Search results for: regional hospital

Authors: Dawid Jakimiuk, Krzysztof Mitura, Leszek Szpakowski, Sławomir Pilip, Daniel Celiński

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The Emergency Medical Teams (EMS) of the Ambulance Service in Siedlce serve the population living in the Mazowieckie Voivodeship (the area of eastern Poland with approximately 550,000 inhabitants). They provide health services at the pre-hospital stage to all life-threatening patients. The analysis covered the interventions of emergency medical teams in cases of suicide attempts that occurred in the years 2015-2018. The study was retrospective. The data was obtained on the basis of digital medical records of completed call-outs. When defining the disease entity, the International Statistical Classification of Diseases and Health Problems ICD-10 prepared by WHO was used. The relationship between selected disease entities and the area of EMT intervention, the patient's sex and age, and the time of occurrence of the event were investigated. Non-urban area was defined as the area inhabited by a population below 10,000 residents. Statistical analysis was performed using Pearson's Chi ^ 2 test and presenting the percentage of cases in the study group. Of all the suicide attempts, drug abuse cases were the most frequent, including: X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics); X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonian and psychotropic drugs, not elsewhere classified); X62 (Intentional self-poisoning by and exposure to narcotics and psycholeptics [hallucinogens], not elsewhere classified); X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system); X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substance) oraz X70 (Intentional self-harm by hanging, strangulation and suffocation). In total, they accounted for 69.4% of all interventions to suicide attempts in the studied period. Statistical analysis shows significant differences (χ2 = 39.30239, p <0.0001, n = 561) between the area of EMT intervention and the type of suicide attempt. In non-urban areas, a higher percentage of X70 diagnoses was recorded (55.67%), while in urban areas, X60-X64 (72.53%). In non-urban areas, a higher proportion of patients attempting suicide was observed compared to patients living in urban areas. For X70 and X60 - X64 in total, the incidence rates in non-urban areas were 80.8% and 56%, respectively. Significant differences were found (χ2 = 119.3304, p <0.0001, n = 561) depending on the method of attempting suicide in relation to the patient's sex. The percentage of women diagnosed with X60-X64 versus X70 was 87.50%, which was the largest number of patients (n = 154) as compared to men. In the case of X70 in relation to X60-X64, the percentage of men was 62.08%, which was the largest number of patients (n = 239) as compared to women (n = 22). In the case of X70, the percentage of men compared to women was as high as 92%. Significant differences were observed (χ2 = 14.94848, p <0.01058) between the hour of EMT intervention and the type of suicide attempt. The highest percentage of X70 occurred between 04:01 - 08:00 (64.44%), while X60-X64 between 00:01 - 04:00 (70.45%). The largest number of cases of all tested suicide attempts was recorded between 16:01 - 20:00 for X70 (n = 62), X60 - X64 (n = 82), respectively. The highest percentage of patients undertaking all suicide attempts studied at work was observed in the age range of 18-30 (31.5%), while the lowest was in the age group over 60 years of age. (11%). There was no significant correlation between the day of the week or individual months of the year and the type of suicide attempt - respectively (χ2 = 6.281729, p <0.39238, n = 561) and (χ2 = 3.348913, p <0.9857, n = 561). There were also no significant differences in the incidence of suicide attempts for each year in the study period (χ2 = 3.348913, p <0.9857 n = 561). The obtained results suggest the necessity to undertake preventive measures in order to minimize the number of suicide attempts. Such activities should be directed especially at young patients living in non-urban areas.

Keywords: emergency med, emergency medical team, attempted suicide, pre-hospital

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Authors: A. Zahedi Yeganeh, A. Khademolhosseini, R. Mokhtari Malekabadi

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Undoubtedly one of the most far-reaching and controversial topics considered in the past few decades, has been globalization. Globalization lies in the essence of the modern culture. It is a complex and rapidly expanding network of links and mutual interdependence that is an aspect of modern life; though some argue that this link existed since the beginning of human history. If we consider globalization as a dynamic social process in which the geographical constraints governing the political, economic, social and cultural relationships have been undermined, it might not be possible to simply describe its impact on the urban fabric. But since in this phenomenon the increase in communications of societies (while preserving the main cultural - regional characteristics) with one another and the increase in the possibility of influencing other societies are discussed, the need for more studies will be felt. The main objective of this study is to grade based on some globalization factors on urban fabric applying the TOPSIS model. The research method is descriptive - analytical and survey. For data analysis, the TOPSIS model and SPSS software were used and the results of GIS software with fourteen cities are shown on the map. The results show that the process of being influenced by the globalization of the urban fabric of fourteen zones of Isfahan was not similar and there have been large differences in this respect between city zones; the most affected areas are zones 5, 6 and 9 of the municipality and the least impact has been on the zones 4 and 3 and 2.

