Search results for: emergency response team

Authors: A. A. Selaimia, H. Bensouilah, M. A. Yallese, I. Meddour, S. Belhadi, T. Mabrouki

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The objective of this work is to model the output responses namely; surface roughness (Ra), cutting force (Fc), during the face milling of the austenitic stainless steel X2CrNi18-9 with coated carbide tools (GC4040). For raison, response surface methodology (RMS) is used to determine the influence of each technological parameter. A full factorial design (L27) is chosen for the experiments, and the ANOVA is used in order to evaluate the influence of the technological cutting parameters namely; cutting speed (Vc), feed per tooth, and depth of cut (ap) on the out-put responses. The results reveal that (Ra) is mostly influenced by (fz) and (Fc) is found considerably affected by (ap).

Keywords: austenitic stainless steel, ANOVA, coated carbide, response surface methodology (RSM)

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Authors: Xiaocong He

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Self-pierce riveting (SPR) is a new high-speed mechanical fastening technique which is suitable for point joining dissimilar sheet materials, as well as coated and pre-painted sheet materials. Mechanical structures assembled by SPR are expected to possess a high damping capacity. In this study, experimental measurement techniques were proposed for the prediction of vibration behavior of single-lap cantilevered SPR beams. The dynamic test software and the data acquisition hardware were used in the experimental measurement of the dynamic response of the single-lap cantilevered SPR beams. Free and forced vibration behavior of the single-lap cantilevered SPR beams was measured using the LMS CADA-X experimental modal analysis software and the LMS-DIFA Scadas II data acquisition hardware. The frequency response functions of the SPR beams of different rivet number were compared. The main goal of the paper is to provide a basic measuring method for further research on vibration based non-destructive damage detection in single-lap cantilevered SPR beams.

Keywords: self-piercing riveting, dynamic response, experimental measurement, frequency response functions

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Authors: Christopher Oyediran, Nicola Ubayasiri, Christopher Gough

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Splenic artery aneurysms are often clinically occult, occasionally identified incidentally with imaging. The pathogenesis of aneurysms is complex, but certain factors are thought to contribute to their development. Given the potential fatal complications of rupture, a high index of suspicion is required to make an early diagnosis. We present a case of a 36-year-old female with a history of endometriosis and multiple sclerosis who presented to the Emergency Department with sudden onset epigastric pain and collapse. On arrival, she was pale and clammy with profound tachycardia and hypotension. An ultrasound done in the resuscitation department revealed abdominal free fluid. She was resuscitated with blood and transferred for emergent laparotomy. Laparotomy revealed massive haemoperitoneum from the spleen. She underwent emergency splenectomy and inspection of the spleen revealed a splenic artery aneurysm. She received our massive transfusion protocol followed by a short stay on ITU, making a good post-operative recovery and was discharged home a week later.

Keywords: aneurysm, human chorionic gonadotrophin (hCG), resuscitation, laparotomy

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Authors: Souhir Chelly, Asma Ben Cheikh, Hela Ghali, Salwa Khefacha, Lamine Dhidah, Mohamed Ben Rejeb, Houyem Said Latiri

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The hospital risk management department is firstly involved in the methodological analysis of grade zero sterilization incidents. The system is based on a subsequent analysis process in compliance with the ongoing requirements of the Haute Autorité de santé (HAS) for a reactive approach to risk, allowing to identify failures and start the appropriate preventive and corrective measures. The use of the association of litigation and risk management (ALARM) method makes easier the grade zero analysis and brings to light the team or institutional, organizational, temporal, individual factors representative of undesirable effects. Two main factors come out again from this analysis, pre-disinfection step of the emergency block unsupervised instrumentalist intern was poorly done since she did not remove the battery from micro air motor. At the sterilization unit, the worker who was not supervised by the nurse did the conditioning of the motor without having checked it if it still contained the battery. The main cause is that the management of human resources was inadequate at both levels, the instrumental trainee in the block who was not supervised by his supervisor and the worker of the sterilization unit who was not supervised by the responsible nurse. There is a lack of research help, advice, and collaboration. The difficulties encountered during this type of analysis are multiple. The first is based on its necessary acceptance by the various actors of care involved, which should not perceive it as a tool leading to individual punishment, but rather as a means to improve their practices.

Keywords: ALARM (Association of Litigation and Risk Management Method), incident, risk management, sterilization

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Authors: Visith Siriphuwanun, Yodying Punjasawadwong, Suwinai Saengyo, Kittipan Rerkasem

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Objective: To determine incidences and factors associated with perioperative cardiac arrest in trauma patients who received anesthesia for emergency surgery. Design and setting: Retrospective cohort study in trauma patients during anesthesia for emergency surgery at a university hospital in northern Thailand country. Patients and methods: This study was permitted by the medical ethical committee, Faculty of Medicine at Maharaj Nakorn Chiang Mai Hospital, Thailand. We clarified data of 19,683 trauma patients receiving anesthesia within a decade between January 2007 to March 2016. The data analyzed patient characteristics, traumas surgery procedures, anesthesia information such as ASA physical status classification, anesthesia techniques, anesthetic drugs, location of anesthesia performed, and cardiac arrest outcomes. This study excluded the data of trauma patients who had received local anesthesia by surgeons or monitoring anesthesia care (MAC) and the patient which missing more information. The factor associated with perioperative cardiac arrest was identified with univariate analyses. Multiple regressions model for risk ratio (RR) and 95% confidence intervals (CI) were used to conduct factors correlated with perioperative cardiac arrest. The multicollinearity of all variables was examined by bivariate correlation matrix. A stepwise algorithm was chosen at a p-value less than 0.02 was selected to further multivariate analysis. A P-value of less than 0.05 was concluded as statistically significant. Measurements and results: The occurrence of perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was 170.04 per 10,000 cases. Factors associated with perioperative cardiac arrest in trauma patients were age being more than 65 years (RR=1.41, CI=1.02–1.96, p=0.039), ASA physical status 3 or higher (RR=4.19–21.58, p < 0.001), sites of surgery (intracranial, intrathoracic, upper intra-abdominal, and major vascular, each p < 0.001), cardiopulmonary comorbidities (RR=1.55, CI=1.10–2.17, p < 0.012), hemodynamic instability with shock prior to receiving anesthesia (RR=1.60, CI=1.21–2.11, p < 0.001) , special techniques for surgery such as cardiopulmonary bypass (CPB) and hypotensive techniques (RR=5.55, CI=2.01–15.36, p=0.001; RR=6.24, CI=2.21–17.58, p=0.001, respectively), and patients who had a history of being alcoholic (RR=5.27, CI=4.09–6.79, p < 0.001). Conclusion: Incidence of perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was very high and correlated with many factors, especially age of patient and cardiopulmonary comorbidities, patient having a history of alcoholic addiction, increasing ASA physical status, preoperative shock, special techniques for surgery, and sites of surgery including brain, thorax, abdomen, and major vascular region. Anesthesiologists and multidisciplinary teams in pre- and perioperative periods should remain alert for warning signs of pre-cardiac arrest and be quick to manage the high-risk group of surgical trauma patients. Furthermore, a healthcare policy should be promoted for protecting against accidents in high-risk groups of the population as well.

