Search results for: tender documentation

Authors: Orose Rugchati, Kanita Thanacharoenchanaphas, Sarawut Wattanawongpitak

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In this study, the effect of electric stimulation on the quality of hot-boned beef brisket muscles was evaluated, including the tenderness, pH, temperature change, and colorant. Muscles were obtained from steers in the local slaughter house. (3 steers for each muscle), removed from the carcasses 4-hour postmortem and variable time to treated with direct current electric 1 and 5 minutes, respectively. Six different electric intensities (direct current voltage of 50, 70 and 90 Volt, pulse with 10, 20 and 40 ms) plus a control were applied to each muscle to determine the optimum treatment conditions. Hot-boned beef brisket was found to get tender with increasing treatment direct current voltage and reduction in the shear force with pulsed with electric treatment. But in a long time to treated with electric current get fading in red color and temperature increase whereas pH quite different compared to non-treated control samples.

Keywords: electric stimulation, characteristic changes, hot-boned beef brisket, potential tenderness

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Authors: Ibrahim Baba

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The work examines the nature and causes of differential politics in Africa with particular reference to the sub-Saharan region of the continent. It also among other objectives provides alternative panacea to gender discrimination in African politics and offers solutions on how to promote political inclusion of all citizens in respect of gender differences in Africa. The work is conducted using library base documentation analysis.

Keywords: gender, political, participation, differential politics, sub-Saharan Africa

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Authors: Ted Silva

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Dietrich de Velsa's Équation à un inconnu / Equation to an Unknown hybridizes art cinema style with the sexually explicit aesthetics of pornography to envision a uniquely queer world unmoored by heteronormative influence. This stylization evokes the memory of a queer history that once approximated such a prospect. With this historical and political context in mind, this paper utilizes formal analysis to assess how the film frames queer sexual encounters as tender acts of care, sometimes literally mending physical wounds. However, Equation to Unknown also highlights the transience of these sexual exchanges. By emphasizing the homogeneity of the protagonist’s sexual conquests, the film reveals that these practices have a darker meaning when the men reject the individualized connection to pursue purely visceral gratification. Given the lack of diversity or even recognizable identifying factors, the men become more anonymous to each other the more they pair up. Ultimately, Equation to an Unknown both celebrates and problematizes its vision of a queer utopia, highlighting areas in the community wherein intimacy and care flourish and locating those spots in which they are neglected.

Keywords: pornography studies, queer cinema, French cinema, history

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Authors: Max Butler

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Melanoma accounts for 80% of skin cancer-related deaths globally. The poor prognosis and increasing incidence of melanoma impose a significant burden on global healthcare systems. Early detection, precise diagnosis, and preventative strategies are critical to improving patient outcomes. Dermoscopy is the gold standard for specialist assessments of pigmented skin lesions, as it can differentiate between benign and malignant growths with greater accuracy than visual inspection. In the United Kingdom, guidelines from the National Institute of Clinical Excellence (NICE) state dermoscopy should be used in all specialist assessments of pigmented skin lesions. Compliance with this guideline is low, resulting in missed and delayed melanoma diagnoses. To address this problem, a quality improvement project was initiated at Buckinghamshire Healthcare Trust (BHT) within the plastic surgery department. The target group was a trainee and consultant plastic surgeons conducting outpatient skin cancer clinics. Analysis of clinic documentation over a one-month period found that only 62% (38/61) of patients referred with pigmented skin lesions were examined using dermoscopy. To increase dermoscopy rates, teaching was delivered to the department highlighting national guidelines and the evidence base for dermoscopic examination. In addition, clinic paperwork was redesigned to include a text box for dermoscopic examination. Reauditing after the intervention found a significant increase in dermoscopy rates (52/61, p = 0.014). In conclusion, implementing a quality improvement project with targeted teaching and documentation template templates successfully increased dermoscopy rates. This is a promising step toward improving early melanoma detection and patient outcomes.

Keywords: melanoma, dermoscopy, plastic surgery, quality improvement

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Authors: Ratchaneewan Salao, Steven W. Edwards, Kiatichai Faksri, Kanin Salao

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Background: A two-dose regimen of COVID-19 vaccination (inactivated whole virion SARS-CoV-2 and adenoviral vector) has been widely used. Side effects are very low, but several adverse effects have been reported. Methods: A 40-year-old female patient, with a previous history of thyroid goitre, developed severe neck pain, headache, nausea and fatigue 7-days after receiving second vaccination with Vaxzevria® (Oxford-AstraZeneca). Clinical and laboratory findings, including thyroid function tests and ultrasound of thyroid glands, were performed. Results: Her left thyroid gland was multinodular enlarged, and severely tender on palpation. She had difficulty in swallowing and had tachycardia but no signs of hyperthyroidism. Laboratory results supported a diagnosis of subacute thyroiditis. She was prescribed NSAID (Ibuprofen 400 mg) and dexamethasone for 3-days and her symptoms resolved. Conclusions: Although this is an extremely rare event, physicians may encounter more cases of this condition due to the extensive vaccination program using this combination of vaccines.

