Search results for: advanced care planning

Authors: Abhishek Oswal

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Background: Inconsistencies between the guidelines for childhood asthma can pose a diagnostic challenge to clinicians. NICE guidelines are the most commonly followed guidelines in primary care in the UK; they state that to be diagnosed with asthma, a child must be more than 5 years old and must have objective evidence of the disease. When diagnoses are coded in general practice (GP), these guidelines may be superseded by communications from secondary care. Hence it is imperative that diagnoses are correct, as per up to date guidelines and evidence, as this affects follow up and management both in primary and secondary care. Methods: A snapshot audit at a general practice surgery was undertaken of children (less than 16 years old) with a coded diagnosis of 'asthma', to review the age at diagnosis and whether any objective evidence of asthma was documented at diagnosis. 50 cases of asthma in children presenting to the emergency department (ED) were then audited to review the age at presentation, whether there was evidence of previous asthma diagnosis and whether the patient was discharged from ED. A repeat audit is planned in ED this winter. Results: In a GP surgery, there were 83 coded cases of asthma in children. 51 children (61%) were diagnosed under 5, with 9 children (11%) who had objective evidence of asthma documented at diagnosis. In ED, 50 cases were collected, of which 4 were excluded as they were referred to the other services, or for incorrect coding. Of the 46 remaining, 27 diagnoses confirmed to NICE guidelines (59%). 33 children (72%) were discharged from ED. Discussion: The most likely reason for the apparent low rate of a correct diagnosis is the significant challenge of obtaining objective evidence of asthma in children. There were a number of patients who were diagnosed from secondary care services and then coded as 'asthma' in GP, without having objective documented evidence. The electronic patient record (EPR) system used in our emergency department (ED) did not allow coding of 'suspected diagnosis' or of 'viral induced wheeze'. This may have led to incorrect diagnoses coded in primary care, of children who had no confirmed diagnosis of asthma. We look forward to the re-audit, as the EPR system has been updated to allow suspected diagnoses. In contrast to the NICE guidelines used here, British Thoracic Society (BTS) guidelines allow for a trial of treatment and subsequent confirmation of diagnosis without objective evidence. It is possible that some of the cases which have been classified as incorrect in this audit may still meet other guidelines. Conclusion: The diagnosis of asthma in children is challenging. Incorrect diagnoses may be related to clinical pressures and the provision of services to allow compliance with NICE guidelines. Consensus statements between the various groups would also aid the decision-making process and diagnostic dilemmas that clinicians face, to allow more consistent care of the patient.

Keywords: asthma, diagnosis, primary care, emergency department, guidelines, audit

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Authors: Alexey Abilov

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The article highlights the experience of training master's and doctoral students at Satbayev University by preparing their course works for disciplines "Principles of Sustainable Architecture", "Energy Efficiency in Urban planning", "Urban planning analysis, "Social foundations of Architecture". The purpose of these works is the acquisition by students of practical skills necessary in their future professional activities, which are achieved through comprehensive assessment of individual sections of the Almaty urban environment. The methodology of student’s researches carried out under the guidance of the author of this publication is based on an expert assessment of the territory through its full-scale survey, analysis of project documents and statistical data, as well as on a social assessment of the territory based on the results of a questionnaire survey of residents. A comprehensive qualitative and quantitative assessment of the selected sites according to the criteria of the quality of the living environment also allows to formulate specific recommendations for designers who carry out a pre-project analysis of the city territory in the process of preparing draft master plans and detailed planning projects.

Keywords: urban environment, expert/social assessment of the territory, questionnaire survey, comprehensive approach

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Authors: B. B. van Schalkwyk, C. B. Schoeman, E. J. Cilliers

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High levels of urbanisation and the lingering effects of Apartheid have caused South African municipalities to experience difficulties in planning for sustainability and, more specifically, sustainable community development. Sustainable community development is needed in order to achieve more integrated and sustainable towns and cities with an improved living environment and a higher quality of life. Due to this, sustainable community development is of particular relevance to South Africa. Although policies and legislation exist at international, national and local level, there is a lack of suitable planning instruments to guide sustainable community development. Tlokwe Local Municipality is researched in this paper as study area to test and develop planning instruments for sustainable community development. A comparative assessment matrix of sustainability indicators is linked to Multi-Criteria Analysis (MCA) and applied to identify the themes and sub-themes applicable to sustainability in which intervention is required to improve the sustainability rating of the municipality. The result of the comparative sustainability assessment is that the Tlokwe Local Municipality is considered to be relatively sustainable, performing overall better than the three spheres of government against which it was measured. It is recommended that municipalities use the comparative assessment matrix method to determine its level of sustainability when developing respective sectorial plans (SDFs, ITPs, EMFs and IDPs). Areas in which there is a lack of sustainability are highlighted and can consequently be addressed through intervention strategies. The comparative assessment matrix method is a valuable planning instrument with which to achieve sustainable community development.

