Search results for: comprehensive care

Authors: Kalinga Jagoda

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With changing population demographics and consumer preferences, specialty crops present significant opportunities for Ontario agri-businesses to develop niche markets. However, the greater rewards offered by such opportunities come with comparable challenges that are driven by specific productmarket attributes, as well as supply and demand-side factors, including certain risks. Thus, initiatives to promote and support such sectors need to be informed by an understanding of the impact of these product-market and industry specific factors on supply chain development. To this end, this project proposes to map selected specialty crops supply chains, using a suite of tested methodological approaches to evaluate their market potential, considering total supply chain costs, lead times and responsiveness. The project will deliver comprehensive supply chain maps identifying the points of value addition and value capture that are of benefit to key stakeholders for the purposes of developing policy interventions, conducting market appraisals and identifying industry best practices.

Keywords: supply chain management, hazelnut industry, supply chain maps, market opportunity

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Authors: Atefeh Saljooghi Khoshkar, Jafar Hassanpour

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One of the main problems of the design stage relating to many tunneling projects is the lack of an appropriate standard for the provision of engineering geological data in a predefined format. In particular, this is more reflected in highway and railroad tunnel projects in which there is a number of tunnels and different professional teams involved. In this regard, comprehensive software needs to be designed using the accepted methods in order to help engineering geologists to prepare standard reports, which contain sufficient input data for the design stage. Regarding this necessity, applied software has been designed using macro capabilities and Visual Basic programming language (VBA) through Microsoft Excel. In this software, all of the engineering geological input data, which are required for designing different parts of tunnels, such as discontinuities properties, rock mass strength parameters, rock mass classification systems, boreability classification, the penetration rate, and so forth, can be calculated and reported in a standard format.

Keywords: engineering geology, rock mass classification, rock mechanic, tunnel

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Authors: Selin Top, Raul Marcos, M. Sinan Bilgili

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Although there have been several studies related to collection, temporary storage, handling and disposal of solid wastes generated by hospitals, there are only a few studies related to liquid wastes generated by hospitals or hospital wastewaters. There is an important amount of water consumptions in hospitals. While minimum domestic water consumption per person is 100 L/day, water consumption per bed in hospitals is generally ranged between 400-1200 L. This high amount of consumption causes high amount of wastewater. The quantity of wastewater produced in a hospital depends on different factors: bed numbers, hospital age, accessibility to water, general services present inside the structure (kitchen, laundry, laboratory, diagnosis, radiology, and air conditioning), number and type of wards and units, institution management policies and awareness in managing the structure in safeguarding the environment, climate and cultural and geographic factors. In our country, characterization of hospital wastewaters conducted by classical parameters in a very few studies. However, as mentioned above, this type of wastewaters may contain different compounds than domestic wastewaters. Hospital Wastewater (HWW) is wastewater generated from all activities of the hospital, medical and non medical. Nowadays, hospitals are considered as one of the biggest sources of wastewater along with urban sources, agricultural effluents and industrial sources. As a health-care waste, hospital wastewater has the same quality as municipal wastewater, but may also potentially contain various hazardous components due to using disinfectants, pharmaceuticals, radionuclides and solvents making not suitable the connection of hospital wastewater to the municipal sewage network. These characteristics may represent a serious health hazard and children, adults and animals all have the potential to come into contact with this water. Therefore, the treatment of hospital wastewater is an important current interest point to focus on. This paper aims to approach on the investigation of hospital wastewater treatment by membrane systems. This study aim is to determined hospital wastewater’s characterization and also evaluates the efficiency of hospital wastewater treatment by high pressure filtration systems such as ultrafiltration (UF). Hospital wastewater samples were taken directly from sewage system from Şişli Etfal Training and Research Hospital, located in the district of Şişli, in the European part of Istanbul. The hospital is a 784 bed tertiary care center with a daily outpatient department of 3850 patients. Ultrafiltration membrane is used as an experimental treatment and the influence of the pressure exerted on the membranes was examined, ranging from 1 to 3 bar. The permeate flux across the membrane was observed to define the flooding membrane points. The global COD and BOD5 removal efficiencies were 54% and 75% respectively for ultrafiltration, all the SST removal efficiencies were above 90% and a successful removal of the pathological bacteria measured was achieved.

Keywords: hospital wastewater, membrane, ultrafiltration, treatment

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Authors: Anisur Rahman, Sabyasachi Behera, Pawan Pathak, Benazir Patil, Rajesh Khanna

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Background: Nearly half of India’s population is expected to reside in urban areas by 2030. The extent to which India's health system can provide for this large and growing city-based population will determine the country's success in achieving universal health coverage and improved national health indices. National Urban Health Mission (NUHM) strive for improving access to primary health care in urban areas. Implementation of NUHM solicits sensitive, effective and sustainable strategies to strengthen the service delivery mechanisms. The Challenge Initiative for Healthy Cities (TCIHC) is working with the Government of India and three provincial states to develop effective service delivery mechanisms for reproductive, maternal, newborn and child health (RMNCH) through a health systems approach for the urban poor. Method: A rapid assessment study was conceptualized and executed to generate evidence in order to address the challenges impeding in functioning of urban health facilities to deliver effective, efficient and equitable health care services in 7 cities spread across two project States viz. Madhya Pradesh and Odisha. Results: The findings of the assessment reflect: 1. The overall ecosystem pertaining to planning and management of public health interventions is not conducive. 2. The challenges regarding population dynamics like migration keeps on influencing the demand-supply-enabling environment triangle for both public and private service providers. 3. Lack of norms for planning and benchmark for service delivery further impedes urban health system as a whole. 4. Operationalization of primary level services have enough potential to meet the demand of slum dwellers at large. 5. Lack of policy driven strategies on how to integrate the NUHM with other thematic areas of Maternal, Newborn & Child Health (MNCH) and Family Planning (FP). 5. The inappropriate capacity building and acute shortage of Human Resources has huge implication on service provisioning and adherence to the service delivery protocols. Conclusion: The findings from rapid assessment are aimed to inform pertinent stakeholders to develop a multiyear city health action plan to strengthen the health systems in order to improve the efficacy of service delivery mechanism in urban settings.

