Search results for: hospital birth

Authors: M. A. Askari, M. A. Nazari, P. Perrier, Y. Payan

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Growth and remodeling of biological structures have gained lots of attention over the past decades. Determining the response of the living tissues to the mechanical loads is necessary for a wide range of developing fields such as, designing of prosthetics and optimized surgery operations. It is a well-known fact that biological structures are never stress-free, even when externally unloaded. The exact origin of these residual stresses is not clear, but theoretically growth and remodeling is one of the main sources. Extracting body organs from medical imaging, does not produce any information regarding the existing residual stresses in that organ. The simplest cause of such stresses is the gravity since an organ grows under its influence from its birth. Ignoring such residual stresses might cause erroneous results in numerical simulations. Accounting for residual stresses due to tissue growth can improve the accuracy of mechanical analysis results. In this paper, we have implemented a computational framework based on fixed-point iteration to determine the residual stresses due to growth. Using nonlinear continuum mechanics and the concept of fictitious configuration we find the unknown stress-free reference configuration which is necessary for mechanical analysis. To illustrate the method, we apply it to a finite element model of healthy human face whose geometry has been extracted from medical images. We have computed the distribution of residual stress in facial tissues, which can overcome the effect of gravity and cause that tissues remain firm. Tissue wrinkles caused by aging could be a consequence of decreasing residual stress and not counteracting the gravity. Considering these stresses has important application in maxillofacial surgery. It helps the surgeons to predict the changes after surgical operations and their consequences.

Keywords: growth, soft tissue, residual stress, finite element method

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Authors: Omolola A. Tajelawi, Hari L. Garbharran

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Revenue leakages are one of the major challenges manufacturers face in production processes, as most of the input materials that should emanate as products from the lines are lost as waste. Rather than generating income from material input which is meant to end-up as products, losses are further incurred as costs in order to manage waste generated. In addition, due to the lack of a clear view of the flow of resources on the lines from input to output stage, acquiring information on the true cost of waste generated have become a challenge. This has therefore given birth to the conceptualization and implementation of waste minimization strategies by several manufacturing industries. This paper reviews the principles and applications of three environmental management accounting tools namely Activity-based Costing (ABC), Life-Cycle Assessment (LCA) and Material Flow Cost Accounting (MFCA) in the manufacturing industry and their effectiveness in curbing revenue leakages. The paper unveils the strengths and limitations of each of the tools; beaming a searchlight on the tool that could allow for optimal resource utilization, transparency in production process as well as improved cost efficiency. Findings from this review reveal that MFCA may offer superior advantages with regards to the provision of more detailed information (both in physical and monetary terms) on the flow of material inputs throughout the production process compared to the other environmental accounting tools. This paper therefore makes a case for the adoption of MFCA as a viable technique for the identification and reduction of waste in production processes, and also for effective decision making by production managers, financial advisors and other relevant stakeholders.

Keywords: MFCA, environmental management accounting, resource efficiency, waste reduction, revenue losses

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Authors: Robert Pintaric, Joze Matela, Stefan Pintaric, Stanka Vadnjal

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Introduction: This work is aimed to represent the use of the OPTI-JET CS MD1 MR prototype for application of neutral electrolyzed oxidizing water (NEOW) in magnetic resonance rooms. Material and Methods: We produced and used OPTI-JET CS MD1 MR aerosolisator whereby was performed aerosolization. The presence of microorganisms before and after the aerosolisation was recorded with the help of cyclone air sampling. Colony formed units (CFU) was counted. Results: The number of microorganisms in magnetic resonance 3T room was low as expected. Nevertheless, a possible CFU reduction of 87% was recorded. Conclusions: The research has shown that the use of EOW for the air and hard surface disinfection can considerably reduce the presence of microorganisms and consequently the possibility of hospital infections. It has also demonstrated that the use of OPTI-JET CS MD1 MR is very good. With this research, we started new guidelines for aerosolization in magnetic resonance rooms. Future work: We predict that presented technique works very good but we must focus also on time capacity sensors, and new appropriate toxicological studies.

Keywords: biocide, electrolyzed oxidizing water (EOW), disinfection, microorganisms, OPTI-JET CS MD1MR

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Authors: Nimasha Malalasekera

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Working with the indigenous Adivasi (Vedda) community of Dambana in the district of Badulla in Sri Lanka, this research documents linguistic data to address language and cultural endangerment. The ancestral language of Adivasi has undergone sustained restructuration over a long historical period due to its contact with Sinhala, an Indo-Aryan language spoken by the majority Sinhalese. The Vedda language is highly endangered today. At present, all speakers of the Vedda language spoken in Dambana are Adivasi men in the parent generation, who are Sinhala-Vedda bilinguals. Adivasi women and children do not speak the Vedda language but Sinhala in everyday life. Women can understand the Vedda language and would respond to a Vedda language utterance in Sinhala. The use of the Vedda language is largely restricted to self-ascribing Adivasi men who employ it in the context of cultural tourism in Dambana to index ethnolinguistic otherness. Adivasi of Dambana often refers to this distinct linguistic code that they speak as baasapojja or language. This research employs a cooperative model of ethnographic documentation to explore the interrelations between discursive practices, linguistic structures, and linguistic (and broader sociocultural) ideologies in this community. The Vedda language has been previously identified as a dialect of Sinhala or a creole emerging in the contact between Sinhala and the ancestral Vedda language. This paper analyzes the current language endangerment context of bilingual Adivasi members that allows the birth of a mixed language. The aim of this research is to preserve ongoing linguistic innovation among this endangered language speech community. It contributes to the appreciation of creative cultural and linguistic production of a stigmatized minuscule indigenous community of South Asia that strives to assert a distinct linguistic and cultural identity from the dominant populations.

