Search results for: clinical decision support systems

Authors: José Batista de Souza Neto

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This research project has as its theme the implementation of public policies to support micro and small businesses (MSEs). The research problem defined was how public policies for access to markets that drive the entrepreneurial ecosystem of MSEs are implemented. The general objective of this research is to understand the process of implementing a public policy to support the entrepreneurial ecosystem of MSEs by the Support Service for Micro and Small Enterprises of the State of São Paulo (SEBRAESP). Public policies are constituent elements of entrepreneurship ecosystems that influence the creation and development of ventures from the action of the entrepreneur. At the end of the research, it is expected to achieve the results for the following specific objectives: (a) understand how the entrepreneurial ecosystem of MSEs is constituted; (b) understand how market access public policies for MSEs are designed and implemented; (c) understand SEBRAE's role in the entrepreneurship ecosystem; and (d) offer an action plan and monitor its execution up to march, 2023. The field research will be conducted based on Action Research, with a qualitative and longitudinal approach to the data. Data collection will be based on narratives produced since 2019 when the decision to implement Comércio Brasil program, a public policy focused on generating market access for 4280 MSEs yearly, was made. The narratives will be analyzed by the method of document analysis and narrative analysis. It is expected that the research will consolidate the relevance of public policies to market access for MSEs and the role of SEBRAE as a protagonist in the implementation of these public policies in the entrepreneurship ecosystem will be demonstrated. Action research is recognized as an intervention method, it is expected that this research will corroborate its role in supporting management processes.

Keywords: entrepreneurship, entrepreneurship ecosystem, public policies, SEBRAE, action research

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Authors: Nadia Arikat, Katharine Blain

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During the worst of the COVID pandemic, only essential treatment was provided for patients needing urgent care. With the prolonged extent of the pandemic, there has been a return to more routine referrals for paediatric dentistry advice and treatment for specialist conditions. However, some of these patients and/or their carers may have significant medical issues meaning that attending in-person appointments carries additional risks. This poses an ethical dilemma for clinicians. This project looks at how a secure video conferencing platform (“Near Me”) has been used to assess the need and urgency for in-person new patient visits, particularly for patients and families with additional risks. “Near Me” is a secure online video consulting service used by NHS Scotland. In deciding whether to bring a new patient to the hospital for an appointment, the clinical condition of the teeth together with the urgency for treatment need to be assessed. This is not always apparent from the referral letter. In addition, it is important to judge the risks to the patients and carers of such visits, particularly if they have medical issues. The use and effectiveness of “Near Me” consultations to help decide whether vulnerable paediatric patients should have in-person appointments will be illustrated and discussed using two families: one where the child is medically compromised (Alagille syndrome with previous liver transplant), and the other where there is a medically compromised parent (undergoing chemotherapy and a bone marrow transplant). In both cases, it was necessary to take into consideration the risks and moral implications of requesting that they attend the dental hospital during a pandemic. The option of remote consultation allowed further clinical information to be evaluated and the families take part in the decision-making process about whether and when such visits should be scheduled. These cases will demonstrate how medically compromised patients (or patients with vulnerable carers), could have their dental needs assessed in a socially distanced manner by video consultation. Together, the clinician and the patient’s family can weigh up the risks, with regards to COVID-19, of attending for in-person appointments against the benefit of having treatment. This is particularly important for new paediatric patients who have not yet had a formal assessment. The limitations of this technology will also be discussed. It is limited by internet availability, the strength of the connection, the video quality and families owning a device which allows video calls. For those from a lower socio-economic background or living in some rural areas, this may not be possible or limit its usefulness. For the two patients discussed in this project, where the urgency of their dental condition was unclear, video consultation proved beneficial in deciding an appropriate outcome and preventing unnecessary exposure of vulnerable people to a hospital environment during a pandemic, demonstrating the usefulness of such technology when it is used appropriately.

Keywords: COVID-19, paediatrics, triage, video consultations

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Authors: Stéfani T. A. Dantas, Laura T. S. Takume, Bruna F. Rossi, Érika R. Bonsaglia, Ivana G. Castilho, José C. F. Pantoja, Ary Fernandes Júnior, Juliano L. Gonçalves, Marcos V. Santos, Rinaldo A. Mota, Vera L. M. Rall

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Staphylococcus aureus is one of the main pathogens causing contagious bovine mastitis, being more frequently isolated from subclinical form, although the clinical form also occurs. Clinical mastitis cause visual signs, such as swelling, fever, hardening of the mammary gland, or any change in the characteristics of the milk. Considering the subclinical type, there are no visible signs in the animal nor changes in the milk. S. aureus has many important virulence factors for the establishment of its pathogenicity in animals, such as enterotoxins, which are also responsible for foodborne poisoning. Our objective is to perform a comparative analysis between 103 isolates of S. aureus, obtained from the milk of cows with clinical mastitis and 103 more, from subclinical type, in relation to the presence of these enterotoxins and verify if their presence plays an important role in the signs of illness. We will investigate all enterotoxins described till now, such as sea-see, seg-sez, sel26, sel 27, se01, and se02 (This study was approved by the Sao Paulo State University Animal Use Ethics Committee, No. 0136/2017). For the PCR assay, we used Illustra Bacteria Mini Spin Kit for bacterial DNA. At this moment, we have already tested sea-see, seg-ser, sew, and sex, and the results have already been submitted to Fisher Exact Probability Test or Chi-square Test. Considering the isolates obtained from clinical mastitis, the most frequent enterotoxins were selw (99%), selx (78%) and selh (50.5%), and sec, see, sej, sell, selp,and ser were absent. Among the subclinics, selw (82.5%) selm (15.5%) and selx (14.6%) were the most frequent, and sea-see, seg, sei-sel, sem-ser were absent. We have already observed statistically significant differences for seb, seg, seh, sei, selo, selu, selw and selx. Other interesting results were the low number of genes in each isolate from subclinical mastitis [0 genes: 14 (13.6%); 1 gene: 55 (53.4%); 2 genes: 33 (32%) or 3: 1 (0.97%)] compared to clinical isolates [1 gene: 5 (4.9%); 2 genes: 29 (28.1%); 3 genes: 38 (36.9%); 4 genes: 14 (13.6%); 5 genes: 5 (4.9%); 6 genes: 4 (3.9%); 7 genes: 5 (4.9%); 8 genes: 2 (1.9%) and 9 genes: 1 (1%)]. Based on these results, we can conclude that enterotoxins indeed play an important role in clinical signs in cattle with mastitis.

