Search results for: Pediatric intensive care unit

Authors: Carlos Roberto Valêncio, Fábio Renato de Almeida, Thatiane Kawabata, Leandro Alves Neves, Julio Cesar Momente, Mario Luiz Tronco, Angelo Cesar Colombini

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By running transactions under the Snapshot isolation we can achieve a good level of concurrency, specially in databases with high-intensive read workloads. However, Snapshot is not immune to all the problems that arise from competing transactions and therefore no serialization warranty exists. We propose in this paper a technique to obtain data consistency with Snapshot by using some special triggers that we named Daemon Triggers. Besides keeping the benefits of the Snapshot isolation, the technique is specially useful for those database systems that do not have an isolation level that ensures serializability, like Firebird and Oracle. We describe all the anomalies that might arise when using the Snapshot isolation and show how to preclude them with Daemon Triggers. Based on the methodology presented here, it is also proposed the creation of a new isolation level: Daemon Snapshot.

Keywords: data consistency, serialization, snapshot, isolation

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Authors: Sima Najafzadehkhoei, George Vega Yon

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This paper presents an approach for calibrating Agent-Based Models (ABMs) efficiently, utilizing Convolutional Neural Networks (CNNs) and Long Short-Term Memory (LSTM) networks. These machine learning techniques are applied to Susceptible-Infected-Recovered (SIR) models, which are a core framework in the study of epidemiology. Our method replicates parameter values from observed trajectory curves, enhancing the accuracy of predictions when compared to traditional calibration techniques. Through the use of simulated data, we train the models to predict epidemiological parameters more accurately. Two primary approaches were explored: one where the number of susceptible, infected, and recovered individuals is fully known, and another using only the number of infected individuals. Our method shows promise for application in other ABMs where calibration is computationally intensive and expensive.

Keywords: ABM, calibration, CNN, LSTM, epidemiology

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Authors: Lu-Chiu Huang, Pei-Pei Chen, Li-Chin Yu, Chiao-Wen Kuo, Tsui-Tao Liu, Rung-Chuang Feng

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Purpose: People put increasing emphasis on demands of medical quality and protecting their interests. Patients' or family's dissatisfaction with medical care may easily lead to medical dispute. Physician-family communication plays an essential role in medical care. A sound communication cannot only strengthen patients' belief in the medical team but make patient have definite insight into treatment course of the disease. A family meeting provides an effective platform for communication between clinical staff, patients and family. Decisions and consensuses formed in family meetings can promote patients' or family's satisfaction with medical care. Clinical staff's attitudes toward family meeting may determine behavioral intentions to hold family meeting. This study aims to explore clinical staff's difficulties in holding family meeting and evaluate how their attitudes and behavior influence the effect of family meetings. Methods: This was a cross-sectional study. It was conducted at a regional teaching hospital in Taipei city. The research team developed its own structural questionnaires, whose expert validity was checked by the nursing experts. Participants filled in the questionnaires online. Data were collected by convenience sampling. A total of 568 participants were invited. They included doctors, nurses, social workers, and so on. Results: 1) The average score of ‘clinical staff’s attitudes to family meetings’ was 5.15 (SD=0.898). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It indicated that clinical staff had positive attitudes toward family meetings, 2) The average score of ‘clinical staff’s behavior to family meetings’ was 5.61 (SD=0.937). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It meant clinical staff tended to have positive behavior at the family meeting, and 3) The average score of ‘Difficulty in conducting family meetings’ was 5.15 (SD=0.897). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. The higher the score was, the less difficulty the clinical staff felt. It demonstrated clinical staff felt less difficulty in conducting family meetings. Clinical staff's identification with family meetings brought favored effects. Persistent and active promotion for family meetings can bring patients and family more benefits. Implications for practice: Understanding clinical staff's difficulty in participating family meeting and exploring their attitudes or behavior toward physician-family communication are helpful to develop modes of interaction. Consequently, quality and satisfaction of physician-family communication can be increased.

