Search results for: patient’s satisfaction

Authors: Sarah Rietze, Hannes Zacher

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Daily stand-up meetings are the most commonly used method in agile teams. In daily stand-ups, team members gather to coordinate and align their efforts, typically for a predefined period of no more than 15 minutes. The primary purpose is to ask and answer the following three questions: What was accomplished yesterday? What will be done today? What obstacles are impeding my progress? Daily stand-ups aim to enhance communication, mutual understanding, and support within the team, as well as promote collective learning from mistakes through daily synchronization and transparency. The use of daily stand-ups is intended to positively influence psychological safety within teams, which is the belief that it is safe to show oneself and take personal risks. Two studies will be presented, which explore the relationships between daily stand-ups, psychological safety, and psychological well-being. In a first study, based on survey results (n = 318), we demonstrated that daily stand-ups have a positive indirect effect on job satisfaction and a negative indirect effect on turnover intention through their impact on psychological safety. In a second study, we investigate, using an experimental design, how the use of daily stand-ups in teams enhances psychological safety and well-being compared to a control group that does not use daily stand-ups. Psychological safety is considered one of the most crucial cultural factors for a sustainable, agile organization. Agile approaches, such as daily stand-ups, are a critical part of the evolving work environment and offer a proactive means to shape and foster psychological safety within teams.

Keywords: occupational wellbeing, agile work practices, psychological safety, daily stand-ups

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Authors: Royia Soliman, Salma ElAnsary, Akram Amin Abdellatif, Florian Holzapfel

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Model-Based Safety Analysis (MBSA) is an approach in which the system and safety engineers share a common system model created using a model-based development process. The model can also be extended by the failure modes of the system components. There are two famous approaches for the addition of fault behaviors to system models. The first one is to enclose the failure into the system design directly. The second approach is to develop a fault model separately from the system model, thus combining both independent models for safety analysis. This paper introduces a hybrid approach of MBSA. The approach tries to use informal abstracted models to investigate failure behaviors. The approach will combine various concepts such as directed graph traversal, event lists and Constraint Satisfaction Problems (CSP). The approach is implemented using an Object Oriented programming language. The components are abstracted to its failure logic and relationships of connected components. The implemented approach is tested on various flight control systems, including electrical and multi-domain examples. The various tests are analyzed, and a comparison to different approaches is represented.

Keywords: flight control systems, model based safety analysis, safety assessment analysis, system modelling

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Authors: Ali Kassem, Yhea Kishik, Ali Hassan, Mohamed Abdelwahab

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Introduction: Accelerated coronary and peripheral vascular atherosclerosis is one of the most common and chronic complications of diabetes mellitus. A recent aspect of coronary artery disease in this condition is its silent nature. The aim of the work: Detection of the prevalence of silent myocardial ischemia (SMI) in Upper Egypt type 2 diabetic males and to select male diabetic population who should be screened for SMI. Patients and methods: 100 type 2 diabetic male patients with a negative history of angina or anginal equivalent symptoms and 30 healthy control were included. Full medical history and thorough clinical examination were done for all participants. Fasting and post prandial blood glucose level, lipid profile, (HbA1c), microalbuminuria, and C-reactive protein were done for all participants Resting ECG, trans-thoracic echocardiography, treadmill exercise ECG, myocardial perfusion imaging were done for all participants and patients positive for one or more NITs were subjected for coronary angiography. Results Twenty nine patients (29%) were positive for one or more NITs in the patients group compared to only one case (3.3%) in the controls. After coronary angiography, 20 patients were positive for significant coronary artery stenosis in the patients group, while it was refused to be done by the patient in the controls. There were statistical significant difference between the two groups regarding, hypertension, dyslipidemia and obesity, family history of DM and IHD with higher levels of microalbuminuria, C-reactive protein, total lipids in patient group versus controls According to coronary angiography, patients were subdivided into two subgroups, 20 positive for SMI (positive for coronary angiography) and 80 negative for SMI (negative for coronary angiography). No statistical difference regarding family history of DM and type of diabetic therapy was found between the two subgroups. Yet, smoking, hypertension, obesity, dyslipidemia and family history of IHD were significantly higher in diabetics positive versus those negative for SMI. 90% of patients in subgroup positive for SMI had two or more cardiac risk factors while only two patients had one cardiac risk factor (10%). Uncontrolled DM was detected more in patients positive for SMI. Diabetic complications were more prevalent in patients positive for SMI versus those negative for SMI. Most of the patients positive for SMI have DM more than 5 years duration. Resting ECG and resting Echo detected only 6 and 11 cases, respectively, of the 20 positive cases in group positive for SMI compared to treadmill exercise ECG and myocardial perfusion imaging that detected 16 and 18 cases respectively, Conclusion: Type 2 diabetic male patients should be screened for detection of SMI when aged above 50 years old, diabetes duration is more than 5 years, presence of two or more cardiac risk factors and/or patients suffering from one or more of the chronic diabetic complications. CRP, is an important parameter for selection of type 2 diabetic male patients who should be screened for SMI. Non invasive cardiac tests are reliable for screening of SMI in these patients in our locality.

