Search results for: forensic audit
99 Sudden Death in Young Patients: A Study of 312 Autopsy Cases
Authors: N. Haj Salem, M. Belhadj, S. Ben Jomâa, S. Saadi, R. Dhouieb, A. Chadly
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Introduction: Sudden death in young is seen as a dramatic phenomenon requiring knowledge of its impact and determining their causes. Aim: We aim to study the epidemiological characteristics of sudden death in young, and to discuss the mechanism and the importance of autopsy in these situations. Material and methods: We performed a retrospective cohort study using autopsy data from the department of forensic medicine at the University Hospital of Fattouma Bourguiba, Monastir-Tunisia. A review of all autopsies performed during 23 years was done. In each case, clinical information and circumstances of death were obtained. We have included all sudden death in persons aged between 1 year and 35 years for the male and from one year to 45 years for female. We collected 312 cases of sudden death during the studied period. The collected data were processed using SPSS 20. The significance level was set at 0.05. Results: Thirty-two cases of cardiac ischemic sudden death have been collected. Myocardial infarction was the second cause of sudden death in young patients. There was a male predominance. The most affected subjects were aged between 25-45 years. The death occurred more frequently at rest. Coronary artery disease has been discovered in twenty-four cases (75%). A severe coronary artery disease was observed in two children with medical history of familial hypercholesterolemia. The myocardial infarction occurred in healthy coronary arteries in eight cases. An anomalous course of coronary arteries, in particular, myocardial bridging, was found in eight cases (25%). Toxicological screening was negative in all cases. Second cause of death was hypertrophic cardiomyopathy. Neurological and respiratory causes of death were implicated respectively in 10% and 15%. Conclusion: Identifying epidemiological characteristics of sudden death in this population is important for guiding approaches to prevention that must be based on dietary hygienic measures and the control of cardiovascular risk factors.Keywords: autopsy, cardiac death, sudden death, young
Procedia PDF Downloads 23298 Applications of Forensics/DNA Tools in Combating Gender-Based Violence: A Case Study in Nigeria
Authors: Edeaghe Ehikhamenor, Jennifer Nnamdi
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Introduction: Gender-based violence (GBV) was a well-known global crisis before the COVID-19 pandemic. The pandemic burden only intensified the crisis. With prevailing lockdowns, increased poverty due to high unemployment, especially affecting females, and other mobility restrictions that have left many women trapped with their abusers, plus isolation from social contact and support networks, GBV cases spiraled out of control. Prevalence of economic with cultural disparity, which is greatly manifested in Nigeria, is a major contributory factor to GBV. This is made worst by religious adherents where the females are virtually relegated to the background. Our societal approaches to investigations and sanctions to culprits have not sufficiently applied forensic/DNA tools in combating these major vices. Violence against women or some rare cases against men can prevent them from carrying out their duties regardless of the position they hold. Objective: The main objective of this research is to highlight the origin of GBV, the victims, types, contributing factors, and the applications of forensics/DNA tools and remedies so as to minimize GBV in our society. Methods: Descriptive information was obtained through the search on our daily newspapers, electronic media, google scholar websites, other authors' observations and personal experiences, plus anecdotal reports. Results: Findings from our exploratory searches revealed a high incidence of GBV with very limited or no applications of Forensics/DNA tools as an intervening mechanism to reduce GBV in Nigeria. Conclusion: Nigeria needs to develop clear-cut policies on forensics/DNA tools in terms of institutional framework to develop a curriculum for the training of all stakeholders to fast-track justice for victims of GBV so as to serve as a deterrent to other culprits.Keywords: gender-based violence, forensics, DNA, justice
Procedia PDF Downloads 7697 A Novel Methodology for Browser Forensics to Retrieve Searched Keywords from Windows 10 Physical Memory Dump
Authors: Dija Sulekha
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Nowadays, a good percentage of reported cybercrimes involve the usage of the Internet, directly or indirectly for committing the crime. Usually, Web Browsers leave traces of browsing activities on the host computer’s hard disk, which can be used by investigators to identify internet-based activities of the suspect. But criminals, who involve in some organized crimes, disable browser file generation feature to hide the evidence while doing illegal activities through the Internet. In such cases, even though browser files were not generated in the storage media of the system, traces of recent and ongoing activities were generated in the Physical Memory of the system. As a result, the analysis of Physical Memory Dump collected from the suspect's machine retrieves lots of forensically crucial information related to the browsing history of the Suspect. This information enables the cyber forensic investigators to concentrate on a few highly relevant selected artefacts while doing the Offline Forensics analysis of storage media. This paper addresses the reconstruction of web browsing activities by conducting live forensics to identify searched terms, downloaded files, visited sites, email headers, email ids, etc. from the physical memory dump collected from Windows 10 Systems. Well-known entry points are available for retrieving all the above artefacts except searched terms. The paper describes a novel methodology to retrieve the searched terms from Windows 10 Physical Memory. The searched terms retrieved in this way can be used for doing advanced file and keyword search in the storage media files reconstructed from the file system recovery in offline forensics.Keywords: browser forensics, digital forensics, live Forensics, physical memory forensics
Procedia PDF Downloads 11096 Uniqueness of Fingerprint Biometrics to Human Dynasty: A Review
Authors: Siddharatha Sharma
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With the advent of technology and machines, the role of biometrics in society is taking an important place for secured living. Security issues are the major concern in today’s world and continue to grow in intensity and complexity. Biometrics based recognition, which involves precise measurement of the characteristics of living beings, is not a new method. Fingerprints are being used for several years by law enforcement and forensic agencies to identify the culprits and apprehend them. Biometrics is based on four basic principles i.e. (i) uniqueness, (ii) accuracy, (iii) permanency and (iv) peculiarity. In today’s world fingerprints are the most popular and unique biometrics method claiming a social benefit in the government sponsored programs. A remarkable example of the same is UIDAI (Unique Identification Authority of India) in India. In case of fingerprint biometrics the matching accuracy is very high. It has been observed empirically that even the identical twins also do not have similar prints. With the passage of time there has been an immense progress in the techniques of sensing computational speed, operating environment and the storage capabilities and it has become more user convenient. Only a small fraction of the population may be unsuitable for automatic identification because of genetic factors, aging, environmental or occupational reasons for example workers who have cuts and bruises on their hands which keep fingerprints changing. Fingerprints are limited to human beings only because of the presence of volar skin with corrugated ridges which are unique to this species. Fingerprint biometrics has proved to be a high level authentication system for identification of the human beings. Though it has limitations, for example it may be inefficient and ineffective if ridges of finger(s) or palm are moist authentication becomes difficult. This paper would focus on uniqueness of fingerprints to the human beings in comparison to other living beings and review the advancement in emerging technologies and their limitations.Keywords: fingerprinting, biometrics, human beings, authentication
Procedia PDF Downloads 31895 A Comparative Analysis of Innovation Maturity Models: Towards the Development of a Technology Management Maturity Model
Authors: Nikolett Deutsch, Éva Pintér, Péter Bagó, Miklós Hetényi
