Search results for: international patient safety goals

Authors: Keita Nishio, Takashi Kaburagi, Yosuke Kurihara

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Recent advances in medical technology have served to enhance average life expectancy. However, the total time for which the patients are prescribed complete bedrest has also increased. With patients being required to maintain a constant lying posture- also called bedsore- development of a system to detect patient roll-over becomes imperative. For this purpose, extant studies have proposed the use of cameras, and favorable results have been reported. Continuous on-camera monitoring, however, tends to violate patient privacy. We have proposed unconstrained bio-signal measurement system that could detect body-motion during sleep and does not violate patient’s privacy. Therefore, in this study, we propose a roll-over detection method by the date obtained from the bi-signal measurement system. Signals recorded by the sensor were assumed to comprise respiration, pulse, body motion, and noise components. Compared the body-motion and respiration, pulse component, the body-motion, during roll-over, generate large vibration. Thus, analysis of the body-motion component facilitates detection of the roll-over tendency. The large vibration associated with the roll-over motion has a great effect on the Root Mean Square (RMS) value of time series of the body motion component calculated during short 10 s segments. After calculation, the RMS value during each segment was compared to a threshold value set in advance. If RMS value in any segment exceeded the threshold, corresponding data were considered to indicate occurrence of a roll-over. In order to validate the proposed method, we conducted experiment. A bi-directional microphone was adopted as a high-sensitivity pressure sensor and was placed between the mattress and bedframe. Recorded signals passed through an analog Band-pass Filter (BPF) operating over the 0.16-16 Hz bandwidth. BPF allowed the respiration, pulse, and body-motion to pass whilst removing the noise component. Output from BPF was A/D converted with the sampling frequency 100Hz, and the measurement time was 480 seconds. The number of subjects and data corresponded to 5 and 10, respectively. Subjects laid on a mattress in the supine position. During data measurement, subjects—upon the investigator's instruction—were asked to roll over into four different positions—supine to left lateral, left lateral to prone, prone to right lateral, and right lateral to supine. Recorded data was divided into 48 segments with 10 s intervals, and the corresponding RMS value for each segment was calculated. The system was evaluated by the accuracy between the investigator’s instruction and the detected segment. As the result, an accuracy of 100% was achieved. While reviewing the time series of recorded data, segments indicating roll-over tendencies were observed to demonstrate a large amplitude. However, clear differences between decubitus and the roll-over motion could not be confirmed. Extant researches possessed a disadvantage in terms of patient privacy. The proposed study, however, demonstrates more precise detection of patient roll-over tendencies without violating their privacy. As a future prospect, decubitus estimation before and after roll-over could be attempted. Since in this paper, we could not confirm the clear differences between decubitus and the roll-over motion, future studies could be based on utilization of the respiration and pulse components.

Keywords: bedsore, high-sensitivity pressure sensor, roll-over, unconstrained bio-signal measurement

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Authors: Shweta Jha, Nandita Chaube

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The concept of self has a major role to play in the study of personality which drives the current study in its present form. This is a case of Miss S, a 17-year-old Hindu, currently in eleventh standard, with no family history of mental illness but with a past history of inability to manage relationships, multiple emotional and sexual relationships, repeated self harming behaviour, and sexual abuse over a period of 2 months at the age of 10 years. She comes with a psychiatric history of one episode of dissociative fall followed by a stressful event which left the patient with many psychological disturbances matching the criterion of Cluster B and C traits. Current episode precipitated due to the relationship failure, predisposing factor is her personality traits, and poor social and family support. Considering the patient’s aspiration for positivity and demand of the therapy, ventilation sessions were carried out which made her capable of understanding and dealing with her negative emotions, also strengthened mother child bond, helped her maintain meaningful and healthy relationships, also helped her increase her problem solving ability and adaptive coping skills making her feel more positive and acceptable towards herself, family members and others.

Keywords: cluster B and C traits, personality, therapy, self

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Authors: C. Bejrananda, Y. Lee, T. Khamkaew

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With the rise of the importance of air transportation in the 21st century, the role of economics in airport planning and decision-making has become more important to the urban structure and land value around it. Therefore, this research aims to examine the relationship between an airport and its impacts on the distribution of urban land uses and land values by applying the Alonso’s bid rent model. The New Bangkok International Airport (Suvarnabhumi International Airport) was taken as a case study. The analysis was made over three different time periods of airport development (after the airport site was proposed, during airport construction, and after the opening of the airport). The statistical results confirm that Alonso’s model can be used to explain the impacts of the new airport only for the northeast quadrant of the airport, while proximity to the airport showed the inverse relationship with the land value of all six types of land use activities through three periods of time. It indicates that the land value for commercial land use is the most sensitive to the location of the airport or has the strongest requirement for accessibility to the airport compared to the residential and manufacturing land use. Also, the bid-rent gradients of the six types of land use activities have declined dramatically through the three time periods because of the Asian Financial Crisis in 1997. Therefore, the lesson learned from this research concerns about the reliability of the data used. The major concern involves the use of different areal units for assessing land value for different time periods between zone block (1995) and grid block (2002, 2009). As a result, this affect the investigation of the overall trends of land value assessment, which are not readily apparent. In addition, the next concern is the availability of the historical data. With the lack of collecting historical data for land value assessment by the government, some of data of land values and aerial photos are not available to cover the entire study area. Finally, the different formats of using aerial photos between hard-copy (1995) and digital photo (2002, 2009) made difficult for measuring distances. Therefore, these problems also affect the accuracy of the results of the statistical analyses.

Keywords: airport development area, economic rents, spatial pattern, suvarnabhumi international airport

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Authors: Brandon Ko

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Whether it’s a kitchen staff or a law firm, many groups tend to have homogenous characteristics of race, gender, interests, and goals. Social groups are not typically random samples of the population and will usually have common identifiers. According to Blau, age, sex, and education all play salient roles in shaping relationships within members of society. So if there is some degree of homogeneity within groups, the question arises whether this is beneficial or harmful to a group’s effectiveness. There has been much disagreement in the scientific community as to whether the presence of homophily benefits or hinders an athletic team's cohesiveness. For this paper, a comparative study of research of soccer case studies that followed various, youth players was studied against examinations of the effects that such a culture has on athletes. The case studies were used as evidence to determine what kind of homophily existed within the soccer camps. One case study followed several European developmental clubs such as Bayern Munich and Barcelona. Another study followed eight different players, four of each gender, implementing a similar method of interviewing, observing, and questioning. The individual and team goals of each athlete were reviewed to see which teams and players were ego-oriented and which were team-oriented. Additionally, there had been little research done on the relationship between homophily and how it applies to the sport community, suggesting the need to develop this neglected problem in applied psychology. This paper argues that the benefits of an egalitarian culture and stronger relations with people of a similar socio-demographic outweigh the liabilities of cohesion like being stereotyped and a lack of network outside the group as produced by homophily in athletic competition.

