Search results for: evaluating effects of health and physical maintenance
Commenced in January 2007
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Edition: International
Paper Count: 23522

Search results for: evaluating effects of health and physical maintenance

5582 Comparative Study Between Two Different Techniques for Postoperative Analgesia in Cesarean Section Delivery

Authors: Nermeen Elbeltagy, Sara Hassan, Tamer Hosny, Mostafa Abdelaziz

Abstract:

Introduction: Adequate postoperative analgesia after caesarean section (CS) is crucial as it impacts the distinct surgical recovery needs of the parturient. Over recent years, there has been increased interest in regional nerve block techniques with promising results on efficacy. These techniques reduce the need for additional analgesia, thereby lowering the incidence of drug-related side effects. As postoperative pain after cesarean is mainly due to abdominal incision, the transverses abdomenis plane ( TAP ) block is a relatively new abdominal nerve block with excellent efficacy after different abdominal surgeries, including cesarean section. Objective: The main objective is to compare ultrasound-guided TAP block provided by the anesthesiologist with TAP provided by the surgeon through a caesarean incision regarding the duration of postoperative analgesia, intensity of analgesia, timing of mobilization, and easiness of the procedure. Method: Ninety pregnant females at term who were scheduled for delivery by elective cesarean section were randomly distributed into two groups. The first group (45) received spinal anesthesia and postoperative ultrasound guided TAP block using 20ml on each side of 0.25% bupivacaine which was provided by the anesthesiologist. The second group (45) received spinal anesthesia plus a TAP block using 20ml on each side of 0.25% bupivacaine, which was provided by the surgeon through the cesarean incision. Visual Analogue Scale (VAS) was used for the comparison between the two groups. Results: VAS score after four hours was higher among the TAP block group provided by the surgeon through the surgical incision than the postoperative analgesic profile using ultrasound-guided TAP block provided by the anesthesiologist (P=0.011). On the contrary, there was no statistical difference in the patient’s dose of analgesia after four hours of the TAP block (P=0.228). Conclusion: TAP block provided through the surgical incision is safe and enhances early patient’s mobilization.

Keywords: TAP block, CS, VAS, analgesia

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5581 Congenital Sublingual Dermoid Cyst with Cutaneous Fistula

Authors: Rafael Ricieri, Rogerio Barros, Francisco Clovis

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Objective– The Objective of this is study is to report a rare case of dermoid cyst, with a sublingual location and cutaneous fistula in a 4 year-old child.Methods: This study is a case report. The main study instrument was the medical record and the radiological and intraoperative image bank. Results: Infants with congenital cervical lesions eventually need tomography for diagnostic elucidation, and health services should be structured to perform sedation and thin tomographic sections in order to reduce morbidity.

Keywords: congenital, sublingual dermoid cyst, fistula, pediatric surgery, head and kneck surgery

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5580 Parameter Fitting of the Discrete Element Method When Modeling the DISAMATIC Process

Authors: E. Hovad, J. H. Walther, P. Larsen, J. Thorborg, J. H. Hattel

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In sand casting of metal parts for the automotive industry such as brake disks and engine blocks, the molten metal is poured into a sand mold to get its final shape. The DISAMATIC molding process is a way to construct these sand molds for casting of steel parts and in the present work numerical simulations of this process are presented. During the process green sand is blown into a chamber and subsequently squeezed to finally obtain the sand mould. The sand flow is modelled with the Discrete Element method (DEM) and obtaining the correct material parameters for the simulation is the main goal. Different tests will be used to find or calibrate the DEM parameters needed; Poisson ratio, Young modulus, rolling friction coefficient, sliding friction coefficient and coefficient of restitution (COR). The Young modulus and Poisson ratio are found from compression tests of the bulk material and subsequently used in the DEM model according to the Hertz-Mindlin model. The main focus will be on calibrating the rolling resistance and sliding friction in the DEM model with respect to the behavior of “real” sand piles. More specifically, the surface profile of the “real” sand pile will be compared to the sand pile predicted with the DEM for different values of the rolling and sliding friction coefficients. When the DEM parameters are found for the particle-particle (sand-sand) interaction, the particle-wall interaction parameter values are also found. Here the sliding coefficient will be found from experiments and the rolling resistance is investigated by comparing with observations of how the green sand interacts with the chamber wall during experiments and the DEM simulations will be calibrated accordingly. The coefficient of restitution will be tested with different values in the DEM simulations and compared to video footages of the DISAMATIC process. Energy dissipation will be investigated in these simulations for different particle sizes and coefficient of restitution, where scaling laws will be considered to relate the energy dissipation for these parameters. Finally, the found parameter values are used in the overall discrete element model and compared to the video footage of the DISAMATIC process.

Keywords: discrete element method, physical properties of materials, calibration, granular flow

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5579 Effects of Zinc and Vitamin A Supplementation on Prognostic Markers and Treatment Outcomes of Adults with Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis

Authors: Fasil Wagnew, Kefyalew Addis Alene, Setegn Eshetie, Tom Wingfield, Matthew Kelly, Darren Gray

Abstract:

Introduction: Undernutrition is a major and under-appreciated risk factor for TB, which is estimated to be responsible for 1.9 million TB cases per year globally. The effectiveness of micronutrient supplementation on TB treatment outcomes and its prognostic markers such as sputum conversion and serum zinc, retinol, and hemoglobin levels has been poorly understood. This systematic review and meta-analysis aimed to determine the association between zinc and vitamin A supplementation and TB treatment outcomes and its prognostic markers. Methods: A systematic literature search for randomized controlled trials (RCTs) was performed in PubMed, Embase, and Scopus databases. Meta-analysis with a random effect model was performed to estimate risk ratio (RR) and mean difference (MD), with a 95% confidence interval (CI), for dichotomous and continuous outcomes, respectively. Results: Our search identified 2,195 records. Of these, nine RCTs consisting of 1,375 participants were included in the final analyses. Among adults with pulmonary TB, zinc (RR: 0.94, 95%CI: 0.86, 1.03), vitamin A (RR: 0.90, 95%CI: 0.80, 1.01), and combined zinc and vitamin A (RR: 0.98, 95%CI: 0.89, 1.08) supplementation were not significantly associated with TB treatment success. Combined zinc and vitamin A supplementation was significantly associated with increased sputum smear conversion at 2 months (RR: 1.16, 95%CI: 1.03, 1.32), serum zinc levels at 2 months (MD of 0.86umol/l, 95% CI: 0.14, 1.57), serum retinol levels at 2 months (MD: 0.06umol/l, 95 % CI: 0.04, 0.08) and 6 months (MD: 0.12umol/l, 95 % CI: 0.10, 0.14), and serum hemoglobin level at 6 months (MD: 0.29 ug/dl, 95% CI: 0.08 to 0.51), among adults with TB. Conclusions: Providing zinc and vitamin A supplementation to adults with pulmonary TB during treatment may increase early sputum smear conversion, serum zinc, retinol, and hemoglobin levels. However, the use of zinc, vitamin A, or both were not associated with TB treatment success.