Keywords: grading, globalization, urban fabric, 14 zones of Isfahan, TOPSIS model

Procedia PDF Downloads 318

Authors: Senait G. Worku, Ellen Mangnus

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Inclusive business models which integrates low-income people with companies value chain in a commercially viable way has gained momentum for the perceived potential to contribute to poverty alleviation and food security in developing countries. This article investigates the impact of Community Revenue Enhancement through Technology Extension (CREATE) project of Heineken brewery on smallholder farmers’ wellbeing in Arsi zone Oromia regional state of Ethiopia. CREATE is a Public-Private Partnership (PPP) between Ministry of Foreign Affairs of the Netherlands and Heineken N.V. which source malt barely from smallholder farmers in three zones of Oromia. The study assessed the impact of CREATE on malt barley productivity, food security and new asset purchase in Arsi zone by comparing households that participate in the project with non-participating households using propensity score matching method. The finding indicated that households that participated in the CREATE project had higher malt barley productivity and purchased more new assets than non-participating households. However, there is no significant difference on food security status of participating and non-participating households indicating that the project has a profound impact on asset accumulation than on food security improvement.

Keywords: inclusive business, malt barley, propensity score matching, wellbeing

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Authors: Karl-Erich Lindenschmidt, Apurba Das, Joel Trudell, Keanne Russell

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In this presentation, we explore options for mitigating ice-jam flooding along the Athabasca River in western Canada. Not only flood hazard, expressed in this case as the probability of flood depths and extents being exceeded, but also flood risk, in which annual expected damages are calculated. Flood risk is calculated, which allows a cost-benefit analysis to be made so that decisions on the best mitigation options are not based solely on flood hazard but also on the costs related to flood damages and the benefits of mitigation. The river ice model is used to simulate extreme ice-jam flood events with which scenarios are run to determine flood exposure and damages in flood-prone areas along the river. We will concentrate on three mitigation options – the placement of a dike, artificial breakage of the ice cover along the river, the installation of an ice-control structure, and the construction of a reservoir. However, any mitigation option is not totally failsafe. For example, dikes can still be overtopped and breached, and ice jams may still occur in areas of the river where ice covers have been artificially broken up. Hence, for all options, it is recommended that zoning of building developments away from greater flood hazard areas be upheld. Flood mitigation can have a negative effect of giving inhabitants a false sense of security that flooding may not happen again, leading to zoning policies being relaxed. (Text adapted from Lindenschmidt [2022] "Ice Destabilization Study - Phase 2", submitted to the Regional Municipality of Wood Buffalo, Alberta, Canada)

Keywords: ice jam, flood hazard, flood risk river ice modelling, flood risk

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Authors: Mohammad Javad Zehtab, S. Alireza Mirghasemi, Ali Majlesara, Parvin Tajik, Babak Siavashi

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Objective: There are different modalities proposed for tennis elbow treatment with few randomized trials comparing them. We designed a study to compare the effectiveness of five different modalities and determine the usefulness of recently proposed extensor grip test (EGT) in predicting the response to treatment. Methods: In a randomized controlled clinical trial 92 of 98 tennis elbow patients in Sina hospital of Tehran, Iran between 2006 and 2007 fulfill trial entry criteria, among these patients 56 (60.9%) had positive EGT result. Stratified on EGT result, patients allocated randomly to 5 treatment groups: Brace (B) group, physiotherapy (P), brace + physiotherapy (BP), injection (I) and injection + physiotherapy (IP). Results: Patients who had positive result of EGT had better response to treatments: less SOC (p = 0.06), less PFFQ and patients’ satisfaction scores (p < 0.001). Among the treatment IP was the most successful, then BP, P and B, respectively; injection was the worst treatment modality. Response to treatment was comparable in all groups between EGT positive and negative patients except bracing; in which positive EGT was correlated with a dramatic response to treatment. Conclusion: In all patients IP and then BP is recommended but in EGT negatives, bracing seems to be of no use. Injection alone is not recommended in either group.

Keywords: tennis elbow, extensor grip test, physiotherapy, tennis elbow treatment

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Authors: Mariana Sary Khalifa Rezk

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The problem of respect for human rights in Southeast Asia has emerged as a main situation and is attracting the attention of the international network. Basically, the affiliation of Southeast Asian Nations (ASEAN) made human rights certainly one of its main troubles inside the ASEAN constitution in 2008. In the end, the Intergovernmental Fee on Human Rights ASEAN Human Rights (AICHR) was set up. AICHR is the Southeast Asia Human Rights Enforcement fee charged with the duties, functions and powers to sell and defend human rights. However, at the cease of 2016, the protecting feature assigned to the AICHR was no longer fulfilled. That is shown via several instances of human rights violations, which can be nonetheless ongoing and have not been solved. One case that has these days come to light is human rights violations against the Rohingya people in Myanmar. Using a felony-normative method, the study examines the urgency of setting up a human rights tribunal in Southeast Asia able to decide binding on ASEAN members or responsible parties. Information indicates ASEAN desires regional courts to cope with human rights abuses in the ASEAN region. Furthermore, the look also highlights 3 critical elements that ASEAN ought to take into account whilst establishing a human rights tribunal, particularly quantity. A good sized distinction in phrases of democracy and human rights improvement a few of the participants, a consistent implementation of the principle of non-interference and the economic trouble of the continuation of the court docket.

