Search results for: fuzzy set methods

Authors: Chia-Chen Hsieh, Fei-Hsiu Hsiao

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Objective: To examine the effects of supportive care interventions on depressive symptoms in patients with lung cancer. Methods: The databases of Cochrane Central Register of Controlled Trials (CENTRAL), Ovid EMBASE, PubMed, and Chinese Electronic Periodical Services (CEPS) were searched from their inception until September 2015. We included the studies with randomized controlled trial design that compared standard care with supportive care interventions using psychotherapeutic or exercises approach. The standardized mean differences (SMD) (Cohen’s d) were calculated to estimate the treatment effects. The Cochrane Risk of Bias Tool was used for quality assessment and subgroup analysis was conducted to identify possible sources of heterogeneity. Results: A total of 1472 patients with lung cancer were identified. Compared with standard care, the overall effects of all supportive care interventions significantly reduced depressive symptoms (SMD = -0.74 with 95% CI = -1.07 to -0.41), and the effect was maintained at the 4th, 8th, and 12th weeks of follow-up. Either psychotherapy combined with psychoeducation or exercise alone produced significant improvements in depressive symptoms, while psychoeducation alone did not. The greater improvements in depressive symptoms occurred in lung cancer patients with severe depressive symptoms at baseline, total duration of interventions of less than ten weeks, and intervention provided through face-to-face delivery. Conclusions: Psychotherapy combined with psychoeducation can help patients manage the causes of depressive symptoms, including both symptom distress and psychological trauma due to lung cancer. Exercise can target the impaired respiratory function that is a cause of depressive symptoms in lung cancer patients.

Keywords: supportive care intervention, depressive symptoms, lung cancer, meta-analysis

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Authors: Hecson Christian, Joel Macwan

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Landfill site selection in an urban area is a critical issue in the planning process. With the growth of the urbanization, it has a mammoth impact on the economy, ecology, and environmental health of the region. Outsized amount of wastes are produced and the problem gets soared every day. Hence, selection of ideal site for sanitary landfill is a challenge for urban planners and solid waste managers. Disposal site is a function of many parameters. Among all, Geotechnical parameters are very vital as the same is related to surrounding open land. Moreover, the accessible safe and acceptable land is also scarce. Therefore, in this paper geotechnical parameters are used to develop a GIS model to identify an ideal location for landfill purpose. Metropolitan city of Surat is highly populated and fastest growing urban area in India. The research objectives are to conduct field experiments to collect data and to transfer the facts in GIS platform to evolve a model, to find ideal location. Planners’ preferences were obtained to use analytical hierarchical process (AHP) to find weights of each parameter. Integration of GIS and Multi-Criteria Decision Analysis (MCDA) techniques are applied to improve decision-making. It augments an environment for transformation and combination of geographical data and planners’ preferences. GIS performs deterministic overlay and buffer operations. MCDA methods evaluate alternatives based on the decision makers’ subjective values and priorities. Research results have shown many alternative locations. Economic analysis of selected site from actual operations point of view is not included in this research.

Keywords: GIS, AHP, MCDA, Geo-technical

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Authors: Maria Jose Mendoza Gordillo

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Introduction: Research regarding breastfeeding is devoted to how essential breastfeeding is to guarantee wellbeing for the mother and the baby from a medical standpoint relegating the cultural, material and social barriers for breastfeeding. Consequently, worldwide breastfeeding rates are low, and Ecuador is not the exception, especially among working mothers. Worldwide, health care providers have low rates of breastfeeding due to several barriers to lactation, such as the work schedule, a lack of private places for pumping while at work, and negative emotions. Goals and Methods: This study aimed to explore how do Ecuadorian women embrace their identities as nutritionists and mothers within their breastfeeding experience. The primary data come from 20 synchronous semi-structured interviews, which follow a topic guide. The interviews were recorded and transcribed verbatim. The data analysis followed the Phronetic Iterative Approach. Results: Women shifted the preconceived idea of the ideal breastfeeding that came from the medicalized discourse of breastfeeding, and that was constructed in their training as nutritionists. Although these women believe that breast milk and breastfeeding is the best way to feed a baby, the internalized ideal of breastfeeding shifted through the experience of motherhood. When these women developed their identity as mothers, they understood that the ideal breastfeeding is different from the medicalized discourse. Although they have that clash between the ideal and the external reality, they continued breastfeeding their babies and those experiences made them improve their professional practice. Conclusions: The narratives that women shared illustrate how complex it was to manage the different roles and identities that they wanted to fulfill to keep their identity of a good mother who breastfeeds her baby and, at the same time, a good healthcare provider identity. The process of breastfeeding for this group of women who are mothers and healthcare professionals appears to be a unique relational and identity negotiation process.

Keywords: breastfeeding, identity, nutritionist, qualitative

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Authors: Sophie Mills, Constantinos Aristotelous, Leila L. Touil, Richard C. W. James

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Objectives: Historical studies of the anatomy of the spinal accessory nerve (SAN) have reported conflicting results regarding its relationship with the internal jugular vein (IJV). A literature review was undertaken to establish the prevalence of anatomical variations of the SAN encountered during routine neck dissection surgery in order to increase awareness and reduce morbidity associated with iatrogenic SAN injury. Materials and Methods: The largest systematic review to date was performed using PRISMA-ScR guidelines, which yielded nine articles following the application of inclusion and exclusion criteria. A case report is also included, which demonstrates the rare anatomical relationship of the SAN traversing a fenestrated IJV, seen for the first time in the senior author’s career. Results: The mean number of dissections per study was 119, of which 55.6% (n=5) studies were performed on cadaver subjects, and 44.4% (n=4) were surgical dissections. Incidences of the SAN lateral to the IJV and medial to the IJV ranged from 38.9%-95.7% and 2.8%-57.4%, respectively. Over half of the studies reported incidences of the SAN traversing the IJV in 0.9%-2.8% of dissections. One study reported an isolated variant of the SAN dividing around the IJV with a prevalence of 0.5%. Conclusion: At the level of the posterior belly of the digastric muscle, the surgeon can anticipate the identification of the SAN lateral to the IJV in approximately three-quarters of cases, whilst around one-quarter are estimated to be medial. A mean of 1.6% of SANs traverses a fenestration of the vein. It is essential for surgeons to be aware of these anatomical variations and their prevalence to prevent injury to vital structures during surgery.