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Strategic technology management has emerged and evolved parallelly with strategic management paradigms. It focuses on the opportunity for organizations operating mainly in technology-intensive industries to explore and exploit technological capabilities upon which competitive advantage can be obtained. As strategic technology management involves multifunction within an organization, requires broad and diversified knowledge, and must be developed and implemented with business objectives to enable a firm’s profitability and growth, excellence in strategic technology management provides unique opportunities for organizations in terms of building a successful future. Accordingly, a framework supporting the evaluation of the technological readiness level of management can significantly contribute to developing organizational competitiveness through a better understanding of strategic-level capabilities and deficiencies in operations. In the last decade, several innovation maturity assessment models have appeared and become designated management tools that can serve as references for future practical approaches expected to be used by corporate leaders, strategists, and technology managers to understand and manage technological capabilities and capacities. The aim of this paper is to provide a comprehensive review of the state-of-the-art innovation maturity frameworks, to investigate the critical lessons learned from their application, to identify the similarities and differences among the models, and identify the main aspects and elements valid for the field and critical functions of technology management. To this end, a systematic literature review was carried out considering the relevant papers and articles published in highly ranked international journals around the 27 most widely known innovation maturity models from four relevant digital sources. Key findings suggest that despite the diversity of the given models, there is still room for improvement regarding the common understanding of innovation typologies, the full coverage of innovation capabilities, and the generalist approach to the validation and practical applicability of the structure and content of the models. Furthermore, the paper proposes an initial structure by considering the maturity assessment of the technological capacities and capabilities - i.e., technology identification, technology selection, technology acquisition, technology exploitation, and technology protection - covered by strategic technology management.Keywords: innovation capabilities, innovation maturity models, technology audit, technology management, technology management maturity models
Procedia PDF Downloads 5294 Child Abuse: Emotional, Physical, Neglect, Sexual and the Psychological Effects: A Case Scenario in Lagos State
Authors: Aminu Ololade Matilda
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Child abuse is a significant issue worldwide, affecting the socio-development and mental and physical health of young individuals. It is the maltreatment of a child by an adult or a child. This paper focuses on child abuse in Communities in Lagos State. The aim of this study is to investigate the extent of child abuse and its impact on the mood, social activities, self-worth, concentration, and academic performance of children in Communities in Lagos State. The primary research instrument used in this study was the interview (Forensic), which consisted of two sections. The first section gathered data on the details of the child and the forms and impacts of abuse experienced, while the second section focused on parental style. The study found that children who experienced various forms of abuse, such as emotional, neglect, physical, or sexual abuse, were hesitant to report it out of fear of threats or even death from the abuser. These abused children displayed withdrawn behaviour, depression, and low self-worth and underperformed academically compared to their peers who did not experience abuse. The findings align with socio-learning and intergenerational transmission of violence theories, which suggest that parents and caregivers who engage in child abuse often do so because they themselves experienced or witnessed abuse as children, thereby normalizing violence. The study highlights the prevalent issue of child abuse in Lagos State and emphasizes the need for advocacy programs and capacity building to raise awareness about child abuse and prevention. The distribution of the Child’s Rights Act in various sectors is also recommended to underscore the importance of protecting the rights of children. Additionally, the inclusion of courses on child abuse in the school curriculum is proposed to ensure children are educated on recognizing and reporting abuse.Keywords: abuse, child, awareness, effects, emotional, neglect, physical, psychological, sexual, recognize, reporting, right
Procedia PDF Downloads 7293 Assessing the Prevalence of Accidental Iatrogenic Paracetamol Overdose in Adult Hospital Patients Weighing <50kg: A Quality Improvement Project
Authors: Elisavet Arsenaki
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Paracetamol overdose is associated with significant and possibly permanent consequences including hepatotoxicity, acute and chronic liver failure, and death. This quality improvement project explores the prevalence of accidental iatrogenic paracetamol overdose in hospital patients with a low body weight, defined as <50kg and assesses the impact of educational posters in trying to reduce it. The study included all adult inpatients on the admissions ward, a short stay ward for patients requiring 12-72 hour treatment, and consisted of three cycles. Each cycle consisted of 3 days of data collection in a given month (data collection for cycle 1 occurred in January 2022, February 2022 for cycle 2 and March 2022 for cycle 3). All patients given paracetamol had their prescribed dose checked against their charted weight to identify the percentage of adult inpatients <50kg who were prescribed 1g of paracetamol instead of 500mg. In the first cycle of the audit, data were collected from 83 patients who were prescribed paracetamol on the admissions ward. Subsequently, four A4 educational posters were displayed across the ward, on two separate occasions and with a one-month interval in between each poster display. The aim of this was to remind prescribing doctors of their responsibility to check patient body weight prior to prescribing paracetamol. Data were collected again one week after each round of poster display, from 72 and 70 patients respectively. Over the 3 cycles with a cumulative 225 patients, 15 weighed <50kg (6.67%) and of those, 5 were incorrectly prescribed 1g of paracetamol, yielding a 33.3% prevalence of accidental iatrogenic paracetamol overdose in adult inpatients. In cycle 1 of the project, 3 out of 6 adult patients weighing <50kg were overdosed on paracetamol, meaning that 50% of low weight patients were prescribed the wrong dose of paracetamol for their weight. In the second data collection cycle, 1 out of 5 <50kg patients were overdosed (20%) and in the third cycle, 1 out of 4 (25%). The use of educational posters resulted in a lower prevalence of accidental iatrogenic paracetamol overdose in low body weight adult inpatients. However, the differences observed were statistically insignificant (p value 0.993 and 0.995 respectively). Educational posters did not induce a significant decrease in the prevalence of accidental iatrogenic paracetamol overdose. More robust strategies need to be employed to further decrease paracetamol overdose in patients weighing <50kg.Keywords: iatrogenic, overdose, paracetamol, patient, safety
Procedia PDF Downloads 10992 Management of Third Stage Labour in a Rural Ugandan Hospital
Authors: Brid Dinnee, Jessica Taylor, Joseph Hartland, Michael Natarajan
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Background:The third stage of labour (TSL) can be complicated by Post-Partum Haemorrhage (PPH), which can have a significant impact on maternal mortality and morbidity. In Africa, 33.9% of maternal deaths are attributable to PPH1. In order to minimise this figure, current recommendations for the developing world are that all women have active management of the third stage of labour (AMTSL). The aim of this project was to examine TSL practice in a rural Ugandan Hospital, highlight any deviation from best practice and identify barriers to change in resource limited settings as part of a 4th year medical student External Student Selected Component field trip. Method: Five key elements from the current World Health Organisation (WHO) guidelines on AMTSL were used to develop an audit tool. All daytime vaginal deliveries over a two week period in July 2016 were audited. In addition to this, a retrospective comparison of PPH rates, between 2006 (when ubiquitous use of intramuscular oxytocin for management of TSL was introduced) and 2015 was performed. Results: Eight vaginal deliveries were observed; at all of which intramuscular oxytocin was administered and controlled cord traction used. Against WHO recommendation, all umbilical cords were clamped within one minute, and no infants received early skin-to-skin contact. In only one case was uterine massage performed after placental delivery. A retrospective comparison of data rates identified a 40% reduction in total number of PPHs from November 2006 to November 2015. Maternal deaths per delivery reduced from 2% to 0.5%. Discussion: Maternal mortality and PPH are still major issues in developing countries. Maternal mortality due to PPH can be reduced by good practices regarding TSL, but not all of these are used in low-resource settings. There is a notable difference in outcomes between the developed and developing world. At Kitovu Hospital, there has been a reduction in maternal mortality and number of PPHs following introduction of IM Oxytocin administration. In order to further improve these rates, staff education and further government funding is key.Keywords: post-partum haemorrhage, PPH, third stage labour, Uganda
Procedia PDF Downloads 19991 A 30 Year Audit of the Vascular Complications of Ports: Permanent Intravascular Access Devices
Authors: S. Kershaw, P. J. Barry, K. Webb
