Search results for: recommended summary plan for emergency care and treatment

Authors: Zemenu Yohannes

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Introduction: The pandemic overstretched the weak health systems in developing countries, including Ethiopia. This study aims to assess and explore the effect of COVID-19 on antenatal care (ANC) provision. Methods: A concurrent mixed methods study was applied. An interrupted time series design was applied for the quantitative study, and in-depth interviews were implemented for the qualitative research to explore maternity care providers' perceptions of ANC provision during COVID-19. We used routine monthly collected data from the health management information system (HMIS) in fifteen hospitals in the Sidama region, Ethiopia, from March 2019 to February 2020 (12 months) before COVID-19 and from March to August 2020 (6 months) during COVID-19. We imported data into STATA V.17 for analysis. ANC provision's mean monthly incidence rate ratio (IRR) was calculated using Poisson regression with a 95% confidence interval. The qualitative data were analysed using thematic analysis. Findings from quantitative and qualitative elements were integrated with a contiguous approach. Results: Our findings indicate the rate of ANC provision significantly decreased in the first six months of COVID-19. This study has three identified main themes: barriers to ANC provision, inadequate COVID-19 prevention approach, and delay in providing ANC. Conclusion and recommendation: Based on our findings, the pandemic affected ANC provision in the study area. The health bureau and stakeholders should take a novel and sustainable approach to prevent future pandemics. The health bureau and hospital administrators should establish a task force that relies on financial self-reliance to close gaps in future pandemics of medical supply shortages. Pregnant women should receive their care promptly from maternity care providers. In order to foster contact and avoid discrimination the future pandemics, hospital administrators should set up a platform for community members and maternity care providers.

Keywords: ANC provision, COVID-19, mixed methods study, Ethiopia

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Authors: Ella Abaev, Shany Segal, Miri Gabay

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Background: Choking is a blockage of airways that prevents efficient breathing and air flow to the lungs. Choking may be partial or full and is an emergency situation. Complete or prolonged choking leads to apnea, lack of oxygen in the tissues of the body and brain, and can cause death. There are three mechanisms of choking: obstruction of internal respiratory tracts by food or object aspiration, any material that blocks or covers external air passages, external pressure on the neck or trapping between objects. Children's airways are narrower than that of adults and therefore the risk of choking is greater, due to the aspiration of food and other foreign bodies into the lungs. In the Child Development Center at Safra Children’s Hospital, Tel Hashomer in Israel are treated infants, toddlers, and children aged 0-18 years with various developmental disabilities. Due to the increase in reports of ‘almost an event’ of choking in the past year and the serious consequences of choking event, it was decided to give an emphasis to the issue. Incidence and methods: The number of reports of ‘almost an event’ or a choking event was examined at the center during the years 2013-2018 and a thorough research work was conducted on the subject in order to build a prevention program. Findings: Between 2013 and 2018 the center reported about ten cases of ‘almost choking events’. In the middle of 2018 alone three cases of ‘almost an event’ were reported. Objective: Providing knowledge leads to awareness raise, change of perception, change in behavior and prevention. The center employs more than 130 staff members from various sectors so that it is the work of multi-professional teams to promote the quality and safety of the treatment. The familiarity of the staff with risk factors, prevention guidelines, identification of choking signs, and treatment are most important and significant in determining the outcome of a choking event. Conclusions and recommendations: After in-depth research work was carried out in cooperation with the Risk Management Unit on the subject of choking, which include a description of the definitions, mechanisms, risk factors, treatment methods and extensive recommendations for prevention (e.g. using treatment and stimulation accessories with standards association stamps and adjustment of the type of food and the way it is served to match to the child's age and the ability to swallow). The expected stages of development and emphasis on the population of children with special needs were taken into account. The research findings will be published by the staff and parents of the patients, professional publications, and lectures and there is an expectation to decrease the number of choking events in the next years.

Keywords: children with special needs, choking, educational system, prevention guidelines

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Authors: Neeti Rustagi, Naveen Dutt, Arvind Sinha, Mahaveer S. Rhodha, Pankaja R. Raghav

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Background: Pre-hospital trauma care services are in developing stage in fast-urbanizing cities of India including Jodhpur. Training of health professionals in providing necessary pre-hospital trauma care is an essential step in decreasing accident related morbidity and mortality. The current study explores the response of a medical graduate toward helping an accident victim in a pre-hospital setting before patient can be transferred to definitive trauma facility. Methodology: This study examines the perceived competence in predicting response to an accident victim by medical graduates in Jodhpur, Rajasthan. Participants completed measures of attitude, normative influence and perceived behavior control toward providing pre-hospital care to an accident victim. Likert scale was used to measure the participant responses. Preliminary and descriptive analysis were used using SPSS 21.0. Internal consistency of the responses received was measured using Cronbach’s alpha. Results: Almost all medical graduates agreed that road accidents are common in their area (male: 92%; female: 78%). More male medical graduates (28%) reported helping an accident victim as compared to female physicians (9%) in the previous three months. Majority of study participants (96%) reported that providing immediate care to an accident victim is essential to save the life of an individual. Experience of helping an accident victim was considered unpleasant by the majority of female participants (70%) as compared to male participants (36%). A large number of participants believed that their friends (80%) and colleagues (96%) would appreciate them helping an accident victim in a pre-hospital setting. A large number of participants also believed that they possess the necessary skills and competencies (80%) towards helping a roadside accident victim in the pre-hospital care environment. Perceived competence of helping a roadside accident victim until they are transferred to a health facility was reported by less than half of the participants (male: 56%; female: 43%). Conclusion: Medical graduates have necessary attitude, competencies, and intention of helping a roadside accident victim. The societal response towards helping a road side accident victim is also supportive. In spite of positive determinants, a large proportion of medical graduates have perceived lack of competence in helping a roadside accident victim. This is essential to explore further as providing pre-hospital care to a roadside accident victim is an essential step in establishing the continuum of care to an accident victim especially in countries where pre-hospital services are in developing phase.

