Search results for: clinical advice services

Authors: Lei Guo, Xu Zhang, Weigang Hou

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Since the traditional network is closed and it has no architecture to create applications, it has been unable to evolve with changing demands under the rapid innovation in services. Additionally, due to the lack of the whole network profile, the quality of service cannot be well guaranteed in the traditional network. The Software Defined Network (SDN) utilizes global resources to support on-demand applications/services via open, standardized and programmable interfaces. In this paper, we implement the traffic grooming application under a real SDN environment, and the corresponding analysis is made. In our SDN: 1) we use OpenFlow protocol to control the entire network by using software applications running on the network operating system; 2) several virtual switches are combined into the data forwarding plane through Open vSwitch; 3) An OpenFlow controller, NOX, is involved as a logically centralized control plane that dynamically configures the data forwarding plane; 4) The traffic grooming based on SDN is demonstrated through dynamically modifying the idle time of flow entries. The experimental results demonstrate that the SDN-based traffic grooming effectively reduces the end-to-end delay, and the improvement ratio arrives to 99%.

Keywords: NOX, OpenFlow, Software Defined Network (SDN), traffic grooming

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Authors: Fahad Alahmadi, Norhan Abd Rahman, Mohammad Abdulrazzak, Zulikifli Yusop

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Runoff prediction of ungauged catchment is still a challenging task especially in arid regions with a unique land cover such as volcanic basalt rocks where geological weathering and fractures are highly significant. In this study, Bathan catchment in Madinah western Saudi Arabia was selected for analysis. The aim of this paper is to evaluate different rainfall loss methods; soil conservation Services curve number (SCS-CN), green-ampt and initial-constant rate. Different direct runoff methods were evaluated: soil conservation services dimensionless unit hydrograph (SCS-UH), Snyder unit hydrograph and Clark unit hydrograph. The study showed the superiority of SCS-CN loss method and Clark unit hydrograph method for ungauged catchment where there is no observed runoff data.

Keywords: urban runoff modelling, arid regions, ungauged catchments, volcanic rocks, Madinah, Saudi Arabia

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Authors: Naman Jain, Shaun Fernandes

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With the increasing prevalence of online healthcare services, selecting the most suitable doctor has become a complex task, requiring careful consideration of both public sentiment and personal preferences. This paper proposes a sentiment analysis-driven method that integrates public reviews with user-specific criteria and correlated attributes to recommend online doctors. By leveraging Natural Language Processing (NLP) techniques, public sentiment is extracted from online reviews, which is then combined with user-defined preferences such as specialty, years of experience, location, and consultation fees. Additionally, correlated attributes like education and certifications are incorporated to enhance the recommendation accuracy. Experimental results demonstrate that the proposed system significantly improves user satisfaction by providing personalized doctor recommendations that align with both public opinion and individual needs.

Keywords: sentiment analysis, online doctors, personal preferences, correlated attributes, recommendation system, healthcare, natural language processing

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Authors: Khalid Al Saleh, Najlaa AlSayed

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Background: Palliative care is changing from just ‘end of life care’ to care delivered earlier in the disease course. Metanalysis showed that Palliative Performance Scale (PPS) is associated with increased length of survival. The Palliative Care Center (PCC) in Kuwait is the only stand-alone center in Eastern Mediterranean Region with a capacity of 92 beds. We compared clinical characteristics between patients referred from the Specialized Cancer Center and general hospitals in Kuwait to PCC. Method: A cross Sectional survey was conducted since the opening of PCC in January 2011 to June 2013. Patients’ data on demographics, type of the cancer, PPS score and referring hospital were collected and analyzed. Results: Total number of the patients was 142. Mean age was 61.05±14.79 years, 66 patients (47.1%) were males and 74 (52.9%) were females. The most common cancers in males were lung (n=18, 27.3%) followed by head and neck cancers (n=8, 12.1%) and brain tumors (n=7, 10.6%) while in females, the most common cancers were breast cancer (n=12, 16.7%) followed by ovarian cancer (n=10, 13.9%) and Cancer Colon (n=8, 11.1%). Patients with PPS score 30% were 27.9% (n=39), 40% in 40.7% (n=57), and 50% in 17.1% (n=24) respectively. Patients referred from the Specialized Cancer Center had significantly higher portion of patients with PPS score > 30% (73.4%, n=94), compared to patients coming from general hospitals (33.3%, n=4), P value= 0.007. Conclusion: There is significant difference in PPS scores between patients referred from the Specialized Cancer Center compared to patients referred from general hospitals. We encourage that all cancer patients should be treated in Specialized Cancer Centers and earlier involvement of Palliative Care Centers to achieve better survival. Training workshops are needed for health care professionals working in general hospitals to raise awareness about earlier referral of patients to palliative care services.

Keywords: palliative care, kuwait, performance scale differences, pps score, specialized hospitals