Keywords: group cohesion, homophily, sports psychology, youth athletics

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Authors: K. Omkar, D. Nayan

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Rapid urbanization is one of the consequences of rapid population explosion, which has also led to massive increase in number of motorized vehicles essential for carrying out all activities needed for sustaining urban livelihood. With this increased use of motorized vehicles over the time there has also been an increase in number of accidents. Study of road network and geometric features are essential to tackle problems of road accidents in any district or town. The increase in road accidents is one of the burning issues in the present society. Records show that there is one death at every 3.7 minutes because of road accident. It has been found from the research that, accidents occur due to, mistakes of the driver (86%) followed by bad street condition (5%), mistake of pedestrian (4%), as well as technical and maintenance defects (1%). Here, case study of Ahmedabad, Gujarat is taken up where first road safety level is assessed considering various parameters. The study confined to accident characteristics of all types of vehicles. For deeper analysis, road safety index for various stretches in Ahmedabad was found out. Crash rate for same stretches was found out. Based on various parameters priority was decided so that which stretch should be look out first to minimize road accidents on that stretch and which stretch should look out last. The major findings of the study are that accident severity of Ahmedabad has increased, but accident fatality risk has decreased; thus there is need to undertake some traffic engineering measures or make some traffic rules that are strictly followed by traffic. From the above study and literature studied it is found that Ahmedabad is suffering from similar problem of accidents and injuries and deaths caused by them, after properly investigating the issue short-term and long-term solutions to minimize road accidents have been presented in this paper.

Keywords: accident severity index, accident fatality rate, accident fatality risk, accident risk, road safety index

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Authors: Kayliegh Richardson, Ana Speed

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The international campaign, '16 Days of Activism against Gender Based Violence', seeks to raise awareness and understanding of gender based violence in a variety of settings. The campaign requires its participants to join in for advancing the right to education and challenging violence, discrimination, and inequality and take into account intersections such as gender, race, ethnicity, religion, sexual orientation, socio-economic status and other social identifiers. The authors of this paper are both clinic supervisors at Northumbria University in Newcastle Upon Tyne, England. As part of their research project, the authors are going to ask final year students on the MLaw degree at Northumbria University to become involved in the campaign by participating in a variety of awareness-raising activities during the course of the 16 days, which runs from 27 November 2017 until 10 December 2017. As part of the campaign, the authors will be running the following activities for students to participate in 1. Documentary showing of Banaz, a love story followed by discussion group. 2. 16 blogs for 16 days. Students will contribute to our family law blog over the 16 days, with articles about gender based violence. 3. Guest lecture on domestic violence (potentially run by a domestic violence organisation) 4. Workshop by Professor Ruth Lewis who will be presenting her innovative research in gender based violence and online abuse. 5. Poster competition - the students are asked to submit a poster about the different forms of gender based violence or proposals for ending violence against women and girls. The research aims are to identify whether participation in the project: 1. increases the students' engagement with issues of gender justice 2. is an effective educational tool for raising the students' awareness and understanding of gender based violence in its many forms. 3. increases the students' understanding of the domestic and international framework for protecting victims (in particular women and children) of gender based violence. After the activities, an impartial, experienced researcher will be holding a focus group with volunteering students to discuss their experiences of participating in the activities and whether they felt that participation in the project achieved the aims set out above. This paper will discuss the activities undertaken by the students and will address the data gathered during the focus group. Finally, the authors will discuss their thoughts on whether awareness of gender-based violence and other international family law issues can be appropriately raised in an educational setting.

Keywords: gender based violence, clinical legal education, international family law, domestic abuse

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Authors: Syed Asif Hassan, Tabrej Khan, Ibrahim Manssor Al Najar, Mohammed Nasser

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The incredible accomplishment achieved by e-commerce in consumer durable area encouraged us to implement the online e-commerce model to tap the business benefits of electronic pharmacy in Saudi Arabia. The Kingdom of Saudi Arabia is famous for traditional herbal medicine. The rich heritage of traditional medicine has helped the mushrooming of regional pharmaceutical industries manufacturing drugs and other therapeutic against various diseases. However, the implementation of e-commerce in pharmacy has not been employed in the Kingdom of Saudi Arabia. The electronic pharmacy (E-Pharm) is an important sector that is flourishing across the globe and providing benefits of E-Pharm to the customers and suppliers all around the world. In this context, our web-based application of electronic pharmacy is the one of its kind in the Kingdom of Saudi Arabia. Surveys and personal interviews were used to identify key objectives of the proposed web-based portal. As per the findings of the surveys and personal interviews, following key objectives were identified: (a) The online platform will be used for ordering of prescription based medications for consumers. (b) The e-portal will provide space for pharmaceutical retailers who do not have an electronic platform to upload and sell their therapeutic products in an organized way. (c) The web portal will provide a tracking system to track the customer’s behavior like choice, offer, order, shipment, payment, etc. The web-based e-pharmacy portal will be developed using MySQL and PHP. The development of e-pharmacy web portal and e-prescription practices will not only improve the growth of electronic pharmacy but would also decrease the possibility of prescription alteration thus providing safety and improving the quality of service provided to the patient or consumers.

