Search results for: Rexa Pasha
18 Relationship between Depression, Stress, and Life Satisfaction among Students
Authors: Rexa Pasha
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The aim of this study was to examine the relationship between depression, stress and life satisfaction with sleep disturbance among Islamic Azad University Ahvaz Branch students. Samples in the study included 230 students who were selected by stratified random sampling. For data collection, the Beck Depression Inventory, stress, life satisfaction and quality of sleep (PSQI) was used. Which all have acceptable reliability and validity. This study was correlation and Data analysis using Pearson correlation and multivariate regression significance level (p17 A New Source on Ottoman Self-Narratives: Kulakzade Mahmud Pasha’s Dream Diary
Authors: Semra Çörekçi̇
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In this study, a new source on Ottoman Self-narratives, Kulakzâde Mahmud Paşa’s Düşname (Dreambook), will be introduced to illustrate how dreams can provide a ground for historical analysis. The manuscript looks like a private notebook of an Ottoman official, Mahmud Pasha, who lived and operated in Rumelia in the early eighteenth century. It provides insight into the ordinary and daily concerns of a bureaucrat who had the knowledge and tools to record them in writing. On the one side of the notebook, Mahmud Pasha recorded his travels and appointments in 1730-1731. He wrote places that he reached and stayed every day. On the reverse side, the same author kept a record of his dreams and named that part of his notebook, Düşname. He recorded his dreams on a daily basis in writing and therefore they were well-preserved in a dream diary. This study aims at drawing the social, cultural and psychic life of an early modern Ottoman bureaucrat. It will uncover the ways and means whereby he interpreted his environment, as well as how he made meaning of his dreams considering the social milieu and historical context within which he lived. The first part will focus on 'official dreams' uncovering how his official life and ambitions coincide with his spiritual life. Related to this, connection between anxiety and dream narratives will be evaluated as dreams in which the mundane concerns of securing a post occupied the most central place in the construction of his narrative. A further point will be made by questioning Mahmud Pasha’s possible Sufi connections and his familiarity with the tradition of dream interpretation. Also, considering Mahmud Pasha’s inclusion of other’s dreams in his Düşnâme, the issue of dream-telling will be questioned in order to reveal how dreams were interconnected and how they created a space for social gathering.Keywords: Ottoman self-narratives, dreams, diary, Ottoman cultural history
Procedia PDF Downloads 25016 An Analysis of Methodological Approaches of Ahmed Cevdet and Fatma Aliye towards the Ottoman Historiography in a Comparative Context
Authors: Aysen Muderrisoglu Esiner
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As an intellectual, scholar, bureaucrat, and statesman, Ahmed Cevdet Pasha (1822-1895) was the prominent figure of “Tanzimat” (reorganization) reforms of the Ottoman State while his daughter Fatma Aliye (1862-1936) was a novelist, columnist, essayist, and women’s rights activist. His father had numerous books on law, grammar, linguistics, logic, and astronomy, moreover, Aliye accepted as the first female novelist in the Turkish literature and the Islamic world. Even if she was better known as a novelist, she also published some works on philosophy, Islam, poetry. In addition, Aliye who was one of the pioneers of the Ottoman women’s movement, also wrote historical works. Her historical works which titled as Tarih-i Osmaninin Bir Devre-i Mühimmesi Kosova Zaferi-Ankara Hezimeti (An Important Era of the Ottoman History: Kosova Victory-Ankara Defeat), and Ahmed Cevdet Paşa ve Zamanı (Ahmed Cevdet Pasha and His Time) have been generally ignored in the literature. However, Aliye’s works in history field are worth being studied in terms of her methodological approach to the Ottoman historiography. On the other hand, written by Ahmed Cevdet Pasha, such as Tarih-i Cevdet (History of Cevdet), Tezâkir (Memoir), Mâruzat (Reports, the events that took place between 1839-1876, 1890), Kısas-ı Enbiya ve Tevârîh-i Hulefa (Retaliation of the Prophets and the History of Calips), Kırım ve Kafkas Tarihçesi (Crimean and Caucasian History) are the most important works in terms of historiography in the 19th century. In contrast to the traditional methodology, Cevdet Pasha brought a new understanding to the Ottoman historiography by making a synthesis between the traditional and modern methods. In this research, the historical works of these two prominent figures of the Ottoman State will be analyzed in terms of their approaches to the Ottoman historiography while evaluating the following questions: to what extent that their use of local and foreign historical sources and their handling of the historical events differ, or if it is possible to talk about a methodological similarities in terms of historiography.Keywords: Ahmed Cevdet Pasha, Fatma Aliye, historiography, methodology
