Search results for: modern analytical methods
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 18970

Search results for: modern analytical methods

12880 A Review on Benzo(a)pyrene Emission Factors from Biomass Combustion

Authors: Franziska Klauser, Manuel Schwabl, Alexander Weissinger, Christoph Schmidl, Walter Haslinger, Anne Kasper-Giebl

Abstract:

Benzo(a)pyrene (BaP) is the most widely investigated representative of Polycyclic Aromatic Hydrocarbons (PAH) as well as one of the most toxic compounds in this group. Since 2013 in the European Union a limit value for BaP concentration in the ambient air is applied, which was set to a yearly average value of 1 ng m-3. Several reports show that in some regions, even where industry and traffic are of minor impact this threshold is regularly exceeded. This is taken as proof that biomass combustion for heating purposes contributes significantly to BaP pollution. Several investigations have been already carried out on the BaP emission behavior of biomass combustion furnaces, mostly focusing on a certain aspect like the influences from wood type, of operation type or of technology type. However, a superior view on emission patterns of BaP from biomass combustion and the aggregation of determined values also from recent studies is not presented so far. The combination of determined values allows a better understanding of the BaP emission behavior from biomass combustion. In this work the review conclusions are driven from the combination of outcomes from different publication. In two examples it was shown that technical progress leads to 10 to 100 fold lower BaP emission from modern furnaces compared to old technologies of equivalent type. It was also indicated that the operation with pellets or wood chips exhibits clearly lower BaP emission factors compared to operation with log wood. Although, the BaP emission level from automatic furnaces is strongly impacted by the kind of operation. This work delivers an overview on BaP emission factors from different biomass combustion appliances, from different operation modes and from the combustion of different fuel and wood types. The main impact factors are depicted, and suggestions for low BaP emission biomass combustion are derived. As one result possible investigation fields concerning BaP emissions from biomass combustion that seem to be most important to be clarified are suggested.

Keywords: benzo(a)pyrene, biomass, combustion, emission, pollution

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12879 Multi-Dimensional (Quantatative and Qualatative) Longitudinal Research Methods for Biomedical Research of Post-COVID-19 (“Long Covid”) Symptoms

Authors: Steven G. Sclan

Abstract:

Background: Since December 2019, the world has been afflicted by the spread of the Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2), which is responsible for the condition referred to as Covid-19. The illness has had a cataclysmic impact on the political, social, economic, and overall well-being of the population of the entire globe. While Covid-19 has had a substantial universal fatality impact, it may have an even greater effect on the socioeconomic, medical well-being, and healthcare planning for remaining societies. Significance: As these numbers illustrate, many more persons survive the infection than die from it, and many of those patients have noted ongoing, persistent symptoms after successfully enduring the acute phase of the illness. Recognition and understanding of these symptoms are crucial for developing and arranging efficacious models of care for all patients (whether or not having been hospitalized) surviving acute covid illness and plagued by post-acute symptoms. Furthermore, regarding Covid infection in children (< 18 y/o), although it may be that Covid “+” children are not major vectors of infective transmission, it now appears that many more children than initially thought are carrying the virus without accompanying obvious symptomatic expression. It seems reasonable to wonder whether viral effects occur in children – those children who are Covid “+” and now asymptomatic – and if, over time, they might also experience similar symptoms. An even more significant question is whether Covid “+” asymptomatic children might manifest increased multiple health problems as they grow – i.e., developmental complications (e.g., physical/medical, metabolic, neurobehavioral, etc.) – in comparison to children who had been consistently Covid “ - ” during the pandemic. Topics Addressed and Theoretical Importance: This review is important because of the description of both quantitative and qualitative methods for clinical and biomedical research. Topics reviewed will consider the importance of well-designed, comprehensive (i.e., quantitative and qualitative methods) longitudinal studies of Post Covid-19 symptoms in both adults and children. Also reviewed will be general characteristics of longitudinal studies and a presentation of a model for a proposed study. Also discussed will be the benefit of longitudinal studies for the development of efficacious interventions and for the establishment of cogent, practical, and efficacious community healthcare service planning for post-acute covid patients. Conclusion: Results of multi-dimensional, longitudinal studies will have important theoretical implications. These studies will help to improve our understanding of the pathophysiology of long COVID and will aid in the identification of potential targets for treatment. Such studies can also provide valuable insights into the long-term impact of COVID-19 on public health and socioeconomics.

Keywords: COVID-19, post-COVID-19, long COVID, longitudinal research, quantitative research, qualitative research

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12878 Improving Healthcare Readiness to Respond to Human Trafficking: A Case Study

Authors: Traci A. Hefner

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Limited research exists on the readiness of emergency departments to respond to human trafficking (HT). The purpose of this qualitative case study was to improve the readiness of a Department of Emergency Medicine (ED), located in the southeast region of the United States, in identifying, assessing, and responding to trafficked individuals. The research objectives were to 1) provide an organizing framework to understand the ED’s readiness to respond to HT, using the Transtheoretical Model’s stages of change construct, 2) explain the readiness of the ED through a three-pronged contextual approach that included policies and procedures, patient data collection processes, and clinical practice methods, and 3) develop recommendations to respond to HT. Content analysis was used for document reviews and on-site observations, while thematic analysis identified themes of staff perceptions of the ED’s readiness in interviews of over 30 clinical and non-clinical healthcare professionals. Results demonstrated low levels of readiness to identify HT through the ED’s policies and procedures, data collection processes, and clinical practice methods. Clinical practice-related factors consisted of limited awareness of HT warning signs and low-levels of knowledge about community resources for possible HT referrals. Policy and practice recommendations to increase the ED’s readiness to respond to HT included: developing staff trainings across the ED system to enhance awareness of HT warning signs, incorporating HT into current policies and procedures for vulnerable patient populations as well as creating a HT protocol that addresses policies and procedures, screening tools, and community referrals.

Keywords: emergency medicine, human trafficking, organizational assessment, stages of change

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12877 Numerical Iteration Method to Find New Formulas for Nonlinear Equations

Authors: Kholod Mohammad Abualnaja

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A new algorithm is presented to find some new iterative methods for solving nonlinear equations F(x)=0 by using the variational iteration method. The efficiency of the considered method is illustrated by example. The results show that the proposed iteration technique, without linearization or small perturbation, is very effective and convenient.

