Search results for: healthcare facility

Authors: Azizah Nurdin, Trika Irianta, Mardiah Tahir, Maisuri T. Chalid

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Background: Studies of anal incontinence in the general population are rare however its financial healthcare cost is significant. Women attended Hasanuddin University Teaching Hospital and its networking in Makassar, Indonesia was surveyed between February to April 2015 about their obstetrical and gynecological history. Aims: To establish obstetrical risk factor of anal incontinence among women in Makassar. Methods: In a cross sectional face to face interview study, 135 women aged 30 years or more were selected randomly. Participants were asked to complete an anal incontinence questionnaire. Results: From a total sample of 135 respondents, 42,2 % reported has flatulence incontinence. Parity, history of anal sphincter laceration, history of having large baby, history of assisted vaginal delivery were shown have no significant association with anal incontinence, while history of episiotomy was shown have a significant association with anal incontinence (p value < 0.05). The risk of flatulence incontinence was higher among women with history of episiotomy (OR : 2,85, 95 % CI = 1,58- 5,13) Conclusions: This study has confirmed that fecal incontinence is a fairly common symptom. Flatulence incontinence is the most frequent even. An obstetrical factor like episiotomy is one of risk factor that could be avoided in order to prevent anal incontinence.

Keywords: anal incontinence, flatulence incontinence, obstetrical risk factor, women

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Authors: Daniel D'Souza, Ping Zou

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

Keywords: eHealth, menopause, mHealth, midlife women

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Authors: Hasn Perera, Is Almeida, Hnk Perera, Mzf Mohammed, Ade Silva, H. Wijesinghe, Ajal Fernando

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Introduction: Dengue is a major Public Health burden of two clinical entities, Dengue Fever & Dengue Haemorrhagic Fever (DHF). The vast majority of dengue deaths occur in DHF patients, where the diagnosis hinges on the presence of fluid leakage. Limited Ultrasound Scans (USS) of chest and abdomen are used widely at Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever (CCMDDHF), as the primary method for detecting fluid leaking in DHF. This study analyses the relationship between haematological and USS findings at the onset of leaking and to further determine the usefulness of ultrasound in diagnosing DHF. Methods: A prospective analysis of 80 serologically confirmed dengue patients initially admitted to a General Medical and Paediatric wards who were subsequently transferred to the CCMDDHF from March to September 2017 were analysed. In addition to repeated blood counts and capillary haematocrits’, serial USS were done to detect the onset fluid leaking by three competent and experienced doctors at CCMDDHF. Results: 80 patients (male: female: 38:42) with a mean age of 20 years (SD ±16.8, range 3-74) were evaluated. Dropping of platelet counts below 100,000 and haematocrit rise towards 20% started 4±1.3 day of fever with a mean platelet value of 69x103(range17-98x103). Gallbladder wall thickening was the commonest (98.7%) USS finding followed by fluid in hepato-renal pouch (95%), pelvic fluid (58.7%), right-sided pleural effusion (35%), bilateral effusions (7.5%). USS evidence of plasma leakage was detected in 11.25 %( n=9) of DHF cases from 1 day before significant haematocrit rise was noted. 35 (43.7%) patients with lowering platelets and haematocrit rise showed no objective evidence of plasma leaking on ultrasound scan. Conclusion: This outbreak underscores the importance of USS as a useful, sensitive and cost-effective tool for early diagnosis of suspected DHF cases, facilitating the tracking of progress of leaking and management of epidemics.

Keywords: dengue, ultrasound, plasma leaking, South Asia

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Authors: Les Paul Valdez, Rowena Manzarate, Joseph Carl Lunizo, Mary Thereze Mabaquiao, Mary Deo Luigi Mabunay

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Background: Across the literature, varying definitions of successful aging can be found. As a result, several determinants have been associated with successful aging. However, there is a paucity of literature exploring the relationship between successful aging and factors such as spiritual experience, gerotranscendence, and social engagement. Objective: Thus, this study purports to ascertain the relationship between and among spiritual experience, gerotranscendence, social engagement and successful aging. Methods: The Daily Spiritual Experience Scale (DSES), Social Engagement Scale (SES), Gerotranscendence Scale Revised (GS-R) and Expectations Regarding Aging (ERA) were fielded to 349 incarcerated elderly to measure spiritual experience, social engagement, gerotranscendence and successful aging respectively. Data was analyzed using Structural Equation Modelling through AMOS 21. The hypothesized model was evaluated using the goodness of fit and parsimony indices. Results: Social engagement (β= .179, p=.128) and spiritual experience (β= .375, p=.262) contribute to successful aging through the mediating effect of gerotranscendence (β= .973, p=.718). Conclusion: Today more than ever, healthcare providers in penal institutions are challenged to ensure that incarcerated elderly are socially and spiritually engaged; and have high levels of gerotranscendence.

Keywords: elderly, Filipino, gerotranscendence, social engagement, spiritual experience, successful aging

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Authors: Saurav Dhawan, Sanchit Bansal

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Background T-MACS is a computer-based decision aid that ‘rules in’ and ‘rules out’ ACS using a combination of the presence or absence of six clinical features with only one biomarker measured on arrival: hs-cTnT. T-MACS had 99.3% negative predictive value and 98.7% sensitivity for ACS, ‘ruling out’ ACS in 40% of patients while ‘ruling in’ 5% at the highest risk. We aim at benchmarking the use of T-MACS which could help to conserve healthcare resources, facilitate early discharges, and ensure safe practice. Methodology Randomized retrospective data collection (n=300) was done from ED electronic records across 3 hospital sites within MFT over a period of 2 months. Data was analysed and compared by percentage for the usage of T-MACS, number of admissions/discharges, and in days for length of stay in hospital. Results MRI A&E had the maximum compliance with the use of T-MACS in the trust at 66%, with minimum admissions (44%) and an average length of stay of 1.825 days. NMG A&E had an extremely low compliance rate (8 %), with 75% admission and 3.387 days as the average length of stay. WYT A&E had no TMACS recorded, with a maximum of 79% admissions and the longest average length of stay at 5.07 days. Conclusion All three hospital sites had a RAG rating of ‘RED’ as per the compliance levels. The assurance level was calculated as ‘Very Limited’ across all sites. There was a positive correlation observed between compliance with TMACS and direct discharges from ED, thereby reducing the average length of stay for patients in the hospital.

