Search results for: long-term care cost

Authors: Emily Purdom, Rachel Robinson

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As the number of students worldwide requiring speech-language therapy, occupational therapy and mental health services during their school day increases, innovation is becoming progressively more important to meet the demand. Telepractice can be used to reach a greater number of students requiring specialized therapy while maintaining the highest quality of care. It can be provided in a way that is not only effective but ultimately more convenient for student, teacher and therapist without the added burden of travel. Teletherapy eradicates many hurdles to traditional on-site service delivery and helps to solve the pervasive shortage of certified professionals. Because location is no longer a barrier to specialized education plans for students with disabilities when teletherapy is conducted, there are many advantages that can be deployed. Increased frequency of engagement is possible along with students receiving specialized care from a clinician that may not be in their direct area. Educational teams, including parents, can work together more easily and engage in face-to-face, student-centered collaboration through videoconference. Practical strategies will be provided for connecting students with qualified therapists without the typical in-person dynamic. In most cases, better therapy outcomes are going to be achieved when treatment is most convenient for the student and educator. This workshop will promote discussion in the field of education to increase advocacy for remote service delivery. It will serve as a resource for those wanting to expand their knowledge of options for students with special needs afforded through innovation.

Keywords: education technology, innovation, student support services, telepractice

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Authors: Abidin Tortum, Kubra Kocabey

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One of the sectors where the competition is experienced at the highest level in the world is the transformer sector, and sales can be made with a limited profit margin. For this reason, manufacturers must develop cost-cutting designs to achieve higher profits. The use of rectangular cores and coils in transformer design is one of the methods that can be used to reduce costs. According to the best knowledge we have obtained, we think that we are the first company producing rectangular core power transformers in our country. BETA, to reduce the cost of this project, more compact products to reveal, as we know it to increase the alleviate and competitiveness of the product, will perform cored coil design and production rectangle for the first-time power transformers in Turkey. The transformer to be designed shall be 16 MVA, 33/11 kV voltage level. With the rectangular design of the transformer core and windings, no-load losses can be reduced. Also, the least costly transformer type is rectangular. However, short-circuit forces on rectangular windings do not affect every point of the windings in the same way. Whereas more force is applied inwards to the mid-points of the low-voltage winding, the opposite occurs in the high-voltage winding. Therefore, the windings tend to deteriorate in the event of a short circuit. While trying to reach the project objectives, the difficulties in the design should be overcome. Rectangular core transformers to be produced in our country offer a more compact structure than conventional transformers. In other words, both height and width were smaller. Thus, the reducer takes up less space in the center. Because the transformer boiler is smaller, less oil is used, and its weight is lower. Biotemp natural ester fluid is used in rectangular transformer and the cooling performance of this oil is analyzed. The cost was also reduced with the reduction of dimensions. The decrease in the amount of oil used has also increased the environmental friendliness of the developed product. Transportation costs have been reduced by reducing the total weight. The amount of carbon emissions generated during the transportation process is reduced. Since the low-voltage winding is wound with a foil winding technique, a more resistant structure is obtained against short circuit forces. No-load losses were lower due to the use of a rectangular core. The project was handled in three phases. In the first stage, preliminary research and designs were carried out. In the second stage, the prototype manufacturing of the transformer whose designs have been completed has been started. The prototype developed in the last stage has been subjected to routine, type and special tests.

Keywords: rectangular core, power transformer, transformer, productivity

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Authors: Bridget J. Kenny, Elizabeth Hoban, Jo Williams

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Adolescent pregnancy presents a significant public health challenge for Cambodia. Despite declines in the overall fertility rate, the adolescent fertility rate is increasing. Adolescent pregnancy is particularly problematic in the Northeast provinces of Ratanak Kiri and Mondul Kiri where 34 percent of girls aged between 15 and 19 have begun childbearing; this is almost three times Cambodia’s national average of 12 percent. Language, cultural and geographic barriers have restricted qualitative exploration of the sexual and reproductive health (SRH) challenges that face indigenous adolescents in Northeast Cambodia. The current study sought to address this gap by exploring the SRH practices of adolescent mothers from indigenous populations in Ratanak Kiri Province. Twenty-two adolescent mothers, aged between 15 and 19, were recruited from seven indigenous villages in Ratanak Kiri Province and asked to participate in a combined body mapping exercise and semi-structured interview. Participants were given a large piece of paper (59.4 x 84.1 cm) with the outline of a female body and asked to draw the female reproductive organs onto the ‘body map’. Participants were encouraged to explain what they had drawn with the purpose of evoking conversation about their reproductive bodies. Adolescent mothers were then invited to participate in a semi-structured interview to further expand on topics of SRH. The qualitative approach offered an excellent avenue to explore the unique SRH challenges that face indigenous adolescents in rural Cambodia. In particular, the use of visual data collection methods reduced the language and cultural barriers that have previously restricted or prevented qualitative exploration of this population group. Thematic analysis yielded six major themes: (1) understanding of the female reproductive body, (2) contraceptive knowledge, (3) contraceptive use, (4) barriers to contraceptive use, (5) sexual practices, (6) contact with healthcare facilities. Participants could name several modern contraceptive methods and knew where they could access family planning services. However, adolescent mothers explained that they gained this knowledge during antenatal care visits and consequently participants had limited SRH knowledge, including contraceptive awareness, at the time of sexual initiation. Fear of the perceived side effects of modern contraception, including infertility, provided an additional barrier to contraceptive use for indigenous adolescents. Participants did not cite cost or geographic isolation as barriers to accessing SRH services. Child marriage and early sexual initiation were also identified as important factors contributing to the high prevalence of adolescent pregnancy in this population group. The findings support the Ministry of Education, Youth and Sports' (MoEYS) recent introduction of SRH education into the primary and secondary school curriculum but suggest indigenous girls in rural Cambodia require additional sources of SRH information. Results indicate adolescent girls’ first point of contact with healthcare facilities occurs after they become pregnant. Promotion of an effective continuum of care by increasing access to healthcare services during the pre-pregnancy period is suggested as a means of providing adolescents girls with an additional avenue to acquire SRH information.

