Search results for: Advance Care Plan

Authors: Mike Wei, Mario Cedillo, Jiahui Lin, Carol Lorraine Storey-Johnson, Carla Boutin-Foster

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Purpose: The extent to which health insurance enrollment succeeds under the Affordable Care Act (ACA) rests heavily on the ability to reach the uninsured and motivate them to enroll. We sought to identify perceptions about the ACA among uninsured patients at a free clinic in New York City. Background: The ACA holds tremendous promise for reducing the number of uninsured Americans. As of April 2014, nearly 8 million people had signed up for health insurance through the Health Insurance Marketplace. Despite this early success, future and continued enrollment rests heavily on the degree of public awareness. Reaching eligible individuals and increasing their awareness and understanding remains a fundamental challenge to realizing the full potential of the ACA. Reaching out to uninsured patients who are seeking care through safety net facilities such as free clinics may provide important avenues for reaching potential enrollees. This project focuses on the experience at the free clinic at Weill Cornell Medical College, the Weill Cornell Community Clinic (WCCC), and seeks to understand perceptions about the ACA among its patient population. Methods: This was a cross-sectional study of all patients who visited the free clinic at Weill Cornell Medical College, the Weill Cornell Community Clinic, from July 2013 to May 2014. Patients who provided informed consent at their visit and completed a semi-structured questionnaire were included (N=62). The questionnaire comprised of questions about demographic characteristics and open-ended questions about their knowledge and perception of the impact of the ACA. Descriptive statistics were used to characterize the population demographics. Qualitative coding techniques were used for open-ended items. Results: Approximately one third of patients surveyed never had health insurance. Of the remaining 65%, 20% lost their insurance within the past year. Only 55% had heard about the ACA, and only 10% knew about the Health Benefits Exchange. Of those who had heard about the ACA, sentiments were tinged with optimistic misperceptions, such as “it will be free health care for all.” While optimistic, most of the responses focused on the economic implications of the ACA. Conclusions: These findings reveal the immense amount of misconception and lack of understanding with regards to the ACA. As such, the study highlights the need to educate and address the concerns of those who remain skeptical or uncertain about the implications of the ACA.

Keywords: Affordable Care Act, demographics, free clinics, underserved.

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Authors: Susanna Asatryan

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The author will introduce the Language Portfolio for master course student-teachers of Yerevan Brusov State University of Languages and Social Sciences The overall aim of the Portfolio is to serve as a visual didactic tool for the pedagogical internship of master students in specialization “A Foreign Language Teacher of High Schools and Professional Educational Institutions”, based on the principles and fundamentals of the EPOSTL. The author will present the parts of the Portfolio, including the programme, goal and objectives of student-teacher’s internship, content and organization, expected outputs and the principles of the student’s self-assessment, based on Can-do philosophy suggested by the EPOSTL. The Language Portfolio for master course student-teachers outlines the distinctive stages of their scientific-pedagogical internship. In Lesson Observation and Teaching section student teachers present thematic planning of the syllabus course, including individual lesson plan-description and analysis of the lesson. In Realization of the Scientific-Pedagogical Research section student-teachers introduce the plan of their research work, its goal, objectives, steps of procedure and outcomes. In Educational Activity section student-teachers analyze the educational sides of the lesson, they introduce the plan of the extracurricular activity, provide psycho-pedagogical description of the group or the whole class, and outline extracurricular entertainments. In the Dossier the student-teachers store up the entire instructional “product” during their pedagogical internship: e.g. samples of surveys, tests, recordings, videos, posters, postcards, pupils’ poems, photos, pictures, etc. The author’s presentation will also cover the Self Assessment Checklist, which highlights the main didactic competences of student-teachers, extracted from the EPOSTL. The Self Assessment Checklist is introduced with some innovations, taking into consideration the local educational objectives that Armenian students come across with. The students’ feedback on the use of the Portfolio will also be presented.

Keywords: internship, lesson observation, can-do philosophy, self-assessment

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Authors: Neda Valizadeh, Mani Mofidi, Sama Haghighi, Ali Hashemaghaee, Soudabeh Shafiee Ardestani

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Background: There are many systems and parameters to evaluate trauma patients in the emergency department. Most of these evaluations are to distinguish patients with worse conditions so that the care systems have a better prediction of condition for a better care-giving. The purpose of this study is to determine the relationship between axillary body temperature and mortality in patients hospitalized in the intensive care unit (ICU) with multiple traumas and with other clinical and para-clinical factors. Methods: All patients between 16 and 75 years old with multiple traumas who were admitted into Emergency Department then hospitalized in the ICU were included in our study. An axillary temperature in the first and the second day of admission, Glasgow cola scale (GCS), systolic blood pressure, Serum glucose levels, and white blood cell counts of all patients at the admission day were recorded and their relationship with mortality were analyzed by SPSS software with suitable statistical tests. Results: Axillary body temperatures in the first and second day were statistically lower in expired traumatic patients (p=0.001 and p<0,001 respectively). Patients with lower GCS had a significantly lower first-day temperature and a significantly higher mortality. (p=0.006 and p=0.006 respectively). Furthermore, the first-day axillary temperature was significantly lower in patients with a lower first-day systolic blood pressure (p=0.014). Conclusion: Our results showed that lower axillary body temperature in the first day is associated with higher mortality, lower GCS, and lower systolic blood pressure. Thus, this could be used as a predictor of mortality in evaluation of traumatic patients in emergency settings.