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Background: Cystic Fibrosis (CF) is a chronic lung disease where patients have chronic lung infection punctuated by acute exacerbations that require intermittent intravenous (IV) antibiotics during their lives. With time, peripheral venous access can become difficult and limited. Accessing these veins can become arduous, traumatic, painful and unworkable. A permanent intravascular access device or Port is a small device that is inserted into the central venous system that allows the delivery of medicine eliminating the need for peripheral venous access. Ports represent a convenient and efficient method when venous access is required on a permanent basis however they are also associated with significant vascular complications. Superior Vena Cava Obstruction (SVCO) is a rare but significant vascular complication of ports in this setting. Objective: We aimed to look at a single CF centre’s experience of port-related SVCO over a thirty year period. Methods: Retrospective data was extracted using patient’s notes, electronic radiological reports and local databases over a period in excess of 30 years from 1982 to 2014. Results: 13 patients were identified with SVCO as a result of their port. 11 patients had CF (9 female, 2 male), one male patient had Primary Ciliary Dyskinesia and one female patient had severe Asthma. The mean port function was 1532 days (range 110 – 4049) and the mean age at SVCO was 24 years (range 11.1 to 36.5 years). The most common symptoms were facial oedema (n=8, 61.5%) and dilated veins (n=6, 46.2%). 7 patients had their Ports removed after SVCO. 6 patients underwent attempted stenting (46.2%) and 6 did not. 4 out of the 6 who underwent stenting required/had re-intervention. 3 of the 6 patients who underwent stenting had symptom resolution, however, 4 of the 6 patients who were not stented had symptom resolution also. Symptom resolution was not guaranteed with stenting and required re-intervention in two-thirds. Conclusion: This case series represents the experience of one of the longest established CF units in the UK and represents the largest cohort ever reported in the literature.Keywords: ports, Superior Vena Cava Obstruction, cystic fibrosis, access devices
Procedia PDF Downloads 31490 The Diurnal and Seasonal Relationships of Pedestrian Injuries Secondary to Motor Vehicles in Young People
Authors: Amina Akhtar, Rory O'Connor
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Introduction: There remains significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population, based on the supposition that injuries would be more prevalent during dusk and dawn and during autumn and winter. Methods: Data was retrieved for patients between 10-25 years old from the National Trauma Audit and Research Network (TARN) database who had been involved as pedestrians in motor vehicle accidents between 2015-2020. The incidence of injuries, their severity (using the Injury Severity Score [ISS]), hospital transfer time, and mortality were analysed according to the hours of daylight, darkness, and season. Results: The study identified a seasonal pattern, showing that autumn was the predominant season and led to 34.9% of injuries, with a further 25.4% in winter in comparison to spring and summer, with 21.4% and 18.3% of injuries, respectively. However, visibility alone was not a sufficient factor as 49.5% of injuries occurred during the time of darkness, while 50.5% occurred during daylight. Importantly, the greatest injury rate (number of injuries/hour) occurred between 1500-1630, correlating to school pick-up times. A further significant relationship between injury severity score (ISS) and daylight was demonstrated (p-value= 0.0124), with moderate injuries (ISS 9-14) occurring most commonly during the day (72.7%) and more severe injuries (ISS>15) occurred during the night (55.8%). Conclusion: We have identified a relationship between time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest injury rate, suggesting that reduced visibility coupled with school pick-up times may play a significant role. This could be addressed through a targeted public health approach to implementing change. We recommend targeted public health measures to improve road safety that focus on these times and that increase the visibility of children combined with education for drivers.Keywords: major trauma, paediatric trauma, road traffic accidents, diurnal pattern
Procedia PDF Downloads 8989 A Novel Study Contrasting Traditional Autopsy with Post-Mortem Computed Tomography in Falls Leading to Death
Authors: Balaji Devanathan, Gokul G., Abilash S., Abhishek Yadav, Sudhir K. Gupta
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Background: As an alternative to the traditional autopsy, a virtual autopsy is carried out using scanning and imaging technologies, mainly post-mortem computed tomography (PMCT). This facility aims to supplement traditional autopsy results and reduce or eliminate internal dissection in subsequent autopsies. For emotional and religious reasons, the deceased's relatives have historically disapproved such interior dissection. The non-invasive, objective, and preservative PMCT is what friends and family would rather have than a traditional autopsy. Additionally, it aids in the examination of the technologies and the benefits and drawbacks of each, demonstrating the significance of contemporary imaging in the field of forensic medicine. Results: One hundred falls resulting in fatalities was analysed by the writers. Before the autopsy, each case underwent a PMCT examination using a 16-slice Multi-Slice CT spiral scanner. By using specialised software, MPR and VR reconstructions were carried out following the capture of the raw images. The accurate detection of fractures in the skull, face bones, clavicle, scapula, and vertebra was better observed in comparison to a routine autopsy. The interpretation of pneumothorax, Pneumoperitoneum, pneumocephalus, and hemosiuns are much enhanced by PMCT than traditional autopsy. Conclusion. It is useful to visualise the skeletal damage in fall from height cases using a virtual autopsy based on PMCT. So, the ideal tool in traumatising patients is a virtual autopsy based on PMCT scans. When assessing trauma victims, PMCT should be viewed as an additional helpful tool to traditional autopsy. This is because it can identify additional bone fractures in body parts that are challenging to examine during autopsy, such as posterior regions, which helps the pathologist reconstruct the victim's life and determine the cause of death.Keywords: PMCT, fall from height, autopsy, fracture
Procedia PDF Downloads 3088 Measuring Corruption from Public Justifications: Insights from the Brazilian Anti-Corruption Agency
Authors: Ana Luiza Aranha
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This paper contributes to the discussions that consider corruption as a challenge to the establishment of more democratically inclusive societies in Latin America. The paper advocates an intrinsic connection between democratic principles and corruption control – it is only possible to achieve just forms of democratic life if accountability institutions are able to control corruption, and therefore control the political exclusions that it brings. Departing from a non-trivial approach to corruption, and recognizing a gap in democratic theory when thinking about this phenomenon, corruption is understood as the breakdown of the democratic inclusive rule, whereby political decisions are made (and actions were taken) in spite of those potentially affected by them. Based on this idea, this paper proposes a new way of measuring corruption, moving away from usual aggregate measures – such as the Corruption Perception Index – and case studies of corruption scandals. The main argument sustains that corruption is intrinsically connected with the ability to be accountable and to provide public justification for the political conduct. The point advocated is that corruption involves a dimension of political exclusion. It generates a private benefit which is, from a democratic point of view, illegitimate, since it benefits some at the expense of the decisions made by the political community. Corruption is then a form of exclusion based on deception and opacity - for corruption, there is no plausible justification. Empirically, the paper uses the audit reports produced by the Brazilian anti-corruption agency (the CGU - Office of the Comptroller General) in its Inspections From Public Lotteries Program to exemplify how we can use this definition to separate corruption cases from mismanagement irregularities. On one side, there is poor management and inefficiencies, and, on the other, corruption, defined by the implausibility of public justifications – because the public officials would have to publicize illegitimate privileges and undue advantages. CGU reports provide the justifications given by the public officials for the irregularities found and also the acceptance or not by the control agency of these justifications. The analysis of this dialogue – between public officials and control agents – makes it possible to divide the irregularities on those that can be publicly justified versus those that cannot. In order to hold public officials accountable for their actions, making them responsible for the exclusions that they may cause (such as corruption), the accountability institutions fulfil an important role in reinforcing and empowering democracy and its basic inclusive condition.Keywords: accountability, brazil, corruption, democracy
Procedia PDF Downloads 25687 Development of a Multi-Locus DNA Metabarcoding Method for Endangered Animal Species Identification
Authors: Meimei Shi
