Search results for: healthcare networks

Authors: Mona Lisa M. Oliveira, Nara A. Policarpo, Ana Luiza B. P. Barros, Carla A. Silva

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Selective catalytic reduction systems for nitrogen oxides reduction by ammonia has been the chosen technology by most of diesel vehicle (i.e. bus and truck) manufacturers in Brazil, as also in Europe. Furthermore, at some conditions, over-stoichiometric ammonia availability is also needed that increases the NH₃ slips even more. Ammonia (NH₃) by this vehicle exhaust aftertreatment system provides a maximum efficiency of NOx removal if a significant amount of NH₃ is stored on its catalyst surface. In the other words, the practice shows that slightly less than 100% of the NOx conversion is usually targeted, so that the aqueous urea solution hydrolyzes to NH₃ via other species formation, under relatively low temperatures. This paper presents a model based on neural networks integrated with a road vehicle simulator that allows to estimate NH₃-slip emission factors for different driving conditions and patterns. The proposed model generates high NH₃slips which are not also limited in Brazil, but more efforts needed to be made to elucidate the contribution of vehicle-emitted NH₃ to the urban atmosphere.

Keywords: ammonia slip, neural-network, vehicles emissions, SCR-NOx

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Authors: Hanbey Hazar, Hakan Gul

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In this study; piston, exhaust, and suction valves of a diesel engine were coated in 300 mm thickness with Tungsten Carbide (WC) by using the HVOF coating method. Mathematical modeling of a coated and uncoated (standardized) engine was performed by using ANN (Artificial Neural Networks). The purpose was to decrease the number of repetitions of tests and reduce the test cost through mathematical modeling of engines by using ANN. The results obtained from the tests were entered in ANN and therefore engines' values at all speeds were estimated. Results obtained from the tests were compared with those obtained from ANN and they were observed to be compatible. It was also observed that, with thermal barrier coating, hydrocarbon (HC), carbon monoxide (CO), and smoke density values of the diesel engine decreased; but nitrogen oxides (NOx) increased. Furthermore, it was determined that results obtained through mathematical modeling by means of ANN reduced the number of test repetitions. Therefore, it was understood that time, fuel and labor could be saved in this way.

Keywords: Artificial Neural Network, Diesel Engine, Mathematical Modelling, Thermal Barrier Coating

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Authors: David Oluwole Moses, Odeyemi Adebowale Toba, Olawale Adetunji Kola

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Candida auris, an emerging fungus, has been reported in more than 30 countries around the world since its first detection in 2009. Due to its several virulence factors, resistance to antifungals, and persistence in hospital settings, Candida auris has been reported to cause treatment-failure infections. This study was therefore carried out to determine the incidence of Candida auris in a tertiary hospital in Ekiti State, Nigeria. In this study, a total of 115 samples were screened for Candida species using cultural and molecular methods. The carriage of virulence factors and antifungal resistance among C. auris was detected using standard microbiological methods. Candida species isolated from the samples were 15 (30.0%) in clinical samples and 22 (33.85%) in hospital equipment screened. Non-albicans Candida accounted for 3 (20%) and 8 (36.36%) among the isolates from the clinical samples and equipment, respectively. Only five of the non-albicans Candida isolates were C. auris. All the isolates produced biofilm, gelatinase, and hemolysin, while none produced germ tubes. Two of the isolates were resistant to all the antifungals tested. Also, all the isolates were resistant to fluconazole and itraconazole. Nystatin appeared to be the most effective among the tested antifungals. The isolation of Candida auris is being reported for the second time in Nigeria, further confirming that the fungus has spread beyond Lagos and Ibadan, where it was first reported. The extent of the spread of the nosocomial fungus needed to be further investigated and curtailed in Nigeria before its outbreak in healthcare facilities.

Keywords: candida auris, virulence factors, antifungals, pathogen, hospital, infection

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Authors: Xi Xiao, Chunhui Chen, Xinyu Liu, Guangwu Hu, Yong Jiang

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Location sharing is a fundamental service in mobile Online Social Networks (mOSNs), which raises significant privacy concerns in recent years. Now, most location-based service applications adopt client/server architecture. In this paper, a location sharing system, named CSLocShare, is presented to provide flexible privacy-preserving location sharing with client/server architecture in mOSNs. CSLocShare enables location sharing between both trusted social friends and untrusted strangers without the third-party server. In CSLocShare, Location-Storing Social Network Server (LSSNS) provides location-based services but do not know the users’ real locations. The thorough analysis indicates that the users’ location privacy is protected. Meanwhile, the storage and the communication cost are saved. CSLocShare is more suitable and effective in reality.

Keywords: mobile online social networks, client/server architecture, location sharing, privacy-preserving

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Authors: Elzbieta Sikorska-Simmons

