A strategic roadmap for achieving the potential benefits of electronic health record system in the state of Kuwait

This research investigates the desired benefits of using an Electronic Health Record (EHR) in Kuwait Primary Health Care Centers and the perceived barriers to its successful adoption. From this, a set of key strategic capabilities are proposed, ranked for priority and urgency as a roadmap for EHR adoption in the State of Kuwait. This thesis examines the organization of the health care system in Kuwait and important issues related to primary health care, including the implementation and current use of the EHR system at Kuwait primary health care centers. International evidence of the EHR system benefits, barriers and capabilities such as interoperability, confidentiality and security were used as the basis for user surveys. The research applied domain theory and research-based improvement strategy as a means of identifying the stakeholders and the priorities area of investigation. The research utilized a quantitative research design focusing on multiple case studies as the survey methodology. Two case study surveys were conducted to identify the main benefits and barriers that affect the adoption of the EHR at international and national (Kuwaiti) levels. The first survey involved international and national decision makers. The second survey involved healthcare professionals working in Kuwait primary health care to assess their view regarding the features of the current system, the benefits and barriers of more complete EHRs. The results of first and second surveys were used to develop a list of key EHR system capabilities and adoption requirements relevant to Kuwait primary care. This list was used for the design of a third survey, for senior stakeholders at the Kuwait Ministry of Health, to identify their strategic roadmap priorities. This research, drawing on the literature of the EHR design and implementation, a study of international initiatives of the EHR adoption and outputs of three case studies, has emphasized the importance of developing a strategic roadmap for Kuwait to achieve the potential benefits of EHRs

Control of Vibrations due to Moving Loads on Suspension Bridges

The flexibility and low damping of the long span suspended cables in suspension bridges makes them prone to vibrations due to wind and moving loads which affect the dynamic responses of the suspended cables and the bridge deck. This paper investigates the control of vibrations of a suspension bridge due to a vertical load moving on the bridge deck with a constant speed. A vertical cable between the bridge deck and the suspended cables is used to install a hydraulic actuator able to generate an active control force on the bridge deck. Two control schemes are proposed to generate the control force needed to reduce the vertical vibrations in the suspended cables and in the bridge deck. The proposed controllers, whose design is based on Lyapunov theory, guarantee the asymptotic stability of the system. The MATLAB software is used to simulate the performance of the controlled system. The simulation results indicate that the proposed controllers work well. In addition, the performance of the system with the proposed controllers is compared to the performance of the system controlled with a velocity feedback controller

Experimental Evaluation of the Deadtime Phenomenon for GM Detector: Deadtime Dependence on Operating Voltages

A detailed analysis of Geiger Mueller counter deadtime dependence on operating voltage is presented in the manuscript using four pairs of radiation sources. Based on two-source method, detector deadtime is calculated for a wide range of operating voltages which revealed a peculiar relationship between the operating voltage and the detector deadtime. In the low voltage range, a distinct drop in deadtime was observed where deadtime reached a value as low as a few microseconds (22 µs for 204Tl, 26 µs for 137Cs, 9 µs for 22Na). This sharp drop in the deadtime is possibly due to reduced recombination with increasing voltage. After the lowest point, the deadtime generally increased rapidly to reach a maximum (292 µs for 204Tl, 277 µs for 137Cs, 258 µs for 22Na). This rapid increase in the deadtime is mainly due to the on-set of charge multiplication. After the maximum deadtime values, there was an exponential decrease in the deadtime reaching an asymptotic low where the manufacturer recommended voltage for operation falls. This pattern of deadtime voltage dependence was repeated for all sources tested with the exception of 54Mn. Low count rates leading to a negative deadtime suggested poor statistical nature of the data collected for 54Mn and the data while being presented here is not used for any inference

Fuzzy Controllers for a Gantry Crane System with Experimental Verifications

The control problem of gantry cranes has attracted the attention of many researchers because of the various applications of these cranes in the industry. In this paper we propose two fuzzy controllers to control the position of the cart of a gantry crane while suppressing the swing angle of the payload. Firstly, we propose a dual PD fuzzy controller where the parameters of each PD controller change as the cart moves toward its desired position, while maintaining a small swing angle of the payload. This controller uses two fuzzy subsystems. Then, we propose a fuzzy controller which is based on heuristics. The rules of this controller are obtained taking into account the knowledge of an experienced crane operator. This controller is unique in that it uses only one fuzzy system to achieve the control objective. The validity of the designed controllers is tested through extensive MATLAB simulations as well as experimental results on a laboratory gantry crane apparatus. The simulation results as well as the experimental results indicate that the proposed fuzzy controllers work well. Moreover, the simulation and the experimental results demonstrate the robustness of the proposed control schemes against output disturbances as well as against uncertainty in some of the parameters of the crane

