Search results for: surgical safety management

Authors: Onur Ozveri, Korkut Karabag, Cagri Keles

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It is an important issue that the occurring of production downtime and repair costs when machines fail in the machine intensive production industries. In the case of failure of more than one machine at the same time, which machines will have the priority to repair, how to determine the optimal repair time should be allotted for this machines and how to plan the resources needed to repair are the key issues. In recent years, Business Process Management (BPM) technique, bring effective solutions to different problems in business. The main feature of this technique is that it can improve the way the job done by examining in detail the works of interest. In the industries, maintenance and repair works are operating as a process and when a breakdown occurs, it is known that the repair work is carried out in a series of process. Maintenance main-process and repair sub-process are evaluated with process management technique, so it is thought that structure could bring a solution. For this reason, in an international manufacturing company, this issue discussed and has tried to develop a proposal for a solution. The purpose of this study is the implementation of maintenance and repair works which is integrated with process management technique and at the end of implementation, analyzing the maintenance related parameters like quality, cost, time, safety and spare part. The international firm that carried out the application operates in a free region in Turkey and its core business area is producing original equipment technologies, vehicle electrical construction, electronics, safety and thermal systems for the world's leading light and heavy vehicle manufacturers. In the firm primarily, a project team has been established. The team dealt with the current maintenance process again, and it has been revised again by the process management techniques. Repair process which is sub-process of maintenance process has been discussed again. In the improved processes, the ABC equipment classification technique was used to decide which machine or machines will be given priority in case of failure. This technique is a prioritization method of malfunctioned machine based on the effect of the production, product quality, maintenance costs and job security. Improved maintenance and repair processes have been implemented in the company for three months, and the obtained data were compared with the previous year data. In conclusion, breakdown maintenance was found to occur in a shorter time, with lower cost and lower spare parts inventory.

Keywords: ABC equipment classification, business process management (BPM), maintenance, repair performance

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Authors: Young-Hun Lee, Tae-Gwan Kim, Jong-Kyu Kim, Young-Chul Park

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In this study, Spring safety valve Heat - structure coupled analysis was carried out. Full analysis procedure and performing thermal analysis at a maximum temperature, them to the results obtained through to give an additional load and the pressure on the valve interior, and Disc holder Heat-Coupled structure Analysis was carried out. Modeled using a 3D design program Solidworks, For the modeling of the safety valve was used 3D finite element analysis program ANSYS. The final result to be obtained through the Analysis examined the stability of the maximum displacement and the maximum stress to the valve internal components occurring in the high-pressure conditions.

Keywords: finite element method, spring safety valve, gap, stress, strain, deformation

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Authors: Rodrigo Aguiar, Adelino Ferreira

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Road traffic accidents are the leading cause of unnatural death and injuries worldwide, representing a significant problem of road safety. In this context, the use of artificial intelligence with advanced machine learning techniques has gained prominence as a promising approach to predict traffic accidents. This article investigates the application of machine learning algorithms to develop traffic accident frequency prediction models. Models are evaluated based on performance metrics, making it possible to do a comparative analysis with traditional prediction approaches. The results suggest that machine learning can provide a powerful tool for accident prediction, which will contribute to making more informed decisions regarding road safety.

Keywords: machine learning, artificial intelligence, frequency of accidents, road safety

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Authors: Palak V. Patel, Jessica Pixley, Steven R. Feldman

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Introduction: Basal cell carcinoma (BCC) is the most common skin cancer worldwide and requires substantial resources to treat. When choosing between indicated therapies, providers consider their associated adverse effects, efficacy, cosmesis, and function preservation. The patient’s tumor burden, infiltrative risk, and risk of tumor recurrence are also considered. Treatment cost is often left out of these discussions. This can lead to financial toxicity, which describes the harm and quality of life reductions inflicted by high care costs. Methods: We studied the guidelines set forth by the American Academy of Dermatology for the treatment of BCC. A PubMed literature search was conducted to identify the costs of each recommended therapy. We discuss costs alongside treatment efficacy and side-effect profile. Results: Surgical treatment for BCC can be cost-effective if the appropriate treatment is selected for the presenting tumor. Curettage and electrodesiccation can be used in low-grade, low-recurrence tumors in aesthetically unimportant areas. The benefits of cost-conscious care are not likely to be outweighed by the risks of poor cosmesis or tumor return ($471 BCC of the cheek). When tumor burden is limited, MMS offers better cure rates and lower recurrence rates than surgical excision, and with comparable costs (MMS $1263; SE $949). Surgical excision with permanent sections may be indicated when tumor burden is more extensive or if molecular testing is necessary. The utility of surgical excision with frozen sections, which costs substantially more than MMS without comparable outcomes, is less clear (SE with frozen sections $2334-$3085). Less data exists on non-surgical treatments for BCC. These techniques cost less, but recurrence-risk is high. Side-effects of nonsurgical treatment are limited to local skin reactions, and cosmesis is good. Cryotherapy, 5-FU, and MAL-PDT are all more affordable than surgery, but high recurrence rates increase risk of secondary financial and psychosocial burden (recurrence rates 21-39%; cost $100-270). Radiation therapy offers better clearance rates than other nonsurgical treatments but is associated with similar recurrence rates and a significantly larger financial burden ($2591-$3460 BCC of the cheek). Treatments for advanced or metastatic BCC are extremely costly, but few patients require their use, and the societal cost burden remains low. Vismodegib and sonidegib have good response rates but substantial side effects, and therapy should be combined with multidisciplinary care and palliative measures. Expert-review has found sonidegib to be the less expensive and more efficacious option (vismodegib $128,358; sonidegib $122,579). Platinum therapy, while not FDA-approved, is also effective but expensive (~91,435). Immunotherapy offers a new line of treatment in patients intolerant of hedgehog inhibitors ($683,061). Conclusion: Dermatologists working within resource-compressed practices and with resource-limited patients must prudently manage the healthcare dollar. Surgical therapies for BCC offer the lowest risk of recurrence at the most reasonable cost. Non-surgical therapies are more affordable, but high recurrence rates increase the risk of secondary financial and psychosocial burdens. Treatments for advanced BCC are incredibly costly, but the low incidence means the overall cost to the system is low.

