Search results for: pediatric intensive care unit

Authors: Fujio Takata

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When governments levy taxes on labor income on the basis of a balanced budget rule, two steady states in an economy exist, of which one can cause two movement patterns, namely, indeterminacy paths and a saddle path. However, in this paper, we assume an economy with divisible labor, in which labor adjustment is made by an intensive margin. We demonstrate that there indeed exist the two paths in the economy and that there exists a critical condition dividing them. This is proved by establishing the relationship between a finite elasticity of labor with regard to real wages and the share of capital in output. Consequently, we deduce the existence of an upper limit in the share of capital in output for indeterminacy to occur. The largest possible value of that share is less than 0.5698.

Keywords: balanced budget rule, divisible labor, labor income taxation, two movement patterns

Procedia PDF Downloads 163

Authors: Kevin Wang, Jian Ge, Yinan Zhao, Kevin Willis

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Kepler has discovered over 4000 exoplanets and candidates. However, current transit planet detection techniques based on the wavelet analysis and the Box Least Squares (BLS) algorithm have limited sensitivity in detecting minor planets with a low signal-to-noise ratio (SNR) and long periods with only 3-4 repeated signals over the mission lifetime of 4 years. This paper presents a novel precise-period transit signal detection methodology based on a new Graphics Processing Unit (GPU) Fast Folding algorithm in conjunction with a Convolutional Neural Network (CNN) to detect low SNR and/or long-period transit planet signals. A comparison with BLS is conducted on both simulated light curves and real data, demonstrating that the new method has higher speed, sensitivity, and reliability. For instance, the new system can detect transits with SNR as low as three while the performance of BLS drops off quickly around SNR of 7. Meanwhile, the GPU Fast Folding method folds light curves 25 times faster than BLS, a significant gain that allows exoplanet detection to occur at unprecedented period precision. This new method has been tested with all known transit signals with 100% confirmation. In addition, this new method has been successfully applied to the Kepler of Interest (KOI) data and identified a few new Earth-sized Ultra-short period (USP) exoplanet candidates and habitable planet candidates. The results highlight the promise for GPU Fast Folding as a replacement to the traditional BLS algorithm for finding small and/or long-period habitable and Earth-sized planet candidates in-transit data taken with Kepler and other space transit missions such as TESS(Transiting Exoplanet Survey Satellite) and PLATO(PLAnetary Transits and Oscillations of stars).

Keywords: algorithms, astronomy data analysis, deep learning, exoplanet detection methods, small planets, habitable planets, transit photometry

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Authors: Wanwisa Deenin, Abdulhadee Yakoh, Chahya Kreangkaiwal, Orawon Chailapakul, Kanitha Patarakul, Sudkate Chaiyo

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LipL32 is an outer membrane protein present only on pathogenic Leptospira species, which are the causative agent of leptospirosis. Leptospirosis symptoms are often misdiagnosed with other febrile illnesses as the clinical manifestations are non-specific. Therefore, an accurate diagnostic tool for leptospirosis is indeed critical for proper and prompt treatment. Typical diagnosis via serological assays is generally performed to assess the antibodies produced against Leptospira. However, their delayed antibody response and complicated procedure are undoubtedly limited the practical utilization especially in primary care setting. Here, we demonstrate for the first time an early-stage detection of LipL32 by an integrated lateral-flow immunoassay with electrochemical readout (eLFIA). A ferrocene trace tag was monitored via differential pulse voltammetry operated on a smartphone-based device, thus allowing for on-field testing. Superior performance in terms of the lowest detectable limit of detection (LOD) of 8.53 pg/mL and broad linear dynamic range (5 orders of magnitude) among other sensors available thus far was established. Additionally, the developed test strip provided a straightforward yet sensitive approach for diagnosis of leptospirosis using the collected human sera from patients, in which the results were comparable to the real-time polymerase chain reaction technique.

Keywords: leptospirosis, electrochemical detection, lateral flow immunosensor, point-of-care testing, early-stage detection

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Authors: Tanja Salary

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This paper discusses a study conducted in a juvenile justice facility regarding medication errors. It includes an introduction to data collected about medication errors in a juvenile justice facility from 2011 - 2019 and explores contributing factors that relate to those errors. The data was obtained from electronic incident records of medication errors that were documented from the years 2011 through 2019. In addition, the presentation reviews both current and historical research of empirical data about patient safety standards and quality care comparing traditional health care facilities to juvenile justice residential facilities and acknowledges a gap in research. The theoretical/conceptual framework for the research study was Bandura and Adams’s self-efficacy theory of behavioral change and Mark Friedman’s results-based accountability theory. Despite the lack of evidence in previous studies addressing medication errors in juvenile justice facilities, this presenter will share information that adds to the body of knowledge, including the potential relationship of medication errors and contributing factors of race and age. Implications for future research include the effect that education and training will have on the communication among juvenile justice staff, including nurses, who administer medications to juveniles to ensure adherence to patient safety standards. There are several opportunities for future research concerning other characteristics about factors that may affect medication administration errors within the residential juvenile justice facility.

Keywords: Juvenile justice, medication errors, juveniles, error reduction strategies

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Authors: Mauricio Quintero Angel, Andrés A. Duque Nivia, Carlos H. Fajardo Toro

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This paper analyzes two approaches of sustainability, the weak and strong, considering a case of study of oil palm production for an industry of biodegradable detergent. In this case, a company demand the oil palm as the active element for washing and through its trademark aims to supply 10% of the Colombian market of washing powders. Under each approach the economic and ecological implications of the palm oil production and especially the implications for crop management are described. The crop production under the weak sustainability implies plantations, intensive use of agrochemicals and the inclusion of new areas of cultivation as the market grows. Under the strong sustainability the production system is limited by the productive vocation of the ecosystem, so that new approaches and creativity for making viable the nature conservancy and the business development are require.