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Authors: Wafa Al Jabri

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Background: In Middle Eastern Countries (MECs), there is a high prevalence of genetic blood disorders (GBDs), particularly sickle cell disease and thalassemia. The GBDs are considered a major public health concern that place a huge burden to individuals, families, communities, and health care systems. The high rates of consanguineous marriages, along with the unacceptable termination of at-risk pregnancy in MECs, reduce the possible solutions to control the high prevalence of GBDs. Since the early 1970s, most of MECs have started introducing premarital screening services (PSS) as a preventive measure to identify the asymptomatic carriers of GBDs and to provide genetic counseling to help couples plan for healthy families; yet, the success rate of PSS is very low. Purpose: This paper aims to highlight the factors that affect the success of PSS in MECs. Methods: An integrative review of articles located in CINAHL, PubMed, SCOPUS, and MedLine was carried out using the following terms: “premarital screening,” “success,” “effectiveness,” and “ genetic blood disorders”. Second, a hand search of the reference lists and Google searches were conducted to find studies that did not exist in the primary database searches. Only studies which are conducted in MECs and published after 2010 were included. Studies that were not published in English were excluded. Results: Eighteen articles were included in the review. The results showed that PSS in most of the MECs was successful in achieving its objective of identifying high-risk marriages; however, the service failed to meet its ultimate goal of reducing the prevalence of GBDs. Various factors seem to hinder the success of PSS, including poor public awareness, late timing of the screening, culture and social stigma, lack of prenatal diagnosis services and therapeutic abortion, emotional factors, religious beliefs, and lack of genetic counseling services. However, poor public awareness, late timing of the screening, religious misbeliefs, and the lack of adequate counseling services were the most common barriers identified. Conclusion and Implications: The review help in providing a framework for an effective preventive measure to reduce the prevalence of GBDs in MECS. This framework focuses primarily in overcoming the identified barriers by providing effective health education programs in collaboration with religious leaders, offering the screening test to young adults at an earlier stage, and tailoring the genetic counseling to consider people’s values, beliefs, and preferences.

Keywords: premarital screening, middle east, genetic blood disorders, factors

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Authors: Ana L. Martins, Luis Orfão

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Healthcare systems have been subject to various research efforts aiming at process improvement under a lean approach. Another perspective, agility, has also been used, though in a lower scale, in order to analyse the ability of different hospital services to adapt to demand uncertainties. Both perspectives have a common denominator, the improvement of effectiveness and efficiency of the services in a healthcare setting context. Mixing the two approached allows, on one hand, to streamline the processes, and on the other hand the required flexibility to deal with demand uncertainty in terms of both volume and variety. The present research aims to analyse the impacts of the combination of both perspectives in the effectiveness and efficiency of an hospital service. The adopted methodology is based on a case study approach applied to the process of the ambulatory surgery service of Hospital de Lamego. Data was collected from direct observations, formal interviews and informal conversations. The analyzed process was selected according to three criteria: relevance of the process to the hospital, presence of human resources, and presence of waste. The customer of the process was identified as well as his perception of value. The process was mapped using flow chart, on a process modeling perspective, as well as through the use of Value Stream Mapping (VSM) and Process Activity Mapping. The Spaghetti Diagram was also used to assess flow intensity. The use of the lean tools enabled the identification of three main types of waste: movement, resource inefficiencies and process inefficiencies. From the use of the lean tools improvement suggestions were produced. The results point out that leagility cannot be applied to the process, but the application of lean and agility in specific areas of the process would bring benefits in both efficiency and effectiveness, and contribute to value creation if improvements are introduced in hospital’s human resources and facilities management.

Keywords: case study, healthcare systems, leagility, lean management

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Authors: Stefaan Carpentier, Aya Al Masri, Fabrice Leroy, Thibault Julien, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may become very high for a burn, necrosis, and ulceration to appear. In order to prevent these deterministic effects, a prediction of the peak skin-dose for the patient is important in order to improve the post-operative care to be given to the patient. The objective of this study is to estimate, before the intervention, the patient dose for ‘Chronic Total Occlusion (CTO)’ procedures by selecting relevant clinical indicators. Materials and methods: 103 procedures were performed in the ‘Interventional Cardiology (IC)’ department using a Siemens Artis Zee image intensifier that provides the Air Kerma of each IC exam. Peak Skin Dose (PSD) was measured for each procedure using radiochromic films. Patient parameters such as sex, age, weight, and height were recorded. The complexity index J-CTO score, specific to each intervention, was determined by the cardiologist. A correlation method applied to these indicators allowed to specify their influence on the dose. A predictive model of the dose was created using multiple linear regressions. Results: Out of 103 patients involved in the study, 5 were excluded for clinical reasons and 2 for placement of radiochromic films outside the exposure field. 96 2D-dose maps were finally used. The influencing factors having the highest correlation with the PSD are the patient's diameter and the J-CTO score. The predictive model is based on these parameters. The comparison between estimated and measured skin doses shows an average difference of 0.85 ± 0.55 Gy for doses of less than 6 Gy. The mean difference between air-Kerma and PSD is 1.66 Gy ± 1.16 Gy. Conclusion: Using our developed method, a first estimate of the dose to the skin of the patient is available before the start of the procedure, which helps the cardiologist in carrying out its intervention. This estimation is more accurate than that provided by the Air-Kerma.

Keywords: chronic total occlusion procedures, clinical experimentation, interventional radiology, patient's peak skin dose

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Authors: Latifah Putti Tiananda, Sasti Khoirunnisa, Taniadiana Yapwito, Jessica Noviena

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Innovations are often met with two responses, acceptance or rejection. In the past few years, Indonesia is experiencing a revolution of transportation service, which utilizes online platform for its operation. Such improvement is welcomed by consumers and challenged by conventional or ‘non-online’ transportation providers simultaneously. Conflicts arise as the existence of this online transportation mode results in declining income of non-online transportation workers. Physical confrontations and demonstrations demand policing from central authority. However, the obscurity of legal measures from the government persists the social instability. Bandung, a city in West Java with the highest rate of online transportation usage, has recently issued a recommendation withholding the operation of online transportation services to maintain peace and order. Thus, this paper seeks to elaborate the social unrest between the two contesting transportation actors in Bandung and explore community-based approaches to solve this problem. Using qualitative research method, this paper will also feature in-depth interviews with directly involved sources from Bandung.

