywords: functional complexity, functional decomposition, development effort, technical difficulty, design team capability, regression analysis

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Authors: Temitayo Ogunsanwo

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Problem-solving is an important way of learning way of learning because it propels children to use previous experiences to deal with new situations. The purpose of this study is to find out the attitude of pre-service teachers to problem-solving as a strategy for promoting early mathematics learning in children. This qualitative study employed a descriptive design to investigate the experiences of twenty second-year undergraduate early childhood education Pre-service teachers in a teaching practice and their attitude towards five-year-old children’s problem-solving strategies in mathematics. Pre-service teachers were exposed to different strategies for teaching children how to solve problems in mathematics. They were taken through a micro teaching in class using different strategies to teach problem-solving in different topics in the five-year-old mathematics curriculum. The students were then made to teach five-year-olds in neighbouring schools for three weeks, working in pairs, observing and recording children’s problem-solving activities and strategies. After the three weeks exercise, their experiences and attitude towards children’s problem-solving strategies were collected using open-ended questions and analysed in themes. Findings were discussed.

Keywords: attitude, early mathematics learning, experience, pre-service teachers, problem-solving, strategies

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Authors: Ebrahim Akbarzadeh, Josep A. Picas Barrachina, Maite Baile Puig

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This study focuses on a novel method for dispersion and distribution of reinforcement under high intensive shear stress to produce metal composites. The polyacrylonitrile (PAN)-based short carbon fiber (Csf) and Nextel 610 alumina fiber were dispersed under high intensive shearing at mushy zone in semi-solid of A356 by a novel method. The bundles and clusters were embedded by infiltration of slurry into the clusters, thus leading to a uniform microstructure. The fibers were embedded homogenously into the aluminum around 576-580°C with around 46% of solid fraction. Other experiments at 615°C and 568°C which are contained 0% and 90% solid respectively were not successful for dispersion and infiltration of aluminum into bundles of Csf. The alumina fiber has been cracked by high shearing load. The morphologies and crystalline phase were evaluated by SEM and XRD. The adopted thixo-process effectively improved the adherence and distribution of Csf into Al that can be developed to produce various composites by thixomixing.

Keywords: aluminum, carbon fiber, alumina fiber, thixomixing, adhesion

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Authors: Salwa Obeisat

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Obesity had become a global issue and a major public health concern, because of its impact on the public health. Obstetric and midwifery evidences reported that maternal obesity an important issue, because of its associated complications like obstructed labors, infections, and hemorrhage. People who are obese are often stigmatized and blamed for their weight. Health care providers are not immune to obesity-related prejudice, and the literature features several examples of their negative attitudes towards obese patients. In Jordan, few studies were conducted to investigate obesity prevalence rate and its associated factors. The purposes of this study were to assess the health care providers' attitudes toward overweight and obese women during the childbirth in the North of Jordan and to investigate the relationships between health care providers' socio-demographic characteristics and their attitudes. A descriptive, cross-sectional design was utilized. A convenient sample was consisted of 95 midwives, 30 nurses and 62 obstetricians, who were working in the labor rooms. A self-administered questionnaire consisted of three sections: demographical data, Arabic version of Fat Phobia Scale (FPS), and Arabic version of Nurses' Attitudes toward Obesity and Obese Patients Scale (NATOOPS). Results: The study findings revealed that the majority of Jordanian health care providers held negative attitudes toward overweight and obese women during childbirth. Midwives held less negative attitudes than did obstetricians and nurses. The majority of participants were perceived the overweight and obese pregnant women during childbirth as overate people, shapeless, slow and unattractive. Age, specialty, education and years of experience were found to be associated with health care providers’ attitudes. The Conclusion: Health care providers negative attitudes toward overweight and obese pregnant women are a cause for concern. Therefore, maternal obesity was needed to be more adequately addressed in basic education courses, and in the continuing professional education classes of practicing health care providers.

Keywords: attitudes, obesity, prevalence rate, nurses, midwives, obstetrician, childbirth

Procedia PDF Downloads 325

Authors: Liu Yi Hui, Chun-Liang Lai, Jhang Yu Cih, He You Jing, Chiu Fan-Yun, Lin Yu Fang

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For universities offering long-term care education, the inclusion of adulting learning and practices in professional courses as appropriate based on holistic design and evaluation could improve talent empowerment by leveraging social capital. Moreover, it could make the courses and materials used in long-term care education responsive to real-life needs. A mixed research method was used in the research design. A quantitative study was also conducted using a questionnaire survey, and the data were analyzed by SPSS 22.0 Chinese version. The qualitative data included students’ learning files (learning reflection notes, course reports, and experience records).