Keywords: anatomical variant, internal jugular vein, neck dissection, spinal accessory nerve

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Authors: Kamel Abd Elaziz Mohamed

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Introduction: Drug related problems (DRPs) are of major concern, affecting patients of both sex. They impose considerable economic burden on the society and the health-care systems. Aim of the work: The aim of this work was to identify and categorize drug-related problems in adult intensive care unit. Patients and methods: The study was a prospective, observational study as eighty six patients were included. They were consecutively admitted to ICU through the emergency room or transferred from the general ward due to DRPs. Parameters included in the study as length of stay in ICU, need for cardiovascular support or mechanical ventilation, dialysis, as well as APACHE II score were recorded. Results: Drug related problems represent 3.6% of the total ICU admission. The median (range) of APACHE II score for 86 patients included in the study was 17 (10-23), and length of ICU stay was 2.4 (1.5-4.2) days. In 45 patients (52%), DRP was drug over dose (group 1), while other DRP was present in the other 41 patients (48%, group 11). Patients in group 1 were older (39 years versus 32 years in group 11), with significant impaired renal function. The need of inotropic drugs and mechanical ventilation as well as the length of stay (LOS) in ICU was significantly higher in group 1. There were no significant difference in GCS between both groups, however APACHE II score was significantly higher in group 1. Only four patients (4.6%) were admitted by suicidal attempt as well as three patients (3.4%) due to trauma drug-related admissions, all were in (group 1). Nineteen percent of the patients had drug related problem due to hypoglycaemic medication followed by tranquilizer (15%). Adverse drug effect followed by failure to receive medication were the most causes of drug problem in (group11).The total mortality rate was 4.6%, all of them were eventually non preventable. Conclusion: The critically ill patients admitted due to drug related problems represented a small proportion (3.6%) of admissions to the ICU. Hypoglycaemic medication was one of the most common causes of admission by drug related problems.

Keywords: drug related problems, ICU, cost, safety

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Authors: Kamal KC, Zhendong Yin, Dasen Li, Zhilu Wu

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Intra-plant disease classification based on leaf images is a challenging computer vision task due to similarities in texture, color, and shape of leaves with a slight variation of leaf spot; and external environmental changes such as lighting and background noises. Deep convolutional neural network (DCNN) has proven to be an effective tool for binary classification. In this paper, two methods for binary classification of diseased plant leaves using DCNN are presented; model created from scratch and transfer learning. Our main contribution is a thorough evaluation of 4 networks created from scratch and transfer learning of 5 pre-trained models. Training and testing of these models were performed on a plant leaf images dataset belonging to 16 distinct classes, containing a total of 22,265 images from 8 different plants, consisting of a pair of healthy and diseased leaves. We introduce a deep CNN model, Optimized MobileNet. This model with depthwise separable CNN as a building block attained an average test accuracy of 99.77%. We also present a fine-tuning method by introducing the concept of a convolutional block, which is a collection of different deep neural layers. Fine-tuned models proved to be efficient in terms of accuracy and computational cost. Fine-tuned MobileNet achieved an average test accuracy of 99.89% on 8 pairs of [healthy, diseased] leaf ImageSet.

Keywords: deep convolution neural network, depthwise separable convolution, fine-grained classification, MobileNet, plant disease, transfer learning

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Authors: Cheng Yang Kwa, Yoke Rung Wong

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Laminated composite materials are widely employed in automotive, aerospace, and other industries. These materials provide distinct benefits due to their high specific strength, high specific modulus, and ability to be customized for a specific function. However, delamination of laminated composite materials is one of the main defects which can occur during manufacturing, regular operations, or maintenance. Delamination can bring about considerable internal damage, unobservable by visual check, that causes significant loss in strength and stability, leading to composite structure catastrophic failure. Structural health monitoring (SHM) is known to be the automated method for monitoring and evaluating the condition of a monitored object. There are several ways to conduct SHM in aerospace. One of the effective methods is to monitor the natural frequency shift of structure due to the presence of defect. This study investigated the mechanical resonance frequency shift of a multi-layer composite cantilever beam due to interlaminar delamination. ANSYS Workbench® was used to create a 4-plies laminated composite cantilever finite element model with [90/0]s fiber setting. Epoxy Carbon UD (230GPA) Prepreg was chosen, and the thickness was 2.5mm for each ply. The natural frequencies of the finite element model with various degree of delamination were simulated based on modal analysis and then validated by using literature. It was shown that the model without delamination had natural frequency of 40.412 Hz, which was 1.55% different from the calculated result (41.050 Hz). Thereafter, the various degree of delamination was mimicked by changing the frictional conditions at the middle ply-to-ply interface. The results suggested that delamination in the laminated composite cantilever induced a change in its stiffness which alters its mechanical resonance frequency.

Keywords: structural health monitoring, NDT, cantilever, laminate

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Authors: Jakob Renko, Deja Praprotnik, Kristina Martinovič, Igor Karnjuš

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Introduction: Catheter-related bloodstream infections are a major burden for healthcare and patients. Although infections of this type cannot be completely avoided, they can be reduced by taking preventive measures. The aim of this study is to review and analyze the existing literature on preventive interventions to prevent central venous catheters (CVC) infections. Methods: A systematic literature review was carried out. The international databases CINAHL, Medline, PubMed, and Web of Science were searched using the search strategy: "catheter-related infections" AND "intensive care units" AND "prevention" AND "central venous catheter." Articles that met the inclusion and exclusion criteria were included in the study. The literature search flow is illustrated by the PRISMA diagram. The descriptive research method was used to analyze the data. Results: Out of 554 search results, 22 surveys were included in the final analysis. We identified seven relevant preventive measures to prevent CVC infections: washing the whole body with chlorhexidine gluconate (CHG) solution, disinfecting the CVC entry site with CHG solution, use of CHG or silver dressings, alcohol protective caps, CVC care education, selecting appropriate catheter and multicomponent care bundles. Discussion and conclusions: Both single interventions and multicomponent care bundles have been shown to be currently effective measures to prevent CVC infections in adult patients in the ICU. None of the measures identified stood out in terms of their effectiveness. Prevention work to reduce CVC infections in the ICU is a complex process that requires the simultaneous consideration of several factors.

