Search results for: Emergency Action Plan

Authors: Jasim Saleh Said AlDairi

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The potential of applying Lean Management in Higher Education Institutions has increased significantly in last few years, leading to tremendous savings. Reviewing and updating competencies’ curriculum matrix is one of the critical and complicated processes that consume time and effort, and this has triggered searching for a scientific and sustainable approach to manage the such review. This paper presents a novel approach of implementing Lean (5S) methodology in reviewing technical competencies required for the graduates of the Military Technological College (MTC) in the Sultanate of Oman. The 5S framework has been imbedded into an action plan using the PDCA cycle. As a result, the method applied has helped in sorting out the actual required competencies, the team has identified the required (new, amended, and deleted) competencies in all of the targeted Engineering Departments, in addition, the major wastes within the overall process were identified, and the future review process was standardized and documented.

Keywords: PDCA, 5S, lean, MTC, competencies, curriculum matrix, higher education

Procedia PDF Downloads 101

Authors: J. Constanzo, B. Paquette, G. Charest, L. Masson-Côté, M. Guillot

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Targeted and whole-brain irradiation in humans can result in significant side effects causing decreased patient quality of life. To adequately investigate structural and functional alterations after stereotactic radiosurgery, preclinical studies are needed. The first step is to establish a robust standardized method of targeted irradiation on small regions of the rat brain. Eleven euthanized male Fischer rats were imaged in a stereotactic bed, by computed tomographic (CT), to estimate positioning variations regarding to the bregma skull reference point. Using a rat brain atlas and the stereotactic bregma coordinates assessed from CT images, various regions of the brain were delimited and a treatment plan was generated. A dose of 37 Gy at 30% isodose which corresponds to 100 Gy in 100% of the target volume (X = 98.1; Y = 109.1; Z = 100.0) was set by Leksell Gamma Plan using sectors number 4, 5, 7, and 8 of the Gamma Knife unit with the 4-mm diameter collimators. Effects of positioning accuracy of the rat brain on the dose deposition were simulated by Gamma Plan and validated with dosimetric measurements. Our results showed that 90% of the target volume received 110 ± 4.7 Gy and the maximum of deposited dose was 124 ± 0.6 Gy, which corresponds to an excellent relative standard deviation of 0.5%. This dose deposition calculated with the Gamma Plan was validated with the dosimetric films resulting in a dose-profile agreement within 2%, both in X- and Z-axis,. Our results demonstrate the feasibility to standardize the irradiation procedure of a small volume in the rat brain using a Gamma Knife.

Keywords: brain irradiation, dosimetry, gamma knife, small-animal irradiation, stereotactic radiosurgery (SRS)

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Authors: Jonathan D. Recchi

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Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

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Authors: Omid Khandel, Azadeh Parvin

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An increase in accidental explosions in recent years has increased the interest on investigating the response and behavior of structures in more details. The present work focused on finite element analysis of multistory steel frame structures with different plan shapes subjected to blast loadings. In order to study the effect of the geometry of the building, three different shapes for the plan of the building were modeled and studied; Rectangular, Square and L shape plans. The nonlinear dynamic analysis was considered in this study. The relocation technique was also used to improve the behavior of structure. The accuracy of the multistory frame model was confirmed with those of the existing study in the literature and they were in good agreement. The effect of span length of the buildings was also considered. Finite element analysis of various scenarios for relocating the plastic hinges and improving the response of the structure was performed. The base shear versus displacement curves were compared to reveal the best possible scenarios to provide recommendations to designers and practitioners.

Keywords: nonlinear dynamic analysis, plastic hinge relocation, Retrofit, SAP2000

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Authors: Alok Kumar, Raviraj Patil

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The ability to respond to an incident of a disastrous event in a vulnerable area is very crucial an aspect of emergency management. The ability to constantly predict the likelihood of an event along with its severity in an area and react to those significant events which are likely to have a high impact allows the authorities to respond by allocating resources optimally in a timely manner. It provides for measuring, monitoring, and modeling facilities that integrate underlying systems into one solution to improve operational efficiency, planning, and coordination. We were particularly involved in this innovative incubation work on the current state of research and development in collaboration. technologies & systems for a disaster.

