Search results for: comfort indicator
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1556

Search results for: comfort indicator

326 Role of Tele-health in Expansion of Medical Care

Authors: Garima Singh, Kunal Malhotra

Abstract:

Objective: The expansion of telehealth has been instrumental in increasing access to medical services, especially for underserved and rural communities. In 2020, 14 million patients received virtual care through telemedicine and the global telemedicine market is expected to reach up to $185 million by 2023. It provides a platform and allows a patient to receive primary care as well as specialized care using technology and the comfort of their homes. Telemedicine was particularly useful during COVID-pandemic and the number of telehealth visits increased by 5000% during that time. It continues to serve as a significant resource for patients seeking care and to bridge the gap between the disease and the treatment. Method: As per APA (American Psychiatric Association), Telemedicine is the process of providing health care from a distance through technology. It is a subset of telemedicine, and can involve providing a range of services, including evaluations, therapy, patient education and medication management. It can involve direct interaction between a physician and the patient. It also encompasses supporting primary care providers with specialist consultation and expertise. It can also involve recording medical information (images, videos, etc.) and sending this to a distant site for later review. Results: In our organization, we are using telepsychiatry and serving 25 counties and approximately 1.4 million people. We provide multiple services, including inpatient, outpatient, crisis intervention, Rehab facility, autism services, case management, community treatment and multiple other modalities. With project ECHO (Extension for Community Healthcare Outcomes) it has been used to advise and assist primary care providers in treating mental health. It empowers primary care providers to treat patients in their own community by sharing knowledge. Conclusion: Telemedicine has shown to be a great medium in meeting patients’ needs and accessible mental health. It has been shown to improve access to care in both urban and rural settings by bringing care to a patient and reducing barriers like transportation, financial stress and resources. Telemedicine is also helping with reducing ER visits, integrating primary care and improving the continuity of care and follow-up. There has been substantial evidence and research about its effectiveness and its usage.

Keywords: telehealth, telemedicine, access to care, medical technology

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325 Relationship Between Insulin Resistance and Some Coagulation and Fibrinolytic Parameters in Subjects With Metabolic Syndrome

Authors: Amany Ragab, Nashwa Khairat Abousamra, Omayma Saleh, Asmaa Higazy

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Insulin resistance syndrome has been shown to be associated with many coagulation and fibrinolytic proteins and these associations suggest that some coagulation and fibrinolytic proteins have a role in atherothrombotic disorders. This study was conducted to determine the levels of some of the haemostatic parameters in subjects having metabolic syndrome and to correlate these values with the anthropometric and metabolic variables associated with this syndrome. The study included 46 obese non diabetic subjects of whom 28 subjects(group1) fulfilled the ATP III criteria of the metabolic syndrome and 18 subjects (group2) did not have metabolic syndrome as well as 14 lean subjects (group 3) of matched age and sex as a control group. Clinical and laboratory evaluation of the study groups stressed on anthropometric measurements (weight, height, body mass index, waist circumference, and sagittal abdominal diameter), blood pressure, and laboratory measurements of fasting plasma glucose, fasting insulin, serum lipids, tissue plasminogen activator (t-PA), antithrombin III activity (ATIII), protein C and von Willebrand factor (vWf) antigen. There was significant increase in the concentrations of t-PA and vWf antigens in subjects having metabolic syndrome (group 1) in comparison to the other groups while there were non-significant changes in the levels of protein C antigen and AT III activity. Both t-PA and vWf showed significant correlation with HOMA-IR as a measure of insulin sensitivity. The t-PA showed also significant correlation with most of the variables of metabolic syndrome including waist circumference, BMI, systolic blood pressure, fasting plasma glucose, fasting insulin, and HDL cholesterol. On the other hand, vWf showed significant correlations with fasting plasma glucose, fasting insulin and sagital abdominal diameter, with non-significant correlations with the other variables. Haemostatic and fibrinolytic parameters should be included in the features and characterization of the insulin resistance syndrome. t-PA and vWf antigens concentrations were increased in subjects with metabolic syndrome and correlated with the HOMA-IR measure of insulin sensitivity. Taking into consideration that both t-PA and vWf are mainly released from vascular endothelium, these findings could be an indicator of endothelial dysfunction in that group of subjects.

Keywords: insulin resistance, obesity, metabolic syndrome, coagulation

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324 Corporate Social Responsibility and Financial Performance Complementarity in Multinational Enterprises of the EU and India: A Socio-Political Approach

Authors: Moses Pinto, Ana Paula Monte

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The present research analyses the interactions between various categories of corporate social responsibility (CSR) that mediate the relationship between CSR and financial performance in Multinational Enterprises (MNE) in light of the present socio-political factors prevalent in the countries under observation. In the research it has been hypothesized that the absence of consensus in the empirical literature on the CSR–financial performance relationship may be explained by the existence of synergies (Complementarities) between the different CSR components. Upon investigation about whether such relationships exist, a final unbalanced panel sample of 1000 observations taken from 100 Multinational Enterprises per year functioning in the Schengen countries and one south east Asian country namely: India, over the span of 10 years i.e. from the year 2008 to 2018 has been analyzed. The empirical analysis used in the research methodology employs dynamic Panel Data in time series specifically, the system Generalized Method of Moments (GMM) which had been used to detect the varying degrees of relationships between the CSR and financial performance parameters in the background of the socio-political factors prevailing in the countries at the time and also taking into account the bilateral treaty obligations between the countries under observation. The econometric model has employed the financial ratio namely the Return on Assets (ROA) as an indicator of financial performance in order to gauge the internal performance and valuation of a firm as opposed to the Tobin’s Q that provides for the external evaluation of a firm’s financial performance which may not always be accurate. The various CSR dimensions have demonstrated significant correlations to the ‘ROA’ which include some negatively associated correlations and one positively associated correlation that is highly significant throughout the analysis of the observations, namely the correlation between the ‘ROA’ and the CSR dimension: ‘Environment’. The results provide a deeper insight in the synergistic CSR activities that managers could adapt into their Firm’s CSR strategy in order to enhance the ‘ROA’ and also to understand which interactions between the CSR dimensions can be adapted together due to their positively correlated association with each other and the ROA. The future lines of research would be inclined to investigate the effects of socio-political factors on the ROA of the MNEs through better designed econometric models.

Keywords: CSR, financial performance, complementarity, sociopolitical factors

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323 Effect of Repellent Coatings, Aerosol Protective Liners, and Lamination on the Properties of Chemical/Biological Protective Textiles

Authors: Natalie Pomerantz, Nicholas Dugan, Molly Richards, Walter Zukas

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The primary research question to be answered for Chemical/Biological (CB) protective clothing, is how to protect wearers from a range of chemical and biological threats in liquid, vapor, and aerosol form, while reducing the thermal burden. Currently, CB protective garments are hot, heavy, and wearers are limited by short work times in order to prevent heat injury. This study demonstrates how to incorporate different levels of protection on a material level and modify fabric composites such that the thermal burden is reduced to such an extent it approaches that of a standard duty uniform with no CB protection. CB protective materials are usually comprised of several fabric layers: a cover fabric with a liquid repellent coating, a protective layer which is comprised of a carbon-based sorptive material or semi-permeable membrane, and a comfort next-to-skin liner. In order to reduce thermal burden, all of these layers were laminated together to form one fabric composite which had no insulative air gap in between layers. However, the elimination of the air gap also reduced the CB protection of the fabric composite. In order to increase protection in the laminated composite, different nonwoven aerosol protective liners were added, and a super repellent coating was applied to the cover fabric, prior to lamination. Different adhesive patterns were investigated to determine the durability of the laminate with the super repellent coating, and the effect on air permeation. After evaluating the thermal properties, textile properties and protective properties of the iterations of these fabric composites, it was found that the thermal burden of these materials was greatly reduced by decreasing the thermal resistance with the elimination of the air gap between layers. While the level of protection was reduced in laminate composites, the addition of a super repellent coating increased protection towards low volatility agents without impacting thermal burden. Similarly, the addition of aerosol protective liner increased protection without reducing water vapor transport, depending on the nonwoven used, however, the air permeability was significantly decreased. The balance of all these properties and exploration of the trade space between thermal burden and protection will be discussed.