Keywords: central venous access, critically ill patients, hospital-acquired complications, prevention

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Authors: Christine Maleesha Withanachchi, Eithne Heffernan, Derek Hoare

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Background: Social isolation (SI} is a major consequence of hearing loss (HL}. Isolation can lead to serious health problems (e.g., dementia and depression). Hearing Aids (HA) is the primary intervention for HL. However, these are less effective in social situations. Interventions are needed for SI in adults with hearing loss (AHL). Objectives: Investigated the relationship between HL and SI. Explored the views of AHL and hearing healthcare professionals (HHP) towards interventions for isolation. Methods: Individual and group semi-structured interviews were conducted. Interviews were conducted at the Nottingham Institute of Health Research (NIHR) Biomedical Research Centre (BRC). Six AHL and seven HHP were recruited via maximum variation sampling. The interview transcripts were analyzed using inductive thematic analysis. Results: Social impacts of HL: Most participants described that HL hurt them. This was in the form of social withdrawal, strain on relationships, and identity loss. Downstream effects of HL: Most audiologists acknowledged that isolation from HL could lead to depression. HL can also lead to exhaustion and unemployment. Impact of stigma: There are negative connotations around HL and HA (e.g. old age) and there is difficulty talking about isolation. The complexity of SI: There can be difficulty separating SI due to HL from SI due to other contributing factors (e.g. comorbidities). Potential intervention for isolation: Participants were unfamiliar with interventions for isolation and few, if any, were targeted for AHL specifically. Most participants thought an intervention should be patient-centered and run by an AHL in the community. Opinions differed regarding whether it should hear specific or generic. Implementation of intervention: Challenges to the implementation of an intervention for SI exist due to the sensitivity of the subject. Conclusions: This study demonstrated that SI is a major consequence of HL and uncovered novel findings related to its interventions. Uptake of interventions offered to AHL to reduce loneliness and social isolation is expected to be better if led by AHL in the community as opposed to HHP led interventions in the hospital or clinic settings.

Keywords: adults with hearing loss, hearing aids, interventions, social isolation

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Authors: Surabhi Agrawal Kohli, Sunita Gupta, Esha Khanuja, Parul Garg, P. Gupta

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Background: Adenomyosis is a common gynaecological condition that affects the menstruating women. Uterine enlargement, dysmenorrhoea, and menorrhagia are regarded as the cardinal clinical symptoms of adenomyosis. Classically it was thought, compared with ultrasonography, when adenomyosis is suspected, MRI enables more accurate diagnosis of the disease. Materials and Methods: 172 subjects were enrolled after an informed consent that had complaints of HMB, dyspareunia, dysmenorrhea, and chronic pelvic pain. Detailed history of the enrolled subjects was taken, followed by a clinical examination. These patients were then subjected to TVS where myometrial echo texture, presence of myometrial cysts, blurring of endomyometrial junction was noted. MRI was followed which noted the presence of junctional zone thickness and myometrial cysts. After hysterectomy, histopathological diagnosis was obtained. Results: 78 participants were analysed. The mean age was 44.2 years. 43.5% had parity of 4 or more. heavy menstrual bleeding (HMB) was present in 97.8% and dysmenorrhea in 93.48 % of HPE positive patient. Transvaginal sonography (TVS) and MRI had a sensitivity of 89.13% and 80.43%, specificity of 90.62% and 84.37%, positive likelihood ratio of 9.51 and 5.15, negative likelihood ratio of 0.12 and 0.23, positive predictive value of 93.18% and 88.1%, negative predictive value of 85.29% and 75% and a diagnostic accuracy of 89.74% and 82.5%. Comparison of sensitivity (p=0.289) and specificity (p=0.625) showed no statistically significant difference between TVS and MRI. Conclusion: Prevalence of 30.23%. HMB with dysmenorrhoea and chronic pelvic pain helps in diagnosis. TVS (Endomyometrial junction blurring) is both sensitive and specific in diagnosing adenomyosis without need for additional diagnostic tool. Both TVS and MRI are equally efficient, however because of certain additional advantages of TVS over MRI, it may be used as the first choice of imaging. MRI may be used additionally in difficult cases as well as in patients with existing co-pathologies.

Keywords: adenomyosis, heavy menstrual bleeding, MRI, TVS

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Authors: D. Farsi, G. Dokhtvasi, S. Abbasi, S. Shafiee Ardestani, E. Payani

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Background and aim:It has not been well studied whether fentanyl-thiopental (FT) is effective and safe for PSA in orthopedic procedures in Emergency Department (ED). The aim of this trial was to evaluate the effectiveness of intravenous FTversusfentanyl-midazolam (FM)in patients who suffered from shoulder dislocation or distal radial fracture-dislocation. Methods:In this randomized double-blinded study, Seventy-six eligible patients were entered the study and randomly received intravenous FT or FM. The success rate, onset of action and recovery time, pain score, physicians’ satisfaction and adverse events were assessed and recorded by treating emergency physicians. The statistical analysis was intention to treat. Results: The success rate after administrating loading dose in FT group was significantly higher than FM group (71.7% vs. 48.9%, p=0.04); however, the ultimate unsuccess rate after 3 doses of drugs in the FT group was higher than the FM group (3 to 1) but it did not reach to significant level (p=0.61). Despite near equal onset of action time in two study group (P=0.464), the recovery period in patients receiving FT was markedly shorter than FM group (P<0.001). The occurrence of adverse effects was low in both groups (p=0.31). Conclusion: PSA using FT is effective and appears to be safe for orthopedic procedures in the ED. Therefore, regarding the prompt onset of action, short recovery period of thiopental, it seems that this combination can be considered more for performing PSA in orthopedic procedures in ED.

