Search results for: indicators of care quality
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 13781

Search results for: indicators of care quality

10571 Computational Fluid Dynamics (CFD) Simulations for Studying Flow Behaviors in Dipping Tank in Continuous Latex Gloves Production Lines

Authors: Worrapol Koranuntachai, Tonkid Chantrasmi, Udomkiat Nontakaew

Abstract:

Medical latex gloves are made from the latex compound in production lines. Latex dipping is considered one of the most important processes that directly affect the final product quality. In a continuous production line, a chain conveyor carries the formers through the process and partially submerges them into an open channel flow in a latex dipping tank. In general, the conveyor speed is determined by the desired production capacity, and the latex-dipping tank can then be designed accordingly. It is important to understand the flow behavior in the dipping tank in order to achieve high quality in the process. In this work, Computational Fluid Dynamics (CFD) was used to simulate the flow past an array of formers in a simplified latex dipping process. The computational results showed both the flow structure and the vortex generation between two formers. The maximum shear stress over the surface of the formers was used as the quality metric of the latex-dipping process when adjusting operation parameters.

Keywords: medical latex gloves, latex dipping, dipping tank, computational fluid dynamics

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10570 Autonomy in Pregnancy and Childbirth: The Next Frontier of Maternal Health Rights Advocacy

Authors: Alejandra Cardenas, Ona Flores, Fabiola Gretzinger

Abstract:

Since the 1990s, legal strategies for the promotion and protection of maternal health rights have achieved significant gains. Successful litigation in courts around the world have shown that these rights can be judicially enforceable. Governments and international organizations have acknowledged the importance of a human rights-based approach to maternal mortality and morbidity, and obstetric violence has been recognized as a human rights issue. Despite the progress made, maternal mortality has worsened in some regions of the world, while progress has stagnated elsewhere, and mistreatment in maternal care is reported almost universally. In this context, issues of maternal autonomy and decision-making during pregnancy, labor, and delivery as a critical barrier to access quality maternal health have been largely overlooked. Indeed, despite the principles of autonomy and informed consent in medical interventions being well-established in international and regional norms, how they are applied particularly during childbirth and pregnancy remains underdeveloped. National and global legal standards and decisions related to maternal health were reviewed and analyzed to determine how maternal autonomy and decision-making during pregnancy, labor, and delivery have been protected (or not) by international and national courts. The results of this legal research and analysis lead to the conclusion that a few standards have been set by courts regarding pregnant people’s rights to make choices during pregnancy and birth; however, most undermine the agency of pregnant people. These decisions recognize obstetric violence and gender-based discrimination, but fail to protect pregnant people’s autonomy, privacy, and their right to informed consent. As current human rights standards stand today, maternal health is the only field in medicine and law in which informed consent can be overridden, and patients can be forced to submit to treatments against their will. Unconsented treatment and loss of agency during pregnancy and childbirth can have long-term physical and mental impacts, reduce satisfaction and trust in health systems, and may deter future health-seeking behaviors. This research proposes a path forward that focuses on the pregnant person as an independent agent, relying on the doctrine of self-determination during pregnancy and childbirth, which includes access to the necessary conditions to enable autonomy and choice throughout pregnancy and childbirth as a critical step towards our approaches to reduce maternal mortality, morbidity, and mistreatment, and realize the promise of access to quality maternal health as a human right.

Keywords: autonomy in childbirth and pregnancy, choice, informed consent, jurisprudential analysis

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10569 Assessment of the Risks of Environmental Factors on the Health of Kazakhstan Cities in Promoting the Sustainable Development Goals

Authors: Rassima Salimbayeva, Kaliash Stamkulova, Gulparshyn Satbayeva

Abstract:

In order to adapt projects to promote Sustainable Development Goal 11. «Ensuring openness, security, resilience and environmental sustainability of cities and human settlements», presented in the UN Concept, it is necessary to assess the environmental sustainability of cities. From the analysis of the problems of sustainable development of cities in Kazakhstan, it can be seen that the industrial past created a typical range of problems -transport, housing, environment, and, importantly, image. Currently, the issue of air pollution in cities whose economies are dominated by one industry or company should be studied in more detail at the level of projects. In this research, using ecological, economic, and social indicators of five single-industry towns of the Karaganda region of Kazakhstan, an assessment of the risks of the negative impact of environmental factors on the health of the population was carried out, including by paying special attention to air quality. In order to investigate the relationship between the structure of industry, environmental pressure, and environmental sustainability of resource-oriented cities, an analysis of the main components was carried out to measure the structure of industry, environmental stress, and environmental sustainability of single-industry towns. It has been established that in resource-based cities, economic growth mainly depends on the development of one main industry, which primarily depends on local natural resources. Empirical results show that the regional structure of industry has a significant negative impact on the environmental sustainability of cities, in particular on the health of the population living in them. The paper complements the study of the theory of urban sustainability and clarifies the relationship between industrial structure and environmental pressure on health safety and environmental sustainability of cities and towns, which is crucial for further promoting the "green" development of single-industry towns based on natural resources.

Keywords: public health risks, urban sustainability, suspended solids, single-industry towns, atmospheric air, environmental pollution

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10568 Transformation of the Business Model in an Occupational Health Care Company Embedded in an Emerging Personal Data Ecosystem: A Case Study in Finland

Authors: Tero Huhtala, Minna Pikkarainen, Saila Saraniemi

Abstract:

Information technology has long been used as an enabler of exchange for goods and services. Services are evolving from generic to personalized, and the reverse use of customer data has been discussed in both academia and industry for the past few years. This article presents the results of an empirical case study in the area of preventive health care services. The primary data were gathered in workshops, in which future personal data-based services were conceptualized by analyzing future scenarios from a business perspective. The aim of this study is to understand business model transformation in emerging personal data ecosystems. The work was done as a case study in the context of occupational healthcare. The results have implications to theory and practice, indicating that adopting personal data management principles requires transformation of the business model, which, if successfully managed, may provide access to more resources, potential to offer better value, and additional customer channels. These advantages correlate with the broadening of the business ecosystem. Expanding the scope of this study to include more actors would improve the validity of the research. The results draw from existing literature and are based on findings from a case study and the economic properties of the healthcare industry in Finland.

