Search results for: healthcare facility

Authors: Man-Yun Liu, Emily Chia-Yu Su

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Alzheimer's disease (AD) is the public health crisis of the 21st century. AD is a degenerative brain disease and the most common cause of dementia, a costly disease on the healthcare system. Unfortunately, the cause of AD is poorly understood, furthermore; the treatments of AD so far can only alleviate symptoms rather cure or stop the progress of the disease. Currently, there are several ways to diagnose AD; medical imaging can be used to distinguish between AD, other dementias, and early onset AD, and cerebrospinal fluid (CSF). Compared with other diagnostic tools, blood (plasma) test has advantages as an approach to population-based disease screening because it is simpler, less invasive also cost effective. In our study, we used blood biomarkers dataset of The Alzheimer’s disease Neuroimaging Initiative (ADNI) which was funded by National Institutes of Health (NIH) to do data analysis and develop a prediction model. We used independent analysis of datasets to identify plasma protein biomarkers predicting early onset AD. Firstly, to compare the basic demographic statistics between the cohorts, we used SAS Enterprise Guide to do data preprocessing and statistical analysis. Secondly, we used logistic regression, neural network, decision tree to validate biomarkers by SAS Enterprise Miner. This study generated data from ADNI, contained 146 blood biomarkers from 566 participants. Participants include cognitive normal (healthy), mild cognitive impairment (MCI), and patient suffered Alzheimer’s disease (AD). Participants’ samples were separated into two groups, healthy and MCI, healthy and AD, respectively. We used the two groups to compare important biomarkers of AD and MCI. In preprocessing, we used a t-test to filter 41/47 features between the two groups (healthy and AD, healthy and MCI) before using machine learning algorithms. Then we have built model with 4 machine learning methods, the best AUC of two groups separately are 0.991/0.709. We want to stress the importance that the simple, less invasive, common blood (plasma) test may also early diagnose AD. As our opinion, the result will provide evidence that blood-based biomarkers might be an alternative diagnostics tool before further examination with CSF and medical imaging. A comprehensive study on the differences in blood-based biomarkers between AD patients and healthy subjects is warranted. Early detection of AD progression will allow physicians the opportunity for early intervention and treatment.

Keywords: Alzheimer's disease, blood-based biomarkers, diagnostics, early detection, machine learning

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Authors: Nicole Marella G. Tan, Al Joseph R. Molina, Raisa Celine R. Rosete, Soraya Elisse E. Escandor, Blythe N. Ke, Veronica Marie E. Ramos, Apolinario Ericson B. Berberabe, Jose Jonas D. del Rosario, Regina Pascua-Berba, Eileen Liesl A. Cubillan, Winlove P. Mojica

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Emergency risk and health communications play a vital role in any pandemic response. However, the Philippine General Hospital (PGH) lacked a system of information delivery that could effectively fulfill the hospital’s communication needs as a COVID-19 referral hospital. This study aimed to describe the establishment of a communication framework for information dissemination within a tertiary government hospital during the COVID-19 pandemic and evaluated the perceived usefulness of its outputs. This is a mixed quantitative-qualitative study with two phases. Phase 1 documented the formation and responsibilities of the Information Education Communication (IEC) Committee. Phase 2 evaluated its output and outcomes through a hospital-wide survey of 528 healthcare workers (HCWs) using a pre-tested questionnaire. In-depth explanations were obtained from five focused group discussions (FGD) amongst various HCW subgroups. Descriptive analysis was done using STATA 16 while qualitative data were synthesized thematically. Communication practices in PGH were loosely structured at the beginning of the pandemic until the establishment of the IEC Committee. The IEC Committee was well-represented by concerned stakeholders. Nine types of infographics tackled different aspects of the hospital’s health operations after thorough inputs from concerned offices. Internal and external feedback mechanisms ensured accurate infographics. Majority of the survey respondents (98.67%) perceived these as useful in their work or daily lives. FGD participants cited the relevance of infographics to their occupations, suggested improvements, and hoped that these efforts would be continued in the future. Sustainability and comprehensive reach were the main concerns in this undertaking. The PGH COVID-19 IEC framework was developed through trial and testing as there were no existing formal structures to communicate health risks and to properly direct the HCWs in the chaotic time of a pandemic. It is a continuously evolving framework which is perceived as useful by HCWs and is hoped to be sustained in the future.

Keywords: COVID-19, pandemic, health communication, infographics, social media

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Authors: Semira Zeru Haileslassie

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Lack of awareness and practices of PEP treatment were observed among respondents, but they had a better attitude towards PEP. To this end, a formal training for all respondents regarding PEP for HIV prior to their clinical attachments is of utmost importance. The training ought to incorporate a brief clarification with respect to the unpleasant impact of non-adherence that essentially incorporate destitute treatment result and most prominent hazard of resistance and few given as a major cause for non-compliance to PEP, common transient side-effects of PEP and its administrations ought to be cloister educated healthcare specialists to diminish its effect on adherence. Besides, the propensity of detailing needle adhere harm was destitute that needs endeavors to progress. Progressing the culture of detailing and making the detailing handle simple is very necessary. In reality, announcing such wounds as early as conceivable will educate others not to commit same issue once more and, for the most part, will empower stakeholders to intercede the issue sometime prior to it re-occur. At long last, as distant as get up and go utilize has cleared out with so numerous bothers, risk decrease is the foremost choice. With this, taking the increased significance of protective barriers so as to decrease the hazard of exposure to HIV, distinctive stakeholders (the healing center hardware supply chain director, the HIV/ Helps clinic, the clinic chief, hardware and supply quality confirmation group, and other authoritative bodies) ought to work together in co-ordination to secure the supply and guarantee the quality of those crucial protective barriers and to advance demand health laborers to continuously wear protective barriers when exposed to HIV hazard components as well as to dispose appropriately once done. At long last, we prescribe future examiners to conduct planned multicenter studies with extra goals (counting indicator investigation) for way better generalization and result. In spite of satisfactory information and favorable state of mind towards PEP for HIV in most of the respondents, this study uncovered that there were delays in starting, low utilization, and fragmented use of the prescribed PEP. So, health care staff need to progress their practice on PEP of HIV through diverse training program related to PEP of HIV.

Keywords: HIV infection, prophylaxis, knowledge, attitude

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Authors: Ibrahim Abubakar Alkali, Abubakar Sarkile Kawuwa, Ibrahim Sani Khalil

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The concept of space and function forms the bedrock for spatial configuration in architectural design. Thus, the effectiveness and functionality of an architectural product depends their cordial relationship. This applies to all buildings especially to a hospital ward setting designed to accommodate various complex and diverse functions. Health care facilities design, especially an inpatient setting, is governed by many regulations and technical requirements. It is also affected by many less defined needs, particularly, response to culture and the need to provide for patient families’ presence and participation. The spatial configuration of the hospital ward setting in developing countries has no consideration for the patient’s families despite the significant role they play in promoting recovery. Attempts to integrate facilities for patients’ families have always been challenging, especially in developing countries like Nigeria, where accommodation for inpatients is predominantly in an open ward system. In addition, the situation is compounded by culture, which significantly dictates healthcare practices in Africa. Therefore, achieving such a hospital ward setting that is patient and family-centered requires careful assessment of family care actions and transaction spaces so as to arrive at an evidence based solution. Therefore, the aim of this study is to identify how hospital ward spaces can be reconfigured to provide for sustainable family integration. In achieving this aim, a qualitative approach using the principles of behavioral mapping was employed in male and female medical wards of the Federal Teaching Hospital (FTH) Gombe, Nigeria. The data obtained was analysed using classical and comparative content analysis. Patients’ families have been found to be a critical component of hospital ward design that cannot be undermined. Accordingly, bedsides, open yards, corridors and foyers have been identified as patient families’ transaction spaces that require design attention. Arriving at sustainable family integration can be achieved by revisiting the design requirements of the family transaction spaces based on the findings in order to avoid the rowdiness of the wards and uncoordinated sprawl.

