Search results for: recovery optimization method
Commenced in January 2007
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Edition: International
Paper Count: 22454

Search results for: recovery optimization method

644 Thinking Lean in ICU: A Time Motion Study Quantifying ICU Nurses’ Multitasking Time Allocation

Authors: Fatma Refaat Ahmed, Sally Mohamed Farghaly

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Context: Intensive care unit (ICU) nurses often face pressure and constraints in their work, leading to the rationing of care when demands exceed available time and resources. Observations suggest that ICU nurses are frequently distracted from their core nursing roles by non-core tasks. This study aims to provide evidence on ICU nurses' multitasking activities and explore the association between nurses' personal and clinical characteristics and their time allocation. Research Aim: The aim of this study is to quantify the time spent by ICU nurses on multitasking activities and investigate the relationship between their personal and clinical characteristics and time allocation. Methodology: A self-observation form utilizing the "Diary" recording method was used to record the number of tasks performed by ICU nurses and the time allocated to each task category. Nurses also reported on the distractions encountered during their nursing activities. A convenience sample of 60 ICU nurses participated in the study, with each nurse observed for one nursing shift (6 hours), amounting to a total of 360 hours. The study was conducted in two ICUs within a university teaching hospital in Alexandria, Egypt. Findings: The results showed that ICU nurses completed 2,730 direct patient-related tasks and 1,037 indirect tasks during the 360-hour observation period. Nurses spent an average of 33.65 minutes on ventilator care-related tasks, 14.88 minutes on tube care-related tasks, and 10.77 minutes on inpatient care-related tasks. Additionally, nurses spent an average of 17.70 minutes on indirect care tasks per hour. The study identified correlations between nursing time and nurses' personal and clinical characteristics. Theoretical Importance: This study contributes to the existing research on ICU nurses' multitasking activities and their relationship with personal and clinical characteristics. The findings shed light on the significant time spent by ICU nurses on direct care for mechanically ventilated patients and the distractions that require attention from ICU managers. Data Collection: Data were collected using self-observation forms completed by participating ICU nurses. The forms recorded the number of tasks performed, the time allocated to each task category, and any distractions encountered during nursing activities. Analysis Procedures: The collected data were analyzed to quantify the time spent on different tasks by ICU nurses. Correlations were also examined between nursing time and nurses' personal and clinical characteristics. Question Addressed: This study addressed the question of how ICU nurses allocate their time across multitasking activities and whether there is an association between nurses' personal and clinical characteristics and time allocation. Conclusion: The findings of this study emphasize the need for a lean evaluation of ICU nurses' activities to identify and address potential gaps in patient care and distractions. Implementing lean techniques can improve efficiency, safety, clinical outcomes, and satisfaction for both patients and nurses, ultimately enhancing the quality of care and organizational performance in the ICU setting.

Keywords: motion study, ICU nurse, lean, nursing time, multitasking activities

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643 Edge Enhancement Visual Methodology for Fat Amount and Distribution Assessment in Dry-Cured Ham Slices

Authors: Silvia Grassi, Stefano Schiavon, Ernestina Casiraghi, Cristina Alamprese

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Dry-cured ham is an uncooked meat product particularly appreciated for its peculiar sensory traits among which lipid component plays a key role in defining quality and, consequently, consumers’ acceptability. Usually, fat content and distribution are chemically determined by expensive, time-consuming, and destructive analyses. Moreover, different sensory techniques are applied to assess product conformity to desired standards. In this context, visual systems are getting a foothold in the meat market envisioning more reliable and time-saving assessment of food quality traits. The present work aims at developing a simple but systematic and objective visual methodology to assess the fat amount of dry-cured ham slices, in terms of total, intermuscular and intramuscular fractions. To the aim, 160 slices from 80 PDO dry-cured hams were evaluated by digital image analysis and Soxhlet extraction. RGB images were captured by a flatbed scanner, converted in grey-scale images, and segmented based on intensity histograms as well as on a multi-stage algorithm aimed at edge enhancement. The latter was performed applying the Canny algorithm, which consists of image noise reduction, calculation of the intensity gradient for each image, spurious response removal, actual thresholding on corrected images, and confirmation of strong edge boundaries. The approach allowed for the automatic calculation of total, intermuscular and intramuscular fat fractions as percentages of the total slice area. Linear regression models were run to estimate the relationships between the image analysis results and the chemical data, thus allowing for the prediction of the total, intermuscular and intramuscular fat content by the dry-cured ham images. The goodness of fit of the obtained models was confirmed in terms of coefficient of determination (R²), hypothesis testing and pattern of residuals. Good regression models have been found being 0.73, 0.82, and 0.73 the R2 values for the total fat, the sum of intermuscular and intramuscular fat and the intermuscular fraction, respectively. In conclusion, the edge enhancement visual procedure brought to a good fat segmentation making the simple visual approach for the quantification of the different fat fractions in dry-cured ham slices sufficiently simple, accurate and precise. The presented image analysis approach steers towards the development of instruments that can overcome destructive, tedious and time-consuming chemical determinations. As future perspectives, the results of the proposed image analysis methodology will be compared with those of sensory tests in order to develop a fast grading method of dry-cured hams based on fat distribution. Therefore, the system will be able not only to predict the actual fat content but it will also reflect the visual appearance of samples as perceived by consumers.

Keywords: dry-cured ham, edge detection algorithm, fat content, image analysis

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642 Trends in Conservation and Inheritance of Musical Culture of Ethnic Groups: A Case Study of the Akha Music in Chiang Rai Province, Thailand

Authors: Nutthan Inkhong, Sutthiphong Ruangchante

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Chiang Rai province is located at the northern border of Thailand. Most of the geography there is the northern continental highlands, and the population has many types of inhabitants, including Thai people, immigrants and ethnic groups such as Akha, Lahu, Lisu, Yao, etc. Most of these ethnic groups migrated from neighbouring countries such as Myanmar, Laos, China, etc. and settled in the mountains. Each ethnic group has their unique traditions, culture, and ways of life, including the musical culture that the ancestors of each ethnic group brought with them. In the present, the Akha have the largest population in the region and still live together in numerous villages in many districts. Thus, Akha musical culture still appears in the community traditions and cultural events of Chiang Rai province regularly. This article presents the situations of Akha musical culture in the present and the predictions for the future. The study method involves the analysis of music information and the related social contexts, which were collected from the fieldwork of ethnomusicological methodology by in-depth interviews, observations, audio and visual recordings, and related documents. The results found that the important persons who are related with Akha musical culture include (1) a musical instrument maker (lives in Mae Chan district) who produces various Akha musical instruments, including gourd mouth organs, Akha drums, two-way flutes, three-hole flutes, Jew’s harps (the sound of teenage love), buffalo horns (the sound symbol of hunting) and bird call instruments (the imitation of bird sounds), (2) a folk philosopher (lives in Mae Pha Luang district) who can teach music to the new generation of Akha people as well as lecture and demonstrate music to academics and tourists, and (3) a community leader (lives in Mae Chan district) who conserves Akha performances, singing and music through various activities of the students in an informal school. Because of the changes to the social contexts and ways of life of the Akha people, such as the educational system, religion, social media, etc., including the popularity of both Thai and international popular music among the new generation of Akha people, changes to and the fading away of Akha musical culture in the future may likely occur. Therefore, the conservation and inheritance of Akha music is an issue that should be resolved quickly. This primary study leads to the next step of the ethnomusicological work and plays a part in preventing or reducing the problems impacting Akha musical culture survival by the recording of Akha music in all of its dimensions, such as producing musical instruments, playing musical instruments, analysis of tuning systems, recording Akha music as musical notation using symbols, researching related social contexts, etc. and the transcription of this information to create lessons that can be returned to the Akha community.

Keywords: Akha music, Chiang Rai, ethnic music in Thailand, ethnomusicology

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641 Servant Leadership and Organisational Climate in South African Private Schools: A Qualitative Study

Authors: Christo Swart, Lidia Pottas, David Maree

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Background: It is a sine qua non that the South African educational system finds itself in a profound crisis and that traditional school leadership styles are outdated and hinder quality education. New thinking is mandatory to improve the status quo and school leadership has an immense role to play to improve the current situation. It is believed that the servant leadership paradigm, when practiced by school leadership, may have a significant influence on the school environment in totality. This study investigates the private school segment in search of constructive answers to assist with the educational crises in South Africa. It is assumed that where school leadership can augment a supportive and empowering environment for teachers to constructively engage in their teaching and learning activities - then many challenges facing by school system may be subjugated in a productive manner. Aim: The aim of this study is fourfold. To outline the constructs of servant leadership which are perceived by teachers of private schools as priorities to enhance a successful school environment. To describe the constructs of organizational climate which are observed by teachers of private schools as priorities to enhance a successful school environment. To investigate whether the participants perceived a link between the constructs of servant leadership and organizational climate. To consider the process to be followed to introduce the constructs of SL and OC the school system in general as perceived by participants. Method: This study utilized a qualitative approach to explore the mediation between school leadership and the organizational climate in private schools in the search for amicable answers. The participants were purposefully selected for the study. Focus group interviews were held with participants from primary and secondary schools and a focus group discussion was conducted with principals of both primary and secondary schools. The interview data were transcribed and analyzed and identical patterns of coded data were grouped together under emerging themes. Findings: It was found that the practice of servant leadership by school leadership indeed mediates a constructive and positive school climate. It was found that the constructs of empowerment, accountability, humility and courage – interlinking with one other - are prominent of servant leadership concepts that are perceived by teachers of private schools as priorities for school leadership to enhance a successful school environment. It was confirmed that the groupings of training and development, communication, trust and work environment are perceived by teachers of private schools as prominent features of organizational climate as practiced by school leadership to augment a successful school environment. It can be concluded that the participants perceived several links between the constructs of servant leadership and organizational climate that encourage a constructive school environment and that there is a definite positive consideration and motivation that the two concepts be introduced to the school system in general. It is recommended that school leadership mentors and guides teachers to take ownership of the constructs of servant leadership as well as organizational climate and that public schools be researched and consider to implement the two paradigms. The study suggests that aspirant teachers be exposed to leadership as well as organizational paradigms during their studies at university.

