Search results for: patient safety in home hemodialysis

Authors: Aulon Shabani, Denis Panxhi, Orion Zavalani

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This paper presents the modelling and development of a simulator for residential electrical appliances. The simulator is developed on MATLAB providing the possibility to analyze and simulate energy consumption of frequently used home appliances in Albania. Modelling of devices considers the impact of different factors, mentioning occupant behavior and climacteric conditions. Most devices are modeled as an electric circuit, and the electric energy consumption is estimated by the solutions of the guiding differential equations. The provided models refer to devices like a dishwasher, oven, water heater, air conditioners, light bulbs, television, refrigerator water, and pump. The proposed model allows us to simulate beforehand the energetic behavior of the largest consumption home devices to estimate peak consumption and improving its reduction. Simulated home prototype results are compared to real measurement of a considered typical home. Obtained results from simulator framework compared to monitored typical household using EmonTxV3 show the effectiveness of the proposed simulation. This conclusion will help for future simulation of a large group of typical household for a better understanding of peak consumption.

Keywords: electrical appliances, energy management, modelling, peak estimation, simulation, smart home

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Authors: N. Borjalilu, P. Rabiei, A. Enjoo

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Flight Data Monitoring (FDM) program assists an operator in aviation industries to identify, quantify, assess and address operational safety risks, in order to improve safety of flight operations. FDM is a powerful tool for an aircraft operator integrated into the operator’s Safety Management System (SMS), allowing to detect, confirm, and assess safety issues and to check the effectiveness of corrective actions, associated with human errors. This article proposes a model for safety risk assessment level of flight data in a different aspect of event focus based on fuzzy set values. It permits to evaluate the operational safety level from the point of view of flight activities. The main advantages of this method are proposed qualitative safety analysis of flight data. This research applies the opinions of the aviation experts through a number of questionnaires Related to flight data in four categories of occurrence that can take place during an accident or an incident such as: Runway Excursions (RE), Controlled Flight Into Terrain (CFIT), Mid-Air Collision (MAC), Loss of Control in Flight (LOC-I). By weighting each one (by F-TOPSIS) and applying it to the number of risks of the event, the safety risk of each related events can be obtained.

Keywords: F-topsis, fuzzy set, flight data monitoring (FDM), flight safety

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Authors: Hanneke J. A. Smaling, Mandy Visser

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One way to reduce the risk of COVID-19 infection is by preventing close interpersonal contact with distancing measures. These social distancing measures presented challenges to the health and wellbeing of people with dementia and their informal and professional caregivers. This study describes the concerns and recommendations of informal and professional caregivers for COVID-19 policy for home care and long-term care for people with dementia during the first and second COVID-19 wave in the Netherlands. In this qualitative interview study, 20 informal caregivers and 20 professional caregivers from home care services and long-term care participated. Interviews were analyzed using an inductive thematic analysis approach. Both informal and professional caregivers worried about getting infected or infecting others with COVID-19, the consequences of the distancing measures, and quality of care. There was a general agreement that policy in the second wave was better informed compared to the first wave. At an organizational level, the policy was remarkably flexible. Recommendations were given for dementia care (need to offer meaningful activities, improve the organization of care, more support for informal caregivers), policy (national vs. locally organization, social isolation measures, visitor policy), and communication. Our study contributes to the foundation of future care decisions by (inter)national policymakers, politicians, and healthcare organizations during the course of the COVID-19 pandemic, underlining the need for balance between safety and autonomy for people with dementia.

Keywords: covid-19, dementia, home care, long-term care, policy

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Authors: Upal Barua

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Crash risk at intersections is a critical safety issue. This paper examines the effectiveness of removing an existing off-set at an intersection by realignment, in reducing crashes. Empirical Bayes method was applied to conduct a before-and-after study to assess the effect of this safety improvement. The Transportation Safety Improvement Program in Austin Transportation Department completed several safety improvement projects at high crash intersections with a view to reducing crashes. One of the common safety improvement techniques applied was the realignment of intersection approaches removing an existing off-set. This paper illustrates how this safety improvement technique is applied at a high crash intersection from inception to completion. This paper also highlights the significant crash reductions achieved from this safety improvement technique applying Empirical Bayes method in a before-and-after study. The result showed that realignment of intersection approaches removing an existing off-set can reduce crashes by 53%. This paper also features the state of the art techniques applied in planning, engineering, designing and construction of this safety improvement, key factors driving the success, and lessons learned in the process.

Keywords: crash risk, intersection, off-set, safety improvement technique, before-and-after study, empirical Bayes method

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Authors: Sagar R. Patil, Dinesh R. Gawade, Sudhir N. Divekar

