Search results for: Emergency nurse

Authors: Lubna M. Zakaryia Mahmoud, Mohammed A. Dawood, Doaa A. Heiba

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A prospective double-blind placebo controlled trial carried out on 60 children known to be asthmatic who presented to the emergency department at Alexandria University of Children’s Hospital at El-Shatby with acute asthma exacerbations to assess the efficacy of adding inhaled magnesium sulfate to β-agonist, compared with β-agonist in saline, in the management of acute asthma exacerbations in children. The participants in the study were divided in two groups; Group A (study group) received inhaled salbutamol solution (0.15 ml/kg) plus isotonic magnesium sulfate 2 ml in a nebulizer chamber. Group B (control group): received nebulized salbutamol solution (0.15 ml/kg) diluted with placebo (2 ml normal saline). Both groups received inhaled solution every 20 minutes that was repeated for three doses. They were evaluated using the Pediatric Asthma Severity Score (PASS), oxygen saturation using portable pulse oximetry and peak expiratory flow rate using a portable peak expiratory flow meter at initially recorded as zero-minute assessment and every 20 minutes from the end of each nebulization (nebulization lasts 5-10 minutes) recorded as 20, 40 and 60-minute assessments. Regarding PASS, comparison showed non-significant difference with p-value 0.463, 0.472, 0.0766 at 20, 40 and 60 minutes. Regarding oxygen saturation, improvement was more significant towards group A starting from 40 min with significant p-value=0.000. At 60 min p-value=0.000. Although mean PEFR significantly improved from zero-min in both groups; however, improvement was more significant in group A with significant p-value = 0.015, 0.001, 0.001 at 20 min, 40 min and 60 min, respectively. The conclusion this study suggests is that inhaled magnesium sulfate is an efficient add on drug to standard β- agonist inhalation used in the treatment of moderate to severe asthma exacerbations.

Keywords: Nebulized, magnesium sulfate, acute asthma, pediatric.

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Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: Critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team.

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Authors: Lixin Tian, Wei Xue

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Many jobs in society go underground, such as mine mining, tunnel construction and subways, which are vital to the development of society. Once accidents occur in these places, the interruption of traditional wired communication is not conducive to the development of rescue work. In order to realize the positioning, early warning and command functions of underground personnel and improve rescue efficiency, it is necessary to develop and design an emergency ground communication system. It is easy to be subjected to narrowband interference when performing conventional underground communication. Spreading communication can be used for this problem. However, general spread spectrum methods such as direct spread communication are inefficient, so it is proposed to use parallel combined spread spectrum (PCSS) communication to improve efficiency. The PCSS communication not only has the anti-interference ability and the good concealment of the traditional spread spectrum system, but also has a relatively high frequency band utilization rate and a strong information transmission capability. So, this technology has been widely used in practice. This paper presents a PCSS communication model-multiple detection parallel combined spread spectrum (MDPCSS) communication system. In this paper, the principle of MDPCSS communication system is described, that is, the sequence at the transmitting end is processed in blocks and cyclically shifted to facilitate multiple detection at the receiving end. The block diagrams of the transmitter and receiver of the MDPCSS communication system are introduced. At the same time, the calculation formula of the system bit error rate (BER) is introduced, and the simulation and analysis of the BER of the system are completed. By comparing with the common parallel PCSS communication, we can draw a conclusion that it is indeed possible to reduce the BER and improve the system performance. Furthermore, the influence of different pseudo-code lengths selected on the system BER is simulated and analyzed, and the conclusion is that the larger the pseudo-code length is, the smaller the system error rate is.

Keywords: Cyclic shift, multiple detection, parallel combined spread spectrum, PN code.

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Authors: J. Urbánek Jiří, Krahulec Josef, Johanidesová Jitka, F. Urbánek Jiří