Keywords: mastitis, S. aureus, PCR, staphylococcal enterotoxin

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Authors: Ayat-Allah Bouramdane

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Since 2010, there have been sustained decreases in the unit costs of onshore wind energy and large increases in its deployment, varying widely across regions. In fact, the onshore wind production is affected by air density— because cold air is more dense and therefore more effective at producing wind power— and by wind speed—as wind turbines cannot operate in very low or extreme stormy winds. The wind speed is essentially affected by the surface friction or the roughness and other topographic features of the land, which slow down winds significantly over the continent. Hence, the identification of the most appropriate locations of onshore wind systems is crucial to maximize their energy output and therefore minimize their Levelized Cost of Electricity (LCOE). This study focuses on the preliminary assessment of onshore wind energy potential, in several areas in Morocco with a particular focus on the Dakhla city, by analyzing the diurnal and seasonal variability of wind speed for different hub heights, the frequency distribution of wind speed, the wind rose and the wind performance indicators such as wind power density, capacity factor, and LCOE. In addition to climate criterion, other criteria (i.e., topography, location, environment) were selected fromGeographic Referenced Information (GRI), reflecting different considerations. The impact of each criterion on the suitability map of onshore wind farms was identified using the Analytic Hierarchy Process (AHP). We find that the majority of suitable zones are located along the Atlantic Ocean and the Mediterranean Sea. We discuss the sensitivity of the onshore wind site suitability to different aspects such as the methodology—by comparing the Multi-Criteria Decision-Making (MCDM)-AHP results to the Mean-Variance Portfolio optimization framework—and the potential impact of climate change on this suitability map, and provide the final recommendations to the Moroccan energy strategy by analyzing if the actual Morocco's onshore wind installations are located within areas deemed suitable. This analysis may serve as a decision-making framework for cost-effective investment in onshore wind power in Morocco and to shape the future sustainable development of the Dakhla city.

Keywords: analytic hierarchy process (ahp), dakhla, geographic referenced information, morocco, multi-criteria decision-making, onshore wind, site suitability.

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Authors: Rosemary E. Huntriss, Lucy Jones

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Obesity and excess weight continue to be significant health problems in England. Traditional weight management programmes offer face-to-face support or group education. Remote care is recognised as a viable means of support; however, its effectiveness has not previously been evaluated in a tier 3 weight management setting. This service evaluation explored the effectiveness of online coaching, telephone support, and face-to-face support as optional management strategies within a tier 3 weight management programme. Outcome data were collected for adults with a BMI ≥ 45 or ≥ 40 with complex comorbidity who were referred to a Tier 3 weight management programme from January 2018 and had been discharged before October 2018. Following an initial 45-minute consultation with a specialist weight management dietitian, patients were offered a choice of follow-up support in the form of online coaching supported by an app (8 x 15 minutes coaching), face-to-face or telephone appointments (4 x 30 minutes). All patients were invited to a final 30-minute face-to-face assessment. The planned intervention time was between 12 and 24 weeks. Patients were offered access to adjunct face-to-face or telephone psychological support. One hundred and thirty-nine patients were referred into the programme from January 2018 and discharged before October 2018. One hundred and twenty-four patients (89%) attended their initial assessment. Out of those who attended their initial assessment, 110 patients (88.0%) completed more than half of the programme and 77 patients (61.6%) completed all sessions. The average length of the completed programme (all sessions) was 17.2 (SD 4.2) weeks. Eighty-five (68.5%) patients were coached online, 28 (22.6%) patients were supported face-to-face support, and 11 (8.9%) chose telephone support. Two patients changed from online coaching to face-to-face support due to personal preference and were included in the face-to-face group for analysis. For those with data available (n=106), average weight loss across the programme was 4.85 (SD 3.49)%; average weight loss was 4.70 (SD 3.19)% for online coaching, 4.83 (SD 4.13)% for face-to-face support, and 6.28 (SD 4.15)% for telephone support. There was no significant difference between weight loss achieved with face-to-face vs. online coaching (4.83 (SD 4.13)% vs 4.70 (SD 3.19) (p=0.87) or face-to-face vs. remote support (online coaching and telephone support combined) (4.83 (SD 4.13)% vs 4.85 (SD 3.30)%) (p=0.98). Remote support has been shown to be as effective as face-to-face support provided by a dietitian in the short-term within a tier 3 weight management setting. The completion rates were high compared with another tier 3 weight management services suggesting that offering remote support as an option may improve completion rates within a weight management service.

Keywords: dietitian, digital health, obesity, weight management

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Authors: Gianluca Castelnuovo, Gian Mauro Manzoni, Giada Pietrabissa, Stefania Corti, Emanuele Giusti, Roberto Cattivelli, Enrico Molinari, Susan Simpson

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Obesity is currently an important public health problem of epidemic proportions (globesity). Moreover Binge Eating Disorder (BED) is typically connected with obesity, even if not occurring exclusively in conjunction with overweight conditions. Typically obesity with BED requires a longer term treatment in comparison with simple obesity. Rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation, due to the growing costs of a limited inpatient approach. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach. The new m health (m-health, mobile health) paradigm, defined as clinical practices supported by up to date mobile communication devices, could increase compliance- engagement and contribute to a significant cost reduction in BED and obesity rehabilitation. Five psychological components need to be considered for successful m Health-based obesity rehabilitation in order to facilitate weight-loss.1) Self-monitoring. Portable body monitors, pedometers and smartphones are mobile and, therefore, can be easily used, resulting in continuous self-monitoring. 2) Counselor feedback and communication. A functional approach is to provide online weight-loss interventions with brief weekly or monthly counselor or psychologist visits. 3) Social support. A group treatment format is typically preferred for behavioral weight-loss interventions. 4) Structured program. Technology-based weight-loss programs incorporate principles of behavior therapy and change with structured weekly protocolos including nutrition, exercise, stimulus control, self-regulation strategies, goal-setting. 5) Individually tailored program. Interventions specifically designed around individual’s goals typically record higher rates of adherence and weight loss. Opportunities and limitations of m health approach in clinical psychology for obesity and BED are discussed, taking into account future research directions in this promising area.

