Search results for: long-term care cost

Authors: Maya Arlini Puspasari, Shafira Karamina Alifah, Hardianto Iridiastadi

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High mental workload can lead to fatigue and further result in decreased concentration and work performance. This study is conducted to see the effects of mental workload towards mental fatigue. Mental fatigue measurement was conducted at the first and the last 10 minutes of the working time using electroencephalogram, while mental workload measurement was conducted after the work is completed using the NASA-TLX questionnaire. The result shows that there is an increase in alpha band which indicates an increase in mental fatigue. This study also shows absolute alpha is more sensitive compared to the relative alpha. This study proves that there is a relationship between mental workload and mental fatigue although not relatively strong.

Keywords: mental workload, electroencephalogram, customer care agents, NASA-TLX

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Authors: Dimitrios Ntardas, Alexandros Tzanetos, Georgios Dounias

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High Voltage Substations (HVS) are the intermediate step between production of power and successfully transmitting it to clients, making them one of the most important checkpoints in power grids. Nowadays - renewable resources and consequently distributed generation are growing fast, the construction of HVS is of high importance both in terms of quality and time completion so that new energy producers can quickly and safely intergrade in power grids. The resources needed, such as machines and workers, should be carefully allocated so that the construction of a HVS is completed on time, with the lowest possible cost (e.g. not spending additional cost that were not taken into consideration, because of project delays), but in the highest quality. In addition, there are milestones and several checkpoints to be precisely achieved during construction to ensure the cost and timeline control and to ensure that the percentage of governmental funding will be granted. The management of such a demanding project is a NP-hard problem that consists of prerequisite constraints and resource limits for each task of the project. In this work, a hybrid meta-heuristic method is implemented to solve this problem. Meta-heuristics have been proven to be quite useful when dealing with high-dimensional constraint optimization problems. Hybridization of them results in boost of their performance.

Keywords: hybrid meta-heuristic methods, substation construction, resource allocation, time-cost efficiency

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Authors: Stephan Printz, Kristina Lahl, René Vossen, Sabina Jeschke

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Strategic investment decisions are characterized by high innovation potential and long-term effects on the competitiveness of enterprises. Due to the uncertainty and risks involved in this complex decision making process, the need arises for well-structured support activities. A method that considers cost and the long-term added value is the cost-benefit effectiveness estimation. One of those methods is the “profitability estimation focused on benefits – PEFB”-method developed at the Institute of Management Cybernetics at RWTH Aachen University. The method copes with the challenges associated with strategic investment decisions by integrating long-term non-monetary aspects whilst also mapping the chronological sequence of an investment within the organization’s target system. Thus, this method is characterized as a holistic approach for the evaluation of costs and benefits of an investment. This participation-oriented method was applied to business environments in many workshops. The results of the workshops are a library of more than 96 cost aspects, as well as 122 benefit aspects. These aspects are preprocessed and comparatively analyzed with regards to their alignment to a series of risk levels. For the first time, an accumulation and a distribution of cost and benefit aspects regarding their impact and probability of occurrence are given. The results give evidence that the PEFB-method combines precise measures of financial accounting with the incorporation of benefits. Finally, the results constitute the basics for using information technology and data science for decision support when applying within the PEFB-method.

Keywords: cost-benefit analysis, multi-criteria decision, profitability estimation focused on benefits, risk and uncertainty analysis

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Authors: Gary Young, David Zepeda, Gilbert Nyaga

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This study investigated whether vertical integration of hospitals and physicians is associated with better care for patients with cardiac conditions. A dramatic change in the U.S. hospital industry is the integration of hospital and physicians through hospital acquisition of physician practices. Yet, there is little evidence regarding whether this form of vertical integration leads to better operational performance of hospitals. The study was conducted as an observational investigation based on a pooled, cross-sectional database. The study sample comprised over hospitals in the State of California. The time frame for the study was 2010 to 2012. The key performance measure was hospitals’ degree of compliance with performance criteria set out by the federal government for managing patients with cardiac conditions. These criteria relate to the types of clinical tests and medications that hospitals should follow for cardiac patients but hospital compliance requires the cooperation of a hospital’s physicians. Data for this measure was obtained from a federal website that presents performance scores for U.S. hospitals. The key independent variable was the percentage of cardiologists that a hospital employs (versus cardiologists who are affiliated but not employed by the hospital). Data for this measure was obtained from the State of California which requires hospitals to report financial and operation data each year including numbers of employed physicians. Other characteristics of hospitals (e.g., information technology for cardiac care, volume of cardiac patients) were also evaluated as possible complements or substitutes for physician employment by hospitals. Additional sources of data included the American Hospital Association and the U.S. Census. Empirical models were estimated with generalized estimating equations (GEE). Findings suggest that physician employment is positively associated with better hospital performance for cardiac care. However, findings also suggest that information technology is a substitute for physician employment.

