Search results for: emergency plan

Authors: Pauline Calleja, Brooke Alexander

Abstract:

In 2010 the College of Emergency Nursing Australasia (CENA) undertook sole administration of the Trauma Nursing Program (TNP) across Australia. The original TNP was developed from recommendations by the Review of Trauma and Emergency Services-Victoria. While participant and faculty feedback about the program was positive, issues were identified that were common for industry training programs in Australia. These issues included didactic approaches, with many lectures and little interaction/activity for participants. Participants were not necessarily encouraged to undertake deep learning due to the teaching and learning principles underpinning the course, and thus participants described having to learn by rote, and only gain a surface understanding of principles that were not always applied to their working context. In Australia, a trauma or emergency nurse may work in variable contexts that impact on practice, especially where resources influence scope and capacity of hospitals to provide trauma care. In 2011, a program review was undertaken resulting in major changes to the curriculum, teaching, learning and assessment approaches. The aim was to improve learning including a greater emphasis on pre-program preparation for participants, the learning environment and clinically applicable contextualized outcomes participants experienced. Previously if participants wished to undertake assessment, they were given a take home examination. The assessment had poor uptake and return, and provided no rigor since assessment was not invigilated. A new assessment structure was enacted with an invigilated examination during course hours. These changes were implemented in early 2012 with great improvement in both faculty and participant satisfaction. This presentation reports on a comparison of participant evaluations collected from courses post implementation in 2012 and in 2015 to evaluate if positive changes were sustained. Methods: Descriptive statistics were applied in analyzing evaluations. Since all questions had more than 20% of cells with a count of <5, Fisher’s Exact Test was used to identify significance (p = <0.05) between groups. Results: A total of fourteen group evaluations were included in this analysis, seven CENA TNP groups from 2012 and seven from 2015 (randomly chosen). A total of 173 participant evaluations were collated (n = 81 from 2012 and 92 from 2015). All course evaluations were anonymous, and nine of the original 14 questions were applicable for this evaluation. All questions were rated by participants on a five-point Likert scale. While all items showed improvement from 2012 to 2015, significant improvement was noted in two items. These were in regard to the content being delivered in a way that met participant learning needs and satisfaction with the length and pace of the program. Evaluation of written comments supports these results. Discussion: The aim of redeveloping the CENA TNP was to improve learning and satisfaction for participants. These results demonstrate that initial improvements in 2012 were able to be maintained and in two essential areas significantly improved. Changes that increased participant engagement, support and contextualization of course materials were essential for CENA TNP evolution.

Keywords: emergency nursing education, industry training programs, teaching and learning, trauma education

Procedia PDF Downloads 272

Authors: M. K. Wijayarathna, S. M. Buddika Harshanath

Abstract:

Monitoring student engagement has become a crucial part of the educational process and a reliable indicator of the capacity to retain information. As online learning classrooms are now more common these days, students' attention levels have become increasingly important, making it more difficult to check each student's concentration level in an online classroom setting. To profile student attention to various gradients of engagement, a study is a plan to conduct using machine learning models. Using a convolutional neural network, the findings and confidence score of the high accuracy model are obtained. In this research, convolutional neural networks are using to help discover essential emotions that are critical in defining various levels of participation. Students' attention levels were shown to be influenced by emotions such as calm, enjoyment, surprise, and fear. An improved virtual learning system was created as a result of these data, which allowed teachers to focus their support and advise on those students who needed it. Student participation has formed as a crucial component of the learning technique and a consistent predictor of a student's capacity to retain material in the classroom. Convolutional neural networks have a plan to implement the platform. As a preliminary step, a video of the pupil would be taken. In the end, researchers used a convolutional neural network utilizing the Keras toolkit to take pictures of the recordings. Two convolutional neural network methods are planned to use to determine the pupils' attention level. Finally, those predicted student attention level results plan to display on the graphical user interface of the System.

Keywords: HTML5, JavaScript, Python flask framework, AI, graphical user

Procedia PDF Downloads 99

Authors: Ghorbanali Mohammadi

Abstract:

Background: Due to the widespread outbreak of the COVID-19 virus, a large number of people become infected with the disease every day and go to hospitals. The acute condition of this disease has caused the death of many people. Since all the stages of treatment for these people happen in the hospitals, nurses are at the forefront of the fight against this virus. This causes nurses to suffer from physical and mental health problems. Methods: Physical and mental problems in nurses were assessed using the Depression, Anxiety and Stress Scale (DASS-42) of Lovibond (1995) and the Nordic Questionnaire. Results: 90 nurses from emergency, intensive care, and coronary care units were examined, and a total of 180 questionnaires were collected and evaluated. It was found that 37.78%, 47.78%, and 21.11% of nurses have symptoms of depression, anxiety, and stress, respectively. 40% of the nurses had physical problems. In total, 65.17% of them were involved in one or more mental or physical illnesses. Conclusions: Of the three units surveyed, the nurses in intensive care, emergency room, and coronary care units worked more than ten hours a day. Examining the interaction of physical and mental health problems indicated that physical problems can aggravate mental problems.