Keywords: prehospital care, perceived behavior, perceived competence, medical graduates

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Authors: G. Ramya

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Value engineering is a systematic approach, widely used to optimize the design or process or product in the designing stage. It used to achieve the client's obligation by increasing the functionality and attain the targeted cost in the cost planning. Value engineering effectiveness and benefits decrease along with the progress of the project since the change in the scope of the work and design will account for more cost all along the lifecycle of the project. Integrating the value engineering with other project management activities will promote cost minimization, client satisfaction, and ensure early completion of the project in time. Previous research studies suggested that value engineering can integrate with other project delivery activities, but research studies unable to frame a model that collaborates the project management activities with the job plan of value engineering approach. I analyzed various project management activities and their synergy between each other. The project management activities and processes like a)risk analysis b)lifecycle cost analysis c)lean construction d)facility management e)Building information modelling f)Contract administration, collaborated, and project delivery model planned along with the RIBA plan of work. The key outcome of the research is a value-driven project delivery model, which will succeed in dealing with the economic impact, constraints and conflicts arise due to the COVID-19 outbreak in the Indian construction sector. Benefits associated with the structured framework is construction project delivery that ensures early contractor involvement, mutual risk sharing, and reviving the project with a cost overrun and delay back on track ,are discussed. Keywords: Value-driven project delivery model, Integration, RIBA plan of work Themes: Design Economics

Keywords: value-driven project delivery model, Integration, RIBA

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Authors: Philip Eappen, Narasimha Rao Vajjhala

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This chapter examines how healthcare organizations harnessed innovative healthcare informatics to navigate the challenges posed by the COVID-19 pan-demic, addressing critical needs and improving care delivery. The pandemic's un-precedented demands necessitated the adoption of new and advanced tools to manage healthcare operations more effectively. Informatics solutions played a crucial role in facilitating the smooth functioning of healthcare systems during this crisis and are anticipated to remain central to future healthcare management. Technologies such as telemedicine helped healthcare professionals minimize ex-posure to COVID-19 patients, thereby reducing infection risks within healthcare facilities. This chapter explores a range of informatics applications utilized worldwide, including telemedicine, AI-driven solutions, big data analytics, drones, robots, and digital platforms for drug delivery, all of which enabled re-mote patient care and enhanced healthcare accessibility and safety during the pan-demic.

Keywords: healthcare informatics, COVID-19 Pandemic, telemedicine, AI-driven healthcare, big data analytics, remote patient care, digital health platforms

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Authors: Christian Böning, Henrik Prinzhorn, Eric C. Hund, Malte Stonis

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In this article, the flexible job-shop scheduling problem is extended by consideration of energy costs which arise owing to the power peak, and further decision variables such as work in process and throughput time are incorporated into the objective function. This enables a production plan to be simultaneously optimized in respect of the real arising energy and logistics costs. The energy-costs-aware flexible job-shop scheduling problem (EFJSP) which arises is described mathematically, and a memetic algorithm (MA) is presented as a solution. In the MA, the evolutionary process is supplemented with a local search. Furthermore, repair procedures are used in order to rectify any infeasible solutions that have arisen in the evolutionary process. The potential for lowering the real arising costs of a production plan through consideration of energy consumption levels is highlighted.

Keywords: energy costs, flexible job-shop scheduling, memetic algorithm, power peak

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Authors: Abdullah Al-Alaian, Ahmad Al-Enzi, Hasan Al-Herz, Ahmad Bakri, Shant Tatorian, Amr Nounou

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Kuwait is a country that has an imbalanced economy since most of its national outcome comes from the oil trade. It is so risky for a country to be dependent on a single source for income, and this increases the need to diversify its economy. In addition, according to the Public Authority for Industry, the contribution of the industrial sector to the current Gross Domestic Product (GDP) of Kuwait is low which is about 4.33%. Therefore, the development of the industrial sector can be one of the means to diversify the economy and increase the industry's contribution to the national outcome. This is in accordance with Kuwait’s vision of 2035 which aims at increasing the contribution of the industrial sector to the GDP to 12%. In order to do so, this study aims at proposing a strategic plan that will accomplish certain objectives when implemented. It is based on analyzing the industrial sectors in Kuwait taking into consideration studying the strengths, weaknesses, opportunities, and threats facing them. At the same time, it tends to gain from the experience of leading models and neighboring countries regarding the development of the industrial sector. In this study, the SWOT analysis technique will be conducted on all industrial sectors based on evaluation criteria in which it is determined whether any of them has a potential for improvement or not. In other words, it is determined whether the sectors are able to compete locally, regionally, or globally. Based on the results of the SWOT analysis, certain sectors will be chosen, assessed based on an assessment scheme, and their potentials for improvement will be aligned with the overall objectives. To ensure the achievement of the study’s objectives, an action plan will be proposed regarding recommendations for the related authorities, and for entrepreneurs. In addition, monitoring tools are going to be provided for the purpose of periodically checking the progress made in the implementation of the plan.

Keywords: industrial sector, SWOT analysis, productivity, competitiveness, GDP, Kuwait, economy

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Authors: Opal Giulianelli, Pegah Zamani

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Sustainable food has become a frequently debated topic in recent years due to a consumer push for environmentally sustainable food. While some research works on improving the monoculture farm systems that are currently in use, others focus on expanding the definition of sustainable food systems. This research looks at those concepts of alternative food systems applied to a more extensive city system. The goal is to create a theoretical site plan that could be implemented in emerging cities and other urban environments. This site plan combines the ideas of environmentally sustainable food development, such as food forests, urban farming, and community gardens. This would represent one part of a larger sustainable food system that can be altered depending on the environment or the people it is serving. However, this research is being carried out with the southeast United States in mind and, therefore, may prove difficult to apply to other regions, especially those of radically different climates.

Keywords: alternative food systems, urban design, food forests, aquaponics, hydroponics, food security, food system design

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Authors: Ahlyum Mun, Ji-Young Moon, Moon-Seok Yoon, Dong-Jin Baek, Doo-Seok Seo, Oun-Kyong Moon