Keywords: Vedda language, language endangerment, mixed languages, indigenous identity

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Authors: Wafeek Mohamed Ibrahim Mohamed

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In the era of globalization and openness informational. Anyone who thinks about innovation in the earth population in Islam in our contemporary reality, he will find that it is not destined to its civilized extension to last. The purpose of the research is a trial to reach a realistic vision for creative, innovative and intellectual thought for the earth population in Islam as an instrument to Confrontation and observe the changes that have affected in the architecture of the land during different eras. Through knowing the controls of the ruling legitimacy(that served as definitions and laws which formulate its features) and using customs, traditions, and conventions as a telescope for the earth population in Islam, It explained the impact of them on features of creative formation for the architecture of the land in our contemporary reality. The study shows a modern vision to identify innovation in the earth population in Islam. As well as reformulating its mental image and monitoring its changes in Islamic heritage cities. This will be done through a two main branches: firstly, set forth a theory represented in studying creative concepts which formulate the population of the earth in Islam. Such as initiative and responsibility for reviving the dead land, the lane [alley] as formation unit and social solidarity,… Etc.. The second branch is preparing a practical, critical vision for innovative conceptual thought for the architecture of the land of Islam, through studying the development of a traditional Islamic city., The conceptual thought of making the birth festival ["Al-Refaee"] and its emulation for governing roles in the traditional city building. The research concludes The necessity of forming the suggested a creative vision for identifying how to re-form the conceptual for our contemporary population of the earth. It poses an important question which is how to return to creativity in the architecture of the land of Islam in our built environments.

Keywords: innovation and creation, architecture, the land in Islam, criticism of design

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Authors: K. S. Suganya, R. Nedunchezhian

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In recent years, blockchain technology has been found to be the most significant discovery in this digital era, after the discovery of the Internet and Cloud Computing. Blockchain is a simple, distributed public ledger that contains all the user’s transaction details in a block. The global copy of the block is then shared among all its peer-peer network users after validation by the Blockchain miners. Once a block is validated and accepted, it cannot be altered by any users making it a trust-free transaction. It also resolves the problem of double-spending by using traditional cryptographic methods. Since the advent of bitcoin, blockchain has been the backbone for all its transactions. But in recent years, it has found its roots and uses in many fields like Smart Contracts, Smart City management, healthcare, etc. Identity management against digital identity theft has become a major concern among financial and other organizations. To solve this digital identity theft, blockchain technology can be employed with existing identity management systems, which maintain a distributed public ledger containing details of an individual’s identity containing information such as Digital birth certificates, Citizenship number, Bank details, voter details, driving license in the form of blocks verified on the blockchain becomes time-stamped, unforgeable and publicly visible for any legitimate users. The main challenge in using blockchain technology to prevent digital identity theft is ensuring the pseudo-anonymity and privacy of the users. This survey paper will exert to study the blockchain concepts, consensus protocols, and various blockchain-based Digital Identity Management systems with their research scope. This paper also discusses the role of Blockchain in COVID-19 pandemic management by self-sovereign identity and supply chain management.

Keywords: blockchain, consensus protocols, bitcoin, identity theft, digital identity management, pandemic, COVID-19, self-sovereign identity

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Authors: Rachel Dolan

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Background: Over two thirds of women in prison in England are mothers, and estimates suggest between 100 and 200 women per year give birth during imprisonment. There are currently six mother and baby units (MBUs) in prisons in England which admit women and babies up to the age of 18 months. Although there are only 65 places available, and despite positive impacts, they are rarely full. Mental illness may influence the number of admissions, as may interpretation of admission criteria. They are the only current alternative to separation for imprisoned mothers and their babies. Aims: To identify the factors that affect the decision to apply for/be offered a place in a prison MBU; to measure the impact of a placement upon maternal mental health and wellbeing; To measure the Initial outcomes for mother and child. Methods: A mixed methods approach - 100 pregnant women in English prisons are currently being recruited from prisons in England. Quantitative measures will establish the prevalence of mental disorder, personality disorder, substance misuse and quality of life. Qualitative interviews will document the experiences of pregnancy and motherhood in prison. Results: Preliminary quantitative findings suggest the most prevalent mental disorders are anxiety and depression and approximately half the participants meet the criteria for one or more personality disorders. The majority of participants to date have been offered a place in a prison MBU, and those in a prison with an MBU prior to applying are more likely to be admitted. Those with a previous history of childcare issues, who are known to social services are less likely to be offered a place. Qualitative findings suggest that many women are often hungry and uncomfortable during pregnancy, many have feelings of guilt about having a child in prison and that feelings of anxiety and worry are exacerbated by lack of information.

