Search results for: intensive care unit

Authors: Adrian Keith Caamino, Sina Shakibania, Lena Sunqvist-Öqvist, Jan Rosenkranz, Yousef Ghorbani

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Feldspar minerals are one of the main components of the earth’s crust. They are tectosilicate, meaning that they mainly contain aluminum and silicon. Besides aluminum and silicon, they contain either potassium, sodium, or calcium. Accordingly, feldspar minerals are categorized into three main groups: K-feldspar, Na-feldspar, and Ca-feldspar. In recent years, the trend to use K-feldspar has grown tremendously, considering its potential to produce potash and alumina. However, the feldspar minerals, in general, are difficult to decompose for the dissolution of their metallic components. Several methods, including intensive milling, leaching under elevated pressure and temperature, thermal pretreatment, and the use of corrosive leaching reagents, have been proposed to improve its low dissolving efficiency. In this study, as part of the POTASSIAL EU project, to overcome the low dissolution efficiency of the K-feldspar components, mechanical activation using intensive milling followed by leaching using hydrochloric acid (HCl) was practiced. Grinding operational parameters, namely time, rotational speed, and ball-to-sample weight ratio, were studied using the Taguchi optimization method. Then, the mineralogy of the grinded samples was analyzed using a scanning electron microscope (SEM) equipped with automated quantitative mineralogy. After grinding, the prepared samples were subjected to HCl leaching. In the end, the dissolution efficiency of the main elements and impurities of different samples were correlated to the mineralogical characterization results. K-feldspar component dissolution is correlated with ore mineralogy, which provides insight into how to best optimize leaching conditions for selective dissolution. Further, it will have an effect on purifying steps taken afterward and the final value recovery procedures

Keywords: K-feldspar, grinding, automated mineralogy, impurity, leaching

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Authors: Dianis Wulan Sari, Takeo Minematsu, Mikako Yoshida, Hiromi Sanada

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Introduction: Pruritus is diagnosed as itching without macroscopic abnormalities on skin. It is the most skin complaint of elderly people. In the present study, we conducted a dermatological study to examine the risk factors of pruritic skin and predicted how to prevent pruritus especially in the elderly population. Pruritus is caused several types of inflammation, including epidermal innate immunity based on keratinocyte responses and acquired immunity regulated by type 1 or 2 helper T (Th) cells. The triggers of pruritus differ among inflammation types, therefore we did separately assess the pruritus-associated factors of each inflammation type in an effort to contribute to the identification of intervention targets for preventing pruritus. Therefore, this study aimed to investigate the factors related with actual condition of pruritic skin by examine the skin properties. Method: This study was conducted in elderly population of Indonesian nursing home. Basic characteristics and behaviors were obtained by interview. The properties of pruritic skin were collected by examination of skin biomarker using skin blotting as novel method of non-invasive skin assessment method and examination of skin barrier function using stratum corneum hydration and skin pH. Result: The average age of participants was 74 years with independent status was 66.8%. Age (β = -0.130, p = 0.044), cumulative lifetime sun exposure (β = 0.145, p = 0.026), bathing duration (β = 0.151, p = 0.022), clothing change frequency (β = 0.135, p = 0.029), and clothing type (β = -0.139, p = 0.021) were risk factors of pruritic skin in multivariate analysis. Conclusion: Risk factors of pruritic skin in elderly population were caused by internal factors such as skin senescence and external factors such as sun exposure, hygiene care and skin care behavior.

Keywords: aging, hygiene care, pruritus, skin care, sun exposure

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Authors: M. J. Pourvaghar, M. E. Bahram, M. Sayyah, Sh. Khoshemehry

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Adiponectin is a cytokine secreted by the adipose tissue that functions as an anti-inflammatory, antiathrogenic and anti-diabetic substance. Its density is inversely correlated with body mass index. The purpose of this research was to examine the effect of 12 weeks of high intensity interval training (HIIT) with the level of serum adiponectin and some selected adiposity markers in overweight and fat college students. This was a clinical research in which 24 students with BMI between 25 kg/m² to 30 kg/m². The sample was purposefully selected and then randomly assigned into two groups of experimental (age =22.7±1.5 yr.; weight = 85.8±3.18 kg and height =178.7±3.29 cm) and control (age =23.1±1.1 yr.; weight = 79.1±2.4 kg and height =181.3±4.6 cm), respectively. The experimental group participated in an aerobic exercise program for 12 weeks, three sessions per weeks at a high intensity between 85% to 95% of maximum heart rate (considering the over load principle). Prior and after the termination of exercise protocol, the level of serum adiponectin, BMI, waist to hip ratio, and body fat percentages were calculated. The data were analyzed by using SPSS: PC 16.0 and statistical procedure such as ANCOVA, was used. The results indicated that 12 weeks of intensive interval training led to the increase of serum adiponectin level and decrease of body weight, body fat percent, body mass index and waist to hip ratio (P < 0.05). Based on the results of this research, it may be concluded that participation in intensive interval training for 12 weeks is a non-invasive treatment to increase the adiponectin level while decreasing some of the anthropometric indices associated with obesity or being overweight.

Keywords: adiponectin, cardiovascular, interval, overweight, training

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Authors: Oguz Ugurkan Akkaya, Alpaslan Sipahi, Ozgur Firat Pamukcu, Murat Yasar, Tolga Guler, Arif Ulu, Ferit Cakir

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With the increase in human population, expansion, and renovation of cities, infrastructure systems today need to be manufactured to be more durable and long-lasting. The most cost-effective and durable manufacturing of components is a general problem of all engineering disciplines. Therefore, it is important to determine the most optimal components. This study mainly focuses on the most optimal component design of the polymer concrete. For this purpose, the lower and upper limits of the three main components of the polymer concrete are determined. The effects of these three principal components on the compressive strength, tensile strength, and unit price of polymer concrete are estimated using the response surface method. Box-Behnken Design is used in designing the experiments. Compressive strength, tensile strength, and unit prices are successfully estimated with variance ratios (R²) of 0.82, 0.92, and 0.90, respectively, and the optimum mixture quantity is determined.