Procedia PDF Downloads 25715 Construction of India’s Largest Blast Furnace (4554 cum) Foundation at JSPL, Angul, Odisha: A Qualitative Approach
Authors: N. S. S. Rao, Tapan Kumar Das, Latiful Pasha
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Tata Projects Limited (TPL) located in Hyderabad, India has taken up the challenging venture of executing the entire civil works for India’s largest Blast Furnace with a capacity of 4554 cum at Jindal Steel and Power Limited (JSPL), Angul, Odisha, India. The following write-up briefly elaborates the various steps and methodologies involved in the construction of the foundation for this India’s largest blast furnace.Keywords: blast furnace, construction, qualitative, approach
Procedia PDF Downloads 57214 Spectrophotometric Determination of 5-Aminosalicylic Acid in Pharmaceutical Samples
Authors: Chand Pasha
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A Simple, accurate and precise spectrophotometric method for the quantitative analysis of determination of 5-aminosalicylic acid is described. This method is based on the reaction of 5-aminosalicylic acid with nitrite in acid medium to form diazonium ion, which is coupled with acetylacetone in basic medium to form azo dyes, which shows absorption maxima at 470 nm. The method obeys Beer’s law in the concentration range of 0.5-11.2 gml-1 of 5-aminosalicylic acid with acetylacetone. The molar absorptivity and Sandell’s sensitivity of 5-aminosalicylic acid -acetylacetone azo dye is 2.672 ×104 lmol-1cm-1, 5.731 × 10-3 gcm-2 respectively. The dye formed is stable for 10 hrs. The optimum reaction conditions and other analytical parameters are evaluated. Interference due to foreign organic compounds have been investigated. The method has been successfully applied to the determination of 5-aminosalicylic acid in pharmaceutical samples.Keywords: spectrophotometry, diazotization, mesalazine, nitrite, acetylacetone
Procedia PDF Downloads 18913 A Spectrophotometric Method for the Determination of Folic Acid - A Vitamin B9 in Pharmaceutical Dosage Samples
Authors: Chand Pasha, Yasser Turki Alharbi, Krasamira Stancheva
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A simple spectrophotometric method for the determination of folic acid in pharmaceutical dosage samples was developed. The method is based on the diazotization reaction of thiourea with sodium nitrite in acidic medium yields diazonium compounds, which is then coupled with folic acid in basic medium yields yellow coloured azo dyes. Beer’s Lamberts law is observed in the range 0.5 – 16.2 μgmL-1 at a maximum wavelength of 416nm. The molar absorbtivity, sandells sensitivity, linear regression equation and detection limit and quantitation limit were found to be 5.695×104 L mol-1cm-1, 7.752×10-3 g cm-2, y= 0.092x - 0.018, 0.687 g mL-1 and 2.083 g mL-1. This method successfully determined Folate in Pharmaceutical formulations.Keywords: folic acid determination, spectrophotometry, diazotization, thiourea, pharmaceutical dosage samples
Procedia PDF Downloads 7612 Stability of Canola Varieties for Oil Percent in Four Regions of Iran
Authors: Seyed Mohammad Nasir Mousavi, Amir Mashayekh, Pasha Hejazi, Sanaz Kanani Zadeh Khalkhali
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To determine the stability of the oil percent canola varieties, an experiment was done in a randomized complete block design with four replications in four research stations of the country Shahrood, Esfahan, Kermanshah, Varamin. Analysis of variance showed that there is cultivars considerable variability in the percentage of oil. The results showed that the coefficient of variation of oil Hyola 401 and Hyola308 stability and flexibility are high. Cultivars Cooper and Likord are minimum variance Shukla that stable for the percentage of oil Based on the chart AMMI 1, cultivars Zarfam and Hyola 401 are of oil percentage than other varieties had higher stability. On the chart AMMI2, cultivars Karun and Hyola 308 are identified as stable, also location Isfahan is stableKeywords: canola, stability, AMMI, variance Shukla
Procedia PDF Downloads 37811 The Study of the Mutual Effect of Genotype in Environment by Percent of Oil Criterion in Sunflower