Keywords: SARS-CoV-2, adenoviral vector vaccines, vaccination, subacute thyroiditis

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Authors: Victor Kang, Sirene Bellahnid, Amy Al-Simaani

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Efficient documentation and completion of clerical tasks are pillars of efficient patient-centered care in acute settings such as the emergency department (ED). Medical scribes aid physicians with documentation, navigation of electronic health records, results gathering, and communication coordination with other healthcare teams. However, the use of medical scribes is not widespread, with some hospitals even continuing to discontinue their programs. One reason for this could be the lack of studies that have outlined concrete improvements in efficiency and patient and provider satisfaction in emergency departments before and after incorporating scribes. Methods: We conducted a review of the literature concerning the implementation of a medical scribe program and emergency department performance. For this review, a narrative synthesis accompanied by textual commentaries was chosen to present the selected papers. PubMed was searched exclusively. Initially, no date limits were set, but seeing as the electronic medical record was officially implemented in Canada in 2013, studies published after this date were preferred as they provided insight into the interplay between its implementation and scribes on quality improvement. Results: Throughput, efficiency, and cost-effectiveness were the most commonly used parameters in evaluating scribes in the Emergency Department. Important throughput metrics, specifically door-to-doctor and disposition time, were significantly decreased in emergency departments that utilized scribes. Of note, this was shown to be the case in community hospitals, where the burden of documentation and clerical tasks would fall directly upon the attending physician. Academic centers differ in that they rely heavily on residents and students; so the implementation of scribes has been shown to have limited effect on these metrics. However, unique to academic centers was the provider’s perception of incrased time for teaching was unique to academic centers. Consequently, providers express increased work satisfaction in relation to time spent with patients and in teaching. Patients, on the other hand, did not demonstrate a decrease in satisfaction in regards to the care that was provided, but there was no significant increase observed either. Of the studies we reviewed, one of the biggest limitations was the lack of significance in the data. While many individual studies reported that medical scribes in emergency rooms improved relative value units, patient satisfaction, provider satisfaction, and increased number of patients seen, there was no statistically significant improvement in the above criteria when compiled in a systematic review. There is also a clear publication bias; very few studies with negative results were published. To prove significance, data from more emergency rooms with scribe programs would need to be compiled which also includes emergency rooms who did not report noticeable benefits. Furthermore, most data sets focused only on scribes in academic centers. Conclusion: Ultimately, the literature suggests that while emergency room physicians who have access to medical scribes report higher satisfaction due to lower clerical burdens and can see more patients per shift, there is still variability in terms of patient and provider satisfaction. Whether or not this variability exists due to differences in training (in-house trainees versus contractors), population profile (adult versus pediatric), setting (academic versus community), or which shifts scribe work cannot be determined based on the studies that exist. Ultimately, more scribe programs need to be evaluated to determine whether these variables affect outcomes and prove whether scribes significantly improve emergency room efficiency.

Keywords: emergency medicine, medical scribe, scribe, documentation

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Authors: Fatima Ali Abbass, Hassan Ibrahim Rkein

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The number of entities worldwide that currently accept digital currency as payment is increasing; however, digital currency still is not widely accepted as a medium of exchange, nor they represent legal tender. At the same time, this makes accounting for cryptocurrency, as cash (Currency) is not possible under IAS 7 and IAS 32, Cryptocurrency also cannot be accounted for as Financial Assets at fair value through profit or loss under IFRS 9. Therefore, this paper studies the possible means to account for Cryptocurrency, since, as of today, there is not yet an accounting standard that deals with cryptocurrency. The request to have a specific accounting standard is increasing from top accounting firms and from professional accounting bodies. This study uses a mixture of qualitative and quantitative analysis in its quest to explore the best possible way to account for cryptocurrency. Interviews and surveys were conducted targeting accounting professionals. This study highlighted the deficiencies in the current way of accounting for Cryptocurrency as intangible Assets with an indefinite life. The deficiency becomes well highlighted, as the asset will then be subject to impairment, where under GAAP, only depreciation in the value of the intangible asset is recognized. On the other hand, appreciation in the value of the asset is ignored, and this prohibits the reporting entity from showing the true value of the cryptocurrency asset. This research highlights the gap that arises due to using accounting standards that are not specific for Cryptocurrency and this study confirmed that there is an urgent need to call upon the accounting standards setters (IASB and FASB) to issue accounting standards specifically for Cryptocurrency.

Keywords: cryptocurrency, accounting, IFRS, GAAP, classification, measurement

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Authors: Pallabi Kalita, Hui Tag, Loxmi Jamoh, H. N. Sarma, A. K. Das

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Wild edible food plants contain a number of organic phytochemical that have been linked to the promotion of good health. These plants used by the local people of Arunachal Pradesh (Northeast India) are found to have high nutritional potential to maintain general balance diet. A study was conducted to evaluate the nutritional potential of five commonly found, unexplored wild food plants namely, Piper pedicellatum C. DC (leaves), Gonostegia hirta (Blume ex Hassk.) Miq. (leaves), Mussaenda roxburghii Hook. f. (leaves), Solanum spirale Roxb. (leaves and fruits) and Cyathea spinulosa Wall. ex Hook. (pith portion and tender rachis) from East Siang District of Arunachal Pradesh Northeast (India) for ascertaining their suitability for utilization as supplementary food. Results of study revealed that P. pedicellatum, C. spinulosa, and S. spirale (leaves) are the most promising species which have high nutritional content out of the five wild food plants investigated which is required for the normal growth and development of human.

