Search results for: event procedures

Authors: Majid Khan

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Introduction: In this era of microsurgery, free flap holds a remarkable spot in reconstructive surgery. A free flap is well suited for composite defects as it provides sufficient and well-vascularized tissue for coverage. We report our experience with the use of the free flaps for the reconstruction of composite defects. Methods: This is a retrospective case series (chart review) of patients who underwent reconstruction of composite defects with a free flap at Aga Khan University Hospital, Karachi (Pakistan) from January 01, 2015, to December 31, 2019. Data were collected for patient demographics, size of the defect, size of flap, recipient vessels, postoperative complications, and outcome of the free flap. Results: Over this period, 532 free flaps are included in this study. The overall success rate is 95.5%. The mean age of the patient was 44.86 years. In 532 procedures, there were 448 defects from tumor ablation of head and neck cancer. The most frequent free flap was the anterolateral thigh flap in 232 procedures. In this study, the risk factor hypertension (p=0.004) was found significant for wound dehiscence, preop radiation/chemotherapy (p=0.003), and malnutrition (p=0.005) were found significant for fistula formation. Malnutrition (p=0.02) and use of vein grafts (p=0.025) were significant factors for flap failure. Conclusion: Free tissue transfer is a reliable option for the reconstruction of large and composite defects. Hypertension, malnutrition, and preoperative radiotherapy can cause significant morbidity.

Keywords: free flap, free flap failure, risk factors for flap failure, free flap outcome

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Authors: Andrew Anis Fakhrey Mosaad

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Objectives: Physiotherapy in the intensive care unit (ICU) improves patient outcomes. We aimed to determine the characteristics of physiotherapy practice and critical barriers to applying physiotherapy in ICUs. Materials and Methods: A 54-item survey for determining the characteristics physiotherapists and physiotherapy applications in the ICU was developed. The survey was electronically sent to potential participants through the Turkish Physiotherapy Association network. Sixty-five physiotherapists (47F and 18M; 23–52 years; ICU experience: 6.0±6.2 years) completed the survey. The data were analyzed using quantitative and qualitative methods. Results: The duration of ICU practice was 3.51±2.10 h/day. Positioning (90.8%), active exercises (90.8%), breathing exercises (89.2%), passive exercises (87.7%), and percussion (87.7%) were the most commonly used applications. The barriers were related to physiotherapists (low level of employment and practice, lack of shift); patients (unwillingness, instability, participation restriction); teamwork (lack of awareness and communication); equipment (inadequacy, non-priority to purchase); and legal (reimbursement, lack of direct physiotherapy access, non-recognition of autonomy) procedures. Conclusion: The most common interventions were positioning, active, passive, breathing exercises, and percussion. Critical barriers toward physiotherapy are multifactorial and related to physiotherapists, patients, teams, equipment, and legal procedures. Physiotherapist employment, service maintenance, and multidisciplinary teamwork should be considered for physiotherapy effectiveness in ICUs.

Keywords: intensive care units, physical therapy, physiotherapy, exercises

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Authors: E. Saeedian, M. Shakerian, A. Zarif Sanayei, Z. Rakeb, F. N. Alizadeh, S. Sarshough, S. Sina

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Radiological protection for plants and animals is an area of regulatory importance. Acute doses of 0.1 Gy/d (10 rad/d) or below are highly unlikely to produce permanent, measurable negative effects on populations or communities of plants or animals. The advancement of radio diagnostics for domestic animals, particularly dogs and cats, has gained popularity in veterinary medicine. As pets are considered to be members of the family worldwide, they are entitled to the same care and protection. It is important to have a system of radiological protection for nonhuman organisms that complies with the focus on human health as outlined in ICRP publication 19. The present study attempts to assess surface-skin entrance doses in small pets undergoing abdominal radio diagnostic procedures utilizing a direct measurements technique with a thermoluminescent dosimeter. These measurements allow the determination of the entrance skin dose (ESD) by calculating the amount of radiation absorbed by the skin during exposure. A group of Thirty TLD-100 dosimeters produced by Harshaw Company, each with repeatability greater than 95% and calibration using ¹³⁷Cs gamma source, were utilized to measure doses to ten small pets, including cats and dogs in the radiological department in a veterinary clinic in Shiraz, Iran. Radiological procedures were performed using a portable imaging unit (Philips Super M100, Philips Medical System, Germany) to acquire images of the abdomen; ten exams of abdomen images of different pets were monitored, measuring the thicknesses of the two projections (lateral and ventrodorsal) and the distance of the X-ray source from the surface of each pet during the exams. A group of two dosimeters was used for each pet which has been stacked on their skin on the abdomen region. The outcome of this study involved medical procedures with the same kVp, mAs, and nearly identical positions for different diagnostic X-ray procedures executed over a period of two months. The result showed the mean ESD value was 260.34±50.06 µGy due to the approximate size of pets. Based on the results, the ESD value is associated with animal size, and larger animals have higher values. If a procedure doesn't require repetition, the dose can be optimized. For smaller animals, the main challenge in veterinary radiology is the dose increase caused by repetitions, which is most noticeable in the ventrodorsal position due to the difficulty in immobilizing the animal. Animals are an area of regulatory importance. Acute doses of 0.1 Gy/d (10 rad/d) or below are highly unlikely to produce permanent, measurable negative effects on populations or communities of plants or animals. The advancement of radio diagnostics for domestic animals, particularly dogs and cats, has gained popularity in veterinary medicine. As pets are considered to be members of the family worldwide, they are entitled to the same care and protection. It is important to have a system of radiological protection for nonhuman organisms that complies with the focus on human health as outlined in ICRP publication 19. The present study attempts to assess surface-skin entrance doses in small pets undergoing abdominal radio diagnostic procedures utilizing direct measurements.

Keywords: direct dose measuring, dosimetry, radiation protection, veterinary medicine

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Authors: Omer Zvi Shaked, Amir Tirosh

