Search results for: emergency plan

Authors: Ewa M. Laskowska, Jorn Vatn

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Industry 4.0 focuses on digital optimization of industrial processes. The idea is to use extracted data in order to build a decision support model enabling use of those data for real time decision making. In terms of predictive maintenance, the desired decision support tool would be a model enabling prognostics of system's health based on the current condition of considered equipment. Within area of system prognostics and health management, a commonly used health indicator is Remaining Useful Lifetime (RUL) of a system. Because the RUL is a random variable, it has to be estimated based on available health indicators. Health indicators can be of different types and come from different sources. They can be process variables, equipment performance variables, data related to number of experienced failures, etc. The aim of this study is the analysis of performance variables of emergency shutdown valves (ESV) used in oil and gas industry. ESV is inspected periodically, and at each inspection torque and time of valve operation are registered. The data will be analyzed by means of machine learning or statistical analysis. The purpose is to investigate whether the available data could be used as a health indicator for a prognostic purpose. The second objective is to examine what is the most efficient way to incorporate the data into predictive model. The idea is to check whether the data can be applied in form of explanatory variables in Markov process or whether other stochastic processes would be a more convenient to build an RUL model based on the information coming from registered data.

Keywords: emergency shutdown valves, health indicator, prognostics, remaining useful lifetime, RUL

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Authors: Joanna Grzybowska, Magdalena Igras, Mariusz Ziółko

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Association rule learning is an approach for discovering interesting relationships in large databases. The analysis of relations, invisible at first glance, is a source of new knowledge which can be subsequently used for prediction. We used this data mining technique (which is an automatic and objective method) to learn about interesting affects associations in a corpus of emergency phone calls. We also made an attempt to match revealed rules with their possible situational context. The corpus was collected and subjectively annotated by two researchers. Each of 3306 recordings contains information on emotion: (1) type (sadness, weariness, anxiety, surprise, stress, anger, frustration, calm, relief, compassion, contentment, amusement, joy) (2) valence (negative, neutral, or positive) (3) intensity (low, typical, alternating, high). Also, additional information, that is a clue to speaker’s emotional state, was annotated: speech rate (slow, normal, fast), characteristic vocabulary (filled pauses, repeated words) and conversation style (normal, chaotic). Exponentially many rules can be extracted from a set of items (an item is a previously annotated single information). To generate the rules in the form of an implication X → Y (where X and Y are frequent k-itemsets) the Apriori algorithm was used - it avoids performing needless computations. Then, two basic measures (Support and Confidence) and several additional symmetric and asymmetric objective measures (e.g. Laplace, Conviction, Interest Factor, Cosine, correlation coefficient) were calculated for each rule. Each applied interestingness measure revealed different rules - we selected some top rules for each measure. Owing to the specificity of the corpus (emergency situations), most of the strong rules contain only negative emotions. There are though strong rules including neutral or even positive emotions. Three examples of the strongest rules are: {sadness} → {anxiety}; {sadness, weariness, stress, frustration} → {anger}; {compassion} → {sadness}. Association rule learning revealed the strongest configurations of affects (as well as configurations of affects with affect-related information) in our emergency phone calls corpus. The acquired knowledge can be used for prediction to fulfill the emotional profile of a new caller. Furthermore, a rule-related possible context analysis may be a clue to the situation a caller is in.

Keywords: data mining, emergency phone calls, emotional profiles, rules

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Authors: Artem Sedov, Aigerim Uyzbayeva, Valeriya Tyo

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The presented article is showing results of dynamic modeling with Mathlab software of optimal automatic room climate control system for two experimental houses in Astana, one of which has circle plan and the other one has square plan. These results are showing that building geometry doesn't influence on climate system PID-controls configuring. This confirms theoretical implication that optimal automatic climate control system parameters configuring should depend on building's internal space volume, envelope heat transfer, number of people inside, supply ventilation air flow and outdoor temperature.

Keywords: climate control system, climate physics, dome-like building, mathematical modeling

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Authors: J. E. Cobbinah

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One of the most challenging issues confronting schools is good leadership succession planning. Experts argue that, although the idea of leadership succession planning is one of the strategies or practices that can help sustain improvement and promote continuity of good leadership, seem to have been neglected in many schools over the years. Appointment of head teachers in senior high schools is based on long service or one’s ability to demonstrate his/her competence in a leadership selection interview. There is no clear and well-structured leadership succession plan, before leadership position is filled, while school leadership succession planning seem to be an issue that nobody talks about. In faith-based schools the issue is even worse, because religious groups impose whoever they consider strong in the faith on schools as leaders, irrespective of the individual competence, ability to take up challenges associated with individuals’ preparedness to take up leadership position. Therefore, the present study examined the nature (including type) of leadership succession plans in faith-based senior high schools and its associated challenges. Convergent mixed method design was employed to effectively achieve the objectives of the study. The data collection strategies involved the use of interviews, questionnaires, and reviews of secondary data. The data was gathered from students, school leaders (head teachers, deputy heads, and head of departments), selected parents teachers associated members, school management committee members and members from school governors. The results show that governors of faith-based schools are making efforts to enhance education quality, by making school leadership accountable, the absence and the neglect of clear, and well-structured leadership succession plan has some negative outcomes. Unsustainable students’ academic performance, lack of support from existing staffs and senior leaders and lack of support in the implementation of school improvement plan. It would be concluded that, faith-based schools should focus on leadership competence and abilities in the selection process of potential school leaders to achieve a good succession plan rather than appointing leaders who are affiliates of one’s faith.