Keywords: city health plan, health system, rapid assessment, urban mission

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Authors: B. Bouadjemi, S. Bentata, T. Lantri, A. Abbad, W. Benstaali, A. Zitouni, S. Cherid

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We investigate the electronic structure, magnetic and optical properties of the orthorhombic NdMnO3 through density-functional-theory (DFT) calculations using both generalized gradient approximation GGA and GGA+U approaches, the exchange and correlation effects are taken into account by an orbital independent modified Becke Johnson (MBJ). The predicted band gaps using the MBJ exchange approximation show a significant improvement over previous theoretical work with the common GGA and GGA+U very closer to the experimental results. Band gap dependent optical parameters like dielectric constant, index of refraction, absorption coefficient, reflectivity and conductivity are calculated and analyzed. We find that when using MBJ we have obtained better results for band gap of NdMnO3 than in the case of GGA and GGA+U. The values of band gap founded in this work by MBJ are in a very good agreement with corresponding experimental values compared to other calculations. This comprehensive theoretical study of the optoelectronic properties predicts that this material can be effectively used in optical devices.

Keywords: DFT, optical properties, absorption coefficient, strong correlation, MBJ, orthorhombic NdMnO3, optoelectronic

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Authors: Ahmed R. Ismail, Hatem A. El Tawil, Nevin G. Rezk

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Historic paths in today's cities are facing the pressure of the urban development due to the rapid urban growth. Every new development is tearing the old urban fabric and the socio-economic character of the historic paths. Furthermore, in some cases historic paths suffer from negligence and decay. Kom El Dekka historic path was one of those deteriorated paths in the city of Alexandria, Egypt, in spite of its high heritage and socio-economic value. Therefore, there was a need to develop urban regeneration strategies as a part of a wider sustainable development vision, to handle the situation and revitalize the path as a livable space in the heart of the city. This study aims to develop a comprehensive assessment methodology to evaluate the different values of the path and to create community-oriented and economic-based analysis methodology for its socio-economic values. These analysis and assessments provide strategies for any regeneration action plan for Kom El Dekka historic path.

Keywords: community-oriented, economic-based, syntactical analysis, urban regeneration

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Authors: Baghdasaryan Marinka

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The current scientific and engineering interest concerning the problems of preventing the emergency manifestations of drive synchronous motors, ensuring the ore grinding technological process has been justified. The analysis of the known works devoted to the abnormal operation modes of synchronous motors and possibilities of protection against them, has shown that their application is inexpedient for preventing the impermissible displays arising in the electrical drive synchronous motors ensuring the ore-grinding process. The main energy and technological factors affecting the technical condition of synchronous motors are evaluated. An algorithm for preventing the irregular operation modes of the electrical drive synchronous motor applied in the ore-grinding technological process has been developed and proposed for further application which gives an opportunity to provide smart solutions, ensuring the safe operation of the drive synchronous motor by a comprehensive consideration of the energy and technological factors.

Keywords: synchronous motor, abnormal operating mode, electric drive, algorithm, energy factor, technological factor

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Authors: Leila Trabelsi

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The urbanization of Information Systems (IS) is an effective approach to master the complexity of the organization. It strengthens the coherence of IS and aligns it with the business strategy. Moreover, this approach has significant advantages such as reducing Information Technologies (IT) costs, enhancing the IS position in a competitive environment and ensuring the scalability of the IS through the integration of technological innovations. Therefore, the urbanization is considered as a business strategic decision. Thus, its embedding becomes a necessity in order to improve the IS practice. However, there is a lack of experimental cases studying meta-modelling of Urbanized Information System (UIS). The aim of this paper addresses new urbanization content meta-model which permits modelling, testing and taking into consideration organizational aspects. This methodological framework is structured according to two main abstraction levels, a conceptual level and an operational level. For each of these levels, different models are proposed and presented. The proposed model for has been empirically tested on company. The findings of this paper present an experimental study of urbanization meta-model. The paper points out the significant relationships between dimensions and their evolution.

Keywords: urbanization, information systems, enterprise architecture, meta-model

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Authors: Chenhui Wang, Chwee Beng Lee

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The practice of critical pedagogy is challenged by resistance from teachers. This study presents a discussion on teachers' resistance to critical pedagogy and previous practical frameworks for assessing critical thinking in formative assessment in the classroom through a critical review of the related literature. The authors found out that the main issue of teachers' resistance is not whether teachers should possess theoretical knowledge of critical thinking but how they apply that knowledge in their classroom teaching. In addition, critical thinking in formative assessment may provide teachers with a comprehensive understanding of critical pedagogical planning, implementing, and reflecting. Therefore, this paper intends to discuss a practical step-by-step framework for critical thinking formative assessment to address this resistance. Such discussion is based on a thorough examination of the related theories and frameworks. This review paper will benefit teachers in understanding and reducing their resistance to critical pedagogy as well as in implementing critical pedagogy.