Appraising Rufaidah Al-Aslamia, First Muslim Nurse and Pioneer of Islamic Nursing: Contributions and Legacy

Global advancement in nursing is attributed mainly to western pioneers with negligible recognition of Rufaidah Al-Aslamia, who was the first Muslim nurse, and pioneer in Islamic nursing more than 1,400 years ago in Madinah (Medina, Saudi Arabia). She responded to the need for the provision of organized nursing care to injured soldiers in the Islamic battles during the time of Prophet Mohammed (Peace & Blessings Upon Him). The paucity of focus on Rufaidah Al-Aslamia triggered this scientific study to appraise her contributions and legacy as the pioneer of Islamic nursing. A qualitative, historical research inquiry was conducted using a research design that was exploratory, descriptive, explanatory, interpretive, and contextual within the constructivist paradigm. Data collection of literature was conducted by purposive sampling. Data analysis was conducted in two parts, which is document analysis, and thematic and content analysis with the use of deductive, inductive and abductive logical reasoning. The results of topic themes related to nurse-, patient-, and system-focused activities are provided with the emerging themes including efficient organizer, effective communication, clinical practice teacher, community care, and spiritual care. The historical narrative is reconstructed using empirical data sources as part of the discussion that includes the biography of Rufaidah Al-Aslamia and a vivid comprehensive portrayal of the contributions and legacy of Rufaidah Al-Aslamia as the first Muslim nurse and the pioneer of Islamic nursing.   Abstrak Rufaidah Al-Aslamia, Perawat Muslim Pertama dan Pelopor Keperawatan Islam: Kontribusi dan Legasi. Kemajuan global di bidang keperawatan seringkali dikaitkan terutama dengan perintis barat dengan sedikit pengakuan terhadap Rufaidah Al-Aslamia, yang merupakan perawat Muslim pertama, dan pelopor dalam keperawatan Islam lebih dari 1.400 tahun yang lalu di Madinah (Arab Saudi). Rufaidah Al-Aslamia menanggapi kebutuhan penyediaan asuhan keperawatan yang terorganisir untuk tentara yang terluka dalam pertempuran Islam pada masa Nabi Muhammad (SAW). Kurangnya fokus pada Rufaidah Al-Aslamia memicu studi ilmiah ini untuk menilai kontribusi dan warisannya sebagai pelopor keperawatan Islam. Penelusuran sejarah dengan pendekatan kualitatif dilakukan dengan menggunakan desain penelitian yang bersifat eksploratif, deskriptif, eksplanatif, interpretif, dan kontekstual dalam paradigma konstruktivis. Pengumpul-an data literatur dilakukan dengan purposive sampling. Analisis data dilakukan dalam dua bagian, yaitu analisis dokumen, dan analisis tematik dan isi dengan menggunakan penalaran logis deduktif, induktif dan abduktif. Hasil dari topik yang berkaitan dengan kegiatan yang berfokus pada perawat, pasien, dan sistem disajikan dengan tema-tema yang muncul termasuk penyelenggara yang efisien, komunikasi yang efektif, guru praktik klinis, perawatan komunitas, dan perawatan spiritual. Narasi sejarah direkonstruksi menggunakan sumber data empiris sebagai bagian dari diskusi yang mencakup biografi Rufaidah Al-Aslamia dan penggambaran komprehensif yang jelas tentang kontribusi dan warisan Rufaidah Al-Aslamia sebagai perawat Muslim pertama dan pelopor keperawatan Islam. Kata kunci: Nabi Muhammad, pelopor keperawatan islam, perawat muslim pertama, Rufaidah Al-Aslami

Simultaneous Experimental Evaluation of Pulse Shape and Deadtime Phenomenon of GM Detector

Analysis of several pulse shape properties generated by a Geiger Mueller (GM) detector and its dependence on applied voltage was performed. The two-source method was utilized to measure deadtime while simultaneously capturing pulse shape parameters on an oscilloscope. A wide range of operating voltages (600-1200 V) beyond the recommended operating voltage of 900 V was investigated using three radioactive sources (204Tl, 137Cs, 22Na). This study investigates the relationship between operating voltage, pulse shape properties, and deadtime of the detector. Based on the data, it is found that deadtime decreases with increasing voltage from 600 to 650 V. At these low voltages (600–650 V), the collection time was long, allowing sufficient time for some recombination to take place. Increasing the voltage in this range decreased the collection time, and hence deadtime decreased. It is also observed that rise and fall time were at their highest at these applied voltages. Increasing the voltage further would result in gas multiplication, where deadtime and pulse width are observed to be increasing. After reaching the maximum point of deadtime (~ 250 µs at ~ 700 V), deadtime started to exponentially decrease until a plateau was reached. In this region, it is observed that detector deadtime and operating voltage show a strong correlation with positive pulse width, rise and fall time, cycle mean, and area. Therefore, this study confirms a correlation between detector deadtime, operating voltage, and pulse shape properties. The results will validate our hypothesis that deadtime phenomena at different operating voltages are phenomenologically different

