Search results for: bleeding events
Commenced in January 2007
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Edition: International
Paper Count: 2303

Search results for: bleeding events

1853 Application of Simulation of Discrete Events in Resource Management of Massive Concreting

Authors: Mohammad Amin Hamedirad, Seyed Javad Vaziri Kang Olyaei

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Project planning and control are one of the most critical issues in the management of construction projects. Traditional methods of project planning and control, such as the critical path method or Gantt chart, are not widely used for planning projects with discrete and repetitive activities, and one of the problems of project managers is planning the implementation process and optimal allocation of its resources. Massive concreting projects is also a project with discrete and repetitive activities. This study uses the concept of simulating discrete events to manage resources, which includes finding the optimal number of resources considering various limitations such as limitations of machinery, equipment, human resources and even technical, time and implementation limitations using analysis of resource consumption rate, project completion time and critical points analysis of the implementation process. For this purpose, the concept of discrete-event simulation has been used to model different stages of implementation. After reviewing the various scenarios, the optimal number of allocations for each resource is finally determined to reach the maximum utilization rate and also to reduce the project completion time or reduce its cost according to the existing constraints. The results showed that with the optimal allocation of resources, the project completion time could be reduced by 90%, and the resulting costs can be reduced by up to 49%. Thus, allocating the optimal number of project resources using this method will reduce its time and cost.

Keywords: simulation, massive concreting, discrete event simulation, resource management

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1852 Identification Algorithm of Critical Interface, Modelling Perils on Critical Infrastructure Subjects

Authors: Jiří. J. Urbánek, Hana Malachová, Josef Krahulec, Jitka Johanidisová

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The paper deals with crisis situations investigation and modelling within the organizations of critical infrastructure. Every crisis situation has an origin in the emergency event occurrence in the organizations of energetic critical infrastructure especially. Here, the emergency events can be both the expected events, then crisis scenarios can be pre-prepared by pertinent organizational crisis management authorities towards their coping or the unexpected event (Black Swan effect) – without pre-prepared scenario, but it needs operational coping of crisis situations as well. The forms, characteristics, behaviour and utilization of crisis scenarios have various qualities, depending on real critical infrastructure organization prevention and training processes. An aim is always better organizational security and continuity obtainment. This paper objective is to find and investigate critical/ crisis zones and functions in critical situations models of critical infrastructure organization. The DYVELOP (Dynamic Vector Logistics of Processes) method is able to identify problematic critical zones and functions, displaying critical interfaces among actors of crisis situations on the DYVELOP maps named Blazons. Firstly, for realization of this ability is necessary to derive and create identification algorithm of critical interfaces. The locations of critical interfaces are the flags of crisis situation in real organization of critical infrastructure. Conclusive, the model of critical interface will be displayed at real organization of Czech energetic crisis infrastructure subject in Black Out peril environment. The Blazons need live power Point presentation for better comprehension of this paper mission.

Keywords: algorithm, crisis, DYVELOP, infrastructure

Procedia PDF Downloads 406
1851 Comparison of Low Velocity Impact Test on Coir Fiber Reinforced Polyester Composites

Authors: Ricardo Mendoza, Jason Briceño, Juan F. Santa, Gabriel Peluffo, Mauricio Márquez, Beatriz Cardozo, Carlos Gutiérrez

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The most common controlled method to obtain impact strength of composites materials is performing a Charpy Impact Test which consists of a pendulum with calibrated mass and length released from a known height. In fact, composites components experience impact events in normal operations such as when a tool drops or a foreign object strikes it. These events are categorized into low velocity impact (LVI) which typically occurs at velocities below 10m/s. In this study, the major aim was to calculate the absorbed energy during the impact. Tests were performed on three types of composite panels: fiberglass laminated panels, coir fiber reinforced polyester and coir fiber reinforced polyester subjected to water immersion for 48 hours. Coir fibers were obtained in local plantations of the Caribbean coast of Colombia. They were alkali treated in 5% aqueous NaOH solution for 2h periods. Three type of shape impactors were used on drop-weight impact test including hemispherical, ogive and pointed. Failure mechanisms and failure modes of specimens were examined using an optical microscope. Results demonstrate a reduction in absorbed energy correlated with the increment of water absorption of the panels. For each level of absorbed energy, it was possible to associate a different fracture state. This study compares results of energy absorbed obtained from two impact test methods.

Keywords: coir fiber, polyester composites, low velocity impact, Charpy impact test, drop-weight impact test

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1850 The Relation between Vitamin C and Oral Health

Authors: Mai Ashraf Talaat

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Background: Vitamin C (ascorbic acid) is an essential nutrient for the development and repair of all body tissues. It can be obtained from a healthy diet or through supplementation. Due to its importance, vitamin C has become a mainstay in the treatment and prevention of many diseases and in maintaining immune, skin, bone and overall health. This review article aims to discuss the studies and case reports conducted to evaluate the effect of Vitamin C on oral health and the recent advances in oral medicine that involve the use of vitamin C. Data/Sources: The review was conducted for clinical studies, case reports and published literature in the English language that addresses this topic. An extensive search in the electronic databases of PubMed, PubMed Central, Web of Science, National Library of Medicine and ResearchGate was performed. Conclusion: Vitamin C is thought to treat periodontal diseases and gingival enlargement. It also affects biofilm formation and therefore, it helps in reducing caries incidence. Recently, vitamin C mesotherapy has been used to treat inflamed gingiva, bleeding gums and gingival hyperpigmentation. More research and randomized controlled trials are needed on this specific topic for more accurate judgment. Clinical significance: A minimally invasive approach - the usage of vitamin C in dental care could drastically reduce the need for surgical intervention.