Keywords: perioperative cardiac arrest, trauma patients, emergency surgery, anesthesia, factors risk, incidence

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Authors: Noureddine Litim

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This work is to theoretical and numerical studying the real analysis of the seismic response of the soil with an Elasto-plastic behavior. To perform this analysis, we used different core drilling performed at the tunnel T4 in El Horace section of the highway east-west. The two-dimensional model (2d) was established by the code of finite element plaxis to estimate the displacement amplification and accelerations caused by the seismic wave in the different core drilling and compared with the factor of acceleration given by the RPA (2003) in the area studying. Estimate the displacement amplification and accelerations caused by the seismic wave.

Keywords: seismic response, deposition of soil, plaxis, elasto-plastic

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Authors: Magdalena Igras, Joanna Grzybowska, Mariusz Ziółko

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The study of emotions expressed in emergency phone call is presented, covering both statistical analysis of emotions configurations and an attempt to automatically classify emotions. An emergency call is a situation usually accompanied by intense, authentic emotions. They influence (and may inhibit) the communication between caller and responder. In order to support responders in their responsible and psychically exhaustive work, we studied when and in which combinations emotions appeared in calls. A corpus of 45 hours of conversations (about 3300 calls) from emergency call center was collected. Each recording was manually tagged with labels of emotions valence (positive, negative or neutral), type (sadness, tiredness, anxiety, surprise, stress, anger, fury, calm, relief, compassion, satisfaction, amusement, joy) and arousal (weak, typical, varying, high) on the basis of perceptual judgment of two annotators. As we concluded, basic emotions tend to appear in specific configurations depending on the overall situational context and attitude of speaker. After performing statistical analysis we distinguished four main types of emotional behavior of callers: worry/helplessness (sadness, tiredness, compassion), alarm (anxiety, intense stress), mistake or neutral request for information (calm, surprise, sometimes with amusement) and pretension/insisting (anger, fury). The frequency of profiles was respectively: 51%, 21%, 18% and 8% of recordings. A model of presenting the complex emotional profiles on the two-dimensional (tension-insecurity) plane was introduced. In the stage of acoustic analysis, a set of prosodic parameters, as well as Mel-Frequency Cepstral Coefficients (MFCC) were used. Using these parameters, complex emotional states were modeled with machine learning techniques including Gaussian mixture models, decision trees and discriminant analysis. Results of classification with several methods will be presented and compared with the state of the art results obtained for classification of basic emotions. Future work will include optimization of the algorithm to perform in real time in order to track changes of emotions during a conversation.

Keywords: acoustic analysis, complex emotions, emotion recognition, machine learning

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Authors: Nioofar Margarite Rouhani

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Using a case study methodology, this study explores the lived experiences of elite women footballers (soccer) team in the United Arab Emirates (UAE) and the challenges and enablers women in this country encountered in their journey to competing at an international level. Through a series of face-to-face interviews with members of the first all-Emirati (people with UAE passport) women’s football team, members of the team’s coaching staff and key policymakers, the study sought to explore the social and cultural conditions that enabled the emergence of this team. A key aim of the study was to analyze the cultural shifts that have seemingly facilitated changes to gender relations in the UAE and to highlight possibilities for future gender equality work. The study explores the significance of sport in UAE society and its role in disrupting traditional gender boundaries. To do this, the study identifies and analyses contemporary social (religion, class, and culture) conditions that facilitate, and/or restrict, women’s sports participation in the public sphere of sport. Drawing on a feminist poststructural framework the study sought to analyse the discursive enactment of (disruptive) gender identity positions, using lenses such as ‘discourse’ and ‘power’. With a particular focus on elite women’s sport, the study sought to build knowledge around the advance of female participation in what has long been considered as a masculine domain. Here, the study sought to explore the lived experience of social change through a series of face-to-face interviews with members of the first all-Emirati- women’s football team and key support personnel. To maintain representational integrity, the principles of narrative methodology were employed for their ability to privilege the voices of participants while integrating contextual forces that comprised the stories they told about their experiences and the key people who participated in them. This approach supported a key aim of the study, being to analyse the cultural shifts that have supported changes in gender performance in the UAE and to highlight possibilities for future gender disruption. While the results of the study convey a growing sense of opportunity for aspiring sportswomen in the UAE, they also reveal that the participant pathways were full of contestation and restriction. What we learn from the stories of the first Emirate women’s football team is that where the will is strong enough, there can be a way. While it is reasonable to assume that such pathways will become easier in the future, as the participation of women in such sporting arenas becomes less exceptional, there are factors that are likely to enable and disable such journeys. Prominent here is the presence of a ‘powerful’ guardian and mentor who can offer sustained support, and influence. In a society where males continue to have disproportionate access to social and domestic power, such support can be extremely influential. Guardians and mentors can play a crucial role in garnering the support of dominant male figures, or helping to find ways to work around it.