Keywords: e-commerce, E-Pharm, MySQL, PHP

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Authors: Joanna Marie A. Paulino-Morente, Vaneza Valentina L. Penolio, Grace Sabado

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Ovarian cancer is extremely hard to diagnose in its early stages, and those afflicted at the time of diagnosis are typically asymptomatic and in the late stages of the disease, with metastasis to other organs. Ovarian cancers often occur sporadically, with only 5% associated with hereditary mutations. Mutations in the BRCA1 and BRCA2 tumor suppressor genes have been found to be responsible for the majority of hereditary ovarian cancers. One type of ovarian tumor is Malignant Mixed Mullerian Tumor (MMMT), which is a very rare and aggressive type, accounting for only 1% of all ovarian cancers. Reported is a case of a 43-year-old G3P3 (3003), who came into our institution due to a 2-month history of difficulty of breathing. Family history reveals that her eldest and younger sisters both died of ovarian malignancy, with her younger sister having a histopathology report of endometrioid ovarian carcinoma, left ovary stage IIIb. She still has 2 asymptomatic sisters. Physical examination pointed to pleural effusion of right lung, and presence of bilateral ovarian new growth, which had a Sassone score of 13. Admitting Diagnosis was G3P3 (3003), Ovarian New Growth, bilateral, Malignant; Pleural effusion secondary to malignancy. BRCA was requested to establish a hereditary mutation; however, the patient had no funds. Once the patient was stabilized, TAHBSO with surgical staging was performed. Intraoperatively, the pelvic cavity was occupied by firm, irregularly shaped ovaries, with a colorectal metastasis. Microscopic sections from both ovaries and the colorectal metastasis had pleomorphic tumor cells lined by cuboidal to columnar epithelium exhibiting glandular complexity, displaying nuclear atypia and increased nuclear-cytoplasmic ratio, which are infiltrating the stroma, consistent with the features of Malignant Mixed Mullerian Tumor, since MMMT is composed histologically of malignant epithelial and sarcomatous elements. In conclusion, discussed is the clinic-pathological feature of a patient with primary ovarian Malignant Mixed Mullerian Tumor, a rare malignancy comprising only 1% of all ovarian neoplasms. Also, by understanding the hereditary ovarian cancer syndromes and its relation to this patient, it cannot be overemphasized that a comprehensive family history is really fundamental for early diagnosis. The familial association of the disease, given that the patient has two sisters who were diagnosed with an advanced stage of ovarian cancer and succumbed to the disease at a much earlier age than what is reported in the general population, points to a possible hereditary syndrome which occurs in only 5% of ovarian neoplasms. In a low-resource setting, being in a third world country, the following will be recommended for monitoring and/or screening women who are at high risk for developing ovarian cancer, such as the remaining sisters of the patient: 1) Physical examination focusing on the breast, abdomen, and rectal area every 6 months. 2) Transvaginal sonography every 6 months. 3) Mammography annually. 4) CA125 for postmenopausal women. 5) Genetic testing for BRCA1 and BRCA2 will be reserved for those who are financially capable.

Keywords: BRCA, hereditary breast-ovarian cancer syndrome, malignant mixed mullerian tumor, ovarian cancer

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Authors: Li-Hsueh Chen

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Efficient operation is more and more important for managers of hotels. Unlike the manufacturing industry, hotels cannot store their products. In addition, many hotels provide room service, and food and beverage service simultaneously. When efficiencies of hotels are evaluated, the internal structure should be considered. Hence, based on the operational characteristics of hotels, this study proposes a DEA model to simultaneously assess the efficiencies among the room production division, food and beverage production division, room service division and food and beverage service division. However, not only the enhancement of efficiency but also the adjustment of scale can improve the performance. In terms of the adjustment of scale, scale elasticity or returns to scale can help to managers to make decisions concerning expansion or contraction. In order to construct a reasonable approach to measure the efficiencies and scale elasticities of hotels, this study builds an alternative variable-returns-to-scale-based two-stage network DEA model with the combination of parallel and series structures to explore the scale elasticities of the whole system, room production division, food and beverage production division, room service division and food and beverage service division based on the data of international tourist hotel industry in Taiwan. The results may provide valuable information on operational performance and scale for managers and decision makers.

Keywords: efficiency, scale elasticity, network data envelopment analysis, international tourist hotel

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Authors: Lucas Bublitz, Michael Herdrich

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By achieving the first commercialization approval in San Francisco the Autonomous Driving (AD) industry proves the technology maturity of the SAE L4 AD systems and the corresponding software and hardware stack. This milestone reflects the upcoming phase in the industry, where the focus is now about scaling and supervising larger autonomous vehicle (AV) fleets in different operation areas. This requires an operation framework, which organizes and assigns responsibilities to the relevant AV technology and operation stakeholders from the AV system provider, the Remote Intervention Operator, the MaaS provider and regulatory & approval authority. This holistic operation framework consists of technological, processual, and organizational activities to ensure safe operation for fully automated vehicles. Regarding the supervision of large autonomous vehicle fleets, a major focus is on the continuous field monitoring. The field monitoring approach must reflect the safety and security criticality of incidents in the field during driving operation. This includes an automatic containment approach, with the overall goal to avoid safety critical incidents and reduce downtime by a malfunction of the AD software stack. An End-to-end (E2E) field monitoring approach detects critical faults in the field, uses a knowledge-based approach for evaluating the safety criticality and supports the automatic containment of these E/E faults. Applying such an approach will ensure the scalability of AV fleets, which is determined by the handling of incidents in the field and the continuous regulatory compliance of the technology after enhancing the Operational Design Domain (ODD) or the function scope by Functions on Demand (FoD) over the entire digital product lifecycle.

Keywords: field monitoring, incident management, multicompliance management for AI in AD, root cause analysis, database approach

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Authors: Mohsin Ali Shaikh, Song Weiguo, Muhammad Kashan Surahio, Usman Shahid, Rehmat Karim

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This study investigated a catastrophic arson fire incident that occurred at a textile garment building in Karachi, Pakistan. Unfortunately, a catastrophic event led to the loss of 262 lives and caused 55 severe injuries. The primary objective is to analyze the aspects of the fire incident and understand the causes of arson fire disasters. The study utilized Fire Dynamic Simulation (F.D.S) was employed to simulate fire propagation, visibility, harmful gas concentration, fire temperature, and numerical results. The analysis report has determined the specific circumstances that created the unpleasant incident in the present study. The significance of the current findings lies in their potential to prevent arson fires, improve fire safety measures, and the development of safety plans in building design. The fire dynamic simulation findings can serve as a theoretical basis for the investigation of arson fires and evacuation planning in textile garment buildings.

