Search results for: palliative care approach

Authors: Wiem Daoud Ben Amor, Luis Martínez López, Hela Moalla Frikha

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Most of the multi-criteria group decision making (MCGDM) problems dealing with qualitative criteria require consideration of the large background of expert information. It is common that experts have different degrees of knowledge for giving their alternative assessments according to criteria. So, it seems logical that they use different evaluation scales to express their judgment, i.e., multi granular linguistic scales. In this context, we propose the extension of the classical additive ratio assessment (ARAS) method to the case of a hierarchical linguistics term for managing multi granular linguistic scales in uncertain contexts where uncertainty is modeled by means in linguistic information. The proposed approach is called the extended hierarchical linguistics-ARAS method (ARAS-ELH). Within the ARAS-ELH approach, the DM can diagnose the results (the ranking of the alternatives) in a decomposed style, i.e., not only at one level of the hierarchy but also at the intermediate ones. Also, the developed approach allows a feedback transformation i.e the collective final results of all experts able to be transformed at any level of the extended linguistic hierarchy that each expert has previously used. Therefore, the ARAS-ELH technique makes it easier for decision-makers to understand the results. Finally, An MCGDM case study is given to illustrate the proposed approach.

Keywords: additive ratio assessment, extended hierarchical linguistic, multi-criteria group decision making problems, multi granular linguistic contexts

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Authors: Taddese Alemu Zerfu, Melaku Umeta Deressa, Kaleab Baye

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Background: Maternal and child under-nutrition is the underlying cause of 3•5 million annual deaths, globally. Anemia during pregnancy is among the leading nutritional disorders with serious short and long term consequences to both the mother and fetus. Objective: Examine the effect of dietary diversity on maternal anemia, nutritional status and key pregnancy outcomes of pregnancy. Methods: A prospective cohort study design, involving a total of 432 eligible pregnant women, in their second antenatal care visit was conducted between August 2014 to March, 2015. The individual dietary diversity status of mothers was used as the exposure variable to select, enroll and follow the mothers. All mothers were enrolled during second antenatal care visit and followed until delivery. Epi-data, SPSS and STATA software are used to enter and analyze the data. Chi-square test, independent 't'-test, and GLM are used to calculate risk, association and differences between key variables at P < 0.05. Results: Study participants did not differ in many of the basic characteristics (p < 0.05). The incidence of maternal anemia increased significantly from 28.6% to 32.1% between baseline and term. Pregnant mothers with inadequate dietary diversity groups had more (56% at baseline and 68% at term) risk of anemia than the comparison (adequate) groups, (RR, 1.56 and 1.68; 95% CI, 1.24 - 1.83 and 1.39 - 2.04). The overall incidence of still birth, low birth weight and pre-term birth was 4.5%, 9.1% and 13.6%, respectively. The variation of these outcomes was significant across study groups (P < 0.05). Conclusion and recommendations: Dietary diversity status of pregnant mothers has significant effect on the incidence of anemia and key pregnancy outcomes in resource limited settings, like rural Ethiopia. Therefore, apart from the ongoing routine IFA supplementation, special emphasis should be given to dietary diversity of mothers to improve related outcomes of pregnancy and maternal health.

Keywords: anemia, birth weight, dietary diversity, pregnancy, pregnancy outcome

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Authors: Taieb Kherafa Noureddine

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The paper presents a new approach regarding the management in sports that is based on the principles of reengineering. Applying that modern and pure management system, called reengineering, in sports activity, we hope to get better and better results, in order to increase both the health state and the performances of trained athletes. The paper also presents the similarities between BPR (Business Process Reengineering) and sports managements, as well as the proposed solution for a proper implementation of such model of management. The five components of the basic BPR model are presented, together with their features for sports management.

Keywords: business process reengineering, great sports events, sports management, training activities

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Authors: Min Shi

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State of the art research with Artificial Neural Networks for the downscaling of General Circulation Models (GCMs) mainly uses back-propagation algorithm as a training approach. This paper introduces another training approach of ANNs, Evolutionary Algorithm. The combined algorithm names neuroevolutionary (NE) algorithm. We investigate and evaluate the use of the NE algorithms in statistical downscaling by generating temperature estimates at interior points given information from a lattice of surrounding locations. The results of our experiments indicate that NE algorithms can be efficient alternative downscaling methods for daily temperatures.

Keywords: temperature, downscaling, artificial neural networks, evolutionary algorithms

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Authors: Jerome Dalphinis, Vishal Patel

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The Bailiwick of Jersey is an island British crown dependency situated off the coast of France. Jersey General Hospital’s emergency department sees approximately 40,000 patients a year. It’s outside the NHS, with secondary care being free at the point of care. Sedation is a continuum which extends from a normal conscious level to being fully unresponsive. Procedural sedation produces a minimally depressed level of consciousness in which the patient retains the ability to maintain an airway, and they respond appropriately to physical stimulation. The goals of it are to improve patient comfort and tolerance of the procedure and alleviate associated anxiety. Indications can be stratified by acuity, emergency (cardioversion for life-threatening dysrhythmia), and urgency (joint reduction). In the emergency department, this is most often achieved using a combination of opioids and benzodiazepines. Some departments also use ketamine to produce dissociative sedation, a cataleptic state of profound analgesia and amnesia. The response to pharmacological agents is highly individual, and the drugs used occasionally have unpredictable pharmacokinetics and pharmacodynamics, which can always result in progression between levels of sedation irrespective of the intention. Therefore, practitioners must be able to ‘rescue’ patients from deeper sedation. These practitioners need to be senior clinicians with advanced airway skills (AAS) training. It can lead to adverse effects such as dangerous hypoxia and unintended loss of consciousness if incorrectly undertaken; studies by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) have reported avoidable deaths. The Royal College of Emergency Medicine, UK (RCEM) released an updated ‘Safe Sedation of Adults in the Emergency Department’ guidance in 2017 detailing a series of standards for staff competencies, and the required environment and equipment, which are required for each target sedation depth. The emergency department in Jersey undertook audit research in 2018 to assess their current practice. It showed gaps in clinical competency, the need for uniform care, and improved documentation. This spurred the development of a checklist incorporating the above RCEM standards, including contraindication for procedural sedation and difficult airway assessment. This was approved following discussion with the relevant heads of departments and the patient safety directorates. Following this, a second audit research was carried out in 2019 with 17 completed checklists (11 relocation of joints, 6 cardioversions). Data was obtained from looking at the controlled resuscitation drugs book containing documented use of ketamine, alfentanil, and fentanyl. TrakCare, which is the patient electronic record system, was then referenced to obtain further information. The results showed dramatic improvement compared to 2018, and they have been subdivided into six categories; pre-procedure assessment recording of significant medical history and ASA grade (2 fold increase), informed consent (100% documentation), pre-oxygenation (88%), staff (90% were AAS practitioners) and monitoring (92% use of non-invasive blood pressure, pulse oximetry, capnography, and cardiac rhythm monitoring) during procedure, and discharge instructions including the documented return of normal vitals and consciousness (82%). This procedural sedation checklist is a safe intervention that identifies pertinent information about the patient and provides a standardised checklist for the delivery of gold standard of care.