Keywords: variational iteration method, nonlinear equations, Lagrange multiplier, algorithms

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12876 Geophysical Approach in the Geological Characterization of a Dam Site: Case of the Chebabta-Dam, Meskiana, Oum El-Bouaghi

Authors: Benhammadi Hocine, Djamel Boubaya, Chaffai Hicham

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Meskiana Area is characterized by a semi-arid climate where the water supply for irrigation and industry is not sufficient as the priority goes for domestic use. To meet the increasing population growth and development, the authorities have considered building a new water retaining structure on some major temporary water streams. For this purpose Chebabta site on Oued Meskiana was chosen as the future dam site. It is large enough to store the desired volume of water. This study comes to investigate the conditions of the site and the adequacy of the ground as a foundation for the projected dam. The conditions of the site include the geological structure and mainly the presence of discontinuities in the formation on which the dam will be built, the nature of the lithologies under the foundation and the future lake, and the presence of any hazard. This site characterization is usually carried out using different methods in order to highlight any underground buried problematic structure. In this context, the different geophysical technics remain the most used ones. Three geophysical methods were used in the case of the Chebabta dam site, namely, electric survey, seismic refraction, and tomography. The choice of the technics and the location of the scan line was made on the basis of the available geological data. In this sense, profiles have been established on both banks of Oued Meskiana. The obtained results have allowed a better characterization of the geological structure, defining the limit between the surface cover and the bedrock, which is, in other words, the limit between the weathered zone and the bedrock. Their respective thicknesses were also determined by seismic refraction and electrical resistivity sounding. However, the tomography imaging technic has succeeded in positioning a fault structure passing through the right bank of the wadi.

Keywords: dam site, fault, geophysic, investigation, Meskiana

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12875 Defining Priority Areas for Biodiversity Conservation to Support for Zoning Protected Areas: A Case Study from Vietnam

Authors: Xuan Dinh Vu, Elmar Csaplovics

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There has been an increasing need for methods to define priority areas for biodiversity conservation since the effectiveness of biodiversity conservation in protected areas largely depends on the availability of material resources. The identification of priority areas requires the integration of biodiversity data together with social data on human pressures and responses. However, the deficit of comprehensive data and reliable methods becomes a key challenge in zoning where the demand for conservation is most urgent and where the outcomes of conservation strategies can be maximized. In order to fill this gap, the study applied an environmental model Condition–Pressure–Response to suggest a set of criteria to identify priority areas for biodiversity conservation. Our empirical data has been compiled from 185 respondents, categorizing into three main groups: governmental administration, research institutions, and protected areas in Vietnam by using a well - designed questionnaire. Then, the Analytic Hierarchy Process (AHP) theory was used to identify the weight of all criteria. Our results have shown that priority level for biodiversity conservation could be identified by three main indicators: condition, pressure, and response with the value of the weight of 26%, 41%, and 33%, respectively. Based on the three indicators, 7 criteria and 15 sub-criteria were developed to support for defining priority areas for biodiversity conservation and zoning protected areas. In addition, our study also revealed that the groups of governmental administration and protected areas put a focus on the 'Pressure' indicator while the group of Research Institutions emphasized the importance of 'Response' indicator in the evaluation process. Our results provided recommendations to apply the developed criteria for identifying priority areas for biodiversity conservation in Vietnam.

Keywords: biodiversity conservation, condition–pressure–response model, criteria, priority areas, protected areas

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12874 A Review of Research on Pre-training Technology for Natural Language Processing

Authors: Moquan Gong

Abstract:

In recent years, with the rapid development of deep learning, pre-training technology for natural language processing has made great progress. The early field of natural language processing has long used word vector methods such as Word2Vec to encode text. These word vector methods can also be regarded as static pre-training techniques. However, this context-free text representation brings very limited improvement to subsequent natural language processing tasks and cannot solve the problem of word polysemy. ELMo proposes a context-sensitive text representation method that can effectively handle polysemy problems. Since then, pre-training language models such as GPT and BERT have been proposed one after another. Among them, the BERT model has significantly improved its performance on many typical downstream tasks, greatly promoting the technological development in the field of natural language processing, and has since entered the field of natural language processing. The era of dynamic pre-training technology. Since then, a large number of pre-trained language models based on BERT and XLNet have continued to emerge, and pre-training technology has become an indispensable mainstream technology in the field of natural language processing. This article first gives an overview of pre-training technology and its development history, and introduces in detail the classic pre-training technology in the field of natural language processing, including early static pre-training technology and classic dynamic pre-training technology; and then briefly sorts out a series of enlightening technologies. Pre-training technology, including improved models based on BERT and XLNet; on this basis, analyze the problems faced by current pre-training technology research; finally, look forward to the future development trend of pre-training technology.

Keywords: natural language processing, pre-training, language model, word vectors

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12873 Structure Clustering for Milestoning Applications of Complex Conformational Transitions

Authors: Amani Tahat, Serdal Kirmizialtin

Abstract:

Trajectory fragment methods such as Markov State Models (MSM), Milestoning (MS) and Transition Path sampling are the prime choice of extending the timescale of all atom Molecular Dynamics simulations. In these approaches, a set of structures that covers the accessible phase space has to be chosen a priori using cluster analysis. Structural clustering serves to partition the conformational state into natural subgroups based on their similarity, an essential statistical methodology that is used for analyzing numerous sets of empirical data produced by Molecular Dynamics (MD) simulations. Local transition kernel among these clusters later used to connect the metastable states using a Markovian kinetic model in MSM and a non-Markovian model in MS. The choice of clustering approach in constructing such kernel is crucial since the high dimensionality of the biomolecular structures might easily confuse the identification of clusters when using the traditional hierarchical clustering methodology. Of particular interest, in the case of MS where the milestones are very close to each other, accurate determination of the milestone identity of the trajectory becomes a challenging issue. Throughout this work we present two cluster analysis methods applied to the cis–trans isomerism of dinucleotide AA. The choice of nucleic acids to commonly used proteins to study the cluster analysis is two fold: i) the energy landscape is rugged; hence transitions are more complex, enabling a more realistic model to study conformational transitions, ii) Nucleic acids conformational space is high dimensional. A diverse set of internal coordinates is necessary to describe the metastable states in nucleic acids, posing a challenge in studying the conformational transitions. Herein, we need improved clustering methods that accurately identify the AA structure in its metastable states in a robust way for a wide range of confused data conditions. The single linkage approach of the hierarchical clustering available in GROMACS MD-package is the first clustering methodology applied to our data. Self Organizing Map (SOM) neural network, that also known as a Kohonen network, is the second data clustering methodology. The performance comparison of the neural network as well as hierarchical clustering method is studied by means of computing the mean first passage times for the cis-trans conformational rates. Our hope is that this study provides insight into the complexities and need in determining the appropriate clustering algorithm for kinetic analysis. Our results can improve the effectiveness of decisions based on clustering confused empirical data in studying conformational transitions in biomolecules.