Keywords: fever, trauma, mortality, emergency

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Authors: Maria Luiza Fulga, Georgeta Truca, Mihaela Alexandru, Andriescu Mariana, Crin Marcean

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The significance of nursing as a subject in the post-secondary healthcare curriculum is a major. We aimed to enable our students to assess the patient's risk, to establish prevention measures and to adapt to a specific learning context, in order to acquire the skills and abilities necessary for the nursing profession. In order to achieve these objectives, during the three years of study, teachers put an emphasis on acquiring communication skills, because in our country after the first cycle of hospital accreditation concluded in 2016, the National Authority for Quality of Health Management has introduced the criteria for the implementation and application of the nursing process according to the accreditation standards. According to these requirements, the nurse has to carry out the nursing assessment, based on communication as a distinct component, so that they can identify nursing diagnoses and implement the nursing plan. In this respect, we, the teachers, have refocused, by approaching various teaching strategies and preparing students for the real context of learning and applying what they learn. In the educational process, the tutors in the hospitals have an important role to play in acquiring professional skills. Students perform their activity in the hospital in accordance with the curriculum, in order to verify the practical applicability of the theoretical knowledge acquired in the school classes and also have the opportunity to acquire their skills in a real learning context. In clinical education, the student nurse learns in the middle of a guidance team which includes a practice tutor, who is a nurse that takes responsibility for the practical/clinical learning of the students in their field of activity. In achieving this objective, the tutor's abilities involve pedagogical knowledge, knowledge for the good of the individual and nursing theory, in order to be able to guide clinical practice in accordance with current requirements. The aim of this study is to find out the students’ confidence level in practice tutors in hospitals, the students’ degree of satisfaction in the pedagogical skills of the tutors and the practical applicability of the theoretical knowledge. In this study, we used as a method of investigation a student satisfaction questionnaire regarding the clinical practice in the hospital and the sample of the survey consisted of 100 students aged between 20 and 50 years, from the first, second and third year groups, with the General Nurse specialty (nurses responsible for general care), from 'Fundeni' Healthcare Post-Secondary School, Bucharest, Romania. Following the analysis of the data provided, we arrived the conclusion that the hospital tutor needs to improve his/her pedagogical skills, the knowledge of nursing diagnostics, and the implementation of the nursing plan, so that the applicability of the theoretical notions would be increased. Future plans include the pedagogical training of the medical staff, as well as updating the knowledge needed to implement the nursing process in order to meet current requirements.

Keywords: clinical training, nursing process, pedagogical skills, tutor

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Authors: Lucia Mavudzi

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Socioeconomic and demographic factors influence male attendance of antenatal care (ANC) activities which are beneficial in improving maternal health and birth outcome. When a male, as the head of the family is expected to solely make decisions of how finances are managed, when and where health services are sought, it impacts on the woman’s health seeking behavior. Using the data from the Zimbabwe Demographic and Health Survey 2010-2011 this paper seeks to assess the prevalence of male ANC attendance in Zimbabwe and factors that influence male ANC attendance. We hypothesized that socioeconomic and demographic factors do not influence male ANC attendance. To achieve the objectives of this paper, descriptive analysis was used to describe the characteristics of men and the Binomial logistic modelling was used to assess the relationship between male ANC attendance and selected socioeconomic and demographic factors. Male ANC attendance was used as the dependent variable, and the independent variables are age, marital status, place of residence, wealth, education, religion and employment. A high percentage of males did not attend ANC with their pregnant partners. Religion, education, and place of residence were found to be significantly associated with male ANC attendance. There was no evidence to show that there was a difference in male ANC attendance by employment, marital status, and age. Findings from this paper are relevant to public health. They will be used to develop strategies and intervention programs to improve pregnant women’s attendance of ANC attendance by involving men in maternal health.

Keywords: antenatal care, male participation, maternal health, socio-economic and demographic factors

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Authors: Ge Zhan

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Mobile health (mHealth) concerns the use of mobile technologies to deliver health care and improve wellness. In this paper, we ask the question of what are the drivers of positive consumer attitude toward mHealth programs. Answers to this question are important to consumer health, but existing marketing and health care service literature does not provide sufficient empirical conclusions on the use of mobile technologies for consumer health. This study aims to fill the knowledge gap by investigating mHealth use and consumer attitude. A content analysis was conducted with sample mHealth programs and online consumer reviews in Hong Kong, UK, US, and India. The research findings will contribute to marketing and health services literature.

Keywords: mobile health, consumer attitude, content analysis, online marketing

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Authors: Luedech Girdwichai, Witthaya Mekhum

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This research analyses the factors affecting the success and develops a guideline for self- reliance planning of the entrepreneurs for effective implementation. Samples in this study included 42 awarded winners from the 2nd Sufficiency Economics Philosophy (SEP) National Contest arranged by Office of the Royal Development Projects Board. The results revealed 4 main factors affecting the success as follows: 1) there is a need to encourage unity and cooperation in the enterprise in conducting development plan. 2) The entrepreneur must be a knowledge seeker and lead by example on SEP life. 3) The entrepreneur must be able to apply traditional local wisdom with his present experience and knowledge in defining product identity. 4) The entrepreneur should provide career training for the staffs to develop their competencies. The guideline for self-reliance planning consisted of 4 aspects: 1) Human resource development: the enterprise should develop its staffs especially on integrity, honesty, and public minded. 2) Local community development: there should be a clear target for the local community development. 3) Local community economic development: by encouraging additional incomes through experience sharing. 4) Enterprise development planning: by arranging monthly meeting to conduct the development plan including analysing problems and synthesizing data.

Keywords: potential development, SME entrepreneurs, sufficiency economics philosophy, finance, management

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Authors: Walid A. Alkeridy, Arwa Aljasser, Khalid Mohammed Alayed, Saad Alsaad, Amani S. Alqahtani, Claire Ann Lim, Sultan H. Alamri, Doaa Zainhom Mekkawy, Mohammed Al-Sofiani