Keywords: wild edible plants, gross energy, Gonostegia hirta, Cyathea spinulosa

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Authors: Nofiu A. Musa, Olubola Babalola

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The study explored the effect of ICT on the accuracy of Preliminary Cost Estimates (PCEs) prepared by quantity surveying consulting firms in Nigeria for building projects, with a view to determining the desirability of the adoption and use of the technological innovation for preliminary estimating. Thus, data pertinent to the study were obtained through questionnaire survey conducted on a sample of one hundred and eight (108) quantity surveying firms selected from the list of registered firms compiled by the Nigerian Institute of Quantity Surveyors (NIQS), Lagos State Chapter through systematic random sampling. The data obtained were analyzed with SPSS version 17 using student’s t-tests at 5% significance level. The results obtained revealed that the mean bias and co-efficient of variation of the PCEs of the firms are significantly less at post ICT adoption period than the pre ICT adoption period, F < 0.05 in each case. The paper concluded that the adoption and use of the Technological Innovation (ICT) has significantly improved the accuracy of the Preliminary Cost Estimates (PCEs) of building projects, hence, it is desirable.

Keywords: accepted tender price, accuracy, bias, building projects, consistency, information and communications technology, preliminary cost estimates

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Authors: Y. B. Sharma, K. B. Biswas

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This research project examines a 5000 cal yr BP sediment core record to reveal the consequences of human impact and climate variability on the tropical dry forests of the Mahi river basin, western India. To date there has been little research to assess the impact of climate variability and human impact on the vegetation dynamics of this region. There has also been little work to link changes in vegetation cover to documented changes in the basin hydrology over the past 100 years – although it is assumed that the two are closely linked. The key objective of this research project therefore is to understand the driving mechanisms responsible for the abrupt changes in the Mahi river basin as detailed in historical documentation and its impact on water resource management. The Mahi river basin is located in western India (22° 11’-24° 35’ N 72° 46’-74° 52’ E). Mahi river arises in the Malwa Plateau, Madhya Pradesh near Moripara and flows through the uplands and alluvial plain of Rajasthan and Gujarat provinces before draining into the Gulf of Cambay. Palaeoecological procedures (sedimentology, geochemical analysis, C&N isotopes and fossil pollen evidences) have been applied on sedimentary sequences collected from lakes in the Mahi basin. These techniques then facilitate to reconstruct the soil erosion, nutrient cycling, vegetation changes and climatic variability over the last 5000 years. Historical documentation detailing changes in demography, climate and landscape use over the past 100 years in this region will also be collated to compare with the most recent palaeoecological records. The results of the research work provide a detailed record of vegetation change, soil erosion, changes in aridity, and rainfall patterns in the region over the past 5000 years. This research therefore aims to determine the drivers of change and natural variability in the basin. Such information is essential for its current and future management including restoration.

Keywords: human impact, climate variability, vegetation cover, hydrology, water resource management, Mahi river basin, sedimentology, geochemistry, fossil pollen, nutrient cycling, vegetation changes, palaeoecology, aridity, rainfall, drivers of change

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Authors: Dulani Jayasuriya

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This study outlines the developmental steps of a chatbot for administrative purposes of a large undergraduate course. The chatbot is able to handle student queries about administrative details, including assessment deadlines, course documentation, how to navigate the course, group formation, etc. The development window screenshots are that of a free account on the Snatchbot platform such that this can be adopted by the wider public. While only one connection to an answer based on possible keywords is shown here, one needs to develop multiple connections leading to different answers based on different keywords for the actual chatbot to function. The overall flow of the chatbot showing connections between different interactions is depicted at the end.

Keywords: chatbots, education, technology, snatch bot, artificial intelligence

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Authors: Andrew Read, Alice Parry, Kate Woods

