Search results for: SPI threshold setting
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2604

Search results for: SPI threshold setting

2214 Physiotherapy Assessment of People with Neurological Conditions in Australia: A National Survey of Clinical Practice

Authors: Jill Garner, Belinda Lange, Sheila Lennon, Maayken van den Berg

Abstract:

Currently, there are approximately one billion people worldwide affected by a neurological condition. Many of whom are assessed and treated by a physiotherapist in a variety of settings. There is a lack of consensus in the literature related to what is clinically assessed by physiotherapists in people with neurological conditions. This study aimed to explore assessment in people with neurological conditions, including how health care setting, experience, and therapeutic approach, may influence neurological assessment. A national survey targeted Australian physiotherapists who assess adults with neurological conditions as part of their clinical practice. The survey consisted of 39 questions and was distributed to physiotherapists through the Australian Physiotherapy Association, and Chief Allied Health Officers across Australia and advertised on the National Neurological Physiotherapy Facebook page. In total, 395 respondents consented to the survey from all states within Australia. Most respondents were female (85.4%) with a mean (SD) age of 35.7 years. Respondents reported working clinically in acute, community, outpatients, and community settings. Stroke was the most assessed condition (58.0%). There is variability in domains assessed by Australian physiotherapists, with common inclusions of balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, coordination, activity tolerance, postural alignment and symmetry and upper limb. There is little evidence to support what physiotherapists assess in practice, in different settings, and in different states within Australia and not enough information to develop a decision tree regarding what is important for assessment in different settings. Further research is needed to explore this area and develop a consensus around best practices.

Keywords: physiotherapy, neurological, assessment, domains

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2213 The Influence of Music Education and the Order of Sounds on the Grouping of Sounds into Sequences of Six Tones

Authors: Adam Rosiński

Abstract:

This paper discusses an experiment conducted with two groups of participants, composed of musicians and non-musicians, in order to investigate the impact of the speed of a sound sequence and the order of sounds on the grouping of sounds into sequences of six tones. Significant differences were observed between musicians and non-musicians with respect to the threshold sequence speed at which the sequence was split into two streams. The differences in the results for the two groups suggest that the musical education of the participating listeners may be a vital factor. The criterion of musical education should be taken into account during experiments so that the results obtained are reliable, uniform, and free from interpretive errors.

Keywords: auditory scene analysis, education, hearing, psychoacoustics

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2212 Reducing Falls in Memory Care through Implementation of the Stopping Elderly Accidents, Deaths, and Injuries Program

Authors: Cory B. Lord

Abstract:

Falls among the elderly population has become an area of concern in healthcare today. The negative impacts of falls lead to increased morbidity, mortality, and financial burdens for both patients and healthcare systems. Falls in the United States is reported at an annual rate of 36 million in those aged 65 and older. Each year, one out of four people in this age group will suffer a fall, with 20% of these falls causing injury. The setting for this Doctor of Nursing Practice (DNP) project was a memory care unit in an assisted living community, as these facilities house cognitively impaired older adults. These communities lack fall prevention programs; therefore, the need exists to add to the body of knowledge to positively impact this population. The objective of this project was to reduce fall rates through the implementation of the Center for Disease Control and Prevention (CDC) STEADI (stopping elderly accidents, deaths, and injuries) program. The DNP project performed was a quality improvement pilot study with a pre and post-test design. This program was implemented in the memory care setting over 12 weeks. The project included an educational session for staff and a fall risk assessment with appropriate resident referrals. The three aims of the DNP project were to reduce fall rates among the elderly aged 65 and older who reside in the memory care unit, increase staff knowledge of STEADI fall prevention measures after an educational session, and assess the willingness of memory care unit staff to adopt an evidence-based a fall prevention program. The Donabedian model was used as a guiding conceptual framework for this quality improvement pilot study. The fall rate data for 12 months before the intervention was evaluated and compared to post-intervention fall rates. The educational session comprised of a pre and post-test to assess staff knowledge of the fall prevention program and the willingness of staff to adopt the fall prevention program. The overarching goal was to reduce falls in the elderly population who live in memory care units. The results of the study showed, on average that the fall rate during the implementation period of STEADI (μ=6.79) was significantly lower when compared to the prior 12 months (μ= 9.50) (p=0.02, α = 0.05). The mean staff knowledge scores improved from pretest (μ=77.74%) to post-test (μ=87.42%) (p=0.00, α= 0.05) after the education session. The results of the willingness to adopt a fall prevention program were scored at 100%. In summation, implementing the STEADI fall prevention program can assist in reducing fall rates for residents aged 65 and older who reside in a memory care setting.

Keywords: dementia, elderly, falls, STEADI

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2211 Close Loop Controlled Current Nerve Locator

Authors: H. A. Alzomor, B. K. Ouda, A. M. Eldeib

Abstract:

Successful regional anesthesia depends upon precise location of the peripheral nerve or nerve plexus. Locating peripheral nerves is preferred to be done using nerve stimulation. In order to generate a nerve impulse by electrical means, a minimum threshold stimulus of current “rheobase” must be applied to the nerve. The technique depends on stimulating muscular twitching at a close distance to the nerve without actually touching it. Success rate of this operation depends on the accuracy of current intensity pulses used for stimulation. In this paper, we will discuss a circuit and algorithm for closed loop control for the current, theoretical analysis and test results and compare them with previous techniques.

Keywords: Close Loop Control (CLC), constant current, nerve locator, rheobase

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2210 The Return of the Rejected Kings: A Comparative Study of Governance and Procedures of Standards Development Organizations under the Theory of Private Ordering