Keywords: advanced airway skills, checklist, procedural sedation, resuscitation

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Authors: Thinakar Mani Balusamy, Ratnakar S. Kini, Bharat Narasimhan, Venkateswaran A. R, Pugazhendi Thangavelu, Mohammed Ali, Prem Kumar K., Kani Sheikh M., Sibi Thooran Karmegam, Radhakrishnan N., Mohammed Noufal

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Introduction: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining nine presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed nonoperatively. Nine patients had a severe injury ( > grade 3) – of which four underwent endotherapy, three had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed nonoperatively, three underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Keywords: endotherapy, non-operative management, surgery, traumatic pancreatic injury

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Authors: Tiffany Riggleman, Andrea Schultheis, Kalyn Jannace, Jerika Taylor, Michelle Nordstrom, Paul F. Pasquina

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Introduction: Posttraumatic Stress (PTS) and Posttraumatic Stress Disorder (PTSD) remain significant problems for military and veteran communities. Symptoms of PTSD often include poor sleep, intrusive thoughts, difficulty concentrating, and trouble with emotional regulation. Unfortunately, despite its high prevalence, service members diagnosed with PTSD often do not seek help, usually because of the perceived stigma surrounding behavioral health care. To help address these challenges, non-pharmacological, therapeutic approaches are being developed to help improve care and enhance compliance. The Service Dog Training Program (SDTP), which involves teaching patients how to train puppies to become mobility service dogs, has been successfully implemented into PTS/PTSD care programs with anecdotal reports of improved outcomes. This study was designed to assess the biopsychosocial effects of SDTP from military beneficiaries with PTS symptoms. Methods: Individuals between the ages of 18 and 65 with PTS symptom were recruited to participate in this prospective study. Each subject completes 4 weeks of baseline testing, followed by 6 weeks of active service dog training (twice per week for one hour sessions) with a professional service dog trainer. Outcome measures included the Posttraumatic Stress Checklist for the DSM-5 (PCL-5), Generalized Anxiety Disorder questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), social support/interaction, anthropometrics, blood/serum biomarkers, and qualitative interviews. Preliminary analysis of 17 participants examined mean scores on the GAD-7, PCL-5, and PHQ-9, pre- and post-SDTP, and changes were assessed using Wilcoxon Signed-Rank tests. Results: Post-SDTP, there was a statistically significant mean decrease in PCL-5 scores of 13.5 on an 80-point scale (p=0.03) and a significant mean decrease of 2.2 in PHQ-9 scores on a 27 point scale (p=0.04), suggestive of decreased PTSD and depression symptoms. While there was a decrease in mean GAD-7 scores post-SDTP, the difference was not significant (p=0.20). Recurring themes among results from the qualitative interviews include decreased pain, forgetting about stressors, improved sense of calm, increased confidence, improved communication, and establishing a connection with the service dog. Conclusion: Preliminary results of the first 17 participants in this study suggest that individuals who received SDTP had a statistically significant decrease in PTS symptom, as measured by the PCL-5 and PHQ-9. This ongoing study seeks to enroll a total of 156 military beneficiaries with PTS symptoms. Future analyses will include additional psychological outcomes, pain scores, blood/serum biomarkers, and other measures of the social aspects of PTSD, such as relationship satisfaction and sleep hygiene.

Keywords: post-concussive syndrome, posttraumatic stress, service dog, service dog training program, traumatic brain injury

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Authors: Mohammed Qasim, Kyoung-Dae Kim

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In this paper, we present the design of the super-ellipsoidal potential function (SEPF), that can be used for autonomous collision avoidance of an unmanned aerial vehicle (UAV) in a 3-dimensional space. In the design of SEPF, we have the full control over the shape and size of the potential function. In particular, we can adjust the length, width, height, and the amount of flattening at the tips of the potential function so that the collision avoidance motion vector generated from the potential function can be adjusted accordingly. Based on the idea of the SEPF, we also propose an approach for the local autonomy of a UAV for its collision avoidance when the UAV is teleoperated by a human operator. In our proposed approach, a teleoperated UAV can not only avoid collision autonomously with other surrounding objects but also track the operator’s control input as closely as possible. As a result, an operator can always be in control of the UAV for his/her high-level guidance and navigation task without worrying too much about the UAVs collision avoidance while it is being teleoperated. The effectiveness of the proposed approach is demonstrated through a human-in-the-loop simulation of quadrotor UAV teleoperation using virtual robot experimentation platform (v-rep) and Matlab programs.