Keywords: ecosystem, business model, personal data, preventive healthcare

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10567 A Study of Growth Performance, Carcass Characteristic, Meat Quality and Association of Polymorphism in the ApoVLDL-II Gene with Fat Accumulation in the Female Broiler, Thai Native and Betong Chickens (KU Line)

Authors: C. Kridtayopas, W. Danvilai, P. Sopannarath, A. Kayan, W. Loongyai

Abstract:

Both Betong chicken (KU Line) and Thai Native chickens were the high quality of the meat and low carcass fat compared to broiler chickens. The objective of this study was to determine the growth performance, carcass characteristic, meat quality and association of polymorphism in the ApoVLDL-II gene with fat accumulation in the female broiler, Thai Native and Betong (KU line) chickens at 4-14 weeks. The chickens were used and reared under the same environment and management (100 chicks per breed). The results showed that body weight (BW) of broiler chickens was significantly higher than Thai Native and Betong (KU line) chickens (P < 0.01) through all the experiment. At 4-8 weeks of age, feed conversion ratio (FCR) of broiler chickens was significantly better than Thai Native and Betong (KU line) chickens (P < 0.01), then increased at week 8-14. The percentage of breast, abdominal fat and subcutaneous fat of broiler chickens was significantly greater than Thai Native and Betong (KU line) chickens (P < 0.01). However, Thai Native chickens showed the highest percentage of liver (P < 0.01) when compared to other breeds. In addition, the percentage of wing of Thai Native and Betong (KU line) chickens were significantly (P < 0.01) higher than broiler chickens. Meat quality was also determined and found that, pH of breast meat left from slaughter 45 minutes (pH45) and 24 hours (pH24) of broiler was significantly higher than Thai Native and Betong (KU line) (P < 0.01) whereas the percentage of drip loss, thawing loss, cooking loss and shear force was not significantly different between breeds. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was used to genotype the polymorphism in the ApoVLDL-II gene in the broiler, Thai Native and Betong (KU line) chickens. The results found that, the polymorphism in the ApoVLDL-II gene at VLDL6 loci was not associated with fat accumulation in those studied population.

Keywords: ApoVLDL-II gene, Betong (KU line) chickens, broiler chickens, carcass characteristic, growth performance, meat quality, Thai native chickens

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10566 Defence Ethics : A Performance Measurement Framework for the Defence Ethics Program

Authors: Allyson Dale, Max Hlywa

Abstract:

The Canadian public expects the highest moral standards from Canadian Armed Forces (CAF) members and Department of National Defence (DND) employees. The Chief, Professional Conduct and Culture (CPCC) stood up in April 2021 with the mission of ensuring that the defence culture and members’ conduct are aligned with the ethical principles and values that the organization aspires towards. The Defence Ethics Program (DEP), which stood up in 1997, is a values-based ethics program for individuals and organizations within the DND/CAF and now falls under CPCC. The DEP is divided into five key functional areas, including policy, communications, collaboration, training and education, and advice and guidance. The main focus of the DEP is to foster an ethical culture within defence so that members and organizations perform to the highest ethical standards. The measurement of organizational ethics is often complex and challenging. In order to monitor whether the DEP is achieving its intended outcomes, a performance measurement framework (PMF) was developed using the Director General Military Personnel Research and Analysis (DGMPRA) PMF development process. This evidence-based process is based on subject-matter expertise from the defence team. The goal of this presentation is to describe each stage of the DGMPRA PMF development process and to present and discuss the products of the DEP PMF (e.g., logic model). Specifically, first, a strategic framework was developed to provide a high-level overview of the strategic objectives, mission, and vision of the DEP. Next, Key Performance Questions were created based on the objectives in the strategic framework. A logic model detailing the activities, outputs (what is produced by the program activities), and intended outcomes of the program were developed to demonstrate how the program works. Finally, Key Performance Indicators were developed based on both the intended outcomes in the logic model and the Key Performance Questions in order to monitor program effectiveness. The Key Performance Indicators measure aspects of organizational ethics such as ethical conduct and decision-making, DEP collaborations, and knowledge and awareness of the Defence Ethics Code while leveraging ethics-related items from multiple DGMPRA surveys where appropriate.

Keywords: defence ethics, ethical culture, organizational performance, performance measurement framework

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10565 Digital Image Steganography with Multilayer Security

Authors: Amar Partap Singh Pharwaha, Balkrishan Jindal

Abstract:

In this paper, a new method is developed for hiding image in a digital image with multilayer security. In the proposed method, the secret image is encrypted in the first instance using a flexible matrix based symmetric key to add first layer of security. Then another layer of security is added to the secret data by encrypting the ciphered data using Pythagorean Theorem method. The ciphered data bits (4 bits) produced after double encryption are then embedded within digital image in the spatial domain using Least Significant Bits (LSBs) substitution. To improve the image quality of the stego-image, an improved form of pixel adjustment process is proposed. To evaluate the effectiveness of the proposed method, image quality metrics including Peak Signal-to-Noise Ratio (PSNR), Mean Square Error (MSE), entropy, correlation, mean value and Universal Image Quality Index (UIQI) are measured. It has been found experimentally that the proposed method provides higher security as well as robustness. In fact, the results of this study are quite promising.

Keywords: Pythagorean theorem, pixel adjustment, ciphered data, image hiding, least significant bit, flexible matrix

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10564 Research of Concentratibility of Low Quality Bauxite Raw Materials

Authors: Nadezhda Nikolaeva, Tatyana Alexandrova, Alexandr Alexandrov

Abstract:

Processing of high-silicon bauxite on the base of the traditional clinkering method is related to high power consumption and capital investments, which makes production of alumina from those ores non-competitive in terms of basic economic showings. For these reasons, development of technological solutions enabling to process bauxites with various chemical and mineralogical structures efficiently with low level of thermal power consumption is important. Flow sheet of the studies on washability of ores from the Timanskoe and the Severo-Onezhskoe deposits is on the base of the flotation method.