Authors: Olia Kanevskaia

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Standardization has been in the limelight of numerous academic studies. Typically described as ‘any set of technical specifications that either provides or is intended to provide a common design for a product or process’, standards do not only set quality benchmarks for products and services, but also spur competition and innovation, resulting in advantages for manufacturers and consumers. Their contribution to globalization and technology advancement is especially crucial in the Information and Communication Technology (ICT) and telecommunications sector, which is also characterized by a weaker state-regulation and expert-based rule-making. Most of the standards developed in that area are interoperability standards, which allow technological devices to establish ‘invisible communications’ and to ensure their compatibility and proper functioning. This type of standard supports a large share of our daily activities, ranging from traffic coordination by traffic lights to the connection to Wi-Fi networks, transmission of data via Bluetooth or USB and building the network architecture for the Internet of Things (IoT). A large share of ICT standards is developed in the specialized voluntary platforms, commonly referred to as Standards Development Organizations (SDOs), which gather experts from various industry sectors, private enterprises, governmental agencies and academia. The institutional architecture of these bodies can vary from semi-public bodies, such as European Telecommunications Standards Institute (ETSI), to industry-driven consortia, such as the Internet Engineering Task Force (IETF). The past decades witnessed a significant shift of standard setting to those institutions: while operating independently from the states regulation, they offer a rather informal setting, which enables fast-paced standardization and places technical supremacy and flexibility of standards above other considerations. Although technical norms and specifications developed by such nongovernmental platforms are not binding, they appear to create significant regulatory impact. In the United States (US), private voluntary standards can be used by regulators to achieve their policy objectives; in the European Union (EU), compliance with harmonized standards developed by voluntary European Standards Organizations (ESOs) can grant a product a free-movement pass. Moreover, standards can de facto manage the functioning of the market when other regulative alternatives are not available. Hence, by establishing (potentially) mandatory norms, SDOs assume regulatory functions commonly exercised by States and shape their own legal order. The purpose of this paper is threefold: First, it attempts to shed some light on SDOs’ institutional architecture, focusing on private, industry-driven platforms and comparing their regulatory frameworks with those of formal organizations. Drawing upon the relevant scholarship, the paper then discusses the extent to which the formulation of technological standards within SDOs constitutes a private legal order, operating in the shadow of governmental regulation. Ultimately, this contribution seeks to advise whether a state-intervention in industry-driven standard setting is desirable, and whether the increasing regulatory importance of SDOs should be addressed in legislation on standardization.

Keywords: private order, standardization, standard-setting organizations, transnational law

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2209 Neural Network in Fixed Time for Collision Detection between Two Convex Polyhedra

Authors: M. Khouil, N. Saber, M. Mestari

Abstract:

In this paper, a different architecture of a collision detection neural network (DCNN) is developed. This network, which has been particularly reviewed, has enabled us to solve with a new approach the problem of collision detection between two convex polyhedra in a fixed time (O (1) time). We used two types of neurons, linear and threshold logic, which simplified the actual implementation of all the networks proposed. The study of the collision detection is divided into two sections, the collision between a point and a polyhedron and then the collision between two convex polyhedra. The aim of this research is to determine through the AMAXNET network a mini maximum point in a fixed time, which allows us to detect the presence of a potential collision.

Keywords: collision identification, fixed time, convex polyhedra, neural network, AMAXNET

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2208 A Generalization of the Secret Sharing Scheme Codes Over Certain Ring

Authors: Ibrahim Özbek, Erdoğan Mehmet Özkan

Abstract:

In this study, we generalize (k,n) threshold secret sharing scheme on the study Ozbek and Siap to the codes over the ring Fq+ αFq. In this way, it is mentioned that the method obtained in that article can also be used on codes over rings, and new advantages to be obtained. The method of securely sharing the key in cryptography, which Shamir first systematized and Massey carried over to codes, became usable for all error-correcting codes. The firewall of this scheme is based on the hardness of the syndrome decoding problem. Also, an open study area is left for those working for other rings and code classes. All codes that correct errors with this method have been the working area of this method.

Keywords: secret sharing scheme, linear codes, algebra, finite rings

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2207 Switched Ultracapacitors for Maximizing Energy Supply

Authors: Nassouh K. Jaber

Abstract:

Supercapacitors (S.C.) are presently attracting attention for driving general purpose (12VDC to 220VAC) inverters in renewable energy systems. Unfortunately, when the voltage of the S.C supplying the inverter reaches the minimal threshold of 7-8VDC the inverter shuts down leaving the remaining 40% of the valuable energy stored inside the ultracapacitor un-usable. In this work a power electronic circuit is proposed which switches 2 banks of supercapacitors from parallel connection when both are fully charged at 14VDC to serial connection when their voltages drop down to 7 volts, thus keeping the inverter working within its operating limits for a longer time and advantageously tapping almost 92% of the stored energy in the supercapacitors.

Keywords: ultra capacitor, switched ultracapacitors, inverter, supercapacitor, parallel connection, serial connection, battery limitation

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2206 An Embedded System for Early Detection of Gas Leakage in Hospitals and Industries

Authors: Sehreen Moorat, Hiba, Maham Mahnoor, Faryal Soomro

Abstract:

Leakage of gases in a system makes infrastructures and users vulnerable; it can occur due to its environmental conditions or old groundwork. In hospitals and industries, it is very important to detect any small level of gas leakage because of their sensitivity. In this research, a portable detection system for the small leakage of gases has been developed, gas sensor (MQ-2) is used to find leakage when it’s at its initial phase. The sensor and transmitting module senses the change in level of gas by using a sensing circuit. When a concentration of gas reach at a specified threshold level, it will activate an alarm and send the alarming situation notification to receiver through GSM module. The proposed system works well in hospitals, home, and industries.

Keywords: gases, detection, Arduino, MQ-2, alarm

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2205 The Prospect of Producing Hydrogen by Electrolysis of Idle Discharges of Water from Reservoirs and Recycling of Waste-Gas Condensates

Authors: Inom Sh. Normatov, Nurmakhmad Shermatov, Rajabali Barotov, Rano Eshankulova

Abstract:

The results of the studies for the hydrogen production by the application of water electrolysis and plasma-chemical processing of gas condensate-waste of natural gas production methods are presented. Thin coating covers the electrode surfaces in the process of water electrolysis. Therefore, water for electrolysis was first exposed to electrosedimentation. The threshold voltage is shifted to a lower value compared with the use of electrodes made of stainless steel. At electrolysis of electrosedimented water by use of electrodes from stainless steel, a significant amount of hydrogen is formed. Pyrolysis of gas condensates in the atmosphere of a nitrogen was followed by the formation of acetylene (3-7 vol.%), ethylene (4-8 vol.%), and pyrolysis carbon (10-15 wt.%).

Keywords: electrolyze, gascondensate, hydrogen, pyrolysis

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2204 Analyzing the Influence of Hydrometeorlogical Extremes, Geological Setting, and Social Demographic on Public Health

Authors: Irfan Ahmad Afip

Abstract:

This main research objective is to accurately identify the possibility for a Leptospirosis outbreak severity of a certain area based on its input features into a multivariate regression model. The research question is the possibility of an outbreak in a specific area being influenced by this feature, such as social demographics and hydrometeorological extremes. If the occurrence of an outbreak is being subjected to these features, then the epidemic severity for an area will be different depending on its environmental setting because the features will influence the possibility and severity of an outbreak. Specifically, this research objective was three-fold, namely: (a) to identify the relevant multivariate features and visualize the patterns data, (b) to develop a multivariate regression model based from the selected features and determine the possibility for Leptospirosis outbreak in an area, and (c) to compare the predictive ability of multivariate regression model and machine learning algorithms. Several secondary data features were collected locations in the state of Negeri Sembilan, Malaysia, based on the possibility it would be relevant to determine the outbreak severity in the area. The relevant features then will become an input in a multivariate regression model; a linear regression model is a simple and quick solution for creating prognostic capabilities. A multivariate regression model has proven more precise prognostic capabilities than univariate models. The expected outcome from this research is to establish a correlation between the features of social demographic and hydrometeorological with Leptospirosis bacteria; it will also become a contributor for understanding the underlying relationship between the pathogen and the ecosystem. The relationship established can be beneficial for the health department or urban planner to inspect and prepare for future outcomes in event detection and system health monitoring.