Keywords: C-reactive protein, Silent myocardial ischemia, Stress tests, type 2 DM

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Authors: Aarti M. Shetty, Estela Davoodi, Subrata Gangooly, Anita Rao-Coppisetty

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Background: Testing Patency of Fallopian Tubes is among one of the several protocols for investigating Subfertile Couples. Both, Hysterosalpingogram (HSG) and Laparoscopy and dye test have been used as Tubal patency test for several years, with well-known limitation. Hysterosalpingo Contrast Sonography (HyCoSy) can be used as an alternative tool to HSG, to screen patency of Fallopian tubes, with an advantage of being non-ionising, and also, use of transvaginal scan to diagnose pelvic pathology. Aim: To determine the indication and analyse the performance of transvaginal scan and HyCoSy in Broomfield Hospital. Methods: We retrospectively analysed fertility workup of 282 women, who attended HyCoSy clinic at our institution from January 2015 to June 2016. An Audit proforma was designed, to aid data collection. Data was collected from patient notes and electronic records, which included patient demographics; age, parity, type of subfertility (primary or secondary), duration of subfertility, past medical history and base line investigation (hormone profile and semen analysis). Findings of the transvaginal scan, HyCoSy and Laparoscopy were also noted. Results: The most common indication for referral were as a part of primary fertility workup on couples who had failure to conceive despite intercourse for a year, other indication for referral were recurrent miscarriage, history of ectopic pregnancy, post reversal of sterilization(vasectomy and tuboplasty), Post Gynaecology surgery(Loop excision, cone biopsy) and amenorrhea. Basic Fertility workup showed 34% men had abnormal semen analysis. HyCoSy was successfully completed in 270 (95%) women using ExEm foam and Transvaginal Scan. Of the 270 patients, 535 tubes were examined in total. 495/535 (93%) tubes were reported as patent, 40/535 (7.5%) tubes were reported as blocked. A total of 17 (6.3%) patients required laparoscopy and dye test after HyCoSy. In these 17 patients, 32 tubes were examined under laparoscopy, and 21 tubes had findings similar to HyCoSy, with a concordance rate of 65%. In addition to this, 41 patients had some form of pelvic pathology (endometrial polyp, fibroid, cervical polyp, fibroid, bicornuate uterus) detected during transvaginal scan, who referred to corrective surgeries after attending HyCoSy Clinic. Conclusion: Our audit shows that HyCoSy and Transvaginal scan can be a reliable screening test for low risk women. Furthermore, it has competitive diagnostic accuracy to HSG in identifying tubal patency, with an additional advantage of screening for pelvic pathology. With addition of 3D Scan, pulse Doppler and other non-invasive imaging modality, HyCoSy may potentially replace Laparoscopy and chromopertubation in near future.

Keywords: hysterosalpingo contrast sonography (HyCoSy), transvaginal scan, tubal infertility, tubal patency test

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Authors: Vineet Agrawal, Deepanjali S., Medha R., Subitha L.

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Background. Hospital malnutrition is a highly prevalent issue and is known to increase the morbidity, mortality, length of hospital stay, and cost of care. In India, studies on hospital malnutrition have been restricted to ICU, post-surgical, and cancer patients. We designed this study to assess the impact of hospital malnutrition on 30-day post-discharge and in-hospital mortality in patients admitted in the general medicine department, irrespective of diagnosis. Methodology. All patients aged above 18 years admitted in the medicine wards, excluding medico-legal cases, were enrolled in the study. Nutritional assessment was done within 72 h of admission, using Subjective Global Assessment (SGA), which classifies patients into three categories: Severely malnourished, Mildly/moderately malnourished, and Normal/well-nourished. Anthropometric measurements like Body Mass Index (BMI), Triceps skin-fold thickness (TSF), and Mid-upper arm circumference (MUAC) were also performed. Patients were followed-up during hospital stay and 30 days after discharge through telephonic interview, and their final diagnosis, comorbidities, and cause of death were noted. Multivariate logistic regression and cox regression model were used to determine if the nutritional status at admission independently impacted mortality at one month. Results. The prevalence of malnourishment by SGA in our study was 67.3% among 395 hospitalized patients, of which 155 patients (39.2%) were moderately malnourished, and 111 (28.1%) were severely malnourished. Of 395 patients, 61 patients (15.4%) expired, of which 30 died in the hospital, and 31 died within 1 month of discharge from hospital. On univariate analysis, malnourished patients had significantly higher morality (24.3% in 111 Cat C patients) than well-nourished patients (10.1% in 129 Cat A patients), with OR 9.17, p-value 0.007. On multivariate logistic regression, age and higher Charlson Comorbidity Index (CCI) were independently associated with mortality. Higher CCI indicates higher burden of comorbidities on admission, and the CCI in the expired patient group (mean=4.38) was significantly higher than that of the alive cohort (mean=2.85). Though malnutrition significantly contributed to higher mortality on univariate analysis, it was not an independent predictor of outcome on multivariate logistic regression. Length of hospitalisation was also longer in the malnourished group (mean= 9.4 d) compared to the well-nourished group (mean= 8.03 d) with a trend towards significance (p=0.061). None of the anthropometric measurements like BMI, MUAC, or TSF showed any association with mortality or length of hospitalisation. Inference. The results of our study highlight the issue of hospital malnutrition in medicine wards and reiterate that malnutrition contributes significantly to patient outcomes. We found that SGA performs better than anthropometric measurements in assessing under-nutrition. We are of the opinion that the heterogeneity of the study population by diagnosis was probably the primary reason why malnutrition by SGA was not found to be an independent risk factor for mortality. Strategies to identify high-risk patients at admission and treat malnutrition in the hospital and post-discharge are needed.