Keywords: Bandung, market competition, online transportation services, social unrest

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Authors: Mary Farrell, Maria Soubra, Sandra Vega, Dorothy Kakraba, Joanne Fontanilla, Moira Kendra, Danielle Tonzola, Stephanie Chiu

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Pneumonia is the most common infectious cause of hospitalizations in the United States, with more than one million admissions annually and costs of $10 billion every year, making it the 8th leading cause of death. Aspiration pneumonia is an aggressive type of pneumonia that results from inhalation of oropharyngeal secretions and/or gastric contents and is preventable. The authors hypothesized that an evidence-based aspiration pneumonia clinical care pathway could reduce 30-day hospital readmissions and mortality rates, while improving the overall care of patients. We conducted a retrospective chart review on 979 patients discharged with aspiration pneumonia from January 2021 to December 2022 at Overlook Medical Center. The authors identified patients who were coded with aspiration pneumonia and/or stable sepsis. Secondarily, we identified 30-day readmission rates for aspiration pneumonia from a SNF. The Aspiration Pneumonia Clinical Care Pathway starts in the emergency department (ED) with the initiation of antimicrobials within 4 hours of admission and early recognition of aspiration. Once this is identified, a swallow test is initiated by the bedside nurse, and if the patient demonstrates dysphagia, they are maintained on strict nothing by mouth (NPO) followed by a speech and language pathologist (SLP) referral for an appropriate modified diet recommendation. Aspiration prevention techniques included the avoidance of straws, 45-degree positioning, no talking during meals, taking small bites, placement of the aspiration wrist band, and consuming meals out of the bed in a chair. Nursing education was conducted with a newly created online learning module about aspiration pneumonia. The authors identified 979 patients, with an average age of 73.5 years old, who were diagnosed with aspiration pneumonia on the index hospitalization. These patients were reviewed for a 30-day readmission for aspiration pneumonia or stable sepsis, and mortality rates from January 2021 to December 2022 at Overlook Medical Center (OMC). The 30-day readmission rates were significantly lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011). When evaluating the mortality rates in the pre and post intervention cohort the authors discovered the mortality rates were lower in the post intervention cohort (23.7% vs 22.4%, p = 0.61) Mortality among non-white (self-reported as non-white) patients were lower in the post intervention cohort (34.4% vs. 21.0% , p = 0.05). Patients who reported as a current smoker/vaper in the pre and post cohorts had increased mortality rates (5.9% vs 22%). There was a decrease in mortality for the male population but an increase in mortality for women in the pre and post cohorts (19% vs. 25%). The authors attributed this increase in mortality in the post intervention cohort to more active smokers, more former smokers, and more being admitted from a SNF. This research identified that implementation of an Aspiration Pneumonia Clinical Care Pathway showed a statistically significant decrease in readmission rates and mortality rates in non-whites. The 30-day readmission rates were lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011).

Keywords: aspiration pneumonia, mortality, quality improvement, 30-day pneumonia readmissions

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Authors: Diego Roberto Goncalves De Pontes, Sergio Donizetti Zorzo

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Studies show that most users do not read privacy policies from the online services they use. Some authors claim that one of the main causes of this is that policies are long and usually hard to understand, which make users lose interest in reading them. In this scenario, users may agree with terms without knowing what kind of data is being collected and why. Given that, we aimed to develop a model that would present the privacy policies contents in an easy and graphical way for the user to understand. We call it the Privacy Label. Using information recovery techniques, we propose an architecture that is able to extract information about what kind of data is being collected and to what end in the policies and show it to the user in an automated way. To assess our model, we calculated the precision, recall and f-measure metrics on the information extracted by our technique. The results for each metric were 68.53%, 85.61% e 76,13%, respectively, making it possible for the final user to understand which data was being collected without reading the whole policy. Also, our proposal can facilitate the notice-and-choice by presenting privacy policy information in an alternative way for online users.

Keywords: privacy, policies, user behavior, computer human interaction

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Authors: Naiara Ozamiz Etcebarria, Sonia Ruiz De Azua Garcia, Agurtzane Ortiz Jauregi, Virginia Guillen Cañas

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Introduction: The most relevant competencies of a health professional are an adequate communication capacity, which will influence the satisfaction of professionals and patients, therapeutic compliance, conflict prevention, clinical outcomes´ improvement and efficiency of health services. The ability of Active listening , empathy, assertiveness and social skills, are important abilities to develop in all professions in which there is a relationship with other people. In the field of health, it is even more important to have adequate qualities so that the treatment with the patient will be adequate and satisfactory. We conducted a research with students of third year in the Degree of Medicine with the objectives: - to know how the active listening, empathy, assertiveness and social skills of students are. - to know if there are differences according to different demographic variables, such as sex, language, age, number of siblings and interest in the subject. Material and Methods: The students of the Third year in the Degree of Medicine (N = 212) participated voluntarily. Sociodemographic data were collected. Descriptive and comparative analysis of the averages of the students with respect to active listening, empathy, assertiveness and social skills were performed. Once the questionnaires were collected, they were entered into the SPSS 21 database. Four communicational aspects were evaluated: The active listening questionnaire, the TECA empathy questionnaire, the ACDA questionnaire and the EHS questionnaire Social Skills Scale. The active listening questionnaire assesses these factors: Listening without interruption and less contradiction, Listening with 100% attention, Listening beyond words, Listening encouraging the other to go deeper. The TECA questionnaire of cognitive and affective empathy evaluates: Adoption of perspectives, Emotional Comprehension, Emphasizing stress, Empathic joy. The EHS questionnaire Social Skills Scale: Self-expression in social situations, Defending one's own rights as a consumer, Expressing anger or dissatisfaction, Refusing to do and cutting interactions off, Making requests, Initiating positive interactions with the other sex. The ACDA questionnaire Assertiveness Assessment Scale evaluates self-assertiveness and heteroaservitivity. Applicability: To train these skills is so important for clinical practice of medical students and these capabilities that can be measured in a longitudinal way time. Ethical-legal aspects: The data were anonymous. The study was approved by the Ethics Committee. Results: The students of the Third year in the Degree of Medicine (34.4% Basque speakers and 65.6% Spanish speakers) with average age 20.93, (27.8% men and 72.2% women). There are no differences in social skills between men and women. The Basque speaker students of are more heteroactive (ACDA) than Spanish students. Active listening has a high correlation with social skills, especially with self-expression in social situations. Listening without interruption has a high correlation with self-expression in social situations and initiating positive interactions with the opposite sex. Adoption of perspectives presents a high correlation with auto- assertiveness. Emotional understanding presents a high correlation with positive interactions with the opposite sex. Empathic joy correlates with self-assertiveness, self-expression in social situations, and initiating positive interactions with the opposite sex.

