Search results for: emergency response team

Authors: Angelis P. Barlampas

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Purpose of Learning Objective: This case depicts the need for cooperation between the emergency department and the radiologist to achieve the best diagnostic result for the patient. The clinical picture must correlate well with the radiology report and when it does not, this is not necessarily someone’s fault. Careful interpretation and good knowledge of the limitations, advantages and disadvantages of each imaging procedure are essential for the final diagnostic goal. Methods or Background: A patient was brought to the emergency department by their relatives. He was suddenly confused and his mental status was altered. He hadn't any history of mental illness and was otherwise healthy. A computing tomography scan without contrast was done, but it was unremarkable. Because of high clinical suspicion of probable neurologic disease, he was admitted to the hospital. Results or Findings: Another T was done after 48 hours. It showed a hypodense region in both thalamic areas. Taking into account that the first CT was normal, but the initial clinical picture of the patient was alerting of something wrong, the repetitive CT exam is highly suggestive of a probable diagnosis of bilateral thalamic infractions. Differential diagnosis: Primary bilateral thalamic glioma, Wernicke encephalopathy, osmotic myelinolysis, Fabry disease, Wilson disease, Leigh disease, West Nile encephalitis, Greutzfeldt Jacob disease, top of the basilar syndrome, deep venous thrombosis, mild to moderate cerebral hypotension, posterior reversible encephalopathy syndrome, Neurofibromatosis type 1. Conclusion: As is the case of limitations for any imaging procedure, the same applies to CT. The acute ischemic attack can not depict on CT. A period of 24 to 48 hours has to elapse before any abnormality can be seen. So, despite the fact that there are no obvious findings of an ischemic episode, like paresis or imiparesis, one must be careful not to attribute the patient’s clinical signs to other conditions, such as toxic effects, metabolic disorders, psychiatric symptoms, etc. Further investigation with MRI or at least a repeated CT must be done.

Keywords: CNS, CT, thalamus, emergency department

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Authors: Şakir Bingöl, Bayram İslamoğlu, Ebubekir Furkan Tepeli, Fatih Mehmet Karakule, Fatih Küçük, Merve Sena Arpacık, Mustafa Taha Kabar, Muhammet Metin Molak, Osman Emre Turan, Ömer Faruk Yesir, Sıla İnanır

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This study introduces an IoT-based real-time safety system for mining, addressing global safety challenges. The wearable device, seamlessly integrated into miners' jackets, employs LoRa technology for communication and offers real-time monitoring of vital health and environmental data. Unique features include an LCD panel for immediate information display and sound-based location tracking for emergency response. The methodology involves sensor integration, data transmission, and ethical testing. Validation confirms the system's effectiveness in diverse mining scenarios. The study calls for ongoing research to adapt the system to different mining contexts, emphasizing its potential to significantly enhance safety standards in the industry.

Keywords: mining safety, internet of things, wearable technology, LoRa, RFID tracking, real-time safety system, safety alerts, safety measures

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Authors: Yun-Tsuen Chen, Shih-Ting Huang, Pi-Fen Cheng, Heng-Hua Wang, Hui-Zhu Chen

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This paper discusses the experience of caring for a patient diagnosed with breast cancer and later received total mastectomy during a 2nd trimester pregnancy. She was hospitalized from January 31 to February 4, 2018. Using 'Gordon’s 11 Functional Health Patterns' through physical exams and interviews, the researcher assessed the patient’s physical and mental health and determined the patient to have anxiety, acute pain, and body image disturbance. After establishing a strong relationship with the patient, the researcher helped the patient express her anxiety and personal feelings. A multi-specialist team was formed to evaluate both the patient and her unborn child, before, during, and after surgery. This individualized care allowed the patient and her child to optimize the post-operative results. Aside from medication, the patient also received non-medicinal treatment, including improvement of sleep quality with body positioning, diaphragmatic breathing exercises for pain and stress relief after surgery. Throughout hospitalization, the patient’s physical and emotional needs were addressed daily with listening sessions and empathy. The patient’s husband was also incorporated in the patient’s recovery by teaching both he and the patient how to change the sterile wound dressing, which may have the added benefit of improving marital relationships through shared activities of nurturing. The patient was also given advice about how to improve self-confidence through clothing. Lastly, the patient was encouraged to join a support group for breast cancer patients. Through the sharing of experience in groups and within the family, the patient was helped to adapt to the change of her appearance and re-establish her self-confidence. This level of care expedited the patient’s return to her family life and role of being a mother.