Keywords: critical thinking, critical pedagogy, critical thinking formative assessment framework, teachers resistance

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Authors: Jim Weese

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The Kinesiology, Exercise and Sport Science environment remain excellent venues for leadership research. Prescribed leadership (coaching), emergent leadership (players and organizations), and executive leadership are all popular themes in the research literature. Leadership remains a popular area of inquiry in the sport management domain as well as an interesting area for practitioners who wish to heighten their leadership practices and effectiveness. The need for effective leadership in these areas given competing demands for attention and resources may be at an all-time high. The presenter has extensive research and practical experience in the area and has developed his concept based on the latest leadership literature. He refers to this as the Five ’C’s of Leadership. These components, noted below, have been empirically validated and have served as the foundation for extensive consulting with academic, sport, and business leaders. Credibility (C1) is considered the foundation of leadership. There are two components to this area, namely: (a) leaders being respected for having the relevant knowledge, insights, and experience to be seen as credible sources of information, and (b) followers perceiving the leader as being a person of character, someone who is honest, reliable, consistent, and trustworthy. Compelling Vision (C2) refers to the leader’s ability to focus the attention of followers on a desired end goal. Effective leaders understand trends and developments in their industry. They also listen attentively to the needs and desires of their stakeholders and use their own instincts and experience to shape these ideas into an inspiring vision that is effectively and continuously communicated. Charismatic Communicator (C3) refers to the leader’s ability to formally and informally communicate with members. Leaders must deploy mechanisms and communication techniques to keep their members informed and engaged. Effective leaders sprinkle in ‘proof points’ that reinforce the vision’s relevance and/or the unit’s progress towards its attainment. Contagious Enthusiasm (C4) draws on the emotional intelligence literature as it relates to exciting and inspiring followers. Effective leaders demonstrate a level of care, commitment, and passion for their people and feelings of engagement permeate the group. These leaders genuinely care about the task at hand, and for the people working to make it a reality. Culture Builder (C5) is the capstone component of the model and is critical to long-term success and survival. Organizational culture refers to the dominant beliefs, values and attitudes of members of a group or organization. Some have suggested that developing and/or imbedding a desired culture for an organization is the most important responsibility for a leader. The author outlines his Five ‘C’s’ of Leadership concept and provide direct application to executive leadership in Kinesiology, Exercise and Sport Science.

Keywords: effectiveness, leadership, management, sport

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Authors: Daniel C. S. Lim

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There are numerous nutritional supplements, such as multivitamins and nutrition drinks, in the market today. Many of these supplements are expensive and tend to be driven commercially by business decisions and big marketing budgets. Many of the costs are ultimately borne by the end user in the quest for keeping to a healthy lifestyle. This paper proposes a system with a list of ten determinants to gauge how to decide the value of various supplements. It suggests variables such as composition, safety, efficacy and bioavailability, as well as several other considerations. These guidelines can help to tackle many of the issues that people of all ages face in the way that they receive essential nutrients. The system also aims to promote and improve the safety and choice of foods and supplements. In so doing, the system aims to promote the individual’s or population’s control over their own health and reduce the growing health care burden on the society.

Keywords: choice of foods and supplements, essential nutrients, nutritional supplements, system safety

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Authors: Farman Ali, Asif Mahmood

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The utilization of genetic markers in prostate cancer management represents a significant advance in personalized medicine, offering the potential for more precise diagnosis and tailored treatment strategies. This paper explores the pivotal role of genetic markers in the diagnosis and treatment of prostate cancer, emphasizing their contribution to the identification of individual risk profiles, tumor aggressiveness, and response to therapy. By integrating current research findings, we discuss the application of genetic markers in developing targeted therapies and the implications for patient outcomes. Despite the promising advancements, challenges such as accessibility, cost, and the need for further validation in diverse populations remain. The paper concludes with an outlook on future directions, underscoring the importance of genetic markers in revolutionizing prostate cancer care.

Keywords: prostate cancer, genetic markers, personalized medicine, BRCA1 and BRCA2

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Authors: Emily Moore, Dora Amos, Tracy Ellimah, Natasha Parrott

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Postoperative haematoma is a well-recognised complication of thyroid surgery with an incidence of 1-5%. Haematoma formation causes progressive airway obstruction, necessitating emergency bedside haematoma evacuation in up to ¼ of patients. ENT UK, BAETS and DAS have developed consensus guidelines to improve perioperative care, recommending that all healthcare staff interacting with patients undergoing thyroid surgery should be trained in managing post-thyroidectomy haematoma. The aim was to assess the effectiveness of a hybrid simulation model in improving clinician’s confidence in dealing with this surgical emergency. A hybrid simulation was designed, consisting of a standardised patient wearing a part-task trainer to mimic a post-thyroidectomy haematoma in a real patient. The part-task trainer was an adapted C-spine collar with layers of silicone representing the skin and strap muscles and thickened jelly representing the haematoma. Both the skin and strap muscle layers had to be opened in order to evacuate the haematoma. Boxes have been implemented into the appropriate post operative areas (recovery and surgical wards), which contain a printed algorithm designed to assist in remembering a sequence of steps for haematoma evacuation using the ‘SCOOP’ method (skin exposure, cut sutures, open skin, open muscles, pack wound) along with all the necessary equipment to open the front of the neck. Small-group teaching sessions were delivered by ENT and anaesthetic trainees to members of the multidisciplinary team normally involved in perioperative patient care, which included ENT surgeons, anaesthetists, recovery nurses, HCAs and ODPs. The DESATS acronym of signs and symptoms to recognise (difficulty swallowing, EWS score, swelling, anxiety, tachycardia, stridor) was highlighted. Then participants took part in the hybrid simulation in order to practice this ‘SCOOP’ method of haematoma evacuation. Participants were surveyed using a Likert scale to assess their level of confidence pre- and post teaching session. 30 clinicians took part. Confidence (agreed/strongly agreed) in recognition of post thyroidectomy haematoma improved from 58.6% to 96.5%. Confidence in management improved from 27.5% to 89.7%. All participants successfully decompressed the haematoma. All participants agreed/strongly agreed, that the sessions were useful for their learning. Multidisciplinary team simulation teaching is effective at significantly improving confidence in both the recognition and management of postoperative haematoma. Hybrid simulation sessions are useful and should be incorporated into training for clinicians.

