Search results for: care networks

Authors: Pi-Chi Wu, Tsui-Ping Chu, Hsiu-Hung Wang

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Background: The ability to provide immediate medical service in outpatient departments is one of the keys to patient satisfaction. Objectives: This project used electronic equipment to integrate nursing care information to patient care at a blood pressure diagnostic counter. Through process reengineering, the average patient waiting time decreased from 35 minutes to 5 minutes, while service satisfaction increased from a score of 2.7 to 4.6. Methods: Data was collected from a local hospital in Southern Taiwan from a daily average of 2,200 patients in the outpatient department. Previous waiting times were affected by (1) space limitations, (2) the need to help guide patient mobility, (3) the need for nurses to appease irate patients and give instructions, (4), the need for patients to replace lost counter tickets, (5) the need to re-enter information, (6) the replacement of missing patient information. An ad hoc group was established to enhance patient satisfaction and shorten waiting times for patients to see a doctor. A four step strategy consisting of (1) counter relocation, (2) queue reorganization, (3) electronic information integration, (4) process reengineering was implemented. Results: Implementation of the developed strategy decreased patient waiting time from 35 minutes to an average of 5 minutes, and increased patient satisfaction scores from 2.7 to 6.4. Conclusion: Through the integration of information technology and process transformation, waiting times were drastically reduced, patient satisfaction increased, and nurses were allowed more time to engage in more cost-effective services. This strategy was simultaneously enacted in separate hospitals throughout Taiwan.

Keywords: process reengineering, electronic information integration, patient satisfaction, patient waiting time

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Authors: Anusha M., V. Srikanth

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Maximizing spectrum usage and numerous applications of the wireless communication networks have forced to a high interest of available spectrum. Cognitive Radio control its receiver and transmitter features exactly so that they can utilize the vacant approved spectrum without impacting the functionality of the principal licensed users. The Use of various channels assists to address interferences thereby improves the whole network efficiency. The MAC protocol in cognitive radio network explains the spectrum usage by interacting with multiple channels among the users. In this paper we studied about the architecture of cognitive wireless mesh network and traditional TDMA dependent MAC method to allocate channels dynamically. The majority of the MAC protocols suggested in the research are operated on Common-Control-Channel (CCC) to handle the services between Cognitive Radio secondary users. In this paper, an extensive study of Multi-Channel Multi-Radios or frequency range channel allotment and continually synchronized TDMA scheduling are shown in summarized way.

Keywords: TDMA, MAC, multi-channel, multi-radio, WMN’S, cognitive radios

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Authors: Dehini Rachid, Ferdi Brahim

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The shunt active power filter (SAPF) is not destined only to improve the power factor, but also to compensate the unwanted harmonic currents produced by nonlinear loads. This paper presents a SAPF with identification and control method based on artificial neural network (ANN). To identify harmonics, many techniques are used, among them the conventional p-q theory and the relatively recent one the artificial neural network method. It is difficult to get satisfied identification and control characteristics by using a normal (ANN) due to the nonlinearity of the system (SAPF + fast nonlinear load variations). This work is an attempt to undertake a systematic study of the problem to equip the (SAPF) with the harmonics identification and DC link voltage control method based on (ANN). The latter has been applied to the (SAPF) with fast nonlinear load variations. The results of computer simulations and experiments are given, which can confirm the feasibility of the proposed active power filter.

Keywords: artificial neural networks (ANN), p-q theory, harmonics, total harmonic distortion

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Authors: Hussain Sajid, Jung-Hun Shin, Kum-Won Cho

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Image super-resolution is the most common computer vision problem with many important applications. Generative adversarial networks (GANs) have promoted remarkable advances in single-image super-resolution (SR) by recovering photo-realistic images. However, high memory requirements of GAN-based SR (mainly generators) lead to performance degradation and increased energy consumption, making it difficult to implement it onto resource-constricted devices. To relieve such a problem, In this paper, we introduce an optimized and highly efficient architecture for SR-GAN (generator) model by utilizing model compression techniques such as Knowledge Distillation and pruning, which work together to reduce the storage requirement of the model also increase in their performance. Our method begins with distilling the knowledge from a large pre-trained model to a lightweight model using different loss functions. Then, iterative weight pruning is applied to the distilled model to remove less significant weights based on their magnitude, resulting in a sparser network. Knowledge Distillation reduces the model size by 40%; pruning then reduces it further by 18%. To accelerate the learning process, we employ the Horovod framework for distributed training on a cluster of 2 nodes, each with 8 GPUs, resulting in improved training performance and faster convergence. Experimental results on various benchmarks demonstrate that the proposed compressed model significantly outperforms state-of-the-art methods in terms of peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and image quality for x4 super-resolution tasks.

Keywords: single-image super-resolution, generative adversarial networks, knowledge distillation, pruning

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Authors: Fernanda M. Assef, Maria Teresinha A. Steiner

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The aim of this paper is to compare and discuss better classifier algorithm options for credit risk assessment by applying different Machine Learning techniques. Using records from a Brazilian financial institution, this study uses a database of 5,432 companies that are clients of the bank, where 2,600 clients are classified as non-defaulters, 1,551 are classified as defaulters and 1,281 are temporarily defaulters, meaning that the clients are overdue on their payments for up 180 days. For each case, a total of 15 attributes was considered for a one-against-all assessment using four different techniques: Artificial Neural Networks Multilayer Perceptron (ANN-MLP), Artificial Neural Networks Radial Basis Functions (ANN-RBF), Logistic Regression (LR) and finally Support Vector Machines (SVM). For each method, different parameters were analyzed in order to obtain different results when the best of each technique was compared. Initially the data were coded in thermometer code (numerical attributes) or dummy coding (for nominal attributes). The methods were then evaluated for each parameter and the best result of each technique was compared in terms of accuracy, false positives, false negatives, true positives and true negatives. This comparison showed that the best method, in terms of accuracy, was ANN-RBF (79.20% for non-defaulter classification, 97.74% for defaulters and 75.37% for the temporarily defaulter classification). However, the best accuracy does not always represent the best technique. For instance, on the classification of temporarily defaulters, this technique, in terms of false positives, was surpassed by SVM, which had the lowest rate (0.07%) of false positive classifications. All these intrinsic details are discussed considering the results found, and an overview of what was presented is shown in the conclusion of this study.