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Objectives: The identification of endangered species, especially simultaneous detection of multiple species in complex samples, plays a critical role in alleged wildlife crime incidents and prevents illegal trade. This study was to develop a multi-locus DNA metabarcoding method for endangered animal species identification. Methods: Several pairs of universal primers were designed according to the mitochondria conserved gene regions. Experimental mixtures were artificially prepared by mixing well-defined species, including endangered species, e.g., forest musk, bear, tiger, pangolin, and sika deer. The artificial samples were prepared with 1-16 well-characterized species at 1% to 100% DNA concentrations. After multiplex-PCR amplification and parameter modification, the amplified products were analyzed by capillary electrophoresis and used for NGS library preparation. The DNA metabarcoding was carried out based on Illumina MiSeq amplicon sequencing. The data was processed with quality trimming, reads filtering, and OTU clustering; representative sequences were blasted using BLASTn. Results: According to the parameter modification and multiplex-PCR amplification results, five primer sets targeting COI, Cytb, 12S, and 16S, respectively, were selected as the NGS library amplification primer panel. High-throughput sequencing data analysis showed that the established multi-locus DNA metabarcoding method was sensitive and could accurately identify all species in artificial mixtures, including endangered animal species Moschus berezovskii, Ursus thibetanus, Panthera tigris, Manis pentadactyla, Cervus nippon at 1% (DNA concentration). In conclusion, the established species identification method provides technical support for customs and forensic scientists to prevent the illegal trade of endangered animals and their products.Keywords: DNA metabarcoding, endangered animal species, mitochondria nucleic acid, multi-locus
Procedia PDF Downloads 13086 Effect of Coaching Related Incompetency to Stand Trial on Symptom Validity Test: Robustness, Sensitivity, and Specificity
Authors: Natthawut Arin
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In forensic contexts, competency to stand trial assessments are the most common referrals. The defendants may attempt to endorse psychopathology symptoms and feign incompetent. Coaching, which can be teaching them test-taking strategies to avoid detection of psychopathological symptoms feigning. Recently, the Symptom Validity Testings (SVTs) were created to detect feigning. Moreover, the works of the literature showed that the effects of coaching on SVTs may be more robust to the effects of coaching. Thai Symptom Validity Test (SVT-Th) was designed as SVTs which demonstrated adequate psychometric properties and ability to classify between feigners and honest responders. Thus, the current study to examine the utility as the robustness of SVT-Th in the detection of feigned psychopathology. Participants consisted of 120 were recruited from undergraduate courses in psychology, randomly assigned to one of three groups. The SVT-Th was administered to those three scenario-experimental groups: (a) Uncoached group were asked to respond honestly (n=40), (b) Symptom-coached without warning group were asked to feign psychiatric symptoms to gain incompetency to stand trial (n=40), while (c) Test-coached with warning group were asked to feign psychiatric symptoms to avoid test detection but being incompetency to stand trial (n=40). Group differences were analyzed using one-way ANOVAs. The result revealed an uncoached group (M = 4.23, SD.= 5.20) had significantly lower SVT-Th mean scores than those both coached groups (M =185.00, SD.= 72.88 and M = 132.10, SD.= 54.06, respectively). Classification rates were calculated to determine the classification accuracy. Result indicated that SVT-Th had overall classification accuracy rates of 96.67% with acceptable of 95% sensitivity and 100% specificity rates. Overall, the results of the present study indicate that the SVT-Th yielded high adequate indices of accuracy and these findings suggest that the SVT-Th is robustness against coaching.Keywords: incompetency to stand trial, coaching, robustness, classification accuracy
Procedia PDF Downloads 12685 Diagnostic Value of CT Scan in Acute Appendicitis
Authors: Maria Medeiros, Suren Surenthiran, Abitha Muralithar, Soushma Seeburuth, Mohammed Mohammed
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Introduction: Appendicitis is the most common surgical emergency globally and can have devastating consequences. Diagnostic imaging in acute appendicitis has become increasingly common in aiding the diagnosis of acute appendicitis. Computerized tomography (CT) and ultrasound (US) are the most commonly used imaging modalities for diagnosing acute appendicitis. Pre-operative imaging has contributed to a reduction of negative appendicectomy rates from between 10-29% to 5%. Literature report CT scan has a diagnostic sensitivity of 94% in acute appendicitis. This clinical audit was conducted to establish if the CT scan's diagnostic yield for acute appendicitis matches the literature. CT scan has a high sensitivity and specificity for diagnosing acute appendicitis and its use can result in a lower negative appendicectomy rate. The aim of this study is to compare the pre-operative imaging findings from CT scans to the histopathology results post-operatively and establish the accuracy of CT scans in aiding the diagnosis of acute appendicitis. Methods: This was a retrospective study focusing on adult presentations to the general surgery department in a district general hospital in central London with an impression of acute appendicitis. We analyzed all patients from July 2022 to December 2022 who underwent a CT scan preceding appendicectomy. Pre-operative CT findings and post-operative histopathology findings were compared to establish the efficacy of CT scans in diagnosing acute appendicitis. Our results were also cross-referenced with pre-existing literature. Data was collected and anonymized using CERNER and analyzed in Microsoft Excel. Exclusion criteria: Children, age <16. Results: 65 patients had CT scans in which the report stated acute appendicitis. Of those 65 patients, 62 patients underwent diagnostic laparoscopies. 100% of patients who underwent an appendicectomy with a pre-operative CT scan showing acute appendicitis had acute appendicitis in histopathology analysis. 3 of the 65 patients who had a CT scan showing appendicitis received conservative treatment. Conclusion: CT scans positive for acute appendicitis had 100% sensitivity and a positive predictive value, which matches published research studies (sensitivity of 94%). The use of CT scans in the diagnostic work-up for acute appendicitis can be extremely helpful in a) confirming the diagnosis and b) reducing the rates of negative appendicectomies and consequently reducing unnecessary operative-associated risks for patients, reducing costs and reducing pressure on emergency theatre lists.Keywords: acute apendicitis, CT scan, general surgery, imaging
Procedia PDF Downloads 7784 Age Estimation from Teeth among North Indian Population: Comparison and Reliability of Qualitative and Quantitative Methods
Authors: Jasbir Arora, Indu Talwar, Daisy Sahni, Vidya Rattan
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Introduction: Age estimation is a crucial step to build the identity of a person, both in case of deceased and alive. In adults, age can be estimated on the basis of six regressive (Attrition, Secondary dentine, Dentine transparency, Root resorption, Cementum apposition and Periodontal Disease) changes in teeth qualitatively using scoring system and quantitatively by micrometric method. The present research was designed to establish the reliability of qualitative (method 1) and quantitative (method 2) of age estimation among North Indians and to compare the efficacy of these two methods. Method: 250 single-rooted extracted teeth (18-75 yrs.) were collected from Department of Oral Health Sciences, PGIMER, Chandigarh. Before extraction, periodontal score of each tooth was noted. Labiolingual sections were prepared and examined under light microscope for regressive changes. Each parameter was scored using Gustafson’s 0-3 point score system (qualitative), and total score was calculated. For quantitative method, each regressive change was measured quantitatively in form of 18 micrometric parameters under microscope with the help of measuring eyepiece. Age was estimated using linear and multiple regression analysis in Gustafson’s method and Kedici’s method respectively. Estimated age was compared with actual age on the basis of absolute mean error. Results: In pooled data, by Gustafson’s method, significant correlation (r= 0.8) was observed between total score and actual age. Total score generated an absolute mean error of ±7.8 years. Whereas, for Kedici’s method, a value of correlation coefficient of r=0.5 (p<0.01) was observed between all the eighteen micrometric parameters and known age. Using multiple regression equation, age was estimated, and an absolute mean error of age was found to be ±12.18 years. Conclusion: Gustafson’s (qualitative) method was found to be a better predictor for age estimation among North Indians.Keywords: forensic odontology, age estimation, North India, teeth
Procedia PDF Downloads 23783 The Analgesic Impact of Adding Intrathecal Ketamine to Spinal Anaesthesia for Hip or Knee Arthroplasty: A Clinical Audit
Authors: Carl Ashworth, Matthys Campher
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Spinal anaesthesia has been identified as the “gold standard” for primary elective total hip and knee arthroplasty, which is most commonly performed using longer-acting local anaesthetics, such as hyperbaric bupivacaine, to prolong the duration of anaesthesia and analgesia suitable for these procedures. Ketamine is known to have local anaesthetic effects with potent analgesic properties and has been evaluated as a sole anaesthetic agent via intrathecal administration; however, the use of intrathecal ketamine as an adjunct to intrathecal hyperbaric bupivacaine, morphine, and fentanyl has not been extensively studied. The objective of this study was to identify the potential analgesic effects of the addition of intrathecal ketamine to spinal anaesthesia and to compare the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine. The medical records of patients who underwent elective hip- or knee arthroplasty under spinal anaesthesia performed by an individual anaesthetist with either intrathecal hyperbaric bupivacaine, morphine and fentanyl or intrathecal hyperbaric bupivacaine, morphine, fentanyl and ketamine between June 4, 2020, and June 4, 2022, were retrospectively reviewed. These encounters were reviewed and analyzed from a perioperative pain perspective, with the primary outcome measure as the oral morphine equivalent (OME) usage in the 48 hours post-spinal anaesthesia, and secondary outcome measures including time to breakthrough analgesia, self-reported pain scores at rest and during movement at 24 and 48 hours after surgery, adverse effects of analgesia, complications, and length of stay. There were 26 patients identified who underwent TKR between June 4, 2020, and June 4, 2022, and 25 patients who underwent THR with the same conditions. It was identified that patients who underwent traditional spinal anaesthesia with the addition of ketamine for elective hip- or knee arthroplasty had a lower mean total OME in the 48 hours immediately post-spinal anaesthesia yet had a shorter time to breakthrough analgesia administration. The proposed mechanism of action for intrathecal ketamine as an additive to traditional spinal anaesthesia for elective hip- or knee arthroplasty is that it may prolong and attenuate the analgesic effect of traditional spinal anaesthesia. There were no significant differences identified in comparing the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine.Keywords: anaesthesia, spinal, intra-thecal, ketamine, spinal-morphine, bupivacaine