Keywords: nonmelanoma skin cancer, basal cell skin cancer, squamous cell skin cancer, cost of care

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Authors: Michael Vieth, Aric Schadler, Hubert Ballard, J. A. Bauer, Pratibha Thakkar

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Introduction: Congenital diaphragmatic hernia (CDH) is a condition characterized by the herniation of abdominal contents into the thoracic cavity requiring postnatal surgical repair. Previous literature suggests improved CDH outcomes at high-volume regional referral centers compared to low-volume centers. The purpose of this study was to examine CDH outcomes at Kentucky Children’s Hospital (KCH), a low-volume center, compared to the Congenital Diaphragmatic Hernia Study Group (CDHSG). Methods: A retrospective chart review was performed at KCH from 2007-2019 for neonates with CDH, and then subdivided into two cohorts: those requiring ECMO therapy and those not requiring ECMO therapy. Basic demographic data and measures of mortality and morbidity including ventilator days and length of stay were compared to the CDHSG. Measures of morbidity for the ECMO cohort including duration of ECMO, clinical bleeding, intracranial hemorrhage, sepsis, need for continuous renal replacement therapy (CRRT), need for sildenafil at discharge, timing of surgical repair, and total ventilator days were collected. Statistical analysis was performed using IBM SPSS Statistics version 28. One-sample t-tests and one-sample Wilcoxon Signed Rank test were utilized as appropriate.Results: There were a total of 27 neonatal patients with CDH at KCH from 2007-2019; 9 of the 27 required ECMO therapy. The birth weight and gestational age were similar between KCH and the CDHSG (2.99 kg vs 2.92 kg, p =0.655; 37.0 weeks vs 37.4 weeks, p =0.51). About half of the patients were inborn in both cohorts (52% vs 56%, p =0.676). KCH cohort had significantly more Caucasian patients (96% vs 55%, p=<0.001). Unadjusted mortality was similar in both groups (KCH 70% vs CDHSG 72%, p =0.857). Using ECMO utilization (KCH 78% vs CDHSG 52%, p =0.118) and need for surgical repair (KCH 95% vs CDHSG 85%, p =0.060) as proxy for severity, both groups’ mortality were comparable. No significant difference was noted for pulmonary outcomes such as average ventilator days (KCH 43.2 vs. CDHSG 17.3, p =0.078) and home oxygen dependency (KCH 44% vs. CDHSG 24%, p =0.108). Average length of hospital stay for patients treated at KCH was similar to CDHSG (64.4 vs 49.2, p=1.000). Conclusion: Our study demonstrates that outcome in CDH patients is independent of center’s case volume status. Management of CDH with a standardized approach in a low-volume center can yield similar outcomes. This data supports the treatment of patients with CDH at low-volume centers as opposed to transferring to higher-volume centers.

Keywords: ECMO, case volume, congenital diaphragmatic hernia, congenital diaphragmatic hernia study group, neonate

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Authors: Andrew Cummings, Rhianne Boag, Sarah Bryson, Gordon Turner

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Packages designed for transport of radioactive material must satisfy rigorous safety regulations specified by the International Atomic Energy Agency (IAEA). Higher Activity Waste (HAW) transport packages have to maintain containment of their contents during normal and accident conditions of transport (NCT and ACT). To ensure containment criteria is satisfied these packages are required to be leak-tight in all transport conditions to meet allowable activity release rates. Package design safety reports are the safety cases that provide the claims, evidence and arguments to demonstrate that packages meet the regulations and once approved by the competent authority (in the UK this is the Office for Nuclear Regulation) a licence to transport radioactive material is issued for the package(s). The standard approach to demonstrating containment in the RWM transport safety case is set out in BS EN ISO 12807. In this document a method for measuring a leak rate from the package is explained by way of a small interspace test volume situated between two O-ring seals on the underside of the package lid. The interspace volume is pressurised and a pressure drop measured. A small interspace test volume makes the method more sensitive enabling the measurement of smaller leak rates. By ascertaining the activity of the contents, identifying a releasable fraction of material and by treating that fraction of material as a gas, allowable leak rates for NCT and ACT are calculated. The adherence to basic safety principles in ISO12807 is very pessimistic and current practice in the demonstration of transport safety, which is accepted by the UK regulator. It is UK government policy that management of HAW will be through geological disposal. It is proposed that the intermediate level waste be transported to the geological disposal facility (GDF) in large cuboid packages. This poses a challenge for containment demonstration because such packages will have long seals and therefore large interspace test volumes. There is also uncertainty on the releasable fraction of material within the package ullage space. This is because the waste may be in many different forms which makes it difficult to define the fraction of material released by the waste package. Additionally because of the large interspace test volume, measuring the calculated leak rates may not be achievable. For this reason a justification for a lower releasable fraction of material is sought. This paper considers the use of aerosol processes to reduce the releasable fraction for both NCT and ACT. It reviews the basic coagulation and removal processes and applies the dynamic aerosol balance equation. The proposed solution includes only the most well understood physical processes namely; Brownian coagulation and gravitational settling. Other processes have been eliminated either on the basis that they would serve to reduce the release to the environment further (pessimistically in keeping with the essence of nuclear transport safety cases) or that they are not credible in the conditions of transport considered.