Keywords: artificial potential function, autonomous collision avoidance, teleoperation, quadrotor

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Authors: Oludamilare Bode Adewuyi, Yanxia Sun, Isaiah Gbadegesin Adebayo

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Voltage stability analysis is crucial to the reliable and economic operation of power systems. The power system of developing nations is more susceptible to failures due to the continuously increasing load demand, which is not matched with generation increase and efficient transmission infrastructures. Thus, most power systems are heavily stressed, and the planning of extra generation from distributed generation sources needs to be efficiently done so as to ensure the security of the power system. Some voltage stability index-based approach for DG siting has been reported in the literature. However, most of the existing voltage stability indices, though sufficient, are found to be inaccurate, especially for overloaded power systems. In this paper, the performance of a relatively different approach using a line voltage stability margin indicator, which has proven to have better accuracy, has been presented and compared with a conventional line voltage stability index for DG siting using the Nigerian 28 bus system. Critical boundary index (CBI) for voltage stability margin estimation was deployed to identify suitable locations for DG placement, and the performance was compared with DG placement using the Novel Line Stability Index (NLSI) approach. From the simulation results, both CBI and NLSI agreed greatly on suitable locations for DG on the test system; while CBI identified bus 18 as the most suitable at system overload, NLSI identified bus 8 to be the most suitable. Considering the effect of the DG placement at the selected buses on the voltage magnitude profile, the result shows that the DG placed on bus 18 identified by CBI improved the performance of the power system better.

Keywords: voltage stability analysis, voltage collapse, voltage stability index, distributed generation

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Authors: Pilly Joseph Kagosi

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The study aims at assessing challenges observed during the implementation of participatory irrigation management (PIM) approach for food security in semi-arid areas of Tanzania. Data were collected through questionnaire, PRA tools, key informants discussion, Focus Group Discussion (FGD), participant observation, and literature review. Data collected from the questionnaire was analysed using SPSS while PRA data was analysed with the help of local communities during PRA exercise. Data from other methods were analysed using content analysis. The study revealed that PIM approach has a contribution in improved food security at household level due to the involvement of communities in water management activities and decision making which enhanced the availability of water for irrigation and increased crop production. However, there were challenges observed during the implementation of the approach including; minimum participation of beneficiaries in decision-making during planning and designing stages, meaning inadequate devolution of power among scheme owners. Inadequate and lack of transparency on income expenditure in Water Utilization Associations’ (WUAs), water conflict among WUAs members, conflict between farmers and livestock keepers and conflict between WUAs leaders and village government regarding training opportunities and status; WUAs rules and regulation are not legally recognized by the National court and few farmers involved in planting trees around water sources. However, it was realized that some of the mentioned challenges were rectified by farmers themselves facilitated by government officials. The study recommends that the identified challenges need to be rectified for farmers to realize impotence of PIM approach as it was realized by other Asian countries.

Keywords: challenges, participatory approach, irrigation management, food security, semi arid areas

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Authors: Tara Hunter, Kristine Concepcion, Wendy Cheng, Brianna Pike, Jane Estoesta, Anne Stuart

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In 2015, Family Planning NSW was contracted by the NSW Ministry of Health to design and deliver Sexual Safety Policy training (SSPT) to mental health professionals across NSW. The training was based on their current guidelines and developed in consultation with an expert reference group. From October 2015 to April 2017 it was delivered to over 2,400 mental health professionals with a view to supporting implementation of consistent prevention and intervention related to sexual safety in the mental health setting. An evaluation was undertaken to determine the knowledge and confidence of participants related to sexual safety before and after the training, and whether any improvements were translated into changes in practice. Participants were invited to complete a survey prior to the training, upon completion and three to six months thereafter. Telephone interviews were conducted among service managers and mental health champions six months post-training. Prior to training, the majority of mental health professionals reported being slightly to moderately confident in identifying a sexual safety incident. When asked on their understanding of sexual safety, gender sensitive practice and trauma informed care, they reported no confidence, slight confidence and moderate confidence. Immediately after the training, 54.5% reported being very confident and 10.9% extremely confident in identifying a sexual safety incident. More than half felt very confident or extremely confident in their understanding of sexual safety principles. The impact survey (six months later) found that the majority of participants (91%) were highly confident in identifying a sexual safety incident. Telephone interviewees reported a change in workplace culture and increased awareness after the training. Mental health professionals experienced increased knowledge and confidence about sexual safety principles following the training and were able to implement positive changes and concrete actions to better address sexual safety issues in their workplace.

Keywords: sexual safety, mental health professionals, trauma informed care, policy training

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Authors: Netanel Stern

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Artificial intelligence (AI) algorithms have emerged as powerful tools in the field of psychiatry, offering new possibilities for enhancing diagnosis and treatment outcomes. This article explores the utilization of AI algorithms in psychiatry, highlighting their potential to revolutionize patient care. Various AI algorithms, including machine learning, natural language processing (NLP), reinforcement learning, clustering, and Bayesian networks, are discussed in detail. Moreover, ethical considerations and future directions for research and implementation are addressed.