Keywords: physician employment, hospitals, verical integration, cardiac care

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Authors: Eda Jazexhiu-Postoli, Gladiola Hoxha, Ada Simeoni, Sonila Biba

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Background Neonatal hypotonia represents a commonly encountered issue in the Neonatal Intensive Care Unit and newborn nursery. The differential diagnosis is broad, encompassing chromosome abnormalities, primary muscular dystrophies, neuropathies and inborn errors of metabolism. Aim of study Our study describes some of the main clinical features of hypotonia in newborns and presents clinical cases of neonatal hypotonia we treated in our Neonatal unit in the last 3 years. Case reports Four neonates born in our hospital presented with hypotonia after birth, one preterm newborn 35-36 weeks of gestational age and three other term newborns (38-39 weeks of gestational age). Prenatal data revealed a decrease in fetal movements in both cases. Intrapartum meconium-stained amniotic fluid was found in 75% of our hypotonic newborns. Clinical features included inability to establish effective respiratory movements and need for resuscitation in the delivery room, respiratory distress syndrome, feeding difficulties and need for oro-gastric tube feeding, dysmorphic features, hoarse voice and moderate to severe muscular hypotonia. The genetic workup revealed the diagnosis of Autosomal Recessive Congenital Myasthenic Syndrome 1-B, Sotos Syndrome, Spinal Muscular Atrophy Type 1 and Transient Hypotonia of the Newborn. Two out of four hypotonic neonates were transferred to the Pediatric Intensive Care Unit and died at the age of three to five months old. Conclusion Hypotonia is a concerning finding in neonatal care and it is suggested by decreased intrauterine fetal movements, failure to establish first breaths, respiratory distress and feeding difficulties in the neonate. Prognosis is determined by its etiology and time of diagnosis and intervention.

Keywords: hypotonic neonate, respiratory distress, feeding difficulties, fetal movements

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Authors: Gyeong-Sung Kim, In-soo Ahn, Yong Cho

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SBR (Sequencing Batch Reactor) process is usually applied to membrane water treatment plants to treat its concentrated wastewater. The role of SBR process is to remove COD (Chemical Oxygen Demand) and NH3 from wastewater before discharging it outside of the water treatment plant using microorganism. Microorganism’s nitrification capability is influenced by water temperature because the nitrification rate of the concentrated wastewater becomes ‘zero’ as water temperature approach 0℃. Heating system is necessary to operate SBR in winter season even though the operating cost increase sharply. The operating cost of SBR at ‘D’ RO water treatment plant in Korea was 51.8 times higher in winter (October to March) compare to summer (April to September) season in 2014. Otherwise the effluent water temperature maintained around 8℃ constantly in winter. This study focuses on application heat pump system to recover the thermal energy from the effluent water of ‘D’ RO plant so that the operating cost will be reduced.

Keywords: water treatment, water thermal energy, energy saving, RO, SBR

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Authors: Priyanka Sharma, Manoj Jais, Poonam Gupta, Suraiya K. Ansari, Ravinder Kaur

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Introduction: As much as the Health Care is necessary for the population, so is the management of the Biomedical waste produced. Biomedical waste is a wide terminology used for the waste material produced during the diagnosis, treatment or immunization of human beings and animals, in research or in the production or testing of biological products. Biomedical waste management is a chain of processes from the point of generation of Biomedical waste to its final disposal in the correct and proper way, assigned for that particular type of waste. Any deviation from the said processes leads to improper disposal of Biomedical waste which itself is a major health hazard. Proper segregation of Biomedical waste is the key for Biomedical Waste management. Improper disposal of BMW can cause sharp injuries which may lead to HIV, Hepatitis-B virus, Hepatitis-C virus infections. Therefore, proper disposal of BMW is of upmost importance. Health care establishments segregate the Biomedical waste and dispose it as per the Biomedical waste management rules in India. Objectives: This study was done to observe the current trends of Biomedical waste generated in a tertiary care Hospital in Delhi. Methodology: Biomedical waste management rounds were conducted in the hospital wards. Relevant details were collected and analysed and sites with maximum Biomedical waste generation were identified. All the data was cross checked with the commons collection site. Results: The total amount of waste generated in the hospital during January 2014 till December 2014 was 6,39,547 kg, of which 70.5% was General (non-hazardous) waste and the rest 29.5% was BMW which consisted highly infectious waste (12.2%), disposable plastic waste (16.3%) and sharps (1%). The maximum quantity of Biomedical waste producing sites were Obstetrics and Gynaecology wards with a total Biomedical waste production of 45.8%, followed by Paediatrics, Surgery and Medicine wards with 21.2 %, 4.6% and 4.3% respectively. The maximum average Biomedical waste generated was by Obstetrics and Gynaecology ward with 0.7 kg/bed/day, followed by Paediatrics, Surgery and Medicine wards with 0.29, 0.28 and 0.18 kg/bed/day respectively. Conclusions: Hospitals should pay attention to the sites which produce a large amount of BMW to avoid improper segregation of Biomedical waste. Also, induction and refresher training Program of Biomedical waste management should be conducted to avoid improper management of Biomedical waste. Healthcare workers should be made aware of risks of poor Biomedical waste management.

Keywords: biomedical waste, biomedical waste management, hospital-tertiary care, New Delhi

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Authors: Manisha Dubey, Gaurav Gupta, Anoop Arya

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The demand for power supply increases day by day in developing countries like India henceforth demand of reactive power support in the form of ancillary services provider also has been increased. The multi-line and multi-type Flexible alternating current transmission system (FACTS) controllers are playing a vital role to regulate power flow through the transmission line. Unified power flow controller and interline power flow controller can be utilized to control reactive power flow through the transmission line. In a restructured power system, the demand of such controller is being popular due to their inherent capability. The transmission pricing by using reactive power cost allocation through modified matrix methodology has been proposed. The FACTS technologies have quite costly assembly, so it is very useful to apportion the expenses throughout the restructured electricity industry. Therefore, in this work, after embedding the FACTS devices into load flow, the impact on the costs allocated to users in fraction to the transmission framework utilization has been analyzed. From the obtained results, it is clear that the total cost recovery is enhanced towards the Reactive Power flow through the different transmission line for 5 bus test system. The fair pricing policy towards reactive power can be achieved by the proposed method incorporating FACTS controller towards cost recovery of the transmission network.

