Search results for: surgical ambulatory assessment unit

Authors: S. Kreitlein, N. Eder, J. Franke

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The importance of energy efficiency within the production process increases steadily. Unfortunately, so far no tools for a comprehensive assessment of energy efficiency within the production process exist. Therefore the Institute for Factory Automation and Production Systems of the Friedrich-Alexander-University Erlangen-Nuremberg has developed two methods with the goal of achieving transparency and a quantitative assessment of energy efficiency: EEV (Energy Efficiency Value) and EPE (Energetic Process Efficiency). This paper describes the basics and state of the art as well as the developed approaches.

Keywords: energy efficiency, energy efficiency value, energetic process efficiency, production

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Authors: Nelson Igaba, C. Onaga, S. Hlongwane

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Background: Medical Male Circumcision (MMC) is part of a comprehensive HIV prevention strategy. The quality of MMC done at Right To Care (RtC) sites is maintained by Continuous Quality Improvement (CQI) based on findings of assessments by internal and independent external assessors who evaluate such parameters as the quality of the surgical procedure, infection control, etc. There are 12 RtC MMC teams in Mpumalanga, two of which are headed by Medical Officers and 10 by Clinical Associates (Clin A). Objectives: To compare the quality (i) of care rendered at doctor headed sites (DHS) versus Clin A headed sites (CHS); (ii) of CQI assessments (external versus internal). Methodology: A retrospective review of data from RightMax™ (a novel RtC data management system) and CQI reports (external and internal) was done. CQI assessment scores of October 2015 and October 2016 were taken as the baseline and latest respectively. Four sites with 745-810 circumcisions per annum were purposively selected; the two DHS (group A) and two CHS (group B). Statistical analyses were conducted using R (2017 version). Results: There were no significant difference in latest CQI scores between the two groups (DHS and CHS) (Anova, F = 1.97, df = 1, P = 0.165); between internal and external CQI assessment scores (Anova, F = 2.251, df = 1, P = 0.139) or among the individual sites (Anova, F = 1.095, df = 2, P = 0.341). Of the total of 16 adverse events reported by the four sites in the 12 months reviewed (all were infections), there was no statistical evidence that the documented severity of the infection was different for DHS and CHS (Fisher’s exact test, p-value = 0.269). Conclusion: At RtC VMMC sites in Mpumalanga, internal and external/independent CQI assessments are comparable, and quality of care of VMMC is standardized with the performance of well-supervised clinical associates comparing well with those of medical officers.

Keywords: adverse events, Right to Care, male medical circumcision, continuous quality improvement

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Authors: Sharadha G., Suresh Kanakkanavar

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Background: Placenta previa is a condition characterized by partial or complete implantation of the placenta in the lower uterine segment. It is one of the main causes of vaginal bleeding in the third trimester and a significant cause of maternal and perinatal morbidity and mortality. Materials and Methods: This is an observational study involving 130 patients diagnosed with placenta previa and satisfying inclusion criteria. The demographic data, clinical, surgical, and treatment, along with maternal and neonatal outcome parameters, were noted in proforma. Results: The incidence of placenta previa among scarred uterus was 1.32%, and in unscarred uterus was 0.67%. The mean age of the study population was 27.12±4.426years. High parity, high abortion rate, multigravida status, and less gestational age at delivery were commonly seen in scarred uterus compared to unscarred uterus. Complete placenta previa, anterior placental position, and adherent placenta were significantly associated with a scarred uterus compared to an unscarred uterus. The rate of caesarean hysterectomy was higher in the scarred uterus, along with statistical association to previous lower-segment caesarean sections. Intraoperative procedures like uterine artery ligation, bakri balloon insertion, and iliac artery ligation were higher in the scarred group. The maternal intensive care unit admission rate was higher in the scarred group and also showed its statistical association with previous lower segment caesarean section. Neonatal outcomes in terms of pre-term birth, still birth, neonatal intensive care unit admission, and neonatal death, though higher in the scarred group, did not differ statistically among the groups. Conclusion: Advancing maternal age, multiparity, prior uterine surgeries, and abortions are independent risk factors for placenta previa. Maternal morbidity is higher in the scarred uterus group compared to the unscarred group. Neonatal outcomes did not differ statistically among the groups. This knowledge would help the obstetricians to take measures to reduce the incidence of placenta previa and scarred uterus which would improve the fetomaternal outcome of placenta previa.

