Search results for: consultation time

Authors: Jaspinder Kaur, Jatinder Pal Singh

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Introduction- Delusional parasitosis is a rare psychotic illness characterized by a fixed belief of manifesting a parasite in a body when in reality, it was not. Also known as Ekbom syndrome or delusional infestations, or acarophobia. Although the patient has no primary skin pathology, but all skin findings were secondary to skin manipulation by the patient itself, which is why up to 90% of patients first seek consultation from a dermatologist. Most commonly, it was seen in older people with female to male ratio is 2:1. For treatment, the patient first need to be investigated to rule all other possible causes, as Delusional parasitosis can be caused by Vitamin B12 deficiency, pellagra, hepatic and renal disease, diabetes mellitus, multiple sclerosis, and leprosy. When all possible causes ruled out, psychiatric referral to be done. Rule out other psychiatric comorbidities, and treatment should be done accordingly. Patient with delusional parasitosis responds well to second generation antipsychotics and need to continuous medication over years, and relapse is likely if treatment is stopped. Case Presentation- A 79-year-old female, belonging to lower socio-economic status, presented with complaints of itching sensation with erythematous patches over the scalp and multiple scratch excoriations lesion over the scalp, face and neck from the past 7-8 months. She had a feeling of small insect crawling under her skin and scalp area. To reduce the itching and kill the insect, she would scratch and squeeze her skin repeatedly. When the family tried to give her explanation that there was no insect in her body, she would not get convinced, rather got angry and abuse family members for not believing her. Gradually, her sleep would remain disturbed, she would be seen awake at night, seen to be scratching her skin, pull her scalp hair, even squeeze out her healed lesions. She collected her skin debris, scalp hairs and look out for insect. Because of her continuous illness, the patient started to remain sad and had crying spells. Her appetite decreased. She became socially isolated and stopped doing her activities of daily living. Family member’s first consulted dermatologist, investigated thoroughly with routine investigations, autoimmune and malignancy workup. As all investigations were normal, following which patient was referred for psychiatric evaluation. The patient was started on Tablet Olanzapine 2.5 mg, gradually increased to 7.5 mg. Over 1 month, there was reduction in itching, skin pricking. Lesions were gradually healed, and the patient continued to take other dermatological medications and ointment and was in regular follow up with psychiatric liaison from past 2 months with 70-80 % improvement in her symptoms. Conclusion- Delusional parasitosis is a psychiatric disorder of insidious onset, seen commonly in middle and old age people. Both psychiatric and dermatology consultation liaison will help the patient for an early diagnosis and adequate treatment. If a primary psychiatric diagnosis, the patient respond well to second generation antipsychotics but always require a further evaluation and treatment management if it is secondary to some physical or other psychiatric comorbidity.

Keywords: delusional parasitosis, delusional infestations, rare, primary psychiatric diagnosis, antipsychotic agents

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Authors: Shagufta Tabassum, V. P. Pawar, jr., G. N. Shinde

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The study of dielectric relaxation properties of polar liquids in the binary mixture has been carried out at 10, 15, 20 and 25 ºC temperatures for 11 different concentrations using time domain reflectometry technique. The dielectric properties of a solute-solvent mixture of polar liquids in the frequency range of 10 MHz to 30 GHz gives the information regarding formation of monomers and multimers and also an interaction between the molecules of the liquid mixture under study. The dielectric parameters have been obtained by the least squares fit method using the Debye equation characterized by a single relaxation time without relaxation time distribution.

Keywords: excess properties, relaxation time, static dielectric constant, and time domain reflectometry technique

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Authors: Parimalakrishnan Sundararjan, Madheswaran Murugan, Dhanya Dharman, Yatindra Kumar, Sudhir Singh Gangwar, Guru Prasad Mohanta

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Antibiotic resistance AR is a global issue, India started to redress the issues of antibiotic resistance late and it plans to have: active surveillance of microbial resistance and promote appropriate use of antibiotics. The present study attempted to achieve appropriate use of antibiotics through pharmacists’ intervention at practice point. In a quasi-experimental prospective cohort study, the cases with bacteremia from four hospitals were identified during 2015 and 2016 for intervention. The pharmacists centered intervention: active screening of each prescription and comparing with the selection of antibiotics with susceptibility of the bacteria. Wherever irrationality noticed, it was brought to the notice of the treating physician for making changes. There were two groups: intervention group and control group without intervention. The active screening and intervention in 915 patients has reduced therapeutic regimen time in patients with bacteremia. The intervention group showed the decreased duration of hospital stay 3.4 days from 5.1 days. Further, multivariate modeling of patients who were in control group showed that patients in the intervention group had a significant decrease in both duration of hospital stay and infection-related mortality. Unlike developed countries, pharmacists are not active partners in patient care in India. This unique attempt of pharmacist’ invention was planned in consultation with hospital authorities which proved beneficial in terms of reducing the duration of treatment, hospital stay, and infection-related mortality. This establishes the need for a collaborative decision making among the health workforce in patient care at least for promoting rational use of antibiotics, an attempt to combat resistance.