Keywords: oral health, periodontology, vitamin C, Gingivitis

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1849 Patient Agitation and Violence in Medical-Surgical Settings at BronxCare Hospital, Before and During COVID-19 Pandemic; A Retrospective Chart Review

Authors: Soroush Pakniyat-Jahromi, Jessica Bucciarelli, Souparno Mitra, Neda Motamedi, Ralph Amazan, Samuel Rothman, Jose Tiburcio, Douglas Reich, Vicente Liz

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Violence is defined as an act of physical force that is intended to cause harm and may lead to physical and/or psychological damage. Violence toward healthcare workers (HCWs) is more common in psychiatric settings, emergency departments, and nursing homes; however, healthcare workers in medical setting are not spared from such events. Workplace violence has a huge burden in the healthcare industry and has a major impact on the physical and mental wellbeing of staff. The purpose of this study is to compare the prevalence of patient agitation and violence in medical-surgical settings in BronxCare Hospital (BCH) Bronx, New York, one year before and during the COVID-19 pandemic. Data collection occurred between June 2021 and August 2021, while the sampling time was from 2019 to 2021. The data were separated into two separate time categories: pre-COVID-19 (03/2019-03/2020) and COVID-19 (03/2020-03/2021). We created frequency tables for 19 variables. We used a chi-square test to determine a variable's statistical significance. We tested all variables against “restraint type”, determining if a patient was violent or became violent enough to restrain. The restraint types were “chemical”, “physical”, or both. This analysis was also used to determine if there was a statistical difference between the pre-COVID-19 and COVID-19 timeframes. Our data shows that there was an increase in incidents of violence in COVID-19 era (03/2020-03/2021), with total of 194 (62.8%) reported events, compared to pre COVID-19 era (03/2019-03/2020) with 115 (37.2%) events (p: 0.01). Our final analysis, completed using a chi-square test, determined the difference in violence in patients between pre-COVID-19 and COVID-19 era. We then tested the violence marker against restraint type. The result was statistically significant (p: 0.01). This is the first paper to systematically review the prevalence of violence in medical-surgical units in a hospital in New York, pre COVID-19 and during the COVID-19 era. Our data is in line with the global trend of increased prevalence of patient agitation and violence in medical settings during the COVID-19 pandemic. Violence and its management is a challenge in healthcare settings, and the COVID-19 pandemic has brought to bear a complexity of circumstances, which may have increased its incidence. It is important to identify and teach healthcare workers the best preventive approaches in dealing with patient agitation, to decrease the number of restraints in medical settings, and to create a less restrictive environment to deliver care.

Keywords: COVID-19 pandemic, patient agitation, restraints, violence

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1848 Reproductive Health of Women After Taking Chemotherapy for Gestational Trophoblastic Disease

Authors: Ezeh Chukwunonso Peter Excel, Akruti Vg

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Aim/Background: To show that even after undergoing 1-5 courses of chemotherapy for Gestational Trophoblastic Disease (GTD) reproductive health of women is intact and they conceive successfully after it. Method: Retrospective cohort analysis using data from the Lugansk regional maternity hospital database of years 1993-2013, which shows n=18 females had GTD and underwent 1-5 courses of chemotherapy. Results and Discussion: Frequency of GTD was rare. All 18 patients (pts) belong to age group of 17-39 years, covering wide range of reproductive age. Out of 18 pts, 15 had hydatidiform mole (HM) while other 3 had choriocarcinoma (CC). In anamnesis, among CC pts, 1 had early pre-eclampsia at 24 weeks and 1 had 4th week of late postpartum (PP) bleeding, while all HM pts had genital inflammatory diseases, 1 pt of HM during follow-up had High hCG and 3 times curettage in 5 months. 18 women became pregnant for 25 times after chemotherapy. Chemotherapy was given under indication of either high level of HCG, luteal cyst >6cm or path-morphological results of curettage. CC 3 pts had (2 spontaneous abortions (SA), 2 term cesarean section (CS), 1 preterm CS). HM 15 pts had (3 artificial abortion, 2 SA, 7CS (5 term and 2 preterm), 8 vaginal deliveries (7 term and 1 preterm)). Conclusion: During our research we got 22.2% preterm deliveries and 55.6% CS which is higher than the normal cases, but still all the 18 women were able to have kids successfully after chemotherapy. So we can conclude that chemotherapy for GTD was successful in keeping the reproductive health of women intact.

Keywords: reproductive health, chemotherapy, gestational trophoblastic disease, women

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1847 Prevalence Of Periodontal Disease In Felines In The Outskirts Of The City Of Manaus, Brazil: An Epidemiological Study

Authors: Pármenas Costa Macedo do Nascimento

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Periodontal disease is the most common disease in the oral cavity of felines. It starts with the accumulation of bacteria on the tooth surface supporting the tissues of the periodontal tissue, namely gums, alveolar bone, cementum, and periodontal ligament. The main clinical symptom observed by the owner is bad breath, which may lead to local and systemic consequences depending on the stage of periodontal disease, such as bleeding and bone loss. Therefore, the study is important to educate tutors to take better care of the felines oral health in order to try to prevent the disease. For this epidemiological study, the target population has been felines, located on the outskirts of Manaus, in the state of Amazonas, with a geographic area of 155.68 km², with no defined breed, from October 1st to 10th, 2021, whose samples has been randomly selected, with a detailed profile. The variables of interest for this study have been: absence or presence of periodontal disease, gender, age (delimited by age group), and condition (domiciled or homeless). Using a sample of 40 felines from 4 districts of the east side of Manaus chosen at random, an oral exam has been made to identify the studied disease. The animal's apparent age, condition, sex, and presence or absence of periodontal disease has been noted. It has been observed that 70% (28/40) of them had periodontal disease, mostly females, aged between 0 and 5 years and domiciled, totaling 30% (12/40).

Keywords: felines, oral cavity, oral exam, periodontal disease

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1846 A Corporate Social Responsibility View on Bribery Control in Business Relationships

Authors: Irfan Ameer

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Bribery control in developing countries is the biggest challenge for multinational enterprises (MNEs). Bribery practices are socially embedded and institutionalized, and therefore may achieve collective legitimacy in the society. MNEs often have better and strict norms, codes and standards about such corrupt practices. Bribery in B2B sales relationships has been researched but studies focusing on the role of firm in controlling bribery are scarce. The main objective of this paper is to explore MNEs strategies to control bribery in an environment where bribery is institutionalized. This qualitative study uses narrative approach and focuses on key events, actors and their role in controlling bribery in B2B sales relationships. The context of this study is pharmaceutical industry of Pakistan and data is collected through 23 episodic interviews supported by secondary data. The Corporate social responsibility (CSR) literature e.g. CSR three domain model and CSR pyramid is used to make sense of MNEs strategies to control bribery in developing countries. Results show that MNEs’ bribery control strategies are rather emerging based on the role of some key stakeholders and events which shape bribery strategies. Five key bribery control strategies were found through which MNEs can control both demand and supply side of bribery: bribery related codes development; bribery related codes implementation; focusing on competitive advantage; find mutually beneficial ethical solution; and collaboration with ethical stakeholders. The results also highlight the problems associated with each strategy. Study is unique in a sense that it focuses on stakeholders having unethical interests and provides guidelines to MNEs in controlling bribery practices in B2B sales relationships.

