Search results for: hospital site suitability

Authors: Ivan Maguire, Ciprian Briciu, Alan Barrett, Dara Kervick, Jens Ducrèe, Fiona Regan

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With the ever-increasing myriad of applications of which microfluidic devices are capable, reliable fluidic actuation development has remained fundamental to the success of these microfluidic platforms. There are a number of approaches which can be taken in order to integrate liquid actuation on microfluidic platforms, which can usually be split into two primary categories; active microvalves and passive microvalves. Active microvalves are microfluidic valves which require a physical parameter change by external, or separate interaction, for actuation to occur. Passive microvalves are microfluidic valves which don’t require external interaction for actuation due to the valve’s natural physical parameters, which can be overcome through sample interaction. The purpose of this paper is to illustrate how further improvements to past microvalve solutions can largely enhance systematic reliability and performance, with both novel active and passive microvalves demonstrated. Covered within this scope will be two alternative and novel microvalve solutions for centrifugal microfluidic platforms; a revamped pneumatic-dissolvable film active microvalve (PAM) strategy and a spray-on Sol-Gel based hydrophobic passive microvalve (HPM) approach. Both the PAM and the HPM mechanisms were demonstrated on a centrifugal microfluidic platform consisting of alternating layers of 1.5 mm poly(methyl methacrylate) (PMMA) (for reagent storage) sheets and ~150 μm pressure sensitive adhesive (PSA) (for microchannel fabrication) sheets. The PAM approach differs from previous SOLUBON™ dissolvable film methods by introducing a more reliable and predictable liquid delivery mechanism to microvalve site, thus significantly reducing premature activation. This approach has also shown excellent synchronicity when performed in a multiplexed form. The HPM method utilises a new spray-on and low curing temperature (70°C) sol-gel material. The resultant double layer coating comprises a PMMA adherent sol-gel as the bottom layer and an ultra hydrophobic silica nano-particles (SNPs) film as the top layer. The optimal coating was integrated to microfluidic channels with varying cross-sectional area for assessing microvalve burst frequencies consistency. It is hoped that these microvalving solutions, which can be easily added to centrifugal microfluidic platforms, will significantly improve automation reliability.

Keywords: centrifugal microfluidics, hydrophobic microvalves, lab-on-a-disc, pneumatic microvalves

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Authors: Brooke Sweeney, David White, Felix Amparano, Nick A. Clark, Amy R. Beck, Mathew Lindquist, Lora Edwards, Julie Vandal, Jennifer Lisondra, Katie Cox, Renee Arensberg, Allen Cummins, Jazmine Cedeno, Jason D. Fraser, Kelsey Dean, Helena H. Laroche, Cristina Fernandez

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Background: National organizations call for standardized pre-surgical requirements and education to optimize postoperative outcomes. Since 2017 our surgery program has used defined protocols and educational curricula pre- and post-surgery. In response to patient outcomes, our educational content was refined to include quizzes to assess patient knowledge and surgical preparedness. We aim to optimize adolescent pre-bariatric surgery preparedness by improving overall aggregate pre-surgical assessment performance from 68% to 80% within 12 months. Methods: A multidisciplinary improvement team was developed within the weight management clinic (WMC) of our tertiary care, free-standing children’s hospital. A manual has been utilized since 2017, with limitations in consistent delivery and patient uptake of information. The curriculum has been improved to include quizzes administered during WMC visits prior to bariatric surgery. The initial outcome measure is the pre-surgical quiz score of adolescents preparing for bariatric surgery. Process measure was the number of questions answered correctly to test the questions. Baseline performance was determined by a patient assessment survey of pre-surgical preparedness at patient visits. Plan-Do-Study-Act cycles (PDSA) included: 1) creation and implementation of a refined curriculum, 2) development of 5 new quizzes based upon learning objectives, and 3) improving provider-lead teaching and quiz administration within clinic workflow. Run charts assessed impact over time. Results: A total of 346 quiz questions were administered to 34 adolescents. The outcome measure improved from a baseline mean of 68% to 86% following PDSA 2 cycles, and it was sustained. Conclusion/Implication: Patient/family comprehension of surgical preparedness improved with standardized education via team member-led teaching and assessment using quizzes during pre-surgical clinic visits. The next steps include launching redesigned teaching materials with modules correlated to quizzes and assessment of comprehension and outcomes post-surgically.

Keywords: bariatric surgery, adolescent, clinic, pre-bariatric training

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Authors: Spencer Liu, William Chan, Marlena Komatz, Tommy Ramos, Mark Trentalange, Faye Rim, Dae Kim, Mary Kelly, Samuel Schuessler, Roberta Stack, Justas Lauzadis, Kathryn DelPizzo, Seth Waldman, Alexandra Sideris

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Background & Significance: The increasing prevalence of cannabis use in the United States has important safety considerations in the perioperative setting, as chronic or heavy preoperative cannabis use may increase the risk of intraoperative complications, postoperative nausea and vomiting (PONV), increased postoperative pain levels, and acute side effects associated with cannabis use cessation. In this retrospective chart review study, we sought to determine the prevalence of self-reported cannabis use in the past 5-years at a single institution in New York City. We hypothesized that there is an increasing prevalence of preoperative self-reported cannabis use among adult and adolescent patients undergoing orthopedic surgery. Methods: After IRB approval for this retrospective study, surgical cases performed on patients 12 years of age and older at the hospital’s main campus and two ambulatory surgery centers between January 1st, 2018, and December 31st, 2023, with preoperatively self-disclosed cannabis use entered in the social history intake form were identified using the tool SlicerDicer in Epic. Case and patient characteristics were extracted, and trends in utilization over time were assessed by the Cochran-Armitage trend test. Results: Overall, the prevalence of self-reported cannabis use increased from 6.6% in 2018 to 10.6% in 2023. By age group, the prevalence of self-reported cannabis use among adolescents remained consistently low (2018: 2.6%, 2023: 2.6%) but increased with significant evidence for a linear trend (p < 0.05) within every adult age group. Among adults, patients who were 18-24 years old (2018: 18%, 2023: 20.5%) and 25-34 years old (2018: 15.9%, 2023: 24.2%) had the highest prevalences of disclosure, whereas patients who were 75 years of age or older had the lowest prevalence of disclosure (2018: 1.9%, 2023: 4.6%). Patients who were 25-34 years old had the highest percent difference in disclosure rates of 8.3%, which corresponded to a 52.2% increase from 2018 to 2023. The adult age group with the highest percent change was patients who were 75 years of age or older, with a difference of 2.7%, which corresponded to a 142.1% increase from 2018 to 2023. Conclusions: These trends in preoperative self-reported cannabis use among patients undergoing orthopedic surgery have important implications for perioperative care and clinical outcomes. Efforts are underway to refine and standardize cannabis use data capture at our institution.

Keywords: orthopedic surgery, cannabis, postoperative pain, postoperative nausea

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Authors: Binaya Tamang, Buddhi R. Pokharel, Narayan Gautam, Puspa R. Dhakal, Yuresh Twayana

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Background and Objective: Microalbuminuria is often regarded as a sign of end-organ damage due to hypertension, with an increased risk for renal diseases. The present study was designed to find the prevalence of microalbuminuria in hypertensive patients by determining albumin creatinine ratio (ACR) and the association of ACR and microalbuminuria status with different stages and duration of hypertension (HTN). Also, to establish the correlation of systolic and diastolic blood pressure (SBP and DBP) with various parameters viz; ACR, urinary microalbumin (UMA), estimated glomerular filtration rate (eGFR), urinary creatinine (Ucreat), serum creatinine (Screat), and find out their significance among HTN and ACR status. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Internal Medicine, UCMS, Bhairahawa, Nepal from April 2019 to September 2019 after obtaining ethical approval from institutional review committee (IRC), UCMS. A total of 120 hypertensive patients were enrolled whose blood, and spot urine samples were taken. eGFR was calculated by using Cockcroft-Gault formula after determining Screat while ACR was calculated after measuring Ucreat and UMA from the spot urine sample. Creatinine was estimated from modified jaffes’ reaction, whereas urinary micro albumin was done by Mispa i3 analyzer. Data were analyzed by using SPSS. 20 using p-value ≤ 0.05 as statistically significant. Results: In our study, the highest enrolled were grade II HTN (36.7%) followed by normal (33.3%), grade I (20.8%) and grade III (9.2%). Evaluating the ACR status, 19.2% were microalbuminuria, and the rest were normal. Though the ACR status (normal and microalbuminuria) was not statistically significant with HTN status (P=0.860) and the duration of HTN status (P=0.165), 5 (45.5%) out of 11 grade III HTN were microalbuminuria and the prevalence was also higher for longer duration .i.e., more than 10 years. In microalbuminuria, both the SBP (p=0.023, r=0.471) and DBP (P=0.034, r= 0.444) were strongly and positively correlated with Screat, in contrast to eGFR, which was negatively but weakly correlated. With the significant difference between the HTN group, the mean ACR (P=0.047) and UMA (P=0.02) were found to be highest among grade III patients, i.e., 84.3 ± 113.3 mg/gm. and 88.4 ± 83.9 mg/l respectively. The mean eGFR (64.2 ± 24.8 vs 77.2 ± 18.1 ml/min) was considerably lower in microalbuminuria ( p=0.026) than the normal in contrast to the SBP (160 ± 33.7 vs. 146.6 ± 19.5 mm of Hg) which was significantly higher (P=0.008). Among the different BMI category, the mean ACR was found to be significantly different (P= 0.01) with the highest value in underweight (115.2 ± 51.5 mg/gm.) and lowest in overweight (31.8 ± 4.3 mg/gm.). Conclusion: The study recommends that the microalbuminuria can be a very useful and imperative predictor of deranged kidney functions in hypertensive patients. The high value of ACR and UMA in hypertensive patients along with significant increased Screat, SBP whereas decreased eGFR in microalbuminuria patients explicitly supports the above statement.

