Search results for: don’t care conditions

Authors: Bollu Mounica

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Background: Nowadays drug related problems were seen very commonly within the health care practice. These could result in the medication errors, adverse events, drug interactions and harm to patients. Pharmacist has an identified role in minimizing and preventing such type of problems. Objectives: To detect the incidence of drug related problems for the hospitalized patient, and to analyze the clinical pharmacist interventions performed during the review of prescription orders of the general medicine, psychiatry, surgery, pediatrics, gynaecology units of a large tertiary care teaching hospital. Methods: It was a retrospective, observational and interventional study. The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions. For a period starting November 2012 until December 2014, the inpatient medication charts and orders were identified and rectified by ward and practicing clinical pharmacists within the inpatient pharmacy services in a tertiary care teaching hospital on routine daily activities. Data was collected and evaluated. The causes of this problem were identified. Results: A total of 360 patients were followed. Male (71.66%) predominance was noted over females (28.33%). Drug related problems were more commonly seen in patients aged in between 31-60. Most of the DRP observed in the study resulted from the dispensing errors (26.11%), improper drug selection (17.22%), followed by untreated indications (14.4%) Majority of the clinical pharmacist recommendations were on need for proper dispensing (26.11%), and drug change (18.05%). Minor significance of DRPs were noted high (41.11 %), whereas (35.27 %) were moderate and (23.61 %) were major. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high (86.66%). Conclusion: Our study showed that the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes needed in the prescriptions. In this context, routine participation of clinical pharmacists in clinical medical rounds facilitates the identification of DRPs and may prevent their occurrence.

Keywords: drug related problems, clinical pharmacist, drug prescriptions, drug related problems, intervention

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Authors: Wisit Wichitkosoom

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Objectives: To find out the more effect of early cardiologist consultation using a simple technology on the diagnosis and early proper management of patients with Non-STEMI at emergency department of district hospitals without cardiologist on site before transferred. Methods: A cohort study was performed in Udonthani general hospital at Udonthani province. From 1 October 2012–30 September 2013 with 892 patients diagnosed with Non-STEMI. All patients mean aged 46.8 years of age who had been transferred because of Non-STEMI diagnosed, over a 12 week period of studied. Patients whose transferred, in addition to receiving proper care, were offered a cardiologist consultation with average time to Udonthani hospital 1.5 hour. The main outcome measure was length of hospital stay, mortality at 3 months, inpatient investigation, and transfer rate to the higher facilitated hospital were also studied. Results: Hospital stay was significantly shorter for those didn’t consult cardiologist (hazard ratio 1.19; approximate 95% CI 1.001 to 1.251; p = 0.039). The 136 cases were transferred to higher facilitated hospital. No statistically significant in overall mortality between the groups (p=0.068). Conclusions: Early cardiologist consultant can reduce length of hospital stay for patients with cardiovascular conditions outside of cardiac center. The new basic technology can apply for the safety patient.

Keywords: critical, telemedicine, safety, non STEMI

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Authors: Maximo Cozzetti

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The aim is to evaluate the capability of the 'Siberian Husky' (FCI-Standard Nº 270) breed of the common dog (Canis lupus familiaris) to detect terminally-ill human patients undergoing palliative care. A total of 49 such patients that fulfill the 'National Scientific and Technical Research Council–Ethical Principles for the Behavior of the Scientific and Technical Investigator' policy, (mainly affected with Stage IV Hodgkin lymphoma or Stage IV Carcinoma, though various other terminal diseases were present) and 49 controls were enrolled. A total of 13 specimens of Siberian Huskies (Canis lupus familiaris FCI – Standard Nº 270) were selected. After a conditioning training regime in which the canines were rewarded when identifying terminally ill patients and excluding the control subjects, a double-blind experiment was conducted in which the canines were presented with a previously unknown patient through an olfactory-proof plexiglass window for 2-minute intervals. The test subjects correctly identified 89.80% of the humans as either ‘ill’ or ‘healthy’. It is important to note that both groups of humans were selected considering and preventing confounding and self-identifying factors such as age, ethnicity, clothing, posture, skin color, alopecia (chemotherapy-induced or otherwise), etc. The olfactory-proofing of the test area rules out the use of the sense of smell to detect distinctive drugs or bodily odors that may be associated with terminal diseases. Thus, the Siberian Husky breed of the common dog shows the visual capability to detect and identify terminally ill patients undergoing palliative care regardless of age, posture, and quantity of hair. Though the capability of the breed of dog to detect terminally-ill patients was observed thoroughly during the course of the experiments, the exact process by which the canines identify the test subjects remains unknown and further research is encouraged.

Keywords: Canis lupus familiaris, Siberian Husky, visual identification of terminall illness, FCI-Standard Nº270

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Authors: Karan Modi, Rajesh Kumar, Jyoti Katiyar, Shreya Thusoo

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This paper presents Finite Element Method (FEM) for analyzing the internal responses generated in thin rectangular plates with various edge conditions and rigidity conditions. Comparison has been made between the FEM (ANSYS software) results for displacement, stresses and moments generated with and without the consideration of hole in plate and different aspect ratios. In the end comparison for responses in plain and composite square plates has been studied.

