Nutritional care of elderly patients in acute care settings: A qualitative study

© 2016 Japan Geriatrics Society. Aim: Poor nutritional status is common in older adult patients. The present study aimed to explore barriers and facilitators to nutritional care of elderly patients in acute care settings. Methods: Data were collected through individual face-to-face interviews with 12 registered nurses, and analyzed using interpretive description methodology. Results: Two core themes emerged from the analysis of data: (i) neglected care, with three subthemes of "support but also independence," "unsupportive environment" and "responsibility of the family;" and (ii) a humanitarian ethic, with two subthemes of "respect and dignity" and "humanitarian care." Conclusions: As an integral part of holistic care, elderly patient nutrition should be emphasised in health professional education, and promoted through managerial support, multidisciplinary collaborations, and implementation of appropriate monitoring and evaluation systems

Seismic Behaviour of Multistorey Steel Framed Tall Buildings Using Intentionally Eccentric Braces

Braces with intentional eccentricity (BIE) are recently proposed to improve the seismic behaviour of conventional buckling braces (CBBs) by inserting intentional eccentricity along the brace length. Due to this eccentricity and the resultant bending moment, the BIE bends uniformly from small storey drifts and moves smoothly into the postbuckling behaviour under compression and sustains trilinear behaviour under tension. This behaviour delays the appearance of midlength local buckling which causes unstable energy dissipation. BIEs have a desirable postyielding stiffness which results in stable energy dissipation during cyclic loading and are capable of dissipating energy during low-intensity earthquakes. The seismic behaviour of structures with BIEs for use in buildings has not yet been investigated, specifically in tall buildings. Therefore, this study concentrates on investigating the seismic behaviour of tall buildings equipped with BIEs that uses a 3-dimensional (3D) finite element model in ETABS. In the first step, a 20-storey structure is designed using both eccentric brace frame (EBF) and BIE system and their seismic performance under the TABAS earthquake record is compared. In the second step, the seismic performance of a 25-storey irregular structure is assessed to evaluate the efficiency of the BIE system in irregular structures. Results show the desirable performance and energy dissipation capacity of the BIE system but it also shows large out-of-plane deformation in some cases

Optimal placement of fuses and switches in active distribution networks using value-based MINLP

Contingency conditions in distribution networks create financial losses for different parts of the system including electricity customers, electricity retailers, distributed generation (DG) units, etc. Therefore, protective device allocation methods have been introduced in recent years to enhance the reliability of the power system. In this study, a new formulation is proposed to find the optimal places of sectionalizing switches and fuses while taking the financial loss of both electricity customers and DG units into account. The current method has the flexibility to consider DG effect on any location of the network and its islanded operation in case of contingencies. Moreover, the uncertainty in load and renewable generation is taken into account using stochastic programming. The results demonstrate that the DG units and their financial loss can change the results of switch and fuse placement dramatically when there are no tie switches in the network. Furthermore, it is found that this method can decrease the total reliability costs by 3.86% when high penetration of DG units is introduced into a modified Roy Billinton test system (RBTS). The problem is modeled as a mixed-integer nonlinear (MINLP) formulation and is handled using BARON solver in GAMS environment

Cesarean delivery in Iran: a population-based analysis using the Robson classification system.

BACKGROUND: The rise of Cesarean Sections (CS) is a global concern. In Iran, the rate of CS increased from 40.7% in 2005 to 53% in 2014. This figure is even higher in the private sector. OBJECTIVE: To analyze the CS rates in the last 2 years using the Robson Classification System in Iran. METHODS: A retrospective analysis of all in-hospital electronically recorded deliveries in Iran was conducted using the Robson classification. Comparisons were made in terms of the type of hospital, CS rate, and obstetric population, and contributions of each group to the overall cesarean deliveries were reported. RESULTS: Two million three hundred twenty-two thousand five hundred women gave birth, 53.6% delivered through CS. Robson group 5 was the largest contributing group to the overall number of cesarean deliveries (47.1%) at a CS rate of 98.4%. Group 2 and 1 ranked the second and third largest contributing groups to overall CSs (20.6 and 10.8%, respectively). The latter groups had CS rates much higher than the WHO recommendation of 67.2 and 33.1%, respectively. "Fetal Distress" and "Undefined Indications" were the most common reasons for cesarean deliveries at CS rates of 13.6 and 13.4%, respectively. There was a significant variation in CS rate among the three types of hospitals for Robson groups 1, 2, 3, 4, and 10. CONCLUSION: The study revealed significant variations in CS rate by hospital peer-group, especially for the private maternity units, suggesting the need for further attention and audit of the Robson groups that significantly influence the overall CS rate. The study results will help policymakers identify effective strategies to reduce the CS rate in Iran, providing appropriate benchmarking to compare obstetric care with other countries that have better maternal and perinatal outcomes

Sleep during and after cardiothoracic intensive care and psychological health during recovery