Keywords: ACS, discharges, ED, T-MACS

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Authors: Trieu Anh Ngoc, Nguyen Quang Kim

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Located at the downstream of the Mekong Delta, the Vietnamese Mekong Delta is well-known as 'rice bowl' of Vietnam. The Vietnamese Mekong Delta experiences widespread flooding annually where is habitat for about 17 million people. The economy of this region mainly depends on the agricultural productivities. The suspended sediment load in the Mekong River plays an important role in carrying contaminants and nutrients to the delta and changing the geomorphology of the delta river system. In many past decades, flooding and suspended sediment were considered as indispensable factors in agricultural cultivations. Although flooding in the wet season caused serious inundation in paddy field and affected livelihoods, it is an effective facility for flushing acid and saline to this area - alluvial soil heavily contaminated with acid and salt intrusion. In addition, sediment delivery to this delta contained rich-nutrients distributed and deposited on the fields through flooding process. In recent decades, the changing of flow and sediment transport have been strongly and clearly occurring due to upstream dam development and climate change. However, effects of sediment delivery on agricultural cultivations were less attention. This study investigated the impacts of upstream flow on sediment distribution in the Vietnamese Mekong Delta. Flow fluctuation and sediment distribution were simulated by the Mike 11 model, including hydrodynamics model and advection-dispersion model. Various scenarios were simulated based on anticipated upstream discharges. Our findings indicated that sediment delivery into the Vietnamese Mekong Delta come from not only Tien River but also border of Cambodia floodplains. Sediment distribution in the Vietnamese Mekong Delta is dramatically changed by the distance from the main rivers and the secondary channels. The dam development in the upstream is one of the major factors leading a decrease in sediment discharge as well as sediment deposition. Moreover, sea level rise partially contributed to decrease in sediment transport and change of sediment distribution between upstream and downstream of the Vietnamese Mekong Delta.

Keywords: sediment transport, sea level rise, climate change, Mike Model

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Authors: Julian Donovan, Jessica Brealey, Matthew Bowker, Marianne Feghali, Gregory Smith, Lee Thompson, Deborah Henderson

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This article details the development of the X-ray response team (XRT), a service that utilises innovative technology to safely deliver acute and elective imaging and medical assessment service in the pre-hospital and community setting. This involves a partnership between Northumbria Healthcare NHS Foundation Trust’s Radiology and Emergency Medicine departments and the North East Ambulance Service to create a multidisciplinary prehospital team. The team committed to the delivery of a two-day acute service every week, alongside elective referrals, starting in November 2020. The service was originally made available to a 15-mile radius surrounding the Northumbria Hospital. Due to demand, this was expanded to include the North Tyneside and Northumberland regions. The target population was specified as frail and vulnerable patients, as well as those deemed to benefit from staying in their own environment. Within the first two months, thirty-six percent of patients assessed were able to stay at home due to the provision of off-site imaging. In the future, this service aims to allow patient transfer directly to an appropriate ward or clinic, bypassing the emergency department to improve the patient journey and reduce emergency care pressures.

Keywords: frailty, imaging, pre-hospital, X-ray

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Authors: Layla Mujahed

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COVID-19 is an exam for all the city’s systems. It shows many gaps in the systems such as healthcare, economic, social, and environment. This pandemic is paving for a new era, an era of technology and it has changed people’s lives, such as physical, and emotional changes, and converting communication into digitalized. The effect of COVID-19 has covered all urban city parts. COVID-19 will not be the last pandemic our cities will face. For that, more researches focus on enhancing the quality of the urban environment. This pandemic encourages a rethinking of the environment’s role, especially in cities. Cities are trying to provide the best suitable strategies and regulations to prevent the spread of COVID-19, and an example of that is Amman city. Amman has a high increment in the number of COVID-19 infected people, while it has controlled the situation for months. For that, this paper studies the relation between COVID-19 and urban environmental studies cases about cities around the world, and learns from their models to face COVID-19. In Amman, people’s behavior has changed towards public transportation and public green spaces. N­ew governmental regulations focus on increasing people’s mental awareness, supporting local businesses, and enhancing neighborhood planning that can help Amman to face any future pandemics.