Keywords: hospitalization outcome, length of hospital stay, mortality, malnutrition, subjective global assessment (SGA)

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Authors: Hassidou Saidou, Soulé Aminou

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As in many towns of African countries, the waste management, in particularly solid constitutes a major problem for the municipal authorities of Maradi. The aim of this study is to make a diagnosis of the present system of waste management in the town of Maradi. The approach was consisted to some interviews with the municipal authorities, cleaning up and health technicians and some housewives investigations. According to the health technicians of the town, the causes due to the problem of waste management in Maradi town are: collecting capacity insufficient, lack of effective sensitization of people, undeveloped and uncontrolled rubbish dumps, lack of gutter and its maintenance, and insufficient and unqualified human resources. As to the authorities, they denounce always the attitude and the behavior of citizens on the waste issue. The waste evacuation is doing by municipal collecting or by depositing in wild rubbish dump. Some people eliminate their waste by burning or duping in the streets or in their houses. According to our investigations, 52% of population evacuates their waste daily. The satisfaction rate of municipal collecting is for 32%. The analysis showed that the present system of waste management in Maradi town is failing. As solutions, we proposed to equip the technical offices with appropriated material and financial means, reinforce the involved actor’s capacities and making in application the operatives regulations for the waste management.

Keywords: maradi, municipal authorities, Niger Republic, solid waste management

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Authors: Elena Ivany, Leanne Aitken

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Little is known about the delivery of end-of-life care in cardiac intensive care unit (CICU) settings. The aims of this study were to highlight the nurse-identified barriers and facilitators to delivering end-of-life care in the CICU, and to identify whether any of the barriers and/or facilitators are specific to the CICU setting. This was an exploratory qualitative study utilizing semi-structured individual interviews as the data collection method and inductive thematic analysis to structure the data. Six CICU nurses took part in the study. Five key themes were identified, each theme including both barriers and facilitators. The five key themes are as follows: patient-centered care, emotional challenges, reaching concordance, nursing contribution and the surgical intensive care unit.

Keywords: end-of-life, cardiovascular disease, cardiac surgery, critical care

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Authors: Rakkrit Duangsoithong, Jermphiphut Jaruenpunyasak, Alba Garcia

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The use of foot recognition can be applied in many medical fields such as the gait pattern analysis and the knee exercises of patients in rehabilitation. Generally, a camera-based foot recognition system is intended to capture a patient image in a controlled room and background to recognize the foot in the limited views. However, this system can be inconvenient to monitor the knee exercises at home. In order to overcome these problems, this paper proposes to use the deep learning method using Convolutional Neural Networks (CNNs) for foot recognition. The results are compared with the traditional classification method using LBP and HOG features with kNN and SVM classifiers. According to the results, deep learning method provides better accuracy but with higher complexity to recognize the foot images from online databases than the traditional classification method.

Keywords: foot recognition, deep learning, knee rehabilitation, convolutional neural network

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Authors: E. Steen, B. Dewulf, N. Müller, C. Vandycke, Y. Vandekerckhove

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Introduction: The care for a ST-elevation myocardial infarction (STEMI) patient is time-critical. Reperfusion therapy within 90 minutes of initial medical contact is mandatory in the improvement of the outcome. Primary percutaneous coronary intervention (PCI) without previous fibrinolytic treatment, is the preferred reperfusion strategy in patients with STEMI, provided it can be performed within guideline-mandated times. Aim of the study: During a one year period (January 2013 to December 2013) the files of all consecutive STEMI patients with urgent referral from non-PCI facilities for primary PCI were reviewed. Special attention was given to a subgroup of patients with prior out-of-hospital medical contact generated by the 112-system. In an effort to reduce out-of-hospital system delay to definitive care a change in pre-hospital 112 dispatch strategies is proposed for these time-critical patients. Actual time recordings were compared with travel time simulations for two suggested scenarios. A first scenario (SC1) involves the decision by the on scene ground EMS (GEMS) team to transport the out-of-hospital diagnosed STEMI patient straight forward to a PCI centre bypassing the nearest non-PCI hospital. Another strategy (SC2) explored the potential role of helicopter EMS (HEMS) where the on scene GEMS team requests a PCI-centre based HEMS team for immediate medical transfer to the PCI centre. Methods and Results: 49 (29,1% of all) STEMI patients were referred to our hospital for emergency PCI by a non-PCI facility. 1 file was excluded because of insufficient data collection. Within this analysed group of 48 secondary referrals 21 patients had an out-of-hospital medical contact generated by the 112-system. The other 27 patients presented at the referring emergency department without prior contact with the 112-system. The table below shows the actual time data from first medical contact to definitive care as well as the simulated possible gain of time for both suggested strategies. The PCI-team was always alarmed upon departure from the referring centre excluding further in-hospital delay. Time simulation tools were similar to those used by the 112-dispatch centre. Conclusion: Our data analysis confirms prolonged reperfusion times in case of secondary emergency referrals for STEMI patients even with the use of HEMS. In our setting there was no statistical difference in gain of time between the two suggested strategies, both reducing the secondary referral generated delay with about one hour and by this offering all patients PCI within the guidelines mandated time. However, immediate HEMS activation by the on scene ground EMS team for transport purposes is preferred. This ensures a faster availability of the local GEMS-team for its community. In case these options are not available and the guideline-mandated times for primary PCI are expected to be exceeded, primary fibrinolysis should be considered in a non-PCI centre.