Keywords: investigation, fire arson incident, textile garment, fire dynamic simulation (FDS)

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Authors: Alisawi Alaa T., Collins P. E. F.

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The analysis and evaluation of slope stability and landslide hazards are landslide hazards are critically important in civil engineering projects and broader considerations of safety. The level of slope stability risk should be identified due to its significant and direct financial and safety effects. Slope stability hazard analysis is performed considering static and/or dynamic loading circumstances. To reduce and/or prevent the failure hazard caused by landslides, a sophisticated and practical hazard analysis method using advanced constitutive modeling should be developed and linked to an effective solution that corresponds to the specific type of slope stability and landslides failure risk. Previous studies on slope stability analysis methods identify the failure mechanism and its corresponding solution. The commonly used approaches include used approaches include limit equilibrium methods, empirical approaches for rock slopes (e.g., slope mass rating and Q-slope), finite element or finite difference methods, and district element codes. This study presents an overview and evaluation of these analysis techniques. Contemporary source materials are used to examine these various methods on the basis of hypotheses, the factor of safety estimation, soil types, load conditions, and analysis conditions and limitations. Limit equilibrium methods play a key role in assessing the level of slope stability hazard. The slope stability safety level can be defined by identifying the equilibrium of the shear stress and shear strength. The slope is considered stable when the movement resistance forces are greater than those that drive the movement with a factor of safety (ratio of the resistance of the resistance of the driving forces) that is greater than 1.00. However, popular and practical methods, including limit equilibrium approaches, are not effective when the slope experiences complex failure mechanisms, such as progressive failure, liquefaction, internal deformation, or creep. The present study represents the first episode of an ongoing project that involves the identification of the types of landslides hazards, assessment of the level of slope stability hazard, development of a sophisticated and practical hazard analysis method, linkage of the failure type of specific landslides conditions to the appropriate solution and application of an advanced computational method for mapping the slope stability properties in the United Kingdom, and elsewhere through geographical information system (GIS) and inverse distance weighted spatial interpolation(IDW) technique. This study investigates and assesses the different assesses the different analysis and solution techniques to enhance the knowledge on the mechanism of slope stability and landslides hazard analysis and determine the available solutions for each potential landslide failure risk.

Keywords: slope stability, finite element analysis, hazard analysis, landslides hazard

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Authors: Xiaomin Zhong, Alexander Pate, Ya-Ting Yang, Ali Fahmi, Darren M. Ashcroft, Ben Goldacre, Brian Mackenna, Amir Mehrkar, Sebastian C. J. Bacon, Jon Massey, Louis Fisher, Peter Inglesby, Kieran Hand, Tjeerd van Staa, Victoria Palin

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Background: This study aimed to predict risks of potentially inappropriate antibiotic type and repeat prescribing and assess changes during COVID-19. Methods: With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system and selected patients prescribed antibiotics from 2019 to 2021. Multinomial logistic regression models predicted the patient’s probability of receiving an inappropriate antibiotic type or repeating the antibiotic course for each common infection. Findings: The population included 9.1 million patients with 29.2 million antibiotic prescriptions. 29.1% of prescriptions were identified as repeat prescribing. Those with same-day incident infection coded in the EHR had considerably lower rates of repeat prescribing (18.0%), and 8.6% had a potentially inappropriate type. No major changes in the rates of repeat antibiotic prescribing during COVID-19 were found. In the ten risk prediction models, good levels of calibration and moderate levels of discrimination were found. Important predictors included age, prior antibiotic prescribing, and region. Patients varied in their predicted risks. For sore throat, the range from 2.5 to 97.5th percentile was 2.7 to 23.5% (inappropriate type) and 6.0 to 27.2% (repeat prescription). For otitis externa, these numbers were 25.9 to 63.9% and 8.5 to 37.1%, respectively. Interpretation: Our study found no evidence of changes in the level of inappropriate or repeat antibiotic prescribing after the start of COVID-19. Repeat antibiotic prescribing was frequent and varied according to regional and patient characteristics. There is a need for treatment guidelines to be developed around antibiotic failure and clinicians provided with individualised patient information.

Keywords: antibiotics, infection, COVID-19 pandemic, antibiotic stewardship, primary care

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Authors: Alireza Vafaei Sadr, Vida Abedi, Jiang Li, Ramin Zand

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Missing data is a common challenge in medical research and can lead to biased or incomplete results. When the data bias leaks into models, it further exacerbates health disparities; biased algorithms can lead to misclassification and reduced resource allocation and monitoring as part of prevention strategies for certain minorities and vulnerable segments of patient populations, which in turn further reduce data footprint from the same population – thus, a vicious cycle. This study compares the performance of six imputation techniques grouped into Linear and Non-Linear models on two different realworld electronic health records (EHRs) datasets, representing 17864 patient records. The mean absolute percentage error (MAPE) and root mean squared error (RMSE) are used as performance metrics, and the results show that the Linear models outperformed the Non-Linear models in terms of both metrics. These results suggest that sometimes Linear models might be an optimal choice for imputation in laboratory variables in terms of imputation efficiency and uncertainty of predicted values.

Keywords: EHR, machine learning, imputation, laboratory variables, algorithmic bias

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Authors: Sara Qandil, Harriet Bothwell, Lowri Evans, Kevin Jones, Simon Collin