Keywords: bribery, developing countries, CSR, narrative research, B2B sales, MNEs

Procedia PDF Downloads 372
1845 Fake Accounts Detection in Twitter Based on Minimum Weighted Feature Set

Authors: Ahmed ElAzab, Amira M. Idrees, Mahmoud A. Mahmoud, Hesham Hefny

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Social networking sites such as Twitter and Facebook attracts over 500 million users across the world, for those users, their social life, even their practical life, has become interrelated. Their interaction with social networking has affected their life forever. Accordingly, social networking sites have become among the main channels that are responsible for vast dissemination of different kinds of information during real time events. This popularity in Social networking has led to different problems including the possibility of exposing incorrect information to their users through fake accounts which results to the spread of malicious content during life events. This situation can result to a huge damage in the real world to the society in general including citizens, business entities, and others. In this paper, we present a classification method for detecting fake accounts on Twitter. The study determines the minimized set of the main factors that influence the detection of the fake accounts on Twitter, then the determined factors have been applied using different classification techniques, a comparison of the results for these techniques has been performed and the most accurate algorithm is selected according to the accuracy of the results. The study has been compared with different recent research in the same area, this comparison has proved the accuracy of the proposed study. We claim that this study can be continuously applied on Twitter social network to automatically detect the fake accounts, moreover, the study can be applied on different Social network sites such as Facebook with minor changes according to the nature of the social network which are discussed in this paper.

Keywords: fake accounts detection, classification algorithms, twitter accounts analysis, features based techniques

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1844 Two-Sided Information Dissemination in Takeovers: Disclosure and Media

Authors: Eda Orhun

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Purpose: This paper analyzes a target firm’s decision to voluntarily disclose information during a takeover event and the effect of such disclosures on the outcome of the takeover. Such voluntary disclosures especially in the form of earnings forecasts made around takeover events may affect shareholders’ decisions about the target firm’s value and in return takeover result. This study aims to shed light on this question. Design/methodology/approach: The paper tries to understand the role of voluntary disclosures by target firms during a takeover event in the likelihood of takeover success both theoretically and empirically. A game-theoretical model is set up to analyze the voluntary disclosure decision of a target firm to inform the shareholders about its real worth. The empirical implication of model is tested by employing binary outcome models where the disclosure variable is obtained by identifying the target firms in the sample that provide positive news by issuing increasing management earnings forecasts. Findings: The model predicts that a voluntary disclosure of positive information by the target decreases the likelihood that the takeover succeeds. The empirical analysis confirms this prediction by showing that positive earnings forecasts by target firms during takeover events increase the probability of takeover failure. Overall, it is shown that information dissemination through voluntary disclosures by target firms is an important factor affecting takeover outcomes. Originality/Value: This study is the first to the author's knowledge that studies the impact of voluntary disclosures by the target firm during a takeover event on the likelihood of takeover success. The results contribute to information economics, corporate finance and M&As literatures.

Keywords: takeovers, target firm, voluntary disclosures, earnings forecasts, takeover success

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1843 Natural Law in the Mu’Tazilite Theology

Authors: Samaneh Khalili

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Natural law theory, in moral philosophy, refers to a system of unchanging values held to be mutual to all humans and can be discovered through reason. The natural law theory is commonly associated with western Philosophers. In contrast, discussions on notions of natural law in Islamic intellectual history were relatively rare. This paper aims to show that the moral theory developed by the Mu'tazilite thinkers can be classified in the ideas of natural law. In doing so, this study will demonstrate that the objective and unchanging values, according to Mu'tazilite theologians, provide the guidelines for assessing the Islamic law rules in the field of human coexistence. The focus of the paper lies on ʿAbd al-Ğabbār, who was the most influential thinker in the late epoch of the Muʿtazila. Although ʿAbd al-Ǧabbār did not leave a text with a systematic discussion of natural law, his teaching of nature, human reason, and the moral values of actions are all scattered throughout his work -'al-Muġnī fī abwāb at-tawḥīd wa-l-'adl'. It is necessary to focus on ʿAbd al-Ǧabbār's theories on reason, nature, and ethics since natural law revolves around the basic concepts of nature, reason, and moral value. While analyzing the concept of the Nature, it will attempt to answer how he explains the world's physical structure and God's relationship to natural events. Moreover, from ʿAbd al-Ǧabbār's point of view, is nature a self-determined system that follows its inner principle in every kind of change, or is nature guided by an external power? Does causality govern natural events? About the concept of reason, an attempt is made to examine how human reason, according to ʿAbd al-Ǧabbār, conceives moral attributes. Finally, the Autor will discuss the concepts of objective values and the place of rights and duties derived from Islamic law in ʿAbd al-Ǧabbār's thought.

Keywords: Islamic law, Mu'tazilite theology, natural law in Islamic theology, objective and unchanging values.

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1842 Rupture Termination of the 1950 C. E. Earthquake and Recurrent Interval of Great Earthquake in North Eastern Himalaya, India

Authors: Rao Singh Priyanka, Jayangondaperumal R.

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The Himalayan active fault has the potential to generate great earthquakes in the future, posing a biggest existential threat to humans in the Himalayan and adjacent region. Quantitative evaluation of accumulated and released interseismic strain is crucial to assess the magnitude and spatio-temporal variability of future great earthquakes along the Himalayan arc. To mitigate the destruction and hazards associated with such earthquakes, it is important to understand their recurrence cycle. The eastern Himalayan and Indo-Burman plate boundary systems offers an oblique convergence across two orthogonal plate boundaries, resulting in a zone of distributed deformation both within and away from the plate boundary and clockwise rotation of fault-bounded blocks. This seismically active region has poorly documented historical archive of the past large earthquakes. Thus, paleoseismologicalstudies confirm the surface rupture evidences of the great continental earthquakes (Mw ≥ 8) along the Himalayan Frontal Thrust (HFT), which along with the Geodetic studies, collectively provide the crucial information to understand and assess the seismic potential. These investigations reveal the rupture of 3/4th of the HFT during great events since medieval time but with debatable opinions for the timing of events due to unclear evidences, ignorance of transverse segment boundaries, and lack of detail studies. Recent paleoseismological investigations in the eastern Himalaya and Mishmi ranges confirms the primary surface ruptures of the 1950 C.E. great earthquake (M>8). However, a seismic gap exists between the 1714 C.E. and 1950 C.E. Assam earthquakes that did not slip since 1697 C.E. event. Unlike the latest large blind 2015 Gorkha earthquake (Mw 7.8), the 1950 C.E. event is not triggered by a large event of 1947 C.E. that occurred near the western edge of the great upper Assam event. Moreover, the western segment of the eastern Himalayadid not witness any surface breaking earthquake along the HFT for over the past 300 yr. The frontal fault excavations reveal that during the 1950 earthquake, ~3.1-m-high scarp along the HFT was formed due to the co-seismic slip of 5.5 ± 0.7 m at Pasighat in the Eastern Himalaya and a 10-m-high-scarp at a Kamlang Nagar along the Mishmi Thrust in the Eastern Himalayan Syntaxis is an outcome of a dip-slip displacement of 24.6 ± 4.6 m along a 25 ± 5°E dipping fault. This event has ruptured along the two orthogonal fault systems in the form of oblique thrust fault mechanism. Approx. 130 km west of Pasighat site, the Himebasti village has witnessed two earthquakes, the historical 1697 Sadiya earthquake, and the 1950 event, with a cumulative dip-slip displacement of 15.32 ± 4.69 m. At Niglok site, Arunachal Pradesh, a cumulative slip of ~12.82 m during at least three events since pre 19585 B.P. has produced ~6.2-m high scarp while the youngest scarp of ~2.4-m height has been produced during 1697 C.E. The site preserves two deformational events along the eastern HFT, providing an idea of last serial ruptures at an interval of ~850 yearswhile the successive surface rupturing earthquakes lacks in the Mishmi Range to estimate the recurrence cycle.