Keywords: STEMI, system delay, HEMS, emergency medicine

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Authors: Abrar Abuzaid, Maha Alaaeddine, Haya Alesayi

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This project is centered around understanding the usage and impact of Alexa, Amazon's popular virtual assistant, in everyday life. Alexa, known for its integration into devices like Amazon Echo, offers functionalities such as voice interaction, media control, providing real-time information, and managing smart home devices. Our primary focus is to conduct a straightforward survey aimed at uncovering how people use Alexa in their daily routines. We plan to reach out to a wide range of individuals to get a diverse perspective on how Alexa is being utilized for various tasks, the frequency and context of its use, and the overall user experience. The survey will explore the most common uses of Alexa, its impact on daily life, features that users find most beneficial, and improvements they are looking for. This project is not just about collecting data but also about understanding the real-world applications of a technology like Alexa and how it fits into different lifestyles. By examining the responses, we aim to gain a practical understanding of Alexa's role in homes and possibly in workplaces. This project will provide insights into user satisfaction and areas where Alexa could be enhanced to meet the evolving needs of its users. It’s a step towards connecting technology with everyday life, making it more accessible and user-friendly

Keywords: Amazon Alexa, artificial intelligence, smart speaker, natural language processing

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Authors: S. AliReza Mirghasemi, Amin Mohamadi, Zameer Hussain, Narges Rahimi Gabaran, Mir Mostafa Sadat, Shervin Rashidinia

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In progressive cases of Ankylosing Spondylitis, patients will have high degrees of kyphosis leading to severe disabilities. Several operative techniques have been used in this stage, but little knowledge exists on the indications for and outcome of these methods. In this study, we examined the efficacy of monosegmental transverse open wedge osteotomy of L3 in 11 patients with progressive spinal kyphosis. The average correction was 36̊ (20 to 42) with no loss of correction after operation. The average operating time was 120 minutes (100 to 130) and the mean blood loss was 1500 ml (1100 to 2000). Osteotomy corrected all patients sufficiently to allow them to see ahead and their posture was improved. There were no fatal complications but one patient had paraplegia after the operation.

Keywords: ankylosing spondylitis, thoracolumbar kyphosis, open wedge osteotomy, L3 transverse open wedge osteotomy

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Authors: Fiona Soraya Addai-Sundiata, Ernest Yeboah Acheampong, Ralph Frimpong

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The rationale of this study is to examine the career experiences of elite female football coaches in Ghana. More importantly, it focus on their motives, the challenges of football coaching and their experiences along their career paths. The study draws from literature on female coaches in football to understand their experiences and reflections in their chosen careers. The findings of the study relied on in-depth semi-structured interviews with five elite female football coaches aged between 28 and 50 years. Participants’ responses reveal that both intrinsic and extrinsic motives drive them into football coaching, including learning experiences from abroad, a strong desire to break the gendered hegemony of coaching in Ghana, serving as role models, enjoyment, satisfaction and passion for their chosen careers. Results indicate that they encountered sociocultural, organisational, personal and interpersonal challenges. Also, they experience gender stereotyping, limited career mobility, sexism and marginalisation, which prevent them from becoming elite coaches. The study provides useful data for stakeholders, including Ghana Football Association (GFA), to use effective strategies (e.g., special incentives for women coaches) to attract and retain women in the football coaching space.

Keywords: elite female football coaches, career experiences, gender, motives, trajectories

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Authors: Fiona Soraya Addai-Sundiata, Ernest Yeboah Acheampong, Ralph Frimpong

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The rationale of this study is to examine the career experiences of elite female football coaches in Ghana. More importantly, it focus on their motives, the challenges of football coaching and their experiences along their career paths. The study draws from literature on female coaches in football to understand their experiences and reflections in their chosen careers. The findings of the study relied on in-depth semi-structured interviews with five elite female football coaches aged between 28 and 50 years. Participants’ responses reveal that both intrinsic and extrinsic motives drive them into football coaching including learning experiences from abroad, a strong desire to break the gendered hegemony of coaching in Ghana, serving as role models, enjoyment, satisfaction and passion for their chosen careers. Results indicate that they encountered sociocultural, organisational, personal and interpersonal challenges. Also, they experience gender stereotyping, limited career mobility, sexism and marginalisation, which prevent them from becoming elite coaches. The study provides useful data for stakeholders including Ghana Football Association (GFA) to use effective strategies (e.g., special incentives for women coaches) to attract and retain women in the football coaching space.

Keywords: elite female football coaches, career experiences, gender, motives, trajectories

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Authors: Thibaud Berthomier, Ali Mansour, Luc Bressollette, Frédéric Le Roy, Dominique Mottier, Léo Fréchier, Barthélémy Hermenault

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Deep Venous Thrombosis (DVT) occurs when a thrombus is formed within a deep vein (most often in the legs). This disease can be deadly if a part or the whole thrombus reaches the lung and causes a Pulmonary Embolism (PE). This disorder, often asymptomatic, has multifactorial causes: immobilization, surgery, pregnancy, age, cancers, and genetic variations. Our project aims to relate the thrombus epidemiology (origins, patient predispositions, PE) to its structure using ultrasound images. Ultrasonography and elastography were collected using Toshiba Aplio 500 at Brest Hospital. This manuscript compares two classification approaches: spectral clustering and scattering operator. The former is based on the graph and matrix theories while the latter cascades wavelet convolutions with nonlinear modulus and averaging operators.

Keywords: deep venous thrombosis, ultrasonography, elastography, scattering operator, wavelet, spectral clustering

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Authors: Menelik Tilahun Alemu

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Customs administrations are now increasingly regarded as the key border agencies responsible for all transactions related to issues arising from the border crossings of goods and people. Raising revenue has traditionally been high on the agenda of governments, represented by the Ministry of Finance (MOF), because of the critical importance of import duties as a source of budget revenue for many developing countries. Most of these functions are undertaken in close cooperation with other national agencies. Due to the need to make structural reforms that consider the nature of business activities in the world and the needs of consumers, the institution was previously divided into the Ministry of Revenue and the Customs Commission. Accordingly, the Ministry of Revenue is primarily responsible for administering and collecting local taxes, while the Customs Commission is responsible for administering customs matters; It supports exports and collects revenue from it. The National Import and Export Trade Service System is working to make the world more transparent and standardized and adapt to the current situation by formulating various guidelines, rules and procedures to provide a clear, simple, predictable and accessible service to customers. As a result, the commission will be able to streamline the business process by enabling Paperless customer service to support the service delivery technology and eliminate the customer iteration without having to incur unnecessary costs and inconveniences.