Keywords: antibiotics resistance, intervention, bacteremia, multivariate modeling

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Authors: Ewa Siedlecka

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Emotional stress is an important risk factor in the rate and severity of traffic accidents. Moreover, incorrect time perception is implicated in the increase of traffic violations, such as running red lights or collisions. While the role of emotional arousal on perceived time is well-established, the role of physiological arousal in time perception remains unexamined. Specific emotions can be, however, associated with distinct physiological responses. In the current research, two studies examined the role of physiological arousal in time perception. In the first experiment, 41 participants engaged in a cold pressor task and had their time perception measured throughout the experiment. In the second study, 138 participants engaged in either isometric or deep breathing exercises. These activities were designed to simulate the sympathetic and parasympathetic nervous systems, respectively. Participants completed a bisection task to measure time perception in both studies, as well as a physiological response via an Electrocardiography (ECG). Results found that activation of the parasympathetic nervous system is associated with greater time perception. These findings are discussed with reference to models of time perception, as well as implications for emotional driving and misperceptions of speed. It is important to consider the role of physiology in the misperception of time, as these factors can lead to increases in driving accidents.

Keywords: emotions, nervous system, physiology, time perception

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Authors: Barbara Pittau, Piergiorgio Palla, Antonio Mastino

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Communication is fundamental to health education. The proper use of medicinal products is a crucial aspect of the health of citizens that affects both safety and health care spending. Therefore, encouraging/promoting communication, concerning the importance of proper use of pharmaceuticals, has substantial implications in terms of individual health, health care, and health care system sustainability. In view of these considerations, in the context of two projects, one of which is still in progress, a relational database-backed web application named COLLABORAFARMACISOLA has been designed and developed as a tool to analyze and visualize how people approach the use of medicinal products, with the aim of improving and enhancing communication efficacy. The software application is being used to collect information (anonymously and voluntarily) from the citizens of Sardinia, an Italian region, regarding their knowledge, experiences, and opinions towards pharmaceuticals. This study that was conducted to date on thousand of interviewed people, has focused on different aspects such as: the treatment interruption and the "self-prescription” without medical consultation, the attention paid to reading the leaflets, the awareness of the economic value of the pharmaceuticals, the importance of avoiding the waste of medicinal products and the attitudes towards the use of generics. To this purpose, our software application provides a set of ad hoc parsing routines, to store information into the structure of a relational database and to process and visualize it through a set of interactive tools aimed to emphasize the findings and the insights obtained. The results of our preliminary analysis show the efficacy of the awareness plan and, at the same time, the criticality and the needs of the territory under examination. The ultimate goal of our study is to provide a contribution to the community by improving communication that can result in a benefit for public health in a context strictly connected to the reality of the territory.

Keywords: communication, pharmaceuticals, public health, relational database, tool, web application

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Authors: M. Kollar, A. Zieba

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In this paper, we present a method for a time synchronization between the two eNodeBs (eNBs) in E-UTRAN (Evolved Universal Terrestrial Radio Access) network. The two eNBs are cooperating in so-called inter eNB CA (Carrier Aggregation) case and connected via asymmetrical IP network. We solve the problem by using broadcasting signals generated in E-UTRAN as synchronization signals. The results show that the time synchronization with the proposed method is possible with the error significantly less than 1 ms which is sufficient considering the time transmission interval is 1 ms in E-UTRAN. This makes this method (with low complexity) more suitable than Network Time Protocol (NTP) in the mobile applications with generated broadcasting signals where time synchronization in asymmetrical network is required.

Keywords: IP scheduled throughput, E-UTRAN, Evolved Universal Terrestrial Radio Access Network, NTP, Network Time Protocol, assymetric network, delay

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Authors: Shishir Kumar, Chhaya Gangwal, Seema Raj

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Public health informatics (PHI) which has seen successful implementation in the developed world, become the buzzword in the developing countries in providing improved healthcare with enhanced access. In rural areas especially, where a huge gap exists between demand and supply of healthcare facilities, PHI is being seen as a major solution. There are factors such as growing network infrastructure and the technological adoption by the health fraternity which provide support to these claims. Public health informatics has opportunities in healthcare by providing opportunities to diagnose patients, provide intra-operative assistance and consultation from a remote site. It also has certain barriers in the awareness, adaptation, network infrastructure, funding and policy related areas. There are certain medico-legal aspects involving all the stakeholders which need to be standardized to enable a working system. This paper aims to analyze the potential and challenges of public health informatics services in rural communities.

Keywords: PHI, e-health, public health, health informatics

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Authors: Amir T. Payandeh Najafabadi

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This article considers the problem of evaluating infinite-time (or finite-time) ruin probability under a given compound Poisson surplus process by approximating the claim size distribution by a finite mixture exponential, say Hyperexponential, distribution. It restates the infinite-time (or finite-time) ruin probability as a solvable ordinary differential equation (or a partial differential equation). Application of our findings has been given through a simulation study.