Keywords: predictive analytics, advanced analytics, area flood likelihood model, area flood severity model, level of impact model, mortality score, economic loss score, resource allocation, crew allocation

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Authors: Sai Rajeev Reddy, Ishita Roy, M. Anji Reddy

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The paper describes the importance of preventive measures and immediate Emergency logistics during accidents and unfortunate Disasters for the Hyderabad Metro Rails in their various stages of construction. This is the need of the modern generation where accidents, explosions, attacks and sudden crisis are frequent casualties which take huge tolls of life in the present world. The paper utilizes the workflow and application of Geographical information System (GIS) to provide information about problems and crisis structures for efficient Metro Transportation in the city. The study analyzes the difficulties and problems which cause accidents during operation and maintenance stages of the Metro Rail. The paper focuses upon the intermediate and firsthand information of Crisis with the help of GIS technology to share Disaster data for effective measures by the Cyber Police stations, Emergency Responders, Hospitals and First Aid Centre to act immediately and save lives. The results and conclusions have nevertheless proved very informative and useful for the safety board authorities of the Hyderabad Metro Rail. The operation and Maintenance are integral stages in the development of any Multipurpose transportation Projects and are usually prone to various Disasters and tragedies. Hence, the GIS technologies help in distribution of information among the masses with the web Technologies and advanced software developed to prevent and manage crisis widely and in a cost-benefits manner.

Keywords: Geographical Information System, emergency assessment, accident zones, surveillance

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Authors: M. P. Casiraghi, C. M. Quintella, P. Almeida

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Paraffinic oils were submitted to microbial action. The microorganisms consisted of bacteria of the genera Pseudomonas sp and Bacillus lincheniforms. The alterations in interfacial tension were determined using a tensometer and applying the hanging drop technique at room temperature (299 K ±275 K). The alteration in the constitution of the paraffins was evaluated by means of gas chromatography. The microbial activity was observed to reduce interfacial tension by 54 to 78%, as well as consuming the paraffins C19 to C29 and producing paraffins C36 to C44. The LIFirr technique made it possible to determine the microbial action quickly.

Keywords: paraffins, biosurfactants, LIFirr, microbial activity

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Authors: Prince Dacosta Aboagye, Ayyoob Sharifi

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Cities respond to climate concerns mainly through their climate action plans (CAPs). A comprehensive content analysis of the dynamics in existing urban CAPs is not well represented in the literature. This literature void presents a difficulty in appreciating the strengths and weaknesses of urban CAPs. Here, we perform a qualitative content analysis (QCA) on CAPs from 278 cities worldwide and use text-mining tools to map and visualize the relevant data. Our analysis showed a decline in the number of CAPs developed and published following the global COVID-19 lockdown period. Evidently, megacities are leading the deep decarbonisation agenda. We also observed a transition from developing mainly mitigation-focused CAPs pre-COP21 to both mitigation and adaptation CAPs. A lack of inclusiveness in local climate planning was common among European and North American cities. The evidence is a catalyst for understanding the trends in existing urban CAPs to shape future urban climate planning.

Keywords: urban, climate action plans, strengths, weaknesses

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Authors: Kati Skarp, Keijo Varis, Juha Kettunen

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The purpose of this paper is to examine and evaluate the top-down and bottom-up leadership development programs focused on human capital that improve the performance of a company. This study reports on the external top-down leadership development program supported by a consulting company and the internal participatory action research of the bottom-up program. The sickness rate and the lost time incident failure rate decreased and the ideas produced for cost savings improved, leading to increased earnings during the top-down program. The estimated cost savings potential of the bottom-up program was 3.8 million euro based on the cost savings of meeting habits, maintenance practices and the way of working in production. The results of this study are useful for those who plan and evaluate leadership development and human capital productivity consultation programs to improve the performance of a company.

Keywords: leadership, development, human resources, company, indicators, evaluation

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Authors: Teng Zhang, Shenshi Huang, Gang Xu, Xuelin Zhang, Shouxiang Lu

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With the acceleration of urbanization and the increasing of the population in the city, the evacuation of pedestrians suffering from disaster environments such as fire in a room or other limited space becomes a vital issue in modern society. Mice have been used in experimental crowd evacuation in recent years for its good similarities to human in physical structure and stress reaction. In this study, the effect of experience or memory on the collective behavior of mice was explored. To help mice familiarize themselves with the design of the space and the stimulus caused by smoke, we trained them repeatedly for 2 days so that they can escape from the emergency conditions as soon as possible. The escape pattern, trajectories, walking speed, turning angle and mean individual escape time of mice in each training trail were analyzed. We found that mice can build memory quickly after the first trial on the first day. On the second day, the evacuation of mice was maintained in a stable and efficient state. Meanwhile, the group with size of 30 (G30) had a shorter mean individual escape time compared with G12. Furthermore, we tested the experience of evacuation skill of mice after several days. The results showed that the mice can hold the experience or memory over 3 weeks. We proposed the importance of experience of evacuation skill and the research of training methods in experimental evacuation of mice. The results can deepen our understanding of collective behavior of mice and conduce to the establishment of animal models in the study of pedestrian crowd dynamics in emergency conditions.

