Search results for: hospital discharge

Authors: Dessy Arumsari, Ais Assana Athqiya, Mulyaminingrum

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Healthcare in remote areas is one of the major concerns in Indonesia. Building hospitals in a nation of 18.000 islands with a larger-than-life bureaucracy and problems with corruption, a critical shortage of qualified medical professionals and well-heeled patients resigned to traveling abroad for health care is a hard feat to accomplish. To assuring that all populations have access to appropriate and cost-effective care, a new solution to tackle this problem is with the presence of RV Car Clinic. This car has a concept such as a walking hospital that provides health facilities inside it. All of the health professionals who work in RV Car Clinic will do the rotation for a year in order to the equitable distribution of health workers. We need to advocate the policy makers to help realize RV Car Clinic in remote areas. Health services can be disseminated by the present of RV Car Clinic. Summarily, the local communities can get cost effectively because RV Car Clinic will come to their place and serve the health services.

Keywords: health policy, health professional, remote areas, RV Car Clinic

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Authors: Kirsten Hoeper, Maike Kriependorf

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This paper firstly discusses the initial situation and problems. Afterward, it defines professional bureaucracies and shows their impact for the OR-work. The OR-center and its actors are shown. Finally, the paper provides the empiric design for detecting the target systems of the different work groups within the OR, the quality criteria in qualitative research and empirical results. It is shown that different groups have different targets in their daily work and that helps for a better understanding. More precisely, by detecting the target systems of these experts, we can ‘bridge’ the different points of view to create a common basis for the work in the OR. One of the aims was to find bridges to overcome separating factors. This paper describes the situation in Germany focusing the Hannover Medical School. It can be assumed that the results can be transferred to other countries using the DRG-System (Diagnosis Related Groups).

Keywords: hospital, OR, professional bureaucracies, target systems

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Authors: Ngwa Lodence Njwe

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This study investigated the response of hemodialysis patients to an established nutrition therapy guide accompanied by a 7-day menu plan administered for a month. End Stage Renal Disease (ESRD), also known as End Stage Kidney Disease (ESKD), is a non-communicable disease primarily caused by hypertension and diabetes, posing significant challenges in both developed and developing nations. Hemodialysis is a key treatment for these patients. In this experimental study, 100 hemodialysis patients from Douala General Hospital in Cameroon participated. A questionnaire was used to collect data on sociodemographic and anthropometric characteristics, health status, and dietary intake, while medical records provided biomedical data. The levels of the biochemical parameters (Phosphorus, calcium and hemoglobin) were determined before and one month after the distribution of the nutrition education guide and the use of a 7-day menu plan. The Phosphorus and Calcium levels were measured using an LTCC03 semi-automatic chemistry analyzer. Blood was collected from each patient into a test tube, allowed to clot and centrifuged. 50µl of the serum was aspirated by the analyzer for Ca and P level analysis, and results were read from the display. The hemoglobin level was measured using the URIT–12 hemoglobin Meter. The blood sample was collected by hand prick and placed in a strip, and the results were read from the screen. The means of the biochemical parameters were then computed. The most prevalent age group was 40-49 years, with males constituting 70% and females 30% of respondents. Among these patients, 80% were hypertensive, 3% had both hypertension and diabetes, 9% were hypertensive, diabetic, and obese, and 1% suffered from hypertension and heart failure. Analysis of anthropometric parameters revealed a high prevalence of underweight, overweight, and obesity, highlighting the urgent need for targeted nutrition interventions to modify cooking methods, enhance food choices, and increase dietary variety for improved quality of life. Before the nutrition therapy guide was implemented, average calcium levels were 73.05 mg/L for males and 89.44 mg/L for females; post-implementation, these values increased to 77.55 mg/L and 91.44 mg/L, respectively. Conversely, average phosphorus levels decreased from 42.05 mg/L for males and 43.55 mg/L for females to 41.05 mg/L and 39.3 mg/L, respectively, after the intervention. Additionally, average hemoglobin levels increased from 8.35 g/dL for males and 8.5 g/dL for females to 9.2 g/dL and 8.95 g/dL, respectively. The findings confirm that the nutrition therapy guide and the 7-day menu significantly impacted the biomedical parameters of hemodialysis patients, underscoring the need for ongoing nutrition education and counseling for this population.

Keywords: end stage kidney disease, nutrition therapy guide, nutritional status, anthropometric parameters, food frequency, biomedical data

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Authors: Mette Kjerholt, Thora Grothe Thomsen, Connie Bøttcher Berthelsen, Bibi Hølge Hazelton

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Academic nursing is a relatively new phenomenon in Denmark. Leadership and management training in nursing does not prepare Danish nurse leaders to become leaders for nurses with academic background, and some leaders may feel estranged with including this kind of nursing staff in clinical settings. Currently there is a debate regarding what academic nurses can contribute with in clinical practice, and some managers express concern regarding whether this will lead to less focus on clinical practice and more focus on theoretical issues that may not seem so relevant in a busy everyday clinical setting. The paper will present the experiences of integrating three advanced nurse practitioners with Ph.D. degrees (ANP) in three different clinical departments at a regional hospital in Denmark with no prior experiences with such profiles among its staff.

Keywords: leadership, advanced nurse practitioners, clinical practice, academic nursing

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Authors: Zahra BehboodiI-Moghadam, Zohre Khalajinia, Ali Reza Nikbakht Nasrabadi, Minoo Mohraz

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The purpose of our study was to explore and describe the experiences of pregnant women with HIV in Iran. A qualitative exploratory study with conventional content analysis was used. Twelve pregnant women with HIV who referred to perinatal care at the Imam Khomeini Hospital Behavioral Diseases Consultation: Center in Tehran were recruited to participate in in-depth interviews. The average age of the participants was 32.5 years. Four main themes were extracted from the data: “fear and hope, “stigma and discrimination, “marital life stability” and “trust”. The findings reveal the pregnant women living with HIV are vulnerable and need professional support. Improving the knowledge of healthcare professionals especially midwifes on pregnancy complications for women with HIV is crucial in order to provide high-quality care to pregnant women with HIV-positive.

