Standard Tools Research Articles

Failure analysis steam turbine in sugar factory thermal power plant: a Review

Generating electricity from thermal energy is one of the main ways of generating electricity. However, it must be generated in the most efficient and effective way. Due to the urgency of electricity generation, it is essential that it is produced in the most efficient way to minimize losses, maximise output, optimise resource utilisation and reduce overall costs of the power plant. These outputs are even more critical in the current era where sustainability has become the top priority. A thermal power plant is a converter of fossil fuels to electricity in which steam is used during a cycle to spin a turbine driving generator to produce electricity. It is important to maintain a power plant if it runs without failure. Reliability analysis is a standard tool for designing, scheduling and maintaining any system. Reliability of a power plant refers to the ability to generate electricity efficiently and more cost-effectively with an acceptable quality assurance. This paper provides an in-depth analysis of power generation in a sugar factory by steam turbine and the reasons for steam turbine failure. It also analyzes the maintenance models employed to enhance steam turbine availability in thermal power plants.

ASSOCIATION BETWEEN OBESITY INDUCED HYPERTENSION AND CONSUMPTION OF JUNK FOOD AMONG UNIVERSITY STUDENTS OF DISTRICT SIALKOT

The principal cause of early death throughout the world is cardiovascular diseases (CVDs). It has been found that, in young adults, high blood pressure (BP) is considered a significant public health concern, with approximately 26.4% of global prevalence. A diet containing junk food is the preliminary cause of obesity, which leads to hypertension and other cardiovascular diseases in adults. The risk factors are prevailing at an alarming rate and have affected university students' physical and mental health. Moreover, these health concerns have caused low productivity among students as well. This problem has not been studied and analyzed in sufficient profundity. This cross-sectional and correlational study investigated the relationship between fast food consumption, obesity, and hypertension among university students. This cross-sectional study was conducted on a sample size of three hundred participants aged twenty-five to forty. To calculate the BMI, the weight and height of the participants were measured, along with the measurements of their systolic and diastolic blood pressure and age, through standard tools and procedures. Their dietary intake was assessed using a questionnaire of food intake that records a 168-hour food intake. The study results revealed that significant positive correlations of high strength between fast food consumption and obesity were found using Spearman rank order correlations (rs = 0.81) and moderate strength of positive correlation between frequent fast-food consumption and hypertension (rs = 0.58). The resultant conclusion of the study shows that junk food is strongly linked with obesity and prehypertension. The findings of the study can reduce the prevalence of obesity and hypertension.

Beyond Standard Measures: Crafting an Inclusive Evaluation Tool for Special Education Teachers in Self-Contained Settings

Self-contained special education teacher evaluations are investigated in this study. The perceptions of special education teachers and building administrators are explored and the suitability of standard teacher evaluation tools, such as the Marzano Teacher Evaluation System, for special education teachers in self-contained classrooms are discussed. This study highlights the significant gap in these tools’ relevance and efficacy due to the unique challenges and individualized instruction required in special education settings. The study utilizes a quantitative survey method to gather perceptions from teachers and administrators, revealing widespread dissatisfaction with current evaluation processes and a lack of alignment with special education needs. Results indicate a pressing need for tailored evaluation frameworks that accurately reflect the pedagogical realities of special education. The article advocates for reforming evaluation systems to foster professional growth and improve educational outcomes for students with disabilities, thus transforming the approach to educator accountability and development in specialized teaching environments.

Diriyah Hospital CT Scan Service’s Readiness for ACR Accreditation: A Gap Analysis

ACR clinical service accreditation Guidelines titled the Practice Parameters and Technical Standards help advance the science of radiology by improving the quality of imaging service to patients. Since the use of computed tomography (CT) has rapidly increased since its introduction in the 1970s, physicians see benefits of using computerized tomography (CT) scanning in their patient care management. It is possible nowadays to perform more examinations on time. However, extending the scope of some examinations, as well as introducing some new techniques occurs sometimes. The ease of acquisition of images results sometimes in unnecessary exposure of patients to radiation, particularly in developed countries. Furthermore, organ doses from CT scanning are considerably larger than those from corresponding conventional X-ray. The CT scan is the most appropriate modality of receive a traumatic patients. The CT scan is also very effective in diagnosis of traumatic cases with high resolution in real time mode and visualization of fine details with or without the use of contrast medium. CT is now a standard diagnostic tool for patient’s pathologies detection, trauma, renal calculi, appendicitis, and heart conditions. The speed, accuracy and availability of CT technology have rapidly raised the volume of CT scans performed in patients, despite the fact that CT scanning delivers a higher radiation dose to the patient than other available procedures.