Keywords: zinc and vitamin A supplementation, tuberculosis, treatment outcomes, meta-analysis, RCT

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5578 Systematic Review and Meta-Analysis of Mid-Term Survival, and Recurrent Mitral Regurgitation for Robotic-Assisted Mitral Valve Repair

Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

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5577 The Role of Transport Investment and Enhanced Railway Accessibility in Regional Efficiency Improvement in Saudi Arabia: Data Envelopment Analysis

Authors: Saleh Alotaibi, Mohammed Quddus, Craig Morton, Jobair Bin Alam

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This paper explores the role of large-scale investment in transport sectors and the impact of increased railway accessibility on the efficiency of the regional economic productivity in the Kingdom of Saudi Arabia (KSA). There are considerable differences among the KSA regions in terms of their levels of investment and productivity due to their geographical scale and location, which in turn greatly affect their relative efficiency. The study used a non-parametric linear programming technique - Data Envelopment Analysis (DEA) - to measure the regional efficiency change over time and determine the drivers of inefficiency and their scope of improvement. In addition, Window DEA analysis is carried out to compare the efficiency performance change for various time periods. Malmquist index (MI) is also analyzed to identify the sources of productivity change between two subsequent years. The analysis involves spatial and temporal panel data collected from 1999 to 2018 for the 13 regions of the country. Outcomes reveal that transport investment and improved railway accessibility, in general, have significantly contributed to regional economic development. Moreover, the endowment of the new railway stations has spill-over effects. The DEA Window analysis confirmed the dynamic improvement in the average regional efficiency over the study periods. MI showed that the technical efficiency change was the main source of regional productivity improvement. However, there is evidence of investment allocation discrepancy among regions which could limit the achievement of development goals in the long term. These relevant findings will assist the Saudi government in developing better strategic decisions for future transport investments and their allocation at the regional level.

Keywords: data envelopment analysis, transport investment, railway accessibility, efficiency

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5576 Curcumin Derivatives as Potent Inhibitors of Inducible Nitric Oxide Synthase in Osteoarthritis: A Molecular Docking Study

Authors: F. Ambreen, A.Naheed

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Osteoarthritis (OA) is a degenerative disorder affecting millions of people worldwide. Nitric oxide (NO) was found to play a catabolic role in the development of osteoarthritis. It is a toxic free radical gas generated during the metabolism of L-arginine by the enzyme Nitric oxide synthase (NOS). Inducible Nitric Oxide Synthase (iNOS) is one of the isoform of NOS, and its overexpression leads to the excessive formation of NO that results in pathophysiological joint conditions. Several synthetic anti-inflammatory drugs and inhibitors are present to date, but all showed side effects and complications. Therefore, the pursuit of natural disease-modifying drugs remains a top priority. Curcumin is an active component of turmeric, and the past few decades have witnessed intense research devoted to the antioxidant and anti-inflammatory properties of curcumin. The present study focused on curcumin and its derivatives in the search for new iNOS inhibitors for the treatment of osteoarthritis. We conducted a molecular docking study on curcumin and its four derivatives; cyclocurcumin, tetrahydrocurcumin, demethoxycurcumin and curcumin monoglucoside with iNOS using CLC Drug discovery work bench 3.02. We selected two co-crystallized ligands for this study; tetrahydrobiopterin and N-omega-propyl-L-arginine present in complex with the enzyme iNOS. Results showed the best binding affinity of N-omega-propyl-L-arginine with cyclocurcumin and curcumin monoglucoside that exhibit binding energies of -65.2 kcal/mol and -68 kcal/mol respectively. Whereas with tetrahydrobiopterin, best binding scores of -64.7 kcal/mol and -62.2 kcal/mol were found with tetrahydrocurcumin and demethoxycurcumin respectively. This information could open doors of research for the designing of novel drugs using herbs such as curcumin for the treatment of inflammatory joint diseases.

Keywords: curcumin, iNOS, molecular docking, osteoarthritis

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5575 Theoretical Evaluation of Minimum Superheat, Energy and Exergy in a High-Temperature Heat Pump System Operating with Low GWP Refrigerants

Authors: Adam Y. Sulaiman, Donal F. Cotter, Ming J. Huang, Neil J. Hewitt

Abstract:

Suitable low global warming potential (GWP) refrigerants that conform to F-gas regulations are required to extend the operational envelope of high-temperature heat pumps (HTHPs) used for industrial waste heat recovery processes. The thermophysical properties and characteristics of these working fluids need to be assessed to provide a comprehensive understanding of operational effectiveness in HTHP applications. This paper presents the results of a theoretical simulation to investigate a range of low-GWP refrigerants and their suitability to supersede refrigerants HFC-245fa and HFC-365mfc. A steady-state thermodynamic model of a single-stage HTHP with an internal heat exchanger (IHX) was developed to assess system cycle characteristics at temperature ranges between 50 to 80 °C heat source and 90 to 150 °C heat sink. A practical approach to maximize the operational efficiency was examined to determine the effects of regulating minimum superheat within the process and subsequent influence on energetic and exergetic efficiencies. A comprehensive map of minimum superheat across the HTHP operating variables were used to assess specific tipping points in performance at 30 and 70 K temperature lifts. Based on initial results, the refrigerants HCFO-1233zd(E) and HFO-1336mzz(Z) were found to be closely aligned matches for refrigerants HFC-245fa and HFC-365mfc. The overall results show effective performance for HCFO-1233zd(E) occurs between 5-7 K minimum superheat, and HFO-1336mzz(Z) between 18-21 K dependant on temperature lift. This work provides a method to optimize refrigerant selection based on operational indicators to maximize overall HTHPs system performance.

Keywords: high-temperature heat pump, minimum superheat, energy & exergy efficiency, low GWP refrigerants

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5574 Nursing Education in Estonia During the Years of Occupation: Paternalism and Ideology

Authors: Merle Talvik, Taimi Tulva, Kristi Puusepp, Ülle Ernits

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Background data. In 1940–1941 and 1945–1991 Estonia was occupied by Soviet Union. Paternalism was a common principle in Soviet social policy, including health care. The Soviet government, not the individuals themselves, decided on achieving a person’s quality of life. With the help of Soviet ideology, the work culture of nurses was constructed and the education system was also reshaped according to the ideology. The “new period of awakening” was initiated under Gorbachev’s perestroika and glasnost (1985–1991), leading to democratization. Aim. The qualitative study aimed to analyze nursing education in Soviet Estonia in the conditions of paternalistic orientation and ideological pressure. Method. The research was conducted in 2021 and 2023. Senior nurses (aged 69–87) who had worked for at least 20 years during the Soviet era were surveyed. Thematic interviews were conducted in written form and orally (13 interviewees), followed by a focus group interview (8 interviewees). A thematic content analysis was performed. Results. Nursing is part of society’s culture and in this sense, in - terviews with nurses provide us with critical information about the functioning of society and cultural identity at a given time. During the Soviet era the training of nurses occured within vocational training institutions. The curricula underwent a shift towards a Soviet-oriented approach. A significant portion of lessons were dedicated to imparting knowledge on the principles and tenets of Communist-Marxist ideology. Therefore, practical subjects and nursing theory were frequently allocated limited space. A paternalistic orientation prevailed in health care: just as the state regulated how to cure, spread hygiene, and healthy lifestyles propaganda, training was also determined by the management of the institution, thereby limiting the person´s autonomy to decide what kind of training was needed. The research is of significant value in the context of the history of nursing, as it helps to understand the difficulties and complexity of the development of nursing on the timeline. The Soviet era still affects Estonian society today and will continue to do so in the future. The same type of developments occurred in other post-Soviet countries.