Keywords: business, consumers, adapt, transparent

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Authors: Ali Abdi Kordani, Meysam Rooyintan, Sid Mohammad Boroomandrad

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Nowadays, one the most important problems in megacities is public transportation and satisfying citizens from this system in order to decrease the traffic congestions and air pollution. Accordingly, to improve the transit passengers and increase the travel safety, new transportation systems such as Bus Rapid Transit (BRT), tram, and monorail have expanded that each one has different merits and demerits. That is why comparing different systems for a systematic selection of public transportation systems in a big city like Tehran, which has numerous problems in terms of traffic and pollution, is essential. In this paper, it is tried to investigate the advantages and feasibility of using monorail, tram and BRT systems, which are widely used in most of megacities in all over the world. In Tehran, by using SPSS statistical analysis software and TOPSIS method, these three modes are compared to each other and their results will be assessed. Experts, who are experienced in the transportation field, answer the prepared matrix questionnaire to select each public transportation mode (tram, monorail, and BRT). The results according to experts’ judgments represent that monorail has the first priority, Tram has the second one, and BRT has the third one according to the considered indices like execution costs, wasting time, depreciation, pollution, operation costs, travel time, passenger satisfaction, benefit to cost ratio and traffic congestion.

Keywords: BRT, costs, monorail, pollution, tram

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Authors: Wong Ka Fai

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Introduction: Many students are worried before an examination; that is a common picture worldwide. Health problems from stress before examination were insomnia, tiredness, isolation, stomach upset, and anxiety. Nursing students experienced high stress from the examination. Guided imagery is a healing process of applying imagination to help the body heal, survive, or live well. It can bring about significant physiological and biochemical changes, which can trigger the recovery process. A study of nursing students improving their anxiety before examination with guided imagery was proposed. Aim: The aim of this study was to explore the outcome of guided imagery on nursing students’ anxiety before examination in Hong Kong. Method: The qualitative study method was used. 16 first-year students studying nursing programme were invited to practice guided imagery to improve their anxiety before the examination period. One week before the examination, the semi-structured interviews with these students were carried out by the researcher. Result: From the content analysis of interview data, these nursing students showed considerable similarities in their anxiety perception. Nursing students’ perceived improved anxiety was evidenced by a reduction of stressful feelings, improved physical health, satisfaction with daily activities, and enhanced skills for solving problems and upcoming situations. Conclusion: This study indicated that guided imagery can be used as an alternative measure to improve students’ anxiety and psychological problems.

Keywords: nursing students, perception, anxiety, guided imagery

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Authors: Bhushan Bhalgat, Suresh Singh, Phanindra Swain, Kamal Kishore Lakhera

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Carcinoma of cervix and carcinoma of vulva have been associated with common predisposing factors like human papillomavirus and smoking. Skip metastases and metachronous appearance of both these tumours have been reported. There is no case report showing synchronous appearance of these tumours in English literature. We herewith report a case report of a middle aged female patient who presented with per vaginal bleeding, and on examination, a cervical mass was palpable. Also, a proliferative growth was seen over her left vulva. Biopsy of both lesions came out to be squamous cell carcinoma and carcinoma in situ, respectively. A radical hysterectomy and bilateral pelvic and paraaortic lymph nodal dissection was performed along with left simple vulvectomy. This thereby underscores that any lesion over vulva appearing during or after treatment of cervical carcinoma should be biopsied to rule out vulvar carcinoma.

Keywords: carcinoma of cervix, carcinoma of vulva, synchronous tumours, gynecological oncology

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Authors: Lara F. Horani, Shurong Tong

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Identification of customer requirements and their preferences are the starting points in the process of product design. Most of design methodologies focus on traditional requirements. But in the previous decade, the green products and the environment requirements have increasingly attracted the attention with the constant increase in the level of consumer awareness towards environmental problems (such as green-house effect, global warming, pollution and energy crisis, and waste management). Determining the importance weights for the customer requirements is an essential and crucial process. This paper used the analytic hierarchy process (AHP) approach to evaluate and rate the customer requirements for green products. With respect to the ultimate goal of customer satisfaction, surveys are conducted using a five-point scale analysis. With the help of this scale, one can derive the weight vectors. This approach can improve the imprecise ranking of customer requirements inherited from studies based on the conventional AHP. Furthermore, the AHP with extent analysis is simple and easy to implement to prioritize customer requirements. The research is based on collected data through a questionnaire survey conducted over a sample of 160 people belonging to different age, marital status, education and income groups in order to identify the customer preferences for green product requirements.

Keywords: analytic hierarchy process (AHP), green product, customer requirements for green design, importance weights for the customer requirements

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Authors: N. N. Pilau, M. S. Abubakar, A. Danmaigoro, P. C. Mshelia, Y. Sani

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A severely debilitated 4months old Caucasian male dog presented dehydration, emaciation, vomiting, icteric ocular and oral mucous membranes, generalized lymphadenopathy, hematuria, anorexia and prolonged recumbency. Clinical workup was done in established protocols for diagnosis based on history, clinical signs and selected laboratory tests. Treatment course were administered over 48hours during which the patient died of overwhelming hepatopathy, nephropathy and pneumonia. Postmortem findings supported by ante mortem laboratory test results tentatively diagnosed leptospirosis, a disease endemic and presenting potentially fatal epidemics and zoonoses in some countries amongst the developing regions of the world. This disease is reviewed and a call for attention on the public health significance of the disease is hereby presented through this case report.