Keywords: empowering environment for teachers and learners, new thinking required, organizational climate, school leadership, servant leadership

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640 Enhanced Physiological Response of Blood Pressure and Improved Performance in Successive Divided Attention Test Seen with Classical Instrumental Background Music Compared to Controls

Authors: Shantala Herlekar

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Introduction: Entrainment effect of music on cardiovascular parameters is well established. Music is being used in the background by medical students while studying. However, does it really help them relax faster and concentrate better? Objectives: This study was done to compare the effects of classical instrumental background music versus no music on blood pressure response over time and on successively performed divided attention test in Indian and Malaysian 1st-year medical students. Method: 60 Indian and 60 Malaysian first year medical students, with an equal number of girls and boys were randomized into two groups i.e music group and control group thus creating four subgroups. Three different forms of Symbol Digit Modality Test (to test concentration ability) were used as a pre-test, during music/control session and post-test. It was assessed using total, correct and error score. Simultaneously, multiple Blood Pressure recordings were taken as pre-test, during 1, 5, 15, 25 minutes during music/control (+SDMT) and post-test. The music group performed the test with classical instrumental background music while the control group performed it in silence. Results were analyzed using students paired t test. p value < 0.05 was taken as statistically significant. A drop in BP recording was indicative of relaxed state and a rise in BP with task performance was indicative of increased arousal. Results: In Symbol Digit Modality Test (SDMT) test, Music group showed significant better results for correct (p = 0.02) and total (p = 0.029) scores during post-test while errors reduced (p = 0.002). Indian music group showed decline in post-test error scores (p = 0.002). Malaysian music group performed significantly better in all categories. Blood pressure response was similar in music and control group with following variations, a drop in BP at 5minutes, being significant in music group (p < 0.001), a steep rise in values till 15minutes (corresponding to SDMT test) also being significant only in music group (p < 0.001) and the Systolic BP readings in controls during post-test were at lower levels compared to music group. On comparing the subgroups, not much difference was noticed in recordings of Indian student’s subgroups while all the paired-t test values in the Malaysian music group were significant. Conclusion: These recordings indicate an increased relaxed state with classical instrumental music and an increased arousal while performing a concentration task. Music used in our study was beneficial to students irrespective of their nationality and preference of music type. It can act as an “active coping” strategy and alleviate stress within a very short period of time, in our study within a span of 5minutes. When used in the background, during task performance, can increase arousal which helps the students perform better. Implications: Music can be used between lectures for a short time to relax the students and help them concentrate better for the subsequent classes, especially for late afternoon sessions.

Keywords: blood pressure, classical instrumental background music, ethnicity, symbol digit modality test

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639 Lake Water Surface Variations and Its Influencing Factors in Tibetan Plateau in Recent 10 Years

Authors: Shanlong Lu, Jiming Jin, Xiaochun Wang

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The Tibetan Plateau has the largest number of inland lakes with the highest elevation on the planet. These massive and large lakes are mostly in natural state and are less affected by human activities. Their shrinking or expansion can truly reflect regional climate and environmental changes and are sensitive indicators of global climate change. However, due to the sparsely populated nature of the plateau and the poor natural conditions, it is difficult to effectively obtain the change data of the lake, which has affected people's understanding of the temporal and spatial processes of lake water changes and their influencing factors. By using the MODIS (Moderate Resolution Imaging Spectroradiometer) MOD09Q1 surface reflectance images as basic data, this study produced the 8-day lake water surface data set of the Tibetan Plateau from 2000 to 2012 at 250 m spatial resolution, with a lake water surface extraction method of combined with lake water surface boundary buffer analyzing and lake by lake segmentation threshold determining. Then based on the dataset, the lake water surface variations and their influencing factors were analyzed, by using 4 typical natural geographical zones of Eastern Qinghai and Qilian, Southern Qinghai, Qiangtang, and Southern Tibet, and the watersheds of the top 10 lakes of Qinghai, Siling Co, Namco, Zhari NamCo, Tangra Yumco, Ngoring, UlanUla, Yamdrok Tso, Har and Gyaring as the analysis units. The accuracy analysis indicate that compared with water surface data of the 134 sample lakes extracted from the 30 m Landsat TM (Thematic Mapper ) images, the average overall accuracy of the lake water surface data set is 91.81% with average commission and omission error of 3.26% and 5.38%; the results also show strong linear (R2=0.9991) correlation with the global MODIS water mask dataset with overall accuracy of 86.30%; and the lake area difference between the Second National Lake Survey and this study is only 4.74%, respectively. This study provides reliable dataset for the lake change research of the plateau in the recent decade. The change trends and influencing factors analysis indicate that the total water surface area of lakes in the plateau showed overall increases, but only lakes with areas larger than 10 km2 had statistically significant increases. Furthermore, lakes with area larger than 100 km2 experienced an abrupt change in 2005. In addition, the annual average precipitation of Southern Tibet and Southern Qinghai experienced significant increasing and decreasing trends, and corresponding abrupt changes in 2004 and 2006, respectively. The annual average temperature of Southern Tibet and Qiangtang showed a significant increasing trend with an abrupt change in 2004. The major reason for the lake water surface variation in Eastern Qinghai and Qilian, Southern Qinghai and Southern Tibet is the changes of precipitation, and that for Qiangtang is the temperature variations.

Keywords: lake water surface variation, MODIS MOD09Q1, remote sensing, Tibetan Plateau

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638 India’s Energy Transition, Pathways for Green Economy

Authors: B. Sudhakara Reddy

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In modern economy, energy is fundamental to virtually every product and service in use. It has been developed on the dependence of abundant and easy-to-transform polluting fossil fuels. On one hand, increase in population and income levels combined with increased per capita energy consumption requires energy production to keep pace with economic growth, and on the other, the impact of fossil fuel use on environmental degradation is enormous. The conflicting policy objectives of protecting the environment while increasing economic growth and employment has resulted in this paradox. Hence, it is important to decouple economic growth from environmental degeneration. Hence, the search for green energy involving affordable, low-carbon, and renewable energies has become global priority. This paper explores a transition to a sustainable energy system using the socio-economic-technical scenario method. This approach takes into account the multifaceted nature of transitions which not only require the development and use of new technologies, but also of changes in user behaviour, policy and regulation. The scenarios that are developed are: baseline business as usual (BAU) as well as green energy (GE). The baseline scenario assumes that the current trends (energy use, efficiency levels, etc.) will continue in future. India’s population is projected to grow by 23% during 2010 –2030, reaching 1.47 billion. The real GDP, as per the model, is projected to grow by 6.5% per year on average between 2010 and 2030 reaching US$5.1 trillion or $3,586 per capita (base year 2010). Due to increase in population and GDP, the primary energy demand will double in two decades reaching 1,397 MTOE in 2030 with the share of fossil fuels remaining around 80%. The increase in energy use corresponds to an increase in energy intensity (TOE/US $ of GDP) from 0.019 to 0.036. The carbon emissions are projected to increase by 2.5 times from 2010 reaching 3,440 million tonnes with per capita emissions of 2.2 tons/annum. However, the carbon intensity (tons per US$ of GDP) decreases from 0.96 to 0.67. As per GE scenario, energy use will reach 1079 MTOE by 2030, a saving of about 30% over BAU. The penetration rate of renewable energy resources will reduce the total primary energy demand by 23% under GE. The reduction in fossil fuel demand and focus on clean energy will reduce the energy intensity to 0.21 (TOE/US$ of GDP) and carbon intensity to 0.42 (ton/US$ of GDP) under the GE scenario. The study develops new ‘pathways out of poverty’ by creating more than 10 million jobs and thus raise the standard of living of low-income people. Our scenarios are, to a great extent, based on the existing technologies. The challenges to this path lie in socio-economic-political domains. However, to attain a green economy the appropriate policy package should be in place which will be critical in determining the kind of investments that will be needed and the incidence of costs and benefits. These results provide a basis for policy discussions on investments, policies and incentives to be put in place by national and local governments.

Keywords: energy, renewables, green technology, scenario

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637 The Touch Sensation: Ageing and Gender Influences

Authors: A. Abdouni, C. Thieulin, M. Djaghloul, R. Vargiolu, H. Zahouani

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A decline in the main sensory modalities (vision, hearing, taste, and smell) is well reported to occur with advancing age, it is expected a similar change to occur with touch sensation and perception. In this study, we have focused on the touch sensations highlighting ageing and gender influences with in vivo systems. The touch process can be divided into two main phases: The first phase is the first contact between the finger and the object, during this contact, an adhesive force has been created which is the needed force to permit an initial movement of the finger. In the second phase, the finger mechanical properties with their surface topography play an important role in the obtained sensation. In order to understand the age and gender effects on the touch sense, we develop different ideas and systems for each phase. To better characterize the contact, the mechanical properties and the surface topography of human finger, in vivo studies on the pulp of 40 subjects (20 of each gender) of four age groups of 26±3, 35+-3, 45+-2 and 58±6 have been performed. To understand the first touch phase a classical indentation system has been adapted to measure the finger contact properties. The normal force load, the indentation speed, the contact time, the penetration depth and the indenter geometry have been optimized. The penetration depth of a glass indenter is recorded as a function of the applied normal force. Main assessed parameter is the adhesive force F_ad. For the second phase, first, an innovative approach is proposed to characterize the dynamic finger mechanical properties. A contactless indentation test inspired from the techniques used in ophthalmology has been used. The test principle is to blow an air blast to the finger and measure the caused deformation by a linear laser. The advantage of this test is the real observation of the skin free return without any outside influence. Main obtained parameters are the wave propagation speed and the Young's modulus E. Second, negative silicon replicas of subject’s fingerprint have been analyzed by a probe laser defocusing. A laser diode transmits a light beam on the surface to be measured, and the reflected signal is returned to a set of four photodiodes. This technology allows reconstructing three-dimensional images. In order to study the age and gender effects on the roughness properties, a multi-scale characterization of roughness has been realized by applying continuous wavelet transform. After determining the decomposition of the surface, the method consists of quantifying the arithmetic mean of surface topographic at each scale SMA. Significant differences of the main parameters are shown with ageing and gender. The comparison between men and women groups reveals that the adhesive force is higher for women. The results of mechanical properties show a Young’s modulus higher for women and also increasing with age. The roughness analysis shows a significant difference in function of age and gender.