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Dementia is a progressive terminal disease. Despite this recognition, research shows that most family caregivers do not know it, and it is unclear how this knowledge affects the quality of patient care. The aim of this qualitative study of 20 family caregivers for patients with advanced dementia is to examine how the caregiver's knowledge about dementia affects the quality of patient care in the context of healthcare decision-making, advanced care planning, and access to adequate support systems. Knowledge about dementia implies family caregivers' understanding of dementia trajectories, common symptoms/complications, and alternative treatment options (e.g., comfort feeding versus tube feeding). Data were collected in semi-structured interviews with 20 family caregivers. The interviews were conducted in person by the author and designed to elicit rich descriptions of family caregivers' experiences with healthcare decision-making and the management of common symptoms/complications of end-stage dementia as patient healthcare proxies. The study findings suggest that caregivers who recognize that dementia is a terminal disease are less likely to opt for life-extending treatments during the advanced stages. They are also more likely to seek palliative/hospice care, and consequently, they are better able to avoid unnecessary hospitalizations or medical procedures. For example, those who know that dementia is a terminal disease tend to opt for "comfort feeding" rather than "tube feeding" in managing the swallowing difficulties that accompany advanced dementia. In the context of advance care planning, family caregivers who know that dementia is a terminal disease tend to have more meaningful advance directives (e.g., Power of Attorney and Do Not Resuscitate orders). They are better prepared to anticipate common problems and pursue treatments that foster the best quality of patient life and care. Greater knowledge about advanced dementia helps them make more informed decisions that focus on enhancing the quality of patient life rather than just survival. In addition, those who know that dementia is a terminal disease are more likely to establish adequate support systems to help them cope with the complex demands of caregiving. For example, they are more likely to seek dementia-oriented primary care programs that offer house visits or respite services. Based on the study findings, knowledge about dementia as a terminal disease is critical in the optimal management of patient care needs and the establishment of adequate support systems. More research is needed to better understand what caregivers need to know to better prepare them for the complex demands of dementia caregiving.

Keywords: dementia education, family caregiver, management of dementia, quality of care

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Authors: Jason M. Hegenauer, Nicholas Fucci

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In the late 1990s, a major deinstitutionalization movement of elderly patients took place, since which, the design of long-term care facilities has not been adequately analyzed in the United States. Over the course of the last 25 years, major innovations in construction methods, technology, and medicine have been developed, drastically changing the landscape of healthcare architecture. In light of recent events, and the expected increase in elderly populations with the aging of the baby-boomer generation, it is evident that reconsideration of these facilities is essential for the proper care of aging populations. The global response has been effective in stifling this pandemic; however, widespread disease still poses an imminent threat to the human race. Having witnessed the devastation Covid-19 has reaped throughout nursing homes and long-term care facilities, it is evident that the current strategies for protecting our most vulnerable populations are not enough. Light renovation of existing facilities and previously overlooked considerations for new construction projects can drastically lower the risk at nursing homes and long-term care facilities. A reconfigured entry sequence supplements several of the features which have been long-standing essentials of the design of these facilities. This research focuses on several aspects identified as needing improvement, including indoor environment quality, security measures incorporated into healthcare architecture and design, and architectural mitigation strategies for sick building syndrome. The results of this study have been compiled as 'best practices' for the design of future healthcare construction projects focused on the health, safety, and quality of life of the residents of these facilities. These design strategies, which can easily be implemented through renovation of existing facilities and new construction projects, minimize risk of infection and spread of disease while allowing routine functions to continue with minimal impact, should the need for future lockdowns arise. Through the current lockdown procedures, which were implemented during the Covid-19 pandemic, isolation of residents has caused great unrest and worry for family members and friends as they are cut off from their loved ones. At this time, data is still being reported, leaving infection and death rates inconclusive; however, recent projections in some states list long-term care facility deaths as high as 60% of all deaths in the state. The population of these facilities consists of residents who are elderly, immunocompromised, and have underlying chronic medical conditions. According to the Centers for Disease Control, these populations are particularly susceptible to infection and serious illness. The obligation to protect our most vulnerable population cannot be overlooked, and the harsh measures recently taken as a response to the Covid-19 pandemic prove that the design strategies currently utilized for doing so are inadequate.

Keywords: building security, healthcare architecture and design, indoor environment quality, new construction, sick building syndrome, renovation

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Authors: Wan You Ning

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Addressing the rising prevalence of mental health issues among youths, the Multi-dimensional Approach to Resilience and Support in Advanced School-based Mental Health Service Delivery (MARS-ASMHSD) framework proposes the implementation of advanced mental health services in low-resource areas to further instil mental health resilience among students in a school-based setting. Recognizing the unsustainability of direct service delivery due to rapidly growing demands and costs, the MARS-ASMHSD framework endorses the deinstitutionalization of mental healthcare and explores a tiered, multi-dimensional approach in mental healthcare provision, establishing advanced school-based mental health service delivery. The framework is developed based on sustainable and credible evidence-based practices and modifications of existing mental health service deliveries in Asia, including Singapore, Thailand, Malaysia, Japan, and Taiwan. Dissemination of the framework model for implementation will enable a more progressive and advanced school-based mental health service delivery in low-resource areas. Through the evaluation of the mental health landscape and the role of stakeholders in the respective countries, the paper concludes with a multi-dimensional framework model for implementation in low-resource areas. A mixed-method independent research study is conducted to facilitate the framework's development.

Keywords: mental health, youths, school-based services, framework development

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Authors: Vishwesh Kulkarni, Nikhil Bellarykar

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Cellular complexity stems from the interactions among thousands of different molecular species. Thanks to the emerging fields of systems and synthetic biology, scientists are beginning to unravel these regulatory, signaling, and metabolic interactions and to understand their coordinated action. Reverse engineering of biological networks has has several benefits but a poor quality of data combined with the difficulty in reproducing it limits the applicability of these methods. A few years back, many of the commonly used predictive algorithms were tested on a network constructed in the yeast Saccharomyces cerevisiae (S. cerevisiae) to resolve this issue. The network was a synthetic network of five genes regulating each other for the so-called in vivo reverse-engineering and modeling assessment (IRMA). The network was constructed in S. cereviase since it is a simple and well characterized organism. The synthetic network included a variety of regulatory interactions, thus capturing the behaviour of larger eukaryotic gene networks on a smaller scale. We derive a new set of algorithms by solving a nonlinear optimization problem and show how these algorithms outperform other algorithms on these datasets.

