Search results for: emergency call center

Authors: Shuen-Tai Wang, Ying-Chuan Chen, Yu-Ching Lin

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There has been renewal of interest in the relation between Green IT and cloud computing in recent years. Cloud computing has to be a highly elastic environment which provides stable services to users. The growing use of cloud computing facilities has caused marked energy consumption, putting negative pressure on electricity cost of computing center or data center. Each year more and more network devices, storages and computers are purchased and put to use, but it is not just the number of computers that is driving energy consumption upward. We could foresee that the power consumption of cloud computing facilities will double, triple, or even more in the next decade. This paper aims at resource allocation and scheduling technologies that are short of or have not well developed yet to reduce energy utilization in cloud computing platform. In particular, our approach relies on recalling services dynamically onto appropriate amount of the machines according to user’s requirement and temporarily shutting down the machines after finish in order to conserve energy. We present initial work on integration of resource and power management system that focuses on reducing power consumption such that they suffice for meeting the minimizing quality of service required by the cloud computing platform.

Keywords: cloud computing, energy utilization, power consumption, resource allocation

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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: Bouami Hind, Millot Patrick

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The implementation of automated devices in life-critical systems such as hospitals can bring a new set of challenges related to automation malfunctions. While automation has been identified as great leverage for the medication dispensing system’s security and efficiency, it also increases the complexity of the organization. In particular, the installation and operation stage of automated devices can be complex when malfunctions related to automated systems occur. This paper aims to document operators’ situation awareness about the malfunctions of automated drug delivery systems (ADCs) during their implementation through Saint Brieuc hospital’s feedback. Our evaluation approach has been deployed in Saint Brieuc hospital center’s pharmacy, which has been equipped with automated nominative drug dispensing systems since January of 2021. The analysis of Saint Brieuc hospital center pharmacy’s automation revealed numerous malfunctions related to the implementation of Automated Delivery Cabinets. It appears that the targeted performance is not reached in the first year of implementation in this case study. Also, errors have been collected in patients' automated treatments’ production such as lack of drugs in pill boxes or nominative carnets, excess of drugs, wrong location of the drug, drug blister damaged, non-compliant sachet, or ticket errors. Saint Brieuc hospital center’s pharmacy is doing a tremendous job of setting up and monitoring performance indicators from the beginning of automation and throughout ADC’s operation to control ADC’s malfunctions and meet the performance targeted by the hospital. Health professionals, including pharmacists, biomedical engineers and directors of work, technical services and safety, are heavily involved in an automation project. This study highlights the importance of the evaluation of ADCs’ performance throughout the implementation process and the hospital’s team involvement in automation supervision and management.

Keywords: life-critical systems, situation awareness, automated delivery cabinets, implementation, risks and malfunctions

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Authors: Soran Aminiaghdam, Christian Rode, Reinhard Blickhan, Astrid Zech

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Despite considerable studies on the impact of imposed trunk posture on human walking, less is known about such locomotion while negotiating changes in ground level. The aim of this study was to investigate the behavior of the VBCOM in response to a two-fold expected perturbation, namely alterations in body posture and in ground level. To this end, the kinematic data and ground reaction forces of twelve able participants were collected. We analyzed the vertical position of the body center of mass (VBCOM) from the ground determined by the body segmental analysis method relative to the laboratory coordinate system at touchdown and toe-off instants during walking across uneven ground — characterized by perturbation contact (a 10-cm visible drop) and pre- and post-perturbation contacts — in comparison to unperturbed level contact while maintaining three postures (regular erect, ~30° and ~50° of trunk flexion from the vertical). The VBCOM was normalized to the distance between the greater trochanter marker and the lateral malleoli marker at the instant of TD. Moreover, we calculated the backward rotation during step-down as the difference of the maximum of the trunk angle in the pre-perturbation contact and the minimal trunk angle in the perturbation contact. Two-way repeated measures ANOVAs revealed contact-specific effects of posture on the VBCOM at touchdown (F = 5.96, p = 0.00). As indicated by the analysis of simple main effects, during unperturbed level and pre-perturbation contacts, no between-posture differences for the VBCOM at touchdown were found. In the perturbation contact, trunk-flexed gaits showed a significant increase of VBCOM as compared to the pre-perturbation contact. In the post-perturbation contact, the VBCOM demonstrated a significant decrease in all gait postures relative to the preceding corresponding contacts with no between-posture differences. Main effects of posture revealed that the VBCOM at toe-off significantly decreased in trunk-flexed gaits relative to the regular erect gait. For the main effect of contact, the VBCOM at toe-off demonstrated changes across perturbation and post-perturbation contacts as compared to the unperturbed level contact. Furthermore, participants exhibited a backward trunk rotation during step-down possibly to control the angular momentum of their whole body. A more pronounced backward trunk rotation (2- to 3-fold compared with level contacts) in trunk-flexed walking contributed to the observed elevated VBCOM during the step-down which may have facilitated drop negotiation. These results may shed light on the interaction between posture and locomotion in able gait, and specifically on the behavior of the body center of mass during perturbed locomotion.