Keywords: experience, evacuation, mice, group size, behavior

Procedia PDF Downloads 275

Authors: M. Hussaina, K. Mahboobb, S. Z. Ilyasa, S. Shaheena

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Plume dispersion modeling is a computational procedure to establish a relationship between emissions, meteorology, atmospheric concentrations, deposition and other factors. The emission characteristics (stack height, stack diameter, release velocity, heat contents, chemical and physical properties of the gases/particle released etc.), terrain (surface roughness, local topography, nearby buildings) and meteorology (wind speed, stability, mixing height, etc.) are required for the modeling of the plume dispersion and estimation of ground and air concentration. During the early phase of Fukushima accident, plume dispersion modeling and decisions were taken for the implementation of protective measures. A difference in estimated results and decisions made by different countries for taking protective actions created a concern in local and international community regarding the exact identification of the safe zone. The current study is focused to highlight the importance of accurate and exact weather data availability, scientific approach for decision making for taking urgent protective actions, compatible and harmonized approach for plume dispersion modeling during a nuclear emergency. As a case study, the influence of meteorological data on plume dispersion modeling and decision-making process has been performed.

Keywords: decision making process, radiation doses, nuclear emergency, meteorological implications

Procedia PDF Downloads 186

Authors: Takamitsu Kodama, Eiji Kawamoto

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Introduction: Ultrasound in emergency room has advantages of safer, faster, repeatable and noninvasive. Especially focused Point-Of-Care Ultrasound (POCUS) is used daily for prompt and accurate diagnoses, for quickly identifying critical and life-threatening conditions. That is why ultrasound has demonstrated its usefulness in emergency medicine. The true value of ultrasound has been once again recognized in recent years. It is thought that all resident physicians working at emergency room should perform an ultrasound scan to interpret signs and symptoms of deteriorating patients in the emergency room. However, a practical education on ultrasound is still in development. To resolve this issue, we established a new educational program using high-fidelity simulators and evaluated the efficacy of this course. Methods: Educational program includes didactic lectures and skill stations in half-day course. Instructor gives a lecture on POCUS such as Rapid Ultrasound in Shock (RUSH) and/or Focused Assessment Transthoracic Echo (FATE) protocol at the beginning of the course. Then, attendees are provided for training of scanning with cooperation of normal simulated patients. In the end, attendees learn how to apply focused POCUS skills at clinical situation using high-fidelity simulators such as SonoSim® (SonoSim, Inc) and SimMan® 3G (Laerdal Medical). Evaluation was conducted through surveillance questionnaires to 19 attendees after two pilot courses. The questionnaires were focused on understanding course concept and satisfaction. Results: All attendees answered the questionnaires. With respect to the degree of understanding, 12 attendees (number of valid responses: 13) scored four or more points out of five points. High-fidelity simulators, especially SonoSim® was highly appreciated to enhance learning how to handle ultrasound at an actual practice site by 11 attendees (number of valid responses: 12). All attendees encouraged colleagues to take this course because the high level of satisfaction was achieved. Discussion: Newly introduced educational course using high-fidelity simulators realizes the circle of learning to deepen the understanding on focused POCUS by gradual stages. SonoSim® can faithfully reproduce scan images with pathologic findings of ultrasound and provide experimental learning for a growth number of beginners such as resident physicians. In addition, valuable education can be provided if it is used combined with SimMan® 3G. Conclusions: Newly introduced educational course using high-fidelity simulators is supposed to be effective and helps in providing better education compared with conventional courses for emergency physicians.

Keywords: point-of-care ultrasound, high-fidelity simulators, education, circle of learning

Procedia PDF Downloads 286

Authors: S. Selman, T. Gout

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Microbial keratitis is a serious complication of contact lens wear that can be vision and eye-threatening. Diverse presentations relating to contact lens wear include dry corneal surface, corneal infiltrate, ulceration, scarring, and complete corneal melt leading to perforation. Contact lens wear is a major risk factor and, as such, is an important consideration in any patient presenting with a red eye in the primary care setting. This paper aims to provide an overview of the risk factors, common organisms, and spectrum of contact lens-associated keratitis (CLAK) complications. It will highlight some of the salient points relevant to the assessment and workup of patients suspected of CLAK in the emergency department based on the recent literature and therapeutic guidelines. An overview of the management principles will also be provided.