Authors: Seyed Mohammad Nasir Mousavi, Pasha Hejazi, Maryam Ebrahimian Dehkordi
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In order to study the Mutual effect of genotype × environment for the percent of oil index in sunflower items, an experiment was accomplished in form of complete random block designs in four iteration in four diverse researching station comprising Esfahan, Birjand, Sari, and Karaj. Complex variance analysis showed that there is an important diversity between the items under investigation. The results pertaining the coefficient variation of items Azargol and Vidoc has respectively allocated the minimum coefficient of variations. According to the results extrapolated from Shokla stability variance, the Items Brocar, Allison and Fabiola, are among the stable genotypes for oil percent respectively. in the biplot GGE, the location under investigations divided in two super-environment, first one comprised of locations naming Esfahan, Karaj, and Birjand, and second one were such a location as Sari. By this point of view, in the first super-environment, the Item Fabiola and in the second Almanzor item was among the best items and crops.Keywords: sunflower, stability, GGE bipilot, super-environment
Procedia PDF Downloads 54610 The Effect of Volume Fraction of Nano-Alumina Strengthening on AC4B Composite Characteristics through the Stir Casting Method as a Material Brake Shoe
Authors: Benny Alexander, Ikhlashia N. Fadhilah, Muhammad R. Pasha, Michelle Julia, Anne Z. Syahrial
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Brake shoe is a component that serves to reduce speed or stop the train's speed by utilizing the friction force. Generally, the material used as a brake shoe is cast iron, where cast iron itself is a heavy, expensive, and easily worn material. Aluminum matrix composites are one of candidates for the cast iron replacement material as the basic material for brake shoe. The matrix in the composite used is Aluminum AC4B. Reinforcement used in aluminum matrix composites is nano-alumina, where the use of nano-alumina of 0.25%, 0.3%, 0.35%, 0.4%, and 0.5% volume fraction will be tested. The sample is made using the stir casting method; then, it will be tested mechanically. The use of nano-alumina as a reinforcement will increase the strength of the matrix. SEM (scanning electron microscopy) testing is used to test the distribution of reinforcing particles due to stirring. Therefore, the addition of nano-alumina will improve AC4B aluminum matrix composites.Keywords: aluminium matrix composites, brake shoe application, stir casting, nano-alumina
Procedia PDF Downloads 1329 Vehicular Speed Detection Camera System Using Video Stream
Authors: C. A. Anser Pasha
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In this paper, a new Vehicular Speed Detection Camera System that is applicable as an alternative to traditional radars with the same accuracy or even better is presented. The real-time measurement and analysis of various traffic parameters such as speed and number of vehicles are increasingly required in traffic control and management. Image processing techniques are now considered as an attractive and flexible method for automatic analysis and data collections in traffic engineering. Various algorithms based on image processing techniques have been applied to detect multiple vehicles and track them. The SDCS processes can be divided into three successive phases; the first phase is Objects detection phase, which uses a hybrid algorithm based on combining an adaptive background subtraction technique with a three-frame differencing algorithm which ratifies the major drawback of using only adaptive background subtraction. The second phase is Objects tracking, which consists of three successive operations - object segmentation, object labeling, and object center extraction. Objects tracking operation takes into consideration the different possible scenarios of the moving object like simple tracking, the object has left the scene, the object has entered the scene, object crossed by another object, and object leaves and another one enters the scene. The third phase is speed calculation phase, which is calculated from the number of frames consumed by the object to pass by the scene.Keywords: radar, image processing, detection, tracking, segmentation
Procedia PDF Downloads 4678 Learning Outcomes Alignment across Engineering Core Courses
Authors: A. Bouabid, B. Bielenberg, S. Ainane, N. Pasha