Keywords: adult learning, community empowerment, social capital, mixed research

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Authors: Gayathri Nagarajan, L. D. Dhinesh Babu

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Health care is one of the prominent industries that generate voluminous data thereby finding the need of machine learning techniques with big data solutions for efficient processing and prediction. Missing data, incomplete data, real time streaming data, sensitive data, privacy, heterogeneity are few of the common challenges to be addressed for efficient processing and mining of health care data. In comparison with other applications, accuracy and fast processing are of higher importance for health care applications as they are related to the human life directly. Though there are many machine learning techniques and big data solutions used for efficient processing and prediction in health care data, different techniques and different frameworks are proved to be effective for different applications largely depending on the characteristics of the datasets. In this paper, we present a framework that uses ensemble machine learning technique gradient boosted trees for data classification in health care big data. The framework is built on Spark platform which is fast in comparison with other traditional frameworks. Unlike other works that focus on a single technique, our work presents a comparison of six different machine learning techniques along with gradient boosted trees on datasets of different characteristics. Five benchmark health care datasets are considered for experimentation, and the results of different machine learning techniques are discussed in comparison with gradient boosted trees. The metric chosen for comparison is misclassification error rate and the run time of the algorithms. The goal of this paper is to i) Compare the performance of gradient boosted trees with other machine learning techniques in Spark platform specifically for health care big data and ii) Discuss the results from the experiments conducted on datasets of different characteristics thereby drawing inference and conclusion. The experimental results show that the accuracy is largely dependent on the characteristics of the datasets for other machine learning techniques whereas gradient boosting trees yields reasonably stable results in terms of accuracy without largely depending on the dataset characteristics.

Keywords: big data analytics, ensemble machine learning, gradient boosted trees, Spark platform

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Authors: Adisu Mengesha Assefa

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The field of cardiovascular care is being transformed by the incorporation of Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR), collectively known as Extended Reality (XR), into medical education, procedural planning, and patient care. This review examines the state-of-the-art applications of XR in cardiology, emphasizing its role in enhancing the precision of interventional procedures and understanding complex anatomical structures. XR technologies complement conventional imaging methods by enabling immersive three-dimensional interaction that facilitates both preoperative planning and intraoperative guidance. Despite these promising developments, challenges such as harmonizing data, integrating various imaging systems, and addressing the prevalence of cybersickness remain. Ethical considerations, including maintaining physician focus and ensuring patient safety, are crucial when implementing XR in clinical settings. This review summarizes the existing literature and highlights the need for more rigorous future studies to validate therapeutic benefits and ensure safe application. By examining both the potential and the challenges, this paper aims to delineate the current and future roles of XR in cardiovascular care, emphasizing the necessity for continued innovation and ethical oversight to improve patient outcomes.

Keywords: virtual reality, augmented reality, mixed reality, cardiovascular care, education, preprocedural planning, intraoperative guidance, postoperative patient rehabilitation

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Authors: Yu-Min Chang, Kuo-Sheng Tsai, Hung-Te Tsai, Chia-Hsin Li

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This paper presents the early-warning lights classification management system for industrial parks promoted by the Taiwan Environmental Protection Administration (EPA) since 2011, including the definition of each early-warning light, objectives, action program and accomplishments. All of the 151 industrial parks in Taiwan were classified into four early-warning lights, including red, orange, yellow and green, for carrying out respective pollution management according to the monitoring data of soil and groundwater quality, regulatory compliance, and regulatory listing of control site or remediation site. The Taiwan EPA set up a priority list for high potential polluted industrial parks and investigated their soil and groundwater qualities based on the results of the light classification and pollution potential assessment. In 2011-2013, there were 44 industrial parks selected and carried out different investigation, such as the early warning groundwater well networks establishment and pollution investigation/verification for the red and orange-light industrial parks and the environmental background survey for the yellow-light industrial parks. Among them, 22 industrial parks were newly or continuously confirmed that the concentrations of pollutants exceeded those in soil or groundwater pollution control standards. Thus, the further investigation, groundwater use restriction, listing of pollution control site or remediation site, and pollutant isolation measures were implemented by the local environmental protection and industry competent authorities; the early warning lights of those industrial parks were proposed to adjust up to orange or red-light. Up to the present, the preliminary positive effect of the soil and groundwater quality management system for industrial parks has been noticed in several aspects, such as environmental background information collection, early warning of pollution risk, pollution investigation and control, information integration and application, and inter-agency collaboration. Finally, the work and goal of self-initiated quality management of industrial parks will be carried out on the basis of the inter-agency collaboration by the classified lights system of early warning and management as well as the regular announcement of the status of each industrial park.