Keywords: agriculture, environmental impacts, oil palm, strong sustainability, weak sustainability

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Authors: Ali Moharrek, Hosein Mobli, Ali Jafari, Ahmad Tabataee Far

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Biomass is a material generally produced by plants living on soil or water and their derivatives. The remains of agricultural and forest products contain biomass which is changeable into fuel. Besides, you can obtain biogas and ethanol from the charcoal produced from biomass through specific actions. this technology was designed for as a useful Native Fuel and Technology in Energy disasters Management Due to the sudden interruption of the flow of heat energy One of the problems confronted by mankind in the future is the limitations of fossil energy which necessitates production of new energies such as biomass. In order to produce biomass from the remains of the plants, different methods shall be applied considering factors like cost of production, production technology, area of requirement, speed of work easy utilization, ect. In this article we are focusing on designing a biomass briquetting portable machine. The speed of installation of the machine on a tractor is estimated as 80 MF 258. Screw press is used in designing this machine. The needed power for running this machine which is estimated as 17.4 kW is provided by the power axis of tractor. The pressing speed of the machine is considered to be 375 RPM Finally the physical and mechanical properties of the product were compared with utilized material which resulted in appropriate outcomes. This machine is designed for Gathering Raw materials of the ground by Head Section. During delivering the raw materials to Briquetting section, they Crushed, Milled & Pre Heated in Transmission section. This machine is a Combine Portable Tractor unit machine and can use all type of Agriculture, Forest & Livestock Animals Resides as Raw material to make Bio fuel. The Briquetting Section was manufactured and it successfully made bio fuel of Sawdust. Also this machine made a biofuel with Ethanol of sugarcane Wastes. This Machine is using P.T.O power source for Briquetting and Hydraulic Power Source for Pre Processing of Row Materials.

Keywords: biomass, briquette, screw press, sawdust, animal wastes, portable, tractors

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Authors: Reuben Mugisha, Stella Bakibinga

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The cervical cancer burden is a global threat, but more so in low income settings where more than 85% of mortality cases occur due to lack of sufficient screening programs. There is consequently a lack of early detection of cancer and precancerous cells among women. Studies show that 3% to 35% of deaths could have been avoided through early screening depending on prognosis, disease progression, environmental and lifestyle factors. In this study, a systematic literature review is undertaken to understand potential barriers and facilitators as documented in previous studies that focus on the application of telehealth in cervical cancer screening programs for early detection of cancer and precancerous cells. The study informs future studies especially those from low income settings about lessons learned from previous studies and how to be best prepared while planning to implement telehealth for cervical cancer screening. It further identifies the knowledge gaps in the research area and makes recommendations. Using a specified selection criterion, 15 different articles are analyzed based on the study’s aim, theory or conceptual framework used, method applied, study findings and conclusion. Results are then tabulated and presented thematically to better inform readers about emerging facts on barriers and facilitators to telehealth implementation as documented in the reviewed articles, and how they consequently lead to evidence informed conclusions that are relevant to telehealth implementation for cervical cancer screening. Preliminary findings of this study underscore that use of low cost mobile colposcope is an appealing option in cervical cancer screening, particularly when coupled with onsite treatment of suspicious lesions. These tools relay cervical images to the online databases for storage and retrieval, they permit integration of connected devices at the point of care to rapidly collect clinical data for further analysis of the prevalence of cervical dysplasia and cervical cancer. Results however reveal the need for population sensitization prior to use of mobile colposcopies among patients, standardization of mobile colposcopy programs across screening partners, sufficient logistics and good connectivity, experienced experts to review image cases at the point-of-care as important facilitators to the implementation of mobile colposcope as a telehealth cervical cancer screening mechanism.

Keywords: cervical cancer screening, digital technology, hand-held colposcopy, knowledge-sharing

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Authors: Naushad Mamode Khan

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The Com-Poisson (CMP) model is one of the most popular discrete generalized linear models (GLMS) that handles both equi-, over- and under-dispersed data. In longitudinal context, an integer-valued autoregressive (INAR(1)) process that incorporates covariate specification has been developed to model longitudinal CMP counts. However, the joint likelihood CMP function is difficult to specify and thus restricts the likelihood based estimating methodology. The joint generalized quasilikelihood approach (GQL-I) was instead considered but is rather computationally intensive and may not even estimate the regression effects due to a complex and frequently ill conditioned covariance structure. This paper proposes a new GQL approach for estimating the regression parameters (GQLIII) that are based on a single score vector representation. The performance of GQL-III is compared with GQL-I and separate marginal GQLs (GQL-II) through some simulation experiments and is proved to yield equally efficient estimates as GQL-I and is far more computationally stable.

Keywords: longitudinal, com-Poisson, ill-conditioned, INAR(1), GLMS, GQL

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Authors: M. Siedlikowski, F. Rauch, A. Tsimicalis

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Osteogenesis Imperfecta (OI) is a genetic disorder of childhood onset that causes frequent fractures after minimal physical stress. To date, OI research has focused on medically- and surgically-oriented outcomes with little attention on the perspective of the affected child. It is a challenge to elicit the child’s voice in health care, in other words, their own perspective on their symptoms, but software development offers a way forward. Sisom (Norwegian acronym derived from ‘Si det som det er’ meaning ‘Tell it as it is’) is an award-winning, rigorously tested, interactive, computerized tool that helps children with chronic illnesses express their symptoms to their clinicians. The successful Sisom software tool, that addresses the child directly, has not yet been adapted to attend to symptoms unique to children with OI. The purpose of this study was to develop a Sisom paper prototype for children with OI by seeking the perspectives of end users, particularly, children with OI and clinicians. Our descriptive qualitative study was conducted at Shriners Hospitals for Children® – Canada, which follows the largest cohort of children with OI in North America. Purposive sampling was used to recruit 12 children with OI over three cycles. Nine clinicians oversaw the development process, which involved determining the relevance of current Sisom symptoms, vignettes, and avatars, as well as generating new Sisom OI components. Data, including field notes, transcribed audio-recordings, and drawings, were deductively analyzed using content analysis techniques. Guided by the following framework, data pertaining to symptoms, vignettes, and avatars were coded into five categories: a) Relevant; b) Irrelevant; c) To modify; d) To add; e) Unsure. Overall, 70.8% of Sisom symptoms were deemed relevant for inclusion, with 49.4% directly incorporated, and 21.3% incorporated with changes to syntax, and/or vignette, and/or location. Three additions were made to the ‘Avatar’ island. This allowed children to celebrate their uniqueness: ‘Makes you feel like you’re not like everybody else.’ One new island, ‘About Me’, was added to capture children’s worldviews. One new sub-island, ‘Getting Around’, was added to reflect accessibility issues. These issues were related to the children’s independence, their social lives, as well as the perceptions of others. In being consulted as experts throughout the co-creation of the Sisom OI paper prototype, children coded the Sisom symptoms and provided sound rationales for their chosen codes. In rationalizing their codes, all children shared personal stories about themselves and their relationships, insights about their OI, and an understanding of the strengths and challenges they experience on a day-to-day basis. The child’s perspective on their health is a basic right, and allowing it to be heard is the next frontier in the care of children with genetic diseases. Sisom OI, a methodological breakthrough within OI research, will offer clinicians an innovative and child-centered approach to capture this neglected perspective. It will provide a tool for the delivery of health care in the center that established the worldwide standard of care for children with OI.

