Search results for: medication compliance

Authors: Abhay Asthana, Shally Toshkhani, Gyati Shilakari

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The objective of the present research work is to develop a topical biodegradable dermal patch based formulation to aid accelerated wound healing. It is always better for patient compliance to be able to reduce the frequency of dressings with improved drug delivery and overall therapeutic efficacy. In present study optimized formulation using biodegradable components was obtained evaluating polymers and excipients (HPMC K4M, Ethylcellulose, Povidone, Polyethylene glycol and Gelatin) to impart significant folding endurance, elasticity, and strength. Molten gelatin was used to get a mixture using ethylene glycol. Chitosan dissolved in acidic medium was mixed with stirring to Gelatin mixture. With continued stirring to the mixture Curcumin was added with the aid of DCM and Methanol in an optimized ratio of 60:40 to get homogenous dispersion. Polymers were dispersed with stirring in the final formulation. The mixture was sonicated casted to get the film form. All steps were carried out under strict aseptic conditions. The final formulation was a thin uniformly smooth textured film with dark brown-yellow color. The film was found to have folding endurance was around 20 to 21 times without a crack in an optimized formulation at RT (23°C). The drug content was in range 96 to 102% and it passed the content uniform test. The final moisture content of the optimized formulation film was NMT 9.0%. The films passed stability study conducted at refrigerated conditions (4±0.2°C) and at room temperature (23 ± 2°C) for 30 days. Further, the drug content and texture remained undisturbed with stability study conducted at RT 23±2°C for 45 and 90 days. Percentage cumulative drug release was found to be 80% in 12h and matched the biodegradation rate as tested in vivo with correlation factor R2>0.9. In in vivo study administration of one dose in equivalent quantity per 2 days was applied topically. The data demonstrated a significant improvement with percentage wound contraction in contrast to control and plain drug respectively in given period. The film based formulation developed shows promising results in terms of stability and in vivo performance.

Keywords: wound healing, biodegradable, polymers, patch

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Authors: Ching-Yi Yiu, Hui-Chen Hsu

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Objectives: Obstructive sleep apnea syndrome (OSAS) is a popular problem in the modern society. It usually leads to sleep disorder, excessive daytime sleepiness and associated with cardiovascular diseases, cognitive dysfunction and even death. The nonsurgical therapies include continuous positive airway pressure (CPAP), diet and oral appliances. The surgical approaches have nasal surgery, tonsillectomy, adenoidectomy, uvulopalatopharyngoplasty (UPPP) and transoral robotic surgery (TORS).We compare the impact of surgical treatments on these kinds of patients. Methods: Between January 2018 to September 2022, We have enrolled 125 OSAS patients including 82 male and 43 female in Chi Mei Medical Center, Liouying, Taiwan. The age distribution from 6 to 71 years old (y/o) with mean age 36.1 y/o. The averaged body mass index (BMI) is 25 kg/m2 in male and 25.5 kg/m2 in female. In this cohort, we evaluated their upper airway obstruction sites with nasopharyngoscopy and scheduled a planned surgery. Some of cases received polysomnography (PSG) preoperatively, the averaged apnea-hypopnea index (AHI) is 37.7 events/hour. We have 68 patients received tonsillectomy, 9 received UPPP, 42 received UPPP and septomeatoplasty (SMP) and 6 received adenoidectomy and tonsillectomy (A and T). The subjective daytime sleepiness was evaluated with the Epworth sleepiness scale (ESS). Results: In the 68 tonsillectomy group, the averaged BMI is 24.9 kg/m2. In the UPPP group, the averaged BMI is 28.9 kg/m2. In UPPP and SMP group, the averaged BMI is 27.9 kg/m2. In the A and T group, the averaged BMI is 17.2 kg/m2. The reduction of AHI less than 20 is 58% postoperatively. The ESS reduced from 10.9 to 4.9 after surgery. Conclusion: Obstructive sleep apnea syndrome is a common upper airway disturbance in the general population. The prevalence rate is ranging high depending on different regions, age, sex and race. It leads to severe morbidity and mortality including car accident, stroke, nocturnal desaand sudden death and should be considered to be a major public health problem. The CPAP is effective to improve daytime sleepiness but the long-term compliance is low. The surgical treatment with different modalities can produce 50% decrease in AHI and ESS after surgery in the 6 to 12 months short-term period.

Keywords: apnea-hypopnea index, obstructive sleep apnea syndrome, polysomnography, uvulopalatopharyngoplasty

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Authors: Arkinzhan Mametov, Alexey Abilov

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Strong earthquakes are dangerous natural phenomena that lead to the destruction of entire cities and the death of a large number of people. The recent strong earthquakes in Turkey and in a number of other states have shown that as a result of them, there are significant human casualties and huge destruction. The city of Almaty is located in the foothill basin of the Trans-Ili Alatau of the Tien Shan Mountain system, in a zone with 9–10-point seismicity. Almaty (formerly Verniy) was founded in 1856 and, since that period, has experienced two catastrophic earthquakes - in 1887 and 1911, which led almost to the complete destruction of the city. Since that time, according to seismologists, the city has been annually exposed to small seismic impacts of 2-3 points. This forced the subsequent search for ways to protect buildings and the public through the use of earthquake-resistant structures and materials, limiting the number of stores of buildings and increasing gaps between them, which was carried out quite consistently and since 1957. However, at present, it is necessary to state a number of violations, primarily of the urban development plan – the placement of high-density multi-stores commercial housing in the urban environment, bypassing the existing regulations and standards in the city. Their appearance contributes to a greater concentration of residents transport in a limited area, which can lead to harmful consequences during powerful earthquakes. The experience of eliminating the consequences of catastrophic earthquakes shows that an important factor in reducing human losses is timely technical and medical assistance to victims of earthquakes, the elimination of blockages, provision of temporary housing and evacuation of the population, especially in winter. In cities located in areas with high seismicity, it is necessary to ensure strict compliance with the requirements of urban development regulations, taking into account the entire complex of planning and organizational measures to minimize the destruction of buildings and human casualties.

Keywords: high seismic zones, urban planning regulations, special standards for planing, minimizing the human casualties

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Authors: Bintou Jobe

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The construction sector, both in the United Kingdom (UK) and developing Anglophone West African countries, specifically The Gambia, is facing significant health and safety challenges. While the UK has established legislation and regulations to support Occupational Health and Safety (OHS) in the industry, the same level of support is lacking in developing countries. The significance of this review is to assess the extent and effectiveness of OHS legislation and regulatory reform in the construction industry, with a focus on understanding the challenges faced by both the UK and developing Anglophone West African countries. It aims to highlight the benefits of implementing an OHS management system, specifically ISO 45001. This study uses a literature review approach, synthesizing publications from the past decade and identifying common themes and best practices related to Occupational Health and Safety in the construction industry. Findings were analysed, compared, and conclusions and recommendations were drawn after developing research questions and addressing them. This comprehensive review of the literature allows for a detailed understanding of the challenges faced by the industry in both contexts. The findings of the study indicate that while the UK has established robust health and safety legislation, many UK construction companies have not fully met the standards outlined in ISO 45001. These challenges faced by the UK include poor data management, inadequate communication of best practices, insufficient training, and a lack of safety culture mirroring those observed in the developing Anglophone countries. Therefore, compliance with OHS management systems has been shown to yield benefits, including injury prevention and centralized health and safety documentation. In conclusion, the effectiveness of OHS legislation for developing Anglophone West African countries should consider the positive impact experienced by the UK. The implementation of ISO 45001 can serve as a benchmark standard and potentially inform recommendations for developing countries. The selection criteria for literature include search keywords and phrases, such as occupational health and safety challenges, The Gambia, developing countries management systems, ISO 45001, and impact and effectiveness of OHS legislation. The literature was sourced from Google Scholar, the UK Health and Safety Executive websites, and Google Advanced Search.