Keywords: politics, human rights, humanities, mankind, law human rights, Nigerian legal provisions, shariah law, comparative study, charter

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Authors: Bhawna Verma

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Looking at the contraceptive use and unmet need specific to the different age groups would help to understand various determinants and characteristics of women from different age groups, which are often being neglected. The study explores contraceptive behavior, unmet need for family planning and its correlates among young nulliparous women aged 15-29, using data from NFHS-4 (2015-16), India. Method: The study utilized information from 26,924 currently married women, who has no child or who have had first terminated pregnancy and was aged 15-29 at the time of the survey. Chi-Square and logistic regression analysis have been used to assess the effects of socio-economic characteristics. Results: Of all the considered explanatory variables religion, caste, education, current age, age at marriage, media exposure and regional differences were found to be significantly affecting the behavior of contraceptive use. Women of the 25-29 age group are 0.6 percent less likely to have an unmet need than women of 12-19 age group. Unmet need is increasing with the increased level of education. Muslim women are 0.3 percent less likely to have an unmet need than women of Hindu category. Conclusion: Separate considerations must be given to the needs for family planning formation among nulliparous women along with the factors associated with the use and non-use of contraceptives among them. Separate considerations must be given for effective promotion of FP knowledge through print, electronic media, towards the unequal access to the contraceptives among nulliparous women. Marriages after legal minimum age and encouraging women for higher education may address existing socio-economic barriers.

Keywords: contraceptive use, unmet need, family planning, contraceptive behavior

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Authors: Chandra Shekhar Majumder, Md. Shamsul Haque, Khondaker Anower Hossain, Md. Rafiqul Islam

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Introduction: Ocular helminths are parasites that infect the eye or its adnexa. They can be either motile worms or sessile worms that form cysts. These parasites require two hosts for their life cycle, a definite host (usually a human) and an intermediate host (usually an insect). While there have been reports of ocular helminths infecting various structures of the eye, including the anterior chamber and subconjunctival space, there is no previous record of such a case involving the lens. Research Aim: The aim of this case report is to present a rare case of ocular helminth infection in the lens and to contribute to the understanding of this unusual site of infection. Methodology: This study is a case report, presenting the details and findings of an 80-year-old retired policeman who presented with severe pain, redness, and vision loss in the left eye. The patient had a history of diabetes mellitus and hypertension. The examination revealed the presence of a thread-like helminth in the lens. The patient underwent treatment and follow-up, and the helminth specimen was sent for identification to the department of Parasitology. Case report: An 80-year-old retired policeman attended the OPD, Faridpur Medical College Hospital with the complaints of severe pain, redness and gross dimness of vision of the left eye for 5 days. He had a history of diabetes mellitus and hypertension for 3 years. On examination, L/E visual acuity was PL only, moderate ciliary congestion, KP 2+, cells 2+ and posterior synechia from 5 to 7 O’clock position was found. Lens was opaque. A thread like helminth was found under the anterior of the lens. The worm was moving and changing its position during examination. On examination of R/E, visual acuity was 6/36 unaided, 6/18 with pinhole. There was lental opacity. Slit-lamp and fundus examination were within normal limit. Patient was admitted in Faridpur Medical College Hospital. Diabetes mellitus was controlled with insulin. ICCE with PI was done on the same day of admission under depomedrol coverage. The helminth was recovered from the lens. It was thread like, about 5 to 6 mm in length, 1 mm in width and pinkish in colour. The patient followed up after 7 days, VA was HM, mild ciliary congestion, few KPs and cells were present. Media was hazy due to vitreous opacity. The worm was sent to the department of Parasitology, NIPSOM, Dhaka for identification. Findings: The findings of this case report highlight the presence of a helminth in the lens, which has not been previously reported. The helminth was successfully removed from the lens, but the patient experienced complications such as anterior uveitis and vitreous opacity. The exact mechanism by which the helminth enters the lens remains unclear. Theoretical Importance: This case report contributes to the existing literature on ocular helminth infections by reporting a unique case involving the lens. It highlights the need for further research to understand the pathogenesis and mechanism of entry of helminths in the lens. Data Collection and Analysis Procedures: The data for this case report were collected through clinical examination and medical records of the patient. The findings were described and presented in a descriptive manner. No statistical analysis was conducted. Question Addressed: This case report addresses the question of whether ocular helminth infections can occur in the lens, which has not been previously reported. Conclusion: To the best of our knowledge, this is the first reported case of ocular helminth infection in the lens. The presence of the helminth in the lens raises interesting questions regarding its pathogenesis and entry mechanism. Further study and research are needed to explore these aspects. Ophthalmologists and parasitologists should be aware of the possibility of ocular helminth infections in unusual sites like the lens.

Keywords: ocular, helminth, unsual site, lens

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Authors: Nivon P. Alejandra, Valencia P. L. Rodrigo, Vivanco V. Martin, Morita A. Adelina

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Technological innovation is fundamental to reach and maintain the levels of competitiveness of agricultural producers, the detection of actors, their activities, resources and capacities of an innovation system is needed for the development of technological packages that adapt to each type of crops, local circumstances and characteristics of the producer. The growing development of the viticulture and wine sector in Mexico prospects an increase in its national market participation for 2020, this is the reason to consider it a fertile field for the technological packages adoption that promote Precision Agriculture (PA) in a harmonic and sustainable development. A viability inspection of technological packages adoption by viticulture and wine sector is made following the methodology proposed by SAGARPA in 2015 and the World Bank in 2008: the history, actors, strengths and opportunities are analyzed in this particular agroindustrial sector, also its technological innovation system is inspected in order to improve technological capacities and innovation networks taking into account local and regional resources. PA and technological packages adoption can help improving the conditions and quality of the grape for winemaking: increasing the wine's storage potential and its nutraceutical nature. The assertive diagnosis in vineyard opportunity areas will help the management of the crop by applying natural treatments at the right time in the right place.