Keywords: COVID-19, urban environment, urban planning, urban resilience

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Authors: Jakub Vávra, Milan Valenta, Petr Kosek

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This article presents a perspective on the conduct of the dramatherapy process with persons with addictive behaviours with regard to the directiveness of the process. Although drama therapy as one of the creative arts approaches is rather non-directive in nature, depending on the clientele, there may be a need to structure the process more and, depending on the needs of the clients, to guide the process more directive. The specificity for people with addictive behaviours is discussed through the prism of the dramatherapeutic perspective, where we can find both a psychotherapeutic component as well as a component touching on expression and art, which is rather non-directive in nature. Within the context of practice with clients, this theme has repeatedly emerged and dramatherapists themselves have sought to find ways of coping with clients' demands and needs for structure and guidance within the dramatherapy process. Some of the outcomes from the supervision work also guided the research. Based on this insight, the research questions were approached. The first research question asks: in what ways is directive in dramatherapy manifested and manifested in the process? The second research question then complements the first and asks: to which phenomena are directivity in dramatherapy linked? In relation to the research questions, data were collected using focus groups and field notes. The qualitative approach of Content analysis and Relational analysis was chosen as the methodology. For analyzing qualitative research, we chose an Inductive coding scheme: Open coding, Axial coding, Pattern matching, Member checking, and Creating a coding scheme. In the presented partial research results, we find recurrent schemes related to directive coding in drama therapy. As an important element, directive leadership emerges in connection with safety for the client group, then in connection with the clients' order and also the department of the facility, and last but not least, to the personality of the drama therapist. By careful analysis and looking for patterns in the research results, we can see connections that are impossible to interpret at this stage but already provide clues to our understanding of the topic and open up further avenues for research in this area.

Keywords: dramatherapy, directivity, personal approach, aims of dramatherapy process, safetyness

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Authors: Ankan Saha, Sourav Majumder, Md. Motaleb Hossen Manik, M. M. A. Hashem

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Hyperledger Fabric (HF), one of the private blockchain architectures, has gained popularity for enterprise use cases, namely supply chain management, finance, healthcare, etc., while focusing on the demand of users and functionalities like privacy, scalability, throughput, and modular architecture. However, enhancing performance is a crucial focus in the everchanging field of blockchain technology, particularly for private blockchains like HF. This paper focuses on the inherent difficulties related to scalability, throughput, and efficiency in handling large transactions. Our framework establishes a solid network architecture with two organizations, each having two types of peers (i.e., endorsing and anchor peers) and three raft orderers. It brings innovation to the chaincode, addresses functionalities like registration and transaction management via CouchDB, and integrates transaction management and block retrieval. Additionally, it includes a distributed consensus mechanism to gain maximum performance in a large architecture. Eventually, the findings assert an apparent enhancement in scalability, transaction speed, and system responsiveness, highlighting the effectiveness of our framework in optimizing the HF architecture.

Keywords: hyperledger fabric, private blockchain, scalability, transaction throughput, latency, consensus mechanism

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Authors: Paul Lam, Chi Him Chan, Alan Tse

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Language laboratories have been widely used in language learning, starting in the middle of the last century as one of the earliest forms of educational technology. They are designed to assist students’ language learning with technological innovations. Traditional language laboratories provide individual workstations that allow students to access multimedia language resources. In this type of facility, students can train their listening and speaking abilities, and teachers can also assess the performance of an individual student. Although such a setting promotes a student-centered pedagogy by encouraging students to work at their own pace and according to their own needs, it still favours a traditional, behaviourist language learning pedagogy which focuses on repetitive drilling. The change of pedagogies poses challenges to both the teachers and the facilities. The peer-learning pedagogy advocates that language learning should focus on the social aspect, which emphasizes the importance of everyday communication in language learning. The self-access, individual workstation language laboratories may not be able to provide the flexibility for interaction in the new pedagogies. Modern advancement in technology is another factor that drove our language laboratory renovation. In particular, mobile and wireless technology enabled the use of smaller and more flexible devices, making possible much clever use of space. The Chinese University of Hong Kong (CUHK) renovated nine existing language laboratories to provide lighter and more advanced equipment, movable tables, and round desks. These facilities allow more flexibility and encourage students’ interaction. It is believed that the renovated language laboratories can serve different peer learning activities and thus support peer-learning pedagogies in language teaching and learning. A survey has been conducted to collect comments from the teachers who have used the renovated language laboratories and received forty-four response. The teachers’ comments reveal that they experienced different challenges in using the renovated language laboratories, and there is a need to provide guidance to teachers during the technological and pedagogical transition. For example, teachers need instruction on using the newly installed devices such as touch-monitor and visualizer. They also need advice on planning new teaching and learning activities. Nevertheless, teachers appreciated that the renovated language laboratories are flexible and provide more spaces for different learning activities.

Keywords: language laboratories, language learning, peer-learning, student interaction

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Authors: B. Rakjarit, S. Athichanagorn

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Double displacement process is a method in which gas is injected at an updip well to displace the oil bypassed by waterflooding operation from downdip water injector. As gas injection is costly and a large amount of gas is needed, gas dump-flood from multiple gas reservoirs is an attractive alternative. The objective of this paper is to demonstrate the benefits of the novel approach of double displacement process via gas dump-flood from multiple gas reservoirs. A reservoir simulation model consisting of a dipping oil reservoir and several underlying layered gas reservoirs was constructed in order to investigate the performance of the proposed method. Initially, water was injected via the downdip well to displace oil towards the producer located updip. When the water cut at the producer became high, the updip well was shut in and perforated in the gas zones in order to dump gas into the oil reservoir. At this point, the downdip well was open for production. In order to optimize oil recovery, oil production and water injection rates and perforation strategy on the gas reservoirs were investigated for different numbers of gas reservoirs having various depths and thicknesses. Gas dump-flood from multiple gas reservoirs can help increase the oil recovery after implementation of waterflooding upto 10%. Although the amount of additional oil recovery is slightly lower than the one obtained in conventional double displacement process, the proposed process requires a small completion cost of the gas zones and no operating cost while the conventional method incurs high capital investment in gas compression facility and high-pressure gas pipeline and additional operating cost. From the simulation study, oil recovery can be optimized by producing oil at a suitable rate and perforating the gas zones with the right strategy which depends on depths, thicknesses and number of the gas reservoirs. Conventional double displacement process has been studied and successfully implemented in many fields around the world. However, the method of dumping gas into the oil reservoir instead of injecting it from surface during the second displacement process has never been studied. The study of this novel approach will help a practicing engineer to understand the benefits of such method and can implement it with minimum cost.

