Search results for: patient communication

Authors: Prem, Norhaya, Vwrene C., Mohammad Harris A., Amarjit, Fazir M.

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Upper limb surgery is a common orthopedic procedure. After surgery, it is necessary to raise the patient's arm to reduce limb swelling and promote recovery. After an injury or surgery, swelling (edema) in the limbs is common. This swelling can be painful, cause stiffness, and affect movement and ability to do daily activities. One of the easiest ways to manage swelling is to elevate the swollen limb. The goal is to elevate the swollen limb slightly above the level of the heart. This helps the extra fluid move back towards the heart for circulation to the rest of the body. Conventional arm sling or pillows are usually placed under the arm to raise it, but in this way the arm cannot be fixed well and easily slide down, without ideal raising effect. Conventional arm sling need experience to tie the sling and this delay in the application process. To reduce the waiting time and cost, modified Norhaya upper limb elevation sling was designed and made readily available. The sling is made from calico fabric, readily available in the ward. Measurements of patients’ arm lengths are obtained, and fabric sizes are cut into the average arm lengths, as well as 1 size above and below. The cut calico fabric is then sewn together with thick sewing threads. Its application is easy and junior most staff or doctor will be able to apply it on patient. The time taken to set up the sling is also reduced. Feedback gathered from ground staff regarding ease of setting up the sling was tremendous and patient also feel comfort in the modified Norhaya sling. The device can freely adjust the raising height of the affected limb and effectively fix the affected limb to reduce its swelling, thus promoting recovery. This device is worthy to be clinically popularized and applied. The Modified Norhaya upper limb elevation sling is the quickest to set up and the delay in elevating the patient’s hand is significantly reduced. Moreover, it is reproducible and there is also significant cost savings.

Keywords: elevate, effective, sling, timely

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Authors: Yosra Benchaabene, Noureddine Boujnah, Faouzi Zarai

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To meet the growing demand of users, the fifth generation (5G) will continue to provide services to higher data rates with higher carrier frequencies and wider bandwidths. As part of the 5G communication paradigm, Ultra Reliable Communication (URC) is envisaged as an important technology pillar for providing anywhere and anytime services to end users. Ultra Reliable Communication (URC) is considered an important technology that why it has become an active research topic. In this work, we analyze the availability of a service in the space domain. We characterize spatially available areas consisting of all locations that meet a performance requirement with confidence, and we define cell availability and system availability, individual user availability, and user-oriented system availability. Poisson point process (PPP) and Voronoi tessellation are adopted to model the spatial characteristics of a cell deployment in heterogeneous networks. Numerical results are presented, also highlighting the effect of different system parameters on the achievable link availability.

Keywords: URC, dependability and availability, space domain analysis, Poisson point process, Voronoi Tessellation

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Authors: Krishna N. Gaikwad, V. R. Kakulte

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Rice (Oryza sativa L.) is the main cereal crop of tribal people of western part of Nasik district. There is a wide fluctuation in yield due to the factors like uncertain rains, pest diseases, socio-economic status of farmers, lack of awareness and traditional knowledge of farmers about agro-practices. In order to achieve more yield, it is a need to adopt low cost, eco-friendly blue green algal biofertilizer technology. Communication of useful information to needy people is basic need in present situation. The paper reports different communication modes of paddy technologies, adoption about BGA technology, attitudinal changes of farmers and yield of rice production during year 2011 and 2012. The results indicate that there is significant effect of communication modes of improved BGA technology on rice yield.

Keywords: rice, BGA, biofertilizer, Oryza sativa L.

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Authors: Semanur Savruk, Onur Akbatı

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Integration of various communication protocols into an automation system causes a rise in setup and maintenance cost and make to control network devices in difficulty. The gateway becomes necessary for reducing complexity in network topology. In this study, Modbus RTU/Modbus TCP industrial ethernet gateway design and implementation are presented with ARM embedded system and FreeRTOS real-time operating system. The Modbus gateway can perform communication with Modbus RTU and Modbus TCP devices over itself. Moreover, the gateway can be adjustable with the user-interface application or messaging interface. Conducted experiments and the results are presented in the paper. Eventually, the proposed system is a complete, low-cost, real-time, and user-friendly design for monitoring and setting devices and useful for meeting remote control purposes.

Keywords: gateway, industrial communication, modbus, network

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Authors: Janine Sommer, Mariana Daus, Mariana Simon, Maria Smith, Daniel Luna

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The technologies and communication advances contributed to new tools development which allows patients to have an active role in their own health. In the light of information needs and paradigms changes about health, the patient self-manages their care. This line of care focuses on patients; specific portals come up to people with particular requirements like pregnant women. Thinking of a portal design to this sector of the population, in September 2016 a survey was made to users with the objective to knowing and understanding information’s needs at the moment to use an application for pregnant. Also, prototypes of the portal´s features were designed to try and validate with users, using the methodology of human-centered design. Investigations have made possible the identification of needs of this population and develop a tool who try to satisfy, providing timely information for each part of pregnancy and allowing the patients to make a physical check and the follow up of pregnancy seeking advice from our obstetricians.

