Search results for: regional hospital

Authors: Ayliana Dharmawan, Heng Yong Sheng, Zhang Xiaojin, Tan Thai Lian

Abstract:

To facilitate discharge planning, doctors are presently required to assign an Estimated Discharge Date (EDD) for each patient admitted to the hospital. This assignment of the EDD is largely based on the doctor’s judgment. This can be difficult for cases which are complex or relatively new to the doctor. It is hypothesized that a data-driven approach would be able to facilitate the doctors to make accurate estimations of the discharge date. Making use of routinely collected data on inpatient discharges between January 2013 and May 2016, a predictive model was developed using machine learning techniques to predict the Length of Stay (and hence the EDD) of inpatients, at the point of admission. The predictive performance of the model was compared to that of the clinicians using accuracy measures. Overall, the best performing model was found to be able to predict EDD with an accuracy improvement in Average Squared Error (ASE) by -38% as compared to the first EDD determined by the present method. It was found that important predictors of the EDD include the provisional diagnosis code, patient’s age, attending doctor at admission, medical specialty at admission, accommodation type, and the mean length of stay of the patient in the past year. The predictive model can be used as a tool to accurately predict the EDD.

Keywords: inpatient, estimated discharge date, EDD, prediction, data-driven

Procedia PDF Downloads 176

Authors: Basan Shrestha

Abstract:

The relationship between the household size and the poverty is not well understood. Malthus followers advocate that the increasing population add pressure to the dwindling resource base due to increasing demand that would lead to poverty. Others claim that bigger households are richer due to availability of household labour for income generation activities. Facts from Nepal were analyzed to examine the relationship between the household size and poverty rate. The analysis of data from 3,968 Village Development Committee (VDC)/ municipality (MP) located in 75 districts of all five development regions revealed that the average household size had moderate positive correlation with the poverty rate (Karl Pearson's correlation coefficient=0.44). In a regression analysis, the household size determined 20% of the variation in the poverty rate. Higher positive correlation was observed in eastern Nepal (Karl Pearson's correlation coefficient=0.66). The regression analysis showed that the household size determined 43% of the variation in the poverty rate in east. The relation was poor in far-west. It could be because higher incidence of poverty was there irrespective of household size. Overall, the facts revealed that the bigger households were relatively poorer. With the increasing level of awareness and interventions for family planning, it is anticipated that the household size will decrease leading to the decreased poverty rate. In addition, the government needs to devise a mechanism to create employment opportunities for the household labour force to reduce poverty.

Keywords: household size, poverty rate, nepal, regional development

Procedia PDF Downloads 365

Authors: Dharshini Selvarajah, Nicula Lui, Karen Kong

Abstract:

Background: Uterine fibroids are a common benign gynaecologic neoplasm in reproductive-aged women. Fibroids may become symptomatic in a vast majority of nulliparous women. Their diagnosis and management is often coordinated between gyneacologists, radiologists and urologists depending on the anatomical location, growth, size and the fibroids sarcomatous evolvement. Some patients may develop obstructive uropathy symptoms, either uni or bilateral secondary urethral obstruction causing hydronephrosis. Uterine artery emoblisation (UAE) has previously shown to effectively resolve symptoms as well as relieve urethral obstruction and resolve the hydronephrosis. UAE has now established itself as an organ preserving and minimally invasive procedure in the management of symptomatic uterine fibroids. It is a safe and effective alternative to hysterectomy for resolving fibroid related pressure symptoms. The case presented examines the clinical manifestations and impact of uterine fibroids on the urinary tract system. The therapeutic options to relieve the urological symptoms as well as preserve fertility are explored and presented. Case: The case is a 29-year-old Nepalese female admitted to hospital with recurrent urosepsis with multiresistant organisms. This was on a background of an enlarged uterus (measuring 17cm x11cm) with multiple subserosal, intramural and exophytic fibroids- causing external ureteric compression. She had bilateral ureteric stents insitu and required bilateral right and left nephrostomies during repeated episodes of urosepsis and bilateral ureteric obstruction. The left nephrostomy was removed a month prior to admission and her most recent CT KUB demonstrated hypofunctioning ureteric stents with bilateral hydronephrosis. Options of hysterectomy versus uterine artery emoblisation (UAE) were extensively explored. The patient was keen to preserve fertility. Risks associated with UAE such as expulsion of the submucosal component of the fibroids and the possibilities of sepsis in the setting of ongoing ureteric colonisation were particularly high. The patient opted to trial UAE even though the risks of recurrent hospital admissions with urosepsis were going to be particularly high. In the event, the uterus fails to shrink adequately enough to relieve the obstructed ureters a hysterectomy would inevitably be required in future. Day 3 post UAE the patient developed fevers, was hypotensive and tachycardic post-receiving prophylactic meropenem and fluconazole pre emoblisation. She was noted to have a CRP of 293 with the most recent urine culture during this time growing Candida albicans. The patient was recommenced on oral fluconazole and IV meropenem, with good effect. Her repeat renal tract ultrasound post-UAE showed ongoing marked left hydronephrosis relatively unchanged from the scan one month prior to the procedure, however the right-sided hydronephrosis had resolved. The patient was discharged on a 2-week course of antibiotics. The patient will have a repeat renal tract ultrasound and MRI of the ureters to re-evaluate the degree of hydronephrosis and progress- this was unavailable at the time of abstract submission and will be presented at the conference. Conclusion: Fibroids are a common benign tumour of the uterus and can frequently impact the lower urinary system resulting in significant uropathy. They often enlarge and compress the urinary bladder, urethra and lower end of the ureters. The effectiveness of UAE as a fertility preserving option is described.

Keywords: Uterine leiomyomas and urological complications, uterine artery embolisation for fibroids, Uterine fibroids and complications, Management of uterine fibroids

Procedia PDF Downloads 228

Authors: Abdsalam Alahwal, Suren Pillay

Abstract:

Libya saw the occurrence of violations of human rights on a large scale as well as the deterioration of the rule of law in large parts of the country after the February 17 revolution that removed the Colonel Muammar Gaddafi from power in what is known upheaval of the Arab Spring. Although Libya, a country with a modern democracy, but he has declared unconstitutional temporarily allowed to exercise all the rights of political, civil and judicial, but the presence of weapons in the hands of militias list on the basis of regional, tribal and ideology was the main reason for the deterioration of the humanitarian situation as well as the foreign intervention in Libya. Where reports stressed that violations are serious committed by the conflicting parties from power after the fall of Gaddafi of assassinations and kidnapping of identity and practices related to human trafficking Some of these reports indicate that some ethnic ingredients such as Tawergha and Epiphyseal where was deliberately targeted by some militias were displacement around the city because of their allegiance to the former regime after the war ended in 2012. It is noteworthy that many of these violations and abuses committed by these militias that participated overthrow Gaddafi may rise to war crimes and crimes against humanity. That the intervention in Libya, although it had a human purpose and under the pretext of reducing the political system of human rights violations, but that the main objective, which was behind the international intervention was to overthrow the existing political system and the elimination of Muammar Gaddafi.