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One of the medical devices we found when we visit a hospital care unit such device is ‘patient monitoring system’. This device (patient monitoring system) informs doctors and nurses about the patient’s physiological signals. However, this device (patient monitoring system) does not have a remote monitoring capability, which is necessitates constant onsite attendance by support personnel (doctors and nurses). Thus, we have developed a Remote Wireless Patient Monitoring System using some biomedical sensors and Android OS, which is a portable patient monitoring. This device(Remote Wireless Patient Monitoring System) monitors the biomedical signals of patients in real time and sends them to remote stations (doctors and nurse’s android Smartphone and web) for display and with alerts when necessary. Wireless Patient Monitoring System different from conventional device (Patient Monitoring system) in two aspects: First its wireless communication capability allows physiological signals to be monitored remotely and second, it is portable so patients can move while there biomedical signals are being monitor. Wireless Patient Monitoring is also notable because of its implementation. We are integrated four sensors such as pulse oximeter (SPO2), thermometer, respiration, blood pressure (BP), heart rate and electrocardiogram (ECG) in this device (Wireless Patient Monitoring System) and Monitoring and communication applications are implemented on the Android OS using threads, which facilitate the stable and timely manipulation of signals and the appropriate sharing of resources. The biomedical data will be display on android smart phone as well as on web Using web server and database system we can share these physiological signals with remote place medical personnel’s or with any where in the world medical personnel’s. We verified that the multitasking implementation used in the system was suitable for patient monitoring and for other Healthcare applications.

Keywords: patient monitoring, wireless patient monitoring, bio-medical signals, physiological signals, embedded system, Android OS, healthcare, pulse oximeter (SPO2), thermometer, respiration, blood pressure (BP), heart rate, electrocardiogram (ECG)

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Authors: Natalie Cutler, Lorna Moxham, Moira Stephens

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Safety is a priority in mental health services, and no more so than in the acute inpatient setting. Mental health service policies and accreditation frameworks commonly approach safety from a risk reduction or elimination perspective leading to service approaches that are arguably more focused on risk than on safety. An exploration what safety means for people who have experienced admission to an acute mental health inpatient unit is currently under way in Sydney, Australia. Using a phenomenographic research approach, this study is seeking to understand the meaning of safety from the perspective of people who use, rather than those who deliver mental health services. Preliminary findings suggest that the meanings of safety for users of mental health services vary from the meanings inherent in the policies and frameworks that inform how mental health services and mental health practice are delivered. This variance has implications for the physical and environmental design of acute mental health inpatient facilities, the policies and practices, and the education and training of mental health staff in particular nurses, who comprise the majority of the mental health workforce. These variances will be presented, along with their implications for the way quality and safety in mental health services are evaluated.

Keywords: acute inpatient, mental health, nursing, phenomenography, recovery, safety

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Authors: Marzieh Ebrahimi, Vahid Changizi, Mohammad Reza Kardan, Seyed Mahdi Hosseini Pooya, Parham Geramifar

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Radiation exposure to the patient's family members is one of the major concerns during thyroid cancer radionuclide therapy. The aim of this study was to measure the total effective dose of the family members by means of thermoluminescence personal dosimeter, and compare with those calculated by analytical methods. Eighty-five adult family members of fifty-one patients volunteered to participate in this research study. Considering the minimum and maximum range of dose rate from 15 µsv/h to 120 µsv/h at patients' release time, the calculated mean and median dose values of family members were 0.45 mSv and 0.28 mSv, respectively. Moreover, almost all family members’ doses were measured to be less than the dose constraint of 5 mSv recommended by Basic Safety Standards. Considering the influence parameters such as patient dose rate and administrated activity, the total effective doses of family members were calculated by TEDE and NRC formulas and compared with those of experimental results. The results indicated that, it is fruitful to use the quantitative calculations for releasing patients treated with I-131 and correct estimation of patients' family doses.

Keywords: effective dose, thermoluminescence, I-131, thyroid cancer

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Authors: Katie E. Jennings

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The interactions between family dynamics and environmental factors with mental health vulnerability in individuals are well known and are a theme for on-going research and debate. The impact upon mental health issues and forensic issues on family dynamics, experience, and emotional wellbeing cannot be over-Emphasised. For forensic patients with diagnosed mental disorders, these relationships and environments may have also been functionally linked to the development and maintenance of those disorders; with significant adverse childhood experiences being a common feature of many Patient’s histories. Mental health hospitals remove the patient from their home environments and provide treatment outside of these relationships and often outside of the home area. There is, therefore, a major focus on Services ensuring that patients are able to build and maintain relationships with family and friends, requiring services to involve families in Patients' care and treatment wherever possible. There are standards set by Government and clinical bodies that require absolute demonstration of the inclusion of family and friends in all aspects of the care and treatment of forensic patients. For some patients and family members, this push to take on a “role” in care can be unhelpful, extremely stressful, and has constant implications for the potential delicate reparation of relationships. Based on work undertaken for over 20 years in forensic mental health settings, this paper explores the positive psychology approach to a dimensional model to family inclusion in mental health care that learns from family court work and allows for the maintenance of relationships to be at both proximal and Distil levels; to prevent the replication of abuse, decrease the need for falsehoods and assist the recovery of all. The model is based on allowing families to choose to not be involved or be involved in different ways if this is seen to be more helpful. It also allows patients to choose the level of potential involvement that they would find helpful, and for this to be reviewed at a timeframe agreed by all parties, rather than when the next survey is due or the patient has a significant care meeting. This paper is significant as there is a lack of research to support services to use a positive psychology approach to work in this area, the assumption that being asked to be involved must be positive for all seems naïve at best for this patient group. Work relating to the psychology of family can significantly contribute to the development of knowledge in this area. The development of a dimensional model will support choice within families and assist in the development of more honest and open relationships.

