Search results for: healthcare delivery

Authors: Jovina Concepcion Bachynski, Lenora Duhn, Idevania G. Costa, Pilar Camargo-Plazas

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Kidney failure is a life-limiting condition for which treatment, such as dialysis (hemodialysis and peritoneal dialysis), can exact a tremendously high physical and psychosocial symptom burden. Kidney failure can be severe enough to require a palliative approach to care. The term supportive care can be used in lieu of palliative care to avoid the misunderstanding that palliative care is synonymous with end-of-life or hospice care. Kidney supportive care, encompassing advance care planning, is an approach to care that improves the quality of life for people receiving dialysis through early identification and treatment of symptoms throughout the disease trajectory. Advanced care planning involves ongoing conversations about the values, goals, and preferences for future care between individuals and their healthcare teams. Kidney supportive care is underutilized and often initiated late in this population. There is evidence to indicate nurses are not providing the necessary elements of supportive kidney care. Dialysis nurses’ delay or lack of engagement in supportive care until close to the end of life may result in people dying without receiving optimal palliative care services. Using Charmaz’s constructivist grounded theory, the purpose of this doctoral study is to develop a substantive theory that explains the process of engagement in supportive care by nurses working in dialysis settings in Canada. Through initial purposeful and subsequent theoretical sampling, 23 nurses with current or recent work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings drawn from across Canada were recruited to participate in two intensive interviews using the Zoom© teleconferencing platform. Concurrent data collection and data analysis, constant comparative analysis of initial and focused codes until the attainment of theoretical saturation, and memo-writing, as well as researcher reflexivity, have been undertaken to aid the emergence of concepts, categories, and, ultimately, the constructed theory. At the time of abstract submission, data analysis is currently at the second level of coding (i.e., focused coding stage) of the research study. Preliminary categories include: (a) focusing on biomedical care; (b) multi-dimensional challenges to having the conversation; (c) connecting and setting boundaries with patients; (d) difficulty articulating kidney-supportive care; and (e) unwittingly practising kidney-supportive care. For the conference, the resulting theory will be presented. Nurses working in dialysis are well-positioned to ensure the delivery of quality kidney-supportive care. This study will help to determine the process and the factors enabling and impeding nurse engagement in supportive care in dialysis to effect change for normalizing advance care planning conversations in the clinical setting. This improved practice will have substantive beneficial implications for the many individuals living with kidney failure and their supporting loved ones.

Keywords: dialysis, kidney failure, nursing, supportive care

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Authors: Fatima Zohra Belghait, Nawal Cheikh, Oscar Palacios, Ramon Barnadas, Pau Bayon

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Metalloporphyrin and its derivatives play an important role in different scientific areas due to its tetradentate vacant site in the center that is suitable for metal coordination. Metalosomes (MTS) are supramolecular aggregates (similar to liposomes) generated by the self-assembly of compounds similar to phospholipids (with a polar and a hydrophobic part), but incorporating, as part of their membrane, molecules that contain bound metals. The aim of our work is to synthesise metalosomes containing catioinc amphiphilic porphyrin and their complexes with Fe and Cu to study their therapeutical applications. All synthesized compounds were confirmed with Dynamic Light Scattering; elemental analysis, Ultraviolet–visible spectroscopy

Keywords: metalloporphyrin, amphiphilique porphyrin, metalosomes, supramolecular

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Authors: Andres Winston Oreta

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Experiential Learning (ELE) is a strategy for enhancing the teaching and learning of courses especially in civil engineering. This paper presents the adaption of the ELE framework in the delivery of various course requirements in an earthquake engineering course. Examples of how ELE is integrated using online tools and hands-on laboratory technology to address the course learning outcomes on earthquake engineering are presented. Student feedback shows that ELE using online tools and technology strengthens students’ understanding and intuition of seismic design and earthquake engineering concepts.

Keywords: earthquake engineering, experiential learning, shake table, online, internet, civil engineering

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Authors: Amlan Kumar Das, Avinash Marwal, Vikram Pareek

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Liposome plays an important role in medical and pharmaceutical science as e.g. nano scale drug carriers. Liposomes are vesicles of varying size consisting of a spherical lipid bilayer and an aqueous inner compartment. Magnet-driven liposome used for the targeted delivery of drugs to organs and tissues1. These liposome preparations contain encapsulated drug components and finely dispersed magnetic particles. Liposomes are vesicles of varying size consisting of a spherical lipid bilayer and an aqueous inner compartment that are generated in vitro. These are useful in terms of biocompatibility, biodegradability, and low toxicity, and can control biodistribution by changing the size, lipid composition, and physical characteristics2. Furthermore, liposomes can entrap both hydrophobic and hydrophilic drugs and are able to continuously release the entrapped substrate, thus being useful drug carriers. Magnetic liposomes (MLs) are phospholipid vesicles that encapsulate magneticor paramagnetic nanoparticles. They are applied as contrast agents for magnetic resonance imaging (MRI)3. The biological synthesis of nanoparticles using plant extracts plays an important role in the field of nanotechnology4. Green-synthesized magnetite nanoparticles-protein hybrid has been produced by treating Iron (III)/Iron(II) chloride with the leaf extract of Dhatura Inoxia. The phytochemicals present in the leaf extracts act as a reducing as well stabilizing agents preventing agglomeration, which include flavonoids, phenolic compounds, cardiac glycosides, proteins and sugars. The magnetite nanoparticles-protein hybrid has been trapped inside the aqueous core of the liposome prepared by reversed phase evaporation (REV) method using oleic and linoleic acid which has been shown to be driven under magnetic field confirming the formation magnetic liposome (ML). Chemical characterization of stealth magnetic liposome has been performed by breaking the liposome and release of magnetic nanoparticles. The presence iron has been confirmed by colour complex formation with KSCN and UV-Vis study using spectrophotometer Cary 60, Agilent. This magnet driven liposome using nanoparticles-protein hybrid can be a smart vesicles for the targeted drug delivery.

Keywords: nanoparticles-protein hybrid, magnetic liposome, medical, pharmaceutical science

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Authors: Liaquat Ali, Khurshid Natasha

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Low resource countries are not usually equipped with the organizational tools to implement health care for chronic diseases, and thus, providing effective diabetes care in such countries is a challenging task. Diabetic Association of Bangladesh (BADAS in Bengali acronym) has created a stimulating example to meet this challenge. Starting its journey in 1956 with 39 patients in a small tin shed clinic BADAS, and its affiliated associations now operate 90 hospitals and health centres all over the country. Together, these facilities provide integrated health care to about 1.5 million registered diabetic patients which constitute about 20% of the estimated diabetic population in the country. BADAS has also become a pioneer in health manpower generation in Bangladesh. Along with its affiliates, it now runs 3 Medical Colleges (to generate graduate physicians), 2 Nursing Institutes, and 2 Postgraduate Institutes which conduct 25 postgraduate courses (under the University of Dhaka) in various basic, clinical and public health disciplines. BADAS gives great emphasis on research, which encompasses basic, clinical as well as public health areas. BADAS is an ideal example of public-private partnership in health as most of its infrastructure has been created through government support but it is almost self-reliant in managing its revenue budget which approached approximately 40 million US dollar during 2010. BADAS raises resources by providing high-quality services to the people, both diabetic and non-diabetic. At the same time, BADAS has developed a cross financing model, to support diabetic patients in general and poor diabetic patients (identified through a social welfare network) in particular, through redistribution of the resources. Along with financial sustainability BADAS ensure organizational sustainability through a process of decentralization, community ownership, and democratic management. Presently a large scale pilot project (named as a Health Care Development Project or HCDP) is under implementation under BADAS umbrella with an objective to transform the diabetes care model to a health care model in general. It is expected to create further evidence on providing sustainable (with social safety net) health care delivery for diabetes, and other chronic illnesses as an integral part of general health care delivery in a resource constrained setting.