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Background: Uganda suffers from high rates of HIV. Misconceptions around HIV are known to be prevalent in Sub-Saharan Africa (SSA). Two of the most common misconceptions in Uganda are that HIV can be transmitted by mosquito bites or from sharing food. The aim of this project was to establish the local misconceptions around HIV in a Central Ugandan population, and identify if there is a role for patient education leaflets. This project was undertaken as a student selected component (SSC) offered by Swindon Academy, based at the Great Western Hospital, to medical students in their fourth year of the undergraduate programme. Methods: The study was conducted at Villa Maria Hospital; a private, rural hospital in Kalungu District, Central Uganda. 36 patients, 23 from the hospital clinic and 13 from the community were interviewed regarding their understanding of HIV and by what channels they had obtained this understanding. Interviews were conducted using local student nurses as translators. Verbal responses were translated and then transcribed by the researcher. The same 36 patients then undertook a 'misconception' test consisting of 35 questions. Quantitative data was analysed using descriptive statistics and results were scored based on three components of 'transmission knowledge', 'prevention knowledge' and 'misconception rejection'. Each correct response to a question was scored one point, otherwise zero e.g. correctly rejecting a misconception scored one point, but answering ‘yes’ or ‘don’t know’ scored zero. Scores ≤ 27 (the average score) were classified as having ‘poor understanding’. Mean scores were compared between participants seen at the HIV clinic and in the community, and p-values (including Fisher’s exact test) were calculated using Stata 2015. Level of significance was set at 0.05. Interviews with 7 members of staff working in the HIV clinic were undertaken to establish what methods of communication are used to educate patients. Interviews were transcribed and thematic analysis undertaken. Results: The commonest misconceptions which failed to be rejected included transmission of HIV by kissing (78%), mosquitoes (69%) and touching (36%). 33% believed HIV may be prevented by praying. The overall mean scores for transmission knowledge (87.5%) and prevention knowledge (81.1%) were better than misconception rejection scores (69.3%). HIV clinic respondents did tend to have higher scores, i.e. fewer misconceptions, although there was statistical evidence of a significant difference only for prevention knowledge (p=0.03). Analysis of the qualitative data is ongoing but several patients expressed concerns about not being able to read and therefore leaflets not having a helpful role. Conclusions: Results from this paper identified that a high proportion of the population studied held misconceptions about HIV. Qualitative data suggests that there may be a role for patient education leaflets, if pictorial-based and suitable for those with low literacy skill.

Keywords: HIV, human immunodeficiency virus, misconceptions, patient education, Sub-Saharan Africa, Uganda

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Authors: Teguh Nurhidayat, Nurhamid, Dicky Muslim, Zufialdi Zakaria, Irvan Sophian

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This paper presents the role of climate change as the factor that induces landslide. Case study is located at Lahat Regency, South Sumatera Province, Indonesia. Study area has high economic value of coal reserves (mostly subbituminous – bituminous), which is developable for open pit coal mining in the future. Seams are found in Muara Enim Formation. This formation is at south Sumatera basin which is formed at Tertiary as a result of collision between the indian plate and eurasian plate. South Sumatera basin which is a basin located in back arc basin. This study aims to unravel the relationship between slope stability with different season condition in tropical climate. Undisturbed soil samples were obtained in the field along with other geological data. Laboratory works were carried out to obtain physical and mechanical properties of soils. Methodology to analyze slope stability is bishop method. Bishop methods are used to identify safety factor of slope. Result shows that slopes in rainy season conditions are more prone to landslides than in dry season. In the dry seasons with moisture content is 22.65%, safety factor is 1.28 the slope in stable condition. If rain is approaching with moisture content increasing to 97.8%, the slope began to be critical. On wet condition groundwater levels is increased, followed by γ (unit weight), c (cohesion), and φ (angle of friction) at 18.04, 5,88 kN/m2, and 28,04°, respectively, which ultimately determines the security factor FS to be 1.01 (slope in unstable conditions).

Keywords: rainfall, moisture content, slope analysis, landslide prone

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Authors: Raju K. Thadikkaran

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Introduction: The IPR have come to the centre stage of development discourse today for a variety of reasons: It ranges from the arbitrariness in the enforcement, overlapping and mismatch with various international agreements and conventions, divergence in the definition, nature and content and the duration as well as severe adverse consequences to technologically weak developing countries. In turn, the IPR have acquired prominence in the foreign policy making as well as in the relations among nations. Quite naturally, there is ample scope for an examination of the correlation between Technology, IPR and International Relations in the contemporary world. Nature and Scope: A cursory examination of the realm of IPR and its protection shall reveals the acute divergence that exists in the perspectives, on all matters related to the very definition, nature, content, scope and duration. The proponents of stronger protection, mostly technologically advanced countries, insist on a stringent IP Regime whereas technologically weak developing countries seem to advocate for flexibilities. From the perspective of developing countries like India, one of the most crucial concerns is related to the patenting of life forms and the protection of TK and BD. There have been several instances of Bio-piracy and Bio-prospecting of the resources related to BD and TK from the Bio-rich Global South. It is widely argued that many provisions in the TRIPS are capable of offsetting the welcome provisions in the CBD such as the Access and Benefit Sharing and Prior Informed Consent. The point that is being argued out is as to how the mismatch between the provisions in the TRIPS Agreement and the CBD could be addressed in a healthy manner so that the essential minimum legitimate interests of all stakeholders could be secured thereby introducing a new direction to the international relations. The findings of this study reveal that the challenges roused by the TRIPS Regime over-weigh the opportunities. The mismatch in the provisions in this regard has generated various crucial issues such as Bio-piracy and Bio-prospecting. However, there is ample scope for managing and protecting IP through institutional innovation, legislative, executive and administrative initiative at the global, national and regional levels. The Indian experience is quite reflective of the same and efforts are being made through the new national IPR policy. This paper, employing Historical Analytical Method, has Three Sections. The First Section shall trace the correlation between the Technology, IPR and international relations. The Second Section shall review the issues and potential concerns in the protection and management of IP related to the BD and TK in the developing countries in the wake of the TRIPS and the CBD. The Final Section shall analyze the Indian Experience in this regard and the experience of the bio-rich Kerala in particular.

Keywords: IPR, technology and international relations, bio-diversity, traditional knowledge

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Authors: F. Christie, M. Staber

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Malnutrition is a predictor of poor clinical outcome in the elderly. Up to 60% of hip fracture patients are clinically malnourished on admission. This study assessed the perioperative nutritional state of patients admitted with a proximal femoral fracture and examined if adequate nutritional support was achieved. Methods: Prospective, the observational audit of 30 patients, admitted with a proximal femoral fracture, over a one-month period. We recorded: patient demographics; surgical delay; nutritional state on admission; documentation of Malnutrition Universal Screening Tool (MUST) score; dietician input and daily calorie intake through food charts. The nutritional state was re-assessed weekly and at discharge. The outcome was measured by the length of hospital stay and thirty-day mortality. Results: Mean age 87, M:F 1:2 and all patients were ASA three or four. Five patients (17%) had a prolonged ( >24 hours) fasting period. All patients had a MUST score completed on admission, 27% were underweight and 30% were high risk for malnutrition. Twenty-six patients (87%) were appropriately assessed for dietician referral. Thirteen patients had food charts; on average, hospital meals provided 1500kcal daily. No patient achieved > 75% of the provided calories with 69% of patients achieving 50% or less. Only three patients were started on nutritional supplements. Twenty-three patients (77%) lost weight, averaging 6% weight loss during admission. Mean length of stay (LOS) was 23 days and 30-day mortality 9%. Four patients (13%) gained weight, their mean LOS was 17 days and 30-day mortality 0%. Discussion: Malnutrition in the elderly originates in the community. Following major trauma it’s difficult to reverse nutritional deficits in hospitals. It’s therefore concerning that no high-risk patient achieved their recommended calorie intake. Perioperative optimisation needs to include early nutritional intervention, early anaesthetic review and adjusted anaesthetic techniques to support feeding.