Keywords: clinical staff, communication, family meeting, physician-family

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Authors: Gaye Demi̇rtaş Adli

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Research: It was conducted to determine the factors affecting the fear of self-injection and self-pricking of fingers of diabetic individuals.The study was conducted as a cross-sectional, relation-seeking, and descriptive study. The study was conducted on 122 patients who had just started insulin therapy. Data were obtained through The Descriptive Patient Form, The Diabetic Self-Injection, and the Fear of Testing Questionnaire Form (D-FISQ). Descriptive statistical methods used in the evaluation of data are the Mann-Whitney U test, Kruskal-Wallis H test, and the Spearman correlation. The factors affecting the scale scores were evaluated with multiple linear regression analysis. The value of P<0.05 was considered statistically significant. Study group: 56.6% of the patients are male patients. Fear of self-injection (injection), fear of self-testing (test), and total fear (total) scores of women were found to be statistically higher than men (p<0.001). Age, gender, and pain experience were important variables that affected patients' fear of injections. With a one-unit increase in age, the injection fear score decreased by 0.13 points, and the mean injection fear score of women was 2.11 points higher than that of men. It was determined that the patient's age, gender, living with whom, and blood donation history were important variables affecting the fear of self-testing. It is seen that the fear test score decreases by 0.18 points with an increase in age by one unit, and the fear test scores of women compared to men are on average 3,358 points, the fear test scores of those living alone are 4,711 points compared to those living with family members, and the fear test scores of those who do not donate blood are 2,572 compared to those who donate blood score, it was determined that those with more pain experience were 3,156 points higher on average than those with less fear of injection. As a result, it was seen that the most important factors affecting the fear of insulin injection and finger punching in individuals with diabetes were age, gender, pain experience, living with whom, and blood donation history.

Keywords: diabetes, needle phobia, fear of injection, insulin injection

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Authors: Upasana Bhumbla

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Background: Hepatitis C virus is a major cause of chronic hepatitis, which can further lead to cirrhosis of the liver and hepatocellular carcinoma. Worldwide the burden of Hepatitis C infection has become a serious threat to the human race. Hepatitis C virus (HCV) has population-specific genotypes and provides valuable epidemiological and therapeutic information. Genotyping and assessment of viral load in HCV patients are important for planning the therapeutic strategies. The aim of the study is to study the changing trends of prevalence and genotypic distribution of hepatitis C virus in a tertiary care hospital in Western India. Methods: It is a retrospective study; blood samples were collected and tested for anti HCV antibodies by ELISA in Dept. of Microbiology. In seropositive Hepatitis C patients, quantification of HCV-RNA was done by real-time PCR and in HCV-RNA positive samples, genotyping was conducted. Results: A total of 114 patients who were seropositive for Anti HCV were recruited in the study, out of which 79 (69.29%) were HCV-RNA positive. Out of these positive samples, 54 were further subjected to genotype determination using real-time PCR. Genotype was not detected in 24 samples due to low viral load; 30 samples were positive for genotype. Conclusion: Knowledge of genotype is crucial for the management of HCV infection and prediction of prognosis. Patients infected with HCV genotype 1 and 4 will have to receive Interferon and Ribavirin for 48 weeks. Patients with these genotypes show a poor sustained viral response when tested 24 weeks after completion of therapy. On the contrary, patients infected with HCV genotype 2 and 3 are reported to have a better response to therapy.

Keywords: hepatocellular, genotype, ribavarin, seropositive

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Authors: Maxim A. Kadatskiy, Konstantin V. Khishchenko

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Iron alloys are widespread components in various types of structural materials which are exposed to intensive thermal and mechanical loads. Various quantum-statistical cell models with the approximation of self-consistent field can be used for the prediction of the behavior of these materials under extreme conditions. The application of these models is even more valid, the higher the temperature and the density of matter. Results of Hugoniot calculation for iron alloys in the framework of three quantum-statistical (the Thomas–Fermi, the Thomas–Fermi with quantum and exchange corrections and the Hartree–Fock–Slater) models are presented. Results of quantum-statistical calculations are compared with results from other reliable models and available experimental data. It is revealed a good agreement between results of calculation and experimental data for terra pascal pressures. Advantages and disadvantages of this approach are shown.