Keywords: gender equality, women, sport, Middle East

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Authors: Hancy Issac, Gerben Keijzers, Ian Yang, Clint Moloney, Jackie Lea, Melissa Taylor

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Introduction: Chronic obstructive pulmonary disease guideline non-adherence is associated with a reduction in health-related quality of life in patients (HRQoL). Improving guideline adherence has the potential to mitigate fragmented care thereby sustaining pulmonary function, preventing acute exacerbations, reducing economic health burdens, and enhancing HRQoL. The development of an electronic proforma stemming from expert consensus, including digital guideline resources and direct interdisciplinary referrals is hypothesised to improve guideline adherence and patient outcomes for emergency department (ED) patients with COPD. Aim: The aim of this study was to develop consensus among ED and respiratory staff for the correct composition of a COPD electronic proforma that aids in guideline adherence and management in the ED. Methods: This study adopted a mixed-method design to develop the most important indicators of care in the ED. The study involved three phases: (1) a systematic literature review and qualitative interdisciplinary staff interviews to assess barriers and solutions for guideline adherence and qualitative interdisciplinary staff interviews, (2) a modified Delphi panel to select interventions for the proforma, and (3) a consensus process through three rounds of scoring through a quantitative survey (ED and Respiratory consensus) and qualitative thematic analysis on each indicator. Results: The electronic proforma achieved acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts. Cronbach’s alpha score for internal consistency (α) in iteration 1 emergency department cohort (EDC) (α = 0.80 [CI = 0.89%]), respiratory department cohort (RDC) (α = 0.95 [CI = 0.98%]). Iteration 2 reported EDC (α = 0.85 [CI = 0.97%]) and RDC (α = 0.86 [CI = 0.97%]). Iteration 3 revealed EDC (α = 0.73 [CI = 0.91%]) and RDC (α = 0.86 [CI = 0.95%]), respectively. Conclusion: Electronic proformas have the potential to facilitate direct referrals from the ED leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life and improved interdisciplinary guideline adherence.

Keywords: COPD, electronic proforma, modified delphi study, interdisciplinary, guideline adherence, COPD-X plan

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Authors: Rumbidzai Sipiwe Zimvumi

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The study aimed to identify the top management team attributes for ambidexterity in small and medium-sized enterprises by utilizing the upper echelons theory. The conventional opinion holds that an organization's ability to pursue both exploitative and explorative innovation methods at the same time is reflected in its ambidexterity. Top-level managers are critical to this matrix because they forecast and explain strategic choices that guarantee success by improving organizational performance. Since the focus of the study was on the unique characteristics of TMTs that can facilitate ambidexterity, the primary goal was to comprehend how TMTs in SMEs can better manage ambidexterity. The study used document analysis to collect information on ambidexterity and TMT traits. Finding, choosing, assessing, and synthesizing data from peer-reviewed publications allowed for the review and evaluation of papers. The fact that SMEs will perform better if they can achieve a balance between exploration and exploitation cannot be overstated. Unfortunately, exploitation is the main priority for most SMEs. The results showed that some of the noteworthy TMT traits that support ambidexterity in SMEs are age diversity, shared responsibility, leadership impact, psychological safety, and self-confidence. It has been shown that most SMEs confront significant obstacles in recruiting people, including formalizing their management and assembling executive teams with seniority. Small and medium-sized enterprises (SMEs) are often held by families or people who neglect to keep their personal lives apart from the firm, which eliminates the opportunity for management and staff to take the initiative. This helps to explain why exploitative strategies, which preserve present success, are used rather than explorative strategies, which open new economic opportunities and dimensions. It is evident that psychological safety deteriorates, and creativity is hindered in the process. The study makes the case that TMTs who are motivated to become ambidextrous can exist. According to the report, small- and medium-sized business owners should value the opinions of all parties involved and provide their managers and regular staff the freedom to think creatively and in a safe environment. TMTs who experience psychological safety are more likely to be inventive, creative, and productive. A team's collective perception that it is acceptable to take chances, voice opinions and concerns, ask questions, and own up to mistakes without fear of unfavorable outcomes is known as team psychological safety. Thus, traits like age diversity, leadership influence, learning agility, psychological safety, and self-assurance are critical to the success of SMEs. As a solution to ensuring ambidexterity is attained, the study suggests a clear separation of ownership and control, the adoption of technology to stimulate creativity, team spirit and excitement, shared accountability, and good management of diversity. Among the suggestions for the SME's success are resource allocation and important collaborations.

Keywords: navigating, ambidexterity, top management team, small and medium enterprises

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Authors: Florencio D. De Los Reyes, Magdaleno R. Vasquez Jr., Mark Daniel G. De Luna, Peerasak Paoprasert

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The effect of adding silica nanoparticles (SiNPs) obtained from rice husk, and phosphorus and nitrogen based compounds namely 9,10-dihydro-9-oxa-10-phosphaphenantrene-10-oxide (DOPO) and melamine, respectively, on the flammability of polystyrene (PS) was studied using response surface methodology (RSM). The flammability of PS was reduced as the limiting oxygen index (LOI) values increased when the flame retardant additives were added. DOPO exhibited the best retarding property increasing the LOI value of PS by 42.4%. A quadratic model for LOI was obtained from the RSM results, with percent loading of SiNPs, DOPO, and melamine, as independent variables. The observed increase in the LOI value as the percent loading of the flame retardant additives is increased, was attributed both to the main effects and synergistic effects of the parameters, as the LOI response of SiNPs is greatly enhanced by the addition of DOPO and melamine, as shown by the response surface plots. This indicates the potential of producing a cheaper, effective, and non-toxic multi-flame retardant system for the polymeric system via different flame retarding mechanisms.

Keywords: flame retardancy, polystyrene, response surface methodology, rice husk, silica nanoparticle

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Authors: Saeed Abbasi, Davood Farsi, Soudabeh Shafiee Ardestani, Neda Valizadeh

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Objectives: Peripheral vertigo is a common complaint of patients who are visited in emergency departments. In our study, we wanted to evaluate the effect of betahistine as an oral drug vs. intravenous diazepam for the treatment of acute peripheral vertigo. We also wanted to see the possibility of substitution of parenteral drug with an oral one with fewer side effects. Materials and Methods: In this randomized, double-blind study, 101 patients were enrolled in the study. The patients were divided in two groups in a double-blind randomized manner. Group A took oral placebo and 10 mg of intravenous diazepam. Group B received 8mg of oral betahistine and intravenous placebo. Patients’ symptoms and signs (Vertigo severity, Nausea, Vomiting, Nistagmus and Gate) were evaluated after 0, 2, 4, 6 hours by emergency physicians and data were collected by a questionnaire. Results: In both groups, there was significant improvement in vertigo (betahistine group P=0.02 and Diazepam group P=0.03). Analysis showed more improvement in vertigo severity after 4 hours of treatment in betahistine group comparing to diazepam group (P=0.02). Nausea and vomiting were significantly lower in patients receiving diazepam after 2 and 6 hours (P=0.02 & P=0.03).No statistically significant differences were found between the groups in nistagmus, equilibrium & vertigo duration. Conclusion: The results of this randomized trial showed that both drugs had acceptable therapeutic effects in peripheral vertigo, although betahistine was significantly more efficacious after 4 hours of drug intake. As for higher nausea and vomiting in betahistine group, physician should consider these side effects before drug prescription.