Keywords: trauma, nutrition, neck of femur fracture

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Authors: Pedro Felgueiras, Ana Miguel, Nélson Almeida, Raquel Silva

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Objective: Through the study of a clinical case of delusional somatic disorder secondary to phantogeusia, we aim to highlight the importance of considering psychosomatic conditions in differential diagnosis, as well as to emphasize the complexity of its comprehension, treatment, and respective impact on patients’ functioning. Methods: Bearing this in mind, we conducted a critical analysis of a case series based on patient observations, clinical data, and complementary diagnostic methods, as well as a non-systematic review of the literature on the subject. Results: A 61-year-old female patient with no history of psychiatric conditions. Family psychiatric history of mood disorder (depression), with psychotic features found in her mother. Medical history of many comorbidities affecting different organ systems (endocrine, gastrointestinal, genitourinary, ophthalmological). Documented neuroticism traits of personality. The patient’s family described a persistent concern about several physical symptoms across her life, with a continuous effort to obtain explanations about any sensation out of her normal perception. Since being subjected to endoscopy in 2018, she started complaints of persistent phantogeusia (acid taste) and developed excessive thoughts, feelings, and behaviors associated with this somatic symptom. The patient was evaluated by several medical specialties, and an extensive panel of medical exams was carried out, excluding any disease. Besides all the investigation and with no evidence of disease signs, acute anxiety, time, and energy dispended to this symptom culminated in severe psychosocial impairment. The patient was admitted to a psychiatric ward for investigation and treatment of this clinical picture, leading to the diagnosis of the delusional somatic disorder. In order to exclude the acute organic etiology of this psychotic disorder, an analytic panel was carried out with no abnormal results. In the context of a psychotic clinical picture, a CT scan was performed, which revealed a right cortical vascular lesion. Neuropsychological evaluation was made, with the description of cognitive functioning being globally normative. During treatment with an antipsychotic (pimozide), a complete remission of the somatic delusion was associated with the disappearance of gustative perception disturbance. In follow-up, a relapse of gustative sensation was documented, and her thoughts and speech were dominated by concerns about multiple somatic symptoms. Conclusion: In terms of abnormal bodily sensations, the oral cavity is one of the frequent sites of delusional disorder. Patients with these gustatory perception distortions complain about unusual sensations without corresponding abnormal findings in the oral area. Its pathophysiology has not been fully elucidated yet. In terms of its comprehensive psychopathology, this case was hypothesized as a paranoid development of a delusional somatic disorder triggered by a post-invasive procedure phantogeusia (which is described as a possible side effect of an endoscopy) in a patient with an anankastic personality. This case presents interesting psychopathology, reinforcing the complexity of psychosomatic disorders in terms of their etiopathogenesis, clinical treatment, and long-term prognosis.

Keywords: psychosomatics, delusional somatic disorder, phantogeusia, paranoid development

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Authors: Madad Ali

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In the contemporary landscape of international travel, the infusion of digital technologies has given rise to innovative business models that are reshaping the dynamics of tourism. This research delves into the transformative potential of these novel business models within the realm of digital tourism and their multifaceted impact on local businesses, residents' quality of life, and the overall travel experience. The study focuses on the captivating backdrop of Yunnan Province, China, renowned for its rich cultural heritage and diverse ethnic minorities, to uncover the intricate nuances of this phenomenon. The primary objectives of this research encompass the identification and categorization of emerging business models facilitated by digital technologies, their implications on tourist engagement, and their integration into the operations of local businesses. By employing a mixed-methods approach, blending qualitative techniques like interviews and content analysis with quantitative tools such as surveys and data analysis, the study provides a comprehensive evaluation of these business models' effects on various dimensions of the tourism landscape. The distinctiveness of this research lies in its exclusive focus on Yunnan Province, China. By concentrating on Yunnan Province, the research contributes exceptional insights into the interplay between digital tourism, ethnic diversity, cultural heritage, and sustainable development. The study's outcomes hold significance for both scholarly discourse and the stakeholders involved in shaping the region's tourism strategies.

Keywords: business model, digital tourism, international travel, local businesses, quality of life

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Authors: Joyce Fernandez

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This study examined the effects of critical incident stress debriefing and other related interventions on the psychological recovery of earthquake survivors. It is a mixed experimental and qualitative study using post-test only control group design and focus group discussion. After the conduct of critical incident stress debriefing activities and other related interventions in the form of counseling and psychiatric treatment to the survivors of a 6.9 magnitude earthquake, a post-test measuring the level of psychological recovery was given to randomized participants categorized as intervention and control groups. Using the traumatic assessment and belief scale as instrument for the quantitative aspect in order to gauge recovery in the psychological need areas of safety, trust, esteem, intimacy and control, the findings are the following: Intervention group participants have relatively better adjustment along the five psychological need areas compared to the control group participants; there is no significant difference in the psychological recovery among female and male participants of the invention and control groups and; there are significant differences between intervention and control groups in the psychological need areas of self-safety, self-trust, other-trust, self-esteem, and self-intimacy. Using a guided interview for the qualitative data, the themes derived are the following. Safety: The world is an unsafe place to live because of the calamities. Trust: Trust and dependence are anchored on the family. Esteem: Participants are having confused self-worth. Intimacy: Participants are thriving on attachment with their family. Control: Participants have unaltered desire to help but feeling restricted because of personal and logistical concerns.As an outcome of the study a Psychosocial Care Program for Individuals, Families and Communities Affected by Disaster and Trauma was proposed.