Keywords: child health, interactive computerized communication tool, participatory approach, symptom management

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Authors: Arash Sepehri bonab

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One of the regions of critical development in medical devices has been the part of the software - as an indispensable component of a therapeutic device, as a standalone device, and more as of late, as applications on portable gadgets. The chance related to a breakdown of the standalone computer program utilized inside healthcare is in itself not a model for its capability or not as a medical device. It is, subsequently, fundamental to clarify a few criteria for the capability of a stand-alone computer program as a medical device. The number of computer program items and therapeutic apps is persistently expanding and so as well is used in wellbeing education (e. g., in clinics and doctors' surgeries) for determination and treatment. Within the last decade, the use of information innovation in healthcare has taken a developing part. In reality, the appropriation of an expanding number of computer devices has driven several benefits related to the method of quiet care and permitted simpler get to social and health care assets. At the same time, this drift gave rise to modern challenges related to the usage of these modern innovations. The program utilized in healthcare can be classified as therapeutic gadgets depending on the way they are utilized and on their useful characteristics. In the event that they are classified as therapeutic gadgets, they must fulfill particular directions. The point of this work is to show a computer program improvement system that can permit the generation of secure and tall, quality restorative gadget computer programs and to highlight the correspondence between each program advancement stage and the fitting standard and/or regulation.

Keywords: medical devices, regulation, software, development, healthcare

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Authors: Byron Baron

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Malta is a Mediterranean archipelago presenting a combination of environmental conditions which are less suitable for agriculture. This has resulted in a heavy dependence on agricultural chemicals, as well as over-extraction of groundwater, compounded by concomitant destruction of natural habitat surrounding the land areas used for agriculture. Such prolonged intensive land use has resulted in even greater degradation of Maltese soils. This study was thus designed with the goal of assessing the viability of implementing a sustainable agricultural system based on permaculture practices compared to the traditional local practices applied for intensive farming. The permaculture model was implemented over a period of two years for a number of locally-grown staple crops. The tangible targets included improved soil health, reduced water consumption, increased reliance on renewable energy, increased wild plant and insect diversity, and sustained crop yield. To achieve this in the permaculture test area, numerous practices were introduced. In line with permaculture principles land, tillage was reduced, only natural fertilisers were used, no herbicides or pesticides were used, irrigation was linked to a desalination system with sensors for monitoring soil parameters, mulching was practiced, and a photovoltaic system was installed. Furthermore, areas for wild plants were increased and controlled only by trimming, not mowing. A variety of environmental parameters were measured at regular intervals as well as crop yield (in kilos of produce) in order to quantify if any improvements in crop output and environmental conditions were obtained. The results obtained show a very slight improvement in overall soil health due to the brevity of the test period. Water consumption was reduced by over 50% with no apparent losses or ill effects on the crops. Renewable energy was sufficient to provide all electric power on-site, so apart from the initial investment costs, there were no limitations. Moreover, surrounding the commercial crops with borders of wild plants whilst only taking up less than 15% of the total land area assisted pollination, increased animal visitors, and did not give rise to any pest infestations. The conclusion from this study was that whilst results are promising, more detailed and long-term studies are required to understand the full extent of the implications brought about by such a transition, which hints towards the untapped potential of investing in the available resources on the island with the goal of improving the balance between economic prosperity and ecological sustainability.

Keywords: agronomic measures, ecological amplification, sustainability, permaculture

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Authors: Rebaz Sdiq Ismail

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Organ donation and transplantation is one of the most debated topics in modern jurisprudence. It is a surgical procedure that aims to prolong a person’s life suffering from damaged or missing organs. This surgical procedure is carried out by removing an organ from a donor and transplanting it into the body of the recipient. As human life is of high value in Islamic Sharia, therefore, the donor and recipient should go through an intensive medical examination to remove any health risk associated with the organ and transplantation procedure. Thus, in carrying out the organ donation process, any violation of the Sharia decree that might cause harm to the human body is strictly prohibited. The researcher concludes that the former scholars of Islamic Sharia, along with some of the contemporary scholars, are against the entire concept of organ donation and transplant. However, the majority of contemporary scholars support organ donation.