Keywords: adolescent pregnancy, contraceptive use, family planning, sexual and reproductive health

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Authors: Ande Nesmith

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There is an ongoing shortage of foster parents worldwide to take on a growing population of children in need of out-of-home care. Currently, resources are primarily aimed at recruitment rather than retention. Retention rates are extraordinarily low, especially in the first two years of fostering. Qualitative interviews with 19 foster parents averaging 20 years of service provided insight into the challenges they faced and how they overcame them. Thematic analysis of interview transcripts identified sources of stress and resiliency. Key stressors included lack of support and responsiveness from the children’s social workers, false maltreatment allegations, and secondary trauma from children’s destructive behaviors and emotional dysregulation. Resilient parents connected with other foster parents for support, engaged in creative problem-solving, recognized that positive feedback from children usually arrives years later, and through training, understood the neurobiological impact of trauma on child behavior. Recommendations include coordinating communication between the foster parent licensing agency social workers and the children’s social workers, creating foster parent support networks and mentoring, and continuous training on trauma including effective parenting strategies. Research is needed to determine whether these resilience indicators in fact lead to long-term retention. Policies should include a mechanism to develop a cohesive line of communication and connection between foster parents and the children’s social workers as well as their respective agencies.

Keywords: foster care stability, foster parent burnout, foster parent resiliency, foster parent retention, trauma-informed fostering

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Authors: Tomohiro Uchida, Noriaki Satake, Toshimichi Nakaho, Akira Inoue, Hidemitsu Saito

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In this study, we assessed the bereavement risk of family caregivers of patients with cancer. In the palliative care unit of Tohoku University Hospital, we conducted a family psychoeducation session to support the family caregivers of patients with cancer. A total of 50 participants (8 males and 42 females; mean age = 62.98 years, SD = 11.10) were assessed after the session for bereavement risk using the Japanese version of the Bereavement Risk Assessment Tool (BRAT-J). According to the BRAT-J scores, eight participants were considered to be having no known risk (Level 1), seventeen had minimal risk (Level 2), twenty had a low risk (Level 3), four had a moderate risk (Level 4), and one had a high risk (Level 5). Of these participants, seven participants had completed the follow-up postal survey that assessed their psychological distress (the Kessler Psychological Distress Scale: K6) to compare the bereavement risk. According to the K6 scores, three-fourth of the individuals, who were considered to be at Level 3 on the BRAT-J, scored higher than the cutoff point (>10) for the detection of depressive disorder. On the other hand, one-third of the individuals, who were considered to be at Level 2 on the BRAT-J, scored higher than the cutoff point. Therefore, it appears that the BRAT-J can predict the likelihood of difficulties or complications in bereaved family caregivers. This research was approved by the Ethics Committee of Tohoku University Graduate School of Medicine and Tohoku University Hospital.

Keywords: palliative care, family caregivers, bereavement risk, BRAT, post-loss psychological distress

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Authors: Raheel Shakoor Siddiqui, Calvin Mathias, Manikandar Srinivas Cheruvu, Bobin Varghese

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A 58 year old gentleman presented to accident and emergency at the district general hospital with worsening shortness of breath and a non-productive cough over a period of five days. He was initially admitted under the medical team for suspicion of SARS-CoV-2 (COVID-19) pneumonitis. Subsequently, upon deterioration of observations and a positive COVID-19 PCR, he was taken to intensive care for invasive mechanical ventilation. He required frequent proning, inotropic support and was intubated for thirty-three days. After successful extubation, he developed myopathy with a limited range of motion to his right knee and right shoulder. Plain film imaging of these limbs demonstrated an unusual formation of heterotopic ossification without any precipitating trauma or surgery. Current literature demonstrates limited case series portraying heterotopic ossification post-COVID-19. There has been negligible evidence of heterotopic ossification in the ipsilateral knee and shoulder post-prolonged immobility secondary to a critical illness. Physiotherapy and rehabilitation are post-intensive care can be prolonged due to the formation of heterotopic ossification around joints. Prolonged hospital stays may lead to a higher risk of developing infections of the chest, urine and pressure sores. This raises the question of whether a severe systemic inflammatory immune response from the SARS-CoV-2 virus results in histopathological processes leading to the formation of heterotopic ossification not previously seen, requiring prolonged physiotherapy.

Keywords: orthopaedics, rehabilitation, physiotherapy, heterotopic ossification, COVID-19

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Authors: Akankunda Veronicah Karuhanga

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Dementia is an age mental disorder that makes victims lose normal functionality that needs delicate attention. It has been technically defined as a clinical syndrome that presents a number of difficulties in speech and other cognitive functions that change someone’s behaviors and can also cause impairments in activities of daily living, not forgetting a range of neurological disorders that bring memory loss and cognitive impairment. Family members are the primary healthcare givers and therefore, the way how they handle the situation in its early stages determines future deterioration syndromes like total memory loss. Unfortunately, most family members are ignorant about this condition and in most cases, the patients are brought to our facilities when their condition was already mismanaged by family members and we thus cannot do much. For example, incontinence can be managed at early stages through potty training or toilet scheduling before resorting to 24/7 diapers which are also not good. Professional Elderly care should be understood and practiced as an extension of homes, not a dumping place for people considered “abnormal” on account of ignorance. Immediate relatives should therefore be sensitized concerning the normalcy of dementia in the context of old age so that they can be understanding and supportive of dementia patients rather than discriminating against them as present-day lepers. There is a need to skill home-based caregivers on how to handle dementia in its early stages. Unless this is done, many of our elderly homes shall be filled with patients who should have been treated and supported from their homes. This skilling of home-based caregivers is a vital intervention because until elderly care is appreciated as a human moral obligation, many transactional rehabilitation centers will crop up and this shall be one of the worst moral decadences of our times.

