Search results for: critical care transition program
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 13161

Search results for: critical care transition program

11871 The Struggle to teach/learn English as a Foreign Language in Turkiye: A Critical Report

Authors: Gizem Yilmazel

Abstract:

Turkiye has been facing failure in English language teaching despite long years of English studies during mandatory education. A body of research studying the reasons of the failure in the literature exists yet the problem has not been solved and English language education is still a phenomenon in Turkiye. The failure is mostly attributed to the methods used in English education (Grammar Translation Method), lack of exposure to the language, inability to practice the language, financial difficulties, the belief of abroad experience necessity, national examinations, and conservative institutional policies. The findings are evident and tangible yet the problem persists. This paper aims to bring the issue a critical perspective and discuss the reasons of the failure.

Keywords: EFL, failure, critical perspective, language education

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11870 A Study on the Development of Self-Help Therapy for Bipolar Disorder

Authors: Bae Yu been, Choi Sung won, Lee Ju yeon, Yang Dan Bi

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The purpose of this study is to develop a self-help therapy program for bipolar disorder (BD). Psychosocial treatment is adjunct to pharmacotherapy for BD, however, it is limited and they demand high costs. Therefore, the objective of the study is to overcome these limitations by developing the self-treatment for BD. The study was examined the efficacy of the self-treatment program for BD. A randomized controlled trial compared the self-help therapy (ST) intervention with a treatment as usual (TAU) group. ST group has conducted the program for 8 weeks (16 sessions). Mood chart, Quality of Life in Bipolar Disorder Questionnaire, Attitudes toward seeking professional help Scale, BIS, CERQ, YMRS, MADRS were used by pre, post, and follow up. The efficacy of the self-help therapy was analyzed by using mixed ANOVAs. There were significant differences in the rate of occurrence of mania or depression between the two groups. ST group reported stable moods on mood chart, and reductions in mood symptoms and improvements in quality of life and treatment adherence. This study was confirmed applicable to BD to the self-help therapy for patients with BD conducted first in Korea.

Keywords: self help therapy, bipolar disorder, self help, self therapy

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11869 Recovery of Physical Performance in Postpartum Women: An Effective Physical Education Program

Authors: Julia A. Ermakova

Abstract:

This study aimed to investigate the efficacy of a physical rehabilitation program for postpartum women. The program was developed with the purpose of restoring physical performance in women during the postpartum period. The research employed a variety of methods, including an analysis of scientific literature, pedagogical testing and experimentation, mathematical processing of study results, and physical performance assessment using a range of tests. The program recommends refraining from abdominal exercises during the first 6-8 months following a cesarean section and avoiding exercises with weights. Instead, a feasible training regimen that gradually increases in intensity several times a week is recommended, along with moderate cardio exercises such as walking, bodyweight training, and a separate workout component that targets posture improvement. Stretching after strength training is also encouraged. The necessary equipment includes comfortable sports attire with a chest support top, mat, push-ups, resistance band, timer, and clock. The motivational aspect of the program is paramount, and the mentee's positive experience with the workout regimen includes feelings of lightness in the body, increased energy, and positive emotions. The gradual reduction of body size and weight loss due to an improved metabolism also serves as positive reinforcement. The mentee's progress can be measured through various means, including an external assessment of her form, body measurements, weight, BMI, and the presence or absence of slouching in everyday life. The findings of this study reveal that the program is effective in restoring physical performance in postpartum women. The mentee achieved weight loss and almost regained her pre-pregnancy shape while her self-esteem improved. Her waist, shoulder, and hip measurements decreased, and she displayed less slouching in her daily life. In conclusion, the developed physical rehabilitation program for postpartum women is an effective means of restoring physical performance. It is crucial to follow the recommended training regimen and equipment to avoid limitations and ensure safety during the postpartum period. The motivational component of the program is also fundamental in encouraging positive reinforcement and improving self-esteem.

Keywords: physical rehabilitation, postpartum, methodology, postpartum recovery, rehabilitation

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11868 Factors Affecting the Mental and Physical Health of Nurses during the Outbreak of COVID-19: A Case Study of a Hospital in Mashhad

Authors: Ghorbanali Mohammadi

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Background: Due to the widespread outbreak of the COVID-19 virus, a large number of people become infected with the disease every day and go to hospitals. The acute condition of this disease has caused the death of many people. Since all the stages of treatment for these people happen in the hospitals, nurses are at the forefront of the fight against this virus. This causes nurses to suffer from physical and mental health problems. Methods: Physical and mental problems in nurses were assessed using the Depression, Anxiety and Stress Scale (DASS-42) of Lovibond (1995) and the Nordic Questionnaire. Results: 90 nurses from emergency, intensive care, and coronary care units were examined, and a total of 180 questionnaires were collected and evaluated. It was found that 37.78%, 47.78%, and 21.11% of nurses have symptoms of depression, anxiety, and stress, respectively. 40% of the nurses had physical problems. In total, 65.17% of them were involved in one or more mental or physical illnesses. Conclusions: Of the three units surveyed, the nurses in intensive care, emergency room, and coronary care units worked more than ten hours a day. Examining the interaction of physical and mental health problems indicated that physical problems can aggravate mental problems.