Keywords: Bangladesh, self sustain, health care, constrain

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Authors: Arunai Nambi Raj N., Kaviarasu Karunakaran, Krishnamurthy K.

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The purpose of this study was to create American Association of Physicist in Medicine (AAPM) Task Group 119 (TG 119) benchmark plans for flattening filter free beam (FFF) deliveries of intensity modulated radiation therapy (IMRT) and volumetric arc therapy (VMAT) in the Eclipse treatment planning system. The planning data were compared with the flattening filter (FF) IMRT & VMAT plan data to verify the dosimetric commissioning accuracy of FFF deliveries. AAPM TG 119 proposed a set of test cases called multi-target, mock prostate, mock head and neck, and C-shape to ascertain the overall accuracy of IMRT planning, measurement, and analysis. We used these test cases to investigate the performance of the Eclipse Treatment planning system for the flattening filter free beam deliveries. For these test cases, we generated two sets of treatment plans, the first plan using 7–9 IMRT fields and a second plan utilizing two arc VMAT technique for both the beam deliveries (6 MV FF, 6MV FFF, 10 MV FF and 10 MV FFF). The planning objectives and dose were set as described in TG 119. The dose prescriptions for multi-target, mock prostate, mock head and neck, and C-shape were taken as 50, 75.6, 50 and 50 Gy, respectively. The point dose (mean dose to the contoured chamber volume) at the specified positions/locations was measured using compact (CC‑13) ion chamber. The composite planar dose and per-field gamma analysis were measured with IMatriXX Evaluation 2D array with OmniPro IMRT Software (version 1.7b). FFF beam deliveries of IMRT and VMAT plans were comparable to flattening filter beam deliveries. Our planning and quality assurance results matched with TG 119 data. AAPM TG 119 test cases are useful to generate FFF benchmark plans. From the obtained data in this study, we conclude that the commissioning of FFF IMRT and FFF VMAT delivery were found within the limits of TG-119 and the performance of the Eclipse treatment planning system for FFF plans were found satisfactorily.

Keywords: flattening filter free beams, intensity modulated radiation therapy, task group 119, volumetric modulated arc therapy

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Authors: Yung-Chih Kuo, Yung-I Lou

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Cationic solid lipid nanoparticles (CSLNs) with anti-melanotransferrin (AMT) and apolipoprotein E (ApoE) were used to carry antimitotic doxorubicin (Dox) across the blood–brain barrier (BBB) for glioblastoma multiforme (GBM) treatment. Dox-loaded CSLNs were prepared in microemulsion, grafted covalently with AMT and ApoE, and applied to human brain microvascular endothelial cells (HBMECs), human astrocytes, and U87MG cells. Experimental results revealed that an increase in the weight percentage of stearyl amine (SA) from 0% to 20% increased the size of AMT-ApoE-Dox-CSLNs. In addition, an increase in the stirring rate from 150 rpm to 450 rpm decreased the size of AMT-ApoE-Dox-CSLNs. An increase in the weight percentage of SA from 0% to 20% enhanced the zeta potential of AMT-ApoE-Dox-CSLNs. Moreover, an increase in the stirring rate from 150 rpm to 450 rpm reduced the zeta potential of AMT-ApoE-Dox-CSLNs. AMT-ApoE-Dox-CSLNs exhibited a spheroid-like geometry, a minor irregular boundary deviating from spheroid, and a somewhat distorted surface with a few zigzags and sharp angles. The encapsulation efficiency of Dox in CSLNs decreased with increasing weight percentage of Dox and the order in the encapsulation efficiency of Dox was 10% SA > 20% SA > 0% SA. However, the reverse order was true for the release rate of Dox, suggesting that AMT-ApoE-Dox-CSLNs containing 10% SA had better-sustained release characteristics. An increase in the concentration of AMT from 2.5 to 7.5 μg/mL slightly decreased the grafting efficiency of AMT and an increase in that from 7.5 to 10 μg/mL significantly decreased the grafting efficiency. Furthermore, an increase in the concentration of ApoE from 2.5 to 5 μg/mL slightly reduced the grafting efficiency of ApoE and an increase in that from 5 to 10 μg/mL significantly reduced the grafting efficiency. Also, AMT-ApoE-Dox-CSLNs at 10 μg/mL of ApoE could slightly reduce the transendothelial electrical resistance (TEER) and increase the permeability of propidium iodide (PI). An incorporation of 10 μg/mL of ApoE could reduce the TEER and increase the permeability of PI. AMT-ApoE-Dox-CSLNs at 10 μg/mL of AMT and 5-10 μg/mL of ApoE could significantly enhance the permeability of Dox across the BBB. AMT-ApoE-Dox-CSLNs did not induce serious cytotoxicity to HBMECs. The viability of HBMECs was in the following order: AMT-ApoE-Dox-CSLNs = AMT-Dox-CSLNs = Dox-CSLNs > Dox. The order in the efficacy of inhibiting U87MG cells was AMT-ApoE-Dox-CSLNs > AMT-Dox-CSLNs > Dox-CSLNs > Dox. A surface modification of AMT and ApoE could promote the delivery of AMT-ApoE-Dox-CSLNs to cross the BBB via melanotransferrin and low density lipoprotein receptor. Thus, AMT-ApoE-Dox-CSLNs have appropriate physicochemical properties and can be a potential colloidal delivery system for brain tumor chemotherapy.

Keywords: anti-melanotransferrin, apolipoprotein E, cationic catanionic solid lipid nanoparticle, doxorubicin, U87MG cells

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Authors: Pakinee Pooprasert, Wanxin Wang, Tina Parmar, Dana Ahnood, Tafadzwa Young-Zvandasara, James Morgan

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Homelessness has been shown to be correlated to poor health outcomes, including increased visual health morbidity. Despite this, there are relatively few studies regarding visual health in the homeless population, especially in the UK. This research aims to investigate visual disability and access barriers prevalent in the homeless population in Cardiff, South Wales. Data was collected from 100 homeless participants in three different shelters. Visual outcomes included near and distance visual acuity as well as non-cycloplegic refraction. Qualitative data was collected via a questionnaire and included socio-demographic profile, ocular history, subjective visual acuity and level of access to healthcare facilities. Based on the participants’ presenting visual acuity, the total prevalence of myopia and hyperopia was 17.0% and 19.0% respectively based on spherical equivalent from the eye with the greatest absolute value. The prevalence of astigmatism was 8.0%. The mean absolute spherical equivalent was 0.841D and 0.853D for right and left eye respectively. The number of participants with sight loss (as defined by VA= 6/12-6/60 in the better-seeing eye) was 27.0% in comparison to 0.89% and 1.1% in the general Cardiff and Wales population respectively (p-value is < 0.05). Additionally, 1.0% of the homeless subjects were registered blind (VA less than 3/60), in comparison to 0.17% for the national consensus after age standardization. Most participants had good knowledge regarding access to prescription glasses and eye examination services. Despite this, 85.0% never had their eyes examined by a doctor and 73.0% had their last optometrist appointment in more than 5 years. These findings suggested that there was a significant disparity in ocular health, including visual acuity and refractive error amongst the homeless in comparison to the general population. Further, the homeless were less likely to receive the same level of support and continued care in the community due to access barriers. These included a number of socio-economic factors such as travel expenses and regional availability of services, as well as administrative shortcomings. In conclusion, this research demonstrated unmet visual health needs within the homeless, and that inclusive policy changes may need to be implemented for better healthcare outcomes within this marginalized community.