Keywords: Box-Behnken Design, compressive strength, mechanical tests, polymer concrete, tensile strength

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Authors: Yetti Marlida, Syukri Arif, Nadirman Haska

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Recently, alcohol fuels have been produced on industrial scales by fermentation of sugars derived from wheat, corn, sugar beets, sugar cane etc. The enzymatic hydrolysis of cellulosic materials to produce fermentable sugars has an enormous potential in meeting global bioenergy demand through the biorefinery concept, since agri-food processes generate millions of tones of waste each year (Xeros and Christakopoulos 2009) such as sugar cane baggase , wheat straw, rice straw, corn cob, and oil palm trunk. In fact oil palm trunk is one of the most abundant lignocellulosic wastes by-products worldwide especially come from Malaysia, Indonesia and Nigeria and provides an alternative substrate to produce useful chemicals such as bioethanol. Usually, from the ages 3 years to 25 years, is the economical life of oil palm and after that, it is cut for replantation. The size of trunk usually is 15-18 meters in length and 46-60 centimeters in diameter. The trunk after cutting is agricultural waste causing problem in elimination but due to the trunk contains about 42% cellulose, 34.4%hemicellulose, 17.1% lignin and 7.3% other compounds,these agricultural wastes could make value added products (Pumiput, 2006).This research was production of bioethanol from oil palm trunk via saccharafication by cocktail carbohydrases enzymes. Enzymatic saccharification of acid treated oil palm trunk was carried out in reaction mixture containing 40 g treated oil palm trunk in 200 ml 0.1 M citrate buffer pH 4.8 with 500 unit/kg amylase for treatment A: Treatment B: Treatment A + 500 unit/kg cellulose; C: treatment B + 500 unit/kgg xylanase: D: treatment D + 500 unit/kg ligninase and E: OPT without treated + 500 unit/kg amylase + 500 unit/kg cellulose + 500 unit/kg xylanase + 500 unit/kg ligninase. The reaction mixture was incubated on a water bath rotary shaker adjusted to 600C and 75 rpm. The samples were withdraw at intervals 12 and 24, 36, 48,60, and 72 hr. For bioethanol production in biofermentor of 5L the hydrolysis product were inoculated a loop of Saccharomyces cerevisiae and then incubated at 34 0C under static conditions. Samples are withdraw after 12, 24, 36, 48 and 72 hr for bioethanol and residual glucose. The results of the enzymatic hidrolysis (Figure1) showed that the treatment B (OPT hydrolyzed with amylase and cellulase) have optimum condition for glucose production, where was both of enzymes can be degraded OPT perfectly. The same results also reported by Primarini et al., (2012) reported the optimum conditions the hydrolysis of OPT was at concentration of 25% (w /v) with 0.3% (w/v) amylase, 0.6% (w /v) glucoamylase and 4% (w/v) cellulase. In the Figure 2 showed that optimum bioethanol produced at 48 hr after incubation,if time increased the biothanol decreased. According Roukas (1996), a decrease in the concentration of ethanol occur at excess glucose as substrate and product inhibition effects. Substrate concentration is too high reduces the amount of dissolved oxygen, although in very small amounts, oxygen is still needed in the fermentation by Saccaromyces cerevisiae to keep life in high cell concentrations (Nowak 2000, Tao et al. 2005). The results of the research can be conluded that the optimum enzymatic hydrolysis occured when the OPT added with amylase and cellulase and optimum bioethanol produced at 48 hr incubation using Saccharomyses cerevicea whereas 18.08 % bioethanol produced from glucose conversion. This work was funded by Directorate General of Higher Education (DGHE), Ministry of Education and Culture, contract no.245/SP2H/DIT.LimtabMas/II/2013

Keywords: oil palm trunk, enzymatic hydrolysis, saccharification

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Authors: Sharon Baoas, Toni Beninato, Michael Zenilman, Gokhan Ozuner

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Background An enhanced recovery after surgery (ERAS) protocol was implemented to improve quality and cost effectiveness of surgical care in elective colorectal procedures. Results A total of 109 patients, 55 (pre-ERAS) and 54 (post-ERAS) are included in the final analysis. There were no differences in complications were recorded (p = 0.37) and 30-day readmissions (p = 0.785). The mean hospital stay was 5.89 ± 2.62 days in pre-ERAS and 4.94 ± 2.27 days in post-ERAS group which was statistically significant (p = 0.047). Conclusions An ERAS protocol for colorectal surgery harmonised perioperative care and decreased length of stay.

Keywords: 30-day readmission, lenght of stay, Enhanced Recovery after surgery, Surgical site infection

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Authors: Sheillah Hlamalani Mboweni, Lufuno Makhado

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Background: The increasing number of people who tested HIV positive and who demand antiretroviral therapy (ART) prompted the National Department of Health to adopt WHO recommendations of task shifting where Professional Nurses(PNs) initiate ART rather than doctors in the hospital. This resulted in the decentralization of services to primary health care(PHC), generating a need to capacitate PNs on NIMART. After years of training, the impact of NIMART was assessed where it was established that even though there was an increased number who accessed ART, the quality of care is of serious concern. The study aims to answer the following question: What are the challenges influencing NIMART implementation in primary health care. Objectives: This study explores challenges influencing NIMART training and implementation and makes recommendations to improve patient and HIV program outcomes. Methods: A qualitative explorative program evaluation research design. The study was conducted in the rural districts of North West province. Purposive sampling was used to sample PNs trained on NIMART. FGDs were used to collect data with 6-9 participants and data was analysed using ATLAS ti. Results: Five FGDs, n=28 PNs and three program managers were interviewed. The study results revealed two themes: inadequacy in NIMART training and the health care system challenges. Conclusion: The deficiency in NIMART training and health care system challenges is a public health concern as it compromises the quality of HIV management resulting in poor patients’ outcomes and retard the goal of ending the HIV epidemic. These should be dealt with decisively by all stakeholders. Recommendations: The national department of health should improve NIMART training and HIV management: standardization of NIMART training curriculum through the involvement of all relevant stakeholders skilled facilitators, the introduction of pre-service NIMART training in institutions of higher learning, support of PNs by district and program managers, plan on how to deal with the shortage of staff, negative attitude to ensure compliance to guidelines. There is a need to develop a conceptual framework that provides guidance and strengthens NIMART implementation in PHC facilities.

