Search results for: health care waste management

Authors: Yi-Jie Lin, Jyh-Cherng Chen

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The fly ash of waste incineration processes is usually hazardous and the disposal or reuse of waste incineration fly ash is difficult. In this study, the waste incineration fly ash was converted to useful zeolites by the alkali fusion and hydrothermal synthesis method. The influence of different operating conditions (the ratio of Si/Al, the ratio of hydrolysis liquid to solid, and hydrothermal time) was investigated to seek the optimum operating conditions for the synthesis of zeolite from waste incineration fly ash. The results showed that concentrations of heavy metals in the leachate of Toxicity Characteristic Leaching Procedure (TCLP) were all lower than the regulatory limits except lead. The optimum operating conditions for the synthesis of zeolite from waste incineration fly ash by the alkali fusion and hydrothermal synthesis method were Si/Al=40, NaOH/ash=1.5, alkali fusion at 400 ^oC for 40 min, hydrolysis with Liquid to Solid ratio (L/S)= 200 at 105 ^oC for 24 h, and hydrothermal synthesis at 105 ^oC for 24 h. The specific surface area of fly ash could be significantly increased from 8.59 m²/g to 651.51 m²/g (synthesized zeolite). The influence of different operating conditions on the synthesis of zeolite from waste incineration fly ash followed the sequence of Si/Al ratio > hydrothermal time > hydrolysis L/S ratio. The synthesized zeolites can be reused as good adsorbents to control the air or wastewater pollutants. The purpose of fly ash detoxification, reduction and waste recycling/reuse is achieved successfully.

Keywords: alkali fusion, hydrothermal, fly ash, zeolite

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Authors: Z. Funda Türkmenoğlu, Mehmet Türkmenoglu, Demet Yavuz,

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In this study, the effects of waste marbles as aggregate material on workability and hardened concrete characteristics of self compacting lightweight concrete are investigated. For this purpose, self compacting light weight concrete are produced by waste marble aggregates are replaced with fine aggregate at 5%, 7.5%, and 10% ratios. Fresh concrete properties, slump flow, T₅₀ time, V funnel, compressive strength and ultrasonic pulse velocity of self compacting lightweight concrete are determined. It is concluded from the test results that using waste marbles as aggregate material by replacement with fine aggregate slightly affects fresh and hardened concrete characteristics of self compacting lightweight concretes.

Keywords: hardened concrete characteristics, self compacting lightweight concrete, waste marble, workability

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Authors: Mohd Moiz Khan, S. M. Mahajani, G. N. Jadhav

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Waste foundry sand (total clay content 15%) contains toxic heavy metals and particulate matter which make dumping of waste sand an environmental and health hazard. Disposal of waste foundry sand (WFS) remains one of the substantial challenges faced by Indian foundries nowadays. To cope up with this issue, the chemical method was used to reclaim WFS. A stirrer tank reactor was used for chemical reclamation. Experiments were performed to reduce the total clay content from 15% to as low as 0.9% in chemical reclamation. This method, although found to be effective for WFS reclamation, it may face a challenge due to the possibly high operating cost. Reclaimed sand was found to be satisfactory in terms of sand qualities such as total clay (0.9%), active clay (0.3%), acid demand value (ADV) (2.6%), loss on igniting (LOI) (3 %), grain fineness number (GFN) (56), and compressive strength (60 kPa). The experimental data generated on chemical reactor under different conditions is further used to optimize the design and operating parameters (rotation speed, sand to acidic solution ratio, acid concentration, temperature and time) for the best performance. The use of reclaimed sand within the foundry would improve the economics and efficiency of the process and reduce environmental concerns.

Keywords: chemical reclamation, clay content, environmental concerns, recycle, waste foundry sand

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Authors: Krishna Gopal Lageju

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On 25th April 2015, a 7.6 magnitude earthquake struck Gorkha district of Nepal, which resulted over 8,790 deaths and 22,300 injuries. In addition, almost one-third of the country’s healthcare service has been disrupted. A total of 1,211 health facilities became non-operational, due to 446 completely and other 765 partially damaged. Nearly 84 percent (375 out of 446) of the completely damaged health facilities are in the 14 most affected districts. As a result, the ability of health facilities to respond to health care needs has been harshly affected. In addition, 18 health workers lost their lives and 75 are injured, which added further challenges in the delivery of health services. Thus, to address the immediate health needs in the most devastated areas, Nepal Red Cross Society (NRCS) in coordination with IFRC and Nepal Government, 8 Field hospitals established with surgical capacities, where around 492 international Emergency Response Units (ERUs) Members are mobilized for 3 months period. More than 54,000 patients have been treated in the Red Cross operated field hospitals. Trauma cases accounted 9,180 (17%) of the total patients off which 1,285 (14%) are major surgical cases. Most of the case loads 44,830 (83%) are outpatients and 9,180 patients got inpatients service. Similarly, 112 births have been performed in the field hospitals. Inpatient mortality rate remained 1.5% (21 deaths), many of them are presented with critical injuries or illnesses. No outbreak has been seen during the ERU operation. Deployment of ERUs together with national health workers are very important to address the immediate health needs of the affected communities. This will ease for transition and handover of emergency service and equipments to local provider. Likewise, capacity building of local staff as on the job training on various clinical teachings would be another important issue to look at before phasing out such services.