Keywords: industrial park, soil and groundwater quality management, early-warning lights classification, SOP for reporting and treatment of monitored abnormal events

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Authors: Irfan Khan, Chiemeka David Ekene Arize, Hilly Swami

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Mental health care access and stigma present global challenges, with disparities significantly influenced by economic, cultural, and societal factors. This paper focuses on the mental health care systems of South Asia and the United States, comparing how cultural norms, infrastructure, and policy affect mental health care accessibility and effectiveness in both regions. In South Asia, mental health care is hindered by a combination of underfunding, a critical shortage of professionals, and deeply ingrained cultural stigmas that deter help-seeking. Traditional beliefs often link mental disorders to supernatural causes, and women face additional barriers due to gender disparities. Despite recent policy reforms, implementation remains a challenge, particularly in rural areas. In contrast, the U.S. has a more developed healthcare infrastructure but continues to grapple with stigma, particularly within professional settings like law enforcement. Interventions such as the use of Community Health Workers (CHWs) and collaborative care models have improved access, especially among underserved populations. However, the U.S. still faces disparities in care for minority groups, where cultural competence and stigma reduction are critical for improving outcomes. The paper’s comparative analysis identifies transferable strategies from the U.S. that could be adapted to South Asia’s context, such as integrating mental health care into primary care and using digital interventions to bridge the treatment gap in rural areas. Additionally, South Asia's community-centered approaches offer insights that could enhance the cultural adaptability of interventions in the U.S., particularly for ethnic minorities and immigrant populations. Through a systematic review, this paper examines intervention strategies, stigma, policy support, and the cultural and social determinants of mental health in both regions. The findings emphasize the need for culturally tailored mental health interventions and policy reforms that promote access and reduce stigma. Recommendations include enhancing public awareness, integrating mental health services into primary care, expanding community-based programs, and leveraging digital health interventions. This research contributes to the global discourse on mental health by highlighting culturally sensitive approaches that can be adapted to improve mental health care access and outcomes in both South Asia and the United States.

Keywords: mental health care, stigma, cultural influences, India, United States, mental health interventions, healthcare disparities

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Authors: Weidong Xia, Malgorzata Kolotylo, Xuan Tan

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This study examines the key factors that influence general practitioners’ learning and transfer of specialized arthritis knowledge and self-care techniques to patients during normal patient visits. Drawing on the theory of planed behavior and using matched survey data collected from general practitioners before and after training sessions provided by specialized orthopedic physicians, the study suggests that the general practitioner’s intention to use and transfer learned knowledge was influenced mainly by intrinsic motivation, organizational learning culture and absorptive capacity, but was not influenced by extrinsic motivation. The results provide both theoretical and practical implications.

Keywords: empirical study, healthcare knowledge management, patient self-care, physician knowledge transfer

Procedia PDF Downloads 292

Authors: Chang Liu, Hanwen Zhang, Vikash Sharma, Don Eliseo Lucerno-Prisno III, Emmanuel Yujuico, Maulik Chokshi, Prashanthi Krishnakumar, Bach Xuan Tran, Giang Thu Vu, Kamilla Anna Pinter, Shenglan Tang

