Search results for: healthcare supply chain

Authors: Jianlin Wang, Jiajia Zhao

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This paper applies the theory and empirical method to examine the relationship between electricity price and coal price, as well as electricity and industry output, for China during Jan 1999-Dec 2012. Our results indicate that there is no any causality between coal price and electricity price under other factors are controlled. However, we found a bi-directional causality between electricity consumption and industry output. Overall, the electricity price set by China’s NDRC is inefficient, which lead to the electricity supply shortage after 2004. It is time to reform electricity price system for China’s reformers.

Keywords: electricity price, coal price, power supply, China

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Authors: Diana F. Lopes, Jorge Simoes, José Martins, Eduardo Castro

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Health professionals are the keystone of any health system, by delivering health services to the population. Given the time and cost involved in training new health professionals, the planning process of the health workforce is particularly important as it ensures a proper balance between the supply and demand of these professionals and it plays a central role on the Health 2020 policy. In the past 40 years, the planning of the health workforce in Portugal has been conducted in a reactive way lacking a prospective vision based on an integrated, comprehensive and valid analysis. This situation may compromise not only the productivity and the overall socio-economic development but the quality of the healthcare services delivered to patients. This is even more critical given the expected shortage of the health workforce in the future. Furthermore, Portugal is facing an aging context of some professional classes (physicians and nurses). In 2015, 54% of physicians in Portugal were over 50 years old, and 30% of all members were over 60 years old. This phenomenon associated to an increasing emigration of young health professionals and a change in the citizens’ illness profiles and expectations must be considered when planning resources in healthcare. The perspective of sudden retirement of large groups of professionals in a short time is also a major problem to address. Another challenge to embrace is the health workforce imbalances, in which Portugal has one of the lowest nurse to physician ratio, 1.5, below the European Region and the OECD averages (2.2 and 2.8, respectively). Within the scope of the HEALTH 2040 project – which aims to estimate the ‘Future needs of human health resources in Portugal till 2040’ – the present study intends to get a comprehensive dynamic approach of the problem, by (i) estimating the needs of physicians and nurses in Portugal, by specialties and by quinquenium till 2040; (ii) identifying the training needs of physicians and nurses, in medium and long term, till 2040, and (iii) estimating the number of students that must be admitted into medicine and nursing training systems, each year, considering the different categories of specialties. The development of such approach is significantly more critical in the context of limited budget resources and changing health care needs. In this context, this study presents the drivers of the healthcare needs’ evolution (such as the demographic and technological evolution, the future expectations of the users of the health systems) and it proposes a Bayesian methodology, combining the best available data with experts opinion, to model such evolution. Preliminary results considering different plausible scenarios are presented. The proposed methodology will be integrated in a user-friendly decision support system so it can be used by politicians, with the potential to measure the impact of health policies, both at the regional and the national level.

Keywords: bayesian estimation, health economics, health workforce planning, human health resources planning

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Authors: Kamran Jawed, Anu Jose Mattam, Zia Fatma, Saima Wajid, Malik Z. Abdin, Syed Shams Yazdani

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Worldwide demand of natural and sustainable fuels and chemicals have encouraged researchers to develop microbial platform for synthesis of short chain fatty acids as they are useful precursors to replace petroleum-based fuels and chemicals. In this study, we evaluated the role of fatty acid synthesis and β-oxidation cycle of Escherichia coli to produce butyric acid, a 4-carbon short chain fatty acid, with the help of three thioesterases, i.e., TesAT from Anaerococcus tetradius, TesBF from Bryantella formatexigens and TesBT from Bacteroides thetaiotaomicron. We found that E. coli strain transformed with gene for TesBT and grown in presence of 8 g/L glucose produced maximum butyric acid titer at 1.46 g/L, followed by that of TesBF at 0.85 g/L and TesAT at 0.12 g/L, indicating that these thioesterases were efficiently converting short chain fatty acyl-ACP intermediate of fatty acid synthesis pathway into the corresponding acid. The titer of butyric acid varied significantly depending upon the plasmid copy number and strain genotype. Deletion of genes for fatty acyl-CoA synthetase and acyl-CoA dehydrogenase, which are involved in initiating the fatty acid degradation cycle, and overexpression of FadR, which is a dual transcriptional regulator and exerts negative control over fatty acid degradation pathway, reduced up to 30% of butyric acid titer. This observation suggested that β-oxidation pathway is working synergistically with fatty acid synthesis pathway in production of butyric acid. Moreover, accelerating the fatty acid elongation cycle by overexpressing acetyl-CoA carboxyltransferase (Acc) and 3-hydroxy-acyl-ACP dehydratase (FabZ) or by deleting FabR, the transcription suppressor of elongation, did not improve the butyric acid titer, rather favored the long chain fatty acid production. Finally, a balance between cell growth and butyric acid production was achieved with the use of phosphorous limited growth medium and 14.3 g/L butyric acid, and 17.5 g/L total free fatty acids (FFAs) titer was achieved during fed-batch cultivation. We have engineered an E. coli strain which utilizes the intermediate of both fatty acid synthesis and degradation pathway, i.e. butyryl-ACP and -CoA, to produce butyric acid from glucose. The strategy used in this study resulted in highest reported titers of butyric acid and FFAs in engineered E. coli.