Parental Feeding Practices among Young Children of Selected Wards of Biratnagar Metropolitan City

Introduction: Traditionally, parenting style has been defined as a classification of attitudes and behaviors that distinguish the way that parents interact with their children across various domains of parenting. The eating behavior of children is not only influenced by feeding practices but also by their food preferences and weight, sooner or later. The objective of the study was to assess the parental feeding practices among young children.
 Methods: A descriptive cross-sectional study was conducted in selected wards of Biratnagar Metropolitan city from 30th December 2018 to 25th January 2019. A total of 96 parents meeting the eligibility criteria were purposively selected. A validated standard ISS tool was used to assess the feeding practices. Student T-test and One-way ANOVA test were used to find out the association between the outcome variable with selected demographic variables.
 Result: Restriction was the most frequently used feeding practice (20.17±3.330) by parents followed by rewarding (11.92±2.582). Restriction was significantly associated with ethnicity (0.010) while rewarding was not significantly associated with any socio-demographic variables. Higher mean restriction scores were found in children who were at risk of being overweight (21.20±3.011). Modeling was significantly associated (0.029) with the body mass index of the child.
 Conclusion: The study concluded that most of the parents used restriction while feeding. Ethnicity was statistically significant with the use of restriction (p=0.010) and monitoring whereas use of pressure was statistically significant with primary care giver and religion.

Prevalence, Surgical, and Medical Management of Patients with Endometriosis amongst Indian Women

Objective: This study aims to determine the prevalence of endometriosis in women in South India, the epidemiological factors involved, and evaluate the symptomatic burden associated with it. Design: A large-scale Hospital-based study was conducted among women of reproductive age (16 to 44 years) in the state of Telangana between March 2018 and March 2023. A randomized multi-stage stratified sampling method was adopted and included 2,400 women who were screened using a validated structured questionnaire. Patients presenting with symptoms indicative of endometriosis underwent additional assessment using abdominal ultrasonography (AUS) and serum cancer antigen 125 (CA125) tests. For confirmation, laparoscopy was offered to the patients who consented. Patients who declined laparoscopy were given the option of undergoing magnetic resonance imaging (MRI) instead. Results: Among 2,400 women who participated, 60 women have been diagnosed with endometriosis during the 5-year study period. The prevalence of endometriosis was found to be 2.5%. The mean age of participants was 15.2 ± 3.5 years and the mean age at menarche was found to be 12.9 ± 1.1 years. Out of 60 participants diagnosed with endometriosis 30% (n = 18) experienced irregular menstrual cycles. Approximately 33.3% (n = 20) of the women reported experiencing Dysmenorrhea, with 28.4% (n = 17) complaining of dyspareunia. Among the cases with menstrual pain, exhibited ultrasound findings suggestive of endometriosis, with elevated CA125 levels observed in 45% (n = 27) of these cases. All 60 patients who consented to laparoscopic confirmation, exhibited positive histo-pathological evidence of endometriosis. The prevalence of endometriosis is found to be significant in women of reproductive age group and found to be associated with high rates of infertility in 15 (25%) patients. The results of this study showed that the prevalence of endometriosis is found to be 2.5% which is similar to the other studies reported. The severity of endometriosis during laparoscopy was assessed using the rAFS staging system, revealing rates of 55% and 45% for disease in Stages I & II, Stages III, & IV, respectively. Conclusion: Our study concludes that endometriosis predominantly affects women in the reproductive age group and is often associated with primary infertility. The laparoscopic findings are identified as a standard tool for both diagnosis and treatment of endometriosis.

Depression, Anxiety and Stress among Nursing Students at Biratnagar

Background: Nursing students’ depression, anxiety and stress are important issue in society with strongest connection to client recover when these students become nurse in future.Such psychological distress among them leads to less productivity, reduced quality of life, learning difficulties and may negatively affect patient care.
 Materials and Methods: A descriptive, cross-sectional study was conducted in Nobel Medical College Teaching Hospital, Biratnagar. A total of 104 Bachelor nursing students were selected by using a non-probability total enumerative sampling technique. Data were collected in the classroom through self-administered questionnaire using standardized tool DASS-21. All calculations and statistical analyzed by using SPSS software version 23.0.
 Results: The mental health status of nursing students reported alarming accounting about 37% severe anxiety, 17% severe depression and severe stress each. Among the six variables run, only year of study found associated with depression, however, stress and anxiety were not found associated with all given six variables. Similarly, there is very strong positive correlation was found among stress, anxiety and depression.
 Conclusion: The number of students experiencing depression, anxiety and stress were some levels. Among the six variables run, only year of study found associated with depression but none of the variables found associated with other mental health dimensions. Similarly, the dimension of mental health: stress, anxiety and depression were found strongly correlated.