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Background and Aims: Globally, many health systems focus on hospital-based healthcare models targeting acute care and disease treatment, which are not effective in addressing the challenges of ageing populations, chronic conditions, multi-morbidities, and increasingly unhealthy lifestyles. Recently, integrated care programs on chronic diseases have been developed, piloted, and implemented to meet such challenges. However, integrated care programs in the Asia-Pacific region vary in the levels of integration from linkage to coordination to full integration. This study aims to identify and analyze existing cases of integrated care in the Asia-Pacific region and identify the facilitators and barriers in order to improve existing cases and inform future cases. Methods: The study is a comparative study, with a combination approach of desk-based research and key informant interviews. The selected countries included in this study represent a good mix of lower-middle income countries (the Philippines, India, Vietnam, and Fiji), upper-middle income country (China), and high-income country (Singapore) in the Asia-Pacific region. Existing integrated care programs were identified through the scoping review approach. Trigger, history, general design, beneficiaries, and objectors were summarized with barriers and facilitators of integrated care based on key informant interviews. Representative case(s) in each country were selected and comprehensively analyzed through deep-dive case studies. Results: A total of 87 existing integrated care programs on chronic diseases were found in all countries, with 44 in China, 21 in Singapore, 12 in India, 5 in Vietnam, 4 in the Philippines, and 1 in Fiji. 9 representative cases of integrated care were selected for in-depth description and analysis, with 2 in China, the Philippines, and Vietnam, and 1 in Singapore, India, and Fiji. Population aging and the rising chronic disease burden have been identified as key drivers for almost all the six countries. Among the six countries, Singapore has the longest history of integrated care, followed by Fiji, the Philippines, and China, while India and Vietnam have a shorter history of integrated care. Incentives, technologies, education, and performance evaluation would be crucial for developing strategies for implementing future programs and improve already existing programs. Conclusion: Integrated care is important for addressing challenges surrounding the delivery of long-term care. To date, there is an increasing trend of integrated care programs on chronic diseases in the Asia-Pacific region, and all six countries in our study set integrated care as a direction for their health systems transformation.

Keywords: integrated healthcare, integrated care delivery, chronic diseases, Asia-Pacific region

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Authors: Arun Prasad

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Introduction: Laparoscopic surgery of hernia started in early 1990 and has had a mixed acceptance across the world, unlike laparoscopic cholecystectomy that has become a gold standard. Laparoscopic hernia repair claims to have less pain, less recurrence, and less wound infection compared to open hernia repair leading to early recovery and return to work. Materials and Methods: Laparoscopic hernia repair has been done in 2100 patients from 1995 till now with a follow-up data of 1350 patients. Data was analysed for results and satisfaction. Results: There is a recurrence rate of 0.1%. Early complications include bleeding, trocar injury and nerve pain. Late complications were rare. Conclusion: Laparoscopic inguinal hernia repair has a steep learning curve but after that the results and patient satisfaction are very good. It should be the procedure of choice in all bilateral and recurrent hernias.

Keywords: laparoscopy, hernia, mesh, surgery

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Authors: Susanne Ferschl, Peter Holzmüller, Elisabeth Wacker

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Ageing populations, advances in medical sciences and digitalization, diversity and social disparities, as well as the increasing need for skilled healthcare professionals, are challenging healthcare systems around the globe. To address these challenges, future healthcare systems need to center on human needs taking into account the living environments that shape individuals’ knowledge of and opportunities to access healthcare. Moreover, health should be considered as a common good and an integral part of securing livelihoods for all people. Therefore, the adoption of a systems approach, as well as inter-disciplinary and inter-sectoral cooperation among healthcare providers, are essential. Additionally, the active engagement of target groups in the planning and design of healthcare structures is indispensable to understand and respect individuals’ health and livelihood needs. We will present the research project b4 – identifying needs | building bridges | developing health care in the social space, which is situated within this reasoning and accompanies the cross-sectoral cooperation project Brückenschlag (building bridges) in a Bavarian district. Brückenschlag seeks to explore effective ways of health care linking university medicine (Maximalversorgung | maximum care) with regional inpatient, outpatient, rehabilitative, and preventive care structures (Regionalversorgung | regional care). To create advantages for both (potential) patients and the involved cooperation partners, project b4 qualitatively assesses needs and motivations among professionals, population groups, and political stakeholders at individual and collective levels. Besides providing an overview of the project structure as well as of regional population and healthcare characteristics, the first results of qualitative interviews conducted with different health experts will be presented. Interviewed experts include managers of participating hospitals, nurses, medical specialists working in the hospital and registered doctors operating in practices in rural areas. At the end of the project life and based on the identified factors relevant to the success -and also for failure- of participatory cooperation in health care, the project aims at informing other districts embarking on similar systems-oriented and human-centered healthcare projects. Individuals’ health care needs in dependence on the social space in which they live will guide the development of recommendations.