Keywords: depression anxiety and stress scale of Lovibond, nordic questionnaire, mental health of nurses, physical health problems in nurses

Procedia PDF Downloads 122

Authors: Edna T. Bernabe, Joshua Bilolo, Sheila Mae Artillero, Catlicia Joy Caseda, Liezel Once, Donne Ynah Grace Quirante

Abstract:

Internal communication is significant for an organization to function to its full extent. A strategic communication plan builds an organization’s structure and makes it more systematic. Information is a vital part of communication inside the organization as this lays every possible outcome—be it positive or negative. It is, therefore, imperative to assess the communication structure of a particular organization to secure a better and harmonious communication environment in any organization. Thus, this research was intended to identify the internal communication channels used in Polytechnic University of the Philippines-College of Communication (PUP-COC) as an organization, to identify the flow of information specifically in downward, upward, and horizontal communication, to assess the accuracy, consistency, and timeliness of its internal communication channels; and to come up with a proposed strategic communication plan of information dissemination to improve the existing communication flow in the college. The researchers formulated a framework from Input-Throughout-Output-Feedback-Goal of General System Theory and gathered data to assess the PUP-COC’s internal communication. The communication model links the objectives of the study to know the internal organization of the college. The qualitative approach and case study as the tradition of inquiry were used to gather deeper understanding of the internal organizational communication in PUP-COC, using Interview, as the primary methods for the study. This was supported with a quantitative data which were gathered through survey from the students of the college. The researchers interviewed 17 participants: the College dean, the 4 chairpersons of the college departments, the 11 faculty members and staff, and the acting Student Council president. An interview guide and a standardized questionnaire were formulated as instruments to generate the data. After a thorough analysis of the study, it was found out that two-way communication flow exists in PUP-COC. The type of communication channel the internal stakeholders use varies as to whom a particular person is communicating with. The members of the PUP-COC community also use different types of communication channels depending on the flow of communication being used. Moreover, the most common types of internal communication are the letters and memoranda for downward communication, while letters, text messages, and interpersonal communication are often used in upward communication. Various forms of social media have been found out to be of use in horizontal communication. Accuracy, consistency, and timeliness play a significant role in information dissemination within the college. However, some problems have also been found out in the communication system. The most common problem are the delay in the dissemination of memoranda and letters and the uneven distribution of information and instruction to faculty, staff, and students. This has led the researchers to formulate a strategic communication plan which aims to propose strategies that will solve the communication problems that are being experienced by the internal stakeholders.

Keywords: communication plan, downward communication, internal communication, upward communication

Procedia PDF Downloads 518

Authors: Priyanshu Sharma

Abstract:

Urban development mechanism has evolved over the years in India, and various planning models and tools have been adopted by different states. Large cities have been able to make and implement plans with the varied degree. However, it has been observed these mechanisms face challenges to gain the momentum in small and medium towns. Gujarat has a very robust legislation that empowers planning authorities to prepare development plans (DP) and town planning scheme (TPS). The DP- TPS planning methods are quite popular for large cities in Gujarat. However, it has been observed that in the smaller towns these methods of plan preparation are facing severe agitations. Recently, development authorities of many small towns like Himmatnagar, Nadiad, and Junagadh, etc. have faced serious protest from local residents. This is because of the large amount of land deduction under the provisions of DP and TPS. And this number of opposition has been increasing since 2012 in Gujarat. This study aims to understand in detail the reasons for agitation against the plans prepared by smaller towns. It will further try to see whether the current framework of urban planning (DP and TPS) are really suitable for these towns. After understanding the development concerns and background, the aim and objectives of the study were outlined: Aim: To evaluate the suitability and acceptability of the current urban development mechanism for the small and medium towns. Objectives: (i) To review the GTPUD Act and identify the provision related to small and medium towns (ii) To understand preparation process of development plan and town planning scheme and issues related to it (iii) To understand the issues raised by the different stakeholder w.r.t plan because of which the plan and authority was agitated (iv) To find out the possible option through which these plans can be made suitable and acceptable to the stakeholder. The approach of this study is more qualitative based with the intention to understand the time frame process of preparation of development plan and town planning scheme and issues related to it. On the basis of literature study, the three towns were selected, and the detailed questionnaire was prepared for the stakeholders (development authorities and local residents) which include the time process taken in the preparation of DP and TPS and what were issues faced during the process and who all were involved. Lastly, the study looks into aspects of the land value of original plots and readjusted plots by concluding the argument whether this TP scheme model really worked in small and medium towns. Because the land deduction under TP scheme is allowed up to 50% as per the act and there is no distinct provision for small and medium towns under the act, so how this could be justified to smaller towns where the market value have not changed over the years. After analyzing the issues and reason behind the agitation against the DP and TPS in these small and medium towns. The broader recommendation has been given which can make these plans acceptable and suitable for the stakeholder.

Keywords: development plans, medium towns, small towns, town planning schemes

Procedia PDF Downloads 157

Authors: Alisher Agzamov, Hanan Al Harbi

Abstract:

BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists (1). We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study of 1501 oncology patients using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction, including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP, were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 210 +/- 40 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 140 +/- 35 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for oncology patients (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 29 % compared with the prerobot era, and there was an ICU cost savings of KD2.2 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, icu management and care, cost and icu occupancy

Procedia PDF Downloads 64

Authors: Andrey V. Timofeev, Dmitry V. Egorov

Abstract:

The practical efficient approach is suggested for estimation of the seismoacoustic sources energy in C-OTDR monitoring systems. This approach represents the sequential plan for confidence estimation both the seismoacoustic sources energy, as well the absorption coefficient of the soil. The sequential plan delivers the non-asymptotic guaranteed accuracy of obtained estimates in the form of non-asymptotic confidence regions with prescribed sizes. These confidence regions are valid for a finite sample size when the distributions of the observations are unknown. Thus, suggested estimates are non-asymptotic and nonparametric, and also these estimates guarantee the prescribed estimation accuracy in the form of the prior prescribed size of confidence regions, and prescribed confidence coefficient value.