Keywords: obesity, rehabilitation, out-patient, new technologies, tele medicine, tele care, m health, clinical psychology, psychotherapy, chronic care management

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Authors: Emily J. Winnall

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It is understood that China has the largest population of people living with dementia in the world; however, little is known about this culturally diverse community, specifically the Chinese Communities, which has been poorly represented in past British research Literature. Further research is needed to gain a greater understanding of the support needs of caregivers caring for a relative living with dementia from the Chinese background. Dementia care and caregivers in Chinese communities are less investigated. The study is a case study of two Chinese community centers and one housing support service. Semi-structured one-to-one interviews and a pilot questionnaire were used as the methods for the study. A toolkit will also be created as a document that provides guidance and signposting to health and social care services for Chinese communities. The findings identified three main themes. Caregivers do not receive any formal support from the UK health and social services, and they felt they would have benefited from getting advice on what support they could access. Furthermore, the data also identified that Chinese organisations do not have the knowledge of dementia, to be able to support those living with dementia and their families. Also, people living with dementia and their families rarely present to Chinese organisations and UK health and social care services, meaning they are not receiving the support they are entitled to or need. Additionally, the community center would like to see workshops/courses around dementia for people from Chinese backgrounds. The study concludes that people from Chinese cultural backgrounds do not have sufficient access to support from UK health and social care services. More information needs to be published that will benefit Chinese communities.

Keywords: Chinese, Chinese organisations, Dementia, family caregivers, social care

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Authors: Aamna Tufail, Kajal Kotecha, Iordanis Toursounidis, Ravinder Pabla

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Introduction/Aims: Acute Myeloid Leukaemia (AML) is a part of leukaemic group of hematopoietic disorders with a varying range of presentations, including oro-facial manifestations. Early recognition and management are essential for favourable outcomes. Materials and Methods: We present our experience, clinical presentation, and clinical photographs of a patient with previously undiagnosed AML who presented with oral symptoms to the emergency department of our hospital. An analysis of clinical characteristics, diagnostic investigations, and management modalities was performed. Results/Statistics: A 58-year-old man presented to A&E reporting an 11-day history of right sided facial swelling, acute TMJ symptoms, and oral discomfort. A dentist ruled out acute dental causes one day post onset of symptoms. Initial assessment was anatomically inconsistent and did not reveal a routine oral or maxillofacial etiology. Detailed clinical examination demonstrated fever, generalised pallor, swelling and erythema of right nasolabial region, bilateral masseteric tenderness, intraoral palatal ecchymosis, palatal ulceration, buccal and labial petechiae, cervical lymphadenopathy, and haematoma on dorsum of right hand overlying right 2nd metacarpal joint. Suspecting a systemic medical cause, we requested haematological investigations, which revealed neutropenia, thrombocytopenia, and anaemia. Flow cytometry confirmed CD34 + AML. Oral discomfort was managed symptomatically. The patient was referred to a tertiary care centre for acute haematologic care, where he was treated with IV antibiotics and continuing cycles of chemotherapy. Conclusions/Clinical Relevance: Oro-facial manifestations may be the first clinical sign of AML. Awareness of its features is vital in early diagnosis. In this context, dentists and oral medicine specialists can play an important role in detecting clinical signs of haematological disorders such as AML.

Keywords: acute myeloid leukaemia, oral symptoms, ulceration, diagnosis, management

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Authors: Ridoy Das, Myriam Neaimeh, Yue Wang, Ghanim Putrus

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Electric vehicles are a popular transportation medium renowned for potential environmental benefits. However, large and uncontrolled charging volumes can impact distribution networks negatively. Smart charging is widely recognized as an efficient solution to achieve both improved renewable energy integration and grid relief. Nevertheless, different decision-makers may pursue diverse and conflicting objectives. In this context, this paper proposes a multi-objective optimization framework to control electric vehicle charging to achieve both energy cost reduction and peak shaving. A weighted-sum method is developed due to its intuitiveness and efficiency. Monte Carlo simulations are implemented to investigate the impact of uncertain electric vehicle driving patterns and provide decision-makers with a robust outcome in terms of prospective cost and network loading. The results demonstrate that there is a conflict between energy cost efficiency and peak shaving, with the decision-makers needing to make a collaborative decision.

Keywords: electric vehicles, multi-objective optimization, uncertainty, mixed integer linear programming

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Authors: O. Badagadze, G. Sirbiladze, I. Khutsishvili

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The work proposes a decision support methodology for the credit risk minimization in selection of investment projects. The methodology provides two stages of projects’ evaluation. Preliminary selection of projects with minor credit risks is made using the Expertons Method. The second stage makes ranking of chosen projects using the Possibilistic Discrimination Analysis Method. The latter is a new modification of a well-known Method of Fuzzy Discrimination Analysis.