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There is a growing public concern over the standards of farm animal welfare, with higher standards of food safety. In addition, the recent low incidence of Avian Influenza in laying hens among certificated farms is receiving attention. In this study, we introduce animal welfare systems covering the rearing, transport and slaughter of farm animals in South Korea. The concepts of animal welfare farm certification are based on ensuring the five freedoms of animal. The animal welfare is also achieved by observing the condition of environment including shelter and resting area, feeding and water and the care for the animal health. The certification of farm animal welfare is handled by the Animal Protection & Welfare Division of Animal and Plant Quarantine Agency (APQA). Following the full amendment of Animal Protection Law in 2011, animal welfare farm certification program has been implemented since 2012. The certification system has expanded to cover laying hen, swine, broiler, beef cattle and dairy cow, goat and duck farms. Livestock farmers who want to be certified must apply for certification at the APQA. Upon receipt of the application, the APQA notifies the applicant of the detailed schedule of the on-site examination after reviewing the document and conducts the on-site inspection according to the evaluation criteria of the welfare standard. If the on-site audit results meet the certification criteria, APQA issues a certificate. The production process of certified farms is inspected at least once a year for follow-up management. As of 2017, a total of 145 farms have been certified (95 laying hen farms, 12 swine farms, 30 broiler farms and 8 dairy cow farms). In addition, animal welfare transportation vehicles and slaughterhouses have been designated since 2013 and currently 6 slaughterhouses have been certified. Animal Protection Law has been amended so that animal welfare certification marks can be affixed only to livestock products produced by animal welfare farms, transported through animal welfare vehicles and slaughtered at animal welfare slaughterhouses. The whole process including rearing–transportation- slaughtering completes the farm animal welfare system. APQA established its second 5-year animal welfare plan (2014-2019) that includes setting a minimum standard of animal welfare applicable to all livestock farms, transportation vehicles and slaughterhouses. In accordance with this plan, we will promote the farm animal welfare policy in order to truly advance the Korean livestock industry.

Keywords: animal welfare, farm animal, certification system, South Korea

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Authors: Guanglin Song

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(Objective) Situated within the context of China's tiered medical treatment system, this study aims to analyze spatial causes of urban healthcare access difficulties from the perspective of the configuration of healthcare facilities. (Methods) A social network analysis approach is employed to construct a healthcare demand and supply flow network between major residential clusters and various tiers of hospitals in the city.(Conclusion) The findings reveal that:1.there exists overall maldistribution and over-concentration of healthcare resources in Study Area, characterized by structural imbalance; 2.the low rate of primary care utilization in Study Area is a key factor contributing to congestion at higher-tier hospitals, as excessive reliance on these institutions by neighboring communities exacerbates the problem; 3.gradual optimization of the healthcare facility layout in Study Area, encompassing holistic, local, and individual institutional levels, can enhance systemic efficiency and resource balance.(Prospects) This research proposes a method for evaluating urban healthcare resource distribution structures based on service flows within hierarchical networks. It offers spatially targeted optimization suggestions for promoting the implementation of the tiered healthcare system and alleviating challenges related to accessibility and congestion in seeking medical care. Provide some new ideas for researchers and healthcare managers in countries, cities, and healthcare management around the world with similar challenges.

Keywords: flow of public services, urban networks, healthcare facilities, spatial planning, urban networks

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Authors: Aimen Batool Bint-E-Rashid, Syed Muhammad Dawood Ali Shah, Muhammad Usman Farooq, Mahgul Anwar

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As the world is progressing, the needs and demands of the consumer market are also changing. Nowadays the trends of consumer purchase decisions are dependent upon multiple factors. This study aims to identify the influential impact of country of origin over the perception and devotion towards daily personal care products specifically in reference to the knowledge and awareness regarding that particular brand in Pakistan. To corroborate this study, a 30-item brand origin questionnaire has been used with 300 purchase decision makers belonging to different age groups. To illustrate this study, a model has been developed based on brand origin, brand awareness and brand loyalty. Correlation and regression analysis have been used to find out the results which conclude the findings on the perspective of Pakistan’s consumer market as that brand origin has a direct relationship with brand loyalty provided that the consumer has a positive brand awareness. Support for the fact that brand origin impacts brand loyalty through brand awareness has been presented in this study.

Keywords: brand awareness, brand loyalty, brand origin, personal care products, P&G, Unilever

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Authors: M. K. Wijayarathna, S. M. Buddika Harshanath

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Monitoring student engagement has become a crucial part of the educational process and a reliable indicator of the capacity to retain information. As online learning classrooms are now more common these days, students' attention levels have become increasingly important, making it more difficult to check each student's concentration level in an online classroom setting. To profile student attention to various gradients of engagement, a study is a plan to conduct using machine learning models. Using a convolutional neural network, the findings and confidence score of the high accuracy model are obtained. In this research, convolutional neural networks are using to help discover essential emotions that are critical in defining various levels of participation. Students' attention levels were shown to be influenced by emotions such as calm, enjoyment, surprise, and fear. An improved virtual learning system was created as a result of these data, which allowed teachers to focus their support and advise on those students who needed it. Student participation has formed as a crucial component of the learning technique and a consistent predictor of a student's capacity to retain material in the classroom. Convolutional neural networks have a plan to implement the platform. As a preliminary step, a video of the pupil would be taken. In the end, researchers used a convolutional neural network utilizing the Keras toolkit to take pictures of the recordings. Two convolutional neural network methods are planned to use to determine the pupils' attention level. Finally, those predicted student attention level results plan to display on the graphical user interface of the System.

Keywords: HTML5, JavaScript, Python flask framework, AI, graphical user

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Authors: Maitri Dave

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Coronaviruses (CoV) is such infectious virus which has impacted globally in a more dangerous manner causing severe lung problems and leaving behind more serious diseases among the people. This pandemic has affected globally and created severe respiratory problems, and damaged the lungs. India has reported the first case of COVID-19 in January 2020. The first wave of COVID-19 took place from April to September of 2020. Soon after, a second peak is also noticed in the month of March 2021, which in turn becomes more dangerous due to a lack of supply of medical equipment. It created resource deficiency globally, specifically in India, where some necessary life-saving equipment like ventilators and oxygenators were not sufficient to cater to the demand-supply ratio effectively. Through carefully examining such a situation, India began to execute the process of vaccination in the month of January 2021 and successfully administered 25,46,71,259 doses of vaccines till now, which is only 15.5% of the total population while only 3.6% of the total population is fully vaccinated. India has authorized the British Oxford–AstraZeneca vaccine (Covishield), the Indian BBV152 (Covaxin) vaccine, and the Russian Sputnik V vaccine for emergency use. In the present study, we have collected all the data state wisely of both first and second wave and analyzed them using MS Excel Version 2019 and SPSS Statistics Version 26. Following the trends, we have predicted the characteristics of the upcoming third wave of COVID-19 and recommended some strategies, early actions, and measures that can be taken by the public health system in India to combat the third wave more effectively.