Keywords: acute peripheral vertigo, betahistine, diazepam, emergency department

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Authors: Aditya Manna, L. K. Khanra, S. K. Sarkar

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Aim: Due to financial incapability and the absence of manpower-poor families often fail to carry their advanced cancer patients to the nodal centers. This pilot study will explore whether communication by mobile phone can lessen this burden. Method: Initially a plan was generated regarding management of an advanced cancer patient in a nodal center at District Head Quarter. Subsequently every two week a trained social worker attached to the nodal center will follow up and give necessary advice and emotional support to the patients and their families through their registered mobile phone number. Patient’s family were also encouraged to communicate with the team by phone in case of fresh complain and urgency in between. Results: Since initiation in January 2013, 193 cancer patients were contacted by mobile phone every two weeks to enquire about their difficulties. In 76% of the situation trained social workers could give necessary advice by phone regarding management of their physical symptoms. Moreover, patient’s family was really overwhelmed by the emotional support offered by the team over the phone. Only 24% of cancer patients have to attend the nodal center for expert advice from Palliative Care specialists. Conclusion: This novel approach helped: (a) In providing regular physical and emotional support to the patients and their families. (b) In significantly reducing the financial and manpower problems of carrying patients to the nodal units. (c) In improving the quality of life of patients by continuous guidance. More and more team members can take help of this new strategy for better communication and uninterrupted care.

Keywords: palliative care, terminal care, home based palliative care, rural india

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Authors: Luedech Girdwichai, Withaya Mekhum

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This research intended to develop the model of community management for sustainable utilization by investigating on 2 groups of population, the family heads and the community management team. The population of the former group consisted of family heads from 511 families in 12 areas to complete the questionnaires which were returned at 479 sets. The latter group consisted of the community management team of 12 areas with 1 representative from each area to give the interview. The questionnaires for the family heads consisted of 2 main parts; general information such as occupations, etc. in the form of checklist. The second part dealt with the data on self reliance community development based on 4P Framework, i.e., People (human resource) development, Place (area) development, Product (economic and income source) development, and Plan (community plan) development in the form of rating scales. Data in the 1st part were calculated to find frequency and percentage while those in the 2nd part were analyzed to find arithmetic mean and SD. Data from the 2nd group of population or the community management team were derived from focus group to find factors influencing successful management together with the in depth interview which were analyzed by descriptive statistics. The results showed that 479 family heads reported that the aspect on the implementation of community plan to self reliance community activities based on Sufficient Economy Philosophy and the 4P was at the average of 3.28 or moderate level. When considering in details, it was found that the 1st aspect was on the area development with the mean of 3.71 or high level followed by human resource development with the mean of 3.44 or moderate level, then, economic and source of income development with the mean of 3.09 or moderate level. The last aspect was community plan development with the mean of 2.89. The results from the small group discussion revealed some factors and guidelines for successful community management as follows: 1) on the People (human resource) development aspect, there was a project to support and develop community leaders. 2) On the aspect of Place (area) development, there was a development on conservative tourism areas. 3) On the aspect of Product (economic and source of income) development, the community leaders promoted the setting of occupational group, saving group, and product processing group. 4) On the aspect of Plan (community plan) development, there was a prioritization through public hearing.

Keywords: model of community management, sustainable utilization, family heads, community management team

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Authors: Saou Mohamed Amine

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The construction industry has been identified as a user of substantial amount of materials and energy resources that has an enormous impact on environment. The energy efficient in refurbishment project is being considered as one of the approaches to achieve sustainability in construction industry. The increasing concern for environment has made building owners and designers to incorporate the energy efficiency features into their building projects. However, an overwhelming issue of existing non-energy efficient buildings which exceeds the number of new building could be ineffective if the buildings are not refurbished through the energy efficient measures. Thus, energy efficient in refurbishment project is being considered as one of the approaches to achieve sustainability that offers significant opportunities for reducing global energy consumption and greenhouse gas emissions. However, the quality of design team attributes and the characteristics of the refurbishment building projects have been argued to be the main factors that determine the energy efficiency performance of the building.

Keywords: construction industry, design team attributes, energy efficient performance, refurbishment projects characteristics

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Authors: Jo Angouri, Charlotte Kennedy, Shawnea Ting, David Rawlinson, Matthew Booker, Nigel Rees

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Ambulance services need to balance the large volume of emergency (999 in the UK) calls they receive (e.g., West Midlands Ambulance Service reports per day about 4,000 999 calls; about 679,000 calls per year are received in Wales), with dispatching limited resource for on-site intervention to the most critical cases. The process by which Emergency Medical Dispatch (EMD) decisions are made is related to risk assessment and involves the caller and call-taker as well as clinical teams negotiating risk levels on a case-by-case basis. Medical Priority Dispatch System (MPDS – also referred to as Advanced Medical Priority Dispatch System AMPDS) are used in the UK by NHS Trusts (e.,g WAST) to process and prioritise 999 calls. MPDS / AMPDS provide structured protocols for call prioritisation and call management. Protocols/policy frameworks have not been examined before in the way we propose in our project. In more detail, the risk factors that play a role in the EMD negotiation between the caller and call-taker have been analysed in both medical and social science research. Research has focused on the structural, morphological and phonological aspects that could improve, and train, human-to-human interaction or automate risk detection, as well as the medical factors that need to be captured from the caller to inform the dispatch decision. There are two significant gaps in our knowledge that we address in our work: 1. the role of backstage clinical teams in translating the caller/call-taker interaction in their internal risk negotiation and, 2. the role of policy frameworks, protocols and regulations in the framing of institutional priorities and resource allocation. We take a multi method approach and combine the analysis of 999 calls with the analysis of policy documents. We draw on interaction analysis, corpus methodologies and thematic analysis. In this paper, we report on our preliminary findings and focus in particular on the risk factors we have identified and the relationship with the regulations that create the frame within which teams operate. We close the paper with implications of our study for providing evidence-based policy intervention and recommendations for further research.