Keywords: microbial keratitis, corneal pathology, contact lens-associated complications, painful vision loss

Procedia PDF Downloads 114

Authors: Asmaa Hamdy, Israa Nassar, Tarek Aly

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Introduction: Femoral fractures are the most common presentation in the Emergency Department (ED), and they can present as isolated injuries or as part of a polytrauma situation. To provide optimum pain management care to these patients, practitioners must be well prepared and current with utilizing modern evidence-based knowledge and practices. Management of pain associated with fracture femur in the emergency department has a critical role in the satisfaction of patients and preventing further complications. This study aimed to evaluate the analgesic efficacy of ultrasound-guided femoral nerve block compared with intravenous fentanyl in fractures of the femur in patients presented to the Emergency Department. Patients and Methods: Fifty patients with femur fractures were divided into two groups: Group A: In this group (twenty-five patients) were given intravenous fentanyl 2 micro-grams/kg and re-assessed for pain by Visual Analogue Score (VAS). Group B: In this group (twenty-five patients) underwent ultrasonography-guided femoral nerve block and were re-assessed for pain by VAS. Results: VAS score on the movement of the fractured limb between group A and group B at a 10-minute post-intervention period shows P= 0.043, and hence the difference is significant. VAS score on the movement of the fractured limb between group A and group B during a 10-minute post-intervention period showed a significant difference. Seventeen patients in group A had major PID with a percentage of 63% VS 10 patients in group B with a percentage of 37%. conclusion: both femoral nerve block and intravenous fentanyl are effective in relieving pain in patients with femur fractures. But femoral nerve block provides better and more intense analgesia and major pain intensity difference in less time. Moreover, the use of FNB had fewer side effects and more Hemodynamics stability compared to opioids.

Keywords: femur fracture, nerve block, fentanyl, ultrasound guided

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Authors: Tan Xin Zhong Timothy, Chang Chen Jie Victor, Yew Kwan Tong, Lim Geok Peng Sandy

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Background: Leaders in crisis response teams such as Trauma Teams in hospitals are essential to the effective coordination and direction of the team. The response to emergency trauma situations must be accurate, rapid, and well executed. To this end, the team leader’s social, technical and leadership skills are essential factors that implicate the success of an emergency trauma intervention. While each emergency trauma case varies in severity and complexity, and the experience and expertise of team leaders may vary, it would be productive to identify certain coordinative and directive functions that improve the capacity for leading a team. Methods: This qualitative study of Trauma Team physicians in Singapore General Hospital (SGH) involved 50 in-depth interviews with doctors and nurses involved in Trauma Team activations, observations of Trauma Teams managing emergency patients, and reviews of audio/video recordings of 65 trauma activations. The interviews were conducted with doctors of various ranks across the relevant departments, 12 from the Emergency Department (ED), 11 from General Surgery (GS) and 8 from Orthopaedics, while the 6 nurses were from ED. In accordance with the grounded theory approach, the content of the interviews was coded and analysed in order to derive broad leadership themes that corresponded with certain behavioural traits exhibited by trauma team leaders, supplemented with the observational and audio/video data. Results: The leadership behaviours of the team leaders could be typified into three broad categories: team orientation, engagement and activeness. Team orientation corresponds with the source and form of cognitive responsibility, decision-making and informational contributions, divisible into individualistic and consultative sub-categories. Engagement refers to the type of activity that leaders prefer to engage in, and which implicates their attentional focus, divisible into participatory and supervisory sub-categories. Activeness is a function of the leader’s attitudes towards the behavioural regulation of the team, which manifests in inactivity or activity to augment or merely align with protocol. These factors are not exhaustive and are contextually sensitive, but collectively implicate a significant portion of the leadership activity observed in trauma teams.

Keywords: trauma team activations, critical event management, leadership, teamwork

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Authors: Jiahui Song, Ravindra P. Joshi

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The use of high-intensity, short-duration electric pulses is a promising development with many biomedical applications. The uses include irreversible electroporation for killing abnormal cells, reversible poration for drug and gene delivery, neuromuscular manipulation, and the shrinkage of tumors, etc. High intensity, short-duration electric pulses result in the creation of high-density, nanometer-sized pores in the cellular membrane. This electroporation amounts to localized modulation of the transverse membrane conductance, and effectively provides a voltage shunt. The electrically controlled changes in the trans-membrane conductivity could be used to affect neural traffic and action potential propagation. A rat was taken as the representative example in this research. The simulation study shows the pathway from the sensorimotor cortex down to the spinal motoneurons, and effector muscles could be reversibly blocked by using high-intensity, short-duration electrical pulses. Also, actual experimental observations were compared against simulation predictions.

