Search results for: health supply chain system strengthening
25732 The Risk of Occupational Health in the Shipbuilding Industry in Bangladesh
Authors: Md. Rashel Sheikh
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The shipbuilding industry in Bangladesh had become a fast-growing industry in recent years when it began to export newly built ships. The various activities of shipbuilding industries in their limited, confined spaces added occupational worker exposures to chemicals, dusts, and metal fumes. The aim of this literature search is to identify the potential sources of occupational health hazards in shipyards and to promote the regulation of appropriate personal protective equipment (PPE) for the workers. In shipyards, occupational workers are involved in various activities, such as the manufacture, repair, maintenance, dismantling of boats and ships, building small ocean-going vessels and ferries. The occupational workers in the shipbuilding industry suffer from a number of hazardous issues, such as asthma, dermatitis, hearing deficits, and musculoskeletal disorders. The use of modern technologies, such as underwater plasma welding, electron beam welding, and friction stir welding and laser cutting and welding, and appropriate PPE (i.e., long-sleeved shirt and long pants, shoes plus socks, safety masks, chemical resistant gloves, eyewear, face shield, and respirators) can help reduce the occupational exposure to environmental hazards created by different activities in the shipyards. However, most shipyards in Bangladesh use traditional methods, e.g., flame cutting and arc, that add hazardous waste and pollutants to the environment in and around the shipyard. The safety and security of occupational workers in the shipyard workplace are very important. It is the primary responsibility of employers to ensure the safety and security of occupational workers in the shipyards. Employers must use advanced technologies and supply adequate and appropriate PPE for the workers. There are a number of accidents and illnesses that happen daily in the shipyard industries in Bangladesh due to the negligence and lack of adequate technologies and appropriate PPE. In addition, there are no specific regulations and implementations available to use the PPE. It is essential to have PPE regulations and strict enforcement for the adoption of PPE in the shipbuilding industries in Bangladesh. Along with the adoption of PPE with regular health examinations, health education to the workers regarding occupational hazards and lifestyle diseases are also important and require reinforcement. Monitoring health and safety hazards in shipyards are essential to enhance worker protection, and ensure worker safety, and mitigate workplace injuries and illnesses.Keywords: shipbuilding Industries, health education, occupational health hazards, personal protective equipment, shipyard workers, occupational workers, shipyards
Procedia PDF Downloads 16925731 Water Crisis or Crisis of Water Management: Assessing Water Governance in Iran
Authors: Sedigheh Kalantari
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Like many countries in the arid and semi-arid belt, Iran experiences a natural limitation in the availability of water resources. However, rapid socioeconomic development has created a serious water crisis in a nation that was once one of the world’s pioneers in sustainable water management, due to the Persians’ contribution to hydraulic engineering inventions – the Qanat – throughout history. The exogenous issues like the changing climate, frequent droughts, and international sanctions are only crisis catalyzers, not the main cause of the water crisis; and a resilient water management system is expected to be capable of coping with these periodic external pressures. The current dramatic water security issues in Iran are rooted in managerial, political, and institutional challenges rather than engineering and technical issues, and the country is suffering from challenges in water governance. The country, instead of rigorous water conservation efforts, is still focused on supply-driven approach, technology and centralized methods, and structural solutions that aim to increase water supply; while the effectiveness of water governance and management has often left unused. To solve these issues, it is necessary to assess the present situation and its evolution over time. In this respect, establishing water governance assessment mechanisms will be a significant aspect of this paper. The research framework, however, is a conceptual framework to assess governance performance of Iran to critically diagnose problematic issues and areas, as well as proffer empirically based solutions and determine the best possible steps towards transformational processes. This concept aims to measure the adequacy of current solutions and strategies designed to ameliorate these problems and then develop and prescribe adequate futuristic solutions. Thus, the analytical framework developed in this paper seeks to provide insights on key factors influencing water governance in Iranian cities, institutional frameworks to manage water across scales and authorities, multi-level management gaps and policy responses, through an evidence-based approach and good practices to drive reform toward sustainability and water resource conservation. The findings of this paper show that the current structure of the water governance system in Iran, coupled with the lack of a comprehensive understanding of the root causes of the problem, leaves minimal hope for developing sustainable solutions to Iran’s increasing water crisis. In order to follow sustainable development approaches, Iran needs to replace symptom management with problem prevention.Keywords: governance, Iran, sustainable development, water management, water resources
Procedia PDF Downloads 3425730 The Technique of Mobilization of the Colon for Pull-Through Procedure in Hirschsprung's Disease
Authors: Medet K. Khamitov, Marat M. Ospanov, Vasiliy M. Lozovoy, Zhenis N. Sakuov, Dastan Z. Rustemov
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With a high rectosigmoid transitional zone in children with Hirschsprung’s disease, the upper rectal, sigmoid, left colon arteries are ligated during the pull-through of the descending part of the colon. As a result, the inferior mesenteric artery ceases to participate in the blood supply to the descending part of the colon. As a result, the reduced colon is supplied with blood only by the middle colon artery, which originates from the superior mesenteric artery. Insufficiency of blood supply to the reduced colon is the cause of the development of chronic hypoxia of the intestinal wall or necrosis of the reduced descending colon. Some surgeons prefer to preserve the left colon artery. However, it is possible to stretch the mesentery, which can lead to bowel retraction to anastomotic leaks and stenosis. Chronic hypoxia of the reduced colon, in turn, is the cause of acquired (secondary) aganglionosis. The highest frequency of anastomotic leaks is observed in children older than five years. The purpose is to reduce the risk of complications in the pull-through procedure of the descending part of the colon in patients with Hirschsprung’s disease by ensuring its sufficient mobility and maintaining blood supply to the lower mesenteric artery. Methodology and events. Two children aged 5 and 7 years with Hirschsprung’s disease were operated under the conditions of the hospital in Nur-Sultan. The diagnosis was made using x-ray contrast enema and histological examination. Operational technique. After revision of the left part of the colon and assessment of the architectonics of its blood vessels, parietal mobilization of the affected sigmoid and rectum was performed on laparotomy access, while maintaining the arterial and venous terminal arcades of the sigmoid vessels. Then, the descending branch of the left colon artery was crossed (if there is an insufficient length of the reduced intestine, the left colonic artery itself may also be crossed). This manipulation