Search results for: outcomes
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3274

Search results for: outcomes

1054 The Conceptualization of Patient-Centered Care in Latin America: A Scoping Review

Authors: Anne Klimesch, Alejandra Martinez, Martin HäRter, Isabelle Scholl, Paulina Bravo

Abstract:

Patient-centered care (PCC) is a key principle of high-quality healthcare. In Latin America, research on and promotion of PCC have taken place in the past. However, thorough implementation of PCC in practice is still missing. In Germany, an integrative model of patient-centeredness has been developed by synthesis of diverse concepts of PCC. The model could serve as a point of reference for further research on the implementation of PCC. However, it is predominantly based on research from Europe and North America. This scoping review, therefore, aims to accumulate research on PCC in Latin America in the past 15 years and analyse how PCC has been conceptualized. The resulting overview of PCC in Latin America will be a foundation for a subsequent study aiming at the adaptation of the integrative model of patient-centeredness to the Latin American health care context. Scientific databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Web of Science, SCIELO, Redalyc.) will be searched, and reference and citation tracking will be performed. Studies will be included if they were carried out in Latin America, investigated PCC in any clinical and community setting (public and private), and were published in English, Spanish, French, or Portuguese since 2006. Furthermore, any theoretical framework or conceptual model to guide how PCC is conceptualized in Latin America will be included. Two reviewers will be responsible for the identification of articles, screening of records, and full-text assessment. The results of the scoping review will be used in the development of a mixed-methods study with the aim to understand the needs for PCC, as well as barriers and facilitators in Latin America. Based on the outcomes, the integrative model of PCC will be translated to Spanish and adapted to the Latin American context. The integrative model will enable the dissemination of the concept of PCC in Latin America and will provide a common ground for further research on the topic. The project will thereby make an important contribution to an evidence-based implementation of PCC in Latin America.

Keywords: conceptual framework, integrative model of PCC, Latin America, patient-centered care

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1053 Real-World Prevalence of Musculoskeletal Disorders in Nigeria

Authors: F. Fatoye, C. E. Mbada, T. Gebrye, A. O. Ogunsola, C. Fatoye, O. Oyewole

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Musculoskeletal disorders (MSDs) are a major cause of pain and disability. It is likely to become a greater economic and public health burden that is unnecessary. Thus, reliable prevalence figures are important for both clinicians and policy-makers to plan health care needs for those affected with the disease. This study estimated hospital based real-world prevalence of MSDs in Nigeria. A review of medical charts for adult patients attending Physiotherapy Outpatient Clinic at the Obafemi Awolowo University Teaching Hospitals Complex, Osun State, Nigeria between 2009 and 2018 was carried out to identify common MSDs including low back pain (LBP), cervical spondylosis (CSD), post immobilization stiffness (PIS), sprain, osteoarthritis (OA), and other conditions. Occupational class of the patients was determined using the International Labour Classification (ILO). Data were analysed using descriptive statistics of frequency and percentages. Overall, medical charts of 3,340 patients were reviewed within the span of ten years (2009 to 2018). Majority of the patients (62.8%) were in the middle class, and the remaining were in low class (25.1%) and high class (10.5%) category. An overall prevalence of 47.35% of MSD was found within the span of ten years. Of this, the prevalence of LBP, CSD, PIS, sprain, OA, and other conditions was 21.6%, 10%, 18.9%, 2%, 6.3%, and 41.3%, respectively. The highest (14.2%) and lowest (10.5%) prevalence of MSDs was recorded in the year of 2012 and 2018, respectively. The prevalence of MSDs is considerably high among Nigerian patients attending outpatient a physiotherapy clinic. The high prevalence of MSDs underscores the need for clinicians and decision makers to put in place appropriate strategies to reduce the prevalence of these conditions. In addition, they should plan and evaluate healthcare services to improve the health outcomes of patients with MSDs. Further studies are required to determine the economic burden of the condition and examine the clinical and cost-effectiveness of physiotherapy interventions for patients with MSDs.

Keywords: musculoskeletal disorders, Nigeria, prevalence, real world

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1052 Hormone Replacement Therapy (HRT) and Its Impact on the All-Cause Mortality of UK Women: A Matched Cohort Study 1984-2017

Authors: Nurunnahar Akter, Elena Kulinskaya, Nicholas Steel, Ilyas Bakbergenuly

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Although Hormone Replacement Therapy (HRT) is an effective treatment in ameliorating menopausal symptoms, it has mixed effects on different health outcomes, increasing, for instance, the risk of breast cancer. Because of this, many symptomatic women are left untreated. Untreated menopausal symptoms may result in other health issues, which eventually put an extra burden and costs to the health care system. All-cause mortality analysis may explain the net benefits and risks of the HRT therapy. However, it received far less attention in HRT studies. This study investigated the impact of HRT on all-cause mortality using electronically recorded primary care data from The Health Improvement Network (THIN) that broadly represents the female population in the United Kingdom (UK). The study entry date for this study was the record of the first HRT prescription from 1984, and patients were followed up until death or transfer to another GP practice or study end date, which was January 2017. 112,354 HRT users (cases) were matched with 245,320 non-users by age at HRT initiation and general practice (GP). The hazards of all-cause mortality associated with HRT were estimated by a parametric Weibull-Cox model adjusting for a wide range of important medical, lifestyle, and socio-demographic factors. The multilevel multiple imputation techniques were used to deal with missing data. This study found that during 32 years of follow-up, combined HRT reduced the hazard ratio (HR) of all-cause mortality by 9% (HR: 0.91; 95% Confidence Interval, 0.88-0.94) in women of age between 46 to 65 at first treatment compared to the non-users of the same age. Age-specific mortality analyses found that combined HRT decreased mortality by 13% (HR: 0.87; 95% CI, 0.82-0.92), 12% (HR: 0.88; 95% CI, 0.82-0.93), and 8% (HR: 0.92; 95% CI, 0.85-0.98), in 51 to 55, 56 to 60, and 61 to 65 age group at first treatment, respectively. There was no association between estrogen-only HRT and women’s all-cause mortality. The findings from this study may help to inform the choices of women at menopause and to further educate the clinicians and resource planners.

