Search results for: customer care agents

Authors: Dessy Arumsari, Ais Assana Athqiya, Mulyaminingrum

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Healthcare in remote areas is one of the major concerns in Indonesia. Building hospitals in a nation of 18.000 islands with a larger-than-life bureaucracy and problems with corruption, a critical shortage of qualified medical professionals and well-heeled patients resigned to traveling abroad for health care is a hard feat to accomplish. To assuring that all populations have access to appropriate and cost-effective care, a new solution to tackle this problem is with the presence of RV Car Clinic. This car has a concept such as a walking hospital that provides health facilities inside it. All of the health professionals who work in RV Car Clinic will do the rotation for a year in order to the equitable distribution of health workers. We need to advocate the policy makers to help realize RV Car Clinic in remote areas. Health services can be disseminated by the present of RV Car Clinic. Summarily, the local communities can get cost effectively because RV Car Clinic will come to their place and serve the health services.

Keywords: health policy, health professional, remote areas, RV Car Clinic

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Authors: M. Yaqoob, C. S. O’Neill, S. Faraj, C. L. O’Neill

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This paper presents the preliminary findings from a study exploring nurse’s contributions to end of life decisions and to the care of dying patients in ICU units in the Kingdom of Bahrain. The process of dying is complex as medical clinicians are frequently unable to say with certainty when death will occur. It is generally accepted that end of life care begins when it is possible to know that death is imminent. Nurses do not make medical treatment decisions when caring for a dying patient. There are, however, many other types of decisions made when a patient is approaching the end of life and nurses are either formally or informally part of these decision making processes. This study explored nurses care practices at the end of life, in two ICU units in large hospitals in the Kingdom of Bahrain. The research design was a grounded theory approach. Ten nurses participated, six of whom were Bahraini nationals and four were Indian. A core category death avoidance talk was supported by three major subcategories, degrees of involvement in decision making; signalling and creating an awareness of death; care shifting from dying patients to family. Despite nurses asserting that they carried out the orders of doctors and had no role in decision making processes at end of life this study showed that there were degrees of nurse involvement. Doctors frequently discussed the patient’s clinical condition with nurses and also sought information regarding the family. Information about the family was of particular relevance if the doctor was considering a DNR order, which the nurses equated with dying. Families were not always informed when a DNR decision was made. When families were not informed the nurses engaged in sophisticated rituals signalling and creating awareness to family members that the death of their loved one was near. This process also involved a subtle shifting of care from the dying patient to the family. This seminar paper will focus particularly on how nurses signal and create an awareness of death in an ICU setting. The findings suggest that despite the avoidance of death talk in the ICU nurses indirectly convey and create an awareness that death is near to family members.

Keywords: decision making, dying patients, end of life, intensive care unit

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Authors: Mehrnoosh Askarizadeh

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Agile manufacturing concept was first coined by Iacocca institute in 1991 as a new manufacturing paradigm in order to provide and ensure competitiveness in the emerging global manufacturing order. Afterward, a considerable number of studies have been conducted in this area. Reviewing these studies reveals that they mostly focus on agile manufacturing drivers, definition and characteristics but few of them propose practical solutions to achieve it. Agile manufacturing is recommended as a successful paradigm after lean for the 21st manufacturing firms. This competitive concept has been developed in response to the continuously changes and uncertainties in today’s business environment. In order to become an agile competitor, a manufacturing firm should focus on enriching its agility capabilities. These agility capabilities can be categorized into seven groups: proactiveness, customer focus, responsiveness, quickness, flexibility, basic competence and partnership. A manufacturing firm which is aiming at achieving agility should first develop its own appropriate agility strategy. This strategy prioritizes required agility capabilities.

Keywords: agile manufacturing, product architecture, customer focus, responsiveness, quickness, flexibility, basic competence

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Authors: Xue Bai, Ranran He, Chang Liu

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Care planning before the onset of intensive care needs can benefit older adults’ psychological well-being and increases families’ ability to manage caregiving crises and cope with care transitions. Effective care planning requires collaborative ‘team-work’ in families. However, future care planning has not been substantially examined in intergenerational or family contexts, let alone among immigrant families who have to face particular challenges in parental caregiving. From a family systems perspective, this study intends to explore the extent, processes, and contents of intergenerational care planning of Mainland immigrant ageing families in Hong Kong and to examine the intergenerational congruence and discrepancies in the care planning process. Adopting a qualitative research design, semi-structured in-depth interviews were conducted with 17 adult child-older parent pairs and another 33 adult children. In total, 50 adult children who migrated to Hong Kong after the age of 18 with more than three years’ work experience in Hong Kong had at least one parent aged over 55 years old who was not a Hong Kong resident and considered his/herself as the primary caregiver of the parent were recruited. Seventeen ageing parents of the recruited adult children were invited for dyadic interviews. Scarcity of caregiving resources in the context of cross-border migration, intergenerational discrepancies in care planning stages, both generations’ struggle and ambivalence toward filial care, intergenerational transmission of care values, and facilitating role of accumulated family capital in care preparation were primary themes concluded from participants’ narratives. Compared with ageing parents, immigrant adult children generally displayed lower levels of care planning. Although with a strong awareness of parents’ future care needs, few adult children were found engaged in concrete planning activities. This is largely due to their uncertainties toward future life and career, huge work and living pressure, the relatively good health status of their parents, and restrictions of public welfare policies in the receiving society. By contrast, children’s cross-border migration encouraged ageing parents to have early and clear preparation for future care. Ageing parents mostly expressed low filial care expectations when realizing the scarcity of family caregiving resources in the cross-border context. Even though they prefer in-person support from children, most of them prepare themselves for independent ageing to prioritize the next generation’s needs or choose to utilize paid services, welfare systems, friend networks, or extended family networks in their sending society. Adult children were frequently found caught in the dilemma of desiring to provide high quality and in-person support for their parents but lacking sufficient resources. Notably, a salient pattern of intergenerational transmission in terms of family and care values and ideal care arrangement emerged from intergenerational care preparation. Moreover, the positive role of accumulated family capital generated by a reunion in care preparation and joint decision-making were also identified. The findings of the current study will enhance professionals’ and service providers’ awareness of intergenerational care planning in cross-border migration contexts, inform services to alleviate unpreparedness for elderly care and intergenerational discrepancies concerning care arrangements and broaden family services to encompass intergenerational care planning interventions. Acknowledgment: This study is supported by a General Research Grant from the Research Grants Council of the HKSAR, China (Project Number: 15603818).