Keywords: nonparametric estimation, sequential confidence estimation, multichannel monitoring systems, C-OTDR-system, non-lineary regression

Procedia PDF Downloads 356

Authors: Michelangelo Liban, Debbie Liquete

Abstract:

A case of a 93-year-old Filipina who experienced a sudden onset of left-sided hemichorea hemiballismus after falling from a standing height due to dizziness and then sought consult at the Emergency Room. She was not known to have diabetes mellitus nor experienced any symptoms of diabetes aside from its rare neurological manifestation of hemichorea-hemiballismus prior to this consult. On further workup, her baseline laboratory tests at the Emergency Room Department showed a CBG of 340mg/dL, an HbA1c of 15%, no ketones were detected in her urine but a hyperdensity with a Hounsfeld unit of 38 on CT, and hyperintensity on T1 weighted MRI on her right striatum with an incidental finding of a subdural hematoma measured as a 0.7cm hyperdensity on her right temporoparietal area with no midline shift. She was then treated with Clonazepam 2mg ¼ tab twice a day before bedtime and insulin 70/30 16 units in the morning and eight units in the evening, which provided good glycemic control maintained at 140-180 mg/dL, complete cessation of the left-sided hemichorea hemiballismus was also observed. The subdural hematoma was deemed non-surgical, and she refused admission into our institution; hence observation on an outpatient basis was done. This is a case of a rare neurological manifestation of diabetes mellitus but with good treatment response to anti-chorea medications combined with diabetes medications.

Keywords: hemichorea, hemiballismus, striatopathy, diabetes

Procedia PDF Downloads 81

Authors: Kazunori Nomura, Hiromichi Ogi, Masaumi Nakahara, Sou Watanabe, Atsuhiro Shibata

Abstract:

Chemical Processing Facility of Japan Atomic Energy Agency is a basic research field for advanced back-end technology developments with using actual high-level radioactive materials such as irradiated fuels from the fast reactor, high-level liquid waste from reprocessing plant. In the nature of a research facility, various kinds of chemical reagents have been offered for fundamental tests. Most of them were treated properly and stored in the liquid waste vessel equipped in the facility, but some were not treated and remained at the experimental space as a kind of legacy waste. It is required to treat the waste in safety. On the other hand, we formulated the Medium- and Long-Term Management Plan of Japan Atomic Energy Agency Facilities. This comprehensive plan considers Chemical Processing Facility as one of the facilities to be decommissioned. Even if the plan is executed, treatment of the “legacy” waste beforehand must be a necessary step for decommissioning operation. Under this circumstance, we launched a collaborative research project called the STRAD project, which stands for Systematic Treatment of Radioactive liquid waste for Decommissioning, in order to develop the treatment processes for wastes of the nuclear research facility. In this project, decomposition methods of chemicals causing a troublesome phenomenon such as corrosion and explosion have been developed and there is a prospect of their decomposition in the facility by simple method. And solidification of aqueous or organic liquid wastes after the decomposition has been studied by adding cement or coagulants. Furthermore, we treated experimental tools of various materials with making an effort to stabilize and to compact them before the package into the waste container. It is expected to decrease the number of transportation of the solid waste and widen the operation space. Some achievements of these studies will be shown in this paper. The project is expected to contribute beneficial waste management outcome that can be shared world widely.

Keywords: chemical processing facility, medium- and long-term management plan of JAEA facilities, STRAD project, treatment of radioactive waste

Procedia PDF Downloads 142

Authors: Mohamed Edesy, Carlo Cecere

Abstract:

This paper is a part of an ongoing research that proposes energy strategies for residential buildings in hot arid climates. In Egypt, the residential sector is dominated by increase in consumption rates annually. A building energy efficiency code was introduced by the government in 2005; it indicates minimum design and application requirements for residential buildings. Submission is mandatory and should lead to about 20% energy savings with an increase in comfort levels. However, compliance is almost nonexistent, electricity is subsidized and incentives to adopt energy efficient patterns are very low. This work presents an overview of the code and analyzes the impact of its introduction on different sectors. It analyses compliance barriers and indicates challenges that stand in the way of a realistic enforcement. It proposes an action plan for immediate code enforcement, updating current code to include retrofit, and development of rating systems for buildings. This work presents a broad national plan for energy efficiency empowerment in the residential sector.

Keywords: energy efficiency, housing, energy policies, code enforcement

Procedia PDF Downloads 347

Authors: Farhood Rismanchian, Seong Hyeon Park, Young Hoon Lee

Abstract:

During the recent years, demand for healthcare services has dramatically increased. As the demand for healthcare services increases, so does the necessity of constructing new healthcare buildings and redesigning and renovating existing ones. Increasing demands necessitate the use of optimization techniques to improve the overall service efficiency in healthcare settings. However, high complexity of care processes remains the major challenge to accomplish this goal. This study proposes a method based on process mining results to address the high complexity of care processes and to find the optimal layout of the various medical centers in an emergency department. ProM framework is used to discover clinical pathway patterns and relationship between activities. Sequence clustering plug-in is used to remove infrequent events and to derive the process model in the form of Markov chain. The process mining results served as an input for the next phase which consists of the development of the optimization model. Comparison of the current ED design with the one obtained from the proposed method indicated that a carefully designed layout can significantly decrease the distances that patients must travel.