Keywords: ISO 45001, developing countries, occupational health and safety, UK

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Authors: Zeineb Yousse, Fakher Kharrat

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Mosaic is a part of a broad universal cultural heritage; sometimes it represents a rather essential source for the researches on the everyday life of some of the previous civilizations. Tunisia has one of the finest and largest collections of mosaics in the world, which is essentially exhibited in the Museums of Bardo and Sousse. Restored and reconstituted, they bear witnesses to hard work. Our paper deals with the discipline of conservation of Roman mosaics based on the proceedings of the workshop of the Museum of Sousse. Thus, we highlight two main objectives. In the first place, it is a question of revealing the techniques adopted by professionals to handle mosaics and to which school of conservation these techniques belong. In the second place, we are going to interpret the works initiated to preserve the archaeological heritage in order to protect it in present time and transmit it to future generations. To this end, we paid attention to four Roman mosaics currently exhibited in the Museum of Sousse. These Mosaics show different voids or gaps at the level of their surfaces and the method used to fill these gaps seems to be interesting to analyze. These mosaics are known under the names of: Orpheus Charming the Animals, Gladiator and Bears, Stud farm of Sorothus and finally Head of Medusa. The study on the conservation passes through two chained phases. We start with a small historical overview in order to gather information related to the original location, the date of its composition as well as the description of its image. Afterward, the intervention process is analyzed by handling three complementary elements which are: diagnosis of the existing state, the study of the medium processing and the study of the processing of the tesselatum surface which includes the pictorial composition of the mosaic. Furthermore, we have implemented an evaluation matrix with six operating principles allowing the assessment of the appropriateness of the intervention. These principles are the following: minimal intervention, reversibility, compatibility, visibility, durability, authenticity and enhancement. Various accumulated outcomes are pointing out the techniques used to fill the gaps as well as the level of compliance with the principles of conservation. Accordingly, the conservation of mosaics in Tunisia is a practice that combines various techniques without really arguing about the choice of a particular theory.

Keywords: conservation, matrix, museum of Sousse, operating particular theory, principles, Roman mosaics

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Authors: L. Donelle, S. Regan, R. Booth, M. Kerr, J. McMurray, D. Fitzsimmons

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Palliative home health care provision within the Canadian context is challenged by: (i) a shortage of registered nurses (RN) and RNs with palliative care expertise, (ii) an aging population, (iii) reliance on unpaid family caregivers to sustain home care services with limited support to conduct this ‘care work’, (iv) a model of healthcare that assumes client self-care, and (v) competing economic priorities. In response, an interprofessional team of service provider organizations, a software/technology provider, and health care providers developed and implemented a technology-enabled model of home care, the eShift model of palliative home care (eShift). The eShift model combines communication and documentation technology with non-traditional utilization of health human resources to meet patient needs for palliative care in the home. The purpose of this study was to investigate the structure, processes, and outcomes of the eShift model of care. Methodology: Guided by Donebedian’s evaluation framework for health care, this qualitative-descriptive study investigated the structure, processes, and outcomes care of the eShift model of palliative home care. Interviews and focus groups were conducted with health care providers (n= 45), decision-makers (n=13), technology providers (n=3) and family care givers (n=8). Interviews were recorded, transcribed, and a deductive analysis of transcripts was conducted. Study Findings (1) Structure: The eShift model consists of a remotely-situated RN using technology to direct care provision virtually to patients in their home. The remote RN is connected virtually to a health technician (an unregulated care provider) in the patient’s home using real-time communication. The health technician uses a smartphone modified with the eShift application and communicates with the RN who uses a computer with the eShift application/dashboard. Documentation and communication about patient observations and care activities occur in the eShift portal. The RN is typically accountable for four to six health technicians and patients over an 8-hour shift. The technology provider was identified as an important member of the healthcare team. Other members of the team include family members, care coordinators, nurse practitioners, physicians, and allied health. (2) Processes: Conventionally, patient needs are the focus of care; however within eShift, the patient and the family caregiver were the focus of care. Enhanced medication administration was seen as one of the most important processes, and family caregivers reported high satisfaction with the care provided. There was perceived enhanced teamwork among health care providers. (3) Outcomes: Patients were able to die at home. The eShift model enabled consistency and continuity of care, and effective management of patient symptoms and caregiver respite. Conclusion: More than a technology solution, the eShift model of care was viewed as transforming home care practice and an innovative way to resolve the shortage of palliative care nurses within home care.

Keywords: palliative home care, health information technology, patient-centred care, interprofessional health care team

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Authors: Zhizhong Yuan, Lili Wang, Chenya Zheng, Wuqi Yang

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How to encourage and support peer-to-peer (P2P) network lending, and effectively monitor the risk of P2P network lending, has become the focus of the Chinese government departments, industrialists, experts and scholars in recent years. The reason is that this convenient online micro-credit service brings a series of credit risks and other issues. Avoiding the risks brought by the P2P network lending model, it can better play a benign role and help China's small and medium-sized private enterprises with vigorous development to solve the capital needs; otherwise, it will bring confusion to the normal financial order. As a form of financial services, P2P network lending has injected new blood into China's non-government finance in the past ten years, and has found a way out for idle funds and made up for the shortage of traditional financial services in China. However, it lacks feasible measures in credit evaluation and government supervision. This paper collects a large amount of data about P2P network lending of China. The data collection comes from the official media of the Chinese government, the public achievements of existing researchers and the analysis and collation of correlation data by the authors. The research content of this paper includes literature review; the current situation of China's P2P network lending development; the risk analysis of P2P network lending in China; the risk prevention strategy of P2P network lending in China. The focus of this paper is to try to find a specific program to strengthen supervision and avoid risks from the perspective of government regulators, operators of P2P network lending platform, investors and users of funds. These main measures include: China needs to develop self-discipline organization of P2P network lending industry and formulate self-discipline norms as soon as possible; establish a regular information disclosure system of P2P network lending platform; establish censorship of credit rating of borrowers; rectify the P2P network lending platform in compliance through the implementation of bank deposition. The results and solutions will benefit all the P2P network lending platforms, creditors, debtors, bankers, independent auditors and government agencies of China and other countries.