Keywords: cross-sectoral collaboration in health care, human-centered health care, regional health care, individual and structural health conditions

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Authors: Nagendra P. Luitel, Mark J. D. Jordans

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Globally, there is a significant gap between the number of individuals in need of mental health care and those who actually receive treatment. The evidence is accumulating that mental health services can be delivered effectively by primary health care workers through community-based programs and task-sharing approaches. Changing the role of specialist mental health workers from service delivery to building clinical capacity of the primary health care (PHC) workers could help in reducing treatment gap in low and middle-income countries (LMICs). We developed a comprehensive mental health care plan in 2012 and evaluated its feasibility and effectiveness over the past three years. Initially, a mixed method formative study was conducted for the development of mental health care plan (MHCP). Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from beneficiaries (n=135) during the pilot-testing phase. Repeated community survey (N=2040); facility detection survey (N=4704) and the cohort study (N=576) were conducted for evaluation of the MHCP. The resulting MHCP consists of twelve packages divided over the community, health facility, and healthcare organization platforms. Detection of mental health problems increased significantly after introducing MHCP. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Currently, MHCP has been implemented in the entire Chitwan district where over 1400 people (438 people with depression, 406 people with psychosis, 181 people with epilepsy, 360 people with alcohol use disorder and 51 others) have received mental health services from trained health workers. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers, high drop-out rates and continue the supply of medicines. The results indicated that involvement of PHC workers in detection and management of mental health problems is an effective strategy to minimize treatment gap on mental health care in Nepal.

Keywords: mental health, Nepal, primary care, treatment gap

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Authors: Shiksha Thakur, Rashmi Jain

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Maternal health is the most crucial element in the primary health care delivery system of any healthy society. We aware that the maternal health situation in India has been a cause of concern for us, in spite of the rapidly progressing socio-economic environment overall. India has realized impressive gains in Mother & Child survival over the last two decades. MMR as per 2012-2013 in India is 167 as per MMR bulletin, though there are variations between states in the Country. In 2013, an estimated 2,89,000 women worldwide died from complications arising from pregnancy & childbirth. In view of the above facts, a study was conducted in Indore to analyse the maternal health status among urban slums and non-slums women.

Keywords: antenatal care, postnatal care, JSY, maternal health, child health, reproductive health

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Authors: Mekroud Amel

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Introduction The rate of use by the elderly of emergency departments, operating rooms and intensive care units has increased worldwide. Emergency surgery is a context where evaluation is often insufficient, with incomplete information gathering. The aim of this work is to shed light on the frequent use of emergency surgeries by the elderly and their characteristics, as well as on the lack of geriatric assessment scores in the emergency room. Material : Prospective, observational and descriptive, monocentric study. Patients aged 65 and over, admitted for emergency surgery in the operating room, were counted. Emergency operating room including visceral surgery, urology, traumatology and neurosurgery. Parameters studied: Patient characteristics, degree of autonomy, type of surgical pathology, operative management times, preoperative evaluation, postoperative outcome Results : 192 patients were identified over 12 months, from 09.01.2017 to 08.31.2018 Age from 65 to 101 years, 79.81 years +/- 8.38. With predominance of the age group between [65-75 years] 41.1% Female predominance, Sexratio = 0.81 Elderly subjects with total motor autonomy are in the majority at 57.8% Subjects without pathological ATCD represent 12.5% of cases Those who are on only one type of medication or without any treatment are at 36.9% Discussion : The emergency operative care of the elderly patient for a surgical or traumatological pathology is characterized by many specificities linked first to the emergency context, where the evaluation is often insufficient, besides the fact that the elderly patient has particularities requiring reception in centers with experience in the care of this category of patient, or, failing that, a center which uses the minimum of geriatric evaluation scores which are simplified for the emergency departments. In our hospital, we have not yet made this evaluation routine in the emergency room and this delay in the introduction of these scores can be directly attributed to the covid 19 pandemic. Besides the standard preoperative assessment, only 43.2% of patients were assessed in the preoperative period by an anesthesiologist. Traumatological emergencies come first 68.2% followed by visceral emergencies 19.2% (including proctological, urological emergencies), neurosurgical emergencies 7.8% and finally peripheral emergency surgery all acts combined 4.7%. Hospital stay at 9.6 +/- 16.8 days, average operability time of 4.5 +/- 3 days. Death rate at 7.29% Conclusion This work has demonstrated the major impact of emergency surgery, which remains curable for the most part, on the elderly patient despite total motor and cognitive autonomy preoperatively. The improvement of the preoperative evaluation, the reduction of the operating time and enhanced recovery after surgery, with personalized protocols, are the only guarantee for the resumption of preoperative autonomy in these patients.

