Search results for: educational data mining
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 26558

Search results for: educational data mining

14168 Developing Optical Sensors with Application of Cancer Detection by Elastic Light Scattering Spectroscopy

Authors: May Fadheel Estephan, Richard Perks

Abstract:

Context: Cancer is a serious health concern that affects millions of people worldwide. Early detection and treatment are essential for improving patient outcomes. However, current methods for cancer detection have limitations, such as low sensitivity and specificity. Research Aim: The aim of this study was to develop an optical sensor for cancer detection using elastic light scattering spectroscopy (ELSS). ELSS is a noninvasive optical technique that can be used to characterize the size and concentration of particles in a solution. Methodology: An optical probe was fabricated with a 100-μm-diameter core and a 132-μm centre-to-centre separation. The probe was used to measure the ELSS spectra of polystyrene spheres with diameters of 2, 0.8, and 0.413 μm. The spectra were then analysed to determine the size and concentration of the spheres. Findings: The results showed that the optical probe was able to differentiate between the three different sizes of polystyrene spheres. The probe was also able to detect the presence of polystyrene spheres in suspension concentrations as low as 0.01%. Theoretical Importance: The results of this study demonstrate the potential of ELSS for cancer detection. ELSS is a noninvasive technique that can be used to characterize the size and concentration of cells in a tissue sample. This information can be used to identify cancer cells and assess the stage of the disease. Data Collection: The data for this study were collected by measuring the ELSS spectra of polystyrene spheres with different diameters. The spectra were collected using a spectrometer and a computer. Analysis Procedures: The ELSS spectra were analysed using a software program to determine the size and concentration of the spheres. The software program used a mathematical algorithm to fit the spectra to a theoretical model. Question Addressed: The question addressed by this study was whether ELSS could be used to detect cancer cells. The results of the study showed that ELSS could be used to differentiate between different sizes of cells, suggesting that it could be used to detect cancer cells. Conclusion: The findings of this research show the utility of ELSS in the early identification of cancer. ELSS is a noninvasive method for characterizing the number and size of cells in a tissue sample. To determine cancer cells and determine the disease's stage, this information can be employed. Further research is needed to evaluate the clinical performance of ELSS for cancer detection.

Keywords: elastic light scattering spectroscopy, polystyrene spheres in suspension, optical probe, fibre optics

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14167 An Interactive User-Oriented Approach to Optimizing Public Space Lighting

Authors: Tamar Trop, Boris Portnov

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Public Space Lighting (PSL) of outdoor urban areas promotes comfort, defines spaces and neighborhood identities, enhances perceived safety and security, and contributes to residential satisfaction and wellbeing. However, if excessive or misdirected, PSL leads to unnecessary energy waste and increased greenhouse gas emissions, poses a non-negligible threat to the nocturnal environment, and may become a potential health hazard. At present, PSL is designed according to international, regional, and national standards, which consolidate best practice. Yet, knowledge regarding the optimal light characteristics needed for creating a perception of personal comfort and safety in densely populated residential areas, and the factors associated with this perception, is still scarce. The presented study suggests a paradigm shift in designing PSL towards a user-centered approach, which incorporates pedestrians' perspectives into the process. The study is an ongoing joint research project between China and Israel Ministries of Science and Technology. Its main objectives are to reveal inhabitants' perceptions of and preferences for PSL in different densely populated neighborhoods in China and Israel, and to develop a model that links instrumentally measured parameters of PSL (e.g., intensity, spectra and glare) with its perceived comfort and quality, while controlling for three groups of attributes: locational, temporal, and individual. To investigate measured and perceived PSL, the study employed various research methods and data collection tools, developed a location-based mobile application, and used multiple data sources, such as satellite multi-spectral night-time light imagery, census statistics, and detailed planning schemes. One of the study’s preliminary findings is that higher sense of safety in the investigated neighborhoods is not associated with higher levels of light intensity. This implies potential for energy saving in brightly illuminated residential areas. Study findings might contribute to the design of a smart and adaptive PSL strategy that enhances pedestrians’ perceived safety and comfort while reducing light pollution and energy consumption.

Keywords: energy efficiency, light pollution, public space lighting, PSL, safety perceptions

Procedia PDF Downloads 115
14166 Application of Aerogeomagnetic and Ground Magnetic Surveys for Deep-Seated Kimberlite Pipes in Central India

Authors: Utkarsh Tripathi, Bikalp C. Mandal, Ravi Kumar Umrao, Sirsha Das, M. K. Bhowmic, Joyesh Bagchi, Hemant Kumar

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The Central India Diamond Province (CIDP) is known for the occurrences of primary and secondary sources for diamonds from the Vindhyan platformal sediments, which host several kimberlites, with one operating mine. The known kimberlites are Neo-Proterozoic in age and intrude into the Kaimur Group of rocks. Based on the interpretation of areo-geomagnetic data, three potential zones were demarcated in parts of Chitrakoot and Banda districts, Uttar Pradesh, and Satna district, Madhya Pradesh, India. To validate the aero-geomagnetic interpretation, ground magnetic coupled with a gravity survey was conducted to validate the anomaly and explore the possibility of some pipes concealed beneath the Vindhyan sedimentary cover. Geologically the area exposes the milky white to buff-colored arkosic and arenitic sandstone belonging to the Dhandraul Formation of the Kaimur Group, which are undeformed and unmetamorphosed providing almost transparent media for geophysical exploration. There is neither surface nor any geophysical indication of intersections of linear structures, but the joint patterns depict three principal joints along NNE-SSW, ENE-WSW, and NW-SE directions with vertical to sub-vertical dips. Aeromagnetic data interpretation brings out three promising zones with the bi-polar magnetic anomaly (69-602nT) that represent potential kimberlite intrusive concealed below at an approximate depth of 150-170m. The ground magnetic survey has brought out the above-mentioned anomalies in zone-I, which is congruent with the available aero-geophysical data. The magnetic anomaly map shows a total variation of 741 nT over the area. Two very high magnetic zones (H1 and H2) have been observed with around 500 nT and 400 nT magnitudes, respectively. Anomaly zone H1 is located in the west-central part of the area, south of Madulihai village, while anomaly zone H2 is located 2km apart in the north-eastern direction. The Euler 3D solution map indicates the possible existence of the ultramafic body in both the magnetic highs (H1 and H2). The H2 high shows the shallow depth, and H1 shows a deeper depth solution. In the reduced-to-pole (RTP) method, the bipolar anomaly disappears and indicates the existence of one causative source for both anomalies, which is, in all probabilities, an ultramafic suite of rock. The H1 magnetic high represents the main body, which persists up to depths of ~500m, as depicted through the upward continuation derivative map. Radially Averaged Power Spectrum (RAPS) shows the thickness of loose sediments up to 25m with a cumulative depth of 154m for sandstone overlying the ultramafic body. The average depth range of the shallower body (H2) is 60.5-86 meters, as estimated through the Peters half slope method. Magnetic (TF) anomaly with BA contour also shows high BA value around the high zones of magnetic anomaly (H1 and H2), which suggests that the causative body is with higher density and susceptibility for the surrounding host rock. The ground magnetic survey coupled with the gravity confirms a potential target for further exploration as the findings are co-relatable with the presence of the known diamondiferous kimberlites in this region, which post-date the rocks of the Kaimur Group.