Keywords: low-quality bauxite, resource-saving technology, optimization, aluminum, conditioning of composition, separation characteristics

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10563 Feasibility and Acceptability of Modified Mindfulness-Based Stress Reduction for Health Care Workers in Acute Stress during the COVID-19 Pandemic

Authors: Susan Evans, Janna Gordon-Elliott, Katarzyna Wyka, Virginia Mutch

Abstract:

During the rise of the COVID-19 pandemic, healthcare workers needed an intervention that could address their profound acute stress. Mindfulness-based stress reduction (MBSR) is a program that has long established effectiveness for mental and physical health outcomes. In recent years, MBSR has been modified such that the duration of both class time and number of sessions has been abbreviated, and its delivery has been adapted for online dissemination, thus increasing the likelihood that individuals who could most benefit from the program would do so. We sought to investigate whether a brief, online version of MBSR could be feasible and acceptable for health care workers (HCW) in acute stress in response to the COVID-19 pandemic. Participants were recruited via an email sent to all hospital employees, which spans residents, physicians, nurses, housekeeping, lab technicians, administrators, and others. Participating HCW were asked about their previous experience with mindfulness and asked to commit to a minimum of 3 sessions. They were then provided with four weekly 1-hour sessions online that included the major mindfulness exercises taught during traditional MBSR programs (i.e., body scan, sitting meditation, mindful eating, and yoga). Participants were provided with supporting slides, videos, demonstrations and asked to track their practice. Hospital staff enrolled in the program; by the end of the first day of recruitment, 40 had applied; by the start date, about 100 were enrolled, and n attended a minimum of 3 sessions, supporting feasibility. Hospital staff also participated and practiced the mindfulness exercises (n=42), thus supporting acceptability. Participants reported that the program was logical, successful, and worth recommending both before starting the program and after completing it (M= 22.02 and M=21.76, respectively, possible range 0-27). There was a slight decline in the belief in improvement in health and well-being due to the program (ES=.37, p=.021). Secondary hypotheses regarding participants’ self-reported stress and levels of mindfulness were also supported, such that participants reported improvements in perceived stress (ES=.45, p=.006), compassion satisfaction, burnout, and secondary traumatic stress (ES=.41, ES=.31, ES=.35, respectively, p<.05). Participants reported significant improvements in the describing facet of mindfulness (ES=.49, p=.004), while all other facets (observing, acting with awareness, nonjudging of inner experience, nonreactivity to inner experience) remained unchanged pre- to post-program. Results from this study suggest that an abridged, online version of MBSR is feasible and accessible to health care workers in acute stress and provides benefits expected from traditional MBSR programs. The lack of a randomized control group limits generalizability. We intend to provide a structure, framework, and lessons learned to hospital administrators and clinical staff seeking to support their employees in acute stress.

Keywords: acute stress, health care workers, mindfulness, online interventions

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10562 Assessment of Technical and Vocational Education and Training Training Quality Factors and Their Impact on Low Enrollment Rates in Ethiopian Technical and Vocational Education and Training Colleges

Authors: Abebe Tibebu

Abstract:

This study investigates the quality of training factors in Ethiopian Technical and Vocational Education and Training (TVET) colleges and their impact on declining enrollment rates. Employing a descriptive survey design, both quantitative and qualitative data were collected from diverse stakeholders, including Grade 12 graduates, current TVET trainees, trainers, college deans, community members, high school directors, teachers, and officials from TVET government agencies. The sample included 20 TVET centers from various Ethiopian regions. Secondary data were obtained from college and government documents, while primary data were gathered through questionnaires, interviews, focus group discussions, and observations. Analysis was conducted using descriptive statistics with SPSS, capturing response frequencies and percentages. The study's findings highlight several key factors affecting TVET enrollment: limited infrastructure capacity, insufficient trainer competency, misaligned curriculum, low-quality training delivery particularly in cooperative training implementation and industry partnership and low success rates on Certification of Competency (CoC) exams. Many TVET institutions lack qualified trainers, adequate machinery, and timely provision of materials for practical skills training. Based on these findings, the study recommends enhanced infrastructure investment, professional development for trainers, curriculum adjustments to better align with industry needs, and standardized assessment practices. Addressing these areas through collaborative efforts with government bodies and industry stakeholders is essential to improving the quality and appeal of Ethiopian TVET programs, ultimately strengthening enrollment and outcomes.

Keywords: TVET, quality factors, enrollment, potentially enrolled

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10561 Innovative Approaches to Water Resources Management: Addressing Challenges through Machine Learning and Remote Sensing

Authors: Abdelrahman Elsehsah, Abdelazim Negm, Eid Ashour, Mohamed Elsahabi

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Water resources management is a critical field that encompasses the planning, development, conservation, and allocation of water resources to meet societal needs while ensuring environmental sustainability. This paper reviews the key concepts and challenges in water resources management, emphasizing the significance of a holistic approach that integrates social, economic, and environmental factors. Traditional water management practices, characterized by supply-oriented strategies and centralized control, are increasingly inadequate in addressing contemporary challenges such as water scarcity, climate change impacts, and ecosystem degradation. Emerging technologies, particularly machine learning and remote sensing, offer innovative solutions to enhance decision-making processes in water management. Machine learning algorithms facilitate accurate water demand forecasting, quality monitoring, and leak detection, while remote sensing technologies provide vital data for assessing water availability and quality. This review highlights the need for integrated water management strategies that leverage these technologies to promote sustainable practices and foster resilience in water systems. Future research should focus on improving data quality, accessibility, and the integration of diverse datasets to optimize the benefits of these technological advancements.

Keywords: water resources management, water scarcity, climate change, machine learning, remote sensing, water quality, water governance, sustainable practices, ecosystem management

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10560 Neighborhood-Scape as a Methodology for Enhancing Gulf Region Cities' Quality of Life: Case of Doha, Qatar

Authors: Eman AbdelSabour

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Sustainability is increasingly being considered as a critical aspect in shaping the urban environment. It works as an invention development basis for global urban growth. Currently, different models and structures impact the means of interpreting the criteria that would be included in defining a sustainable city. There is a collective need to improve the growth path to an extremely durable path by presenting different suggestions regarding multi-scale initiatives. The global rise in urbanization has led to increased demand and pressure for better urban planning choice and scenarios for a better sustainable urban alternative. The need for an assessment tool at the urban scale was prompted due to the trend of developing increasingly sustainable urban development (SUD). The neighborhood scale is being managed by a growing research committee since it seems to be a pertinent scale through which economic, environmental, and social impacts could be addressed. Although neighborhood design is a comparatively old practice, it is in the initial years of the 21st century when environmentalists and planners started developing sustainable assessment at the neighborhood level. Through this, urban reality can be considered at a larger scale whereby themes which are beyond the size of a single building can be addressed, while it still stays small enough that concrete measures could be analyzed. The neighborhood assessment tool has a crucial role in helping neighborhood sustainability to perform approach and fulfill objectives through a set of themes and criteria. These devices are also known as neighborhood assessment tool, district assessment tool, and sustainable community rating tool. The primary focus of research has been on sustainability from the economic and environmental aspect, whereas the social, cultural issue is rarely focused. Therefore, this research is based on Doha, Qatar, the current urban conditions of the neighborhoods is discussed in this study. The research problem focuses on the spatial features in relation to the socio-cultural aspects. This study is outlined in three parts; the first section comprises of review of the latest use of wellbeing assessment methods to enhance decision process of retrofitting physical features of the neighborhood. The second section discusses the urban settlement development, regulations and the process of decision-making rule. An analysis of urban development policy with reference to neighborhood development is also discussed in this section. Moreover, it includes a historical review of the urban growth of the neighborhoods as an atom of the city system present in Doha. Last part involves developing quantified indicators regarding subjective well-being through a participatory approach. Additionally, applying GIS will be utilized as a visualizing tool for the apparent Quality of Life (QoL) that need to develop in the neighborhood area as an assessment approach. Envisaging the present QoL situation in Doha neighborhoods is a process to improve current condition neighborhood function involves many days to day activities of the residents, due to which areas are considered dynamic.