Keywords: paleoseismology, surface rupture, recurrence interval, Eastern Himalaya

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1841 Configuring Systems to Be Viable in a Crisis: The Role of Intuitive Decision-Making

Authors: Ayham Fattoum, Simos Chari, Duncan Shaw

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Volatile, uncertain, complex, and ambiguous (VUCA) conditions threaten systems viability with emerging and novel events requiring immediate and localized responses. Such responsiveness is only possible through devolved freedom and emancipated decision-making. The Viable System Model (VSM) recognizes the need and suggests maximizing autonomy to localize decision-making and minimize residual complexity. However, exercising delegated autonomy in VUCA requires confidence and knowledge to use intuition and guidance to maintain systemic coherence. This paper explores the role of intuition as an enabler of emancipated decision-making and autonomy under VUCA. Intuition allows decision-makers to use their knowledge and experience to respond rapidly to novel events. This paper offers three contributions to VSM. First, it designs a system model that illustrates the role of intuitive decision-making in managing complexity and maintaining viability. Second, it takes a black-box approach to theory development in VSM to model the role of autonomy and intuition. Third, the study uses a multi-stage discovery-oriented approach (DOA) to develop theory, with each stage combining literature, data analysis, and model/theory development and identifying further questions for the subsequent stage. We synthesize literature (e.g., VSM, complexity management) with seven months of field-based insights (interviews, workshops, and observation of a live disaster exercise) to develop a framework of intuitive complexity management framework and VSM models. The results have practical implications for enhancing the resilience of organizations and communities.

Keywords: Intuition, complexity management, decision-making, viable system model

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1840 Epigenetic and Archeology: A Quest to Re-Read Humanity

Authors: Salma A. Mahmoud

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Epigenetic, or alteration in gene expression influenced by extragenetic factors, has emerged as one of the most promising areas that will address some of the gaps in our current knowledge in understanding patterns of human variation. In the last decade, the research investigating epigenetic mechanisms in many fields has flourished and witnessed significant progress. It paved the way for a new era of integrated research especially between anthropology/archeology and life sciences. Skeletal remains are considered the most significant source of information for studying human variations across history, and by utilizing these valuable remains, we can interpret the past events, cultures and populations. In addition to archeological, historical and anthropological importance, studying bones has great implications in other fields such as medicine and science. Bones also can hold within them the secrets of the future as they can act as predictive tools for health, society characteristics and dietary requirements. Bones in their basic forms are composed of cells (osteocytes) that are affected by both genetic and environmental factors, which can only explain a small part of their variability. The primary objective of this project is to examine the epigenetic landscape/signature within bones of archeological remains as a novel marker that could reveal new ways to conceptualize chronological events, gender differences, social status and ecological variations. We attempted here to address discrepancies in common variants such as methylome as well as novel epigenetic regulators such as chromatin remodelers, which to our best knowledge have not yet been investigated by anthropologists/ paleoepigenetists using plethora of techniques (biological, computational, and statistical). Moreover, extracting epigenetic information from bones will highlight the importance of osseous material as a vector to study human beings in several contexts (social, cultural and environmental), and strengthen their essential role as model systems that can be used to investigate and construct various cultural, political and economic events. We also address all steps required to plan and conduct an epigenetic analysis from bone materials (modern and ancient) as well as discussing the key challenges facing researchers aiming to investigate this field. In conclusion, this project will serve as a primer for bioarcheologists/anthropologists and human biologists interested in incorporating epigenetic data into their research programs. Understanding the roles of epigenetic mechanisms in bone structure and function will be very helpful for a better comprehension of their biology and highlighting their essentiality as interdisciplinary vectors and a key material in archeological research.

Keywords: epigenetics, archeology, bones, chromatin, methylome

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1839 The Development of an Anaesthetic Crisis Manual for Acute Critical Events: A Pilot Study

Authors: Jacklyn Yek, Clara Tong, Shin Yuet Chong, Yee Yian Ong

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Background: While emergency manuals and cognitive aids (CA) have been used in high-hazard industries for decades, this has been a nascent field in healthcare. CAs can potentially offset the large cognitive load involved in crisis resource management and possibly facilitate the efficient performance of key steps in treatment. A crisis manual was developed based on local guidelines and the latest evidence-based information and introduced to a tertiary hospital setting in Singapore. Hence, the objective of this study is to evaluate the effectiveness of the crisis manual in guiding response and management of critical events. Methods: 7 surgical teams were recruited to participate in a series of simulated emergencies in high-fidelity operating room simulator over the period of April to June 2018. All teams consisted of a surgical consultant and medical officer/registrar, anesthesia consultant and medical officer/registrar; as well as a circulating, scrub and anesthetic nurse. Each team performed a simulated operation in which 1 or more of the crisis events occurred. The teams were randomly assigned to a scenario of the crisis manual and all teams were deemed to be equal in experience and knowledge. Before the simulation, teams were instructed on proper checklist use but the use of the checklist was optional. Results: 7 simulation sessions were performed, consisting of the following scenarios: Airway fire, Massive Transfusion Protocol, Malignant Hyperthermia, Eclampsia, and Difficult Airway. Out of the 7 surgical teams, 2 teams made use of the crisis manual – of which both teams had encountered a ‘Malignant Hyperthermia’ scenario. These team members reflected that the crisis manual assisted allowed them to work in a team, especially being able to involve the surgical doctors who were unfamiliar with the condition and management. A run chart plotted showed a possible upward trend, suggesting that with increasing awareness and training, staff would become more likely to initiate the use of the crisis manual. Conclusion: Despite the high volume load in this tertiary hospital, certain crises remain rare and clinicians are often caught unprepared. A crisis manual is an effective tool and easy-to-use repository that can improve patient outcome and encourage teamwork. With training, familiarity would allow clinicians to be increasingly comfortable with reaching out for the crisis manual. More simulation training would need to be conducted to determine its effectiveness.

