Search results for: rural healthcare settings

Authors: Ankita Baidya, Vanishri Ganakumar, Ranveer S. Jadon, Piyush Ranjan, Rita Sood

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Septic embolism can have varied presentations and clinical considerations. Infected central venous catheters are commonly associated with septic emboli but peripheral vascular catheters are rarely implicated. We describe a rare case of septic pulmonary emboli related to infected peripheral venous cannulation caused by an unusual etiological agent. A young male presented with complaints of fever, productive cough, sudden onset shortness of breath and cellulitis in both the upper limbs. He was recently hospitalised for dengue fever and administered intravenous fluids through peripheral venous line. The patient was febrile, tachypneic and in respiratory distress, there were multiple pus filled bullae in left hand alongwith swelling and erythema involving right forearm that started at the site of cannulation. Chest examination showed active accessory muscles of respiration, stony dull percussion at the base of right lung and decreased breath sounds at right infrascapular, infraaxillary and mammary area. Other system examination was within normal limits. Chest X-ray revealed bilateral multiple patchy heterogenous peripheral opacities and infiltrates with right-sided pleural effusion. Contrast-enhanced computed tomography (CECT) chest showed feeding vessel sign confirming the diagnosis as septic emboli. Venous Doppler and 2D-echocardiogarm were normal. Laboratory findings showed marked leucocytosis (22000/mm3). Pus aspirate, blood sample, and sputum sample were sent for microbiological testing. The patient was started empirically on ceftriaxone, vancomycin, and clindamycin. The Pus culture and sputum culture showed Klebsiella pneumoniae sensitive to cefoperazone-sulbactum, piperacillin-tazobactum, meropenem and amikacin. The antibiotics were modified accordingly to antimicrobial sensitivity profile to Cefoperazone-sulbactum. Bronchoalveolar lavage (BAL) was done and sent for microbiological investigations. BAL culture showed Klebsiella pneumoniae with same antimicrobial resistance profile. On day 6 of starting cefoperazone-sulbactum, he became afebrile. The skin lesions improved significantly. He was administered 2 weeks of cefoperazone–sulbactum and discharged on oral faropenem for 4 weeks. At the time of discharge, TLC was 11200/mm3 with marked radiological resolution of infection and healed skin lesions. He was kept in regular follow up. Chest X-ray and skin lesions showed complete resolution after 8 weeks. Till date, only couple of case reports of septic emboli through peripheral intravenous line have been reported in English literature. This case highlights that a simple procedure of peripheral intravenous cannulation can lead to catastrophic complication of septic pulmonary emboli and widespread cellulitis if not done with proper care and precautions. Also, the usual pathogens in such clinical settings are gram positive bacteria, but with the history of recent hospitalization, empirical therapy should also cover drug resistant gram negative microorganisms. It also emphasise the importance of appropriate healthcare practices to be taken care during all procedures.

Keywords: antibiotics, cannula, Klebsiella pneumoniae, septic emboli

Procedia PDF Downloads 145

Authors: Jhiamluka Zservando Solano Velasquez, Raul Palma, Alejandro Calderon, Servio Paguada, Erick Marin, Kellyn Funes, Hana Sandoval, Oscar Hernandez

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Background: Screening cardiac conditions in primary care in developing countries can be challenging, and Honduras is not the exception. One of the main limitations is the underfunding of the Healthcare System in general, causing conventional ECG acquisition to become a secondary priority. Objective: Development of a low-cost ECG to improve screening of arrhythmias in primary care and communication with a specialist in secondary and tertiary care. Methods: Design a portable, pocket-size low-cost 3 lead ECG (Handy EKG). The device is autonomous and has Wi-Fi/Bluetooth connectivity options. A mobile app was designed which can access online servers with machine learning, a subset of artificial intelligence to learn from the data and aid clinicians in their interpretation of readings. Additionally, the device would use the online servers to transfer patient’s data and readings to a specialist in secondary and tertiary care. 50 randomized patients volunteer to participate to test the device. The patients had no previous cardiac-related conditions, and readings were taken. One reading was performed with the conventional ECG and 3 readings with the Handy EKG using different lead positions. This project was possible thanks to the funding provided by the National Autonomous University of Honduras. Results: Preliminary results show that the Handy EKG performs readings of the cardiac activity similar to those of a conventional electrocardiograph in lead I, II, and III depending on the position of the leads at a lower cost. The wave and segment duration, amplitude, and morphology of the readings were similar to the conventional ECG, and interpretation was possible to conclude whether there was an arrhythmia or not. Two cases of prolonged PR segment were found in both ECG device readings. Conclusion: Using a Frugal innovation approach can allow lower income countries to develop innovative medical devices such as the Handy EKG to fulfill unmet needs at lower prices without compromising effectiveness, safety, and quality. The Handy EKG provides a solution for primary care screening at a much lower cost and allows for convenient storage of the readings in online servers where clinical data of patients can then be accessed remotely by Cardiology specialists.

Keywords: low-cost hardware, portable electrocardiograph, prototype, remote healthcare

Procedia PDF Downloads 156

Authors: Janet D. Fish

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This paper will analyze how advanced information technology communications platform’s such as you tube, twitter, Facebook, and websites are being used in marketing cultural diversity on a global scale. The scope of this topic will encompass the use of marketing terror as a tool of educational understanding, accepting, and incorporating other ethnic groups into extremist Islamic cultural practices with an end goal of cultural assimilation. This paper will examine the impacts of various influences, such as globalism and technology on common public values and cultural diversity. Additionally, multiculturalism in public administration settings will be examined across cultures. Communications are a primary focus of review for this paper, the purpose of this review is to see how different technological platforms are currently being used as major tools of influence within the public sector. Technology and terror must become a primary concern for new public administrators in a modern world. While its existence is acknowledged, boundaries of legal recourse are currently few. Public administrators must understand the depth and reach of the future consequences of an unchecked process in the realm of technology and terror on a global scale.