Keywords: ruin probability, compound poisson processes, mixture exponential (hyperexponential) distribution, heavy-tailed distributions

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Authors: Wang Xingbo

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Computation of determinant in the form |I-X| is primary and fundamental because it can help to compute many other determinants. This article puts forward a time-reducible approach to compute determinant |I-X|. The approach is derived from the Newton’s identity and its time complexity is no more than that to compute the eigenvalues of the square matrix X. Mathematical deductions and numerical example are presented in detail for the approach. By comparison with classical approaches the new approach is proved to be superior to the classical ones and it can naturally reduce the computational time with the improvement of efficiency to compute eigenvalues of the square matrix.

Keywords: algorithm, determinant, computation, eigenvalue, time complexity

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Authors: Sašo Pečnik, Borut Žalik

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This paper presents a real-time visualization technique and filtering of classified LiDAR point clouds. The visualization is capable of displaying filtered information organized in layers by the classification attribute saved within LiDAR data sets. We explain the used data structure and data management, which enables real-time presentation of layered LiDAR data. Real-time visualization is achieved with LOD optimization based on the distance from the observer without loss of quality. The filtering process is done in two steps and is entirely executed on the GPU and implemented using programmable shaders.

Keywords: filtering, graphics, level-of-details, LiDAR, real-time visualization

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Authors: V. S. S. Kumar, B. Vikram, G. C. S. Reddy

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Time and cost are the two critical objectives of construction project management and are not independent but intricately related. Trade-off between project duration and cost are extensively discussed during project scheduling because of practical relevance. Generally when the project duration is compressed, the project calls for an increase in labor and more productive equipments, which increases the cost. Thus, the construction time-cost optimization is defined as a process to identify suitable construction activities for speeding up to attain the best possible savings in both time and cost. As there is hidden tradeoff relationship between project time and cost, it might be difficult to predict whether the total cost would increase or decrease as a result of compressing the schedule. Different combinations of duration and cost for the activities associated with the project determine the best set in the time-cost optimization. Therefore, the contractors need to select the best combination of time and cost to perform each activity, all of which will ultimately determine the project duration and cost. In this paper, the fuzzy set theory is used to model the uncertainties in the project environment for time-cost trade off analysis.

Keywords: fuzzy sets, uncertainty, qualitative factors, decision making

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Authors: Tak-Chung Fu, Ying-Kit Hung, Fu-Lai Chung

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In the field of time series data mining, the concept of the Perceptually Important Point (PIP) identification process is first introduced in 2001. This process originally works for financial time series pattern matching and it is then found suitable for time series dimensionality reduction and representation. Its strength is on preserving the overall shape of the time series by identifying the salient points in it. With the rise of Big Data, time series data contributes a major proportion, especially on the data which generates by sensors in the Internet of Things (IoT) environment. According to the nature of PIP identification and the successful cases, it is worth to further explore the opportunity to apply PIP in time series ‘Big Data’. However, the performance of PIP identification is always considered as the limitation when dealing with ‘Big’ time series data. In this paper, two distributed versions of PIP identification based on the Specialized Binary (SB) Tree are proposed. The proposed approaches solve the bottleneck when running the PIP identification process in a standalone computer. Improvement in term of speed is obtained by the distributed versions.

Keywords: distributed computing, performance analysis, Perceptually Important Point identification, time series data mining

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Authors: Beverly Wang

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Background: Rosai-Dorfman disease (RDD), aka sinus histiocytosis with massive lymphadenopathy, is a rare, idiopathic histiocytic proliferative disorder. Although RDD can be seen involving the head and neck lymph nodes, rarely it can affect other extranodal sites. It present 3 unique cases of RDD affecting the nasal cavity, paranasal sinuses, and ear canal. The initial clinical presentation on two cases mimicked a malignant neoplasm. The 3rd case of RDD co-existed with a cholesteatoma of the ear canal. The clinical presentation, histology and immunohistochemical stains, and radiographic findings are discussed. Design: An overview of 3 cases of RDD affected sinonasal cavity and ear canal from UCI Medical Center was conducted. Case 1: A 61 year old male complaining of breathing difficulty presented with bilateral polypoid sinonasal masses and severe nasal obstruction. The masses elevated the nasal floor, and involved the anterior nasal septum to lateral wall. It was endoscopically excised. At intraoperative consultation, frozen section reported a pleomorphic spindle cell neoplasm with scattered large atypical spindle cells, resembling a high grade sarcoma. Case 2: A 46 year old male presented with recurrent bilateral maxillary chronic sinusitis with mass formation, clinically suspicious for malignant lymphoma. Excisional tissue sample showed large irregular spindled histiocytes with abundant granular and vacuolated cytoplasm. Case 3: A 36 year old female with a history of asthma initially presented with left-sided chronic otalgia, occasional nausea, vertigo, and fluctuating pain exacerbated by head movement and temperature changes. CT scan revealed an external auditory canal mass extending to the middle ear, coexisting with a small cholesteatoma. Results: The morphology of all cases revealed large atypical spindled histiocytes resembling fibrohistiocytic or myofibroblastic proliferative neoplasms. Scattered emperipolesis was seen. All 3 cases were confirmed as extranodal sinus RDD, confirmed by immunohistochemistry. The large atypical cells were positive for S100, CD68, and CD163. No evidence for malignancy was identified. Case 3 showed concurrent RDD co-existing with a cholesteatoma. Conclusion: Due to its rarity and variable clinical presentations, the diagnosis of RDD is seldom clinically considered. Extranodal sinus RDD morphologically can be pitfall as mimicker of spindly neoplasm, especially at intraoperative consultation. It can create diagnostic and therapeutic challenges. Correlation of radiological findings with histologic features will help to reach the diagnosis.