Keywords: sustainable community development, sustainability indicators, comparative sustainability, urbanisation, development planning, urban management

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Authors: Liane J. Ioannou, Jonathan Serpell, Cino Bendinelli, David Walters, Jenny Gough, Dean Lisewski, Win Meyer-Rochow, Julie Miller, Duncan Topliss, Bill Fleming, Stephen Farrell, Andrew Kiu, James Kollias, Mark Sywak, Adam Aniss, Linda Fenton, Danielle Ghusn, Simon Harper, Aleksandra Popadich, Kate Stringer, David Watters, Susannah Ahern

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BACKGROUND: There are significant variations in the management, treatment and outcomes of thyroid cancer, particularly in the role of: diagnostic investigation and pre-treatment scanning; optimal extent of surgery (total or hemi-thyroidectomy); use of active surveillance for small low-risk cancers; central lymph node dissections (therapeutic or prophylactic); outcomes following surgery (e.g. recurrent laryngeal nerve palsy, hypocalcaemia, hypoparathyroidism); post-surgical hormone, calcium and vitamin D therapy; and provision and dosage of radioactive iodine treatment. A proven strategy to reduce variations in the outcome and to improve survival is to measure and compare it using high-quality clinical registry data. Clinical registries provide the most effective means of collecting high-quality data and are a tool for quality improvement. Where they have been introduced at a state or national level, registries have become one of the most clinically valued tools for quality improvement. To benchmark clinical care, clinical quality registries require systematic measurement at predefined intervals and the capacity to report back information to participating clinical units. OBJECTIVE: The aim of this study was to develop a core set clinical indicators that enable measurement and reporting of quality of care for patients with thyroid cancer. We hypothesise that measuring clinical quality indicators, developed to identify differences in quality of care across sites, will reduce variation and improve patient outcomes and survival, thereby lessening costs and healthcare burden to the Australian community. METHOD: Preparatory work and scoping was conducted to identify existing high quality, clinical guidelines and best practice for thyroid cancer both nationally and internationally, as well as relevant literature. A bi-national panel was invited to participate in a modified Delphi process. Panelists were asked to rate each proposed indicator on a Likert scale of 1–9 in a three-round iterative process. RESULTS: A total of 236 potential quality indicators were identified. One hundred and ninety-two indicators were removed to reflect the data capture by the Australian and New Zealand Thyroid Cancer Registry (ANZTCR) (from diagnosis to 90-days post-surgery). The remaining 44 indicators were presented to the panelists for voting. A further 21 indicators were later added by the panelists bringing the total potential quality indicators to 65. Of these, 21 were considered the most important and feasible indicators to measure quality of care in thyroid cancer, of which 12 were recommended for inclusion in the final set. The consensus indicator set spans the spectrum of care, including: preoperative; surgery; surgical complications; staging and post-surgical treatment planning; and post-surgical treatment. CONCLUSIONS: This study provides a core set of quality indicators to measure quality of care in thyroid cancer. This indicator set can be applied as a tool for internal quality improvement, comparative quality reporting, public reporting and research. Inclusion of these quality indicators into monitoring databases such as clinical quality registries will enable opportunities for benchmarking and feedback on best practice care to clinicians involved in the management of thyroid cancer.

Keywords: clinical registry, Delphi survey, quality indicators, quality of care

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Authors: Néstor Iván Rojas, Wilson Medina Sierra

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Managing spatial information is described through a Geographic Information System (GIS), for some neighborhoods in the city of Tunja, in relation to the structural typology of the buildings. The use of GIS provides tools that facilitate the capture, processing, analysis and dissemination of cartographic information, product quality evaluation of the classification of buildings. Allows the development of a method that unifies and standardizes processes information. The project aims to generate a geographic database that is useful to the entities responsible for planning and disaster prevention and care for vulnerable populations, also seeks to be a basis for seismic vulnerability studies that can contribute in a study of urban seismic microzonation. The methodology consists in capturing the plat including road naming, neighborhoods, blocks and buildings, to which were added as attributes, the product of the evaluation of each of the housing data such as the number of inhabitants and classification, year of construction, the predominant structural systems, the type of mezzanine board and state of favorability, the presence of geo-technical problems, the type of cover, the use of each building, damage to structural and non-structural elements . The above data are tabulated in a spreadsheet that includes cadastral number, through which are systematically included in the respective building that also has that attribute. Geo-referenced data base is obtained, from which graphical outputs are generated, producing thematic maps for each evaluated data, which clearly show the spatial distribution of the information obtained. Using GIS offers important advantages for spatial information management and facilitates consultation and update. Usefulness of the project is recognized as a basis for studies on issues of planning and prevention.

Keywords: microzonation, buildings, geo-processing, cadastral number

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Authors: Ghorbanali Mohammadi

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Background: Due to the widespread outbreak of the COVID-19 virus, a large number of people become infected with the disease every day and go to hospitals. The acute condition of this disease has caused the death of many people. Since all the stages of treatment for these people happen in the hospitals, nurses are at the forefront of the fight against this virus. This causes nurses to suffer from physical and mental health problems. Methods: Physical and mental problems in nurses were assessed using the Depression, Anxiety and Stress Scale (DASS-42) of Lovibond (1995) and the Nordic Questionnaire. Results: 90 nurses from emergency, intensive care, and coronary care units were examined, and a total of 180 questionnaires were collected and evaluated. It was found that 37.78%, 47.78%, and 21.11% of nurses have symptoms of depression, anxiety, and stress, respectively. 40% of the nurses had physical problems. In total, 65.17% of them were involved in one or more mental or physical illnesses. Conclusions: Of the three units surveyed, the nurses in intensive care, emergency room, and coronary care units worked more than ten hours a day. Examining the interaction of physical and mental health problems indicated that physical problems can aggravate mental problems.