Keywords: interline power flow controller, transmission pricing, unified power flow controller, cost allocation

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Authors: Yu-Wen Lin, Li-Ni Liu

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Introduction: Fatigue is the most common symptoms experienced by cancer patients undergoing chemotherapy. Patients receiving anticancer therapies develop a higher proportion of fatigue compared with patients who do not receive anticancer therapies. Fatigue has significant impacts on quality of life, daily activities, mood status, and social behaviors. A warm-water footbath (WWF) at 41℃ promotes circulation and removes metabolites resulting in improving sleep and relieving fatigue. The aim of this study is to determine the effectiveness of WWF for relieving fatigue with cancer patients undergoing chemotherapy. Materials and Methods: This is a single-center, prospective, quasi-experimental design study in the oncology ward in Taiwan. Participants in this study were assigned to WWF group as experimental group and standard care group as a control group by purposive sampling. In the WWF group, the participants were asked to soak their feet in 42-43℃ water 15 minutes for consecutive 6 days at one day before chemotherapy. Each participant was evaluated for fatigue level by the Taiwanese version of the Brief Fatigue Inventory (BFI-T). BFI-T was completed for consecutive 8 days of the study. The primary outcome was compared the BFI-T score of WWF group to the standard care group. Results: There were 60 participants enrolled in this study. Thirty participants were assigned to WWF group and 30 participants were assigned to standard care group. Both groups have comparable characteristic. The BFI-T scores of both groups were increased associated with the days of chemotherapy. The highest BFI-T scores of both groups were on the day 4 of chemotherapy. The BFI-T scores of both groups were decreased since day 5 and significantly decreased in WWF group on day 5 compared to standard care group (4.17 vs. 5.7, P ＜ .05). At the end of the study the fatigue at its worse were significantly decreased in WWF group (2.33 vs. 4.37, P ＜ .001). There was no adverse event reported in this study. Conclusion: WWF is an easy, safe, non-invasive, and relatively inexpensive nursing intervention for improving fatigue of cancer patients undergoing chemotherapy. In summary, this study shows the WWF is a simple complementary care method, and it is effective for improving and relieving fatigue in a short time. Through improving fatigue is a way to enhance the quality of life which is important for cancer patients undergoing chemotherapy. Larger prospective randomized controlled trial and long-term effectiveness and outcomes of WWF should be performed to confirm this study.

Keywords: chemotherapy, warm-water footbath, fatigue, Taiwanese version of the brief fatigue inventory

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Authors: Juan Pablo Hervas-Perez, Jesus Guodemar-Perez, Montserrat Ruiz-Lopez, Elena Sonsoles Rodriguez-Lopez, Noemi Mayoral-Gonzalo, Eduardo Cimadevilla Fernandez-Pola, Mario Caballero-Corella

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Physiotherapy is a healthcare discipline that covers many fields of action within the recovery and prevention of health. Some are well known, but others, such as working with newborns and premature children are not so. Physical therapist functions are well defined, but the impression of the population is that there are other professionals who can develop them, and a large part are unknown. Objective: To evaluate the level of knowledge of the sample on the role of the physiotherapist in general, and more specifically in the neonatal intensive care (NICU) units, and estimate your level of notions on the development centered care (DCC). Method: A descriptive, transversal, observational and prospective study developed on a 125 participants' sample. Results: From the sample studied, 87.2% had already had contact with physiotherapy previously. An 80.9% believed that the physiotherapist intervention was decisive for the cure, and 84.0% would recommend physiotherapy treatment to others. Of the total surveyed, 98.0% felt that the physiotherapist is who should run the physiotherapeutic treatments, but shares with other professions 71.0% of votes. The field's best-known work is rehabilitation (94.0%); Neonatology is on the 4th place (66.0% of votes). Conclusions: Many areas of work of physical therapy are unknown to a big part of the population, including the own health workers. Less than half of the sample meets the DCC, and only 58% of the interviewed physiotherapists know them.

Keywords: functions of physiotherapist, neonatal intensive care, physiotherapy, prematurity

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Authors: Alireza Ghaffari, Hassan Saghi

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Project management is more complex than managing the day-to-day affairs of an organization. When the project dimensions are broad and multiple projects have to be monitored in different locations, the integrated management becomes even more complicated. One of the main concerns of project managers is the integrated project management, which is mainly rooted in the lack of accurate and accessible information from different projects in various locations. The collection of dispersed information from various parts of the network, their integration and finally the selective reporting of this information is among the goals of integrated information systems. It can help resolve the main problem, which is bridging the information gap between executives and senior managers in the organization. Therefore, the main objective of this study is to design and implement an important subset of a project management information system in order to successfully control the cost of construction projects so that its results can be used to design raw software forms and proposed relationships between different project units for the collection of necessary information.