Keywords: hormone replacement therapy, multiple imputations, primary care data, the health improvement network (THIN)

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1051 A Modified Open Posterior Approach for the Fixation of Posterior Cruciate Ligament Tibial Avulsion Fractures

Authors: Babak Mirzashahi, Arvin Najafi, Pejman Mansouri, Mahmoud Farzan

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Background: The most effective treatment of posterior cruciate ligament (PCL) tears and the consequence of untreated PCL injuries remain controversial. Objectives: The aim of this study is to assess outcomes of fixation of tibial posterior cruciate ligament (PCL) avulsion fractures via a modified technique. Patients and Methods: From January, 2009 to March, 2012, there were 45 cases of PCL tibial avulsion fractures that were referred to our hospital and were managed through a modified open posterior approach. Fixation of Tibial PCL avulsion fractures were fixed by means of a lag screw and washer placed through our modified open posterior approach. Range of motion was begun on the first postoperative day. Clinical stability, range of motion, gastrocnemius muscle strength, radiographic investigation, and patient’s overall quality of life was analyzed at final follow up visit. Results: The average of overall musculoskeletal functional evaluation scores was 15 (range 3–35). All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. The mean preoperative Lysholm score for 15 knees was 62 ± 8 (range, 50-75); the mean postoperative Lysholm score was 92± 7 (range, 75-101). A significant difference in Lysholm scores between preoperative and final follow-up evaluations was found (P < .05). At first-year follow-up, 42 (93%) patients revealed a difference of less than 10 mm in thigh circumference between their injured and healthy knees. Conclusions: The management of displaced large PCL avulsion fractures with placement of a cancellous lag screw with washer by means of the modified open posterior approach leads to satisfactory clinical, radiographic, and functional results and reduces the operation time and less blood loss. Level of evidence: IV.

Keywords: posterior cruciate ligament, tibial fracture, lysholm knee score, patient outcome assessment

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1050 Legal Pluralism and Efficiency in International Marriage Law: Implications of Regulatory Competition on an Analysis of Conflict of Law Rules

Authors: Rorick Daniel Tovar Galvan

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The existence of different legal systems represents an important barrier for married couples that attempt to reside in another country. Each movement can cause important changes in the rights and obligations derived from the marriage since a different law could be used by the courts to solve legal disputes arising from their relationship. In a context in which it is increasingly common to move from one country to another, people cannot be certain about the outcomes of proceedings dealing with i.e., the dissolution of property regime, maintenance payments or time to wait to initiate divorce because a foreign – and in most cases unknown – law could apply every time they move. At first glance, the answer to this issue seems to be the harmonization of the legal systems: the greater the mobility of individuals inside a group of countries, the higher the similarities of their laws should be. Such a solution could be positive for spouses because a higher degree of legal certainty would be reached in case the same legal rules applied regardless of the place where the couple lives. However, the legal pluralism brings with it also advantages that could be appreciated when one looks closely at the economic rationale behind the legal institution of marriage. This contribution carries out an economic analysis of the existence of different legal systems in the area of marriage law and proposes another strategy to cope with the problems arising from legal pluralism. Far from eliminating the diversity of legal systems, one wishes to foster it, since significant advantages could arise from such diversity in case couples are permitted to choose the applicable law themselves. Based on the idea that the law could be seem as a product offered in the market as well as states and spouses as suppliers and consumers of this product, the paper shows the advantages of designing a legal framework that allows spouses to determine freely the law governing the legal effects of their marriage. Instead of promoting the harmonization of the substantive law, one explores the benefits of encouraging the regulatory competition at international level in the area of marriage law.

Keywords: conflict of laws, harmonization, international marriage law, law and economics, regulatory competition

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1049 Empirical Analysis of Forensic Accounting Practices for Tackling Persistent Fraud and Financial Irregularities in the Nigerian Public Sector

Authors: Sani AbdulRahman Bala

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This empirical study delves into the realm of forensic accounting practices within the Nigerian Public Sector, seeking to quantitatively analyze their efficacy in addressing the persistent challenges of fraud and financial irregularities. With a focus on empirical data, this research employs a robust methodology to assess the current state of fraud in the Nigerian Public Sector and evaluate the performance of existing forensic accounting measures. Through quantitative analyses, including statistical models and data-driven insights, the study aims to identify patterns, trends, and correlations associated with fraudulent activities. The research objectives include scrutinizing documented fraud cases, examining the effectiveness of established forensic accounting practices, and proposing data-driven strategies for enhancing fraud detection and prevention. Leveraging quantitative methodologies, the study seeks to measure the impact of technological advancements on forensic accounting accuracy and efficiency. Additionally, the research explores collaborative mechanisms among government agencies, regulatory bodies, and the private sector by quantifying the effects of information sharing on fraud prevention. The empirical findings from this study are expected to provide a nuanced understanding of the challenges and opportunities in combating fraud within the Nigerian Public Sector. The quantitative insights derived from real-world data will contribute to the refinement of forensic accounting strategies, ensuring their effectiveness in addressing the unique complexities of financial irregularities in the public sector. The study's outcomes aim to inform policymakers, practitioners, and stakeholders, fostering evidence-based decision-making and proactive measures for a more resilient and fraud-resistant financial governance system in Nigeria.

Keywords: fraud, financial irregularities, nigerian public sector, quantitative investigation

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1048 Sodium-glucose Co-transporter-2 Inhibitors in Heart Failure with Mildly Reduced Reduced Ejection Fraction: Future Perspectives in Patients with Neoplasia

Authors: M. A. Munteanu, A. M. Lungu, A. I. Chivescu, V. Teodorescu, E. Tufanoiu, C. Nicolae, T. I. Nanea

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Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i), which were first developed as antidiabetic medications, have demonstrated numerous positive benefits on the cardiovascular system, especially in the prevention of heart failure (HF). HF is a challenging, multifaceted disease that needs all-encompassing therapy. It should not be viewed as a limited form of heart illness but rather as a systemic disease that leads to multiple organ failure and death. SGLT2i is an extremely effective tool for treating HF by using its pleiotropic effects. In addition to its use in patients with diabetes mellitus who are at high cardiovascular risk or who have already experienced a cardiovascular event, SGLT2i administration has been shown to have positive effects on a variety of HF manifestations and stages, regardless of the patient's presence of diabetes mellitus. Material and Methods: According to the guide, 110 patients (83 males and 27 females) with heart failure with mildly reduced ejection fraction (HFmrEF), with T2D and neoplasia, were enrolled in the prospective study. The structural and functional state of the left ventricle myocardium and ejection fraction was assessed through echocardiography. Patients were randomized to receive once-daily dapagliflozin 10 mg. Results: Patients with HFmrEF were divided into 3 subgroups according to age. 7% (8) patients aged < 45 years, 35% (28) patients aged between 46-59 years, and 58% (74) patients aged> 60 years. The most prevalent comorbidities were hypertension (43.1%), coronary heart disease (40%), and obesity (33.2%). Study drug discontinuation and serious adverse events were not frequent in the subgroups, in either men or women, until now. Conclusions: SGLT-2 inhibitors are a novel class of antidiabetic agents that have demonstrated positive efficacy and safety outcomes in the setting of HFmrEF. Until now, in our study, dapagliflozin was safe and well-tolerated irrespective of sex.