Keywords: head and neck, extranodal, rosai-dorfman disease, mimicker, immunohistochemistry

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Authors: Yanshuang Zhang, Byungho Jeong

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There exists some time lag between the consumption of inputs and the production of outputs. This time lag effect should be considered in calculating efficiency of decision making units (DMU). Recently, a couple of DEA models were developed for considering time lag effect in efficiency evaluation of research activities. However, these models can’t discriminate efficient DMUs because of the nature of basic DEA model in which efficiency scores are limited to ‘1’. This problem can be resolved a super-efficiency model. However, a super efficiency model sometimes causes infeasibility problem. This paper suggests an output oriented super-efficiency model for efficiency evaluation under the consideration of time lag effect. A case example using a long term research project is given to compare the suggested model with the MpO model

Keywords: DEA, Super-efficiency, Time Lag, research activities

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Authors: Yanshuang Zhang, Byungho Jeong

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In many cases, there is a time lag between the consumption of inputs and the production of outputs. This time lag effect should be considered in evaluating the performance of organizations. Recently, a couple of DEA models were developed for considering time lag effect in efficiency evaluation of research activities. Multi-periods input(MpI) and Multi-periods output(MpO) models are integrated models to calculate simple efficiency considering time lag effect. However, these models can’t discriminate efficient DMUs because of the nature of basic DEA model in which efficiency scores are limited to ‘1’. That is, efficient DMUs can’t be discriminated because their efficiency scores are same. Thus, this paper suggests a super-efficiency model for efficiency evaluation under the consideration of time lag effect based on the MpO model. A case example using a long-term research project is given to compare the suggested model with the MpO model.

Keywords: DEA, super-efficiency, time lag, multi-periods input

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Authors: Yih-Jer Wu, Ling-Lang Huang

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Shared decision-making (SDM) is a critical aspect of determining optimal medical strategies. However, current patient decision aids (PDAs) often prioritize evidence-based discussions over value-based considerations. Despite its significance, there is limited research addressing the 'value gap' between patients and healthcare providers. To address this gap, we developed the 'Patient-Doctor Relationship Questionnaire,' consisting of 12 questions. To explore potential variations in the patient-doctor value gap across different medical specialties, we conducted interviews with physicians, surgeons, and their respective patients, utilizing the questionnaire. Between 2020 and 2022, we interviewed a total of 144 patients and 19 doctors. Among the 12 questions, physicians demonstrated significant patient-doctor value gaps in 5 questions, while surgeons in 3 questions. Only one question turned out significant gaps in both physicians and surgeons. When asking both doctors and their patients to choose one from the following 6 answers (1. No issue significant; 2. Not knowing how to make a medical decision; 3. Not confident in the doctor’s clinical judgment; 4. Not knowing how to articulate one’s own condition; 5. Unable to afford medical expenses; 6. Not understanding what doctors explain) in response to the question “what the most significant issue is in the medical consultation”, over 50% of doctors chose “Not knowing how to make a medical decision” (physicians vs. patients, 50% vs. 11%, p=0.046; surgeon vs. patients, 83% vs. 29%, p=0.001), while significantly more patients chose “No issue significant” (10% vs. 52%, p=0.002; 0% vs. 33%, p<0.001, respectively). Our findings indicate that value gaps do exist between patients and doctors and that most patients in Taiwan "fully trust" their doctors' recommendations for medical decisions. However, when treatment outcomes are far from ideal, this overinflated "trust" may turn into frustration, which could become the catalyst for medical disputes. Doctors should spend more time having more effective communication with their patients, particularly regarding potentially dissatisfactory treatment outcomes. This study underscores the substantial variability in the patient-doctor value gap, often overlooked in SDM. Patients from different clinical backgrounds may hold values distinct from those of their healthcare providers. Bridging this value gap is imperative for achieving genuine and effective SDM.

Keywords: share-decision making, value gaps, communication, doctor-patient relationship

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Authors: Tarek Fatouh, Chehab Elbelehy, Alaa Abdelsalam, Eman Elakkad, Alaa Abdelshafie

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This paper aims to explore the possibility of time compression in Engineer to Order production networks. A case study research method is used in a Norwegian shipbuilding project by implementing a value stream mapping lean tool with total cycle time as a unit of analysis. The analysis resulted in demonstrating the time deviations for the planned tasks in one of the processes in the shipbuilding project. So, authors developed a future state map by removing time wastes from value stream process.