Keywords: school leadership, succession planning, faith-based schools, school governors

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Authors: Vijayabhaskar Reddy Kandula, Peter Provost Taillac, Balasubramanya M. A., Ram Krishnan Nair, Gokul Toshnival, Vibhu Dhawan, Vijaya Karanam, Buffy Cramer

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Introduction: The lack of Emergency Care Services (ECS) is a cause of extensive and serious public health problems in low- and middle-income countries (LMIC), Many LMIC countries have ambulance services that allow timely transfer of ill patients but due to poor care during the ‘Golden Hour’ many deaths occur which are otherwise preventable. Lack of adequate training as evidenced by a study in India is a major reason for poor care during the ‘Golden Hour’. Adapting developed country models which includes staffing specialty-trained doctors in emergency care, is neither feasible nor guarantees cost-effective ECS. Methods: Based on our assessment and felt needs by first-line doctors providing emergency care in 2014, Rajiv Gandhi Health Sciences University’s JeevaRaksha Trust in partnership with the University of Utah, USA, designed, piloted and successfully implemented a 4-day Comprehensive-Emergency Care and Life Support course (C-ECLS) for allopathic doctors. 1730 doctors completed the 4-day course between June 2014 and December- 2020. Subsequently, we conducted a survey to investigate the utilization rates and usefulness of the training. 1662 were contacted but only 309 completed the survey. The respondents had the following designations: Senior faculty (33%), junior faculty (25), Resident (16%), Private-Practitioners (8%), Medical-Officer (16%) and not-working (11%). 51% were generalists (51%) and the rest were specialists (>30 specialties). Results: 97% (271/280) felt they are better doctors because of C-ECLS. 79% (244/309) reported that training helped to save life- specialists more likely than generalists (91% v/s 68%. P<0.05). 64% agreed that they were confident of managing COVID-19 symptomatic patients better because of C-ECLS. 27% (77) were neutral; 9% (24) disagreed. 66% agreed that training helps to be confident in managing COVID-19 critically ill patients. 26% (72) were neutral; 8% (23) disagreed. Frequency of use of C-ECLS skills: Hemorrhage-control (70%), Airway (67%), circulation skills (62%), Safe-transport and communication (60%), managing critically ill patients (58%), cardiac arrest (51%), Trauma (49%), poisoning/animal bites/stings (44%), neonatal-resuscitation (39%), breathing (36%), post-partum-hemorrhage and eclampsia (35%). Among those who used the skills, the majority (ranging from (88%-94%) reported that they were able to apply the skill more effectively because of ECLS training. Conclusion: JeevaRaksha’s C-ECLS is the world’s first comprehensive training. It improves the confidence of front-line doctors and enables them to provide quality care during the ‘Golden Hour’ of emergency. It also prepares doctors to manage unknown emergencies (e.g., COVID-19). C-ECLS was piloted in Morocco, and Uzbekistan and implemented countrywide in Bhutan. C-ECLS is relevant to most settings and offers a replicable model across LMIC.

Keywords: comprehensive emergency care and life support, training, capacity building, low- and middle-income countries, developing countries

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Authors: Souad Romdhane, Lotfi Belkacem

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When referring to actuarial analysis of lifetime, only models accounting for observable risk factors have been developed. Within this context, Cox proportional hazards model (CPH model) is commonly used to assess the effects of observable covariates as gender, age, smoking habits, on the hazard rates. These covariates may fail to fully account for the true lifetime interval. This may be due to the existence of another random variable (frailty) that is still being ignored. The aim of this paper is to examine the shared frailty issue in the Cox proportional hazard model by including two different parametric forms of frailty into the hazard function. Four estimated methods are used to fit them. The performance of the parameter estimates is assessed and compared between the classical Cox model and these frailty models through a real-life data set from the Quebec Pension Plan and then using a more general simulation study. This performance is investigated in terms of the bias of point estimates and their empirical standard errors in both fixed and random effect parts. Both the simulation and the real dataset studies showed differences between classical Cox model and shared frailty model.

Keywords: life insurance-pension plan, survival analysis, risk factors, cox proportional hazards model, multivariate failure-time data, shared frailty, simulations study

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Authors: Lee Boudreau, Ash Kumar Khaitu, Laura A. S. MacDonald

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In April 2015, a magnitude 7.8 earthquake struck Nepal, killing, injuring, and displacing thousands of people. The earthquake also damaged water and sanitation service networks, leading to a high risk of diarrheal disease and the associated negative health impacts. In response to the disaster, the Environment and Public Health Organization (ENPHO), a Kathmandu-based non-governmental organization, worked with the Centre for Affordable Water and Sanitation Technology (CAWST), a Canadian education, training and consulting organization, to develop two training programs to educate volunteers on water, sanitation, and hygiene (WASH) needs. The first training program was intended for acute response, with the second focusing on longer term recovery. A key focus was to equip the volunteers with the knowledge and skills to formulate useful WASH advice in the unanticipated circumstances they would encounter when working in affected areas. Within the first two weeks of the disaster, a two-day acute response training was developed, which focused on enabling volunteers to educate those affected by the disaster about local WASH issues, their link to health, and their increased importance immediately following emergency situations. Between March and October 2015, a total of 19 training events took place, with over 470 volunteers trained. The trained volunteers distributed hygiene kits and liquid chlorine for household water treatment. They also facilitated health messaging and WASH awareness activities in affected communities. A three-day recovery phase training was also developed and has been delivered to volunteers in Nepal since October 2015. This training focused on WASH issues during the recovery and reconstruction phases. The interventions and recommendations in the recovery phase training focus on long-term WASH solutions, and so form a link between emergency relief strategies and long-term development goals. ENPHO has trained 226 volunteers during the recovery phase, with training ongoing as of April 2016. In the aftermath of the earthquake, ENPHO found that its existing pool of volunteers were more than willing to help those in their communities who were more in need. By training these and new volunteers, ENPHO was able to reach many more communities in the immediate aftermath of the disaster; together they reached 11 of the 14 earthquake-affected districts. The collaboration between ENPHO and CAWST in developing the training materials was a highly collaborative and iterative process, which enabled the training materials to be developed within a short response time. By training volunteers on basic WASH topics during both the immediate response and the recovery phase, ENPHO and CAWST have been able to link immediate emergency relief to long-term developmental goals. While the recovery phase training continues in Nepal, CAWST is planning to decontextualize the training used in both phases so that it can be applied to other emergency situations in the future. The training materials will become part of the open content materials available on CAWST’s WASH Resources website.