Keywords: placenta previa, scarred uterus, unscarred uterus, adherent placenta

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Authors: Emmanuel Kamal Aziz Saba, Gihan Abd El-Lateif Younis El-Tantawi, Mohammed Hamdy Zahran, Ibrahim Khalil Ibrahim, Mohammed Abd El-Salam Shehata, Hussein Al-Moghazy Sultan, Medhat Mohamed Anwar

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Examination of the external anal sphincter muscle strength of voluntary contraction is essential in initial assessment and assessment of efficacy of rehabilitation of patients with faecal incontinence (FI) and obstructed defecation (OD). The present study was conducted to evaluate the digital assessment of the external anal sphincter muscle strength of voluntary contraction by using Modified Oxford Scale (MOS) in comparison to anal manometry squeeze pressure. The present cross-sectional study included 65 patients. There were 40 patients (61.5 %) with FI and 25 patients (38.5 %) with OD. All patients were subjected to history taking, clinical examination including assessment of the external anal sphincter muscle strength of voluntary contraction by using MOS and anal manometry (mean squeeze pressure and maximal squeeze pressure). There was a statistically significant positive correlation between MOS and anal manometry squeeze pressures including mean squeeze pressure and maximal squeeze pressure among FI group and OD group. In conclusion, assessment of the external anal sphincter muscle strength of voluntary contraction by using MOS is a valid method and can substitute anal manometry assessment.

Keywords: anal manometry, external anal sphincter muscle, Modified Oxford Scale, muscle strength

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Authors: Hoda Abugharsa

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In this paper we propose to design a sorter circuit using insertion sorting algorithm. The circuit will be designed using Algorithmic State Machines (ASM) method. That means converting the insertion sorting flowchart into an ASM chart. Then the ASM chart will be used to design the sorter circuit and the control unit.

Keywords: insert sorting algorithm, ASM chart, sorter circuit, state machine, control unit

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Authors: Swathi Sampath, V. Kalaichelvi

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The assessment of the risk posed by a borrower to a lender is one of the common problems that financial institutions have to deal with. Consumers vying for a mortgage are generally compared to each other by the use of a number called the Credit Score, which is generated by applying a mathematical algorithm to information in the applicant’s credit report. The higher the credit score, the lower the risk posed by the candidate, and the better he is to be taken on by the lender. The objective of the present work is to use fuzzy logic and linguistic rules to create a model that generates Credit Scores.

Keywords: credit scoring, fuzzy logic, mortgage, risk assessment

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Authors: Ashish Agarwal, Vaibhav Singh

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Harmful emissions from oil and gas processing facilities have long remained a matter of concern for governments and environmentalists throughout the world. This paper analyses Oil and Natural Gas Corporation (ONGC) gas processing plant in Hazira, Gujarat, India. It is the largest gas-processing complex in the country designed to process 41MMSCMD sour natural gas & associated sour condensate. The complex, sprawling over an area of approximate 705 hectares is the mother plant for almost all industries at Hazira and enroute Hazira Bijapur Jagdishpur pipeline. Various sources of pollution from each unit starting from Gas Terminal to Dew Point Depression unit and Caustic Wash unit along the processing chain were examined with the help of different emission data obtained from ONGC. Pollution discharged to the environment was classified into Water, Air, Hazardous Waste and Solid (Non-Hazardous) Waste so as to analyze each one of them efficiently. To protect air environment, Sulphur recovery unit along with automatic ambient air quality monitoring stations, automatic stack monitoring stations among numerous practices were adopted. To protect water environment different effluent treatment plants were used with due emphasis on aquaculture of the nearby area. Hazira plant has obtained the authorization for handling and disposal of five types of hazardous waste. Most of the hazardous waste were sold to authorized recyclers and the rest was given to Gujarat Pollution Control Board authorized vendors. Non-Hazardous waste was also handled with an overall objective of zero negative impact on the environment. The effect of methods adopted is evident from emission data of the plant which was found to be well under Gujarat Pollution Control Board limits.

Keywords: sulphur recovery unit, effluent treatment plant, hazardous waste, sour gas

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Authors: Preeda Sansakorn, Min An

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In order to be capable of dealing with uncertainties, subjectivities, including vagueness arising in building construction projects, the application of fuzzy reasoning technique based on fuzzy set theory is proposed. This study contributes significantly to the development of a fuzzy reasoning safety risk assessment model for building construction projects that could be employed to assess the risk magnitude of each hazardous event identified during construction, and a third parameter of probability of consequence is incorporated in the model. By using the proposed safety risk analysis methodology, more reliable and less ambiguities, which provide the safety risk management project team for decision-making purposes.