Keywords: geographical information system, hydrometeorological, leptospirosis, multivariate regression

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2203 Private Coded Computation of Matrix Multiplication

Authors: Malihe Aliasgari, Yousef Nejatbakhsh

Abstract:

The era of Big Data and the immensity of real-life datasets compels computation tasks to be performed in a distributed fashion, where the data is dispersed among many servers that operate in parallel. However, massive parallelization leads to computational bottlenecks due to faulty servers and stragglers. Stragglers refer to a few slow or delay-prone processors that can bottleneck the entire computation because one has to wait for all the parallel nodes to finish. The problem of straggling processors, has been well studied in the context of distributed computing. Recently, it has been pointed out that, for the important case of linear functions, it is possible to improve over repetition strategies in terms of the tradeoff between performance and latency by carrying out linear precoding of the data prior to processing. The key idea is that, by employing suitable linear codes operating over fractions of the original data, a function may be completed as soon as enough number of processors, depending on the minimum distance of the code, have completed their operations. The problem of matrix-matrix multiplication in the presence of practically big sized of data sets faced with computational and memory related difficulties, which makes such operations are carried out using distributed computing platforms. In this work, we study the problem of distributed matrix-matrix multiplication W = XY under storage constraints, i.e., when each server is allowed to store a fixed fraction of each of the matrices X and Y, which is a fundamental building of many science and engineering fields such as machine learning, image and signal processing, wireless communication, optimization. Non-secure and secure matrix multiplication are studied. We want to study the setup, in which the identity of the matrix of interest should be kept private from the workers and then obtain the recovery threshold of the colluding model, that is, the number of workers that need to complete their task before the master server can recover the product W. The problem of secure and private distributed matrix multiplication W = XY which the matrix X is confidential, while matrix Y is selected in a private manner from a library of public matrices. We present the best currently known trade-off between communication load and recovery threshold. On the other words, we design an achievable PSGPD scheme for any arbitrary privacy level by trivially concatenating a robust PIR scheme for arbitrary colluding workers and private databases and the proposed SGPD code that provides a smaller computational complexity at the workers.

Keywords: coded distributed computation, private information retrieval, secret sharing, stragglers

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2202 Renal Angiomyolipoma Rupture Following COVID-19 Infection: A Case Report

Authors: Mohammed Abdurabu, Akram Al-Warqi, Ebrahim M. A. Ebrahim, Jouhar Kollari, Salman Mirza

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The novel coronavirus (COVID-19) is one of the most recent pandemics that invaded earth that left and still leaving hundreds of thousands of patients and ended with high morbidity and mortality rates with no clear cure till this moment. COVID-19 has been proven to be associated with pathologic changes in coagulation, characterized by either thromboembolic or bleeding events. We present this case of a 44-year-old male patient that presented to our Emergency Department with flank pain that later was found to have renal angiomyolipoma (AML) rupture during his COVID-19 infection, ultimately requiring admission for hemorrhage control via Interventional Radiology (IR) drainage. Here, we discuss the role of the front-line physicians and how they should keep a low threshold for the different presentations that could be associated with COVID-19 infection.

Keywords: angiomyolipoma, COVID-19, renal, rupture

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2201 Accessibility of the Labor Market in Indonesian Cities

Authors: Hananto Prakoso, Jean-Pierre Orfeuil

Abstract:

The relationship between city size, urban transport efficiency (speed), employment proximity (distance) and accessibility of labour market is rarely examined especially in developing countries. This paper reveals the relationship using 2 points of views (active population and company). Then the analysis is divided according to 3 transport modes (car, public transport and motorcycle) and takes into account the vehicle ownership rate. We employ data across 111 districts in 4 big cities of Indonesia. In our result, speed indicator contributed positively to accessibility of labour market while distance elasticity is negative. In absolute value, elasticity of speed indicator is higher than that of distance.

Keywords: labour market, travel time, travel cost threshold, transportation

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2200 Corporate Governance Development in Mongolia: The Role of Professional Accountants

Authors: Ernest Nweke

Abstract:

The work of Professional Accountants and Corporate governance are synonymous and cannot be divorced from each other. Organizations, profit and non-profit alike cannot implement sound corporate practices without inputs from Professional Accountants. In today’s dynamic corporate world, good corporate governance practice is a sine qua non. More so, following the corporate failures of the past decades like Enron and WorldCom, governments around the world, including Mongolia are becoming more proactive in ensuring sound corporate governance mechanisms. In the past fifteen years, the Mongolian government has taken several measures to establish and strengthen internal corporate governance structures in firms. This paper highlights the role of professional accountants and auditors play in ensuring that good corporate governance mechanisms are entrenched in listed companies in Mongolia. Both primary and secondary data are utilized in this research. In collection of primary data, Delphi method was used, securing responses from only knowledgeable senior employees, top managers, and some CEOs. Using this method, a total of 107 top-level company employees and executives randomly selected from 22 companies were surveyed; maximum of 5 and minimum of 4 from each company. These companies cut across several sectors. It was concluded that Professional Accountants play key roles in setting and maintaining firm governance. They do this by ensuring full compliance with all the requirements of good and sound corporate governance, establishing reporting, monitoring and evaluating standards, assisting in the setting up of proper controls, efficient and effective audit systems, sound fraud risk management and putting in place an overall vision for the enterprise. Companies with effective corporate governance mechanisms are usually strong and fraud-resilient. It was also discovered that companies with big 4 audit firms tend to have better governance structures in Mongolia.