Keywords: Mixed Integer programming, Facility layout problem, Process Mining, Healthcare Operation Management

Procedia PDF Downloads 339

Authors: Tugce Duygu Koksal

Abstract:

In recent years, given the fact that the acts of terrorism and the threat of the latter are taking place without any border and distinction, it has led the states to deal with the terrorism as a priority issue. More recently, as seen in different countries during state of emergency, the adoption of anti-terrorism measures motivated by the sole need of the prevention of terrorism targets directly the fundamental rights of individuals. Therefore, a contribution to the understanding of the value of the principle of legality is becoming more and more important nowadays. This paper aims to reflect the probable effects of the adoption of anti-terrorism measures regardless of the principle of legality, on the fundamental rights. In this respect, this paper will first discuss the margin of appreciation of the national authorities by countering terrorism, and then, the importance of the respect of the legality of the anti-terrorism measures will be examined in the light of actual examples. Indeed, one of the major findings of this study is the fact that the anti-terrorism laws and measures were taken in this framework must be subject to close scrutiny in democracies, which adopted the principle of the rule of law and respect human rights. Although the state's margin of appreciation in the field of counter-terrorism is broad, these measures which are based on the legitimate aim of a democracies’ legitimate right to protect itself against the activities of terrorist organizations should have the legal basis and be strictly required by the exigencies of the fight against terrorism. While combating terrorism, the legal basis shall only be achieved if the legal consequences of an individuals’ actions related to terrorism shall be clear and foreseeable by the individuals of a society. On the other hand, particularly during the state of emergency, the ambiguity of the law might be used to include a wide range of actions under acts of terrorism. This is becoming more dangerous where freedom of expression, freedom of the press, freedom of association and the right to information is in the substance of these actions. Disregarding the principle of legality is susceptible to create a chilling effect on the exercise of human rights, and therefore, the fight against terrorism can be transformed into a repressive regime on opponents. As a result, the efforts to counter terrorism of the national authorities irrespective of the principle of legality are susceptible to cause a transformation of the rule of law to a state of law which cannot be appreciated in a democratic society.

Keywords: anti-terrorism measures, chilling effect, predictability, the principle of legality, state of emergency

Procedia PDF Downloads 203

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

Abstract:

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. ICD 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-19 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-19, but ectopic pregnancy operative management remained unchanged.

Keywords: early pregnancy, ultrasound, COVID-19, obstetrics

Procedia PDF Downloads 20

Authors: Lluís Bermúdez, Isabel Morillo

Abstract:

Road safety involves carrying out a determined and explicit policy to reduce accidents. In the city of Barcelona, through the Local Road Safety Plan 2013-2018, in line with the framework that has been established at the European and state level, a series of preventive, corrective and technical measures are specified, with the priority objective of reducing the number of serious injuries and fatalities. In this work, based on the data from the accidents managed by the local police during the period 2010-2019, an analysis is carried out to verify whether the measures established in the Plan to reduce the accident rate have had an effect or not and to what extent. The analysis focuses on the type of accident and the type of vehicles involved. Different count regression models have been fitted, from which it can be deduced that the number of serious and fatal victims of the accidents that have occurred in the city of Barcelona has been reduced as the measures approved by the authorities.

Keywords: accident reduction, count regression models, road safety, urban traffic

Procedia PDF Downloads 133

Authors: Oussedik Lydia, Zaouani-Denoux Souâd

Abstract:

In an economic context characterized by intense competition and the impact of new technologies, companies have a constant need to adapt to the environment and the changes imposed. This situation leads companies to take training actions to develop employees’ required skills. Further, training is considered as a strategic lever for the company's growth. Accordingly, an increasing number of companies are adopting training to ensure continuous employees qualification. Thus, the aim of this research is to understand the process of training engineering occurring in the context of a company's continuous training, which will help to identify the gaps that can hinder or promote the development of employees' knowledge and skills. The research methodology is based on a mixed-method approach. Interviews and questionnaires are implemented to collect qualitative and quantitative data. The study results can help managers to identify gaps at each stage of training design. Finally, the research findings provide important information to help design a training plan to support the development of employees' knowledge and performance.

Keywords: training engineering, training needs, training plan, competences, continuing training, perception

Procedia PDF Downloads 136

Authors: Taehyun Kim, Hyunjoo Park, Taehyun Kim

Abstract:

Since the rapid economic development, Korea has recently entered a period of low growth due to population decline and aging. Due to the urbanization around the metropolitan area and the hollowing of local cities, the ecological capacity of a city is decreasing while ecological footprints are increasing, requiring a compact space plan for maintaining urban functions. The purpose of this study is to analyze the relationship between urban spatial structure and residents' ecological footprints for sustainable spatial planning. To do this, we try to analyze the relationship between intra-urban spatial structure, such as net/gross density and service accessibility, and resident ecological footprints of food, housing, transportation, goods and services through survey and structural equation modeling. The results of the study will be useful in establishing an implementation plan for sustainable development goals (SDGs), especially for sustainable cities and communities (SDG 11) and responsible consumption and production (SDG 12) in the future.