Keywords: intergenerational care planning, mainland immigrants in Hong Kong, migrant family, older adults

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Authors: Safia Rabaaoui, Héla Hachicha, Ezzeddine Zagrouba

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Nowadays, cloud computing is becoming the more popular technology to various companies and consumers, which benefit from its increased efficiency, cost optimization, data security, unlimited storage capacity, etc. One of the biggest challenges of cloud computing is resource allocation. Its efficiency directly influences the performance of the whole cloud environment. Finding an effective method to address these critical issues and increase cloud performance was necessary. This paper proposes a mobile agents-based framework for dynamic resource allocation in cloud computing to minimize both the cost of using virtual machines and the makespan. Furthermore, its impact on the best response time and power consumption has been studied. The simulation showed that our method gave better results than here.

Keywords: cloud computing, multi-agent system, mobile agent, dynamic resource allocation, cost, makespan

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Authors: Joshua Garba Dodo

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Corruption has become endemic in Nigeria, affecting almost all facets of the society, thereby thwarting the effort of national development. The thrust of this paper, therefore, is to see how corruption can be brought to its barest minimum if not totally eradicated using social studies and other agents of socialization. In doing that, the paper defines the concepts of corruption, social studies, and socialization. Discourse on the causes of corruption and the effect on national development is made. The paper examines the role of social studies, family, and the mass media in tackling corruption. The paper also asserts that if an aggressive campaign is mounted by the mass media as a way of supporting the present government in her effort to solve the corruption problem in the country, it will help in changing the psyche of the citizenry about corruption. Finally, the paper recommends, among others, that families and communities should sanction their sons and daughters involved in corrupt practices if proven by a competent court of law.

Keywords: corruption, social studies, family, mass media, socialization

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Authors: David Gottlieb, Jason Yoder

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The feeling of loneliness is not uncommon in modern society, and yet, there is a fundamental lack of understanding in its origins and purpose in nature. One interpretation of loneliness is that it is a subjective experience that punishes a lack of social behavior, and thus its emergence in human evolution is seemingly tied to the survival of early human tribes. Still, a common counterintuitive response to loneliness is a state of hypervigilance, resulting in social withdrawal, which may appear maladaptive to modern society. So far, no computational model of loneliness’ effect during evolution yet exists; however, agent-based models (ABM) can be used to investigate social behavior, and applying evolution to agents’ behaviors can demonstrate selective advantages for particular behaviors. We propose an ABM where each agent contains four social behaviors, and one goal-seeking behavior, letting evolution select the best behavioral patterns for resource allocation. In our paper, we use an algorithm similar to the boid model to guide the behavior of agents, but expand the set of rules that govern their behavior. While we use cohesion, separation, and alignment for simple social movement, our expanded model adds goal-oriented behavior, which is inspired by particle swarm optimization, such that agents move relative to their personal best position. Since agents are given the ability to form connections by interacting with each other, our final behavior guides agent movement toward its social connections. Finally, we introduce a mechanism to represent a state of loneliness, which engages when an agent's perceived social involvement does not meet its expected social involvement. This enables us to investigate a minimal model of loneliness, and using evolution we attempt to elucidate its value in human survival. Agents are placed in an environment in which they must acquire resources, as their fitness is based on the total resource collected. With these rules in place, we are able to run evolution under various conditions, including resource-rich environments, and when disease is present. Our simulations indicate that there is strong selection pressure for social behavior under circumstances where there is a clear discrepancy between initial resource locations, and against social behavior when disease is present, mirroring hypervigilance. This not only provides an explanation for the emergence of loneliness, but also reflects the diversity of response to loneliness in the real world. In addition, there is evidence of a richness of social behavior when loneliness was present. By introducing just two resource locations, we observed a divergence in social motivation after agents became lonely, where one agent learned to move to the other, who was in a better resource position. The results and ongoing work from this project show that it is possible to glean insight into the evolutionary advantages of even simple mechanisms of loneliness. The model we developed has produced unexpected results and has led to more questions, such as the impact loneliness would have at a larger scale, or the effect of creating a set of rules governing interaction beyond adjacency.

Keywords: agent-based, behavior, evolution, loneliness, social

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Authors: E. O. Fakoya, B. G. Abiona, J. O. Soetan

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The study determined Perception of Agricultural Extension Agents of Private Sector Participation in Extension Services in Ogun State, Nigeria. Data were collected from 80 respondents with a well-structured questionnaire. The result of the findings showed that there is need for private sector participation in extension services (=4.313), private extension services has facilities than public extension services (=4.97). Private sector participated in extension services by: giving of loans and credits to farmers (=4.50). Major constraints identified by the respondents were: Transportation problem (=2.88) and lack of fund (=2.77) A significant relationship (P<0.05) exists between factors affecting public extension services(r = 0.641, p = 0.00) and private sector participation in extension services. It was concluded from the study that there is need for private sector to participate in extension service in order to improve productivity of the farmers.