Neutronic Investigation of Alternative & Composite Burnable Poisons for the Soluble-Boron-Free and Long Life Civil Marine Small Modular Reactor Cores

Concerns about the effects of global warming provide a strong case to consider how best nuclear power could be applied to marine propulsion. Currently, there are persistent efforts worldwide to combat global warming, and that also includes the commercial freight shipping sector. In an effort to decarbonize the marine sector, there are growing interests in replacing the contemporary, traditional propulsion systems with nuclear propulsion systems. The latter system allows freight ships to have longer intervals before refueling; subsequently, lower fuel costs, and minimal carbon emissions. Nonetheless, nuclear propulsion systems have remained largely confined to military vessels. It is highly desirable that a civil marine core not use soluble boron for reactivity control, but it is then a challenge to achieve an adequate shutdown margin throughout the core life while maintaining reactivity control and acceptable power distributions in the core. High-thickness ZrB2 150 μm Integral Fuel Burnable Absorber (IFBA) is an excellent burnable poison (BP) candidate for long life soluble-boron-free core. However, in this study, we want to minimize the use of 150 μm IFBA since B-10 undergoes an (n, α) capture reaction, and the resulting helium raises the pressure within the plenum and in the cladding. Therefore, we have considered several alternative and novel burnable BP design strategies to minimize the use of IFBA for reactivity control in this study: (Case 1) a composite BP: gadolinia (Gd2O3) or erbia (Er2O3) with 150 μm thickness ZrB2 IFBA; (Case 2) Pu-240 or Am-241 mixed homogeneously with the fuel; and (Case 3) another composite BP: Pu-240 or Am-241 with 150 μm thickness ZrB2 IFBA. The results are compared against those for a high-thickness 150 μm 25 IFBA pins design from a previous study. The high-thickness 150 μm 25 IFBA pins design is termed the IFBA-only BP design throughout this study. We arrive at a design using 15% U-235 fuel loaded into 13 x 13 assemblies with Case 3 BPs (IFBA+Pu-240 or IFBA+Am-241) for reactivity control while reducing 20% IFBA use. This design exhibits lower assembly reactivity swing and minimal burnup penalty due to the self-shielding effect. Case 3 provides ~10% more initial (beginning-of-life) reactivity suppression with ~70% less reactivity swing compared to the IFBA-only design for UO2 fuel while achieving almost the same core lifetime. Finally, optimized Case 3 assemblies were loaded in 3D nodal diffusion and reactor model code. The results obtained from the 3D reactor model confirmed that the designed core with the proposed Case 3 BPs can achieve the target lifetime of 15 years while contributing to ~10% higher BOL reactivity suppression, ~70% lower reactivity swings, ~30% lower radial form factor and ~28% lower total peaking factor compared to the IFBA-only core

Plasmin Inhibitor in Health and Diabetes: Role of the Protein as a Therapeutic Target

The vascular obstructive thrombus is composed of a mesh of fibrin fibers with blood cells trapped in these networks. Enhanced fibrin clot formation and/or suppression of fibrinolysis are associated with an increased risk of vascular occlusive events. Inhibitors of coagulation factors and activators of plasminogen have been clinically used to limit fibrin network formation and enhance lysis. While these agents are effective at reducing vascular occlusion, they carry a significant risk of bleeding complications. Fibrin clot lysis, essential for normal hemostasis, is controlled by several factors including the incorporation of antifibrinolytic proteins into the clot. Plasmin inhibitor (PI), a key antifibrinolytic protein, is cross-linked into fibrin networks with higher concentrations of PI documented in fibrin clots and plasma from high vascular risk individuals. This review is focused on exploring PI as a target for the prevention and treatment of vascular occlusive disease. We first discuss the relationship between the PI structure and antifibrinolytic activity, followed by describing the function of the protein in normal physiology and its role in pathological vascular thrombosis. Subsequently, we describe in detail the potential use of PI as a therapeutic target, including the array of methods employed for the modulation of protein activity. Effective and safe inhibition of PI may prove to be an alternative and specific way to reduce vascular thrombotic events while keeping bleeding risk to a minimum