Search results for: long-term care cost

Authors: M. Illias Kanchan

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The death of a woman during pregnancy and childbirth is not only a health issue, but also a matter of social injustice. This study makes an attempt to explore the association between maternal death and associated factors in West Bengal using the approaches of facility-based and community-based maternal death review. Bivariate and binary logistic regression analysis have been performed to understand the causes and circumstances of maternal deaths in West Bengal. Delay in seeking care was the major contributor in maternal deaths, near about one-third women died due to this factor. The most common cause of maternal death is found to be hypertensive disorders of pregnancy or eclampsia. We believe that these deaths can be averted by reducing hypertensive disorders of pregnancy or eclampsia.

Keywords: maternal death, facility-based, community-based, review, west Bengal, eclampsia

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Authors: Tao Feng, Fei Xing, Ye Lu, Jun Li Fang

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NDN is a kind of future Internet architecture. Due to the NDN design introduces four privacy challenges,Many research institutions began to care about the privacy issues of naming data network(NDN).In this paper, we are in view of the major NDN’s privacy issues to investigate privacy protection,then put forwards more effectively anonymous transfer policy for NDN.Firstly,based on mutual anonymity communication for MP2P networks,we propose NDN mutual anonymity protocol.Secondly,we add interest package authentication mechanism in the protocol and encrypt the coding coefficient, security of this protocol is improved by this way.Finally, we proof the proposed anonymous transfer protocol security and anonymity.

Keywords: NDN, mutual anonymity, anonymous routing, network coding, authentication mechanism

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Authors: Abdullah A. Al Orainy

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Small cell backhaul solutions need to be cost-effective, scalable, and easy to install. This paper presents an overview of small cell backhaul technologies. Wireless solutions including TV white space, satellite, sub-6 GHz radio wave, microwave and mmWave with their backhaul characteristics are discussed. Recent research on issues like beamforming, backhaul architecture, precoding and large antenna arrays, and energy efficiency for dense small cell backhaul with mmWave communications is reviewed. Recent trials of 5G technologies are summarized.

Keywords: backhaul, small cells, wireless, 5G

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Authors: Jang-Hwan Yin, Hae-Jeong Jeong, Hyo-Geun Jeong

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K-water (Korea Water Resources Corporation) conducted basic and working design about floating PV generation system installed above water in the upstream of dam to develop clean energy using water with importance of green growth is magnified ecumenically. PV Generation System on the ground applied considerably until now raise environmental damage by using farmland and forest land, PV generation system on the building roof is already installed at almost the whole place of business and additional installation is almost impossible. Installation space of PV generation system is infinite and efficient national land use is possible because it is installed above water. Also, PV module's efficiency increase by natural water cooling method and no shade. So it is identified that annual power generation is more than PV generation system on the ground by operating performance data. Although it is difficult to design and construct by high cost, little application case, difficult installation of floater, mooring device, underwater cable, etc. However, it has been examined cost reduction plan such as structure weight lightening, floater optimal design, etc. This thesis described basic and working design result systematically about K-water's floating PV generation system development and suggested optimal design method of floating PV generation system. Main contents are photovoltaic array location select, substation location select related underwater cable, PV module and inverter design, transmission and substation equipment design, floater design related structure weight lightening, mooring system design related water level fluctuation, grid connecting technical review, remote control and monitor equipment design, etc. This thesis will contribute to optimal design and business extension of floating PV generation system, and it will be opportunity revitalize clean energy development using water.

Keywords: PV generation system, clean energy, green growth, solar energy

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Authors: Adeaga Ibiyemi Iyabo, Adeaga Oyetunde Adeoye

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Interestingly, mechanical drying methods has played a major role in the commercialization of agricultural and agricultural allied sectors. In the overall, drying enhances the favorable storability and preservation of agricultural produce which in turn promotes its producibility, marketability, salability, and profitability. Recent researches have shown that solar drying is easier, affordable, controllable, and of course, cleaner and purer than other means of drying methods. It is, therefore, needful to persistently appraise solar dryers with a view to improving on the existing advantages. In this paper, mathematical equations were formulated for solar dryer using mass conservation law, material balance law and least cost savings method. Computer codes were written in Visual Basic.Net. The developed computer software, which considered Ibadan, a strategic south-western geographical location in Nigeria, was used to investigate the relationship between variable orientation angle of flat plate collector on solar energy trapped, derived monthly heat load, available energy supplied by solar and fraction supplied by solar energy when 50000 Kg/Month of produce was dried over a year. At variable collector tilt angle of 10°.13°,15°,18°, 20°, the derived monthly heat load, available energy supplied by solar were 1211224.63MJ, 102121.34MJ, 0.111; 3299274.63MJ, 10121.34MJ, 0.132; 5999364.706MJ, 171222.859MJ, 0.286; 4211224.63MJ, 132121.34MJ, 0.121; 2200224.63MJ, 112121.34MJ, 0.104, respectively .These results showed that if optimum collector angle is not reached, those factors needed for efficient and cost reduction drying will be difficult to attain. Therefore, this software has revealed that off - optimum collector angle in commercial solar drying does not worth it, hence the importance of the software in decision making as to the optimum collector angle of orientation.

Keywords: energy, ibadan, heat - load, visual-basic.net

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Authors: Seyedeh Mozhgan Seyed-Talebi, Javad Beheshtian

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The toxicity of lead associated with the lifecycle of perovskite solar cells (PSCs( is a serious concern which may prove to be a major hurdle in the path toward their commercialization. The current proposed lead-free PSCs including Ag(I), Bi(III), Sb(III), Ti(IV), Ge(II), and Sn(II) low-toxicity cations are still plagued with the critical issues of poor stability and low efficiency. This is mainly because of their chemical stability. In the present research, utilization of all inorganic CsSnGeI₃ based materials offers the advantages to enhance resistance of device to degradation, reduce the cost of cells, and minimize the carrier recombination. The presence of inorganic halide perovskite improves the photovoltaic parameters of PCSs via improved surface coverage and stability. The inverted structure of simulated devices using a 1D simulator like solar cell capacitance simulator (SCAPS) version 3308 involves TCOHTL/Perovskite/ETL/Au contact layer. PEDOT:PSS, PCBM, and CsSnGeI₃ used as hole transporting layer (HTL), electron transporting layer (ETL), and perovskite absorber layer in the inverted structure for the first time. The holes are injected from highly stable and air tolerant Sn_0.5Ge_0.5I₃ perovskite composition to HTM and electrons from the perovskite to ETL. Simulation results revealed a great dependence of power conversion efficiency (PCE) on the thickness and defect density of perovskite layer. Here the effect of an increase in operating temperature from 300 K to 400 K on the performance of CsSnGeI₃ based perovskite devices is investigated. Comparison between simulated CsSnGeI₃ based PCSs and similar real testified devices with spiro-OMeTAD as HTL showed that the extraction of carriers at the interfaces of perovskite absorber depends on the energy level mismatches between perovskite and HTL/ETL. We believe that optimization results reported here represent a critical avenue for fabricating the stable, low-cost, efficient, and eco-friendly all-inorganic Cs-Sn-Ge based lead-free perovskite devices.