Keywords: procedural sedation and analgesia, thiopental, fentanyl, midazolam, orthopedic procedure, emergency department, pain

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Authors: Adil Basuki Ahza, Michael Liong, Subarna Suryatman

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Healthy chips now dominating the snack market shelves. More than 80% processed snack foods in the market are chips. This research takes the advantages of twin extrusion technology to produce two types of product, i.e. directly expanded and intermediate ready-to-fry or microwavable chips. To improve the functional quality, the cereal-tuber based mix was enriched with antioxidant rich mix of temurui, celery, carrot and isolated soy protein (ISP) powder. Objectives of this research were to find best composite cassava-sorghum ratio, i.e. 60:40, 70:30 and 80:20, to optimize processing conditions of extrusion and study the microstructural, physical and sensorial characteristics of the final products. Optimization was firstly done by applying metering section of extruder barrel temperatures of 120, 130 and 140 °C with screw speeds of 150, 160 and 170 rpm to produce direct expanded product. The intermediate product was extruded in 100 °C and 100 rpm screw speed with feed moisture content of 35, 40 and 45%. The directly expanded products were analyzed for color, hardness, density, microstructure, and organoleptic properties. The results showed that interaction of ratio of cassava-sorghum and cooking methods affected the product's color, hardness, and bulk density (p<0.05). Extrusion processing conditions also significantly affected product's microstructure (p<0.05). The direct expanded snacks of 80:20 cassava-sorghum ratio and fried expanded one 70:30 and 80:20 ratio shown the best organoleptic score (slightly liked) while baking the intermediate product with microwave were resulted sensorial not acceptable quality chips.

Keywords: cassava-sorghum composite, extrusion, microstructure, physical characteristics

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Authors: Sajjad Jafari

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Background and Aim: The use of herbal medicines has a long history. Today, due to the resistance of microorganisms to antibiotics and antimicrobial substances, herbal medicines have attracted attention due to their significant antimicrobial effects and low toxicity. This study aims to systematically review the antimicrobial effects of different plant extracts (Quercus infectoria) as possible candidates for treating infectious diseases. Material and Methods: The present study is a review study by searching reputable scientific databases such as PubMed, Google Scholar, Scopus, and Web of Science from 2000 to 2023 using the keywords Antimicrobial, Quercus infectoria, Medicinal herbal, Infectious diseases the latest information obtained. Results: In this study, 45 articles were found and reviewed. Quercus infectoria is a small tree native to Greece, Asia Minor, and Iran. Quercus is a plant genus in the family of Fagaceae. This species is generally known under the name ‘‘baloot” in Iran and is commonly used as a medicinal plant. The extracts used included water, hydro-alcoholic, ethanol, methanol. This plant had high inhibition activity and a lethal effect on gram-positive and gram-negative bacteria of ATCC strains, hospital, and resistant strains. Therefore, in addition to antibacterial effects, antiparasitic and antifungal effects. The seed of the plant was the most used and the most effective antimicrobial extract among the ethanol and methanol extracts. Conclusion: The findings of this study suggest that Quercus infectoria has significant antimicrobial effects against a wide range of microorganisms. This makes it a potential candidate for the development of new antimicrobial drugs. Further research is needed to confirm the efficacy and safety of Quercus infectoria in clinical trials.

Keywords: antimicrobial, Quercus infectoria, medicinal herbal, infectious diseases

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Authors: Francesco Ceresia

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Workplace aggression is broadly recognized as a main work-related risk for healthcare organizations the world over. Scholars underlined that nonfatal workplace aggressions can be also produced by Type II workplace aggression, that occur when the aggressor has a legitimate relationship with the organization and commits an act of hostility while being served or cared for by members of the organization. Several reviews and meta-analysis highlighted the main antecedents and consequences of Type II verbal and physical workplace aggression in the healthcare sector, also focusing on its economic and psychosocial costs. However, some scholars emphasized the need for a systemic and multi-factorial approach to deeply understand and effectively respond to such kind of aggression. The main aim of the study is to propose a qualitative model of Type II workplace aggression in a health care organization in accordance with the system thinking and multi-factorial perspective. A case study research approach, conducted in an Italian non-hospital healthcare organization, is presented. Two main data collection methods have been adopted: individual and group interviews with a sample (N = 24) of physicians, nurses and clericals. A causal loop diagram (CLD) that describes the main causal relationships among the key-variables of the proposed model has been outlined. The main feedback loops and the causal link polarities have been also defined to fully describe the structure underlining the Type II workplace aggression phenomenon. The proposed qualitative model shows how the Type II workplace aggression is related with burnout, work performance, job satisfaction, turnover intentions, work motivation and emotional dissonance. Finally, strategies and policies to reduce the strength of workplace aggression’s drivers are suggested.

Keywords: healthcare, system thinking, work motivation, workplace aggression

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Authors: Houyem Kotti

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The development in societies requires that these societies are continuously changing in various aspects, a change that requires continuous adaptation to the data of the technical age. In order for the individual to perform his/her duty or task in a perfect way, it is necessary to provide all the basic requirements and necessities to increase the efficiency and effectiveness of the personnel working to accomplish their tasks, requirements, and work successfully. The success of the industries and organizations are linked to the need to create individuals in the creative and innovative field. Formation process is considered an economic development and social prosperity, and to improve the quantity and quality of artistic work. Therefore, creativity and innovation play an important role in improving the performance of the artistic organization as it is one of the variables affecting the organization's ability to grow and invest. In order to provide better services to their customers, especially in the face of competition and traditional methods of work, and in an environment that discourages and hinders creativity and impairs any process of development, change or creative behavior. The research methodology that will be performed for this study is described as qualitative by conducting several interviews with artistic people, experts in the artistic field and reviewing the related literature to collect the necessary and required qualitative data from secondary sources such as statistical reports, previous research studies, etc. In this research, we will attempt to clarify the relationship between innovation and its importance in the artistic organization, the conditions of achieving innovation and its constraints, barriers, and challenges. The creativity and innovation and their impacts on the performance of artistic organizations, explaining this mechanism, so as to ensure continuity of these organizations and keeping pace with developments in the global economic environment.