Keywords: aerosol processes, Brownian coagulation, gravitational settling, transport regulations

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Authors: Prasanna Kumar Khaund, Sukanya Talukdar

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A concrete gravity dam is a major hydraulic structure and it is very essential to consider the earthquake forces, to get a proper design base width, so that the entire weight of the dam resists the overturning moment due to earthquake and other forces. The main objective of this study is to obtain the design base width of a dam for different seismic conditions by varying the earthquake coefficients in both vertical and horizontal directions. This shall be done by equating the factor of safety against overturning, factor of safety against sliding and factor of safety against shear friction factor for a dam with their limiting values, under both tail water and no tail water condition. The shape of the Mettur dam in India is considered for the study. The study has been done taking a constant head of water at the reservoir, which is the maximum reservoir water level and a constant height of tail water. Using linear approximation method of Newton Raphson, the obtained equations against different factors of safety under different earthquake conditions are solved using a programme in C++ to get different values of base width of dam for varying earthquake conditions.

Keywords: design base width, horizontal earthquake coefficient, tail water, vertical earthquake coefficient

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Authors: Vasuki Rayapati, Bhanu Duggal

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Trans catheter aortic valve replacement (TAVR) is the recommended treatment over surgical aortic valve replacement (SAVR) for high-risk groups, patients >75 years of age with severe symptomatic Aortic stenosis (AS). In high income countries TAVR is more cost effective because of – i) Reduction in total length of stay including less number of days in ICU ii) Non-procedural costs like cost of general anaesthesia are higher for SAVR. In India, there are two kinds of hospitals – Public and Private. Most patients visit public sector hospitals than private sector hospitals. In a LMIC like India, especially in the Public health sector cost of TAVR is prohibitive. In a small study from three (public) hospitals in India, it was envisaged that cost of TAVR should decrease at least by 2/3 to be a cost effective option in Public health sector for severe AS.

Keywords: cost effectiveness, TAVR vs SAVR, LMIC, HTA

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Authors: Dimitra V. Peristeri, Hussameldin M. Nour, Amiya Ahsan, Sameh Abogabal, Krishna K. Singh, Muhammad Shafique Sajid

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Introduction: The use of optimal skin antiseptic agents for the prevention of surgical site infection (SSI) is of critical importance, especially during abdominal surgical procedures. Alcohol-based chlorhexidine gluconate (CHG) and aqueous-based povidone-iodine (PVI) are the two most common skin antiseptics used nowadays. The objective of this article is to evaluate the effectiveness of alcohol-based CHG versus aqueous-based PVI used for skin preparation before abdominal surgery to reduce SSIs. Methods: Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find randomised, controlled trials (RCTs) comparing alcohol-based CHG skin preparation versus aqueous-based PVI in patients undergoing abdominal surgery. The combined outcomes of SSIs were calculated using an odds ratio (OR) with 95% confidence intervals (95% CI). All data were analysed using Review Manager (RevMan) Software 5.4, and the meta-analysis was performed with a random effect model analysis. Results: A total of 11 studies, all RCTs, were included (n= 12072 participants), recruiting adult patients undergoing abdominal surgery. In the random effect model analysis, the use of alcohol-based CHG in patients undergoing abdominal surgery was associated with a reduced risk of SSI compared to aqueous-based PVI (OR: 0.84; 95% CI [0.74, 0.96], z= 2.61, p= 0.009). Conclusion: Alcohol-based CHG may be more effective for preventing the risk of SSI compared to aqueous-based PVI agents in abdominal surgery. The conclusion of this meta-analysis may add a guiding value to reinforce current clinical practice guidelines.

Keywords: skin preparation, surgical site infection, chlorhexidine, skin antiseptics

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Authors: Seyed Abbas Tabatabaei, Marjan Naderan Tahan, Arman Kadkhodai

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An efficient optimization approach, called feasible gate (FG), is developed to enhance the computation efficiency and solution quality of the previously developed highway alignment optimization (HAO) model. This approach seeks to realistically represent various user preferences and environmentally sensitive areas and consider them along with geometric design constraints in the optimization process. This is done by avoiding the generation of infeasible solutions that violate various constraints and thus focusing the search on the feasible solutions. The proposed method is simple, but improves significantly the model’s computation time and solution quality. On the other, highway alignment optimization through Feasible Gates, eventuates only economic model by considering minimum design constrains includes minimum reduce of circular curves, minimum length of vertical curves and road maximum gradient. This modelling can reduce passenger comfort and road safety. In most of highway optimization models, by adding penalty function for each constraint, final result handles to satisfy minimum constraint. In this paper, we want to propose a safety-function solution by introducing gift function.