Keywords: financial performance, cost subsystem, PMIS, project management

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Authors: Soheila Sadeghi

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Accurate cost prediction is essential for effective project management and decision-making in the construction industry. This study aims to develop a cost prediction model for construction projects using Machine Learning techniques and Particle Swarm Optimization (PSO). The research utilizes a comprehensive dataset containing project cost estimates, actual costs, resource details, and project performance metrics from a road reconstruction project. The methodology involves data preprocessing, feature selection, and the development of an Artificial Neural Network (ANN) model optimized using PSO. The study investigates the impact of various input features, including cost estimates, resource allocation, and project progress, on the accuracy of cost predictions. The performance of the optimized ANN model is evaluated using metrics such as Mean Squared Error (MSE), Root Mean Squared Error (RMSE), Mean Absolute Error (MAE), and R-squared. The results demonstrate the effectiveness of the proposed approach in predicting project costs, outperforming traditional benchmark models. The feature selection process identifies the most influential variables contributing to cost variations, providing valuable insights for project managers. However, this study has several limitations. Firstly, the model's performance may be influenced by the quality and quantity of the dataset used. A larger and more diverse dataset covering different types of construction projects would enhance the model's generalizability. Secondly, the study focuses on a specific optimization technique (PSO) and a single Machine Learning algorithm (ANN). Exploring other optimization methods and comparing the performance of various ML algorithms could provide a more comprehensive understanding of the cost prediction problem. Future research should focus on several key areas. Firstly, expanding the dataset to include a wider range of construction projects, such as residential buildings, commercial complexes, and infrastructure projects, would improve the model's applicability. Secondly, investigating the integration of additional data sources, such as economic indicators, weather data, and supplier information, could enhance the predictive power of the model. Thirdly, exploring the potential of ensemble learning techniques, which combine multiple ML algorithms, may further improve cost prediction accuracy. Additionally, developing user-friendly interfaces and tools to facilitate the adoption of the proposed cost prediction model in real-world construction projects would be a valuable contribution to the industry. The findings of this study have significant implications for construction project management, enabling proactive cost estimation, resource allocation, budget planning, and risk assessment, ultimately leading to improved project performance and cost control. This research contributes to the advancement of cost prediction techniques in the construction industry and highlights the potential of Machine Learning and PSO in addressing this critical challenge. However, further research is needed to address the limitations and explore the identified future research directions to fully realize the potential of ML-based cost prediction models in the construction domain.

Keywords: cost prediction, construction projects, machine learning, artificial neural networks, particle swarm optimization, project management, feature selection, road reconstruction

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Authors: Pankhuri Dagaonkar, Charumani Singh, Poornima Krothapalli, Krishna Karthik

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The backbone of any retail e-commerce success story is a unique design of supply chain network, providing the business an unparalleled speed and scalability. Primary goal of the supply chain strategy is to meet customer expectation by offering fastest deliveries while keeping the cost minimal. Meeting this objective at the large market that India provides is the problem statement that we have targeted here. There are many models and optimization techniques focused on network design to identify the ideal facility location and size, optimizing cost and speed. In this paper we are presenting a tactical approach to optimize cost of an existing network for a predefined speed. We have considered both forward and reverse logistics of a retail e-commerce supply chain consisting of multiple fulfillment (warehouse) and delivery centers, which are connected via sortation nodes. The mathematical model presented here determines if the shipment from a node should get sorted directly for the last mile delivery center or it should travel as consolidated package to another node for further sortation (resort). The objective function minimizes the total cost by varying the resort percentages between nodes and provides the optimal resource allocation and number of sorts at each node.

Keywords: distribution strategy, mathematical model, network design, supply chain management

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Authors: Sonto Maputle

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Background: Support during labour increase women's chances of having positive childbirth experiences as well as childbirth outcomes. The purpose of this study was to determine the support provided by midwives to women during labour at the public hospital in Limpopo Province. The study was conducted at the Tertiary hospital in Limpopo Province. Methods: A qualitative, participant observation approach was used. Population consisted of all women that were admitted to deliver their babies and the midwives who provided midwifery care in the obstetric unit of one tertiary public hospital in Limpopo Province. Non-probability, purposive and convenience sampling were used to sample 24 women and 12 midwives. Data were collected through participant observations which included unstructured conversations with the use of observational guide, field notes of events and conversations that occurred when women interact with midwives were recorded verbatim and a Visual Analog Scale to complement the observations. Data was analysed qualitatively but were presented in the tables and bar graphs. Results: Five themes emerged as support provided by midwives during labour, namely; communication between women and midwives, informational support, emotional support activities, interpretation of the experienced labour pain and supportive care activities during labour. Conclusion: The communication was occurring when the midwife was rendering midwifery care and very limited for empowering. The information sharing focused on the assistive actions rather than on the activities that would promote mothers’ participation. The emotional support activities indicated lack of respect and disregard cultural preferences and this contributed to inability to exercise choices in decision-making. The study recommended the implementation of Batho Pele principles in order to provide woman-centred care during labour.

Keywords: communication between women and midwives, labour pains, informational and emotional support, physical comforting measures

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Authors: Geetha Jayapathy, Lakshmi Muthukrishnan, Manoj Kumar Reddy Pulim , Radhika Raman

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Introduction: Ketones are the end products of fatty acid metabolism and a source of energy for vital organs such as the brain, heart and skeletal muscles. Ketones are produced in excess when glucose is not available as a source of energy or it cannot be utilized as in diabetic ketoacidosis. Children admitted in the emergency department often have starvation ketosis which is not clinically manifested. Decision on admission of children to the emergency room with subtle signs can be difficult at times. Point of care blood ketone testing can be done at the bedside even in a primary level care setting to supplement and guide us in our management decisions. Hence this study was done to explore the utility of this simple bedside parameter as a supplement in assessing pediatric patients presenting to the emergency department. Objectives: To estimate blood ketones of children admitted in the emergency department. To analyze the significance of blood ketones in various disease conditions. Methods: Blood ketones using point of care testing instrument (ABOTTprecision Xceed Pro meters) was done in patients getting admitted in emergency room and in out-patients (through sample collection centre). Study population: Children aged 1 month to 18 years were included in the study. 250 cases (In-patients) and 250 controls (out-patients) were collected. Study design: Prospective observational study. Data on details of illness and physiological status were documented. Blood ketones were compared between the two groups and all in patients were categorized into various system groups and analysed. Results: Mean blood ketones were high in in-patients ranging from 0 to 7.2, with a mean of 1.28 compared to out-patients ranging from 0 to 1.9 with a mean of 0.35. This difference was statistically significant with a p value < 0.001. In-patients with shock (mean of 4.15) and diarrheal dehydration (mean of 1.85) had a significantly higher blood ketone values compared to patients with other system involvement. Conclusion: Blood ketones were significantly high (above the normal range) in pediatric patients who are sick requiring admission. Patients with various forms of shock had very high blood ketone values as found in diabetic ketoacidosis. Ketone values in diarrheal dehydration were moderately high correlating to the degree of dehydration.