Keywords: technological packages, precision farming, sustainable development, innovation

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Authors: Wei-Hwa Chiang, Wei-Ting Hsu, Yuan-Chi Liu, Cheng-Che Tsai

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A sustainable built environment aims for minimizing both regional and global environmental impact while maintaining a healthy living for individuals. Sustainability of performing venues has rarely been discussed when compared with residential, office, and other popular building types. Life-cycle carbon emission due to the high standard requirements in acoustics, stage engineering, HVAC, and building structure need to be carefully examined. This can be complicated by social-economic and cultural concerns in addition to technical excellence. This paper reported case-based study and statistics of performing venues regarding urban connectivity and spatial layouts in enhancing facility usage and promoting cultural vitality. Interviews conducted for a major venue at Taipei indicated high linkage with surrounding leisure activity and the need for quality pedestrian and additional spaces open to the general public. Statistics of venues with various size and function suggested the possibility and strategies limit the size and height of reception and foyer spaces, and to maximize their use when there are no performances. Design strategies are identified to increase visual contact or facility sharing between the artists and the audience or the general public in reducing facility size and promoting potential involvement in cultural activities.

Keywords: sustainability, performing venue, design, operation

Procedia PDF Downloads 126

Authors: Ajit Kumar Sah, Rajesh Kumar Jha, Phoolgen Sah, Dev Kumar Shah

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Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The purpose of this study was to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department. Beers’ criteria are the most widely used tools to assess PIM to elderly patients. Prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a hospital of Bharatpur, Chitwan, Nepal during November 2011 to October 2012 to 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analyzed using Beers Criteria updated to 2013. In the 869 patients included the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with a number of medications prescribed. Further research is warranted to study the impact of PIMs towards health-related outcomes in these elderly.

Keywords: Beers criteria, elderly, polypharmacy, potentially inappropriate medicines

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Authors: Khawar Naeem, Adel Elomri, Adel Zghibi

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Contamination leakage from municipal solid waste (MSW) landfills is a serious environmental challenge that poses a threat to interconnected ecosystems. It not only contaminates the soil of the saturated zone, but it also percolates down the earth and contaminates the groundwater (GW). In this concise literature review, an effort is made to understand the environmental hazards posed by this contamination to the soil and groundwater, the type of contamination, and possible solutions proposed in the literature. In the study’s second phase, the MSW management practices are explored as the landfill site dump rate and type of MSW into the landfill site directly depend on the MSW management strategies. Case studies from multiple developed and underdeveloped countries are presented, and the complex MSW management system is investigated from an operational perspective to minimize the contamination of GW. One of the significant tools used in the literature was found to be Systems Dynamic Modeling (SDM), which is a simulation-based approach to study the stakeholder’s approach. By employing the SDM approach, the risk of GW contamination can be reduced by devising effective MSW management policies, ultimately resulting in water resource sustainability and regional sustainable development.

Keywords: groundwater contamination, environmental risk, municipal solid waste management, system dynamic modeling, water resource sustainability, sustainable development

Procedia PDF Downloads 81

Authors: Pramote Thangkratok

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The aims of this experimental study were to investigate the effect of Reverse Trendelenburg Position on the Back Pain after Cardiovascular Angiography and Interventions. In addition, to compare bleeding and hematoma occurrences at the Access site between experimental and control groups. The randomized controlled trial (RCT) was conducted in 70 patients who underwent Cardiovascular Angiography and Interventions via the femoral artery and received post procedural care at the intermediate cardiac care unit, Bangkok Heart Hospital. From December 2015 to February 2016. The control group (35 patients) was to get standard care after the intervention, whereas the experimental group (35 patients) was Reverse Trendelenburg Position 30-45 degrees. The groups were not significantly different in terms of demographic characteristics, Age, Gender, BMI, blood pressure, heart rate. While not significantly different from each other, the intensity of back pain control group had a significantly higher pain score than experimental group. Vascular complications in terms of bleeding and hematoma were not significantly different between the control and experimental groups. The findings show that Reverse Trendelenburg Position after Cardiovascular Angiography and Interventions would reduce or prevent the back pain without increasing the chance of bleeding and hematoma.

Keywords: reverse trendelenburg position, back pain, cardiovascular angiography, cardiovascular interventions

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Authors: Yuhua Yang, Yingcheng Li

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As a new form of intercity economic cooperation, innovation enclaves have received much attention from governments and scholars in China, which are of great significance in promoting the flow of innovation elements and advancing regional integration. Utilizing inter-city linkages of innovation enclaves within and beyond the Yangtze River Delta Region, we construct multi-scalar innovation enclave networks in 2018 and 2022, and analyze the evolutionary characteristics and underlying mechanisms of the networks. Overall, we find that: (1) The intercity innovation enclave networks have the characteristics of preferential connection and are gradually forming a clear multi-scale and hierarchical structure, with Shanghai, Hangzhou and Nanjing as the core and other cities as the general nodes; (2) The intercity innovation enclave networks exhibit local clustering dominated by geographical proximity connections, and are becoming more noticeable in the effect of distance decay and functionally polycentric as the spatial scale decreases; (3) The intercity innovation enclave networks are influenced by both functional distance and multidimensional proximity. While the innovation potential differences caused by urban attributes internally drive the formation of innovation enclave cooperation, geographic proximity, technological proximity and institutional proximity externally affect the selection of cooperation partners.