Keywords: expert valuations, expertons, investment project risks, positive and negative discriminations, possibility distribution

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Authors: Julianne Mullen-Williams

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This paper will provide an overview of a three year mixed methods research project that explores if methods from the supervision of dramatherapy can augment the occupational psychology of newly qualified secondary school teachers. It will consider how creativity and the use of metaphor, as applied in the supervision of dramatherapists, can be translated to an educational context in order to explore the explicit / implicit dynamics between the teacher trainee/ newly qualified teacher and the organisation in order to support the super objective in training for teaching; how to ‘be a teacher.’ There is growing evidence that attrition rates among teachers are rising after only five years of service owing to too many national initiatives, an unmanageable curriculum and deteriorating student discipline. The fieldwork conducted entailed facilitating a reflective space for Newly Qualified Teachers from all subject areas, using methods from the supervision of dramatherapy, to explore the social and emotional aspects of teaching and learning with the ultimate aim of improving the occupational psychology of teachers. Clinical supervision is a formal process of professional support and learning which permits individual practitioners in frontline service jobs; counsellors, psychologists, dramatherapists, social workers and nurses to expand their knowledge and proficiency, take responsibility for their own practice, and improve client protection and safety of care in complex clinical situations. It is deemed integral to continued professional practice to safeguard vulnerable people and to reduce practitioner burnout. Dramatherapy supervision incorporates all of the above but utilises creative methods as a tool to gain insight and a deeper understanding of the situation. Creativity and the use of metaphor enable the supervisee to gain an aerial view of the situation they are exploring. The word metaphor in Greek means to ‘carry across’ indicating a transfer of meaning form one frame of reference to another. The supervision support was incorporated into each group’s induction training programme. The first year group attended fortnightly one hour sessions, the second group received two one hour sessions every term. The existing literature on the supervision and mentoring of secondary school teacher trainees calls for changes in pre-service teacher education and in the induction period. There is a particular emphasis on the need to include reflective and experiential learning, within training programmes and within the induction period, in order to help teachers manage the interpersonal dynamics and emotional impact within a high pressurised environment

Keywords: dramatherapy supervision, newly qualified secondary school teachers, professional development, teacher education

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Authors: Tayaba Dastgeer, Farhan Rasheed, Muhammad Saeed, Maqsood Ahmad, Zia Ashraf, Abdul Waheed, Muhammad Kamran, Mohsin Khurshid

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Objectives: The study aimed to determine the efficacy of linezolid against clinical isolates of methicillin-resistant staphylococcus aureus (MRSA). Methodology: This cross-sectional study was conducted in the microbiology department of Allama Iqbal Medical College Lahore from August 2017 to September 2019. Isolates were confirmed as MRSA via the presence of the mec-A gene. Confirmed MRSA isolates were processed for susceptibility testing against different antimicrobials, especially linezolid, via the disc diffusion method. Zone sizes were interpreted according to CLSI guidelines. Results: Various types of clinical samples were included in the study; however, the highest frequency of MRSA isolates was found in pus samples, followed by other clinical samples. Among hospitalized patients, most MRSA isolates were obtained from patients in the surgical ward. Of 243 mec-A gene detected isolates, Vancomycin and linezolid showed 100% susceptibility, chloramphenicol showed declining resistance 78 (32.09%), and emerging sensitivity 165 (67.90%) against MRSA. Conclusion: Linezolid is a very efficient drug against MRSA, but the use of this novel drug must be conserved for vancomycin-resistant Staphylococcus aureus or when more resistant pathogens are suspected.

Keywords: MRSA, chloramphenicol, linezolid, nosocomial infections

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Authors: Liaquat Ali, Khurshid Natasha

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Low resource countries are not usually equipped with the organizational tools to implement health care for chronic diseases, and thus, providing effective diabetes care in such countries is a challenging task. Diabetic Association of Bangladesh (BADAS in Bengali acronym) has created a stimulating example to meet this challenge. Starting its journey in 1956 with 39 patients in a small tin shed clinic BADAS, and its affiliated associations now operate 90 hospitals and health centres all over the country. Together, these facilities provide integrated health care to about 1.5 million registered diabetic patients which constitute about 20% of the estimated diabetic population in the country. BADAS has also become a pioneer in health manpower generation in Bangladesh. Along with its affiliates, it now runs 3 Medical Colleges (to generate graduate physicians), 2 Nursing Institutes, and 2 Postgraduate Institutes which conduct 25 postgraduate courses (under the University of Dhaka) in various basic, clinical and public health disciplines. BADAS gives great emphasis on research, which encompasses basic, clinical as well as public health areas. BADAS is an ideal example of public-private partnership in health as most of its infrastructure has been created through government support but it is almost self-reliant in managing its revenue budget which approached approximately 40 million US dollar during 2010. BADAS raises resources by providing high-quality services to the people, both diabetic and non-diabetic. At the same time, BADAS has developed a cross financing model, to support diabetic patients in general and poor diabetic patients (identified through a social welfare network) in particular, through redistribution of the resources. Along with financial sustainability BADAS ensure organizational sustainability through a process of decentralization, community ownership, and democratic management. Presently a large scale pilot project (named as a Health Care Development Project or HCDP) is under implementation under BADAS umbrella with an objective to transform the diabetes care model to a health care model in general. It is expected to create further evidence on providing sustainable (with social safety net) health care delivery for diabetes, and other chronic illnesses as an integral part of general health care delivery in a resource constrained setting.

Keywords: Bangladesh, self sustain, health care, constrain

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Authors: Ilma Robo, Manola Kelmendi, Kleves Elezi, Nevila Alliu

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The most important stage in deciding whether to re-treat or not endodontically is to find the reason for the clinical in-success. Therefore, endodontic re-treatment aims to eliminate the etiology of the pathology, where the main ones are the bacteria remaining in the inter-radicular spaces or the presence of other irritants that can be not only bacterial toxins but also the elements that keep the batteries fixed or extra-canal toxins such as extraction outside the apex of the canal filling. Shortcomings of endodontic treatment can be corrected, if possible, only with endodontic re-treatment that is initially attempted orthograde, and if clinical endodontic success is not achieved again, it can be performed retrograde or surgically. The elements that do not help in this direction are the anatomical deformations in the canal network of the tooth roots, in the presence of the delta at the apex of the tooth root, in the isthmuses present, all of which can be explained by the endodontic canal anatomical morphology. Actually, even if the causative endodontic bacteria remains isolated and without an exit in the healthy periodontal tissues, then this can also be a clinical endodontic success, regardless of the fact that the endodontic isolation occurred only in the exits such as the apex or the accessory canals. Clinical endodontic in-success occurs only when bacterial residues emerge or provide an exit in the healthy periradicular tissues or along the entire length of the canal where the accessory canals exit.