Keywords: Estonian SSR, nursing education, paternalism, senior nurse, Soviet ideology

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5573 Preventable Stress and Trauma, and Menstrual Health Management: Experiences of Adolescent Girls from India

Authors: Daisy Dutta, Chhanda Chakraborti

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Background and significance of the study: Menstrual Hygiene Management (MHM) is poor in many Lower and Middle-Income Countries (LMIC) such as India. Poor and inadequate menstrual hygiene has an adverse effect on the health and social life of adolescent girls and women. There are many well-known barriers to adequate Menstrual Hygiene Management (MHM); e.g., lack of awareness, lack of WASH (Water, Sanitation and Hygiene) facilities, lack of affordable menstrual absorbents, etc. But, there is a unique barrier which is very much avoidable; i.e., lack of proper guidance and counseling about menstruation. Menstruation is associated with various social and cultural restrictions and taboos and being a taboo topic; often there is no discussion in the society on this topic. Thus, many adolescent girls encounter the menarche with a lot of unnecessary and avoidable trauma, stress and awkwardness. This trauma, stress, and anxiety are even more prevalent among adolescent girls residing in rural areas. This study argues that this unnecessary stress and anxiety of the adolescent girls can be alleviated by reinforcing social support and adequate information and guidance about MHM and eliminating the futile socio-cultural restrictions during menstruation. Methodology: A qualitative study was conducted in a North-eastern State of India where 45 adolescent girls were interviewed both from rural and urban areas. The adolescent girls were asked about their experiences of stress and anxiety on their first menstruation, their preparedness for menarche, their source of information and guidance, their hygiene-practices, and the various restrictions they follow. Findings: Maximum number of girls did not receive any information about menstruation before menarche. Most of them reported that they were terrified about their first menstruation as they were unprepared. Among those who were aware before menarche, reported that they did not receive proper guidance to manage their menstruation in a hygienic manner. Hygiene-related practices are also influenced by their knowledge about MHM. In maximum cases, girls are bound to follow certain cultural and religious restrictions even if they don’t want to follow which created additional stress in managing their menstruation with dignity. Conclusion: Lack of proper guidance and counseling about menstruation and MHM along with an array of socio-cultural restrictions can enhance a negative attitude in adolescent girls towards menstruation due to which they have to go through an extra and unnecessary burden of stress and trauma. This stress and trauma is preventable by improving the provisions of proper guidance and counseling about menstruation in a supportive environment.

Keywords: adolescent girls, menstrual hygiene management, socio-cultural restrictions, stress, trauma

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5572 Emergence of Fluoroquinolone Resistance in Pigs, Nigeria

Authors: Igbakura I. Luga, Alex A. Adikwu

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A comparison of resistance to quinolones was carried out on isolates of Shiga toxin-producing Escherichia coliO157:H7 from cattle and mecA and nuc genes harbouring Staphylococcus aureus from pigs. The isolates were separately tested in the first and current decades of the 21st century. The objective was to demonstrate the dissemination of resistance to this frontline class of antibiotic by bacteria from food animals and bring to the limelight the spread of antibiotic resistance in Nigeria. A total of 10 isolates of the E. coli O157:H7 and 9 of mecA and nuc genes harbouring S. aureus were obtained following isolation, biochemical testing, and serological identification using the Remel Wellcolex E. coli O157:H7 test. Shiga toxin-production screening in the E. coli O157:H7 using the verotoxin E. coli reverse passive latex agglutination (VTEC-RPLA) test; and molecular identification of the mecA and nuc genes in S. aureus. Detection of the mecA and nuc genes were carried out using the protocol by the Danish Technical University (DTU) using the following primers mecA-1:5'-GGGATCATAGCGTCATTATTC-3', mecA-2: 5'-AACGATTGTGACACGATAGCC-3', nuc-1: 5'-TCAGCAAATGCATCACAAACAG-3', nuc-2: 5'-CGTAAATGCACTTGCTTCAGG-3' for the mecA and nuc genes, respectively. The nuc genes confirm the S. aureus isolates and the mecA genes as being methicillin-resistant and so pathogenic to man. The fluoroquinolones used in the antibiotic resistance testing were norfloxacin (10 µg) and ciprofloxacin (5 µg) in the E. coli O157:H7 isolates and ciprofloxacin (5 µg) in the S. aureus isolates. Susceptibility was tested using the disk diffusion method on Muller-Hinton agar. Fluoroquinolone resistance was not detected from isolates of E. coli O157:H7 from cattle. However, 44% (4/9) of the S. aureus were resistant to ciprofloxacin. Resistance of up to 44% in isolates of mecA and nuc genes harbouring S. aureus is a compelling evidence for the rapid spread of antibiotic resistance from bacteria in food animals from Nigeria. Ciprofloxacin is the drug of choice for the treatment of Typhoid fever, therefore widespread resistance to it in pathogenic bacteria is of great public health significance. The study concludes that antibiotic resistance in bacteria from food animals is on the increase in Nigeria. The National Food and Drug Administration and Control (NAFDAC) agency in Nigeria should implement the World Health Organization (WHO) global action plan on antimicrobial resistance. A good starting point can be coordinating the WHO, Office of International Epizootics (OIE), Food and Agricultural Organization (FAO) tripartite draft antimicrobial resistance monitoring and evaluation (M&E) framework in Nigeria.

Keywords: Fluoroquinolone, Nigeria, resistance, Staphylococcus aureus

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5571 A Computational Investigation of Knocking Tendency in a Hydrogen-Fueled SI Engine

Authors: Hammam Aljabri, Hong G. Im

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Hydrogen is a promising future fuel to support the transition of the energy sector toward carbon neutrality. The direct utilization of H2 in Internal Combustion Engines (ICEs) is possible, and this technology faces mainly two challenges; high NOx emissions and severe knocking at mid to high loads. In this study, we numerically investigated the potential of H2 combustion in a truck-size engine operated in SI mode. To mitigate the knocking nature of H2 combustion, we have focused on studying the effects of three primary parameters; the compression ratio (CR), the air-fuel ratio, and the spark time. The baseline case was set using a CR of 16.5 and an equivalence ratio of 0.35. In simulations, the auto-ignition tendency was evaluated based on the maximum pressure rise rate and the local pressure fluctuations at the monitoring points set along the wall of the combustion chamber. To mitigate the auto-ignition tendency while enabling a wider range of engine operation, the effect of lowering the compression ratio was assessed. The results indicate that by lowering the compression ratio from 16.5:1 to 12.5:1, an indicated thermal efficiency of 47.5% can be achieved. Aiming to restrain the auto-ignition while maintaining good efficiency, a reduction in the equivalence ratio was examined under different compression ratios. The result indicates that higher compression ratios will require lower equivalence ratios, and due to practical limitations, a lower equivalence ratio of 0.25 was set as the limit. Using a compression ratio of 13.5 combined with an equivalence ratio of 0.3 resulted in an indicated thermal efficiency of 48.6%, that is, at a fixed spark time. It is found that under such lean conditions, the incomplete combustion losses and exhaust losses were high. Thus, advancing the spark time was assessed as a possible solution. The results demonstrated the advantages of advancing the spark time, where an indicated thermal efficiency exceeding 50% was achieved using a compression ratio of 14.5:1 and an equivalence ratio of 0.25.