Keywords: AI, software engineering, psychiatry, neuroimaging

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Authors: Esther Van Andel, Stefanie C. Lange, Maarten M. J. Smulders, Han Zuilhof

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False outcomes of diagnostic tests are a major concern in medical health care. To improve the reliability of surface-based diagnostic tests, it is of crucial importance to diminish background signals that arise from the non-specific binding of biomolecules, a process called fouling. The aim is to create surfaces that repel all biomolecules except the molecule of interest. This can be achieved by incorporating antifouling protein repellent coatings in between the sensor surface and it’s recognition elements (e.g. antibodies, sugars, aptamers). Zwitterionic polymer brushes are considered excellent antifouling materials, however, to be able to bind the molecule of interest, the polymer brushes have to be functionalized and so far this was only achieved at the expense of either antifouling or binding capacity. To overcome this limitation, we combined both features into one single monomer: a zwitterionic sulfobetaine, ensuring antifouling capabilities, equipped with a clickable azide moiety which allows for further functionalization. By copolymerizing this monomer together with a standard sulfobetaine, the number of azides (and with that the number of recognition elements) can be tuned depending on the application. First, the clickable azido-monomer was synthesized and characterized, followed by copolymerizing this monomer to yield functionalizable antifouling brushes. The brushes were fully characterized using surface characterization techniques like XPS, contact angle measurements, G-ATR-FTIR and XRR. As a proof of principle, the brushes were subsequently functionalized with biotin via strain-promoted alkyne azide click reactions, which yielded a fully zwitterionic biotin-containing 3D-functionalized coating. The sensing capacity was evaluated by reflectometry using avidin and fibrinogen containing protein solutions. The surfaces showed excellent antifouling properties as illustrated by the complete absence of non-specific fibrinogen binding, while at the same time clear responses were seen for the specific binding of avidin. A great increase in signal-to-noise ratio was observed, even when the amount of functional groups was lowered to 1%, compared to traditional modification of sulfobetaine brushes that rely on a 2D-approach in which only the top-layer can be functionalized. This study was performed on stoichiometric silicon nitride surfaces for future microring resonator based assays, however, this methodology can be transferred to other biosensor platforms which are currently being investigated. The approach presented herein enables a highly efficient strategy for selective binding with retained antifouling properties for improved signal-to-noise ratios in binding assays. The number of recognition units can be adjusted to a specific need, e.g. depending on the size of the analyte to be bound, widening the scope of these functionalizable surface coatings.

Keywords: antifouling, signal-to-noise ratio, surface functionalization, zwitterionic polymer brushes

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Authors: Elucir Gir, Laelson Rochelle Milanês Sousa, Pedro Henrique Tertuliano Leoni, Carla Aparecida Arena Ventura, Ana Cristina de Oliveira e Silva, Renata Karina Reis

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Context and significance: Resilience is a protective agent for the physical and mental well-being of nursing professionals. Team members are constantly subjected to high levels of work stress that can negatively impact care performance and users of health services. Stress levels have been exacerbated with the COVID-19 pandemic. Objective: The aim of this study was to analyze the resilience of nursing professionals in Brazil during the COVID-19 pandemic. Method: Cross-sectional study with a quantitative approach carried out with professionals from nursing teams from all regions of Brazil. Data collection took place in the first year of the pandemic between October and December 2020. Data were obtained through an online questionnaire posted on social networks. The information collected included the sociodemographic characterization of the nursing professionals and the Brief Resilient Coping Scale was applied. Student's t-test for independent samples and analysis of variance (ANOVA) were used to compare resilience scores with sociodemographic variables. Results: 8,792 nursing professionals participated in the study, 5,767 (65.6%) were nurses, 7,437 (84.6%) were female and 2,643 (30.1%) were from the Northeast region of Brazil, 5,124 (58.8% ) had low levels of resilience. The results showed a statistically significant difference between the resilience score and the variables: professional category (p<0.001); sex (p = 0.003); age range (p<0.001); region of Brazil (p<0.001); marital status (p=0.029) and providing assistance in a field hospital (p<0.001). Conclusion: Participants in this study had, in general, low levels of resilience. There is an urgent need for actions aimed at promoting the psychological health of nursing professionals inserted in pandemic contexts. Descriptors: Psychological Resilience; Nursing professionals; COVID-19; SARSCoV-2.

Keywords: psychological resilience, nursing professionals, COVID-19, SARS-CoV-2

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Authors: Kuei-Chun Liu, Yu-Yu Lai, Ching-Hong Wu

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A good automated testing tool could reduce as much as possible the manual work done by testers. Traditional record-replay testing tool provides an automated testing solution by recording mouse coordinates as test scripts, but it will be easily broken if any change of resolutions. Therefore, more and more testers design multiple test scripts to automate the testing process for different devices. In order to improve the traditional record-replay approach and reduce the effort that the testers spending on writing test scripts, we propose an approach for generating the Android application test scripts based on accessibility service without connecting to a computer. This approach simulates user input actions and replays them correctly even at the different conditions such as the internet connection is unstable when the device under test, the different resolutions on Android devices. In this paper, we describe how to generate test scripts automatically and make a comparison with existing tools for Android such as Robotium, Appium, UIAutomator, and MonkeyTalk.

Keywords: accessibility service, Appium, automated testing, MonkeyTalk, Robotium, testing, UIAutomator

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Authors: Ebtehal Qulisy, Geoffrey Dougherty, Kholoud Hothan, Mylene Dandavino