Keywords: agricultural extension, extension agent, private sector, perception

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Authors: Ahmed Negm, George Aggidis, Xiandong Ma

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With the diverse nature of urban cities, customer demand patterns, landscape topologies or even seasonal weather trends; managing our water distribution networks (WDNs) has proved a complex task. These unpredictable circumstances manifest as pipe failures, intermittent supply and burst events thus adding to water loss, energy waste and increased carbon emissions. Whilst these events are unavoidable, advanced pressure management has proved an effective tool to control and mitigate them. Henceforth, water utilities have struggled with developing a real-time control method that is resilient when confronting the challenges of water distribution. In this paper we use deep reinforcement learning (DRL) algorithms as a novel pressure control strategy to minimise pressure violations and leakage under both burst and background leakage conditions. Agents based on asynchronous actor critic (A2C) and recurrent proximal policy optimisation (Recurrent PPO) were trained and compared to benchmarked optimisation algorithms (differential evolution, particle swarm optimisation. A2C manages to minimise leakage by 32.48% under burst conditions and 67.17% under background conditions which was the highest performance in the DRL algorithms. A2C and Recurrent PPO performed well in comparison to the benchmarks with higher processing speed and lower computational effort.

Keywords: deep reinforcement learning, pressure management, water distribution networks, leakage management

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Authors: Surjeet Bakshi, Surabhi Sharma

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Objective: To assess the impact of educational sessions by reputed regional faculties on knowledge of primary care physicians on evidence based diabetes management methods and practice. Study Design: Retrospective pre-post intervention study. Methodology: Nine cities in Kerala from August to October, 2012 were selected for the study. 125 MBBS doctors participated in the study. 11 regional faculties provided six educational sessions throughout the period. Validated questionnaires were used to evaluate the knowledge of the participants on evidence based diabetes management methods before and after the intervention. Results: The mean score on pre-test was 8 and the mean score on post-test was 9. A paired t-test was conducted on participant’s pre- and post test score and the results were statistically significant (p<0.001). Conclusion: Even though the general attitude to and level of knowledge of diabetes management is good among the primary care physicians in India, there do exist some knowledge gaps which might influence their future practices when it comes to counselling and information on diabetes management methods. In the present study, the performance and awareness level of the participants have expressively improved among primary care physicians. There is a significant improvement in the test score and the training conducted. It seems that if such study programmes are included in the students study programme, it will give higher score in the knowledge and attitude towards diabetes management.

Keywords: diabetes, management, primary care physicians, evidence base, improvement score, knowledge

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Authors: Yu Zhang, Pedro Desouza

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Since big data has become substantially more accessible and manageable due to the development of powerful tools for dealing with unstructured data, people are eager to mine information from social media resources that could not be handled in the past. Sentiment analysis, as a novel branch of text mining, has in the last decade become increasingly important in marketing analysis, customer risk prediction and other fields. Scientists and researchers have undertaken significant work in creating and improving their sentiment models. In this paper, we present a concept of selecting appropriate classifiers based on the features and qualities of data sources by comparing the performances of five classifiers with three popular social media data sources: Twitter, Amazon Customer Reviews, and Movie Reviews. We introduced a couple of innovative models that outperform traditional sentiment classifiers for these data sources, and provide insights on how to further improve the predictive power of sentiment analysis. The modelling and testing work was done in R and Greenplum in-database analytic tools.

Keywords: sentiment analysis, social media, Twitter, Amazon, data mining, machine learning, text mining

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Authors: Hsin-Hsin Chang, Jann-Tay Wang, Wang-Huei Sheng

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Background: Hospital-associated infections (HAIs) have significant medical and social resource consumption. In view of medical technology change rapidly and the prolonged average life expectancy, the patients' chances of receiving invasive medical devices have also increased. As well as the potential disease of the patients, the aging, and immune dysfunction makes the disease more serious, raising the risk of HAIs. In our adult intensive care units, catheter-associated urinary tract infections (CAUTIs) have an average of 4.6% in 2014, which is much higher than that of the National Healthcare Safety Network (NHSN). Therefore, we started the intervention of CAUTI bundle care. Methods: This 3-year intervention was conducted in adults’ intensive care units (ICUs) during January 2015 to December 2017. The implementation of CAUTI bundle care in order to reduce invasive catheter-associated infections were built on evidence-based infection control measures. Prospective surveillance was performed on all patients admitted to hospital. The four major directions are 'Leader Engagement', 'Educate Personnel', 'Executive Multidisciplinary Teamwork', 'Innovation and Improvement of Tools'. Results: During the intervention period, there were 167,024 patient-days with a total of 508 episodes of CAUTIs in the entire adult ICUs identified. The incidence of CAUTIs in adult ICU was significantly decreased in the intervention period (from 2015 to 2017), from 4.6 to 3.6 per 1000 catheter days (p=0.05). Conclusion: The necessity for the implementation of CAUTI bundle care in the health care system plays an important role in the quality and policy of infection control. Multidisciplinary teamwork, education, a comprehensive checklist and from time to time audit feedback to improve healthcare workers’ compliance are the keys to success.

