Search results for: hospital inventory

Authors: Paul Holmes, Mike N. G.

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Foundation-year doctors face increased stress, pressure and uncertainty when starting new rotations throughout their first years of work. This research questionnaire resulted in an induction cheat sheet and induction video that enhanced the Junior doctor's understanding of how to work effectively within the plastic surgery department at NHS Tayside. The objectives and goals were to improve the transition between cohorts of junior doctors in ward 26 at Ninewells Hospital. Before this quality improvement project, the induction pack was 74 pages long and over eight years old. With the support of consultant Mike Ng a new up-to-date induction was created. This involved a questionnaire and cheat sheet being developed. The questionnaire covered clerking, venipuncture, ward pharmacy, theatres, admissions, specialties on the ward, the cardiac arrest trolley, clinical emergencies, discharges and escalation. This audit has three completed cycles between August 2022 and August 2023. The cheat sheet developed a concise two-page A4 document designed for doctors to be able to reference easily and understand the essentials. The document format is a table containing ward layout; specialty; location; physician associate, shift patterns; ward rounds; handover location and time; hours coverage; senior escalation; nights; daytime duties, meetings/MDTs/board meetings, important bleeps and codes; department guidelines; boarders; referrals and patient stream; pharmacy; absences; rota coordinator; annual leave; top tips. The induction video is a 10-minute in-depth explanation of all aspects of the ward. The video explores in more depth the contents of the cheat sheet. This alternative visual format familiarizes the junior doctor with all aspects of the ward. These were provided to all foundation year 1 and 2 doctors on ward 26 at Ninewells Hospital at NHS Tayside Scotland. This work has since been adopted by the General Surgery Department, which extends to six further wards and has improved the effective handing over of the junior doctor’s role between cohorts. There is potential to further expand the cheat sheet to other departments as the concise document takes around 30 minutes to complete by a doctor who is currently on that ward. The time spent filling out the form provides vital information to the incoming junior doctors, which has a significant possibility to improve patient care.

Keywords: induction, junior doctor, handover, plastic surgery

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Authors: Zeynep İnan Ocak, Gülsün Tanyeli

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One of the most important architectural types of Islamic architecture is madrasah used as educational institutions, hospital or observatory. This type of buildings has one or two storeys, central open or closed courtyards, four iwans and students cells located among the iwans. The main characteristic of the designs featured in the portals. The Islamic art features and adornments are seen well on these buildings made of stone. The earliest examples date to late 12th century in Anatolia after the Battle of Manzikert. Under the Seljuks rule over the one thousand facilities were built in 12th and 13th centuries and there are one hundred thirty five madrasah in total list. But today no all of them are conserved only forty percent are remained. The Seljuks madrasah located in many Anatolian were registered as immovable cultural property in several times by Turkish Culture and Tourism Ministry. The first Turkish buildings inscribed on the World Heritage List are the Great Mosque and Hospital of Divriği in 1985. Also the nominated site named as Anatolian Seljuks Madrasah is in the tentative list of UNESCO World Heritage in 2014. The property is composed some of notable madrasah such as İnce Minareli Madrasah and Karatay Madrasah in Konya; Çifte Madrasah and Sahibiye Madrasah in Kayseri; Buruciye Madrasah, Çifte Minareli Madrasah and Gök Madrasah in Sivas; Çifte Minareli Madrasah and Yakutiye Madrasah in Erzurum; Cacabey Madrasah in Kirşehir. Certainly the advantage of tourism is important for conducting the preservation of heritage. It offers much kind of cultural heritage products by means of visiting monuments. In spite of advantage of tourism, it can be the negative effects of tourism on sites and places of cultural significance. While assisting and guiding the conservation works of madrasah, it should be get reference to international charters and other doctrinal texts about the relation between heritage and tourism. Thereby the monuments will be conserved in good condition promoting by tourism. It should be plan a project about the correlation of visitors and heritage to focus on theme of Seljuks architecture. This study aims to set out the principles about the conservation of madrasah as world heritage taking advantages of tourism. The madrasah as a heritage should be evaluated not only a monument but also cultural route. So the cultural route for madrasah is determined by means of a journey through space and time, how the heritage of the different Anatolian cities. Also the cultural route is created visiting both the madrasah and the other medieval structures. In this study, the route, the principles, relation of tourism are represented considering the conservation of Seljuks madrasah.

Keywords: architectural heritage, cultural routes, Seljuks madrasah, Anatolia

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Authors: Abdulrahman Algaeed

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The Ophthalmic Ultrasound is the easiest method of early diagnosing Retinoblastoma after clinical examination. It can be done with ease without sedation. King Khaled Eye Specialist Hospital is a tertiary care center where Retinoblastoma patients are often seen and treated there. The first modality to rule out the disease is Ophthalmic Ultrasound. Classic Retinoblastoma is easily diagnosed by using the conventional 10MHz Ophthalmic Ultrasound probe in the regular clinic setup. Retinal lesion with multiple, very highly reflective surfaces within lesion typical of Calcium deposits. The use of Standardized A-scan is very useful where internal reflectivity is classified as very highly reflective. Color Doppler is extremely useful as well to show the blood flow within lesion/s. In conclusion: Ophthalmic Ultrasound should be the first tool to be used to diagnose Retinoblastoma after clinical examination. The accuracy of the Exam is very high.