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Since the advent of the SARS-CoV-2 pandemic, the search for medications that can reduce mortality and morbidity has been a global research priority. Several multi-center trials have recently demonstrated improved mortality associated with the use of Tocilizumab, an interleukin-6 receptor antagonist, in patients with severe SARS-CoV-2 pneumonia. Initial data supported the administration in patients requiring respiratory support (non-invasive or invasive ventilation), but more recent data has shown benefit in all hypoxic patients. At the height of the second wave of COVID-19 infections in London, our hospital introduced the use of Tocilizumab for patients with severe COVID-19. Tocilizumab is licensed for use in chronic inflammatory conditions and has been associated with an increased risk of severe bacterial and fungal infections, as well as reactivation of chronic viral infections (e.g., hepatitis B). It is a specialist drug that suppresses the formation of C-reactive protein (CRP) for 6 – 12 weeks. It is not widely used by the general medical community. We aimed to assess Tocilizumab use in our hospital and to implement changes to the protocol as required to ensure administration was safe and appropriate. A retrospective study design was used to assess prescriptions over an initial 3-week period in both intensive care and on the medical wards. This amounted to a total of 13 patients. The initial data collection identified four key areas of concern: adherence to national and local inclusion & exclusion criteria; a collection of appropriate screening blood prior to administration; documentation of informed consent or best interest decision and documentation of Tocilizumab administration on patient discharge information, to alert future healthcare providers that typical measures of inflammation and infection, such as CRP, are unreliable for up to 3-months. Data were collected from electronic notes, blood results and observation charts, and cross referenced with pharmacy data. Initial results showed that all four key areas were completed in approximately 50% of cases. Of particular concern was adherence to exclusion criteria, such as current evidence of bacterial infection, and ensuring the correct screening blood was sent to exclude infections such as hepatitis. To remedy this and improve patient safety, the initial data was presented to relevant healthcare professionals. Subsequently, three interventions were introduced and education on each provided to hospital staff. An electronic ‘order set’ collating the appropriate screening blood was created simplifying the screening process. Pre-formed electronic documentation which can be inserted into the notes was created to provide a framework for consent discussions and reduce the time needed for junior doctors to complete this task. Additionally, a ‘Tocilizumab’ administration card was created and administered via pharmacy. This was distributed to each patient on discharge to ensure future healthcare professionals were aware of the potential effects of Tocilizumab administration, including suppression of CRP. Following these changes, repeat data collection over two months illustrated that each of the 4 safety aspects was met with a 100% success rate in every patient. Although this demonstrates good progress and effective interventions the challenge will be to maintain this progress. The audit data collection is ongoing

Keywords: education, patient safety , SARS-CoV-2, Tocilizumab

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Authors: M. Ridwanul Hassan, Samuel George

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Aims: Steroid injections are commonly used as a diagnostic tool or an alternative to surgical management of carpal tunnel syndrome (CTS) and are generally safe. Ischaemia is a rare complication with very few cases reported in the literature. Methods: We report a case of a 50-year-old female that presented with a necrotic wound to her left palm one month after a steroid injection into the carpal tunnel. She had a 2-year history of CTS in her left hand that was treated with six previous steroid injections in primary care during this period. The wound evolved from a blister to a necrotic ulcer which led to a painful, hollow defect in the centre of her palm. She did not report any history of trauma, nor did she have any co-morbidities. Clinical photographs were taken. Results: On examination, she had a 0.5 cmx1 cm defect in the palm of her left hand down to aponeurosis. There was purulent discharge in the wound with surrounding erythema but no spreading cellulitis. She had full function of her fingers but was very tender on movements and at rest. She was admitted for intravenous antibiotics and underwent a debridement, washout, and carpal tunnel release the next day. The defect was packed to heal by secondary intention and has now fully healed one month following her operation. Conclusions: This is an extremely rare complication of steroid injections to the carpal tunnel and may have been avoided by earlier referral for surgery rather than treatment using multiple steroid injections.

Keywords: hand surgery, complication, rare, carpal tunnel syndrome

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Authors: Milton Montejano Castillo, Tarsicio Pastrana Salcedo

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Based on the hypothesis that disaster risk is constructed socially and historically, this article shows the importance of keeping alive the historical memory of disaster by means of architectural and urban heritage conservation. This is illustrated with three examples of Latin American World Heritage cities where disasters like floods and earthquakes have shaped urban form. Therefore, the study of urban form or ‘Urban Morphology’ is proposed as a tool to understand and analyze urban transformations with the documentation of the occurrence of disasters. Lessons learned from such cities may be useful to reduce disasters risk in contemporary built environments.

Keywords: conservation, disaster risk reduction, urban morphology, World Heritage

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Authors: Gruffydd E. Jones

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The world’s largest collection of historical, cultural, and heritage material is unarchived and undocumented in the hands of the public. Not only does this material represent the missing collections in heritage sector archives today, but it is also the key to providing a diverse range of communities with the means to express their history in their own words and to celebrate their unique, personal heritage. The People’s Collection Wales (PCW) acts as a platform on which the heritage of Wales and her people can be collated and shared, at the heart of which is a thriving community engagement programme across a network of museums, archives, and libraries. By providing communities with the archival skillset commonly employed throughout the heritage sector, PCW enables local projects, societies, and individuals to express their understanding of local heritage with their own voices, empowering communities to embrace their diverse and complex identities around Wales. Drawing on key examples from the project’s history, this paper will demonstrate the successful way in which museums have been developed as hubs for community engagement where the public was at the heart of collection and documentation activities, informing collection and curatorial policies to benefit both the institute and its local community. This paper will also highlight how collections from marginalised, under-represented, and minority communities have been published and celebrated extensively around Wales, including adoption by the education system in classrooms today. Any activity within the heritage sector, whether of collection, preservation, digitisation, or accessibility, should be considerate of community engagement opportunities not only to remain relevant but in order to develop as community hubs, pivots around which local heritage is supported and preserved. Attention will be drawn to our digitisation workflow, which, through training and support from museums and libraries, has allowed the public not only to become involved but to actively lead the contemporary evolution of documentation strategies in Wales. This paper will demonstrate how the PCW online access archive is promoting museum collections, encouraging user interaction, and providing an invaluable platform on which a broader community can inform, preserve and celebrate their cultural heritage through their own archival material too. The continuing evolution of heritage engagement depends wholly on placing communities at the heart of the sector, recognising their wealth of cultural knowledge, and developing the archival skillset necessary for them to become archival practitioners of their own.