Keywords: peer-to-peer(P2P), regulation, risk prevention, supervision

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Authors: Timothy Wale Olaosebikan

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The adverse effect of the Covid-19 outbreak and lock-downs on the world economy has coursed a major disrupt in mostly all sectors. The educational sector is not exempted from this disruption as it is one of the most affected sectors in the world. Similarly, most developing countries are still struggling to adopt/ adapt with the 21st-century advancement of technology, which includes e-learning/ e-education. Furthermore, one is left to wonder of the possibility of these countries surviving this disruption on their various educational systems that may no longer be business as usual after the Covid Pandemic era. This study evaluates the e-learning process of educational systems, especially in developing countries. The collection of data for the study was effected through the use of questionnaires with sampling drawn by stratified random sampling. The data was analyzed using descriptive and inferential statistics. The findings of the study show that about 30% of developing countries have fully adopted the e-learning system, about 45% of these countries are still struggling to upgrade while about 25% of these countries are yet to adopt the e-learning system of education. The study concludes that the sudden closure of educational institutions around the world during the Covid Pandemic period should facilitate a teaching pedagogy of e-learning and virtual delivery of courses and programmes in these developing countries. If this approach can be fully adopted, schools might have to grapple with the initial teething problems, given the sudden transition just in order to preserve the welfare of students. While progress should be made to transit as the case may be, lectures and seminars can be delivered through the web conferencing site-zoom. Interestingly, this can be done on a mobile phone. The demands of this approach would equally allow lecturers to make major changes to their work habits, uploading their teaching materials online, and get to grips with what online lecturing entails. Consequently, the study recommends that leaders of developing countries, regulatory authorities, and heads of educational institutions must adopt e-learning into their educational system. Also, e-learning should be adopted into the educational curriculum of students, especially from elementary school up to tertiary level. Total compliance to the e-learning system must be ensured on the part of both the institutions, stake holders, lecturers, tutors, and students. Finally, collaborations with developed countries and effective funding for e-learning integration must form the heart of their cardinal mission.

Keywords: Covid pandemic, developing countries, educational system, e-learning

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Authors: Abhishek Oswal

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

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

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Authors: Shu-Yen Wang, Shyh-Huei Hwang

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Designated as an important architectural complex of settlement by the Ministry of Culture, Hua-Zhai Settlement located in Wang-An Township, Peng-Hu County, of Taiwan has been progressively restored year by year and is now at the revitalization and reutilization stage. Over the last 5 years, YunTech has participated in the restoration project while being in compliance with the Bureau of Cultural Heritage’s spirit of 'Living Heritage Conservation'. In this study, reflections have been made to evaluate the contemporariness of traditional settlement development from the aspects of revitalization and reutilization. On the one hand, the connection between settlers’ experiences and emotions have been clarified through the living nodes, collective memory, and social-cultural connotation. On the other hand, activity design has promoted the reconstruction of living nodes and facilitated the reconnection of collective memory, enabling us to explore the contemporariness of living nodes after the reconstruction. With the adoption of literature review, participant observation, and interview analysis methods, this study concludes the following results: 1) The node reconstruction brings back the memories and makes emotional connections: the spatial collective memory is composed of different components. During the reconstruction of node space, villagers participated not only in the narration of the history but also in the restoration of the space. This process enables villagers to bring back their memories and make emotional connections thereto. 2) Villagers’ understanding towards revitalization has been facilitated through node reconstruction: as a medium of this project, activity design has facilitated node reconstruction by offering villagers a natural environment to build up emotional connections to the settlement. This also enables us to better understand the meaning of settlement activation for the local community. 3) New connections are established in life between villagers and the university through the construction of living nodes: through the local implementation of node reconstruction, new connections have been established in life between villagers who participated in the project and the university. In the meantime, the university’s entrance to the community has also been revalued.

Keywords: collective memory, local sense of belonging, reconstruction of living nodes, the important architectural complex of Wang-An Hua-Zhai settlement

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Authors: Yu-Yu Wang, Shih-Hua Hsieh, Ru-Shian Hsieh

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Wishes and choices being respected, and the right to be supported rather than coerced, have been internationally recognized as the human rights of persons with mental illness. In Taiwan, ‘coerced hospitalization’ has become difficult since the revision of the mental health legislation in 2007. Despite trend towards human rights, the real problem families face when their family members are in mental health crisis is the lack of alternative services. This study aims to explore: 1) When is hospitalization seen as the only solution by family members? 2) What are the barriers for arranging hospitalization, and how are they managed? 3) What have family carers learned, in their experiences of caring for their family members with mental illness? To answer these questions, qualitative approach was adopted, and focus group interviews were taken to collect data. This study includes 24 family carers. The main findings of this research include: First, hospital is the last resort for carers in helplessness. Family carers tend to do everything they could to provide care at home for their family members with mental illness. Carers seek hospitalization only when a patient’s behavior is too violent, weird, and/or abnormal, and beyond their ability to manage. Hospitalization, nevertheless, is never an easy choice. Obstacles emanate from the attitudes of the medical doctors, the restricted areas of ambulance service, and insufficient information from the carers’ part. On the other hand, with some professionals’ proactive assistance, access to medical care while in crisis becomes possible. Some family carers obtained help from the medical doctor, nurse, therapist and social workers. Some experienced good help from policemen, taxi drivers, and security guards at the hospital. The difficulty in accessing medical care prompts carers to work harder on assisting their family members with mental illness to stay in stable states. Carers found different ways of helping the ‘person’ to get along with the ‘illness’ and have better quality of life. Taking back ‘the right to control’ in utilizing medication, from passiveness to negotiating with medical doctors and seeking alternative therapies, are seen in many carers’ efforts. Besides, trying to maintain regular activities in daily life and play normal family roles are also experienced as important. Furthermore, talking with the patient as a person is also important. The authors conclude that in order to protect the human rights of persons with mental illness, it is crucial to make the medical care system more flexible and to make the services more humane: sufficient information should be provided and communicated, and efforts should be made to maintain the person’s social roles and to support the family.

Keywords: family carers, independent living, mental health crisis, persons with mental illness

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Authors: T. S. Beerenahally, S. Amruthavalli, C. M. Munegowda, Leelavathi, Nagarathna

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Introduction: In majority of urban India, the health system is split between different authorities being responsible for the health care of urban population. We believe that, apart from poor awareness and financial barriers to care, there are other health system barriers which affect quality and access to care for people with diabetes. In this paper, we attempted to identify health system complexity that determines access to public health system for diabetes care in KG Halli, a poor urban neighborhood in Bengaluru. The KG Halli has been a locus of a health systems research from 2009 to 2015. Methodology: The source of data is from the observational field-notes written by research team as part of urban health action research project (UHARP). Field notes included data from the community and the public primary care center. The data was generated by the community health assistants and the other research team members during regular home visits and interaction with individuals who self-reported to be diabetic over four years as part of UHARP. Results: It emerged during data analysis that the patients were not keen on utilizing primary public health center for many reasons. Patient has felt that the service provided at the center was not integrated. There was lack of availability of medicines, with a regular stock out of medicines in a year and laboratory service for investigation was limited. Many of them said that the time given by the providers was not sufficient and there was also a feeling of providers not listening to them attentively. The power dynamics played a huge role in communication. Only the consultation was available for free of cost at the public primary care center. The patient had to spend for the investigations and the major portion for medicine. Conclusion: Diabetes is a chronic disease that poses an important emerging public health concern. Most of the financial burden is borne by the family as the public facilities have failed to provide free care in India. Our study indicated various factors including individual beliefs, stigma and financial constraints affecting compliance to diabetes care.