Keywords: artistic work, creativity and innovation, artistic organization, performance

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Authors: Maryam Borjali

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Introduction. Mortality due to noncommunicable diseases has increased in the world today with the advent of demographic shifts, growing age, and lifestyle patterns in the world, which have been affected by economic and social crises. Congenital heart defects are one of the forms of diseases that have raised infant mortality worldwide. e objective of present study was to identify nonmedical determinants related to this abnormality from the mother’s perspectives. Methods. is research was a qualitative study and the data collection method was a semistructured interview with mothers who had children with congenital heart diseases referring to the Shahid Rajaei Heart Hospital in Tehran, Iran. A thematic analysis approach was employed to analyze transcribed documents assisted by MAXQDA Plus version 12. Results. Four general themes and ten subthemes including social contexts (social harms, social interactions, and social necessities), psychological contexts (mood disorders and mental well-being), cultural contexts (unhealthy lifestyle, family culture, and poor parental health behaviors), and environmental contexts (living area and polluted air) were extracted from interviews with mothers of children with congenital heart diseases. Conclusions. Results suggest that factors such as childhood poverty, lack of parental awareness of congenital diseases, lack of proper nutrition and health facilities, education, and lack of medical supervision during pregnancy were most related with the birth of children with congenital heart disease from mothers’ prospective. In this regard, targeted and intersectorial collaborations are proposed to address nonmedical determinants related to the incidence of congenital heart diseases.

Keywords: congenital_cou, cultural, social, platform

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Authors: Sonia Nemakallu, Pota Kalima

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Introduction: Vancomycin is a glycopeptide antibiotic, commonly used to treat gram-positive bacteraemia. It has been increasingly used in the critical care setting due to an increased awareness of resistant gram positive organisms. In Edinburgh both tertiary hospitals, The Western General Hospital and The Royal Infirmary Of Edinburgh, commonly use Vancomycin for a variety of infections. Administration of Vancomyicn in these hospitals is by continuous infusion as it is thought to maintain serum concentrations easier and is a simpler monitoring system. Purpose: The aim of the study was to evaluate the efficacy and reliability in which Vancomycin is used. Material and Methods: A retrospective study, over a 6-month period from January 2014 to June 2014. 91 admissions were included, all received Vancomycin by continuous infusion during their critical care stay. Results: The number one use for Vancomycin in critical care settings was in the treatment of ventilator or hospital-acquired pneumonia. Only 3% of population had MRSA. 49% of admissions were not therapeutic on day 1 post loading dose. Of those that were therapeutic on day 1 post loading dose, 39% of admissions showed no organisms in any cultures taken, 42% had organisms sensitive to Vancomycin and 19% had only organisms resistant to Vancomycin. Those that were not therapeutic on day 1 showed similar organism sensitivities. 15% of admissions had Vancomycin levels above 25 (levels should be maintained between 15-25). An increase in creatinine was proportionally seen with an increase in Vancomycin levels. Conclusion: Within Edinburgh Vancomycin is being overused in the critical care setting with only 3% of the population having highly resistant organisms. Continuous infusion have not ruled out the complexity of maintaining therapeutic levels, with a large proportion of patients not being therapeutic on day 1. Further research is also required into the nephrotoxic effects of using higher doses of Vancomycin.

Keywords: Vancomycin, continuous infusion, multi resistant organisms, sepsis, renal toxicity

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Authors: Usama Abdulwahab, Mohammed Wahab

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This paper presents the application of uncapacitated facility location problems (UFLP) and 1-median problems to support decision making in blood supply chain networks. A plethora of factors make blood supply-chain networks a complex, yet vital problem for the regional blood bank. These factors are rapidly increasing demand; criticality of the product; strict storage and handling requirements; and the vastness of the theater of operations. As in the UFLP, facilities can be opened at any of $m$ predefined locations with given fixed costs. Clients have to be allocated to the open facilities. In classical location models, the allocation cost is the distance between a client and an open facility. In this model, the costs are the allocation cost, transportation costs, and inventory costs. In order to address this problem the median algorithm is used to analyze inventory, evaluate supply chain status, monitor performance metrics at different levels of granularity, and detect potential problems and opportunities for improvement. The Euclidean distance data for some Ontario cities (demand nodes) are used to test the developed algorithm. Sitation software, lagrangian relaxation algorithm, and branch and bound heuristics are used to solve this model. Computational experiments confirm the efficiency of the proposed approach. Compared to the existing modeling and solution methods, the median algorithm approach not only provides a more general modeling framework but also leads to efficient solution times in general.

Keywords: approximate dynamic programming, facility location, perishable product, inventory model, blood platelet, P-median problem

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Authors: E. P. Bhowmik, R. Singh

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Certain materials casually thrown away as by-product household waste, such as used tea leaves, used coffee remnants, eggshells, peanut husks, coconut coir, unwanted paper, and pencil shavings- have scope in the hidden properties that they offer as recyclable raw ingredients. This paper aims to explore and experiment with the sustainable potential of such disposed wastes, obtained from domestic and commercial backgrounds, that could otherwise contribute to the field of interior design if mass-collected and repurposed. Research has been conducted on available recorded methods of mass-collection, storage, and processing of such materials by certain brands, designers, and researchers, as well as the various application and angles possible with regards to re-usage. A questionnaire survey was carried out to understand the willingness of the demographics for efforts of the mass collection and their openness to such unconventional materials for interiors. An experiment was also conducted where the selected waste ingredients were used to create small samples that could be used as decorative panels. Comparisons were made for properties like color, smell, texture, relative durability, and weight- and accordingly, applications were suggested. The experiment, therefore, helped to propose to recycle of the common household as a potential surface finish for floors, walls, and ceilings, and even founding material for furniture and decor accessories such as pottery and lamp shades; for non-structural application in both residential and commercial interiors. Common by-product wastes often see their ends at landfills- laymen unaware of their sustainable possibilities dispose of them. However, processing these waste materials and repurposing them by incorporating them into interiors would serve as a sustainable alternative to ethical dilemmas in the construction of interior design/architecture elements.