Keywords: doppler, retinoblastoma, reflectivity, ultrasound

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Authors: Frederik Schulte, Stefan Voß

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The adverse effects of air pollution on public health are an increasingly vital problem in planning for urban regions in many parts of the world. The issue is addressed from various angles and by distinct disciplines in research. Epidemiological studies model the relative increase of numerous diseases in response to an increment of different forms of air pollution. A significant share of air pollution in urban regions is related to transport emissions that are often measured and stored in emission inventories. Though, most approaches in transport planning, engineering, and operational design of transport activities are restricted to general emission limits for specific air pollutants and do not consider more nuanced exposure models. We conduct an extensive literature review on exposure models and emission inventories used to study the health impact of transport emissions. Furthermore, we review methods applied in both domains and use emission inventory data of transportation hubs such as ports, airports, and urban traffic for an in-depth analysis of public health impacts deploying medical exposure models. The results reveal specific urban health risks related to transport emissions that may improve urban planning for environmental health by providing insights in actual health effects instead of only referring to general emission limits.

Keywords: emission inventories, exposure models, transport emissions, urban health

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Authors: Monika Paleczna, Barbara Szmigielska

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Adolescence is a developmental period, covering the period from 10 to 20 years of age, in which young people face many challenges. One of the most important tasks of the adolescence period is getting a structured identity. The development of identity is possible by undertaking various activities. Nowadays, virtual activities are very common among young people. One of the main adolescents’ activities in the online environment is playing computer games. The main aim of this work is to answer the question about the relationship between the identity style of adolescents and immersion, -a phenomenon often observed while playing computer games. The concept of identity created by Berzonsky is considered as one of the best-defined concepts of identity. He defines identity as both a structure and a process and distinguishes three styles of identity: informational, normative, and diffuse/avoidant. Immersion is a concept that can be applied in a broad context, but in the game environment, it is a specific psychological experience of being involved in a computer game. It refers to the relocation of the attention resources to the game world, with a limited or impossible perception of stimuli from reality. Considering how much time adolescents spend playing computer games, the question about the relationship between their identity and the immersion in the game seems to be extremely interesting. Fifty adolescents aged 15-17 participated in the study. They played a computer game and completed the Identity Style Inventory and the Immersion Questionaire.

Keywords: identity, immersion, computer games, adolescence

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Authors: Ghada Elshafei, Abdelazim Negm

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Life cycle assessment is a technique to assess the environmental aspects and potential impacts associated with a product, process, or service, by compiling an inventory of relevant energy and material inputs and environmental releases; evaluating the potential environmental impacts associated with identified inputs and releases; and interpreting the results to help you make a more informed decision. In this paper, the life cycle assessment of aluminum and beech wood as two commonly used materials in Egypt for window frames are heading, highlighting their benefits and weaknesses. Window frames of the two materials have been assessed on the basis of their production, energy consumption and environmental impacts. It has been found that the climate change of the windows made of aluminum and beech wood window, for a reference window (1.2m × 1.2m), are 81.7 mPt and - 52.5 mPt impacts respectively. Among the most important results are: fossil fuel consumption, potential contributions to the green building effect and quantities of solid waste tend to be minor for wood products compared to aluminum products; incineration of wood products can cause higher impacts of acidification and eutrophication than aluminum, whereas thermal energy can be recovered.

Keywords: aluminum window, beech wood window, green building, life cycle assessment, life cycle analysis, SimaPro software, window frame

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Authors: Simplejit Kaur Dhanoa, Manmohan Singh

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This study was done with the primary objective to evaluate the motor and mental developmental delays among children having neonatal Jaundice. A total sample of 300 neonates were collected; out of them, 150 were preterm neonates, and 150 were full term neonates from the hospital setting and follow up study was done with the help of the Developmental Assessment scale of the Indian Infant. The registered samples were assessed up to 2.6 years with a gap of 6 months. The outcomes of this study reveal that developmental delays were present among children who had preterm neonatal jaundice as compare to full term normal babies. Further, It was reported that both motor and mental development is affected due to neonatal hyperbilirubinemia in addition to preterm birth.

Keywords: hyperbinirubinemia, preterm neonates, developmental delays, preterm

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Authors: Mekroud Amel

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Introduction The rate of use by the elderly of emergency departments, operating rooms and intensive care units has increased worldwide. Emergency surgery is a context where evaluation is often insufficient, with incomplete information gathering. The aim of this work is to shed light on the frequent use of emergency surgeries by the elderly and their characteristics, as well as on the lack of geriatric assessment scores in the emergency room. Material : Prospective, observational and descriptive, monocentric study. Patients aged 65 and over, admitted for emergency surgery in the operating room, were counted. Emergency operating room including visceral surgery, urology, traumatology and neurosurgery. Parameters studied: Patient characteristics, degree of autonomy, type of surgical pathology, operative management times, preoperative evaluation, postoperative outcome Results : 192 patients were identified over 12 months, from 09.01.2017 to 08.31.2018 Age from 65 to 101 years, 79.81 years +/- 8.38. With predominance of the age group between [65-75 years] 41.1% Female predominance, Sexratio = 0.81 Elderly subjects with total motor autonomy are in the majority at 57.8% Subjects without pathological ATCD represent 12.5% of cases Those who are on only one type of medication or without any treatment are at 36.9% Discussion : The emergency operative care of the elderly patient for a surgical or traumatological pathology is characterized by many specificities linked first to the emergency context, where the evaluation is often insufficient, besides the fact that the elderly patient has particularities requiring reception in centers with experience in the care of this category of patient, or, failing that, a center which uses the minimum of geriatric evaluation scores which are simplified for the emergency departments. In our hospital, we have not yet made this evaluation routine in the emergency room and this delay in the introduction of these scores can be directly attributed to the covid 19 pandemic. Besides the standard preoperative assessment, only 43.2% of patients were assessed in the preoperative period by an anesthesiologist. Traumatological emergencies come first 68.2% followed by visceral emergencies 19.2% (including proctological, urological emergencies), neurosurgical emergencies 7.8% and finally peripheral emergency surgery all acts combined 4.7%. Hospital stay at 9.6 +/- 16.8 days, average operability time of 4.5 +/- 3 days. Death rate at 7.29% Conclusion This work has demonstrated the major impact of emergency surgery, which remains curable for the most part, on the elderly patient despite total motor and cognitive autonomy preoperatively. The improvement of the preoperative evaluation, the reduction of the operating time and enhanced recovery after surgery, with personalized protocols, are the only guarantee for the resumption of preoperative autonomy in these patients.