Keywords: diabetes care, disintegrated health system, quality of care, urban health

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Authors: Pavitra Sharma, Anuradha Singh, Nupur Mathur

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There exist more than 100 trillion bacteria in the digestive system of human-beings. Such bacteria are referred to as gut microbiota. Gut microbiota comprises around 75% of our immune system. The bacteria that comprise the gut microbiota are unique to every individual and their composition keeps changing with time owing to factors such as the host’s age, diet, genes, environment, and external medication. Of these factors, the variable easiest to control is one’s diet. By modulating one’s diet, one can ensure an optimal composition of the gut microbiota yielding several health benefits. Prebiotics and probiotics are two compounds that have been considered as viable options to modulate the host’s diet. Prebiotics are basically plant products that support the growth of good bacteria in the host’s gut. Examples include garden asparagus, aloe vera etc. Probiotics are living microorganisms that exist in our intestines and play an integral role in promoting digestive health and supporting our immune system in general. Examples include yogurt, kimchi, kombucha etc. In the context of modulating the host’s diet, the key attribute of prebiotics is that they support the growth of probiotics. By developing the right combination of prebiotics and probiotics, food products or supplements can be created to enhance the host’s health. An effective combination of prebiotics and probiotics that yields health benefits to the host is referred to as synbiotics. Synbiotics comprise of an optimal proportion of prebiotics and probiotics, their application benefits the host’s health more than the application of prebiotics and probiotics used in isolation. When applied to food supplements, synbiotics preserve the beneficial probiotic bacteria during storage period and during the bacteria’s passage through the intestinal tract. When applied to the gastrointestinal tract, the composition of the synbiotics assumes paramount importance. Reason being that for synbiotics to be effective in the gastrointestinal tract, the chosen probiotic must be able to survive in the stomach’s acidic environment and manifest tolerance towards bile and pancreatic secretions. Further, not every prebiotic stimulates the growth of a particular probiotic. The prebiotic chosen should be one that not only maintains 2 balance in the host’s digestive system, but also provides the required nutrition to probiotics. Hence in each application of synbiotics, the prebiotic-probiotic combination needs to be carefully selected. Once the combination is finalized, the exact proportion of prebiotics and probiotics to be used needs to be considered. When determining this proportion, only that amount of a prebiotic should be used that activates metabolism of the required number of probiotics. It was observed that while probiotics are active is both the small and large intestine, the effect of prebiotics is observed primarily in the large intestine. Hence in the host’s small intestine, synbiotics are likely to have the maximum efficacy. In small intestine, prebiotics not only assist in the growth of probiotics, but they also enable probiotics to exhibit a higher tolerance to pH levels, oxygenation, and intestinal temperature

Keywords: microbiota, probiotics, prebiotics, synbiotics

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Authors: Hamdan Hamood Aldumaini, Amjad Hussein Meqdam, Shamsaldeen kassim Ali, Hamed Mohammed Al-Yousefi, Haron Ahmed Al-Badawi

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Background: Autism Spectrum Disorder (ASD) is a complex developmental challenge characterized by significant impairments in social interaction, communication, and behavioral patterns. Diagnosing ASD is challenging due to the lack of definitive medical tests, making early identification crucial. Therefore, increasing people's awareness about autism leads to early diagnosis and better prognosis. Objective: Our study aims to identify the initial symptoms prompting families to seek medical advice, determine the timeline between symptom onset and formal diagnosis, and explore methods for assessing the severity of ASD. Subjects and Methods: The study design employed was a descriptive cross-sectional design, which was suitable for the nature of the research. The data collection took place from March 5, 2022, to April 5, 2022, in Autism Rehabilitation Centers in Sana'a, Yemen. The study population consisted of all children who were diagnosed with autism and visited Autism rehabilitation centers in Sana'a city. The sample size was determined using Epi info version 7, and a total population of 587 autistic children attending the treatment was calculated, but only 250 children were included in this study (176 were male vs. 74 female). Result: In terms of sociability problems, it was found that a significant proportion of Yemeni children with autism experienced difficulties in this area. Specifically, 39.6% were classified as having severe sociability problems, while 28.4% were classified as having moderate issues. Sensory-cognitive awareness problems were also prevalent among the respondents, with 29.6% exhibiting severe difficulties in this domain. Health and physical problems were identified as significant concerns for Yemeni children with autism. The results indicated that 38.4% of the participants experienced severe health and physical issues. Identifying the first symptoms of autism is crucial for early detection and intervention. According to the study, speech delay was the most commonly observed first abnormality, reported by 71.3% of parents. Communication difficulties with others were the second most noticed abnormality, reported by 54.9% of parents. Repetitive movements were the third most commonly observed abnormality, reported by 18% of parents. Regarding the awareness among parents of ASD, our study showed that a significant portion (62%) of parents lack awareness about Autism Spectrum Disorder (ASD) and its causes. Surprisingly, a majority of these parents (over 80%) believe that autism is a curable condition. Additionally, more than half (51.2%) of the parents surveyed reported insufficient knowledge about medication options available to support therapy and rehabilitation for their autistic children.

Keywords: autism characteristics, rehabilitation centres, yemen, children

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Authors: Pedro Esteban

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Most installations nowadays are exposed to many power quality problems, and they also face numerous challenges to comply with grid code and energy efficiency requirements. The reason behind this is that they are not designed to support nonlinear, non-balanced, and variable loads and generators that make up a large percentage of modern electric power systems. These problems and challenges become especially critical when designing green buildings and smart cities. These problems and challenges are caused by equipment that can be typically found in these installations like variable speed drives (VSD), transformers, lighting, battery chargers, double-conversion UPS (uninterruptible power supply) systems, highly dynamic loads, single-phase loads, fossil fuel generators and renewable generation sources, to name a few. Moreover, events like capacitor switching (from existing capacitor banks or passive harmonic filters), auto-reclose operations of transmission and distribution lines, or the starting of large motors also contribute to these problems and challenges. Active power filters (APF) are one of the fastest-growing power electronics technologies for solving power quality problems and meeting grid code and energy efficiency requirements for a wide range of segments and applications. They are a high performance, flexible, compact, modular, and cost-effective type of power electronics solutions that provide an instantaneous and effective response in low or high voltage electric power systems. They enable longer equipment lifetime, higher process reliability, improved power system capacity and stability, and reduced energy losses, complying with most demanding power quality and energy efficiency standards and grid codes. There can be found several types of active power filters, including active harmonic filters (AHF), static var generators (SVG), active load balancers (ALB), hybrid var compensators (HVC), and low harmonic drives (LHD) nowadays. All these devices can be used in applications in Smart Cities bringing several technical and economic benefits.

Keywords: power quality improvement, energy efficiency, grid code compliance, green buildings, smart cities

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Authors: Mohammed E. A. Brixi Nigassa, Nassima Labdelli, Ahmed Slami, Arnaud Pothier, Sofiane Soulimane

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According to the world health organization (WHO), there are almost 285 million people with visual disability, 39 million of these people are blind. Nevertheless, there is a code for these people that make their life easier and allow them to access information more easily; this code is the Braille code. There are several commercial devices allowing braille reading, unfortunately, most of these devices are not ergonomic and too expensive. Moreover, we know that 90 % of blind people in the world live in low-incomes countries. Our contribution aim is to concept an original microactuator for Braille reading, as well as being ergonomic, inexpensive and lowest possible energy consumption. Nowadays, the piezoelectric device gives the better actuation for low actuation voltage. In this study, we focus on piezoelectric (PZT) material which can bring together all these conditions. Here, we propose to use one matrix composed by six actuators to form the 63 basic combinations of the Braille code that contain letters, numbers, and special characters in compliance with the standards of the braille code. In this work, we use a finite element model with Comsol Multiphysics software for designing and modeling this type of miniature actuator in order to integrate it into a test device. To define the geometry and the design of our actuator, we used physiological limits of perception of human being. Our results demonstrate in our study that piezoelectric actuator could bring a large deflection out-of-plain. Also, we show that microactuators can exhibit non uniform compression. This deformation depends on thin film thickness and the design of membrane arm. The actuator composed of four arms gives the higher deflexion and it always gives a domed deformation at the center of the deviceas in case of the Braille system. The maximal deflection can be estimated around ten micron per Volt (~ 10µm/V). We noticed that the deflection according to the voltage is a linear function, and this deflection not depends only on the voltage the voltage, but also depends on the thickness of the film used and the design of the anchoring arm. Then, we were able to simulate the behavior of the entire matrix and thus display different characters in Braille code. We used these simulations results to achieve our demonstrator. This demonstrator is composed of a layer of PDMS on which we put our piezoelectric material, and then added another layer of PDMS to isolate our actuator. In this contribution, we compare our results to optimize the final demonstrator.