Keywords: depression anxiety and stress scale of Lovibond, nordic questionnaire, mental health of nurses, physical health problems in nurses

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Authors: Sidra Rizwan

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The article focuses on the training needs of secondary school teachers related to the knowledge component of instructional planning and strategies as stated in the National professional standards for teachers in Pakistan. The study aimed to determine the training needs of secondary school teachers on different aspects of knowledge & understanding component of instructional planning and strategies. The target population of the study was the secondary school teachers across Pakistan. For this purpose, a sample of 400 secondary school teachers was selected through multistage sampling from all the four provinces and Federal capital area. Survey method was adopted to assess the training needs by using a self reporting tool. The tool helped to gauge the training needs through indirect inventory questions as well as a ranking list in which the respondents themselves prioritized their training areas. The results showed variation between the direct and indirect reporting of the teachers on the basis of which it was concluded that the secondary school teachers needed awareness about the knowledge component of instructional planning and strategies in order to redefine their actual training needs. The researcher further identified the training needs of secondary school teachers within each province and Islamabad capital territory; including an analysis of variations between strata. As teachers are considered agents of change, their training according to the professional standards should provide a solid base for “rethinking education”.

Keywords: training needs, secondary school teachers, instructional planning & strategies, knowledge & understanding

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Authors: S. Cheng, C. Catallo

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Introduction: Canada's healthcare and social services systems are failing high risk, vulnerable older adults. Care for vulnerable older Canadians (65 and older) is not optimal in Canada. It does not address the care needs of vulnerable, high risk adults using a holistic approach. Given the growing aging population, and the care needs for seniors with complex conditions is one of the highest in Canada's health care system, there is a sense of urgency to optimize care. Integration of health and social services is an emerging trend in Canada when compared to European countries. There is no common and universal understanding of healthcare and social services integration within the country. Consequently, a clear understanding and definition of integrated health and social services are absent in Canada. Objectives: A study was undertaken to develop a case definition for integrated health and social care initiatives that serve older adults, which was then tested against three Canadian integrated initiatives. Methodology: A limited literature review was undertaken to identify common characteristics of integrated health and social care initiatives that serve older adults, and comprised both scientific and grey literature, in order to develop a case definition. Three Canadian integrated initiatives that are located in the province of Ontario, were identified using an online search and a screening process. They were surveyed to determine if the literature-based integration definition applied to them. Results: The literature showed that there were 24 common healthcare and social services integration characteristics that could be categorized into ten themes: 1) patient-care approach; 2) program goals; 3) measurement; 4) service and care quality; 5) accountability and responsibility; 6) information sharing; 7) Decision-making and problem-solving; 8) culture; 9) leadership; and 10) staff and professional interaction. The three initiatives showed agreement on all the integration characteristics except for those characteristics associated with healthcare and social care professional interaction, collaborative leadership and shared culture. This disagreement may be due to several reasons, including the existing governance divide between the healthcare and social services sectors within the province of Ontario that has created a ripple effect in how professions in the two different sectors interact. In addition, the three initiatives may be at maturing levels of integration, which may explain disagreement on the characteristics associated with leadership and culture. Conclusions: The development of a case definition for healthcare and social services integration that incorporates common integration characteristics can act as a useful instrument in identifying integrated healthcare and social services, particularly given the emerging and evolutionary state of this phenomenon within Canada.

Keywords: Canada, case definition, healthcare and social services integration, integration, seniors health, services delivery

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Authors: Farnaz Farzadnia, Ahmad Alibabaei

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Enterprise Resource Planning (ERP) systems are considered as complicated information systems. Many organizations failed implementing ERP systems because it is a very difficult, time-consuming and expensive process. Enterprise resource planning system is appropriate for organizations in all economic sectors. As banking is currently considered a non-typical area for ERP usage, there are very little studies on ERP implementation in banking. This paper presents a general risks taxonomy. In this research, after identifying implementation risks, a process quality management method has been applied to identify relations between risks of implementation ERP in banking sectors and implementation phases. Oracle application implementation method titled as AIM used in this research for classifying the risks. These findings will help managers to develop better strategies for supervising and controlling ERP implementation projects.

Keywords: AIM implementation, bank, enterprise resource planning, risk, process quality management method

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Authors: Zhipeng Yan, Janice Wing-Tung Kwong, Ching-Lung Lai

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Background: Advanced melanoma accounts for the majority of skin cancer death due to its poor prognosis. Nivolumab and ipilimumab are monoclonal antibodies targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocytes antigen 4 (CTLA-4). Nivolumab and ipilimumab combination therapy has been proven to be effective for advanced melanoma. This systematic review and meta-analysis are to evaluate its clinical efficacy and adverse events. Method: A systematic search was done on databases (Pubmed, Embase, Medline, Cochrane) on 21 June 2020. Search keywords were nivolumab, ipilimumab, melanoma, and randomised controlled trials. Clinical trials fulfilling the inclusion criteria were selected to evaluate the efficacy of combination therapy in terms of prolongation of progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The odd ratios and distributions of grade 3 or above adverse events were documented. Subgroup analysis was performed based on PD-L1 expression-status and BRAF-mutation status. Results: Compared with nivolumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR in combination therapy were 0.64 (95% CI, 0.48-0.85; p=0.002), 0.84 (95% CI, 0.74-0.95; p=0.007) and 1.76 (95% CI, 1.51-2.06; p < 0.001), respectively. Compared with ipilimumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR were 0.46 (95% CI, 0.37-0.57; p < 0.001), 0.54 (95% CI, 0.48-0.61; p < 0.001) and 6.18 (95% CI, 5.19-7.36; p < 0.001), respectively. In combination therapy, the odds ratios of grade 3 or above adverse events were 4.71 (95% CI, 3.57-6.22; p < 0.001) compared with nivolumab monotherapy, and 3.44 (95% CI, 2.49-4.74; p < 0.001) compared with ipilimumab monotherapy, respectively. High PD-L1 expression level and BRAF mutation were associated with better clinical outcomes in patients receiving combination therapy. Conclusion: Combination therapy is effective for the treatment of advanced melanoma. Adverse events were common but manageable. Better clinical outcomes were observed in patients with high PD-L1 expression levels and positive BRAF-mutation.