Keywords: Arab Spring, democracy, revolution , Libya

Procedia PDF Downloads 304

Authors: Aparajita Bhattacharya, Mousumi Dutta, Zakir Husain, Dionne Sequeira, Asima Mukhopadhyay

Abstract:

Background: Tata Medical Centre (TMC), Kolkata is a major cancer referral centre in Eastern India and neighbouring countries providing state of the art facilities; however, it is a non-profit organisation with patients requiring to pay at subsidised rates. Although a system for social assessment and applying for governmental/ non-governmental (NGO) funds is in place, access is challenging. Amongst gynaecological cancers (GC), ovarian cancer (OC) is associated with the highest treatment cost; majority of which is required at the beginning when complex surgery is performed and funding arrangements cannot be made in time. We therefore appointed a dedicated Medical Social Worker (MSW) in 2016, supported by NGO for GC patients in order to assist patients/family members to access/avail these funds more readily and assist in economic evaluation for both direct and opportunity costs. Objectives: To reflect on our experience and challenges in collecting data on economic evaluation of cancer patients and compare success rates in achieving fund mobilization after introduction of MSW. Methods: A Retrospective survey. Patients with OC and their relatives were seen by the MSW during the initial outpatients department visit and followed though till discharge from the hospital and during follow-up visits. Assistance was provided in preparing the essential documents/paperwork/contacts for the funding agencies including both governmental (Chief-Minister/Prime-Minister/President) and NGO sources. In addition, a detailed questionnaire was filled up for economic assessment of direct/opportunity costs during the entire treatment and 12 months follow up period which forms a part of the study called HEPTROC (Health economic evaluation of primary treatment for ovarian cancer) developed in collaboration with economics departments of Universities. Results: In 2015, 102 patients were operated for OC; only 16 patients (15.68 %) had availed funding of a total sum of INR 1640000 through the hospital system for social assessment. Following challenges were faced by majority of the relatives: 1. Gathering important documents/proper contact details for governmental funding bodies and difficulty in following up the current status 3. Late arrival of funds. In contrast in 2016, 104 OC patients underwent surgery; the direct cost of treatment was significantly higher (median, INR 300000- 400000) compared to other GCs (n=274). 98/104 (94.23%) OC patients could be helped to apply for funds and 90/104(86.56%) patients received funding amounting to a total of INR 10897000. There has been a tenfold increase in funds mobilized in 2016 after the introduction of dedicated MSW in GC. So far, in 2017 (till June), 46/54(85.18%) OC patients applied for funds and 37/54(68.51%) patients have received funding. In a qualitative survey, all patients appreciated the role of the MSW who subsequently became the key worker for patient follow up and the chief portal for patient reported outcome monitoring. Data collection quality for the HEPTROC study was improved when questionnaires were administered by the MSW compared to researchers. Conclusion: Introduction of cancer specific MSW can expedite the availability of funds required for cancer patients and it can positively impact on patient satisfaction and outcome reporting. The economic assessment will influence fund allocation and decision for policymaking in ovarian cancer. Acknowledgement: Jivdaya Foundation Dallas, Texas.

Keywords: economic evaluation, funding, medical social worker, ovarian cancer

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Authors: Osatuyi Kehinde Micheal

Abstract:

There is much research that has contributed to an improved understanding of the future of food security, especially during the COVID-19 pandemic. A pathway was developed by using a local community kitchen in Muizenberg in western cape province, cape town, south Africa, a case study to map out the future of food security in times of crisis. This kitchen aims to provide nutritious, affordable, plant-based meals to our community. It is also a place of diverse learning, sharing, empowering the volunteers, and growth to support the local economy and future resilience by sustaining our community kitchen for the community. This document contains an overview of the story of the community kitchen on how we create self-sustainability as a new pathway development to sustain the community and reduce Zero hunger in the regional food system. This paper describes the key elements of how we respond to covid-19 pandemic by sharing food parcels and creating 13 soup kitchens across the community to tackle the immediate response to covid-19 pandemic and agricultural systems by growing home food gardening in different homes, also having a consciousness Dry goods store to reduce Zero waste and a local currency as an innovation to reduce food crisis. Insights gained from our article and outreach and their value in how we create adaptation, transformation, and sustainability as a new development pathway to solve any future problem crisis in the food security system in our society.

Keywords: sustainability, food security, community development, adapatation, transformation

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Authors: Gousilin Leandra Rocha Da Silva, Stéfani T. A. Dantas, Bruna F. Rossi, Erika R. Bonsaglia, Ivana G. Castilho, Terue Sadatsune, Ary Fernandes Júnior, Vera l. M. Rall

Abstract:

Kidney failure causes decreased diuresis and accumulation of nitrogenous substances in the body. To increase patient survival, hemodialysis is used as a partial substitute for renal function. However, contamination of the water used in this treatment, causing bacteremia in patients, is a worldwide concern. The Burkholderia cepacia complex (Bcc), a group of bacteria with more than 20 species, is frequently isolated from hemodialysis water samples and comprises opportunistic bacteria, affecting immunosuppressed patients, due to its wide variety of virulence factors, in addition to innate resistance to several antimicrobial agents, contributing to the permanence in the hospital environment and to the pathogenesis in the host. The objective of the present work was to characterize molecularly and phenotypically Bcc isolates collected from the water and dialysate of the Hemodialysis Unit and from the blood of patients at a Public Hospital in Botucatu, São Paulo, Brazil, between 2019 and 2021. We used 33 Bcc isolates, previously obtained from blood cultures from patients with bacteremia undergoing hemodialysis treatment (2019-2021) and 24 isolates obtained from water and dialysate samples in a Hemodialysis Unit (same period). The recA gene was sequenced to identify the specific species among the Bcc group. All isolates were tested for the presence of some genes that encode virulence factors such as cblA, esmR, zmpA and zmpB. Considering the epidemiology of the outbreak, the Bcc isolates were molecularly characterized by Multi Locus Sequence Type (MLST) and by pulsed-field gel electrophoresis (PFGE). The verification and quantification of biofilm in a polystyrene microplate were performed by submitting the isolates to different incubation temperatures (20°C, average water temperature and 35°C, optimal temperature for group growth). The antibiogram was performed with disc diffusion tests on agar, using discs impregnated with cefepime (30µg), ceftazidime (30µg), ciprofloxacin (5µg), gentamicin (10µg), imipenem (10µg), amikacin 30µg), sulfametazol/trimethoprim (23.75/1.25µg) and ampicillin/sulbactam (10/10µg). The presence of ZmpB was identified in all isolates, while ZmpA was observed in 96.5% of the isolates, while none of them presented the cblA and esmR genes. The antibiogram of the 33 human isolates indicated that all were resistant to gentamicin, colistin, ampicillin/sulbactam and imipenem. 16 (48.5%) isolates were resistant to amikacin and lower rates of resistance were observed for meropenem, ceftazidime, cefepime, ciprofloxacin and piperacycline/tazobactam (6.1%). All isolates were sensitive to sulfametazol/trimethoprim, levofloxacin and tigecycline. As for the water isolates, resistance was observed only to gentamicin (34.8%) and imipenem (17.4%). According to PFGE results, all isolates obtained from humans and water belonged to the same pulsotype (1), which was identified by recA sequencing as B. cepacia¸, belonging to sequence type ST-767. By observing a single pulse type over three years, one can observe the persistence of this isolate in the pipeline, contaminating patients undergoing hemodialysis, despite the routine disinfection of water with peracetic acid. This persistence is probably due to the production of biofilm, which protects bacteria from disinfectants and, making this scenario more critical, several isolates proved to be multidrug-resistant (resistance to at least three groups of antimicrobials), turning the patient care even more difficult.

Keywords: hemodialysis, burkholderia cepacia, PFGE, MLST, multi drug resistance

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Authors: Jana Gebhartova, Tomas Duda, Ivan Benes

Abstract:

World is characterized by constantly emerging new links, increasing complexity and speed of processes in the society. The globalized world needs (except political and financial mechanisms and institutions) functional supply chains. Transport and supply chains can be interrupted in case of natural disasters, conflicts and civil disorders, sudden demand shocks, export/import restrictions, terrorism. Long-term interruption of crucial services for human existence can results in breakdown of the whole society. If global supply chains can be interrupted, the ability to survive a crisis situation depends on local self-sufficiency, it means ensuring water, food and energy. In the world of 21st century, new way of thinking (based on the concept of resilience) is needed. Planning for self-sufficiency and resilience must be part of the agenda of local governments. The paper presents first results of research project VF20112015518 “Security of population – crisis management” that deals with issue of critical infrastructure, ensuring regional self-sufficiency in crisis situations and issues related to population protection and water, energy and food security. The project is being solved within Security Research of Ministry of the Interior of the Czech Republic in 2011-2015.

Keywords: crisis management, resilience, indicators of self-sufficiency, continuity of supplies

Procedia PDF Downloads 381

Authors: Dharshini Selvarajah, Karen Kong

Abstract:

Background: Uterine fibroids are a common benign gynaecologic neoplasm in reproductive-aged women. Fibroids may become symptomatic in a vast majority of nulliparous women. Their diagnosis and management are often coordinated between gyneacologists, radiologists and urologists depending on the anatomical location, growth, size and the fibroids' sarcomatous evolvement. Some patients may develop obstructive uropathy symptoms, either uni or bilateral secondary urethral obstruction causing hydronephrosis. Uterine artery embolization (UAE) has previously been shown to effectively resolve symptoms as well as relieve urethral obstruction and resolve hydronephrosis. UAE has now established itself as an organ-preserving and minimally invasive procedure in the management of symptomatic uterine fibroids. It is a safe and effective alternative to hysterectomy for resolving fibroid-related pressure symptoms. The case presented examines the clinical manifestations and impact of uterine fibroids on the urinary tract system. The therapeutic options to relieve the urological symptoms as well as preserve fertility are explored and presented. Case: The case is a 29-year-old Nepalese female admitted to the hospital with recurrent urosepsis with multiresistant organisms. This was on a background of an enlarged uterus (measuring 17cm x11cm) with multiple subserosal, intramural and exophytic fibroids- causing external ureteric compression. She had bilateral ureteric stents in situ and required bilateral right and left nephrostomies during repeated episodes of urosepsis and bilateral ureteric obstruction. The left nephrostomy was removed a month prior to admission, and her most recent CT KUB demonstrated hypofunctioning ureteric stents with bilateral hydronephrosis. Options of hysterectomy versus uterine artery embolization (UAE) were extensively explored. The patient was keen to preserve fertility. Risks associated with UAE, such as the expulsion of the submucosal component of the fibroids and the possibilities of sepsis in the setting of ongoing ureteric colonisation were particularly high. The patient opted to trial UAE even though the risks of recurrent hospital admissions with urosepsis were going to be particularly high. In the event, the uterus fails to shrink adequately enough to relieve the obstructed ureters, a hysterectomy would inevitably be required in the future. Day 3 post-UAE the patient developed fevers, was hypotensive and tachycardic post-receiving prophylactic meropenem and fluconazole pre emoblisation. She was noted to have a CRP of 293 with the most recent urine culture during this time growing Candida albicans. The patient was recommenced on oral fluconazole and IV meropenum, with good effect. Her repeat renal tract ultrasound post-UAE showed ongoing marked left hydronephrosis relatively unchanged from the scan one month prior to the procedure; however, the right-sided hydronephrosis had resolved. The patient was discharged on a 2-week course of antibiotics. The patient will have a repeat renal tract ultrasound and MRI of the ureters to re-evaluate the degree of hydronephrosis and progress- this was unavailable at the time of abstract submission and will be presented at the conference. Conclusion: Fibroids are a common benign tumor of the uterus and can frequently impact the lower urinary system resulting in significant uropathy. They often enlarge and compress the urinary bladder, urethra and lower end of the ureters. The effectiveness of the UAE as a fertility-preserving option is described.

