Search results for: intensive and comprehensive

Authors: Zhenhua Wei, Gabriel Falzone, Bu Wang, Laurent Pilon, Gaurav Sant

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The production of ordinary Portland cement (OPC) is a CO₂ intensive process. Specifically, cement clinkering reactions require not only substantial energy in the form of heat, but also result in the release of CO₂, from limestone decarbonation and the combustion of fuel. To overcome this CO₂ intensive process, clinkering-free cementation is demonstrated by the carbonation of fly ash; i.e., a by-product of coal combustion. It is shown that in moist environments and at sub-boiling temperatures, calcium-rich fly ashes readily react with gas-phase CO₂ to provide cementation. After seven days of CO₂ exposure at 75°C, such formulations achieve a compressive strength on the order of 35 MPa and take-up 9% CO₂ (by mass of the solid). On the other hand, calcium-deficient fly ashes, due to their lack of alkalinity (i.e., abundance of mobile Ca or Mg), show little if any potential for CO₂ uptake and strength gain. The role of the CO₂ concentration and processing temperature are discussed and linked to the progress of reactions, and the development of microstructure. The outcomes demonstrate a means for enabling clinkering-free cementation while enabling beneficial utilization of CO₂ and fly ash; i.e., two abundant but underutilized industrial by-products.

Keywords: fly ash, carbonation, concrete, strength

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Authors: Miseri Roeslan Afany, Nur Ainun Pulungan

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The unique characteristics of Andisol differentiate them from other soils. These characteristics become a guideline in determining management and usage with regards to agriculture. Especially in the tropical area, Andisols may have fast mineral alteration due to intensive water movement in the soils. Four soil chemical tests were conducted for evaluating soils in the study area. Al/Fe humus, allophane, pH, and P retention were used to differentiate Andisols under different practices. Non-cultivation practice (e.g. natural forest) and cultivation practices (e.g. horticulture systems and intensive farming systems) are compared in this study. We applied Blackmore method for P retention analysis. The aims of this study are: (i) to analyze the specific behavior of Al/Fe humus, pH, and allophane towards P retention in order (ii) to evaluate the effect of cultivation practices on their behavior changes among Andisols, and (iii) to gain the sustainable agriculture through proposing an appropriate soil managements in the study area. 5 observation sites were selected, and 75 soil sampling were analyzed in this study. The results show that the cultivation decreases P retention in all sampling sites. There is a declining from ±90% to ±50% of P retention in the natural forest where shifts into cultivated land. The average of P retention under 15 years of cultivation down into 63%, whereas, the average of P retention more than 15 years of cultivation down into 54%. Many factors affect the retention of P in the soil such as: (1) type and amount of clay, (2) allophone and/or imogolit, (3) Al/Fe humus, (4) soil pH, (5) type and amount of organic material, (6) Exchangeable bases (Ca, Mg, Na, K), (7) forms and solubility of Al/Fe. To achieve the sustainable agriculture in the study area, conventional agriculture practices should be preserved and intensive fertilizing practices should be applied in order to increase the soil pH, to maintain the organic matter of andisols, to maintain microba activities, and to release Al/Fe humus complex, and thus increase available P in the soils.

Keywords: Andisols, cultivation, P retention, sustainable agriculture

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Authors: Parastoo Ahmadpoor

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Textile waste has become a significant environmental concern in recent years due to its adverse effects on ecosystems and human health. This manuscript presents a comprehensive overview of textile waste management, focusing on sustainable solutions for minimizing waste generation, promoting recycling and upcycling, and adopting circular economy principles. The manuscript explores the challenges and opportunities in textile waste management and highlights the importance of collaboration between stakeholders to achieve a more sustainable and responsible textile industry.

Keywords: textile waste, waste management, recycling, upcycling, circular economy, sustainability, environmental impact

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Authors: Vahdetti̇n Sariyel, Bi̇rol Dağ

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In this research, growth and development parameters in Konya, a private company in Saanen kids reared in intensive conditions in the province were examined. Average birth weights were 3.42, 2.96, 3.57, 3.23 and 2.77 kg for male, female, single, twins and triplets kids. Average weaning weights (three months of age) were 12.65, 12.09, 12.80, 12.65 and 11.68 kg for male, female, single, twins and triplets kids. Average body weights at seven months of age were 20.55, 18.98, 20.12, 20.12 and 19.05 kg for male, female, single, twins and triplets kids respectively. Considering the gender of the live weight factors birth control and rule in favor of the first en ( P <0.01), the second control finally it disappeared statistically significant ( P> 0.05). Main age and the effect of birth weight in the first month, while significant (P < 0.01); The effect of the second month following the live weight of the kid was not significant.

Keywords: Saanen kids, growth, development, body weight

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Authors: Awa Diouf

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Since 2004, inputs specific to the agricultural sector have been exempt from VAT in Senegal. This paper measures, using the Naatal Mbay survey, the impact of this reform on agricultural productivity. The survey covers a sample of 3,122 rice, millet and maize farms for the 2016 crop year. The regressions show that tax incentives are ineffective in improving partial productivity of the land factor: the higher the share of the value of exemptions in the higher the production costs, the less productive the operation. The negative effect of the exemptions on productivity is accentuated for the most intensive agricultural area: the Senegal River Delta, and the most intensive crop: irrigated rice. This relationship could stem from a decrease in allocative efficiency: farmers have overinvested in the most accessible inputs. The loose budget constraint syndrome, therefore, explains this result: farmers who benefit more from exemptions reduce their managerial effort. The results suggest a removal of the VAT exemptions applied to finished products and agricultural inputs for a better efficiency of this tax, which typically taxes final consumption and should be neutral for the producer.