Keywords: caregiving, design basics, family integration, hospital ward, sustainability

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Authors: Priyanka Kumari

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Menstrual hygiene is an important aspect in the life of young girls. Menstrual Hygiene Management (MHM) is defined as ‘Women and adolescent girls using a clean material to absorb or collect menstrual blood that can be changed in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required and having access to facilities to dispose of used menstrual management materials. This paper aims to investigate the prevalence of hygienic menstrual practices and socio-demographic correlates of hygienic menstrual practices among women aged 15-24 in India. Data from the 2015–2016 National Family Health Survey–4 for 244,500 menstruating women aged 15–24 were used. The methods have been categorized into two, women who use sanitary napkins, locally prepared napkins and tampons considered as a hygienic method and those who use cloth, any other method and nothing used at all during menstruation considered as an unhygienic method. Women’s age, year of schooling, religion, place of residence, caste/tribe, marital status, wealth index, type of toilet facility used, region, the structure of the house and exposure to mass media are taken as an independent variables. Bivariate analysis was carried out with selected background characteristics to analyze the socio-economic and demographic factors associated with the use of hygienic methods during menstruation. The odds for the use of the hygienic method were computed by employing binary logistic regression. Almost 60% of the women use cloth as an absorbent during menstruation to prevent blood stains from becoming evident. The hygienic method, which includes the use of locally prepared napkins, sanitary napkins and tampons, is 16.27%, 41.8% and 2.4%. The proportion of women who used hygienic methods to prevent blood stains from becoming evident was 57.58%. Multivariate analyses reveal that education of women, wealth and marital status are found to be the most important positive factors of hygienic menstrual practices. The structure of the house and exposure to mass media also have a positive impact on the use of menstrual hygiene practices. In contrast, women residing in rural areas belonging to scheduled tribes are less likely to use hygienic methods during their menstruation. Geographical regions are also statistically significant with the use of hygienic methods during menstruation. This study reveals that menstrual hygiene is not satisfactory among a large proportion of adolescent girls. They need more education about menstrual hygiene. A variety of factors affect menstrual behaviors; amongst these, the most influential is economic status, educational status and residential status, whether urban or rural. It is essential to design a mechanism to address and access healthy menstrual knowledge. It is important to encourage policies and quality standards that promote safe and affordable options and dynamic markets for menstrual products. Materials that are culturally acceptable, contextually available and affordable. Promotion of sustainable, environmentally friendly menstrual products and their disposal as it is a very important aspect of sustainable development goals. We also need to educate the girls about the services which are provided by the government, like a free supply of sanitary napkins to overcome reproductive tract infections. Awareness regarding the need for information on healthy menstrual practices is very important. It is essential to design a mechanism to address and access healthy menstrual practices. Emphasis should be given to the education of young girls about the importance of maintaining hygiene during menstruation to prevent the risk of reproductive tract infections.

Keywords: adolescent, menstruation, menstrual hygiene management, menstrual hygiene

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Authors: Lee Yujin, Han Jiye, Oh Jin-Woo

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The adverse effects of endocrine disrupting chemicals (EDCs) has attracted considerable public interests. The benzene-like EDCs structure mimics the mechanisms of hormones naturally occurring in vivo, and alters physiological function of the endocrine system. Although, some of the most representative EDCs such as polychlorinated biphenyls (PCBs) and phthalates compounds already have been prohibited to produce and use in many countries, however, PCBs and phthalates in plastic products as flame retardant and plasticizer are still circulated nowadays. EDCs can be released from products while using and discarding, and it causes serious environmental and health issues. Here, we developed virus-based structurally coloured nanostructure that can detect minute EDCs concentration sensitively and selectively. These structurally coloured nanostructure exhibits characteristic angel-independent colors due to the regular virus bundle structure formation through simple pulling technique. The designed number of different colour bands can be formed through controlling concentration of virus solution and pulling speed. The virus, M-13 bacteriophage, was genetically engineered to react with specific ECDs, typically PCBs and phthalates. M-13 bacteriophage surface (pVIII major coat protein) was decorated with benzene derivative binding peptides (WHW) through phage library method. In the initial assessment, virus-based color sensor was exposed to several organic chemicals including benzene, toluene, phenol, chlorobenzene, and phthalic anhydride. Along with the selectivity evaluation of virus-based colour sensor, it also been tested for sensitivity. 10 to 300 ppm of phthalic anhydride and chlorobenzene were detected by colour sensor, and showed the significant sensitivity with about 90 of dissociation constant. Noteworthy, all measurements were analyzed through principal component analysis (PCA) and linear discrimination analysis (LDA), and exhibited clear discrimination ability upon exposure to 2 categories of EDCs (PCBs and phthalates). Because of its easy fabrication, high sensitivity, and the superior selectivity, M-13 bacteriophage-based color sensor could be a simple and reliable portable sensing system for environmental monitoring, healthcare, social security, and so on.

Keywords: M-13 bacteriophage, colour sensor, genetic engineering, EDCs

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Authors: Mehmet Savsar

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Industrial Engineering is one of the engineering disciplines that deal with analysis, design, and improvement of systems, which include manufacturing, supply chain, healthcare, communication, and general service systems. Industrial engineers involve with comprehensive study of a given system, analysis of its interacting units, determination of problem areas, application of various optimization and operations research tools, and recommendation of solutions resulting in significant improvements. The Senior Design course in Industrial Engineering is the culmination of the Industrial Engineering Curriculum in a Capstone Design course, which fundamentally deals with systems analysis and design. The course at Kuwait University has been carefully designed with various course objectives and course outcomes in mind to achieve several program outcomes by practices and learning experiences, which are explicitly gained by systems analysis and design. The Senior Design Course is carried out in a selected industrial or service organization, with support from its engineering personnel, during a full semester by a team of students, who are usually in the last semester of their academic programs. A senior faculty member constantly administers the course to ensure that the students accomplish the prescribed objectives. Students work in groups to formulate issues and propose solutions and communicate, results in formal written and oral presentations. When the course is completed, they emerge as engineers that can be clearly identified as more mature, able to communicate better, able to participate in team work, able to see systems perspective in analysis and design, and more importantly, able to assume responsibility at entry level as engineers. The accomplishments are mainly due to real life experiences gained during the course of their design study. This paper presents methods, procedures, and experiences in teaching a Senior Design Course in Industrial Engineering Curriculum. A detailed description of the course, its role, its objectives, outcomes, learning practices, and assessments are explained in relation to other courses in Industrial Engineering Curriculum. The administration of the course, selected organizations where the course project is carried out, problems and solution tools utilized, student accomplishments and obstacles faced are presented. Issues discussed in this paper could help instructors in teaching the course as well as in clarifying the contribution of a design course to the industrial engineering education in general. In addition, the methods and teaching procedures presented could facilitate future improvements in industrial engineering curriculum.