Keywords: neighborhood, subjective wellbeing, decision support tools, Doha, retrofiring

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10559 The Impact of the Lexical Quality Hypothesis and the Self-Teaching Hypothesis on Reading Ability

Authors: Anastasios Ntousas

Abstract:

The purpose of the following paper is to analyze the relationship between the lexical quality and the self-teaching hypothesis and their impact on the reading ability. The following questions emerged, is there a correlation between the effective reading experience that the lexical quality hypothesis proposes and the self-teaching hypothesis, would the ability to read by analogy facilitate and create stable, synchronized four-word representational, and would word morphological knowledge be a possible extension of the self-teaching hypothesis. The lexical quality hypothesis speculates that words include four representational attributes, phonology, orthography, morpho-syntax, and meaning. Those four-word representations work together to make word reading an effective task. A possible lack of knowledge in one of the representations might disrupt reading comprehension. The degree that the four-word features connect together makes high and low lexical word quality representations. When the four-word representational attributes connect together effectively, readers have a high lexical quality of words; however, when they hardly have a strong connection with each other, readers have a low lexical quality of words. Furthermore, the self-teaching hypothesis proposes that phonological recoding enables printed word learning. Phonological knowledge and reading experience facilitate the acquisition and consolidation of specific-word orthographies. The reading experience is related to strong reading comprehension. The more readers have contact with texts, the better readers they become. Therefore, their phonological knowledge, as the self-teaching hypothesis suggests, might have a facilitative impact on the consolidation of the orthographical, morphological-syntax and meaning representations of unknown words. The phonology of known words might activate effectively the rest of the representational features of words. Readers use their existing phonological knowledge of similarly spelt words to pronounce unknown words; a possible transference of this ability to read by analogy will appear with readers’ morphological knowledge. Morphemes might facilitate readers’ ability to pronounce and spell new unknown words in which they do not have lexical access. Readers will encounter unknown words with similarly phonemes and morphemes but with different meanings. Knowledge of phonology and morphology might support and increase reading comprehension. There was a careful selection, discussion of theoretical material and comparison of the two existing theories. Evidence shows that morphological knowledge improves reading ability and comprehension, so morphological knowledge might be a possible extension of the self-teaching hypothesis, the fundamental skill to read by analogy can be implemented to the consolidation of word – specific orthographies via readers’ morphological knowledge, and there is a positive correlation between effective reading experience and self-teaching hypothesis.

Keywords: morphology, orthography, reading ability, reading comprehension

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10558 Localized Variabilities in Traffic-related Air Pollutant Concentrations Revealed Using Compact Sensor Networks

Authors: Eric A. Morris, Xia Liu, Yee Ka Wong, Greg J. Evans, Jeff R. Brook

Abstract:

Air quality monitoring stations tend to be widely distributed and are often located far from major roadways, thus, determining where, when, and which traffic-related air pollutants (TRAPs) have the greatest impact on public health becomes a matter of extrapolation. Compact, multipollutant sensor systems are an effective solution as they enable several TRAPs to be monitored in a geospatially dense network, thus filling in the gaps between conventional monitoring stations. This work describes two applications of one such system named AirSENCE for gathering actionable air quality data relevant to smart city infrastructures. In the first application, four AirSENCE devices were co-located with traffic monitors around the perimeter of a city block in Oshawa, Ontario. This study, which coincided with the COVID-19 outbreak of 2020 and subsequent lockdown measures, demonstrated a direct relationship between decreased traffic volumes and TRAP concentrations. Conversely, road construction was observed to cause elevated TRAP levels while reducing traffic volumes, illustrating that conventional smart city sensors such as traffic counters provide inadequate data for inferring air quality conditions. The second application used two AirSENCE sensors on opposite sides of a major 2-way commuter road in Toronto. Clear correlations of TRAP concentrations with wind direction were observed, which shows that impacted areas are not necessarily static and may exhibit high day-to-day variability in air quality conditions despite consistent traffic volumes. Both of these applications provide compelling evidence favouring the inclusion of air quality sensors in current and future smart city infrastructure planning. Such sensors provide direct measurements that are useful for public health alerting as well as decision-making for projects involving traffic mitigation, heavy construction, and urban renewal efforts.

Keywords: distributed sensor network, continuous ambient air quality monitoring, Smart city sensors, Internet of Things, traffic-related air pollutants

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10557 Low Back Pain and Patients Lifting Behaviors among Nurses Working in Al Sadairy Hospital, Aljouf

Authors: Fatma Abdel Moneim Al Tawil

Abstract:

Low back pain (LBP) among nurses has been the subject of research studies worldwide. However, evidence of the influence of patients lifting behaviors and LBP among nurses in Saudi Arabia remains scarce. The purpose of this study was to investigate the relationship between LBP and nurses lifting behaviors. LBP questionnaire was distributed to 100 nurses working in Alsadairy Hospital distributed as Emergency unit(9),Coronary Care unit (9), Intensive Care Unit (7), Dialysis unit (30), Burn unit (5), surgical unit (11), Medical (14) and, X-ray unit (15). The questionnaire included demographic data, attitude scale, Team work scale, Back pain history and Knowledge scale. Regarding to emergency unit, there is appositive significant relation between teamwork scale and Knowledge as r = (0.807) and P =0.05. Regarding to ICU unit, there is a positive significant relation between teamwork scale and attitude scale as r= (0.781) and P =0.05. Regarding to Dialysis unit, there is a positive significant relation between attitude scale and teamwork scale as r=(0.443) and P =0.05. The findings suggest enhanced awareness of occupational safety with safe patient handling practices among nursing students must be emphasized and integrated into their educational curriculum. Moreover, back pain prevention program should incorporate the promotion of an active lifestyle and fitness training the implementation of institutional patient handling policies.