Keywords: inclusionism, exclusionism, technology, terror

Procedia PDF Downloads 364

Authors: Martin S. Mulyadi

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This research investigates the corporate governance disclosure behavior of Indonesian corporations with type II agency problems. The primary cause of the 1990s Asian financial crisis has been attributed to poor corporate governance practices in Indonesia. Most importantly, these poor practices were commonly found in family-owned and government-owned corporations. There are a lot of publicly listed family-owned and government-owned corporations in Indonesia. Agency theory refers to these corporations as corporations with type II agency problems. This research employs agency theory to analyzes corporate governance practice and disclosures in such settings and found that government-owned corporations perform better than family-owned corporations.

Keywords: corporate governance, corporate disclosures, agency theory, type II agency problems

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Authors: Stephanie Yun Yu Law

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Background: This study aims to investigate into communication between trainee doctors and patients, especially how doctor’s reaction to patient’s emotional issues expressed in the consultation affect patient’s satisfaction. Objectives: Thus, there are three aims in this study, 1.) how do trainee doctors react to patients emotional cues in OSCE station? 2.) Any differences in the respond type to emotional cues between first year students and third year students? 3.) Is response type (reducing space) related to OSCE outcome (patient satisfaction and expert rating)? Methods: Fifteen OSCE stations was videotaped, in which 9 were stations with first-year students and 6 were with third-year students. OSCE outcomes were measured by Communication Assessment Tool and Examiners Checklist. Analyses: All patient’s cues/concerns and student’s reaction were coded by Verona Coding Definitions of Emotional Sequence. Descriptive data was gathered from Observer XT and logistic regression (two-level) was carried out to see if occurrence of reducing space response can be predicted by OSCE outcomes. Results: Reducing space responses from all students were slightly less than a half in total responses to patient’s cues. The mean percentage of reducing space behaviours was lower among first year students when compared to third year students. Patient’s satisfaction significantly (p<0.05) and negatively predicted reducing space behaviours. Conclusions: Most of the medical students, to some extent, did not provide adequate responses for patient’s emotional cues. But first year students did provide more space for patients to talk about their emotional issues when compared to third year students. Lastly, patients would feel less satisfied if trainee doctors use more reducing space responses in reaction to patient’s expressed emotional cues/concerns. Practical implications: Firstly, medical training programme can be tailored on teaching students how to detect and respond appropriately to emotional cues in order to improve underperformed student’s communication skills in healthcare setting. Furthermore, trainee doctor’s relationship with patients in clinical practice can also be improved by reacting appropriately to patient’s emotive cues in consultations (such as limit the use of reducing space behaviours).

Keywords: doctors-patients communication, applied clinical psychology, health psychology, healthcare professionals

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Authors: Manasi V. Shah

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Organizations, in the competitive era, are participating in the competency act. They have discerned that, strategically researched and defined competencies when put up on the shelf, can help in achieving business goals. The research focuses on critical elements of competency-based talent acquisition process from practical vantage, with significant experience in a variety of business settings. The research is exploratory and descriptive in nature. The research conduct and outcome is the hinge on with reference to Indian Industries. It elaborates about the concept, practice and a brief model that human resource practitioner can use for effective talent acquisition process, which in turn would be in alignment with business performance. The research helps to present a prudent understanding of recruiting and selecting apt human capital, that can fit in a given job role and has action oriented competency based assessment approach for measuring the probable success of a job incumbent in a given job role.

Keywords: competency based talent acquisition, competency model, talent acquisition concept, talent acquisition practice

Procedia PDF Downloads 286

Authors: K. N. Dinesh Babu, M. V. Gopalan, G. R. Manjunatha, R. Ramaprabha, V. Rajini

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In this paper, monitoring and control of tap changer mechanism of a transformer implementation in an intelligent electronic device (IED) is discussed. Its been a custom for decades to provide a separate panel for on load tap changer control for monitoring the tap position. However this facility cannot either record or transfer the information to remote control centers. As there is a technology shift towards the smart grid protection and control standards, the need for implementing remote control and monitoring has necessitated the implementation of this feature in numerical relays. This paper deals with the programming, settings and logic implementation which is applicable to both IEC 61850 compatible and non-compatible IEDs thereby eliminating the need for separate tap changer control equipment. The monitoring mechanism has been implemented in a 28MVA, 110 /6.9kV transformer with 16 tap position with GE make T60 IED at Ultratech cement limited Gulbarga, Karnataka and is in successful service.

Keywords: transformer protection, tap changer control, tap position monitoring, on load tap changer, intelligent electronic device (IED)

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Authors: Nellie Nosisi Feza

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Developing young students' number sense is a priority if the aim is to build a rich mathematical foundation for successful schooling and future innovative careers. Capturing students’ interests is crucial while mediating counting concepts. This paper reports South African young children number concepts demonstrated before entering the reception class. It indicates the diverse knowledge attained in different settings before entering formal schooling. The findings indicate that their start is uneven with fully and partly attained number concepts. The findings suggest pre-schooling stimulation that provides rich mathematical experiences and purposeful play towards the attainment of core foundational concepts. Literature directs practice on important core concepts that are foundational in developing number sense.

Keywords: numeracy, learning trajectories, innate abilities, counting, Grade R/reception class

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Authors: Mariana Calderón, Paola Montenegro, Diana Moreno

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Through this study, it was possible to identify the different levels and types of violence, both individual and collective, experienced by women, girls, and the sexually diverse population of Buenaventura translated from the different tensions and threats against ancestrality and accounting for a social and political context of violence related to race and geopolitical location. These threats are related to: the stigma and oblivion imposed on practices and knowledge; the imposition of the hegemonic culture; the imposition of external customs as a way of erasing ancestrality; the singling out and persecution of those who practice it; the violence that the health system has exercised against ancestral knowledge and practices, especially in the case of midwives; the persecution of the Catholic religion against this knowledge and practices; the difficulties in maintaining the practices in the displacement from rural to urban areas; the use and control of ancestral knowledge and practices by the armed actors; the rejection and stigma exercised by the public forces; and finally, the murder of the wise women at the hands of the armed actors. This research made it possible to understand the importance of using tools such as the violence meter to support processes of resistance to violence against women, girls, and sexually diverse people; however, it is essential that these tools be adapted to the specific contexts of the people. In the analysis of violence, it was possible to identify that these not only affect women, girls, and sexually diverse people individually but also have collective effects that threaten the territory and the ancestral culture to which they belong. Ancestrality has been the object of violence, but at the same time, it has been the place from which resistance has been organized. The identification of the violence suffered by women, girls, and sexually diverse people is also an opportunity to make visible the forms of resistance of women and communities in the face of this violence. This study examines how women, girls, and sexually diverse people in Buenaventura have been exposed to sexism and racism, which historically have been translated into specific forms of violence, in addition to the other forms of violence already identified by the traditional models of the violentometer. A qualitative approach was used in the study. The study included the participation of more than 40 people and two women's organizations from Buenaventura. The participants came from both urban and rural areas of the municipality of Buenaventura and were over 15 years of age. The participation of such a diverse group allowed for the exchange of knowledge and experiences, particularly between younger and older people. The instrument used for the exercise was previously defined with the leaders of the organizations and consisted of four moments that referred to i) ancestry, ii) threats to ancestry, iii) identification of resistance and iv) construction of the ancestral violentometer.