Keywords: emergency surgery, elderly patients, preoperative geriatric scores, curable emergency surgical pathologies

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Authors: Tsung Chieh Ma, I-Ling Chen

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Disclosing family origins to adoptees is an important topic in the adoption process. Adoption agencies usually educate adoptive parents on how to disclose to adoptees, but many adoptive parents worry that the disclosure will affect the parent–child relationship. Thus, how adoptees would like to receive the disclosure and whether they subjectively feel that the parent–child relationship is affected are both topics worthy of further discussion. This research takes a qualitative approach and connects with adoption agencies to interview six adoptees who are now adults. The purpose of the interviews is to learn about their experience receiving disclosures and their subjective feelings after learning of their family origins. The aim is to reveal the changes disclosure brought to the parent–child relationship and whether common concerns are raised due to the adoptive status. We also want to know about factors that affect their identification with their adopted status so that we can consequently give advice to other adoptive families. in this study finds that adoptees see disclosure as a process rather than an isolated event. The majority want to be told their family origin as early and proactively as possible and expect to learn the reasons they were given up for adoption and taken in as adoptees. The disclosure does not necessarily influence the parent–child relationship, and adoptees care more about the positive experiences they had with adoptive parents in their childhood. Moreover, adopted children seek contact with their original family mostly to understand why they were given up for adoption. The effects of disclosure depend on how the adoptive parents or other significant people in the lives of adoptees interpret the identity of the adoptees. That is, their response and attitude toward the identity have a lasting impact on the adoptees. The study suggests that early disclosure gives adoptees a chance to internalize the experience in the process and find self-identification.

Keywords: adoption, adoptees, disclosure of family origins, parent–child relationship, self-identity

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Authors: Sumaira Ashraf, Elisabete G.S. Félix, Zélia Serrasqueiro

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Traditional financial distress prediction models performed well to predict bankrupt and insolvent firms of the developed markets. Previous studies particularly focused on the predictability of financial distress, financial failure, and bankruptcy of firms. This paper contributes to the literature by extending the definition of financial distress with the inclusion of early warning signs related to quotation of face value, dividend/bonus declaration, annual general meeting, and listing fee. The study used five well-known distress prediction models to see if they have the ability to predict early warning signs of financial distress. Results showed that the predictive ability of the models varies over time and decreases specifically for the sample with early warning signs of financial distress. Furthermore, the study checked the differences in the predictive ability of the models with respect to the financial crisis. The results conclude that the predictive ability of the traditional financial distress prediction models decreases for the firms with early warning signs of financial distress and during the time of financial crisis. The study developed a new model comprising significant variables from the five models and one new variable earning response. This new model outperforms the old distress prediction models before, during and after the financial crisis. Thus, it can be used by researchers, organizations and all other concerned parties to indicate early warning signs for the emerging markets.

Keywords: financial distress, emerging market, prediction models, Z-Score, logit analysis, probit model

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Authors: Tiago Sigal Linhares, Ana Amélia Nascimento da Silva Bones, Juliana Miola, McArthur Alexander Barrow, Airton Tetelbom Stein

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Introduction: As a result of increased globalization and changing migration trends, it is expected that a significant portion of People Living with HIV/AIDS (PLWHA) will change their place of residence over time. In order to provide better health care, monitor the HIV epidemic and plan urban public health care and policies, there is a growing need to formulate a strategy for monitoring PLWHA care, location and migration patterns. The Porto Alegre District is characterized by a high prevalence of PLWHA and is considered one of the epicenters of HIV epidemic in Latin America. Objectives: The aim of this study is to create a digital and easily editable map in order to create a visual representation of the location of PLWHA and to monitor their migration within the city and the country in an effort to promote longitudinal care. Methods: This Experience Report used Google Maps Map Creator to generate an active digital map showing the location and changes in residence of 165 PLWHA who received care at two Primary Health Care (PHC) clinics, which attended an estimated population of five thousand patients, in downtown Porto Alegre over the last four years. Their current addresses were discovered in the unified Brazilian health care system digital records (e-SUS) and updated on the map. Results: A digital map with PLWHA current residence location was created. It was possible to demonstrate visually areas with a large concentration of PLWHA and the migration of the population within the city as wells as other cities, regions and states. Conclusions: An easily reproducible and free map could aid in PLWHA monitoring, urban public health planning, target interventions and situational diagnosis. Moreover, a visual representation of PLWHA location and migration could help bring more attention and investments to areas with geographic inequities or higher prevalence of PLWHA. It also enables notification of local PHC units of monitored patients inside their area, which are in clinical risk or with treatment abandonment through active case findings, improving the care of PLWHA.