Keywords: COVID-19, vaccination, Covishiled, Coronavirus

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Authors: Zanib Nafees, Amir Razaghizad, Ibtisam Mahmoud, Abhinav Sharma, Renzo Cecere

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More than one million surgeries are performed each year in Canada, resulting in more than 100,000 associated serious adverse events (SAEs) per year. These are defined as unintended injuries or complications that adversely affect the well-being of patients. In recent years, there has been a proliferation of digital health interventions that have the potential to assist, monitor, and educate patients—facilitating self-care following post-operative discharge. Among digital health, interventions are interactive-voice response technologies (IVRs), which have been shown to be highly effective in certain medical settings. Although numerous IVR-based interventions have been developed, their effectiveness and utility remain unclear, notably in post-operative settings. To the best of our knowledge, no systematic or scoping reviews have evaluated this topic to date. Thus, the objective of this scoping review protocol is to systematically map and explore the literature and evidence describing and examining IVR tools, implementation, evaluation, outcome, and experience for post-operative patients. The focus will be primarily on the evaluation of baseline performance status, clinical assessment, treatment outcomes, and patient management, including self-management and self-monitoring. The objective of this scoping review is to assess the extent of the literature to direct future research efforts by identifying gaps and limitations in the literature and to highlight relevant determinants of positive outcomes in the emerging field of IVR monitoring for health outcomes in post-operative patients.

Keywords: digital healthcare technologies, post-surgery, interactive voice technology, interactive voice response

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Authors: Gregor Moncrieff, Ursula Bahlmann

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A number of incident reports were filed from the intensive care unit with regards to adult patients admitted following operations who had a central venous catheter inserted of the incorrect length for the relevant anatomical site and catheters not compatible with pressurised injection inserted whilst in theatre. Incorrect catheter length can lead to a variety of complications and pressurised injection is a requirement for contrast enhanced computerised tomography scans. This led to several patients having a repeat procedure to insert a catheter of the correct length and also compatible with pressurised injection. This project aimed to identify the types of central venous catheters used in theatres and ensure the correct equipment would be stocked and used in future cases in accordance the existing Association of Anaesthetics of Great Britain and Northern Ireland guidelines. A questionnaire was sent out to all of the anaesthetic department in our hospital aiming to determine what types of central venous catheters were preferably used by anaesthetists and why these had been chosen. We also explored any concerns regarding introduction of standardised, pressure injectable central venous catheters to the theatre department which were already in use in other parts of the hospital and in keeping with national guidance. A total of 56 responses were collected. 64% of respondents routinely used a central venous catheter which was significantly shorter than the national recommended guidance with a further 4 different types of central venous catheters used which were different to other areas of the hospital and not pressure injectable. 75% of respondents were in agreement to standardised introduction of the pressure injectable catheters of the recommended length in accordance with national guidance. Reasons why 25% respondents were opposed to introduction of these catheters were explored and discussed. We were successfully able to introduce the standardised central catheters to the theatre department following presentation at the local anaesthetic quality and safety meeting. Reasons against introduction of the catheters were discussed and a compromise was reached that the existing catheters would continue to be stocked but would only be available on request, with a focus on encouraging use of the standardised catheters. Additional changes achieved included removing redundant catheters from the theatre stock. Ongoing data is being collected to analyse positive and negative feedback from use of the introduced catheters.

Keywords: central venous catheter, medical equipment, medical safety, quality improvement

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Authors: Pantip Kayee, Yuwadee Yaponha, Jiranit Pongtubthai

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This study focused on the determination of heavy metal concentration in wastewater and the investigation of heavy metal removal of wastewater treatment system of Suan Sunandha Rajabhat University. Heavy metals (Pb, Cu, Mn, Ni and Zn) were found in wastewater of Suan Sunandha Rajabhat University. Wastewater treatment systems of Suan Sunandha Rajabhat University showed the performance to remove heavy metals. However, heavy metals were still presented in effluent but these residue heavy metals were not over the standard for industrial wastewater. Wastewater treatment system can remove heavy metal by different process such as bioaccumulation by microorganism and biosorption on activated sludge.

Keywords: heavy metal, wastewater, bioaccumulation, biosorption

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Authors: Lukman Abiodun Nafiu

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This study examines the impact evaluation of vaccination against eight-child-killer diseases on under-five children mortality at Mbale District. It was driven by three specific objectives which are to determine the proportion of under-five children mortality due to the eight-child-killer diseases to the total under-five children mortality; establish the cause-effect relationship between the eight-child-killer diseases and under-five children mortality; as well as establish the dependence of under-five children mortality in the location at Mbale District. A community based cross-sectional and longitudinal (panel) study design involving both quantitative and qualitative (focus group discussion and in-depth interview) approaches was employed over a period of 36 months. Multi-stage cluster design involving Health Sub-District (HSD), Forms of Ownership (FOO) and Health Facilities Centres (HFC) as the first, second and third stages respectively was used. Data was collected regarding the eight-child-killer diseases namely: measles, pneumonia, pertussis (whooping cough), diphtheria, poliomyelitis (polio), tetanus, haemophilus influenza, rotavirus gastroenteritis and mortality regarding immunized and non-immunized children aged 0-59 months. We monitored the children over a period of 24 months. The study used a sample of 384 children out of all the registered children for each year at Mbale Referral Hospital and other Primary Health Care Centres (HCIV, HCIII and HCII) at Mbale District between 2015 and 2019. These children were followed from birth to their current state (living or dead). The data collected in this study was analysed using cross tabulation and the chi-square test. The study concluded that majority of mothers at Mbale district took their children for immunization and thus reducing the occurrence of under-five children mortality. Overall, 2.3%, 4.6%, 3.1%, 5.4%, 1.5%, 3.8%, 0.0% and 0.0% of under-five children had polio, tetanus, diphtheria, measles, pertussis, pneumonia, haemophilus influenzae and rotavirus gastroenteritis respectively across all the sub counties at Mbale district during the period considered. Also, different locations (sub counties) do not have significant influence on the occurrence of these eight-child-killer diseases among the under-five children at Mbale district. Therefore, the study recommended that government and agencies should continue to work together to implement measures of vaccination programs and increasing access to basic health care with a continuous improvement on the social interventions to progress child survival.