Keywords: HIV, pregnancy, content analysis, experiences, Iran, qualitative research

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Authors: Aakriti Chetan Shah, Elle Sein

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Background/purpose: Group B Streptococcus(GBS) is the leading cause of severe early onset infection in newborns, with the incidence of Early Onset Group B Streptococcus (EOGBS) in the UK and Ireland rising from 0.48 to 0.57 per 1000 births from 2000 to 2015. A WHO study conducted in 2017, has shown that 38.5% of cases can result in stillbirth and infant deaths. This is an important problem to consider as 20% of women worldwide have GBS colonisation and can suffer from these detrimental effects. Current Royal College of Obstetricians and Midwives (RCOG) guidelines do not recommend bacteriological screening for pregnant women due to its low sensitivity in antenatal screening correlating with the neonate having GBS but advise a patient information leaflet be given to pregnant women. However, a Healthcare Safety Investigation Branch (HSIB) 2019 learning report found that only 50% of trusts and health boards reported giving GBS information leaflets to all pregnant mothers. Therefore, this audit aimed to assess current practices of information dissemination about GBS at Chelsea & Westminster (C&W) Hospital. Methodology: A quantitative cross-sectional study was carried out using a questionnaire based on the RCOG GBS guidelines and the HSIB Learning report. The study was conducted in antenatal clinics at Chelsea & Westminster Hospital, from 29th January 2021 to 14th February 2021, with twenty-two practicing obstetricians and midwives participating in the survey. The main outcome measure was the proportion of obstetricians and midwives who disseminate information about GBS to pregnant women, and the reasons behind why they do or do not. Results: 22 obstetricians and midwives responded with 18 complete responses. Of which 12 were obstetricians and 6 were midwives. Only 17% of clinical staff routinely inform all pregnant women about GBS, and do so at varying timeframes of the pregnancy, with an equal split in the first, second and third trimester. The primary reason for not informing women about GBS was influenced by three key factors: Deemed relevant only for patients at high risk of GBS, lack of time in clinic appointments and no routine NHS screening available. Interestingly 58% of staff in the antenatal clinic believe it is necessary to inform all women about GBS and its importance. Conclusion: It is vital for obstetricians and midwives to inform all pregnant women about GBS due to the high prevalence of incidental carriers in the population, and the harmful effects it can cause for neonates. Even though most clinicians believe it is important to inform all pregnant women about GBS, most do not. To ensure that RCOG and HSIB recommendations are followed, we recommend that women should be given this information at 28 weeks gestation in the antenatal clinic. Proposed implementations include an information leaflet to be incorporated into the Mum and Baby app, an informative video and end-to-end digital clinic documentation to include this information sharing prompt.

Keywords: group B Streptococcus, early onset sepsis, Antenatal care, Neonatal morbidity, GBS

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Authors: Manisha A. Hira, Arup Rakshit

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Textile substrates are endowed with flexibility and ease of making–up, but are non-conductors of electricity. Conductive materials like carbon can be incorporated into textile structures to make flexible conductive materials. Such conductive textiles find applications as electrostatic discharge materials, electromagnetic shielding materials and flexible materials to carry current or signals. This work focuses on use of carbon fiber as conductor of electricity. Carbon fibers in staple or tow form can be incorporated in textile yarn structure to conduct electricity. The paper highlights the process for development of these conductive yarns of polyester/carbon using Friction spinning (DREF) as well as ring spinning. The optimized process parameters for processing hybrid structure of polyester with carbon tow on DREF spinning and polyester with carbon staple fiber using ring spinning have been presented. The studies have been linked to highlight the electrical conductivity of the developed yarns. Further, the developed yarns have been incorporated as weft in fabric and their electrical conductivity has been evaluated. The paper demonstrates the structure and properties of fabrics developed from such polyester/carbon blend yarns and their suitability as electrically dissipative fabrics.

Keywords: carbon fiber, conductive textiles, electrostatic dissipative materials, hybrid yarns

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Authors: Constantinos S. Mammas, Andreas Lazaris, Adamantia S. Mamma-Graham, Georgia Kostopanagiotou, Chryssa Lemonidou, John Mantas, Eustratios Patsouris