Keywords: bundle care, hospital-associated infections, leader engagement, multidisciplinary team work

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Authors: Raja Omman Zafar, Yves Rybarczyk, Johan Borg

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This article proposes a conceptual framework for the application of digital twin technology in home care. The main goal is to bridge the gap between advanced digital twin concepts and their practical implementation in home care. This study uses a literature review and thematic analysis approach to synthesize existing knowledge and proposes a structured framework suitable for homecare applications. The proposed framework integrates key components such as IoT sensors, data-driven models, cloud computing, and user interface design, highlighting the importance of personalized and predictive homecare solutions. This framework can significantly improve the efficiency, accuracy, and reliability of homecare services. It paves the way for the implementation of digital twins in home care, promoting real-time monitoring, early intervention, and better outcomes.

Keywords: digital twin, homecare, older adults, healthcare, IoT, artificial intelligence

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Authors: Talal Alsulaiman, Khaldoun Khashanah

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In this paper, we provided a literature survey on the artificial stock problem (ASM). The paper began by exploring the complexity of the stock market and the needs for ASM. ASM aims to investigate the link between individual behaviors (micro level) and financial market dynamics (macro level). The variety of patterns at the macro level is a function of the AFM complexity. The financial market system is a complex system where the relationship between the micro and macro level cannot be captured analytically. Computational approaches, such as simulation, are expected to comprehend this connection. Agent-based simulation is a simulation technique commonly used to build AFMs. The paper proceeds by discussing the components of the ASM. We consider the roles of behavioral finance (BF) alongside the traditionally risk-averse assumption in the construction of agent's attributes. Also, the influence of social networks in the developing of agents’ interactions is addressed. Network topologies such as a small world, distance-based, and scale-free networks may be utilized to outline economic collaborations. In addition, the primary methods for developing agents learning and adaptive abilities have been summarized. These incorporated approach such as Genetic Algorithm, Genetic Programming, Artificial neural network and Reinforcement Learning. In addition, the most common statistical properties (the stylized facts) of stock that are used for calibration and validation of ASM are discussed. Besides, we have reviewed the major related previous studies and categorize the utilized approaches as a part of these studies. Finally, research directions and potential research questions are argued. The research directions of ASM may focus on the macro level by analyzing the market dynamic or on the micro level by investigating the wealth distributions of the agents.

Keywords: artificial stock markets, market dynamics, bounded rationality, agent based simulation, learning, interaction, social networks

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Authors: Deepti Kohli, Meeta Keswani Mehra

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The paper develops a theoretical model of electoral competition with purely opportunistic candidates and a uni-dimensional policy using the probability voting approach while focusing on the aspect of lobby formation to analyze the inherent complex interactions between centripetal and centrifugal forces and their effects on equilibrium policy platforms. There exist three types of agents, namely, Left-wing, Moderate and Right-wing who comprise of the total voting population. Also, it is assumed that the Left and Right agents are free to initiate a lobby of their choice. If initiated, these lobbies generate donations which in turn can be contributed to one (or both) electoral candidates in order to influence them to implement the lobby’s preferred policy. Four different lobby formation scenarios have been considered: no lobby formation, only Left, only Right and both Left and Right. The equilibrium policy platforms, amount of individual donations by agents to their respective lobbies and the contributions offered to the electoral candidates have been solved for under each of the above four cases. Since it is assumed that the agents cannot coordinate each other’s actions during the lobby formation stage, there exists a probability with which a lobby would be formed, which is also solved for in the model. The results indicate that the policy platforms of the two electoral candidates converge completely under the cases of no lobby and both (extreme) formations but diverge under the cases of only one (Left or Right) lobby formation. This is because in the case of no lobby being formed, only the centripetal forces (emerging from the election-winning aspect) are present while in the case of both extreme (Left-wing and Right-wing) lobbies being formed, centrifugal forces (emerging from the lobby formation aspect) also arise but cancel each other out, again resulting in a pure policy convergence phenomenon. In contrast, in case of only one lobby being formed, both centripetal and centrifugal forces interact strategically, leading the two electoral candidates to choose completely different policy platforms in equilibrium. Additionally, it is found that in equilibrium, while the donation by a specific agent type increases with the formation of both lobbies in comparison to when only one lobby is formed, the probability of implementation of the policy being advocated by that lobby group falls.

Keywords: electoral competition, equilibrium policy platforms, lobby formation, opportunistic candidates

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Authors: Asma Batool

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Immigrant families raising a child with developmental disabilities in Canada encounter many challenges during the process of disability care. Starting from the early screening of their child for diagnosis followed by challenges associated with treatment, access and service utilization. A substantial amount of research focuses on identifying barriers. However, the functional aspects of barriers in terms of their potential influences on parents and children with disabilities are unexplored yet. This paper presents functional analysis of barriers in disability care research by adopting a method of integrated approach. Juxtaposition of two developmental approaches, Bronfenbrenner’s ecological model and parents ‘transformational process model is generating multiple hypotheses to be considered while empirically investigating causal relationships and mediating or moderating factors among various variables related with disability care research. This functional analysis suggests that barriers have negative impacts on the physical and emotional development of children with disabilities as well as on the overall quality of family life (QOFL). While, barriers have facilitating impacts on parents, alternatively, the process of transformation in parents expedite after experiencing barriers. Consequently, parents reconstruct their philosophy of life and experience irreversible but continuous developmental change in terms of transformations simultaneously with their developing child and may buffer the expected negative impacts of barriers on disabled child and QOFL. Overall, this paper is suggesting implications for future research and parents’ transformations are suggesting potential pathways to minimize the negative influences of barriers that parents experience during disability care, hence improving satisfaction in QOFL in general.