Keywords: nivolumab, ipilimumab, advanced melanoma, systematic review, meta-analysis

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Authors: Abdelkader Ababneh

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Heritage management planning is increasingly important throughout the international context, particularly in the developing countries. Jordan has important and unique heritage resources due to its natural topography and climate, but also to its history and old sites. A high number of these archaeological sites are in very good state of preservation. Most natural sites and resources are privately managed while archaeological heritage sites are publicly managed within national legal texts and with some referencing to international legal documents. This study examines the development of cultural heritage management in Jarash, and questions if this heritage has been managed in an appropriate manner. The purpose of this paper is to define and review the stakeholders in charge of the management of the archaeological site of Jarash, the legal texts, laws and documents adopted to apply the site management. Relations and coordination between stakeholders and the challenge of the planning process is also the focus of this paper. A review of pertinent academic, technical studies, reports and projects literature pertaining to the heritage management planning in general and related to the site of Jarash in particular coupled with field study of the site served as the background of the information base for the study. Current context of actors, legislative framework, planning policies and initiatives for the site of Jarash reveal important and continuous challenge for managing the site. Recommendations suggest reviewing and restructuring the entity responsible of the sites management. It is also recommended to review their applied policies and a redevelopment of the legislative frame work.

Keywords: heritage management, stakeholders, legal protection, Jarash

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Authors: Kwanele Qonono

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Despite the significance and economic benefits of petrol stations in South Africa, these still pose a huge risk of fire and explosion threatening public safety. This research paper examines the extent to which land-use planning in Stellenbosch, South Africa, considers the fire risk posed by petrol stations and the implications for public safety as well as preparedness for large fires or explosions. To achieve this, the research identified the land-use types around petrol stations in Stellenbosch and determined the extent to which their locations comply with the local, national, and international land-use planning regulations. A mixed research method consisting of the collection and analysis of geospatial data and qualitative data was an applied method, where petrol stations within a six-kilometre radius of Stellenbosch’s town centre were utilised as study sites. The research examined the risk of fires/explosions at these petrol stations. The research investigated Stellenbosch Municipality’s institutional preparedness to respond in the event of a fire/explosion at these petrol stations. The research observed that siting of petrol stations does not comply with local, national, and international good practices, thus exposing the surrounding developments to fires and explosions. Land-use planning practice does not consider hazards created by petrol stations. Despite the potential for major fires at petrol stations, Stellenbosch Municipality’s level of preparedness to respond to petrol station fires appears low due to the prioritisation of more frequent events.

Keywords: petrol stations, technological hazard, drr, land-use planning, risk analysis

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Authors: Alisher Agzamov, Hanan Al Harbi

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BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists (1). We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study of 1501 oncology patients using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction, including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP, were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 210 +/- 40 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 140 +/- 35 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for oncology patients (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 29 % compared with the prerobot era, and there was an ICU cost savings of KD2.2 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, icu management and care, cost and icu occupancy

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Authors: Lourenço José, Elsa Melo, Sandra Viera, Ana Pinheiro

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Introduction: People with stroke in Angola face challenges in accessing appropriate healthcare and rehabilitation services. There is a lack of information on the quality of care provided and the development of early intervention plans Methods: Two different methods will be chosen. The exploratory, descriptive, and longitudinal study (E1) to characterize health care for people with stroke, housed in 2 hospitals in Luanda; the quality and transverse study (E2) concerning the development and evaluation of a strategic early intervention plan for a stroke patient. Ethical and deontological principles for an investigation will be proposed. Results: Contributor to the knowledge of the reality of providing care to the person after a stroke, in Angola; Propose and develop an early action plan. Contribute to integration to influence policy makers on the need for assistance with stroke, aiming at their functional, family and social rehabilitation, particularly in the labor market.

Keywords: stroke, functional recovery, quality of life, health

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Authors: Victor Arokia Doss, Kuberapandian Dharaniyambigai, K. Julia Rose Mary

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Advanced Glycation End (AGE) products are the end products due to the reaction between excess reducing sugar present in diabetes and free amino group in protein lipids and nucleic acids. Thus, non-enzymic glycation of molecules such as hemoglobin, collagen, and other structurally and functionally important proteins add to the pathogenic complications such as diabetic retinopathy, neuropathy, nephropathy, vascular changes, atherosclerosis, Alzheimer's disease, rheumatoid arthritis, and chronic heart failure. The most common non-cross linking AGE, carboxymethyl lysine (CML) is formed by the oxidative breakdown of fructosyllysine, which is a product of glucose and lysine. CML is formed in a wide variety of tissues and is an index to assess the extent of glycoxidative damage. Thus we have constructed a mathematical and computational model that predicts the effect of temperature differences in vivo, on the formation of CML, which is now being considered as an important intracellular milieu. This hybrid model that had been tested for its parameter fitting and its sensitivity with available experimental data paves the way for designing novel laboratory experiments that would throw more light on the pathological formation of AGE adducts and in the pathophysiology of diabetic complications.