Keywords: agricultural productivity, agricultural taxation, Senegal, tax incentives

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Authors: Recep Kesli, Huseyin Bilgin, Ela Tasdogan, Ercan Kurtipek

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Aim: The aim of this study was to compare resin based Bactec plus aerobic/anaerobic blood culture bottles (Becton Dickinson, MD, USA) and polymeric beads based BacT/Alert FA/FN plus blood culture bottles (bioMerieux, NC, USA) in terms of microorganisms recovery rates and time to detection (TTD) in the patients receiving antibiotic treatment. Method: Blood culture samples were taken from the patients who admitted to the intensive care unit and received antibiotic treatment. Forty milliliters of blood from patients were equally distributed into four types of bottles: Bactec Plus aerobic, Bactec Plus anaerobic, BacT/Alert FA Plus, BacT/Alert FN Plus. Bactec Plus and BacT/Alert Plus media were compared to culture recovery rates and TTD. Results: Blood culture samples were collected from 382 patients hospitalized in the intensive care unit and 245 patients who were diagnosed as having bloodstream infections were included in the study. A total of 1528 Bactec Plus aerobic, Bactec Plus anaerobic, BacT/Alert FA Plus, BacT/Alert FN Plus blood culture bottles analyzed and 176, 144, 154, 126 bacteria or fungi were isolated, respectively. Gram-negative and gram-positive bacteria were significantly more frequently isolated in the resin-based Bactec Plus bottles than in the polymeric beads based BacT/Alert Plus bottles. The Bactec Plus and BacT/Alert Plus media recovery rates were similar for fungi and anaerobic bacteria. The mean TTDs in the Bactec Plus bottles were shorter than those in the BacT/Alert Plus bottles regardless of the microorganisms. Conclusion: The results of this study showed that resin-containing media is a reliable and time-saving tool for patients who are receiving antibiotic treatment due to sepsis in the intensive care unit.

Keywords: Bactec Plus, BacT/Alert Plus, blood culture, antibiotic

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Authors: Jully Handoko, B. Kuntoro, E. Saleh, Sadarman

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Most farmers in Bangkinang Seberang sub district raise Bali cattle in semi-intensive husbandry system. The farmers believe that raising such a way is economical and quite effective. The farmers do not need to provide forage and plant feed crops. Furthermore, the raising method is considered not to interfere with the main job. Screening for anemia in Bali cattle of Bangkinang Seberang subdistrict, Kampar regency, Riau, Indonesia, had been conducted. The aim of the study was to analyze hematological alterations in the anemic Bali cattle. A number of 75 Bali cattle were screened for anemia on the basis of Hemoglobin (Hb) concentration. The other hematological parameters that were measured including packed cell volume (PCV), total erythrocyte count (TEC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). The screening showed that 18 (24.00%) of Bali cattle were anemic. Levels of Hb, PCV, TEC, MCV, MCH and MCHC in anemic Bali cattle were 7.15±1.61 g/dl, 21.15±4.16%, 3.72±1.10x106/µl, 52.75±4.13 fl, 17.31±1.86 pg and 32.77±1.69 g/dl respectively. Hematological values of Hb, PCV, TEC, MCV, MCH and MCHC were significantly (p < 0.05) lower in anemic Bali cattle compared to non-anemic Bali cattle.

Keywords: anemia, Bali cattle, alterations, hematology

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Authors: Leandra Prempeh, Emily Malugen

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Prenatal drug exposure can have a molecular impact on the hypothalamic and reward genes that regulate feeding behavior. This can impact feeding regulation, resulting in feeding difficulties and growth failure. This was potentially seen in “McKayla,” a 19- month old girl with a history of in-utero drug exposure, patent ductus arteriosus, and gastroesophageal reflux disease who presented for intensive day treatment feeding therapy. She was diagnosed with Avoidant Restrictive Food Intake Disorder, described as total food refusal and meeting 100% of her caloric needs from a gastrostomy tube. The primary goals during intensive feeding therapy were to increase her oral intake and decrease her reliance on supplementation with formula. Several behavioral antecedent manipulations were implemented to establish consistent responding and make progress towards treatment goals. This included multiple modified bolus placements (using underloaded and Nuk brush), reinforcement contingencies, and variety fading before stability was finally achieved. Following, increasing retention of bites then increasing volume and variety were goals targeted. From treatment onset to the last 3 days of treatment, McKayla's rate of rapid acceptance of bite presentations increased significantly from 33.33% to 93.13%, rapid swallowing went from 0.00% to 92.32%, and her percentage of inappropriate mealtime behavior and expels decreased from 58.33% and 100% to 2.31% and 7.68%, respectively. Overall, the treatment team successfully introduced and increased the bite size of 7 pureed foods, generalize the treatment to caregivers with high integrity, and began facilitating tube weaning. She was receiving about 33.42% of her needs by mouth at the time of discharge. Other nutritional concerns addressed during treatment included drinking a nutritionally complete drink out of an open cup and age appropriate growth. McKayla continued to have emesis almost daily, as was her baseline before starting treatment; however, the frequency during mealtime decreased. Overall, McKayla responded well to treatment. She had a very slow response to treatment and required a lot of antecedent manipulations to establish consistent responding. As the literature suggests, [drug]-exposed neonates, like McKayla, may be at increased risk for nutritional and growth challenges that may persist throughout development. This supports the need for longterm follow-up of infant growth.

Keywords: behavioral intervention, feeding problems, in-utero drug exposure, intensive multidisciplinary intervention

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Authors: M. Deligianni, P. Voultsos, E. Tsamadou

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Background/Introduction: Moral distress is a common occurrence for health professionals working in neonatal critical care. Despite a growing number of critically ill neonatal and pediatric patients, only a few articles related to moral distress as experienced by neonatal physicians have been published over the last years. Objectives/Aims: The aim of this study was to define and identify barriers to and facilitators of moral distress based on the perceptions and experiences of neonatal physicians working in neonatal intensive care units (NICUs). This pilot study is a part of a larger nationwide project. Methods: A multicenter qualitative descriptive study using focus group methodology was conducted. In-depth interviews lasting 45 to 60 minutes were audio-recorded. Once data were transcribed, conventional content analysis was used to develop the definition and categories, as well as to identify the barriers to and facilitators of moral distress. Results: Participants defined moral distress broadly in the context of neonatal critical care. A wide variation of definitions was displayed. The physicians' responses to moral distress included different feelings and other situations. The overarching categories that emerged from the data were patient-related, family-related, and physician-related factors. Moreover, organizational factors may constitute major facilitators of moral distress among neonatal physicians in NICUs. Note, however, that moral distress may be regarded as an essential component to caring for neonates in critical care. The present study provides further insight into the moral distress experienced by physicians working in Greek NICUs. Discussion/Conclusions: Understanding how neonatal and pediatric critical care nurses define moral distress and what contributes to its development is foundational to developing targeted strategies for mitigating the prevalence of moral distress among neonate physicians in the context of NICUs.