Keywords: artificial neural networks (ANNs), classifier algorithms, credit risk assessment, logistic regression, machine Learning, support vector machines

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Authors: Pei Yi Lin

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Objective: The objective of this study is to use machine learning methods to build an early prediction classifier model for acute delirium to improve the quality of medical care for intensive care patients. Background: Delirium is a common acute and sudden disturbance of consciousness in critically ill patients. After the occurrence, it is easy to prolong the length of hospital stay and increase medical costs and mortality. In 2021, the incidence of delirium in the intensive care unit of internal medicine was as high as 59.78%, which indirectly prolonged the average length of hospital stay by 8.28 days, and the mortality rate is about 2.22% in the past three years. Therefore, it is expected to build a delirium prediction classifier through big data analysis and machine learning methods to detect delirium early. Method: This study is a retrospective study, using the artificial intelligence big data database to extract the characteristic factors related to delirium in intensive care unit patients and let the machine learn. The study included patients aged over 20 years old who were admitted to the intensive care unit between May 1, 2022, and December 31, 2022, excluding GCS assessment <4 points, admission to ICU for less than 24 hours, and CAM-ICU evaluation. The CAMICU delirium assessment results every 8 hours within 30 days of hospitalization are regarded as an event, and the cumulative data from ICU admission to the prediction time point are extracted to predict the possibility of delirium occurring in the next 8 hours, and collect a total of 63,754 research case data, extract 12 feature selections to train the model, including age, sex, average ICU stay hours, visual and auditory abnormalities, RASS assessment score, APACHE-II Score score, number of invasive catheters indwelling, restraint and sedative and hypnotic drugs. Through feature data cleaning, processing and KNN interpolation method supplementation, a total of 54595 research case events were extracted to provide machine learning model analysis, using the research events from May 01 to November 30, 2022, as the model training data, 80% of which is the training set for model training, and 20% for the internal verification of the verification set, and then from December 01 to December 2022 The CU research event on the 31st is an external verification set data, and finally the model inference and performance evaluation are performed, and then the model has trained again by adjusting the model parameters. Results: In this study, XG Boost, Random Forest, Logistic Regression, and Decision Tree were used to analyze and compare four machine learning models. The average accuracy rate of internal verification was highest in Random Forest (AUC=0.86), and the average accuracy rate of external verification was in Random Forest and XG Boost was the highest, AUC was 0.86, and the average accuracy of cross-validation was the highest in Random Forest (ACC=0.77). Conclusion: Clinically, medical staff usually conduct CAM-ICU assessments at the bedside of critically ill patients in clinical practice, but there is a lack of machine learning classification methods to assist ICU patients in real-time assessment, resulting in the inability to provide more objective and continuous monitoring data to assist Clinical staff can more accurately identify and predict the occurrence of delirium in patients. It is hoped that the development and construction of predictive models through machine learning can predict delirium early and immediately, make clinical decisions at the best time, and cooperate with PADIS delirium care measures to provide individualized non-drug interventional care measures to maintain patient safety, and then Improve the quality of care.

Keywords: critically ill patients, machine learning methods, delirium prediction, classifier model

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Authors: Zeeshan Hamid, Asher Ramish

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The purpose of this paper is to focus on security and safety issues facing by pharmaceutical industry globally when counterfeit drugs are in question. Hence, there is an intense need to secure and authenticate pharmaceutical products in the emerging counterfeit product market. This paper will elaborate the application of radio frequency identification (RFID) in pharmaceutical industry and to identify its key benefits for patient’s care. The benefits are: help to co-ordinate the stream of supplies, accuracy in chains of supplies, maintaining trustworthy information, to manage the operations in appropriate and timely manners and finally deliver the genuine drug to patient. It is discussed that how RFID supported supply chain information sharing (SCIS) helps to combat against counterfeit drugs. And a solution how to tag pharmaceutical products; since, some products prevent RFID implementation in this industry. In this paper, a proposed model for pharma industry distribution suggested to combat against the counterfeit drugs when they are in supply chain.

Keywords: supply chain, RFID, pharmaceutical industry, counterfeit drugs, patients care

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Authors: Zeina Bou Diab, Arij Daou

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The neural mechanisms of sequential behaviors are intensively studied, with songbirds a focus for learned vocal production. We are studying the premotor nucleus HVC at a nexus of multiple pathways contributing to song learning and production. The HVC consists of multiple classes of neuronal populations, each has its own cellular, electrophysiological and functional properties. During singing, a large subset of motor cortex analog-projecting HVCRA neurons emit a single 6-10 ms burst of spikes at the same time during each rendition of song, a large subset of basal ganglia-projecting HVCX neurons fire 1 to 4 bursts that are similarly time locked to vocalizations, while HVCINT neurons fire tonically at average high frequency throughout song with prominent modulations whose timing in relation to song remains unresolved. This opens the opportunity to define models relating explicit HVC circuitry to how these neurons work cooperatively to control learning and singing. We developed conductance-based Hodgkin-Huxley models for the three classes of HVC neurons (based on the ion channels previously identified from in vitro recordings) and connected them in several physiologically realistic networks (based on the known synaptic connectivity and specific glutaminergic and gabaergic pharmacology) via different architecture patterning scenarios with the aim to replicate the in vivo firing patterning behaviors. We are able, through these networks, to reproduce the in vivo behavior of each class of HVC neurons, as shown by the experimental recordings. The different network architectures developed highlight different mechanisms that might be contributing to the propagation of sequential neural activity (continuous or punctate) in the HVC and to the distinctive firing patterns that each class exhibits during singing. Examples of such possible mechanisms include: 1) post-inhibitory rebound in HVCX and their population patterns during singing, 2) different subclasses of HVCINT interacting via inhibitory-inhibitory loops, 3) mono-synaptic HVCX to HVCRA excitatory connectivity, and 4) structured many-to-one inhibitory synapses from interneurons to projection neurons, and others. Replication is only a preliminary step that must be followed by model prediction and testing.