Keywords: Diseases, Mortality, Children, Vaccination

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Authors: Joana PaScoa Pinheiro, David Goncalves Ferreira, Filipe Ramos, Joaquim Soares Do Brito, Samuel Martins, Marco Sarmento

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Introduction: The SARS-CoV-2 (COVID-19) pandemic was identified in January 2020 in China, in the city of Wuhan. The increase in the number of cases over the following months was responsible for the restructuring of hospitals and departments in order to accommodate admissions related to COVID-19. Essential services, such as trauma, had to readapt to maintain their functionality and thus guarantee quick and safe access in case of an emergency. Objectives: This study describes the impact of COVID-19 on a Level III Trauma Center and particularly on the clinical management of hospitalized patients with spine injuries. Study Design & Methods: This is a retrospective cohort study whose results were obtained through the medical records of patients with spine injuries who underwent surgical intervention in the years 2019 and 2020 (period from March 1st to December 31st). A comparison between the two groups was made. In the study patients with injuries in the context of trauma were included who underwent surgery in the periods previously described. Patients hospitalized with a spine injury in a non-traumatic context and/or were not surgically treated were excluded. Results: In total, 137 patients underwent trauma spine surgery of which 71 in 2019 (51.8%) were without significant differences in intergroup comparisons. The most frequent injury mechanism in 2019 was motor vehicle crash (47.9%) compared to 2020 which was of a person falling from a height between 2-4 meters (37.9%). Cervical trauma was reported to be the most frequent spine injury in both years. There was a significant decrease in the need for intensive care in 2020, 51.4% vs 30.3%, p = .015 and the number of complications was also lower in 2020 (1.35% vs 0.98%), including the number of deaths, being the difference marginally significant. There were no significant differences regarding time for presentation to surgery or in the total days of hospitalization. Conclusions: The restructuring made in the trauma unit at a Level III Trauma Center in the context of the current COVID-19 pandemic was effective, with no significant differences between the years of 2019 vs 2020 when compared with the time for presentation to surgery or the number of days of hospitalization. It was also found that lockdown rules in 2020 were probably responsible for the decrease in the number of road traffic accidents, which justifies a significant decrease in the need for intensive care as well as in the number of complications in patients hospitalized in the context of spine trauma.

Keywords: trauma, spine, impact, covid-19

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Authors: Jessica Gladden

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This study explored the perceived benefits of trauma-sensitive yoga programs. Participants attended one of two six-week trauma-sensitive yoga programs utilizing the G.R.A.C.E model, a format developed based on Emerson’s trauma-sensitive yoga guidelines and modified by the instructors. Participants in this study completed surveys on their experiences. The results of the surveys indicated that participants perceived improvements in self-care, embodiment, and mood. These results show that trauma-sensitive yoga may have benefits beyond the treatment of specific diagnoses that could be applied to a variety of populations. Reflections from one of the researchers who teaches in this program, as well as qualitative statements from the participants, will be shared to support the continued use of this method.

Keywords: yoga, trauma-sensitive, yoga therapy, trauma

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Authors: A. F. Jaber, E. Dean, M. Liu, J. He, D. Sabata, J. Radel

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Background: Stroke is a serious health care concern and a major cause of disability in the United States. This condition impacts the individual’s functional ability to perform daily activities. Predicting functional performance of people with stroke assists health care professionals in optimizing the delivery of health services to the affected individuals. The purpose of this study was to identify significant predictors of Motor FIM and of Cognitive FIM subscores among individuals with stroke after discharge from inpatient rehabilitation (typically 4-6 weeks after stroke onset). A second purpose is to explore the relation among personal characteristics, health status, and functional performance of daily activities within 2 weeks of stroke onset. Methods: This study used a retrospective chart review to conduct a secondary analysis of data obtained from the Healthcare Enterprise Repository for Ontological Narration (HERON) database. The HERON database integrates de-identified clinical data from seven different regional sources including hospital electronic medical record systems of the University of Kansas Health System. The initial HERON data extract encompassed 1192 records and the final sample consisted of 207 participants who were mostly white (74%) males (55%) with a diagnosis of ischemic stroke (77%). The outcome measures collected from HERON included performance scores on the National Institute of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), and the Functional Independence Measure (FIM). The data analysis plan included descriptive statistics, Pearson correlation analysis, and Stepwise regression analysis. Results: significant predictors of discharge Motor FIM subscores included age, baseline Motor FIM subscores, discharge NIHSS scores, and comorbid electrolyte disorder (R2 = 0.57, p <0.026). Significant predictors of discharge Cognitive FIM subscores were age, baseline cognitive FIM subscores, client cooperative behavior, comorbid obesity, and the total number of comorbidities (R2 = 0.67, p <0.020). Functional performance on admission was significantly associated with age (p < 0.01), stroke severity (p < 0.01), and length of hospital stay (p < 0.05). Conclusions: our findings show that younger age, good motor and cognitive abilities on admission, mild stroke severity, fewer comorbidities, and positive client attitude all predict favorable functional outcomes after inpatient stroke rehabilitation. This study provides health care professionals with evidence to evaluate predictors of favorable functional outcomes early at stroke rehabilitation, to tailor individualized interventions based on their client’s anticipated prognosis, and to educate clients about the benefits of making lifestyle changes to improve their anticipated rate of functional recovery.

Keywords: functional performance, predictors, stroke, recovery

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Authors: Harmeet Pal Singh Dhooria, Deepinder Chinna, UPS Sidhu, Alok Jain