Keywords: butenoic acid, butyric acid, Escherichia coli, fed-batch fermentation, short chain fatty acids, thioesterase

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Authors: A. Shirazibeheshti, T. Radwan, A. Ettefaghian, G. Wilson, C. Luca, Farbod Khanizadeh

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Anticholinergic medication has been associated with events such as falls, delirium, and cognitive impairment in older patients. To further assess this, anticholinergic burden scores have been developed to quantify risk. A risk model based on clustering was deployed in a healthcare management system to cluster patients into multiple risk groups according to anticholinergic burden scores of multiple medicines prescribed to patients to facilitate clinical decision-making. To do so, anticholinergic burden scores of drugs were extracted from the literature, which categorizes the risk on a scale of 1 to 3. Given the patients’ prescription data on the healthcare database, a weighted anticholinergic risk score was derived per patient based on the prescription of multiple anticholinergic drugs. This study was conducted on over 300,000 records of patients currently registered with a major regional UK-based healthcare provider. The weighted risk scores were used as inputs to an unsupervised learning algorithm (mean-shift clustering) that groups patients into clusters that represent different levels of anticholinergic risk. To further evaluate the performance of the model, any association between the average risk score within each group and other factors such as socioeconomic status (i.e., Index of Multiple Deprivation) and an index of health and disability were investigated. The clustering identifies a group of 15 patients at the highest risk from multiple anticholinergic medication. Our findings also show that this group of patients is located within more deprived areas of London compared to the population of other risk groups. Furthermore, the prescription of anticholinergic medicines is more skewed to female than male patients, indicating that females are more at risk from this kind of multiple medications. The risk may be monitored and controlled in well artificial intelligence-equipped healthcare management systems.

Keywords: anticholinergic medicines, clustering, deprivation, socioeconomic status

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Authors: Shu-Hui Chuang, Shao-Chun Chiu, Shu-Hsin Chuang

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While the marketing management literature is regarding the direct benefits of market orientation (MO) on firm value, the impact of such MO-based value co-creation remains largely an unexplored area of research. Thus, the primary objective of this study is to provide some new perspectives in examining how MO can enhance value co-creation for customers and sellers. In particular, drawing from the relational view of the firm and IT literature, we propose that the chain of MO-based co-creation of value and how adopt e-marketing systems between partners can facilitate this chain. Using data on use of the e-marketing system, we empirically validate that the sellers’ integrated MO is critical in increasing the e-marketing adoption, which in turn helps to creation co-creation value for both parties.

Keywords: market orientation, value co-creation, e-marketing system, relational view of the firm

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Authors: Peiyin Hung, Katy Kozhimannil, Michelle Casey, Ira Moscovice

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Background/Objective: The loss of obstetric services has been a pressing concern in urban and rural areas nationwide. This study aims to determine factors that contribute to the loss of obstetric care through closures of a hospital or obstetric unit. Methods: Data from 2002-2013 American Hospital Association annual surveys were used to identify hospitals providing obstetric services. We linked these data to Medicare Healthcare Cost Report Information for hospital financial indicators, the US Census Bureau’s American Community Survey for zip-code level characteristics, and Area Health Resource files for county- level clinician supply measures. A discrete-time multinomial logit model was used to determine contributing factors to obstetric unit or hospital closures. Results: Of 3,551 hospitals providing obstetrics services during 2002-2013, 82% kept units open, 12% stopped providing obstetrics services, and 6% closed down completely. State-level variations existed. Factors that significantly increased hospitals’ probability of obstetric unit closures included lower than 250 annual birth volume (adjusted marginal effects [95% confidence interval]=34.1% [28%, 40%]), closer proximity to another hospital with obstetric services (per 10 miles: -1.5% [-2.4, -0.5%]), being in a county with lower family physician supply (-7.8% [-15.0%, -0.6%), being in a zip code with higher percentage of non-white females (per 10%: 10.2% [2.1%, 18.3%]), and with lower income (per $1,000 income: -0.14% [-0.28%, -0.01%]). Conclusions: Over the past 12 years, loss of obstetric services has disproportionately affected areas served by low-volume urban and rural hospitals, non-white and low-income communities, and counties with fewer family physicians, signaling a need to address maternity care access in these communities.

Keywords: access to care, obstetric care, service line discontinuation, hospital, obstetric unit closures

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Authors: Reina Kawase

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World GHG emissions should be reduced 50% by 2050 compared with 1990 level. CO2 emission reduction from steel sector, an energy-intensive sector, is essential. To estimate CO2 emission from steel sector in the world, estimation of steel production is required. The world steel production by process is estimated during the period of 2005-2050. The world is divided into aggregated 35 regions. For a steel making process, two kinds of processes are considered; basic oxygen furnace (BOF) and electric arc furnace (EAF). Steel production by process in each region is decided based on a current production capacity, supply-demand balance of steel and scrap, technology innovation of steel making, steel consumption projection, and goods trade. World steel production under moderate countermeasure scenario in 2050 increases by 1.3 times compared with that in 2012. When domestic scrap recycling is promoted, steel production in developed regions increases about 1.5 times. The share in developed regions changes from 34 %(2012) to about 40%(2050). This is because developed regions are main suppliers of scrap. 48-57% of world steel production is produced by EAF. Under the scenario which thinks much of supply-demand balance of steel, steel production in developing regions increases is 1.4 times and is larger than that in developed regions. The share in developing regions, however, is not so different from current level. The increase in steel production by EAF is the largest under the scenario in which supply-demand balance of steel is an important factor. The share reaches 65%.

Keywords: global steel production, production distribution scenario, steel making process, supply-demand balance

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Authors: Ahmed Shariful Alam, Abu Hena M. Mustafa Kamal, M. Abdul Rahman, M. Nasmus Sakib Khan Shabbir, Atiqul Islam

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According to the rules of quantum mechanics there is a non-vanishing probability of for an electron to tunnel through a thin insulating barrier or a thin capacitor which is not possible according to the laws of classical physics. Tunneling of electron through a thin insulating barrier or tunnel junction is a random event and the magnitude of current flowing due to the tunneling of electron is very low. As the current flowing through a Single Electron Transistor (SET) is the result of electron tunneling through tunnel junctions of its source and drain the supply voltage requirement is also very low. As a result, the power consumption across a Single Electron Transistor is ultra-low in comparison to that of a MOSFET. In this paper simulations have been done with PSPICE for an inverter built with both SETs and MOSFETs. 35mV supply voltage was used for a SET built inverter circuit and the supply voltage used for a CMOS inverter was 3.5V.