Keywords: hydrogen, combustion, engine knock, SI engine

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5570 A Compact Via-less Ultra-Wideband Microstrip Filter by Utilizing Open-Circuit Quarter Wavelength Stubs

Authors: Muhammad Yasir Wadood, Fatemeh Babaeian

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By developing ultra-wideband (UWB) systems, there is a high demand for UWB filters with low insertion loss, wide bandwidth, and having a planar structure which is compatible with other components of the UWB system. A microstrip interdigital filter is a great option for designing UWB filters. However, the presence of via holes in this structure creates difficulties in the fabrication procedure of the filter. Especially in the higher frequency band, any misalignment of the drilled via hole with the Microstrip stubs causes large errors in the measurement results compared to the desired results. Moreover, in this case (high-frequency designs), the line width of the stubs are very narrow, so highly precise small via holes are required to be implemented, which increases the cost of fabrication significantly. Also, in this case, there is a risk of having fabrication errors. To combat this issue, in this paper, a via-less UWB microstrip filter is proposed which is designed based on a modification of a conventional inter-digital bandpass filter. The novel approaches in this filter design are 1) replacement of each via hole with a quarter-wavelength open circuit stub to avoid the complexity of manufacturing, 2) using a bend structure to reduce the unwanted coupling effects and 3) minimising the size. Using the proposed structure, a UWB filter operating in the frequency band of 3.9-6.6 GHz (1-dB bandwidth) is designed and fabricated. The promising results of the simulation and measurement are presented in this paper. The selected substrate for these designs was Rogers RO4003 with a thickness of 20 mils. This is a common substrate in most of the industrial projects. The compact size of the proposed filter is highly beneficial for applications which require a very miniature size of hardware.

Keywords: band-pass filters, inter-digital filter, microstrip, via-less

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5569 The Impacts of New Digital Technology Transformation on Singapore Healthcare Sector: Case Study of a Public Hospital in Singapore from a Management Accounting Perspective

Authors: Junqi Zou

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As one of the world’s most tech-ready countries, Singapore has initiated the Smart Nation plan to harness the full power and potential of digital technologies to transform the way people live and work, through the more efficient government and business processes, to make the economy more productive. The key evolutions of digital technology transformation in healthcare and the increasing deployment of Internet of Things (IoTs), Big Data, AI/cognitive, Robotic Process Automation (RPA), Electronic Health Record Systems (EHR), Electronic Medical Record Systems (EMR), Warehouse Management System (WMS in the most recent decade have significantly stepped up the move towards an information-driven healthcare ecosystem. The advances in information technology not only bring benefits to patients but also act as a key force in changing management accounting in healthcare sector. The aim of this study is to investigate the impacts of digital technology transformation on Singapore’s healthcare sector from a management accounting perspective. Adopting a Balanced Scorecard (BSC) analysis approach, this paper conducted an exploratory case study of a newly launched Singapore public hospital, which has been recognized as amongst the most digitally advanced healthcare facilities in Asia-Pacific region. Specifically, this study gains insights on how the new technology is changing healthcare organizations’ management accounting from four perspectives under the Balanced Scorecard approach, 1) Financial Perspective, 2) Customer (Patient) Perspective, 3) Internal Processes Perspective, and 4) Learning and Growth Perspective. Based on a thorough review of archival records from the government and public, and the interview reports with the hospital’s CIO, this study finds the improvements from all the four perspectives under the Balanced Scorecard framework as follows: 1) Learning and Growth Perspective: The Government (Ministry of Health) works with the hospital to open up multiple training pathways to health professionals that upgrade and develops new IT skills among the healthcare workforce to support the transformation of healthcare services. 2) Internal Process Perspective: The hospital achieved digital transformation through Project OneCare to integrate clinical, operational, and administrative information systems (e.g., EHR, EMR, WMS, EPIB, RTLS) that enable the seamless flow of data and the implementation of JIT system to help the hospital operate more effectively and efficiently. 3) Customer Perspective: The fully integrated EMR suite enhances the patient’s experiences by achieving the 5 Rights (Right Patient, Right Data, Right Device, Right Entry and Right Time). 4) Financial Perspective: Cost savings are achieved from improved inventory management and effective supply chain management. The use of process automation also results in a reduction of manpower costs and logistics cost. To summarize, these improvements identified under the Balanced Scorecard framework confirm the success of utilizing the integration of advanced ICT to enhance healthcare organization’s customer service, productivity efficiency, and cost savings. Moreover, the Big Data generated from this integrated EMR system can be particularly useful in aiding management control system to optimize decision making and strategic planning. To conclude, the new digital technology transformation has moved the usefulness of management accounting to both financial and non-financial dimensions with new heights in the area of healthcare management.

Keywords: balanced scorecard, digital technology transformation, healthcare ecosystem, integrated information system

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5568 Enhancement of Growth and Lipid Accumulation in Microalgae with Aggregation Induced Emission-Based Photosensitiser

Authors: Sharmin Ferdewsi Rakhi, AHM Mohsinul Reza, Brynley Davies, Jianzhong Wang, Youhong Tang, Jian Qin

Abstract:

Mass production of microalgae has become a focus of research owing to their promising aspects for sustainable food, biofunctional compounds, and biofuel feedstock. However, low lipid content with optimum algal biomass is still a challenge that must be resolved for commercial use. This research aims to determine the effects of light spectral shift and reactive oxygen species (ROS) on growth and lipid biosynthesis in a green microalga, Chlamydomonas reinhardtii. Aggregation Induced Emission (AIE)-based photosensitisers, CN-TPAQ-PF6 ([C₃₂H₂₃N₄]+) with high ROS productivity, was introduced into the algal culture media separately for effective conversion of the green-yellow-light to the red spectra. The intense photon energy and high-photon flux density in the photosystems and ROS supplementation induced photosynthesis and lipid biogenesis. In comparison to the control, maximum algal growth (0.15 g/l) was achieved at 2 µM CN-TPAQ-PF6 exposure. A significant increase in total lipid accumulation (146.87 mg/g dry biomass) with high proportion of 10-Heptadecanoic acid (C17:1) linolenic acid (C18:2), α-linolenic acid (C18:3) was observed. The elevated level of cellular NADP/NADPH triggered the Acetyl-Co-A production in lipid biogenesis cascade. Furthermore, MTT analysis suggested that this nanomaterial is highly biocompatible on HaCat cell lines with 100% cell viability. This study reveals that the AIE-based approach can strongly impact algal biofactory development for sustainable food, healthy lipids and eco-friendly biofuel.