Keywords: computational modeling, neural networks, temporal neural sequences, ionic currents, songbird

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Authors: F. Ruiz-Navarro, M. Matzner, G. Kobinia

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Background: Cerebral palsy (CP) encompasses the largest group of childhood movement disorders, the patterns and severity varies widely. Today, the management focuses only on a rehabilitation therapy that tries to secure the functions remained and prevents complications. However the treatments are not aimed to cure the disease. Stem cells (SCs) transplant via intrathecal is a new approach to the disease. Method: Our aim was to performed a pilot study under the condition of unproven treatment on clinical practice to assessed the safety and efficacy of Neuron Point-of-care Stem cell Therapy (N-POCST), an ambulatory procedure of autologous bone marrow derived SCs (BM-SCs) harvested from the posterior superior iliac crest undergo an on-site cell separation for intrathecal infusion via lumbar puncture. Results: 82 patients were treated in a period of 28 months, with a follow-up after 6 months. They had a mean age of 6,2 years old and male predominance (65,9%). Our preliminary results show that: A. No patient had any major side effects, B. Only 20% presented mild headache due to LP, C. 53% of the patients had an improvement in spasticity, D. 61% improved the coordination abilities, 23% improved the motor function, 15% improved the speech, 23% reduced the number of convulsive events with the same doses or less doses of anti-convulsive medication and 94% of the patients report a subjective general improvement. Conclusions: These results support previous worldwide publications that described the safety and effectiveness of autologous BM-SCs transplant for patients wit CP.

Keywords: autologous transplant, cerebral palsy, point of care, childhood movement disorders

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Authors: Maryam Goodarzi, Mahdieh Sheikhi, Mehdi Goodarzi

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This study intends to offer an appropriate strategy development framework for a telecommunication firm (as a case study) which works on Information and Communication Technology (ICT) projects, development of telecommunication networks, and maintenance of local networks, according to its dominant condition. In this approach, first, the objectives were set and the mission was defined. Then, the capability was assessed by SWOT matrix. Using SPACE matrix, the strategy of the company was determined. The strategic direction is set and an appropriate and superior strategy was developed and offered employing QSPM matrix. The theoretical framework or conceptual model of the present study first involves 4 stages of framework development and then from stage 3 (assessing capability) onward, a strategic management model by Fred R. David. In this respect, the tools and methods offered in the framework are appropriate for all kinds of organizations, particularly small firms, and help strategists identify, evaluate, and select strategies.

Keywords: strategy formulation, firm mission, strategic direction, space diagram, quantitative strategic planning matrix, SWOT matrix

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Authors: O. A. Al-Mashaqbeh, A. M. Ghrair, D. Alsafadi, S. S. Dalahmeh, S. L. Bartelt-Hunt, D. D. Snow

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Grab samples were collected in the summer to characterize selected pharmaceuticals and personal care products (PPCPs) in the influent of two wastewater treatment plants (WWTPs) in Jordan. Liquid chromatography tandem mass spectrometry (LC–MS/MS) was utilized to determine the concentrations of 18 compounds of PPCPs. Among all of the PPCPs analyzed, eight compounds were detected in the influent samples (1,7-dimethylxanthine, acetaminophen, caffeine, carbamazepine, cotinine, morphine, sulfamethoxazole and trimethoprim). However, five compounds (amphetamine, cimetidine, diphenhydramine, methylenedioxyamphetamine (MDA) and sulfachloropyridazine) were not detected in collected samples (below the detection limits <0.005 µg/l). Moreover, the results indicated that the highest concentration levels detected in collected samples were caffeine, acetaminophen, 1,7-dimethylxanthine, cotinine and carbamazepine at concentration of 182.5 µg/L, 28.7 µg/l, 7.47 µg/l, 4.67 µg/l and 1.54 µg/L, respectively. In general, most of compounds concentrations measured in wastewater in Jordan are within the range for wastewater previously reported in India wastewater except caffeine.

Keywords: pharmaceuticals, personal care products, wastewater, Jordan

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Authors: K. Sangeeth, P. Rekha, P. Preeja, P. Divya, R. Arya, R. Maneesha

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Wireless sensor networks (WSN) are small or tiny devices that consists of different sensors to sense physical parameters like air pressure, temperature, vibrations, movement etc., process these data and sends it to the central data center to take decisions. The WSN domain, has wide range of applications such as monitoring and detecting natural hazards like landslides, forest fire, avalanche, flood monitoring and also in healthcare applications. With such different applications, it is being taught in undergraduate/post graduate level in many universities under department of computer science. But the cost and infrastructure required to purchase WSN nodes for having the students getting hands on expertise on these devices is expensive. This paper gives overview about the remote triggered lab that consists of more than 100 WSN nodes that helps the students to remotely login from anywhere in the world using the World Wide Web, configure the nodes and learn the WSN concepts in intuitive way. It proposes new way called over the air programming (OTAP) and its internals that program the 100 nodes simultaneously and view the results without the nodes being physical connected to the computer system, thereby allowing for sparse deployment.

Keywords: WSN, over the air programming, virtual lab, AT45DB

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Authors: Sara Fioretti

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During the Middle Bronze Age, southern Italy underwent a reorganisation of social structures where local cultures, such as the sub-Apennine and Nuragic, flourished and participated in maritime trade. This paper explores the socio-economic relationships, in both cross-cultural and potentially inter-regional settings, present within the archaeological repertoire of the southern Italian Late Bronze Age (LBA 1600 -1050 BCE). The emergence of economic relations within the connectivity of the regional settlements is explored through ceramic contexts found in the case studies Punta di Zambrone, Broglio di Trebisacce, and Nuraghe Antigori. This paper discusses the findings of a statistical and theoretical approach from an ongoing study in relation to the Mediterranean’s characterisation as a period dominated by Mycenaean influence. This study engages with a theoretical bricolage of Social Networks Entanglement, and Assertive Objects Theory to address the selective and assertive dynamics evident in the cross-cultural trade exchanges as well as consider inter-regional dynamics. Through this intersection of theory and statistical analysis, the case studies establish a small percentage of pottery as imported, whilst assertive productions have a relatively higher quantity. Overall, the majority still adheres to regional Italian traditions. Therefore, we can dissect the rhizomatic relationships cultivated by the Italian coasts and Mycenaeans and their roles within their networks through the intersection of theoretical and statistical analysis. This research offers a new perspective on the complex nature of the Late Bronze Age relational structures.