Keywords: law, donation, organ, Kurdistan, sharia

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Authors: Zahid Hussain

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Provincial Disaster Management Authority (PDMA) Punjab was established under NDM Act 2010 and now working under Senior Member Board of Revenue, deals with the whole spectrum of disasters including preparedness, mitigation, early warning, response, relief, rescue, recovery and rehabilitation. The District Disaster Management Authorities (DDMA) are acting as implementing arms of PDMA in the districts to respond any disaster. DDMAs' role is very important in disaster mitigation, response and recovery as they are the first responder and closest tier to the community. Keeping in view the significant role of DDMAs, technical and human resource capacity are need to be checked. For calculating the technical efficiencies of District Disaster Management Authority (DDMA) in Punjab, three inputs like number of labour, the number of transportation and number of equipment, two outputs like relief assistance and the number of rescue and 25 districts as decision making unit have been selected. For this purpose, 8 years secondary data from 2005 to 2012 has been used. Data Envelopment Analysis technique has been applied. DEA estimates the relative efficiency of peer entities or entities performing the similar tasks. The findings show that all decision making unit (DMU) (districts) are inefficient on techonological and scale efficiency scale while technically efficient on pure and total factor productivity efficiency scale. All DMU are found technically inefficient only in the year 2006. Labour and equipment were not efficiently used in the year 2005, 2007, 2008, 2009 and 2012. Furthermore, only three years 2006, 2010 and 2011 show that districts could not efficiently use transportation in a disaster situation. This study suggests that all districts should curtail labour, transportation and equipment to be efficient. Similarly, overall all districts are not required to achieve number of rescue and relief assistant, these should be reduced.

Keywords: DEA, DMU, PDMA, DDMA

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Authors: Hadia Rafi

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To make any decision in any work/task/project it involves many factors that needed to be looked. The analytic Hierarchy process (AHP) is based on the judgments of experts to derive the required results this technique measures the intangibles and then by the help of judgment and software analysis the comparisons are made which shows how much a certain element/unit leads another. AHP includes how an inconsistent judgment should be made consistent and how the judgment should be improved when possible. The Priority scales are obtained by multiplying them with the priority of their parent node and after that they are added.

Keywords: AHP, priority scales, parent node, software analysis

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Authors: Bolysbek Utelbayev, Tasmagambetova Aigerim, Toktasyn Raila, Markayev Yergali, Myrzakhanov Maxat

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Intensive development of secondary processes of destructive processing of crude oil has led to the occurrence of oil refining factories resources of C2-C4 hydrocarbons. Except for oil gases also contain basically C2-C4 hydrocarbon gases where some of the amounts are burned. All these data has induced interest to the study of producing alkylate from hydrocarbons С2-С4 which being as components of motor fuels. The purpose of this work was studying transformation propane-propene, butane-butene fractions at the presence of the ruthenium-chromic support catalyst whereas the carrier is served pillar - structural montmorillonite containing in native bentonite clay. In this work is considered condition and structure of the bentonite clay from the South-Kazakhstan area of the Republic Kazakhstan. For preparation rhodium support catalyst (0,5-1,0 mass. % Rh) was used chloride of rhodium-RhCl3∙3H2O, as a carrier was used modified bentonite clay. For modifying natural clay to pillar structural form were used polyhydroxy complexes of chromium. To aqueous solution of chloride chromium gradually flowed the solution of sodium hydroxide at gradual hashing up to pH~3-4. The concentration of chloride chromium was paid off proceeding from calculation 5-30 mmole Cr3+ per gram clay. Suspension bentonite (~1,0 mass. %) received by intensive washing it in water during 4 h, pH-water extract of clay makes -8-9. The acidity of environment supervised by means of digital pH meter OP-208/1. In order to prevent coagulation of a solution polyhydroxy complexes of chromium, it was slowly added to a suspension of clay. "Reserve of basicity" Cr3+:/OH-allowing to prevent coagulation chloride of rhodium made 1/3. After endurance processed suspensions of clay during 24 h, a deposit was washed by water and condensed. The sample, after separate from a liquid phase, dried at first at the room temperature, and then at 110°C (2h) with the subsequent rise the temperature up to 180°C (4h). After cooling the firm mass was pounded to a powder, it was shifted infractions with the certain sizes of particles. Fractions of particles modifying clay in the further were impregnated with an aqueous solution with rhodium-RhCl3∙3H2O (0,5-1,0 mаss % Rh ). Obtained pillar structural bentonite approaches heat resistance and its porous structure above the 773K. Pillar structural bentonite was used for preparation 1.0% Ru/Carrier (modifying bentonite) support catalysts where is realised alkylation of C2-C4 hydrocarbons. The process of alkylation is carried out at a partial pressure of hydrogen 0.5-1.0MPa. Outcome 2.2.4 three methyl pentane and 2.2.3 trimethylpentane achieved 40%. At alkylation butane-butene mixture outcome of the isooctane is achieved 60%. In this condition of studying the ethene is not undergoing to alkylation.

Keywords: alkylation, butene, pillar structure, ruthenium catalyst

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Authors: Innocent Atuhe, Babra Nalwadda, Grace Mulyowa Kitunzi, Annabella Haninka Ejiri

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Background: Atopic Dermatitis (AD) is one of the most prevalent and growing chronic inflammatory skin diseases in African prisons. AD care is limited in African due to lack of information about the disease amongst primary care workers, limited access to dermatologists, lack of proper training of healthcare workers, and shortage of appropriate treatments. We designed and implemented the Prisons Telederma project based on the recommendations of the International Society of Atopic Dermatitis. Our overall goal was to increase access to dermatologist-led care for prisoners with AD through teledermatology in Uganda. We aimed to; i) to increase awareness and understanding of teledermatology among prison health workers; and ii) to improve treatment outcomes of prisoners with atopic dermatitis through increased access to and utilization of consultant dermatologists through teledermatology in Uganda prisons: Approach: We used Store-and-forward Teledermatology (SAF-TD) to increase access to dermatologist-led care for prisoners and prisons staff with AD. We conducted a five days training for prison health workers using an adapted WHO training guide on recognizing neglected tropical diseases through changes on the skin together with an adapted American Academy of Dermatology (AAD) Childhood AD Basic Dermatology Curriculum designed to help trainees develop a clinical approach to the evaluation and initial management of patients with AD. This training was followed by blended e-learning, webinars facilitated by consultant Dermatologists with local knowledge of medication and local practices, apps adjusted for pigmented skin, WhatsApp group discussions, and sharing pigmented skin AD pictures and treatment via zoom meetings. We hired a team of Ugandan Senior Consultant dermatologists to draft an iconographic atlas of the main dermatoses in pigmented African skin and shared this atlas with prison health staff for use as a job aid. We had planned to use MySkinSelfie mobile phone application to take and share skin pictures of prisoners with AD with Consultant Dermatologists, who would review the pictures and prescribe appropriate treatment. Unfortunately, the National Health Service withdrew the app from the market due to technical issues. We monitored and evaluated treatment outcomes using the Patient Oriented Eczema Measure (POEM) tool. We held four advocacy meetings to persuade relevant stakeholders to increase supplies and availability of first-line AD treatments such as emollients in prison health facilities. Results: Draft iconographic atlas of the main dermatoses in pigmented African skin Increased proportion of prison health staff with adequate knowledge of AD and teledermatology from 20% to 80% Increased proportion of prisoners with AD reporting improvement in disease severity (POEM scores) from 25% to 35% in one year. Increased proportion of prisoners with AD seen by consultant dermatologist through teledermatology from 0% to 20% in one year. Increased the availability of AD recommended treatments in prisons health facilities from 5% to 10% in one year