Procedia PDF Downloads 4882 Evaluation of Information Technology Governance Frameworks for Better Governance in South Africa
Authors: Memory Ranga, Phillip Pretorious
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The South African Government has invested a lot of money in Information Technology Governance (ITG) within the Government departments. The ITG framework was spearheaded by the Department of Public Service and Administration (DPSA). This led to the development of a governing ITG DPSA framework and later the Government Wide Enterprise Architecture (GWEA) Framework for assisting the departments to implement ITG. In addition to this, the government departments have adopted the Information Systems Audit and Control Association (ISACA) Control Objectives for Information and Related Technology (COBIT) for ITG processes. Despite all these available frameworks, departments fail to fully capitalise and improve the ITG processes mainly as these are too generic and difficult to apply for specific governance needs. There has been less research done to evaluate the progress on ITG initiatives within the government departments. This paper aims to evaluate the existing ITG frameworks within selected government departments in South Africa. A quantitative research approach was used in this study. Data was collected through an online questionnaire targeting ICT Managers and Directors from government departments. The study is undertaken within a case study and only the Eastern Cape Province was selected for the research. Document review mainly on ITG framework and best practices was also used. Data was analysed using the Google Analytic tools and SPSS. A one–sample Chi-Squared Test was used to verity the evaluation findings. Findings show that there is evidence that the current guiding National governance framework (DPSA) is out dated and does not accommodate the new changes in other governance frameworks. The Eastern Cape Government Departments have spent huge amount of money on ITG but not yet able to identify the benefits of the ITG initiatives. The guiding framework is rigid and does to address some of the departmental needs making it difficult to be flexible and apply the DPSA framework. Furthermore, despite the large budget on ITG, the departments still find themselves with many challenges and unable to improve some of the processes and services. All the engaged Eastern Cape departments have adopted the COBIT framework, but none has been conducting COBIT maturity Assessment which is a functionality of COBIT. There is evidence of too many the ITG frameworks and underutilisation of these frameworks. The study provides a comprehensive evaluation of the ITG frameworks that have been adopted by the South African Government Departments in the Eastern Cape Province. The evaluation guides and recommends the government departments to rethink and adopt ITG frameworks that could be customised to accommodate their needs. The adoption and application of ITG by government departments should assist in better governance and service delivery to the citizens.Keywords: information technology governance, COBIT, evaluate, framework, governance, DPSA framework
Procedia PDF Downloads 11581 Synthesis and Characterization of Anti-Psychotic Drugs Based DNA Aptamers
Authors: Shringika Soni, Utkarsh Jain, Nidhi Chauhan
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Aptamers are recently discovered ~80-100 bp long artificial oligonucleotides that not only demonstrated their applications in therapeutics; it is tremendously used in diagnostic and sensing application to detect different biomarkers and drugs. Synthesizing aptamers for proteins or genomic template is comparatively feasible in laboratory, but drugs or other chemical target based aptamers require major specification and proper optimization and validation. One has to optimize all selection, amplification, and characterization steps of the end product, which is extremely time-consuming. Therefore, we performed asymmetric PCR (polymerase chain reaction) for random oligonucleotides pool synthesis, and further use them in Systematic evolution of ligands by exponential enrichment (SELEX) for anti-psychotic drugs based aptamers synthesis. Anti-psychotic drugs are major tranquilizers to control psychosis for proper cognitive functions. Though their low medical use, their misuse may lead to severe medical condition as addiction and can promote crime in social and economical impact. In this work, we have approached the in-vitro SELEX method for ssDNA synthesis for anti-psychotic drugs (in this case ‘target’) based aptamer synthesis. The study was performed in three stages, where first stage included synthesis of random oligonucleotides pool via asymmetric PCR where end product was analyzed with electrophoresis and purified for further stages. The purified oligonucleotide pool was incubated in SELEX buffer, and further partition was performed in the next stage to obtain target specific aptamers. The isolated oligonucleotides are characterized and quantified after each round of partition, and significant results were obtained. After the repetitive partition and amplification steps of target-specific oligonucleotides, final stage included sequencing of end product. We can confirm the specific sequence for anti-psychoactive drugs, which will be further used in diagnostic application in clinical and forensic set-up.Keywords: anti-psychotic drugs, aptamer, biosensor, ssDNA, SELEX
Procedia PDF Downloads 12880 Preparedness for Microbial Forensics Evidence Collection on Best Practice
Authors: Victor Ananth Paramananth, Rashid Muniginin, Mahaya Abd Rahman, Siti Afifah Ismail
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Safety issues, scene protection, and appropriate evidence collection must be handled in any bio crime scene. There will be a scene or multi-scene to be cordoned for investigation in any bio-incident or bio crime event. Evidence collection is critical in determining the type of microbial or toxin, its lethality, and its source. As a consequence, from the start of the investigation, a proper sampling method is required. The most significant challenges for the crime scene officer would be deciding where to obtain samples, the best sampling method, and the sample sizes needed. Since there could be evidence in liquid, viscous, or powder shape at a crime scene, crime scene officers have difficulty determining which tools to use for sampling. To maximize sample collection, the appropriate tools for sampling methods are necessary. This study aims to assist the crime scene officer in collecting liquid, viscous, and powder biological samples in sufficient quantity while preserving sample quality. Observational tests on sample collection using liquid, viscous, and powder samples for adequate quantity and sample quality were performed using UV light in this research. The density of the light emission varies upon the method of collection and sample types. The best tools for collecting sufficient amounts of liquid, viscous, and powdered samples can be identified by observing UV light. Instead of active microorganisms, the invisible powder is used to assess sufficient sample collection during a crime scene investigation using various collection tools. The liquid, powdered and viscous samples collected using different tools were analyzed using Fourier transform infrared - attenuate total reflection (FTIR-ATR). FTIR spectroscopy is commonly used for rapid discrimination, classification, and identification of intact microbial cells. The liquid, viscous and powdered samples collected using various tools have been successfully observed using UV light. Furthermore, FTIR-ATR analysis showed that collected samples are sufficient in quantity while preserving their quality.Keywords: biological sample, crime scene, collection tool, UV light, forensic
Procedia PDF Downloads 19179 Central Line Stock and Use Audit in Adult Patients: A Quality Improvement Project on Central Venous Catheter Standardisation Across Hospital Departments
Authors: Gregor Moncrieff, Ursula Bahlmann