Keywords: mothers, prison, mother and baby units, mental health

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Authors: H. Boulahyaoui, S. Alaoui Amine, C. Loutfi, H. El Annaz, N. Touil, El M. El Fahim, S. Mrani

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Three Moroccan children fully vaccinated with Rotarix™ have been hospitalized for Rotavirus Gastroenteritis (RVGE) in the pediatric division of the Farabi Hospital, Oujda. Rotavirus G/P genotypes could not be typed because of their delayed crossing threshold (Ct) resolute with a group A rotavirus (RVA) real time RT-PCR. These strains were adapted to cell culture. All viruses replicated and caused extensive cytopathic effects after four or five passages in MA104 cell lines. Significant improvements have been obtained in the amount of viral particles. Each virus multiplied to a high titer (7.5 TCID50/ml). VP7 and VP4 partial gene sequencing revealed distinct genotypes compared to the Rotarix(®) vaccine strain. Two strains were of G2P[4] genotype whereas the third was G9P[8] genotype. Virus isolation while labor intensive, is recommended as a second test, especially when higher sensitivity for conventional RVA genotyping RT-PCR is needed. VP7 antigenic similarities between these strains and Rotarix were determined.

Keywords: esacpe-vaccine, Morocco, Rotarix, G2P[4], G9P[8]

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Authors: Izzudeen Adetunji

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The intrinsic nexus between man and society is apparently unknown to many people despite understanding the real responsibility and immense roles in society. Amongst the in-depth roles of a man as an agent of the societal reformer is to be a driven force towards installing normalcy and socio-cultural change in society. The paradoxical attitudes of man in engaging in social vices, illicit characters, and unwanted attitudes have given birth to decay and ill-society. However, the need for social change or socio-cultural evolution might be necessary to install normalcy and social order. Nigerian Arabic poets since the 19th century have tremendously engaged in utilizing their poetry for social change through socio-cultural, religious, economic, scientific, or technological forces. This engagement has hitherto yielded a positive outcome for societal reform. The anthology of Ibn Yusuf is one of the compendiums of poetries revealing societal depravity, man’s social vices, and atrocities; which later called to flawlessness. The theoretical framework would be examined through the Heraclitan model, focusing on a parallel to that of a living organism, which, in order to remain alive, must constantly change. Therefore, the thrust of this paper is to examine the societal maladies as elucidated in Ibn Yusuf’s anthology and proffer a contrapuntal criticism of it. Before delving into the main discussion, the paper will examine the concepts of existentialism and realism as a philosophical interface. Likewise, the issues of man and social change, an overview of Nigerian Arabic poetry, will be discussed. Ibn Yusuf’s biography and scholarship and the review of his anthology will be studied. The paper will conclude by critically examining the contrapuntal criticism of societal maladies through Ibn Yusuf’s anthology.

Keywords: societal depravity, existentialism, realism, Nigeria Arabic poetry, Ibn Yusuf’s anthology, contrapuntal criticism

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Authors: Zain Khan, Steve Ahn, Kathy Monypenny, James Fink

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In Australian public hospitals, there were approximately 34,000 reported inpatient falls between 2015 to 2016. The gold standard for diagnosing intracranial injury is non-contrast enhanced brain computed tomography (CTB). Over a three-month timeframe, a total of one hundred and eighty (180) falls were documented between the hours of 4pm and 8am at a large metro hospital. Only three (3) of these scans demonstrated a positive intra-cranial finding. The rationale for scanning varied. The common indications included a fall with head strike, the presence of blood thinning medication, loss of consciousness, reduced Glasgow Coma Scale (GCS), vomiting and new neurological findings. There are several validated tools to aid in decision-making around ordering CTB scans in the acute setting, but no such accepted tool exists for the inpatient space. With further data collection, spanning a greater length of time and through involving multiple centres, work can be done towards generating such a tool that can be utilized for inpatient falls.

Keywords: computed tomography, falls, inpatient, intracranial hemorrhage

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Authors: Irem Ozten, Neri̇man Caglayan Keles

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Aim: Breastfeeding is a special process for a mother and her baby, and it is the first feeding option for a baby. However, not every society approves of breastfeeding in public to the same degree. The purpose of this study is to determine the attitudes and behaviors of women living in Türkiye toward breastfeeding in public. Materials and methods: This descriptive study was carried out in December 2023 with 515 women (N=515) who had babies aged 0-5 years and breastfed their babies. Based on the review of the literature, an online (Google Forms) data collection form consisting of 40 questions was created. While 13 of these questions were about sociodemographic and obstetric characteristics, 27 were about breastfeeding in public. It took each participant 5-7 minutes to respond to the data collection form by marking their choices on the form. The responses of the participants were analyzed using the R Core Team statistics program. Results: The mean age of the participants (N=515) was 30.6±4.07 (range: 20-44). According to their statements, 76.1% of the participants had undergraduate university degrees, and 77.1% of them had given vaginal birth in their last delivery. While 68.3% of the participants stated that they had heard about the concept of breastfeeding in public, 47.4% said they comfortably breastfed their babies in public, but 33.6% said they breastfed their babies for a shorter period than usual. It was determined that 40% of the participants were embarrassed about being seen by someone while breastfeeding their babies in public, 38.6% were afraid of men while breastfeeding, and 89.7% looked for a suitable place to breastfeed their babies. Among the participants, 93.6% stated that they covered their breasts with a cloth while breastfeeding, 49.5% thought a mother should breastfeed her baby in a place where she can be alone with her baby, and 29.1% thought a mother should breastfeed her baby in private. Conclusion: According to the results of the study, although most women had heard of the concept of breastfeeding in public, and some were comfortable breastfeeding in public, some breastfed their baby in public for a shorter period than usual, they covered their breasts with a cloth while breastfeeding their babies, they were embarrassed about being seen by someone while breastfeeding, and they were afraid of men while breastfeeding. Therefore, awareness should be raised about breastfeeding in public, and environments where mothers can conveniently breastfeed their babies should be created.