Keywords: endodontic success, E. foecalis, nanoparticles, laser diode, antibacterial, antiseptic

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Authors: Edward Nartey

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Although sustainability management control (SMC) systems provide information that enhances corporate sustainability decisions, reviews on the SMC implications for sustainable supply chains (SCs) demonstrate a wide research gap, particularly the sustainability performance of healthcare SCs in unusual times. This study provides preliminary empirical evidence on the level of SMC adoption and the decision-making implications for the Tripple Bottom Line (TBL) principles of SC sustainability of Ghanaian public healthcare institutions (PHIs). Using a sample of 226 public health managers, the results show that sustainable formal control has a positive and significant impact on economic sustainability but an insignificant effect on social and environmental sustainability. In addition, a positive relationship was established between informal controls and economic and environmental sustainability but an insignificant relationship with social sustainability. Although the findings highlight the prevalence of the SMC system being prioritized over regular MCS in crisis situations, the MCSs are inadequate in promoting PHIs' sustainable behaviours in SCs. It also provides little empirical evidence on the effective enhancement of the TBL principle of SC sustainability perhaps because the SMC is in misalignment with the TBL principle in crisis situations. Thus, in crisis situations, PHIs need to redesign their MCSs to support the integration of sustainability issues in SCs.

Keywords: sustainability management control, informal control, formal control, sustainable supply chain performance

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Authors: Clemens Bulitta, Sasan Sadrizadeh, Sebastian Buhl

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Introduction: Ventilation technology in operating theatres (OT)is internationally regulated by dif-ferent standards, which define basic specifications for technical equipment and many times also the necessary operating and performance parameters. This confronts the operators of healthcare facilities with the question of finding the best ventilation and air conditioning system for the OT in order to achieve the goal of a large and robust surgicalworkzone with appropriate air quality and climate for patient safety and occupational health. Additionally, energy consumption and the potential need for clothing that limits transmission of bacteria must be considered as well as the total life cycle cost. However, the evaluation methodology of ventilation systems regarding these matters are still a topic of discussion. To date, there are neither any uniform standardized specifications nor any common validation criteria established. Thus, this study aimed to review data in the literature and add ourown research results to compare and assess the performance of different ventilations systems regarding infection preventive effects, energy efficiency, and staff comfort. Methods: We have conducted a comprehensive literature review on OT ventilation-related topics to understand the strengths and limitations of different ventilation systems. Furthermore, data from experimental assessments on OT ventilation systems at the University of Amberg-Weidenin Germany were in-cluded to comparatively assess the performance of Laminar Airflow (LAF), Turbulent Mixing Air-flow(TMA), and Temperature-controlled Airflow (TcAF) with regards to patient and occupational safety as well as staff comfort including indoor climate.CFD simulations from the Royal Institute of Technology in Sweden (KTH) were also studied to visualize the differences between these three kinds of ventilation systems in terms of the size of the surgical workzone, resilience to obstacles in the airflow, and energy use. Results: A variety of ventilation concepts are in use in the OT today. Each has its advantages and disadvantages, and thus one may be better suited than another depend-ing on the built environment and clinical workflow. Moreover, the proper functioning of OT venti-lation is also affected by multiple external and internal interfering factors. Based on the available data TcAF and LAF seem to provide the greatest effects regarding infection control and minimizing airborne risks for surgical site infections without the need for very tight surgical clothing systems. Resilience to obstacles, staff comfort, and energy efficiency seem to be favourable with TcAF. Conclusion: Based on literature data in current publications and our studies at the Technical Uni-versity of Applied Sciences Amberg-Weidenand the Royal Institute of Technoclogy, LAF and TcAF are more suitable for minimizing the risk for surgical site infections leading to improved clin-ical outcomes. Nevertheless, regarding the best management of thermal loads, atmosphere, energy efficiency, and occupational safety, overall results and data suggest that TcAF systems could pro-vide the economically most efficient and clinically most effective solution under routine clinical conditions.

Keywords: ventilation systems, infection control, energy efficiency, operating theatre, airborne infection risks

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Authors: Walailak Atthirawong

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By the end of 2015, the Association of Southeast Asian Nations (ASEAN) countries proclaim to transform into the next stage of an economic era by having a single market and production base called ASEAN Economic Community (AEC). One objective of the AEC is to establish ASEAN as a single market and one production base making ASEAN highly competitive economic region and competitive with new mechanisms. As a result, it will open more opportunities to enterprises in both trade and investment, which offering a competitive market of US$ 2.6 trillion and over 622 million people. Location decision plays a key role in achieving corporate competitiveness. Hence, it may be necessary for enterprises to redesign their supply chains via enlarging a new production base which has low labor cost, high labor skill and numerous of labor available. This strategy will help companies especially for apparel industry in order to maintain a competitive position in the global market. Therefore, in this paper a generic model for location selection decision for Thai apparel industry using Fuzzy Analytical Network Process (FANP) is proposed. Myanmar, Vietnam and Cambodia are referred for alternative location decision from interviewing expert persons in this industry who have planned to enlarge their businesses in AEC countries. The contribution of this paper lies in proposing an approach model that is more practical and trustworthy to top management in making a decision on location selection.