Keywords: action potential, electroporation, high-intensity, short-duration

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Authors: R. A. Temah, L. A. Nkengla-Asi

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Planning for future disasters sets the stage for a variety of activities that may trigger multiple recurring operations and expose the community to opportunities to minimize risks. Local communities are increasingly embracing the necessity for planning based on local risks, but are also significantly challenged to effectively plan and response to disasters. This research examines basic risk-based disaster planning model and compares it with advanced risk-based planning that introduces the identification and alignment of varieties of local capabilities within and out of the local community that can be pivotal to facilitate the management of local risks and cascading effects prior to a disaster. A critical review shows that the identification and alignment of capabilities can potentially enhance risk-based disaster planning. A tailored holistic approach to risk based disaster planning is pivotal to enhance collective action and a reduction in disaster collective cost.

Keywords: capabilities, disaster planning, hazards, local community, risk-based

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Authors: Luedech Girdwichai, Withaya Mekhum

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This research intended to develop the model of community management for sustainable utilization by investigating on 2 groups of population, the family heads and the community management team. The population of the former group consisted of family heads from 511 families in 12 areas to complete the questionnaires which were returned at 479 sets. The latter group consisted of the community management team of 12 areas with 1 representative from each area to give the interview. The questionnaires for the family heads consisted of 2 main parts; general information such as occupations, etc. in the form of checklist. The second part dealt with the data on self reliance community development based on 4P Framework, i.e., People (human resource) development, Place (area) development, Product (economic and income source) development, and Plan (community plan) development in the form of rating scales. Data in the 1st part were calculated to find frequency and percentage while those in the 2nd part were analyzed to find arithmetic mean and SD. Data from the 2nd group of population or the community management team were derived from focus group to find factors influencing successful management together with the in depth interview which were analyzed by descriptive statistics. The results showed that 479 family heads reported that the aspect on the implementation of community plan to self reliance community activities based on Sufficient Economy Philosophy and the 4P was at the average of 3.28 or moderate level. When considering in details, it was found that the 1st aspect was on the area development with the mean of 3.71 or high level followed by human resource development with the mean of 3.44 or moderate level, then, economic and source of income development with the mean of 3.09 or moderate level. The last aspect was community plan development with the mean of 2.89. The results from the small group discussion revealed some factors and guidelines for successful community management as follows: 1) on the People (human resource) development aspect, there was a project to support and develop community leaders. 2) On the aspect of Place (area) development, there was a development on conservative tourism areas. 3) On the aspect of Product (economic and source of income) development, the community leaders promoted the setting of occupational group, saving group, and product processing group. 4) On the aspect of Plan (community plan) development, there was a prioritization through public hearing.

Keywords: model of community management, sustainable utilization, family heads, community management team

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Authors: Jessie Fazel, Kristen Smith

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Human trafficking is a multi-billion-dollar criminal industry that affects 24.9 million people around the world. There are several different types of trafficking, the most common being sex trafficking, labor trafficking, and domestic servitude. Survival sex is common in the pediatric population, as they engage in sex for food, a place to sleep, or other basic needs. Statistics show that health care workers are at a unique advantage to help identify victims and get them the help they need, as 88% of trafficked victims encounter a health care worker while being trafficked. Unfortunately, victims don’t usually self-identify that they are being trafficked and the situations they face can vary dramatically. It is imperative to remember that traditional red flags are not always present in the pediatric population. Risk factors and red flags with their history and physical exam are one of the best indicators that health care providers need to be vigilant in looking at. There are numerous barriers for disclosure in the healthcare setting. Periods of time before and after disclosure are often emotionally difficult and could be dangerous for the victim. It is extremely important to have a plan in place for intervention if the victim does disclose trafficking. A trauma informed approach to medical and mental health interventions, that focus on safety, are vital in this population. This is happening where you live and you can make a difference in their lives.

Keywords: human trafficking, public health, emergency medicine, sexual health

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Authors: Kavish Kejriwal, Richa Grover

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Consumer awareness and pending legislation have pushed environmental issues into the spotlight, making it imperative for organizations to have a plan of action for “going green.” This is the reason why Green Supply Chain Management has become the integral part of many organization with a goal to reduce cost, increase efficiency and be environmental friendly. Implementation of GSCM involves many factors which act as barriers, making it a tedious task. These barriers have different relationship among themselves creating different impact on implementation Green Supply Chain Management. This work focuses on determining those barriers which have essentially to be removed in the initial stages of GSCM adoption. In this work, the author has taken the case of a petroleum industry in order to come up with a solution. A DEMATEL approach is used to reach the solution.