Keywords: late bronze age, mediterranean archaeology, exchanges and trade, frequency distribution of ceramic assemblages, social network theory, rhizomatic exchanges

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Authors: Hyunsun Lee, Yi Zhu

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Wireless ad-hoc network is a decentralized type of temporary machine-to-machine connection that is spontaneous or impromptu so that it does not rely on any fixed infrastructure and centralized administration. As unmanned aerial vehicles (UAVs), also called drones, have recently become more accessible and widely utilized in military and civilian domains such as surveillance, search and detection missions, traffic monitoring, remote filming, product delivery, to name a few. The communication between these UAVs become possible and materialized through Flying Ad-hoc Networks (FANETs). However, due to the high mobility of UAVs that may cause different types of transmission interference, it is vital to design robust routing protocols for FANETs. In this talk, the multicast routing method based on a modified stochastic branching process is proposed. The stochastic branching process is often used to describe an early stage of an infectious disease outbreak, and the reproductive number in the process is used to classify the outbreak into a major or minor outbreak. The reproductive number to regulate the local transmission rate is adapted and modified for flying ad-hoc network communication. The performance of the proposed routing method is compared with other well-known methods such as flooding method and gossip method based on three measures; average reachability, average node usage and average branching factor. The proposed routing method achieves average reachability very closer to flooding method, average node usage closer to gossip method, and outstanding average branching factor among methods. It can be concluded that the proposed multicast routing scheme is more efficient than well-known routing schemes such as flooding and gossip while it maintains high performance.

Keywords: Flying Ad-hoc Networks, Multicast Routing, Stochastic Branching Process, Unmanned Aerial Vehicles

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Authors: Zena F. Mushtaq, Iqbal M. Abbas

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Background: Diabetes mellitus during pregnancy is one of the major medical and social problems with increasing prevalence in last decades and may lead to more vulnerable to dental problems and increased risk for periodontal diseases. Objectives: To assess oral hygiene behaviors among pregnant women with diabetes who attended primary health care centers and find out the relationship between oral hygiene behaviors and studied variables. Methodology: A cross sectional design was conducted from 7 July to 30 September 2014 on non probability (convenient sample) of 150 pregnant women with diabetes was selected from twelve Primary Health Care Centers at Baghdad city. Questionnaire format is tool for data collection which had designed and consisted of three main parts including: socio demographic, reproductive characteristics and items of oral hygiene behaviors among pregnant women with diabetes. Reliability of the questionnaire was determined through internal consistency of correlation coefficient (R= 0.940) and validity of content was determined through reviewing it by (12) experts in different specialties and was determined through pilot study. Descriptive and inferential statistics were used to analyze collected data. Result: Result of study revealed that (35.3%) of study sample was (35-39) years old with mean and SD is (X & SD = 33.57 ± 5.54) years, and (34.7%) of the study sample was graduated from primary school and less, half of the study sample was government employment and self employed, (42.7%) of the study sample had moderate socioeconomic status, the highest percentage (70.0%) of the study sample was nonsmokers, The result indicates that oral hygiene behaviors have moderate mean score in all items. There are no statistical significant association between oral hygiene domain and studied variables. Conclusions: All items related to health behavior concerning oral hygiene is in moderate mean of score, which may expose pregnant women with diabetes to high risk of periodontal diseases. Recommendations: Dental care provider should perform a dental examination at least every three months for each pregnant woman with diabetes, explanation of the effect of DM on periodontal health, oral hygiene instruction, oral prophylaxis, professional cleaning and treatment of periodontal diseases(scaling and root planing) when needed.

Keywords: diabetes, health behavior, pregnant women, oral hygiene

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Authors: Yujiang Wu

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As electrical machine (e-machine) power density re-querulents become more stringent in vehicle electrification, mounting a temperature sensor for e-machine stator windings becomes increasingly difficult. This can lead to higher manufacturing costs, complicated harnesses, and reduced reliability. In this paper, we propose a deep-learning method for predicting electric machine winding temperature, which can either replace the sensor entirely or serve as a backup to the existing sensor. We compare the performance of our method, the stateful long short-term memory networks (LSTM) with truncated backpropagation through time (TBTT), with that of linear regression, as well as stateless LSTM with/without residual connection. Our results demonstrate the strength of combining stateful LSTM and TBTT in tackling nonlinear time series prediction problems with long sequence lengths. Additionally, in industrial applications, high-temperature region prediction accuracy is more important because winding temperature sensing is typically used for derating machine power when the temperature is high. To evaluate the performance of our algorithm, we developed a temperature-stratified MSE. We propose a simple but effective data preprocessing trick to improve the high-temperature region prediction accuracy. Our experimental results demonstrate the effectiveness of our proposed method in accurately predicting winding temperature, particularly in high-temperature regions, while also reducing manufacturing costs and improving reliability.

Keywords: deep learning, electrical machine, functional safety, long short-term memory networks (LSTM), thermal management, time series prediction

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Authors: Dorota Galeza

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This paper argues that networks, such as the ECN and the American network, are affected by certain small events which are inherent to path dependence and preclude the full evolution towards efficiency. It is advocated that the American network is superior to the ECN in many respects due to its greater flexibility and longer history. This stems in particular from the creation of the American network, which was based on a small number of cases. Such structure encourages further changes and modifications which are not necessarily radical. The ECN, by contrast, was established by legislative action, which explains its rigid structure and resistance to change. It might be the case that the ECN is subject not so much to path dependence but to past dependence. It might have to be replaced, as happened to its predecessor. This paper is an attempt to transpose the superiority of the American network on to the ECN. It looks at concepts such as judicial cooperation, harmonization of procedure, peer review and regulatory impact assessments (RIAs), and dispute resolution procedures. The aim is to adopt these concepts into the EU setting without recourse to legal transplantation. The major difficulty is that many of these concepts have been tested only in the US and it is difficult to tell whether they could be modified to meet EU standards. Concepts such as judicial cooperation might be difficult due to different language traditions in EU member states. It is hoped that greater flexibility, as in the American network, would boost legitimacy and transparency.