Keywords: engineer to order, total cycle time, value stream mapping, shipbuilding

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Authors: Muhammad Omer Farooq Saeed

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The purpose of the proposal is to find out what time actually is! And to understand the natural phenomenon of the behavior of time and light corresponding to the motion of the bodies at relatively high speeds. The utmost concern of the paper is to deal with the possible demerits in the equations of relativity, thereby providing some valuable extensions in those equations and concepts. The idea used develops the most basic conception of the relative motion of the body with respect to space and a real understanding of time and the variation of energy of the body in different frames of reference. The results show the development of a completely new understanding of time, relative motion and energy, along with some extensions in the equations of special relativity most importantly the time dilation and the mass-energy relationship that will explain all frames of a body, all in one go. The proposal also raises serious questions on the validity of the “Principle of Equivalence” on which the General Relativity is based, most importantly a serious case of the bending light that eventually goes against its own governing concepts of space-time being proposed in the theory. The results also predict the existence of a completely new field that explains the fact just how and why bodies acquire energy in space-time. This field explains the production of gravitational waves based on time. All in all, this proposal challenges the formulas and conceptions of Special and General Relativity, respectively.

Keywords: time, relative motion, energy, speed, frame of reference, photon, curvature, space-time, time –differentials

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Authors: Maria Isabel Garcia-Planas, Maria Victoria Garcia-Camba

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The use of brain stem auditory evoked potential (BAEP) is a common way to study the auditory function of people, a way to learn the functionality of a part of the brain neuronal groups that intervene in the learning process by studying the behaviour of wave VI. The latest advances in neuroscience have revealed the existence of different brain activity in the learning process that can be highlighted through the use of innocuous, low-cost, and easy-access techniques such as, among others, the BAEP that can help us to detect early possible neurodevelopmental difficulties for their subsequent assessment and cure. To date and to the authors' best knowledge, only the latency data obtained, observing the first to V waves and mainly in the left ear, were taken into account. This work shows that it is essential to take into account both ears; with these latest data, it has been possible had diagnosed more precise some cases than with the previous data had been diagnosed as 'normal' despite showing signs of some alteration that motivated the new consultation to the specialist.

Keywords: ear, neurodevelopment, auditory evoked potentials, intervals of normality, learning disabilities

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Authors: Fernando Araujo, Sandra Cardoso, Fátima Fonseca, Sandra Cavaca

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A debureaucratization strategy for the Portuguese Health Service was assumed by the Executive Board of the SNS, in deep articulation with the Shared Services of the Ministry of Health. Two of the main dimensions were focused on sick leaves (SL), that transform primary health care (PHC) in administrative institutions, limiting access to patients. The self-declaration of illness (SDI) project, through the National Health Service Contact Centre (SNS24), began on May 1, 2023, and has already resulted in the issuance of more than 300,000 SDI without the need to allocate resources from the National Health Service (NHS). This political decision allows each citizen, in a maximum 2 times/year, and 3 days each time, if ill, through their own responsibility, report their health condition in a dematerialized way, and by this way justified the absence to work, although by Portuguese law in these first three days, there is no payment of salary. Using a digital approach, it is now feasible without the need to go to the PHC and occupy the time of the PHC only to obtain an SL. Through this measure, bureaucracy has been reduced, and the system has been focused on users, improving the lives of citizens and reducing the administrative burden on PHC, which now has more consultation times for users who need it. The second initiative, which began on March 1, 2024, allows the SL to be issued in emergency departments (ED) of public hospitals and in the health institutions of the social and private sectors. This project is intended to allow the user who has suffered a situation of acute urgent illness and who has been observed in an ED of a public hospital or in a private or social entity no longer need to go to PHC only to apply for the respective SL. Since March 1, 54,453 SLs have been issued, 242 in private or social sector institutions and 6,918 in public hospitals, of which 134 were in ED and 47,292 in PHC. This approach has proven to be technically robust, allows immediate resolution of problems and differentiates the performance of doctors. However, it is important to continue to qualify the proper functioning of the ED, preventing non-urgent users from going there only to obtain SL. Thus, in order to make better use of existing resources, it was operationalizing this extension of its issuance in a balanced way, allowing SL to be issued in the ED of hospitals only to critically ill patients or patients referred by INEM, SNS24, or PHC. In both cases, an intense public campaign was implemented to explain the way it works and the benefits for patients. In satisfaction surveys, more than 95% of patients and doctors were satisfied with the solutions, asking for extensions to other areas. The administrative simplification agenda of the NHS continues its effective development. For the success of this debureaucratization agenda, the key factors are effective communication and the ability to reach patients and health professionals in order to increase health literacy and the correct use of NHS.

Keywords: debureaucratization strategy, self-declaration of illness, sick leaves, SNS24

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Authors: Parsa Keyvani, Alistair Phillips, David Warwick

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Background: The current process for gaining patient consent for hand and wrist surgery at University Hospital Southampton (UHS) is paper-based and makes use of generic forms provided by the NHS and no patient information leaflet is available relating to hand and wrist surgery. Aims: To evaluate the process of obtaining clinical consent and suggest ways in which the service can be improved. Methods: A log-book review of four orthopaedic surgeons at UHS was carried out over a three-month period in order to identify the 10 most common types of elective hand and wrist surgeries performed. A literature review was carried out to identify the complications of these surgeries. The surgeries were then divided into 6 types: nerve, bone, ligament, joint, tendon and dupuytren’s surgery. A digitised consent form was created covering the complications of all 6 surgery types. Finally, the surgeons at the orthopaedic department of UHS were asked whether they prefer the old paper-based or the digitised consent form. Results: All of the surgeons felt that the procedure type-based form was easier to read, use and understand. Conclusion: This research highlights a number of problems related to the use of current NHS consent forms. The proposed solution is to use a set of digitised, procedure type-based consent forms. Digital consent forms can be filled in in advance and sent to the patient electronically along with any relevant information leaflets, thus giving them time to absorb the information and come up with any questions before they have their pre-procedure discussion with their doctor. This would allow the doctor to focus the consultation on the patient rather than writing out the consent form and would ultimately be a step forward in making the NHS a global digital leader and fully embrace the opportunity offered by technology.