Keywords: anxiety, body image disturbance, breast cancer during pregnancy, multi-specialist team

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Authors: Radia Chemlal, Salim Mehenni, Dahbia Leila Anes-boulahbal, Mohamed Kherat, Nabil Mameri

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The application of the electric field is considered to be a very promising method in cancer therapy. Indeed, cancer cells are very sensitive to the electric field, although the cellular response is not entirely clear. The tests carried out consisted in subjecting the RD cell line under the effect of the continuous electric field while varying certain parameters (voltage, exposure time, and cell concentration). The response surface methodology (RSM) was used to assess the effect of the chosen parameters, as well as the existence of interactions between them. The results obtained showed that the voltage, the cell concentration as well as the interaction between voltage and exposure time have an influence on the mortality rate of the RD cell line.

Keywords: continuous electric field, RD cancer cell line, RSM, voltage

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Authors: Varsha Singh, Kishan Fuse

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This paper presents a study of the grey-Taguchi method to optimize CNC milling parameters of AA6061 T6 aluminium alloy. Grey-Taguchi method combines Taguchi method based design of experiments (DOE) with grey relational analysis (GRA). Multi-response optimization of different quality characteristics as surface roughness, material removal rate, cutting forces is done using grey relational analysis (GRA). The milling parameters considered for experiments include cutting speed, feed per tooth, and depth of cut. Each parameter with three levels is selected. A grey relational grade is used to estimate overall quality characteristics performance. The Taguchi’s L9 orthogonal array is used for design of experiments. MINITAB 17 software is used for optimization. Analysis of variance (ANOVA) is used to identify most influencing parameter. The experimental results show that grey relational analysis is effective method for optimizing multi-response characteristics. Optimum results are finally validated by performing confirmation test.

Keywords: ANOVA, CNC milling, grey relational analysis, multi-response optimization

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Authors: Nadja Ylvestedt

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Uppsala University Library is a geographically dispersed research library consisting of nine subject libraries located in different campus areas throughout the city of Uppsala. Despite the geographical dispersion, it is the library's ambition to be perceived as a cohesive library with consistently high service and quality. A key factor to being one cohesive library is the library's online services, especially the virtual reference service. E-mail, chat and phone are answered by a team of specially trained staff under the supervision of a team leader. When covid-19 hit, well-established routines and processes to provide an infrastructure for students and researchers at the university changed radically. The strong connection between services provided at the library locations as well as at the VRS has been one of the key components of the library’s success in providing patrons with the help they need. With radically minimized availability at the physical locations, the infrastructure was at risk of collapsing. Objectives:- The objective of this project has been to evaluate the consequences of the sudden change in the organization of the library. The focus of this evaluation is the library’s VRS as an important space for learning, interaction and communication between the library and the community when other traditional spaces were not available. The goal of this evaluation is to capture the lessons learned from providing infrastructure for learning and research in times of crisis both on a practical, user-centered level but also to stress the importance of leadership in ever-changing environments that supports and creates agile, flexible services and teams instead of rigid processes adhering to obsolete goals. Results:- Reduced availability at the physical library locations was one of the strategies to prevent the spread of the covid-19 virus. The library staff was encouraged to work from home, so student workers staffed the library’s physical locations during that time, leaving the VRS to be the only place where patrons could get expert help. The VRS had an increase of 65% of questions asked between spring term 2019 and spring term 2020. The VRS team had to navigate often complicated and fast-changing new routines depending on national guidelines. The VRS team has a strong emphasis on agility in their approach to the challenges and opportunities, with methods to evaluate decisions regularly with user experience in mind. Fast decision-making, collecting feedback, an open-minded approach to reviewing rules and processes with both a short-term and a long-term focus and providing a healthy work environment have been key factors in managing this crisis and learn from it. This was resting on a strong sense of ownership regarding the VRS, well-working communication tools and agile and active communication between team members, as well as between the team and the rest of the organization who served as a second-line support system to aid the VRS team. Moving forward, the VRS has become an important space for communication, interaction and provider of infrastructure, implementing new routines and more extensive availability due to the lessons learned during crisis. The evaluation shows that the virtual environment has become an important addition to the physical spaces, existing in its own right but always in connection with and in relationship with the library structure as a whole. Thereby showing that the basis of human interaction stays the same while its form morphs and adapts to changes, thus leaving the virtual environment as a space of communication and infrastructure with unique opportunities for outreach and the potential to become a staple in patron’s education and learning.