Keywords: senior design course, industrial engineering, capstone design, education

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Authors: Sadaf H. Khan, Jyoti Kumar

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Sick Building Syndrome (SBS) is a situation in which inhabitants of a building develop illness symptoms or get infected with a chronic disease as a result of the building in which they reside or work. Certain symptoms tend to get more severe as an individual spends more time in the building; however, they generally improve with time or even disappear when they leave that space. Though ‘Design of Built-Spaces’ is a crucial factor in regulating these symptoms but it still needs to be identified further as to what specific design features of a ‘Built-Space’ trigger sick building syndrome (SBS). Much of the research work present to date is focused on the physiological or physical sickness caused due to inappropriate built-space design. In this paper, the psychological aspects of sick building syndrome (SBS) will be investigated across the adult population, more specifically graduate students in India trying to settle in back to their previous physical work environments, i.e., campus, classrooms, hostels, after a very long hold which lasted more than a year due to lockdowns during Covid-19 crisis all over the world. The study will follow an analytical approach and the data will be collected through self-reported online surveys. The purpose of this study is to enquire causal agents, diagnosable symptoms and remedial design of built spaces which can enhance the productive level of built environments and better facilitate the inhabitants by improving their psychological wellbeing, which is the most uprising concern. The fact that SBS symptoms can be studied only within the initial few weeks as an occupant starts interacting with a built-environment and leaves as the occupant leaves that space or zone, the post-lockdown incoming of students back to their respective campuses provides an opportunity to clearly draw multiple conclusions of the relationship that exist between the Design of Built-Spaces and Psychological Sickness Syndrome associated with it. The study will be one of a kind approach for understanding and formulating methods to improve psychological wellbeing within a built-setting by better identifying factors associated with these psychological symptoms, including anxiety, mental fatigue, reduced attention span and reduced memory span as refined symptoms of SBS discussed in 1987 by Molhave within his study.

Keywords: built-environment psychology, built-space design, healthcare architecture, psychological wellbeing

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Authors: Swati Rajput

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Environmental psychology explains that the person is a social agent that seeks to extract meaning from their built and natural environment to behave in a particular manner. It also shows the attachment or detachment of people to their environment. Assessing environmental psychology of people is imperative for planners and policy makers for urban planning. The paper investigates the environmental psychology of people living in nine districts of Delhi by calculating and assessing their Environmental Emotional Quotient (EEQ). Emotional Quotient deals with the ability to sense, understand, attach and respond according to the power of emotions. An Environmental Emotional Quotient has been formulated based upon the inventory administered to them. The respondents were asked questions related to their view and emotions about the green spaces, water resource conservation, air and environmental quality. An effort has been made to assess the feeling of belongingness among the residents. Their views were assessed on green spaces, reuse, and recycling of resources and their participation level. They were also been assessed upon health awareness level by considering both preventive and curative segments of health care. It was found that only 12 percent of the people is emotionally attached to their surroundings in the city. The emotional attachment reduces as we move away from the house to housing complex to neighbouring areas and rest of the city. In fact, the emotional quotient goes lower to lowest from house to other ends of the city. It falls abruptly after the radius of 1 km from the residence. The result also shows that nearly 54% respondents accept that there is environment pollution in their area. Around 47.8% respondents in the survey consider that diseases occur because of green cover depiction in their area. Major diseases are to airborne diseases like asthma and bronchitis. Seasonal disease prevalent, which specially occurred from last 3-4 years are malaria, dengue and chikengunya. Survey also shows that only 31 % of respondents visit government hospitals while 69% respondents visit private hospitals or small clinics for healthcare services. The paper suggests the need for environmental sensitive policies and need for green insurance in mega cities like Delhi.

Keywords: environmental psychology, environmental emotional quotient, preventive health care and curative health care, sustainable living

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Authors: S. D. Kadir

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Background: Antibiotics have always been at the centrum of the revolution of modern microbiology. Micro-organisms and its pathogenicity, resistant organisms, inappropriate or over usage of various types of antibiotic agents are fuelled multidrug-resistant pathogenic organisms. Our present time review report mainly focuses on the therapeutic condition of antibiotic resistance and the possible roots behind the development of antibiotic resistance in Bangladesh in 2019. Methodology: The systemic review has progressed through a series of research analyses on various manuscripts published on Google Scholar, PubMed, Research Gate, and collected relevant information from established popular healthcare and diagnostic center and its subdivisions all over Bangladesh. Our research analysis on the possible assurance of antibiotic resistance been ensured by the selective medical reports and on random assay on the extent of individual antibiotic in 2019. Results: 5 research articles, 50 medical report summary, and around 5 patients have been interviewed while going through the estimation process. We have prioritized research articles where the research analysis been performed by the appropriate use of the Kirby-Bauer method. Kirby-Bauer technique is preferred as it provides greater efficiency, ensures lower performance expenditure, and supplies greater convenience and simplification in the application. In most of the reviews, clinical and laboratory standards institute guidelines were strictly followed. Most of our reports indicate significant resistance shown by the Beta-lactam drugs. Specifically by the derivatives of Penicillin's, Cephalosporin's (rare use of the first generation Cephalosporin and overuse of the second and third generation of Cephalosporin and misuse of the fourth generation of Cephalosporin), which are responsible for almost 67 percent of the bacterial resistance. Moreover, approximately 20 percent of the resistance was due to the fact of drug pumping from the bacterial cell by tetracycline and sulphonamides and their derivatives. Conclusion: 90 percent of the approximate antibiotic resistance is due to the usage of relative and true broad-spectrum antibiotics. The environment has been created by the following circumstances where; the excessive usage of broad-spectrum antibiotics had led to a condition where the disruption of native bacteria and a series of anti-microbial resistance causing a disturbance of the surrounding environments in medium, leading to a state of super-infection.

Keywords: antibiotics, antibiotic resistance, Kirby Bauer method, microbiology

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Authors: Elizabeth J. Currie, Fernando Ortega Perez

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—‘MEDICINE’ is a new project funded under the EC Horizon 2020 Marie-Sklodowska Curie Actions, to determine concepts of health and healing from a culturally specific indigenous context, using a framework of interdisciplinary methods which integrates archaeological-historical, ethnographic and modern health sciences approaches. The study will generate new theoretical and methodological approaches to model how peoples survive and adapt their traditional belief systems in a context of alien cultural impacts. In the immediate wake of the conquest of Peru by invading Spanish armies and ideology, native Andeans responded by forming the Taki Onkoy millenarian movement, which rejected European philosophical and ontological teachings, claiming “you make us sick”. The study explores how people’s experience of their world and their health beliefs within it, is fundamentally shaped by their inherent beliefs about the nature of being and identity in relation to the wider cosmos. Cultural and health belief systems and related rituals or behaviors sustain a people’s sense of identity, wellbeing and integrity. In the event of dislocation and persecution these may change into devolved forms, which eventually inter-relate with ‘modern’ biomedical systems of health in as yet unidentified ways. The development of new conceptual frameworks that model this process will greatly expand our understanding of how people survive and adapt in response to cultural trauma. It will also demonstrate the continuing role, relevance and use of TM in present-day indigenous communities. Studies will first be made of relevant pre-Colombian material culture, and then of early colonial period ethnohistorical texts which document the health beliefs and ritual practices still employed by indigenous Andean societies at the advent of the 17^th century Jesuit campaigns of persecution - ‘Extirpación de las Idolatrías’. Core beliefs drawn from these baseline studies will then be used to construct a questionnaire about current health beliefs and practices to be taken into the study population of indigenous Quechua peoples in the northern Andean region of Ecuador. Their current systems of knowledge and medicine have evolved within complex historical contexts of both the conquest by invading Inca armies in the late 15^th century, followed a generation later by Spain, into new forms. A new model will be developed of contemporary  Andean concepts of health, illness and healing demonstrating  the way these have changed through time. With this, a ‘policy tool’ will be constructed as a bridhging facility into contemporary global scenarios relevant to other Indigenous, First Nations, and migrant peoples to provide a means through which their traditional health beliefs and current needs may be more appropriately understood and met. This paper presents findings from the first analytical phases of the work based upon the study of the literature and the archaeological records. The study offers a novel perspective and methods in the development policies sensitive to indigenous and minority people’s health needs.