Keywords: depression anxiety and stress scale of Lovibond, nordic questionnaire, mental health of nurses, physical health problems in nurses

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11867 A Green Hydrogen Route for Electromobility in Brazil and Its Impact in Climate Change

Authors: Milena França Marques

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Due to the climate crisis, several countries such as Brazil began to look for energy alternatives, finding green hydrogen as a possible solution. In addition to not emitting polluting gasses, it also has a large energy capacity, being an excellent alternative for the transport sector, the third sector that emits the most Greenhouse Gases (GHG) in Brazil. Therefore, this work aims to suggest a route for using green hydrogen, through the analysis of plans implemented in other countries, the Brazilian situation, and its difficulties in the development of hydrogen and electromobility, aiming to understand how its value chain works, as well as how to make the Brazilian fleet more efficient and decarbonize. As a result, 68 structuring measures were suggested for the first 5 axes of the National Hydrogen Program (PNH2) using the Three-Year Plan as a basis. Categorizations of measures were also made, definitions of those responsible for their development and implementation, as well as deadlines for them to be met. It is concluded that the study has the potential to promote national energy-environmental mobility transition planning realistically, capable of developing hydrogen and electromobility in Brazil, in addition to contributing to achieving the goals established by its Nationally Determined Contribution (NDC).

Keywords: climate change, electromobility, hydrogen, roadmap

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11866 The Relationship between Confidence, Accuracy, and Decision Making in a Mobile Review Program

Authors: Carla Van De Sande, Jana Vandenberg

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Just like physical skills, cognitive skills grow rusty over time unless they are regularly used and practiced, so academic breaks can have negative consequences on student learning and success. The Keeping in School Shape (KiSS) program is an engaging, accessible, and cost-effective intervention that harnesses the benefits of retrieval practice by using technology to help students maintain proficiency over breaks from school by delivering a daily review problem via text message or email. A growth mindset is promoted through feedback messages encouraging students to try again if they get a problem wrong and to take on a challenging problem if they get a problem correct. This paper reports on the relationship between confidence, accuracy, and decision-making during the implementation of the KiSS Program at a large university during winter break for students enrolled in an engineering introductory Calculus course sequence.

Keywords: growth mindset, learning loss, on-the-go learning, retrieval practice

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11865 Efficacy of Transcranial Magnetic Therapy on Balance in Patients with Vestibular Dysfunction

Authors: Ibrahim M. I. Hamoda, Ahmed R. Z. Baghdadi, Mohammed K. Mohamed, Nawal A. Abu-Shady

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Background: Most of patients with vestibular dysfunction suffering from balance disorders, Abnormality in balance increase effort and exertion which affect the independency, so this study might be a guide in managing balance problem and consequently improve walking with less exertion and maximum function. Purpose: to analyze and discuss the effect of transcranial magnetic therapy on balance in patients with vestibular dysfunction. Methods: forty subjects from both sexes were classified to divided randomly into two equal groups; Group I study group: this group received transcranial magnetic therapy, with a selected physical therapy program for improving balance and vestibular disorders (Balance training, Cawthorne-Cooksey Exercises) and group II (control group): this group received a selected physical therapy program as group I without transcranial magnetic therapy. This treatment procedure will be applied three times weekly for three months. The mean age was 54.53±3.44 and 55.33±2.32 years and BMI 35.7±3.03 and 35.73±1.03 kg/m2 for group I and II respectively. The Biodex Balance System, Berge balances scale (BBS) and brain MRI were used for assessment. Assessments were conducted before and after treatment. The treatment program for group I included balance training, Cawthorne-Cooksey Exercises and pulsed magnetic therapy (Parameters used in the program of 20 minutes, Intensity 2 gausses, Frequency 1 Hz). This selected program was done in approximately one hour every other day for three month. The treatment program group II Patients received the same program as group A without transcranial magnetic therapy. Results: The One-way ANOVA revealed that there were no significant differences in BBS scores, overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability between both groups. Moreover, the BBS scores increased and overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability decreased significantly after treatment in group I and II compared with before treatment. Interpretation/Conclusion: Adding pulsed magnetic therapy to balance training, Cawthorne-Cooksey Exercises has no effect on static and dynamic balance in patients with balance problems due to benign positional paroxysmal vertigo.

Keywords: balance, transcranial magnetic therapy, vestibular dysfunction, biomechanic

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11864 Development of the Family Capacity of Management of Patients with Autism Spectrum Disorder Diagnosis

Authors: Marcio Emilio Dos Santos, Kelly C. F. Dos Santos

Abstract:

Caregivers of patients diagnosed with ASD are subjected to high stress situations due to the complexity and multiple levels of daily activities that require the organization of events, behaviors and socioemotional situations, such as immediate decision making and in public spaces. The cognitive and emotional requirement needed to fulfill this caregiving role exceeds the regular cultural process that adults receive in their process of preparation for conjugal and parental life. Therefore, in many cases, caregivers present a high level of overload, poor capacity to organize and mediate the development process of the child or patient about their care. Aims: Improvement in the cognitive and emotional capacities related to the caregiver function, allowing the reduction of the overload, the feeling of incompetence and the characteristic level of stress, developing a more organized conduct and decision making more oriented towards the objectives and procedural gains necessary for the integral development of the patient with diagnosis of ASD. Method: The study was performed with 20 relatives, randomly selected from a total of 140 patients attended. The family members were submitted to the Wechsler Adult Intelligence Scale III intelligence test and the Family assessment Management Measure (FaMM) questionnaire as a previous evaluation. Therapeutic activity in a small group of family members or caregivers, with weekly frequency, with a minimum workload of two hours, using the Feuerstein Instrumental Enrichment Cognitive Development Program - Feuerstein Instrumental Enrichment for ten months. Reapplication of the previous tests to verify the gains obtained. Results and Discussion: There is a change in the level of caregiver overload, improvement in the results of the Family assessment Management Measure and highlight to the increase of performance in the cognitive aspects related to problem solving, planned behavior and management of behavioral crises. These results lead to the discussion of the need to invest in the integrated care of patients and their caregivers, mainly by enabling cognitively to deal with the complexity of Autism. This goes beyond the simple therapeutic orientation about adjustments in family and school routines. The study showed that when the caregiver improves his/her capacity of management, the results of the treatment are potentiated and there is a reduction of the level of the caregiver's overload. Importantly, the study was performed for only ten months and the number of family members attended in the study (n = 20) needs to be expanded to have statistical strength.