Keywords: ANSYS, finite element method, plates, static analysis

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Authors: Chanhoe Kang, Changhyun Lee, Seock-Hee Jun, Yeong-Tae Oh

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Offshore floating structure under the various environmental conditions maintains a fixed position by mooring system. Environmental conditions, vessel motions and mooring loads are applied to mooring lines as the dynamic tension. Because global responses of mooring system in deep water are specified as wave frequency and low frequency response, they should be calculated from the time-domain analysis due to non-linear dynamic characteristics. To take into account all mooring loads, environmental conditions, added mass and damping terms at each time step, a lot of computation time and capacities are required. Thus, under the premise that reliable fatigue damage could be derived through reasonable analysis method, it is necessary to reduce the analysis cases through the sensitivity studies and appropriate assumptions. In this paper, effects in fatigue are studied for spread mooring system connected with oil FPSO which is positioned in deep water of West Africa offshore. The target FPSO with two Mbbls storage has 16 spread mooring lines (4 bundles x 4 lines). The various sensitivity studies are performed for environmental loads, type of responses, vessel offsets, mooring position, loading conditions and riser behavior. Each parameter applied to the sensitivity studies is investigated from the effects of fatigue damage through fatigue analysis. Based on the sensitivity studies, the following results are presented: Wave loads are more dominant in terms of fatigue than other environment conditions. Wave frequency response causes the higher fatigue damage than low frequency response. The larger vessel offset increases the mean tension and so it results in the increased fatigue damage. The external line of each bundle shows the highest fatigue damage by the governed vessel pitch motion due to swell wave conditions. Among three kinds of loading conditions, ballast condition has the highest fatigue damage due to higher tension. The riser damping occurred by riser behavior tends to reduce the fatigue damage. The various analysis results obtained from these sensitivity studies can be used for a simplified fatigue analysis of spread mooring line as the reference.

Keywords: mooring system, fatigue analysis, time domain, non-linear dynamic characteristics

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Authors: Xuan Hua Huang, Shu Fen Wu, Yi Ting Huang, Pi Yueh Lee

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Background: In Taiwan, the Taiwan healthcare care Indicator Series regards the rate of hospital readmission as an important indicator of healthcare quality. Unplanned readmission not only effects patient’s condition but also increase healthcare utilization rate and healthcare costs. Purpose: The purpose of this study was explored the effects of adult unplanned readmission within 14 days of discharge at a regional teaching hospital in South Taiwan. Methods: The retrospectively review design was used. A total 495 participants of unplanned readmissions and 878 of non-readmissions within 14 days recruited from a regional teaching hospital in Southern Taiwan. The instruments used included the Charlson Comorbidity Index, and demographic characteristics, and disease-related variables. Statistical analyses were performed with SPSS version 22.0. The descriptive statistics were used (means, standard deviations, and percentage) and the inferential statistics were used T-test, Chi-square test and Logistic regression. Results: The unplanned readmissions within 14 days rate was 36%. The majorities were 268 males (54.1%), aged >65 were 318 (64.2%), and mean age was 68.8±14.65 years (23-98years). The mean score for the comorbidities was 3.77±2.73. The top three diagnosed of the readmission were digestive diseases (32.7%), respiratory diseases (15.2%), and genitourinary diseases (10.5%). There were significant relationships among the gender, age, marriage, comorbidity status, and discharge planning services (χ2: 3.816-16.474, p: 0.051~0.000). Logistic regression analysis showed that old age (OR = 1.012, 95% CI: 1.003, 1.021), had the multi-morbidity (OR = 0.712~4.040, 95% CI: 0.559~8.522), had been consult with discharge planning services (OR = 1.696, 95% CI: 1.105, 2.061) have a higher risk of readmission. Conclusions: This study finds that multi-morbidity was independent risk factor for unplanned readmissions at 14 days, recommended that the interventional treatment of the medical team be provided to provide integrated care for multi-morbidity to improve the patient's self-care ability and reduce the 14-day unplanned readmission rate.

Keywords: unplanned readmission, comorbidities, Charlson comorbidity index, logistic regression

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Authors: Thusitha Mabotuwana, Christopher S. Hall

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Radiologists routinely make follow-up imaging recommendations, usually based on established clinical practice guidelines, such as the Fleischner Society guidelines for managing lung nodules. In order to ensure optimal care, it is important to make guideline-compliant recommendations, and also for patients to follow-up on these imaging recommendations in a timely manner. However, determining such compliance rates after a specific finding has been observed usually requires many time-consuming manual steps. To address some of these limitations with current approaches, in this paper we discuss a methodology to automatically detect finding-specific follow-up recommendations from radiology reports and create a visualization for relevant subsequent exams showing the modality transitions. Nearly 5% of patients who had a lung related follow-up recommendation continued to have at least eight subsequent outpatient CT exams during a seven year period following the recommendation. Radiologist and section chiefs can use the proposed tool to better understand how a specific patient population is being managed, identify possible deviations from established guideline recommendations and have a patient-specific graphical representation of the imaging pathways for an abstract view of the overall treatment path thus far.

Keywords: follow-up recommendations, follow-up tracking, care pathways, imaging pathway visualization

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Authors: Tomoko Adachi

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Although, thirty years have passed since the enactment of Equal Employment Opportunity Law, contemporary Japanese citizens still have difficulties in balancing work and life responsibilities. Not a few women give up their professional career after childbirth, meanwhile, men spend longer hours at work and have minimal time for their families. One of the reasons should be attributed to the traditional gender role ideas which have been entrenched even among younger generations. In an attempt to explore the psychological factors which enable work-life balance, the current study investigated attitudes of Japanese youth toward work-life balance and their relationships with gender role attitudes. Participants were 948 Japanese (165 men and 783 women) with the average age of 19.60 (SD=1.18). As for measure, a scale developed and modified by the author was used to assess attitudes toward work-life balance and Short form of the Scale of Egalitarian Sex Role Attitudes (SESRA-S) was used to assess traditional vs. egalitarian gender role attitudes. The results showed clear gender differences as follows. First, examination of attitudes toward work-life balance showed that more than 90% of men preferred to continue their work without child care interruption. Meanwhile, women showed various attitudes, with around 50% wanted to have child care interruption, 40% wanted to continue working without it, while, 10% wanted to work until childbirth. Secondly, gender comparison of egalitarian gender role attitudes showed that women possessed equal ideas on gender roles than men. Thirdly, relationships between gender role attitudes and attitudes for work-life balance were examined. No significant relationship between the two was found among men, which implies that regardless of the gender role attitudes, most of the men thought that continuing work without child care interruption was the ideal path for them. On the other hand, the effects of gender role attitudes were apparent among women, showing that women with egalitarian attitudes preferred to continue their professional career even after childbirth. The present study revealed gender difference in the idea about work-life balance with men possessing traditional ideas of 'men should be a bread winner'. Implications for support on young adults to reconcile work and family responsibilities were discussed.

