Search results for: difficulty in hospital acceptance

Authors: Sundaresan Soundararajan, George Ezekiel Silvananthan, Chor Ngee Tan

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Introduction: Transforaminal Interbody Fusion (TLIF) has been adopted for many decades now, however, XLIF, still in relative infancy, has grown to be accepted as a new Minimally Invasive Surgery (MIS) option. There is a paucity of reports directly comparing lateral approach surgery to other MIS options such as TLIF in the treatment of lumbar degenerative disc diseases. Aims/Objectives: The objective of this study was to compare the efficacy and clinical outcomes between Minimally Invasive Transforaminal Interbody Fusion (TLIF) and Minimally Invasive Lateral Interbody Fusion (XLIF) in the treatment of patients with degenerative disc disease of the lumbar spine. Methods: A single center, retrospective cohort study involving a total of 38 patients undergoing surgical intervention between 2010 and 2013 for degenerative disc disease of lumbar spine at single L4/L5 level. 18 patients were treated with MIS TLIF, and 20 patients were treated with XLIF. Results: The XLIF group showed shorter duration of surgery compared to the TLIF group (176 mins vs. 208.3 mins, P = 0.03). Length of hospital stay was also significantly shorter in XLIF group (5.9 days vs. 9 days, p = 0.03). Intraoperative blood loss was favouring XLIF as 85% patients had blood loss less than 100cc compared to 58% in the TLIF group (P = 0.03). Radiologically, disc height was significantly improved post operatively in the XLIF group compared to the TLIF group (0.56mm vs. 0.39mm, P = 0.01). Foraminal height increment was also higher in the XLIF group (0.58mm vs. 0.45mm , P = 0.06). Clinically, back pain and leg pain improved in 85% of patients in the XLIF group and 78% in the TLIF group. Post op hip flexion weakness was more common in the XLIF group (40%) than in the TLIF group (0%). However, this weakness resolved within 6 months post operatively. There was one case of dural tear and surgical site infection in the TLIF group respectively and none in the XLIF group. Visual Analog Scale (VAS) score 6 months post operatively showed comparable reduction in both groups. TLIF group had Owsterty Disability Index (ODI) improvement on 67% while XLIF group showed improvement of 70% of its patients. Conclusions: Lateral approach surgery shows comparable clinical outcomes in resolution of back pain and radiculopathy to conventional MIS techniques such as TLIF. With significantly shorter duration of surgical time, minimal blood loss and shorter hospital stay, XLIF seems to be a reasonable MIS option compared to other MIS techniques in treating degenerative lumbar disc diseases.

Keywords: extreme lateral interbody fusion, lateral approach, minimally invasive, XLIF

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Authors: Mosupi Ratshaa

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Despite years of diligent study, sedimentation is still undoubtedly the most severe technical problem faced by the dam industry. The problem of sedimentation build-up and its removal should be the focus as an approach to remedy this. The world's reservoirs lose about 1% of their storage capacity yearly to sedimentation, what this means is that 1% of water that could be stored is lost the world-over. The increase in population means that the need for water also increases and, therefore, the loss due to sedimentation is of great concern especially to the conservation of water. When it comes to reservoir sedimentation, the thought of water conservation comes with soil conservation since this increasing sediment that takes the volume meant for water is being lost from dry land. For this reason, reservoir sediment control is focused on reducing sediment entering the reservoir and reducing sediment within the reservoir. There are many problems with sediment control such as the difficulty to predict settling patterns, inability to greatly reduce the sediment volume entering the river flow which increases the reservoirs trap efficiency just to mention a few. Notably reservoirs are habitats for flora and fauna, the process of removing sediment from these reservoirs damages this ecosystem so there is an ethical point to be considered in this section. This paper looks at the methods used to control the sedimentation of reservoirs and their effects to the ecosystem in the aim of reducing water losses due to sedimentation. Various control measures which reduce sediment entering the reservoir such as Sabo dams or Check dams along with measures which emphasize the reduction in built-up settled sediment such as flushing will be reviewed all with the prospect of conservation.

Keywords: sedimentation, conservation, ecosystem, flushing

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Authors: Zakieh Piri, Shahla Damanabi, Peyman Rezaii Hachesoo

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Introduction: Healthcare organizations like other organizations suffer from a number of disorders such as Business Sponsor Disorder, Business Acceptance Disorder, Cultural/Political Disorder, Data Disorder, etc. As quality in healthcare care mostly depends on the quality of data, we aimed to identify data disorders and its symptoms in two teaching hospitals. Methods: Using a self-constructed questionnaire, we asked 20 questions in related to quality and usability of patient data stored in patient records. Research population consisted of 150 managers, physicians, nurses, medical record staff who were working at the time of study. We also asked their views about the symptoms and treatments for any data disorders they mentioned in the questionnaire. Using qualitative methods we analyzed the answers. Results: After classifying the answers, we found six main data disorders: incomplete data, missed data, late data, blurred data, manipulated data, illegible data. The majority of participants believed in their important roles in treatment of data disorders while others believed in health system problems. Discussion: As clinicians have important roles in producing of data, they can easily identify symptoms and disorders of patient data. Health information managers can also play important roles in early detection of data disorders by proactively monitoring and periodic check-ups of data.