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Type 1 Diabetes (T1DM) is an incurable chronic illness with no known preventive measures. Excess to insulin therapy can lead to hypoglycemia with neuro-glycogenic symptoms such as shakiness, nausea, sweating, irritability, fatigue, excessive thirst or hunger, weakness, seizure, and coma. Severe Hypoglycemia (SH) is also considered a most aversive event since it may put patients at risk for injury and death, which matches the criteria of a traumatic event. SH has a ranging prevalence of 20%, which makes it a primary medical Issue. One of the results of SH is an intense emotional fear reaction resembling the form of post-traumatic stress symptoms (PTS), causing many patients to avoid insulin therapy and social activities in order to avoid the possibility of hypoglycemia. As a result, they are at risk for irreversible health deterioration and medical complications. Fear of Hypoglycemia (FOH) is, therefore, a major disturbance for T1DM patients. FOH differs from prevalent post-traumatic stress reactions to other forms of traumatic events since the threat to life continuously exists in the patient's body. That is, it is highly probable that orthodox interventions may not be sufficient for helping patients after SH to regain healthy social function and proper medical treatment. Accordingly, the current presentation will demonstrate the results of a study conducted among T1DM patients after SH. The study was designed in two stages. First, a preliminary qualitative phenomenological study among ten patients after SH was conducted. Analysis revealed that after SH, patients confuse between stress symptoms and Hypoglycemia symptoms, divide life before and after the event, report a constant sense of fear, a loss of freedom, a significant decrease in social functioning, a catastrophic thinking pattern, a dichotomous split between the self and the body, and internalization of illness identity, a loss of internal locus of control, a damaged self-representation, and severe loneliness for never being understood by others. The second stage was a two steps study of intervention among five patients after SH. The first part of the intervention included three months of therapeutic 3rd wave CBT therapy. The contents of the therapeutic process were: acceptance of fear and tolerance to stress; cognitive de-fusion combined with emotional self-regulation; the adoption of an active position relying on personal values; and self-compassion. Then, the intervention included a one-week practical real-time 24/7 support by trained medical personnel, alongside a gradual exposure to increased insulin therapy in a protected environment. The results of the intervention are a decrease in stress symptoms, increased social functioning, increased well-being, and decreased avoidance of medical treatment. The presentation will discuss the unique emotional state of T1DM patients after SH. Then, the presentation will discuss the effectiveness of the intervention for patients with chronic conditions after a traumatic event. The presentation will make evident the unique situation of illness-related PTSD. The presentation will also demonstrate the requirement for multi-professional collaboration between social work and medical care for populations with chronic medical conditions. Limitations of the study and recommendations for further research will be discussed.

Keywords: type 1 diabetes, chronic illness, post-traumatic stress, illness-related PTSD

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Authors: Mogale Sabone, Thabiso Ntlole

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The pressure from globalization has made manufacturing organizations to move towards three major competitive arenas: quality, cost, and responsiveness. Quality is a universal value and has become a global issue. In order to survive and be able to provide customers with good products, manufacturing organizations’ supporting systems, tools, and structures it uses must grow or evolve. The majority of quality management concepts and strategies that are practiced recently are aimed at detecting and correcting problems which already exist and serve to limit losses. In agile manufacturing environment there is no room for defect and error so it needs a quality management which is proactively directed at problem prevention. This proactive quality management avoids losses by focusing on failure prevention, virtual elimination of the possibility of premature failure, mistake-proofing, and assuring consistently high quality in the definition and design of creation processes. To achieve this, a decision support tool for quality control and management is suggested. Current decision support tools/methods used by most manufacturing companies in Botswana for quality management and control are not integrated, for example they are not consistent since some tests results data is recorded manually only whilst others are recorded electronically. It is only a set of procedures not a tool. These procedures cannot offer interactive decision support. This point brings to light the aim of this research which is to develop a framework which will help manufacturing companies in Botswana build a decision support tool for quality control and management.

Keywords: decision support tool, manufacturing, quality control, quality management

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Authors: Badryah Alshehri, Kevin Gormley, Gillian Prue, Karen McCutcheon

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In a disaster event, sharing patient information between the pre-hospitals Emergency Medical Services (EMS) and Emergency Department (ED) hospitals is a complex process during which important information may be altered or lost due to poor communication. The aim of this study was to critically discuss the current evidence base in relation to communication between pre-EMS hospital and ED hospital professionals by the use of Information and Communication Systems (ICT). This study followed the systematic approach; six electronic databases were searched: CINAHL, Medline, Embase, PubMed, Web of Science, and IEEE Xplore Digital Library were comprehensively searched in January 2018 and a second search was completed in April 2020 to capture more recent publications. The study selection process was undertaken independently by the study authors. Both qualitative and quantitative studies were chosen that focused on factors which are positively or negatively associated with coordinated communication between pre-hospital EMS and ED teams in a disaster event. These studies were assessed for quality and the data were analysed according to the key screening themes which emerged from the literature search. Twenty-two studies were included. Eleven studies employed quantitative methods, seven studies used qualitative methods, and four studies used mixed methods. Four themes emerged on communication between EMTs (pre-hospital EMS and ED staff) in a disaster event using the ICT. (1) Disaster preparedness plans and coordination. This theme reported that disaster plans are in place in hospitals, and in some cases, there are interagency agreements with pre-hospital and relevant stakeholders. However, the findings showed that the disaster plans highlighted in these studies lacked information regarding coordinated communications within and between the pre-hospital and hospital. (2) Communication systems used in the disaster. This theme highlighted that although various communication systems are used between and within hospitals and pre-hospitals, technical issues have influenced communication between teams during disasters. (3) Integrated information management systems. This theme suggested the need for an integrated health information system which can help pre-hospital and hospital staff to record patient data and ensure the data is shared. (4) Disaster training and drills. While some studies analysed disaster drills and training, the majority of these studies were focused on hospital departments other than EMTs. These studies suggest the need for simulation disaster training and drills, including EMTs. This review demonstrates that considerable gaps remain in the understanding of the communication between the EMS and ED hospitals staff in relation to response in disasters. The review shows that although different types of ICTs are used, various issues remain which affect coordinated communication among the relevant professionals.

Keywords: communication, emergency communication services, emergency medical teams, emergency physicians, emergency nursing, paramedics, information and communication technology, communication systems

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Authors: Donald G. Danmeier, Gian Marco Pizzo, Matthew Brennan

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Although wetlands have been proposed as a green alternative to manage coastal flood hazards because of their capacity to adapt to sea level rise and provision of multiple ecological and social co-benefits, they are often overlooked due to challenges in quantifying the uncertainty and naturally, variability of these systems. This objective of this study was to quantify wave attenuation provided by a natural marsh surrounding a large oil refinery along the US Gulf Coast that has experienced steady erosion along the shoreward edge. The vegetation module of the SWAN was activated and coupled with a hydrodynamic model (DELFT3D) to capture two-way interactions between the changing water level and wavefield over the course of a storm event. Since the marsh response to relative sea level rise is difficult to predict, a range of future marsh morphologies is explored. Numerical results were examined to determine the amount of wave attenuation as a function of marsh extent and the relative contributions from white-capping, depth-limited wave breaking, bottom friction, and flexing of vegetation. In addition to the coupled DELFT3D-SWAN modeling of a storm event, an uncoupled SWAN-VEG model was applied to a simplified bathymetry to explore a larger experimental design space. The wave modeling revealed that the rate of wave attenuation reduces for higher surge but was still significant over a wide range of water levels and outboard wave heights. The results also provide insights to the minimum marsh extent required to fully realize the potential wave attenuation so the changing coastal hazards can be managed.