Keywords: career path, gender role attitudes, work-life balance, youth

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Authors: Saeed M. Al Qahtani, Alaa Eldin A. Ayoub

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The study aimed to develop a battery of measures to assessment gifted initiatives in Saudi Arabia. The battery consisted of 17 measures developed in light of Saudi Arabia's future vision objectives for gifted education. A battery was applied to 193 gifted students who benefit from gifted initiatives and programs, 42 teachers of gifted as well as, 40 experts of gifted. Samples were taken from three main regions: Riyadh, Sharqia, Gharbia in Saudi Arabia. The results indicated that battery measures have a reliability and stability index ranging from 0.6 to 0.87. Besides that, results showed that the educational environment lacks many basic components such as facilities, laboratories, and activities that may stimulate creativity and innovation. Furthermore, results showed that there is a weakness in private sector involvement in the construction of educational buildings, special centers for gifted people and the provision of certain facilities that support talented programs. The recommendations of the study indicate the need for the private sector participation in the provision of services and projects for the care of gifted students in Saudi Arabia.

Keywords: battery of measures, gifted care initiatives, Saudi future vision, gifted student

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Authors: Zahra Abdi, Roghayeh Alipour, Babak Farahi Ghasraboonasr

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Introduction: Diabetes is a serious medical condition that requires constant care. People with type 2 diabetes may also be likely to experience dry, itchy skin and poor wound healing. Some people with diabetes will have a skin problems at some time in their lives and for those not yet diagnosed with diabetes, a skin problem can be an indication of the disease. our purpose was to assess the capability and knowledge of students of Shiraz University of Medical Sciences about prevent from skin complications in diabetes type 2. Methods: In this descriptive cross-sectional study, knowledge of 360 students of Shiraz University of Medical Sciences was evaluated about different ways to avoid skin complications in diabetes type 2. Data were analyzed by spss19.(P<0.05) was considered significant. Results: 360 students of Shiraz University of Medical Sciences participated in this study. 45% of students agree with the effect of Moisturize skin daily, If Diabetics have sensitive skin, choose a fragrance-free, dye-free moisturizer that won’t irritate skin. 52% believe that Protect skin from sun can be so useful, Sun exposure is drying and aging. Use sunscreen with SPF 30 or higher whenever you’re outside. Wear gloves when doing yardwork to protect the skin on your hands. 62% of students strongly agree with Carefully clean any cuts and scrapes, If diabetics notice any sign of infection skin that’s red, swollen, or warm to the touch, or has a foul-smelling drainage or pus should consulting with a doctor immediately. Diabetics should be careful about any injury that takes longer than normal to heal and they should consulting with doctor about them too. 72% of students believe that diabetics should be diligent about daily foot care. Clean and moisturize feet each day and check each foot closely, top and bottom, for wounds even a tiny cut, blisters, or cracked skin. Conclusions: The risk of getting these diabetes complications can be lessened by controlling blood sugar. Skin complications can cause serious consequences. Taking care of skin is so important and using these tips are remarkable effective and help diabetics to look after their skin easier.

Keywords: skin complications, diabetes type 2, Shiraz University of Medical Sciences, diabetics

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Authors: Yadira Tejeda, Wynette Whitegoat, Dylan Jones, Brett Drake

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Background and Purpose: Hispanic and American Indian/Alaska Native (AI/AN) families impacted by child protective services (CPS) continue to be a population in literature where little is known. There is less known about the fathers of these children and the safety or risk factors attributed to child maltreatment and case outcomes. However, it is known that involving fathers in children’s lives is needed for healthy development, academic achievement, and cognitive development. The few articles that have studied the impacts of engaging fathers in the CPS have found that children in general experience shorter times in foster care, are likely to reunify with their biological family, and overall have better case outcomes. The purpose of this study is to determine whether perpetrators identified as the mother, father, or both impact foster care placement in Hispanic and AI/AN families in CPS. Methods: Using NCANDS Child File data, the selected reports submitted in FY2017 with at least one substantiated allegation, i.e. those with perpetrator information. Reports were categorized into one of three categories: mom-perpetrator-only, father-perpetrator-only, and both. Reports that did not fall into any one of these three categorizations were omitted (<18%). Lastly, only reports where the mother and father self-identified as Hispanic or AI/AN were kept. Foster care placement was measured if any child in the report was placed within three months of the report date. Multilevel Logistic Regression models (random intercepts at the state and county) were used to model the relationship between report-parent type and foster care placement. Controls included Maltreatment types, number of children, any prior reports, and age of the youngest child. Results: For AI/AN reports, 64% were mom-perpetrator-only, 20% were father-perpetrator-only, and 16% both. Father-perpetrator-only reports had 60% lower odds of placement than mom-perpetrator-only, and both had 35% greater odds than mom-only. For Hispanics, 51% were mom-perpetrator-only, 30% father-perpetrator-only, and 19% both. Father-perpetrator-only reports had 74% lower odds than mom-perpetrator-only, and both had 55% greater odds than mom-perpetrator-only. Conclusion and Implications: Fatherhood research focused on prevention and intervention services should include Hispanic and AI/AN fathers to create culturally relevant and tailored services for both groups. By identifying differences in children’s CPS trajectories conditional on fathers’ involvement as a perpetrator, this analysis helps to inform where and how prevention efforts should be focused when considering variation in parental involvement for both populations. The findings indicate that the father’s involvement predicts substantial differences in the probability of future placement, with the direction depending on the mother’s joint involvement. Future research should investigate mediating pathways of these relationships while accounting for the unique experiences of AI/AN and Hispanic families. Each of these racial groups faces unique and differing challenges related to CPS, yet both groups have a shared understanding of the importance of fatherhood in the lives of children. Developing a better understanding of what is happening with Hispanic and AI/AN fathers as it relates to children's CPS experiences may result in new tools to reduce child maltreatment rates in these communities.