Keywords: critical care, moral distress, neonatal physician, neonatal intensive care unit, NICU

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Authors: Michael Sonne Kristensen, Frank Loesche, James Foster, Elif Ozcan, Judy Edworthy

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Auditory alarms play an integral role in intensive care nurses’ daily work. Most medical devices in the intensive care unit (ICU) are designed to produce alarm sounds in order to make nurses aware of immediate or prospective safety risks. The utilisation of sound as a carrier of crucial patient information is highly dependent on nurses’ presence - both physically and mentally. For ICU nurses, especially the ones who work with stationary alarm devices at the patient bed space, it is a challenge to display ‘appropriate’ alarm responses at all times as they have to navigate with great flexibility in a complex work environment. While being primarily responsible for a small number of allocated patients they are often required to engage with other nurses’ patients, relatives, and colleagues at different locations inside and outside the unit. This work explores the social strategies used by a team of nurses to comprehend and react to the information conveyed by the alarms in the ICU. Two main research questions guide the study: To what extent do alarms from a patient bed space reach the relevant responsible nurse by direct auditory exposure? By which means do responsible nurses get informed about their patients’ alarms when not directly exposed to the alarms? A comprehensive video-ethnographic field study was carried out to capture and evaluate alarm-related events in an ICU. The study involved close collaboration with four nurses who wore eye-level cameras and ear-level binaural audio recorders during several work shifts. At all time the entire unit was monitored by multiple video and audio recorders. From a data set of hundreds of hours of recorded material information about the nurses’ location, social interaction, and alarm exposure at any point in time was coded in a multi-channel replay-interface. The data shows that responsible nurses’ direct exposure and awareness of the alarms of their allocated patients vary significantly depending on work load, social relationships, and the location of the patient’s bed space. Distributed listening is deliberately employed by the nursing team as a social strategy to respond adequately to alarms, but the patterns of information flow prompted by alarm-related events are not uniform. Auditory Spatiotemporal Trajectory (AST) is proposed as a methodological label to designate the integration of temporal, spatial and auditory load information. As a mixed-method metrics it provides tangible evidence of how nurses’ individual alarm-related experiences differ from one another and from stationary points in the ICU. Furthermore, it is used to demonstrate how alarm-related information reaches the individual nurse through principles of social and distributed cognition, and how that information relates to the actual alarm event. Thereby it bridges a long-standing gap in the literature on medical alarm utilisation between, on the one hand, initiatives to measure objective data of the medical sound environment without consideration for any human experience, and, on the other hand, initiatives to study subjective experiences of the medical sound environment without detailed evidence of the objective characteristics of the environment.

Keywords: auditory spatiotemporal trajectory, medical alarms, social cognition, video-ethography

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Authors: Mustafa Yıldız, Ali Ulvi Uzer, Murat Olgun

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In this study, geotechnical and mineralogical properties of gypsum containing clay basis which form the ground of Second Organized Industrial Zone in Konya province have been researched through comprehensive field and laboratory experiments. Although sufficient geotechnical research has not been performed yet, an intensive structuring in the region continues at present. The study area consists of mid-lake sediments formed by gypsum containing soft silt-clay basis which evolves to a large area. To determine the soil profile and geotechnical specifications; 18 drilling holes were opened and disturbed / undisturbed soil samples have been taken through shelby tubes within 1.5m intervals. Tests have been performed on these samples to designate the index and strength properties of soil. Besides, at all drilling holes Standart Penetration Tests have been done within 1.5m intervals. For the purpose of determining the mineralogical characteristics of the soil; all rock and X-RD analysis have been carried out on 6 samples which were taken from various depths through the soil profile. Strength and compressibility characteristics of the soil were defined with correlations using laboratory and field test results. Unconfined compressive strength, undrained cohesion, compression index varies between 16 kN/m2 and 405.4 kN/m2, 6.5 kN/m2 and 72 kN/m2, 0.066 and 0.864, respectively.

Keywords: Konya second organized industrial region, strength, compressibility, soft clay

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Authors: Pablo González Álvarez, Anna Vinaixa Vergés, Paula Sol Ventura, Paula Fernández, Mercè Redorta, Gemma Ginovart Galiana, Maria Méndez Hernández

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Context: The use of music therapy is gaining popularity worldwide, and it has shown positive effects in neonatology. Hospital Germans Trias i Pujol has recently established a music therapy unit and initiated a project in their neonatal intensive care unit (NICU). Research Aim: The aim of this study is to measure the effect of a music therapy intervention in the NICU of Hospital Germans Trias i Pujol in Spain. Methodology: The study will be an observational analytical case-control study. All newborns admitted to the neonatology unit, both term and preterm, and their parents will be offered a session of music therapy. Data will be collected from families who receive at least two music therapy sessions. Maternal and paternal anxiety levels will be measured through a pre- and post-intervention test. Findings: The study aims to demonstrate the benefits and acceptance of music therapy by patients, parents, and healthcare workers in the neonatal unit. The findings are expected to show a reduction in maternal and paternal anxiety levels following the music therapy sessions. Theoretical Importance: This study contributes to the growing body of literature on the effectiveness of music therapy in neonatal care. It will provide evidence of the acceptance and potential benefits of music therapy in reducing anxiety levels in both parents and babies in the NICU setting. Data Collection: Data will be collected from families who receive at least two music therapy sessions. This will include pre- and post-intervention test results to measure anxiety levels. Analysis Procedures: The collected data will be analyzed using appropriate statistical methods to determine the impact of music therapy on reducing anxiety levels in parents. Questions Addressed: - What is the effect of music therapy on maternal anxiety levels? - What is the effect of music therapy on paternal anxiety levels? - What is the acceptability and perceived benefits of music therapy among patients and healthcare workers in the NICU? Conclusion: The study aims to provide evidence supporting the value of music therapy in the neonatal intensive care unit. It seeks to demonstrate the positive effect of music therapy on reducing anxiety levels among parents.