Keywords: admission, blood ketones, paediatric emergencies, point of care testing

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Authors: Ibrahim Ahmed Jajere

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Resource use conflicts capable of undermining of pastoralists’ livelihoods are on the increase in the North East Arid Zone of Nigeria. In order to expose socio - economic effects of conflicts and benefits of peace, this study assessed cost implications of farmers/pastoralists conflicts over natural resources. Interviews were conducted with 94 farmers, 90 agro-pastoralists and 91 pastoralists’ household heads. The farmers and agro-pastoralists were systematically sampled while pastoralists were located using snowballing. Both farmers and pastoralists suffered losses in the form of injuries to, and even death of household members, and loss of shelter. Farmers sustained losses of facilities and farm produce while pastoralists suffered loss and seizure of livestock, arrest of household members and forced migrations. The material losses in monetary terms amounted to 14,242,200.00 nairas for farmers, a figure higher than the 10,915,500.00 nairas incurred by pastoralists.

Keywords: cost, conflicts, farmers, pastoralists

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Authors: Anna Ching-Yu Wong

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Introduction: Textbooks play a sizable portion of the overall cost of higher education students. It is a board consent that open education resources (OER) reduce the te4xtbook costs and provide students a way to receive high-quality learning materials at little or no cost to them. However, there is less agreement over exactly how much. This study presents an approach for calculating OER savings by using SUNY Canton NON-OER courses (N=233) to estimate the potentially textbook savings for one semester – Fall 2022. The purpose in collecting data is to understand how much potentially saved from using OER materials and to have a record for future further studies. Literature Reviews: In the past years, researchers identified the rising cost of textbooks disproportionately harm students in higher education institutions and how much an average cost of a textbook. For example, Nyamweya (2018) found that on average students save $116.94 per course when OER adopted in place of traditional commercial textbooks by using a simple formula. Student PIRGs (2015) used reports of per-course savings when transforming a course from using a commercial textbook to OER to reach an estimate of $100 average cost savings per course. Allen and Wiley (2016) presented at the 2016 Open Education Conference on multiple cost-savings studies and concluded $100 was reasonable per-course savings estimates. Ruth (2018) calculated an average cost of a textbook was $79.37 per-course. Hilton, et al (2014) conducted a study with seven community colleges across the nation and found the average textbook cost to be $90.61. There is less agreement over exactly how much would be saved by adopting an OER course. This study used SUNY Canton as a case study to create an approach for estimating OER savings. Methodology: Step one: Identify NON-OER courses from UcanWeb Class Schedule. Step two: View textbook lists for the classes (Campus bookstore prices). Step three: Calculate the average textbook prices by averaging the new book and used book prices. Step four: Multiply the average textbook prices with the number of students in the course. Findings: The result of this calculation was straightforward. The average of a traditional textbooks is $132.45. Students potentially saved $1,091,879.94. Conclusion: (1) The result confirms what we have known: Adopting OER in place of traditional textbooks and materials achieves significant savings for students, as well as the parents and taxpayers who support them through grants and loans. (2) The average textbook savings for adopting an OER course is variable depending on the size of the college and as well as the number of enrollment students.

Keywords: textbook savings, open textbooks, textbook costs assessment, open access

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Authors: Wen Liang Chang, Mei Wei Wang, Ruey Huei Yeh

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This paper studies the comparisons of individual and group replacement policies for a series connection system with two machines. Suppose that manufacturer’s production system is a series connection system which is combined by two machines. For two machines, when machines fail within the operating time, minimal repair is performed for machines by the manufacturer. The manufacturer plans to a preventive replacement for machines at a pre-specified time to maintain system normal operation. Under these maintenance policies, the maintenance cost rate models of individual and group replacement for a series connection system with two machines is derived and further, optimal preventive replacement time is obtained such that the expected total maintenance cost rate is minimized. Finally, some numerical examples are given to illustrate the influences of individual and group replacement policies to the maintenance cost rate.

Keywords: individual replacement, group replacement, replacement time, two machines, series connection system

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Authors: M. Shemis, O. Maher, G. Casterou, F. Gauffre

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Hepatitis C virus (HCV) is a major cause of chronic liver disease with a global 170 million chronic carriers at risk of developing liver cirrhosis and/or liver cancer. Egypt reports the highest prevalence of HCV worldwide. Currently, two classes of assays are used in the diagnosis and management of HCV infection. Despite the high sensitivity and specificity of the available diagnostic assays, they are time-consuming, labor-intensive, expensive, and require specialized equipment and highly qualified personal. It is therefore important for clinical and economic terms to develop a low-tech assay for the direct detection of HCV RNA with acceptable sensitivity and specificity, short turnaround time, and cost-effectiveness. Such an assay would be critical to control HCV in developing countries with limited resources and high infection rates, such as Egypt. The unique optical and physical properties of gold nanoparticles (AuNPs) have allowed the use of these nanoparticles in developing simple and rapid colorimetric assays for clinical diagnosis offering higher sensitivity and specificity than current detection techniques. The current research aims to develop a detection assay for HCV RNA using gold nanoparticles (AuNPs). Methods: 200 anti-HCV positive samples and 50 anti-HCV negative plasma samples were collected from Egyptian patients. HCV viral load was quantified using m2000rt (Abbott Molecular Inc., Des Plaines, IL). HCV genotypes were determined using multiplex nested RT- PCR. The assay is based on the aggregation of AuNPs in presence of the target RNA. Aggregation of AuNPs causes a color shift from red to blue. AuNPs were synthesized using citrate reduction method. Different sets of probes within the 5’ UTR conserved region of the HCV genome were designed, grafted on AuNPs and optimized for the efficient detection of HCV RNA. Results: The nano-gold assay could colorimetrically detect HCV RNA down to 125 IU/ml with sensitivity and specificity of 91.1% and 93.8% respectively. The turnaround time of the assay is < 30 min. Conclusions: The assay allows sensitive and rapid detection of HCV RNA and represents an inexpensive and simple point-of-care assay for resource-limited settings.