Keywords: homelessness, refractive error, visual disability, Wales

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Authors: Kalpana Gupta

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Sexually transmitted infections (STIs) are infections that are spread primarily through sexual contact. In our daily practice, we see gonorrhea, chancroid, syphilis, and chlamydial infections that can be cured, as well as HIV, genital herpes, HPV, and hepatitis B infections that cannot be cured but can be managed with available treatments. Many people in India are infected with Sexually transmitted diseases (STDs), and the figures are quite high because of a lack of awareness and communication, as well as a taboo against these diseases. Numerous taboos and associated stigma shape patients’ lives and have a significant impact on health care policies, medical research, and current issues in medical ethics. Current statistics emphasize the importance of delivering sex education to this important demographic promptly. The long-standing tradition of girls marrying very young, especially in rural areas, and often too much older men, causes a slew of STIs. Stigma and HIV have a cyclical relationship; people who experience stigma and discrimination are marginalized and made more vulnerable to HIV/STDs, while those living with HIV are more vulnerable to stigma and discrimination. As urban pressures have grown, so have slums - and they have fast become ideal breeding grounds for STDs. In developed countries, strict laws have been enacted requiring people suffering from STDs to seek immediate treatment as well as contact the health department. Unfortunately, because of the stigma associated with the disease, patients in India are reluctant to reveal the source of infection. With various schemes, India is attempting to promote sex education and awareness. For example, the Ministry of Health and Family Welfare developed the National Adolescent Health Programme (also known as the Rashtriya Kishor Swasthya Karyakram) in partnership with the United Nations Population Fund (UNFPA). Whereas, National AIDS Control Organisation was set up so that every person living with HIV has access to quality care and is treated with dignity and breaking all taboos. It becomes clear that research and healthcare policies will not be effective in assisting patients with STDs unless these "nonscientific" elements are taken into account.

Keywords: sexually transmitted diseases, sexually transmitted infections, taboo, stigma, HIV/STDs, sex education and awareness, treatment, quality care, medications, healthcare policies

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Authors: Sabyasachi Behera, Shiv Kumar, Pramod Gautam, Anisur Rahman, Pawan Pathak, Rahul Bhadouria

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Background: The increasing proportion of population especially urban poor and vulnerable groups or groups with specific needs, with health indicators worse than their rural counterparts in India face various issues related with availability and quality of health care. The reasons are myriad, starting from information and awareness of the community, especially, in a scenario wherein the needs and challenges of floating and migrant urban populations remain poorly understood. Weak linkages between health care facilities and slum dwellers and vulnerable populations hinder the improvement of health services for urban poor. Method: To address this issue, TCIHC program is helping health department of Indore city of Madhya Pradesh to establish a referral mechanism with a dual approach: at both community and facility level. The former is based on the premise of ‘building social capital’, i.e. norms and networks within a community facilitating collective action, helps improve the demand and supply of health services at appropriate levels of care (Minus 2: Accredited Social Health Activist and Community Health Groups; Minus 1: Urban Health Nutrition Days; Zero: Urban Primary Health Center; Plus 1: secondary facility with BEmONC services; Plus 2: secondary facilities with CEmONC services; Plus 3: tertiary level facility) for the urban poor. The latter focuses on encouraging the provision of all services at various levels of service delivery points and stakeholders to function in a coordinated manner to ensure better health service availability and coverage in underserved slum areas. Results: This initiative has enhanced the utilization of community based, primary and secondary level services through defined referral pathways that are clearly known to a community dweller. Conclusion: An ideal referral mechanism should begin with referral at the community level wherein services of a frontline health care provider are accessed by them at their door-step, causing no delay in both understanding and decision on the health issues faced by them.

Keywords: levels of care, linkages, referral mechanism, service delivery

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Authors: Brogan Guest, Amy Donaldson-Perrott

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The Master’s of Physician Associate Studies (MPAS) programme at St George’s, University of London (SGUL), is an intensive two-year course that trains students to become physician associates (PAs). PAs are generalized healthcare providers who work in primary and secondary care across the UK. PA programmes face the difficult task of preparing students to become safe medical providers in two short years. Our goal is to teach students to develop clinical reasoning early on in their studies and historically, this has been done predominantly though problem-based learning (PBL). We have had an increase concern about student engagement in PBL and difficulty recruiting facilitators to maintain the low student to facilitator ratio required in PBL. To address this issue, we created ‘Clinical Application of Anatomy and Physiology (CAAP)’. These peer-led, interactive, problem-based, small group sessions were designed to facilitate students’ clinical reasoning skills. The sessions were designed using the concept of Team-Based Learning (TBL). Students were divided into small groups and each completed a pre-session quiz consisting of difficult questions devised to assess students’ application of medical knowledge. The quiz was completed in small groups and they were not permitted access of external resources. After the quiz, students worked through a series of openended, clinical tasks using all available resources. They worked at their own pace and the session was peer-led, rather than facilitator-driven. For a group of 35 students, there were two facilitators who observed the sessions. The sessions utilised an infinite space whiteboard software. Each group member was encouraged to actively participate and work together to complete the 15-20 tasks. The session ran for 2 hours and concluded with a post-session quiz, identical to the pre-session quiz. We obtained subjective feedback from students on their experience with CAAP and evaluated the objective benefit of the sessions through the quiz results. Qualitative feedback from students was generally positive with students feeling the sessions increased engagement, clinical understanding, and confidence. They found the small group aspect beneficial and the technology easy to use and intuitive. They also liked the benefit of building a resource for their future revision, something unique to CAAP compared to PBL, which out students participate in weekly. Preliminary quiz results showed improvement from pre- and post- session; however, further statistical analysis will occur once all sessions are complete (final session to run December 2022) to determine significance. As a post-graduate healthcare professional programme, we have a strong focus on self-directed learning. Whilst PBL has been a mainstay in our curriculum since its inception, there are limitations and concerns about its future in view of student engagement and facilitator availability. Whilst CAAP is not TBL, it draws on the benefits of peer-led, small group work with pre- and post- team-based quizzes. The pilot of these sessions has shown that students are engaged by CAAP, and they can make significant progress in clinical reasoning in a short amount of time. This can be achieved with a high student to facilitator ratio.