Keywords: accountants, corporate disclosure, corporate failure, corporate governance

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2199 A Systematic Review of Prevalence, Gender and Age Differences in Cyberbullying Studies in Croatia

Authors: Stjepka Popović, Lucija Vejmelka

Abstract:

Background: Cyberbullying has become a prevalent issue worldwide, including in Croatia. However, a comprehensive understanding of the extent and nature of cyberbullying in the Croatian context is lacking. Objective: The objective of this systematic review is to evaluate the quality of current research conducted in Croatia on the subject of cyberbullying, identify any gaps in the research, and provide suggestions for future investigations. It examines the prevalence gender and age differences of cyberbullying in Croatia. Participants and Setting: Research is done on secondary data resources (published studies) of cyberbullying in Croatia. The participants in these studies that were included in systematic review are children and youth of all ages residing in Croatia who have been involved in cyberbullying incidents. The setting includes various environments where cyberbullying may occur, such as social media platforms and educational institutions. Methods: To identify pertinent studies on cyberbullying in Croatia, a comprehensive exploration of both international and domestic electronic databases was systematically undertaken. Relevant studies were chosen according to predefined criteria that determined inclusion and exclusion. Key findings from the selected studies were extracted and synthesized, enabling the identification of patterns in the data. Results: A total of 43 studies that fulfilled the inclusion criteria were identified in the review. The prevalence of cyberbullying victimization in Croatia ranged from 7% - 55.3%, with adolescents being the most affected group. The prevalence of cyberbullying perpetration was ranging from 3.2% - 30.3%. The most prevalent form of cyberbullying included gossiping and mocking others. Gender and age differences are highlighted. Conclusions: The outcomes of this systematic review highlight the pressing need for targeted interventions and preventative measures to address cyberbullying in Croatia. Additionally, it is crucial to conduct further research to investigate the long-term impacts and potential factors that can help mitigate cyberbullying in the context of Croatia.

Keywords: cyberbullying, online risky behavior, Croatia, systematic review

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2198 Re-Defining Academic Literacy: An Information Literacy Approach to Helping Chinese International Students Succeed in American Colleges

Authors: Yi Ding

Abstract:

With the upsurge of Chinese international students in American higher education, serious academic problems Chinese international students are suffering from are also striking. While most practices and research in higher education focus on the role of professors, writing centers, and tutoring centers to help international students succeed in college, this research study focuses on a more fundamental skill that is neglected in most conversations: information literacy, which is usually addressed by academic librarians. Transitioning from an East-Asian, developing educational system that values authority, set knowledge more than independent thinking, scholarly conversation, Chinese international students need support from academic librarians to acquire information literacy, which is crucial to understand expectations of a Western academic setting and thus to succeed in college. This research study illustrates how academic librarians can play an integral role in helping Chinese international students acclimate to the expectations of American higher education by teaching information literacy as academic literacy unique to the Western academic setting. Six keys of information literacy put forward by Association of College and Research Libraries, which are 'Authority Is Constructed and Contextual', 'Information Creation as a Process', 'Information Has Value', 'Research as Inquiry', 'Scholarship as Conversation', and 'Searching as Strategic Exploration', are analyzed through the lens of Chinese educational system and students’ backgrounds. Based on the analysis as well as results from surveys and interviews among academic librarians, professors, and international students, this research further examines current practices from a wide range of academic libraries and finally, provides evidence-based recommendations for academic librarians to use information literacy instruction to help Chinese international students succeed in American higher education.

Keywords: academic librarians, Chinese international students, information literacy, student success

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2197 Amniotic Fluid Mesenchymal Stem Cells Selected for Neural Specificity Ameliorates Chemotherapy Induced Hearing Loss and Pain Perception

Authors: Jan F. Talts, Amit Saxena, Kåre Engkilde

Abstract:

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most frequent side effects caused by anti-neoplastic agents, with a prevalence from 19 % to 85 %. Clinically, CIPN is a mostly sensory neuropathy leading to pain and to motor and autonomic changes. Due to its high prevalence among cancer patients, CIPN constitutes a major problem for both cancer patients and survivors, especially because currently, there is no single effective method of preventing CIPN. Hearing loss is the most common form of sensory impairment in humans and can be caused by ototoxic chemical compounds such as chemotherapy (platinum-based antineoplastic agents).In rodents, single or repeated cisplatin injections induce peripheral neuropathy and hearing impairment mimicking human disorder, allowing studying the efficacy of new pharmacological candidates in chemotherapy-induced hearing loss and peripheral neuropathy. RNA sequencing data from full term amniotic fluid (TAF) mesenchymal stemcell (MSC) clones was used to identify neural-specific markers present on TAF-MSC. Several prospective neural markers were tested by flow cytometry on cultured TAF-MSC. One of these markers was used for cell-sorting using Tyto MACSQuant cell sorter, and the neural marker positive cell population was expanded for several passages to the final therapeutic product stage. Peripheral neuropathy and hearing loss was induced in mice by administration of cisplatin in three week-long cycles. The efficacy of neural-specific TAF-MSC in treating hearing loss and pain perception was evaluated by administration of three injections of 3 million cells/kg by intravenous route or three injections of 3 million cells/kg by intra-arterial route after each cisplatin cycle treatment. Auditory brainstem responses (ABR) are electric potentials recorded from scalp electrodes, and the first ABR wave represents the summed activity of the auditory nerve fibers contacting the inner hair cells. For ABR studies, mice were anesthetized, then earphones were placed in the left ear of each mouse, an active electrode was placed in the vertex of the skull, a reference electrode under the skin of the mastoid bone, and a ground electrode in the neck skin. The stimuli consisted of tone pips of five frequencies (2, 4, 6, 12, 16, and 24 kHz) at various sound levels (from 0 to 90 dB) ranging to cover the mouse auditory frequency range. The von Frey test was used to assess the onset and maintenance of mechanical allodynia over time. Mice were placed in clear plexiglass cages on an elevated mesh floor and tested after 30 min of habituation. Mechanical paw withdrawal threshold was examined using an electronic von Frey anesthesiometer. Cisplatin groups treated with three injections of 3 million cells/kg by intravenous route and three injections of 3 million cells/kg by intra-arterial route after each cisplatin cycle treatment presented, a significant increase of hearing acuity characterized by a decrease of ABR threshold and a decrease of neuropathic pain characterized by an increase of von Frey paw withdrawal threshold compared to controls only receiving cisplatin. This study shows that treatment with MSCselected for neural specificity presents significant positive efficacy on the chemotherapy-induced neuropathic pain and the chemotherapy-induced hearing loss.