Keywords: antiretroviral therapy, nurse initiated management of retroviral therapy, primary health care, professional nurses

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Authors: V. I. Kozyavkin, L. F. Shestopalova, T. B. Voloshyn

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Introduction: Rehabilitation of children with Autism is the issue of the day in psychiatry and neurology. It is attributed to constantly increasing quantity of autistic children - Autistic Spectrum Disorders (ASD) Existing rehabilitation approaches in treatment of children with Autism improve their medico- social and social- psychological adjustment. Experience of treatment for different kinds of Autistic disorders in International Clinic of Rehabilitation (ICR) reveals the necessity of complex intensive approach for healing this malady and wider implementation of a Kozyavkin method for treatment of children with ASD. Methods: 19 children aged from 3 to 14 years were examined. They were diagnosed ‘Autism’ (F84.0) with comorbid neurological pathology (from pyramidal insufficiency to para- and tetraplegia). All patients underwent rehabilitation in ICR during two weeks, where INRS approach was used. INRS included methods like biomechanical correction of the spine, massage, physical therapy, joint mobilization, wax-paraffin applications. They were supplemented by art- therapy, ergotherapy, rhythmical group exercises, computer game therapy, team Olympic games and other methods for improvement of motivation and social integration of the child. Estimation of efficacy was conducted using parent’s questioning and done twice- on the onset of INRS rehabilitation course and two weeks afterward. For efficacy assessment of rehabilitation of autistic children in ICR standardized tool was used, namely Autism Treatment Evaluation Checklist (ATEC). This scale was selected because any rehabilitation approaches for the child with Autism can be assessed using it. Results: Before the onset of INRS treatment mean score according to ATEC scale was 64,75±9,23, it reveals occurrence in examined children severe communication, speech, socialization and behavioral impairments. After the end of the rehabilitation course, the mean score was 56,5±6,7, what indicates positive dynamics in comparison to the onset of rehabilitation. Generally, improvement of psychoemotional state occurred in 90% of cases. Most significant changes occurred in the scope of speech (16,5 before and 14,5 after the treatment), socialization (15.1 before and 12,5 after) and behavior (20,1 before and 17.4 after). Conclusion: As a result of INRS rehabilitation course reduction of autistic symptoms was noted. Particularly improvements in speech were observed (children began to spell out new syllables, words), there was some decrease in signs of destructiveness, quality of contact with the surrounding people improved, new skills of self-service appeared. The prospect of the study is further, according to evidence- based medicine standards, deeper examination of INRS and assessment of its usefulness in treatment for Autism and ASD.

Keywords: intensive neurophysiological rehabilitation system (INRS), international clinic od rehabilitation, ASD, rehabilitation

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Authors: P. Nayak, Shakeel Shaikh

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In this paper, we analyse the apparel export performance of Southeast Asian Nations (ASEAN) in the world market. The study covers the 2003-2012 period at the sector as well as product levels (6 digit HS) and analysis is based HS 2002 nomenclature. We measure export similarity among Southeast Asian nations for the apparel sector (two digit HS-61 & 62), besides analysing the products performance in the world through Revealed Comparative Advantage (RCA) technique. Coupled with RCA, the price as a factor of competitiveness was examined from the available Unit Value Realizations (UVR). Further to this, the resource availability or outsourced from the region was considered as an extension to the analysis of competitiveness between the nations. With the help of these methodologies, we examine the degree of competition between the exports of southeast nations in the world market. Our results show that Cambodia, Indonesia, Thailand, and Vietnam are well performing states within ASEAN. The paper further delves into sustainability of the export performing countries within ASEAN.

Keywords: export competitiveness, export similarity index, revealed comparative advantage, unit value realisation

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Authors: Aritra Das, Tanmay Mahapatra, Prabir Maharana, Sridhar Srikantiah

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In the absence of adequate well-equipped neonatal-care facilities serving rural Bihar, India, the practice of essential home-based newborn-care remains critically important for reduction of neonatal and infant mortality, especially among pre-term and small-for-gestational-age (Low-birth-weight) newborns. To improve the child health parameters in Bihar, ‘Very-Low-Birth-Weight (vLBW) Tracking’ intervention is being conducted by CARE India, since 2015, targeting public facility-delivered newborns weighing ≤2000g at birth, to improve their identification and provision of immediate post-natal care. To assess the effectiveness of the intervention, 200 public health facilities were randomly selected from all functional public-sector delivery points in Bihar and various outcomes were tracked among the neonates born there. Thus far, one pre-intervention (Feb-Apr’2015-born neonates) and three post-intervention (for Sep-Oct’2015, Sep-Oct’2016 and Sep-Oct’2017-born children) follow-up studies were conducted. In each round, interviews were conducted with the mothers/caregivers of successfully-tracked children to understand outcome, service-coverage and care-seeking during the neonatal period. Data from 171 matched facilities common across all rounds were analyzed using SAS-9.4. Identification of neonates with birth-weight ≤ 2000g improved from 2% at baseline to 3.3%-4% during post-intervention. All indicators pertaining to post-natal home-visits by frontline-workers (FLWs) improved. Significant improvements between baseline and post-intervention rounds were also noted regarding mothers being informed about ‘weak’ child – at the facility (R1 = 25 to R4 = 50%) and at home by FLW (R1 = 19%, to R4 = 30%). Practice of ‘Kangaroo-Mother-Care (KMC)’– an important component of essential newborn care – showed significant improvement in postintervention period compared to baseline in both facility (R1 = 15% to R4 = 31%) and home (R1 = 10% to R4=29%). Increasing trend was noted regarding detection and birth weight-recording of the extremely low-birth-weight newborns (< 1500 g) showed an increasing trend. Moreover, there was a downward trend in mortality across rounds, in each birth-weight strata (< 1500g, 1500-1799g and >= 1800g). After adjustment for the differential distribution of birth-weights, mortality was found to decline significantly from R1 (22.11%) to R4 (11.87%). Significantly declining trend was also observed for both early and late neonatal mortality and morbidities. Multiple regression analysis identified - birth during immediate post-intervention phase as well as that during the maintenance phase, birth weight > 1500g, children of low-parity mothers, receiving visit from FLW in the first week and/or receiving advice on extra care from FLW as predictors of survival during neonatal period among vLBW newborns. vLBW tracking was found to be a successful and sustainable intervention and has already been handed over to the Government.