Keywords: alloy, Hugoniot, iron, terapascal pressure

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Authors: Prabha Rohatgi

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To obtain an efficient control over a huge amount of inventory of drugs in pharmacy department of any hospital, generally, the medicines are categorized on the basis of their cost ‘ABC’ (Always Better Control), first and then categorize on the basis of their criticality ‘VED’ (Vital, Essential, desirable) for prioritization. About one-third of the annual expenditure of a hospital is spent on medicines. To minimize the inventory investment, the hospital management may like to keep the medicines inventory low, as medicines are perishable items. The main aim of each and every hospital is to provide better services to the patients under certain limited resources. To achieve the satisfactory level of health care services to outdoor patients, a hospital has to keep eye on the wastage of medicines because expiry date of medicines causes a great loss of money though it was limited and allocated for a particular period of time. The objectives of this study are to identify the categories of medicines requiring incentive managerial control. In this paper, to minimize the total inventory cost and the cost associated with the wastage of money due to expiry of medicines, an inventory control model is used as an estimation tool and then nonlinear programming technique is used under limited budget and fixed number of orders to be placed in a limited time period. Numerical computations have been given and shown that by using scientific methods in hospital services, we can give more effective way of inventory management under limited resources and can provide better health care services. The secondary data has been collected from a hospital to give empirical evidence.

Keywords: ABC-VED inventory classification, multi item inventory problem, nonlinear programming technique, optimization of EOQ

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Authors: Frezer Alem Kebede

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The notion of viewing ICT as merely support for the business process has shifted towards viewing ICT as a critical business enabler. As such, the need for ICT devices has increased, contributing to high electronic equipment acquisition and disposal. Hence, its use and disposal must be seen in light of environmental sustainability, i.e., in terms of green use and disposal. However, there are limited studies on green Use and Disposal framework to be used as guiding lens by organizations in developing countries. And this study endeavors to address that need taking one of the largest multinational ICT intensive company in the country. The design and development of this framework passed through several stages, initially factors affecting green use and disposal were identified after quantitative and qualitative data analysis then there were multiple brainstorming sessions for the design enhancement as participative modelling was employed. Given the difference in scope and magnitude of the challenges identified, the proposed framework approaches green use and disposal in four imperatives; strategically, tactically, operationally and through continuous improvement.

Keywords: energy efficiency, green disposal, green ICT, green use, green use and disposal framework, sustainability

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Authors: Gulnaz Erkomaishvili, Eteri Kharaishvili, Marina Chavleishvili

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The paper discusses the economic policy of increasing national competitiveness, the tools, and means which help the country to improve its competitiveness. The sectors of the economy, in which the country can achieve a competitive advantage, are studied. It is noted that the country’s economic policy plays an important role in obtaining and maintaining a competitive advantage - authority should take measures to ensure a high level of education; scientific and research activities should be funded by the state; foreign direct investments should be attracted mainly in science-intensive industries; adaptation with the latest scientific achievements of the modern world and deepening of scientific and technical cooperation. Stable business environment and export-oriented strategy is the basis for the country’s economic growth. The studies have shown that institutional reforms in Georgia are not enough to significantly improve the country's competitiveness.

Keywords: competitiveness, economic policy, competitiveness improvement strategy, competitiveness of Georgia

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Authors: Ebele V. Okoli, Emmanuel Nwobi, Dozie Ezechukwu, Ijeoma Itanyi