Keywords: active listening, assertiveness, communicational skills, empathy, students of medicine

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Authors: Hyunjoo Choi, Jeonghun Nam, Chae Seung Lim

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Acoustomicrofluidics has gained much attention due to the advantages, such as noninvasiveness and easy integration with other miniaturized systems, for clinical and biological applications. However, a limitation of acoustomicrofluidics is the complicated and costly fabrication process of electrodes. In this study, we propose a low-cost and lithography-free device using Lamb wave for blood analysis. Using a Lamb wave, calcium ion-removed blood plasma and coagulation reagents can be rapidly mixed for blood coagulation test. Due to the coagulation process, the viscosity of the sample increases and the viscosity change can be monitored by internal acoustic streaming of microparticles suspended in the sample droplet. When the acoustic streaming of particles stops by the viscosity increase is defined as the coagulation time. With the addition of calcium ion at 0-25 mM, the coagulation time was measured and compared with the conventional index for blood coagulation analysis, prothrombin time, which showed highly correlated with the correlation coefficient as 0.94. Therefore, our simple and cost-effective Lamb wave-based blood analysis device has the powerful potential to be utilized in clinical settings.

Keywords: acoustomicrofluidics, blood analysis, coagulation, lamb wave

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Authors: Mahboobe Daneshvar

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Introduction: Clinical studies on the effect of systemic conditions on periodontal diseases have shown that some systemic deficiencies may provide grounds for the onset of periodontal diseases. One of these systemic problems is osteoporosis, which may be a risk factor for the onset and exacerbation of periodontitis. This study tends to evaluate periodontal indices in osteoporotic menopausal women and compare them with healthy controls. Materials and Methods: In this case-control study, participants included 45-75-year-old menopausal women referred to rheumatology wards of the Khatamolanbia Clinic and Shahid Sadoughi Hospital in Yazd; Their bone density was determined by DEXA-scan and by imaging the femoral-lumbar bone. Thirty patients with osteoporosis and 30 subjects with normal BMD were selected. Then, informed consent was obtained for participation in the study. During the clinical examinations, tooth loss (TL), plaque index (PI), gingival recession, pocket probing depth (PPD), clinical attachment loss (CAL), and tooth mobility (TM) were measured to evaluate the periodontal status. These clinical examinations were performed to determine the periodontal status by catheter, mirror and probe. Results: During the evaluation, there was no significant difference in PPD, PI, TM, gingival recession, and CAL between case and control groups (P-value>0.05); that is, osteoporosis has no effect on the above factors. These periodontal factors are almost the same in both healthy and patient groups. In the case of missing teeth, the following results were obtained: the mean of missing teeth was 22.173% of the total teeth in the case group and 18.583% of the total teeth in the control group. In the study of the missing teeth in the case and control groups, there was a significant relationship between case and control groups (P-value = 0.025). Conclusion: In fact, since periodontal disease is multifactorial and microbial plaque is the main cause, osteoporosis is considered a predisposing factor in exacerbation or persistence of periodontal disease. In patients with osteoporosis, usually pathological fractures, hormonal changes, and aging lead to reduced physical activity and affect oral health, which leads to the manifestation of periodontal disease. But this disease increases tooth loss by changing the shape and structure of bone trabeculae and weakening them. Osteoporosis does not seem to be a deterministic factor in the incidence of periodontal disease, since it affects bone quality rather than bone quantity.

Keywords: plaque index, Osteoporosis, tooth mobility, periodontal packet

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Authors: Marzieh Yassin, Masoud Rashed, Soheil Mansour Sohani, Reza Salehi

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Background: Hip arthroplasty is one of the surgical methods to improve symptoms in patients with hip osteoarthritis. The use of electroacupuncture and TENS reduces pain, increases range of motion and improves performance. Methods: In this clinical trial study, 30 patients after hip arthroplasty were randomly divided into two groups: electroacupuncture (n=16) with exercise therapy and TENS with exercise therapy (n=14). Severity of pain, quality of life, range of motion, edema and function were evaluated in two groups before and after the interventions. Interventions of 10 sessions (three sessions per week) were conducted for two groups. The significance level in all tests was below 0.05. Results: The results showed that both groups improved all of the symptoms after the intervention (p≤0.05), although there was no statistically significant difference between the two groups in terms of effectiveness (p≥0.05). Conclusion: The results showed that both methods improve symptoms in patients after surgery. According to this study, electroacupuncture is suggested as a new method effective for the treatment of people with post-Total Hip Arthroplasty.