Keywords: aerosol protection, CBRNe protection, lamination, nonwovens, repellent coatings, thermal burden

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322 Dynamic Ambulance Deployment to Reduce Ambulance Response Times Using Geographic Information Systems

Authors: Masoud Swalehe, Semra Günay

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Developed countries are losing many lives to non-communicable diseases as compared to their developing counterparts. The effects of these diseases are mostly sudden and manifest at a very short time prior to death or a dangerous attack and this has consolidated the significance of emergency medical system (EMS) as one of the vital areas of healthcare service delivery. The primary objective of this research is to reduce ambulance response times (RT) of Eskişehir province EMS since a number of studies have established a relationship between ambulance response times and survival chances of patients especially out of hospital cardiac arrest (OHCA) victims. It has been found out that patients who receive out of hospital medical attention in few (4) minutes after cardiac arrest because of low ambulance response times stand higher chances of survival than their counterparts who take longer times (more than 12 minutes) to receive out of hospital medical care because of higher ambulance response times. The study will make use of geographic information systems (GIS) technology to dynamically reallocate ambulance resources according to demand and time so as to reduce ambulance response times. Geospatial-time distribution of ambulance calls (demand) will be used as a basis for optimal ambulance deployment using system status management (SSM) strategy to achieve much demand coverage with the same number of ambulance resources to cause response time reduction. Drive-time polygons will be used to come up with time specific facility coverage areas and suggesting additional facility candidate sites where ambulance resources can be moved to serve higher demands making use of network analysis techniques. Emergency Ambulance calls’ data from 1st January 2014 to 31st December 2014 obtained from Eskişehir province health directorate will be used in this study. This study will focus on the reduction of ambulance response times which is a key Emergency Medical Services performance indicator.

Keywords: emergency medical services, system status management, ambulance response times, geographic information system, geospatial-time distribution, out of hospital cardiac arrest

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321 Performance of Different Spray Nozzles in the Application of Defoliant on Cotton Plants (Gossypium hirsutum L.)

Authors: Mohamud Ali Ibrahim, Ali Bayat, Ali Bolat

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Defoliant spraying is an important link in the mechanized cotton harvest because adequate and uniform spraying can improve defoliation quality and reduce cotton trash content. In defoliant application, application volume and spraying technology are extremely important. In this study, the effectiveness of defoliant application to cotton plant that has come to harvest with two different application volumes and three different types of nozzles with a standard field crop sprayer was determined. Experiments were carried in two phases as field area trials and laboratory analysis. Application rates were 250 l/ha and 400 L/ha, and spraying nozzles were (1) Standard flat fan nozzle (TP8006), (2) Air induction nozzle (AI 11002-VS), and (3) Dual Pattern nozzle (AI307003VP). A tracer (BSF) and defoliant were applied to mature cotton with approximately 60% open bolls and samplings for BSF deposition and spray coverage on the cotton plant were done at two plant height (upper layer, lower layer) of plant. Before and after spraying, bolls open and leaves rate on cotton plants were calculated, and filter papers were used to detect BSF deposition, and water sensitive papers (WSP) were used to measure the coverage rate of spraying methods used. Spectrofluorophotometer was used to detect the amount of tracer deposition on targets, and an image process computer programme was used to measure coverage rate on WSP. In analysis, conclusions showed that air induction nozzle (AI 11002-VS) achieved better results than the dual pattern and standard flat fan nozzles in terms of higher depositions, coverages, and leaf defoliations, and boll opening rates. AI nozzles operating at 250 L/ha application rate provide the highest deposition and coverage rate on applications of the defoliant; in addition, BSF as an indicator of the defoliant used reached on leaf beneath in merely this spray nozzle. After defoliation boll opening rate was 85% on the 7th and 12th days after spraying and falling rate of leaves was 76% at application rate of 250 L/ha with air induction (AI1102) nozzle.

Keywords: cotton defoliant, air induction nozzle, dual pattern nozzle, standard flat fan nozzle, coverage rate, spray deposition, boll opening rate, leaves falling rate

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320 Assessment and Adaptation Strategy of Climate Change to Water Quality in the Erren River and Its Impact to Health

Authors: Pei-Chih Wu, Hsin-Chih Lai, Yung-Lung Lee, Yun-Yao Chi, Ching-Yi Horng, Hsien-Chang Wang

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The impact of climate change to health has always been well documented. Amongst them, water-borne infectious diseases, chronic adverse effects or cancer risks due to chemical contamination in flooding or drought events are especially important in river basin. This study therefore utilizes GIS and different models to integrate demographic, land use, disaster prevention, social-economic factors, and human health assessment in the Erren River basin. Therefore, through the collecting of climatic, demographic, health surveillance, water quality and other water monitoring data, potential risks associated with the Erren River Basin are established and to understand human exposure and vulnerability in response to climate extremes. This study assesses the temporal and spatial patterns of melioidosis (2000-2015) and various cancer incidents in Tainan and Kaohsiung cities. The next step is to analyze the spatial association between diseases incidences, climatic factors, land uses, and other demographic factors by using ArcMap and GeoDa. The study results show that amongst all melioidosis cases in Taiwan, 24% cases (115) residence occurred in the Erren River basin. The relationship between the cases and in Tainan and Kaohsiung cities are associated with population density, aging indicator, and residence in Erren River basin. Risks from flooding due to heavy rainfall and fish farms in spatial lag regression are also related. Through liver cancer, the preliminary analysis in temporal and spatial pattern shows an increases pattern in annual incidence without clusters in Erren River basin. Further analysis of potential cancers connected to heavy metal contamination from water pollution in Erren River is established. The final step is to develop an assessment tool for human exposure from water contamination and vulnerability in response to climate extremes for the second year.

Keywords: climate change, health impact, health adaptation, Erren River Basin

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319 Gender Equity in Everyday Lives: A Case Study from New Delhi, India

Authors: Shrutika Lakshmi

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Gender inequality has been quite evident particularly in the third world economies in different domains like health, education, marriages and personal freedom. Women’s exercise to personal freedom is driven by their financial standing in third world social milieu. However, even after decades of attempt to achieve a socio-economic standing equal to men, their attempts have failed in registering success.This research has been conducted in the national capital of India New Delhi aiming to reflect upon the gendered relations in society on the category of employed women. This particular category of women have been chosen for the study in order to study the gender relations, subordination of such women in household despite having an economic standing of their own, etc. The methodology used for this study is semi-structured interview along with qualitative analysis. Moreover, with the help of direct interaction with these women, we get insight into the kind of gendered relations prevailing inside the household structure which have their roots in age old customs and stereotype of the social milieu. Most importantly, the highlight of the study remains on the point where the hierarchy remains in the subconscious of these women and they never forget their social standing. It has been interesting to note that how even after contributing to the family income successively, their position remains subjugated in front of their male counterparts and thus, they are not ‘free’ in the real sense of the term. Even after attaining an economically stable position, these women did not enjoy the same comfort and freedom of choice as their male counterparts do, this could be gauged from the fact that when asked about ‘time for one’s own self’ they had no sense of it. This is astonishing in today’s world where every individual works and strives for a better livelihood and quality existence. Such findings reflect upon the reality of our society where women are still subjugated and duty bound towards the household even after having the same economic stand as their male counterparts. The burden of household chores and responsibilities fall solely on the shoulders of a women despite being an employed women even in the present times. Cooperation comes primarily from female members of the household and not from males. And thus, we as a society are far away from gender equity. We still suffer from prejudices and stereotypes which prevent us from giving same respect to women which we keep reserved for the man. Given this scenario, it seems, gender equity is a distant goal which we will have to keep striving for even harder even after decades of feminist struggles all over the world.