Keywords: synthetic gene network, network identification, optimization, nonlinear modeling

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Authors: S. O. Uwaifo

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The paper examines the pivotal role of the library in university education through the provision of a wide range of information materials (print and non- print) required for the teaching, learning and research activities of the university. However certain impediments to the effectiveness of Nigerian university libraries, such as financial constraints, high foreign exchange, global disparities in accessing the internet, lack of local area networks, erratic electric power supply, absence of ICT literacy, poor maintenance culture, etc., were identified. Also, the necessity of repositioning Nigerian university libraries for effective information provision and delivery was stressed by pointing out their dividends, such as users’ access to Directory of Open Access Journals (DOAJ), Online Public Access Catalogue (OPAC), Institutional Repositories, Electronic Document Delivery, Social Media Networks, etc. It therefore becomes necessary for the libraries to be repositioned by way of being adequately automated or digitized for effective service delivery, in this age of globalization. Based on the identified barriers by this paper, some recommendations were proffered.

Keywords: repositioning, Nigerian university libraries, effective information provision and delivery, globalization

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Authors: Merav Ben Natan, Heba Igbarin, Arwa Watted

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Introduction: The rising prevalence of autism spectrum disorders (ASD) has heightened the need to understand the challenges faced by children with ASD and their families in emergency departments (EDs). Children with ASD often experience additional health issues and heightened anxiety in the chaotic ED environment, which can impact their care and parental satisfaction. Purpose: This study aimed to examine factors identified by mothers as affecting their satisfaction with the care provided to their children in the ED, among mothers of children with ASD in comparison to mothers of children without ASD. Design and methods: In this correlational quantitative study, 128 Israeli mothers – 59 (46%) mothers of children with ASD and 69 (54%) of children without ASD - completed an online survey based on a Ministry of Health national survey of patient experience. Results: Mothers of children with ASD expressed lower satisfaction with the care provided. The difference was particularly evident concerning waiting times for examination of the child by nurses and physicians in the ED, whether the nurses were attentive and responsive to the mother's questions and concerns, whether the ED staff demonstrated coordination and cooperation with regard to medical care of the child, and whether work in the ED was conducted in an orderly and organized manner. The presence of communication difficulties in children predicted mothers' satisfaction with care. Conclusions: These findings suggest that certain needs of mothers and/or their children with ASD do not receive an appropriate response in the ED. Practice implications: It is important to raise the awareness of healthcare providers in EDs regarding the needs of children with ASD and their parents, especially children with communication difficulties. Strategies should be implemented to improve the experience of children with ASD and their parents in the ED.

Keywords: autism spectrum disorder, emergency department, parental satisfaction, healthcare challenges

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Authors: V. Vicente E. Mujica, Gustavo Gonzalez

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The global coverage of broadband multimedia and internet-based services in terrestrial-satellite networks demand particular interests for satellite providers in order to enhance services with low latencies and high signal quality to diverse users. In particular, the delay of on-board processing is an inherent source of latency in a satellite communication that sometimes is discarded for the end-to-end delay of the satellite link. The frame work for this paper includes modelling of an on-orbit satellite payload using an agent model that can reproduce the properties of processing delays. In essence, a comparison of different spatial interpolation methods is carried out to evaluate physical data obtained by an GEO satellite in order to define a discretization function for determining that delay. Furthermore, the performance of the proposed agent and the development of a delay discretization function are together validated by simulating an hybrid satellite and terrestrial network. Simulation results show high accuracy according to the characteristics of initial data points of processing delay for Ku bands.

Keywords: terrestrial-satellite networks, latency, on-orbit satellite payload, simulation

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Authors: Vandana Maurya

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Positive psychological capital is the key contributor to the competitive advantage of the organizations. Moreover, work engagement and sense of humor are also positive notions and are able to facilitate positive workplace behaviour but the mechanism behind these relationships are not well understood. The purpose of this study was to examine the relationships among work engagement, sense of humor and outcome variables (organizational citizenship behaviour and ethical performance) as well as investigating how psychological capital (PsyCap) mediates the relationships between work engagement, sense of humor and the outcome variables among healthcare professionals. A cross-sectional survey was conducted on healthcare professionals (n= 240). Data were collected using questionnaires which includes Utrecht Work Engagement Scale (UWES), Multi-dimensional Sense of Humor Scale (MSHS), Psychological Capital Questionnaire (PCQ), Organizational Citizenship Behavior Questionnaire, and Ethical Performance Scale (EPS). The results of the regression analyses showed that work engagement and sense of humor both positively predicted the outcome variables. Mediation analysis reveals that psychological capital mediates the relationship between predictor and outcome variables. The study recommends that the framework presented in this study can be an important tool for managers to enhance their employees’ psychological capital by increasing their levels of work engagement and sense of humor. In turn, psychological capital could be a positive resource for employees to dealing more ethically and enhancing more positive workplace behaviour.