Keywords: digitised consent form, elective surgery, hand surgery complications, informed consent, procedure type-based consent form

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Authors: Liam Martin, Martha Watson

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Patients with learning disabilities (LD) are at increased risk of physical and mental illness due to health inequality. To address this, NICE recommends that people from the age of 14 with a learning disability should have an annual LD health check. This consultation should include a holistic review of the patient’s physical, mental and social health needs with a view of creating an action plan to support the patient’s care. The expected standard set by the Quality and Outcomes Framework (QOF) is that each general practice should review at least 75% of their LD patients annually. During COVID-19, there have been barriers to primary care, including health anxiety, the shift to online general practice and the increase in GP workloads. A surgery in North London wanted to assess whether they were falling short of the expected standard for LD patient annual reviews in order to optimize care post Covid-19. A baseline audit was completed to assess how many LD patients were receiving their annual reviews over the period of 29th September 2020 to 29th September 2021. This information was accessed using EMIS Web Health Care System (EMIS). Patients included were aged 14 and over as per QOF standards. Doctors were not notified of this audit taking place. Following the results of this audit, the creation of learning disability clinics was recommended. These clinics were recommended to be on the ground floor and should be a dedicated time for LD reviews. A re-audit was performed via the same process 6 months later in March 2022. At the time of the baseline audit, there were 71 patients aged 14 and over that were on the LD register. 54% of these LD patients were found to have documentation of an annual LD review within the last 12 months. None of the LD patients between the ages of 14-18 years old had received their annual review. The results were discussed with the practice, and dedicated clinics were set up to review their LD patients. A second pass of the audit was completed 6 months later. This showed an improvement, with 84% of the LD patients registered at the surgery now having a documented annual review within the last 12 months. 78% of the patients between the ages of 14-18 years old had now been reviewed. The baseline audit revealed that the practice was not meeting the expected standard for LD patient’s annual health checks as outlined by QOF, with the most neglected patients being between the ages of 14-18. Identification and awareness of this vulnerable cohort is important to ensure measures can be put into place to support their physical, mental and social wellbeing. Other practices could consider an audit of their annual LD health checks to make sure they are practicing within QOF standards, and if there is a shortfall, they could consider implementing similar actions as used here; dedicated clinics for LD patient reviews.

Keywords: COVID-19, learning disability, learning disability health review, quality and outcomes framework

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Authors: Saeed Sayyad Hagh Shomar

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Modeling users’ decisions on departure time choice is the main motivation for this research. In particular, it examines the impact of social-demographic features, household, job characteristics and trip qualities on individuals’ departure time choice. Departure time alternatives are presented as adjacent discrete time periods. The choice between these alternatives is done using a discrete choice model. Since a great deal of early morning trips and traffic congestion at that time of the day comprise work trips, the focus of this study is on the work trip over the entire day. Therefore, this study by using questionnaire of stated preference models users’ departure time choice affected by congestion pricing plan in downtown Tehran. Experimental results demonstrate efficient social-demographic impact on work trips’ departure time. These findings have substantial outcomes for the analysis of transportation planning. Particularly, the analysis shows that ignoring the effects of these variables could result in erroneous information and consequently decisions in the field of transportation planning and air quality would fail and cause financial resources loss.

Keywords: modeling, departure time, travel timing, time of the day, congestion pricing, transportation planning

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Authors: Anastasiya Paltarzhitskaya

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Subjective time plays an important role in consciousness processes and self-awareness at the moment. The concept of intrinsic neural timescales (INT) explains the difference in perceiving various time intervals. The capacity to experience the present builds on the fundamental properties of temporal cognition. The challenge that both philosophy and neuroscience try to answer is how the brain differentiates the present from the past and future. In our work, we analyze papers which describe mechanisms involved in the perception of ‘present’ and ‘non-present’, i.e., future and past moments. Taking into account that we perceive time intervals even during rest or relaxation, we suppose that the default-mode network activity can code time features, including the present moment. We can compare some results of time perceptual studies, where brain activity was shown in states with different flows of time, including resting states and during “mental time travel”. According to the concept of mental traveling, we employ a range of scenarios which demand episodic memory. However, some papers show that the hippocampal region does not activate during time traveling. It is a controversial result that is further complicated by the phenomenological aspect that includes a holistic set of information about the individual’s past and future.