Keywords: employed women, subjugation in household, gender hierarchy, financial independence,

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318 Women’s Empowerment on Modern Contraceptive Use in Poor-Rich Segment of Population: Evidence from South Asian Countries

Authors: Muhammad Asim

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Background: Less than half of women in South Asia (SA) use any modern contraceptive method which leads to a huge burden of unintended pregnancies, unsafe abortions, maternal deaths, and socioeconomic loss. Women empowerment plays a pivotal role in improving various health seeking behaviours, including contraceptive use. The objective of this study to explore the association between women's empowerment and modern contraceptive, among rich and poor segment of population in SA. Methods: We used the most recent, large-scale, demographic health survey data of five South Asian countries, namely Afghanistan, Pakistan, Bangladesh, India, and Nepal. The outcome variable was the current use of modern contraceptive methods. The main exposure variable was a combination (interaction) of socio-economic status (SES) and women’s level of empowerment (low, medium, and high), where SES was bifurcated into poor and rich; and women empowerment was divided into three categories: decision making, attitude to violence and social independence. Moreover, overall women empowerment indicator was also created by using three dimensions of women empowerment. We applied both descriptive statistics and multivariable logistic regression techniques for data analyses. Results: Most of the women possessed ‘medium’ level of empowerment across South Asian Countries. The lowest attitude to violence empowerment was found in Afghanistan, and the lowest social independence empowerment was observed in Bangladesh across SA. However, Pakistani women have the lowest decision-making empowerment in the region. The lowest modern contraceptive use (22.1%) was found in Afghanistan and the highest (53.2%) in Bangladesh. The multivariate results depict that the overall measure of women empowerment does not affect modern contraceptive use among poor and rich women in most of South Asian countries. However, the decision-making empowerment plays a significant role among both poor and rich women to use modern contraceptive methods across South Asian countries. Conclusions: The effect of women’s empowerment on modern contraceptive use is not consistent across countries, and among poor and rich segment of population. Of the three dimensions of women’s empowerment, the autonomy of decision making in household affairs emerged as a stronger determinant of mCPR as compared with social independence and attitude towards violence against women.

Keywords: women empowerment, contraceptive use, South Asia, women autonomy

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317 Women’s Empowerment on Modern Contraceptive Use in Poor-Rich Segment of Population: Evidence From South Asian Countries

Authors: Muhammad Asim

Abstract:

Background: Less than half of women in South Asia (SA) use any modern contraceptive method which leads to a huge burden of unintended pregnancies, unsafe abortions, maternal deaths, and socioeconomic loss. Women empowerment plays a pivotal role in improving various health seeking behaviours, including contraceptive use. The objective of this study to explore the association between women's empowerment and modern contraceptive, among rich and poor segment of population in SA. Methods: We used the most recent, large-scale, demographic health survey data of five South Asian countries, namely Afghanistan, Pakistan, Bangladesh, India, and Nepal. The outcome variable was the current use of modern contraceptive methods. The main exposure variable was a combination (interaction) of socio-economic status (SES) and women’s level of empowerment (low, medium, and high), where SES was bifurcated into poor and rich; and women empowerment was divided into three categories: decision making, attitude to violence and social independence. Moreover, overall women empowerment indicator was also created by using three dimensions of women empowerment. We applied both descriptive statistics and multivariable logistic regression techniques for data analyses. Results: Most of the women possessed ‘medium’ level of empowerment across South Asian Countries. The lowest attitude to violence empowerment was found in Afghanistan, and the lowest social independence empowerment was observed in Bangladesh across SA. However, Pakistani women have the lowest decision-making empowerment in the region. The lowest modern contraceptive use (22.1%) was found in Afghanistan and the highest (53.2%) in Bangladesh. The multivariate results depict that the overall measure of women empowerment does not affect modern contraceptive use among poor and rich women in most of South Asian countries. However, the decision-making empowerment plays a significant role among both poor and rich women to use modern contraceptive methods across South Asian countries. Conclusions: The effect of women’s empowerment on modern contraceptive use is not consistent across countries, and among poor and rich segment of population. Of the three dimensions of women’s empowerment, the autonomy of decision making in household affairs emerged as a stronger determinant of mCPR as compared with social independence and attitude towards violence against women.

Keywords: women empowerment, modern contraceptive use, South Asia, women autonomy

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316 Comparison of Microbiological Assessment of Non-adhesive Use and the Use of Adhesive on Complete Dentures

Authors: Hyvee Gean Cabuso, Arvin Taruc, Danielle Villanueva, Channela Anais Hipolito, Jia Bianca Alfonso

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Introduction: Denture adhesive aids to provide additional retention, support and comfort for patients with loose dentures, as well as for patients who seek to achieve optimal denture adhesion. But due to its growing popularity, arising oral health issues should be considered, including its possible impact that may alter the microbiological condition of the denture. Changes as such may further resolve to denture-related oral diseases that can affect the day-to-day lives of patients. Purpose: The study aims to assess and compare the microbiological status of dentures without adhesives versus dentures when adhesives were applied. The study also intends to identify the presence of specific microorganisms, their colony concentration and their possible effects on the oral microflora. This study also aims to educate subjects by introducing an alternative denture cleaning method as well as denture and oral health care. Methodology: Edentulous subjects age 50-80 years old, both physically and medically fit, were selected to participate. Before obtaining samples for the study, the alternative cleaning method was introduced by demonstrating a step-by-step cleaning process. Samples were obtained by swabbing the intaglio surface of their upper and lower prosthesis. These swabs were placed in a thioglycollate broth, which served as a transport and enrichment medium. The swabs were then processed through bacterial culture. The colony-forming units (CFUs) were calculated on MacConkey Agar Plate (MAP) and Blood Agar Plate (BAP) in order to identify and assess the microbiological status, including species identification and microbial counting. Result: Upon evaluation and analysis of collected data, the microbiological assessment of the upper dentures with adhesives showed little to no difference compared to dentures without adhesives, but for the lower dentures, (P=0.005), which is less than α = 0.05; therefore, the researchers reject (Ho) and that there is a significant difference between the mean ranks of the lower denture without adhesive to those with, implying that there is a significant decrease in the bacterial count. Conclusion: These results findings may implicate the possibility that the addition of denture adhesives may contribute to the significant decrease of microbial colonization on the dentures.

Keywords: denture, denture adhesive, denture-related, microbiological assessment

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315 Predictability of Thermal Response in Housing: A Case Study in Australia, Adelaide

Authors: Mina Rouhollahi, J. Boland

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Changes in cities’ heat balance due to rapid urbanization and the urban heat island (UHI) have increased energy demands for space cooling and have resulted in uncomfortable living conditions for urban residents. Climate resilience and comfortable living spaces can be addressed through well-designed urban development. The sustainable housing can be more effective in controlling high levels of urban heat. In Australia, to mitigate the effects of UHIs and summer heat waves, one solution to sustainable housing has been the trend to compact housing design and the construction of energy efficient dwellings. This paper analyses whether current housing configurations and orientations are effective in avoiding increased demands for air conditioning and having an energy efficient residential neighborhood. A significant amount of energy is consumed to ensure thermal comfort in houses. This paper reports on the modelling of heat transfer within the homes using the measurements of radiation, convection and conduction between exterior/interior wall surfaces and outdoor/indoor environment respectively. The simulation was tested on selected 7.5-star energy efficient houses constructed of typical material elements and insulation in Adelaide, Australia. The chosen design dwellings were analyzed in extremely hot weather through one year. The data were obtained via a thermal circuit to accurately model the fundamental heat transfer mechanisms on both boundaries of the house and through the multi-layered wall configurations. The formulation of the Lumped capacitance model was considered in discrete time steps by adopting a non-linear model method. The simulation results focused on the effects of orientation of the solar radiation on the dynamic thermal characteristics of the houses orientations. A high star rating did not necessarily coincide with a decrease in peak demands for cooling. A more effective approach to avoid increasing the demands for air conditioning and energy may be to integrate solar–climatic data to evaluate the performance of energy efficient houses.