Keywords: gas dump-flood, multi-gas layers, double displacement process, reservoir simulation

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Authors: Alain Rousseau, Alfred Aragones, Gilles Rougier

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The study is based on lightning and surge standards mainly the EN series 62305 for facility protection, EN series 61643 for Low Voltage Surge Protective Devices, High Voltage surge arrester standard en 60099-4 and the traction arrester standards namely EN 50526-1 and 50526-1 dealing respectively with railway applications fixed installations D.C. surge arresters and voltage limiting devices. The more severe stress for tramways installations is caused by direct lightning on the catenary line. In such case, the surge current propagates towards the various poles and sparkover the insulators leading to a lower stress. If the impact point is near enough, a significant surge current will flow towards the traction surge arrester that is installed on the catenary at the location the substation is connected. Another surge arrester can be installed at the entrance of the substation or even inside the rectifier to avoid insulation damages. In addition, surge arresters can be installed between + and – to avoid damaging sensitive circuits. Based on disturbances encountered in a substation following a lighting event, the engineering department of RATP has decided to investigate the cause of such damage and more generally to question the efficiency of the various possible protection means. Based on the example of a recent tramway line the paper present the result of a lightning study based on direct lightning strikes. As a matter of fact, the induced surges on the catenary are much more frequent but much less damaging. First, a lightning risk assessment is performed for the substations that takes into account direct lightning and induced lightning both on the substation and its connected lines such as the catenary. Then the paper deals with efficiency of the various surge arresters is discussed based on field experience and calculations. The efficiency of the earthing system used at the bottom of the pole is also addressed based on high frequency earthing measurement. As a conclusion, the paper is making recommendations for an enhanced efficiency of existing protection means.

Keywords: surge arrester, traction, lightning, risk, surge protective device

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Authors: Amin Nakhostin-Ansari, Samaneh Akbarour, Khosro Sadeghniiat Haghighi, Zahra Banafsheh Alemohammad, Farnaz Etesam, Arezu Najafi, Mahnaz Khalafehnilsaz

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Introduction: The outbreak of coronavirus disease has considerably burdened the healthcare system in Iran. This study aimed to evaluate the characteristics of insomnia experienced by the general Iranian population during the COVID-19 pandemic. Method: A scale(FCV-19) was used for Fear of COVID-19, Insomnia Severity Index (ISI), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder Scale-2 (GAD-2) for detailed characterization of insomnia and its patterns Results: In total, 675 people with insomnia with the mean age of 40.28 years (SD=11.15) participated in this study. Prevalence of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) were 91.4%, 86.7%, and 77%, respectively. DIS, DMS, and EMA were more common in people with depression and anxiety. FCV-19 score was higher in those with more severe types of DIS, DMS, and EMA (P<0.001). FCV-19 was a risk factor for all patterns of insomnia (OR=1.19, 1.12, 1.02 for DIS, DMS, and EMA, respectively). Conclusion: fear of COVID-19 is a major factor to insomnia patterns. Investigation of COVID-19 fear in people with insomnia and the addition of attributed relieving or management strategies to conventional management of insomnia are reasonable approaches to improve the sleep condition of people in the pandemic.

Keywords: insomnia, difficulty maintaining sleep, COVID-19, Coronavirus

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Authors: Kenji Gwee

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The Mental Capacity Act is a new legislation that allows for lasting powers of attorney and court-appointed deputies, in respect of people who lack legal capacity. While the UK Act, after which the Singapore Act is modeled, has been shown to be therapeutic to donors, the Singapore Act differs from its UK counterpart and it is unclear if the Singapore Act can be beneficial to donors as purported. The purpose of this study was to determine what the perceptions of three groups of stakeholders (patients, caregivers and psychiatrists) are about the aspects of the Mental Capacity Act that are therapeutic to donors. In addition, ways to increase the therapeutic value of the Act to donors are sought. A qualitative methodology was used and the research was guided by two theoretical frameworks: therapeutic jurisprudence and an interpretive constructive framework. Interviews with 12 psychiatrists, and focus groups with twenty three patients and seven caregivers showed agreement that, allowing donors to nominate more than one decision- maker, and whistle-blowing mechanisms for recourse for abuse, were therapeutic to donors. To further increase the therapeutic value of the Act, 2 suggestions were made: the Act should provide for (i) advanced healthcare directives- allowing donors to make advance decisions to refuse treatment, or cease existing treatment, and (ii) independent advocacy services- to have a case worker to represent people who have no family or friends and are thus unable to find suitable donees.