Keywords: violence against women, intersectionality, sexual and reproductive rights, black communities

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Authors: Pawel Kiper, Alfonc Baba, Mahmoud Alhelou, Giorgia Pregnolato, Michela Agostini, Andrea Turolla

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Impairment of cervical spine mobility is often related to pain triggered by musculoskeletal disorders or direct traumatic injuries of the spine. To date, these disorders are assessed with goniometers and inclinometers, which are the most popular devices used in clinical settings. Nevertheless, these technologies usually allow measurement of no more than two-dimensional range of motion (ROM) quotes in static conditions. Conversely, the wide use of motion tracking systems able to measure 3 to 6 degrees of freedom dynamically, while performing standard ROM assessment, are limited due to technical complexities in preparing the setup and high costs. Thus, motion tracking systems are primarily used in research. These systems are an integral part of virtual reality (VR) technologies, which can be used for measuring spine mobility. To our knowledge, the accuracy of VR measure has not yet been studied within virtual environments. Thus, the aim of this study was to test the reliability of a protocol for the assessment of sensorimotor function of the cervical spine in a population of healthy subjects and to compare whether using immersive or non-immersive VR for visualization affects the performance. Both VR assessments consisted of the same five exercises and random sequence determined which of the environments (i.e. immersive or non-immersive) was used as first assessment. Subjects were asked to perform head rotation (right and left), flexion, extension and lateral flexion (right and left side bending). Each movement was executed five times. Moreover, the participants were invited to perform head reaching movements i.e. head movements toward 8 targets placed along a circular perimeter each 45°, visualized one-by-one in random order. Finally, head repositioning movement was obtained by head movement toward the same 8 targets as for reaching and following reposition to the start point. Thus, each participant performed 46 tasks during assessment. Main measures were: ROM of rotation, flexion, extension, lateral flexion and complete kinematics of the cervical spine (i.e. number of completed targets, time of execution (seconds), spatial length (cm), angle distance (°), jerk). Thirty-five healthy participants (i.e. 14 males and 21 females, mean age 28.4±6.47) were recruited for the cervical spine assessment with immersive and non-immersive VR environments. Comparison analysis demonstrated that: head right rotation (p=0.027), extension (p=0.047), flexion (p=0.000), time (p=0.001), spatial length (p=0.004), jerk target (p=0.032), trajectory repositioning (p=0.003), and jerk target repositioning (p=0.007) were significantly better in immersive than non-immersive VR. A regression model showed that assessment in immersive VR was influenced by height, trajectory repositioning (p<0.05), and handedness (p<0.05), whereas in non-immersive VR performance was influenced by height, jerk target (p=0.002), head extension, jerk target repositioning (p=0.002), and by age, head flex/ext, trajectory repositioning, and weight (p=0.040). The results of this study showed higher accuracy of cervical spine assessment when executed in immersive VR. The assessment of ROM and kinematics of the cervical spine can be affected by independent and dependent variables in both immersive and non-immersive VR settings.

Keywords: virtual reality, cervical spine, motion analysis, range of motion, measurement validity

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Authors: Kazuhiro Tateda, Elisa Gonzalez, Shuhei Ito, Kirstin Heinrich, Kevin Sweetland, Pingping Zhang, Catia Ferreira, Michael Pride, Jennifer Moisi, Sharon Gray, Bennett Lee, Fred Angulo

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Clostridium difficile (C. difficile) is the most common cause of antibiotic-associated diarrhea and infectious diarrhea in healthcare settings. Japan has an aging population; the elderly are at increased risk of hospitalization, antibiotic use, and C. difficile infection (CDI). Little is known about the population-based incidence and disease burden of CDI in Japan although limited hospital-based studies have reported a lower incidence than the United States. To understand CDI disease burden in Japan, CLOUD (Clostridium difficile Infection Burden of Disease in Adults in Japan) was developed. CLOUD will derive population-based incidence estimates of the number of CDI cases per 100,000 population per year in Ota-ku (population 723,341), one of the districts in Tokyo, Japan. CLOUD will include approximately 14 of the 28 Ota-ku hospitals including Toho University Hospital, which is a 1,000 bed tertiary care teaching hospital. During the 12-month patient enrollment period, which is scheduled to begin in November 2018, Ota-ku residents > 50 years of age who are hospitalized at a participating hospital with diarrhea ( > 3 unformed stools (Bristol Stool Chart 5-7) in 24 hours) will be actively ascertained, consented, and enrolled by study surveillance staff. A stool specimen will be collected from enrolled patients and tested at a local reference laboratory (LSI Medience, Tokyo) using QUIK CHEK COMPLETE® (Abbott Laboratories). which simultaneously tests specimens for the presence of glutamate dehydrogenase (GDH) and C. difficile toxins A and B. A frozen stool specimen will also be sent to the Pfizer Laboratory (Pearl River, United States) for analysis using a two-step diagnostic testing algorithm that is based on detection of C. difficile strains/spores harboring toxin B gene by PCR followed by detection of free toxins (A and B) using a proprietary cell cytotoxicity neutralization assay (CCNA) developed by Pfizer. Positive specimens will be anaerobically cultured, and C. difficile isolates will be characterized by ribotyping and whole genomic sequencing. CDI patients enrolled in CLOUD will be contacted weekly for 90 days following diarrhea onset to describe clinical outcomes including recurrence, reinfection, and mortality, and patient reported economic, clinical and humanistic outcomes (e.g., health-related quality of life, worsening of comorbidities, and patient and caregiver work absenteeism). Studies will also be undertaken to fully characterize the catchment area to enable population-based estimates. The 12-month active ascertainment of CDI cases among hospitalized Ota-ku residents with diarrhea in CLOUD, and the characterization of the Ota-ku catchment area, including estimation of the proportion of all hospitalizations of Ota-ku residents that occur in the CLOUD-participating hospitals, will yield CDI population-based incidence estimates, which can be stratified by age groups, risk groups, and source (hospital-acquired or community-acquired). These incidence estimates will be extrapolated, following age standardization using national census data, to yield CDI disease burden estimates for Japan. CLOUD also serves as a model for studies in other countries that can use the CLOUD protocol to estimate CDI disease burden.