provides additional mobility of the pull-through descending part of the colon. The resulting "windows" in the mesentery of the reduced intestine were sutured to prevent the development of an internal hernia. Formed a full-blooded, sufficiently long transplant from the transverse loops of the splenic angle and the descending parts of the colon with blood supply from the upper and lower mesenteric artery, freely, without tension, is reduced to the rectal zone with the coloanal anastomosis 1.5 cm above the dentate line. Results. The postoperative period was uneventful. Patients were discharged on the 7th day. The observation was carried out for six months. In no case, there was a bowel retraction, anastomotic leak, anastomotic stenosis, or other complications. Conclusion. The presented technique of mobilization of the colon for the pull-through procedure in a high transitional rectosigmoid zone of Hirschsprung’s disease allows to maintain normal blood supply to the distal part of the colon and to avoid the tension of the colon. The technique allows reducing the risk of anastomotic leak, bowel necrosis, chronic ischemia, to exclude colon retraction and anastomotic stenosis.Keywords: blood supply, children, colon mobilization, Hirschsprung's disease, pull-through
Procedia PDF Downloads 14725729 Surface Active Phthalic Acid Ester Produced by a Rhizobacterial Strain
Authors: M. L. Ibrahim, A. Abdulhamid
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A surface active molecule synthesized by a rhizobacterial strain Bacillus lentus isolated from Cajanus cajan was investigated. The bioemulsifier was extracted, purified and partially characterized using standard methods. Surface properties of the bioemulsifier were determined by studying the emulsification index, solubility test and stability studies. Partial purification of the bioemulsifier was carried out using FT-IR analysis, Silica-gel column chromatography and thin layer chromatography. GC-MS analysis was carried out to detect the composition and mass of the lipids and esters. The isolate showed an emulsifying activity of 57% and surface activity of 36mm. The stability studies revealed that the bioemulsifier had better stability at temperature of 70oC, 8% pH and 8% NaCl concentration. FT-IR indicated the bioemulsifier to contain peptide and aliphatic chain, TLC revealed the compound to be ninhydrin positive and Column chromatography showed the presence of three amino acids namely; glutamine, valine and cysteine. GC-MS indicated the lipid moiety to contain aliphatic chain ranging from C9-C16 and two major peaks of 1,2-benzenedicarboxylic acid diethyl octyl ester. Therefore, surface active agent from Bacillus lentus can be used effectively in a wide range of applications such as in MEOR and in the biosynthesis of plasticizers for industrial uses.Keywords: Bacillus lentus, bioemulsifiers, phthalic acid ester, Rhizosphere
Procedia PDF Downloads 41525728 Modeling of Oxygen Supply Profiles in Stirred-Tank Aggregated Stem Cells Cultivation Process
Authors: Vytautas Galvanauskas, Vykantas Grincas, Rimvydas Simutis
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This paper investigates a possible practical solution for reasonable oxygen supply during the pluripotent stem cells expansion processes, where the stem cells propagate as aggregates in stirred-suspension bioreactors. Low glucose and low oxygen concentrations are preferred for efficient proliferation of pluripotent stem cells. However, strong oxygen limitation, especially inside of cell aggregates, can lead to cell starvation and death. In this research, the oxygen concentration profile inside of stem cell aggregates in a stem cell expansion process was predicted using a modified oxygen diffusion model. This profile can be realized during the stem cells cultivation process by manipulating the oxygen concentration in inlet gas or inlet gas flow. The proposed approach is relatively simple and may be attractive for installation in a real pluripotent stem cell expansion processes.Keywords: aggregated stem cells, dissolved oxygen profiles, modeling, stirred-tank, 3D expansion
Procedia PDF Downloads 30825727 Health Care Waste Management Practices in Liberia: An Investigative Case Study
Authors: V. Emery David Jr., J. Wenchao, D. Mmereki, Y. John, F. Heriniaina
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Healthcare waste management continues to present an array of challenges for developing countries, and Liberia is of no exception. There is insufficient information available regarding the generation, handling, and disposal of health care waste. This face serves as an impediment to healthcare management schemes. The specific objective of this study is to present an evaluation of the current health care management practices in Liberia. It also presented procedures, techniques used, methods of handling, transportation, and disposal methods of wastes as well as the quantity and composition of health care waste. This study was conducted as an investigative case study, covering three different health care facilities; a hospital, a health center, and a clinic in Monrovia, Montserrado County. The average waste generation was found to be 0-7kg per day at the clinic and health center and 8-15kg per/day at the hospital. The composition of the waste includes hazardous and non-hazardous waste i.e. plastic, papers, sharps, and pathological elements etc. Nevertheless, the investigation showed that the healthcare waste generated by the surveyed healthcare facilities were not properly handled because of insufficient guidelines for separate collection, and classification, and adequate methods for storage and proper disposal of generated wastes. This therefore indicates that there is a need for improvement within the healthcare waste management system to improve the existing situation.Keywords: disposal, healthcare waste, management, Montserrado County, Monrovia
Procedia PDF Downloads 34925726 Assessment of the Impact of Atmospheric Air, Drinking Water and Socio-Economic Indicators on the Primary Incidence of Children in Altai Krai
Authors: A. P. Pashkov
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The number of environmental factors that adversely affect children's health is growing every year; their combination in each territory is different. The contribution of socio-economic factors to the health status of the younger generation is increasing. It is the child’s body that is most sensitive to changes in environmental conditions, responding to this with a deterioration in health. Over the past years, scientists have determined the influence of environmental factors and the incidence of children. Currently, there is a tendency to study regional characteristics of the interaction of a combination of environmental factors with the child's body. The aim of the work was to identify trends in the primary non-infectious morbidity of the children of the Altai Territory as a unique region that combines territories with different levels of environmental quality indicators, as well as to assess the effect of atmospheric air, drinking water and socio-economic indicators on the incidence of children in the region. An unfavorable tendency has been revealed in the region for incidence of such nosological groups as neoplasms, including malignant ones, diseases of the endocrine system, including obesity and thyroid disease, diseases of the circulatory system, digestive diseases, diseases of the genitourinary system, congenital anomalies, and respiratory diseases. Between some groups of diseases revealed a pattern of geographical distribution during mapping and a significant correlation. Some nosologies have a relationship with socio-economic indicators for an integrated assessment: circulatory system diseases, respiratory diseases (direct connection), endocrine system diseases, eating disorders, and metabolic disorders (feedback). The analysis of associations of the incidence of children with average annual concentrations of substances that pollute the air and drinking water showed the existence of reliable correlation in areas of critical and intense degree of environmental quality. This fact confirms that the population living in contaminated areas is subject to the negative influence of environmental factors, which immediately affects the health status of children. The results obtained indicate the need for a detailed assessment of the influence of environmental factors on the incidence of children in the regional aspect, the formation of a database, and the development of automated programs that can predict the incidence in each specific territory. This will increase the effectiveness, including economic of preventive measures.Keywords: incidence of children, regional features, socio-economic factors, environmental factors
