Search results for: Pediatric intensive care unit

Authors: Katie E. Jennings

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The interactions between family dynamics and environmental factors with mental health vulnerability in individuals are well known and are a theme for on-going research and debate. The impact upon mental health issues and forensic issues on family dynamics, experience, and emotional wellbeing cannot be over-Emphasised. For forensic patients with diagnosed mental disorders, these relationships and environments may have also been functionally linked to the development and maintenance of those disorders; with significant adverse childhood experiences being a common feature of many Patient’s histories. Mental health hospitals remove the patient from their home environments and provide treatment outside of these relationships and often outside of the home area. There is, therefore, a major focus on Services ensuring that patients are able to build and maintain relationships with family and friends, requiring services to involve families in Patients' care and treatment wherever possible. There are standards set by Government and clinical bodies that require absolute demonstration of the inclusion of family and friends in all aspects of the care and treatment of forensic patients. For some patients and family members, this push to take on a “role” in care can be unhelpful, extremely stressful, and has constant implications for the potential delicate reparation of relationships. Based on work undertaken for over 20 years in forensic mental health settings, this paper explores the positive psychology approach to a dimensional model to family inclusion in mental health care that learns from family court work and allows for the maintenance of relationships to be at both proximal and Distil levels; to prevent the replication of abuse, decrease the need for falsehoods and assist the recovery of all. The model is based on allowing families to choose to not be involved or be involved in different ways if this is seen to be more helpful. It also allows patients to choose the level of potential involvement that they would find helpful, and for this to be reviewed at a timeframe agreed by all parties, rather than when the next survey is due or the patient has a significant care meeting. This paper is significant as there is a lack of research to support services to use a positive psychology approach to work in this area, the assumption that being asked to be involved must be positive for all seems naïve at best for this patient group. Work relating to the psychology of family can significantly contribute to the development of knowledge in this area. The development of a dimensional model will support choice within families and assist in the development of more honest and open relationships.

Keywords: family dynamics, forensic, mental disorder, positive psychology

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Authors: Mahdi Akhbardeh

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St John's wort plant can help to treat depression disease through decreasing this disease symptom, due to having some similar features of Prozac (Fluoxetine Hcl) pill. People suffering from slight depression who have fear of using antidepressants side effects can use St John's wort drops under doctor observation. This method of treatment is proposed specially to those women who are spending menopause or depression resulted from this period. St John's wort plant have proposed traditional and plant medicine as newest researches in treating mood disorders compared to Prozac (Fluoxetine Hcl) drug in treating depression disease which is being administrated in clinic research center of Washington. Objective: the aim of this study is to find an alternative treatment method in people suffering from depression which are treated with Prozac (Fluoxetine Hcl). Almost 70 percent of treatment failures with Prozac (Fluoxetine Hcl) drug in patients suffering from slight to normal depression is due to intensive side effects including: decrease in blood pressure, reduce in sexual desire and 30 percent of it is due to this drug affectless in treatment procedure which leads to leaving treatment. Results of Hypercuim plant function are exactly similar to antidepressants. Increase in serotonin amount in brain synopsis terminal end causes increase in existence time of this material in this part. In fact these two drugs have similar function. Though side effects of Hypercuim plant(St John's wort) including headache and slight nausea tolerable. Results: St John's wort plant can be used lonely in slight to normal depressions in which patients are avoiding Prozac (Fluoxetine Hcl) drug due to it's side effects. In intensive depressions through which general patients don’t indicate positive response to drug, it is probably expected relative or even complete treatment through combining antidepressants drugs with this plant. This treatment method has been investigated and confirmed in clinical tests and researches.

Keywords: depression, St John's wort, Prozac, antidepressant

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Authors: R. Tariq, R. Lee

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Background: Heywood, Middleton & Rochdale Urgent Community Care Team (UCCT)1 is a great example of using a multidisciplinary team to cope with demand. The service reduces unnecessary admissions to hospitals and ensures that patients can leave the hospital quicker by making care more readily available within the community and patient’s homes. The team comprises nurses, community practitioners, and allied health professions, including physiotherapy, occupational therapy, pharmacy, and GPs. The main challenge for a team with a range of experiences and skill sets is to maintain consistency of care, which technology can help address. Allied healthcare professionals (HCPs) are often used in expanded roles with duties mainly involving patient consultations and decision making to ease pressure on doctors. The Clinical Reasoning Platform (CRP) Dem Dx is used to support new as well as experienced professionals in the decision making process. By guiding HCPs through diagnosing patients from an expansive directory of differential diagnoses, patients can receive quality care in the community. Actions on the platform are determined using NICE guidelines along with local guidance influencing the assessment and management of a patient. Objective: To compare the clinical assessment, decisions, and actions taken by the UCCT multidisciplinary team in the community and Dem Dx, using retrospective clinical cases. Methodology: Dem Dx was used to analyse 192 anonymised cases provided by the HMR UCCT. The team’s performance was compared with Dem Dx regarding the quality of the documentation of the clinical assessment and the next steps on the patient’s journey, including the initial management, actions, and any onward referrals made. The cases were audited by two medical doctors. Results: The study found that the actions outlined by the Dem Dx platform were appropriate in almost 87% of cases. When in a direct comparison between DemDX and the actions taken by the clinical team, it was found that the platform was suitable 83% (p<0.001) of the time and could lead to a potential improvement of 66% in the assessment and management of cases. Dem Dx also served to highlight the importance of comprehensive and high quality clinical documentation. The quality of documentation of cases by UCCT can be improved to provide a detailed account of the assessment and management process. By providing step-by-step guidance and documentation at every stage, Dem Dx may ensure that legal accountability has been fulfilled. Conclusion: With the ever expanding workforce in the NHS, technology has become a key component in driving healthcare outcomes. To improve healthcare provision and clinical reasoning, a decision support platform can be integrated into HCPs’ clinical practice. Potential assistance with clinical assessments, the most appropriate next step and actions in a patient’s care, and improvements in the documentation was highlighted by this retrospective study. A further study has been planned to ascertain the effectiveness of improving outcomes using the clinical reasoning platform within the clinical setting by clinicians.