Unveiling the Link between Perceived Social Support and Psychological Well-being: A Study on Satisfaction with Life among Cardiovascular Patients

Cardiovascular diseases affecting the heart and blood vessels are the primary global cause of mortality (McNamara et al., 2019). The current investigation explored the relationships between perceived social support, psychological well-being, and life satisfaction in individuals diagnosed with cardiovascular disease. In a recent study conducted in Sialkot, Pakistan, 100 individuals diagnosed with cardiovascular disease (CVD) were purposively sampled. The evaluation utilized custom demographic questionnaires and standardized tools, including the Multidimensional Scale of Perceived Social Support, Ryff 42-item Psychological Well-being Scale, and Satisfaction with Life Scale. Data analysis employed descriptive and inferential statistics, encompassing normality tests, correlation coefficients, T-tests, and regression analysis to examine the relationships among variables. The study uncovered a compelling association, indicating a notably strong positive correlation (r = .51, p < 0.01) between perceived social support and psychological well-being, suggesting that increased social support may contribute to improved mental wellness. Additionally, the investigation revealed another significant finding, highlighting a robust positive correlation (r = .60, p < 0.01) between perceived social support and life satisfaction, emphasizing the positive impact of social support on overall life contentment. Individuals diagnosed with cardiovascular disease (CVD) and strong perceived social support generally exhibit positive psychological well-being and increased life satisfaction.

In Ukrainian

The purpose of the review is to find, generalize and analyze scientific data related to the specifics of the interaction of chemotherapeutic official drugs and nanocomposites based on them with malignant cells and tumors, primarily characterized by the emergence of drug resistance, the determination of promising directions and ways to overcome it, and the creation of new effective nanocomposite remedies for use in antitumor chemotherapy. The given data indicate the relevance of the topic. Targeted studies of the resistance of malignant cells and neoplasms to chemotherapeutic drugs have been carried out since the 1990s. The majority of works were performed according to the methodology, that involves the traditional use of chemotherapeutic drugs. In these works, the principle of the multifactorial nature of resistance was determined, the processes and mechanisms of its implementation were studied, related to the reduction of the accumulation of the chemotherapeutic drug in cells, the increase in the activity of detoxification systems, the strengthening of DNA repair processes, the reduction of apoptosis, and autophagy. A number of promising substances and influencing factors contributing to overcoming of resistance have been identified. However, the discovered ways to overcome the resistance of malignant cells and neoplasms to the corresponding drugs are at the stages of laboratory, preclinical, or, in the best case, clinical research. At the same time, it is not excluded that the use of the latest highly effective chemotherapeutic drugs will lead to the emergence of new mechanisms of resistance. Thus, at this time the results of research on the traditional use of chemotherapeutic drugs constitute a significant fundamental and practically important development regarding the determination of mechanisms of drug resistance, however, the problem of its medicinal overcoming remains far from being solved, and the used approaches give the impression of dead ends. With the development of nanotechnology, new scientific directions have been initiated and a significant amount of researches has been carried out, devoted to the creation and search for promising applications in oncology of nanocomposites based on bioinert, biocompatible and bioactive nanoparticle materials and modern chemotherapeutic drugs. It should be emphasized that all these works contain data indicating the advantages of introducing nanocomposite drugs into clinical practice, compared to the use of chemotherapeutic drugs in traditional forms. Against this background, purposeful researches are distinguished carried out by scientists of O.O. Chuiko Institute of Surface Chemistry of National Academy of Sciences of Ukraine and R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology of National Academy of Sciences of Ukraine in the field of creation of modern polyfunctional nanocomposite chemotherapeutic agents for use in antitumor therapy, capable of overcoming drug resistance of malignant cells and neoplasms. So, at O.O. Chuiko Institute of Surface Chemistry of National Academy of Sciences of Ukraine for the first time magnetic fluids were synthesized containing antitumor drugs cisplatin, doxorubicin, gemcitabine, corresponding antibodies, their physicochemical properties were studied, and parameters for standardization were determined. At R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology of National Academy of Sciences of Ukraine the antitumor properties of magnetic fluids were studied. On the basis of magnetic fluid with cisplatin, the first native magnetosensitive oncological drug "Feroplat" has been proposed, which has no analogues in the world. Feroplat is a standardized tool for increasing the effectiveness of chemotherapy and overcoming drug resistance of malignant neoplasms, intended for the delivery of cytostatics directly to the tumor tissue. This ensures its maximum entry into the cells and helps to increase the therapeutic effect. In order to introduce "Feroplat" into production and clinical practice, its preclinical tests were successfully performed. The analysis of the given data indicates the priority of works in the field of creation of new nanocomposite chemotherapeutic drugs for use in antitumor therapy, capable of overcoming drug resistance of malignant cells and neoplasms. The facts of overcoming the drug resistance of malignant neoplasms to cisplatin with the new native oncological drug "Feroplat", as well as high indicators of cytotoxic / cytostatic activity of nanobiocomposites based on saline solution, magnetite and cisplatin, doxorubicin, gemcitabine, etc., may indicate the fundamental need to change approaches to the use of modern antitumor chemotherapeutic agents – by replacing their traditional molecular forms with appropriate nanocomposite forms.