Keywords: uterine artery embolisation for fibroids, urological complications from fibroids, uropathy of fibroids, obstructive fibroid management

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Authors: Sandra Soca Lozano, Teresa Isabel Lozano Pérez, Germain Weber

Abstract:

Cancer is a chronic disease of high prevalence in children and adolescents. Medical care in Cuba is carried out by a multidisciplinary team and family is the mediator between this team and the patient. Around this disease, there are interwoven many stereotypes and taboos by its relation to death. In this research report, we describe the work paradigm of psychological care to patients suffering from these diseases in the University Pediatric Hospital Juan Manuel Márquez of Havana, Cuba. We present the psychosocial factors that must be taken into account to provide comprehensive care and ensuring the quality of life of patients and their families. We also present the factors related to the health team and the management of information done with the patient. This is a descriptive proposal from the working experience accumulated in the named institution and in the review of the literature. As a result of this report we make a proposal of teamwork and the aspects in which psychological intervention should be continue performing in terms of increasing the quality of the care made by the health team. We conclude that it is necessary to continue improving the information management of children and adolescents with theses health problems and took into account their right to autonomy.

Keywords: comprehensive care, management of information, psychosocial factors, right to autonomy

Procedia PDF Downloads 338

Authors: Sadaf Abbas, HimGauri Sabnis

Abstract:

Introduction: Peripartum cardiomyopathy is a rare but potentially life-threatening condition that presents as heart failure during the last month of pregnancy or within five months postpartum. The incidence of postpartum cardiomyopathy ranges from 1 in 1300 to 1 in 15,000 pregnancies. Risk factors include multiparty, advanced maternal age, multiple pregnancies, pre-eclampsia, and chronic hypertension. Study: A 30-year-old Para3+0 presented to the Emergency Department of St’Marry Hospital, Isle of Wight, on the seventh day postpartum, with acute shortness of breath (SOB), chest pain, cough, and a temperature of 38 degrees. The risk factors were smoking and class II obesity (BMI of 40.62). The patient had mild pre-eclampsia in the last pregnancy and was on labetalol and aspirin during an antenatal period, which was stopped postnatally. There was also a history of pre-eclampsia and haemolysis, elevated liver enzymes, low platelets (HELLP syndrome) in previous pregnancies, which led to preterm delivery at 35 weeks in the second pregnancy, and the first baby was stillborn at 24 weeks. On assessment, there was a national early warning score (NEWS score) of 3, persistent tachycardia, and mild crepitation in the lungs. Initial investigations revealed an enlarged heart on chest X-ray, and a CT pulmonary angiogram indicated bilateral basal pulmonary congestion without pulmonary embolism, suggesting fluid overload. Laboratory results showed elevated CRP and normal troponin levels initially, which later increased, indicating myocardial involvement. Echocardiography revealed a severely dilated left ventricle with an ejection fraction (EF) of 31%, consistent with severely impaired systolic function. The cardiology team reviewed the patient and admitted to the Coronary Care Unit. As sign and symptoms were suggestive of fluid overload and congestive cardiac failure, management was done with diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), proton pump inhibitors, and supportive care. During admission, there was complications such as acute kidney injury, but then recovered well. Chest pain had resolved following the treatment. After being admitted for eight days, there was an improvement in the symptoms, and the patient was discharged home with a further plan of cardiac MRI and genetic testing due to a family history of sudden cardiac death. Regular appointment has been made with the Cardiology team to follow-up on the symptoms. Since discharge, the patient made a good recovery. A cardiac MRI was done, which showed severely impaired left ventricular function, ejection fraction (EF) of 38% with mild left ventricular dilatation, and no evidence of previous infarction. Overall appearance is of non-ischemic dilated cardiomyopathy. The main challenge at the time of admission was the non-availability of a cardiac radiology team, so the definitive diagnosis was delayed. The long-term implications include risk of recurrence, chronic heart failure, and, consequently, an effect on quality of life. Therefore, regular follow-up is critical in patient’s management. Conclusions: Peripartum cardiomyopathy is one of the cardiovascular diseases whose causes are still unknown yet and, in some cases, are uncontrolled. By raising awareness about the symptoms and management of this complication it will reduce morbidity and mortality rates and also the length of stay in the hospital.

Keywords: cardiomyopathy, cardiomegaly, pregnancy, puerperium

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Authors: Efrizal, Ferdiansyah, Noorlailie Soewarno, Bambang Tjahjadi

Abstract:

Tax revenue plays an important role in the State Budget of the Government of Indonesia (GOI). The GOI keeps raising tax revenue portion of the Budget from year to year. The low tax ratio of 11 percent in Indonesia shows a big opportunity to collect taxes in the future. The Directorate General of Taxation (DGT) is the institution mandated by the Law to collect tax revenue. This is a case study using quantitative and qualitative approaches. This study introduces contingent factors of taxpayers’ compliance as the mediating variable and internal business process as the independent variable. This study aims to empirically test the contingency theory, especially the mediating effect of taxpayers’ compliance on internal business process-tax revenue relationship. Internal business processes of the DGT include servicing, counseling, expanding, supervising, inspecting, and enforcing. The secondary data of 31 regional offices representing 293 tax offices in Indonesia was collected and analyzed using Partial Least Square. The result showed the following: (1) internal business process affected tax revenue; (2) taxpayers’ compliance did not mediate internal business processes - tax revenue relationship, and (3) taxpayers’ compliance affected tax revenue. In-depth interviews revealed that the DGT needs to make more innovations in business processes in the future.

Keywords: innovations, internal business process, taxpayers’ compliance, tax revenue

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Authors: Navodita Mishra, T. J. Kamalanabhan

Abstract:

The primary purpose of this study was to identify the antecedents of sport commitment among cricket players and to understand demographic variables that may impact these factors. Commitment towards one’s sport play a crucial role in determining discipline and efforts of the player. Moreover, demographic variables would seem to play an important role in determining which factors or predictors have the greatest impact on commitment level. This study hypothesized the effect of demographic factors on sport commitment among cricket players. It attempts to examine the extent to which demographic factors can differentially motivate players to exhibit commitment towards their respective sport. Questionnaire survey method was adopted using purposive sampling technique. Using Multiple Regression, ANOVA and t-test, the hypotheses were tested based on a sample of 350 players from Cricket Academy. Our main results from the multivariate analysis indicated that (1) enjoyment and leadership of coach and peer affect the level of commitment to a greater extent whereas (2) personal investment is a significant predictor of commitment among rural background players Moreover, level of sport commitment among players is positively related to household income, the rural background players participate in sports to a greater extent than the urban players, there is no evidence of regional differentials in commitment but age differences (i.e. U-19 vs. U-25) play an important role in the decision to continue the participation in sports.