Keywords: milestoning, self organizing map, single linkage, structure clustering

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12872 Agroecological and Socioeconomic Determinants of Conserving Diversity On-Farm: The Case of Wheat Genetic Resources in Ethiopia

Authors: Bedilu Tafesse

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Conservation of crop genetic resources presents a challenge of identifying specific determinants driving maintenance of diversity at farm and agroecosystems. The objectives of this study were to identify socioeconomic, market and agroecological determinants of farmers’ maintenance of wheat diversity at the household level and derive implications for policies in designing on-farm conservation programs. We assess wheat diversity at farm level using household survey data. A household decision making model is conceptualized using microeconomic theory to assess and identify factors influencing on-farm rice diversity. The model is then tested econometrically by using various factors affecting farmers’ variety choice and diversity decisions. The findings show that household-specific socioeconomic, agroecological and market factors are important in determining on-farm wheat diversity. The significant variables in explaining richness and evenness of wheat diversity include distance to the nearest market, subsistence ratio, modern variety sold, land types and adult labour working in agriculture. The statistical signs of the factors determining wheat diversity are consistent in explaining the richness, dominance and evenness among rice varieties. Finally, the study implies that the cost-effective means of promoting and sustaining on-farm conservation programmes is to target them in market isolated geographic locations of high crop diversity where farm households have more heterogeneity of agroecological conditions and more active family adult labour working on-farm.

Keywords: diversity indices, dominance, evenness, on-farm conservation, wheat diversity, richness

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12871 Guidelines for Sustainable Urban Mobility in Historic Districts from International Experiences

Authors: Tamer ElSerafi

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In recent approaches to heritage conservation, the whole context of historic areas becomes as important as the single historic building. This makes the provision of infrastructure and network of mobility an effective element in the urban conservation. Sustainable urban conservation projects consider the high density of activities, the need for a good quality access system to the transit system, and the importance of the configuration of the mobility network by identifying the best way to connect the different districts of the urban area through a complex unique system that helps the synergic development to achieve a sustainable mobility system. A sustainable urban mobility is a key factor in maintaining the integrity between socio-cultural aspects and functional aspects. This paper illustrates the mobility aspects, mobility problems in historic districts, and the needs of the mobility systems in the first part. The second part is a practical analysis for different mobility plans. It is challenging to find innovative and creative conservation solutions fitting modern uses and needs without risking the loss of inherited built resources. Urban mobility management is becoming an essential and challenging issue in the urban conservation projects. Depending on literature review and practical analysis, this paper tries to define and clarify the guidelines for mobility management in historic districts as a key element in sustainability of urban conservation and development projects. Such rules and principles could control the conflict between the socio–cultural and economic activities, and the different needs for mobility in these districts in a sustainable way. The practical analysis includes a comparison between mobility plans which have been implemented in four different cities; Freiburg in Germany, Zurich in Switzerland and Bray Town in Ireland. This paper concludes with a matrix of guidelines that considers both principles of sustainability and livability factors in urban historic districts.

Keywords: sustainable mobility, urban mobility, mobility management, historic districts

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12870 Indigeneity of Transgender Cultures: Traditional Knowledge and Appropriation

Authors: Priyanka Sinnarkar

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The appropriation of traditional knowledge has already deprived vast indigenous communities of material benefits. One such industry in India responsible for the extensive exploitation of the indigenous communities is Bollywood or the film industry. Indigenous communities are usually marginalized and exploited, whilst the beneficiary is always the third part. Transgender culture in India dates back to 400 AD with a precise description in the Kama Sutra. Since then, with escalating evolution in governance, the community lost its glory and was criminalized until late 2014. However, the traditional knowledge and cultural practices never diminished. The formation of cults (gharanas) and peculiar folklore has remained in place. This study is intended to highlight the culture of the hijra gharanas and their contribution to intangible cultural heritage. Whilst adhering to the norms of the United Nations pertaining to traditional knowledge and indigenous communities, these papers focuses on the fact that one of the most marginalized and ostracized communities in India treasures a huge amount of rituals and practices that are appropriated by the film industry, leaving the transgender community to indulge into odd jobs and commercial sex work leading to poverty and illiteracy. A comparison between caste reservations and no reservation for this community will bring to light the lacuna in the democratic system. Also, through empirical findings, it can be inferred that a creative sector of the society is not properly exploited to its complete potential, thereby restricting a good contribution to intellectual property. It is important to state that the roots of this problem are not in modern practices. Thus an etymological analysis from mythology to the present will help understand that appropriate application of human rights in this segment will be useful to render justice to this community and thereby recognize the IP that has been succumbed since ages.

Keywords: indigenous, intellectual property, traditional knowedge, transgender

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12869 Characterization and Degradation of 3D Printed Polycaprolactone-Freeze Dried Bone Matrix Constructs for Use in Critical Sized Bone Defects

Authors: Samantha Meyr, Eman Mirdamadi, Martha Wang, Tao Lowe, Ryan Smith, Quinn Burke

Abstract:

Critical-sized bone defects (CSD) treatment options remain a major clinical orthopedic challenge. They are uniquely contoured diseased or damaged bones and can be defined as those that will not heal spontaneously and require surgical intervention. Autografts are the current gold standard CSD treatment, which are histocompatible and provoke a minimal immunogenic response; however, they can cause donor site morbidity and will not suffice for the size required for replacement. As an alternative to traditional surgical methods, bone tissue engineering will be implemented via 3D printing methods. A freeze-dried bone matrix (FDBM) is a type of graft material available but will only function as desired when in the presence of bone growth factors. Polycaprolactone (PCL) is a known biodegradable material with good biocompatibility that has been proven manageable in 3D printing as a medical device. A 3D-extrusion printing strategy is introduced to print these materials into scaffolds for bone grafting purposes, which could be more accessible and rapid than the current standard. Mechanical, thermal, cytotoxic, and physical properties were investigated throughout a degradation period of 6 months using fibroblasts and dental pulp stem cells. PCL-FDBM scaffolds were successfully printed with high print fidelity in their respective pore sizes and allograft content. Additionally, we have created a method for evaluating PCL using differential scanning calorimetry (DSC) and have evaluated PCL degradation over roughly 6 months.