Keywords: Mental Capacity Act, therapeutic jurisprudence, qualitative methodology, the UK Act

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Authors: Chanchal Biswas, Anrin Bhattacharyya, Gopes Chandra Das, Mahua Ghosh Chaudhuri, Rajib Dey

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Boiler coals with low fixed carbon and higher ash content have always challenged the metallurgists to develop a suitable method for their utilization. In the present study, an attempt is made to establish an energy effective method for the reduction of iron ore fines in the form of nuggets by using ‘Syngas’. By devolatisation (expulsion of volatile matter by applying heat) of boiler coal, gaseous product (enriched with reducing agents like CO, CO2, H2, and CH4 gases) is generated. Iron ore nuggets are reduced by this syngas. For that reason, there is no direct contact between iron ore nuggets and coal ash. It helps to control the minimization of the sulphur intake of the reduced nuggets. A laboratory scale devolatisation furnace designed with reduction facility is evaluated after in-depth studies and exhaustive experimentations including thermo-gravimetric (TG-DTA) analysis to find out the volatile fraction present in boiler grade coal, gas chromatography (GC) to find out syngas composition in different temperature and furnace temperature gradient measurements to minimize the furnace cost by applying one heating coil. The nuggets are reduced in the devolatisation furnace at three different temperatures and three different times. The pre-reduced nuggets are subjected to analytical weight loss calculations to evaluate the extent of reduction. The phase and surface morphology analysis of pre-reduced samples are characterized using X-ray diffractometry (XRD), energy dispersive x-ray spectrometry (EDX), scanning electron microscopy (SEM), carbon sulphur analyzer and chemical analysis method. Degree of metallization of the reduced nuggets is 78.9% by using boiler grade coal. The pre-reduced nuggets with lesser sulphur content could be used in the blast furnace as raw materials or coolant which would reduce the high quality of coke rate of the furnace due to its pre-reduced character. These can be used in Basic Oxygen Furnace (BOF) as coolant also.

Keywords: alternative ironmaking, coal gasification, extent of reduction, nugget making, syngas based DRI, solid state reduction

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Authors: Monique Palma, Isabel Amaral

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This paper aims at mapping medical places in Oporto in the twentieth century in order to bring the urban history of medicine and healthcare in Portugal to a large audience, using Oporto as a case study. This analysis is consistent with the SDS's 2030 goals for policy guidance for heritage and development actors. As a result, it is critical to begin this research in order to place on the political agenda the preservation of Portuguese culture's history, memory, and heritage, particularly the medical culture, which is one of the most important drivers of civilizational development. To understand the evolution of medical care in urban history, we will conduct archive research (manuals, treatises, reports, periodic journals, newspapers, etc.) and interviews with key actors from medical institutions and medical museums. The findings of this study will be used to develop medical itineraries for inclusion in touristic agendas in Portugal and abroad, to include Portuguese medicine in global roadmaps, and to promote the preservation of the most iconic places of health care and medical heritage, as well as tools to promote social cohesion, dialogue among people, and "sense of place" globally.

Keywords: medical itineraries, history of medicine, urban history, Oporto

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Authors: Jacob Nortey

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Introduction: In recent years, there has been an enormous success in discoveries of scientific knowledge in medicine coupled with the advancement of technology. Despite all these successes, diagnoses and treatment of diseases have become complex. According to the Ibero – American Study of Adverse Effects (IBEAS), about 10% of hospital patients suffer from secondary damage during the care process, and approximately 2% die from this process. Many clinical decision support systems have been developed to help mitigate some healthcare medical errors. Method: Relevant databases were searched, including ones that were peculiar to the clinical decision support system (that is, using google scholar, Pub Med and general google searches). The articles were then screened for a comprehensive overview of the functionality, consultative style and statistical usage of Dxplain Clinical decision support systems. Results: Inferences drawn from the articles showed high usage of Dxplain clinical decision support system for problem-based learning among students in developed countries as against little or no usage among students in Low – and Middle – income Countries. The results also indicated high usage among general practitioners. Conclusion: Despite the challenges Dxplain presents, the benefits of its usage to clinicians and students are enormous.

Keywords: dxplain, clinical decision support sytem, diagnosis, support systems

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Authors: Arezoo Fallahi

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We aimed at investigating the association between health beliefs and exercise behavior in infertile women who were at risk of developing osteoporosis. This cross-sectional study was conducted in Sanandaj city, west of Iran in 2018. From 35 comprehensive healthcare centers, 483 infertile women were included in the study through convenience sampling. Standardized face-to-face interviews were conducted using established, reliable instruments for the assessment of exercise behavior behavior and health beliefs. Logistic regression models were applied to assess the association between exercise behavior and health beliefs. Estimates were adjusted for age, job status, income, literacy, and duration and type of infertility. We reported estimated logits and Odds Ratios (OR) with corresponding 95% confidence intervals (95% CI). Employed women compared to housewives had substantially higher odds of adopting exercise behavior behaviors (OR=3.19, 95% CI=1.53-6.66, p<0.01). Moreover, the odds of exercise behavior adoption increased with self-efficacy (OR=1.35, 95% CI=1.20-1.52, p<0.01), and decreased with perceived barriers (OR=0.90, 95% CI=0.84-0.97, p<0.01). It is essential to increase perceived self-efficacy and reduce perceived barriers to promote EB in infertile women. Consequently, health professionals should develop or adopt appropriate strategies to decrease barriers and increase self-efficacy to enhance exercise behavior in this group of women.

Keywords: infertility, women, exercise, osteoporosis

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Authors: Raimoana Frogier, Luc Girard, Pierre Bauduin, Diane Rebiscoul, Olivier Diat