Keywords: thyroid surgery, haematoma, teaching, hybrid simulation

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Authors: Claudia Norambuena, Myissa Weiss, Maria Ruiz Maya, Matthew Straley, Elijah Hammond, Benjamin Chesebrough, David Grow

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The purpose of this project is to develop a low-cost, portable sensor device that can be used at home for long-term analysis of gait and balance abnormalities. One area of particular concern involves the asymmetries in movement and balance that can accompany certain types of injuries and/or the associated devices used in the repair and rehabilitation process (e.g. the use of splints and casts) which can often increase chances of falls and additional injuries. This device has the capacity to monitor a patient during the rehabilitation process after injury or operation, increasing the patient’s access to healthcare while decreasing the number of visits to the patient’s clinician. The sensor device may thereby improve the quality of the patient’s care, particularly in rural areas where access to the clinician could be limited, while simultaneously decreasing the overall cost associated with the patient’s care. The device consists of nine interconnected accelerometer/ gyroscope/compass chips (9-DOF IMU, Adafruit, New York, NY). The sensors attach to and are used to determine the orientation and acceleration of the patient’s lower abdomen, C7 vertebra (lower neck), L1 vertebra (middle back), anterior side of each thigh and tibia, and dorsal side of each foot. In addition, pressure sensors are embedded in shoe inserts with one sensor (ESS301, Tekscan, Boston, MA) beneath the heel and three sensors (Interlink 402, Interlink Electronics, Westlake Village, CA) beneath the metatarsal bones of each foot. These sensors measure the distribution of the weight applied to each foot as well as stride duration. A small microntroller (Arduino Mega, Arduino, Ivrea, Italy) is used to collect data from these sensors in a CSV file. MATLAB is then used to analyze the data and output the hip, knee, ankle, and trunk angles projected on the sagittal plane. An open-source program Processing is then used to generate an animation of the patient’s gait. The accuracy of the sensors was validated through comparison to goniometric measurements (±2° error). The sensor device was also shown to have sufficient sensitivity to observe various gait abnormalities. Several patients used the sensor device, and the data collected from each represented the patient’s movements. Further, the sensors were found to have the ability to observe gait abnormalities caused by the addition of a small amount of weight (4.5 - 9.1 kg) to one side of the patient. The user-friendly interface and portability of the sensor device will help to construct a bridge between patients and their clinicians with fewer necessary inpatient visits.

Keywords: biomedical sensing, gait analysis, outpatient, rehabilitation

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Authors: Ruth Green, Samantha Milton, Rinal Desai

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Background/Aims: Eye pain/swelling/redness is a common presentation to Barnet General Hospital (a district general hospital), pediatric emergency department, and is managed by both the pediatric and emergency teams. The management of each child differs dramatically depending on the healthcare professional who reviews them. There also appears to be confusion in diagnosis between periorbital cellulitis, pre-septal cellulitis, and orbital cellulitis. Pre septal cellulitis refers to an inflammation of the eyelids and soft tissue anterior to the orbital septum. In contrast, orbital cellulitis is a serious, rapidly progressive infection of soft tissues located posterior to the orbital septum. Pre-septal cellulitis is more prevalent and less serious than orbital cellulitis, although it may be part of a continuous spectrum if untreated. Pre-septal cellulitis should there be diagnosed and treated urgently to prevent spread to the septum. For the purpose of the audit, the term periorbital cellulitis has been used as an umbrella term for all spectrums of this infection. The audit aimed to look at, how as a whole, the department is diagnosing and managing orbital and pre-septal cellulitis. Gold Standard: Patients of the same age and diagnosis should be treated with the same medication, advice, and follow-up. Method: Data was collected retrospectively from pediatric patients ( < 18years) who attended the emergency department from June 2019 to February 2020 who had been coded as pre-septal cellulitis, periorbital cellulitis, orbital cellulitis, or eye pain/swelling/redness. Demographics, signs and symptoms, management, and follow-up were recorded for all patients with any of the diagnoses of pre-septal, periorbital, or orbital cellulitis. A Microsoft Excel spreadsheet was used to record the anonymised data. Results: There were vast discrepancies in the diagnosis, management, and follow-up of patients with periorbital cellulitis. Conclusion/Discussion: The audit concluded there is no uniform approach to managing periorbital cellulitis in Barnet General Hospital Paediatric Emergency Department. Healthcare professionals misdiagnosed conjunctivitis as periorbital cellulitis, and adequate steps did not appear to be documented on excluding red flag signs and symptoms of patients presenting. There was no consistency in follow-up, with some patients having timely phone reviews or clinical reviews for mild symptoms. Advice given by the staff was appropriate, and patients did return when symptoms got worse and were treated accordingly. Plan: Given the inconsistency, a gold standard care pathway or local easily accessible clinical guideline can be developed to help with the diagnosis and management of periorbital cellulitis. Along with this, a teaching session can be carried out for the staff of the pediatric team and emergency department to disseminate the teaching. Following the introduction of a guideline and teaching sessions, patients notes can be re-reviewed to check improvement in patient care.

Keywords: periorbital cellulitis, preseptal cellulitis, orbital cellulitis, erythematous eyelid

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Authors: Nasrine Olson

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With over 70,000 scholarly publications on the topic of biosensors, an overview of the field has become a challenge. To facilitate, there are currently over 700 expert-reviews of publications on biosensors and related topics. This study focuses on these review papers in order to provide a Meta-Review of the area. This paper provides a statistical analysis and overview of biosensor-related review papers. Comprehensive searches are conducted in the Web of Science, and PubMed databases and the resulting empirical material are analyzed using bibliometric methods and tools. The study finds that the biosensor-related review papers can be categorized in five related subgroups, broadly denoted by (i) properties of materials and particles, (ii) analysis and indicators, (iii) diagnostics, (iv) pollutant and analytical devices, and (v) treatment/ application. For an easy and clear access to the findings visualization of clusters and networks of connections are presented. The study includes a temporal dimension and identifies the trends over the years with an emphasis on the most recent developments. This paper provides useful insights for those who wish to form a better understanding of the research trends in the area of biosensors.