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Introduction: The history of publicly funded Home Health Care (HHC) service in Saudi Arabia dates back to 1991. The first HC program was launched to provide palliative home care services for patients with terminal cancer. Thereafter, more programs launched across Saudi Arabia most remarkably was launching the national program for HHC by the Ministry Of Health (MOH) in 2008. The national HHC MOH program is mainly providing long-term care home care services for over 40,000 Saudi citizens. The scope of the HHC service program provided by the Saudi MOH is quite diverse, ranging from basic nursing care to specialized care programs, e.g., home peritoneal dialysis, home ventilation, home infusion therapy, etc. Objectives: The primary aim of our study is to report the prevalence of chronic conditions among Saudi people receiving long-term HHC services. Secondary aims include identifying the predictors of mortality among individuals receiving long-term HHC services and studying the association between frailty and poor health outcomes among HHC users. Methods: We conducted a retrospective and cross-sectional data collection from participants receiving HHC services at King Saud University Medical City, Riyadh, Saudi Arabia. Data were collected from electronic health records (EHR), patient charts, and interviewing caregivers from the year 2019 to 2022. We assessed functional performance by Katz's activity of daily living and the Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). Mortality was assessed by reviewing the death certificates if patients were hospitalized through discharge status ascertainment from EHR. Results: The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. The following variables were statistically significant between deceased and alive individuals receiving HHC services; clinical frailty scale, the total number of comorbid conditions, and functional performance based on the KATZ activity of daily living scale and the BADLS. We found that the strongest predictors for mortality were pressure ulcers which had an odds ratio of 3.75 and p-value of < 0.0001, and the clinical frailty scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services. Moreover, we found a high rate of annual readmission for individuals enrolled in HHC, which requires further analysis to understand the possible contributing factors for the increased rate of hospital readmission and develop strategies to address them. Future studies should focus on designing quality improvement projects aimed at improving the quality of life for individuals receiving HHC services, especially those who have pressure ulcers at the end of life.

Keywords: homecare, Saudi, prevalence, chronic

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Authors: C. Asarkaya, S. Z. Siretioglu Girgin

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Turkish migrants constitute the largest group among people with migration background living in Germany. Turkish women’s labor market participation is of significant importance for their social and economic integration to the German society. This paper thus aims to investigate their labor market positions. Turkish migrant women participate less in the labor market compared to men, and are responsible for most of the housework, child care, and elderly care. This is due to their traditional roles in the family, educational level, insufficient knowledge of German language, and insufficient professional experience. We strongly recommend that wide-reaching integration policies for women are formulated, so as to encourage participation of not only migrant women but also their husbands, fathers and/or brothers, and natives.

Keywords: empowerment, Germany, labor market, migration, Turkish, women

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Authors: Jasim Uddin, Rod Smith, Malcolm Gillies

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Surface irrigation is the most popular irrigation method all over the world. However, two issues: low efficiency and huge labour involvement concern irrigators due to scarcity in recent years. To address these issues, a smart automated furrow is conceptualised that can be operated using digital devices like smartphone, iPad or computer and a preliminary evaluation was conducted in this study. The smart automated system is the integration of commercially available software and hardware. It includes real-time surface irrigation optimisation software (SISCO) and Rubicon Water’s surface irrigation automation hardware and software. The automated system consists of automatic water delivery system with 300 mm flexible pipes attached to both sides of a remotely controlled valve to operate the irrigation. A water level sensor to obtain the real-time inflow rate from the measured head in the channel, advance sensors to measure the advance time to particular points of an irrigated field, a solar-powered telemetry system including a base station to communicate all the field sensors with the main server. On the basis of field data, the software (SISCO) is optimised the ongoing irrigation and determine the optimum cut-off for particular irrigation and send this information to the control valve to stop the irrigation in a particular (cut-off) time. The preliminary evaluation shows that the automated surface irrigation worked reasonably well without manual intervention. The evaluation of farmers managed irrigation events show the potentials to save a significant amount of water and labour. A substantial amount of economic and social benefits are expected in rural industries by adopting this system. The future outcome of this work would be a fully tested commercial adaptive real-time furrow irrigation system able to compete with the pressurised alternative of centre pivot or lateral move machines on capital cost, water and labour savings but without the massive energy costs.

Keywords: furrow irrigation, smart automation, infiltration, SISCO, real-time irrigation, adoptive control

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Authors: Nangialai Yousufzai, Eysosiyas Etana, Ikuo Sugiyama

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Kabul population has been growing continually since 2001 and reaching six million in 2025 due to the rapid inflow from the neighboring countries. As a result of the population growth, lack of living facilities supported by infrastructure services is becoming serious in social and economic aspects. However, about 70% of the city is still occupied illegally and the government has little information on the infrastructure demands. To improve this situation, land readjustment is one of the powerful development tools, because land readjustment does not need a high governmental budget of itself. Instead, the method needs cooperation between stakeholders such as landowners, developers and a local government. So it is becoming crucial for both government and citizens to implement land readjustment for providing tidy urban areas with enough public services to realize more livable city as a whole. On the contrary, the traditional land readjustment tends to spend a long time until now to get consensus on the new plan between stakeholders. One of the reasons is that individual land area (land parcel) is decreased due to the contribution to public such as roads/parks/squares for improving the urban environment. The second reason is that the new plan is difficult for dwellers to imagine new life after the readjustment. Because the paper-based plan is made by an authority not for dwellers but for specialists to precede the project. This paper aims to shorten the time to realize quick consensus between stakeholders. The first improvement is utilizing questionnaire(s) to assess the demand and preference of the landowners. The second one is utilizing 3D model for dwellers to visualize the new environment easily after the readjustment. In additions, the 3D model is reflecting the demand and preference of the resident so that they could select a land parcel according to their sense value of life. The above-mentioned two improvements are carried out after evaluating total land prices of the new plans to select for maximizing the project value. The land price forecasting formula is derived from the current market ones in Kabul. Finally, it is stressed that the rapid consensus-building of land readjustment utilizing ICT and open data analysis is essential to redevelop slums and illegal occupied areas in Kabul.

Keywords: land readjustment, consensus building, land price formula, 3D simulation

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Authors: Mohammad A. Masoumi, Mohammad Zare, Soroush Sabouki

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This study investigates the aerodynamic characteristics of supertall buildings to evaluate wind turbine installation at high altitudes. Most recent studies have investigated supertall buildings at a horizontal plane, while a vertical plan could be as important, especially to install wind turbines. A typical square-plan building with a height of 500 m is investigated numerically at horizontal and vertical plans to evaluate wind power generation potentials. The results show good agreement with experimental data and past studies. Then four new geometries are proposed to improvise regions at high altitudes to install wind turbines. Evaluating the simulations shows two regions with high power density, which have the possibility to install wind turbines. Results show that improvised regions to install wind turbines at high altitudes contain significant power density while higher power density is found behind buildings in a far distance. In addition, power density fluctuations behind buildings are investigated, which show decreasing fluctuations by reaching 50 m altitude while altitudes lower than 20 m have the most fluctuations.