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Nano-ions (NIs) are ionic species or clusters of nanometric size. Their low charge density and the delocalization of their charges give special properties to some of NIs belonging to chemical classes of polyoxometalates (POMs) or boron clusters. They have the particularity of interacting non-covalently with neutral hydrated surface or interfaces such as assemblies of surface-active molecules (micelles, vesicles, lyotropic liquid crystals), foam bubbles or emulsion droplets. This makes possible to classify those NIs in the Hofmeister series as superchaotropic ions. The mechanism of adsorption is complex, linked to the simultaneous dehydration of the ion and the molecule or supramolecular assembly with which it can interact, all with an enthalpic gain on the free energy of the system. This interaction process is reversible and is sufficiently pronounced to induce changes in molecular and supramolecular shape or conformation, phase transitions in the liquid phase, all at sub-millimolar ionic concentrations. This new property of some NIs opens up new possibilities for applications in fields as varied as biochemistry for solubilization, recovery of metals of interest by foams in the form of NIs... In order to better understand the physico-chemical mechanisms at the origin of this interaction, we use silicon wafers functionalized by non-ionic oligomers (polyethylene glycol chains or PEG) to study in situ by X-ray reflectivity this interaction of NIs with the grafted chains. This study carried out at ESRF (European Synchrotron Radiation Facility) and has shown that the adsorption of the NIs, such as POMs, has a very fast kinetics. Moreover the distribution of the NIs in the grafted PEG chain layer was quantify. These results are very encouraging and confirm what has been observed on soft interfaces such as micelles or foams. The possibility to play on the density, length and chemical nature of the grafted chains makes this system an ideal tool to provide kinetic and thermodynamic information to decipher the complex mechanisms at the origin of this adsorption.

Keywords: adsorption, nano-ions, solid-liquid interface, superchaotropicity

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Authors: Eugene Muambeh Muntoh

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Corruption has a destructive effect on State institutions and on the capacity of States to respect, protect and fulfil human rights, particularly of those persons and groups in situation of vulnerability and marginalization. In Cameroon, corruption pose a major challenge as it divert public revenues and cripple public budgets that should provide healthcare, housing, education, and other essential services. Corruption has undermined the States’ ability to meet the minimum core obligations and pre-existing legal obligations to maximize all available resources to respect, protect and fulfil Economic, Social and Cultural Rights. This study therefore makes use of the qualitative research design, ranging from interviews, observations and content analysis of vital documents to provide evidence and associations between corruption and human rights concerns in Cameroon. The study made use of research material from both primary and secondary sources. Findings from the study reveals that the impact of corruption in Cameroon is especially pronounced regarding economic, social and cultural rights. In most cases, the right to be treated equally is violated, for example, when someone is requested to pay a bribe to obtain a public service. There is an urgent need for sustainable measures to counter corruption in order to protect and promote human rights.

Keywords: corruption, governance, human rights, law

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Authors: Aschenaki Zerihun Kea, Bernt Lindtjorn, Achamyelesh Gebretsadik, Sven Gudmund Hinderaker

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Introduction: Maternal mortality studies conducted at the national level do not provide the information needed for planning and monitoring health programs at lower administrative levels. The aim of this study was to measure maternal mortality, identify risk factors and district-level variations in Sidama National Regional State, southern Ethiopia. Methods: A cross sectional population-based survey was carried out in households where women reported pregnancy and birth outcomes in the past five years. The study was conducted in the Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. Multi-stage cluster sampling technique was employed. The outcome variable of the study was maternal mortality. Complex sample logistic regression analysis was applied to assess variables independently associated with maternal mortality. Results: We registered 10602 live births (LB) and 48 maternal deaths, yielding an overall maternal mortality ratio (MMR) of 419; 95% CI: 260-577 per 100,000 LB. Aroresa district had the highest MMR with 1142 (95% CI: 693-1591) per 100,000 LB. Leading causes of death were haemorrhage 21 (41%) and eclampsia 10 (27%). Thirty (59%) mothers died during labour, or within 24 hours after delivery, 25 (47%) died at home and 17 (38%) at a health facility. Mothers who did not have formal education had a higher risk of maternal death (AOR: 4.4; 95% CI: 1.7 – 11.0). The risk of maternal death was higher in districts with a low midwife-to-population ratio (AOR: 2.9; 95% CI: 1.0-8.9). Conclusion: The high maternal mortality with district-level variations in Sidama Region highlights the importance of improving obstetric care and employing targeted interventions in areas with high mortality rates. Due attention should be given to improving access to female education. Additional midwives have to be trained and deployed to improve maternal health services and consequently save the lives of mothers.

Keywords: maternal mortality variation, maternal death, Sidama, Ethiopia

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Authors: Taju Abdela Mohammed

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Introduction: There has been a rise in awareness of violence against young women and girls, particularly when it occurs in educational environments. Gender-based violence in schools is a significant barrier. Therefore, it would be a threat to the achievement of the sustainable development goals, strive for gender equality in all our programs, right from the planning stages, to make sure we are as equitable as possible. Research on the causes, attitudes, and perceptions of gender-based violence was scant. Furthermore, there aren't many studies done on female students attending private colleges. Thus, the purpose of this study is to evaluate the frequency of gender-based violence and related variables among female students attending private colleges in Harar City, Ethiopia. Methodology: A facility-based mixed method concurrent triangulation study design was conducted among 500 randomly selected Private college female students in Harar City. Self-administered questionnaire and an in-depth interview were used to collect the data. The collected data were cleaned and analyzed using a statistical package for social science. Descriptive statistics were conducted and the results were reported using frequency, and percentile. Bivariate logistic regression was performed to identify associated factors. Adjusted odds ratios with 95% confidence intervals and p values < 0.05 were used to explain statistically significant associations. Thematic analysis was used to manually translate, transcribe, and analyze qualitative data. Result: The study showed the prevalence of gender-based violence was 338 (67.6%) (CI 0.432–0.721) Private college female students in Harar city Administration. Age less than 20 years and 20–24 years, [AOR = 0.21, 95% CI (0.03–0.81)] and [AOR = 0.12, 95% CI (0.03–0.51)], tight family control, [AOR = 5.12, 95% CI (1.43–6.9)], Witnessed father abuse mother at childhood; [AOR = 4.04, 95% CI (1.36–12.1)], had drunkenness female or boyfriend; [AOR = 2.12, 95% CI (1.60–14.05)] had significant association with gender-based violence. Conclusion: Our study shows the prevalence of gender-based violence among Private college female students is significant. This is due to the fact that gender-based violence, such as school dropout, unintended pregnancy, abortion, STDs, and psychological disorders, is abandoning young girls' lives and lowering their productivity.