Keywords: electroacupuncture, physical performance, total hip arthroplasty, TENS

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Authors: V. Vicente E. Mujica, Gustavo Gonzalez

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The global coverage of broadband multimedia and internet-based services in terrestrial-satellite networks demand particular interests for satellite providers in order to enhance services with low latencies and high signal quality to diverse users. In particular, the delay of on-board processing is an inherent source of latency in a satellite communication that sometimes is discarded for the end-to-end delay of the satellite link. The frame work for this paper includes modelling of an on-orbit satellite payload using an agent model that can reproduce the properties of processing delays. In essence, a comparison of different spatial interpolation methods is carried out to evaluate physical data obtained by an GEO satellite in order to define a discretization function for determining that delay. Furthermore, the performance of the proposed agent and the development of a delay discretization function are together validated by simulating an hybrid satellite and terrestrial network. Simulation results show high accuracy according to the characteristics of initial data points of processing delay for Ku bands.

Keywords: terrestrial-satellite networks, latency, on-orbit satellite payload, simulation

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Authors: Debra L. Stanley, Gabriela Wasileski

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Offenders face many challenges as they transition from being incarcerated to the community, ranging from housing and employment needs to long standing problems with addictions and mental health issues. A lack of appropriate behavioral health services in the more remote parts of the United States has led to a significant illegal substance abuse problem, housing instability, and unaddressed mental health and trauma issues. High rates of poverty and unemployment exacerbate the growing behavioral health issues, drug overdoses, co-occurring disorders, and crime that are so prevalent across rural communities. This study examines the challenges of rural jail reentry faced by offenders in a treatment capacity. The client-centered evidence-based program is uniquely designed to provide continuity of care that focuses on issues which affect rural communities. Prior to release from jail, individuals go through comprehensive assessment screenings to measure mental health and substance use disorder as well as trauma and prior crime victimization histories; the assessments help to target client-specific services. The quasi-experimental research design tracks clients throughout their recovery and reintegration into the community. Individuals in a rural program often do not have the benefit of easy access or peer mentoring that is so often found in urban recovery programs. Therefore, much of the support is provided through telehealth and e-services. The goal of this study is to explore the nature of rural reentry programs and measures of recidivism, drug overdoses, and other behavioral health needs and successful reentry to include stable housing and employment.

Keywords: jail reentry, rehabilitation, behavioral health, drug abuse, recidivism

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Authors: Tess Hartland, Moitree Banerjee, Sue Churchill, Antonina Pereira, Ian Tyndall, Ruth Lowry

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Background: Sexual health services and policies for middle-aged and older adults are underdeveloped, while global sexually transmitted infections in this age group are on the rise. The Interreg cross-Europe Sexual Health In Over 45s (SHIFT) project aims to increase participation in sexual health services and improve sexual health and wellbeing in people aged over 45, with an additional focus on disadvantaged groups. Methods: A two-pronged mixed-methodology is being used to develop a model for good service provision in sexual health for over 45s. (1) Following PRISMA-ScR guidelines, a scoping review is being conducted, using the databases PsychINFO, Web of Science, ERIC and PubMed. A key search strategy using terms around sexual health, good practice, over 45s and disadvantaged groups. The initial search for literature yielded 7914 results. (2) Surveys (n=1000) based on the Theory of Planned Behaviour are being administered across the UK, Belgium and Netherlands to explore current sexual health knowledge, awareness and attitudes. Expected results: It is expected that sexual health needs and potential gaps in service provision will be identified in order to inform good practice for sexual health services for the target population. Results of the scoping review are being analysed, while focus group and survey data is being gathered. Preliminary analysis of the survey data highlights barriers to access such as limited risk awareness and stigma. All data analysis will be completed by the time of the conference. Discussion: Findings will inform the development of a model to improve sexual health and wellbeing for among over 45s, a population which is often missed in sexual health policy improvement.

Keywords: adult health, disease prevention, health promotion, over 45s, sexual health

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Authors: Samaneh Pouyanfar, Michael Oliff

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The industry of home appliances may beone of theindustries which has the highest competition, and actually what can guarantee the survival of this industry is discovering the superior services. A trend to provide quality products and services plays an important role in this industry because discovering the services is counted as a vital affair for Manufacturing Organizations’ survival and profitability. Given the importance of the topic, this paper attempts to investigate the relative priority of the factors influencing the customer satisfaction in gaining the competitive advantage in Pars-Khazar Company. In sum, 96 executives of Pars-Khazar Company where investigated in a census. For this purpose, after reviewing the research literature and performing deep interviews between pundits and experts active in the industry, the research questionnaire was made based on variables affecting customer satisfaction and components determining business competitive advantage. Determining the content validity took place by judgement of the experts. The reliability of each structure was measured based on Cronbach’s alpha coefficient. Since the value of Cronbach's alpha was higher than 0.7 for each structure, internal consistency of statements was high and the reliability of the questionnaire was acceptable. The data analysis was also done with Kulmgrf-asmyrnf test and Friedman test using SPSS software. The results showed that in dimension of factors affecting customer satisfaction, the History of trade name (brand), Familiarity with the product brand, Brand reputation and Safety have the highest value of priority respectively, and the variable of firm growth has the highest value of priority among the components determining the performance of competitive advantage.