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This paper deals with using of prevailing operation system MS Office (SmartArt...) for mathematical models, using DYVELOP (Dynamic Vector Logistics of Processes) method. It serves for crisis situations investigation and modelling within the organizations of critical infrastructure. In first part of paper, it will be introduced entities, operators, and actors of DYVELOP method. It uses just three operators of Boolean algebra and four types of the entities: the Environments, the Process Systems, the Cases, and the Controlling. The Process Systems (PrS) have five “brothers”: Management PrS, Transformation PrS, Logistic PrS, Event PrS and Operation PrS. The Cases have three “sisters”: Process Cell Case, Use Case, and Activity Case. They all need for the controlling of their functions special Ctrl actors, except ENV – it can do without Ctrl. Model´s maps are named the Blazons and they are able mathematically - graphically express the relationships among entities, actors and processes. In second part of this paper, the rich blazons of DYVELOP method will be used for the discovering and modelling of the cycling cases and their phases. The blazons need live PowerPoint presentation for better comprehension of this paper mission. The crisis management of energetic crisis infrastructure organization is obliged to use the cycles for successful coping of crisis situations. Several times cycling of these cases is necessary condition for the encompassment for both emergency events and the mitigation of organization´s damages. Uninterrupted and continuous cycling process brings for crisis management fruitfulness and it is good indicator and controlling actor of organizational continuity and its sustainable development advanced possibilities. The research reliable rules are derived for the safety and reliable continuity of energetic critical infrastructure organization in the crisis situation.

Keywords: Blazons, computational assistance, DYVELOP method, critical infrastructure.

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Authors: Wan-I Lee, Nelio Mendoza Figueredo

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The impact of COVID-19 has a significant effect on all sectors of society globally. Health information technology (HIT) has become an effective health strategy in this age of distancing. In this regard, Mobile Health (mHealth) plays a critical role in managing patient and provider workflows during the COVID-19 pandemic. Therefore, the users' perception of service quality about mHealth services plays a significant role in shaping confidence and subsequent behaviors regarding the mHealth users' intention of use. This study's objective was to explore levels of user attributes analyzed by a qualitative method of how health practitioners and patients are satisfied or dissatisfied with using mHealth services; and analyzed the users' intention in the context of Taiwan during the COVID-19 pandemic. This research explores the experienced usability of a mHealth services during the Covid-19 pandemic. This study uses qualitative methods that include in-depth and semi-structured interviews that investigate participants' perceptions and experiences and the meanings they attribute to them. The five cases consisted of health practitioners, clinic staff, and patients' experiences using mHealth services. This study encourages participants to discuss issues related to the research question by asking open-ended questions, usually in one-to-one interviews. The findings show the positive and negative attributes of mHealth service quality. Hence, the significant importance of patients' and health practitioners' issues on several dimensions of perceived service quality is system quality, information quality, and interaction quality. A concept map for perceptions regards to emergency uses' intention of mHealth services process is depicted. The findings revealed that users pay more attention to "Medical care", "ease of use" and "utilitarian benefits" and have less importance for "Admissions and Convenience" and "Social influence". To improve mHealth services, the mHealth providers and health practitioners should better manage users' experiences to enhance mHealth services. This research contributes to the understanding of service quality issues in mHealth services during the COVID-19 pandemic.

Keywords: COVID-19, mobile health, mHealth, service quality, use intention.

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Authors: Aparajita Santra

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In the context of the government's vision of turning Delhi into a green, privatized and slum free city, giving it a world-class image at par with the global cities of the world, this paper investigates into the various processes and politics of things that went behind defining spaces in the city and attributing an aesthetic image to it. The paper will explore two cases that were forged primarily through the forces of one particular type of power relation. One would be to look at the modernist movement adopted by the Nehruvian government post-independence and the next case will look at special periods like Emergency and Commonwealth games. The study of these cases will help understand the ambivalence embedded in the different rationales of the Government and different powerful agencies adopted in order to build world-classness. Through the study, it will be easier to discern how city spaces were reconfigured in the name of 'good governance'. In this process, it also became important to analyze the double nature of law, both as a protector of people’s rights and as a threat to people. What was interesting to note through the study was that in the process of nation building and creating an image for the city, the government’s policies and programs were mostly aimed at the richer sections of the society and the poorer sections and people from lower income groups kept getting marginalized, subdued, and pushed further away (These marginalized people were pushed away even geographically!). The reconfiguration of city space and attributing an aesthetic character to it, led to an alteration not only in the way in which citizens perceived and engaged with these spaces, but also brought about changes in the way they envisioned their place in the city. Ironically, it was found that every attempt to build any kind of facility for the city’s elite in turn led to an inevitable removal of the marginalized sections of the society as a necessary step to achieve a clean, green and world-class city. The paper questions the claim made by the government for creating a just, equitable city and granting rights to all. An argument is put forth that in the politics of redistribution of space, the city that has been designed is meant for the aspirational middle-class and elite only, who are ideally primed to live in world-class cities. Thus, the aim is to study city spaces, urban form, the associated politics and power plays involved within and understand whether segmented cities are being built in the name of creating sensible, inclusive cities.