Keywords: breastfeeding in public, breastfeeding, breastfeeding attitudes, breastfeeding bahaviors

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Authors: Boma Nellie S, Nambiar Ritu, K. Kanchanmala, T. Rashida, Israell Imelda, Moul Khusnud, Michael Marina

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Gestational diabetes (GDM) imparts an increased life long risk of developing Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease in women. Once diagnosed with GDM women have up to 74% increased cumulative risk developing T2DM in 10-15 years. Identifying women at increased risk of developing T2DM and offering them pharmacological and lifestyle management interventions will delay or eliminate the development of diabetes in this population. While ADA recommends that all gestational diabetics be offered postnatal screening, worldwide the screening rates from 35-75% and Al Rahba Hospital with a robust universal antenatal screening program for GDM was at a dismal 9% in 2011. A multidisciplinary team was put together involving OB/Gyn Physicians, Midwives, Nurses (ward and OPD) Diabetic Educators, Dietitians, Medical Records, Laboratory & IT with the implementation of multiple strategies to increase the uptake of postpartum screening of the gestational diabetic.

Keywords: GDM, postnatal screening, preventing type 2 diabetes, lifestyle management

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Authors: P. Nafisi Poor, P. Javid

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Religion and divinity have always held important meaning to humans, and therefore it affects different aspects of life including art and architecture. Numerous works of art are related to religion whether supporting or denying it. Religion and religious scholars have influenced and changed art throughout history. This paper focuses on Islam and Christianity because these two religions have been the most discussed and most popular of all time, starting from the birth of Jesus to the arrival of Mohammad. Based on this popularity, these religions have influenced the arts and especially architecture. Islam on one hand changed Iranian and Arabian architecture and they applied it in different places around the world. From the appearance of Islam at 622 AD to this day, Islamic architecture has been evolving; however, one of the most important periods for this style was between 1501 AD and 1736 AD in Iran. Christianity, on the other hand, changed European architecture especially between 1150 AD and 1450 AD or the so-called "Gothic" era, which begins at medieval time and reaches its peak at International Gothic ages. At both of these periods, designing buildings based on spiritual concepts and divine statements reached its peak, and architects were considering God and religion as their center of attention. This article studies the focus on the religions of Islam and Christianity in terms of architecture and presents a general philosophy of both styles to comprehend the idea behind each one, followed by an analysis of their geometry and architectural aspects derived from the best examples, all to understand the purpose of each style and to realize, which one was more successful in reaching their purpose. Subsequently, a comprehensive review of each building is provided including 3D visualizations to help achieve the goal of the article. These studies can support diverse inquiries about both Islamic and Gothic architecture and can be used as a resource to support studies and research towards designing based on religion or for divine purposes.

Keywords: architecture, Gothic, Islamic, religion

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Authors: Maryam Nazari, Atefeh Ghanbari, Saghar Noorinia

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Obesity, as an abnormal or excessive accumulation of fat, is caused by genetic, behavioral and environmental factors. Recently, obesity surgeries, such as bariatric surgery, as the last measure to control obesity, have attracted experts and society, especially women, attention, so knowing the possible complications of this major surgery and their control in reproductive age is of particular importance due to its effects on pregnancy outcomes. Bariatric surgery reduces the risk of diabetes and high blood pressure associated with pregnancy, premature birth, macrosomia, stillbirth and dumping syndrome. Although in the first months after surgery, nausea and vomiting caused by changes in intra-abdominal pressure are associated with an increased risk of malabsorption of micronutrients such as folic acid, iron, vitamin B1, D, calcium, selenium and phosphorus and finally, fetal growth disorder. Moreover, serum levels of micronutrients such as vitamin D, calcium, and iron in mothers who used to have bariatric surgery and their babies have been shown to be lower than in mothers without a history of bariatric surgery. Moreover, vitamin A deficiency is shown to be more widespread in pregnancies after bariatric surgery, which leads to visual problems in newborns and premature delivery. However, complications such as the duration of hospitalization of newborns in the NICU, disease rate in the first 28 days of life and congenital anomalies are not significantly different in babies born to mothers undergoing bariatric surgery compared to the control group. In spite of the vast advantages following obesity surgeries, due to the catabolic conditions and severe weight loss followed by such major intervention and the probability of nutrients malnutrition in a pregnant woman and her baby, after having surgery, at least 12 to 18 months should be considered to get pregnant as a recovery period. In addition, taking essential supplements before and at least 6 months after this approach is recommended.

Keywords: bariatric surgery, pregnancy, malnutrition, vitamin and mineral deficiency

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Authors: Edna Roseline Dede Tetteh

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Reproductive health research and discussions have, over the years, placed a special focus on Africa. This is partly due to the significant relationship between African cultures and reproductive health. Several studies have also acknowledged the economic impact of reproductive health in Africa, because of which reproductive health, particularly family planning, has featured prominently in many economic discussions about Africa. Gender, which is a major element of most African cultures, inspired this study. Given that gender has a significant cultural influence in Africa, the study examined the effect of gender inequality on reproductive health in Africa, with a special focus on Ghana. Specifically, the study examined whether there exists any relationship between gender inequality and reproductive health and, if there is, what the nature and the effect of the relationship are. The study's findings were based on data gathered from 2304 respondents, randomly selected from Ghana's different tribes and ethnic groups. Given that the study was focused on the influence of gender in sexual relationships, the study’s population was people 16 years and above since 16 is the legal age of sexual consent in Ghana. Data was collected through questionnaires and interviews. It was found that the beliefs and practices of the traditional Ghanaian society, like most African societies, have direct and significant impacts on reproductive health. Males in these cultures have more control over reproductive health decisions and choices than females. The study found that it was culturally condemnable for a wife to refuse her husband’s request for sex, even when she is not in the mood for sex, or she is unwell. It was further found that, when it comes to the decision of birth control, males have more power. Consequently, females with reproductive health conditions have no control over choices that support their reproductive health conditions; they must always satisfy their husbands’ sexual needs. Most of the female respondents indicated they had less or no control over protecting themselves from reproductive health risks unless they had the understanding and support of their sexual partners.