Keywords: ecological footprint, structural equation modeling, survey, sustainability, urban spatial structure

Procedia PDF Downloads 265

Authors: Tassana Boontong, Vilaivan Thongcharoen, Orapan Thosingha, Suphamon Chansakul, Anorut Jenwitheesuk, Chanin Chakkrapopyodhin, Isara Phiwchai, Mattika Chaichan, Rungnapha Khiewchaum

Abstract:

According to Thailand health policy, subdistrict health promoting hospitals (SHPHs) serve as forefront facilities for inclusive health care service. Those services include health promotion, disease prevention, primary medical care and rehabilitation. However, SHPHs residing in some distant area, such as SHPHs residing on the islands, would deliver different services relevant to health needs of the local people and the tourists. This research aimed to study health care delivery services at SHPHs on the islands in Thailand. Data were collected using questionnaires. The result revealed that in Thailand, there are 58 SHPHs on the islands. During data collection process, the researchers were not allowed to collect data in 5 SHPHs in the southern part due to Covid-19 pandemic. The report is based on 53 SHPHs on the islands. Numbers of health care personnel were 201, 72.14 % were female, with the ages ranged from 22 to 60 years (mean = 35.56 years). About 53% were community health personnel, while 26.08% were professional nurses. In regard to work experiences, the range of year varied from less than 1 year to 30 years, with the mean of 8.36 years. The majority of their responsibilities focused on providing primary medical care (86.34%), caring of people with chronic illnesses (85.30%) and providing medical care procedures for patients with chronic illnesses at home (84.36%). Nurses were main health care personnel in performing primary medical care. Due to difficulty transportation from the islands to the mainland, nurses had to provide prompt emergency medical care while the patients arrived with emergency and critical illnesses such as severe head trauma, stroke or coronary artery disease. Although some medical procedures were complex and not covered by nursing and midwifery license, they decided to protect patients from life- threatening conditions and make them stable before transportation. In SHPHs, the workload exceeded manpower, health care personnel had to work overtime almost every day. In the famous tourist islands, health care personnel had to carry 3-4 folds of their workload during the holidays because of the large crowds of foreign and Thai tourists. It is recommended that SHPHs on the islands should scale up the level of services to cover advanced medical care. Health care personnel, in particular, professional nurses, should be equipped with emergency and critical care skills. The expected outcomes of the services should emphasize on rescuing patients with emergency and life-threatening illnesses and providing comprehensive care for people living on or visiting the islands.

Keywords: distant area, islands, sub district health promoting hospital, heath care services, Thailand

Procedia PDF Downloads 78

Authors: Darma Putra Sitepu, Dewi Larasati, Yohanes Wolter Hendrik George

Abstract:

Sepsis is a life-threatening medical emergency frequently observed in intensive care unit (ICU). Surviving Sepsis Campaign in 2018 has recommended the administration of early vasopressor in the first hour of sepsis or septic shock but has not yet included de-resuscitation protocol. De-resuscitation in acute management of septic shock is where patient received active removal of accumulated fluid. It has been proposed by some studies and ongoing clinical trials. Here we present a case with early vasopressor and de-resuscitation. Male, 27 years old presenting to the emergency room with shortness of breath, altered mental status, and widespread blisters on his body and lips started a few hours prior, after receiving non-steroidal anti-inflammatory drug through intravenous injection. Patient was hypotensive, tachycardic, and tachypneic at admission, diagnosed with Steven Johnson Syndrome with Septic Shock. Patient received fluid resuscitation, early vasopressor, and diuresis agent aimed to actively remove fluid after the initial phase of resuscitation. Patient was admitted to ICU and progressively recovering. At day-10, patient was stabilized and was transferred to general ward. Early vasopressor and de-resuscitation are beneficial for the patient.

Keywords: sepsis, shock, de-resuscitation, vasopressor, fluid, case report

Procedia PDF Downloads 167

Authors: Patrick Strefford, Michael Davies, Masahiko Iguchi

Abstract:

The Sustainable Development Goals (SDGs) were adopted in 2015 to end poverty, protect the planet, and ensure prosperity for all. Sustainable tourism is firmly positioned in these Goals, since tourism has significant potential to contribute to inclusive and sustainable economic growth, as well as to promote sustainable use of natural capital. Recognizing this, the new quasi-democratic government of Myanmar has embraced Sustainable Tourism as a core component of its economic reforms and opening up of the country. However, it is also highly likely that the Democrats within the government also support Sustainable Tourism as a potential contributor to the democratization of the country. This paper outlines how the government of Myanmar has understood the concept of Sustainable Tourism, and how it intends to implement and facilitate Sustainable Tourism. This paper, therefore, focuses primarily on the institutional frameworks that have been put in place, a specific one being the Inlay Lake Destination Management Plan, which is one of the four priority destinations identified by the government. The plan aims to improve local infrastructure, manage the local environment and develop local human resources. Importantly, the Plan also includes the establishment of a Destination Management Organization (DMO) to implement and manage Inlay Lake as a Sustainable Tourism destination. This research aims to investigate, for example, the equality in both input to the DMO and benefits accrued to the various stakeholders. How such equality can be ensured and how this can be reliably quantified will be crucial to ultimately evaluating the success of any such plans to implement Sustainable Tourism in Myanmar in the coming years. However, this research paper concludes that while the establishment of the DMO is a positive development, there are considerable institutional, economic and cultural factors that severely limit the ability of the DMO to function as an agent of sustainable tourism implementation.