Keywords: Aesthetics, ambivalence, governmentality, power, world-class.

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Authors: Yi-Chun Kuo, Jo-Chieh Lin

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The objective of a supply chain strategy is to reduce waste and increase efficiency to attain cost benefits, and to guarantee supply chain flexibility when facing the ever-changing market environment in order to meet customer requirements. Strategy implementation aims to fulfill common goals and attain benefits by integrating upstream and downstream enterprises, sharing information, conducting common planning, and taking part in decision making, so as to enhance the overall performance of the supply chain. With the rise of outsourcing and globalization, the increasing dependence on suppliers and customers and the rapid development of information technology, the complexity and uncertainty of the supply chain have intensified, and supply chain vulnerability has surged, resulting in adverse effects on supply chain performance. Thus, this study aims to use supply chain vulnerability as a moderating variable and apply structural equation modeling (SEM) to determine the relationships among supply chain strategy, supply chain integration, and supply chain performance, as well as the moderating effect of supply chain vulnerability on supply chain performance. The data investigation of this study was questionnaires which were collected from the management level of enterprises in Taiwan and China, 149 questionnaires were received. The result of confirmatory factor analysis shows that the path coefficients of supply chain strategy on supply chain integration and supply chain performance are positive (0.497, t= 4.914; 0.748, t= 5.919), having a significantly positive effect. Supply chain integration is also significantly positively correlated to supply chain performance (0.192, t = 2.273). The moderating effects of supply chain vulnerability on supply chain strategy and supply chain integration to supply chain performance are significant (7.407; 4.687). In Taiwan, 97.73% of enterprises are small- and medium-sized enterprises (SMEs) focusing on receiving original equipment manufacturer (OEM) and original design manufacturer (ODM) orders. In order to meet the needs of customers and to respond to market changes, these enterprises especially focus on supply chain flexibility and their integration with the upstream and downstream enterprises. According to the observation of this research, the effect of supply chain vulnerability on supply chain performance is significant, and so enterprises need to attach great importance to the management of supply chain risk and conduct risk analysis on their suppliers in order to formulate response strategies when facing emergency situations. At the same time, risk management is incorporated into the supply chain so as to reduce the effect of supply chain vulnerability on the overall supply chain performance.

Keywords: Supply chain integration, supply chain performance, supply chain vulnerability, structural equation modeling.

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Authors: Han-Mei Chen, Rongxin Zhou, Taige Wang

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Glass is widely used in everyday life, from glass bottles for beverages, to architectural glass for various forms of glazing. Although the mainstream of used glass is recycled in the UK, the single-use and then recycling procedure results in a lot of waste as it incorporates intact glass with smashing, re-melting and remanufacturing. These processes bring massive energy consumption with a huge loss of high embodied energy and economic value, compared to re-use which’s towards a ‘zero carbon’ target. As a tourism city, Liverpool has more glass bottle consumption than most less leisure focused cities. It is therefore vital for Liverpool to find an upgrading approach for the single-use glass bottles with a low carbon output. This project aims to assess the feasibility of an industrial symbiosis and upgrading framework of glass and to investigate the ways of achieving them. It is significant to Liverpool’s future industry strategy since it provides an opportunity to target on economy recovery for post-COVID by industry symbiosis and an up-grading waste management in Liverpool to respond to the climate emergency. In addition, it will influence the local government policy for glass bottle reuse and recycling in North West England, and as a good practice to be further recommended to other areas of the UK. First, critical literature review of glass waste strategies has been conducted in the UK, and world-wide industrial symbiosis practices. Second, mapping, data collection and analysis have shown the current life cycle chain and the strong links of glass reuse and upgrading potentials via site visits to 16 local waste recycling centres. The results of this research have demonstrated the understanding the influence of key factors on the development of a circular industrial symbiosis business model for beverage glass bottles. The current waste management procedures of glass bottle industry, its business model, supply chain and the material flow have been reviewed. The various potential opportunities for glass bottle up-valuing have been investigated towards an industrial symbiosis in Liverpool. Finally, an up-valuing business model has been developed for an industrial symbiosis framework of glass in Liverpool. For glass bottles, there are two possibilities: 1) focus on upgrading processes towards re-use rather than single-use and recycling, 2) focus on ‘smart’ re-use and recycling leading to optimised values in other sectors to create a wider industry symbiosis for a multi-level and circular economy.