Keywords: weak newborn tracking, very low birth weight babies, newborn care, community response

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Authors: Md. Selim Reza, Mohammad Zohir Uddin

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Geophysical logging technique was conducted in a borehole in the north-western part of Bangladesh. The main objectives of this study were to identify the subsurface lithology and the presence of magnetic minerals within the basement complex. In this survey, full waveform sonic, magnetic susceptibility and natural gamma logs were conducted up to the depth of 660 m. From sonic log, three distinct velocity zones were observed at depths ranging from 20 m to 81 m, 81m to 360 m and 420 m to 660 m having the average velocity of 1600 m/s indicating unconsolidated sediment, 2500 m/s indicating hard, compact and matured sediments and 6300 m/s indicating basement complex respectively. Some low-velocity zones within the basement were identified as fractures/fissures. Natural gamma log was carried out only in the basement complex. According to magnetic susceptibility log, broadly three important zones were identified which had good agreement with the natural gamma, sonic as well as geological logs. The zone at the depth from 460 m to 470 m had the average susceptibility value of 3445 cgs unit. The average natural gamma value and sonic velocity in this zone are 150 cps and 3000 m/s respectively. The zone at the depth from 571 m to 598 m had the average susceptibility value of 5158 cgs unit with the average natural gamma value and sonic velocity are 160 cps and 6000 m/s respectively. On the other hand, the zone at the depth from 598 m to 620 m had the average susceptibility value of 1998 cgs unit with the average natural gamma value and sonic velocity show 200 cps and 3000 m/s respectively. From the interpretation of geophysical logs the 1st and 3rd zones within the basement complex are considered to be less significant whereas the 2nd zone is described as the most significant for magnetic minerals. Therefore, more drill holes are recommended on the anomalous body to delineate the extent, thickness and reserve of the magnetic body and further research are needed to determine the quality of mineral resources.

Keywords: basement complex, fractures/fissures, geophysical logging, lithology, magnetic susceptibility

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Authors: Zhongmin Wang, Wudong Fan, Hengshan Zhang, Yimin Zhou

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In data-driven prognostic methods, the prediction accuracy of the estimation for remaining useful life of bearings mainly depends on the performance of health indicators, which are usually fused some statistical features extracted from vibrating signals. However, the existing health indicators have the following two drawbacks: (1) The differnet ranges of the statistical features have the different contributions to construct the health indicators, the expert knowledge is required to extract the features. (2) When convolutional neural networks are utilized to tackle time-frequency features of signals, the time-series of signals are not considered. To overcome these drawbacks, in this study, the method combining convolutional neural network with gated recurrent unit is proposed to extract the time-frequency image features. The extracted features are utilized to construct health indicator and predict remaining useful life of bearings. First, original signals are converted into time-frequency images by using continuous wavelet transform so as to form the original feature sets. Second, with convolutional and pooling layers of convolutional neural networks, the most sensitive features of time-frequency images are selected from the original feature sets. Finally, these selected features are fed into the gated recurrent unit to construct the health indicator. The results state that the proposed method shows the enhance performance than the related studies which have used the same bearing dataset provided by PRONOSTIA.

Keywords: continuous wavelet transform, convolution neural net-work, gated recurrent unit, health indicators, remaining useful life

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Authors: S. Ozeri, D. Shmilovitz

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Micro‐Turbine Generators (MTG) are small size power plants that consist of a high speed, gas turbine driving an electrical generator. MTGs may be fueled by either natural gas or kerosene and may also use sustainable and recycled green fuels such as biomass, landfill or digester gas. The typical ratings of MTGs start from 20 kW up to 200 kW. The primary use of MTGs is for backup for sensitive load sites such as hospitals, and they are also considered a feasible power source for Distributed Generation (DG) providing on-site generation in proximity to remote loads. The MTGs have the compressor, the turbine, and the electrical generator mounted on a single shaft. For this reason, the electrical energy is generated at high frequency and is incompatible with the power grid. Therefore, MTGs must contain, in addition, a power conditioning unit to generate an AC voltage at the grid frequency. Presently, this power conditioning unit consists of a rectifier followed by a DC/AC inverter, both rated at the full MTG’s power. The losses of the power conditioning unit account to some 3-5%. Moreover, the full-power processing stage is a bulky and costly piece of equipment that also lowers the overall system reliability. In this study, we propose a new type of power conditioning stage in which only a small fraction of the power is processed. A low power converter is used only to program the rotor current (i.e. the excitation current which is substantially lower). Thus, the MTG's output voltage is shaped to the desired amplitude and frequency by proper programming of the excitation current. The control is realized by causing the rotor current to track the electrical frequency (which is related to the shaft frequency) with a difference that is exactly equal to the line frequency. Since the phasor of the rotation speed and the phasor of the rotor magnetic field are multiplied, the spectrum of the MTG generator voltage contains the sum and the difference components. The desired difference component is at the line frequency (50/60 Hz), whereas the unwanted sum component is at about twice the electrical frequency of the stator. The unwanted high frequency component can be filtered out by a low-pass filter leaving only the low-frequency output. This approach allows elimination of the large power conditioning unit incorporated in conventional MTGs. Instead, a much smaller and cheaper fractional power stage can be used. The proposed technology is also applicable to other high rotation generator sets such as aircraft power units.

Keywords: gas turbine, inverter, power multiplier, distributed generation

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Authors: Kaleeswari R. K., Seevagan L .

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Soil quality in an agroecosystem is influenced by the cropping system, water and soil fertility management. A valid soil quality index would help to assess the soil and crop management practices for desired productivity and soil health. The soil quality indices also provide an early indication of soil degradation and needy remedial and rehabilitation measures. Imbalanced fertilization and inadequate organic carbon dynamics deteriorate soil quality in an intensive cropping system. The rice soil ecosystem is different from other arable systems since rice is grown under submergence, which requires a different set of key soil attributes for enhancing soil quality and productivity. Assessment of the soil quality index involves indicator selection, indicator scoring and comprehensive score into one index. The most appropriate indicator to evaluate soil quality can be selected by establishing the minimum data set, which can be screened by linear and multiple regression factor analysis and score function. This investigation was carried out in intensive rice cultivating regions (having >1.0 lakh hectares) of Tamil Nadu viz., Thanjavur, Thiruvarur, Nagapattinam, Villupuram, Thiruvannamalai, Cuddalore and Ramanathapuram districts. In each district, intensive rice growing block was identified. In each block, two sampling grids (10 x 10 sq.km) were used with a sampling depth of 10 – 15 cm. Using GIS coordinates, and soil sampling was carried out at various locations in the study area. The number of soil sampling points were 41, 28, 28, 32, 37, 29 and 29 in Thanjavur, Thiruvarur, Nagapattinam, Cuddalore, Villupuram, Thiruvannamalai and Ramanathapuram districts, respectively. Principal Component Analysis is a data reduction tool to select some of the potential indicators. Principal Component is a linear combination of different variables that represents the maximum variance of the dataset. Principal Component that has eigenvalues equal or higher than 1.0 was taken as the minimum data set. Principal Component Analysis was used to select the representative soil quality indicators in rice soils based on factor loading values and contribution percent values. Variables having significant differences within the production system were used for the preparation of the minimum data set. Each Principal Component explained a certain amount of variation (%) in the total dataset. This percentage provided the weight for variables. The final Principal Component Analysis based soil quality equation is SQI = ∑ i=1 (W ᵢ x S ᵢ); where S- score for the subscripted variable; W-weighing factor derived from PCA. Higher index scores meant better soil quality. Soil respiration, Soil available Nitrogen and Potentially Mineralizable Nitrogen were assessed as soil quality indicators in rice soil of the Cauvery Delta zone covering Thanjavur, Thiruvavur and Nagapattinam districts. Soil available phosphorus could be used as a soil quality indicator of rice soils in the Cuddalore district. In rain-fed rice ecosystems of coastal sandy soil, DTPA – Zn could be used as an effective soil quality indicator. Among the soil parameters selected from Principal Component Analysis, Microbial Biomass Nitrogen could be used quality indicator for rice soils of the Villupuram district. Cauvery Delta zone has better SQI as compared with other intensive rice growing zone of Tamil Nadu.