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In this paper, a team of faculty members of the Petroleum Institute in Abu Dhabi, UAE representing six different courses across General Engineering (ENGR), Communication (COMM), and Design (STPS) worked together to establish a clear developmental progression of learning outcomes and performance indicators for targeted knowledge, areas of competency, and skills for the first three semesters of the Bachelor of Sciences in Engineering curriculum. The sequences of courses studied in this project were ENGR/COMM, COMM/STPS, and ENGR/STPS. For each course’s nine areas of knowledge, competency, and skills, the research team reviewed the existing learning outcomes and related performance indicators with a focus on identifying linkages across disciplines as well as within the courses of a discipline. The team reviewed existing performance indicators for developmental progression from semester to semester for same discipline related courses (vertical alignment) and for different discipline courses within the same semester (horizontal alignment). The results of this work have led to recommendations for modifications of the initial indicators when incoherence was identified, and/or for new indicators based on best practices (identified through literature searches) when gaps were identified. It also led to recommendations for modifications of the level of emphasis within each course to ensure developmental progression. The exercise has led to a revised Sequence Performance Indicator Mapping for the knowledge, skills, and competencies across the six core courses.Keywords: curriculum alignment, horizontal and vertical progression, performance indicators, skill level
Procedia PDF Downloads 2227 Population Structure Analysis of Pakistani Indigenous Cattle Population by Using High Density SNP Array
Authors: Hamid Mustafa, Huson J. Heather, Kim Eiusoo, McClure Matt, Khalid Javed, Talat Nasser Pasha, Afzal Ali1, Adeela Ajmal, Tad Sonstegard
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Genetic differences associated with speciation, breed formation or local adaptation can help to preserve and effective utilization of animals in selection programs. Analyses of population structure and breed diversity have provided insight into the origin and evolution of cattle. In this study, we used a high-density panel of SNP markers to examine population structure and diversity among ten Pakistani indigenous cattle breeds. In total, 25 individuals from three cattle populations, including Achi (n=08), Bhagnari (n=04) and Cholistani (n=13) were genotyped for 777, 962 single nucleotide polymorphism (SNP) markers. Population structure was examined using the linkage model in the program STRUCTURE. After characterizing SNP polymorphism in the different populations, we performed a detailed analysis of genetic structure at both the individual and population levels. The whole-genome SNP panel identified several levels of population substructure in the set of examined cattle breeds. We further searched for spatial patterns of genetic diversity among these breeds under the recently developed spatial principal component analysis framework. Overall, such high throughput genotyping data confirmed a clear partitioning of the cattle genetic diversity into distinct breeds. The resulting complex historical origins associated with both natural and artificial selection have led to the differentiation of numerous different cattle breeds displaying a broad phenotypic variety over a short period of time.Keywords: Pakistan, cattle, genetic diversity, population structure
Procedia PDF Downloads 6206 Effect of Multi-Enzyme Supplementation on Growth Performance of Broiler
Authors: Abdur Rahman, Saima, T. N. Pasha, Muhammad Younus, Yassar Abbas, Shahid Jaleel
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Non-starch polysaccharides (NSPs) are not completely digested by broiler endogenous enzymes and consequently the soluble NSPs in feed results in high digesta viscosity and poor retention of nutrients. Supplementation of NSPs digesting enzymes may release the nutrients from feed and reduce the anti-nutritional effects of NSP’s. The present study was conducted to determine the effects of NSPs digesting enzymes (Zympex) in broiler chicks. A total of 120 day old broiler chicks (Hubbard) were categorized into 3 treatments and each treatment was having four replicates with 10 birds in each. Dietary treatments comprised of Basal diet (2740 KCal/Kg) as control-1 (T1), low energy diet (2630 KCal/kg) control-2 (T2) and low energy diet with 0.5 gm/Kg enzyme as T3. Multi-enzymes supplementation showed significant (P < 0.05) positive effect on weight gain (last three weeks), feed intake (last two weeks), FCR (1st, 2nd, 4th and 5th) and nutrient retention in T3 when compared with control-2. Weight gain was lower (P < 0.05) in low caloric feed group C when compared with control-1 in all weeks except last week (P > 0.05), feed consumption was significantly lower (P < 0.05) in 5th week and results showed significantly poor FCR (P < 0.05) in 2nd, 3rd and 4th week but non-significant effect in 1st and 5th week when compared with control-1 group, which revealed the positive effect of enzyme supplementation in low energy diet. These results revealed that enzyme supplementation releases more energy from low energy diets and results in equal performance to normal diet.Keywords: body weight, FCR, feed intake, enzyme, non-starch polysaccharides