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A number of incident reports were filed from the intensive care unit with regards to adult patients admitted following operations who had a central venous catheter inserted of the incorrect length for the relevant anatomical site and catheters not compatible with pressurised injection inserted whilst in theatre. Incorrect catheter length can lead to a variety of complications and pressurised injection is a requirement for contrast enhanced computerised tomography scans. This led to several patients having a repeat procedure to insert a catheter of the correct length and also compatible with pressurised injection. This project aimed to identify the types of central venous catheters used in theatres and ensure the correct equipment would be stocked and used in future cases in accordance the existing Association of Anaesthetics of Great Britain and Northern Ireland guidelines. A questionnaire was sent out to all of the anaesthetic department in our hospital aiming to determine what types of central venous catheters were preferably used by anaesthetists and why these had been chosen. We also explored any concerns regarding introduction of standardised, pressure injectable central venous catheters to the theatre department which were already in use in other parts of the hospital and in keeping with national guidance. A total of 56 responses were collected. 64% of respondents routinely used a central venous catheter which was significantly shorter than the national recommended guidance with a further 4 different types of central venous catheters used which were different to other areas of the hospital and not pressure injectable. 75% of respondents were in agreement to standardised introduction of the pressure injectable catheters of the recommended length in accordance with national guidance. Reasons why 25% respondents were opposed to introduction of these catheters were explored and discussed. We were successfully able to introduce the standardised central catheters to the theatre department following presentation at the local anaesthetic quality and safety meeting. Reasons against introduction of the catheters were discussed and a compromise was reached that the existing catheters would continue to be stocked but would only be available on request, with a focus on encouraging use of the standardised catheters. Additional changes achieved included removing redundant catheters from the theatre stock. Ongoing data is being collected to analyse positive and negative feedback from use of the introduced catheters.Keywords: central venous catheter, medical equipment, medical safety, quality improvement
Procedia PDF Downloads 10878 Morphology and Risk Factors for Blunt Aortic Trauma in Car Accidents: An Autopsy Study
Authors: Ticijana Prijon, Branko Ermenc
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Background: Blunt aortic trauma (BAT) includes various morphological changes that occur during deceleration, acceleration and/or body compression in traffic accidents. The various forms of BAT, from limited laceration of the intima to complete transection of the aorta, depends on the force acting on the vessel wall and the tolerance of the aorta to injury. The force depends on the change in velocity, the dynamics of the accident and of the seating position in the car. Tolerance to aortic injury depends on the anatomy, histological structure and pathomorphological alterations due to aging or disease of the aortic wall.An overview of the literature and medical documentation reveals that different terms are used to describe certain forms of BAT, which can lead to misinterpretation of findings or diagnoses. We therefore, propose a classification that would enable uniform systematic screening of all forms of BAT. We have classified BAT into three morphologycal types: TYPE I (intramural), TYPE II (transmural) and TYPE III (multiple) aortic ruptures with appropriate subtypes. Methods: All car accident casualties examined at the Institute of Forensic Medicine from 2001 to 2009 were included in this retrospective study. Autopsy reports were used to determine the occurrence of each morphological type of BAT in deceased drivers, front seat passengers and other passengers in cars and to define the morphology of BAT in relation to the accident dynamics and the age of the fatalities. Results: A total of 391 fatalities in car accidents were included in the study. TYPE I, TYPE II and TYPE III BAT were observed in 10,9%, 55,6% and 33,5%, respectively. The incidence of BAT in drivers, front seat and other passengers was 36,7%, 43,1% and 28,6%, respectively. In frontal collisions, the incidence of BAT was 32,7%, in lateral collisions 54,2%, and in other traffic accidents 29,3%. The average age of fatalities with BAT was 42,8 years and of those without BAT 39,1 years. Conclusion: Identification and early recognition of the risk factors of BAT following a traffic accident is crucial for successful treatment of patients with BAT. Front seat passengers over 50 years of age who have been injured in a lateral collision are the most at risk of BAT.Keywords: aorta, blunt trauma, car accidents, morphology, risk factors
Procedia PDF Downloads 50377 Carbapenem Usage in Medical Wards: An Antibiotic Stewardship Feedback Project
Authors: Choon Seong Ng, P. Petrick, C. L. Lau
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Background: Carbapenem-resistant isolates have been increasingly reported recently. Carbapenem stewardship is designed to optimize its usage particularly among medical wards with high prevalence of carbapenem prescriptions to combat such emerging resistance. Carbapenem stewardship programmes (CSP) can reduce antibiotic use but clinical outcome of such measures needs further evaluation. We examined this in a prospective manner using feedback mechanism. Methods: Our single-center prospective cohort study involved all carbapenem prescriptions across the medical wards (including medical patients admitted to intensive care unit) in a tertiary university hospital setting. The impact of such stewardship was analysed according to the accepted and the rejected groups. The primary endpoint was safety. Safety measure applied in this study was the death at 1 month. Secondary endpoints included length of hospitalisation and readmission. Results: Over the 19 months’ period, input from 144 carbapenem prescriptions was analysed on the basis of acceptance of our CSP recommendations on the use of carbapenems. Recommendations made were as follows : de-escalation of carbapenem; stopping the carbapenem; use for a short duration of 5-7 days; required prolonged duration in the case of carbapenem-sensitive Extended Spectrum Beta-Lactamases bacteremia; dose adjustment; and surgical intervention for removal of septic foci. De-escalation, shorten duration of carbapenem and carbapenem cessation comprised 79% of the recommendations. Acceptance rate was 57%. Those who accepted CSP recommendations had no increase in mortality (p = 0.92), had a shorter length of hospital stay (LOS) and had cost-saving. Infection-related deaths were found to be higher among those in the rejected group. Moreover, three rejected cases (6%) among all non-indicated cases (n = 50) were found to have developed carbapenem-resistant isolates. Lastly, Pitt’s bacteremia score appeared to be a key element affecting the carbapenem prescription’s behaviour in this trial. Conclusions: Carbapenem stewardship program in the medical wards not only saves money, but most importantly it is safe and does not harm the patients with added benefits of reducing the length of hospital stay. However, more time is needed to engage the primary clinical teams by formal clinical presentation and immediate personal feedback by senior Infectious Disease (ID) personnel to increase its acceptance.Keywords: audit and feedback, carbapenem stewardship, medical wards, university hospital
Procedia PDF Downloads 20076 Comparative Study of Case Files in the Context of H. P. Grice’s Pragmatic Theory
Authors: Tugce Arslan
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For a communicative act to be carried out successfully, the speaker and the listener must consider certain principles in line with the intention–centered “Cooperative Principle” expressed by H. P. Grice. Violation of a communication principle causes the listener to make new inferences called “implicatures”. In this study, focusing on the linguistic use of H. P. Grice’s principles, we aim to find out which principles of conversation are generally followed in case files from different fields and which principles are frequently violated. Three case files were examined, and the violating and the abiding cases of the maxims were classified in terms of four categories (Quality, Quantity, Relevance and Manner). The results of this investigation is reported below (V: Violating, A: Abiding): Quality Quantity Relevance Manner V A V A V A V A Case 1 10 8 5 9 3 15 16 6 Case 2 4 5 11 6 2 11 7 14 Case 3 21 13 7 12 9 14 15 9 Total 35 26 23 27 14 40 38 29 The excerpts were selected from files covering three different areas: the Assize Court, the Family Court and the Commercial Court of First Instance. In this way, the relations between the types of violations and the types of courts are examined. Our main finding is that in the 1st and the 3rd file, as the cases of violation in “Quality” and “Manner” increase, the cases of violation in “Quantity” and “Relevance” decrease. In the second file, on the other hand, as the cases of violation in “Quantity” increase, the cases of violation in “Quality”, “Relevance” and “Manner” decrease. In the talk, we shall compare these results with the results obtained in the study of Tajabadi, Dowlatabadi, and Mehric (2014), which examined various case files in Iran. Our main finding is that in the study conducted in Iran, violations were found only on the principles of “Quantity” and “Relevance”, while violations were found on the principles of “Quality”, “Quantity” and “Manner” in this study. In this case, it shows us that there is a connection between at least two maxims. In both cases, it has been noticed that the “Quantity” maxim is a common denominator. Studies in this field can be enlightening for many areas such as discourse analysis, legal studies, etc. Accordingly, comments will be made about the nature of the violations mentioned in H. P. Grice’s “Cooperation Principle”. We shall also discuss various conversational practices that cannot be analysed with these maxims.Keywords: comparative analysis, cooperation principle, forensic linguistics, pragmatic.