Keywords: caregiver overload, cognitive development program ASD caregivers, feuerstein instrumental enrichment, family assessment management measure

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11863 Factor Influencing Pharmacist Engagement and Turnover Intention in Thai Community Pharmacist: A Structural Equation Modelling Approach

Authors: T. Nakpun, T. Kanjanarach, T. Kittisopee

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Turnover of community pharmacist can affect continuity of patient care and most importantly the quality of care and also the costs of a pharmacy. It was hypothesized that organizational resources, job characteristics, and social supports had direct effect on pharmacist turnover intention, and indirect effect on pharmacist turnover intention via pharmacist engagement. This research aimed to study influencing factors on pharmacist engagement and pharmacist turnover intention by testing the proposed structural hypothesized model to explain the relationship among organizational resources, job characteristics, and social supports that effect on pharmacist turnover intention and pharmacist engagement in Thai community pharmacists. A cross sectional study design with self-administered questionnaire was conducted in 209 Thai community pharmacists. Data were analyzed using Structural Equation Modeling technique with analysis of a moment structures AMOS program. The final model showed that only organizational resources had significant negative direct effect on pharmacist turnover intention (β =-0.45). Job characteristics and social supports had significant positive relationship with pharmacist engagement (β = 0.44, and 0.55 respectively). Pharmacist engagement had significant negative relationship with pharmacist turnover intention (β = - 0.24). Thus, job characteristics and social supports had significant negative indirect effect on turnover intention via pharmacist engagement (β =-0.11 and -0.13, respectively). The model fit the data well (χ2/ degree of freedom (DF) = 2.12, the goodness of fit index (GFI)=0.89, comparative fit index (CFI) = 0.94 and root mean square error of approximation (RMSEA) = 0.07). This study can be concluded that organizational resources were the most important factor because it had direct effect on pharmacist turnover intention. Job characteristics and social supports were also help decrease pharmacist turnover intention via pharmacist engagement.

Keywords: community pharmacist, influencing factor, turnover intention, work engagement

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11862 Intervention Programs for Children of Divorced Parents: Presentation of the Children’s Support Group Developed in Belgium

Authors: Therese Scali

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Couple separations and divorces seem to be commonplace events. However, their frequency does not reduce their impact. Indeed, the adverse effects of parental divorce on children have been well documented. Thus, supporting the children from divorced families is a key concern. Several preventive interventions have been developed for children of divorced parents, such as Children’s Support Group. The present paper aims at presenting the program that has been created in Liege (Belgium). The setting and the tools will be presented. This Children’s Support Group is based on psychoeducational and systemic principles, art-therapy, and aims at acquiring coping skills and seeking social support. Also, the effectiveness of the program will be discussed. Results show that after parental divorce, a group intervention for children can be efficacious in promoting children’s well-being and parent-child communication. This paper contributes to enrich the understanding of children’s needs and to highlight the existence and efficacy of a program that helps them overcome the difficulties of divorce.

Keywords: art-therapy, children’s support group, divorce, efficacy, separation

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11861 Early Outcomes and Lessons from the Implementation of a Geriatric Hip Fracture Protocol at a Level 1 Trauma Center

Authors: Peter Park, Alfonso Ayala, Douglas Saeks, Jordan Miller, Carmen Flores, Karen Nelson

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Introduction Hip fractures account for more than 300,000 hospital admissions every year. Many present as fragility fractures in geriatric patients with multiple medical comorbidities. Standardized protocols for the multidisciplinary management of this patient population have been shown to improve patient outcomes. A hip fracture protocol was implemented at a Level I Trauma center with a focus on pre-operative medical optimization and early surgical care. This study evaluates the efficacy of that protocol, including the early transition period. Methods A retrospective review was performed of all patients ages 60 and older with isolated hip fractures who were managed surgically between 2020 and 2022. This included patients 1 year prior and 1 year following the implementation of a hip fracture protocol at a Level I Trauma center. Results 530 patients were identified: 249 patients were treated before, and 281 patients were treated after the protocol was instituted. There was no difference in mean age (p=0.35), gender (p=0.3), or Charlson Comorbidity Index (p=0.38) between the cohorts. Following the implementation of the protocol, there were observed increases in time to surgery (27.5h vs. 33.8h, p=0.01), hospital length of stay (6.3d vs. 9.7d, p<0.001), and ED LOS (5.1h vs. 6.2h, p<0.001). There were no differences in in-hospital mortality (2.01% pre vs. 3.20% post, p=0.39) and complication rates (25% pre vs 26% post, p=0.76). A trend towards improved outcomes was seen after the early transition period but failed to yield statistical significance. Conclusion Early medical management and surgical intervention are key determining factors affecting outcomes following fragility hip fractures. The implementation of a hip fracture protocol at this institution has not yet significantly affected these parameters. This could in part be due to the restrictions placed at this institution during the COVID-19 pandemic. Despite this, the time to OR pre-and post-implementation was quicker than figures reported elsewhere in literature. Further longitudinal data will be collected to determine the final influence of this protocol. Significance/Clinical Relevance Given the increasing number of elderly people and the high morbidity and mortality associated with hip fractures in this population finding cost effective ways to improve outcomes in the management of these injuries has the potential to have enormous positive impact for both patients and hospital systems.