Keywords: ECN, networks, regulation, competition

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Authors: Abdessalam Hijab, Hafida Boulekbache, Eric Henry

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The objective of this article is to explain the use of geographic information system (GIS) and information and communication technologies (ICTs) in the real-time processing and analysis of data on the status of an urban sanitation network by integrating professional actors in sanitation for sustainable management in urban areas. Indeed, it is a smart geo-collaboration based on the complementarity of ICTs and GIS. This multi-actor reflection was built with the objective of contributing to the development of complementary solutions to the existing technologies to better protect the urban environment, with the help of a checklist with the spatial reference "E-Géo-LD" dedicated to the "professional/professional" actors in sanitation, for intelligent monitoring of liquid sanitation networks in urban areas. In addition, this research provides a good understanding and assimilation of liquid sanitation schemes in the "Lamkansa" sampling area of the city of Casablanca, and spatially evaluates these schemes. Downstream, it represents a guide to assess the environmental impacts of the liquid sanitation scheme.

Keywords: ICT, GIS, spatial checklist, liquid sanitation, environment

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Authors: B. Thanasansomboon, S. Choemprayong, N. Parinyanitikul, U. Tanlamai

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Being diagnosed with metastatic breast cancer, the patients as well as their caretakers are affected physically and mentally. Although the medical systems in Thailand have been attempting to improve the quality and effectiveness of the treatment of the disease in terms of physical illness, the success of the treatment also depends on the quality of mental health. Metastatic breast cancer patients have found that social support is a key factor that helps them through this difficult time. It is recognized that social support in different dimensions, including emotional support, social network support, informational support, instrumental support and appraisal support, are contributing factors that positively affect the quality of life of patients in general, and it is undeniable that social support in various forms is important in promoting the quality of life of metastatic breast patients. However, previous studies have not been dedicated to investigating their quality of life concerning affective, cognitive, and behavioral outcomes. Therefore, this study aims to develop integrated social support through social networks to improve the quality of life of metastatic breast cancer patients in Thailand.

Keywords: social support, metastatic breath cancer, quality of life, social network

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Authors: Robert E. Kenney, Efrain Antunez, Samuel Nodal, Ameer Malik, Richard B. Aguilar

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Physician burnout has gained much attention during the COVID pandemic. After-hours workload, HCC coding, HEDIS metrics, and clinical documentation negatively impact career satisfaction. These and other influences have increased the rate of physicians leaving the workforce. In addition, roughly 1% of the entire physician workforce will be retiring earlier than expected based on pre-pandemic trends. The two Medical Specialties with the highest rates of burnout are Family Medicine and Primary Care. With a predicted shortage of primary care physicians looming, the need to address physician burnout is crucial. Commonly reported issues leading to clinician burnout are clerical documentation requirements, increased time working on Electronic Health Records (EHR) after hours, and a decrease in work-life balance. Clinicians experiencing burnout with physical and emotional exhaustion are at an increased likelihood of providing lower quality and less efficient patient care. This may include a lack of suitable clinical documentation, medication reconciliation, clinical assessment, and treatment plans. While the annual baseline turnover rates of physicians hover around 6-7%, the COVID pandemic profoundly disrupted the delivery of healthcare. A report found that 43% of physicians switched jobs during the initial two years of the COVID pandemic (2020 and 2021), tripling the expected average annual rate to 21.5 %/yr. During this same time, an average of 4% and 1.5% of physicians retired or left the workforce for a non-clinical career, respectively. The report notes that 35.2% made career changes for a better work-life balance and another 35% reported the reason as being unhappy with their administration’s response to the pandemic. A physician-led primary care-focused health organization, Cano Health (CH), based out of Florida, sought to preemptively address this problem by implementing several supportive measures. Working with >120 clinics and >280 PCPs from Miami to Tampa and Orlando, managing nearly 120,000 Medicare Advantage lives, CH implemented a number of changes to assist with the clinician’s workload. Supportive services such as after hour and home visits by APRNs, in-clinic care managers, and patient educators were implemented. In 2021, assistive Artificial Intelligence Software (AIS) was integrated into the EHR platform. This AIS converts free text within PDF files into a usable (copy-paste) format facilitating documentation. The software also systematically and chronologically organizes clinical data, including labs, medical records, consultations, diagnostic images, medications, etc., into an easy-to-use organ system or chronic disease state format. This reduced the excess time and documentation burden required to meet payor and CMS guidelines. A clinician Documentation Support team was employed to improve the billing/coding performance. The effects of these newly designed workflow interventions were measured via analysis of clinician turnover from CH’s hiring and termination reporting software. CH’s annualized average clinician turnover rate in 2020 and 2021 were 17.7% and 12.6%, respectively. This represents a 30% relative reduction in turnover rate compared to the reported national average of 21.5%. Retirement rates during both years were 0.1%, demonstrating a relative reduction of >95% compared to the national average (4%). This model successfully promoted the retention of clinicians in a Value-Based Care setting.

Keywords: clinician burnout, COVID-19, value-based care, burnout, clinician retirement

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Authors: Renjith George Pallivathukal, Preethy Mary Donald

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Asymptomatic oral lesions are often ignored by the patients and usually will be identified only in advanced stages. Early detection of precancerous lesions is important for better prognosis. It is also important for the oral health care person to be aware of the regional prevalence of oral lesions in order to provide early care for the same. We conducted a retrospective study to assess the prevalence of oral lesions based on the information available from patient records in a teaching dental school. Dental records of patients who attended the department of Oral medicine and diagnosis between September 2014 and September 2016 were retrieved and verified for oral lesions. Results: The ages of the patients ranged from 13 to 38 years with a mean age of 21.8 years. The lesions were classified as white (40.5%), red (23%), ulcerated (10.5%), pigmented (15.2%) and soft tissue enlargements (10.8%). 52% of the patients were unaware of the oral lesions before the dental visit. Overall, the prevalence of lesions in dental patients lower to national estimates, but the prevalence of some lesions showed variations.