Keywords: mesenchymal stem cell, peripheral neuropathy, amniotic fluid, regenerative medicine

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2196 Optimizing Oil Production through 30-Inch Pipeline in Abu-Attifel Field

Authors: Ahmed Belgasem, Walid Ben Hussin, Emad Krekshi, Jamal Hashad

Abstract:

Waxy crude oil, characterized by its high paraffin wax content, poses significant challenges in the oil & gas industry due to its increased viscosity and semi-solid state at reduced temperatures. The wax formation process, which includes precipitation, crystallization, and deposition, becomes problematic when crude oil temperatures fall below the wax appearance temperature (WAT) or cloud point. Addressing these issues, this paper introduces a technical solution designed to mitigate the wax appearance and enhance the oil production process in Abu-Attifil Field via a 30-inch crude oil pipeline. A comprehensive flow assurance study validates the feasibility and performance of this solution across various production rates, temperatures, and operational scenarios. The study's findings indicate that maintaining the crude oil's temperature above a minimum threshold of 63°C is achievable through the strategic placement of two heating stations along the pipeline route. This approach effectively prevents wax deposition, gelling, and subsequent mobility complications, thereby bolstering the overall efficiency, reliability, safety, and economic viability of the production process. Moreover, this solution significantly curtails the environmental repercussions traditionally associated with wax deposition, which can accumulate up to 7,500kg. The research methodology involves a comprehensive flow assurance study to validate the feasibility and performance of the proposed solution. The study considers various production rates, temperatures, and operational scenarios. It includes crude oil analysis to determine the wax appearance temperature (WAT), as well as the evaluation and comparison of operating options for the heating stations. The study's findings indicate that the proposed solution effectively prevents wax deposition, gelling, and subsequent mobility complications. By maintaining the crude oil's temperature above the specified threshold, the solution improves the overall efficiency, reliability, safety, and economic viability of the oil production process. Additionally, the solution contributes to reducing environmental repercussions associated with wax deposition. The research conclusion presents a technical solution that optimizes oil production in the Abu-Attifil Field by addressing wax formation problems through the strategic placement of two heating stations. The solution effectively prevents wax deposition, improves overall operational efficiency, and contributes to environmental sustainability. Further research is suggested for field data validation and cost-benefit analysis exploration.

Keywords: oil production, wax depositions, solar cells, heating stations

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2195 The Prevalence and Profile of Extended Spectrum B-Lactamase (ESBL) Producing Enterobacteriaceae Species in the Intensive Care Unit (ICU) Setting of a Tertiary Care Hospital of North India

Authors: Harmeet Pal Singh Dhooria, Deepinder Chinna, UPS Sidhu, Alok Jain

Abstract:

Serious infections caused by gram-negative bacteria are a significant cause of mortality and morbidity in the hospital setting. In acute care facilities like in intensive care units (ICUs), the intensity of antimicrobial use together with a population highly susceptible to infection, creates an environment, which facilitates both emergence and transmission of Extended Spectrum -lactamase (ESBL) producing Enterobacteriaceae species. The study was conducted in the Medical Intensive Care Unit (MICU) and the Pulmonary Critical Care Unit (PCCU) of the Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Out of a total of 1108 samples of urine, blood and respiratory tract secretions received for culture and sensitivity analysis from Medical Intensive Care Unit and Pulmonary Critical Care Unit, a total of 170 isolates of Enterobacteriaceae species were obtained which were then included in our study. Out of these 170 isolates, confirmed ESBL production was seen in 116 (68.24%) cases. E.coli was the most common species isolated (56.47%) followed by Klebsiella (32.94%), Enterobacter (5.88%), Citrobacter (3.53%), Enterobacter (0.59%) and Morganella (0.59%) among the total isolates. The rate of ESBL production was more in Klebsiella (78.57%) as compared to E.coli (60.42%). ESBL producers were found to be significantly more common in patients with prior history of hospitalization, antibiotic use, and prolonged ICU stay. Also significantly increased the prevalence of ESBL related infections was observed in patients with a history of catheterization or central line insertion but not in patients with the history of intubation. Patients who had an underlying malignancy had significantly higher prevalence of ESBL related infections as compared to other co-morbid illnesses. A slightly significant difference in the rate of mortality/LAMA was observed in the ESBL producer versus the non-ESBL producer group. The rate of mortality/LAMA was significantly higher in the ESBL related UTI but not in the ESBL related respiratory tract and bloodstream infections. ESBL producing isolates had significantly higher rates of resistance to Cefepime and Piperacillin/Tazobactum, and to non β-lactum antibiotics like Amikacin and Ciprofloxacin. The level of resistance to Imipenem was lower as compared to other antibiotics. However, it was noted that ESBL producing isolates had higher levels of resistance to Imipenem as compared to non-ESBL producing isolates. Conclusion- The prevalence of ESBL producing organisms was found to be very high (68.24%) among Enterobacteriaceae isolates in our ICU setting as among other ICU care settings around the world.

Keywords: enterobacteriaceae, extended spectrum B-lactamase (ESBL), ICU, antibiotic resistance

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2194 Laser Paint Stripping on Large Zones on AA 2024 Based Substrates

Authors: Selen Unaldi, Emmanuel Richaud, Matthieu Gervais, Laurent Berthe

Abstract:

Aircrafts are painted with several layers to guarantee their protection from external attacks. For aluminum AA 2024-T3 (metallic structural part of the plane), a protective primer is applied to ensure its corrosion protection. On top of this layer, the top coat is applied for aesthetic aspects. During the lifetime of an aircraft, top coat stripping has an essential role which should be operated as an average of every four years. However, since conventional stripping processes create hazardous disposals and need long hours of labor work, alternative methods have been investigated. Amongst them, laser stripping appears as one of the most promising techniques not only because of the reasons mentioned above but also its controllable and monitorable aspects. The application of a laser beam from the coated side provides stripping, but the depth of the process should be well controlled in order to prevent damage to a substrate and the anticorrosion primer. Apart from that, thermal effects should be taken into account on the painted layers. As an alternative, we worked on developing a process that includes the usage of shock wave propagation to create the stripping via mechanical effects with the application of the beam from the substrate side (back face) of the samples. Laser stripping was applied on thickness-specified samples with a thickness deviation of 10-20%. First, the stripping threshold is determined as a function of power density which is the first flight off of the top coats. After obtaining threshold values, the same power densities were applied to specimens to create large stripping zones with a spot overlap of 10-40%. Layer characteristics were determined on specimens in terms of physicochemical properties and thickness range both before and after laser stripping in order to validate the substrate material health and coating properties. The substrate health is monitored by measuring the roughness of the laser-impacted zones and free surface energy tests (both before and after laser stripping). Also, Hugoniot Elastic Limit (HEL) is determined from VISAR diagnostic on AA 2024-T3 substrates (for the back face surface deformations). In addition, the coating properties are investigated as a function of adhesion levels and anticorrosion properties (neutral salt spray test). The influence of polyurethane top-coat thickness is studied in order to verify the laser stripping process window for industrial aircraft applications.