Keywords: allied health professional, assessment, clinical reasoning, clinical records, clinical decision-making, ocumentation

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Authors: Meng-Fei Cheng, Wei Fneg

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New Taiwan high school standards emphasize employing scientific models and modeling practices in physics learning. However, to our knowledge. Few studies address how scientific models and modeling are approached in current science teaching, and they do not examine the views of scientific models portrayed in the textbooks. To explore the views of scientific models and modeling in textbooks, this study investigated the atomic unit in different textbook versions as an example and provided suggestions for modeling curriculum. This study adopted a quantitative analysis of qualitative data in the atomic units of four mainstream version of Taiwan high school physics textbooks. The models were further analyzed using five dimensions of the views of scientific models (nature of models, multiple models, purpose of the models, testing models, and changing models); each dimension had three levels (low, medium, high). Descriptive statistics were employed to compare the frequency of describing the five dimensions of the views of scientific models in the atomic unit to understand the emphasis of the views and to compare the frequency of the eight scientific models’ use to investigate the atomic model that was used most often in the textbooks. Descriptive statistics were further utilized to investigate the average levels of the five dimensions of the views of scientific models to examine whether the textbooks views were close to the scientific view. The average level of the five dimensions of the eight atomic models were also compared to examine whether the views of the eight atomic models were close to the scientific views. The results revealed the following three major findings from the atomic unit. (1) Among the five dimensions of the views of scientific models, the most portrayed dimension was the 'purpose of models,' and the least portrayed dimension was 'multiple models.' The most diverse view was the 'purpose of models,' and the most sophisticated scientific view was the 'nature of models.' The least sophisticated scientific view was 'multiple models.' (2) Among the eight atomic models, the most mentioned model was the atomic nucleus model, and the least mentioned model was the three states of matter. (3) Among the correlations between the five dimensions, the dimension of 'testing models' was highly related to the dimension of 'changing models.' In short, this study examined the views of scientific models based on the atomic units of physics textbooks to identify the emphasized and disregarded views in the textbooks. The findings suggest how future textbooks and curriculum can provide a thorough view of scientific models to enhance students' model-based learning.

Keywords: atomic models, textbooks, science education, scientific model

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Authors: Yaser Al-Anii, Abdulmajeed Almaneea, Jonathan L. Summers, Harvey M. Thompson, Nikil Kapur

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The natural convection cooling system of a fully immersed server in a dielectric liquid is studied numerically. In the present case study, the dielectric liquid represents working fluid and it is in contact with server inside capsule. The capsule includes electronic component and fluid which can be modeled as saturated porous media. This medium follow Darcy flow regime and assumed to be in balance between its components. The study focus is on role of spatial parameters on thermal behavior of convective heat transfer. Based on server known unit, which is 1U, two parameters Ly and S are changed to test their effect. Meanwhile, wide-range of modified Rayleigh number, which is 0.5 to 300, are covered to better understand thermal performance. Navier-Stokes equations are used to model physical domain. Furthermore, successive over-relaxation and time marching techniques are used to solve momentum and energy equation. From obtained correlation, the in-between distance S is more effective on Nusselt number than distance to edge Ly by approximately 14%. In addition, as S increases, the average Nusselt number of the upper unit increases sharply, whereas the lower one keeps on the same level.

Keywords: convective cooling of server, Darcy flow, liquid-immersed server, porous media

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Authors: Rasha Shoumar

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Background: Since the onset of the Syria crisis in 2011, Jordan has hosted many Syrian refugees, many of which are residing in urban and rural areas. Vulnerability of refugees has increased due to the COVID-19 pandemic, adding to their already existing challenge in access to medical services, rendering them vulnerable to the complications of untreated medical conditions and amplifying their risk for severe COVID-19 disease. To improve health outcomes and access to health care services in a COVID-19 context, IOM (The International Organization for Migration) provided health services including awareness raising, direct primary health care through mobile teams and referrals to secondary services were extended to the vulnerable populations of refugees. Method: 6 community health volunteers were trained and deployed to different governorates to provide COVID-19 and non-communicable disease awareness and collect data rated to non-communicable disease and access to medical health services. Primary health care services were extended to 7 governorates through a mobile medical team, providing medical management. The collected Data was reviewed and analyzed. Results: 2150 refugees in rural areas were reached out by community health volunteers, out of which 78 received their medications through the Ministry of Health, 121 received their medications through different non-governmental organizations, 665 patients couldn’t afford buying any medications, 1286 patients were occasionally buying their medications when they were able to afford it. 853 patients received medications and follow up through IOM mobile clinics, the most common conditions were hypertension, diabetes, hyperlipidemia, anemia, heart disease, thyroid disease, asthma, seizures, and psychiatric conditions. 709 of these patients had more than 3 of the comorbidities. Multiple cases were referred for secondary and tertiary lifesaving interventions. Conclusion: Non communicable diseases are highly prevalent among refugee population in Jordan, access to medical services have proven to be a challenge in rural areas especially during the COVID-19 era, many of the patients have multiple uncontrolled medical conditions placing them at risk for complications and risk for severe COVID-19 disease. Deployment of mobile clinics to rural areas plays an essential role in managing such medical conditions, thus improving the continuum of health care approach, physical and mental wellbeing of refugees and reducing the risk for severe COVID-19 disease among this group, taking us one step forward toward universal health access.

Keywords: COVID-19, refugees, mobile clinics, primary health care

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Authors: T. Mokhele, O. Mutanga, F. Ahmed

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South Africa is one of the few countries that have stopped using the same Enumeration Areas (EAs) for census enumeration and dissemination. The advantage of this change is that confidentiality issue could be addressed for census dissemination as the design of geographic unit for collection is mainly to ensure that this unit is covered by one enumerator. The objective of this paper was to evaluate the performance of automated zone design output areas against non-zone design developed geographies using the 2001 census data, and 2011 census to some extent, as the main input. The comparison of the Automated Zone-design Tool (AZTool) census output areas with the Small Area Layers (SALs) and SubPlaces based on confidentiality limit, population distribution, and degree of homogeneity, as well as shape compactness, was undertaken. Further, SPSS was employed for validation of the AZTool output results. The results showed that AZTool developed output areas out-perform the existing official SAL and SubPlaces with regard to minimum population threshold, population distribution and to some extent to homogeneity. Therefore, it was concluded that AZTool program provides a new alternative to the creation of optimised census output areas for dissemination of population census data in South Africa.