Keywords: customer satisfaction, competitive advantage, brand history, safety, growth

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Authors: Mahkameh Asadi, Habibollah Dadgar

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The precise definition margin of high and low-grade glioma is crucial for choosing best treatment approach after surgery and radio-chemotherapy. The aim of the current study was to assess the O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) positron emission tomography (PET)/computed tomography (CT) in patients with low (LGG) and high grade glioma (HGG). We retrospectively analyzed 18F-FET PET/CT of 10 patients (age: 33 ± 12 years) with suspicious for recurrent LGG and HGG. The final decision of recurrence was made by magnetic resonance imaging (MRI) and registered clinical data. While response to radio-chemotherapy by MRI is often complex and sophisticated due to the edema, necrosis, and inflammation, emerging amino acid PET leading to better interpretations with more specifically differentiate true tumor boundaries from equivocal lesions. Therefore, integrating amino acid PET in the management of glioma to complement MRI will significantly improve early therapy response assessment, treatment planning, and clinical trial design.

Keywords: positron emission tomography, amino acid positron emission tomography, magnetic resonance imaging, low and high grade glioma

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Authors: Brogan Guest, Amy Donaldson-Perrott

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

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

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Authors: K. Mellou, G. Anastopoulos, T. Zakinthinos, C. Botsi, A. Terzidis

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‘PHILOS – Emergency health response to refugee crisis’ is a programme of the Greek Ministry of Health, implemented by the Hellenic Center for Disease Control and Prevention (HCDCP). The programme is funded by the Asylum, Migration and Integration Fund (AMIF) of EU’s DG Migration and Home Affairs. With the EU Member States accepting, the last period, accelerating migration flows, Greece inevitably occupies a prominent position in the migratory map due to this geographical location. The main objectives of the programme are a) reinforcement of the capacity of the public health system and enhancement of the epidemiological surveillance in order to cover refugees/migrant population, b) provision of on-site primary health care and psychological support services, and c) strengthening of national health care system task-force. The basic methods for achieving the aforementioned goals are: a) implementation of syndromic surveillance system at camps and enhancement of public health response with the use of mobile medical units (Sub-action A), b) enhancement of health care services inside the camps via increasing human resources and implementing standard operating procedures (Sub-action B), and c) reinforcement of the national health care system (primary healthcare units, hospitals, and emergency care spots) of affected regions with personnel (Sub-action C). As a result, 58 health professionals were recruited under sub-action 2 and 10 mobile unit teams (one or two at each health region) were formed. The main actions taken so far by the mobile units are the evaluation, of syndromic surveillance, of living conditions at camps and medical services. Also, vaccination coverage of children population was assessed, and more than 600 catch-up vaccinations were performed by the end of June 2017. Mobile units supported transportation of refugees/migrants from camps to medical services reducing the load of the National Center for Emergency Care (more than 350 transportations performed). The total number of health professionals (MD, nurses, etc.) placed at camps was 104. Common practices were implemented in the recording and collection of psychological and medical history forms at the camps. Protocols regarding maternity care, gender based violence and handling of violent incidents were produced and distributed at personnel working at camps. Finally, 290 health care professionals were placed at primary healthcare units, public hospitals and the National Center for Emergency Care at affected regions. The program has, also, supported training activities inside the camps and resulted to better coordination of offered services on site.

Keywords: migrants, refugees, public health, syndromic surveillance, national health care system, primary care, emergency health response

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Authors: Michal Christina Steven, Mohd. Yusof Hj Ibrahim, Haryati Abdul Karim, Prabakaran Dhanaraj, Kelly Alexius Mansin

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After 27 years, Malaysia reported polio cases in 2019 involving the children of the undocumented migrants living in Sabah. These undocumented migrants present a significant challenge in achieving the elimination of vaccine-preventable diseases (VPD). Due to the recent polio outbreak among the undocumented migrant children in Sabah, an in-depth interview was conducted among the caregivers of undocumented migrant children to identify the barriers and drivers towards vaccinating their children. Financial barriers, legal citizenship status, language barrier, the COVID-19 pandemic, and physical barriers have been the barriers to access vaccination services by undocumented migrants. Five significant drivers for undocumented migrants to vaccinate their children are social influence, fear of disease, parental trust in healthcare providers, good support, and vaccine availability. Necessary action should be taken immediately to address the problems of vaccinating the children of undocumented migrants to prevent the re-emergence of VPD.

Keywords: Malaysia, polio, Sabah, undocumented migrants

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Authors: Jawad Alzeer

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Cultural setup is varied from country to country and nation to nation, but the ability to adapt successfully to the new cultural setup may pave the way toward the development of cultural intelligence. Overcoming differences may require to build up our personality with the ability to learn, exchange thoughts, and have a constructive dream. Adaptation processes can be accelerated if we effectively utilize our cultural diversity. This can be done through a unified body or society; people with common goals can collectively work to satisfy their values. Narrowing the gap between developed and developing countries is of prime importance. Many international organizations are trying to resolve these issues by rational and peaceful means. Failing to understand the cultural differences, mentalities, strengths and weaknesses of developed and developing countries led to the collapse of many partnerships. Establishment of a neutral body influenced by developed countries intellectuality and developing countries personality may offer a better understanding and reasonable solutions, suggestions, advice that may assist in narrowing gaps and promote-strengthening relationship between developed and developing countries. The key issues, goals, and potential concepts associated with initiating Swiss scientific society for developing countries as a model to facilitate integration of highly skilled scientists are discussed.

Keywords: cultural diversity, developing countries, integration, Switzerland

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Authors: Manas Tripathi, Arunabha Mukhopadhyay

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In Cloud computing environment, cloud servers, sometimes may crash after receiving huge amount of request and cloud services may stop which can create huge loss to users of that cloud services. This situation is called Denial of Service (DoS) attack. In Distributed Denial of Service (DDoS) attack, an attacker targets multiple network paths by compromising various vulnerable systems (zombies) and floods the victim with huge amount of request through these zombies. There are many solutions to mitigate this challenge but most of the methods allows the attack traffic to arrive at Cloud Service Provider (CSP) and then only takes actions against mitigation. Here in this paper we are rather focusing on preventive mechanism to deal with these attacks. We analyze network topology and find most vulnerable paths beforehand without waiting for the traffic to arrive at CSP. We have used Dijkstra's and Yen’s algorithm. Finally, risk assessment of these paths can be done by multiplying the probabilities of attack for these paths with the potential loss.