Keywords: Clostridium difficile, disease burden, epidemiology, study protocol

Procedia PDF Downloads 242

Authors: Sahar Sohrabi

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The emergence of Cloud data centers has revolutionized the IT industry. Private Clouds in specific provide Cloud services for certain group of customers/businesses. In a real-time private Cloud each task that is given to the system has a deadline that desirably should not be violated. Scheduling tasks in a real-time private CLoud determine the way available resources in the system are shared among incoming tasks. The aim of the scheduling policy is to optimize the system outcome which for a real-time private Cloud can include: energy consumption, deadline violation, execution time and the number of host switches. Different scheduling policies can be used for scheduling. Each lead to a sub-optimal outcome in a certain settings of the system. A Bayesian Scheduling strategy is proposed for scheduling to further improve the system outcome. The Bayesian strategy showed to outperform all selected policies. It also has the flexibility in dealing with complex pattern of incoming task and has the ability to adapt.

Keywords: cloud computing, scheduling, real-time private cloud, bayesian

Procedia PDF Downloads 340

Authors: Jeroen S. de Bruin, Karin Schindler, Christian Schuh

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With increasingly more mobile health applications appearing due to the popularity of smartphones, the possibility arises that these data can be used to improve the medical diagnostic process, as well as the overall quality of healthcare, while at the same time lowering costs. However, as of yet there have been no reports of a successful combination of patient-generated data from smartphones with data from clinical routine. In this paper, we describe how these two types of data can be combined in a secure way without modification to hospital information systems, and how they can together be used in a medical expert system for automatic nutritional classification and triage.

Keywords: mobile health, data integration, expert systems, disease-related malnutrition

Procedia PDF Downloads 461

Authors: Andrew Read, Alice Parry, Kate Woods

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Since the advent of the SARS-CoV-2 pandemic, the search for medications that can reduce mortality and morbidity has been a global research priority. Several multi-center trials have recently demonstrated improved mortality associated with the use of Tocilizumab, an interleukin-6 receptor antagonist, in patients with severe SARS-CoV-2 pneumonia. Initial data supported the administration in patients requiring respiratory support (non-invasive or invasive ventilation), but more recent data has shown benefit in all hypoxic patients. At the height of the second wave of COVID-19 infections in London, our hospital introduced the use of Tocilizumab for patients with severe COVID-19. Tocilizumab is licensed for use in chronic inflammatory conditions and has been associated with an increased risk of severe bacterial and fungal infections, as well as reactivation of chronic viral infections (e.g., hepatitis B). It is a specialist drug that suppresses the formation of C-reactive protein (CRP) for 6 – 12 weeks. It is not widely used by the general medical community. We aimed to assess Tocilizumab use in our hospital and to implement changes to the protocol as required to ensure administration was safe and appropriate. A retrospective study design was used to assess prescriptions over an initial 3-week period in both intensive care and on the medical wards. This amounted to a total of 13 patients. The initial data collection identified four key areas of concern: adherence to national and local inclusion & exclusion criteria; a collection of appropriate screening blood prior to administration; documentation of informed consent or best interest decision and documentation of Tocilizumab administration on patient discharge information, to alert future healthcare providers that typical measures of inflammation and infection, such as CRP, are unreliable for up to 3-months. Data were collected from electronic notes, blood results and observation charts, and cross referenced with pharmacy data. Initial results showed that all four key areas were completed in approximately 50% of cases. Of particular concern was adherence to exclusion criteria, such as current evidence of bacterial infection, and ensuring the correct screening blood was sent to exclude infections such as hepatitis. To remedy this and improve patient safety, the initial data was presented to relevant healthcare professionals. Subsequently, three interventions were introduced and education on each provided to hospital staff. An electronic ‘order set’ collating the appropriate screening blood was created simplifying the screening process. Pre-formed electronic documentation which can be inserted into the notes was created to provide a framework for consent discussions and reduce the time needed for junior doctors to complete this task. Additionally, a ‘Tocilizumab’ administration card was created and administered via pharmacy. This was distributed to each patient on discharge to ensure future healthcare professionals were aware of the potential effects of Tocilizumab administration, including suppression of CRP. Following these changes, repeat data collection over two months illustrated that each of the 4 safety aspects was met with a 100% success rate in every patient. Although this demonstrates good progress and effective interventions the challenge will be to maintain this progress. The audit data collection is ongoing

Keywords: education, patient safety , SARS-CoV-2, Tocilizumab

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Authors: Tarek Kandil, Ameen Ali

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Distributed generation (DG) has recently gained a lot of momentum in power industry due to market deregulation and environmental concerns. One of the most technical challenges facing DGs is islanding of distributed generators. The current industry practice is to disconnect all distributed generators immediately after the occurrence of islands within 200 to 350 ms after loss of main supply. To achieve such goal, each DG must be equipped with an islanding detection device. Frequency relays are one of the most commonly used loss of mains detection method. However, distribution utilities may be faced with concerns related to false operation of these frequency relays due to improper settings. The commercially available frequency relays are considering standard tight setting. This paper investigates some factors related to relays internal algorithm that contribute to their different operating responses. Further, the relay operation in the presence of multiple distributed at the same network is analyzed. Finally, the relay setting can be accurately determined based on these investigation and analysis.