Keywords: wind power, supertall building, power density, aerodynamic characteristics, wind turbine mobile, quality assurance, testing, applications

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Authors: Amardass Dhami, Clare Samuelson

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Background: Sickle cell disease (SCD) is a complex, multisystem condition that significantly impacts patients' quality of life, characterized by acute illness episodes, progressive organ damage, and reduced life expectancy. In the UK, over 13,000 individuals are affected, with South Yorkshire having the fifth highest prevalence, including approximately 800 patients. Retinal complications in SCD can manifest as either proliferative or non-proliferative disease, with proliferative changes being more prevalent. These retinal issues can cause significant morbidity, including visual loss and increased care requirements, underscoring the need for regular monitoring. An integrated approach was applied to ensure timely interventions, ultimately enhancing patient outcomes and reduce ‘did not attend’ rates. Aim: To assess the factors which may influence attendance to Haematology and Ophthalmology Clinics with attention towards levels of deprivation towards non-attendance. Method : A retrospective study on 84 eligible patients, from the regional tertiary Centre for Sickle Cell Care (Sheffield Teaching Hospital) from 2017 to 2023. The study focused on the incidence of sickle cell eye disease, specifically examining the outcomes of patients who attended the combined haematology and ophthalmology clinics. Patients who did not attend either clinic were excluded from the analysis to ensure a clear understanding of the combined clinic's impact. This data was then compared with the United Kingdom’s Index of Multiple Deprivation (IMD) datasets to assess if inequalities of care affected this population. Results: The study concluded that the effectiveness of combining haematology and ophthalmology clinics was reduced following the intervention. The DNA rates increased to 40% for the haematology clinic. Additionally, a significant proportion of the cohort was classified as residing in areas of deprivation, suggesting a possible link between socioeconomic factors and non-attendance rates Conclusion: These findings underscore the challenges of integrating care for SCD patients, particularly in relation to socioeconomic barriers. Despite the intent to streamline care and improve patient outcomes, the increase in DNA rates points to the need for further investigation into the underlying causes of non-attendance. Addressing these issues, especially in deprived areas, could enhance the effectiveness of combined clinics and ensure that patients receive the necessary monitoring and interventions for their eye health and overall well-being. Future strategies may need to focus on improving accessibility, outreach, and support for patients to mitigate the impact of socioeconomic factors on healthcare attendance.

Keywords: south yorkshire, sickle cell anemia, deprivation, factors, haematology

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Authors: Rojan Dahal

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One Health refers to a collaborative effort between multiple disciplines - locally, nationally, and globally - to attain optimal health. Although there were unprecedented intersectoral alliances between the animal and human health sectors during the avian influenza outbreak, there are different views and perceptions concerning institutionalizing One Health in South Asia. It is likely a structural barrier between the relevant professionals working in different entities or ministries when it comes to collaborating on One Health actions regarding zoonotic diseases. Politicians and the public will likely need to invest large amounts of money, demonstrate political will, and understand how One Health works to overcome these barriers. One Health might be hard to invest in South Asian countries, where the benefits are based primarily on models and projections and where numerous issues related to development and health need urgent attention. The other potential barrier to enabling the One Health concept in responding to zoonotic diseases is a failure to represent One Health in zoonotic disease control and prevention measures in the national health policy, which is a critical component of institutionalizing the One Health concept. One Health cannot be institutionalized without acknowledging the linkages between animal, human, and environmental sectors in dealing with zoonotic diseases. Efforts have been made in the past to prepare a preparedness plan for One Health implementation, but little has been done to establish a policy environment to institutionalize One Health. It is often assumed that health policy refers specifically to medical care issues and health care services. When drafting, reviewing, and redrafting the policy, it is important to engage a wide range of stakeholders. One Health institutionalization may also be hindered by the interplay between One Health professionals and bureaucratic inertia in defining the priorities of diseases due to competing interests on limited budgets. There is a possibility that policymakers do not recognize the importance of veterinary professionals in preventing human diseases originating in animals. Compared to veterinary medicine, the human health sector has produced most of the investment and research outputs related to zoonotic diseases. The public health profession may consider itself superior to the veterinary profession. Zoonotic diseases might not be recognized as threats to human health, impeding integrated policies. The effort of One Health institutionalization remained only among the donor agencies and multi-sectoral organizations. There is a need for strong political will and state capacity to overcome the existing institutional, financial, and professional barriers for its effective implementation. There is a need to assess the structural challenges, policy challenges, and the attitude of the professional working in the multiple disciplines related to One Health. Limited research has been conducted to identify the reasons behind the barriers to institutionalizing the One Health concept in South Asia. Institutionalizing One Health in responding to zoonotic diseases breaks down silos and integrates animals, humans, and the environment.

Keywords: one health, institutionalization, South Asia, institutionalizations

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Authors: Jamal Shokrzadehmadiyeh, Kambiz Kamkari, Shohreh Shokrzadeh

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According to the research topic, the purpose of the current paper is to research personality characteristics in adolescents under the care of the Tehran Juvenile Detention Centre, and a survey research method has been used. In this regard, through systematic random sampling, 120 people from the research population were selected as a sample, who were referred to Tehran Juvenile Detention Centre after the decision was reached by the court. Data collection was carried out by separate examination using NEO-PI-III personality inventory, and statistical analysis was done using a one-sample t-test. Finally, the results of the research revealed that the level of neuroticism is higher than the average level, the level of conscientiousness is lower than the average level, and the level of extraversion, agreeableness, and openness are at the average level.