Keywords: social history, cultural heritage, community heritage, museums, archives, libraries, community engagement, oral history, community archives

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Authors: Yifu Ding, Vijay Avinash, Malcolm McCulloch

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As the proliferation of decentralized energy systems, the UK power system allows small-scale entities such as microgrids (MGs) to tender multiple energy services including energy arbitrage and frequency responses (FRs). However, its operation requires the balance between the uncertain renewable generations and loads in real-time and has to fulfill their provision requirements of contract services continuously during the time window agreed, otherwise it will be penalized for the under-delivered provision. To hedge against risks due to uncertainties and maximize the economic benefits, we propose a stochastic model predictive control (SMPC) framework to optimize its operation for the multi-service provision. Distinguished from previous works, we include a detailed economic-degradation model of the lithium-ion battery to quantify the costs of different service provisions, as well as accurately describe the changing dynamics of the battery. Considering a branch of load and generation scenarios and the battery aging, we formulate a risk-averse cost function using conditional value at risk (CVaR). It aims to achieve the maximum expected net revenue and avoids severe losses. The framework will be performed on a case study of a PV-battery grid-tied microgrid in the UK with real-life data. To highlight its performance, the framework will be compared with the case without the degradation model and the deterministic formulation.

Keywords: model predictive control (MPC), battery degradation, frequency response, microgrids

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Authors: Bahram Fathi, Mahdi Khodaparast Mashhadi, Masuod Homayounifar

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According to 1404 forecasting documentation, among the most fundamental ways of Iran’s success in competition with other regional countries are innovations, efficiency enhancements and domestic productivity. Therefore, in this study, the energy consumption efficiency of Iran and the neighbor countries has been measured in the period between 2007-2012 considering the simultaneous economic activities, CO2 emission, and consumption of energy through data envelopment analysis of undesirable output. The results of the study indicated that the energy efficiency changes in both Iran and the average neighbor countries has been on a descending trend and Iran’s energy efficiency status is not desirable compared to the other countries in the region.

Keywords: energy efficiency, environmental, undesirable output, data envelopment analysis

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Authors: Othoman Elsayah, Naren Gupta, Binsheng Zhang

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The construction sector constitutes one of the most important sectors in the economy of any country. Contractor selection is a critical decision that is undertaken by client organizations and is central to the success of any construction project. Contractor selection (CS) is a process which involves investigating, screening and determining whether candidate contractors have the technical and financial capability to be accepted to formally tender for construction work. The process should be conducted prior to the award of contract, characterized by many factors such as: contactor’s skills, experience on similar projects, track- record in the industry, and financial stability. However, this paper evaluates the current state of knowledge in relation to contractor selection process and demonstrates the findings from the analysis of the data collected from the Delphi questionnaire survey. The survey was conducted with a group of 12 experts working in the Libyan construction industry (LCI). The paper starts by briefly explaining the general outline of the questionnaire including the survey participation rate, the different fields the experts came from, and the business titles of the participants. Then, the paper describes the tests used to determine when the experts had reached consensus. The paper is based on research which aims to develop rank contractor selection criteria with specific application to make construction projects in the Libyan context. The findings of this study will be utilized to establish the scope of work that will be used as part of a PhD research.

Keywords: contractor selection, Libyan construction industry, decision experts, Delphi technique

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Authors: James Newman

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Process mining is an emerging technology that looks to serialize enterprise data in time series data. It has been used by many companies and has been the subject of a variety of research papers. However, the majority of current efforts have looked at how to best create process mining from standard relational databases. This paper is the first pass at outlining a database custom-built for the minimal viable product of process mining. We present Block Miner, a blockchain protocol to store process mining data across a distributed network. We demonstrate the feasibility of storing process mining data on the blockchain. We present a proof of concept and show how the intersection of these two technologies helps to solve a variety of issues, including but not limited to ransomware attacks, tax documentation, and conflict resolution.

Keywords: blockchain, process mining, memory optimization, protocol

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Authors: Benjamin Kuester, Bjoern Eilert, Malte Stonis, Ludger Overmeyer

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Increasing quality requirements make reliable and effective quality management indispensable. This includes the complaint handling in which the 8D method is widely used. The 8D report as a written documentation of the 8D method is one of the key quality documents as it internally secures the quality standards and acts as a communication medium to the customer. In practice, however, the 8D report is mostly faulty and of poor quality. There is no quality control of 8D reports today. This paper describes the use of natural language processing for the automated evaluation of 8D reports. Based on semantic analysis and text-mining algorithms the presented system is able to uncover content and formal quality deficiencies and thus increases the quality of the complaint processing in the long term.