Keywords: safety risk assessment, building construction safety, fuzzy reasoning, construction risk assessment model, building construction projects

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Authors: Adriana C. Panayi, Riaz A. Agha, Brady A. Sieber, Dennis P. Orgill

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Background: Increased rates of both breast cancer and obesity have resulted in more women seeking breast reconstruction. These women may be at increased risk for perioperative complications. A systematic review was conducted to assess the outcomes in obese women who have undergone breast reconstruction following mastectomy. Methods: Cochrane, PUBMED and EMBASE electronic databases were screened and data was extracted from included studies. The clinical outcomes assessed were surgical complications, medical complications, length of postoperative hospital stay, reoperation rate and patient satisfaction. Results: 33 studies met the inclusion criteria for the review and 29 provided enough data to be included in the meta-analysis (71368 patients, 20061 of which were obese). Obese women were 2.3 times more likely to experience surgical complications (95 percent CI 2.19 to 2.39; P < 0.00001), 2.8 times more likely to have medical complications (95 percent CI 2.41 to 3.26; P < 0.00001) and had a 1.9 times higher risk of reoperation (95 percent CI 1.75 to 2.07; P < 0.00001). The most common complication, wound dehiscence, was 2.5 times more likely in obese women (95 percent CI 1.80 to 3.52; P < 0.00001). Sensitivity analysis confirmed that obese women were more likely to experience surgical complications (RR 2.36, 95% CI 2.22–2.52; P < 0.00001). Conclusions: This study provides evidence that obesity increases the risk of complications in both implant and autologous reconstruction. Additional prospective and observational studies are needed to determine if weight reduction prior to reconstruction reduces the perioperative risks associated with obesity.

Keywords: autologous reconstruction, breast cancer, breast reconstruction, literature review, obesity, oncology, prosthetic reconstruction

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Authors: Van Thien NGO

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The purpose of the study is to examine the effect of student response systems in computer-based formative assessment on learning outcomes. The backward design course is a tool to be applied for collecting necessary assessment evidence. The quasi-experimental research design involves collecting pre and posttest data on students assigned to the control group and the experimental group. The sample group consists of 150 college students randomly selected from two of the eight classes of electrical and electronics students at Cao Thang Technical College in Ho Chi Minh City, Vietnam. Findings from this research revealed that the experimental group, in which student response systems were applied, got better results than the controlled group, who did not apply them. Results show that using student response systems for technology-based formative assessment is vital and meaningful not only for teachers but also for students in the teaching and learning process.

Keywords: student response system, computer-based formative assessment, learning outcome, backward design course

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Authors: Li-Ching Hung

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The lack of empirical research on portfolio assessment in aboriginal EFL English classes of junior high schools in Taiwan may inhibit EFL teachers from appreciating the utility of this alternative assessment approach. This study addressed the following research questions: 1) understand how aboriginal EFL students and instructors of junior high schools in Taiwan perceive portfolio assessment, and 2) how portfolio assessment affects Taiwanese aboriginal EFL students’ learning outcomes. Ten classes of five junior high schools in Taiwan (from different regions of Taiwan) participated in this study. Two classes from each school joined the study, and each class was randomly assigned as a control group, and one was the experimental group. These five junior high schools consisted of at least 50% of aboriginal students. A mixed research design was utilized. The instructor of each class implemented a portfolio assessment for 15 weeks of the 2015 Fall Semester. At the beginning of the semester, all participants took a GEPT test (pretest), and in the 15th week, all participants took the same level of GEPT test (post-test). Scores of students’ GEPT tests were checked by the researcher as supplemental data in order to understand each student’s performance. In addition, each instructor was interviewed to provide qualitative data concerning students’ general learning performance and their perception of implementing portfolio assessments in their English classes. The results of this study were used to provide suggestions for EFL instructors while modifying their lesson plans regarding assessment. In addition, the empirical data were used as references for EFL instructors implementing portfolio assessments in their classes effectively.

Keywords: assessment, portfolio assessment, qualitative design, aboriginal ESL students

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Authors: Musbah Abdussayed

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The washback effect refers to the influence of assessment on teaching and learning, and this washback effect can either be positive or negative. This study implemented, sequentially, self-assessment (SA) and peer assessment (PA) and examined the washback effect of self and peer assessment (SPA) activities on the writing growth during the revision phase in the writing process. Twenty advanced Arabic as a second language learners from a private school in the USA participated in the study. The participants composed and then revised a short Arabic story as a part of a midterm grade. Qualitative data was collected, analyzed, and synthesized from ten interviews with the learners and from the twenty learners’ post-reflective journals. The findings indicate positive washback effects on the learners’ writing growth. The PA activity enhanced descriptions and meaning, promoted creativity, and improved textual coherence, whereas the SA activity led to detecting editing issues. Furthermore, both SPA activities had washback effects in common, including helping the learners meet the writing genre conventions and developing metacognitive awareness. However, the findings also demonstrate negative washback effects on the learners’ attitudes during the revision phase in the writing process, including bias toward self-evaluation during the SA activity and reluctance to rate peers’ writing performance during the PA activity. The findings suggest that self-and peer assessment activities are essential teaching and learning tools that can be utilized sequentially to help learners tackle multiple writing areas during the revision phase in the writing process.