Keywords: frequency relay, distributed generation, islanding detection, relay setting

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Authors: Neetesh Saxena, Narendra S. Chaudhari

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Nowadays, SMS is a very popular mobile service and even the poor, illiterate people and those living in rural areas use SMS service very efficiently. Although many mobile operators have already started 3G and 4G services, 2G services are still being used by the people in many countries. In 2G (GSM), only encryption provided is between the MS and the BTS, there is no end-to-end encryption available. Sometimes we all need to send some confidential message to other person containing bank account number, some password, financial details, etc. Normally, a message is sent in plain text only to the recipient and it is not an acceptable standard for transmitting such important and confidential information. Authors propose an end-to-end encryption approach by proposing a terminal for sending/receiving a secure message. An asymmetric key exchange algorithm is used in order to transmit secret shared key securely to the recipient. The proposed approach with terminal device provides authentication, confidentiality, integrity and non-repudiation.

Keywords: AES, DES, Diffie-Hellman, ECDH, A5, SMS

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Authors: Michelle Jennett, Jana Dengler, Maytal Perlman

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Background: Cervical spinal cord injury (SCI) is a devastating event that results in upper limb paralysis, loss of independence, and disability. People living with cervical SCI have identified improvement of upper limb function as a top priority. Nerve and tendon transfer surgery has successfully restored upper limb function in cervical SCI but is not universally used or available to all eligible individuals. This exploratory mixed-methods study used an implementation science approach to better understand these factors that influence access to upper limb reconstruction in the Canadian context and design an intervention to increase access to care. Methods: Data from the Canadian Institute for Health Information’s Discharge Abstracts Database (CIHI-DAD) and the National Ambulatory Care Reporting System (NACRS) were used to determine the annual rate of nerve transfer and tendon transfer surgeries performed in cervical SCI in Canada over the last 15 years. Semi-structured interviews informed by the consolidated framework for implementation research (CFIR) were used to explore Ontario healthcare provider knowledge and practices around upper limb reconstruction. An inductive, iterative constant comparative process involving descriptive and interpretive analyses was used to identify themes that emerged from the data. Results: Healthcare providers (n = 10 upper extremity surgeons, n = 10 SCI physiatrists, n = 12 physical and occupational therapists working with individuals with SCI) were interviewed about their knowledge and perceptions of upper limb reconstruction and their current practices and discussions around upper limb reconstruction. Data analysis is currently underway and will be presented. Regional variation in rates of upper limb reconstruction and trends over time are also currently being analyzed. Conclusions: Utilization of nerve and tendon transfer surgery to improve upper limb reconstruction in Canada remains low. There are a complex array of interrelated individual-, provider- and system-level barriers that prevent individuals with cervical SCI from accessing upper limb reconstruction. In order to offer equitable access to care, a multi-modal approach addressing current barriers is required.

Keywords: cervical spinal cord injury, nerve and tendon transfer surgery, spinal cord injury, upper extremity reconstruction

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Authors: Rema Daher, Theodor Chakhachiro, Daniel Asmar

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In the era of autonomous robot mapping, assessing the goodness of the generated maps is important, and is usually performed by aligning them to ground truth. Map alignment is difficult for two reasons: first, the query maps can be significantly distorted from ground truth, and second, establishing what constitutes ground truth for different settings is challenging. Most map alignment techniques to this date have addressed the first problem, while paying too little importance to the second. In this paper, we propose a benchmark dataset, which consists of synthetically transformed maps with their corresponding displacement fields. Furthermore, we propose a new system for comparison, where the displacement field of any map alignment technique can be computed and compared to the ground truth using statistical measures. The local information in displacement fields renders the evaluation system applicable to any alignment technique, whether it is linear or not. In our experiments, the proposed method was applied to different alignment methods from the literature, allowing for a comparative assessment between them all.

Keywords: assessment methods, benchmark, image deformation, map alignment, robot mapping, robot motion

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Authors: Y. Alqaheem, A. Alomair, F. Altarkait, F. Alswaileh, Nusrat Tanoli

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Helium market is continuously growing due to its essential uses in the electronic and healthcare sectors. Currently, helium is produced by cryogenic distillation but the process is uneconomical especially for low production volumes. On the other hand, polymeric membranes can provide a cost-effective solution for helium purification due to their low operating energy. However, the preparation of membranes involves the use of very toxic solvents such as chloroform. In this work, polyetherimide membranes were prepared using a less toxic solvent, n-methylpyrrolidone with a polymer-to-solvent ratio of 27 wt%. The developed membrane showed a superior helium permeability of 15.9 Barrer that surpassed the permeability of membranes made by chloroform.

Keywords: helium separation, polyetherimide, dense membrane, gas permeability

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Authors: R. R. Govind

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In the digital age, artificial intelligence (AI) is having a significant impact on the rapid changes that cities are experiencing. This study explores the profound impact of AI on urban morphology, especially with regard to promoting friendly design choices. It addresses a significant research gap by examining the real-world effects of integrating AI into urban design and management. The main objective is to outline a framework for integrating AI to transform urban settings. The study employs an urban design framework to effectively navigate complicated urban environments, emphasize the need for urban management, and provide efficient planning and design strategies. Taking Gangtok's informal settlements as a focal point, the study employs AI methodologies such as machine learning, predictive analytics, and generative AI to tackle issues of 'urban informality'. The insights garnered not only offer valuable perspectives but also unveil AI's transformative potential in addressing contemporary urban challenges.