Keywords: low back pain, lifting behaviors, nurses, team work

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10556 Parenting Practices, Challenges and Prospectus of Working Mothers in Arsi University: Oromia Regional State, Ethiopia

Authors: Endalew Fufa Kufi

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Every married person aspires to be a parent regardless of the situation in which s/he lives. Such aspiration meets with reality when the destined parent is able to give adequate supports and services to his/her children, whether the latter are got by birth or through adoption. The adequacy of services parents provide their children is both enriched and tempted by the work on which they involve. On the one hand, parents need to work and earn a living in order to support their family. On the other hand, they must spend most of their time outside home to do the work, which shortens the time and might they spare to care for their children. Where the sufficiency of services parents owe their children could be ascertained by in terms of life skills, physical care and related provisions, the role of working fathers and mothers in providing such supports could be diverse across cultures and work traditions. Hence, this research deals with the investigation of working mothers’ parental practices, challenges they face in providing parental services and the implication for the future progress of the parents and their children. Target of the study will be Arsi University in Oromia Regional State of Ethiopia. Descriptive survey design in holding the research, and data for the research will be collected in the form of experiential self-report from 150 working mothers selected from the entire working women population of Colleges of Agriculture and Environmental Studies and College of Health Sciences through stratified random-sampling. Instruments of data collection will be closed and open-ended questionnaire. Complementary data will also be collected from purposively selected samples through semi-structured interview. Data for the research will be collected through questionnaire first and then through interview. Data analysis will also follow the same procedure. The collected data will systematically be organized and statistically and thematically analyzed in order to come up with indicative findings. The overarching thesis is that, working mothers in the study area bear a lot of responsibilities both at home and at work place which leave them very little time for parenting services. Unless due attention is given to the way they can spare time for their children, they are more likely to be tense between work-life and family care services, which tempt them in different directions.

Keywords: challenges, mothers, practices, university, working

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10555 Impact of Audit Committee on Real Earnings Management: Cases of Netherlands

Authors: Sana Masmoudi Mardassi, Yosra Makni Fourati

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Regulators highlight the importance of the Audit Committee (AC) as a key internal corporate governance mechanism. One of the most important roles of this committee is to oversee the financial reporting process. The purpose of this paper is to examine the link between the characteristics of an audit committee and the financial reporting quality by investigating whether the characteristics of audit committees are associated with improved financial reporting quality, especially the Real Earnings Management. In the current study, a panel data from 80 nonfinancial companies listed on the Amsterdam Stock Exchange during the period between 2010 and 2017 were used. To measure audit committee characteristics, four proxies have been used, specifically, audit committee independence, financial expertise, gender diversity and AC meetings. For this research, a linear regression model was used to identify the influence of a set of board characteristics of the audit committee on real earnings management after controlling for firm audit committee size, leverage, size, loss, growth and board size. This research provides empirical evidence of the association between audit committee independence, financial expertise, gender diversity and meetings and Real Earnings Management (REM) as a proxy of financial reporting quality. The study finds that independence and AC Gender diversity are strongly related to financial reporting quality. In fact, these two characteristics constrain REM. The results also suggest that AC- financial expertise reduces to some extent, the likelihood of engaging in REM. These conclusions provide support then to the audit committee requirement under the Dutch Corporate Governance Code rules regarding gender diversity and AC meetings.

Keywords: audit committee, financial expertise, independence, real earnings management

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10554 Quality Assessment of Hollow Sandcrete Blocks in Minna, Nigeria

Authors: M. Abdullahi, S. Sadiku, Bashar S. Mohammed, J. I. Aguwa

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The properties of hollow sandcrete blocks produced in Minna, Nigeria are presented. Sandcrete block is made of cement, water and sand bound together in certain mix proportions. For the purpose of this work, fifty (50) commercial sandcrete block industries were visited in Minna, Nigeria to obtain block samples and aggregates used for the manufacture, and to also take inventory of the mix composition and the production process. Sieve analysis tests were conduction on the soil sample from various block industries to ascertain their quality to be used for block making. The mix ratios were also investigated. Five (5) nine inches (9’’ or 225mm) blocks were obtained from each block industry and tested for dimensional compliance and compressive strength. The result of test shows that the grading of the sand falls within the limit required by BS 882: 1990. The sand particles generally satisfy the grading requirement of overall grading and also fall in at least one of the classification of coarse grading, medium grading or fine grading. This clearly indicates that the quality of the aggregates used for the production of sandcrete blocks in Minna, Nigeria are of good quality in terms of grading and workable mix can easily be achieved to obtain high quality product. Physical examinations of the block sizes show slight deviation from the standard requirement in NIS 87:2000. Compressive strength of hollow sandcrete blocks in range of 0.12 N/mm2 to 0.54 N/mm2 was obtained which is below the recommendable value of 3.45 N/mm2 for load bearing hollow sandcrete blocks. This indicates that these blocks are below the standard for load-bearing sandcrete blocks and cannot be used as load bearing walling units. The mix composition also indicated low cement content resulting in low compressive strength. Most of the commercial block industries visited do not take curing very serious. Water were only sprinkled ones or twice before the blocks were stacked and made readily available for sale. It is recommended that a mix ratio of 1:4 to 1:6 should be used for the production of sandcrete blocks and proper curing practice should be adhered to. Blocks should also be cured for 14 days before making them available for consumers.

Keywords: compressive strength, dimensions, mix proportions, sandcrete blocks

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10553 Bayesian Inference of Physicochemical Quality Elements of Tropical Lagoon Nokoué (Benin)

Authors: Hounyèmè Romuald, Maxime Logez, Mama Daouda, Argillier Christine

Abstract:

In view of the very strong degradation of aquatic ecosystems, it is urgent to set up monitoring systems that are best able to report on the effects of the stresses they undergo. This is particularly true in developing countries, where specific and relevant quality standards and funding for monitoring programs are lacking. The objective of this study was to make a relevant and objective choice of physicochemical parameters informative of the main stressors occurring on African lakes and to identify their alteration thresholds. Based on statistical analyses of the relationship between several driving forces and the physicochemical parameters of the Nokoué lagoon, relevant Physico-chemical parameters were selected for its monitoring. An innovative method based on Bayesian statistical modeling was used. Eleven Physico-chemical parameters were selected for their response to at least one stressor and their threshold quality standards were also established: Total Phosphorus (<4.5mg/L), Orthophosphates (<0.2mg/L), Nitrates (<0.5 mg/L), TKN (<1.85 mg/L), Dry Organic Matter (<5 mg/L), Dissolved Oxygen (>4 mg/L), BOD (<11.6 mg/L), Salinity (7.6 .), Water Temperature (<28.7 °C), pH (>6.2), and Transparency (>0.9 m). According to the System for the Evaluation of Coastal Water Quality, these thresholds correspond to” good to medium” suitability classes, except for total phosphorus. One of the original features of this study is the use of the bounds of the credibility interval of the fixed-effect coefficients as local weathering standards for the characterization of the Physico-chemical status of this anthropized African ecosystem.