Keywords: trauma management, critical injuries, earthquake, health

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Authors: S. Murugan, Bohumil Horak

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Pyrolysis is one of the possible technologies to derive energy from waste organic substances. In recent years, pilot level and demonstrated plants have been installed in few countries. The heat energy lost during the process is not effectively utilized resulting in less savings of energy and money. This paper proposes a novel approach to integrate a combined heat and power unit(CHP) and reduce the primary energy consumption in a tyre pyrolysis pilot plant. The proposal primarily uses the micro combined heat and power concept that will help to produce both heat and power in the process.

Keywords: pyrolysis, waste tyres, waste plastics, biomass, waste heat

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Authors: Dragos Dragomir-Stanciu, Leon Marsh

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Background As a response to the gaps identified in recent research in the provision of residential care to address co-occurring health needs, including mental health problems and complexities Gamble Aware has facilitated the possibility to provide a new service which would extend the NGTS provision of residential rehabilitation for gambling disorder with complex and co-morbid presentation. Gordon Moody, together with Adferiad have been successful in securing the tender for this service and this presentation aims to introduce FOLD, the resulting model of treatment developed for the delivery of the service. Setting As a partnership, we have come together to coproduce a model which allows us to share our clinical and industry knowledge and build on our reputations as trusted treatment providers. The presentation will outline our expertise share in development of a unified approach to recovery-oriented models of care, clinical governance, risk assessment and management and aftercare and continuous recovery. We will also introduce our innovative specialist referral portal which will offer referring partners the ability to include the service user in planning their own recovery journey. Outcomes Our collaboration has resulted in the development of the FOLD model which includes three agile and flexible treatment packages aimed at offering the most enhanced and comprehensive treatment in UK, to date, for those most affected by gambling harm. The paper will offer insight into each treatment package and all recovery model stages involved, as well as into the partnership work with NGST providers, local mental health and social care providers and lived experience organisation that will enable us to offer support to more 100 people a year who would otherwise get “lost in the system”. Conclusion FOLD offers a great opportunity to develop, implement and evaluate a new, much needed, whole-person and whole-system approach to counter gambling related harms.

Keywords: gambling treatment, partnership working, integrated care pathways, NGTS, complex needs

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Authors: Faeze omid, Morteza Banakar

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Background: The COVID-19 pandemic has had a significant impact on global health and healthcare systems, including oral health. The lockdown measures implemented in many countries have led to changes in oral health behaviors, access to dental care, and the delivery of dental services. However, the extent of these changes and their effects on oral health outcomes remains unclear. This systematic review aims to synthesize the available evidence on the state of oral health after the COVID-19 lockdown. Methods: We conducted a systematic search of electronic databases (PubMed, Embase, Scopus, and Web of Science) and grey literature sources for studies reporting on oral health outcomes after the COVID-19 lockdown. We included studies published in English between January 2020 and March 2023. Two reviewers independently screened the titles, abstracts, and full texts of potentially relevant articles and extracted data from included studies. We used a narrative synthesis approach to summarize the findings. Results: Our search identified 23 studies from 12 countries, including cross-sectional surveys, cohort studies, and case reports. The studies reported on changes in oral health behaviors, access to dental care, and the prevalence and severity of dental conditions after the COVID-19 lockdown. Overall, the evidence suggests that the lockdown measures had a negative impact on oral health outcomes, particularly among vulnerable populations. There were decreases in dental attendance, increases in dental anxiety and fear, and changes in oral hygiene practices. Furthermore, there were increases in the incidence and severity of dental conditions, such as dental caries and periodontal disease, and delays in the diagnosis and treatment of oral cancers. Conclusion: The COVID-19 pandemic and associated lockdown measures have had significant effects on oral health outcomes, with negative impacts on oral health behaviors, access to care, and the prevalence and severity of dental conditions. These findings highlight the need for continued monitoring and interventions to address the long-term effects of the pandemic on oral health.

Keywords: COVID-19, oral health, systematic review, dental public health

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Authors: Salami Abiodun Olusola, Bankole Faith Ayobami

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Agro-wastes are wastes produced from various agricultural activities and include manures, corncob, plant stalks, hulls, leaves, sugarcane bagasse, oil-palm spadix, and rice bran. In farming situation, the agro-waste is often useless and, thus, discarded. Huge quantities of waste resources generated from Nigerian agriculture could be converted to more useful forms of energy, which could contribute to the country’s primary energy needs and reduce problems associated with waste management. Accumulation of agro-wastes may cause health, safety, and environmental concern. However, biotechnological use of agro-waste could enhance food security through its bioconversion to useful renewable energy. Mushrooms are saprophytes which feed by secreting extracellular enzymes, digesting food externally, and absorb the nutrients in net-like hyphae. Therefore, mushrooms could be exploited for bioconversion of the cheap and numerous agro-wastes for providing nutritious food for animals, human and carbon recycling. The study investigated the bioconversion potentials of Pleurotus florida on agro-wastes using a simple and cost-effective biotechnological method. Four agro-wastes; corncobs, oil-palm spadix, corn straw, and sawdust, were composted and used as substrates while the biological efficiency (BE) and the nutritional composition of P. florida grown on the substrates were determined. Pleurotus florida contained 26.28-29.91% protein, 86.90-89.60% moisture, 0.48-0.91% fat, 19.64-22.82% fibre, 31.37-38.17% carbohydrate and 5.18-6.39% ash. The mineral contents ranged from 342-410 mg/100g Calcium, 1009-1133 mg/100g Phosphorus, 17-21 mg/100g Iron, 277-359 mg/100g Sodium, and 2088-2281 mg/100g Potassium. The highest yield and BE were obtained on corncobs (110 g, 55%), followed by oil-palm spadix (76.05 g, 38%), while the least BE was recorded on corn straw substrate (63.12 g, 31.56%). Utilization of the composted substrates yielded nutritional and edible mushrooms. The study presents biotechnological procedure for bioconversion of agro-wastes to edible and nutritious mushroom for efficient agro-wastes’ management, utilization, and recycling.