Keywords: energy-efficient residential building, heat transfer, neighborhood orientation, solar–climatic data

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314 Analysis of the Annual Proficiency Testing Procedure for Intermediate Reference Laboratories Conducted by the National Reference Laboratory from 2013 to 2017

Authors: Reena K., Mamatha H. G., Somshekarayya, P. Kumar

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Objectives: The annual proficiency testing of intermediate reference laboratories is conducted by the National Reference Laboratory (NRL) to assess the efficiency of the laboratories to correctly identify Mycobacterium tuberculosis and to determine its drug susceptibility pattern. The proficiency testing results from 2013 to 2017 were analyzed to determine laboratories that were consistent in reporting quality results and those that had difficulty in doing so. Methods: A panel of twenty cultures were sent out to each of these laboratories. The laboratories were expected to grow the cultures in their own laboratories, set up drug susceptibly testing by all the methods they were certified for and report the results within the stipulated time period. The turnaround time for reporting results, specificity, sensitivity positive and negative predictive values and efficiency of the laboratory in identifying the cultures were analyzed. Results: Most of the laboratories had reported their results within the stipulated time period. However, there was enormous delay in reporting results from few of the laboratories. This was mainly due to improper functioning of the biosafety level III laboratory. Only 40% of the laboratories had 100% efficiency in solid culture using Lowenstein Jensen medium. This was expected as a solid culture, and drug susceptibility testing is not used for diagnosing drug resistance. Rapid molecular methods such as Line probe assay and Genexpert are used to determine drug resistance. Automated liquid culture system such as the Mycobacterial growth indicator tube is used to determine prognosis of the patient while on treatment. It was observed that 90% of the laboratories had achieved 100% in the liquid culture method. Almost all laboratories had achieved 100% efficiency in the line probe assay method which is the method of choice for determining drug-resistant tuberculosis. Conclusion: Since the liquid culture and line probe assay technologies are routinely used for the detection of drug-resistant tuberculosis the laboratories exhibited higher level of efficiency as compared to solid culture and drug susceptibility testing which are rarely used. The infrastructure of the laboratory should be maintained properly so that samples can be processed safely and results could be declared on time.

Keywords: annual proficiency testing, drug susceptibility testing, intermediate reference laboratory, national reference laboratory

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313 Renovation of Dilapidated Areas and Sustainable Reconstruction of Various Parts of Tehran, Iran

Authors: Alireza Rahpeyma

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One of the most significant challenges faced by cities is inefficient and deteriorated urban fabric. Deteriorated areas bring about numerous issues, including economic, social, physical, and infrastructural problems, sewage management, environmental concerns, and security issues. One of the crucial necessities of modern urban life is the revitalization and renovation of these urban fabrics. Another important aspect is preserving a cohesive cultural and social identity during the urban renewal process. Urban renovation and upgrading are not a one-time occurrence but rather an ongoing process that ultimately needs to become ingrained in the system. This process is not swift; it involves sensitive and intricate stages that require well-designed plans within short, medium, and long-term timeframes. To revitalize dilapidated areas, a comprehensive understanding of the urban region's sustainability is essential. The goal of this study is to provide a suitable model for the upgrading and renewal of areas 2, 4, 5, 7, 8, and 10 in Tehran, preserving the heritage within these urban fabrics (urban assets), including the valuable morphologies of these areas, to prevent financial wastage. This study was conducted descriptively and analytically using the SWOT technique and GIS software. The research results regarding urban upgrading and renewal bring about the following points: 1) Urban upgrading and renewal ensure satisfactory efficiency, justice, environmental quality, safety and security, hygiene, sewage management, and the comfort and aesthetics of urban spaces. 2) Employing the above processes in old city centers re-establishes the historical and cultural connection between people and their past, a past that is evolving and improving and will not repeat itself. 3) Despite the expansion and growth of Iranian cities, cultural and national identity can be preserved by adhering to healthy urban revitalization principles. 4) Proper urban upgrading and renewal prevent social fragmentation, deviant behavioral patterns, psychological and occupational disorders, and financial losses. In general, preserving the identity and urban life in renovation and upgrading must be comprehensive, encompassing various dimensions, including physical, social, economic, political, and administrative aspects.

Keywords: dilapidated areas, renovation, sustainable reconstruction, Tehran-Iran

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312 Relationships Between the Petrophysical and Mechanical Properties of Rocks and Shear Wave Velocity

Authors: Anamika Sahu

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The Himalayas, like many mountainous regions, is susceptible to multiple hazards. In recent times, the frequency of such disasters is continuously increasing due to extreme weather phenomena. These natural hazards are responsible for irreparable human and economic loss. The Indian Himalayas has repeatedly been ruptured by great earthquakes in the past and has the potential for a future large seismic event as it falls under the seismic gap. Damages caused by earthquakes are different in different localities. It is well known that, during earthquakes, damage to the structure is associated with the subsurface conditions and the quality of construction materials. So, for sustainable mountain development, prior estimation of site characterization will be valuable for designing and constructing the space area and for efficient mitigation of the seismic risk. Both geotechnical and geophysical investigation of the subsurface is required to describe the subsurface complexity. In mountainous regions, geophysical methods are gaining popularity as areas can be studied without disturbing the ground surface, and also these methods are time and cost-effective. The MASW method is used to calculate the Vs30. Vs30 is the average shear wave velocity for the top 30m of soil. Shear wave velocity is considered the best stiffness indicator, and the average of shear wave velocity up to 30 m is used in National Earthquake Hazards Reduction Program (NEHRP) provisions (BSSC,1994) and Uniform Building Code (UBC), 1997 classification. Parameters obtained through geotechnical investigation have been integrated with findings obtained through the subsurface geophysical survey. Joint interpretation has been used to establish inter-relationships among mineral constituents, various textural parameters, and unconfined compressive strength (UCS) with shear wave velocity. It is found that results obtained through the MASW method fitted well with the laboratory test. In both conditions, mineral constituents and textural parameters (grain size, grain shape, grain orientation, and degree of interlocking) control the petrophysical and mechanical properties of rocks and the behavior of shear wave velocity.

Keywords: MASW, mechanical, petrophysical, site characterization

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311 Effect of Preoperative Single Dose Dexamethasone and Lignocaine on Post-Operative Quality of Recovery and Pain Relief after Laparoscopic Cholecystectomy