Keywords: bibliometrics, biosensors, meta-review, statistical analysis, trends visualization

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Authors: Erika Ruiz, Nestor Ortiz

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Lean philosophy has evolved over time and has been implemented both in manufacturing and services, more recently lean has been integrated in the companies of the health sector. Currently it is important to understand the successful way to implement this philosophy and try to identify barriers and enablers to the sustainability of lean healthcare. The main purpose of this research is to identify the barriers and enablers in the implementation of Lean Healthcare based on case studies of Colombian healthcare centers. In order to do so, we conducted semi-structured interviews based on a maturity model. The main results indicate that the success of Lean implementation depends on its adaptation to contextual factors. In addition, in the Colombian context were identified new factors such as organizational culture, management models, integration of the care and administrative departments and triple helix relationship.

Keywords: barriers, enablers, implementation, lean healthcare, sustainability

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Authors: A. A. Okafor, C. H. Achebe, J. L. Chukwuneke, C. G. Ozoegwu

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The performance of an engine whose basic design parameters are known can be predicted with the assistance of simulation programs into the less time, cost and near value of actual. This paper presents a comprehensive mathematical model of the performance parameters of four stroke spark ignition engine. The essence of this research work is to develop a mathematical model for the analysis of engine performance parameters of four stroke spark ignition engine before embarking on full scale construction, this will ensure that only optimal parameters are in the design and development of an engine and also allow to check and develop the design of the engine and it’s operation alternatives in an inexpensive way and less time, instead of using experimental method which requires costly research test beds. To achieve this, equations were derived which describe the performance parameters (sfc, thermal efficiency, mep and A/F). The equations were used to simulate and optimize the engine performance of the model for various engine speeds. The optimal values obtained for the developed bivariate mathematical models are: sfc is 0.2833kg/kwh, efficiency is 28.77% and a/f is 20.75.

Keywords: bivariate models, engine performance, injector engine, optimization, performance parameters, simulation, spark ignition

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Authors: Honey Bryant, Elvina Chu

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Stroke is the leading cause of disability in adults in Canada and directly related to depression, anxiety, and sleep disorders; with an estimated annual cost of $50 billion in health care. Strokes not only impact the individual but society as a whole. Current stroke rehabilitation does not include Music Therapy, although it has success in clinical research in the use of stroke rehabilitation. This study examines the use of neurologic music therapy (NMT) in conjunction with stroke rehabilitation to improve sleep quality, reduce stress levels, and promote neurogenesis. Existing research on NMT in stroke is limited, which means any conclusive information gathered during this study will be significant. My novel hypotheses are a.) stroke patients will become less depressed and less anxious with improved sleep following NMT. b.) NMT will reduce stress levels and promote neurogenesis in stroke patients admitted for rehabilitation. c.) Beneficial effects of NMT will be sustained at least short-term following treatment. Participants were recruited from the in-patient stroke rehabilitation program at Providence Care Hospital in Kingston, Ontario, Canada. All participants-maintained stroke rehabilitation treatment as normal. The study was spilt into two groups, the first being Passive Music Listening (PML) and the second Neurologic Music Therapy (NMT). Each group underwent 10 sessions of intensive music therapy lasting 45 minutes for 10 consecutive days, excluding weekends. Psychiatric Assessments, Epworth Sleepiness Scale (ESS), Hospital Anxiety & Depression Rating Scale (HADS), and Music Engagement Questionnaire (MusEQ), were completed, followed by a general feedback interview. Physiological markers of stress were measured through blood pressure measurements and heart rate variability. Serum collections reviewed neurogenesis via Brain-derived neurotrophic factor (BDNF) and stress markers of cortisol levels. As this study is still on-going, a formal analysis of data has not been fully completed, although trends are following our hypotheses. A decrease in sleepiness and anxiety is seen upon the first cohort of PML. Feedback interviews have indicated most participants subjectively felt more relaxed and thought PML was useful in their recovery. If the hypothesis is supported, larger external funding which will allow for greater investigation of the use of NMT in stroke rehabilitation. As we know, NMT is not covered under Ontario Health Insurance Plan (OHIP), so there is limited scientific data surrounding its uses as a clinical tool. This research will provide detailed findings of the treatment of neuropsychiatric aspects of stroke. Concurrently, a passive music listening study is being designed to further review the use of PML in rehabilitation as well.

Keywords: music therapy, psychotherapy, neurologic music therapy, passive music listening, neuropsychiatry, counselling, behavioural, stroke, stroke rehabilitation, rehabilitation, neuroscience

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Authors: Marcio Emilio Dos Santos, Kelly C. F. Dos Santos