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Background: For more than 200 years, journal clubs (JCs) have been used to teach the fundamentals of critical appraisal and evidence-based practice (EBP). However, JCs curricula face important challenges, including poor sustainability, insufficient time to prepare for and conduct the activities, and lack of trainee skills and self-efficacy with critical appraisal. Andragogy principles and modern technology could help EBP be taught in more relevant, modern, and interactive ways. Method: We propose a fresh educational activity to teach EBP. Educational sessions are designed to encourage collaborative and experiential learning and do not require advanced preparation by the participants. Each session lasts 60 minutes and is adaptable to in-person, virtual, or hybrid contexts. Sessions are structured around a worksheet and include three educational objectives: “1. Identify a Clinical Conundrum”, “2. Compare and Contrast Current Guidelines”, and “3. Choose a Recent Journal Article”. Sessions begin with a short presentation by a facilitator of a clinical scenario highlighting a “grey-zone” in pediatrics. Trainees are placed in groups of two to four (based on the participants’ number) of varied training levels. The first task requires the identification of a clinical conundrum (a situation where there is no clear answer but only a reasonable solution) related to the scenario. For the second task, trainees must identify two or three clinical guidelines. The last task requires trainees to find a journal article published in the last year that reports an update regarding the scenario’s topic. Participants are allowed to use their electronic devices throughout the session. Our university provides full-text access to major journals, which facilitated this exercise. Results: Participants were a convenience sample of trainees in the inpatient services at the Montréal Children’s Hospital, McGill University. Sessions were conducted as a part of an existing weekly academic activity and facilitated by pediatricians with experience in critical appraisal. There were 28 participants in 4 sessions held during Spring 2022. Time was allocated at the end of each session to collect participants’ feedback via a self-administered online survey. There were 22 responses, were 41%(n=9) pediatric residents, 22.7%(n=5) family medicine residents, 31.8%(n=7) medical students, and 4.5%(n=1) nurse practitioner. Four respondents participated in more than one session. The “Satisfied” rates were 94.7% for session format, 100% for topic selection, 89.5% for time allocation, and 84.3% for worksheet structure. 60% of participants felt that including the sessions during the clinical ward rotation was “Feasible.” As per self-efficacy, participants reported being “Confident” for the tasks as follows: 89.5% for the ability to identify a relevant conundrum, 94.8% for the compare and contrast task, and 84.2% for the identification of a published update. The perceived effectiveness to learn EBP was reported as “Agreed” by all participants. All participants would recommend this session for further teaching. Conclusion: We developed a modern approach to teach EBP, enjoyed by all levels of participants, who also felt it was a useful learning experience. Our approach addresses known JCs challenges by being relevant to clinical care, fostering active engagement but not requiring any preparation, using available technology, and being adaptable to hybrid contexts.

Keywords: medical education, journal clubs, post-graduate teaching, andragogy, experiential learning, evidence-based practice

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Authors: Kinza Qadeer, Muhammad Abdul Qyyum, Moonyong Lee

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Natural gas has become an attractive energy source in comparison with other fossil fuels because of its lower CO₂ and other air pollutant emissions. Therefore, compared to the demand for coal and oil, that for natural gas is increasing rapidly world-wide. The transportation of natural gas over long distances as a liquid (LNG) preferable for several reasons, including economic, technical, political, and safety factors. However, LNG production is an energy-intensive process due to the tremendous amount of power requirements for compression of refrigerants, which provide sufficient cold energy to liquefy natural gas. Therefore, one of the major issues in the LNG industry is to improve the energy efficiency of existing LNG processes through a cost-effective approach that is 'optimization'. In this context, a bio-inspired Krill-herd (KH) step-up approach was examined to enhance the energy efficiency of a single mixed refrigerant (SMR) natural gas liquefaction (LNG) process, which is considered as a most promising candidate for offshore LNG production (FPSO). The optimal design of a natural gas liquefaction processes involves multivariable non-linear thermodynamic interactions, which lead to exergy destruction and contribute to process irreversibility. As key decision variables, the optimal values of mixed refrigerant flow rates and process operating pressures were determined based on the herding behavior of krill individuals corresponding to the minimum energy consumption for LNG production. To perform the rigorous process analysis, the SMR process was simulated in Aspen Hysys® software and the resulting model was connected with the Krill-herd approach coded in MATLAB. The optimal operating conditions found by the proposed approach significantly reduced the overall energy consumption of the SMR process by ≤ 22.5% and also improved the coefficient of performance in comparison with the base case. The proposed approach was also compared with other well-proven optimization algorithms, such as genetic and particle swarm optimization algorithms, and was found to exhibit a superior performance over these existing approaches.

Keywords: energy efficiency, Krill-herd, LNG, optimization, single mixed refrigerant

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Authors: Christian Neunzig, Simon Fahle, Jürgen Schulz, Matthias Möller, Bernd Kuhlenkötter

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The increasing use of deep learning applications in production is becoming a competitive advantage. Predictive quality enables the assurance of product quality by using data-driven forecasts via machine learning models as a basis for decisions on test results. The use of real Bosch production data along the value chain of hydraulic valves is a promising approach to classifying the leakage of directional valves.

Keywords: artificial neural networks, classification, hydraulics, predictive quality, deep learning

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Authors: Fatiha Naaoui-Outini

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Purpose – The purpose of this paper is to shed light on how a Downstream Supply Chain facilitated the Customer Service Performance (BTB) by more collaborative practices between the different stakeholders in the chain. Methodology/approach – The paper developed a theoretical framework and conducted a qualitative exploratory study approach based on six semi-structured interviews with two international groups in the distribution sector with the aim of understanding and analyzing how companies have changed their supply chains to ensure optimal customer service. Findings/Implications – The study contributes to the Global Supply Chain Management and Collaboration literature by integrating the role of the downstream supply chain into research that may actually influence customer service performance on BTB. Our findings also provide firms with some guidelines on building successful downstream supply chain collaboration and a significant influence on customer service performance in BTB. Because of the exploratory nature of the study approach, the research results are limited to the data collected, and these preliminary findings require further confirmation.

Keywords: customer service performance (B2B), global supply chain, downstream supply collaboration, qualitative case study

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Authors: Ebrahim Asadi-Gangraj

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Hybrid flow shop scheduling problem (HFS) contains sequencing in a flow shop where, at any stage, there exist one or more related or unrelated parallel machines. This production system is a common manufacturing environment in many real industries, such as the steel manufacturing, ceramic tile manufacturing, and car assembly industries. In this research, a mixed integer linear programming (MILP) model is presented for the hybrid flow shop scheduling problem, in which, the objective consists of minimizing the maximum completion time (makespan). For this purpose, a Benders Decomposition (BD) method is developed to solve the research problem. The proposed approach is tested on some test problems, small to moderate scale. The experimental results show that the Benders decomposition approach can solve the hybrid flow shop scheduling problem in a reasonable time, especially for small and moderate-size test problems.