Intensive care patients and former ICU patients experience poor sleep quality. Psychological distress and diminished health-related quality of life are common among former ICU patients. Coronary artery bypass graft (CABG) surgery is the main reason for adults being admitted to ICU in Australia but the effect of on-pump vs off-pump surgery on sleep and recovery has not been reported. The aim was to assess self-reported sleep quality of CABG patients during and after ICU, psychological wellbeing, HRQOL during recovery and whether on-pump vs off-pump method of surgery affects sleep and recovery. Patients who underwent CABG surgery completed self-report questionnaires on sleep quality, psychological health and quality of life using validated instruments. Data collection occurred in ICU, on the hospital ward, and two months and six months after hospital discharge. Patients (n=101) were aged (mean±SD) 66.6±11.1 years, 79% male and had a median ICU stay (IQR) of 2 (2-4) days, BMI 27.3±4.3 and on-pump surgery (75%). Poor sleep was reported by 44 (62%) patients at six months and by 12 patients (12%) at all time points. Patients who had off-pump surgery had lower posttraumatic stress symptoms (p=.02) and better physical HRQOL (p=.01). In multivariate analysis, prehospital insomnia (P=.004), and physical (p<.0005) and mental p<.0005) HRQOL were independently associated with sleep quality at six months. There was no association between on-pump vs off-pump CABG surgical techniques and sleep quality at six months. Sleep quality of postoperative CABG patients was poor in ICU, in the hospital ward and up to six months. Poor sleep quality at six months was associated with prehospital insomnia, and physical and mental HRQOL at six months, but not with on-pump vs off-pump surgical techniques

Automated Assessment of Capital Allowances

Capital allowances play a crucial role in enabling businesses to claim tax relief on specific capital expenditures, reducing their taxable profits and overall tax burden. However, the current manual process for managing capital allowance claims is time-consuming and complex, particularly for small and medium enterprises (SMEs) that often lack access to expert consultation. Furthermore, the distinct nature of construction expenditure on buildings adds to the complexity, with unique costs and data for each property and project. These challenges underscore the necessity for the development of automated technologies and systems for capital allowance assessment. To address these challenges, we present the development of an automated capital allowance assessment system comprising three key components: a capital allowance expert system, a tax coding system, and an integrated web-based application. The capital allowance expert system covers the entire process of capital allowance assessment, leveraging rules and procedures extracted from standardised processes and expertise. The tax coding system automatically classifies textual costing items into corresponding tax codes, addressing the complexity of capital allowance rules and frequent legislative changes. The integrated web-based application offers an interactive experience for data gathering, analysis, coding, and report generation, providing a comprehensive solution for efficient and accurate capital allowance assessment. This automated system addresses the complexities and inefficiencies associated with manual capital allowance assessment. It potentially benefits tax authorities in standardising and streamlining allowance assessment processes while fostering economic growth through accessible services for SMEs and promoting environmental sustainability by encouraging energy-efficient practices.10.13039/501100006041-Innovate U.K. Knowledge Transfer Partnership Program

Factors affecting the quality of work-life of nurses: a correlational study

Background Quality of work-life is an important factor in the recruitment and retention of the nursing workforce and their work productivity. Aims This study aimed to identify factors that affect the quality of work-life of nurses. Methods In this correlational study, 239 nurses employed in a tertiary teaching hospital in Iran completed the study questionnaires, including the quality of work-life questionnaire. The associations between potential independent variables and quality of work-life were examined using multivariate regression analysis. Results Participants were mostly women (80.33%) and within the age range of 30–45 years (71.54%). Working in other hospitals, having a second job and health information-seeking behaviours were significant predictors of quality of work-life, explaining 28.68% of the total variance in quality of work-life of nurses. Conclusions Improving working standards may prevent nurses from working extra hours or in different occupations. This, along with facilitating the health information-seeking behaviours of nurses, may help improve their quality of work-life by maintaining a better work-life balance and acquiring knowledge and skills that can help with effective management of work and life commitments. </jats:sec

Evaluation of new suspension system for limb prosthetics

Background: Good prosthetic suspension system secures the residual limb inside the prosthetic socket and enables easy donning and doffing. This study aimed to introduce, evaluate and compare a newly designed prosthetic suspension system (HOLO) with the current suspension systems (suction, pin/lock and magnetic systems).Methods: All the suspension systems were tested (tensile testing machine) in terms of the degree of the shear strength and the patient's comfort. Nine transtibial amputees participated in this study. The patients were asked to use four different suspension systems. Afterwards, each participant completed a questionnaire for each system to evaluate their comfort. Furthermore, the systems were compared in terms of the cost.Results: The maximum tensile load that the new system could bear was 490 N (SD, 5.5) before the system failed. Pin/lock, magnetic and suction suspension systems could tolerate loads of580 N (SD, 8.5), 350.9 (SD, 7) and 310 N (SD, 8.4), respectively. Our subjects were satisfied with the new hook and loop system, particularly in terms of easy donning and doffing. Furthermore, the new system is considerably cheaper (35 times) than the current locking systems in the market.Conclusions: The new suspension system could successfully retain the prosthesis on the residual limb as a good alternative for lower limb amputees. In addition, the new system addresses some problems of the existing systems and is more cost effective than its counterparts. © 2014 Gholizadeh et al.; licensee BioMed Central Ltd

High speed chalcogenide glass electrochemical metallization cells with various active metals

We fabricated electrochemical metallization (ECM) cells using a GaLaSO solid electrolyte, a InSnO inactive electrode and active electrodes consisting of various metals (Cu, Ag, Fe, Cu, Mo, Al). Devices with Ag and Cu active metals showed consistent and repeatable resistive switching behaviour, and had a retention of 3 and >43 days, respectively; both had switching speeds of < 5 ns. Devices with Cr and Fe active metals displayed incomplete or intermittent resistive switching, and devices with Mo and Al active electrodes displayed no resistive switching ability. Deeper penetration of the active metal into the GaLaSO layer resulted in greater resistive switching ability of the cell. The off-state resistivity was greater for more reactive active metals which may be due to a thicker intermediate layer