Keywords: ethical performance, humor, organizational citizenship behavior, PsyCap, work engagement

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Authors: Chondrogianni Dimitra, Yorgos J. Stephanedes

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The impact of the economic crisis, coupled with the aging of the city's old core, is reflected in central Athens. Public and private users, residents, employees, visitors desire the quality upgrading of abandoned buildings and public spaces through environmental upgrading and sustainable mobility, and promotion of the international metropolitan character of the city. In the study, a strategy for reshaping the character and function of the historic Athenian triangle is proposed, aiming at its economic, environmental, and social sustainable development through feasible, meaningful, and non-landscaping solutions of low cost and high positive impact. Sustainable mobility is the main principle in re-planning the study area and transforming it into a “Low Pollution and Limited Vehicle Traffic Zone” is the main strategy. Τhe proposed measures include the development of pedestrian mobility networks by expanding the pedestrian roads and limited-traffic routes, of bicycle networks based on the approved Metropolitan Bicycle Route of Athens, of public transportation networks with new lines of electric mini-buses, and of new regulations for vehicle mobility in the historic triangle. In addition, complementary actions are proposed regarding the provision of Wi-Fi on fixed track media, development of applications that facilitate combined travel and provide real-time data, integration of micromobility (roller skates, Segway, Hoverboard), and its enhancement as a flexible means of personal mobility, and development of car-sharing, ride-sharing and dynamic carpooling initiatives.

Keywords: regeneration plans, sustainable mobility, environmental upgrading, athens historical triangle

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Authors: Sarra Hasni, Sami Faiz

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In recent years, location prediction on social networks has gained significant attention, with short and unstructured texts like tweets posing additional challenges. Advanced geolocation models have been proposed, increasing the need to explain their predictions. In this paper, we provide explanations for a geolocation black-box model using LIME and SHAP, two state-of-the-art XAI (eXplainable Artificial Intelligence) methods. We extend our evaluations to Large Language Models (LLMs) as post hoc explainers for tweet geolocation. Our preliminary results show that LLMs outperform LIME and SHAP by generating more accurate explanations. Additionally, we demonstrate that prompts with examples and meta-prompts containing phonetic spelling rules improve the interpretability of these models, even with informal input data. This approach highlights the potential of advanced prompt engineering techniques to enhance the effectiveness of black-box models in geolocation tasks on social networks.

Keywords: large language model, post hoc explainer, prompt engineering, local explanation, tweet geolocation

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Authors: Racha El Kadiri, Mohamed Sultan, Henrique Momm, Zachary Blair, Rachel Schultz, Tamer Al-Bayoumi

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The Mediterranean Basin is a very diverse region of nationalities and climate zones, with a strong dependence on agricultural activities. Predicting long term (with a lead of 1 to 12 months) rainfall, and future droughts could contribute in a sustainable management of water resources and economical activities. In this study, an integrated approach was adopted to construct predictive tools with lead times of 0 to 12 months to forecast rainfall amounts over nine subzones of the Mediterranean Basin region. The following steps were conducted: (1) acquire, assess and intercorrelate temporal remote sensing-based rainfall products (e.g. The CPC Merged Analysis of Precipitation [CMAP]) throughout the investigation period (1979 to 2016), (2) acquire and assess monthly values for all of the climatic indices influencing the regional and global climatic patterns (e.g., Northern Atlantic Oscillation [NOI], Southern Oscillation Index [SOI], and Tropical North Atlantic Index [TNA]); (3) delineate homogenous climatic regions and select nine pilot study zones, (4) apply data mining methods (e.g. neural networks, principal component analyses) to extract relationships between the observed rainfall and the controlling factors (i.e. climatic indices with multiple lead-time periods) and (5) use the constructed predictive tools to forecast monthly rainfall and dry and wet periods. Preliminary results indicate that rainfall and dry/wet periods were successfully predicted with lead zones of 0 to 12 months using the adopted methodology, and that the approach is more accurately applicable in the southern Mediterranean region.

Keywords: rainfall, neural networks, climatic indices, Mediterranean

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Authors: Saira Mehnaz, Ali Jafar Abedi, Shazia Farooq Fazli, Sakeena Mushfiq, Zulfia Khan, M. Athar Ansari

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Introduction: Public health spending is a necessity in an underdeveloped country like India. The people are already suffering from poverty and that clubbed with out of pocket expenditure leads them to a very catastrophic situation, reducing the overall access to healthcare. Objectives: This study was designed to determine the usual source of medical care opted, the illness pattern, the expenditure incurred on illness and its source of procurement by the study population. It also intended to assess this expenditure as a determinant of access to health care. Methodology: Cities like Aligarh, which are classified as B grade cities in India are thought to be ripe sites for getting livelihood and hence are almost half filled with migrants living in urban slums. A cross sectional study was done to study the newer slum pockets. 3409 households with a population of 16,978 were studied with the help of pretested questionnaire; SPSS 20 was used for statistical analysis. Results and Conclusions: In our study, we found that almost all the households suffered from catastrophic health expenditure. The study population, which was already vulnerable owing to their low socio-economic and migrant status was further being forced with into poverty and indebtedness on account of expenditure on illness. This lead to a significant decrease in access to health. National health financing systems should be designed to protect households from financial catastrophe, by reducing out-of-pocket spending.

Keywords: access to healthcare, catastrophic health expenditure, new urban slums, out of pocket expenditure

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Authors: Davi Marinho de Araujo Falcão, Ronaldo Moreira Salles, Paulo Henrique Maranhão

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Disruption Tolerant Networks (DTN) are an evolution of Mobile Adhoc Networks (MANET) and work good in scenarioswhere nodes are sparsely distributed, with low density, intermittent connections and an end-to-end infrastructure is not possible to guarantee. Therefore, DTNs are recommended for high latency applications that can last from hours to days. The maritime scenario has mobility characteristics that contribute to a DTN network approach, but the concern with data security is also a relevant aspect in such scenarios. Continuing the previous work, which evaluated the performance of some DTN protocols (Epidemic, Spray and Wait, and Direct Delivery) in three warship scenarios and proposed the application of discriminant analysis, as a classification technique for secure connections, in the Epidemic protocol, thus, the current article proposes a new analysis of the directional discriminant function with opening angles smaller than 90 degrees, demonstrating that the increase in directivity influences the selection of a greater number of secure connections by the directional discriminant Epidemic protocol.