Keywords: Kaimur, kimberlite, Euler 3D solution, magnetic

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14165 Computational Tool for Surface Electromyography Analysis; an Easy Way for Non-Engineers

Authors: Fabiano Araujo Soares, Sauro Emerick Salomoni, Joao Paulo Lima da Silva, Igor Luiz Moura, Adson Ferreira da Rocha

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This paper presents a tool developed in the Matlab platform. It was developed to simplify the analysis of surface electromyography signals (S-EMG) in a way accessible to users that are not familiarized with signal processing procedures. The tool receives data by commands in window fields and generates results as graphics and excel tables. The underlying math of each S-EMG estimator is presented. Setup window and result graphics are presented. The tool was presented to four non-engineer users and all of them managed to appropriately use it after a 5 minutes instruction period.

Keywords: S-EMG estimators, electromyography, surface electromyography, ARV, RMS, MDF, MNF, CV

Procedia PDF Downloads 533
14164 Performance Evaluation of Arrival Time Prediction Models

Authors: Bin Li, Mei Liu

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Arrival time information is a crucial component of advanced public transport system (APTS). The advertisement of arrival time at stops can help reduce the waiting time and anxiety of passengers, and improve the quality of service. In this research, an experiment was conducted to compare the performance on prediction accuracy and precision between the link-based and the path-based historical travel time based model with the automatic vehicle location (AVL) data collected from an actual bus route. The research results show that the path-based model is superior to the link-based model, and achieves the best improvement on peak hours.

Keywords: bus transit, arrival time prediction, link-based, path-based

Procedia PDF Downloads 346
14163 Scheduled Maintenance and Downtime Cost in Aircraft Maintenance Management

Authors: Remzi Saltoglu, Nazmia Humaira, Gokhan Inalhan

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During aircraft maintenance scheduling, operator calculates the budget of the maintenance. Usually, this calculation includes only the costs that are directly related to the maintenance process such as cost of labor, material, and equipment. In some cases, overhead cost is also included. However, in some of those, downtime cost is neglected claiming that grounding is a natural fact of maintenance; therefore, it is not considered as part of the analytical decision-making process. Based on the normalized data, we introduce downtime cost with its monetary value and add its seasonal character. We envision that the rest of the model, which works together with the downtime cost, could be checked with the real life cases, through the review of MRO cost and airline spending in the particular and scheduled maintenance events.

Keywords: aircraft maintenance, downtime, downtime cost, maintenance cost

Procedia PDF Downloads 335
14162 An Accurate Method for Phylogeny Tree Reconstruction Based on a Modified Wild Dog Algorithm

Authors: Essam Al Daoud

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This study solves a phylogeny problem by using modified wild dog pack optimization. The least squares error is considered as a cost function that needs to be minimized. Therefore, in each iteration, new distance matrices based on the constructed trees are calculated and used to select the alpha dog. To test the suggested algorithm, ten homologous genes are selected and collected from National Center for Biotechnology Information (NCBI) databanks (i.e., 16S, 18S, 28S, Cox 1, ITS1, ITS2, ETS, ATPB, Hsp90, and STN). The data are divided into three categories: 50 taxa, 100 taxa and 500 taxa. The empirical results show that the proposed algorithm is more reliable and accurate than other implemented methods.

Keywords: least square, neighbor joining, phylogenetic tree, wild dog pack

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14161 A Comparative Study of Sampling-Based Uncertainty Propagation with First Order Error Analysis and Percentile-Based Optimization

Authors: M. Gulam Kibria, Shourav Ahmed, Kais Zaman

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In system analysis, the information on the uncertain input variables cause uncertainty in the system responses. Different probabilistic approaches for uncertainty representation and propagation in such cases exist in the literature. Different uncertainty representation approaches result in different outputs. Some of the approaches might result in a better estimation of system response than the other approaches. The NASA Langley Multidisciplinary Uncertainty Quantification Challenge (MUQC) has posed challenges about uncertainty quantification. Subproblem A, the uncertainty characterization subproblem, of the challenge posed is addressed in this study. In this subproblem, the challenge is to gather knowledge about unknown model inputs which have inherent aleatory and epistemic uncertainties in them with responses (output) of the given computational model. We use two different methodologies to approach the problem. In the first methodology we use sampling-based uncertainty propagation with first order error analysis. In the other approach we place emphasis on the use of Percentile-Based Optimization (PBO). The NASA Langley MUQC’s subproblem A is developed in such a way that both aleatory and epistemic uncertainties need to be managed. The challenge problem classifies each uncertain parameter as belonging to one the following three types: (i) An aleatory uncertainty modeled as a random variable. It has a fixed functional form and known coefficients. This uncertainty cannot be reduced. (ii) An epistemic uncertainty modeled as a fixed but poorly known physical quantity that lies within a given interval. This uncertainty is reducible. (iii) A parameter might be aleatory but sufficient data might not be available to adequately model it as a single random variable. For example, the parameters of a normal variable, e.g., the mean and standard deviation, might not be precisely known but could be assumed to lie within some intervals. It results in a distributional p-box having the physical parameter with an aleatory uncertainty, but the parameters prescribing its mathematical model are subjected to epistemic uncertainties. Each of the parameters of the random variable is an unknown element of a known interval. This uncertainty is reducible. From the study, it is observed that due to practical limitations or computational expense, the sampling is not exhaustive in sampling-based methodology. That is why the sampling-based methodology has high probability of underestimating the output bounds. Therefore, an optimization-based strategy to convert uncertainty described by interval data into a probabilistic framework is necessary. This is achieved in this study by using PBO.