Keywords: data disorders, quality, healthcare, treatment

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Authors: Zhao Jiashen, Serene Goh, Jerry Goo, Anthony Li, Lim Woan Wui, Paul Drakeford, Chen Qing Yan

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Introduction: Emergency laparotomy (EL) is one of the most common surgeries done in Singapore to treat acute abdominal pathologies. A significant proportion of these surgeries are performed in the geriatric population (65 years and older), who tend to have the highest postoperative morbidity, mortality, and highest utilization of intensive care resources. Frailty, the state of vulnerability to adverse outcomes from an accumulation of physiological deficits, has been shown to be associated with poorer outcomes after surgery and remains a strong driver of healthcare utilization and costs. To date, there is little understanding of the impact it has on emergency laparotomy outcomes. The objective of this study is to examine the impact of frailty on postoperative morbidity, mortality, and length of stay after EL. Methods: A retrospective study was conducted in two tertiary centres in Singapore, Tan Tock Seng Hospital and Khoo Teck Puat Hospital the period from January to December 2019. Patients aged 65 years and above who underwent emergency laparotomy for intestinal obstruction, perforated viscus, bowel ischaemia, adhesiolysis, gastrointestinal bleed, or another suspected acute abdomen were included. Laparotomies performed for trauma, cholecystectomy, appendectomy, vascular surgery, and non-GI surgery were excluded. The Clinical Frailty Score (CFS) developed by the Canadian Study of Health and Aging (CSHA) was used. A score of 1 to 4 was defined as non-frail and 5 to 7 as frail. We compared the clinical outcomes of elderly patients in the frail and non-frail groups. Results: There were 233 elderly patients who underwent EL during the study period. Up to 26.2% of patients were frail. Patients who were frail (CFS 5-9) tend to be older, 79 ± 7 vs 79 ± 5 years of age, p <0.01. Gender distribution was equal in both groups. Indication for emergency laparotomies, time from diagnosis to surgery, and presence of consultant surgeons and anaesthetists in the operating theatre were comparable (p>0.05). Patients in the frail group were more likely to receive postoperative geriatric assessment than in the non-frail group, 49.2% vs. 27.9% (p<0.01). The postoperative complications were comparable (p>0.05). The length of stay in the critical care unit was longer for the frail patients, 2 (IQR 1-6.5) versus 1 (IQR 0-4) days, p<0.01. Frailty was found to be an independent predictor of 90-day mortality but not age, OR 2.9 (1.1-7.4), p=0.03. Conclusion: Up to one-fourth of the elderly who underwent EL were frail. Patients who were frail were associated with a longer length of stay in the critical care unit and a 90-day mortality rate of more than three times that of their non-frail counterparts. PPOSSUM was a better predictor of 90-day mortality in the non-frail group than in the frail group. As frailty scoring was a significant predictor of 90-day mortality, its integration into acute surgical units to facilitate shared decision-making and discharge planning should be considered.

Keywords: frailty elderly, emergency, laparotomy

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Authors: Teresa Mili

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The significance of political and economic factors have barely been neglected while assessing bilateral relations, but the significance of culture as a soft power in Japan-Vietnam relations has largely been understated. While the close ties had their birth ever since the 14th century, this paper sets out with an inductive lens to analyze the role of culture as a variable in bilateral relations. Vietnam, which then had a history of war devastation had taken refuge in Japan and later sought inspiration from Japan’s economy with the simultaneous influence of culture since Japan was a developed nation, and Vietnam a third world country. Evidencing facts with illustrations, the paper shows how the twenty-first century has brought a growing bond as well as the onset of stronger ties between the two states based, primarily, on an emerging convergence of interests and culture. The cultural influence of Japan may be seen much in the Vietnamese cities, through evidences like the growing numbers of Japanese items on sale. The variety in cultural influence may be seen through the acceptance of Japanese fashion trends, mange comic, pop music, cuisine, tourism, Japanese studies and language, the translations of Japanese literature which are very much popular at Vietnam. Using secondary sources as well as assessing travel accounts and official websites, this research work will try to find out how much Japanese culture has influenced Vietnam and whether such influences will be strong enough to qualify culture as an intervening variable in the bilateral relations.