Keywords: hole transporting layer, lead-free, perovskite solar cell, SCAPS-1D, Sn-Ge based

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Authors: E. V. Fakhrutdinova, K. R. Maksimova, P. B. Chursin

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At the present stage of the society progress the health care is an integral part of both the economic system and social, while in the second case the medicine is a major component of a number of basic and necessary social programs. Since the foundation of the health system are highly qualified health professionals, it is logical proposition that increase of doctor`s professionalism improves the effectiveness of the system as a whole. Professionalism of the doctor is a collection of many components, essential role played by such personal-psychological factors as honesty, willingness and desire to help people, and motivation. A number of researchers consider motivation as an expression of basic human needs that have passed through the “filter” which is a worldview and values learned in the process of socialization by the individual, to commit certain actions designed to achieve the expected result. From this point of view a number of researchers propose the following classification of highly skilled employee’s needs: 1. the need for confirmation the competence (setting goals that meet the professionalism and receipt of positive emotions in their decision), 2. The need for independence (the ability to make their own choices in contentious situations arising in the process carry out specialist functions), 3. The need for ownership (in the case of health care workers, to the profession and accordingly, high in the eyes of the public status of the doctor). Nevertheless, it is important to understand that in a market economy a significant motivator for physicians (both legal and natural persons) is to maximize its own profits. In the case of health professionals duality motivational structure creates an additional contrast, as in the public mind the image of the ideal physician; usually a altruistically minded person thinking is not primarily about their own benefit, and to assist others. In this context, the question of the real motivation of health workers deserves special attention. The survey conducted by the American researcher Harrison Terni for the magazine "Med Tech" in 2010 revealed the opinion of more than 200 medical students starting courses, and the primary motivation in a profession choice is "desire to help people", only 15% said that they want become a doctor, "to earn a lot". From the point of view of most of the classical theories of motivation this trend can be called positive, as intangible incentives are more effective. However, it is likely that over time the opinion of the respondents may change in the direction of mercantile motives. Thus, it is logical to assume that well-designed system of motivation of doctor`s labor should be based on motivational foundations laid during training in higher education.

Keywords: motivation, quality of working life, health system, personal-psychological factors, motivational structure

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Authors: Fathonah Siti, Ardiana Irma

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Indonesia is currently on its track to achieve Universal Health Coverage (UHC) by 2019. The program aims to address issues on disintegration in the implementation and coverage of various health insurance schemes and fragmented fund pooling. Family planning service is covered as one of benefit packages under preventive care. However, little has been done to examine how family planning program are appropriately managed across levels of governments and how family planning services are delivered to the end user. The study is performed through focus group discussion to related policy makers and selected programmers at central and district levels. The study is also benefited from relevant studies on family planning in the UHC scheme and other supporting data. The study carefully investigates some programmatic implications when family planning is integrated in the UHC program encompassing the need to recalculate contraceptive logistics for beneficiaries (eligible couple); policy reformulation for contraceptive service provision including supply chain management; establishment of family planning standard of procedure; and a call to update Management Information System. The study confirms that there is a significant increase in the numbers of contraceptive commodities needs to be procured by the government. Holding an assumption that contraceptive prevalence rate and commodities cost will be as expected increasing at 0.5% annually, the government need to allocate almost IDR 5 billion by 2019, excluded fee for service. The government shifts its focus to maintain eligible health facilities under National Population and Family Planning Board networks. By 2019, the government has set strategies to anticipate the provision of family planning services to 45.340 health facilities distributed in 514 districts and 7 thousand sub districts. Clear division of authorities has been established among levels of governments. Three models of contraceptive supply planning have been developed and currently in the process of being institutionalized. Pre service training for family planning services has been piloted in 10 prominent universities. The position of private midwives has been appreciated as part of the system. To ensure the implementation of quality and health expenditure control, family planning standard has been established as a reference to determine set of services required to deliver to the clients properly and types of health facilities to conduct particular family planning services. Recognition to individual status of program participation has been acknowledged in the Family Enumeration since 2015. The data is precisely recorded by name by address for each family and its members. It supplies valuable information to 15.131 Family Planning Field Workers (FPFWs) to provide information and education related to family planning in an attempt to generate demand and maintain the participation of family planning acceptors who are program beneficiaries. Despite overwhelming efforts described above, some obstacles remain. The program experiences poor socialization and yet removes geographical barriers for those living in remote areas. Family planning services provided for this sub population conducted outside the scheme as a complement strategy. However, UHC program has brought remarkable improvement in access and quality of family planning services.

Keywords: beneficiary, family planning services, national population and family planning board, universal health coverage

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Authors: Amir Sina Fouladi, Arul Arulrajah, Jian Chu, Suksun Horpibulsuk

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Waste generation is a growing concern in many countries across the world, particularly in urban areas with high rates of population growth and industrialization. The increasing amount of waste generated from human activities has led to environmental, economic, and health issues. Improper disposal of waste can result in air and water pollution, land degradation, and the spread of diseases. Waste generation also consumes large amounts of natural resources and energy, leading to the depletion of valuable resources and contributing to greenhouse gas emissions. To address these concerns, there is a need for sustainable waste management practices that reduce waste generation and promote resource recovery and recycling. Amongst these, developing innovative technologies such as Microbially Induced Calcite Precipitation (MICP) in construction materials is an effective approach to transforming waste into valuable and sustainable applications. MICP is an environmentally friendly microbial-chemical technology that applies microorganisms and chemical reagents to biological processes to produce carbonate mineral. This substance can be an energy-efficient, cost-effective, sustainable solution to environmental and engineering challenges. Recent research has shown that waste streams can replace several MICP-chemical components in the cultivation media of microorganisms and cementation reagents (calcium sources and urea). In addition to its effectiveness in treating hazardous waste streams, MICP has been found to be cost-effective and sustainable solution applicable to various waste media. This comprehensive review paper aims to provide a thorough understanding of the environmental advantages and engineering applications of MICP technology, with a focus on the contribution of waste streams. It also provides researchers with guidance on how to identify and overcome the challenges that may arise applying the MICP technology using waste streams.

Keywords: waste stream, microbially induced calcite precipitation, construction materials, sustainability

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Authors: Sadaoui Djaouida

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In this paper, the predictive control method is proposed to control the synchronization of two perturbed satellites attitude motion. Based on delayed feedback control of continuous-time systems combines with the prediction-based method of discrete-time systems, this approach only needs a single controller to realize synchronization, which has considerable significance in reducing the cost and complexity for controller implementation.