Keywords: safety, highway geometry, optimization, alignment

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Authors: Ayodele Adekunle Faiyetole, Olumide Olawale Jegede

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This paper presents the experimental design and needs justifications for a localized intelligent parking system (L-IPS), ideal for quasi-close communities with increasing vehicular volume that depends on limited or constant parking facilities. For a constant supply in parking facilities, the demand for an increasing vehicular volume could lead to poor time conservation or extended travel time, traffic congestion or impeded mobility, and safety issues. Increased negative environmental and economic externalities are other associated and consequent downsides of disparities in demand and supply. This L-IPS is designed using a microcontroller, ultrasonic sensors, LED indicators, such that the current status, in terms of parking spots availability, can be known from the main entrance to the community or a parking zone on a LCD screen. As an advanced traffic management system (ATMS), the L-IPS is designed to resolve aspects of infrastructure-to-driver (I2D) communication and parking detection issues. Thus, this L-IPS can act as a timesaver for users by helping them know the availability of parking spots. Providing on-time, informed routing, to a next preference or seamless moving to berth on the available spot on a proximate facility as the case may be. Its use could also increase safety and increase mobility, and fuel savings and costs, therefore, reducing negative environmental and economic externalities due to transportation systems.

Keywords: intelligent parking systems, localized intelligent parking system, intelligent transport systems, advanced traffic management systems, infrastructure-to-drivers communication

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Authors: Dae Kyung Choi, Won Man Park, Kyungsoo Kim, Yoon Hyuk Kim

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The interspinous process devices have been recently used due to its advantages such as minimal invasiveness and less subsidence of the implant to the osteoporotic bone. In this paper, we have analyzed the influences of ligature tightening of several interspinous process devices using finite element analysis. Four types of interspinous process implants were inserted to the L3-4 spinal motion segment based on their surgical protocols. Inferior plane of L4 vertebra was fixed and 7.5 Nm of extension moment were applied on superior plane of L3 vertebra with 400N of compressive load along follower load direction and pretension of the ligature. The stability of the spinal unit was high enough than that of intact model. The higher value of pretension in the ligature led the decrease of dynamic stabilization effect in cases of the WallisTM, DiamTM, Viking, and Spear®. The results of present study could be used to evaluate surgical option and validate the biomechanical characteristics of the spinal implants.

Keywords: interspinous process device, bone fracture risk, lumbar spine, finite element analysis

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Authors: Himanshu Rohela

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BACKGROUND: Ewing sarcoma can arise in either bone or soft tissue. Extraskeletal Ewing sarcoma (EES) is an uncommon primary tumor of the soft tissues, accounting for 20 30% of all reported cases of ES. AIM: Was to investigate demographic distribution, survival analysis and factors affecting the survival and recurrence in patients of EES. METHODS: Retrospective study of 19 biopsy-proven EES was performed. Overall survival (OS) using log-rank test and factors affecting OS and local recurrence (LR) were evaluated for the entire cohort. RESULTS: Patients with EES had a mean age of 19.5 and it was more commonly seen in males (63%). Axial location (58%) and solitary presentation (84%) were more common. The average size was 11 cm, 3 of 19 were metastatic at presentation, with the lung beings the most common site for metastasis. 17 received NACT, 16 with VAC-IE regimen and 1 underwent a second line with GEM/DOCE regimen. Unplanned surgery was done in 2 of 19. 3 patients received definitive RT and 13 underwent surgical-wide local excision. 2 of 13 showed good response to NACT. 10 patients required readmission out of which 6 patients had chemotherapy-related complications, 2 had surgical site complications and one patient developed secondary AML post-completion of treatment. A total of 4 patients had a recurrence. One had local recurrence alone, one had distant recurrence alone and 2 patients had a distant and local recurrence both. Tumor size >10 cm, axial location, and previous unplanned surgery was associated with higher LR rate. The mean overall survival was 32 months (2.66 years), with higher rates seen in non-metastatic and non-recurrent settings. CONCLUSIONS: Early and accurate diagnosis is the key to the management of EES, with promising results seen via NACT and RO resection regimens. But further studies with larger study groups are needed to standardize the treatment protocol and evaluate its efficacy.

Keywords: Ewings, sarcoma, extraskeletal, chemotherapy

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Authors: Wisit Wichitkosoom

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Objective:The majority of the hisk-risk patients (ST-elevation myocardial infarction (STEMI), Acute cerebrovascular accident, Sepsis, Acute Traumatic patient ) are admitted to district or lacal hospitals (average 1-1.30 hr. from Udonthani general hospital, Northeastern province, Thailand) without proper facilities. The referral system was support to early care and early management at pre-hospital stage and prepare for the patient data to higher hospital. This study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to Udonthani General Hospital. Methods and results: Four district or local hospitals without proper facilities for treatment the very high-risk patient were serving the study region. Pre-hospital diagnoses were established with the simple technology such as LINE, SMS, telephone and Fax for concept of LEAN process and then the telemedicine, by ambulance monitoring (ECG, SpO2, BT, BP) in both real time and snapshot mode was administrated during the period of transfer for safety transfer concept (inter-hospital stage). The standard treatment for patients with STEMI, Intracranial injury and acute cerebrovascular accident were done. From 1 October 2012 to 30 September 2013, the 892 high-risk patients transported by ambulance and transferred to Udonthani general hospital were registered. Patients with STEMI diagnosed pre-hospitally and referred directly to the Udonthani general hospital with telemedicine closed monitor (n=248). The mortality rate decreased from 11.69% in 2011 to 6.92 in 2012. The 34 patients were arrested on the way and successful to CPR during transfer with the telemedicine consultation were 79.41%. Conclusion: The proper innovation could apply for health care system. The very high-risk patients must had the closed monitoring with two-way communication for the “safety transfer period”. It could modified to another high-risk group too.