Keywords: hip fracture, geriatric, treatment algorithm, preoperative optimization

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11860 Meaningful General Education Reform: Integrating Core Curricula and Institutional Values

Authors: Michael W. Markowitz

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A central element of higher education today is the “core” or “general education” curriculum: that configuration of courses that often encompasses the essence of liberal arts education. Ensuring that such offerings reflect the mission and values of the institution is a challenge faced by most college and universities, often more than once. This paper presents an action model of program planning designed to structure the processes of developing, implementing and revising core curricula in a manner consistent with key institutional goals and objectives. Through presentation of a case study from a university in the United States, the elements of needs assessment, stakeholder investment and collaborative compromise are shown as key components of a planning strategy that can produce a general education program that is comprehensive, academically rigorous, assessable and mission consistent. The paper concludes with recommendations for both the implementation and evaluation of such programs in practice.

Keywords: academic assessment, academic program planning, curriculum development, general education reform

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11859 Enhancement of Critical Temperature and Improvement of Mechanical Properties of Yttrium Barium Copper Oxide Superconductor

Authors: Hamed Rahmati

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Nowadays, increasing demand for electric energy makes applying high-temperature superconductors inevitable. However, the most important problem of the superconductors is their critical temperature, which necessitates using a cryogenic system for keeping these substances’ temperatures lower than the critical level. Cryogenic systems used for this reason are not efficient enough, and keeping these large systems maintained is costly. Moreover, the low critical temperature of superconductors has delayed using them in electrical equipment. In this article, at first, characteristics of three superconductors, magnesium diboride (MgB2), yttrium barium copper oxide (YBCO), and iron-based superconductors (FeSC), have been analyzed and a new structure of YBCO superconductors is presented. Generally, YBCO (YBa2Cu7O2) has a weak mechanical structure. By introducing some changes in its configuration and adding one silver atom (Ag) to it, its mechanical characteristics improved significantly. Moreover, for each added atom, a star-form structure was introduced in which changing the location of Ag atom led to considerable changes in temperature. In this study, Ag has been added by applying two accurate methods named random and substitute ones. The results of both methods have been examined. It has been shown that adding Ag by applying the substitute method can improve the mechanical properties of the superconductor in addition to increasing its critical temperature. In the mentioned strategy (using the substitute method), the critical temperature of the superconductor was measured up to 99 Kelvin. This new structure is usable in designing superconductors’ rings to be applied in superconducting magnetic energy storage (SMES). It can also lead to a reduction in the cryogenic system size, a decline in conductor wastes, and a decrease in costs of the whole system.

Keywords: critical temperature, cryogenic system, high-temperature superconductors, YBCO

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11858 The Robot Physician's (Rp-7) Management and Care in Unstable Oncology Patients

Authors: Alisher Agzamov, Hanan Al Harbi

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BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists (1). We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study of 1501 oncology patients using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction, including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP, were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 210 +/- 40 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 140 +/- 35 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for oncology patients (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 29 % compared with the prerobot era, and there was an ICU cost savings of KD2.2 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, icu management and care, cost and icu occupancy

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11857 A Prediction Method of Pollutants Distribution Pattern: Flare Motion Using Computational Fluid Dynamics (CFD) Fluent Model with Weather Research Forecast Input Model during Transition Season

Authors: Benedictus Asriparusa, Lathifah Al Hakimi, Aulia Husada

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A large amount of energy is being wasted by the release of natural gas associated with the oil industry. This release interrupts the environment particularly atmosphere layer condition globally which contributes to global warming impact. This research presents an overview of the methods employed by researchers in PT. Chevron Pacific Indonesia in the Minas area to determine a new prediction method of measuring and reducing gas flaring and its emission. The method emphasizes advanced research which involved analytical studies, numerical studies, modeling, and computer simulations, amongst other techniques. A flaring system is the controlled burning of natural gas in the course of routine oil and gas production operations. This burning occurs at the end of a flare stack or boom. The combustion process releases emissions of greenhouse gases such as NO2, CO2, SO2, etc. This condition will affect the chemical composition of air and environment around the boundary layer mainly during transition season. Transition season in Indonesia is absolutely very difficult condition to predict its pattern caused by the difference of two air mass conditions. This paper research focused on transition season in 2013. A simulation to create the new pattern of the pollutants distribution is needed. This paper has outlines trends in gas flaring modeling and current developments to predict the dominant variables in the pollutants distribution. A Fluent model is used to simulate the distribution of pollutants gas coming out of the stack, whereas WRF model output is used to overcome the limitations of the analysis of meteorological data and atmospheric conditions in the study area. Based on the running model, the most influence factor was wind speed. The goal of the simulation is to predict the new pattern based on the time of fastest wind and slowest wind occurs for pollutants distribution. According to the simulation results, it can be seen that the fastest wind (last of March) moves pollutants in a horizontal direction and the slowest wind (middle of May) moves pollutants vertically. Besides, the design of flare stack in compliance according to EPA Oil and Gas Facility Stack Parameters likely shows pollutants concentration remains on the under threshold NAAQS (National Ambient Air Quality Standards).

Keywords: flare motion, new prediction, pollutants distribution, transition season, WRF model

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11856 A Path for Assistance for People With Stroke in Angola

Authors: Lourenço José, Elsa Melo, Sandra Viera, Ana Pinheiro

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Introduction: People with stroke in Angola face challenges in accessing appropriate healthcare and rehabilitation services. There is a lack of information on the quality of care provided and the development of early intervention plans Methods: Two different methods will be chosen. The exploratory, descriptive, and longitudinal study (E1) to characterize health care for people with stroke, housed in 2 hospitals in Luanda; the quality and transverse study (E2) concerning the development and evaluation of a strategic early intervention plan for a stroke patient. Ethical and deontological principles for an investigation will be proposed. Results: Contributor to the knowledge of the reality of providing care to the person after a stroke, in Angola; Propose and develop an early action plan. Contribute to integration to influence policy makers on the need for assistance with stroke, aiming at their functional, family and social rehabilitation, particularly in the labor market.