Keywords: interior materials, mass-collection, sustainable, waste recycle

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Authors: Akudo Ejelonu, Sarah Willig, J. Anthony Sauder, Heather Murphy, Frances Shofer

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Background: The high prevalence of diarrheal diseases in the village of Tzununá, Guatemala is linked to lack of sanitation facilities and handwashing practices. Diarrheal diseases are preventable and improved access to latrines, hygiene education and clean water may improve sanitation by reducing the spread of disease. Objective: Between May 2015-January 2017, the University of Pennsylvania Chapter of Engineers Without Border (PennEWB) and local partners designed an intervention to reduce diarrheal disease by building pour flush latrines in 50 individual households and providing education on the importance of handwashing practice. Design/Methods: Through convenient sampling, we surveyed 45 households to evaluate the community’s knowledge of diarrheal disease, handwashing practices, and maintenance of the latrines. Results: 92% of the study participants experienced decrease of new cases of diarrheal disease after receiving a latrine. Only 11% washed their hands after defecating in the latrine. There was gap in understanding the health outcome of latrine sanitation and handwashing education. The respondents did not connect the reduction of diarrheal disease with latrine use and maintenance. Instead, they associated their motivation for latrine use with aesthetics, proximity to their home, ease and comfort, and reduction of shame. We recommend that PennEWB adopt UNICEF or WHO education on hand washing practice. Conclusion: Social interaction and social pressure drove the household use of latrines. The latrines are being valued and cleaned. The education that the residents received did not target norms and behaviors. Latrines could be used to create a new social norm that supports behavioral change.

Keywords: diarrheal disease, latrine, open defecation, water, sanitation and hygiene

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Authors: Varsha Shinde, Belle Damodara Shenoy

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Tarballs are crude oil remnants found in oceans after long term weathering process and are a global concern since several decades as potential marine pollutant. Being complicated in structure microbial remediation of tarballs in natural environment is a slow process. They are rich in high molecular weight alkanes and poly aromatic hydrocarbons which are resistant to microbial attack and other environmental factors, therefore remain in environment for long time. However, it has been found that many bacteria and fungi inhabit on tarballs for nutrients and shelter. Many of them are supposed to be oil degraders, while others are supposed to be getting benefited by byproducts formed during hydrocarbon metabolism. Thus tarballs are forming special interesting ecological niche of microbes. This work aimed to study diversity of bacteria and fungi from tarballs and to see their potential application in crude oil degradation. The samples of tarballs were collected from Betul beach of south Goa (India). Different methods were used to isolate culturable fraction of bacteria and fungi from it. Those were sequenced for 16S rRNA gene and ITS for molecular level identification. The 16S rRNA gene sequence analysis revealed the presence of 13 bacterial genera/clades (Alcanivorax, Brevibacterium, Bacillus, Cellulomonas, Enterobacter, Klebsiella, Marinobacter, Nitratireductor, Pantoea, Pseudomonas, Pseudoxanthomonas, Tistrella and Vibrio), while the ITS sequence analysis placed the fungi in 8 diverse genera/ clades (Aspergillus, Byssochlamys, Monascus, Paecilomyces, Penicillium, Scytalidium/ Xylogone, Talaromyces and Trichoderma). All bacterial isolates were screened for oil degradation capacity. Potential strains were subjected to crude oil degradation experiment for quantification. Results were analyzed by GC-MS-MS.

Keywords: bacteria, biodegradation, crude oil, diversity, fungi, tarballs

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Authors: Milca F. Coelho, K. Bousson, Kawser Ahmed

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To accurately track an aerospace vehicle in a time-critical situation and in a highly nonlinear environment, is one of the strongest interests within the aerospace community. The tracking is achieved by estimating accurately the state of a moving target, which is composed of a set of variables that can provide a complete status of the system at a given time. One of the main ingredients for a good estimation performance is the use of efficient estimation algorithms. A well-known framework is the Kalman filtering methods, designed for prediction and estimation problems. The success of the Kalman Filter (KF) in engineering applications is mostly due to the Extended Kalman Filter (EKF), which is based on local linearization. Besides its popularity, the EKF presents several limitations. To address these limitations and as a possible solution to tracking problems, this paper proposes the use of the Ensemble Kalman Filter (EnKF). Although the EnKF is being extensively used in the context of weather forecasting and it is being recognized for producing accurate and computationally effective estimation on systems with a very high dimension, it is almost unknown by the tracking community. The EnKF was initially proposed as an attempt to improve the error covariance calculation, which on the classic Kalman Filter is difficult to implement. Also, in the EnKF method the prediction and analysis error covariances have ensemble representations. These ensembles have sizes which limit the number of degrees of freedom, in a way that the filter error covariance calculations are a lot more practical for modest ensemble sizes. In this paper, a realistic simulation of a radar tracking was performed, where the EnKF was applied and compared with the Extended Kalman Filter. The results suggested that the EnKF is a promising tool for tracking applications, offering more advantages in terms of performance.