Keywords: family dynamics, forensic, mental disorder, positive psychology

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Authors: Hussain Ali, Ahmad Ali, Syed Rashid Ali

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The maternal mortality is one of the basic health issues faced by rural women in Pakistan. There are various structural and socio-cultural determinants which confine women to domestic sphere. Such mobility restriction compels women for home delivery which causes high maternal mortality and morbidity. However, it is hard to find out the research findings and well-organized literature that explain the cultural factors act as determinant to home delivery among Pakhtun women. The overall objective of this research is to study men’s decision making within the household in Pakhtun society as determinant of home delivery among Pakhtun women in Khyber Pakhtunkhwa province of Pakistan. In the present study, researchers used the quantitative research design in which the data are collected through household survey technique from (n=503) ever-married women having reproductive age (15-49 years) by using interview schedule. The data are analyzed through SPSS, and binary logistic regression was applied to draw the association between home as a place of delivery and men’s decision making in the Pakhtun society. The results show that majority (76%) of the husbands are key decision makers about the home delivery due to their superior position within household. Similarly, majority (88%) Pakhtun women prefer to stay in home for their delivery due to their dependency on husband’s decision. The researcher concludes that men are key decision makers in Pakhtun society and their decisions affect women maternal health care. Similarly, the women are in subordinate position, and their limited decision making in the domestic sphere are greatly responsible for home delivery which causing high maternal mortality rate in the study area. In order to achieve Sustainable Development Goal No. 3, the study recommends empowering women in the decision making about accessing and utilizing maternal health care services and given financial autonomy to them.

Keywords: home delivery, men’s decision, Pakhtun women, subordinate position

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Authors: Preeda Sansakorn, Min An

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In order to be capable of dealing with uncertainties, subjectivities, including vagueness arising in building construction projects, the application of fuzzy reasoning technique based on fuzzy set theory is proposed. This study contributes significantly to the development of a fuzzy reasoning safety risk assessment model for building construction projects that could be employed to assess the risk magnitude of each hazardous event identified during construction, and a third parameter of probability of consequence is incorporated in the model. By using the proposed safety risk analysis methodology, more reliable and less ambiguities, which provide the safety risk management project team for decision-making purposes.

Keywords: safety risk assessment, building construction safety, fuzzy reasoning, construction risk assessment model, building construction projects

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Authors: Zainab Bashir

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There has been a lot of quantitative research on end-stage renal disease (ESRD), its implications, psychological effects and so on across the world, however little qualitative information is available on coping strategies and illness role adaptations specific to renal failure. This article attempts to learn about illness roles and coping strategies specific to aged ESRD patients on hemodialysis in Lahore. The patients were interviewed on a structured schedule and were asked questions on tasks and coping related to physical, psychological, and social consequences of renal failure. Standardised techniques and methods of grounded theory were used to analyse and code the information in this small-scale, in-depth study. An analysis of tasks faced by the ESRD patients and coping they employ to fulfill or overcome those tasks were done. This analysis was based on three different types of data: experiential accounts of ESRD patients with respect to tasks and strategies for coping, coping styles and illness roles typologies, and monographs of coping styles. In the information gathered using interviews with respondents, three styles of problem focused coping, and two styles of emotion focused coping could be identified. Problem focused coping included making physical adjustments to suit the requirements of the health condition, including dialysis and medical regime as integral part of patients’ lives, and altering future plans according to the course of the disease. Emotion focused coping included seeking help to manage stress/anxiety and resenting the disease condition and giving up. These coping styles are linked to the illness roles assigned to the respondents. In conclusion, there is no single formula to deal with the disease, however, some typologies can be established. In most of the cases discussed in the paper, adjustment to a regular dialysis routine, restriction in bodily function, inability to work and negative impacts on family life, especially spousal relationships have come to fore as common problems. A large part of coping with these problems had to do with mentally accepting the disease and carrying on despite. These cannot be seen as deviant adaptations to the depressive situation arising from renal failure, but more of patterned ways in which patients can approximate a close to normal lifestyle despite the terminal disease.

Keywords: coping strategies, ESRD patients, hemodialysis, illness roles

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Authors: Hennie Boeije, Renate Verkaik, Joke Korevaar

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In Dutch national policy, it is promoted that the elderly remain living at home longer. They are less often admitted to a nursing home or only later in life. While living at home, it is important that they experience a good quality of life. Care providers in primary care support this. In this study, it was investigated what quality of life means for the elderly and which characteristics care should have that supports living at home longer with quality of life. To explore this topic, a qualitative methodology was used. Four focus groups were conducted: two with elderly people who live at home and their family caregivers, one with district nurses employed in-home care services and one with elderly care physicians working in primary care. Next to this individual interviews were employed with general practitioners (GPs). In total 32 participants took part in the study. The data were thematically analysed with MaxQDA software for qualitative analysis and reported. Quality of life is a multi-faceted term for elderly. The essence of their description is that they can still undertake activities that matter to them. Good physical health, mental well-being and social connections enable them to do this. Own control over their life is important for some. They are of opinion that how they experience life and manage old age is related to their resilience and coping. Key terms in the definitions of quality of life by GPs are also physical and mental health and social contacts. These are the three pillars. Next, to this elderly care, physicians mention security and safety and district nurses add control over their own life and meaningful daily activities. They agree that with frail elderly people, the balance is delicate and a change in one of the three pillars can cause it to collapse like a house of cards. When discussing what support is needed, professionals agree on access to care with a low threshold, prevention, and life course planning. When care is provided in a timely manner, a worsening of the situation can be prevented. They agree that hospital care often is not needed since most of the problems with the elderly have to do with care and security rather than with a cure per se. GPs can consult elderly care physicians to lower their workload and to bring in specific knowledge. District nurses often signal changes in the situation of the elderly. According to them, the elderly predominantly need someone to watch over them and provide them with a feeling of security. Life course planning and advance care planning can contribute to uniform treatment in line with older adults’ wishes. In conclusion, all stakeholders, including elderly persons, agree on what entails quality of life and the quality of care that is needed to support that. A future challenge is to shape conditions for the right skill mix of professionals, cooperation between the professions and breaking down differences in financing and supply. For the elderly, the challenge is preparing for aging.