Procedia PDF Downloads 11625725 Reinvestment of the Urban Context in Historic Cities: The Case Study of El Sheikh Kandil Street, Rosetta, Egypt
Authors: Riham A. Ragheb, Ingy M. Naguib
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Conservation and urban investment are a prerequisite to improve the quality of life. Since the historic street is a part of the economic system, it should be able to play an important role in the city development by upgrading all services, public open spaces and reuse of historical buildings and sites. Furthermore, historical conservation enriches the political, economic, social, cultural and functional aspects of the site. Rosetta has been selected as an area of study because it has a unique character due to its possession of a variety of monuments and historical buildings. The aim of this research is to analyze the existing situation of an historic street named El Sheikh Kandil, to be able to identify the potentials and problems. The paper gives a proposal for the redesign and reinvestment of the street and the reuse for the historical buildings to serve the community, users and visitors. Then, it concludes with recommendations to improve quality of life through the rehabilitation of the historical buildings and strengthening of the cultural and historical identity of the street. Rosetta city can benefit from these development proposals by preserving and revitalizing its unique character which leads to tourism development and benefits from the new investments.Keywords: adaptive reuse, heritage street, historic investment, restoration, urban design
Procedia PDF Downloads 18025724 Strengthening Islamic Banking Customer Behavioral Intention through Value and Commitment
Authors: Mornay Roberts-Lombard
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Consumers’ perceptions of value are crucial to ensuring their future commitment and behavioral intentions. As a result, service providers, such as Islamic banks, must provide their customers with products and services that are regarded as valuable, stimulating, collaborative, and competent. Therefore, the value provided to customers must meet or surpass their expectations, which can drive customers’ commitment (affective and calculative) and eventually favorably impact their future behavioral intentions. Consequently, Islamic banks in South Africa, as a growing African market, need to obtain a better understanding of the variables that impact Islamic banking customers’ value perceptions and how these impact their future behavioral intentions. Furthermore, it is necessary to investigate how customers’ perceived value perceptions impact their affective and calculative commitment and how the latter impact their future behavioral intentions. The purpose of this study is to bridge these gaps in knowledge, as the competitiveness of the Islamic banking industry in South Africa requires a deeper understanding of the aforementioned relationships. The study was exploratory and quantitative in nature, and data was collected from 250 Islamic banking customers using self-administered questionnaires. These banking customers resided in the Gauteng province of South Africa. Exploratory factor analysis, Pearson’s coefficient analysis, and multiple regression analysis were applied to measure the proposed hypotheses developed for the study. This research will aid Islamic banks in the country in potentially strengthening customers’ future commitment (affective and calculative) and positively impact their future behavioral intentions. The findings of the study established that service quality has a significant and positive impact on perceived value. Moreover, it was determined that perceived value has a favorable and considerable impact on affective and calculative commitment, while calculative commitment has a beneficial impact on behavioral intention. The research informs Islamic banks of the importance of service engagement in driving customer perceived value, which stimulates the future affective and calculative commitment of Islamic bank customers in an emerging market context. Finally, the study proposes guidelines for Islamic banks to develop an enhanced understanding of the factors that impact the perceived value-commitment-behavioral intention link in a competitive Islamic banking market in South Africa.Keywords: perceived value, affective commitment, calculative commitment, behavioural intention
Procedia PDF Downloads 8125723 Salt Scarcity and Crisis Solution in Islam Perspective
Authors: Taufik Nugroho, Firsty Dzainuurahmana, Tika Widiastuti
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The polemic about the salt crisis re-emerged, this is a classic problem in Indonesia and is still a homework that is not finished yet. This salt crisis occurs due to low productivity of salt commodities that have not been able to meet domestic demand and lack of salt productivity caused by several factors. One of the biggest factors of the crisis is the weather anomaly that disrupts salt production, less supportive technology and price stability. This study will try to discuss the salt scarcity and crisis solution in Islamic view. As for the conclusion of this study is the need for equilibrium or balancing between demand and supply, need to optimize the role of the government as Hisbah to maintain the balance of market mechanisms and prepare the stock system of salt stock by buying farmers products at reasonable prices then storing them.Keywords: crisis, Islamic solution, scarcity, salt
Procedia PDF Downloads 29325722 Development and Implementation of E-Disease Surveillance Systems for Public Health Southern Africa: A Critical Review
Authors: Taurai T. Chikotie, Bruce W. Watson
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The manifestation of ‘new’ infectious diseases and the re-emergence of ‘old’ infectious diseases now present global problems and Southern Africa has not been spared from such calamity. Although having an organized public health system, countries in this region have failed to leverage on the proliferation in use of Information and Communication Technologies to promote effective disease surveillance. Objective: The objective of this study was to critically review and analyse the crucial variables to consider in the development and implementation of electronic disease surveillance systems in public health within the context of Southern Africa. Methodology: A critical review of literature published in English using, Google Scholar, EBSCOHOST, Science Direct, databases from the Centre for Disease Control (CDC and articles from the World Health Organisation (WHO) was undertaken. Manual reference and grey literature searches were also conducted. Results: Little has been done towards harnessing the potential of information technologies towards disease surveillance and this has been due to several challenges that include, lack of funding, lack of health informatics experts, poor supporting infrastructure, an unstable socio-political and socio-economic ecosystem in the region and archaic policies towards integration of information technologies in public health governance. Conclusion: The Southern African region stands to achieve better health outcomes if they adopt the use of e-disease surveillance systems in public health. However, the dynamics and complexities of the socio-economic, socio-political and technical variables would need addressing to ensure the successful development and implementation of e-disease surveillance systems in the region.Keywords: critical review, disease surveillance, public health informatics, Southern Africa