Keywords: Andean ethnomedicine, Andean health beliefs, health beliefs models, traditional medicine

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Authors: Tadele Araya, Tsehaye Asmelash, Girmatsion Fiseha

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Background: Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV) constitute serious healthcare problems worldwide. Blood-borne pathogens HBV, HCV and HIV are commonly associated with infections among substance or Injection Drug Users (IDUs). The objective of this study was to determine the prevalence of HBV, HCV, and HIV infections among substance users in Mekelle Substance users Treatment and Rehabilitation Centers. Methods: A cross-sectional study design was used from Dec 2020 to Sep / 2021 to conduct the study. A total of 600 substance users were included. Data regarding the socio-demographic, clinical and sexual behaviors of the substance users were collected using a structured questionnaire. For laboratory analysis, 5-10 ml of venous blood was taken from the substance users. The laboratory analysis was performed by Enzyme-Linked Immunosorbent Assay (ELISA) at Mekelle University, Department of Medical Microbiology and Immunology Research Laboratory. The Data was analyzed using SPSS and Epi-data. The association of variables with HBV, HCV and HIV infections was determined using multivariate analysis and a P value < 0.05 was considered statistically significant. Result: The overall prevalence rate of HBV, HCV and HIV infections were 10%, 6.6%, and 7.5%, respectively. The mean age of the study participants was 28.12 ± 6.9. A higher prevalence of HBV infection was seen in participants who were users of drug injections and in those who were infected with HIV. HCV was comparatively higher in those who had a previous history of unsafe surgical procedures than their counterparts. Homeless participants were highly exposed to HCV and HIV infections than their counterparts. The HBV/HIV Co-infection prevalence was 3.5%. Those doing unprotected sexual practices [P= 0.03], Injection Drug users [P= 0.03], those who had an HBV-infected person in their family [P=0.02], infected with HIV [P= 0.025] were statistically associated with HBV infection. HCV was significantly associated with Substance users and previous history of unsafe surgical procedures [p=0.03, p=0.04), respectively. HIV was significantly associated with unprotected sexual practices and being homeless [p=0.045, p=0.05) respectively. Conclusion-The highly prevalent viral infection was HBV compared to others. There was a High prevalence of HBV/HIV co-infection. The presence of HBV-infected persons in a family, unprotected sexual practices and sharing of needles for drug injection were the risk factors associated with HBV, HIV, and HCV. Continuous health education and screening of the viral infection coupled with medical and psychological treatment is mandatory for the prevention and control of the infections.

Keywords: hepatitis b virus, hepatitis c virus, HIV, substance users

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Authors: Shamie Kumar

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Background: Radiologists and radiographers (RR) need to educate themselves and their colleagues to ensure that AI is integrated safely, useful, and in a meaningful way with the direction it always benefits the patients. AI education and training are fundamental to the way RR work and interact with it, such that they feel confident using it as part of their clinical practice in a way they understand it. Methodology: This exploratory research will outline the current educational and training gaps for radiographers and radiologists in AI radiology diagnostics. It will review the status, skills, challenges of educating and teaching. Understanding the use of artificial intelligence within daily clinical practice, why it is fundamental, and justification on why learning about AI is essential for wider adoption. Results: The current knowledge among RR is very sparse, country dependent, and with radiologists being the majority of the end-users for AI, their targeted training and learning AI opportunities surpass the ones available to radiographers. There are many papers that suggest there is a lack of knowledge, understanding, and training of AI in radiology amongst RR, and because of this, they are unable to comprehend exactly how AI works, integrates, benefits of using it, and its limitations. There is an indication they wish to receive specific training; however, both professions need to actively engage in learning about it and develop the skills that enable them to effectively use it. There is expected variability amongst the profession on their degree of commitment to AI as most don’t understand its value; this only adds to the need to train and educate RR. Currently, there is little AI teaching in either undergraduate or postgraduate study programs, and it is not readily available. In addition to this, there are other training programs, courses, workshops, and seminars available; most of these are short and one session rather than a continuation of learning which cover a basic understanding of AI and peripheral topics such as ethics, legal, and potential of AI. There appears to be an obvious gap between the content of what the training program offers and what the RR needs and wants to learn. Due to this, there is a risk of ineffective learning outcomes and attendees feeling a lack of clarity and depth of understanding of the practicality of using AI in a clinical environment. Conclusion: Education, training, and courses need to have defined learning outcomes with relevant concepts, ensuring theory and practice are taught as a continuation of the learning process based on use cases specific to a clinical working environment. Undergraduate and postgraduate courses should be developed robustly, ensuring the delivery of it is with expertise within that field; in addition, training and other programs should be delivered as a way of continued professional development and aligned with accredited institutions for a degree of quality assurance.

Keywords: artificial intelligence, training, radiology, education, learning

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Authors: Mohammad R. Aghakashkooli, Milutin G. Jovanovic

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The brushless doubly-fed reluctance generator (BDFRG) is an emerging, medium-speed alternative to a conventional wound rotor slip-ring doubly-fed induction generator (DFIG) in wind energy conversion systems (WECS). It can provide competitive overall performance and similar low failure rates of a typically 30% rated back-to-back power electronics converter in 2:1 speed ranges but with the following important reliability and cost advantages over DFIG: the maintenance-free operation afforded by its brushless structure, 50% synchronous speed with the same number of rotor poles (allowing the use of a more compact, and more efficient two-stage gearbox instead of a vulnerable three-stage one), and superior grid integration properties including simpler protection for the low voltage ride through compliance of the fractional converter due to the comparatively higher leakage inductances and lower fault currents. Vector controlled pulse-width-modulated converters generally feature a much lower total harmonic distortion relative to hysteresis counterparts with variable switching rates and as such have been a predominant choice for BDFRG (and DFIG) wind turbines. Eliminating a shaft position sensor, which is often required for control implementation in this case, would be desirable to address the associated reliability issues. This fact has largely motivated the recent growing research of sensorless methods and developments of various rotor position and/or speed estimation techniques for this purpose. The main limitation of all the observer-based control approaches for grid-connected wind power applications of the BDFRG reported in the open literature is the requirement for pre-commissioning procedures and prior knowledge of the machine inductances, which are usually difficult to accurately identify by off-line testing. A model reference adaptive system (MRAS) based sensor-less vector control scheme to be presented will overcome this shortcoming. The true machine parameter independence of the proposed field-oriented algorithm, offering robust, inherently decoupled real and reactive power control of the grid-connected winding, is achieved by on-line estimation of the inductance ratio, the underlying rotor angular velocity and position MRAS observer being reliant upon. Such an observer configuration will be more practical to implement and clearly preferable to the existing machine parameter dependent solutions, and especially bearing in mind that with very little modifications it can be adapted for commercial DFIGs with immediately obvious further industrial benefits and prospects of this work. The excellent encoder-less controller performance with maximum power point tracking in the base speed region will be demonstrated by realistic simulation studies using large-scale BDFRG design data and verified by experimental results on a small laboratory prototype of the WECS emulation facility.

Keywords: brushless doubly fed reluctance generator, model reference adaptive system, sensorless vector control, wind energy conversion

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Authors: Cherrie Mae S. Sia, Noel J. Belonguel, Jarungchai Anton S. Vatanagul