Keywords: emergency surgery, elderly patients, preoperative geriatric scores, curable emergency surgical pathologies

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Authors: N. Gharooni-Dowrani, B. Gharooni-Dowrani

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The benefits of hilotherapy following orthogonathic surgery have been explored in recent years, demonstrating reduction in patient pain and swelling post-operatively. However, hilotherapy is not always widely accessible to all patients following orthognathic surgery. In this study, 50 patients were examined at Luton and Dunstable Hospital, half (25) of which used hilotherm masks post operatively and half of which opted for traditional ice packs in order to aid recovery. This study demonstrated that the use of hilotherapy reduced patient pain when analgesia need and use were analysed, as well as shortening inpatient stay. Although no current hilotherm masks are available without rental services in our trust, this study demonstrated the positive outcomes that they may bring, which may be worth future investment for our department.

Keywords: orthognathic surgery, orthodontics, hilotherapy, OMFS

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Authors: Gizem Akcan, Erdinc Ozturk

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When it is examined as historically, it has caught attention that homosexual people try to behave as heterosexual or come out to have a place in community. Homosexual people have identity confusion during identity development, they have high levels of need for absolute truth and their psychological well being is affected negatively because of high levels of need for absolute truth and they have problems about self concept clarity. People who have problems about self concept clarity have problems on problem solving and show lots of symptoms of stress. People who have clear self concept use healthier coping strategies to solve problems. The purpose of this study is to show whether need for absolute truth predicts problem solving and symptoms of stress via mediator effect of self concept clarity or not on homosexual men. The participants of this study were 200 homosexual men. The ages of participants were 20-50. In addition, Demographic Information Form, Self Concept Clarity Scale, Need for Absolute Truth Scale, Stres Self-Assessment Checklist and Problem Solving Inventory were applied to the participants. The assessment of the data was made with confirmatory factor analysis and structural equation modeling analysis. According to the results of this study, need for absolute truth predicts problem solving and symptoms of stress via mediator effect of self concept clarity on homosexual men.

Keywords: need for absolute truth, self concept clarity, symptoms of stress, problem solving

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Authors: Seng Sing Tan

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Clamping of the umbilical cord after birth is widely practiced as a part of labor management. Further improvements were proposed to produce a smaller, lighter and more comfortable clamp while still maintaining current standards of clamping. A detachable holder was also developed to facilitate the clamping process. This pilot study on the efficacy of the mini-clamp was conducted to evaluate a tightness of the seal and a firm grip of the clamp on the umbilical cord. The study was carried out at National University Hospital, using 5 sets of placental cord. 18 samples of approximate 10 cm each were harvested. The test results showed that the mini-clamp was able to stop the flow through the cord after clamping without rupturing the cord. All slip tests passed with a load of 0.2 kg. In the pressure testing, 30kPa of saline was exerted into the umbilical veins. Although there was no physical sign of fluid leaking through the end secured by the mini-clamp, the results showed the pressure was not able to sustain the pressure set during the tests. 12 out of the 18 test samples have more than 7% of pressure drop in 30 seconds. During the pressure leak test, it was observed on several samples that when pressurized, small droplets of saline were growing on the outer surface of the cord lining membrane. It was thus hypothesized that the pressure drop was likely caused by the perfusion of the injected saline through the Wharton’s jelly and the cord lining membrane. The average pressure in the umbilical vein is roughly 2.67kPa (20 mmHg), less than 10% of 30kPa (~225mmHg), set for the pressure testing. As such, the pressure set could be over-specified, leading to undesirable outcomes. The development of the mini-clamp was an attempt to increase the comfort of newly born babies while maintaining the usability and efficacy of hospital grade umbilical cord clamp. The pressure leak in this study would be unfair to fully attribute it to the design and efficacy of the mini-clamp. Considering the unexpected leakage of saline through the umbilical membrane due to over-specified pressure exerted on the umbilical veins, improvements can definitely be made to the existing experimental setup to obtain a more accurate and conclusive outcome. If proven conclusive and effective, the mini-clamp with a detachable holder could be a smaller and potentially cheaper alternative to existing umbilical cord clamps. In addition, future clinical trials could be conducted to determine the user-friendliness of the mini-clamp and evaluate its practicality in the clinical setting by labor ward clinicians. A further potential improvement could be proposed on the sustainability factor of the mini-clamp. A biodegradable clamp would revolutionise the industry in this increasingly environmentally sustainability world.