Keywords: predictive control, synchronization, satellite attitude, control engineering

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Authors: Rahou Mohamed , Sebaa Fethi, Cheikh Abdelmadjid

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Manufacturing tolerancing is intended to determine the intermediate geometrical and dimensional states of the part during its manufacturing process. These manufacturing dimensions also serve to satisfy not only the functional requirements given in the definition drawing but also the manufacturing constraints, for example geometrical defects of the machine, vibration, and the wear of the cutting tool. The choice of positioning has an important influence on the cost and quality of manufacture. To avoid this problem, a two-step approach have been developed. The first step is dedicated to the determination of the optimum position. As for the second step, a study was carried out for the tightening effect on the tolerance interval.

Keywords: dispersion, tolerance, manufacturing, position

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Authors: N. Tochukwu, M. Mukhopadhyay, A. Mohamed

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It is no new that Nigeria faces a continual power shortage problem due to its vast population power demand and heavy reliance on nonrenewable forms of energy such as thermal power or fossil fuel. Many researchers have recommended using geothermal energy as an alternative; however, Past studies focus on the geophysical & geochemical investigation of this energy in the sedimentary and basement complex; only a few studies incorporated the remote sensing methods. Therefore, in this study, the preliminary examination of geothermal resources in the Middle Benue was carried out using satellite imagery in ArcMap. Landsat 8 scene (TIR, NIR, Red spectral bands) was used to estimate the Land Surface Temperature (LST). The Maximum Likelihood Classification (MLC) technique was used to classify sites with very low, low, moderate, and high LST. The intermediate and high classification happens to be possible geothermal zones, and they occupy 49% of the study area (38077km2). Riverline were superimposed on the LST layer, and the identification tool was used to locate high temperate sites. Streams that overlap on the selected sites were regarded as geothermal springs as. Surprisingly, the LST results show lower temperatures (<36°C) at the famous thermal springs (Awe & Wukari) than some unknown rivers/streams found in Kwande (38°C), Ussa, (38°C), Gwer East (37°C), Yola Cross & Ogoja (36°C). Studies have revealed that temperature increases with depth. However, this result shows excellent geothermal resources potential as it is expected to exceed the minimum geothermal gradient of 25.47 with an increase in depth. Therefore, further investigation is required to estimate the depth of the causative body, geothermal gradients, and the sustainability of the reservoirs by geophysical and field exploration. This method has proven to be cost-effective in locating geothermal resources in the study area. Consequently, the same procedure is recommended to be applied in other regions of the Precambrian basement complex and the sedimentary basins in Nigeria to save a preliminary field survey cost.

Keywords: ArcMap, geothermal resources, Landsat 8, LST, thermal springs, MLC

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Authors: Emanuela Zilli, Suana Tikvina, Davide Bonaldo, Monica Varotto, Scilla Rizzardi, Barbara Ruzzante, Raffaele Napolitano, Stefano Bevilacqua, Antonella Ruffatto

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A healthy workplace increases productivity, creativity and decreases absenteeism and turnover. It also contributes to creating a more secure work environment with fewer risks of violence. In the past 3 years, the healthcare system has suffered the psychological, economic and social consequences of the COVID-19 pandemic. On the other hand, the healthcare staff reductions determine high levels of work-related stress that are often unsustainable. The Hospital of Cittadella (in the province of Padua) has 400 beds and serves a territory of 300,000 inhabitants. The hospital itself counts 1.250 healthcare employees (healthcare professionals). This year, the Medical Board of Directors has requested additional staff; however, the economic situation of Italy can not sustain additional hires. At the same time, we have initiated projects that aim to increase well-being, decrease stress and encourage activities that promote self-care. One of the projects that the hospital has organized is the psychomotor practice. It is held by therapists and trainers who operate according to the traditional method. According to the literature, the psychomotor practice is specifically intended for the staff operating in the Intensive Care Unit, Emergency Department and Pneumology Ward. The project consisted of one session of 45 minutes a week for 3 months. This method brings focus to controlled breathing, posture, muscle work and movement that help manage stress and fatigue, creating a more mindful and sustainable lifestyle. In addition, a Qigong course was held every two weeks for 5 months. It is an ancient Chinese practice designed to optimize the energy within the body, reducing stress levels and increasing general well-being. Finally, Tibetan singing crystal bowls sessions, held by a music therapist, consisted of monthly guided meditation sessions using the sounds of the crystal bowls. Sound therapy uses the vibrations created from the crystal bowls to balance the vibrations within the body to promote relaxation. In conclusion, well-being and organizational performance are closely related to each other. It is crucial for any organization to encourage and maintain better physical and mental health of the healthcare staff as it directly affects productivity and, consequently, user satisfaction of the services provided.

Keywords: health promotion, healthcare workers management, Weel being and organizational performance, Psychomotor practice

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Authors: Heena Dabas, Anju Paul, Suman Chaurasia, Ramesh Agarwal, M. Jeeva Sankar, Anurag Bajpai, Manju Saksena

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Background: Traumatic lumbar puncture (LP) is a common occurrence and causes substantial diagnostic ambiguity. There is paucity of data regarding its epidemiology. Objective: To assess the incidence and risk factors of traumatic LP in newborns. Design/Methods: In a prospective cohort study, all inborn neonates admitted in NICU and planned to undergo LP for a clinical indication of sepsis were included. Neonates with diagnosed intraventricular hemorrhage (IVH) of grade III and IV were excluded. The LP was done by operator - often a fellow or resident assisted by bedside nurse. The unit has policy of not routinely using any sedation/analgesia during the procedure. LP is done by 26 G and 0.5-inch-long hypodermic needle inserted in third or fourth lumbar space while the infant is in lateral position. The infants were monitored clinically and by continuous measurement of vital parameters using multipara monitor during the procedure. The occurrence of traumatic tap along with CSF parameters and other operator and assistant characteristics were recorded at the time of procedure. Traumatic tap was defined as presence of visible blood or more than 500 red blood cells on microscopic examination. Microscopic trauma was defined when CSF is not having visible blood but numerous RBCs. The institutional ethics committee approved the study protocol. A written informed consent from the parents and the health care providers involved was obtained. Neonates were followed up till discharge/death and final diagnosis was assigned along with treating team. Results: A total of 362 (21%) neonates out of 1726 born at the hospital were admitted during the study period (July 2016 to January, 2017). Among these neonates, 97 (26.7%) were suspected of sepsis. A total of 54 neonates were enrolled who met the eligibility criteria and parents consented to participate in the study. The mean (SD) birthweight was 1536 (732) grams and gestational age 32.0 (4.0) weeks. All LPs were indicated for late onset sepsis at the median (IQR) age of 12 (5-39) days. The traumatic LP occurred in 19 neonates (35.1%; 95% C.I 22.6% to 49.3%). Frank blood was observed in 7 (36.8%) and in the remaining, 12(63.1%) CSF was detected to have microscopic trauma. The preliminary risk factor analysis including birth weight, gestational age and operator/assistant and other characteristics did not demonstrate clinically relevant predictors. Conclusion: A significant number of neonates requiring lumbar puncture in our study had high incidence of traumatic tap. We were not able to identify modifiable risk factors. There is a need to understand the reasons and further reduce this issue for improving management in NICUs.