Keywords: dementia, family, Alzheimers, relevancy

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Authors: Hyunjoo Choi, Jeonghun Nam, Chae Seung Lim

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Acoustomicrofluidics has gained much attention due to the advantages, such as noninvasiveness and easy integration with other miniaturized systems, for clinical and biological applications. However, a limitation of acoustomicrofluidics is the complicated and costly fabrication process of electrodes. In this study, we propose a low-cost and lithography-free device using Lamb wave for blood analysis. Using a Lamb wave, calcium ion-removed blood plasma and coagulation reagents can be rapidly mixed for blood coagulation test. Due to the coagulation process, the viscosity of the sample increases and the viscosity change can be monitored by internal acoustic streaming of microparticles suspended in the sample droplet. When the acoustic streaming of particles stops by the viscosity increase is defined as the coagulation time. With the addition of calcium ion at 0-25 mM, the coagulation time was measured and compared with the conventional index for blood coagulation analysis, prothrombin time, which showed highly correlated with the correlation coefficient as 0.94. Therefore, our simple and cost-effective Lamb wave-based blood analysis device has the powerful potential to be utilized in clinical settings.

Keywords: acoustomicrofluidics, blood analysis, coagulation, lamb wave

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Authors: Gianne Bianca P. Manalo, Ernesto A. Martin, Vanessa V. Velasco

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The laying performance, egg quality, egg classification, and income over feed cost of Improved Philippine Mallard duck (Itik Pinas) were examined as influenced by garlic powder in drinking water. A total of 48 ducks (42 females and 6 males) were used in the study. The ducks were allocated into two treatments - with garlic powder (GP) and without garlic powder (control) in drinking water. Each treatment had three replicates with eight ducks (7 females and 1 male) per replication. The results showed that there was a significant (P = 0.03) difference in average egg weight where higher values were attained by ducks with GP (77.67 g ± 0.64) than the control (75.64 g ± 0.43). The supplementation of garlic powder in drinking water, however, did not affect the egg production, feed intake, FCR, egg mass, livability, egg quality and egg classification. The Itik Pinas with GP in drinking water had numerically higher income over feed cost than those without. GP in drinking water can be considered in raising Itik Pinas. Further studies on increasing level of GP and long feeding duration also merit consideration to substantiate the findings.

Keywords: phytogenic, garlic powder, Itik-Pinas, egg weight, egg production

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Authors: C. Treadgold, S. Sivaraman

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The Starlight Children's Foundation (Starlight) is an Australian non-profit organisation that delivers programs, in partnership with health professionals, to support children, adolescents, and their families who are living with a serious illness. While supporting children and adolescents with life-limiting conditions has always been a feature of Starlight's work, providing a dedicated program, specifically targeting and meeting the needs of the paediatric palliative population, is a recent area of focus. Recognising the challenges in providing children’s palliative services, Starlight initiated a research and development project to better understand and meet the needs of this group. The aim was to create a program which enhances the wellbeing of children, adolescents, and their families receiving paediatric palliative care in their community through the provision of on-going, tailored, positive experiences or 'moments'. This paper will present the results of the formative evaluation of this unique program, highlighting the development processes and outcomes of the pilot. The pilot was designed using an innovation methodology, which included a number of research components. There was a strong belief that it needed to be delivered in partnership with a dedicated palliative care team, helping to ensure the best interests of the family were always represented. This resulted in Starlight collaborating with both the Victorian Paediatric Palliative Care Program (VPPCP) at the Royal Children's Hospital, Melbourne, and the Sydney Children's Hospital Network (SCHN) to pilot the 'Moments' program. As experts in 'positive disruption', with a long history of collaborating with health professionals, Starlight was well placed to deliver a program which helps children, adolescents, and their families to experience moments of joy, connection and achieve their own sense of accomplishment. Building on Starlight’s evidence-based approach and experience in creative service delivery, the program aims to use the power of 'positive disruption' to brighten the lives of this group and create important memories. The clinical and Starlight team members collaborate to ensure that the child and family are at the centre of the program. The design of each experience is specific to their needs and ensures the creation of positive memories and family connection. It aims for each moment to enhance quality of life. The partnership with the VPPCP and SCHN has allowed the program to reach families across metropolitan and regional locations. In late 2019 a formative evaluation of the pilot was conducted utilising both quantitative and qualitative methodologies to document both the delivery and outcomes of the program. Central to the evaluation was the interviews conducted with both clinical teams and families in order to gain a comprehensive understanding of the impact of and satisfaction with the program. The findings, which will be shared in this presentation, provide practical insight into the delivery of the program, the key elements for its success with families, and areas which could benefit from additional research and focus. It will use stories and case studies from the pilot to highlight the impact of the program and discuss what opportunities, challenges, and learnings emerged.

Keywords: children, families, memory making, pediatric palliative care, support

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Authors: Hene L. Hapinat, Mae D. Dumapig

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This study aimed to determine the lime potential of 3 mollusks, namely: Crassostrea iredalei (Oyster shell), Turritella terebra (Turret shell), and Anodontia edentula (Mangrove clam shell) as alternative for commercially produced agricultural lime. The hydrogen ion concentration (pH) and the lime concentration using Calcium Carbonate Equivalent (CCE) of each shellfish species were measured and tested for the enhancement of an acidic soil. The experiment was laid out in a Completely Randomized Design (CRD) with 4 treatments replicated 3 times. The treatments were as follows: Treatment A- 100 g agricultural lime; B- 100 g oyster shell lime; C- 100 g turret shell lime; and D- 100 g mangrove clam shell lime. Each treatment was combined to the acidic soil sample. The results were statistically analyzed using One-way Analysis of Variance (ANOVA) and Least Square Difference (LSD) at 0.01 and 0.05 levels of significance. Results revealed that lime produced from the 3 selected mollusks can be a potential source of alternative and/or supplement materials for agricultural lime in dealing with soil acidity, entailing lower cost of farm production.