Keywords: advanced glycation end-products, CML, mathematical model, computational model

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Authors: Rene Hellmuth

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The requirements for the factory planning and the building concerned have changed in the last years. Factory planning has the task of designing products, plants, processes, organization, areas, and the building of a factory. Regular restructuring gains more importance in order to maintain the competitiveness of a factory. Restrictions regarding new areas, shorter life cycles of product and production technology as well as a VUCA (volatility, uncertainty, complexity and ambiguity) world cause more frequently occurring rebuilding measures within a factory. Restructuring of factories is the most common planning case today. Restructuring is more common than new construction, revitalization and dismantling of factories. The increasing importance of restructuring processes shows that the ability to change was and is a promising concept for the reaction of companies to permanently changing conditions. The factory building is the basis for most changes within a factory. If an adaptation of a construction project (factory) is necessary, the inventory documents must be checked and often time-consuming planning of the adaptation must take place to define the relevant components to be adapted, in order to be able to finally evaluate them. The different requirements of the planning participants from the disciplines of factory planning (production planner, logistics planner, automation planner) and industrial construction planning (architect, civil engineer) come together during reconstruction and must be structured. This raises the research question: Which requirements do the disciplines involved in the reconstruction planning place on a digital factory model? A subordinate research question is: How can model-based decision support be provided for a more efficient design of the conversion within a factory? Because of the high adaptation rate of factories and its building described above, a methodology for rescheduling factories based on the requirements engineering method from software development is conceived and designed for practical application in factory restructuring projects. The explorative research procedure according to Kubicek is applied. Explorative research is suitable if the practical usability of the research results has priority. Furthermore, it will be shown how to best use a digital factory model in practice. The focus will be on mobile applications to meet the needs of factory planners on site. An augmented reality (AR) application will be designed and created to provide decision support for planning variants. The aim is to contribute to a shortening of the planning process and model-based decision support for more efficient change management. This requires the application of a methodology that reduces the deficits of the existing approaches. The time and cost expenditure are represented in the AR tablet solution based on a building information model (BIM). Overall, the requirements of those involved in the planning process for a digital factory model in the case of restructuring within a factory are thus first determined in a structured manner. The results are then applied and transferred to a construction site solution based on augmented reality.

Keywords: augmented reality, digital factory model, factory planning, restructuring

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Authors: Ivonne N. Pérez-Sánchez. María L. Rascón- Gasca, Angélica Riveros-Rosas, Rebeca Robles García

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Introduction: Primary caregivers of cancer patients have health problems related to their lack of time, stress, and fiscal strain. Their health problems could affect their patients’ health and also increase the expenses in public health. Aim: To describe self-care and risk behaviors in a sample of Mexican primary caregiver and the relation of these behaviors with emotional distress (caregiver burden, anxiety and depression symptoms), coping and sociodemographic variables. Method: Participated in this study 173 caregivers of a third level reference medical facility (age: M=49.4, SD=13.5) females 78%, males 22%, 57.5% were caregivers of patients with terminal cancer (CPTC), and 40.5% were caregivers of patients on oncology treatment (CPOT). Results: The 75.7% of caregivers reported to have had health problem in last six months as well as several symptoms which were related to emotional distress, these symptoms were more frequently between CPTC and female caregivers. A half (47.3%) of sample reported have had difficulties in caring their health; these difficulties were related to emotional distress and lower coping, more affected caregivers were who attend male patients and CPTC. The 76.8% of caregivers had health problems in last six months, but 26.5% of them waited to search medical care until they were very sick, and 11% didn't do it. Also, more than a half of sample (56.1%) admitted to have risk behaviors as drink alcohol, smoke or overeating for feeling well, these caregivers showed high emotional distress and lower coping. About caregivers healthy behaviors, 80% of them had a hobby; 27.2% do exercise usually and between 12% to 60% did medical checkups (glucose tests, blood pressure and cholesterol tests, eye exams and watched their weight), these caregivers had lower emotional distress and high coping, some variables related health behaviors were: care only one patient or a female patient and be a CPOT, social support, high educational level and experience as a caregiver in past. The half of caregivers were worrying to develop cancer in the future; this idea was 2.5 times more frequent in caregiver with problems to care their health. Conclusions: The results showed a big proportion of caregivers with medical problems. High emotional distress and low coping were related to physical symptoms, risk behaviors, and low self-care; poor self-care was frequently even in caregiver who have chronic illness.