Keywords: ageing, finger, gender, touch

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636 [Keynote Talk]: New Generations and Employment: An Exploratory Study about Tensions between the Psycho-Social Characteristics of the Generation Z and Expectations and Actions of Organizational Structures Related with Employment (CABA, 2016)

Authors: Esteban Maioli

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Generational studies have an important research tradition in social and human sciences. On the one hand, the speed of social change in the context of globalization imposes the need to research the transformations are identified both the subjectivity of the agents involved and its inclusion in the institutional matrix, specifically employment. Generation Z, (generally considered as the population group whose birth occurs after 1995) have unique psycho-social characteristics. Gen Z is characterized by a different set of values, beliefs, attitudes and ambitions that impact in their concrete action in organizational structures. On the other hand, managers often have to deal with generational differences in the workplace. Organizations have members who belong to different generations; they had never before faced the challenge of having such a diverse group of members. The members of each historical generation are characterized by a different set of values, beliefs, attitudes and ambitions that are manifest in their concrete action in organizational structures. Gen Z it’s the only one who can fully be considered "global," while its members were born in the consolidated context of globalization. Some salient features of the Generation Z can be summarized as follows. They’re the first fully born into a digital world. Social networks and technology are integrated into their lives. They are concerned about the challenges of the modern world (poverty, inequality, climate change, among others). They are self-expressive, more liberal and open to change. They often bore easily, with short attention spans. They do not like routine tasks. They want to achieve a good life-work balance, and they are interested in a flexible work environment, as opposed to traditional work schedule. They are critical thinkers, who come with innovative and creative ideas to help. Research design considered methodological triangulation. Data was collected with two techniques: a self-administered survey with multiple choice questions and attitudinal scales applied over a non-probabilistic sample by reasoned decision. According to the multi-method strategy, also it was conducted in-depth interviews. Organizations constantly face new challenges. One of the biggest ones is to learn to manage a multi-generational scope of work. While Gen Z has not yet been fully incorporated (expected to do so in five years or so), many organizations have already begun to implement a series of changes in its recruitment and development. The main obstacle to retaining young talent is the gap between the expectations of iGen applicants and what companies offer. Members of the iGen expect not only a good salary and job stability but also a clear career plan. Generation Z needs to have immediate feedback on their tasks. However, many organizations have yet to improve both motivation and monitoring practices. It is essential for companies to take a review of organizational practices anchored in the culture of the organization.

Keywords: employment, expectations, generation Z, organizational culture, organizations, psycho-social characteristics

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635 Procedure for Monitoring the Process of Behavior of Thermal Cracking in Concrete Gravity Dams: A Case Study

Authors: Adriana de Paula Lacerda Santos, Bruna Godke, Mauro Lacerda Santos Filho

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Several dams in the world have already collapsed, causing environmental, social and economic damage. The concern to avoid future disasters has stimulated the creation of a great number of laws and rules in many countries. In Brazil, Law 12.334/2010 was created, which establishes the National Policy on Dam Safety. Overall, this policy requires the dam owners to invest in the maintenance of their structures and to improve its monitoring systems in order to provide faster and straightforward responses in the case of an increase of risks. As monitoring tools, visual inspections has provides comprehensive assessment of the structures performance, while auscultation’s instrumentation has added specific information on operational or behavioral changes, providing an alarm when a performance indicator exceeds the acceptable limits. These limits can be set using statistical methods based on the relationship between instruments measures and other variables, such as reservoir level, time of the year or others instruments measuring. Besides the design parameters (uplift of the foundation, displacements, etc.) the dam instrumentation can also be used to monitor the behavior of defects and damage manifestations. Specifically in concrete gravity dams, one of the main causes for the appearance of cracks, are the concrete volumetric changes generated by the thermal origin phenomena, which are associated with the construction process of these structures. Based on this, the goal of this research is to propose a monitoring process of the thermal cracking behavior in concrete gravity dams, through the instrumentation data analysis and the establishment of control values. Therefore, as a case study was selected the Block B-11 of José Richa Governor Dam Power Plant, that presents a cracking process, which was identified even before filling the reservoir in August’ 1998, and where crack meters and surface thermometers were installed for its monitoring. Although these instruments were installed in May 2004, the research was restricted to study the last 4.5 years (June 2010 to November 2014), when all the instruments were calibrated and producing reliable data. The adopted method is based on simple linear correlations procedures to understand the interactions among the instruments time series, verifying the response times between them. The scatter plots were drafted from the best correlations, which supported the definition of the limit control values. Among the conclusions, it is shown that there is a strong or very strong correlation between ambient temperature and the crack meters and flowmeters measurements. Based on the results of the statistical analysis, it was possible to develop a tool for monitoring the behavior of the case study cracks. Thus it was fulfilled the goal of the research to develop a proposal for a monitoring process of the behavior of thermal cracking in concrete gravity dams.

Keywords: concrete gravity dam, dams safety, instrumentation, simple linear correlation

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634 Cardiac Rehabilitation Program and Health-Related Quality of Life; A Randomized Control Trial

Authors: Zia Ul Haq, Saleem Muhammad, Naeem Ullah, Abbas Shah, Abdullah Shah

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Pakistan being the developing country is facing double burden of communicable and non-communicable disease. The aspect of secondary prevention of ischemic heart disease in developing countries is the dire need for public health specialists, clinicians and policy makers. There is some evidence that psychotherapeutic measures, including psychotherapy, recreation, exercise and stress management training have positive impact on secondary prevention of cardiovascular diseases but there are some contradictory findings as well. Cardiac rehabilitation program (CRP) has not yet fully implemented in Pakistan. Psychological, physical and specific health-related quality of life (HRQoL) outcomes needs assessment with respect to its practicality, effectiveness, and success. Objectives: To determine the effect of cardiac rehabilitation program (CRP) on the health-related quality of life (HRQoL) measures of post MI patients compared to the usual care. Hypothesis: Post MI patients who receive the interventions (CRP) will have better HRQoL as compared to those who receive the usual cares. Methods: The randomized control trial was conducted at a Cardiac Rehabilitation Unit of Lady Reading Hospital (LRH), Peshawar. LRH is the biggest hospital of the Province Khyber Pakhtunkhwa (KP). A total 206 participants who had recent first myocardial infarction were inducted in the study. Participants were randomly allocated into two group i.e. usual care group (UCG) and cardiac rehabilitation group (CRG) by permuted-block randomization (PBR) method. CRP was conducted in CRG in two phases. Three HRQoL outcomes i.e. general health questionnaire (GHQ), self-rated health (SRH) and MacNew quality of life after myocardial infarction (MacNew QLMI) were assessed at baseline and follow-up visits among both groups. Data were entered and analyzed by appropriate statistical test in STATA version 12. Results: A total of 195 participants were assessed at the follow-up period due to lost-to-follow-up. The mean age of the participants was 53.66 + 8.3 years. Males were dominant in both groups i.e. 150 (76.92%). Regarding educational status, majority of the participants were illiterate in both groups i.e. 128 (65.64%). Surprisingly, there were 139 (71.28%) who were non-smoker on the whole. The comorbid status was positive in 120 (61.54%) among all the patients. The SRH at follow-up among UCG and CRG was 4.06 (95% CI: 3.93, 4.19) and 2.36 (95% CI: 2.2, 2.52) respectively (p<0.001). GHQ at the follow-up of UCG and CRG was 20.91 (95% CI: 18.83, 21.97) and 7.43 (95% CI: 6.59, 8.27) respectively (p<0.001). The MacNew QLMI at follow-up of UCG and CRG was 3.82 (95% CI: 3.7, 3.94) and 5.62 (95% CI: 5.5, 5.74) respectively (p<0.001). All the HRQoL measures showed strongly significant improvement in the CRG at follow-up period. Conclusion: HRQOL improved in post MI patients after comprehensive CRP. Education of the patients and their supervision is needed when they are involved in their rehabilitation activities. It is concluded that establishing CRP in cardiac units, recruiting post-discharged MI patients and offering them CRP does not impose high costs and can result in significant improvement in HRQoL measures. Trial registration no: ACTRN12617000832370

Keywords: cardiovascular diseases, cardiac rehabilitation, health-related quality of life, HRQoL, myocardial infarction, quality of life, QoL, rehabilitation, randomized control trial

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633 Harnessing Sunlight for Clean Water: Scalable Approach for Silver-Loaded Titanium Dioxide Nanoparticles

Authors: Satam Alotibi, Muhammad J. Al-Zahrani, Fahd K. Al-Naqidan, Turki S. Hussein, Moteb Alotaibi, Mohammed Alyami, Mahdy M. Elmahdy, Abdellah Kaiba, Fatehia S. Alhakami, Talal F. Qahtan

Abstract:

Water pollution is a critical global challenge that demands scalable and effective solutions for water decontamination. In this captivating research, we unveil a groundbreaking strategy for harnessing solar energy to synthesize silver (Ag) clusters on stable titanium dioxide (TiO₂) nanoparticles dispersed in water, without the need for traditional stabilization agents. These Ag-loaded TiO₂ nanoparticles exhibit exceptional photocatalytic activity, surpassing that of pristine TiO₂ nanoparticles, offering a promising solution for highly efficient water decontamination under sunlight irradiation. To the best knowledge, we have developed a unique method to stabilize TiO₂ P25 nanoparticles in water without the use of stabilization agents. This breakthrough allows us to create an ideal platform for the solar-driven synthesis of Ag clusters. Under sunlight irradiation, the stable dispersion of TiO₂ P25 nanoparticles acts as a highly efficient photocatalyst, generating electron-hole pairs. The photogenerated electrons effectively reduce silver ions derived from a silver precursor, resulting in the formation of Ag clusters. The Ag clusters loaded on TiO₂ P25 nanoparticles exhibit remarkable photocatalytic activity for water decontamination under sunlight irradiation. Acting as active sites, these Ag clusters facilitate the generation of reactive oxygen species (ROS) upon exposure to sunlight. These ROS play a pivotal role in rapidly degrading organic pollutants, enabling efficient water decontamination. To confirm the success of our approach, we characterized the synthesized Ag-loaded TiO₂ P25 nanoparticles using cutting-edge analytical techniques, such as transmission electron microscopy (TEM), scanning electron microscopy (SEM), X-ray diffraction (XRD), and spectroscopic methods. These characterizations unequivocally confirm the successful synthesis of Ag clusters on stable TiO₂ P25 nanoparticles without traditional stabilization agents. Comparative studies were conducted to evaluate the superior photocatalytic performance of Ag-loaded TiO₂ P25 nanoparticles compared to pristine TiO₂ P25 nanoparticles. The Ag clusters loaded on TiO₂ P25 nanoparticles exhibit significantly enhanced photocatalytic activity, benefiting from the synergistic effect between the Ag clusters and TiO₂ nanoparticles, which promotes ROS generation for efficient water decontamination. Our scalable strategy for synthesizing Ag clusters on stable TiO₂ P25 nanoparticles without stabilization agents presents a game-changing solution for highly efficient water decontamination under sunlight irradiation. The use of commercially available TiO₂ P25 nanoparticles streamlines the synthesis process and enables practical scalability. The outstanding photocatalytic performance of Ag-loaded TiO₂ P25 nanoparticles opens up new avenues for their application in large-scale water treatment and remediation processes, addressing the urgent need for sustainable water decontamination solutions.