Keywords: center of mass, perturbation, posture, uneven ground, walking

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Authors: Fatima Zehra Allahverdi, Nukhet Bayer

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Objective: Three questions were formulated to examine stressful working units (intensive care units, emergency unit nurses) utilizing the self-perception theory and social support theory. This study provides a distinctive input by inspecting the combination of variables regarding stressful working environments. Method: The descriptive research was conducted with the participation of 400 nurses working at Ankara City Hospital. The study used Multivariate Analysis of Variance (MANOVA), regression analysis, and a mediation model. Hypothesis one used MANOVA followed by a Scheffe post hoc test. Hypothesis two utilized regression analysis using a hierarchical linear regression model. Hypothesis three used a mediation model. Result: The study utilized mediation analyses. Findings supported the hypotheses that intensive care units have significantly high scores in virtual communication and virtual tolerance. The number of years on the job, virtual communication, virtual tolerance, and phubbing significantly predicted 51% of the variance of perception of addiction. Interestingly, the number of years on the job, while significant, was negatively related to perception of addiction. Conclusion: The reasoning behind these findings and the lack of significance in the emergency unit is discussed. Around 7% of the variance of phubbing was accounted for through working in intensive care units. The model accounted for 26.80 % of the differences in the perception of addiction.

Keywords: phubbing, social media, working units, years on the job, stress

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Authors: Daud Muhammad

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Introduction: Ankle radiographs are frequently requested in Emergency Departments (ED) for patients presenting with traumatic ankle pain. The Ottawa Ankle Rules (OAR) serve as a clinical guideline to determine the necessity of these radiographs, aiming to reduce unnecessary imaging. This audit was conducted to evaluate the adequacy of clinical information provided in radiograph requests in relation to the OAR. Methods: A retrospective analysis was performed on 50 consecutive ankle radiograph requests under ED clinicians' names for patients aged above 5 years, specifically excluding follow-up radiographs for known fractures. The study assessed whether the provided clinical information met the criteria outlined by the OAR. Results: The audit revealed that none of the 50 radiograph requests contained sufficient information to satisfy the Ottawa Ankle Rules. Furthermore, 10 out of the 50 radiographs (20%) identified fractures. Discussion: The findings indicate a significant lack of adherence to the OAR, suggesting potential overuse of radiography and unnecessary patient exposure to radiation. This non-compliance may also contribute to increased healthcare costs and resource utilization, as well as possible delays in diagnosis and treatment. Recommendations: To address these issues, the following recommendations are proposed: (1) Education and Training: Enhance awareness and training among ED clinicians regarding the OAR. (2) Standardised Request Forms: Implement changes to imaging request forms to mandate relevant information according to the OAR. (3) Scan Vetting: Promote awareness among radiographers to discuss the appropriateness of scan requests with clinicians. (4) Regular re-audits should be conducted to monitor improvements in compliance.

Keywords: Ottawa ankle rules, ankle radiographs, emergency department, traumatic pain

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Authors: Muhammad Haitham Albahnassi, Adnan Malki, Shokri Almekdad

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In this paper, a method for reconfiguring bandwidth in a circular dual-mode resonator is presented. The method concerns the optimized geometry of a structure that may be used to host the tuning elements, which are typically RF (Radio Frequency) switches. The tuning elements themselves, and their performance during tuning, are not the focus of this paper. The designed resonator is able to reconfigure its fractional bandwidth by adjusting the inter-coupling level between the degenerate modes, while at the same time improving its response by adjusting the external-coupling level and keeping the center frequency fixed. The inter-coupling level has been adjusted by changing the dimensions of the perturbation element, while the external-coupling level has been adjusted by changing one of the feeder dimensions. The design was arrived at via optimization. Agreeing simulation and measurement results of the designed and implemented filters showed good improvements in return loss values and the stability of the center frequency.

Keywords: dual-mode resonators, perturbation theory, reconfigurable filters, software defined radio, cognitine radio

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Authors: Jianhua Zhou, Yuwen Zhang

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A two-step multigrid approach is proposed to solve the inverse heat conduction problem in a 3-D object under laser irradiation. In the first step, the location of the laser center is estimated using a coarse and uniform grid system. In the second step, the front-surface temperature is recovered in good accuracy using a multiple grid system in which fine mesh is used at laser spot center to capture the drastic temperature rise in this region but coarse mesh is employed in the peripheral region to reduce the total number of sensors required. The effectiveness of the two-step approach and the multiple grid system are demonstrated by the illustrative inverse solutions. If the measurement data for the temperature and heat flux on the back surface do not contain random error, the proposed multigrid approach can yield more accurate inverse solutions. When the back-surface measurement data contain random noise, accurate inverse solutions cannot be obtained if both temperature and heat flux are measured on the back surface.

Keywords: conduction, inverse problems, conjugated gradient method, laser

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Authors: Daria Druzhinenko- Silhan, Patrick Schmoll

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Childhood obesity is one of the important problem in domain of health care. During two recent decades we are observing a real epidemic of this noninfectious illness. Its consequences are hard: cardio-vascular disease; diabetes; arthrosis etc. (OMS, 2012) Keep Healthy Kids  » study aims to create a new system of accompanying of childhood obesity based on new technologies as mobile applications or serious video-games. We realize a support-study which aims to understand motivations, psychological dynamite and family's impact on weight-loss process in childhood. Sample: 65 children from 7 to 10 years old accompanied by special Care Center in France. Methodology: we proceed by an innovative approach that bases on quantitative and qualitative methods of data collection. We focus our proposal on data collected from medical files. We are also realizing individual assessment (still ongoing) that aims to understand psychological profiles of obese children and their family dynamic. Results: Only 16,9% of children asked for medical accompanying of obesity. We noted that the most important reason to come to the care Center was the fact of mates' scoffs (46,2%°), the second one was the appearance or look (40 %). We found out that the self-image of these children in self-evaluation questionnaire was described mostly as rather good (46,2) or good (28,2%); the most part of children evaluated their well-being as rather good (29,7%) or good (51,4%). In interviews children had tendency to not recall why they came to the Care Center. Discussion : These results permit us to make a hypothesis that children suffering of overweight or obesity are not clearly aware why they must loose weight. It was rather the peer environment that pointed out the problem of overweight for them. So the motivation to loose weight is mostly supported by environment. We suppose that it is a « weak-point » of their motivation and it can be over-come using serious video-games supporting physical activity that can make deviate the motivation from « to loose weight for be looked better by the others » into « have fun and feeling me better ».