Keywords: culture, gender, Ghana, inequality, reproductive health

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Authors: Siobhan Laird

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Under article 12 of the Convention on the Rights of the Child, which extends human rights in their application to those under the age of 18 years, children must be consulted ‘in all matters affecting the child’. The Office of the Children’s Commissioner for England is responsible for improving the welfare of children and young people by ensuring that their Convention rights are respected and realised and their views taken seriously. In 2014 the Children’s Commissioner engaged a team of researchers at the Centre for Social Work, University of Nottingham to develop and roll out an online survey to gather information from children and young people about their exercise of choice within the public care system. Approximately 3,000 children responded to this survey, which comprised both closed and open-ended questions. SPSS was used to analyse the numerical data and a thematic analysis of textual data was conducted on answers to open-ended questions. Findings revealed that children exercised considerable choice over personal space and their spare time, but had much less choice in relation to contact with their birth families, where they lived, or the timings of moves from one placement into another. The majority of children described how they were supported to express their opinions and believed that these were taken seriously. However, a significant number reported problems and explained how specific behaviours by professionals and carers made it difficult for them to express their opinion or to feel that they had influenced decisions which affected them. In open-ended questions eliciting information about their experiences, children and young people were asked to describe how they could be better supported to make choices and what changes would assist for these to be better acknowledged and acted upon by professionals and carers. This paper concludes by presenting the ideas and suggestions of children and young people for improving the public care system in Britain in relation to their exercise of choice.

Keywords: children, choice, participation, public care

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Authors: Sayed Ahmed

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Religious activities that have evolved the sacred into a dynamic cultural phenomenon in the public realm of Sylhet, Bangladesh, and the spatiality of sacred sites and everyday practices in certain built forms have framed these phenomena. Religious rituals in Sylhet gave birth to unique practices of their own and have a vast impact even on contemporary spatial practices, while most Western researchers are not hopeful about the future of religion. However, despite extensive research on urban morphology and religion separately, there is limited literature on the relationship between these two topics to capture religious perceptions and experiences in urban spaces. This research will try to fill the existing gap and explain sacred within the range of Western sociological and philosophical tools implemented in third-world contexts, which was never highlighted before. This perspective of research puts forth the argument that urban morphology influences sacred experiences and how consecrated entities and religious activities shape the city's structure in return. The methodology of the research will map key morphological and religious variables. This mapping might include festival trajectories, street life observations, pedestrian densities, religious activities, public and private interface types with religious commodification, and the identification of blurred boundaries between sacred and profane on smaller to broader urban scales. To relate the derived cartography, illustrative (not representative) interviews about religious signs and symbols will be conducted and compared accordingly. The possible findings might reintroduce the diversity of religious practices in urban places and develop a decent concept of how sacred and urban morphology are mutually reinforcing the city, which has remained a vital nutrient for the survival of its inhabitants. Such infrequent conceptualizations of urban morphology and its relationship to symbolic sacralization are truly ‘outside’ to those that exist in the West.

Keywords: sylhet, religion, urban morphology, symbolic exchange, Baudrillard

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Authors: Lauren G. Coggins

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Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) are among the most common healthcare-associated infections (HAI), contributing to prolonged lengths of stay, greater costs of patient care, and increased patient mortality. Evidence-based preventative care bundles exist to establish consistent, safe patient-care practices throughout an entire organization, helping to ensure the collective application of care strategies that aim to improve patient outcomes and minimize complications. The cardiac intensive care unit at a nationally ranked teaching and research hospital in the United States exceeded its annual CAUTI and CLABSI targets in the fiscal year 2019, prompting examination into the unit’s infection prevention efforts that included preventative care bundles for both HAIs. Adherence to the CAUTI and CLABSI preventative care bundles was evaluated through frequent audits conducted over three months, using standards and resources from The Joint Commission, a globally recognized leader in quality improvement in healthcare and patient care safety. The bundle elements with the lowest scores were identified as the most commonly missed elements. Three elements from both bundles, six elements in total, served as key content areas for the educational interventions targeted to bedside nurses. The CAUTI elements included appropriate urinary catheter order, appropriate continuation criteria, and urinary catheter care. The CLABSI elements included primary tubing compliance, needleless connector compliance, and dressing change compliance. An integrated, multi-platform education campaign featured content on each CAUTI and CLABSI preventative care bundle in its entirety, with additional reinforcement focused on the lowest scoring elements. One-on-one educational materials included an informational pamphlet, badge buddy, a presentation to reinforce nursing care standards, and real-time application through case studies and electronic health record demonstrations. A digital hub was developed on the hospital’s Intranet for quick access to unit resources, and a bulletin board helped track the number of days since the last CAUTI and CLABSI incident. Audits continued to be conducted throughout the education campaign, and staff were given real-time feedback to address any gaps in adherence. Nearly every nurse in the cardiac intensive care unit received all educational materials, and adherence to all six key bundle elements increased after the implementation of educational interventions. Recommendations from this implementation include providing consistent, comprehensive education across multiple teaching tools and regular audits to track adherence. The multi-platform education campaign brought focus to the evidence-based CAUTI and CLABSI bundles, which in turn will help to reduce CAUTI and CLABSI rates in clinical practice.