Keywords: elderly living at home, quality of life, quality of care, professional cooperation, life course planning, advance care planning

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Authors: Ahdab H. Mahdaly, Debajyoti Pati, Sharran Parkinson, Lee S. Duemer

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The importance of providing employed mothers with the right physical environment inside the home is not an easy task, especially when the culture is involved. This study examines the typical Saudi home as a personal, emotional, social and cultural setting, especially on the interactions between the physical design and perceived control of working mothers. However, owing to the scarcity of published literature on Saudi homes, American employed mothers were included in the study to provide a baseline. With the ongoing transformations in women’s role in Saudi Arabia, there is a perception that traditional home designs may not afford the appropriate sense of control inside the home. Saudi Arabia has numerous interacting layers of socio-cultural-religious forces that affect residential design, and understanding the moderating role of the Saudi home is vital to the ongoing national policy transition on women. The study investigated one narrow, albeit critical, influence of home design on ones sense of control – direct visual and physical accessibility between sets of rooms. Ten subjects, five Saudis and five American, examined visual and physical access between 171 room sets, and provided qualitative responses on how each access influences their sense of control. Three main themes emerged, with potential effects on control: 1- Openness, 2- Proximity, and 3- Separation. Data suggest that although the Saudi home is a substantially more complex setting than the American ones, a class of spaces that can be termed as ‘Neutral Rooms’ serving as cultural separators may represent the ideal solution for optimizing sense of control, without ignoring cultural-religious traditions, during the transition of the Saudi women.

Keywords: direct physical accessibility, home environment, sense of control, visual accessibility, working mothers

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Authors: Philippe Gugler

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The aim of this study is to investigate how home country patterns may influence the competitiveness of EMNEs in international markets and more specifically their ability to invest abroad. The study examines the dynamic relationship between home country specific advantage and firms’ competitiveness. Are EMNEs still driven by strong country specific advantages or are EMNEs increasingly relying on their own firm specific competitiveness? EMNEs are not commonly recognized as a ‘homogeneous group’. Therefore, the approaches to these questions need to be specific while still attempting to extract some common evidence. The aim of the study is to elaborate a framework to investigate this issue in a dynamic context of international business’s strategies. The study focuses on two major research questions. The first one relates to the role of the home-base context in the internationalization process of EMNEs and more specifically the home-base assets’ influence on EMNEs competitiveness. Another question is to investigate the interactions among home-base context, recipient country context and EMNEs competitiveness. The evolution of EMNEs’ competitiveness is shaped by the evolution of the home country’s business environment. The nature of the home-based components in EMNEs’ specific advantages has changed over time due to the increased integration of emerging countries in the world market and the inherent changes related to their institutional, structural and regulatory patterns. The home country offers not only inherited assets but also a productive business environment, allowing firms to innovate, be more productive, create unique value for customers and finally, to face international competition successfully. The more sophisticated the home business environment is, the more opportunities there are for firms to developed exclusive and unique competitive assets. The international expansion of EMNEs is a fascinating but challenging issue. Among the numerous questions raised by the involvement of EMNEs in international competition is the evolving role of the home market. The purpose of this study is to examine some of the theoretical ideas and empirical evidence to allow us to deepen our understanding of the role of emerging home countries in the internationalization process of their domestic firms and more specifically in their ability to compete successfully abroad. How much do home specific assets still influence EMNEs’ foreign investment? Which home country assets provide the main competitive drivers to invest and compete abroad? How do EMNEs combine home country assets and host country assets to strengthen their competitive advantages? These questions as well as various others deserve further examination by the scientific community.

Keywords: competitiveness, emerging countries' multinational enterprises, foreign direct investments, international business

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Authors: Rafaella Nogaroli

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It is presented hypothetical cases in the context of AI algorithms to support clinical decisions, in order to discuss the importance of doctors to respect AI ethical principles. Regarding the principle of transparency and explanation, there is an impact on the new model of patient consent and on the understanding of qualified information. Besides, the human control of technology (AI as a tool) should guide the physician's activity; otherwise, he breaks the patient's legitimate expectation in a specific result, with the consequent transformation of the medical obligation nature.