Keywords: apparel industry, ASEAN Economic Community (AEC), Fuzzy Analytical Network Process (FANP), location decision

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Authors: Aakriti Lohiya

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Sigmund Freud’s clinical theories were deeply influenced by his childhood and his environment before his exile in England. In this article, the author illuminates his different works and the metaphors in them. The clinical relevance of Freud’s theories is much disputed and chatted but rarely has any psychoanalytic writing touched upon the way in which his theories are linked with life experiences. Exploring the metaphors in Freud’s theories will take us into the uncharted paths of how the experience of life events meets experience in the clinic. A sincere and critical reflection of the ideas proposed by Freud would certainly help us to locate its unfamiliar stages. Many of his theories and ideas attempted to create contact with his early childhood experiences. Freud was Jewish by birth but atheist by nature, which was reflected in many of his theories. The ways in which Freud theorizes the psychosexual development of a being and many of his mammoth theories are elucidated in this study. On the other hand, some of his ideas remain a challenge, which requires remembering, restating, and functioning through the clinical and mystical elements in his writing.

Keywords: sigmund freud, exile, psychoanalytic theory, metaphor, psychosexual theory

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Authors: Andrey V. Timofeev

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The practical efficient approach is suggested to estimate the high-speed objects instant bounds in C-OTDR monitoring systems. In case of super-dynamic objects (trains, cars) is difficult to obtain the adequate estimate of the instantaneous object localization because of estimation lag. In other words, reliable estimation coordinates of monitored object requires taking some time for data observation collection by means of C-OTDR system, and only if the required sample volume will be collected the final decision could be issued. But it is contrary to requirements of many real applications. For example, in rail traffic management systems we need to get data off the dynamic objects localization in real time. The way to solve this problem is to use the set of statistical independent parameters of C-OTDR signals for obtaining the most reliable solution in real time. The parameters of this type we can call as 'signaling parameters' (SP). There are several the SP’s which carry information about dynamic objects instant localization for each of C-OTDR channels. The problem is that some of these parameters are very sensitive to dynamics of seismoacoustic emission sources but are non-stable. On the other hand, in case the SP is very stable it becomes insensitive as a rule. This report contains describing the method for SP’s co-processing which is designed to get the most effective dynamic objects localization estimates in the C-OTDR monitoring system framework.

Keywords: C-OTDR-system, co-processing of signaling parameters, high-speed objects localization, multichannel monitoring systems

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Authors: T. H. Bitebe, T. M. Lima, F. Charrua-Santos, C. J. Matias Oliveira

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This study aims to present a proposal for an economic integration model for the development of the manufacturing industry in Cabinda, Angola. It seeks to analyze the degree of economic integration of Cabinda and the dynamics of the manufacturing industry. Therefore, in the same way, to gather information to support the decision-making for public financing programs that will aim at the disengagement of the manufacturing industry in Angola and Cabinda in particular. The Cabinda Province is the 18^th of Angola, the enclave is located in a privileged area of the African and arable land.

Keywords: economic integration, industrial development, Cabinda industry, Angola

Procedia PDF Downloads 236

Authors: Yuen Man Yan

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Peer support has been a rising prevalent mental health service in the globe. The community-based mental health services employ persons with lived experience of mental illness to be peer support workers (PSWs) to provide peer support service to those who are in the progress of recovery (PIRs). It represents the transformation of mental health service system to a recovery-oriented and person-centered care. Literatures proved the feasibility and effectiveness of the peer support service. Researchers have attempted to explore the unique good qualities of peer support service that benefit the PIRs. Empirical researches found that the strength of the relationship between those who sought for change and the change agents positively related to the outcomes in one-to-one therapies across theoretical orientations. However, there is lack of literature on investigating the relationship building between the PSWs and PIRs in the one-to-one community-based peer support service. This study aims to identify and characterise the relationship in the community-based one-to-one peer support service from the perspectives of PSWs and PIRs; and to conceptualize the components of relationship building between PSWs and PIRs in the community-based one-to-one peer support service. The study adopted the constructivist grounded theory approach. 10 pairs of the PSWs and PIRs participated in the study. Data were collected through multiple qualitative methods, including observation of the interaction and exchange of the PSWs and PIRs in the 1ₛₜ, 3ᵣ𝒹 and 9th sessions of the community-based one-to-one peer support service; and semi-structural interview with the PSWs and PIRs separately after the 3ᵣ𝒹and 9ₜₕ session of the peer support service. This presentation is going to report the preliminary findings of the study. PSWs and PIRs identified their relationship as “life alliance”. Empathy was found to be one of key components of the relationship between the PSWs and the PIRs. Unlike the empathy, as explained by Carl Roger, in which the service provider was able to put themselves into the shoes of the service recipients as if he was the service recipients, the intensity of the empathy was much greater in the relationship between PSWs and PIRs because PSWs had the lived experience of mental illness and recovery. The dimensions of the empathy in the relationship between PSWs and PIRs was found to be multiple, not only related to the mental illness but also related to various aspects in life, like family relationship, employment, interest of life, self-esteem and etc.

Keywords: person with lived experience, peer support worker, peer support service, relationship building, therapeutic alliance, community-based mental health setting

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Authors: H. Booke, R. Nordmeier

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Sudden cardiac arrest is sometimes eye-witnessed by kids. Mostly, their (grand-)parents are affected by sudden cardiac arrest, putting these kids under enormous psychological pressure: Although they are more than desperate to help, they feel insecure and helpless and are afraid of causing harm rather than realizing their chance to help. Even years later, they may blame themselves for not having helped their beloved ones. However, the absolute majority of school children - at least in Germany - is not educated to provide first aid. Teaching young kids (5th grade) in basic life support thus may help to save lives while washing away the kids' fear from causing harm during cardio-pulmonary resuscitation. A teaching of circulatory and respiratory (patho-)physiology, followed by hands-on training of basic life support for every single child, was offered to each school in our district. The teaching was performed by anesthesiologists, and the program was called 'kids can save lives'. However, before enrollment in this program, the entire class must have had lessons in biology with a special focus on heart and circulation as well as lung and gas exchange. More than 1.000 kids were taught and trained in basic life support, giving them the knowledge and skills to provide basic life support. This may help to reduce the rate of failure to provide first aid. Therefore, educating young kids in basic life support may not only help to save lives, but it also may help to prevent any feelings of guilt because of not having helped in cases of eye-witnessed sudden cardiac arrest.