Keywords: aleatory uncertainty, epistemic uncertainty, first order error analysis, uncertainty quantification, percentile-based optimization

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14160 A Generalisation of Pearson's Curve System and Explicit Representation of the Associated Density Function

Authors: S. B. Provost, Hossein Zareamoghaddam

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A univariate density approximation technique whereby the derivative of the logarithm of a density function is assumed to be expressible as a rational function is introduced. This approach which extends Pearson’s curve system is solely based on the moments of a distribution up to a determinable order. Upon solving a system of linear equations, the coefficients of the polynomial ratio can readily be identified. An explicit solution to the integral representation of the resulting density approximant is then obtained. It will be explained that when utilised in conjunction with sample moments, this methodology lends itself to the modelling of ‘big data’. Applications to sets of univariate and bivariate observations will be presented.

Keywords: density estimation, log-density, moments, Pearson's curve system

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14159 Full Mini Nutritional Assessment Questionnaire and the Risk of Malnutrition and Mortality in Elderly, Hospitalized Patients: A Cross-Sectional Study

Authors: Christos E. Lampropoulos, Maria Konsta, Tamta Sirbilatze, Ifigenia Apostolou, Vicky Dradaki, Konstantina Panouria, Irini Dri, Christina Kordali, Vaggelis Lambas, Georgios Mavras

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Objectives: Full Mini Nutritional Assessment (MNA) questionnaire is one of the most useful tools in diagnosis of malnutrition in hospitalized patients, which is related to increased morbidity and mortality. The purpose of our study was to assess the nutritional status of elderly, hospitalized patients and examine the hypothesis that MNA may predict mortality and extension of hospitalization. Methods: One hundred fifty patients (78 men, 72 women, mean age 80±8.2) were included in this cross-sectional study. The following data were taken into account in analysis: anthropometric and laboratory data, physical activity (International Physical Activity Questionnaires, IPAQ), smoking status, dietary habits, cause and duration of current admission, medical history (co-morbidities, previous admissions). Primary endpoints were mortality (from admission until 6 months afterwards) and duration of admission. The latter was compared to national guidelines for closed consolidated medical expenses. Logistic regression and linear regression analysis were performed in order to identify independent predictors for mortality and extended hospitalization respectively. Results: According to MNA, nutrition was normal in 54/150 (36%) of patients, 46/150 (30.7%) of them were at risk of malnutrition and the rest 50/150 (33.3%) were malnourished. After performing multivariate logistic regression analysis we found that the odds of death decreased 20% per each unit increase of full MNA score (OR=0.8, 95% CI 0.74-0.89, p < 0.0001). Patients who admitted due to cancer were 23 times more likely to die, compared to those with infection (OR=23, 95% CI 3.8-141.6, p=0.001). Similarly, patients who admitted due to stroke were 7 times more likely to die (OR=7, 95% CI 1.4-34.5, p=0.02), while these with all other causes of admission were less likely (OR=0.2, 95% CI 0.06-0.8, p=0.03), compared to patients with infection. According to multivariate linear regression analysis, each increase of unit of full MNA, decreased the admission duration on average 0.3 days (b:-0.3, 95% CI -0.45 - -0.15, p < 0.0001). Patients admitted due to cancer had on average 6.8 days higher extension of hospitalization, compared to those admitted for infection (b:6.8, 95% CI 3.2-10.3, p < 0.0001). Conclusion: Mortality and extension of hospitalization is significantly increased in elderly, malnourished patients. Full MNA score is a useful diagnostic tool of malnutrition.

Keywords: duration of admission, malnutrition, mini nutritional assessment score, prognostic factors for mortality

Procedia PDF Downloads 299
14158 Adequacy of Antenatal Care and Its Relationship with Low Birth Weight in Botucatu, São Paulo, Brazil: A Case-Control Study

Authors: Cátia Regina Branco da Fonseca, Maria Wany Louzada Strufaldi, Lídia Raquel de Carvalho, Rosana Fiorini Puccini

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Background: Birth weight reflects gestational conditions and development during the fetal period. Low birth weight (LBW) may be associated with antenatal care (ANC) adequacy and quality. The purpose of this study was to analyze ANC adequacy and its relationship with LBW in the Unified Health System in Brazil. Methods: A case-control study was conducted in Botucatu, São Paulo, Brazil, 2004 to 2008. Data were collected from secondary sources (the Live Birth Certificate), and primary sources (the official medical records of pregnant women). The study population consisted of two groups, each with 860 newborns. The case group comprised newborns weighing less than 2,500 grams, while the control group comprised live newborns weighing greater than or equal to 2,500 grams. Adequacy of ANC was evaluated according to three measurements: 1. Adequacy of the number of ANC visits adjusted to gestational age; 2. Modified Kessner Index; and 3. Adequacy of ANC laboratory studies and exams summary measure according to parameters defined by the Ministry of Health in the Program for Prenatal and Birth Care Humanization. Results: Analyses revealed that LBW was associated with the number of ANC visits adjusted to gestational age (OR = 1.78, 95% CI 1.32-2.34) and the ANC laboratory studies and exams summary measure (OR = 4.13, 95% CI 1.36-12.51). According to the modified Kessner Index, 64.4% of antenatal visits in the LBW group were adequate, with no differences between groups. Conclusions: Our data corroborate the association between inadequate number of ANC visits, laboratory studies and exams, and increased risk of LBW newborns. No association was found between the modified Kessner Index as a measure of adequacy of ANC and LBW. This finding reveals the low indices of coverage for basic actions already well regulated in the Health System in Brazil. Despite the association found in the study, we cannot conclude that LBW would be prevented only by an adequate ANC, as LBW is associated with factors of complex and multifactorial etiology. The results could be used to plan monitoring measures and evaluate programs of health care assistance during pregnancy, at delivery and to newborns, focusing on reduced LBW rates.