Process mining software engineering practices: A case study for deployment pipelines

Context:In mature software development organizations the ci/cd pipeline is the only route to deploy software into production. While the workflow of this process seems straightforward, the reality is different since exceptions and deviations are the norm in actual industry practice. In this context, Process Mining appears as a promising technique to uncover deviations and check compliance with standardized DevOps processes, and highlight bottlenecks and potential improvement areas. Objective:This paper presents a case study designed to assess the potential of using Process Mining techniques to provide visibility into the deployment pipeline. Method:This research uses raw event data extracted from the continuous practices toolchain, which is then used to compute a comprehensive set of DevOps-specific metrics, thus supporting objective monitoring of the quality and efficiency of the deployment workflow. The study focuses on different development units in the Engineering team, each working in a distinct business context but sharing standard practices. Results:We verified that even though there are standards for the deployment pipelines, each team’s workflow denotes local variations with unique points for improvement that are highly coupled to their business unit context. We observed that each team’s pipeline has different temporal profiles that reflect their context and work practices. Additionally, we identified a set of deployment pipeline metrics focusing on process compliance, efficiency, and deployment stability. Conclusion:The main contributions of this paper include (1) the description of an actual application of Process Mining to the deployment pipeline of a highly complex e-commerce platform, (2) how this approach provided an objective understanding of the efficiency and quality of the development workflow, (3) how this process-centric view, combined with domain-specific DevOps metrics, supports continuous practices, and (4) how Developers can analyse their workflows by applying Process Mining while using standard tools like GitLab and PM4Py.

A current role status of micro-ultrasound imaging in prostate cancer diagnosis.

Recently diagnostic field in medicine was enriched by advances in ultrasonography (US) technology, which led to establishment of novel modalities, one of which is micro-ultrasound. Results demonstrated by early studies have been promising, simultaneously rising a question if those new modalities could become an alternative in diagnosis of prostatic carcinoma (PCa). To answer this question, several studies have been conducted where micro-ultrasound have been compared to standard diagnostic tools, such as conventional TRUS or mpMRI. Nevertheless, new technology presents with some limitations, which include inconsistent results, necessity for specialized equipment, need of training for investigators to understand the findings, and external validation. In this publication, we have identified studies that provided evaluation of the accuracy and efficiency of the micro-ultrasound technology. Additionally, analysis of the results provided a better understanding of the novel imaging tool when compared standard modalities in diagnosis of PCa. Increasing number of studies demonstrated that micro-ultrasound carries high detection rate of PCa and clinically significant prostatic cancer (csPCa), suggesting a similar performance to mpMRI and even showing superiority over conventional TRUS. Recent studies have also showed that micro-ultrasound takes active role in improving the detection of csPCa and guidance for prostate biopsy (PBx) as well as further treatment. Moreover, certain practical aspects such as lower costs, decreased waiting time, real-time imaging and application of the imaging tool for patients that are not suitable for mpMRI (contrast allergy, prosthetics etc.) are significant advantages. Analysis of the results still does not provide clear answer whether micro-ultrasound outperforms mpMRI. Further studies are necessary in order to completely understand the potential of this new technology.