Keywords: sustainable tourism, myanmar, country in transition, destination management organizations

Procedia PDF Downloads 308

Authors: Nuhi Arslani, Aleks Brumec

Abstract:

Adhesive small bowel obstruction (ASBO) accounts for 20% of emergency surgical procedures and intraabdominal adhesions account for 65% of such cases. In a 10-year post-operative period of abdominal surgery patients, around 35% of them will be readmitted because of ASBO. The first step in approaching ASBOs is using the Bologna guidelines, which include a thorough initial evaluation to diagnose or rule out an ASBO and then proceed with either further imaging studies or emergency surgery, which can be either open or laparoscopic. The contraindications for a laparoscopic approach include hemodynamic instability of the patient and infections in the peritoneum or port sites. Studies have shown that a laparoscopic approach to adhesiolysis is linked with a significantly smaller risk of readmissions and reoperations as well as with faster recovery time and fewer postoperative infections, but has a higher risk of bowel injuries, so a careful selection of patients is required. Although studies favor a laparoscopic approach, many countries still prefer a laparotomy, often because a laparoscopic approach requires surgeons to be highly skilled in the procedure. In the US and UK, between 50 and 60% of surgeons would approach an ASBO with laparoscopy, while in Italy, this number is around 15% and it is most likely similar in Slovenia. We believe that in the right cases and in the right patients, a laparoscopic approach can be equally feasible for treating ASBOs and is associated with fewer intraoperative and postoperative complications.

Keywords: adhesive small bowel obstruction, laparoscopy, adhesions, adhesiolysis

Procedia PDF Downloads 86

Authors: Rafi Ullah, Shah Muhammad Emaduddin, Taha Jilani

Abstract:

Vehicle Adhoc Networks (VANET) belongs to a special class of Mobile Adhoc Network (MANET) with high mobility. Network is created by road side vehicles equipped with communication devices like GPS and Wifi etc. Since the environment is highly dynamic due to difference in speed and high mobility of vehicles and weak stability of the network connection, it is a challenging task to design an efficient routing protocol for such an unstable environment. Our proposed algorithm uses heuristic for the calculation of optimal path for routing the packet efficiently in collaboration with several other parameters like geographical location, speed, priority, the distance among the vehicles, communication range, and networks congestion. We have incorporated probabilistic, heuristic and machine learning based approach inconsistency with the relay function of the memory buffer to keep the packet moving towards the destination. These parameters when used in collaboration provide us a very strong and admissible heuristics. We have mathematically proved that the proposed technique is efficient for the routing of packets, especially in a medical emergency situation. These networks can be used for medical emergency, security, entertainment and routing purposes.

Keywords: heuristics routing, intelligent routing, VANET, route optimization

Procedia PDF Downloads 176

Authors: Lokvendra S. Budania, Yogesh K Gaude, Vamsidhar Chamala

Abstract:

Introduction: Congenitally corrected transposition of great arteries (CCTGA) is a complex congenital heart disease where there are both atrioventricular and ventriculoarterial discordances, usually accompanied by other cardiovascular malformations. Case Report: A 24-year-old primigravida known case of CCTGA at 37 weeks of gestation was referred to our hospital for safe delivery. Her electrocardiogram showed HR-40/pm, echocardiography showed Ejection Fraction of 65% and CCTGA. Temporary pacemaker was inserted by cardiologist in catheterization laboratory, before giving trial of labour in view of complete heart block. She was planned for normal delivery, but emergency Caesarean section was planned due to non-reassuring foetal Cardiotocography Pre-op vitals showed PR-50 bpm with temporary pacemaker, Blood pressure-110/70 mmHg, SpO2-99% on room air. Nil per oral was inadequate. Patency of two peripheral IV cannula checked and left radial arterial line secured. Epidural Anaesthesia was planned, and catheter was placed at L2-L3. Test dose was given, Anaesthesia was provided with 5ml + 5ml of 2% Lignocaine with 25 mcg Fentanyl and further 2.5Ml of 0.5% Bupivacaine was given to achieve a sensory level of T6. Cesarean section was performed and baby was delivered. Cautery was avoided during this procedure. IV Oxytocin (15U) was added to 500 mL of ringer’s lactate. Hypotension was treated with phenylephrine boluses. Patient was shifted to post-operative care unit and later to high dependency unit for monitoring. Post op vitals remained stable. Temporary pacemaker was removed after 24 hours of surgery. Her post-operative period was uneventful and discharged from hospital. Conclusion: Rare congenital cardiac disorders require detail knowledge of pathophysiology and associated comorbidities with the disease. Meticulously planned and carefully titrated neuraxial techniques will be beneficial for such cases.

Keywords: congenitally corrected transposition of great arteries, complete heart block, emergency LSCS, epidural anaesthesia

Procedia PDF Downloads 130

Authors: Gokulan Vethanayakam, Daniel Aston

Abstract:

Introduction: The ReSPECT process supports healthcare professionals when making patient-centered decisions in the event of an emergency. It has been widely adopted by the NHS in England and allows patients to express thoughts and wishes about treatments and outcomes that they consider acceptable. It includes (but is not limited to) cardiopulmonary resuscitation decisions. ReSPECT conversations should ideally occur prior to ICU admission and should be documented in the eight sections of the nationally-standardised ReSPECT form. This audit evaluated the use of ReSPECT on a busy cardiothoracic ICU in an NHS Trust where established policies advocating its use exist. Methods: This audit was a retrospective review of ReSPECT forms for a sample of high-risk patients admitted to ICU at the Royal Papworth Hospital between January 2021 and March 2022. Patients all received one of the following interventions: Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) for severe respiratory failure (retrieved via the national ECMO service); cardiac or pulmonary transplantation-related surgical procedures (including organ transplants and Ventricular Assist Device (VAD) implantation); or elective non-transplant cardiac surgery. The quality of documentation on ReSPECT forms was evaluated using national standards and a graded ranking tool devised by the authors which was used to assess narrative aspects of the forms. Quality was ranked as A (excellent) to D (poor). Results: Of 230 patients (74 VV-ECMO, 104 transplant, 52 elective non-transplant surgery), 43 (18.7%) had a ReSPECT form and only one (0.43%) patient had a ReSPECT form completed prior to ICU admission. Of the 43 forms completed, 38 (88.4%) were completed due to the commencement of End of Life (EoL) care. No non-transplant surgical patients included in the audit had a ReSPECT form. There was documentation of balance of care (section 4a), CPR status (section 4c), capacity assessment (section 5), and patient involvement in completing the form (section 6a) on all 43 forms. Of the 34 patients assessed as lacking capacity to make decisions, only 22 (64.7%) had reasons documented. Other sections were variably completed; 29 (67.4%) forms had relevant background information included to a good standard (section 2a). Clinical guidance for the patient (section 4b) was given in 25 (58.1%), of which 11 stated the rationale that underpinned it. Seven forms (16.3%) contained information in an inappropriate section. In a comparison of ReSPECT forms completed ahead of an EoL trigger with those completed when EoL care began, there was a higher number of entries in section 3 (considering patient’s values/fears) that were assessed at grades A-B in the former group (p = 0.014), suggesting higher quality. Similarly, forms from the transplant group contained higher quality information in section 3 than those from the VV-ECMO group (p = 0.0005). Conclusions: Utilisation of the ReSPECT process in high-risk patients is yet to be well-adopted in this trust. Teams who meet patients before hospital admission for transplant or high-risk surgery should be encouraged to engage with the ReSPECT process at this point in the patient's journey. VV-ECMO retrieval teams should consider ReSPECT conversations with patients’ relatives at the time of retrieval.

Keywords: audit, critical care, end of life, ICU, ReSPECT, resuscitation

Procedia PDF Downloads 66

Authors: Adrian Morris, Rodney Phillips, Mattia Tabacchi

Abstract:

Minimizing construction noise and vibration impacts is a key challenge for major infrastructure projects in urban environments. Before commencing construction works, Construction Noise and Vibration Management Plan (CNVMP) and Construction Noise and Vibration Impact Statements (CNVIS) are required to be prepared and submitted to the relevant government authorities for review and approval. However, the assessment of potential impacts from work activities at pre-approval stage may be inaccurate as works methodology and scheduling are yet to be determined. In response, noise and vibration management tools have been developed to refine and supplement the CNVIS as works progress. These tools have been successfully implemented in major infrastructure projects allowing contractors to plan and assess construction works in a cost effective and timely manner. As a result, noise and vibration management tools have been incorporated into management plans and are increasingly required by regulators.

Keywords: noise management, environmental noise, infrastructure projects, construction, vibration, cost effective

Procedia PDF Downloads 131

Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah

Abstract:

Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.

Keywords: ambulance offload, district general hospital, handover, quality improvement

Procedia PDF Downloads 105

Authors: Satoko Yamasaki, Hiromi Kawasaki, Kotomi Yamashita, Susumu Fukita, Kei Sounai

Abstract:

People are susceptible to rumors when the cause of their health problems is unknown or invisible. In order for individuals to be unaffected by rumors, they need basic knowledge and correct information. Community health nursing classes use cases where basic knowledge of radiation can be utilized on a regular basis, thereby teaching that basic knowledge is important in preventing anxiety caused by rumors. Nursing students need to learn that preventive activities are essential for public health nursing care. This is the same methodology used to reduce COVID-19 anxiety among individuals. This study verifies the learning effect concerning the basic knowledge of radiation necessary for case consultation by emergency distance learning. Sixty third-year nursing college students agreed to participate in this research. The knowledge tests conducted before and after classes were compared, with the chi-square test used for testing. There were five knowledge questions regarding distance lessons. This was considered to be 5% significant. The students’ reports which describe the results of responding to health consultations, were analyzed qualitatively and descriptively. In this case study, a person living in an area not affected by radiation was anxious about drinking water and, thus, consulted with a student. The contents of the lecture were selected the minimum amount of knowledge used for the answers of the consultant; specifically hot spots, internal exposure risk, food safety, characteristics of cesium-137, and precautions for counselors. Before taking the class, the most correctly answered question by students concerned daily behavior at risk of internal exposure (52.2%). The question with the fewest correct answers was the selection of places that are likely to be hot spots (3.4%). All responses increased significantly after taking the class (p < 0.001). The answers to the counselors, as written by the students, were 'Cesium is strongly bound to the soil, so it is difficult to transfer to water' and 'Water quality test results of tap water are posted on the city's website.' These were concrete answers obtained by using specialized knowledge. Even in emergency distance learning, the students gained basic knowledge regarding radiation and created a document to utilize said knowledge while assuming the situation concretely. It was thought that the flipped classroom method, even if conducted remotely, could maintain students' learning. It was thought that setting specific knowledge and scenes to be used would enhance the learning effect. By changing the case to concern that of the anxiety caused by infectious diseases, students may be able to effectively gain the basic knowledge to decrease the anxiety of residents due to infectious diseases.