Keywords: cancer, primary caregiver, risk behaviors, self-care

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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: Akhtar Nawaz, Sahar Noor, Iftikhar Hussain

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This paper considers advanced hybrid manufacturing planning both push and pull system in which each customer order has a due date by demand forecast and customer orders. We present a tool for model for tool development that requires an absolute due dates and customer orders in a manufacturing supply chain. It is vital for the manufacturing companies to face the problem of variations in demands, increase in varieties by maintaining safety stock and to minimize components obsolescence and uselessness. High inventory cost and low delivery lead time is expected in push type of system and on contrary high delivery lead time and low inventory cost is predicted in the pull type. For this tool for model we need an MRP system for the push and pull environment and control of inventories in push parts and lead time in the pull part. To retain process data quickly, completely and to improve responsiveness and minimize inventory cost, a tool is required to deal with the high product variance and short cycle parts. In practice, planning and scheduling are interrelated and should be solved simultaneously with supply chain to ensure that the due dates of customer orders are met. The proposed tool for model considers alternative process plans for job types, with precedence constraints for job operations. Such a tool for model has not been treated in the literature. To solve the model, tool was developed, so a new technique was required to deal with the issue of high product variance and short life cycles in assemble to order.

Keywords: hybrid manufacturing system, supply chain system, make to order, make to stock, assemble to order

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Authors: Edwin Javier Cortes, Surupa Shaw

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In recent years, there has been a growing emphasis on enhancing the efficiency and performance of wind and water turbines to meet the increasing demand for sustainable energy sources. One promising approach is the utilization of advanced flow control techniques to optimize aerodynamic performance. This paper explores the application of advanced flow control techniques in both wind and water turbines, aiming to maximize their efficiency and output. By manipulating the flow of air or water around the turbine blades, these techniques offer the potential to improve energy capture, reduce drag, and minimize turbulence-induced losses. The paper will review various flow control strategies, including passive and active techniques such as vortex generators, boundary layer suction, and plasma actuators. It will examine their effectiveness in optimizing turbine performance under different operating conditions and environmental factors. Furthermore, the paper will discuss the challenges and opportunities associated with implementing these techniques in practical turbine designs. It will consider factors such as cost-effectiveness, reliability, and scalability, as well as the potential impact on overall turbine efficiency and lifecycle. Through a comprehensive analysis of existing research and case studies, this paper aims to provide insights into the potential benefits and limitations of advanced flow control techniques for wind and water turbines. It will also highlight areas for future research and development, with the ultimate goal of advancing the state-of-the-art in turbine technology and accelerating the transition towards a more sustainable energy future.

Keywords: flow control, efficiency, passive control, active control

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Authors: Elizelle Juanee Cilliers

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Recent planning thinking has laid the foundations for a general sense of best practice that aims to enhance the quality of life, suggesting an open and participatory process. It is accepted that integration of top-down and bottom-up approaches may lead to efficient action in environments and sustainable planning and development, although it is also accepted that such an integrated approach has various challenges of implementation. A flexible framework in which the strengths of both the top-down and bottom-up approaches were explored in this research, based on the EU Interreg VALUE Added project and five case studies where student education and student involvement played a crucial role within the participation process of the redesign of the urban environment. It was found that international student workshops were an effective tool to integrate bottom-up and top-down structures, as it acted as catalyst for communication, interaction, creative design, quick transformation from planning to implementation, building social cohesion, finding mutual ground between stakeholders and thus enhancing overall quality of life and quality of environments. It offered a good alternative to traditional participation modes and created a platform for an integrative planning approach. The role and importance of education and integration within the urban environment were emphasized.

Keywords: top-down, bottom-up, flexible, student involvement

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Authors: C. P. Griffin

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This paper seeks to critically review special educational needs (SEN) policy in the Irish education system since the introduction of the Education Act in 1998. In particular, the author seeks to focus on the impact of SEN policy on inclusionary practices for children with significant care needs in light of the introduction on the Special Needs Assistant (SNA) scheme. Following a systematic review of the literature, the growth of the SNA scheme in Ireland will be critically reviewed. Strengths and weaknesses of the scheme will be forwarded and comparisons drawn between contrasting international models of teaching assistant support. Based on this review, avenues for future research will be forwarded, with the aim of supporting effective inclusionary practices for children with SEN based on evidence-based practice.

Keywords: care needs, inclusion, Ireland, special needs assistants

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Authors: Saeed M. Alshahrani

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This research integrated blockchain technology to reform medical records management in healthcare informatics. It was aimed at resolving the limitations of centralized systems by establishing a secure, decentralized, and user-centric platform. The system was architected with a sophisticated three-tiered structure, integrating advanced cryptographic methodologies, consensus algorithms, and the Fast Healthcare Interoperability Resources (HL7 FHIR) standard to ensure data security, transaction validity, and semantic interoperability. The research has profound implications for healthcare delivery, patient care, legal compliance, operational efficiency, and academic advancements in blockchain technology and healthcare IT sectors. The methodology adapted in this research comprises of Preliminary Feasibility Study, Literature Review, Design and Development, Cryptographic Algorithm Integration, Modeling the data and testing the system. The research employed a permissioned blockchain with a Practical Byzantine Fault Tolerance (PBFT) consensus algorithm and Ethereum-based smart contracts. It integrated advanced cryptographic algorithms, role-based access control, multi-factor authentication, and RESTful APIs to ensure security, regulate access, authenticate user identities, and facilitate seamless data exchange between the blockchain and legacy healthcare systems. The research contributed to the development of a secure, interoperable, and decentralized system for managing medical records, addressing the limitations of the centralized systems that were in place. Future work will delve into optimizing the system further, exploring additional blockchain use cases in healthcare, and expanding the adoption of the system globally, contributing to the evolution of global healthcare practices and policies.