Keywords: agrowaste, bioconversion, biotechnology, utilization, recycling

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Authors: Oral S. Saulters, Shanon D. Goldberg, Wendy A. Staples, Ellena I. Martinez, Lorie M. Sanchez, Diego E. Archuleta, Deborah L. Williams, Scot D. Johnson

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To address an important set of unverified field conditions, the Los Alamos National Laboratory Waste Compliance and Tracking System (WCATS) Wall-to-Wall Team performed an unprecedented and advanced inventory. This reconciliation involved confirmation analysis for approximately 5850 hazardous, low-level, mixed low-level, and transuranic waste containers located in more than 200 staging and storage areas across 33 technical areas. The interdisciplinary team scoped, planned, and developed the multidimensional assessments. Through coordination with cross-functional site hosts, they were able to verify and validate data while resolving discrepancies identified in WCATS. The results were extraordinary with an updated inventory, tailored outreach, more cohesive communications, and timely closed-loop feedback.

Keywords: circular economy, environmental performance data, social-ecological-technological systems, waste management

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Authors: Delband Yekta Moazami

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Background: For proper care and treatment of HIV patients and drug users, the medical staff and physicians must have a correct and positive attitude and knowledge towards such patients. We aimed to assess the attitudes in a sample of health care workers (HCW) working in different hospitals and clinics and medical students in Georgia towards HIV infected people and drug users in Tbilisi. Method: We conducted a cross-sectional study to assess attitudes of health care workers towards people living with HIV and drug users in hospitals and clinics in Tbilisi. The study was carried out from 1st of May 2020 till 30th of September 2020. Data were collected using a self-administered structured online questionnaire. With this tool we evaluated four facets of attitudes: Discrimination, Acceptance of HIV/AIDS patients, Acceptance of drug users and Fear. All data were imported and analyzed with the software SPSS 22 for windows. Results: In total data was collected from168 respondents, that among them 107 (65%) were women and majority of the participants were medical doctors. Women had more acceptance attitudes rather than men towards drug abusers. We found significant differences regarding expressing negative attitudes among HCW who were more than 50 years old comparing with other age groups in all four aspects. Medical doctors expressed more acceptances towards people with HIV and drug users comparing two other groups. Also our study revealed that the group with working experience 21 years and more, showed more discriminatory attitudes comparing other groups. Conclusion: Based on our study findings, there are significant differences regarding respondent’s attitudes based on gender, medical specialty and working experience in health care system. People struggling with HIV and drug use need nonjudgmental and positive behaviors from health care workers and physicians in order to help them for harm reduction and receiving appropriate treatment.

Keywords: hiv, addiction, attitudes, healthcare workers

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Authors: Allaw Kamel, Bazzi Hasan

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Municipal solid waste (MSW) generation is among the most significant sources which threaten the global environmental health. Solid Waste Management has been an important environmental problem in developing countries because of the difficulties in finding sustainable solutions for solid wastes. Therefore, more efforts are needed to be implemented to overcome this problem. Lebanon has suffered a severe solid waste management problem in 2015, and a new landfill site was proposed to solve the existing problem. The study aims to identify and locate the most suitable area to construct a landfill taking into consideration the sustainable development to overcome the present situation and protect the future demands. Throughout the article, a landfill site selection methodology was discussed using Geographic Information System (GIS) and Multi Criteria Decision Analysis (MCDA). Several environmental, economic and social factors were taken as criterion for selection of a landfill. Soil, geology, and LUC (Land Use and Land Cover) indices with the Sustainable Development Index were main inputs to create the final map of Environmentally Sensitive Area (ESA) for landfill site. Different factors were determined to define each index. Input data of each factor was managed, visualized and analyzed using GIS. GIS was used as an important tool to identify suitable areas for landfill. Spatial Analysis (SA), Analysis and Management GIS tools were implemented to produce input maps capable of identifying suitable areas related to each index. Weight has been assigned to each factor in the same index, and the main weights were assigned to each index used. The combination of the different indices map generates the final output map of ESA. The output map was reclassified into three suitability classes of low, moderate, and high suitability. Results showed different locations suitable for the construction of a landfill. Results also reflected the importance of GIS and MCDA in helping decision makers finding a solution of solid wastes by a sanitary landfill.

Keywords: sustainable development, landfill, municipal solid waste (MSW), geographic information system (GIS), multi criteria decision analysis (MCDA), environmentally sensitive area (ESA)

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Authors: Khushalini N. Ulman, Samane Maroufi, Veena H. Sahajwalla

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Globally, electronic waste (e-waste) continues to grow at an alarming rate. Several technologies have been developed to recover valuable materials from e-waste, however, their efficiency can be increased with a better knowledge of the e-waste components. Random access memory cards (RAMs) are considered as high value scrap for the e-waste recyclers. Despite their high precious metal content, RAMs are still recycled in a conventional manner resulting in huge loss of resources. Our research work highlights the precious metal rich components of a RAM. Inductively coupled plasma (ICP) analysis of RAMs of six different generations have been carried out and the trends in their metal content have been investigated. Over the past decade, the copper content of RAMs has halved and their tin content has increased by 70 %. The stricter environmental laws have facilitated ~96 % drop in the lead content of RAMs. To comprehend the fundamentals of thermal transformation of RAMs, our research provides their detailed kinetic study. This can assist the e-waste recyclers in optimising their metal recovery processes. Thus, understanding the chemical and thermal behaviour of RAMs can open new avenues for efficient e-waste recycling.