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One in seven people worldwide suffer from a disability. 80% of people with disabilities live in developing countries. Negative attitudes and misconceptions among health-care providers constitute barri¬ers to optimal health care for people with disabilities. This underscores the relevance of a study of the attitude of Nigerian medical students towards disability and their willingness to work in the disability sector. This was a descriptive cross-sectional study conducted among 254 penultimate and final year medical students of a university in southeastern Nigeria. The mean age of the students was 24.8 ± 3.12 years. Majority of the students were male (75.2%), single (96.9%), of the Igbo tribe (86.6%), Christian (97.6%) and grew up in urban areas (68.1%). Results indicated that the medical students had a predominantly positive attitude towards people with disability as 73.8% had a positive attitude and mean attitude score was 67.03 ± 0.14 (positive attitude = 61 – 120, negative attitude = 0 - 60). Chi-square analysis did not show any significant effect of demographic and social factors on the students’ attitude towards People with Disabilities. The students were mostly willing to work in areas that address the challenges of people with disability (70.4%) but a greater proportion had never heard about Disability Studies (67.5%). About a third of the students (33.2%) would like to travel abroad to practice in the disability sector. Conclusions: The students generally had a positive attitude towards people with disability and a greater percentage were willing to work in the disability sector in their future career. About two-thirds had however, never heard about disability studies. There was some potential for brain drain among the students as a third of the population intended to practice abroad on graduation.

Keywords: attitudes, career interest, disability, medical students

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Authors: Xianglu Tang, Zhenxue Jiang, Zhuo Li

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Characterization of shale multi scale heterogeneity is an important part to evaluate size and space distribution of shale gas reservoirs in sedimentary basins. The origin of shale heterogeneity has always been a hot research topic for it determines shale micro characteristics description and macro quality reservoir prediction. Shale multi scale heterogeneity was discussed based on thin section observation, FIB-SEM, QEMSCAN, TOC, XRD, mercury intrusion porosimetry (MIP), and nitrogen adsorption analysis from 30 core samples in Silurian Longmaxi formation. Results show that shale heterogeneity can be characterized by pore structure and mineral composition. The heterogeneity of shale pore is showed by different size pores at nm-μm scale. Macropores (pore diameter > 50 nm) have a large percentage of pore volume than mesopores (pore diameter between 2~ 50 nm) and micropores (pore diameter < 2nm). However, they have a low specific surface area than mesopores and micropores. Fractal dimensions of the pores from nitrogen adsorption data are higher than 2.7, what are higher than 2.8 from MIP data, showing extremely complex pore structure. This complexity in pore structure is mainly due to the organic matter and clay minerals with complex pore network structures, and diagenesis makes it more complicated. The heterogeneity of shale minerals is showed by mineral grains, lamina, and different lithology at nm-km scale under the continuous changing horizon. Through analyzing the change of mineral composition at each scale, random arrangement of mineral equal proportion, seasonal climate changes, large changes of sedimentary environment, and provenance supply are considered to be the main reasons that cause shale minerals heterogeneity from microcosmic to macroscopic. Due to scale effect, the change of shale multi scale heterogeneity is a discontinuous process, and there is a transformation boundary between homogeneous and in homogeneous. Therefore, a shale multi scale heterogeneity changing model is established by defining four types of homogeneous unit at different scales, which can be used to guide the prediction of shale gas distribution from micro scale to macro scale.

Keywords: heterogeneity, homogeneous unit, multiscale, shale

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Authors: Lali Kalanadzde

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We investigated magneto-optical Kerr effect in transparent region of implanted ferrite-garnet films for the (YBiCa)3(FeGe)5O12. The implantation process was carried out at room temperature by Ne+ ions with energy of 100 KeV and with various doses (0.5-2.5) 1014 ion/cm². We discovered that slight deviation of the plane of external alternating magnetic field from plane of sample leads to appearance intensive magneto-optical maximum in transparent region of garnet films ħω=0.5-2.0 eV. In the proceeding, we have also found that the deviation of polarization plane from P- component of incident light leads to the appearance of the similar magneto-optical effects in this region. The research of magnetization processes in transparent region of garnet films showed that the formation of magneto-optical effects in region ħω⁼0.5-2.3 eV has a rather complex character.