Keywords: education, healthcare-associated infections, infection, nursing, prevention

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Authors: Gagandeep Singh Grover, Vini Mahajan, Bhagmal, Priti Thaware, Jaspreet Takkar

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Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The state of Punjab in India shows cyclical and seasonal variation in dengue cases. The Case Fatality Rate of Dengue has ranged from 0.6 to 1.0 in the past years. The department has initiated a review of the cases that have died due to dengue in order to know the exact cause of the death in a case of dengue. The study has been undertaken to know the other associated co-morbidities and factors causing death in a case of dengue. The study used the predesigned proforma on which the records (medical and Lab) were recorded and reviewed by the expert committee of the doctors. This study has revealed that cases of dengue having co-morbidities have a longer stay in the hospital. Fluid overload and co-morbidities have been found as major factors leading to death, however, in a confirmed case of dengue hepatorenal shutdown was found to be a major cause of mortality. The data obtained will help in sensitizing the treating physicians in order to decrease the mortality due to dengue in future.

Keywords: dengue, death, morbidities, DHF, DSS

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Authors: U. P. Rathnakar, Medha Urval, K. Ashok Shenoy

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Introduction: There are many tools available for the measurement of health literacy. REALM (Rapid Estimate of Adult Literacy in Medicine) is a very commonly used tool in advanced countries. It comes in two forms-one with 66 words and shorter version (REALM-SF) with seven words. We decided to test the applicability of shorter version of the REALM test among our patients. Methodology: REALM (SF) was tested among 200 patients in a tertiary hospital. Discussion and conclusion: From the analysis of results, when the results of pronunciation indicate adequate levels of HL skills, analysis of comprehension shows that mere reading skills is likely to be misleading. So it is proposed that in Indian population who have adequate reading skills without adequate comprehension the REALM-SF test tool in its present form may not be an ideal testing tool for assessing HL.

Keywords: health literacy, REALM, short form, India

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Authors: Habtamu Fufa, Yemane Berhane

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Child under nutrition has long-term consequences for intellectual ability, economic productivity, reproductive performance and susceptibility to metabolic and cardiovascular disease. The unacceptably high prevalence of malnutrition in young children of the region has not changed much over the last decades, which could make the achievement of the corresponding Millennium Development Goals very unlikely. Despite the well-documented problems of child malnutrition in Sub-Saharan Africa, there is few systematic review of evidences on determinants of child malnutrition in the region. The current available evidence on determinants of child under nutrition in Sub-Saharan Africa is systematically reviewed. The method used in searching relevant literature was using bio medical databases PUBMED, Google scholar and the website of the World Health Organization on nutrition using the following key words: "Determinants “, "Child Malnutrition", and "Sub- Saharan Africa". The search was limited to articles published in and after 1995 up to date. In all the reviewed articles, the data were analyzed using multivariate regression analysis and or odds ratios for significance of determinants in child malnutrition. Synthesis of 40 published articles from various countries of the region is done and noted that household economic status, maternal education, disease, breastfeeding practices, age and sex of a child, birth interval and residential areas were found to be determinants of child under nutrition. Poverty remains the main factor of malnutrition in Sub-Saharan Africa and poor education of parents aggravates the malnutrition through perpetuation of poor nutrition practices. Male children under five years are the most affected ones. Understanding of these determinants of poor nutritional attainment would provide insights in designing interventions for reducing the high levels of child malnutrition in this region. Large-scale multi-sectoral community-based interventions are urgently needed for a sustainable improvement of child nutritional & health status in Sub-Saharan Africa.

Keywords: child malnutrition, determinants, Sub-Saharan Africa, health status

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Authors: Shalini Misra

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The means and methods of education have been changing fast since the invention of internet. Both, ancient and modern education emphasized on the holistic development of students. But, a significant change has been observed in the 21st century learners. Online classes, intercultural and interdisciplinary education which were exceptions in the past, are setting new trends in the field of education. In the modern era, intercultural and interpersonal skills are of immense importance, not only for students but for everyone. It sets a platform for better understanding and deeper learning by ensuring the active participation and involvement of students belonging to different social and cultural backgrounds in various academic and non-academic pursuits. On October 31, 2015, on the occasion of 140th birth anniversary of Sardar Vallabhbhai Patel, Hon’ble Prime Minister of India, Narendra Modi announced a wonderful initiative, ‘Ek Bharat Shreshtha Bharat’ i.e. ‘One India Best India’ commonly known as ‘EBSB’. The program highlighted India’s rich culture and traditions. The objective of the program was to foster a better understanding and healthy relationship among Indian States. Under this program, a variety of subjects were covered like ‘Arts, Culture and Language’ .It was claimed to be a successful cultural exchange where students from diverse communities shared their thoughts and experiences with one another. Under this online cultural exchange program, the state of Uttarakhand was paired with the state of Karnataka in the year 2022. The present paper proposes to undertake a survey of a total of thirty secondary level students of Uttarakhand and the partner state Karnataka, who participated in this program with a purpose of learning and embracing new ideas and culture thus promoting intercultural education. It aims to study and examine the role of intercultural education in shifting and establishing new paradigms of education.