Keywords: economic enclave, intercity cooperation, proximity, yangtze river delta region

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Authors: Laila Seada, Hanan Oreiby, Fawaz Al Rashid, Ashraf Negm

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Background and Objective: In most areas of the world, the incidence of thyroid cancer has been increasing over the last decade, mostly due to a combination of early detection of the neoplasm resulting from sensitive procedures and increased population exposure to radiation and unrecognized carcinogens. Methods: Cases of thyroid cancer have been retrieved from the cancer registry at King Khalid Hospital during the period from August 2012 to April 2016. Age, gender and histopathologic types have been recorded. Results: Thyroid carcinoma ranked as the second most common malignancy in females (25%) after breast cancer (31%). It constituted 20.8% of all newly diagnosed cancer cases. As for males, it ranked the 4^th type of malignancy after gastrointestinal cancer, lymphomas and soft tissue sarcomas. Mean age for females and males was 38.7 +/- 13.2 and 60.25 +/- 11.5 years, respectively, and the difference between the two groups was statistically significant (p value = 0.0001). Fifty-five (82%) were papillary carcinomas including 10 follicular variant of papillary (FVPC), and eight papillary micro carcinomas (PMC) and two tall cell/oncocytic variants. Follicular carcinomas constituted two (3.1%), while two (3.1%) were anaplastic, and two (3.1%) were medullary. Conclusion: Thyroid cancer incidence in Hail is ranking as the 2^nd most common female malignancy similar to other regions in the Kingdom. However, this high incidence contrasts with much lower rates worldwide.

Keywords: thyroid, hail, papillary, microcarcinoma

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Authors: Tugba Gurler, Irfan Kurtbas

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Roof influences considerably energy demand of buildings. In order to reduce this energy demand, various solutions have been proposed, such as roofs with variable thermal insulation, cool roofs, green roofs, heat exchangers and ventilated roofs, and phase change material (PCM) layered roofs. PCMs suffer from relatively low thermal conductivity despite of their promise of the energy-efficiency initiatives for thermal energy storage (TES). This study not only presents the thermal performance of the concrete roof with PCM layers but also evaluates the products with different design configurations and thicknesses under Central Anatolia Region, Turkey and Nottinghamshire, UK weather conditions. System design limitations and proposed prediction models are discussed in this study. A two-dimensional numerical model has been developed, and governing equations have been solved at each time step. Upper surfaces of the roofs have been modelled with heat flux conditions, while lower surfaces of the roofs with boundary conditions. In addition, suitable roofs have been modeled under symmetry boundary conditions. The results of the designed concrete roofs with PCM layers have been compared with common concrete roofs in Turkey. The UK and the numerical modeling results have been validated with the data given in the literature.

Keywords: phase change material, regional energy demand, roof layers, thermal energy storage

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Authors: Griaznova Svetlana, Umedov Mekhroz

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The current healthcare facilities trend is the creation of multidisciplinary large-scale centers to provide the maximum possible services in one place, minimizing the number of possible instances in the path of patient treatment. The multifunctional medical centers are mainly designed in urban infrastructure for good accessibility. However, many functions and connections define the building shape, often make it inharmonious, that greatly destroys the city's appearance. The purpose of the research is to scientifically substantiate the factors influencing the shaping, the formation of architectural solutions principles, the formation of recommendations and principles for the multifunctional medical centers' design. The result of the research is the elaboration of architectural and planning solutions principles and the determination of factors affecting the multifunctional healthcare facilities shaping. Research method: Study and generalization of international experience in scientific research, literature, standards, teaching aids, and design materials on the topic of research. An integrated approach to the study of existing international experience of multidisciplinary medical centers. Elaboration of graphical analysis and diagrams based on the system analysis of the processed information. Identification of methods and principles of functional zoning of nuclear medicine centers.

Keywords: health care, multifunctionality, form, medical center, hospital, PET, CT scan

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Authors: Anju Elizbath Peter, S. M. Shiva Nagendra, Indumathi M.Nambi

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The deliberate fires initiated by dump managers and human scavengers to reduce the volume of waste and recovery of valuable metals/materials are common at municipal solid waste (MSW) disposal sites in developed country. A large amount of toxic gases released due to this act is responsible for the deterioration of regional and local air quality, which causes visibility impairment and acute respiratory diseases. The present study was aimed at the characterization of MSW and emission characteristics of burning of MSW in the laboratory. MSW samples were collected directly from the one of the open dumpsite located in Chennai city. Solid waste sampling and laboratory analysis were carried out according to American Society of Testing and Materials (ASTM) standards. Results indicated the values of moisture content, volatile solids (VS) and calorific values of solid waste samples were 16.67%,8%,9.17MJ/kg, respectively. The elemental composition showed that the municipal solid waste contains 25.84% of carbon, 3.69% of hydrogen, 1.57% of nitrogen and 0.26% of sulphur. The calorific value of MSW was found to be 9.17 MJ/Kg which is sufficient to facilitate self-combustion of waste. The characterization of emissions from the burning of 1 kg of MSW in the test chamber showed a total of 90 mg/kg of PM10 and 243 mg/kg of PM2.5. The current research study results will be useful for municipal authorities to formulate guideline and policy structure regarding the MSW management to reduce the impact of air emissions at an open dump site.