Keywords: barriers, environment, green supply chain management, impact, interpretive structural modeling

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Authors: Sabah Mohammed, Jinan Fiaidhi, Darien Sawyer

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Describing clinical cases according to a clinical charting standard that enforces interoperability and enables connected care services can save lives in the event of a medical emergency or provide efficient and effective interventions for the benefit of the patients through the integration of bedside and bench side clinical research. This article presented a multi-tenant extension to the problem-oriented medical record that we have prototyped previously upon using the GraphQL Application Programming Interface to represent the notion of a problem list. Our implemented extension enables physicians and patients to collaboratively describe the patient case via using multi chatbots to collaboratively describe the patient case using the SOAP charting standard. Our extension also connects the described SOAP patient case with the HL7 FHIR (Health Interoperability Resources) medical record for connecting the patient case to the bench data.

Keywords: problem-oriented medical record, graphQL, chatbots, SOAP

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Authors: Zhiyong Shan, Preethi Santhanam, Vinod Namboodiri, Rajiv Bagai

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In recent years, the emerging network worms and attacks have distributive characteristics, which can spread globally in a very short time. Security management crossing networks to co-defense network-wide attacks and improve the efficiency of security administration is urgently needed. We propose a hierarchical distributed network security management system (HD-NSMS), which can integrate security management across multiple networks. First, we describe the system in macrostructure and microstructure; then discuss three key problems when building HD-NSMS: device model, alert mechanism, and emergency response mechanism; lastly, we describe the implementation of HD-NSMS. The paper is valuable for implementing NSMS in that it derives from a practical network security management system (NSMS).

Keywords: network security management, device organization, emergency response, cross-network

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Authors: Mimoun Melliti

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This research paper investigates the promises, challenges, and perspectives associated with teaching STEM subjects in English within Tunisian higher education institutions. The study explores the potential benefits of English-medium instruction in Science, Technology, Engineering, and Mathematics (henceforth STEM) education, with a special focus on enhanced global competitiveness, improved English language proficiency, and increased access to international resources and collaborations. Additionally, it examines the various challenges faced by educators and students, such as language shift/barriers, curriculum adaptation, faculty training, and student support. Through a comprehensive analysis of promises and challenges, this paper aims to provide insights and recommendations for effectively implementing English medium instruction (henceforth EMI) of STEM in Tunisian higher education institutions. The paper concludes with a recommended action plan for the proper introduction of EMI of STEM in Tunisia.

Keywords: EMI;, STEM education, EFL, language reforms

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Authors: Manganyi Patricia Siphiwe

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Work environments are characterised by performance pressure and mechanisation, which lead to job stress and the dehumanisation of work spaces. The personnel’s competence to accomplish job responsibilities and high job demands lead to a substantial load of health. Therefore, providing employees with conducive working environments is essential. In order to attain it, the employer should ensure that responsive and institutional safe systems are in place. The employer’s responses to employees’ needs are of significance to a healthy and developmental work environment. Denying employees a developmental and flourishing workplace is to deprive a workplace of being humane. Stressors coming from various aspects in the workplace can yield undue pressure and undesired responses for the workforces. Against the profiled background, this paper examines the causes and consequences of workplace stress within the Emergency Medical sector. The paper utilised a qualitative methodology and in-depth interviews for data collection with the purposively sampled emergency medical personnel. The findings showed that workplace stress has been associated with high demands and lack of support which has an adverse effect on biopsychosocial wellbeing of employees. This paper, therefore, recommends an engaged involvement of social workers through work organisational initiatives, such as Employee Assistance Programmes (EAP) and related labour relations policy activities to promote positive and developmental working environments.

Keywords: stress, employee, workplace, wellbeing

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Authors: N. Al Khashan, H. Al Shammari, W. Al Bahli

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Patients who are eligible to receive treatment at the National Guard Health Affairs (NGHA), Saudi Arabia will typically have four medical record numbers (MRN), one in each of the geographical areas. More hospitals and primary healthcare facilities in other geographical areas will launch soon which means more MRNs. When patients own four MRNs, this will cause major drawbacks in patients’ quality of care such as creating new medical files in different regions for relocated patients and using referral system among regions. Consequently, the access to a patient’s medical record from other regions and the interoperability of health information between the four hospitals’ information system would be challenging. Thus, there is a need to unify medical records among these five facilities. As part of the effort to increase the quality of care, a new Hospital Information Systems (HIS) was implemented in all NGHA facilities by the end of 2016. NGHA’s plan is put to be aligned with the Saudi Arabian national transformation program 2020; whereby 70% citizens and residents of Saudi Arabia would have a unified medical record number that enables transactions between multiple Electronic Medical Records (EMRs) vendors. The aim of the study is to explore the plan, the challenges and barriers of unifying the 4 MRNs into one Enterprise Patient Identifier (EPI) in NGHA hospitals by December 2018. A descriptive study methodology was used. A journey map and a project plan are created to be followed by the project team to ensure a smooth implementation of the EPI. It includes the following: 1) Approved project charter, 2) Project management plan, 3) Change management plan, 4) Project milestone dates. Currently, the HIS is using the regional MRN. Therefore, the HIS and all integrated health care systems in all regions will need modification to move from MRN to EPI without interfering with patient care. For now, the NGHA have successfully implemented an EPI connected with the 4 MRNs that work in the back end in the systems’ database.