Keywords: water pollution, solar energy, silver clusters, TiO₂ nanoparticles, photocatalytic activity

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632 Starting the Hospitalization Procedure with a Medicine Combination in the Cardiovascular Department of the Imam Reza (AS) Mashhad Hospital

Authors: Maryamsadat Habibi

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Objective: pharmaceutical errors are avoidable occurrences that can result in inappropriate pharmaceutical use, patient harm, treatment failure, increased hospital costs and length of stay, and other outcomes that affect both the individual receiving treatment and the healthcare provider. This study aimed to perform a reconciliation of medications in the cardiovascular ward of Imam Reza Hospital in Mashhad, Iran, and evaluate the prevalence of medication discrepancies between the best medication list created for the patient by the pharmacist and the medication order of the treating physician there. Materials & Methods: The 97 patients in the cardiovascular ward of the Imam Reza Hospital in Mashhad were the subject of a cross-sectional study from June to September of 2021. After giving their informed consent and being admitted to the ward, all patients with at least one underlying condition and at least two medications being taken at home were included in the study. A medical reconciliation form was used to record patient demographics and medical histories during the first 24 hours of admission, and the information was contrasted with the doctors' orders. The doctor then discovered medication inconsistencies between the two lists and double-checked them to separate the intentional from the accidental anomalies. Finally, using SPSS software version 22, it was determined how common medical discrepancies are and how different sorts of discrepancies relate to various variables. Results: The average age of the participants in this study was 57.6915.84 years, with 57.7% of men and 42.3% of women. 95.9% of the patients among these people encountered at least one medication discrepancy, and 58.9% of them suffered at least one unintentional drug cessation. Out of the 659 medications registered in the study, 399 cases (60.54%) had inconsistencies, of which 161 cases (40.35%) involved the intentional stopping of a medication, 123 cases (30.82%) involved the stopping of a medication unintentionally, and 115 cases (28.82%) involved the continued use of a medication by adjusting the dose. Additionally, the category of cardiovascular pharmaceuticals and the category of gastrointestinal medications were found to have the highest medical inconsistencies in the current study. Furthermore, there was no correlation between the frequency of medical discrepancies and the following variables: age, ward, date of visit, type, and number of underlying diseases (P=0.13), P=0.61, P=0.72, P=0.82, P=0.44, and so forth. On the other hand, there was a statistically significant correlation between the number of medications taken at home (P=0.037) and the prevalence of medical discrepancies with gender (P=0.029). The results of this study revealed that 96% of patients admitted to the cardiovascular unit at Imam Reza Hospital had at least one medication error, which was typically an intentional drug discontinuance. According to the study's findings, patients admitted to Imam Reza Hospital's cardiovascular ward have a great potential for identifying and correcting various medication discrepancies as well as for avoiding prescription errors when the medication reconciliation method is used. As a result, it is essential to carry out a precise assessment to achieve the best treatment outcomes and avoid unintended medication discontinuation, unwanted drug-related events, and drug interactions between the patient's home medications and those prescribed in the hospital.

Keywords: drug combination, drug side effects, drug incompatibility, cardiovascular department

Procedia PDF Downloads 92
631 Killing for the Great Peace: An Internal Perspective on the Anti-Manchu Theme in the Taiping Movement

Authors: Zihao He

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The majority of existing studies on the Taiping Movement (1851-1864) viewed their anti-Manchu attitudes as nationalist agendas: Taiping was aimed at revolting against the Manchu government and establishing a new political regime. To explain these aggressive and violent attitudes towards Manchu, these studies mainly found socio-economic factors and stressed the status of “being deprived”. Even the ‘demon-slaying’ narrative of the Taiping to dehumanize the Manchu tends to be viewed as a “religious tool” to achieve their political, nationalist aim. This paper argues that these studies on Taiping’s anti-Manchu attitudes and behaviors are analyzed from an external angle and have two major problems. Firstly, they distinguished “religion” from “nationalist” or “political”, focusing on the “political” nature of the movement. “Religion” and the religious experience within Taiping were largely ignored. This paper argues that there was no separable and independent “religion” in the Taiping Movement, as opposed to secular, nationalist politics. Secondly, these analyses held an external perspective on Taiping’s anti-Manchu agenda. Demonizing and killing Manchu were viewed as purely political actions. On the contrary, this paper focuses on the internal perspective of anti-Manchu narratives in the Taiping Movement. The method of this paper is mainly textual analysis, focusing on the official documents, edicts, and proclamations of the Taiping movement. It views the writing of the Taiping as a coherent narrative and rhetoric, which was attractive and convincing for its followers. In terms of the main findings, firstly, internal and external perspectives on anti-Manchu violence are different. Externally, violence was viewed as a tool and necessary process to achieve the political goal. However, internally speaking, in Taiping’s writing, violence was a result of Godlessness, which would be solved as far as the faith in God is restored in China. Having a framework of universal love among human beings as sons and daughters of the Heavenly Father and killing was forbidden, the Taiping excluded Manchus from the family of human beings and demonized them. “Demon-slaying” was not violence. It was constructed as a necessary process to achieve the Great Peace. Moreover, Taiping’s anti-Manchu violence was not merely “political.” Rather, the category “religion” and its binary opposition, “secular,” is not suitable for Taiping. A key point related to this argument is the revolutionary violence against the Manchu government, which inherited the traditional “Heavenly Mandate” model. From an internal, theological perspective, anti-Manchu was ordained and commanded by the Heavenly Father. Manchu, as a regime, was standing as a hindrance in the path toward God. Besides, Manchu was not only viewed as a regime, but they were also “demons.” Therefore, the paper examines how Manchus were dehumanized in Taiping’s writings and were situated outside of the consideration of nonviolent and love. Manchu as a regime and Manchu as demons are in a dynamic relationship. As a regime, the Manchu government was preventing Chinese people from worshipping the Heavenly Father, so they were demonized. As they were demons, killing Manchus during the revolt was justified and not viewed as being contradicted the universal love among human beings.

Keywords: anti-manchu, demon-slaying, heavenly mandate, religion and violence, the taiping movement.

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630 Patterns and Predictors of Intended Service Use among Frail Older Adults in Urban China

Authors: Yuanyuan Fu

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Background and Purpose: Along with the change of society and economy, the traditional home function of old people has gradually weakened in the contemporary China. Acknowledging these situations, to better meet old people’s needs on formal services and improve the quality of later life, this study seeks to identify patterns of intended service use among frail old people living in the communities and examined determinants that explain heterogeneous variations in old people’s intended service use patterns. Additionally, this study also tested the relationship between culture value and intended service use patterns and the mediating role of enabling factors in terms of culture value and intended service use patterns. Methods:Participants were recruited from Haidian District, Beijing, China in 2015. The multi-stage sampling method was adopted to select sub-districts, communities and old people aged 70 years old or older. After screening, 577 old people with limitations in daily life, were successfully interviewed. After data cleaning, 550 samples were included for data analysis. This study establishes a conceptual framework based on the Anderson Model (including predisposing factors, enabling factors and need factors), and further developed it by adding culture value factors (including attitudes towards filial piety and attitudes towards social face). Using a latent class analysis (LCA), this study classifies overall patterns of old people’s formal service utilization. Fourteen types of formal services were taken into account, including housework, voluntary support, transportation, home-delivered meals, and home-delivery medical care, elderly’s canteen and day-care center/respite care and so on. Structural equation modeling (SEM) was used to examine the direct effect of culture value on service use pattern, and the mediating effect of the enabling factors. Results: The LCA classified a hierarchical structure of service use patterns: multiple intended service use (N=69, 23%), selective intended service use (N=129, 23%), and light intended service use (N=352, 64%). Through SEM, after controlling predisposing factors and need factors, the results showed the significant direct effect of culture value on older people’s intended service use patterns. Enabling factors had a partial mediation effect on the relationship between culture value and the patterns. Conclusions and Implications: Differentiation of formal services may be important for meeting frail old people’s service needs and distributing program resources by identifying target populations for intervention, which may make reference to specific interventions to better support frail old people. Additionally, culture value had a unique direct effect on the intended service use patterns of frail old people in China, enriching our theoretical understanding of sources of culture value and their impacts. The findings also highlighted the mediation effects of enabling factors on the relationship between culture value factors and intended service use patterns. This study suggests that researchers and service providers should pay more attention to the important role of culture value factors in contributing to intended service use patterns and also be more sensitive to the mediating effect of enabling factors when discussing the relationship between culture value and the patterns.