Keywords: canine, endemic, leptospirosis, prevalence

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Authors: Francisco José Plácido da Cunha, Tassio Ferenzini Martins Sirqueira, Marx Leles Viana, Carlos José Pereira de Lucena

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Open Multiagent Systems (MASs) are societies in which heterogeneous and independently designed entities (agents) work towards similar, or different ends. Software agents are autonomous and the diversity of interests among different members living in the same society is a fact. In order to deal with this autonomy, these open systems use mechanisms of social control (norms) to ensure a desirable social order. This paper considers the following types of norms: (i) obligation — agents must accomplish a specific outcome; (ii) permission — agents may act in a particular way, and (iii) prohibition — agents must not act in a specific way. All of these characteristics mean to encourage the fulfillment of norms through rewards and to discourage norm violation by pointing out the punishments. Once the software agent decides that its priority is the satisfaction of its own desires and goals, each agent must evaluate the effects associated to the fulfillment of one or more norms before choosing which one should be fulfilled. The same applies when agents decide to violate a norm. This paper also introduces a framework for the development of MASs that provide support mechanisms to the agent’s decision-making, using norm-based reasoning. The applicability and validation of this approach is demonstrated applying a traffic intersection scenario.

Keywords: BDI agent, BDI4JADE framework, multiagent systems, normative agents

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Authors: Fernanda S. Oliveira

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The architectural science of lighting has been mainly concerned with technical aspects and has tended to ignore the psychophysical. There is a growing evidence that adopting passive design solutions may contribute to higher satisfaction. This is even more important in countries with higher solar radiation, which should take advantage of favourable daylighting conditions. However, in art museums, the same light that stimulates vision can also cause permanent damage to the exhibits. Not only the visitors want to see the objects, but also to understand their nature and the artist’s intentions. This paper examines the hypothesis that the more varied and exciting the lighting (and particularly the daylight) in museums rooms, over space and time, the more likely it is that visitors will stay longer, enjoy their experience and be willing to return. This question is not often considered in museums that privilege artificial lighting neglecting the various qualities of daylight other than its capacity to illuminate spaces. The findings of this paper show that daylight plays an important role in museum design, affecting how visitors perceive the exhibition space, as well as contributing to their overall enjoyment in the museum. Rooms with high luminance means were considered more pleasant (r=.311, p<.05) and cheerful (r=.349, p<.05). Lighting conditions also have a direct effect on the phenomenon of museum fatigue with the overall room quality showing an effect on how tired visitors reported to be (r=.421, p<.01). The control and distribution of daylight in museums can therefore contribute to create pleasant conditions for learning, entertainment and amusement, so that visitors are willing to return.

Keywords: daylight, comfort, museums, luminance, visitor

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Authors: Shahid Noor, Kazim Najjad, Muhammad Nasir, Irshad Bhutto, Abdul Samad Memon, Khurram Anwar, Tehseen Riaz, Mian Muhammad Hanif, Nauman A. Mallik, Saeed Ahmed, Israr Ahmed, Ali Yasir

Abstract:

Background: Musculoskeletal pain is the most common complaint presented to the health practitioner. It is well known that untreated or under-treated pain can have a significant negative impact on an individual’s quality of life (QoL). Objectives: This study was conducted across 10 sites in six (6) major cities of Pakistan to evaluate the tolerability, safety, and the clinical response of Nuberol Forte® (Paracetamol 650 mg + Orphenadrine 50 mg) to musculoskeletal pain in routine Pakistani practice and its impact on improving the patient’s QoL. Design & Methods: This NFORT-EFFECT observational, prospective multicenter study was conducted in compliance with Good Clinical Practice guidelines and local regulatory requirements. The study sponsor was "The Searle Company Limited, Pakistan. To maintain the GCP compliances, the sponsor assigned the CRO for the site and data management. Ethical approval was obtained from an independent ethics committee. The IEC reviewed the progress of the study. Written informed consent was obtained from the study participants, and their confidentiality was maintained throughout the study. A total of 399 patients with known prescreened musculoskeletal conditions and pain who attended the study sites were recruited, as per the inclusion/exclusion criteria (clinicaltrials.gov ID# NCT04765787). The recruited patients were then prescribed Paracetamol (650 mg) and Orphenadrine (50 mg) combination (Nuberol Forte®) for 7 to 14 days as per the investigator's discretion based on the pain intensity. After the initial screening (visit 1), a follow-up visit was conducted after 1-2 weeks of the treatment (visit 2). Study Endpoints: The primary objective was to assess the pain management response of Nuberol Forte treatment and the overall safety of the drug. The Visual Analogue Scale (VAS) scale was used to measure pain severity. Secondary to pain, the patients' health-related quality of life (HRQoL) was also assessed using the Muscle, Joint Measure (MJM) scale. The safety was monitored on the first dose by the patients. These assessments were done on each study visit. Results: Out of 399 enrolled patients, 49.4% were males, and 50.6% were females with a mean age of 47.24 ± 14.20 years. Most patients were presented with Knee Osteoarthritis (OA), i.e., 148(38%), followed by backache 70(18.2%). A significant reduction in the mean pain score was observed after the treatment with the combination of Paracetamol and Orphenadrine (p<0.05). Furthermore, an overall improvement in the patient’s QoL was also observed. During the study, only ten patients reported mild adverse events (AEs). Conclusion: The combination of Paracetamol and Orphenadrine (Nuberol Forte®) exhibited effective pain management among patients with musculoskeletal conditions and also improved their QoL.