Keywords: Glass bottles, industry symbiosis, smart reuse, waste upgrading.

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Authors: Z. A. Ahmad Noor Syukri, A. J. Nawal Aswan, S. V. Wong

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The motorcycle has become one of the most common type of vehicles used on the road, particularly in the Asia region, including Malaysia, due to its size-convenience and affordable price. This study focuses only on crashes involving motorcycles with passenger cars consisting 43 real world crashes obtained from in-depth crash investigation process from June 2016 till July 2017. The study collected and analyzed vehicle and site parameters obtained during crash investigation and injury information acquired from the patient-treating hospital. The investigation team, consisting of two personnel, is stationed at the Emergency Department of the treatment facility, and was dispatched to the crash scene once receiving notification of the related crashes. The injury information retrieved was coded according to the level of severity using the Abbreviated Injury Scale (AIS) and classified into different body regions. The data revealed that weekend crashes were significantly higher for the night time period and the crash occurrence was the highest during morning hours (commuting to work period) for weekdays. Bad weather conditions play a minimal effect towards the occurrence of motorcycle – passenger vehicle crashes and nearly 90% involved motorcycles with single riders. Riders up to 25 years old are heavily involved in crashes with passenger vehicles (60%), followed by 26-55 year age group with 35%. Male riders were dominant in each of the age segments. The majority of the crashes involved side impacts, followed by rear impacts and cars outnumbered the rest of the passenger vehicle types in terms of crash involvement with motorcycles. The investigation data also revealed that passenger vehicles were the most at-fault counterpart (62%) when involved in crashes with motorcycles and most of the crashes involved situations whereby both of the vehicles are travelling in the same direction and one of the vehicles is in a turning maneuver. More than 80% of the involved motorcycle riders had sustained yellow severity level during triage process. The study also found that nearly 30% of the riders sustained injuries to the lower extremities, while MAIS level 3 injuries were recorded for all body regions except for thorax region. The result showed that crashes in which the motorcycles were found to be at fault were more likely to occur during night and raining conditions. These types of crashes were also found to be more likely to involve other types of passenger vehicles rather than cars and possess higher likelihood in resulting higher ISS (>6) value to the involved rider. To reduce motorcycle fatalities, it first has to understand the characteristics concerned and focus may be given on crashes involving passenger vehicles as the most dominant crash partner on Malaysian roads.

Keywords: Motorcycle crash, passenger vehicle, in-depth crash investigation, injury mechanism.

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Authors: B. Lefranc, C. Aufauvre-Poupon, C. Martin-Krumm, M. Trousselard

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Isolated and confined environments (ICE) present several challenges which may adversely affect human’s psychology and physiology. Submariners in Sub-Surface Ballistic Nuclear (SSBN) mission exposed to these environmental constraints must be able to perform complex tasks as part of their normal duties, as well as during crisis periods when emergency actions are required or imminent. The operational and environmental constraints they face contribute to challenge human adaptability. The impact of such a constrained environment has yet to be explored. Establishing a knowledge framework is a determining factor, particularly in view of the next long space travels. Ensuring that the crews are maintained in optimal operational conditions is a real challenge because the success of the mission depends on them. This study focused on the evaluation of the impact of stress on mental health and sensory degradation of submariners during a mission on SSBN using cardiac biosignal (heart rate variability, HRV) clustering. This is a pragmatic exploratory study of a prospective cohort included 19 submariner volunteers. HRV was recorded at baseline to classify by clustering the submariners according to their stress level based on parasympathetic (Pa) activity. Impacts of high Pa (HPa) versus low Pa (LPa) level at baseline were assessed on emotional state and sensory perception (interoception and exteroception) as a cardiac biosignal during the patrol and at a recovery time one month after. Whatever the time, no significant difference was found in mental health between groups. There are significant differences in the interoceptive, exteroceptive and physiological functioning during the patrol and at recovery time. To sum up, compared to the LPa group, the HPa maintains a higher level in psychosensory functioning during the patrol and at recovery but exhibits a decrease in Pa level. The HPa group has less adaptable HRV characteristics, less unpredictability and flexibility of cardiac biosignals while the LPa group increases them during the patrol and at recovery time. This dissociation between psychosensory and physiological adaptation suggests two treatment modalities for ICE environments. To our best knowledge, our results are the first to highlight the impact of physiological differences in the HRV profile on the adaptability of submariners. Further studies are needed to evaluate the negative emotional and cognitive effects of ICEs based on the cardiac profile. Artificial intelligence offers a promising future for maintaining high level of operational conditions. These future perspectives will not only allow submariners to be better prepared, but also to design feasible countermeasures that will help support analog environments that bring us closer to a trip to Mars.