Keywords: low birth weight, antenatal care, prenatal care, adequacy of health care, health evaluation, public health system

Procedia PDF Downloads 415
14157 Patient Experience in a Healthcare Setting: How Patients' Encounters Make for Better Value Co-creation

Authors: Kingsley Agyapong

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Research conducted in recent years has delved into the concept of patient-perceived value within the context of co-creation, particularly in the realm of doctor-patient interactions within healthcare settings. However, existing scholarly discourse lacks exploration regarding the emergence of patient-derived value in the co-creation process, specifically within encounters involving patients and stakeholders such as doctors, nurses, pharmacists, and other healthcare professionals. This study aims to fill this gap by elucidating the perspectives of patients regarding the value they derive from their interactions with multiple stakeholders in the delivery of healthcare services. The fieldwork was conducted at a university clinic located in Ghana. Data collection procedures involved conducting 20 individual interviews with key informants on distinct value accrued from co-creation practices and interactions with stakeholders. The key informants consisted of patients receiving care at the university clinic during the Malaria Treatment Process. Three themes emerged from both the existing literature and the empirical data collected. The first theme, labeled as "patient value needs in co-creation," encapsulates elements such as communication effectiveness, interpersonal interaction quality, treatment efficacy, and enhancements to the overall quality of life experienced by patients during their interactions with healthcare professionals. The second theme, designated as "services that enhance patients' experience in value co-creation," pertains to patients' perceptions of services that contribute favourably to co-creation experiences, including initiatives related to health promotion and the provision of various in-house services that patients deem pertinent for augmenting their overall experiences. The third theme, titled "Challenges in the co-creation of patients' value," delineates obstacles encountered within the co-creation process, including health professionals' challenges in effectively following up with patients scheduled for review and prolonged waiting times for healthcare delivery. This study contributes to the patients' perceptions of value within the co-creation process during their interactions with service providers, particularly healthcare professionals. By gaining a deeper insight into this process, healthcare providers can enhance the delivery of patient-centered care, thereby leading to improved healthcare outcomes. The study further offers managerial implications derived from its findings, providing actionable insights for healthcare managers and policymakers aiming to optimize patient value creation in healthcare services. Furthermore, it suggests avenues for future research endeavors within healthcare settings.

Keywords: patient, healthcare, co-creation, malaria

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14156 Applying Organic Natural Fertilizer to 'Orange Rubis' and 'Farbaly' Apricot Growth, Yield and Fruit Quality

Authors: A. Tarantino, F. Lops, G. Lopriore, G. Disciglio

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Biostimulants are known as the organic fertilizers that can be applied in agriculture in order to increase nutrient uptake, growth and development of plants and improve quality, productivity and the environmental positive impacts. The aim of this study was to test the effects of some commercial biostimulants products (Bion® 50 WG, Hendophyt ® PS, Ergostim® XL and Radicon®) on vegeto-productive behavior and qualitative characteristics of fruits of two emerging apricot cultivars (Orange Rubis® and Farbaly®). The study was conducted during the spring-summer season 2015, in a commercial orchard located in the agricultural area of Cerignola (Foggia district, Apulian region, Southern Italy). Eight years old apricot trees, cv ‘Orange Rubis’ and ‘Farbaly®’, were used. The experimental data recorded during the experimental trial were: shoot length, total number of flower buds, flower buds drop and time of flowering and fruit set. Total yield of fruits per tree and quality parameters were determined. Experimental data showed some specific differences among the biostimulant treatments. Concerning the yield of ‘Orange Rubis’, except for the Bion treatment, the other three biostimulant treatments showed a tendentially lower values than the control. The yield of ‘Farbaly’ was lower for the Bion and Hendophyt treatments, higher for the Ergostim treatment, when compared with the yield of the control untreated. Concerning the soluble solids content, the juice of ‘Farbaly’ fruits had always higher content than that of ‘Orange Rubis’. Particularly, the Bion and the Hendophyt treatments showed in both harvest values tendentially higher than the control. Differently, the four biostimulant treatments did not affect significantly this parameter in ‘Orange Rubis’. With regard to the fruit firmness, some differences were observed between the two harvest dates and among the four biostimulant treatments. At the first harvest date, ‘Orange Rubis’ treated with Bion and Hendophyt biostimulants showed texture values tendentially lower than the control. Instead, ‘Farbaly’ for all the biostimulant treatments showed fruit firmness values significantly lower than the control. At the second harvest, almost all the biostimulants treatments in both ‘Orange Rubis’ and ‘Farbaly’ cultivar showed values lower than the control. Only ‘Farbaly’ treated with Radicon showed higher value in comparison to the control.

Keywords: apricot, fruit quality, growth, organic natural fertilizer

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14155 Infusion of Skills for Undergraduate Scholarship into Teacher Education: Two Case Studies in New York and Florida

Authors: Tunde Szecsi, Janka Szilagyi

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Students majoring in education are underrepresented in undergraduate scholarship. To enable and encourage teacher candidates to engage in scholarly activities, it is essential to infuse skills such as problem-solving, critical thinking, oral and written communication, collaboration and the utilization of information literacy, into courses in teacher preparation programs. In this empirical study, we examined two teacher education programs – one in New York State and one in Florida – in terms of the approaches of the course-based infusion of skills for undergraduate research, and the effectiveness of this infusion. First, course-related documents such as syllabi, assignment descriptions, and course activities were reviewed and analyzed. The goal of the document analysis was to identify and describe the targeted skills, and the pedagogical approaches and strategies for promoting research skills in teacher candidates. Next, a selection of teacher candidates’ scholarly products from the institution in Florida was used as a data set to examine teacher candidates’ skill development in the context of the identified assignments. This dataset was analyzed both quantitatively and qualitatively to describe the changes that occurred in teacher candidates’ critical thinking, communication, and information literacy skills, and to uncover patterns in the skill development at the two institutions. Descriptive statistics were calculated to explore the changes in these skills of teacher candidates over a period of three years. The findings based on data from the teacher education program in Florida indicated a steady gain in written communication and critical thinking and a modest increase in informational literacy. At the institution in New York, candidates’ submission and success rates on the edTPA, a New York State Teacher Certification exam, was used as a measure of scholarly skills. Overall, although different approaches were used for infusing the development of scholarly skills in the courses, the results suggest that a holistic and well-orchestrated infusion of the skills into most courses in the teacher education program might result in steadily developing scholarly skills. These results offered essential implications for teacher education programs in terms of further improvements in teacher candidates’ skills for engaging in undergraduate research and scholarship. In this presentation, our purpose is to showcase two approaches developed by two teacher education programs to demonstrate how diverse approaches toward the promotion of undergraduate scholarship activities are responsive to the context of the teacher preparation programs.