Keywords: incidence, newborn, traumatic, lumbar puncture

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Authors: Hela Ghali, Sihem Ben Fredj, Mohamed Ben Rejeb, Sawssen Layouni, Salwa Khefacha, Lamine Dhidah, Houyem Said Laatiri

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Background: Antimicrobial resistance is a growing threat to public health and motivates to improve prevention and control programs both at international (WHO) and national levels. Despite their low pathogenicity, vancomycin-resistant enterococci (VRE) are common nosocomial pathogens in several countries. The high potential for transmission of VRE between patients and the threat to send its resistance genes to other bacteria such as staphylococcus aureus already resistant to meticilin, justify strict control measures. Indeed, in Europe, the proportion of Enterococcus faecium responsible for invasive infections, varies from 1% to 35% in 2011 and less than 5% were resistant to vancomycin. In addition, it represents the second cause of urinary tract and wound infections and the third cause of nosocomial bacteremia in the United States. The nosocomial outbreaks of VRE have been mainly described in intensive care services, hematology-oncology and haemodialysis. An epidemic of VRE has affected our hospital and the objective of this work is to describe the measures put in place. Materials/Methods: Following the alert given by the service of plastic surgery concerning a patient carrier of VRE, a team of the prevention and healthcare security service (doctor + technician) made an investigation. A review of files was conducted to draw the synoptic table and the table of cases. Results: By contacting the microbiology laboratory, we have identified four other cases of VRE and who were hospitalized in Medical resuscitation department (2 cases, one of them was transferred to the Physical rehabilitation department), and Nephrology department (2 cases). The visit has allowed to detect several malfunctions in professional practice. A crisis cell has allowed to validate, coordinate and implement control measures following the recommendations of the Technical Center of nosocomial infections. In fact, the process was to technically isolate cases in their sector of hospitalization, to restrict the use of antibiotics, to strength measures of basic hygiene, and to make a screening by rectal swab for both cases and contacts (other patients and health staff). These measures have helped to control the situation and no other case has been reported for a month. 2 new cases have been detected in the intensive care unit after a month. However, these are short-term strategies, and other measures in the medium and long term should be taken into account in order to face similar outbreaks. Conclusion: The efforts to control the outbreak were not efficient since 2 new cases have been reported after a month. Therefore, a continuous monitoring in order to detect new cases earlier is crucial to minimize the dissemination of VRE.

Keywords: hospitals, nosocomial infection, outbreak, vancomycin-resistant enterococci

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Authors: Alberto Veses, Olga Sanhauja, María Soledad Callén, Tomás García

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The appropriate use of renewable sources emerges as a decisive point to minimize the environmental impact caused by fossil fuels use. Particularly, the use of lignocellulosic biomass becomes one of the best promising alternatives since it is the only carbon-containing renewable source that can produce bioproducts similar to fossil fuels and it does not compete with food market. Among all the processes that can valorize lignocellulosic biomass, pyrolysis is an attractive alternative because it is the only thermochemical process that can produce a liquid biofuel (bio-oil) in a simple way and solid and gas fractions that can be used as energy sources to support the process. However, in order to incorporate bio-oils in current infrastructures and further process in future biorefineries, their quality needs to be improved. Introducing different low-cost catalysts and/or incorporating different polymer residues to the process are some of the new, simple and low-cost strategies that allow the user to directly obtain advanced bio-oils to be used in future biorefineries in an economic way. In this manner, from previous thermogravimetric analyses, local agricultural wastes such as grape seeds (GS) were selected as lignocellulosic biomass while, waste tires (WT) were selected as polymer residue. On the other hand, CaO was selected as low-cost catalyst based on previous experiences by the group. To reach this aim, a specially-designed fixed bed reactor using N₂ as a carrier gas was used. This reactor has the peculiarity to incorporate a vertical mobile liner that allows the user to introduce the feedstock in the oven once the selected temperature (550 ºC) is reached, ensuring higher heating rates needed for the process. Obtaining a well-defined phase distribution in the resulting bio-oil is crucial to ensure the viability to the process. Thus, once experiments were carried out, not only a well-defined two layers was observed introducing several mixtures (reaching values up to 40 wt.% of WT) but also, an upgraded organic phase, which is the one considered to be processed in further biorefineries. Radical interactions between GS and WT released during the pyrolysis process and dehydration reactions enhanced by CaO can promote the formation of better-quality bio-oils. The latter was reflected in a reduction of water and oxygen content of bio-oil and hence, a substantial increase of its heating value and its stability. Moreover, not only sulphur content was reduced from solely WT pyrolysis but also potential and negative issues related to a strong acidic environment of conventional bio-oils were minimized due to its basic pH and lower total acid numbers. Therefore, acidic compounds obtained in the pyrolysis such as CO₂-like substances can react with the CaO and minimize acidic problems related to lignocellulosic bio-oils. Moreover, this CO₂ capture promotes H₂ production from water gas shift reaction favoring hydrogen-transfer reactions, improving the final quality of the bio-oil. These results show the great potential of grapes seeds to carry out the catalytic co-pyrolysis process with different plastic residues in order to produce a liquid bio-oil that can be considered as a high-quality renewable vector.

Keywords: advanced bio-oils, biorefinery, catalytic co-pyrolysis of biomass and waste tires, lignocellulosic biomass

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Authors: Mohamed Adel Ahmed, Warda Youssef Morsy , Hanaa Ali El Feky