Keywords: Braille code, comsol software, microactuators, piezoelectric

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Authors: Abhay Asthana, Gyati Shilakari Asthana

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It’s the patient compliance and stability in combination with controlled drug delivery and biocompatibility that forms the core feature in present research and development of sustained biodegradable patch formulation intended for wound healing. The aim was to impart sustained degradation, sterile formulation, significant folding endurance, elasticity, biodegradability, bio-acceptability and strength. The optimized formulation was developed using component including polymers including Hydroxypropyl methyl cellulose, Ethylcellulose, and Gelatin, and Citric Acid PEG Citric acid (CPEGC) triblock dendrimers and active Curcumin. Polymeric mixture dissolved in geometric order in suitable medium through continuous stirring under ambient conditions. With continued stirring Curcumin was added with aid of DCM and Methanol in optimized ratio to get homogenous dispersion. The dispersion was sonicated with optimum frequency and for given time and later casted to form a patch form. All steps were carried out under under strict aseptic conditions. The formulations obtained in the acceptable working range were decided based on thickness, uniformity of drug content, smooth texture and flexibility and brittleness. The patch kept on stability using butter paper in sterile pack displayed folding endurance in range of 20 to 23 times without any evidence of crack in an optimized formulation at room temperature (RT) (24 ± 2°C). The patch displayed acceptable parameters after stability study conducted in refrigerated conditions (8±0.2°C) and at RT (24 ± 2°C) upto 90 days. Further, no significant changes were observed in critical parameters such as elasticity, biodegradability, drug release and drug content during stability study conducted at RT 24±2°C for 45 and 90 days. The drug content was in range 95 to 102%, moisture content didn’t exceeded 19.2% and patch passed the content uniformity test. Percentage cumulative drug release was found to be 80% in 12h and matched the biodegradation rate as drug release with correlation factor R2>0.9. The biodegradable patch based formulation developed shows promising results in terms of stability and release profiles.

Keywords: sustained biodegradation, wound healing, polymers, stability

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Authors: Badriah Alayidi, Emad Alyahya

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Background: Most people with Multiple Sclerosis (MS) report worsening balance as the condition progresses. Poor balance control is also well known to be a significant risk factor for both falling and fear of falling. The increased risk of falls with disease progression thus makes balance control an essential target of gait rehabilitation amongst people with MS. Intervention programs have developed various methods to improve balance control, and accumulating evidence suggests that exercise programs may help people with MS improve their balance. Among these methods, virtual reality (VR) is growing in popularity as a balance-training technique owing to its potential benefits, including better compliance and greater user happiness. However, it is not clear if a VR environment will induce different balance control mechanisms in MS as compared to healthy individuals or traditional environments. Therefore, this study aims to examine how individuals with MS control their balance in a VR setting. Methodology: The proposed study takes an empirical approach to estimate and determine the role of balance response in persons with MS using a VR environment. It will use primary data collected through patient observations, physiological and biomechanical evaluation of balance, and data analysis. Results: The preliminary systematic review and meta-analysis indicated that there was variability in terms of the outcome assessing balance response in people with MS. The preliminary results of these assessments have the potential to provide essential indicators of the progression of MS and contribute to the individualization of treatment and evaluation of the interventions’ effectiveness. The literature describes patients who have had the opportunity to experiment in VR settings and then used what they have learned in the real world, suggesting that this VR setting could be more appealing than conditional settings. The findings of the proposed study will be beneficial in estimating and determining the effect of VR on balance control in persons with MS. In previous studies, VR was shown to be an interesting approach to neurological rehabilitation, but more data are needed to support this approach in MS. Conclusions: The proposed study enables an assessment of balance and evaluations of a variety of physiological implications related to neural activity as well as biomechanical implications related to movement analysis.

Keywords: multiple sclerosis, virtual reality, postural control, balance

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Authors: Yu-Min Chang, Kuo-Sheng Tsai, Hung-Te Tsai, Chia-Hsin Li

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This paper presents the early-warning lights classification management system for industrial parks promoted by the Taiwan Environmental Protection Administration (EPA) since 2011, including the definition of each early-warning light, objectives, action program and accomplishments. All of the 151 industrial parks in Taiwan were classified into four early-warning lights, including red, orange, yellow and green, for carrying out respective pollution management according to the monitoring data of soil and groundwater quality, regulatory compliance, and regulatory listing of control site or remediation site. The Taiwan EPA set up a priority list for high potential polluted industrial parks and investigated their soil and groundwater qualities based on the results of the light classification and pollution potential assessment. In 2011-2013, there were 44 industrial parks selected and carried out different investigation, such as the early warning groundwater well networks establishment and pollution investigation/verification for the red and orange-light industrial parks and the environmental background survey for the yellow-light industrial parks. Among them, 22 industrial parks were newly or continuously confirmed that the concentrations of pollutants exceeded those in soil or groundwater pollution control standards. Thus, the further investigation, groundwater use restriction, listing of pollution control site or remediation site, and pollutant isolation measures were implemented by the local environmental protection and industry competent authorities; the early warning lights of those industrial parks were proposed to adjust up to orange or red-light. Up to the present, the preliminary positive effect of the soil and groundwater quality management system for industrial parks has been noticed in several aspects, such as environmental background information collection, early warning of pollution risk, pollution investigation and control, information integration and application, and inter-agency collaboration. Finally, the work and goal of self-initiated quality management of industrial parks will be carried out on the basis of the inter-agency collaboration by the classified lights system of early warning and management as well as the regular announcement of the status of each industrial park.

Keywords: industrial park, soil and groundwater quality management, early-warning lights classification, SOP for reporting and treatment of monitored abnormal events

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Authors: Semira Zeru Haileslassie

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Lack of awareness and practices of PEP treatment were observed among respondents, but they had a better attitude towards PEP. To this end, a formal training for all respondents regarding PEP for HIV prior to their clinical attachments is of utmost importance. The training ought to incorporate a brief clarification with respect to the unpleasant impact of non-adherence that essentially incorporate destitute treatment result and most prominent hazard of resistance and few given as a major cause for non-compliance to PEP, common transient side-effects of PEP and its administrations ought to be cloister educated healthcare specialists to diminish its effect on adherence. Besides, the propensity of detailing needle adhere harm was destitute that needs endeavors to progress. Progressing the culture of detailing and making the detailing handle simple is very necessary. In reality, announcing such wounds as early as conceivable will educate others not to commit same issue once more and, for the most part, will empower stakeholders to intercede the issue sometime prior to it re-occur. At long last, as distant as get up and go utilize has cleared out with so numerous bothers, risk decrease is the foremost choice. With this, taking the increased significance of protective barriers so as to decrease the hazard of exposure to HIV, distinctive stakeholders (the healing center hardware supply chain director, the HIV/ Helps clinic, the clinic chief, hardware and supply quality confirmation group, and other authoritative bodies) ought to work together in co-ordination to secure the supply and guarantee the quality of those crucial protective barriers and to advance demand health laborers to continuously wear protective barriers when exposed to HIV hazard components as well as to dispose appropriately once done. At long last, we prescribe future examiners to conduct planned multicenter studies with extra goals (counting indicator investigation) for way better generalization and result. In spite of satisfactory information and favorable state of mind towards PEP for HIV in most of the respondents, this study uncovered that there were delays in starting, low utilization, and fragmented use of the prescribed PEP. So, health care staff need to progress their practice on PEP of HIV through diverse training program related to PEP of HIV.