Keywords: teledermatology, prisoners, reaching, un-reachable

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Authors: Reshma Parvin Nuri, Heather Michelle Aldersey, Setareh Ghahari

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Objectives: Worldwide, it is well known that taking care of children with disabilities (CWD) can have a significant impact on the entire family unit. Over the last few decades, an increased number of studies have been conducted on families of CWD in higher income countries, and much of this research has identified family needs and strategies to meet those needs. However, family needs are incredibly under-studied in developing countries. Therefore, the aims of this study were to: (a) explore the needs of families of children with cerebral palsy (CP) in Bangladesh; (b) investigate how some of the family needs have been met and (c) identify the sources of supports that might help the families to meet their needs in the future. Methods: A face to face, semi-structured in-depth interview was conducted with 20 family members (12 mothers, 4 fathers, 1 sister, 2 grandmothers, and 1 aunt) who visited the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh between June and August 2016. Constant comparison method of grounded theory approach within the broader spectrum of qualitative study was used to analyze the data. Results: Participants identified five categories of needs: (a) financial needs, (b) access to disability-related services, (c) family and community cohesion, (d) informational needs, and (e) emotional needs. Participants overwhelmingly reported that financial need is their greatest family need. Participants noted that families encountered additional financial expenses for a child with CP, beyond what they would typically pay for their other children. Participants were seeing education as their non-primary need as they had no hope that their children would be physically able to go to school. Some participants also shared their needs for social inclusion and participation and receiving emotional support. Participants further expressed needs to receive information related to the child’s health condition and availability/accessibility of governmental support programs. Besides unmet needs, participants also highlighted that some of their needs have been met through formal and informal support systems. Formal support systems were mainly institution-based and run by non-governmental organizations, whereas participants identified informal support coming from family, friends and community members. Participants overwhelmingly reported that they receive little to no support from the government. However, participants identified the government as the key stakeholder who can play vital role in meeting their unmet needs. Conclusions: In the next phase of this research, the plan is to understand how the Government of the People’s Republic of Bangladesh is working to meet the needs of families of CWD. There is also need for further study on needs of families of children with conditions other than CP and those who live in the community and do not have access to the CRP Services. There is clear need to investigate ways to enable children with CP have better access to education in Bangladesh.

Keywords: Bangladesh, children with cerebral palsy, family needs, support

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Authors: Cecilia Fagerstrom, Solve Elmstahl, Lena S. Wranker

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The conditions of increased morbidity in an aging population cause the need for family care to become more common at an advanced age. The role of family caregivers may well last for a long time but may also change over time, from being caregivers to being non-caregivers or vice versa. Although demands associated with family caring change as individuals enter into, engage with, and exit from this role, the evidence regarding the impact of family caregiving transitions on the health of older carers is still limited. This study comprised individuals (n=2294, 60+years) from the southern part of Sweden included in the project Swedish National study of Aging and Care. Caregiving transitions are discussed in the categories: enter, exit, and continuing during a six-year period. Individuals who exited caregiving during the time were older than those who continued or entered into the role of caregiving. At the six-year follow-up, caregivers who were continuing or had exited caregiving were more often worried about their own health compared to baseline. Resembling findings were not found in those who entered caregiving. Family caregiving transitions of exiting, entering or continuing had no effect on the individuals’ functional, physical and mental health expect for participants who entered in caregiving. For them, entering the role of family caregiving was associated with an improvement in physical health during the six years follow up period. Conclusion: Although the health impact of different caregiving transitions in late life does not differ, individual conditions and health at baseline are important parameters to take into consideration to improve long-term health in family caregivers.

Keywords: family caregiving, health, old age, transition

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Authors: Sh. Arzani, H. Kazemi Esfeh, Y. Galeh Zadeh, V. Akbari

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Ethylene dichloride is a colorless liquid with a smell like chloroform. EDC is classified in the simple hydrocarbon group which is obtained from chlorinating ethylene gas. Its chemical formula is C2H2Cl2 which is used as the main mediator in VCM production. Therefore, the purification process of EDC is important in the petrochemical process. In this study, the purification unit of EDC was simulated, and then validation was performed. Finally, the impact of process parameter was studied for the degree of EDC purity. The results showed that by increasing the feed flow, the reflux impure combinations increase and result in an EDC purity decrease.

Keywords: ethylene dichloride, purification, edc, simulation

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Authors: Ivannys Cappas Perez

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Worldwide the population of older adults is increasing. The World Health Organization (2022) estimates that it will double by 2050. Informal caregivers of older adults may experience contradictory impulses, overload, and multiple losses before the death of the older adult in their care. The general purpose of research was to identify and describe the affective ambivalence in informal caregivers of older adults in the face of loss and grief processes. The dimensions under study were affective ambivalence, informal caregivers of older adults, loss processes and the grieving process. A qualitative approach methodology and an empirical phenomenological design were used through Clark Moustakas' Multiangulation Model to describe, categorize and interpret, intentionality, temporality and intersubjectivity a problem never studied. Among the findings was the feminization of the role. Affective ambivalence is manifested through emotions, feelings, thoughts and behavior, including non-verbal language. The assumption of the role is highly influenced by an affective and moral factor, where a minimum of 35 hours per week are invested in without family and financial support. It was found that the participants experience objective and subjective overload. Furthermore, because of the role, they experienced loss of life, loss of aspects of themselves, loss of objects, emotional losses, and losses linked to development. On the other hand, up to two types of grief were found simultaneously. Finally, the presence of affective ambivalence was found with the same intensity 13 years after the loss of the older adult under care.