Keywords: shell lime, pH, calcium carbonate concentrations, mollusks, agricultural lime, lime potential concentration, acidic soil

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Authors: J. H. Park, S. K. Lee, Y. W. Kim, D. C. Ko

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A large variety of pipe flange is required in marine and construction industry.Pipe flanges are usually welded or screwed to the pipe end and are connected with bolts.This approach is very simple and widely used for a long time, however, it results in high development cost and low productivity, and the productions made by this approach usually have safety problem at the welding area.In this research, a new approach of forming pipe flange based on cold forging and floating die concept is presented.This innovative approach increases the effectiveness of the material usage and save the time cost compared with conventional welding method. To ensure the dimensional accuracy of the final product, the finite element analysis (FEA) was carried out to simulate the process of cold forging, and the orthogonal experiment methods were used to investigate the influence of four manufacturing factors (pin die angle, pipe flange angle, rpm, pin die distance from clamp jig) and predicted the best combination of them. The manufacturing factors were obtained by numerical and experimental studies and it shows that the approach is very useful and effective for the forming of pipe flange, and can be widely used later.

Keywords: cold forging, FEA (finite element analysis), forge-3D, rotating forming, tubes

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Authors: Sophia Cyril Vincent

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Background: As per the Indian Census 2011, there is nearly 104 million elderly population aged above 60 years (53 million females and 51 males), and the count is expected to be 173 million by the end of 2026. Nearly 5.5% of women and 1.5% of men are living alone.1 In India, even though it is the moral duty of the children to take care of aged parents, many elders are landing in old age homes due to the social transformation factors like mushrooming of nuclear families, migration of children, cultural echoes, differences in mindset and values. Nearly 728 old age homes are seen across the country, out of which 78 old age homes with approximately 3000 inmates are seen only in Bangalore2. The existing literature shows that elderly women residing in old age homes experience the challenges like- loneliness, health issues, rejection from children, grief, death anxiety, etc, which leads to mental and physical wellbeing in numerous and tangible ways3. Hence the best and cost-effective way to improve the meaning and quality of life among elderly females is logotherapy, a type of psychotherapeutic analysis and treatment, motivating and driving force4 within the human experience to lead a decent life. Aim: The current research is aimed at studying the effectiveness of a logotherapy intervention on meaning and quality of life among elderly women of old age homes. Samples:200 women aged < 60 years and staying in the old age home for more than 1 year were randomly allocated to the control group and experimental group. Methodology: Using the Meaning in life questionnaire (MLQ)and the World health organization quality of life (WHOQOL) questionnaire, meaning and quality of life were assessed among both groups' women. Intensive Logotherapy and meaning in life program for five days were provided for the experimental group and the control group, with no treatment. Result: Under analysis. Conclusion: It is the right of the elderly woman to lead a happy and peaceful life till her death irrespective of the residing place. Hence, continuous monitoring and effective management are necessary for elderly women.

Keywords: quality of life, meaning of life, logo therapy, old age home

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Authors: Nassim Salmi

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This study aimed to identify the administrative, social, cultural, economic and psychological challenges facing the nursing s ector in the Tebessa Algeria. It also seeks to identify whether there are differences between the opinions of managers in public and private hospitals about these challenges. To achieve the objectives of the study, the descriptive analytical method was adopted. The study also used the questionnaire as a tool for collecting the necessary data and information, which was applied to a sample of directors of public and private hospitals in the Tebessa, which amounted to (114) individuals. The study reached a set of results, including: that there are no statistically significant differences between the opinions of managers in public and private hospitals about the administrative, social, cultural, economic and psychological challenges facing the nursing sector in the Tebessa . The results also showed agreement between the views of managers in private public hospitals that the most important administrative challenges are the lack of training programs that affect the efficiency and performance of nursing work, and that the most important social and cultural challenges are the hospital’s failure to provide suitable nurseries for Saudi female nurses, and that the most important economic challenges are the lack of Availability of medical equipment and devices, and the most important psychological challenge is the tense relationship between the administration and the hospital's nursing staff. The study recommended focusing on the importance of rehabilitation and training together, activating the role of training in the ministry and making it compulsory and a condition of renewal for practicing and continuing the nursing profession, and providing the social and economic needs of the nursing staff.

Keywords: postoperative care, gynecology, nursing documentation, database

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Authors: Naman Singla, Ajay Pal Singh Chauhan

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As the demand for providing high bit rate and high bandwidth is increasing at a rapid rate so there is a need to see in this problem and finds a technology that provides high bit rate and also high bandwidth. One possible solution is by use of optical fiber. Optical fiber technology provides high bandwidth in THz. But the disadvantage of optical fiber is of high cost and not used everywhere because it is not possible to reach all the locations on the earth. Also high maintenance required for usage of optical fiber. It puts a lot of cost. Another technology which is almost similar to optical fiber is Free Space Optics (FSO) technology. FSO is the line of sight technology where modulated optical beam whether infrared or visible is used to transfer information from one point to another through the atmosphere which works as a channel. This paper concentrates on analyzing the performance of FSO in terms of bit error rate (BER) and quality factor (Q) using different modulation techniques like non return to zero on off keying (NRZ-OOK), differential phase shift keying (DPSK) and differential quadrature phase shift keying (DQPSK) using OptiSystem software. The findings of this paper show that FSO system based on DQPSK modulation technique performs better.