Keywords: ferrite-garnet films, ion implantation, magneto-optical, thin films

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Authors: Luksanaporn Krungkraipetch

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One hundred cataract patients with phacoemulsification were enrolled in the study to compare of visual acuity outcome and complication after phacoemulsification between diabetic and non-diabetic patients at Burapha University Hospital, Chonburi, Thailand. Fifty patients were diabetic (type II) group and 50 patients were non-diabetic group. All cases were operated by one doctor with the same pre-operative care, operation (phacoemulsification), and post-operative care. Visual acuity and complication after surgery were assessed after the operation for two years. There were no significant differences in demographic data between the two groups. The visual outcome values ≥ 2 lines and ≥ 20/40 had no significant differences between two groups after two years of surgery. The complication rate in diabetic group had cystoid macular edema 16%, rupture posterior capsule 8%, posterior capsule opacity 2%, uveitis 2 %, and 2% endophthalmitis. The non-diabetic group had cystoid macular edema 12%, rupture posterior capsule 8%, uveitis 2%, posterior capsule opacity 2%, and 2% wound leak. Comparison of visual acuity outcome and complication after phacoemulsification between diabetic and non-diabetic patients had no statistical significant differences between these two groups. It was found that cystoid macular edema was the most common complication in both groups and 10% of retinopathy progression was seen.

Keywords: cataract, visual acuity, cataract extraction, phacoemulsification, diabetic retinopathy

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Authors: Emily Purdom, Rachel Robinson

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

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

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Authors: Shu Jiuan Chen, Shu Fen Wu, I. Ling Tsai, Chia Yu Chen, Yen Lin Liu, Chen-Fuh Lam

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Background: Increased emotional stress in workplace and depressed job satisfaction may significantly affect the turnover intention and career life of personnel. However, very limited studies have reported the factors influencing the turnover intention of the surgical team members in the operating rooms, where extraordinary stress is normally exit in this isolated medical care unit. Therefore, this study aimed to determine the environmental and personal characteristic factors that might be associated with job satisfaction and turnover intention in the non-physician staff who work in the operating rooms. Methods: This was a cross-sectional, descriptive study performed in a metropolitan teaching hospital in southern Taiwan between May 2017 to July 2017. A structured self-administered questionnaire, modified from the Practice Environment Scale of the Nursing Work Index (PES-NWI), Occupational Stress Indicator-2 (OSI-2) and Maslach Burnout Inventory (MBI) manual was collected from the operating room nurses, nurse anesthetists, surgeon assistants, orderly and other non-physician staff. Numerical and categorical data were analyzed using unpaired t-test and Chi-square test, as appropriate (SPSS, version 20.0). Results: A total of 167 effective questionnaires were collected from 200 eligible, non-physician personnel who worked in the operating room (response rate 83.5%). The overall satisfaction of all responders was 45.64 ± 7.17. In comparison to those who had more than 4-year working experience in the operating rooms, the junior staff ( ≤ 4-year experience) reported to have significantly higher satisfaction in workplace environment and job contentment, as well as lower intention to quit (t = 6.325, P =0.000). Among the different specialties of surgical team members, nurse anesthetists were associated with significantly lower levels of job satisfaction (P=0.043) and intention to stay (x² = 8.127, P < 0.05). Multivariate regression analysis demonstrates job title, seniority, working shifts and job satisfaction are the significant independent predicting factors for quit jobs. Conclusion: The results of this study highlight that increased work seniorities ( > 4-year working experience) are associated with significantly lower job satisfaction, and they are also more likely to leave their current job. Increased workload in supervising the juniors without appropriate job compensation (such as promotions in job title and work shifts) may precipitate their intention to quit. Since the senior staffs are usually the leaders and core members in the operating rooms, the retention of this fundamental manpower is essential to ensure the safety and efficacy of surgical interventions in the operating rooms.

Keywords: surgical team, job satisfaction, resignation intention, operating room

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Authors: N. Gopalakrishna Kini, Ranjana Paleppady, Akshata K. Naik

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Password authentication is one of the widely used methods to achieve authentication for legal users of computers and defense against attackers. There are many different ways to authenticate users of a system and there are many password cracking methods also developed. This paper is mainly to propose how best password cracking can be performed on a CPU-GPGPU based system. The main objective of this work is to project how quickly a password can be cracked with some knowledge about the computer security and password cracking if sufficient security is not incorporated to the system.