Procedia PDF Downloads 3495 Preparation and Optimization of Curcumin-HPβCD Complex Bioadhesive Vaginal Films for Vaginal Candidiasis by Factorial Design
Authors: Umme Hani, H. G. Shivakumar, M. D. Younus Pasha
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The purpose of this work was to design and optimize a novel vaginal drug delivery system for more effective treatment against vaginal candidiasis. To achieve a better therapeutic efficacy and patient compliance in the treatment for vaginal candidiasis, herbal antifungal agent Curcumin which is 2.5 fold more potent than fluconazole at inhibiting the adhesion of candida albicans has been formulated in a bio-adhesive vaginal film. Curcumin was formulated in bio-adhesive film formulations that could be retained in the vagina for prolonged intervals. The polymeric films were prepared by solvent evaporation and optimized for various physicodynamic and aesthetic properties. Curcumin HPβCD (Hydroxypropyl β Cyclodextrin) was first developed to increase the solubility of curcumin. The formation of the Curcumin HPβCD complex was characterized by scanning electron microscopy (SEM), differential scanning calorimetry (DSC), and FT-IR and evaluated for its solubility. Curcumin HPβCD complex was formulated in a bio-adhesive film using hydroxypropyl methyl cellulose (HPMC) and Carbopol 934P and characterized. DSC and FT-IR data of Curcumin HPβCD indicate there was complex formation between the drug and HPβCD. The little moisture content (8.02±0.34% w/w) was present in the film, which helps them to remain stable and kept them from being completely dry and brittle. The mechanical properties, tensile strength, and percentage elongation at break reveal that the formulations were found to be soft and tough. The films showed good peelability, relatively good swelling index, and moderate tensile strength and retained vaginal mucosa up to 8 h. The developed Curcumin vaginal film could be a promising safe herbal medication and can ensure longer residence at the vagina and provide an efficient therapy for vaginal candidiasis.Keywords: curcumin, curcumin-HPβCD complex, bio-adhesive vaginal film, vaginal candidiasis, 23 factorial design
Procedia PDF Downloads 3824 Impact of Non-Starch Polysaccharides on Sensorial Characteristics and Textural Properties of Bread
Authors: Farhan Saeed, Imran Pasha, Faqir M. Anjum, Muhammad U. Arshad
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Introduction: Cereals especially wheat is one example in this respite as it contains several nutrients and phytochemicals. In this regard, presences of non-starch polysaccharides are of significance value e.g. arabinoxylans (AX) and arabinogalactans (AG). These ingredients possess several functional and nutritional properties and in this project, efforts were directed to extract AX and AG from different spring wheat varieties of Pakistan and subsequent utilization in cereal based baked products. Methodology: In the present study, effort was made to characterize eight different spring wheats e.g. Lasani-08, FSD-08, Mairaj-08, Shafaq-06, Sehar-06, Bhakkar-02, Uqab-2000 and Inqalab-91 with special reference to non-starch polysaccharides (arabinoxylans and arabinogalactans) extraction followed by their utilization in baked products. Major Findings of Study: Results showed that the arabinoxylans and arabinogalactans content in whole wheat flour of different wheat varieties ranged from 2.93 to 4.68% and 0.47 to 0.93%, respectively while in bran, they ranged from 11.71 to 18.38% and 1.07-4.43%, respectively. Phenolic compounds i.e. ferulic acid, p-coumaric acids were 1.12 and 19.6mg/100g, respectively. Owing to presence of these phenolic compounds, it has persuasive antioxidant potential. Arabinoxylan has negative impact on gluten quality as reduced gluten strength was observed while significant results were obtained for rheological characteristic. Moreover, adding Arabinoxylan and arabinogalactan in bread formulation resulted in significant increase in volume and texture of the final product. In addition, the hardness of bread lessened considerably due to the increase in the concentration of arabinoxylan and arabinogalactan. Additionally, fracturability of bread improved as the both non-starch polysaccharides levels increased. The highest gumminess value was given to Shafaq-06 with increasing trend from control to 0.5% arabinoxylan. Whilst with the addition of arabinogalactan, the highest bread gumminess value (155.74 ± 6.1, 156.32 ± 7.9) was also observed in Shafaq-06. Concluding Statement: Conclusively, it may be inferred that non-starch polysaccharides hold potential to be extracted and utilized in cereal based products for best quality and value addition.Keywords: non-starch polysaccharides, arabinoxylan, arabinogalactan, bread