Keywords: microalgae, photosensitiser, lipid, biomass, aggregation-induced-emission, reactive oxygen species

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5567 Spanish Language Violence Corpus: An Analysis of Offensive Language in Twitter

Authors: Beatriz Botella-Gil, Patricio Martínez-Barco, Lea Canales

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The Internet and ICT are an integral element of and omnipresent in our daily lives. Technologies have changed the way we see the world and relate to it. The number of companies in the ICT sector is increasing every year, and there has also been an increase in the work that occurs online, from sending e-mails to the way companies promote themselves. In social life, ICT’s have gained momentum. Social networks are useful for keeping in contact with family or friends that live far away. This change in how we manage our relationships using electronic devices and social media has been experienced differently depending on the age of the person. According to currently available data, people are increasingly connected to social media and other forms of online communication. Therefore, it is no surprise that violent content has also made its way to digital media. One of the important reasons for this is the anonymity provided by social media, which causes a sense of impunity in the victim. Moreover, it is not uncommon to find derogatory comments, attacking a person’s physical appearance, hobbies, or beliefs. This is why it is necessary to develop artificial intelligence tools that allow us to keep track of violent comments that relate to violent events so that this type of violent online behavior can be deterred. The objective of our research is to create a guide for detecting and recording violent messages. Our annotation guide begins with a study on the problem of violent messages. First, we consider the characteristics that a message should contain for it to be categorized as violent. Second, the possibility of establishing different levels of aggressiveness. To download the corpus, we chose the social network Twitter for its ease of obtaining free messages. We chose two recent, highly visible violent cases that occurred in Spain. Both of them experienced a high degree of social media coverage and user comments. Our corpus has a total of 633 messages, manually tagged, according to the characteristics we considered important, such as, for example, the verbs used, the presence of exclamations or insults, and the presence of negations. We consider it necessary to create wordlists that are present in violent messages as indicators of violence, such as lists of negative verbs, insults, negative phrases. As a final step, we will use automatic learning systems to check the data obtained and the effectiveness of our guide.

Keywords: human language technologies, language modelling, offensive language detection, violent online content

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5566 Whatsapp Messaging Platform and Academic Performance of Mass Communication Students, Abdu Gusau Polytechnic, Talata Mafara

Authors: Ibrahim Magaji

Abstract:

WhatsApp messaging platform brings about new opportunities for users to participate in unique storytelling experiences and audience engagement, particularly to Students of Mass communication who receive training to report events and issues accurately and objectively in accordance with official controls. Also, the complex nature of society today made it possible to use the WhatsApp platform that revolutionizes the means of sharing information, ideas, and experiences. This paper examined the WhatsApp messaging platform and how it influenced the academic performance of students in the Department of Mass Communication, Abdu Gusau Polytechnic, Talata Mafara. It used in-depth interview techniques and focus group discussion with students, as well as the use of published materials as well as unpublished materials to gather related and relevant data. Also, the paper used procedures involved to analyze long interview content. This procedure includes observation of a useful utterance, development of expanded observation, the examination of the interconnection of observed comments, collective scrutiny of observation for patterns and themes, and review and analysis of the themes across all interviews for development of the thesis. The result revealed that the majority of students used WhatsApp messenger for making friends and chatting. Also, the students experienced negative effects such as poor grammar and spelling, less study time, and poor academic performance because of active participation in the use of WhatsApp messaging platform. Surprisingly, there was a high addiction rate among students in the usage of WhatsApp messenger. However, other students experienced an improvement in their readings skills as a result of participation in the use of the platform. Also, students shared ideas, discussed, and shared examination questions among themselves on WhatsApp messenger.

Keywords: WhatsApp messenger, students, participation, group

Procedia PDF Downloads 106
5565 Prediction of Mental Health: Heuristic Subjective Well-Being Model on Perceived Stress Scale

Authors: Ahmet Karakuş, Akif Can Kilic, Emre Alptekin

Abstract:

A growing number of studies have been conducted to determine how well-being may be predicted using well-designed models. It is necessary to investigate the backgrounds of features in order to construct a viable Subjective Well-Being (SWB) model. We have picked the suitable variables from the literature on SWB that are acceptable for real-world data instructions. The goal of this work is to evaluate the model by feeding it with SWB characteristics and then categorizing the stress levels using machine learning methods to see how well it performs on a real dataset. Despite the fact that it is a multiclass classification issue, we have achieved significant metric scores, which may be taken into account for a specific task.

Keywords: machine learning, multiclassification problem, subjective well-being, perceived stress scale

Procedia PDF Downloads 99
5564 Virtualizing Attendance and Reducing Impacts on the Environment with a Mobile Application

Authors: Paulo R. M. Andrade, Adriano B. Albuquerque, Otávio F. Frota, Robson V. Silveira, Fátima A. da Silva

Abstract:

Information technology has been gaining more and more space whether in industry, commerce or even for personal use, but the misuse of it brings harm to the environment and human health as a result. Contribute to the sustainability of the planet is to compensate the environment, all or part of what withdraws it. The green computing also came to propose practical for use in IT in an environmentally correct way in aid of strategic management and communication. This work focuses on showing how a mobile application can help businesses reduce costs and reduced environmental impacts caused by its processes, through a case study of a public company in Brazil.

Keywords: green computing, information technology, e-government, sustainable development, mobile computing

Procedia PDF Downloads 391
5563 Lack of Regulation Leads to Complexity: A Case Study of the Free Range Chicken Meat Sector in the Western Cape, South Africa

Authors: A. Coetzee, C. F. Kelly, E. Even-Zahav

Abstract:

Dominant approaches to livestock production are harmful to the environment, human health and animal welfare, yet global meat consumption is rising. Sustainable alternative production approaches are therefore urgently required, and ‘free range’ is the main alternative for chicken meat offered in South Africa (and globally). Although the South African Poultry Association provides non-binding guidelines, there is a lack of formal definition and regulation of free range chicken production, meaning it is unclear what this alternative entails and if it is consistently practised (a trend observed globally). The objective of this exploratory qualitative case study is therefore to investigate who and what determines free range chicken. The case study, conducted from a social constructivist worldview, uses semi-structured interviews, photographs and document analysis to collect data. Interviews are conducted with those involved with bringing free range chicken to the market - farmers, chefs, retailers, and regulators. Data is analysed using thematic analysis to establish dominant patterns in the data. The five major themes identified (based on prevalence in data and on achieving the research objective) are: 1) free range means a bird reared with good animal welfare in mind, 2) free range means quality meat, 3) free range means a profitable business, 4) free range is determined by decision makers or by access to markets, and 5) free range is coupled with concerns about the lack of regulation. Unpacking the findings in the context of the literature reveals who and what determines free range. The research uncovers wide-ranging interpretations of ‘free range’, driven by the absence of formal regulation for free range chicken practices and the lack of independent private certification. This means that the term ‘free range’ is socially constructed, thus varied and complex. The case study also shows that whether chicken meat is free range is generally determined by those who have access to markets. Large retailers claim adherence to the internationally recognised Five Freedoms, also include in the South African Poultry Association Code of Good Practice, which others in the sector say are too broad to be meaningful. Producers describe animal welfare concerns as the main driver for how they practice/view free range production, yet these interpretations vary. An additional driver is a focus on human health, which participants achieve mainly through the use of antibiotic-free feed, resulting in what participants regard as higher quality meat. The participants are also strongly driven by business imperatives, with most stating that free range chicken should carry a higher price than conventionally-reared chicken due to increased production costs. Recommendations from this study focus on, inter alia, a need to understand consumers’ perspectives on free range chicken, given that those in the sector claim they are responding to consumer demand, and conducting environmental research such as life cycle assessment studies to establish the true (environmental) sustainability of free range production. At present, it seems the sector mostly responds to social sustainability: human health and animal welfare.