Keywords: Kalman filter, nonlinear state estimation, optimal tracking, stochastic environment

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Authors: Raul G. Angeles

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The Philippine government instituted major reforms in its educational system. The Department of Education pushes the K to 12 program that makes kindergarten mandatory and adds two years of senior high school to the country's basic education. In essence, the students’ stay in basic education particularly those who are supposedly going to college is extended. The majority of the students expressed that they will be taking the Academic Track of the Senior High School curriculum specifically the Science, Technology, Engineering and Mathematics (STEM) and General Academic (GA) strands. Almost certainly, instruction should match the students' styles and thus through this descriptive study a city survey was conducted to explore the teaching strategies preferences of junior high school students and teachers who will be promoted to senior high school during the Academic Year 2016-2017. This study was conducted in selected public and private secondary schools in Metro Manila. Questionnaires were distributed to students and teachers; and series of follow-up interviews were also carried out to generate additional information. Preferences of students are centered on employing innovations such as technology, cooperative and problem-based learning. While the students will still be covered by basic education their interests in science are sparking to a point where the usual teaching styles may no longer work to them and for that cause, altering the teaching methods is recommended to create a teacher-student style matching. Other effective strategies must likewise be implemented.

Keywords: curriculum development, effective teaching strategies, problem-based learning, senior high school, science education, technology

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Authors: Melanie Macgregor-Ramiasa, Isabel Hopp, Patricia Murray, Krasimir Vasilev

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Stem cells based therapies are one of the greatest promises of new-age medicine due to their potential to help curing most dreaded conditions such as cancer, diabetes and even auto-immune disease. However, establishing suitable in vitro culture materials allowing to control the fate of stem cells remain a challenge. Amongst the factor influencing stem cell behavior, substrate chemistry and nanotopogaphy are particularly critical. In this work, we used plasma assisted surface modification methods to produce model substrates with tailored nanotopography and controlled chemistry. Three different sizes of gold nanoparticles were bound to amine rich plasma polymer layers to produce homogeneous and gradient surface nanotopographies. The outer chemistry of the substrate was kept constant for all substrates by depositing a thin layer of our patented biocompatible polyoxazoline plasma polymer on top of the nanofeatures. For the first time, protein adsorption and stem cell behaviour (mouse kidney stem cells and mesenchymal stem cells) were evaluated on nanorough plasma deposited polyoxazoline thin films. Compared to other nitrogen rich coatings, polyoxazoline plasma polymer supports the covalent binding of proteins. Moderate surface nanoroughness, in both size and density, triggers cell proliferation. In association with polyoxazoline coating, cell proliferation is further enhanced on nanorough substrates. Results are discussed in term of substrates wetting properties. These findings provide valuable insights on the mechanisms governing the interactions between stem cells and their growth support.

Keywords: nanotopography, stem cells, differentiation, plasma polymer, oxazoline, gold nanoparticles

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Authors: Pegah Farokhzad

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Family has a crucial role in maintaining the physical, social and mental health of the children. Most of the mental and anxiety problems of children reflects the complex interpersonal situations among family members, especially parents. In other words, anxiety problems of the children is correlated with deficit relationships of family members and improper child rearing styles. The parental child rearing styles leads to positive and negative consequences which affect the children’s mental health. Therefore, the present research was aimed to compare the parental child rearing styles and anxiety of children with stuttering and normal population. It was also aimed to study the relationship between parental child rearing styles and anxiety of children. The research sample included 54 boys with stuttering and 54 normal boys who were selected from the children (boys) of Tehran, Iran in the age range of 5 to 8 years in 2013. In order to collect data, Baumrind Child rearing Styles Inventory and Spence Parental Anxiety Inventory were used. Appropriate descriptive statistical methods and multivariate variance analysis and t test for independent groups were used to test the study hypotheses. Statistical data analyses demonstrated that there was a significant difference between stuttering boys and normal boys in anxiety (t = 7.601, p< 0.01); But there was no significant difference between stuttering boys and normal boys in parental child rearing styles (F = 0.129). There was also not found significant relationship between parental child rearing styles and children anxiety (F = 0.135, p< 0.05). It can be concluded that the influential factors of children’s society are parents, school, teachers, peers and media. So, parental child rearing styles are not the only influential factors on anxiety of children, and other factors including genetic, environment and child experiences are effective in anxiety as well. Details are discussed.

Keywords: child rearing styles, anxiety, stuttering, Iran

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Authors: K. N. Dinesh Babu, P. K. Gargava

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Energization of a transformer results in sudden flow of current which is an effect of core magnetization. This current will be dominated by the presence of second harmonic, which in turn is used to segregate fault and inrush current, thus guaranteeing proper operation of the relay. This additional security in the relay sometimes obstructs or delays differential protection in a specific scenario, when the 2^nd harmonic content was present during a genuine fault. This kind of scenario can result in isolation of the transformer by Buchholz and pressure release valve (PRV) protection, which is acted when fault creates more damage in transformer. Such delays involve a huge impact on the insulation failure, and chances of repairing or rectifying fault of problem at site become very dismal. Sometimes this delay can cause fire in the transformer, and this situation becomes havoc for a sub-station. Such occurrences have been observed in field also when differential relay operation was delayed by 10-15 ms by second harmonic blocking in some specific conditions. These incidences have led to the need for an alternative solution to eradicate such unwarranted delay in operation in future. Modern numerical relay, called as intelligent electronic device (IED), is embedded with advanced protection features which permit higher flexibility and better provisions for tuning of protection logic and settings. Such flexibility in transformer protection IEDs, enables incorporation of alternative methods such as dynamic switching of second harmonic feature for blocking the differential protection with additional security. The analysis and precautionary measures carried out in this case, have been simulated and discussed in this paper to ensure that similar solutions can be adopted to inhibit analogous issues in future.