Keywords: aircraft coatings, laser stripping, laser adhesion tests, epoxy, polyurethane

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2193 Impact of Hybrid Optical Amplifiers on 16 Channel Wavelength Division Multiplexed System

Authors: Inderpreet Kaur, Ravinder Pal Singh, Kamal Kant Sharma

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This paper addresses the different configurations used of optical amplifiers with 16 channels in Wavelength Division Multiplexed system. The systems with 16 channels have been simulated for evaluation of various parameters; Bit Error Rate, Quality Factor, for threshold values for a range of wavelength from 1471 nm to 1611 nm. Comparison of various combination of configurations have been analyzed with EDFA and FRA but EDFA-FRA configuration performance has been found satisfactory in terms of performance indices and stable region. The paper also compared various parameters quantized with different configurations individually. It has been found that Q factor has high value with less value of BER and high resolution for EDFA-FRA configuration.

Keywords: EDFA, FRA, WDM, Q factor, BER

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2192 Investigating the English Speech Processing System of EFL Japanese Older Children

Authors: Hiromi Kawai

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This study investigates the nature of EFL older children’s L2 perceptive and productive abilities using classroom data, in order to find a pedagogical solution to the teaching of L2 sounds at an early stage of learning in a formal school setting. It is still inconclusive whether older children with only EFL formal school instruction at the initial stage of L2 learning are able to attain native-like perception and production in English within the very limited amount of exposure to the target language available. Based on the notion of the lack of study of EFL Japanese children’s acquisition of English segments, the researcher uses a model of L1 speech processing which was developed for investigating L1 English children’s speech and literacy difficulties using a psycholinguistic framework. The model is composed of input channel, output channel, and lexical representation, and examines how a child receives information from spoken or written language, remembers and stores it within the lexical representations and how the child selects and produces spoken or written words. Concerning language universality and language specificity in the language acquisitional process, the aim of finding any sound errors in L1 English children seemed to conform to the author’s intention to find abilities of English sounds in older Japanese children at the novice level of English in an EFL setting. 104 students in Grade 5 (between the ages of 10 and 11 years old) of an elementary school in Tokyo participated in this study. Four tests to measure their perceptive ability and three oral repetition tests to measure their productive ability were conducted with/without reference to lexical representation. All the test items were analyzed to calculate item facility (IF) indices, and correlational analyses and Structural Equation Modeling (SEM) were conducted to examine the relationship between the receptive ability and the productive ability. IF analysis showed that (1) the participants were better at perceiving a segment than producing a segment, (2) they had difficulty in auditory discrimination of paired consonants when one of them does not exist in the Japanese inventory, (3) they had difficulty in both perceiving and producing English vowels, and (4) their L1 loan word knowledge had an influence on their ability to perceive and produce L2 sounds. The result of the Multiple Regression Modeling showed that the two production tests could predict the participants’ auditory ability of real words in English. The result of SEM showed that the hypothesis that perceptive ability affects productive ability was supported. Based on these findings, the author discusses the possible explicit method of teaching English segments to EFL older children in a formal school setting.

Keywords: EFL older children, english segments, perception, production, speech processing system

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2191 The Usage of Mudbrick in Historical Structures of Van City

Authors: Mustafa Gulen, Eylem Guzel, Soner Guler

Abstract:

The studies concentrated on the historical background of Van city show the fact that Van city has had a significant position as a settlement since ancient times and that it has hosted many civilizations during history. With the dominance of Ottoman Empire in 16th century, the region had been re-constructed by building new walls at the southern side of Van Castle. These construction activities had mostly been fulfilled by the usage of mudbrick which had been a fundamental material for thousands of years. As a result of natural disasters, battles and the move at the threshold of 20th century to the new settlement which is 9 kilometers away from the Ancient City Van is an open-air museum with the ruins of churches, mosques and baths. In this study, the usage of mudbrick from past till today in historical structures of Van city is evaluated in detail.

Keywords: historical structures, history, mudbrick, Van city

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2190 Biological Soil Crust Effects on Dust Control Around the Urmia Lake

Authors: Abbas Ahmadi, Nasser Aliasgharzad, Ali Asghar Jafarzadeh

Abstract:

Nowadays, drying of the Urmia Lake as a largest saline lake in the world and emerging its saline bed from water has caused the risk of salty dune storms, which threats the health of human society and also plants and animal communities living in the region. Biological soil crusts (BSCs) as a dust stabilizer attracted the attention of Soil conservation experts in recent years. Although the presence of water by the impenetrable lake bed and endorheic basin can be an advantage to create BSCs, but the extraordinary of the lake bed salinity is a factor for prevention of its establishment in the region. Therefore, the present research work has been carried out to investigate the effects of inoculating the Cyanobacteria, algae and their combination to create BSCs for dust control. In this study, an algae attributed to Chlamydomonas sp and a cyanobacteria attributed to Anabaena sp isolated from the soils of Urmia Lake margin were used to create BSC in four soil samples which collected from 0-10 cm of the current margin (A), the previous bed (B), affected lands by lake (C) and Quomtappe sand dune (D). The main characteristics of the A, B and C soil samples are their highly salinity (their ECe are 108, 140 and 118 dS/m, respectively) and sodicity. Also, texture class of the soil A was loamy sand, and other two soils had clay textures. Soil D was Non-saline, but it was sodic with a sandy texture class. This study was conducted separately in each soil in a completely randomized design under four inoculation treatments of non-inoculated (T0), Algae (T1), cyanobacteria (T2) and equal mixture of algae and cyanobacteria (T3) with three replications. In the experiment, the soil was placed into wind tunnel trays, and a suspension containing microorganisms mixed with the trays surface soil. During the experiment, water was sprayed to the trays at the morning and evening of every day. After passing the incubation period (30 days), some characteristics of samples such as pH, EC, cold water extractable carbohydrate (CWEC), hot water extractable carbohydrate (HWEC), sulfuric acid extractable carbohydrate (SAEC), organic matter, crust thickness, penetration resistance, wind erosion threshold velocity and soil loss in the wind tunnel were measured, and Correlation between the measured characteristics was obtained through the SPSS software. Analysis of variance and so comparison between the means of treatments were analyzed with MSTATC software. In this research, Chlorophyll, an amount, was used as an indicator of the microorganism's population in the samples. Based on obtained results, the amount of Chlorophyll a in the T2 treatment of soil A and all treatments of soil D was significantly increased in comparison to the control and crust thickness showed increase in all treatments by microorganism’s inoculation. But effect of the treatments was significant in soils A and D. At all treatment’s inoculation of microorganisms in soil A caused to increase %46, %34 and %55 of the wind erosion threshold velocity in T1, T2 and T3 treatments in comparison to the control, respectively, and in soil D all treatments caused wind erosion threshold velocity became two times more than control. However, soil loss in the wind tunnel experiments was significant in T2 and T3 treatments of these soils and T1 treatment had no effect in reducing soil loss. Correlation between Chlorophyll a and salinity shows the important role of salinity in microbial growth prevention and formation of BSCs in the studied samples. In general, according to the obtained results, it can be concluded that salinity reduces the growth of microorganisms in saline soils of the region, and in soils with fine textures, salinity role in prevention of the microbial growth is clear. Also, using the mix of algae and cyanobacteria together caused the synergistic growth of them and consequently, better protection of the soil against wind erosion was provided.