Keywords: diabetes mellitus type 2, Sodium-glucose co-transporters-2 inhibitors, heart failure, neoplasia

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1047 VeriFy: A Solution to Implement Autonomy Safely and According to the Rules

Authors: Michael Naderhirn, Marco Pavone

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Problem statement, motivation, and aim of work: So far, the development of control algorithms was done by control engineers in a way that the controller would fit a specification by testing. When it comes to the certification of an autonomous car in highly complex scenarios, the challenge is much higher since such a controller must mathematically guarantee to implement the rules of the road while on the other side guarantee aspects like safety and real time executability. What if it becomes reality to solve this demanding problem by combining Formal Verification and System Theory? The aim of this work is to present a workflow to solve the above mentioned problem. Summary of the presented results / main outcomes: We show the usage of an English like language to transform the rules of the road into system specification for an autonomous car. The language based specifications are used to define system functions and interfaces. Based on that a formal model is developed which formally correctly models the specifications. On the other side, a mathematical model describing the systems dynamics is used to calculate the systems reachability set which is further used to determine the system input boundaries. Then a motion planning algorithm is applied inside the system boundaries to find an optimized trajectory in combination with the formal specification model while satisfying the specifications. The result is a control strategy which can be applied in real time independent of the scenario with a mathematical guarantee to satisfy a predefined specification. We demonstrate the applicability of the method in simulation driving scenarios and a potential certification. Originality, significance, and benefit: To the authors’ best knowledge, it is the first time that it is possible to show an automated workflow which combines a specification in an English like language and a mathematical model in a mathematical formal verified way to synthesizes a controller for potential real time applications like autonomous driving.

Keywords: formal system verification, reachability, real time controller, hybrid system

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1046 Centrifuge Modelling Approach on Sysmic Loading Analysis of Clay: A Geotechnical Study

Authors: Anthony Quansah, Tresor Ntaryamira, Shula Mushota

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Models for geotechnical centrifuge testing are usually made from re-formed soil, allowing for comparisons with naturally occurring soil deposits. However, there is a fundamental omission in this process because the natural soil is deposited in layers creating a unique structure. Nonlinear dynamics of clay material deposit is an essential part of changing the attributes of ground movements when subjected to solid seismic loading, particularly when diverse intensification conduct of speeding up and relocation are considered. The paper portrays a review of axis shaking table tests and numerical recreations to explore the offshore clay deposits subjected to seismic loadings. These perceptions are accurately reenacted by DEEPSOIL with appropriate soil models and parameters reviewed from noteworthy centrifuge modeling researches. At that point, precise 1-D site reaction investigations are performed on both time and recurrence spaces. The outcomes uncover that for profound delicate clay is subjected to expansive quakes, noteworthy increasing speed lessening may happen close to the highest point of store because of soil nonlinearity and even neighborhood shear disappointment; nonetheless, huge enhancement of removal at low frequencies are normal in any case the forces of base movements, which proposes that for dislodging touchy seaward establishments and structures, such intensified low-recurrence relocation reaction will assume an essential part in seismic outline. This research shows centrifuge as a tool for creating a layered sample important for modelling true soil behaviour (such as permeability) which is not identical in all directions. Currently, there are limited methods for creating layered soil samples.

Keywords: seismic analysis, layered modeling, terotechnology, finite element modeling

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1045 Hydraulics of 3D Aerators with Lateral Enlargements

Authors: Nirmala Lama

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The construction of high dams has led to significant challenges in managing flow rates discharging over spillways, resulting in cavitation damages on hydraulic surfaces. To address this, aerator devices were designed and installed to promote fore aeration, thereby controlling and mitigating damages caused by cavitation. Consequently, these aerator types, three-dimensional aerators (3DAEs), have demonstrated superior efficiency in introducing forced air into the flow.This research focuses on the installation and evaluation of three-dimensional aerator devices at the high discharge spillway surface. In the laboratory, the air concentration downstream of the hydraulic structures was extensively measured, and the data were analyzed in details.Multiple flow scenarios and structural arrangements of the aerators were adopted for the study. The outcomes of these experiments are listed as In terms of air concentration value, the comparison between 3 DAE (three-dimensional aerator) with offset only and offset with ramp reveals significant differences. The concentration value on the side wall was justified. The side cavity length was found to increase with higher approach Froude numbers and lateral enlargement widths. Furthermore, 3DAE exhibited shorter side cavity lengths compared to three-dimensional aerator devices without ramps (3DAD), a beneficial features for controlling water fins. An empirical formula to express the side cavity length was derived from the measured data. Also, the comparison were made on the basis of water fin formation between the different arrangements of 3D aerators. In conclusion, this research provides valuable insights into the performance of three-dimensional aerators in mitigating cavitation damages and controlling water fins in high dam spillways. The findings offer practical implications for designers and engineers seeking to enhance the efficiency and safety of hydraulic structures subjected to high flow rates.

Keywords: three-dimension aerator, cavity, water fin, air entrainment

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1044 Chinese on the Move: Residential Mobility and Evolution of People's Republic of China-Born Migrants in Australia

Authors: Siqin Wang, Jonathan Corcoran, Yan Liu, Thomas Sigler

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Australia is a quintessentially immigrant nation with 28 percent of its residents being foreign-born. By 2011, People’s Republic of China (PRC) overtook the United Kingdom to become the largest source country in Australia. Significantly, the profile of PRC-born migrants has changed to mirror broader global shifts towards high-skilled labour, education-related, and investment-focussed migration, all of which reflect an increasing trend in the mobility of wealthy and/or educated cohorts. Together, these coalesce to form a more complex pattern of migrant settlement –both spatially and socio-economically. This paper focuses on the PRC-born migration, redresses these lacunae, with regard to the settlement outcomes of PRC migrants to Australia, with a particular focus on spatial evolution and residential mobility at both the metropolitan and national scales. By drawing on Census Data and migration Micro Datasets, the aim of this paper is to examine the shifting dynamics of PRC-born migrants in Australian capital cities to unveil their socioeconomic characteristics, residential patterns and change of spatial concentrations during their transition into the new host society. This paper finds out three general patterns in the residential evolution of PRC-born migrants depending on the size of capital cities where they settle down, as well as the association of socio-economic characters with the formation of enclaves. It also examines the residential mobility across states and cities from 2001 to 2011 indicating the rising status of median-size Australian capital cities for receiving PRC-born migrants. The paper concludes with a discussion of evidences for policy formation, facilitates the effective transition of PRC-born populations into the mainstream of host society and enhances social harmony to help Australia become a more successful multicultural nation.

Keywords: Australia, Chinese migrants, residential mobility, spatial evolution

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1043 Inadequacy and Inefficiency of the Scoping Requirements in the Preparation of Environmental Impact Assessment Reports for Dam and Reservoir Projects in Thailand

Authors: Natsuda Rattamanee

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Like other countries, Thailand continually experiences strong protests against dam and reservoir proposals, especially large-scale projects. The protestors are constantly worried about the potential significant adverse impacts of the projects on the environment and society. Although project proponents are required by laws to assess the environmental and social impacts of the dam proposals by making environmental impact assessment (EIA) reports and finding mitigation measures before implementing the plans, the outcomes of the assessments often do not lessen the affected people and public’s concerns about the potential negative effects of the projects. One of the main reasons is that Thailand does not have a proper and efficient law to regulate project proponents when determining the scope of environmental impact assessments. Scoping is the crucial second stage of the preparation of an EIA report. The appropriate scope of assessments will allow EIA studies to focus only on the significant effects of the proposed project on particular resources, areas, and communities. It will offer crucial and sufficient information to the decision-makers and the public. The decision to implement the dam and reservoir projects considered based on the assessments with a proper scoping will eventually be more widely accepted by the public and reduce community opposition. The research work seeks to identify flaws in the current requirements of scoping steps under Thai laws and regulations and proposes recommendations to improve the legal scheme. The paper explores the well-established United States laws and relevant rules regulating how lead agencies determine the scope of their environmental impact assessments and some guidelines concerning scoping published by dominant institutions. Policymakers and legislature will find the results of studies helpful in improving the scoping-step requirements of EIA for dam and reservoir projects and reducing the level of anti-dam protests in Thailand.