Keywords: health care, medical public health, theoretical and conceptual innovations, urban public health

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Authors: Isabelle Gobatto

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Based on an anthropological approach, this paper explores the medical profession and the construction of medical practices by considering the multiform articulations between structural poverty and the production of care from a low-resource francophone West African country, Burkina Faso. This country is considered in its exemplary dimension of culturally differentiated countries of the African continent that share the same situation of structural poverty. The objective is to expose the effects of structural poverty on the ways of constructing professional knowledge and thinking about the sense of the medical profession. If doctors are trained to have the same capacities in South and West countries, which are to treat and save lives whatever the cultural contexts of the practice of medicine, the ways of investing their role and of dealing with this context of action fracture the homogenization of the medical profession. In the line of anthropology of biomedicine, this paper outlines the complex effects of structural poverty on health care, care relations, and the moral economy of doctors. The materials analyzed are based on an ethnography including two temporalities located thirty years apart (1990-1994 and 2020-2021), based on long-term observations of care practices conducted in healthcare institutions, interviews coupled with the life histories of physicians. The findings reveal that disabilities faced by doctors to deliver care are interpreted as policy gaps, but they are also considered by physicians as constitutive of the social and cultural characteristics of patients, making their capacities and incapacities in terms of accompanying caregivers in the production of care. These perceptions have effects on know-how, structured around the need to act even when diagnoses are not made so as not to see patients desert health structures if the costs of care are too high for them. But these interpretations of highly individualizing dimensions of these difficulties place part of the blame on patients for the difficulties in using learned knowledge and delivering effective care. These situations challenge the ethics of caregivers but also of ethnologists. Firstly because the interpretations of disabilities prevent caregivers from considering vulnerabilities of care as constituting a common condition shared with their patients in these health systems, affecting them in an identical way although in different places in the production of care. Correlatively, these results underline that these professional conceptions prevent the emergence of a figure of victim, which could be shared between patients and caregivers who, together, undergo working and care conditions at the limit of the acceptable. This dimension directly involves politics. Secondly, structural poverty and its effects on care challenge the ethics of the anthropologist who observes caregivers producing, without intent to arm, experiences of care marked by an ordinary violence, by not giving them the care they need. It is worth asking how anthropologists could get doctors to think in this light in west-African societies.

Keywords: Africa, care, ethics, poverty

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Authors: Behrooz Nikahval, Mohammad Saeed Ahrari-Khafi, Sakineh Behroozpoor, Saeed Nazifi

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Osteoarthritis (OA) is a progressive and degenerative condition of the articular cartilage and other joints’ structures. It is essential to diagnose this condition as early as possible. The present research was performed to measure the Osteoprotegrin (OPG) and Tumor Necrosis Factor α (TNF-α) in synovial fluid and blood serum of dogs with surgically transected cruciate ligament as a model of OA, to evaluate if measuring of these parameters can be used as a way of early diagnosis of OA. In the present study, four mature, clinically healthy dogs were selected to investigate the effect of experimental OA, on OPG and TNF-α as a way of early detection of OA. OPG and TNF-α were measured in synovial fluid and blood serum on days 0, 14, 28, 90 and 180 after surgical transaction of cranial cruciate ligament in one stifle joint. Statistical analysis of the results showed that there was a significant increase in TNF-α in both synovial fluid and blood serum. OPG showed a decrease two weeks after OA induction. However, it fluctuated afterward. In conclusion, TNF-α could be used in both synovial fluid and blood serum as a way of early detection of OA; however, further research still needs to be conducted on OPG values in OA detection.