Keywords: female students, gender-violence, harar, Ethiopia

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Authors: Mahnaz Motamedi, Mohammad Shahbazi, Shahrzad Rahimi-Naghani, Mehrdad Salehi

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Introduction: Identifying sexual health needs, developing appropriate plans, and delivering services to meet those needs is an essential component of health programs for women, men, and children all over the world, especially in poor countries. Main Subject: The aim of this study was to describe the needs of sexual health from the viewpoint of health policymakers in Iran. Methods: A qualitative study using thematic content analysis was designed and conducted. Data gathering was conducted through semi-structured, in-depth interviews with 25 key informants within the healthcare system. Key informants were selected through both purposive and snowball sampling. MAXQUDA software (version 10) was used to facilitate transcription, classification of codes, and conversion of data into meaningful units, by the process of reduction and compression. Results: The analysis of narratives and information categorized sexual health needs into five categories: culturalization of sexual health discourse, sexual health care services, sexual health educational needs, sexual health research needs, and organizational needs. Conclusion: Identifying and explaining sexual health needs is an important factor in determining the priority of sexual health programs and identification of barriers to meet these needs. This can help other policymakers and health planners to develop appropriate programs to promote sexual and reproductive health.

Keywords: sexual health, sexual health needs, policy makers, health system, qualitative study

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Authors: Prama Mukhopadhyay, Rishika Mukhopadhyay

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The twentieth century has seen the world getting divided into three distinct blocks, created by the proponents of the mainstream developmental discourse. India, which has now gained the label of being a ‘developing nation’, stands in between these three groups, as it constantly tries to ‘catch up’ and emulate the developmental standards of the ‘west’. In this endeavour, we find our country trying really hard to blindly replicate the health care infrastructures of the ‘first worlds’, without realizing the needs of evaluating the ground reality. In such a situation, the sudden outbreak of child death in the district of Malda, WB, poses an obvious questions towards the kind of development that our country has been engaging in, ever since its Post Colonial inception. Through this paper we thus try to understand the harsh veracity of the health care facility that exists in rural Bengal, and thereby challenge the conventional notion of ‘health-care’ as is normally discussed in the mainstream developmental discourse. Grounding our research work on detailed ethnography and through the help of questionnaire, interviews and focus group discussions with the local government officials(BDOs), health workers (ICDS, ASHA workers, ANHM and BMOHs) and members of families with experiences of child deaths, we have tried to find out the real and humane factors behind the sudden rise of reported infant deaths in the district, issues which are normally neglected and left out while discussing and evaluating IMR in the mainstream studies on health care and planning in our nation. Therefore the main aim of this paper is to try and look at child death from a ‘wider perspective’, where it is seen from an eye not bounded by the common registers of caste, class and religion. This paper, would thus be an eye opener in some sense, bringing in stories from the rural belt of the country; where the people are regularly torn between the binaries of the developing and shining modernity of ‘India’ which now gets ready to run the last lap and gain the status of becoming a ‘developed nation’ by 2020, and the staggering, dark traditional ‘ Bharat, which lags behind.

Keywords: child mortality, development discourse, health care, tradition and modernity

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Authors: Mahera Abdulrahman

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Objective: Healthcare transformation from traditional to modern in the country recently prompted the need to address career choices, accreditation perception and satisfaction among medical residents. However, a concerted nationwide study to understand and address burnout in the medical residency program has not been conducted in the UAE and the region. Methods: A nationwide, multicenter, cross-sectional study was designed to evaluate professional burnout and depression among medical residents in order to address the gap. Results: Our results indicate that 75.5% (216/286) of UAE medical residents had moderate to high emotional exhaustion, 84% (249/298) had high depersonalization, and 74% (216/291) had a low sense of personal accomplishment. In aggregate, 70% (212/302) of medical residents were considered to be experiencing at least one symptom of burnout based on a high emotional exhaustion score or a high depersonalization score. Depression ranging from 6-22%, depending on the specialty was also striking given the fact the Arab culture lays high emphasis on family bonding. Interestingly 83% (40/48) of medical residents who had high scores for depression also reported burnout. Conclusion: Our data indicate that burnout and depression among medical residents is epidemic. There is an immediate need to address burnout through effective interventions at both the individual and institutional levels. It is imperative to reconfigure the approach to medical training for the well-being of the next generation of physicians in the Arab world.

Keywords: mental health, Gulf, Arab, residency training, burnout, depression

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Authors: Valerie Isaak

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Background: This study explores the effectiveness of refresher training sessions of an intervention program at reducing the employees’ risk of injury due to patient violence in a forensic psychiatric hospital. Methods: The original safety intervention program that consisted of a 3 days’ workshop was conducted in the maximum-security ward of a psychiatric hospital in Israel. Ever since the original intervention, annual refreshers were conducted, highlighting one of the safety elements covered in the original intervention. The study examines the effect of the intervention program along with the refreshers over a period of 10 years in four wards. Results: Analysis of the data demonstrates that beyond the initial reduction following the original intervention, refreshers seem to have an additional positive long-term effect, reducing both the number of violent incidents and the number of actual employee injuries in a forensic psychiatric hospital. Conclusions: We conclude that such an intervention program followed by refresher training would promote employees’ wellbeing. A healthy work environment is part of management’s commitment to improving employee wellbeing at the workplace.