Authors: Gurjeet Khurana, Surender Singh, Poonam Arora, Praveendra K. Sachan

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Introduction: Post-operative quality of recovery is the key outcome in the perspective of anesthesiologist. It is directly related to patient satisfaction. This is unsurprising, considering most aspects of a poor quality recovery after surgery will impair satisfaction with care. This study was thus undertaken to evaluate effects of Dexamethasone and Lignocaine on Quality of Recovery using QoR- 40 questionnaire and compare their effects. Material and methods: After obtaining the ethical committee approval and written informed consent, 67 patients of 18-60 years, ASA grade I and II scheduled for elective laparoscopic cholecystectomy were randomly allocated into two groups. Group I of 34 patients received 2mg/kg lignocaine diluted to 10ml with normal saline. Group 2 of 33 patients received 0.1 mg/kg I/V Dexamethasone diluted to 10ml with normal saline. QoR-40 was assessed on pre-operative day, and again QoR-40 was assessed at 24 hr post-operative day-1. Postoperative pain scores, nausea and vomiting and shoulder pain were secondary outcomes. Results: The Global QoR-40 was more than 180 at 24 hr in both the groups. The Dexamethasone group had higher Global QoR-40 than lignocaine group 187.94 v/s 182.85. Amongst dimensions of QoR-40 Dexamethasone had statistically better physical comfort, physical independence, and pain relief as compared to Lignocaine. Positive items had excellent responses in Dexamethasone group. Headache, backache and sore throat were also less severe in Dexamethasone group as compared to Lignocaine group. Dexamethasone group had lower VAS compared to lignocaine group. Similarly, there was less fentanyl consumption in dexamethasone group (364.08 ± 127.31) in postoperative period when compared to the lignocaine group (412.31 ± 147.8). Group receiving dexamethasone had 36% increase in appetite compared to lignocaine group (17.6%), which facilitated early oral feeding. Frequency of PONV was less in group-2 at different time interval as compared to group 1. Total episode of PONV were 18 in group 1 and 7 in group 2. Statistically significant difference was seen among two groups (p value= 0.007). Use of antiemetic was more in group 1 as compared to group 2 at all the times, though it was not statistically significant at different time intervals. Antiemetics were administered to 18 patients in group 1 as compared to 5 patients in group 2 postoperatively. Statistically significant difference (p value= 0.011) was seen in total antiemetic consumption. Conclusion: Our study demonstrated that pre-operative administration of a single dose of dexamethasone enhanced the quality of recovery after laparoscopic cholecystectomy as compared to Lignocaine bolus dose.

Keywords: dexamethasone, lignocaine, QoR-40 questionnaire, quality of recovery

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310 Arterial Line Use for Acute Type 2 Respiratory Failure

Authors: C. Scurr, J. Jeans, S. Srivastava

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Introduction: Acute type two respiratory failure (T2RF) has become a common presentation over the last two decades primarily due to an increase in the prevalence of chronic lung disease. Acute exacerbations can be managed either medically or in combination with non-invasive ventilation (NIV) which should be monitored with regular arterial blood gas samples (ABG). Arterial lines allow more frequent arterial blood sampling with less patient discomfort. We present the experience from a teaching hospital emergency department (ED) and level 2 medical high-dependency unit (HDU) that together form the pathway for management of acute type 2 respiratory failure. Methods: Patients acutely presenting to Charing Cross Hospital, London, with T2RF requiring non-invasive ventilation (NIV) over 14 months (2011 to 2012) were identified from clinical coding. Retrospective data collection included: demographics, co-morbidities, blood gas numbers and timing, if arterial lines were used and who performed this. Analysis was undertaken using Microsoft Excel. Results: Coding identified 107 possible patients. 69 notes were available, of which 41 required NIV for type 2 respiratory failure. 53.6% of patients had an arterial line inserted. Patients with arterial lines had 22.4 ABG in total on average compared to 8.2 for those without. These patients had a similar average time to normalizing pH of (23.7 with arterial line vs 25.6 hours without), and no statistically significant difference in mortality. Arterial lines were inserted by Foundation year doctors, Core trainees, Medical registrars as well as the ICU registrar. 63% of these were performed by the medical registrar rather than ICU, ED or a junior doctor. This is reflected in that the average time until an arterial line was inserted was 462 minutes. The average number of ABGs taken before an arterial line was 2 with a range of 0 – 6. The average number of gases taken if no arterial line was ever used was 7.79 (range of 2-34) – on average 4 times as many arterial punctures for each patient. Discussion: Arterial line use was associated with more frequent arterial blood sampling during each inpatient admission. Additionally, patients with an arterial line have less individual arterial punctures in total and this is likely more comfortable for the patient. Arterial lines are normally sited by medical registrars, however this is normally after some delay. ED clinicians could improve patient comfort and monitoring thus allowing faster titration of NIV if arteral lines were regularly inserted in the ED. We recommend that ED doctors insert arterial lines when indicated in order improve the patient experience and facilitate medical management.

Keywords: non invasive ventilation, arterial blood gas, acute type, arterial line

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309 Identifying Factors of Wellbeing in Russian Orphans

Authors: Alexandra Telitsyna, Galina Semya, Elvira Garifulina

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Introduction: Starting from 2012 Russia conducts deinstitutionalization policy and now the main indicator of success is the number of children living in institutions. Active family placement process has resulted in residents of the institution now mainly consists of adolescents with behavioral and emotional problems, children with disabilities and groups of siblings. Purpose of science research: The purpose of science research is to identify factors for child’s wellbeing while temporary stay in an orphanage and the subjective assessment of children's level of well-being (psychological well-being). Methods: The data used for this project was collected by the questionnaire of 72 indicators, a tool for monitoring the behavior of children and caregivers, an additional questionnaire for children; well-being assessment questionnaire containing 10 scales for three age groups from preschool to older adolescents. In 2016-2018, the research was conducted in 1873 institution in 85 regions of Russia. In each region a team of academics, specialists from Non-profits, independent experts was created. Training was conducted for team members through a series of webinars prior to undertaking the assessment. The results: To ensure the well-being of the children, the following conditions are necessary: 1- Life of children in institution is organised according to the principles of family care (including the creation of conditions for attachment to be formed); 2- Contribution to find family-based placement for children (including reintegration into the primary family); 3- Work with parents of children, who are placed in an organization at the request of parents; 4- Children attend schools according to their needs; 5- Training of staff and volunteers; 6- Special environment and services for children with special needs and children with disabilities; 7- Cooperation with NGOs; 8 - Openness and accessibility of the organization. Conclusion: A study of the psychological well-being of children showed that the most emotionally stressful for children were questions about the presence and frequency of contact with relatives, and the level of well-being is higher in the presence of a trusted adult and respect for rights. The greatest contribution to the trouble is made by the time the child is in the orphanage, the lack of contact with parents and relatives, the uncertainty of the future.

Keywords: identifying factors, orphans, Russia, wellbeing

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308 Reconstruction Paleogeomorphological Map of the Nile River in Upper Egypt by Using Some Geomorphological and Geoarchaeological Indicators

Authors: Magdy Torab

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Ancient Egyptians built their temples purposefully close to the River Nile to use it for transporting construction stones from far away quarries to building sites in river-boats. Most temples, therefore, have river-harbors associated with their geometric designs. The paleoriver channel remapped by using this idea, besides other geomorphological and geoarchaeological indicators/evidence located between Aswan and Luxor cities. In this sense, this paper defines the characteristics of this ancient course and its associated landforms using paleochannel morphology, paleomeandering, and ancient river dynamics during historic and prehistoric times. Both geomorphological and geoarchaeological approaches used to reconstruct the paleomorphology of the river course. It helps to investigate the ancient river morphology by using the following techniques: comparison and interpretation of multi dates satellite images and historical maps between 1943 and 2004. The results illustrated on maps using GIS (ARC GIS V.10 software) and the field data collected from the western bank of The Nile River at Luxor area and Karnak, Edfu, Esna and Kom Ombo temples. Created both current and paleogeomorphological maps depending upon the results of geoarchaeological surveying and soil analysis and dating, for surface and subsurface soil sampling by handle auger, laser diffraction analysis for 7 soil samples collected from some mounds and Malkata channel in the western bank of The Nile River near Luxor. Paleo-current directions were determined by using standard Brunton compass to use it as an indicator is evidence for the direction of flow of The Nile River during deposition of some accumulated mounds on the western part of the floodplain near Luxor city. C-14 dating was used for two samples collected from these mounds as well as geographical information system (GIS) technique for mapping. The geomorphological and geoarchaeological evidence shows that the Nile River course in Luxor area was around 4.5 km wide and contained many islands and sandbars which separated inside the river channel, now appearing as scattered mounds inside the floodplain. Upper Egypt has migrated during the historic times to the east up to five kilometers and become far away from the ancient temples, quarries, and harbors. It has also become as well as become more meandering and narrower than before.