Keywords: affective ambivalence, informal caregivers of older adults, loss processes, grief processes

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Authors: Stephane Maingard, Babu Paturi, Maura Daly, Finnola Armstrong

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Background: Perinatal optimization involves the implementation of twelve intervention bundles of care at Our Lady of Lourdes Hospital, reliably delivering evidence-based interventions in the antenatal, intrapartum, and neonatal period to improve preterm outcomes. These key interventions (e.g. Antenatal steroids, Antenatal counselling, Optimal cord management, Respiratory management etc.) are based on WHO (World Health Organization, BAPM (British Association of Perinatal Medicine), and the latest 2022 European Consensus guidelines recommendations. Methodology: In February 2023, a quality improvement project team (pediatricians, neonatologists, obstetricians, clinical skills managers) was established, and a project implementation plan was developed. The Program Study Act implemented the following: 1. Antenatal consultation pathway, 2. Creation and implementation of a perinatal checklist for preterm births less than 34 weeks of gestation, 3. Process changes to ensure the checklist is completed, 4. Completion of parent and staff surveys, 5. Ongoing training. We collected and compared a range of data before and after implementation. Results: Preliminary analysis so far at 1 month demonstrates improvement in the following areas: 50% increase in antenatal counselling. Right place of birth increased from 85% to 100%. Magnesium sulphate increased from 56% to 100%. No change was observed in buccal colostrum administration (28%), delayed cord clamping (75%), caffeine administration (100%), blood glucose level at one hour of life > 2,6mmol (85%). There was also no change noted in respiratory support at resuscitation, CPAP only (47%), IPPV with CPAP (45%), IPPV with intubation (20%), and surfactant administration (28%). A slight decrease in figures was noted in the following: steroid administration from 80% to 75% and thermal care obtaining optimal temperature on admission (65% to 50%). Discussion: Even though the findings are preliminary, the directional improvement shows promise. Improved communication has been achieved between all stakeholders, including our patients, who are key team members. Adherence to the bundles of care will help to improve survival and neurodevelopmental outcomes as well as reduce the length of stay, thereby overall reducing the financial cost, considering the lifetime cost of cerebral palsy is estimated at €800,000 and reducing the length of stay can result in savings of up to €206,000. Conclusion: Preliminary results demonstrate improvements across a range of patient, process, staff, and financial outcomes. Our future goal is a seamless pathway of patient centered care for babies and their families. This project is an interdisciplinary collaboration to implement best practices for a vulnerable patient cohort. Our two main challenges are changing our organization’s culture as well as ensuring the sustainability of the project.

Keywords: perinatal, optimization, antenatal, counselling, IPPV

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Authors: Dana Mohammed, Fatemah Abdullah, Hawraa Ali, Najat Al-Shaer, Rawan Al-Awadhi, , Magdy Helal

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We study the patient service performance at the emergency department of a major Kuwaiti public hospital, using discrete simulation and lean concepts. In addition to the common problems in such health care systems (over crowdedness, facilities planning and usage, scheduling and staffing, capacity planning) the emergency department suffered from several cultural and patient behavioural issues. Those contributed significantly to the system problems and constituted major obstacles in maintaining the performance in control. This led to overly long waiting times and the potential of delaying providing help to critical cases. We utilized the visual management tools to mitigate the impact of the patients’ behaviours and attitudes and improve the logistics inside the system. In addition a proposal is made to automate the date collection and communication within the department using RFID-based barcoding system. Discrete event simulation models were developed as decision support systems; to study the operational problems and assess achieved improvements. The simulation analysis resulted in cutting the patient delays to about 35% of their current values by reallocating and rescheduling the medical staff. Combined with the application of the visual management concepts, this provided the basis to improving patient service without any major investments.

Keywords: simulation, visual management, health care system, patient

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Authors: Lukasz Baka

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Objective. The study aimed to investigate the direct and indirect - mediated through insomnia - effect of coronavirus anxiety on exhaustion from the perspective of Hobfol Conservation of Resources (COR) theory. According to COR theory, critical events (e.g. the coronavirus epidemic) make people fearful of losing their valuable resources. A prolonged state of anxiety may lead to sleep troubles, which over time, results in an increase in exhaustion. Materials and Methods: Data were collected among 440 Polish healthcare providers, including nurses and midwives, doctors, paramedics, medical assistance, and wardens. Three measurements were used: Coronavirus Anxiety Scale (CAS), Copenhagen Psychosocial Questionnaire (COPSOQ, sleep trouble subscale) and Oldenburg Burnout Inventory (OLBI, exhaustion subscale). Hypotheses were tested by the use of Structural Equation Modelling (SEM). Results: The obtained results fully support the hypotheses. Both the direct and indirect relationships between coronavirus anxiety and exhaustion were observed. Specifically, high coronavirus anxiety increased insomnia, which in turn contributed to the development of exhaustion. Conclusion: The results are consistent with the COR theory. Prolonged coronavirus anxiety and sleep problems depleted healthcare providers’ resources and made them feel exhausted. Exhaustion among these workers can have serious consequences not only for themselves but also for the health of their patients, therefore researches into effective ways to deal with coronavirus anxiety are needed.