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Caregivers of patients diagnosed with ASD are subjected to high stress situations due to the complexity and multiple levels of daily activities that require the organization of events, behaviors and socioemotional situations, such as immediate decision making and in public spaces. The cognitive and emotional requirement needed to fulfill this caregiving role exceeds the regular cultural process that adults receive in their process of preparation for conjugal and parental life. Therefore, in many cases, caregivers present a high level of overload, poor capacity to organize and mediate the development process of the child or patient about their care. Aims: Improvement in the cognitive and emotional capacities related to the caregiver function, allowing the reduction of the overload, the feeling of incompetence and the characteristic level of stress, developing a more organized conduct and decision making more oriented towards the objectives and procedural gains necessary for the integral development of the patient with diagnosis of ASD. Method: The study was performed with 20 relatives, randomly selected from a total of 140 patients attended. The family members were submitted to the Wechsler Adult Intelligence Scale III intelligence test and the Family assessment Management Measure (FaMM) questionnaire as a previous evaluation. Therapeutic activity in a small group of family members or caregivers, with weekly frequency, with a minimum workload of two hours, using the Feuerstein Instrumental Enrichment Cognitive Development Program - Feuerstein Instrumental Enrichment for ten months. Reapplication of the previous tests to verify the gains obtained. Results and Discussion: There is a change in the level of caregiver overload, improvement in the results of the Family assessment Management Measure and highlight to the increase of performance in the cognitive aspects related to problem solving, planned behavior and management of behavioral crises. These results lead to the discussion of the need to invest in the integrated care of patients and their caregivers, mainly by enabling cognitively to deal with the complexity of Autism. This goes beyond the simple therapeutic orientation about adjustments in family and school routines. The study showed that when the caregiver improves his/her capacity of management, the results of the treatment are potentiated and there is a reduction of the level of the caregiver's overload. Importantly, the study was performed for only ten months and the number of family members attended in the study (n = 20) needs to be expanded to have statistical strength.

Keywords: caregiver overload, cognitive development program ASD caregivers, feuerstein instrumental enrichment, family assessment management measure

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Authors: Itee Chowdhury, Shikha Modi

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Introduction: Cancer is beginning to outpace cardiovascular disease as a cause of death affecting every major organ system with profound implications for perioperative management. Breast cancer is the most common cancer in women in India, accounting for 27% of all cancers. The small changes in analgesic management of cancer patients can greatly improve prognosis and reduce the risk of postsurgical cancer recurrence as opioid-based analgesia has a deleterious effect on cancer outcomes. Shortened postsurgical recovery time facilitates earlier return to intended oncological therapy maximising the chance of successful treatment. Literature reveals that the role of BIS since FDA approval has been assessed in various types of surgeries, but clinical data on its use in oncosurgical patients are scanty. Our study focuses on the role of BIS-guided anaesthesia for breast cancer surgery patients. Methods: A prospective randomized controlled study in patients aged 36-55years scheduled for modified radical mastectomy was conducted in 51 patients in each group who met the inclusion and exclusion criteria, and randomization was done by sealed envelope technique. In BIS guided anaesthesia group (B), sevoflurane was titrated to keep the BIS value 45-60, and thereafter if the patient showed hypertension/tachycardia, an opioid was given. In standard anaesthesia care (group C), sevoflurane was titrated to keep MAC in the range of 0.8-1, and fentanyl was given if the patient showed hypertension/tachycardia. Intraoperative opioid consumption was calculated. Postsurgery recovery characteristics, including Aldrete score, were assessed. Patients were questioned for pain, PONV, and recall of the intraoperative event. A comparison of age, BMI, ASA, recovery characteristics, opioid, and VAS score was made using the non-parametric Mann-Whitney U test. Categorical data like intraoperative awareness of surgery and PONV was studied using the Chi-square test. A comparison of heart rate and MAP was made by an independent sample t-test. #ggplot2 package was used to show the trend of the BIS index for all intraoperative time points for each patient. For a statistical test of significance, the cut-off p-value was set as <0.05. Conclusions: BIS monitoring led to reduced opioid consumption and early recovery from anaesthesia in breast cancer patients undergoing MRM resulting in less postoperative nausea and vomiting and less pain intensity in the immediate postoperative period without any recall of the intraoperative event. Thus, the use of a Bispectral index monitor allows for tailoring of anaesthesia administration with a good outcome.

Keywords: bispectral index, depth of anaesthesia, recovery, opioid consumption

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Authors: Ashish Payal, C. S. Rai, B. V. R. Reddy

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With the increasing use and application of Wireless Sensor Networks (WSN), need has arisen to explore them in more effective and efficient manner. An important area which can bring efficiency to WSNs is the localization process, which refers to the estimation of the position of wireless sensor nodes in an ad hoc network setting, in reference to a coordinate system that may be internal or external to the network. In this paper, we have done comparison and analysed Sigmoidal Feedforward Artificial Neural Networks (SFFANNs) and Radial Basis Function (RBF) networks for developing localization framework in WSNs. The presented work utilizes the Received Signal Strength Indicator (RSSI), measured by static node on 100 x 100 m² grid from three anchor nodes. The comprehensive evaluation of these approaches is done using MATLAB software. The simulation results effectively demonstrate that FFANNs based sensor motes will show better localization accuracy as compared to RBF.

Keywords: localization, wireless sensor networks, artificial neural network, radial basis function, multi-layer perceptron, backpropagation, RSSI, GPS

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Authors: Hyunho Shin, Jaekwang Jung, Jeongho Park, Sungwon Hwang

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For the application of graphene quantum dots (GQDs) to optoelectronic nanodevices, it is of critical importance to understand the mechanisms which result in novel phenomena of their light absorption/emission. The optical transitions are known to be available up to ~6 eV in GQDs, especially useful for ultraviolet (UV) photodetectors (PDs). Here, we present size-dependent shape/edge-state variations of GQDs and visible photoluminescence (PL) showing anomalous size dependencies. With varying the average size (da) of GQDs from 5 to 35 nm, the peak energy of the absorption spectra monotonically decreases, while that of the visible PL spectra unusually shows nonmonotonic behaviors having a minimum at diameter ∼17 nm. The PL behaviors can be attributed to the novel feature of GQDs, that is, the circular-to-polygonal-shape and corresponding edge-state variations of GQDs at diameter ∼17 nm as the GQD size increases, as demonstrated by high resolution transmission electron microscopy. We believe that such a comprehensive scheme in designing device architecture and the structural formulation of GQDs provides a device for practical realization of environmentally benign, high performance flexible devices in the future.