Keywords: problem based learning, team based learning, active learning, peer-to-peer teaching, engagement

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Authors: Adel H. Hejaaji

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The need for organisations to be flexible to meet the rapidly changing requirements of their customers is now well appreciated and can be witnessed within companies with their use of techniques such as single-minute exchange of die (SMED) for machine change-over or Kanban as the visual production and inventory control for Just-in-time manufacture and delivery. What is not so well appreciated by companies is the need for agility. Put simply it is the need to be alert for a new and unexpected opportunity and quick to respond with the changes necessary in order to profit from it. This paper aims to study the literature of agility in manufacturing to understand the concept of agility and how it is important and critical for the small and medium size manufacturing organisations (SMEs), and to defined the specific benefits of moving towards agility, and thus what benefit it can bring to an organisation.

Keywords: SMEs, agile manufacturing, manufacturing, industrial engineering

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Authors: Emma R. Arakelova, Stepan G. Grigoryan, Flora G. Arsenyan, Nelli S. Babayan, Ruzanna M. Grigoryan, Natalia K. Sarkisyan

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Novel nanosize zinc oxide composites of doxorubicin obtained by deposition of 180 nm thick zinc oxide film on the drug surface using DC-magnetron sputtering of a zinc target in the form of gels (PEO+Dox+ZnO and Starch+NaCMC+Dox+ZnO) were studied for drug delivery applications. The cancer specificity was revealed both in in vitro and in vivo models. The cytotoxicity of the test compounds was analyzed against human cancer (HeLa) and normal (MRC5) cell lines using MTT colorimetric cell viability assay. IC50 values were determined and compared to reveal the cancer specificity of the test samples. The mechanistic study of the most active compound was investigated using Flow cytometry analyzing of the DNA content after PI (propidium iodide) staining. Data were analyzed with Tree Star FlowJo software using cell cycle analysis Dean-Jett-Fox module. The in vivo anticancer activity estimation experiments were carried out on mice with inoculated ascitic Ehrlich’s carcinoma at intraperitoneal introduction of doxorubicin and its zinc oxide compositions. It was shown that the nanosize zinc oxide film deposition on the drug surface leads to the selective anticancer activity of composites at the cellular level with the range of selectivity index (SI) from 4 (Starch+NaCMC+Dox+ZnO) to 200 (PEO(gel)+Dox+ZnO) which is higher than that of free Dox (SI = 56). The significant increase in vivo antitumor activity (by a factor of 2-2.5) and decrease of general toxicity of zinc oxide compositions of doxorubicin in the form of the above mentioned gels compared to free doxorubicin were shown on the model of inoculated Ehrlich's ascitic carcinoma. Mechanistic studies of anticancer activity revealed the cytostatic effect based on the high level of DNA biosynthesis inhibition at considerable low concentrations of zinc oxide compositions of doxorubicin. The results of studies in vitro and in vivo behavior of PEO+Dox+ZnO and Starch+NaCMC+Dox+ZnO composites confirm the high potential of the nanosize zinc oxide composites as a vector delivery system for future application in cancer chemotherapy.

Keywords: anticancer activity, cancer specificity, doxorubicin, zinc oxide

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Authors: Jiazhi Zeng, Leiyu Shi, Xia Zou, Wen Chen, Li Ling

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Background: China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Due to the household registration system, migrants are in a vulnerable state when they attempt to access to primary care services. A strong primary care system can reduce health inequities and mitigate socioeconomic disparities in healthcare utilization. Literature indicated that migrants were more reliant on the primary care system than local residents. Although the Chinese government has attached great importance to creating an efficient health system, primary care services are still underutilized. The referral system between primary care institutions and hospitals has not yet been completely established in China. The general populations often go directly to hospitals instead of primary care institutions for their primary care. Primary care institutions generally consist of community health centers (CHCs) and community health stations (CHSs) in urban areas, and township health centers (THCs) and rural health stations (THSs) in rural areas. In addition, primary care services are also provided by the outpatient department of municipal hospitals and tertiary hospitals. A better understanding of migrants’ experiences with primary care in the above-mentioned medical institutions is critical for improving the performance of primary care institutions and providing indications of the attributes that require further attention. The purpose of this pioneering study is to explore rural-to-urban migrants’ experiences in primary care, compare their primary care experiences in four types of medical institutions in Guangzhou, China, and suggest implications for targeted interventions to improve primary care for the migrants. Methods: This was a cross-sectional study conducted with 736 rural-to-urban migrants in Guangzhou, China, in 2014. A multistage sampling method was employed. A validated Chinese version of Primary Care Assessment Tool - Adult Short Version (PCAT-AS) was used to collect information on migrants’ primary care experiences. The PCAT-AS consists of 10 domains. Analysis of covariance was conducted for comparison on PCAT domain scores and total scores among migrants accessing four types of medical institutions. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results: After controlling for socio-demographic characteristics, migrant characteristics, health status and health insurance status, migrants accessing primary care in tertiary hospitals had the highest PCAT total scores when compared with those accessing primary care THCs/ RHSs (25.49 vs. 24.18, P=0.007) and CHCs/ CHSs(25.49 vs. 24.24, P=0.006). There was no statistical significant difference for PCAT total scores between migrants accessing primary care in CHCs/CHSs and those in municipal hospitals (24.24 vs. 25.02, P=0.436). Factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P < 0.001). Conclusions: This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Migrants receiving primary care from THCs, RHSs, CHSs and CHSs reported worse primary care experiences than those receiving primary care from tertiary hospitals. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care. Further research exploring the specific reasons for poorer PCAT scores of primary care institutions users will be needed.

Keywords: China, PCAT, primary care, rural-to-urban migrants

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Authors: Si-Gwan Kim

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Small-size and low-power sensors with sensing, signal processing and wireless communication capabilities is suitable for the wireless sensor networks. Due to the limited resources and battery constraints, complex routing algorithms used for the ad-hoc networks cannot be employed in sensor networks. In this paper, we propose node-disjoint multi-path hexagon-based routing algorithms in wireless sensor networks. We suggest the details of the algorithm and compare it with other works. Simulation results show that the proposed scheme achieves better performance in terms of efficiency and message delivery ratio.