Keywords: personality characteristics, adolescents, Juvenile Detention Center, Tehran city

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Authors: Saeed Dehnavi, Zahra Dehnavi

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Background: Psychodrama, as a form of art therapy, helps people to enact and use role-plays for a specific problem, rather than just talking about it, in an effort to review the problem, gain feedback from group members, find appropriate solutions, and practice them for their life. This paper evaluated the effectiveness of psychodrama on enhancing self-esteem of young adolescent boys. Methodology: This is aquasi-experimental research study, using a pre-post testing plan with control group.From four secondary schools in Kermanshah – Iran, 210 adolescent boys (aged 13 and 14 years) were asked to complete Koper Smith's self-esteem measure scale. Given the low self-esteem scores (less than the cut-off of 23), a number of 20 individuals were selected and randomly placed into two control and experimental groups. The experimental group participated in a twelve-session psychodrama therapy plan for 6 weeks, while the control group received no intervention. Data analysis was carried out by the analysis of covariance (ANCOVA). Results: The results of ANCOVA analysis showed an increase in the post-test scores for self-esteem, and such increase was statistically significant. Conclusion: The findings indicated the effectiveness of psychodrama on self-esteem enhancement of young boys. During psychodrama sessions, the adolescents learned to take the initiative, communicate with others in an excited state, and improve their self-esteem with positive and constructive experiences.

Keywords: psychodrama, self-esteem, young adolescents, boys

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Authors: Naseem M. Twaissi

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Medical professionals play an important role in society, and in general, they care more about their patients than about their personal well-being. They need to take a professional approach to maintain a work-life balance. Through a collection of primary data from 1020 medical professionals and the application of relevant statistical tools, this paper explores the pressures on medical professionals with reference to their work-life balance. This study highlights how hospital management, in addition to economic reasons, needs to identify variables to enhance the work-life balance of medical professionals so that quality healthcare facilities may be provided to the citizens of Jordan. Results indicate that formulation and implementation of policies for enhancing work-life balance together with career and retention plans for medical professionals would enhance the performance of hospitals and the quality of health care in Jordan, leading to greater societal well-being.

Keywords: work life balance, job environment, job satisfaction, employee well-being, stress, hospital industry

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Authors: Zahra BehboodiI-Moghadam, Zohre Khalajinia, Ali Reza Nikbakht Nasrabadi, Minoo Mohraz

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The purpose of our study was to explore and describe the experiences of pregnant women with HIV in Iran. A qualitative exploratory study with conventional content analysis was used. Twelve pregnant women with HIV who referred to perinatal care at the Imam Khomeini Hospital Behavioral Diseases Consultation: Center in Tehran were recruited to participate in in-depth interviews. The average age of the participants was 32.5 years. Four main themes were extracted from the data: “fear and hope, “stigma and discrimination, “marital life stability” and “trust”. The findings reveal the pregnant women living with HIV are vulnerable and need professional support. Improving the knowledge of healthcare professionals especially midwifes on pregnancy complications for women with HIV is crucial in order to provide high-quality care to pregnant women with HIV-positive.

Keywords: HIV, pregnancy, content analysis, experiences, Iran, qualitative research

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Authors: Hugo Rodríguez

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Migrations of researchers, scientists, and inventors are a widespread phenomenon in modern times. In some cases, migrants stay linked to research groups in their countries of origin, either out of their own conviction or because of government policies. We examine different linear models of technological development (using the Ordinary Least Squares (OLS) technique) in eight selected countries and find that the collaborations between resident and nonresident patent applicants correlate with different levels of performance of the technological policies in three different scenarios. Therefore, the reinforcement of that link must be considered a powerful tool for technological development.

Keywords: development, collaboration, patents, technology

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Authors: Priyanka Dixit

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Reproductive health problem is an important public health issue in most of the developing countries like India. It is a common problem in India for women in the reproductive age group to suffer from reproductive illnesses and not seek care. Existing literatures tell us very little about the several dimensions of reproductive morbidity. In addition the general perception says, metros have better medical infrastructure, so its residents should lead a healthier life. However some of the studies reveal a very different picture. Therefore, the present study is conducted with the specific objectives to find out the prevalence of reproductive health problem and treatment seeking behavior of currently married women in four metro cities in India namely; Mumbai, Delhi, Chennai and Kolkata. In addition, this paper also examines the effect of socio-economic and demographic factors on self-reported reproductive health problems. Bi-variate and multivariate regression have been applied to achieve the proposed objectives. Study is based on National Family Health Survey 2015-16 data. The analysis shows that the prevalence of any reproductive health problem among women is the highest in Mumbai followed by Delhi, Chennai, and Kolkata. A bulk of women in all four metro cities has reported abdominal pain, itching and burning sensation as the major problems while urinating. However, in spite of the high prevalence of reproductive health problems, a huge proportion of such women in all these cities do not seek any advice or treatment for these problems. This study also investigates determinants that affect the prevalence of reproductive health problem to policy makers plan for proper interventions for improving women’s reproductive health.

Keywords: reproductive health, India, national family health survey-4, city

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Authors: Anthony J. Kondracki, Bonzo Reddick, Jennifer L. Barkin

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Background: Many pregnancies in the United States are affected each year with the most common sexually transmitted infections (STIs), including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Treponema pallidum (TP, syphilis), and the rate of congenital syphilis has reached a 20-year high. We sought to estimate the prevalence of CT, NG, and TP in pregnancy and the risk of preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2500g) deliveries according to utilization of prenatal care (PNC) during the COVID-19 pandemic. Methods: This study was based on the 2020 National Center for Health Statistics (NCHS) Natality File restricted to singleton births (N=3,512,858). We estimated the prevalence of CT, NG, TP, PTBand LBW across timing and the number of prenatal care (PNC) visits attended. In multivariable logistic regression models, adjusted odds ratios of PTB and LBW were assessed according to STIs and PNC status. E-values, based on effect size estimates and the lower bound of the 95% confidence intervals (CIs) of the association, examined the potential impact of unmeasured confounding. Results: CT (1.8%) was most prevalent in pregnancy, followed by NG (0.3%) and TP (0.1%). The strongest predictors of PTB and LBW were maternal NG (12.2% and 12.1%, respectively), late initiation/no PNC (8.5% and 7.6%, respectively), and ≤10 prenatal visits (13.1% and 10.3%, respectively). The odds of PTB and LBW were 2.5- to 3-fold greater for each STI in women who received ≤10 compared to >10 prenatal visits. E-values demonstrated the minimum strength of potential unmeasured confounding necessary to explain away observed associations. Conclusions: Timely initiation and receipt of recommended number of prenatal visits benefits screening and treatment of all women for STIs, including NG to substantially reduce infant morbidity and mortality related to PTB and LBW among infants born during the COVID-19 pandemic.