Keywords: influence, culture, language, cold war

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Authors: Lur N. Dreier

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Spontaneous transformation in Ursus maritimus is generally considered to be seldom, albeit not, to this author's best knowledge, previously unpublished in the medical literature. However, no case series has to date described transformative spontaneous processes to filios hominum species. Norwegian public hospital system, is, however, especially the grounds of the specific climate in the Northern hemisphere, and because of a high suited to observe such transformations, both on income level. Hence, this paper describes, to our knowledge, the first case series of 25 patients undergoing treatment for spontaneous transformation in four Norwegian hospitals. The methodology was to include patients on a consecutive basis, identifying clinically and laboratory the typology in each of the four hospitals. The major findings were that the archetypes were heterogeneous, with coercive laboratory findings, with a high degree of redundancy of the process. This might potentially lead to many advances in the diagnostics.

Keywords: case series, transformation, hominum species, maritimus species

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Authors: Valerie Isaak

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This study examines the effectiveness of an intervention program aimed at enhancing a unit-level safety climate as a way to minimize the risk of employees being injured by patient violence. The intervention program conducted in maximum security units in one of the psychiatric hospitals in Israel included a three day workshop. Safety climate was examined before and after the implementation of the intervention. We also collected data regarding incidents involving patient violence. Six months after the intervention a significant improvement in employees’ perceptions regarding management’s commitment to safety were found as well as a marginally significant improvement in communication concerning safety issues. Our research shows that an intervention program aimed at enhancing a safety climate is associated with a decrease in the number of aggressive incidents. We conclude that such an intervention program is likely to return the sense of safety and reduce the scope of violence.

Keywords: violence, intervention, safety climate, performance, public sector

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Authors: Belgherbi Aicha, Hadjidj Ismahen, Bessaid Abdelhafid

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The phase of segmentation is an important step in the processing and interpretation of medical images. In this paper, we focus on the segmentation of liver and spleen from the abdomen computed tomography (CT) images. The importance of our study comes from the fact that the segmentation of ROI from CT images is usually a difficult task. This difficulty is the gray’s level of which is similar to the other organ also the ROI are connected to the ribs, heart, kidneys, etc. Our proposed method is based on the anatomical information and mathematical morphology tools used in the image processing field. At first, we try to remove the surrounding and connected organs and tissues by applying morphological filters. This first step makes the extraction of interest regions easier. The second step consists of improving the quality of the image gradient. In this step, we propose a method for improving the image gradient to reduce these deficiencies by applying the spatial filters followed by the morphological filters. Thereafter we proceed to the segmentation of the liver, spleen. To validate the segmentation technique proposed, we have tested it on several images. Our segmentation approach is evaluated by comparing our results with the manual segmentation performed by an expert. The experimental results are described in the last part of this work.The system has been evaluated by computing the sensitivity and specificity between the semi-automatically segmented (liver and spleen) contour and the manually contour traced by radiological experts.

Keywords: CT images, liver and spleen segmentation, anisotropic diffusion filter, morphological filters, watershed algorithm

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Authors: Juliet Sorensen, Megan Schliep

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Introduction: After a multidisciplinary assessment of health and human rights issues in central Mali, a musical album was created in 2014 in Douentza, Mali to provide health information on female genital mutilation/cutting (FGM/C), malaria, HIV/AIDS, girls’ education, breastfeeding, and sanitation. The objective of this study was to assess the impact of this album. Methods: A mixed-methods assessment was conducted with 149 individuals across 10 villages in Douentza Cercle. Analyses focused on the association of radio listening habits, age, sex, ethnicity and education with a public health knowledge score. Results: Over 90% of respondents reported daily radio listening, many listening five or more hours per day. Potential risks of FGM/C cited by participants included death (59%), difficulty in childbirth (48%), sterility (34%), and fistula (33%); when asked about their level of control over FGM/C, 28% stated they would never cut their daughters. Being a listener for 1-5 hours per day was associated with a 11.5% higher score of 'public health knowledge' compared to those listening only a little or not at all (p < 0.01). Education (marginal versus no formal education) was associated with 7.6% increased score (p < 0.01). Conclusion: Radio appears to be a significant part of community members’ daily routines and may be a valuable medium for transmitting information, particularly for lower literacy individuals.

Keywords: female genital cutting, public health and social justice education, radio, Mali

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Authors: Ashish Kumar Pathak, Ritika Sharma, Vishal Nath, Sudhir Pratap Singh, Rakesh Tuli

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Litchi is a sub-tropical fruit crop with genotypes bearing delicious juicy fruits with variable seed size (bold to rudimentary size). Small seed size is a desirable trait in litchi, as it increases consumer acceptance and fruit processing. The biochemical activities in mid- stage ovules (e.g. 16, 20, 24 and 28 days after anthesis) determine the fate of seed and fruit development in litchi. Comprehensive ovule-specific transcriptome analysis was performed in two litchi genotypes with contrasting seed size to gain molecular insight on determinants of seed fates in litchi fruits. The transcriptomic data was de-novo assembled in 1,39,608 trinity transcripts, out of which 6,325 trinity transcripts were differentially expressed between the two contrasting genotypes. Differential transcriptional pattern was found among ovule development stages in contrasting litchi genotypes. The putative genes for salicylic acid, jasmonic acid and brassinosteroid pathway were down-regulated in ovules of small-seeded litchi. Embryogenesis, cell expansion, seed size and stress related trinity transcripts exhibited altered expression in small-seeded genotype. The putative regulators of seed maturation and seed storage were down-regulated in small-seed genotype.