Keywords: chicken meat production, free range, socially constructed, sustainability

Procedia PDF Downloads 127
5562 Roboweeder: A Robotic Weeds Killer Using Electromagnetic Waves

Authors: Yahoel Van Essen, Gordon Ho, Brett Russell, Hans-Georg Worms, Xiao Lin Long, Edward David Cooper, Avner Bachar

Abstract:

Weeds reduce farm and forest productivity, invade crops, smother pastures and some can harm livestock. Farmers need to spend a significant amount of money to control weeds by means of biological, chemical, cultural, and physical methods. To solve the global agricultural labor shortage and remove poisonous chemicals, a fully autonomous, eco-friendly, and sustainable weeding technology is developed. This takes the form of a weeding robot, ‘Roboweeder’. Roboweeder includes a four-wheel-drive self-driving vehicle, a 4-DOF robotic arm which is mounted on top of the vehicle, an electromagnetic wave generator (magnetron) which is mounted on the “wrist” of the robotic arm, 48V battery packs, and a control/communication system. Cameras are mounted on the front and two sides of the vehicle. Using image processing and recognition, distinguish types of weeds are detected before being eliminated. The electromagnetic wave technology is applied to heat the individual weeds and clusters dielectrically causing them to wilt and die. The 4-DOF robotic arm was modeled mathematically based on its structure/mechanics, each joint’s load, brushless DC motor and worm gear’ characteristics, forward kinematics, and inverse kinematics. The Proportional-Integral-Differential control algorithm is used to control the robotic arm’s motion to ensure the waveguide aperture pointing to the detected weeds. GPS and machine vision are used to traverse the farm and avoid obstacles without the need of supervision. A Roboweeder prototype has been built. Multiple test trials show that Roboweeder is able to detect, point, and kill the pre-defined weeds successfully although further improvements are needed, such as reducing the “weeds killing” time and developing a new waveguide with a smaller waveguide aperture to avoid killing crops surrounded. This technology changes the tedious, time consuming and expensive weeding processes, and allows farmers to grow more, go organic, and eliminate operational headaches. A patent of this technology is pending.

Keywords: autonomous navigation, machine vision, precision heating, sustainable and eco-friendly

Procedia PDF Downloads 207
5561 Men Act, Women Are Acted Upon: Morphosyntactic Framing of the Sexual Intercourse in Online Pornography Titles

Authors: Aleksandra Tomic

Abstract:

According to reliable sources, 4% of all websites is devoted to pornographic material, yet these estimates are often reported to be much higher. The largest internet pornography streaming website reports 21.2 billion visits in 2015 only. Considering the ubiquity of online pornography and the frequency of use, it is necessary to examine its potential influence on the construal of the sexual act and the roles of participants. Apart from the verbal and physical interactions in the pornographic movies themselves, the language in the titles of movies has the power to frame the sexual intercourse. In this study, Critical Discourse Analysis and corpus linguistics approaches will be used to examine the way the sexual intercourse and the roles of the participants are ideologically construed and perpetuated in the Internet pornography discourse. To this end, the study will explore the association between the specific morphosyntactic aspects of the references to performers of both genders, the person and the thematic role, and the gender of referred performer in the corpus of online pornographic movie titles. Distinctive collexeme analysis will be conducted to uncover possible associations between for gender of the performer denoted by the linguistic expression, and the person and thematic role assigned to it in the titles of online pornography movies. Initial results of the chi-square procedure performed on a sample of 295 online pornography movie titles on the largest pornography streaming website ‘Pornhub’ yielded significant results. The use of the three person categories was not equally distributed between genders, X2 (2, N = 106) = 32.52, p < 0.001, with female performers being referred to in the third person in 71.7% of the instances, and speaking in the first person 20.8% of the time, whereas male performers spoke in the first person 68% of the time, and were referred to in the third person in 17% of the instances. Moreover, there was a gender disparity in the assignment of thematic roles, with linguistic expressions for women being assigned the Patient role and men the Agent role in 58.8% of the cases, whereas the roles were reversed in 41.2% of the instances, X2 (1, N = 262) = 8.07633, p < 0.005. The results are discussed in terms of the ideologies surrounding female and male sexuality in the pornography discourse. Potential patterns of power imbalance, objectification, and discrimination are highlighted. Finally, the evidence from psycholinguistic studies on the influence of the language structure on event construal is related to the results of the study.

Keywords: corpus linguistics, gender studies, pornography, thematic roles

Procedia PDF Downloads 159
5560 Impact Analysis of Quality Control Practices in Veterinary Diagnostic Labs in Lahore, Pakistan

Authors: Faiza Marrium, Masood Rabbani, Ali Ahmad Sheikh, Muhammad Yasin Tipu Javed Muhammad, Sohail Raza

Abstract:

More than 75% diseases spreading in the past 10 years in human population globally are linked to veterinary sector. Veterinary diagnostic labs are the powerful ally for diagnosis, prevention and monitoring of animal diseases in any country. In order to avoid detrimental effects of errors in disease diagnostic and biorisk management, there is a dire need to establish quality control system. In current study, 3 private and 6 public sectors veterinary diagnostic labs were selected for survey. A questionnaire survey in biorisk management guidelines of CWA 15793 was designed to find quality control breaches in lab design, personal, equipment and consumable, quality control measures adopted in lab, waste management, environmental monitoring and customer care. The data was analyzed through frequency distribution statistically by using (SPSS) version 18.0. A non-significant difference was found in all parameters of lab design, personal, equipment and consumable, quality control measures adopted in lab, waste management, environmental monitoring and customer care with an average percentage of 46.6, 57.77, 52.7, 55.5, 54.44, 48.88 and 60, respectively. A non-significant difference among all nine labs were found, with highest average compliance percentage of all parameters are lab 2 (78.13), Lab 3 (70.56), Lab 5 (57.51), Lab 6 (56.37), Lab 4 (55.02), Lab 9 (49.58), Lab 7 (47.76), Lab 1 (41.01) and Lab 8 (36.09). This study shows that in Lahore district veterinary diagnostic labs are not giving proper attention to quality of their system and there is no significant difference between setups of private and public sector laboratories. These results show that most of parameters are between 50 and 80 percent, which needs some work and improvement as per WHO criteria.

