Waiting is a common phenomenon in the doctor's waiting room. The purpose of this audit is to assess patient waiting time and doctor consultation time in a primary healthcare clinic and to formulate strategies for improvement. This audit was conducted at a primary care clinic for 4 weeks using the universal sampling method. All patients who attended the clinic during this period was included in the study except for those who required more time to be seen such as those who were critically ill, aggressive or those who came for repeat medication or procedures only without needing to see the doctor. The time of arrival was captured using the queue management system (QMS) and then the patient was given a timing chit which had to be manually filled by the staff at every station. The waiting time for registration, pre-consultation, consultation, appointment, payment and pharmacy were recorded as well as consultation time. The data were entered into the statistical software SPSS version 17 for analysis. version 17. Results showed that more than half of the patients were registered within 15 minutes (53%) and the average total waiting time from registration to seeing a doctor was 41 minutes. Ninety-nine percentage of patients waited less than 30 minutes to get their medication. The average consultation time was 18.21 minutes. The problems identified in this audit were addressed and strategies formulated to improve the waiting and consultation time were carried out including increasing the number of staff at the registration counter, enforcing the staggered appointment system for follow-up patients and improving the queuing system for walk-in patients.
The timing of ABG procedure in a cleft patient is crucial to provide room and bony
support for the eruption of canine. However, there seems to be a delay in execution of this
procedure in certain centres. Material and Methods: Sample consists of records of cleft patients
treated from 2000-2016. The date and age for commencement of active orthodontic treatment,
date referred for ABG and date ABG done were retrieved. The centres that conducted these
surgeries identified. (Copied from article).
Fast and computationally less complex feature extraction for moving object detection using aerial images from unmanned aerial vehicles (UAVs) remains as an elusive goal in the field of computer vision research. The types of features used in current studies concerning moving object detection are typically chosen based on improving detection rate rather than on providing fast and computationally less complex feature extraction methods. Because moving object detection using aerial images from UAVs involves motion as seen from a certain altitude, effective and fast feature extraction is a vital issue for optimum detection performance. This research proposes a two-layer bucket approach based on a new feature extraction algorithm referred to as the moment-based feature extraction algorithm (MFEA). Because a moment represents the coherent intensity of pixels and motion estimation is a motion pixel intensity measurement, this research used this relation to develop the proposed algorithm. The experimental results reveal the successful performance of the proposed MFEA algorithm and the proposed methodology.
'Causal' direction is of great importance when dealing with complex systems. Often big volumes of data in the form of time series are available and it is important to develop methods that can inform about possible causal connections between the different observables. Here we investigate the ability of the Transfer Entropy measure to identify causal relations embedded in emergent coherent correlations. We do this by firstly applying Transfer Entropy to an amended Ising model. In addition we use a simple Random Transition model to test the reliability of Transfer Entropy as a measure of 'causal' direction in the presence of stochastic fluctuations. In particular we systematically study the effect of the finite size of data sets.
Newtonian and special-relativistic predictions, based on the same model parameters and initial conditions for the trajectory of a low-speed scattering system are compared. When the scattering is chaotic, the two predictions for the trajectory can rapidly diverge completely, not only quantitatively but also qualitatively, due to an exponentially growing separation taking place in the scattering region. In contrast, when the scattering is nonchaotic, the breakdown of agreement between predictions takes a very long time, since the difference between the predictions grows only linearly. More importantly, in the case of low-speed chaotic scattering, the rapid loss of agreement between the Newtonian and special-relativistic trajectory predictions implies that special-relativistic mechanics must be used, instead of the standard practice of using Newtonian mechanics, to correctly describe the scattering dynamics.
Schizophrenia is a common and devastating illness. Patients with schizophrenia may develop many disabilities both due to the disease process as well as due to side effects of the medication used. There are many advances in the treatment of schizophrenia, which can effectively reduce many of these disabilities. Treatment of schizophrenia is a primary health care responsibility and thus all health care personnel need to equip themselves with the latest knowledge on management issues. This article outlines the current management issues in schizophrenia.
Temporary cardiac pacing is an established therapeutic modality in the treatment of heart block and bradyarrythmias due to various causes like drugs and metabolic causes and prior to permanent pacing. Temporary pacing using fluoroscopy is best but the image intensifier is not available to all medical units. The method of temporary pacing at the bedside is described in detail.