Keywords: electronic health record, health personal record, mobile applications, pregnant women

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Authors: Tingwei Shu, Dong Zhou, Chengjun Guo

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Semantic communication is an emerging form of communication that realize intelligent communication by extracting semantic information of data at the source and transmitting it, and recovering the data at the receiving end. It can effectively solve the problem of data transmission under the situation of large data volume, low SNR and restricted bandwidth. With the development of Deep Learning, semantic communication further matures and is gradually applied in the fields of the Internet of Things, Uumanned Air Vehicle cluster communication, remote sensing scenarios, etc. We propose an improved semantic communication system for the situation where the data volume is huge and the spectrum resources are limited during the transmission of remote sensing images. At the transmitting, we need to extract the semantic information of remote sensing images, but there are some problems. The traditional semantic communication system based on Convolutional Neural Network cannot take into account the global semantic information and local semantic information of the image, which results in less-than-ideal image recovery at the receiving end. Therefore, we adopt the improved vision-Transformer-based structure as the semantic encoder instead of the mainstream one using CNN to extract the image semantic features. In this paper, we first perform pre-processing operations on remote sensing images to improve the resolution of the images in order to obtain images with more semantic information. We use wavelet transform to decompose the image into high-frequency and low-frequency components, perform bilinear interpolation on the high-frequency components and bicubic interpolation on the low-frequency components, and finally perform wavelet inverse transform to obtain the preprocessed image. We adopt the improved Vision-Transformer structure as the semantic coder to extract and transmit the semantic information of remote sensing images. The Vision-Transformer structure can better train the huge data volume and extract better image semantic features, and adopt the multi-layer self-attention mechanism to better capture the correlation between semantic features and reduce redundant features. Secondly, to improve the coding efficiency, we reduce the quadratic complexity of the self-attentive mechanism itself to linear so as to improve the image data processing speed of the model. We conducted experimental simulations on the RSOD dataset and compared the designed system with a semantic communication system based on CNN and image coding methods such as BGP and JPEG to verify that the method can effectively alleviate the problem of excessive data volume and improve the performance of image data communication.

Keywords: semantic communication, transformer, wavelet transform, data processing

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Authors: Hugo Reis, Isabel Rabiais

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

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

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Authors: Thitima Plejai

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The practice in the operating room has been continually performed according to standards of services; however, undesirable incidents from surgical services are found such as surgical complications in the operating room. This participation action research aimed to develop practice guidelines for surgical safety management to reduce undesirable incidents from surgical services in the operating room of Songkhla Hospital. The target population was all 84 members of the multidisciplinary team who were involved in surgical services in the operating room consisting of 28 surgeons from five branches of surgery, 27 anesthetists and nurse anesthetists, and 29 surgical nurses. The data were collected through in-depth interviews, and non-participatory observations. The research instrument was tested by three experts, and the steps of the development consisted of four cycles, each consisting of assessment, planning, practice, practice reflection, and improvement until every step is practicable. The data were validated through triangulation research method, analyzed through content analysis and statistical analysis with number and percentage. The results of the development of practice guidelines surgical safety management to reduce undesirable incidents from surgical services could be concluded as follows. 1) The multidisciplinary team in surgery participated in the needs assessment for development of practice guidelines for surgical patient safety, and agreed on adapting the WHO Surgical Safety Checklists for use. 2) The WHO Surgical Safety Checklists was implemented, and meetings were held for the multidisciplinary team in surgery and the organizational risk committee to improve the practice guidelines to make them more practicable. 3) The multidisciplinary team consisting of surgeons from five branches of surgery, anesthetists, nurse anesthetists, surgical nurses, and the organizational risk committee announced policy on safety for surgical patients; the organizational risk committee designated the Surgical Safety Checklist as an instrument for surgical patient safety. The results of the safety management found that the surgical team members who could follow 100 percent of the guidelines were: professional nurses who checked patient identity and information before taking the patient to the operating room and kept complete records of data on the patients; surgical nurses who checked readiness of the patient before surgery; nurse anesthetists who assessed readiness before administering anesthetic drugs, and confirmed correctness of the patient; and circulating perioperative nurses who gave confirmation to the surgical team after completion of the surgery. The rates of undesirable incidents (surgical complications rates) before and after the implementation of the surgical safety management were 1.60 percent and 0.66 percent, respectively. The satisfaction of the surgery-related teams towards the use of the guidelines was 89 percent. The practice guidelines for surgical safety management to reduce undesirable incidents were taken as guidelines for surgical safety that the multidisciplinary team involved in the surgical process implemented correctly and in the same direction and clearly reduced undesirable incidents in surgical patients.