Employing word-embedding for schema matching in standard lifecycle management

Today, businesses rely on numerous information systems to achieve their production goals and improve their global competitiveness. Semantically integrating those systems is essential for businesses to achieve both. To do so, businesses must rely on standards, the most important of which are data exchange standards (DES). DES focus on technical and business semantics that are needed to deliver quality and timely products and services. Consequently, the ability for businesses to quickly use and adapt DES to their innovations and processes is crucial.Traditionally, information standards are managed and used 1) in a platform-specific form and 2) usually with standalone and file-based applications. These traditional approaches no longer meet today's business and information agility needs. For example, businesses now must deal with companies and suppliers that use heterogeneous syntaxes for their information. Syntaxes that are optimized for individual but have different objectives. Moreover, file-based standards and the usage specifications derived from the standards cause inconsistencies since there is neither a single standard format for each usage specification nor a single source of truth for all of them.As the number and types of information systems grow, developing, maintaining, reviewing, and approving standards and their derived usage specifications are becoming more difficult and time consuming. Each file-based usage specification is typically based on a different syntax than the standard syntax. As a result, each usage specification must be manually updated as the standard evolves; this can cause significant delays and costs in adopting the new and better standard versions. National Institute of Standards and Technology (NIST) in collaboration with the Open Application Groups Inc. (OAGi) has developed a web-based standard lifecycle management tool called SCORE to address these problems. The objective of this paper is to introduce the SCORE tool and discuss its particular functionality where a word-embedding technique has been employed along with other schema-matching approaches. Together they can assist standard users in updating the usage specification due to the release of new version of a standard leading to faster adaptations of DES to new processes.

Long-Term Developmental Assessment of Children Recovered from Hypernatremia

Purpose: Imbalances in sodium result in acute neurologic symptoms such as seizures and impaired mental status. Studies investigating the long-term consequences of hypernatremia on cognitive, motor, and language development in children are limited. The aim of this study was to assess the long-term impact of hypernatremia on children’s cognitive, motor, and language development. Methodology:It was an observational study conducted from March 2016 to March 2017 in Dhaka Hospital of icddr,b. In this study,211 children with acute watery diarrhea accompanied with hypernatremia (serum sodium level 150 mmol/L) who had already been enrolled in a previous observational study were prospectively followed for one year.The objective was to investigate if there are any long term neurologic and developmental consequences of hypernatremia in those children. Physical, cognitive, motor, and language development as well as expressive or receptive expression of the children were assessed using a standard tool at the time of discharge (Baseline) and 12 months after discharge (End line). We also assessed IQ in a subgroup of children > 36 months (n=57) using the Wechsler Preschool and Primary Scale of Intelligence in parallel. Results: Among the 211 participants, developmental assessment on motor, cognitive, and language development test was done on 140 (66.3%) children. The mean age of the children at the time of discharge from the hospital (baseline) was 7.9±4.5 months. Compared to mild (serum Na 150 mmol/L to less than 160 mmol/L), and moderately (serum Na 160 mmol/L to 169 mmol/L) hypernatremia, children with severe hypernatremia (serum sodium >170mmol/L) significantly had lower mean scores on the motor, fine motor, and language development score at baseline after adjusting age and weight for the age z score. Although there was an improvement in motor, language, and socioemotional scores, significant improvement was only observed with cognitive function at the end line (p=0.002). In Mmultiple regression after adjusting for potential confounders such as levels of hypernatremia, parents’ education, age of the child, and WAZ, these factors were showed significantly associated with the cognitive function of children. There was no difference in mean IQ level performed at the end-line among the children with different level of hypernatremia (mild, moderate or severe). Conclusion: Children with hypernatremia had poor developmental scores in cognitive, motor, language, and socio-emotional domains at the time of recovery from hypernatremia. However, other than cognitive score, there was no significant improvement in motor or language development at 12 months in children recovering from hypernatremia. Further studies are therefore warranted to reveal any association of motor or language deficit with neurological deficit in those children beyond 12 months. Bioresearch Commu. 10(1): 1386-1392, 2024 (January)

Health Outcomes Following Engagement With a Digital Health Tool Among People With Prediabetes and Type 2 Diabetes: Prospective Evaluation Study.