Keywords: neonatology, music therapy, neonatal intensive care unit, babies, parents

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Authors: Sultana Razia

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The purpose of this study was to investigate the effect of early therapeutic intervention for the children with autism spectrum disorder. Participants were 63 children with autism spectrum disorder from Autism Corner in a selected rehabilitation center of Bangladesh. The hypothesis of the study was that participants would demonstrate significant improvement in social skills, speech and sensory skills following a 3-month intensive therapeutic protocol. This study included children who are at age of 18-month to 36-month and who were taking occupational therapy and speech and language therapy from the autism center. They were primarily screened using M-CHAT; however, children with other physical disability or medical conditions excluded. 3-months interventions of 6 sessions per week are a minimum of 45-minutes long per session, one to one interaction followed by parent-led structured home-based therapy was provided. The results indicated that early intensive therapeutic intervention improve understanding, social skills and sensory skills. It can be concluded that therapeutic early intervention a positive effect on Autism Spectrum Disorder.

Keywords: M-CHAT, ASD, sensory cheeklist, OT

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Authors: Asif Hasan

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Among the reported suitable mariculture species in Bangladesh, seabass and mullet are the two most popular candidates due to their high market values. Several field studies conducted on the culture of seabass in Bangladesh, it still remains a challenge to commercially grow this species due to its exclusive carnivorous nature. In contrast, the grey mullet (M. cephalus) is a fast-growing, omnivorous euryhaline fish that has shown excellent growth in many areas including South Asia. Choice of a sustainable aquaculture technique must consider the productivity and yield as well as their environmental suitability. This study was designed to elucidate the ecologically suitable culture technique of M. cephalus in brakishwater ponds by comparing the biotic and abiotic components of pond ecosystem. In addition to growth parameters (yield, ADG, SGR, weight gain, FCR), Physicochemical parameters (Temperature, DO, pH, salinity, TDS, transparency, ammonia, and Chlorophyll-a concentration) and biological community composition (phytoplankton, zooplankton and benthic macroinvertebrates) were investigated from ponds under Semi-intensive, Improve extensive and Traditional culture system. While temperature were similar in the three culture types, ponds under improve-extensive showed better environmental conditions with significantly higher mean DO and transparency, and lower TDS and Chlorophyll-a. The abundance of zooplankton, phytoplankton and benthic macroinvertebrates were apparently higher in semi-intensive ponds. The Analysis of Similarity (ANOSIM) suggested moderate difference in the planktonic community composition. While the fish growth parameters of M. cephalus and total yield did not differ significantly between three systems, M. cephalus yield (kg/decimal) was apparently higher in semi-intensive pond due to high stocking density and intensive feeding. The results suggested that the difference between the three systems were due to more efficient utilization of nutrients in improve extensive ponds which affected fish growth through trophic cascades. This study suggested that different culture system of M. cephalus is an alternative and more beneficial method owing to its ecological and economic benefits in brackishwater ponds.

Keywords: Mugil cephalus, pond ecosystem, mariculture, fisheries management

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Authors: Ann Dashwood

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Using Standard Australian English with confidence is a cultural expectation of parents of primary school aged children who want to engage effectively with their children’s teachers and school administration. That confidence in support of their children’s learning at school is seldom experienced by parents whose first language is not English. Sharing language with competence in an intercultural environment is the common denominator for meaningful communication and engagement to occur in a school community. Experience in relevant, interactive sessions is known to enhance engagement and participation. The purpose of this paper is to identify a pedagogy for parents otherwise isolated from daily use of functional Australian cultural language learned to engage effectively in their children’s learning at school. The outcomes measure parents’ intercultural engagement with classroom teachers and attention to the school’s administrative procedures using quantitative and qualitative methods. A principled communicative task-based language learning approach, combined with intercultural communication strategies provide the theoretical base for intensive English inquiry-based learning and engagement. The quantitative analysis examines data samples collected by classroom teachers and administrators and parents’ writing samples. Interviews and observations qualitatively inform the study. Currently, significant numbers of projects are active in community centers and schools to enhance English language knowledge of parents from Language Backgrounds Other Than English (LBOTE). The study is significant to explore the effects of an intensive English pedagogy with parents of varied English language backgrounds, by targeting inquiry-based language use for social interactions in the school and wider community, specific engagement and cultural interaction with teachers and school activities and procedures.

Keywords: engagement, intercultural communication, language teaching pedagogy, LBOTE, school community

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Authors: Kamel Abdelaziz Mohamed

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Intoduction:Inadequate knowledge about obstetric admission and infrequent dealing with the obstetric patients in ICU results in high mortality and morbidity. Aim of the work:To evaluate the indications, course, severity of illness, and outcome of obstetric patients admitted to the intensive care unit (ICU). Patients and Methods: We collected baseline data and acute physiology and chronic health evaluation II (APACHE II) scores. ICU mortality was the primary outcome. Results: Seventy obstetric patients were admitted to the ICU over 3 years, 36 of these patients (51.4 %) were admitted during the antepartum period. The primary obstetric indication for ICU admission was pregnancy-induced hypertension (22 patients, 31.4%), followed by sepsis (8 patients, 11.4%) as the leading non-obstetric admission. The mean APACHE II score was 19.6. The predicted mortality rate based on the APACHE II score was 22%, however, only 4 maternal deaths (5.7%) were among the obstetric patients admitted to the ICU. Conclusion: Evaluation of obstetric patients by (APACHE II) scores showed higher predicted mortality rate, however the overall mortality was lower. Regular follow up, together with early detection of complications and prompt ICU admission necessitating proper management by specialized team can improve mortality.