Keywords: childhood obesity, motivation, weight-loss, serious video-game

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Authors: Sikander Nawaz Khan

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Natural disasters like flood, earthquake, cyclone, volcanic eruption and others are causing immense losses to the property and lives every year. Current status and actual loss information of natural hazards can be determined and also prediction for next probable disasters can be made using different remote sensing and mapping technologies. Global Positioning System (GPS) calculates the exact position of damage. It can also communicate with wireless sensor nodes embedded in potentially dangerous places. GPS provide precise and accurate locations and other related information like speed, track, direction and distance of target object to emergency responders. Remote Sensing facilitates to map damages without having physical contact with target area. Now with the addition of more remote sensing satellites and other advancements, early warning system is used very efficiently. Remote sensing is being used both at local and global scale. High Resolution Satellite Imagery (HRSI), airborne remote sensing and space-borne remote sensing is playing vital role in disaster management. Early on Geographic Information System (GIS) was used to collect, arrange, and map the spatial information but now it has capability to analyze spatial data. This analytical ability of GIS is the main cause of its adaption by different emergency services providers like police and ambulance service. Full potential of these so called 3S technologies cannot be used in alone. Integration of GPS and other remote sensing techniques with GIS has pointed new horizons in modeling of earth science activities. Many remote sensing cases including Asian Ocean Tsunami in 2004, Mount Mangart landslides and Pakistan-India earthquake in 2005 are described in this paper.

Keywords: disaster mitigation, GIS, GPS, remote sensing

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Authors: Juntip Kanjanasilp, Ratree Sawangjit, Kanokporn Meelap, Kwanchanok Kruthakool

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Depression is a common mental health disorder. Antidepressants are effective pharmacological treatments, but most patients have low medication adherence. This study aims to systematic review and meta-analysis what method increase the antidepressants adherence efficiently and improve clinical outcome. Systematic review of articles of randomized controlled trials obtained by a computerized literature search of The Cochrane, Library, Pubmed, Embase, PsycINFO, CINAHL, Education search, Web of Science and ThaiLIS (28 December 2017). Twenty-three studies were included and assessed the quality of research by ROB 2.0. The results reported that printing media improved in number of people who had medication adherence statistical significantly (p= 0.018), but education, phone call, and program utilization were no different (p=0.172, p=0.127, p=0.659). There was no significant difference in pharmacist’s group, health care team’s group and physician’s group (p=0.329, p=0.070, p=0.040). Times of intervention at 1 month and 6 months improved medication adherence significantly (p= 0.0001, p=0.013). There was significantly improved adherence in single intervention (p=0.027) but no different in multiple interventions (p=0.154). When we analyzed medication adherence with the mean score, no improved adherence was found, not relevant with who gives the intervention and times to intervention. However, the multiple interventions group was statistically significant improved medication adherence (p=0.040). Phone call and the physician’s group were statistically significant improved clinical outcomes in number of improved patients (0.025 and 0.020, respectively). But in the pharmacist’s group and physician’s group were not found difference in the mean score of clinical outcomes (p=0.993, p=0.120, respectively). Times to intervention and number of intervention were not significant difference than usual care. The overall intervention can increase antidepressant adherence, especially the printing media, and the appropriate timing of the intervention is at least 6 months. For effective treatment, the provider should have experience and expert in caring for patients with depressive disorders, such as a psychiatrist. Medical personnel should have knowledge in caring for these patients also.

Keywords: depression, medication adherence, clinical outcomes, systematic review, meta-analysis

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Authors: Md. Shakhawat Hossain, Jimma Hossain, Md. Naushad Ali

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Acute pancreatitis is a dangerous medical emergency in the practice of gastroenterology. Management of acute pancreatitis needs multidisciplinary approach with support starts from emergency to ICU. So, there is a chance of mismanagement in every steps, especially in low resource settings. Other factors such as patient’s financial condition, education, social custom, transport facility, referral system from periphery may also challenge the current guidelines for management. The present study is intended to determine the clinico-pathological profile, severity assessment and challenges of management of acute pancreatitis in a government laid tertiary care hospital to image the real scenario of management in a low resource place. A total 100 patients of acute pancreatitis were studied in this prospective study, held in the Department of Gastroenterology, Rangpur medical college hospital, Bangladesh from July 2017 to July 2018 within one year. Regarding severity, 85 % of the patients were mild, whereas 13 were moderately severe, and 2 had severe acute pancreatitis according to the revised Atlanta criteria. The most common etiologies of acute pancreatitis in our study were gall stone (15%) and biliary sludge (15%), whereas 54% were idiopathic. The most common challenges we faced were delay in hospital admission (59%) and delay in hospital diagnosis (20%). Others are non-adherence of patient party, and lack of investigation facility, physician’s poor knowledge about current guidelines. We were able to give early aggressive fluid to only 18% of patients as per current guideline. Conclusion: Management of acute pancreatitis as per guideline is challenging when optimum facility is lacking. So, modified guidelines for assessment and management of acute pancreatitis should be prepared for low resource setting.