Keywords: cloud computing, DDoS, Dijkstra, Yen’s k-shortest path, network security

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Authors: Yenisleidy Martínez-Martínez, Yannay Casas-Ledón, Jo Dewulf

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Wind power constitutes a cleaner energy source with smaller unfavorable impacts on the environment than fossil fuels. Its development could be an alternative to fight climate change while meeting energy demands. However, wind energy development requires first determining the existing potential and areas with aptitude. Also, potential socio-economic and environmental impacts should be analyzed to prevent social rejection of this technology. In this context, this work performs a suitability assessment on a GIS environment to locate suitable areas for wind energy expansion in South-Central Chile. In addition, suitable areas were characterized in terms of potential goods and services to be produced as a proxy for analyzing potential impacts and trade-offs. First, layers of annual wind speed were generated as they represent the resource potential, and layer representing previously defined territorial constraints were created. Zones depicting territorial constraints were removed from resource measurement layers to identify suitable sites. Then, the appropriation of the primary production in suitable sites was determined to measure potential ecosystem services derived from human interventions in those areas. Results show that approximately 52% of the total surface of the study area has a good aptitude to install wind farms. In this area, provisioning services like food crops production, timber, and other forest resources like firewood play a key role in the regional economy and thus are the main cause of human interventions. This is reflected by human appropriation of the primary production values of 0.71 KgC/m².yr, 0.36 KgC/m².yr, and 0.14 KgC/m².yr, respectively. In this sense, wind energy development could be compatible with croplands, which is the predominant land use in suitable areas, and provide farmers with cheaper energy and extra income. Also, studies have reported changes in local temperature associated with wind turbines, which could be beneficial to crop growth. The results obtained in this study prove to be useful for identifying available areas for wind development, which could be very useful in decision-making processes related to energy planning.

Keywords: net primary productivity, provisioning services, suitability assessment, wind energy

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Authors: Shuen-Tai Wang, Hsi-Ya Chang

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Cloud computing is becoming more and more matured over the last few years and consequently the demands for better cloud services is increasing rapidly. One of the research topics to improve cloud services is the desktop computing in virtualized environment. This paper aims at the development of an adaptive virtual desktop service in cloud computing platform based on our previous research on the virtualization technology. We implement cloud virtual desktop and application software streaming technology that make it possible for providing Virtual Desktop as a Service (VDaaS). Given the development of remote desktop virtualization, it allows shifting the user’s desktop from the traditional PC environment to the cloud-enabled environment, which is stored on a remote virtual machine rather than locally. This proposed effort has the potential to positively provide an efficient, resilience and elastic environment for online cloud service. Users no longer need to burden the platform maintenances and drastically reduces the overall cost of hardware and software licenses. Moreover, this flexible remote desktop service represents the next significant step to the mobile workplace, and it lets users access their desktop environments from virtually anywhere.

Keywords: cloud computing, virtualization, virtual desktop, VDaaS

Procedia PDF Downloads 286

Authors: El Hadji Mamadou Sonko, Ndiogou Sankhare, Maïmouna Lo, Jean Birane Gning, Cheikh Diop

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In Senegal, access to water, hygiene, and sanitation in small island towns is a particular problem, which is still poorly understood by the public authorities and development aid actors. The main objective of this study carried out in the Municipality of Foundiougne is to contribute to the knowledge of the problems related to the supply of drinking water, access to sanitation, and hygiene in small island towns in Senegal. The methodology adopted consisted of a literature review and quantitative surveys of a sample of 100 households in the Municipality. Semi-structured interviews using interview guides and informal interviews were also conducted with mechanical and manual emptiers, municipal authorities, public toilet managers, and neighbourhood leaders. Direct observation with photography was also used. The results show that, with regard to access to drinking water, 35% of households have unimproved water services, 46% have a limited level of service, and 19% have a basic level of service. Regarding sanitation, 77% of households are considered to have access to basic sanitation services, compared to 23% with limited sanitation services. However, these figures hide the dysfunctions of the sanitation system. Indeed, manual emptying is practiced exclusively by 4% of households, while 17% of households combine it with mechanical emptying. In addition, domestic wastewater is mainly evacuated outside the sanitation facilities, and all the sludge extracted from the pits is discharged directly into the environment without treatment. As a matter of fact, the surveys showed that 52% of households do not have access to a basic level of hygiene-related to handwashing when leaving the toilet. These results show that there is real work to be done at the level of small urban centres if we want to achieve MDG 6.