Keywords: medical law, artificial intelligence, ethical principles, patient´s informed consent, medical obligations

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Authors: Sung Hyun Yoo, In Hwan Choi, Jun Ho Jung, Choon Ki Ahn, Myo Taeg Lim

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Home energy management system (HEMS) has been issued to reduce the power consumption. The HEMS performs electric power control for the indoor electric device. However, HEMS commonly treats the smart devices. In this paper, we suggest the output estimation of home legacy device using the artificial neural fuzzy inference system (ANFIS). This paper discusses the overview and the architecture of the system. In addition, accurate performance of the output estimation using the ANFIS inference system is shown via a numerical example.

Keywords: artificial neural fuzzy inference system (ANFIS), home energy management system (HEMS), smart device, legacy device

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Authors: Winncy Du, Jeremy Nguyen, Harpinder Dhillon, Reinardus Justin Halim, Clayton Haske, Trent Hughes, Marissa Ortiz, Rozy Saini

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Stroke often causes death or cerebro-vascular (CV) brain damage. Most patients with CV brain damage lost their motor control on their limbs. This paper focuses on developing a reliable, safe, and non-invasive EEG-based robot-assistant stroke rehabilitation system to help stroke survivors to rapidly restore their motor control functions for their limbs. An electroencephalogram (EEG) recording device (EPOC Headset) and was used to detect a patient’s brain activities. The EEG signals were then processed, classified, and interpreted to the motion intentions, and then converted to a series of robot motion commands. A six-axis articulated robot (AdeptSix 300) was employed to provide the intended motions based on these commends. To ensure the EEG device, the computer, and the robot can communicate to each other, an Arduino microcontroller is used to physically execute the programming codes to a series output pins’ status (HIGH or LOW). Then these “hardware” commends were sent to a 24 V relay to trigger the robot’s motion. A lookup table for various motion intensions and the associated EEG signal patterns were created (through training) and installed in the microcontroller. Thus, the motion intention can be direct determined by comparing the EEG patterns obtaibed from the patient with the look-up table’s EEG patterns; and the corresponding motion commends are sent to the robot to provide the intended motion without going through feature extraction and interpretation each time (a time-consuming process). For safety sake, an extender was designed and attached to the robot’s end effector to ensure the patient is beyond the robot’s workspace. The gripper is also designed to hold the patient’s limb. The test results of this rehabilitation system show that it can accurately interpret the patient’s motion intension and move the patient’s arm to the intended position.

Keywords: brain waves, EEG sensor, motion control, robot-assistant stroke rehabilitation

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Authors: Marek Długosz, Paweł Skruch

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One of purposes of home automation systems is to provide appropriate comfort to the users by suitable air temperature control and stabilization inside the rooms. The control of temperature level is not a simple task and the basic difficulty results from the fact that accurate parameters of the object of control, that is a building, remain unknown. Whereas the structure of the model is known, the identification of model parameters is a difficult task. In this paper, a control algorithm allowing the present temperature to be reached inside the building within the specified time without the need to know accurate parameters of the building itself is presented.

Keywords: control, home automation system, wireless networking, automation engineering

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Authors: Yu Sin Syu

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Objective: The study aimed to improve the patient guidance satisfaction of patients hospitalized in iodine-131 isolation rooms, as well as the patient guidance completion rate for such patients. Method: A patient care guidance checklist and patient care guidance satisfaction questionnaire were administered to 29 patients who had previously been hospitalized in iodine-131 isolation rooms. The evaluation was conducted on a one-on-one basis, and its results showed that the patients’ satisfaction with patient guidance was only 3.7 points and that the completion rate for the patient guidance performed by nurses was only 67%. Therefore, various solutions were implemented to create a more complete patient guidance framework for nurses, including the incorporation of regular care-related training in in-service education courses; the establishment of patient care guidance standards for patients in iodine-131 isolation rooms; the establishment of inpatient care standards and auditing processes for iodine-131 isolation rooms; the creation of an introductory handbook on ward environment; Invite other the care team the revision of iodine-131 health education brochures; the creation of visual cards and videos covering equipment operation procedures; and introduction of QR codes. Results: Following the implementation of the above measures, the overall satisfaction of patients hospitalized in iodine-131 isolation rooms increased from 3.7 points to 4.6 points, and the completion rate for patient guidance rose from 67% to 100%. Conclusion: Given the excellent results achieved in this study, it is hoped that this nursing project can serve as a benchmark for other relevant departments.

Keywords: admission care guidance, guidance satisfaction, integrity, Iodine131 isolation

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Authors: Pi-Chi Wu, Tsui-Ping Chu, Hsiu-Hung Wang

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Background: The ability to provide immediate medical service in outpatient departments is one of the keys to patient satisfaction. Objectives: This project used electronic equipment to integrate nursing care information to patient care at a blood pressure diagnostic counter. Through process reengineering, the average patient waiting time decreased from 35 minutes to 5 minutes, while service satisfaction increased from a score of 2.7 to 4.6. Methods: Data was collected from a local hospital in Southern Taiwan from a daily average of 2,200 patients in the outpatient department. Previous waiting times were affected by (1) space limitations, (2) the need to help guide patient mobility, (3) the need for nurses to appease irate patients and give instructions, (4), the need for patients to replace lost counter tickets, (5) the need to re-enter information, (6) the replacement of missing patient information. An ad hoc group was established to enhance patient satisfaction and shorten waiting times for patients to see a doctor. A four step strategy consisting of (1) counter relocation, (2) queue reorganization, (3) electronic information integration, (4) process reengineering was implemented. Results: Implementation of the developed strategy decreased patient waiting time from 35 minutes to an average of 5 minutes, and increased patient satisfaction scores from 2.7 to 6.4. Conclusion: Through the integration of information technology and process transformation, waiting times were drastically reduced, patient satisfaction increased, and nurses were allowed more time to engage in more cost-effective services. This strategy was simultaneously enacted in separate hospitals throughout Taiwan.