Keywords: obstetric, complication, postpartum, sepsis

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Authors: Sung-Jun Yoo, Kazuhide Ito

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In this study, a comprehensive computer simulated person (CSP) that integrates computational human model (virtual manikin) and respiratory tract model (virtual airway), was applied for estimation of indoor environmental quality. Moreover, an inclusive prediction method was established by integrating computational fluid dynamics (CFD) analysis with advanced CSP which is combined with physiologically-based pharmacokinetic (PBPK) model, unsteady thermoregulation model for analysis targeting micro-climate around human body and respiratory area with high accuracy. This comprehensive method can estimate not only the contaminant inhalation but also constant interaction in the contaminant transfer between indoor spaces, i.e., a target area for indoor air quality (IAQ) assessment, and respiratory zone for health risk assessment. This study focused on the usage of the CSP as an air/thermal quality sensor in indoors, which means the application of comprehensive model for assessment of IAQ and thermal environmental quality. Demonstrative analysis was performed in order to examine the applicability of the comprehensive model to the heating, ventilation, air conditioning (HVAC) control scheme. CSP was located at the center of the simple model room which has dimension of 3m×3m×3m. Formaldehyde which is generated from floor material was assumed as a target contaminant, and flow field, sensible/latent heat and contaminant transfer analysis in indoor space were conducted by using CFD simulation coupled with CSP. In this analysis, thermal comfort was evaluated by thermoregulatory analysis, and respiratory exposure risks represented by adsorption flux/concentration at airway wall surface were estimated by PBPK-CFD hybrid analysis. These Analysis results concerning IAQ and thermal comfort will be fed back to the HVAC control and could be used to find a suitable ventilation rate and energy requirement for air conditioning system.

Keywords: CFD simulation, computer simulated person, HVAC control, indoor environmental quality

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Authors: Christine Pichler

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The German word Bildung in a comprehensive understanding can be defined as the development of the personality and as a process, which lasts from birth, or even before birth, until death. Gaining experience, acquiring abilities and knowledge as a lifelong learning process is what Bildung means. The development of the personality is intransitive because of the personality’s development itself, and transitive because of influences on the formation of a person by individuals and institutions. In public and political discussions, the term Bildung is understood with a constricted usage as education at schools. This leads to the research question, which consequences this limited comprehension of the term Bildung implies and how a comprehensive term of Bildung has to be defined. In discussions, Bildung is limited to its formal part. The limited understanding prevents from accurate analyses and discussions as well as adequate actions. This hypothesis and the research issue will be processed by theoretical analyses of the factors of Bildung, guideline-controlled expert interviews and a qualitative content analysis. The limited understanding on the term Bildung is a methodological problem. This results in inaccuracies in the analysis of the processes of Bildung and their effects on the development of personality structures. On the one hand, an individual is influenced by formal structures in the system of Bildung (e.g. schools) and on the other hand an individual is influenced by gained individual and informal personality and character attributes. In general, too little attention is given to these attributes and individual qualifications. The aim of this work is to demonstrate informative terms so the educational process with all its facets could be considered and applicable analyses can be made. If the informative terms can be defined, it´s also possible to identify and discuss the components of a comprehensive term Bildung to enable correct action.

Keywords: Bildung, development of personality, education, formative process, organized and non-organized Bildung

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Authors: Meltem Kürtüncü, Işın Alkan

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Objective: This study was carried out with an experimental design in order to determine whether the lullaby, which was listened from mother’s voice and a stranger’s voice to the babies born at term and hospitalized in neonatal intensive care unit, had an effect on stress and relaxation symptoms of the infants. Method: Data from the study were obtained from 90 newborn babies who were hospitalized in Neonatal Intensive Care Unit of Zonguldak Maternity And Children Hospital between September 2015-January 2016 and who met the eligibility criteria. Lullaby concert was performed by choosing one of the suitable care hours. Stress and relaxation symptoms were recorded by the researcher on “Newborn response follow-up form” at pre-care and post-care. Results: After lullaby concert when stress symptoms compared to infants in the experimental and control groups before the care was not detected statistically significant difference between crying, contraction, facial grimacing, flushing, cyanosis and the rates of increase in temperature. After care, crying, contractions, facial grimacing, flushing, and restlessness revealed a statistically significant difference between the groups, but as the cyanosis and temperature increased stress responses did not result in a significant difference between the groups. In the control group babies the crying, contraction, facial grimacing, flushing, and restlessness behaviors rates were found to be significantly higher than experimental group babies. After lullaby concert when relaxation symptoms compared to infants in the experimental and control groups before the care, eye contact rates who listen to lullaby from mother’s voice was found to be significantly higher than infants who listen to lullaby from stranger’s voice and infants in the control group. After care as eye contact, smiling, sucking/searching, yawning, non-crying and sleep behaviors relaxation symptoms revealed statistically significant results. In the control group, these behaviors were found statistically lower degree than the experimental groups. Conclusion: Lullaby concerts as masking the ambient noise, reducing the stress symptoms and increasing the relaxation symptoms, and also for soothing and stimulant affects, due to ease the transition to the sleep state should be preferred in the neonatal intensive care units.