Keywords: safety transfer, telemedicine, critical patients, medical and health sciences

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Authors: S. Lemoussu, J. C. Chaudemar, R. A. Vingerhoeds

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The aeronautics sector is currently living an unprecedented growth largely due to innovative projects. In several cases, such innovative developments are being carried out by Small and Medium sized-Enterprises (SMEs). For instance, in Europe, a handful of SMEs are leading projects like airships, large civil drones, or flying cars. These SMEs have all limited resources, must make strategic decisions, take considerable financial risks and in the same time must take into account the constraints of safety, cost, time and performance as any commercial organization in this industry. Moreover, today, no international regulations fully exist for the development and certification of this kind of projects. The absence of such a precise and sufficiently detailed regulatory framework requires a very close contact with regulatory instances. But, SMEs do not always have sufficient resources and internal knowledge to handle this complexity and to discuss these issues. This poses additional challenges for those SMEs that have system integration responsibilities and that must provide all the necessary means of compliance to demonstrate their ability to design, produce, and operate airships with the expected level of safety and reliability. The final objective of our research is thus to provide a methodological framework supporting SMEs in their development taking into account recent innovation and institutional rules of the sector. We aim to provide a contribution to the problematic by developing a specific Model-Based Systems Engineering (MBSE) approach. Airspace regulation, aeronautics standards and international norms on systems engineering are taken on board to be formalized in a set of models. This paper presents the on-going research project combining Systems Engineering and Project Management process modeling and taking into account the metamodeling problematic.

Keywords: aeronautics, certification, process modeling, project management, SME, systems engineering

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Authors: Maria Giovanna Pacifico

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Maintenance, in Italy, is not yet a consolidated practice despite the benefits that could come from. Among the main reasons, there are the lack of financial resources and personnel in the public administration and a general lack of knowledge about how to activate and to manage a prevented and programmed maintenance. The experimentation suggests that users and tourists could be involved in the maintenance process from the knowledge phase to the monitoring ones by using mobile devices. The goal is to increase the quality of Facility Management for cultural heritage, prioritizing usage needs, and limiting interference between the key stakeholders. The method simplifies the consolidated procedures for the Information Systems, avoiding a loss in terms of quality and amount of information by focusing on the users' requirements: management economy, user safety, accessibility, and by receiving feedback information to define a framework that will lead to predictive maintenance. This proposal was designed to be tested in the Archaeological Park of Pompeii on the state property asset.

Keywords: asset maintenance, key stakeholders, Pompeii, user requirement

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Authors: Shahid Noor, Kazim Najjad, Muhammad Nasir, Irshad Bhutto, Abdul Samad Memon, Khurram Anwar, Tehseen Riaz, Mian Muhammad Hanif, Nauman A. Mallik, Saeed Ahmed, Israr Ahmed, Ali Yasir

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Background: Musculoskeletal pain is the most common complaint presented to the health practitioner. It is well known that untreated or under-treated pain can have a significant negative impact on an individual’s quality of life (QoL). Objectives: This study was conducted across 10 sites in six (6) major cities of Pakistan to evaluate the tolerability, safety, and the clinical response of Nuberol Forte® (Paracetamol 650 mg + Orphenadrine 50 mg) to musculoskeletal pain in routine Pakistani practice and its impact on improving the patient’s QoL. Design & Methods: This NFORT-EFFECT observational, prospective multicenter study was conducted in compliance with Good Clinical Practice guidelines and local regulatory requirements. The study sponsor was "The Searle Company Limited, Pakistan. To maintain the GCP compliances, the sponsor assigned the CRO for the site and data management. Ethical approval was obtained from an independent ethics committee. The IEC reviewed the progress of the study. Written informed consent was obtained from the study participants, and their confidentiality was maintained throughout the study. A total of 399 patients with known prescreened musculoskeletal conditions and pain who attended the study sites were recruited, as per the inclusion/exclusion criteria (clinicaltrials.gov ID# NCT04765787). The recruited patients were then prescribed Paracetamol (650 mg) and Orphenadrine (50 mg) combination (Nuberol Forte®) for 7 to 14 days as per the investigator's discretion based on the pain intensity. After the initial screening (visit 1), a follow-up visit was conducted after 1-2 weeks of the treatment (visit 2). Study Endpoints: The primary objective was to assess the pain management response of Nuberol Forte treatment and the overall safety of the drug. The Visual Analogue Scale (VAS) scale was used to measure pain severity. Secondary to pain, the patients' health-related quality of life (HRQoL) was also assessed using the Muscle, Joint Measure (MJM) scale. The safety was monitored on the first dose by the patients. These assessments were done on each study visit. Results: Out of 399 enrolled patients, 49.4% were males, and 50.6% were females with a mean age of 47.24 ± 14.20 years. Most patients were presented with Knee Osteoarthritis (OA), i.e., 148(38%), followed by backache 70(18.2%). A significant reduction in the mean pain score was observed after the treatment with the combination of Paracetamol and Orphenadrine (p<0.05). Furthermore, an overall improvement in the patient’s QoL was also observed. During the study, only ten patients reported mild adverse events (AEs). Conclusion: The combination of Paracetamol and Orphenadrine (Nuberol Forte®) exhibited effective pain management among patients with musculoskeletal conditions and also improved their QoL.

