Search results for: airport emergency plan

Authors: Phatthara Surachon, Tosaphol Ratniyomchai, Thanatchai Kulworawanichpong

Abstract:

This paper presents an aerodynamic brake study of reducing braking distance for high-speed trains (HST) using aerodynamic brakes as inspiration from the applications on the commercial aircraft wings. In case of emergency, both braking distance and stopping time are longer than the usual situation. Therefore, the passenger safety and the HST driving control management are definitely obtained by reducing the time and distance of train braking during emergency situation. Due to the limited study and implementation of the aerodynamic brake in HST, the possibility in use and the effectiveness of the aerodynamic brake to the train dynamic movement during braking are analyzed and considered. Regarding the aircraft’s flaps that applied in the HST, the areas of the aerodynamic brake acted as an additional drag force during train braking are able to vary depending on the operating angle and the required dynamic braking force. The HST with a varying speed of 200 km/h to 350 km/h is taken as a case study of this paper. The results show that the stopping time and the brake distance are effectively reduced by the aerodynamic brakes. The mechanical brake and its maintenance are effectively getting this benefit by extending its lifetime for longer use.

Keywords: high-speed train, aerodynamic brake, brake distance, drag force

Procedia PDF Downloads 167

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 126

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 316

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. 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 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: 220 +/- 80 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 150 +/- 55 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for patients with AML (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 20 % compared with the prerobot era, and there was an ICU cost savings of KD2.5 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, rp - 7 in icu management, cost and icu occupancy

Procedia PDF Downloads 53

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 98

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 107

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 241

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 283

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 243

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 101

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 93

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 47

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 44

Authors: Grzegorz Baranski, Piotr Kacejko, Konrad Pietrykowski, Mariusz Duk

Abstract:

This paper discusses a model of a bus-driving scheme. Rapid changes in speed result in a constantly changing kinetic energy accumulated in a bus mass and an increased fuel consumption due to hardly recuperated kinetic energy. The model is based on the results achieved from chassis dynamometer, airport and city street researches. The verified model was applied to simulate the mechanical energy recuperation during the Japanese JE05 Emission Test Cycle. The simulations were performed for several values of vehicle mass. The research results show that fuel economy is impacted by kinetic energy recuperation.

Keywords: heavy duty vehicle, city bus, Japanese JE05 test cycle, kinetic energy, simulations

Procedia PDF Downloads 190

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 209

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 149

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 139

Authors: Joko Nurkamto

Abstract:

A lesson plan is a part of the planning phase in a learning and teaching system framing the scenario of pedagogical activities in the classroom. It informs a decision on what to teach and how to landscape classroom interaction. Regardless of these benefits, the writer has witnessed the fact that lesson plans are viewed merely as a teaching document. Therefore, this paper will explore teachers’ beliefs and practices in designing lesson plans. It focuses primarily on how both teachers and students negotiate lesson plans in which the students are deemed to be the agents of instructional innovations. Additionally, the paper will talk about how such lesson plans are enacted. To investigate these issues, document analysis, in-depth interviews, participant classroom observation, and focus group discussion will be deployed as data collection methods in this explorative case study. The benefits of the paper are to show different roles of lesson plans and to discover different ways to design and enact such plans from a socio-interactional perspective.

Keywords: instructional innovation, learning and teaching system, lesson plan, pedagogical activities, teachers' beliefs and practices

Procedia PDF Downloads 134

Authors: Mohanad Rezeq, Tarik Aouam, Frederik Gailly

Abstract:

In times of armed conflicts, various security checkpoints are placed by authorities to control the flow of merchandise into and within areas of conflict. The flow of humanitarian trucks that is added to the regular flow of commercial trucks, together with the complex security procedures, creates congestion and long waiting times at the security checkpoints. This causes distribution costs to increase and shortages of relief aid to the affected people to occur. Our research proposes a decision-support tool to assist planners and policymakers in building efficient plans for the distribution of relief aid, taking into account congestion at security checkpoints. The proposed tool is built around a multi-item humanitarian distribution planning model based on multi-phase design science methodology that has as its objective to minimize distribution and back ordering costs subject to capacity constraints that reflect congestion effects using nonlinear clearing functions. Using the 2014 Gaza War as a case study, we illustrate the application of the proposed tool, model the underlying relief-aid humanitarian supply chain, estimate clearing functions at different security checkpoints, and conduct computational experiments. The decision support tool generated a shipment plan that was compared to two benchmarks in terms of total distribution cost, average lead time and work in progress (WIP) at security checkpoints, and average inventory and backorders at distribution centers. The first benchmark is the shipment plan generated by the fixed capacity model, and the second is the actual shipment plan implemented by the planners during the armed conflict. According to our findings, modeling and optimizing supply chain flows reduce total distribution costs, average truck wait times at security checkpoints, and average backorders when compared to the executed plan and the fixed-capacity model. Finally, scenario analysis concludes that increasing capacity at security checkpoints can lower total operations costs by reducing the average lead time.