Keywords: attenuation, bit rate, free space optics, link length

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Authors: Desmond Wade, Alfredo Ormazabal

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Background: Ever since it commenced its registration process of pre-hospital practitioners in the year 2000 through the Irish Government Statute Instrument (SI 109 of 2000) process, the approach to education of its professionals has changed drastically. The progression from the traditional behaviouristic to the current constructivist approach has been based on experiences from other sectors and industries, nationally and internationally. Today, the delivery of a safe and efficient ambulance service heavily depends on its practitioners’ range of technical skills, academic knowledge, and overall competences. As these increase, so does the level of complexity of paramedics’ everyday practice. This has made it inevitable to consider the 'Human Factor' as a source of potential risk and made formative institutions like the National Ambulance Service College to include it in their curriculum. Methods: This paper used a mixed-method approach, where both, an online questionnaire and a set of semi-structured interviews were the source of primary data. An analysis of this data was carried out using qualitative and quantitative data analysis. Conclusions: The evidence presented leads to the conclusion that in the National Ambulance Service there is a considerable lack of education of Human Factors and the levels in understanding of how to manage Human Factors in practice vary across its spectrum. Paramedic Practitioners in Ireland seem to understand that the responsibility of patient care lies on the team, rather than on the most hierarchically senior practitioner present in the scene.

Keywords: human factors, ergonomics, stress, decision making, pre-hospital care, paramedic, education

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Authors: Vijay Kumar, Ron Bird

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The study investigates the effect of bank-specific, industry-specific and macroeconomic variables on the profitability of conventional and Islamic banks. Our sample comprises 1,781 bank-year observations of 205 banks from four countries in the Asian region for the period 2004-2014. Our results suggest that credit quality, cost management and bank size are the keys factors that contribute positively to bank profitability in Asia. The banks with high non-performing loans and high cost-to-income ratio are more likely to be exposed to losses. The impacts of the bank-specific variables are stronger than are the industry-specific and macroeconomic variables. We find that Malaysian banks are the least profitable compared to the banks in Bangladesh, Indonesia and Pakistan. There is strong evidence to suggest that conventional banks are more profitable than Islamic banks. Our results suggest that the impact of capital adequacy ratio and bank size and loan to deposit ratio vary across Islamic and conventional banks and across different subsamples.

Keywords: capital adequacy ratio, Islamic banks, non-performing loan ratio, ownership

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Authors: Scott Cavinder

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Surgical site infections (SSI) are a known complication to any surgical procedure and are one of the most common nosocomial infections. Globally it is estimated 300 million surgical procedures take place annually, with an incidence of SSI’s estimated to be 11 of 100 surgical patients developing an infection within 30 days after surgery. The specific purpose of the project is to address the PICOT (Problem, Intervention, Comparison, Outcome, Time) question: In patients who have undergone cardiothoracic or vascular surgery (P), does implementation of a post-operative care bundle based on current EBP (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period (T)? Synthesis of Supporting Evidence: A literature search of five databases, including citation chasing, was performed, which yielded fourteen pieces of evidence ranging from high to good quality. Four common themes were identified for the prevention of SSI’s including use and removal of surgical dressings; use of topical antibiotics and antiseptics; implementation of evidence-based care bundles, and implementation of surveillance through auditing and feedback. The Iowa Model was selected as the framework to help guide this project as it is a multiphase change process which encourages clinicians to recognize opportunities for improvement in healthcare practice. Practice/Implementation: The process for this project will include recruiting postsurgical participants who have undergone cardiovascular or thoracic surgery prior to discharge at a Northwest Indiana Hospital. The patients will receive education, verbal instruction, and return demonstration. The patients will be followed for 12 weeks, and wounds assessed utilizing the National Healthcare Safety Network//Centers for Disease Control (NHSN/CDC) assessment tool and compared to the SSI rate of 2021. Key stakeholders will include two cardiovascular surgeons, four physician assistants, two advance practice nurses, medical assistant and patients. Method of Evaluation: Chi Square analysis will be utilized to establish statistical significance and similarities between the two groups. Main Results/Outcomes: The proposed outcome is the prevention of SSIs in the post-op cardiothoracic and vascular patient. Implication/Recommendation(s): Implementation of standardized post operative care bundles in the prevention of SSI in cardiovascular and thoracic surgical patients.

Keywords: cardiovascular, evidence based practice, infection, post-operative, prevention, thoracic, surgery

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Authors: Joana Margarida Bôto, Belmira Neto, Vera Miguéis, Manuela Meireles, Ada Rocha

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The Mediterranean diet has been recognized as a sustainable model of living with benefits for the environment and human health. However, a complete assessment of its sustainability, encompassing all dimensions and aspects, to our best knowledge, has not yet been realized. This systematic literature review aimed to fill this gap by identifying and describing the indicators used to assess the sustainability of the Mediterranean diet, looking at several dimensions, and presenting the results from their application. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines methodology was used, and searches were conducted in PubMed, Scopus, Web of Science, and GreenFile. There were identified thirty-two articles evaluating the sustainability of the Mediterranean diet. The environmental impact was quantified in twenty-five of these studies, the nutritional quality was evaluated in seven studies, and the daily cost of the diet was assessed in twelve studies. A total of thirty-three indicators were identified and separated by four dimensions of sustainability, specifically, the environmental dimension (ten indicators, namely carbon, water, and ecological footprint), the nutritional dimension (eight indicators, namely Health score and Nutrient Rich Food Index), the economic dimension (one indicator, the dietary cost), the sociocultural dimension (six indicators – with no results). Only eight of the studies used combined indicators. The Mediterranean diet was considered in all articles as a sustainable dietary pattern with a lower impact than Western diets. The carbon footprint ranged between 0.9 and 6.88 kg CO₂/d per capita, the water footprint between 600 and 5280 m³/d per capita, and the ecological footprint between 2.8 and 53.42 m²/d per capita. The nutritional quality was high, obtaining 122 points using the Health score and 12.95 to 90.6 points using the Nutrient Rich Food Index. The cost of the Mediterranean diet did not significantly differ from other diets and varied between 3.33 and 14.42€/d per capita. A diverse approach to evaluating the sustainability of the Mediterranean diet was found.