Keywords: education, intercultural, interpersonal, traditions, understanding

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Authors: Mukesh Ravi Raushan

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Despite consideration of obesity as a deadly public health issue contributing 2.6 million deaths worldwide every year developing country like India is facing malnutrition and it is more common than in Sub-Saharan Africa. About one in every three malnourished children in the world lives in India. The paper assess the nutritional health among children using data from total number of 43737 infant and young children aged 0-59 months (µ = 29.54; SD = 17.21) of the selected households by National Family Health Survey, 2005-06. The wasting was measured by a Z-score of standardized weight-for-height according to the WHO child growth standards. The impact of education with place of residence was found to be significantly associated with the complementary food diversity score (CFDS) in India. The education of mother was positively associated with the CFDS but the degree of performance was lower in rural India than their counterpart from urban. The result of binary logistic regression on wasting with WHO seven types of recommended food for children in India suggest that child who consumed the milk product food (OR: 0.87, p<0.0001) were less likely to be malnourished than their counterparts who did not consume, whereas, in case of other food items as the child who consumed food product of seed (OR: 0.75, p<0.0001) were less likely to be malnourished than those who did not. The nutritional status among children were negatively associated with the protein containing complementary food given the child as those child who received pulse in last 24 hour were less likely to be wasted (OR: 0.87, p<0.00001) as compared to the reference categories. The frequency to feed the indexed child increases by 10 per cent the expected change in child health outcome in terms of wasting decreases by 2 per cent in India when place of residence, education, religion, and birth order were controlled. The index gets improved as the risk for malnutrition among children in India decreases.

Keywords: CFDS, food diversity index, India, logistic regression

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Authors: Nick Toossi, Joseph Hartland

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Background: Malawi is an example of a low resource setting which faces a chronic shortage of doctors and other medical staff. This shortfall is made up for by clinical officers (COs), who are para-medicals trained for 4 years. The literature suggests to improve outcomes surgical skills training specifically should be promoted for COs in district and mission hospitals. Accordingly, the primary author was tasked with developing a basic surgical skills teaching package for COs of Mulanje Mission Hospital (MMH), Malawi, as part of a 4th year medical student External Student Selected Component field trip. MMH is a hospital based in the South of Malawi near the base of Mulanje Mountain and works in an extremely isolated environment with some of the poorest communities in the country. Traveling to Malawi the medical student author performed an educational needs assessment to develop and deliver a bespoke basic surgical skills teaching package. Methodology: An initial needs assessment identified the following domains: basic surgical skills (instrument naming & handling, knot tying, suturing principles and suturing techniques) and perineal repair. Five COs took part in a teaching package involving an interactive group simulation session, overseen by senior clinical officers and surgical trainees from the UK. Non-organic and animal models were used for simulation practice. This included the use of surgical skills boards to practice knot tying and ox tongue to simulate perineal repair. All participants spoke and read English. The impact of the session was analysed in two different ways. The first was via a pre and post Single Best Answer test and the second a questionnaire including likert’s scales and free text response questions. Results: There was a positive trend in pre and post test scores on competition of the course. There was increase in the mean confidence of learners before and after the delivery of teaching in basic surgical skills and simulated perineal repair, especially in ‘instrument naming and handling’. Whilst positively received it was discovered that learners desire more frequent surgical skills teaching sessions in order to improve and revise skills. Feedback suggests that the learners were not confident in retaining the skills without regular input. Discussion: Skills and confidence were improved as a result of the teaching provided. Learner's written feedback suggested there was an overall appetite for regular surgical skills teaching in the clinical environment and further opportunities to allow for deliberate self-practice. Surgical mentorship schemes facilitating supervised theatre time among trainees and lead surgeons along with improving access to surgical models/textbooks were some of the simple suggestions to improve surgical skills and confidence among COs. Although, this study is limited by population size it is reflective of the small, isolated and low resource environment in which this healthcare is delivered. This project does suggest that current surgical skills packages used in the UK could be adapted for employment in low resource settings, but it is consistency and sustainability that staff seek above all in their on-going education.

Keywords: clinical officers, education, Malawi, surgical skills

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Authors: Mohammad Hossain Validad, Maryam Nakhaei-Moghadam, Monire Mahjoob

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Introduction: The prevalence of type 1 diabetes is increasing worldwide, and given the role of ethnicity and race in complications of diabetes, this study was designed to evaluate the ocular complications of type 1 diabetes mellitus in Zahedan. Methods: This prospective cross-sectional study was conducted on Type 1 diabetic children that referred to Alzahra Eye Hospital. All patients had a dilated binocular indirect ophthalmoscopy using a +90 D condensing lens and slit-lamp biomicroscopy. Age, gender, onset, duration of diabetes, and HbA1c level were recorded. Results: 76 type 1 diabetes patients with an age of 11.93 ± 3.76 years participated in this study. Out of 76 patients with diabetes, 19 people (25%) had ocular complications. There was a significant difference in age (P=0.01) and disease duration (P=0.07) between the two groups with and without ocular complications. Odd ratios for ocular complications with age and duration of diabetes were 1.32 and 1.32, respectively. Conclusion: Cataract was the most common ocular complication in type 1 diabetes in Zahedan, a tropical region that was significantly related to the duration of the disease and the age of the patients.