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Background: Parkinson’s disease (PD) is a chronic progressive, neurodegenerative disorder known for its motor symptoms such as bradykinesia, resting tremor, muscle rigidity, and postural instability. Patients with PD also experience non-motor symptoms (NMS) such as depression, fatigue, and sleep disturbances that are most of the time unrecognized by clinicians. This may be due to the lack of spontaneous reports from the patients or partly because of the lack of systematic questioning from the healthcare professional. There is limited data with regards to these NMS especially that of Filipino patients with PD. Objectives: This study aims to determine the non-motor symptoms of Filipino patients with Parkinson’s disease. Materials and Methods: This is a prospective, cohort study involving thirty-four patients of Filipino-descent diagnosed with PD in three out-patient clinics in Cebu City from April to September 2014. Each patient was interviewed using the Non-Motor Symptom Scale (NMSS). A Cebuano version of the NMSS was also provided for the non-English speaking patients. Interview time was approximately ten to fifteen minutes for each respondent. Results: Of the thirty-four patients with Parkinson’s disease, majority was noted to be males (N=19) and the disease was noted to be more prevalent in patients with a mean age of 62 (SD±9) years old. Hypertension (59%) and diabetes mellitus (29%) were the common co-morbidities in the study population. All patients presented more than one NMS, with insomnia (41.2%), poor memory (23.5%) and depression (14.7%) being the first non-motor symptoms to occur. Symptoms involving mood/cognition (mean=2.21), and attention/memory (mean=2.05) were noted to be the most frequent and of moderate severity. Based on the NMSS, the symptoms that were noted to be mild and often to occur were those that involved the mood/cognition (score=3.84), attention/memory (score=3.50), and sleep/fatigue (score=3.00) domains. Levodopa-Carbidopa, Ropinirole, and Pramipexole were the most frequently used medications in the study population. Conclusion: Non-motor symptoms (NMS) are common in patients with Parkinson’s disease (PD). They appear at the time of diagnosis of PD or even before the motor symptoms manifest. The earliest non-motor symptoms to occur are insomnia, poor memory, and depression. Those pertaining to mood/cognition and attention/memory are the most frequent NMS and they are of moderate severity. Identifying these NMS by doing a questionnaire-guided interview such as the Non-Motor Symptom Scale (NMSS) before they can become more severe and affect the patient’s quality of life is a must for every clinician caring for a PD patient. Early treatment and control of these NMS can then be given, hence, improving the patient’s outcome and prognosis.

Keywords: non motor symptoms, Parkinson's Disease, insomnia, depression

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Authors: Siddharth Jain, Abhenil Mittal, Surendra Kumar Sharma

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Background: With its recent emergence and re-emergence, dengue has become a major international public health concern, imposing significant financial burden especially in developing countries. Despite aggressive control measures in place, India experienced one of its largest outbreaks in 2015 with Delhi being most severely affected. There is a lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak. Methods: This prospective observational study conducted at an apex tertiary care center in Delhi, India included confirmed adult dengue patients admitted between August-November 2015. Patient demographics, clinical details, and laboratory findings were recorded in a predesigned proforma. Appropriate statistical tests were used to summarize and compare the clinical and laboratory characteristics and derive predictors of mortality and severe disease, while developing a clinical risk score for mortality. Serotype analysis was also done for 75 representative samples to identify the dominant serotypes. Results: Data of 369 patients were analyzed (mean age 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (DHF Grade 1,2)and 46 (12%) developed dengue shock syndrome (DSS). Twenty two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnoea at rest were identified as independent predictors of severe disease. Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnoea) which, if ≥ 22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were DENV-2 and DENV-4. Conclusion: Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine the outcome in dengue patients. Timely referral/access to health care is important. Development and use of validated predictors of disease severity and simple clinical risk scores, which can be applied in all healthcare settings, can help minimize mortality and morbidity, especially in resource limited settings.

Keywords: dengue, mortality, predictors, severity

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Authors: Senthil Kumar Anantharaman

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Providing telecommunications based network services in developing countries like India which has a population of 1.5 billion people, so that these services reach every individual, is one of the greatest challenges the country has been facing in its journey towards economic growth and development. With growing number of telecommunications service providers in the country, a constant challenge that has been faced by these providers is in providing not only quality but also delightful customer experience while simultaneously generating enhanced revenues and profits. Thus, the role played by process improvement methodologies like Six Sigma cannot be undermined and specifically in telecom service provider based operations, it has provided substantial benefits. Therefore, it advantages are quite comparable to its applications and advantages in other sectors like manufacturing, financial services, information technology-based services and Healthcare services. One of the key reasons that this methodology has been able to reap great benefits in telecommunications sector is that this methodology has been combined with many of its competing process improvement techniques like Theory of Constraints, Lean and Kaizen to give the maximum benefit to the service providers thereby creating a winning combination of organized process improvement methods for operational excellence thereby leading to business excellence. This paper discusses about some of the key projects and areas in the end to end ‘Quote to Cash’ process at big three Indian telecommunication companies that have been highly assisted by applying Six Sigma along with other process improvement techniques. While the telecommunication companies which we have considered, is primarily in India and run by both private operators and government based setups, the methodology can be applied equally well in any other part of developing countries around the world having similar context. This study also compares the enhanced revenues that can arise out of appropriate opportunities in emerging market scenarios, that Six Sigma as a philosophy and methodology can provide if applied with vigour and robustness. Finally, the paper also comes out with a winning framework in combining Six Sigma methodology with Kaizen, Lean and Theory of Constraints that will enhance both the top-line as well as the bottom-line while providing the customers a delightful experience.

Keywords: emerging markets, lean, process improvement, six sigma, telecommunications, theory of constraints

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Authors: Ila Gupta

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The government hospitals in India by and large lack the necessary aesthetic therapeutic components, both in their interior and exterior space designs. These components especially in terms of color application are important to the emotional as well as physical well being of the patients and other participants of the space. The preliminary survey of few government hospitals in Uttarakhand, India, reveals that the government health care industry provides a wide scope for intervention. All most all of the spaces do not adhere to a proper therapeutic color scheme which directly helps the well-being of their patients and workers. The paper aims to conduct a survey and come up with recommendations in this regard. The government hospitals also lack a proper signage system which allows the space to be more user-friendly. The hospital spaces in totality also have scope for improvement in terms of space/landscape design which enhances the work environment in an efficient and positive way. This study will thus enable to come up with feasible recommendations for healthcare and built environment as well as retrofitting the existing spaces. The objective of the paper is mainly on few case studies. The present ambience in many government hospitals generally lacks a welcoming ambience. It is proposed to select one or two government hospitals and demonstrate application of appropriate and self-sustainable color schemes, placement of artifacts, changes in outdoor and indoor space design to bring about a change that is conducive for cognitive healing. Exterior changes to existing and old hospital buildings in depressed historic areas signify financial investment and change, and have the potential to play a significant role in both urban preservation and revitalization. Changes to exterior architectural colors are perhaps the most visible signifier of such revitalization, as the use of color changes as a tool in façade and interior improvement programs. The present project will provide its recommendations on the basis of case studies done in the Indian Public Health Care system. Furthermore, the recommendations will be in accordance with the extended study conducted in Indian Ayurvedic, Yogic texts as well as Vastu texts, which provides knowledge about built environments and healing properties of color.

Keywords: color, environment, facade, architectural color history, interior improvement programs, community development, district/government hospitals

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Authors: Rui Lin, Jimmy Xiangji Huang, Gary Spraakman

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This forthcoming systematic review will underscore the imperative of leveraging technology to mitigate social isolation in older adults, particularly in the context of unprecedented global challenges such as the COVID-19 pandemic. With the continual evolution of technology, it becomes crucial to scrutinize the efficacy of interventions and discern how they can alleviate social isolation and augment social well-being among the elderly. This review will strive to clarify the best methods for older adults to utilize cost-effective and user-friendly technology and will investigate how the adaptation and execution of such interventions can be fine-tuned to maximize their positive outcomes. The study will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to filter pertinent studies. We foresee conducting an analysis of articles and executing a narrative analysis to discover themes and indicators related to quality of life and, technology use and well-being. The review will examine how involving older adults at the community level, applying top practices from community-based participatory research, can establish efficient strategies to implement technology-based interventions designed to diminish social isolation and boost digital use self-efficacy. Applications based on mobile technology and virtual platforms are set to assume a crucial role not only in enhancing connections within families but also in connecting older adults to vital healthcare resources, fostering both physical and mental well-being. The review will investigate how technological devices and platforms can address the cognitive, visual, and auditory requirements of older adults, thus strengthening their confidence and proficiency in digital use—a crucial factor during enforced social distancing or self-isolation periods during pandemics. This review will endeavor to provide insights into the multifaceted benefits of technology for older adults, focusing on how tailored technological interventions can be a beacon of social and mental wellness in times of social restrictions. It will contribute to the growing body of knowledge on the intersection of technology and elderly well-being, offering nuanced understandings and practical implications for developing user-centric, effective, and inclusive technological solutions for older populations.