Keywords: albumin creatinine ratio, hypertension, microalbuminuria, renal disease

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Authors: Louise Penzenstadler, Tiphaine Robet, Radu Iuga, Daniele Zullino

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Context: The outpatient clinic of the psychiatric addiction service of Geneva University Hospital has been providing support to individuals affected by various narcotics for 30 years. However, the increasing consumption of crack cocaine in Geneva has presented a new challenge for the healthcare system. Research Aim: The aim of this research is to evaluate the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder. Methodology: The research utilizes a combination of quantitative and qualitative retrospective data analysis to evaluate the effectiveness of the outreach intervention. Findings: The data collected from October 2023 to December 2023 show that the outreach program successfully made 1,071 contacts with drug users and led to 15 new requests for care and enrollment in treatment. Patients expressed high satisfaction with the intervention, citing easy and rapid access to treatment and social support. Theoretical Importance: This research contributes to the understanding of the challenges and specific needs of a complex group of drug users who face severe health problems. It highlights the importance of outreach interventions in establishing trust, connecting users with care, and facilitating medication-assisted treatment for opioid addiction. Data Collection: Data was collected through the outreach program's interactions with drug users, including street outreach interventions and presence at locations frequented by users. Patient satisfaction surveys were also utilized. Analysis Procedures: The collected data was analyzed using both quantitative and qualitative methods. The quantitative analysis involved examining the number of contacts made, new requests for care, and treatment enrollment. The qualitative analysis focused on patient satisfaction and their perceptions of the intervention. Questions Addressed: The research addresses the following questions: What is the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder? How effective is the outreach program in connecting drug users with care and initiating medication-assisted treatment? Conclusion: The outreach program has proven to be an effective intervention in establishing trust with crack users, connecting them with care, and initiating medication-assisted treatment for opioid addiction. It has also highlighted the importance of addressing the specific challenges faced by this group of drug users.

Keywords: crack addiction, outreach treatment, peer intervention, polydrug use

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Authors: Harini Atturu, Divyani Byagari, Bindhu Rani Thumkunta, Sahitya Bammidi, Manasa Badveli

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Introduction: Biological, psychological and social domains influence the outcomes of pregnancy. The COVID19 pandemic had a significant effect on the psychological and social domains of pregnant women all over the world. Everyone has inherent coping mechanisms which ultimately determine the actual impact of such external stimulus on outcomes of pregnancy. This study aims to understand the coping strategies used by pregnant women to overcome the psychological impact of the first wave of the COVID 19 pandemic. Methods: Institutional ethics permission was sought. All pregnant women attending antenatal clinics in the institution during September 2020 were included in the study. Brief-COPE, a self-rated questionnaire, was provided to understand the coping strategies used by them. The Questionnaire consists of 28 questions that fall into 14 themes. These 14 themes were mapped into four domains consisting of Approaching coping (APC) styles, Avoidant Coping (AVC) styles, Humor and Religion. The results were analyzed using univariate and multivariate analysis. Factor analysis was performed to identify themes that are most frequently used. Results: 162 pregnant women were included in the study. The majority of the women were aged between 18 and 30 (90.1%). 60.9% of the respondents were having their first pregnancy and were in the 2nd trimester (59.6%). The majority of them were living in the city (74%), belonged to the middle class (77.6%) and were not working (70.1%). 56 respondents (34.6%) reported that they had contact with suspected or Covid positive patients. Many were worried that their pregnancy might be complicated (43%), their baby may contract COVID (45%) and their family members could get COVID during the hospital visits for antenatal check-ups. 33.6% of women admitted missing their regular antenatal check-ups because of the above concerns. All respondents used various coping strategies to overcome the psychological impact of COVID 19. Out of the 4 coping strategies, participants scored high on Religion with a mean of 5.471.45 followed by Approaching Coping (APC) styles (5.131.25), Humor (4.592.07) and Avoidant Coping (AVC) styles (4.130.88). Religion as a coping strategy scored high for all respondents irrespective of age, parity, trimester, social and employment status. Exploratory Factor analysis revealed two cluster groups that explained 68% of the variance, with Component 1 contributing to 58.9% and component 2 contributing 9.13% of the variance. Humor, Acceptance, Planning, and Religion were the top 4 factors that showed strong loadings. Conclusion: Most of the pregnant women were worried about the negative impact of COVID 19 on the outcomes of their pregnancy. Religion and Approaching coping styles seem to be the predominant coping strategies used by them. Interventionists and policymakers should consider these factors while providing support to such women.

Keywords: coping strategies, pregnancy, COVID-19, brief-COPE

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Authors: Teagan Fink, Lynn Chong, Michael Hii, Brett Knowles

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Background: Telemedicine is a rapidly advancing field providing healthcare to patients at a distance from their treating clinician. There is a paucity of high-quality evidence detailing the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial – conducted prior to the COVID 19 pandemic – aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) of telephone compared to face-to-face clinic follow-up after uncomplicated general surgical procedures. Methods: Patients following uncomplicated laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic follow-up. Data points including patient demographics, perioperative details and postoperative outcomes (eg. wound healing complications, pain scores, unplanned readmission to hospital and return to daily activities) were compared between groups. Patients also completed a Likert patient satisfaction survey following their consultation. Results: 103 patients were recruited over a 12-month period (21 laparoscopic appendicectomies, 65 laparoscopic cholecystectomies, nine open umbilical hernia repairs, six laparoscopic inguinal hernia repairs and two laparoscopic umbilical hernia repairs). Baseline patient demographics and operative interventions were the same in both groups. Patient or clinician-reported concerns on postoperative pain, use of analgesia, wound healing complications and return to daily activities at clinic follow-up were not significantly different between the two groups. Of the 58 patients randomized to the telemedicine arm, 40% reported high and 60% reported very high patient satisfaction. Telemedicine clinic mean consultation times were significantly shorter than face-to-face consultation times (telemedicine 10.3 +/- 7.2 minutes, face-to-face 19.2 +/- 23.8 minutes, p-value = 0.014). Rates of failing to attend clinic were not significantly different (telemedicine 3%, control 6%). There was no increased rate of postoperative complications in patients followed up by telemedicine compared to in-person. There were no unplanned readmissions, return to theatre, or mortalities in this study. Conclusion: Telemedicine follow-up of patients undergoing uncomplicated general surgery is safe and does not result in any missed diagnosis or higher rates of complications. Telemedicine provides high patient satisfaction and steps to implement this modality in inpatient care should be undertaken.