Keywords: DTN, discriminant function, epidemic protocol, security, tactical messages, warship scenario

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Authors: Ather Saeed, Arif Khan, Jeffrey Gosper

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Sensor devices are prone to errors and sudden node failures, which are difficult to detect in a timely manner when deployed in real-time, hazardous, large-scale harsh environments and in medical emergencies. Therefore, the loss of data can be life-threatening when the sensed phenomenon is not disseminated due to sudden node failure, battery depletion or temporary malfunctioning. We introduce a set of partial differential equations for localizing faults, similar to Green’s and Maxwell’s equations used in Electrostatics and Electromagnetism. We introduce a node organization and clustering scheme for self-stabilizing sensor networks. Green’s theorem is applied to regions where the curve is closed and continuously differentiable to ensure network connectivity. Experimental results show that the proposed GTFD (Green’s Theorem fault-detection and Self-stabilization) protocol not only detects faulty nodes but also accurately generates network stability graphs where urgent intervention is required for dynamically self-stabilizing the network.

Keywords: Green’s Theorem, self-stabilization, fault-localization, RSSI, WSN, clustering

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Authors: Aisulu Tileukulova, Zhexebay Dauren

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Radar plays an important role because it is widely used in civil and military fields. Target detection is one of the most important radar applications. The accuracy of detecting inconspicuous aerial objects in radar facilities is lower against the background of noise. Convolutional neural networks can be used to improve the recognition of this type of aerial object. The purpose of this work is to develop an algorithm for recognizing aerial objects using convolutional neural networks, as well as training a neural network. In this paper, the structure of a convolutional neural network (CNN) consists of different types of layers: 8 convolutional layers and 3 layers of a fully connected perceptron. ReLU is used as an activation function in convolutional layers, while the last layer uses softmax. It is necessary to form a data set for training a neural network in order to detect a target. We built a Confusion Matrix of the CNN model to measure the effectiveness of our model. The results showed that the accuracy when testing the model was 95.7%. Classification of echo signals using CNN shows high accuracy and significantly speeds up the process of predicting the target.

Keywords: radar, neural network, convolutional neural network, echo signals

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Authors: Rejab Hajlaoui, Tarek Moulahi, Hervé Guyennet

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In a highway scenario, the vehicle speed can exceed 120 kmph. Therefore, any vehicle can enter or leave the network within a very short time. This mobility adversely affects the network connectivity and decreases the life time of all established links. To ensure an effective stability in vehicular ad hoc networks with minimum broadcasting storm, we have developed a weighted algorithm based on the k-medoids clustering algorithm (WKCA). Indeed, the number of clusters and the initial cluster heads will not be selected randomly as usual, but considering the available transmission range and the environment size. Then, to ensure optimal assignment of nodes to clusters in both k-medoids phases, the combined weight of any node will be computed according to additional metrics including direction, relative speed and proximity. Empirical results prove that in addition to the convergence speed that characterizes the k-medoids algorithm, our proposed model performs well both AODV-Clustering and OLSR-Clustering protocols under different densities and velocities in term of end-to-end delay, packet delivery ratio, and throughput.

Keywords: communication, clustering algorithm, k-medoids, sensor, vehicular ad hoc network

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Authors: Emma Worley, Mhairi De Sainte Croix, Savneet Lochab, Christopher Roberts, Mark Stroud, Mo Salehan, Kevin Jones

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Awareness about the importance of teaching about diversity at medical school is growing. In the realm of diversity includes discussion around the LGBTQ+ community. At Bristol, diversity is taught in first or second year. However, echoing and expanding that teaching throughout the curriculum is needed. This feeds into the spiral curriculum but also highlights the relevance of the topic. It is well known that some people in the LGBTQ+ community struggle the access healthcare due to previous negative experiences. In 2019, 1 in 7 LGBTQ+ people avoided seeking medical care due to fears about discrimination. If people have fears about seeking medical help, then seeking help from Palliative care when they are at their most vulnerable situation can be even harder. To improve positive healthcare situations for people who identify as LGBTQ+ needs to start with talking. Along with some of our CTAs (clinical teaching assistants) we created a teaching session to explore the barriers faced by LGBTQ+ and incorporated communication stations into this. Our plan is to run this session as a three-hour session first discussing different topics: ethnical diversity, ‘coming out’, LGBTQ+ in the older generation, transgender. This will be followed by looking more closely at the barriers to accessing the hospice. The next part of the session will encompass two or three communication scenarios hopefully prompting further discussion and reflection on ways to improve our communication. The first scenario outline is a gay man/lesbian woman with lung cancer discussing options around the hospice. The second scenario is a transgender person with female genitalia who now has cervical cancer (as was not followed up on pap smears after the change of name). The third scenario is a HIV homosexual male patient who has been admitted with dementia. He has a partner but is not married. His next of kin is down as his parents but his parents do not know about his sexuality and HIV status. It allows discussion around confidentiality as well as broaching the meaning of ‘family’ in the LGBTQ+ community. We have chosen to pitch this teaching session to Bristol Year 4 students. They will be currently doing their 6-week Palliative care block, which fits in well. Each session will have four students attend. We have been lucky enough to have two CTAs (clinical teaching assistants) who identify as LGBTQ+ offer their experiences and help. They have been able to help us with the preparation and delivery of the session. Given anecdotal evidence and stories helps to highlight the importance and relevance of this session. The aim is to increase awareness of some factors that may contribute to people who identify as LGBTQ+ having a negative healthcare experience. By starting to talk about it allows awareness and only then will we be able to start to change and improve. Our aim, if the sessions run well, is to expand these sessions to different academy hospitals. Therefore, all Bristol 4th year students would have the opportunity to take part in the teaching session. We would like to expand our portfolio of case scenarios, to address so tricker topics such as a transgender person with dementia who reverts back to a different gender. We would also like to recruit a diverse range of actors, ideally people who identify as the patient in the scenario does. For example, a transgender person acts the transgender scenario. This would give authenticity and enhance the student’s learning experience.