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Serious infections caused by gram-negative bacteria are a significant cause of mortality and morbidity in the hospital setting. In acute care facilities like in intensive care units (ICUs), the intensity of antimicrobial use together with a population highly susceptible to infection, creates an environment, which facilitates both emergence and transmission of Extended Spectrum -lactamase (ESBL) producing Enterobacteriaceae species. The study was conducted in the Medical Intensive Care Unit (MICU) and the Pulmonary Critical Care Unit (PCCU) of the Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Out of a total of 1108 samples of urine, blood and respiratory tract secretions received for culture and sensitivity analysis from Medical Intensive Care Unit and Pulmonary Critical Care Unit, a total of 170 isolates of Enterobacteriaceae species were obtained which were then included in our study. Out of these 170 isolates, confirmed ESBL production was seen in 116 (68.24%) cases. E.coli was the most common species isolated (56.47%) followed by Klebsiella (32.94%), Enterobacter (5.88%), Citrobacter (3.53%), Enterobacter (0.59%) and Morganella (0.59%) among the total isolates. The rate of ESBL production was more in Klebsiella (78.57%) as compared to E.coli (60.42%). ESBL producers were found to be significantly more common in patients with prior history of hospitalization, antibiotic use, and prolonged ICU stay. Also significantly increased the prevalence of ESBL related infections was observed in patients with a history of catheterization or central line insertion but not in patients with the history of intubation. Patients who had an underlying malignancy had significantly higher prevalence of ESBL related infections as compared to other co-morbid illnesses. A slightly significant difference in the rate of mortality/LAMA was observed in the ESBL producer versus the non-ESBL producer group. The rate of mortality/LAMA was significantly higher in the ESBL related UTI but not in the ESBL related respiratory tract and bloodstream infections. ESBL producing isolates had significantly higher rates of resistance to Cefepime and Piperacillin/Tazobactum, and to non β-lactum antibiotics like Amikacin and Ciprofloxacin. The level of resistance to Imipenem was lower as compared to other antibiotics. However, it was noted that ESBL producing isolates had higher levels of resistance to Imipenem as compared to non-ESBL producing isolates. Conclusion- The prevalence of ESBL producing organisms was found to be very high (68.24%) among Enterobacteriaceae isolates in our ICU setting as among other ICU care settings around the world.

Keywords: enterobacteriaceae, extended spectrum B-lactamase (ESBL), ICU, antibiotic resistance

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Authors: Ortega Ivan, De La Plaza Edurne

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Background: Spain and other European countries have implemented Uncontrolled Donation after Cardiac Death (uDCD) programs. After 15 years of experience in Spain, many things have changed. Recent evidence and technical breakthroughs achieved in resuscitation are relevant for uDCD programs and raise some ethical concerns related to these protocols. Aim: To rethink current uDCD programs in the light of recent evidence on available therapeutic procedures applicable to victims of out-of-hospital cardiac arrest (OHCA). To address the following question: What is the current standard of treatment owed to victims of OHCA before including them in an uDCD protocol? Materials and Methods: Review of the scientific and ethical literature related to both uDCD programs and innovative resuscitation techniques. Results: 1) The standard of treatment received and the chances of survival of victims of OHCA depend on whether they are classified as Non-Heart Beating Patients (NHBP) or Non-Heart-Beating-Donors (NHBD). 2) Recent studies suggest that NHBPs are likely to survive, with good quality of life, if one or more of the following interventions are performed while ongoing CPR -guided by suspected or known cause of OHCA- is maintained: a) direct access to a Cath Lab-H24 or/and to extra-corporeal life support (ECLS); b) transfer in induced hypothermia from the Emergency Medical Service (EMS) to the ICU; c) thrombolysis treatment; d) mobile extra-corporeal membrane oxygenation (mini ECMO) instituted as a bridge to ICU ECLS devices. 3) Victims of OHCA who cannot benefit from any of these therapies should be considered as NHBDs. Conclusion: Current uDCD protocols do not take into account recent improvements in resuscitation and need to be adapted. Operational criteria to distinguish NHBDs from NHBP should seek a balance between the technical imperative (to do whatever is possible), considerations about expected survival with quality of life, and distributive justice (costs/benefits). Uncontrolled DCD protocols can be performed in a way that does not hamper the legitimate interests of patients, potential organ donors, their families, the organ recipients, and the health professionals involved in these processes. Families of NHBDs’ should receive information which conforms to the ethical principles of respect of autonomy and transparency.

Keywords: uncontrolled donation after cardiac death resuscitation, refractory cardiac arrest, out of hospital cardiac, arrest ethics

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Authors: Edna T. Bernabe, Joshua Bilolo, Sheila Mae Artillero, Catlicia Joy Caseda, Liezel Once, Donne Ynah Grace Quirante

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Internal communication is significant for an organization to function to its full extent. A strategic communication plan builds an organization’s structure and makes it more systematic. Information is a vital part of communication inside the organization as this lays every possible outcome—be it positive or negative. It is, therefore, imperative to assess the communication structure of a particular organization to secure a better and harmonious communication environment in any organization. Thus, this research was intended to identify the internal communication channels used in Polytechnic University of the Philippines-College of Communication (PUP-COC) as an organization, to identify the flow of information specifically in downward, upward, and horizontal communication, to assess the accuracy, consistency, and timeliness of its internal communication channels; and to come up with a proposed strategic communication plan of information dissemination to improve the existing communication flow in the college. The researchers formulated a framework from Input-Throughout-Output-Feedback-Goal of General System Theory and gathered data to assess the PUP-COC’s internal communication. The communication model links the objectives of the study to know the internal organization of the college. The qualitative approach and case study as the tradition of inquiry were used to gather deeper understanding of the internal organizational communication in PUP-COC, using Interview, as the primary methods for the study. This was supported with a quantitative data which were gathered through survey from the students of the college. The researchers interviewed 17 participants: the College dean, the 4 chairpersons of the college departments, the 11 faculty members and staff, and the acting Student Council president. An interview guide and a standardized questionnaire were formulated as instruments to generate the data. After a thorough analysis of the study, it was found out that two-way communication flow exists in PUP-COC. The type of communication channel the internal stakeholders use varies as to whom a particular person is communicating with. The members of the PUP-COC community also use different types of communication channels depending on the flow of communication being used. Moreover, the most common types of internal communication are the letters and memoranda for downward communication, while letters, text messages, and interpersonal communication are often used in upward communication. Various forms of social media have been found out to be of use in horizontal communication. Accuracy, consistency, and timeliness play a significant role in information dissemination within the college. However, some problems have also been found out in the communication system. The most common problem are the delay in the dissemination of memoranda and letters and the uneven distribution of information and instruction to faculty, staff, and students. This has led the researchers to formulate a strategic communication plan which aims to propose strategies that will solve the communication problems that are being experienced by the internal stakeholders.