Keywords: critical incident stress debriefing, earthquake survivors, psychological recovery, related interventions

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Authors: Nazli Ustunes Demirhan

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Norms of any nature are subject to pressures of change throughout their lifespans, as they are interpreted and re-interpreted every time they are used rhetorically or practically by international actors. The inevitable contestation of different interpretations may lead to an erosion of the norm, as well as to its strengthening. This paper aims to question the role of formal legality on the change of norm strength, using a norm contestation framework and a multidimensional norm strength conceptualization. It argues that the role of legality is not necessarily linked to the formal legal characteristics of a norm, but is about the legality of the contestation processes. In order to demonstrate this argument, the paper examines the evolutionary path of the humanitarian intervention norm as a case study. Humanitarian intervention, as a norm of very low formal legal characteristics, has been subject to numerous cycles of contestation, demonstrating a fluctuating pattern of norm strength. With the purpose of examining the existence and role of legality in the selected contestation periods from 1999 to 2017, this paper uses process tracing method with a detailed document analysis on the Security Council documents; including decisions, resolutions, meeting minutes, press releases as well as individual country statements. Through the empirical analysis, it is demonstrated that the legality of the contestation processes has a positive effect at least on the authoritativeness dimension of norm strength. This study tries to contribute to the developing dialogue between international relations (IR) and internal law (IL) disciplines with its better-tuned understanding of legality. It connects to further questions in IR/IL nexus, relating to the value added of norm legality, and politics of legalization as well as better international policies for norm reinforcement.

Keywords: humanitarian intervention, legality, norm contestation, norm dynamics, responsibility to protect

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Authors: Rishi Agarwal

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Digital twins are emerging as a strong technology used to imitate and monitor physical objects digitally in real time across sectors. It is not only dealing with the digital space, but it is also actuating responses in the physical space in response to the digital space processing like storage, modeling, learning, simulation, and prediction. This paper explores the application of digital twins for enhancing physical security in retail stores. The retail sector still relies on outdated physical security practices like manual monitoring and metal detectors, which are insufficient for modern needs. There is a lack of real-time data and system integration, leading to ineffective emergency response and preventative measures. As retail automation increases, new digital frameworks must control safety without human intervention. To address this, the paper proposes implementing an intelligent digital twin framework. This collects diverse data streams from in-store sensors, surveillance, external sources, and customer devices and then Advanced analytics and simulations enable real-time monitoring, incident prediction, automated emergency procedures, and stakeholder coordination. Overall, the digital twin improves physical security through automation, adaptability, and comprehensive data sharing. The paper also analyzes the pros and cons of implementation of this technology through an Emerging Technology Analysis Canvas that analyzes different aspects of this technology through both narrow and wide lenses to help decision makers in their decision of implementing this technology. On a broader scale, this showcases the value of digital twins in transforming legacy systems across sectors and how data sharing can create a safer world for both retail store customers and owners.

Keywords: digital twin, retail store safety, digital twin in retail, digital twin for physical safety

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Authors: Wen Jiayuan

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This article traces the broadening of the refugee definition from the early 1970s onwards. It first discusses Article 1A(1), the core universal legal definition of ‘refugee’ provided by the 1951 Geneva Convention. It then focuses on Article 1A(2), read together with the 1967 Protocol, which without time or geographical limits, offers a general definition of the refugee as including any person who is outside their country or origin and unable or unwilling to return there or to avail themselves of its protection, owing to a well-founded fear of persecution for reasons of race, religion, nationality, social group or political opinion. It then shifts to the contemporary alternative refugee definitions adopted in regional areas, namely Africa, Latin America, and Europe. By looking deeply into the 1969 OAU Convention, the 1984 Cartagena Declaration, and ECtHR, the assertation is that while the appearance of new definitions may lead to a more responsive international environment, it may also undermine the consistency of the international refugee regime.

Keywords: refugee definition, 1951 Geneva Convention, 1969 OAU Convention, 1984 Cartagena Declaration

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Authors: Princes Ann E. Prieto, Denise F. Alpuerto, John Rafael C. Unlayao, Neil Concibido, Monet Concepcion Maguyon-Detras

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Failure Mode and Effects Analysis (FMEA) has been used in the virtual Process Hazard Analysis (PHA) of the Acetone production process through the dehydrogenation of isopropyl alcohol, for which very limited process risk assessment has been published. In this study, the potential failure modes, effects, and possible causes of selected major equipment in the process were identified. During the virtual FMEA mock sessions, the risks in the process were evaluated and recommendations to reduce and/or mitigate the process risks were formulated. The risk was estimated using the calculated risk priority number (RPN) and was classified into four (4) levels according to their effects on acetone production. Results of this study were also used to rank the criticality of equipment in the process based on the calculated criticality rating (CR). Bow tie diagrams were also created for the critical hazard scenarios identified in the study.

Keywords: chemical process safety, failure mode and effects analysis (FMEA), process hazard analysis (PHA), process safety management (PSM)

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Authors: Zhaohui Tian

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China’s growing and deepening engagement in Africa has attracted numerous controversial debates on Chinese-African social-racial relations both in the media and academia. Most research tends to discuss this issue and the tensions involved at the state level, but limited attention has been given to the individual relating processes of those two racial groups from an intercultural politeness evaluation angle. Thus, taking Kenya as a country focus and putting it under recent perspectives on pragmatics and politeness, this study explores the Chinese-Kenyan workplace relating experience in Chinese-owned companies with the aim to offer new insights on Chinese-African social-racial tensions. The original data were collected through 25 interviews from 29 Chinese and Kenyan participants working in different Chinese companies and industries, some of which had been later on converted into 182 short story data in order to better capture the process and content dimensions of their experiences using Spencer &Kádár’s politeness evaluation model. Both interview and story data were analysed in MAXQDA to understand the personal relating process and the criteria they were drawing from when making evaluative judgements of their relations. The result particular draws attention to tensions around goals, rights, and obligations, and social-moral dimensions that had been underrepresented in intercultural and pragmatics literature. The study offers alternative empirical insights into Chinese-Kenyan relations from an intercultural politeness management perspective and the possible mismatches of the evaluative criteria that potentially cause tension in this context.