Keywords: AZTool, enumeration areas, small areal layers, South Africa

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Authors: Zheng Wang, Zhenhong Li, Jon Mills

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Ground-based synthetic aperture radar (GBSAR) represents a powerful remote sensing tool for deformation monitoring towards various geohazards, e.g. landslides, mudflows, avalanches, infrastructure failures, and the subsidence of residential areas. Unlike spaceborne SAR with a fixed revisit period, GBSAR data can be acquired with an adjustable temporal resolution through either continuous or discontinuous operation. However, challenges arise from processing high temporal-resolution continuous GBSAR data, including the extreme cost of computational random-access-memory (RAM), the delay of displacement maps, and the loss of temporal evolution. Moreover, repositioning errors between discontinuous campaigns impede the accurate measurement of surface displacements. Therefore, a versatile package with two complete chains is developed in this study in order to process both continuous and discontinuous GBSAR data and address the aforementioned issues. The first chain is based on a small-baseline subset concept and it processes continuous GBSAR images unit by unit. Images within a window form a basic unit. By taking this strategy, the RAM requirement is reduced to only one unit of images and the chain can theoretically process an infinite number of images. The evolution of surface displacements can be detected as it keeps temporarily-coherent pixels which are present only in some certain units but not in the whole observation period. The chain supports real-time processing of the continuous data and the delay of creating displacement maps can be shortened without waiting for the entire dataset. The other chain aims to measure deformation between discontinuous campaigns. Temporal averaging is carried out on a stack of images in a single campaign in order to improve the signal-to-noise ratio of discontinuous data and minimise the loss of coherence. The temporal-averaged images are then processed by a particular interferometry procedure integrated with advanced interferometric SAR algorithms such as robust coherence estimation, non-local filtering, and selection of partially-coherent pixels. Experiments are conducted using both synthetic and real-world GBSAR data. Displacement time series at the level of a few sub-millimetres are achieved in several applications (e.g. a coastal cliff, a sand dune, a bridge, and a residential area), indicating the feasibility of the developed GBSAR data processing package for deformation monitoring of a wide range of scientific and practical applications.

Keywords: ground-based synthetic aperture radar, interferometry, small baseline subset algorithm, deformation monitoring

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Authors: Weihsuan Lin

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The Swiss Bethlehem Mission Society (BMS) in Taiwan has influenced and made an important contribution to religion and social work in Taidong. This German-speaking Catholic missionary society is located in Taidong, which is the political and economic periphery of Taiwan but is the cultural center of the Chinese and many different Austronesian ethnic groups, including Amis, Paiwan, Puyuma, Yami, Bunun, and Rukai. Through document analysis and fieldwork, this research aims to explore the result of the confrontation, exchange, and innovation between the BMS and other ethnic groups. Further, based upon Michael Foucault’s discussion of two modalities of constructing individuals, namely ‘discipline’ and ‘care of the self,’ this research will analyze the ‘discipline’ and ‘care of the self’ mechanisms of and between BMS Fathers, Brothers, and Church followers at the scale of individuals. At the scale of groups, the ‘autonomy’ and ‘been governed’ of the BMS in relationship to the Catholic Church in Taiwan and the world will also be examined.

Keywords: Bethlehem Mission Society, Religion and Geography, Spirituality, Foucault

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Authors: Eugene Y. C. Wong, Daniel Y. W. Mo, Cosmo T. Y. Ng, Jessica K. Y. Chan, Leith K. Y. Chan, Henry Y. K. Lau

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The real-time planning visualisation, precise allocation and loading optimisation in air cargo load planning operations are increasingly important as more considerations are needed on dangerous cargo loading, locations of lithium batteries, weight declaration and limited aircraft capacity. The planning of the unit load devices (ULD) can often be carried out only in a limited number of hours before flight departure. A dynamic air cargo load planning system is proposed with the optimisation of cargo load plan and visualisation of planning results in virtual reality systems. The system aims to optimise the cargo load planning and visualise the simulated loading planning decision on air cargo terminal operations. Adopting simulation tools, Cave Automatic Virtual Environment (CAVE) and virtual reality technologies, the results of planning with reference to weight and balance, Unit Load Device (ULD) dimensions, gateway, cargo nature and aircraft capacity are optimised and presented. The virtual reality system facilities planning, operations, education and training. Staff in terminals are usually trained in a traditional push-approach demonstration with enormous manual paperwork. With the support of newly customized immersive visualization environment, users can master the complex air cargo load planning techniques in a problem based training with the instant result being immersively visualised. The virtual reality system is developed with three-dimensional (3D) projectors, screens, workstations, truss system, 3D glasses, and demonstration platform and software. The content will be focused on the cargo planning and loading operations in an air cargo terminal. The system can assist decision-making process during cargo load planning in the complex operations of air cargo terminal operations. The processes of cargo loading, cargo build-up, security screening, and system monitoring can be further visualised. Scenarios are designed to support and demonstrate the daily operations of the air cargo terminal, including dangerous goods, pets and animals, and some special cargos.

Keywords: air cargo load planning, optimisation, virtual reality, weight and balance, unit load device

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Authors: Nuri Balta, Ali Eryilmaz

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High-quality teachers are the key to improve student learning. Without a professional development of the teachers, the improvement of student success is difficult and incomplete. This study offers an in-service training course model for professional development of teachers (PD) entitled "teachers teaching teachers" (TTT). The basic premise of the PD program, designed for this study, was primarily aimed to increase the subject matter knowledge of high school physics teachers. The TTT course (the three hour long workshops), organized for this study, lasted for seven weeks with seventeen teachers took part in the TTT program at different amounts. In this study, the effect of the TTT program on teachers’ knowledge improvement was searched through the modern physics unit (MPU). The participating teachers taught the unit to one of their grade ten classes earlier, and they taught another equivalent class two months later. They were observed in their classes both before and after TTT program. The teachers were divided into placebo and the treatment groups. The aim of Solomon four-group design is an attempt to eliminate the possible effect of pre-test. However, in this study the similar design was used to eliminate the effect of pre teaching. The placebo group teachers taught their both classes as regular and the treatment group teachers had TTT program between the two teachings. The class observation results showed that the TTT program increased teachers’ knowledge and skills in teaching MPU. Further, participating in the TTT program caused teachers to teach the MPU in accordance with the requirements of the curriculum. In order to see any change in participating teachers’ success, an achievement test was applied to them. A large effect size (dCohen=.93) was calculated for the effect of TTT program on treatment group teachers’ achievement. The results suggest that staff developers should consider including topics, attractive to teachers, in-service training programs (a) to help teachers’ practice teaching the new topics (b) to increase the participation rate. During the conduction of the TTT courses, it was observed that teachers could not end some discussions and explain some concepts. It is now clear that teachers need support, especially when discussing counterintuitive concepts such as modern physics concepts. For this reason it is recommended that content focused PD programs be conducted at the helm of a scholarly coach.