Keywords: oral mucosal lesion, pre-cancer, prevalence, soft tissue lesion

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Authors: Jason M. Hegenauer, Nicholas Fucci

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In the late 1990s, a major deinstitutionalization movement of elderly patients took place, since which, the design of long-term care facilities has not been adequately analyzed in the United States. Over the course of the last 25 years, major innovations in construction methods, technology, and medicine have been developed, drastically changing the landscape of healthcare architecture. In light of recent events, and the expected increase in elderly populations with the aging of the baby-boomer generation, it is evident that reconsideration of these facilities is essential for the proper care of aging populations. The global response has been effective in stifling this pandemic; however, widespread disease still poses an imminent threat to the human race. Having witnessed the devastation Covid-19 has reaped throughout nursing homes and long-term care facilities, it is evident that the current strategies for protecting our most vulnerable populations are not enough. Light renovation of existing facilities and previously overlooked considerations for new construction projects can drastically lower the risk at nursing homes and long-term care facilities. A reconfigured entry sequence supplements several of the features which have been long-standing essentials of the design of these facilities. This research focuses on several aspects identified as needing improvement, including indoor environment quality, security measures incorporated into healthcare architecture and design, and architectural mitigation strategies for sick building syndrome. The results of this study have been compiled as 'best practices' for the design of future healthcare construction projects focused on the health, safety, and quality of life of the residents of these facilities. These design strategies, which can easily be implemented through renovation of existing facilities and new construction projects, minimize risk of infection and spread of disease while allowing routine functions to continue with minimal impact, should the need for future lockdowns arise. Through the current lockdown procedures, which were implemented during the Covid-19 pandemic, isolation of residents has caused great unrest and worry for family members and friends as they are cut off from their loved ones. At this time, data is still being reported, leaving infection and death rates inconclusive; however, recent projections in some states list long-term care facility deaths as high as 60% of all deaths in the state. The population of these facilities consists of residents who are elderly, immunocompromised, and have underlying chronic medical conditions. According to the Centers for Disease Control, these populations are particularly susceptible to infection and serious illness. The obligation to protect our most vulnerable population cannot be overlooked, and the harsh measures recently taken as a response to the Covid-19 pandemic prove that the design strategies currently utilized for doing so are inadequate.

Keywords: building security, healthcare architecture and design, indoor environment quality, new construction, sick building syndrome, renovation

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Authors: W. Mazari, K. Boucherit, Z. Boucherit-Otmani, M. N. Rahmoun, M. Benabdallah

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The hospital or any other establishment of care can be considered as an ecosystem where the patient comes into contact with a frightening microbial universe and a risk to contract infection that is referred to as nosocomial or health care-associated. In these last years, the incidence of these infections has risen sharply. Several microorganisms are the cause of these nosocomial infections and the emergence of resistance of the microbial strains against antibiotics creates a danger to public health. The search for new antimicrobial agents to overcome this problem has produced interesting compounds through chemical synthesis, which plays a very important role in the research and discovery of new drugs. It is in this framework that our study was conducted at our laboratory and it involves evaluating the antibacterial activity of thirteen 2-pyridone derivatives synthesized by two methods, the diffusion disc method and the dilution method against eight Gram negative bacterial strains. The results seem interesting especially for two products that have shown the best activities against Escherichia coli ATCC 25922 and Enterobacter cloacae ATCC 13047 with CMI of 512µg/ml.

Keywords: heterocyclic derivatives, chemical synthesis, antimicrobial activity, biotechnology

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Authors: Jirapan Khruesarn, Wimwipa Boonklin

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Background: Currently, Thailand has an aging population. In 2017, the elderly population was over 11.14 million. There will be an increase in the number of elderly people, 8.39 million, some people grumble to themselves and have conflicts with their offspring or those close to them. It is a source of stress. Mental health promotion should be given to the elderly in order to cope with these changes. Due to the family characteristics of Thai society, these family members will act as caregivers for the elderly. Therefore, a group-counseling program based on Personnel-Centered Theory for Elderly Caregivers in Mental Health Promotion for Older People in Na Kaeo Municipality, Kau Ka District, Lampang Province, has been developed to compare the elderly care behavior before and after the participation. Methods: This research was study for 20 elderly' caregiver: Those aimed to compare the before and after use of group program for caregiver to promoting for the elderly by the following methods: Step 1 Establish a framework for evaluating elderly care behaviors and develop a group counseling program for promote mental health for elderly on: 1) Body 2) Willpower 3) Social and community management and 4) Organizing learning process. Step 2 Assessing an Elderly Care Behaviors by using "The behavior assessment on caring for the elderly" and assessing the mental health power level of the elderly and follow the counseling program 9 times and compare of the elderly care behaviors before and after joined a group program, and compare of mental health level of caregiver attends a group program. Results: This study is developing a group counseling program to promoting for the resilience quotient in elderly people that the results of the study could be summarized as follows: 1) Before the elderly's caregivers join a group counseling program: Mental health promotion behaviors of the elderly were at the high level of (3.32), and after: were at the high level of (3.44). 2) Before the elderly's caregiver attends a group counseling program: the mental health level of the elderly the mean score was (47.85 percent), and the standard deviation was (0.21 percent) and after. The elderly had a higher score of (51.45 percent) In summary, after the elderly caregivers joined the group, the elderly are higher in all aspects promote mental health for elderly and the statistically significance at the 0.05, It shows that programs are fit for personal and community condition in promoting the mental health of the elderly because this theory has the idea that: Humans have the ability to use their intelligence to solve problems or make decisions effectively, And member of group counseling program have ventured and express grievances that the counselor is a facilitator who focuses on personal development by building relationships among people. In other words, the factors contributing to higher levels of elderly care behaviors is group counseling, that isn't a hypothetical process but focus on building relationships that are based on mutual trust and Unconditional acceptance.