Keywords: humanitarian distribution planning, relief-aid distribution, congestion, clearing functions

Procedia PDF Downloads 60

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 72

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 52

Authors: Prangvalai Buasan, Boonrod Sajjakulnukit, Thongchart Bowonthumrongchai

Abstract:

The demand for biomass pellets in the industrial sector has significantly increased since 2020. The revised version of Thailand’s power development plan as well as the Alternative Energy Development Plan, aims to promote biomass fuel consumption by around 485 MW by 2030. The replacement of solid fossil fuel with biomass pellets will affect medium-term and long-term national benefits for all industries throughout the supply chain. Therefore, the evaluation of environmental and economic impacts throughout the biomass pellet supply chain needs to be performed to provide better insight into the goods and financial flow of this activity. This study extended the national input-output table for the biomass pellet industry and applied the input-output analysis (IOA) method, a sort of macroeconomic analysis, to interpret the result of transactions between industries in the monetary unit when the revised national power development plan was adopted and enforced. Greenhouse gas emissions from consuming energy and raw material through the supply chain are also evaluated. The total intermediate transactions of all economic sectors, which included the biomass pellets sector (CASE 2), increased by 0.02% when compared with the conservative case (CASE 1). The control total, which is the sum of total intermediate transactions and value-added, the control total of CASE 2 is increased by 0.07% when compared with CASE 1. The pellet production process emitted 432.26 MtCO2e per year. The major sharing of the GHG is from the plantation process of raw biomass.

Keywords: input-output analysis, environmental extended input-output analysis, macroeconomic planning, biomass pellets, renewable energy

Procedia PDF Downloads 79

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 314

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 182

Authors: Suneel Kumar, Nanda Kumar J. Sreelal Sreedhar, Suchibrata Sen, V. Muralidharan,

Abstract:

Fan technology is very critical and crucial for any aero engine technology. The fan disc forms a critical part of the fan module. It is an airworthiness requirement to have a metrological qualified quality disc. The current study uses a tactile probing and scanning on an articulated measuring machine (AMM), a bridge type coordinate measuring machine (CMM) and Metrology software for intermediate and final dimensional and geometrical verification during the prototype development of the disc manufactured through forging and machining process. The circumferential dovetails manufactured through the milling process are evaluated based on the evaluated and analysed metrological process. To perform metrological optimization a change of philosophy is needed making quality measurements available as fast as possible to improve process knowledge and accelerate the process but with accuracy, precise and traceable measurements. The offline CMM programming for inspection and optimisation of the CMM inspection plan are crucial portions of the study and discussed. The dimensional measurement plan as per the ASME B 89.7.2 standard to reach an optimised CMM measurement plan and strategy are an important requirement. The probing strategy, stylus configuration, and approximation strategy effects on the measurements of circumferential dovetail measurements of the developmental prototype disc are discussed. The results were discussed in the form of enhancement of the R &R (repeatability and reproducibility) values with uncertainty levels within the desired limits. The findings from the measurement strategy adopted for disc dovetail evaluation and inspection time optimisation are discussed with the help of various analyses and graphical outputs obtained from the verification process.

Keywords: coordinate measuring machine, CMM, aero engine, articulated measuring machine, fan disc

Procedia PDF Downloads 86

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 49

Authors: Angsumalin Puntho

Abstract:

Disruptive technology has had a great influence on our everyday lives and the existence of an organization. Geologists in the public sector need to keep up with digital technology and be able to work and collaborate in a more effective manner. The result from SWOT and 7S McKinsey analyses suggest that there are inadequate IT personnel, no individual digital literacy development plan, and a misunderstanding of management policies. The Office of Civil Service Commission develops digital literacy skills that civil servants and government officers should possess in order to work effectively; it consists of nine dimensions, including computer skills, internet skills, cyber security awareness, word processing, spreadsheets, presentation programs, online collaboration, graphics editors and cyber security practices; and six steps of digital literacy development including self-assessment, individual development plan, self-learning, certified test, learning reflection, and practices. Geologists can use digital literacy as a learning tool to develop themselves for better career opportunities.

Keywords: disruptive technology, digital technology, digital literacy, computer skills

Procedia PDF Downloads 81

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 132

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 60

Authors: Ana Luiza Da Gama E Souza

Abstract:

This article aims to discuss the problem of food insecurity in Brazil in what it refers to contamination of food by chemical substances such as herbicides, pesticides, and other contaminants. The issue will be faced by analyzing, on the one hand, the standards that guide the food system in the world and, on the other hand, human rights indicators whose purpose is to provide an effective monitoring of the State's obligations to guarantee food security, analyzing the implications of the former for the success of the latter. The methodology adopted in this article was bibliographic-documentary and consists of three moments of analysis. The first moment consists in the analysis of the reports of the Commission on Human Rights of the Organization of American States to identify the set of progress indicators developed by the Commission. This analysis will involve the new methodology used to evaluate the efficiency in monitoring food security in Brazil the case of using pesticides in the production of food at levels of toxicity not admitted by the inspection bodies. The second moment consists in evaluating the mechanism for monitoring food security in Brazil, which was initially established by the National Food Security Plan (PLANSAN) for 2012-2015 and improved by the II National Food Security Plan for 2016-2019. Those mechanisms were prepared by the Chamber (CAISAN), and have the function to compare the monitoring proposals with the results presented by CAISAN on the Indicators and Results Report of the National Plan for Food and Nutrition Security 2012-2015. The third moment was intended to understand, analyze and evaluate the standardization process of the agri-food system, especially regarding the level of toxicity standards, that is related to food safety monitoring as a guarantee of pesticide-free food. The results show the dependence between private standards of toxicity and the indicators of food safety that leads to inefficiency on monitoring that mechanism in Brazil.

Keywords: standards, indicators, human rights, food security

Procedia PDF Downloads 311