Keywords: electronic waste, kinetic study, recycling, thermal transformation

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Authors: Gianluca Castelnuovo, Gian Mauro Manzoni, Giada Pietrabissa, Stefania Corti, Emanuele Giusti, Roberto Cattivelli, Enrico Molinari, Susan Simpson

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Obesity is currently an important public health problem of epidemic proportions (globesity). Moreover Binge Eating Disorder (BED) is typically connected with obesity, even if not occurring exclusively in conjunction with overweight conditions. Typically obesity with BED requires a longer term treatment in comparison with simple obesity. Rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation, due to the growing costs of a limited inpatient approach. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach. The new m health (m-health, mobile health) paradigm, defined as clinical practices supported by up to date mobile communication devices, could increase compliance- engagement and contribute to a significant cost reduction in BED and obesity rehabilitation. Five psychological components need to be considered for successful m Health-based obesity rehabilitation in order to facilitate weight-loss.1) Self-monitoring. Portable body monitors, pedometers and smartphones are mobile and, therefore, can be easily used, resulting in continuous self-monitoring. 2) Counselor feedback and communication. A functional approach is to provide online weight-loss interventions with brief weekly or monthly counselor or psychologist visits. 3) Social support. A group treatment format is typically preferred for behavioral weight-loss interventions. 4) Structured program. Technology-based weight-loss programs incorporate principles of behavior therapy and change with structured weekly protocolos including nutrition, exercise, stimulus control, self-regulation strategies, goal-setting. 5) Individually tailored program. Interventions specifically designed around individual’s goals typically record higher rates of adherence and weight loss. Opportunities and limitations of m health approach in clinical psychology for obesity and BED are discussed, taking into account future research directions in this promising area.

Keywords: obesity, rehabilitation, out-patient, new technologies, tele medicine, tele care, m health, clinical psychology, psychotherapy, chronic care management

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Authors: Upasana Pattnaik, Akshaya Kumar Sabat

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The compaction properties, unconfined compressive strength (UCS), soaked California bearing ratio (CBR), hydraulic conductivity, and swelling pressure of lime stabilized expansive soil-shredded waste tyre mixes have been discussed in this paper. Shredded waste tyres, passing 4.75 mm Indian Standard (IS) sieve and retained on 75µ IS sieve have been used in the experimental programme. First of all expansive soil-shredded waste tyre mixes were prepared by adding shredded waste tyre from 0 to 20% at an increment of 5%.Standard Proctor compaction, UCS and soaked CBR tests were conducted on these mixes. The optimum percentage of shredded waste tyre found out was 10%.In the second phase of the experiment, lime was added to sample having optimum percentage of expansive soil and shredded waste tyre from 2 to 6% at an increment of 1%.Compaction, UCS, soaked CBR, hydraulic conductivity, and swelling pressure tests were conducted on lime stabilized expansive soil-shredded waste tyre mixes. The optimum percentage of lime for stabilization was found out to be 5%.At the optimum percentage of lime the stabilized expansive soil-shredded waste tyre mix had increased strength, reduced hydraulic conductivity and swelling pressure.

Keywords: expansive soil, hydraulic conductivity, lime, shredded waste tyre, soaked california bearing ratio

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

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The demand for care support has been rising with the aging of society and the advancement of medical science and technology. To meet rising demand, the Taiwanese government promoted the “Long Term Care Ten-Year Plan 2.0” in 2017. However, this policy and its related services failed to be fully implemented because of the ignorance of the public, and their lack of desire, fear, or discomfort in using them, which is a major obstacle to the promotion of long-term care services. Given the above context, this research objectives included the following: (1) to understand the current situation and predicament of family caregivers; (2) to reveal the actual use and assistance of government’s long-term care resources for family caregivers; and (3) to explore the support and impact of social capital on family caregivers. A semi-structured in-depth interview with five family caregivers to understand long-term care networks and social capital for family caregivers.

Keywords: family caregivers, long-term care, social capital

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Authors: Paola Villoria Saez, Mercedes Del Rio Merino, Jaime Santacruz Astorqui, Cesar Porras Amores

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In construction the Circular Economy covers the whole cycle of the building construction: from production and consumption to waste management and the market for secondary raw materials. The circular economy will definitely contribute to 'closing the loop' of construction product lifecycles through greater recycling and re-use, helping to build a market for reused construction materials salvaged from demolition sites, boosting global competitiveness and fostering sustainable economic growth. In this context, this paper presents the latest research of 'Waste to resources (W2R)' project funded by the Spanish Government, which seeks new solutions to improve energy efficiency in buildings by developing new building materials and products that are less expensive, more durable, with higher quality and more environmentally friendly. This project differs from others as its main objective is to reduce to almost zero the Construction and Demolition Waste (CDW) generated in building rehabilitation works. In order to achieve this objective, the group is looking for new ways of CDW recycling as raw materials for new conglomerate materials. With these new materials, construction elements reducing building energy consumption will be proposed. In this paper, the results obtained in the project are presented. Several tests were performed to gypsum samples containing different percentages of CDW waste generated in Spanish building retroffiting works. Results were further analyzed and one of the gypsum composites was highlighted and discussed. Acknowledgements: This research was supported by the Spanish State Secretariat for Research, Development and Innovation of the Ministry of Economy and Competitiveness under 'Waste 2 Resources' Project (BIA2013-43061-R).