Keywords: dam and reservoir, EIA, environmental impact assessment, law, scoping, Thailand

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1042 Life Cycle Assessment of Mass Timber Structure, Construction Process as System Boundary

Authors: Mahboobeh Hemmati, Tahar Messadi, Hongmei Gu

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Today, life cycle assessment (LCA) is a leading method in mitigating the environmental impacts emerging from the building sector. In this paper, LCA is used to quantify the Green House Gas (GHG) emissions during the construction phase of the largest mass timber residential structure in the United States, Adohi Hall. This building is a 200,000 square foot 708-bed complex located on the campus of the University of Arkansas. The energy used for buildings’ operation is the most dominant source of emissions in the building industry. Lately, however, the efforts were successful at increasing the efficiency of building operation in terms of emissions. As a result, the attention is now shifted to the embodied carbon, which is more noticeable in the building life cycle. Unfortunately, most of the studies have, however, focused on the manufacturing stage, and only a few have addressed to date the construction process. Specifically, less data is available about environmental impacts associated with the construction of mass timber. This study presents, therefore, an assessment of the environmental impact of the construction processes based on the real and newly built mass timber building mentioned above. The system boundary of this study covers modules A4 and A5 based on building LCA standard EN 15978. Module A4 includes material and equipment transportation. Module A5 covers the construction and installation process. This research evolves through 2 stages: first, to quantify materials and equipment deployed in the building, and second, to determine the embodied carbon associated with running equipment for construction materials, both transported to, and installed on, the site where the edifice is built. The Global Warming Potential (GWP) of the building is the primary metric considered in this research. The outcomes of this study bring to the front a better understanding of hotspots in terms of emission during the construction process. Moreover, the comparative analysis of the mass timber construction process with that of a theoretically similar steel building will enable an effective assessment of the environmental efficiency of mass timber.

Keywords: construction process, GWP, LCA, mass timber

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1041 Technological and Economic Investigation of Concentrated Photovoltaic and Thermal Systems: A Case Study of Iran

Authors: Moloud Torkandam

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Any cities must be designed and built in a way that minimizes their need for fossil fuel. Undoubtedly, the necessity of accepting this principle in the previous eras is undeniable with respect to the mode of constructions. Perhaps only due to the great diversity of materials and new technologies in the contemporary era, such a principle in buildings has been forgotten. The question of optimizing energy consumption in buildings has attracted a great deal of attention in many countries and, in this way, they have been able to cut down the consumption of energy up to 30 percent. The energy consumption is remarkably higher than global standards in our country, and the most important reason is the undesirable state of buildings from the standpoint of energy consumption. In addition to providing the means to protect the natural and fuel resources for the future generations, reducing the use of fossil energies may also bring about desirable outcomes such as the decrease in greenhouse gases (whose emissions cause global warming, the melting of polar ice, the rise in sea level and the climatic changes of the planet earth), the decrease in the destructive effects of contamination in residential complexes and especially urban environments and preparation for national self-sufficiency and the country’s independence and preserving national capitals. This research realize that in this modern day and age, living sustainably is a pre-requisite for ensuring a bright future and high quality of life. In acquiring this living standard, we will maintain the functions and ability of our environment to serve and sustain our livelihoods. Electricity is now an integral part of modern life, a basic necessity. In the provision of electricity, we are committed to respecting the environment by reducing the use of fossil fuels through the use of proven technologies that use local renewable and natural resources as its energy source. As far as this research concerned it is completely necessary to work on different type of energy producing such as solar and CPVT system.

Keywords: energy, photovoltaic, termal system, solar energy, CPVT

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1040 Chassis Level Control Using Proportional Integrated Derivative Control, Fuzzy Logic and Deep Learning

Authors: Atakan Aral Ormancı, Tuğçe Arslantaş, Murat Özcü

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This study presents the design and implementation of an experimental chassis-level system for various control applications. Specifically, the height level of the chassis is controlled using proportional integrated derivative, fuzzy logic, and deep learning control methods. Real-time data obtained from height and pressure sensors installed in a 6x2 truck chassis, in combination with pulse-width modulation signal values, are utilized during the tests. A prototype pneumatic system of a 6x2 truck is added to the setup, which enables the Smart Pneumatic Actuators to function as if they were in a real-world setting. To obtain real-time signal data from height sensors, an Arduino Nano is utilized, while a Raspberry Pi processes the data using Matlab/Simulink and provides the correct output signals to control the Smart Pneumatic Actuator in the truck chassis. The objective of this research is to optimize the time it takes for the chassis to level down and up under various loads. To achieve this, proportional integrated derivative control, fuzzy logic control, and deep learning techniques are applied to the system. The results show that the deep learning method is superior in optimizing time for a non-linear system. Fuzzy logic control with a triangular membership function as the rule base achieves better outcomes than proportional integrated derivative control. Traditional proportional integrated derivative control improves the time it takes to level the chassis down and up compared to an uncontrolled system. The findings highlight the superiority of deep learning techniques in optimizing the time for a non-linear system, and the potential of fuzzy logic control. The proposed approach and the experimental results provide a valuable contribution to the field of control, automation, and systems engineering.

Keywords: automotive, chassis level control, control systems, pneumatic system control

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1039 A Scoping Review of Psychosocial Interventions for the Survivors and/or Victims of Intimate Partner Violence in Low- and Middle-Income Countries

Authors: Mukondi Nethavhakone

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The high prevalence of violence against women is a global public health problem. Our societies have become dangerous places for women. Women during their child-bearing ages are at a higher risk of experiencing emotional, physical, and sexual violence. What makes it more concerning is that these violent acts are perpetrated by family members or partners, or ex-partners. Intimate Partner Violence (IPV) is associated with long-lasting physical, reproductive, sexual, mental, and maternal health implications. Expectedly women’s mental health would dimmish as a result of experiencing IPV. The burden of violence against women is seen to be heavier in low- and middle-income countries (LMICs) compared to the rest of the world. Countries have committed to eliminating all forms of violence against women through the sustainable development goal, aiming to see changes by the year 2030. As such, various countries have implemented psychosocial interventions of different levels of impact. However, little is known, especially in low- and middle-income countries, with regard to the potential of psychosocial interventions for IPV to improve the mental health outcomes for the survivors and/or victims of IPV. Analysing the risk for IPV through a social-ecological theoretical approach, low- and middle-income countries still readdressing gender inequality which is the cause of intimate partner violence. That is why it is taking time for these countries to shift psychosocial interventions to focus more on the improvement of the mental health of the survivors. It is, therefore, against this backdrop that the researcher intends to undertake a scoping review to understand the nature and characteristics of psychosocial interventions that have been implemented in low- and middle-income countries. With the findings from the scoping review, the researcher aims to develop a conceptual framework that may be a useful resource for healthcare practitioners and researchers in low- and middle-income countries. As this area of research has not been thoroughly reviewed, the results from this scoping will determine whether a systematic review will be justifiable. Additionally, the researcher will identify gaps and opportunities for future research in this area.