Existing structural components require strengthening after a certain period of time due to increases in service loads, errors in design, mechanical damage, and the need to extend the service period. Externally-bonded reinforcement (EBR) and near-surface mounted (NSM) reinforcement are two preferred strengthening approach. This paper presents a NSM technique incorporating NSM composites, namely steel and carbon fiber-reinforced polymer (CFRP) bars, as reinforcement. Experimental and analytical studies carried out to explore the performance of reinforced concrete (RC) members strengthened with the NSM composites. Analytical models were developed in predicting the maximum crack spacing and width, concrete cover separation failure loads, and deflection. A four-point bending test was applied on beams strengthened with different types and ratios of NSM reinforcement. The failure characteristics, yield, and ultimate capacities, deflection, strain, and cracking behavior of the beams were evaluated based on the experimental output. The test results indicate an increase in the cracking load of 69% and an increase in the ultimate load of 92% compared with the control beam. The predicted result from the analytical model shows good agreement with the experimental result, which ensures the competent implementation of the present NSM-steel and CFRP technique.
Patients are increasingly dissatisfied with the “waiting time” and “duration of consultation” at outpatient clinics. A cross sectional study was carried out to measure waiting time and duration of consultation and to examine patients’ level of satisfaction towards waiting time and duration of consultation at the Orthopedic Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This study also examined patient’s satisfaction towards the overall clinic services. Data was collected using a self-administered questionnaire. A total of 81 patients participated in this study with a response rate of 100 percent. Findings indicated a significant difference in the mean between expected waiting time level II (from the time the patient is given the calling number till the time patient is called into the doctor’s room) and the actual waiting time level II experienced. A significant difference in the mean between the expected duration of consultation and the actual duration of consultation experienced was also noted. However, no significant difference was found between the mean of expected waiting time level I (the time patient register at the counter till the patient is given the calling number) and the actual waiting time (p>0.05). Overall, patient satisfaction towards waiting time was low (29.6%) and duration of consultation was of moderate level (41.9%). The overall satisfaction towards the clinic services were of average level (56.8%). Findings also indicated that patient satisfaction was not influenced by socio-demographic factors of respondents such as age, ethnic, education level, occupation and income level. Important findings from this study may help staff managing the clinic in addressing patients’ complaint on waiting time and improve patients’ satisfaction on the overall services of the Orthopedic clinic in UKMMC.
Study site: Orthopedic clinc, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fannia prisca Stein, 1918 is newly recorded from peninsular Malaysia. This record is based on 4 male specimens from Mount Berembun, Brinchang, Cameron Highland, Pahang state, peninsular Malaysia. It is previously recorded from China, Mongolia, Korea, Japan, Taiwan, Bonin Island, Thailand and oriental region. The male of Fannia prisca can be differentiated from male Fannia scalaris by the following features: for F. prisca, mid-coxa without spine; mid-tibia normal or without stout triangular ventral projection; and hind tibia usually with 2 av, while F. scalaris has several stout hook-like spines on the anterior margin; mid-tibia with stout triangular ventral projection and hind tibia usually with 3 av. Both F. prisca and F. scalaris can be differentiated from Fannia leucosticta by looking at its hind tibia, which only has 1 av.
We have used electron probe microanalysis to examine Southeast Asian nephrite (jade) artifacts, many archeologically excavated, dating from 3000 B.C. through the first millennium A.D. The research has revealed the existence of one of the most extensive sea-based trade networks of a single geological material in the prehistoric world. Green nephrite from a source in eastern Taiwan was used to make two very specific forms of ear pendant that were distributed, between 500 B.C. and 500 A.D., through the Philippines, East Malaysia, southern Vietnam, and peninsular Thailand, forming a 3,000-km-diameter halo around the southern and eastern coastlines of the South China Sea. Other Taiwan nephrite artifacts, especially beads and bracelets, were distributed earlier during Neolithic times throughout Taiwan and from Taiwan into the Philippines.
The mangrove forests of Southeast Asia are highly biodiverse and provide multiple ecosystem services upon which millions of people depend. Mangroves enhance fisheries and coastal protection, and store among the highest densities of carbon of any ecosystem globally. Mangrove forests have experienced extensive deforestation owing to global demand for commodities, and previous studies have identified the expansion of aquaculture as largely responsible. The proportional conversion of mangroves to different land use types has not been systematically quantified across Southeast Asia, however, particularly in recent years. In this study we apply a combined geographic information system and remote sensing method to quantify the key proximate drivers (i.e., replacement land uses) of mangrove deforestation in Southeast Asia between 2000 and 2012. Mangrove forests were lost at an average rate of 0.18% per year, which is lower than previously published estimates. In total, more than 100,000 ha of mangroves were removed during the study period, with aquaculture accounting for 30% of this total forest change. The rapid expansion of rice agriculture in Myanmar, and the sustained conversion of mangroves to oil palm plantations in Malaysia and Indonesia, are identified as additional increasing and under-recognized threats to mangrove ecosystems. Our study highlights frontiers of mangrove deforestation in the border states of Myanmar, on Borneo, and in Indonesian Papua. To implement policies that conserve mangrove forests across Southeast Asia, it is essential to consider the national and subnational variation in the land uses that follow deforestation.