Keywords: child Abuse, child maltreatment, NDACAN, latino, native American

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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Authors: S. Łęgowik-Świącik

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This article is a contribution to the research into the determinants of value creation via digital platforms in variable operating conditions. The dynamics of the market environment caused by the COVID-19 pandemic have made enterprises built on digital platforms financially successful. While many classic companies are struggling with the uncertainty of conducting a business and difficulties in the process of value creation, digital platforms create value by modifying the existing business model to meet the changing needs of customers. Therefore, the objective of this publication is to understand and explain the relationship between value creation and the conversion of the business model built on digital platforms under pandemic conditions. The considerations relating to the conceptual framework and determining the research objective allowed for adopting the hypothesis, assuming that the processes of value creation are evolving, and the measurement of these processes allows for the protection of value created and enables its growth in changing circumstances. The research methods, such as critical literature analysis and case study, were applied to accomplish the objective pursued and verify the hypothesis formulated. The empirical research was carried out based on the data from enterprises listed on the Nasdaq Stock Exchange: Amazon, Alibaba, and Facebook. The research period was the years 2018-2021. The surveyed enterprises were chosen based on the targeted selection. The problem discussed is important and current since the lack of in-depth theoretical research results in few attempts to identify the determinants of value creation via digital platforms. The above arguments led to an attempt at theoretical analysis and empirical research to fill in the gap perceived by deepening the understanding of the process of value creation through network effects via digital platforms under pandemic conditions.

Keywords: business model, digital platforms, enterprise management, pandemic conditions, value creation process

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Authors: Priscila A. M. Rodrigues

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In Brazil, higher education is usually offered in three parts of the day: in the morning, afternoon and evening. Students have to decide what part of the day they are going to study in the application process. Most of the admitted students who choose to study in the evening also work during the day, because of their financial conditions. Brazilian higher education courses in the evening were initially created to meet the demand for teacher training. These teacher-training courses are socially discredited and considered easily accessible in the country, mostly due to the fact that students who enroll for those courses come from very poor basic education. The research has analyzed the differences between the social profiles and studying conditions of students of teacher education, especially the training intended for would-be elementary education teachers. An investigation has been conducted with these undergraduate students, who were divided into a group of those who study both in the morning and in the afternoon (group 1) and a group of those who study in the evening (group 2). The hypothesis predicted that students in group 1 would perform better than students in group 2. The analysis of training and studying conditions departed from the point of view of students and their teachers. The hypothesis predicted that students in group 1 would perform better than students in group 2. The analysis of training and studying conditions departed from the point of view of students and their teachers. Data was collected from survey, qualitative interviews, field observation and reports from students. Sociological concepts of habitus, cultural capital, trajectories and strategies are essential for this study as well as the literature on quality of higher education. The research revealed that there are differences of studying conditions between group 1 and group 2, precisely when it comes to the university atmosphere, that is to say, academic support resources and enrichment activities which promote educational, cultural and social opportunities, for example conferences, events, scholarships of different types, etc. In order to counteract the effects of their poor educational performance, students who generally come from popular strata require conditions of greater dedication and investment in higher education, which most of them do not have. Despite the considerable difficulties that students in group 2 encounter in their academic experience, the university experience per se brings a gain for the lives of these students, which translates into the expansion of their capital structure – i.e. symbolic, cultural and educational capital – with repercussions on their social trajectory, especially in professional conditions.

Keywords: higher education, higher education students’ performance, quality of higher education, teacher’s education

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Authors: R. Tariq, R. Lee

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Background: Additional demands placed on senior clinical teams with ongoing COVID-19 management has accelerated the need to harness the wider healthcare professional resources and upskill them to take on greater clinical responsibility safely. The UK NHS Long Term Plan (2019)¹ emphasises the importance of expanding Advanced Practitioners’ (APs) roles to take on more clinical diagnostic responsibilities to cope with increased demand. In acute settings, APs are often the first point of care for patients and require training to take on initial triage responsibilities efficiently and safely. Critically, their roles include determining which onward services the patients may require, and assessing whether they can be treated at home, avoiding unnecessary admissions to the hospital. Dem Dx is a Clinical Reasoning Platform (CRP) that claims to help frontline healthcare professionals independently assess and triage patients. It guides the clinician from presenting complaints through associated symptoms to a running list of differential diagnoses, media, national and institutional guidelines. The objective of this study was to compare the clinical referral rates and guidelines adherence registered by the HMR Urgent Community Care Team (UCCT)² and Dem Dx recommendations using retrospective cases. Methodology: 192 cases seen by the UCCT were anonymised and reassessed using Dem Dx clinical pathways. We compared the UCCT’s performance with Dem Dx regarding the appropriateness of onward referrals. We also compared the clinical assessment regarding adherence to NICE guidelines recorded on the clinical notes and the presence of suitable guidance in each case. The cases were audited by two medical doctors. Results: Dem Dx demonstrated appropriate referrals in 85% of cases, compared to 47% in the UCCT team (p<0.001). Of particular note, Dem Dx demonstrated an almost 65% (p<0.001) improvement in the efficacy and appropriateness of referrals in a highly experienced clinical team. The effectiveness of Dem Dx is in part attributable to the relevant NICE and local guidelines found within the platform's pathways and was found to be suitable in 86% of cases. Conclusion: This study highlights the potential of clinical decision support, as Dem Dx, to improve the quality of onward clinical referrals delivered by a multidisciplinary team in primary care. It demonstrated that it could support healthcare professionals in making appropriate referrals, especially those that may be overlooked by providing suitable clinical guidelines directly embedded into cases and clear referral pathways. Further evaluation in the clinical setting has been planned to confirm those assumptions in a prospective study.