Keywords: wind erosion, algae, cyanobacteria, carbohydrate

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2189 The Need for a More Defined Role for Psychologists in Adult Consultation Liaison Services in Hospital Settings

Authors: Ana Violante, Jodie Maccarrone, Maria Fimiani

Abstract:

In the United States, over 30 million people are hospitalized annually for conditions that require acute, 24-hour, supervised care. The experience of hospitalization can be traumatic, exposing the patient to loss of control, autonomy, and productivity. Furthermore, 40% of patients admitted to hospitals for general medical illness have a comorbid psychiatric diagnosis. Research suggests individuals admitted with psychiatric comorbidities experience poorer health outcomes, higher utilization rates and increased overall cost of care. Empirical work suggests hospital settings that include a consultation liaison (CL) service report reduced length of stay, lower costs per patient, improved medical staff and patient satisfaction and reduced readmission after 180 days. Despite the overall positive impact CL services can have on patient care, it is estimated that only 1% - 2.8% of hospital admits receive these services, and most research has been conducted by the field of psychiatry. Health psychologists could play an important role in increasing access to this valuable service, though the extent to which health psychologists participate in CL settings is not well known. Objective: Outline the preliminary findings from an empirical study to understand how many APPIC internship training programs offer adult consultation liaison rotations within inpatient hospital settings nationally, as well as describe the specific nature of these training experiences. Research Method/Design: Data was exported into Excel from the 2022-2023 APPIC Directory categorized as “health psychology” sites. It initially returned a total of 537 health training programs out 1518 total programs (35% of all APPIC programs). A full review included a quantitative and qualitative comprehensive review of the APPIC program summary, the site website, and program brochures. The quantitative review extracted the number of training positions; amount of stipend; location or state of program, patient, population, and rotation. The qualitative review examined the nature of the training experience. Results: 29 (5%) of all APPIC health psychology internship training programs (2%) respectively of all APPIC training internship programs offering internship CL training were identified. Of the 29 internship training programs, 16 were exclusively within a pediatric setting (55%), 11 were exclusively within an adult setting (38%), and two were a mix of pediatric and adult settings (7%). CL training sites were located to 19 states, offering a total of 153 positions nationally, with Florida containing the largest number of programs (4). Only six programs offered 12-month training opportunities while the rest offered CL as a major (6 month) to minor (3-4 month) rotation. The program’s stipend for CL training positions ranged from $25,000 to $62,400, with an average of $32,056. Conclusions: These preliminary findings suggest CL training and services are currently limited. Training opportunities that do exist are mostly limited to minor, short rotations and governed by psychiatry. Health psychologists are well-positioned to better define the role of psychology in consultation liaison services and enhance and formalize existing training protocols. Future research should explore in more detail empirical outcomes of CL services that employ psychology and delineate the contributions of psychology from psychiatry and other disciplines within an inpatient hospital setting.

Keywords: consultation liaison, health psychology, hospital setting, training

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2188 Regional Identity Construction of Acehnese English Teachers in Professional Practice

Authors: Ugahara Bin Mahyuddin Yunus

Abstract:

In English Language Teaching, it cannot be denied that the backgrounds of English teachers do affect the way they teach English to their students, which in turn will affect their students’ English learning itself. Thus, it is very important to understand who the English teachers are so that how they teach English to their students can be understood. One of their backgrounds that is essential to be highlighted is their culture. Certainly, they wittingly or not will bring the perspectives and values of their culture into their daily teaching practices. In other words, their cultural identities do shape how they teach their students. Cultural identities themselves actually consist of some elements, one of which is regional identity. Indeed, the culture of the region in which English teachers identify with has impact on their beliefs and actions during teaching. For this reason, this study aims to understand how the regional identity of English teachers influence the way they teach English to their students. This study is a qualitative study conducted in a multilingual and multicultural setting, namely Aceh, Indonesia. Here, four Acehnese English teachers were involved as the research participants. In addition, this study adopted poststructuralist perspective to identity as the theoretical framework. Three research instruments were used in this study, namely semi-structured interviews, classroom observation, and teacher journal. The data gained from these instruments were then analyzed by using thematic analysis. Obviously, the research about the regional identity of English teachers in English Language Teaching has been studied worldwide. However, little is still known about it in Indonesian context, let alone Indonesia itself is a super diverse country with 34 regions. As a result, this study presents a good opportunity to advance the knowledge of how the regional identity construction of English teachers in this setting is. The findings of the study revealed that their regional identity construction in teaching was highly influenced by their indigenous language and religious faith. Even, how they teach English in classroom, in fact, is related to these two things. The conclusion that can be drawn from this study is for these English teachers, in fact, their regional identity itself constitutes their use of local language and religious identity, which are considered by them as their core identity.

Keywords: English language teaching, English teachers, identity construction, regional identity

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2187 Air Breakdown Voltage Prediction in Post-arcing Conditions for Compact Circuit Breakers

Authors: Jing Nan

Abstract:

The air breakdown voltage in compact circuit breakers is a critical factor in the design and reliability of electrical distribution systems. This voltage determines the threshold at which the air insulation between conductors will fail or 'break down,' leading to an arc. This phenomenon is highly sensitive to the conditions within the breaker, such as the temperature and the distance between electrodes. Typically, air breakdown voltage models have been reliable for predicting failure under standard operational temperatures. However, in conditions post-arcing, where temperatures can soar above 2000K, these models face challenges due to the complex physics of ionization and electron behaviour at such high-energy states. Building upon the foundational understanding that the breakdown mechanism is initiated by free electrons and propelled by electric fields, which lead to ionization and, potentially, to avalanche or streamer formation, we acknowledge the complexity introduced by high-temperature environments. Recognizing the limitations of existing experimental data, a notable research gap exists in the accurate prediction of breakdown voltage at elevated temperatures, typically observed post-arcing, where temperatures exceed 2000K.To bridge this knowledge gap, we present a method that integrates gap distance and high-temperature effects into air breakdown voltage assessment. The proposed model is grounded in the physics of ionization, accounting for the dynamic behaviour of free electrons which, under intense electric fields at elevated temperatures, lead to thermal ionization and potentially reach the threshold for streamer formation as Meek's criterion. Employing the Saha equation, our model calculates equilibrium electron densities, adapting to the atmospheric pressure and the hot temperature regions indicative of post-arc temperature conditions. Our model is rigorously validated against established experimental data, demonstrating substantial improvements in predicting air breakdown voltage in the high-temperature regime. This work significantly improves the predictive power for air breakdown voltage under conditions that closely mimic operational stressors in compact circuit breakers. Looking ahead, the proposed methods are poised for further exploration in alternative insulating media, like SF6, enhancing the model's utility for a broader range of insulation technologies and contributing to the future of high-temperature electrical insulation research.