Keywords: differential protection, intelligent electronic device (IED), 2nd harmonic inhibit, inrush inhibit

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Authors: Farhad Farahvash, Parya Mobaseri

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Weeds control based on their critical period leads to less production costs and risks of wide chemical application of weeds control methods. The present study considered effect of weeds control time (weeds interference after 20, 40 and 60 days, weeds full control, weeds interference and weeds control after 20, 40 and 60 days) on growth and yield of forage maize 454. The experiment based on full-randomized blocks design with three replications was conducted at research farm of Islamic Azad University of Tabriz located at 15th km of East Tabriz in 2013. According to the results, weeds interference after 40 and 60 days as well as weeds control after 20 days prevented from decrease of maize biomass resulted from weeds presence while weeds interference after 20 days, weeds interference and weeds control after 40 and 60 days led respectively to 41.2%, 35%, 25% and 32.5% decrease of forage maize biomass. The weeds-influenced decrease was manifested at different parts of the plant depending on presence period of weeds. Decrease of fresh weight of ear and fresh weight of leaf and stem was observed due to weeds interference after 20 days and weeds interference. If weeds are controlled after 60 days, decrease of ear weight and fresh weight of stem will lead to biomass decrease. Also, if weeds are controlled after 40 days, decrease of fresh weight of maize stems will result in biomass decrease. Ear traits were affected by weeds control treatment. Being affected by treatments of weeds interference after 20 days, weeds non-interference, weeds control after 40 and 60 days, ear length was shortened 29.9 %, 41.4 %, 27.6 % and 37.2 %, respectively. The stem diameter demonstrated a significant decrease although it was only affected by treatments of weeds interference and weeds control after 60 days. Considering results of the present study, generally, it is suggested to control weeds during initial 20-60 days of maize growth in order to prevent undesirable effect of weeds on growth, production and production biomass of maize and decrease of production costs.

Keywords: maize, competition, weed, biomass

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Authors: Sanjeewa Seneviratne, Ian Campbell, Nina Scott, Ross Lawrenson

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Introduction: Indigenous Māori women experience a 60% higher breast cancer mortality rate compared with European women in New Zealand. We explored the impact of difference in the rate of screen detected breast cancer between Māori and European women on more advanced disease at diagnosis and lower survival in Māori women. Methods: All primary in-situ and invasive breast cancers diagnosed in screening age women (as defined by the New Zealand National Breast Cancer Screening Programme) between 1999 and 2012 in the Waikato area were identified from the Waikato Breast Cancer Register and the national screening database. Association between screen versus non-screen detection and cancer stage at diagnosis and survival were compared by ethnicity and socioeconomic deprivation. Results: Māori women had 50% higher odds of being diagnosed with more advance staged cancer compared with NZ European women, a half of which was explained by the lower rate of screen detected cancer in Māori women. Significantly lower breast cancer survival rates were observed for Māori compared with NZ European and most deprived compared with most affluent socioeconomic groups for symptomatically detected breast cancer. No significant survival differences by ethnicity or socioeconomic deprivation were observed for screen detected breast cancer. Conclusions: Low rate of screen detected breast cancer appears to be a major contributor for more advanced stage disease at diagnosis and lower breast cancer survival in Māori compared with NZ European women. Increasing screening participation for Māori has the potential to substantially reduce breast cancer mortality inequity between Māori and NZ European women.

Keywords: breast cancer, screening, ethnicity, inequity

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Authors: Syaza Isma, Timothy Higgins

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In Malaysia, increased take-up rates of tertiary student borrowing, and reliance on retirement savings to fund children's education show the importance of public higher education financing schemes (PTPTN). PTPTN has been operating for 2 decades now; however, there are some critical issues and challenges that include low loan recovery and loan default that suggest a detailed consideration of student loan/financing scheme alternatives is crucial. In addition, the decline in funding level per student following introduction of the new PTPTN full and partial loan scheme has raised ongoing concerns over the sustainability of the scheme to provide continuous financial assistance to students in tertiary education. This research seeks to assess these issues that put greater efficiency in an effort to ensure equitable access to student funding for current and future generations. We explore the extent of repayment hardship under the current loan arrangements that presumably led to low recovery from the borrowers, particularly low-income graduates. The concept of manageable debt exists in the design of income-contingent repayment schemes, as practiced in Australia, New Zealand, UK, Hungary, USA (in limited form), the Netherlands, and South Korea. Can Income Contingent Loans (ICL) offer the best practice for an education financing scheme, and address the issue of repayment hardship and concurrently, can a properly designed ICL scheme provide a solution to the current issues and challenges facing Malaysia student financing? We examine the different potential ICL models using deterministic and stochastic approach to simulate income of graduates.

Keywords: deterministic, income contingent loan, repayment burden, simulation, stochastic

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Authors: Linta Koka

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Aim: The way people with severe mental disorders deal with self-stigma and how it affects their self-esteem is a problem that has gained much attention in recent years. The primary aim of this study was to empirically explore the link between self-stigma and self-esteem of individuals with the presence of a mental illness, offering a novel perspective by exploring the same variables amongst a sample without a mental illness. Methods: This study utilized a cross-sectional study. Participants with (N=85) and without (N=75) a mental health issue were included from Darlingdon's Mind organization. Participants completed two scales, one of Self-Stigma of Mental Illness Scale and one of Self-Esteem, following some demographics questions. Results: According to the primary hypothesis, self-stigma significantly correlates with self-esteem in the clinical population. Furthermore, gender and ethnicity, above all the demographics, positively correlates to the relationship of self-stigma with self-esteem in people who endure a mental health issue. Limitations: A significant limitation is that of the size of the sample of participants conducted in this study. The clinical population was limited to 85 participants, and the control group consisted of 76 participants. Since the sample was not representative. The small size used did not allow any comparisons between the group with mental illness and the control group. There was a restricted time to approach the participants since the online survey was released by the end of May. Conclusions: Individuals suffering from mental illnesses may internalize stigmatizing stereotypes on an explicit level. Efforts should be made to lessen the harmful impact stigma may have on mentally ill people, such as worsening symptoms or delays in receiving care. Further study is needed within this small research topic to improve awareness and regulate mental health among the general population. Undoubtedly, people with mental disorders are stigmatized; therefore, more research is required to explore all factors contributing to mentally ill patients' devaluation.

Keywords: self-stigma, mental illness, self-esteem, clinical population, non-clinical population

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