Keywords: emergency (999) call, interaction analysis, discourse analysis, ambulance dispatch, medical discourse

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Authors: Anjana Sreedharan, Harish Rao

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Background: India has the world’s third largest population of people living with HIV/AIDS, with a prevalence rate of 0.69 in the state of Karnataka. This study aims at assessing the HIV/AIDS related knowledge, attitude and behavior of the medical personnel in 3 hospitals in the city of Mangalore. Methods: Surgeons, Anesthetists, OT staff nurses, ward nursing staff, House surgeons working in the hospitals associated with Kasturba Medical college, Mangalore were given questionnaires and interviewed. Their knowledge about HIV, their attitude towards HIV positive patients and bias in management of the patients was assessed. Conclusion: So far, it has been found that amongst doctors, discrimination was mainly in the form of HIV testing without consent and a lack of confidentiality. However, the doctors rarely changed the treatment plan on knowing the HIV status of the patient. Amongst the nursing staff and interns, there is a serious lacuna of knowledge regarding HIV transmission, as compared to consultants. The patient seldom faced verbal abuse from the team. Use of universal precautions is less among the entire team due to insufficient availability of the same.

Keywords: discrimination, HIV/ AIDS, medical colleges, stigma

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Authors: U. K. Tamuli

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Introduction: North East India is graced with natural beauty and hazards. This area is prone to major earthquakes, floods, landslides, accidents, terrorist activities etc. Academy of Trauma (AOT), an NGO of Doctors, conducts training programs, mock drills, field trials amongst the doctors and paramedics in North East India. The present study is to evaluate the efficacy of such training in terms of sensitivity, awareness, and delivery systems of the products. Here the health care delivery system for disaster management is inadequate. Clear guideline of mass casualty management is unavailable. AOT has initiated steps to increase the awareness and handling of mass casualty management to improve the emergency health care delivery system. Method: AOT has conducted training programmes on emergency health management, mass casualty management and hospital preparedness amongst 800 doctors and 1200 paramedics in twenty-two districts of Assam in Northeast India. The training module consists of lectures, hands-on workshop using manikins, mock drills, distribution of manuals, emergency management exercises, periodic exchange of experience and debriefings. AOT evaluates the impact of these trainings by conducting pre and post tests of delegates, trainer’s evaluation, delegate’s satisfaction and confidence level and their suggestions. Results: The module, training, hands-on workshops, mock drills were highly appreciated. There is significant improvement in scores on the post-training tests. The confidence level of the participants has risen to deal with emergency medical situation Conclusion: These kinds of trainings increase the awareness of the medical members to handle mass casualties in different situations. One such training actually sensitises the delegates. Repetition of such training, TOT (Training-of-Trainers) programs, and individual efforts of delegates are extremely important for sustenance and success of health care delivery service during disasters in the developing countries. Further collaboration, assistance, networking, suggestions from established global agencies in this field will be highly appreciated.

Keywords: capacity building, North East India, non-governmental organization, trauma

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Authors: Tanmaya Kumar Dash, Tarun Karamshetty, Soumitra Paul

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The Barkhausen Noise Analysis (BNA) technique has been utilized to assess surface integrity of steels. But the BNA technique is not very successful in evaluating surface integrity of ground steels that exhibit poor micro-magnetic response. A new approach has been proposed for the processing of BN signal with Fast Fourier transforms while Wavelet transforms has been used to remove noise from the BN signal, with judicious choice of the ‘threshold’ value, when the micro-magnetic response of the work material is poor. In the present study, the effect of down feed induced upon conventional plunge surface grinding of hardened bearing steel has been investigated along with an ultrasonically cleaned, wet polished and a sample ground with spark out technique for benchmarking. Moreover, the FFT analysis has been established, at different sets of applied voltages and applied frequency and the pattern of the BN signal in the frequency domain is analyzed. The study also depicts the wavelet transforms technique with different levels of decomposition and different mother wavelets, which has been used to reduce the noise value in BN signal of materials with poor micro-magnetic response, in order to standardize the procedure for all BN signals depending on the frequency of the applied voltage.

Keywords: barkhausen noise analysis, grinding, magnetic properties, signal processing, micro-magnetic response

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Authors: Latif Duran, Erdem Aydin, Ahmet Baydin, Ali Kemal Erenler, Iskender Aksoy

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Aim: In this retrospective study, we aim to contribute to the literature by presenting the proposals for taking measures to reduce the mortality by examining the demographic characteristics of the pediatric age group patients presenting with trauma and the factors that may cause mortality Material and Method: This study has been performed by retrospectively investigating the data obtained from the patient files and the hospital automation registration system of the pediatric trauma patients who applied to the Adult Emergency Department of the Ondokuz Mayıs University Medical Faculty between January 1, 2016, and December 31, 2016. Results: 289 of 415 patients involved in our study, were males. The median age was 11.3 years. The most common trauma mechanism was falling from the high. A significant statistical difference was found on the association between trauma mechanisms and gender. An increase in the number of trauma cases was found especially in the summer months. The study showed that thoracic and abdominal trauma was relevant to the increased mortality. Computerized tomography was the most common diagnostic imaging modality. The presence of subarachnoid hemorrhage has increased the risk of mortality by 62.3 fold. Eight of the patients (1.9%) died. Scoring systems were statistically significant to predict mortality. Conclusion: Children are vulnerable to trauma because of their unique anatomical and physiological differences compared to adult patient groups. It will be more successful in the mortality rate and in the post-traumatic healing process by administering the patient triage fast and most appropriate trauma centers in the prehospital period, management of the critical patients with the scoring systems and management with standard treatment protocols

Keywords: emergency service, pediatric patients, scoring systems, trauma, age groups

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Authors: L. M. H. Mustonen, S. A. Heikkilä