Keywords: 3D printing, bone tissue engineering, cytotoxicity, degradation, scaffolds

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12868 Electrochemical Coordination Polymers of Copper(II) Synthesis by Using Rigid and Felexible Ligands

Authors: P. Mirahmadpour, M. H. Banitaba, D. Nematollahi

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The chemistry of coordination polymers in recent years has grown exponentially not only because of their interesting architectures but also due to their various technical applications in many fields including ion exchange, chemical catalysis, small molecule separations, and drug release. The use of bridging ligands for the controlled self-assembly of one, two or three dimensional metallo-supramolecular species is the subject of serious study in last decade. Numerous different synthetic methods have been offered for the preparation of coordination polymers such as (a) diffusion from the gas phase, (b) slow diffusion of the reactants into a polymeric matrix, (c) evaporation of the solvent at ambient or reduced temperatures, (d) temperature controlled cooling, (e) precipitation or recrystallisation from a mixture of solvents and (f) hydrothermal synthesis. The electrosynthetic process suggested several advantages over conventional approaches. A general advantage of electrochemical synthesis is that it allows synthesis under milder conditions than typical solvothermal or microwave synthesis. In this work we have introduced a simple electrochemical method for growing metal coordination polymers based on copper with a flexible 2,2’-thiodiacetic acid (TDA) and rigid 1,2,4,5-benzenetetracarboxylate (BTC) ligands. The structure of coordination polymers were characterized by scanning electron microscopy (SEM), X-ray powder diffraction (XRD), elemental analysis, thermal gravimetric (TG) and differential thermal analyses (DTA). The single-crystal X-ray diffraction analysis revealed that different conformations of the ligands and different coordination modes of the carboxylate group as well as different coordination geometries of the copper atoms. Electrochemical synthesis of coordination polymers has different advantages such as faster synthesis at lower temperature in compare with conventional chemical methods and crystallization of desired materials in a single synthetic step.

Keywords: 1, 2, 4, 5-benzenetetracarboxylate, coordination polymer, copper, 2, 2’-thiodiacetic acid

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12867 Free Radical Scavenging, Antioxidant Activity, Phenolic, Alkaloids Contents and Inhibited Properties against α-Amylase and Invertase Enzymes of Stem Bark Extracts Coula edulis B

Authors: Eric Beyegue, Boris Azantza, Judith Laure Ngondi, Julius E. Oben

Abstract:

Background: It is clearly that phytochemical constituents of plants in relation exhibit free radical scavenging, antioxidant and glycosylation properties. This study investigated the in vitro antioxidant and free radical scavenging, inhibited activities against α-amylase and invertase enzymes of stem bark extracts C. edulis (Olacaceae). Methods: Four extracts (hexane, dichloromethane, ethanol and aqueous) from the barks of C. edulis were used in this study. Colorimetric in vitro methods were using for evaluate free radical scavenging activity DPPH, ABTS, NO, OH, antioxidant capacity, glycosylation activity, inhibition of α-amylase and invertase activities, phenolic, flavonoid and alkaloid contents. Results: C. edulis extracts (CEE) had a higher scavenging potential on the 2, 2-diphenyl-1-picrylhydrazyl (DPPH), hydroxyl (OH), nitrite oxide (NO), 2, 2-azinobis (3-ethylbenzthiazoline)-6-sulfonic acid (ABTS) radicals and glucose scavenging with the IC50 varied between 41.95 and 36694.43 µg/ml depending on the solvent of extraction. The ethanol extract of C. edulis stem bark (CE EtOH) showed the highest polyphenolic (289.10 + 30.32), flavonoid (1.12 + 0.09) and alkaloids (18.47 + 0.16) content. All the tested extracts demonstrated a relative high inhibition potential against α-amylase and invertase digestive enzymes activities. Conclusion: This study suggests that CEE exhibited higher antioxidant potential and significant inhibition potential against digestive enzymes.

Keywords: Coula edulis, antioxidant, scavenging activity, amylase, invertase

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12866 Study of Methods to Reduce Carbon Emissions in Structural Engineering

Authors: Richard Krijnen, Alan Wang

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As the world is aiming to reach net zero around 2050, structural engineers must begin finding solutions to contribute to this global initiative. Approximately 40% of global energy-related emissions are due to buildings and construction, and a building’s structure accounts for 50% of its embodied carbon, which indicates that structural engineers are key contributors to finding solutions to reach carbon neutrality. However, this task presents a multifaceted challenge as structural engineers must navigate technical, safety and economic considerations while striving to reduce emissions. This study reviews several options and considerations to reduce carbon emissions that structural engineers can use in their future designs without compromising the structural integrity of their proposed design. Low-carbon structures should adhere to several guiding principles. Firstly, prioritize the selection of materials with low carbon footprints, such as recyclable or alternative materials. Optimization of design and engineering methods is crucial to minimize material usage. Encouraging the use of recyclable and renewable materials reduces dependency on natural resources. Energy efficiency is another key consideration involving the design of structures to minimize energy consumption across various systems. Choosing local materials and minimizing transportation distances help in reducing carbon emissions during transport. Innovation, such as pre-fabrication and modular design or low-carbon concrete, can further cut down carbon emissions during manufacturing and construction. Collaboration among stakeholders and sharing experiences and resources are essential for advancing the development and application of low-carbon structures. This paper identifies current available tools and solutions to reduce embodied carbon in structures, which can be used as part of daily structural engineering practice.