Keywords: coronavirus anxiety, front-line healt-care workers, insomnia, job burnout

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Authors: Xindong An, Kai Gu

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Urban intensification is regarded as the prevalent strategy in many cities of the world to ease the pressures of urban sprawl and deliver sustainable development through increasing the density of built form and activities. However, within the context of intensive development, planning and design control measures that help to maintain and promote the character of existing residential environments have been slow to develop. This causes the possible loss of the character of an area that makes a place unique and distinctive. The purpose of this paper is to explore the way of identifying the character of an urban area for the planning of urban landscape in the implementation of intensification. By employing the theory of urban morphology, the concept of morphological region is used for the analysis and characterisation of the spatial structure of the urban landscape in terms of ground plans, building types, and building and land utilisation. The morphological mapping of the character of urban landscape is suggested, which lays a foundation for more sensitive planning of urban landscape changes.

Keywords: character areas, urban intensification, urban morphology, urban landscape

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Authors: Debabrata Adhikari, Mikhail Matveev, Louise Brown, Jan Kočí, Andy Long

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Resin transfer molding (RTM) is increasingly used for manufacturing high-quality composite structures due to its additional advantages over prepregs of low-cost out-of-autoclave processing. However, to retain the advantages, it is critical to reduce the void content during the injection. Reinforcements commonly used in RTM, such as woven fabrics, have dual-scale porosity with mesoscale pores between the yarns and the micro-scale pores within the yarns. Due to the fabric geometry and the nature of the dual-scale flow, the flow front during injection creates a complicated fingering formation which leads to void formation. Analytical modeling of void formation for woven fabrics has been widely studied elsewhere. However, there is scope for improvement to the reduction in void formation in 3D fabrics wherein the in-plane yarn layers are confined by additional through-thickness binder yarns. In the present study, the structural morphology of the tortuous pore spaces in the 3D fabric has been studied and implemented using open-source software TexGen. An analytical model for the void and the fingering formation has been implemented based on an idealized unit cell model of the 3D fabric. Since the pore spaces between the yarns are free domains, the region is treated as flow-through connected channels, whereas intra-yarn flow has been modeled using Darcy’s law with an additional term to account for capillary pressure. Later the void fraction has been characterised using the criterion of void formation by comparing the fill time for inter and intra yarn flow. Moreover, the dual-scale two-phase flow of resin with air has been simulated in the commercial CFD solver OpenFOAM/ANSYS to predict the probable location of voids and validate the analytical model. The use of an idealised unit cell model will give the insight to optimise the mesoscale geometry of the reinforcement and injection parameters to minimise the void content during the LCM process.

Keywords: 3D fiber, void formation, RTM, process modelling

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Authors: Sharon Milberger, Jane Turner, Denise White-Perkins

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Michigan shares the overall U.S. national need for more highly qualified professionals who have knowledge and experience in the use of evidence-based practices to meet the special health care needs of children, adolescents, and adults with neurodevelopmental disabilities including autism spectrum disorder (DD/ASD). The Michigan Leadership Education in Neurodevelopmental Disabilities (MI-LEND) program is a consortium of six universities that spans the state of Michigan and serves more than 181,800 undergraduate, graduate, and professional students. The purpose of the MI LEND program is to improve the health of infants, children and adolescents with disabilities in Michigan by training individuals from different disciplines to assume leadership roles in their respective fields and work across disciplines. The MI-LEND program integrates “L.I.F.E.” perspectives into all training components. L.I.F.E. is an acronym for Leadership, Interdisciplinary, Family-Centered and Equity perspectives. This paper will describe how L.I.F.E. perspectives are embedded into all aspects of the MI-LEND training program including the application process, didactic training, community and clinical experiences, discussions, journaling and projects. Specific curriculum components will be described including content from a training module dedicated to Equity. Upon completion of the Equity module, trainees are expected to be able to: 1) Use a population health framework to identify key social determinants impacting families and children; 2) Explain how addressing bias and providing culturally appropriate linguistic care/services can influence patient/client health and wellbeing; and 3) Describe the impact of policy and structural/institutional factors influencing care and services for children with DD/ASD and their families. Each trainee completes two self-assessments: the Cultural and Linguistic Competence Health Practitioner Assessment and the other assessing social attitudes/implicit bias. Trainees also conduct interviews with a family with a child with DD/ASD. In addition, interdisciplinary Equity-related group activities are incorporated into face-to-face training sessions. Each MI-LEND trainee has multiple ongoing opportunities for self-reflection through discussion and journaling and completion of a L.I.F.E. project as a culminating component of the program. The poster will also discuss the challenges related to teaching and measuring successful outcomes related to diversity/equity perspectives.

Keywords: disability, diversity, equity, training

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Authors: Mona Nada, Fahmy Fahmy

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Background: Pleomorphic dermal sarcoma is a rare form of skin cancer affecting cutaneous layer and, in some cases associated with recurrence and metastasis, very commonly to seen in elderly patient affecting the area of head and neck. Pleomorphic dermal sarcoma rises in ultraviolet light exposed areas. The symptoms and severity of this kind of skin cancer varies according to histological factors. The differentiation of Pleomorphic dermal sarcoma needs extensive immunohistochemistry, as the diagnosis depends mainly on exclusion to rule out other malignancy like poorly differentiated squamous cell carcinoma, melanoma, angiosarcoma and leiomyosarcoma. Objective: assessing the management of Pleomorphic dermal sarcoma in our unit and compared to the updated guidelines. Design: Retrospective study Collection of patient data from medical records at countess of Chester plastic surgery unit of the last 5 years, all histologically confirmed Pleomorphic dermal sarcoma (2017-2023). Data were collected confirmed to be Pleomorphic dermal sarcoma were included in the study. The data collected: clinical description of the lesions at first presentation, operation time, multidisciplinary team discussion, plan, referral as well as second operation and investigation done. With comparison of histological examination, immunohistochemistry staining, the excision and rate of recurrence. Results: data collected N19 from (2017-2023) showed the disease predominantly affecting males and the lesion mainly in head and neck, the diagnosis needed extensive immunohistochemistry to differentiate between other malignancy. recurrence present in numbers of the cases which managed after multidisciplinary team discussion either by excision or radiotherapy. Conclusion: Pleomorphic dermal sarcoma is a rare malignancy which needs more understanding and avoid missing as it is aggressive form of skin cancer, there is a chance of metastasis and recurrence which makes it very important to understand the process of development of the cancer and frequent review of the management guidelines.