Keywords: stroke, functional recovery, quality of life, health

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11855 Security in Resource Constraints: Network Energy Efficient Encryption

Authors: Mona Almansoori, Ahmed Mustafa, Ahmad Elshamy

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Wireless nodes in a sensor network gather and process critical information designed to process and communicate, information flooding through such network is critical for decision making and data processing, the integrity of such data is one of the most critical factors in wireless security without compromising the processing and transmission capability of the network. This paper presents mechanism to securely transmit data over a chain of sensor nodes without compromising the throughput of the network utilizing available battery resources available at the sensor node.

Keywords: hybrid protocol, data integrity, lightweight encryption, neighbor based key sharing, sensor node data processing, Z-MAC

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11854 Factors Associated with Treatment Adherence among Pulmonary Tuberculosis Patients in New Delhi

Authors: Ilham Zaidi, P. Sankara Sarma, Quazi Taufique Ahmed, V. Raman Kutty, Khalid Umer Khayyam, Gurpreet Singh, Abhishek Royal

Abstract:

Introduction: Tuberculosis is a global public health emergency, but it is particularly acute in India, which has the world's highest tuberculosis burden. Due to overpopulation, lack of sanitation, malnutrition, low living standards, and poor socioeconomic status, among other factors, it is India's most common infectious disease. The long period of treatment is one of the main reasons for considering it as a public health emergency. Consequently, there is an increase in patient noncompliance, which leads to treatment failure, adverse treatment outcomes, and deaths. This could lead to the growth of anti-TB drug resistance. According to the WHO, approximately 558 thousand new cases of Multi-Drug Resistance Tuberculosis were diagnosed worldwide, with 8.5 percent developed Extensively Drug Resistance Tuberculosis. Methodology: This study is a program-based cross-sectional descriptive survey of adult tuberculosis patients enrolled in the Delhi-based Revised National Tuberculosis Program. The study setting was 27 NTEP districts of Delhi. (N=65,893) and Sample size- was 200; the sampling method which is used in the study was the systemic random sampling method. Results: Most of the demographic factors (age, gender, residence, and family type) were not significantly associated with adherence; marital status was found statistically significant with the treatment compliance. Hesitation while telling people about the disease and motivation to strictly follow drug schedule by healthcare workers were other factors where a significant association with drug adherence was observed. The study findings also suggest that provision of food, minimal financial and other moral support from family, counseling, discussion and politeness by healthcare providers might also facilitate adherence. Discussion and Conclusions: For TB treatment, adherence, age, sex, socioeconomic status, types of accommodations, malnutrition, and personal hygiene should all be considered; similar results were observed in previous studies. In the care of TB patients, DOTS services, health workers, and family support play a significant role. According to the country's National Strategic Plan, the Indian government has set a goal of eliminating tuberculosis by 2025 and patients' compliance with TB care and treatment adherence is very crucial to achieve this aim. A cohort study will be able to give a better understanding of factors associated with adherence since this study may have missed some defaulters who were absconding and could not be reached. Important Terms: RNTCP, NTEP, DOTS, DS-TB, DR-TB, RR-TB, MDR-TB, XDR-TB, Treatment failure, Treatment relapse, Treatment adherence.

Keywords: treatment adherence, treatment relapse, treatment failure, drug resistance tuberculosis

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11853 Magnetic Fluctuations in the Terrestrial Magnetosheath

Authors: Alexandre Gurchumelia, Luca Sorriso-Valvo, David Burgess, Khatuna Elbakidze, Oleg Kharshiladze, Diana Kvaratskhelia

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The terrestrial magnetosheath is a highly turbulent medium, with a high level of magnetic1field fluctuations throughout a broad range of scales. These often include an inertial range where a2magnetohydrodynamic turbulent cascade is observed. The multifractal properties of the turbulent3cascade, strictly related to intermittency, are observed here during the transition from quasi-parallel to4quasi-perpendicular magnetic field with respect to the bow-shock normal. The different multifractal5behavior in the two regions is analyzed. A standard coarse-graining technique has been used6to evaluate the generalized dimensions and the corresponding multifractal spectrumf(α). A7p-model fit provided a quantitative measure of multifractality and intermittency, to be compared with8standard indicators: the width of the multifractal spectrum, the peak of the kurtosis, and its scaling9exponent. Results show a clear transition and sharp differences in the intermittency properties for the two regions.

Keywords: magnetos heath, turbulence, multifractal, instabilities

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11852 The Use of the Limit Cycles of Dynamic Systems for Formation of Program Trajectories of Points Feet of the Anthropomorphous Robot

Authors: A. S. Gorobtsov, A. S. Polyanina, A. E. Andreev

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The movement of points feet of the anthropomorphous robot in space occurs along some stable trajectory of a known form. A large number of modifications to the methods of control of biped robots indicate the fundamental complexity of the problem of stability of the program trajectory and, consequently, the stability of the control for the deviation for this trajectory. Existing gait generators use piecewise interpolation of program trajectories. This leads to jumps in the acceleration at the boundaries of sites. Another interpolation can be realized using differential equations with fractional derivatives. In work, the approach to synthesis of generators of program trajectories is considered. The resulting system of nonlinear differential equations describes a smooth trajectory of movement having rectilinear sites. The method is based on the theory of an asymptotic stability of invariant sets. The stability of such systems in the area of localization of oscillatory processes is investigated. The boundary of the area is a bounded closed surface. In the corresponding subspaces of the oscillatory circuits, the resulting stable limit cycles are curves having rectilinear sites. The solution of the problem is carried out by means of synthesis of a set of the continuous smooth controls with feedback. The necessary geometry of closed trajectories of movement is obtained due to the introduction of high-order nonlinearities in the control of stabilization systems. The offered method was used for the generation of trajectories of movement of point’s feet of the anthropomorphous robot. The synthesis of the robot's program movement was carried out by means of the inverse method.