Keywords: crisis resource management, high fidelity simulation training, medical errors, visual aids

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1838 Sweepline Algorithm for Voronoi Diagram of Polygonal Sites

Authors: Dmitry A. Koptelov, Leonid M. Mestetskiy

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Voronoi Diagram (VD) of finite set of disjoint simple polygons, called sites, is a partition of plane into loci (for each site at the locus) – regions, consisting of points that are closer to a given site than to all other. Set of polygons is a universal model for many applications in engineering, geoinformatics, design, computer vision, and graphics. VD of polygons construction usually done with a reduction to task of constructing VD of segments, for which there are effective O(n log n) algorithms for n segments. Preprocessing – constructing segments from polygons’ sides, and postprocessing – polygon’s loci construction by merging the loci of the sides of each polygon are also included in reduction. This approach doesn’t take into account two specific properties of the resulting segment sites. Firstly, all this segments are connected in pairs in the vertices of the polygons. Secondly, on the one side of each segment lies the interior of the polygon. The polygon is obviously included in its locus. Using this properties in the algorithm for VD construction is a resource to reduce computations. The article proposes an algorithm for the direct construction of VD of polygonal sites. Algorithm is based on sweepline paradigm, allowing to effectively take into account these properties. The solution is performed based on reduction. Preprocessing is the constructing of set of sites from vertices and edges of polygons. Each site has an orientation such that the interior of the polygon lies to the left of it. Proposed algorithm constructs VD for set of oriented sites with sweepline paradigm. Postprocessing is a selecting of edges of this VD formed by the centers of empty circles touching different polygons. Improving the efficiency of the proposed sweepline algorithm in comparison with the general Fortune algorithm is achieved due to the following fundamental solutions: 1. Algorithm constructs only such VD edges, which are on the outside of polygons. Concept of oriented sites allowed to avoid construction of VD edges located inside the polygons. 2. The list of events in sweepline algorithm has a special property: the majority of events are connected with “medium” polygon vertices, where one incident polygon side lies behind the sweepline and the other in front of it. The proposed algorithm processes such events in constant time and not in logarithmic time, as in the general Fortune algorithm. The proposed algorithm is fully implemented and tested on a large number of examples. The high reliability and efficiency of the algorithm is also confirmed by computational experiments with complex sets of several thousand polygons. It should be noted that, despite the considerable time that has passed since the publication of Fortune's algorithm in 1986, a full-scale implementation of this algorithm for an arbitrary set of segment sites has not been made. The proposed algorithm fills this gap for an important special case - a set of sites formed by polygons.

Keywords: voronoi diagram, sweepline, polygon sites, fortunes' algorithm, segment sites

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1837 Phytochemial Screening, Anti-Microbial and Mineral Determination of Brysocarpus coccineus Root

Authors: I. L. Ibrahim, A. Mann, A. Ndanaimi

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The research involved phytochemical screening, antibacterial activities and mineral determination by flame photometry of the crude extract of Brysocarpus coccineus schum indeed were carried out. The result of Phytochemical screening reveal tha saponins, alkaloids, cardiac glycosides, and anthraquinones were present. This suggests that the plant extract could be used as anti-inflammatory and anti-bleeding agents. Estimation of mineral content shows that the crude extract of B. coccineus contains 0.73 (Na+), 1.06 (K+) and 1.98 (Ca+) which justifies its use to be safe for hypertensive patients and could be used to lower blood pressure. The antibacterial properties of aqueous and ethanol extract were studied against some bacteria; pseudomonas aeruginosa, Escherichia coli, Bacilus subtilis, Klebsilla penmuoniae by disc diffusion method. The aqueous extract showed significant activity against the organisms while the ethanol at concentrations 5-10mg/ml ethanol extract showed significant zone of inhibition against the organisms, E. coli, (19 mm), B. cereus (12 mm), P. aeruginosa (11 mm), K. pnemuoniae (11 mm). Minimum inhibitory concentration (MIC) was carried with considerable effect of inhibition on the organisms. The MIC values observed were 1, 24, 16 and 19 mm against E. coli, B. cereus, P. aeruginosa and K. pnemuoniae respectively. Therefore, the plant could be a potential source of antibacterial agent although more pharmacological and clinical study may be recommended.

Keywords: phytochemicals, microorganisms, screenings, mineral ions

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1836 Efficacy and Safety of Probiotic Treatment in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis

Authors: Samir Malhotra, Rajan K. Khandotra, Rakesh K. Dhiman, Neelam Chadha

Abstract:

There is paucity of data about safety and efficacy of probiotic treatment on patient outcomes in cirrhosis. Specifically, it is important to know whether probiotics can improve mortality, hepatic encephalopathy (HE), number of hospitalizations, ammonia levels, quality of life, and adverse events. Probiotics may improve outcomes in patients with acute or chronic HE. However, it is also important to know whether probiotics can prevent development of HE, even in situations where patients do not have acute HE at the time of administration. It is also important to know if probiotics are useful as primary prophylaxis of HE. We aimed to conduct an updated systematic review and meta-analysis to evaluate the safety and efficacy of probiotics in patients with cirrhosis. We searched PubMed, Cochrane library, Embase, Scopus, SCI, Google Scholar, conference proceedings, and references of included studies till June 2017 to identify randomised clinical trials comparing probiotics with other treatments in cirrhotics. Data was analyzed using MedCalc. Probiotics had no effect on mortality but significantly reduced HE (14 trials, 1073 patients, OR 0.371; 95% CI 0.282 to 0.489). There was not enough data to conduct a meta-analysis on outcomes like hospitalizations and quality of life. The effect on plasma ammonia levels was not significant (SMD -0.429; 95%CI -1.034 – 0.177). There was no difference in adverse events. To conclude, although the included studies had a high risk of bias, the available evidence does suggest a beneficial effect on HE. Larger studies with longer periods of follow-up are needed to determine if probiotics can reduce all-cause mortality.