Keywords: practice guidelines, surgical safety management, reduce undesirable incidents, operating Room

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Authors: Lily Chimuanya, Esther Ajiboye, Emmanuel Uba

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One of the consequences of online communication is the birth of new orthography genres characterised by novel conventions of abbreviation and acronyms usually referred to as Netspeak. Netspeak, also known as internet slang, is a style of writing mainly used in online communication to limit the length of text characters and to save time. The aim of this study is to evaluate how second language users of the English language have internalised this new convention of writing; identify the recurrent patterns of Netspeak; and assess the consistency of the use of the identified patterns in relation to their meanings. The study is corpus-based, and data drawn from WhatsApp chart pages of selected groups of Nigerian English speakers show a large occurrence of inconsistencies in the patterns of Netspeak and their meanings. The study argues that rather than emphasise the negative impact of Netspeak on the communicative competence of second language users, studies should focus on suggesting models as yardsticks for standardising the usage of Netspeak and indeed all other emerging language conventions resulting from online communication. This stance stems from the inevitable global language transformation that is eminent with the coming of age of information technology.

Keywords: abbreviation, acronyms, Netspeak, online communication, standardisation

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Authors: Ayalew Tadese Kibret, Belayneh Sisay Alemu, Amare Kassaw Yimer

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Intelligent reflecting surfaces (IRSs) are considered to be a key enabling technology for sixth-generation (6G) wireless networks. IRSs are electromagnetic (EM) surfaces that are fabricated and have integrated electronics, electronically controlled processes, and particularly wireless communication features. IRSs operate without the need for complex signal processing and the encoding and decoding steps that improve the signal quality at the receiver. Improving vital performance parameters such as energy efficiency (EE) and spectral efficiency (SE) have frequently been the primary goals of research in order to meet the increasing requirements for advanced services in the future 6G communications. In this research, we conduct a comparative analysis on single and multi-IRS wireless communication networks using energy and spectrum efficiency. The energy efficiency versus user distance, energy efficiency versus signal to noise ratio, and spectral efficiency versus user distance are the basis for our result with 1, 2, 4, and 6 IRSs. According to the results of our simulation, in terms of energy and spectral efficiency, six IRS perform better than four, two, and single IRS. Overall, our results suggest that multi-IRS-assisted wireless communication systems outperform single IRS systems in terms of communication performance.

Keywords: sixth-generation (6G), wireless networks, intelligent reflecting surfaces, energy efficiency, spectral efficiency

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Authors: Donghee Kang

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Background: Cancer pain is very difficult to control as the mechanism of pain is varied, and the patient has several co-morbidities. The use of Intravenous Patient-Controlled Analgesia (IV-PCA) can effectively control underlying pain and breakthrough pain. Ketamine is used in many pain patients due to its unique analgesic effect. In this study, it was checked whether there was a difference in the amount of analgesic usage, pain control degree, and side effects between patients who controlled pain with fentanyl-based IV-PCA and those who added Ketamine for pain control. Methods: Among the patients referred to this department for cancer pain, IV-PCA was applied to patients who were taking sufficient oral analgesics but could not control them or had blood clotting disorders that made the procedure difficult, and this patient group was targeted. In IV-PCA, 3000 mcg of Fentanyl, 160 mg of Nefopam, and 0.3 mg of Ramosetrone were mixed with normal saline to make a total volume of 100 ml. Group F used this IV-PCA as it is, and group K mixed 250 mg of Ketamine with normal saline to make a total volume of 100 ml. For IV-PCA, the basal rate was 0.5ml/h, the bolus was set to 1ml when pressed once, and the lockout time was set to 15 minutes. If pain was not controlled after IV-PCA application, 500 mcg of Fentanyl was added, and if excessive sedation or breathing difficulties occurred, the use was stopped for one hour. After that, the degree of daily pain control, analgesic usage, and side effects were investigated for seven days using this IV-PCA. Results: There was no difference between the two groups in the demographic data. Both groups had adequate pain control. Initial morphine milligram equivalents did not differ between the two groups, but the total amount of Fentanyl used for seven days was significantly different between the two groups [p=0.014], and group F used more Fentanyl through IV-PCA. In addition, the amount of sleeping pills used during the seven days was higher in Group F [p<0.01]. Overall, there was no difference in the frequency of side effects between the two groups, but the nausea was more frequent in Group F [p=0.031]. Discussion: When the two groups were compared, pain control was good in both groups. This seems to be because Fentanyl-based IV-PCA showed an adequate pain control effect. However, there was a significant difference in the total amount of opioid (Fentanyl) used, which is thought to be the opioid-sparing effect of Ketamine. Also, among the side effects, nausea was significantly less, which is thought to be possible because the amount of opioids used in the Ketamine group was small. The frequency of requesting sleeping pills was significantly less in the group using Ketamine, and it seems that Ketamine also helped improve sleep quality. In conclusion, using Ketamine with an opioid to control pain seems to have advantages. IV-PCA, which can be used effectively when other procedures are difficult, is more effective and safer when used together with Ketamine than opioids alone.