Keywords: Mediterranean diet, sustainability, environmental indicators, nutritional indicators

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Authors: Jingya Liu, Yue Wu, Jiabin Luo

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This work investigates an intermodal transportation system for delivering goods from a Regional Distribution Centre to supermarkets on the Isle of Wight (IOW) via the port of Southampton or Portsmouth in the UK. We consider this integrated logistics chain as a 3-echelon transportation system. In such a system, there are two types of transport methods used to deliver goods across the Solent Channel: one is accompanied transport, which is used by most supermarkets on the IOW, such as Spar, Lidl and Co-operative food; the other is unaccompanied transport, which is used by Aldi. Five transport scenarios are studied based on different transport modes and ferry routes. The aim is to determine an optimal delivery plan for supermarkets of different business scales on IOW, in order to minimise the total running cost, fuel consumptions and carbon emissions. The problem is modelled as a vehicle routing problem with time windows and solved by genetic algorithm. The computing results suggested that accompanied transport is more cost efficient for small and medium business-scale supermarket chains on IOW, while unaccompanied transport has the potential to improve the efficiency and effectiveness of large business scale supermarket chains.

Keywords: genetic algorithm, intermodal transport system, Isle of Wight, optimization, supermarket

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Authors: Yi-Fung Lin, Shiow-Ching Shun, Wen-Yu Hu

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Background: A skill mix model is regarded as one of the most effective methods of reducing nursing shortages, as well as easing nursing staff workloads and labor costs. Although this model shows several benefits for the health workforce, the relationship between the optimal model of skill mix and the patient mortality rate remains to be discovered. Objectives: This review aimed to explore the relationship between the skill mix model and patient mortality rate in acute care hospitals. Data Sources: A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases and researchers retrieved studies published between January 1986 and March 2022. Review methods: Two independent reviewers screened the titles and abstracts based on selection criteria, extracted the data, and performed critical appraisals using the STROBE checklist of each included study. The studies focused on adult patients in acute care hospitals, and the skill mix model and patient mortality rate were included in the analysis. Results: Six included studies were conducted in the USA, Canada, Italy, Taiwan, and European countries (Belgium, England, Finland, Ireland, Spain, and Switzerland), including patients in medical, surgical, and intensive care units. There were both nurses and nursing assistants in their skill mix team. This main finding is that three studies (324,592 participants) show evidence of fewer mortality rates associated with hospitals with a higher percentage of registered nurse staff (range percentage of registered nurse staff 36.1%-100%), but three articles (1,122,270 participants) did not find the same result (range of percentage of registered nurse staff 46%-96%). However, based on appraisal findings, those showing a significant association all meet good quality standards, but only one-third of their counterparts. Conclusions: In light of the limited amount and quality of published research in this review, it is prudent to treat the findings with caution. Although the evidence is not insufficient certainty to draw conclusions about the relationship between nurse staffing level and patients' mortality, this review lights the direction of relevant studies in the future. The limitation of this article is the variation in skill mix models among countries and institutions, making it impossible to do a meta-analysis to compare them further.

Keywords: nurse staffing level, nursing assistants, mortality, skill mix

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Authors: Juan Luis Leal, Rafael Maestre, Ovidio López

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As innovation progresses, more possibilities are made available to increase the efficiency and reach of solutions for Smart Cities, most of which require the data provided by the Internet of Things (IoT) devices and may even have higher power requirements such as motors or actuators. A reliable power supply with the lowest maintenance is a requirement for the success of these solutions in the long term. Energy harvesting, mainly solar, becomes the solution of choice in most cases, but only if there is enough power to be harvested, which may depend on the device location (e.g., outdoors vs. indoor). This is the case of Smart Waste Containers with compaction systems, which have moderately high-power requirements, and may be installed in places with little sunlight for solar generation. It should be noted that waste is unloaded from the containers with cranes, so sudden and irregular movements may happen, making wired power unviable. In these cases, a wireless power supply may be a great alternative. This paper proposes a cost-effective two coil resonant wireless power transfer (WPT) system and describes its implementation, which has been carried out within an R&D project and validated in real settings with smart containers. Experimental results prove that the developed system achieves wireless power transmission up to 35W in the range of 5 cm to 1 m with a peak efficiency of 78%. The circuit is operated at relatively low resonant frequencies, which combined with enough wire-to-wire separation between the coil windings, reduce the losses caused by the proximity effect and, therefore, allow the use of common stranded wire instead of Litz wire, this without reducing the efficiency significantly. All these design considerations led to a final system that achieves a high efficiency for the desired charging range, simplifying the energy supply for Smart Containers as well as other devices that may benefit from a cost-effective wireless charging system.

Keywords: electromagnetic coupling, resonant wireless charging, smart recycling containers, wireless power transfer

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Authors: Júlia Alarcon Pinto, Carlos João Schaffhausser, Gustavo Alarcon Pinto

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Introduction: The deaf people in Brazil communicate through the Brazilian Sign Language (LIBRAS), which is restricted to this minority and people that received training. However, there is a lack of prepared professionals in the health system to deal with these patients. Therefore, effective communication, health education, quality of support and assistance are compromised. It is of utmost importance to develop measures that ensure the inclusion of deaf parents and children since there are frequent doubts about sphincter training and an absence of tools to promote effective communication between doctors and their patients. Objective: Use of an efficient, rapid and cheap communication method to promote social inclusion and patient education of deaf parents and children during pediatrics appointments. Results; The application demonstrates how to express phrases and symptoms within seconds and this allows patients to fully understand the information provided during the appointment and are capable to evaluate the signs of readiness, learn the correct approaches with the child, what are the adequate instruments, possible obstacles and the importance to execute medical orientations in order to achieve success in the process. Consequently, patients feel more satisfied, secured and embraced by professionals in the health system care. Conclusion: It is of utmost importance to use efficient and cheap methods that support patient care and education in order to promote health and social inclusion.