Keywords: graphene, quantum dot, size, photoluminescence

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Authors: Fezzani Boubaker

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In this work, a comprehensive study of respirometric method was performed to assess the biodegradable COD fractions of domestic sewage mixed with baker’s yeast factory effluent treated by wastewater treatment plant (WWTP) of Beja. Three respirometric runs were performed in a closed tank reactor to characterize this mixed raw effluent. Respirometric result indicated that the readily biodegradable fraction (SS) was in range of 6-22%, the slowly biodegradable fraction (Xs) was in range of 33-42%, heterotrophic biomass (XH) was in range of 9-40% and the inert fractions: XI and SI were in range of 2-40% and 6-12% respectively which were high due to the presence of baker’s yeast factory effluent compared to domestic effluent alone. The fractions of the total nitrogen showed that SNO fraction is between 6 and 9% of TKN, the fraction of nitrogen ammonia SNH was ranging from 5 to 68%. The organic fraction divided into two compartments SND (11-85%) and XND (5-20%) the inert particulate nitrogen fraction XNI was between 0.4 and 1% and the inert soluble fraction of nitrogen SNI was ranged from 0.4 to 3%.

Keywords: wastewater characterization, COD fractions, respirometry, domestic sewage

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Authors: S. U. Kunya, S. A. Mohammad

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Construction projects in Nigeria are characterized with risks emanating from delays and accompanying cost-overruns. The aim of the study was to identify and assess factors constraining the utilization of risk management strategies in the execution of public construction project in North-East Nigeria. Data was collected with the aid of a well-structured questionnaire administered to three identified projects in the North-east. Data collected were analysed using the severity index. Findings revealed political involvement, selection of inexperienced contractors and lack of coordinated public sector strategy as the most severe factors constraining the utilization of risk management strategies. The study recommended that: formulation of laws to prevent negative political meddling in construction projects; selection of experienced, risk-informed contractors; and comprehensive risk assessment and planning on all public construction projects.

Keywords: factors, Nigeria, north-east, public projects, risk management, strategies, utilization

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Authors: Seyed Reza Agha Seyed Hosseini, Nicolas Hamelin

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Many marketing executives are looking for a comprehensive plan for delivering quality services and products that will create a distinct and unforgettable long-term experience for customers in dealing with their brand. Various brand management experts believe that a company looking to enhance its brand experience in the minds of customers should have a plan to increase customer satisfaction as well as customer loyalty. The purpose of this research was to investigate the role of brand experience in customer satisfaction and customer loyalty in Ayandeh Bank branches in Tehran. The study employed a quantitative methodology. For data gathering, a questionnaire was utilised to measure all the variables of the research. The statistical population of the study consisted of all the customers of Ayandeh Bank branches in Tehran, and the study data was gathered from 400 respondents. The findings indicate that brand experience has a direct and meaningful impact on customer satisfaction and customer loyalty, and, furthermore, that customer satisfaction has a direct and significant effect on customer loyalty in the branches of Ayandeh Bank in Tehran.

Keywords: brand experience, customer satisfaction, customer loyalty, bank

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Authors: Ilham Zaidi, P. Sankara Sarma, Quazi Taufique Ahmed, V. Raman Kutty, Khalid Umer Khayyam, Gurpreet Singh, Abhishek Royal

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Introduction: Tuberculosis is a global public health emergency, but it is particularly acute in India, which has the world's highest tuberculosis burden. Due to overpopulation, lack of sanitation, malnutrition, low living standards, and poor socioeconomic status, among other factors, it is India's most common infectious disease. The long period of treatment is one of the main reasons for considering it as a public health emergency. Consequently, there is an increase in patient noncompliance, which leads to treatment failure, adverse treatment outcomes, and deaths. This could lead to the growth of anti-TB drug resistance. According to the WHO, approximately 558 thousand new cases of Multi-Drug Resistance Tuberculosis were diagnosed worldwide, with 8.5 percent developed Extensively Drug Resistance Tuberculosis. Methodology: This study is a program-based cross-sectional descriptive survey of adult tuberculosis patients enrolled in the Delhi-based Revised National Tuberculosis Program. The study setting was 27 NTEP districts of Delhi. (N=65,893) and Sample size- was 200; the sampling method which is used in the study was the systemic random sampling method. Results: Most of the demographic factors (age, gender, residence, and family type) were not significantly associated with adherence; marital status was found statistically significant with the treatment compliance. Hesitation while telling people about the disease and motivation to strictly follow drug schedule by healthcare workers were other factors where a significant association with drug adherence was observed. The study findings also suggest that provision of food, minimal financial and other moral support from family, counseling, discussion and politeness by healthcare providers might also facilitate adherence. Discussion and Conclusions: For TB treatment, adherence, age, sex, socioeconomic status, types of accommodations, malnutrition, and personal hygiene should all be considered; similar results were observed in previous studies. In the care of TB patients, DOTS services, health workers, and family support play a significant role. According to the country's National Strategic Plan, the Indian government has set a goal of eliminating tuberculosis by 2025 and patients' compliance with TB care and treatment adherence is very crucial to achieve this aim. A cohort study will be able to give a better understanding of factors associated with adherence since this study may have missed some defaulters who were absconding and could not be reached. Important Terms: RNTCP, NTEP, DOTS, DS-TB, DR-TB, RR-TB, MDR-TB, XDR-TB, Treatment failure, Treatment relapse, Treatment adherence.