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The process to build a better safety culture, methods of error analysis, and preventive measures, starts with an understanding of the effects when human factors engineering refer to remote microscopic diagnosis in surgery and specially in organ transplantation for the evaluation of the grafts. Α high percentage of solid organs arrive at the recipient hospitals and are considered as injured or improper for transplantation in the UK. Digital microscopy adds information on a microscopic level about the grafts (G) in Organ Transplant (OT), and may lead to a change in their management. Such a method will reduce the possibility that a diseased G will arrive at the recipient hospital for implantation. Aim: The aim of this study is to analyze the ergonomics of digital microscopy (DM) based on virtual slides, on telemedicine systems (TS) for tele-pathological evaluation (TPE) of the grafts (G) in organ transplantation (OT). Material and Methods: By experimental simulation, the ergonomics of DM for microscopic TPE of renal graft (RG), liver graft (LG) and pancreatic graft (PG) tissues is analyzed. In fact, this corresponded to the ergonomics of digital microscopy for TPE in OT by applying virtual slide (VS) system for graft tissue image capture, for remote diagnoses of possible microscopic inflammatory and/or neoplastic lesions. Experimentation included the development of an OTE-TS similar experimental telemedicine system (Exp.-TS) for simulating the integrated VS based microscopic TPE of RG, LG and PG Simulation of DM on TS based TPE performed by 2 specialists on a total of 238 human renal graft (RG), 172 liver graft (LG) and 108 pancreatic graft (PG) tissues digital microscopic images for inflammatory and neoplastic lesions on four electronic spaces of the four used TS. Results: Statistical analysis of specialist‘s answers about the ability to accurately diagnose the diseased RG, LG and PG tissues on the electronic space among four TS (A,B,C,D) showed that DM on TS for TPE in OT is elaborated perfectly on the ES of a desktop, followed by the ES of the applied Exp.-TS. Tablet and mobile-phone ES seem significantly risky for the application of DM in OT (p<.001). Conclusion: To make the largest reduction in errors and adverse events referring to the quality of the grafts, it will take application of human factors engineering to procurement, design, audit, and awareness-raising activities. Consequently, it will take an investment in new training, people, and other changes to management activities for DM in OT. The simulating VS based TPE with DM of RG, LG and PG tissues after retrieval, seem feasible and reliable and dependable on the size of the electronic space of the applied TS, for remote prevention of diseased grafts from being retrieved and/or sent to the recipient hospital and for post-grafting and pre-transplant planning.

Keywords: digital microscopy, organ transplantation, tele-pathology, virtual slides

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Authors: Nixon Kuruvila, H. V. Ravindra

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Wire-cut Electro Discharge Machining (WEDM) is a special form of conventional EDM process in which electrode is a continuously moving conductive wire. The present study aims at determining parametric influence and optimum process parameters of Wire-EDM using Taguchi’s Technique and Genetic algorithm. The variation of the performance parameters with machining parameters was mathematically modeled by Regression analysis method. The objective functions are Dimensional Accuracy (DA) and Material Removal Rate (MRR). Experiments were designed as per Taguchi’s L16 Orthogonal Array (OA) where in Pulse-on duration, Pulse-off duration, Current, Bed-speed and Flushing rate have been considered as the important input parameters. The matrix experiments were conducted for the material Oil Hardened Non Shrinking Steel (OHNS) having the thickness of 40 mm. The results of the study reveals that among the machining parameters it is preferable to go in for lower pulse-off duration for achieving over all good performance. Regarding MRR, OHNS is to be eroded with medium pulse-off duration and higher flush rate. Finally, the validation exercise performed with the optimum levels of the process parameters. The results confirm the efficiency of the approach employed for optimization of process parameters in this study.

Keywords: dimensional accuracy (DA), regression analysis (RA), Taguchi method (TM), volumetric material removal rate (VMRR)

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Authors: Golaleh Ghaffari

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A basin sediment yield refers to the amount of sediment exported by a basin over a period of time, which will enter a reservoir located at the downstream limit of the basin. The Soil and Water Assessment Tool (SWAT, 2008) was used to hydrology and sediment transport modeling at daily and monthly time steps within the Gheshlagh dam basin in north-west of Iran. The SWAT model and Geographic Information System (GIS) techniques were applied to evaluate basin hydrology and sediment yield using historical flow and sediment data and to identify and prioritize critical sub-basins based on sediment transport. The results of this study indicated that simulated daily discharge and sediment values matched the observed values satisfactorily. The model predicted that mean annual basin precipitation for the total study period (413 mm) was partitioned in to evapotranspiration (36%), percolation/groundwater recharge (21%) and stream water (25%), yielding 18% surface runoff. Potential source areas of erosion were also identified with the model. The range of the annual contributing erosive zones varied spatially from 0.1 to 103 t/ha according to the slope and land use at the basin scale. Also the fifteen sub basins create the 60% of the total sediment yield between the all (102) sub basins. The results of the study indicated that SWAT can be a useful tool for assessing hydrology and sediment yield response of the watersheds in the region.

Keywords: erosion, Gheshlagh dam, sediment yield, SWAT

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Authors: Avantika Verma

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Diabetic retinopathy (DR) and Central serous retinopathy (CSR) are 2 distinct entities, with difference in age of presentation, eitiopathogenesis and clinical features, but when occurring together, can be a diagnostic dilemma and requires careful evaluation. Case study of 3 patients with long standing diabetes (>15yrs) and features of Central serous retinopathy was done at Bangalore West Lions Superspeciality Eye Hospital, Bangalore, India in 2013. Even though diabetic retinopathy and CSR have different pathologies, they can coexist. The reason for coexistence could be the following: A patient with CSR as a young adult could develop DR in later years. Stress could be the contributing factor in older patient with diabetes.Stress could be a common factor for both, as it is one of the important factors in the pathogenesis of Maturity Onset Diabetes Miletus (MODY). In any situation, a careful evaluation is necessary to differentiate the cause of fundus picture, as treatment differs for the two diseases.