Keywords: consumer health, health informatics, hospital information system, universal medical record number

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Authors: Frederik Calsius, Mirela Popa, Alexia Briassouli

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In the field of machine learning, it is common practice to use benchmark datasets to prove the working of a method. The domain of action recognition in videos often uses datasets like Kinet-ics, Something-Something, UCF-101 and HMDB-51 to report results. Considering the properties of the datasets, there are no datasets that focus solely on very short clips (2 to 3 seconds), and on highly-similar fine-grained actions within one specific domain. This paper researches how current state-of-the-art action recognition methods perform on a dataset that consists of highly similar, fine-grained actions. To do so, a dataset of skateboarding tricks was created. The performed analysis highlights both benefits and limitations of state-of-the-art methods, while proposing future research directions in the activity recognition domain. The conducted research shows that the best results are obtained by fusing RGB data with OpenPose data for the Temporal Shift Module.

Keywords: activity recognition, fused deep representations, fine-grained dataset, temporal modeling

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Authors: Maher El-Masri, Jamie Crawley, Judy Bornais, Abeer Omar

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Background: Misuse of Emergency Department (ED) for non-urgent healthcare results in unnecessary crowdedness that can result in long ED waits and delays in treatment, diversion of ambulances to other hospitals, poor health outcomes for patients, and increased risk of death Objectives: The main purpose of this study was to explore the independent predictors of non-urgent ED visits in Erie St. Clair LHIN. Secondary purposes of the study include comparison of the rates of non-urgent ED visits between urban and rural hospitals Design: A secondary analysis of archived population-based data on 597,373 ED visits in southwestern Ontario Results The results suggest that older (OR = .992; 95% CI .992 – .993) and female patients (OR = .940; 95% CI .929 - .950) were less likely to visit ED for non-urgent causes. Non-urgent ED visits during the winter, spring, and fall were 13%, 5.8%, and 7.5%, respectively, lesser than they were during the summer time. The data further suggest that non-urgent visits were 19.6% and 21.3% less likely to occur in evening and overnight shifts compared to the day shift. Non-urgent visits were 2.76 times more likely to present to small community hospitals than large community hospitals. Health care providers were 1.92 times more likely to refer patients with non-urgent health problem to the ED than the decision taken by patients, family member or caretakers. Conclusion: In conclusion, our study highlights a number of important factors that are associated with inappropriate use of ED visits for non-urgent health problems. Knowledge of these factors could be used to address the issue of unnecessary ED crowdedness.

Keywords: emergency department, non-urgent visits, predictors, logistic regression

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Authors: Sameer Masood, Lucas Chartier

Abstract:

Head injuries are a commonly encountered presentation in emergency departments (ED) and the Choosing Wisely Canada (CWC) campaign was released in June 2015 in an attempt to decrease imaging utilization for patients with minor head injuries. The impact of the CWC campaign on imaging utilization for head injuries has not been explored in the ED setting. In our study, we describe the characteristics of patients with head injuries presenting to a tertiary care academic ED and the impact of the CWC campaign on CT head utilization. This retrospective cohort study used linked databases from the province of Ontario, Canada to assess emergency department visits with a primary diagnosis of head injury made between June 1, 2014 and Aug 31, 2016 at the University Health Network in Toronto, Canada. We examined the number of visits during the study period, the proportion of patients that had a CT head performed before and after the release of the CWC campaign, as well as mode of arrival, and disposition. There were 4,322 qualifying visits at our site during the study period. The median presenting age was 44.12 years (IQR 27.83,67.45), the median GCS was 15 (IQR 15,15) and the majority of patients presenting had intermediate acuity (CTAS 3). Overall, 43.17% of patients arrived via ambulance, 49.24 % of patients received a CT head and 10.46% of patients were admitted. Compared to patients presenting before the CWC campaign release, there was no significant difference in the rate of CT heads after the CWC (50.41% vs 47.68%, P = 0.07). There were also no significant differences between the two groups in mode of arrival (ambulance vs ambulatory) (42.94% vs 43.48%, P = 0.72) or admission rates (9.85% vs 11.26%, P = 0.15). However, more patients belonged to the high acuity groups (CTAS 1 or 2) in the post CWC campaign release group (12.98% vs 8.11% P <0.001). Visits for head injuries make up a significant proportion of total ED visits and approximately half of these patients receive CT imaging in the ED. The CWC campaign did not seem to impact imaging utilization for head injuries in the 14 months following its launch. Further efforts, including local quality improvement initiatives, are likely needed to increase adherence to its recommendation and reduce imaging utilization for head injuries.