Keywords: teaching, children, basic life support, cardiac arrest, CPR

Procedia PDF Downloads 134

Authors: Amine Ben Slama, Aymen Mouelhi, Sondes Manoubi, Chiraz Mbarek, Hedi Trabelsi, Mounir Sayadi, Farhat Fnaiech

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Vertigo is a sensation of feeling off balance; the cause of this symptom is very difficult to interpret and needs a complementary exam. Generally, vertigo is caused by an ear problem. Some of the most common causes include: benign paroxysmal positional vertigo (BPPV), Meniere's disease and vestibular neuritis (VN). In clinical practice, different tests of videonystagmographic (VNG) technique are used to detect the presence of vestibular neuritis (VN). The topographical diagnosis of this disease presents a large diversity in its characteristics that confirm a mixture of problems for usual etiological analysis methods. In this study, a vestibular neuritis analysis method is proposed with videonystagmography (VNG) applications using an estimation of pupil movements in the case of an uncontrolled motion to obtain an efficient and reliable diagnosis results. First, an estimation of the pupil displacement vectors using with Hough Transform (HT) is performed to approximate the location of pupil region. Then, temporal and frequency features are computed from the rotation angle variation of the pupil motion. Finally, optimized features are selected using Fisher criterion evaluation for discrimination and classification of the VN disease.Experimental results are analyzed using two categories: normal and pathologic. By classifying the reduced features using the Support Vector Machine (SVM), 94% is achieved as classification accuracy. Compared to recent studies, the proposed expert system is extremely helpful and highly effective to resolve the problem of VNG analysis and provide an accurate diagnostic for medical devices.

Keywords: nystagmus, vestibular neuritis, videonystagmographic system, VNG, Fisher criterion, support vector machine, SVM

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Authors: Constanza Monterrubio-Solis, Jose Tomas Ibarra

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The fertile interdependence of social-ecological systems reveals itself in the interactions between native forests and seeds, home gardens, kitchens, foraging activities, local knowledge, and food practices, creating particular flavors and food meanings as part of cultural identities within territories. Resilience in local-food systems, from a relational perspective, can be understood as the balance between persistence and adaptability to change. Food growing, preparation, and consumption are constantly changing and adapting as expressions of agency of female and male indigenous peoples and peasants. This paper explores local food systems’ expressions of resilience in the la Araucanía region of Chile, namely: diversity, redundancy, buffer capacity, modularity, self-organization, governance, learning, equity, and decision-making. Applying ethnographic research methods (participant observation, focus groups, and semi-structured interviews), this work reflects on the experience developed through work with Mapuche women cultivating home gardens in the region since 2012; it looks to material and symbolic elements of resilience in the local indigenous food systems. Local food systems show indeed indicators of social-ecological resilience. The biocultural memory is expressed in affection to particular flavors and recipes, the cultural importance of seeds and reciprocity networks, as well as an accurate knowledge about the indicators of the seasons and weather, which have allowed local food systems to thrive with a strong cultural foundation. Furthermore, these elements turn into biocultural resistance in the face of the current institutional pressures for rural specialization, processes of cultural assimilation such as agroecosystems and diet homogenization, as well as structural threats towards the diversity and freedom of native seeds. Thus, the resilience-resistance dynamic shown by the social-ecological systems of the southern Andes is daily expressed in the local food systems and flavors and is key for diverse and culturally sound social-ecological health.

Keywords: biocultural heritage, indigenous food systems, social-ecological resilience, southern Andes

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Authors: Anita Lazurko, Laszlo Pinter, Jeremy Richardson

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Uncertain climate projections, multiple possible development futures, and a financing gap create challenges for water infrastructure decision making. In contrast to conventional predict-plan-act methods, an emerging decision paradigm that enables social-ecological resilience supports decisions that are appropriate for uncertainty and leverage social, ecological, and economic multifunctionality. Concurrently, water infrastructure project finance plays a powerful role in sustainable infrastructure development but remains disconnected from discourse in socio-ecological resilience. At the time of research, a project to transfer water from Lesotho to Botswana through South Africa in the Orange-Senqu River Basin was at the pre-feasibility stage. This case was analysed through documents and interviews to investigate how uncertainty and multifunctionality are conceptualised and considered in decisions for the resilience of water infrastructure and to explore bridging concepts that might allow project finance to better enable socio-ecological resilience. Interviewees conceptualised uncertainty as risk, ambiguity and ignorance, and multifunctionality as politically-motivated shared benefits. Numerous efforts to adopt emerging decision methods that consider these terms were in use but required compromises to accommodate the persistent, conventional decision paradigm, though a range of future opportunities was identified. Bridging these findings to finance revealed opportunities to consider a more comprehensive scope of risk, to leverage risk mitigation measures, to diffuse risks and benefits over space, time and to diverse actor groups, and to clarify roles to achieve multiple objectives for resilience. In addition to insights into how multiple decision paradigms interact in real-world decision contexts, the research highlights untapped potential at the juncture between socio-ecological resilience and project finance.

Keywords: socio-ecological resilience, finance, multifunctionality, uncertainty

Procedia PDF Downloads 127

Authors: Nayera E. Hassan, Sahar A. El-Masry, Rokia El-Banna, Mohamed S. El Hussieny

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There are several different modalities for treatment of obesity. Common intervention methods for obesity include low-calorie diet, exercise. Also acupuncture has shown good therapeutic results in the treatment of obesity. A recent clinical observation showed that laser acupuncture could reduce body weight and body mass index in obese persons. So, the aim of this research is focused on body composition changes as related to type of intervention, before and after intentional weight loss in overweight and obesity. 76 subjects were included in the study analysis. The present study recommended that every obese female must do lipid profile and fasting blood sugar analysis before weight-loss intervention to take the decision of which method should be used.