Keywords: general surgery, telemedicine, patient satisfaction, patient safety

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Authors: Ashok Kumar Rastogi

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Glass is a material commonly used for Glassdoor, glass bottles, cookware, and containers. It can be harmful, as it is a hard and blunt object. Glass has been associated with severe injury and is a common cause of injuries warranting hospital visits to the emergency department (ED). These injuries can be accidental or intentionally inflicted. Broken glass injuries can be severe, even deadly. If broken glass shards fall out on your arm, it may cause fatal injuries. Case history: A 20-year-old male dead body was found aside the road, police informed, and a video recording ceased during an investigation. In the video recording, the person was in a drunken state (unable to walk and disoriented), wandering in the residential area road. He saw a barber shop, the shop door made of Glass. Suddenly, he hit the Glassdoor with his right hand forcefully. The Glassdoor broke into multiple pieces, and multiple injuries were seen over the right hand. Observations: Multiple small and large lacerations were seen over the right anterior part of the elbow. The main injury looked like an incised wound caused by a hard and sharp object. The main injury was noted as a laceration of size 13 x 06 cm bone deep, placed obliquely over the anteromedial aspect of the right elbow joint, its medial end at medial end of elbow joint while its anterior end was 04 cm below the elbow joint with laceration of underline brachialis muscles and complete transaction of ulnar artery and vein, skin margins looking sharply cut with irregular margins with tiny cuts at the medial lower border of laceration. Injuries were antemortem and fresh in nature, caused by hard and blunt objects but looking like hard and sharp objects. All organs were found pale, and the cause of death was shock and hemorrhage because of ulnar vessel injury. Conclusion: The findings of this case report highlight the potentially lethal consequences of glass injuries, especially those involving Glassdoors. The study underscores the importance of accurate interpretation and identification of wounds caused by Glass, as they may resemble injuries caused by other objects. It emphasizes the challenges faced by autopsy surgeons when determining the cause and manner of death in cases where visual evidence of injury is absent or when the weapon is not recovered. Ultimately, this case report serves as a reminder of the potential dangers posed by Glass and the importance of comprehensive forensic examinations.

Keywords: glassdoor, incised, wound, laceration, autopsy

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Authors: Sanjay Singh, Parameswara Rao Vuddanda

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The aim of the present study is study the factual benefit of nano size and surface coating of p-gp efflux inhibitor on enhancement of bioavailability of Berberine chloride (BBR); a p-gp substrate. In addition, 28 days sub acute oral toxicity study was also conducted to assess the toxicity of the formulation on chronic administration. BBR loaded polymeric nanoparticles (BBR-NP) were prepared by nanoprecipitation method. BBR NP were surface coated (BBR-SCNP) with the 1 % w/v of vitamin E TPGS. For bioavailability study, total five groups (n=6) of rat were treated as follows first; pure BBR, second; physical mixture of BBR, carrier and vitamin E TPGS, third; BBR-NP, fourth; BBR-SCNP and fifth; BBR and verapamil (widely used p-gp inhibitor). Blood was withdrawn at pre-set timing points in 24 hrs study and drug was quantified by HPLC method. In oral chronic toxicity study, total four groups (n=6) were treated as follows first (control); water, second; pure BBR, third; BBR surface coated nanoparticles and fourth; placebo BBR surface coated nanoparticles. Biochemical levels of liver (AST, ALP and ALT) and kidney (serum urea and creatinine) along with their histopathological studies were also examined (0-28 days). The AUC of BBR-SCNP was significantly 3.5 folds higher compared to all other groups. The AUC of BBR-NP was 3.23 and 1.52 folds higher compared to BBR solution and BBR with verapamil group, respectively. The physical mixture treated group showed slightly higher AUC than BBR solution treated group but significantly low compared to other groups. It indicates that encapsulation of BBR in nanosize form can circumvent P-gp efflux effect. BBR-NP showed pharmacokinetic parameters (Cmax and AUC) which are near to BBR-SCNP. However, the difference in values of T1/2 and clearance indicate that surface coating with vitamin E TPGS not only avoids the P-gp efflux at its absorption site (intestine) but also at organs which are responsible for metabolism and excretion (kidney and liver). It may be the reason for observed decrease in clearance of BBR-SCNP. No toxicity signs were observed either in biochemical or histopathological examination of liver and kidney during toxicity studies. The results indicate that administration of BBR in surface coated nanoformulation would be beneficial for enhancement of its bioavailability and longer retention in systemic circulation. Further, sub acute oral dose toxicity studies for 28 days such as evaluation of intestine, liver and kidney histopathology and biochemical estimations indicated that BBR-SCNP developed were safe for long use.

Keywords: bioavailability, berberine nanoparticles, p-gp efflux inhibitor, nanoprecipitation method

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Authors: Maphuti Georgina Kwata

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Coal mining in Mpumalanga Province is known of contributing to the atmospheric pollution from various activities. Gold mining in North-West Province is known of also contributing to the atmospheric pollution especially with the production of radon gas. In this research directional dust deposition gauge was used to measure source of direction and meteorological data was used to determine the wind rose blowing and the influence of the seasonal changes. Fourteen months of dust collection was undertaken in Witbank Area and Carletonville Area. The results shows that the sources of direction for Ericson Dam its East in February 2010 and Tip Area shows that the source of direction its West in October 2010. In the East direction there were mining operations, power stations which contributed to the East to be the sources of direction. In the West direction there were smelters, power stations and agricultural activities which contributed for the source of direction to be the West direction for Driefontein Mine: East Recreational Village Club. The East of Leslie Williams hospital is the source of direction which also indicated that there dust generating activities such as mining operation, agricultural activities. The meteorological results for Emalahleni Area in summer and winter the wind rose blow with wind speed of 5-10 ms-1 from the East sector. Annual average for the wind rose blow its East South eastern sector with 20 ms-1 and day time the wind rose from northwestern sector with excess of 20 ms-1. The night time wind direction East-eastern direction with a maximum wind speed of 20 ms-1. The meteorogical results for Driefontein Mine show that North-western sector and north-eastern sector wind rose is blowing with 5-10 ms-1 win speed. Day time wind blows from the West sector and night time wind blows from the north sector. In summer the wind blows North-east sector with 5-10 ms-1 and winter wind blows from North-west and it’s also predominant. In spring wind blows from north-east. The conclusion is that not only mining operation where the directional dust deposit gauge were installed contributed to the source of direction also the power stations, smelters, and other activities nearby the mining operation contributed. The recommendations are the dust suppressant for unpaved roads should be used on a regular basis and there should be monitoring of the weather conditions (the wind speed and direction prior to blasting to ensure minimal emissions).

Keywords: directional dust deposition gauge, BS part 5 1747 dust deposit gauge, wind rose, wind blowing

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Authors: N. Pritchard

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Within architectural education, students arrive fore-armed with; their life-experience; knowledge gained from subject-based learning; their brains and more specifically their imaginations. The learning-by-doing that they embark on in studio-based/project-based learning calls for supervision that allows the student to proactively undertake research and experimentation with design solution possibilities. The degree to which this supervision includes direction is subject to debate and differing opinion. It can be argued that if the student is to learn-by-doing, then design decision making within the design process needs to be instigated and owned by the student so that they have the ability to personally reflect on and evaluate those decisions. Within this premise lies the problem that the student's endeavours can become unstructured and unfocused as they work their way into a new and complex activity. A resultant weakness can be that the design activity is compartmented and not holistic or comprehensive, and therefore, the student's reflections are consequently impoverished in terms of providing a positive, informative feedback loop. The construct proffered in this paper is that a supportive 'armature' or 'Heuristic-Framework' can be developed that facilitates a holistic approach and reflective learning. The normal explorations of architectural design comprise: Analysing the site and context, reviewing building precedents, assimilating the briefing information. However, the student can still be compromised by 'not knowing what they need to know'. The long-serving triad 'Firmness, Commodity and Delight' provides a broad-brush framework of considerations to explore and integrate into good design. If this were further atomised in subdivision formed from the disparate aspects of architectural design that need to be considered within the design process, then the student could sieve through the facts more methodically and reflectively in terms of considering their interrelationship conflict and alliances. The words facts and sieve hold the acronym of the aspects that form the Heuristic-Framework: Function, Aesthetics, Context, Tectonics, Spatial, Servicing, Infrastructure, Environmental, Value and Ecological issues. The Heuristic could be used as a Hermeneutic Model with each aspect of design being focused on and considered in abstraction and then considered in its relation to other aspect and the design proposal as a whole. Importantly, the heuristic could be used as a method for gathering information and enhancing the design brief. The more poetic, mysterious, intuitive, unconscious processes should still be able to occur for the student. The Heuristic-Framework should not be seen as comprehensive prescriptive formulaic or inhibiting to the wide exploration of possibilities and solutions within the architectural design process.