Keywords: efficient structural design, embodied carbon, low-carbon material, sustainable structural design

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12865 The Development of Traffic Devices Using Natural Rubber in Thailand

Authors: Weeradej Cheewapattananuwong, Keeree Srivichian, Godchamon Somchai, Wasin Phusanong, Nontawat Yoddamnern

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Natural rubber used for traffic devices in Thailand has been developed and researched for several years. When compared with Dry Rubber Content (DRC), the quality of Rib Smoked Sheet (RSS) is better. However, the cost of admixtures, especially CaCO₃ and sulphur, is higher than the cost of RSS itself. In this research, Flexible Guideposts and Rubber Fender Barriers (RFB) are taken into consideration. In case of flexible guideposts, the materials used are both RSS and DRC60%, but for RFB, only RSS is used due to the controlled performance tests. The objective of flexible guideposts and RFB is to decrease a number of accidents, fatal rates, and serious injuries. Functions of both devices are to save road users and vehicles as well as to absorb impact forces from vehicles so as to decrease of serious road accidents. This leads to the mitigation methods to remedy the injury of motorists, form severity to moderate one. The solution is to find the best practice of traffic devices using natural rubber under the engineering concepts. In addition, the performances of materials, such as tensile strength and durability, are calculated for the modulus of elasticity and properties. In the laboratory, the simulation of crashes, finite element of materials, LRFD, and concrete technology methods are taken into account. After calculation, the trials' compositions of materials are mixed and tested in the laboratory. The tensile test, compressive test, and weathering or durability test are followed and based on ASTM. Furthermore, the Cycle-Repetition Test of Flexible Guideposts will be taken into consideration. The final decision is to fabricate all materials and have a real test section in the field. In RFB test, there will be 13 crash tests, 7 Pickup Truck tests, and 6 Motorcycle Tests. The test of vehicular crashes happens for the first time in Thailand, applying the trial and error methods; for example, the road crash test under the standard of NCHRP-TL3 (100 kph) is changed to the MASH 2016. This is owing to the fact that MASH 2016 is better than NCHRP in terms of speed, types, and weight of vehicles and the angle of crash. In the processes of MASH, Test Level 6 (TL-6), which is composed of 2,270 kg Pickup Truck, 100 kph, and 25 degree of crash-angle is selected. The final test for real crash will be done, and the whole system will be evaluated again in Korea. The researchers hope that the number of road accidents will decrease, and Thailand will be no more in the top tenth ranking of road accidents in the world.

Keywords: LRFD, load and resistance factor design, ASTM, american society for testing and materials, NCHRP, national cooperation highway research program, MASH, manual for assessing safety hardware

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12864 Determination of the Informativeness of Instrumental Research Methods in Assessing Risk Factors for the Development of Renal Dysfunction in Elderly Patients with Chronic Ischemic Heart Disease

Authors: Aksana N. Popel, Volha A. Sujayeva, Olga V. Kоshlataja, Irеna S. Karpava

Abstract:

Introduction: It is a known fact that cardiovascular pathology and its complications cause a more severe course and worse prognosis in patients with comorbid kidney pathology. Chronic kidney disease (CKD) is associated with inflammation, endothelial dysfunction, and increased activity of the sympathoadrenal system. This circumstance increases the risk of cardiovascular diseases and the progression of kidney pathology. The above determines the need to identify cardiorenal changes at early stages to reduce the risks of cardiovascular complications and the progression of CKD. Objective: To identify risk factors (RF) for the development of CKD in elderly patients with chronic ischemic heart disease (CIHD). Methods: The study included 64 patients (40 women and 24 men) with a mean age of 74.4±4.5 years with coronary heart disease, without a history of structural kidney pathology and CKD. All patients underwent transthoracic echocardiography (TTE) and kidney ultrasound (KU) using GE Vivid 9 equipment (GE HealthCare, USA), and cardiac computed tomography (CCT) using Siemens Somatom Force equipment (Siemens Healthineers AG, Germany) in 3 months and in 1 year. Data obtained were analyzed using multiple regression analysis and nonparametric Mann-Whitney test. Statistical analysis was performed using the STATISTICA 12.0 program (StatSoft Inc.). Results: Initially, CKD was not diagnosed in all patients. In 3 months, CKD was diagnosed: stage C1 had 11 people (18%), stage C2 had 4 people (6%), stage C3A had 11 people (18%), stage C3B had 2 people (3%). After 1 year, CKD was diagnosed: stage C1 had 22 people (35%), stage C2 had 5 people (8%), stage C3A had 17 people (27%), stage C3B had 10 people (15%). In 3 months, statistically significant (p<0.05) risk factors were: 1) according to TTE: mitral peak E-wave velocity (U=678, p=0.039), mitral E-velocity DT (U=514, p=0.0168), mitral peak A-wave velocity (U=682, p=0.013). In 1 year, statistically significant (p<0.05) risk factors were: according to TTE: left ventricular (LV) end-systolic volume in B-mode (U=134, p=0.006), LV end-diastolic volume in B-mode (U=177, p=0.04), LV ejection fraction in B-mode (U=135, p=0.006), left atrial volume (U=178, p=0.021), LV hypertrophy (U=294, p=0.04), mitral valve (MV) fibrosis (U=328, p=0.01); according CCT: epicardial fat thickness (EFT) on the right ventricle (U=8, p=0.015); according to KU: interlobar renal artery resistance index (RI) (U=224, p=0.02), segmental renal artery RI (U=409, p=0.016). Conclusions: Both TTE and KU are very informative methods to determine the additional risk factors of CKD development and progression. The most informative risk factors were LV global systolic and diastolic functions, LV and LA volumes. LV hypertrophy, MV fibrosis, interlobar renal artery and segmental renal artery RIs, EFT.

Keywords: chronic kidney disease, ischemic heart disease, prognosis, risk factors

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12863 Digital Leadership and HR practices

Authors: Joanna Konstantinou

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Due to the pandemic, we have recently witnessed an explosion of HR Tech offering a variety of solutions for digital transformation, as well as a large number of HR practices implemented by professionals both in data science and occupational psychology. The aim of this study is to explore the impact of these practices and their effectiveness and to develop an understanding of digital leadership. The study will be based on semi-structured interviews using qualitative research methods and tools.