Procedia PDF Downloads 28525721 Real-Time Fitness Monitoring with MediaPipe
Authors: Chandra Prayaga, Lakshmi Prayaga, Aaron Wade, Kyle Rank, Gopi Shankar Mallu, Sri Satya, Harsha Pola
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In today's tech-driven world, where connectivity shapes our daily lives, maintaining physical and emotional health is crucial. Athletic trainers play a vital role in optimizing athletes' performance and preventing injuries. However, a shortage of trainers impacts the quality of care. This study introduces a vision-based exercise monitoring system leveraging Google's MediaPipe library for precise tracking of bicep curl exercises and simultaneous posture monitoring. We propose a three-stage methodology: landmark detection, side detection, and angle computation. Our system calculates angles at the elbow, wrist, neck, and torso to assess exercise form. Experimental results demonstrate the system's effectiveness in distinguishing between good and partial repetitions and evaluating body posture during exercises, providing real-time feedback for precise fitness monitoring.Keywords: physical health, athletic trainers, fitness monitoring, technology driven solutions, Google’s MediaPipe, landmark detection, angle computation, real-time feedback
Procedia PDF Downloads 6825720 Software Defined Storage: Object Storage over Hadoop Platform
Authors: Amritesh Srivastava, Gaurav Sharma
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The purpose of this project is to develop an open source object storage system that is highly durable, scalable and reliable. There are two representative systems in cloud computing: Google and Amazon. Their storage systems for Google GFS and Amazon S3 provide high reliability, performance and stability. Our proposed system is highly inspired from Amazon S3. We are using Hadoop Distributed File System (HDFS) Java API to implement our system. We propose the architecture of object storage system based on Hadoop. We discuss the requirements of our system, what we expect from our system and what problems we may encounter. We also give detailed design proposal along with the abstract source code to implement it. The final goal of the system is to provide REST based access to our object storage system that exists on top of HDFS.Keywords: Hadoop, HBase, object storage, REST
Procedia PDF Downloads 34125719 Sewage Sludge Management: A Case Study of Monrovia, Montserrado County, Liberia
Authors: Victor Emery David Jr, Md S. Hossain
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Sewage sludge management has been a problem faced by most developing cities as in the case of Monrovia. The management of sewage sludge in Monrovia is still in its infant stage. The city is still struggling with poor sanitation, clogged pipes, shortage of septic tanks, lack of resources/human capacity, inadequate treatment facilities, open defecation, the absence of clear guidelines, etc. The rapid urban population growth of Monrovia has severely stressed Monrovia’s marginally functional urban WSS system caused by the civil conflict which led to break down in many sectors as well as infrastructure. The sewerage system which originally covered 17% of the population of Monrovia was down to serving about 7% because of bursts and blockages causing backflows in other areas. Prior to the Civil War, the average water production for Monrovia was about 68,000 m3/day but has now dropped to about 10,000 m3/day. Only small parts of Monrovia currently have direct access to the piped water supply while most areas depend on trucked water delivered to community collection points or household tanks, and/or on water from unprotected dug wells or hand pumps. There are only two functional treatment plants; The Fiamah Treatment plant and the White Plains Treatment Plant.Keywords: Fiamah Treatment plant, management, Monrovia/Montserrado County, sewage, sludge
Procedia PDF Downloads 29225718 Freshwater Pinch Analysis for Optimal Design of the Photovoltaic Powered-Pumping System
Authors: Iman Janghorban Esfahani
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Due to the increased use of irrigation in agriculture, the importance and need for highly reliable water pumping systems have significantly increased. The pumping of the groundwater is essential to provide water for both drip and furrow irrigation to increase the agricultural yield, especially in arid regions that suffer from scarcities of surface water. The most common irrigation pumping systems (IPS) consume conventional energies through the use of electric motors and generators or connecting to the electricity grid. Due to the shortage and transportation difficulties of fossil fuels, and unreliable access to the electricity grid, especially in the rural areas, and the adverse environmental impacts of fossil fuel usage, such as greenhouse gas (GHG) emissions, the need for renewable energy sources such as photovoltaic systems (PVS) as an alternative way of powering irrigation pumping systems is urgent. Integration of the photovoltaic systems with irrigation pumping systems as the Photovoltaic Powered-Irrigation Pumping System (PVP-IPS) can avoid fossil fuel dependency and the subsequent greenhouse gas emissions, as well as ultimately lower energy costs and improve efficiency, which made PVP-IPS systems as an environmentally and economically efficient solution for agriculture irrigation in every region. The greatest problem faced by integration of PVP with IPS systems is matching the intermittence of the energy supply with the dynamic water demand. The best solution to overcome the intermittence is to incorporate a storage system into the PVP-IPS to provide water-on-demand as a highly reliable stand-alone irrigation pumping system. The water storage tank (WST) is the most common storage device for PVP-IPS systems. In the integrated PVP-IPS with a water storage tank (PVP-IPS-WST), a water storage tank stores the water pumped by the IPS in excess of the water demand and then delivers it when demands are high. The Freshwater pinch analysis (FWaPA) as an alternative to mathematical modeling was used by other researchers for retrofitting the off-grid battery less photovoltaic-powered reverse osmosis system. However, the Freshwater pinch analysis has not been used to integrate the photovoltaic systems with irrigation pumping system with water storage tanks. In this study, FWaPA graphical and numerical tools were used for retrofitting an existing PVP-IPS system located in Salahadin, Republic of Iraq. The plant includes a 5 kW submersible water pump and 7.5 kW solar PV system. The Freshwater Composite Curve as the graphical tool and Freashwater Storage Cascade Table as the numerical tool were constructed to determine the minimum required outsourced water during operation, optimal amount of delivered electricity to the water pump, and optimal size of the water storage tank for one-year operation data. The results of implementing the FWaPA on the case study show that the PVP-IPS system with a WST as the reliable system can reduce outsourced water by 95.41% compare to the PVP-IPS system without storage tank.Keywords: irrigation, photovoltaic, pinch analysis, pumping, solar energy
Procedia PDF Downloads 13925717 Analysis of Distance Travelled by Plastic Consumables Used in the First 24 Hours of an Intensive Care Admission: Impacts and Methods of Mitigation
Authors: Aidan N. Smallwood, Celestine R. Weegenaar, Jack N. Evans