Keywords: atomistic, hermeneutic, holistic, approach architectural design studio education

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Authors: Rohit Kothari

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Background: Leprosyis a chronic granulomatous diseasecaused by Mycobacterium leprae (M. Lepra). Reactions may interrupt its usual chronic course.Type-1 (T1R)and type-2 lepra reaction(T2R) are acute events and signifytype-IV and type-III hypersensitivity responses, respectively. Various chemokines like CCL3, 5, 11, and CCL24 may be increased during the course of leprosy or during reactions and may serve as markers of early diagnosis, response to therapy, and prognosis. Objective: To find correlation of CCL3, 5, 11, and CCL24 in leprosy patients on multidrug therapy and their family contacts after ruling out active disease during leprosy treatment and during periods of lepra reactions. Methodology: This randomized control trial was conducted in 50 clinico-histopathologically diagnosed cases of leprosy in a tertiary care hospital in Bengaluru, India. 50 of their family contacts were adequately examined and investigated should the need be to rule out active disease. The two study-groups comprised of leprosy cases, and the age, sex, and area of residence matched healthy contactswho were given single-dose rifampicin prophylaxis, respectively. Blood samples were taken at baseline, six months, and after one yearin both the groups (on completion of MDT in leprosy cases)and also during periods of reaction if occurred in leprosy cases. Results: Our study found that at baseline, CCL5, 11, and 24 were higher in leprosy cases as compared to the healthy contacts, and the difference was statistically significant.CCL3 was also found to be higherat baseline in leprosy cases, however, the difference was not statistically significant. At six months and one year, the levels of CCL 5, 11, and 24 reduced, and the difference was statistically significant in leprosy cases, whereas it remained almost static in all the healthy contacts. Twenty patients of leprosy developed lepra reaction during the course of one year, and during reaction, the increase in CCL11 and 24 was statistically significant from baseline, whereas CCL3 and 5 did not rise significantly. One of the healthy contacts developed signs of leprosy in the form of hypopigmented numb patch and was clinico-histopathologically, and CCL11 and 24 were found to be higher with a statistically significant difference from the baseline values. Conclusion: CCL5, 11, and 24 are sensitive markers of diagnosing leprosy, response to MDT, and prognosis and are not increased in healthy contacts. CCL11 and 24 are sensitive markers of lepra reactions and may serve as one of the early diagnostic modalities for identifying lepra reaction and also leprosy in healthy contacts. To the best of our knowledge, this is the first study to evaluate these biomarkers in leprosy cases and their healthy contacts with a follow-up of upto one year with one of them developing the disease, and the same was confirmed based on these biomarkers as well.

Keywords: chemokine profile, healthy contacts, leprosy, lepra reactions

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Authors: Bruno Tassin, Robin Treilles, Cleo Stratmann, Minh Trang Nguyen, Sam Azimi, Vincent Rocher, Rachid Dris, Johnny Gasperi

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Microplastics (<5mm) in the environment and in hydro systems is one of the major present environmental issues. Over the last five years a research programme was conducted in order to assess the behavior of microplastics in the Seine river catchment, in a Man-Land-Sea continuum approach. Results show that microplastic concentration varies at the seasonal scale, but also at much smaller scales, during flood events and with tides in the estuary for instance. Moreover, microplastic sampling and characterization issues emerged throughout this work. The Seine river is a 750km long river flowing in Northwestern France. It crosses the Paris megacity (12 millions inhabitants) and reaches the English Channel after a 170 km long estuary. This site is a very relevant one to assess the effect of anthropogenic pollution as the mean river flow is low (mean flow around 350m³/s) while the human presence and activities are very intense. Monthly monitoring of the microplastic concentration took place over a 19-month period and showed significant temporal variations at all sampling stations but no significant upstream-downstream increase, indicating a possible major sink to the sediment. At the scale of a major flood event (winter and spring 2018), microplastic concentration shows an evolution similar to the well-known suspended solids concentration, with an increase during the increase of the flow and a decrease during the decrease of the flow. Assessing the position of the concentration peak in relation to the flow peak was unfortunately impossible. In the estuary, concentrations vary with time in connection with tides movements and in the water column in relation to the salinity and the turbidity. Although major gains of knowledge on the microplastic dynamics in the Seine river have been obtained over the last years, major gaps remain to deal mostly with the interaction with the dynamics of the suspended solids, the selling processes in the water column and the resuspension by navigation or shear stress increase. Moreover, the development of efficient chemical characterization techniques during the 5 year period of this pluriannual research programme led to the improvement of the sampling techniques in order to access smaller microplastics (>10µm) as well as larger but rare ones (>500µm).

Keywords: microplastics, Paris megacity, seine river, suspended solids

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Authors: Alexandru Achim, Tamás Szűcsborus, Viktor Sasi, Ferenc Nagy, Zoltán Jambrik, Attila Nemes, Albert Varga, Călin Homorodean, Olivier F. Bertrand, Zoltán Ruzsa

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Aim: Our study aimed to establish the safety and the technical success of distal radial access for balloon aortic valvuloplasty (DR-BAV). The secondary objective was to determine the effectiveness and appropriate role of DR-BAV within half year follow-up. Methods: Clinical and angiographic data from 32 consecutive patients with symptomatic aortic stenosis were evaluated in a prospective pilot single-center study. Between 2020 and 2021, the patients were treated utilizing dual distal radial access with 6-10F compatible balloons. The efficacy endpoint was divided into technical success (successful valvuloplasty balloon inflation at the aortic valve and absence of intra- or periprocedural major complications), hemodynamic success (a reduction of the mean invasive gradient >30%), and clinical success (an improvement of at least one clinical category in the NYHA classification). The safety endpoints were vascular complications (major and minor Valve Academic Research Consortium (VARC)-2 bleeding, diminished or lost arterial pulse or the presence of any pseudo-aneurysm or arteriovenous fistula during the clinical follow-up) and major adverse events, MAEs (the composite of death, stroke, myocardial infarction, and urgent major aortic valve replacement or implantation during the hospital stay and or at one-month follow-up). Results: 32 patients (40 % male, mean age 80 ± 8,5) with severe aortic valve stenosis were included in the study and 4 patients were excluded. Technical success was achieved in all patients (100%). Hemodynamic success was achieved in 30 patients (93,75%). Invasive max and mean gradients were reduced from 73±22 mm Hg and 49±22 mm Hg to 49±19 mm Hg and 20±13 mm Hg, respectively (p = <.001). Clinical success was achieved in 29 patients (90,6%). In total, no major adverse cardiac or cerebrovascular event nor vascular complications (according to VARC 2 criteria) occurred during the intervention. All-cause death at 6 months was 12%. Conclusion: According to our study, dual distal radial artery access is a safe and effective option for balloon aortic valvuloplasty in patients with severe aortic valve stenosis and can be performed in all patients with sufficient lumen diameter. Future randomized studies are warranted to investigate whether this technique is superior to other approaches.

Keywords: mean invasive gradient, distal radial access for balloon aortic valvuloplasty (DR-BAV), aortic valve stenosis, pseudo-aneurysm, arteriovenous fistula, valve academic research consortium (VARC)-2

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Authors: Shu Jiuan Chen, Shu Fen Wu, I. Ling Tsai, Chia Yu Chen, Yen Lin Liu, Chen-Fuh Lam

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Background: Increased emotional stress in workplace and depressed job satisfaction may significantly affect the turnover intention and career life of personnel. However, very limited studies have reported the factors influencing the turnover intention of the surgical team members in the operating rooms, where extraordinary stress is normally exit in this isolated medical care unit. Therefore, this study aimed to determine the environmental and personal characteristic factors that might be associated with job satisfaction and turnover intention in the non-physician staff who work in the operating rooms. Methods: This was a cross-sectional, descriptive study performed in a metropolitan teaching hospital in southern Taiwan between May 2017 to July 2017. A structured self-administered questionnaire, modified from the Practice Environment Scale of the Nursing Work Index (PES-NWI), Occupational Stress Indicator-2 (OSI-2) and Maslach Burnout Inventory (MBI) manual was collected from the operating room nurses, nurse anesthetists, surgeon assistants, orderly and other non-physician staff. Numerical and categorical data were analyzed using unpaired t-test and Chi-square test, as appropriate (SPSS, version 20.0). Results: A total of 167 effective questionnaires were collected from 200 eligible, non-physician personnel who worked in the operating room (response rate 83.5%). The overall satisfaction of all responders was 45.64 ± 7.17. In comparison to those who had more than 4-year working experience in the operating rooms, the junior staff ( ≤ 4-year experience) reported to have significantly higher satisfaction in workplace environment and job contentment, as well as lower intention to quit (t = 6.325, P =0.000). Among the different specialties of surgical team members, nurse anesthetists were associated with significantly lower levels of job satisfaction (P=0.043) and intention to stay (x² = 8.127, P < 0.05). Multivariate regression analysis demonstrates job title, seniority, working shifts and job satisfaction are the significant independent predicting factors for quit jobs. Conclusion: The results of this study highlight that increased work seniorities ( > 4-year working experience) are associated with significantly lower job satisfaction, and they are also more likely to leave their current job. Increased workload in supervising the juniors without appropriate job compensation (such as promotions in job title and work shifts) may precipitate their intention to quit. Since the senior staffs are usually the leaders and core members in the operating rooms, the retention of this fundamental manpower is essential to ensure the safety and efficacy of surgical interventions in the operating rooms.