Keywords: musculoskeletal pain, orphenadrine/paracetamol combination, pain management, quality of life, Pakistani population

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Authors: Hermanto J. M, Mirna Febriani

Abstract:

Resin acrylic, which is widely used, has the physical properties that can absorb liquids. This can lead to a change in the dimensions of the acrylic resin material. If repeated immersions were done, its strength would be affected. Disinfectant solutions have been widely used to reduce microorganisms both inside and outside the patient's mouth. One of the disinfecting materials that can be used is a clover solution. The purpose of this research is to find the ratio of water absorption of the acrylic resin material of self-cured type, soaked in clover solution for 10 minutes. The results showed that the average value obtained before soaked in clover solution was 0.0692 mg/cm3 and after soaked, in clover solution, the value was 0.090 mg/cm3. The conclusion of this research shows that the values of water sorption of acrylic resin before and after soaked in clover solution is still in ISO standard 1567/2001. Differences in water sorption value of self-cured acrylic resin before and after the immersion are caused by the process of liquid diffusion into the acrylic resin.

Keywords: absorption of fluid, self-cured acrylic resin, soaked, clover solution

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Authors: Mohammed A. Abutalib

Abstract:

Papillary thyroid carcinoma (PTC) accounts for the most common type of thyroid cancer, a well-differentiated type. PTC is featured by biologically low-grade and less aggressive tumors with a survival rate of 10 years in most of the diagnosed cases. PTC can be presented with the involvement of cervical lymph nodes in about 50% of the patients, yet the distant spread is very uncommon. Herein, we discussed an early 50-year-old male patient with a history of PTC that presented to the emergency department complaining of shortness of breath and a radiological finding of hydrothorax. Cytologic examination, together with immune-histochemical staining and molecular studies of pleural effusion aspiration, concluded the definitive diagnosis of metastatic papillary thyroid carcinoma in the pleural space. PTC seldom causes metastatic niches in the pleural space, and this is a rare clinical presentation; nevertheless, a differential diagnosis of thyroid metastasis needs to be excluded.

Keywords: thyroid cancer, malignant pleural effusion, cytology aspiration, papillary thyroid carcinoma

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Authors: A. Chtourou, K. Ben Youssef, M. Friel, T. Leicht

Abstract:

These Place attributes and destination images associated with tourism destinations are often crucial important for tourist travel decisions and choice behavior. Understanding the interactions between them is fundamental for developing sustainable place brands. Despite their extensive use on an empirical ground, little research has been done in terms of analyzing the constructs that determine the sense of place in the marketing of cultural heritage sites and on how tourist experiences at such places influence tourist motivations to revisit destinations. By referring to the Italian city of Vicenza, internationally renowned for its gold jewelry production and for the Palladian architectures and buildings which have been recognized World Heritage by the UNESCO, the paper aims to identify how destination image, place familiarity and travel satisfaction influence tourists’ motivations to revisit Vicenza. After an introduction and literature review, the paper investigates the importance of the core constructs that determine the sense of place in the tourist practice. In accordance with previous research, the results provide evidence that favorable travel experiences influence revisit intentions positively. The managerial implications and recommendations for the city of Vicenza are discussed.

Keywords: consumer behavior, heritage tourism, sense of place, place branding, territorial marketing

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Authors: Mary Farrell, Maria Soubra, Sandra Vega, Dorothy Kakraba, Joanne Fontanilla, Moira Kendra, Danielle Tonzola, Stephanie Chiu

Abstract:

Pneumonia is the most common infectious cause of hospitalizations in the United States, with more than one million admissions annually and costs of $10 billion every year, making it the 8th leading cause of death. Aspiration pneumonia is an aggressive type of pneumonia that results from inhalation of oropharyngeal secretions and/or gastric contents and is preventable. The authors hypothesized that an evidence-based aspiration pneumonia clinical care pathway could reduce 30-day hospital readmissions and mortality rates, while improving the overall care of patients. We conducted a retrospective chart review on 979 patients discharged with aspiration pneumonia from January 2021 to December 2022 at Overlook Medical Center. The authors identified patients who were coded with aspiration pneumonia and/or stable sepsis. Secondarily, we identified 30-day readmission rates for aspiration pneumonia from a SNF. The Aspiration Pneumonia Clinical Care Pathway starts in the emergency department (ED) with the initiation of antimicrobials within 4 hours of admission and early recognition of aspiration. Once this is identified, a swallow test is initiated by the bedside nurse, and if the patient demonstrates dysphagia, they are maintained on strict nothing by mouth (NPO) followed by a speech and language pathologist (SLP) referral for an appropriate modified diet recommendation. Aspiration prevention techniques included the avoidance of straws, 45-degree positioning, no talking during meals, taking small bites, placement of the aspiration wrist band, and consuming meals out of the bed in a chair. Nursing education was conducted with a newly created online learning module about aspiration pneumonia. The authors identified 979 patients, with an average age of 73.5 years old, who were diagnosed with aspiration pneumonia on the index hospitalization. These patients were reviewed for a 30-day readmission for aspiration pneumonia or stable sepsis, and mortality rates from January 2021 to December 2022 at Overlook Medical Center (OMC). The 30-day readmission rates were significantly lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011). When evaluating the mortality rates in the pre and post intervention cohort the authors discovered the mortality rates were lower in the post intervention cohort (23.7% vs 22.4%, p = 0.61) Mortality among non-white (self-reported as non-white) patients were lower in the post intervention cohort (34.4% vs. 21.0% , p = 0.05). Patients who reported as a current smoker/vaper in the pre and post cohorts had increased mortality rates (5.9% vs 22%). There was a decrease in mortality for the male population but an increase in mortality for women in the pre and post cohorts (19% vs. 25%). The authors attributed this increase in mortality in the post intervention cohort to more active smokers, more former smokers, and more being admitted from a SNF. This research identified that implementation of an Aspiration Pneumonia Clinical Care Pathway showed a statistically significant decrease in readmission rates and mortality rates in non-whites. The 30-day readmission rates were lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011).