Keywords: self assessment, peer assessment, washback effect, second language writing, writing process

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Authors: Hsiaoping Wu

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With the wide use of Internet, learners are exposed to the wider world. This exposure permits learners to discover new information and combine a variety of media in order to reach in-depth and broader understanding of their literacy and the world. Many paper-based teaching, learning and assessment modalities can be transferred to a digital platform. This study examines the use of e-portfolios for ESL (English as a second language) pre-service teacher. The data were collected by reviewing 100 E-portfolio from 2013 to 2015 in order to synthesize meaningful information about e-portfolios for ESL pre-service teachers. Participants were generalists, bilingual and ESL pre-service teachers. The studies were coded into two main categories: learning gains, including assessment, and technical skills. The findings showed that using e-portfolios enhanced and developed ESL pre-service teachers’ teaching and assessment skills. Also, the E-portfolio also developed the pre-service teachers’ technical stills to prepare a comprehensible portfolio to present who they are. Finally, the study and presentation suggested e-portfolios for ecological issues and educational purposes.

Keywords: assessment, e-portfolio, pre-service teacher, reflection

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Authors: Emil Sakharov, Alex Zotov, Ilkin Osmanov, Oleg Shelest, Aleksander Troitskiy, Robert Khabazov

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Objective: Since 2015, our center has been actively implementing methods of surgical correction of atrial fibrillation, in particular, in patients with coronary heart disease. The study presents a comparative analysis of the late postoperative period in patients with coronary artery bypass grafting and atrial fibrillation. Methods: The study included 150 patients with ischemic heart disease and atrial fibrillation for the period from 2015 to 2021. Patients were divided into 2 groups. The first group is represented by patients with ischemic heart disease and atrial fibrillation who underwent coronary bypass surgery and surgical correction of atrial fibrillation (N=50). The second group is represented by patients with ischemic heart disease and atrial fibrillation who underwent only myocardial revascularization (N=100). Patients were comparable in age, gender, and initial severity of the condition. Among the patients in group 1 there were 82% were men, while in the second group, their number was 75%. Among the patients of the first group, there were 36% with persistent atrial fibrillation, 20% with long-term persistent atrial fibrillation. In the second group, 10% with persistent atrial fibrillation and 17% with long-term persistent atrial fibrillation. Results: Average follow-up for groups 1 and 2 amounted to 47 months. There were no complications in group 1, such as bleeding and stroke. There was only 1 patient in group 1, who had died from cardiovascular disease. Freedom of atrial fibrillation was in 82% without AADs therapy. In group 2 there were 8 patients who had died from cardiovascular diseases and total freedom of atrial fibrillation was in 35% of patients, among which 42.8% had additional AADs therapy. Follow-up data are presented in Table 2. Progression of heart failure was observed in 3% in group 1 and 7% in group 2. Combined endpoints (recurrence of AF, stroke, progression of heart failure, myocardial infarction) were achieved in 16% in group 1 and 34% in group 2, respectively. Freedom from atrial fibrillation without antiarrhythmic therapy was 82% for group 1 and 35% for group 2. In the first group, there is a more pronounced decrease in heart failure rates. Deaths from cardiovascular causes were recorded in 2% for group 1 and 7% for group 2. Conclusion: Surgical treatment of atrial fibrillation helps to reduce adverse complications in the late postoperative period and contributes to the regression of heart failure.

Keywords: atrial fibrillation, coronary artery bypass grafting, ischaemic heart disease, heart failure

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Authors: Yang Song, Yifan Guo, Edward F. Gehringer

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Fifty years of research has found great potential for peer assessment as a pedagogical approach. With peer assessment, not only do students receive more copious assessments; they also learn to become assessors. In recent decades, more educational peer assessments have been facilitated by online systems. Those online systems are designed differently to suit different class settings and student groups, but they basically fall into two categories: rating-based and ranking-based. The rating-based systems ask assessors to rate the artifacts one by one following some review rubrics. The ranking-based systems allow assessors to review a set of artifacts and give a rank for each of them. Though there are different systems and a large number of users of each category, there is no comprehensive comparison on which design leads to higher reliability. In this paper, we designed algorithms to evaluate assessors' reliabilities based on their rating/ranking against the global ranks of the artifacts they have reviewed. These algorithms are suitable for data from both rating-based and ranking-based peer assessment systems. The experiments were done based on more than 15,000 peer assessments from multiple peer assessment systems. We found that the assessors in ranking-based peer assessments are at least 10% more reliable than the assessors in rating-based peer assessments. Further analysis also demonstrated that the assessors in ranking-based assessments tend to assess the more differentiable artifacts correctly, but there is no such pattern for rating-based assessors.