Keywords: HR practices, digital trasformation, pandemic, digital leadership

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12862 International Collaboration: Developing the Practice of Social Work Curriculum through Study Abroad and Participatory Research

Authors: Megan Lindsey

Abstract:

Background: Globalization presents international social work with both opportunities and challenges. Thus, the design of this international experience aligns with the three charges of the Commission on Global Social Work Education. An international collaborative effort between an American and Scottish University Social Work Program was based on an established University agreement. The presentation provides an overview of an international study abroad among American and Scottish Social Work students. Further, presenters will discuss the opportunities of international collaboration and the challenges of the project. First, we will discuss the process of a successful international collaboration. This discussion will include the planning, collaboration, execution of the experience, along with its application to the international field of social work. Second, we will discuss the development and implementation of participatory action research in which the student engage to enhance their learning experience. A collaborative qualitative research project was undertaken with three goals. First, students gained experience in Scottish social services, including agency visits and presentations. Second, a collaboration between American and Scottish MSW Students allowed the exchange of ideas and knowledge about services and social work education. Third, students collaborated on a qualitative research method to reflect on their social work education and the formation of their professional identity. Methods/Methodology: American and Scottish students engaged in participatory action research by using Photovoice methods while studying together in Scotland. The collaboration between faculty researchers framed a series of research questions. Both universities obtained IRB approval and trained students in Photovoice methods. The student teams used the research question and Photovoice method to discover images that represented their professional identity formation. Two Photovoice goals grounded the study's research question. First, the methods enabled the individual students to record and reflect on their professional strengths and concerns. Second, student teams promoted critical dialogue and knowledge about personal and professional issues through large and small group discussions of photographs. Results: The international participatory approach generated the ability for students to contextualize their common social work education and practice experiences. Team discussions between representatives of each country resulted in understanding professional identity formation and the processes of social work education that contribute to that identity. Students presented the photograph narration of their knowledge and understanding of international social work education and practice. Researchers then collaborated on finding common themes. The results found commonalities in the quality and depth of social work education. The themes found differences regarding how professional identity is formed. Students found great differences between their and American accreditation and certification. Conclusions: Faculty researchers’ collaboration themes sought to categorize the students’ experiences of their professional identity. While the social work education systems are similar, there are vast differences. The Scottish themes noted structures within American social work not found in the United Kingdom. The American researchers noted that Scotland, as does the United Kingdom, relies on programs, agencies, and the individual social worker to provide structure to identity formation. Other themes will be presented.

Keywords: higher education curriculum, international collaboration, social sciences, action research

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12861 Unshackled Slaves: An Analysis of the Adjudication of Degrading Conditions of Work by Brazilian Labour Courts

Authors: Aline F. C. Pereira

Abstract:

In recent years, modern slavery has increasingly gathered attention in scholarly discussions and policy debates. Whereas the mainstream studies focus on forced labour and trafficking, little attention is paid to other forms of exploitation, such as degrading conditions of work –criminalised in Brazil as an autonomous type of slavery since 2003. This paper aims to bridge this gap. It adopts a mixed method that comprises both qualitative and quantitative analysis, to investigate the adjudication of 164 cases of degrading conditions of work by Brazilian labour courts. The research discloses an ungrounded reluctance to apply the domestic legal framework, as in most of the cases degrading conditions of work are not recognised as contemporary slavery, despite the law. In some cases, not even situations described as subhuman and degrading of human dignity were framed as slavery. The analysis also suggests that, as in chattel times, lack of freedom and subjection remain relevant in the legal characterisation of slave labour. The examination has further unraveled a phenomenon absent in previous studies: normalisation of precarity. By depicting precarity as natural and inevitable in rural areas, labour courts ensure conformity to the status quo and reduce the likelihood of resistance by victims. Moreover, compensations afforded to urban workers are higher than granted to rural employees, which seems to place human beings in hierarchical categories -a trace of colonialism. In sum, the findings challenge the worldwide spread assumption that Brazil addresses slavery efficiently. Conversely, the Brazilian Labour Judiciary seems to remain subservient to a colonial perspective of slavery, legitimising, and sanctioning abusive practices.

Keywords: adjudication, contemporary slavery, degrading conditions of work, normalisation of precarity

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12860 Removal of Polycyclic Aromatic Hydrocarbons (PAHS) and the Response of Indigenous Bacteria in Highly Contaminated Aged Soil after Persulfate Oxidation

Authors: Yaling Gou, Sucai Yang, Pengwei Qiao

Abstract:

Integrated chemical-biological treatment is an attractive alternative to remove polycyclic aromatic hydrocarbons (PAHs) from contaminated soil; wherein indigenous bacteria is the key factor for the biodegradation of residual PAHs concentrations after the application of chemical oxidation. However, the systematical study on the impact of persulfate (PS) oxidation on indigenous bacteria as well as PAHs removal is still scarce. In this study, the influences of different PS dosages (1%, 3%, 6%, and 10% [w/w]), as well as various activation methods (native iron, H2O2, alkaline, ferrous iron, and heat) on PAHs removal and indigenous bacteria in highly contaminated aged soil were investigated. Apparent degradation of PAHs in the soil treated with PS oxidation was observed, and the removal efficiency of total PAHs in the soil ranged from 38.28% to 79.97%. The removal efficiency of total PAHs in the soil increased with increasing consumption of PS. However, the bacterial abundance in soil was negatively affected following oxidation for all of the treatments added with PS, with bacterial abundance in the soil decreased by 0.89~2.88 orders of magnitude compared to the untreated soil. Moreover, the number of total bacteria in the soil decreased as PS consumption increased. Different PS activation methods and PS dosages exhibited different influences on the bacterial community composition. Bacteria capable of degrading PAHs under anoxic conditions were composed predominantly by Proteobacteria and Firmicutes. The total amount of Proteobacteria and Firmicutes also decreased with increasing consumption of PS. The results of this study provide important insight into the design of PAHs contaminated soil remediation projects.

Keywords: activation method, chemical oxidation, indigenous bacteria, polycyclic aromatic hydrocarbon

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12859 Signs and Symbols of a Modern Sufi Ceremony in Istanbul

Authors: Antonio De Lisa

Abstract:

The aim of this contribution is to describe a Sufi ceremony personally observed and recorded in Istanbul. It is part of research on the semiotics of religion that has been going on for some time. Over the centuries, Sufism has produced remarkable literature, elaborated mainly in the context of Arabic literature and Persian literature, but has also found expression in many other languages (Turkish, Indian, Malayo-Indonesian, etc.). Among the genres cultivated are: devotional books (prayers, meditation, spiritual exercises, etc.); the hagiographic texts, containing the biographies and sentences of the best-known Sufis; the texts that illustrate the abodes or stations of the spiritual path; finally, the theoretical treatises on various topics, often of an apologetic nature. Another typical expression of Sufism is in the literature in verse, which includes first-rate poets of both Arabic (Ibn al-Farid, Ibn 'Arabi) and Persian (Farid al-Din al-Attar, Rumi, Hafez, Gohar Shahi) expression. To observe an authentic Sufi ceremony, we contacted the Silivrikapı Mevlana Cultural Center in Istanbul. The ceremony we will talk about is a characteristic of the brotherhood called Mevleviyye (Mawlawiyya), so called from Mawlānā ('our lord', in Turkish: Mevlānā) Jalāl al-Dīn Muḥammad Rūmī (13th century) better known as the brotherhood of the Whirling Dervishes, founded in Konya. The characteristic of the order is to pray about one's love for Allah with music and dance in a ritual that has the name of Semà. The dance is a swirling movement in a group, representing a mystical journey of the spiritual ascent of man through the mind and love for the 'perfect'. Turning towards the truth, the follower of the group ascends towards love, passing beyond the World and Nothingness. After asceticism, he returns to the common world to communicate his own experience.