Keywords: high school physics, in-service training course, modern physics unit, teacher professional development

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Authors: Ahmed Sami Hammami, Mohamed Jellazi

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Background: The aim of the study is to evaluate the magnitude of different psychological outcomes among Tunisian health care professionals (HCP) during the COVID-19 pandemic and to identify the associated factors. Methods: HCP completed a cross-sectional questionnaire from April 4th to April, 28th 2020. The survey collected demographic information, factors that may interfere with the psychological outcomes, behavior changes and mental health measurements. The latter was assessed through 3 scales; the 7-item questions Insomnia Severity Index, the 2-item Patient Health Questionnaire and the 2-item Generalized Anxiety Disorder. Multivariable logistic regression was conducted to identify factors associated with psychological outcomes. Results: A total of 503 HCP successfully completed the survey; among those, n=493 consented to enroll in the study, 411 [83.4%] were physicians, 323 [64.2%] were women and 271 [55%] had a second-line working position. A significant proportion of HCP had anxiety 35.7%, depression 35.1% and insomnia 23.7%. Females, those with psychiatric history and those using public transport exhibited the highest proportions for overall symptoms compared to other groups e.g., depression among females vs. males: 44,9% vs. 18,2%, P=0.00. Those with a previous medical history and nurses, had more anxiety and insomnia compared to other groups e.g. anxiety among nurses vs. interns/residents vs. attending 45,1% vs 36,1% vs 27,5%; p=0.04. Multivariable logistic regression showed that female gender was a risk factor for all psychological outcomes e.g. female sex increased the odds of anxiety by 2.86; 95% confidence interval [CI], 1, 78-4, 60; P=0.00, whereas having a psychiatric history was a risk factor for both anxiety and insomnia. (e.g. for insomnia OR=2,86; 95% [CI], 1,78-4,60; P=0.00), Having protective equipment was associated with lower risk for depression (OR=0,41; 95% CI, 0,27-0,62; P=0.00) and anxiety. Physical activity was also protective against depression and anxiety (OR=0,41, 95% CI, 0,25-0,67, P=0.00). Conclusion: Psychological symptoms are usually undervalued among HCP, though the COVID-19 pandemic played a major role in exacerbating this burden. Prompt psychological support should be endorsed and simple measures such as physical activity and ensuring the necessary protection are paramount to improve mental health outcomes and the quality of care provided to patients.

Keywords: COVID-19 pandemic, health care professionals, mental health, protective factors, psychological symptoms, risk factors

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Authors: Louise Penzenstadler, Tiphaine Robet, Radu Iuga, Daniele Zullino

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Context: The outpatient clinic of the psychiatric addiction service of Geneva University Hospital has been providing support to individuals affected by various narcotics for 30 years. However, the increasing consumption of crack cocaine in Geneva has presented a new challenge for the healthcare system. Research Aim: The aim of this research is to evaluate the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder. Methodology: The research utilizes a combination of quantitative and qualitative retrospective data analysis to evaluate the effectiveness of the outreach intervention. Findings: The data collected from October 2023 to December 2023 show that the outreach program successfully made 1,071 contacts with drug users and led to 15 new requests for care and enrollment in treatment. Patients expressed high satisfaction with the intervention, citing easy and rapid access to treatment and social support. Theoretical Importance: This research contributes to the understanding of the challenges and specific needs of a complex group of drug users who face severe health problems. It highlights the importance of outreach interventions in establishing trust, connecting users with care, and facilitating medication-assisted treatment for opioid addiction. Data Collection: Data was collected through the outreach program's interactions with drug users, including street outreach interventions and presence at locations frequented by users. Patient satisfaction surveys were also utilized. Analysis Procedures: The collected data was analyzed using both quantitative and qualitative methods. The quantitative analysis involved examining the number of contacts made, new requests for care, and treatment enrollment. The qualitative analysis focused on patient satisfaction and their perceptions of the intervention. Questions Addressed: The research addresses the following questions: What is the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder? How effective is the outreach program in connecting drug users with care and initiating medication-assisted treatment? Conclusion: The outreach program has proven to be an effective intervention in establishing trust with crack users, connecting them with care, and initiating medication-assisted treatment for opioid addiction. It has also highlighted the importance of addressing the specific challenges faced by this group of drug users.

Keywords: crack addiction, outreach treatment, peer intervention, polydrug use

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Authors: Brock Buckingham, Zhe Lin, Wenxuan Guo

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Accurate elevation data is critical in deriving topographic attributes for the precision management of crop inputs, especially water and nutrients. Traditional ground-based elevation data acquisition is time consuming, labor intensive, and often inconvenient at the field scale. Various unmanned aerial systems (UAS) provide the capability of generating digital elevation data from high-resolution images. The objective of this study was to compare the performance of two UAS with different global positioning system (GPS) receivers in determining elevation at the field scale. A DJI Phantom 4 Pro and a DJI Phantom 4 RTK(real-time kinematic) were applied to acquire images at three heights, including 40m, 80m, and 120m above ground. Forty ground control panels were placed in the field, and their geographic coordinates were determined using an RTK GPS survey unit. For each image acquisition using a UAS at a particular height, two elevation datasets were generated using the Pix4D stitching software: a calibrated dataset using the surveyed coordinates of the ground control panels and an uncalibrated dataset without using the surveyed coordinates of the ground control panels. Elevation values for each panel derived from the elevation model of each dataset were compared to the corresponding coordinates of the ground control panels. The coefficient of the determination (R²) and the root mean squared error (RMSE) were used as evaluation metrics to assess the performance of each image acquisition scenario. RMSE values for the uncalibrated elevation dataset were 26.613 m, 31.141 m, and 25.135 m for images acquired at 120 m, 80 m, and 40 m, respectively, using the Phantom 4 Pro UAS. With calibration for the same UAS, the accuracies were significantly improved with RMSE values of 0.161 m, 0.165, and 0.030 m, respectively. The best results showed an RMSE of 0.032 m and an R² of 0.998 for calibrated dataset generated using the Phantom 4 RTK UAS at 40m height. The accuracy of elevation determination decreased as the flight height increased for both UAS, with RMSE values greater than 0.160 m for the datasets acquired at 80 m and 160 m. The results of this study show that calibration with ground control panels improves the accuracy of elevation determination, especially for the UAS with a regular GPS receiver. The Phantom 4 Pro provides accurate elevation data with substantial surveyed ground control panels for the 40 m dataset. The Phantom 4 Pro RTK UAS provides accurate elevation at 40 m without calibration for practical precision agriculture applications. This study provides valuable information on selecting appropriate UAS and flight heights in determining elevation for precision agriculture applications.