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The intensive care unit (ICU) is a particularly resource heavy environment, in terms of staff, drugs and equipment required. Whilst many areas of the hospital are attempting to cut down on plastic use and minimise their impact on the environment, this has proven challenging within the confines of intensive care. Concurrently, as globalization has progressed over recent decades, there has been a tendency towards centralised manufacturing with international distribution networks for products, often covering large distances. In this study, we have modelled the standard consumption of plastic single-use items over the course of the first 24-hours of an average individual patient’s stay in a 12 bed ICU in the United Kingdom (UK). We have identified the country of manufacture and calculated the minimum possible distance travelled by each item from factory to patient. We have assumed direct transport via the shortest possible straight line from country of origin to the UK and have not accounted for transport within either country. Assuming an intubated patient with invasive haemodynamic monitoring and central venous access, there are a total of 52 distincts, largely plastic, disposable products which would reasonably be required in the first 24-hours after admission. Each product type has only been counted once to account for multiple items being shipped as one package. Travel distances from origin were summed to give the total distance combined for all 52 products. The minimum possible total distance travelled from country of origin to the UK for all types of product was 273,353 km, equivalent to 6.82 circumnavigations of the globe, or 71% of the way to the moon. The mean distance travelled was 5,256 km, approximately the distance from London to Mecca. With individual packaging for each item, the total weight of consumed products was 4.121 kg. The CO2 produced shipping these items by air freight would equate to 30.1 kg, however doing the same by sea would produce 0.2 kg CO2. Extrapolating these results to the 211,932 UK annual ICU admissions (2018-2019), even with the underestimates of distance and weight of our assumptions, air freight would account for 6586 tons CO2 emitted annually, approximately 130 times that of sea freight. Given the drive towards cost saving within the UK health service, and the decline of the local manufacturing industry, buying from intercontinental manufacturers is inevitable However, transporting all consumables by sea where feasible would be environmentally beneficial, as well as being less costly than air freight. At present, the NHS supply chain purchases from medical device companies, and there is no freely available information as to the transport mode used to deliver the product to the UK. This must be made available to purchasers in order to give a fuller picture of life cycle impact and allow for informed decision making in this regard.Keywords: CO2, intensive care, plastic, transport
Procedia PDF Downloads 18325716 Techno-Economic Analysis of Offshore Hybrid Energy Systems with Hydrogen Production
Authors: Anna Crivellari, Valerio Cozzani
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Even though most of the electricity produced in the entire world still comes from fossil fuels, new policies are being implemented in order to promote a more sustainable use of energy sources. Offshore renewable resources have become increasingly attractive thanks to the huge entity of power potentially obtained. However, the intermittent nature of renewables often limits the capacity of the systems and creates mismatches between supply and demand. Hydrogen is foreseen to be a promising vector to store and transport large amounts of excess renewable power by using existing oil and gas infrastructure. In this work, an offshore hybrid energy system integrating wind energy conversion with hydrogen production was conceptually defined and applied to offshore gas platforms. A techno-economic analysis was performed by considering two different locations for the installation of the innovative power system, i.e., the North Sea and the Adriatic Sea. The water depth, the distance of the platform from the onshore gas grid, the hydrogen selling price and the green financial incentive were some of the main factors taken into account in the comparison. The results indicated that the use of well-defined indicators allows to capture specifically different cost and revenue features of the analyzed systems, as well as to evaluate their competitiveness in the actual and future energy market.Keywords: cost analysis, energy efficiency assessment, hydrogen production, offshore wind energy
Procedia PDF Downloads 12825715 Management of Interdependence in Manufacturing Networks
Authors: Atour Taghipour
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In the real world each manufacturing company is an independent business unit. These business units are linked to each other through upstream and downstream linkages. The management of these linkages is called coordination which, could be considered as a difficult engineering task. The degree of difficulty of coordination depends on the type and the nature of information exchanged between partners as well as the structure of relationship from mutual to the network structure. The literature of manufacturing systems comprises a wide range of varieties of methods and approaches of coordination. In fact, two main streams of research can be distinguished: central coordination versus decentralized coordination. In the centralized systems a high degree of information exchanges is required. The high degree of information exchanges sometimes leads to difficulties when independent members do not want to share information. In order to address these difficulties, decentralized approaches of coordination of operations planning decisions based on some minimal information sharing have been proposed in many academic disciplines. This paper first proposes a framework of analysis in order to analyze the proposed approaches in the literature, based on this framework which includes the similarities between approaches we categorize the existing approaches. This classification can be used as a research map for future researches. The result of our paper highlights several opportunities for future research. First, it is proposed to develop more dynamic and stochastic mechanisms of planning coordination of manufacturing units. Second, in order to exploit the complementarities of approaches proposed by diverse science discipline, we propose to integrate the techniques of coordination. Finally, based on our approach we proposed to develop coordination standards to guaranty both the complementarity of these approaches as well as the freedom of companies to adopt any planning tools.Keywords: network coordination, manufacturing, operations planning, supply chain
Procedia PDF Downloads 28525714 Bayesian Semiparametric Geoadditive Modelling of Underweight Malnutrition of Children under 5 Years in Ethiopia
Authors: Endeshaw Assefa Derso, Maria Gabriella Campolo, Angela Alibrandi
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Objectives:Early childhood malnutrition can have long-term and irreversible effects on a child's health and development. This study uses the Bayesian method with spatial variation to investigate the flexible trends of metrical covariates and to identify communities at high risk of injury. Methods: Cross-sectional data on underweight are collected from the 2016 Ethiopian Demographic and Health Survey (EDHS). The Bayesian geo-additive model is performed. Appropriate prior distributions were provided for scall parameters in the models, and the inference is entirely Bayesian, using Monte Carlo Markov chain (MCMC) stimulation. Results: The results show that metrical covariates like child age, maternal body mass index (BMI), and maternal age affect a child's underweight non-linearly. Lower and higher maternal BMI seem to have a significant impact on the child’s high underweight. There was also a significant spatial heterogeneity, and based on IDW interpolation of predictive values, the western, central, and eastern parts of the country are hotspot areas. Conclusion: Socio-demographic and community- based programs development should be considered compressively in Ethiopian policy to combat childhood underweight malnutrition.Keywords: bayesX, Ethiopia, malnutrition, MCMC, semi-parametric bayesian analysis, spatial distribution, P- splines