Keywords: GPGPU, password cracking, secret key, user authentication

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Authors: Y. D. Lim, K. S. Yap, K. T. Ooi

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In recent years, environmental issue has been a hot topic in the world, especially the global warming effect caused by conventional non-environmentally friendly refrigerants has increased. Several studies of a more energy-efficient and environmentally friendly refrigeration system have been conducted in order to tackle the issue. In search of a better refrigeration system, CO2 refrigeration system has been proposed as a better option. However, the high throttling loss involved during the expansion process of the refrigeration cycle leads to a relatively low efficiency and thus the system is impractical. In order to improve the efficiency of the refrigeration system, it is suggested by replacing the conventional expansion valve in the refrigeration system with an expander. Based on this issue, a new type of expander-compressor combined unit, named Cross Vane Expander-Compressor (CVEC) was introduced to replace the compressor and the expansion valve of a conventional refrigeration system. A mathematical model was developed to calculate the performance of CVEC, and it was found that the machine is capable of saving the energy consumption of a refrigeration system by as much as 18%. Apart from energy saving, CVEC is also geometrically simpler and more compact. To further improve its efficiency, optimization study of the device is carried out. In this report, several design parameters of CVEC were chosen to be the variables of optimization study. This optimization study was done in a simulation program by using complex optimization method, which is a direct search, multi-variables and constrained optimization method. It was found that the main design parameters, which was shaft radius was reduced around 8% while the inner cylinder radius was remained unchanged at its lower limit after optimization. Furthermore, the port sizes were increased to their upper limit after optimization. The changes of these design parameters have resulted in reduction of around 12% in the total frictional loss and reduction of 4% in power consumption. Eventually, the optimization study has resulted in an improvement in the mechanical efficiency CVEC by 4% and improvement in COP by 6%.

Keywords: complex optimization method, COP, cross vane expander-compressor, CVEC, design optimization, direct search, energy saving, improvement, mechanical efficiency, multi variables

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Authors: Loveline Ambo Angwah

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The processing of cassava from tubers or roots into food using crude and rudimentary method (hand peeling, grating, frying and to sun drying) is a very cumbersome and difficult process. The crude methods are time consuming and labour intensive. While on the other hand, modern processing method, that is using machines to perform the various processes as washing, peeling, grinding, oven drying, fermentation and frying is easier, less time consuming, and less labour intensive. Rudimentarily, cassava roots are processed into numerous products and utilized in various ways according to local customs and preferences. For the people of Ngwo village, cassava is transformed locally into flour or powder form called ‘cumcum’. It is also sucked into water to give a kind of food call ‘water fufu’ and fried to give ‘garri’. The leaves are consumed as vegetables. Added to these, its relative high yields; ability to stay underground after maturity for long periods give cassava considerable advantage as a commodity that is being used by poor rural folks in the community, to fight poverty. It plays a major role in efforts to alleviate the food crisis because of its efficient production of food energy, year-round availability, tolerance to extreme stress conditions, and suitability to present farming and food systems in Africa. Improvement of cassava processing and utilization techniques would greatly increase labor efficiency, incomes, and living standards of cassava farmers and the rural poor, as well as enhance the-shelf life of products, facilitate their transportation, increase marketing opportunities, and help improve human and livestock nutrition. This paper presents a general overview of crude ways in cassava processing and utilization methods now used by subsistence and small-scale farmers in Ngwo village of the North West region in Cameroon, and examine the opportunities of improving processing technologies. Cassava needs processing because the roots cannot be stored for long because they rot within 3-4 days of harvest. They are bulky with about 70% moisture content, and therefore transportation of the tubers to markets is difficult and expensive. The roots and leaves contain varying amounts of cyanide which is toxic to humans and animals, while the raw cassava roots and uncooked leaves are not palatable. Therefore, cassava must be processed into various forms in order to increase the shelf life of the products, facilitate transportation and marketing, reduce cyanide content and improve palatability.