Keywords: lullaby, mother voice, relaxation, stress

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Authors: Wen Hsin Hsu, Pin Lin

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Objective: Thirst discomfort is the most common yet often overlooked symptom in patients in the intensive care unit (ICU), with an incidence rate of 69.8%. If not properly cared for, it can easily lead to irritability, affect sleep quality, and increase the incidence of delirium, thereby extending the length of hospital stay. Research points out that the sensation of coldness is an effective strategy to alleviate thirst. Using a combined care approach for thirst can prolong the sensation of coldness in the mouth and reduce thirst discomfort. Therefore, it needs to be further analyzed and its effectiveness reviewed. Methods: This study uses systematic literature review and meta-analysis methodologies and searched databases including PubMed, MEDLINE, EMBASE, Cochrane, CINAHL, and two Chinese databases (CEPS and CJTD) based on keywords. JBI was used to appraise the quality of the literature. RevMen 5.4 software package was used, and Fix Effect Model was applied for data analysis. We selected experimental articles, including those in English and Chinese, that met the inclusion and exclusion criteria. Three research articles were included in total, with a sample size of 416 people. Two were randomized controlled trials, and one was a quasi-experimental design. Results: The results show that the combined care for thirst, which includes ice water spray or oral swab wipes, menthol mouthwash, and lip balm, can significantly relieve thirst intensity MD=-1.36 (3 studies, 95% CI (-1.77, -0.95), p <0.001) and thirst distress MD=-0.71 (2 studies, 95% CI (-1.32, -0.10), p =0.02). Therefore, it is recommended that medical staff identify high-risk groups for thirst early on. Implications for Practice: For patients who cannot eat orally, providing combined care for thirst can increase oral comfort and improve the quality of care.

Keywords: thirst bundle care, intensive care units, meta-analysis, ice water spray, menthol

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Authors: Lavinia Flueckiger, Roselind Lieb, Andrea H. Meyer, Cornelia Witthauer, Jutta Mata

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Objective: Health behaviors tend to show a high variability over time within the same person. However, most existing research can only assess a snapshot of a person’s behavior and not capture this natural daily variability. Two intensive longitudinal studies examine the variability in health behavior over one academic year and their implications for other aspects of daily life such as affect and academic performance. Can already a single day of increased physical activity, snacking, or improved sleep have beneficial effects? Methods: In two intensive longitudinal studies with up to 65 assessment days over an entire academic year, university students (Study 1: N = 292; Study 2: N = 304) reported sleep quality, physical activity, snacking, positive and negative affect, and learning goal achievement. Results: Multilevel structural equation models showed that on days on which participants reported better sleep quality or more physical activity than usual, they also reported increased positive affect, decreased negative affect, and better learning goal achievement. Higher day-to-day snacking was only associated with increased positive affect. Both, increased day-to-day sleep quality and physical activity were indirectly associated with better learning goal achievement through changes in positive and negative affect; results for snacking were mixed. Importantly, day-to-day sleep quality was a stronger predictor for affect and learning goal achievement than physical activity or snacking. Conclusion: One day of better sleep or more physical activity than usual is associated with improved affect and academic performance. These findings have important implications for low-threshold interventions targeting the improvement of daily functioning.

Keywords: sleep quality, physical activity, snacking, affect, academic performance, multilevel structural equation model

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Authors: Ann Dashwood

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Using standard Australian English with confidence is a cultural expectation of parents of primary school aged children who want to engage effectively with their children’s teachers and school administration. That confidence in support of their children’s learning at school is seldom experienced by parents whose first language is not English. Sharing language with competence in an intercultural environment is the common denominator for meaningful communication and engagement to occur in a school community. Experience in relevant interactive sessions is known to enhance engagement and participation. The purpose of this paper is to identify interactional settings for which parents who are isolated from the daily use of functional Australian cultural language learned to engage more effectively in their children’s learning at school. The outcomes measured parents’ intercultural engagement with classroom teachers and attention to the school’s administrative procedures. The study used quantitative and qualitative methods. The principles of communicative task-based language learning combined with intercultural communication principles provided the theoretical base for intensive English task-based learning and engagement. The quantitative analysis examined data samples collected by classroom teachers and administrators and parents’ writing samples. Interviews and observations qualitatively informed the study. Currently significant numbers of projects are active in community centres and schools to enhance English language knowledge of parents from Language Backgrounds Other Than English (LBOTE). The study was significant to explore the effects of conducting intensive English with parents of varied English language backgrounds by targeting language use for social interactions in the community, specific engagement in school activities, cultural interaction with teachers and responsiveness to complying with school procedures.

Keywords: engagement, intercultural communication, LBOTE, school community

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Authors: Delly C. Lestari, Linosefa, Ardiana Kusumaningrum, Andi Yasmon, Anis Karuniawati

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The objective of this study is to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) harboring mecA genes from screening isolates among intensive care unit (ICU) patients. All MRSA screening isolates from ICU’s patients of Cipto Mangunkusumo Hospital during 2011 and 2014 were included in this study. Identification and susceptibility test was performed using Vitek2 system (Biomereux®). PCR was conducted to characterize the SCCmec of S. aureus harboring the mecA gene on each isolate. Patient’s history of illness was traced through medical record. 24 isolates from 327 screening isolates were MRSA positive (7.3%). From PCR, we found 17 (70.8%) isolates carrying SCCmec type I, 3 (12.5%) isolates carrying SCCmec type III, and 2 (8.3%) isolates carrying SCCmec type IV. In conclusion, SCCmec type I is the most prevalent MRSA colonization among ICU patients in Cipto Mangunkusumo Hospital.

Keywords: MRSA, mecA genes, ICU, colonization

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Authors: Hyunsik Park

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Objective: To provide information of charged nursing care facility for helping to establish geriatric health care policy, and to figure out which factors would be the main determinants for the choice of it. Method: 46 males and 53 females, and the same number of their caregivers admitted into the charged nursing care facility were recruited for intensive interview including personal information, disease information, and economic, familial, marital and emotional statuses. This is a cross-sectional study and we analyzed the data qualitatively. Results: Patients had 3.2 diseases and a hospitalization for 2.3 years on average. They were consists of 46 singles (46.9%), 8 unmarried (8.2%), 5 divorced (5.1%) and 32 married (32.7%). More than two third (70.1%) were supported by their eldest son or daughter. Mostly, the family caregivers decided to admit into the facilities by the doctor’s recommendation (68.4%). When they made a choice for a facility, most of them (42.9%) considered environmental and sanitary conditions. According to their expectation for management in nursing care facility, most caregivers (59.2%) wanted simple-staying for the duration, but most patients (61.3%) expected to be home after taking comprehensive rehabilitation. Three-quarter of the caregivers would agree to use nursing care facilities in the future, if they would be the same situation. Conclusion: Life style and environment are rapidly changing. In the near future, we need lots of the charged nursing care facilities for the old, thus this study can be the good reference for the preparing upcoming aged and super-aged society.