Keywords: clustering, multi-path, routing protocol, sensor network

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Authors: Maznieda Mahjom, Rohaida Ismail, Masita Arip, Mohd Shaiful Azlan, Nor’Ashikin Othman, Hafizah Abdullah, nor Zahrin Hasran, Joshita Jothimanickam, Syaqilah Shawaluddin, Nadia Mohamad, Raheel Nazakat, Tuan Mohd Amin, Mizanurfakhri Ghazali, Rosmanajihah Mat Lazim

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COVID-19 outbreak is particularly detrimental to the mental health of everyone as well as leaving a long devastating crisis in the healthcare sector. Daily increment of COVID-19 cases and close contact, necessitating the testing of a large number of samples, thus increasing the workload and burden to laboratory personnel. This study aims to determine the prevalence of personal-, work- and client-related burnout as well as to measure the concentration of salivary cortisol among laboratory personnel in the main laboratories in Klang Valley, Malaysia. This cross-sectional study was conducted in late 2021 and recruited a total of 404 respondents from three laboratories in Klang Valley, Malaysia. The level of burnout was assessed using Copenhagen Burnout Inventory (CBI) comprising three sub-dimensions of personal-, work- and client-related burnout. The cut-off score of 50% and above indicated possible burnout. Meanwhile, salivary cortisol was measured using a competitive enzyme immunoassay kit (Salimetrics, State College, PA, USA). Normal levels of salivary cortisol concentration in adults are within 0.094 to 1.551 μg/dl (morning) and can be none detected to 0.359 μg/dl (evening). The prevalence of personal-, work- and client-related burnout among laboratory personnel were 36.1%, 17.8% and 7.2% respectively. Meanwhile, the abnormal morning and evening cortisol concentration recorded were 29.5% and 21.8% excluding 6.9%-7.4% missing data. While the IgA level is normal for most of the respondents, which recorded at 95.53%. Laboratory personnel were at risk of suffering burnout during the COVID-19 pandemic. Thus, mental health programs need to be addressed at the department and hospital level by regularly screening healthcare workers and designing an intervention program. It is also vital to improve the coping skills of laboratory personnel by increasing the awareness of good coping skill techniques. The training must be in an innovative way to ensure that the lab personnel can internalise the technique and practise it in real life.

Keywords: burnout, COVID-19, laborotary personnel, salivary cortisol

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Authors: Akriti Kafle Baral, Ruixing Zhang, Dzifa K Lalit, Manthar M Alli

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Introduction: Hemodialysis is the most common type of dialysis globally approximately million are reported to receive this type of dialysis. Psychosocial issues in hemodialysis are the psychological and socioeconomic burdens emanating from the initiation and course of treatment and have the potential for gross deterioration in the quality of life and general well-being of patients. Understanding the psychosocial issues and needs of patients undergoing hemodialysis could pave the way for comprehensive support and therapies designed to reduce stress, improve social support, and foster mental resilience. Objectives: The aim of this study was to explore the psychosocial issues and support needs of patients undergoing hemodialysis at a tertiary care center in Nepal. Methods: A qualitative descriptive study was conducted among 20 purposefully selected patients attending hemodialysis treatment at Pokhara Academy of Health Sciences, Nepal. Data was analyzed via thematic analysis. Results: The study resulted in three major themes which included Emotional, psychological, and spiritual struggles, Social and economic impacts, and Support and information needs. Moreover, 16 sub-themes emerged which are Frustration with daily life, Constant fear of death, Thoughts of self-harm, Perceived Burden on Family, Sense of Divine Punishment, Sense of Unfairness, Fear about future uncertainties, Social avoidance, Social stigmatization, Loss of employment, Financial strain, Transportation challenges, Need for early, clear and comprehensive information, Need for support and reassurance from family, Support through peer connections, and Reassurance from healthcare providers. Conclusion: The findings of this study indicate that patients undergoing hemodialysis in Nepal experience numerous hardships and multifaceted struggles that require support from different dimensions. Establishing robust support systems that include family involvement, peer networks, and effective communication from healthcare professionals can significantly mitigate feelings of anxiety and isolation.

Keywords: hemodialysis, psychosocial issues, support needs, chronic kidney disease, end stage renal disease, Nepal

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Authors: Pravina Gurjar, Bothiraja Pour, Vijay Kumbhar, Ganesh Dama

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Andrographolide (AG), a bioactive phytoconstituent, has a wider range of pharmacological action. However, due to the intestinal degradation, shows low oral bioavailability. The aim of the present work was to develop Floating In-situ gelling Gastro retentive System (FISGS) for AG in order to enhance its site specific absorption and minimize pH dependent hydrolysis in alkaline environment. Further to increase its therapeutic efficacy for peptic ulcer disease caused by H. pyroli. Gellan based floating in situ gelling system of AG were prepared by using sodium citrate and calcium carbonate. The 32 factorial designs was used to study the effect of gellan and calcium carbonate concentration (independent variables) on dependent variable such as viscosity, floating lag time and drug release. Developed system was evaluated for drug content, floating lag time, viscosity, and drug release studies. Drug content, viscosity, and floating lag time was found to be 81-99%, 67-117 Cps, and 3-5 sec, respectively. The obtained system showed good in vitro floating ability for more than 12 h using 0.1 N HCl as dissolution medium with initial burst release followed by the controlled zero order drug release up to 24 hrs. In vivo testing of FISGS of AG to rats demonstrated significant antiulcer activity that were evaluated by various parameters like pH, volume, total acidity, millimole equivalent of H+ ions/30 min, and protein content of gastric content. The densities of all the formulation batches were found to be near about 0.9 and floating duration above 12 hr. It was observed that with the increase in conc. of gellan there was increase in the viscosity of formulation but all formulations were in optimum range. The drug content of optimized batch was found to be 99.23. In histopathology study of stomach, the villi at the mucosal surface, the intercellular junction, the intestinal lumen were intact; no destruction of the epithelium, and submucosal gland in formulation treated and control group animals as compared to pure drug AG and standard ranitidine. Gellan-based in situ gastro retentive floating system could be advantageous in terms of increased bioavailability of AG to maintain an effective drug conc. in gastric fluid as well as in serum for longer period of time.

Keywords: andrographolide, floating drug delivery, in situ gelling system, gastroretentive system

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Authors: Freya Harding, Anne Gatuguta, Chi Eziefula

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Introduction Research shows the quality of experiences of pregnancy, birth, and postpartum impacts the health and well-being of the mother and baby. This is recognised by the WHO in their recommendations ‘Intrapartum care for a positive childbirth experience’. The COVID-19 pandemic saw the transformation of the NHS Maternity services to prevent the transmission of COVID-19. Physical and social isolation may have affected women’s experiences of pregnancy, birth and postpartum; especially those of healthcare. Examples of such changes made to the NHS include both the reduction in volume of face-to-face consultations and restrictions to visitor time in hospitals. One notable detriment due to these changes was the absence of a partner during certain stages of birth. The aim of this study was to explore women’s experiences of pregnancy, birth, and postnatal period during the COVID-19 pandemic in the UK. Methods We collected qualitative data from women who had given birth during the COVID-19 pandemic. In-depth, semi-structured interviews were conducted with twelve participants recruited from mother and baby groups in Southeast England. Data were audio-recorded, transcribed verbatim, and analysed thematically using both inductive and deductive approaches. Ethics permission was granted from Brighton and Sussex Medical School (ER/BSMS9A83/1). Results Interviews were conducted with 12 women who gave birth between May 2020 and February 2021. Ages of the participants ranged between 28 and 42 years, most of which were white British, with one being Asian British. All participants were heterosexual and either married or co-habiting with their partner. Five participants worked in the NHS, and all participants had professional occupations. Women felt inadequately supported both socially and medically. An appropriate sense of control over their own birthing experience was lacking. Safety mechanisms, such as in-person visits from the midwife, had no suitable alternatives in place. Serious health issues were able to “slip through the net.” Mental health conditions in some of those interviewed worsened or developed. Similarly, reduced support from partners during birth and during the immediate postpartum period at the hospital, coupled with reduced ward staffing, resulted in some traumatic experiences; particularly for women who had undergone caesarean section. However, some unexpected positive effects were reported; one example being that partners were able to spend more time with their baby due to furlough schemes and working from home. Similarly, emergency care was not felt to have been compromised. Overall, six themes emerged: (1) Self-reported traumatic experiences, (2) Challenges of caring for a baby with reduced medical and social support, (3) Unexpected benefits to the parenting experience, (4) The effects of a sudden change in medical management (5) Poor communication from healthcare professionals (6) Social change; with subthemes of support accessing medical care, the workplace, family and friends, and antenatal & baby groups. Conclusions The results indicate that the healthcare system was unable to adequately deliver maternity care to facilitate positive pregnancy, birth, and postnatal experiences during the heights of the pandemic. The poor quality of such experiences has been linked an increased risk of long-term health complications in both the mother and child.