Keywords: soil quality index, soil attributes, soil mapping, and rice soil

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Authors: Guowei Hou, Lixin Yu, Wei Zhuang, Hui Qin, Xue Yang

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Formal verification is proposed to ensure the correctness of the design and make functional verification more efficient. As cache plays a vital role in the design of System on Chip (SoC), and cache with Memory Management Unit (MMU) and cache memory unit makes the state space too large for simulation to verify, then a formal verification is presented for such system design. In the paper, a formal model checking verification flow is suggested and a new cache memory model which is called “exhaustive search model” is proposed. Instead of using large size ram to denote the whole cache memory, exhaustive search model employs just two cache blocks. For cache system contains data cache (Dcache) and instruction cache (Icache), Dcache memory model and Icache memory model are established separately using the same mechanism. At last, the novel model is employed to the verification of a cache which is module of a custom-built SoC system that has been applied in practical, and the result shows that the cache system is verified correctly using the exhaustive search model, and it makes the verification much more manageable and flexible.

Keywords: cache system, formal verification, novel model, system on chip (SoC)

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Authors: S. M. Ahuja

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A Rice Sheller is used for obtaining polished white rice from paddy. There are about 3000 Rice Shellers in Punjab and 50000 in India. During the process of shelling lot of dust is emitted from different unit operations like paddy silo, paddy shaker, bucket elevators, huskers, paddy separator etc. These dust emissions have adverse effect on the health of the workers and the wear and tear of the shelling machinery is also fast. All the dust emissions spewing out of these unit operations of a rice Sheller were contained by providing suitable hoods and enclosures while ensuring their workability. These were sucked by providing an induced draft fan followed by a high efficiency cyclone separator that has got an overall dust collection efficiency of more than 90 %. This cyclone separator replaced two cyclone separators and a filter bag house, which the Rice Sheller was already having. The dust concentration in the stack after the installation of cyclone separator is well within the stipulated standards. Besides controlling pollution there is improvement in the quality of products like bran and the life of shelling machinery has also enhanced. The payback period of this technology is less than four shelling months.

Keywords: air pollution, cyclone separator, pneumatic conveying, rice shellers

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Authors: Helen Coronel, Will Brewer, Peggy Bergeron, Clarissa Hall, Victoria Casson

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Simulation-based training provides the nurse practitioner (NP) student with a safe and controlled environment in which they can practice a real-life scenario. This type of learning fosters critical thinking skills essential to practice. The expectation of this study was that students would have an increase in their competency and confidence after performing the simulation. Approximately 8.4% of Americans suffer from depression. The state of Alabama is ranked 47th out of 50 for access to mental health care. As a result of this significant shortage of mental health providers, primary care providers are frequently put in the position of screening for and treating mental health conditions, such as depression. Family nurse practitioners are often utilized as primary care providers, making their ability to assess, diagnose and treat these disorders a necessary skill. The expected outcome of this simulation is an increase in confidence, competency and the empowerment of the nurse practitioner student’s ability to assess, diagnose and treat a common mood disorder they may encounter in practice. The Kirkpatrick Module was applied for this study. A non-experimental design using descriptive statistical analysis was utilized. The simulation was based on a common psychiatric mood disorder frequently observed in primary care and mental health clinics. Students were asked to watch a voiceover power point presentation prior to their on-campus simulation. The presentation included training on the assessment, diagnosis, and treatment of a patient with depression. Prior to the simulation, the students completed a pre-test, then participated in the simulation, and completed a post-test when done. Apple iPads were utilized to access a simulated health record. Major findings of the study support an increase in students’ competency and confidence when assessing, diagnosing, and treating an adult patient with depression.

Keywords: advanced practice, nurse practitioner, simulation, primary care, depression

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Authors: Nithiya C., Komathi B. J., Praveena N. G., Samuda Prathima

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At present, the ultimate aim in digital system designs, especially at the gate level and lower levels of design abstraction, is power optimization. Adders are a nearly universal component of today's integrated circuits. Most of the research was on the design of high-speed adders to execute addition based on various adder structures. This paper discusses the ideal path for selecting an arithmetic unit for IoT applications. Based on the analysis of eight types of 16-bit adders, we found out Carry Look-ahead (CLA) produces low power. Additionally, multiplier and accumulator (MAC) unit is implemented with the Booth multiplier by using the low power adders in the order of preference. The design is synthesized and verified using Synopsys Design Compiler and VCS. Then it is implemented by using Cadence Encounter. The total power consumed by the CLA based booth multiplier is 0.03527mW, the total area occupied is 11260 um², and the speed is 2034 ps.

Keywords: carry look-ahead, carry select adder, CSA, internet of things, ripple carry adder, design rule check, power delay product, multiplier and accumulator

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Authors: Orawan Vichiansan, J. Kraipoj, K.Phandech, P. Sirasaporn

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Generally, frozen shoulder will improve over time, although it may take a long time up to year. The symptoms of frozen shoulder present by pain around shoulder and consequently limit range of motions. The effect of frozen shoulder leads to limit activities daily living life and high medical care cost. Physiotherapy is well known treatment for frozen shoulder but there was no data about the treatment of physiotherapy in frozen shoulder and length of follow up. Thus the aim of this study was to investigate physiotherapy program for frozen shoulder on range of motion and length of follow up. A retrospective study design was conducted. 469 medical records of patients with frozen shoulder were reviewed. These frozen shoulders were treated at physiotherapy unit, department of Rehabilitation last 3 years (January, 2014- December, 2016). The data consist of range of motions and length of follow up was recorded. The medical record of 183 males and 286 females with average aged 57.82±12.32 years were reviewed in this study. There was a statistically significant increase in shoulder flexion [mean difference 30.24 with 95%CI were [24.37-36.12], shoulder abduction [mean difference 34.93 with 95%CI were 27.8-42.0], shoulder internal rotation [mean difference 17.25 with 95%CI were 12.55-21.95] and shoulder external rotation [mean difference 17.71 with 95%CI were [13.07-22.36] respectively. In addition, the length of follow up averaged 84 days. In summary, the retrospective study show physiotherapy program likely to be benefit for patients with frozen shoulder in term of range of motion and short length of follow up.