Keywords: mental health improvement, psychosocial interventions, intimate partner violence, LMICs

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1038 Community Involvement in Reducing Maternal and Perinatal Mortality in Cross River State, Nigeria: 'The Saving Mother Giving Life' Strategic Approach in Cross River State

Authors: Oluwayemisi Femi-Pius, Kazeem Arogundade, Eberechukwu Eke, Jimmy Eko

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Introduction: Globally, community involvement in improving their own health has been widely adopted as a strategy in Sub-Saharan Africa principally to ensure equitable access to essential health care as well as improve the uptake of maternal and newborn health services especially in poor-resource settings. Method: The Saving Mother Giving Life (SMGL) Initiative implemented by Pathfinder International with funding support from USAID conducted a Health Facility Assessment (HFA) and found out that maternal mortality ratio in Cross River State was 812 per 100,000 live birth and perinatal mortality was 160 per 1000 live birth. To reduce maternal and perinatal mortality, Pathfinder International mobilized, selected and trained community members as community volunteers, traditional birth attendants, and emergency transport service volunteer drivers mainly to address the delay in decision making and reaching the health facility among pregnant women. Results: The results showed that maternal mortality ratio in Cross River State decrease by 25% from 812 per 100,000 live birth at baseline to 206 per 100,000 live birth at June 2018 and perinatal mortality reduced by 35% from 160 per 100,000 at baseline to 58 per 1000 live birth at June 2018. Data also show that ANC visit increased from 7,451 to 11,344; institutional delivery increased from 8,931 at baseline to 10,784 in June 2018. There was also a remarkable uptake of post-partum family planning from 0 at baseline to 233 in June 2018. Conclusion: There is clear evidence that community involvement yields positive maternal outcomes and is pivotal for sustaining most health interventions.

Keywords: maternal mortality, Nigeria, pathfinder international, perinatal mortality, saving mother giving life

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1037 Exercise Intensity Increasing Appetite, Energy, Intake Energy Expenditure, and Fat Oxidation in Sedentary Overweight Individuals

Authors: Ghalia Shamlan, M. Denise Robertson, Adam Collins

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Appetite control (i.e. control of energy intake) is important for weight maintenance. Exercise contributes to the most variable component of energy expenditure (EE) but its impact is beyond the energy cost of exercise including physiological, behavioural, and appetite effects. Exercise is known to acutely influence effect appetite but evidence as to the independent effect of intensity is lacking. This study investigated the role of exercise intensity on appetite, energy intake (EI), appetite related hormone, fat utilisation and subjective measures of appetite. One hour after a standardised breakfast, 10 sedentary overweight volunteers. Subjects undertook either 8 repeated 60 second bouts of cycling at 95% VO2max (high intensity) or 30 minutes of continuous cycling, at a fixed cadence, equivalent to 50% of the participant’s VO2max (low intensity) in a randomised crossover design. Glucose, NEFA, glucagon-like peptide-1 (GLP-1) were measured fasted, postprandial, and pre and post-exercise. Satiety was assessed subjectively throughout the study using visual analogue scales (VAS). Ad libitum intake of a pasta meal was measured at the end (3-h post-breakfast). Interestingly, there was not significant difference in EE fat oxidation between HI and LI post-exercise. Also, no significant effect of high intensity (HI) was observed on the ad libitum meal, 24h and 48h EI post-exercise. However the mean 24h EI was 3000 KJ lower following HI than low intensity (LI). Despite, no significant differences in hunger score, glucose, NEFA and GLP-1 between both intensities were observed. However, NEFA and GLP-1 plasma level were higher until 30 min post LI. In conclusion, the similarity of EE and oxidation outcomes could give overweight individuals an option to choose between intensities. However, HI could help to reduce EI. There are mechanisms and consequences of exercise in short and long-term appetite control; however, these mechanisms warrant further explanation. These results support the need for future research in to the role of in regulation energy balance, especially for obese people.

Keywords: appetite, exercise, food intake, energy expenditure

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1036 Combining the Fictitious Stress Method and Displacement Discontinuity Method in Solving Crack Problems in Anisotropic Material

Authors: Bahatti̇n Ki̇mençe, Uğur Ki̇mençe

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In this study, the purpose of obtaining the influence functions of the displacement discontinuity in an anisotropic elastic medium is to produce the boundary element equations. A Displacement Discontinuous Method formulation (DDM) is presented with the aim of modeling two-dimensional elastic fracture problems. This formulation is found by analytical integration of the fundamental solution along a straight-line crack. With this purpose, Kelvin's fundamental solutions for anisotropic media on an infinite plane are used to form dipoles from singular loads, and the various combinations of the said dipoles are used to obtain the influence functions of displacement discontinuity. This study introduces a technique for coupling Fictitious Stress Method (FSM) and DDM; the reason for applying this technique to some examples is to demonstrate the effectiveness of the proposed coupling method. In this study, displacement discontinuity equations are obtained by using dipole solutions calculated with known singular force solutions in an anisotropic medium. The displacement discontinuities method obtained from the solutions of these equations and the fictitious stress methods is combined and compared with various examples. In this study, one or more crack problems with various geometries in rectangular plates in finite and infinite regions, under the effect of tensile stress with coupled FSM and DDM in the anisotropic environment, were examined, and the effectiveness of the coupled method was demonstrated. Since crack problems can be modeled more easily with DDM, it has been observed that the use of DDM has increased recently. In obtaining the displacement discontinuity equations, Papkovitch functions were used in Crouch, and harmonic functions were chosen to satisfy various boundary conditions. A comparison is made between two indirect boundary element formulations, DDM, and an extension of FSM, for solving problems involving cracks. Several numerical examples are presented, and the outcomes are contrasted to existing analytical or reference outs.