Keywords: critical thinking, pedagogical strategies, teacher education, undergraduate student research

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14154 Urban Livelihoods and Climate Change: Adaptation Strategies for Urban Poor in Douala, Cameroon

Authors: Agbortoko Manyigbe Ayuk Nkem, Eno Cynthia Osuh

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This paper sets to examine the relationship between climate change and urban livelihood through a vulnerability assessment of the urban poor in Douala. Urban development in Douala places priority towards industrial and city-centre development with little focus on the urban poor in terms of housing units and areas of sustenance. With the high rate of urbanisation and increased land prices, the urban poor are forced to occupy marginal lands which are mainly wetlands, wastelands and along abandoned neighbourhoods prone to natural hazards. Due to climate change and its effects, these wetlands are constantly flooded thereby destroying homes, properties, and crops. Also, most of these urban dwellers have found solace in urban agriculture as a means for survival. However, since agriculture in tropical regions like Cameroon depends largely on seasonal rainfall, the changes in rainfall pattern has led to misplaced periods for crop planting and a huge wastage of resources as rainfall becomes very unreliable with increased temperature levels. Data for the study was obtained from both primary and secondary sources. Secondary sources included published materials related to climate change and vulnerability. Primary data was obtained through focus-group discussions with some urban farmers while a stratified sampling of residents within marginal lands was done. Each stratum was randomly sampled to obtain information on different stressors related to climate change and their effect on livelihood. Findings proved that the high rate of rural-urban migration into Douala has led to increased prevalence of the urban poor and their vulnerability to climate change as evident in their constant fight against flood from unexpected sea level rise and irregular rainfall pattern for urban agriculture. The study also proved that women were most vulnerable as they depended solely on urban agriculture and its related activities like retailing agricultural products in different urban markets which to them serves as a main source of income in the attainment of basic needs for the family. Adaptation measures include the constant use of sand bags, raised makeshifts as well as cultivation along streams, planting after evidence of constant rainfall has become paramount for sustainability.

Keywords: adaptation, Douala, Cameroon, climate change, development, livelihood, vulnerability

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14153 Land Cover Mapping Using Sentinel-2, Landsat-8 Satellite Images, and Google Earth Engine: A Study Case of the Beterou Catchment

Authors: Ella Sèdé Maforikan

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Accurate land cover mapping is essential for effective environmental monitoring and natural resources management. This study focuses on assessing the classification performance of two satellite datasets and evaluating the impact of different input feature combinations on classification accuracy in the Beterou catchment, situated in the northern part of Benin. Landsat-8 and Sentinel-2 images from June 1, 2020, to March 31, 2021, were utilized. Employing the Random Forest (RF) algorithm on Google Earth Engine (GEE), a supervised classification categorized the land into five classes: forest, savannas, cropland, settlement, and water bodies. GEE was chosen due to its high-performance computing capabilities, mitigating computational burdens associated with traditional land cover classification methods. By eliminating the need for individual satellite image downloads and providing access to an extensive archive of remote sensing data, GEE facilitated efficient model training on remote sensing data. The study achieved commendable overall accuracy (OA), ranging from 84% to 85%, even without incorporating spectral indices and terrain metrics into the model. Notably, the inclusion of additional input sources, specifically terrain features like slope and elevation, enhanced classification accuracy. The highest accuracy was achieved with Sentinel-2 (OA = 91%, Kappa = 0.88), slightly surpassing Landsat-8 (OA = 90%, Kappa = 0.87). This underscores the significance of combining diverse input sources for optimal accuracy in land cover mapping. The methodology presented herein not only enables the creation of precise, expeditious land cover maps but also demonstrates the prowess of cloud computing through GEE for large-scale land cover mapping with remarkable accuracy. The study emphasizes the synergy of different input sources to achieve superior accuracy. As a future recommendation, the application of Light Detection and Ranging (LiDAR) technology is proposed to enhance vegetation type differentiation in the Beterou catchment. Additionally, a cross-comparison between Sentinel-2 and Landsat-8 for assessing long-term land cover changes is suggested.

Keywords: land cover mapping, Google Earth Engine, random forest, Beterou catchment

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14152 Cost Overrun Causes in Public Construction Projects in Saudi Arabia

Authors: Ibrahim Mahamid, A. Al-Ghonamy, M. Aichouni

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This study is conducted to identify causes of cost deviations in public construction projects in Saudi Arabia from contractors’ perspective. 41 factors that might affect cost estimating accuracy were identified through literature review and discussion with some construction experts. The factors were tabulated in a questionnaire form and a field survey included 51 contractors from the Northern Province of Saudi Arabia was performed. The results show that the top five important causes are: wrong estimation method, long period between design and time of implementation, cost of labor, cost of machinary and absence of construction-cost data.

Keywords: cost deviation, public construction, cost estimating, Saudi Arabia, contractors

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14151 Connecting the Dots: Bridging Academia and National Community Partnerships When Delivering Healthy Relationships Programming

Authors: Nicole Vlasman, Karamjeet Dhillon

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Over the past four years, the Healthy Relationships Program has been delivered in community organizations and schools across Canada. More than 240 groups have been facilitated in collaboration with 33 organizations. As a result, 2157 youth have been engaged in the programming. The purpose and scope of the Healthy Relationships Program are to offer sustainable, evidence-based skills through small group implementation to prevent violence and promote positive, healthy relationships in youth. The program development has included extensive networking at regional and national levels. The Healthy Relationships Program is currently being implemented, adapted, and researched within the Resilience and Inclusion through Strengthening and Enhancing Relationships (RISE-R) project. Alongside the project’s research objectives, the RISE-R team has worked to virtually share the ongoing findings of the project through a slow ontology approach. Slow ontology is a practice integrated into project systems and structures whereby slowing the pace and volume of outputs offers creative opportunities. Creative production reveals different layers of success and complements the project, the building blocks for sustainability. As a result of integrating a slow ontology approach, the RISE-R team has developed a Geographic Information System (GIS) that documents local landscapes through a Story Map feature, and more specifically, video installations. Video installations capture the cartography of space and place within the context of singular diverse community spaces (case studies). By documenting spaces via human connections, the project captures narratives, which further enhance the voices and faces of the community within the larger project scope. This GIS project aims to create a visual and interactive flow of information that complements the project's mixed-method research approach. Conclusively, creative project development in the form of a geographic information system can provide learning and engagement opportunities at many levels (i.e., within community organizations and educational spaces or with the general public). In each of these disconnected spaces, fragmented stories are connected through a visual display of project outputs. A slow ontology practice within the context of the RISE-R project documents activities on the fringes and within internal structures; primarily through documenting project successes as further contributions to the Centre for School Mental Health framework (philosophy, recruitment techniques, allocation of resources and time, and a shared commitment to evidence-based products).