Keywords: pregnancy, birth, postpartum, postnatal, COVID-19, maternity, social support, qualitative, pandemic

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Authors: D. van der Merwe

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Despite unprecedented changes in the media formats, typologies, delivery channels, and content that can be seen between Walter Benjamin’s writings from the era of modernity and those observable in the contemporary era of metamodernity, parallels can be drawn between the media effects experienced by audiences across the temporal divide. This paper will explore alignments between these two eras as evidenced by various media effects. First, convergence in the historical paradigm of film will be compared with the same effect as seen within the digital domain. Second, the uses and gratifications theory will be explored to delineate parallels in terms of user behaviours across both eras, regardless of medium. Third, cultivation theory and its role in manipulation via the media in both modernity and metamodernity will be discussed. Lastly, similarities between the archetypal personae populating each era will be unpacked.

Keywords: convergence, cultivation theory, media effects, metamodernity, uses and gratifications theory

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Authors: Josiane Yaguibou, Ngoy Kishimba, Issiaka V. Coulibaly, Sabrina Pestilli, Falinirina Razanalison, Hantanirina Andremanisa

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Background: Madagascar has one of the least developed road networks in the world with a majority of its national and local roads being earth roads and in poor condition. In addition, the country is affected by frequent natural disasters that further affect the road conditions limiting the accessibility to some parts of the country. In 2021 and 2022, 2.21 million people were affected by drought in the Grand Sud region, and by cyclones and floods in the coastal regions, with disruptions of the health system including last mile distribution of lifesaving maternal health commodities and reproductive health commodities in the health facilities. Program intervention: The intervention uses drone technology to deliver maternal health and family planning commodities in hard-to-reach health facilities in the Grand Sud and Sud-Est of Madagascar, the regions more affected by natural disasters. Methodology The intervention was developed in two phases. A first phase, conducted in the Grand Sud, used drones leased from a private company to deliver commodities in isolated health facilities. Based on the lesson learnt and encouraging results of the first phase, in the second phase (2023) the intervention has been extended to the Sud Est regions with the purchase of drones and the recruitment of pilots to reduce costs and ensure sustainability. Key findings: The drones ensure deliveries of lifesaving commodities in the Grand Sud of Madagascar. In 2023, 297 deliveries in commodities in forty hard-to-reach health facilities have been carried out. Drone technology reduced delivery times from the usual 3 - 7 days necessary by road or boat to only a few hours. Program Implications: The use of innovative drone technology demonstrated to be successful in the Madagascar context to reduce dramatically the distribution time of commodities in hard-to-reach health facilities and avoid stockouts of life-saving medicines. When the intervention reaches full scale with the completion of the second phase and the extension in the Sud-Est, 150 hard-to-reach facilities will receive drone deliveries, avoiding stockouts and improving the quality of maternal health and family planning services offered to 1,4 million people in targeted areas.

Keywords: commodities, drones, last-mile distribution, lifesaving supplies

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Authors: Alija Uzunovic, Sasa Pilipovic, Aida Sapcanin, Zahida Ademovic, Berina Pilipović

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Capsaicin is a naturally occurring alkaloid extracted from capsicum fruit extracts of different of Capsicum species. It has been employed topically to treat many diseases such as rheumatoid arthritis, osteoarthritis, cancer pain and nerve pain in diabetes. The high degree of pre-systemic metabolism of intragastrical capsaicin and the short half-life of capsaicin by intravenous administration made topical application of capsaicin advantageous. In this study, we have evaluated differences in the dissolution characteristics of capsaicin patch 11 mg (purchased from market) at different dissolution rotation speed. The proposed patch area is 308 cm2 (22 cm x 14 cm; it contains 36 µg of capsaicin per square centimeter of adhesive). USP Apparatus 5 (Paddle Over Disc) is used for transdermal patch testing. The dissolution study was conducted using USP apparatus 5 (n=6), ERWEKA DT800 dissolution tester (paddle-type) with addition of a disc. The fabricated patch of 308 cm2 is to be cut into 9 cm2 was placed against a disc (delivery side up) retained with the stainless-steel screen and exposed to 500 mL of phosphate buffer solution pH 7.4. All dissolution studies were carried out at 32 ± 0.5 °C and different rotation speed (50± 5; 100± 5 and 150± 5 rpm). 5 ml aliquots of samples were withdrawn at various time intervals (1, 4, 8 and 12 hours) and replaced with 5 ml of dissolution medium. Withdrawn were appropriately diluted and analyzed by reversed-phase liquid chromatography (RP-LC). A Reversed Phase Liquid Chromatography (RP-LC) method has been developed, optimized and validated for the separation and quantitation of capsaicin in a transdermal patch. The method uses a ProntoSIL 120-3-C18 AQ 125 x 4,0 mm (3 μm) column maintained at 600C. The mobile phase consisted of acetonitrile: water (50:50 v/v), the flow rate of 0.9 mL/min, the injection volume 10 μL and the detection wavelength 222 nm. The used RP-LC method is simple, sensitive and accurate and can be applied for fast (total chromatographic run time was 4.0 minutes) and simultaneous analysis of capsaicin and dihydrocapsaicin in a transdermal patch. According to the results obtained in this study, we can conclude that the relative difference of dissolution rate of capsaicin after 12 hours was elevated by increase of dissolution rotation speed (100 rpm vs 50 rpm: 84.9± 11.3% and 150 rpm vs 100 rpm: 39.8± 8.3%). Although several apparatus and procedures (USP apparatus 5, 6, 7 and a paddle over extraction cell method) have been used to study in vitro release characteristics of transdermal patches, USP Apparatus 5 (Paddle Over Disc) could be considered as a discriminatory test. would be able to point out the differences in the dissolution rate of capsaicin at different rotation speed.