Keywords: leak test, mini-clamp, slip test, umbilical cord

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Authors: Chandra Shekhar Majumder, Orin Sultana Jamie

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Background: Dacryocystorhinostomy (DCR) has been a widely accepted surgical intervention for nasolacrimal duct obstructions. Some previous studies demonstrated the potential benefits of the peroperative application of agents like Mitomycin-C (MMC) with DCR to improve surgical outcomes. Relevant studies are rare in Bangladesh, and there are controversies about the dose, duration of MMC, and outcome. Therefore, the present study aimed to investigate the comparative efficacy of DCR with and without MMC in a tertiary hospital in Bangladesh. Objective: The study aims to determine the outcome of a dacryocystorhinostomy with preoperative local use of mitomycin–C. Methods: An analytical study was conducted in the Department of Ophthalmology, Sir Salimullah Medical College & Mitford Hospital, Dhaka, from January 2023 to September 2023. Seventy patients who were admitted for DCR operation were included according to the inclusion and exclusion criteria. Patients were divided into two groups: those who underwent DCR with peroperative administration of 0.2 mg/ml Mitomycin-C for 5 minutes (Group I) and those who underwent DCR alone (Group II). All patients were subjected to detailed history taking, clinical examination, and relevant investigations. All patients underwent DCR according to standard guidelines and ensured the highest peroperative and postoperative care. Then, patients were followed up at 7th POD, 1-month POD, 3 months POD, and 6 months POD to observe the success rate between the two groups by assessing tearing condition, irrigation, height of tear meniscus, and FDDT- test. Data was recorded using a pre-structured questionnaire, and collected data were analyzed using SPSS 23. Results: The mean age of the study patients was 42.17±6.7 (SD) years and 42.29±7.1 (SD) years in Groups I and II, respectively, with no significant difference (p=0.945). At the 6th month’s follow-up, group I patients were observed with 94.3% frequency of symptom-free, 85.6% patency of lacrimal drainage system, 68.6% had tear meniscus <0.1mm and 88.6% had positive Fluorescence Dye Disappearance Test (FDDT test). In group II, 91.4% were symptom-free, 68.6% showed patency, 57.1% had a height of tear meniscus < 0.1 mm, and 85.6% had FDDT test positive. But no statistically significant difference was observed (p<.05). Conclusion: The use of Mitomycin-C preoperatively during DCR offers better postoperative outcomes, particularly in maintaining patency and achieving symptom resolution with more FDDT test positive and improvement of tear meniscus in the MMC group than the control group. However, this study didn’t demonstrate a statistically significant difference between the two groups. Further research with larger sample sizes and longer follow-up periods would be beneficial to corroborate these findings.

Keywords: dacryocystorhinostomy, mitomycin-c, dacryocystitis, nasolacrimal duct obstruction

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Authors: Chao Li, Lei Zhou, Ruiqi Ren, Dan Li, Yali Wang, Daxin Ni, Zijian Feng, Qun Li

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Background: In 2016, yellow fever had been first ever discovered in China, soon after the yellow fever epidemic occurred in Angola. After the discovery, China had promptly made the national protocol of control and prevention and strengthened the surveillance on passenger and vector. In this study, a descriptive analysis was conducted to summarize China’s experiences of response towards this import epidemic, in the hope of providing experiences on prevention and control of yellow fever and other similar imported infectious diseases in the future. Methods: The imported cases were discovered and reported by General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) and several hospitals. Each clinically diagnosed yellow fever case was confirmed by real-time reverse transcriptase polymerase chain reaction (RT–PCR). The data of the imported yellow fever cases were collected by local Centers for Disease Control and Prevention (CDC) through field investigations soon after they received the reports. Results: A total of 11 imported cases from Angola were reported in China, during Angola’s yellow fever outbreak. Six cases were discovered by the AQSIQ, among which two with mild symptom were initiative declarations at the time of entry. Except for one death, the remaining 10 cases all had recovered after timely and proper treatment. All cases are Chinese, and lived in Luanda, the capital of Angola. 73% were retailers (8/11) from Fuqing city in Fujian province, and the other three were labors send by companies. 10 cases had experiences of medical treatment in Luanda after onset, among which 8 cases visited the same local Chinese medicine hospital (China Railway four Bureau Hospital). Among the 11 cases, only one case had an effective vaccination. The result of emergency surveillance for mosquito density showed that only 14 containers of water were found positive around places of three cases, and the Breteau Index is 15. Conclusions: Effective response was taken to control and prevent the outbreak of yellow fever in China after discovering the imported cases. However, though the similar origin of Chinese in Angola has provided an easy access for disease detection, information sharing, health education and vaccination on yellow fever; these conveniences were overlooked during previous disease prevention methods. Besides, only one case having effective vaccination revealed the inadequate capacity of immunization service in China. These findings will provide suggestions to improve China’s capacity to deal with not only yellow fever but also other similar imported diseases in China.

Keywords: yellow fever, first import, China, suggestion

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Authors: Michael Vieth, Aric Schadler, Hubert Ballard, J. A. Bauer, Pratibha Thakkar