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Background: Literature review cited that sleep is absolutely essential for surviving and reclamation of the quality of life. Critically ill patients often have poor sleep quality with prolonged sleep latency, sleep fragmentation, decreased sleep efficiency and frequent arousals. Nurses have a unique role for the early diagnosis of sleep disorders, decreasing stressors levels and providing the necessary environmental regulations to create a therapeutic ambiance. The aim of the study: to assess perceived sleep quality and identify factors affecting sleep quality among adult critically ill patients At El Manial University Hospital. Research Design: A descriptive exploratory design was utilized. Research questions: a) how do adult critically ill patients perceive sleep quality in the Critical Care Department of El Manial University Hospital? b) What are the factors affecting sleep quality among adult critically ill patients at El Manial University Hospital? Setting: selected critical and cardiac care units at El Manial University Hospital. Sample: A samples of convenience consisting of 100 adult male and female patients were included in the study. Tools of data collection: tool 1: Socio-demographic and Medical Data Sheet, tool 2: Modified St Mary's Hospital Sleep Questionnaire tool 3: Factors Affecting Sleep Quality Questionnaire among ICU Patients Results: The current study revealed that 76.0% of the studied sample had lack of sleep disturbance before hospitalization. However, 84 % had sleep disturbances during ICU stay, of these more than two-thirds (67 %) had moderate sleep disturbance. Presence of strange and bad odors, noise, having pain, fear of death and a loud voice produced by the ICU personnel had the most significant negative impact on patients’ sleep in percentage of 52.4, 50, 61.9, 45.2, 52.4, respectively. Conclusion: Sleep disturbances in the ICU are multifactorial, and ICU patients’ perceived degrees of sleep disturbance as a moderate. Recommendations: Based on findings of the present study, the following are recommended to be done by ICU nurses; create a healing ICU environment that should incorporate noise, light and temperature controls; decrease stimuli during night time hours to promote regulation of the circadian rhythm, allow usage of sleeping aids such as relaxing music, eye patches and earplugs into their daily nursing practice; cluster nursing activities and eliminate non-essential treatments during night time hours to allow uninterrupted sleep periods of at least 90 minutes to complete one sleep cycle , and minimize staff conversation, alarm noise and light during the quiet night time hours.

Keywords: sleep quality, critically ill, patients, perception

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Authors: Shreya Saxena, Felix Miller-Molloy, Phillipa Bowen, Greg Fellows, Elizabeth Bowen

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Background: Complex fluid balance abnormalities are well-established post-neurosurgery and traumatic brain injury (TBI). The triple-phase response requires fluid management strategies reactive to urine output and sodium homeostasis as patients shift between Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH). It was observed, at a tertiary paediatric center, a relatively high prevalence of the above complications within a cohort of paediatric post-neurosurgical and TBI patients. An audit of the clinical practice against set institutional guidelines was undertaken and analyzed to understand why this was occurring. Based on those results, new guidelines were developed with structured educational packages for the specialist teams involved. This was then reaudited, and the findings were compared. Methods: Two independent audits were conducted across two time periods, pre and post guideline change. Primary data was collected retrospectively, including both qualitative and quantitative data sets from the CQUIN neurosurgical database and electronic medical records. All paediatric patients post posterior fossa (PFT) or supratentorial surgery or with a TBI were included. A literature review of evidence-based practice, initial audit data, and stakeholder feedback was used to develop new clinical guidelines and nursing standard operation procedures. Compliance against these newly developed guidelines was re-assessed and a thematic, trend-based analysis of the two sets of results was conducted. Results: Audit-1 January2017-June2018, n=80; Audit-2 January2020-June2021, n=30 (reduced operative capacity due to COVID-19 pandemic). Overall, improvements in the monitoring of both fluid balance and electrolyte trends were demonstrated; 51% vs. 77% and 78% vs. 94%, respectively. The number of clear fluid management plans documented postoperatively also increased (odds ratio of 4), leading to earlier recognition and management of evolving fluid-balance abnormalities. The local paediatric endocrine team was involved in the care of all complex cases and notified sooner for those considered to be developing DI or SIADH (14% to 35%). However, significant Na fluctuations (>12mmol in 24 hours) remained similar – 5 vs six patients – found to be due to complex pituitary hypothalamic pathology – and the recommended adaptive fluid management strategy was still not always used. Qualitative data regarding useability and understanding of fluid-balance abnormalities and the revised guidelines were obtained from health professionals via surveys and discussion in the specialist teams providing care. The feedback highlighted the new guidelines provided a more consistent approach to the post-operative care of these patients and was a better platform for communication amongst the different specialist teams involved. The potential limitation to our study would be the small sample size on which to conduct formal analyses; however, this reflects the population that we were investigating, which we cannot control. Conclusion: The revised clinical guidelines, based on audited data, evidence-based literature review and stakeholder consultations, have demonstrated an improvement in understanding of the neuro-endocrine complications that are possible, as well as increased compliance to post-operative monitoring of fluid balance and electrolytes in this cohort of patients. Emphasis has been placed on preventative rather than treatment of DI and SIADH. Consequently, this has positively impacted patient safety for the center and highlighted the importance of educational awareness and multi-disciplinary team working.

Keywords: post-operative, fluid-balance management, neuro-endocrine complications, paediatric

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Authors: Siming Wang, Qing Ni, Yu Wu, Ruihai Xu, Hong Ye

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Porous electric heaters, compared to conventional electric heaters, exhibit excellent heating performance due to their large specific surface area. Porous electric heaters employ porous metallic materials or conductive porous ceramics as the heating element. The former attains a low heating power with a fixed current due to the low electrical resistivity of metal. Although the latter can bypass the inherent challenges of porous metallic materials, the fabrication process of the conductive porous ceramics is complicated and high cost. This work proposed a porous ceramic electric heater with dielectric honeycomb ceramic as a substrate and surface conductive coating as a heating element. The conductive coating was prepared by the sol-gel method using silica sol and methyl trimethoxysilane as raw materials and graphite powder as conductive fillers. The conductive mechanism and degradation reason of the conductive coating was studied by electrical resistivity and thermal stability analysis. The heating performance of the proposed heater was experimentally investigated by heating air and deionized water. The results indicate that the electron transfer is achieved by forming the conductive network through the contact of the graphite flakes. With 30 wt% of graphite, the electrical resistivity of the conductive coating can be as low as 0.88 Ω∙cm. The conductive coating exhibits good electrical stability up to 500°C but degrades beyond 600°C due to the formation of many cracks in the coating caused by the weight loss and thermal expansion. The results also show that the working medium has a great influence on the volume power density of the heater. With air under natural convection as the working medium, the volume power density attains 640.85 kW/m3, which can be increased by 5 times when using deionized water as the working medium. The proposed honeycomb ceramic electric heater has the advantages of the simple fabrication method, low cost, and high volume power density, demonstrating great potential in the fluid heating field.