Keywords: central serous retinopathy, diabetic retinopathy, existence, stress

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Authors: Umran Kurtan, Hamide Aydin, Sevim Unugur Celik, Ayhan Bozkurt

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In the present work, novel hBN/polyacrylonitrile composite nanofibers were produced via electrospinning approach and loaded with the electrolyte for rechargeable lithium-ion battery applications. The electrospun nanofibers comprising various hBN contents were characterized by using Fourier transform infrared spectroscopy (FT-IR), thermogravimetric analysis (TGA), X-ray diffraction (XRD) and scanning electron microscopy (SEM) techniques. The influence of hBN/PAN ratios onto the properties of the porous composite system, such as fiber diameter, porosity, and the liquid electrolyte uptake capability were systematically studied. Ionic conductivities and electrochemical characterizations were evaluated after loading electrospun hBN/PAN composite nanofiber with liquid electrolyte, i.e., 1 M lithium hexafluorophosphate (LiPF6) in ethylene carbonate (EC)/ethyl methyl carbonate (EMC) (1:1 vol). The electrolyte loaded nanofiber has a highest ionic conductivity of 10−3 S cm⁻¹ at room temperature. According to cyclic voltammetry (CV) results it exhibited a high electrochemical stability window up to 4.7 V versus Li+/Li. Li//10 wt% hBN/PAN//LiCO₂ cell was produced which delivered high discharge capacity of 144 mAhg⁻¹ and capacity retention of 92.4%. Considering high safety and low cost properties of the resulting hBN/PAN fiber electrolytes, these materials can be suggested as potential separator materials for lithium-ion batteries.

Keywords: hexagonal boron nitride, polyacrylonitrile, electrospinning, lithium ion battery

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Authors: Jeet Vijay Sah, Alphonsa Joseph, Pravin Kumari Dwivedi, Ghanshyam Jhala, Subroto Mukherjee

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AISI 304 is known for its corrosion resistance which comes from Cr that forms passive Cr₂O₃ on the surface. But its poor hardness makes it unsuitable for applications where the steel also requires high wear resistance. This can be improved by surface hardening using nitrocarburizing processes, which form ε-Fe2-3N, γ’-Fe4N, nitrides, and carbides of Cr and Fe on the surface and subsurface. These formed phases give the surface greater hardness, but the corrosion resistance drops because of the lack of Cr2O3 passivation as a result. To overcome this problem, plasma nitrocarburizing processes are being developed where the process temperatures are kept below 723 K to avoid Cr-N precipitation. In the presented work, low-temperature pulsed-DC plasma nitrocarburizing utilizing a discharge of N₂-H₂-C₂H₂ at 500 Pa with varying N₂:H₂ ratios was conducted on AISI 304 samples at 673 K. The process durations were also varied, and the samples were characterized by microindentation using Vicker’s hardness tester, corrosion resistances were established from electrochemical impedance studies, and corrosion potentials and corrosion currents were obtained by potentiodynamic polarization testing. XRD revealed S-phase, which is a supersaturated solid solution of N and C in the γ phase. The S-phase was observed to be composed of the expanded phases of γ; γN, γC, and γ’N and ε’N phases. Significant improvement in surface hardness was achieved after every process, which is attributed to the S-phase. Corrosion resistance was also found to improve after the processes. The samples were also characterized by XPS, SEM, and GDOES.

Keywords: AISI 304, surface engineering, nitrocarburizing, S-phase

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Authors: G. Nyongombe, Guy L. Kabongo, B. M. Mothudi, M. S. Dhlamini

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A series of Transition Metals Oxides (TMOs) doped graphene were synthesized and successfully used as supercapacitor electrode materials. The as-synthesized materials exhibited exceptional electrochemical properties owing to the combined properties of its constituents; high surface area and good conductivity were achieved. Several analytical characterization techniques were employed to investigate the morphology, crystal structure atomic arrangement and elemental chemical state in the materials for which scanning electron microscopy (SEM), X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) were conducted, respectively. Moreover, the electrochemical properties of the as-synthesized materials were examined by performing cyclic voltammetry (CV), galvanostatic charge-discharge (GCD) and electrochemical impedance spectroscopy (EIS) measurements. Furthermore, the effect of doping concentration on the interlayer distance of the graphene materials and the charge transfer resistance are investigated and correlated to the exceptional current density which was multiplied by a factor of ~80 after TMOs doping in graphene. Finally, the resulting high capacitance obtained confirms the contribution of grapheme exceptional electronic conductivity and large surface area on the electrode materials. Such good-performing electrode materials are highly promising for supercapacitors and other energy storage devices.

Keywords: energy density, graphene, supercapacitors, TMOs

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Authors: Mwafak Shakoor

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The purpose of this study was to reduce patient waiting times, improve system throughput and improve resources utilization in radiology department. A discrete event simulation model was developed using Arena simulation software to investigate different alternatives to improve the overall system delivery based on adding resource scenarios due to the linkage between patient waiting times and resource availability. The study revealed that there is no addition investment need to procure additional scanner but hospital management deploy managerial tactics to enhance machine utilization and reduce the long waiting time in the department.

Keywords: discrete event simulation, radiology department, arena, waiting time, healthcare modeling, computed tomography

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Authors: Joseph C. Chen, Joshua Cox

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This research focuses on the use of the Taguchi method to reduce the surface roughness and improve dimensional accuracy of parts machined by Wire Electrical Discharge Machining (EDM) with S7 heat treated steel material. Due to its high impact toughness, the material is a candidate for a wide variety of tooling applications which require high precision in dimension and desired surface roughness. This paper demonstrates that Taguchi Parameter Design methodology is able to optimize both dimensioning and surface roughness successfully by investigating seven wire-EDM controllable parameters: pulse on time (ON), pulse off time (OFF), servo voltage (SV), voltage (V), servo feed (SF), wire tension (WT), and wire speed (WS). The temperature of the water in the Wire EDM process is investigated as the noise factor in this research. Experimental design and analysis based on L₁₈ Taguchi orthogonal arrays are conducted. This paper demonstrates that the Taguchi-based system enables the wire EDM process to produce (1) high precision parts with an average of 0.6601 inches dimension, while the desired dimension is 0.6600 inches; and (2) surface roughness of 1.7322 microns which is significantly improved from 2.8160 microns.