Keywords: process reengineering, electronic information integration, patient satisfaction, patient waiting time

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Authors: George Zhou, Yunchan Chen, Candace Chien

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Kidney replacement therapy is the current standard of care for end-stage renal diseases. In-center or home hemodialysis remains an integral component of the therapeutic regimen. Arteriovenous fistulas (AVF) make up the vascular circuit through which blood is filtered and returned. Naturally, AVF patency determines whether adequate clearance and filtration can be achieved and directly influences clinical outcomes. Our aim was to build a deep learning model for automated AVF stenosis screening based on the sound of blood flow through the AVF. A total of 311 patients with AVF were enrolled in this study. Blood flow sounds were collected using a digital stethoscope. For each patient, blood flow sounds were collected at 6 different locations along the patient’s AVF. The 6 locations are artery, anastomosis, distal vein, middle vein, proximal vein, and venous arch. A total of 1866 sounds were collected. The blood flow sounds are labeled as “patent” (normal) or “stenotic” (abnormal). The labels are validated from concurrent ultrasound. Our dataset included 1527 “patent” and 339 “stenotic” sounds. We show that blood flow sounds vary significantly along the AVF. For example, the blood flow sound is loudest at the anastomosis site and softest at the cephalic arch. Contextualizing the sound with location metadata significantly improves classification performance. How to encode and incorporate categorical metadata is an active area of research1. Herein, we study ordinal (i.e., integer) encoding schemes. The numerical representation is concatenated to the flattened feature vector. We train a vision transformer (ViT) on spectrogram image representations of the sound and demonstrate that using scalar multiples of our integer encodings improves classification performance. Models are evaluated using a 10-fold cross-validation procedure. The baseline performance of our ViT without any location metadata achieves an AuROC and AuPRC of 0.68 ± 0.05 and 0.28 ± 0.09, respectively. Using the following encodings of Artery:0; Arch: 1; Proximal: 2; Middle: 3; Distal 4: Anastomosis: 5, the ViT achieves an AuROC and AuPRC of 0.69 ± 0.06 and 0.30 ± 0.10, respectively. Using the following encodings of Artery:0; Arch: 10; Proximal: 20; Middle: 30; Distal 40: Anastomosis: 50, the ViT achieves an AuROC and AuPRC of 0.74 ± 0.06 and 0.38 ± 0.10, respectively. Using the following encodings of Artery:0; Arch: 100; Proximal: 200; Middle: 300; Distal 400: Anastomosis: 500, the ViT achieves an AuROC and AuPRC of 0.78 ± 0.06 and 0.43 ± 0.11. respectively. Interestingly, we see that using increasing scalar multiples of our integer encoding scheme (i.e., encoding “venous arch” as 1,10,100) results in progressively improved performance. In theory, the integer values do not matter since we are optimizing the same loss function; the model can learn to increase or decrease the weights associated with location encodings and converge on the same solution. However, in the setting of limited data and computation resources, increasing the importance at initialization either leads to faster convergence or helps the model escape a local minimum.

Keywords: arteriovenous fistula, blood flow sounds, metadata encoding, deep learning

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Authors: Sze Wai Veera Fung, Peter W. Ferretto

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Since the economic reform in 1980s, many men and women of the southern dialect Dong minority have migrated to coastal cities for employment. Responding to the outgoing providers of the families, women, especially those at the middle age, resort to the informal home-based services and goods production for income generation. Homework, therefore, becomes a key economic strategy in supporting the household expenses in rural China, where formal employment is often inadequate for local women. This paper seeks to examine the intersection between gender and household strategy in the broader economic context of rural China. Based on the interviews and site survey in Tongdao Dong Autonomous County, the study analyses the variety of the home-based production activities, the experience of women in the production process, and the impact on familial relation and gender division of labor at home. The objective of this research is to advance the understanding of the informal economic landscape in the contemporary rural China, through which an alternative and possibly a more appropriate mode of development can be investigated.

Keywords: gender relation, home-based production, household strategy, informal economy, rural China, dong minority

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Authors: Erol Karaca

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This study aims to analyze ceramic employees’ occupational health and safety training expectations. To that general objective, the study tries to examine whether occupational health and safety training expectations of ceramic employees meaningfully differentiate depending on demographic features and professional, social and economic conditions. For this purpose, the research data was collected through “Questionnaire of Occupational Health and Safety Training Expectation” (QSOHSTE) consisting of 25 open and close-ended questions developed by the researcher on the base of the literature review. QSOHSTE was applied to 125 ceramic employees working in Kutahya, Turkey. Data obtained from questionnaires were analyzed via SPSS 21. The findings, obtained from the study, revealed that employees’ agreement level to occupational health and safety training expectation statements is generally high-level. These findings also reveals that employees have various expectations about occupational health and safety training. These expectations are increasing sensitivity towards occupational health and safety training about the prevention of occupational accidents and diseases, contributing occupational health and safety training in establishing healthy and safe working environment, requiring occupational health and safety training before starting work, in case of changing working equipment and new technological applications, necessity of measurement and evaluation after occupational health and safety training. Besides these findings, employees’ agreement level to occupational health and safety training expectation statements also varies in terms of educational level, professional seniority, income level and perception of economic condition.