Keywords: treatment adherence, treatment relapse, treatment failure, drug resistance tuberculosis

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Authors: Fariba Ebrahimi, Mehdi Ghorbani

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Achieving to integrated Water management fundamentally needs to effective relation, coordination, collaboration and synergy among various actors who have common but different responsibilities. In this sense, the foundation of comprehensive and integrated management is not compatible with centralization and top-down strategies. The aim of this paper is analysis institutional network of water relevant stakeholders and water policy monitoring in Shemiranat. In this study collaboration networks between informal and formal institutions co-management process have been investigated. Stakeholder network analysis as a quantitative method has been implicated in this research. The results of this study indicate that institutional cohesion is medium; sustainability of institutional network is about 40 percent (medium). Additionally the core-periphery index has measured in this study according to reciprocity index. Institutional capacities for integrated natural resource management in regional level are measured in this study. Furthermore, the necessity of centrality reduction and promote stakeholders relations and cohesion are emphasized to establish a collaborative natural resource governance.

Keywords: policy monitoring, water management, social network, stakeholder, shemiranat

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Authors: Dmitriy Chernov, Maria Karavassilis, Suhyoun Youn, Amna Izhar, Devasenan Devendra

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Introduction and Background: A well-structured and comprehensive departmental induction improves patient safety and job satisfaction amongst doctors. The aims of our Project were as follows: 1. Assess the perceived preparedness of junior doctors starting their rotation in Acute Medicine at Watford General Hospital. 2. Develop a supplemental Induction Guide and Pocket reference in the form of an iOS mobile application. 3. To collect feedback after implementing the mobile application following a trial period of 8 weeks with a small cohort of junior doctors. Materials and Methods: A questionnaire was distributed to all new junior trainees starting in the department of Acute Medicine to assess their experience of current induction. A mobile Induction application was developed and trialled over a period of 8 weeks, distributed in addition to the existing didactic induction session. After the trial period, the same questionnaire was distributed to assess improvement in induction experience. Analytics data were collected with users’ consent to gauge user engagement and identify areas of improvement of the application. A feedback survey about the app was also distributed. Results: A total of 32 doctors used the application during the 8-week trial period. The application was accessed 7259 times in total, with the average user spending a cumulative of 37 minutes 22 seconds on the app. The most used section was Clinical Guidelines, accessed 1490 times. The App Feedback survey revealed positive reviews: 100% of participants (n=15/15) responded that the app improved their overall induction experience compared to other placements; 93% (n=14/15) responded that the app improved overall efficiency in completing daily ward jobs compared to previous rotations; and 93% (n=14/15) responded that the app improved patient safety overall. In the Pre-App and Post-App Induction Surveys, participants reported: a 48% improvement in awareness of practical aspects of the job; a 26% improvement of awareness on locating pathways and clinical guidelines; a 40% reduction of feelings of overwhelmingness. Conclusions and recommendations: This study demonstrates the importance of technology in Medical Education and Clinical Induction. The mobile application average engagement time equates to over 20 cumulative hours of on-the-job training delivered to each user, within an 8-week period. The most used and referred to section was clinical guidelines. This shows that there is high demand for an accessible pocket guide for this type of material. This simple mobile application resulted in a significant improvement in feedback about induction in our Department of Acute Medicine, and will likely impact workplace satisfaction. Limitations of the application include: post-app surveys had a small number of participants; the app is currently only available for iPhone users; some useful sections are nested deep within the app, lacks deep search functionality across all sections; lacks real time user feedback; and requires regular review and updates. Future steps for the app include: developing a web app, with an admin dashboard to simplify uploading and editing content; a comprehensive search functionality; and a user feedback and peer ratings system.

Keywords: mobile app, doctor induction, medical education, acute medicine

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Authors: Naomi Grigoryan, Alexandros Loutsioli Daskalakis, Anna Elisse Uy, Yihe Huang, Aude Laurent (Webanck)

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In response to the building and construction sectors accounting for a third of all energy demand and emissions, the European Union has placed new laws and regulations in the construction sector that emphasize material circularity, energy efficiency, biodiversity, and social impact. Existing design tools assess sustainability in early-stage design for products or buildings; however, there is no standardized methodology for measuring the circularity performance of building components. Existing assessment methods for building components focus primarily on carbon footprint but lack the comprehensive analysis required to design for circularity. The research conducted in this paper covers the parameters needed to assess sustainability in the design process of architectural products such as doors, windows, and facades. It maps a framework for a tool that assists designers with real-time sustainability metrics. Considering the life cycle of building components such as façades, windows, and doors involves the life cycle stages applied to product design and many of the methods used in the life cycle analysis of buildings. The current industry standards of sustainability assessment for metal building components follow cradle-to-grave life cycle assessment (LCA), track Global Warming Potential (GWP), and document the parameters used for an Environmental Product Declaration (EPD). Developed by the Ellen Macarthur Foundation, the Material Circularity Indicator (MCI) is a methodology utilizing the data from LCA and EPDs to rate circularity, with a "value between 0 and 1 where higher values indicate a higher circularity+". Expanding on the MCI with additional indicators such as the Water Circularity Index (WCI), the Energy Circularity Index (ECI), the Social Circularity Index (SCI), Life Cycle Economic Value (EV), and calculating biodiversity risk and uncertainty, the assessment methodology of an architectural product's impact can be targeted more specifically based on product requirements, performance, and lifespan. Broadening the scope of LCA calculation for products to incorporate aspects of building design allows product designers to account for the disassembly of architectural components. For example, the Material Circularity Indicator for architectural products such as windows and facades is typically low due to the impact of glass, as 70% of glass ends up in landfills due to damage in the disassembly process. The low MCI can be combatted by expanding beyond cradle-to-grave assessment and focusing the design process on disassembly, recycling, and repurposing with the help of real-time assessment tools. Design for Disassembly and Urban Mining has been integrated within the construction field on small scales as project-based exercises, not addressing the entire supply chain of architectural products. By adopting more comprehensive sustainability metrics and incorporating uncertainty calculations, the sustainability assessment of building components can be more accurately assessed with decarbonization and disassembly in mind, addressing the large-scale commercial markets within construction, some of the most significant contributors to climate change.

Keywords: architectural products, early-stage design, life cycle assessment, material circularity indicator

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