Diabetes is a worldwide chronic condition causing morbidity and mortality, with a growing economic burden on health care systems. Complications from poorly controlled diabetes are associated with increased socioeconomic costs and reduced quality of life. Smartphones have become an influential platform, providing feasible tools such as health apps to deliver tailored support to enhance the ability of patients with diabetes for self-management. Gro Health is a National Health Service division X-certified digital health tool used to deliver educational and monitoring support to facilitate the development of skills and practices for maintaining good health. This study aims to assess self-reported outcomes of the Gro Health app among users with diabetes and prediabetes and identify the factors that determine engagement with the digital health tool. This was a service evaluation of self-reported data collected prospectively by the developers of the Gro Health app. The EQ-5D questionnaire is a standardized tool used to measure health status for clinical and economic appraisal. Gro Health users completed the EQ-5D at baseline and 6 months after using the app. Users provided informed consent for the use of their anonymized data for research purposes. EQ-5D index scores and visual analogue scale (VAS) scores were calculated at baseline and 6 months for individuals with prediabetes and type 2 diabetes. Descriptive statistics and multiple-regression models were used to assess changes in the outcome measures and determine factors that affected engagement with the digital tool. A total of 84% (1767/2114) of Gro Health participants completed EQ-5D at baseline and 6 months. EQ-5D index scores are average values that reflect people's preferences about their health state (1=full health and 0=moribund). There was a significant and clinically meaningful increase in mean EQ-5D index scores among app users between baseline (0.746, SD 0.23) and follow-up (0.792, SD 0.22; P<.001). The greatest change was observed in the mean VAS score, with a percentage change of 18.3% improvement (61.7, SD 18.1 at baseline;73.0, SD 18.8 at follow-up; P<.001). Baseline EQ-5D index scores, age, and completion of educational modules were associated with significant changes in the follow-up EQ-5D index scores, with baseline EQ-5D index scores, race and ethnicity, and completion of educational modules being significantly associated with app engagement (P<.001). This study provides evidence of a significant positive effect on self-reported quality of life among people living with type 2 diabetes engaging with a digital health intervention. The improvements, as demonstrated by the EQ-5D questionnaire, are facilitated through access to education and monitoring support tools within the app. This provides an opportunity for health care professionals to incorporate National Health Service-certified digital tools, such as Gro Health, as part of the holistic management of people living with diabetes.

An Orthopaedic perspective on developing a Patient Experience Survey tool

Introduction: Our program’s aim is to integrate patients' values and perceptions of quality care into clinical decision-making and integrated orthopaedic care models that are reflective of the community/population that is served. Our institution currently has limited patient experience data or standardized tools that would allow us to comprehensively understand patient perspective across our orthopaedic populations. To that end, we designed a survey to understand patients’ experiences and any gaps that would require actionable change in real-time.&#x0D; Objectives and Methodology: The goal was to develop a survey tool that can meaningfully capture patient needs and preferences that impact their experiences and help identify any gaps or areas of opportunity to address. An environmental scan was completed which identified two validated patient experience surveys used to inform our survey development: CIHI’s CPES-IC (Canadian Institue for Health Information Canadian Patient Experience Survey - Inpatient Care) and OHA (Ontario Hospital Association) Outpatient Experience Survey. The survey was tested across a multidisciplinary team via feedback surveys and focus groups: 6 Patient Partners, 1 Clinical Manager, 3 Advanced Practice Practitioners, 3 Orthopaedic Surgeons, 4 Researchers, and 2 Administrators. Findings were collated and used to iterate the survey content until consensus was reached on a final patient experience survey. &#x0D; Highlights or Results or Key Findings: The focus of the survey is on understanding the patient’s Outpatient experience with their care team in orthopaedic clinics from referral to assessment. The survey was designed to cover multiple orthopaedic populations including patients with Hip and Knee, Foot and Ankle, Shoulder, Elbow and Spine issues. It focuses on two key components of the patient journey: 1) Pre-appointment and 2) Post-appointment. The pre-appointment pathway was deemed to be important as patient experience is often captured once care is delivered and it was important to understand how patients perceive their pre-appointment experience defined as the time from referral through day of appointment up to the time patients are seen (arrival at hospital, checking in to clinic). Specifically, the pre-appointment survey has up to 42 questions that aim to capture the patients’ perspectives on the clinic’s communication practices, wait time to be contacted, wait time for an appointment, how prepared patients felt for their appointment, how they felt about access to the clinic, their experiences with care transitions, their thoughts on transportation and any education that they received, and their overall experience. The post-appointment survey has up to 41 questions focused on understanding the patients’ perspectives on care transitions, the clinic space; wait time to see the practitioner, expectations, engagement in decision making, communication practices, education they received, and any other factors impacting their experience (e.g. confidentiality, empathy, trust, dignity). &#x0D; Conclusion and Next Steps: The survey, reviewed with our patient partners and multidisciplinary team, was found to be comprehensive and have good face validity. The survey will be implemented and the data will be analyzed to understand themes around areas of success and areas of improvement to advance our integrated models of care in order to provide high quality patient-centered care.