Keywords: virtual reference service, leadership, digital infrastructure, research library

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Authors: Ivana R. Moser, Joao C. Souza

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Building fires are random phenomena that can be extremely violent, and safe evacuation of people is the most guaranteed tactic in saving lives. The correct evacuation of buildings, and other spaces occupied by people, means leaving the place in a short time and by the appropriate way. It depends on the perception of spaces by the individual, the architectural layout and the presence of appropriate routing systems. As historical buildings were constructed in other times, when, as in general, the current security requirements were not available yet, it is necessary to adapt these spaces to make them safe. Computer models of evacuation simulation are widely used tools for assessing the safety of people in a building or agglomeration sites and these are associated with the analysis of human behaviour, makes the results of emergency evacuation more correct and conclusive. The objective of this research is the performance evaluation of historical interest buildings, regarding the safe evacuation of people, through computer simulation, using PTV Viswalk software. The buildings objects of study are the Colégio Catarinense, centennial building, located in the city of Florianópolis, Santa Catarina / Brazil. The software used uses the variables of human behaviour, such as: avoid collision with other pedestrians and avoid obstacles. Scenarios were run on the three-dimensional models and the contribution to safety in risk situations was verified as an alternative measure, especially in the impossibility of applying those measures foreseen by the current fire safety codes in Brazil. The simulations verified the evacuation time in situations of normality and emergency situations, as well as indicate the bottlenecks and critical points of the studied buildings, to seek solutions to prevent and correct these undesirable events. It is understood that adopting an advanced computational performance-based approach promotes greater knowledge of the building and how people behave in these specific environments, in emergency situations.

Keywords: computer simulation, escape routes, fire safety, historic buildings, human behavior

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Authors: P. Vosynek, T. Návrat, M. Peč, J. Pořízka, P. Diviš

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Changes of mechanical properties and response behavior of bones is an important external sign of medical problems like osteoporosis, bone remodeling after fracture or surgery, osteointegration, or bone tissue loss of astronauts in space. Measuring of mechanical behavior of bones in physiological and osteoporotic states, quantified by different degrees of protein (collagen) and mineral loss, is thus an important topic in biomechanical research. This contribution deals with the relation between mechanical properties of the turkey long bone–tibia in physiological, demineralized, and deproteinized state. Three methods for comparison were used: densitometry, three point bending and harmonic response analysis. The results help to find correlations between the methods and estimate their possible application in medical practice.

Keywords: bone properties, long bone, osteoporosis, response behavior

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Authors: Alan Ruiz-Padilla, Brando Villalobos-Villalobos, Yeniley Ruiz-Noa, Claudia Mendoza-Macías, Claudia Palafox-Sánchez, Miguel Marín-Rosales, Álvaro Cruz, Rubén Rangel-Salazar

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Introduction: In patients with rheumatoid arthritis, resistance or poor response to disease modifying antirheumatic drugs (DMARD) may be a reflection of the increase in g-P. The expression of g-P may be important in mediating the effluence of DMARD from the cell. In addition, P-glycoprotein is involved in the transport of cytokines, IL-1, IL-2 and IL-4, from normal lymphocytes activated to the surrounding extracellular matrix, thus influencing the activity of RA. The involvement of P-glycoprotein in the transmembrane transport of cytokines can serve as a modulator of the efficacy of DMARD. It was shown that a number of lymphocytes with glycoprotein P activity is increased in patients with RA; therefore, P-glycoprotein expression could be related to the activity of RA and could be a predictor of poor response to therapy. Objective: To evaluate in RA patients, if the G2677T/A MDR1 polymorphisms is associated with differences in the rate of therapeutic response to disease-modifying antirheumatic agents in patients with rheumatoid arthritis. Material and Methods: A prospective cohort study was conducted. Fifty seven patients with RA were included. They had an active disease according to DAS-28 (score >3.2). We excluded patients receiving biological agents. All the patients were followed during 6 months in order to identify the rate of therapeutic response according to the American College of Rheumatology (ACR) criteria. At the baseline peripheral blood samples were taken in order to identify the G2677T/A MDR1 polymorphisms using PCR- Specific allele. The fragment was identified by electrophoresis in polyacrylamide gels stained with ethidium bromide. For statistical analysis, the genotypic and allelic frequencies of MDR1 gene polymorphism between responders and non-responders were determined. Chi-square tests as well as, relative risks with 95% confidence intervals (95%CI) were computed to identify differences in the risk for achieving therapeutic response. Results: RA patients had a mean age of 47.33 ± 12.52 years, 87.7% were women with a mean for DAS-28 score of 6.45 ± 1.12. At the 6 months, the rate of therapeutic response was 68.7 %. The observed genotype frequencies were: for G/G 40%, T/T 32%, A/A 19%, G/T 7% and for A/A genotype 2%. Patients with G allele developed at 6 months of treatment, higher rate for therapeutic response assessed by ACR20 compared to patients with others alleles (p=0.039). Conclusions: Patients with G allele of the - G2677T/A MDR1 polymorphisms had a higher rate of therapeutic response at 6 months with DMARD. These preliminary data support the requirement for a deep evaluation of these and other genotypes as factors that may influence the therapeutic response in RA.