Keywords: acute pancreatitis, challenges of management, severity, prognosis

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Authors: Gauri Shankar Shah

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Objectives: The Type I diabetes mellitus in children is frequently a missed diagnosis and children presents in emergency with diabetic ketoacidosis having significant morbidity and mortality. The present study was done to find out the clinical presentation and outcome at a tertiary-care centre. Methods: This was retrospective analysis of data of Type I diabetes mellitus reporting to our centre during last one year (2012-2013). Results: There were 12 patients (8 males) and the age group was 4-14 years (mean ± 3.7). The presenting symptoms were fever, vomiting, altered sensorium and fast breathing in 8 (66.6%), 6 (50%), 4 (33.3%), and 4 (33.3%) cases, respectively. The classical triad of polyuria, polydypsia, and polyphagia were present only in two patients (33.2%). Seizures and epigastric pain were found in two cases each (33.2%). The four cases (33.3%) presented with diabetic ketoacidosis due to discontinuation of insulin doses, while 2 had hyperglycemia alone. The hemogram revealed mean hemoglobin of 12.1± 1.6 g/dL and total leukocyte count was 22,883.3 ± 10,345.9 per mm3, with polymorphs percentage of 73.1 ± 9.0%. The mean blood sugar at presentation was 740 ± 277 mg/ dl (544–1240). HbA1c ranged between 7.1-8.8 with mean of 8.1±0.6 %. The mean sodium, potassium, blood ph, pCO2, pO2 and bicarbonate were 140.8 ± 6.9 mEq/L, 4.4 ± 1.8mEq/L, 7.0 ± 0.2, 20.2 ± 10.8 mmHg, 112.6 ± 46.5 mmHg and 9.2 ± 8.8 mEq/L, respectively. All the patients were managed in pediatric intensive care unit as per our protocol, recovered and discharged on intermediate insulin given twice daily. Conclusions: Thus, it shows that these patients have uncontrolled hyperglycemia and often presents in emergency with ketoacidosis and deranged biochemical profile. The regular administration of insulin, frequent monitoring of blood sugar and health education are required to have better metabolic control and good quality of life.

Keywords: type I diabetes mellitus, hyperglycemia, outcome, glycemic control

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Authors: Abderrahim Siam, Ramdane Maamri, Zaidi Sahnoun

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The development of adaptive user interfaces (UI) presents for a long time an important research area in which researcher attempt to call upon the full resources and skills of several disciplines. The adaptive UI community holds a thorough knowledge regarding the adaptation of UIs with users and with contexts of use. Several solutions, models, formalisms, techniques, and mechanisms were proposed to develop adaptive UI. In this paper, we propose an approach based on the fuzzy set theory for modeling the concept of the appropriateness of different solutions of UI adaptation with different situations for which interactive systems have to adapt their UIs.

Keywords: adaptive user interfaces, adaptation solution’s appropriateness, fuzzy sets

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Authors: Balakrishna Valluru, Ruth Suckling

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A 16 year old male was found collapsed on the road following stab injuries to the chest and abdomen and was transported to the emergency department by ambulance. On arrival in the emergency department the patient was breathless and appeared pale. He was maintaining his airway with spontaneous breathing and had a heart rate of 122 beats per minute with a blood pressure of 83/63 mmHg. He was resuscitated initially with three units of packed red cells. Clinical examination identified three incisional wounds each measuring 2 cm. These were in the left para-sternal region, right infra-scapular region and left upper quadrant of the abdomen. The chest wound over the left parasternal area at the level of 4tth intercostal space was bleeding intermittently on leaning forwards and was relieving his breathlessness intermittently. CT imaging was performed to characterize his injuries and determine his management. CT scan of chest and abdomen showed moderate size haemopericardium with left sided haemopneumothorax. The patient underwent urgent surgical repair of the left ventricle and left anterior descending artery. He recovered without complications and was discharged from the hospital. This case highlights the fact that the potential to develop a life threatening cardiac tamponade was mitigated by the left parasternal stab wound. This injury fortuitously provided a pericardial window through which the bleeding from the injured left ventricle and left anterior descending artery could drain into the left hemithorax providing an opportunity for timely surgical intervention to repair the cardiac injuries.

Keywords: stab, incisional, haemo-pericardium, haemo-pneumothorax

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Authors: Laleh Boroumand, Muhammad Shiraz, Abdullah Gani, Rashid Hafeez Khokhar

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Cloud computing being the use of hardware and software that are delivered as a service over a network has its application in the area of health care. Due to the emergency cases reported in most of the medical centers, prompt for an efficient scheme to make health data available with less response time. To this end, we propose a mobile global healthcare village (MGHV) model that combines the components of three deployment model which include country, continent and global health cloud to help in solving the problem mentioned above. In the creation of continent model, two (2) data centers are created of which one is local and the other is global. The local replay the request of residence within the continent, whereas the global replay the requirements of others. With the methods adopted, there is an assurance of the availability of relevant medical data to patients, specialists, and emergency staffs regardless of locations and time. From our intensive experiment using the simulation approach, it was observed that, broker policy scheme with respect to optimized response time, yields a very good performance in terms of reduction in response time. Though, our results are comparable to others when there is an increase in the number of virtual machines (80-640 virtual machines). The proportionality in increase of response time is within 9%. The results gotten from our simulation experiments shows that utilizing MGHV leads to the reduction of health care expenditures and helps in solving the problems of unqualified medical staffs faced by both developed and developing countries.