Keywords: conductive coating, honeycomb ceramic electric heater, high specific surface area, high volume power density

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Authors: Selin Top, Raul Marcos, M. Sinan Bilgili

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Although there have been several studies related to collection, temporary storage, handling and disposal of solid wastes generated by hospitals, there are only a few studies related to liquid wastes generated by hospitals or hospital wastewaters. There is an important amount of water consumptions in hospitals. While minimum domestic water consumption per person is 100 L/day, water consumption per bed in hospitals is generally ranged between 400-1200 L. This high amount of consumption causes high amount of wastewater. The quantity of wastewater produced in a hospital depends on different factors: bed numbers, hospital age, accessibility to water, general services present inside the structure (kitchen, laundry, laboratory, diagnosis, radiology, and air conditioning), number and type of wards and units, institution management policies and awareness in managing the structure in safeguarding the environment, climate and cultural and geographic factors. In our country, characterization of hospital wastewaters conducted by classical parameters in a very few studies. However, as mentioned above, this type of wastewaters may contain different compounds than domestic wastewaters. Hospital Wastewater (HWW) is wastewater generated from all activities of the hospital, medical and non medical. Nowadays, hospitals are considered as one of the biggest sources of wastewater along with urban sources, agricultural effluents and industrial sources. As a health-care waste, hospital wastewater has the same quality as municipal wastewater, but may also potentially contain various hazardous components due to using disinfectants, pharmaceuticals, radionuclides and solvents making not suitable the connection of hospital wastewater to the municipal sewage network. These characteristics may represent a serious health hazard and children, adults and animals all have the potential to come into contact with this water. Therefore, the treatment of hospital wastewater is an important current interest point to focus on. This paper aims to approach on the investigation of hospital wastewater treatment by membrane systems. This study aim is to determined hospital wastewater’s characterization and also evaluates the efficiency of hospital wastewater treatment by high pressure filtration systems such as ultrafiltration (UF). Hospital wastewater samples were taken directly from sewage system from Şişli Etfal Training and Research Hospital, located in the district of Şişli, in the European part of Istanbul. The hospital is a 784 bed tertiary care center with a daily outpatient department of 3850 patients. Ultrafiltration membrane is used as an experimental treatment and the influence of the pressure exerted on the membranes was examined, ranging from 1 to 3 bar. The permeate flux across the membrane was observed to define the flooding membrane points. The global COD and BOD5 removal efficiencies were 54% and 75% respectively for ultrafiltration, all the SST removal efficiencies were above 90% and a successful removal of the pathological bacteria measured was achieved.

Keywords: hospital wastewater, membrane, ultrafiltration, treatment

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Authors: Seungmin Shin, Jin-Baek Kim

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Hematite (α-Fe2O3) has very good semiconducting properties with a band gap of 2.1 eV and is antiferromagnetic. Due to its electrochemical stability, low toxicity, wide abundance, and low-cost, hematite, it is a particularly attractive material for photoelectrochemical cells. Additionally, hematite has also found applications in gas sensing, field emission, heterogeneous catalysis, and lithium-ion battery electrodes. Here, we discovered a new universal top-down method for the synthesis of one-dimensional hematite nanowire arrays. Various shapes and lengths of hematite nanowire have been easily fabricated over large areas by sequential processes. The obtained hematite nanowire arrays are promising candidates as photoanodes in photoelectrochemical solar cells.

Keywords: hematite, lithography, nanowire, top-down process

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Authors: Olivia R. Rendon

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More than half of the world population lives in cities, in the UK, for example, 82% of the population was urban by 2013. Cities concentrate valuable and numerous infrastructure and sectors of the national economies. Cities are particularly vulnerable to climate change which will lead to higher damage costs in the future. There is thus a need to develop and invest in adaptation measures for cities to reduce the impact of flooding and other extreme weather events. Recent flood episodes present a significant and growing challenge to the UK and the estimated cost of urban flood damage is 270 million a year for England and Wales. This study aims to carry out cost-benefit analysis (CBA) of a nature-based approach for flood risk management in cities, focusing on the city of Leeds and the wider Aire catchment as a case study. Leeds was chosen as a case study due to its being one of the most flood vulnerable cities in the UK. In Leeds, over 4,500 properties are currently vulnerable to flooding and approximately £450 million of direct damage is estimated for a potential major flood from the River Aire. Leeds is also the second largest Metropolitan District in England with a projected population of 770,000 for 2014. So far the city council has mainly focused its flood risk management efforts on hard infrastructure solutions for the city centre. However, the wider Leeds district is at significant flood risk which could benefit from greener adaptation measures. This study presents estimates of a nature-based adaptation approach for flood risk management in Leeds. This land use management estimate is based on generating costings utilising primary and secondary data. This research contributes findings on the costs of different adaptation measures to flood risk management in a UK city, including the trade-offs and challenges of utilising nature-based solutions. Results also explore the potential implementation of the adaptation measures in the case study and the challenges of data collection and analysis for adaptation in flood risk management.

Keywords: green infrastructure, ecosystem services, woodland, adaptation, flood risk

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Authors: ALi Zaker, Zhi Chen

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Due to the concerns about the depletion of fossil fuel sources and the deteriorating environment, the attempt to investigate the production of renewable energy will play a crucial role as a potential to alleviate the dependency on mineral fuels. In this respect, biofuels are measured as a vital nominee for national energy security and energy sustainability. Sewage sludge (SS), as an alternative source of renewable energy with a complex composition, is a major waste generated during wastewater treatment. Stricter legislation is continuously refining the requirements for the level of removal of various pollutants in treated water, causing continuous growth of sludge production, which has become a global challenge. In general, there are two main procedures for dealing with SS: incineration and landfill. However, there are a variety of limitations in these options (e.g., production of greenhouse gases and restrictive environmental regulations) in regard to negative social and economic impacts. Pyrolysis is a feasible and cost-effective technology that can simultaneously tackle boundaries concerning the current disposal routes while retrieving bioenergy. Pyrolysis of SS has drawn vigorous interest in research due to the ability of high mass yield of pyrolytic liquid production. Nonetheless, the presence of high molecular weight hydrocarbons and oxygenated- and nitrogenated compounds poses a considerable challenge. In this context, catalytic pyrolysis is another attainable route in order to upgrade the bio-oil quality. Among different catalysts (i.e., zeolites) studied for sewage sludge pyrolysis, activated chars are eco-friendly and low-cost alternatives. The beneficial features comprise comparatively large surface area, long-term stability, and enriched surface functional groups. In light of these premises, this research attempts to investigate the catalytic pyrolysis of sewage sludge with a high-performance sludge-based activated char in contrast to HZSM5 from a theoretical and experimental point of view.

Keywords: catalytic pyrolysis, sewage sludge, char, HZSM5, bio-oil.

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Authors: Anisur Rahman, Sabyasachi Behera, Pawan Pathak, Benazir Patil, Rajesh Khanna

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Background: Nearly half of India’s population is expected to reside in urban areas by 2030. The extent to which India's health system can provide for this large and growing city-based population will determine the country's success in achieving universal health coverage and improved national health indices. National Urban Health Mission (NUHM) strive for improving access to primary health care in urban areas. Implementation of NUHM solicits sensitive, effective and sustainable strategies to strengthen the service delivery mechanisms. The Challenge Initiative for Healthy Cities (TCIHC) is working with the Government of India and three provincial states to develop effective service delivery mechanisms for reproductive, maternal, newborn and child health (RMNCH) through a health systems approach for the urban poor. Method: A rapid assessment study was conceptualized and executed to generate evidence in order to address the challenges impeding in functioning of urban health facilities to deliver effective, efficient and equitable health care services in 7 cities spread across two project States viz. Madhya Pradesh and Odisha. Results: The findings of the assessment reflect: 1. The overall ecosystem pertaining to planning and management of public health interventions is not conducive. 2. The challenges regarding population dynamics like migration keeps on influencing the demand-supply-enabling environment triangle for both public and private service providers. 3. Lack of norms for planning and benchmark for service delivery further impedes urban health system as a whole. 4. Operationalization of primary level services have enough potential to meet the demand of slum dwellers at large. 5. Lack of policy driven strategies on how to integrate the NUHM with other thematic areas of Maternal, Newborn & Child Health (MNCH) and Family Planning (FP). 5. The inappropriate capacity building and acute shortage of Human Resources has huge implication on service provisioning and adherence to the service delivery protocols. Conclusion: The findings from rapid assessment are aimed to inform pertinent stakeholders to develop a multiyear city health action plan to strengthen the health systems in order to improve the efficacy of service delivery mechanism in urban settings.