Keywords: HCV, gold nanoparticles, point of care, viral load

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Authors: Benga Ebouele, Thomas Tengen

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Implementing either periodic or continuous inventory review model within most manufacturing-companies-supply chains as a management tool may incur higher costs. These high costs affect the system flexibility which in turn affects the level of service required to satisfy customers. However, these effects are not clearly understood because the parameters of both inventory review policies (protection demand interval, order quantity, etc.) are not designed to be fully utilized under different and uncertain conditions such as poor manufacturing, supplies and delivery performance. Coming up with a hybrid model which may combine in some sense the feature of both continuous and a periodic inventory review models should be useful. Therefore, there is a need to build and evaluate such hybrid model on the annual total cost, stock out probability and system’s flexibility in order to search for the most cost effective inventory review model. This work also seeks to find the optimal sets of parameters of inventory management under stochastic condition so as to optimise each policy independently. The results reveal that a continuous inventory system always incurs lesser cost than a periodic (R, S) inventory system, but this difference tends to decrease as time goes by. Although the hybrid inventory is the only one that can yield lesser cost over time, it is not always desirable but also natural to use it in order to help the system to meet high performance specification.

Keywords: demand and lead time randomness, hybrid Inventory model, optimization, supply chain

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Authors: Tedros Asefaw Gebremeskel, Xaoyi Yang

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The potential of solar energy in Eritrea is relatively high, based on this truth, there are a number of isolated and remote villages situated far away from the electrical national grid which don’t get access to electricity. The core objective of this work is to design a most favorable and cost-effective power by means of standalone PV system for the electrification of a single housing in the inaccessible area of Eritrea. The sizing of the recommended PV system is achieved, such as radiation data and electrical load for the typical household of the selected site is also well thought-out in the design steps. Finally, the life cycle cost (LCC) analysis is conducted to evaluate the economic viability of the system. The outcome of the study promote the use of PV system for a residential building and show that PV system is a reasonable option to provide electricity for household applications in the rural area of Eritrea.

Keywords: electrification, inaccessible area, life cycle cost, residential building, stand-alone PV system

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Authors: Mohammad H. Yarmohamadian, Reza Safdari, Nahid Tavakoli

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In recent years, many countries have suffered various natural disasters. Disaster response continues to face the challenges in health care sector in all countries. Information and communication management is a significant challenge in disaster scene. During the last decades, rapid advances in information technology have led to manage information effectively and improve communication in health care setting. Information technology is a vital solution for effective response to disasters and emergencies so that if an efficient ICT-based health information system is available, it will be highly valuable in such situation. Of that, mobile technology represents a nearly computing technology infrastructure that is accessible, convenient, inexpensive and easy to use. Most projects have not yet reached the deployment stage, but evaluation exercises show that mHealth should allow faster processing and transport of patients, improved accuracy of triage and better monitoring of unattended patients at a disaster scene. Since there is a high prevalence of cell phones among world population, it is expected the health care providers and managers to take measures for applying this technology for improvement patient safety and public health in disasters. At present there are challenges in the utilization of mhealth in disasters such as lack of structural and financial issues in our country. In this paper we will discuss about benefits and challenges of mhealth technology in disaster setting considering connectivity, usability, intelligibility, communication and teaching for implementing this technology for disaster response.

Keywords: information technology, mhealth, disaster, effective response

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Authors: Jin Woo Hwang, Byung Kwan Oh, Yousok Kim, Hyo Seon Park

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As greenhouse effect has been recognized as serious environmental problem of the world, interests in carbon dioxide (CO₂) emission which comprises major part of greenhouse gas (GHG) emissions have been increased recently. Since construction industry takes a relatively large portion of total CO₂ emissions of the world, extensive studies about reducing CO₂ emissions in construction and operation of building have been carried out after the 2000s. Also, performance based design (PBD) methodology based on nonlinear analysis has been robustly developed after Northridge Earthquake in 1994 to assure and assess seismic performance of building more exactly because structural engineers recognized that prescriptive code based design approach cannot address inelastic earthquake responses directly and assure performance of building exactly. Although CO₂ emissions and PBD approach are recent rising issues on construction industry and structural engineering, there were few or no researches considering these two issues simultaneously. Thus, the objective of this study is to minimize the CO₂ emissions and cost of building designed by PBD approach in structural design stage considering structural materials. 4 story and 4 span reinforced concrete building optimally designed to minimize CO₂ emissions and cost of building and to satisfy specific seismic performance (collapse prevention in maximum considered earthquake) of building satisfying prescriptive code regulations using non-dominated sorting genetic algorithm-II (NSGA-II). Optimized design result showed that minimized CO₂ emissions and cost of building were acquired satisfying specific seismic performance. Therefore, the methodology proposed in this paper can be used to reduce both CO₂ emissions and cost of building designed by PBD approach.