Keywords: cirrhosis, hepatic encephalopathy, meta-analysis, probiotic

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1835 Quality of Care of Medical Male Circumcisions: A Non-Negotiable for Right to Care

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

Abstract:

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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1834 Phytochemial Screening, Anti-Microbial, and Minerals Determination of Leptadenia Hastata

Authors: I. L. Ibrahim, A. Mann, B. A. Adam

Abstract:

This project involved screening for antibacterial activity, phytochemical and mineral properties of Leptadenia hastata by flame photometry. The result of phytochemical screening reveals that the presence of flavonoids, tannins, saponins, alkaloids, steroidal, and anthraquinones while the cardiac glycoside was absent. This justifies the plant been used as anti-bleeding and anti-inflammatory agents. The result of flame photometry revealed that 1.85 % (Na), 0.65% (K) and 1.85 % (Ca) which indicates the safe nature of the plant extract as such could be used to lower high blood pressure. The antibacterial properties of both the aqueous and ethanolic extract were studied against some bacteria, Escherichia coli, Bacillus Cercus, Pseudomonas aeruginas, and Enterobacter aerogegens, by disc diffusion method and the result reveals that there are very good activities against the organism while the ethanolic extract at concentration 1.0 – 1.2 mg/ml. the ethanolic extract showed in considerable zone inhibition against bacteria’s; Escherichia coli, Bacillus Cercus, pseudomonas aeruginosa andklebsellapnemuoniae. Minimum inhibitory concentration (MIC) and minimum Bacterial concentration (MBC) were conducted with fairly good significant effect of inhibition on the organism, therefore, plant extract could be a potential source of antibacterial agent.

Keywords: antibacterial activity, Leptadenia hastata, infectious diseases, phytochemical screening

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1833 Extreme Value Theory Applied in Reliability Analysis: Case Study of Diesel Generator Fans

Authors: Jelena Vucicevic

Abstract:

Reliability analysis represents a very important task in different areas of work. In any industry, this is crucial for maintenance, efficiency, safety and monetary costs. There are ways to calculate reliability, unreliability, failure density and failure rate. In this paper, the results for the reliability of diesel generator fans were calculated through Extreme Value Theory. The Extreme Value Theory is not widely used in the engineering field. Its usage is well known in other areas such as hydrology, meteorology, finance. The significance of this theory is in the fact that unlike the other statistical methods it is focused on rare and extreme values, and not on average. It should be noted that this theory is not designed exclusively for extreme events, but for extreme values in any event. Therefore, this is a great opportunity to apply the theory and test if it could be applied in this situation. The significance of the work is the calculation of time to failure or reliability in a new way, using statistic. Another advantage of this calculation is that there is no need for technical details and it can be implemented in any part for which we need to know the time to fail in order to have appropriate maintenance, but also to maximize usage and minimize costs. In this case, calculations have been made on diesel generator fans but the same principle can be applied to any other part. The data for this paper came from a field engineering study of the time to failure of diesel generator fans. The ultimate goal was to decide whether or not to replace the working fans with a higher quality fan to prevent future failures. The results achieved in this method will show the approximation of time for which the fans will work as they should, and the percentage of probability of fans working more than certain estimated time. Extreme Value Theory can be applied not only for rare and extreme events, but for any event that has values which we can consider as extreme.

Keywords: extreme value theory, lifetime, reliability analysis, statistic, time to failure

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1832 Next Generation UK Storm Surge Model for the Insurance Market: The London Case

Authors: Iacopo Carnacina, Mohammad Keshtpoor, Richard Yablonsky

Abstract:

Non-structural protection measures against flooding are becoming increasingly popular flood risk mitigation strategies. In particular, coastal flood insurance impacts not only private citizens but also insurance and reinsurance companies, who may require it to retain solvency and better understand the risks they face from a catastrophic coastal flood event. In this context, a framework is presented here to assess the risk for coastal flooding across the UK. The area has a long history of catastrophic flood events, including the Great Flood of 1953 and the 2013 Cyclone Xaver storm, both of which led to significant loss of life and property. The current framework will leverage a technology based on a hydrodynamic model (Delft3D Flexible Mesh). This flexible mesh technology, coupled with a calibration technique, allows for better utilisation of computational resources, leading to higher resolution and more detailed results. The generation of a stochastic set of extra tropical cyclone (ETC) events supports the evaluation of the financial losses for the whole area, also accounting for correlations between different locations in different scenarios. Finally, the solution shows a detailed analysis for the Thames River, leveraging the information available on flood barriers and levees. Two realistic disaster scenarios for the Greater London area are simulated: In the first scenario, the storm surge intensity is not high enough to fail London’s flood defences, but in the second scenario, London’s flood defences fail, highlighting the potential losses from a catastrophic coastal flood event.

Keywords: storm surge, stochastic model, levee failure, Thames River

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1831 [Keynote Talk]: Unlocking Transformational Resilience in the Aftermath of a Flood Disaster: A Case Study from Cumbria

Authors: Kate Crinion, Martin Haran, Stanley McGreal, David McIlhatton

Abstract:

Past research has demonstrated that disasters are continuing to escalate in frequency and magnitude worldwide, representing a key concern for the global community. Understanding and responding to the increasing risk posed by disaster events has become a key concern for disaster managers. An emerging trend within literature, acknowledges the need to move beyond a state of coping and reinstatement of the status quo, towards incremental adaptive change and transformational actions for long-term sustainable development. As such, a growing interest in research concerns the understanding of the change required to address ever increasing and unpredictable disaster events. Capturing transformational capacity and resilience, however is not without its difficulties and explains the dearth in attempts to capture this capacity. Adopting a case study approach, this research seeks to enhance an awareness of transformational resilience by identifying key components and indicators that determine the resilience of flood-affected communities within Cumbria. Grounding and testing a theoretical resilience framework within the case studies, permits the identification of how perceptions of risk influence community resilience actions. Further, it assesses how levels of social capital and connectedness impacts upon the extent of interplay between resources and capacities that drive transformational resilience. Thus, this research seeks to expand the existing body of knowledge by enhancing the awareness of resilience in post-disaster affected communities, by investigating indicators of community capacity building and resilience actions that facilitate transformational resilience during the recovery and reconstruction phase of a flood disaster.