Keywords: chinese-kenyan, evaluation, relating, workplace

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Authors: Min-Pei Ling

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Aflatoxin is a fungal secondary metabolite with high toxicity capable of contaminating various types of food crops. It has been identified as a Group 1 human carcinogen by the International Agency for Research on Cancer. Chronic aflatoxin exposure has caused a worldwide public food safety concern. Peanuts and peanut products are the major sources of aflatoxin exposure. Therefore, some reduction interventions have been developed to minimize contamination through the peanut production chain. The purpose of this study is to estimate the efficacy of interventions in reducing the health impact of hepatocellular carcinoma caused by aflatoxin contamination in peanuts. The estimated total disability-adjusted life-years (DALYs) was calculated using FDA-iRISK online software. Six aflatoxin reduction strategies were evaluated, including good agricultural practice (GAP), biocontrol, Purdue Improved Crop Storage packaging, basic processing, ozonolysis, and ultraviolet irradiation. The results indicated that basic processing could prevent huge public health loss of 4,079.7–21,833 total DALYs per year, which accounted for 39.6% of all decreased total DALYs. GAP and biocontrol were both effective strategies in the farm field, while the other three interventions were limited in reducing total DALYs. In conclusion, this study could help farmers, processing plants, and government policymakers to alleviate aflatoxin contamination issues in the peanut production chain.

Keywords: aflatoxin, health burden, disability-adjusted life-years, peanuts

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Authors: Wisdom Robert Duruji, Moses Kanayochukwu Ifoh, Efeoghene Edward Esiemunobo

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This study examines the impact of natural and artificial disasters, lackadaisical and semantic approach in risk management, and mitigation implication for sustainable development goals in Nigeria, from 2009 to 2022. The study utilizes a range of research methods to achieve its objectives. These include literature review, website knowledge, Google search, news media information, academic journals, field-work and on-site observations. These diverse methods allow for a comprehensive analysis on the impact and the implications being study. The study finds that paradigm shift from remediating seismic, flooding, environmental pollution and degradation natural disasters by Nigeria Emergency Management Agency (NEMA), to political and charity organization; has plunged risk reduction strategies to embezzling opportunities. However, this lackadaisical and semantic approach in natural disaster mitigation, invariably replicates artificial disasters in Nigeria through: Boko Haram terrorist organization, Fulani herdsmen and farmers conflicts, political violence, kidnapping for ransom, ethnic conflicts, Religious dichotomy, insurgency, secession protagonists, unknown-gun-men, and banditry. This study also, finds that some Africans still engage in self-imposed slavery through human trafficking, by nefariously stow-away to Europe; through Libya, Sahara desert and Mediterranean sea; in search for job opportunities, due to ineptitude in governance by their leaders; a perilous journey that enhanced artificial disasters in Nigeria. That artificial disaster fatality in Nigeria increased from about 5,655 in 2009 to 114,318 in 2018; and to 157,643 in 2022. However, financial and material loss of about $9.29 billion was incurred in Nigeria due to natural disaster, while about $70.59 billion was accrued due to artificial disaster; from 2009 to 2018. Although disaster risk mitigation and politics can synergistically support sustainable development goals; however, they are different entities, and need for distinct separations in Nigeria, as in reality and perception. This study concluded that referendum should be conducted in Nigeria, to ascertain its current status as a nation. Therefore it is recommended that Nigerian governments should refine its naturally endowed crude oil locally; to end fuel subsidy scam, corruption and poverty in Nigeria!

Keywords: corruption, crude oil, environmental risk analysis, Nigeria, referendum, terrorism

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Authors: Bruno Kinyaga

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Motorcycles transport commonly known as (Boda boda) in Tanzania has been growing up in the recent years in both urban and rural areas. Since motorcycles have been authorized to carry passengers in Tanzania they have been associated with many accidents resulting in large number of deaths and injuries in the country. Most of the road traffic injury victims are passengers, motorcyclists and pedestrians. Males are over represented in all cases. Most of the deceased were 18-29 years old. The increase of motorcycles has been accompanied with the increase of motorcycle crashes causing deaths and injuries to passengers as well as riders. According to the data collected, the statistics shows that from January to December 2015, the total number of 4079 motorcycles was involved in accidents in the country, causing 1747 deaths and 4826 injuries. Compares to the report of January to December 2014 whereby the total number of motorcycles involved in accidents were 3710, causing 1423 deaths and 3622 injuries. This is according to the report provided by the Road safety Chief Commander in Tanzania.

Keywords: accidents, road, safety, Tanzania

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Authors: Ebtisam A. Benomran, Abdurrauf M. Gusbi, Malak S. Elazarg, M. Sultan, Layla M. Kafu, Arwa M. Matoug, Esra E. Benamara

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Normal pregnancy is associated with metabolic changes leading to decreased insulin sensitivity and reduced glucose tolerance, however, 3-5% of pregnant women proceed to develop gestational diabetes mellitus (GDM). Researcher studied the use of metformin in many fields and the benefit to risk balance of using metformin during pregnancy and the risk of fetotoxic. In this study we examined the use of Metformin to control Glucose in pregnant Women with gestational diabetes mellitus (GDM) and evaluate its safety use during the first trimester of pregnancy.A group of pregnant patients with gestational diabetes mellitus from the first trimester of pregnancy, non smoking with no family history of congenital malformation disease, aged between (20-45 years) and have no liver diseases and who had indicating good compliance at more than one visit over several month until delivery put on Metformin were participated in this trial. Our study shown that all the studied group of pregnant women using metformin 500 mg daily delivered a healthy babies. Meta-analysis by mother risk program showed no increase in incidence of malformations by use Metformin during the first trimester of pregnancy. A hundred outpatients were participated in the survey on the general knowledge and awareness of diabetic patients to their illness and medication used their aged between 20-40 years old. In this survey we realize that 90% of the doctors are not giving the patient full information about their illness and the use of metformin during pregnancy, also about 65% of the patients did not know about the nutritionist in the hospital and the right control diet for diabetes. Courses on first aid, rapid diagnosis of poisoning and follow the written procedures to dealing with such cases.

Keywords: gestational diabetes, malformations, metformin, pregnancy

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