Keywords: Litchi, seed, transcriptome, defence

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Authors: Emmylou Rahtz, Sarah Goldingay, Sara Warber, Ann Arbor, Paul Dieppe

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Introduction: Lourdes is a Catholic, Marian healing venue in South West France. Many miraculous cures have been attributed to visits there. In addition, many visitors seem to experience improvements in health and wellbeing, in the absence of a cure of disease. We wanted to investigate that phenomenon. Methods: We spent 10 days in Lourdes in 2017, carrying out ethnographic research, talking to many visitors, and carrying out formal, recorded interviews with several pilgrims, doctors, nurses, helpers, and priests. Results: Profound experiences and improvements in health and wellbeing were commonly reported. A number of ‘noetic’ experiences were also described. The paper will illustrate these phenomena. In addition, many participants in the research talked about why being in Lourdes was so beneficial to them. The community spirit, ethos of prayer, flow, synchronicity, and ability to find new meaning for life’s ills were cited as likely reasons. Conclusions: We believe that the ‘real miracle’ of Lourdes is the fact that of the many hundreds of thousands of people who go there each year, many find great benefit in health and wellbeing. It is likely that this is due to the ethos of the place, the community spirit, non-judgmental approach and loving acceptance of all aspects of humanity. Acknowledgments: We thank the BIAL foundation for generous funding of this research, and Dr. Alessandro de Franciscis and his team for facilitating our work, as well as all those who participated.

Keywords: healing, miracles, noetic experiences, wellbeing

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Authors: Dejene Ermias Mekango, Mussie Alemayehu, Gebremedhin Berhe Gebregergs, Araya Abrha Medhanye, Gelila Goba

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Background: Maternal near miss (MNM) can be used as a proxy indicator of maternal mortality ratio. There is a huge gap in life time risk between Sub-Saharan Africa and developed countries. In Ethiopia, a significant number of women die each year from complications during pregnancy, childbirth and the post-partum period. Besides, a few studies have been performed on MNM, and little is known regarding determinant factors. This study aims to identify determinants of MNM among women in Tigray region, Northern Ethiopia. Methods: a case-control study in hospital found in Tigray region, Ethiopia was conducted from January 30 - March 30, 2016. The sample included 103 cases and 205 controls recruited from women seeking obstetric care at six public hospitals. Clients having a life-threatening obstetric complication including haemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia or clinical signs of severe anemia in women without haemorrhage were taken as cases and those with normal obstetric outcomes were considered as controls. Cases were selected based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression (odds ratio) analyses were calculated with 95% CI. Results: The largest proportion of cases and controls was among the ages of20–29 years, accounting for37.9 %( 39) of cases and 31.7 %( 65) of controls. Roughly 90% of cases and controls were married. About two-thirds of controls and 45.6 %( 47) of cases had gestational age between 37-41 weeks. History of chronic medical conditions was reported in 55.3 %(57) of cases and 33.2%(68) of controls. Women with no formal education [AOR=3.2;95%CI:1.24, 8.12],being less than 16 years old at first pregnancy [AOR=2.5; 95%CI:1.12,5.63],induced labor[AOR=3; 95%CI:1.44, 6.17], history of Cesarean section (C-section) [AOR=4.6; 95%CI: 1.98, 7.61] or chronic medical disorder[AOR=3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR=2.8;95% CI: 1.19,6.35] all had higher odds of experiencing MNM. Conclusions: The Government of Ethiopia should continue its effort to address the lack of road and health facility access as well as education, which will help reduce MNM. Work should also be continued to educate women and providers about common predictors of MNM like the history of C-section, chronic illness, and teenage pregnancy. These efforts should be carried out at the facility, community, and individual levels. The targeted follow-up to women with a history of chronic disease and C-section could also be a practical way to reduce MNM.