Keywords: nursing care facility, aged society, qualitative analysis, health

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Authors: Lateefat Amao, Misagh Faezipour

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Implementing electronic health records (EHR) in healthcare is a pivotal transition aimed at digitizing and optimizing patient health information management. The expectations associated with this transition are high, even towards other health information systems (HIS) and health technology. This multifaceted process involves careful planning and execution to improve the quality and efficiency of patient care, especially as healthcare technology is a sensitive niche. Key considerations include a thorough needs assessment, judicious vendor selection, robust infrastructure development, and training and adaptation of healthcare professionals. Comprehensive training programs, data migration from legacy systems and models, interoperability, as well as security and regulatory compliance are imperative for healthcare staff to navigate EHR systems adeptly. The purpose of this work is to offer a comprehensive review of the literature on EHR implementation. It explores the impact of this health technology on health practices, highlights challenges and barriers to its successful utility, and offers practical strategies that can impact its success in healthcare. This paper provides a thorough review of studies on the adoption of EHRs, emphasizing the wide range of experiences and results connected to EHR use in the medical field, especially across different types of healthcare organizations.

Keywords: healthcare, electronic health records, EHR implementation, patient care, interoperability

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Authors: Yunyong Guo, Man Wang, Bryan Guo, Nathan Guo

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This paper introduces an advanced security and privacy model tailored for Telehealth systems, emphasizing end-to-end protection across IoT, Fog, and Cloud components. The proposed model integrates encryption, key management, intrusion detection, and privacy-preserving measures to safeguard patient data. A comprehensive simulation study evaluates the model's effectiveness in scenarios such as unauthorized access, physical breaches, and insider threats. Results indicate notable success in detecting and mitigating threats yet underscore areas for refinement. The study contributes insights into the intricate balance between security and usability in Telehealth environments, setting the stage for continued advancements.

Keywords: cloud, enhancing security, fog, IoT, telehealth

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Authors: Ben Cheikh Asma, Bouafia Nabiha, Ammar Asma, Ezzi Olfa, Meddeb Khaoula, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Hospital Acquired Infection (HAI) constitutes an important worldwide health problem. It was associated with high mortality rate in intensive care units (ICU). This study aimed to determine HAI mortality rate in Tunisian intensive care units and identify its risk factors. Methods: We conducted a prospective observational cohort study over a 12 months period (September 15th 2015 to September 15 th 2016) in the adult medical ICU of University Hospital-Farhat Hached (Sousse-Tunisia). All patients admitted in the ICU for more than 48 hours were included in the study. We used an anonymous standardized survey record form to collect data by a medical hygienist assisted by an intensivist. We adopted definitions of Center for Diseases Control and prevention of Atlanta to detect HAI, Kaplan Meier survival analysis and Cox proportional hazard regression to identify independent risk factor of HAI mortality. Results: Of 171 patients, 67 developed ICU-acquired infection (global incidence rate=39.2%). The mean age of patients was 59 ± 21.2 years and 60.8% were male. The most frequently identified infections were pulmonary acquired infection (ventilator associated pneumonia (VAP) and infected atelectasis with density rates 21.4 VAP/1000 days of mechanical ventilation and 9.4 infected atelectasis /1000 days of mechanical ventilation; respectively) and central venous catheter associated infection (CVC - AI) with density rate 28.4 CVC-AI / 1000 CVC-days). HAI mortality rate was 66.7% (n=44). The median survival was 20 days 3.36, 95% Confidential Interval [13.39 – 26.60]. Specific mortality rates according to infectious site were 65.5%, 36.4% and 4.5% respectively for VAP, CVC associated infection and infected atelectasis. In univariate analysis, a significant associations between mortality and cardiovascular history (p=0.04) tracheotomy (p=0.00), peripheral venous catheterization (p=0.04), VAP (p=0.04) and infected atelectasis (p=0.04) were detected. Independent risk factors for HAI mortality were VAP with Hazard Ratio = 3.14, 95% Confidential Interval [1.63 – 6.05] (p=0.001) and tracheotomy (Hazard Ratio=0.22, 95% Confidential Interval [0.10 – 0.44], p=0.000). Conclusions: In the present study, hospital acquired infection mortality rate was relatively high. We need to intensify the fight against these infections especially ventilator-associated pneumonia that is associated with higher risk of mortality in many studies. Thus, more effective infection control interventions were necessary in our hospital.

Keywords: hospital acquired infection, intensive care unit, mortality, risk factors

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Authors: Farah Syazwani Hilmy Zaki

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Background: Compared to adult cardiopulmonary resuscitation (CPR), high-quality research and evidence on pediatric CPR remain relatively scarce. This knowledge gap hinders the development of optimal guidelines and best practices for resuscitating children. Objectives: To explore pediatric intensive care unit (PICU) CPR current practices in PICU of Institut Jantung Negara (IJN) Malaysia. Method: The research employed a qualitative approach, utilising case study research design. The data collection process involved in-depth interviews and reviewing the Resuscitation Feedback Form. Purposive sampling was used to select two cases consisting of 14 participants. The study participants comprised a cardiologist, one anaesthetist, and twelve nurses. The data collected were transcribed and entered into NVivo software to facilitate theme development. Subsequently, thematic analysis was conducted to analyse the data. Findings: The study yielded key findings regarding the enhancement of PICU CPR practices. These findings are categorised into four themes, namely routine procedures, resuscitation techniques, team dynamics, and individual contributions. Establishment of cohesive team is crucial in facilitating the effectiveness of resuscitation. According to participants, lack of confidence, skills and knowledge presents significant obstacles to effective PICU CPR. Conclusion: The findings of this study indicate that the participants express satisfaction with the current practices of PICU CPR. However, the research also highlights the need for enhancements in various areas, including routine procedures, resuscitation techniques, as well as team and individual factors. Furthermore, it was suggested that additional training be conducted on the resuscitation process to enhance the preparedness of the medical team.