Keywords: unmanned aerial system, elevation, precision agriculture, real-time kinematic (RTK)

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Authors: M. Saifudin Ahmed Atique, Santosh Paudyal, Caixia Yang

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In an aircraft, a great portion of energy is wasted due to its inflight structural vibration. Structural components vibrate due to aeroelastic instabilities, gust perturbations and engine rotation at very high rpm. Energy losses due to mechanical vibration can be utilized by harvesting energy from aircraft structure as electrical energy. This harvested energy can be stored in battery panels built into aircraft fuselage and can be used to power inflight auxiliary accessories i.e., lighting and entertainment systems. Moreover, this power can be used for wireless Structural Health Monitoring System (SHM) for aircraft and as an excellent replacement of aircraft Ground Power Unit (GPU)/Auxiliary Power Unit (APU) during passenger onboard time to power aircraft cabin accessories to reduce aircraft ground operation cost significantly. In this paper, we propose the design of a noble aircraft wing in which Piezoelectric panels placed under the composite skin of aircraft wing will generate electrical charges from any inflight aerodynamics or mechanical vibration and store it into battery to power auxiliary inflight systems/accessories as per requirement. Experimental results show that a well-engineered piezoelectric energy harvester based aircraft wing can produce adequate energy to support in-flight lighting and auxiliary cabin accessories.

Keywords: vibration energy, aircraft wing, piezoelectric material, inflight accessories

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Authors: Mohammad Naeem Lakanwall, Jamshid Abdul-Ghafar

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Background: Endocrinopathies are a commonly occurring entity, particularly those of the thyroid gland; however, there is a lack of scientific literature from Afghanistan, a country with very limited health care facilities and resources. To our best knowledge, this is the first study aimed to describe the frequency of occurrence and factors associated with thyroid dysfunction in the Afghan population. The aim of this study is to estimate the frequency and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Methods: A cross-sectional study was conducted from July to Sep 2018 at the Department of Clinical Pathology, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan. Blood samples were obtained, serum TSH levels were analyzed, and the patients were divided into three diagnostic categories according to their serum TSH concentrations: 1) hypothyroidism, 2) hyperthyroidism, 3) normal. Results: A total of 127 individuals were included in the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction. 74% of the participants in the study had normal TSH levels classified as normal thyroid function, (14%) had lower TSH levels, and (12%) higher TSH levels, classified as hyper and hypothyroid, respectively. Conclusions: The findings of the current study showed a high frequency of thyroid dysfunctions from a single center. Further large-scale studies are needed to find out the prevalence and document this entity for better health outcomes in the country.

Keywords: Afghanistan, factors, frequency, hypothyroid, hyperthyroid, thyroid, thyroid stimulating hormone

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Authors: Rakiya Abba

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This paper investigates the effect of the money supply, exchange and interest rate on economic growth in Nigeria through the application of Augmented Dickey-Fuller technique in testing the unit root property of the series and Granger causality test of causation between GDP, money supply, the exchange, and interest rate. The results of unit root suggest that all the variables in the model are stationary at 1, 5 and 10 percent level of significance, and the results of Causality suggest that money supply and exchange granger cause IR, the result further reveals two – way causation existed between M2 and EXR while IR granger cause GDP the null hypothesis is rejected and GDP does not granger cause IR as indicated by their probability values of 0.4805 and confirmed by F-statistics values of 0.75483. The results revealed that M2 and EXR do not granger causes GDP, the null hypothesis is accepted at 75percent 18percent respectively as indicated by their probability values of 0.7472 and 0.1830 respectively; also, GDP does not granger cause M2 and EXR. The Johansen cointegration result indicates that despite GDP does not granger cause M2, IR, and EXR, but there existed 1 cointegrating equation, implying the existence of long-run relationship between GDP, M2 IR, and EXR. A major policy implication of this result is that economic growth is function of and money supply and exchange rate, effective monetary policies should direct on manipulating instruments and importance should be placed on justification for adopting a particular policy be rationalized in order to increase growth in economy

Keywords: economic growth, money supply, interest rate, exchange rate, causality

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Authors: May Bazzi, Shafik Tokmaj, Younes Saberi, Mats Geijer, Tony Jurkiewicz, Patrik Sund, Anna Bjällmark

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Mobile radiography, employing portable X-ray equipment, has become a routine procedure within hospital settings, with chest X-rays in intensive care units standing out as the most prevalent mobile X-ray examinations. This approach is not limited to hospitals alone, as it extends its benefits to imaging patients in various settings, particularly those too frail to be transported, such as elderly care residents in nursing homes. Moreover, the utility of mobile X-ray isn't confined solely to traditional healthcare recipients; it has proven to be a valuable resource for vulnerable populations, including the homeless, drug users, asylum seekers, and patients with multiple co-morbidities. Mobile X-rays reduce patient stress, minimize costly hospitalizations, and offer cost-effective imaging. While studies confirm its reliability, further research is needed, especially regarding image quality. Recent advancements in lightweight equipment with enhanced battery and detector technology provide the potential for nearly handheld radiography. The main aim of this study was to evaluate a new lightweight mobile X-ray system with two different detectors and compare the image quality with a modern stationary system. Methods: A total of 74 images of the chest (chest anterior-posterior (AP) views and chest lateral views) and pelvic/hip region (AP pelvis views, hip AP views, and hip cross-table lateral views) were acquired on a whole-body phantom (Kyotokagaku, Japan), utilizing varying image parameters. These images were obtained using a stationary system - 18 images (Mediel, Sweden), a mobile X-ray system with a second-generation detector - 28 images (FDR D-EVO II; Fujifilm, Japan) and a mobile X-ray system with a third-generation detector - 28 images (FDR D-EVO III; Fujifilm, Japan). Image quality was assessed by visual grading analysis (VGA), which is a method to measure image quality by assessing the visibility and accurate reproduction of anatomical structures within the images. A total of 33 image criteria were used in the analysis. A panel of two experienced radiologists, two experienced radiographers, and two final-term radiographer students evaluated the image quality on a 5-grade ordinal scale using the software Viewdex 3.0 (Viewer for Digital Evaluation of X-ray images, Sweden). Data were analyzed using visual grading characteristics analysis. The dose was measured by the dose-area product (DAP) reported by the respective systems. Results: The mobile X-ray equipment (both detectors) showed significantly better image quality than the stationary equipment for the pelvis, hip AP and hip cross-table lateral images with AUCVGA-values ranging from 0.64-0.92, while chest images showed mixed results. The number of images rated as having sufficient quality for diagnostic use was significantly higher for mobile X-ray generation 2 and 3 compared with the stationary X-ray system. The DAP values were higher for the stationary compared to the mobile system. Conclusions: The new lightweight radiographic equipment had an image quality at least as good as a fixed system at a lower radiation dose. Future studies should focus on clinical images and consider radiographers' viewpoints for a comprehensive assessment.