Keywords: ITRS, enhancement type MOSFET, island, DC analysis, transient analysis, power consumption, background charge co-tunneling

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Authors: Wesam Darawsheh

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Background: there are scarcity of studies done to investigate the level of knowledge and the level of awareness and perception of Jordanians about occupational therapy (OT). Aim: to investigate the level of awareness of lay people, clients receiving services and healthcare professionals of OT, identify the common misconceptions about OT, and to explore ways whereby the knowledge and awareness about OT can be increased. Methodology: a cross sectional design was employed in this study where a survey was distributed in the Northern, Southern, Western, Eastern provinces and the Middle (capital city: Amman) province of Jordan. The survey consisted of eight section and 61 questions that aims to investigate the demographics of participants, self evaluation concerning knowledge and awareness about OT, sources of knowledge about OT, the perception of the aims, fields of practice, OT settings, misconceptions about OT, and suggestion to improve knowledge and awareness about OT. Results: A total of 829 participants were enrolled in this study: 459 lay people, 155 clients who are currently receiving OT services, 215 healthcare professionals. About 57% of the participants did not hear about OT, and 48% of those who reported to hear about OT did not have sufficient knowledge about it. There are several misconceptions associated with OT. The statistical analysis was executed using IBM SPSS software, Version 22.0 (SPSS, Chicago, USA). Conclusion: it is the responsibility of OTRs to increase the knowledge and awareness about OT in Jordan. This is required for the profession to proliferate and to be given its status.

Keywords: knowledge, occupational therapy misconceptions, healthcare professionals, lay people, Jordan

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Authors: Noha El-Gohary, Thanaa El-Shater, A. A. Mahfouz, M. M. Sakr

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Searching for high power conversion efficiency and long lifetime are important goals when designing a power supply subsystem for satellite applications. To fulfill these goals, this paper presents a power supply subsystem for small satellites in which flywheel energy storage system is used as a secondary power source instead of chemical battery. In this paper, the model of flywheel energy storage system is introduced; a DC bus regulation control algorithm for charging and discharging of flywheel based on space vector pulse width modulation technique and motor current control is also introduced. Simulation results showed the operation of the flywheel for charging and discharging mode during illumination and shadowed period. The advantages of the proposed system are confirmed by the simulation results of the power supply system.

Keywords: small-satellites, flywheel energy storage system, space vector pulse width modulation, power conversion

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Authors: N. M. Sani, I. Bitrus, A. M. Sarki, N. S. Mujahid

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Hepatitis is one of the neglected infectious diseases in sub Saharan Africa, and most of the available data is based on blood donors. Health care workers (HCWs) often get infected as a result of their close contact with patients. A cross-sectional study was conducted to determine the prevalence of hepatitis B and C among this group of professionals with a view to improving the quality of care to their patients. Hepatitis B and C infections pose a major public health problem worldwide. While infection is highest in the developing world particularly Asia and sub-Saharan Africa, healthcare workers are at higher risk of acquiring blood-borne viral infections, particularly Hepatitis B and C which are mostly asymptomatic. This study was aimed at determining the prevalence of Hepatitis B and C infections and associated risk factors among health care workers in Dutse Metropolis, Jigawa State - Nigeria. A standard rapid immuno-chromatographic technique i.e. rapid ELISA was used to screen all sera for Hepatitis B surface antigen (HBsAg) and Hepatitis C viral antibody (HCVAb) respectively. Strips containing coated antibodies and antigens to HBV and HCV respectively were removed from the foil. Strips were labeled according to samples. Using a separate disposable pipette, 2 drops of the sample (plasma) were added into each test strip and allowed to run across the absorbent pad. Results were read after 15 minutes. The prevalence of HBV and HCV infection in 100 healthcare workers was determined by testing the plasma collected from the clients during their normal checkup using HBsAg and HCVAb test strips. Results were subjected to statistical analysis using chi-square test. The prevalence of HBV among HCWs was 19 out of 100 (19.0%) and that of HCV was 5 out of 100 (5.0%) where in both cases, higher prevalence was observed among female nurses. It was also observed that all HCV positive cases were recorded among nurses only. The study revealed that nurses are at greater risk of contracting HBV and HCV due to their frequent contact with patients. It is therefore recommended that effective vaccination and other infection control measures be encouraged among healthcare workers.

Keywords: prevalence, hepatitis, viruses, healthcare workers, infection

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Authors: G. W. Greubel, A. Kalam

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This paper provides a review of the technical problems facing the South African electricity system and discusses a hypothetical ‘virtual grid’ concept that may assist in solving the problems. The proposed solution has potential application across emerging markets with constrained power infrastructure or for companies who wish to be entirely powered by renewable energy. South Africa finds itself at a confluence of forces where the national electricity supply system is constrained with under-supply primarily from old and failing coal-fired power stations and congested and inadequate transmission and distribution systems. Simultaneously, the country attempts to meet carbon reduction targets driven by both an alignment with international goals and a consumer-driven requirement. The constrained electricity system is an aspect of an economy characterized by very low economic growth, high unemployment, and frequent and significant load shedding. The fiscus does not have the funding to build new generation capacity or strengthen the grid. The under-supply is increasingly alleviated by the penetration of wind and solar generation capacity and embedded roof-top solar. However, this increased penetration results in less inertia, less synchronous generation, and less capability for fast frequency response, with resultant instability. The renewable energy facilities assist in solving the under-supply issues but merely ‘kick the can down the road’ by not contributing to grid stability or by substituting the lost inertia, thus creating an expanding issue for the grid to manage. By technically balancing its electricity demand and supply a company with facilities located across the country can be protected from the effects of load shedding, and thus ensure financial and production performance, protect jobs, and contribute meaningfully to the economy. By treating the company’s load (across the country) and its various distributed generation facilities as a ‘virtual grid’, which by design will provide ancillary services to the grid one is able to create a win-win situation for both the company and the grid.