Keywords: cloud computing (MCC), e-healthcare, availability, response time, service broker policy

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Authors: Keiko Naito, Y. Nakashima, S. Yamauchi, Y. Kunitani, Y. Ishigami, K. Numata, M. Mizobe, Y. Homma, J. Takahashi, T. Inoue, T. Shiga, H. Funakoshi

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Background: A presence of severe acidemia, defined as pH < 7.2, is common during endotracheal intubation for critically ill patients in the emergency department (ED). Severe acidemia is widely recognized as a predisposing factor for intubation failure. However, it is unclear that acidemic condition itself actually makes endotracheal intubation more difficult. We aimed to evaluate if a presence of severe acidemia before intubation is associated with the lower first attempt intubation success rate in the ED. Methods: This is a retrospective observational cohort study in the ED of an urban hospital in Japan. The collected data included patient demographics, such as age, sex, and body mass index, presence of one or more factors of modified LEMON criteria for predicting difficult intubation, reasons for intubation, blood gas levels, airway equipment, intubation by emergency physician or not, and the use of the rapid sequence intubation technique. Those with any of the following were excluded from the analysis: (1) no blood gas drawn before intubation, (2) cardiopulmonary arrest, and (3) under 18 years of age. The primary outcome was the first attempt intubation success rates between a severe acidemic patients (SA) group and a non-severe acidemic patients (NA) group. Logistic regression analysis was used to test the first attempt success rates for intubations between those two groups. Results: Over 5 years, a total of 486 intubations were performed; 105 in the SA group and 381 in the NA group. The univariate analysis showed that the first attempt intubation success rate was lower in the SA group than in the NA group (71.4% vs 83.5%, p < 0.01). The multivariate logistic regression analysis identified that severe acidemia was significantly associated with the first attempt intubation failure (OR 1.9, 95% CI 1.03-3.68, p = 0.04). Conclusions: A presence of severe acidemia before endotracheal intubation lowers the first attempt intubation success rate in the ED.

Keywords: acidemia, airway management, endotracheal intubation, first-attempt intubation success rate

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Authors: Mary Cruz

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Founded from 1496 to 1502, Santo Domingo is the oldest European settlement in the Americas, inhabited without any discontinuity and was the first seat of Spanish power in the new world. Capital of the country since 1932.In this text, we discover Santo Domingo as an international tourist center, Urban Structure, Eco-tourism, Contamination and other issues related to tourism and development of this city. Founded from 1496 to 1502, Santo Domingo is the oldest European settlement in the Americas, inhabited without any discontinuity and was the first seat of Spanish power in the new world. Capital of the country since 1932. Encouraged by the United Nations and the World Bank, many Caribbean governments have encouraged tourism from the 1950s to boost their Third World economies. In this text, we discover Santo Domingo as an international tourist center, Urban Structure, Eco-tourism, Contamination and challenges of the first tourist destination in the Caribbean.

Keywords: eco-tourism, urban structure, contamination, development

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Authors: Monireh Ahmadi Bani, Adel Khorramrouz, Lalenoor Morvarid, Bagheri Mahtab

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Background:- Foot disorders are common in musculoskeletal problems. Plantar pressure distribution measurement is one the most important part of foot disorders diagnosis for quantitative analysis. However, the association of plantar pressure and foot disorders is not clear. With the growth of dataset and machine learning methods, the relationship between foot disorders and plantar pressures can be detected. Significance of the study:- The purpose of this study was to predict the probability of common foot disorders based on peak plantar pressure distribution and center of pressure during walking. Methodologies:- 2323 participants were assessed in a foot therapy clinic between 2015 and 2021. Foot disorders were diagnosed by an experienced physician and then they were asked to walk on a force plate scanner. After the data preprocessing, due to the difference in walking time and foot size, we normalized the samples based on time and foot size. Some of force plate variables were selected as input to a deep neural network (DNN), and the probability of any each foot disorder was measured. In next step, we used support vector machine (SVM) and run dataset for each foot disorder (classification of yes or no). We compared DNN and SVM for foot disorders prediction based on plantar pressure distributions and center of pressure. Findings:- The results demonstrated that the accuracy of deep learning architecture is sufficient for most clinical and research applications in the study population. In addition, the SVM approach has more accuracy for predictions, enabling applications for foot disorders diagnosis. The detection accuracy was 71% by the deep learning algorithm and 78% by the SVM algorithm. Moreover, when we worked with peak plantar pressure distribution, it was more accurate than center of pressure dataset. Conclusion:- Both algorithms- deep learning and SVM will help therapist and patients to improve the data pool and enhance foot disorders prediction with less expense and error after removing some restrictions properly.

Keywords: deep neural network, foot disorder, plantar pressure, support vector machine

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Authors: Emily Moore, Andrew Gaukroger, Matthew Solan, Lucy Bailey, Alexandra Boxall, Andrew Carne, Chintu Gadamsetty, Charlotte Morley, Katy Western, Iwona Kolodziejczyk