Keywords: capsaicin, in vitro, patch, RP-LC, transdermal

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Authors: Supriyo Das, Elbir Jove, Ajay Singh, Sophie Corbet, Noel Carr, Martin Deetz

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Water is a critical commodity in the healthcare and medical field. The utility of medical-grade water spans from washing surgical equipment, drug preparation to the key element of life-saving therapy such as hydrotherapy and hemodialysis for patients. A properly treated medical water reduces the bioburden load and mitigates the risk of infection, ensuring patient safety. However, any compromised condition during the production of medical-grade water can create a favorable environment for microbial growth putting patient safety at high risk. Therefore, proper upstream treatment of the medical water is essential before its application in healthcare, pharma and medical space. Reverse Osmosis (RO) is one of the most preferred treatments within healthcare industries and is recommended by all International Pharmacopeias to achieve the quality level demanded by global regulatory bodies. The RO process can remove up to 99.5% of constituents from feed water sources, eliminating bacteria, proteins and particles sizes of 100 Dalton and above. The combination of RO with other downstream water treatment technologies such as Electrodeionization and Ultrafiltration meet the quality requirements of various pharmacopeia monographs to produce highly purified water or water for injection for medical use. In the reverse osmosis process, the water from a liquid with a high concentration of dissolved solids is forced to flow through an especially engineered semi-permeable membrane to the low concentration side, resulting in high-quality grade water. However, these specially engineered RO membranes need to be sanitized either chemically or at high temperatures at regular intervals to keep the bio-burden at the minimum required level. In this paper, we talk about Dupont´s FilmTec Heat Sanitizable Reverse Osmosis membrane (HSRO) for the production of medical-grade water. An HSRO element must be pre-conditioned prior to initial use by exposure to hot water (80°C-85°C) for its stable performance and to meet the manufacturer’s specifications. Without pre-conditioning, the membrane will show variations in feed pressure operations and salt rejection. The paper will discuss the critical variables of pre-conditioning steps that can affect the overall performance of the HSRO membrane and demonstrate the data to support the need for pre-conditioning of HSRO elements. Our preliminary data suggests that there can be up to 35 % reduction in flow due to initial heat treatment, which also positively affects the increase in salt rejection. The paper will go into detail about the fundamental understanding of the performance change of HSRO after the pre-conditioning step and its effect on the quality of medical water produced. The paper will also discuss another critical point, “regular hot water sanitization” of these HSRO membranes. Regular hot water sanitization (at 80°C-85°C) is necessary to keep the membrane bioburden free; however, it can negatively impact the performance of the membrane over time. We will demonstrate several data points on hot water sanitization using FilmTec HSRO elements and challenge its robustness to produce quality medical water. The last part of this paper will discuss the construction details of the FilmTec HSRO membrane and features that make it suitable to pre-condition and sanitize at high temperatures.

Keywords: heat sanitizable reverse osmosis, HSRO, medical water, hemodialysis water, water for Injection, pre-conditioning, heat sanitization

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Authors: Abigail Kusi Amponsah, Evans Frimpong Kyei, John Bright Agyemang, Hanson Boakye, Joana Kyei-Dompim, Collins Kwadwo Ahoto, Evans Oduro

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Staff shortages, deficient knowledge, inappropriate attitudes, demanding workloads, analgesic shortages, and low prioritization of pain management have been identified in earlier studies as the nursing-related barriers to optimal children’s pain management. These studies have mainly been undertaken in developed countries, which have different healthcare dynamics than those in developing countries. The current study, therefore, sought to identify and understand the nursing-related barriers to children’s pain management in the Ghanaian context. A descriptive qualitative study was conducted among 28 purposively sampled nurses working in the pediatric units of five hospitals in the Ashanti region of Ghana. Over the course of three months, participants were interviewed on the barriers which prevented them from optimally managing children’s pain in practice. Recorded interviews were transcribed verbatim and deductively analysed based on a conceptual interest in pain assessment and management-related barriers. NVivo 12 plus software guided data management and analyses. The mean age of participating nurses was 30 years, with majority being females (n =24). Participants had worked in the nursing profession for an average of five years and in the pediatric care settings for an average of two years. The nursing-related barriers identified in the present study included communication difficulties in assessing and evaluating pain management interventions with children who have nonfunctional speech, insufficient training, misconceptions on the experience of pain in children, lack of assessment tools, and insufficient number of nurses to manage the workload and nurses’ inability to prescribe analgesics. The present study revealed some barriers which prevented Ghanaian nurses from optimally managing children’s pain. Nurses should be educated, empowered, and supported with the requisite material resources to effectively manage children’s pain and improve outcomes for families, healthcare systems, and the nation. Future studies should explore the facilitators and barriers from other stakeholders involved in pediatric pain management

Keywords: Nursing-Related Barriers, Children, Pain Management, Ghana

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Authors: Fatih Sogut

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Developments in information technologies have caused significant changes in terms of radio and television broadcasting. With these changes in terms of production format, transmission techniques and service delivery, the distinction between traditional media and New Media has emerged. The viewer/listener, who was in a passive position before, is now in an active position and has a say in many matters, including content production. Visual and auditory data transfer has diversified and become easier thanks to the convergence phenomenon. These transformations and developments also affected one of the oldest electronic communication tools, radio. In this study, in order to adapt to the new era that emerged with the digital age, the change in radio broadcasting and the factors that led to this change were tried to be explained.

Keywords: Internet, radio broadcasting, digital transformation, Internet broadcasting

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Authors: Thomas Suarez, Anne-Sophie Grenouilleau, Erwan Autin, Alexandre Biosse-Duplan, Emmanuelle Blondet, Laurence Chazalette, Marie Coniel, Agnes Dessaigne, Sylvie Lascols, Andrea Lasserre, Candice Legris, Pierre Liot, Aline Metais, Karine Petitprez, Christophe Varlet, Christian Saout

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Background: The role of biological sex and gender identity -whether assigned or chosen- as health determinants are far from a recent discovery: several reports have stressed out how being a woman or a man could affect health on various scales. However, taking it into consideration beyond stereotypes and rigid binary assumptions still seems to be a work in progress. Method: The report is a synthesis on a variety of specific topics, each of which was studied by a specialist from the French National Authority for Health (HAS), through an analysis of existing literature on both healthcare policy construction process and instruments (norms, data analysis, clinical trials, guidelines, and professional practices). This work also implied a policy analysis of French recent public health laws and a retrospective study of guidelines with a gender mainstreaming approach. Results: The analysis showed that though sex and gender were well-known determinants of health, their consideration by both public policy and health operators was often incomplete, as it does not incorporate how sex and gender interact, as well as how they interact with other factors. As a result, the health and social care systems and their professionals tend to reproduce some stereotypical and inadequate habits. Though the data available often allows to take sex and gender into consideration, such data is often underused in practice guidelines and policy formulation. Another consequence is a lack of inclusiveness towards transgender or intersex persons. Conclusions: This report first urges for raising awareness of all the actors of health, in its broadest definition, that sex and gender matter beyond first-look conclusions. It makes a series of recommendations in order to reshape policy construction in the health sector on the one hand and to design public health instruments to make them more inclusive regarding sex and gender on the other hand. The HAS finally committed to integrate sex and gender preoccupations in its workings methods, to be a driving force in the spread of these concerns.