Keywords: maternal near miss, severe obstetric hemorrhage, hypertensive disorder, c-section, Tigray, Ethiopia

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Authors: Ilaria Lucrezia Amerise

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The statistical modelling of precipitation data for a given portion of territory is fundamental for the monitoring of climatic conditions and for Hydrogeological Management Plans (HMP). This modelling is rendered particularly complex by the changes taking place in the frequency and intensity of precipitation, presumably to be attributed to the global climate change. This paper applies the Wakeby distribution (with 5 parameters) as a theoretical reference model. The number and the quality of the parameters indicate that this distribution may be the appropriate choice for the interpolations of the hydrological variables and, moreover, the Wakeby is particularly suitable for describing phenomena producing heavy tails. The proposed estimation methods for determining the value of the Wakeby parameters are the same as those used for density functions with heavy tails. The commonly used procedure is the classic method of moments weighed with probabilities (probability weighted moments, PWM) although this has often shown difficulty of convergence, or rather, convergence to a configuration of inappropriate parameters. In this paper, we analyze the problem of the likelihood estimation of a random variable expressed through its quantile function. The method of maximum likelihood, in this case, is more demanding than in the situations of more usual estimation. The reasons for this lie, in the sampling and asymptotic properties of the estimators of maximum likelihood which improve the estimates obtained with indications of their variability and, therefore, their accuracy and reliability. These features are highly appreciated in contexts where poor decisions, attributable to an inefficient or incomplete information base, can cause serious damages.

Keywords: generalized extreme values, likelihood estimation, precipitation data, Wakeby distribution

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Authors: Zahzouh Zoubir, Bouzaouit Azzeddine, Gahgah Mounir

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The use of more and more electronic power switches with a nonlinear behavior generates non-sinusoidal currents in distribution networks, which causes damage to domestic and industrial equipment. The multi-level shunt power active filter is subsequently shown to be an adequate solution to the problem raised. Nevertheless, the difficulty of adjusting the active filter DC supply voltage requires another technology to ensure it. In this article, a photovoltaic generator is associated with the DC bus power terminals of the active filter. The proposed system consists of a field of solar panels, three multi-level voltage inverters connected to the power grid and a non-linear load consisting of a six-diode rectifier bridge supplying a resistive-inductive load. Current control techniques of active and reactive power are used to compensate for both harmonic currents and reactive power as well as to inject active solar power into the distribution network. An algorithm of the search method of the maximum power point of type Perturb and observe is applied. Simulation results of the system proposed under the MATLAB/Simulink environment shows that the performance of control commands that reassure the solar power injection in the network, harmonic current compensation and power factor correction.

Keywords: Actif power filter, MPPT, pertub&observe algorithm, PV array, PWM-control

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Authors: Yoon- Ho Shin, Jin-Seung Choi, Dong-Won Kang, Jeong-Woo Seo, Joo-Hack Lee, Ju-Young Kim, Dae-Hyeok Kim, Seung-Tae Yang, Gye-Rae Tack

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It is difficult to study the effect of various variables on cycle fitting through actual experiment. To overcome such difficulty, the forward dynamics of a musculoskeletal model was applied to cycle fitting in this study. The measured EMG data were compared with the muscle activities of the musculoskeletal model through forward dynamics. EMG data were measured from five cyclists who do not have musculoskeletal diseases during three minutes pedaling with a constant load (150 W) and cadence (90 RPM). The muscles used for the analysis were the Vastus Lateralis (VL), Tibialis Anterior (TA), Bicep Femoris (BF), and Gastrocnemius Medial (GM). Person’s correlation coefficients of the muscle activity patterns, the peak timing of the maximum muscle activities, and the total muscle activities were calculated and compared. BIKE3D model of AnyBody (Anybodytech, Denmark) was used for the musculoskeletal model simulation. The comparisons of the actual experiments with the simulation results showed significant correlations in the muscle activity patterns (VL: 0.789, TA: 0.503, BF: 0.468, GM: 0.670). The peak timings of the maximum muscle activities were distributed at particular phases. The total muscle activities were compared with the normalized muscle activities, and the comparison showed about 10% difference in the VL (+10%), TA (+9.7%), and BF (+10%), excluding the GM (+29.4%). Thus, it can be concluded that muscle activities of model & experiment showed similar results. The results of this study indicated that it was possible to apply the simulation of further improved musculoskeletal model to cycle fitting.

Keywords: musculoskeletal modeling, EMG, cycle fitting, simulation

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Authors: Mananya Meenakorn

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This research aims to investigate: (1) Relationship between the quality of working life and organizational commitment of municipal employee in Samut Sakhon Province. (2) To compare the quality of working life and the organizational commitment of municipal employee in Samut Sakhon Province by the gender, age, education, official experience, position, division, and income. This study is a quantitative research; data was collected by questionnaires distributed to the municipal employee in Samut Sakhon province for 241 sample by stratified random sampling. Data was analyzed by descriptive statistic including percentage, mean, standard deviation and inferential statistic including t-test, F-test and Pearson correlation for hypothesis testing. Finding showed that the quality of working life and the organizational commitment of municipal Employee in Samut Sakhon province in terms of compensation and fair has a positive correlation (r = 0.673) and the comparison of the quality of working life and organizational commitment of municipal employees in Samut Sakhon province by gender. We found that the overall difference was statistically significant at the 0.05 level and we also found stability and progress in career path and the characteristics are beneficial to society has a difference was statistically significant at the 0.01 level, and the participation and social acceptance has a difference was statistically significant at the 0.05 level.