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Introduction: Congenital diaphragmatic hernia (CDH) is a condition characterized by the herniation of abdominal contents into the thoracic cavity requiring postnatal surgical repair. Previous literature suggests improved CDH outcomes at high-volume regional referral centers compared to low-volume centers. The purpose of this study was to examine CDH outcomes at Kentucky Children’s Hospital (KCH), a low-volume center, compared to the Congenital Diaphragmatic Hernia Study Group (CDHSG). Methods: A retrospective chart review was performed at KCH from 2007-2019 for neonates with CDH, and then subdivided into two cohorts: those requiring ECMO therapy and those not requiring ECMO therapy. Basic demographic data and measures of mortality and morbidity including ventilator days and length of stay were compared to the CDHSG. Measures of morbidity for the ECMO cohort including duration of ECMO, clinical bleeding, intracranial hemorrhage, sepsis, need for continuous renal replacement therapy (CRRT), need for sildenafil at discharge, timing of surgical repair, and total ventilator days were collected. Statistical analysis was performed using IBM SPSS Statistics version 28. One-sample t-tests and one-sample Wilcoxon Signed Rank test were utilized as appropriate.Results: There were a total of 27 neonatal patients with CDH at KCH from 2007-2019; 9 of the 27 required ECMO therapy. The birth weight and gestational age were similar between KCH and the CDHSG (2.99 kg vs 2.92 kg, p =0.655; 37.0 weeks vs 37.4 weeks, p =0.51). About half of the patients were inborn in both cohorts (52% vs 56%, p =0.676). KCH cohort had significantly more Caucasian patients (96% vs 55%, p=<0.001). Unadjusted mortality was similar in both groups (KCH 70% vs CDHSG 72%, p =0.857). Using ECMO utilization (KCH 78% vs CDHSG 52%, p =0.118) and need for surgical repair (KCH 95% vs CDHSG 85%, p =0.060) as proxy for severity, both groups’ mortality were comparable. No significant difference was noted for pulmonary outcomes such as average ventilator days (KCH 43.2 vs. CDHSG 17.3, p =0.078) and home oxygen dependency (KCH 44% vs. CDHSG 24%, p =0.108). Average length of hospital stay for patients treated at KCH was similar to CDHSG (64.4 vs 49.2, p=1.000). Conclusion: Our study demonstrates that outcome in CDH patients is independent of center’s case volume status. Management of CDH with a standardized approach in a low-volume center can yield similar outcomes. This data supports the treatment of patients with CDH at low-volume centers as opposed to transferring to higher-volume centers.

Keywords: ECMO, case volume, congenital diaphragmatic hernia, congenital diaphragmatic hernia study group, neonate

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Authors: Elyas Akbari, Jafar Hasani, Newsha Dehestani, Mohammad Khaleghi, Alireza Moradi

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The aim of the present study was to assess the effect of emotional experience induction in the mirror neurons systems (MNS) activity with regard to the spectrum of depressive symptoms. For this purpose, at first stage, 449 students of Kharazmi University of Tehran were selected randomly and completed the second version of the Beck Depression Inventory (BDI-II). Then, 36 students with standard Z-score equal or above +1.5 and equal or equal or below -1.5 were selected to construct two groups of high and low spectrum of depressive symptoms. In the next stage, the basic activity of MNS was recorded (mu wave) before presenting the positive and negative emotional video clips by Electroencephalography (EEG) technique. The findings related to emotion induction (neutral, negative and positive emotion) demonstrated that the activity of recorded mirror neuron areas had a significant difference between the depressive and non-depressive groups. These findings suggest that probably processing of negative emotions in depressive individuals is due to the idea that the mirror neurons in motor cortex matched up the activity of cognitive regions with the person’s schema. Considering the results of the present study, it could be said that the MNS provides a substrate where emotional disorders can be studied and evaluated.

Keywords: emotional experiences, mirror neurons, depressive symptoms, negative and positive emotion

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Authors: Akat Sordum Owen

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This paper focuses on the interface between the phonemes and the orthography of Kānà, an endangered language spoken in Khānà and Tàì Local Government Areas of Rivers State of Nigeria. Kānà is one of the four languages (others being Gòkānà, Bāān Ògóì and Ẹ́lẹ́mẹ́) of Ogonoid (i.e. Ogoni group of languages) located in the Cross River branch of Benue-Congo phylum. A good number of scholars, including Ikoro (1996) and Vobnu (2001) agree on the phonemes inventory of the language but differ on the choice of the letters of the orthography. Whereas many scholars on the language accept that the language is alphabetic and satisfactory with respect to the use of Latin (English) alphabetic orthography with emphasis on phoneme-grapheme relation, some other scholars tend to uphold that the complex consonants in the phonemic chart should be treated as a consonant cluster in the alphabet. This paper argues that consonant clusters occur at syntactic (and morphological) levels with regard to certain items in order to produce desired pronunciations and spellings. Each consonant in a cluster is identical and can be used with other letters to produce a different word. The data was obtained from scholarly writings on the language, by interviews and our intuition as a native speaker of the language. It is believed that this study will trigger further research into the orthography of Kānà and other tonal languages, such as Igbo and Yoruba having similar features in order to reanalyze the number of letters in the alphabets of those languages.

Keywords: KANA, phonemes, orthography, letters

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Authors: Silvia Riva, Ezekiel Chinyio

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Introduction: Workers in different sectors are prone to stress at varying levels. They also respond to stress in different ways. An inspiration was to study stress development amongst workers in a work dangerous setting (Construction Industry) as well as how they cope with specific stress incidences. Objective: The overarching objective of the study was to study and correlate between stress and coping strategies. The research was conducted in an organizational industrial setting, and its findings on the coping actions of construction workers are reported in this article. Methods: An online cross-sectional survey was conducted with 80 participants aged 18-62. These were working for three different construction organizations in the West Midland region of the UK. Their coping actions were assessed using the COPE Inventory (Carver, 2013) instrument while the level of stress was assessed by the Perceived Stress Scale (Cohen, 1994). Results: Out of 80 workers (20 female, 25%, mean age 40.66), positive reinterpretation (M=4.15, SD=2.60) and active coping (M=4.18, SD=2.55) were the two most adaptive strategies reported by the workers while the most frequent maladaptive behavior was mental disengagement (M=3.62, SD=2.25). Among the maladaptive tactics, alcohol and drug abuse was a significant moderator in stress reactions (t=6.12, p=.000). Conclusion: Some maladaptive strategies are adopted by construction workers to cope with stress. So, it could be argued that programs of stress prevention and control in the construction industry have a basis to develop solutions that can improve and strengthen effective interventions when workers are stressed or getting stressed.