Keywords: 8D report, complaint management, evaluation system, text-mining

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Authors: Cristina Fernandez, Felix Amparano, John Tumberger, Stephani Stancil, Sarah Hampl, Brooke Sweeney, Amy R. Beck, Helena H Laroche, Jared Tucker, Eileen Chaves, Sara Gould, Matthew Lindquist, Lora Edwards, Renee Arensberg, Meredith Dreyer, Jazmine Cedeno, Alleen Cummins, Jennifer Lisondra, Katie Cox, Kelsey Dean, Rachel Perera, Nicholas A. Clark

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Background: Adolescents with obesity are at higher risk of disordered eating than the general population. Detection of eating disorders (ED) is difficult. Screening questionnaires may aid in early detection of ED. Our team’s prior efforts focused on increasing ED screening rates to ≥90% using a validated 10-question adolescent binge eating disorder screening questionnaire (ADO-BED). This aim was achieved. We then aimed to improve treatment plan initiation of patients ≥12 years of age who screen positive for BED within our WMC from 33% to 70% within 12 months. Methods: Our WMC is within a tertiary-care, free-standing children’s hospital. A3, an improvement framework, was used. A multidisciplinary team (physicians, nurses, registered dietitians, psychologists, and exercise physiologists) was created. The outcome measure was documentation of treatment plan initiation of those who screen positive (goal 70%). The process measure was ADO-BED screening rate of WMC patients (goal ≥90%). Plan-Do-Study-Act (PDSA) cycle 1 included provider education on current literature and treatment plan initiation based upon ADO-BED responses. PDSA 2 involved increasing documentation of treatment plan and retrain process to providers. Pre-defined treatment plans were: 1) repeat screen in 3-6 months, 2) resources provided only, or 3) comprehensive multidisciplinary weight management team evaluation. Run charts monitored impact over time. Results: Within 9 months, 166 patients were seen in WMC. Process measure showed sustained performance above goal (mean 98%). Outcome measure showed special cause improvement from mean of 33% to 100% (n=31). Of treatment plans provided, 45% received Plan 1, 4% Plan 2, and 46% Plan 3. Conclusion: Through a multidisciplinary improvement team approach, we maintained sustained ADO-BED screening performance, and, prior to our 12-month timeline, achieved our project aim. Our efforts may serve as a model for other multidisciplinary WMCs. Next steps may include expanding project scope to other WM programs.

Keywords: obesity, pediatrics, clinic, eating disorder

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Authors: Charlie Jeffkins

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Sickle cell disease is a serious life-limiting condition which can reduce the quality of life for many patients. Public Health England (PHE), in partnership with the Sickle Cell Society (SCS), has created guidelines to prevent severe complications from sickle cell disease. Data was collected from Children’s Hospital for Wales between 15/03/21-26/03/21. Methods: A manual search of patient records for children under the care of Rocket Ward and a key term search of online records was used. Results: Penicillin prophylaxis was given at 90 days for 89%, 77% of TCDs scans were done at 2-3 years, and 72% have had a scan in the last year. 53% of patients have had discussions about hydroxycarbamide, whilst 65% have started it. PPV vaccination was documented for 19%. Conclusion: Overall, none of the four standards were reached; however, TCD uptake has improved. There is a need for better documentation of treatment and annual re-audits.

Keywords: paediatric, haematology, sickle cell, audit

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Authors: Tania Chalton

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In June 2013, an independent review of the Liverpool Care Pathway (LCP) identified a number of problems with the implementation of the LCP in the UK and recommended that it be replaced by individual care plans for each patient. As a result of the UK findings, in November 2013 the Ministry of Health (MOH) commissioned the Palliative Care Council to initiate a programme of work to investigate an appropriate approach for the care of people in their last days of life in New Zealand (NZ). The Last Days of Life Working Group commenced a process to develop national consensus on the care of people in their last days of life in April 2014. In order to develop its advice for the future provision of care to people in their last days of life, the Working Group (WG) established a comprehensive work programme and as a result has developed a series of working papers. Specific areas of focus included: An analysis of the UK Independent Review findings and an assessment of these findings to the NZ context. A stocktake of services providing care to people in their last days of life, including aged residential care (ARC); hospices; hospitals; and primary care. International and NZ literature reviews of evidence and best practice. Survey of family to understand the consumer perspective on the care of people in their last days of life. Key aspects of care that required further considerations for NZ were: Terminology: clarify terminology used in the last days of life and in relation to death and dying. Evidenced based: including specific review of evidence regarding, spiritual, culturally appropriate care as well as dementia care. Diagnosis of dying: need for both guidance around the diagnosis of dying and communication with family. Workforce issues: access to an appropriate workforce after hours. Nutrition and hydration: guidance around appropriate approaches to nutrition and hydration. Symptom and pain management: guidance around symptom management. Documentation: documentation of the person’s care which is robust enough for data collection and auditing requirements, not ‘tick box’ approach to care. Education and training: improved consistency and access to appropriate education and training. Leadership: A dedicated team or person to support and coordinate the introduction and implementation of any last days of life model of care. Quality indicators and data collection: model of care to enable auditing and regular reviews to ensure on-going quality improvement. Cultural and spiritual: address and incorporate any cultural and spiritual aspects. A final document was developed incorporating all the evidence which provides guidance to the health sector on best practice for people at end of life: “Principles and guidance for the last days of life: Te Ara Whakapiri”.