Keywords: capacity building, community, flooding, transformational resilience

Procedia PDF Downloads 285
1830 Assessing the Efficiency of Sports Stadiums in India: An Explorative Study of Socio-Economic Sustainability

Authors: Shivam Adhikary

Abstract:

Sports stadiums are not merely public amenities for entertainment and recreation for a city. They are buildings with extremely high construction investment and running costs which holds the supreme responsibility of social integration, nation building and financial upliftment of the community apart from its primary motive of conducting and promotion of the sports. But the present scenario of sports performances at international events and growing physical inactivity among the youth in India show that the sports facilities are far behind in achieving these goals. A pilot study of Indira Gandhi Sports complex in Vijayawada, Andhra Pradesh gave an indication of underutilization of sports stadia in India. This probed a crying need for the assessment of the present usage and functioning of the major sports (non-cricketing) facilities within the country. This paper assesses the sustainability of stadiums built for national and international sporting (non-cricket) events in terms of sporting, socio-cultural and financial sustainability by mainly focusing on their usage in non-event days. The criteria for the assessment and comparison of the stadiums within the nation is done using World Stadium Index and GDI (Gross Domestic Income) while with international counterparts using WSI and GNI (Gross National Income). The pilot case of India Gandhi Sports complex in Vijayawada is further investigated for a deeper understanding of the present usage, the existing issues for its underutilization and the way-forward (at least a few) to reach its sustainable potential. The paper finally concludes with the discussion on whether sports stadiums are being utilized to its financial potential and if it is at par with its international counterparts.

Keywords: economic sustainability, social sustainability, sports infrastructure, stadium efficiency

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1829 Chance One’s Arm: Critical Evaluation on Laws of Sports Gambling in India

Authors: Archen Sara Vincent

Abstract:

Gambling is the practice or act of betting or wagering on uncertain events with the hope of winning money or any other valuable assets. Nowadays, the practice of gambling can be seen in almost all grounds of events, especially in sports. In sports, this is commonly known among people as sports betting. The history of gambling can be traced about 2,000 years back. It originated from Greeks, from Greeks to the Romans, then to England, where betting on horse races was much popular among the elites. The evolution of gambling in sports has made a greater impact in the modern era. In India, the legality of gambling in sports is regulated by The Public Gambling Act 1867, which prohibits gambling activities in public places. The major draw of this statute is that it does not have specific laws regarding online sports gambling. Section 30 of The Indian Contract Act 1872 considers wagering agreements void. However, there are certain exceptions for this section, that is, (1) state-owned lotteries and (2) wagering on horse races with a sum of Rupees 500 or upward. As per the Indian Constitution, the rules regarding sports gambling are within the powers of the state legislatures. Some of the states have enacted their own laws which explicitly permit or prohibit gambling within their jurisdiction. Recently in Tamilnadu, The Tamilnadu Gaming Act was amended in 2021 to completely ban online gambling and betting. Moreover, the Central Government has introduced the Online Gaming and Prevention of Fraud Bill, 2018, to legalize and regulate sports betting in India. However, this bill has not yet been passed as law. Now as the Indian legal system does not have a specific rule regarding online sports gambling, sports betting companies use this major drawback and attract people to use the gambling and betting apps by advertising with well-known sports players and other celebrities. This paper aims to critically evaluate gambling in sports and the laws relating to it in India.

Keywords: history of gambling, The Public Gambling Act 1862, state legislations, gambling in India

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1828 Comparing Field Displacement History with Numerical Results to Estimate Geotechnical Parameters: Case Study of Arash-Esfandiar-Niayesh under Passing Tunnel, 2.5 Traffic Lane Tunnel, Tehran, Iran

Authors: A. Golshani, M. Gharizade Varnusefaderani, S. Majidian

Abstract:

Underground structures are of those structures that have uncertainty in design procedures. That is due to the complexity of soil condition around. Under passing tunnels are also such affected structures. Despite geotechnical site investigations, lots of uncertainties exist in soil properties due to unknown events. As results, it possibly causes conflicting settlements in numerical analysis with recorded values in the project. This paper aims to report a case study on a specific under passing tunnel constructed by New Austrian Tunnelling Method in Iran. The intended tunnel has an overburden of about 11.3m, the height of 12.2m and, the width of 14.4m with 2.5 traffic lane. The numerical modeling was developed by a 2D finite element program (PLAXIS Version 8). Comparing displacement histories at the ground surface during the entire installation of initial lining, the estimated surface settlement was about four times the field recorded one, which indicates that some local unknown events affect that value. Also, the displacement ratios were in a big difference between the numerical and field data. Consequently, running several numerical back analyses using laboratory and field tests data, the geotechnical parameters were accurately revised to match with the obtained monitoring data. Finally, it was found that usually the values of soil parameters are conservatively low-estimated up to 40 percent by typical engineering judgment. Additionally, it could be attributed to inappropriate constitutive models applied for the specific soil condition.

Keywords: NATM, surface displacement history, numerical back-analysis, geotechnical parameters

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1827 Heat Vulnerability Index (HVI) Mapping in Extreme Heat Days Coupled with Air Pollution Using Principal Component Analysis (PCA) Technique: A Case Study of Amiens, France

Authors: Aiman Mazhar Qureshi, Ahmed Rachid

Abstract:

Extreme heat events are emerging human environmental health concerns in dense urban areas due to anthropogenic activities. High spatial and temporal resolution heat maps are important for urban heat adaptation and mitigation, helping to indicate hotspots that are required for the attention of city planners. The Heat Vulnerability Index (HVI) is the important approach used by decision-makers and urban planners to identify heat-vulnerable communities and areas that require heat stress mitigation strategies. Amiens is a medium-sized French city, where the average temperature has been increasing since the year 2000 by +1°C. Extreme heat events are recorded in the month of July for the last three consecutive years, 2018, 2019 and 2020. Poor air quality, especially ground-level ozone, has been observed mainly during the same hot period. In this study, we evaluated the HVI in Amiens during extreme heat days recorded last three years (2018,2019,2020). The Principal Component Analysis (PCA) technique is used for fine-scale vulnerability mapping. The main data we considered for this study to develop the HVI model are (a) socio-economic and demographic data; (b) Air pollution; (c) Land use and cover; (d) Elderly heat-illness; (e) socially vulnerable; (f) Remote sensing data (Land surface temperature (LST), mean elevation, NDVI and NDWI). The output maps identified the hot zones through comprehensive GIS analysis. The resultant map shows that high HVI exists in three typical areas: (1) where the population density is quite high and the vegetation cover is small (2) the artificial surfaces (built-in areas) (3) industrial zones that release thermal energy and ground-level ozone while those with low HVI are located in natural landscapes such as rivers and grasslands. The study also illustrates the system theory with a causal diagram after data analysis where anthropogenic activities and air pollution appear in correspondence with extreme heat events in the city. Our suggested index can be a useful tool to guide urban planners and municipalities, decision-makers and public health professionals in targeting areas at high risk of extreme heat and air pollution for future interventions adaptation and mitigation measures.