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The focus of the paper is to describe team teaching as a HAMK’s pedagogical method, and its impacts to the teachers work. Background: Traditionally it is thought that teaching is a job where one mostly works alone. More and more teachers feel that their work is getting more stressful. Solutions to these problems have been sought in Häme University of Applied sciences’ (From now on referred to as HAMK). HAMK has made a strategic change to move to the group oriented working of teachers. Instead of isolated study courses, there are now larger 15 credits study modules. Implementation: As examples of the method, two cases are presented: technical project module and summer studies module, which was integrated into the EU development project called Energy Efficiency with Precise Control. In autumn 2017, technical project will be implemented third time. There are at least three teachers involved in it and it is the first module of the new students. Main focus is to learn the basic skills of project working. From communicational viewpoint, they learn the basics of written and oral reporting and the basics of video reporting skills. According to our quality control system, the need for the development is evaluated in the end of the module. There are always some differences in each implementation but the basics are the same. The other case summer studies 2017 is new and part of a larger EU project. For the first time, we took a larger group of first to third year students from different study programmes to the summer studies. The students learned professional skills and also skills from different fields of study, international cooperation, and communication skills. Benefits and challenges: After three years, it is possible to consider what the changes mean in the everyday work of the teachers - and of course – what it means to students and the learning process. The perspective is HAMK’s electrical and automation study programme: At first, the change always means more work. The routines born after many years and the course material used for years may not be valid anymore. Teachers are teaching in modules simultaneously and often with some subjects overlapping. Finding the time to plan the modules together is often difficult. The essential benefit is that the learning outcomes have improved. This can be seen in the feedback given by both the teachers and the students. Conclusions: A new type of working environment is being born. A team of teachers designs a module that matches the objectives and ponders the answers to such questions as what are the knowledge-based targets of the module? Which pedagogical solutions will achieve the desired results? At what point do multiple teachers instruct the class together? How is the module evaluated? How can the module be developed further for the next execution? The team discusses openly and finds the solutions. Collegiate responsibility and support are always present. These are strengthening factors of the new communal university teaching culture. They are also strong sources of pleasure of work.

Keywords: pedagogical development, summer studies, team teaching, well-being at work

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Authors: A. Kourou, A. Ioakeimidou, S. Hadjiefthymiades, V. Abramea

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During the last decades, the task of engaging governments, communities and citizens to reduce risk and vulnerability of the populations has made variable progress. Experience has demonstrated that lack of awareness, education and preparedness may result in significant material and other losses both on the onset of the disaster. Schools play a vital role in the community and are important elements of values and culture of the society. A proper school education not only teaches children, but also is a key factor in the promotion of a safety culture into the wider community. In Greece School Earthquake Safety Initiative has been undertaken by Earthquake Planning and Protection Ogranization with specific actions (seminars, lectures, guidelines, educational material, campaigns, national or EU projects, drills etc.). The objective of this initiative is to develop disaster-resilient school communities through awareness, self-help, cooperation and education. School preparedness requires the participation of Principals, teachers, students, parents, and competent authorities. Preparation and earthquake readiness involves: a) learning what should be done before, during, and after earthquake; b) doing or preparing to do these things now, before the next earthquake; and c) developing teachers’ and students’ skills to cope efficiently in case of an earthquake. In the above given framework this paper presents the results of a survey aimed to identify the level of education and preparedness of school community in Greece. More specifically, the survey questionnaire investigates issues regarding earthquake protection actions, appropriate attitudes and behaviors during an earthquake and existence of contingency plans at elementary and secondary schools. The questionnaires were administered to Principals and teachers from different regions of the country that attend the EPPO national training project 'Earthquake Safety at Schools'. A closed-form questionnaire was developed for the survey, which contained questions regarding the following: a) knowledge of self protective actions b) existence of emergency planning at home and c) existence of emergency planning at school (hazard mitigation actions, evacuation plan, and performance of drills). Survey results revealed that a high percentage of teachers have taken the appropriate preparedness measures concerning non-structural hazards at schools, emergency school plan and simulation drills every year. In order to improve the action-planning for ongoing school disaster risk reduction, the implementation of earthquake drills, the involvement of students with disabilities and the evaluation of school emergency plans, EPPO participates in E-PreS project. The main objective of this project is to create smart tools which define, simulate and evaluate all hazards emergency steps customized to the unique district and school. The project comes up with a holistic methodology using real-time evaluation involving different categories of actors, districts, steps and metrics. The project is supported by EU Civil Protection Financial Instrument with a duration of two years. Coordinator is the Kapodistrian University of Athens and partners are from four countries; Greece, Italy, Romania and Bulgaria.

Keywords: drills, earthquake, emergency plans, E-PreS project

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Authors: Breanna Wright, Peter Bragge

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Diagnostic error rates in healthcare are approximately 10% of cases. Diagnostic errors can cause patient harm due to inappropriate, inadequate or delayed treatment, and such errors contribute heavily to medical liability claims globally. Therefore, addressing diagnostic error is a high priority. In most cases, diagnostic errors are the result of faulty information synthesis rather than lack of knowledge. Specifically, the majority of diagnostic errors involve cognitive factors, and in particular, cognitive biases. Emergency Departments are an environment with heightened risk of diagnostic error due to time and resource pressures, a frequently chaotic environment, and patients arriving undifferentiated and with minimal context. This project aimed to develop a behavioural, evidence-informed intervention to reduce diagnostic error in Emergency Departments through co-design with emergency physicians, insurers, researchers, hospital managers, citizens and consumer representatives. The Forum Process was utilised to address this aim. This involves convening a small (4 – 6 member) expert panel to guide a focused literature and practice review; convening of a 10 – 12 person citizens panel to gather perspectives of laypeople, including those affected by misdiagnoses; and a 18 – 22 person structured stakeholder dialogue bringing together representatives of the aforementioned stakeholder groups. The process not only provides in-depth analysis of the problem and associated behaviours, but brings together expertise and insight to facilitate identification of a behaviour change intervention. Informed by the literature and practice review, the Citizens Panel focused on eliciting the values and concerns of those affected or potentially affected by diagnostic error. Citizens were comfortable with diagnostic uncertainty if doctors were honest with them. They also emphasised the importance of open communication between doctors and patients and their families. Citizens expect more consistent standards across the state and better access for both patients and their doctors to patient health information to avoid time-consuming re-taking of long patient histories and medication regimes when re-presenting at Emergency Departments and to reduce the risk of unintentional omissions. The structured Stakeholder Dialogue focused on identifying a feasible behavioural intervention to review diagnoses in Emergency Departments. This needed to consider the role of cognitive bias in medical decision-making; contextual factors (in Victoria, there is a legislated 4-hour maximum time between ED triage and discharge / hospital admission); resource availability; and the need to ensure the intervention could work in large metropolitan as well as small rural and regional ED settings across Victoria. The identified behavioural intervention will be piloted in approximately ten hospital EDs across Victoria, Australia. This presentation will detail the findings of all review and consultation activities, describe the behavioural intervention developed and present results of the pilot trial.