Procedia PDF Downloads 9425713 Study of Two MPPTs for Photovoltaic Systems Using Controllers Based in Fuzzy Logic and Sliding Mode
Authors: N. Ould cherchali, M. S. Boucherit, L. Barazane, A. Morsli
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Photovoltaic power is widely used to supply isolated or unpopulated areas (lighting, pumping, etc.). Great advantage is that this source is inexhaustible, it offers great safety in use and it is clean. But the dynamic models used to describe a photovoltaic system are complicated and nonlinear and due to nonlinear I-V and P–V characteristics of photovoltaic generators, a maximum power point tracking technique (MPPT) is required to maximize the output power. In this paper, two online techniques of maximum power point tracking using robust controller for photovoltaic systems are proposed, the first technique use fuzzy logic controller (FLC) and the second use sliding mode controller (SMC) for photovoltaic systems. The two maximum power point tracking controllers receive the partial derivative of power as inputs, and the output is the duty cycle corresponding to maximum power. A Photovoltaic generator with Boost converter is developed using MATLAB/Simulink to verify the preferences of the proposed techniques. SMC technique provides a good tracking speed in fast changing irradiation and when the irradiation changes slowly or is constant the panel power of FLC technique presents a much smoother signal with less fluctuations.Keywords: fuzzy logic controller, maximum power point, photovoltaic system, tracker, sliding mode controller
Procedia PDF Downloads 54925712 Witchcraft Belief and HIV/AIDS in Edo State, Nigeria: Implications for Health-Care
Authors: Celestina Omoso Isiramen
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The influence of witchcraft belief on disease causation, cure and public health system in Nigeria cannot be underrated. This paper investigated the nexus between witchcraft phenomenon and health-seeking behaviour of HIV sufferers in Edo state, Nigeria. Survey methodology was adopted and stratified random sampling technique was employed in the selection of 600 sample group spread into 200 HIV sufferers, 200 spiritual healers and 200 bio-medics from the three Senatorial districts of the state. Data were collected through the use of structured questionnaire and in-dept interview and analyzed using simple percentage and frequency. Major findings were: belief in witchcraft significantly influenced the people’s perception of HIV causation and wellness and this impacted adversely on public health-care. Poverty, ignorance and dearth of retroviral drugs enhanced the people’s recourse to spiritual healers. Collaboration between spiritual healing techniques and biomedicine was recommended as panacea for curbing HIV/AIDS related morbidity and mortality. It concluded that socio-economic problems must be addressed while the importance of integrating the values of spiritual healing into biomedicine cannot be overstressed.Keywords: biomedicine, health care, HIV/AIDS, spirituality, witchcraft
Procedia PDF Downloads 14325711 The Optimal Location of Brickforce in Brickwork
Authors: Sandile Daniel Ngidi
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A brickforce is a product consisting of two main parallel wires joined by in-line welded cross wires. Embedded in the normal thickness of the brickwork joint, the wires are manufactured to a flattened profile to simplify location into the mortar joint without steel build-up problems at lap positions corners/junctions or when used in conjunction with wall ties. A brickforce has been in continuous use since 1918. It is placed in the cement between courses of bricks. Brickforce is used in every course of the foundations and every course above lintel height. Otherwise, brickforce is used every fourth course in between the foundations and lintel height or a concrete slab and lintel height. The brickforce strengthens and stabilizes the wall, especially if you are building on unstable ground. It provides brickwork increased resistance to tensional stresses. Brickforce uses high tensile steel wires, which can withstand high forces but with a very little stretch. This helps to keep crack widths to a minimum. Recently a debate has opened about the purpose of using brickforce in single-story buildings. The debate has been compounded by the fact that there is no consensus about the spacing of brickforce in brickwork or masonry. In addition, very little information had been published on the relative merits of using the same size of brickforce for the different atmospheric conditions in South Africa. This paper aims to compare different types of brickforce systems used in different countries. Conclusions are made to identify the point and location of brickforce that optimize the system.Keywords: brickforce, masonry concrete, reinforcement, strengthening, wall panels
Procedia PDF Downloads 23225710 Therapeutic Nihilism: Challenging Aging Diseases in Cameroon
Authors: Chick Loveline Ayoh Epse Ndi
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Our cultural stance has deep implications for the psychological and physical well-being of the old. Cameroon is still rooted on the traditional belief that stipulates that; the aged are best catered for in the family setting where the children and grandchildren are supposed to give in return for services invested on them by the former. This is why up till date, there are no “Rest Homes” or “Convalescent hospitals” despite the rising challenges faced by the aged in this context. Beside the special measure set aside to cater for the aged, such as “Rest Homes” for the healthy, “Convalescent hospitals” are created set to cater for the health of the aged in the Western context with other facilities such as geriatric units. The health care practitioners are aware of aging diseases and have trained human resources like Gerontologists to cater for the aged and aging diseases. Meanwhile, in Africa and Cameroon in particular, such infrastructural and human resources are still to be considered in the health care system. It can be assumed that the aged and aging diseases are still to be considered in the health care system in this context. This is why we talk of therapeutic nihilism, where the aged are mixed up with other categories of patients with no special attention given to them. This qualitative study carried out in the Yaounde, the capital city of Cameroon, with their best referent hospitals, reveal that; the aged and aging diseases are still a myth in this context. Data collected in both private and public health institutions show that there is only one public institution in Cameroon that has a geriatric unit with no specialists. Patients who aretreated in this unit are considered as aged with terminal diseases that need palliative care and not intensive care. Cameroon is still lacking in terms of health care to the aged and ageing diseases. Like other patients, the aged are treated with a lot of laxity and no value. There is an emergency to create special health care units for geriatrics and and train gerontologist. Mentally or physically ill aged faced medical rational with psychodynamic treatment considered as waste of time. The aged are less likely to be regarded salvageable when they enter a hospital in serious conditions due to the lack of specialists and geriatric units for them. The implication of this study is to sensitization the stake holders for an urgent need to extend special care units for the aged and aging diseases in this context.Keywords: challeng, therapy, agtng, diseases cameroon
Procedia PDF Downloads 9825709 Optimization of Culture Conditions of Paecilomyces tenuipes, Entomopathogenic Fungi Inoculated into the Silkworm Larva, Bombyx mori
Authors: Sunghee Nam