Keywords: green infrastructure, wave attenuation, wave modeling, wetland

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Authors: Vladimir A. Vinnikov

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The paper proposes a model of an inhomogeneous rock mass with initially random distribution of microcracks on mineral grain boundaries. It describes the behavior of cracks in a medium under the effect of thermal field, the medium heated instantaneously to a predetermined temperature. Crack growth occurs according to the concept of fracture mechanics provided that the stress intensity factor K exceeds the critical value of Kc. The modeling of thermally induced acoustic emission memory effects is based on the assumption that every event of crack nucleation or crack growth caused by heating is accompanied by a single acoustic emission event. Parameters of the thermally induced acoustic emission memory effect produced by cyclic heating and cooling (with the temperature amplitude increasing from cycle to cycle) were calculated for several rock texture types (massive, banded, and disseminated). The study substantiates the adaptation of the proposed model to humidity interference with the thermally induced acoustic emission memory effect. The influence of humidity on the thermally induced acoustic emission memory effect in quasi-homogeneous and banded rocks is estimated. It is shown that such modeling allows the structure and texture of rocks to be taken into account and the influence of interference factors on the distinctness of the thermally induced acoustic emission memory effect to be estimated. The numerical modeling can be used to obtain information about the thermal impacts on rocks in the past and determine the degree of rock disturbance by means of non-destructive testing.

Keywords: degree of rock disturbance, non-destructive testing, thermally induced acoustic emission memory effects, structure and texture of rocks

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Authors: Tamara Vagg, Cathy Shortt, Claire Hickey, Joseph A. Eustace, Barry J. Plant, Sabin Tabirca

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Introduction: Paper-based patient passports have been used advantageously for older patients, patients with diabetes, and patients with learning difficulties. However, these passports can experience issues with data security, patients forgetting to bring the passport, patients being over encumbered, and uncertainty with who is responsible for entering and managing data in this passport. These issues could be resolved by transferring the paper-based system to a convenient platform such as a smartphone application (app). Background: Life expectancy for some Cystic Fibrosis (CF) patients are rising and as such new complications and procedures are predicted. Subsequently, there is a need for education and management interventions that can benefit CF adults. This research proposes a CF patient passport to record basic medical information through a smartphone app which will allow CF adults access to their basic medical information. Aim: To provide CF patients with their basic medical information via mobile multimedia so that they can receive care when traveling abroad or between CF centres. Moreover, by recording their basic medical information, CF patients may become more aware of their own condition and more active in their health care. Methods: This app is designed by a CF multidisciplinary team to be a lightweight reflection of a hospital patient file. The passport app is created using PhoneGap so that it can be deployed for both Android and iOS devices. Data entered into the app is encrypted and stored locally only. The app is password protected and includes the ability to set reminders and a graph to visualise weight and lung function over time. The app is introduced to seven participants as part of a stress test. The participants are asked to test the performance and usability of the app and report any issues identified. Results: Feedback and suggestions received via this testing include the ability to reorder the list of clinical appointments via date, an open format of recording dates (in the event specifics are unknown), and a drop down menu for data which is difficult to enter (such as bugs found in mucus). The app is found to be usable and accessible and is now being prepared for a pilot study with adult CF patients. Conclusions: It is anticipated that such an app will be beneficial to CF adult patients when travelling abroad and between CF centres.

Keywords: Cystic Fibrosis, digital patient passport, mHealth, self management

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Authors: Maryam Solgi, Behzad Shahmohammadi, Morteza Raissi Dehkordi

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One of the main steps for seismic retrofitting of buildings is to determine the vulnerability of structures. While current procedures for evaluating existing buildings are complicated, and there is no limitation between short, middle-high, and tall buildings. This research utilizes a simplified method for assessing structures, which is adequate for existing reinforced concrete buildings. To approach this aim, Simple Lateral Mechanisms Analysis (SLaMA) procedure proposed by NZSEE (New Zealand Society for Earthquake Engineering) has been carried out. In this study, three RC moment-resisting frame buildings are determined. First, these buildings have been evaluated by inelastic static procedure (Pushover) based on acceptance criteria. Then, Park-Ang Damage Index is determined for the whole members of each building by Inelastic Time History Analysis. Next, the Simple Lateral Mechanisms Analysis procedure, a hand method, is carried out to define the capacity of structures. Ultimately, existing procedures are compared with Peak Ground Acceleration caused to fail (PGAfail). The results of this comparison emphasize that the Pushover procedure and SLaMA method define a greater value of PGAfail than the Park-Ang Damage model.

Keywords: peak ground acceleration caused to fail, reinforced concrete moment-frame buildings, seismic vulnerability analysis, simple lateral mechanisms analysis

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Authors: J. Yan, B. Pieper, B. Bucsky, B. Nasseri, S. Klotz, H. H. Sievers, S. Mohamed

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Cryoablation is evermore applied for interventional treatment of paroxysmal (PAAF) or persistent atrial fibrillation (PEAF). In the cardiac surgery, this procedure is often combined with coronary arterial bypass graft (CABG) and valve operations. Three different methods are feasible in this sense in respect to practicing extents and mechanisms such as lone left atrial cryoablation, Cox-Maze IV and III in our heart center. 415 patients (68 ± 0.8ys, male 68.2%) with predisposed atrial fibrillation who initially required either coronary or valve operations were enrolled and divided into 3 matched groups according to deployed procedures: CryoLA-group (cryoablation of lone left atrium, n=94); Cox-Maze-IV-group (n=93) and Cox-Maze-III-group (n=8). All patients additionally received closure of the left atrial appendage (LAA) and regularly underwent three-year ambulant follow-up assessments (3, 6, 9, 12, 18, 24, 30 and 36 months). Burdens of atrial fibrillation were assessed directly by means of cardiac monitor (Reveal XT, Medtronic) or of 3-day Holter electrocardiogram. Herewith, attacks frequencies of AF and their circadian patterns were systemically analyzed. Furthermore, anticoagulants and regular rate-/rhythm-controlling medications were evaluated and listed in terms of anti-rate and anti-rhythm regimens. Concerning PAAF treatment, Cox Maze IV procedure provided therapeutically acceptable effect as lone left atrium (LA) cryoablation did (5.25 ± 5.25% vs. 10.39 ± 9.96% AF-burden, p > 0.05). Interestingly, Cox Maze III method presented a better short-term effect in the PEAF therapy in comparison to lone cryoablation of LA and Cox Maze IV (0.25 ± 0.23% vs. 15.31 ± 5.99% and 9.10 ± 3.73% AF-burden within the first year, p < 0.05). But this therapeutic advantage went lost during ongoing follow-ups (26.65 ± 24.50% vs. 8.33 ± 8.06% and 15.73 ± 5.88% in 3rd follow-up year). In this way, lone LA-cryoablation established its antiarrhythmic efficacy and 69.5% patients were released from the Vit-K-antagonists, while Cox Maze IV liberated 67.2% patients from continuous anticoagulant medication. The AF-recurrences mostly performed such attacks property as less than 60min duration for all 3 procedures (p > 0.05). In the sense of the circadian distribution of the recurrence attacks, weighted by ongoing follow-ups, lone LA cryoablation achieved and stabilized the antiarrhythmic effects over time, which was especially observed in the treatment of PEAF, while Cox Maze IV and III had their antiarrhythmic effects weakened progressively. This phenomenon was likewise evaluable in the therapy of circadian rhythm of reverting AF-attacks. Furthermore, the strategy of rate control was much more often applied to support and maintain therapeutic successes obtained than the one of rhythm control. Derived from experiences in our heart center, lone LA cryoablation presented equivalent effects in the treatment of AF in comparison to Cox Maze IV and III procedures. These therapeutic successes were especially investigable in the patients suffering from persistent AF (PEAF). Additional supportive strategies such as rate control regime should be initialized and implemented to improve the therapeutic effects of the cryoablations according to appropriate criteria.