Keywords: cancer pain, intravenous patient-controlled analgesia, Ketamine, opioid

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Authors: Elzbieta Sikorska-Simmons

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

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

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Authors: Man Li, Wanting Zhou, Lei Li

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Communication stability is the primary concern of communication satellites. Communication satellites are easily affected by particle radiation to generate single event effects (SEE), which leads to soft errors (SE) of the combinational logic circuit. The existing research on soft error rates (SER) of the combined logic circuit is mostly based on the assumption that the logic gates being bombarded have the same pulse width. However, in the actual radiation environment, the pulse widths of the logic gates being bombarded are different due to different linear energy transfers (LET). In order to improve the accuracy of SER evaluation model, this paper proposes a soft error rate evaluation method based on LET. In this paper, the authors analyze the influence of LET on the pulse width of combinational logic and establish the pulse width model based on the LET. Based on this model, the error rate of test circuit ISCAS'85 is calculated. The effectiveness of the model is proved by comparing it with previous experiments.

Keywords: communication satellite, pulse width, soft error rates, LET

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Authors: Mohammad Y. Abualhoul, Edgar Talavera Munoz, Fawzi Nashashibi

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The new emerging Visible Light Communication (VLC) technology has been subjected to intensive investigation, evaluation, and lately, deployed in the context of convoy-based applications for Intelligent Transportations Systems (ITS). The technology limitations were defined and supported by different solutions proposals to enhance the crucial alignment and mobility limitations. In this paper, we propose the incorporation of VLC technology and Lane-Centering (LC) technique to assure the VLC-connectivity by keeping the autonomous vehicle aligned to the lane center using vision-based lane detection in a convoy-based formation. Such combination can ensure the optical communication connectivity with a lateral error less than 30 cm. As soon as the road lanes are detectable, the evaluated system showed stable behavior independently from the inter-vehicle distances and without the need for any exchanged information of the remote vehicles. The evaluation of the proposed system is verified using VLC prototype and an empirical result of LC running application over 60 km in Madrid M40 highway.

Keywords: visible light communication, lane-centerin, platooning, intelligent transportation systems, road safety applications

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Authors: Kassem Saab, Fritzen Bart, Yves-Marie Seveque

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The deployment of Free Space Optical Communications (FSOC) systems requires the development of robust and reliable Optical Ground Stations (OGS) that can be easily installed and operated. To this end, the Engineering Department of Airbus Defence and Space is actively working on the development of innovative and compact OGS solutions that can be deployed in various environments and provide high-quality connectivity under different atmospheric conditions. This article presents an overview of our recent developments in this field, including an evaluation study of different use cases of the FSOC with respect to different atmospheric conditions. The goal is to provide OGS solutions that are both simple and highly effective, allowing for the deployment of high-speed communication networks in a wide range of scenarios.

Keywords: end to end optical communication, laser propagation, optical ground station, turbulence

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Authors: B. Karabuluter, O. Karaduman

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Connected-Vehicles consists of intelligent vehicles, each of which can communicate with each other. Smart Cities are the most prominent application area of intelligent vehicles that can communicate with each other. The most important goal that is desired to be realized in Smart Cities planned for facilitating people's lives is to make transportation more comfortable and safe with intelligent/autonomous/driverless vehicles communicating with each other. In order to ensure these, the city must have communication infrastructure in the first place, and the vehicles must have the features to communicate with this infrastructure and with each other. In this context, intelligent transport studies to solve all transportation and traffic problems in classical cities continue to increase rapidly. In this study, current connected-vehicle applications developed for smart cities are considered in terms of communication techniques, vehicular networking, IoT, urban transportation implementations, intelligent traffic management, road safety, self driving. Taxonomies and assessments performed in the work show the trend of studies in inter-vehicle communication systems in smart cities and they are contributing to by ensuring that the requirements in this area are revealed.

Keywords: smart city, connected vehicles, infrastructures, VANET, wireless communication, intelligent traffic management

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Authors: Pooja Sanathkumar, Srinidhi Murali, Sethuraman TV, Saravanan M, Paventhan Arumugam, Ashwin Ashok

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The last decade has witnessed a significant interest in visible light communication (VLC) technology, as VLC can potentially achieve high data rate links and secure communication channels. However, the use of VLC under mobile settings is fundamentally limited as its a line-of-sight (LOS) technology and there has been limited breakthroughs in realizing VLC for mobile settings. In this regard, this work targets to study the VLC channel under mobility. Through a use-case study analysis with experiment data traces this paper presents an empirical VLC channel study considering the application of VLC for smart lighting in an indoor room environment. This paper contributes a calibration study of a prototype VLC smart lighting system in an indoor environment and through the inferences gained from the calibration, and considering a user is carrying a mobile device fit with a VLC receiver, this work presents recommendations for user's position adjustments, with the goal to ensure maximum connectivity across the room.