Keywords: choosing wisely, emergency department, head injury, quality improvement

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Authors: Paulina Clara Appiah, Kofi Issah, Timothy Letsa, Kennedy Nartey, Amanua Chinbuah, Adoma Dwomo-Fokuo, Jacqeline G. Asibey

Abstract:

Background: The Every Newborn Action Plan provides evidence–based interventions to end preventable deaths in high burden countries. Brong Ahafo Region is one of ten regions in Ghana with less than half of its district hospitals having sick newborn units. Facility-based neonatal care is not prioritized and under-funded, and there is also inadequate knowledge and competence to manage the sick. The aim of this intervention was to make available in–patient care for sick newborns in all 19 district hospitals through the strengthening of facility-based systems. Methods: With the development and dissemination of the National Newborn Strategy and Action Plan 2014-2018, the country was able to attract PATH which provided the region with basic resuscitation equipment, supported hospital providers’ capacity building in Helping Babies Breathe, Essential Care of Every Baby, Infection Prevention and Management and held a symposia on managing the sick newborn. Newborn advocacy was promoted through newborn champions at the facility and community levels. Hospital management was then able to mobilize resources from communities, corporate organizations and from internally generated funds; created or expanded sick newborn care units and provided essential medicines and equipment. Kangaroo Mother Care was initiated in 6 hospitals. Pediatric specialist outreach services initiated comprised telephone consultations, teaching ward rounds and participating in perinatal death audits meetings. Newborn data capture and management was improved through the provision and training on the use of standard registers provided from the national level. Results: From February 2015 to November 2017, hospitals with sick newborn units increased from 7 to 19 (37%-100%). 180 pieces each of newborn ventilation bags and masks size 0, 1 and penguin suction bulbs were distributed to the hospitals, in addition to 20 newborn mannequin sets and 90 small clinical reminder posters. 802 providers (96.9%) were trained in resuscitation, of which 96% were successfully followed up in 6 weeks, 91% in 6 months and 80% in 12 months post-training. 53 clinicians (65%) were trained and mentored to manage sick newborns. 56 specialist teaching ward rounds were conducted. Data completeness improved from 92.6% - 99.9%. Availability of essential medicines improved from 11% to 100%. Number of hospital cots increased from 116 to 248 (214%). Cot occupancy rate increased from 57.4% to 92.5%. Hospitals with phototherapy equipment increased from 0 to 12 (63%). Hospitals with incubators increased from 1 to 12 (5%-63%). Newborn deaths among admissions reduced from 6.3% to 5.4%. Conclusion: Access to in-patient care increased significantly. Newborn advocacy successfully mobilized resources required for strengthening facility –based systems.

Keywords: facility-based systems, Ghana, in-patient care, newborn advocacy

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Authors: Rhodine Hickman, Craig Wylie, Michael G. McCaul

Abstract:

Introduction: The World Health Organisation has called on governments around the world to recognise emergency conditions as a global public health problem and respond with appropriate steps for effective preventative strategies. However, to understand the magnitude of the problem, good quality epidemiological data is required. This is especially challenging in low and middle-income countries, where routine data is scarce, specifically within the prehospital setting. Methods: We conducted a retrospective cross-sectional study of a national prehospital private sector EMS database. The database being the property of ER24 (private Emergency Medical Services (EMS) company in South Africa) contains claims submitted by the majority of ambulance services in South Africa during the period between 1 January 2008 to 28 March 2017. We used descriptive statistics and control charts to describe the data using STATA 14. Results: 299,257 calls were included in the analysis. The top clinical conditions requiring ambulance transport were transport accidents (10% of total call volume) and ischaemic heart disease (4.4%). The number of transport accidents consistently increased between 2009 and 2014 and reached beyond the limit for normal variation in 2015. Victims of transport accidents required basic life support services 60% of the time with 80% of injuries being minor to moderate. The frequency of ischaemic heart disease had a steady incline from 2011 to 2016. Advanced life support services were required about 50% of the time, with 60% of patients needing urgent care. Conclusion: Transport accidents, followed by ischaemic heart disease, are the most prevalent conditions in South African private EMS. There is a potential to address these conditions by developing the capacity of low and mid-level providers in trauma and advanced EMS providers in ischaemic heart disease.

Keywords: emergency care, emergency medicine, prehospital providers, South Africa

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