Keywords: water and sanitation, emergency response, education and training, building resilience

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Authors: Julia Rey Perez, Victoria Dominguez Ruiz

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The phenomenon of depopulation puts the authorities at risk of abandoning a number of rural-urban areas of significant cultural value, affecting their architecture and intangible cultural heritage. The purpose of this research is to present a methodology created according to the UNESCO Recommendation on the Historic Urban Landscape (HUL), which through the identification of cultural values and attributes, leads to ´Strategic Plans´ build upon the culture and heritage. This methodology is based on the analysis of the town from three perspectives: 1) from the public administration, 2) from the discipline of architecture, and 3) from citizen perception. In order to be able to work on the development of a diagnosis from three very different approaches, collaborative cartographies have been used as working tools. The methodology discussed was applied in Valverde de Burguillos, in Spain, leading to the construction of an inclusive ‘Strategic Plan’ that integrates the management of the town within the overall territorial development plan. The importance of incorporating culture and heritage as a conductor for sustainable urban development through the HUL approach has allowed the local authorities to assume these new tools for heritage conservation, acknowledging community participation as the main element for the ´Strategic Plan” elaboration.

Keywords: rural heritage, citizen participation, inclusiveness, urban governance, UNESCO

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Authors: Itsaree Padphai, Jiranan Pakpeian, Suksun Niponchai

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This study is a descriptive research which aims to: 1) Compare the difference of knowledge before and after using the e-Learning program entitled “Basic Cardiopulmonary Resuscitation for Students in an Emergency Medical Technician Diploma Program”, and 2) Assess the students’ satisfaction after using the said program. This research is a kind of teaching and learning management supplemented with the e-Learning system; therefore, the purposively selected samples are 44 first-year and class-16 students of an emergency medical technician diploma program who attend the class in a second semester of academic year 2012 in Sirindhorn College of Public Health, Khon Kaen province. The research tools include 1) the questionnaire for general information of the respondents, 2) the knowledge tests before and after using the e-Learning program, and 3) an assessment of satisfaction in using the e-Learning program. The statistics used in data analysis percentage, include mean, standard deviation, and inferential statistics: paired t-test. 1. The general information of the respondents was mostly 37 females representing 84.09 percent. The average age was 19.5 years (standard deviation was 0.81), the maximum age was 21 years, and the minimum age was 19 years respectively. Students (35 subjects) admitted that they preferred the methods of teaching and learning by using the e-Learning systems. This was totally 79.95 percent. 2. A comparison on the difference of knowledge before and after using the e-Learning program showed that the mean before an application was 6.64 (standard deviation was 1.94) and after was 18.84 (standard deviation 1.03), which was higher than the knowledge of students before using the e-Learning program with the statistical significance (P value < 0.001). 3. For the satisfaction after using the e-Learning program, it was found that students’ satisfaction was at a very good level with the mean of 4.93 (standard deviation was 0.11).

Keywords: e-Learning, cardiopulmonary resuscitation, diploma program, Khon Kaen Province

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Authors: Daniel Alfonso Reséndiz-García, Luis Antonio García-Villanueva

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As a result of the high industrial activity, which arises from the search to satisfy the needs of products and services for society, several chemical accidents have occurred, causing serious damage to different sectors: human, economic, infrastructure and environmental losses. Historically, with the study of this chemical accidents, it has been determined that the causes are mainly due to human errors (inexperienced personnel, negligence, lack of maintenance and deficient risk analysis). The industries have the aim to increase production and reduce costs. However, it should be kept in mind that the costs involved in risk studies, implementation of barriers and safety systems is much cheaper than paying for the possible damages that could occur in the event of an accident, without forgetting that there are things that cannot be replaced, such as human lives.Therefore, it is of utmost importance to implement risk studies in all industries, which provide information for prevention and planning. The aim of this study is to compare risk methodologies by identifying the consequences of accidents related to the storage of flammable, dangerous goods for decision making and emergency response.The methodologies considered in this study are qualitative and quantitative risk analysis and consequence analysis. The latter, by means of modeling software, which provides radius of affectation and the possible scope and magnitude of damages.By using risk analysis, possible scenarios of occurrence of chemical accidents in the storage of flammable substances are identified. Once the possible risk scenarios have been identified, the characteristics of the substances, their storage and atmospheric conditions are entered into the software.The results provide information that allows the implementation of prevention, detection, control, and combat elements for emergency response, thus having the necessary tools to avoid the occurrence of accidents and, if they do occur, to significantly reduce the magnitude of the damage.This study highlights the importance of risk studies applying tools that best suited to each case study. It also proves the importance of knowing the risk exposure of industrial activities for a better prevention, planning and emergency response.

Keywords: chemical accidents, emergency response, flammable substances, risk analysis, modeling