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Introduction: Rupture of the Achilles tendon is common and has a long recovery period. Most cases are managed non-operatively. Foot and Ankle Surgeons advise an ultrasound scan to check the gap between the torn ends. A large gap (with the ankle in equinus) is a relative indication for surgery. The definitive decision regarding surgical versus non-operative management can only be made once an ultrasound scan is undertaken and the patient is subsequently reviewed by a Foot and Ankle surgeon. To get to this point, the patient journey involves several hospital departments. In nearby trusts, patients reattend for a scan and go to the plaster room both before and after the ultrasound for removal and re-application of the cast. At a third visit to the hospital, the surgeon and patient discuss options for definitive treatment. It may take 2-3 weeks from the initial Emergency Department visit before the final treatment decision is made. This “wasted time” is ultimately added to the recovery period for the patient. In this hospital, Achilles rupture patients are seen in a weekly multidisciplinary OneStop Heel Pain clinic. This pathway was already efficient but subject to occasional frustrating delays if a key staff member was absent. A new pathway was introduced with the goal to reduce delays to a definitive treatment plan. Method: A retrospective series of Achilles tendon ruptures managed according to the 2019 protocol was identified. Time taken from the Emergency Department to have both an ultrasound scan and specialist Foot and Ankle surgical review were calculated. 30 consecutive patients were treated with our new pathway and prospectively followed. The time taken for a scan and for specialist review were compared to the 30 consecutive cases from the 2019 (pre-COVID) cohort. The new pathway includes 1. A new contoured splint applied to the front of the injured limb held with a bandage. This can be removed and replaced (unlike a plaster cast) in the ultrasound department, removing the need for plaster room visits. 2. Urgent triage to a Foot and Ankle specialist. 3. Ultrasound scan for assessment of rupture gap and deep vein thrombosis check. 4. Early decision regarding surgery. Transfer to weight bearing in a prosthetic boot in equinuswithout waiting for the once-a-week clinic. 5. Extended oral VTE prophylaxis. Results: The time taken for a patient to have both an ultrasound scan and specialist review fell > 50%. All patients in the new pathway reached a definitive treatment decision within one week. There were no significant differences in patient demographics or rates of surgical vs non-operative treatment. The mean time from Emergency Department visit to specialist review and ultrasound scan fell from 8.7 days (old protocol) to 2.9 days (new pathway). The maximum time for this fell from 23 days (old protocol) to 6 days (new pathway). Conclusion: Teamwork and innovation have improved the experience for patients with an Achilles tendon rupture. The new pathway brings many advantages - reduced time in the Emergency Department, fewer hospital visits, less time using crutches and reduced overall recovery time.

Keywords: orthopaedics, achilles rupture, ultrasound, innovation

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Authors: Thidathit Prachanukool, Chaiyaporn Yuksen, Welawat Tienpratarn, Sorravit Savatmongkorngul, Panvilai Tangkulpanich, Chetsadakon Jenpanitpong, Yuranan Phootothum, Malivan Phontabtim, Promphet Nuanprom

Abstract:

Background: Ruptured appendicitis has a high morbidity and mortality and requires immediate surgery. The Alvarado Score is used as a tool to predict the risk of acute appendicitis, but there is no such score for predicting rupture. This study aimed to developed the prediction score to determine the likelihood of ruptured appendicitis in an Asian population. Methods: This study was diagnostic, retrospectively cross-sectional and exploratory model at the Emergency Medicine Department in Ramathibodi Hospital between March 2016 and March 2018. The inclusion criteria were age >15 years and an available pathology report after appendectomy. Clinical factors included gender, age>60 years, right lower quadrant pain, migratory pain, nausea and/or vomiting, diarrhea, anorexia, fever>37.3°C, rebound tenderness, guarding, white blood cell count, polymorphonuclear white blood cells (PMN)>75%, and the pain duration before presentation. The predictive model and prediction score for ruptured appendicitis was developed by multivariable logistic regression analysis. Result: During the study period, 480 patients met the inclusion criteria; of these, 77 (16%) had ruptured appendicitis. Five independent factors were predictive of rupture, age>60 years, fever>37.3°C, guarding, PMN>75%, and duration of pain>24 hours to presentation. A score > 6 increased the likelihood ratio of ruptured appendicitis by 3.88 times. Conclusion: Using the Ramathibodi Welawat Ruptured Appendicitis Score. (RAMA WeRA Score) developed in this study, a score of > 6 was associated with ruptured appendicitis.

Keywords: predictive model, risk score, ruptured appendicitis, emergency room

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Authors: Jiří F. Urbánek, Alena Oulehlová, Hana Malachová, Jiří J. Urbánek Jr.

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Crisis situations investigation and modelling are introduced and made within the complex system of energetic critical infrastructure, operating on peril´s environments. Every crisis situations and perils has an origin in the emergency/ crisis event occurrence and they need critical/ crisis interfaces assessment. Here, the emergency events can be expected - then crisis scenarios can be pre-prepared by pertinent organizational crisis management authorities towards their coping; or it may be unexpected - without pre-prepared scenario of event. But the both need operational coping by means of crisis management as well. The operation, forms, characteristics, behaviour and utilization of crisis management have various qualities, depending on real critical infrastructure organization perils, and prevention training processes. An aim is always - better security and continuity of the organization, which successful obtainment needs to find and investigate critical/ crisis zones and functions in critical infrastructure organization models, operating in pertinent perils environment. Our DYVELOP (Dynamic Vector Logistics of Processes) method is disposables for it. Here, it is necessary to derive and create identification algorithm of critical/ crisis interfaces. The locations of critical/ crisis interfaces are the flags of crisis situation in organization of critical infrastructure models. Then, the model of crisis situation will be displayed at real organization of Czech energetic crisis infrastructure subject in real peril environment. These efficient measures are necessary for the infrastructure protection. They will be derived for peril mitigation, crisis situation coping and for environmentally friendly organization survival, continuity and its sustainable development advanced possibilities.