Keywords: communication skills, healthcare barriers, LGBTQ+, palliative care

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Authors: Gikunda Aloise, Mjema Saida, Barasa Herbert, Wanyungu John, Kimani Maureen

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Background: Community Health Workforce (CHW) is health care providers at the community level (Level 1) and serves as a bridge between the community and the formal healthcare system. This human resource has enormous potential to extend healthcare services and ensures that the vulnerable, marginalized, and hard-to-reach populations have access to quality healthcare services at the community and primary health facility levels. However, these cadres are neither recognized, remunerated, nor in most instances, registered in a master list. Management and supervision of CHWs is not easy if their individual demographics, training capacity and incentives is not well documented through a centralized registry. Description: In February 2022, Amref supported the Kenya Ministry of Health in developing a community health workforce database called Community Health Workers Master List Registry (CHWML), which is hosted in Kenya Health Information System (KHIS) tracker. CHW registration exercise was through a sensitization meeting conducted by the County Community Health Focal Person for the Sub-County Community Health Focal Person and Community Health Assistants who uploaded information on individual demographics, training undertaken and incentives received by CHVs. Care was taken to ensure compliance with Kenyan laws on the availability and use of personal data as prescribed by the Data Protection Act, 2019 (DPA). Results and lessons learnt: By June 2022, 80,825 CHWs had been registered in the system; 78,174 (96%) CHVs and 2,636 (4%) CHAs. 25,235 (31%) are male, 55,505 (68%) are female & 85 (1%) are transgender. 39,979. (49%) had secondary education and 2500 (3%) had no formal education. Only 27 641 (34%) received a monthly stipend. 68,436 CHVs (85%) had undergone basic training. However, there is a need to validate the data to align with the current situation in the counties. Conclusions/Next steps: The use of CHWML will unlock opportunities for building more resilient and sustainable health systems and inform financial planning, resource allocation, capacity development, and quality service delivery. The MOH will update the CHWML guidelines in adherence to the data protection act which will inform standard procedures for maintaining, updating the registry and integrate Community Health Workforce registry with the HRH system.

Keywords: community health registry, community health volunteers (CHVs), community health workers masters list (CHWML), data protection act

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Authors: Ezzi Olfa, Bouafia Nabiha, Ammar Asma, Ben Cheikh Asma, Mahjoub Mohamed, Bannour Wadiaa, Achour Bechir, Khelif Abderrahim, Njah Mansour

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Background: In hematology/oncology, health care improvement has allowed increasingly aggressive management in diagnostic and therapeutic procedures. Nevertheless, these intensified procedures have been associated with higher risk of healthcare associated infections (HAIs). We undertook this study to estimate the burden of HAIs in the cancer patients in an onco -hematology unit in a Tunisian university hospital. Materials/Methods: A prospective, observational study, based on active surveillance for a period of 06 months from Mars through September 2016, was undertaken in the department of onco-hematology in a university hospital in Tunisia. Patients, who stayed in the unit for ≥ 48 h, were followed until hospital discharge. The Centers for Disease Control and Prevention criteria (CDC) for site-specific infections were used as standard definitions for HAIs. Results: One hundred fifty patients were included in the study. The gender distribution was 33.3% for girls and 66.6% boys. They have a mean age of 23.12 years (SD = 18.36 years). The main patient’s diagnosis is: Acute Lymphoblastic Leukemia (ALL): 48.7 %( n=73). The mean length of stay was 21 days +/- 18 days. Almost 8% of patients had an implantable port (n= 12), 34.9 % (n=52) had a lumber puncture and 42.7 % (n= 64) had a medullary puncture. Chemotherapy was instituted in 88% of patients (n=132). Eighty (53.3%) patients had neutropenia at admission. The incidence rate of HAIs was 32.66 % per patient; the incidence density was 15.73 per 1000 patient-days in the unit. Mortality rate was 9.3% (n= 14), and 50% of cases of death were caused by HAIs. The most frequent episodes of infection were: infection of skin and superficial mucosa (5.3%), pulmonary aspergillosis (4.6%), Healthcare associated pneumonia (HAP) (4%), Central venous catheter associated infection (4%), digestive infection (5%), and primary bloodstream infection (2.6%). Finally, fever of unknown origin (FUO) incidence rate was 14%. In case of skin and superficial infection (n= 8), 4 episodes were documented, and organisms implicated were Escherichia.coli, Geotricum capitatum and Proteus mirabilis. For pulmonary aspergillosis, 6 cases were diagnosed clinically and radiologically, and one was proved by positive aspergillus antigen in bronchial aspiration. Only one patient died due this infection. In HAP (6 cases), four episodes were diagnosed clinically and radiologically. No bacterial etiology was established in these cases. Two patients died due to HAP. For primary bloodstream infection (4 cases), implicated germs were Enterobacter cloacae, Geotricum capitatum, klebsiella pneumoniae, and Streptococcus pneumoniae. Conclusion: This type of prospective study is an indispensable tool for internal quality control. It is necessary to evaluate preventive measures and design control guides and strategies aimed to reduce the HAI’s rate and the morbidity and mortality associated with infection in a hematology/oncology unit.