Keywords: load shedding, renewable energy integration, smart grid, virtual grid, virtual power plant

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Authors: Nona Mirzamohammadi, Bahram Nasernejad

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This work mainly focuses on studying the mechanism governing the adsorption of tetraethylammonium bromide, a short-chain quaternary ammonium salt, on the surface of natural zeolite and to characterize modified and raw zeolites in order to study the removal of nitrate anions from water. Natural clinoptilolite, as the most common zeolite, was chosen and modified in an ultrasonication process using tetraethylammonium bromide, subsequent to being contacted with NaCl solutions. FT-IR studies indicated a peak attributed to the stretching vibrations of the –CH₂ group in the molecule of tetraethylammonium bromide in the spectrum of the modified sample. Moreover, the SEM images showed some obvious changes in the surface morphology and crystallinity of clinoptilolite after being modified. Batch adsorption experiments show that the modified zeolite is capable of removing nitrate anions, and the predominant removal mechanism is suggested to be a combination of electrostatic attraction and ion exchange since the results from the zeta potential analysis showed a decrease in the net negative charge of clinoptilolite after modification, while bromide ions were detected in the modified sample in the µXRF analysis.

Keywords: adsorption, clinoptilolite, short-chain quaternary ammonium salt, tetraethylammoniumbromide, ultrasonication

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Authors: O. G. Onuk, L. S. Taura, C. M. Eze, S. M. Ngaram

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The decay chain of radioactive elements in the laboratory and the verification of natural radioactivity of the human body was investigated using the High Purity Germanium (HPGe) detector. Properties of the HPGe detectors were also investigated. The efficiency and energy resolution of HPGe detector used in the laboratory was found to be excellent. The detector was calibrated three times so as to cover a wider energy range. Also the Centroid C of the detector was found to have a linear relationship with the energies of the known gamma-rays. Using the three calibrations of the detector, the energy of an unknown radionuclide was found to follow the decay chain of thorium-232 (232Th) and it was also found that an average adult has about 2.5g Potasium-40 (40K) in the body.

Keywords: detector, efficiency, energy, radionuclides, resolution

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Authors: Emmanuel Chibuogu Asogwa, Tochukwu Sunday Belonwu

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An urgent demand for creative solutions has been created by the rapid expansion of medical knowledge, the complexity of patient care, and the requirement for more precise decision-making. As a solution to this problem, the creation of a Medical Intelligent Process Model (MIPM) utilizing ontology-based appears as a promising way to overcome this obstacle and unleash the full potential of healthcare systems. The development of a Medical Intelligent Process Model (MIPM) using ontology-based techniques is motivated by a lack of quick access to relevant medical information and advanced tools for treatment planning and clinical decision-making, which ontology-based techniques can provide. The aim of this work is to develop a structured and knowledge-driven framework that leverages ontology, a formal representation of domain knowledge, to enhance various aspects of healthcare. Object-Oriented Analysis and Design Methodology (OOADM) were adopted in the design of the system as we desired to build a usable and evolvable application. For effective implementation of this work, we used the following materials/methods/tools: the medical dataset for the test of our model in this work was obtained from Kaggle. The ontology-based technique was used with Confusion Matrix, MySQL, Python, Hypertext Markup Language (HTML), Hypertext Preprocessor (PHP), Cascaded Style Sheet (CSS), JavaScript, Dreamweaver, and Fireworks. According to test results on the new system using Confusion Matrix, both the accuracy and overall effectiveness of the medical intelligent process significantly improved by 20% compared to the previous system. Therefore, using the model is recommended for healthcare professionals.

Keywords: ontology-based, model, database, OOADM, healthcare

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Authors: Fatima Faraz

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BACKGROUND: While Artificial intelligence (AI) provides new opportunities across a wide variety of industries, healthcare is no exception. AI can lead to advancements in how the healthcare system functions and improves the quality of patient care. Developing countries like Pakistan are lagging in the implementation of AI-based solutions in healthcare. This demands increased knowledge and AI literacy among health care professionals. OBJECTIVES: To assess the level of awareness among medical students and faculty about AI in preparation for teaching AI basics and data science applications in clinical practice in an integrated medical curriculum. METHODS: An online 15-question semi-structured questionnaire, previously tested and validated, was delivered among participants through convenience sampling. The questionnaire composed of 3 parts: participant’s background knowledge, AI awareness, and attitudes toward AI applications in medicine. RESULTS: A total of 182 students and 39 faculty members from Rawalpindi Medical University, Pakistan, participated in the study. Only 26% of students and 46.2% of faculty members responded that they were aware of AI topics in clinical medicine. The major source of AI knowledge was social media (35.7%) for students and professional talks and colleagues (43.6%) for faculty members. 23.5% of participants answered that they personally had a basic understanding of AI. Students and faculty (60.1%) were interested in AI in patient care and teaching domain. These findings parallel similar published AI survey results. CONCLUSION: This survey concludes interest among students and faculty in AI developments and technology applications in healthcare. Further studies are required in order to correctly fit AI in the integrated modular curriculum of medical education.