Keywords: quality of working life, organizational commitment, municipal employee, Samut Sakhon province

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Authors: Khodi Morgan, Kasey Crowe, Amanda Morgan

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Canadian High School Students' Attitudes & Objective: To survey Canadian high school students regarding their attitudes and perspectives towards people with disabilities and explore how age, gender, and personal experience with a disability may impact these views. Methods: A survey was developed using the standardized Attitude Toward Persons With Disability Scale as its base, with the addition of questions specifically about Autism and Attention Deficit Hyperactivity Disorder (ADHD). The survey also gathered information about the participant’s age and gender and whether or not they, or a close family member, had any disabilities. Participants were recruited at a public Canadian high school by fellow student researchers. Results: A total of 219 (N=219) students ranging from 13 - 19 years old participated in the study (m= 15.9 years of age). Gender was equally split, with 44% male, 42% female and 14% undeclared. Experience with a disability was common amongst participants, with 25% self-identifying as having a personal disability and 48% claiming to have a close family member with a disability. Exploratory trends indicated that females, people with self-identified disabilities, and people with close family members with disabilities trended towards having more positive attitudes toward persons with disabilities.

Keywords: disability, autism, ADHD, high school, adolescence, community research, acceptance

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Authors: Mulugeta Gurum Gerechal

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Nowadays, the photocatalytic mechanism of water purification using nanoparticles has gained wider acceptance. For this purpose, the Crystal form of N- TiO₂ and Ag-TiO₂ was prepared from TiCl₄, Urea, NH₄OH and AgNO₃ by sol-gel method and simple solid phase reaction followed by calcination at a temperature of 400 °C for 4h at each. The synthesized photocatalysts were characterized using XRD, SEM and UV-visible diffuse reflectance spectra. In the experiment, it was found that the absorption edge of N-TiO₂ was a well efficient shift to visible light as compared to Ag-TiO₂. The XRD diffraction makes the particle size of N-TiO₂ smaller than Ag-TiO₂. The effect of catalyst loading and the effect of temperature on the photocatalytic efficiency of the prepared samples was tested using methylene blue as a target pollutant. The photocatalytic degradation efficiency of the catalysts for methylene blue was increased from 57.05 to 96.02% under solar radiation as the amount of the catalyst increased from 0.15 to 0.45 gram for N-TiO₂. Similarly, photocatalytic degradation of methylene blue was increased from 40.32 to 81.21% as the amount of Ag-TiO₂ increased from 0.05g to 0.1g. In addition, the photocatalytic degradation efficiency of the catalysts for the removal of methylene blue was increased from 58.00 to 98.00 and 47.00 to 81.21 % under solar radiation as the calcination temperature of the catalyst increased from 300 to 500 for N-TiO₂ for Ag-TiO₂ 300 to 4000C. However, a further increase in catalyst loading and calcination temperature was found to decrease the degradation efficiency.

Keywords: photocatalysis, degradation, nanoparticles, catalyst loading, calcination and methylene blue

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Authors: Hsiao-Lin Fang

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Every life is precious, and comprehensive care should be provided to individuals who are in the final stages of their lives. Hospice-shared care aims to provide optimal symptom control and palliative care to terminal (cancer) patients through the implementation of shared care, and to support patients and their families in making various physical and psychological adjustments in the face of death. This report examines a 10-year-boy diagnosed with Out-of-Hospital Cardiac Arrest (OHCA). The individual fainted when swimming at school and underwent 31 minutes of cardiopulmonary resuscitation (CPR). While receiving treatment at the hospital, the individual received extracorporeal membrane oxygenation(ECMO) due to unstable hemodynamics. Urgent cardiac catheterization found: Suspect acute fulminant myocarditis or underlying cardiomyopathy with acute decompensation, After the active rescue by the medical team, hemodynamics still showed only mean pressure value. With respect to the patient, interdepartmental hospice-shared care was implemented and a do-not-resuscitate (DNR) order was signed after family discussions were conducted. Assistance and instructions were provided as part of the comfort care process. A farewell gathering attended by the patient’s relatives, friends, teachers, and classmates was organized in an intensive care unit (ICU) in order to look back on the patient’s life and the beautiful memories that were created, as well as to alleviate the sorrow felt by family members, including the patient’s father and sister. For example, the patient was presented with drawings and accompanied to a garden to pick flowers. In this manner, the patient was able to say goodbye before death. Finally, the patient’s grandmother and father participated in the clinical hospice care and post-mortem care processes. A hospice-shared care clinician conducted regular follow-ups and provided care to the family of the deceased, supporting family members through the sorrowful period. Birth, old age, sickness, and death are the natural phases of human life. In recent years, growing attention has been paid to human-centered hospice care. Hospice care is individual holistic care provided by a professional team and it involves the provision of comprehensive care to a terminal patient. Hospice care aims to satisfy the physical, psychological, mental, and social needs of patients and their families. It does not involve the cessation of treatment but rather avoids the exacerbation or extension of the suffering endured by patients, thereby preserving the dignity and quality of life during the end-of-life period. Patients enjoy the company of others as they complete the last phase of their lives, and their families also receive guidance on how they can move on with their own lives after the patient’s death.