Keywords: end of life, guidelines, New Zealand, palliative care

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Authors: Mamoon M. Atout

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The Middle East Gulf region has witnessed rapid growth and development in many areas over the last two decades. The development of the real-estate sector, construction industry and infrastructure projects are a major share of the development that has participated in the civilization of the countries of the Gulf. Construction industry projects were planned and managed by different types of experts, who came from all over the world having different types of experiences in construction management and industry. Some of these projects were completed on time, while many were not, due to many accumulating factors. Many accumulated factors are considered as the principle reason for the problem experienced at the project construction stage, which reflected negatively on the project success. Specific causes of delay have been identified by construction managers to avoid any unexpected delays through proper analysis and considerations to some implications such as risk assessment and analysis for many potential problems to ensure that projects will be delivered on time. Construction management implications were adopted and considered by project managers who have experience and knowledge in applying the techniques of the system of engineering construction management. The aim of this research is to determine the benefits of the implications of construction management by the construction team and level of considerations of the techniques and processes during the project development and construction phases to avoid any delay in the projects. It also aims to determine the factors that participate to project completion delays in case project managers are not well committed to their roles and responsibilities. The results of the analysis will determine the necessity of the applications required by the project team to avoid the causes of delays that help them deliver projects on time, e.g. verifying tender documents, quantities and preparing the construction method of the project.

Keywords: construction management, control process, cost control, planning and scheduling

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Authors: D. M. Lewis, L. Frisby, U. Stead

Abstract:

Objective: Many patients are receiving invasive treatments in acute care or are dying in hospital without having had comprehensive goals of care conversations. Some of these treatments may not align with the patient’s wishes, may be futile, and may cause unnecessary suffering. While many staff may recognize the benefits of engaging patients and families in Serious Illness Conversations (a goal of care framework developed by Ariadne Labs in Boston), few staff feel confident and/or competent in having these conversations in acute care. Another barrier to having these conversations may be due to a lack of incorporation in the current workflow. An educational exercise, titled the Two Question Challenge, was initiated on four medical units across two Vancouver Coastal Health (VCH) hospitals in attempt to engage the entire interdisciplinary team in asking patients and families questions around goals of care and to improve the documentation of these expressed wishes and preferences. Methods: Four acute care units across two separate hospitals participated in the Two Question Challenge. On each unit, over the course of two eight-hour shifts, all members of the interdisciplinary team were asked to select at least two questions from a selection of nine goals of care questions. They were asked to pose these questions of a patient or family member throughout their shift and then asked to document their conversations in a centralized Advance Care Planning/Goals of Care discussion record in the patient’s chart. A visual representation of conversation outcomes was created to demonstrate to staff and patients the breadth of conversations that took place throughout the challenge. Staff and patients were interviewed about their experiences throughout the challenge. Two palliative approach leads remained present on the units throughout the challenge to support, guide, or role model these conversations. Results: Across four acute care medical units, 47 interdisciplinary staff participated in the Two Question Challenge, including nursing, allied health, and a physician. A total of 88 questions were asked of patients, or their families around goals of care and 50 newly documented goals of care conversations were charted. Two code statuses were changed as a result of the conversations. Patients voiced an appreciation for these conversations and staff were able to successfully incorporate these questions into their daily care. Conclusion: The Two Question Challenge proved to be an effective way of having teams explore the goals of care of patients and families in an acute care setting. Staff felt that they gained confidence and competence. Both staff and patients found these conversations to be meaningful and impactful and felt they were notably different from their usual interactions. Documentation of these conversations in a centralized location that is easily accessible to all care providers increased significantly. Application of the Two Question Challenge in non-medical units or other care settings, such as long-term care facilities or community health units, should be explored in the future.

Keywords: advance care planning, goals of care, interdisciplinary, palliative approach, serious illness conversations

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Authors: Taha Anjamrooz, Sareh Rajabi, Salwa Bheiry

Abstract:

Selection between the available projects in bidding processes for the contractor is one of the essential areas to concentrate on. It is important for the contractor to choose the right projects within its portfolio during the tendering stage based on certain criteria. It should align the bidding process with its origination strategies and goals as a screening process to have the right portfolio pool to start with. Secondly, it should set the proper framework and use a suitable technique in order to optimize its selection process for concertation purpose and higher efforts during the tender stage with goals of success and winning. In this research paper, a two steps framework proposed to increase the efficiency of the contractor’s bidding process and the winning chance of getting the new projects awarded. In this framework, initially, all the projects pass through the first stage screening process, in which the portfolio basket will be evaluated and adjusted in accordance with the organization strategies to the reduced version of the portfolio pool, which is in line with organization activities. In the second stage, the contractor uses linear programming to optimize the portfolio pool based on available resources such as manpower, light equipment, heavy equipment, financial capability, return on investment, and success rate of winning the bid. Therefore, this optimization model will assist the contractor in utilizing its internal resource to its maximum and increase its winning chance for the new project considering past experience with clients, built-relation between two parties, and complexity in the exertion of the projects. The objective of this research will be to increase the contractor's winning chance in the bidding process based on the success rate and expected return on investment.