Keywords: HIV infection, prophylaxis, knowledge, attitude

Procedia PDF Downloads 186

Authors: Desalegn Feyissa Desu

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Drug therapy problem is a significant challenge to provide high quality health care service for the patients. It is associated with morbidity, mortality, increased hospital stay, and reduced quality of life. Moreover, pediatric patients are quite susceptible to drug therapy problems. Thus this study aimed to assess drug therapy problem and its contributing factors among pediatric patients diagnosed with infectious disease admitted to pediatric ward of Jimma university medical center, from April 1 to June 30, 2018. Prospective observational study was conducted among pediatric patients with infectious disease admitted from April 01 to June 30, 2018. Drug therapy problems were identified by using Cipolle’s and strand’s drug related problem classification method. Patient’s written informed consent was obtained after explaining the purpose of the study. Patient’s specific data were collected using structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug therapy problems occurrence, multiple stepwise backward logistic regression analysis was done. The 95% CI was used to show the accuracy of data analysis and statistical significance was considered at p-value < 0.05. A total of 304 pediatric patients were included in the study. Of these, 226(74.3%) patients had at least one drug therapy problem during their hospital stay. A total of 356 drug therapy problems were identified among two hundred twenty six patients. Non-compliance (28.65%) and dose too low (27.53%) were the most common type of drug related problems while disease comorbidity [AOR=3.39, 95% CI= (1.89-6.08)], Polypharmacy [AOR=3.16, 95% CI= (1.61-6.20)] and more than six days stay in hospital [AOR=3.37, 95% CI= (1.71-6.64) were independent predictors of drug therapy problem occurrence. Drug therapy problems were common in pediatric patients with infectious disease in the study area. Presence of comorbidity, polypharmacy and prolonged hospital stay were the predictors of drug therapy problem in study area. Therefore, to overcome the significant gaps in pediatric pharmaceutical care, clinical pharmacists, Pediatricians, and other health care professionals have to work in collaboration.

Keywords: drug therapy problem, pediatric, infectious disease, Ethiopia

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Authors: Szilvia Halmos

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Hungary was one of the first countries to sign and ratify the UN Convention on the Rights of Persons with Disabilities (hereinafter: CRPD). Consequently, Hungary assumed an obligation under international law to review the national law in the light of the Article 12 of the CRPD requiring the States parties to guarantee the equality of persons with disabilities in terms of legal capacity, and to replace the regimes of substitute decision-making by the instruments of supported decision-making. This article is often characterized as one of the key norms of the CRPD, since the legal autonomy of the persons with disabilities is an essential precondition of their participation in the social life on an equal basis with others, envisaged by the social paradigm of disability. This paper examines the impact of the CRPD on the relevant Hungarian national legal norms, with special focus on the relevant rules of the recently codified Civil Code. The employed research methodologies include (1) the specification of the implementation requirements imposed by the Article 12 of the CRPD, (2) the determination of the indicators of the appropriate implementation, (3) the critical analysis of compliance of the relevant Hungarian legal regulation with the indicators, (4) with respect to the relevant case law of the Hungarian Constitutional Court and ordinary courts, the European Court of Human Rights and the Committee of Rights of Persons with Disabilities and (5) to the available empirical figures on the functioning of substitute and supported decision-making regimes. It will be established that the new Civil Code has made large steps toward the equality of persons with disabilities in terms of legal capacity and the support model of decision-making by the introduction of some specific instruments of supported decision-making and the restriction of the application of guardianship. Nevertheless, the regulation currently in effect fails to represent some crucial principles of the Article 12 of the CRPD, such as the non-discrimination of persons with psycho-social disabilities, the support of the articulation of the will and preferences of the individual instead of his/her best interest in the course of decision-making. The changes in the practice of the substitute and the support model brought about by the new legal norms can also be assessed as significant, however, so far unsatisfactory. The number of registered supporters is rather low, and the preconditions of the effective functioning of the support (e.g. the proper training of the supporters) are not ensured.

Keywords: Article 12 of the UN CRPD, Hungarian law on legal capacity, persons with intellectual and psycho-social disabilities, supported decision-making

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Authors: Palash Soni, Vivek Kumar Gaba, Shubhankar Bhowmick, Bidyut Mazumdar

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Refrigeration technology is a fast developing field at the present era since it has very wide application in both domestic and industrial areas. It started from the usage of simple ice coolers to store food stuffs to the present sophisticated cold storages along with other air conditioning system. A variety of techniques are used to bring down the temperature below the ambient. Adsorption refrigeration technology is a novel, advanced and promising technique developed in the past few decades. It gained attention due to its attractive property of exploiting unlimited natural sources like solar energy, geothermal energy or even waste heat recovery from plants or from the exhaust of locomotives to fulfill its energy need. This will reduce the exploitation of non-renewable resources and hence reduce pollution too. This work is aimed to develop a model for a solar adsorption refrigeration system and to simulate the same for different operating conditions. In this system, the mechanical compressor is replaced by a thermal compressor. The thermal compressor uses renewable energy such as solar energy and geothermal energy which makes it useful for those areas where electricity is not available. Refrigerants normally in use like chlorofluorocarbon/perfluorocarbon have harmful effects like ozone depletion and greenhouse warming. It is another advantage of adsorption systems that it can replace these refrigerants with less harmful natural refrigerants like water, methanol, ammonia, etc. Thus the double benefit of reduction in energy consumption and pollution can be achieved. A thermodynamic model was developed for the proposed adsorber, and a universal MATLAB code was used to simulate the model. Simulations were carried out for a different operating condition for the silicagel-methanol working pair. Various graphs are plotted between regeneration temperature, adsorption capacities, the coefficient of performance, desorption rate, specific cooling power, adsorption/desorption times and mass. The results proved that adsorption system could be installed successfully for refrigeration purpose as it has saving in terms of power and reduction in carbon emission even though the efficiency is comparatively less as compared to conventional systems. The model was tested for its compliance in a cold storage refrigeration with a cooling load of 12 TR.