Keywords: peer assessment, peer rating, peer ranking, reliability

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Authors: Shane R. Jackson

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Gluteal augmentation with fat grafting, commonly referred to as the Brazilian Butt Lift, is the fastest-growing cosmetic surgical procedure, despite the risks and controversy that surrounds it. While many commentators attribute this rise in popularity with current societal trends towards public sharing of private life, the fascination with buttock size is in fact a much older human trait. By searching beyond medical literature and delving into historical sources, from ancient civilisations, through the Renaissance and Victorian eras to the ‘Instagram generation’ of the present day, this paper examines the differences – and similarities – in society’s ideal buttock shape and size. Furthermore, the ways in which these various cultures have altered their appearance to achieve this ideal are also examined, looking at the influence of the broader historical context. A deeper understanding of the historical, cultural and psychosocial factors that influence a patient’s desire for buttock augmentation allows the clinician to formulate a well-rounded surgical plan.

Keywords: augmentation, Brazilian butt lift, buttock, fat graft, gluteal

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Authors: Diego Carrasco, Catarina Freitas, Hugo Rio Tinto, Ricardo Rio Tinto, Nuno Couto, Joaquim Gago, Carlos Carvalho

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Introduction: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) to drain the gallbladder can be a palliative care procedure for non-surgical oncologic patients with cholelithiasis and cholangitis process. Case description: A 59-years old Caucasian male diagnosed with extrahepatic cholangiocarcinoma with multiple liver, lung and peritoneum metastasis, unresponsive to treatment with gemcitabine/cisplatin, presented in the institution with fever, hypotension, and severe upper right abdominal pain secondary to cholelithiasis and cholangitis process. The patient was admitted and started on large spectrum antibiotics plus fluid-challenge. Afterward, a percutaneous transhepatic biliary drainage (PTBD) was performed to drain the gallbladder. This procedure temporarily stabilized the patient. However, the definitive solution required gallbladder removal. Since the patient exhibited an advanced oncologic disease and poor response to the chemotherapy, he was not a candidate for surgical intervention. Diagnostic Pathways: A self-expanding metal stent was placed from the duodenum into the bile duct by endoscopic ultrasound-guided. The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure. Conclusion and Discussion: The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure and successfully reversed the cholangitis process. EUS-CD is an effective and safe technique and can be used as a palliative care procedure for non-surgical oncologic patients.

Keywords: palliative care, cholangiocarcinoma, choledochoduodenostomy, endoscopic ultrasound-guided

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Authors: Helena Costa Oliveira, Carmem Oliveira, Rita Moutinho

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The Balanced Scorecard (BSC) is a continuous strategic monitoring model focused not only on financial issues but also on internal processes, patients/users, and learning and growth. Initially dedicated to business management, it currently serves organizations of other natures - such as hospitals. This paper presents a BSC designed for a Portuguese Acute Pain Unit (APU). This study is qualitative and based on the experience of collaborators at the APU. The management of APU is based on four perspectives – users, internal processes, learning and growth, and financial and legal. For each perspective, there were identified strategic objectives, critical factors, lead indicators and initiatives. The strategic map of the APU outlining sustained strategic relations among strategic objectives. This study contributes to the development of research in the health management area as it explores how organizational insufficiencies and inconsistencies in this particular case can be addressed, through the identification of critical factors, to clearly establish core outcomes and initiatives to set up.

Keywords: acute pain unit, balanced scorecard, hospital management, organizational performance, Portugal

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Authors: Netta Horesh Reinman

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The inability to communicate feelings and thoughts to people close to oneself may be an important risk factor for suicidal behavior. This inability has been operationalized in the concept of “self-disclosure.” The purpose of this paper was to evaluate the correlation of self-disclosure with suicidal behavior in adolescents. Eighty consecutive admissions to an adolescent psychiatric inpatient unit were evaluated. Thirty-four were suicide attempters, 18 were suicidal ideators, and 18 were non-suicidal. Assessment measures included the Child Suicide Potential Scale, the Suicide Intent Scale, the Suicide Ideation Scale, and the Self-Disclosure Scale. The results show that low self-disclosure levels are associated with suicidal thinking, suicide attempts and suicidal attitudes. Thus, low self-disclosure may well be a risk factor worthy of further evaluation in the attempt to understand adolescent suicidal behavior.