Keywords: musculoskeletal pain, orphenadrine/paracetamol combination, pain management, quality of life, Pakistani population

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Authors: Özlem Turan, Şule Turhan

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About 1 billion people in the world are suffering from hunger. Approximately 1.3 billion tons of produced food is wasted each year as well. While the waste of industrialized countries is 670 million tons per year, the waste per year in developing countries is estimated as 630 million tons. When evaluated in this respect, the importance of sustainability and food security can be seen clearly. Food safety is defined as taking the necessary measures and eliminating all risk arising from food. The goal of sustainable food security is, protection of consumer health, development of safe food and beverages trade nationally and internationally and to ensure reliable fair trade schemes. In this study, this study will focus on sustainable food systems and food security, by examining the food wastage and losses from environmental and economic point of views and the precautions that need to be taken will be discussed.

Keywords: food, food safety, food systems, sustainability

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Authors: Issam Alnader, Aboubaker Lasebae, Rand Raheem

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Wireless sensor networks (WSNs) are distributed network systems used in a wide range of applications, including safety-critical systems. The latter provide critical services, often concerned with human life or assets. Therefore, ensuring the dependability requirements of Safety critical systems is of paramount importance. The purpose of this paper is to utilize the Hidden Markov Model (HMM) to elongate the service availability of WSNs by increasing the time it takes a node to become obsolete via optimal load balancing. We propose an HMM algorithm that, given a WSN, analyses and predicts undesirable situations, notably, nodes dying unexpectedly or prematurely. We apply this technique to improve on C. Lius’ algorithm, a scheduling-based algorithm which has served to improve the lifetime of WSNs. Our experiments show that our HMM technique improves the lifetime of the network, achieved by detecting nodes that die early and rebalancing their load. Our technique can also be used for diagnosis and provide maintenance warnings to WSN system administrators. Finally, our technique can be used to improve algorithms other than C. Liu’s.

Keywords: wireless sensor networks, IoT, dependability of safety WSNs, energy conservation, sleep awake schedule

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Authors: Gaurav Kumar Sinha

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The oil and gas industry is a critical component of the global economy, relying heavily on industrial control systems (ICS) to manage and monitor operations. However, these systems are increasingly becoming targets for cyber-attacks, posing significant risks to operational continuity, safety, and environmental integrity. This paper explores comprehensive cybersecurity strategies for protecting oil and gas industrial control systems. It delves into the unique vulnerabilities of ICS in this sector, including outdated legacy systems, integration with IT networks, and the increased connectivity brought by the Industrial Internet of Things (IIoT). We propose a multi-layered defense approach that includes the implementation of robust network security protocols, regular system updates and patch management, advanced threat detection and response mechanisms, and stringent access control measures. We illustrate the effectiveness of these strategies in mitigating cyber risks and ensuring the resilient and secure operation of oil and gas industrial control systems. The findings underscore the necessity for a proactive and adaptive cybersecurity framework to safeguard critical infrastructure in the face of evolving cyber threats.

Keywords: cybersecurity, industrial control systems, oil and gas, cyber-attacks, network security, IoT, threat detection, system updates, patch management, access control, cybersecurity awareness, critical infrastructure, resilience, cyber threats, legacy systems, IT integration, multi-layered defense, operational continuity, safety, environmental integrity

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Authors: Guoqiang Yu, Mehrana Mohtasebi, Jinghong Sun, Thomas Pittman

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Malignant glioma (MG) is the most common type of primary malignant brain tumor. Surgical resection of MG remains the cornerstone of therapy, and the extent of resection correlates with patient survival. A limiting factor for resection, however, is the difficulty in differentiating the tumor from normal tissue during surgery. Fluorescence imaging is an emerging technique for real-time intraoperative visualization of MGs and their boundaries. However, most clinical-grade neurosurgical operative microscopes with fluorescence imaging ability are hampered by low adoption rates due to high cost, limited portability, limited operation flexibility, and lack of skilled professionals with technical knowledge. To overcome the limitations, we innovatively integrated miniaturized light sources, flippable filters, and a recording camera to the surgical eye loupes to generate a wearable fluorescence eye loupe (FLoupe) device for intraoperative imaging of fluorescent MGs. Two FLoupe prototypes were constructed for imaging of Fluorescein and 5-aminolevulinic acid (5-ALA), respectively. The wearable FLoupe devices were tested on tumor-simulating phantoms and patients with MGs. Comparable results were observed against the standard neurosurgical operative microscope (PENTERO® 900) with fluorescence kits. The affordable and wearable FLoupe devices enable visualization of both color and fluorescence images with the same quality as the large and expensive stationary operative microscopes. The wearable FLoupe device allows for a greater range of movement, less obstruction, and faster/easier operation. Thus, it reduces surgery time and is more easily adapted to the surgical environment than unwieldy neurosurgical operative microscopes.

Keywords: fluorescence guided surgery, malignant glioma, neurosurgical operative microscope, wearable fluorescence imaging device

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Authors: Mohammad H. Yarmohammadian, Fatemeh Rezaei