Keywords: control, limits cycle, robot, stability

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11851 Software Architecture Implications on Development Productivity: A Case of Malawi Point of Care Electronic Medical Records

Authors: Emmanuel Mkambankhani, Tiwonge Manda

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Software platform architecture includes system components, their relationships, and design, as well as evolution principles. Software architecture and documentation affect a platform's customizability and openness to external innovators, thus affecting developer productivity. Malawi Point of Care (POC) Electronic Medical Records System (EMRS) follows some architectural design standards, but it lacks third-party innovators and is difficult to customize as compared to CommCare and District Health Information System 2 (DHIS2). Improving software architecture and documentation for the Malawi POC will increase productivity and third-party contributions. A conceptual framework based on Generativity and Boundary Resource Model (BRM) was used to compare the three platforms. Interviews, observations, and document analysis were used to collect primary and secondary data. Themes were found by analyzing qualitative and quantitative data, which led to the following results. Configurable, flexible, and cross-platform software platforms and the availability of interfaces (Boundary Resources) that let internal and external developers interact with the platform's core functionality, hence boosting developer productivity. Furthermore, documentation increases developer productivity, while its absence inhibits the use of resources. The study suggests that the architecture and openness of the Malawi POC EMR software platform will be improved by standardizing web application program interfaces (APIs) and making interfaces that can be changed by the user. In addition, increasing the availability of documentation and training will improve the use of boundary resources, thus improving internal and third-party development productivity.

Keywords: health systems, configurable platforms, software architecture, software documentation, software development productivity

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11850 Self-Care and Risk Behaviors in Primary Caregiver of Cancer Patients

Authors: Ivonne N. Pérez-Sánchez. María L. Rascón- Gasca, Angélica Riveros-Rosas, Rebeca Robles García

Abstract:

Introduction: Primary caregivers of cancer patients have health problems related to their lack of time, stress, and fiscal strain. Their health problems could affect their patients’ health and also increase the expenses in public health. Aim: To describe self-care and risk behaviors in a sample of Mexican primary caregiver and the relation of these behaviors with emotional distress (caregiver burden, anxiety and depression symptoms), coping and sociodemographic variables. Method: Participated in this study 173 caregivers of a third level reference medical facility (age: M=49.4, SD=13.5) females 78%, males 22%, 57.5% were caregivers of patients with terminal cancer (CPTC), and 40.5% were caregivers of patients on oncology treatment (CPOT). Results: The 75.7% of caregivers reported to have had health problem in last six months as well as several symptoms which were related to emotional distress, these symptoms were more frequently between CPTC and female caregivers. A half (47.3%) of sample reported have had difficulties in caring their health; these difficulties were related to emotional distress and lower coping, more affected caregivers were who attend male patients and CPTC. The 76.8% of caregivers had health problems in last six months, but 26.5% of them waited to search medical care until they were very sick, and 11% didn't do it. Also, more than a half of sample (56.1%) admitted to have risk behaviors as drink alcohol, smoke or overeating for feeling well, these caregivers showed high emotional distress and lower coping. About caregivers healthy behaviors, 80% of them had a hobby; 27.2% do exercise usually and between 12% to 60% did medical checkups (glucose tests, blood pressure and cholesterol tests, eye exams and watched their weight), these caregivers had lower emotional distress and high coping, some variables related health behaviors were: care only one patient or a female patient and be a CPOT, social support, high educational level and experience as a caregiver in past. The half of caregivers were worrying to develop cancer in the future; this idea was 2.5 times more frequent in caregiver with problems to care their health. Conclusions: The results showed a big proportion of caregivers with medical problems. High emotional distress and low coping were related to physical symptoms, risk behaviors, and low self-care; poor self-care was frequently even in caregiver who have chronic illness.

Keywords: cancer, primary caregiver, risk behaviors, self-care

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11849 A Retrospective Study to Evaluate Verbal Scores of Autistic Children Who Received Hyperbaric Oxygen Therapy

Authors: Tami Peterson

Abstract:

Hyperbaric oxygen therapy (HBOT) has been hypothesized as an effective treatment for increasing verbal language skills in individuals on the autism spectrum. A child’s ability to effectively communicate with peers, parents, and caregivers impacts their level of independence and quality of personal relationships. This retrospective study will compare the speech development of participants aged 2-17 years that received 40 sessions of HBOT at 2.0 ATA to those who had not. Both groups will have a verbal assessment every six months. There were 31 subjects in the HBO group and 32 subjects in the non-HBO group. The statistical analysis will focus on whether hyperbaric oxygen therapy made a significant difference in Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) or Assessment of Basic Language and Learning Skills (ABLLS) results. The evidence demonstrates a strong correlation between HBOT and an increased change from baseline verbal scores compared to the control group, even in difficult to grasp areas such as spontaneous vocalization. We suggest this is due to the anti-inflammatory effects of hyperbaric oxygen therapy. Neuroinflammation causes hypoperfusion of critical central nervous system areas responsible for the symptoms described within the autism spectrum, such as problems with thought processing, memory, and speech. Decreasing the inflammation allows the brain to function properly, which results in improved verbal scores for the participants that underwent HBOT.