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Entomopathogenic fungi is a Cordyceps species that is isolated from dead silkworm and cicada. Fungi on cicadas were described in old Chinese medicinal books and from ancient times, vegetable wasps and plant worms were widely known to have active substance and have been studied for pharmacological use. Among many fungi belonging to the genus Cordyceps, Cordyceps sinensis have been demonstrated to yield natural products possessing various biological activities and many bioactive components. Generally, It is commonly used to replenish the kidney and soothe the lung, and for the treatment of fatigue. Due to their commercial and economic importance, the demand for Cordyceps has been rapidly increased. However, a supply of Cordyceps specimen could not meet the increasing demand because of their sole dependence on field collection and habitat destruction. Because it is difficult to obtain many insect hosts in nature and the edibility of host insect needs to be verified in a pharmacological aspect. Recently, this setback was overcome that P. tenuipes was able to be cultivated in a large scale using silkworm as host. Pharmacological effects of P. tenuipes cultured on silkworm such as strengthening immune function, anti-fatigue, anti-tumor activity and controlling liver etc. have been proved. They are widely commercialized. In this study, we attempted to establish a method for stable growth inhibition of P. tenuipes on silkworm hosts and an optimal condition for synnemata formation. To determine optimum culturing conditions, temperature and light conditions were varied. The length and number of synnemata was highest at 25℃ temperature and 100~300 lux illumination. On an average, the synnemata of wild P. tenuipes measures 70 ㎜ in length and 20 in number; those of the cultured strain were relatively shorter and more in number. The number of synnemata may have increased as a result of inoculating the host with highly concentrated conidia, while the length may have decreased due to limited nutrition per individual. It is not able that changes in light illumination cause morphological variations in the synnemata. However, regulation of only light and temperature could not produce stromata like perithecia, asci, and ascospores.Keywords: optimization of culture conditions of paecilomyces tenuipes, entomopathogenic fungi optimization of culture conditions of paecilomyces tenuipes, entomopathogenic fungi silkworm larva, bombyx mori
Procedia PDF Downloads 25325708 Deficiencies in Vitamin A and Iron Supply Potential of Selected Indigenous Complementary Foods of Infants in Uganda
Authors: Richard Kajjura, Joyce Kikafunda, Roger Whitehead
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Introduction: Indigenous complementary recipes for children (6-23 months) are bulky and inextricably linked. The potential contribution of indigenous complementary foods to infant’s vitamin A and iron needs is not well investigated in Uganda. Less is known whether children in Uganda are living with or without adequate supply of vitamin A and iron nutrients. In this study, vitamin A and iron contents were assessed in the complementary foods fed to infants aged 6-11 months in a Peri-urban setting in Kampala District in Central Uganda. Objective: Assessment of vitamin A and iron contents of indigenous complementary foods of children as fed and associated demographic factor. Method: In a cross sectional study design, one hundred and three (153) households with children aged 6-11 months were randomly selected to participate in the assessment. Complementary food samples were collected from the children’s mothers/caretakers at the time of feeding the child. The mothers’ socio-demographic characteristics of age, education, marital status, occupation and sex collected a semi-qualitative questionnaire. The Vitamin A and iron contents in the complementary foods were analyzed using a UV/VIS spectrophotometer for vitamin A and Atomic Absorption spectrophotometer for iron samples. The data was analyzed using Gene-stat software program. Results: The mean vitamin A content was 97.0± 72.5 µg while that of iron was 1.5 ± 0.4 mg per 100g of food sample as fed. The contribution of indigenous complementary foods found was 32% for vitamin A and 15% iron of the recommended dietary allowance. Age of children was found to be significantly associated Vitamin A and Iron supply potential. Conclusion: The contribution of indigenous complementary foods to infant’s vitamin A and iron needs was low. Complementary foods in Uganda are more likely to be deficient in vitamin A and iron content. Nutrient dense dietary supplementation should be intervened in to make possible for Ugandan children attain full growth potential.Keywords: indigenous complementary food, infant, iron, vitamin A
Procedia PDF Downloads 48025707 Catalytic Deoxygenation of Non-Edible Oil to Renewable Fuel by Using Calcium-Based Nanocatalyst
Authors: Hwei Voon Lee, N. Asikin-Mijana, Y. H. Taufiq-Yap, J. C. Juan, N. A. Rahman
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Cracking–Deoxygenation process is one of the important reaction pathways for the production of bio-fuel with desirable n-C17 hydrocarbon chain via removal of oxygen compounds. Calcium-based catalyst has attracted much attention in deoxygenation process due to its relatively high capacity in removing oxygenated compounds in the form of CO₂ and CO under decarboxylation and decarbonylation reaction, respectively. In the present study, deoxygenation of triolein was investigated using Ca(OH)₂ nanocatalyst derived from low cost natural waste shells. The Ca(OH)₂ nanocatalyst was prepared via integration techniques between surfactant treatment (anionic and non-ionic) and wet sonochemical effect. Results showed that sonochemically assisted surfactant treatment has successfully enhanced the physicochemical properties of Ca(OH)₂ nanocatalyst in terms of nanoparticle sizes (∼50 nm), high surface area(∼130 m²g⁻¹), large porosity (∼18.6 nm) and strong basic strength. The presence of superior properties from surfactant treated Ca(OH)₂ nanocatalysts rendered high deoxygenation degree, which is capable of producing high alkane and alkene selectivity in chain length of n-C17(high value of C17/(n-C17+ n-C18)ratio = 0.88). Furthermore, both Ca(OH)₂–EG and Ca(OH)₂–CTAB nanocatalysts showed high reactivity with 47.37% and 44.50%, respectively in total liquid hydrocarbon content of triolein conversion with high H/C and low O/C ratio.Keywords: clamshell, cracking, decarboxylation-decarbonylation, hydrocarbon
Procedia PDF Downloads 18925706 An Estimation of Rice Output Supply Response in Sierra Leone: A Nerlovian Model Approach
Authors: Alhaji M. H. Conteh, Xiangbin Yan, Issa Fofana, Brima Gegbe, Tamba I. Isaac
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Rice grain is Sierra Leone’s staple food and the nation imports over 120,000 metric tons annually due to a shortfall in its cultivation. Thus, the insufficient level of the crop's cultivation in Sierra Leone is caused by many problems and this led to the endlessly widening supply and demand for the crop within the country. Consequently, this has instigated the government to spend huge money on the importation of this grain that would have been otherwise cultivated domestically at a cheaper cost. Hence, this research attempts to explore the response of rice supply with respect to its demand in Sierra Leone within the period 1980-2010. The Nerlovian adjustment model to the Sierra Leone rice data set within the period 1980-2010 was used. The estimated trend equations revealed that time had significant effect on output, productivity (yield) and area (acreage) of rice grain within the period 1980-2010 and this occurred generally at the 1% level of significance. The results showed that, almost the entire growth in output had the tendency to increase in the area cultivated to the crop. The time trend variable that was included for government policy intervention showed an insignificant effect on all the variables considered in this research. Therefore, both the short-run and long-run price response was inelastic since all their values were less than one. From the findings above, immediate actions that will lead to productivity growth in rice cultivation are required. To achieve the above, the responsible agencies should provide extension service schemes to farmers as well as motivating them on the adoption of modern rice varieties and technology in their rice cultivation ventures.Keywords: Nerlovian adjustment model, price elasticities, Sierra Leone, trend equations