Keywords: osteoarthritis, osteoprotegrin, tumor necrosis factor α, synovial fluid, serum, dog

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Authors: Fahimeh Ghorbani, Alam Saleh

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Ideology, politics and art have always been omnipresent patterns of Islam since its early age. The Islamic empire, expanded from China to Andalusia, has instrumentalized art and architecture to enhance political legitimacy of different dynasties or states throughout its history. Quranic verses utilized to convey ideological messages in the major mosques and mausoleums. Iranians had already been employing art and architecture to propagate their political legitimacy prior to Islam. The land of Iran and its art with strong civilizational pre-Islamic history has been profoundly politicized since the rise of Islam in the region. Early Islamic period in Iran has witnessed introduction of a new architectural language, new formulas for spatial configuration in built spaces, as well as new system of architectural decoration. Studying Iran’s Early Islamic architecture helps in better understanding the process of socio-political identity making of Iranian-Islamic culture, and thus art and architecture. This period also set the stage for formation of glorious architectural movements through Persianate world in later periods. During the Early Islamic period in Iran, the innovative combination of Islamic ideology and Iranian Architecture created formidable ideological tools in politicizing art in the region and beyond. As such, this paper aims to investigate the political history and architectural legacy from late Sassanid to Early Islamic period, delves into the ways in which Early Islamic architecture played role in transforming Persian concepts of kingship, administration, and social organization. In so doing, the study focuses on the Perso-Islamic architectural synthesis under the Samanids and Seljuk dynasty as case studies. The paper also explores how the newly introduced Islamic architecture has been employed to address the question of political legitimacy and to propagate states’ political agenda in early Islamic Iran (650-1250). As for the existing literature, despite its uniqueness and significance, Early Islamic architecture of Iran has received little scholarly attention. However, there exists a sizeable body of scholarship on socio-historic condition of the land of Iran during Early Islamic period which provide a solid base for the project. Methodologically speaking, the authors look into the subject through various lenses. They will conduct historic and archival research in libraries, private collections, and archives in Iran and the related neighbouring countries in Persian, Arabic and English. The methods of visual and formal analysis are applied to examine architectural features of the period. There are also a high number of intriguing, yet poorly examined, published and unpublished documents, old plans, drawings and photos of monuments preserved in Cultural Heritage of Iran Organization which will be consulted.

Keywords: Iran, Islamic architecture, early Islamic Iran, early Islamic architecture, politicized art, political legitimacy, propaganda, aesthetics

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Authors: Mahmut Genc, Seda Genc

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Wine is the most popular alcoholic drink in the World with 274.4 million of hectoliter annual production in the year of 2015. The wine industry is very important for some regions as well as creating significant value in their economies. This industry is very sensitive to the global warming since viticulture highly depends on climate and geographical region. Sustainability concept is a crucial issue for the wine industry and sustainability performances of wine production processes should be determined. Although wine production industry is an energy intensive sector as a whole, the most energy intensive products are widely used both in the viti and vinicultural process. In this study, gate-to-gate LCA approach in energy resource utilization and global warming potential impacts for white wine production line were attempted and carbon footprint and exergy destruction footprint were calculated, accordingly. As a result, carbon footprint and exergy destruction footprint values were calculated to be 1.75 kg CO2eq and 365.3kW, respectively.

Keywords: carbon footprint, exergy analysis, exergy destruction footprint, white wine

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Authors: Jevonte Abioye, Dylan Savary

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The aim of this research is to present a disaggregated geostatistical analysis of the subnational provincial trends of child mortality variation in Zimbabwe from a child health policy perspective. Soon after gaining independence in 1980, the government embarked on efforts towards promoting equitable health care, namely through the provision of primary health care. Government intervention programmes brought hope and promise, but achieving equity in primary health care coverage was hindered by previous existing disparities in maternal health care disproportionately concentrated in urban settings to the detriment of rural communities. The article highlights policies and programs adopted by the government during the millennium development goals period between 1990-2015 as a response to the inequities that characterised the country’s maternal health care. A longitudinal comparative method for a spatial variation on child mortality rates across provinces is developed based on geostatistical analysis. Cross-sectional and time-series data was extracted from the World Health Organisation (WHO) global health observatory data repository, demographic health survey reports, and previous academic and technical publications. Results suggest that although health care policy was uniform across provinces, not all provinces received the same antenatal and perinatal services. Accordingly, provincial rates of child mortality growth between 1994 and 2015 varied significantly. Evidence on the trends of child mortality rates and maternal health policies in Zimbabwe can be valuable for public child health policy planning and public service delivery design both in Zimbabwe and across developing countries pursuing the sustainable development agenda.

Keywords: antenatal care, perinatal care, infant mortality rate, neonatal mortality rate, under-five mortality rate, millennium development goals, sustainable development agenda

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