Keywords: displacement discontinuity method, fictitious stress method, crack problems, anisotropic material

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1035 Anatomically-Based Oropharyngeal Rehabilitation for the Patients with Obstructive Sleep Apnea Using a Multilevel Approach

Authors: Hsin-Yu Lin, Ching-Hsia Hung

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Obstructive sleep apnea (OSA) is characterized by a complete or partial obstruction of the upper airway during sleep. The vulnerable sites of upper airway collapses are consequences of sleep state-dependent reductions in tone in specific pharyngeal dilators. Clinical examinations reveal multilevel collapses of the upper airway among the patients with OSA. Therefore, an anatomically-based oropharyngeal rehabilitation should comprise a multilevel approach, including retropalatal, retroglossal, hypopharyngeal, temporomandibular, and facial levels, all of which involve different muscle groups and contribute to multifunctional interaction and coordination, such as swallowing, breathing, and phonation. The purpose of the study was to exam the effects of this rehabilitation program with a multilevel approach. In this study, fifteen subjects with newly diagnosed moderate or severe OSA (Apnea-Hypopnea-Index≥15) were randomized into an intervention group and control group. The intervention group (N=8) underwent a 12-week-intervention of a hospital-based rehabilitation program, while the control group (N=7) was kept on the waiting list. The 12-week-intervention comprised an anatomically based multilevel approach. The primary outcome was Polysomnography (PSG) data, and the secondary outcome was oropharyngeal and respiratory muscle function. In the intervention group, Apnea-Hypopnea-Index significantly improved (46.96±19.45 versus 32.78±10.78 events/h, p=0.017) compared with control group (35.77±17.49 versus 42.96±17.32 events/h, p=0.043). While the control group remained no change, the intervention group demonstrated other PSG outcomes significantly improvement, including arousal index (46.04±18.9 versus 32.98±8.35/h, p=0.035), mean SpO2 (92.88±2.1 versus 94.13±1.46%, p=0.039). Besides, the intervention group demonstrated significant improvement in oropharyngeal and respiratory muscle function compared to the control group. This anatomically-based oropharyngeal rehabilitation with a multilevel approach can be proven as a non-invasive therapy for patients with OSA.

Keywords: obstructive sleep apnea, upper airway, oropharyngeal rehabilitation, multilevel approach

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1034 Statistical Approach to Identify Stress and Biases Impairing Decision-Making in High-Risk Industry

Authors: Ph. Fauquet-Alekhine

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Decision-making occurs several times an hour when working in high risk industry and an erroneous choice might have undesirable outcomes for people and the environment surrounding the industrial plant. Industrial decisions are very often made in a context of acute stress. Time pressure is a crucial stressor leading decision makers sometimes to boost up the decision-making process and if it is not possible then shift to the simplest strategy. We thus found it interesting to update the characterization of the stress factors impairing decision-making at Chinon Nuclear Power Plant (France) in order to optimize decision making contexts and/or associated processes. The investigation was based on the analysis of reports addressing safety events over the last 3 years. Among 93 reports, those explicitly addressing decision-making issues were identified. Characterization of each event was undertaken in terms of three criteria: stressors, biases impairing decision making and weaknesses of the decision-making process. The statistical analysis showed that biases were distributed over 10 possibilities among which the hypothesis confirmation bias was clearly salient. No significant correlation was found between criteria. The analysis indicated that the main stressor was time pressure and highlights an unexpected form of stressor: the trust asymmetry principle of the expert. The analysis led to the conclusion that this stressor impaired decision-making from a psychological angle rather than from a physiological angle: it induces defensive bias of self-esteem, self-protection associated with a bias of confirmation. This leads to the hypothesis that this stressor can intervene in some cases without being detected, and to the hypothesis that other stressors of the same kind might occur without being detected too. Further investigations addressing these hypotheses are considered. The analysis also led to the conclusion that dealing with these issues implied i) decision-making methods being well known to the workers and automated and ii) the decision-making tools being well known and strictly applied. Training was thus adjusted.

Keywords: bias, expert, high risk industry, stress.

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1033 Return to Bowel Function after Right versus Extended Right Hemicolectomy: A Retrospective Review

Authors: Zak Maas, Daniel Carson, Rachel McIntyre, Mark Omundsen, Teresa Holm

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Aim: After hemicolectomy a period of obligatory bowel dysfunction is expected, termed postoperative ileus (POI). Prolonged postoperative ileus (PPOI), typically four or more days, is associated with higher morbidity and extended inpatient stay. This leads to significant financial and resource-related burdens on healthcare systems. Several studies including a meta-analysis have compared rates of PPOI in left vs right hemicolectomy, which suggest that right-sided resections may be more likely to result in PPOI. Our study aims to further investigate whether significant differences in PPOI and obligatory POI exist between right versus extended right hemicolectomy. Methods: This is a retrospective review assessing rates of PPOI in patients who underwent right vs extended right hemicolectomy at Tauranga Hospital. Patients were divided and compared depending on approach (open versus laparoscopic) and acuity (acute versus elective). Exclusion criteria included synchronous major operations and patients preoperatively on parenteral nutrition. Primary outcome was PPOI as pre-defined in contemporary literature. Secondary outcomes were time to passage of flatus, passage of stool, toleration of oral diet and rate of complications. Results: There were 669 patients identified for analysis (507 laparoscopic vs 162 open; 194 acute vs 475 elective). Early analysis indicates rates of PPOI was significantly increased in patients undergoing extended right hemicolectomy. Factors including age, gender, ethnicity, preoperative haemaglobin, preoperative albumin and diagnosis of inflammatory bowel disease were examined by multivariate analysis to determine correlation with PPOI. Conclusion: PPOI is a common complication of hemicolectomy surgery. Higher rates of PPOI in extended right vs right hemicolectomy warrants further research into determining the cause. This study examines some other factors which may contribute to PPOI.

Keywords: hemicolectomy, colorectal, complications, postoperative ileus

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1032 A Perspective on Teaching Mathematical Concepts to Freshman Economics Students Using 3D-Visualisations

Authors: Muhammad Saqib Manzoor, Camille Dickson-Deane, Prashan Karunaratne

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Cobb-Douglas production (utility) function is a fundamental function widely used in economics teaching and research. The key reason is the function's characteristics to describe the actual production using inputs like labour and capital. The characteristics of the function like returns to scale, marginal, and diminishing marginal productivities are covered in the introductory units in both microeconomics and macroeconomics with a 2-dimensional static visualisation of the function. However, less insight is provided regarding three-dimensional surface, changes in the curvature properties due to returns to scale, the linkage of the short-run production function with its long-run counterpart and marginal productivities, the level curves, and the constraint optimisation. Since (freshman) learners have diverse prior knowledge and cognitive skills, the existing “one size fits all” approach is not very helpful. The aim of this study is to bridge this gap by introducing technological intervention with interactive animations of the three-dimensional surface and sequential unveiling of the characteristics mentioned above using Python software. A small classroom intervention has helped students enhance their analytical and visualisation skills towards active and authentic learning of this topic. However, to authenticate the strength of our approach, a quasi-Delphi study will be conducted to ask domain-specific experts, “What value to the learning process in economics is there using a 2-dimensional static visualisation compared to using a 3-dimensional dynamic visualisation?’ Here three perspectives of the intervention were reviewed by a panel comprising of novice students, experienced students, novice instructors, and experienced instructors in an effort to determine the learnings from each type of visualisations within a specific domain of knowledge. The value of this approach is key to suggesting different pedagogical methods which can enhance learning outcomes.