Keywords: communication plan, downward communication, internal communication, upward communication

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Authors: R. S. Giraddi, C. M. Poleshi

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Organic cultivation of crops is gaining importance consumer awareness towards pesticide residue free foodstuffs is increasing globally. This is also because of high costs of synthetic fertilizers and pesticides, making the conventional farming non-remunerative. In India, organic manures (such as vermicompost) are an important input in organic agriculture.  Though vermicompost obtained through earthworm and microbe-mediated processes is known to comprise most of the crop nutrients, but they are in small amounts thus necessitating enrichment of nutrients so that crop nourishment is complete. Another characteristic of organic manures is that the pest infestations are kept under check due to induced resistance put up by the crop plants. In the present investigation, deoiled neem cake containing azadirachtin, copper ore tailings (COT), a source of micro-nutrients and microbial consortia were added for enrichment of vermicompost. Neem cake is a by-product obtained during the process of oil extraction from neem plant seeds. Three enriched vermicompost blends were prepared using vermicompost (at 70, 65 and 60%), deoiled neem cake (25, 30 and 35%), microbial consortia and COTwastes (5%). Enriched vermicompost was thoroughly mixed, moistened (25+5%), packed and incubated for 15 days at room temperature. In the crop response studies, the field trials on chili (Capsicum annum var. longum) and soybean, (Glycine max cv JS 335) were conducted during Kharif 2015 at the Main Agricultural Research Station, UAS, Dharwad-Karnataka, India. The vermicompost blend enriched with neem cake (known to possess higher amounts of nutrients) and vermicompost were applied to the crops and at two dosages and at two intervals of crop cycle (at sowing and 30 days after sowing) as per the treatment plan along with 50% recommended dose of fertilizer (RDF). 10 plants selected randomly in each plot were studied for pest density and plant damage. At maturity, crops were harvested, and the yields were recorded as per the treatments, and the data were analyzed using appropriate statistical tools and procedures. In the crops, chili and soybean, crop nourishment with neem enriched vermicompost reduced insect density and plant damage significantly compared to other treatments. These treatments registered as much yield (16.7 to 19.9 q/ha) as that realized in conventional chemical control (18.2 q/ha) in soybean, while 72 to 77 q/ha of green chili was harvested in the same treatments, being comparable to the chemical control (74 q/ha). The yield superiority of the treatments was of the order neem enriched vermicompost>conventional chemical control>neem cake>vermicompost>untreated control.  The significant features of the result are that it reduces use of inorganic manures by 50% and synthetic chemical insecticides by 100%.

Keywords: humic acid, azadirachtin, vermicompost, insect-pest

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Authors: Arezoo Fallahi, Fateme Aslibigi, Parvaneh Taymoori, Babak Nematshahrbabaki

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Background and Aims: Cancer of the cervix, one of cancer-related death, is the second most common cancer in women worldwide. It develops over time but it is one of the most preventable types of cancer and there is the available proper screening program for its preventing. Since Pap smear test is vital to prevent and control of disease but women do not accomplish it regularly. Therefore, this study was aimed to explore women's needs referring to health care centers for doing Pap smear test. Material and methods: In this study, an inductive qualitative method with content analysis approach was used. This survey was done in varamin city (is located capital of Iran) in year 2014. Through the purposive sampling 15 women's view of point referring to health care centers of for doing Pap smear test was surveyed. Inclusion criteria were: 20-50 years old married women, having experience Pap smear test and attendance to participate in the Study. Recorded semi- structured interviews were typed and analyzed through of content analysis method. To obtain trustworthiness and rigor of the data, the criteria of credibility, dependability, confirmability and transferability was used. Results: During the data analysis, four main categories of “role of health care team”, “role of organizations”, “social support” and “policies and administration system” were developed. The participants emphasized on making motivational rules and coordination among organizations to do behaviors related to women health. Conclusion: The findings of study showed that doing Pap smear test are attributed to appropriate and intimate interactions with health professionals, family support, encouraging legislation and policies and coordination and notification of organizations. Therefore, designers and stockholders of policies and health system should more consider to growth and involve other organizations toward women's health.

Keywords: qualitative approach, pap smear test, women, health care centers

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Authors: Priyanshu Sharma

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Urban development mechanism has evolved over the years in India, and various planning models and tools have been adopted by different states. Large cities have been able to make and implement plans with the varied degree. However, it has been observed these mechanisms face challenges to gain the momentum in small and medium towns. Gujarat has a very robust legislation that empowers planning authorities to prepare development plans (DP) and town planning scheme (TPS). The DP- TPS planning methods are quite popular for large cities in Gujarat. However, it has been observed that in the smaller towns these methods of plan preparation are facing severe agitations. Recently, development authorities of many small towns like Himmatnagar, Nadiad, and Junagadh, etc. have faced serious protest from local residents. This is because of the large amount of land deduction under the provisions of DP and TPS. And this number of opposition has been increasing since 2012 in Gujarat. This study aims to understand in detail the reasons for agitation against the plans prepared by smaller towns. It will further try to see whether the current framework of urban planning (DP and TPS) are really suitable for these towns. After understanding the development concerns and background, the aim and objectives of the study were outlined: Aim: To evaluate the suitability and acceptability of the current urban development mechanism for the small and medium towns. Objectives: (i) To review the GTPUD Act and identify the provision related to small and medium towns (ii) To understand preparation process of development plan and town planning scheme and issues related to it (iii) To understand the issues raised by the different stakeholder w.r.t plan because of which the plan and authority was agitated (iv) To find out the possible option through which these plans can be made suitable and acceptable to the stakeholder. The approach of this study is more qualitative based with the intention to understand the time frame process of preparation of development plan and town planning scheme and issues related to it. On the basis of literature study, the three towns were selected, and the detailed questionnaire was prepared for the stakeholders (development authorities and local residents) which include the time process taken in the preparation of DP and TPS and what were issues faced during the process and who all were involved. Lastly, the study looks into aspects of the land value of original plots and readjusted plots by concluding the argument whether this TP scheme model really worked in small and medium towns. Because the land deduction under TP scheme is allowed up to 50% as per the act and there is no distinct provision for small and medium towns under the act, so how this could be justified to smaller towns where the market value have not changed over the years. After analyzing the issues and reason behind the agitation against the DP and TPS in these small and medium towns. The broader recommendation has been given which can make these plans acceptable and suitable for the stakeholder.