Keywords: COVID-19 pandemic, sexually transmitted infections, preterm birth, low birthweight, prenatal care

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Authors: Manisha Singh, Padam Simkhada

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Background: Although mental health policy has been adapted in Nepal since 1997, the implementation of the policy framework is yet to happen. The fact that mental health services are largely concentrated in urban areas more specific to treatment only provides a clear picture of the scarcity of mental health services in the country. The shreds of evidence from around the world, along with WHO’s (World Health Organization) Mental Health Gap Action Program (mhGAP) suggest that effective mental health services can be provided from Primary Health Care (PHC) centers through community-based programs without having to place a specialized health worker. However, the country is still facing the same challenges to date with very few psychiatrists and psychologists, but they are largely based in cities. Objectives: The main objectives of this study are; (a) to understand the perception of health workers at PHC on maternal mental health, and (b) to assess the availability of the mental health services at PHC to address maternal mental health. Methods: This study used a qualitative approach where an in-depth interview was conducted with the health workers at the primary level. “Mayadevi” rural municipality in Rupendehi District that comprised of 13 small villages, was chosen as the study site. A total 8 health institutions which covered all 13 sites were included where either the health post in- charge or health worker working in maternal and child health care was interviewed for the study. All the health posts in the study area were included in the study. The interviews were conducted in Nepali; later, they were translated in English, transcribed, and triangulated. NViVO was used for the analysis. Results: The findings show that most of the health workers understood what maternal mental health was and deemed it as a public health issue. They could explain the symptoms and knew what medication to prescribe if need be. However, the majority of them failed to name the screening tools in place for maternal mental health. Moreover, they hadn’t even seen one. None of the health care centers had any provision for screening mental health status. However, one of the centers prescribed medication when the patients displayed symptoms of depression. But they believed there were a significant number of hidden cases in the community due to the stigma around mental health and being a woman with mental health problem makes the situation even difficult. Nonetheless, the health workers understood the importance of having screening tools and acknowledged the need of training and support in order to provide the services from PHC. Conclusion: Community health workers can identify cases with mental health problems and prevent them from deteriorating further. But there is a need for robust training and support to build the capacity of the health workers. The screening tools on mental health needs to be encouraged to be used in the PHC levels. Furthermore, community-based culture-sensitive programs need to be initiated and implemented to mitigate the stigma related issues around mental health.

Keywords: maternal mental health, health care providers, screening, Nepal

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Authors: Ahmeda Ali, Mary Codd, Susan Brundage

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Importance: This research focuses on devising and improving Health Service Executive (HSE) policy and legislation and therefore improving patient trauma care and outcomes in Ireland. Objectives: The study measures components of the Trauma System in the district hospital setting of the Cavan/Monaghan Hospital Group (CMHG), HSE, Ireland, and uses the collected data to identify the strengths and weaknesses of the CMHG Trauma System organisation, to include governance, injury data, prevention and quality improvement, scene care and facility-based care, and rehabilitation. The information will be made available to local policy makers to provide objective situational analysis to assist in future trauma service planning and service provision. Design, setting and participants: From 28 April to May 28, 2016 a cross-sectional survey using World Health Organisation (WHO) Trauma System Assessment Tool (TSAT) was conducted among healthcare professionals directly involved in the level III trauma system of CMHG. Main outcomes: Identification of the strengths and weaknesses of the Trauma System of CMHG. Results: The participants who reported inadequate funding for pre hospital (62.3%) and facility based trauma care at CMHG (52.5%) were high. Thirty four (55.7%) respondents reported that a national trauma registry (TARN) exists but electronic health records are still not used in trauma care. Twenty one respondents (34.4%) reported that there are system wide protocols for determining patient destination and adequate, comprehensive legislation governing the use of ambulances was enforced, however, there is a lack of a reliable advisory service. Over 40% of the respondents reported uncertainty of the injury prevention programmes available in Ireland; as well as the allocated government funding for injury and violence prevention. Conclusions: The results of this study contributed to a comprehensive assessment of the trauma system organisation. The major findings of the study identified three fundamental areas: the inadequate funding at CMHG, the QI techniques and corrective strategies used, and the unfamiliarity of existing prevention strategies. The findings direct the need for further research to guide future development of the trauma system at CMHG (and in Ireland as a whole) in order to maximise best practice and to improve functional and life outcomes.

Keywords: trauma, education, management, system

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Authors: Patrick Nurse, Professor Neil Sebire, Polly Livermore

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The use of digital systems in healthcare is now highly prevalent. With further advancement of technology, these systems will become increasingly utilised within the healthcare sector. Therefore understanding how clinicians (for example, doctors, nurses) interact with technology and digital systems is critical to making care safer. Seven members from the Parent/Carers’ Research Advisory Group and the Young-Persons’ Research Group at a healthcare Trust in London and three staff members contributed to an engagement workshop to assess the impact of digital systems on the practice of nurses. The group also advised on the viability of a research study to investigate this further. A wide range of issues within digital system implementation in healthcare were raised, such as ‘workarounds’, system’s training, and upkeep and regulation of usage, which all emerged as early themes during the discussion. Further discussion focused on the subject of escalation of issues, ‘workarounds’, and problem solving. While challenging to implement, digital systems are hugely beneficial to healthcare providers. The workshop indicated that there is scope for investigation of the prevalence, nature, and escalation of ‘workarounds’, this was of key interest to the advisory group. An interesting concern of the group was their worry from a patient and parental perspective regarding how nurses might feel when needing to complete a ‘workaround’ during a busy shift. This is especially relevant if the reasons to complete the ‘workaround’ were outside the nurse’s control, driven by clinical need and urgency of care. This showed the level of insight that those using healthcare services have into the reality of workflows of those providing care. Additionally, it reflects the desire for patients and families to understand more about the administration and methodology of their care. Future study should be dedicated to understanding why nurses deploy ‘workarounds’, as well as their perspective and experience of them and subsequent escalation through leadership hierarchies