A centrifugal compact disc (CD) microfluidic platform with reservoirs, micro-channels, and valves can be employed for implementing a complete immunoassay. Detection or biosensor chambers are either coated for immuno-interaction or a biosensor chip is inserted in them. On microfluidic CDs featuring such multi-step chemical/biological processes, the biosensor chamber must be repeatedly filled with fluids such as enzymes solutions, buffers, and washing solutions. After each filling step, the biosensor chamber needs to be evacuated by a passive siphoning process to prepare it for the next step in the assay. However, rotational speed dependency and limited space on a CD are two big obstacles to performing such repetitive filling and siphoning steps. In this work, a unique thermo-pneumatic (TP) Push-Pull pumping method is employed to provide a superior alternative biosensor chamber filling and evacuation technique. The proposed technique is demonstrated on two CD designs. The first design features a simple two-step microfluidic process to demonstrate the evacuation technique, while the second design shows the filling and evacuation technique with an example sequence for an actual immunoassay. In addition, the performance of the filling and evacuation technique as a washing step is also evaluated quantitatively and compared to the conventional manual bench top washing method. The two designs and the performance evaluation demonstrate that the technique is simple to implement, reliable, easy to control, and allows for repeated push-pulls and thus filling and emptying of the biosensor chamber. Furthermore, by addressing the issue of rotational speed dependency and limited space concerns in implementing repetitive filling and evacuation steps, this newly introduced technique increases the flexibility of the microfluidic CD platform to perform multi-step biological and chemical processes.
As a part of the study to explore the possible strategy for enhancing the shelf life of mango fruits, we investigated the changes in biochemical parameters and activities of ripening associated enzymes of Ashwina hybrid mangoes at 4-day regular intervals during storage at -10°C, 4°C, and 30 ± 1°C. Titratable acidity, vitamin C, starch content, and reducing sugar were higher at unripe state and gradually decreased with the increasing of storage time at all storage temperatures while phenol content, total soluble solid, total sugar, and nonreducing sugar contents gradually increased. The activities of amylase, α-mannosidase, α-glucosidase, and invertase increased sharply within first few days and decreased significantly in the later stage of ripening at 30 ± 1°C. Meanwhile polyphenol oxidase, β-galactosidase, and β-hexosaminidase predominantly increased significantly with the increasing days of storage till later stage of ripening. At -10°C and 4°C, the enzymes as well as carbohydrate contents of storage mango changed slightly up to 4 days and thereafter the enzyme became fully dormant. The results indicated that increase in storage temperature and time correlated with changes in biochemical parameters and activities of glycosidases suggested the suppression of β-galactosidase and β-hexosaminidase might enhance the shelf life of mango fruits.
The design and implementation of a high-speed direct digital frequency synthesizer are presented. A modified Brent-Kung parallel adder is combined with pipelining technique to improve the speed of the system. A gated clock technique is proposed to reduce the number of registers in the phase accumulator design. The quarter wave symmetry technique is used to store only one quarter of the sine wave. The ROM lookup table (LUT) is partitioned into three 4-bit sub-ROMs based on angular decomposition technique and trigonometric identity. Exploiting the advantages of sine-cosine symmetrical attributes together with XOR logic gates, one sub-ROM block can be removed from the design. These techniques, compressed the ROM into 368 bits. The ROM compressed ratio is 534.2:1, with only two adders, two multipliers, and XOR-gates with high frequency resolution of 0.029 Hz. These techniques make the direct digital frequency synthesizer an attractive candidate for wireless communication applications.
Effective waste management has been greatly restricted by insufficient statistical data on the generation, processing and waste disposal. This study was undertaken in the municipality of Tehran. A total of 6,060 samples were compared by statistically comparing source generation, destination and intermediate stations. The results from these analyses showed that the average per capita waste generation in Tehran was 589 g day(-1). It was also observed that, of the total amount of waste generated in the municipality of Tehran, 73% was domestic waste and 27% was non-domestic waste. In addition, 68% of total household waste was organic waste, while 41% of non-domestic waste was organic waste. Furthermore, 61% of waste in Tehran was generated at the source, while 72% of the waste coming into the Aradkoh disposal and processing center was organic waste. The physical analysis was showed that there was no significant difference between the wastes generated in 2004 and those generated in 2009 and that there was not equal percentage of wet waste coming into the disposal center with urban service stations. This indicates that active source separation programs in metropolitan Tehran.