Keywords: driving forces, alteration thresholds, acadjas, monitoring, modeling, human activities

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10552 Effects of Oil Pollution on Euryglossa orientalis and Psettodes erumei in the Persian Gulf

Authors: Majid Afkhami, Maryam Ehsanpour, Reza Khoshnood, Zahra Khoshnood, Rastin Afkhami

Abstract:

Marine pollution is a global environmental problem. Different human activities on land, in the water and in the air contribute to the contamination of seawater, sediments and organisms with potentially toxic substances. Contaminants can be natural substances or artificially produced compounds. After discharge into the sea, contaminants can stay in the water in dissolved form or they can be removed from the water column through sedimentation to the bottom sediments. Histopathological alterations can be used as indicators for the effects of various anthropogenic pollutants on organisms and are a reflection of the overall health of the entire population in the ecosystem. These histo pathological biomarkers are closely related to other biomarkers of stress since many pollutants have to undergo metabolic activation in order to be able to provoke cellular change in the affected organism. In order to make evaluation of the effects of oil pollution, some heavy metals bioaccumulation and explore their histopathological effects on hepatocytes of Oriental sole (Euryglossa orientalis) and Deep flounder (Psettodes erumei), fishes caught from two areas of north coast of the Persian Gulf: Bandar Abbass and Bandar Lengeh. Concentrations of Ni and V in liver of both species in two sampling regions were in following order: Bandar abbass Bandar lengeh; also between two species, these quantities were higher in P. erumei than E. orientalis in both sampling regions. Histopathology of the liver shows some cellular alterations including: degeneration, necrosis and tissue disruption, and histopathological effects were severe in P. erumei than E. orientalis. Results showed that Bandar Abbass region was more polluted than Bandar Lengeh, and because Ni and V were oil pollution indicators, and two flat fishes were benthic, they can receive considerable amount of oil pollution through their biological activities like feeding. Also higher amounts of heavy metal concentrations and major histopathological effects in E. orientalis showed strong relationship between benthic habitat of the fish and amounts of received pollutants from water and sediments, because E. orientalis is more related to the bottom than P. erumei.

Keywords: heavy metals, flatfishes, Persian Gulf, oil pollution

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10551 The Presence of Dogs in Nursing Homes: Experiences Concerning the Mental Health of Residents

Authors: Ellen Dahl Gundersen, Berit Johannessen

Abstract:

Introduction: Dementia and depression are common mental disorders of nursing home residents. The care of these residents consists of providing both physical, social and mental care. Too often, the physical needs are given priority, and municipal health services are urged to focus more on the patients mental and social needs. The presence of dogs may have positive impact on the mental health of nursing home residents by improving mood, social interaction and enjoyment of the visits. The voluntary organization Red Cross, has given priority to this subject by training and certifying dogs and owners (equipages), committed for regular visits at local nursing homes. Focus of this study: How do the dog owners and employees experience the presence of a dog equipage concerning the mental health of nursing home residents? Method: Individual interviews with 8-10 certified dog owners who are volunteers from Red Cross, contributing with regular visits at local nursing homes. Focus group interviews with 10 employees working in two different nursing homes. Preliminary results: Five to seven residents and one or two employees attended weekly dog equipage visits during a period of six months. The presence of an equipage seems to have made the residents calm and more social orientated with a lighter mood and better verbal expression. Some of the residents with dementia remembered the name of the dog from one week to another. The informants also reported positive outcome for the residents by their opportunity to give and get close through physical contact with a dog. Further, the presence of an equipage affected the atmosphere at the nursing home positively by promoting joy and initiating conversations about dogs. A conscious approach by the dog owners towards the residents seems to be of significance to this matter. The positive attitude and support from employees also seem to be of crucial importance for the maintenance of these visits. Conclusion: The presence of trained dog equipages in nursing homes seems to have had an overall positive impact on the mental health of residents. A conscious approach from the dog owners as well as positive support from employees seems to have a crucial impact on the success and maintenance of the visits. These findings correspond well to former research and can thereby give implications for more extended use of dogs as a mental health promoting initiative towards geriatric consumers of municipal health care services. Further research through larger studies is needed.

Keywords: animal assisted intervention, geriatric mental health, nursing home, resident

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10550 Sources of Water Supply and Water Quality for Local Consumption: The Case Study of Eco-Tourism Village, Suan Luang Sub- District Municipality, Ampawa District, Samut Songkram Province, Thailand

Authors: Paiboon Jeamponk, Tasanee Ponglaa, Patchapon Srisanguan

Abstract:

The aim of this research paper was based on an examination of sources of water supply and water quality for local consumption, conducted at eco-tourism villages of Suan Luang Sub- District Municipality of Amphawa District, Samut Songkram Province. The study incorporated both questionnaire and field work of water testing as the research tool and method. The sample size of 288 households was based on the population of the district, whereas the selected sample water sources were from 60 households: 30 samples were ground water and another 30 were surface water. Degree of heavy metal contamination in the water including copper, iron, manganese, zinc, cadmium and lead was investigated utilizing the Atomic Absorption- Direct Aspiration method. The findings unveiled that 96.0 percent of household water consumption was based on water supply, while the rest on canal, river and rain water. The household behaviour of consumption revealed that 47.2 percent of people routinely consumed water without boiling or filtering prior to consumption. The investigation of water supply quality found that the degree of heavy metal contamination including metal, lead, iron, copper, manganese and cadmium met the standards of the Department of Health.