Keywords: algorithms, energetic infrastructure complex system, modelling, peril´s environment

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Authors: Elif Aksel, Çagrı Imamoglu

Abstract:

This ongoing study aims to investigate the effects of neighborhood location on place attachment and residential satisfaction. Place attachment will be examined by comparing place of residence in different areas of the city. Furthermore, the relationship between neighborhood and residential satisfaction will be investigated in terms of physical and social aspects of the places influencing residential satisfaction. This study will be carried out in two different districts of Ankara which are Çankaya, located in the city center, and Sincan, a suburb. Two-hundred adult respondents will participate in this research; 100 men and 100 women aged between 18-65 years with different socio-economic status using snowball sampling. A place attachment scale and a questionnaire related with residential satisfaction, including open-ended questions and 7-point Likert type scale, will be used as instruments. Apart from these, demographic information of the participants such as gender, age, education, the length of residence will be collected. The findings of the study are expected to demonstrate that neighborhood is seen to be influential on place attachment by affecting the intensity of attachment. The level of place attachment is expected to be greater in areas far from the city compared to areas in the center of the city. Apart from this, the neighborhood is also effective in residential satisfaction. The residents living in these neighborhoods having strong physical and social opportunities will be expected to have higher residential satisfaction.

Keywords: neighborhood, neighborhood satisfaction, place attachment, residential satisfaction

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Authors: Jamal Fayazi, Farhad Anoosheh, Mohammad R. Ghorbani, Ali R. Paydar

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In this study, to determine the best non-linear regression model describing the growth curve of native poultry, 9657 chicks of generations 18, 19, and 20 raised in Mazandaran breeding center were used. Fowls and roosters of this center distributed in south of Caspian Sea region. To estimate the genetic variability of none linear regression parameter of growth traits, a Gibbs sampling of Bayesian analysis was used. The average body weight traits in the first day (BW1), eighth week (BW8) and twelfth week (BW12) were respectively estimated as 36.05, 763.03, and 1194.98 grams. Based on the coefficient of determination, mean squares of error and Akaike information criteria, Gompertz model was selected as the best growth descriptive function. In Gompertz model, the estimated values for the parameters of maturity weight (A), integration constant (B) and maturity rate (K) were estimated to be 1734.4, 3.986, and 0.282, respectively. The direct heritability of BW1, BW8 and BW12 were respectively reported to be as 0.378, 0.3709, 0.316, 0.389, 0.43, 0.09 and 0.07. With regard to estimated parameters, the results of this study indicated that there is a possibility to improve some property of growth curve using appropriate selection programs.

Keywords: direct heritability, Gompertz, growth traits, maturity weight, native poultry

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Authors: Morteza Rahiminejad

Abstract:

There are over 1200 cities and municipalities all around Iran, including 30 mega cities, which municipal organizations, Interior ministries, and city councils supervise. Even so, there has been neither any research about the process of success nor performance assessment in municipalities. In this research an attempt is made to build a comprehensive theory (or model) to show the reasons or success process among the local governments. The present research is based on the contingency approach in which the relevant circumstances are important, and both environment and situations call for their own management methods. The methodology of research is grounded theory, which uses Atlas.ti software as a tool.

Keywords: success, municipality, Iran, theory building

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Authors: Nihad Karim Chowdhury, Mohammad Sanaullah Chowdhury, Muhammed Jamshed Alam Patwary, Rubel Biswas

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In content-based 3D shape retrieval system, achieving high search performance has become an important research problem. A challenging aspect of this problem is to find an effective shape descriptor which can discriminate similar shapes adequately. To address this problem, we propose a new shape descriptor for 3D shape models by combining multi-resolution with multi-block center-symmetric local binary pattern operator. Given an arbitrary 3D shape, we first apply pose normalization, and generate a set of multi-viewed 2D rendered images. Second, we apply Gaussian multi-resolution filter to generate several levels of images from each of 2D rendered image. Then, overlapped sub-images are computed for each image level of a multi-resolution image. Our unique multi-block CS-LBP comes next. It allows the center to be composed of m-by-n rectangular pixels, instead of a single pixel. This process is repeated for all the 2D rendered images, derived from both ‘depth-buffer’ and ‘silhouette’ rendering. Finally, we concatenate all the features vectors into one dimensional histogram as our proposed 3D shape descriptor. Through several experiments, we demonstrate that our proposed 3D shape descriptor outperform the previous methods by using a benchmark dataset.

Keywords: 3D shape retrieval, 3D shape descriptor, CS-LBP, overlapped sub-images

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Authors: Imam Muthohar, Budi Hartono, Sigit Priyanto, Hardiansyah Hardiansyah

Abstract:

The eruption of Merapi Volcano in Yogyakarta, Indonesia in 2010 caused many casualties due to minimum preparedness in facing disaster. Increasing population capacity and evacuating to safe places become very important to minimize casualties. Regional government through the Regional Disaster Management Agency has divided disaster-prone areas into three parts, namely ring 1 at a distance of 10 km, ring 2 at a distance of 15 km and ring 3 at a distance of 20 km from the center of Mount Merapi. The success of the evacuation is fully supported by road network infrastructure as a way to rescue in an emergency. This research attempts to model evacuation process based on the rise of refugees in ring 1, expanded to ring 2 and finally expanded to ring 3. The model was developed using SATURN (Simulation and Assignment of Traffic to Urban Road Networks) program version 11.3. 12W, involving 140 centroid, 449 buffer nodes, and 851 links across Yogyakarta Special Region, which was aimed at making a preliminary identification of road networks considered vulnerable to disaster. An assumption made to identify vulnerability was the improvement of road network performance in the form of flow and travel times on the coverage of ring 1, ring 2, ring 3, Sleman outside the ring, Yogyakarta City, Bantul, Kulon Progo, and Gunung Kidul. The research results indicated that the performance increase in the road networks existing in the area of ring 2, ring 3, and Sleman outside the ring. The road network in ring 1 started to increase when the evacuation was expanded to ring 2 and ring 3. Meanwhile, the performance of road networks in Yogyakarta City, Bantul, Kulon Progo, and Gunung Kidul during the evacuation period simultaneously decreased in when the evacuation areas were expanded. The results of preliminary identification of the vulnerability have determined that the road networks existing in ring 1, ring 2, ring 3 and Sleman outside the ring were considered vulnerable to the evacuation of Mount Merapi eruption. Therefore, it is necessary to pay a great deal of attention in order to face the disasters that potentially occur at anytime.