Keywords: cohort prospective studies, healthcare associated infections, hematology oncology department, incidence

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Authors: N. Drir, L. Barazane, M. Loudini

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It is well known that photovoltaic (PV) cells are an attractive source of energy. Abundant and ubiquitous, this source is one of the important renewable energy sources that have been increasing worldwide year by year. However, in the V-P characteristic curve of GPV, there is a maximum point called the maximum power point (MPP) which depends closely on the variation of atmospheric conditions and the rotation of the earth. In fact, such characteristics outputs are nonlinear and change with variations of temperature and irradiation, so we need a controller named maximum power point tracker MPPT to extract the maximum power at the terminals of photovoltaic generator. In this context, the authors propose here to study the modeling of a photovoltaic system and to find an appropriate method for optimizing the operation of the PV generator using two intelligent controllers respectively to track this point. The first one is based on artificial neural networks and the second on fuzzy logic. After the conception and the integration of each controller in the global process, the performances are examined and compared through a series of simulation. These two controller have prove by their results good tracking of the MPPT compare with the other method which are proposed up to now.

Keywords: maximum power point tracking, neural networks, photovoltaic, P&O

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Authors: Shibo Wei, Ting Jiang

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Convolutional-recurrent neural networks (CRN) have achieved much success recently in the speech enhancement field. The common processing method is to use the convolution layer to compress the feature space by multiple upsampling and then model the compressed features with the LSTM layer. At last, the enhanced speech is obtained by deconvolution operation to integrate the global information of the speech sequence. However, the feature space compression process may cause the loss of information, so we propose to model the upsampling result of each step with the residual LSTM layer, then join it with the output of the deconvolution layer and input them to the next deconvolution layer, by this way, we want to integrate the global information of speech sequence better. The experimental results show the network model (RES-CRN) we introduce can achieve better performance than LSTM without residual and overlaying LSTM simply in the original CRN in terms of scale-invariant signal-to-distortion ratio (SI-SNR), speech quality (PESQ), and intelligibility (STOI).

Keywords: convolutional-recurrent neural networks, speech enhancement, residual LSTM, SI-SNR

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Authors: Meron Okbandrias

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The South African formal economy is rule-based economy, unlike most African and Asian markets. It has a highly developed financial market. In such a market, foreign migrants have dominated the small or spaza shops that service the poor. They are highly competitive and capture significant market share in South Africa. This paper analyses the factors that assisted the foreign migrants in having a competitive age. It does that by interviewing Somali, Bangladesh, and Ethiopian shop owners in Cape Town analysing the data through a narrative analysis. The paper also analyses the 2019 South African consumer report. The three migrant nationalities mentioned above dominate the spaza shop business and have significant distribution networks. The findings of the paper indicate that family, ethnic, and nationality based network, in that order of importance, form bases for a relationship-based business network that has trust as its mainstay. Therefore, this network ensures the pooling of resources and abiding by certain principles outside the South African rule-based system. The research identified practises like bulk buying within a community of traders, sharing information, buying from a within community distribution business, community based transportation system and providing seed capital for people from the community to start a business is all based on that relationship-based system. The consequences of not abiding by the rules of these networks are social and economic exclusion. In addition, these networks have their own commercial and social conflict resolution mechanisms aside from the South African justice system. Network theory and relationship based systems theory form the theoretical foundations of this paper.

Keywords: migrant, spaza shops, relationship-based system, South Africa

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Authors: Venkat S. Somayajula

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Ground surface temperature history prediction model plays a vital role in determining standards for international nuclear waste management. International standards for borehole based nuclear waste disposal require paleoclimate cycle predictions on scale of a million forward years for the place of waste disposal. This research focuses on developing a paleoclimate cycle prediction model using Bayesian long-short term memory (LSTM) neural architecture operated on accumulated borehole temperature history data. Bayesian models have been previously used for paleoclimate cycle prediction based on Monte-Carlo weight method, but due to limitations pertaining model coupling with certain other prediction networks, Bayesian models in past couldn’t accommodate prediction cycle’s over 1000 years. LSTM has provided frontier to couple developed models with other prediction networks with ease. Paleoclimate cycle developed using this process will be trained on existing borehole data and then will be coupled to surface temperature history prediction networks which give endpoints for backpropagation of LSTM network and optimize the cycle of prediction for larger prediction time scales. Trained LSTM will be tested on past data for validation and then propagated for forward prediction of temperatures at borehole locations. This research will be beneficial for study pertaining to nuclear waste management, anthropological cycle predictions and geophysical features

Keywords: Bayesian long-short term memory neural network, borehole temperature, ground surface temperature history, paleoclimate cycle

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Authors: Sarah Pfoser, Lisa-Maria Putz, Thomas Berger