Keywords: visible light communication, mobility, empirical study, channel characterization

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Authors: Aulia Dwi Nastiti

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A number of studies and reports on terrorism have continuously addressed the role of internet and online activism to support terrorist and extremist groups. In particular, they stress on social media’s usage that generally serves for the terrorist’s propaganda as well as justification of their causes. While those analyses are important to understand how social media is a vital tool for global network terrorism, they are inadequate to explain the online communication patterns that enable terrorism acts. Beyond apparent online narratives, there is a deep cyber sphere where the very vein of terrorism movement lies. That is a hidden space in the internet called ‘darknet’. Recent investigations, particularly in Middle Eastern context, have shed some lights that this invisible space in the internet is fundamental to maintain the terrorist activities. Despite that, limited number of research examines darknet within the issue of terrorist movements in Indonesian context—where the country is considered quite a hotbed for extremist groups. Therefore, this paper attempts to provide an insight of darknet operation in Indonesian cases. By exploring how the darknet is used by the Indonesian-based extremist groups, this paper maps out communication patterns of terrorist groups on the internet which appear as an intermingled network. It shows the usage of internet is differentiated in different level of anonymity for distinctive purposes. This paper further argues that the emerging terrorist communication network calls for a more comprehensive counterterrorism strategy on the Internet.

Keywords: communication pattern, counterterrorism, darknet, extremist groups, terrorism

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Authors: A. A. Md. Ryhan Uddin, Swarup Das, Rajesh Barua, Joheb Hasan, Rashedul Islam

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Background: The herbicide has toxicological importance because some of them are associated with high mortality rates due to respiratory failure. Organophosphate poisoning (OPC) & Paraquat self-poisoning is a major clinical and public health problems in low and middle-income countries across much of South Asia. Paraquat was not used as a common suicidal agent previously in Bangladesh. We report a case of 15 years old female admitted to the ER with a history of nausea & vomiting after ingestion of an unknown substance in a suicidal attempt, later identified as mixed poisoning- OPC & Paraquat. She was initially asymptomatic but later developed renal shutdown & lung injuries as well as pneumothorax, referred to as Daisley Barton Syndrome. Objective: This case report aims to alert spontaneous pneumothorax in mixed poisoning on uncommon forms of presentation. Pneumothorax in a patient with paraquat poisoning is a less unusual but underdiagnosed finding. It has a high index of early mortality. Case history: The patient's attendant complained about nausea followed by vomiting, which was nonprojectile & contains undigested food materials first, then gastric juice later. After a few hours, she also complains of urinary retention. Her family members treated her with some home remedies for her initial symptoms, but all attempts failed. After admission, the patient was initially asymptomatic. Through repeated history taking, her attendant showed a bottle of OPC in liquid form, which they suspected that she may have ingested some of the liquid from that bottle accidentally or attempted Suicide. So, management started for OPC poisoning. She responded well initially, but on 4th day of admission, the patient's condition became deteriorating. After the workout with the family member, 2nd bottle of Pesticide was discovered, which was Paraquat. Conclusion: Physicians should be aware of the symptoms of mixed poisoning and the timely use of urine dithionate testing for early detection and treatment. Pneumothorax is an early predictor of mortality in patients with paraquat poisoning.

Keywords: pneumothorax, suicide, dithionate, OPC, herbicide

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Authors: Chaliya Wamaloon, Malee Chaisaena, Nusara Prasertsri

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

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

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Authors: Roseanne Sharon Borromeo, Mariana Carvalho, Mariia Karizhenskaia

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Healthcare providers need to comprehend cultural diversity for optimal patient-centered care, especially near the end of life. Although a universal method for navigating cultural differences would be ideal, culture’s high complexity makes this strategy impossible. Adding cultural humility, a process of self-reflection to understand personal and systemic biases and humbly acknowledging oneself as a learner when it comes to understanding another's experience leads to a meaningful process in palliative care generating respectful, honest, and trustworthy relationships. This study is a systematic review of the literature on cultural humility in palliative care research and best practices. Race, religion, language, values, and beliefs can affect an individual’s access to palliative care, underscoring the importance of culture in palliative care. Cultural influences affect end-of-life care perceptions, impacting bereavement rituals, decision-making, and attitudes toward death. Cultural factors affecting the delivery of care identified in a scoping review of Canadian literature include cultural competency, cultural sensitivity, and cultural accessibility. As the different parts of the world become exponentially diverse and multicultural, healthcare providers have been encouraged to give culturally competent care at the bedside. Therefore, many organizations have made cultural competence training required to expose professionals to the special needs and vulnerability of diverse populations. Cultural competence is easily standardized, taught, and implemented; however, this theoretically finite form of knowledge can dangerously lead to false assumptions or stereotyping, generating poor communication, loss of bonds and trust, and poor healthcare provider-patient relationship. In contrast, Cultural humility is a dynamic process that includes self-reflection, personal critique, and growth, allowing healthcare providers to respond to these differences with an open mind, curiosity, and awareness that one is never truly a “cultural” expert and requires life-long learning to overcome common biases and ingrained societal influences. Cultural humility concepts include self-awareness and power imbalances. While being culturally competent requires being skilled and knowledgeable in one’s culture, being culturally humble involves the sometimes-uncomfortable position of healthcare providers as students of the patient. Incorporating cultural humility emphasizes the need to approach end-of-life care with openness and responsiveness to various cultural perspectives. Thus, healthcare workers need to embrace lifelong learning in individual beliefs and values on suffering, death, and dying. There have been different approaches to this as well. Some adopt strategies for cultural humility, addressing conflicts and challenges through relational and health system approaches. In practice and research, clinicians and researchers must embrace cultural humility to advance palliative care practices, using qualitative methods to capture culturally nuanced experiences. Cultural diversity significantly impacts patient-centered care, particularly in end-of-life contexts. Cultural factors also shape end-of-life perceptions, impacting rituals, decision-making, and attitudes toward death. Cultural humility encourages openness and acknowledges the limitations of expertise in one’s culture. A consistent self-awareness and a desire to understand patients’ beliefs drive the practice of cultural humility. This dynamic process requires practitioners to learn continuously, fostering empathy and understanding. Cultural humility enhances palliative care, ensuring it resonates genuinely across cultural backgrounds and enriches patient-provider interactions.