Keywords: AF-burden, atrial fibrillation, cardiac monitor, COX MAZE, cryoablation, Holter, LAA

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Authors: Ye Tian

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Soft power has replaced hard power and become one of the most attractive ways nations pursue to expand their international influence. One of the ways to improve a nation’s soft power is to commercialise the country and brand or rebrand it to the international audience, and thus attract interests or foreign investments. In this process, translation has often been regarded as merely a tool, and researches in it are either in translating literature as culture export or in how (in)accuracy of translation influences the branding campaign. This paper proposes to analyse nation branding campaign with framing theory, and thus gives an entry for translation studies to come to a central stage in today’s soft power research. To frame information or elements of a text, an event, or, as in this paper, a nation is to put them in a mental structure. This structure can be built by outsiders or by those who create the text, the event, or by citizens of the nation. To frame information like this can be regarded as a process of translation, as what translation does in its traditional meaning of ‘translating a text’ is to put a framework on the text to, deliberately or not, highlight some of the elements while hiding the others. In the discourse of nations, then, people unavoidably simplify a national image and put the nation into their imaginary framework. In this way, problems like stereotype and prejudice come into being. Meanwhile, if nations seek ways to frame or reframe themselves, they make efforts to have in control what and who they are in the eyes of international audiences, and thus make profits, economically or politically, from it. The paper takes African nations, which are usually perceived as a whole, and the United Kingdom as examples to justify passive and active framing process, and assesses both positive and negative influence framing has on nations. In conclusion, translation as framing causes problems like prejudice, and the image of a nation is not always in the hands of nation branders, but reframing the nation in a positive way has the potential to turn the tide.

Keywords: framing, nation branding, stereotype, translation

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Authors: D. Tedesco, G. Feletti, P. Trucco

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The present study aims to develop a Decision Support System (DSS) to support the operational decision of the Emergency Medical Service (EMS) regarding the assignment of medical emergency requests to Emergency Departments (ED). In the literature, this problem is also known as “hospital selection” and concerns the definition of policies for the selection of the ED to which patients who require further treatment are transported by ambulance. The employed research methodology consists of the first phase of revision of the technical-scientific literature concerning DSSs to support the EMS management and, in particular, the hospital selection decision. From the literature analysis, it emerged that current studies are mainly focused on the EMS phases related to the ambulance service and consider a process that ends when the ambulance is available after completing a request. Therefore, all the ED-related issues are excluded and considered as part of a separate process. Indeed, the most studied hospital selection policy turned out to be proximity, thus allowing to minimize the transport time and release the ambulance in the shortest possible time. The purpose of the present study consists in developing an optimization model for assigning medical emergency requests to the EDs, considering information relating to the subsequent phases of the process, such as the case-mix, the expected service throughput times, and the operational capacity of different EDs in hospitals. To this end, a Discrete Event Simulation (DES) model was created to evaluate different hospital selection policies. Therefore, the next steps of the research consisted of the development of a general simulation architecture, its implementation in the AnyLogic software and its validation on a realistic dataset. The hospital selection policy that produced the best results was the minimization of the Time To Provider (TTP), considered as the time from the beginning of the ambulance journey to the ED at the beginning of the clinical evaluation by the doctor. Finally, two approaches were further compared: a static approach, which is based on a retrospective estimate of the TTP, and a dynamic approach, which is based on a predictive estimate of the TTP determined with a constantly updated Winters model. Findings reveal that considering the minimization of TTP as a hospital selection policy raises several benefits. It allows to significantly reduce service throughput times in the ED with a minimum increase in travel time. Furthermore, an immediate view of the saturation state of the ED is produced and the case-mix present in the ED structures (i.e., the different triage codes) is considered, as different severity codes correspond to different service throughput times. Besides, the use of a predictive approach is certainly more reliable in terms of TTP estimation than a retrospective approach but entails a more difficult application. These considerations can support decision-makers in introducing different hospital selection policies to enhance EMSs performance.

Keywords: discrete event simulation, emergency medical services, forecast model, hospital selection

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Authors: Victor Vasques Ribeiro

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The Santa Cruz dos Navegantes beach is located in the city of Guarujá, in the central portion of the coast of the state of São Paulo. Next to this beach is located the Channel of the Port of Santos, configured as a source of plastic pellets for marine environments. On sandy beaches near the sources, especially during the winter and after cold front entrance events, the amounts of pellets can be very high. This study aimed to determine the influence of a cold front entry event of the winter of 2019 on the amount of pellets found on Santa Cruz dos Navegantes beach, besides assuming the proximity of the sources. During six consecutive collection campaigns, three of which were previous and three after the cold front entry peak, 30.0 square meters of surface sediments were sampled in each campaign. The color and shape of the pellets were determined to assume the length of the permanence of these granules in the marine environment and, consequently, the proximity of the sources. This beach was considered ideal for this type of research. The pellet pollution index (PPI) was from moderate to very high right after the peak of the cold front entry. The cold front peak event significantly influenced the amount of pellets found on the beach of Santa Cruz dos Navegantes. The factors that can bury the pellets in the sediments were classified as low when compared to other beaches in the region. Most of the pellets found were recently produced and lost to aquatic environments. Like the other beaches near Santos Bay, Santa Cruz dos Navegantes beach receives significant amounts of pellets that have nearby origins. Therefore, it was supposed that the activities of the Santos port complex are sources of pellets for the marine environment. This pollution can be further worsened in certain meteoceanographic events. The beaches of this region need to be constantly monitored and evaluated for pollution by pellets.