Keywords: self disclosure, suicide, adolescents, treatment

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Authors: Mohammad Abotalib, Hamid Alhamadi

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In Kuwait, electricity is generated from two primary sources that are heavy fuel combustion and natural gas combustion. As Kuwait relies mainly on petroleum-based products for electricity generation, identifying and understanding the environmental trade-off of such operations should be carefully investigated. The life cycle assessment (LCA) tool is applied to identify the potential environmental impact of electricity generation under three scenarios by considering the material flow in various stages involved, such as raw-material extraction, transportation, operations, and waste disposal. The three scenarios investigated represent current and futuristic electricity grid mixes. The analysis targets six environmental impact categories: (1) global warming potential (GWP), (2) acidification potential (AP), (3) water depletion (WD), (4) acidification potential (AP), (4) eutrophication potential (EP), (5) human health particulate matter (HHPM), and (6) smog air (SA) per one kWh of electricity generated. Results indicate that one kWh of electricity generated would have a GWP (881-1030) g CO₂-eq, mainly from the fuel combustion process, water depletion (0.07-0.1) m³ of water, about 68% from cooling processes, AP (15.3-17.9) g SO₂-eq, EP (0.12-0.14) g N eq., HHPA (1.13- 1.33)g PM₂.₅ eq., and SA (64.8-75.8) g O₃ eq. The variation in results depend on the scenario investigated. It can be observed from the analysis that introducing solar photovoltaic and wind to the electricity grid mix improves the performance of scenarios 2 and 3 where 15% of the electricity comes from renewables correspond to a further decrease in LCA results.

Keywords: energy, functional uni, global warming potential, life cycle assessment, energy, functional unit

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Authors: Lauren Dhugga, Meena Parameswaran, David Blundell, Abbas Khushnood

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Context: A multidisciplinary weekly safety briefing was implemented at the Paediatric Cardiothoracic Unit at the Freeman Hospital in Newcastle-upon-Tyne. It is a tertiary referral centre with a quarternary cardiac paediatric intensive care unit and provides complexed care including heart and lung transplants, mechanical support and advanced heart failure assessment. Aim: The aim of this briefing is to provide a structured platform of communication, in an effort to improve efficiency, safety, and patient care. Problem: The paediatric cardiothoracic unit is made up of a vast multidisciplinary team including doctors, intensivists, anaesthetists, surgeons, specialist nurses, echocardiogram technicians, physiotherapists, psychologists, dentists, and dietitians. It provides care for children with congenital and acquired cardiac disease and is one of only two units in the UK to offer paediatric heart transplant. The complexity of cases means that there can be many teams involved in providing care to each patient, and frequent movement of children between ward, high dependency, and intensive care areas. Currently, there is no structured forum for communicating important information across the department, for example, staffing shortages, prescribing errors and significant events. Strategy: An initial survey questioning the need for better communication found 90% of respondents agreed that they could think of an incident that had occurred due to ineffective communication, and 85% felt that incident could have been avoided had there been a better form of communication. Lastly, 80% of respondents felt that a weekly 60 second safety briefing would be beneficial to improve communication within our multidisciplinary team. Based on those promising results, a weekly 60 second safety briefing was implemented to be conducted on a Monday morning. The safety briefing covered four key areas (SAFE): staffing, awareness, fix and events. This was to highlight any staffing gaps, any incident reports to be learned from, any issues that required fixing and any events including teachings for the week ahead. The teams were encouraged to email suggestions or issues to be raised for the week or to approach in person with information to add. The safety briefing was implemented using change theory. Effect: The safety briefing has been trialled over 6 weeks and has received a good buy in from staff across specialties. The aim is to embed this safety briefing into a weekly meeting using the PDSA cycle. There will be a second survey in one month to assess the efficacy of the safety briefing and to continue to improve the delivery of information. The project will be presented at the next clinical governance briefing to attract wider feedback and input from across the trust. Lessons: The briefing displays promise as a tool to improve vigilance and communication in a busy multi-disciplinary unit. We have learned about how to implement quality improvement and about the culture of our hospital - how hierarchy influences change. We demonstrate how to implement change through a grassroots process, using a junior led briefing to improve the efficiency, safety, and communication in the workplace.

Keywords: briefing, communication, safety, team

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Authors: H. Pasternak, A. Chwastek

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The paper describes the results from a research project about repair of welds. The repair was carried out by grinding the flawed seams and re-welding them. The main task was to determine the FAT classes of original state and after repair of seams according to the assessment procedures, such as nominal, structural and effective notch stress approach. The first part shows the results of the tests, the second part encloses numerical analysis and evaluation of results to determine the fatigue strength classes according to three assessment procedures.

Keywords: cyclic loading, fatigue crack, post-weld treatment, seams’ repair

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Authors: Wala A. Bagunaid, Maram Meccawy, Arwa Allinjawi, Zilal Meccawy

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Continuous self-assessment becomes crucial in self-paced online learning environments. Students often depend on themselves to assess their progress; which is considered an essential requirement for any successful learning process. Today’s education institutions face major problems around student motivation and engagement. Thus, personalized e-learning systems aim to help and guide the students. Gamification provides an opportunity to help students for self-assessment and social comparison with other students through attempting to harness the motivational power of games and apply it to the learning environment. Furthermore, Open Social Student Modeling (OSSM) as considered as the latest user modeling technologies is believed to improve students’ self-assessment and to allow them to social comparison with other students. This research integrates OSSM approach and gamification concepts in order to provide self-assessment for English language learners at King Abdulaziz University (KAU). This is achieved through an interactive visual representation of their learning progress.