Keywords: older adults, health service delivery, digital health, social isolation, social well-being

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Authors: Anila Naz, Arusa Lakhani, Kiran Mubeen, Yasmeen Amarsi

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Pakistan's neonatal mortality rate has the highest proportion in the South Asian region and it is higher in the rural areas as compared to the urban areas. Poor resuscitation techniques and lack of basic newborn resuscitation skills in birth attendants, are contributing factors towards neonatal deaths. Based on the significant outcomes of the Helping Baby Breath (HBB) training, a similar training was implemented for Community Midwives (CMWs) in a low resource setting in Gujrat, Pakistan, to improve their knowledge and skills. The training evaluation was conducted and participant feedback was obtained through both qualitative and quantitative methods. The findings of the quantitative assessment of the training evaluation will be published elsewhere. This paper presents the qualitative evaluation of the training. Objective: The objective of the study was to determine the perceptions of HBB trained CMWs about the effectiveness of the HBB training, and the challenges faced in the implementation of HBB skills for newborn resuscitation, at their work settings. The qualitative descriptive design was used in this study. The purposive sampling technique was chosen to recruit midwives and key informants as participants of the training. Interviews were conducted by using a semi-structured interview guide. The study included a total of five interviews: two focus group interviews for CMWs (10 in each group), and three individual interviews of key informants. The content analysis of the qualitative data yielded three themes: the effectiveness of training, challenges, and suggestions. The findings revealed that the HBB training was effective for the CMWs in terms of its usability, regarding improvement in newborn resuscitation knowledge and skills. Moreover, it enhanced confidence and satisfaction in CMWs. However, less volume of patients was a challenge for a few CMWs with regards to practicing their skills. Due to the inadequate number of patients and less opportunities of practice for several CMWs, they required such trainings frequently, in order to maintain their competency. The CMWs also recommended that HBB training should be part of the Midwifery program curriculum. Moreover, similar trainings were also recommended for other healthcare providers working in low resource settings, including doctors and nurses.

Keywords: neonatal resuscitation technique, helping baby breathe, community midwives, training evaluation

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Authors: Rujeko Samanthia Chimukuche

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Introduction: Transboundary migration at both regional and continental levels has become the defining feature of the 21st century. The recent global migration crisis due to economic strife and war brings back to the fore an old age problem, but with fresh challenges. Migration and forced displacement are issues that require long-term solutions. In South Africa, for example, whilst much attention has been placed on xenophobic attacks and other issues at the nexus of immigrant and indigenous communities, the limited focus has been placed on the integration, specifically formal labour integration of immigrant communities and the gender inequalities that are prevalent. Despite noble efforts by South Africa, hosting several immigrants, several challenges arise in integrating the migrants into society as it is often difficult to harmonize the interests of indigenous communities and those of foreign nationals. This research study has aimed to fill in the gaps by analyzing how stringent immigration and visa regulations prevent skilled migrant women spouses from employment, which often results in several societal vices, including domestic abuse, minimum or no access to important services such as healthcare, education, social welfare among others. Methods: Using a qualitative approach, the study analyzed South Africa migration and labour policies in terms of mainstreaming the gender needs of skilled migrant women. Secondly, the study highlighted the migratory experiences and constraints of skilled Zimbabwean women migrant spouses in South Africa labour integration. The experiences of these women have shown the gender inequalities of the migratory policies. Thirdly, Zimbabwean women's opportunities and/or challenges in integration into the South African formal labour market were explored. Lastly, practical interventions to support the integration of skilled migrant women spouses into South Africa’s formal labour market were suggested. Findings: Key findings show that gender dynamics are pivotal in migration patterns and the mainstreaming of gender in migration policies. This study, therefore, contributed to the fields of gender and migration by examining ways in which gender rights of skilled migrant women spouses can be incorporated in labour integration policy making.

Keywords: accompanying spouse visa, gender-migration, labour-integration, Zimbabwean women

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Authors: Ghada El-Husseiny, Dina Yousri, Christian Richter

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Social services are often characterized by market failures, which justifies government intervention in the provision of these services. It is widely acknowledged that government intervention breeds corruption since resources are being transferred from one party to another. However, what is still being extensively studied is the magnitude of the negative impact of corruption on publicly provided services and development outcomes. Corruption has the power to hinder development and cripple our march towards the Sustainable Development Goals. Corruption diminishes the efficiency and effectiveness of public health and education spending and directly impacts the outcomes of these sectors. This paper empirically examines the impact of Institutional Failure on public sector services provision, with the sole purpose of studying the impact of corruption on SDG3 and 4; Good health and wellbeing and Quality education, respectively. The paper explores the effect of corruption on these goals from various perspectives and extends the analysis by examining if the impact of corruption on these goals differed when it accounted for the current corruption state. Using Pooled OLS(Ordinary Least Square) and Fixed effects panel estimation on 22 corrupt and 22 clean countries between 2000 and 2017. Results show that corruption in both corrupt and clean countries has a more severe impact on Health than the Education sector. In almost all specifications, corruption has an insignificant effect on School Enrollment rates but a significant effect on Infant Mortality rates. Results further indicate that, on average, a 1 point increase in the CPI(Consumer Price Index) can increase health expenditures by 0.116% in corrupt and clean countries. However, the fixed effects model indicates that the way Health and Education expenditures are determined in clean and corrupt countries are completely country-specific, in which corruption plays a minimal role. Moreover, the findings show that School Enrollment rates and Infant Mortality rates depend, to a large extent, on public spending. The most astounding results-driven is that corrupt countries, on average, have more effective and efficient healthcare expenditures. While some insights are provided as to why these results prevail, they should be further researched. All in all, corruption impedes development outcomes, and any Anti-corrupt policies taken will bring forth immense improvements and speed up the march towards sustainability.

Keywords: corruption, education, health, public spending, sustainable development

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Authors: Ali Hamza

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Accurate segmentation of breast ultrasound images is of paramount importance in enhancing the diagnostic capabilities of breast cancer detection. This study presents an approach utilizing the U-Net architecture for segmenting breast ultrasound images aimed at improving the accuracy and reliability of mass identification within the breast tissue. The proposed method encompasses a multi-stage process. Initially, preprocessing techniques are employed to refine image quality and diminish noise interference. Subsequently, the U-Net architecture, a deep learning convolutional neural network (CNN), is employed for pixel-wise segmentation of regions of interest corresponding to potential breast masses. The U-Net's distinctive architecture, characterized by a contracting and expansive pathway, enables accurate boundary delineation and detailed feature extraction. To evaluate the effectiveness of the proposed approach, an extensive dataset of breast ultrasound images is employed, encompassing diverse cases. Quantitative performance metrics such as the Dice coefficient, Jaccard index, sensitivity, specificity, and Hausdorff distance are employed to comprehensively assess the segmentation accuracy. Comparative analyses against traditional segmentation methods showcase the superiority of the U-Net architecture in capturing intricate details and accurately segmenting breast masses. The outcomes of this study emphasize the potential of the U-Net-based segmentation approach in bolstering breast ultrasound image analysis. The method's ability to reliably pinpoint mass boundaries holds promise for aiding radiologists in precise diagnosis and treatment planning. However, further validation and integration within clinical workflows are necessary to ascertain their practical clinical utility and facilitate seamless adoption by healthcare professionals. In conclusion, leveraging the U-Net architecture for breast ultrasound image segmentation showcases a robust framework that can significantly enhance diagnostic accuracy and advance the field of breast cancer detection. This approach represents a pivotal step towards empowering medical professionals with a more potent tool for early and accurate breast cancer diagnosis.