Keywords: frail old people, intended service use pattern, culture value, enabling factors, contemporary China, latent class analysis

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629 Application of NBR 14861: 2011 for the Design of Prestress Hollow Core Slabs Subjected to Shear

Authors: Alessandra Aparecida Vieira França, Adriana de Paula Lacerda Santos, Mauro Lacerda Santos Filho

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The purpose of this research i to study the behavior of precast prestressed hollow core slabs subjected to shear. In order to achieve this goal, shear tests were performed using hollow core slabs 26,5cm thick, with and without a concrete cover of 5 cm, without cores filled, with two cores filled and three cores filled with concrete. The tests were performed according to the procedures recommended by FIP (1992), the EN 1168:2005 and following the method presented in Costa (2009). The ultimate shear strength obtained within the tests was compared with the values of theoretical resistant shear calculated in accordance with the codes, which are being used in Brazil, noted: NBR 6118:2003 and NBR 14861:2011. When calculating the shear resistance through the equations presented in NBR 14861:2011, it was found that provision is much more accurate for the calculation of the shear strength of hollow core slabs than the NBR 6118 code. Due to the large difference between the calculated results, even for slabs without cores filled, the authors consulted the committee that drafted the NBR 14861:2011 and found that there is an error in the text of the standard, because the coefficient that is suggested, actually presents the double value than the needed one! The ABNT, later on, soon issued an amendment of NBR 14861:2011 with the necessary corrections. During the tests for the present study, it was confirmed that the concrete filling the cores contributes to increase the shear strength of hollow core slabs. But in case of slabs 26,5 cm thick, the quantity should be limited to a maximum of two cores filled, because most of the results for slabs with three cores filled were smaller. This confirmed the recommendation of NBR 14861:2011which is consistent with standard practice. After analyzing the configuration of cracking and failure mechanisms of hollow core slabs during the shear tests, strut and tie models were developed representing the forces acting on the slab at the moment of rupture. Through these models the authors were able to calculate the tensile stress acting on the concrete ties (ribs) and scaled the geometry of these ties. The conclusions of the research performed are the experiments results have shown that the mechanism of failure of the hollow-core slabs can be predicted using the strut-and-tie procedure, within a good range of accuracy. In addition, the needed of the correction of the Brazilian standard to review the correction factor σcp duplicated (in NBR14861/2011), and the limitation of the number of cores (Holes) to be filled with concrete, to increase the strength of the slab for the shear resistance. It is also suggested the increasing the amount of test results with 26.5 cm thick, and a larger range of thickness slabs, in order to obtain results of shear tests with cores concreted after the release of prestressing force. Another set of shear tests on slabs must be performed in slabs with cores filled and cover concrete reinforced with welded steel mesh for comparison with results of theoretical values calculated by the new revision of the standard NBR 14861:2011.

Keywords: prestressed hollow core slabs, shear, strut, tie models

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628 A Smart Sensor Network Approach Using Affordable River Water Level Sensors

Authors: Dian Zhang, Brendan Heery, Maria O’Neill, Ciprian Briciu-Burghina, Noel E. O’Connor, Fiona Regan

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Recent developments in sensors, wireless data communication and the cloud computing have brought the sensor web to a whole new generation. The introduction of the concept of ‘Internet of Thing (IoT)’ has brought the sensor research into a new level, which involves the developing of long lasting, low cost, environment friendly and smart sensors; new wireless data communication technologies; big data analytics algorithms and cloud based solutions that are tailored to large scale smart sensor network. The next generation of smart sensor network consists of several layers: physical layer, where all the smart sensors resident and data pre-processes occur, either on the sensor itself or field gateway; data transmission layer, where data and instructions exchanges happen; the data process layer, where meaningful information is extracted and organized from the pre-process data stream. There are many definitions of smart sensor, however, to summarize all these definitions, a smart sensor must be Intelligent and Adaptable. In future large scale sensor network, collected data are far too large for traditional applications to send, store or process. The sensor unit must be intelligent that pre-processes collected data locally on board (this process may occur on field gateway depends on the sensor network structure). In this case study, three smart sensing methods, corresponding to simple thresholding, statistical model and machine learning based MoPBAS method, are introduced and their strength and weakness are discussed as an introduction to the smart sensing concept. Data fusion, the integration of data and knowledge from multiple sources, are key components of the next generation smart sensor network. For example, in the water level monitoring system, weather forecast can be extracted from external sources and if a heavy rainfall is expected, the server can send instructions to the sensor notes to, for instance, increase the sampling rate or switch on the sleeping mode vice versa. In this paper, we describe the deployment of 11 affordable water level sensors in the Dublin catchment. The objective of this paper is to use the deployed river level sensor network at the Dodder catchment in Dublin, Ireland as a case study to give a vision of the next generation of a smart sensor network for flood monitoring to assist agencies in making decisions about deploying resources in the case of a severe flood event. Some of the deployed sensors are located alongside traditional water level sensors for validation purposes. Using the 11 deployed river level sensors in a network as a case study, a vision of the next generation of smart sensor network is proposed. Each key component of the smart sensor network is discussed, which hopefully inspires the researchers who are working in the sensor research domain.

Keywords: smart sensing, internet of things, water level sensor, flooding

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627 A Comparative Study of the Impact of the Total Fertility Rate (TFR) on Trends in the Second Demographic Transition in Rwanda

Authors: Etienne Gatera

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Many studies have been conducted on SDT. Most of them focus on developed countries because of influencing factors such as; education, health, labor force, female labor force participation, industrialization, urbanization and migration. However, this thesis project paper aims to assess the impact of the total fertility rate (TFR) on the trends of the SDR in Rwanda. We will mainly be based in Rwanda after the 1994 genocide. Rwanda is located in East Africa, with approximately 13 million inhabitants. Thus, after the 1994 Tutsi genocide. The population growth rate exploded out of control with 6.17 children per woman in 1995. However, it's declined to 4.2 in 2014-2015 and declining to 4.1% in 2019-2020. Respectively with 3.4 children per woman in urban areas and 4.3 in rural areas. According to the National Institute of Statistics of Rwanda. Rwanda's population is expected to continue to grow for the rest of the century and reach 33.35 million people in 2099, with 2.1 children per woman in 2050. However, this project document aims to demonstrate the impact of the TFR on SDT trends in Rwanda. Thus, the decline in the TFR in Rwanda began with the introduction of family planning practices, which now account for 47.5% in 2019. Childbearing with three children for rural women compared to two children in the city, the increase in Divorce and separation caused by the behavior called "Kuza n'ijoro" or "coming at night" similar to cohabitation in developed countries. The decline in remarriage is caused by single mothers behavior who prefer to raise their children rather than remarry. Therefore, the study used probability sampling with (Stratified random sampling) method with a survey questionnaire of 1067 respondents in the 5 Districts (3 in rural areas and two in urban areas), with the target group of women Age between 15-49. The study demonstrated that the age of marriage in rural areas is two years higher than in urban areas. Divorce is more common in urban is with 6.2% with 5.2% in rural areas. However, separation is more common in rural areas than in urban areas, with a lower rate of 3%, due to the higher system called "Kuza n'ijoro" or "come at night", similar to cohabitation in developed countries. The study revealed that more than 85% of divorced people prefer to remain single, which confirms the low remarriage rate. Childbearing has started to decrease, especially for young singles in urban areas, due to the economic situation, with national statistics showing that unemployment in the youth community is still 16% higher. Therefore, the study concluded by confirming the hypothesis based on the results of the TFR indicators such as marriage, remarriage, divorce, separation, divorce, Kuza n'ijoro, childbearing] and abortion. The study consists of four sections, an introduction and background, a review of the literature, a description of the data and methodology, an analysis of the data, discussion results and a conclusion.

Keywords: Kuza n'ijoro, Rwanda, second demographic transition (SDT), total fertility rate (TFR)

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626 Managing Type 1 Diabetes in College: A Thematic Analysis of Online Narratives Posted on YouTube

Authors: Ekaterina Malova

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Type 1 diabetes (T1D) is a chronic illness requiring immense lifestyle changes to reduce the chance of life-threatening complications. Moving to a college may be the first time for a young adult with T1D to take responsibility for all the aspects of their diabetes care. In addition, people with T1D constantly face stigmatization and discrimination as a result of their health condition, which puts additional pressure on young adults with T1D. Hence, omissions in diabetes self-care often occur during the time of transition to college when both the social and physical environment of young adults changes drastically and contribute to the fact that emerging young adults remain one of the age groups with the highest hemoglobin levels and poorest diabetes control. However, despite potential severe health risks caused by a lack of proper diabetes self-care, little is known about the experiences of emerging adults embarking on a higher education journey as this population. Thus, young adults with type 1 diabetes are a 'forgotten group,' meaning that their experiences are rarely addressed by researchers. Given that self-disclosure and information-seeking can be challenging for individuals with stigmatized illnesses, online platforms like YouTube have become a popular medium of self-disclosure and information-seeking for people living with T1D. Thus, this study aims to provide an analysis of experiences that college students with T1D choose to share with the general public online and explore the nature of information being communicated by college students with T1D to the online community in personal narratives posted on YouTube. A systematic approach was used to retrieve a video sample by searching YouTube with keywords 'type 1 diabetes' and 'college,' with results ordered by relevance. A total of 18 videos were saved. Video lengths ranged from 2 to 28 minutes. The data were coded using NVivo. Video transcripts were coded and analyzed utilizing the thematic analysis method. Three key themes emerged from thematic analysis: 1) Advice, 2) Personal experience, and 3) Things I wish everyone knew about T1D. In addition, Theme 1 was divided into subtopics to differentiate between the most common types of advice: 1) Overcoming stigma and b) Seeking social support. The identified themes indicate that two groups of the population can potentially benefit from watching students’ video testimonies: 1) lay public and 2) other students with T1D. Given that students in the videos reported a lack of T1D education in the lay public, such video narratives can serve important educational purposes and reduce health stigma, while perceived similarity and identification with students in the videos may facilitate the transition of health information to other individuals with T1D and positively affect their diabetes routine. Thus, online video narratives can potentially serve both educational and persuasive purposes, empowering students with T1D to stay in control of T1D while succeeding academically.