Keywords: behavioural intervention, cognitive bias, decision-making, diagnostic error

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Authors: Juliette MacDonald, Jun Li, Wenji Xiang, Mingwei Zhao

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Shanghai International College of Fashion and Innovation (SCF) was created as a result of a collaborative partnership agreement between the University of Edinburgh and Donghua University. The College provides two programmes: Fashion Innovation and Fashion Interior Design and the overarching curriculum has the intention of developing innovation and creativity within an international learning, teaching, knowledge exchange and research context. The research problem presented here focuses on the multi-national/cultural faculty in the team, the challenges arising from difficulties in communication and the associated limitations of management frameworks. The teaching faculty at SCF are drawn from China, Finland, Korea, Singapore and the UK with input from Flying Faculty from Fashion and Interior Design, Edinburgh College of Art (ECA), for 5 weeks each semester. Rather than fully replicating the administrative and pedagogical style of one or other of the institutions within this joint partnership the aim from the outset was to create a third way which acknowledges the quality assurance requirements of both Donghua and Edinburgh, the academic and technical needs of the students and provides relevant development and support for all the SCF-based staff and Flying Academics. It has been well acknowledged by those who are involved in teaching across cultures that there is often a culture shock associated with transnational education but that the experience of being involved in the delivery of a curriculum at a Joint Institution can also be very rewarding for staff and students. It became clear at SCF that if a third way might be achieved which encourages innovative approaches to fashion education whilst balancing the expectations of Chinese and western concepts of education and the aims of two institutions, then it was going to be necessary to construct a framework which developed close working relationships for the entire teaching team, so not only between academics and students but also between technicians and administrators at ECA and SCF. The attempts at co-construction and integration are built on the sharing of cultural and educational experiences and knowledge as well as provision of opportunities for reflection on the pedagogical purpose of the curriculum and its delivery. Methods on evaluating the effectiveness of these aims include a series of surveys and interviews and analysis of data drawn from teaching projects delivered to the students along with graduate successes from the last five years, since SCF first opened its doors. This paper will provide examples of best practice developed by SCF which have helped guide the faculty and embed common core values and aims of co-construction regulations and management, whilst building a pro-active TNE (Trans-National Education) team which enhances the learning experience for staff and students alike.

Keywords: cultural co-construction, educational team management, multi-cultural challenges, TNE integration for teaching teams

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Authors: Hyeon-Kyo Lim, Tong-Il Jang, Yong-Hee Lee

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For the past several decades, not a few researchers have warned that even a trivial human error may result in unexpected accidents, especially in Nuclear Power Plants. To prevent accidents in Nuclear Power Plants, it is quite indispensable to make any factors under the effective control that may raise the possibility of human errors for accident prevention. This study aimed to develop a risk management program, especially in the sense that guaranteeing Fitness-for-Duty (FFD) of human beings working in Nuclear Power Plants. Throughout a literal survey, it was found that work stress and fatigue are major psychophysical factors requiring sophisticated management. A set of major management factors related to work stress and fatigue was through repetitive literal surveys and classified into several categories. To maintain the fitness of human workers, a 4-level – individual worker, team, staff within plants, and external professional - approach was adopted for FFD management program. Moreover, the program was arranged to envelop the whole employment cycle from selection and screening of workers, job allocation, and job rotation. Also, a managerial care program was introduced for employee assistance based on the concept of Employee Assistance Program (EAP). The developed program was reviewed with repetition by ex-operators in nuclear power plants, and assessed in the affirmative. As a whole, responses implied additional treatment to guarantee high performance of human workers not only in normal operations but also in emergency situations. Consequently, the program is under administrative modification for practical application.

Keywords: fitness-for-duty (FFD), human error, work stress, fatigue, Employee-Assistance-Program (EAP)

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Authors: G. Kaushik, A. Gupta, S. Lalwani, K. D. Soni, S. Kumar, S. Sagar

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Objective: Alcohol is a leading risk factor associated with the disability and death due to RTI. Present study aims to demonstrate the demographic profile, injury pattern, physiological parameters of victims of trauma following alcohol consumption arriving in the emergency department (ED) and mortality in alcohol intoxicated trauma patients admitted to Apex Trauma Center in Delhi. Design and Methods: Present study was performed in randomly selected 182 alcohol breath analyzer tested RTI patients from the emergency department of Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences, New Delhi for over a period of 3 months started from September 2013 to November 2013. Results: A total 182 RTI patients with blunt injury were selected between 30-40 years of age and equally distributed to male and female group. Of these, 93 (51%) were alcohol negative and 89 (49%) were alcohol positive. In 89 alcohol positive patients, 47 (53%) had Artificial Airway as compared to 17 (18%), (p < 0.001) in the other group. The Glasgow Coma Scale (GCS) score was lower (p < 0.001) and higher Injury Severity Score (ISS) was observed in alcohol positive group as compared to other group (p < 0.03). Increased number of patients (58%) were admitted to Intensive Care Unit (ICU), in alcohol positive group (p < 0.001) and they were in ICU for longer time compare to other group (p < 0.001). The alcohol positive patients were on ventilator support for longer duration as compared to non-alcoholic group (p < 0.001). Mortality rate was higher in alcohol intoxicated patients as compared to non-alcoholic RTI patients, however, the difference was not statistically significant. Conclusion: This study revealed that GCS, mean ISS, ICU stay, ventilation time etc. might have considerable impact on mortality in alcohol intoxicated patients as compared to non-alcoholic group.