Implementing Measurement-Based Care (MBC) for Mental Health in a Paediatric Hospital Setting

Introduction: Measurement-Based Care (MBC) is the routine, systematic use of validated measures (e.g., patient-reported outcome measures [PROMs]) before or during clinical encounters to inform treatment decision-making. A large body of evidence, including randomized controlled trials, suggest that MBC outperforms usual care in response to treatment, remission rates, time to response and remission for individuals with depression, anxiety and other mental health conditions. MBC is a standard of care for most chronic conditions (e.g., diabetes, hypertension, asthma), however, it is underutilized in pediatric mental healthcare, despite well documented benefits and feasibility. As part of the hospital’s broader mandate to better integrate physical and mental healthcare, the MBC implementation team set out to develop an MBC system for evaluation of mental health concerns across the hospital with the goal to facilitate monitoring and response of mental health metrics at the patient, provider, organizational, and system levels.&#x0D; Methods: An environmental scan was conducted to understand the priority areas for health systems’ improvement. Stakeholders engaged in the process were physician leaders, clinical operational directors, clinical staff, Youth and Family Advisory Panel members across hospital departments. The environmental scan and follow-up focus groups (n=57) highlighted the need to prioritize implementation of standardized mental assessment tools hospital-wide for patients at each health system encounter as part of a vision to deliver holistic, integrated care and improve quality of patient care. Early identification of mental health needs of patients across the hospital and the importance of establishing standardized metrics for common mental health conditions were additional key priorities. Hospital surveys highlighted anxiety and depression as the top mental health concerns across the hospital. An extensive review was conducted to identify validated tools available and to understand implementation best practices.&#x0D; Learnings: Learnings from our review pointed to some key factors for successful implementation. These included the need for tools that are brief and easy to use, are validated and sensitive to change, are user friendly and visually appealing for the pediatric population and are integrated into the electronic health record with appropriate decision support tools to enable real time review. The need for extensive patient and provider education about the value of MBC and its implementation was also a key learning.&#x0D; &#x0D; Work in progress &amp; next steps: Work is underway to map out clinical workflows, including ensuring a timely response to results, addressing implementation challenges such as virtual vs. in-person tool completion, and managing accessibility of sensitive data to the patient or their proxy in the electronic health record. Workflows will take an integrated, holistic care approach, whereby, a patient’s care team will action appropriate interventions based on a standardized algorithm that engages an interdisciplinary care team. Voxe, an external, patient-friendly platform to administer the two chosen assessment tools will be trialed. Discussions are underway with Information Management and Technology teams to integrate Voxe and clinical workflows in the hospital’s electronic health record. Evaluation of implementation of MBC in clinical settings will consider both process and outcome measures such as uptake, timely receipt of services, and clinical response.

ContactDoctor app: Video-consultations between citizens, municipality health or social care employees and general practitioners.

Introduction: The ContactDoctor app enables citizen-centric, interdisciplinary and cross-sector video-consultations to improve quality and integration of care and provide equitable access to healthcare.&#x0D; Background: Video-consultations with healthcare professionals, incl. general practitioners (GP), accelerated in 2020-2021 to limit the spread of Covid-19. During that time, the app ContactDoctor was rapidly developed in a successful public-private collaboration.&#x0D; A national project was initiated to support wider implementation of ContactDoctor, where the goal is 60/98 municipalities and 700/1600 GP clinics. &#x0D; The project is financed by the Danish Ministry of Health. The ContactDoctor-app is owned by the Organisation of General Practitioners in Denmark.&#x0D; Target group: ContactDoctor is intended for elderly and vulnerable citizens, e.g., people with social, psychological, physical problems, in nursing homes, homecare, rehabilitation, emergency teams and living-arrangement offers, who are not able to conduct a video-consultation with their GP without support. In Denmark, these welfare and healthcare areas are decentralised to municipalities. Municipality employees facilitate video-consultations between citizens and GPs and support citizens during the conversation. Citizens’ relatives can participate in the video-consultation too. &#x0D; The project collaborates with interested municipalities concerning implementation. A User Group, consisting of representatives from 10 municipalities and a data-consultant from each region, is closely involved in the development of ContactDoctor and in preparing guidelines and implementation-material. &#x0D; Results: The evaluation design is ‘Model for Assessment of Telemedicine’. Four evaluation reports are published between November 2021-February 2023 and collect different learnings and results from the implementation process or target groups. &#x0D; The following results are derived from two published reports and based on statistical data, 10 different questionnaires and 7 focus-group interviews targeted municipality employees, GPs, and project managers.&#x0D; &#x0D; By September 2022, the total number of video-consultation via ContactDoctor is 1614. The data is showing a continuous increase, albeit with large differences between the municipalities. Currently, 36 municipalities and 203 clinics is using ContactDoctor.&#x0D; Users report great potential in ContactDoctor due to the flexible and integrated format and user-friendliness. ContactDoctor has been used in many different situations: acute, follow-up, medication assessment, physical problems, preparation for doctor's visit. &#x0D; ContactDoctor has the potential to improve quality of care, enable better integrated care and provide equitable access to healthcare services. Users agree that ContactDoctor can lead to faster and more efficient treatment, fewer inconveniences for vulnerable citizens who, due to e.g., anxiety, reduced mobility, find it difficult getting to their GP. &#x0D; Conclusion and learnings: The use of video-consultations is voluntary and the implementation of ContactDoctor is progressing, however slowly despite users reporting it a beneficial supplement to physical consultations. During the pandemic, ContactDoctor was essential, but now several municipality employees recognize that they forget to use it during a busy workday. It requires great awareness and continuous implementation focus before the app is a standard work tool and its full potential in an integrated care approach is reached. This applies to both GPs and municipalities. Without local initiatives in regions and municipalities, including management support and implementation follow-up, the initiative can result in a low degree of use and distribution.