Keywords: model, evacuation, SATURN, vulnerability

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Authors: Lamia Emam

Abstract:

The attractiveness of entrepreneurship education stems from its perceived value as a venue through which students can develop an entrepreneurial mindset, skill set, and practice, which may not necessarily lead to them starting a new business, but could, more importantly, be manifested as a life skill that could be applied to all types of organizations and career endeavors. This, in turn, raises important questions about what happens in our classrooms; our role as educators, the role of students, center of learning, and the instructional approach; all of which eventually contribute to achieving the desired EE outcomes. With application to an undergraduate entrepreneurship course -Entrepreneurship as Practice- the current paper aims to explore the effect of entrepreneurship education on the development of students’ general entrepreneurial tendencies. Towards that purpose, the researcher herein uses a pre-test and post-test quasi-experimental research design where the Durham University General Enterprising Tendency Test (GET2) is administered to the same group of students before and after course delivery. As designed and delivered, the Entrepreneurship as Practice module is a highly applied and experiential course where students are required to develop an idea for a start-up while practicing the entrepreneurship-related knowledge, mindset, and skills that are taught in class, both individually and in groups. The course is delivered using a combination of short lectures, readings, group discussions, case analysis, guest speakers, and, more importantly, actively engaging in a series of activities that are inspired by diverse methods for developing successful and innovative business ideas, including design thinking, lean-start up and business feasibility analysis. The instructional approach of the course particularly aims at developing the students' critical thinking, reflective, analytical, and creativity-based problem-solving skills that are needed to launch one’s own start-up. The analysis and interpretation of the experiment’s outcomes shall simultaneously incorporate the views of both the educator and students. As presented, the study responds to the rising call for the application of experimental designs in entrepreneurship in general and EE in particular. While doing so, the paper presents an educator’s perspective of EE to complement the dominant stream of research which is constrained to the students’ point of view. Finally, the study sheds light on EE in the MENA region, where the study is applied.

Keywords: entrepreneurship education, andragogy and heutagogy, scholarship of teaching and learning, experiment

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Authors: Angelis P. Barlampas

Abstract:

Purpose: A 29 years old woman presented in the emergency department with psychiatric symptoms. The psychiatrist ordered a computed tomography scan as part of a general examination. Material and methods: The CT showed bilateral enlarged choroid plexus structures mimicking papillomata and situated in the trigones of the lateral ventricles. The left choroid plexus was heavily calcified, but the right one has no any obvious calcifications. Results: It is well kown that any brain mass can present with behavioral changes and even psychiatric symptomatology. Papillomata of the ventricular system have been described to cause psychotic episodes. According to literature, choroid plexus papillomas are seldom neuroepithelial intraventricular tumors, which are benign and categorized as WHO grade 1 tumors. They are more common in the pediatric population, but they can occur in the adults, too1. In addition, the distinction between choroid plexus papilloma and carcinoma is very difficult and impossible by imagine alone. It can only be implied with more advanced imaging, such as arterial spin labeling and MRI. The final diagnosis is, of course, after surgical excision. The usual location in adults is the fourth ventricle, but in children, it is the lateral ventricles. Their imaging appearance is that of a solid vascular tumor, which enhances intensely after the intravenous administration of contrast material. One out of fourth tumors presents speckled calcifications1. In our case, there are symmetrically sized masses at the trigones, and there are no calcifications in one of them, whereas the other one is grossly calcified. Also, there is no obvious hydrocephalus or any other evidence of increased intracranial pressure. General conclusions: When there is a new psychiatric patient, someone must undergo any possible examination, and of course, a brain CT study should be done to exclude any rare organic causes that may be responsible for the disease.

Keywords: phycosis, intraventricular masses, CT, brain calcifications

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Authors: Sajida Rasheed, Imran Hashmi, Luiza Campos, Qizhi Zhou, Kim Keu

Abstract:

A quadratic model (p ˂ 0.0001) was developed by using central composite design of 50 experimental runs (42 non-center + 8 center points) to assess efficiency of background chlorine residuals in combating accidental microbial episode in a prototype distribution network (DN) (rig). A known amount of background chlorine residuals were maintained in DN and a required number of bacteria, Escherichia coli K-12 strain were introduced by an injection port in the pipe loop system. Samples were taken at various time intervals at different pipe lengths. Spread plate count was performed to count bacterial number. The model developed was significant. With microbial concentration and time (p ˂ 0.0001), pipe length (p ˂ 0.022), background chlorine residuals (p ˂ 0.07) and time^2 (p ˂ 0.09) as significant factors. The ramp function of variables shows that at the microbial count of 10^6, at 0.76 L/min, and pipe length of 133 meters, a background residual chlorine 0.16 mg/L was enough for complete inactivation of microbial episode in approximately 18 minutes.

Keywords: central composite design (CCD), distribution network, Escherichia coli, residual chlorine

Procedia PDF Downloads 462