Keywords: adsorption, refrigeration, renewable energy, silicagel-methanol

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Authors: I. C. Orabueze, A. A. Amudalat, S. A. Adesegun, A. A. Usman

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Dental and associated oral diseases are increasingly affecting a considerable portion of the population and are considered some of the major causes of tooth loss, discomfort, mouth odor and loss of confidence. This study focused on the ethnobotanical survey of medicinal plants used in oral therapy and evaluation of the antimicrobial activities of methanolic extracts of two selected plants from the survey for their efficacy against dental microorganisms. The ethnobotanical survey was carried out in six herbal markets in Lagos State, Nigeria by oral interviewing and information obtained from an old family manually complied herbal medication book. Methanolic extracts of Olax subscorpioidea (stem bark) and Bridelia ferruginea (stem bark) were assayed for their antimicrobial activities against clinical oral isolates (Aspergillus fumigatus, Candida albicans, Streptococcus spp, Staphylococcus aureus, Lactobacillus acidophilus and Pseudomonas aeruginosa). In vitro microbial technique (agar well diffusion method and minimum inhibitory concentration (MIC) assay) were employed for the assay. Chlorhexidine gluconate was used as the reference drug for comparison with the extract results. And the preliminary phytochemical screening of the constituents of the plants were done. The ethnobotanical survey produced plants (28) of diverse family. Different parts of plants (seed, fruit, leaf, root, bark) were mentioned but 60% mentioned were either the stem or the bark. O. subscorpioidea showed considerable antifungal activity with zone of inhibition ranging from 2.650 – 2.000 cm against Aspergillus fumigatus but no such encouraging inhibitory activity was observed in the other assayed organisms. B. ferruginea showed antibacterial sensitivity against Streptococcus spp, Staphylococcus aureus, Lactobacillus acidophilus and Pseudomonas aeruginosa with zone of inhibitions ranging from 3.400 - 2.500, 2.250 - 1.600, 2.700 - 1.950, 2.225 – 1.525 cm respectively. The minimum inhibitory concentration of O. subscorpioidea against Aspergillus fumigatus was 51.2 mg ml-1 while that of B. ferruginea against Streptococcus spp was 0.1mg ml-1 and for Staphylococcus aureus, Lactobacillus acidophilus and Pseudomonas aeruginosa were 25.6 mg ml-1. A phytochemical analysis reveals the presence of alkaloids, saponins, cardiac glycoside, tannins, phenols and terpenoids in both plants, with steroids only in B. ferruginea. No toxicity was observed among mice given the two methanolic extracts (1000 mg Kg-1) after 21 days. The barks of both plants exhibited antimicrobial properties against periodontal diseases causing organisms assayed, thus up-holding their folkloric use in oral disorder management. Further research could be done viewing these extracts as combination therapy, checking for possible synergistic value in toothpaste and oral rinse formulations for reducing oral bacterial flora and fungi load.

Keywords: antimicrobial activities, Bridelia ferruginea, dental disinfection, methanolic extract, Olax subscorpioidea, ethnobotanical survey

Procedia PDF Downloads 232

Authors: Ioannis Panagiotopoulos, Aristidis Anastasakis, Konstantinos Toutouzas, Ioannis Iakovou, Charalampos Vlachopoulos, Vasilis Voudris, Georgios Tziomalos, Konstantinos Tsioufis, Efstathios Kastritis, Alexandros Briassoulis, Kimon Stamatelopoulos, Alexios Antonopoulos, Paraskevi Exadaktylou, Evanthia Giannoula, Anastasia Katinioti, Maria Kalantzi, Evangelos Leontiadis, Eftychia Smparouni, Ioannis Malakos, Nikolaos Aravanis, Argyrios Doumas, Maria Koutelou

Abstract:

Introduction: Cardiac amyloidosis from Transthyretin (ATTR-CA) is an infiltrative disease characterized by the deposition of pathological transthyretin complexes in the myocardium. This study describes the characteristics of patients diagnosed with ATTR-CA from 2019 until present at the Nuclear Medicine Department of Onassis Cardiac Surgery Center and AHEPA Hospital. These centers have extensive experience in amyloidosis and modern technological equipment for its diagnosis. Materials and Methods: Records of consecutive patients (N=73) diagnosed with any type of amyloidosis were collected, analyzed, and prospectively followed. The diagnosis of amyloidosis was made using specific myocardial scintigraphy with Tc-99m DPD. Demographic characteristics, including age, gender, marital status, height, and weight, were collected in a database. Clinical characteristics, such as amyloidosis type (ATTR and AL), serum biomarkers (BNP, troponin), electrocardiographic findings, ultrasound findings, NYHA class, aortic valve replacement, device implants, and medication history, were also collected. Some of the most significant results are presented. Results: A total of 73 cases (86% male) were diagnosed with amyloidosis over four years. The mean age at diagnosis was 82 years, and the main symptom was dyspnea. Most patients suffered from ATTR-CA (65 vs. 8 with AL). Out of all the ATTR-CA patients, 61 were diagnosed with wild-type and 2 with two rare mutations. Twenty-eight patients had systemic amyloidosis with extracardiac involvement, and 32 patients had a history of bilateral carpal tunnel syndrome. Four patients had already developed polyneuropathy, and the diagnosis was confirmed by DPD scintigraphy, which is known for its high sensitivity. Among patients with isolated cardiac involvement, only 6 had left ventricular ejection fraction below 40%. The majority of ATTR patients underwent tafamidis treatment immediately after diagnosis. Conclusion: In conclusion, the experiences shared by the two centers and the continuous exchange of information provide valuable insights into the diagnosis and management of cardiac amyloidosis. Clinical suspicion of amyloidosis and early diagnostic approach are crucial, given the availability of non-invasive techniques. Cardiac scintigraphy with DPD can confirm the presence of the disease without the need for a biopsy. The ultimate goal still remains continuous education and awareness of clinical cardiologists so that this systemic and treatable disease can be diagnosed and certified promptly and treatment can begin as soon as possible.

Keywords: amyloidosis, diagnosis, myocardial scintigraphy, Tc-99m DPD, transthyretin

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Authors: Danar Agus Susanto, Hermawan Febriansyah, Meilinda Ayundyahrini

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The availability of spring water to meet people demand is often a problem, especially in tropical areas with very limited surface water sources, or very deep underground water. Although the technology and equipment of pumping system are available and easy to obtain, but in remote areas, the availability of pumping system is difficult, due to the unavailability of fuel or the lack of electricity. Solar Water Pumping System (SWPS) became one of the alternatives that can overcome these obstacles. In the tropical country, sunlight can be obtained throughout the year, even in remote areas. SWPS were already widely built in Indonesia, but many encounter problems during operations, such as decreased of efficiency; pump damaged, damaged of controllers or inverters, and inappropriate photovoltaic performance. In 2011, International Electrotechnical Commission (IEC) issued the IEC standard 62253:2011 titled Photovoltaic pumping systems - Design qualification and performance measurements. This standard establishes design qualifications and performance measurements related to the product of a solar water pumping system. National Standardization Agency of Indonesia (BSN) as the national standardization body in Indonesia, has not set the standard related to solar water pumping system. This research to study operational procedures of SWPS by adopting of IEC Standard 62253:2011 to be Indonesia Standard (SNI). This research used literature study and field observation for installed SWPS in Indonesia. Based on the results of research on SWPS already installed in Indonesia, IEC 62253: 2011 standard can improve efficiency and reduce operational failure of SWPS. SWPS installed in Indonesia still has GAP of 51% against parameters in IEC standard 62253: 2011. The biggest factor not being met is related to operating and maintenance handbooks for personnel that included operation and repair procedures. This may result in operator ignorance in installing, operating and maintaining the system. The Photovoltaic (PV) was also the most non-compliance factor of 71%, although there are 22 Indonesia Standard (SNI) for PV (modules, installation, testing, and construction). These research samples (installers, manufacturers/distributors, and experts) agreed on the parameter in the IEC standard 62253: 2011 able to improve the quality of SWPS in Indonesia. Recommendations of this study, that is required the adoption of IEC standard 62253:2011 into SNI to support the development of SWPS for remote areas in Indonesia.