Keywords: Adaptation, exteroception, HRV, ICE, interoception, SSBN.

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Authors: Ana Cristina García-Luna Romero

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This document seeks to reflect on the urban project from its conceptual identity root. In the first instance, a proposal is made on how the city project is sustained from the conceptual root, from the logos: it opens a way to assimilate the imagination; what we imagine becomes a reality. In this way, firstly, the need to use language as a vehicle for transmitting the stories that sustain us as humanity can be deemed as an important social factor that enables us to social behavior. Secondly, the need to attend to the written language as a mechanism of power, as a means to consolidate a dominant ideology or a political position, is raised; as it served to carry out the modernization project, it is therefore addressed differences between the real and the literate city. Thus, the consolidated urban-architectural project is based on logos, the project, and planning. Considering the importance of materiality and its relation to subjective well-being contextualized from a socio-urban approach, we question ourselves into how we can look at something that is doubtful. From a philosophy perspective, the truth is considered to be nothing more than a matter of correspondence between the observer and the observed. To understand beyond the relative of the gaze, it is necessary to expose different perspectives since it depends on the understanding of what is observed and how it is critically analyzed. Therefore, the analysis of materiality, as a political field, takes a proposal based on this research in the principles in transgenesis: principle of communication, representativeness, security, health, malleability, availability of potentiality or development, conservation, sustainability, economy, harmony, stability, accessibility, justice, legibility, significance, consistency, joint responsibility, connectivity, beauty, among others. The (urban) human being acts because he wants to live in a certain way: in a community, in a fair way, with opportunity for development, with the possibility of managing the environment according to their needs, etc. In order to comply with this principle, it is necessary to design strategies from the principles in transgenesis, which must be named, defined, understood, and socialized by the urban being, the companies, and from themselves. In this way, the technical status of the city in the neoliberal present determines extraordinary conditions for reflecting on an almost emergency scenario created by the impact of cities that, far from being limited to resilient proposals, must aim at the reflection of the urban process that the present social model has generated. Therefore, can we rethink the paradigm of the perception of life quality in the current neoliberal model in the production of the character of public space related to the practices of being urban. What we are trying to do within this document is to build a framework to study under what logic the practices of the social system that make sense of the public space are developed, what the implications of the phenomena of the inscription of action and materialization (and its results over political action between the social and the technical system) are and finally, how we can improve the quality of life of individuals from the urban space.

Keywords: Cities, nature, society, urban quality of life.

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Authors: Sara S. Fouad, Omneya Messallam

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Egypt has countless prestigious buildings and diversity of cultural heritage which are located in many cities. Most of the researchers, archaeologists, stakeholders and governmental bodies are paying more attention to the big cities such as Cairo and Alexandria, due to the country’s centralization nature. However, there are other historic cities that are grossly neglected and in need of emergency conservation. For instance, Port Said which is a former colonial city that was established in nineteenth century located at the edge of the northeast Egyptian coast between the Mediterranean Sea and the Suez Canal. This city is chosen because it presents one of the important Egyptian archaeological sites that archive Egyptian architecture of the 19^th and 20^th centuries. The historic urban fabric is divided into three main districts; the Arab, the European (Al-Afrang), and Port Fouad. The European district is selected to be the research case study as it has culture diversity, significant buildings, and includes the largest number of the listed heritage buildings in Port Said. Based on questionnaires and interviews, since 2003 several initiative trials have been taken by Alliance Francaise, the National Organization for Urban Harmony (NOUH), some Non-Governmental Organizations (NGOs), and few number of community residents to highlight the important city legacy and protect it from being demolished. Unfortunately, the limitation of their participation in decision-making policies is considered a crucial threat facing sustainable heritage conservation. Therefore, encouraging the local community to participate in their architecture heritage conservation would create a self-confident one, capable of making decisions for the city’s future development. This paper aims to investigate the role of the local inhabitants in protecting their buildings heritage through listing the community level of participations twice (2012 and 2018) in preserving their heritage based on the ladder citizen participation approach. Also, it is to encourage community participation in order to promote city architecture conservation, heritage management, and sustainable development. The methodology followed in this empirical research involves using several data assembly methods such as structural observations, questionnaires, interviews, and mental mapping. The questionnaire was distributed among 92 local inhabitants aged 18-60 years. However, the outset of this research at the beginning demonstrated the majority negative attitude, motivation, and confidence of the local inhabitants’ role to safeguard their architectural heritage. Over time, there was a change in the negative attitudes. Therefore, raising public awareness and encouraging community participation by providing them with a real opportunity to take part in the decision-making. This may lead to a positive relationship between the community residents and the built heritage, which is essential for promoting its preservation and sustainable development.