Keywords: hybrid flow shop, mixed integer linear programming, Benders decomposition, makespan

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Authors: Milan Paudel, Fook Fah Yap, Anil K. Bastola

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The difficulties in riding small wheel bicycles and their lesser stability have been perceived for a long time. Although small wheel bicycles are designed using the similar approach and guidelines that have worked well for big wheel bicycles, the performance of the big wheelers and the smaller wheelers are markedly different. Since both the big wheelers and small wheelers have same fundamental geometry, most blame the small wheel for this discrepancy in the performance. This paper reviews existing guidelines for bicycle design, especially the front steering geometry for the bicycle, and provides a systematic and quantitative analysis of different wheel sized bicycles. A validated mathematical model has been used as a tool to assess the dynamic performance of the bicycles in term of their self-stability. The results obtained were found to corroborate the subjective perception of cyclists for small wheel bicycles. The current approach for small wheel bicycle design requires higher speed to be self-stable. However, it was found that increasing the headtube angle and selecting a proper trail could improve the dynamic performance of small wheel bicycles. A range of parameters for front steering geometry has been identified for small wheel bicycles that have comparable stability as big wheel bicycles. Interestingly, most of the identified geometries are found to be beyond the ISO recommended range and seem to counter the current approach of small wheel bicycle design. Therefore, it was successfully shown that the guidelines for big wheelers do not translate directly to small wheelers, but careful selection of the front geometry could make small wheel bicycles as stable as big wheel bicycles.

Keywords: big wheel bicycle, design approach, ISO requirements, small wheel bicycle, stability and performance

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Authors: Hozaifa Zaki, Ghada Soliman

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In this paper, we introduced an approach for Automated Dotted Arabic Expiration Date Extraction using Optimized Convolutional Autoencoder (ARABEX) with bidirectional LSTM. This approach is used for translating the Arabic dot-matrix expiration dates into their corresponding filled-in dates. A custom lightweight Convolutional Recurrent Neural Network (CRNN) model is then employed to extract the expiration dates. Due to the lack of available dataset images for the Arabic dot-matrix expiration date, we generated synthetic images by creating an Arabic dot-matrix True Type Font (TTF) matrix to address this limitation. Our model was trained on a realistic synthetic dataset of 3287 images, covering the period from 2019 to 2027, represented in the format of yyyy/mm/dd. We then trained our custom CRNN model using the generated synthetic images to assess the performance of our model (ARABEX) by extracting expiration dates from the translated images. Our proposed approach achieved an accuracy of 99.4% on the test dataset of 658 images, while also achieving a Structural Similarity Index (SSIM) of 0.46 for image translation on our dataset. The ARABEX approach demonstrates its ability to be applied to various downstream learning tasks, including image translation and reconstruction. Moreover, this pipeline (ARABEX+CRNN) can be seamlessly integrated into automated sorting systems to extract expiry dates and sort products accordingly during the manufacturing stage. By eliminating the need for manual entry of expiration dates, which can be time-consuming and inefficient for merchants, our approach offers significant results in terms of efficiency and accuracy for Arabic dot-matrix expiration date recognition.

Keywords: computer vision, deep learning, image processing, character recognition

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Authors: Erion Luga, Aksel Seitllari, Kemal Pervanqe

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This study investigates the relation between physical and mechanical properties of concrete paving stones using neuro-fuzzy approach. For this purpose 200 samples of concrete paving stones were selected randomly from different sources. The first phase included the determination of physical properties of the samples such as water absorption capacity, porosity and unit weight. After that the indirect tensile strength test and compressive strength test of the samples were performed. İn the second phase, adaptive neuro-fuzzy approach was employed to simulate nonlinear mapping between the above mentioned physical properties and mechanical properties of paving stones. The neuro-fuzzy models uses Sugeno type fuzzy inference system. The models parameters were adapted using hybrid learning algorithm and input space was fuzzyfied by considering grid partitioning. It is concluded based on the observed data and the estimated data through ANFIS models that neuro-fuzzy system exhibits a satisfactory performance.

Keywords: paving stones, physical properties, mechanical properties, ANFIS

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Authors: Frodouard Minani

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Since last decade, wireless sensor networks (WSNs) have been used in many areas like health care, agriculture, defense, military, disaster hit areas and so on. Wireless Sensor Networks consist of a Base Station (BS) and more number of wireless sensors in order to monitor temperature, pressure, motion in different environment conditions. The key parameter that plays a major role in designing a protocol for Wireless Sensor Networks is energy efficiency which is a scarcest resource of sensor nodes and it determines the lifetime of sensor nodes. Maximizing sensor node’s lifetime is an important issue in the design of applications and protocols for Wireless Sensor Networks. Clustering sensor nodes mechanism is an effective topology control approach for helping to achieve the goal of this research. In this paper, the researcher presents an energy efficiency protocol to prolong the network lifetime based on Energy efficient clustering algorithm. The Low Energy Adaptive Clustering Hierarchy (LEACH) is a routing protocol for clusters which is used to lower the energy consumption and also to improve the lifetime of the Wireless Sensor Networks. Maximizing energy dissipation and network lifetime are important matters in the design of applications and protocols for wireless sensor networks. Proposed system is to maximize the lifetime of the Wireless Sensor Networks by choosing the farthest cluster head (CH) instead of the closest CH and forming the cluster by considering the following parameter metrics such as Node’s density, residual-energy and distance between clusters (inter-cluster distance). In this paper, comparisons between the proposed protocol and comparative protocols in different scenarios have been done and the simulation results showed that the proposed protocol performs well over other comparative protocols in various scenarios.