Keywords: assessment of basic language and learning skills, autism spectrum disorder, hyperbaric oxygen therapy, verbal behavior milestones assessment and placement program

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11848 Disparity in New Born Care Practices Reducing in Uttar Pradesh: Evidences from NFHS and DLHS

Authors: Gudakesh Yadav

Abstract:

Utter Pradesh, which is one of the largest states of India with unequal distribution of resources and different socioeconomic and cultural characteristics, level of different new born health care indicators varies a lot from one district to another district. State shared more than 21 percent of total live births of India; whereas, it accounts for 28 percent of total infant deaths of the country, with the 53 per thousand infant mortality rate. The present paper attempts to examine tempo-spatial changes in new born care practices during NFHS-1 to NFHS-3 and DLHS-2 to DLHS-3 in Uttar Pradesh and different regions. Descriptive statistics, rate-ratios, concentration index, multivariate and decomposition analysis has been used for the study. Findings of the study reveal that new born care practices have improved over the time in the state and across all the regions because of giving more emphasis on venerable groups like poor, rural, less educated mothers and scheduled caste & tribes but still it did not achieve the desired successes. Regional analysis of third rounds of DLHS shows that, coverage of intuitional delivery was the lowest in the central region. Performance of the southern region was the lowest in terms of initiation of breastfeeding, keeping baby warm and dry after the birth. The study calls for proper follow up of new born children to accelerate new born and child health care service and prioritises increasing antenatal check-ups and institutional delivery, which helps to improve level of other new born care services. At the policy level there is need to reach venerable groups like scheduled caste and tribes, poor and uneducated, and new mother especially in rural areas. High focused district should be allocated for better implementation of new born care promotion programme in low performing districts. Partnership with the private sector health professional is necessary to reach the every part of population.

Keywords: decomposition, inequality, initiation of breastfeeding, institutional delivery

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11847 Virtual Simulation as a Teaching Method for Community Health Nursing: An Investigation of Student Performance

Authors: Omar Mayyas

Abstract:

Clinical decision-making (CDM) is essential to community health nursing (CHN) education. For this reason, nursing educators are responsible for developing these skills among nursing students because nursing students are exposed to highly critical conditions after graduation. However, due to limited exposure to real-world situations, many nursing students need help developing clinical decision-making skills in this area. Therefore, the impact of Virtual Simulation (VS) on community health nursing students' clinical decision-making in nursing education has to be investigated. This study aims to examine the difference in CDM ability among CHN students who received traditional education compared to those who received VS classes, to identify the factors that may influence CDM ability differences between CHN students who received a traditional education and VS classes, and to provide recommendations for educational programs that can enhance the CDM ability of CHN students and improve the quality of care provided in community settings. A mixed-method study will conduct. A randomized controlled trial will compare the CDM ability of CHN students who received 1hr traditional class with another group who received 1hr VS scenario about diabetic patient nursing care. Sixty-four students in each group will randomly select to be exposed to the intervention from undergraduate nursing students who completed the CHN course at York University. The participants will receive the same Clinical Decision Making in Nursing Scale (CDMNS) questionnaire. The study intervention will follow the Medical Research Council (MRC) approach. SPSS and content analysis will use for data analysis.

Keywords: clinical decision-making, virtual simulation, community health nursing students, community health nursing education

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11846 Limits of the Dot Counting Test: A Culturally Responsive Approach to Neuropsychological Evaluations and Treatment

Authors: Erin Curtis, Avraham Schwiger

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Neuropsychological testing and evaluation is a crucial step in providing patients with effective diagnoses and treatment while in clinical care. The variety of batteries used in these evaluations can help clinicians better understand the nuanced declivities in a patient’s cognitive, behavioral, or emotional functioning, consequently equipping clinicians with the insights to make intentional choices about a patient’s care. Despite the knowledge these batteries can yield, some aspects of neuropsychological testing remain largely inaccessible to certain patient groups as a result of fundamental cultural, educational, or social differences. One such battery includes the Dot Counting Test (DCT), during which patients are required to count a series of dots on a page as rapidly and accurately as possible. As the battery progresses, the dots appear in clusters that are designed to be easily multiplied. This task evaluates a patient’s cognitive functioning, attention, and level of effort exerted on the evaluation as a whole. However, there is evidence to suggest that certain social groups, particularly Latinx groups, may perform worse on this task as a result of cultural or educational differences, not reduced cognitive functioning or effort. As such, this battery fails to account for baseline differences among patient groups, thus creating questions surrounding the accuracy, generalizability, and value of its results. Accessibility and cultural sensitivity are critical considerations in the testing and treatment of marginalized groups, yet have been largely ignored in the literature and in clinical settings to date. Implications and improvements to applications are discussed.

Keywords: culture, latino, neuropsychological assessment, neuropsychology, accessibility

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11845 Mechanisms in Regulating Language Practices in Electronics Engineering: A Program Plan for Outcomes-Based Education

Authors: Analiza Acuña-Villacorte

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The underlying principle behind the harmonization in international education does not solely aim for the comparability but also the compatibility of outputs produced. The international standard in the different professions particularly in engineering defines the required graduate attributes to attain suitable qualifications and recognitions. This study described the language practices of the Electronics Engineering students of Bulacan State University, Philippines who will be deployed for their internship program. The purpose of the study was achieved by determining the language proficiency of the students in terms of speaking, listening, reading, and writing, and checking the adherence of the University to the commitment of intensifying community building for the Association of Southeast Asian Nation Vision 2020. The analysis of variance of the variables defined the significance between the causal variables and dependent variables. Thus, this study identified the mechanism that would regulate language practices in the Electronics Engineering program.