Keywords: coping, organization, strategies, stress

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Authors: Ria M. Caramoan, Analiza P. Rollon, Karl N. Vergel

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The Simple Interactive Models for Better Air Quality (SIM-air) is an integrated approach model that allows the available information to support the integrated urban air quality management. This study utilized the vehicular air pollution information system module of SIM-air for the assessment of vehicular emissions in Commonwealth Avenue, Quezon City, Philippines. The main objective of the study is to assess and predict the contribution of different types of vehicles to the vehicular emissions in terms of PM₁₀, SOₓ, and NOₓ at different policy and technology scenarios. For the base year 2017, the results show vehicular emissions of 735.46 tons of PM₁₀, 108.90 tons of SOₓ, and 2,101.11 tons of NOₓ. Motorcycle is the major source of particulates contributing about 52% of the PM₁₀ emissions. Meanwhile, Public Utility Jeepneys contribute 27% of SOₓ emissions and private cars using gasoline contribute 39% of NOₓ emissions. Ambient air quality monitoring was also conducted in the study area for the standard parameters of PM₁₀, S0₂, and NO₂. Results show an average of 88.11 µg/Ncm, 47.41 µg/Ncm and 22.54 µg/Ncm for PM₁₀, N0₂, and SO₂, respectively, all were within the DENR National Ambient Air Quality Guideline Values. Future emissions of PM₁₀, NOₓ, and SOₓ are estimated at different scenarios. Results show that in the year 2030, PM₁₀ emissions will be increased by 186.2%. NOₓ emissions and SOₓ emissions will also be increased by 38.9% and 5.5%, without the implementation of the scenarios.

Keywords: ambient air quality, emissions inventory, mobile air pollution, vehicular emissions

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Authors: Elda Maraj, Shkelqim Kuka

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Coronary heart disease causes many deaths in the world. Unfortunately, this problem will continue to increase in the future. In this paper, a fuzzy logic model to predict coronary heart disease is presented. This model has been developed with seven input variables and one output variable that was implemented for 30 patients in Albania. Here fuzzy logic toolbox of MATLAB is used. Fuzzy model inputs are considered as cholesterol, blood pressure, physical activity, age, BMI, smoking, and diabetes, whereas the output is the disease classification. The fuzzy sets and membership functions are chosen in an appropriate manner. Centroid method is used for defuzzification. The database is taken from University Hospital Center "Mother Teresa" in Tirana, Albania.

Keywords: coronary heart disease, fuzzy logic toolbox, membership function, prediction model

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Authors: Mohamad Reza Khodabakhsh

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The present study investigated the effectiveness of attachment-based family therapy on maladaptive schemas and depressive symptoms of adolescence. This study was a quasi-experimental study, and a pre-test and post-test design with a control group were used. In this study, the study population included all adolescence. The sample consisted of 30 adolescents who were selected by the available sampling method. Then they were randomly divided into experimental (n = 15) and control (n = 15) groups. Data were collected in this study using the Beck Depression Inventory (1974) and the short form of Young's early maladaptive schema questionnaire (1988). After taking the pre-test, group implementation of family therapy based on attachment style was presented for 11 sessions of two and a half hours for two months in the experimental group. At the end of the sessions, both groups were retested, and the data were analyzed using analysis of covariance in SPSS-22 software. The results showed that attachment-based family therapy led to a significant reduction in maladaptive schemas, including emotional deprivation, rejection/abandonment, mistrust/abuse, social isolation, disability/shame, dependence/inadequacy, vulnerability/trauma, and depressive symptoms were compared to the control group. It can be concluded that this treatment has an effect on maladaptive schemas and symptoms of depression.

Keywords: attachment-based family therapy, maladaptive schemas, depressive symptoms, adolescence

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Authors: Amanda de Oliveira Ferreira Leite, Ana Luiza del Pino Ferreira, Bruna Garcez Correa, Janaíne de Souza Mello, Marla Manquevich, Mirna Wetters Portuguez

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Objective: We sought to investigate a neuropsychological intervention focused on improving cognition, psychological aspects, and quality of life of elderly people with mild cognitive impairment. Method: A controlled and randomized study, blind to the evaluator, was executed. We evaluated 78 elderly people, divided into the neuropsychological and control groups, through a semi-structured interview, Addenbrooke’s Cognitive Examination, Katz Index, Lawton and Brody Scale, Geriatric Depression Scale, Beck Anxiety Inventory, Personal Development Scale, WHOQOL-bref and WHOQOL--old. Results: After the intervention, the neuropsychological group showed improvement in the cognitive subtests and in the total score, reduction in the frequency of symptoms associated with anxiety and depression, better psychological well-being, and quality of life. The research highlights useful intervention strategies for improving the general condition of these patients and rehabilitating damaged areas. Conclusion: We concluded that there is a relationship between neuropsychological intervention and improvement in cognitive and psychological performance, as well as in the quality of life in elderly people with mild cognitive impairment.

Keywords: aging, mild cognitive impairment, neuropsychology, quality of life

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Authors: Ali Kassem, Esam Nada, Amro Abdelhamed, Shigeo Horie

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Objective: Diabetes mellitus (DM) is associated with macrovascular complications, including coronary artery disease (CAD), and microvascular complications that contribute to the pathogenesis of erectile dysfunction (ED). On the other hand, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and mortality in diabetic and non-diabetic patients. Recently, Multidetector computed tomographic coronary angiography (MDCT-CA) has become a reliable non-invasive imaging modality for screening diabetic patients for SMI. We aim to evaluate the presence of SMI using (MDCT-CA) in patients with type 2DM having ED. Methods: This study evaluated 20 patients (mean age 61.45 ± 10.7 years), with DM and ED without any history of angina or angina equivalent. ED was tested with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erect meter. Results: Of twenty studied patients, coronary artery stenosis was detected in 13 (65%) patients in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Maximum coronary artery stenosis was positively correlated with age (P < 0.016,) and negatively correlated with EHS (P <04). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P <04). Conclusion: MDCT-CA is a useful tool to identify SMI in patients with diabetes mellitus and ED. One should consider the possibility of SMI especially in elderly patients with DM who have ED.