Keywords: advanced practitioner, clinical reasoning, clinical decision-making, management, multidisciplinary team, referrals, triage

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Authors: Véronique Georlette, Sebastien Bette, Sylvain Brohez, Nicolas Point, Veronique Moeyaert

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Visible light communication (VLC) is a communication technology that is part of the optical wireless communication (OWC) family. It uses the visible and infrared spectrums to send data. For now, this technology has widely been studied for indoor use-cases, but it is sufficiently mature nowadays to consider the outdoor environment potentials. The main outdoor challenges are the meteorological conditions and the presence of smoke due to fire or pollutants in urban areas. This paper proposes a methodology to assess the robustness of an outdoor VLC system given the outdoor conditions. This methodology is put into practice in two realistic scenarios, a VLC bus stop, and a VLC streetlight. The methodology consists of computing the power margin available in the system, given all the characteristics of the VLC system and its surroundings. This is done thanks to an outdoor VLC communication channel simulator developed in Python. This simulator is able to quantify the effects of fog and smoke thanks to models taken from environmental and fire engineering scientific literature as well as the optical power reaching the receiver. These two phenomena impact the communication by increasing the total attenuation of the medium. The main conclusion drawn in this paper is that the levels of attenuation due to fog and smoke are in the same order of magnitude. The attenuation of fog being the highest under the visibility of 1 km. This gives a promising prospect for the deployment of outdoor VLC uses-cases in the near future.

Keywords: channel modeling, fog modeling, meteorological conditions, optical wireless communication, smoke modeling, visible light communication

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Authors: Issa M. Hweidi, Saba W. Al-Ibraheem

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This study aimed to assess the increased hospital length of stay and healthcare costs associated with SSIs among ventriculoperitoneal shunting surgery patients in Jordan. This study adopted a retrospective and nested 1:1 matched case-control design. A non-probability convenient sample of 48 VP shunt patients was recruited for the purpose of the study. The targeted groups of the study basically used to cross-match the variables investigated to minimize the risk of confounding. Information was extracted from the text of patients' electronic health records. As compared to the non-SSI group, the SSI group had an extra mean healthcare cost of $13,696.53 (p=0.001) and longer hospital length of stay (22.64 mean additional days). Furthermore, Acinetobacter baumannii and Klebsiella pneumonia were identified as being the most predominant causative agents of SSIs. The results of this study may provide baseline data for national and regional benchmarking to evaluate the quality of care provided to likewise patients. Adherence to infection control strategies and protocols considering new surveillance methods of SSIs is encouraged.

Keywords: ventriculoperitoneal shunt, health care cost, length of stay, neurosurgery, surgical site infections

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Authors: Desiree Vandenberghe, Johan Albrecht

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Non-communicable diseases (NCDs) are responsible for the vast majority of deaths in the European Union (EU) and represent a large share of total health care spending. A future increase in this health and financial burden is likely to be driven by population ageing, lifestyle changes and technological advances in medicine. Without adequate prevention measures, this burden can severely threaten population health and economic development. To tackle this challenge, a correct assessment of the current burden of NCDs is required, as well as a projection of potential increases of this burden. The contribution of this paper is to offer perspective on the evolution of the NCD burden towards the future and to give an indication of the potential of prevention policy. A Non-Homogenous, Semi-Markov model for the EU was constructed, which allowed for a projection of the cost burden for the four main NCDs (cancer, cardiovascular disease, chronic respiratory disease and diabetes mellitus) towards 2030 and 2050. This simulation is done based on multiple baseline scenarios that vary in demand and supply factors such as health status, population structure, and technological advances. Finally, in order to assess the potential of preventive measures to curb the cost explosion of NCDs, a simulation is executed which includes increased efforts for preventive health care measures. According to the Markov model, by 2030 and 2050, total costs (direct and indirect costs) in the EU could increase by 30.1% and 44.1% respectively, compared to 2015 levels. An ambitious prevention policy framework for NCDs will be required if the EU wants to meet this challenge of rising costs. To conclude, significant cost increases due to Non-Communicable Diseases are likely to occur due to demographic and lifestyle changes. Nevertheless, an ambitious prevention program throughout the EU can aid in making this cost burden manageable for future generations.

Keywords: non-communicable diseases, preventive health care, health policy, Markov model, scenario analysis

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Authors: George Adomako Kumi

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The response of structural members, when subjected to various forms of non-proportional loading, plays a major role in the overall stability and integrity of a structure. This research seeks to present the outcome of a finite element investigation conducted by the use of finite element programming software ABAQUS to validate the experimental results of elastic and inelastic behavior and strength of beam-columns subjected to axial loading, biaxial bending, and torsion under ambient temperature conditions. The application of the rigorous and highly complicated ABAQUS finite element software will seek to account for material, non-linear geometry, deformations, and, more specifically, the contact behavior between the beam-columns and support surfaces. Comparisons of the three-dimensional model with the results of actual tests conducted and results from a solution algorithm developed through the use of the finite difference method will be established in order to authenticate the veracity of the developed model. The results of this research will seek to provide structural engineers with much-needed knowledge about the behavior of steel beam columns and their response to various non-proportional loading conditions under ambient temperature conditions.