Keywords: Al-Afrang/Port Said, community participation, heritage conservation, ladder of citizen participation, NGOs.

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Authors: Sandhya Rijal, Saroj Adhikari, Ramesh R. Pant

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Non-Timber Forest Products (NTFPs) have attracted substantial interest in the recent years with the increasing recognition that these can provide essential community needs for improved and diversified rural livelihood and support the objectives of biodiversity conservation. Nevertheless, various challenges are witnessed in their sustainable harvest and management. Assuming that sustainable management with community stewardship can offer one of the solutions to existing challenges, the study assesses the linkages between NTFPs and rural livelihood in Lamabagar village of Dolakha, Nepal. The major objective was to document the status of NTFPs and their contributions in households of Lamabagar. For status documentation, vegetation sampling was done using systematic random sampling technique. 30 plots of 10 m × 10 m were laid down in six parallel transect lines at horizontal distance of 160 m in two different community forests. A structured questionnaire survey was conducted in 76 households (excluding non-response rate) using stratified random sampling technique for contribution analysis. Likewise, key informant interview and focus group discussions were also conducted for data triangulations. 36 different NTFPs were recorded from the vegetation sample in two community forests of which 50% were used for medicinal purposes. The other uses include fodder, religious value, and edible fruits and vegetables. Species like Juniperus indica, Daphne bholua Aconitum spicatum, and Lyonia ovalifolia were frequently used for trade as a source of income, which was sold in local market. The protected species like Taxus wallichiana and Neopicrorhiza scrophulariiflora were also recorded in the area for which the trade is prohibited. The protection of these species urgently needs community stewardship. More than half of the surveyed households (55%) were depending on NTFPs for their daily uses, other than economic purpose whereas 45% of them sold those products in the market directly or in the form of local handmade products as a source of livelihood. NTFPs were the major source of primary health curing agents especially for the poor and unemployed people in the study area. Hence, the NTFPs contributed to livelihood under three different categories: subsistence, supplement income and emergency support, depending upon the economic status of the households. Although the status of forest improved after handover to the user group, the availability of valuable medicinal herbs like Rhododendron anthopogon, Swertia nervosa, Neopicrorhiza scrophulariiflora, and Aconitum spicatum were declining. Inadequacy of technology, lack of easy transport access, and absence of good market facility were the major limitations for external trade of NTFPs in the study site. It was observed that people were interested towards conservation only if they could get some returns: economic in terms of rural settlements. Thus, the study concludes that NTFPs could contribute rural livelihood and support conservation objectives only if local communities are provided with the easy access of technology, market and capital.

Keywords: Contribution, medicinal, subsistence, sustainable harvest.

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Authors: Maisam Rafiee, Chikashi Deguchi, Akio Odake, Minoru Matsui, Takanori Sata