Keywords: temporal consciousness, time perception, memory, present

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Authors: Karen Armstrong

Abstract:

Although invisible and fleeting, time is an essential variable in perception. Ritual is proposed as an antithesis to the passage of time, a way of linking our narratives with the past, present and future. This qualitative exploration examines a variety of award winning twentieth-century children’s picture books, specifically regarding the issues of time’s urgency and ritual with respect to children and grandparents. The paper will begin with a consideration of issues of time from the area of psychology, with regard to age, specifically contrasting later age and childhood. Next the value of ritual as represented by the presence of grandparents in children’s books. Specific instances of the contributions of grandparents or older adults with regard to this balancing function between time’s urgency and ritual will be discussed. Recommendations for future research include a consideration of grandparents’ or older characters’ depictions in books for older children.

Keywords: children's picture books, grandparents, ritual, time

Procedia PDF Downloads 279

Authors: Sinisa J. Vukicevic

Abstract:

Edmonton is currently one of the youngest North American cities and has achieved significant growth over the past 40 years. Strong urban shift requires a new approach to how the city is envisioned, planned, and built. This approach is evidence-based scenario development, and an urban growth model was a key support tool in framing Edmonton development strategies, developing urban policies, and assessing policy implications. The urban growth model has been developed using the Metronamica software platform. The Metronamica land use model evaluated the dynamic of land use change under the influence of key development drivers (population and employment), zoning, land suitability, and land and activity accessibility. The model was designed following the Big City Moves ideas: become greener as we grow, develop a rebuildable city, ignite a community of communities, foster a healing city, and create a city of convergence. The Big City Moves were converted to three development scenarios: ‘Strong Central City’, ‘Node City’, and ‘Corridor City’. Each scenario has a narrative story that expressed scenario’s high level goal, scenario’s approach to residential and commercial activities, to transportation vision, and employment and environmental principles. Land use demand was calculated for each scenario according to specific density targets. Spatial policies were analyzed according to their level of importance within the policy set definition for the specific scenario, but also through the policy measures. The model was calibrated on the way to reproduce known historical land use pattern. For the calibration, we used 2006 and 2011 land use data. The validation is done independently, which means we used the data we did not use for the calibration. The model was validated with 2016 data. In general, the modeling process contain three main phases: ‘from qualitative storyline to quantitative modelling’, ‘model development and model run’, and ‘from quantitative modelling to qualitative storyline’. The model also incorporates five spatial indicators: distance from residential to work, distance from residential to recreation, distance to river valley, urban expansion and habitat fragmentation. The major finding of this research could be looked at from two perspectives: the planning perspective and technology perspective. The planning perspective evaluates the model as a tool for scenario development. Using the model, we explored the land use dynamic that is influenced by a different set of policies. The model enables a direct comparison between the three scenarios. We explored the similarities and differences of scenarios and their quantitative indicators: land use change, population change (and spatial allocation), job allocation, density (population, employment, and dwelling unit), habitat connectivity, proximity to objects of interest, etc. From the technology perspective, the model showed one very important characteristic: the model flexibility. The direction for policy testing changed many times during the consultation process and model flexibility in applying all these changes was highly appreciated. The model satisfied our needs as scenario development and evaluation tool, but also as a communication tool during the consultation process.

Keywords: urban growth model, scenario development, spatial indicators, Metronamica

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Authors: Sandra Cardoso, Gaspar Pais, Judite Neves, Sandra Cavaca, Fernando Araújo

Abstract:

In 2021, Portugal has 63 emergency department (ED) visits per 100 people annually, the highest numbers in Europe. While EDs provide a critical service, high use is indicative of inappropriate and inefficient healthcare. In Portugal, all ED have the Manchester Triage System (MTS), a clinical risk management tool to enable that patients are seen in order of clinical priority. In 2023, more than 40% of the ED visits were of non-urgent conditions (blue and green), that could be better managed in primary health care (PHC), meaning wrong use of resources and lack of health literacy. From 2017, the country has a phone line, SNS24 (Contact Centre of the National Health Service), for triage, counseling, and referral service, 24 hours/7 days a week. The pilot project ‘Call before, save lives’ was implemented in the municipalities of Póvoa de Varzim and Vila do Conde (around 150.000 residents), in May 2023, by the executive board of the Portuguese Health Service, with the support of the Shared Services of the Ministry of Health, and local authorities. This geographical area has short travel times, 99% of the population a family doctor and the region is organized in a health local unit (HLU), integrating PHC and the local hospital. The purposes of this project included to increase awareness to contact SNS 24, before going to an ED, and non-urgent conditions oriented to a family doctor, reducing ED visits. The implementation of the project involved two phases, beginning with: i) development of campaigns using local influencers (fishmonger, model, fireman) through local institutions and media; ii) provision of telephone installed on site to contact SNS24; iii) establishment of open consultation in PHC; iv) promotion of the use of SNS24; v) creation of acute consultations at the hospital for complex chronic patients; and vi) direct referral for home hospitalization by PHC. The results of this project showed an excellent level of access to SNS24, an increase in the number of users referred to ED, with great satisfaction of users and professionals. The second phase, initiated in January 2024, for access to the ED, the need for prior referral was established as an admission rule, except for certain situations, as trauma patients. If the patient refuses, their registration in the ED and subsequent screening in accordance with the MTS must be ensured. When the patient is non-urgent, shall not be observed in the ED, provided that, according to his clinical condition, is guaranteed to be referred to PHC or to consultation/day hospital, through effective scheduling of an appointment for the same or the following day. In terms of results, 8 weeks after beginning of phase 2, we assist of a decrease in self-reported patients to ED from 59% to 15%, and a reduction of around 7% of ED visits. The key for this success was an effective public campaign that increases the knowledge of the right use of the health system, and capable of changing behaviors.