Keywords: barriers in disability care, developmental disabilities, parents’ transformations, quality of family life

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Authors: Merfat Algethami, Anton Blencowe, Bryce Feltis, Stephen Best, Moshi Geso

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Nano-materials with high atomic number atoms have been demonstrated to enhance the effective radiation dose and thus potentially could improve therapeutic efficacy in radiotherapy. The optimal nanoparticulate agents require high X-ray absorption coefficients, low toxicity, and should be cost effective. The focus of our research is the development of a nanoparticle therapeutic agent that can be used in radiotherapy to provide optimal enhancement of the radiation effects on the target. In this study, we used bismuth (Bi) nanoparticles coated with starch and bismuth sulphide nanoparticles (Bi2S3) coated with polyvinylpyrrolidone (PVP). These NPs are of low toxicity and are one of the least expensive heavy metal-based nanoparticles. The aims of this study were to synthesise Bi2S3 and Bi NPs, and examine their cytotoxicity to human lung adenocarcinoma epithelial cells (A549). The dose enhancing effects of NPs on A549 cells were examined at both KV and MV energies. The preliminary results revealed that bismuth based nanoparticles show increased radio-sensitisation of cells, displaying dose enhancement with KV X-ray energies and to a lesser degree for the MV energies. We also observed that Bi NPs generated a greater dose enhancement effect than Bi2S3 NPs in irradiated A549 cells. The maximum Dose Enhancement Factor (DEF) was obtained at lower energy KV range when cells treated with Bi NPs (1.5) compared to the DEF of 1.2 when cells treated with Bi2S3NPs. Less radiation dose enhancement was observed when using high energy MV beam with higher DEF value of Bi NPs treatment (1.26) as compared to 1.06 DEF value with Bi2S3 NPs. The greater dose enhancement was achieved at KV energy range, due the effect of the photoelectric effect which is the dominant process of interaction of X-ray. The cytotoxic effect of Bi NPs on enhancing the X-ray dose was higher due to the higher amount of elemental Bismuth present in Bi NPs compared to Bi2S3 NPs. The results suggest that Bismuth based NPs can be considered as valuable dose enhancing agents when used in clinical applications.

Keywords: A549 lung cancer cells, Bi2S3 nanoparticles, dose enhancement effect, radio-sensitising agents

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Authors: Ayman M. Mansour

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In this paper, we propose a multi-agent intelligent system that is used for monitoring the health conditions of elderly people. Monitoring the health condition of elderly people is a complex problem that involves different medical units and requires continuous monitoring. Such expert system is highly needed in rural areas because of inadequate number of available specialized physicians or nurses. Such monitoring must have autonomous interactions between these medical units in order to be effective. A multi-agent system is formed by a community of agents that exchange information and proactively help one another to achieve the goal of elderly monitoring. The agents in the developed system are equipped with intelligent decision maker that arms them with the rule-based reasoning capability that can assist the physicians in making decisions regarding the medical condition of elderly people.

Keywords: fuzzy logic, inference system, monitoring system, multi-agent system

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Authors: Jennifer Wheeldon, Nick de Viggiani, Nikki Cotterill

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Background: Urinary and fecal incontinence affect a significant proportion of older adults aged 65 and over who permanently reside in residential and nursing home facilities. Incontinence symptoms have been linked to comorbidities, an increased risk of infection and reduced quality of life and mental wellbeing of residents. However, continence care provision can often be poor, further compromising the health and wellbeing of this vulnerable population. Objectives: To identify experiences and perceptions of continence care provision in older adult residential care settings and to identify factors that help or hinder good continence care provision. Settings included both residential care homes and nursing homes for older adults. Methods: A qualitative evidence synthesis using systematic review methodology established the current evidence-base. Data from 20 qualitative and mixed-method studies was appraised and synthesized. Following the review process, 10* qualitative interviews with staff working in older adult residential care settings were conducted across six* sites, which included registered managers, registered nurses and nursing/care assistants/aides. Purposive sampling recruited individuals from across England. Both evidence synthesis and interview data was analyzed thematically, both manually and with NVivo software. Results: The evidence synthesis revealed complex barriers and facilitators for continence care provision at three influencing levels: macro (structural and societal external influences), meso (organizational and institutional influences) and micro (day-to-day actions of individuals impacting service delivery). Macro-level barriers included negative stigmas relating to incontinence, aging and working in the older adult social care sector, restriction of continence care resources such as containment products (i.e. pads), short staffing in care facilities, shortfalls in the professional education and training of care home staff and the complex health and social care needs of older adult residents. Meso-level barriers included task-centered organizational cultures, ageist institutional perspectives regarding old age and incontinence symptoms, inadequate care home management and poor communication and teamwork among care staff. Micro-level barriers included poor knowledge and negative attitudes of care home staff and residents regarding incontinence symptoms and symptom management and treatment. Facilitators at the micro-level included proactive and inclusive leadership skills of individuals in management roles. Conclusions: The findings of the evidence synthesis study help to outline the complexities of continence care provision in older adult care homes facilities. Macro, meso and micro level influences demonstrate problematic and interrelated barriers across international contexts, indicating that improving continence care in this setting is extremely challenging due to the multiple levels at which care provision and services are impacted. Both international and national older adult social care policy-makers, researchers and service providers must recognize this complexity, and any intervention seeking to improve continence care in older adult care home settings must be planned accordingly and appreciatively of the complex and interrelated influences. It is anticipated that the findings of the qualitative interviews will shed further light on the national context of continence care provision specific to England; data collection is ongoing*. * Sample size is envisaged to be between 20-30 participants from multiple sites by Spring 2023.