Keywords: mobile x-ray, visual grading analysis, radiographer, radiation dose

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Authors: D. Velayadum, P. Sthandiwe , N. Maharaj, T. Munien, S. Ndamase, G. Zulu, S. Xulu, F. Oosthuizen

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Introduction and aims of the study: It is the responsibility of the pharmacist to manage drug-related problems in order to ensure the greatest benefit to the patient. In order to prevent drug-related morbidity, pharmacists should be aware of medicines that may contribute to certain drug-related problems due to their pharmacological action. In an attempt to assist healthcare practitioners to prevent drug-related morbidity (PDRM), indicators for prevention have been designed. There are currently no indicators available for primary health care in developing countries like South Africa, where the majority of the population access primary health care. There is, therefore, a need to develop such indicators, specifically with the aim of assisting healthcare practitioners in primary health care. Methods: A literature study was conducted to compile a comprehensive list of PDRM indicators as developed internationally using the search engines Google Scholar and PubMed. MESH term used to retrieve suitable articles was 'preventable drug-related morbidity indicators'. The comprehensive list of PDRM indicators obtained from the literature study was further evaluated for face validity. Face validity was done in duplicate by 2 sets of independent researchers to ensure 1) no duplication of indicators when compiling a single list, 2) inclusion of only medication available in primary healthcare, and 3) inclusion of medication currently available in South Africa. Results: The list of indicators, compiled from PDRM indicators in the USA, UK, Portugal, Australia, India, and Canada contained 324 PDRM. 184 of these indicators were found to be duplicates, and the duplications were omitted, leaving a final list of 140. The 140 PDRM indicators were evaluated for face-validity, and 97 were accepted as relevant to primary health care in South Africa. 43 indicators did not comply with the criteria and were omitted from the final list. Conclusion: This study is a first step in compiling a list of PDRM indicators for South Africa. It is important to take cognizance to the fact the health systems differ vastly internationally, and it is, therefore, important to develop country-specific indicators.

Keywords: drug-related morbidity, primary healthcare, South Africa, developing countries

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

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

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

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Authors: Glenda Wrenn, Juliet Muzere, Meldra Hall, Allyson Belton, Kisha Holden, Chanita Hughes-Halbert, Martha Kent, Bekh Bradley

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Understanding the help seeking decision making process and experiences of health disparity populations with posttraumatic stress disorder (PTSD) is central to development of trauma-informed, culturally centered, and patient focused services. Yet, little is known about the decision making process among adult Black women who are non-treatment seekers as they are, by definition, not engaged in services. Methods: Audiotaped interviews were conducted with 30 African American adult women with clinically significant PTSD symptoms who were engaged in primary care, but not in treatment for PTSD despite symptom burden. A qualitative interview guide was used to elucidate key themes. Independent coding of themes mapped to theory and identification of emergent themes were conducted using qualitative methods. An existing quantitative dataset was analyzed to contextualize responses and provide a descriptive summary of the sample. Results: Emergent themes revealed that active mental avoidance, the intermittent nature of distress, ambivalence, and self-identified resilience as undermining to help seeking decisions. Participants were stuck within the help-seeking phase of ‘recognition’ of illness and retained a sense of “it is my decision” despite endorsing significant social and environmental negative influencers. Participants distinguished ‘help acceptance’ from ‘help seeking’ with greater willingness to accept help and importance placed on being of help to others. Conclusions: Elucidation of the decision-making process from the perspective of non-treatment seekers has implications for outreach and treatment within models of integrated and specialty systems care. The salience of responses to trauma symptoms and stagnation in the help seeking recognition phase are findings relevant to integrated care service design and community engagement.

Keywords: culture, help-seeking, integrated care, PTSD

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Authors: Diego Carrasco, Catarina Freitas, Hugo Rio Tinto, Ricardo Rio Tinto, Nuno Couto, Joaquim Gago, Carlos Carvalho

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Introduction: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) to drain the gallbladder can be a palliative care procedure for non-surgical oncologic patients with cholelithiasis and cholangitis process. Case description: A 59-years old Caucasian male diagnosed with extrahepatic cholangiocarcinoma with multiple liver, lung and peritoneum metastasis, unresponsive to treatment with gemcitabine/cisplatin, presented in the institution with fever, hypotension, and severe upper right abdominal pain secondary to cholelithiasis and cholangitis process. The patient was admitted and started on large spectrum antibiotics plus fluid-challenge. Afterward, a percutaneous transhepatic biliary drainage (PTBD) was performed to drain the gallbladder. This procedure temporarily stabilized the patient. However, the definitive solution required gallbladder removal. Since the patient exhibited an advanced oncologic disease and poor response to the chemotherapy, he was not a candidate for surgical intervention. Diagnostic Pathways: A self-expanding metal stent was placed from the duodenum into the bile duct by endoscopic ultrasound-guided. The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure. Conclusion and Discussion: The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure and successfully reversed the cholangitis process. EUS-CD is an effective and safe technique and can be used as a palliative care procedure for non-surgical oncologic patients.

Keywords: palliative care, cholangiocarcinoma, choledochoduodenostomy, endoscopic ultrasound-guided

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Authors: Silpa Mariyam John, S. Baburaj, Prajit Geevarghese

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Diabetes accelerates pregnancy and can cause adverse effects on the fetus. Studies have shown that fetal abdominal circumference measured in ultrasound is an early parameter for the assessment of macrosomia. The objective of the study is to compare the fetal abdominal circumferences between diabetes and non-diabetic mothers. It was a comparative cross-sectional study conducted in a tertiary care hospital in Trivandrum, Kerala, with a sample size calculated as 95 for each group. All mothers taking antenatal care and delivering at the hospital were included after obtaining consent. The mothers and their newborns were divided into 2 groups (diabetic and non-diabetic). Relevant fetal biometry values were collected from medical records, and birth weight was measured by a calibrated electronic weighing machine after birth. The data were entered in MS EXCEL and analyzed. It was found that there is a significant relationship between the fetal abdominal circumference and birthweight in diabetic mothers during the first and third trimesters.