Keywords: individual sport commitment, social factors, demographic factors, cricket

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Authors: Mohamed A. Alhammad, Hadia A. Abou-Donia, Mona H. Hashish, Mohamed N. Massoud

Abstract:

Background: Rotavirus is the leading etiologic agent of severe diarrheal disease in infants and young children worldwide. The present study was aimed 1) to detect rotavirus infection as a cause of diarrhoea among children under 5 years of age using the two serological methods (ELISA and LA) and the PCR technique (2) to evaluate the three methodologies used for human RV detection in stool samples. Materials and Methods: This study was carried out on 247 children less than 5 years old, diagnosed clinically as acute gastroenteritis and attending Alexandria University Children Hospital at EL-Shatby. Rotavirus antigen was screened by ELISA and LA tests in all stool samples, whereas only 100 samples were subjected to RT-PCR method for detection of rotavirus RNA. Results: Out of the 247 studied cases with diarrhoea, rotavirus antigen was detected in 83 (33.6%) by ELISA and 73 (29.6%) by LA, while the 100 cases tested by RT-PCR showed that 44% of them had rotavirus RNA. Rotavirus diarrhoea was significantly presented with a marked seasonal peak during autumn and winter (61.4%). Conclusion: The present study confirms the huge burden of rotavirus as a major cause of acute diarrhoea in Egyptian infants and young children. It was concluded that; LA is equal in sensitivity to ELISA, ELISA is more specific than LA, and RT-PCR is more specific than ELISA and LA in diagnosis of rotavirus infection.

Keywords: rotavirus, diarrhea, immunoenzyme techniques, latex fixation tests, RT-PCR

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Authors: Jerome Dalphinis, Vishal Patel

Abstract:

The Bailiwick of Jersey is an island British crown dependency situated off the coast of France. Jersey General Hospital’s emergency department sees approximately 40,000 patients a year. It’s outside the NHS, with secondary care being free at the point of care. Sedation is a continuum which extends from a normal conscious level to being fully unresponsive. Procedural sedation produces a minimally depressed level of consciousness in which the patient retains the ability to maintain an airway, and they respond appropriately to physical stimulation. The goals of it are to improve patient comfort and tolerance of the procedure and alleviate associated anxiety. Indications can be stratified by acuity, emergency (cardioversion for life-threatening dysrhythmia), and urgency (joint reduction). In the emergency department, this is most often achieved using a combination of opioids and benzodiazepines. Some departments also use ketamine to produce dissociative sedation, a cataleptic state of profound analgesia and amnesia. The response to pharmacological agents is highly individual, and the drugs used occasionally have unpredictable pharmacokinetics and pharmacodynamics, which can always result in progression between levels of sedation irrespective of the intention. Therefore, practitioners must be able to ‘rescue’ patients from deeper sedation. These practitioners need to be senior clinicians with advanced airway skills (AAS) training. It can lead to adverse effects such as dangerous hypoxia and unintended loss of consciousness if incorrectly undertaken; studies by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) have reported avoidable deaths. The Royal College of Emergency Medicine, UK (RCEM) released an updated ‘Safe Sedation of Adults in the Emergency Department’ guidance in 2017 detailing a series of standards for staff competencies, and the required environment and equipment, which are required for each target sedation depth. The emergency department in Jersey undertook audit research in 2018 to assess their current practice. It showed gaps in clinical competency, the need for uniform care, and improved documentation. This spurred the development of a checklist incorporating the above RCEM standards, including contraindication for procedural sedation and difficult airway assessment. This was approved following discussion with the relevant heads of departments and the patient safety directorates. Following this, a second audit research was carried out in 2019 with 17 completed checklists (11 relocation of joints, 6 cardioversions). Data was obtained from looking at the controlled resuscitation drugs book containing documented use of ketamine, alfentanil, and fentanyl. TrakCare, which is the patient electronic record system, was then referenced to obtain further information. The results showed dramatic improvement compared to 2018, and they have been subdivided into six categories; pre-procedure assessment recording of significant medical history and ASA grade (2 fold increase), informed consent (100% documentation), pre-oxygenation (88%), staff (90% were AAS practitioners) and monitoring (92% use of non-invasive blood pressure, pulse oximetry, capnography, and cardiac rhythm monitoring) during procedure, and discharge instructions including the documented return of normal vitals and consciousness (82%). This procedural sedation checklist is a safe intervention that identifies pertinent information about the patient and provides a standardised checklist for the delivery of gold standard of care.

Keywords: advanced airway skills, checklist, procedural sedation, resuscitation

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Authors: Tripta Dixit, Smita Sahu, William Selvamurthy, Sadhana Srivastava

Abstract:

India is battling with the issues of accessibility, affordability and availability of quality health to the masses. Indian medical heritage which dated back to 3000 BC unveils the rich knowledge pool which has undergone a perceptible change over years, such as eradication of many communicable diseases, increasing individual awareness of quality health and import driven medical device market etc. Despite a slew of initiatives the holistic slogan of ‘health for all’ remains elusive and a concern for the nation. The 21st-century projects a myriad of challenges like cultural diversity, large population, demographic dividend and geographical segmentation leading to varied needs of people as per their regional conditions of climate, disease prevalence, nutrition and sanitation. But these challenges are also opportunities for the development of indigenous, low cost and accessible technologies to tackle them. This requires reinforcing the potential of indigenous technologies in coordination with prevailing health issues in various regions of country. This paper emphasis on the strategy for exploring the indigenous technologies with entrusted up-scaling to meet the diverse needs of the people. This review proposes to adopt technology transfer as a strategy to establish a vibrant ecosystem for identifying and up-scaling the indigenous medical technologies with diligent hand-holding for public health.