Keywords: efficiency, inappropriate installation, remote areas, solar water pumping system, standard

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Authors: Dianne Lyneth Alavado

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At the turn of the millennium, development paradigms in the international scene revolved around one goal: elimination of global poverty without comprising human rights. One measure which achieved high endorsement and visibility in the world of work is the Decent Work Agenda (DWA) championed by the United Nation’s (UN) specialized agency for work, the International Labour Organization (ILO). The DWA has been thoroughly promoted and recommended as an ingredient of development planning and a poverty reduction strategy, particularly in developing countries such as the Philippines. The global imperative of economic growth is measurable not only in the numbers raked in by countries in terms of expanding economy but also by the development and realization of the full capacities of their people. Decent work (DW), as an outcome and not just a development approach, promises poverty eradication by means of providing both quantity and quality work that is accompanied by rights, representation, and protection. As a party to these international pacts, the Philippines is expected to heed the call towards a world free from poverty through well-endorsed measures such as the DWA with the aid of multilateral and donor organizations such as the ILO. This study aims to assess the capacity and readiness of the Philippines to achieve the goals of the DWA. This is a qualitative research using the sociological and juridical lens in the desk analysis of existing Philippine laws, policies, and programs vis-à-vis decent work indicators set forth by the ILO. Interview with experts on the Philippine labor situation is conducted for further validation. The paper identifies gaps within the Philippine legal system and its collection of laws, acts, presidential decrees, department orders and other policy instruments aimed towards achieving the goals of the DWA. Among the major findings of this paper are: the predisposition of Philippine labor laws towards the formal sector; the need for alternative solutions for the informal sector veering away from the usual dole-outs and livelihood projects; the needs for evaluation of policies and programs that are usually self-evaluated; the minimal reach of the labour inspectorate which ensures decent work; and the lack of substantial penalty for non-compliance with labor laws. The paper concludes with policy implications and recommendations towards addressing the potholes on the road to Decent Work.

Keywords: decent work agenda, labor laws, millennium development goals, poverty eradication, sustainable development goal

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Authors: Melissa K. Hord, Stephen P. Whiteside

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With lifetime prevalence rates ranging from 6% to 15%, anxiety disorders are among the most common childhood mental health diagnoses. Anxiety disorders diagnosed in childhood generally show an unremitting course, lead to additional psychopathology and interfere with social, emotional, and academic development. Effective evidence-based treatments include cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRI’s). However, if anxious children receive any treatment, it is usually through primary care, typically consists of medication, and very rarely includes evidence-based psychotherapy. Despite the high prevalence of anxiety disorders, there have only been two independent research labs that have investigated long-term results for CBT treatment for all childhood anxiety disorders and two for specific anxiety disorders. Generally, the studies indicate that the majority of youth maintain gains up to 7.4 years after treatment. These studies have not been replicated. In addition, little is known about the additional mental health care received by these patients in the intervening years after anxiety treatment, which seems likely to influence maintenance of gains for anxiety symptoms as well as the development of additional psychopathology during the subsequent years. The original sample consisted of 335 children ages 7 to 17 years (mean 13.09, 53% female) diagnosed with an anxiety disorder in 2010. Medical record review included provider billing records for mental health appointments during the five years after anxiety treatment. The subsample for this study was classified into three groups: 64 children who received CBT in an anxiety disorders clinic, 56 who received treatment from a psychiatrist, and 10 who were seen in a primary care setting. Chi-square analyses resulted in significant differences in mental health care utilization across the five years after treatment. Youth receiving treatment in primary care averaged less than one appointment each year and the appointments continued at the same rate across time. Children treated by a psychiatrist averaged approximately 3 appointments in the first two years and 2 in the subsequent three years. Importantly, youth treated in the anxiety clinic demonstrated a gradual decrease in mental health appointments across time. The nuanced differences will be presented in greater detail. The results of the current study have important implications for developing dissemination materials to help guide parents when they are selecting treatment for their children. By including all mental health appointments, this study recognizes that anxiety is often comorbid with additional diagnoses and that receiving evidence-based treatment may have long-term benefits that are associated with improvements in broader mental health. One important caveat might be that the acuity of mental health influenced the level of care sought by patients included in this study; however, taking this possibility into account, it seems those seeking care in a primary care setting continued to require similar care at the end of the study, indicating little improvement in symptoms was experienced.

Keywords: anxiety, children, mental health, outcomes

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Authors: Shreya Goyal

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The study aims to build user-friendly software to understand patient arrival patterns and compute the number of potential patients who will visit a particular health facility for a given period by using a machine learning algorithm. The underlying machine learning algorithm used in this study is the Support Vector Machine (SVM). Accurate prediction of patient arrival allows hospitals to operate more effectively, providing timely and efficient care while optimizing resources and improving patient experience. It allows for better allocation of staff, equipment, and other resources. If there's a projected surge in patients, additional staff or resources can be allocated to handle the influx, preventing bottlenecks or delays in care. Understanding patient arrival patterns can also help streamline processes to minimize waiting times for patients and ensure timely access to care for patients in need. Another big advantage of using this software is adhering to strict data protection regulations such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States as the hospital will not have to share the data with any third party or upload it to the cloud because the software can read data locally from the machine. The data needs to be arranged in. a particular format and the software will be able to read the data and provide meaningful output. Using software that operates locally can facilitate compliance with these regulations by minimizing data exposure. Keeping patient data within the hospital's local systems reduces the risk of unauthorized access or breaches associated with transmitting data over networks or storing it in external servers. This can help maintain the confidentiality and integrity of sensitive patient information. Historical patient data is used in this study. The input variables used to train the model include patient age, time of day, day of the week, seasonal variations, and local events. The algorithm uses a Supervised learning method to optimize the objective function and find the global minima. The algorithm stores the values of the local minima after each iteration and at the end compares all the local minima to find the global minima. The strength of this study is the transfer function used to calculate the number of patients. The model has an output accuracy of >95%. The method proposed in this study could be used for better management planning of personnel and medical resources.

Keywords: machine learning, SVM, HIPAA, data

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Authors: Rajesh Karki, Safal Bhattarai, Saket Adhikari

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Reliable and economic operation of power systems are becoming extremely challenging with large scale integration of renewable energy sources due to the intermittency and uncertainty associated with renewable power generation. It is, therefore, important to make a quantitative risk assessment and explore the potential resources to mitigate such risks. Probabilistic models for different energy storage systems (ESS), such as the flywheel energy storage system (FESS) and the compressed air energy storage (CAES) incorporating specific charge/discharge performance and failure characteristics suitable for probabilistic risk assessment in power system operation and planning are presented in this paper. The proposed methodology used in FESS modelling offers flexibility to accommodate different configurations of plant topology. It is perceived that CAES has a high potential for grid-scale application, and a hybrid approach is proposed, which embeds a Monte-Carlo simulation (MCS) method in an analytical technique to develop a suitable reliability model of the CAES. The proposed ESS models are applied to a test system to investigate the economic and reliability benefits of the energy storage technologies in system operation and planning, as well as to assess their contributions in facilitating wind integration during different operating scenarios. A comparative study considering various storage system topologies are also presented. The impacts of failure rates of the critical components of ESS on the expected state of charge (SOC) and the performance of the different types of ESS during operation are illustrated with selected studies on the test system. The paper also applies the proposed models on the test system to investigate the economic and reliability benefits of the different ESS technologies and to evaluate their contributions in facilitating wind integration during different operating scenarios and system configurations. The conclusions drawn from the study results provide valuable information to help policymakers, system planners, and operators in arriving at effective and efficient policies, investment decisions, and operating strategies for planning and operation of power systems with large penetrations of renewable energy sources.

Keywords: flywheel energy storage, compressed air energy storage, power system reliability, renewable energy, system planning, system operation

Procedia PDF Downloads 119