Keywords: semiotics of religion, sufi, rumi, islamic philosophy

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12858 Advanced Techniques in Robotic Mitral Valve Repair

Authors: Abraham J. Rizkalla, Tristan D. Yan

Abstract:

Purpose: Durable mitral valve repair is preferred to a replacement, avoiding the need for anticoagulation or re-intervention, with a reduced risk of endocarditis. Robotic mitral repair has been gaining favour globally as a safe, effective, and reproducible method of minimally invasive valve repair. In this work, we showcase the use of the Davinci© Xi robotic platform to perform several advanced techniques, working synergistically to achieve successful mitral repair in advanced mitral disease. Techniques: We present the case of a Barlow type mitral valve disease with a tall and redundant posterior leaflet resulting in severe mitral regurgitation and systolic anterior motion. Firstly, quadrangular resection of P2 is performed to remove the excess and redundant leaflet. Secondly, a sliding leaflet plasty of P1 and P3 is used to reconstruct the posterior leaflet. To anchor the newly formed posterior leaflet to the papillary muscle, CV-4 Goretex neochordae are fashioned using the innovative string, ruler, and bulldog technique. Finally, mitral valve annuloplasty and closure of a patent foramen ovale complete the repair. Results: There was no significant residual mitral regurgitation and complete resolution of the systolic anterior motion of the mitral valve on post operative transoesophageal echocardiography. Conclusion: This work highlights the robotic approach to complex repair techniques for advanced mitral valve disease. Familiarity with resection and sliding plasty, neochord implantation, and annuloplasty allows the modern cardiac surgeon to achieve a minimally-invasive and durable mitral valve repair when faced with complex mitral valve pathology.

Keywords: robotic mitral valve repair, Barlow's valve, sliding plasty, neochord, annuloplasty, quadrangular resection

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12857 Quantification of Soft Tissue Artefacts Using Motion Capture Data and Ultrasound Depth Measurements

Authors: Azadeh Rouhandeh, Chris Joslin, Zhen Qu, Yuu Ono

Abstract:

The centre of rotation of the hip joint is needed for an accurate simulation of the joint performance in many applications such as pre-operative planning simulation, human gait analysis, and hip joint disorders. In human movement analysis, the hip joint center can be estimated using a functional method based on the relative motion of the femur to pelvis measured using reflective markers attached to the skin surface. The principal source of errors in estimation of hip joint centre location using functional methods is soft tissue artefacts due to the relative motion between the markers and bone. One of the main objectives in human movement analysis is the assessment of soft tissue artefact as the accuracy of functional methods depends upon it. Various studies have described the movement of soft tissue artefact invasively, such as intra-cortical pins, external fixators, percutaneous skeletal trackers, and Roentgen photogrammetry. The goal of this study is to present a non-invasive method to assess the displacements of the markers relative to the underlying bone using optical motion capture data and tissue thickness from ultrasound measurements during flexion, extension, and abduction (all with knee extended) of the hip joint. Results show that the artefact skin marker displacements are non-linear and larger in areas closer to the hip joint. Also marker displacements are dependent on the movement type and relatively larger in abduction movement. The quantification of soft tissue artefacts can be used as a basis for a correction procedure for hip joint kinematics.

Keywords: hip joint center, motion capture, soft tissue artefact, ultrasound depth measurement

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12856 Computational Methods in Official Statistics with an Example on Calculating and Predicting Diabetes Mellitus [DM] Prevalence in Different Age Groups within Australia in Future Years, in Light of the Aging Population

Authors: D. Hilton

Abstract:

An analysis of the Australian Diabetes Screening Study estimated undiagnosed diabetes mellitus [DM] prevalence in a high risk general practice based cohort. DM prevalence varied from 9.4% to 18.1% depending upon the diagnostic criteria utilised with age being a highly significant risk factor. Utilising the gold standard oral glucose tolerance test, the prevalence of DM was 22-23% in those aged >= 70 years and <15% in those aged 40-59 years. Opportunistic screening in Australian general practice potentially can identify many persons with undiagnosed type 2 DM. An Australian Bureau of Statistics document published three years ago, reported the highest rate of DM in men aged 65-74 years [19%] whereas the rate for women was highest in those over 75 years [13%]. If you consider that the Australian Bureau of Statistics report in 2007 found that 13% of the population was over 65 years of age and that this will increase to 23-25% by 2056 with a further projected increase to 25-28% by 2101, obviously this information has to be factored into the equation when age related diabetes prevalence predictions are calculated. This 10-15% proportional increase of elderly persons within the population demographics has dramatic implications for the estimated number of elderly persons with DM in these age groupings. Computational methodology showing the age related demographic changes reported in these official statistical documents will be done showing estimates for 2056 and 2101 for different age groups. This has relevance for future diabetes prevalence rates and shows that along with many countries worldwide Australia is facing an increasing pandemic. In contrast Japan is expected to have a decrease in the next twenty years in the number of persons with diabetes.

Keywords: epidemiological methods, aging, prevalence, diabetes mellitus

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12855 Development and Acceptance of a Proposed Module for Enhancing the Reading and Writing Skills in Baybayin: The Traditional Writing System in the Philippines

Authors: Maria Venus G. Solares

Abstract:

The ancient Filipinos had their own spelling or alphabet that differed from the modern Roman alphabet brought by the Spaniards. It consists of seventeen letters, three vowels, and fourteen consonants and is called Baybayin. The word Baybayin is a Tagalog word that refers to all the letters used in writing a language, an alphabet; however, it is also a syllable. The House Bill 4395, first proposed by Rep. Leopoldo Bataoil of the second district of Pangasinan in 2011, which later became House Bill 1022 of what he called The Declaration of the Baybayin as the National Writing System of the Philippines, prompted the researcher to conduct a study on the topic. The main objective of this study was to develop and assess the proposed module for enhancing the reading and writing skills in Baybayin of the students. The researchers wanted to ensure the acceptability of the Baybayin using the proposed module and meet the needs of students in developing their ability to read and write Baybayin through the module. The researchers used quasi-experimental research in this study. The data was collected through the initial and final analysis of the students of Adamson University's ABM 1102 using convenient sampling techniques. Based on statistical analysis of data using weighted mean, standard deviation, and paired t-tests, the proposed module helped improve the students' literacy skills, and the response exercises in the proposed module changed the acceptability of the Baybayin in their minds. The study showed that there was an important difference in the scores of students before and after the use of the module. The student's response to the assessment of their reading and writing skills on Baybayin was highly acceptable. This study will help develop the reading and writing skills of the students in Baybayin and teach Baybayin in response to the revival of a part of Philippine culture that has been long forgotten.