Keywords: beach, cold front, pellets, sources

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Authors: Richard J. Hanowski, Rebecca L. Hammond

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Very few studies have been conducted to investigate safety issues associated with motorcoach/bus operations. The current study investigates the impact that roadway infrastructure, including locality, roadway grade, traffic flow and traffic density, have on bus safety. A naturalistic driving study was conducted in the U.S.A that involved 43 motorcoaches. Two fleets participated in the study and over 600,000 miles of naturalistic driving data were collected. Sixty-five bus drivers participated in this study; 48 male and 17 female. The average age of the drivers was 49 years. A sophisticated data acquisition system (DAS) was installed on each of the 43 motorcoaches and a variety of kinematic and video data were continuously recorded. The data were analyzed by identifying safety critical events (SCEs), which included crashes, near-crashes, crash-relevant conflicts, and unintentional lane deviations. Additionally, baseline (normative driving) segments were also identified and analyzed for comparison to the SCEs. This presentation highlights the need for bus safety research and the methods used in this data collection effort. With respect to elements of roadway infrastructure, this study highlights the methods used to assess locality, roadway grade, traffic flow, and traffic density. Locality was determined by manual review of the recorded video for each event and baseline and was characterized in terms of open country, residential, business/industrial, church, playground, school, urban, airport, interstate, and other. Roadway grade was similarly determined through video review and characterized in terms of level, grade up, grade down, hillcrest, and dip. The video was also used to make a determination of the traffic flow and traffic density at the time of the event or baseline segment. For traffic flow, video was used to assess which of the following best characterized the event or baseline: not divided (2-way traffic), not divided (center 2-way left turn lane), divided (median or barrier), one-way traffic, or no lanes. In terms of traffic density, level-of-service categories were used: A1, A2, B, C, D, E, and F. Highlighted in this abstract are only a few of the many roadway elements that were coded in this study. Other elements included lighting levels, weather conditions, roadway surface conditions, relation to junction, and roadway alignment. Note that a key component of this study was to assess the impact that driver distraction and fatigue have on bus operations. In this regard, once the roadway elements had been coded, the primary research questions that were addressed were (i) “What environmental condition are associated with driver choice of engagement in tasks?”, and (ii) “what are the odds of being in a SCE while engaging in tasks while encountering these conditions?”. The study may be of interest to researchers and traffic engineers that are interested in the relationship between roadway infrastructure elements and safety events in motorcoach bus operations.

Keywords: bus safety, motorcoach, naturalistic driving, roadway infrastructure

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Authors: Sajed A. Habib

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Problem-based learning (PBL) is a student-centered pedagogy that originated in the medical field and has also been used extensively in other knowledge disciplines with recognized advantages and limitations. PBL has been used in various undergraduate engineering programs with mixed outcomes. The current fourth industrial revolution (digital era or Industry 4.0) has made it essential for many science and engineering students to receive effective training in advanced courses such as industrial automation and robotics. This paper presents a case study at Assumption University of Thailand, where a PBL-like approach was used to teach some aspects of automation and robotics to selected groups of undergraduate engineering students. These students were given some basic level training in automation prior to participating in a subsequent training session in order to solve technical problems with increased complexity. The participating students’ evaluation of the training sessions in terms of learning effectiveness, skills enhancement, and incremental knowledge following the problem-solving session was captured through a follow-up survey consisting of 14 questions and a 5-point scoring system. From the most recent training event, an overall 70% of the respondents indicated that their skill levels were enhanced to a much greater level than they had had before the training, whereas 60.4% of the respondents from the same event indicated that their incremental knowledge following the session was much greater than what they had prior to the training. The instructor-facilitator involved in the training events suggested that this method of learning was more suitable for senior/advanced level students than those at the freshmen level as certain skills to effectively participate in such problem-solving sessions are acquired over a period of time, and not instantly.

Keywords: automation, industry 4.0, model-based design training, problem-based learning

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Authors: G. Hubert, S. Aubry

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The earth is constantly bombarded by cosmic rays that can be of either galactic or solar origin. Thus, humans are exposed to high levels of galactic radiation due to altitude aircraft. The typical total ambient dose equivalent for a transatlantic flight is about 50 μSv during quiet solar activity. On the contrary, estimations differ by one order of magnitude for the contribution induced by certain solar particle events. Indeed, during Ground Level Enhancements (GLE) event, the Sun can emit particles of sufficient energy and intensity to raise radiation levels on Earth's surface. Analyses of GLE characteristics occurring since 1942 showed that for the worst of them, the dose level is of the order of 1 mSv and more. The largest of these events was observed on February 1956 for which the ambient dose equivalent rate is in the orders of 10 mSv/hr. The extra dose at aircraft altitudes for a flight during this event might have been about 20 mSv, i.e. comparable with the annual limit for aircrew. The most recent GLE, occurred on September 2017 resulting from an X-class solar flare, and it was measured on the surface of both the Earth and Mars using the Radiation Assessment Detector on the Mars Science Laboratory's Curiosity Rover. Recently, Hubert et al. proposed a GLE model included in a particle transport platform (named ATMORAD) describing the extensive air shower characteristics and allowing to assess the ambient dose equivalent. In this approach, the GCR is based on the Force-Field approximation model. The physical description of the Solar Cosmic Ray (i.e. SCR) considers the primary differential rigidity spectrum and the distribution of primary particles at the top of the atmosphere. ATMORAD allows to determine the spectral fluence rate of secondary particles induced by extensive showers, considering altitude range from ground to 45 km. Ambient dose equivalent can be determined using fluence-to-ambient dose equivalent conversion coefficients. The objective of this paper is to analyze the GCR and SCR impacts on ambient dose equivalent considering a high number statistic of world-flight paths. Flight trajectories are based on the Eurocontrol Demand Data Repository (DDR) and consider realistic flight plan with and without regulations or updated with Radar Data from CFMU (Central Flow Management Unit). The final paper will present exhaustive analyses implying solar impacts on ambient dose equivalent level and will propose detailed analyses considering route and airplane characteristics (departure, arrival, continent, airplane type etc.), and the phasing of the solar event. Preliminary results show an important impact of the flight path, particularly the latitude which drives the cutoff rigidity variations. Moreover, dose values vary drastically during GLE events, on the one hand with the route path (latitude, longitude altitude), on the other hand with the phasing of the solar event. Considering the GLE occurred on 23 February 1956, the average ambient dose equivalent evaluated for a flight Paris - New York is around 1.6 mSv, which is relevant to previous works This point highlights the importance of monitoring these solar events and of developing semi-empirical and particle transport method to obtain a reliable calculation of dose levels.

Keywords: cosmic ray, human dose, solar flare, aviation

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Authors: Sujata Kulkarni, Udhav Bhosle, Vijaykumar T.

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Due to the closeness between seismic signals and non-seismic signals, it is vital to detect earthquakes using conventional methods. In order to distinguish between seismic events and non-seismic events depending on their amplitude, our study processes the data that come from seismic sensors. The authors suggest a robust noise suppression technique that makes use of a bandpass filter, an IIR Wiener filter, recursive short-term average/long-term average (STA/LTA), and Carl short-term average (STA)/long-term average for event identification (LTA). The trigger ratio used in the proposed study to differentiate between seismic and non-seismic activity is determined. The proposed work focuses on significant feature extraction for machine learning-based seismic event detection. This serves as motivation for compiling a dataset of all features for the identification and forecasting of seismic signals. We place a focus on feature vector dimension reduction techniques due to the temporal complexity. The proposed notable features were experimentally tested using a machine learning model, and the results on unseen data are optimal. Finally, a presentation using a hybrid dataset (captured by different sensors) demonstrates how this model may also be employed in a real-time setting while lowering false alarm rates. The planned study is based on the examination of seismic signals obtained from both individual sensors and sensor networks (SN). A wideband seismic signal from BSVK and CUKG station sensors, respectively located near Basavakalyan, Karnataka, and the Central University of Karnataka, makes up the experimental dataset.