Keywords: health, indigenous, medical technology, technology transfer

Procedia PDF Downloads 255

Authors: Lina Aleassa

Abstract:

When the EU launched the European Union Global strategy in 2016, state and societal resilience to the EU's East and South was a main priority, and it was a ‘Governing Principle’ when responding to crises, including its migration crisis of 2015. Yet, with the launching of the EU strategic compass in 2022, after the return of high-intensity war, namely the Ukrainian war, the emphasis became on the EU’s own resilience. Consequently, this can be interpreted as a shift from outward building resilience into inward-building resilience. However, this paper argues that the EU effort is not a shift but rather an attempt to balance between building the EU's own resilience and its neighbors’ resilience. Thus, the main question of this paper is about the EU’s balance between building its own resilience and building the resilience of its neighbors in the case of Jordan in response to crises. To answer this question, this article attempts an in-depth analysis considering the case of displacement from Syria and the Ukrainian war focuses on the EU’s approach to building its own resilience and building resilience in its neighborhood through the EU’s refugee cooperation with Jordan, one of the key regional hosts of Syrian refugees. Textual analysis of secondary data of various texts from official European and Jordanian websites, news reports, and scholarly literature on resilience, as well as document analysis of different EU and the EU-Jordan policies, including their bilateral and multilateral agreements, will be examined to trace the EU's effort to maintain a balance between building its own resilience in its neighbor’s resilience.

Keywords: inward approach, outward approach, resilience, Syrian refugee crisis

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Authors: Filippo Verre

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This paper explores Turkey’s role as an influential waterpower in the Middle East, emphasizing the Peace Water Pipeline Project (PWPP) as a paradigm of hydro solidarity rather than conventional water diplomacy. Hydro solidarity transcends the strategic and often competitive nature of water diplomacy, highlighting cooperative, inclusive, and mutually beneficial approaches to water resource management. The PWPP, which aimed to transport freshwater from Turkey’s Manavgat River to several water-scarce nations in the Middle East, exemplifies this ethos. By providing a reliable water supply to address the chronic shortages in the region, the project underscored Turkey’s commitment to fostering regional cooperation, stability, and collective well-being through shared water resources. This paper provides an in-depth analysis of the Peace Water Pipeline Project, examining its technical specifications, environmental impact, and political implications. It discusses how the project’s foundation on principles of hydro solidarity could facilitate stronger regional ties, mitigate water-related conflicts, and promote sustainable development. By prioritizing collective benefits over unilateral gains, Turkey’s approach exemplified a transformative model of resource sharing that could inspire similar initiatives globally. This paper argues that the Peace Water Pipeline Project serves as a crucial case study in demonstrating how shared natural resources can be leveraged to build trust, enhance cooperation, and achieve common goals in a geopolitically volatile region. The findings emphasize the importance of adopting hydro solidarity as a guiding principle for future transboundary water projects, showcasing how collaborative water management can play a pivotal role in fostering peace, security, and sustainable development in the Middle East and beyond. This research is based on a mixed methodological approach combining qualitative and quantitative methods. The most relevant qualitative methods will involve Case Studies and Content Analysis. Concretely, the Friendship Dam Project (FDP) between Turkey and Syria will be mentioned to underline the importance of hydro solidarity approaches as opposed to water diplomacy. Analyzing this case aims to identify factors that contribute to successful hydro solidarity agreements, such as effective communication channels, trust-building measures, and adaptive management practices. Concerning Content Analysis, reviewing and analyzing policy documents, treaties, media reports, and public statements will help identify the official narratives and discourses surrounding the PWPP. This method fully comprehends how different stakeholders frame the issues and what solutions they propose. The quantitative methodology used in this research, which complements the qualitative approaches, involves economic valuation, which quantifies the PWPP’s economic impacts on Turkey and the Middle Eastern region. This includes assessing the cost of construction and maintenance and the financial benefits derived from improved water access and reduced conflict. Hydrological modelling will also be used as a quantitative research method. Using hydrological models to simulate the water flow and distribution scenarios helps quantify the pipeline’s potential impacts on water resources. By assessing the sustainability of water extraction and predicting how changes in water availability might affect different regions, these models play a crucial role in this research, shedding light on the impact of transboundary infrastructures on water management.

Keywords: hydro-solidarity, Middle East, transboundary water management, peace water pipeline project, water scarcity

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Authors: Ina Dajci

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Biologic Materials presents groundbreaking transdisciplinary research aimed at fostering new collaborative models across the Built Environment, Forestry, and Agriculture sectors. This initiative seeks to establish innovative paradigms for local and global material flows by developing a biocompatible, regenerative material economy. The project focuses on creating materials derived from biowaste and silvicultural practices, ensuring the preservation of endangered indigenous and vernacular techniques through the integration of emerging biosciences. By utilizing biomaterials sourced from agricultural waste and forest byproducts, the initiative incorporates fabrication methods recognized by UNESCO as ‘intangible cultural heritage of humanity,’ which are currently at risk. The structural, mechanical, and environmental properties of these materials are enhanced through advanced CAD-CAM fabrication, along with energy-efficient biochemical and bacterial processes that promote healthy indigo coloration. Furthermore, the integration of AI technologies in species selection facilitates a novel partnership model, enabling designers to collaborate effectively with forest managers and silviculture practitioners. This collaborative approach not only optimizes the use of plant-based materials but also enhances biodiversity and climate resilience in regional ecosystems. Overall, this project embodies a holistic strategy for addressing environmental challenges while revitalizing traditional practices and fostering sustainable innovation.

Keywords: material, architecture, culture, heritage, ecology, environment

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Authors: Harry Aginta

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Using Phillips curve framework, this paper seeks for new empirical evidence on the relationship between inflation and output in a major emerging economy. By exploiting sub-national data, the contribution of this paper is threefold. First, it resolves the issue of using on-target national inflation rates that potentially causes weakening inflation-output nexus. This is very relevant for Indonesia as its central bank has been adopting inflation targeting framework based on national consumer price index (CPI) inflation. Second, the study tests the relevance of mining sector in output gap estimation. The test for mining sector is important to control for the effects of mining regulation and nominal effects of coal prices on real economic activities. Third, the paper applies panel econometric method by incorporating regional variation that help to improve model estimation. The results from this paper confirm the strong presence of Phillips curve in Indonesia. Positive output gap that reflects excess demand condition gives rise to the inflation rates. In addition, the elasticity of output gap is higher if the mining sector is excluded from output gap estimation. In addition to inflation adaptation, the dynamics of exchange rate and international commodity price are also found to affect inflation significantly. The results are robust to the alternative measurement of output gap

Keywords: Phillips curve, inflation, Indonesia, panel data

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Authors: Raj C. Aparna

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In India, the mandatory clause on Corporate Social Responsibility (CSR) in Companies Act, 2013 has led to varying responses from the companies. From excessive spending to resistance, the private and the public stakeholders have been considering the law from different perspectives. This paper tends to study the characteristics of CSR spending in India with emphasis on the locations to which the funds are routed. This study examines the effects of CSR fund flow on regional development by considering the growth in Gross State Domestic Product (GSDP), agriculture, education and healthcare using panel data for the 29 States in the country. The results confirm that the CSR funds have been instrumental in improving the quality of teaching and healthcare in the areas around the industrial hubs. However, the study shows that the corporates mostly invest in regions which are easily accessible to them, by their physical presence, irrespective of whether the area is developed or not. Such a skewness is visible in the extensive spending in and around the metropolitan cities, the established centers, in the country to which large chunks of CSR funds are channeled. The results show that there is a variation from what the government had proposed while initiating the CSR law to promote social inclusion and equality in the rural and isolated areas in the country. The implication is that even though societal improvement is the aim of CSR, ease of access to the needy is an essential factor in corporate choices. As poverty and lack of facilities are found in the innermost parts, it is vital to have government policies for their aid as corporate help.