Keywords: bidding process, internal resources, optimization, contracting portfolio management

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Authors: Sameer Muhammad Aslam, Nura Said Mohsin Al-Saifi

Abstract:

This research shows the process of creating a blood donation website for Oman. Blood donation is a widespread, crucial, ongoing process, so it is important that this website is easy to use. Several automated blood management systems are available, but none provides an effective algorithm that takes into account variables such as frequency of donation, donation date, and gender. In Oman, the Ministry of Health maintains a blood bank and keeps donors informed about the need for blood through a website. They also inform donors and the wider public where and when is their next blood donation event. The website's main goals are to educate the community about the benefits of blood donation. It also manages donor and receiver documentation and encourages voluntary blood donation by providing easy access to information about blood types and blood distribution in various hospitals in Oman, based on hospital needs.

Keywords: Oman, blood bank, blood donors, donor website

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Authors: Sonia Sirtoli Färber

Abstract:

Objective: This study aims to investigate selective attention in the process of mourning, as a normal reaction to loss. Method: In order to develop this research, we used a systematic bibliographic review, following the process of investigation, cataloging, careful evaluation and synthesis of the documentation, associated with the method of thanatological hemenutics proposed by Elisabeth Kübler-Ross. Conclusion: After a significant loss, especially the death of a loved one or family member, it is normal for the mourner, motivated by absence, to have a false perception of the presence of the deceased. This phenomenon happens whenever the mourner is in the middle of the crowd, because his selective attention causes him to perceive physical characteristics, tone of voice, or feel fragrance of the perfume that the deceased possessed. Details characterizing the dead are perceived by the mourner because he seeks the presence in the absence.

Keywords: Elisabeth Kübler-Ross, mourning, selective attention, thanatology

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Authors: Ailene B. Anonuevo

Abstract:

The aim of the study was to evaluate the quality of life presently available for the IP students in selected schools in the Division of Panabo City. This further explores their future dreams and current status in classes and examines some implications relative to their studies. The study adopted the mixed methodology and used a survey research design as the operational framework for data gathering. Data were collected by self-administered questionnaires and interviews with sixty students from three schools in Panabo City. In addition, this study describes the learners’ background and school climate as variables that might influence their performance in school. The study revealed that an IP student needs extra attention due to their unfavorable learning environment. The study also found out that like any other students, IP learners yearns for a brighter future with the support of our government.

Keywords: IP learners, learning landscape, school climate, quality of life

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Authors: L. Donelle, S. Regan, R. Booth, M. Kerr, J. McMurray, D. Fitzsimmons

Abstract:

Palliative home health care provision within the Canadian context is challenged by: (i) a shortage of registered nurses (RN) and RNs with palliative care expertise, (ii) an aging population, (iii) reliance on unpaid family caregivers to sustain home care services with limited support to conduct this ‘care work’, (iv) a model of healthcare that assumes client self-care, and (v) competing economic priorities. In response, an interprofessional team of service provider organizations, a software/technology provider, and health care providers developed and implemented a technology-enabled model of home care, the eShift model of palliative home care (eShift). The eShift model combines communication and documentation technology with non-traditional utilization of health human resources to meet patient needs for palliative care in the home. The purpose of this study was to investigate the structure, processes, and outcomes of the eShift model of care. Methodology: Guided by Donebedian’s evaluation framework for health care, this qualitative-descriptive study investigated the structure, processes, and outcomes care of the eShift model of palliative home care. Interviews and focus groups were conducted with health care providers (n= 45), decision-makers (n=13), technology providers (n=3) and family care givers (n=8). Interviews were recorded, transcribed, and a deductive analysis of transcripts was conducted. Study Findings (1) Structure: The eShift model consists of a remotely-situated RN using technology to direct care provision virtually to patients in their home. The remote RN is connected virtually to a health technician (an unregulated care provider) in the patient’s home using real-time communication. The health technician uses a smartphone modified with the eShift application and communicates with the RN who uses a computer with the eShift application/dashboard. Documentation and communication about patient observations and care activities occur in the eShift portal. The RN is typically accountable for four to six health technicians and patients over an 8-hour shift. The technology provider was identified as an important member of the healthcare team. Other members of the team include family members, care coordinators, nurse practitioners, physicians, and allied health. (2) Processes: Conventionally, patient needs are the focus of care; however within eShift, the patient and the family caregiver were the focus of care. Enhanced medication administration was seen as one of the most important processes, and family caregivers reported high satisfaction with the care provided. There was perceived enhanced teamwork among health care providers. (3) Outcomes: Patients were able to die at home. The eShift model enabled consistency and continuity of care, and effective management of patient symptoms and caregiver respite. Conclusion: More than a technology solution, the eShift model of care was viewed as transforming home care practice and an innovative way to resolve the shortage of palliative care nurses within home care.

Keywords: palliative home care, health information technology, patient-centred care, interprofessional health care team

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