Keywords: biological sex, determinants of health, gender, healthcare policy instruments, social accompaniment

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Authors: Kuo-Kai Lin, Po-Lun Chang

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Research Background and Purpose: Following the development of the Internet and multimedia, the Internet and information technology have become crucial avenues of modern communication and knowledge acquisition. The advantages of using mobile devices for learning include making learning borderless and accessible. Mobile learning has become a trend in disease management and health promotion in recent years. End-stage renal disease (ESRD) is an irreversible chronic disease, and patients who do not receive kidney transplants can only rely on hemodialysis or peritoneal dialysis to survive. Due to the complexities in caregiving for patients with ESRD that stem from their advanced age and other comorbidities, the patients’ incapacity of self-care leads to an increase in the need to rely on their families or primary caregivers, although whether the primary caregivers adequately understand and implement patient care is a topic of concern. Therefore, this study explored whether primary caregivers’ health care provisions can be improved through the intervention of an automatic speech intelligent system, thereby improving the objective health outcomes of patients undergoing long-term dialysis. Method: This study developed an automatic speech intelligent system with healthcare functions such as health information voice prompt, two-way feedback, real-time push notification, and health information delivery. Convenience sampling was adopted to recruit eligible patients from a hemodialysis center at a regional teaching hospital as research participants. A one-group pretest-posttest design was adopted. Descriptive and inferential statistics were calculated from the demographic information collected from questionnaires answered by patients and primary caregivers, and from a medical record review, a health care scale (recorded six months before and after the implementation of intervention measures), a subjective health assessment, and a report of objective physiological indicators. The changes in health care behaviors, subjective health status, and physiological indicators before and after the intervention of the proposed automatic speech intelligent system were then compared. Conclusion and Discussion: The preliminary automatic speech intelligent system developed in this study was tested with 20 pretest patients at the recruitment location, and their health care capacity scores improved from 59.1 to 72.8; comparisons through a nonparametric test indicated a significant difference (p < .01). The average score for their subjective health assessment rose from 2.8 to 3.3. A survey of their objective physiological indicators discovered that the compliance rate for the blood potassium level was the most significant indicator; its average compliance rate increased from 81% to 94%. The results demonstrated that this automatic speech intelligent system yielded a higher efficacy for chronic disease care than did conventional health education delivered by nurses. Therefore, future efforts will continue to increase the number of recruited patients and to refine the intelligent system. Future improvements to the intelligent system can be expected to enhance its effectiveness even further.

Keywords: automatic speech intelligent system for health care, primary caregiver, long-term hemodialysis, health care capabilities, health outcomes

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Authors: Esha Thakkar, Ina Liu, Kalynn Hosea, Shana Katz, Katie Marks, Sarah Hall, Cat Liu, Suzanne Harris

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Purpose: Inequities in mental healthcare accessibility are cited as an international public health concern by the World Health Organization (WHO) and National Alliance on Mental Illness (NAMI). These disparities are further exacerbated in racial and ethnic minority groups and are especially concerning in health professional training settings such as Doctor of Pharmacy (PharmD) programs and postgraduate residency training where mental illness rates are high. The purpose of the study was to determine baseline access to culturally sensitive mental healthcare and how to improve such access and communication for racially and ethnically minoritized pharmacy students and residents at one school of pharmacy and a partnering academic medical center in the United States. Methods: This IRB-exempt study included 60-minute focus groups conducted in person or online from November 2021 to February 2022. Eligible participants included PharmD students in their first (P1), second (P2), third (P3), or fourth year (P4) or pharmacy residents completing a postgraduate year 1 (PGY1) or PGY2 who identify as Black, Indigenous, or Person of Color (BIPOC). There were four core theme questions asked during the focus groups to lead the discussion, specifically on the core themes of personal barriers, identities, areas that are working well, and areas for improvement. Participant responses were transcribed and analyzed using an open coding system with two individual reviews, followed by collaborative and intentional discussion and, as needed, an external audit of the coding by a third research team member to reach a consensus on themes. Results: This study enrolled 26 participants, with eight P1, five P2, seven P3, two P4, and four resident participants. Within the four core themes of barriers, identities, areas working well, and areas for improvement, emerging subthemes included: lack of time, access to resources, and stigma under barriers; lack of representation, cultural and family stigma, and gender identities for identity barriers; supportive faculty, sense of community and culture supporting paid time off for areas going well; and wellness days, reduced workload and diversity of the workforce in areas of improvement. Subthemes sometimes varied within a core theme depending on the participant year. Conclusions: There is a gap in the literature in addressing barriers and disparities in mental health access for pharmacy trainees who identify as BIPOC. We identified key findings in regards to barriers, identities, areas going well and areas for improvement that can inform the School and the Residency Program in two priority initiatives of well-being and diversity equity and inclusion in creating actionable recommendations for trainees, program directors, and employers of our institutions, and also has the potential to provide insight for other organizations about the structures influencing access to culturally sensitive care in BIPOC trainees. These findings can inform organizations on how to continue building on communication with those who identify as BIPOC and improve access to care.

Keywords: mental health, disparities, minorities, wellbeing, identity, communication, barriers

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Authors: Chih Chin Yang

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The paper proposed a new theory of intellectual capital (so called IC) and a value approach in associated with production and market. After an in-depth review and research analysis of leading firms in this field, a holistic intellectual capital model is discussed, which involves transport, delivery supporting, and interface and systems of on intellectual capital. Through a quantity study, it is found that there is a significant relationship between the product value and infrastructure in a company. The product values are transferred from intellectual capital elements which includes three elements of content and the enterprise includes three elements of infrastructure in its market and product values of enterprise.

Keywords: enterprise, product value, intellectual capital, market and product values

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Authors: Deenadayalan Govender

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In South Africa, similar to nations globally, the prevailing tangible link between people and the state is public infrastructure. Services delivered through infrastructure to the people and to the state form a critical enabler for social development in communities and economic development in the country. In this regard, infrastructure, being the backbone to a nation’s prosperity, ideally should be effectively maintained for seamless delivery of services. South African infrastructure is in a state of deterioration, which is leading to infrastructure dysfunction and collapse and is negatively affecting development of the economy. This infrastructure deterioration stems from deficiencies in maintenance practices and strategies. From the birth of South African democracy, government has pursued socio-economic transformation and the delivery of critical basic services to decrease the broadening boundaries of disparity. In this regard, the National Infrastructure Plan borne from strategies encompassed in the National Development Plan is given priority by government in delivering strategic catalytic infrastructure projects. The National Infrastructure Plan is perceived to be the key in unlocking opportunities that generate economic growth, kerb joblessness, alleviate poverty, create new entrepreneurial prospects, and mitigate population expansion and rapid urbanisation. Socio-economic transformation benefits from new infrastructure spend is not being realised as initially anticipated. In this context, South Africa is currently in a state of weakening economic growth, with further amassed levels of joblessness, unremitting poverty and inequality. Due to investor reluctance, solicitation of strategic infrastructure funding is progressively becoming a debilitating challenge in all government institutions. Exacerbating these circumstances further, is substandard functionality of existing infrastructure subsequent to inadequate maintenance practices. This in-depth multi-sectoral study into the state of infrastructure is to understand the principal reasons for infrastructure functionality regression better; furthermore, prioritised investigations into progressive maintenance strategies is focused upon. Resultant recommendations reveal enhanced maintenance strategies, with a vision to capitalize on infrastructure design life, and also give special emphasis to socio-economic development imperatives in the long-term. The research method is principally based on descriptive methods (survey, historical, content analysis, qualitative).

Keywords: infrastructure, maintenance, socio-economic, strategies

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