Keywords: frozen shoulder, physiotherapy, range of motions, length of follow up

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Authors: Sadeq Al Yaari, Fayza Alhammadi, Ayman Al Yaari, Montaha Al Yaari, Aayah Al Yaari, Adham Al Yaari, Sajedah Al Yaari, Saleh Al Yami

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Background: There has been a debate in the literature over the years as to whether or not MossTalk Words program fits Arab Broca’s aphasics (BAs) due to that language differences and also the fact that the technique has not yet been used for aphasics with semantic dementia (SD aphasics). Aims: To oversimplify the above mentioned debate slightly for purposes of exposition, the purpose of the present study is to investigate the “usability” of this program as well as pictures and community as therapeutic techniques for both Arab BAs and SD aphasics. Method: The subjects of this study are two Saudi aphasics (53 and 57 years old, respectively). The former suffers from Broca’s aphasia due to a stroke, while the latter suffers from semantic dementia. Both aphasics can speak English and have used the Moss Talk Words program in addition to intensive picture-naming therapeutic sessions for two years. They were tested by one of the researchers four times (a time per six months). The families of the two subjects, in addition to their relatives and friends, played a major part in all therapeutic sessions. Conclusion: Results show that in averages across the entire therapeutic sessions, MossTalk Words program was clearly found more effective in modeling BAs’ pronunciation than that of SD aphasic. Furthermore, picture-naming intensive exercises in addition to the positive role of the community members played a major role in the progress of the two subjects’ performance.

Keywords: moss talk words, program, technique, Broca’s aphasia, semantic dementia, subjects, picture, community

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Authors: Jaejeogn Kim, Jeongmin Hong, Jungin Lee

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The Hydrogen Storage System Management Unit (HMU) is a controller that manages hydrogen charging and storage. It detects hydrogen leaks and tank pressure and temperature, calculates the charging concentration and remaining amount, and controls the opening and closing of the hydrogen tank valve. Since this role is an important part of the vehicle behavior and stability of Fuel Cell Electric Vehicles (FCEV), verifying the HMU controller is an essential part. To perform verification under various conditions, it is necessary to increase time efficiency based on an automated verification environment and increase the reliability of the controller by applying numerous test cases. To this end, we introduce the HMU controller automation verification method by applying the HILS environment and an automation test program with the ASAM XIL standard.

Keywords: HILS, ASAM, fuel cell electric vehicle, automation test, hydrogen storage system

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Authors: Prama Mukhopadhyay, Rishika Mukhopadhyay

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The twentieth century has seen the world getting divided into three distinct blocks, created by the proponents of the mainstream developmental discourse. India, which has now gained the label of being a ‘developing nation’, stands in between these three groups, as it constantly tries to ‘catch up’ and emulate the developmental standards of the ‘west’. In this endeavour, we find our country trying really hard to blindly replicate the health care infrastructures of the ‘first worlds’, without realizing the needs of evaluating the ground reality. In such a situation, the sudden outbreak of child death in the district of Malda, WB, poses an obvious questions towards the kind of development that our country has been engaging in, ever since its Post Colonial inception. Through this paper we thus try to understand the harsh veracity of the health care facility that exists in rural Bengal, and thereby challenge the conventional notion of ‘health-care’ as is normally discussed in the mainstream developmental discourse. Grounding our research work on detailed ethnography and through the help of questionnaire, interviews and focus group discussions with the local government officials(BDOs), health workers (ICDS, ASHA workers, ANHM and BMOHs) and members of families with experiences of child deaths, we have tried to find out the real and humane factors behind the sudden rise of reported infant deaths in the district, issues which are normally neglected and left out while discussing and evaluating IMR in the mainstream studies on health care and planning in our nation. Therefore the main aim of this paper is to try and look at child death from a ‘wider perspective’, where it is seen from an eye not bounded by the common registers of caste, class and religion. This paper, would thus be an eye opener in some sense, bringing in stories from the rural belt of the country; where the people are regularly torn between the binaries of the developing and shining modernity of ‘India’ which now gets ready to run the last lap and gain the status of becoming a ‘developed nation’ by 2020, and the staggering, dark traditional ‘ Bharat, which lags behind.

Keywords: child mortality, development discourse, health care, tradition and modernity

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Authors: Gianluca Castelnuovo, Giada Pietrabissa, Gian Mauro Manzoni, Margherita Novelli, Emanuele Maria Giusti, Roberto Cattivelli, Enrico Molinari

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Diabesity could be defined as a new global epidemic of obesity and being overweight with many complications and chronic conditions. Such conditions include not only type 2 diabetes, but also cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer, and various psychosocial and psychopathological disorders. The financial direct and indirect burden (considering also the clinical resources involved and the loss of productivity) is a real challenge in many Western health-care systems. Recently the Lancet journal defined diabetes as a 21st-century challenge. In order to promote patient compliance in diabesity treatment reducing costs, evidence-based interventions to improve weight-loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. Moreover, new technologies can provide useful solutions in this multidisciplinary approach, above all in maintaining long-term compliance and adherence in order to ensure clinical efficacy. Psychological therapies with diet and exercise plans could better help patients in achieving weight loss outcomes, both inside hospitals and clinical centers and during out-patient follow-up sessions. In the management of chronic diseases clinical psychology play a key role due to the need of working on psychological conditions of patients, their families and their caregivers. mHealth approach could overcome limitations linked with the traditional, restricted and highly expensive in-patient treatment of many chronic pathologies: one of the best up-to-date application is the management of obesity with type 2 diabetes, where mHealth solutions can provide remote opportunities for enhancing weight reduction and reducing complications from clinical, organizational and economic perspectives. A stepped care mHealth-based approach is an interesting perspective in chronic care management of obesity with type 2 diabetes. One promising future direction could be treating obesity, considered as a chronic multifactorial disease, using a stepped-care approach: -mhealth or traditional based lifestyle psychoeducational and nutritional approach. -health professionals-driven multidisciplinary protocols tailored for each patient. -inpatient approach with the inclusion of drug therapies and other multidisciplinary treatments. -bariatric surgery with psychological and medical follow-up In the chronic care management of globesity mhealth solutions cannot substitute traditional approaches, but they can supplement some steps in clinical psychology and medicine both for obesity prevention and for weight loss management.