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Authors: Yu-Hsin Tsai

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A new, mandated county regional plan system has been initiated since 2010 nationwide in Taiwan, with its role situated in-between the policy-led cross-county regional plan and the blueprint-led city plan. This new regional plan contain both urban and rural areas in one single plan, which provides a more complete planning territory, i.e., city region within the county’s jurisdiction, and to be executed and managed effectively by the county government. However, the full picture of its functions and characteristics seems still not totally clear, compared with other levels of plans; either are planning goals and issues that can be most appropriately dealt with at this spatial scale. In addition, the extent to which the inclusion of sustainability ideal and measures to cope with climate change are unclear. Based on the above issues, this study aims to clarify the roles of county regional plan, to analyze the extent to which the measures cope with sustainability, climate change, and forecasted declining population, and the success factors and issues faced in the planning process. The methodology applied includes literature review, plan quality evaluation, and interview with officials of the central and local governments and urban planners involved for all the 23 counties in Taiwan. The preliminary research results show, first, growth management related policies have been widely implemented and expected to have effective impact, including incorporating resources capacity to determine maximum population for the city region as a whole, developing overall vision of urban growth boundary for all the whole city region, prioritizing infill development, and use of architectural land within urbanized area over rural area to cope with urban growth. Secondly, planning-oriented zoning is adopted in urban areas, while demand-oriented planning permission is applied in the rural areas with designated plans. Then, public participation has been evolved to the next level to oversee all of government’s planning and review processes due to the decreasing trust in the government, and development of public forum on the internet etc. Next, fertile agricultural land is preserved to maintain food self-supplied goal for national security concern. More adoption-based methods than mitigation-based methods have been applied to cope with global climate change. Finally, better land use and transportation planning in terms of avoiding developing rail transit stations and corridor in rural area is promoted. Even though many promising, prompt measures have been adopted, however, challenges exist to surround: first, overall urban density, likely affecting success of UGB, or use of rural agricultural land, has not been incorporated, possibly due to implementation difficulties. Second, land-use related measures to mitigating climate change seem less clear and hence less employed. Smart decline has not drawn enough attention to cope with predicted population decrease in the next decade. Then, some reluctance from county’s government to implement county regional plan can be observed vaguely possibly since limits have be set on further development on agricultural land and sensitive areas. Finally, resolving issue on existing illegal factories on agricultural land remains the most challenging dilemma.

Keywords: city region plan, sustainability, global climate change, growth management

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Authors: Ogwueleka Francisca Nonyelum, Jiya Muhammad

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Poor communication between the victims of the burglaries, road and fire accidents and the agencies, and lack of quick emergency response by the agencies is solved through Machine-to-Machine (M2M) communication. A distress caller is expected to make a call through a network to the respective agency for emergency response but due to some challenges, this often becomes arduous and futile. This research puts forth an Internet-based architecture for Machine-to-Machine (M2M) communication to enhance information dissemination in National Public Security Communication System (NPSCS) network. M2M enables the flow of data between machines and machines and ultimately machines and people with information flowing from a machine over a network, and then through a gateway to a system where it is reviewed and acted on. The research findings showed that Internet-based architecture for M2M communication is most suitable for deployment of a public security network which will allow machines to use Internet to talk to each other.

Keywords: machine-to-machine (M2M), internet-based architecture, network, gateway

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Authors: Firjeeth C. Paramba, Vamanjore A. Naushad, Nishan K. Purayil, Osama H. Mohammed, Prem Chandra

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Background: Fever is a common problem in adults visiting the emergency department. Extensive studies have been done in children comparing the efficacy of various antipyretics. However, studies on the efficacy of antipyretic drugs in adults are very scarce. To the best of our knowledge, no controlled trial has been carried out comparing the antipyretic efficacy of paracetamol (oral and intravenous) and intramuscular diclofenac in adults. Methods: In this parallel-group, open-label trial, participants aged 14–75 years presenting with fever who had a temperature of more than 38.5°C were enrolled and treated. Participants were randomly allocated to receive treatment with 1,000 mg oral paracetamol (n=145), 1,000 mg intravenous paracetamol (n=139), or 75 mg intramuscular diclofenac (n=150). The primary outcome was degree of reduction in mean oral temperature at 90 minutes. The efficacy of diclofenac versus oral and intravenous paracetamol was assessed by superiority comparison. Analysis was done using intention to treat principles. Results: After 90 minutes, all three groups showed a significant reduction in mean temperature, with intramuscular diclofenac showing the greatest reduction (−1.44 ± 0.43, 95% confidence interval [CI] −1.4 to −2.5) and oral paracetamol the least (−1.08 ± 0.51, 95% CI −0.99 to −2.2). After 120 minutes, there was a significant difference observed in the mean change from baseline temperature between the three treatment groups (P, 0.0001). Significant changes in temperature were observed in favor of intramuscular diclofenac over oral and intravenous paracetamol at each time point from 60 minutes through 120 minutes inclusive. Conclusion: Both intramuscular diclofenac and intravenous paracetamol showed superior antipyretic activity than oral paracetamol. However, in view of its ease of administration, intramuscular diclofenac can be used as a first-choice antipyretic in febrile adults in the emergency department.

Keywords: antipyretic, intramuscular, intravenous, paracetamol, diclofenac, emergency department

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Authors: Chin-Hsiang Lo, Wey Chia, Shih-Tien Hsu

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Introduction: Since 2016, the annual number of passengers on commercial flights at Taoyuan International Airport (TIA) has been ~40 million. Due to the outbreak and spread of COVID-19, the number of international flights sharply diminished in recent years. However, TIA is located at an East-Asian flight transportation junction; thus, many commercial and cargo flights continue service. When severe medical events happen on a commercial airliner, the decision to divert or not is based on consideration of both medical and operational issues. This study discusses the events related to the diversion of airplanes or reentry after taxiing for medical emergencies at Taoyuan International Airport. Background: We analyzed emergency medical records from the medical clinic of TIA from January 1, 2017, to December 31, 2022, for patients who needed emergency medical services but were unable to reach the airport clinic by themselves. We also collected data for patients treated after diversion from other airports or reentry after taxiing due to medical emergencies. Information such as when and where the event occurred, chief signs and symptoms, the tentative diagnosis (using the ICD-9-CM), management, and the sociodemographic features of the passengers were extracted from the medical records. Summary of Cases: TIA handled approximately 152 million passengers and 1,093,762 flights during the study period; a total of 2,804 emergencies occurred during this time period. Thirty-three medical emergencies warranted diversion (21 cases) or reentry (12 cases); 13 cases were diverted from Asia-Pacific flights and five from Asia-North America flights. The age of the passengers with diversion emergencies ranged from 2–85 years (mean, 46±20-years-old). Twenty-seven patients were transported to an emergency department, and four patients died. For all cases of diversion or reentry, the most common diagnoses were neurogenic problems (42.4%), Out-of-hospital cardiac arrest (OHCA) (15.2%), and cardiovascular problems (12.1%). Discussion: Most aircraft diversions were related to syncope, seizure, and OHCA. The decision to divert depends on medical and operational considerations. Emergency conditions are often serious; thus, improvement of the effectiveness of cooperation between airlines and medical teams remains a challenge.