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Introduction: Improving patient safety in health systems is one of the main priorities in healthcare systems, so clinical risk management in organizations has become increasingly significant. Although several tools have been developed for clinical risk management, each has its own limitations. Aims: This study aims to develop a comprehensive tool that can complete the limitations of each risk assessment and management tools with the advantage of other tools. Methods: Procedure was determined in two main stages included development of an initial model during meetings with the professors and literature review, then implementation and verification of final model. Subjects and Methods: This study is a quantitative − qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment of the two parts of the fourth phase and seven phases of the research was conducted. Purposive and stratification sampling of various responsible teams for the selected process was conducted in the operating room. Final model verified in eight phases through application of activity breakdown structure, failure mode and effects analysis (FMEA), healthcare risk priority number (RPN), root cause analysis (RCA), FT, and Eindhoven Classification model (ECM) tools. This model has been conducted typically on patients admitted in a day-clinic ward of a public hospital for surgery in October 2012 to June. Statistical Analysis Used: Qualitative data analysis was done through content analysis and quantitative analysis done through checklist and edited RPN tables. Results: After verification the final model in eight-step, patient's admission process for surgery was developed by focus discussion group (FDG) members in five main phases. Then with adopted methodology of FMEA, 85 failure modes along with its causes, effects, and preventive capabilities was set in the tables. Developed tables to calculate RPN index contain three criteria for severity, two criteria for probability, and two criteria for preventability. Tree failure modes were above determined significant risk limitation (RPN > 250). After a 3-month period, patient's misidentification incidents were the most frequent reported events. Each RPN criterion of misidentification events compared and found that various RPN number for tree misidentification reported events could be determine against predicted score in previous phase. Identified root causes through fault tree categorized with ECM. Wrong side surgery event was selected by focus discussion group to purpose improvement action. The most important causes were lack of planning for number and priority of surgical procedures. After prioritization of the suggested interventions, computerized registration system in health information system (HIS) was adopted to prepare the action plan in the final phase. Conclusion: Complexity of health care industry requires risk managers to have a multifaceted vision. Therefore, applying only one of retrospective or prospective tools for risk management does not work and each organization must provide conditions for potential application of these methods in its organization. The results of this study showed that the integrated clinical risk management model can be used in hospitals as an efficient tool in order to improve clinical governance.

Keywords: failure modes and effective analysis, risk management, root cause analysis, model

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Authors: Ismail Muratoglu, Ahmet Meyveci, Abdurrahman Tuncer, Erkan Demirci

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This study is dedicated to the analysis of the problems of occupational safety in Turkey, Italy and Poland. The need analysis was applied to three different countries which are Turkey; 4, Poland; 1, Italy; 1 state. The number of the subjects is 891 in Turkey. The number of the subjects is 26 in Italy and the number of the subjects is 19 in Poland. The total number of samples of study is 936. Four different forms (Job Security Experts Form, Student Form, Teacher Form and Company Form) were applied. Results of experts of job security forms are rate of 7.1%. Then, the students’ forms are rate of 34.3%, teacher or instructor forms are rate of 9.9%. The last corporation forms are rate of 48.7%.

Keywords: Europe, need analysis, occupational safety, Turkey, vocational education

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Authors: Oliveira M., Gonçalves L., Francisco I., Caramelo F., Vale F., Sanz D., Domingues M., Lopes M., Moreia D., Lopes T., Santos T., Cardoso H.

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The ARTHUR project consists of a platform that allows the virtual performance of maxillofacial surgeries, offering, in a photorealistic concept, the possibility for the patient to have an idea of the surgical changes before they are performed on their face. For this, the system brings together several image formats, dicoms and objs that, after loading, will generate the bone volume, soft tissues and hard tissues. The system also incorporates the patient's stereophotogrammetry, in addition to their data and clinical history. After loading and inserting data, the clinician can virtually perform the surgical operation and present the final result to the patient, generating a new facial surface that contemplates the changes made in the bone and tissues of the maxillary area. This tool acts in different situations that require facial reconstruction, however this project focuses specifically on two types of use cases: bone congenital disfigurement and acquired disfiguration such as oral cancer with bone attainment. Being developed a cloud based solution, with mobile support, the tool aims to reduce the decision time window of patient. Because the current simulations are not realistic or, if realistic, need time due to the need of building plaster models, patient rates on decision, rely on a long time window (1,2 months), because they don’t identify themselves with the presented surgical outcome. On the other hand, this planning was performed time based on average estimated values of the position of the maxilla and mandible. The team was based on averages of the facial measurements of the population, without specifying racial variability, so the proposed solution was not adjusted to the real individual physiognomic needs.

Keywords: 3D computing, image processing, image registry, image reconstruction

Procedia PDF Downloads 194

Authors: Naim Izet Kajtazi

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Context: Although rare, glomus tumor (i.e., nonchromaffin chemodectomas and paragan¬gliomas) is the most common middle ear tumor, with female predominance. Pre-operative embolization is often required to devascularize the hypervascular tumor for better surgical outcomes. Process: A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor, compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Outcome: Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist. Relevance: This case highlights the complex nature of these tumors, which often bring challenges to the patients as well as treatment teams. The multi-disciplinary team approach is necessary to tailor the management plan for individual tumors. Although embolization is a safe procedure, careful attention and thoughtful anatomic knowledge regarding dangerous anastomosis are essential to avoid devastating complications. Complications occur due to encountered vessel anomalies and new anastomoses formed during the gluing and changes in hemodynamics.

Keywords: stroke, embolization, MRI brain, cerebral angiogram

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Authors: Manthan Patel, Vinit Ahlawat, Anshh Singh Claire, Pijush Samui

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This paper focuses on the analysis of quicksand condition for a dam foundation. The quicksand condition occurs in cohesion less soil when effective stress of soil becomes zero. In a dam, the saturated sediment may appear quite solid until a sudden change in pressure or shock initiates liquefaction. This causes the sand to form a suspension and lose strength hence resulting in failure of dam. A soil profile shows different properties at different points and the values obtained are uncertain thus reliability analysis is performed. The reliability is defined as probability of safety of a system in a given environment and loading condition and it is assessed as Reliability Index. The reliability analysis of dams under quicksand condition is carried by Gaussian Process Regression (GPR). Reliability index and factor of safety relating to liquefaction of soil is analysed using GPR. The results of reliability analysis by GPR is compared to that of conventional method and it is demonstrated that on applying GPR the probabilistic analysis reduces the computational time and efforts.