Keywords: surgical team, job satisfaction, resignation intention, operating room

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Authors: Eliza Torrigue, Efrelyn Iellamo

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Maternal death is one of the rising health issues in the Philippines. It is alarming to know that in every hour of each day, a mother gives birth to a child who may not live to see the next day. Statistics shows that intrapartum period and third stage of labor are the very crucial periods for the expectant mother, as well as the first six hours of life for the newborn. To address the issue, The Essential Intrapartum Newborn Care (EINC) was developed. Through this, Obstetric Delivery Room (OB-DR) Nurses shall be updated with the evidence-based maternal and newborn care to ensure patient safety, thus, reducing maternal and child mortality. This study aims to describe the compliance of hospitals, especially of OB-DR nurses, to the EINC Protocols. The researcher aims to link the profile variables of the respondents in terms of age, length of service and formal training to their compliance on the EINC Protocols. The outcome of the study is geared towards the development of appropriate training program for OB-DR Nurses assigned in the delivery room of the hospitals based on the study’s results to sustain the EINC standards. A descriptive correlational method was used. The sample consists of 75 Obstetric Delivery Room (OB-DR) Nurses from three government hospitals in the City of Manila namely, Ospital ng Maynila Medical Center, Tondo Medical Center, and Gat Andres Bonifacio Memorial Medical Center. Data were collected using an evaluative checklist. Ranking, weighted mean, Chi-square and Pearson’s R were used to analyze data. The level of compliance to the EINC Protocols by the respondents was evaluated with an overall mean score of 4.768 implying that OB-DR Nurses have a high regard in complying with the step by step procedure of the EINC. Furthermore, data shows that formal training on EINC have a significant relationship with OB-DR Nurses’ level of compliance during cord care, AMTSL, and immediate newborn care until the first ninety minutes to six hours of life. However, the respondents’ age and length of service do not have a significant relationship with the compliance of OB-DR Nurses on EINC Protocols. In the pursuit of decreasing the maternal mortality in the Philippines, EINC Protocols have been widely implemented in the country especially in the government hospitals where most of the deliveries happen. In this study, it was found out that OB-DR Nurses adhere and are highly compliant to the standards in order to assure that optimum level of care is delivered to the mother and newborn. Formal training on EINC, on the other hand, create the most impact on the compliance of nurses. It is therefore recommended that there must be a structured enhancement training program to plan, implement and evaluate the EINC protocols in these government hospitals.

Keywords: compliance, intrapartum, newborn care, nurses

Procedia PDF Downloads 377

Authors: Akulov M. A., Orlova O. R., Zaharov V. O., Tomskij A. A.

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Introduction: One of the common postoperative complications of posterior cranial fossa (PCF) and cerebello-pontine angle tumor treatment is a facial nerve palsy, which leads to multiple and resistant to treatment impairments of mimic muscles structure and functions. After 4-6 months after facial nerve palsy with insufficient therapeutic intervention patients develop a postparalythic syndrome, which includes such symptoms as mimic muscle insufficiency, mimic muscle contractures, synkinesis and spontaneous muscular twitching. A novel method of treatment is the use of a recent local neuromuscular blocking agent– botulinum toxin A (BTA). Experience of BTA treatment enables an assumption that it can be successfully used in late facial nerve palsy complications to significantly increase quality of life of patients. Study aim. To evaluate the efficacy of botulinum toxin A (BTA) (Xeomin) treatment in patients with late facial nerve palsy complications. Patients and Methods: 31 patients aged 27-59 years 6 months after facial nerve palsy development were evaluated. All patients received conventional treatment, including massage, movement therapy etc. Facial nerve palsy developed after acoustic nerve tumor resection in 23 (74,2%) patients, petroclival meningioma resection – in 8 (25,8%) patients. The first group included 17 (54,8%) patients, receiving BT-therapy; the second group – 14 (45,2%) patients continuing conventional treatment. BT-injections were performed in synkinesis or contracture points 1-2 U on injured site and 2-4 U on healthy side (for symmetry). Facial nerve function was evaluated on 2 and 4 months of therapy according to House-Brackman scale. Pain syndrome alleviation was assessed on VAS. Results: At baseline all patients in the first and second groups demonstrated аpostparalytic syndrome. We observed a significant improvement in patients receiving BTA after only one month of treatment. Mean VAS score at baseline was 80,4±18,7 and 77,9±18,2 in the first and second group, respectively. In the first group after one month of treatment we observed a significant decrease of pain syndrome – mean VAS score was 44,7±10,2 (р<0,01), whereas in the second group VAS score was as high as 61,8±9,4 points (p>0,05). By the 3d month of treatment pain syndrome intensity continued to decrease in both groups, but, the first group demonstrated significantly better results; mean score was 8,2±3,1 and 31,8±4,6 in the first and second group, respectively (р<0,01). Total House-Brackman score at baseline was 3,67±0,16 in the first group and 3,74±0,19 in the second group. Treatment resulted in a significant symptom improvement in the first group, with no improvement in the second group. After 4 months of treatment House-Brockman score in the first group was 3,1-fold lower, than in the second group (р<0,05). Conclusion: Botulinum toxin injections decrease postparalytic syndrome symptoms in patients with facial nerve palsy.

Keywords: botulinum toxin, facial nerve palsy, postparalytic syndrome, synkinesis

Procedia PDF Downloads 280

Authors: M. De Iuliis, O. Kammouh, G. P. Cimellaro, S. Tesfamariam

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Community Resilience has gained a significant attention due to the recent unexpected natural and man-made disasters. Resilience is the process of maintaining livable conditions in the event of interruptions in normally available services. Estimating the resilience of systems, ranging from individuals to communities, is a formidable task due to the complexity involved in the process. The most challenging parameter involved in the resilience assessment is the 'downtime'. Downtime is the time needed for a system to recover its services following a disaster event. Estimating the exact downtime of a system requires a lot of inputs and resources that are not always obtainable. The uncertainties in the downtime estimation are usually handled using probabilistic methods, which necessitates acquiring large historical data. The estimation process also involves ignorance, imprecision, vagueness, and subjective judgment. In this paper, a fuzzy-based approach to estimate the downtime of building structures following earthquake events is proposed. Fuzzy logic can integrate descriptive (linguistic) knowledge and numerical data into the fuzzy system. This ability allows the use of walk down surveys, which collect data in a linguistic or a numerical form. The use of fuzzy logic permits a fast and economical estimation of parameters that involve uncertainties. The first step of the method is to determine the building’s vulnerability. A rapid visual screening is designed to acquire information about the analyzed building (e.g. year of construction, structural system, site seismicity, etc.). Then, a fuzzy logic is implemented using a hierarchical scheme to determine the building damageability, which is the main ingredient to estimate the downtime. Generally, the downtime can be divided into three main components: downtime due to the actual damage (DT1); downtime caused by rational and irrational delays (DT2); and downtime due to utilities disruption (DT3). In this work, DT1 is computed by relating the building damageability results obtained from the visual screening to some already-defined components repair times available in the literature. DT2 and DT3 are estimated using the REDITM Guidelines. The Downtime of the building is finally obtained by combining the three components. The proposed method also allows identifying the downtime corresponding to each of the three recovery states: re-occupancy; functional recovery; and full recovery. Future work is aimed at improving the current methodology to pass from the downtime to the resilience of buildings. This will provide a simple tool that can be used by the authorities for decision making.