Keywords: community programming, geographic information system, project development, project management, qualitative, slow ontology

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14150 The Effectiveness of Extracorporeal Shockwave Therapy on Pain and Motor Function in Subjects with Knee Osteoarthritis A Systematic Review and Meta-Analysis of Randomized Clinical Trial

Authors: Vu Hoang Thu Huong

Abstract:

Background and Purpose: The effects of Extracorporeal Shockwave Therapy (ESWT) in the participants with knee osteoarthritis (KOA) were unclear on physical performance although its effects on pain had been investiagted. This study aims to explore the effects of ESWT on pain relief and physical performance on KOA. Methods: The studies with the randomized controlled design to investigate the effects of ESWT on KOA were systematically searched using inclusion and exclusion criteria through seven electronic databases including Pubmed etc. between 1990 and Dec 2022. To summarize those data, visual analog scale (VAS) or pain scores were determined for measure of pain intensity. Range of knee motion, or the scores of physical activities including Lequesne index (LI), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were determined for measure of physical performances. The first evaluate after treatment period was define as the effect of post-treatment period or immediately effect; and the last evaluate was defined as the effect of following period or the end effect in our study. Data analysis was performed using RevMan 5.4.1 software. A significant level was set at p<0.05. Results: Eight studies (number of participant= 499) reporting the ESWT effects on mild-to-moderate severity (Grades I to III Kellgren–Lawrence) of KOA were qualified for meta-analysis. Compared with sham or placebo group, the ESWT group had a significant decrease of VAS rest score (0.90[0.12~1.67] as mean difference [95% confidence interval]) and pain score WOMAC (2.49[1.22~3.76]), and a significant improvement of physical performance with a decrease of the scores of WOMAC activities (8.18[3.97~12.39]), LI (3.47[1.68~5.26]), and KOOS (5.87[1.73~ 10.00]) in the post-treatment period. There were also a significant decrease of WOMAC pain score (2.83[2.12~3.53]) and a significant decrease of the scores of WOMAC activities (9.47[7.65~11.28]) and LI (4.12[2.34 to 5.89]) in the following period. Besides, compared with other treatment groups, ESWT also displayed the improvement in pain and physical performance, but it is not significant. Conclusions: The ESWT was effective and valuable method in pain relief as well as in improving physical activities in the participants with mild-to-moderate KOA. Clinical Relevance: There are the effects of ESWT on pain relief and the improvement of physical performance in the with KOA.

Keywords: knee osteoarthritis, extracorporeal shockwave therapy, pain relief, physical performance, shockwave

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14149 Blockchain Security in MANETs

Authors: Nada Mouchfiq, Ahmed Habbani, Chaimae Benjbara

Abstract:

The security aspect of the IoT occupies a place of great importance especially after the evolution that has known this field lastly because it must take into account the transformations and the new applications .Blockchain is a new technology dedicated to the data sharing. However, this does not work the same way in the different systems with different operating principles. This article will discuss network security using the Blockchain to facilitate the sending of messages and information, enabling the use of new processes and enabling autonomous coordination of devices. To do this, we will discuss proposed solutions to ensure a high level of security in these networks in the work of other researchers. Finally, our article will propose a method of security more adapted to our needs as a team working in the ad hoc networks, this method is based on the principle of the Blockchain and that we named ”MPR Blockchain”.

Keywords: Ad hocs networks, blockchain, MPR, security

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14148 Traffic Study and Proposal for a Bike Lane for the University of the Basque Country

Authors: Elisabete Alberdi, Irantzu Álvarez, Laura Girón

Abstract:

The objective of this work is to propose a cycle path or network of paths to the UPV/EHU Campus in Leioa. The proposal will be presented from the point of view of sustainability. In order to achieve this, the roads that are already built will be used, and the road or network will be proposed to be built with the least amount of money possible. To select the most suitable route for the bike lane, various sources of information have been used. Through this data, we analyse the transport infrastructure and the mobility around the UPV/EHU Campus in Leioa. This work aims to satisfy the mobility needs of users on the University Campus to contribute to the sustainability of the campus.

Keywords: cycle lane, sustainability, accessibility, transport, agenda 2030

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14147 Design and Implementation of an Affordable Electronic Medical Records in a Rural Healthcare Setting: A Qualitative Intrinsic Phenomenon Case Study

Authors: Nitika Sharma, Yogesh Jain

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Introduction: An efficient Information System helps in improving the service delivery as well provides the foundation for policy and regulation of other building blocks of Health System. Health care organizations require an integrated working of its various sub-systems. An efficient EMR software boosts the teamwork amongst the various sub-systems thereby resulting in improved service delivery. Although there has been a huge impetus to EMR under the Digital India initiative, it has still not been mandated in India. It is generally implemented in huge funded public or private healthcare organizations only. Objective: The study was conducted to understand the factors that lead to the successful adoption of an affordable EMR in the low level healthcare organization. It intended to understand the design of the EMR and address the solutions to the challenges faced in adoption of the EMR. Methodology: The study was conducted in a non-profit registered Healthcare organization that has been providing healthcare facilities to more than 2500 villages including certain areas that are difficult to access. The data was collected with help of field notes, in-depth interviews and participant observation. A total of 16 participants using the EMR from different departments were enrolled via purposive sampling technique. The participants included in the study were working in the organization before the implementation of the EMR system. The study was conducted in one month period from 25 June-20 July 2018. The Ethical approval was taken from the institute along with prior approval of the participants. Data analysis: A word document of more than 4000 words was obtained after transcribing and translating the answers of respondents. It was further analyzed by focused coding, a line by line review of the transcripts, underlining words, phrases or sentences that might suggest themes to do thematic narrative analysis. Results: Based on the answers the results were thematically grouped under four headings: 1. governance of organization, 2. architecture and design of the software, 3. features of the software, 4. challenges faced in adoption and the solutions to address them. It was inferred that the successful implementation was attributed to the easy and comprehensive design of the system which has facilitated not only easy data storage and retrieval but contributes in constructing a decision support system for the staff. Portability has lead to increased acceptance by physicians. The proper division of labor, increased efficiency of staff, incorporation of auto-correction features and facilitation of task shifting has lead to increased acceptance amongst the users of various departments. Geographical inhibitions, low computer literacy and high patient load were the major challenges faced during its implementation. Despite of dual efforts made both by the architects and administrators to combat these challenges, there are still certain ongoing challenges faced by organization. Conclusion: Whenever any new technology is adopted there are certain innovators, early adopters, late adopters and laggards. The same pattern was followed in adoption of this software. He challenges were overcome with joint efforts of organization administrators and users as well. Thereby this case study provides a framework of implementing similar systems in public sector of countries that are struggling for digitizing the healthcare in presence of crunch of human and financial resources.