Keywords: medical education, data science, artificial intelligence, curriculum

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Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

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Obesity-related health conditions impose a substantial economic burden on payers due to increased healthcare use. Estimates of healthcare resource use and costs associated with obesity-related comorbidities are needed to inform policies and interventions targeting these conditions. Methods: Adults living with obesity were identified (a procedure-related body mass index code for class 2/3 obesity between 2012 and 2019 in Alberta, Canada; excluding those with bariatric surgery), and outcomes were compared over 1-year (2019/2020) between those who had and did not have specific obesity-related comorbidities. The probability of using a healthcare service (based on the odds ratio of a zero [OR-zero] cost) was compared; 95% confidence intervals (CI) were reported. Logistic regression and a generalized linear model with log link and gamma distribution were used for total healthcare cost comparisons ($CDN); cost ratios and estimated cost differences (95% CI) were reported. Potential socio-demographic and clinical confounders were adjusted for, and incremental cost differences were representative of a referent case. Results: A total of 220,190 adults living with obesity were included; 44% had hypertension, 25% had osteoarthritis, 24% had type-2 diabetes, 17% had cardiovascular disease, 12% had insulin resistance, 9% had chronic back pain, and 4% of females had polycystic ovarian syndrome (PCOS). The probability of hospitalization, ED visit, and ambulatory care was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (hospitalization: 1.8-times [OR-zero: 0.57 [0.55/0.59]] / ED visit: 1.9-times [OR-zero: 0.54 [0.53/0.56]] / ambulatory care visit: 2.4-times [OR-zero: 0.41 [0.40/0.43]]), cardiovascular disease (2.7-times [OR-zero: 0.37 [0.36/0.38]] / 1.9-times [OR-zero: 0.52 [0.51/0.53]] / 2.8-times [OR-zero: 0.36 [0.35/0.36]]), osteoarthritis (2.0-times [OR-zero: 0.51 [0.50/0.53]] / 1.4-times [OR-zero: 0.74 [0.73/0.76]] / 2.5-times [OR-zero: 0.40 [0.40/0.41]]), type-2 diabetes (1.9-times [OR-zero: 0.54 [0.52/0.55]] / 1.4-times [OR-zero: 0.72 [0.70/0.73]] / 2.1-times [OR-zero: 0.47 [0.46/0.47]]), hypertension (1.8-times [OR-zero: 0.56 [0.54/0.57]] / 1.3-times [OR-zero: 0.79 [0.77/0.80]] / 2.2-times [OR-zero: 0.46 [0.45/0.47]]), PCOS (not significant / 1.2-times [OR-zero: 0.83 [0.79/0.88]] / not significant), and insulin resistance (1.1-times [OR-zero: 0.88 [0.84/0.91]] / 1.1-times [OR-zero: 0.92 [0.89/0.94]] / 1.8-times [OR-zero: 0.56 [0.54/0.57]]). After fully adjusting for potential confounders, the total healthcare cost ratio was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (1.54-times [1.51/1.56]), cardiovascular disease (1.45-times [1.43/1.47]), osteoarthritis (1.36-times [1.35/1.38]), type-2 diabetes (1.30-times [1.28/1.31]), hypertension (1.27-times [1.26/1.28]), PCOS (1.08-times [1.05/1.11]), and insulin resistance (1.03-times [1.01/1.04]). Conclusions: Adults with obesity who have specific disease-related health conditions have a higher probability of healthcare use and incur greater costs than those without specific comorbidities; incremental costs are larger when other obesity-related health conditions are not adjusted for. In a specific referent case, hypertension was costliest (44% had this condition with an additional annual cost of $715 [$678/$753]). If these findings hold for the Canadian population, hypertension in persons with obesity represents an estimated additional annual healthcare cost of $2.5 billion among adults living with obesity (based on an adult obesity rate of 26%). Results of this study can inform decision making on investment in interventions that are effective in treating obesity and its complications.

Keywords: administrative data, healthcare cost, obesity-related comorbidities, real world evidence

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Authors: Yenisleidy Martinez Martinez, Yannay Casas-Ledon, Jo Dewulf

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The ecosystem services (ES) concept has contributed to draw attention to the benefits ecosystems generate for people and how necessary natural resources are for human well-being. The identification and prioritization of the ES constitute the first steps to undertake conservation and valuation initiatives on behalf of people. Additionally, mapping the supply of ES is a powerful tool to support decision making regarding the sustainable management of landscape and natural resources. In this context, the present study aimed to identify, prioritize and map the primary ES in Biobio and Nuble regions using a methodology that combines expert judgment, multi-attribute evaluation methods, and Geographic Information Systems (GIS). Firstly, scores about the capacity of different land use/cover types to supply ES and the importance attributed to each service were obtained from experts and stakeholders via an online survey. Afterward, the ES assessment matrix was constructed, and the weighted linear combination (WLC) method was applied to mapping the overall capacity of supply of provisioning, regulating and maintenance, and cultural services. Finally, prioritized ES for the study area were selected and mapped. The results suggest that native forests, wetlands, and water bodies have the highest supply capacities of ES, while urban and industrial areas and bare areas have a very low supply of services. On the other hand, fourteen out of twenty-nine services were selected by experts and stakeholders as the most relevant for the regions. The spatial distribution of ES has shown that the Andean Range and part of the Coastal Range have the highest ES supply capacity, mostly regulation and maintenance and cultural ES. This performance is related to the presence of native forests, water bodies, and wetlands in those zones. This study provides specific information about the most relevant ES in Biobio and Nuble according to the opinion of local stakeholders and the spatial identification of areas with a high capacity to provide services. These findings could be helpful as a reference by planners and policymakers to develop landscape management strategies oriented to preserve the supply of services in both regions.