Keywords: Taguchi Parameter Design, surface roughness, Wire EDM, dimensional accuracy

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Authors: Godfrey Katende, Lillian Nakimera

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The process of caregiving may cause emotional distress in form of anxiety and depression among family carers of cancer patients. Little is known about the prevalence anxiety and depression among family carers of cancer patients in Uganda. This cross-sectional study aimed to determine the prevalence of anxiety and depression among family carers of cancer patients and related factors associated with abnormal levels of anxiety and depression. A total of 119 family carers from Uganda Cancer Institute (UCI) were assessed by the Hospital Anxiety and Depression Scale (HADS) standardized questionnaire. The prevalence of anxiety and depression among family carers was high (45% and 26 % respectively); (2) abnormal levels of anxiety (ALA) and depression (ALD) was significantly associated with being a relative carer. Incorporating evidence based psychological therapies targeting family carers into usual care of cancer patients is imperative.

Keywords: anxiety, cancer, carer, cross-sectional design, depression, Uganda

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Authors: V. Moser-Siegmeth, M. C. Gambal, M. Jelovcak, B. Prytek, I. Swietalsky, D. Würzl, C. Fida, V. Mühlegger

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Adaptability is the capacity to adjust without great difficulty to changing circumstances. Within our project, we aimed to detect whether older people living within a long-term care hospital lose the ability to adapt. Theoretical concepts are contradictory in their statements. There is also lack of evidence in the literature how the adaptability of older people changes over the time. Following research questions were generated: Are older residents of a long-term care facility able to adapt to changes within their daily routine? How long does it take for older people to adapt? The study was designed as a convergent parallel mixed method intervention study, carried out within a four-month period and took place within seven wards of a long-term care hospital. As a planned intervention, a change of meal-times was established. The inhabitants were surveyed with qualitative interviews and quantitative questionnaires and diaries before, during and after the intervention. In addition, a survey of the nursing staff was carried out in order to detect changes of the people they care for and how long it took them to adapt. Quantitative data was analysed with SPSS, qualitative data with a summarizing content analysis. The average age of the involved residents was 82 years, the average length of stay 45 months. The adaptation to new situations does not cause problems for older residents. 47% of the residents state that their everyday life has not changed by changing the meal times. 24% indicate ‘neither nor’ and only 18% respond that their daily life has changed considerably due to the changeover. The diaries of the residents, which were conducted over the entire period of investigation showed no changes with regard to increased or reduced activity. With regard to sleep quality, assessed with the Pittsburgh sleep quality index, there is little change in sleep behaviour compared to the two survey periods (pre-phase to follow-up phase) in the cross-table. The subjective sleep quality of the residents is not affected. The nursing staff points out that, with good information in advance, changes are not a problem. The ability to adapt to changes does not deteriorate with age or by moving into a long-term care facility. It only takes a few days to get used to new situations. This can be confirmed by the nursing staff. Although there are different determinants like the health status that might make an adjustment to new situations more difficult. In connection with the limitations, the small sample size of the quantitative data collection must be emphasized. Furthermore, the extent to which the quantitative and qualitative sample represents the total population, since only residents without cognitive impairments of selected units participated. The majority of the residents has cognitive impairments. It is important to discuss whether and how well the diary method is suitable for older people to examine their daily structure.

Keywords: adaptability, intervention study, mixed methods, nursing home residents

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Authors: R. Frikha, H. Kamoun

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Background:Chronicmyeloidleukemia (CML), a hematologicaldisease, ischaracterized by t (9; 22) and relatedoncogene BCR-ABL formation. Although Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of CML, resistanceoccurs and possibly médiates by mutation in severalgenesindependently of the bcr-abl1 kinase mechanism. it has been reportedthat JAK2V617F/BCR-ABL double positivitymaybe a potential marker of resistance in CML. Aims: This studywasinvestigated the JAK2V617F mutation in TKI-resistant CML patients. Methods: A retrospectivestudywasconducted in the Hospital University of Sfax, south of Tunisia, including all CML TKI-resistant patients. A Sanger sequencingwasperformedusing a high-fidelity DNA polymerase. Results:Nineresistant CP-CML patients wereenrolled in thisstudy. The JAK2V617F mutation wasdetectedin 3 patients with TKI resistance. Conclusion:Despite the limit of ourstudy, ourfinding highlights the high frequency of JAK2V617F/BCR-ABL double positivity as an important marker of resistance. So; the combination of JAK and TKI inhibitorsmightbe effective and potentiallybeguided by molecular monitoring of minimal residual disease1.

Keywords: chronic myeloid leukemia, tyrosine kinase inhibitors, resistance, JAK2V617F, BCR-ABL

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Authors: Rattakorn Poonsuph

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Technological innovation plays a crucial role in virtual healthcare services. A growing number of telehealth platforms are concentrating on using digital tools to improve the quality and availability of care. As a result, telehealth represents an opportunity to redesign the way health services are delivered. The research objective is to discover a new business model for digital health services and related industries to participate with telehealth solutions. The business opportunity is valuable for healthcare investors as a startup company to further investigations or implement the telehealth platform. The paper presents a digital healthcare business model and business opportunities to related industries. These include digital healthcare services extending from a traditional business model and use cases of business opportunities to related industries. Although there are enormous business opportunities, telehealth is still challenging due to the patient adaption and digital transformation process within a healthcare organization.