Keywords: diabet mellitus type one, cataract, ocular complication, hemoglobin A1C

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Authors: Rhaed Khiati, Muhammad Hanif

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In the past decade, smart healthcare systems have been on an ascendant drift, especially with the evolution of hospitals and their increasing reliance on bioinformatics and software specializing in healthcare. Doctors have become reliant on technology more than ever, something that in the past would have been looked down upon, as technology has become imperative in reducing overall costs and improving the quality of patient care. With patient-doctor interactions becoming more necessary and more complicated than ever, systems must be developed while taking into account costs, patient comfort, and patient data, among other things. In this work, we proposed a smart hospital bed, which mixes the complexity and big data usage of traditional healthcare systems with the comfort found in soft beds while taking certain concerns like data confidentiality, security, and maintaining SLA agreements, etc. into account. This research work potentially provides users, namely patients and doctors, with a seamless interaction with to their respective nurses, as well as faster access to up-to-date personal data, including prescriptions and severity of the condition in contrast to the previous research in the area where there is lack of consideration of such provisions.

Keywords: big data, smart healthcare, distributed systems, bioinformatics

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Authors: Gokulan Vethanayakam, Daniel Aston

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

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

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Authors: Rafael Muñoz, Juan Melchor, Alicia Valera, Laura Peralta, Guillermo Rus

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A torsional piezoelectric ultrasonic transducer design is proposed to measure shear moduli in soft tissue with direct access availability, using shear wave elastography technique. The measurement of shear moduli of tissues is a challenging problem, mainly derived from a) the difficulty of isolating a pure shear wave, given the interference of multiple waves of different types (P, S, even guided) emitted by the transducers and reflected in geometric boundaries, and b) the highly attenuating nature of soft tissular materials. An immediate application, overcoming these drawbacks, is the measurement of changes in cervix stiffness to estimate the gestational age at delivery. The design has been optimized using a finite element model (FEM) and a semi-analytical estimator of the probability of detection (POD) to determine a suitable geometry, materials and generated waves. The technique is based on the time of flight measurement between emitter and receiver, to infer shear wave velocity. Current research is centered in prototype testing and validation. The geometric optimization of the transducer was able to annihilate the compressional wave emission, generating a quite pure shear torsional wave. Currently, mechanical and electromagnetic coupling between emitter and receiver signals are being the research focus. Conclusions: the design overcomes the main described problems. The almost pure shear torsional wave along with the short time of flight avoids the possibility of multiple wave interference. This short propagation distance reduce the effect of attenuation, and allow the emission of very low energies assuring a good biological security for human use.

Keywords: cervix ripening, preterm birth, shear modulus, shear wave elastography, soft tissue, torsional wave

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Authors: Natia Kvachakidze

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The given research aims to study and analyze the influence of Ernest Hemingway’s writing style on Georgian prose of 1950s and 1960s. It is universally known that Ernest Hemingway’s unique writing style has had an enormous effect on various writers. His work remains highly relevant and influential even today. This is especially true about the works written in English, but literary prose created in other languages is not an exception. Certain stylistic peculiarities characteristic for Hemingway’s writing can be traced in literary works written in various languages. It is particularly interesting for us, Georgians, how all these aspects were reflected in Georgian prose of the second-half of XX century. This particular paper (which is a part of a larger research) focuses on major significant peculiarities of Georgian prose of 1950-1960s that might be connected to Hemingway's writing. In this respect, GuramRcheulishvili’s (1934-1960) works should be particularly distinguished (especially his short fiction), but literary works of other Georgian authors are not at all less important. The research involves the analysis of the prose works of some Georgian writers of the given period in the context of tracing similarities and parallels between them and the characteristic features of Ernest Hemingway’s writing style. The use of everyday language as well as short and simple sentences, a concise and sparse style, repetitions, intense dialogues are some of the essential traits in question. Themes like birth and death, war and violence, family, nature, disillusionment also prove to be vitally important for this research. Complex interconnections between the author, the narrator, and the protagonist (often autobiographical) provide another interesting subject to study. At the same time, this paper aims at studying and revealing how Hemingway’s method was reflected and transformed in Georgian prose. In this respect, it is interesting to trace not only the direct effect of Hemingway’s style but also the role of certain Georgian translations of the works of this American writer.

Keywords: hemingway, prose, georgian writers, writing style

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Authors: F. Noto, G. Costa, L. Celona, F. Chines, G. Ciavola, G. Cuttone, S. Gammino, O. Leonardi, S. Marletta, G. Torrisi

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At Istituto Nazionale di Fisica Nucleare – Laboratorio Nazionale del Sud (INFN-LNS), a broad experience in the design, construction and commissioning of ECR and microwave ion sources is available. The AISHa ion source has been designed by taking into account the typical requirements of hospital-based facilities, where the minimization of the mean time between failures (MTBF) is a key point together with the maintenance operations, which should be fast and easy. It is intended to be a multipurpose device, operating at 18 GHz, in order to achieve higher plasma densities. It should provide enough versatility for future needs of the hadron therapy, including the ability to run at larger microwave power to produce different species and highly charged ion beams. The source is potentially interesting for any hadron therapy facility using heavy ions. In this paper, we analyzed the dimensional test and electrical test about an innovative solution for the containment chamber that allows us to solve our isolation and structural problems.

Keywords: FEM analysis, electron cyclotron resonance ion source, dielectrical measurement, hadron therapy

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