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In the EU, the transport sector accounts for roughly one fourth of the total greenhouse gas emissions. In fact, the transport sector is one of the main contributors of greenhouse gas emissions. Climate protection targets aim to reduce the negative effects of greenhouse gas emissions (e.g. climate change, global warming) worldwide. Achieving a modal shift to foster environmentally friendly modes of transport such as rail and inland waterways is an important strategy to fulfill the climate protection targets. The present paper goes beyond these conventional transport modes and reflects upon currently emerging high-performance transport modes that yield the potential of complementing future transport systems in an efficient way. It will be defined which properties describe high-performance transport modes, which types of technology are included and what is their potential to contribute to a sustainable future transport network. The first step of this paper is to compile state-of-the-art information about high-performance transport modes to find out which technologies are currently emerging. A multidimensional impact analysis will be conducted afterwards to evaluate which of the technologies is most promising. This analysis will be performed from a spatial, social, economic and environmental perspective. Frequently used instruments such as cost-benefit analysis and SWOT analysis will be applied for the multidimensional assessment. The estimations for the analysis will be derived based on desktop research and discussions in an interdisciplinary team of researchers. For the purpose of this work, high-performance transport modes are characterized as transport modes with very fast and very high throughput connections that could act as efficient extension to the existing transport network. The recently proposed hyperloop system represents a potential high-performance transport mode which might be an innovative supplement for the current transport networks. The idea of hyperloops is that persons and freight are shipped in a tube at more than airline speed. Another innovative technology consists in drones for freight transport. Amazon already tests drones for their parcel shipments, they aim for delivery times of 30 minutes. Drones can, therefore, be considered as high-performance transport modes as well. The Trans-European Transport Networks program (TEN-T) addresses the expansion of transport grids in Europe and also includes high speed rail connections to better connect important European cities. These services should increase competitiveness of rail and are intended to replace aviation, which is known to be a polluting transport mode. In this sense, the integration of high-performance transport modes as described above facilitates the objectives of the TEN-T program. The results of the multidimensional impact analysis will reveal potential future effects of the integration of high-performance modes into transport networks. Building on that, a recommendation on the following (research) steps can be given which are necessary to ensure the most efficient implementation and integration processes.

Keywords: drones, future transport networks, high performance transport modes, hyperloops, impact analysis

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Authors: E. Sobhani-Tehrani, K. Khorasani, N. Meskin

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This paper presents a novel integrated hybrid approach for fault diagnosis (FD) of nonlinear systems. Unlike most FD techniques, the proposed solution simultaneously accomplishes fault detection, isolation, and identification (FDII) within a unified diagnostic module. At the core of this solution is a bank of adaptive neural parameter estimators (NPE) associated with a set of single-parameter fault models. The NPEs continuously estimate unknown fault parameters (FP) that are indicators of faults in the system. Two NPE structures including series-parallel and parallel are developed with their exclusive set of desirable attributes. The parallel scheme is extremely robust to measurement noise and possesses a simpler, yet more solid, fault isolation logic. On the contrary, the series-parallel scheme displays short FD delays and is robust to closed-loop system transients due to changes in control commands. Finally, a fault tolerant observer (FTO) is designed to extend the capability of the NPEs to systems with partial-state measurement.

Keywords: hybrid fault diagnosis, dynamic neural networks, nonlinear systems, fault tolerant observer

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Authors: Ashley L. Freeman, Jessica D. Watkins

Abstract:

TeleEmergency Medicine (TeleEM) is an innovative approach leveraging virtual technology to deliver specialized emergency medical care across diverse healthcare settings, including internal acute care and critical access hospitals, remote patient monitoring, and nurse triage escalation, in addition to external emergency departments, skilled nursing facilities, and community health centers. TeleEM represents a significant advancement in the delivery of emergency medical care, providing healthcare professionals the capability to deliver expertise that closely mirrors in-person emergency medicine, exceeding geographical boundaries. Through qualitative research, the extension of timely, high-quality care has proven to address the critical needs of patients in remote and underserved areas. TeleEM’s service design allows for the expansion of existing services and the establishment of new ones in diverse geographic locations. This ensures that healthcare institutions can readily scale and adapt services to evolving community requirements by leveraging on-demand (non-scheduled) telemedicine visits through the deployment of multiple video solutions. In terms of financial management, TeleEM currently employs billing suppression and subscription models to enhance accessibility for a wide range of healthcare facilities. Plans are in motion to transition to a billing system routing charges through a third-party vendor, further enhancing financial management flexibility. To address state licensure concerns, a patient location verification process has been integrated through legal counsel and compliance authorities' guidance. The TeleEM workflow is designed to terminate if the patient is not physically located within licensed regions at the time of the virtual connection, alleviating legal uncertainties. A distinctive and pivotal feature of TeleEM is the introduction of the TeleEmergency Medicine Care Team Assistant (TeleCTA) role. TeleCTAs collaborate closely with TeleEM Physicians, leading to enhanced service activation, streamlined coordination, and workflow and data efficiencies. In the last year, more than 800 TeleEM sessions have been conducted, of which 680 were initiated by internal acute care and critical access hospitals, as evidenced by quantitative research. Without this service, many of these cases would have necessitated patient transfers. Barriers to success were examined through thorough medical record review and data analysis, which identified inaccuracies in documentation leading to activation delays, limitations in billing capabilities, and data distortion, as well as the intricacies of managing varying workflows and device setups. TeleEM represents a transformative advancement in emergency medical care that nurtures collaboration and innovation. Not only has advanced the delivery of emergency medicine care virtual technology through focus group participation with key stakeholders, rigorous attention to legal and financial considerations, and the implementation of robust documentation tools and the TeleCTA role, but it’s also set the stage for overcoming geographic limitations. TeleEM assumes a notable position in the field of telemedicine by enhancing patient outcomes and expanding access to emergency medical care while mitigating licensure risks and ensuring compliant billing.

Keywords: emergency medicine, TeleEM, rural healthcare, telemedicine

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