Keywords: base station, clustering algorithm, energy efficient, sensors, wireless sensor networks

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Authors: Robert E. Kenney, Richard B. Aguilar, Efrain Antunez, Gregory Schor-Haskin, Rafael Rey, Catie Falcon, Luis Arce

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This study sought to explore the effect of Sarapin injections on chronic knee pain (CKP). Many adults suffer from CKP which is most often attributed to osteoarthritis. Current treatment regimens for CKP involve the use NSAIDS medications, injections with steroids/analgesic, platelet rich plasma injections, or orthopedic surgical interventions. Sarapin is a commercially available homeopathic aqueous extract from the pitcher plant. Studies on the use of Sarapin as a treatment for cervical, thoracic, and lumbosacral facet joint nerve blocks have been performed with mixed results. There is little available evidence on the use of Sarapin in CKP. This study examines the effect of a series of 3 weekly injections of aqueous Sarapin in 95 elderly patients with CKP in a primary care setting. Cano Health, a primary care group, identified 95 successive patients with CKP from its multimodal physiotherapy program for chronic pain. Patients underwent evaluation by a clinician, underwent diagnostic Xrays of the knees, and the treatment plan with three weekly Sarapin injections was discussed. A pain and functional limitation survey (a modified Lower Extremity Functional Scale (mLEFS)) was administered prior to initiating treatment (Entry Survey (ES)). Each patient received an intraarticular injection of 2 cc of aqueous Sarapin with 1cc 1% lidocaine during weeks 1, 2 and 3. The mLEFS was administered again at week 4, one week after the third Sarapin injection (Exit Survey (ExS)). Demographics: Mean Age 62 +/- 9.8; 73% female; 89% Hispanic/Latino; mean time between ES and ExS was 27.5 +/-8.2 days. Survey: The mLEFS was based on a published Lower Extremity Functional Scale and each patient rated their pain or functional limitation from 0 (no difficulty) to 5 (severe difficulty) for 10 questions. Answers were summed and compared. Maximum score for severe difficulty would be 50 points. Results: Mean pain/functional scores: ES was 30.3 +/-12.1 and ExS was 19.5 +/- 12.5. This represents a relative improvement of 35.7% (P<0.00001). A total of 81% (77/95) of the patients showed improvement in symptoms at week four as assessed by the mLEFS. There were 11 patients who reported an increase in their survey scores while 7 patients reported no change. When evaluating the cohort that reported improvement, the ES was 30.9 +/-11.4 and ExS was 16.3 +/-9.8 yielding a 47.2% relative improvement (P<0.00001). Injections were well tolerated, and no adverse events were reported. Conclusions: In this cohort of 95 elderly patients with CKP, treatment with 3 weekly injections of Sarapin significantly improved pain and function as assessed by a mLEFS survey. The majority (81%) of patients responded positively to therapy, 12% had worsening symptoms and 7% reported no change. The use of intraarticular injections of Sarapin for CKP was shown to be an effective modality of treatment. Sarapin’s low cost, tolerability, and ease of use make it an attractive alternative to NSAIDS, steroids, PRP or surgical intervention for this common debilitating condition.

Keywords: Sarapin, intraarticular, chronic knee pain, osteoarthritis

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Authors: Chinwe Okpoko, Vivian Atasie

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One of the leading causes of death amongst women of child-bearing age in southeast Nigeria is pregnancy. Women in the reproductive age group die at a higher rate than men of the same age bracket. Furthermore, most maternal deaths occur among poor women who live in rural communities, and who generally fall within the low socio-economic group in society. Failure of policy makers and the media to create the strategic awareness and communication that conform with the sensibilities of this group account, in part, for the persistence of this malaise. Family planning (FP) is an essential component of safe motherhood, which is designed to ensure that women receive high-quality care to achieve an optimum level of health of mother and infant. The aim is to control the number of children a woman can give birth to and prevent maternal and child mortality and morbidity. This is what sustainable development goal (SDG) health target of World Health Organization (WHO) also strives to achieve. FP programmes reduce exposure to the risks of child-bearing. Indeed, most maternal deaths in the developing world can be prevented by fully investing simultaneously in FP and maternal and new-born care. Given the intrinsic value of communication in health care delivery, it is vital to adopt the most efficacious means of awareness creation and communication amongst rural women in FP. In a country where over 50% of her population resides in rural areas with attendant low-level profile standard of living, the need to communicate health information like FP through indigenous channels becomes pertinent. Interpersonal communication amongst family, friends, religious groups and other associations, is an efficacious means of communicating social issues in rural Africa. Communication in informal settings identifies with the values and social context of the recipients. This study therefore sought to determine the place of interpersonal communication on the knowledge of rural women on FP and how it influences uptake of FP. Descriptive survey design was used in the study, with interviewer administered questionnaire constituting the instrument for data collection. The questionnaire was administered on 385 women from rural communities in southeast Nigeria. The results show that majority (58.5%) of the respondents agreed that interpersonal communication helps women understand how to plan their family size. Many rural women (82%) prefer the short term natural method to the more effective modern contraceptive methods (38.1%). Husbands’ approval of FP, as indicated in the Mean response of 2.56, is a major factor that accounts for the adoption of FP messages among rural women. Socio-demographic data also reveal that educational attainment and/or exposure influenced women’s acceptance or otherwise of FP messages. The study, therefore, recommends amongst others, the targeting of husbands in subsequent FP communication interventions, since they play major role on contraceptive usage.