Keywords: road traffic injuries, alcohol, trauma, emergency department

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Authors: Sadaf Abbas, HimGauri Sabnis

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Introduction: Peripartum cardiomyopathy is a rare but potentially life-threatening condition that presents as heart failure during the last month of pregnancy or within five months postpartum. The incidence of postpartum cardiomyopathy ranges from 1 in 1300 to 1 in 15,000 pregnancies. Risk factors include multiparty, advanced maternal age, multiple pregnancies, pre-eclampsia, and chronic hypertension. Study: A 30-year-old Para3+0 presented to the Emergency Department of St’Marry Hospital, Isle of Wight, on the seventh day postpartum, with acute shortness of breath (SOB), chest pain, cough, and a temperature of 38 degrees. The risk factors were smoking and class II obesity (BMI of 40.62). The patient had mild pre-eclampsia in the last pregnancy and was on labetalol and aspirin during an antenatal period, which was stopped postnatally. There was also a history of pre-eclampsia and haemolysis, elevated liver enzymes, low platelets (HELLP syndrome) in previous pregnancies, which led to preterm delivery at 35 weeks in the second pregnancy, and the first baby was stillborn at 24 weeks. On assessment, there was a national early warning score (NEWS score) of 3, persistent tachycardia, and mild crepitation in the lungs. Initial investigations revealed an enlarged heart on chest X-ray, and a CT pulmonary angiogram indicated bilateral basal pulmonary congestion without pulmonary embolism, suggesting fluid overload. Laboratory results showed elevated CRP and normal troponin levels initially, which later increased, indicating myocardial involvement. Echocardiography revealed a severely dilated left ventricle with an ejection fraction (EF) of 31%, consistent with severely impaired systolic function. The cardiology team reviewed the patient and admitted to the Coronary Care Unit. As sign and symptoms were suggestive of fluid overload and congestive cardiac failure, management was done with diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), proton pump inhibitors, and supportive care. During admission, there was complications such as acute kidney injury, but then recovered well. Chest pain had resolved following the treatment. After being admitted for eight days, there was an improvement in the symptoms, and the patient was discharged home with a further plan of cardiac MRI and genetic testing due to a family history of sudden cardiac death. Regular appointment has been made with the Cardiology team to follow-up on the symptoms. Since discharge, the patient made a good recovery. A cardiac MRI was done, which showed severely impaired left ventricular function, ejection fraction (EF) of 38% with mild left ventricular dilatation, and no evidence of previous infarction. Overall appearance is of non-ischemic dilated cardiomyopathy. The main challenge at the time of admission was the non-availability of a cardiac radiology team, so the definitive diagnosis was delayed. The long-term implications include risk of recurrence, chronic heart failure, and, consequently, an effect on quality of life. Therefore, regular follow-up is critical in patient’s management. Conclusions: Peripartum cardiomyopathy is one of the cardiovascular diseases whose causes are still unknown yet and, in some cases, are uncontrolled. By raising awareness about the symptoms and management of this complication it will reduce morbidity and mortality rates and also the length of stay in the hospital.

Keywords: cardiomyopathy, cardiomegaly, pregnancy, puerperium

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Authors: Shah Sufaid, Hussain Shahid, Tianyan You, Liu Guiwu, Qiao Guanjun

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Nickel oxide (NiO) is an optimal material for precise detection of hydrogen (H₂) gas due to its high catalytic activity and low resistivity. However, the gas response kinetics of H₂ gas molecules with the surface of NiO concurrence limitation imposed by its solid structure, leading to a diminished gas response value and slow electron-hole transport. Herein, NiO@CuO NFs with porous sharp-tip and nanospheres morphology were successfully synthesized by using a metal-organic framework (MOFs) as a precursor. The fabricated porous 2 wt% NiO@CuO NFs present outstanding selectivity towards H₂ gas, including a high sensitivity of a response value (170 to 20 ppm at 150 °C) higher than that of porous Ni-MOF (6), low detection limit (300 ppb) with a notable response (21), short response and recovery times at (300 ppb, 40/63 s and 20 ppm, 100/167 s), exceptional long-term stability and repeatability. Furthermore, an understanding of NiO@CuO sensor functioning in an actual environment has been obtained by using the impact of relative humidity as well. The boosted hydrogen sensing properties may be attributed due to synergistic effects of numerous facts including p-p heterojunction at the interface between NiO and CuO nanoflowers. Particularly, a porous Ni-MOF structure combined with the chemical sensitization effect of NiO with the rough surface of CuO nanosphere, are examined. This research presents an effective method for development of Ni-MOF derived metal oxide semiconductor (MOS) heterostructures with rigorous morphology and composition, suitable for gas sensing application.

Keywords: NiO@CuO NFs, metal organic framework, porous structure, H₂, gas sensing

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Authors: Nina Øystad-Larsen, Miran Cemalovic, Amir M. Kaynia

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The nonlinear static and dynamic analysis procedures presented in EN 1998-1 for the structural response of a RC wall-frame building are assessed. The structure is designed according to the guidelines for high ductility (DCH) in 1998-1. The finite element packages SeismoStruct and OpenSees are utilized and evaluated. The structural response remains nearly in the elastic range even though the building was designed for high ductility. The overstrength is a result of oversized and heavily reinforced members, with emphasis on the lower storey walls. Nonlinear response history analysis in the software packages give virtually identical results for displacements.

Keywords: behaviour factor, dual system, OpenSEES, overstrength, seismostruct

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Authors: R. J. Kuo, W. C. Cheng, W. C. Lien, T. J. Yang

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Taiwan is a hyper endemic area for the Hepatitis B virus (HBV). The estimated total number of HBsAg carriers in the general population who are more than 20 years old is more than 3 million. Therefore, a case record review is conducted from January 2003 to June 2007 for all patients with a diagnosis of acute hepatitis who were admitted to the Emergency Department (ED) of a well-known teaching hospital. The cost for the use of medical resources is defined as the total medical fee. In this study, principal component analysis (PCA) is firstly employed to reduce the number of dimensions. Support vector regression (SVR) and artificial neural network (ANN) are then used to develop the forecasting model. A total of 117 patients meet the inclusion criteria. 61% patients involved in this study are hepatitis B related. The computational result shows that the proposed PCA-SVR model has superior performance than other compared algorithms. In conclusion, the Child-Pugh score and echogram can both be used to predict the cost of medical resources for patients with acute hepatitis in the ED.

Keywords: acute hepatitis, medical resource cost, artificial neural network, support vector regression

Procedia PDF Downloads 418