Keywords: effect of class, emergency distance learning, nursing student, radiation

Procedia PDF Downloads 114

Authors: Marinko Maslaric, Maja Jokic

Abstract:

When searching for fast and long term responses, sustainable logistics and supply chain applications have developed irrefutable theories and hypotheses towards market requirements. Nevertheless, there are certain misunderstandings on how the implementation of sustainability principles (social, economical, and environmental) and concepts should work in practice, more specifically, within a humanitarian supply chain management context. This paper will focus on the review and analysis of risk management concepts in humanitarian supply chain in order to identify their compliance with sustainable principles. In this direction, the study will look for strategies that suggest: minimization of environmental impacts throughout the reduction of resources consumption, depreciation of logistics costs, including supply chain ones, minimization of transportation and service costs, elaboration of quality performance of supply chain and logistics, and reduction of supply chain delivery time. On the side of meeting all defense, trades and humanitarian logistics needs, the research will be aligned to UN Sustainable Development Goals, standards, and performances. It will start with relevant strategies for identification of risk indicators and it will end with suggestion of valuable strategic approaches for their minimization or total prevention. Finally, a content analysis will propose a suitable methodological structure for the creation of most sustainable strategy in risk management of humanitarian supply chain. Content analysis will accompany thorough, consistent and methodical approach of literature review for potential disaster risk management plan. Thereupon, the propositions of this research will look for contemporary literature gaps, with respect to operate the literature analysis and to suggest the appropriate sustained risk low master plan. The indicated is here to secure the high quality of logistics practices in hazardous events.

Keywords: humanitarian logistics, sustainability, supply chain risk, risk management plan

Procedia PDF Downloads 239

Authors: Vibhore Bakshi

Abstract:

This research paper is a step towards understanding the role of governance in the plan preparation process. It addresses the complexities of the peri-urban, historical constructions, politics and policies of sustainability, and legislative frameworks. The paper reflects on the Delhi NCT as one of the classical cases that have happened to witness different structural changes in the master plan around 1981, 2001, 2021, and Proposed Draft 2041. The Delhi Landsat imageries for 1989 and 2018 show an increase in the built-up areas around the periphery of NCT. The peri-urbanization has been a result of increasing in-migration to peri–urban areas of Delhi. The built-up extraction for years 1981, 1991, 2001, 2011, and 2018 highlights the growing peri-urbanization on scarce land therefore, it becomes equally important to research the history of the land and its legislative measures. It is interesting to understand the streaks of changes that have occurred in the land of Delhi in accordance with the different master plans and land legislative policies. The process of masterplan process in Delhi has experienced a lot of complexities in juxtaposition to other metropolitan regions of the world. The paper identifies the shortcomings in the current master planning process approach in regard to the stage of the planning process, traditional planning approach, and lagging ICT-based interventions. The metropolitan governance systems across the globe and India depict diversity in the organizational setup and varied dissemination of functions. It addresses the complexity of the peri-urban, historical constructions, politics and policies of sustainability, and legislative frameworks.

Keywords: governance, land provisions, built-up areas, in migration, built up extraction, master planning process, legislative policies, metropolitan governance systems

Procedia PDF Downloads 172

Authors: Aref Lashin

Abstract:

Saudi Arabia vision of 2030 calls for the diversification of energy sources in the Kingdom. Accordingly, Saudi Arabia has launched a promising plan aims to gradually power the major industrial activities in country by renewable and low carbon energy sources. The geothermal sources are among the promising renewable sources that can support the achievement of the country vision and energy mix plan. Saudi Arabia is enriched with several geothermal resources especially in the western and southwestern regions along the Red Sea region. This paper will give an overview on the different geothermal resources (Hydrothermal, Harrats volcanic eruptions and hot dry rocks) of Saudi Arabia, their categories and classifications as well as the different exploration (Geophysical, geological, geochemical, etc) and drilling enhanced during the last few decades. The economic viability and the possible contribution of geothermal resources in the future of renewable energy of Saudi Arabia is discussed. Some case studies from Jizan, Al-Lith, Harrats and Midyan areas are demonstrated. Scenarios of different low and high geothermal applications for possible power generations, as well as other low-grade utilizations, e.g. direct use, district heating & cooling, medical therapy, etc., are presented.

Keywords: KSA vison 2023, energy mix, geothermal resources, applications, Saudi Arabia

Procedia PDF Downloads 23

Authors: Samuel Fernandes, Dylan Kato, Emin Burak Onat, Patrick Keyantuo, Raja Sengupta, Amine Bouzaghrane

Abstract:

The COVID-19 pandemic has spread across the United States, forcing cities to impose stay-at-home and shelter-in-place orders. Building operations had to adjust as non-essential personnel worked from home. But as buildings prepare for personnel to return, they need to plan for safe operations amid new COVID-19 guidelines. In this paper we propose a methodology for capacity and flow modeling of personnel within buildings to safely operate under COVID-19 guidelines. We model personnel flow within buildings by network flows with queuing constraints. We study maximum flow, minimum cost, and minimax objectives. We compare our network flow approach with a simulation model through a case study and present the results. Our results showcase various scenarios of how buildings could be operated under new COVID-19 guidelines and provide a framework for building operators to plan and operate buildings in this new paradigm.

Keywords: network analysis, building simulation, COVID-19

Procedia PDF Downloads 160