Keywords: Carl STA/LTA, features extraction, real time, dataset, machine learning, seismic detection

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Authors: Petar Kurecic, Josipa Penic

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The paper represents a product of mentor-graduate student cooperation, developed at the graduate study of Business Economics, major Tourism. The analysis was made through the anonymous questionnaire filled by the respondents from Croatia. Following the latest threatening events and having in mind those yet to come, it can be concluded that no country can benefit from the tourism industry if at the same time does not develop its security system as an integral part of the standard tourist offer. Analyzing the trends in contemporary tourism, the safety and security issues became the decisive factors for the choice of a certain destination. Consequently, countries must not perceive security systems and measures as an unnecessary expense but as an essential element in organizing their tourist services. All hotels and respectable tourist agencies should have a crisis management, with detailed, thoroughly elaborated procedures for emergency situations. Tourists should be timely informed about the potential dangers and risks and the measures taken to prevent them, as well as on procedures for emergency situations. Additionally, it would be good to have mobile applications that would enable tourists to make direct emergency calls with instructions on behavior in crisis situations. It is also essential to implement and put into effect sophisticated security measures such as using surveillance cameras, controlling access to buildings, information exchange with colleagues and neighbors, reporting the suspicious occurrences to the security services, and training staff for crisis management. The security issue is definitely one of the crucial factors in the development of tourism in a certain country.

Keywords: security, security measures in tourism, tourism, tourist destinations

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Authors: Mircea Pastrav, Horia Constantinescu

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The construction industry is currently trying to develop sustainable reinforced concrete structures. In trying to aid in the effort, the research presented in this paper aims to prove the efficiency of modified special hybrid moment frames composed of discretely jointed precast and post-tensioned concrete members. This aim is due to the fact that current design standards do not cover the spatial design of moment frame structures assembled by post-tensioning with special hybrid joints. This lack of standardization is coupled with the fact that previous experimental programs, available in scientific literature, deal mainly with plane structures and offer little information regarding spatial behavior. A spatial model of a modified hybrid moment frame is experimentally analyzed. The experimental results of a natural scale model test of a corner column-beams sub-structure, cut from an actual multilevel building tested to seismic type loading are presented in order to highlight the behavior of this type of structure. The test is performed under alternative cycles of imposed lateral displacements, up to a storey drift ratio of 0.035. Seismic response of the spatial model is discussed considering the acceptance criteria for reinforced concrete frame structures designed based on experimental tests, as well as some of its major sustainability features. The results obtained show an overall excellent behavior of the system. The joint detailing allows for quick and cheap repairs after an accidental event and a self-balancing behavior of the system that ensures it can be used almost immediately after an accidental event it.

Keywords: modified hybrid joint, seismic type loading response, self-balancing structure, acceptance criteria

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Authors: Saied Farham-Nia, Alireza Ghaffari-Hadigheh

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Game theory is a mathematical tool to study the behaviors of a rational and strategic decision-makers, that analyze existing equilibrium in interest conflict situation and provides an appropriate mechanisms for cooperation between two or more player. Game theory is applicable for any strategic and interest conflict situation in politics, management and economics, sociology and etc. Real worlds’ decisions are usually made in the state of indeterminacy and the players often are lack of the information about the other players’ payoffs or even his own, which leads to the games in uncertain environments. When historical data for decision parameters distribution estimation is unavailable, we may have no choice but to use expertise belief degree, which represents the strength with that we believe the event will happen. To deal with belief degrees, we have use uncertainty theory which is introduced and developed by Liu based on normality, duality, subadditivity and product axioms to modeling personal belief degree. As we know, the personal belief degree heavily depends on the personal knowledge concerning the event and when personal knowledge changes, cause changes in the belief degree too. Uncertainty theory not only theoretically is self-consistent but also is the best among other theories for modeling belief degree on practical problem. In this attempt, we primarily reintroduced Expected Utility Function in uncertainty environment according to uncertainty theory axioms to extract payoffs. Then, we employed Nash Equilibrium to investigate the solutions. For more practical issues, Stackelberg leader-follower Game and Bertrand Game, as a benchmark models are discussed. Compared to existing articles in the similar topics, the game models and solution concepts introduced in this article can be a framework for problems in an uncertain competitive situation based on experienced expert’s belief degree.

Keywords: game theory, uncertainty theory, belief degree, uncertain expected value, Nash equilibrium

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Authors: Darawan Augsornwan, Artitaya Sabangbal, Maneewan Srijan, Kanokarn Kongpitee, Lalida Petphai, Palakorn Surakunprapha

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Background: Srinagarind Hospital, Ward 3C, has patients with head and neck cancer, congenital urology anomalies such as hypospadis, cleft lip and cleft palate and congenital megacolon who need surgery. Undergoing surgery is a difficult time for patients/ family; they feel fear and anxiety. Nurses work closely with patients and family for 24 hours in the process of patients care, so should have the good nursing ability, innovation and an efficient nursing care system to promote patients self-care ability reducing suffering and preventing complications. From previous nursing outcomes we found patients did not receive appropriate information, could not take care of their wound, not early ambulation after the operation and lost follow-up. Objective: to develop the nursing system for patients who were undergoing an operation. Method: this is a participation action research. The sample population was 11 nurses and 60 patients. This study was divided into 3 phase: Phase 1. Situation review In this phase we review the clinical outcomes, the process of care from documents such as nurses note and interview nurses, patients and family about the process of care by nurses. Phase 2: focus group with 11 nurses, searching guideline for specific care, nursing care system then establish the protocol. This phase we have the protocol for giving information, teaching protocol and teaching record, leaflet for all of top five diseases, make video media to convey information, ambulation package and protocol for patients with head and neck cancer, patients zoning, primary nurse, improved job description for each staff level. Program to record number of patients, kind of medical procedures for showing nurses activity each day. Phase 3 implementation and evaluation. Result: patients/family receive appropriate information about deep breathing exercise, cough, early ambulation after the operation, information during the stay in the hospital. Patients family satisfaction is 95.04 percent, appropriate job description for a practical nurse, nurse aid, and worker. Nurses satisfaction is 95 percent. The complications can be prevented. Conclusion: the nursing system is the dynamic process using evidence to develop nursing care. The appropriate system depends on context and needs to keep an eye on every event.