Keywords: characterization, MSW, open burning, PM10, PM2.5

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Authors: Wlodzimierz Ogryczak, Tomasz Sliwinski, Jaroslaw Hurkala, Mariusz Kaleta, Bartosz Kozlowski, Piotr Palka

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Implementation concepts of a decision support system for planning and management of mobile personnel tasks (sales representatives and others) are discussed. Large-scale periodic time-dependent vehicle routing and scheduling problems with complex constraints are solved for this purpose. Complex nonuniform constraints with respect to frequency, time windows, working time, etc. are taken into account with additional fast adaptive procedures for operational rescheduling of plans in the presence of various disturbances. Five individual solution quality indicators with respect to a single personnel person are considered. This paper deals with modeling issues corresponding to the problem and general solution concepts. The research was supported by the European Union through the European Regional Development Fund under the Operational Programme ‘Innovative Economy’ for the years 2007-2013; Priority 1 Research and development of modern technologies under the project POIG.01.03.01-14-076/12: 'Decision Support System for Large-Scale Periodic Vehicle Routing and Scheduling Problems with Complex Constraints.'

Keywords: mobile personnel management, multiple criteria, time dependent, time windows, vehicle routing and scheduling

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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 and aLternative medicine, Lebanon, quality of life

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Authors: Laila Algalal, Chen Xi

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The US dollar has long served as the world's primary reserve currency. However, this dominance faces growing challenges from internal US economic pressures and the rise of alternative currencies. Internally, issues like high debt, inflation, reduced competitiveness, and economic instability due to inequality in economic policies threaten the dollar's position. Externally, more countries are establishing alternative currencies, payment systems, and regional financial institutions to reduce dollar dependence. These drivers have contributed to a decline in the dollar's share of global foreign exchange reserves from 71% in 2001 to an estimated 58% in 2022. While this 13-percentage point drop took two decades, recent initiatives suggest de-dollarization could accelerate in the coming few decades. Efforts to establish non-dollar trade deals and alternative financial systems show more substantial progress compared to initiatives in the early 2000s. As the nature of the world system is anarchic, states make either individual or group efforts to guarantee their economic security and achieve their interests. Based on neoclassical realism, this paper analyzes both internal and external US economic factors driving current and future de-dollarization and the implications on the international monetary system, in addition to examining the motivation for such moves.

Keywords: de-dollarization, US dollar, monetary system, economic security, economic policies.

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Authors: Immanuel Darkwa

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Climate change and environmental degradation are existential threats requiring urgent transnational action. The SDGs, as well as regional initiatives the like European Green Deal, as ambitious as they are, put an emphasis on innovatively tackling threats posed by climate change regionally. While co-creational approaches are being propagated, there is no reference blueprint for how potential solutions, particularly nature-based solutions, may be developed and implemented within urban-settings. Using a single case study in Zagreb, Croatia, this paper proposes a workshop-tool for a Living Lab as a Service model for sustainable Nature-Based-Thinking, Nature–Centred-Design and Nature based solutions. The approach is based on a co-creational methodology developed through literature synthesis, expert interviews, focus group discussions, surveys and synthesized through rigorous research analysis and participatory observation. The ensuing tool involves workshop-processes, tested with through-the-process identified stakeholders with distinctive roles and functions. The resulting framework proposes a Nature-Based-Centred-Thinking process tool involving ‘green’ routines supported by a focal unit and a collaborative network, and that allows for the development of nature-based solutions.

Keywords: living labs, nature-based solutions, nature- based design, innovation processes, innovation routines and tools

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Authors: Corina Muscurel, Irina Stoian, Laura Gaman, Valeriu Atanasiu

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Chronic inflammation predisposes cells to neoplastic transformation and is associated with angiogenesis. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) give rise to anti-inflammatory metabolites and decrease some inflammatory cytokines. The aim of the study was to analyze the effect of n-3 PUFAs intake on patients with tumors in early-stage (without regional or distant metastasis). There were two groups of patients: one group with colon tumors and one group with lung tumors. All patients took for 60 days daily supplements from fish-oil containing 600 mg eicosapentaenoic acid and 400 mg docosahexaenoic acid. The plasma markers were evaluated before and after PUFAs intake: ceruloplasmin (using p-phenylenediamine oxidase method), plasma total thiol groups (using dithiobis-nitrobenzoic acid method) and CEA (carcinoembryonic antigen using electrochemiluminescent immunoassay). The results reflect ceruloplasmin decrease (p < 0.05), plasma total thiol groups increase (not statistically significant) and CEA decrease (p < 0.05) after n-3 PUFAs intake. Conclusions: n-3 PUFAs intake is favorable in premalignant lesions or in early tumor stage and dietary fish-oil has anti-inflammatory effects and can contribute to reduce cancer progression.