Keywords: Nile River, ancient harbours, Luxor, paleogeomorphology, geoarchaeology

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307 Evaluating the Probability of Foreign Tourists' Return to the City of Mashhad, Iran

Authors: Mohammad Rahim Rahnama, Amir Ali Kharazmi, Safiye Rokni

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The tourism industry will be the most important unlimited, sustainable source of income after the oil and automotive industries by 2020 and not only countries, but cities are striving to apprehend its various facets. In line with this objective, the present descriptive-analytical study, through survey and using a questionnaire, seeks to evaluate the probability of tourists’ return and their recommendation to their countrymen to travel to Mashhad, Iran. The population under study is a sample of 384 foreign tourists who, in 2016, arrived at Mashhad, the second metropolis in Iran and its biggest religious city. The Kaplan-Meier estimator was used to analyze the data. Twenty-six percent of the tourists are female and 74% are male. On average, each tourist has had 3.02 trips abroad and 2.1 trips to Mashhad. Tourists from 14 different countries have arrived at Mashhad. Kuwait (15.9%), Armenia (15.6%), and Iraq (10.9%) were the countries where most tourists originated. Seventy-six percent of the tourists traveled with family and 90% of the tourists arrived at Mashhad via airplane. Major purposes of tourists’ trip include pilgrimage (27.9%), treatment (22.1%) followed by pilgrimage and treatment combined (35.4%). Major issues for tourists, in the order of priority, include quality of goods and services (30.2%), shopping (18%), and inhabitants’ treatment of foreigners (15.9%). Main tourist attractions, in addition to the Holy Shrine of Imam Reza, include Torqabeh and Shandiz (Torqabeh 40.9% and Shandiz 29.9%), Neyshabour (18.2%) followed by Kalat, 4.4%. The average willingness to return among tourists is 3.13, which is higher than the mean 3, indicating satisfaction with the stay in Mashhad. Similarly, the average for tourists’ recommending to their countrymen to visit Mashhad is 3.42, which is also an indicator of tourists’ satisfaction with their presence in Mashhad. According to the findings of the Kaplan-Meier estimator, an increase in the number of tourists’ trips to Mashhad, and an increase in the number of tourists’ foreign trips, reduces the probability of recommending a trip to Mashhad by tourists. Similarly, willingness to return is higher among those who stayed at a relatives’ home compared with other patterns of residence (hotels, self-catering accommodation, and pilgrim houses). Therefore, addressing the issues raised by tourists is essential for their return and their recommendation to others to travel to Mashhad.

Keywords: international tourist, probability of return, satisfaction, Mashhad

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306 Assessment of Interior Environmental Quality and Airborne Infectious Risk in a Commuter Bus Cabin by Using Computational Fluid Dynamics with Computer Simulated Person

Authors: Yutaro Kyuma, Sung-Jun Yoo, Kazuhide Ito

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A commuter bus remains important as a means to network public transportation between railway stations and terminals within cities. In some cases, the boarding time becomes longer, and the boarding rate tends to be higher corresponding to the development of urban cities. The interior environmental quality, e.g. temperature and air quality, in a commuter bus is relatively heterogeneous and complex compared to that of an indoor environment in buildings due to several factors: solar radiative heat – which comes from large-area windows –, inadequate ventilation rate caused by high density of commuters, and metabolic heat generation from travelers themselves. In addition to this, under conditions where many passengers ride in the enclosed space, contact and airborne infectious risk have attracted considerable attention in terms of public health. From this point of view, it is essential to develop the prediction method for assessment of interior environmental quality and infection risk in commuter bus cabins. In this study, we developed a numerical commuter bus model integrated with computer simulated persons to reproduce realistic indoor environment conditions with high occupancy during commuting. Here, computer simulated persons were newly designed considering different types of geometries, e.g., standing position, seating position, and individual differences. Here we conducted coupled computational fluid dynamics (CFD) analysis with radiative heat transfer analysis under steady state condition. Distributions of heterogeneous air flow patterns, temperature, and moisture surrounding the human body under some different ventilation system were analyzed by using CFD technique, and skin surface temperature distributions were analyzed using thermoregulation model that integrated into computer simulated person. Through these analyses, we discussed the interior environmental quality in specific commuter bus cabins. Further, inhaled air quality of each passenger was also analyzed. This study may have possibility to design the ventilation system in bus for improving thermal comfort of occupants.

Keywords: computational fluid dynamics, CFD, computer simulated person, CSP, contaminant, indoor environment, public health, ventilation

Procedia PDF Downloads 237
305 Transformation in Palliative Care Delivery in Surgery

Authors: W. L. Tsang, H. Y. Li, S. L. Wong, T. Y. Kwok, S. C. Yuen, S. S. Kwok, P. S. Ko, S. Y. Lau

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Introduction: Palliative care is no doubt necessary in surgery. When one looks at studies of what patients with life-threatening illness want and compares to what they experience in surgical units, the gap is huge. Surgical nurses, being patient advocates, should engage with patients and families sooner rather than later in their illness trajectories to consider how to manage the illness, not just their capacity to survive. Objective: This clinical practice guide aims to fill the service gap of palliative care in surgery by producing a quality-driven, evidence-based yet straightforward clinical practice guide based on a focus strategy. Methodology: In line with Guide to Good Nursing Practice: End-of-Life Care recommended by Nursing Council of Hong Kong and the strategic goal of improving quality of palliative care proposed in HA Strategic Plan 2017-2022, multiple phases of work were undertaken from July 2015 to December 2017. A pragmatic clinical practice guide for surgical patients facing life-threatening conditions was developed based on assessments on knowledge of and attitudes towards end-of-life care of surgical nurses. Key domains, including preparation for bereavement, nursing care for imminently dying patients and at the dying scene were crystallized according to the results of the assessments and the palliative care checklist formulated by UCH Palliative Care Team. After a year of rollout, its content was refined through analyses of implementation in routine practice and consensus opinions from frontline nurses. Results and Outcomes: This clinical practice guide inspires surgical nurses with the art of care to provide for patients’ comfort, function, and longevity. It provides practical directions and assists nurses to master the skills on advance care planning and learn how to be clear with patients, families and themselves about the realities of the disease pictures. Through the implementation, patients and families are included in the decision process, and their wishes are honored. The delivery of explicit and high-quality palliative care maintains good nurse-to-patient relations and enhances satisfaction of hospital care of patients and families. Conclusion: Surgical nursing has always been up to the unique challenges of the era. This clinical practice guide has become an island of credibility for our nurses as they traverse the often stormy waters of life-limiting illness.

Keywords: palliative care delivery, palliative care in surgery, hospice care, end-of-life care

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304 Determination of Bromides, Chlorides and Fluorides in Case of Their Joint Presence in Ion-Conducting Electrolyte

Authors: V. Golubeva, O. Vakhnina, I. Konopkina, N. Gerasimova, N. Taturina, K. Zhogova

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To improve chemical current sources, the ion-conducting electrolytes based on Li halides (LiCl-KCl, LiCl-LiBr-KBr, LiCl-LiBr-LiF) are developed. It is necessary to have chemical analytical methods for determination of halides to control the electrolytes technology. The methods of classical analytical chemistry are of interest, as they are characterized by high accuracy. Using these methods is a difficult task because halides have similar chemical properties. The objective of this work is to develop a titrimetric method for determining the content of bromides, chlorides, and fluorides in their joint presence in an ion-conducting electrolyte. In accordance with the developed method of analysis to determine fluorides, electrolyte sample is dissolved in diluted HCl acid; fluorides are titrated by La(NO₃)₃ solution with potentiometric indication of equivalence point, fluoride ion-selective electrode is used as sensor. Chlorides and bromides do not form a hardly soluble compound with La and do not interfere in result of analysis. To determine the bromides, the sample is dissolved in a diluted H₂SO₄ acid. The bromides are oxidized with a solution of KIO₃ to Br₂, which is removed from the reaction zone by boiling. Excess of KIO₃ is titrated by iodometric method. The content of bromides is calculated from the amount of KIO₃ spent on Br₂ oxidation. Chlorides and fluorides are not oxidized by KIO₃ and do not interfere in result of analysis. To determine the chlorides, the sample is dissolved in diluted HNO₃ acid and the total content of chlorides and bromides is determined by method of visual mercurometric titration with diphenylcarbazone indicator. Fluorides do not form a hardly soluble compound with mercury and do not interfere with determination. The content of chlorides is calculated taking into account the content of bromides in the sample of electrolyte. The validation of the developed analytical method was evaluated by analyzing internal reference material with known chlorides, bromides and fluorides content. The analytical method allows to determine chlorides, bromides and fluorides in case of their joint presence in ion-conducting electrolyte within the range and with relative total error (δ): for bromides from 60.0 to 65.0 %, δ = ± 2.1 %; for chlorides from 8.0 to 15.0 %, δ = ± 3.6 %; for fluorides from 5.0 to 8.0%, ± 1.5% . The analytical method allows to analyze electrolytes and mixtures that contain chlorides, bromides, fluorides of alkali metals and their mixtures (K, Na, Li).