Keywords: development, nursing system, patients undergoing operation, 3C Ward

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Authors: Ganga Brahma

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Boro employs verbs hooked up with morphemes which lead verbs to adjust with their arguments and hence, affecting the whole of sentence structures. This paper is based on few such syntactic parameters which are usually considered as argument decreasing parameters in linguistic works. Passivizing of few transitive clauses which are usually construed from the verbs occurring with certain morphemes and representation in middle constructions are few of such strategies which lead to conceptualizing of decreasing of syntactic arguments from a sentence. This paper focuses on the mentioned linguistic strategies and attempts to describe the linguistic processes as for how these parameters work in languages especially by concentrating on a particular Tibeto-Burman language i.e. Boro. Boro is a Tibeto-Burman language widely spoken in parts of the north-eastern regions of India. It has an agglutinative nature in forming words as well as clauses. There is a morpheme ‘za’ which means ‘to happen, become’ in Boro whose appearances with verb roots denotes an idea of the subject being passivized. Passivization, usually has notions that it is a reversed representation of its active sentence forms in the terms of argument placements. (However, it is not accountably true as passives and actives have some distinct features of their own and independent of one and the other.) This particular work will concentrate on the semantics of passivization at the same time along with its syntactic reality. The verb khɑo meaning ‘to steal’ offers a sense of passivization with the appearance of the morpheme zɑ which means ‘to happen, become’ (e.g Zunu-ɑ lama-ɑo phɯisɑ khɑo-zɑ-bɑi; Junu-NOM road-LOC money steal-PASS-PRES: Junu got her money stolen on the road). The focus, here, is more on the argument placed at the subject position (i.e. Zunu) and the event taken place. The semantics of such construction asks for the agent because without an agent the event could not have taken place. However, the syntactic elements fill the slots of relegated or temporarily deleted agent which, infact, is the actual subject cum agent in its active representation. Due to the event marker ‘zɑ’ in this presentation it affords to reduce one participant from such a situation which in actual is made up of three participants. Hence, the structure of di-transitive construction here reduces to mono-transitive structure. Unlike passivization, middle construction does not allow relegation of the agents. It permanently deletes agents. However, it also focuses on the fore-grounded subject and highlighting on the changed states on the subjects which happens to be the underlying objects of their respective transitive structures (with agents). This work intends to describe how these two parameters which are different at their semantic realization can meet together at a syntactic level in order to create a linguistic parameter that decreases participants from their actual structures which are with more than one participant.

Keywords: argument-decrease, middle-construction, passivization, transitivity-intransitivity

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Authors: Du Kim, Nelson Baro

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According to a report of International Atomic Energy Agency (IAEA), there are approximately 437 nuclear power stations are in operation in the present around the world in order to meet increasing energy demands. Indeed, nearly, a third of the world’s energy demands are met through nuclear power because it is one of the most efficient and long-lasting sources of energy. However, there are also consequences when a major event takes place at a nuclear power station. Over the past years, a few major nuclear accidents have occurred around the world. According to a report of International Nuclear and Radiological Event Scale (INES), there are six nuclear accidents that are considered to be high level (risk) of the events: Fukushima Dai-chi (Level 7), Chernobyl (Level 7), Three Mile Island (Level 5), Windscale (Level 5), Kyshtym (Level 6) and Chalk River (Level 5). Today, many people still have doubt about using nuclear power. There is growing number of people who are against nuclear power after the serious accident occurred at the Fukushima Dai-chi nuclear power plant in Japan. In other words, there are public concerns about radiation impacts which emphasize Linear-No-Threshold (LNT) Issues, Radiation Health Effects, Radiation Protection and Social Impacts. This paper will address those keywords by looking back at the history of these major nuclear accidents worldwide, based on INES. This paper concludes that all major mistake from nuclear accidents are preventable due to the fact that most of them are caused by human error. In other words, the human factor has played a huge role in the malfunction and occurrence of most of those events. The correct handle of a crisis is determined, by having a good radiation protection program in place, it’s what has a big impact on society and determines how acceptable people are of nuclear.

Keywords: linear-no-threshold (LNT) issues, radiation health effects, radiation protection, social impacts

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Authors: Hongquan Zhang

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Inspired by endogenous protein motors, researchers have constructed various synthetic DNA motors based on the specificity and predictability of Watson-Crick base pairing. However, the application of DNA motors to signal amplification and biosensing is limited because of low mobility and difficulty in real-time monitoring of the walking process. The objective of our work was to construct a new type of DNA motor termed target-triggered DNA motors that can walk for hundreds of steps in response to a single target binding event. To improve the mobility and processivity of DNA motors, we used gold nanoparticles (AuNPs) as scaffolds to build high-density, three-dimensional tracks. Hundreds of track strands are conjugated to a single AuNP. To enable DNA motors to respond to specific protein and nucleic acid targets, we adapted the binding-induced DNA assembly into the design of the target-triggered DNA motors. In response to the binding of specific target molecules, DNA motors are activated to autonomously walk along AuNP, which is powered by a nicking endonuclease or DNAzyme-catalyzed cleavage of track strands. Each moving step restores the fluorescence of a dye molecule, enabling monitoring of the operation of DNA motors in real time. The motors can translate a single binding event into the generation of hundreds of oligonucleotides from a single nanoparticle. The motors have been applied to amplify the detection of proteins and nucleic acids in test tubes and live cells. The motors were able to detect low pM concentrations of specific protein and nucleic acid targets in homogeneous solutions without the need for separation. Target-triggered DNA motors are significant for broadening applications of DNA motors to molecular sensing, cell imagining, molecular interaction monitoring, and controlled delivery and release of therapeutics.

Keywords: biosensing, DNA motors, gold nanoparticles, signal amplification

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Authors: Fuad Alzahrani, Yiannis Kyratsis

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Although emergency nurses, being the frontline workers in mass-gatherings, are essential for providing an effective public health response, little is known about the skills that emergency nurses have, or require, in order to respond effectively to a disaster event. This paper is designed to address this gap in the literature by conducting an empirical study on emergency nurses’ preparedness at the mass-gathering event of Hajj in Mecca city. To achieve this aim, this study conducted a cross-sectional survey among 106 emergency department nurses in all the public hospitals in Mecca in 2014. The results revealed that although emergency nurses’ role understanding is high; they have limited knowledge and awareness of how to respond appropriately to mass-gathering disaster events. To address this knowledge gap, the top three most beneficial types of education and training courses suggested are: hospital education sessions, the Emergency Management Saudi Course and workshop; and short courses in disaster management. Finally, recommendations and constructive strategies are developed to provide the best practice in enhancing disaster preparedness. This paper adds to the body of knowledge regarding emergency nurses and mass gathering disasters. This paper measures the level of disaster knowledge, previous disaster response experience and disaster education and training amongst emergency nurses in Mecca, Saudi Arabia. It is anticipated that this study will provide a foundation for future studies aimed at better preparing emergency nurses for disaster response. This paper employs new strategies to improve the emergency nurses’ response during mass gatherings for the Hajj. Increasing the emergency nurses’ knowledge will develop their effective responses in mass-gathering disasters.