Keywords: cancer, fish-oil, inflammation, n-3 polyunsaturated fatty acids

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Authors: Keshari Shrestha, Philip Vatterott

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Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal drug-related syndrome. DRESS classically presents with a diffuse maculopapular rash, fevers, and eosinophilia more than three weeks after drug exposure. DRESS can present with multi-organ involvement, with liver damage being the most common and severe. Pulmonary involvement is a less common manifestation and is associated with poor clinical outcomes. Chest imaging is often nonspecific, and symptoms can range from mild cough to acute respiratory distress syndrome (ARDS) . This is a case of a 49-year-old female with a history of recent clostridium difficile colitis status post treatment with oral vancomycin who presented with rash, acute liver and kidney failure, as well as diffuse nodular alveolar lung opacities concerning for DRESS syndrome with multi-organ involvement. Clinical Course: This patient initially presented to an outside hospital with clostridium difficile colitis, acute liver injury, and acute kidney injury. She developed a desquamating maculopapular rash in the setting of recent oral vancomycin, meloxicam, and furosemide initiation. She was hospitalized on two additional occasions with worsening altered mental status, liver injury, and acute kidney injury and was initiated on intermittent hemodialysis. Notably, she was found to have systemic eosinophilia (4100 cells/microliter) several weeks prior. She was transferred to this institution for further management where she was found to have encephalopathy, jaundice, lower extremity edema, and diffuse bilateral rhonchorous breath sounds on pulmonary examination. The patient was started on methylprednisolone for suspected DRESS syndrome. She underwent an evaluation for alternative causes of her organ failure. Her workup included a negative infectious, autoimmune, metabolic, toxic, and malignant work-up. Abdominal computed tomography (CT) and ultrasound were remarkable for evidence of hepatic steatosis and possible cirrhotic morphology. Additionally, a chest CT demonstrated diffuse and symmetric nodular alveolar lung opacities with peripheral sparing not consistent with acute respiratory distress syndrome or edema. Ultimately, her condition continued to decline, and she required intubation on several occasions. On hospital day 25 she succumbed to distributive shock in the setting of probable sepsis and multi-organ failure. Discussion: DRESS syndrome occurs in 1 in 1,000 to 10,000 patients with a mortality rate of around 10%. Anti-convulsant, anti-bacterial, anti-viral, and sulfonamide drugs are the most common drugs implicated in the development of DRESS syndrome; however, the list of offending agents is extensive . The diagnosis of DRESS syndrome is made after excluding other causes of disease such as infectious and autoimmune etiologies. The RegiSCAR scoring system is used to diagnose DRESS syndrome with 2-3 points indicating possible disease, 4-5 probable disease, and >5 definite disease. This patient scored a 7 on the RegiSCAR scale for eosinophilia, rash, organ involvement, and exclusion of other causes (infectious and autoimmune). While the pharmacologic trigger in this case is unknown, it is speculated to be caused by vancomycin, meloxicam, or furosemide due to the favorable timeline of initiation. Despite aggressive treatment, DRESS syndrome can often be fatal. Because of this, early diagnosis and treatment of patients with suspected DRESS syndrome is imperative.

Keywords: drug reaction with eosinophilia and systemic symptoms, multi-organ failure, pulmonary involvement, renal failure

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Authors: A. M. Almujalli, G. M. Al-Ghamdi

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Mycobacterium avium subspecies paratuberculosis causes paratuberculosis, a chronic debilitating granulomatous enteritis, in camels as well as domestic and wild ruminants. The clinical manifestation of the disease in camel is not well characterized, therefore this study was aimed to investigate the clinical and pathological pictures of camels that are suffering from partuberculosis. Twelve young camels that were presented to the Veterinary Teaching Hospital, King Faisal University were investigated. Clinical and pathological examination were performed. The results revealed highly significant increase in creatinine, blood urea nitrogen, magnesium, AST and ALT in diseased camels, while glucose, total protein and albumin were highly significantly decreased in diseased camels when compared to healthy ones. Post-mortem testing indicated thickening, corrugation of the intestinal wall, folded mucosa, enlarged and oedemated ileocaecal and mesenteric lymph nodes. The microscopic findings detected short, blunt and distorted intestinal villi with hyperactive goblet cells of the villi and the crypts of lieberkuhn contained mucin droplets. The lamina propria was heavily infiltrated with mononuclear cells mostly macrophages. This clinical picture of paratuberculosis may be used to initiate control strategy to limit the spread of the disease in camel herds.

Keywords: camel, partuberclosis, control, Saudi Arabia

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Authors: Idit Miller

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This paper examines the effect of a common organizational identity on intergroup relations of Israeli-Jews and non-Israeli Palestinians medical interns who are employed together within the Israeli hospitals, while asymmetrical relationships and ongoing conflict between the two groups still exist. Using mixed theory, which included the Intergroup contact, Othering, and the Common social identity theories, the study examines the intra-organizational identities dynamic involved within the hospital department and its effects on intergroup relations. In-depth, semi-structured interviews with the Palestinian and Jews physicians were conducted. Findings show three social identity responses are being constructed during the shared employment: Them vs. Us construction, Them vs. Us deconstruction, and an 'Organizational Us' reconstruction. Despite the inequality inherent within the intergroup relations, by holding a universal identity and using a deconstruction pattern, positive emotions are demonstrated by both sides. The adoption of a shared professional super-identity is found as an essential component for fostering and maintaining positive attitudes between the parties. This finding strengthens the significance of a long-term continuous intergroup contact inside the organization and especially between two polarized groups.