Keywords: bromides, chlorides, fluorides, ion-conducting electrolyte

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303 Determinants of Repeated Abortion among Women of Reproductive Age Attending Health Facilities in Northern Ethiopia: A Case-Control Study

Authors: Henok Yebyo Henok, Araya Abrha Araya, Alemayehu Bayray Alemayehu, Gelila Goba Gelila

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Background: Every year, an estimated 19–20 million unsafe abortions take place, almost all in developing countries, leading to 68,000 deaths and millions more injured many permanently. Many women throughout the world, experience more than one abortion in their lifetimes. Repeat abortion is an indicator of the larger problem of unintended pregnancy. This study aimed to identify determinants of repeat abortion in Tigray Region, Ethiopia. Methods: Unmatched case-control study was conducted in hospitals in Tigray Region, Northern Ethiopia, from November 2014 to June 2015. The sample included 105 cases and 204 controls, recruited from among women seeking abortion care at public hospitals. Clients having two or more abortions (“repeat abortion”) were taken as cases, and those who had a total of one abortion were taken as controls (“single abortion”). Cases were selected consecutive based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression analyses were calculated with 95% CI. Results: Mean age of cases was 24 years (±6.85) and 22 years (±6.25) for controls. 79.0% of cases had their sexual debut in less than 18 years of age compared to 57% of controls. 42.2% of controls and 23.8% of cases cited rape as the reason for having an abortion. Study participants who did not understand their fertility cycle and when they were most likely to conceive after menstruation (adjusted odds ratio [AOR]=2.0, 95% confidence interval [CI]: 1.1-3.7), having a previous abortion using medication(AOR=3.3, CI: 1.83, 6.11), having multiple sexual partners in the preceding 12 months (AOR=4.4, CI: 2.39,8.45), perceiving that the abortion procedure is not painful (AOR=2.3, CI: 1.31,4.26), initiating sexual intercourse before the age of 18 years (AOR=2.7, CI: 1.49, 5.23) and disclosure to a third-party about terminating the pregnancy (AOR=2.1, CI: 1.2,3.83) were independent predictors of repeat abortion. Conclusion: This study identified several factors correlated with women having repeat abortions. It may be helpful for the Government of Ethiopia to encourage women to delay sexual debut and decrease their number of sexual partners, including by promoting discussion within families about sexuality, to decrease the occurrence of repeated abortion.

Keywords: abortion, Ethiopia, repeated abortion, single abortion

Procedia PDF Downloads 256
302 Advancing Healthcare Excellence in China: Crafting a Strategic Operational Evaluation Index System for Chinese Hospital Departments amid Payment Reform Initiatives

Authors: Jing Jiang, Yuguang Gao, Yang Yu

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Facing increasingly challenging insurance payment pressures, the Chinese healthcare system is undergoing significant transformations, akin to the implementation of DRG payment models by the United States' Medicare. Consequently, there is a pressing need for Chinese hospitals to establish optimizations in departmental operations tailored to the ongoing healthcare payment reforms. This abstract delineates the meticulous construction of a scientifically rigorous and comprehensive index system at the departmental level in China strategically aligned with the evolving landscape of healthcare payment reforms. Methodologically, it integrates key process areas and maturity assessment theories, synthesizing relevant literature and industry standards to construct a robust framework and indicator pool. Employing the Delphi method, consultations with 21 experts were conducted, revealing a collective demonstration of high enthusiasm, authority, and coordination in designing the index system. The resulting model comprises four primary indicators -technical capabilities, cost-effectiveness, operational efficiency, and disciplinary potential- supported by 14 secondary indicators and 23 tertiary indicators with varied coefficient adjustment for department types (platform or surgical). The application of this evaluation system in a Chinese hospital within the northeastern region yielded results aligning seamlessly with the actual operational scenario. In conclusion, the index system comprehensively considers the integrity and effectiveness of structural, process, and outcome indicators and stands as a comprehensive reflection of the collective expertise of the engaged experts, manifesting in a model designed to elevate the operational management of hospital departments. Its strategic alignment with healthcare payment reforms holds practical significance in guiding departmental development positioning, brand cultivation, and talent development.

Keywords: Chinese healthcare system, Delphi method, departmental management, evaluation indicators, hospital operations, weight coefficients

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301 Impact of Intelligent Transportation System on Planning, Operation and Safety of Urban Corridor

Authors: Sourabh Jain, S. S. Jain

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Intelligent transportation system (ITS) is the application of technologies for developing a user–friendly transportation system to extend the safety and efficiency of urban transportation systems in developing countries. These systems involve vehicles, drivers, passengers, road operators, managers of transport services; all interacting with each other and the surroundings to boost the security and capacity of road systems. The goal of urban corridor management using ITS in road transport is to achieve improvements in mobility, safety, and the productivity of the transportation system within the available facilities through the integrated application of advanced monitoring, communications, computer, display, and control process technologies, both in the vehicle and on the road. Intelligent transportation system is a product of the revolution in information and communications technologies that is the hallmark of the digital age. The basic ITS technology is oriented on three main directions: communications, information, integration. Information acquisition (collection), processing, integration, and sorting are the basic activities of ITS. In the paper, attempts have been made to present the endeavor that was made to interpret and evaluate the performance of the 27.4 Km long study corridor having eight intersections and four flyovers. The corridor consisting of six lanes as well as eight lanes divided road network. Two categories of data have been collected such as traffic data (traffic volume, spot speed, delay) and road characteristics data (no. of lanes, lane width, bus stops, mid-block sections, intersections, flyovers). The instruments used for collecting the data were video camera, stop watch, radar gun, and mobile GPS (GPS tracker lite). From the analysis, the performance interpretations incorporated were the identification of peak and off-peak hours, congestion and level of service (LOS) at midblock sections and delay followed by plotting the speed contours. The paper proposed the urban corridor management strategies based on sensors integrated into both vehicles and on the roads that those have to be efficiently executable, cost-effective, and familiar to road users. It will be useful to reduce congestion, fuel consumption, and pollution so as to provide comfort, safety, and efficiency to the users.