Keywords: EMR, healthcare technology, e-health, EHR

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14146 Reflective Portfolio to Bridge the Gap in Clinical Training

Authors: Keenoo Bibi Sumera, Alsheikh Mona, Mubarak Jan Beebee Zeba Mahetaab

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Background: Due to the busy schedule of the practicing clinicians at the hospitals, students may not always be attended to, which is to their detriment. The clinicians at the hospitals are also not always acquainted with teaching and/or supervising students on their placements. Additionally, there is a high student-patient ratio. Since they are the prospective clinical doctors under training, they need to reach the competence levels in clinical decision-making skills to be able to serve the healthcare system of the country and to be safe doctors. Aims and Objectives: A reflective portfolio was used to provide a means for students to learn by reflecting on their experiences and obtaining continuous feedback. This practice is an attempt to compensate for the scarcity of lack of resources, that is, clinical placement supervisors and patients. It is also anticipated that it will provide learners with a continuous monitoring and learning gap analysis tool for their clinical skills. Methodology: A hardcopy reflective portfolio was designed and validated. The portfolio incorporated a mini clinical evaluation exercise (mini-CEX), direct observation of procedural skills and reflection sections. Workshops were organized for the stakeholders, that is the management, faculty and students, separately. The rationale of reflection was emphasized. Students were given samples of reflective writing. The portfolio was then implemented amongst the undergraduate medical students of years four, five and six during clinical clerkship. After 16 weeks of implementation of the portfolio, a survey questionnaire was introduced to explore how undergraduate students perceive the educational value of the reflective portfolio and its impact on their deep information processing. Results: The majority of the respondents are in MD Year 5. Out of 52 respondents, 57.7% were doing the internal medicine clinical placement rotation, and 42.3% were in Otorhinolaryngology clinical placement rotation. The respondents believe that the implementation of a reflective portfolio helped them identify their weaknesses, gain professional development in terms of helping them to identify areas where the knowledge is good, increase the learning value if it is used as a formative assessment, try to relate to different courses and in improving their professional skills. However, it is not necessary that the portfolio will improve the self-esteem of respondents or help in developing their critical thinking, The portfolio takes time to complete, and the supervisors are not useful. They had to chase supervisors for feedback. 53.8% of the respondents followed the Gibbs reflective model to write the reflection, whilst the others did not follow any guidelines to write the reflection 48.1% said that the feedback was helpful, 17.3% preferred the use of written feedback, whilst 11.5% preferred oral feedback. Most of them suggested more frequent feedback. 59.6% of respondents found the current portfolio user-friendly, and 28.8% thought it was too bulky. 27.5% have mentioned that for a mobile application. Conclusion: The reflective portfolio, through the reflection of their work and regular feedback from supervisors, has an overall positive impact on the learning process of undergraduate medical students during their clinical clerkship.

Keywords: Portfolio, Reflection, Feedback, Clinical Placement, Undergraduate Medical Education

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14145 Reverse Logistics Information Management Using Ontological Approach

Authors: F. Lhafiane, A. Elbyed, M. Bouchoum

Abstract:

Reverse Logistics (RL) Process is considered as complex and dynamic network that involves many stakeholders such as: suppliers, manufactures, warehouse, retails, and costumers, this complexity is inherent in such process due to lack of perfect knowledge or conflicting information. Ontologies, on the other hand, can be considered as an approach to overcome the problem of sharing knowledge and communication among the various reverse logistics partners. In this paper, we propose a semantic representation based on hybrid architecture for building the Ontologies in an ascendant way, this method facilitates the semantic reconciliation between the heterogeneous information systems (ICT) that support reverse logistics Processes and product data.

Keywords: Reverse Logistics, information management, heterogeneity, ontologies, semantic web

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14144 Development of Vertically Integrated 2D Lake Victoria Flow Models in COMSOL Multiphysics

Authors: Seema Paul, Jesper Oppelstrup, Roger Thunvik, Vladimir Cvetkovic

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Lake Victoria is the second largest fresh water body in the world, located in East Africa with a catchment area of 250,000 km², of which 68,800 km² is the actual lake surface. The hydrodynamic processes of the shallow (40–80 m deep) water system are unique due to its location at the equator, which makes Coriolis effects weak. The paper describes a St.Venant shallow water model of Lake Victoria developed in COMSOL Multiphysics software, a general purpose finite element tool for solving partial differential equations. Depth soundings taken in smaller parts of the lake were combined with recent more extensive data to resolve the discrepancies of the lake shore coordinates. The topography model must have continuous gradients, and Delaunay triangulation with Gaussian smoothing was used to produce the lake depth model. The model shows large-scale flow patterns, passive tracer concentration and water level variations in response to river and tracer inflow, rain and evaporation, and wind stress. Actual data of precipitation, evaporation, in- and outflows were applied in a fifty-year simulation model. It should be noted that the water balance is dominated by rain and evaporation and model simulations are validated by Matlab and COMSOL. The model conserves water volume, the celerity gradients are very small, and the volume flow is very slow and irrotational except at river mouths. Numerical experiments show that the single outflow can be modelled by a simple linear control law responding only to mean water level, except for a few instances. Experiments with tracer input in rivers show very slow dispersion of the tracer, a result of the slow mean velocities, in turn, caused by the near-balance of rain with evaporation. The numerical and hydrodynamical model can evaluate the effects of wind stress which is exerted by the wind on the lake surface that will impact on lake water level. Also, model can evaluate the effects of the expected climate change, as manifest in changes to rainfall over the catchment area of Lake Victoria in the future.

Keywords: bathymetry, lake flow and steady state analysis, water level validation and concentration, wind stress

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14143 Using HABIT to Establish the Chemicals Analysis Methodology for Maanshan Nuclear Power Plant

Authors: J. R. Wang, S. W. Chen, Y. Chiang, W. S. Hsu, J. H. Yang, Y. S. Tseng, C. Shih

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In this research, the HABIT analysis methodology was established for Maanshan nuclear power plant (NPP). The Final Safety Analysis Report (FSAR), reports, and other data were used in this study. To evaluate the control room habitability under the CO2 storage burst, the HABIT methodology was used to perform this analysis. The HABIT result was below the R.G. 1.78 failure criteria. This indicates that Maanshan NPP habitability can be maintained. Additionally, the sensitivity study of the parameters (wind speed, atmospheric stability classification, air temperature, and control room intake flow rate) was also performed in this research.