Keywords: type 1 diabetes, college students, health communication, transition period

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625 Antibacterial Activity of Rosmarinus officinalis (Rosemary) and Murraya koenigii (Curry Leaves) against Multidrug Resistant S. aureus and Coagulase Negative Staphylococcus Species

Authors: Asma Naim, Warda Mushtaq

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Staphylococcus species are the most versatile and adaptive organism. They are widespread and naturally found on the skin, mucosa and nose in humans. Among these, Staphylococcus aureus is the most important species. These organisms act as opportunistic pathogens and can infect various organs of the host, causing minor skin infection to severe toxin mediated diseases, and life threatening nosocomial infections. Staphylococcus aureus has acquired resistance against β-lactam antibiotics by the production of β-lactamase, and Methicillin-Resistant Staphylococcus aureus (MRSA) strains have also been reported with increasing frequency. MRSA strains have been associated with nosocomial as well as community acquired infections. Medicinal plants have enormous potential as antimicrobial substances and have been used in traditional medicine. Search for medicinally valuable plants with antimicrobial activity is being emphasized due to increasing antibiotic resistance in bacteria. In the present study, the antibacterial potential of Rosmarinus officinalis (Rosemary) and Murraya koenigii (curry leaves) was evaluated. These are common household herbs used in food as enhancer of flavor and aroma. The crude aqueous infusion, decoction and ethanolic extracts of curry leaves and rosemary and essential oil of rosemary were investigated in the present study for antibacterial activity against multi-drug resistant Staphylococcus strains using well diffusion method. In the present study, 60 Multi-drug resistant clinical isolates of S. aureus (43) and Coagulase Negative Staphylococci (CoNS) (17) were screened against different concentrations of crude extracts of Rosmarinus officinalis and Murraya koenigii. Out of these 60 isolates, 43 were sensitive to the aqueous infusion of rosemary; 23 to aqueous decoction and 58 to ethanolic extract whereas, 24 isolates were sensitive to the essential oil. In the case of the curry leaves, no antibacterial activity was observed in aqueous infusion and decoction while only 14 isolates were sensitive to the ethanolic extract. The aqueous infusion of rosemary (50% concentration) exhibited a zone of inhibition of 21(±5.69) mm. against CoNS and 17(±4.77) mm. against S. aureus, the zone of inhibition of 50% concentration of aqueous decoction of rosemary was also larger against CoNS 17(±5.78) mm. then S. aureus 13(±6.91) mm. and the 50% concentrated ethanolic extract showed almost similar zone of inhibition in S. aureus 22(±3.61) mm. and CoNS 21(±7.64) mm. whereas, the essential oil of rosemary showed greater zone of inhibition against S. aureus i.e., 16(±4.67) mm. while CoNS showed 15(±6.94) mm. These results show that ethanolic extract of rosemary has significant antibacterial activity. Aqueous infusion and decoction of curry leaves revealed no significant antibacterial potential against all Staphylococcal species and ethanolic extract also showed only a weak response. Staphylococcus strains were susceptible to crude extracts and essential oil of rosemary in a dose depend manner, where the aqueous infusion showed highest zone of inhibition and ethanolic extract also demonstrated antistaphylococcal activity. These results demonstrate that rosemary possesses antistaphylococcal activity.

Keywords: antibacterial activity, curry leaves, multidrug resistant, rosemary, S. aureus

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624 Management of Non-Revenue Municipal Water

Authors: Habib Muhammetoglu, I. Ethem Karadirek, Selami Kara, Ayse Muhammetoglu

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The problem of non-revenue water (NRW) from municipal water distribution networks is common in many countries such as Turkey, where the average yearly water losses are around 50% . Water losses can be divided into two major types namely: 1) Real or physical water losses, and 2) Apparent or commercial water losses. Total water losses in Antalya city, Turkey is around 45%. Methods: A research study was conducted to develop appropriate methodologies to reduce NRW. A pilot study area of about 60 thousands inhabitants was chosen to apply the study. The pilot study area has a supervisory control and data acquisition (SCADA) system for the monitoring and control of many water quantity and quality parameters at the groundwater drinking wells, pumping stations, distribution reservoirs, and along the water mains. The pilot study area was divided into 18 District Metered Areas (DMAs) with different number of service connections that ranged between a few connections to less than 3000 connections. The flow rate and water pressure to each DMA were on-line continuously measured by an accurate flow meter and water pressure meter that were connected to the SCADA system. Customer water meters were installed to all billed and unbilled water users. The monthly water consumption as given by the water meters were recorded regularly. Water balance was carried out for each DMA using the well-know standard IWA approach. There were considerable variations in the water losses percentages and the components of the water losses among the DMAs of the pilot study area. Old Class B customer water meters at one DMA were replaced by more accurate new Class C water meters. Hydraulic modelling using the US-EPA EPANET model was carried out in the pilot study area for the prediction of water pressure variations at each DMA. The data sets required to calibrate and verify the hydraulic model were supplied by the SCADA system. It was noticed that a number of the DMAs exhibited high water pressure values. Therefore, pressure reducing valves (PRV) with constant head were installed to reduce the pressure up to a suitable level that was determined by the hydraulic model. On the other hand, the hydraulic model revealed that the water pressure at the other DMAs cannot be reduced when complying with the minimum pressure requirement (3 bars) as stated by the related standards. Results: Physical water losses were reduced considerably as a result of just reducing water pressure. Further physical water losses reduction was achieved by applying acoustic methods. The results of the water balances helped in identifying the DMAs that have considerable physical losses. Many bursts were detected especially in the DMAs that have high physical water losses. The SCADA system was very useful to assess the efficiency level of this method and to check the quality of repairs. Regarding apparent water losses reduction, changing the customer water meters resulted in increasing water revenue by more than 20%. Conclusions: DMA, SCADA, modelling, pressure management, leakage detection and accurate customer water meters are efficient for NRW.

Keywords: NRW, water losses, pressure management, SCADA, apparent water losses, urban water distribution networks

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623 Methodology for the Determination of Triterpenic Compounds in Apple Extracts

Authors: Mindaugas Liaudanskas, Darius Kviklys, Kristina Zymonė, Raimondas Raudonis, Jonas Viškelis, Norbertas Uselis, Pranas Viškelis, Valdimaras Janulis

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Apples are among the most commonly consumed fruits in the world. Based on data from the year 2014, approximately 84.63 million tons of apples are grown per annum. Apples are widely used in food industry to produce various products and drinks (juice, wine, and cider); they are also used unprocessed. Apples in human diet are an important source of different groups of biological active compounds that can positively contribute to the prevention of various diseases. They are a source of various biologically active substances – especially vitamins, organic acids, micro- and macro-elements, pectins, and phenolic, triterpenic, and other compounds. Triterpenic compounds, which are characterized by versatile biological activity, are the biologically active compounds found in apples that are among the most promising and most significant for human health. A specific analytical procedure including sample preparation and High Performance Liquid Chromatography (HPLC) analysis was developed, optimized, and validated for the detection of triterpenic compounds in the samples of different apples, their peels, and flesh from widespread apple cultivars 'Aldas', 'Auksis', 'Connel Red', 'Ligol', 'Lodel', and 'Rajka' grown in Lithuanian climatic conditions. The conditions for triterpenic compound extraction were optimized: the solvent of the extraction was 100% (v/v) acetone, and the extraction was performed in an ultrasound bath for 10 min. Isocratic elution (the eluents ratio being 88% (solvent A) and 12% (solvent B)) for a rapid separation of triterpenic compounds was performed. The validation of the methodology was performed on the basis of the ICH recommendations. The following characteristics of validation were evaluated: the selectivity of the method (specificity), precision, the detection and quantitation limits of the analytes, and linearity. The obtained parameters values confirm suitability of methodology to perform analysis of triterpenic compounds. Using the optimised and validated HPLC technique, four triterpenic compounds were separated and identified, and their specificity was confirmed. These compounds were corosolic acid, betulinic acid, oleanolic acid, and ursolic acid. Ursolic acid was the dominant compound in all the tested apple samples. The detected amount of betulinic acid was the lowest of all the identified triterpenic compounds. The greatest amounts of triterpenic compounds were detected in whole apple and apple peel samples of the 'Lodel' cultivar, and thus apples and apple extracts of this cultivar are potentially valuable for use in medical practice, for the prevention of various diseases, for adjunct therapy, for the isolation of individual compounds with a specific biological effect, and for the development and production of dietary supplements and functional food enriched in biologically active compounds. Acknowledgements. This work was supported by a grant from the Research Council of Lithuania, project No. MIP-17-8.

Keywords: apples, HPLC, triterpenic compounds, validation

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622 Classification of ECG Signal Based on Mixture of Linear and Non-Linear Features

Authors: Mohammad Karimi Moridani, Mohammad Abdi Zadeh, Zahra Shahiazar Mazraeh

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In recent years, the use of intelligent systems in biomedical engineering has increased dramatically, especially in the diagnosis of various diseases. Also, due to the relatively simple recording of the electrocardiogram signal (ECG), this signal is a good tool to show the function of the heart and diseases associated with it. The aim of this paper is to design an intelligent system for automatically detecting a normal electrocardiogram signal from abnormal one. Using this diagnostic system, it is possible to identify a person's heart condition in a very short time and with high accuracy. The data used in this article are from the Physionet database, available in 2016 for use by researchers to provide the best method for detecting normal signals from abnormalities. Data is of both genders and the data recording time varies between several seconds to several minutes. All data is also labeled normal or abnormal. Due to the low positional accuracy and ECG signal time limit and the similarity of the signal in some diseases with the normal signal, the heart rate variability (HRV) signal was used. Measuring and analyzing the heart rate variability with time to evaluate the activity of the heart and differentiating different types of heart failure from one another is of interest to the experts. In the preprocessing stage, after noise cancelation by the adaptive Kalman filter and extracting the R wave by the Pan and Tampkinz algorithm, R-R intervals were extracted and the HRV signal was generated. In the process of processing this paper, a new idea was presented that, in addition to using the statistical characteristics of the signal to create a return map and extraction of nonlinear characteristics of the HRV signal due to the nonlinear nature of the signal. Finally, the artificial neural networks widely used in the field of ECG signal processing as well as distinctive features were used to classify the normal signals from abnormal ones. To evaluate the efficiency of proposed classifiers in this paper, the area under curve ROC was used. The results of the simulation in the MATLAB environment showed that the AUC of the MLP and SVM neural network was 0.893 and 0.947, respectively. As well as, the results of the proposed algorithm in this paper indicated that the more use of nonlinear characteristics in normal signal classification of the patient showed better performance. Today, research is aimed at quantitatively analyzing the linear and non-linear or descriptive and random nature of the heart rate variability signal, because it has been shown that the amount of these properties can be used to indicate the health status of the individual's heart. The study of nonlinear behavior and dynamics of the heart's neural control system in the short and long-term provides new information on how the cardiovascular system functions, and has led to the development of research in this field. Given that the ECG signal contains important information and is one of the common tools used by physicians to diagnose heart disease, but due to the limited accuracy of time and the fact that some information about this signal is hidden from the viewpoint of physicians, the design of the intelligent system proposed in this paper can help physicians with greater speed and accuracy in the diagnosis of normal and patient individuals and can be used as a complementary system in the treatment centers.