Keywords: city health plan, health system, rapid assessment, urban mission

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Authors: Ja-Keoung Koo, Kensuke Nakamura, Hyohun Kim, Dongwha Shin, Yeonseok Kim, Ji-Su Ahn, Byung-Woo Hong

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The machine learning techniques based on a convolutional neural network (CNN) have been actively developed and successfully applied to a variety of image analysis tasks including reconstruction, noise reduction, resolution enhancement, segmentation, motion estimation, object recognition. The classical visual information processing that ranges from low level tasks to high level ones has been widely developed in the deep learning framework. It is generally considered as a challenging problem to derive visual interpretation from high dimensional imagery data. A CNN is a class of feed-forward artificial neural network that usually consists of deep layers the connections of which are established by a series of non-linear operations. The CNN architecture is known to be shift invariant due to its shared weights and translation invariance characteristics. However, it is often computationally intractable to optimize the network in particular with a large number of convolution layers due to a large number of unknowns to be optimized with respect to the training set that is generally required to be large enough to effectively generalize the model under consideration. It is also necessary to limit the size of convolution kernels due to the computational expense despite of the recent development of effective parallel processing machinery, which leads to the use of the constantly small size of the convolution kernels throughout the deep CNN architecture. However, it is often desired to consider different scales in the analysis of visual features at different layers in the network. Thus, we propose a CNN model where different sizes of the convolution kernels are applied at each layer based on the random projection. We apply random filters with varying sizes and associate the filter responses with scalar weights that correspond to the standard deviation of the random filters. We are allowed to use large number of random filters with the cost of one scalar unknown for each filter. The computational cost in the back-propagation procedure does not increase with the larger size of the filters even though the additional computational cost is required in the computation of convolution in the feed-forward procedure. The use of random kernels with varying sizes allows to effectively analyze image features at multiple scales leading to a better generalization. The robustness and effectiveness of the proposed CNN based on random kernels are demonstrated by numerical experiments where the quantitative comparison of the well-known CNN architectures and our models that simply replace the convolution kernels with the random filters is performed. The experimental results indicate that our model achieves better performance with less number of unknown weights. The proposed algorithm has a high potential in the application of a variety of visual tasks based on the CNN framework. Acknowledgement—This work was supported by the MISP (Ministry of Science and ICT), Korea, under the National Program for Excellence in SW (20170001000011001) supervised by IITP, and NRF-2014R1A2A1A11051941, NRF2017R1A2B4006023.

Keywords: deep learning, convolutional neural network, random kernel, random projection, dimensionality reduction, object recognition

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Authors: Muhammad Abdul Qyyum, Kinza Qadeer, Moonyong Lee

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Globally, liquefied natural gas (LNG) has drawn interest as a green energy source in comparison with other fossil fuels, mainly because of its ease of transport and low carbon dioxide emissions. It is expected that demand for LNG will grow steadily over the next few decades. In addition, because the demand for clean energy is increasing, LNG production facilities are expanding into new natural gas reserves across the globe. However, LNG production is an energy and cost intensive process because of the huge power requirements for compression and refrigeration. Therefore, one of the major challenges in the LNG industry is to improve the energy efficiency of existing LNG processes through economic and ecological strategies. The advancement in expansion devices such as two-phase cryogenic expander (TPE) and cryogenic hydraulic turbine (HT) were exploited for energy and cost benefits in natural gas liquefaction. Retrofitting the conventional Joule–Thompson (JT) valve with TPE and HT have the potential to improve the energy efficiency of LNG processes. This research investigated the potential feasibility of the retrofitting of a dual mixed refrigerant (DMR) process by replacing the isenthalpic expansion with isentropic expansion corresponding to energy efficient LNG production. To fully take the potential benefit of the proposed process retrofitting, the proposed DMR schemes were optimized by using a Coggins optimization approach, which was implemented in Microsoft Visual Studio (MVS) environment and linked to the rigorous HYSYS® model. The results showed that the required energy of the proposed isentropic expansion based DMR process could be saved up to 26.5% in comparison with the conventional isenthalpic based DMR process using the JT valves. Utilization of the recovered energy into boosting the natural gas feed pressure could further improve the energy efficiency of the LNG process up to 34% as compared to the base case. This work will help the process engineers to overcome the challenges relating to energy efficiency and safety concerns of LNG processes. Furthermore, the proposed retrofitting scheme can also be implemented to improve the energy efficiency of other isenthalpic expansion based energy intensive cryogenic processes.

Keywords: cryogenic liquid turbine, Coggins optimization, dual mixed refrigerant, energy efficient LNG process, two-phase expander

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Authors: Jim Weese

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The Kinesiology, Exercise and Sport Science environment remain excellent venues for leadership research. Prescribed leadership (coaching), emergent leadership (players and organizations), and executive leadership are all popular themes in the research literature. Leadership remains a popular area of inquiry in the sport management domain as well as an interesting area for practitioners who wish to heighten their leadership practices and effectiveness. The need for effective leadership in these areas given competing demands for attention and resources may be at an all-time high. The presenter has extensive research and practical experience in the area and has developed his concept based on the latest leadership literature. He refers to this as the Five ’C’s of Leadership. These components, noted below, have been empirically validated and have served as the foundation for extensive consulting with academic, sport, and business leaders. Credibility (C1) is considered the foundation of leadership. There are two components to this area, namely: (a) leaders being respected for having the relevant knowledge, insights, and experience to be seen as credible sources of information, and (b) followers perceiving the leader as being a person of character, someone who is honest, reliable, consistent, and trustworthy. Compelling Vision (C2) refers to the leader’s ability to focus the attention of followers on a desired end goal. Effective leaders understand trends and developments in their industry. They also listen attentively to the needs and desires of their stakeholders and use their own instincts and experience to shape these ideas into an inspiring vision that is effectively and continuously communicated. Charismatic Communicator (C3) refers to the leader’s ability to formally and informally communicate with members. Leaders must deploy mechanisms and communication techniques to keep their members informed and engaged. Effective leaders sprinkle in ‘proof points’ that reinforce the vision’s relevance and/or the unit’s progress towards its attainment. Contagious Enthusiasm (C4) draws on the emotional intelligence literature as it relates to exciting and inspiring followers. Effective leaders demonstrate a level of care, commitment, and passion for their people and feelings of engagement permeate the group. These leaders genuinely care about the task at hand, and for the people working to make it a reality. Culture Builder (C5) is the capstone component of the model and is critical to long-term success and survival. Organizational culture refers to the dominant beliefs, values and attitudes of members of a group or organization. Some have suggested that developing and/or imbedding a desired culture for an organization is the most important responsibility for a leader. The author outlines his Five ‘C’s’ of Leadership concept and provide direct application to executive leadership in Kinesiology, Exercise and Sport Science.