Keywords: aspiration pneumonia, mortality, quality improvement, 30-day pneumonia readmissions

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Authors: Chris Cadman, Marcel Strauss

Abstract:

Background: In 2020, the University Hospital Wishaw in the United Kingdom became the centre for trauma and orthopaedics within its health board. This resulted in the majority of patients with suspected cauda equina syndrome (CES) being assessed and imaged at this site, putting an increased demand on MR imaging and displacing other previous activity. Following this transition, imaging requests for CES did not always follow national guidelines and would often be missing important clinical and safety information. There also appeared to be a very low positive scan rate compared with previously reported studies. In an attempt to improve patient selection and reduce the burden of CES imaging at this site clinical audit was performed. Methods: A total of 250 consecutive patients imaged to assess for CES were evaluated. Patients had to have presented to either the emergency or orthopaedic department acutely with a presenting complaint of suspected CES. Patients were excluded if they were not admitted acutely or were assessed by other clinical specialities. In total, 233 patients were included. Requests were assessed for appropriate clinical history, accurate and complete clinical assessment and MRI safety information. Clinical assessment was allocated a score of 1-6 based on information relating to history of pain, level of pain, dermatomes/myotomes affected, peri-anal paraesthesia/anaesthesia, anal tone and post-void bladder volume with each element scoring one point. Images were assessed for positive findings of CES, acquired spinal stenosis or nerve root compression. Results: Overall, 73% of requests had a clear clinical history of CES. The urgency of the request for imaging was given in 23% of cases. The mean clinical assessment score was 3.7 out of a total of 6. Overall, 2% of scans were positive for CES, 29% had acquired spinal stenosis and 30% had nerve root compression. For patients with CES, 75% had acute neurological signs compared with 68% of the study population. CES patients had a mean clinical history score of 5.3 compared with 3.7 for the study population. Overall, 95% of requests had appropriate MRI safety information. Discussion: it study included 233 patients who underwent specialist assessment and referral for MR imaging for suspected CES. Despite the serious nature of this condition, a large proportion of imaging requests did not have a clear clinical query of CES and the level of urgency was not given, which could potentially lead to a delay in imaging and treatment. Clinical examination was often also incomplete, which can make triaging of patients presenting with similar symptoms challenging. The positive rate for CES was only 2%, much below other studies which had positive rates of 6–40% with a large meta-analysis finding a mean positive rate of 19%. These findings demonstrate an opportunity to improve the quality of imaging requests for suspected CES. This may help to improve patient selection for imaging and result in a positive rate for CES imaging that is more in line with other centres.

Keywords: cauda equina syndrome, acute back pain, MRI, spine

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Authors: Smita Lakhotia, C. Kew, S. H. M. Siraj, B. Chern

Abstract:

Up to 50% of those with endometriosis may suffer from infertility due to either distorted pelvic anatomy/impaired oocyte release or inhibit ovum pickup and transport, altered peritoneal function, endocrine and anovulatory disorders, including LUF, impaired implantation, progesterone resistance or decreased levels of cellular immunity. The dilemma continues as to whether the surgery or IVF is the optimal management for such recurrent endometriomas. The core question is whether surgery adds anything of value for infertile women with recurrent endometriosis or not. Complete and detailed information on risks and benefits of treatment alternatives must be offered to patients, giving a realistic estimate of chances of success of repetitive surgery and of multiple IVF cycles in order to allow unbiased choices between different possible optionsAn individualized treatment plan should be developed taking into account patient age, duration of infertility, previous pregnancies and specific clinical conditions and wish.

Keywords: recurrent endometriosis, infertility, oocyte release, pregnancy

Procedia PDF Downloads 244

Authors: Soodabeh Dehghan, Siavash Hamidzadeh, Naqshbandi Seyyed Salahedin, Ali Mohammad Safania

Abstract:

The present research with the aim of the relationship between organizational silence and organizational voice with quality of work-life among employees of the sport and youth departments of Tehran Province was done. The statistical population of this research includes all employees of the sport and youth departments of Tehran province, and considering the not very large number of society, the sample and society were considered to be the same, and the sample was considered as the whole number. To measure each of these variables, a questionnaire was used. The research questionnaire was presented in four sections. The results showed that, since the extension of the process of organizational silence is usually done by managers, their attitude and attitudes toward this phenomenon are prioritized and also because silence reduces learning due to lack of knowledge sharing, makes it less effective and makes changes more difficult, it is necessary to take steps to break the silence and to further urge the staff (employees) to express their beliefs (organizational voices) and to share them in the organization's fate individuals, whose beliefs are respected and so called taken into account in the organization, would be dependent on the organization and feel obliged to remain with the organization during the hardships. This affects employees' quality of work life and their satisfaction too much.

Keywords: organizational silence, organizational voice, quality of work life, the sports and youth departments of Tehran province

Procedia PDF Downloads 147