Keywords: diversion, syncope, seizure, OHCA

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Authors: Eleni Stefania Kalapoda

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Recurring heat waves due to the global climate change emergency pose continuous risks to human health and urban resources. Local and state decision-makers incorporate Heat Vulnerability Indices (HVIs) to quantify and map the relative impact on human health in emergencies. These maps enable government officials to identify the highest-risk districts and to concentrate emergency planning efforts and available resources accordingly (e.g., to reevaluate the location and the number of heat-relief centers). Even though the framework of conducting an HVI is unique per municipality, its accuracy in assessing the heat risk is limited. To resolve this issue, varied housing-related metrics should be included. This paper quantifies and classifies NYC’s single detached housing typology within high-vulnerable NYC districts using detailed energy simulations and post-processing calculations. The results show that the variation in indoor heat risk depends significantly on the dwelling’s design/operation characteristics, concluding that low-ventilated dwellings are the most vulnerable ones. Also, it confirmed that when building-level determinants of exposure are excluded from the assessment, HVI fails to capture important components of heat vulnerability. Lastly, the overall vulnerability ratio of the housing units was calculated between 0.11 to 1.6 indoor heat degrees in terms of ventilation and shading capacity, insulation degree, and other building attributes.

Keywords: heat vulnerability index, energy efficiency, urban heat, resiliency to heat, climate adaptation, climate mitigation, building energy

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Authors: Masoud Swalehe, Semra Günay

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Developed countries are losing many lives to non-communicable diseases as compared to their developing counterparts. The effects of these diseases are mostly sudden and manifest at a very short time prior to death or a dangerous attack and this has consolidated the significance of emergency medical system (EMS) as one of the vital areas of healthcare service delivery. The primary objective of this research is to reduce ambulance response times (RT) of Eskişehir province EMS since a number of studies have established a relationship between ambulance response times and survival chances of patients especially out of hospital cardiac arrest (OHCA) victims. It has been found out that patients who receive out of hospital medical attention in few (4) minutes after cardiac arrest because of low ambulance response times stand higher chances of survival than their counterparts who take longer times (more than 12 minutes) to receive out of hospital medical care because of higher ambulance response times. The study will make use of geographic information systems (GIS) technology to dynamically reallocate ambulance resources according to demand and time so as to reduce ambulance response times. Geospatial-time distribution of ambulance calls (demand) will be used as a basis for optimal ambulance deployment using system status management (SSM) strategy to achieve much demand coverage with the same number of ambulance resources to cause response time reduction. Drive-time polygons will be used to come up with time specific facility coverage areas and suggesting additional facility candidate sites where ambulance resources can be moved to serve higher demands making use of network analysis techniques. Emergency Ambulance calls’ data from 1st January 2014 to 31st December 2014 obtained from Eskişehir province health directorate will be used in this study. This study will focus on the reduction of ambulance response times which is a key Emergency Medical Services performance indicator.

Keywords: emergency medical services, system status management, ambulance response times, geographic information system, geospatial-time distribution, out of hospital cardiac arrest

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Authors: Baljit Singh Khehra, Jagreeti Kaur

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In this paper, steganographic strategy is used to hide the text file inside an image. To increase the storage limit, predictive coding is utilized to implant information. In the proposed plan, one can exchange secure information by means of predictive coding methodology. The predictive coding produces high stego-image. The pixels are utilized to insert mystery information in it. The proposed information concealing plan is powerful as contrasted with the existing methodologies. By applying this strategy, a provision helps clients to productively conceal the information. Entropy, standard deviation, mean square error and peak signal noise ratio are the parameters used to evaluate the proposed methodology. The results of proposed approach are quite promising.

Keywords: cryptography, steganography, reversible image, predictive coding

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Authors: Hester Fass, Ofir Pinto

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Research indicates gaps in education, employment rates and wages between people with disabilities and those without disabilities. One of the main tools available to reduce these gaps is vocational rehabilitation. In order to examine the effects of vocational rehabilitation, a follow-up study, based on comprehensive administrative data, was conducted. The study included 88,286 people with disabilities who participated in vocational rehabilitation of the National Insurance Institute of Israel (NII), and completed the process between 1999 and 2012. Research variables included: employment rates, job persistence and wage levels. This research, the first of its kind in Israel, has several unique aspects: a)a long-range follow-up study on people who completed vocational rehabilitation; b) examination of a broad population spectrum, including also people that are not eligible to disability pensions ; c) a comparison among those with work-related injuries, those injured in hostile acts and those injured in other circumstances; and finally d) the identification of the characteristics of those who are entitled to vocational rehabilitation but who do not participate in any vocational rehabilitation plan. The most notable results include: 1. Vocational rehabilitation contributed to employment, job persistence and wage levels. Participation in vocational rehabilitation resulted in an employment rate of 65% within two years after completing the program, and 73% eventually. Participation in a vocational rehabilitation plan also contributed to job persistence and wage levels. 2. Vocational rehabilitation plans aimed at integration in universal frameworks increased the chances of being employed, persisting at the job and receiving a higher wage than did the vocational rehabilitation aimed at selective frameworks (such as sheltered workshops). 3. The type of disability affected the chances of integration in a vocational rehabilitation plan and in the labor market. People with a disability from birth had greater chances of integration in a vocational rehabilitation plan, while the type of disability and its severity affected the chances of the person with disabilities to find employment.