Keywords: resilience, restoration, downtime, community resilience, fuzzy logic, recovery, damage, built environment

Procedia PDF Downloads 151

Authors: Manal Anis, Bin Bakhti Sayeed

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With the encroachment of automobile upon our communities for decades and the concomitant urban sprawl resulting in a loss of public place, it was only a matter of time before people, realizing the role of streets in stimulating urban prosperity, would start reclaiming them to rebuild their communities. In order for this restoration of communities to take effect it is imperative that streets be freed from the dominance of motor vehicles. A holistic approach to pedestrian-friendly street environment can help build communities that embody the cities in which they are found. While the developed countries are finding more and more innovative ways to integrate walkable streets to foster communal living, the developing countries still have a long way to go. Since Dhaka is still struggling to balance the growing needs of accommodating automobiles for increased population with the loss of urban community life that comes with it, it is high time that alternate approaches are looked into. This study aims to understand streets as a living corridor through which one discovers and identifies with the city. The research area is chosen to be Manik Mia Avenue, overlooking the South Plaza of the National Parliament Building in Dhaka city. Being the site of supreme power, it is precisely this symbolic importance that the National Parliament Building has in the psyche of Bangladeshis, which has given Manik Mia Avenue a significant place in the country’s history. Above all, being an avenue it is essentially a neutral territory, universally accessible, inclusive and pluralist. The needs of the Avenue’s frequent users are analyzed with the help of a multi-method approach to survey consisting of an empirical study, a questionnaire survey and interview with relevant users. The research then tries to understand the concept of walkability by exploring the different ways in which the built environment influences walking. For this analysis, the six dimensions of Matthew Carmona are taken as a guideline for a holistic approach toward the different interacting facets of an urban public space. Based on the studies, a set of criteria is proposed to evaluate, plan and design streets that are more contextual in nature. The study concludes with how the existing street patterns of Dhaka city can be rethought and redesigned to cater to peoples’ need for a public place. The proposal is meant to be an inspiration for further studies in this respect in the context of Bangladesh.

Keywords: public space, six dimensions, street, urban, walkability

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Authors: Işın Alkan, Meltem Kürtüncü

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Objective: This study was carried out with an experimental design in order to determine whether the lullaby, which was listened from mother’s voice and a stranger’s voice to the babies born at term and hospitalized in neonatal intensive care unit, had an effect on saturation values (SpO2), peak heart rate (PHR), respiration, fever, growth and development and hospitalization times of the infants. Method: Data from the study were obtained from 90 newborn babies who were hospitalized in Neonatal Intensive Care Unit of Zonguldak Maternity And Children Hospital between September 2015-January 2016 and who met the eligibility criteria. Lullaby concert was performed by choosing one of the suitable care hours. SpO2, PHR, respiration, fever, growth and development and hospitalization times of the infants were recorded by the researcher on “Newborn response follow-up form” at pre-care and post-care. Vital signs of babies every day, weight, height and head circumference measurements at admission, weakly rated at an output. Results: In the experimental and control groups, like weight, height and head circumference anthropometric measurements were not found statistically significant difference intensive care units admission and output times. Hospitalization times on babies who listen to lullaby mother’s voice revealed statistically significant difference according to babies who listen to lullaby stranger’s voice. Before care and after care were examined, SpO2 rates of babies who listen to lullaby mother’s voice revealed statistically significant higher difference according to babies who listen to lullaby stranger’s voice and control group babies. Before care on PHR of babies in three groups were not found the statistical difference, but aftercare, it was found that statistically lower (normal range) on babies who listen to lullaby mother’s voice according to babies who listen to lullaby stranger’s voice. Before care in three groups were not found the statistical difference on respiration values of babies, but aftercare, it was found that statistically lower (normal range) on babies who listen to lullaby stranger’s voice according to babies who listen to mother’s voice and control groups. Before care and after care were examined, fever signs did not reveal statistically significant difference in three groups. Conclusion: Lullaby concerts as being normal ranges of vital signs of infants and also helping to shorten hospitalization times should be preferred in the neonatal intensive care units.

Keywords: growth and development, lullaby, mother voice, vital signs

Procedia PDF Downloads 200

Authors: Mary Bernardin, Margie Batek, Joseph Moen, David Schnadower

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Background: Exposure to violence not only has negative psychological impact on children but is a risk factor for children becoming recurrent victims of violence. However, little is known regarding the degree to which child victims of violence are exposed to trauma at home and in their community, or its association with specific psychological diagnoses. Objective: The aims of this study were to perform in-depth characterizations of family, community and psychological wellness amongst pediatric victims of interpersonal violence. Methods: As standard of care at the Saint Louis Children’s Hospital pediatric emergency department (ED), social workers perform in-depth interviews with all children presenting due to violent interpersonal encounters. In this retrospective cross-sectional study, we collected data from social work interviews on family structure, exposure to violence in the community and the home, as well as history of psychological diagnoses amongst children ages 8-19 years who presented to the ED for injuries related to interpersonal violence from 2014-2017. Results: A total of 407 patients presenting to the ED for an interpersonal violent encounter were analyzed. The average age of studied youths was 14.7 years (SD 2.5). Youths were 97.5% African American ethnicity and 66.6% male. 67.8% described their home having a nonnuclear family structure, 50% of which reported living with a single mother. Of the 21% who reported having incarcerated family members, 56.3% reported their father being incarcerated, 15% reported their mother being incarcerated, and 12.5% reported multiple family members being incarcerated. 11.3% reported witnessing domestic violence in their home. 12.8% of youths reported some form of child abuse. The type of child abuse was not specified in 29.3% of cases, but physical abuse (32.8%) followed by sexual abuse (22.4%) were the most commonly reported. 14.5% had history of placement in foster care and/or adoption. 64% reported having witnessed violence in their community. 30.2% reported having lost friends or family due to violence, and of those, 26.4% reported the loss of a cousin, 18.9% the loss of a friend, 16% the loss of their father, and 12.3% the loss of their brother due to violence. Of the 22.4% youths with psychiatric diagnose(s), 48.4% had multiple diagnoses, the most common of which were ADD/ADHD (62.6%), followed by depression (31.9%), bipolar disorder (27.5%) and anxiety (15.4%). Conclusions: A remarkable proportion of children presenting to EDs due to interpersonal violence have a history of exposure to instability and violence in their homes and communities. Additionally, psychological diagnoses are frequent among pediatric victims of violence. More research is needed to better understand the association between trauma exposure, psychological health and violent victimization amongst children.

Keywords: community violence, emergency department, pediatric interpersonal violence, pediatric trauma, psychological effects of trauma

Procedia PDF Downloads 223

Authors: K. Mokatse, O. M. Barei, K. Gabanakgosi, P. Matlhabaphiri

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The mining of pit slopes is often associated with some level of deviation from design recommendations, and this may translate to associated changes in the stability of the excavated pit slopes. Therefore slope angle design reconciliations are essential for assessing and monitoring compliance of excavated pit slopes to accepted slope designs. These associated changes in slope stability may be reflected by changes in the calculated factors of safety and/or probabilities of failure. Reconciliations of as-mined and slope design profiles are conducted periodically to assess the implications of these deviations on pit slope stability. Currently, the slope design reconciliation process being implemented in Jwaneng Mine involves the measurement of as-mined and design slope angles along vertical sections cut along the established geotechnical design section lines on the GEOVIA GEMS™ software. Bench retentions are calculated as a percentage of the available catchment area, less over-mined and under-mined areas, to that of the designed catchment area. This process has proven to be both tedious and requires a lot of manual effort and time to execute. Consequently, a new semi-automated mine-to-design reconciliation approach that utilizes laser scanning and GIS-based tools is being proposed at Jwaneng Mine. This method involves high-resolution scanning of targeted bench walls, subsequent creation of 3D surfaces from point cloud data and the derivation of slope toe lines and crest lines on the Maptek I-Site Studio software. The toe lines and crest lines are then exported to the ArcGIS software where distance offsets between the design and actual bench toe lines and crest lines are calculated. Retained bench catchment capacity is measured as distances between the toe lines and crest lines on the same bench elevations. The assessment of the performance of the inter-ramp and overall slopes entails the measurement of excavated and design slope angles along vertical sections on the ArcGIS software. Excavated and design toe-to-toe or crest-to-crest slope angles are measured for inter-ramp stack slope reconciliations. Crest-to-toe slope angles are also measured for overall slope angle design reconciliations. The proposed approach allows for a more automated, accurate, quick and easier workflow for carrying out slope angle design reconciliations. This process has proved highly effective and timeous in the assessment of slope performance in Jwaneng Mine. This paper presents a newly proposed process for assessing compliance to slope angle designs for Jwaneng Mine.