Keywords: sources of water supply, water quality, water supply, Thailand

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10549 Overall Assessment of Human Research and Ethics Committees in the United Arab Emirates

Authors: Mahera Abdulrahman, Satish Chandrasekhar Nair

Abstract:

Growing demand for human health research in the United Arab Emirates (UAE) has prompted the need to develop a robust research ethics oversight, particularly given the large unskilled-worker immigrant population and the elderly citizens utilizing health services. Examination of the structure, function, practices and outcomes of the human research ethics committees (HREC) was conducted using two survey instruments, reliable and validated. Results indicate that in the absence of a national ethics regulatory body, the individual emirate’s governed 21 HRECs covering health facilities and academic institutions in the UAE. Among the HRECs, 86% followed International Council for Harmonization-Good Clinical Practice guidelines, 57% have been in operation for more than five years, 81% reviewed proposals within eight weeks, 48% reviewed for clinical and scientific merit apart from ethics, and 43% handled more than 50 research proposals per year. However, researcher recognition, funding transparency, adverse event reporting systems were widespread in less than one-third of all HRECs. Surprisingly, intellectual property right was not included as a research output. Research was incorporated into the vision and mission statements of many (62%) organizations and, mechanisms such as research publications, collaborations, and recognitions were employed as key performance indicators to measure research output. In spite, resources to generate research output such as dedicated budget (19%), support staff (19%) and continuous training and mentoring program for medical residents and HREC members were somehow lacking. HREC structure and operations in the UAE are similar to other regions of the world, resources allocation for efficient, quality monitoring, continuous training, and the creation of a clinical research network are needed to strengthen the clinical research enterprise to scale up for the future. It is anticipated that the results of this study will benefit investigators, regulators, pharmaceutical sponsors and the policy makers in the region.

Keywords: institutional review board, ethics committee, human research ethics, United Arab Emirates (UAE)

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10548 Drowning: An Emergency Department Guideline

Authors: Thomas P. Jones

Abstract:

Overview: Drowning is an important cause of accidental death, particularly in children and young people. Although many survive drowning incidents, it is a relatively rare presenting complaint in Emergency Departments. When cases do present, they can be complex and unpredictable. For patients to receive the best care, it is important that their management is standardized and evidence based, however this can be difficult in a topic area with limited studies and inconsistencies in case reporting. Objectives: To review recent cases to assess the performance of Manchester Royal Infirmary Emergency Department in the management of near drowning. To produce evidence based guideline on the management of drowning victims in the ED. Methods: Emergency department records were searched for patients with the diagnosis of ‘fatal drowning’ or ‘nearly drowning’ and two relevant case notes reviewed. To produce the guideline a literature review was conducted and a series of structured short cut systematic reviews known as Best BETs carried out. This information was used to produce a clear treatment pathway. Results: The case studies emphasized the variety in presentation of drowning victims whilst highlighting inconsistencies in management and documentation. An evidence-based guideline is presented as a flowchart, which illustrates the relevant investigations and treatment that victims of a drowning incident should receive, based on the best available evidence. Conclusion: It is hoped that when put into practice, the guideline will improve and standardize patient care in cases of near drowning. An audit is recommended to assess its effectiveness.

Keywords: drowning, near drowning, non fatal drowning, fatal drowning

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10547 Behavior, Temperament and Food Intake of Urban Indian Adolescents

Authors: Preeti Khanna, Bani T. Aeri

Abstract:

Background: Recent studies have indicated challenges that hamper health and wellbeing of a vast majority of adolescents in developing countries. Many modifiable factors like behavior and temperament related to food intake among adolescents have not been adequately explored. The aim of the proposed research is to study the impact of behavior and temperament on food intake and diet quality of adolescents. Objectives: In the present study data on dietary behavior and anthropometry of adolescent boys & girls (aged 13-16 years) studying in public schools of Delhi will be gathered to ascertain the quality of diet among adolescent boys and girls and to study the effect of behavior and temperament on diet quality of adolescents. Methods: In total, 400 adolescents will participate in this cross-sectional study. Weight and height of adolescents will be measured and BMI will be calculated. Information will be obtained on their socio-demographic profile and various factors influencing their Food Choices and diet quality such as body image perception, Behavior, temperament, locus of control and parental influence. Expected results: Several direct effects of adolescent traits and behavior on food intake will be observed. Maturational patterns and gender differences in behavior traits will be assessed. By profiling of the behavior and temperament traits, we will have a better understanding of impact of these factors on weight and eating behaviors in overweight/obese or even underweight adolescents. Conclusions: The proposed study will highlight the association of behavioral factors with nutritional status of adolescents. It will also serve as a strategic approach for the obesity prevention and health management policies designed for adolescents.

Keywords: behaviour, temperament, food intake, adolescents

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10546 Use of Chlorophyll Meters to Assess In-Season Wheat Nitrogen Fertilizer Requirements in the Southern San Joaquin Valley

Authors: Brian Marsh

Abstract:

Nitrogen fertilizer is the most used and often the most mismanaged nutrient input. Nitrogen management has tremendous implications on crop productivity, quality and environmental stewardship. Sufficient nitrogen is needed to optimum yield and quality. Soil and in-season plant tissue testing for nitrogen status are a time consuming and expensive process. Real time sensing of plant nitrogen status can be a useful tool in managing nitrogen inputs. The objectives of this project were to assess the reliability of remotely sensed non-destructive plant nitrogen measurements compared to wet chemistry data from sampled plant tissue, develop in-season nitrogen recommendations based on remotely sensed data for improved nitrogen use efficiency and assess the potential for determining yield and quality from remotely sensed data. Very good correlations were observed between early-season remotely sensed crop nitrogen status and plant nitrogen concentrations and subsequent in-season fertilizer recommendations. The transmittance/absorbance type meters gave the most accurate readings. Early in-season fertilizer recommendation would be to apply 40 kg nitrogen per hectare plus 16 kg nitrogen per hectare for each unit difference measured with the SPAD meter between the crop and reference area or 25 kg plus 13 kg per hectare for each unit difference measured with the CCM 200. Once the crop was sufficiently fertilized meter readings became inconclusive and were of no benefit for determining nitrogen status, silage yield and quality and grain yield and protein.

Keywords: wheat, nitrogen fertilization, chlorophyll meter

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10545 Exploratory Study on Psychosocial Influences of Spinal Cord Injury to Patients: Basis for Medical Social Work Intervention Plan

Authors: Delies L. Alejo

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This study explores the psychosocial influences of Spinal Cord Injury (SCI) on patients in the Philippine Orthopedic Center Hospital in the Philippines, examining their social functioning and proposing interventions for reintegration. Quantitative data were collected through surveys using a concurrent triangulation research design, while qualitative insights were obtained via interviews. Findings revealed significant psychosocial challenges among SCI patients, impacting relationships, family dynamics, work, friendships, parenting, education, and self-care. Demographic profiles indicated variations in psychosocial functioning. The study underscores the importance of tailored interventions for SCI patients based on age, marital status, gender, education, and occupation. Triangulation of data enhanced understanding, revealing four themes: ‘Resilient Navigation of Intimacy and Connection,’ ‘Family Dynamics and Care Challenges,’ ‘Occupational Hurdles and Work Engagement,’ and ‘Social and Community Integration Obstacles.’ The study proposes a holistic intervention plan, addressing emotional challenges, creating support networks, implementing vocational rehabilitation, promoting community engagement, and sustaining collaboration with healthcare professionals.