Keywords: beam-columns, axial loading, biaxial bending, torsion, ABAQUS, finite difference method

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Authors: Weirong Wang, Shenghong Huang, Xisheng Luo, Zhenyu Li

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Material mixing process and related dynamic issues at extreme compressing conditions have gained more and more concerns in last ten years because of the engineering appealings in inertial confinement fusion (ICF) and hypervelocity aircraft developments. However, there lacks models and methods that can handle fully coupled turbulent material mixing and complex fluid evolution under conditions of high energy density regime up to now. In aspects of macro hydrodynamics, three numerical methods such as direct numerical simulation (DNS), large eddy simulation (LES) and Reynolds-averaged Navier–Stokes equations (RANS) has obtained relative acceptable consensus under the conditions of low energy density regime. However, under the conditions of high energy density regime, they can not be applied directly due to occurrence of dissociation, ionization, dramatic change of equation of state, thermodynamic properties etc., which may make the governing equations invalid in some coupled situations. However, in view of micro/meso scale regime, the methods based on Molecular Dynamics (MD) as well as Monte Carlo (MC) model are proved to be promising and effective ways to investigate such issues. In this study, both classical MD and first-principle based electron force field MD (eFF-MD) methods are applied to investigate Richtmyer-Meshkov Instability of metal Lithium and gas Hydrogen (Li-H2) interface mixing at different shock loading speed ranging from 3 km/s to 30 km/s. It is found that: 1) Classical MD method based on predefined potential functions has some limits in application to extreme conditions, since it cannot simulate the ionization process and its potential functions are not suitable to all conditions, while the eFF-MD method can correctly simulate the ionization process due to its ‘ab initio’ feature; 2) Due to computational cost, the eFF-MD results are also influenced by simulation domain dimensions, boundary conditions and relaxation time choices, etc., in computations. Series of tests have been conducted to determine the optimized parameters. 3) Ionization induced by strong shock compression has important effects on Li-H2 interface evolutions of RMI, indicating a new micromechanism of RMI under conditions of high energy density regime.

Keywords: first-principle, ionization, molecular dynamics, material mixture, Richtmyer-Meshkov instability

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Authors: Galih Imaduddin

Abstract:

Knowledge has been viewed as one of the most important resources in organizations, including those that operate in the healthcare sector. On that basis, Knowledge Management (KM) is crucial for healthcare organizations to improve their productivity and ensure effective utilization of their resources. Despite the growing interests to understand how KM might work for healthcare organizations, there is only a modest amount of empirical inquiries which have specifically focused on the tools and initiatives to share knowledge. Hence, the main purpose of this paper is to investigate the way healthcare organizations, particularly public sector ones, utilize knowledge sharing tools and initiatives for the benefit of patient-care. Employing a qualitative method, 13 (thirteen) Community Health Centers (CHCs) from a high-performing district health setting in Indonesia were observed. Data collection and analysis involved a repetition of document retrievals and interviews (n=41) with multidisciplinary health professionals who work in these CHCs. A single case study was cultivated reflecting on the means that were used to share knowledge, along with the factors that inhibited the exchange of knowledge among those health professionals. The study discovers that all of the thirteen CHCs exhibited and applied knowledge sharing means which included knowledge documents, virtual communication channels (i.e. emails and chatting applications), and social learning forums such as staff meetings, morning briefings, and communities of practices. However, the intensity of utilization was different among these CHCs, in which organizational culture, leadership, professional boundaries, and employees’ technological aptitude were presumed to be the factors that inhibit knowledge sharing processes. Making a distance with the KM literature of other sectors, this study denounces the primacy of technology-based tools, suggesting that socially-based initiatives could be more reliable for sharing knowledge. This suggestion is largely due to the nature of healthcare work which is still predominantly based on the tacit form of knowledge.

Keywords: knowledge management, knowledge sharing, knowledge sharing tools and initiatives, knowledge sharing inhibitors, primary health care organizations

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Authors: Tariq Bashir, Muhammad Waseem Tahir, Ulf Stigh, Behnaz Baghaie, Mikael Skrifvars

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Absorption of moisture may cause many problems in a composite material, such as delamination, degradation of the strength and increase in the weight. For small coupons, the increase in weight may be negligible, however, for large structures increase in weight due to moisture absorption may be quite significant. Polyamides (PA6, PA66) absorb more moisture as compared to other thermoplastics. There are many parameters which affect the moisture absorption of the composite material for example temperature, pressure, type of matrix and fibers, thickness of the material and relative humidity (RH) etc. So, it is utmost important to investigate the impact of moisture on PA66 based composites which can be done by characterizing the mechanical properties of composite materials both for dry and wet conditions. In this study, laminates of C/PA66 composite are manufactured by first heating the commingled material in conventional oven at a temperature of 220 °C followed by pressing in a manual hot press for 20 minutes with preheated platen at 220 °C. To observe the moisture absorption of the composite, coupons of the material were placed in a climate chamber at five different conditions 0, 25, 50, 75 and 100% RH for 24 hours. Five specimens were used for each condition. These coupons were weighed before placing in the climate chamber and just after removing from the chamber to observe the moisture absorption of the material. The mechanical characterization such as tensile strength, flexural modulus, impact strength and DMTA of C/PA66 material are performed at 0, 50 and 100 % RH. The work is going on for the testing of the material and results will be presented in full paper.