Keywords: healthcare informatics, blockchain, medical records management, decentralized architecture, data security, cryptographic algorithms

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Authors: Olifan Degebas Olkeba

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Background: Males participate in family planning by utilizing the method, having discussions, approving decisions, and supporting their partners and other family members. One of the reasons Ethiopia has a low rate of FP use is the poor participation of men in family planning. So, the finding of the study could help married men and other stakeholders to alleviate the problems related to low involvement. Objective: To assess males’ involvement in family planning use and associated factors among married men in the pastoralist community of Yabelo district, Borena, Oromia, Ethiopia, 2024. Methods: Cross sectional study design supplemented by qualitative and multistage sampling method for quantitative one and purposive sampling method for qualitative was done. The interviewer administered questionnaires from 531 samples for quantitative and from 14 key informants for qualitative were taken. Quantitative data were entered using Epi Info version 7.2.2.6 and analyzed using SPSS version 24. Bivariate associations between dependent and independent variables were examined. Multi variable logistic regression analysis was done to identify factors significantly associated with male involvement. Qualitative data was analyzed using open code 4.03. The study was conducted from January 1-February 29, 2024. Results: A total of 531 respondents participated. The mean age of the study participant was 28 ±2.1 (SD). The prevalence of male involvement in FP use among married males in Yabelo district was 9.6 (AOR= 9.6, 95% CI: 7.14-12.15). Age above 40 years (AOR=0.18, 95% CI: 0.05-0.6 p=0.009), educational status unable read and write (AOR=9.4, 95% CI:3.5-25.4 p=0.001), read and write only (AOR=7.1, 95% CI:2.4-21.4 p=0.001), knowledge on side effects of FP (AOR=2.35, 95% CI: 1.09-5.06 p=0.029) were factors associated with male involvement in FP use. A total of 14 key informants participated in the interview of qualitative part and culturally perceived FP issues, lack of awareness and desire of more children were among the reasons for low involvement in FP use. Conclusion: The finding of the study showed that the magnitude of male involvement in family planning use was low. Age (>40), educational status (read and write only) and fear of side effects were factors associated with low husband involvement in FP use. Therefore, family planning programs need to target men at all levels of the service.

Keywords: family planning, male involvement, married men, Yabelo district

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Authors: Rajendra N. Ghosh, Paramjeet Singh, Niranjan Khandelwal, Sameer Vyas, Pratibha Singhi, Naveen Sankhyan

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Background: Tuberculoma and neurocysticercosis (NCC) are two most common intracranial infections in developing country. They often simulate on neuroimaging and in absence of typical imaging features cause significant diagnostic dilemmas. Differentiation is extremely important to avoid empirical exposure to antitubercular medications or nonspecific treatment causing disease progression. Purpose: Better characterization and differentiation of CNS tuberculoma and NCC by using morphological and multiple advanced functional MRI. Material and Methods: Total fifty untreated patients (20 tuberculoma and 30 NCC) were evaluated by using conventional and advanced sequences like CISS, SWI, DWI, DTI, Magnetization transfer (MT), T2Relaxometry (T2R), Perfusion and Spectroscopy. rCBV,ADC,FA,T2R,MTR values and metabolite ratios were calculated from lesion and normal parenchyma. Diagnosis was confirmed by typical biochemical, histopathological and imaging features. Results: CISS was most useful sequence for scolex detection (90% on CISS vs 73% on routine sequences). SWI showed higher scolex detection ability. Mean values of ADC, FA,T2R from core and rCBV from wall of lesion were significantly different in tuberculoma and NCC (P < 0.05). Mean values of rCBV, ADC, T2R and FA for tuberculoma and NCC were (3.36 vs1.3), (1.09x10⁻³vs 1.4x10⁻³), (0.13 x10⁻³ vs 0.09 x10⁻³) and (88.65 ms vs 272.3 ms) respectively. Tuberculomas showed high lipid peak, more choline and lower creatinine with Ch/Cr ratio > 1. T2R value was most significant parameter for differentiation. Cut off values for each significant parameters have proposed. Conclusion: Quantitative MRI in combination with conventional sequences can better characterize and differentiate similar appearing tuberculoma and NCC and may be incorporated in routine protocol which may avoid brain biopsy and empirical therapy.

Keywords: advanced functional MRI, differentiation, neurcysticercosis, tuberculoma

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Authors: Javed Mohammed

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As urbanization process has been and will be happening in an unprecedented scale worldwide, strong requirements from academic research and practical fields for smart management and intelligent planning of cities are pressing to handle increasing demands of infrastructure and potential risks of inhabitants agglomeration in disaster management. Geo-spatial data and Geographic Information System (GIS) are essential components for building smart cities in a basic way that maps the physical world into virtual environment as a referencing framework. On higher level, GIS has been becoming very important in smart cities on different sectors. In the digital city era, digital maps and geospatial databases have long been integrated in workflows in land management, urban planning and transportation in government. People have anticipated GIS to be more powerful not only as an archival and data management tool but also as spatial models for supporting decision-making in intelligent cities. The purpose of this project is to offer observations and analysis based on a detailed discussion of Geographic Information Systems( GIS) driven Framework towards the development of Smart and Sustainable Cities through high penetration of Renewable Energy Technologies.