Keywords: corporate social responsibility, geographic spread, panel data analysis, strategic implementation

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Authors: Abed Al-Bial, S. Alazazie, A. Shami

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The data were collected from 1992 to 2009 of White Boni sheep maintained at the Regional Research Station in the Central Highlands of Yemen. Data were analyzed to study the growth related traits and their genetic control. The least square means for body weights were 2.26±0.67, 11.14±0.46 and 19.21±1.25 kg for birth weight (BW), weaning weight (WW), six-month weight (WM6), respectively. The pre- and post-weaning average daily weight gains (ADG1 and ADG2) were 106.04±4.98g and 46.21±8.36 g/ day. Significant differences associated with the year of lambing were observed in body weight and weight gain at different stages of growth. Males were heavier and had a higher weight gain than females at almost all stages of growth and differences tended to increase with age. Single-born lambs had a distinct advantage over those born in twin births at all stages of growth. The lambs in the dam’s second to fourth parities were generally of heavier weight and higher daily weight gain than those in other parities. The heritabilities of all body weights, weight gains at different stages of growth were moderate (0.11-0.43). The phenotypic and genetic correlation among the different body weights were positive and high. The genetic correlations of the pre- and post-weaning average daily gains with body weights were hight to moderate, except BW with ADG2.

Keywords: breed, genetics, growth traits, heritability, sheep

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Authors: Urszula Stachewicz

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Surface properties of materials are the key parameter in many applications, especially in the biomedical field, to control cell-material interactions. In our work, we want to achieve the controllability of surface properties of polymer fibers via a single-step electrospinning process by alternating voltage polarities. Voltage polarity defines the charge accumulated on the surface of the liquid jet and the surface of the fibers. Positive polarity attracts negatively charged groups to fibers’ surface, whereas negative polarity moves the negatively charged functional groups away from the surface. This way, we can control the surface chemistry, wettability, and additionally surface potential of electrospun fibers. Within our research, we characterized surface chemistry using X-ray photoelectron microscopy (XPS) and surface potential with Kelvin probe force microscopy (KPFM) on electrospun fibers of commonly used polymers such as PCL, PVDF, and PMMA, often used as biomaterials. We proved the significant effect of fibers' surface potential on cell integration with the scaffolds and further cells development for the regeneration processes based on the osteoblast and fibroblast culture studies. Acknowledgments: The study was conducted within ‘Nanofiber-based sponges for atopic skin treatment’ project, which is carried out within the First TEAM programme of the Foundation for Polish Science co-financed by the European Union under the European Regional Development Fund, project no POIR.04.04.00-00- 4571/18-00.

Keywords: cell attachment, fibers, fibroblasts, osteoblast, proliferation, surface potential

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Authors: Soo Hong Da, Ng Zheng Yao, Burra Venkata Durga Kumar

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The Healthcare sector is a business that consists of providing medical services, manufacturing medical equipment and drugs as well as providing medical insurance to the public. Most of the time, the data stored in the healthcare database is to be related to patient’s information which is required to be accurate when it is accessed by authorized stakeholders. In distributed systems, one important issue is concurrency in the system as it ensures the shared resources to be synchronized and remains consistent through multiple read and write operations by multiple clients. The problems of concurrency in the healthcare sector are who gets the access and how the shared data is synchronized and remains consistent when there are two or more stakeholders attempting to the shared data simultaneously. In this paper, a framework that is beneficial to distributed healthcare sector concurrent environment is proposed. In the proposed framework, four different level nodes of the database, which are national center, regional center, referral center, and local center are explained. Moreover, the frame synchronization is not symmetrical. There are two synchronization techniques, which are complete and partial synchronization operation are explained. Furthermore, when there are multiple clients accessed at the same time, synchronization types are also discussed with cases at different levels and priorities to ensure data is synchronized throughout the processes.

Keywords: resources, healthcare, concurrency, synchronization, stakeholders, database

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Authors: Giga Phartenadze

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In the legal framework of regulation of electronic governance, those norms are considered which include measures for improvement of functions of public institutions and a complex of actions for raising their standard such as websites of public institutions, online services, some forms of internet interactions and higher level of internet services. An important legal basis for electronic governance in Georgia is Georgian Law about Electronic Communications which defines legal and economic basis for utilizing electronic communication systems in Georgia. As for single electronic basis for e-governance regulation, it can be said that it does not exist at all. The official websites of public institutions do not have standards for proactive spreading of information. At the same time, there is no common legal norm which would make all public institutions have an official website for public relations, accountability, publicity, and raising information quality. Electronic governance in Georgia needs comprehensive legal regulation. Public administration in electronic form is on the initial stage of development. Currently existing legal basis has a low quality for public institutions and officials as well as citizens and business. Services of e-involvement and e-consultation have also low quality. So far there is no established legal framework for e-governance. Therefore, a single legislative system of e-governance should be created which will help develop effective, comprehensive and multi component electronic systems in the country (central, regional, local levels). Such comprehensive legal framework will provide relevant technological, institutional, and informational conditions.