Keywords: Carbon/Polyamide 66 composites, structural composites, mechanical characterizations, wet and dry conditions

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Authors: Lei Liu

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Since the famous opening up and reform strategy of China, lots of migrants have flowed from rural areas to urban areas. In this paper, the author investigates the rural elderly left behind, which are defined aged people left alone at home while their adult children have to migrant outside. This phenomenon is a quite general and serious social problem that cannot be ignored, accompanied by the process of urbanization and regional transferring of rural labor. The Chinese internal migration not only exerts great influence to China’s economy and urbanization but also obviously reduces the labor and care to rural aged people. Contrary to assumptions in some migration and aging studies, which show the inevitable negative effects of migration upon the old age care, the author highlights unique features in their daily strategies of house holding to integrate into society with the analysis of the conception of social inclusion. Through life history interviews with elderly left behind in one rural village, this article sheds light on three different factors of social inclusion, namely, economic inclusion, social identity and political inclusion and shows its necessaries to fully understand the status of the social wellbeing of rural elderly left behind.

Keywords: labor migration, elderly left behind, social inclusion, rural China

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Authors: Ali Bakhtiari Gharibdosti, Mohammad Hosein Bijeh Keshavarzi, Samira Alijani

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To understand internal characteristics relationships and determine factors which explain under consideration characteristics in rapeseed varieties, 10 rapeseed genotypes were implemented in complete accidental plot with three-time repetitions under drought stress in 2009-2010 in research field of agriculture college, Islamic Azad University, Karaj branch. In this research, 11 characteristics include of characteristics related to growth, production and functions stages was considered. Variance analysis results showed that there is a significant difference among rapeseed varieties characteristics. By calculating simple correlation coefficient under both conditions, normal and drought stress indicate that seed function characteristics in plant and pod number have positive and significant correlation in 1% probable level with seed function and selection on the base of these characteristics was effective for improving this function. Under normal and drought stress, analyzing the main factors showed that numbers of factors which have more than one amount, had five factors under normal conditions which were 82.72% of total variance totally, but under drought stress four factors diagnosed which were 76.78% of total variance. By considering total results of this research and by assessing effective characteristics for factor analysis and selecting different components of these characteristics, they can be used for modifying works to select applicable and tolerant genotypes in drought stress conditions.

Keywords: correlation, drought stress, factor analysis, rapeseed

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Authors: Scarlet Tabot Enanga Longsti

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Community-Based Health Insurance (CBHI) schemes have been proposed as a possible means to achieve affordable health care in low-and lower-middle-income countries. The existing evidence provides mixed results on the impact of CBHI schemes on healthcare utilisation and out -of-pocket payments (OOPP) for healthcare. Over 900 CBHI schemes have been implemented in underdeveloped countries, and these schemes have undergone different modifications over the years. Prior reviews have suggested that different designs of CBHI schemes may result in different outcomes. Objectives: This review sought to determine the interventions that affect the impact of CBHI schemes on OOPP and health service utilisation. Interventions in this study referred to any action or modification in the design of a CBHI scheme that affected the impact of the scheme on OOPP and/or healthcare utilization. Methods: Any CBHI study that was done in a lower middle-income country, that used an experimental design, that included OOPP or health care utilisation as outcome variables, and that was published in either English or French was included in this study. Studies were searched for in MEDLINE, Embase, CINAHL, EconLit, IBSS, Web of Science, Cochrane Library, and Global Index Medicus from July to August 2023. Bias was assessed using Joanna Brigs Institute tools for quality assessment for randomized control trials and quasi experimental studies. A narrative synthesis was done. Results: 12 studies were included in the review, with a total of 69 villages, 13,653 households, and 62,786 participants. Average premium collection was 4.8 USD/year. Most CBHI schemes had flat rates. The study revealed that a range of interventions impact OOPP and health care utilisation. Five categories of interventions were identified. The intervention with the highest impact on OOPP and utilisation was “Audit visits”. Next in line came external funds, training scheme workers, and engaging community leaders and village heads to advertise the scheme. Free healthcare led to a significant increase in utilisation of health services, a significant reduction in Catastrophic health expenditure, but an insignificant effect on OOPP among insured compared with uninsured. Conclusions: Community-Based Health Insurance could pave the way for Universal Health Care in low and middle-income countries. However, this can only be possible if careful thought is given to how schemes are designed. Due to the heterogeneity of studies and results on CBHI schemes, there is need for further research for more effective designs to be developed.

Keywords: community based health insurance, developing countries, health service utilisation, out of pocket payment

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Authors: Tugba Gurler, Irfan Kurtbas

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Roof influences considerably energy demand of buildings. In order to reduce this energy demand, various solutions have been proposed, such as roofs with variable thermal insulation, cool roofs, green roofs, heat exchangers and ventilated roofs, and phase change material (PCM) layered roofs. PCMs suffer from relatively low thermal conductivity despite of their promise of the energy-efficiency initiatives for thermal energy storage (TES). This study not only presents the thermal performance of the concrete roof with PCM layers but also evaluates the products with different design configurations and thicknesses under Central Anatolia Region, Turkey and Nottinghamshire, UK weather conditions. System design limitations and proposed prediction models are discussed in this study. A two-dimensional numerical model has been developed, and governing equations have been solved at each time step. Upper surfaces of the roofs have been modelled with heat flux conditions, while lower surfaces of the roofs with boundary conditions. In addition, suitable roofs have been modeled under symmetry boundary conditions. The results of the designed concrete roofs with PCM layers have been compared with common concrete roofs in Turkey. The UK and the numerical modeling results have been validated with the data given in the literature.