Keywords: application, deaf patients, social inclusion, sphincter training

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Authors: Zatil Afifah Omar, Siti Nur Izati Azmi, Kathi Swaran, Navin Kumar

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Lost circulation has always been one of the greatest problems faced by drilling companies during drilling operations due to excessive drilling Fluids losses. Loss of circulation leads to Huge cost and non-productive time. The objective of this study is to evaluate the sealing efficiency of a proprietary blend of synthetic rubber as loss circulation material in comparison with a conventional product such as calcium carbonate, graphite, cellulosic, and nutshells. Sand Bed Tester with a different proprietary blend of synthetic rubber compositions has been used to determine the effectiveness of the LCM in preventing drilling fluids losses in a lab scale. Test results show the proprietary blend of synthetic rubber have good bridging properties and sealing Off fractures of various sizes. The finish product is environmentally friendly with lower production lead time and lower production cost compared to current conventional loss circulation materials used in current drilling operations.

Keywords: loss circulation materials, drilling operation, sealing efficiency, LCM

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Authors: Mohammad Tofayel Ahmed, Seung Kook An

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In contemporary research world, focus is more set on sustainable products and innovative processes. The global textile industries are putting tremendous effort to achieve a balance between economic development and ecological protection concurrently. The conservation of water sources and environment have become immensely significant issue in textile dyeing production. Accordingly, an attempt has been taken in this study to develop a process to dye polyester blend cotton without reduction clearing process and any extra wash off chemical by simple modification aiming at cost reduction and sustainability. A widely used combination of 60/40 cotton/polyester (c/p) single jersey knitted fabric of 30’s, 180 g/m² was considered for study. Traditionally, pretreatment is done followed by polyester part dyeing, reduction clearing and cotton part dyeing for c/p blend dyeing. But in this study, polyester part is dyed right away followed by pretreatment process and cotton part dyeing by skipping the reduction clearing process diametrically. The dyed samples of both traditional and modified samples were scrutinized by various color fastness tests, dyeing parameters and by consumption of water, steam, power, process time and total batch cost. The modified process in this study showed no necessity of reduction clearing process for polyester blend cotton dyeing. The key issue contributing to avoid the reduction clearing after polyester part dyeing has been the multifunctional effect of NaOH and H₂O₂ while pretreatment of cotton after polyester part dyeing. The results also revealed that the modified process could reduce the consumption of water, steam, power, time and cost remarkably. The bulk trial of modified process demonstrated the well exploitability to dye polyester blend cotton substrate ensuring all fastness and dyeing properties regardless of dyes category, blend ratio, color, and shade percentage thus making the process sustainable, eco-friendly and economical. Furthermore, the proposed method could be applicable to any cellulosic blend with polyester.

Keywords: cotton, dyeing, economical, polyester

Procedia PDF Downloads 166

Authors: Sandra Cecilia Muhirirwe, Bart Van Der Bruggen, Violet Kisakye

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Economic analysis of Rainwater harvesting (RWH) systems is vital in search of a cost-effective solution to water unreliability, especially in low-income countries. There is little literature focusing on the financial aspects of RWH for dairy farmers. The main purpose was to assess the economic viability of rainwater harvesting for diary framers in the Rwenzori region. The study focused on the use of rainwater harvesting systems from the rooftop and collection in above surface tanks. Daily rainfall time series for 12 years was obtained across nine gauging stations. The daily water balance equation was used for optimal sizing of the tank. Economic analysis of the investment was carried out based on the life cycle costs and the accruing benefits for the period of 15 years. Roof areas were varied from 75m2 as the minimum required area to 500m2 while maintaining the same number of cattle and keeping the daily water demand constant. The results show that the required rainwater tank sizes are very large and may be impractical to install due to the strongly varying terrain and the initial cost of investment. In all districts, there is a significant reduction of the volume of the required tank with an increasing collection area. The results further show that increasing the collection area has a minor effect on reducing the required tank size. Generally, for all rainfall areas, the reliability increases with an increase in the roof area. The results indicate that 100% reliability can only be realized with very large collection areas that are impractical to install. The estimated benefits outweigh the cost of investment. The Present Net Value shows that the investment is economically viable and investment with a short payback of a maximum of 3 years for all the time series in the study area.

Keywords: dairy cattle, optimisation, rainwater harvesting, economic analysis

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Authors: Cuong D. Dao, Rob J.I. Basten, Andreas Hartmann

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This paper studies the optimal maintenance planning of preventive maintenance and renewal activities for components in a single railway track when the available time for maintenance is limited. The rail-track system consists of several types of components, such as rail, ballast, and switches with different preventive maintenance and renewal intervals. To perform maintenance or renewal on the track, a train free period for maintenance, called a possession, is required. Since a major possession directly affects the regular train schedule, maintenance and renewal activities are clustered as much as possible. In a highly dense and utilized railway network, the possession time on the track is critical since the demand for train operations is very high and a long possession has a severe impact on the regular train schedule. We present an optimization model and investigate the maintenance schedules with and without the possession capacity constraint. In addition, we also integrate the social-economic cost related to the effects of the maintenance time to the variable possession cost into the optimization model. A numerical example is provided to illustrate the model.