Keywords: ITS strategies, congestion, planning, mobility, safety

Procedia PDF Downloads 166
300 Visual Preferences of Elementary School Children with Autism Spectrum Disorder: An Experimental Study

Authors: Larissa Pliska, Isabel Neitzel, Michael Buschermöhle, Olga Kunina-Habenicht, Ute Ritterfeld

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Visual preferences, which can be assessed using eye tracking technologies, are considered one of the defining hallmarks of Autism Spectrum Disorder (ASD). Specifically, children with ASD show a decreased preference for social images rather than geometric images compared to typically developed (TD) children. Such differences are already prevalent at a very early age and indicate the severity of the disorder: toddlers with ASD who preferred geometric images when confronted with social and geometric images showed higher ASD symptom severity than toddlers with ASD who showed higher social attention. Furthermore, the complexity of social pictures (one child playing vs. two children playing together) as well as the mode of stimulus presentation (video or image), are not decisive for the marker. The average age of diagnosis for ASD in Germany is 6.5 years, and visual preference data on this age group is missing. In the present study, we therefore investigated whether visual preferences persist into school age. We examined the visual preferences of 16 boys aged 6 to 11 with ASD and unimpaired cognition as well as TD children (1:1 matching based on children's age and the parent's level of education) within an experimental setting. Different stimulus presentation formats (images vs. videos) and different levels of stimulus complexity were included. Children with and without ASD received pairs of social and non-social images and video stimuli on a screen while eye movements (i.e., eye position and gaze direction) were recorded. For this specific use case, KIZMO GmbH developed a customized, native iOS app (KIZMO Face-Analyzer) for use on iPads. Neither the format of stimulus presentation nor the complexity of the social images had a significant effect on the visual preference of children with and without ASD in this study. Despite the tendency for a difference between the groups for the video stimuli, there were no significant differences. Overall, no statistical differences in visual preference occurred between boys with and without ASD, suggesting that gaze preference in these groups is similar at primary school age. One limitation is that the children with ASD were already receiving Autism-specific intervention. The potential of a visual preference task as an indicator of ASD can be emphasized. The article discusses the clinical relevance of this marker in elementary school children.

Keywords: autism spectrum disorder, eye tracking, hallmark, visual preference

Procedia PDF Downloads 43
299 Improved Technology Portfolio Management via Sustainability Analysis

Authors: Ali Al-Shehri, Abdulaziz Al-Qasim, Abdulkarim Sofi, Ali Yousef

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The oil and gas industry has played a major role in improving the prosperity of mankind and driving the world economy. According to the International Energy Agency (IEA) and Integrated Environmental Assessment (EIA) estimates, the world will continue to rely heavily on hydrocarbons for decades to come. This growing energy demand mandates taking sustainability measures to prolong the availability of reliable and affordable energy sources, and ensure lowering its environmental impact. Unlike any other industry, the oil and gas upstream operations are energy-intensive and scattered over large zonal areas. These challenging conditions require unique sustainability solutions. In recent years there has been a concerted effort by the oil and gas industry to develop and deploy innovative technologies to: maximize efficiency, reduce carbon footprint, reduce CO2 emissions, and optimize resources and material consumption. In the past, the main driver for research and development (R&D) in the exploration and production sector was primarily driven by maximizing profit through higher hydrocarbon recovery and new discoveries. Environmental-friendly and sustainable technologies are increasingly being deployed to balance sustainability and profitability. Analyzing technology and its sustainability impact is increasingly being used in corporate decision-making for improved portfolio management and allocating valuable resources toward technology R&D.This paper articulates and discusses a novel workflow to identify strategic sustainable technologies for improved portfolio management by addressing existing and future upstream challenges. It uses a systematic approach that relies on sustainability key performance indicators (KPI’s) including energy efficiency quotient, carbon footprint, and CO2 emissions. The paper provides examples of various technologies including CCS, reducing water cuts, automation, using renewables, energy efficiency, etc. The use of 4IR technologies such as Artificial Intelligence, Machine Learning, and Data Analytics are also discussed. Overlapping technologies, areas of collaboration and synergistic relationships are identified. The unique sustainability analyses provide improved decision-making on technology portfolio management.

Keywords: sustainability, oil& gas, technology portfolio, key performance indicator

Procedia PDF Downloads 168
298 Nanobiosensor System for Aptamer Based Pathogen Detection in Environmental Waters

Authors: Nimet Yildirim Tirgil, Ahmed Busnaina, April Z. Gu

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Environmental waters are monitored worldwide to protect people from infectious diseases primarily caused by enteric pathogens. All long, Escherichia coli (E. coli) is a good indicator for potential enteric pathogens in waters. Thus, a rapid and simple detection method for E. coli is very important to predict the pathogen contamination. In this study, to the best of our knowledge, as the first time we developed a rapid, direct and reusable SWCNTs (single walled carbon nanotubes) based biosensor system for sensitive and selective E. coli detection in water samples. We use a novel and newly developed flexible biosensor device which was fabricated by high-rate nanoscale offset printing process using directed assembly and transfer of SWCNTs. By simple directed assembly and non-covalent functionalization, aptamer (biorecognition element that specifically distinguish the E. coli O157:H7 strain from other pathogens) based SWCNTs biosensor system was designed and was further evaluated for environmental applications with simple and cost-effective steps. The two gold electrode terminals and SWCNTs-bridge between them allow continuous resistance response monitoring for the E. coli detection. The detection procedure is based on competitive mode detection. A known concentration of aptamer and E. coli cells were mixed and after a certain time filtered. The rest of free aptamers injected to the system. With hybridization of the free aptamers and their SWCNTs surface immobilized probe DNA (complementary-DNA for E. coli aptamer), we can monitor the resistance difference which is proportional to the amount of the E. coli. Thus, we can detect the E. coli without injecting it directly onto the sensing surface, and we could protect the electrode surface from the aggregation of target bacteria or other pollutants that may come from real wastewater samples. After optimization experiments, the linear detection range was determined from 2 cfu/ml to 10⁵ cfu/ml with higher than 0.98 R² value. The system was regenerated successfully with 5 % SDS solution over 100 times without any significant deterioration of the sensor performance. The developed system had high specificity towards E. coli (less than 20 % signal with other pathogens), and it could be applied to real water samples with 86 to 101 % recovery and 3 to 18 % cv values (n=3).

Keywords: aptamer, E. coli, environmental detection, nanobiosensor, SWCTs

Procedia PDF Downloads 174
297 The Effects of Subjective and Objective Indicators of Inequality on Life Satisfaction in a Comparative Perspective Using a Multi-Level Analysis

Authors: Atefeh Bagherianziarat, Dana Hamplova

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The inverse social gradient in life satisfaction (LS) is a well-established research finding. To estimate the influence of inequality on LS, most of the studies have explored the effect of the objective aspects of inequality or individuals’ socioeconomic status (SES). However, relatively fewer studies have confirmed recently the significant effect of the subjective aspect of inequality or subjective socioeconomic status (SSS) on life satisfaction over and above SES. In other words, it is confirmed by some studies that individuals’ perception of their unequal status in society or SSS can moderate the impact of their absolute unequal status on their life satisfaction. Nevertheless, this newly confirmed moderating link has not been affirmed to work likewise in societies with different levels of social inequality and also for people who believe in the value of equality, at different levels. In this study, we compared the moderative influence of subjective inequality on the link between objective inequality and life satisfaction. In particular, we focus on differences across welfare state regimes based on Esping-Andersen's theory. Also, we explored the moderative role of believing in the value of equality on the link between objective and subjective inequality on LS in the given societies. Since our studied variables were measured at both individual and country levels, we applied a multilevel analysis to the European Social Survey data (round 9). The results showed that people in deferent regimes reported statistically meaningful different levels of life satisfaction that is explained to different extends by their household income and their perception of their income inequality. The findings of the study supported the previous findings of the moderator influence of perceived inequality on the link between objective inequality and LS. However, this link is different in various welfare state regimes. The results of the multilevel modeling showed that country-level subjective equality is a positive predictor for individuals’ life satisfaction, while the GINI coefficient that was considered as the indicator of absolute inequality has a smaller effect on life satisfaction. Also, country-level subjective equality moderates the confirmed link between individuals’ income and their life satisfaction. It can be concluded that both individual and country-level subjective inequality slightly moderate the effect of individuals’ income on their life satisfaction.

Keywords: individual values, life satisfaction, multilevel analysis, objective inequality, subjective inequality, welfare regimes status

Procedia PDF Downloads 81