Keywords: continence care, residential and nursing homes, evidence synthesis, qualitative

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Authors: Maria Sonto Maputle, Rhulani C. Shihundla, Rachel T. Lebese

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Background: Patients’ information must be complete and accurately documented in order to foster quality and continuity of care. The multidisciplinary health care members use patients’ documentation to communicate about health status, preventive health services, treatment, planning and delivery of care. The purpose of this study was to determine the practice of nursing documentation of patients’ information at selected Primary Health Care (PHC) facilities in Vhembe District, Limpopo Province, South Africa. Methods: The research approach adopted was qualitative while exploratory and descriptive design was used. The study was conducted at selected PHC facilities. Population included twelve professional nurses. Non-probability purposive sampling method was used to sample professional nurses who were willing to participate in the study. The criteria included participants’ whose daily work and activities, involved creating, keeping and updating nursing documentation of patients’ information. Qualitative data collection was through unstructured in-depth interviews until no new information emerged. Data were analysed through open–coding of, Tesch’s eight steps method. Results: Following data analysis, it was found that professional nurses’ had knowledge deficit related to insufficient training on updates and rendering multiple services daily had negative impact on accurate documentation of patients’ information. Conclusion: The study recommended standardization of registers, books and forms used at PHC facilities, and reorganization of PHC services into open day system.

Keywords: documentation, knowledge, patient care, patient’s information, training

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Authors: Pannathorn Chachvarat, Smarnjit Piromrun

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Aging is the reality for the future world. An urgent priority for the development of the elderlies’ quality living is needed. The promotion of quality the elderly to live longer in their dignity and being independence are essential. The objective of this descriptive research was to study the self-care regarding to the valuable living in Thai elderly. The randomized sample was 100 elderly who live in Muang district of Phayao province. The tools included 2 parts; 1) Personal data (gender, age, income, occupation, marital status, living condition and disease), and 2) the self-care regarding to the valuable living questionnaire consisted of 3 domains, physical (21items), spiritual (13 items) and social domain (12 items). The content validity tool was tested the IOC ranged between 0.60 – 1.00 and the reliability test, Cronbach Alpha was 0.82. The research found that; The most participants were female (60 %), Farmer (37%), and underlying disease (65 %). The range of age was 68 years. Overall of the self-care regarding to the valuable living of physical, spiritual and social were at the high level.The highest level of physical activities was self-taking bath twice a day (morning and evening), and slept at least 5-6 hours at night time.The highest level of spirit activities was a good member of the family, contributions to persons in family, good emotion. Additionally were enjoyable, accepting changes in the body such as the dry skin and the blurred vision, accepting the roles and duties in taking care of house and grandchildren, selecting the applicable activities and practice according to religious Buddhateachingfor the happiness and meditated life.The highest of the social activities were the good relationship between other elderlies and family members, happy to help social activities as of their capacity, and being happy to help other people who have problems.

Keywords: self-care, valuable living, elderly, Thai

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Authors: Jiri F. Urbanek, Jiri Barta, Oldrich Svoboda, Jiri J. Urbanek

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The organizations of European and Czech critical infrastructure have specific position, mission, characteristics and behaviour in European Union and Czech state/ business environments, regarding specific requirements for regional and global security environments. They must respect policy of national security and global rules, requirements and standards in all their inherent and outer processes of supply-customer chains and networks. A controlling is generalized capability to have control over situational policy. This paper aims and purposes are to introduce the controlling as quite new necessary process attribute providing for critical infrastructure is environment the capability and profit to achieve its commitment regarding to the effectiveness of the quality management system in meeting customer/ user requirements and also the continual improvement of critical infrastructure organization’s processes overall performance and efficiency, as well as its societal security via continual planning improvement via DYVELOP modelling.

Keywords: added value, DYVELOP, controlling, environments, process approach

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Authors: Athena Johnson

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Special education is an important field but often under-researched, particularly for the cause of learning deficiencies. Often times special education looks at the symptoms rather than the cause, and this can lead to many misdiagnoses. Student trauma, as measured by the Adverse Childhood Experiences (ACE) test, is extremely common, often resulting in Post Traumatic Stress Disorder (PTSD). PTSD affects the brain's ability to learn properly, making students have a much more difficult time with auditory learning and memory due to always being in flight or fight mode, and due to this, students with PTSD are often misdiagnosed with Attention Deficit and Hyperactivity Disorder (ADHD). This can lead to them getting the wrong support, with PTSD students needing more counseling than anything else. Through these research papers' methodologies, a literature review on article research from the perspectives of students who were misdiagnosed, and imperial research, the major findings of this study were the importance of trauma-informed care in schools. Trauma-informed care in the school system is crucial for helping the many students who experience traumatic life events and struggle in school due to it. It is important to support students with PTSD so that they are able to integrate and learn better in society and school with trauma-informed school care.

Keywords: ACE test, ADHD, misdiagnoses, special education, trauma, trauma-informed care, PTSD

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Authors: Alejandra Sierra, Gloria Valadez, Adriana Dávalos, Mirliana Ramírez

Abstract:

For years, the Pan American Health Organization/World Health Organization and other organizations have made efforts to the improve access and the quality of prenatal care as part of comprehensive programs for maternal and neonatal health, the standards of care have been renewed in order to migrate from a medical perspective to a holistic perspective. However, despite the efforts currently antenatal care models have not been verified by a scientific evaluation in order to determine their effectiveness. The teenage pregnancy is considered as a very important phenomenon since it has been strongly associated with inequalities, poverty and the lack of gender quality; therefore it is important to analyze the antenatal care that’s been given, including not only the clinical intervention but also the activities surrounding the advertising and the health education. In this study, the objective was to describe if the previously established activities (on the prenatal care models) are being performed in the care of pregnant teenagers attending prenatal care in health institutions in two cities in México and Chile during 2013. Methods: Observational and descriptive study, of a transversal cohort. 170 pregnant women (13-19 years) were included in prenatal care in two health institutions (100 women from León-Mexico and 70 from Chile-Coquimbo). Data collection: direct survey, perinatal clinical record card which was used as checklists: WHO antenatal care model WHO-2003, Official Mexican Standard NOM-007-SSA2-1993 and Personalized Service Manual on Reproductive Process- Chile Crece Contigo; for data analysis descriptive statistics were used. The project was approved by the relevant ethics committees. Results: Regarding the fulfillment of interventions focused on physical, gynecological exam, immunizations, monitoring signs and biochemical parameters in both groups was met by more than 84%; the activities of guidance and counseling pregnant teenagers in Leon compliance rates were below 50%, on the other hand, although pregnant women in Coquimbo had a higher percentage of compliance, no one reached 100%. The topics that less was oriented were: family planning, signs and symptoms of complications and labor. Conclusions: Although the coverage of the interventions indicated in the prenatal care models was high, there were still shortcomings in the fulfillment of activities to orientation, education and health promotion. Deficiencies in adherence to prenatal care guidelines could be due to different circumstances such as lack of registration or incomplete filling of medical records, lack of medical supplies or health personnel, absences of people at prenatal check-up appointments, among many others. Therefore, studies are required to evaluate the quality of prenatal care and the effectiveness of existing models, considering the role of the different actors (pregnant women, professionals and health institutions) involved in the functionality and quality of prenatal care models, in order to create strategies to design or improve the application of a complete process of promotion and prevention of maternal and child health as well as sexual and reproductive health in general.

Keywords: adolescent health, health systems, maternal health, primary health care

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Authors: João Rato, Nuno Costa

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The human verbal communication is a two-way process which requires a mutual understanding that will result in some considerations. This kind of communication, also called dialogue, besides the supposed human agents it can also be performed between human agents and machines. The interaction between Men and Machines, by means of a natural language, has an important role concerning the improvement of the communication between each other. Aiming at knowing the performance of some speech recognition systems, this document shows the results of the accomplished tests according to the Word Error Rate evaluation method. Besides that, it is also given a set of information linked to the systems of Man-Machine communication. After this work has been made, conclusions were drawn regarding the Speech Recognition Systems, among which it can be mentioned their poor performance concerning the voice interpretation in noisy environments.

Keywords: automatic speech recognition, man-machine conversation, speech recognition, spoken dialogue systems, word error rate

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Authors: Mohsin Shahab, Shagufta Rehmat, Faisal F. Khan

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Background: The global COVID-19 pandemic has generated health problems worldwide. Health care workers are the front-line warriors against the pandemic. The aim of this study was to find out the prevalence of COVID-19 (7th May 2021 to 3rd August 2021) amongst Health Care Workers (HCWs) and to assess the complications associated with it and its effects on their quality of life. Material and Method: The study was conducted in healthcare facilities which serve as pandemic hospitals in district Swat. A total of 140 healthcare workers, who were employed in the COVID-19 health care facilities, including the department of Pulmonology, Intensive Care Unit (ICU), and COVID-19 wards. Participants were tested for COVIID-19 using RT PCR test. A Case Report Form (CRF) for conditions during and post COVID-19 was filled to assess the complications and quality of life of health care workers. Results: A total of 140 Health Care Workers were studied, out of which 40% were doctors, 22% nursing staff, 17% paramedic staff, 9% cleaning staff, lab technologist 6%, 2% operation theater staff, administration staff, and pharmacist. The respondents were also investigated for pre-existing illness prior to SARS-CoV-2 infection, hypertension was the most prevalent, followed by chronic heart diseases and neurological disorders. Fever was the most common symptom, recorded 76.42% in the participants, while 55.71% of participants had dry cough, 55% had a sore throat, following by chest pain 43.56%. Reinfection rate was 10%, with chest pain being recorded in 85.71%. Post disease complication analysis showed that 47.14% of the participants were diagnosed with a new diagnosis after the COVID-19 recovery. Pulmonological diseases were recorded the most as a new diagnosis in, followed by gastrointestinal and psychological problems. Conclusions: The results of the study illustrates how COVID-19 has affected the overall health and quality of life of HCWs in District Swat of Khyber Pakhtunkhwa, Pakistan.

Keywords: SARS-CoV-2, COVID-19, HCW's, symptoms, questionnaire, post COVID-19

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Authors: Rasouli Divkalaee Zeinab, Kalteh Safa, Roudbari Aliakbar

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Introduction: Medical waste can lead to the generation and transmission of many infectious and contagious diseases due to the presence of pathogenic agents, thereby necessitating the need for special management to collect, decontaminate, and finally dispose of such products. This study aimed to design a centralized health care (medical) waste management program for the cities of Semnan, Mahdishahr, and Shahmirzad. Methods: This descriptive-analytical study was conducted for six months in the cities of Semnan, Mahdishahr, and Shahmirzad. In this study, the quantitative and qualitative characteristics of the generated wastes were determined by taking samples from all medical waste production centers. Then, the equipment, devices, and machines required for separate collection of the waste from the production centers and for their subsequent decontamination were estimated. Next, the investment costs, current costs, and working capital required for collection, decontamination, and final disposal of the wastes were determined. Finally, the payment for proper waste management of each category of medical waste-producing centers was determined. Results: 1021 kilograms of medical waste are produced daily in the cities of Semnan, Mahdishahr, and Shahmirzad. It was estimated that a 1000-liter autoclave, a machine for collecting medical waste, four 60-liter bins, four 120-liter bins, and four 1200-liter bins were required for implementing the study plan. Also, the estimated total annual medical waste management costs for Semnan City were determined (23,283,903,720 Iranian Rials). Conclusion: The study results showed that establishing a proper management system for medical wastes generated in the three studied cities will cost between 334,280 and 1,253,715 Iranian Rials in fees for the medical centers. The findings of this study provided comprehensive data regarding medical wastes from the generation point to the landfill site, which is vital for the government and the private sector.