Keywords: slope angle designs, slope design recommendations, slope performance, slope stability

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Authors: R. Tariq, R. Lee

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Background: Additional demands placed on senior clinical teams with ongoing COVID-19 management has accelerated the need to harness the wider healthcare professional resources and upskill them to take on greater clinical responsibility safely. The UK NHS Long Term Plan (2019)¹ emphasises the importance of expanding Advanced Practitioners’ (APs) roles to take on more clinical diagnostic responsibilities to cope with increased demand. In acute settings, APs are often the first point of care for patients and require training to take on initial triage responsibilities efficiently and safely. Critically, their roles include determining which onward services the patients may require, and assessing whether they can be treated at home, avoiding unnecessary admissions to the hospital. Dem Dx is a Clinical Reasoning Platform (CRP) that claims to help frontline healthcare professionals independently assess and triage patients. It guides the clinician from presenting complaints through associated symptoms to a running list of differential diagnoses, media, national and institutional guidelines. The objective of this study was to compare the clinical referral rates and guidelines adherence registered by the HMR Urgent Community Care Team (UCCT)² and Dem Dx recommendations using retrospective cases. Methodology: 192 cases seen by the UCCT were anonymised and reassessed using Dem Dx clinical pathways. We compared the UCCT’s performance with Dem Dx regarding the appropriateness of onward referrals. We also compared the clinical assessment regarding adherence to NICE guidelines recorded on the clinical notes and the presence of suitable guidance in each case. The cases were audited by two medical doctors. Results: Dem Dx demonstrated appropriate referrals in 85% of cases, compared to 47% in the UCCT team (p<0.001). Of particular note, Dem Dx demonstrated an almost 65% (p<0.001) improvement in the efficacy and appropriateness of referrals in a highly experienced clinical team. The effectiveness of Dem Dx is in part attributable to the relevant NICE and local guidelines found within the platform's pathways and was found to be suitable in 86% of cases. Conclusion: This study highlights the potential of clinical decision support, as Dem Dx, to improve the quality of onward clinical referrals delivered by a multidisciplinary team in primary care. It demonstrated that it could support healthcare professionals in making appropriate referrals, especially those that may be overlooked by providing suitable clinical guidelines directly embedded into cases and clear referral pathways. Further evaluation in the clinical setting has been planned to confirm those assumptions in a prospective study.

Keywords: advanced practitioner, clinical reasoning, clinical decision-making, management, multidisciplinary team, referrals, triage

Procedia PDF Downloads 135

Authors: Jaime E. Salazar Lagos

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Chongqing is located in southwest China and is becoming one of the most significant cities in the world. Its urban territories and metropolitan-related areas have one of the largest urban populations in China and are partitioned and shaped by two of the biggest and longest rivers on Earth, the Yangtze and Jialing Rivers, making Chongqing a megalopolis intersected by rivers. Historically, Chongqing City enjoyed fundamental connections with its rivers; however, current urban development of Chongqing City has lost effective integration of the riverbanks within the urban space and structural dynamics of the city. Therefore, there exists a critical lack of physical and urban space conjoined with the rivers, which diminishes the economic, tourist, and environmental development of Chongqing. Using multi-scale satellite-map site verification the study confirmed the hypothesis and urban-waterside disconnect. Collected data demonstrated that the Chongqing urban zone, an area of 5292 square-kilometers and a water front of 203.4 kilometers, has only 23.49 kilometers of extension (just 11.5%) with high-quality physical and spatial urban-waterside connection. Compared with other metropolises around the world, this figure represents a significant lack of spatial development along the rivers, an issue that has not been successfully addressed in the last 10 years of urban development. On a macro scale, the study categorized the different kinds of relationships between the city and its riverbanks. This data was then utilized in the creation of an urban-waterfront relationship map that can be a tool for future city planning decisions and real estate development. On a micro scale, we discovered there are three primary elements that are causing the urban-waterside disconnect: extensive highways along the most dense areas and city center, large private real estate developments that do not provide adequate riverside access, and large industrial complexes that almost completely lack riverside utilization. Finally, as part of the suggested strategies, the study concludes that the most efficient and practical way to improve this situation is to follow the historic master-planning of Chongqing and create connective nodes in critical urban locations along the river, a strategy that has been used for centuries to handle the same urban-waterside relationship. Reviewing and implementing this strategy will allow the city to better connect with the rivers, reducing the various impacts of disconnect and urban transformation.

Keywords: Chongqing City, megalopolis, nodes, riverbanks disconnection, urban

Procedia PDF Downloads 207

Authors: Pierre Mintom, Ebai Patricia, Merlin Dasse, Marlyse Chantal Nyangon Ndongo, Aicha Aretouyap Kouotou, Felix Essiben, Christine Fernande Nyangono Biyegue

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Background: The death of women during and after pregnancy remains a major concern in public health policy in Cameroon. Among the causes of this mortality is eclampsia which is a consequence of the Pre-eclampsia characterized by the double burden of pregnancy-induced hypertension and albuminuria in pregnant women. Objective: To determine the various factors associated with the pre-eclampsia in pregnant women of Foumban. Methodology: A cross-sectional and analytical study was carried out during the period from July to August 2020 and supplemented by another study carried out from August 05 to September 05, 2022, at the Foumban district hospital. A questionnaire was administered to pregnant women. It focused on socio-demographic parameters, the state nutritional, health status, and maternal parameters. Blood pressure was taken using an electronic blood pressure monitor, and urinary albumin was measuring using urine dipstick. Pre-eclampsia was defined by three types of double burden: double burden systolic hypertension–hyperalbuminuria (SHH), defined for SBP≥140 mmHg and hyperalbuminuria ≥1+ on urine dipstick, double burden diastolic hypertension–hyperalbuminuria (DHH), defined for PAD≥90 mmHg and hyperalbuminuria ≥1+ on the urine dipstick, and the double burden systolodiastolic arterial hypertension– hyperalbuminuria (SDHH), defined for SBP ≥ 140mmHg, PAD≥90 mmHg and hyperalbuminuria ≥1+ on urine dipstick. IBM SPSS Software was used for statistical analysis. Results: The results of this study show that the prevalence of pre-eclampsia was 17.3% for the double burden SHH, 19.9% for the double burden DHH and 14.1% for double burden SDHH. Associated factors with pre-eclampsia according to the three types of double burden were marital status (P<0.05), religion (P<0.05), history of hypertension before pregnancy (P<0.05). Associated factors for the double burden of DHH and SDHH were the nutritional status before the pregnancy (P<0.05) and the number of prenatal consultations (P<0.05). In terms of food groups, regular consumption of spices significantly increased the risk of pre-eclampsia by 5.318, 6.277 and 11.271 times respectively for the SHH, DHH and SDHH double burdens, while regular consumption of sweets regular consumption of sweets increased by 2.42 times and 2.053 times respectively the double DHH and SDHH burdens respectively. Conclusion: Our study made it possible to redefine pre-eclampsia by considering the subtypes of hypertension. Certain socio-demographic parameters and certain dietary habits influence the occurrence of pre-eclampsia characterized by the double burden Hypertension-hyperalbuminuria in pregnant women, which may later lead to the occurrence of eclampsia. Moreover, albuminemia could be a good predicitive factor of pre-eclampsia and could be explored.

Keywords: hypertension, hyperalbuminuria, pregnant women, foumban

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Authors: Soumyadip Banerjee, Tanmoy Maity

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The recovery of power from waste air generated by mine ventilation fans presents a promising avenue for enhancing energy efficiency in mining operations. This abstract explores the feasibility and benefits of utilizing turbine generators to capture the kinetic energy present in waste air and convert it into electrical power. By integrating turbine generator systems into mine ventilation infrastructures, the potential to harness and utilize the previously untapped energy within the waste air stream is realized. This study examines the principles underlying turbine generator technology and its application within the context of mine ventilation systems. The process involves directing waste air from ventilation fans through specially designed turbines, where the kinetic energy of the moving air is converted into rotational motion. This mechanical energy is then transferred to connected generators, which convert it into electrical power. The recovered electricity can be employed for various on-site applications, including powering mining equipment, lighting, and control systems. The benefits of power recovery from waste air using turbine generators are manifold. Improved energy efficiency within the mining environment results in reduced dependence on external power sources and associated cost savings. Additionally, this approach contributes to environmental sustainability by utilizing a previously wasted resource for power generation. Resource conservation is further enhanced, aligning with modern principles of sustainable mining practices. However, successful implementation requires careful consideration of factors such as waste air characteristics, turbine design, generator efficiency, and integration into existing mine infrastructure. Maintenance and monitoring protocols are necessary to ensure consistent performance and longevity of the turbine generator systems. While there is an initial investment associated with equipment procurement, installation, and integration, the long-term benefits of reduced energy costs and environmental impact make this approach economically viable. In conclusion, the recovery of power from waste air from mine ventilation fans using turbine generators offers a tangible solution to enhance energy efficiency and sustainability within mining operations. By capturing and converting the kinetic energy of waste air into usable electrical power, mines can optimize resource utilization, reduce operational costs, and contribute to a greener future for the mining industry.