Keywords: urban design, artificial intelligence, urban challenges, machine learning, urban informality

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Authors: Roger WUMBA

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The objective of this study was to determine the prevalence of intestinal parasites, with special emphasis on microsporidia and Cryptosporidium, as well as their association with human immunodeficiency virus (HIV) symptoms, risk factors, and other digestive parasites. We also wish to determine the molecular biology definitions of the species and genotypes of microsporidia and Cryptosporidium in HIV patients. In this cross-sectional study, carried out in Kinshasa, Democratic Republic of the Congo, stool samples were collected from 242 HIV patients (87 men and 155 women) with referred symptoms and risk factors for opportunistic intestinal parasites. The analysis of feces specimen were performed using Ziehl–Neelsen stainings, real-time polymerase chain reaction (PCR), immunofluorescence indirect monoclonal antibody, nested PCR-restriction fragment length polymorphism, and PCR amplification and sequencing. Odds ratio (OR) and 95% confidence intervals were used to quantify the risk. Of the 242 HIV patients, 7.8%, 0.4%, 5.4%, 0.4%, 2%, 10.6%, and 2.8% had Enterocytozoon bieneusi, Encephalitozoon intestinalis, Cryptosporidium spp., Isospora belli, pathogenic intestinal protozoa, nonpathogenic intestinal protozoa, and helminths, respectively. We found five genotypes of E. bieneusi: two older, NIA1 and D, and three new, KIN1, KIN2, and KIN3. Only 0.4% and 1.6% had Cryptosporidium parvum and Cryptosporidium hominis, respectively. Of the patients, 36.4%, 34.3%, 31%, and 39% had asthenia, diarrhea, a CD4 count of ,100 cells/mm³, and no antiretroviral therapy (ART), respectively. The majority of those with opportunistic intestinal parasites and C. hominis, and all with C. parvum and new E. bieneusi genotypes, had diarrhea, low CD4+ counts of ,100 cells/mm³, and no ART. There was a significant association between Entamoeba coli, Kaposi sarcoma, herpes zoster, chronic diarrhea, and asthenia, and the presence of 28 cases with opportunistic intestinal parasites. Rural areas, public toilets, and exposure to farm pigs were the univariate risk factors present in the 28 cases with opportunistic intestinal parasites. In logistic regression analysis, a CD4 count of ,100 cells/mm³ (OR = 4.60; 95% CI 1.70–12.20; P = 0.002), no ART (OR = 5.00; 95% CI 1.90–13.20; P , 0.001), and exposure to surface water (OR = 2.90; 95% CI 1.01–8.40; P = 0.048) were identified as the significant and independent determinants for the presence of opportunistic intestinal parasites. E. bieneusi and Cryptosporidium are becoming more prevalent in Kinshasa, Congo. Based on the findings, we recommend epidemiology surveillance and prevention by means of hygiene, the emphasis of sensitive PCR methods, and treating opportunistic intestinal parasites that may be acquired through fecal–oral transmission, surface water, normal immunity, rural area-based person–person and animal–human nfection, and transmission of HIV. Therapy, including ART and treatment with fumagillin, is needed.

Keywords: diarrhea, enterocytozoon bieneusi, cryptosporidium hominis, cryptosporidium parvum, risk factors, africans

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Authors: N. S. A. Rahim, N. N. Abu Mansor, M. I. Saidi, N. R. A. Rahim, K. F. Adrutdin

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The use of coaching as one of organizational culture with the contribution of the involvement of line manager roles is an important to update employees’ knowledge and skills continuously. In healthcare sector, it is dynamic that nurse must update their knowledge and skills to keep pace with change. This paper attempts to discuss the involvement of line manager roles towards creating a coaching culture who give their support and innovation towards motivate nurses to give their best performance either in public or private hospitals.

Keywords: nursing, line managers’ roles, coaching, coaching culture

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Authors: Mohamad Chour

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Nowadays, a record number of households are headed by single fathers in most of the European societies. Our research aims to explore how French single fathers experience the domestic sphere, a traditionally feminized field while accomplishing their role of fathers. We adopt a gender role and a parenting role construction theoretical perspectives. Indeed, the interior domestic sphere has been traditionally considered as related to the role of the mother. Moreover, according to the masculine domination theory of Bourdieu, men avoid caregiving and domestic practices that are economically and culturally undervalued. Hence, mothers are considered as more likely to handle the expressive dimension of duties whereas fathers’ role is represented as instrumental, functional and independent. Long interviews have been conducted with twenty French single fathers in order to investigate how the absence of the mother affects the practices of fatherhood. We combined the long interviews with projective techniques method in order to better understand their conception of the family and their family values. Seeking a qualitative diversity, our respondents are from various ages (between 30 and 60); they are coming from different regions in France; living in rural, semi-rural and urban areas. Based on the analysis of 427 pages of data, we identify three main categories of single fathers depending on their strategies to copy and/or delegate the role of the mother. 1) Nurturing fathers completely assume the role of the absent mother as well as her functions. Their discourse is characterized by abnegation and sacrifices reflecting a nurturing role. 2) Juggling fathers are those who take charge of a part of the household duties and delegate the other part to the market or to 'feminine resources' for lacking skills or time. 3) Resistant fathers are the very few respondents who refuse to assume any activities related to the domestic sphere that they perceive as feminine. For lacking competences and even for ideological reasons, they have tendency to delegate all the tasks that were assumed by their ex-spouses. Generally, the majority of fathers seem to experience the domestic sphere differently, and their domestic involvement has been underestimated and even misunderstood. Household duties such as cooking and housekeeping in addition to the nurturing role are experienced by many of the respondents as constructing elements of their fatherhood. Our respondents do not seem to accomplish house holding duties in a functional way. The domestic sphere is managed by those fathers with a strong dimension of abnegation. Thus, our research contributes to illustrating the evolution of gender roles and shows how being simultaneously 'a father and a mother' seems to be an emerging social norm in a French and European cultural context.