Keywords: wellbeing, violence at work, intervention program refreshers, public sector mental healthcare

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Authors: L. Krpalkova, N. O' Mahony, A. Carvalho, S. Campbell, S. Harapanahalli, J. Walsh

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The objective of this study was to determine the effects of environmental stressors on the performance of lactating dairy cows and discuss some future trends. There exists a relationship between the meteorological data and milk yield prediction accuracy in pasture-based dairy systems. New precision technologies are available and are being developed to improve the sustainability of the dairy industry. Some of these technologies focus on welfare of individual animals on dairy farms. These technologies allow the automatic identification of animal behaviour and health events, greatly increasing overall herd health and yield while reducing animal health inspection demands and long-term animal healthcare costs. The data set consisted of records from 489 dairy cows at two dairy farms and temperature measured from the nearest meteorological weather station in 2018. The effects of temperature on milk production and behaviour of animals were analyzed. The statistical results indicate different effects of temperature on milk yield and behaviour. The “comfort zone” for animals is in the range 10 °C to 20 °C. Dairy cows out of this zone had to decrease or increase their metabolic heat production, and it affected their milk production and behaviour.

Keywords: behavior, milk yield, temperature, precision technologies

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Authors: Mike Chia-Yu Huang

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China’s port facility construction projects in the Indian Ocean (IO) region, Gwadar Port and Djibouti Port projects in particular, have led to a heated debate among both Chinese and Western strategists over whether the country has literally been carrying out its “string of pearls” strategy, an alleged Chinese plan to challenge America’s military predominance in South Asia. Even though the Chinese government repeatedly denied the existence of such a strategy and highlighted the civilian/commercial nature of its port projects, it has significantly enhanced its strategic cooperation with littoral countries in the IO region since the “One Belt One Road” initiative was introduced by Chinese President Xi Jinping in 2013. Whether China does have a plan to expand its sphere of military influence westward concerns the balance of power in the IO region. If the answer is positive, the security environment there will be changed drastically. This paper argues that rather than simply copying the U.S. model of developing overseas military bases along the IO periphery, Beijing has been deliberating a more sophisticated plan for its physical presence there: creating a new set of “overseas strategic pivots.” These “pivots,” semi-military and semi-commercial in nature, are designed to help Beijing sustain its anti-piracy operations in the Gulf of Aden and serve as forward stations for the transportation of China’s imported energy and merchandise. They can support the Chinese Navy’s operations overseas but are not supposed to undertake face-to-face combat missions. This upgraded Chinese scheme can be identified as “string of pearls” strategy 2.0. Moreover, it is expected to help China deepen its roots in the IO region, implying that Beijing has to a large extent scratched its old diplomatic philosophy which highlighted the merits of non-interference and nonalignment. While a full-scale maritime confrontation between China and the U.S.-India security alliance is unlikely to be witnessed in the near future, an ambitious Chinese plan to step into the global maritime domain has been evidently shown.

Keywords: Chinese navy, Djibouti, Gwadar, Indian Ocean, string of pearls strategy

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Authors: Pippa Sipanoun, Jo Wray, Kate Oulton, Faith Gibson

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Background: With rapidly evolving digital health innovation, there is a need for digital health transformation that is accessible and sustainable, that demonstrates utility for all stakeholders while maintaining data safety. Great Ormond Street Hospital for Children aimed to future-proof the hospital by transitioning to an electronic patient record (EPR) system with a tethered patient portal (MyGOSH) in April 2019. MyGOSH patient portal enables patients 12 years or older (with their parent's consent) to access their digital health data. This includes access to results, documentation, and appointments that facilitate communication with their care team. As part of the Going Digital Study conducted between 2018-2021, data were collected from a sample of all relevant stakeholders before and after EPR and MyGOSH implementation. Data collection reach was wide and included the hospital legal and ethics teams. Aims: This study aims to understand the ethical and legal implications of young people and their parents accessing their digital health data. Methods: A focus group was conducted. Recruited participants were members of the Great Ormond Street Hospital Paediatric Bioethics Centre. Participants included expert and lay members from the Committee from a variety of professional or academic disciplines. Written informed consent was provided by all participants (n=7). The focus group was recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Six themes were identified: access, competence and capacity - granting access to the system; inequalities in access resulting in inequities; burden, uncertainty and responding to change - managing expectations; documenting, risks and data safety; engagement, empowerment and understanding – how to use and manage personal information; legal considerations and obligations. Discussion: If healthcare professionals are to empower young people to be more engaged in their care, the importance of including them in decisions about their health is paramount, especially when they are approaching the age of becoming the consenter for treatment. Complexities exist in assessing competence or capacity when granting system access, when disclosing sensitive information, and maintaining confidentiality. Difficulties are also present in managing clinician burden, managing user expectations whilst providing an equitable service, and data management that meets professional and legal requirements. Conclusion: EPR and tethered-portal implementation at Great Ormond Street Hospital for Children was not only timely, due to the need for a rapid transition to remote consultations during the COVID-19 pandemic, which would not have been possible had EPR/MyGOSH not been implemented, but also integral to the digital health revolution required in healthcare today. This study is highly relevant in understanding the complexities around young people and their parents accessing their digital health data and, although the focus of this research related to portal use and access, the findings translate to young people in the wider digital health context. Ongoing support is required for all relevant stakeholders following MyGOSH patient portal implementation to navigate the ethical and legal complexities. Continued commitment is needed to balance the benefits and burdens, promote inclusion and equity, and ensure portal utility for patient benefit, whilst maintaining an individualized approach to care.

Keywords: patient portal, young people and their parents, ethical, legal

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