Keywords: spinal cord injury, psychosocial influences, social functioning, concurrent triangulation, intervention plan

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10544 The Effect of Solid Wastes Disposal at Amokpala Dump Site in Orumba North Local Government Area, Anambra State

Authors: Nwanneka Mmonwuba

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Solid waste disposal to the environment was investigated by analyzing the quality characteristics of waste, air quality, and heavy metal concentration in the soil. The characteristics of waste were analyzed by enumerating the number of houses, hostels, hotels, markets, schools, and industries with the type of waste being discharged or deposited into the dump site. The percentage of waste was estimated with organic ranking first for both wet and dry seasons, 54% and 44%, respectively. The ambient air quality was analyzed using the crown gas monitor analyzer. The analysis showed that the mean concentration of NO₂, SO₂, and Co is 0.74, 0.37, and 47.35 ppm for the wet season and 0.47, 0.35, and 37.65 ppm for the dry season, respectively, and do not conform with the USEPA standard. The chemical analysis of the groundwater sample indicates alkalinity ranging from 7.38 to 9.11. the heavy metals concentration in the soil of cadmium, iron, copper, calcium, and potassium with 0.053, 0.722, 0227, 21.3, and 9.019, respectively, obtained from 0.3 m at the subsurface failed to conform to the NRC (2013) standard. Iron consent in the soil can be corrected using ascorbic acid and soda ash. The permanent reduction of effects is to try relocating people who live very close to the dumpsite, or the dumpsite should be sited elsewhere and replaced with a sanitary landfill.

Keywords: solid waste, groundwater, disposal, dumpsite

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10543 Applying Integrated QFD-MCDM Approach to Strengthen Supply Chain Agility for Mitigating Sustainable Risks

Authors: Enes Caliskan, Hatice Camgoz Akdag

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There is no doubt that humanity needs to realize the sustainability problems in the world and take serious action regarding that. All members of the United Nations adopted the 2030 Agenda for Sustainable Development, the most comprehensive study on sustainability internationally, in 2015. The summary of the study is 17 sustainable development goals. It covers everything about sustainability, such as environment, society and governance. The use of Information and Communication Technology (ICT), such as the Internet, mobile phones, and satellites, is essential for tackling the main issues facing sustainable development. Hence, the contributions of 3 major ICT companies to the sustainable development goals are assessed in this study. Quality Function Deployment (QFD) is utilized as a methodology for this study. Since QFD is an excellent instrument for comparing businesses on relevant subjects, a House of Quality must be established to complete the QFD application. In order to develop a House of Quality, the demanded qualities (voice of the customer) and quality characteristics (technical requirements) must first be determined. UN SDGs are used as demanded qualities. Quality characteristics are derived from annual sustainability and corporate social responsibility reports of ICT companies. The companies' efforts, as indicated by the QFD results, are concentrated on the use of recycled raw materials and recycling, reducing GHG emissions through energy saving and improved connectivity, decarbonizing the value chain, protecting the environment and water resources by collaborating with businesses that have completed CDP water assessments and paying attention to reducing water consumption, ethical business practices, and reducing inequality. The evaluations of the three businesses are found to be very similar when they are compared. The small differences between the companies are usually about the region they serve. Efforts made by the companies mostly concentrate on responsible consumption and production, life below water, climate action, and sustainable cities and community goals. These efforts include improving connectivity in needed areas for providing access to information, education and healthcare.

Keywords: multi-criteria decision-making, sustainable supply chain risk, supply chain agility, quality function deployment, Sustainable development goals

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10542 Reducing System Delay to Definitive Care For STEMI Patients, a Simulation of Two Different Strategies in the Brugge Area, Belgium

Authors: E. Steen, B. Dewulf, N. Müller, C. Vandycke, Y. Vandekerckhove

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Introduction: The care for a ST-elevation myocardial infarction (STEMI) patient is time-critical. Reperfusion therapy within 90 minutes of initial medical contact is mandatory in the improvement of the outcome. Primary percutaneous coronary intervention (PCI) without previous fibrinolytic treatment, is the preferred reperfusion strategy in patients with STEMI, provided it can be performed within guideline-mandated times. Aim of the study: During a one year period (January 2013 to December 2013) the files of all consecutive STEMI patients with urgent referral from non-PCI facilities for primary PCI were reviewed. Special attention was given to a subgroup of patients with prior out-of-hospital medical contact generated by the 112-system. In an effort to reduce out-of-hospital system delay to definitive care a change in pre-hospital 112 dispatch strategies is proposed for these time-critical patients. Actual time recordings were compared with travel time simulations for two suggested scenarios. A first scenario (SC1) involves the decision by the on scene ground EMS (GEMS) team to transport the out-of-hospital diagnosed STEMI patient straight forward to a PCI centre bypassing the nearest non-PCI hospital. Another strategy (SC2) explored the potential role of helicopter EMS (HEMS) where the on scene GEMS team requests a PCI-centre based HEMS team for immediate medical transfer to the PCI centre. Methods and Results: 49 (29,1% of all) STEMI patients were referred to our hospital for emergency PCI by a non-PCI facility. 1 file was excluded because of insufficient data collection. Within this analysed group of 48 secondary referrals 21 patients had an out-of-hospital medical contact generated by the 112-system. The other 27 patients presented at the referring emergency department without prior contact with the 112-system. The table below shows the actual time data from first medical contact to definitive care as well as the simulated possible gain of time for both suggested strategies. The PCI-team was always alarmed upon departure from the referring centre excluding further in-hospital delay. Time simulation tools were similar to those used by the 112-dispatch centre. Conclusion: Our data analysis confirms prolonged reperfusion times in case of secondary emergency referrals for STEMI patients even with the use of HEMS. In our setting there was no statistical difference in gain of time between the two suggested strategies, both reducing the secondary referral generated delay with about one hour and by this offering all patients PCI within the guidelines mandated time. However, immediate HEMS activation by the on scene ground EMS team for transport purposes is preferred. This ensures a faster availability of the local GEMS-team for its community. In case these options are not available and the guideline-mandated times for primary PCI are expected to be exceeded, primary fibrinolysis should be considered in a non-PCI centre.

Keywords: STEMI, system delay, HEMS, emergency medicine

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