Keywords: ecosystem services, expert judgment, mapping, multi-criteria decision making, prioritization

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Authors: Marwin M. Dela Cruz

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Aviation as a transport sector is supportive of the seventeen (17) Sustainable Goals espoused by the United Nations. Air Transport Action Group (ATAG) states that over 18.1 million indirect jobs globally were sustained through the purchase of goods and services by companies in the aviation industry. This supply chain activity contributed approximately $816.4 billion to global GDP. This was achieved through numerous actions to lessen economic uncertainty and challenges. Its impact is not just a by-product of economic activity but of the facilities it generates. As the aviation industry is unifying its efforts, education and training should also come with it. The need for aviation education and training and a well-crafted regulatory policy initiated by lawmakers can provide a better aviation education. The Philippine State College of Aeronautics (PhilSCA), being the only government Higher Education Institution (HEI) in the Philippines, is given a very distinct congressional mandate to offer aviation-related courses to afford those in the aviation industry the opportunity to pursue studies. Having this, the industry has become the precursor and venue of present-day communities. In addition, it becomes an essential measure of a better life.

Keywords: Philippine state college of aeronautics, aviation industry, sustainable goals, aviation education

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Authors: Mansoor Soomro

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The evolution of power electronic equipment has been pivotal in making industrial processes productive, efficient and safe. Despite its attractive features, it has been due to nonlinear loads which make it vulnerable to power quality conditions. Harmonics is one of the power quality problem in which the harmonic frequency is integral multiple of supply frequency. Therefore, the supply voltage and supply frequency do not last within their tolerable limits. As a result, distorted current and voltage waveform may appear. Attributes of low power quality confirm that an electrical device or equipment is likely to malfunction, fail promptly or unable to operate under all applied conditions. The electrical power system is designed for delivering power reliably, namely maximizing power availability to customers. However, power quality events are largely untracked, and as a result, can take out a process as many as 20 to 30 times a year, costing utilities, customers and suppliers of load equipment, a loss of millions of dollars. The ill effects of current harmonics reduce system efficiency, cause overheating of connected equipment, result increase in electrical power and air conditioning costs. With the passage of time and the rapid growth of power electronic converters has highlighted the damages of current harmonics in the electrical power system. Therefore, it has become essential to address the bad influence of current harmonics while planning any suitable changes in the electrical installations. In this paper, an effort has been made to mitigate the effects of dominant 3rd order current harmonics. Passive filtering technique with six pulse multiplication converter has been employed to mitigate them. Since, the standards of power quality are to maintain the supply voltage and supply current within certain prescribed standard limits. For this purpose, the obtained results are validated as per specifications of IEEE 519-1992 and IEEE 519-2014 performance standards.

Keywords: current harmonics, power quality, passive filters, power electronic converters

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Authors: Alok Raghav, Jamal Ahmad

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Background: Serum albumin glycation and advanced glycation end products (AGE) formation correlates in diabetes and its associated complications. Extensive modified human serum albumin is used to study the biochemical, electrochemical and functional properties in hyperglycemic environment with relevance to diabetes. We evaluate Spectroscopic, side chain modifications, amino acid analysis, biochemical and functional group properties in four glucose modified samples. Methods: A series four human serum albumin samples modified with glucose was characterized in terms of amino acid analysis, spectroscopic properties and side chain modifications. The diagnostic technique employed incorporates UV Spectroscopy, Fluorescence Spectroscopy, biochemical assays for side chain modifications, amino acid estimations. Conclusion: Glucose modified human serum albumin confers AGE formation causes biochemical and functional property that depend on the reactivity of glucose and its concentration used for in-vitro glycation. A biochemical and functional characterization of modified albumin in-vitro produced AGE product that will be useful to interpret the complications and pathophysiological significance in diabetes.

Keywords: glycation, diabetes, human serum albumin, biochemical and electrochemical characterization

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Authors: Al Huuskonen, Clio Lake, K. M. Naude, Polina Petlitsyna, Sorsha Henning, Julia Wimmers-Klick

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This project presents the outcomes of a community-based participatory action initiative aimed at advocating for equitable healthcare and human rights for trans, two-spirit, and gender-diverse individuals, building upon the University of British Columbia (UBC) Trans Coalition's ongoing efforts. Participatory Action Research (PAR) was chosen as the research method with the goal of improving trans rights on the UBC campus, particularly regarding equitable access to healthcare. PAR involves active community contribution throughout the research process, which in this case was done by way of liaising with student resource groups and advocacy leaders. The goals of this project were as follows: a) identify gaps in gender-affirming healthcare for UBC students by consulting the community and collaborating with UBC services, b) develop an information package outlining provincial and university-based health insurance for gender-affirming care (including hormone therapy and surgeries), FAQs, and resources for UBC's trans students, c) make this package available to UBC students and other national transgender advocacy organizations. The initiative successfully expanded the UBC AMS Student Health and Dental Plan to include gender-affirming procedural coverage, developed a care access guide for students, and advocated for improved health records inclusivity, mechanisms for trans students to report negative care experiences, and increased access to gender-affirming primary care through the on-campus health clinic. Collaboration with other universities' pride organizations and Trans Care BC yielded positive outcomes through broader coalition building and resource sharing. Ongoing efforts are underway to update provincial policies, particularly through expanding coverage under fair pharma care and addressing the compounding effects of the primary care crisis for trans individuals. The project's tangible results include improved trans rights on campus, especially in terms of healthcare access. Expanding healthcare coverage through student care benefits thousands of students, making the ability to undergo important affirming procedures more affordable. Providing students with information on extended coverage options and communication with their doctors further removes barriers to care and positively impacts student wellbeing. This initiative demonstrates the effectiveness of community-based participatory action in advancing equitable healthcare for trans and gender-diverse individuals and serves as a model for other institutions and organizations striving to promote inclusivity and advocate for marginalized populations' rights.