Keywords: factor of safety, GPR, reliability index, quicksand

Procedia PDF Downloads 470

Authors: Princes Ann E. Prieto, Denise F. Alpuerto, John Rafael C. Unlayao, Neil Concibido, Monet Concepcion Maguyon-Detras

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Failure Mode and Effects Analysis (FMEA) has been used in the virtual Process Hazard Analysis (PHA) of the Acetone production process through the dehydrogenation of isopropyl alcohol, for which very limited process risk assessment has been published. In this study, the potential failure modes, effects, and possible causes of selected major equipment in the process were identified. During the virtual FMEA mock sessions, the risks in the process were evaluated and recommendations to reduce and/or mitigate the process risks were formulated. The risk was estimated using the calculated risk priority number (RPN) and was classified into four (4) levels according to their effects on acetone production. Results of this study were also used to rank the criticality of equipment in the process based on the calculated criticality rating (CR). Bow tie diagrams were also created for the critical hazard scenarios identified in the study.

Keywords: chemical process safety, failure mode and effects analysis (FMEA), process hazard analysis (PHA), process safety management (PSM)

Procedia PDF Downloads 125

Authors: Rauno Pääkkönen, Fabriziomaria Gobba, Leena Korpinen

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The objective of the study is to assess the implementation of LED lighting into forest machine work in the dark. In addition, the paper includes a wide variety of important and relevant safety and health parameters. In modern, computerized work in the cab of forest machines, artificial illumination is a demanding task when performing duties, such as the visual inspections of wood and computer calculations. We interviewed entrepreneurs and gathered the following as the most pertinent themes: (1) safety, (2) practical problems, and (3) work with LED lighting. The most important comments were in regards to the practical problems of LED lighting. We found indications of technical problems in implementing LED lighting, like snow and dirt on the surfaces of lamps that dim the emission of light. Moreover, service work in the dark forest is dangerous and increases the risks of on-site accidents. We also concluded that the amount of blue light to the eyes should be assessed, especially, when the drivers are working in a semi-dark cab.

Keywords: forest machines, health, LED, safety

Procedia PDF Downloads 416

Authors: Matjaž Šraml, Marko Renčelj, Tomaž Tollazzi, Chiara Gruden

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Road safety is a worldwide issue with numerous and heterogeneous factors influencing it. On the side, driver state – comprising distraction/inattention, fatigue, drowsiness, extreme emotions, and socio-cultural factors highly affect road safety. On the other side, the vehicle state has an important role in mitigating (or not) the road risk. Finally, the road environment is still one of the main determinants of road safety, defining driving task complexity. At the same time, thanks to technological development, a lot of detailed data is easily available, creating opportunities for the detection of driver state, vehicle characteristics and road conditions and, consequently, for the design of ad hoc interventions aimed at improving driver performance, increase awareness and mitigate road risks. This is the challenge faced by the i-DREAMS project. i-DREAMS, which stands for a smart Driver and Road Environment Assessment and Monitoring System, is a 3-year project funded by the European Union’s Horizon 2020 research and innovation program. It aims to set up a platform to define, develop, test and validate a ‘Safety Tolerance Zone’ to prevent drivers from getting too close to the boundaries of unsafe operation by mitigating risks in real-time and after the trip. After the definition and development of the Safety Tolerance Zone concept and the concretization of the same in an Advanced driver-assistance system (ADAS) platform, the system was tested firstly for 2 months in a driving simulator environment in 5 different countries. After that, naturalistic driving studies started for a 10-month period (comprising a 1-month pilot study, 3-month baseline study and 6 months study implementing interventions). Currently, the project team has approved a common evaluation approach, and it is developing the assessment of the usage and outcomes of the i-DREAMS system, which is turning positive insights. The i-DREAMS consortium consists of 13 partners, 7 engineering universities and research groups, 4 industry partners and 2 partners (European Transport Safety Council - ETSC - and POLIS cities and regions for transport innovation) closely linked to transport safety stakeholders, covering 8 different countries altogether.

Keywords: advanced driver assistant systems, driving simulator, safety tolerance zone, traffic safety

Procedia PDF Downloads 55

Authors: M. Khalid Alamgir, Javed Ahsan Bhatti, M. Zafarullah Khan

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Thin film of amorphous carbon (DLC) was deposited on 316 steel using Nd: YAG laser having energy 300mJ. Pure graphite was used as a target. The vacuum in the deposition chamber was generated in the range of 10-6 mbar by turbo molecular pump. Ratio of sp3 to sp2 content shows amorphous nature of the film. This was confirmed by Raman spectra having two peaks around 1300 cm-1 i.e. D-band to 1700 cm-1 i.e. G-band. If sp3 bonding ratio is high, the films behave like diamond-like whereas, with high sp2, films are graphite-like. The ratio of sp3 and sp2 contents in the film depends upon the deposition method, hydrogen contents and system parameters. The structural study of the film was carried out by XRD. The hardness of the films as measured by Vickers hardness tester and was found to be 28 GPa. The EDX result shows the presence of carbon contents on the surface in high rate and optical microscopy result shows the smoothness of the film on substrate. The film possesses good adhesion and can be used to coat surgical instruments.

Keywords: DLC, thin film, Raman spectroscopy, XRD, EDX

Procedia PDF Downloads 549