Keywords: clinics, decontamination, management, medical waste

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Authors: Lily Farris, Chantel E. Canessa, Rena Heathcote, Susan Shumay, Suzanna V. McRae, Alissa Collingridge, Minna K. Miller

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Objective: To describe how the Lean approach can be applied to improve access, quality and safety of care in an ambulatory pediatric primary care setting. Background: Lean was originally developed by Toyota manufacturing in Japan, and subsequently adapted for use in the healthcare sector. Lean is a systematic approach, focused on identifying and reducing waste within organizational processes, improving patient-centered care and efficiency. Limited literature is available on the implementation of the Lean methodologies in a pediatric ambulatory care setting. Methods: A strategic continuous improvement event or Rapid Process Improvement Workshop (RPIW) was launched with the aim evaluating and structurally supporting clinic workflow, capacity building, sustainability, and ultimately improving access to care and enhancing the patient experience. The Lean process consists of five specific activities: Current state/process assessment (value stream map); development of a future state map (value stream map after waste reduction); identification, quantification and prioritization of the process improvement opportunities; implementation and evaluation of process changes; and audits to sustain the gains. Staff engagement is a critical component of the Lean process. Results: Through the implementation of the RPIW and shifting workload among the administrative team, four hours of wasted time moving between desks and doing work was eliminated from the Administrative Clerks role. To streamline clinic flow, the Nursing Assistants completed patient measurements and vitals for Nurse Practitioners, reducing patient wait times and adding value to the patients visit with the Nurse Practitioners. Additionally, through the Nurse Practitioners engagement in the Lean processes a need was recognized to articulate clinic vision, mission and the alignment of NP role and scope of practice with the agency and Ministry of Health strategic plan. Conclusions: Continuous improvement work in the Pediatric Primary Care NP Clinic has provided a unique opportunity to improve the quality of care delivered and has facilitated further alignment of the daily continuous improvement work with the strategic priorities of the Ministry of Health.

Keywords: ambulatory care, lean, pediatric primary care, system efficiency

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Authors: Anastasia Constantinou, Panayiotis Laouris, Stephen Morris

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Background: Climate change has been reported as one of the worst threats to healthcare. The healthcare sector is a significant contributor to greenhouse gas emissions with primary care being responsible for 23% of the NHS’ total carbon footprint. Digital interventions, primarily focusing on telemedicine, offer a route to change. This systematic review aims to quantify and characterize the carbon footprint savings associated with the implementation of digital interventions in the setting of primary care. Methods: A systematic review of published literature was conducted according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, PubMed, and Scopus databases as well as Google scholar were searched using key terms relating to “carbon footprint,” “environmental impact,” “sustainability”, “green care”, “primary care,”, and “general practice,” using citation tracking to identify additional articles. Data was extracted and analyzed in Microsoft Excel. Results: Eight studies were identified conducted in four different countries between 2010 and 2023. Four studies used interventions to address primary care services, three studies focused on the interface between primary and specialist care, and one study addressed both. Digital interventions included the use of mobile applications, online portals, access to electronic medical records, electronic referrals, electronic prescribing, video-consultations and use of autonomous artificial intelligence. Only one study carried out a complete life cycle assessment to determine the carbon footprint of the intervention. It estimate that digital interventions reduced the carbon footprint at primary care level by 5.1 kgCO2/visit, and at the interface with specialist care by 13.4 kg CO₂/visit. When assessing the relationship between travel-distance saved and savings in emissions, we identified a strong correlation, suggesting that most of the carbon footprint reduction is attributed to reduced travel. However, two studies also commented on environmental savings associated with reduced use of paper. Patient savings in the form of reduced fuel cost and reduced travel time were also identified. Conclusion: All studies identified significant reductions in carbon footprint following implementation of digital interventions. In the future, controlled, prospective studies incorporating complete life cycle assessments and accounting for double-consulting effects, use of additional resources, technical failures, quality of care and cost-effectiveness are needed to fully appreciate the sustainable benefit of these interventions

Keywords: carbon footprint, environmental impact, primary care, sustainable healthcare

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Authors: Mohd Ridzwan Yaakub, Muhammad Iqbal Abu Latiffi

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Online business has become popular recently due to the massive amount of information and medium available on the Internet. This has resulted in the huge number of reviews where the consumers share their opinion, criticisms, and satisfaction on the products they have purchased on the websites or the social media such as Facebook and Twitter. However, to analyze customer’s behavior has become very important for organizations to find new market trends and insights. The reviews from the websites or the social media are in structured and unstructured data that need a sentiment analysis approach in analyzing customer’s review. In this article, techniques used in will be defined. Definition of the ontology and description of its possible usage in sentiment analysis will be defined. It will lead to empirical research that related to mobile phones used in research and the ontology used in the experiment. The researcher also will explore the role of preprocessing data and feature selection methodology. As the result, ontology-based approach in sentiment analysis can help in achieving high accuracy for the classification task.

Keywords: feature selection, ontology, opinion, preprocessing data, sentiment analysis

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