Keywords: e-learning system, gamification, motivation, social comparison, visualization

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

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

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

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Authors: Anders Thorsén, Behrooz Sangchoolie, Peter Folkesson, Ted Strandberg

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As more parts of the power grid become connected to the internet, the risk of cyberattacks increases. To identify the cybersecurity threats and subsequently reduce vulnerabilities, the common practice is to carry out a cybersecurity risk assessment. For safety classified systems and products, there is also a need for safety risk assessments in addition to the cybersecurity risk assessment in order to identify and reduce safety risks. These two risk assessments are usually done separately, but since cybersecurity and functional safety are often related, a more comprehensive method covering both aspects is needed. Some work addressing this has been done for specific domains like the automotive domain, but more general methods suitable for, e.g., intelligent distributed grids, are still missing. One such method from the automotive domain is the Security-Aware Hazard Analysis and Risk Assessment (SAHARA) method that combines safety and cybersecurity risk assessments. This paper presents an approach where the SAHARA method has been modified in order to be more suitable for larger distributed systems. The adapted SAHARA method has a more general risk assessment approach than the original SAHARA. The proposed method has been successfully applied on two use cases of an intelligent distributed grid.

Keywords: intelligent distribution grids, threat analysis, risk assessment, safety, cybersecurity

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Authors: Kréhi Serge Agbli, Samuel Portebos, Michaël Salomon

Abstract:

Here a methodology is considered aiming at evaluating the economic benefit of the provision of a primary frequency control unit using a Battery Energy Storage System (BESS). In this methodology, two control types (basic and hysteresis) are implemented and the corresponding minimum energy storage system power allowing to maintain the frequency drop inside a given threshold under a given contingency is identified and compared using DigSilent’s PowerFactory software. Following this step, the corresponding energy storage capacity (in MWh) is calculated. As PowerFactory is dedicated to dynamic simulation for transient analysis, a first order model related to the IEEE 9 bus grid used for the analysis under PowerFactory is characterized and implemented on MATLAB-Simulink. Primary frequency control is simulated using the two control types over one-month grid's frequency deviation data on this Simulink model. This simulation results in the energy throughput both basic and hysteresis BESSs. It emerges that the 15 minutes operation band of the battery capacity allocated to frequency control is sufficient under the considered disturbances. A sensitivity analysis on the width of the control deadband is then performed for the two control types. The deadband width variation leads to an identical sizing with the hysteresis control showing a better frequency control at the cost of a higher delivered throughput compared to the basic control. An economic analysis comparing the cost of the sized BESS to the potential revenues is then performed.

Keywords: battery energy storage system, electrical network frequency stability, frequency control unit, PowerFactor

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Authors: O. Davies, K. Veravalli, P. Panwalkar, M. Tofighi, P. Butterick, B. Healy, A. Mofidi

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Vancomycin resistant enterococcus infection is a condition that usually impacts ICUs, transplant, dialysis, and cancer units, often as a nosocomial infection. After an outbreak in the acute trauma and orthopaedic unit in Morriston hospital, we aimed to access the conditions that predispose VRE infections in our unit. Thirteen cases of VRE infection and five cases of VRE colonisations were identified in patients who were treated for orthopaedic care between 1/1/2020 and 1/11/2021. Cases were reviewed to identify predisposing factors, specifically looking at age, presenting condition and treatment, presence of infection and antibiotic care, active haemo-oncological condition, long term renal dialysis, previous hospitalisation, VRE predisposition, and clearance (PREVENT) scores, and outcome of care. The presenting condition, treatment, presence of postoperative infection, VRE scores, age was compared between colonised and the infected cohort. VRE type in both colonised and infection group was Enterococcus Faecium in all but one patient. The colonised group had the same age (T=0.6 P>0.05) and sex (2=0.115, p=0.74), presenting condition and treatment which consisted of peri-femoral fixation or arthroplasty in all patients. The infected group had one case of myelodysplasia and four cases of chronic renal failure requiring dialysis. All of the infected patient had sustained an infected complication of their fracture fixation or arthroplasty requiring reoperation and antibiotics. The infected group had an average VRE predisposition score of 8.5 versus the score of 3 in the colonised group (F=36, p<0.001). PREVENT score was 7 in the infected group and 2 in the colonised group(F=153, p<0.001). Six patients(55%) succumbed to their infection, and one VRE infection resulted in limb loss. In the orthopaedic cohort, VRE infection is a nosocomial condition that has peri-femoral predilection and is seen in association with immunosuppression or renal failure. The VRE infection cohort has been treated for infective complication of original surgery weeks prior to VRE infection. Based on our findings, we advise avoidance of infective complications, change of practice in use of antibiotics and use radical surgery and surveillance for VRE infections beyond infective precautions. PREVENT score shows that the infected group are unlikely to clear their VRE in the future but not the colonised group.