Keywords: patient engagement/involvement, workarounds, medication-administration, digital systems

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Authors: Yeasir Arafat Alve, Nazmun Nahar, Salma BeguM

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Introduction / Rationale: Caregivers of stroke survivors have experienced financial, emotional, physical and mental anxiety and have influence of family bonding and social customs, where 80% of caregivers were women and majority of the patients were cared for by immediate family members for example a spouse, son/daughter, son-in-law, daughter-in-law, siblings and they are significantly feel burden as a caregiver. In Bangladeshi context, there has a limitation of knowledge about the level of caregiver burden. This study could be suggested the health professional to focus on the care giving stress to provide a better support to them and also it will be advisable to provide equivalent services for caregivers and their families. Objectives: The study finds out the socio-demographic image of caregivers of stroke survivors in Bangladesh as well as discovers the level of burden of caregiver of stroke survivor in relation to general strain, isolation, disappointment, emotional involvement and environment. The study will find out the association between level of burden among caregivers and onset of stroke of survivors & duration of care giving. As well as to determine the association between level of burden among caregivers and caregiver’s age, gender, occupation and caregiver’s relationship with stroke survivors. Method / Approach: The study is a non experimental cross-sectional study design where 151 participants were selected through purposive comprehensive sampling. Data were selected from occupational therapy outdoor and stroke rehab unit, CRP (Savar & Mirpur) where using the Caregiver Burden Scale (a structured questionnaire) with face to face interview. Results: Most of the caregivers (78.8%) of stroke survivors faced moderate level of burden in general strain (37.7%), isolation (27.2%) but in case of disappointment (60.3%) feel higher burden and lower burden in emotional involvement (9.9%) and environment (0.7%). Caregiver burden level was significantly associated with caregivers’ age (P=0.006), sex (P=0.002), occupation (p= 0.04), relationship with stroke survivors (P=0.02), care giving duration (P=0.000), care giving hours (P=0.009), and onset of stroke (P=0.000) of stroke survivors. Conclusion: The study findings revealed that most of the caregivers faced moderate burden where no environmental burden for them, this is possibly in case of Bangladeshi culture where people hospitable. Through this study, it was also found that there is a possibility to have the higher burden. Finally, it is being also suggested that appropriate advice and support may preserve care giving which eventually enables the survivors to live a longer and more fulfilling life in the community.

Keywords: caregiver, level of caregiver burden, stroke survivor, stroke rehab unit

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Authors: Jollen Dai, Truman You, Xinyun Du, Katrina Liu

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Transportation is one of the leading sources of greenhouse gas emissions (GHG). Thus, to meet the Paris Agreement 2015, all countries must adopt a different and more sustainable transportation system. From bikes to Maglev, the world is slowly shifting to sustainable transportation. To develop a utility public transit system, a sustainable web of buses must be implemented. As of now, only a handful of cities have adopted a detailed plan to implement a full fleet of e-buses by the 2030s, with Shenzhen in the lead. Every change requires a detailed plan and a focused analysis of the impacts of the change. In this report, the economic implications and financial implications have been taken into consideration to develop a well-rounded 10-year plan for New York City. We also apply the same financial model to the other cities, LA and Chicago. We picked NYC, Chicago, and LA to conduct the comparative NPB analysis since they are all big metropolitan cities and have complex transportation systems. All three cities have started an action plan to achieve a full fleet of e-bus in the decades. Plus, their energy carbon footprint and their energy price are very different, which are the key factors to the benefits of electric buses. Using TCO (Total Cost Ownership) financial analysis, we developed a model to calculate NPB (Net Present Benefit) /and compare EBS (electric buses) to DBS (diesel buses). We have considered all essential aspects in our model: initial investment, including the cost of a bus, charger, and installation, government fund (federal, state, local), labor cost, energy (electricity or diesel) cost, maintenance cost, insurance cost, health and environment benefit, and V2G (vehicle to grid) benefit. We see about $1,400,000 in benefits for a 12-year lifetime of an EBS compared to DBS provided the government fund to offset 50% of EBS purchase cost. With the government subsidy, an EBS starts to make positive cash flow in 5th year and can pay back its investment in 5 years. Please remember that in our model, we consider environmental and health benefits, and every year, $50,000 is counted as health benefits per bus. Besides health benefits, the significant benefits come from the energy cost savings and maintenance savings, which are about $600,000 and $200,000 in 12-year life cycle. Using linear regression, given certain budget limitations, we then designed an optimal three-phase process to replace all NYC electric buses in 10 years, i.e., by 2033. The linear regression process is to minimize the total cost over the years and have the lowest environmental cost. The overall benefits to replace all DBS with EBS for NYC is over $2.1 billion by the year of 2033. For LA, and Chicago, the benefits for electrification of the current bus fleet are $1.04 billion and $634 million by 2033. All NPB analyses and the algorithm to optimize the electrification phase process are implemented in Python code and can be shared.

Keywords: financial modeling, total cost ownership, net present benefits, electric bus, diesel bus, NYC, LA, Chicago

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Authors: Shende Suraj Balu, A. B. Deoghare, K. M. Pandey

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The human middle ear (ME) is a delicate and vital organ. It has a complex structure that performs various functions such as receiving sound pressure and producing vibrations of eardrum and propagating it to inner ear. It consists of Tympanic Membrane (TM), three auditory ossicles, various ligament structures and muscles. Incidents such as traumata, infections, ossification of ossicular structures and other pathologies may damage the ME organs. The conditions can be surgically treated by employing prosthesis. However, the suitability of the prosthesis needs to be examined in advance prior to the surgery. Few decades ago, this issue was addressed and analyzed by developing an equivalent representation either in the form of spring mass system, electrical system using R-L-C circuit or developing an approximated CAD model. But, nowadays a three-dimensional ME model can be constructed using micro X-Ray Computed Tomography (μCT) scan data. Moreover, the concern about patient specific integrity pertaining to the disease can be examined well in advance. The current research work emphasizes to develop the ME model from the stacks of μCT images which are used as input file to MIMICS Research 19.0 (Materialise Interactive Medical Image Control System) software. A stack of CT images is converted into geometrical surface model to build accurate morphology of ME. The work is further extended to understand the dynamic behaviour of Harmonic response of the stapes footplate and umbo for different sound pressure levels applied at lateral side of eardrum using finite element approach. The pathological condition Cholesteatoma of ME is investigated to obtain peak to peak displacement of stapes footplate and umbo. Apart from this condition, other pathologies, mainly, changes in the stiffness of stapedial ligament, TM thickness and ossicular chain separation and fixation are also explored. The developed model of ME for pathologies is validated by comparing the results available in the literatures and also with the results of a normal ME to calculate the percentage loss in hearing capability.