Keywords: Baybayin, proposed module, skill, acceptability

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12854 Low-Proficiency L2 Learners’ Dyadic Interactions in Collaborative Writing: An Exploratory Case Study

Authors: Bing-Qing Lu, Hui-Tzu Min

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Recent research, supported by sociocultural theory, has shown that collaborative writing in the second language (L2) contexts afford students opportunities to interact with each other to co-construct knowledge during the co-composing process. To date, much research on pair interaction in L2 collaborative writing settings has centered on intermediate and advanced learners by using static categorization of pair interaction patterns. Little is known about the fluid nature of pair interaction during collaborative writing, especially among low-proficiency learners. This study, thus, is aimed to explore the interaction dynamics of low-proficiency L2 learners during collaborative writing via examining the interaction pattern, focus of interaction, and the language related episodes (LREs) of 5 low-proficiency L2 writers from Taiwan. Employing a micro-level functional analytical method to capture the changing nature of pair interaction dynamics, the researchers calculated the number of characters/words produced by each pair member during CW and then classified their utterances into four task related-aspects--content, organization, language use, and task management--to determine each pair member's relative contribution to different dimensions of the evolving text. The LREs were also identified and examined. The results show that, of the five pairs, three pairs changed their interaction patterns when discussing different aspects of writing. Regarding the focus of their interaction, all five pairs paid attention to content most, followed by language use, task management, and organization. They were able to successfully resolve the majority of language issues (75.2%) in LREs and use the correct forms in their writing. These findings lend support to the fluid nature of pairs’ interactions and the changing roles of L2 learners in collaborative writing and highlighted the necessity of examining learners’ interaction patterns from a micro-level perspective. These findings also support previous research that low-proficiency pairs are able to correctly revolve 2/3 of their produced LREs, suggesting that collaborative writing may also be suitable for L2 low-proficiency learners.

Keywords: collaborative writing, low-proficiency L2 learners, micro-level functional analysis, pair interaction pattern

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12853 Reproductive Health Knowledge, Attitude and Health Services Utilization among Adolescents in Kaski District of Nepal

Authors: Dipendra Kumar Yadav, Rajani Ghimire, Saroj Yadav

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Background: The concern about adolescent on reproductive health has grown due to unprecedented increasing rates of early pregnancies and sexually transmitted Infections and they do not have adequate awareness and knowledge about it. Access to these services as well as information about them is, therefore, crucial for adolescents to utilize and benefit from sexual and reproductive health services. The objective of the study was to assess the reproductive health knowledge, attitude and health services utilization among adolescents in rural and urban areas of Kaski district. Materials and Methods: A community-based descriptive cross-sectional study was conducted among adolescents (10-19 years of age) in rural and urban areas of Kaski district, Nepal. The period of data collection was October to November, 2014. Altogether 419 participants were taken for the study. Results: The mean age of the respondents was 15.86 and standard deviation was ±2.305. More than half (58.7 %) of the respondents were females and 41.3 % were males. Out of 419, majority (78.8%) of the respondents were known about family planning, among them only 70 % of respondents were aware about family planning methods. Fifty-one percentages of the respondents were aware about the sexually transmitted diseases. Before giving a birth there is need to consult with partner with this fact 68.7 % of the respondents were agree, 23.6 % of them were neutral and very few (7.6%) of them were disagree. Nearly twenty six percentage of the respondents were faced the reproductive health problems within one month. Out of 107 respondents, 57.9 % did not utilize reproductive health services because of different reasons. Conclusions: The overall level of knowledge towards reproductive health among adolescents was found low. However, levels of attitude towards different reproductive health components were found favorable. Only 42.1% of the respondents were utilized reproductive health services among those who was faced the reproductive health problems within one month which was low coverage of reproductive health services utilization.

Keywords: reproductive health knowledge, reproductive health attitudes, adolescent, service utilization

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12852 The Quest for Institutional Independence to Advance Police Pluralism in Ethiopia

Authors: Demelash Kassaye Debalkie

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The primary objective of this study is to report the tributes that are significantly impeding the Ethiopian police's ability to provide quality services to the people. Policing in Ethiopia started in the medieval period. However, modern policing was introduced instead of vigilantism in the early 1940s. The progress counted since the date police became modernized is, however, under contention when viewed from the standpoint of officers’ development and technologies in the 21st century. The police in Ethiopia are suffering a lot to be set free from any form of political interference by the government and to be loyal to impartiality, equity, and justice in enforcing the law. Moreover, the institutional competence of the police in Ethiopia is currently losing its power derived from the constitution as a legitimate enforcement agency due to the country’s political landscape encouraging ethnic-based politics. According to studies, the impact of ethnic politics has been a significant challenge for police in controlling conflicts between two ethnic groups. The study used qualitative techniques and data was gathered from key informants selected purposely. The findings indicate that governments in the past decades were skeptical about establishing a constitutional police force in the country. This has certainly been one of the challenges of pluralizing the police: building police-community relations based on trust. The study conducted to uncover the obstructions has finally reported that the government’s commitment to form a non-partisan, functionally decentralized, and operationally demilitarized police force is too minimal and appalling. They mainly intend to formulate the missions of the police in accordance with their interests and political will to remain in power. It, therefore, reminds the policymakers, law enforcement officials, and the government in power to revise its policies and working procedures already operational to strengthen the police in Ethiopia based on public participation and engagement.

Keywords: community, constitution, Ethiopia, law enforcement

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12851 Applying the Global Trigger Tool in German Hospitals: A Retrospective Study in Surgery and Neurosurgery

Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser

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Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.

Keywords: adverse events, global trigger tool, patient safety, record review

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