Keywords: equitable healthcare, trans and gender-diverse individuals, inclusivity, participatory action research project

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Authors: Raphaël Weuts, Mykyta Petik, Anton Vedder

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Artificial Intelligence has the potential to create and already creates enormous value in healthcare. Prescriptive systems might be able to make the use of healthcare capacity more efficient. Such systems might entail interpretations that exclude the effect of confounders that brings risks with it. Those risks might be mitigated by regulation that prevents systems entailing such risks to come to market. One modality of regulation is that of legislation, and the European AI Act is an example of such a regulatory instrument that might mitigate these risks. To assess the risk mitigation potential of the AI Act for those risks, this research focusses on a case study of a hypothetical application of medical device software that entails the aforementioned risks. The AI Act refers to the harmonised norms for already existing legislation, here being the European medical device regulation. The issue at hand is a causal link between a confounder and the value the algorithm optimises for by proxy. The research identifies where the AI Act already looks at confounders (i.a. feedback loops in systems that continue to learn after being placed on the market). The research identifies where the current proposal by parliament leaves legal uncertainty on the necessity to check for confounders that do not influence the input of the system, when the system does not continue to learn after being placed on the market. The authors propose an amendment to article 15 of the AI Act that would require high-risk systems to be developed in such a way as to mitigate risks from those aforementioned confounders.

Keywords: AI Act, healthcare, confounders, risks

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Authors: Lobna Hafez, Eman Elakkad

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Sustainability is no longer a choice for firms. To achieve sustainable supply chain, all three dimensions of sustainability should be considered. Unlike the economic and environmental aspects, social sustainability has been rarely given attention. The problem surrounding social sustainability and employees’ welfare in Egypt is complex and remains unsolved. The aim of this study is to qualitatively assess the current level of application of social sustainability in the retailing sector in Egypt through using the social sustainability indicators identified in the literature. The purpose of this investigation is to gain knowledge about the complexity of the system involved. A case study is conducted on one of the largest retailers in Egypt. Data were collected through semi-structured interviews with managers and employees to determine the level of application and identify the major obstacles affecting the social sustainability in the retailing context. The work developed gives insights about the details and complexities of the application of social sustainability in developing countries, from the retailing perspective. The outcomes of this study will help managers to understand the enablers of social sustainability and will direct them to methods of sound implementation.

Keywords: developing countries, Egyptian retailing sector, sustainability, social sustainability

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Authors: Nizar Ghali, Bernard Fortin, Guy Lacroix

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In Quebec, colonoscopies volumes have continued to rise in recent years in the absence of effective monitoring mechanism for the appropriateness and the quality of these exams. In 2010, November, Quebec Government introduced the colorectal cancer-screening program in the objective to control for volume and cost imperfection. This program is based on clinical standards and was initiated for first group of institutions. One year later, Government adds financial incentives for participants institutions. In this analysis, we want to assess for the causal effect of the two components of this program: clinical pathways and financial incentives. Especially we assess for the reform effect on healthcare quality and population health in the context that medical remuneration is not directly dependent on this additional funding offered by the program. We have data on admissions episodes and deaths for 8 years. We use multistate model analog to difference in difference approach to estimate reform effect on the transition probability between different states for each patient. Our results show that the reform reduced length of stay without deterioration in hospital mortality or readmission rate. In the other hand, the program contributed to decrease the hospitalization rate and a less invasive treatment approach for colorectal surgeries. This is a sign of healthcare quality and population health improvement. We demonstrate in this analysis that physicians’ behavior can be affected by both clinical standards and financial incentives even if offered to facilities.

Keywords: multi-state and multi-episode transition model, healthcare quality, length of stay, transition probability, difference in difference

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Authors: Sabita Subedi, Bhojan Dhakal, Shankar Raj Pant, Naba Raj Devkota

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An assessment was made about the available feed resources, its utilization pattern, specifically, roughage and concentrate, produced from the Manaslu Conservation Area (MCA) of Nepal to formulate the appropriate strategies in satisfying the annual dietary requirements of the livestock covering its present production and management scenarios. A comparative study was done by employing a purposively conducted survey to deduct the distribution of forage sources in the area. Findings revealed that natural vegetation, seasonally available crop residues, and dried grasses were major feed resources, whereas their contribution to the total supply varied significantly (p < 0.01). The amount of feed obtained from various sources was calculated by standard conversion and using primary household data. Findings revealed that farmers practice significantly higher (p < 0.01) number of grazing days and hours per day for large ruminants such as Yak and Chauries as compared to small ruminants such as goats and sheep. The findings also indicated seasonal variations of feed supply, whereas January to March is the period of short supply (p < 0.01). It was relatively in good supply from June to September though average roughage and crude protein supplement for the animals was far below than optimum requirements. These scenarios suggest the need for immediate attention to improve the range productivity in the MCA as the deteriorating situations of the rangelands may raise questions on the sustainability of livestock herders.