Keywords: Foundiougne, Senegal, small island, small town, water-sanitation, hygiene

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Authors: Till Gramberg, Erwin Gross, Christoph Birenbaum

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This paper presents the approach of the Easy2IoT research project. Easy2IoT aims to enable companies in the prefabrication sheet metal and sheet metal processing industry to enter the Industrial Internet of Things (IIoT) with a low-threshold and cost-effective approach. It focuses on the development of physical hardware and software to easily capture machine activities from on a sawing machine, benefiting various stakeholders in the SME value chain, including machine operators, tool manufacturers and service providers. The methodological approach of Easy2IoT includes an in-depth requirements analysis and customer interviews with stakeholders along the value chain. Based on these insights, actions, requirements and potential solutions for smart services are derived. The focus is on providing actionable recommendations, competencies and easy integration through no-/low-code applications to facilitate implementation and connectivity within production networks. At the core of the project is a novel, non-invasive measurement and analysis system that can be easily deployed and made IIoT-ready. This system collects machine data without interfering with the machines themselves. It does this by non-invasively measuring the tension on a sawing machine. The collected data is then connected and analyzed using artificial intelligence (AI) to provide smart services through a platform-based application. Three Smart Services are being developed within Easy2IoT to provide immediate benefits to users: Wear part and product material condition monitoring and predictive maintenance for sawing processes. The non-invasive measurement system enables the monitoring of tool wear, such as saw blades, and the quality of consumables and materials. Service providers and machine operators can use this data to optimize maintenance and reduce downtime and material waste. Optimize Overall Equipment Effectiveness (OEE) by monitoring machine activity. The non-invasive system tracks machining times, setup times and downtime to identify opportunities for OEE improvement and reduce unplanned machine downtime. Estimate CO2 emissions for connected machines. CO2 emissions are calculated for the entire life of the machine and for individual production steps based on captured power consumption data. This information supports energy management and product development decisions. The key to Easy2IoT is its modular and easy-to-use design. The non-invasive measurement system is universally applicable and does not require specialized knowledge to install. The platform application allows easy integration of various smart services and provides a self-service portal for activation and management. Innovative business models will also be developed to promote the sustainable use of the collected machine activity data. The project addresses the digitalization gap between large enterprises and SME. Easy2IoT provides SME with a concrete toolkit for IIoT adoption, facilitating the digital transformation of smaller companies, e.g. through retrofitting of existing machines.

Keywords: smart services, IIoT, IIoT-platform, industrie 4.0, big data

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Authors: Bui Phuong Linh, Yuki Sakakibara, Ryuto Tanaka, Elizabeth H. Pigney, Taishi Hashiguchi

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Non-alcoholic steatohepatitis (NASH) is a chronic liver disease, often associated with type II diabetes, which sometimes progresses to more serious conditions such as liver fibrosis and hepatocellular carcinoma (HCC). NASH has become an important health problem worldwide, buttherapeutic agents for NASH have not yet been approved, and animal models with high clinical correlation are required. TheSTAM™ mouse shows the same pathological progression as human NASH patients and has been widely used for both drug efficacy and basic research, such as lipid profiling and gut microbiota research. In this study, we analyzed the RNA-seq data of STAM™mice at each pathological stage (steatosis, steatohepatitis, liver fibrosis, and HCC) and examined the clinical correlation at the genetic level. NASH was induced in male mice by a single subcutaneous injection of 200 µg streptozotocin solution 2 days after birth and feeding with high fat dietafter 4 weeks of age. The mice were sacrificed and livers collected at 6, 8, 10, 12, 16, and 20 weeks of age. For liver samples, the left lateral lobe was snap frozen in liquid nitrogen and stored at -80˚C for RNA-seq analysis. Total RNA of the cells was isolated using RNeasy mini kit. The gene expression of the canonical pathways in NASH progression from steatosis to hepatocellular carcinoma were analyzed, such as immune system process, oxidation-reduction process, lipid metabolic process. Moreover, since it has been reported that genetic traits are involved in the development of NASH-HCC, we next analyzed the genetic mutations in the STAM™mice. The number of individuals showing mutations in Mtorinvolved in Insulin signaling increases as the disease progresses, especially in the liver cancer phase. These results indicated a clinical correlation of gene profiles in the STAM™mouse.

Keywords: steatosis, non-alcoholic steatohepatitis, fibrosis, hepatocellular carcinoma, RNA-seq

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Authors: Shazia Anwer Bukhari, Madiha Javeed Ghani, Muhammad Ibrahim Rajoka

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Objective: Biochemical, environmental, physical and genetic factors have a strong effect on the development of coronary disease (CAD). Plasma homocysteine (Hcy) level and DNA damage play a pivotal role in its development and progression. The aim of this study was to investigate the predictive strength of an oxidative stress, clinical biomarkers and total antioxidant status (TAS) in CAD patients to find the correlation of homocysteine, TOS and oxidative DNA damage with other clinical parameters. Methods: Sixty confirmed patients with CAD and 60 healthy individuals as control were included in this study. Different clinical and laboratory parameters were studied in blood samples obtained from patients and control subjects using commercially available biochemical kits and statistical software Results: As compared to healthy individuals, CAD patients had significantly higher concentrations of indices of oxidative stress: homocysteine (P=0.0001), total oxidative stress (TOS) (P=0.0001), serum cholesterol (P=0.04), low density lipoprotein cholesterol (LDL) (P=0.01), high density lipoprotein-cholesterol (HDL) (P=0.0001), and malondialdehyde (MDA) (P=0.001) than those of healthy individuals. Plasma homocysteine level and oxidative DNA damage were positively correlated with cholesterol, triglycerides, systolic blood pressure, urea, total protein and albumin (P values= 0.05). Both Hcy and oxidative DNA damage were negatively correlated with TAS and proteins. Conclusion: Coronary artery disease patients had a significant increase in homocysteine level and DNA damage due to increased oxidative stress. In conclusion, our study shows a significantly increase in lipid peroxidation, TOS, homocysteine and DNA damage in the erythrocytes of patients with CAD. A significant decrease level of HDL-C and TAS was observed only in CAD patients. Therefore these biomarkers may be useful diagnosis of patients with CAD and play an important role in the pathogenesis of CAD.

Keywords: antioxidants, coronary artery disease, DNA damage, homocysteine, oxidative stress, malondialdehyde, 8-Hydroxy-2’deoxyguanosine

Procedia PDF Downloads 485