Keywords: occupational health and safety, occupational training, occupational expectation, professional seniority

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Authors: Pieter A. Cornelissen, Joris J. Van Hoof

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The interest in improving occupational safety started almost simultaneously with the beginning of the Industrial Revolution. Yet, it was not until the late 1970’s before the role of communication was considered in scientific research regarding occupational safety. In recent years the importance of communication as a means to improve occupational safety has increased. Not only as communication might have a direct effect on safety performance and safety outcomes, but also as it can be viewed as a major component of other important safety-related elements (e.g., training, safety meetings, leadership). And while safety communication is an increasingly important topic in research, its operationalization is often vague and differs among studies. This is not only problematic when comparing results, but also in applying these results to practice and the work floor. By means of an in-depth analysis—building on an existing dataset—this review aims to overcome these problems. The initial database search yielded 25.527 articles, which was reduced to a research corpus of 176 articles. Focusing on the 37 articles of this corpus that addressed communication (related to safety outcomes and safety performance), the current study will provide a comprehensive overview of the role and effects of safety communication and outlines the conditions under which communication contributes to a safer work environment. The study shows that in literature a distinction is commonly made between safety communication (i.e., the exchange or dissemination of safety-related information) and feedback (i.e. a reactive form of communication). And although there is a consensus among researchers that both communication and feedback positively affect safety performance, there is a debate about the directness of this relationship. Whereas some researchers assume a direct relationship between safety communication and safety performance, others state that this relationship is mediated by safety climate. One of the key findings is that despite the strongly present view that safety communication is a formal and top-down safety management tool, researchers stress the importance of open communication that encourages and allows employees to express their worries, experiences, views, and share information. This raises questions with regard to other directions (e.g., bottom-up, horizontal) and forms of communication (e.g., informal). The current review proposes a framework to overcome the often vague and different operationalizations of safety communication. The proposed framework can be used to characterize safety communication in terms of stakeholders, direction, and characteristics of communication (e.g., medium usage).

Keywords: communication, feedback, occupational safety, review

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Authors: Aodai Abdul-Illah Ismail

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Even though the dramatic progress that has been made in traffic safety, but still millions of peoples get killed or injured as a result of traffic crashes, besides the huge amount of economic losses due to these crashes. So traffic safety continues to be one of the most important serious issues worldwide, and it affects everyone who uses the road network system, whether you drive, walk, cycle, or push a pram. One of the most important sides that offers promise for further progress in relation to traffic safety is related to risky groups (special population groups) who may have higher potential to be involved in accidents. Traffic safety needs of risky groups are different from each other and also from the average population. Due to the various limitations between these special groups from each other and from the average population, it is not possible to address all the issues –at the same time- raising the importance ranking among the other safety issues. This paper explains a procedure used to identify the most critical traffic safety issues of five risky groups, which include younger, older and female drivers, people with disabilities and school aged children. Multi criteria used in selecting the critical issues because the single criteria is not sufficient. Highway safety professionals were surveyed to obtain the ranking of importance among the risky groups and then to develop the final ranking among issues by applying weight for each of the criteria.

Keywords: traffic safety, risky groups, old drivers, young drivers

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Authors: Claudia Seabra, Elisabeth Kastenholz, José Luís Abrantes, Manuel Reis

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In a world of increasing mobility and global risks, terrorism has, in a perverse way, capitalized on contemporaneous society’s growing interest in travel to explore a world whose national boundaries and distances have decreased. Terrorists have identified the modern tourist flows originated from the economically more developed countries as new appealing targets so as to: i) call attention to the causes they defend and ii) destroy a country’s foundations of tourism, with the final aim of disrupting the economic and consequently social fabric of the affected countries. The present study analyses sensitivity towards risk and travel behaviors in international travel amongst a sample of 600 international tourists from 49 countries travelling by air. Specifically, the sample was segmented according to the Global Peace Index. This index defines country profiles regarding the levels of peace. The indicators used are established over three broad themes: i) ongoing domestic and international conflict; ii) societal safety and security; and iii) militarisation. Tourists were segmented, according to their country of origin, in different levels of peacefulness. Several facets of travel behavior were evaluated, namely motivations, attitude towards trip planning, quality perception and perceived value of the trip. Also factors related with risk perception were evaluated, specifically terrorism risk perception during the trip, unsafety sensation as well as importance attributed to safety in travel. Results contribute to our understanding of the role of previous exposure to the lack of peace and safety at home in the international tourists behaviors, which is further discussed in terms of tourism management and marketing implications which should particularly interest tourism services and destinations more affected by terrorism, war, political turmoil, crime and other safety risks.