Keywords: cobb-douglas production function, quasi-Delphi method, effective teaching and learning, 3D-visualisations

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1031 Endoscopic Versus Open Treatment of Carpal Tunnel Syndrome: Postoperative Complications in Patients on Anticoagulation

Authors: Arman Kishan, Mark Haft, Kiyanna Thomas, Duc Nguyen, Dawn Laporte

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Objective: Patients receiving anticoagulation therapy frequently experience increased rates of postoperative complications. Presently, limited data exist regarding the outcomes of patients undergoing carpal tunnel release surgery (CTR) while on anticoagulation. Our objective is to examine and compare the occurrence of complications in patients on anticoagulation who underwent either endoscopic CTR (ECTR) or open CTR (OCTR) for CTS. Methods: The Trinet X database was utilized to retrospectively identify patients who underwent OCTR or ECTR while concurrently on anticoagulation. Demographic data, medical comorbidities, and complication rates were analyzed. We used multivariable analysis to identify differences in postoperative complications, including wound infection within 90 days, wound dehiscence within 90 days, and intraoperative median nerve injury between the two surgical methods in patients on anticoagulation. Results: A total of 10,919 carpal tunnel syndrome patients on anticoagulation were included in the study, with 9082 and 1837 undergoing OCTR and ECTR, respectively. Among patients on anticoagulation, those undergoing ECTR exhibited a significantly lower occurrence of 90-day wound infection (p < 0.001) and nerve injury (p < 0.001) compared to those who underwent OCTR. However, there was no statistically significant difference in the risk of 90-day wound dehiscence between the two groups (p = 0.323). Conclusion:  In prior studies, ECTR demonstrated reduced rates of postoperative complications compared to OCTR in the general population. Our study demonstrates that among patients on anticoagulation, those undergoing ECTR experienced a significantly lower incidence of 90-day wound infection and nerve injury, with risk reductions of 35% and 40%, respectively. These findings support using ECTR as a preferred surgical method for patients with CTS who are on anticoagulation therapy.

Keywords: endoscopic treatment of carpal tunnel syndrome, open treatment of carpal tunnel syndrome, postoperative complications in patients on anticoagulation, carpal tunnel syndrome

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1030 Evaluation of the Spectrum of Cases of Perforation Peritonitis at Jawaharlal Nehru Medical College, Aligarh Muslim University

Authors: Mujahid Ali, Wasif Mohammed Ali, Meraj Ahmad

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Background: Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well as in India. The etiology of perforation peritonitis in India continues to be different from its western counterparts. The aim of this study is to evaluate the spectrum of cases of perforation peritonitis at our hospital. Methods: A prospective study conducted includes three hundred thirtysix patients of perforation peritonitis at J. N. Medical College from October 2015 to July 2017. The patients were admitted, resuscitated and underwent emergency laparotomy. Data were collected in terms of demographic profile, clinical presentations, site of perforations, causes and surgical outcomes. Results: In this study, the most common cause of perforation peritonitis was peptic ulcer disease (43%), followed by enteric perforation (12.8%), tubercular perforation (12.5%), traumatic perforation (11.9%), appendicular perforation (9.8%), amoebic caecal perforation (3%), malignant perforation (1.5%), etc. The sites of perforations were stomach in majority (38.3%), ileum (31%), appendix (8%), duodenum (5.%), caecum (4.4%) ,colon (3%), jejunum (8.5%) and gall bladder (2%). The overall mortality was 21% in our study. Age >50 years (p= <0.0001, OR= 3.9260, CI= 2.2 to 6.9), organ failure (p= <0.0001, OR= 29.2, CI= 14.8 to 57.6), shock (p=<0.0001, OR=20.20, CI= 10.56 to 38.6), diffuse peritonitis (p<0.0015, OR= 6.8810, CI= 2.09 to 22.57) and faecal exudates (p<0.0001) were found to be significant factors affecting mortality. The most common complication associated was superficial wound infection (40%), followed by burst abdomen seen in 21% cases, intra-abdominal sepsis in 18% cases, electrolyte imbalances in 15% cases, anastomotic leak in 6% cases. Conclusion: In this study, stomach is the most common site of perforation with peptic ulcer disease being the most common etiology. Older age, presence of shock, organ failure and faecal peritonitis were the risk factors affecting the mortality of the patients. Early recognition, adequate resuscitation and referral of patients can influence outcome and reduces mortality as well as morbidity.

Keywords: etiology, mortality, perforation, spectrum

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1029 Long-Term Effects of Psychosocial Interventions for Adolescents on Depression and Anxiety: A Systematic Review and Meta-Analysis

Authors: Denis Duagi, Ben Carter, Maria Farrelly, Stephen Lisk, June S. L. Brown

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Background: Adolescence represents a distinctive phase of development, and variables linked to this developmental period could affect the efficiency of prevention and treatment for depression and anxiety, as well as the long-term prognosis. The objectives of this study were to investigate the long-term effectiveness of psychosocial interventions for adolescents on depression and anxiety symptoms and to assess the influence of different intervention parameters on the long-term effects. Methods: Searches were carried out on the 11ᵗʰ of August 2022 using five databases (Cochrane Library, Embase, Medline, PsychInfo, Web of Science), as well as trial registers. Randomized controlled trials of psychosocial interventions targeting specifically adolescents were included if they assessed outcomes at 1-year post-intervention or more. The Cochrane risk of bias-2 quality assessment tool was used. The primary outcome was depression, and studies were pooled using a standardised mean difference, with an associated 95% confidence interval, p-value, and I². The study protocol was pre-registered (CRD42022348668). Findings: A total of 57 reports (n= 46,678 participants) were included in the review. Psychosocial interventions led to small reductions in depressive symptoms, with a standardised mean difference (SMD) at 1-year of -0.08 (95%CI -0.20, -0.03, p=0.002, I²=72%), 18-months SMD=-0.12, 95% CI -0.22, -0.01, p=0.03, I²=63%) and 2-years SMD=-0.12 (95% CI -0.20, -0.03, p=0.01, I²=68%). Sub-group analyses indicated that targeted interventions produced stronger effects, particularly when delivered by trained mental health professionals (K=18, SMD=-0.24, 95% CI -0.38, -0.10, p=0.001, I²=60%). No effects were detected for anxiety at any assessment. Conclusion: Psychosocial interventions specifically targeting adolescents were shown to have small but positive effects on depression symptoms but not anxiety symptoms, which were sustained for up to 2 years. These findings highlight the potential population-level preventive effects if such psychosocial interventions become widely implemented in accessible settings such as schools.