Keywords: cultural competency, cultural diversity, cultural humility, palliative care, self-awareness

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Authors: Butta Singh

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This paper presents a chaotic map based approach for secured embedding of patient’s confidential data in electrocardiogram (ECG) signal. The chaotic map generates predefined locations through the use of selective control parameters. The sample value difference method effectually hides the confidential data in ECG sample pairs at these predefined locations. Evaluation of proposed method on all 48 records of MIT-BIH arrhythmia ECG database demonstrates that the embedding does not alter the diagnostic features of cover ECG. The secret data imperceptibility in stego-ECG is evident through various statistical and clinical performance measures. Statistical metrics comprise of Percentage Root Mean Square Difference (PRD) and Peak Signal to Noise Ratio (PSNR). Further, a comparative analysis between proposed method and existing approaches was also performed. The results clearly demonstrated the superiority of proposed method.

Keywords: chaotic maps, ECG steganography, data embedding, electrocardiogram

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Authors: Rasha Alsabbah

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This study explores the relationship between polite language use and religion in the Iraqi culture in computer mediated communication. It tackles the speech acts where these expressions are employed, the frequency of their occurrence and the aims behind them. It also investigates if they have equivalent expressions in English and the possibility of translating them in intercultural communication. Despite the wide assumption that language is a reflection of culture and religion, it started to grant the attention sociologists during the recent 40 years when scholars have questioned the possible interconnection between religion and language in which religion is used as a mean of producing language and performing pragmatic functions. It is presumed that Arabs in general, and Iraqis in particular, have an inclination to use religious vocabulary in showing politeness in their greeting and other speech acts. Due to Islamic religion and culture’s influences, it is observed that Iraqis are very much concerned of maintaining social solidarity and harmonious relationships which make religion a politeness strategy that operates as the key point of their social behaviours. In addition, religion has found to influence almost all their interactions in which they have a tendency of invoking religious expressions, the lexicon of Allah (God), and Qur’anic verses in their daily politeness discourse. This aspect of Islamic culture may look strange, especially to people who come from individualist societies, such as England. Data collection in this study is based on messaging applications like Viber, WhatsApp, and Facebook. After gaining the approval of the participants, there was an investigation for the different aims behind these expressions and the pragmatic function that they perform. It is found that Iraqis tend to incorporate the lexicon of Allah in most of their communication. Such employment is not only by religious people but also by individuals who do not show strong commitment to religion. Furthermore, the social distance and social power between people do not play a significant role in increasing or reducing the rate of using these expressions. A number of these expressions, though can be translated into English, do not have one to one counterpart or reflect religious feeling. In addition, they might sound odd upon being translated or transliterated in oral and written communication in intercultural communication.

Keywords: computer mediated communication (CMC), intercultural communication, politeness, religion, situation bound utterances rituals, speech acts

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

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

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

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Authors: Erika Humphreys

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The effectiveness of treating anxiety with Reiki is explored within ten quantitative studies. The methodology utilized for a critical appraisal and systematic review of the literature is explained with inclusion and exclusion criteria. The theoretical framework for the project is grounded in the work of Hildegard Peplau, whose nursing theory based on the therapeutic use of self is foundational for Reiki implementation. A thorough critique of the literature is conducted for key components of robustness and believability. This critique is conducted using a structured guide addressing synthesized strengths and weaknesses of the body of literature. A synthesis of the literature explores the findings of the studies. This synthesis reports on Reiki’s effectiveness in treating anxiety within a variety of patient settings and populations, its effect on subscales of anxiety, physiological manifestations of anxiety, and pain associated with anxiety. Cultural considerations affecting Reiki’s potential effectiveness are discussed. Gaps in the literature are examined, including the studies’ narrow sample population, lack of participant exclusionary factors for controlled outcome data, and the lack of studies across time. Implications for future research are discussed with recommendations for expanded research that includes a broader variety of settings, age groups, and patient diagnoses, including anxiety disorders, for research data that is transferable. Implications for further practice for the advanced practice registered nurse (APRN) are explored, with the potential benefits for both providers and patients, including improved patient satisfaction and expansion of provider treatment modalities.