Keywords: effectiveness, leadership, management, sport

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Authors: Daniel C. S. Lim

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There are numerous nutritional supplements, such as multivitamins and nutrition drinks, in the market today. Many of these supplements are expensive and tend to be driven commercially by business decisions and big marketing budgets. Many of the costs are ultimately borne by the end user in the quest for keeping to a healthy lifestyle. This paper proposes a system with a list of ten determinants to gauge how to decide the value of various supplements. It suggests variables such as composition, safety, efficacy and bioavailability, as well as several other considerations. These guidelines can help to tackle many of the issues that people of all ages face in the way that they receive essential nutrients. The system also aims to promote and improve the safety and choice of foods and supplements. In so doing, the system aims to promote the individual’s or population’s control over their own health and reduce the growing health care burden on the society.

Keywords: choice of foods and supplements, essential nutrients, nutritional supplements, system safety

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Authors: Emily Moore, Dora Amos, Tracy Ellimah, Natasha Parrott

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Postoperative haematoma is a well-recognised complication of thyroid surgery with an incidence of 1-5%. Haematoma formation causes progressive airway obstruction, necessitating emergency bedside haematoma evacuation in up to ¼ of patients. ENT UK, BAETS and DAS have developed consensus guidelines to improve perioperative care, recommending that all healthcare staff interacting with patients undergoing thyroid surgery should be trained in managing post-thyroidectomy haematoma. The aim was to assess the effectiveness of a hybrid simulation model in improving clinician’s confidence in dealing with this surgical emergency. A hybrid simulation was designed, consisting of a standardised patient wearing a part-task trainer to mimic a post-thyroidectomy haematoma in a real patient. The part-task trainer was an adapted C-spine collar with layers of silicone representing the skin and strap muscles and thickened jelly representing the haematoma. Both the skin and strap muscle layers had to be opened in order to evacuate the haematoma. Boxes have been implemented into the appropriate post operative areas (recovery and surgical wards), which contain a printed algorithm designed to assist in remembering a sequence of steps for haematoma evacuation using the ‘SCOOP’ method (skin exposure, cut sutures, open skin, open muscles, pack wound) along with all the necessary equipment to open the front of the neck. Small-group teaching sessions were delivered by ENT and anaesthetic trainees to members of the multidisciplinary team normally involved in perioperative patient care, which included ENT surgeons, anaesthetists, recovery nurses, HCAs and ODPs. The DESATS acronym of signs and symptoms to recognise (difficulty swallowing, EWS score, swelling, anxiety, tachycardia, stridor) was highlighted. Then participants took part in the hybrid simulation in order to practice this ‘SCOOP’ method of haematoma evacuation. Participants were surveyed using a Likert scale to assess their level of confidence pre- and post teaching session. 30 clinicians took part. Confidence (agreed/strongly agreed) in recognition of post thyroidectomy haematoma improved from 58.6% to 96.5%. Confidence in management improved from 27.5% to 89.7%. All participants successfully decompressed the haematoma. All participants agreed/strongly agreed, that the sessions were useful for their learning. Multidisciplinary team simulation teaching is effective at significantly improving confidence in both the recognition and management of postoperative haematoma. Hybrid simulation sessions are useful and should be incorporated into training for clinicians.

Keywords: thyroid surgery, haematoma, teaching, hybrid simulation

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Authors: Ruth Green, Samantha Milton, Rinal Desai

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Background/Aims: Eye pain/swelling/redness is a common presentation to Barnet General Hospital (a district general hospital), pediatric emergency department, and is managed by both the pediatric and emergency teams. The management of each child differs dramatically depending on the healthcare professional who reviews them. There also appears to be confusion in diagnosis between periorbital cellulitis, pre-septal cellulitis, and orbital cellulitis. Pre septal cellulitis refers to an inflammation of the eyelids and soft tissue anterior to the orbital septum. In contrast, orbital cellulitis is a serious, rapidly progressive infection of soft tissues located posterior to the orbital septum. Pre-septal cellulitis is more prevalent and less serious than orbital cellulitis, although it may be part of a continuous spectrum if untreated. Pre-septal cellulitis should there be diagnosed and treated urgently to prevent spread to the septum. For the purpose of the audit, the term periorbital cellulitis has been used as an umbrella term for all spectrums of this infection. The audit aimed to look at, how as a whole, the department is diagnosing and managing orbital and pre-septal cellulitis. Gold Standard: Patients of the same age and diagnosis should be treated with the same medication, advice, and follow-up. Method: Data was collected retrospectively from pediatric patients ( < 18years) who attended the emergency department from June 2019 to February 2020 who had been coded as pre-septal cellulitis, periorbital cellulitis, orbital cellulitis, or eye pain/swelling/redness. Demographics, signs and symptoms, management, and follow-up were recorded for all patients with any of the diagnoses of pre-septal, periorbital, or orbital cellulitis. A Microsoft Excel spreadsheet was used to record the anonymised data. Results: There were vast discrepancies in the diagnosis, management, and follow-up of patients with periorbital cellulitis. Conclusion/Discussion: The audit concluded there is no uniform approach to managing periorbital cellulitis in Barnet General Hospital Paediatric Emergency Department. Healthcare professionals misdiagnosed conjunctivitis as periorbital cellulitis, and adequate steps did not appear to be documented on excluding red flag signs and symptoms of patients presenting. There was no consistency in follow-up, with some patients having timely phone reviews or clinical reviews for mild symptoms. Advice given by the staff was appropriate, and patients did return when symptoms got worse and were treated accordingly. Plan: Given the inconsistency, a gold standard care pathway or local easily accessible clinical guideline can be developed to help with the diagnosis and management of periorbital cellulitis. Along with this, a teaching session can be carried out for the staff of the pediatric team and emergency department to disseminate the teaching. Following the introduction of a guideline and teaching sessions, patients notes can be re-reviewed to check improvement in patient care.

Keywords: periorbital cellulitis, preseptal cellulitis, orbital cellulitis, erythematous eyelid

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