Keywords: vocational rehabilitation, employment, job persistence, wages

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Authors: Behcet Al, Mustafa Bogan, Mehmet Murat Oktay, Suat Zengin, Hasan Bayram

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Objective: In the last two decades there is a strong scientific interest regarding the role of aerosols for the Earth’s climate and associated changes. Aerosol particles are very important to the Earth-atmosphere climate system playing a crucial role in cloud and precipitation processes, air quality and climate. Here, we evaluated the association between saharran dust and emergency department admission, hospitalization, and mortality. Method: The records of admission to emergency department of Gaziantep University and the dust stroms of 31 months were studied. Patients admitted to ED at dust strom with chronic obstructive lung disease (COLD), asthma bronchiale (AB), serebrovascular events (SVE), acute myocardial infarction (AMI), stabile and unstabile angina pectoris (SAAP andUSAP); and the days with and without dust stroms were included. The study was realized from March 2010 to October 2012. The admission of three days before strom (group 1), during strom days (group 2) and three days after strom (group 3) were determined. The mean level of dust PM10 particulate was calculated, and the results were compared. Results: 5864 patients with chronic obstructive lung disease, asthma bronchiale, serebrovascular events, acute myocardial infarction, stabile and unstabile angyina pectoris admitted during the days with and without dust stroms. 28 dust stroms ocurred during 31 months. The totaliy of stroms continiued 78 days. Of admissions, 35.5% (n=2075) were in group1, 29.8% (n=1746) in group 2, and 34.8% (n=2043) were in group 3. The mean of PM10 for groups (group 1, 2 and 3) were 78.53 mg/m3 (range 19–276) particulate, 108.7 mg/m3 (range 34–631) particulate, and 60.9 mg/m3 (range 17–160) particulate respectively. The mean admission per a day for groups were 24.86, 22.55, and 24.50 respectively. The mortality was 12 in group 1, 12 in group 2, and 17 in grou 3. The hospitalization ratio for groups were 0.24, 0.27, and 0.27 respectively. Conclusion: However, the mean level of PM10 particulate for groups 2 (in dust strom days) is significantly higher (p=0.001) than the days before (group 1) and after (group 3) dust stroms, the mean admissions/day, hostilalization and mortality related to deseases (COLD, AB, SVE, AMI, SAAP andUSA) for group 2 is lower than the group 1 and group 3.

Keywords: Saharran dust, PM10 particulate, emergency department admission, mortality

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Authors: Young S. Bang, Dong H. Yoon, Seung H. Yoo

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Emergency Core Coolant Bypass (ECC Bypass) has been regarded as an important phenomenon to peak cladding temperature of large-break loss-of-coolant-accidents (LBLOCA) in nuclear power plants (NPP). A modeling scheme to address the ECC Bypass phenomena and the calculation of LBLOCA using that scheme are discussed in the present paper. A hydraulic form loss coefficient (HFLC) from the reactor vessel downcomer to the broken cold leg is predicted by the computational fluid dynamics (CFD) code with a variation of the void fraction incoming from the downcomer. The maximum, mean, and minimum values of FLC are derived from the CFD results and are incorporated into the LBLOCA calculation using a system thermal-hydraulic code, MARS-KS. As a relevant parameter addressing the ECC Bypass phenomena, the FLC to the break and its range are proposed.

Keywords: CFD analysis, ECC bypass, hydraulic form loss coefficient, system thermal-hydraulic code

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Authors: A. J. Otjen

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Native American communities are struggling with unemployment and depressed economies. A major cause is a lack of business knowledge, education, and cultural desire. And yet, in the history of the American West, Native Americans were considered the best traders and negotiators for everything from furs to weapons to buffalo. To improve these economies, there has been an effort to reintroduce that heritage to todays and tomorrows generation of tribal members, such Crow, Cheyenne, and Blackfeet. Professors at the College of Business Montana State University-Billings (MSUB) teach tribal students in Montana to create business plans. These plans have won national small business plan competitions. The teaching and advising method used at MSUB is uniquely successful as theses business students are now five time national champions. This article reviews the environment and the method of learning to achieve a winning small business plan with Native American students. It discusses the five plans that became national champions. And it discusses the problems and solutions discovered in the process of achieving results. Students who participated in this endeavor have graduated and become CPAs, MBAs, and gainfully employed in their chosen professions. They have also worked to improve the economies of their native lands and homes. By educating members of these communities with business strategy and plan development, they are better able to impact their own economies.

Keywords: entrepreneurship, native American economies, small businesses, unemployment

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Authors: M. A. Brown, K. Hugill, D. Meredith

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Since the establishment of midwifery, as a professional identity in its own right, in the early years of the 20th century, midwifery-led models of childbirth have prevailed in many parts of the world. However, in many locations midwives’ scope of practice remains underdeveloped or absent. In Qatar, all births take place in hospital and are under the professional jurisdiction of obstetricians, predominately supported by internationally trained nurse-midwives and obstetric nurses. The strategic vision for health services in Qatar endorsed a desire to provide women with the ‘Best Care Always’ and the introduction of midwifery was seen as a way to achieve this. In 2015 the process of recruiting postgraduate educated Clinical Midwife Specialists from international sources began. The midwives were brought together to initiate an in hospital and community service transformation plan. This plan set out a series of wide-ranging actions to transform maternity and neonatal services to make care safer and give women more health choices. Change in any organization is a complex and dynamic process. This is made even more complex when multifaceted professional and cross cultural factors are involved. This presentation reports upon the motivations and challenges that exist and the progress around introducing a multicultural midwifery model of childbirth care in the state of Qatar. The paper examines and reflects upon the drivers and unique features of childbirth in the country. Despite accomplishments, progress still needs to be made in order to fully implement sustainable changes to further improve care and ensure women and neonates get the ‘Best Care Always’. The progress within the transformation plan highlights how midwifery may coexist with competing models of maternity care to create an innovative, eclectic and culturally sensitive paradigm that can best serve women and neonatal health needs.