Keywords: computed tomography (μCT), human middle ear (ME), harmonic response, pathologies, tympanic membrane (TM)

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Authors: Ling-Lang Huang

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Background: The holistic health care should ideally cover physical, mental, spiritual, and social aspects of a patient. With very constrained time in current clinical practice system, medical decisions often tip the balance in favor of evidence-based medicine (EBM) in comparison to patient's personal values. Even in the era of competence-based medical education (CBME), when scrutinizing the items of entrustable professional activities (EPAs), we found that EPAs of establishing doctor-patient relationship remained incomplete or even missing. This phenomenon prompted us to raise this project aiming at advocating value-based medicine (VBM), which emphasizes the importance of patient’s values in medical decisions. A true and effective doctor-patient communication and relationship should be a well-balanced harmony of EBM and VBM. By constructing VBM into current EPAs, we can further promote genuine shared decision making (SDM) and fix the missing link in holistic health care. Methods: In this project, we are going to find out EPA elements crucial for establishing an ideal doctor-patient relationship through three distinct pairs of doctor-patient relationships: patients with pulmonary arterial hypertension (relatively young but with grave disease), patients undergoing surgery (facing critical medical decisions), and patients with terminal diseases (facing forthcoming death). We’ll search for important EPA elements through the following steps: 1. Narrative approach to delineate patients’ values among 2. distinct groups. 3.Hermeneutics-based interview: semi-structured interview will be conducted for both patients and physicians, followed by qualitative analysis of collected information by compiling, disassembling, reassembling, interpreting, and concluding. 4. Preliminarily construct those VBM elements into EPAs for doctor-patient relationships in 3 groups. Expected Outcomes: The results of this project are going to give us invaluable information regarding the impact of patients’ values, while facing different medical situations, on the final medical decision. The competence of well-blending and -balanced both values from patients and evidence from clinical sciences is the missing link in holistic health care and should be established in future EPAs to enhance an effective SDM.

Keywords: value-based medicine, shared decision making, entrustable professional activities, holistic health care

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Authors: Sirimanee Banjong

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This study aimed to 1) develop pre-service teachers’ leadership skills through camp-based learning, and 2) develop pre-service teachers’ teamwork skills through camp-based learning. An applied research methodology was used. The target group was derived from a purposive selection. It involved 32 fourth-year students in Early Childhood Education Program enrolling in a course entitled Seminar in Early Childhood Education provided during the second semester of the academic year 2013. The treatment was camp-based learning activities which applied a PDCA process including four stages: 1) plan, 2) do, 3) check, and 4) act. Research instruments were a learning camp program, a camp-based learning management plan, a 5-level assessment form for leadership skills and a 5-level assessment form for assessing teamwork skills. Data were analyzed using descriptive statistics. Results were: 1) pre-service teachers’ leadership skills yielded the before treatment average score at ¯("x" )=3.4, S.D.= 0.62 and the after-treatment average score at ¯("x" ) 4.29, S.D.=0.66 pre-service teachers’ teamwork skills yielded the before-treatment average score at ¯("x" )=3.31, S.D.= 0.60 and the after-treatment average score at ¯("x" )=4.42, S.D.= 0.66. Both differences were statistically significant at the .05 level. Thus, the pre-service teachers’ leadership and teamwork skills were significantly improved through the camp-based learning approach.

Keywords: learning camp, leadership skills, teamwork skills, pre-service teachers

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Authors: Niyada Naksuk, Thoetchai Peeraphatdit, Vitaly Herasevich, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham

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Introduction: Little is known about the safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. Methods: Pre-study Confusion Assessment Method-Intensive Care Unit (CAM–ICU) criteria were implemented in screening consecutive patients admitted to Mayo Clinic, Rochester, the USA from 2004 through 2013. Death status was prospectively ascertained. Results: Of 11,079 study patients, the incidence of delirium was 8.3% (n=925). Delirium was associated with an increased risk of in-hospital mortality (adjusted OR 1.49; 95% CI, 1.08-2.08; P=.02) and one-year mortality among patients who survived from CCU admission (adjusted HR 1.46; 95% CI, 1.12-1.87; P=.005). A total of 792 doses of haloperidol (5 IQR [3-10] mg/day) or quetiapine (25 IQR [13-50] mg/day) were given to 244 patients with delirium. The clinical characteristics of patients with delirium who did and did not receive antipsychotic therapy were not different (baseline corrected QT [QTc] interval 460±61 ms vs. 457±58 ms, respectively; P = 0.57). In comparison to baseline, mean QTc intervals after the first and third doses of the antipsychotics were not significantly prolonged in haloperidol (448±56, 458±57, and 450±50 ms, respectively) or quetiapine groups (459±54, 467±68, and 462±46 ms, respectively) (P > 0.05 for all). Additionally, in-hospital mortality (adjusted OR 0.67; 95% CI, 0.42-1.04; P=.07), ventricular arrhythmia (adjusted OR 0.87; 95% CI, 0.17-3.62; P=.85) and one-year mortality among the hospital survivors (adjusted HR 0.86; 95% CI 0.62-1.17; P = 0.34) were not different in patients with delirium irrespective of whether or not they received antipsychotics. Conclusions: In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.

Keywords: arrhythmias, haloperidol, mortality, qtc interval, quetiapine

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