Keywords: heat vulnerability index, heat mapping, heat health-illness, remote sensing, urban heat mitigation

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1826 Inter-Annual Variations of Sea Surface Temperature in the Arabian Sea

Authors: K. S. Sreejith, C. Shaji

Abstract:

Though both Arabian Sea and its counterpart Bay of Bengal is forced primarily by the semi-annually reversing monsoons, the spatio-temporal variations of surface waters is very strong in the Arabian Sea as compared to the Bay of Bengal. This study focuses on the inter-annual variability of Sea Surface Temperature (SST) in the Arabian Sea by analysing ERSST dataset which covers 152 years of SST (January 1854 to December 2002) based on the ICOADS in situ observations. To capture the dominant SST oscillations and to understand the inter-annual SST variations at various local regions of the Arabian Sea, wavelet analysis was performed on this long time-series SST dataset. This tool is advantageous over other signal analysing tools like Fourier analysis, based on the fact that it unfolds a time-series data (signal) both in frequency and time domain. This technique makes it easier to determine dominant modes of variability and explain how those modes vary in time. The analysis revealed that pentadal SST oscillations predominate at most of the analysed local regions in the Arabian Sea. From the time information of wavelet analysis, it was interpreted that these cold and warm events of large amplitude occurred during the periods 1870-1890, 1890-1910, 1930-1950, 1980-1990 and 1990-2005. SST oscillations with peaks having period of ~ 2-4 years was found to be significant in the central and eastern regions of Arabian Sea. This indicates that the inter-annual SST variation in the Indian Ocean is affected by the El Niño-Southern Oscillation (ENSO) and Indian Ocean Dipole (IOD) events.

Keywords: Arabian Sea, ICOADS, inter-annual variation, pentadal oscillation, SST, wavelet analysis

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1825 Challenges That People with Autism and Caregivers Face in Public Environments

Authors: Andrei Pomana, Graham Brewer

Abstract:

Autism is a lifelong developmental disorder that affects verbal and non-verbal communication, behaviour and sensory processing. As a result, people on the autism spectrum have a difficult time when confronted with environments that have high levels of sensory stimulation. This is often compounded by the inability to properly communicate their wants and needs to caregivers. The capacity for people with autism to integrate depends on their ability to at least tolerate highly stimulating public environments for short periods of time. The overall challenges that people on the spectrum and their caregivers face need to be established in order to properly create and assess methods to mitigate the effects of high stimulus public spaces. The paper aims to identify the challenges that people on the autism spectrum and their caregivers face in typical public environments. Nine experienced autism therapists have participated in a semi-structured interview regarding the challenges that people with autism and their caregivers face in public environments. The qualitative data shows that the unpredictability of events and the high sensory stimulation present in public environments, especially auditory, are the two biggest contributors to the difficulties that people on the spectrum face. If the stimuli are not removed in a short period of time, uncontrollable behaviours or 'meltdowns' can occur, which leave the person incapacitated and unable to respond to any outside input. Possible solutions to increase integration in public spaces for people with autism revolve around removing unwanted sensory stimulus, creating personalized barriers for certain stimuli, equipping people with autism with better tools to communicate their needs or to orient themselves to a safe location and providing a predictable pattern of events that would prepare individuals for tasks ahead of time.

Keywords: autism, built environment, meltdown, public environment, sensory processing disorders

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1824 Malnutrition Among Adult Hospitalized Orthopedic Patients: Nursing Role And Nutrition Screening

Authors: Ehsan Ahmed Yahia

Abstract:

Introduction: The nursing role in nutrition screening and assessing hospitalized patients is important. Malnutrition is a common and costly problem, particularly among hospitalized patients, and can have an adverse effect on the healing process. The study's goal is to assess the prevalence of malnutrition among adult hospitalized orthopedic patients and to detect the barriers to the nutrition screening process. Aim of the study: This study aimed to (a) assess the prevalence of malnutrition in hospitalized orthopedic patients and (b) evaluate the relationship between malnutrition and selected clinical outcomes. Material and Methods: This prospective field study was conducted for three months between 03/2022 and 06/2022 in the selected orthopedic departments in a teaching hospital affiliated withCairo University, Egypt. with a total number of one hundred twenty (120) patients. Patients' assessment included checking for malnutrition using the Nutritional Risk Screening Questionnaire. Patients at risk for malnourishment were defined as NRS score ≥ 3. Clinical outcomes under consideration included 1) length of hospitalization, 2) mobilization after surgery and conservative treatment, and 3) rate of adverse events. Results: This study found that malnutrition is a significant problem among patients hospitalized in an orthopedic ward. The prevalence of malnutrition was the highest in patients with lumbar spine and pelvis fractures, followed by the proximal femur and proximal humerus fractures. Patients at risk for malnutrition had significantly prolonged hospitalization, delayed postoperative mobilization, and increased incidence of adverse events.27.8% of the study sample were at risk for malnutrition. The highest prevalence of malnourishment was found in Septic Surgery with 32%, followed by Traumatology with 19.6% and Arthroplasty with 15.3%. A higher prevalence of malnutrition was detected among patients with typical fractures, such as lumbar spine and pelvis (46.7%), proximal femur (34.4%), and proximal humeral (23.7%) fractures. Additionally, patients at risk for malnutrition showed prolonged hospitalization (14.7 ± 11.1 vs. 21.2 ± 11.7 days), delayed postoperative mobilization (2.3 ± 2.9 vs. 4.1 ± 4.9 days), and delayed to mobilize after conservative treatment (1.1 ± 2.7 vs. 1.8 ± 1.9 days). A significant statistical correlation of NRS with individual parameters (Spearman's rank correlation, p < 0.05) was observed. The rate of adverse incidents in patients at risk for malnutrition was significantly higher than that of patients with a regular nutritional status (37.2% vs. 21.1%, p < 0.001). Conclusions: Our results indicate that the prevalence of malnutrition in surgical patients is significant. The nutritional status of patients with typical fractures is especially at risk. Prolonged hospitalization, delayed postoperative mobilization, and delayed mobilization after conservative treatment is significantly associated with malnutrition. In addition, the incidence of adverse events in patients at risk for malnutrition is significantly higher.

Keywords: malnutrition, nutritional risk screening, surgery, nursing, orthopedic nurse

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