Farklı Et Kalınlıklarına Sahip Soğuk Şekillendirilmiş Kare İçi Boş Kesitli Elemanlara Monte Edilen Kör Perçin Somunlarının (BRN'ler) Çekme Kapasitesi Üzerine Deneysel Çalışma

In this study, pull-out tests of blind rivet nuts (BRNs) mounted on cold-formed square hollow section (SHS) webs with 100×100 mm nominal cross-section dimensions and different wall thicknesses (2.0 to 5.0 mm) were performed, and the effect of different wall thicknesses and BRN thread sizes on the test results was experimentally investigated. M10 and M12 stainless steel BRNs were mounted on SHSs using a standard riveter tool, and the test elements were prepared for the experiment. Load–displacement curves and the final damage modes were obtained for each test specimen. The results show that the pull-out capacity depends on both the SHS wall thickness and rivet nut thread size. Although the pull-out capacity increased in both thread sizes with the increase in wall thickness parameters, the effect of thread size is negligible in the case of 2.5, 3.0, and 4.0 wall thickness. In addition, when a connection is created using a BRN, the design should consider the stripped thread strength in addition to the pull-out capacity.

Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review.

This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation methods. VR is presented as a transformative tool that immerses individuals in interactive environments, offering promising opportunities for enhancing cognitive functions and improving quality of life. This article covers the foundational principles of VR, its applications across different clinical conditions and cognitive domains, and evaluates empirical evidence supporting its efficacy. It also discusses the advantages, limitations, challenges, and ethical considerations in the use of VR for cognitive rehabilitation. This review concludes by exploring future developments, including advancements in VR technology, the integration of Augmented Reality (AR) and artificial intelligence (AI), and the importance of standardized assessment tools for the objective evaluation of rehabilitation outcomes.

Measuring goal progress using the goal-based outcome (GBO) measure in Youth Wellness Hubs Ontario – an integrated youth mental health service

Problem and Context. There is a growing body of evidence indicating that the prevalence of mental health difficulties, in particular anxiety and depression, is increasing among youth, and many young people in this age group (12-25 years) do not get adequate mental health support. Recently, a global movement to transform youth mental health services is underway with the establishment of integrated youth services (IYS) that offer youth-specific care and emphasize early intervention and prevention, developmentally and culturally- informed services, community engagement, evidence-based and evidence-informed interventions, and youth and family engagement. While outcome data has an important role in enhancing the effectiveness of care for youth mental health, having young people define for themselves the area they feel should be the focus of in an intervention are also common measures used in IYS settings. Goal-setting has been used in therapy for several decades, and agreement on goals between young person and their clinician is thought to be central to successfully building a good therapeutic relationship and improving outcomes.&#x0D; Who is it for? Service providers, researchers, clinicians, youth and families.&#x0D; Who did you involve and engage with? Participants were young people (&gt;5000) who engaged with a Youth Wellness Hub service between April 2020 and October 2022. The data for this study comprised over 15,000 goals. Youth can set up to one, two or three goals at each visit using the Goal-Based Outcome (GBO) tool. Inductive thematic analysis was employed on the types of goals set by young people.&#x0D; What did you do? The aim of this study was to explore the type of service goals set by young people who are engaging with integrated mental health services. The study also looked at whether services facilitated progress in goals as set by young people.&#x0D; What results did you get? What impact did you have? The analysis identified a number of goal-related themes related to improving mental health, reducing substance use and other addictions, improving physical health, service navigation, and self-improvement. Data from presentation to last assessment will be reviewed to examine change in progress on goals over time.&#x0D; What is the learning for the international audience? Understanding the clinical utility of an idiographic measure like the GBO with young people accessing community-based services is critical because the tool allows for capturing aspects of young people’s lives that are of importance to them that may not be as easily captured on standardized outcome tools. &#x0D; What are the next steps? Future directions include continuous learning and evaluation of the GBO in integrated care settings and examining the association between goal progress and standardize outcomes.&#x0D;