Keywords: diabetes mellitus, erectile dysfunction, microvascular, silent ischemia

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Authors: Parul Bhalla, Sarvesh Palria

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Wetlands are areas of land that are either temporarily or permanently covered by water. Wetlands exhibit enormous diversity according to their genesis, geographical location, water regime and chemistry, dominant plants and soil or sediment characteristics. The spatial and temporal characteristics of wetland in terms of turbidity and aquatic vegetation could serve as guiding tool, in conservation prioritization of wetlands. The aquatic vegetation in the wetland is an indicator of the trophic status of the wetland which has a bearing on the water quality, the turbidity level in any wetland is indicative of the quality of the water in it. To conserve and manage wetland resources, it is important to have inventory of wetland and its catchment. Fateh Sagar wetland in Udaipur city is the one of the important wetland for tourism industry and other economic activities in the region. Realizing the importance of the wetland, the present study has been taken up with the specific objective of delineation and characterization of Fateh Sagar wetland in terms of turbidity and aquatic vegetation, using high resolution satellite data such as Cartosat and LISS IV multi-temporal data, which will efficiently bring out the changes in water spread and quality parameters. The catchment of wetland has been also characterized for various features. The study leads in to takes necessary steps to conserve the wetland and its resources.

Keywords: aquatic vegetation, catchment, turbidity status, wetland

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Authors: U. B. Zubair, A. Kiyani

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Introduction: Depressive illness predispose individuals to a lot of physical and mental health issues. Anxiety and substance use disorders have been studied widely as comorbidity. Biological symptoms also now considered part of the depressive spectrum. Cognitive abilities also decline or get affected and need to be looked into in detail in depressed patients. Objective: To determine the prevalence of cognitive decline among patients with major depressive illness and analyze the associated socio-demographic factors. Methods: 190 patients of major depressive illness were included in our study to determine the presence of cognitive decline among them. Depression was diagnosed by a consultant psychiatrist by using the ICD-10 criteria for major depressive disorder. British Columbia Cognitive Complaints Inventory (BC-CCI) was the psychometric tool used to determine the cognitive decline. Sociodemographic profile was recorded and the relationship of various factors with cognitive decline was also ascertained. Findings: 70% of the patients suffering from depression included in this study showed the presence of some degree of cognitive decline, while 30% did not show any evidence of cognitive decline when screened through BCCCI. Statistical testing revealed that the female gender was the only socio-demographic parameter linked significantly with the presence of cognitive decline. Conclusion: Decline in cognitive abilities was found in a significant number of patients suffering from major depression in our sample population. Screening for this parameter f mental function should be done in depression clinics to pick it early.

Keywords: depression, cognitive decline, prevalence, socio-demographic factors

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Authors: Jacklyn Yek, Clara Tong, Shin Yuet Chong, Yee Yian Ong

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Background: While emergency manuals and cognitive aids (CA) have been used in high-hazard industries for decades, this has been a nascent field in healthcare. CAs can potentially offset the large cognitive load involved in crisis resource management and possibly facilitate the efficient performance of key steps in treatment. A crisis manual was developed based on local guidelines and the latest evidence-based information and introduced to a tertiary hospital setting in Singapore. Hence, the objective of this study is to evaluate the effectiveness of the crisis manual in guiding response and management of critical events. Methods: 7 surgical teams were recruited to participate in a series of simulated emergencies in high-fidelity operating room simulator over the period of April to June 2018. All teams consisted of a surgical consultant and medical officer/registrar, anesthesia consultant and medical officer/registrar; as well as a circulating, scrub and anesthetic nurse. Each team performed a simulated operation in which 1 or more of the crisis events occurred. The teams were randomly assigned to a scenario of the crisis manual and all teams were deemed to be equal in experience and knowledge. Before the simulation, teams were instructed on proper checklist use but the use of the checklist was optional. Results: 7 simulation sessions were performed, consisting of the following scenarios: Airway fire, Massive Transfusion Protocol, Malignant Hyperthermia, Eclampsia, and Difficult Airway. Out of the 7 surgical teams, 2 teams made use of the crisis manual – of which both teams had encountered a ‘Malignant Hyperthermia’ scenario. These team members reflected that the crisis manual assisted allowed them to work in a team, especially being able to involve the surgical doctors who were unfamiliar with the condition and management. A run chart plotted showed a possible upward trend, suggesting that with increasing awareness and training, staff would become more likely to initiate the use of the crisis manual. Conclusion: Despite the high volume load in this tertiary hospital, certain crises remain rare and clinicians are often caught unprepared. A crisis manual is an effective tool and easy-to-use repository that can improve patient outcome and encourage teamwork. With training, familiarity would allow clinicians to be increasingly comfortable with reaching out for the crisis manual. More simulation training would need to be conducted to determine its effectiveness.