Keywords: building waste, CDW, gypsum, recycling, resources

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Authors: Simona Ziukaite, Remigijus Ivanauskas, Gintaras Denafas

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Market development of electrical and electronic equipment and a short life cycle is driven by the increasing waste streams. Gold Au, copper Cu, silver Ag and palladium Pd can be found on printed circuit board. These metals make up the largest value of printed circuit board. Therefore, the printed circuit boards scrap is valuable as potential raw material for precious metals recovery. A comparison of Cu, Au, Ag, Pd recovery from waste printed circuit techniques was selected metals leaching of chemical reagents. The study was conducted using the selected multistage technique for Au, Cu, Ag, Pd recovery of printed circuit board. In the first and second metals leaching stages, as the elution reagent, 2M H2SO4 and H2O2 (35%) was used. In the third stage, leaching of precious metals used solution of 20 g/l of thiourea and 6 g/l of Fe2 (SO4)3. Verify the efficiency of the method was carried out the metals leaching test with aqua regia. Based on the experimental study, the leaching efficiency, using the preferred methodology, 60 % of Au and 85,5 % of Cu dissolution was achieved. Metals leaching efficiency after waste mechanical crushing and thermal treatment have been increased by 1,7 times (40 %) for copper, 1,6 times (37 %) for gold and 1,8 times (44 %) for silver. It was noticed that, the Au amount in old (> 20 years) waste is 17 times more, Cu amount - 4 times more, and Ag - 2 times more than in the new (< 1 years) waste. Palladium in the new printed circuit board waste has not been found, however, it was established that from 1 t of old printed circuit board waste can be recovered 1,064 g of Pd (leaching with aqua regia). It was found that from 1 t of old printed circuit board waste can be recovered 1,064 g of Ag. Precious metals recovery in Lithuania was estimated in this study. Given the amounts of generated printed circuit board waste, the limits for recovery of precious metals were identified.

Keywords: leaching efficiency, limits for recovery, precious metals recovery, printed circuit board waste

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Authors: Nükhet Konuk, N. Gamze Turan, Yüksel Ardalı

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Cities play a vital role in the social fabric of countries and in national and regional economic growth worldwide; however, the environmental effects of such growth need to be assessed and managed better. The critical and most immediate problems faced by cities of developing countries are the health impacts of urban pollution that derive from inadequate water, sanitation, drainage and solid waste services, poor urban and industrial waste management, and air pollution. As globalization continues, earth's natural processes transform local problems into international issues. The aim of this study is to provide a broad overview of the pollution from urban wastes and emissions in Turkey which is a developing country. It is aimed to underline the significance of reorganizing the institutional tools in a worldwide perspective in order to generate coherent solutions to urban problems, and to enhance urban quality.

Keywords: environmental pollution, developing countries, environmental degradation, urban environmental problems

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Authors: Elzbieta Sikorska-Simmons

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Advanced dementia is a progressive terminal brain disease that is accompanied by a syndrome of difficult to manage symptoms and complications that eventually lead to death. The management of advanced dementia poses major challenges to family caregivers who act as patient health care proxies in making medical treatment decisions. Little is known, however, about how they manage advanced dementia and how their treatment choices influence the quality of patient life. This prospective qualitative study examines the key medical treatment decisions that family caregivers make while managing advanced dementia. The term ‘family caregiver’ refers to a relative or a friend who is primarily responsible for managing patient’s medical care needs and legally authorized to give informed consent for medical treatments. Medical decision-making implies a process of choosing between treatment options in response to patient’s medical care needs (e.g., worsening comorbid conditions, pain, infections, acute medical events). Family caregivers engage in this process when they actively seek treatments or follow recommendations by healthcare professionals. Better understanding of medical decision-making from the family caregiver perspective is needed to design interventions that maximize the quality of patient life and limit inappropriate treatments. Data were collected in three waves of semi-structured interviews with 20 family caregivers for patients with advanced dementia. A purposive sample of 20 family caregivers was recruited from a senior care center in Central Florida. The qualitative personal interviews were conducted by the author in 4-5 months intervals. The ethical approval for the study was obtained prior to the data collection. Advanced dementia was operationalized as stage five or higher on the Global Deterioration Scale (GDS) (i.e., starting with the GDS score of five, patients are no longer able survive without assistance due to major cognitive and functional impairments). Information about patients’ GDS scores was obtained from the Center’s Medical Director, who had an in-depth knowledge of each patient’s health and medical treatment history. All interviews were audiotaped and transcribed verbatim. The qualitative data analysis was conducted to answer the following research questions: 1) what treatment decisions do family caregivers make while managing the symptoms of advanced dementia and 2) how do these treatment decisions influence the quality of patient life? To validate the results, the author asked each participating family caregiver if the summarized findings accurately captured his/her experiences. The identified medical decisions ranged from seeking specialist medical care to end-of-life care. The most common decisions were related to arranging medical appointments, medication management, seeking treatments for pain and other symptoms, nursing home placement, and accessing community-based healthcare services. The most challenging and consequential decisions were related to the management of acute complications, hospitalizations, and discontinuation of treatments. Decisions that had the greatest impact on the quality of patient life and survival were triggered by traumatic falls, worsening psychiatric symptoms, and aspiration pneumonia. The study findings have important implications for geriatric nurses in the context of patient/caregiver-centered dementia care. Innovative nursing approaches are needed to support family caregivers to effectively manage medical care needs of patients with advanced dementia.