Keywords: clinical health psychology, mhealth, obesity, type 2 diabetes, stepped care, chronic care management

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Authors: Nicolas Galazis, Nikolina Docheva, Constantinos Simillis, Kypros Nicolaides

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Background: Obese women are at increased risk for many pregnancy complications, and bariatric surgery (BS) before pregnancy has shown to improve some of these. Objectives: To review the current literature and quantitatively assess the obstetric and neonatal outcomes in pregnant women who have undergone BS. Search Strategy: MEDLINE, EMBASE and Cochrane databases were searched using relevant keywords to identify studies that reported on pregnancy outcomes after BS. Selection Criteria: Pregnancy outcome in firstly, women after BS compared to obese or BMI-matched women with no BS and secondly, women after BS compared to the same or different women before BS. Only observational studies were included. Data Collection and Analysis: Two investigators independently collected data on study characteristics and outcome measures of interest. These were analysed using the random effects model. Heterogeneity was assessed and sensitivity analysis was performed to account for publication bias. Main Results: The entry criteria were fulfilled by 17 non-randomised cohort or case-control studies, including seven with high methodological quality scores. In the BS group, compared to controls, there was a lower incidence of preeclampsia (OR, 0.45, 95% CI, 0.25-0.80; p=0.007), GDM (OR, 0.47, 95% CI, 0.40-0.56; P<0.001) and large neonates (OR 0.46, 95% CI 0.34-0.62; p<0.001) and a higher incidence of small neonates (OR 1.93, 95% CI 1.52-2.44; p<0.001), preterm birth (OR 1.31, 95% CI 1.08-1.58; p=0.006), admission for neonatal intensive care (OR 1.33, 95% CI 1.02-1.72; p=0.03) and maternal anaemia (OR 3.41, 95% CI 1.56-7.44, p=0.002). Conclusions: BS as a whole improves some pregnancy outcomes. Laparoscopic adjustable gastric banding does not appear to increase the rate of small neonates that was seen with other BS procedures. Obese women of childbearing age undergoing BS need to be aware of these outcomes.

Keywords: bariatric surgery, pregnancy, preeclampsia, gestational diabetes, birth weight

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Authors: Kadhim Alabady

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Purpose: Mental health problems affect women and men equally, but some are more common among women. To Provide a baseline of the current picture of major mental health challenges among women in Dubai. which can then be used to measure the impact of interventions or service development. Method: We have used mixed methods evaluation approaches. This was used to increase the validity of findings by using a variety of data collection techniques. We have integrated qualitative and quantitative methods in this piece of work. Conducting the two approaches is to explore issues that might not be highlighted enough through one method. Results: The key findings are: The prevalence of people who suffer from different types of mental disorders remains largely unknown, many women are unwilling to seek professional help because of lack of awareness or the stigma attached to it. -It is estimated there were around 2,928–4,392 mothers in Dubai (2014) suffering from postnatal depression of which 858–1,287, early intervention can be effective. -The system for managing health care for women with mental illness is fragmented and contains gaps and duplications. -It is estimated 1,029 girl aged 13–19 years affected with anorexia nervosa and there would be an estimated 1,029 girl aged 13–19 years affected with anorexia nervosa. Recommendations: -Work is required with primary health care in order to identify women with undiagnosed mental illnesses. Further work is undertaken within primary health care to assess disease registries with the aim of helping GP practices to improve their disease registers. -It is important to conduct local psychiatric morbidity surveys in Dubai to obtain data and assess the prevalence of essential mental health symptoms and conditions that are not routinely collected to get a clear sense of what is needed and to assist decision and policy making in getting a complete picture on what services are required. -Emergency Mental Health Care – there is a need for a crisis response team to respond to emergencies in the community. -Continuum of care – a significant gap in the services for women once they diagnosed with mental disorder.

Keywords: mental health, depression, schizophrenia, women

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Authors: Priscila A. Bernardes, Marcos E. Buzanskas, Luciana C. A. Regitano, Ricardo V. Ventura, Danisio P. Munari

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The best linear unbiased predictor (BLUP) is a method commonly used in genetic evaluations of breeding programs. However, this approach can lead to higher inbreeding coefficients in the population due to the intensive use of few bulls with higher genetic potential, usually presenting some degree of relatedness. High levels of inbreeding are associated to low genetic viability, fertility, and performance for some economically important traits and therefore, should be constantly monitored. Unreliable pedigree data can also lead to misleading results. Genomic information (i.e., single nucleotide polymorphism – SNP) is a useful tool to estimate the inbreeding coefficient. Runs of homozygosity have been used to evaluate homozygous segments inherited due to direct or collateral inbreeding and allows inferring population selection history. This study aimed to evaluate runs of homozygosity (ROH) and inbreeding in a population of Nelore beef cattle. A total of 814 animals were genotyped with the Illumina BovineHD BeadChip and the quality control was carried out excluding SNPs located in non-autosomal regions, with unknown position, with a p-value in the Hardy-Weinberg equilibrium lower than 10⁻⁵, call rate lower than 0.98 and samples with the call rate lower than 0.90. After the quality control, 809 animals and 509,107 SNPs remained for analyses. For the ROH analysis, PLINK software was used considering segments with at least 50 SNPs with a minimum length of 1Mb in each animal. The inbreeding coefficient was calculated using the ratio between the sum of all ROH sizes and the size of the whole genome (2,548,724kb). A total of 25.711 ROH were observed, presenting mean, median, minimum, and maximum length of 3.34Mb, 2Mb, 1Mb, and 80.8Mb, respectively. The number of SNPs present in ROH segments varied from 50 to 14.954. The longest ROH length was observed in one animal, which presented a length of 634Mb (24.88% of the genome). Four bulls were among the 10 animals with the longest extension of ROH, presenting 11% of ROH with length higher than 10Mb. Segments longer than 10Mb indicate recent inbreeding. Therefore, the results indicate an intensive use of few sires in the studied data. The distribution of ROH along the chromosomes showed that chromosomes 5 and 6 presented a large number of segments when compared to other chromosomes. The mean, median, minimum, and maximum inbreeding coefficients were 5.84%, 5.40%, 0.00%, and 24.88%, respectively. Although the mean inbreeding was considered low, the ROH indicates a recent and intensive use of few sires, which should be avoided for the genetic progress of breed.