Keywords: neart rate variability, signal processing, linear and non-linear features, classification methods, ROC Curve

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621 Enhancement of Radiosensitization by Aptamer 5TR1-Functionalized AgNCs for Triple-Negative Breast Cancer

Authors: Xuechun Kan, Dongdong Li, Fan Li, Peidang Liu

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Triple-negative breast cancer (TNBC) is the most malignant subtype of breast cancer with a poor prognosis, and radiotherapy is one of the main treatment methods. However, due to the obvious resistance of tumor cells to radiotherapy, high dose of ionizing radiation is required during radiotherapy, which causes serious damage to normal tissues near the tumor. Therefore, how to improve radiotherapy resistance and enhance the specific killing of tumor cells by radiation is a hot issue that needs to be solved in clinic. Recent studies have shown that silver-based nanoparticles have strong radiosensitization, and silver nanoclusters (AgNCs) also provide a broad prospect for tumor targeted radiosensitization therapy due to their ultra-small size, low toxicity or non-toxicity, self-fluorescence and strong photostability. Aptamer 5TR1 is a 25-base oligonucleotide aptamer that can specifically bind to mucin-1 highly expressed on the membrane surface of TNBC 4T1 cells, and can be used as a highly efficient tumor targeting molecule. In this study, AgNCs were synthesized by DNA template based on 5TR1 aptamer (NC-T5-5TR1), and its role as a targeted radiosensitizer in TNBC radiotherapy was investigated. The optimal DNA template was first screened by fluorescence emission spectroscopy, and NC-T5-5TR1 was prepared. NC-T5-5TR1 was characterized by transmission electron microscopy, ultraviolet-visible spectroscopy and dynamic light scattering. The inhibitory effect of NC-T5-5TR1 on cell activity was evaluated using the MTT method. Laser confocal microscopy was employed to observe NC-T5-5TR1 targeting 4T1 cells and verify its self-fluorescence characteristics. The uptake of NC-T5-5TR1 by 4T1 cells was observed by dark-field imaging, and the uptake peak was evaluated by inductively coupled plasma mass spectrometry. The radiation sensitization effect of NC-T5-5TR1 was evaluated through cell cloning and in vivo anti-tumor experiments. Annexin V-FITC/PI double staining flow cytometry was utilized to detect the impact of nanomaterials combined with radiotherapy on apoptosis. The results demonstrated that the particle size of NC-T5-5TR1 is about 2 nm, and the UV-visible absorption spectrum detection verifies the successful construction of NC-T5-5TR1, and it shows good dispersion. NC-T5-5TR1 significantly inhibited the activity of 4T1 cells and effectively targeted and fluoresced within 4T1 cells. The uptake of NC-T5-5TR1 reached its peak at 3 h in the tumor area. Compared with AgNCs without aptamer modification, NC-T5-5TR1 exhibited superior radiation sensitization, and combined radiotherapy significantly inhibited the activity of 4T1 cells and tumor growth in 4T1-bearing mice. The apoptosis level of NC-T5-5TR1 combined with radiation was significantly increased. These findings provide important theoretical and experimental support for NC-T5-5TR1 as a radiation sensitizer for TNBC.

Keywords: 5TR1 aptamer, silver nanoclusters, radio sensitization, triple-negative breast cancer

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620 The Impact of Using Flattening Filter-Free Energies on Treatment Efficiency for Prostate SBRT

Authors: T. Al-Alawi, N. Shorbaji, E. Rashaidi, M.Alidrisi

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Purpose/Objective(s): The main purpose of this study is to analyze the planning of SBRT treatments for localized prostate cancer with 6FFF and 10FFF energies to see if there is a dosimetric difference between the two energies and how we can increase the plan efficiency and reduce its complexity. Also, to introduce a planning method in our department to treat prostate cancer by utilizing high energy photons without increasing patient toxicity and fulfilled all dosimetric constraints for OAR (an organ at risk). Then toevaluate the target 95% coverage PTV95, V5%, V2%, V1%, low dose volume for OAR (V1Gy, V2Gy, V5Gy), monitor unit (beam-on time), and estimate the values of homogeneity index HI, conformity index CI a Gradient index GI for each treatment plan.Materials/Methods: Two treatment plans were generated for15 patients with localized prostate cancer retrospectively using the CT planning image acquired for radiotherapy purposes. Each plan contains two/three complete arcs with two/three different collimator angle sets. The maximum dose rate available is 1400MU/min for the energy 6FFF and 2400MU/min for 10FFF. So in case, we need to avoid changing the gantry speed during the rotation, we tend to use the third arc in the plan with 6FFF to accommodate the high dose per fraction. The clinical target volume (CTV) consists of the entire prostate for organ-confined disease. The planning target volume (PTV) involves a margin of 5 mm. A 3-mm margin is favored posteriorly. Organs at risk identified and contoured include the rectum, bladder, penile bulb, femoral heads, and small bowel. The prescription dose is to deliver 35Gyin five fractions to the PTV and apply constraints for organ at risk (OAR) derived from those reported in references. Results: In terms of CI=0.99, HI=0.7, and GI= 4.1, it was observed that they are all thesame for both energies 6FFF and 10FFF with no differences, but the total delivered MUs are much less for the 10FFF plans (2907 for 6FFF vs.2468 for 10FFF) and the total delivery time is 124Sc for 6FFF vs. 61Sc for 10FFF beams. There were no dosimetric differences between 6FFF and 10FFF in terms of PTV coverage and mean doses; the mean doses for the bladder, rectum, femoral heads, penile bulb, and small bowel were collected, and they were in favor of the 10FFF. Also, we got lower V1Gy, V2Gy, and V5Gy doses for all OAR with 10FFF plans. Integral dosesID in (Gy. L) were recorded for all OAR, and they were lower with the 10FFF plans. Conclusion: High energy 10FFF has lower treatment time and lower delivered MUs; also, 10FFF showed lower integral and meant doses to organs at risk. In this study, we suggest usinga 10FFF beam for SBRTprostate treatment, which has the advantage of lowering the treatment time and that lead to lessplan complexity with respect to 6FFF beams.

Keywords: FFF beam, SBRT prostate, VMAT, prostate cancer

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619 Better Together: Diverging Trajectories of Local Social Work Practice and Nationally-Regulated Social Work Education in the UK

Authors: Noel Smith

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To achieve professional registration, UK social workers need to complete a programme of education and training which meets standards set down by central government. When it comes to practice, social work in local authorities must fulfil requirements of national legislation but there is considerable local variation in the organisation and delivery of services. This presentation discusses the on-going reform of social work education by central government in the context of research of social work services in a local authority. In doing so it highlights that the ‘direction of travel’ of the national reform of social work education seems at odds with the trajectory of development of local social work services. In terms of education reform, the presentation cites key government initiatives including the knowledge and skills requirements which have been published separately for, respectively, child and family social work and adult social work. Also relevant is the Government’s new ‘teaching partnership’ pilot which focuses exclusively on social work in local government, in isolation from social work in NGOs. In terms of research, the presentation discusses two studies undertaken by Professor Smith in Suffolk County Council, a local authority in the east of England. The first is an equality impact analysis of the introduction of a new model for the delivery of adult and community services in Suffolk. This is based on qualitative research with local government representatives and NGOs involved in social work with older people and people with disabilities. The second study is an on-going, mixed method evaluation of the introduction of a new model of social care for children and young people in Suffolk. This new model is based on the international ‘Signs of Safety’ approach, which is applied in this model to a wide range of services from early intervention to child protection. While both studies are localised, the service models they examine are good illustrations of the way services are developing nationally. Analysis of these studies suggest that, if services continue to develop as they currently are, then social workers will require particular skills which are not be adequately addressed in the Government’s plans for social work education. Two issues arise. First, education reform concentrates on social work within local government while increasingly local authorities are outsourcing service provision to NGOs, expecting greater community involvement in providing care, and integrating social care with health care services. Second, education reform focuses on the different skills required for working with older and disabled adults and working with children and families, to the point where potentially the profession would be fragmented into two different classes of social worker. In contrast, the development of adult and children’s services in local authorities re-asserts the importance of common social work skills relating to personalisation, prevention and community development. The presentation highlights the importance for social work education in the UK to be forward looking, in terms of the changing design of service delivery, and outward looking, in terms of lessons to be drawn from international social work.