Keywords: telehealth, Internet hospital, HealthTech, InsurTech

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Authors: Wahab Ali Shah, Junjia He

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In this work, we performed a large-scale investigation into leader development in a 10 m rod-plane gap under a long front positive impulse. To describe the leader propagation under slow front impulse voltages, we recorded the leader propagation with a high-speed charge coupled device (CCD) camera. It is important to figure out this phenomenon to deepen our understanding of leader discharge. The observation results showed that the leader mechanism is a very complex physical phenomenon; it could be categorized into two types of leader process, namely, continuous and the discontinuous leader streamer-leader propagation. Furthermore, we studied the continuous leader development parameters, including two-dimensional (2-D) leader length, injected charge, and final jump stage, as well as leader velocity for rod–plane configuration. We observed that the discontinuous leader makes an important contribution to the appearance of channel re-illuminations of the positive leader. The comparative study shows better results in terms of standard switch impulse and long front positive impulse. Finally, the results are presented with a view toward improving our understanding of propagation mechanisms related to restrike phenomena, which are rarely reported. To clarify the above doubts under long front cases, we carried out extensive experiments in this study.

Keywords: continuous and discontinuous leader, high-speed photographs, long air gap, positive long front impulse, restrike phenomena

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Authors: Imtisal-e-Noor, Andrew Martin, Olli Dahl

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Chemical Mechanical Polishing (CMP) has developed as a chosen planarization technique in nano-electronics industries for fabrication of the integrated circuits (ICs). These CMP processes release a huge amount of wastewater that contains oxides of nano-particles (silica, alumina, and ceria) and oxalic acid. Since, this wastewater has high solid content (TS), chemical oxygen demand (COD), and turbidity (NTU); therefore, in order to fulfill the environmental regulations, it needs to be treated up to the local and international standards. The present study proposed a unique CMP wastewater treatment method called Membrane Distillation (MD). MD is a non-isothermal membrane separation process, which allows only volatiles, i.e., water vapors to permeate through the membrane and provides 100% contaminants rejection. The performance of the MD technology is analyzed in terms of total organic carbon (TOC), turbidity, TS, COD, and residual oxide concentration in permeate/distilled water while considering different operating conditions (temperature, flow rate, and time). The results present that high-quality permeate has been recovered after removing 99% of the oxide particles and oxalic acid. The distilled water depicts turbidity < 1 NTU, TOC < 3 mg/L, TS < 50 mg/L, and COD < 100 mg/L. These findings clearly show that the MD treated water can be reused further in industrial processes or allowable to discharge in any water body under the stringent environmental regulations.

Keywords: chemical mechanical polishing, environmental regulations, membrane distillation, wastewater treatment

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Authors: Pejman Salimi, Sebastiano Tieuli, Somayeh Taghavi, Michela Signoretto, Remo Proietti Zaccaria

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Increasing the growth of industrial waste due to the large quantities of production leads to numerous environmental and economic challenges, such as climate change, soil and water contamination, human disease, etc. Energy recovery of waste can be applied to produce heat or electricity. This strategy allows for the reduction of energy produced using coal or other fuels and directly reduces greenhouse gas emissions. Among different factories, leather manufacturing plays a very important role in the whole world from the socio-economic point of view. The leather industry plays a very important role in our society from a socio-economic point of view. Even though the leather industry uses a by-product from the meat industry as raw material, it is considered as an activity demanding integrated prevention and control of pollution. Along the entire process from raw skins/hides to finished leather, a huge amount of solid and water waste is generated. Solid wastes include fleshings, raw trimmings, shavings, buffing dust, etc. One of the most abundant solid wastes generated throughout leather tanning is shaving waste. Leather shaving is a mechanical process that aims at reducing the tanned skin to a specific thickness before tanning and finishing. This product consists mainly of collagen and tanning agent. At present, most of the world's leather processing is chrome-tanned based. Consequently, large amounts of chromium-containing shaving wastes need to be treated. The major concern about the management of this kind of solid waste is ascribed to chrome content, which makes the conventional disposal methods, such as landfilling and incineration, not practicable. Therefore, many efforts have been developed in recent decades to promote eco-friendly/alternative leather production and more effective waste management. Herein, shaving waste resulting from metal-free tanning technology is proposed as low-cost precursors for the preparation of carbon material as anodes for lithium-ion batteries (LIBs). In line with the philosophy of a reduced environmental impact, for preparing fully sustainable and environmentally friendly LIBs anodes, deionized water and carboxymethyl cellulose (CMC) have been used as alternatives to toxic/teratogen N-methyl-2- pyrrolidone (NMP) and to biologically hazardous Polyvinylidene fluoride (PVdF), respectively. Furthermore, going towards the reduced cost, we employed water solvent and fluoride-free bio-derived CMC binder (as an alternative to NMP and PVdF, respectively) together with LiFePO₄ (LFP) when a full cell was considered. These actions make closer to the 2030 goal of having green LIBs at 100 $ kW h⁻¹. Besides, the preparation of the water-based electrodes does not need a controlled environment and due to the higher vapour pressure of water in comparison with NMP, the water-based electrode drying is much faster. This aspect determines an important consequence, namely a reduced energy consumption for the electrode preparation. The electrode derived from leather waste demonstrated a discharge capacity of 735 mAh g⁻¹ after 1000 charge and discharge cycles at 0.5 A g⁻¹. This promising performance is ascribed to the synergistic effect of defects, interlayer spacing, heteroatoms-doped (N, O, and S), high specific surface area, and hierarchical micro/mesopore structure of the biochar. Interestingly, these features of activated biochars derived from the leather industry open the way for possible applications in other EESDs as well.