Keywords: Reiki, anxiety, complementary alternative medicine, pandemic

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Authors: Sarah Hazelwood, Janice Hay

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Methoxyflurane is an inhaled analgesic administered via a disposable inhaler, which has been used in Australia for 40 years for the management of pain in children & adults. However, there is a lack of data for methoxyflurane as a frontline analgesic medication within the emergency department (ED). This study will investigate the usefulness of methoxyflurane in a private inner-city ED. The study concluded that the inclusion of all key stakeholders in the prescribing, administering & use of this new process led to comprehensive uptake & vastly positive outcomes for consumer & health professionals. Method: A 12-week prospective pilot study was completed utilizing patients presenting to the ED in pain (numeric pain rating score > 4) that fit the requirement of methoxyflurane use (as outlined in the Australian Prescriber information package). Nurses completed a formatted spreadsheet for each interaction where methoxyflurane was used. Patient demographics, day, time, initial numeric pain score, analgesic response time, the reason for use, staff concern (free text), & patient feedback (free text), & discharge time was documented. When clinical concern was raised, the researcher retrieved & reviewed patient notes. Results: 140 methoxyflurane inhalers were used. 60% of patients were 31 years of age & over (n=82) with 16% aged 70+. The gender split; 51% male: 49% female. Trauma-related pain (57%) saw the highest use of administration, with the evening hours (1500-2259) seeing the greatest numbers used (39%). Tuesday, Thursday & Sunday shared the highest daily use throughout the study. A minimum numerical pain score of 4/10 (n=13, 9%), with the ranges of 5 - 7/10 (moderate pain) being given by almost 50% of patients. Only 3 instances of pain scores increased post use of methoxyflurane (all other entries showed pain score < initial rating). Patients & staff noted obvious analgesic response within 3 minutes (n= 96, 81%, of administration). Nurses documented a change in patient vital signs for 4 of the 15 patient-related concerns; the remaining concerns were due to “gagging” on the taste, or “having a coughing episode”; one patient tried to leave the department before the procedure was attended (very euphoric state). Upon review of the staff concerns – no adverse events occurred & return to therapeutic vitals occurred within 10 minutes. Length of stay for patients was compared with similar presentations (such as dislocated shoulder or ankle fracture) & saw an average 40-minute decrease in time to discharge. Methoxyflurane treatment was rated “positively” by > 80% of patients – with remaining feedback related to mild & transient concerns. Staff similarly noted a positive response to methoxyflurane as an analgesic & as an added tool for frontline analgesic purposes. Conclusion: Methoxyflurane should be used on suitable patient presentations requiring immediate, short term pain relief. As a highly portable, non-narcotic avenue to treat pain this study showed obvious therapeutic benefit, positive feedback, & a shorter length of stay in the ED. By partnering with key stake holders, this study determined methoxyflurane use decreased work load, decreased wait time to analgesia, and increased patient satisfaction.

Keywords: analgesia, benefits, emergency, methoxyflurane

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Authors: Hamide Farshad, Mohammadreza Javidi Abdollah Zadeh Aval

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As a result of the growing penetration of the media into human life, a new role under the title of "audience" is defined in the social life .A kind of role which is dramatically changed since its formation. This article aims to define the audience position in the new media equations which is concluded to the transformation of the media role. By using the Library and Attributive method to study the history, the evolutionary outlook to the audience and the recognition of the audience and the media relation in the new media context is studied. It was perceived in past that public communication would result in receiving the audience. But after the emergence of the interactional media and transformation in the audience social life, a new kind of public communication is formed, and also the imaginary picture of the audience is replaced by the audience impact on the communication process. Part of this impact can be seen in the form of feedback which is one of the public communication elements. In public communication, the audience feedback is completely accepted. But in many cases, and along with the audience feedback, the media changes its direction; this direction shift is known as media feedback. At this state, the media and the audience are both doers and consistently change their positions in an interaction. With the greater number of the audience and the media, this process has taken a new role, and the role of this doer is sometimes taken by an audience while influencing another audience, or a media while influencing another media. In this article, this multiple public communication process is shown through representing a model under the title of ”The bilateral influence of the audience and the media.” Based on this model, the audience and the media power are not the two sides of a coin, and as a result, by accepting these two as the doers, the bilateral power of the audience and the media will be complementary to each other. Also more, the compatibility between the media and the audience is analyzed in the bilateral and interactional relation hypothesis, and by analyzing the action law hypothesis, the dos and don’ts of this role are defined, and media is obliged to know and accept them in order to be able to survive. They also have a determining role in the strategic studies of a media.

Keywords: audience, effect, media, interaction, action laws

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Authors: Karim Matter, Heba Fayed, Ahmed Abd-Elaziz, Moustafa Hussein

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Due to the exponential growth of mobile devices and wireless services, a huge demand for radiofrequency has increased. The presence of several frequencies causes interference between cells, which must be minimized to get the lower Bit Error Rate (BER). For this reason, it is of great interest to use visible light communication (VLC). This paper suggests a VLC system that decreases the BER by applying a new LED distribution with a hexagonal shape using a Frequency Reuse (FR) concept to mitigate the interference between the reused frequencies inside the hexagonal shape. The BER is measured in two scenarios, Line of Sight (LoS) and Non-Line of Sight (Non-LoS), for each technique that we used. The recommended values of BER in the proposed model for Soft Frequency Reuse (SFR) in the case of Los at 4, 8, and 10 dB signal to noise ratio (SNR), are 3.6×10⁻⁶, 6.03×10⁻¹³, and 2.66×10⁻¹⁸, respectively.