Procedia PDF Downloads 21375 The Potential of Potato and Maize Based Snacks as Fire Accelerants
Authors: E. Duffin, L. Brownlow
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Arson is a crime which can provide exceptional problems to forensic specialists. Its destructive nature makes evidence much harder to find, especially when used to cover up another crime. There is a consistent potential threat of arsonists seeking new and easier ways to set fires. Existing research in this field primarily focuses on the use of accelerants such as petrol, with less attention to other more accessible and harder to detect materials. This includes the growing speculation of potato and maize-based snacks being used as fire accelerants. It was hypothesized that all ‘crisp-type’ snacks in foil packaging had the potential to act as accelerants and would burn readily in the various experiments. To test this hypothesis, a series of small lab-based experiments were undertaken, igniting samples of the snacks. Factors such as ingredients, shape, packaging and calorific value were all taken into consideration. The time (in seconds) spent on fire by the individual snacks was recorded. It was found that all of the snacks tested burnt for statistically similar amounts of time with a p-value of 0.0157. This was followed with a large mock real-life scenario using packets of crisps on fire and car seats to investigate as to the possibility of these snacks being verifiable tools to the arsonist. Here, three full packets of crisps were selected based on variations in burning during the lab experiments. They were each lit with a lighter to initiate burning, then placed onto a car seat to be timed and observed with video cameras. In all three cases, the fire was significant and sustained by the 200-second mark. On the basis of this data, it was concluded that potato and maize-based snacks were viable accelerants of fire. They remain an effective method of starting fires whilst being cheap, accessible, non-suspicious and non-detectable. The results produced supported the hypothesis that all ‘crisp-type’ snacks in foil packaging (that had been tested) had the potential to act as accelerants and would burn readily in the various experiments. This study serves to raise awareness and provide a basis for research and prevention of arson regarding maize and potato-based snacks as fire accelerants.Keywords: arson, crisps, fires, food
Procedia PDF Downloads 11974 Self-Inflicted Major Trauma: Inpatient Mental Health Management and Patient Outcomes
Authors: M. Walmsley, S. Elmatarri, S. Mannion
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Introduction: Self-inflicted injury is a recognised cause of major trauma in adults and is an independent indicator of a reduced functional outcome compared to non-intentional major trauma. There is little literature available on the inpatient mental health (MH) management of this vulnerable group. A retrospective review was conducted of inpatient MH management of major trauma patients admitted to a UK regional Major Trauma Centre (MTC). Their outcomes were compared to all major trauma patients. This group of patients required multiple MH interventions whilst on the Major Trauma Ward (MTW) and a had worse functional outcome compared to non-intentional trauma. Method: The national TARN (Trauma Audit and Research Network) database was used to identify patients admitted to a regional MTC over a 2-year period from June 2018 to July 2020. Patients with an ISS (Injury Severity Score) of greater than 15 with a mechanism of either self-harm or high-risk behavior were included for further analysis. Inpatient medical notes were reviewed for MH interventions on the MTW. Further outcomes, including mortality, length of stay (LOS) and Glasgow Outcome Score (GOS) were compared with all major trauma patients for the same time period. Results: A total of 60 patients were identified in the time period and of those, 27 spent time on the MTW. A total of 23 (85%) had a prior MH diagnosis, with 11 (41%) under the care of secondary MH services. Adequate inpatient records for review were available for 24 patients. During their inpatient stay, 8 (33%) were reviewed on the ward by the inpatient MH team. There were 10 interventions required for 6 (25%) patients on the MTW including, sections under the Mental Health Act, transfer to specialist MH facility, pharmacological sedation and security being called to the MTW. When compared to all major trauma patients, those admitted due to self-harm or high-risk behavior had a statistically significantly higher ISS (31.43 vs 24.22, p=0.0001) and LOS (23.51d vs 16.06d, p=0.002). Functional outcomes using the GOS were reduced in this group of patients, GOS 5 (low disability) (51.66% vs. 61.01%) and they additionally had a higher level of mortality, GOS 1 (15.00% vs 11.67%). Discussion: Intentional self-harm is a recognised cause of major trauma in adults and this patient group sustains more severe injuries, requiring a longer hospital stay with worse outcomes compared to all major trauma patients. Inpatient MH interventions are required for a significant proportion of these patients and therefore, there needs to be a close relationship with MH services. There is limited available evidence for how this patient group is best managed as an inpatient to aid their recovery and further work is needed on how outcomes in this vulnerable group can be improved.Keywords: adult major trauma, attempted suicide, self-inflicted major trauma, inpatient management
Procedia PDF Downloads 17773 Preparedness for Nurses to Adopt the Implementation of Inpatient Medication Order Entry (IPMOE) System at United Christian Hospital (UCH) in Hong Kong
Authors: Yiu K. C. Jacky, Tang S. K. Eric, W. Y. Tsang, C. Y. Li, C. K. Leung
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Objectives : (1) To enhance the competence of nurses on using IPMOE for drug administration; (2) To ensure the transition on implementation of IPMOE in safer and smooth way hospital-wide. Methodology: (1) Well-structured Governance: To make provision for IPMOE implementation, multidisciplinary governance structure at Corporate and Local levels are well established. (2) Staff Engagement: A series of staff engagement events were conducted including Staff Forum, IPMOE Hospital Visit, Kick-off Ceremony and establishment of IPMOE Webpage for familiarizing the forthcoming implementation with frontline staff. (3) Well-organized training program: from Workshop to Workplace Two different IPMOE training programs were tailor-made which aimed at introducing the core features of administration module. Fifty-five identical training classes and six train-the-trainer workshops were organized at 2-3Q 2015. Lending Scheme on IPMOE hardware for hands-on practicing was launched and further extended the training from workshop to workplace. (4) Standard Guidelines and Workflow: the related workflow and guidelines are developed which facilitates users to acquire the competence towards IPMOE and fully familiarize with the standardized contingency plan. (5) Facilities and Equipment: The installations of IPMOE hardware were promptly arranged for rollout. Besides, IPMOE training venue was well-established for staff training. (6) Risk Management Strategy: UCH Medication Safety Forum is organized in December 2015 for sharing “Tricks & Tips” on IPMOE which further disseminate at webpage for arousal of medication safety. Hospital-wide annual audit on drug administration was planned to figure out the compliance and deliberate the rooms for improvement. Results: Through the comprehensive training plan, over 1,000 UCH nurses attended the training program with positive feedback. They agreed that their competence on using IPMOE was enhanced. By the end of November 2015, 28 wards (over 1,000 Inpatient-bed) involving departments of M&G, SUR, O&T and O&G have been successfully rolled out IPMOE in 5-month. A smooth and safe transition of implementation of IPMOE was achieved. Eventually, we all get prepared for embedding IPMOE into daily nursing and work altogether for medication safety at UCH.Keywords: drug administration, inpatient medication order entry system, medication safety, nursing informatics
Procedia PDF Downloads 33272 Education for Sustainable Development and the Eco School Initiative in Two Primary Schools in The North East of England
Authors: Athanasia Chatzifotiou, Karen Tait