Keywords: culture, managing change, midwifery, neonatal, service transformation plan

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Authors: Jeffrey Ho, Scott Joing, Paul Nystrom, William Heegaard, Danielle Hart, David Plummer, James Miner

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Body-Worn Cameras (BWCs) are used in public safety to record encounters. They are shown to enhance the accuracy of documentation in virtually every situation. They are not widely used in medical encounters in part because of concern for patient acceptance. The goal of this pilot study was to determine if BWC use is acceptable to the patient. This was a prospective, observational study of the AXON Flex BWC (TASER International, Scottsdale, AZ) conducted at an urban, Level 1 Trauma Center Emergency Department (ED). The BWC was worn by Emergency Physicians (EPs) on their shifts during a 30-day period. The BWC was worn at eye-level mounted on a pair of clear safety glasses. Patients seen by the EP were enrolled in the study by a trained research associate. Patients who were <18 years old, who were with other people in the exam room, did not speak English, were critically ill, had chief complaints involving genitalia or sexual assault, were considered to be vulnerable adults, or with an altered mental status were excluded. Consented patients were given a survey after the encounter to determine their perception of the BWC. The questions asked involved the patients’ perceptions of a BWC being present during their interaction with their EP. Data were analyzed with descriptive statistics. There were 417 patients enrolled in the study. 3/417 (0.7%) patients were intimidated by the BWC, 1/417 (0.2%) was nervous because of the BWC, 0/417 (0%) were inhibited from telling the EP certain things because of the BWC, 57/417 (13.7%) patients did not notice the device, and 305/417 (73.1%) patients were had a favorable perception about the BWC being used during their encounter. The use of BWCs appears feasible in the ED, with largely favorable perceptions and acceptance of the device by the patients. Further study is needed to determine the best use and practices of BWCs during ED patient encounters.

Keywords: body-worn camera, documentation, patient satisfaction, video

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Authors: Giuseppe Timperio, Robert De Souza

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The combination of factors such as temperamental climate change, rampant urbanization of risk exposed areas, political and social instabilities, is posing an alarming base for the further growth of number and magnitude of humanitarian crises worldwide. Given the unique features of humanitarian supply chain such as unpredictability of demand in space, time, and geography, spike in the number of requests for relief items in the first days after the calamity, uncertain state of logistics infrastructures, large volumes of unsolicited low-priority items, a proactive approach towards design of disaster response operations is needed to achieve high agility in mobilization of emergency supplies in the immediate aftermath of the event. This paper is an attempt in that direction, and it provides decision makers with crucial strategic insights for a more effective network design for disaster response. Decision sciences and ICT are integrated to analyse the robustness and resilience of a prepositioned network of emergency strategic stockpiles for a real-life case about Indonesia, one of the most vulnerable countries in Asia-Pacific, with the model being built upon a rich set of quantitative data. At this aim, a network optimization approach was implemented, with several what-if scenarios being accurately developed and tested. Findings of this study are able to support decision makers facing challenges related with disaster relief chains resilience, particularly about optimal configuration of supply chain facilities and optimal flows across the nodes, while considering the network structure from an end-to-end in-country distribution perspective.

Keywords: disaster preparedness, humanitarian logistics, network optimization, resilience

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Authors: T. Penkova, A. Korobko, V. Nicheporchuk, L. Nozhenkova, A. Metus

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This paper presents an approach of on-line control of the state of technosphere and environment objects based on the integration of Data Warehouse, OLAP and Expert systems technologies. It looks at the structure and content of data warehouse that provides consolidation and storage of monitoring data. There is a description of OLAP-models that provide a multidimensional analysis of monitoring data and dynamic analysis of principal parameters of controlled objects. The authors suggest some criteria of emergency risk assessment using expert knowledge about danger levels. It is demonstrated now some of the proposed solutions could be adopted in territorial decision making support systems. Operational control allows authorities to detect threat, prevent natural and anthropogenic emergencies and ensure a comprehensive safety of territory.

Keywords: decision making support systems, emergency risk assessment, natural and anthropogenic safety, on-line control, territory

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Authors: Harley Bray, Helen Pymar, Michelle Liu, Chau Pham, Tomislav Jelic, Fran Mulhall

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Background: Our study assesses the impact of the COVID-19 pandemic on Early Pregnancy Assessment Clinic (EPAC) referrals and the use of virtual consultation in Winnipeg, Manitoba. Our clinic expanded to accept referrals from all Winnipeg Emergency Department (ED)/Urgent Care (UC) sites beginning November 2019 to April 2020. By May 2020, the COVID-19 pandemic reached Manitoba, and EPAC virtual care was expanded by performing hCG remotely and reviewing blood and ED/UC ultrasound results by phone. Methods: Emergency Department Information Systems (EDIS) and EPAC data reviewed ED/UC visits for pregnancy <20 weeks and vaginal bleeding 1-year pre-COVID (March 12, 2019, to March 11, 2020) and during COVID (March 12, 2020 (first case in Manitoba) to March 11, 2021). Results: There were fewer patient visits for vaginal bleeding or pregnancy of <20 weeks (4264 vs. 5180), diagnoses of threatened abortion (1895 vs. 2283), and ectopic pregnancy (78 vs. 97) during COVID compared with pre-COVID, respectively. International Classification of Disease 10 codes were missing in 849 (20%) and 1183 (23%) of patients during COVID and pre-COVID, respectively. Wait times for all patient visits improved during COVID-19 compared to pre-COVID (5.1 ±4.4 hours vs. 5.5 ± 3.8 hours), more patients received obstetrical ultrasounds, 761 (18%) vs. 787 (15%), and fewer patients returned within 30 days (1360 (32%) vs. 1848 (36%); p<0.01). EPAC saw 708 patients (218; 31% new ED/UC) during COVID compared to 552 (37; 7% new ED/UC) pre-COVID. Fewer operative interventions for pregnancy loss (346 vs. 456) and retained products (236 vs. 272) were noted. Surgeries to treat ectopic pregnancy (106 vs. 113) remained stable during the study time interval. Conclusion: Accurate identification of pregnancy complications was difficult, with over 20% missing ICD-10 diagnostic codes. There were fewer ED/UC visits and surgical management for threatened abortion during COVID, but ectopic pregnancy operative management remained unchanged.