Keywords: veterinary lab, quality management system, accreditation, regulatory body, disease identification

Procedia PDF Downloads 123
5559 In-situ and Laboratory Characterization of Fiji Lateritic Soils

Authors: Faijal Ali, Darga Kumar N., Ravikant Singh, Rajnil Lal

Abstract:

Fiji has three major landforms such as plains, low mountains, and hills. The low land soils are formed on beach sand. Fiji soils contain high concentration of iron (III), aluminum oxides and hydroxides. The soil possesses reddish or yellowish colour. The characterization of lateritic soils collected from different locations along the national highway in Viti Levu, Fiji Islands. The research has been carried out mainly to understand the physical and strength properties to assess their suitability for the highway and building construction. In this paper, the field tests such as dynamic cone penetrometer test, field vane shear, field density and laboratory tests such as unconfined compression stress, compaction, grain size analysis and Atterberg limits are conducted. The test results are analyzed and presented. From the results, it is revealed that the soils are having more percentage of silt and clay which is more than 80% and 5 to 15% of fine to medium sand is noticed. The dynamic cone penetrometer results up to 3m depth had similar penetration resistance. For the first 1m depth, the rate of penetration is found 300mm per 3 to 4 blows. In all the sites it is further noticed that the rate of penetration at depths beyond 1.5 m is decreasing for the same number of blows as compared to the top soil. From the penetration resistance measured through dynamic cone penetrometer test, the California bearing ratio and allowable bearing capacities are 4 to 5% and 50 to 100 kPa for the top 1m layer and below 1m these values are increasing. The California bearing ratio of these soils for below 1m depth is in the order of 10% to 20%. The safe bearing capacity of these soils below 1m and up to 3m depth is varying from 150 kPa to 250 kPa. The field vane shear was measured within a depth of 1m from the surface and the values were almost similar varying from 60 kPa to 120 kPa. The liquid limit and plastic limits of these soils are in the range of 40 to 60% and 20 to 25%. Overall it is found that the top 1m soil along the national highway in majority places possess a soft to medium stiff behavior with low to medium bearing capacity as well low California bearing ratio values. It is recommended to ascertain these soils behavior in terms of geotechnical parameters before taking up any construction activity.

Keywords: California bearing ratio, dynamic cone penetrometer test, field vane shear, unconfined compression stress.

Procedia PDF Downloads 167
5558 Aerosol Direct Radiative Forcing Over the Indian Subcontinent: A Comparative Analysis from the Satellite Observation and Radiative Transfer Model

Authors: Shreya Srivastava, Sagnik Dey

Abstract:

Aerosol direct radiative forcing (ADRF) refers to the alteration of the Earth's energy balance from the scattering and absorption of solar radiation by aerosol particles. India experiences substantial ADRF due to high aerosol loading from various sources. These aerosols' radiative impact depends on their physical characteristics (such as size, shape, and composition) and atmospheric distribution. Quantifying ADRF is crucial for understanding aerosols’ impact on the regional climate and the Earth's radiative budget. In this study, we have taken radiation data from Clouds and the Earth’s Radiant Energy System (CERES, spatial resolution=1ox1o) for 22 years (2000-2021) over the Indian subcontinent. Except for a few locations, the short-wave DARF exhibits aerosol cooling at the TOA (values ranging from +2.5 W/m2 to -22.5W/m2). Cooling due to aerosols is more pronounced in the absence of clouds. Being an aerosol hotspot, higher negative ADRF is observed over the Indo-Gangetic Plain (IGP). Aerosol Forcing Efficiency (AFE) shows a decreasing seasonal trend in winter (DJF) over the entire study region while an increasing trend over IGP and western south India during the post-monsoon season (SON) in clear-sky conditions. Analysing atmospheric heating and AOD trends, we found that only the aerosol loading is not governing the change in atmospheric heating but also the aerosol composition and/or their vertical profile. We used a Multi-angle Imaging Spectro-Radiometer (MISR) Level-2 Version 23 aerosol products to look into aerosol composition. MISR incorporates 74 aerosol mixtures in its retrieval algorithm based on size, shape, and absorbing properties. This aerosol mixture information was used for analysing long-term changes in aerosol composition and dominating aerosol species corresponding to the aerosol forcing value. Further, ADRF derived from this method is compared with around 35 studies across India, where a plane parallel Radiative transfer model was used, and the model inputs were taken from the OPAC (Optical Properties of Aerosols and Clouds) utilizing only limited aerosol parameter measurements. The result shows a large overestimation of TOA warming by the latter (i.e., Model-based method).

Keywords: aerosol radiative forcing (ARF), aerosol composition, MISR, CERES, SBDART

Procedia PDF Downloads 27
5557 Factors Related to Oncology Ward Nurses’ Job Stress Adaptation Needs in Southern Taiwan Regional Hospital

Authors: Minhui Chiu

Abstract:

According to relevant studies, clinical nurses have high work pressure and relatively high job adaptation needs. The nurses who work in oncology wards have more adaptation needs when they face repeating hospitalization patients. The aims of this study were to investigate the job stress adaptation and related factors of nurses in oncology wards and to understand the predictors of job stress adaptation needs. Convenience sampling was used in this study. The nurses in the oncology specialist ward of a regional teaching hospital in southern Taiwan were selected as the research objects. A cross-sectional survey was conducted using a structured questionnaire, random sampling, and the questionnaires were filled out by the participating nurses. A total of 68 people were tested, and 65 valid questionnaires (95.6%). One basic data questionnaire and nurses’ job stress adaptation needs questionnaire were used. The data was archived with Microsoft Excel, and statistical analysis was performed with JMP12.0. The results showed that the average age was 28.8 (±6.7) years old, most of them were women, 62 (95.38%), and the average clinical experience in the hospital was 5.7 years (±5.9), and 62 (95.38%) were university graduates. 39 people (60.0%) had no work experience. 39 people (60.0%) liked nursing work very much, and 23 people (35.3%) just “liked”. 47 (72.3%) people were supported to be oncology nurses by their families. The nurses' job stress adaptation needs were 119.75 points (±17.24). The t-test and variance analysis of the impact of nurses' job pressure adaptation needs were carried out. The results showed that the score of college graduates was 121.10 (±16.39), which was significantly higher than that of master graduates 96.67 (±22.81), and the degree of liking for nursing work also reached a Significant difference. These two variables are important predictors of job adaptation needs, and the R Square is 24.15%. Conclusion: Increasing the love of clinical nurses in nursing and encouraging university graduation to have positive effects on job pressure adaptation needs and can be used as a reference for the management of human resources hospitals for oncology nurses.

Keywords: oncology nurse, job stress, job stress adaptation needs, manpower

Procedia PDF Downloads 88
5556 Utilization of Informatics to Transform Clinical Data into a Simplified Reporting System to Examine the Analgesic Prescribing Practices of a Single Urban Hospital’s Emergency Department

Authors: Rubaiat S. Ahmed, Jemer Garrido, Sergey M. Motov

Abstract:

Clinical informatics (CI) enables the transformation of data into a systematic organization that improves the quality of care and the generation of positive health outcomes.Innovative technology through informatics that compiles accurate data on analgesic utilization in the emergency department can enhance pain management in this important clinical setting. We aim to establish a simplified reporting system through CI to examine and assess the analgesic prescribing practices in the EDthrough executing a U.S. federal grant project on opioid reduction initiatives. Queried data points of interest from a level-one trauma ED’s electronic medical records were used to create data sets and develop informational/visual reporting dashboards (on Microsoft Excel and Google Sheets) concerning analgesic usage across several pre-defined parameters and performance metrics using CI. The data was then qualitatively analyzed to evaluate ED analgesic prescribing trends by departmental clinicians and leadership. During a 12-month reporting period (Dec. 1, 2020 – Nov. 30, 2021) for the ongoing project, about 41% of all ED patient visits (N = 91,747) were for pain conditions, of which 81.6% received analgesics in the ED and at discharge (D/C). Of those treated with analgesics, 24.3% received opioids compared to 75.7% receiving opioid alternatives in the ED and at D/C, including non-pharmacological modalities. Demographics showed among patients receiving analgesics, 56.7% were aged between 18-64, 51.8% were male, 51.7% were white, and 66.2% had government funded health insurance. Ninety-one percent of all opioids prescribed were in the ED, with intravenous (IV) morphine, IV fentanyl, and morphine sulfate immediate release (MSIR) tablets accounting for 88.0% of ED dispensed opioids. With 9.3% of all opioids prescribed at D/C, MSIR was dispensed 72.1% of the time. Hydrocodone, oxycodone, and tramadol usage to only 10-15% of the time, and hydromorphone at 0%. Of opioid alternatives, non-steroidal anti-inflammatory drugs were utilized 60.3% of the time, 23.5% with local anesthetics and ultrasound-guided nerve blocks, and 7.9% with acetaminophen as the primary non-opioid drug categories prescribed by ED providers. Non-pharmacological analgesia included virtual reality and other modalities. An average of 18.5 ED opioid orders and 1.9 opioid D/C prescriptions per 102.4 daily ED patient visits was observed for the period. Compared to other specialties within our institution, 2.0% of opioid D/C prescriptions are given by ED providers, compared to the national average of 4.8%. Opioid alternatives accounted for 69.7% and 30.3% usage, versus 90.7% and 9.3% for opioids in the ED and D/C, respectively.There is a pressing need for concise, relevant, and reliable clinical data on analgesic utilization for ED providers and leadership to evaluate prescribing practices and make data-driven decisions. Basic computer software can be used to create effective visual reporting dashboards with indicators that convey relevant and timely information in an easy-to-digest manner. We accurately examined our ED's analgesic prescribing practices using CI through dashboard reporting. Such reporting tools can quickly identify key performance indicators and prioritize data to enhance pain management and promote safe prescribing practices in the emergency setting.

Keywords: clinical informatics, dashboards, emergency department, health informatics, healthcare informatics, medical informatics, opioids, pain management, technology

Procedia PDF Downloads 121
5555 The Impact of Cognitive Load on Deceit Detection and Memory Recall in Children’s Interviews: A Meta-Analysis

Authors: Sevilay Çankaya

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The detection of deception in children’s interviews is essential for statement veracity. The widely used method for deception detection is building cognitive load, which is the logic of the cognitive interview (CI), and its effectiveness for adults is approved. This meta-analysis delves into the effectiveness of inducing cognitive load as a means of enhancing veracity detection during interviews with children. Additionally, the effectiveness of cognitive load on children's total number of events recalled is assessed as a second part of the analysis. The current meta-analysis includes ten effect sizes from search using databases. For the effect size calculation, Hedge’s g was used with a random effect model by using CMA version 2. Heterogeneity analysis was conducted to detect potential moderators. The overall result indicated that cognitive load had no significant effect on veracity outcomes (g =0.052, 95% CI [-.006,1.25]). However, a high level of heterogeneity was found (I² = 92%). Age, participants’ characteristics, interview setting, and characteristics of the interviewer were coded as possible moderators to explain variance. Age was significant moderator (β = .021; p = .03, R2 = 75%) but the analysis did not reveal statistically significant effects for other potential moderators: participants’ characteristics (Q = 0.106, df = 1, p = .744), interview setting (Q = 2.04, df = 1, p = .154), and characteristics of interviewer (Q = 2.96, df = 1, p = .086). For the second outcome, the total number of events recalled, the overall effect was significant (g =4.121, 95% CI [2.256,5.985]). The cognitive load was effective in total recalled events when interviewing with children. All in all, while age plays a crucial role in determining the impact of cognitive load on veracity, the surrounding context, interviewer attributes, and inherent participant traits may not significantly alter the relationship. These findings throw light on the need for more focused, age-specific methods when using cognitive load measures. It may be possible to improve the precision and dependability of deceit detection in children's interviews with the help of more studies in this field.

Keywords: deceit detection, cognitive load, memory recall, children interviews, meta-analysis

Procedia PDF Downloads 35
5554 Utilizing Fiber-Based Modeling to Explore the Presence of a Soft Storey in Masonry-Infilled Reinforced Concrete Structures

Authors: Akram Khelaifia, Salah Guettala, Nesreddine Djafar Henni, Rachid Chebili

Abstract:

Recent seismic events have underscored the significant influence of masonry infill walls on the resilience of structures. The irregular positioning of these walls exacerbates their adverse effects, resulting in substantial material and human losses. Research and post-earthquake evaluations emphasize the necessity of considering infill walls in both the design and assessment phases. This study delves into the presence of soft stories in reinforced concrete structures with infill walls. Employing an approximate method relying on pushover analysis results, fiber-section-based macro-modeling is utilized to simulate the behavior of infill walls. The findings shed light on the presence of soft first stories, revealing a notable 240% enhancement in resistance for weak column—strong beam-designed frames due to infill walls. Conversely, the effect is more moderate at 38% for strong column—weak beam-designed frames. Interestingly, the uniform distribution of infill walls throughout the structure's height does not influence soft-story emergence in the same seismic zone, irrespective of column-beam strength. In regions with low seismic intensity, infill walls dissipate energy, resulting in consistent seismic behavior regardless of column configuration. Despite column strength, structures with open-ground stories remain vulnerable to soft first-story emergence, underscoring the crucial role of infill walls in reinforced concrete structural design.

Keywords: masonry infill walls, soft Storey, pushover analysis, fiber section, macro-modeling

Procedia PDF Downloads 34
5553 The Crossroads of Corruption and Terrorism in the Global South

Authors: Stephen M. Magu

Abstract:

The 9/11 and Christmas bombing attacks in the United States are mostly associated with the inability of intelligence agencies to connect dots based on intelligence that was already available. The 1998, 2002, 2013 and several 2014 terrorist attacks in Kenya, on the other hand, are probably driven by a completely different dynamic: the invisible hand of corruption. The World Bank and Transparency International annually compute the Worldwide Governance Indicators and the Corruption Perception Index respectively. What perhaps is not adequately captured in the corruption metrics is the impact of corruption on terrorism. The World Bank data includes variables such as the control of corruption, (estimates of) government effectiveness, political stability and absence of violence/terrorism, regulatory quality, rule of law and voice and accountability. TI's CPI does not include measures related to terrorism, but it is plausible that there is an expectation of some terrorism impact arising from corruption. This paper, by examining the incidence, frequency and total number of terrorist attacks that have occurred especially since 1990, and further examining the specific cases of Kenya and Nigeria, argues that in addition to having major effects on governance, corruption has an even more frightening impact: that of facilitating and/or violating security mechanisms to the extent that foreign nationals can easily obtain identification that enables them to perpetuate major events, targeting powerful countries' interests in countries with weak corruption-fighting mechanisms. The paper aims to model interactions that demonstrate the cost/benefit analysis and agents' rational calculations as being non-rational calculations, given the ultimate impact. It argues that eradication of corruption is not just a matter of a better business environment, but that it is implicit in national security, and that for anti-corruption crusaders, this is an argument more potent than the economic cost / cost of doing business argument.

Keywords: corruption, global south, identification, passports, terrorism

Procedia PDF Downloads 397