Keywords: law, e-government, public administration, Georgia

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Authors: Ankur P. Sati, Manju Mohan

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The hazardous combination of smoke and pollutant gases, smog, is harmful for health. There are strong evidences that the Agricultural waste burning (AWB) in the Northern India leads to adverse air quality in Delhi and its surrounding regions. A severe smog episode was observed over Delhi, India during November 2012 which resulted in very low visibility and various respiratory problems. Very high values of pollutants (PM10 as high as 989 µg m-3, PM2.5 as high as 585 µg m-3 an NO2 as high as 540 µg m-3) were measured all over Delhi during the smog episode. Ultra Violet Aerosol Index (UVAI) from Aura satellite and Aerosol Optical Depth (AOD) are used in the present study along with the output trajectories from HYSPLIT model and the in-situ data. Satellite data also reveal that AOD, UVAI are always at its highest during the farmfires duration in Punjab region of India and the extent of these farmfires may be increasing. It is observed that during the smog episode all the AOD, UVAI, PM2.5 and PM10 values surpassed those of the Diwali period (one of the most polluted events in the city) by a considerable amount at all stations across Delhi. The parameters used from the remote sensing data and the ground based observations at various stations across Delhi are very well in agreement about the intensity of Smog episode. The analysis clearly shows that regional pollution can have greater contributions in deteriorating the air quality than the local under adverse meteorological conditions.

Keywords: smog, farmfires, AOD, remote sensing

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Authors: Yang Wei, Xueyan Wang, Hui Zou

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Objective: Investigation the prevalence of menopausal symptoms in patients with allergic symptoms, evaluation of the effect of sex hormones combined with anti-allergic therapy in these patients. Method: Age of 45-65 years old women with allergic symptoms at the same time in gynecological-endocrinology clinic in our hospital were selected from Feb 1 to May 31, 2010, randomly. The patients were given oral estradiol valerate plus progestin pills combined with anti-allergy treatment and then evaluated twice a week and one month later. Evaluation criterion: Menopause Rating Scale (MRS) and the degree of clinical symptoms were used to evaluate menopause and allergy separately. Results: 1) There were 195 cases of patients with menopausal symptoms at the age. Their MRS were all over 15. 2) Among them 45 patients were with allergic symptom accounted for 23% which were diagnosed by allergic department. 3) Evaluated after one week: the menopausal symptoms were improved and MRS were less than or equal to 5 in all these patients; the skin symptom of allergic symptoms vanished completely. 4) Evaluated after one month: Menopause symptoms were improved steadily; other clinical symptoms of allergy were also improved or without recurrence. Conclusion: The incidence rate of menopausal women with clinical symptoms of allergic diseases is high and it needs attention. The effect of sex hormones combined with anti-allergic therapy is obvious.

Keywords: menopausal, allergy, sex hormone, anti-allergy treatment

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Authors: Farah Naja, Romy Abi Fadel, Yasmin Aridi, Aya Zarif, Dania Hariri, Mohammad Alameddine, Anas Mugharbel, Maya Khalil, Zeina Nahleh, Arafat Tfayli

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The objective of this study is to assess the prevalence and determinants of CAM use among breast cancer patients in Beirut, Lebanon. A secondary objective is to evaluate the association between CAM use and quality of life (QOL). A cross-sectional survey was conducted on 180 breast cancer patients recruited from two major referral centers in Beirut. In a face to face interview, participants completed a questionnaire comprised of three sections: socio-demographic and lifestyle characteristics, breast cancer condition, and CAM use. The assessment of QOL was carried using the FACT-B Arabic version. Prevalence of CAM use since diagnosis was 40%. CAM use was negatively associated with age, treatment at a philanthropic hospital and positively associated with having an advanced stage of disease. The most commonly used CAM was ‘Special food’ followed by ‘Herbal teas’. Only 4% of CAM users cited health care professionals as influencing their choice of CAM. One in four patients disclosed CAM use to their treating physician. There was no significant association between CAM use and QOL. The use of CAM therapies among breast cancer patients is prevalent in Lebanon. Efforts should be dedicated at educating physicians to discuss CAM use with their patients and advising patients to disclose of their use with their physicians.

Keywords: breast cancer , complementary medicine, alternative medicine, lebanon , quality of life

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Authors: Anucha Taiwong, Nirobol Kanogsunthornrat

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This predictive research aimed to investigate the symptom clusters that influence the quality of life among patients with chronic kidney disease, as indicated in the Theory of Unpleasant Symptoms. The purposive sample consisted of 150 patients with stage 3-4 chronic kidney disease who received care at an outpatient chronic kidney disease clinic of a tertiary hospital in Roi-Et province. Data were collected from January to March 2016 by using a patient general information form, unpleasant symptom form, and quality of life (SF-36) and were analyzed by using descriptive statistics, factor analysis, and multiple regression analysis. Findings revealed six core symptom clusters including symptom cluster of the mental and emotional conditions, peripheral nerves abnormality, fatigue, gastro-intestinal tract, pain and, waste congestion. Significant predictors for quality of life were the two symptom clusters of pain (Beta = -.220; p < .05) and the mental and emotional conditions (Beta=-.204; p<.05) which had predictive value of 19.10% (R2=.191, p<.05). This study indicated that the symptom cluster of pain and the mental and emotional conditions would worsen the patients’ quality of life. Nurses should be attentive in managing the two symptom clusters to facilitate the quality of life among patients with chronic kidney disease.

Keywords: chronic kidney disease, symptom clusters, predictors of quality of life, pre-dialysis

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Authors: Zayre I. Gonzalez-Acevedo, Marco A. Garcia-Zarate

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Environmental pollution by heavy metals is due to several processes, whether natural as weathering, or anthropogenic, related to human activities. Geysers may content dissolved heavy metals, related with their geothermal origin, and they are widely used by local people and tourists for treatment of dermal diseases and other therapeutic applications. In this study, 20 geysers with temperatures between 32 to 94 °C, located in the vicinity of Queretaro and Guanajuato in Central Mexico, were studied. These geysers were sampled in dry and rainy seasons in order to investigate seasonal changes of trace elements. The samples were analyzed in SWAMP Lab, University of Alberta, Canada for 34 elements. Most of the analyzed trace elements sowed concentrations below guidelines for natural waters. The elements showed seasonal variability with higher concentrations during rainy season. Arsenic varied from 49.29 to 2.16 µg L⁻¹. Arsenic was highly correlated with Fe, Sr, Th and Tl. Barium varied from 93.52 to 1.79 µg L⁻¹. Barium was highly correlated with Co, Cr, Mo, Ni, U, V, and Y. Copper and Zinc were correlated as well. According to the comparison of sites and the correlations between trace elements, their source was identified as natural regional, geothermal or anthropogenic origin. Because of application of geyser's water to balneology and health treatments, and also, because they are located in an urban zone in development, advise on their direct uses, according to their environmental quality is appointed in this research.

Keywords: balneology, direct uses, environmental quality and trace elements

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