Keywords: CO2 emissions, performance based design, optimization, sustainable design

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Authors: Paulina Clara Appiah, Kofi Issah, Timothy Letsa, Kennedy Nartey, Amanua Chinbuah, Adoma Dwomo-Fokuo, Jacqeline G. Asibey

Abstract:

Background: The Every Newborn Action Plan provides evidence–based interventions to end preventable deaths in high burden countries. Brong Ahafo Region is one of ten regions in Ghana with less than half of its district hospitals having sick newborn units. Facility-based neonatal care is not prioritized and under-funded, and there is also inadequate knowledge and competence to manage the sick. The aim of this intervention was to make available in–patient care for sick newborns in all 19 district hospitals through the strengthening of facility-based systems. Methods: With the development and dissemination of the National Newborn Strategy and Action Plan 2014-2018, the country was able to attract PATH which provided the region with basic resuscitation equipment, supported hospital providers’ capacity building in Helping Babies Breathe, Essential Care of Every Baby, Infection Prevention and Management and held a symposia on managing the sick newborn. Newborn advocacy was promoted through newborn champions at the facility and community levels. Hospital management was then able to mobilize resources from communities, corporate organizations and from internally generated funds; created or expanded sick newborn care units and provided essential medicines and equipment. Kangaroo Mother Care was initiated in 6 hospitals. Pediatric specialist outreach services initiated comprised telephone consultations, teaching ward rounds and participating in perinatal death audits meetings. Newborn data capture and management was improved through the provision and training on the use of standard registers provided from the national level. Results: From February 2015 to November 2017, hospitals with sick newborn units increased from 7 to 19 (37%-100%). 180 pieces each of newborn ventilation bags and masks size 0, 1 and penguin suction bulbs were distributed to the hospitals, in addition to 20 newborn mannequin sets and 90 small clinical reminder posters. 802 providers (96.9%) were trained in resuscitation, of which 96% were successfully followed up in 6 weeks, 91% in 6 months and 80% in 12 months post-training. 53 clinicians (65%) were trained and mentored to manage sick newborns. 56 specialist teaching ward rounds were conducted. Data completeness improved from 92.6% - 99.9%. Availability of essential medicines improved from 11% to 100%. Number of hospital cots increased from 116 to 248 (214%). Cot occupancy rate increased from 57.4% to 92.5%. Hospitals with phototherapy equipment increased from 0 to 12 (63%). Hospitals with incubators increased from 1 to 12 (5%-63%). Newborn deaths among admissions reduced from 6.3% to 5.4%. Conclusion: Access to in-patient care increased significantly. Newborn advocacy successfully mobilized resources required for strengthening facility –based systems.

Keywords: facility-based systems, Ghana, in-patient care, newborn advocacy

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Authors: Odaleia de O. Farias, Suzelene C. Marinho, Ecleidson B. Fragoso, Daniel S. Lima, Francisco R. S. Lira, Lara S. Araújo, Gabriel dos S. D. Soares

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In populous cities, prehospital care services that use vehicles alternative to ambulances are needed in order to reduce costs and improve response time to occurrences in areas with large concentration of people, such as leisure and tourism spaces. In this context, it was implanted a program called BIKE VIDA, that is innovative quick access and assistance program. The aim of this study is to describe the implantation and initial profile of occurrences performed by an urgency/emergency pre-hospital care service through paramedics on bicycles. It is a cross-sectional, descriptive study carried out in the city of Fortaleza, Ceara, Brazil. The data included service records from July to August 2017. Ethical aspects were respected. The service covers a perimeter of 4.5 km, divided into three areas with perimeter of 1.5 km for each paramedic, attending from 5 am to 9 pm. Materials transported by bicycles include External Automated Defibrillator - DEA, portable oxygen, oximeter, cervical collar, stethoscope, sphygmomanometer, dressing and immobilization materials and personal protective equipment. Occurrences are requested directly by calling the emergency number 192 or through direct approach to the professional. In the first month of the program, there were 93 emergencies/urgencies, mainly in the daytime period (71,0%), in males (59,7%), in the age range of 26 to 45 years (46,2%). The main nature was traumatic incidents (53.3%). Most of the cases (88,2%) did not require ambulance transport to the hospital, and there were two deaths. Pre-hospital service through bicycles is an innovative strategy in Brazil and has shown to be promising in terms of reducing costs and improving the quality of the services offered.

Keywords: emergency, response time, prehospital care, urgency

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Authors: Inna Vinokurova, N. Savvina

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The goal of research: to study the organization of multi-field hospital’s work environment in the Republic of Sakha (Yakutia), Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine. Results: Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine is a multidisciplinary, specialized hospital complex that provides specialized and high-tech medical care to children and adults in the Republic of Sakha (Yakutia) of the Russian Federation. There are 5 diagnostic and treatment centers (advisory and diagnostic, clinical, pediatric, perinatal, Republican cardiologic dispensary) with 45 clinical specialized departments with 727 cots, 5 resuscitation departments, 20 operating rooms and out-patient department with 905 visits in alternation in the National Center of Medicine. Annually more than 20,000 patients receive treatment in the hospital of the Republican Hospital of the Republic of Sakha (Yakutia), more than 70,000 patients visit out-patient sections, more than 2 million researches are done, more than 12,000 surgeries are performed, more than 2 thousand babies are delivered. National Center of Medicine has a great influence with such population’s health indicators as total mortality, birth rate, maternal, infant and perinatal mortality, circulatory system incidence. The work environment of the Republican Hospital of the Republic of Sakha (Yakutia) is represented by the following structural departments: pharmacy, blood transfusion department, sterilization department, laundry, dietetic department, infant-feeding centre, material and technical supply. More than 200 employees work in this service. The main function of these services is to provide on-time and fail-safe supply with all necessary: wear parts, medical supplies, donated blood and its components, foodstuffs, hospital linen , sterile instruments, etc. Thus, the activity of medical organization depends on the work environment, including quality health care, so it is a main part of multi-field hospital activity.