Keywords: advanced dementia, family caregiver, medical decision-making, symptom management

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Authors: M. C. Pardo-Ferreira, J. C. Rubio-Romero, M. Martínez-Rojas

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Resilience Engineering is a new paradigm of safety management that proposes to change the way of managing the safety to focus on the things that go well instead of the things that go wrong. Many complex and high-risk sectors such as air traffic control, health care, nuclear power plants, railways or emergencies, have applied this new vision of safety and have obtained very positive results. In the construction sector, safety management continues to be a problem as indicated by the statistics of occupational injuries worldwide. Therefore, it is important to improve safety management in this sector. For this reason, it is proposed to apply Resilience Engineering to the construction sector. The Construction Phase Health and Safety Plan emerges as a key element for the planning of safety management. One of the key tools of Resilience Engineering is the Resilience Assessment Grid that allows measuring the four essential abilities (respond, monitor, learn and anticipate) for resilient performance. The purpose of this paper is to develop a questionnaire based on the Resilience Assessment Grid, specifically on the ability to learn, to assess whether a Construction Phase Health and Safety Plans helps companies in a construction site to implement this ability. The research process was divided into four stages: (i) initial design of a questionnaire, (ii) validation of the content of the questionnaire, (iii) redesign of the questionnaire and (iii) application of the Delphi method. The questionnaire obtained could be used as a tool to help construction companies to evolve from Safety-I to Safety-II. In this way, companies could begin to develop the ability to learn, which will serve as a basis for the development of the other abilities necessary for resilient performance. The following steps in this research are intended to develop other questions that allow evaluating the rest of abilities for resilient performance such as monitoring, learning and anticipating.

Keywords: resilience engineering, construction sector, resilience assessment grid, construction phase health and safety plan

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Authors: Samara R. Dania, Maulana S. Aji, Dewi Lestari

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Diabetes is a common disease in Indonesia. One of the risk factors of diabetes is an unhealthy diet which is consuming food that contains too much glucose, one of glucose sources presents in food containing carbohydrate. The purpose of this study is to identify the amount of glucose level in the consumed food. The authors use literature studies for this research method. For the results of this study, the authors expect diabetics to be more aware of diabetes by applying daily dietary regulation through D-Care. D-Care is an application that can enhance people awareness to diabetes in Indonesia. D-Care provides two menus; there are nutrition calculation and healthy food. Nutrition calculation menu is used for knowing estimated glucose intake level by calculating food that consumed each day. Whereas healthy food menu, it provides a combination of healthy food menu for diabetic. The conclusion is D-Care is useful to be used for reducing diabetes prevalence in Indonesia.

Keywords: D-Care, diabetes, awareness, healthy food

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Authors: Naseem M. Twaissi

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Medical professionals play an important role in society, and in general, they care more about their patients than about their personal well-being. They need to take a professional approach to maintain a work-life balance. Through a collection of primary data from 1020 medical professionals and the application of relevant statistical tools, this paper explores the pressures on medical professionals with reference to their work-life balance. This study highlights how hospital management, in addition to economic reasons, needs to identify variables to enhance the work-life balance of medical professionals so that quality healthcare facilities may be provided to the citizens of Jordan. Results indicate that formulation and implementation of policies for enhancing work-life balance together with career and retention plans for medical professionals would enhance the performance of hospitals and the quality of health care in Jordan, leading to greater societal well-being.

Keywords: work life balance, job environment, job satisfaction, employee well-being, stress, hospital industry

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Authors: Prama Mukhopadhyay, Rishika Mukhopadhyay

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The twentieth century has seen the world getting divided into three distinct blocks, created by the proponents of the mainstream developmental discourse. India, which has now gained the label of being a ‘developing nation’, stands in between these three groups, as it constantly tries to ‘catch up’ and emulate the developmental standards of the ‘west’. In this endeavour, we find our country trying really hard to blindly replicate the health care infrastructures of the ‘first worlds’, without realizing the needs of evaluating the ground reality. In such a situation, the sudden outbreak of child death in the district of Malda, WB, poses an obvious questions towards the kind of development that our country has been engaging in, ever since its Post Colonial inception. Through this paper we thus try to understand the harsh veracity of the health care facility that exists in rural Bengal, and thereby challenge the conventional notion of ‘health-care’ as is normally discussed in the mainstream developmental discourse. Grounding our research work on detailed ethnography and through the help of questionnaire, interviews and focus group discussions with the local government officials(BDOs), health workers (ICDS, ASHA workers, ANHM and BMOHs) and members of families with experiences of child deaths, we have tried to find out the real and humane factors behind the sudden rise of reported infant deaths in the district, issues which are normally neglected and left out while discussing and evaluating IMR in the mainstream studies on health care and planning in our nation. Therefore the main aim of this paper is to try and look at child death from a ‘wider perspective’, where it is seen from an eye not bounded by the common registers of caste, class and religion. This paper, would thus be an eye opener in some sense, bringing in stories from the rural belt of the country; where the people are regularly torn between the binaries of the developing and shining modernity of ‘India’ which now gets ready to run the last lap and gain the status of becoming a ‘developed nation’ by 2020, and the staggering, dark traditional ‘ Bharat, which lags behind.

Keywords: child mortality, development discourse, health care, tradition and modernity

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Authors: Ali Jahanfar, Brajesh Dubey, Bahram Gharabaghi, Saber Bayat Movahed

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Ever increasing population growth of major urban centers and environmental challenges in siting new landfills have resulted in a growing trend in design of mega-landfills some with extraordinary heights and dangerously steep slopes. Landfill failure mobility risk analysis is one of the most uncertain types of dynamic rheology models due to very large inherent variabilities in the heterogeneous solid waste material shear strength properties. The waste flow of three historic dumpsite and two landfill failures were back-analyzed using run-out modeling with DAN-W model. The travel distances of the waste flow during landfill failures were calculated approach by taking into account variability in material shear strength properties. The probability distribution function for shear strength properties of the waste material were grouped into four major classed based on waste material compaction (landfills versus dumpsites) and composition (high versus low quantity) of high shear strength waste materials such as wood, metal, plastic, paper and cardboard in the waste. This paper presents a probabilistic method for estimation of the spatial extent of waste avalanches, after a potential landfill failure, to create maps of vulnerability scores to inform property owners and residents of the level of the risk.