Keywords: obstetrics and gynecology, EPAC, early pregnancy assessment, first trimester, emergency department, abortion, pregnancy, COVID-19

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Authors: S. K. Ashiquer Rahman

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The paper concentrates on the importance of Sustainable Campus Strategies, emphasizing the significance of mobilizing Innovative technological tools for constructing effectiveness of higher education strategy and institutional cooperation for sustainable campus at the university level and preparing the university’s authority to face the upcoming higher education strategy and institutional cooperation difficulties to the Sustainable Campus Plan. Within a framework of Sustainable Campus Strategies and institutional cooperation, the paper discusses the significance of a set of reference points that will lead to operational activities for multi-stakeholder multi-criteria evaluation of Higher Education and Research Institutions relative to the Sustainable Campus criteria and potential action plan for the University’s Strategy and Institutional Cooperation. It makes mention of the emergence of the effectiveness of Higher Education Strategy and Institutional Cooperation as well as the necessity of mobilizing innovative technological methods and tools for constructing the effectiveness of this Process. The paper outlines the conceptual framing of a Sustainable Campus Strategy, Institutional Cooperation and Action Plan for a sustainable campus. Optimistically, these will be a milestone in higher education, a pathway to meet the imminent Sustainable Campus Strategy and Institutional Cooperation of the completive world, and be able to manage the required criteria for a Sustainable University.

Keywords: higher education strategy, institutional cooperation, sustainable campus, multi-criteria evaluation, innovative method and tools

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Authors: Ghazwan Al-Haji

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Most accidents occur in urban areas, and the most related casualties are vulnerable road users (pedestrians and cyclists). The traffic calming measures (TCMs) are widely used and considered to be successful in reducing speed and traffic volume. However, TCMs create unwanted effects include: noise, emissions, energy consumption, vehicle delays and emergency response time (ERT). Different vertical and horizontal TCMs have been already applied nationally (Sweden) and internationally with different impacts. It is a big challenge among traffic engineers, planners, and policy-makers to choose and priorities the best TCMs to be implemented. This study will assess the existing guidelines for TCMs in relation to safety and ERT with focus on data from Norrkoping city in Sweden. The expected results will save lives, time, and money on particularly Swedish Roads. The study will also review newly technologies and how they can improve safety and reduce ERT.

Keywords: traffic calming measures, traffic safety, delay time, vulnerable road users

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Authors: Traci A. Hefner

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Limited research exists on the readiness of emergency departments to respond to human trafficking (HT). The purpose of this qualitative case study was to improve the readiness of a Department of Emergency Medicine (ED), located in the southeast region of the United States, in identifying, assessing, and responding to trafficked individuals. The research objectives were to 1) provide an organizing framework to understand the ED’s readiness to respond to HT, using the Transtheoretical Model’s stages of change construct, 2) explain the readiness of the ED through a three-pronged contextual approach that included policies and procedures, patient data collection processes, and clinical practice methods, and 3) develop recommendations to respond to HT. Content analysis was used for document reviews and on-site observations, while thematic analysis identified themes of staff perceptions of the ED’s readiness in interviews of over 30 clinical and non-clinical healthcare professionals. Results demonstrated low levels of readiness to identify HT through the ED’s policies and procedures, data collection processes, and clinical practice methods. Clinical practice-related factors consisted of limited awareness of HT warning signs and low-levels of knowledge about community resources for possible HT referrals. Policy and practice recommendations to increase the ED’s readiness to respond to HT included: developing staff trainings across the ED system to enhance awareness of HT warning signs, incorporating HT into current policies and procedures for vulnerable patient populations as well as creating a HT protocol that addresses policies and procedures, screening tools, and community referrals.

Keywords: emergency medicine, human trafficking, organizational assessment, stages of change

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Authors: Nadeem Yousuf Khan

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This paper proposes the formation of a digital emergency response system (dERS) in the aged, long-term care, and chronic disease setups in the post-COVID healthcare ecosystem, focusing on the Asia Pacific market where the aging population is increasing significantly. It focuses on the use of digital technologies such as wearables, a global positioning system (GPS), and mobile applications to build an integrated care system for old folks with co-morbidities and other chronic diseases. The paper presents a conceptual framework of a connected digital health ecosystem that not only provides proactive care to registered patients but also prevents the damages due to sudden conditions such as strokes by alerting and treating the patients in a digitally connected and coordinated manner. A detailed review of existing digital health technologies such as wearables, GPS, and mobile apps was conducted in context with the new post-COVID healthcare paradigm, along with a detailed literature review on the digital health policies and usability. A good amount of research papers is available in the application of digital health, but very few of them discuss the formation of a new framework for a connected digital ecosystem for the aged care population, which is increasing around the globe. A connected digital emergency response system has been proposed by the author whereby all registered patients (chronic disease and aged/long term care) will be connected to the proposed digital emergency response system (dERS). In the proposed ecosystem, patients will be provided with a tracking wrist band and a mobile app through which the control room will be monitoring the mobility and vitals such as atrial fibrillation (AF), blood sugar, blood pressure, and other vital signs. In addition to that, an alert in case if the patient falls down will add value to this system. In case of any variation in the vitals, an alert is sent to the dERS 24/7, and dERS clinical staff immediately trigger that alert which goes to the connected hospital and the adulatory service providers, and the patient is escorted to the nearest connected tertiary care hospital. By the time, the patient reaches the hospital, dERS team is ready to take appropriate clinical action to save the life of the patient. Strokes or myocardial infarction patients can be prevented from disaster if they are accessible to engagement healthcare. This dERS will play an effective role in saving the lives of aged patients or patients with chronic co-morbidities.

Keywords: aged care, atrial fibrillation, digital health, digital emergency response system, digital technology

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