Keywords: organization of multi-field hospital’s, work environment, quality health care, pharmacy, blood transfusion department, sterilization department

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Authors: Maziyar Nouraee

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Electronic markets in recent decades contribute remarkably in business transactions. Many organizations consider traditional ways of trade non-economical and therefore they do trade only through electronic markets. There are different categorizations of electronic markets functions. In one classification, functions of electronic markets are categorized into classes as information, transactions, and value added. In the present paper, effects of the three classes on the two major elements of the supply chain management are measured. The two elements are decrease in the product unit cost and reduction in response time to the customer. The results of the current research show that among nine minor elements related to the three classes of electronic markets functions, six factors and three factors influence on reduction of the product unit cost and reduction of response time to the customer, respectively.

Keywords: electronic commerce, electronic market, B2B trade, supply chain management

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Authors: Yu-Ju Hsieh, Lin-Hung Lin, Wen-Hui Chang

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This study was designed as an interventional research and intended to validate whether the introduction of drinking vinegar every day can reduce and even prevent urinary tract infection in Taiwan home stayed disabilities who using indwelling catheter. The data was collected from the subjects who have received home care case at northern Taiwan, according to the questionnaire and a medical records retroactive methodology, the subjects were informed and consent to drink 15ml of table vinegar in a daily diet, and through routine urine testing and culture study. Home care nurses would assist collecting urine at the point of before and after a meal from total 35 studied subjects per month, and total collected 4 times for testing. The results showed that when the average age of study subjects was 65.46 years and catheter indwelling time was 15 years, drinking table vinegar could inhibit the activity of E. coli O157: H7 and reduce its breeding. Before drinking table vinegar daily, the subjects’ urine pH value was 7.0-8.0, and the average was 7.5, and the urine PH value dropped to 6.5 after drinking table vinegar for a month. There were two purple urine cases whose urine were changed from purple to normal color after two weeks of drinking, and the protein and bacteria values of urine gradually improved. Urine smell unpleasant before attending to this study, and the symptom improved significantly only after 1 week, and the urine smell returned to normal ammonia and became clean after 1 month later. None of these subjects received treatment in a hospital due to urinary tract infection, and there were no signs of bleeding in all cases during this study. The subjects of this study are chronic patients with a long-term bedridden catheterization; drinking cranberry juice is an economic burden for them, and also highly prohibited for diabetes patients. By adapting to use cheaper table vinegar to acidified urine and improve its smell and ease Purple Urine Syndrome, to furthermore, proven urinary tract infection, it can also to reduce the financial burden on families, the cost of social resources and the rate of re-admission.

Keywords: table vinegar, urinary tract infection, disability patients, long-term indwelling catheter

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Authors: Jyun-Huei Huang, Ting-I Lee

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Urban heat island effect is derived from the reduction of vegetative cover by urban development. Because plants can improve air quality and microclimate, green walls have been applied as a sustainable design approach to cool building temperature. By using plants to green vertical surfaces, they decrease room temperature and, as a result, decrease the energy use for air conditioning. Based on their structures, green walls can be divided into two categories, green façades and living walls. A green façade uses the climbing ability of a plant itself, while a living wall assembles planter modules. The latter one is widely adopted in public space, as it is time-effective and less limited. Although a living wall saves energy spent on cooling, it is not necessarily cost-effective from the perspective of a lifecycle analysis. The Italian study shows that the overall benefit of a living wall is only greater than its costs after 47 years of its establishment. In Taiwan, urban greening policies encourage establishment of green walls by referring to their benefits of energy saving while neglecting their low performance on cost-effectiveness. Thus, this research aims at understanding the perception of appliers and consumers on the cost-effectiveness of their living wall products from the lifecycle viewpoint. It adopts semi-structured interviews and field observations on the maintenance of the products. By comparing the two results, it generates insights for sustainable urban greening policies. The preliminary finding shows that stakeholders do not have a holistic sense of lifecycle or cost-effectiveness. Most importantly, a living wall well maintained is often with high input due to the availability of its maintenance budget, and thus less sustainable. In conclusion, without a comprehensive sense of cost-effectiveness throughout a product’s lifecycle, it is very difficult for suppliers and consumers to maintain a living wall system while achieve sustainability.

Keywords: case study, maintenance, post-occupancy evaluation, vertical greening

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Authors: Chinelo Igwenagu

Abstract:

Teenage childbearing in developing countries has been a thing of great concern as it has often led to a number of socioeconomic problems both to the society and to the families affected. The outcome of teenage pregnancy has been generally associated with higher rates of maternal morbidity and mortality, greater risks for delivery complications, low-birth weight infants and child mortality. As a result of teenagers’ physiological and social immaturity and their lack of adequate prenatal care, health risks associated with their pregnancies and childbearing are more pronounced than those of older women. Therefore this study has examined the relationship between the age of teenagers and the outcome of teenage pregnancy. Based on this study, the result of the analysis shows that both teenagers and older mothers suffer similarly during child bearing. Hence improve medical care is paramount in all the situations.

Keywords: childbearing, mortality, Nigeria, pregnancy, prematurity, teenagers

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