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Cities in Afghanistan have been rapidly urbanized; however, many parts of these cities have been developed with no detailed land use plan or infrastructure. In other words, they have been informally developed without any government leadership. The new government started the In-situ Upgrading Project in Kabul to upgrade roads, the water supply network system, and the surface water drainage system on the existing street layout in 2002, with the financial support of international agencies. This project is an appropriate emergency improvement for living life, but not an essential improvement of living conditions and infrastructure problems because the life expectancies of the improved facilities are as short as 10–15 years, and residents cannot obtain land tenure in the unplanned areas. The Land Readjustment System (LRS) conducted in Japan has good advantages that rearrange irregularly shaped land lots and develop the infrastructure effectively. This study investigates the effects of the In-situ Upgrading Project on private investment, land prices, and residents’ satisfaction with projects in Kart-e-Char, where properties are registered, and in Afshar-e-Silo Lot 1, where properties are unregistered. These projects are located 5 km and 7 km from the CBD area of Kabul, respectively. This study discusses whether LRS should be applied to the unplanned area based on the questionnaire and interview responses of experts experienced in the In-situ Upgrading Project who have knowledge of LRS. The analysis results reveal that, in Kart-e-Char, a lot of private investment has been made in the construction of medium-rise (five- to nine-story) buildings for commercial and residential purposes. Land values have also incrementally increased since the project, and residents are commonly satisfied with the road pavement, drainage systems, and water supplies, but dissatisfied with the poor delivery of electricity as well as the lack of public facilities (e.g., parks and sport facilities). In Afshar-e-Silo Lot 1, basic infrastructures like paved roads and surface water drainage systems have improved from the project. After the project, a few four- and five-story residential buildings were built with very low-level private investments, but significant increases in land prices were not evident. The residents are satisfied with the contribution ratio, drainage system, and small increase in land price, but there is still no drinking water supply system or tenure security; moreover, there are substandard paved roads and a lack of public facilities, such as parks, sport facilities, mosques, and schools. The results of the questionnaire and interviews with the four engineers highlight the problems that remain to be solved in the unplanned areas if LRS is applied—namely, land use differences, types and conditions of the infrastructure still to be installed by the project, and time spent for positive consensus building among the residents, given the project’s budget limitation.

Keywords: In-Situ Upgrading, Kabul, Land Readjustment, Land value, Planned areas, Private investment, Resident satisfaction, Unplanned areas.

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Authors: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan

Abstract:

The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Keywords: Anemia, haemoglobinopathies, pregnancy, sickle cell disease.

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Authors: Sotirios Raptis

Abstract:

Health and Social care (HSc) services planning and scheduling are facing unprecedented challenges, due to the pandemic pressure and also suffer from unplanned spending that is negatively impacted by the global financial crisis. Data-driven approaches can help to improve policies, plan and design services provision schedules using algorithms that assist healthcare managers to face unexpected demands using fewer resources. The paper discusses services packing using statistical significance tests and machine learning (ML) to evaluate demands similarity and coupling. This is achieved by predicting the range of the demand (class) using ML methods such as Classification and Regression Trees (CART), Random Forests (RF), and Logistic Regression (LGR). The significance tests Chi-Squared and Student’s test are used on data over a 39 years span for which data exist for services delivered in Scotland. The demands are associated using probabilities and are parts of statistical hypotheses. These hypotheses, as their NULL part, assume that the target demand is statistically dependent on other services’ demands. This linking is checked using the data. In addition, ML methods are used to linearly predict the above target demands from the statistically found associations and extend the linear dependence of the target’s demand to independent demands forming, thus, groups of services. Statistical tests confirmed ML coupling and made the prediction statistically meaningful and proved that a target service can be matched reliably to other services while ML showed that such marked relationships can also be linear ones. Zero padding was used for missing years records and illustrated better such relationships both for limited years and for the entire span offering long-term data visualizations while limited years periods explained how well patients numbers can be related in short periods of time or that they can change over time as opposed to behaviours across more years. The prediction performance of the associations were measured using metrics such as Receiver Operating Characteristic (ROC), Area Under Curve (AUC) and Accuracy (ACC) as well as the statistical tests Chi-Squared and Student. Co-plots and comparison tables for the RF, CART, and LGR methods as well as the p-value from tests and Information Exchange (IE/MIE) measures are provided showing the relative performance of ML methods and of the statistical tests as well as the behaviour using different learning ratios. The impact of k-neighbours classification (k-NN), Cross-Correlation (CC) and C-Means (CM) first groupings was also studied over limited years and for the entire span. It was found that CART was generally behind RF and LGR but in some interesting cases, LGR reached an AUC = 0 falling below CART, while the ACC was as high as 0.912 showing that ML methods can be confused by zero-padding or by data’s irregularities or by the outliers. On average, 3 linear predictors were sufficient, LGR was found competing well RF and CART followed with the same performance at higher learning ratios. Services were packed only when a significance level (p-value) of their association coefficient was more than 0.05. Social factors relationships were observed between home care services and treatment of old people, low birth weights, alcoholism, drug abuse, and emergency admissions. The work found  that different HSc services can be well packed as plans of limited duration, across various services sectors, learning configurations, as confirmed by using statistical hypotheses.

Keywords: Class, cohorts, data frames, grouping, prediction, probabilities, services.

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