Keywords: contact centre of the national health service, emergency department visits, public campaign, health literacy, SNS24

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Authors: Nasim Hashemi, Abbas Sheikhtaheri

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Telemedicine is the use of telecommunication and information technologies to provide health care services that would often not be consistently available in distant rural communities to people at these remote areas. Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Thus, teleophthalmology can overcome geographical barriers and improve quality, access, and affordability of eye health care services. Since teleophthalmology has been widespread applied in recent years, the aim of this study was to determine the different applications of teleophthalmology in the world. To this end, three bibliographic databases (Medline, ScienceDirect, Scopus) were comprehensively searched with these keywords: eye care, eye health care, primary eye care, diagnosis, detection, and screening of different eye diseases in conjunction with telemedicine, telehealth, teleophthalmology, e-services, and information technology. All types of papers were included in the study with no time restriction. We conducted the search strategies until 2015. Finally 70 articles were surveyed. We classified the results based on the’type of eye problems covered’ and ‘the type of telemedicine services’. Based on the review, from the ‘perspective of health care levels’, there are three level for eye health care as primary, secondary and tertiary eye care. From the ‘perspective of eye care services’, the main application of teleophthalmology in primary eye care was related to the diagnosis of different eye diseases such as diabetic retinopathy, macular edema, strabismus and aged related macular degeneration. The main application of teleophthalmology in secondary and tertiary eye care was related to the screening of eye problems i.e. diabetic retinopathy, astigmatism, glaucoma screening. Teleconsultation between health care providers and ophthalmologists and also education and training sessions for patients were other types of teleophthalmology in world. Real time, store–forward and hybrid methods were the main forms of the communication from the perspective of ‘teleophthalmology mode’ which is used based on IT infrastructure between sending and receiving centers. In aspect of specialists, early detection of serious aged-related ophthalmic disease in population, screening of eye disease processes, consultation in an emergency cases and comprehensive eye examination were the most important benefits of teleophthalmology. Cost-effectiveness of teleophthalmology projects resulted from reducing transportation and accommodation cost, access to affordable eye care services and receiving specialist opinions were also the main advantages of teleophthalmology for patients. Teleophthalmology brings valuable secondary and tertiary care to remote areas. So, applying teleophthalmology for detection, treatment and screening purposes and expanding its use in new applications such as eye surgery will be a key tool to promote public health and integrating eye care to primary health care.

Keywords: applications, telehealth, telemedicine, teleophthalmology

Procedia PDF Downloads 344

Authors: Hanan Abufares Elkhimry

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Looking for more effective teaching and learning approaches, teaching instructors have been telling trainee teachers to decrease their talking time, but the problem is how best to do this. Doing classroom research, specifically in the area of teacher talking time (TTT), is worthwhile, as it could improve the quality of teaching languages, as the learners are the ones who should be practicing and using the language. This work hopes to ascertain if teachers consider this need in a way that provides the students with the opportunities to increase their production of language. This is a question that is worthwhile answering. As many researchers have found, TTT should be decreased to 30% of classroom talking time and STT should be increased up to 70%. Other researchers agree with this, but add that it should be with awareness of the quality of teacher talking time. Therefore, this study intends to investigate the balance between quantity and quality of teacher talking time in the EFL classroom. For this piece of research and in order to capture the amount of talking in a four classrooms. The amount of talking time was measured. A Checklist was used to assess the quality of the talking time In conclusion, In order to improve the quality of TTT, the results showed that teachers may use more or less than 30% of the classroom talking time and still produce a successful classroom learning experience. As well as, the important factors that can affect TTT is the English level of the students. This was clear in the classroom observations, where the highest TTT recorded was with the lowest English level group.

Keywords: teacher talking time TTT, learning experience, classroom research, effective teaching

Procedia PDF Downloads 389

Authors: Eddy K. Mukadi

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The aim of this study was to provide contributing elements to improve the management of the asthma crisis in the intensive care unit of the General Reference Hospital of Kinshasa. This was a descriptive study of all patients in the intensive care unit presenting with the asthma attack during the period from February 5, 2013 to February 5, 2014. The main data were obtained from consultation registry and medical records. A total of 35 patients, 21 of whom were male (majority) compared to 14 female. Average age of patients was 46.48 plus or minus 16.98 with extremes ranging from 21-75 years. The clinic was dominated by dyspnea in 100% of cases, followed by rales with 91.4% of cases. In spite of the control of the crisis obtained after the treatment with B2 mimetic by inhalation was introduced A 91.5%; 88% corticosteroids; 80% oxygen, the therapeutic principle recommended for the management of asthma attacks was not respected in the majority of cases. This is why we suggest that improving the quality of care to be administered to patients will yield more adequate results.

Keywords: asthma crisis, intensive care, general hospital, Kinshasa

Procedia PDF Downloads 205