Keywords: family planning, interpersonal communication, interpersonal interaction, traditional communication

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Authors: Khachen Kongpakwattana, Charungthai Dejthevaporn, Orapitchaya Krairit, Piyameth Dilokthornsakul, Devi Mohan, Nathorn Chaiyakunapruk

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Background: Although an increase in the burden of Alzheimer’s disease (AD) is evident worldwide, knowledge of costs and health-related quality of life (HR-QoL) associated with AD in Low- and Middle-Income Countries (LMICs) is still lacking. We, therefore, aimed to collect real-world cost and HR-QoL data, and investigate their associations with multiple disease-severity indicators among AD patients in Thailand. Methods: We recruited AD patients aged ≥ 60 years accompanied by their caregivers at a university-affiliated tertiary hospital. A one-time structured interview was conducted to collect disease-severity indicators, HR-QoL and caregiving information using standardized tools. The hospital’s database was used to retrieve healthcare resource utilization occurred over 6 months preceding the interview date. Costs were annualized and stratified based on cognitive status. Generalized linear models were employed to evaluate determinants of costs and HR-QoL. Results: Among 148 community-dwelling patients, average annual total societal costs of AD care were 8,014 US$ [95% Confidence Interval (95% CI): 7,295 US$ - 8,844 US$] per patient. Total costs of patients with severe stage (9,860 US$; 95% CI: 8,785 US$ - 11,328 US$) were almost twice as high as those of mild stage (5,524 US$; 95% CI: 4,649 US$ - 6,593 US$). The major cost driver was direct medical costs, particularly those incurred by AD prescriptions. Functional status was the strongest determinant for both total costs and patient’s HR-QoL (p-value < 0.001). Conclusions: Our real-world findings suggest the distinct major cost driver which results from expensive AD treatment, emphasizing the demand for country-specific cost evidence. Increases in cognitive and functional status are significantly associated with decreases in total costs of AD care and improvement on patient’s HR-QoL.

Keywords: Alzheimer's disease, associations, costs, disease-severity indicators, health-related quality of life

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Authors: Naeemeh Silvari

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The tourism industry is important for different nations in two ways. Apart from economic benefits, it provides a basis for getting acquainted with the culture of different regions of the world. Depending on the capacities and contexts of their geography, countries try to attract more people to their country in different ways. Health tourism has been an important branch of the tourism industry in recent years, and many countries around the world are trying to make progress in this field and attract many tourists from around the world. Iran, like many developing countries in the Middle East and East Asia, is trying to improve and develop tourist attractions in the field of health. Due to the cheapness of providing medical services to tourists, many people have traveled to Iran for medical and health care. However, there is a long way to go before recognizing and reaching the desired position in this field. Due to the direct relationship between tourism and culture, the negative attitude towards the context of Iran has caused foreign travelers not to choose this country as their tourist destination. In this article, we tried to study the change in their attitude towards Iran by using semi-structured interviews of foreign travelers who traveled to Iran for treatment and medical services. The text of the interviews was coded and analyzed by MAX QDA software. Many of the people in the sample were from Middle Eastern and Arabic-speaking countries. Influenced by the media, they felt rejected by the Iranians before the trip. During their stay in Iran and in connection with the health care staff, in the first stage, they pointed out that many of their anxieties about the kind of treatment of Iranians have been allayed. In addition to the satisfaction with the medical services provided, they considered the atmosphere of Iranians' interaction with foreign travelers to be relatively appropriate, and some stated that Iran would be the destination of their leisure trip in the future. At the end of the research, policymakers were suggested that in order to resolve cultural contradictions rooted in values, they should first be recognized and seek to use other opportunities to resolve contradictions and form interactions with other cultures.

Keywords: cultural conflict, health tourism, cultural prejudice, advertising and media

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Authors: Junaid Mahmood Alam

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Revalidating and harmonizing clinical chemistry analytical principles and optimizing methods through quality control programs and assessments is the preeminent means to attain optimal outcome within the clinical laboratory services. Present study reports revalidation of our existing IFCC regularized analytical methods, particularly hepatic and thyroid function tests, by optimization of precision analyses and processing through external and internal quality assessments and regression determination. Parametric components of hepatic (Bilirubin ALT, γGT, ALP), cardiac (LDH, AST, Trop I) and thyroid/pituitary (T3, T4, TSH, FT3, FT4) function tests were used to validate analytical techniques on automated chemistry and immunological analyzers namely Hitachi 912, Cobas 6000 e601, Cobas c501, Cobas e411 with UV kinetic, colorimetric dry chemistry principles and Electro-Chemiluminescence immunoassay (ECLi) techniques. Process of validation and revalidation was completed with evaluating and assessing the precision analyzed Preci-control data of various instruments plotting against each other with regression analyses R2. Results showed that: Revalidation and optimization of respective parameters that were accredited through CAP, CLSI and NEQAPP assessments depicted 99.0% to 99.8% optimization, in addition to the methodology and instruments used for analyses. Regression R2 analysis of BilT was 0.996, whereas that of ALT, ALP, γGT, LDH, AST, Trop I, T3, T4, TSH, FT3, and FT4 exhibited R2 0.998, 0.997, 0.993, 0.967, 0.970, 0.980, 0.976, 0.996, 0.997, 0.997, and R2 0.990, respectively. This confirmed marked harmonization of analytical methods and instrumentations thus revalidating optimized precision standardization as per IFCC recommended guidelines. It is concluded that practices of revalidating and harmonizing the existing or any new services should be followed by all clinical laboratories, especially those associated with tertiary care hospital. This is will ensure deliverance of standardized, proficiency tested, optimized services for prompt and better patient care that will guarantee maximum patients’ confidence.

Keywords: revalidation, standardized, IFCC, CAP, harmonized

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Authors: Francesco Buccafurri, Celeste Romolo

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Nowadays phishing is the most frequent starting point of cyber-attack vectors. Phishing is implemented both via email and social network messages. While a wide scientific literature exists which addresses the problem of contrasting email spam-phishing, no specific countermeasure has been so far proposed for phishing included into private messages of social network platforms. Unfortunately, the problem is severe. This paper proposes an approach against social network phishing, based on a non invasive collaborative information-sharing approach which leverages blockchain. The detection method works by filtering candidate messages, by distilling them by means of a distance-preserving hash function, and by publishing hashes over a public blockchain through a trusted smart contract (thus avoiding denial of service attacks). Phishing detection exploits social information embedded into social network profiles to identify similar messages belonging to disjoint contexts. The main contribution of the paper is to introduce a new approach to contrasting the problem of social network phishing, which, despite its severity, received little attention by both research and industry.

Keywords: phishing, social networks, information sharing, blockchain

Procedia PDF Downloads 328