Keywords: development plans, medium towns, small towns, town planning schemes

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Authors: Naila Awan, Shahrukh Inam

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This study was conducted to highlight the role of basic health units in district Swabi, which provides primary health services to the people of district Swabi having four tehsils. Tehsil Swabi was selected purposively for the study. Three villages were purposively selected from district Swabi. A sum of 110 respondents was randomly selected for interview i.e., 27 from Botakaa, 39 from Gulatee, and 44 from Darra Cham, using proportion allocation sampling technique. A pretested and well-designed interview schedule was used to collect as per the objective and Chi square test was applied to find an association between the quality of medicines and health improvement. The output of the test shows that the government was doing its best and providing enough facilities to the individuals at the healthcare units, and they were utilizing them. These resources were easily accessible to the people of the community. Medicines provided by the government were of good quality and quantity. There were also school health sessions and community health sessions (SHS/CHS) to deliver useful information and awareness regarding health problems and diseases were conducted. The staff of the BHU was present at work time and was performing their duties. The respondents seemed satisfied with their behavior and the duty of the staff. However, there were no emergency resources existing at the BHU after the working hours of the medical staff. It is recommended that government should provide appropriate quantity and quality of medicines to the basic health units so that these healthcare units don’t have to face any shortages regarding medicines at the end of the month. In addition, laboratory and blood testing facilities need to be provided in the basic health units, and also the infrastructure should be made suitable, satisfactory, and more functional.

Keywords: community health session, basic health units, outpatient department, tuberculosis

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Authors: Emanuela Zilli, Antonella Ruffatto, Davide Bonaldo, Stefano Bevilacqua, Tommaso Caputo, Luisa Fontana, Carmelina Saraceno, Antonio Sturaroo, Teodoro Sava, Antonio Madia

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The new Hospital in Cittadella - ULSS 6 Euganea Health Trust, in the North-East of Italy (400 beds, project completion date in 2026), will partially take the place of the existing building. Interesting features have been suggested in order to project a modern, “environmental-friendly” and “people-friendly” building. Specific multidisciplinary meetings (involving stakeholders and professionals with different backgrounds) have been organized on a periodic basis in order to guarantee the appropriate implementation of logistic and organizational solutions related to eco-sustainability, integration with the context, and the concept of “design for all” and “humanization of care.” The resulting building will be composed of organic shapes determined by the external environment (sun movement, climate, landscape, pre-existing buildings, roads) and the needs of the internal environment (areas of care and diagnostic-treatment paths reorganized with experience gained during the pandemic), with extensive use of renewable energy, solar panels, a 4th-generation heating system, sanitised and maintainable surfaces. There is particular attention to the quality of the staff areas, which include areas dedicated to psycho-physical well-being (relax points, yoga gym), study rooms, and a centralized conference room. Outdoor recreational spaces and gardens for music and watercolour therapy will be included; atai-chi gym is dedicated to oncology patients. Integration in the urban and social context is emphasized through window placement toward the gardens (maternal-infant, mental health, and rehabilitation wards). Service areas such as dialysis, radiology, and labs have views of the medieval walls, the symbol of the city’s history. The new building has been designed to pursue the maximum level of eco-sustainability, harmony with the environment, and integration with the historical, urban, and social context; the concept of humanization of care has been considered in all the phases of the project management.

Keywords: environmental-friendly, humanization, eco-sustainability, new hospital

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Authors: Sandip Shrestha, Ann M. Donoghue, Komala Arsi, Basanta R. Wagle, Abhinav Upadhyay, Dan J. Donoghue

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Campylobacter, one of the major cause of foodborne illness worldwide, is commonly present in the intestinal tract of poultry. Many strategies are currently being investigated to reduce Campylobacter counts on commercial poultry during processing with limited success. This study investigated the efficacy of the generally recognized as safe compound, carvacrol (CR), a component of wild oregano oil as a wash treatment for reducing C. jejuni and aerobic bacteria on chicken skin. A total of two trials were conducted, and in each trial, a total of 75 skin samples (4cm × 4cm each) were randomly allocated into 5 treatment groups (0%, 0.25%, 0.5%, 1% and 2% CR). Skin samples were inoculated with a cocktail of four wild strains of C. jejuni (~ 8 log10 CFU/skin). After 30 min of attachment, inoculated skin samples were dipped in the respective treatment solution for 1 min, allowed to drip dry for 2 min and processed at 0, 8, 24 h post treatment for enumeration of C. jejuni and aerobic bacterial counts (n=5/treatment/time point). The data were analyzed by ANOVA using PROC GLM procedure of SAS 9.3. All the tested doses of CR suspension consistently reduced C. jejuni counts across all time points. The 2% CR wash was the most effective treatment and reduced C. jejuni counts by ~4 log₁₀ CFU/sample (P < 0.05). Aerobic counts were reduced for the 0.5% CR dose at 0 and 24h in Trial 1 and at 0, 8 and 24h in Trial 2. The 1 and 2% CR doses consistently reduced aerobic counts in both trials up to 2 log₁₀ CFU/skin.

Keywords: Campylobacter jejuni, carvcrol, chicken skin, postharvest

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Authors: Tong Mei Yan

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Introduction: The experience of infertility could be excruciating but has not received much attention in Hong Kong. The strong Confucian culture pressures couples to continue their family lineage resulting in women facing more stress than men in the social-cultural milieu. In Vitro Fertilization (IVF) treatment is one of the common ways to deal with the problem. Abundant literature exists the psychological trajectories of people receiving IVF treatment in Europe, the USA and other east Asian societies but not in Hong Kong. Aim: This study aims to highlight the circumstances and needs of the women before, during and after IVF treatment through examining their lived experiences. It is hoped that the public, once informed of regarding their tribulations and needs , would support the adequate provision of the required psychological support . Methods: Qualitative analysis was adopted in this study. In-depth interviews were conducted with six women who have undergone at least one complete cycle of IVF treatment within the past five years. Data was analyzed through thematic analysis and narrative analysis. Results: 4 broad themes were found, including (i) emotional responses; (ii) experiences in medical consultation; (iii) impacts of the treatment; and (iv) their coping strategies. Additionally, specific events in three cases were chosen for narrative analysis to further examine their unresolved emotional distress and the ethical issues. Conclusion: IVF treatment distressed the interviewees immensely, both physically and psychologically, with the negative emotions outweighing their physical strains, a result unexpected by all of the interviewees. The pressure for lineage continuation, the demanding treatment process and the dearth of support from health professionals all contribute to their emotional pain which could linger for both successful and unsuccessful cases. Although a number of coping strategies were attempted, most of them completely failed to ease their psychological tension. The findings of this study therefore evidence the need for psychological support for this population. A service model to cater their needs of IVF treatment before, during and after treatment is therefore proposed.

Keywords: coping strategies, emotional experiences, impacts of IVF, infertility, IVF treatment, medical experiences

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