Keywords: landfill failure, waste flow, Voellmy rheology, friction coefficient, waste compaction and type

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Authors: E. Tuğba Topçu, Ebru E. Kazan, Erhan Büken

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Emergency nurses are the first health care professional to generally observe the patients, communicate patients’ family or relatives, touch the properties of patients and contact to laboratory sample of patients. Also, they are the encounter incidents related crime, people who engage in violence or suspicious injuries frequently. So, documentation of patients’ condition came to the hospital and conservation of evidence are important in the inquiry of forensic medicine. The aim of the study was to determine the knowledge level of healthcare professional working at the emergency services regarding their approaches to common forensic cases. The study was comprised of 404 healthcare professional working (nurse, emergency medicine technician, health officer) at the emergency services of 6 state hospitals, 6 training and 6 research hospitals and 3 university hospitals in Ankara. Data was collected using questionnaire form which was developed by researches in the direction of literature. Questionnaire form is comprised of two sections. The first section includes 17 questions related demographic information about health care professional and 4 questions related Turkish laws. The second section includes 43 questions to the determination of knowledge level of health care professional’s working in the emergency department, about approaches to frequently encountered forensic cases. For the data evaluation of the study; Mann Whitney U test, Bonferroni correction Kruskal Wallis H test and Chi Square tests have been used. According to study, it’s said that there is no forensic medicine expert in the foundation by 73.4% of health care professionals. Two third (66%) of participants’ in emergency department reported daily average 7 or above forensic cases applied to the emergency department and 52.1% of participants did not evaluate incidents came to the emergency department as a forensic case. Most of the participants informed 'duty of preservation of evidence' is health care professionals duty related forensic cases. In result, we determinated that knowledge level of health care professional working in the emergency department, about approaches to frequently encountered forensic cases, is not the expected level. Because we found that most of them haven't received education about forensic nursing.Postgraduates participants, educated health professional about forensic nursing, staff who applied to sources about forensic nursing and staff who evaluated emergency department cases as forensic cases have significantly higher level of knowledge. Moreover, it’s found that forensic cases diagnosis score is the highest in health officer and university graduated. Health care professional’s deficiency in knowledge about forensic cases can cause defects in operation of the forensic process because of mistakes in collecting and conserving of evidence. It is obvious that training about the approach to forensic nursing should be arranged.

Keywords: emergency nurses, forensic case, forensic nursing, level of knowledge

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Authors: Gudakesh Yadav

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Utter Pradesh, which is one of the largest states of India with unequal distribution of resources and different socioeconomic and cultural characteristics, level of different new born health care indicators varies a lot from one district to another district. State shared more than 21 percent of total live births of India; whereas, it accounts for 28 percent of total infant deaths of the country, with the 53 per thousand infant mortality rate. The present paper attempts to examine tempo-spatial changes in new born care practices during NFHS-1 to NFHS-3 and DLHS-2 to DLHS-3 in Uttar Pradesh and different regions. Descriptive statistics, rate-ratios, concentration index, multivariate and decomposition analysis has been used for the study. Findings of the study reveal that new born care practices have improved over the time in the state and across all the regions because of giving more emphasis on venerable groups like poor, rural, less educated mothers and scheduled caste & tribes but still it did not achieve the desired successes. Regional analysis of third rounds of DLHS shows that, coverage of intuitional delivery was the lowest in the central region. Performance of the southern region was the lowest in terms of initiation of breastfeeding, keeping baby warm and dry after the birth. The study calls for proper follow up of new born children to accelerate new born and child health care service and prioritises increasing antenatal check-ups and institutional delivery, which helps to improve level of other new born care services. At the policy level there is need to reach venerable groups like scheduled caste and tribes, poor and uneducated, and new mother especially in rural areas. High focused district should be allocated for better implementation of new born care promotion programme in low performing districts. Partnership with the private sector health professional is necessary to reach the every part of population.

Keywords: decomposition, inequality, initiation of breastfeeding, institutional delivery

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Authors: Feten Chihi, Gabriella Varga

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The world's most prevalent waste management strategy is landfills. However, it grew more difficult due to a lack of acceptable waste sites. In order to develop larger landfills and extend their lifespan, the purpose of this article is to expand the capacity of the construction by varying the slope's inclination and to examine its effect on the safety factor. The capacity change with tilt is mathematically determined. Using a new probabilistic calculation method that takes into account the heterogeneity of waste layers, the safety factor for various slope angles is examined. To assess the effect of slope variation on the overall safety of landfills, over a hundred computations were performed for each angle. It has been shown that capacity increases significantly with increasing inclination. Passing from 1:3 to 2:3 slope angles and from 1:3 to 1:2 slope angles, the volume of garbage that can be deposited increases by 40 percent and 25 percent, respectively, of the initial volume. The results of the safety factor indicate that slopes of 1:3 and 1:2 are safe when the standard method (homogenous waste) is used for computation. Using the new approaches, a slope with an inclination of 2:3 can be deemed safe, despite the fact that the calculation does not account for the safety-enhancing effect of daily cover layers. Based on the study reported in this paper, the malty layered nonhomogeneous calculating technique better characterizes the safety factor. As it more closely resembles the actual state of landfills, the employed technique allows for more flexibility in design parameters. This work represents a substantial advance in limiting both safe and economical landfills.