Procedia PDF Downloads 2233 Association of Post-Traumatic Stress Disorder with Work Performance amongst Emergency Medical Service Personnel, Karachi, Pakistan
Authors: Salima Kerai, Muhammad Islam, Uzma Khan, Nargis Asad, Junaid Razzak, Omrana Pasha
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Background: Pre-hospital care providers are exposed to various kinds of stressors. Their daily exposure to diverse critical and traumatic incidents can lead to stress reactions like Post-Traumatic Stress Disorder (PTSD). Consequences of PTSD in terms of work loss can be catastrophic because of its compound effect on families, which affect them economically, socially and emotionally. Therefore, it is critical to assess the association between PTSD and Work performance in Emergency Medical Service (EMS) if exist any. Methods: This prospective observational study was carried out at AMAN EMS in Karachi, Pakistan. EMS personnel were screened for potential PTSD using impact of event scale-revised (IES-R). Work performance was assessed on basis of five variables; number of late arrivals to work, number of days absent, number of days sick, adherence to protocol and patient satisfaction survey over the period of 3 months. In order to model outcomes like number of late arrivals to work, days absent and days late; negative binomial regression was used whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores. Results: Out of 536 EMS personnel, 525 were found to be eligible, of them 518 consented. However data on 507 were included because 7 left the job during study period. The mean score of PTSD was found to be 24.0 ± 12.2. However, weak and insignificant association was found between PTSD and work performance measures: number of late arrivals (RRadj 0.99; 95% CI 0.98-1.00), days absent (RRadj 0.98; 95% CI 0.96-0.99), days sick (Rradj 0.99; 95% CI 0.98 to 1.00), adherence to protocol (ORadj 1.01: 95% CI 0.99 to 1.04) and patient satisfaction (0.001% score; 95% CI -0.03% to 0.03%). Conclusion: No association was found between PTSD and Work performance in the selected EMS population in Karachi Pakistan. Further studies are needed to explore the phenomenon of resiliency in these populations. Moreover, qualitative work is required to explore perceptions and feelings like willingness to go to work, readiness to carry out job responsibilities.Keywords: trauma, emergency medical service, stress, pakistan
Procedia PDF Downloads 3372 University Students’ Perception on Public Transit in Dhaka City
Authors: Mosabbir Pasha, Ijaj Mahmud Chowdhury, M. A. Afrahim Bhuiyann
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With the increasing population and intensive land use, huge traffic demand is generating worldwide both in developing and developed countries. As a developing country, Bangladesh is also facing the same problem in recent years by producing huge numbers of daily trips. As a matter of fact, extensive traffic demand is increasing day by day. Also, transport system in Dhaka is heterogeneous, reflecting the heterogeneity in the socio-economic and land use patterns. As a matter of fact, trips produced here are for different purposes such as work, business, educational etc. Due to the significant concentration of educational institutions a large share of the trips are generated by educational purpose. And one of the major percentages of educational trips is produced by university going students and most of them are travelled by car, bus, train, taxi, rickshaw etc. The aim of the study was to find out the university students’ perception on public transit ridership. A survey was conducted among 330 students from eight different universities. It was found out that 26% of the trips produced by university going students are travelled by public bus service and only 5% are by train. Percentage of car share is 16% and 12% of the trips are travelled by private taxi. From the study, it has been found that more than 42 percent student’s family resides outside of Dhaka, eventually they prefer bus instead of other options. Again those who chose to walk most of the