Keywords: crisis resource management, high fidelity simulation training, medical errors, visual aids

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Authors: Tetyana Kendzerska, David T. Zhu, Michael Pugliese, Douglas Manuel, Mohsen Sadatsafavi, Marcus Povitz, Therese A. Stukel, Teresa To, Shawn D. Aaron, Sunita Mulpuru, Melanie Chin, Claire E. Kendall, Kednapa Thavorn, Rebecca Robillard, Andrea S. Gershon

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The impact of the COVID-19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown. To compare observed and expected (projected based on previous years) trends in all-cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 - March 2021). A population-based study using provincial health administrative data.General adult population (Ontario, Canada). Monthly all-cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at-risk) for seven combined ACSCs (asthma, COPD, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016-2019) by fitting monthly time series auto-regressive integrated moving-average models. Compared to previous years, all-cause mortality rates increased at the beginning of the pandemic (observed rate in March-May 2020 of 79.98 vs. projected of 71.24 [66.35-76.50]) and then returned to expected in June 2020—except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 vs. projected of 52.07 (47.84-56.68); observed ED visit rate of 92.55 vs. projected of 134.72 (124.89-145.33). ACSC outpatient visit rates decreased initially (observed rate of 4,299.57 vs. projected of 5,060.23 [4,712.64-5,433.46]) and then returned to expected in June 2020. Reductions in outpatient visits for ACSCs at the beginning of the pandemic combined with reduced hospital admissions may have been associated with temporally increased mortality—disproportionately experienced by immigrants and those with mental health conditions. The Ottawa Hospital Academic Medical Organization

Keywords: COVID-19, chronic disease, all-cause mortality, hospitalizations, emergency department visits, outpatient visits, modelling, population-based study, asthma, COPD, angina, heart failure, hypertension, diabetes, epilepsy

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Authors: Nathan Moran, Robert Hanser, Attapol Kuanliang

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The purpose of this study is to determine the relationship between personal and social resources and burnout for police officers. Current conceptualizations of the condition of burnout are challenged as being too phenomenological and ambiguous, and consequently, not given to direct empirical testing. The conservation of resources model is based on the supposition that people strive to retain, protect, and build resources as a means to protect them from the impacts of burnout. The model proposes that the effects of stress (i.e. burnout) can be manifested in personal and professional attitudes and attributes, which can measure burnout using self-reports to provide strong support for the conservation of resources model, in that, personal and professional demands are related to the exhaustion component of burnout, whereas personal and professional resources can be compiled to counteract the negative impact of the burnout condition. Highly similar patterns of burnout resistance factors were witnessed in police officers in two department precincts (N:81). In addition, results confirmed the positive influence of key demographic variables in burnout resistance using the conservation of resources model. Participants in this study are all sheriff’s deputies with a populous county in a Pacific Northwestern state (N = 274). Four instruments will be used in this quantitative study for data collection (a) a series of demographic questions, (b) the Organizational Citizenship Behavior, (c) the PANAS-X Scale (OCB: Watson& Clark, 1994), and (d) The Maslach Burnout Inventory.

Keywords: behavioral, burnout, law enforcement, quantitative

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Authors: Narges Solaymani

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medical training of patients. Nursing is a very important profession in the societies of the world. Although in the past, all caregivers of the sick and disabled were called nurses, nowadays, a nurse is a person who has a university education in this field. There are nurses in bachelor's, master's, and doctoral degrees in nursing. New courses have been launched in the master's degree based on duty-oriented nurses. A nurse cannot have an independent treatment center but is a member of the treatment team in established treatment centers such as hospitals, clinics, or offices. Nurses can establish counseling centers and provide nursing services at home. According to the standards, the number of nurses should be three times the number of doctors or twice the number of hospital beds, or there should be three nurses for every thousand people. Also, international standards show that in the internal and surgical department, every 4 to 6 patients should have a nurse.

Keywords: Nurse, Intensive Care, CPR, Bandage

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Authors: Jeonghun Lee

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Thyroid-stimulating hormone (TSH) is regulated by the negative feedback of T3 and T4 but is affected by cortisol and cytokines during allostasis. Hence, TSH levels can be influenced by stress through cortisol. In the present study, changes in TSH levels under stress and the potential of TSH as a stress marker were examined in patients lacking T3 or T4 feedback after thyroid surgery. The three stress questionnaires (Korean version of the Daily Stress Inventory, Social Readjustment Rating Scale, and Stress Overload Scale-Short [SOSS]), open-ended question (OQ), and thyroid function tests were performed twice in 106 patients enrolled from January 2019 to October 2020. Statistical analysis was performed using the generalized linear mixed effect model (GLMM) in R software version 4.1.0. In a multiple LMM involving 106 patients, T3, T4, SOSS (category), open-ended questions, the extent of thyroidectomy, and preoperative TSH were significantly correlated with lnTSH. T3 and T4 increased by 1 and lnTSH decreased by 0.03, 3.52, respectively. In case of a stressful event on OQ, lnTSH increased by 1.55. In the high-risk group, lnTSH increased by 0.79, compared with the low group (p<0.05). TSH had a significant relationship with stress, together with T3, T4, and the extent of thyroidectomy. As such, it has the potential to be used as a stress marker, though it showed a low correlation with other stress questionnaires. To address this limitation, questionnaires on various social environments and research on copy strategies are necessary for future studies.

Keywords: stress, surgery, thyroid stimulating hormone, thyroidectomy

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Authors: Mohammad Reza Dawoudi

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With the increasing rate of patients suffering from chronic pain, several methods for evaluating of chronic pain are suggested. Motion of morbid has been defined as the rate of pine and it is linked with various co-morbid conditions. This study provides a summary of procedure useful to statistics performing direct behavioral observation in hospital settings. We describe the need for and usefulness of comprehensive “morbid motions” observations; provide a primer on the identification, definition, and assessment of morbid behaviors; and outline and discuss specific statistical procedures, including formulating referral motions, describing and conducting the observation. We also provide practical devices for observing and analyzing the obtained information into a report that guides clinical intervention.

Keywords: assessing pain, DNA modeling, image matching technique, pain scale

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