Keywords: cardiopulmonary resuscitation, feedback, nurses, pediatric intensive care unit

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Authors: K. Rhea Devaiah, B. S. Premalatha

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Background: Tonsillar Lingual sulcus is the area between the tonsils and the base of the tongue. The surgical resection of the lesions in the head and neck results in changes in speech and swallowing functions. The severity of the speech and swallowing problem depends upon the site and extent of the lesion, types and extent of surgery and also the flexibility of the remaining structures. Need of the study: This paper focuses on the importance of speech and swallowing rehabilitation in an individual with the lesion in the Tonsillar Lingual Sulcus and post-operative functions. Aim: Evaluating the speech and swallow functions post-intensive speech and swallowing rehabilitation. The objectives are to evaluate the speech intelligibility and swallowing functions after intensive therapy and assess the quality of life. Method: The present study describes a report of an individual aged 47years male, with the diagnosis of basaloid squamous cell carcinoma, left tonsillar lingual sulcus (pT2n2M0) and underwent wide local excision with left radical neck dissection with PMMC flap reconstruction. Post-surgery the patient came with a complaint of reduced speech intelligibility, and difficulty in opening the mouth and swallowing. Detailed evaluation of the speech and swallowing functions were carried out such as OPME, articulation test, speech intelligibility, different phases of swallowing and trismus evaluation. Self-reported questionnaires such as SHI-E(Speech handicap Index- Indian English), DHI (Dysphagia handicap Index) and SESEQ -K (Self Evaluation of Swallowing Efficiency in Kannada) were also administered to know what the patient feels about his problem. Based on the evaluation, the patient was diagnosed with pharyngeal phase dysphagia associated with trismus and reduced speech intelligibility. Intensive speech and swallowing therapy was advised weekly twice for the duration of 1 hour. Results: Totally the patient attended 10 intensive speech and swallowing therapy sessions. Results indicated misarticulation of speech sounds such as lingua-palatal sounds. Mouth opening was restricted to one finger width with difficulty chewing, masticating, and swallowing the bolus. Intervention strategies included Oro motor exercise, Indirect swallowing therapy, usage of a trismus device to facilitate mouth opening, and change in the food consistency to help to swallow. A practice session was held with articulation drills to improve the production of speech sounds and also improve speech intelligibility. Significant changes in articulatory production and speech intelligibility and swallowing abilities were observed. The self-rated quality of life measures such as DHI, SHI and SESE Q-K revealed no speech handicap and near-normal swallowing ability indicating the improved QOL after the intensive speech and swallowing therapy. Conclusion: Speech and swallowing therapy post carcinoma in the tonsillar lingual sulcus is crucial as the tongue plays an important role in both speech and swallowing. The role of Speech-language and swallowing therapists in oral cancer should be highlighted in treating these patients and improving the overall quality of life. With intensive speech-language and swallowing therapy post-surgery for oral cancer, there can be a significant change in the speech outcome and swallowing functions depending on the site and extent of lesions which will thereby improve the individual’s QOL.

Keywords: oral cancer, speech and swallowing therapy, speech intelligibility, trismus, quality of life

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Authors: Antonio Marco Miotti, Antonella Ruffatto, Giampaola Basso, Antonio Madia, Giulia Zavatta, Emanuela Salvatico, Emanuela Zilli

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A National Action Plan to fight antimicrobial resistance was launched in Italy in 2017. In order to reduce inappropriate exposure to antibiotics and infections from multi-drug resistant bacteria, it is essential to set up a structured system of surveillance and monitoring of the implementation of National Action Plan standards, including antimicrobial consumption, with a special focus on quinolones, third generation cephalosporins and carbapenems. A quantitative estimate of antibiotic consumption (defined daily dose - DDD - consumption per 100 days of hospitalization) has been provided by the Pharmaceutical Service to the Hospital of Cittadella, ULSS 6 Euganea – Health Trust (District of Padua) for the years 2019 (before the pandemic), 2020 and 2021 for all classes of antibiotics. Multidisciplinary meetings have been organized monthly by the local Antimicrobial Stewardship Group. Between 2019 and 2021, an increase in the consumption of carbapenems in the Intensive Care Unit (from 12.2 to 18.2 DDD, + 49.2%) and a decrease in Medical wards (from 5.3 to 2.6 DDD, - 50.9%) was reported; a decrease in the consumption of quinolones in Intensive Care Unit (from 17.2 to 10.8 DDD, - 37.2%), Medical wards (from 10.5 to 6.6 DDD, - 37.1%) and Surgical wards (from 10.2 to 9.3 DDD, - 8.8%) was highlighted; an increase in the consumption of third generation cephalosporins in Medical wards (from 18.1 to 22.6 DDD, + 24,1%) was reported. Finally, after an increase in the consumption of macrolides between 2020 and 2019, in 2021, a decrease was reported in the Intensive Care Unit (DDD: 8.0 in 2019, 18.0 in 2020, 6.4 in 2021) and Medical wards (DDD: 9.0 in 2019, 13.7 in 2020, 10.9 in 2021). Constant monitoring of antimicrobial consumption and timely identifying of warning situations that may need a specific intervention are the cornerstone of Antimicrobial Stewardship programs, together with analysing data on bacterial resistance rates and infections from multi-drug resistant bacteria.

Keywords: carbapenems, quinolones, antimicrobial, stewardship

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