time, of them, over 40 percent students’ family reside outside of Dhaka and of them over 85 percent students have a tendency to live in a mess. They generally choose a neighboring location to their respective university so that they can reach their destination by walk. On the other hand, those who travel by car 80 percent of their family reside inside Dhaka. The study also revealed that the most important reason that restricts students not to use public transit is poor service. Negative attitudes such as discomfort, uneasiness in using public transit also reduces the usage of public transit. The poor waiting area is another major cause of not using public transit. Insufficient security also plays a significant role in not using public transit. On the contrary, the fare is not a problem for students those who use public transit as a mode of transportation. Students also think stations are not far away from their home or institution and they do not need to wait long for the buses or trains. It was also found accessibility to public transit is moderate.Keywords: traffic demand, fare, poor service, public transit ridership
Procedia PDF Downloads 2681 Risk Factors Associated with Increased Emergency Department Visits and Hospital Admissions Among Child and Adolescent Patients
Authors: Lalanthica Yogendran, Manassa Hany, Saira Pasha, Benjamin Chaucer, Simarpreet Kaur, Christopher Janusz
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Children and adolescent patients visit the Psychiatric Emergency Department (ED) for multiple reasons. Visiting the Psychiatric ED itself can be a traumatic experience that can affect an adolescents mental well-being, regardless of a history of mental illness. Despite this, limited research exists in this domain. Prospective studies have correlated adverse psychosocial determinants among adolescents to risk factors for poor well-being and unfavorable behavior outcomes. Studies have also shown that physiological stress is a contributor in the development of health problems and an increase in substance abuse in adolescents. This study aimed to retrospectively determine which psychosocial factors are associated with an increase in psychiatric ED visits. 600 charts of patients who had a psychiatric ED and inpatient admission visit from January 2014 through December 2014 were reviewed. Sociodemographics, diagnoses, ED visits and inpatient admissions were collected. Descriptive statistics, chi-square tests and independent t-test analyses were utilized to examine differences in the sample to determine which factors affected ED visits and admissions. The sample was 50% female, 35.2% self-identified black, and had a mean age of 13 years. The majority, 85%, went to public school and 17% were in special education. Attention Deficit Hyperactivity Disorder was the most common admitting diagnosis, found in 132(23%) responders. Most patients came from single parent household 305 (53%). The mean ages of patients that were sexually active, with legal issues, and reporting marijuana substance abuse were 15, 14.35, and 15 years respectively. Patients from two biological parent households had significantly fewer ED visits (1.2 vs. 1.7, p < 0.01) and admissions (0.09 vs. 0.26, p < 0.01). Among social factors, those who reported sexual, physical or emotional abuse had a significantly greater number of ED visits (2.1 vs. 1.5, p < 0.01) and admissions (0.61 vs. 0.14, p < 0.01) than those who did not. Patients that were sexually active or had legal issues or substance abuse with marijuana had a significantly greater number of admissions (0.43 vs. 0.17, p < 0.01), (0.54 vs. .18, p < 0.01) and (0.46 vs. 0.18, p < 0.01) respectively. This data supports the theory of the stability of a two parent home. Dual parenting plays a role in creating a safe space where a child can develop; this is shown by subsequent decreases in psychiatric ED visits and admissions. This may highlight the psychological protective role of a two parent household. Abuse can exacerbate existing psychiatric illness or initiate the onset of new disease. Substance abuse and legal issues result in early induction to the criminal system. Results show that this causes an increase in frequency of visits and severity of symptoms. Only marijuana, but not other illicit substances, correlated with higher incidence of psychiatric ED visits. This may speak to the psychotropic nature of tetrahydrocannabinols and their role in mental illness. This study demonstrates the array of psychosocial factors that lead to increased ED visits and admissions in children and adolescents.Keywords: adolescent, child psychiatry, emergency department, substance abuse
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