Keywords: obesity, weight-loss, body composition, modalities

Procedia PDF Downloads 489

Authors: Malik Abdul Jabbar Zen, Wiwik Misaco Yuniarti, Azisya Amalia Karimasari, Novita Priandini

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Zoonos is as an infectiontransmitted froma nimals to human sand vice versa currently having increased in the last 20 years. The experts/scientists predict that zoonosis will be a threat to the community in the future since it leads on 70% emerging infectious diseases (EID) and the high mortality of 50%-90%. The zoonosis’ spread from animal to human is caused by contaminated food known as foodborne disease. One World One Health, as the conceptual prevention toward zoonosis, requires the crossed disciplines cooperation to accelerate and streamlinethe handling ofanimal-based disease. E-Vet Smart Rapid System is an integrated innovation in the veterinary expertise application is able to facilitate the prevention, treatment, and educationagainst pandemic diseases and zoonosis. This system is constructed by Decision Support System (DSS) method provides a database of knowledge that is expected to facilitate the identification of disease rapidly, precisely, and accurately as well as to identify the deduction. The testingis conducted through a black box test case and questionnaire (N=30) by validity and reliability approach. Based on the black box test case reveals that E-Vet Rapid System is able to deliver the results in accordance with system design, and questionnaire shows that this system is valid (r > 0.361) and has a reliability (α > 0.3610).

Keywords: diagnosis, disease, expert systems, livestock, zoonosis

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Authors: Nieto Bernal Wilson, Carmona Suarez Edgar

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The organizations have structured and unstructured information in different formats, sources, and systems. Part of these come from ERP under OLTP processing that support the information system, however these organizations in OLAP processing level, presented some deficiencies, part of this problematic lies in that does not exist interesting into extract knowledge from their data sources, as also the absence of operational capabilities to tackle with these kind of projects.  Data Warehouse and its applications are considered as non-proprietary tools, which are of great interest to business intelligence, since they are repositories basis for creating models or patterns (behavior of customers, suppliers, products, social networks and genomics) and facilitate corporate decision making and research. The following paper present a structured methodology, simple, inspired from the agile development models as Scrum, XP and AUP. Also the models object relational, spatial data models, and the base line of data modeling under UML and Big data, from this way sought to deliver an agile methodology for the developing of data warehouses, simple and of easy application. The methodology naturally take into account the application of process for the respectively information analysis, visualization and data mining, particularly for patterns generation and derived models from the objects facts structured.

Keywords: data warehouse, model data, big data, object fact, object relational fact, process developed data warehouse

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Authors: Nivedita Paul

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The changing character of marriage be it arranged marriage, love marriage, polygamy, informal unions, all signify different gender relations in everyday lives. Marriages in India are part and parcel of the kinship and cultural practices. Arranged marriage is still the dominant form of marriage where spouse selection is the initiative and decision of the parents; but its form is changing, as women are now actively participating in spouse selection but with parental consent. Spouse selection related decision making is important because marriage as an institution brings social change and gender inequality; especially in a women’s life as marriages in India are mostly patrilocal. Moreover, the amount of say in spouse selection can affect a woman’s reproductive rights, domestic violence issues, household resource allocation, communication possibilities with the spouse/husband, marital life, etc. The present study uses data from Indian Human Development Survey II (2011-12) which is a nationally representative multitopic survey that covers 41,554 households. Currently, married women of age group 15-49 in their first marriage; whose year of marriage is from 1970s to 2000s have been taken for the study. Based on spouse selection experiences, the sample of women has been divided into three marriage categories-self, semi and family arranged. Women in self arranged or love marriage is the sole decision maker in choosing the partner, in semi arranged marriage or arranged marriage with consent both parents and women together take the decision, whereas in family arranged or arranged marriage without consent only parents take the decision. The main aim of the study is to find the relationship between spouse selection experiences and women’s autonomy in India. Decision making in economic matters, child and health related decision making, mobility and access to resources are taken to be proxies of autonomy. Method of ordinal regression has been used to find the relationship between spouse selection experiences and autonomy after marriage keeping other independent variables as control factors. Results show that women in semi arranged marriage have more decision making power regarding financial matters of the household, health related matters, mobility and accessibility to resources, when compared to women in family, arranged marriages. For freedom of movement and access to resources women in self arranged marriage have the highest say or exercise greatest power. Therefore, greater participation of women (even though not absolute control) in spouse selection may lead to greater autonomy after marriage.

Keywords: arranged marriage, autonomy, consent, spouse selection

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Authors: Berna Eren Tokgoz, Mahdi Safa, Seokyon Hwang

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Power distribution systems are essential and crucial infrastructures for the development and maintenance of a sustainable society. These systems are extremely vulnerable to various types of natural and man-made disasters. The assessment of resilience focuses on preparedness and mitigation actions under pre-disaster conditions. It also concentrates on response and recovery actions under post-disaster situations. The aim of this study is to present a methodology to assess the resilience of electric power distribution poles against wind-related events. The proposed methodology can improve the accuracy and rapidity of the evaluation of the conditions and the assessment of the resilience of poles. The methodology provides a metric for the evaluation of the resilience of poles under pre-disaster and post-disaster conditions. The metric was developed using mathematical expressions for physical forces that involve various variables, such as physical dimensions of the pole, the inclination of the pole, and wind speed. A three-dimensional imaging technology (photogrammetry) was used to determine the inclination of poles. Based on expert opinion, the proposed metric was used to define zones to visualize resilience. Visual representation of resilience is helpful for decision makers to prioritize their resources before and after experiencing a wind-related disaster. Multiple electric poles in the City of Beaumont, TX were used in a case study to evaluate the proposed methodology.  

Keywords: photogrammetry, power distribution systems, resilience metric, system resilience, wind-related disasters

Procedia PDF Downloads 221