Keywords: surgical site infection, enterococcus, orthopaedic surgery, vancomycin resistance

Procedia PDF Downloads 117

Authors: A. S. Grewal, R. S. Sangwan, Dharambir, Vikas Dhanda

Abstract:

The purpose of this paper is to develop and analyze two reliability models for a system of non-identical firearms – one is standard firearm (called as original unit) and the other is a country-made firearm (called as duplicate /substandard unit). There is a single server who comes immediately to do inspection and repair whenever needed. On the failure of standard firearm, the server inspects the operative country-made firearm to see whether the unit is capable of performing the desired function well or not. If country-made firearm is not capable to do so, the operation of the system is stopped and server starts repair of the standard firearms immediately. However, no inspection is done at the failure of the country-made firearm as the country-made firearm alone is capable of performing the given task well. In model I, priority to repair the standard firearm is given in case system fails completely and country-made firearm is already under repair, whereas in model II there is no such priority. The failure and repair times of each unit are assumed to be independent and uncorrelated random variables. The distributions of failure time of the units are taken as negative exponential while that of repair and inspection times are general. By using semi-Markov process and regenerative point technique some econo-reliability measures are obtained. Graphs are plotted to compare the MTSF (mean time to system failure), availability and profit of the models for a particular case.

Keywords: non-identical firearms, inspection, priority to repair, semi-Markov process, regenerative point

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Authors: Mostosi C., Stéphenne J., Kempeneers E.

Abstract:

Introduction: Refuellers from Brussels South Charleroi Airport (BSCA) expressed concerns about the risks involved in handling JET-A1 fuel. The HSE Manager of BSCA, in collaboration with the occupational physician and the industrial hygiene unit of the External Service of Occupational Medicine, decided to assess the toxicological exposure of these workers. Materials and methods: Two measurement methods were used. The first was to assay three types of metabolites in urine to highlight the exposure to xylenes, toluene, and benzene in aircraft fuels. Out of 32 refuellers in the department, 26 participated in the sampling, and 23 samples were exploited. The second method targeted the assessment of environmental exposure to certain potentially hazardous substances that refuellers are likely to breathe in work areas at the airport. It was decided to carry out two ambient air measurement campaigns, using static systems on the one hand and, on the other hand, using individual sensors worn by the refuellers at the level of the respiratory tract. Volatile organic compounds and diesel particles were analyzed. Results: Despite the fears that motivated these analyzes, the overall results showed low levels of exposure, far below the existing limit values, both in air quality and in urinary measurements. Conclusion: These results are comparable to a study carried out in several French airports. The staff could be reassured, and then the medical surveillance was modified by the occupational physician. With the aviation development at BSCA, equipment and methods are evolving. Their exposure will have to be reassessed.

Keywords: refuelling, airport, exposure, fuel, occupational health, air quality

Procedia PDF Downloads 62

Authors: Seongjun Kim, Jinwooung Kim, Sung-Ah Kim

Abstract:

The development of information and communication technology also affects human cognition and thinking, especially in the field of design, new techniques are being tried. In architecture, new design methodologies such as machine learning or data-driven design are being applied. In particular, these methodologies are used in analyzing the factors related to the value of real estate or analyzing the feasibility in the early planning stage of the apartment housing. However, since the value of apartment buildings is often determined by external factors such as location and traffic conditions, rather than the interior elements of buildings, data is rarely used in the design process. Therefore, although the technical conditions are provided, the internal elements of the apartment are difficult to apply the data-driven design in the design process of the apartment. As a result, the designers of apartment housing were forced to rely on designer experience or modular design alternatives rather than data-driven design at the design stage, resulting in a uniform arrangement of space in the apartment house. The purpose of this study is to propose a methodology to support the designers to design the apartment unit plan with high consumer preference by deriving the correlation and importance of the floor plan elements of the apartment preferred by the consumers through the machine learning and reflecting this information from the early design process. The data on the pre-sale competition rate and the elements of the floor plan are collected as data, and the correlation between pre-sale competition rate and independent variables is analyzed through machine learning. This analytical model can be used to review the apartment unit plan produced by the designer and to assist the designer. Therefore, it is possible to make a floor plan of apartment housing with high preference because it is possible to feedback apartment unit plan by using trained model when it is used in floor plan design of apartment housing.

Keywords: apartment unit plan, data-driven design, design methodology, machine learning

Procedia PDF Downloads 236