Keywords: fathering, gender roles, gender studies, identity construction, single fathers

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Authors: Gadinga Walter Forje, Martin Ngankam Tchamba, Nyong Princely Awazi, Barnabas Neba Nfornka

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Ecotourism is viewed as a double edge sword for the enhancement of conservation and local livelihood within a protected landscape. The Campo Ma’an National Park (CMNP) adopted ecotourism in its management plan as a strategic axis for better management of the park. The growing importance of ecotourism as a strategy for the sustainable management of CMNP and its environs requires adequate information to bolster the sector. This study was carried out between November 2018 and September 2021, with the main objective to contribute to the sustainable management of the CMNP through suggestions for enhancing the capacity of ecotourism in and around the park. More specifically, the study aimed at; 1) Analyse the governance of ecotourism in the CMNP and its surrounding; 2) Assessing the impact of ecotourism on local livelihood around the CMNP; 3) Evaluating the contribution of ecotourism to biodiversity conservation in and around the CMNP; 4) Evaluate the determinants of ecotourism possibilities in achieving sustainable livelihood and biodiversity conservation in and around the CMNP. Data were collected from both primary and secondary sources. Primary data were obtained from household surveys (N=124), focus group discussions (N=8), and key informant interviews (N=16). Data collected were coded and imputed into SPSS (version 19.0) software and Microsoft Excel spreadsheet for both quantitative and qualitative analysis. Findings from the Chi-square test revealed overall poor ecotourism governance in and around the CMNP, with benefit sharing (X2 = 122.774, p <0.01) and conflict management (X2 = 90.839, p<0.01) viewed to be very poor. For the majority of the local population sampled, 65% think ecotourism does not contribute to local livelihood around CMNP. The main factors influencing the impact of ecotourism around the CMNP on the local population’s livelihood were gender (logistic regression (β) = 1.218; p = 0.000); and level of education (logistic regression (β) = 0.442; p = 0.000). Furthermore, 55.6% of the local population investigated believed ecotourism activities do not contribute to the biodiversity conservation of CMNP. Spearman correlation between socio-economic variables and ecotourism impact on biodiversity conservation indicated relationships with gender (r = 0.200, p = 0.032), main occupation (r = 0.300 p = 0.012), time spent in the community (r = 0.287 p = 0.017), and number of children (r =-0.286 p = 0.018). Variables affecting ecotourism impact on biodiversity conservation were age (logistic regression (β) = -0.683; p = 0.037) and gender (logistic regression (β) = 0.917; p = 0.045). This study recommends the development of ecotourism-friendly policies that can accelerate Public Private Partnership for the sustainable management of the CMNP as a commitment toward good governance. It also recommends the development of gender-sensitive ecotourism packages, with fair opportunities for rural women and more parity in benefit sharing to improve livelihood and contribute more to biodiversity conservation in and around the Park.

Keywords: biodiversity conservation, Campo Ma’an national park, ecotourism, ecotourism governance, rural livelihoods, protected area management

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Authors: Sophia El Ouazzani, Amer M. Burhan, Mary Wickenden

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Background: Despite improvements in recent years, the Moroccan mental healthcare system still face disparity between available resources and the current population’sneeds. The societal stigma, and limited economic, political, and human resources are all factors in shaping the psychiatric system, exacerbating the discontinuity of services for users after discharged from the hospital. As a result, limited opportunities for social inclusion and meaningful community engagement undermines human rights and recovery potential for people with mental health problems, especially those with psychiatric disabilities from serious mental illness (SMI). Recovery-oriented practice, such as mental health rehabilitation, addresses the complex needs of patients with SMI and support their community inclusion. The cultural acceptability of recovery-oriented practice is an important notion to consider for a successful implementation. Exploring the extent to which recovery-oriented practices are used in Morocco is a necessary first step to assess the cultural relevance of such a practice model. Aims: This study aims to explore understanding and knowledge, perception, and perspective about core concepts in mental health rehabilitation, including psychiatric disability, recovery, and engagement in meaningful occupations for people with SMI in Morocco. Methods: A pilot qualitative study was undertaken. Data was collected via semi-structured interviews and focusgroup discussions with healthcare professional students. Questions were organised around the following themes: 1) students’ perceptions, understanding, and expectations around concepts such as SMI, mental health disability, and recovery, and 2) changes in their views and expectations after starting their professional training. Further analysis of students’ perspectives on the concept of ‘meaningful occupation’ and how is this viewed within the context of the research questions was done. The data was extracted using an inductive thematic analysis approach. This is a pilot stage of a doctoral project, further data will be collected and analysed until saturation is reached. Results: A total of eight students were included in this study which included occupational therapy and mental health nursing students receiving training in Morocco. The following themes emerged as influencing students’ perceptions and views around the main concepts: 1) Stigma and discrimination, 2) Fatalism and low expectations, 3) Gendered perceptions, 4) Religious causation, 5) Family involvement, 6) Professional background, 7) Inaccessibility of services and treatment. Discussion/Contribution: Preliminary analysis of the data suggests that students’ perceptions changed after gaining more clinical experiences and being exposed to people with psychiatric disabilities. Prior to their training, stigma shaped greatly how they viewed people with SMI. The fear, misunderstanding, and shame around SMI and their functional capacities may contribute to people with SMI being stigmatizedand marginalised from their family and their community. Religious causations associated to SMIsare understood as further deepening the social stigma around psychiatric disability. Perceptions are influenced by gender, with women being doubly discriminated against in relation to recovery opportunities. Therapeutic pessimism seems to persist amongst students and within the mental healthcare system in general and regarding the recovery potential and opportunities for people with SMI. The limited resources, fatalism, and stigma all contribute to the low expectations for recovery and community inclusion. Implications and future directions will be discussed.

Keywords: disability, mental health rehabilitation, recovery, serious mental illness, transcultural psychiatry

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Authors: Jialin Wu, Zhiwei Lian, Jieyu Tang, Jingyun Shen

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Tornado is a serious and unpredictable natural disaster, which has an important impact on people's production and life. The probability of being hit by tornadoes in China was analyzed considering the principles of tornado formation. Then some suggestions on layout and shapes for newly-built buildings were provided combined with the characteristics of tornado wind fields. Fuzzy clustering and inverse closeness methods were used to evaluate the probability levels of tornado risks in various provinces based on classification and ranking. GIS was adopted to display the results. Finally, wind field single-vortex tornado was studied to discuss the optimized design of rural low-rise houses in Yancheng, Jiangsu as an example. This paper may provide enough data to support building and urban design in some specific regions.