Keywords: landfill, municipal solid waste, slope inclination, capacity, safety factor

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Authors: T. Mcgraw, F. N. Morin, N. Desai

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Background: Antimicrobial resistance is a critical issue in global health care and a significant contributor to increased patient morbidity and mortality. Suspected urinary tract infection (UTI) is a key area of inappropriate antibiotic prescription in pediatrics. Management patterns of infectious diseases have been shown to vary by provider type within a single setting. The aim of this study was to assess compliance with national UTI management guidelines by nurse practitioners in a pediatric emergency department (ED). Methods: This was a post-hoc analysis of a retrospective cohort study to review and evaluate visits to a tertiary care freestanding pediatric emergency department. Patients were included if they were 60 days to 36 months old and discharged with a diagnosis of UTI or ‘rule-out UTI’ between July 2015 and July 2020. Primary outcome measure was proportion of visits seen by Nurse Practitioners (NP) which were associated with national guideline compliance in the diagnosis and treatment of suspected UTI. We performed descriptive statistics and comparative analyses to determine differences in practice patterns between NPs, and physicians. Results: A total of 636 charts were reviewed, of which 402 patients met inclusion criteria. 17 patients were treated by NPs, 385 were treated by either Pediatric Emergency Medicine physicians (PEM) or non-PEM physicians. Overall, the proportion of infants receiving guideline-compliant care was 25.9% (21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (74.7-83.8%) received first line guideline recommended therapy and 58.9% (53.8-63.8%) received fully compliant therapy with respect to age, dose, duration, and frequency. In patients treated by NPs, 16/17 (94%(95% CI:73.0-99.0)) required antibiotics, 15/16 (93%(95% CI: 71.7-98.9)) were treated with first line agent (cephalexin), 8/16 (50%(95% CI:28-72)) were guideline compliant of dose and duration. 5/8 (63%(95% CI:30.6-86.3)) were noncompliant for dose being too high. There was no difference in receiving guideline compliant empiric antibiotic therapy between physicians and nurse practitioners (OR: 0.837 CI: 0.302-2.69). Conclusion: In this post-hoc analysis, guideline noncompliance by nurse practitioners is common in children tested and treated for UTIs in a pediatric emergency department. Care by a Nurse Practitioner was not associated with greater rate of noncompliance than care by a Pediatric Emergency Medicine physician. Future appropriately powered studies may focus on confirming these results.

Keywords: antibiotic stewardship, infectious disease, nurse practitioner, urinary tract infection

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Authors: Josephine Aikpitanyi, Friday Okonofua, Lorrettantoimo, Sandy Tubeuf

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Every day, 800 women die from conditions related to pregnancy and childbirth, resulting in an estimated 300,000 maternal deaths worldwide per year. Over 99 percent of all maternal deaths occur in developing countries, with more than half of them occurring in sub-Saharan Africa. Nigeria being the most populous nation in sub-Saharan Africa bears a significant burden of worsening maternal and child health outcomes with a maternal mortality rate of 917 per 100,000 live births and child mortality rate of 117 per 1,000 live births. While several studies have documented that financial barriers disproportionately discourage poor women from seeking needed maternal and child healthcare, other studies have indicated otherwise. Evidence shows that there are instances where health facilities with skilled healthcare providers exist, and yet maternal, and child health outcomes remain abysmally low, indicating the presence of non-cognitive and behavioural factors that may affect the utilization of healthcare services. This study investigated the influence of locus of control and self-esteem on utilization of maternal and child healthcare services in Nigeria. Specifically, it explored the differences in utilization of antenatal care, skilled birth care, postnatal care, and child vaccination by women having an internal and external locus of control and women having high and low self-esteem. We collected information on non-cognitive traits of 1411 randomly selected women, along with information on utilization of the various indicators of maternal and child healthcare. Estimating logistic regression models for various components of healthcare services utilization, we found that women’s internal locus of control was a significant predictor of utilization of antenatal care, skilled birth care, and completion of child vaccination. We also found that having high self-esteem was a significant predictor of utilization of antenatal care, postnatal care, and completion of child vaccination after adjusting for other control variables. By improving our understanding of non-cognitive traits as possible barriers to maternal and child healthcare utilization, our findings offer important insights for enhancing participant engagement in intervention programs that are initiated to improve maternal and child health outcomes in low-and-middle-income countries.

Keywords: behavioural economics, health-seeking behaviour, locus of control and self-esteem, maternal and child healthcare, non-cognitive traits, and healthcare utilization

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Authors: A. Shishkin, V. Mironovs, D. Goljandin, A. Korjakins

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The goal of this work is to develop sustainable and durable ceramic cellular structures using widely available natural resources- clay and milled waste glass. Present paper describes method of obtaining clay ceramic foam (CCF) with addition of milled waste glass in 5, 7 and 10 wt% by direct foaming with high speed mixer-disperser (HSMD). For more efficient clay and waste glass milling and mixing, the high velocity disintegrator was used. The CCF with 5, 7, and 10 wt% were obtained at 900, 950, 1000 and 1050 °C firing temperature and they have demonstrated mechanical compressive strength for all 12 samples ranging from 3.8 to 14.3 MPa and porosity 76-65%. Obtained CCF has compressive strength 14.3 MPa and porosity 65.3%.

Keywords: ceramic foam, waste glass, clay foam, glass foam, open cell, direct foaming

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