Keywords: mage segmentation, U-Net, deep learning, breast cancer detection, diagnostic accuracy, mass identification, convolutional neural network

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Authors: M. Shahab Uddin, Pennung Warnitchai

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Currently more than half of the world’s populations are living in cities, and the number and sizes of cities are growing faster than ever. Cities rely on the effective functioning of complex and interdependent critical infrastructures networks to provide public services, enhance the quality of life, and save the community from hazards and disasters. In contrast, complex connectivity and interdependency among the urban critical infrastructures bring management challenges and make the urban system prone to the domino effect. Unplanned rapid growth, increased connectivity, and interdependency among the infrastructures, resource scarcity, and many other socio-political factors are affecting the typical state of an urban system and making it susceptible to numerous sorts of diversion. In addition to internal vulnerabilities, urban systems are consistently facing external threats from natural and manmade hazards. Cities are not just complex, interdependent system, but also makeup hubs of the economy, politics, culture, education, etc. For survival and sustainability, complex urban systems in the current world need to manage their vulnerabilities and hazardous incidents more wisely and more interactively. Coordinated management in such systems makes for huge potential when it comes to absorbing negative effects in case some of its components were to function improperly. On the other hand, ineffective management during a similar situation of overall disorder from hazards devastation may make the system more fragile and push the system to an ultimate collapse. Following the quantum, the current research hypothesizes that a hazardous event starts its journey as an emergency, and the system’s internal vulnerability and response capacity determine its destination. Connectivity and interdependency among the urban critical infrastructures during this stage may transform its vulnerabilities into dynamic damaging force. An emergency may turn into a disaster in the absence of effective management; similarly, mismanagement or lack of management may lead the situation towards a catastrophe. Situation awareness and factual decision-making is the key to win a battle. The current research proposed a contextual decision support system for an urban critical infrastructure system while integrating three different models: 1) Damage cascade model which demonstrates damage propagation among the infrastructures through their connectivity and interdependency, 2) Restoration model, a dynamic restoration process of individual infrastructure, which is based on facility damage state and overall disruptions in surrounding support environment, and 3) Optimization model that ensures optimized utilization and distribution of available resources in and among the facilities. All three models are tightly connected, mutually interdependent, and together can assess the situation and forecast the dynamic outputs of every input. Moreover, this integrated model will hold disaster managers and decision makers responsible when it comes to checking all the alternative decision before any implementation, and support to produce maximum possible outputs from the available limited inputs. This proposed model will not only support to reduce the extent of damage cascade but will ensure priority restoration and optimize resource utilization through adaptive and collaborative management. Complex systems predictably fail but in unpredictable ways. System understanding, situation awareness, and factual decisions may significantly help urban system to survive and sustain.

Keywords: disaster prevention, decision support system, emergency response, urban critical infrastructure system

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Authors: Prasad Urvashi, Wynn Yezarni, Williams Shehan, Ravindran Arun

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Introduction: Primary health services are often the first point of contact that patients with mental illness have with the healthcare system. A number of tools have been developed to increase detection of depression in the context of primary care. However, one challenge amongst many includes utilizing these tools within the limited primary care consultation timeframe. Therefore, short questionnaires that screen for depression that are just as effective as more comprehensive diagnostic tools may be beneficial in improving detection rates of patients visiting a primary care setting. Objective: To develop and determine the sensitivity and specificity of a 2-Question Questionnaire (2-QQ) to screen for depression in in a suburban primary care clinic in Ragama, Sri Lanka. The purpose is to develop a short screening tool for depression that is culturally adapted in order to increase the detection of depression in the Sri Lankan patient population. Methods: This was a cross-sectional study involving two steps. Step one: verbal administration of 2-QQ to patients by their primary care physician. Step two: completion of the Peradeniya Depression Scale, a validated diagnostic tool for depression, the patient after their consultation with the primary care physician. The results from the PDS were then correlated to the results from the 2-QQ for each patient to determine sensitivity and specificity of the 2-QQ. Results: A score of 1/+ on the 2-QQ was most sensitive but least specific. Thus, setting the threshold at this level is effective for correctly identifying depressed patients, but also inaccurately captures patients who are not depressed. A score of 6 on the 2-QQ was most specific but least sensitive. Setting the threshold at this level is effective for correctly identifying patients without depression, but not very effective at capturing patients with depression. Discussion: In the context of primary care, it may be worthwhile setting the 2-QQ screen at a lower threshold for positivity (such as a score of 1 or above). This would generate a high test sensitivity and thus capture the majority of patients that have depression. On the other hand, by setting a low threshold for positivity, patients who do not have depression but score higher than 1 on the 2-QQ will also be falsely identified as testing positive for depression. However, the benefits of identifying patients who present with depression may outweigh the harms of falsely identifying a non-depressed patient. It is our hope that the 2-QQ will serve as a quick primary screen for depression in the primary care setting and serve as a catalyst to identify and treat individuals with depression.

Keywords: depression, primary care, screening tool, Sri Lanka

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Authors: Yvonne Howard

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This project currently under development is centered around current learning processes, including a thorough literature review and ongoing practical experiences gained as a deputy head in a school. These daily experiences with students engaging in animal-assisted interventions and the school therapy dog form a strong base for this research. The primary objective of this research is to comprehensively explore the impact of dog-assisted well-being interventions on student motivation and affective engagement within primary and secondary school settings. The educational domain currently encounters a significant challenge due to the lack of substantial research in this area. Despite the perceived positive outcomes of such interventions being acknowledged and shared in various settings, the evidence supporting their effectiveness in an educational context remains limited. This study aims to bridge the gap in the research and shed light on the potential benefits of dog-assisted well-being interventions in promoting student motivation and affective engagement. The significance of this topic recognizes that education is not solely confined to academic achievement but encompasses the overall well-being and emotional development of students. Over recent years, there has been a growing interest in animal-assisted interventions, particularly in healthcare settings. This interest has extended to the educational context. While the effectiveness of these interventions in these areas has been explored in other fields, the educational sector lacks comprehensive research in this regard. Through a systematic and thorough research methodology, this study seeks to contribute valuable empirical data to the field, providing evidence to support informed decision-making regarding the implementation of dog-assisted well-being interventions in schools. This research will utilize a mixed-methods design, combining qualitative and quantitative measures to assess the research objectives. The quantitative phase will include surveys and standardized scales to measure student motivation and affective engagement, while the qualitative phase will involve interviews and observations to gain in-depth insights from students, teachers, and other stakeholders. The findings will contribute evidence-based insights, best practices, and practical guidelines for schools seeking to incorporate dog-assisted interventions, ultimately enhancing student well-being and improving educational outcomes.

Keywords: therapy dog, wellbeing, engagement, motivation, AAI, intervention, school

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Authors: H. Akhloufi, M. Hulscher, J. M. Prins, I. H. Van Der Sijs, D. Melles, A. Verbon

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Background: A timely switch from intravenous to oral antibiotic therapy has many advantages, such as reduced incidence of IV-line related infections, a decreased hospital length of stay and less workload for healthcare professionals with equivalent patient safety. Additionally, numerous studies have demonstrated significant decreases in costs of a timely intravenous to oral antibiotic therapy switch, while maintaining efficacy and safety. However, a considerable variation in iv to oral antibiotic switch therapy criteria has been described in literature. Here, we report the development of a set of iv to oral switch criteria that are generally applicable in all hospitals. Material/methods: A RAND-modified Delphi procedure, which was composed of 3 rounds, was used. This Delphi procedure is a widely used structured process to develop consensus using multiple rounds of questionnaires within a qualified panel of selected experts. The international expert panel was multidisciplinary and composed out of clinical microbiologists, infectious disease consultants and clinical pharmacists. This panel of 19 experts appraised 6 major intravenous to oral antibiotic switch therapy criteria and operationalized these criteria using 41 measurable conditions extracted from the literature. The procedure to select a concise set of iv to oral switch criteria included 2 questionnaire rounds and a face-to-face meeting. Results: The procedure resulted in the selection of 16 measurable conditions, which operationalize 6 major intravenous to oral antibiotic switch therapy criteria. The following 6 major switch therapy criteria were selected: (1) Vital signs should be good or improving when bad. (2) Signs and symptoms related to the infection have to be resolved or improved. (3) The gastrointestinal tract has to be intact and functioning. (4) The oral route should not be compromised. (5) Absence of contra-indicated infections. (6) An oral variant of the antibiotic with good bioavailability has to exist. Conclusions: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 major intravenous to oral antibiotic switch therapy criteria operationalized by 16 measurable conditions. This set of early antibiotic iv to oral switch criteria can be used in daily practice in all adult hospital patients. Future use in audits and as rules in computer assisted decision support systems will lead to improvement of antimicrobial steward ship programs.