Keywords: communicative competence, language practices, mechanisms, outcomes-based education

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11844 Collaborative Platform for Learning Basic Programming (Algorinfo)

Authors: Edgar Mauricio Ruiz Osuna, Claudia Yaneth Herrera Bolivar, Sandra Liliana Gomez Vasquez

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The increasing needs of professionals with skills in software development in industry are incremental, therefore, the relevance of an educational process in line with the strengthening of these competencies, are part of the responsibilities of universities with careers related to the area of Informatics and Systems. In this sense, it is important to consider that in the National Science, Technology and Innovation Plan for the development of the Electronics, Information Technologies and Communications (2013) sectors, it is established as a weakness in the SWOT Analysis of the Software sector and Services, Deficiencies in training and professional training. Accordingly, UNIMINUTO's Computer Technology Program has addressed the analysis of students' performance in software development, identifying various problems such as dropout in programming subjects, academic averages, as well as deficiencies in strategies and competencies developed in the area of programming. As a result of this analysis, it was determined to design a collaborative learning platform in basic programming using heat maps as a tool to support didactic feedback. The pilot phase allows to evaluate in a programming course the ALGORINFO platform as a didactic resource, through an interactive and collaborative environment where students can develop basic programming practices and in turn, are fed back through the analysis of time patterns and difficulties frequent in certain segments or program cycles, by means of heat maps. The result allows the teacher to have tools to reinforce and advise critical points generated on the map, so that students and graduates improve their skills as software developers.

Keywords: collaborative platform, learning, feedback, programming, heat maps

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11843 Towards an Adornian Critical Theory of the Environment

Authors: Dominic Roulx

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Many scholars have in the past decade emphasized the relevance of Adorno’s criticism of the rationalized domination of nature (Naturbeherrschung) for thinking the environmental crisis. Beyond the intersubjective critical models of thinkers such as Habermas and Honneth, Adorno’s critical theory has the benefit, according to them, of disclosing the entwinement of social and natural domination in a critically productive way. The author will be arguing in this paper that Adorno’s model of critical theory displays a theoretical framework that is both original and relevant for thinking the ins and outs of the currentenvironmental crisis. To do so, he first construe Adorno’s understanding of the historical domination of nature and argue that Adorno’s method for its criticizing is immanent critique. He puts emphasis on how his understanding of the domination of nature implicitly implies an account of thedialectical relationship between reason and nature. In doing so, he presents a naturalistic understanding of his idea of the primacy of the object. Second, regarding Adorno’s concept of nature, he discusses what he sees as the shortcomings of many commentators’ understanding of the concept of nature in Adorno. He contends that they tend to fall short of Adorno’s concept of nature in failing to make sense of its thoroughly negative signification, thereby falling into an uncritical and fetichized comprehension of “nature. Third, he discusses the prospect for a possible “reconciliation” (Versöhnung) of nature with society. Highlighting how the domination of nature proves to produce the necessary conditions for its own overcoming, he contends that reconciliation with nature relies mainly on the subject’s capacity for critical self-reflection.

Keywords: german philosophy, adorno, nature, environmental crisis

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11842 The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) Process: An Audit of Its Utilisation on a UK Tertiary Specialist Intensive Care Unit

Authors: Gokulan Vethanayakam, Daniel Aston

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Introduction: The ReSPECT process supports healthcare professionals when making patient-centered decisions in the event of an emergency. It has been widely adopted by the NHS in England and allows patients to express thoughts and wishes about treatments and outcomes that they consider acceptable. It includes (but is not limited to) cardiopulmonary resuscitation decisions. ReSPECT conversations should ideally occur prior to ICU admission and should be documented in the eight sections of the nationally-standardised ReSPECT form. This audit evaluated the use of ReSPECT on a busy cardiothoracic ICU in an NHS Trust where established policies advocating its use exist. Methods: This audit was a retrospective review of ReSPECT forms for a sample of high-risk patients admitted to ICU at the Royal Papworth Hospital between January 2021 and March 2022. Patients all received one of the following interventions: Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) for severe respiratory failure (retrieved via the national ECMO service); cardiac or pulmonary transplantation-related surgical procedures (including organ transplants and Ventricular Assist Device (VAD) implantation); or elective non-transplant cardiac surgery. The quality of documentation on ReSPECT forms was evaluated using national standards and a graded ranking tool devised by the authors which was used to assess narrative aspects of the forms. Quality was ranked as A (excellent) to D (poor). Results: Of 230 patients (74 VV-ECMO, 104 transplant, 52 elective non-transplant surgery), 43 (18.7%) had a ReSPECT form and only one (0.43%) patient had a ReSPECT form completed prior to ICU admission. Of the 43 forms completed, 38 (88.4%) were completed due to the commencement of End of Life (EoL) care. No non-transplant surgical patients included in the audit had a ReSPECT form. There was documentation of balance of care (section 4a), CPR status (section 4c), capacity assessment (section 5), and patient involvement in completing the form (section 6a) on all 43 forms. Of the 34 patients assessed as lacking capacity to make decisions, only 22 (64.7%) had reasons documented. Other sections were variably completed; 29 (67.4%) forms had relevant background information included to a good standard (section 2a). Clinical guidance for the patient (section 4b) was given in 25 (58.1%), of which 11 stated the rationale that underpinned it. Seven forms (16.3%) contained information in an inappropriate section. In a comparison of ReSPECT forms completed ahead of an EoL trigger with those completed when EoL care began, there was a higher number of entries in section 3 (considering patient’s values/fears) that were assessed at grades A-B in the former group (p = 0.014), suggesting higher quality. Similarly, forms from the transplant group contained higher quality information in section 3 than those from the VV-ECMO group (p = 0.0005). Conclusions: Utilisation of the ReSPECT process in high-risk patients is yet to be well-adopted in this trust. Teams who meet patients before hospital admission for transplant or high-risk surgery should be encouraged to engage with the ReSPECT process at this point in the patient's journey. VV-ECMO retrieval teams should consider ReSPECT conversations with patients’ relatives at the time of retrieval.

Keywords: audit, critical care, end of life, ICU, ReSPECT, resuscitation

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