Keywords: air breakdown voltage, high-temperature insulation, compact circuit breakers, electrical discharge, saha equation

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2186 Utilizing Artificial Intelligence to Predict Post Operative Atrial Fibrillation in Non-Cardiac Transplant

Authors: Alexander Heckman, Rohan Goswami, Zachi Attia, Paul Friedman, Peter Noseworthy, Demilade Adedinsewo, Pablo Moreno-Franco, Rickey Carter, Tathagat Narula

Abstract:

Background: Postoperative atrial fibrillation (POAF) is associated with adverse health consequences, higher costs, and longer hospital stays. Utilizing existing predictive models that rely on clinical variables and circulating biomarkers, multiple societies have published recommendations on the treatment and prevention of POAF. Although reasonably practical, there is room for improvement and automation to help individualize treatment strategies and reduce associated complications. Methods and Results: In this retrospective cohort study of solid organ transplant recipients, we evaluated the diagnostic utility of a previously developed AI-based ECG prediction for silent AF on the development of POAF within 30 days of transplant. A total of 2261 non-cardiac transplant patients without a preexisting diagnosis of AF were found to have a 5.8% (133/2261) incidence of POAF. While there were no apparent sex differences in POAF incidence (5.8% males vs. 6.0% females, p=.80), there were differences by race and ethnicity (p<0.001 and 0.035, respectively). The incidence in white transplanted patients was 7.2% (117/1628), whereas the incidence in black patients was 1.4% (6/430). Lung transplant recipients had the highest incidence of postoperative AF (17.4%, 37/213), followed by liver (5.6%, 56/1002) and kidney (3.6%, 32/895) recipients. The AUROC in the sample was 0.62 (95% CI: 0.58-0.67). The relatively low discrimination may result from undiagnosed AF in the sample. In particular, 1,177 patients had at least 1 AI-ECG screen for AF pre-transplant above .10, a value slightly higher than the published threshold of 0.08. The incidence of POAF in the 1104 patients without an elevated prediction pre-transplant was lower (3.7% vs. 8.0%; p<0.001). While this supported the hypothesis that potentially undiagnosed AF may have contributed to the diagnosis of POAF, the utility of the existing AI-ECG screening algorithm remained modest. When the prediction for POAF was made using the first postoperative ECG in the sample without an elevated screen pre-transplant (n=1084 on account of n=20 missing postoperative ECG), the AUROC was 0.66 (95% CI: 0.57-0.75). While this discrimination is relatively low, at a threshold of 0.08, the AI-ECG algorithm had a 98% (95% CI: 97 – 99%) negative predictive value at a sensitivity of 66% (95% CI: 49-80%). Conclusions: This study's principal finding is that the incidence of POAF is rare, and a considerable fraction of the POAF cases may be latent and undiagnosed. The high negative predictive value of AI-ECG screening suggests utility for prioritizing monitoring and evaluation on transplant patients with a positive AI-ECG screening. Further development and refinement of a post-transplant-specific algorithm may be warranted further to enhance the diagnostic yield of the ECG-based screening.

Keywords: artificial intelligence, atrial fibrillation, cardiology, transplant, medicine, ECG, machine learning

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2185 Audit Examining Maternity Assessment Suite Triage Compliance with Birmingham Symptom Specific Obstetric Triage System in a London Teaching Hospital

Authors: Sarah Atalla, Shubham Gupta, Kim Alipio, Tanya Maric

Abstract:

Background: Chelsea and Westminster Hospital have introduced the Birmingham Symptom Specific Obstetric Triage System (BSOTS) for patients who present acutely to the Maternity Assessment Suite (MAS) to prioritise care by urgency. The primary objective was to evaluate whether BSOTS was used appropriately to assess patients (defined as a 90% threshold). The secondary objective was to assess whether patients were seen within their designated triaged timeframe (defined as a 90% threshold). Methodology: MAS records were retrospectively reviewed for a randomly selected one-week period of data from 2020 (21/09/2020 - 27/09/2020). 189 patients presented to MAS during this time. Data were collected on the presenting complaint, time of attendance (divided into four time categories), and triage colour code for the urgency of a review by a doctor (red: immediately, orange: within 15 minutes, yellow: within 1 hour, green: within 4 hours). The number of triage waiting times that were breached and the outcome of the attendance was noted. Results: 49% of patients presenting to MAS during this time period were triaged, which therefore did not meet the 90% target. 67% of patients who were triaged were seen within their allocated timeframe as designated by their triage colour code, which therefore did not meet the 90% target. The most frequent reason for patient attendance was reduced fetal movements (30.5% of attendances). The busiest time of day (when most patients presented) was between 06:01-12:00, and this was also when the highest number of patients were not triaged (26 patients or 54% of patients presenting in this time category). The most used triage category (59%) was the green colour code (to be seen by a doctor within 4 hours), followed by orange (24%), yellow (14%), and red (3%). 45% of triaged patients were admitted, whilst 55% were discharged. 62% of patients allocated to the green triage category were discharged, as compared to 56% of yellow category patients, 27% of orange category patients, and 50% of red category patients. The time of patient presentation to the hospital was also associated with the level of urgency and outcome. Patients presenting from 12:01 to 18:00 were more likely to be discharged (72% discharged) compared to 00:01-06:00 where only 12.5% of patients were discharged. Conclusion: The triage system for assessing the urgency of acutely presenting obstetric patients is only being effectively utilised for 49% of patients. There is potential for enhancing the employment of the triage system to enable further efficiency and boost the promotion of patient safety. It is noted that MAS was busiest at 06:01 - 12:00 when there was also the highest number of non-triaged patients – this highlights some areas where we can improve, including higher levels of staffing, better use of BSOTS to triage patients, and patient education.

Keywords: birmingham, BSOTS, maternal, obstetric, pregnancy, specific, symptom, triage

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