Keywords: PWR, HABIT, Habitability, Maanshan

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14142 Problems Encountered in Teaching English as a Second Language in Asia

Authors: Geraldine Agbor Ojong

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This paper conveys some of the problems teachers of ESL face in classroom settings in Thailand. The results of this paper is achieved through close and open ended questionaires administered to a group of English language teachers of three prominent schools in Kaengkhoi, saraburi Province, Thailand.(Saengvithaya school, kaengkhoi school and Pytoon withaya school). Face to face interview of some foreign teachers and students selected randomly And general observation. The data was analysed by frequency distribution and percentage: The result of the study may be generalized so that the conference committee can suggest possible solutions or give contributing ideas on how to handle some of these problems.

Keywords: Asian, colonize, ESL, foreign country

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14141 Evaluation of the Trauma System in a District Hospital Setting in Ireland

Authors: Ahmeda Ali, Mary Codd, Susan Brundage

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

Keywords: trauma, education, management, system

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14140 Distributed Listening in Intensive Care: Nurses’ Collective Alarm Responses Unravelled through Auditory Spatiotemporal Trajectories

Authors: Michael Sonne Kristensen, Frank Loesche, James Foster, Elif Ozcan, Judy Edworthy

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Auditory alarms play an integral role in intensive care nurses’ daily work. Most medical devices in the intensive care unit (ICU) are designed to produce alarm sounds in order to make nurses aware of immediate or prospective safety risks. The utilisation of sound as a carrier of crucial patient information is highly dependent on nurses’ presence - both physically and mentally. For ICU nurses, especially the ones who work with stationary alarm devices at the patient bed space, it is a challenge to display ‘appropriate’ alarm responses at all times as they have to navigate with great flexibility in a complex work environment. While being primarily responsible for a small number of allocated patients they are often required to engage with other nurses’ patients, relatives, and colleagues at different locations inside and outside the unit. This work explores the social strategies used by a team of nurses to comprehend and react to the information conveyed by the alarms in the ICU. Two main research questions guide the study: To what extent do alarms from a patient bed space reach the relevant responsible nurse by direct auditory exposure? By which means do responsible nurses get informed about their patients’ alarms when not directly exposed to the alarms? A comprehensive video-ethnographic field study was carried out to capture and evaluate alarm-related events in an ICU. The study involved close collaboration with four nurses who wore eye-level cameras and ear-level binaural audio recorders during several work shifts. At all time the entire unit was monitored by multiple video and audio recorders. From a data set of hundreds of hours of recorded material information about the nurses’ location, social interaction, and alarm exposure at any point in time was coded in a multi-channel replay-interface. The data shows that responsible nurses’ direct exposure and awareness of the alarms of their allocated patients vary significantly depending on work load, social relationships, and the location of the patient’s bed space. Distributed listening is deliberately employed by the nursing team as a social strategy to respond adequately to alarms, but the patterns of information flow prompted by alarm-related events are not uniform. Auditory Spatiotemporal Trajectory (AST) is proposed as a methodological label to designate the integration of temporal, spatial and auditory load information. As a mixed-method metrics it provides tangible evidence of how nurses’ individual alarm-related experiences differ from one another and from stationary points in the ICU. Furthermore, it is used to demonstrate how alarm-related information reaches the individual nurse through principles of social and distributed cognition, and how that information relates to the actual alarm event. Thereby it bridges a long-standing gap in the literature on medical alarm utilisation between, on the one hand, initiatives to measure objective data of the medical sound environment without consideration for any human experience, and, on the other hand, initiatives to study subjective experiences of the medical sound environment without detailed evidence of the objective characteristics of the environment.

Keywords: auditory spatiotemporal trajectory, medical alarms, social cognition, video-ethography

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14139 Medical Decision-Making in Advanced Dementia from the Family Caregiver Perspective: A Qualitative Study

Authors: Elzbieta Sikorska-Simmons

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Advanced dementia is a progressive terminal brain disease that is accompanied by a syndrome of difficult to manage symptoms and complications that eventually lead to death. The management of advanced dementia poses major challenges to family caregivers who act as patient health care proxies in making medical treatment decisions. Little is known, however, about how they manage advanced dementia and how their treatment choices influence the quality of patient life. This prospective qualitative study examines the key medical treatment decisions that family caregivers make while managing advanced dementia. The term ‘family caregiver’ refers to a relative or a friend who is primarily responsible for managing patient’s medical care needs and legally authorized to give informed consent for medical treatments. Medical decision-making implies a process of choosing between treatment options in response to patient’s medical care needs (e.g., worsening comorbid conditions, pain, infections, acute medical events). Family caregivers engage in this process when they actively seek treatments or follow recommendations by healthcare professionals. Better understanding of medical decision-making from the family caregiver perspective is needed to design interventions that maximize the quality of patient life and limit inappropriate treatments. Data were collected in three waves of semi-structured interviews with 20 family caregivers for patients with advanced dementia. A purposive sample of 20 family caregivers was recruited from a senior care center in Central Florida. The qualitative personal interviews were conducted by the author in 4-5 months intervals. The ethical approval for the study was obtained prior to the data collection. Advanced dementia was operationalized as stage five or higher on the Global Deterioration Scale (GDS) (i.e., starting with the GDS score of five, patients are no longer able survive without assistance due to major cognitive and functional impairments). Information about patients’ GDS scores was obtained from the Center’s Medical Director, who had an in-depth knowledge of each patient’s health and medical treatment history. All interviews were audiotaped and transcribed verbatim. The qualitative data analysis was conducted to answer the following research questions: 1) what treatment decisions do family caregivers make while managing the symptoms of advanced dementia and 2) how do these treatment decisions influence the quality of patient life? To validate the results, the author asked each participating family caregiver if the summarized findings accurately captured his/her experiences. The identified medical decisions ranged from seeking specialist medical care to end-of-life care. The most common decisions were related to arranging medical appointments, medication management, seeking treatments for pain and other symptoms, nursing home placement, and accessing community-based healthcare services. The most challenging and consequential decisions were related to the management of acute complications, hospitalizations, and discontinuation of treatments. Decisions that had the greatest impact on the quality of patient life and survival were triggered by traumatic falls, worsening psychiatric symptoms, and aspiration pneumonia. The study findings have important implications for geriatric nurses in the context of patient/caregiver-centered dementia care. Innovative nursing approaches are needed to support family caregivers to effectively manage medical care needs of patients with advanced dementia.

Keywords: advanced dementia, family caregiver, medical decision-making, symptom management

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