Keywords: tornado probability, computational fluid dynamics, fuzzy mathematics, optimal design

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Authors: Hyeondal Jeong, Yoonjung Baek

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This study was carried out a meta-analysis on team workforce diversity and team outcomes. Using data from 3,534 teams in 13 studies conducted in team-level settings, we examined whether contextual factors at research local and team-size, influenced team outcomes of team workforce diversity. This meta-analytic examines the team workforce diversity and team outcomes. 13 studies included in the analysis are studies published from 2009 to 2014. We first examined the correlations between all types of diversity and team performance, significant result (Fisher`s Z = .112, k = 32, 95% CI = 0.039 to 0.183). After the analysis was conducted to moderating effect of research local (Republic of Korea=1, other area=0) and team-size. As a result, research local moderating effect had a significant but team-size was not supported. Based on the above findings suggest implications and future research directions.

Keywords: team workforce diversity, team outcomes, meta- analytic, cross-cultural research

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Authors: Hualter Oliveira Barbosa, Raquel Feitosa do Vale Cunha, Erika Muniz dos Santos, Fernanda Belmira Souza, Fabio Sousa, Luis Henrique Pascareli, Franciney de Oliveira Lima, Ana Cláudia Reis da Silva, Christiane Moreira de Almeida

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Software development is intrinsic human-based knowledge-intensive. Due to globalization, software development has become a complex challenge and we usually face barriers related to knowledge management, team building, costly testing processes, especially in distributed settings. For this reason, several approaches have been proposed to minimize barriers caused by geographic distance. In this paper, we present as we use experimental studies to improve our knowledge management process using the Wiki system. According to the results, it was possible to identify learning preferences from our software projects leader team, organize and improve the learning experience of our Wiki and; facilitate collaboration by newcomers to improve Wiki with new contents available in the Wiki.

Keywords: mobile product, knowledge transfer, knowledge management process, wiki, GSD

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Authors: Victor Kang, Sirene Bellahnid, Amy Al-Simaani

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Efficient documentation and completion of clerical tasks are pillars of efficient patient-centered care in acute settings such as the emergency department (ED). Medical scribes aid physicians with documentation, navigation of electronic health records, results gathering, and communication coordination with other healthcare teams. However, the use of medical scribes is not widespread, with some hospitals even continuing to discontinue their programs. One reason for this could be the lack of studies that have outlined concrete improvements in efficiency and patient and provider satisfaction in emergency departments before and after incorporating scribes. Methods: We conducted a review of the literature concerning the implementation of a medical scribe program and emergency department performance. For this review, a narrative synthesis accompanied by textual commentaries was chosen to present the selected papers. PubMed was searched exclusively. Initially, no date limits were set, but seeing as the electronic medical record was officially implemented in Canada in 2013, studies published after this date were preferred as they provided insight into the interplay between its implementation and scribes on quality improvement. Results: Throughput, efficiency, and cost-effectiveness were the most commonly used parameters in evaluating scribes in the Emergency Department. Important throughput metrics, specifically door-to-doctor and disposition time, were significantly decreased in emergency departments that utilized scribes. Of note, this was shown to be the case in community hospitals, where the burden of documentation and clerical tasks would fall directly upon the attending physician. Academic centers differ in that they rely heavily on residents and students; so the implementation of scribes has been shown to have limited effect on these metrics. However, unique to academic centers was the provider’s perception of incrased time for teaching was unique to academic centers. Consequently, providers express increased work satisfaction in relation to time spent with patients and in teaching. Patients, on the other hand, did not demonstrate a decrease in satisfaction in regards to the care that was provided, but there was no significant increase observed either. Of the studies we reviewed, one of the biggest limitations was the lack of significance in the data. While many individual studies reported that medical scribes in emergency rooms improved relative value units, patient satisfaction, provider satisfaction, and increased number of patients seen, there was no statistically significant improvement in the above criteria when compiled in a systematic review. There is also a clear publication bias; very few studies with negative results were published. To prove significance, data from more emergency rooms with scribe programs would need to be compiled which also includes emergency rooms who did not report noticeable benefits. Furthermore, most data sets focused only on scribes in academic centers. Conclusion: Ultimately, the literature suggests that while emergency room physicians who have access to medical scribes report higher satisfaction due to lower clerical burdens and can see more patients per shift, there is still variability in terms of patient and provider satisfaction. Whether or not this variability exists due to differences in training (in-house trainees versus contractors), population profile (adult versus pediatric), setting (academic versus community), or which shifts scribe work cannot be determined based on the studies that exist. Ultimately, more scribe programs need to be evaluated to determine whether these variables affect outcomes and prove whether scribes significantly improve emergency room efficiency.

Keywords: emergency medicine, medical scribe, scribe, documentation

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Authors: Qirat Naz, Abasiokpon Udoakah

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In developed countries, global migration is diversifying. The minority ethnic population, including refugees and asylum seekers who, fled their home countries due to war, terrorism, oppression, or natural disasters, and returning home is dangerous for them. They need sanctuary and peaceful environment in host countries. They begin the process of acculturation, in which a person adopts the social mores and behavioral patterns of the dominant culture, yet they still have unique multicultural needs that the dominant society fails to address. The aim of this research is to provide a holistic understanding of the living experiences of a minority population, particularly migrants, including asylum seekers and refugees, in the health and social care system of South Wales. The purpose of this study is to investigate three research objectives: the multicultural health care needs of minorities, as well as the barriers to seeking health and social care facilities. There are Welsh policies for promoting cultural competence in the health and social care sectors; this research will explore the implications and impact of these policies on the target population. This research study will be conducted using qualitative research methods, tools, and techniques. This research is an inductive approach to coming up with a grounded theory. The sample will be divided into two groups: migrants and professionals providing any kind of services to migrants; each group will contain 30 participants. Interpretive phenomenological analysis would be utilized during the process of coding and developing the main themes of this research. The positionality of the researcher would be minimized by unloaded and open-ended questions, researcher’s work experience in research, continuous evaluation of her positionality, daily base reflection of fieldwork and seeking the help of male and female gatekeepers. The research findings would be based on emic perspective, and by documenting the emic perspective of minorities, this research will contribute to the knowledge of appropriate channels, including organizations, academics, and policymakers, to discover possible solutions and coping mechanisms to deal with the challenges and meet the multicultural demands of minorities. This research will provide a more in-depth understanding of minorities and will help to promote the diversity of health and social care in South Wales.

Keywords: migration, migrants, cultural competence, cultural barriers, healthcare challenges

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