Keywords: antibiotic resistance, antibiotic stewardship, intravenous to oral, switch therapy

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Authors: Karan Sharma, Ajay Kumar

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Epileptic seizure is a type of disease due to which electrical charge in the brain flows abruptly resulting in abnormal activity by the subject. One percent of total world population gets epileptic seizure attacks.Due to abrupt flow of charge, EEG (Electroencephalogram) waveforms change. On the display appear a lot of spikes and sharp waves in the EEG signals. Detection of epileptic seizure by using conventional methods is time-consuming. Many methods have been evolved that detect it automatically. The initial part of this paper provides the review of techniques used to detect epileptic seizure automatically. The automatic detection is based on the feature extraction and classification patterns. For better accuracy decomposition of the signal is required before feature extraction. A number of parameters are calculated by the researchers using different techniques e.g. approximate entropy, sample entropy, Fuzzy approximate entropy, intrinsic mode function, cross-correlation etc. to discriminate between a normal signal & an epileptic seizure signal.The main objective of this review paper is to present the variations in the EEG signals at both stages (i) Interictal (recording between the epileptic seizure attacks). (ii) Ictal (recording during the epileptic seizure), using most appropriate methods of analysis to provide better healthcare diagnosis. This research paper then investigates the effects of a noninvasive healing therapy on the subjects by studying the EEG signals using latest signal processing techniques. The study has been conducted with Reiki as a healing technique, beneficial for restoring balance in cases of body mind alterations associated with an epileptic seizure. Reiki is practiced around the world and is recommended for different health services as a treatment approach. Reiki is an energy medicine, specifically a biofield therapy developed in Japan in the early 20th century. It is a system involving the laying on of hands, to stimulate the body’s natural energetic system. Earlier studies have shown an apparent connection between Reiki and the autonomous nervous system. The Reiki sessions are applied by an experienced therapist. EEG signals are measured at baseline, during session and post intervention to bring about effective epileptic seizure control or its elimination altogether.

Keywords: EEG signal, Reiki, time consuming, epileptic seizure

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Authors: Jonny Beirne

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Hydropower developments have come to assume an important role within the Ethiopian government's overall development strategy for the country during the last ten years. The Gilgel Gibe III on the Omo river, due to become operational in September 2014, represents the most ambitious, and controversial, of these projects to date. Further aspects of the government's national development strategy include leasing vast areas of designated 'unused' land for large-scale commercial agricultural projects and 'voluntarily' villagizing scattered, semi-nomadic agro-pastoralist groups to centralized settlements so as to use land and water more efficiently and to better provide essential social services such as education and healthcare. The Lower Omo valley, along the Omo River, is one of the sites of this villagization programme as well as of these large-scale commercial agricultural projects which are made possible owing to the regulation of the river's flow by Gibe III. Though the Ethiopian government cite many positive aspects of these agricultural and hydropower developments there are still expected to be serious regional and transnational effects, including on migration flows, in an area already characterized by increasing climatic vulnerability with attendant population movements and conflicts over scarce resources. The following paper is an attempt to track actual and anticipated migration flows resulting from the construction of Gibe III in the immediate vicinity of the dam, downstream in the Lower Omo Valley and across the border in Kenya around Lake Turkana. In the case of those displaced in the Lower Omo Valley, this will be considered in view of the distinction between voluntary villagization and forced resettlement. The research presented is not primary-source material. Instead, it is drawn from the reports and assessments of the Ethiopian government, rights-based groups, and academic researchers as well as media articles. It is hoped that this will serve to draw greater attention to the issue and encourage further methodological research on the dynamics of dam constructions (and associated large-scale irrigation schemes) on migration flows and on the ultimate experience of displacement and resettlement for environmental migrants in the region.

Keywords: forced displacement, voluntary resettlement, migration, human rights, human security, land grabs, dams, commercial agriculture, pastoralism, ecosystem modification, natural resource conflict, livelihoods, development

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Authors: Piacentini Diego, Della Rovere Federica, Fattorini Laura, Lanni Francesca, Cittadini Martina, Altamura Maria Maddalena, Falasca Giuseppina

Abstract:

Plants have evolved sophisticated mechanisms to cope with environmental cues. Changes in intracellular content and distribution of phytohormones, such as the auxin indole-3-acetic acid (IAA), have been involved in morphogenic adaptation to environmental stresses. In addition to phytohormones, plants can rely on a plethora of small signal molecules able to promptly sense and transduce the stress signals, resulting in morpho/physiological responses thanks also to their capacity to modulate the levels/distribution/reception of most hormones. Among these signaling molecules, nitrogen monoxide (nitric oxide – NO) is a critical component in several plant acclimation strategies to both biotic and abiotic stresses. Depending on its levels, NO increases plant adaptation by enhancing the enzymatic or non-enzymatic antioxidant systems or by acting as a direct scavenger of reactive oxygen/nitrogen (ROS/RNS) species produced during the stress. In addition, exogenous applications of NO-specific donor compounds showed the involvement of the signal molecule in auxin metabolism, transport, and signaling, under both physiological and stress conditions. However, the complex mechanisms underlying NO action in interacting with phytohormones, such as auxins, during metal stress responses are still poorly understood and need to be better investigated. Emphasis must be placed on the response of the root system since it is the first plant organ system to be exposed to metal soil pollution. The monocot Oryza sativa L. (rice) has been chosen given its importance as a stable food for some 4 billion people worldwide. In addition, increasing evidence has shown that rice is often grown in contaminated paddy soils with high levels of heavy metal cadmium (Cd) and metalloid arsenic (As). The facility through which these metals are taken up by rice roots and transported to the aerial organs up to the edible caryopses makes rice one of the most relevant sources of these pollutants for humans. This study aimed to evaluate if NO has a mitigatory activity in the roots of rice seedlings against Cd or As toxicity and to understand if this activity requires interactions with auxin. Our results show that exogenous treatments with the NO-donor SNP alleviate the stress induced by Cd, but not by As, in in-vitro-grown rice seedlings through increased intracellular root NO levels. The damages induced by the pollutants include root growth inhibition, root histological alterations and ROS (H2O2, O2●ˉ), and RNS (ONOOˉ) production. Also, SNP treatments mitigate both the root increase in root IAA levels and the IAA alteration in distribution monitored by the OsDR5::GUS system due to the toxic metal exposure. Notably, the SNP-induced mitigation of the IAA homeostasis altered by the pollutants does not involve changes in the expression of OsYUCCA1 and ASA2 IAA-biosynthetic genes. Taken together, the results highlight a mitigating role of NO in the rice root system, which is pollutant-specific, and involves the interaction of the signal molecule with both IAA and brassinosteroids at different (i.e., transport, levels, distribution) and multiple levels (i.e., transcriptional/post-translational levels). The research is supported by Progetti Ateneo Sapienza University of Rome, grant number: RG120172B773D1FF

Keywords: arsenic, auxin, cadmium, nitric oxide, rice, root system

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