Keywords: altitude, carrying capacity, dietary requirement, feed resources, rangeland, ruminant

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Authors: Christoph Köster

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Supplier selection is one of the key challenges in supply chain management and can be considered a multi-criteria decision-making (MCDM) problem. In the 1960s, it evolved from considering only economic criteria, such as price, quality, and performance, to including environmental and social criteria nowadays. Although receiving considerable attention from scholars and practitioners over the past decades, existing research has not considered governance criteria so far. This is, however, surprising, as ESG (environmental, social, and governance) criteria have gained considerable attention. In order to complement ESG criteria in the supplier selection process, this study investigates German DAX and MDAX companies and evaluates the impact of governance criteria along their supplier selection process. Moreover, it proposes a set of criteria for the respective process steps. Specifically, eleven criteria for the first process step and five criteria for the second process step are identified. This paper contributes to a better understanding of the supplier selection process by elucidating the relevance of governance criteria in the supplier selection process and providing a set of empirically developed governance criteria. These results can be applied by practitioners to complement the criteria set in the supplier selection process and thus balance economic, environmental, social, and governance targets.

Keywords: ESG, governance, sustainable supplier selection, sustainability

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Authors: Aykut Bedük, Kemalettin Eryeşil, Osman Eşmen

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The aim of this study is to examine the relationship between organizational commitment which is defined as a strong belief in and acceptance of the organization’s goals and values, and burnout syndrome and organizational cynicism. Accordingly, a field research based on survey method was conducted on the employees of a health institution operating in the province of Konya. The findings of the research show that there is a positive statistically significant relationship between organizational cynicism and burnout while there is a negative statistically significant relationship between organizational commitment and burnout. Furthermore, it has been also realized that there is a negative and statistically significant relationship between organizational commitment and organizational cynicism.

Keywords: burnout, organizational commitment, organizational cynicism, healthcare management

Procedia PDF Downloads 277

Authors: Evans Oteng, Clement Yeboah, Alexander Otechere-Fianko

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In today’s economy, despite achievements and advances in the banking and financial institutions, there are challenges that will require intensive attempts on the portion of the banks in Ghana. The perceived decline in profitability of banks seems to have emanated from ineffective branding. Hence, the purpose of this quantitative descriptive-correlational study was to examine the effects of branding on the profitability of banks in Ghana. The researchers purposively sampled some 116 banks in Ghana. Self-developed Likert scale questionnaires were administered to the finance officers of the financial institutions. The results were found to be statistically significant, F (1, 114) = 4. 50, p = .036. This indicates that those banks in Ghana with good branding practices have strong marketing tools to identify and sell their products and services and, as such, have a big market share. The correlation coefficients indicate that branding has a positive correlation with profitability and are statistically significant (r=.207, p<0.05), which signifies that as branding increases, the return on equity’s profitability indicator improves and vice versa. Future researchers can consider other factors beyond branding, such as online banking. The study has significant implications for the success and competitive advantage of those banks that effective branding allows them to differentiate themselves from their competitors. A strong and unique brand identity can help a bank stand out in a crowded market, attract customers, and build customer loyalty. This can lead to increased market share and profitability. Branding influences customer perception and trust. A well-established and reputable brand can create a positive image in the minds of customers, enhancing their confidence in the bank's products and services. This can result in increased customer acquisition, customer retention and a positive impact on profitability. Banks with strong brands can leverage their reputation and customer trust to cross-sell additional products and services. When customers have confidence in the brand, they are more likely to explore and purchase other offerings from the same institution. Cross-selling can boost revenue streams and profitability. Successful branding can open up opportunities for brand extensions and diversification into new products or markets. Banks can leverage their trusted brand to introduce new financial products or expand their presence into related areas, such as insurance or investment services. This can lead to additional revenue streams and improved profitability. This study can have implications for education. Thus, increased profitability of banks due to effective branding can result in higher financial resources available for corporate social responsibility (CSR) activities. Banks may invest in educational initiatives, such as scholarships, grants, research projects, and sponsorships, to support the education sector in Ghana. Also, this study can have implications for logistics and supply chain management. Thus, strong branding can create trust and credibility among customers, leading to increased customer loyalty. This loyalty can positively impact the bank's relationships with its suppliers and logistics partners. It can result in better negotiation power, improved supplier relationships, and enhanced supply chain coordination, ultimately leading to more efficient and cost-effective logistics operations.

Keywords: branding, profitability, competitors, customer loyalty, customer retention, corporate social responsibility, cost-effective, logistics operations

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Authors: Elucir Gir, Myllena Nilce de Freitas Surmano, Laelson Rochelle Milanês Sousa, Mayra Gonçalves Menegueti, Ana Cristina de Oliveira E Silva, Renata Karina Reis

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Objective: To analyze the factors associated with the worsening of the quality of life of health professionals in the Southeast region of Brazil during the COVID-19 pandemic and its associated factors. Method: Analytical cross-sectional study carried out with health professionals from the southeastern region of Brazil. Data collection took place through an online survey with a form stored on the Survey Monkey platform. Bivariate analysis was used, and the chi-square test was adopted, followed by the multiple binary logistic regression model based on the stepwise method. Results: 3,493 health professionals participated in the study. Factors associated with worsening quality of life were: Professional Category (Nursing assistant) [OR 1.851 (95%CI 1.035-3.311) p= 0.038]; types of people who provided care (people in general) [OR 1.445 (95%CI 1.072-1.945) p=0.015]; Supply of good quality PPE by the institution where he works (no) [OR 1.595 (CI 95% 1.144-2.223) p= 0.006] and Supply of good quality PPE by the institution where he works (in part) [OR 1.563 (CI 95% 1.257-1.943) p < 0.001]. Conclusion: The factors associated with the worsening of the quality of life of health professionals during the COVID-19 pandemic were: Professional Category (Nursing assistant); types of people who provided assistance (people in general); Supply of sufficient PPE by the institution where you work (no) and Supply of good quality PPE by the institution where you work (in part). Future studies should investigate to what extent QoL can be improved based on modifiable factors.

Keywords: COVID-19, quality of life, health professionals, respiratory infections

Procedia PDF Downloads 91