Keywords: group counseling base on person-centered theory, elderly person, resilience quotient: RQ, caregiver

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Authors: Kimberly Winnie Achieng Otieno

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The Nairobi Hospital plays a pivotal role in healthcare provision in East and Central Africa, yet it faces challenges in providing accessible dialysis care. This paper explores strategic interventions to enhance dialysis care, improve access and streamline health information management, with an aim of fostering an integrated and patient-centered healthcare system in our region. Challenges at The Nairobi Hospital The Nairobi Hospital currently grapples with insufficient dialysis machines which results in extended turn around times. This issue stems from both staffing bottle necks and infrastructural limitations given our growing demand for renal care services. Our Paper-based record keeping system and fragmented flow of information downstream hinders the hospital’s ability to manage health data effectively. There is also a need for investment in expanding The Nairobi Hospital dialysis facilities to far reaching communities. Setting up satellite clinics that are closer to people who live in areas far from the main hospital will ensure better access to underserved areas. Community Outreach and Education Implementing education programs on kidney health within local communities is vital for early detection and prevention. Collaborating with local leaders and organizations can establish a proactive approach to renal health hence reducing the demand for acute dialysis interventions. We can amplify this effort by expanding The Nairobi Hospital’s corporate social responsibility outreach program with weekend engagement activities such as walks, awareness classes and fund drives. Enhancing Efficiency in Dialysis Care Demand for dialysis services continues to rise due to an aging Kenyan population and the increasing prevalence of chronic kidney disease (CKD). Present at this years International Nursing Conference are a diverse group of caregivers from around the world who can share with us their process optimization strategies, patient engagement techniques and resource utilization efficiencies to catapult The Nairobi Hospital to the 21st century and beyond. Plans are underway to offer ongoing education opportunities to keep staff updated on best practices and emerging technologies in addition to utilizing a patient feedback mechanisms to identify areas for improvement and enhance satisfaction. Staff empowerment and suggestion boxes address The Nairobi Hospital’s organizational challenges. Current financial constraints may limit a leapfrog in technology integration such as the acquisition of new dialysis machines and an investment in predictive analytics to forecast patient needs and optimize resource allocation. Streamlining Health Information Management Fully embracing a shift to 100% Electronic Health Records (EHRs) is a transformative step toward efficient health information management. Shared information promotes a holistic understanding of patients’ medical history, minimizing redundancies and enhancing overall care quality. To manage the transition to community-based care and EHRs effectively, a phased implementation approach is recommended. Conclusion By strategically enhancing dialysis care access and streamlining health information management, The Nairobi Hospital can strengthen its position as a leading healthcare institution in both East and Central Africa. This comprehensive approach aligns with the hospital’s commitment to providing high-quality, accessible, and patient-centered care in an evolving landscape of healthcare delivery.

Keywords: Africa, urology, diaylsis, healthcare

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Authors: Zeyad Abdelmageid, Xianbin Wang

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Choosing the operational channel for a WLAN access point (AP) in WLAN networks has been a static channel assignment process initiated by the user during the deployment process of the AP, which fails to cope with the dynamic conditions of the assigned channel at the station side afterward. However, the dramatically growing number of Wi-Fi APs and stations operating in the unlicensed band has led to dynamic, distributed, and often severe interference. This highlights the urgent need for the AP to dynamically select the best overall channel of operation for the basic service set (BSS) by considering the distributed and changing channel conditions at all stations. Consequently, dynamic channel selection algorithms which consider feedback from the station side have been developed. Despite the significant performance improvement, existing channel selection algorithms suffer from very high feedback overhead. Feedback latency from the STAs, due to the high overhead, can cause the eventually selected channel to no longer be optimal for operation due to the dynamic sharing nature of the unlicensed band. This has inspired us to develop our own dynamic channel selection algorithm with reduced overhead through the proposed low-overhead, cluster-based station reporting mechanism. The main idea behind the cluster-based station reporting is the observation that STAs which are very close to each other tend to have very similar channel conditions. Instead of requesting each STA to report on every candidate channel while causing high overhead, the AP divides STAs into clusters then assigns each STA in each cluster one channel to report feedback on. With the proper design of the cluster based reporting, the AP does not lose any information about the channel conditions at the station side while reducing feedback overhead. The simulation results show equal performance and, at times, better performance with a fraction of the overhead. We believe that this algorithm has great potential in designing future dynamic channel selection algorithms with low overhead.

Keywords: channel assignment, Wi-Fi networks, clustering, DBSCAN, overhead

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Authors: Silvia D. Vaca, Benjamin J. Kuo, Joao Ricardo N. Vissoci, Catherine A. Staton, Linda W. Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

Abstract:

Background: While delays to care exist in resource rich settings, greater delays are seen along the care continuum in low- and middle-income countries (LMICs) largely due to limited healthcare capacity to address the disproportional rates of traumatic brain injury (TBI) in Sub Saharan Africa (SSA). While many LMICs have government subsidized systems to offset surgical costs, the burden of securing funds by the patients for medications, supplies, and CT diagnostics poses a significant challenge to timely surgical interventions. In Kampala Uganda, the challenge of obtaining timely CT scans is twofold. First, due to a lack of a functional CT scanner at the tertiary hospital, patients need to arrange their own transportation to the nearby private facility for CT scans. Second, self-financing for the private CT scans ranges from $80 - $130, which is near the average monthly income in Kampala. These bottlenecks contribute significantly to the care continuum delays and are associated with poor TBI outcomes. Objective: The objectives of this study are to 1) describe the temporal delays through a modified three delays model that fits the context of neurosurgical interventions for TBI patients in Kampala and 2) investigate the association between delays and mortality. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Four time intervals were constructed along five time points: injury, hospital arrival, neurosurgical evaluation, CT results, and definitive surgery. Time interval differences among mild, moderate and severe TBI and their association with mortality were analyzed. Results: The mortality rate of all TBI patients presenting to MNRH was 9.6%, which ranged from 4.7% for mild and moderate TBI patients receiving surgery to 81.8% for severe TBI patients who failed to receive surgery. The duration from injury to surgery varied considerably across TBI severity with the largest gap seen between mild TBI (174 hours) and severe TBI (69 hours) patients. Further analysis revealed care continuum differences for interval 3 (neurosurgical evaluation to CT result) and 4 (CT result to surgery) between severe TBI patients (7 hours for interval 3 and 24 hours for interval 4) and mild TBI patients (19 hours for interval 3, and 96 hours for interval 4). These post-arrival delays were associated with mortality for mild (p=0.05) and moderate TBI (p=0.03) patients. Conclusions: To our knowledge, this is the first analysis using a modified ‘three delays’ framework to analyze the care continuum of TBI patients in Uganda from injury to surgery. We found significant associations between delays and mortality for mild and moderate TBI patients. As it currently stands, poorer outcomes were observed for these mild and moderate TBI patients who were managed non-operatively or failed to receive surgery while surgical services were shunted to more severely ill patients. While well intentioned, high mortality rates were still observed for the severe TBI patients managed surgically. These results suggest the need for future research to optimize triage practices, understand delay contributors, and improve pre-hospital logistical referral systems.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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Authors: Mona Lisa M. Oliveira, Nara A. Policarpo, Ana Luiza B. P. Barros, Carla A. Silva

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Selective catalytic reduction systems for nitrogen oxides reduction by ammonia has been the chosen technology by most of diesel vehicle (i.e. bus and truck) manufacturers in Brazil, as also in Europe. Furthermore, at some conditions, over-stoichiometric ammonia availability is also needed that increases the NH₃ slips even more. Ammonia (NH₃) by this vehicle exhaust aftertreatment system provides a maximum efficiency of NOx removal if a significant amount of NH₃ is stored on its catalyst surface. In the other words, the practice shows that slightly less than 100% of the NOx conversion is usually targeted, so that the aqueous urea solution hydrolyzes to NH₃ via other species formation, under relatively low temperatures. This paper presents a model based on neural networks integrated with a road vehicle simulator that allows to estimate NH₃-slip emission factors for different driving conditions and patterns. The proposed model generates high NH₃slips which are not also limited in Brazil, but more efforts needed to be made to elucidate the contribution of vehicle-emitted NH₃ to the urban atmosphere.

Keywords: ammonia slip, neural-network, vehicles emissions, SCR-NOx

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Authors: Lauren Dhugga, Meena Parameswaran, David Blundell, Abbas Khushnood

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Context: A multidisciplinary weekly safety briefing was implemented at the Paediatric Cardiothoracic Unit at the Freeman Hospital in Newcastle-upon-Tyne. It is a tertiary referral centre with a quarternary cardiac paediatric intensive care unit and provides complexed care including heart and lung transplants, mechanical support and advanced heart failure assessment. Aim: The aim of this briefing is to provide a structured platform of communication, in an effort to improve efficiency, safety, and patient care. Problem: The paediatric cardiothoracic unit is made up of a vast multidisciplinary team including doctors, intensivists, anaesthetists, surgeons, specialist nurses, echocardiogram technicians, physiotherapists, psychologists, dentists, and dietitians. It provides care for children with congenital and acquired cardiac disease and is one of only two units in the UK to offer paediatric heart transplant. The complexity of cases means that there can be many teams involved in providing care to each patient, and frequent movement of children between ward, high dependency, and intensive care areas. Currently, there is no structured forum for communicating important information across the department, for example, staffing shortages, prescribing errors and significant events. Strategy: An initial survey questioning the need for better communication found 90% of respondents agreed that they could think of an incident that had occurred due to ineffective communication, and 85% felt that incident could have been avoided had there been a better form of communication. Lastly, 80% of respondents felt that a weekly 60 second safety briefing would be beneficial to improve communication within our multidisciplinary team. Based on those promising results, a weekly 60 second safety briefing was implemented to be conducted on a Monday morning. The safety briefing covered four key areas (SAFE): staffing, awareness, fix and events. This was to highlight any staffing gaps, any incident reports to be learned from, any issues that required fixing and any events including teachings for the week ahead. The teams were encouraged to email suggestions or issues to be raised for the week or to approach in person with information to add. The safety briefing was implemented using change theory. Effect: The safety briefing has been trialled over 6 weeks and has received a good buy in from staff across specialties. The aim is to embed this safety briefing into a weekly meeting using the PDSA cycle. There will be a second survey in one month to assess the efficacy of the safety briefing and to continue to improve the delivery of information. The project will be presented at the next clinical governance briefing to attract wider feedback and input from across the trust. Lessons: The briefing displays promise as a tool to improve vigilance and communication in a busy multi-disciplinary unit. We have learned about how to implement quality improvement and about the culture of our hospital - how hierarchy influences change. We demonstrate how to implement change through a grassroots process, using a junior led briefing to improve the efficiency, safety, and communication in the workplace.

Keywords: briefing, communication, safety, team

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Authors: Hanbey Hazar, Hakan Gul

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In this study; piston, exhaust, and suction valves of a diesel engine were coated in 300 mm thickness with Tungsten Carbide (WC) by using the HVOF coating method. Mathematical modeling of a coated and uncoated (standardized) engine was performed by using ANN (Artificial Neural Networks). The purpose was to decrease the number of repetitions of tests and reduce the test cost through mathematical modeling of engines by using ANN. The results obtained from the tests were entered in ANN and therefore engines' values at all speeds were estimated. Results obtained from the tests were compared with those obtained from ANN and they were observed to be compatible. It was also observed that, with thermal barrier coating, hydrocarbon (HC), carbon monoxide (CO), and smoke density values of the diesel engine decreased; but nitrogen oxides (NOx) increased. Furthermore, it was determined that results obtained through mathematical modeling by means of ANN reduced the number of test repetitions. Therefore, it was understood that time, fuel and labor could be saved in this way.

Keywords: Artificial Neural Network, Diesel Engine, Mathematical Modelling, Thermal Barrier Coating

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