Keywords: autozygosity, Bos taurus indicus, genomic information, single nucleotide polymorphism

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Authors: Mohamedou El Boukhary, Farba Bouyagui Tamboura, A. Hamady Barry, T. Moussa Seck, Mohamed L. Gaye

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Nowadays, low-schiff acyl-hydrazone ligands are highly sought after due to their wide applications in various fields of biology, coordination chemistry, and catalysis. They are studied for their antioxidant, antibacterial and antiviral properties. The complexes of transition metals and the lanthanide they derive are well known for their magnetic, optical, and catalytic properties. In this work, we present the synthesis of an acyl-hydrazone (H2L) schiff base and their 3d transition complexes. The ligand (H2L) is characterized by IR, NMR (1H; 13C) spectroscopy. The complexes are characterized by different physic-chemical techniques such as IR, UV-visible, conductivity, measurement of magnetic susceptibility. The study of XRD allowed us to elucidate the crystalline structure of the manganese (Mn) complex. The asymmetric unit of the complex is composed of two molecules of the ligand, one manganese (II) ion, and two coordinate chloride ions; the environment around Mn is described as a pentagonal base bipyramid. In the crystal lattice, the asymmetric unit is bound by hydrogen bonds.

Keywords: synthene, acyl-hydrazone, 3D transition metal complex, application

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Authors: Areej Al-Hamad, Cheryl Forchuk, Abe Oudshoorn, Gerald Patrick Mckinley

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Syrian refugee women face many obstacles when accessing health services in host countries that are influenced by various cultural, structural, and practical factors. This paper is based on critical ethnographic research undertaken in Canada to explore Syrian refugee women's migration experiences. Also, we aim to critically examine how the intersection of gender, trauma, violence and the political and economic conditions of Syrian refugee women shapes their everyday lives and health. The study also investigates the strategies and practices by which Syrian refugee women are currently addressing their healthcare needs and the models of care that are suggested for meeting their physical and mental health needs. Findings show that these women experienced constant worries, hardship, vulnerability, and intrusion of dignity. These experiences and challenges were aggravated by the structure of the Canadian social and health care system. This study offers a better understanding of the impact of migration and trauma on Syrian refugee women's roles, responsibilities, gender dynamics, and interaction with Ontario's healthcare system to improve interaction and outcomes. Health care models should address these challenges among Syrian refugee families in Canada.

Keywords: Syrian refugee women, intersectionality, critical ethnography, migration

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Authors: Tanit Pruktara

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The research aimed to study the students’ learning achievement and awareness level on electrical energy consumption and conservation and also to investigate the students’ attitude on the developed multimedia supplemented instructional unit for learning household electrical energy consumption and conservation in grade 10 Thailand student. This study used a quantitative method using MCQ for pre and post-achievement tests and Likert scales for awareness and attitude survey questionnaires. The results from this were employed to improve the multimedia to be appropriate for the classroom and with real life situations in the second phase, the main study. The experimental results showed that the developed learning unit significantly improved the students’ learning achievement as well as their awareness of electric energy conservation. Additional we found the student will enjoy participating in class activities when the lessons are taught using multimedia and helps them to develop the relevance between the course and real world situations.

Keywords: lesson plan, media and animations, training course, vocational school in Thailand

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Authors: Roseanne Sharon Borromeo, Mariana Carvalho, Mariia Karizhenskaia

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Healthcare providers need to comprehend cultural diversity for optimal patient-centered care, especially near the end of life. Although a universal method for navigating cultural differences would be ideal, culture’s high complexity makes this strategy impossible. Adding cultural humility, a process of self-reflection to understand personal and systemic biases and humbly acknowledging oneself as a learner when it comes to understanding another's experience leads to a meaningful process in palliative care generating respectful, honest, and trustworthy relationships. This study is a systematic review of the literature on cultural humility in palliative care research and best practices. Race, religion, language, values, and beliefs can affect an individual’s access to palliative care, underscoring the importance of culture in palliative care. Cultural influences affect end-of-life care perceptions, impacting bereavement rituals, decision-making, and attitudes toward death. Cultural factors affecting the delivery of care identified in a scoping review of Canadian literature include cultural competency, cultural sensitivity, and cultural accessibility. As the different parts of the world become exponentially diverse and multicultural, healthcare providers have been encouraged to give culturally competent care at the bedside. Therefore, many organizations have made cultural competence training required to expose professionals to the special needs and vulnerability of diverse populations. Cultural competence is easily standardized, taught, and implemented; however, this theoretically finite form of knowledge can dangerously lead to false assumptions or stereotyping, generating poor communication, loss of bonds and trust, and poor healthcare provider-patient relationship. In contrast, Cultural humility is a dynamic process that includes self-reflection, personal critique, and growth, allowing healthcare providers to respond to these differences with an open mind, curiosity, and awareness that one is never truly a “cultural” expert and requires life-long learning to overcome common biases and ingrained societal influences. Cultural humility concepts include self-awareness and power imbalances. While being culturally competent requires being skilled and knowledgeable in one’s culture, being culturally humble involves the sometimes-uncomfortable position of healthcare providers as students of the patient. Incorporating cultural humility emphasizes the need to approach end-of-life care with openness and responsiveness to various cultural perspectives. Thus, healthcare workers need to embrace lifelong learning in individual beliefs and values on suffering, death, and dying. There have been different approaches to this as well. Some adopt strategies for cultural humility, addressing conflicts and challenges through relational and health system approaches. In practice and research, clinicians and researchers must embrace cultural humility to advance palliative care practices, using qualitative methods to capture culturally nuanced experiences. Cultural diversity significantly impacts patient-centered care, particularly in end-of-life contexts. Cultural factors also shape end-of-life perceptions, impacting rituals, decision-making, and attitudes toward death. Cultural humility encourages openness and acknowledges the limitations of expertise in one’s culture. A consistent self-awareness and a desire to understand patients’ beliefs drive the practice of cultural humility. This dynamic process requires practitioners to learn continuously, fostering empathy and understanding. Cultural humility enhances palliative care, ensuring it resonates genuinely across cultural backgrounds and enriches patient-provider interactions.

Keywords: cultural competency, cultural diversity, cultural humility, palliative care, self-awareness

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