Keywords: visible light communication (VLC), field of view (FoV), hexagonal array, frequency reuse

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Authors: Zainab Elazab, Azhar Aziz

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Background: Spontaneous Splenic artery pseudoaneurysm rupture is a rare condition which is potentially life threatening, if not detected and managed early. We report a case of abdominal pain with intraperitoneal free fluid, which turned out to be spontaneous rupture of a splenic artery pseudoaneurysm, and was treated with arterial embolization. Case presentation: A 28-year old, previously healthy male presented to the ED with a history of sudden onset upper abdominal pain and fainting attack. The patient denied any history of trauma or prior similar attacks. On examination, the patient had tachycardia and a low-normal BP (HR 110, BP 106/66) but his other vital signs were normal (Temp. 37.2, RR 18 and SpO2 100%). His abdomen was initially soft with mild tenderness in the upper region. Blood tests showed leukocytosis of 12.3 X109/L, Hb of 12.6 g/dl and lactic acid of 5.9 mmol/L. Ultrasound showed trace of free fluid in the perihepatic and perisplenic areas, and a splenic hypoechoic lesion. The patient remained stable; however, his abdomen became increasingly tender with guarding. We made a provisional diagnosis of a perforated viscus and the patient was started on IV fluids and IV antibiotics. An erect abdominal x-ray did not show any free air under the diaphragm so a CT abdomen was requested. Meanwhile, bedside ultrasound was repeated which showed increased amount of free fluid, suggesting intra-abdominal bleeding as the most probable etiology for the condition. His CT abdomen revealed a splenic injury with multiple lacerations, a focal intrasplenic enhancing area on venous phase scan (suggesting a pseudoaneurysm with associated splenic intraparenchymal, sub capsular and perisplenic hematomas). Free fluid in the subhepatic and intraperitoneal regions along the small bowel was also detected. Angiogram was done which confirmed a diagnosis of pseudoaneurysm of intrasplenic arterial branch, and angio-embolization was done to control the bleeding. The patient was later discharged in good condition with a surgery follow-up. Conclusion: Splenic artery pseudoaneurysm rupture is a rare cause of abdominal pain which should be considered in any case of abdominal pain with intraperitoneal bleeding. Early management is crucial as it carries a high mortality. Bedside ultrasound is a useful tool to help for early diagnosis of such cases.

Keywords: abdominal pain, pseudo aneurysm, rupture, splenic artery

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Authors: E. Tugba Topcu

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The emergency services are usually the first places to encounter forensic cases. Hence, it is important to consider forensics from the perspective of the emergency services staff and the physiological and psychological consequences that may arise as a result of behaviour by itself or another person. Accurate and detailed documentation of the situation in which the patient first arrives at the emergency service and preservation of the forensic findings is pivotal for the subsequent forensic investigation. The first step in determining whether or not a forensic case exists is to perform a medical examination of the patient. For each individual suspected to be part of a forensic case, police officers should be informed at the same time as the medical examination is being conducted. Violent events are increasing every year and with an increase in the number of forensic cases, emergency service workers have increasing responsibility and consequently play a key role in protecting, collecting and arranging the forensic evidence. In addition, because the emergency service workers involved in forensic events typically have information about the accused and/or victim, as well as evidence related to the events and the cause of injuries, police officers often require their testimony. However, both nurses and other health care personnel do not typically have adequate expertise in forensic medicine. Emergency nurses should take an active role for determining that whether any patient admitted to the emergency services is a clinical forensic patient the emergency service with injury and requiring possible punishment and knowing of their roles and responsibilities in this area provides legal protection as well as the protection of the judicial affair. Particularly, in emergency services, where rapid patient turnover and high workload exists, patient registration and case reporting may not exist. In such instances, the witnesses, typically the nurses, are often consulted for information. Knowledge of forensic medical matters plays a vital role in achieving justice. According to the Criminal Procedure Law, Article 75, Paragraph 3, ‘an internal body examination or the taking of blood or other biological samples from the body can be performed only by a doctor or other health professional member’. In favour of this item, the clinic nurse and doctor are mainly responsible for evaluating forensic cases in emergency departments, performing the examination, collecting evidence, and storing and reporting data. The courts place considerable importance on determining whether a suspect is the victim or accused and, thus, in terms of illuminating events, it is crucial that any evidence is gathered carefully and appropriately. All the evidence related to the forensic case including the forensic report should be handed over to the police officers. In instances where forensic evidence cannot be collected and the only way to obtain the evidence is the hospital environment, health care personnel in emergency services need to have knowledge about the diagnosis of forensic evidence, the collection of evidence, hiding evidence and provision of the evidence delivery chain.

Keywords: emergency department, emergency nursing, forensic cases, forensic nursing

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