Keywords: adult social work, children and families social work, European social work, social work education

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618 Risk Assessment Tools Applied to Deep Vein Thrombosis Patients Treated with Warfarin

Authors: Kylie Mueller, Nijole Bernaitis, Shailendra Anoopkumar-Dukie

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Background: Vitamin K antagonists particularly warfarin is the most frequently used oral medication for deep vein thrombosis (DVT) treatment and prophylaxis. Time in therapeutic range (TITR) of the international normalised ratio (INR) is widely accepted as a measure to assess the quality of warfarin therapy. Multiple factors can affect warfarin control and the subsequent adverse outcomes including thromboembolic and bleeding events. Predictor models have been developed to assess potential contributing factors and measure the individual risk of these adverse events. These predictive models have been validated in atrial fibrillation (AF) patients, however, there is a lack of literature on whether these can be successfully applied to other warfarin users including DVT patients. Therefore, the aim of the study was to assess the ability of these risk models (HAS BLED and CHADS2) to predict haemorrhagic and ischaemic incidences in DVT patients treated with warfarin. Methods: A retrospective analysis of DVT patients receiving warfarin management by a private pathology clinic was conducted. Data was collected from November 2007 to September 2014 and included demographics, medical and drug history, INR targets and test results. Patients receiving continuous warfarin therapy with an INR reference range between 2.0 and 3.0 were included in the study with mean TITR calculated using the Rosendaal method. Bleeding and thromboembolic events were recorded and reported as incidences per patient. The haemorrhagic risk model HAS BLED and ischaemic risk model CHADS2 were applied to the data. Patients were then stratified into either the low, moderate, or high-risk categories. The analysis was conducted to determine if a correlation existed between risk assessment tool and patient outcomes. Data was analysed using GraphPad Instat Version 3 with a p value of <0.05 considered to be statistically significant. Patient characteristics were reported as mean and standard deviation for continuous data and categorical data reported as number and percentage. Results: Of the 533 patients included in the study, there were 268 (50.2%) female and 265 (49.8%) male patients with a mean age of 62.5 years (±16.4). The overall mean TITR was 78.3% (±12.7) with an overall haemorrhagic incidence of 0.41 events per patient. For the HAS BLED model, there was a haemorrhagic incidence of 0.08, 0.53, and 0.54 per patient in the low, moderate and high-risk categories respectively showing a statistically significant increase in incidence with increasing risk category. The CHADS2 model showed an increase in ischaemic events according to risk category with no ischaemic events in the low category, and an ischaemic incidence of 0.03 in the moderate category and 0.47 high-risk categories. Conclusion: An increasing haemorrhagic incidence correlated to an increase in the HAS BLED risk score in DVT patients treated with warfarin. Furthermore, a greater incidence of ischaemic events occurred in patients with an increase in CHADS2 category. In an Australian population of DVT patients, the HAS BLED and CHADS2 accurately predicts incidences of haemorrhage and ischaemic events respectively.

Keywords: anticoagulant agent, deep vein thrombosis, risk assessment, warfarin

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617 A Study on Green Building Certification Systems within the Context of Anticipatory Systems

Authors: Taner Izzet Acarer, Ece Ceylan Baba

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This paper examines green building certification systems and their current processes in comparison with anticipatory systems. Rapid growth of human population and depletion of natural resources are causing irreparable damage to urban and natural environment. In this context, the concept of ‘sustainable architecture’ has emerged in the 20th century so as to establish and maintain standards for livable urban spaces, to improve quality of urban life, and to preserve natural resources for future generations. The construction industry is responsible for a large part of the resource consumption and it is believed that the ‘green building’ designs that emerge in construction industry can reduce environmental problems and contribute to sustainable development around the world. A building must meet a specific set of criteria, set forth through various certification systems, in order to be eligible for designation as a green building. It is disputable whether methods used by green building certification systems today truly serve the purposes of creating a sustainable world. Accordingly, this study will investigate the sets of rating systems used by the most popular green building certification programs, including LEED (Leadership in Energy and Environmental Design), BREEAM (Building Research Establishment's Environmental Assessment Methods), DGNB (Deutsche Gesellschaft für Nachhaltiges Bauen System), in terms of ‘Anticipatory Systems’ in accordance with the certification processes and their goals, while discussing their contribution to architecture. The basic methodology of the study is as follows. Firstly analyzes of brief historical and literature review of green buildings and certificate systems will be stated. Secondly, processes of green building certificate systems will be disputed by the help of anticipatory systems. Anticipatory Systems is a set of systems designed to generate action-oriented projections and to forecast potential side effects using the most current data. Anticipatory Systems pull the future into the present and take action based on future predictions. Although they do not have a claim to see into the future, they can provide foresight data. When shaping the foresight data, Anticipatory Systems use feedforward instead of feedback, enabling them to forecast the system’s behavior and potential side effects by establishing a correlation between the system’s present/past behavior and projected results. This study indicates the goals and current status of LEED, BREEAM and DGNB rating systems that created by using the feedback technique will be examined and presented in a chart. In addition, by examining these rating systems with the anticipatory system that using the feedforward method, the negative influences of the potential side effects on the purpose and current status of the rating systems will be shown in another chart. By comparing the two obtained data, the findings will be shown that rating systems are used for different goals than the purposes they are aiming for. In conclusion, the side effects of green building certification systems will be stated by using anticipatory system models.

Keywords: anticipatory systems, BREEAM, certificate systems, DGNB, green buildings, LEED

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616 Abnormal Pap Smear Detection by Application of Revised Bethesda System in Commercial Sex Workers and a Control Group: A Comparative Study

Authors: Priyanka Manghani, Manthan Patel, Rahul Peddawad

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Cervical Cancer is a major public health hurdle in the area of women’s health. The most common cause of Cervical Cancer is the Human Papilloma Virus (HPV). Human papilloma virus has various genotypes, with HPV 16 and HPV 18 being the major etiological factor causing carcinoma of the Cervix. Early screening and detection by Papanicolaou Smears (PAP) is an effective method for identifying premalignant and malignant lesions. In case of existing pre- malignant lesions /cervical dysplasia’s found with HPV 16 or 18, appropriate follow up can be done to prevent it from developing into a neoplasm. Aims and Objectives: Primary Aim; To study various abnormal cervical cytology reports as detected by Pap Smear Tests, using the Bethesda System in women at a Tertiary Care Hospital. Secondary Aim; To discuss the importance of Pap smear in Cervical Cancer Screening Program. Materials and Methods: Our study is a prospective study, based on 101 women who attended the Out-patient department of Obstetrics and Gynecology at a tertiary care hospital in age group 20-40 years with chief complaints of white/foul vaginal discharge, post-coital Bleeding, low back pain, irregular menstruation, etc. 60 women, who were tested, of the total no of women, were commercial sex workers, thus being a high-risk group for HPV infection. All women underwent conventional cytology. For all the abnormal smears, further cervical biopsies were done, and the final diagnosis was done on the basis of histopathology (gold standard). Results: In all these patients, 16 patients presented with normal smears out of which 2 belonged to the category of commercial sex workers (3.33%) and 14 being from the normal/control group (34.15%). 44 women presented with inflammatory smears out of which 30 were commercial sex workers (50%) and 14 from the control Group (34.15%). A total of 11 women presented with infectious etiology with 6 being commercial sex workers (10%) and 5 (12.2%) being in the control group. A total of 8 patients presented with low-grade squamous intra epithelial lesion (LSIL) with 7 (11.7%) being commercial sex workers and 1(2.44%) patient belonging to the control group. A Total of 7 patients presented with high-grade squamous intraepithelial lesion (HSIL) with 6 (10%) being commercial sex workers and 1 (2.44%) belonging to the control group. 9 patients in total presented with atypical squamous cells of undetermined significance (ASCUS) with 6(10%) being commercial sex workers and 3 (7.32%) belonging to the control group. Squamous cell carcinoma(SCC) presence was found only in 1(1.7%) commercial sex worker. Conclusion – We conclude that HSIL, LSIL, SCC and sexually related infections are comparatively more common in vulnerable groups such as sex workers due to a variety of factors such as multiple sexual partners and poor genital hygiene. Early screening and follow up interventions are highly needed for them along with Health education for risk factors and to emphasize on the importance of Pap smear screening.

Keywords: cervical cancer, papanicolaou (pap) smear, bethesda system, neoplasm

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615 An Introspective look into Hotel Employees Career Satisfaction

Authors: Anastasios Zopiatis, Antonis L. Theocharous

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In the midst of a fierce war for talent, the hospitality industry is seeking new and innovative ways to enrich its image as an employer of choice and not a necessity. Historically, the industry’s professions are portrayed as ‘unattractive’ due to their repetitious nature, long and unsocial working schedules, below average remunerations, and the mental and physical demands of the job. Aligning with the industry, hospitality and tourism scholars embarked on a journey to investigate pertinent topics with the aim of enhancing our conceptual understanding of the elements that influence employees at the hospitality world of work. Topics such as job involvement, commitment, job and career satisfaction, and turnover intentions became the focal points in a multitude of relevant empirical and conceptual investigations. Nevertheless, gaps or inconsistencies in existing theories, as a result of both the volatile complexity of the relationships governing human behavior in the hospitality workplace, and the academic community’s unopposed acceptance of theoretical frameworks mainly propounded in the United States and United Kingdom years ago, necessitate our continuous vigilance. Thus, in an effort to enhance and enrich the discourse, we set out to investigate the relationship between intrinsic and extrinsic job satisfaction traits and the individual’s career satisfaction, and subsequent intention to remain in the hospitality industry. Reflecting on existing literature, a quantitative survey was developed and administered, face-to-face, to 650 individuals working as full-time employees in 4- and 5- star hotel establishments in Cyprus, whereas a multivariate statistical analysis method, namely Structural Equation Modeling (SEM), was utilized to determine whether relationships existed between constructs as a means to either accept or reject the hypothesized theory. Findings, of interest to both industry stakeholders and academic scholars, suggest that the individual’s future intention to remain within the industry is primarily associated with extrinsic job traits. Our findings revealed that positive associations exist between extrinsic job traits, and both career satisfaction and future intention. In contrast, when investigating the relationship of intrinsic traits, a positive association was revealed only with career satisfaction. Apparently, the local industry’s environmental factors of seasonality, excessive turnover, overdependence on seasonal, and part-time migrant workers, prohibit industry stakeholders in effectively investing the time and resources in the development and professional growth of their employees. Consequently intrinsic job satisfaction factors such as advancement, growth, and achievement, take backstage to the more materialistic extrinsic factors. Findings from the subsequent mediation analysis support the notion that intrinsic traits can positively influence future intentions indirectly only through career satisfaction, whereas extrinsic traits can positively impact both career satisfaction and future intention both directly and indirectly.

Keywords: career satisfaction, Cyprus, hotel employees, structural equation modeling, SEM

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