Keywords: pleomorphic dermal sarcoma, recurrence, radiotherapy, surgical

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Authors: N. H. D. P. Fonseka, I. H. Rajapakse, A. S. Dissanayake

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Background: Problem drinking, namely alcohol dependence (AD) and alcohol abuse (AA) are associated with major medical, social and economic adverse consequences. Problem drinking behavior is noted among those admitted to hospitals due to alcohol-related medical/surgical complaints as well as those with unrelated complaints. Literature shows an association between alcohol consumption and depression. Aims of this study were to determine the frequency of problem drinking and depression among males with a history of alcohol consumption tertiary care setting in Southern Sri Lanka. Method: Two-hundred male patients who consumed alcohol, receiving care in medical and surgical wards in Teaching Hospital Galle, were assessed. A validated J12 questionnaire of the Mini International Neuropsychiatric Interview was administered to determine frequency AA and AD. A validated PHQ 9 questionnaire to determine the prevalence and severity of depression. Results: Sixty-three participants (31%) had problem drinking. Of them, 61% had AD, and 39% had AA. Depression was noted in 39 (19%) subjects. In those who reported alcohol consumption not amounting to problem drinking, depression was noted in 23 (16%) participants. Mild depression was seen in 17, moderate in five and moderately severe in one. Among those who had problem drinking, 16 (25%) had depression. Mild depression was seen in four, moderate in seven, moderately severe in three and severe in two. Conclusions: A high proportion alcohol users had problem drinking. Adverse consequences associated with problem drinking places a major strain on the health system especially in a low resource setting where healthcare spending is limited and alcohol cessation support services are not well organised. Thus alcohol consumption and problem drinking behaviour need to be inquired into all medical consultations. Community prevalence of depression in Sri Lanka is approximately 10%. Depression among those consuming alcohol was two times higher compared to the general population. The rates of depression among those with problem drinking were especially high being 2.5 times more common than in the general population. A substantial proportion of these patients with depression had moderately severe or severe depression. When depression coexists with problem drinking, it may increase the tendency to consume alcohol as well as act as a barrier to the success of alcohol cessation interventions. Thus screening all patients who consume alcohol for depression, especially those who are problem drinkers becomes an important step in their clinical evaluation. In addition, in view of the high prevalence of problem drinking and coexistent depression, the need to organize a structured alcohol cessation support service in Sri Lanka as well as the need for increasing access to psychological evaluation and treatment of those with problem drinking are highlighted.

Keywords: alcohol abuse, alcohol, depression, problem drinking

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Authors: S. Hallal, Z. Chami, A. Hadji-Lehtihet, S. Sokhal-Boudella, A. Berhoune, L. Yargui

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Gaucher disease is the most common lysosomal storage in our population, it is due to a deficiency of β –glucosidase acid. The enzyme deficiency causes a pathological accumulation of undegraded substrate in lysosomes. This metabolic overload is responsible for a multisystemic disease with hepatosplenomegaly, anemia, thrombocytopenia, and bone involvement. Neurological involvement is rare. The laboratory diagnosis of Gaucher disease consists of phenotypic diagnosis by determining the enzymatic activity of β - glucosidase by fluorimetric method, a study by genotypic diagnosis in the GBA gene, limiting the search recurrent mutations (N370S, L444P, 84 GG); PCR followed by an enzymatic digestion. Abnormal profiles were verified by sequencing. Monitoring of treated patients is provided by the determination of chitotriosidase. Our experience spaning a period of 6 years (2007-2014) has enabled us to diagnose 78 patients out of a total of 328 requests from the various departments of pediatrics, internal medicine, neurology. Genotypic diagnosis focused on the entire family of 9 children treated at pediatric CHU Mustapha, which help define the clinical form; or 5 of them had type III disease, carrying the L444P mutation in the homozygous state. Three others were composite (N370/L444P) (N370S/other unintended mutation in our study), and only in one family no recurrent mutation has been found. This molecular study permits screening of heterozygous essential for genetic counseling.

Keywords: Gaucher disease, mutations, N370S, L444P

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Authors: Norhan Anwar Elshikh

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The study aimed to identify the extent of rural women’s awareness of gender issues and discrimination against women. The study also investigated the relationship between the extent of that awareness and the social and economic characteristics of the surveyed women. The study aimed to find both the related factors and the affecting factors of the surveyed women's awareness of gender issues and the discrimination against them. The study then proposed some recommendations that can raise rural women's ability to understand gender issues and discrimination against women. To achieve the study goals, a field study was conducted in the Al-Buhaira governorate. Abu Homs township was chosen as one of the traditional rural areas closest in its characteristics to most rural areas in Egypt, and the Abu Homs township consists of one town and seven rural local units. The local unit of Baraka Ghattas was chosen, as it is considered on average level in human development. Baraka Ghattas local unit includes five villages. Alherfah village and Barakat Ghatas village were chosen to conduct the study as they represent the high and the low levels of human development, respectively. The study included households of women who were in their fertile period in the sample’s villages. The volume of the sample was divided among the two villages according to the number of families in each village, so that each village is represented in the sample space by the same percentage of its presence in the original community. The size of the sample was determined, which is 385 women, According to the Crijsey and Morgen equation. To execute the study, a questionnaire was designed and collected through personal interviews. The results showed that the independent variables most influencing the dependent variable are, from high to low, the economic level of the respondent's family, the number of children of the respondent, the level of formal education of the husband, then leadership ability and the level of ambition, respectively. These variables are responsible for explaining 52% of the change in the extent of rural women's awareness of gender issues and discrimination against women. The study was concluded by providing suggestions and recommendations to improve rural women's awareness of gender issues and discrimination against women.

Keywords: gender, rural women, discrimination, discrimination against women

Procedia PDF Downloads 42