Keywords: biowaste, lithium-ion batteries, physical activation, waste management, leather industry

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Authors: Ali Siami, Masoud Asayesh, Asghar Najafi, Amirhosein Hamedanian

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There are so many noise sources in power generation units that these sources can produce high-level sound noise. Therefore, sound noise reduction methods can assist these industries, especially in these days that laws related to environmental issues become more strict. In a typical power plant, so many machines and devices with high-level sound noise are arranged beside of each others. Therefore, the sound source identification and reducing the noise level can be very vital. In this paper, the procedure for designing, manufacturing and testing of a silencer-muffler used for a power plant steam vent is mentioned. This unit is placed near the residential area and so it is very important to reduce the noise emission. For this purpose, in the first step, measurements have done to identify the sound source and the frequency content of noise. The overall level of noise was so high and it was more than 120dB. Then, the appropriate noise control device is designed according to the measurement results and operational conditions. In the next step, the designed silencer-muffler has been manufactured and installed on the steam discharge of the ejector. For validation of the silencer-muffler effect, the acoustic test was done again in operating mode. Finally, the measurement results before and after the installation are compared. The results have confirmed a considerable reduction in noise level resultant of using silencer-muffler in the designed frequency range.

Keywords: silencer-muffler, sound noise control, sound measurement, steam ejector

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Authors: T. R. Sreekrishnan, Mukesh Khare, Dinesh Upadhyay

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In a Rotating Biological Contactor (RBC), the biological film responsible for removal of pollutants is formed on the surface of discs. Evaluation studies of a pilot RBC designed to treat sewage of 150 persons with BOD Loading Rate: 8.2–26.7 g/m2/d, Discharge: 57.6 – 115.2 m3/day, HRT 1.25 – 2.5 hrs, at STP Yamuna Vihar Delhi. Removal of organic materials through use of fixed film reactors such as RBC is accomplished by means of a biological film on the fixed media. May and June in Delhi are dry summer months where the ambient temperature is in the range of 35oC to 45oC. July is a wet monsoon month that receives occasional precipitation, cloud cover, high humidity, with ambient temperature in the range of 30oC to 35oC. The organic and inorganic loads to the RBC employed in this study are actual city sewage conditions. Average in fluent BOD concentrations have been 330 mg/l, 245 mg/l and 160 mg/l and the average COD concentrations have been 670 mg/l, 500 mg/l, and 275 mg/l. The city sewage also has high concentration of ammonia, phosphorous, total suspended solids (TSS). pH of the city sewage is near neutral. Overall, the substrate conditions of city sewage are conducive for biological treatment though aerobic process. The presentation is a part of the ongoing collaborative research initiative between IIT Delhi and Karlsruhe Institute of Technology, Germany which is going on for last 15 years or so in the treatment of sewage waste of Delhi using semi-decentralized treatment system based on Rotating Biological Contactor.

Keywords: Rotating Biological Contactor (RBC), COD, BOD, HRT, STP

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Authors: Vijay Meena, Arup Kumar Sarma, Chandan Mahanta

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The environment has been getting contaminated by anthropogenic processes including those that discharge heavy metals to air, soil and water. The present work emphasizes the spatial distribution and vertical profile of six heavy metals (Cu, Zn, Mn, Ni, Fe, Cr) in three layers of mid sand bars (bed surface layer, 50 cm and 100 cm depth) at 42 sampling stations covering around 600 km stretch of the Brahmaputra River, India. Heavy metal analysis was conducted on the sample collected from mid-sand bars in the river stretch to examine the impact of dredging for various hydrological operations in the future. Sediment quality was assessed by calculating six different indices viz., EF, CF, CD, PLI, Igeo, and PERI. In all sediment layers, heavy metal concentrations have been observed to be the same as listed, Fe > Mn > Zn > Ni > Cr > Cu in μg/g. The average concentration of Cu, Mn, and Fe was found in the middle layer while Zn, Ni, and Cr were in the Surface layer. EF indicates higher enrichment in reach 2 which is likely to be due to anthropogenic sources of industrial and urbanized effluents. The sediment of the mid-sand bar was generally found moderately polluted possessing low risk to aquatic lives and the environment. Suggesting, Dredging can be possible in the future. An examination of correlation matrices, principal components analysis, and cluster analyses indicated that these heavy metals possess similar anthropogenic origins for their enrichment.

Keywords: heavy metal contamination, risk assessment, anthropogenic impacts, sediment

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Authors: Camille Plant, Katherine McGill, Pek Ang

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Oncology patients face a host of unique challenges, which are physical, psychological and philosophical in nature. This preliminary study aimed to explore the psychiatric morbidity of oncology patients in an outpatient setting at a major public hospital in Australia. The study found that 33 patients were referred to a Psychiatrist by a Clinical Psychologist or treating Oncologist. These patients attended an outpatient Psychiatry appointment at the Calvary Mater Hospital, Newcastle, over a 7 month period (June 2017-January 2018). Of these, 45% went on to have a follow-up appointment. The Clinical Global Impressions Scale (CGI) was used to gather symptom severity scores at baseline and at follow-up. The CGI is a clinician determined instrument that provides an assessment of global functioning. It is comprised of two companion one-item measures: the CGI-Severity (CGI-S) rates mental illness severity, and the CGI-Improvement (CGI-I) rates change in condition or improvement from initiation of treatment. Patients referred to a Psychiatrist were observed to be on average in the Markedly ill approaching Severely ill range (CGI-S average of 5.5). However, those patients who attended a follow-up appointment were on average only Moderately Ill at baseline (CGI-S average of 3.9). Despite these follow patients not being severely mentally ill initially, the contact was helpful, as their CGI-S scores improved on average to the Mildly Ill range (CGI-S average of 2.8). A Mixed ANOVA revealed that there was a significant improvement in mental illness severity post-follow-up appointment (Greenhouse-Geisser .000). There was a near even proportion of males and females attending appointments (58% female), and slightly more females attended a follow-up (60% female). Males were on average more mentally ill at baseline compared to females at baseline (male average M=3.86, female average M=3.56), and males had a greater reduction in mental illness severity on average compared to females (male average M=2.71, female average 3.00). This was approaching significance (.073) and would be important to explore with a larger sample size. Change in clinical condition for follow-up patients was also recorded. It was found that more than half of patients (53%) were observed to experience Minimal improvement in attending at least one follow-up appointment. There was no change for 27% of patients, and there were no patients who were worse at follow up. As this was a preliminary study with small sample size, future research conducted could explore whether there are any significant gender differences, such as whether males experience the significantly greater reduction in symptoms of mental illness compared to females, as well as any effects of cancer stage or type on psychiatric outcomes. Future research could also investigate outcomes for those patients who concurrently access a Clinical Psychologist alongside the Psychiatrist. A limitation of the study is that the outcome measure is a brief item rating completed by the clinician.