Keywords: cassava roots, crude ways, food system, poverty

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Authors: Ande Nesmith

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

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

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Authors: Akankunda Veronicah Karuhanga

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

Keywords: dementia, family, Alzheimers, relevancy

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Authors: Wendy Carolina Gomez Ramirez, Rodulfo Ospina Torres

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Thygater aethiops is a species of solitary bee with a neotropical distribution that has been adapted to live in urban environments. This species of bee presents a marked sexual dimorphism since the males have antenna almost as long as their body different from the females that present antenna with smaller size. In this work, placoid sensilla were studied, which are structures that appear in the antenna and are involved in the detection of substances both, for reproduction and for the search of food. The aim of this study was to evaluate the differences between these sensory structures in the different sexes, for which males and females were captured. Later some body measures were taken such as fresh weight with abdomen and without it, since the weight could be modified by the stomach content; other measures were taken as the total antenna length and length of the flagellum and flagelomere. After negative imprints of the antenna were made using nail polish, the imprint was cut with a microblade and mounted onto a microscope slide. The placoid sensilla were visible on the imprint, so they were counted manually on the 100x objective lens of the optical microscope. Initially, the males presented a specific distribution pattern in two types of sensilla: trichoid and placoid, the trichoid were found aligned in the dorsal face of the antenna and the placoid were distributed along the entire antenna; that was different to the females since they did not present a distribution pattern the sensilla were randomly organized. It was obtained that the males, because they have a longer antenna, have a greater number of sensilla in relation to the females. Additionally, it was found that there was no relationship between the weight and the number of sensilla, but there was a positive relationship between the length of the antenna, the length of the flagellum and the number of sensilla. The relationship between the number of sensilla per unit area in each of the sexes was also calculated, which showed that, on average, males have 4.2 ± 0.38 sensilla per unit area and females present 2.2 ± 0.20 and likewise a significant difference between sexes. This dimorphism found may be related to the sexual behavior of the species, since it has been demonstrated that males are more adapted to the perception of substances related to reproduction than to the search of food.

Keywords: antenna, olfactory organ, sensilla, sexual dimorphism, solitary bees

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Authors: Djendi Mohmaed

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In this paper, we propose a dual adaptive algorithm, which is based on the combination between the forward blind source separation (FBSS) structure and the affine projection algorithm (APA). This proposed algorithm combines the advantages of the source separation properties of the FBSS structure and the fast convergence characteristics of the APA algorithm. The proposed algorithm needs two noisy observations to provide an enhanced speech signal. This process is done in a blind manner without the need for ant priori information about the source signals. The proposed dual forward blind source separation affine projection algorithm is denoted (DFAPA) and used for the first time in an airplane cockpit context to enhance the communication from- and to- the airplane. Intensive experiments were carried out in this sense to evaluate the performance of the proposed DFAPA algorithm.

Keywords: adaptive algorithm, speech enhancement, system mismatch, SNR

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Authors: Nassim Salmi

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

Keywords: postoperative care, gynecology, nursing documentation, database

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Authors: 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: Heng Ma

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Third-party warehousing logistics has an important role in the development of external logistics. At present, the third-party logistics in our country is still a new industry, the accounting system has not yet been established, the current financial accounting system of third-party warehousing logistics is mainly in the traditional way of thinking, and only able to provide the total cost information of the entire enterprise during the accounting period, unable to reflect operating indirect cost information. In order to solve the problem of third-party logistics industry cost information distortion, improve the level of logistics cost management, the paper combines theoretical research and case analysis method to reflect cost allocation by building third-party logistics costing model using Time-Driven Activity-Based Costing(TDABC), and takes S company as an example to account and control the warehousing logistics cost. Based on the idea of “Products consume activities and activities consume resources”, TDABC put time into the main cost driver and use time-consuming equation resources assigned to cost objects. In S company, the objects focuses on three warehouse, engaged with warehousing and transportation (the second warehouse, transport point) service. These three warehouse respectively including five departments, Business Unit, Production Unit, Settlement Center, Security Department and Equipment Division, the activities in these departments are classified by in-out of storage forecast, in-out of storage or transit and safekeeping work. By computing capacity cost rate, building the time-consuming equation, the paper calculates the final operation cost so as to reveal the real cost. The numerical analysis results show that the TDABC can accurately reflect the cost allocation of service customers and reveal the spare capacity cost of resource center, verifies the feasibility and validity of TDABC in third-party logistics industry cost accounting. It inspires enterprises focus on customer relationship management and reduces idle cost to strengthen the cost management of third-party logistics enterprises.