Keywords: psychosocial, adolescent, interventions, depression, anxiety, meta-analysis, randomized controlled trial

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1028 Dynamic Control Theory: A Behavioral Modeling Approach to Demand Forecasting amongst Office Workers Engaged in a Competition on Energy Shifting

Authors: Akaash Tawade, Manan Khattar, Lucas Spangher, Costas J. Spanos

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Many grids are increasing the share of renewable energy in their generation mix, which is causing the energy generation to become less controllable. Buildings, which consume nearly 33% of all energy, are a key target for demand response: i.e., mechanisms for demand to meet supply. Understanding the behavior of office workers is a start towards developing demand response for one sector of building technology. The literature notes that dynamic computational modeling can be predictive of individual action, especially given that occupant behavior is traditionally abstracted from demand forecasting. Recent work founded on Social Cognitive Theory (SCT) has provided a promising conceptual basis for modeling behavior, personal states, and environment using control theoretic principles. Here, an adapted linear dynamical system of latent states and exogenous inputs is proposed to simulate energy demand amongst office workers engaged in a social energy shifting game. The energy shifting competition is implemented in an office in Singapore that is connected to a minigrid of buildings with a consistent 'price signal.' This signal is translated into a 'points signal' by a reinforcement learning (RL) algorithm to influence participant energy use. The dynamic model functions at the intersection of the points signals, baseline energy consumption trends, and SCT behavioral inputs to simulate future outcomes. This study endeavors to analyze how the dynamic model trains an RL agent and, subsequently, the degree of accuracy to which load deferability can be simulated. The results offer a generalizable behavioral model for energy competitions that provides the framework for further research on transfer learning for RL, and more broadly— transactive control.

Keywords: energy demand forecasting, social cognitive behavioral modeling, social game, transfer learning

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1027 Pre-Experimental Research to Investigate the Retention of Basic and Advanced Life Support Measures Knowledge and Skills by Qualified Nurses Following a Course in Professional Development in a Tertiary Teaching Hospital

Authors: Ram Sharan Mehta, Gayanandra Malla, Anita Gurung, Anu Aryal, Divya Labh, Hricha Neupane

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Objectives: Lack of resuscitation skills of nurses and doctors in basic life support (BLS) and advanced life support (ALS) has been identified as a contributing factor to poor outcomes of cardiac arrest victims. The objective of this study was to examine retention of life support measures (BLS/ALS) knowledge and skills of nurses following education intervention programme. Materials and Methods: Pre-experimental research design was used to conduct the study among the nurses working in medical units of B.P Koirala Institute of Health Sciences, where CPR is very commonly performed. Using convenient sampling technique total of 20 nurses agreed to participate and give consent were included in the study. The theoretical, demonstration and re-demonstration were arranged involving the trained doctors and nurses during the three hours educational session. Post-test was carried out after two week of education intervention programme. The 2010 BLS & ALS guidelines were used as guide for the study contents. The collected data were analyzed using SPSS-15 software. Results: It was found that there is significant increase in knowledge after education intervention in the components of life support measures (BLS/ALS) i.e. ratio of chest compression to ventilation in BLS (P=0.001), correct sequence of CPR (p <0.001), rate of chest compression in ALS (P=0.001), the depth of chest compression in adult CPR (p<0.001), and position of chest compression in CPR (P=0.016). Nurses were well appreciated the programme and request to continue in future for all the nurses. Conclusions: At recent BLS/ALS courses (2010), a significant number of nurses remain without any such training. Action is needed to ensure all nurses receive BLS training and practice this skill regularly in order to retain their knowledge.

Keywords: pre-experimental, basic and advance life support, nurses, sampling technique

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1026 Examining Patterns in Ethnoracial Diversity in Los Angeles County Neighborhoods, 2016, Using Geographic Information System Analysis and Entropy Measure of Diversity

Authors: Joseph F. Cabrera, Rachael Dela Cruz

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This study specifically examines patterns that define ethnoracially diverse neighborhoods. Ethnoracial diversity is important as it facilitates cross-racial interactions within neighborhoods which have been theorized to be associated with such outcomes as intergroup harmony, the reduction of racial and ethnic prejudice and discrimination, and increases in racial tolerance. Los Angeles (LA) is an ideal location to study ethnoracial spatial patterns as it is one of the most ethnoracially diverse cities in the world. A large influx of Latinos, as well as Asians, have contributed to LA’s urban landscape becoming increasingly diverse over several decades. Our dataset contains all census tracts in Los Angeles County in 2016 and incorporates Census and ACS demographic and spatial data. We quantify ethnoracial diversity using a derivative of Simpson’s Diversity Index and utilize this measure to test previous literature that suggests Latinos are one of the key drivers of changing ethnoracial spatial patterns in Los Angeles. Preliminary results suggest that there has been an overall increase in ethnoracial diversity in Los Angeles neighborhoods over the past sixteen years. Patterns associated with this trend include decreases in predominantly white and black neighborhoods, increases in predominantly Latino and Asian neighborhoods, and a general decrease in the white populations of the most diverse neighborhoods. A similar pattern is seen in neighborhoods with large Latino increases- a decrease in white population, but with an increase in Asian and black populations. We also found support for previous research that suggests increases in Latino and Asian populations act as a buffer, allowing for black population increases without a sizeable decrease in the white population. Future research is needed to understand the underlying causes involved in many of the patterns and trends highlighted in this study.

Keywords: race, race and interaction, racial harmony, social interaction

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1025 Selective Recovery and Molecular Identification of Laccase-Producing Bacteria from Selected Terrestrial and Aquatic Milieu in the Eastern Cape, South Africa: Toward the Production of Environmentally Relevant Biocatalysts

Authors: John Onolame Unuofin, Uchechukuw U. Nwodo, Anthony I. Okoh

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Laccase is constantly gaining status as important biocatalyst in biotechnology. The illimitable potential of its industrial applications and the corresponding aggressive need for phenomenal volumes of extracellularly secreted laccases have called for its interminable production from sources which are able to meet this demand within a relatively short period of time, preferably bacteria. In response to this call, this study was designed to source for laccase-producing bacteria from different environmental matrices. Three sampling environments were chosen such as wastewater treatment plants, University of Fort Hare vicinity and the Hogback woodland, all within the Eastern Cape, South Africa. Samples such as effluents, sediments, leaf litters, degrading wood and rock scrapings were selectively enriched with some model aromatic compounds and were further screened qualitatively and quantitatively on five phenolic substrates ABTS (2,2’-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid), Guaiacol, 1-Naphthol, Potassium Ferric Cyanide and Syringaldazine). Basis for selection was their ability to elicit a colour change on at least three of the above mentioned agar based assay substrates. The choice isolates were further identified based on 16S rRNA molecular identification techniques. 33 isolates were screened out of the 40 representative distinct colonies during the qualitative plate screens, while quantitative screens selected out 11 bacterial isolates. They were, based on molecular identification, desginated as members of the genera Pseudomonas, Stenotrophomonas and Citrobacter of the gammaproteobacteria and Bordetalla and Achromobacter of the betaproteobacteria respectively. We therefore conclude based on our outcomes that we may have isolated efficient laccase-producing bacteria, which might be of beneficial significance in catalysis and biotechnology.

Keywords: beta proteobacteria, catalysis, gammaproteobacteria, laccase

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