Keywords: clinical global impressions scale, psychiatry, morbidity, oncology, outcomes, psychiatry

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Authors: Okunola Oluseye Ademola

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The study investigated various socio-cultural factors influencing adherence to antiretroviral drugs among people living with HIV in a University Teaching Hospital in South-western Nigeria. The objectives are to examine the perception of people living with HIV/AIDS (PLWHA) of antiretroviral therapy (ART) in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, investigate the influence of socio-cultural factors on adherence of PLWHA to treatment regimen in the study area and assess the prevalence of adherence to ART among PLWHA in the study area. It was a cross-sectional where both qualitative and quantitative research methods were adopted. The participants were HIV diagnosed patients attending clinic at the Obafemi Awolowo University Teaching Hospitals Complex in Ile-Ife between the ages of 18 and 60 years. Also three healthcare delivery personnel working in the clinic were interviewed. Out of the 3007 patients receiving treatment, using Fischer’s formula of sampling technique, 336 patients living with HIV/AIDS were selected for the study. These participants had been on antiretroviral drugs for more than six months prior to the study and were selected using simple random sampling technique. Two focus group discussion sessions comprising of 10 male and 10 female living with HIV and currently on ART were conducted. These groups were purposively selected based on their being on ART for more than one year. Also in-depth interviews were conducted among three purposively selected healthcare givers (an experienced nurse, a doctor and a pharmacist) who are working in this clinic. All the participants were interviewed at the clinic on the various clinic days. Data were collected using a structured questionnaire, an interview guide and tape-recorder. The quantitative data were analysed using descriptive and inferential statistics. Content analysis was employed to analyse responses from IDI and FGD sessions. The findings from the study revealed a very positive perception to ART among PLWHA which was about 86.3% while the level of adherence to ART was 89.0% among the respondents. There was a very strong relationship between social and family supports and the degree of adherence to ART in the PLWHA. Nutrition, polygamy, difficulty in financing transportation fare to the clinic, unemployment, drug hawkers, religion, excuse duty from work and waking up very early were highlighted as socio-cultural barriers to adherence to ART. Fear of death, strong family support, religion belief, not seeking alternative treatment, absence of rituals and perceived improved health status were identified as very strong facilitators to adherence. The study concluded that to achieve a very optimal outcome in the management of HIV among PLWHA, various social and cultural contexts should be taken into consideration as this study was able to ascertain the influence of various socio-cultural factors militating and facilitating adherence to ART.

Keywords: ART, HIV, PLWHA, socio-cultural

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Authors: Thibaud Berthomier, Ali Mansour, Luc Bressollette, Frédéric Le Roy, Dominique Mottier, Léo Fréchier, Barthélémy Hermenault

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Deep Venous Thrombosis (DVT) occurs when a thrombus is formed within a deep vein (most often in the legs). This disease can be deadly if a part or the whole thrombus reaches the lung and causes a Pulmonary Embolism (PE). This disorder, often asymptomatic, has multifactorial causes: immobilization, surgery, pregnancy, age, cancers, and genetic variations. Our project aims to relate the thrombus epidemiology (origins, patient predispositions, PE) to its structure using ultrasound images. Ultrasonography and elastography were collected using Toshiba Aplio 500 at Brest Hospital. This manuscript compares two classification approaches: spectral clustering and scattering operator. The former is based on the graph and matrix theories while the latter cascades wavelet convolutions with nonlinear modulus and averaging operators.

Keywords: deep venous thrombosis, ultrasonography, elastography, scattering operator, wavelet, spectral clustering

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Authors: Mojibul Sajjad, Mohammad G. Rasul, Md. Sharif Imam Ibne Amir

Abstract:

The rate of natural gas dissociation from the Coal Matrix depends on depressurization of reservoir through removing of the cleat water from the coal seam. These waters are similar to brine and aged of long years. For improving the connectivity through fracking /fracturing, high pressure liquids are pumped off inside the coal body. A significant quantity of accumulated water, a combined mixture of cleat water and fracking fluids (back flow water) is pumped out through gas well. In Queensland Coal Seam Gas industry is in booming state and estimated of 30,000 wells would be active for CSG production forecasting life span of 30 years. Integrated water management along with water softening programs is practiced for subsequent treatment and later on discharge to nearby surface water catchment. Water treatment is an important part of the CSG industry. A case study on a CSG site and review on the test results are discussed for assessing the Standards & Practices for management of CSG by-product water and their subsequent disposal activities. This study was directed toward (i) water management and softening process in Spring Gully Mine field, (ii) Comparative analysis on experimental study and standards and (iii) Disposal of the treated water. This study also aimed for alternative usages and their impact on vegetation, living species as well as long term effects.

Keywords: coal seam gas (CSG), cleat water, hydro-fracking, product water

Procedia PDF Downloads 413