Keywords: waste to energy, wind power generation, exhaust air, power recovery

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Authors: Gamze Safak, Umut Arslanoglu

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Cultural and tourism conservation and development zones and tourism centers are the boundaries declared for the purpose of protecting, using, and evaluating the sectoral development and planned development in areas where historical and cultural values are heavily involved and/or where tourism potential is high. The most rapidly changing regions in Turkey are tourism areas, especially the coastal areas. Planning these regions is not about only an economic gain but also a natural and physical environment and refers to a complex process. If the tourism sector is not well controlled, excessive use of natural resources and wrong location choices may cause damage to natural areas, historical values, and socio-cultural structure. Since the strategic decisions taken in the environmental order and zoning plans, which are the means of guiding the physical environment of the Ministry of Culture and Tourism, which have the authority to make plans in tourism centers, are transformed into plan decisions that find the spatial expression, comprehensive evaluation of all kinds of data, following the historical development and based on the correct and current data is required. In addition, the authority has a number of competences in tourism promotion as well as the authority to plan, leading to the necessity of taking part in the applications requiring complex analysis such as the management and integration of the country's economic, political, social and cultural resources. For this purpose, Tourism Inventory System (TES) project, which consists of a series of subsystems, has been developed in order to solve complex planning and method problems in the management of site-related information. The scope of the project is based on the integration of numerical and verbal data in the regions within the jurisdiction of the authority, and the monitoring of the historical development of urban planning studies, making the spatial data of the institution easily accessible, shared, questionable and traceable in international standards. A dynamic and continuous system design has been put into practice by utilizing the advantage of the use of Geographical Information Systems in the planning process to play a role in making the right decisions, revealing the tools of social, economic, cultural development, and preservation of natural and cultural values. This paper, which is prepared by the project team members in TES (Tourism Inventory System), will present a study regarding the applicability of GIS in cultural and natural heritage conservation.

Keywords: cultural conservation, GIS, geographic information system, tourism inventory system, urban planning

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Authors: Madre Paarlber, Alwiena Blignaut

Abstract:

Background: Medication administration errors remains a global patient safety problem targeted by the WHO (World Health Organization), yet research on this matter is sparce within the South African context. Objective: The aim was to explore and describe nurses’ (medication administrators) perceptions regarding medication administration safety-related culture, incidence, causes, and reporting in the Gauteng Province of South Africa, and to determine any relationships between perceived variables concerned with medication safety (safety culture, incidences, causes, reporting of incidences, and reasons for non-reporting). Method: A quantitative research design was used through which self-administered online surveys were sent to 768 nurses (medication administrators) (n=217). The response rate was 28.26%. The survey instrument was synthesised from the Agency of Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture, the Registered Nurse Forecasting (RN4CAST) survey, a survey list prepared from a systematic review aimed at generating a comprehensive list of medication administration error causes and the Medication Administration Error Reporting Survey from Wakefield. Exploratory and confirmatory factor analyses were used to determine the validity and reliability of the survey. Descriptive and inferential statistical data analysis were used to analyse quantitative data. Relationships and correlations were identified between items, subscales and biographic data by using Spearmans’ Rank correlations, T-Tests and ANOVAs (Analysis of Variance). Nurses reported on their perceptions of medication administration safety-related culture, incidence, causes, and reporting in the Gauteng Province. Results: Units’ teamwork deemed satisfactory, punitive responses to errors accentuated. “Crisis mode” working, concerns regarding mistake recording and long working hours disclosed as impacting patient safety. Overall medication safety graded mostly positively. Work overload, high patient-nurse ratios, and inadequate staffing implicated as error-inducing. Medication administration errors were reported regularly. Fear and administrative response to errors effected non-report. Non-report of errors’ reasons was affected by non-punitive safety culture. Conclusions: Medication administration safety improvement is contingent on fostering a non-punitive safety culture within units. Anonymous medication error reporting systems and auditing nurses’ workload are recommended in the quest of improved medication safety within Gauteng Province private hospitals.

Keywords: incidence, medication administration errors, medication safety, reporting, safety culture

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Authors: Meiying Liao, Poya Huang

Abstract:

The aesthetic domain is one of the six major domains in the Taiwanese preschool curriculum, encompassing visual arts, music, and dramatic play. Its primary objective is to cultivate children’s abilities in exploration and awareness, expression and creation, and response and appreciation. The purpose of this study was to explore the effects of hosting a vocal music concert on aesthetic inspiration and learning among preschoolers in a preschool setting. The primary research method employed was a case study focusing on a private preschool in Northern Taiwan that organized a school-wide event featuring two vocalists. The concert repertoires included children’s songs, folk songs, and arias performed in Mandarin, Hakka, English, German, and Italian. In addition to professional performances, preschool teachers actively participated by presenting a children’s song. A total of 5 classes, comprising approximately 150 preschoolers, along with 16 teachers and staff, participated in the event. Data collection methods included observation, interviews, and documents. Results indicated that both teachers and children thoroughly enjoyed the concert, with high levels of acceptance when the program was appropriately designed and hosted. Teachers reported that post-concert discussions with children revealed the latter’s ability to recall people, events, and elements observed during the performance, expressing their impressions of the most memorable segments. The concert effectively achieved the goals of the aesthetic domain, particularly in fostering response and appreciation. It also inspired preschoolers’ interest in music. Many teachers noted an increased desire for performance among preschoolers after exposure to the concert, with children imitating the performers and their expressions. Remarkably, one class extended this experience by incorporating it into the curriculum, autonomously organizing a high-quality concert in the music learning center. Parents also reported that preschoolers enthusiastically shared their concert experiences at home. In conclusion, despite being a single event, the positive responses from preschoolers towards the music performance suggest a meaningful impact. These experiences extended into the curriculum, as firsthand exposure to performances allowed teachers to deepen related topics, fostering a habit of autonomous learning in the designated learning centers.

Keywords: concert, early childhood music education, aesthetic education, music develpment

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Authors: Meera Tandan, Mohan Timilsina, Martin Cormican, Akke Vellinga

Abstract:

Background: In general practice, many infections are treated empirically without microbiological confirmation. Understanding susceptibility of antimicrobials during empirical prescribing can be helpful to reduce inappropriate prescribing. This study aims to apply a prediction model using a decision tree approach to predict the antimicrobial resistance (AMR) of urinary tract infections (UTI) based on non-clinical features of patients over 65 years. Decision tree models are a novel idea to predict the outcome of AMR at an initial stage. Method: Data was extracted from the database of the microbiological laboratory of the University Hospitals Galway on all antimicrobial susceptibility testing (AST) of urine specimens from patients over the age of 65 from January 2011 to December 2014. The primary endpoint was resistance to common antimicrobials (Nitrofurantoin, trimethoprim, ciprofloxacin, co-amoxiclav and amoxicillin) used to treat UTI. A classification and regression tree (CART) model was generated with the outcome ‘resistant infection’. The importance of each predictor (the number of previous samples, age, gender, location (nursing home, hospital, community) and causative agent) on antimicrobial resistance was estimated. Sensitivity, specificity, negative predictive (NPV) and positive predictive (PPV) values were used to evaluate the performance of the model. Seventy-five percent (75%) of the data were used as a training set and validation of the model was performed with the remaining 25% of the dataset. Results: A total of 9805 UTI patients over 65 years had their urine sample submitted for AST at least once over the four years. E.coli, Klebsiella, Proteus species were the most commonly identified pathogens among the UTI patients without catheter whereas Sertia, Staphylococcus aureus; Enterobacter was common with the catheter. The validated CART model shows slight differences in the sensitivity, specificity, PPV and NPV in between the models with and without the causative organisms. The sensitivity, specificity, PPV and NPV for the model with non-clinical predictors was between 74% and 88% depending on the antimicrobial. Conclusion: The CART models developed using non-clinical predictors have good performance when predicting antimicrobial resistance. These models predict which antimicrobial may be the most appropriate based on non-clinical factors. Other CART models, prospective data collection and validation and an increasing number of non-clinical factors will improve model performance. The presented model provides an alternative approach to decision making on antimicrobial prescribing for UTIs in older patients.

Keywords: antimicrobial resistance, urinary tract infection, prediction, decision tree

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