Keywords: digital maps, geo-spatial, geographic information system, smart cities, renewable energy, urban planning

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Authors: M. A. Brown, K. Hugill, D. Meredith

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Since the establishment of midwifery, as a professional identity in its own right, in the early years of the 20th century, midwifery-led models of childbirth have prevailed in many parts of the world. However, in many locations midwives’ scope of practice remains underdeveloped or absent. In Qatar, all births take place in hospital and are under the professional jurisdiction of obstetricians, predominately supported by internationally trained nurse-midwives and obstetric nurses. The strategic vision for health services in Qatar endorsed a desire to provide women with the ‘Best Care Always’ and the introduction of midwifery was seen as a way to achieve this. In 2015 the process of recruiting postgraduate educated Clinical Midwife Specialists from international sources began. The midwives were brought together to initiate an in hospital and community service transformation plan. This plan set out a series of wide-ranging actions to transform maternity and neonatal services to make care safer and give women more health choices. Change in any organization is a complex and dynamic process. This is made even more complex when multifaceted professional and cross cultural factors are involved. This presentation reports upon the motivations and challenges that exist and the progress around introducing a multicultural midwifery model of childbirth care in the state of Qatar. The paper examines and reflects upon the drivers and unique features of childbirth in the country. Despite accomplishments, progress still needs to be made in order to fully implement sustainable changes to further improve care and ensure women and neonates get the ‘Best Care Always’. The progress within the transformation plan highlights how midwifery may coexist with competing models of maternity care to create an innovative, eclectic and culturally sensitive paradigm that can best serve women and neonatal health needs.

Keywords: culture, managing change, midwifery, neonatal, service transformation plan

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Authors: Fernando Augusto Ullmann Tobe, Moacyr Amaral Domingues, Figueiredo, Stephany Rie Yamamoto Gushiken

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The purpose of this paper is to present the process of elaborating the layout of an assembly line of a welding industry using the principles of lean manufacturing as the main driver. The objective of this paper is relevant since the current layout of the assembly line causes non-productive times for operators, being related to the lean waste of unnecessary movements. The methodology used for the project development was Project-based Learning (PBL), which is an active way of learning focused on real problems. The process of selecting the methodology for layout planning was developed considering three criteria to evaluate the most relevant one for this paper's goal. As a result of this evaluation, Systematic Layout Planning was selected, and three steps were added to it – Value Stream Mapping for the current situation and after layout changed and the definition of lean tools and layout type. This inclusion was to consider lean manufacturing in the layout redesign of the industry. The layout change resulted in an increase in the value-adding time of operations carried out in the sector, reduction in movement times between previous and final assemblies, and in cost savings regarding the man-hour value of the employees, which can be invested in productive hours instead of movement times.

Keywords: assembly line, layout, lean manufacturing, systematic layout planning

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Authors: Swati Rajput

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Environmental psychology explains that the person is a social agent that seeks to extract meaning from their built and natural environment to behave in a particular manner. It also shows the attachment or detachment of people to their environment. Assessing environmental psychology of people is imperative for planners and policy makers for urban planning. The paper investigates the environmental psychology of people living in nine districts of Delhi by calculating and assessing their Environmental Emotional Quotient (EEQ). Emotional Quotient deals with the ability to sense, understand, attach and respond according to the power of emotions. An Environmental Emotional Quotient has been formulated based upon the inventory administered to them. The respondents were asked questions related to their view and emotions about the green spaces, water resource conservation, air and environmental quality. An effort has been made to assess the feeling of belongingness among the residents. Their views were assessed on green spaces, reuse, and recycling of resources and their participation level. They were also been assessed upon health awareness level by considering both preventive and curative segments of health care. It was found that only 12 percent of the people is emotionally attached to their surroundings in the city. The emotional attachment reduces as we move away from the house to housing complex to neighbouring areas and rest of the city. In fact, the emotional quotient goes lower to lowest from house to other ends of the city. It falls abruptly after the radius of 1 km from the residence. The result also shows that nearly 54% respondents accept that there is environment pollution in their area. Around 47.8% respondents in the survey consider that diseases occur because of green cover depiction in their area. Major diseases are to airborne diseases like asthma and bronchitis. Seasonal disease prevalent, which specially occurred from last 3-4 years are malaria, dengue and chikengunya. Survey also shows that only 31 % of respondents visit government hospitals while 69% respondents visit private hospitals or small clinics for healthcare services. The paper suggests the need for environmental sensitive policies and need for green insurance in mega cities like Delhi.

Keywords: environmental psychology, environmental emotional quotient, preventive health care and curative health care, sustainable living

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Authors: William Coburn, Dylan Hauchard, Amel Naouali

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Background: The nature of the HIV epidemic in Puerto Rico (PR) is less understood than in the continental U.S. There is evidence to suggest that there are differences in health care access based on geographical location, such that rural areas are less underserved and have less immediate access to HIV prevention resources. Methods: The current study consists of a cross-sectional online survey of self-reporting HIV-negative sexual minority men (SMM) residing in PR. Results: In this sample, there were no differences between urban and rural-based services for SMM. However, more than half of the sample reported that they have never disclosed their gender identity and sexual practices to a physician. Conclusion: HIV is a significant public health concern affecting Latinos/Hispanics in the U.S. Findings in this paper can have implications for HIV prevention services in PR specifically, as few studies have directly focused on the impact of HIV and health care services in PR outside of the continental U.S.

Keywords: HIV, Puerto Rico, infectious diseases , public health

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