Keywords: emergency nurses, mass-gatherings, hajj, disaster preparedness, disaster knowledge, perceived role, disaster training, previous disaster response experience

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Authors: Shazia Salam

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This paper focuses on studying the literary reactions of selected Muslim women writers to the event of Partition of India in the north western region. It aims to explore how Muslim women experienced the Partition and how that experience was articulated through their writing. There is a serious dearth of research on the experience of Muslim women who had to witness the momentous event of the subcontinent. Since scholars have often questioned the silence around the historiography related to the experiences of Muslim women, this paper aims to explore if literature could provide insights that may be less readily available in other modes of narration. Using literature as an archival source, it aims to delve into the arenas of history that have been cloistered and closed. Muslim women have been silent about their experiences of Partition which at the cost of essentializing could be attributed to patriarchal constraints, and taboos, on speaking of intimate matters. These silences have consigned the question of their experience to a realm of anonymity. The lack of ethnographic research has in a way been compensated in the realm of literature, mainly poetry and fiction. Besides reportage, literature remains an important source of social history about Partition and how Muslim women lived through it. Where traditional history fails to record moments of rupture and dislocation, literature serves the crucial purpose. The central premise in this paper is that there is a need to revise the history of partition owing to the gaps in historiography. It looks into if literature can serve as a ground for developing new approaches to history since the question of the representation always confronts us--between what a text represents and how it represents it since imagination of the writer plays a great role in the construction of any text. With this approach as an entry point, this paper aims to unpack the questions of representation, the coalescing of history /literature and the gendered nature of partition history. It concludes that the gaps in the narratives of Partition and the memory of Partition can be addressed by way of suing literary as a source to fill in the cracks and fissures.

Keywords: gender, history, literature, partition

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Authors: Claudia Pimentel, Nuno Resende, Maria Fatima Lambert

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In the present time, catastrophe seems to be inevitable, and individuals are permanently overwhelmed with challenges that test one’s ability to cope with reality. Undoubtedly, photography surpassed the barrier of efficient communication in a world filled with omnifarious narratives. It wandered an outing shorter than words and younger than other sciences but became, nowadays, imperative in the context of several fields of knowledge, namely Heritage studies. Heritage and photography thus emerge as unapologetically related concepts, a fact that makes them equally relevant in today's society. Political, economic, social and humanitarian challenges alter the way in which the relationship with the past is managed and the way in which identities and ideas for the future are constructed. Ruins and destruction have become part of aesthetics discourse since the 18th century and are an area of interest when we discuss cultural heritage preservation. The image proves to be a unique way of revealing the event details when we refer to a catastrophic situation, whether it be anthropic, social or climatic. Like poetry, which has a challenging connection with silence, image is capable of creating spaces of sound and silence, and it is often these “pseudo-voids” that capture the attention of the spectator, of the one who sees/observes/contacts with the photography. The way we look at the catastrophe, how we describe it, and the images we keep in our memory will determine the record/capture/news of the event. We, thus, have a visual record, a document that will contribute to the creation of individual and collective identity, in a jigsaw puzzle of memories, pseudo memories and post memories. Based on photographic records in the Portuguese press, we intend to rethink the earthquake at Angra do Heroísmo – Azores in 1980, exploring the viewer´s perspective on the catastrophe’s iconography under the perspective of aesthetics and genealogy of the catastrophe.

Keywords: photography, aesthetics, catastrophe, Portugal

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Authors: Amichai Ben ari, Daniella Margalit

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Medical procedures, such as surgery, may have traumatic significance for some children. This study examines the relationship between maltreatment in children and the development Pediatric Medical Traumatic Stress (PMTS). To this end, differences in the level of distress of children after surgery were examined between two groups: children who were maltreated ("children at risk") and children from the control group ("children who are not at risk"). The study involved 230 parents of children who came to the hospital to undergo surgery. Parents filled out demographic questionnaires to measure socioeconomic variables and psychological questionnaires to measure the distress of the child and parent before surgery. After 6 months from the time of surgery, the parents again filled in the questionnaire measuring the child's distress. The results of the study showed that the level of distress experienced by children at risk after surgery was significantly higher relative to children who are not at risk. It was also found that the level of distress experienced by parents of children at risk in relation to their child’s surgery is significantly higher compared to parents of children who are not at risk. Finally, it was found that the variables: (1) pre-morbid psychological functioning of the child. (2) Parental and family functioning in daily life. (3) Exposure of the child to traumatic events. (4) Support factors for the family. Are variables that predict the development of PMTS in children after surgery, but only for children at risk and not for children who are not at risk. The significance of the findings in relation to the need to identify at-risk populations in the hospitals and the policies derived from them were discussed, and several directions were raised for further research.

Keywords: children at risk, pediatric medical traumatic stress (PMTS), PTSD, medical procedures

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Authors: Mekni Sabrine, Nouira Mariem

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Background and aim: Allogeneic hematopoietic stem cell transplantation is a curative treatment for several hematological diseases; however, it has a non-negligible morbidity and mortality depending on several prognostic factors, including pre-transplant hyperferritinemia. The aim of our study was to estimate the impact of hyperferritinemia on survivals and on the occurrence of post-transplant complications. Methods: It was a longitudinal study conducted over 8 years and including all patients who had a first allograft. The impact of pretransplant hyperferritinemia (ferritinemia ≥1500) on survivals was studied using the Kaplan Meier method and the COX model for uni- and multivariate analysis. The Khi-deux test and binary logistic regression were used to study the association between pretransplant ferritinemia and post-transplant complications. Results: One hundred forty patients were included with an average age of 26.6 years and a sex ratio (M/F)=1.4. Hyperferritinemia was found in 33% of patients. It had no significant impact on either overall survival (p=0.9) or event -free survival (p=0.6). In multivariate analysis, only the type of disease was independently associated with overall survival (p=0.04) and event-free survival (p=0.002). For post-allograft complications: The occurrence of early documented infections was independently associated with pretransplant hyperferritinemia (p=0.02) and the presence of acute graft versus host disease( GVHD) (p<10-3). The occurrence of acute GVHD was associated with early documented infection (p=0.002) and Cytomegalovirus reactivation (p<10-3). The occurrence of chronic GVHD was associated with the presence of Cytomegalovirus reactivation (p=0.006) and graft source (p=0.009). Conclusion: Our study showed the significant impact of pre-transplant hyperferritinemia on the occurrence of early infections but not on survivals. Early and more accurate assessment iron overload by other tests such as liver magnetic resonance imaging with initiation of chelating treatment could prevent the occurrence of such complications after transplantation.

Keywords: allogeneic, transplants, ferritin, survival

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