Keywords: third-party logistics enterprises, TDABC, cost management, S company

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Authors: Desmond Wade, Alfredo Ormazabal

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

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

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Authors: Pushpavathi M., Kavya V., Akshatha V.

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Introduction: Cleft lip and palate (CLP) is a congenital condition which hinders effectual communication due to associated speech and language difficulties. Expressive language delay (ELD) is a feature seen in this population which is influenced by factors such as type and severity of CLP, age at surgical and linguistic intervention and also the type and intensity of speech and language therapy (SLT). Since CLP is the most common congenital abnormality seen in Indian children, early intervention is a necessity which plays a critical role in enhancing their speech and language skills. The interaction between the timing of intervention and factors which contribute to effective intervention by caregivers is an area which needs to be explored. Objectives: The present study attempts to determine the effect of timing of intervention on the contributing maternal factors for effective linguistic intervention in toddlers with repaired CLP with respect to the awareness, home training patterns, speech and non-speech behaviors of the mothers. Participants: Thirty six toddlers in the age range of 1 to 4 years diagnosed as ELD secondary to repaired CLP, along with their mothers served as participants. Group I (Early Intervention Group, EIG) included 19 mother-child pairs who came to seek SLT soon after corrective surgery and group II (Delayed Intervention Group, DIG) included 16 mother-child pairs who received SLT after the age of 3 years. Further, the groups were divided into group A, and group B. Group ‘A’ received SLT for 60 sessions by Speech Language Pathologist (SLP), while Group B received SLT for 30 sessions by SLP and 30 sessions only by mother without supervision of SLP. Method: The mothers were enrolled for the Early Language Intervention Program and following this, their awareness about CLP was assessed through the Parental awareness questionnaire. The quality of home training was assessed through Mohite’s Inventory. Subsequently, the speech and non-speech behaviors of the mothers were assessed using a Mother’s behavioral checklist. Detailed counseling and orientation was done to the mothers, and SLT was initiated for toddlers. After 60 sessions of intensive SLT, the questionnaire and checklists were re-administered to find out the changes in scores between the pre- and posttest measurements. Results: The scores obtained under different domains in the awareness questionnaire, Mohite’s inventory and Mothers behavior checklist were tabulated and subjected to statistical analysis. Since the data did not follow normal distribution (i.e. p > 0.05), Mann-Whitney U test was conducted which revealed that there was no significant difference between groups I and II as well as groups A and B. Further, Wilcoxon Signed Rank test revealed that mothers had better awareness regarding issues related to CLP and improved home-training abilities post-orientation (p ≤ 0.05). A statistically significant difference was also noted for speech and non-speech behaviors of the mothers (p ≤ 0.05). Conclusions: Extensive orientation and counseling helped mothers of both EI and DI groups to improve their knowledge about CLP. Intensive SLT using focused stimulation and a parent-implemented approach enabled them to carry out the intervention in an effectual manner.

Keywords: awareness, cleft lip and palate, early language intervention program, home training, orientation, timing of intervention

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Authors: Scott Cavinder

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

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

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Authors: Young Man Cho, Sang Hyun Kim

Abstract:

Even though various management practices such as sediment dredging were attempted to improve water quality of Dongcheon located in Busan, the environmental condition of this stream was deteriorated. Therefore, Busan metropolitan city had pumped and diverted sea water to upstream of Dongcheon for several years. This study explored hydraulic characteristics of Dongcheon to configure the best management practice for ecological restoration and water quality improvement of a man-made urban stream. Intensive field investigation indicates that average flow velocities at depths of 20% and 80% from the water surface ranged 5 to 10 cm/s and 2 to 5 cm/s, respectively. Concentrations of dissolved oxygen for all depths were less than 0.25 mg/l during low tidal period. Even though density difference can be found along stream depth, density current seems rarely generated in Dongcheon. Short period of high tidal portion and shallow depths are responsible for well-mixing nature of Doncheon.

Keywords: hydraulic, tidal river, density current, sea water

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

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

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

Procedia PDF Downloads 125