Keywords: terrorism, tourism, safety, risk perception

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Authors: K. Alaka, A. Obi

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Home garden has proved to be significant to rural inhabitants by providing a wide range of useful products such as fruits, vegetables and medicine. There is need for quantitative information on its benefits and contributions to rural household. The main objective of this study is to investigate contributions of home garden to income of rural households in Raymond Mhlaba Local Municipality, formerly Nkonkobe Local Municipality of Eastern Cape Province South Africa. The stratified random sampling method was applied in order to choose a sample of 160 households.The study was conducted among 80 households engaging in home gardens and 80 non- participating households in the study area. Data analysis employed descriptive statistics with the use of frequency table and one way sample T test to show actual contributions. The overall model shows that social grant has the highest contribution to total household income for both categories while income generated from home garden has the second largest share to total household income, this shows that the majority of rural households in the study area rely on social grant as their source of income. However, since most households are net food buyers, it is essential to have policies that are formulated with an understanding that household food security is not only a function of the food that farming households produce for their own consumption but more so a function of total household income. The results produced sufficient evidence that home gardens contribute significantly to income of rural household.

Keywords: food security, home gardening, household, income

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Authors: Pradeep Kumar, Shibashish Chakraborty, Sasadhar Bera

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In the anticipation of demand fluctuations, services cannot be inventoried and hence it creates a difficult problem in marketing of services. The inability to meet customers (patients) requirements in healthcare context has more serious consequences than other service sectors. In order to meet patient requirements in the current uncertain environment, healthcare organizations are seeking ways for improved service delivery. Flexibility provides a mechanism for reducing variability in service encounters and improved performance. Flexibility is defined as the ability of the organization to cope with changing circumstances or instability caused by the environment. Patient satisfaction is an important performance outcome of healthcare organizations. However, the paucity of information exists in healthcare delivery context to examine the impact of flexibility on patient satisfaction and behavioral intention. The present study is an attempt to develop a conceptual foundation for investigating overall impact of flexibility on patient satisfaction and behavioral intention. Several dimensions of flexibility in healthcare context are examined and proposed to have a significant impact on patient satisfaction and intention. Furthermore, the study involves a critical examination of determinants of patient satisfaction and development of a comprehensive view the relationship between flexibility, patient satisfaction and behavioral intention. Finally, theoretical contributions and implications for healthcare professionals are suggested from flexibility perspective.

Keywords: healthcare, flexibility, patient satisfaction, behavioral intention

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Authors: Kristin Prentice, Carri Hand

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As the Canadian population ages and chronic health conditions continue to escalate, older adults will require various types of housing, such as long term care or retirement homes. Moving to a new home may require a change in leisure activities and social networks, which could be challenging to maintain identity and create a sense of home. Leisure has been known to help older adults maintain or increase their quality of life and life satisfaction and may help older adults in moving to new homes. Sense of home and identity within older adults' transitions to new homes are concepts that may also relate to leisure engagement. Literature is scant regarding the role of leisure in older adults moving to new homes and how the sense of home and identity inter-relate. This study aims to explore how leisure may play a role in older adults' transitioning to new homes, including how sense of home and identity inter-relate. An ethnographic approach will be used to understand the culture of older adults transitioning to new homes. This study will involve older adults who have recently relocated to a mid-sized city in Ontario, Canada. The study will focus on the older adult’s interactions with and connections to their home environment through leisure. Data collection will take place via video-conferencing and will include a narrative interview and two other interviews to discuss an activity diary of leisure engagement pre and post move and mental maps to capture spaces where participants engaged in leisure. Participants will be encouraged to share photographs of leisure engagement taken inside and outside their home to help understand the social spaces the participants refer to in their activity diaries and mental maps. Older adults attempt to adjust to their new homes by maintaining their identity, developing a sense of home through creating attachment to place, and maintaining social networks, all of which have been linked to engaging in leisure. This research will provide insight into the role of leisure in this transition process and the extent that the home and community can contribute to aiding their transition to the new home. This research will contribute to existing literature on the inter-relationships of leisure, sense of home, and identity and how they relate to older adults moving to new homes. This research also has potential for influencing policy and practice for meeting the housing needs of older adults.

Keywords: leisure, older adults, transition, identity

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Authors: Jonathan Doku

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The study's goal was to evaluate construction site safety management in Ghana. The construction sector has long been seen as a high-risk business. It entails a variety of hazardous and challenging labor duties, such as lifting and working at a height, among others. The accident rate is a standard indicator for comparing the safety performance of construction projects. Because of its high-risk and fast-changing work environment, the construction business is regarded as one of the industries with the highest accident rates in the world. Many mishaps and work-related diseases have occurred there, and construction workers are particularly vulnerable to catastrophic calamities such as falls, collapses, and burial. The study's main goals were to discover characteristics that have a substantial impact on construction site safety, to evaluate the safety management methods utilized on construction sites, and to assess the obstacles associated with construction site safety management. The study was conducted using a quantitative research method and a purposive sampling strategy. Google forms were used to distribute self-administered surveys to 85 responders. 72 of the 85 questionnaires were completed and submitted for analysis, accounting for 84.7 percent of the total. The variables were analyzed using descriptive statistics, mean score ranking, and Cronbach's Alpha Coefficient to ensure the scale's reliability. The formal safety organization structure and the Safety checklist were identified as the key practices of safety management on site as part of the study goals. In addition, it was discovered that the most serious problem with safety management is ineffective supervision. To guarantee efficient monitoring and proper implementation of health and safety rules on building sites, management must be on the ball.

Keywords: construction, safety, risk, management

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