Keywords: rail-track components, maintenance, optimal clustering, possession capacity

Procedia PDF Downloads 243

Authors: Prem K. Mony, Bharadwaj Amrutur, Prashanth Thankachan, Swarnarekha Bhat, Suman Rao, Maryann Washington, Annamma Thomas, N. Sheela, Hiteshwar Rao, Sumi Antony

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The disease burden among mothers and newborns is caused mostly by a handful of avoidable conditions occurring around the time of childbirth and within the first month following delivery. Real-time monitoring of vital parameters of mothers and neonates offers a potential opportunity to impact access as well as the quality of care in vulnerable populations. We describe the design, development and testing of an innovative wearable device for remote biomonitoring (RBM) of body temperatures in mothers and neonates in a hospital in southern India. The architecture consists of: [1] a low-cost, wearable sensor tag; [2] a gateway device for ‘real-time’ communication link; [3] piggy-backing on a commercial GSM communication network; and [4] an algorithm-based data analytics system. Requirements for the device were: long battery-life upto 28 days (with sampling frequency 5/hr); robustness; IP 68 hermetic sealing; and human-centric design. We undertook pre-clinical laboratory testing followed by clinical trial phases I & IIa for evaluation of safety and efficacy in the following sequence: seven healthy adult volunteers; 18 healthy mothers; and three sets of babies – 3 healthy babies; 10 stable babies in the Neonatal Intensive Care Unit (NICU) and 1 baby with hypoxic ischaemic encephalopathy (HIE). The 3-coin thickness, pebble-design sensor weighing about 8 gms was secured onto the abdomen for the baby and over the upper arm for adults. In the laboratory setting, the response-time of the sensor device to attain thermal equilibrium with the surroundings was 4 minutes vis-a-vis 3 minutes observed with a precision-grade digital thermometer used as a reference standard. The accuracy was ±0.1°C of the reference standard within the temperature range of 25-40°C. The adult volunteers, aged 20 to 45 years, contributed a total of 345 hours of readings over a 7-day period and the postnatal mothers provided a total of 403 paired readings. The mean skin temperatures measured in the adults by the sensor were about 2°C lower than the axillary temperature readings (sensor =34.1 vs digital = 36.1); this difference was statistically significant (t-test=13.8; p<0.001). The healthy neonates provided a total of 39 paired readings; the mean difference in temperature was 0.13°C (sensor =36.9 vs digital = 36.7; p=0.2). The neonates in the NICU provided a total of 130 paired readings. Their mean skin temperature measured by the sensor was 0.6°C lower than that measured by the radiant warmer probe (sensor =35.9 vs warmer probe = 36.5; p < 0.001). The neonate with HIE provided a total of 25 paired readings with the mean sensor reading being not different from the radian warmer probe reading (sensor =33.5 vs warmer probe = 33.5; p=0.8). No major adverse events were noted in both the adults and neonates; four adult volunteers reported mild sweating under the device/arm band and one volunteer developed mild skin allergy. This proof-of-concept study shows that real-time monitoring of temperatures is technically feasible and that this innovation appears to be promising in terms of both safety and accuracy (with appropriate calibration) for improved maternal and neonatal health.

Keywords: public health, remote biomonitoring, temperature surveillance, wearable sensors, mothers and newborns

Procedia PDF Downloads 190

Authors: Omar Mayyas

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Clinical decision-making (CDM) is essential to community health nursing (CHN) education. For this reason, nursing educators are responsible for developing these skills among nursing students because nursing students are exposed to highly critical conditions after graduation. However, due to limited exposure to real-world situations, many nursing students need help developing clinical decision-making skills in this area. Therefore, the impact of Virtual Simulation (VS) on community health nursing students' clinical decision-making in nursing education has to be investigated. This study aims to examine the difference in CDM ability among CHN students who received traditional education compared to those who received VS classes, to identify the factors that may influence CDM ability differences between CHN students who received a traditional education and VS classes, and to provide recommendations for educational programs that can enhance the CDM ability of CHN students and improve the quality of care provided in community settings. A mixed-method study will conduct. A randomized controlled trial will compare the CDM ability of CHN students who received 1hr traditional class with another group who received 1hr VS scenario about diabetic patient nursing care. Sixty-four students in each group will randomly select to be exposed to the intervention from undergraduate nursing students who completed the CHN course at York University. The participants will receive the same Clinical Decision Making in Nursing Scale (CDMNS) questionnaire. The study intervention will follow the Medical Research Council (MRC) approach. SPSS and content analysis will use for data analysis.

Keywords: clinical decision-making, virtual simulation, community health nursing students, community health nursing education

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Authors: Peter R. Reuter

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Health professionals play important roles in helping patients use Complementary and Alternative Medicine (CAM) practices safely and accurately. Consequently, it is important for future health professionals to learn about CAM practices during their time in undergraduate and graduate programs. To satisfy this need for education, teaching CAM in nursing and medical schools and other health professions programs is becoming more prevalent. Our study was the first to look specifically at the knowledge of, and attitude toward CAM of undergraduate health professions students at a university in the U.S. Students were invited to participate in one of two anonymous online surveys depending on whether they were pre-health professions students or graduating health professions seniors. Of the 763 responses analyzed, 71.7% were from pre-health professions students, and 28.3% came from graduating seniors. The overall attitude of participants toward and interest in learning about CAM practices was generally fairly positive with graduating seniors being more positive than pre-health professions students. Yoga, meditation, massage therapy, aromatherapy, and chiropractic care were the practices most respondents had personal experience with. Massage therapy, yoga, chiropractic care, meditation, music therapy, and diet-based therapy received the highest ratings from respondents. Three-quarters of respondents planned on including aspects of holistic medicine in their future career as a health professional. The top five practices named were yoga, meditation, massage therapy, diet-based therapy, and music therapy. The study confirms the need to educate health professions students about CAM practices to give them the background information they need to select or recommend the best practices for their patients' needs.

Keywords: CAM education, health professions, health professions students, pre-health professions students

Procedia PDF Downloads 130