Procedia PDF Downloads 23725705 A Drop of Water for the Thirsty Ground: Implementing Drip-Irrigation System as an Alternative to the Existing System to Promote Sustainable Livelihoods in the Archipelagic Dryland East Nusa Tenggara, Indonesia
Authors: F. L. Benu, I. W. Mudita, R. L. Natonis
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East Nusa Tenggara, together with part of East Java, West Nusa Tenggara, and Maluku, has been included as part of global drylands defined according to the ratio of annual precipitation (P) and annual potential evaporation (PET) and major vegetation types of grassland and savannah ecosystems. These tropical drylands are unique because, whereas drylands in other countries are mostly continental, here they are archipelagic. These archipelagic drylands are also unique in terms of being included because of more on their major vegetation types than of their P/PET ratio. Slash-and-burn cultivation and free roaming animal husbandry are two major livelihoods being widely practiced, along with alternative seasonal livelihood such as traditional fishing. Such livelihoods are vulnerable in various respects, especially because of drought, which becomes more unpredictable in the face of climate changes. To cope with such vulnerability, semi-intensive farming using drip irrigation is implemented as an appropriate technology with the goal of promoting a more sustainable alternative to the existing livelihoods. The implementation was started in 2016 with a pilot system at the university field laboratory in Kupang in which various designs of installation were tested. The modified system consisting of an uplifted water reservoir and solar-powered pump was tested in Papela, the District of Rote-Ndao, in 2017 to convince fishermen who had been involved in illegal fishing in Australia-Indonesia transboundary waters, to adopt small-scale farming as a more sustainable alternative to their existing livelihoods. The system was again tested in a larger coverage in Oesena, the District of Kupang, in 2018 to convince slash-and-burn cultivators to adopt an environmentally friendlier cultivation system. From the implementation of the modified system in both sites, the participating fishermen in Papela were able to manage the system under tight water supply to grow chili pepper, tomatoes, and watermelon and the slash-and-burn cultivators in Oesena to grow chili pepper in a more efficient water use than water use in a conventional irrigation system. The gross margin obtained from growing chili pepper, tomatoes, and watermelon in Papela and from growing chili pepper in Oesena showed that small-scale farming using drip irrigation system was a promising alternative to local people in generating cash income to support their livelihoods. However, before promoting this appropriate technology as a more sustainable alternative to the existing livelihoods elsewhere in the region, better understanding on social-related contexts of the implementation is needed.Keywords: archipelagic drylands, drip irrigation system, East Nusa Tenggara, sustainable livelihoods
Procedia PDF Downloads 11725704 Interdisciplinary Teaching for Nursing Students: A Key to Understanding Teamwork
Authors: Ilana Margalith, Yaron Niv
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One of the most important factors of professional health treatment is teamwork, in which each discipline contributes its expert knowledge, thus ensuring quality and a high standard of care as well as efficient communication (one of the International Patient Safety Goals). However, in most countries, students are educated separately by each health discipline. They are exposed to teamwork only during their clinical experience, which in some cases is short and skill-oriented. In addition, health organizations in most countries are hierarchical and although changes have occurred in the hierarchy of the medical system, there are still disciplines that underrate the unique contributions of other health professionals, thus, young graduates of health professions develop and base their perception of their peers from other disciplines on insufficient knowledge. In order to establish a wide-ranging perception among nursing students as to the contribution of different health professionals to the health of their patients, students at the Clalit Nursing Academy, Rabin Campus (Dina), Israel, participated in an interdisciplinary clinical discussion with students from several different professions, other than nursing, who were completing their clinical experience at Rabin Medical Center in medicine, health psychology, social work, audiology, physiotherapy and occupational therapy. The discussion was led by a medical-surgical nursing instructor. Their tutors received in advance, a case report enabling them to prepare the students as to how to present their professional theories and interventions regarding the case. Mutual stimulation and acknowledgment of the unique contribution of each part of the team enriched the nursing students' understanding as to how their own nursing interventions could be integrated into the entire process towards a safe and speedy recovery of the patient.Keywords: health professions' students, interdisciplinary clinical discussion, nursing education, patient safety
Procedia PDF Downloads 17325703 The Management of Care by People with Type 2 Diabetes versus the Professional Care at Primary Health Care in Brazil
Authors: Nunila Ferreira de Oliveira, Silvana Martins Mishima
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Diabetes mellitus type 2 (DM2) prevalence, is increasing on the world, in Brazil is considered a public health problem. Treatment focuses on glycemic control depending primarily of lifestyle changes - not drug treatment (NDT), may involve drug therapy (DT) and requires continuous health monitoring. In Brazil this monitoring is performed by the Unified Health System (SUS) through Primary Health Care (PHC), which stimulate people with DM2 empowerment for care management. SUS was approved in 1988 and the PHC operationalization was strengthened with the creation of the Family Health Strategy (FHS) in 1994. Our aim was to analyze the people with DM2 participation in front of the care management health monitoring in the FHS. Qualitative research was carried out through non-participant observation of attendance of 25 people with DM2 in the FHS and interviewed at home. Ethical guidelines were followed. It was found that people with DM2 only follow professionals’ recommendations that make sense according to their own conceptions of health/disease; most of them emphasize the importance of (DT) with little emphasis on the NDT, was found great difficulty in the NDT and lack of knowledge about the disease and care. As regards monitoring the FHS, were observed therapeutic practices based on the bio medical model, although the APS search for another care perspective; NDT is not systematically accompanied by the health team and takes place a few educational activities on the DM2 in the FHS, with low user adoption. The work of the FHS is done by multidisciplinary teams, but we see the need for greater participation of nurses in clinical-care follow-up of this population and may also act in adapting to the NDT. Finally we emphasize the need for professional practices that consider the difficulties to care management by people with DM2, especially because of the NDT. It is noticed that the measures recommended by the FHS professionals are not always developed by people with DM2. We must seek the empowerment of people with DM2 to manage the form of care associated with the FHS team, seeking to reduce the incidence of complications and higher quality of life.Keywords: diabetes mellitus, primary health care, nursing, management of care
Procedia PDF Downloads 457