Keywords: newborn, diabetes, abdominal circumference, ultrasound

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Authors: Antonio Lopez-Villegas, Rafael Bautista-Mesa, Emilio Robles-Musso, Daniel Catalan-Matamoros, Cesar Leal-Costa

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Objectives: The purpose of this trial was to evaluate the burden borne by and the costs to informal caregivers of users with telemonitoring of pacemakers. Methods: This is a controlled, non-randomised clinical trial, with data collected from informal caregivers, five years after implantation of pacemakers. The Spanish version of the Survey on Disabilities, Personal Autonomy, and Dependency Situations was used to get information on clinical and social characteristics, levels of professionalism, duration and types of care, difficulties in providing care, health status, economic and job aspects, impact on the family or leisure due to informal caregiving for patients with pacemakers. Results: After five years of follow-up, 55 users with pacemakers finished the study. Of which, 50 were helped by a caregiver, 18 were included in the telemonitoring group (TM) and 32 in the conventional follow-up group (HM). Overall, females represented 96.0% of the informal caregivers (88.89% in TM and 100.0% in HM group). The mean ages were 63.17 ± 15.92 and 63.13 ± 14.56 years, respectively (p = 0.83) in the groups. The majority (88.0%) of the caregivers declared that they had to provide their services between 6 and 7 days per week (83.33% in TM group versus 90.63% in HM group), without significant differences between both groups. The costs related to care provided by the informal caregivers were 47.04% higher in the conventional follow-up group than in the TM group. Conclusions: The results of this trial confirm that there were no significant differences between the informal caregivers regarding to baseline characteristics, workload and time worked in both groups of follow-up. The costs incurred by the informal caregivers providing care for users with pacemakers included in telemonitoring group are significantly lower than those in the conventional follow-up group. Trial registration: ClinicalTrials.gov NCT02234245. Funding: The PONIENTE study, has been funded by the General Secretariat for Research, Development and Innovation, Regional Government of Andalusia (Spain), project reference number PI/0256/2017, under the research call 'Development and Innovation Projects in the Field of Biomedicine and Health Sciences', 2017.

Keywords: costs, disease burden, informal caregiving, pacemaker follow-up, remote monitoring, telemedicine

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Authors: M. Shahana

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Introduction: Leprosy (Hansens) is one of the major health problems in the developing countries. Sixty percent of the world leprosy cases are in India. According to the 2006 census India has about 54% of the total new cases detected globally. The National Leprosy Elimination Programme in 2012 has reported 9.7% of childhood leprosy. There are only few studies related to paediatric leprosy. Aim: To study the epidemiology and various clinical presentations of leprosy in the paediatric age group. Material and Methods: A 4-year prospective study was done in the out-patient department of dermatology in a tertiary care hospital. All the patients were screened for leprosy and children with a confirmed diagnosis of leprosy were taken up for the study. Results: Total of 321 cases of Hansens were recorded during this period out of which 41 were children. The male to female ratio was 2.72:1. A positive family history was found in 18%. Most of them presented with single hypopigmented hypoanesthetic patch. Conclusions: Children presented with more of Borderline tuberculoid type and reactions or deformities were less common.

Keywords: Hansens, hypoaneasthetic patch, leprosy, reactions

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Authors: Sadia Rafiq, Md. Ashab Siddique Zaki, Ananya Roy

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Mountain cycling is a type of off-road bicycle racing that typically takes place on rocky, arid, or other challenging terrains on specially-made mountain cycles. Professional cyclists race while attempting to stay on their bikes in a variety of locales across the world. For safety measures in mountain cycling, as there we have a high chance of injury in case of tire puncture, it’s a preferable way to use an airless tire instead of a pneumatic tire. As airless tire does not tend to go flat, it needs to be replaced less frequently. The airless tire replaces the pneumatic tire, wheel, and tire system with a single unit. It consists of a stiff hub connected to a shear band by flexible, pliable spokes, which is made of poly-composite and a tread band, all of which work together as a single unit to replace all of the components of a normal radial tire. In this paper, an analysis of airless tires in the mountain cycle is shown along with structure and material study. We will be taking the Honeycomb and Diamond Structure of spokes to compare the deformation in both cases and choose our preferable structure. As we know, the tread and spokes deform with the surface roughness and impact. So, the tire tread thickness and the design of spokes can control how much the tire can distort. Through the simulation, we can come to the conclusion that the diamond structure deforms less than the honeycomb structure. So, the diamond structure is more preferable.

Keywords: airless tire, diamond structure, honeycomb structure, deformation

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Authors: Peter J. Fusco, Dave M. Mathew, Chris Mathew, Kenneth H. Levy, Kathryn S. Varghese, Stephanie Salazar-Restrepo, Serena M. Mathew, Sofia Khaja, Eamon Vega, Mia Polizzi, Alyssa Mullane, Adham Ahmed