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Eco-school is an international initiative that offers schools the opportunity to develop practices on education for sustainable development (EfSD). Such practices need to focus on nine areas, namely: energy, water, biodiversity, school grounds, healthy living, transport, litter, waste and global citizenship. Acquiring the green flag status is the ultimate stage (silver and bronze are the other two) that is awarded by a committee external to the school and it lasts for two years. Our project focused on two such primary schools that had acquired the green flag status. The aim of our project is to describe the schools’ approach of becoming an eco-school, the practitioners’ role in promoting the values and principles of such endeavors, thus identifying the impact of EfSD. We chose the eco-schools initiative as it gives a clear and straightforward way to identify a school with an interest in EfSD. The project is important because even though EfSD attracts high attention in rhetoric, there is evidence indicating that EfSD may be neglected in practice. This paper presents part of a bigger project that aims to compare how primary schools and early years settings have approached EfSD via the eco-school initiative in the North East of England. This is a qualitative project that used a case study design to focus on the practices of two particular primary schools to gain a green flag status. A semi-structured interview was used with the lead teachers/practitioners of the schools; an audit was also conducted as part of a tour of the schools’ premises highlighting the initiatives, curriculum work, projects undertaken as well as resources available to school. A content analysis of the interview transcripts was conducted with the creation of response categories and response narratives by the two researchers first working individually and then collaboratively; the findings of the project reflected issues that concerned: a) pupils’ cognitive, physical and socio-emotional development, b) the wider community and c) the lead practitioners’ role and status in school. In relation to EfSD, our findings indicated that its impact upon these two eco-schools was rather minimal; a mismatch was identified between the eco-school practices and a holistic understanding of issues that EfSD aims to achieve. This mismatch between eco-school practices and EfSD is discussed with regard to: a) pupils’ understanding of the sustainability dimension in the topics they addressed; and b) teachers’ knowledge of sustainability and willingness to keep on such work in schools.Keywords: eco-schools, environment, primary schools, sustainability education
Procedia PDF Downloads 24271 Knowledge Creation and Diffusion Dynamics under Stable and Turbulent Environment for Organizational Performance Optimization
Authors: Jessica Gu, Yu Chen
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Knowledge Management (KM) is undoubtable crucial to organizational value creation, learning, and adaptation. Although the rapidly growing KM domain has been fueled with full-fledged methodologies and technologies, studies on KM evolution that bridge the organizational performance and adaptation to the organizational environment are still rarely attempted. In particular, creation (or generation) and diffusion (or share/exchange) of knowledge are of the organizational primary concerns on the problem-solving perspective, however, the optimized distribution of knowledge creation and diffusion endeavors are still unknown to knowledge workers. This research proposed an agent-based model of knowledge creation and diffusion in an organization, aiming at elucidating how the intertwining knowledge flows at microscopic level lead to optimized organizational performance at macroscopic level through evolution, and exploring what exogenous interventions by the policy maker and endogenous adjustments of the knowledge workers can better cope with different environmental conditions. With the developed model, a series of simulation experiments are conducted. Both long-term steady-state and time-dependent developmental results on organizational performance, network and structure, social interaction and learning among individuals, knowledge audit and stocktaking, and the likelihood of choosing knowledge creation and diffusion by the knowledge workers are obtained. One of the interesting findings reveals a non-monotonic phenomenon on organizational performance under turbulent environment while a monotonic phenomenon on organizational performance under a stable environment. Hence, whether the environmental condition is turbulence or stable, the most suitable exogenous KM policy and endogenous knowledge creation and diffusion choice adjustments can be identified for achieving the optimized organizational performance. Additional influential variables are further discussed and future work directions are finally elaborated. The proposed agent-based model generates evidence on how knowledge worker strategically allocates efforts on knowledge creation and diffusion, how the bottom-up interactions among individuals lead to emerged structure and optimized performance, and how environmental conditions bring in challenges to the organization system. Meanwhile, it serves as a roadmap and offers great macro and long-term insights to policy makers without interrupting the real organizational operation, sacrificing huge overhead cost, or introducing undesired panic to employees.Keywords: knowledge creation, knowledge diffusion, agent-based modeling, organizational performance, decision making evolution
Procedia PDF Downloads 23470 Gender and Total Compensation, in an ‘Age’ of Disruption
Authors: Daniel J. Patricio Jiménez
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The term 'total compensation’ refers to salary, training, innovation, and development, and of course, motivation; total compensation is an open and flexible system which must facilitate personal and family conciliation and therefore cannot be isolated from social reality. Today, the challenge for any company that wants to have a future is to be sustainable, and women play a ‘special’ role in this. Spain, in its statutory and conventional development, has not given sufficient response to new phenomena such as ‘bonuses’, ‘stock options’ or ‘fringe benefits’ (constructed dogmatically and by court decisions), the new digital reality, where cryptocurrency, new collaborative models and service provision -such as remote work-, are always ahead of the law. To talk about compensation is to talk about the gender gap, and with the entry into force of RD.902 /2020 on 14 April 2021, certain measures are necessary under the principle of salary transparency; the valuation of jobs, the pay register (Rd. 6/2019) and the pay audit, are an example of this. Analyzing the methodologies, and in particular the determination and weight of the factors -so that the system itself is not discriminatory- is essential. The wage gap in Spain is smaller than in Europe, but the sources do not reflect the reality, and since the beginning of the pandemic, there has been a clear stagnation. A living wage is not the minimum wage; it is identified with rights and needs; it is that which, based on internal equity, reflects the competitiveness of the company in terms of human capital. Spain has lost and has not recovered the relative weight of its wages; this is having a direct impact on our competitiveness, consequently on the precariousness of employment and undoubtedly on the levels of extreme poverty. Training is becoming more than ever a strategic factor; the new digital reality requires that each component of the system is connected, the transversality is imposed on us, this forces us to redefine content, to give answers to the new demands that the new normality requires because technology and robotization are changing the concept of employability. The presence of women in this context is necessary, and there is a long way to go. The so-called emotional compensation becomes particularly relevant at a time when pandemics, silence, and disruption, are leaving after-effects; technostress (in all its manifestations) is just one of them. Talking about motivation today makes no sense without first being aware that mental health is a priority, that it must be treated and communicated in an inclusive way because it increases satisfaction, productivity, and engagement. There is a clear conclusion to all this: compensation systems do not respond to the ‘new normality’: diversity, and in particular women, cannot be invisible in human resources policies if the company wants to be sustainable.Keywords: diversity, gender gap, human resources, sustainability.
Procedia PDF Downloads 164