Keywords: hospice-shared care, extracorporeal membrane oxygenation (ECMO), hospice-shared care, child patient

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Authors: Hanlin Liu, Hua Li, Yintan AI

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Network performance prediction (NPP) is essential for the management and optimization of software-defined networking (SDN) and contributes to improving the quality of service (QoS) in SDN to meet the requirements of users. Although current deep learning-based methods can achieve high effectiveness, they still suffer from some problems, such as difficulty in capturing global information of the network, inefficiency in modeling end-to-end network performance, and inadequate graph feature extraction. To cope with these issues, our proposed Graphormer-based architecture for NPP leverages the powerful graph representation ability of Graphormer to effectively model the graph structure data, and a node-edge transformation algorithm is designed to transfer the feature extraction object from nodes to edges, thereby effectively extracting the end-to-end performance characteristics of the network. Moreover, routing oriented centrality measure coefficient for nodes and edges is proposed respectively to assess their importance and influence within the graph. Based on this coefficient, an enhanced feature extraction method and an advanced centrality encoding strategy are derived to fully extract the structural information of the graph. Experimental results on three public datasets demonstrate that the proposed GraphNPP architecture can achieve state-of-the-art results compared to current NPP methods.

Keywords: software-defined networking, network performance prediction, Graphormer, graph neural network

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Authors: Dessy Arumsari, Ais Assana Athqiya, Mulyaminingrum

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

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

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Authors: Kirsten Hoeper, Maike Kriependorf

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

Keywords: hospital, OR, professional bureaucracies, target systems

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Authors: M. Khazam, M. Altawil, A. Eljabri

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Fluid properties in states near a vapor-liquid critical region are the most difficult to measure and to predict with EoS models. The principal model difficulty is that near-critical property variations do not follow the same mathematics as at conditions far away from the critical region. Libyan NC98 field in Sirte basin is a typical example of near critical fluid characterized by high initial condensate gas ratio (CGR) greater than 160 bbl/MMscf and maximum liquid drop-out of 25%. The objective of this paper is to model NC98 phase behavior with the proper selection of EoS parameters and also to model reservoir depletion versus gas cycling option using measured PVT data and EoS Models. The outcomes of our study revealed that, for accurate gas and condensate recovery forecast during depletion, the most important PVT data to match are the gas phase Z-factor and C7+ fraction as functions of pressure. Reasonable match, within -3% error, was achieved for ultimate condensate recovery at abandonment pressure of 1500 psia. The smooth transition from gas-condensate to volatile oil was fairly simulated by the tuned PR-EoS. The predicted GOC was approximately at 14,380 ftss. The optimum gas cycling scheme, in order to maximize condensate recovery, should not be performed at pressures less than 5700 psia. The contribution of condensate vaporization for such field is marginal, within 8% to 14%, compared to gas-gas miscible displacement. Therefore, it is always recommended, if gas recycle scheme to be considered for this field, to start it at the early stage of field development.

Keywords: EoS models, gas-condensate, gas cycling, near critical fluid

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Authors: Abdelkarim M. Ertiame, D. W. Yu, D. L. Yu, J. B. Gomm

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In this paper, a new robust fault detection and isolation (FDI) scheme is developed to monitor a multivariable nonlinear chemical process called the Chylla-Haase polymerization reactor when it is under the cascade PI control. The scheme employs a radial basis function neural network (RBFNN) in an independent mode to model the process dynamics and using the weighted sum-squared prediction error as the residual. The recursive orthogonal Least Squares algorithm (ROLS) is employed to train the model to overcome the training difficulty of the independent mode of the network. Then, another RBFNN is used as a fault classifier to isolate faults from different features involved in the residual vector. The several actuator and sensor faults are simulated in a nonlinear simulation of the reactor in Simulink. The scheme is used to detect and isolate the faults on-line. The simulation results show the effectiveness of the scheme even the process is subjected to disturbances and uncertainties including significant changes in the monomer feed rate, fouling factor, impurity factor, ambient temperature and measurement noise. The simulation results are presented to illustrate the effectiveness and robustness of the proposed method.