Keywords: common social identity theory, intergroup contact theory, inequality, intergroup conflict, othering theory

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Authors: Ahmed Hamzi, Bryan Norman

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Having scribes help document patient records in electronic health record systems can improve hospitalists’ productivity. But hospitals need to determine the optimum number of scribes to hire to maximize scribe cost effectiveness. Scribe attendance uncertainty due to planned and unplanned absences is a primary challenge. This paper presents simulation and analytical models to determine the optimum number of scribes for a hospital to hire. Scribe staffing practices vary from one context to another; different staffing scenarios are considered where having extra attending scribes provides or does not provide additional value and utilizing on-call scribes to fill in for potentially absent scribes. These staffing scenarios are assessed for different scribe revenue ratios (ratio of the value of the scribe relative to scribe costs) ranging from 100% to 300%. The optimum solution depends on the absenteeism rate, revenue ratio, and desired service level. The analytical model obtains solutions easier and faster than the simulation model, but the simulation model is more accurate. Therefore, the analytical model’s solutions are compared with the simulation model’s solutions regarding both the number of scribes hired and cost-effectiveness. Additionally, an Excel tool has been developed to facilitate decision-makers in easily obtaining solutions using the analytical model.

Keywords: hospitalists, workload, optimization cost, economic analysis

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Authors: Savaş Karpuz, Sami Küçükşen

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The aim of this study is to investigate the effectiveness of neurological rehabilitation in patients with traumatic brain injury. Participants were 45 consecutive adults with traumatic brain injury who were received the neurologic rehabilitation. Sociodemographic characteristics of the patients, the cause of the injury, the duration of the coma and posttraumatic amnesia, the length of stay in the other inpatient clinics before rehabilitation, the time between injury and admission to the rehabilitation clinic, and the length of stay in the rehabilitation clinic were recorded. The differences in functional status between admission and discharge were determined with Disability Rating Scale (DRS), Functional Independence Measure (FIM), and Functional Ambulation Scale (FAS) and levels of cognitive functioning determined with Ranchos Los Amigos Scale (RLAS). According to admission time, there was a significant improvement identified in functional status of patients who had been given the intensive in-hospital cognitive rehabilitation program. At discharge time, the statistically significant differences were obtained in DRS, FIM, FAS and RLAS scores according to admission time. Better improvement in functional status was detected in patients with lower scores in DRS, and higher scores FIM and RLAS scores at the entry time. The neurologic rehabilitation significantly affects the recovery of functional status after traumatic brain injury.

Keywords: traumatic brain injury, rehabilitation, functional status, neurological

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Authors: Salieg L. Munestri

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War on Terror became a principal war after the 9/11 attacks on U.S. homeland. Instead of helping to build up worldwide efforts to condemn terror and suicide bombings, the U.S.-led war on terror has given opportunities for the vast spread of terror. In much of Muslim world recently, the Bush’s Doctrine pushing all nations to choose sides in a war that is not truly a war has resulted worse effects. In the world’s most populous Muslim nation, Indonesia, more terror occurred since then. Instead of reinforcing the well-trained anti-terror military forces, Indonesian government established US-funded Special Detachment 88 to guarantee the accomplishment of war on terror in Indonesia and significantly to bring impact on regional security atmosphere. Indonesia is a potential power in Asia but it lacked off sophisticated military equipments. Consequently, Indonesia agrees to become a U.S. mutual partner in combating terrorism managed by Defense Security Cooperation Agency. The formation of elite anti-terror forces and U.S. partnerships perform Indonesia’s commitment to take a position beside the U.S. in coping with terrorism issue. However, this undeniably brings consequences on Indonesian political athmosphere, which encourages the writer to dig deep the consequences on the domestic environment of Indonesian political system. The establishment of the elite forces has aroused fluctuations within government, chiefly Indonesian House, concerning the establishment urgency, the large amount of funding, and the unpleasant performances, particularly the treatment toward suspected terrorists. Hence, evaluation process upon the Detachment 88 is highly demanding.

Keywords: anti-terror forces, Indonesia, political system, war on terror

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Authors: Nyussupova Gulnara, Kenespayeva Laura, Kelinbayeva Roza, Aubakirova Gaukhar, Zhumagulov Chingiz, Aidarkhanova Gaukhar

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The article analyzes the development of demographic processes in four regions of the Western region of the Republic of Kazakhstan (Aktobe, Atyrau, West Kazakhstan, and Mangystau) for the period from 2000 to 2022. This study uses theoretical and methodological analysis of scientific literature, methods of comparative, statistical analysis, GIS methods, grouping and systematization, index method and structural analysis. The research identified regional characteristics, development trends, and disproportions in the population of the studied areas within the framework of sustainable demographic development. The population dynamics, the age-sex structure of the population, life expectancy, natural movement of the population, including maternal and infant mortality, are considered as important indicators of the region’s sustainability. The features of migration processes in the Western region of Kazakhstan and the factors that determine them are identified. Conclusions are drawn about the level of sustainable development of the population of the studied region based on demographic processes. The results obtained will provide scientific, methodological and information support in the sectors of economics and science, including the preparation of socio-economic development programs and the development of scientific research using GIS.

Keywords: sustainable development, demographic processes, Western Region, Republic of Kazakhstan, population structure, natural population movement, migration

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