Keywords: phase change material, regional energy demand, roof layers, thermal energy storage

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Authors: Shivam Patel, Abdullah Y. Usmani

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Physiological flow under rest and exercise conditions in patient-specific cerebral aneurysm models is numerically investigated. A finite-volume based code with BiCGStab as the linear equation solver is used to simulate unsteady three-dimensional flow field through the incompressible Navier-Stokes equations. Flow characteristics are first established in a healthy cerebral artery for both physiological conditions. The effect of saccular aneurysm on cerebral hemodynamics is then explored through a comparative analysis of the velocity distribution, nature of flow patterns, wall pressure and wall shear stress (WSS) against the reference configuration. The efficacy of coil embolization as a potential strategy of surgical intervention is also examined by modelling coil as a homogeneous and isotropic porous medium where the extended Darcy’s law, including Forchheimer and Brinkman terms, is applicable. The Carreau-Yasuda non-Newtonian blood model is incorporated to capture the shear thinning behavior of blood. Rest and exercise conditions correspond to normotensive and hypertensive blood pressures respectively. The results indicate that the fluid impingement on the outer wall of the arterial bend leads to abnormality in the distribution of wall pressure and WSS, which is expected to be the primary cause of the localized aneurysm. Exercise correlates with elevated flow velocity, vortex strength, wall pressure and WSS inside the aneurysm sac. With the insertion of coils in the aneurysm cavity, the flow bypasses the dilatation, leading to a decline in flow velocities and WSS. Particle residence time is observed to be lower under exercise conditions, a factor favorable for arresting plaque deposition and combating atherosclerosis.

Keywords: 3D FVM, Cerebral aneurysm, hypertension, coil embolization, non-Newtonian fluid

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Authors: Daniel D'Souza, Ping Zou

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The period before, during, and after menopause is a sensitive time for women as they experience intense physical and psychological health changes and symptoms. These changes accompany the hormonal changes that mark the end of a woman’s reproductive age. To help mitigate and cope with these changes, prompt and correct treatment is needed. eHealth has emerged as a branch of telemedicine in the past few decades as an alternate avenue for patients to receive care quickly and conveniently, as it relies on the Internet and computers. Within the past few years, eHealth has also given rise to mHealth, which is the use of personal mobile devices to receive treatment and care. However, there is a lack of study on their use for menopause. This review aimed to review and summarize the literature for eHealth or mHealth and menopause. Several databases related to women’s health and digital health were searched for original studies about eHealth or mHealth and menopause. The search yielded 25 results. The results were generally positive, with these interventions being feasible and having positive effects on physical and psychosocial outcomes. However, several issues were raised regarding their design process that may inadvertently prevent these interventions from addressing the needs of all potential users. Therefore, while eHealth and mHealth certainly represent a future model of healthcare delivery for menopausal women, further research and design modifications are needed before this can happen.

Keywords: eHealth, menopause, mHealth, midlife women

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Authors: Sadiah Baharom, Che Nidzam Che Ahmad, Saipol Barin Ramli, Asmayati Yahaya, Sopia Md Yassin

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The early childhood care and education (ECCE) in Malaysia aspire to develop children who are intellectually, emotionally, physically and spiritually balanced. This aspiration can only materialise if the early childhood program developed comprehensive and is of high quality comparable to international standards. As such, there is a pressing need to assess the quality of the program in an all-encompassing manner. The overall research project aims at developing a comprehensive and integrated model of high-quality Malaysian ECCE. One of the major objectives of this project is to assess and evaluate the scope and quality of the existing ECCE programs in Malaysia. To this end, a specific aspect of this objective is to develop and validate an instrument to assess and evaluate the ECCE curriculum of the country. Thus this paper describes the development and validation of an instrument to explore the quality of early childhood care and education curriculum currently implemented in the country’s ECCE centres. The generation of the constructs and items were based on a set of criteria mapped against existing ECCE practice, document analyses, expert interviews and panel discussions. The items went through expert validation and were field tested on 597 ECCE teachers. The data obtained went through an exploratory factor analysis to validate the constructs of the instrument followed by reliability studies on internal consistency based on the Cronbach Alpha values. The final set of items for the ECCE curriculum instrument, earmarked for the main study, consists of four constructs namely philosophy and core values, curriculum content, curriculum review and unique features. Each construct consists of between 21 to 3 items with a total of 36 items in all. The reliability coefficients for each construct range from 0.65 to 0.961. These values are within the acceptable limits for a reliable instrument to be used in the main study.

Keywords: early childhood and care education, instrument development, reliability studies, validity studies

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Authors: Ihn Sook Jeong, Eun Joo Lee, Jae Hyung Kim, Gun Ho Kim, Young Jun Hwang

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This study investigated intravenous (IV) infiltration using bioelectrical impedance for 27 hospitalized patients in a long-term care hospital. Impedance parameters showed significant differences before and after infiltration as follows. First, the resistance (R) after infiltration significantly decreased compared to the initial resistance. This indicates that the IV solution flowing from the vein due to infiltration accumulates in the extracellular fluid (ECF). Second, the relative resistance at 50 kHz was 0.94 ± 0.07 in 9 subjects without infiltration and was 0.75 ± 0.12 in 18 subjects with infiltration. Third, the magnitude of the reactance (Xc) decreased after infiltration. This is because IV solution and blood components released from the vein tend to aggregate in the cell membrane (and acts analogously to the linear/parallel circuit), thereby increasing the capacitance (Cm) of the cell membrane and reducing the magnitude of reactance. Finally, the data points plotted in the R-Xc graph were distributed on the upper right before infiltration but on the lower left after infiltration. This indicates that the infiltration caused accumulation of fluid or blood components in the epidermal and subcutaneous tissues, resulting in reduced resistance and reactance, thereby lowering integrity of the cell membrane. Our findings suggest that bioelectrical impedance is an effective method for detection of infiltration in a noninvasive and quantitative manner.

Keywords: intravenous infiltration, impedance, parameters, resistance, reactance

Procedia PDF Downloads 176