Keywords: Robust fault detection, cascade control, independent RBF model, RBF neural networks, Chylla-Haase reactor, FDI under closed-loop control

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Authors: Sukaina Al-Nasrawi, Maysoun Ibrahim

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Information and communication technologies (ICT) have affected recent public administration and governance. Electronic Government (e-government) services were developed to simplify government procedures and improve interaction with citizens on one hand and to create new governance models to empower citizens and involve them in the decision-making process while increasing transparency on another hand. It is worth noting that efficient governance models enable sustainable development at the social and economic levels. Currently, the status of e-government national strategies and implementation programs vary from one country to another. This variance in the development levels of e-government initiatives and applications noted the digital divide between countries of the same region, thereby highlighting the difficulty to reach regional integration. Many Arab countries realized the need for a well-articulated e-government strategy and launched national e-government initiatives. In selected Arab countries, the focus of e-government initiatives and programs shifted from the provision of services to advanced concepts such as open data initiatives. This paper aims at over viewing the e-government achievements of Arab countries and areas for enhancement, and share best practices in the area.of the best e-government programmes from the Arab region the world. It will also shed the light on the impact of the information society in general and e-government, in specific, on the social and economic development in the Arab region.

Keywords: Information and Communication Technologies (ICT), services, e-government, development, Arab region, digital divide, citizens

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

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

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

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

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

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

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Authors: Lama Bendak

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Parents and teachers face major problems dealing with attention deficit hyperactivity students. One solution is by changing the school to a less restrictive one or leaving school for good. The purpose of this study is to highlight the importance and role of individual educational plans (IEP) in helping cycle one ages six to nine attention deficit hyperactivity disorder (ADHD) students on the behavioral level. We have adopted the qualitative approach experimental where the total number of the students in our field of study was 66 from four schools. We have limited our study to cycle one students; that is grades 1, 2 and 3, whose ages range from 5.5 to 8.5. We divided the students into two groups where the controlled group was 36 students, and the experimental group was 30 students. The measuring instrument or tool that we used in our study is The SNAP-IV Teacher and Parents Rating Scale and was filled by class teachers. We did the pretest during the first trimester of the school year. Then we applied the Individual Educational Plans IEP's for two trimesters. Then we did the posttest and submitted the results for analysis, where we used the ANCOVA. The results of this study showed that the IEP's efficacy in helping ADHD students on the behavioral aspect showed statistical differences and varied depending on the initial level of difficulty of the student.

Keywords: attention deficit hyperactivity disorder, individual educational plans, behavioral charts, SNAP-IV teacher and parents rating scale

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Authors: Majed Alobudi

Abstract:

Edward Said is considered among the most prominent figures in postcolonial theoretical studies and his work has largely influenced critical discussion for many decades. And in the globalized world of today where immigration and dislocation are intense and thoroughly discussed, Said`s views on these issues seem more relevant than ever. This paper will endeavor to bring together Said`s theoretical texts and other writings on immigration and exile in parallel. The aim is to try to find a better understanding of Said`s theories on dislocation and exile theoretically and personally. The combination of these two strands of narrative will eventually shed more light on self location in postcolonial theories and further the understanding of Said's theories and personal life narratives. The paper propose the difficulty dislocation poses in counter colonial narratives such as those written by Said. As an exile, the mission of defining the self and the other becomes obscure when place becomes impossible or prohibited. The clear result becomes a self which proclaims rather than inhabits reality, a treat Said criticized in colonial representation. The self becomes trapped between the worlds of distant reality of dislocation and the estranged world of exile. The outcome would reveal a more weakened attempt at defining the self and countering the postcolonial narrative. The reason for such confusion and contradiction is directly connected to place and dis-location. To summarize, the paper proposes to examine and investigate the implications exile and dislocation have inflected on Said as a prominent postcolonial figure and how that affects his theories and personal life. The outcome, it is argued, would be a vast and lasting effect which such colonial and postcolonial phenomenon have on personal and theoretical narratives written by Said.

Keywords: Edward Said, exile, postcolonialism, dislocation

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Authors: Ana Nascimento

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For several reasons and in different countries worldwide, there is an increasing difficulty of the States to finance higher education. However, most societies consider education as a public good, so it should be a State obligation to provide this service to citizens. In Portugal, over the last decades, state has diminished its contribution to public higher education and the public higher education institutions started to look for alternative incoming sources, namely charging student’s taxes and fees, provision of services to companies, production of applied research, search for sponsors, configuring new forms of fundraising. This financial policy can raise some concerns to the scientific and pedagogical autonomy of these institutions as well as concerns in access and equity in higher education. For these reasons and in the scope of a PhD research in the area of Economy of Education, a survey is taking place in all public higher education institutions in the Great Lisbon area that intends to analyze and discuss the policy measures in each institution in the search for external financing. The research aims to understand what these measures are and what implications they might have in the institution’s autonomy as well as in higher education access by students from less favored backgrounds. The research uses a qualitative approach, namely through semi-structured interviews to presidents, directors and rectors of each institution, totalizing 50 interviews. In this paper are discussed some of the results from the interviews made so far that present the subjects opinion about higher education finance, the right to education, the search for fundraising and the possible consequences to the institution’s autonomy as well as some literature on the state of the art.

Keywords: autonomy, finance, higher education, public goods

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