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Background: Laparoscopic (LS) removal of neuroblastomas in children has been reported to offer favorable outcomes compared to the conventional open thoracotomy (OT) procedure. Critical perioperative measures such as blood loss, operative time, length of stay, and time to postoperative chemotherapy have all supported laparoscopic use rather than its more invasive counterpart. Herein, a pairwise meta-analysis was performed comparing perioperative outcomes between LS and OT in thoracoabdominal neuroblastoma cases. Methods: A comprehensive literature search was performed on PubMed, Ovid EMBASE, and Scopus databases to identify studies comparing the outcomes of pediatric patients with thoracoabdominal neuroblastomas undergoing resection via OT or LS. After deduplication, 4,227 studies were identified and subjected to initial title screening with exclusion and inclusion criteria to ensure relevance. When studies contained overlapping cohorts, only the larger series were included. Primary outcomes include estimated blood loss (EBL), hospital length of stay (LOS), and mortality, while secondary outcomes were tumor recurrence, post-operative complications, and operation length. The “meta” and “metafor” packages were used in R, version 4.0.2, to pool risk ratios (RR) or standardized mean differences (SMD) in addition to their 95% confidence intervals in the random effects model via the Mantel-Haenszel method. Heterogeneity between studies was assessed using the I² test, while publication bias was assessed via funnel plot. Results: The pooled analysis included 209 patients from 5 studies (141 OT, 68 LS). Of the included studies, 2 originated from the United States, 1 from Toronto, 1 from China, and 1was from a Japanese center. Mean age between study cohorts ranged from 2.4 to 5.3 years old, with female patients occupying between 30.8% to 50% of the study populations. No statistically significant difference was found between the two groups for LOS (SMD -1.02; p=0.083), mortality (RR 0.30; p=0.251), recurrence(RR 0.31; p=0.162), post-operative complications (RR 0.73; p=0.732), or operation length (SMD -0.07; p=0.648). Of note, LS appeared to be protective in the analysis for EBL, although it did not reach statistical significance (SMD -0.4174; p= 0.051). Conclusion: Despite promising literature assessing LS removal of pediatric neuroblastomas, results showed it was non-superior to OT for any explored perioperative outcomes. Given the limited comparative data on the subject, it is evident that randomized trials are necessary to further the efficacy of the conclusions reached.

Keywords: laparoscopy, neuroblastoma, thoracoabdominal, thoracotomy

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Authors: Asma Ahmed, Farah Khalid, Sahlah Sohail, Saira Banusokwalla, Sabiha Banu, Inaara Akbar, Safia Awan, Syed Iqbal Azam

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Background and Objectives: The level of knowledge regarding obesity as a disease condition and health-seeking behavior regarding its management is grossly lacking. We present data from our multidisciplinary obesity clinic at the large tertiary care facility in Karachi, Pakistan, to provide baseline profiles and outcomes of patients attending these clinics. Methods: 260 who attended the obesity clinic between June 2018 to March 2020 were enrolled in this study. The analysis included descriptive and ROC analysis to identify the best cut-offs of theanthropometric measurements to diagnose obesity-related comorbid conditions. Results: The majority of the studied population were women (72.3%) and employed(43.7%) with a mean age of 35.5 years. Mean BMIwas 37.4, waist circumference was 112.4 cm, visceral fat was 11.7%, and HbA1C was 6.9%. The most common comorbidities were HTN & D.M (33 &31%, respectively). The prevalence of MetS was 16.3% in patients and was slightly higher in males. Visceral fat was the main factor in predicting D.M (0.750; 95% CI: 0.665, 0.836) and MetS (0.709; 95% CI: 0.590, 0.838) compared to total body fat, waist circumference, and BMI. The risk of predicting DM &MetS for the visceral fat above 9.5% in women had the highest sensitivity (80% for D.M & 79% for MetS) and an NPV (92.75% for D.M & 95% for MetS). Conclusions: This study describes and establishes characteristics of these obese individuals, which can help inform clinical practices. These practices may involve using visceral fat for earlier identification and counseling-based interventions to prevent more severe surgical interventions down the line.

Keywords: obesity, metabolic syndrome, tertiary care facility, BMI, waist circumference, visceral fat

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Authors: Cemile Kütmeç Yilmaz, Güler Duru Asiret, Gulcan Bagcivan

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The aim of this study was to evaluate the reliability and validity of the Turkish version of the Carer’s Assessment of Satisfaction Index (CASI-TR). The study was conducted between the dates of June 2016 and September 2017 at the Training and Research Hospital of Aksaray University with the caregiving family members of the inpatients with chronic diseases. For this study, the sample size was calculated as at least 10 individuals for each item (item number (30)X10=300). The study sample included 300 caregiving family members, who provided primer care for at least three months for a patient (who had at least one chronic disease and received inpatient treatment in general internal medicine and palliative care units). Data were collected by using a demographic questionnaire and CASI-TR. Descriptive statistics, and psychometric tests were used for the data analysis. Of those caregivers, 76.7% were female, 86.3% were 65 years old and below, 43.7% were primary school graduates, 87% were married, 86% were not working, 66.3% were housewives, and 60.3% defined their income status as having an income covering one’s expenses. Care recipients often had problems in terms of walking, sleep, balance, feeding and urinary incontinence. The Cronbach Alpha value calculated for the CASI-TR (30 items) was 0,949. Internal consistency coefficients calculated for subscales were: 0.922 for the subscale of ‘caregiver satisfaction related to care recipient’, 0.875 for the subscale of ‘caregiver satisfaction related to themselves’, and 0.723 for the subscale of ‘dynamics of interpersonal relations’. Factor analysis revealed that three factors accounted for 57.67% of the total variance, with an eigenvalue of >1. assessed in terms of significance, we saw that the items came together in a significant manner. The factor load of the items were between 0.311 and 0.874. These results show that the CASI-TR is a valid and reliable scale. The adoption of the translated CASI in Turkey is found reliable and valid to assessing the satisfaction of caregivers. CASI-TR can be used easily in clinics or house visits by nurses and other health professionals for assessing caregiver satisfaction from caregiving.

Keywords: carer’s assessment of satisfaction index, caregiver, validity, reliability

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Authors: Haaris Khan, Farhad Udwadia

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South Asians are the fastest-growing immigrant population in Canada and are 3-4 times more likely to develop diabetes. In a primary care setting, language barriers continue to persist as a prominent obstacle when delivering crucial health information. Given the abundance of languages in the South Asian community and the varying levels of English fluency, there is compelling evidence that these language barriers can adversely impact health outcomes. The microvascular and macrovascular complications of poor diabetic management are well established and universally recognized. However, these are often difficult concepts to grasp for even individuals fluent in English. In order to lessen the burden of language barriers, we developed a comprehensive guide in various languages that discuss the complications and screening guidelines for diabetic and prediabetic patients. The guide is presented in the form of a pamphlet, with an electronic version being constructed as well, that provides basic information on diabetic retinopathy, neuropathy and nephropathy as well as the screening recommendations. We also conducted a review of the literature around the topic and incorporated our findings into our project. Our goal is for primary care physicians to have this resource and to be able to provide the link or pamphlet to patients in need. Our presentation also provides a comprehensive overview of some of the other barriers that individuals in the South Asian community face when seeking care. Given the staggering number of individuals in the South Asian community with diabetes and the morbidity and mortality associated with diabetes and its complications, effective community-specific strategies are needed to mitigate the potential consequences of poor diabetes management.

Keywords: diabetes, patient education, ophthalmology, vascular surgery

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