Keywords: pharmacogenetics, MDR1, P-glycoprotein, therapeutic response, rheumatoid arthritis

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Authors: Amel M. A. Osman, Roy Mahony, Lisa Dann, McKenna S.

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Background: Computed Tomography (CT) is a significant source of radiation in the pediatric population. A new head injury (HI) pathway was introduced in 2021, which altered the previous process of HI being jointly admitted with general pediatrics and surgery to admit these patients under the Emergency Medicine Team. Admitted patients included those with positive CT findings not requiring immediate neurosurgical intervention and those who did not meet current criteria for urgent CT brain as per NICE guidelines but were still symptomatic for prolonged observations. This approach aims to decrease the number of CT scans performed. The main aim is to assess the variation in CT scanning rates since the change in the admitting process. A retrospective review of patients presenting to CHI PECU with HI over 6-month period (01/01/19-31/05/19) compared to a 6-month period post introduction of the new pathway (01/06/2022-31/12/2022). Data was collected from the electronic record databases, symphony, and PACS. Results: In 2019, there were 869 presentations of HI, among which 32 (3.68%) had CT scans performed. 2 (6.25%) of those scanned had positive findings. In 2022, there were 1122 HI presentations, with 47 (4.19%) CT scans performed and positive findings in 5 (10.6%) cases. 57 patients were admitted under the new pathway for observation, with 1 having a CT scan following admission. Conclusion: Quantitative lifetime radiation risks for children are not negligible. While there was no statistically significant reduction in CTs performed amongst HIs presenting to our department, a significant group met the criteria for admission under the PECU consultant for prolonged monitoring. There was also a greater proportion of abnormalities on CT scans performed in 2022, demonstrating improved patient selection for imaging. Further data analysis is ongoing to determine if those who were admitted would have previously been scanned under the old pathway.

Keywords: head injury, CT, admission, guidline

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Authors: Shreya Thusoo, Karan Modi, Rajesh Kumar, Hitesh Madahar

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Over the years, it has been extensively established that the practice of assuming a structure being fixed at base, leads to gross errors in evaluation of its overall response due to dynamic loadings and overestimations in design. The extent of these errors depends on a number of variables; soil type being one of the major factor. This paper studies the effect of Soil Structure Interaction (SSI) on multi-storey buildings with varying under-laying soil types after proper validation of the effect of SSI. Analysis for soft, stiff and very stiff base soils has been carried out, using a powerful Finite Element Method (FEM) software package ANSYS v14.5. Results lead to some very important conclusions regarding time period, deflection and acceleration responses.

Keywords: dynamic response, multi-storey building, soil-structure interaction, varying soil types

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Authors: Raj Banerjee, Aniruddha Sengupta

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An earthquake event, associated with a typical fault rupture, initiates at the source, propagates through a rock or soil medium and finally daylights at a surface which might be a populous city. The detrimental effects of an earthquake are often quantified in terms of the responses of superstructures resting on the soil. Hence, there is a need for the estimation of amplification of the bedrock motions due to the influence of local site conditions. In the present study, field borehole log data of Mangalwadi and Walkeswar sites in Mumbai city are considered. The data consists of variation of SPT N-value with the depth of soil. A correlation between shear wave velocity (Vₛ) and SPT N value for various soil profiles of Mumbai city has been developed using various existing correlations which is used further for site response analysis. MATLAB program is developed for studying the ground response analysis by performing two dimensional linear and equivalent linear analysis for some of the typical Mumbai soil sites using pure shear (Multi Point Constraint) boundary condition. The model is validated in linear elastic and equivalent linear domain using the popular commercial program, DEEPSOIL. Three actual earthquake motions are selected based on their frequency contents and durations and scaled to a PGA of 0.16g for the present ground response analyses. The results are presented in terms of peak acceleration time history with depth, peak shear strain time history with depth, Fourier amplitude versus frequency, response spectrum at the surface etc. The peak ground acceleration amplification factors are found to be about 2.374, 3.239 and 2.4245 for Mangalwadi site and 3.42, 3.39, 3.83 for Walkeswar site using 1979 Imperial Valley Earthquake, 1989 Loma Gilroy Earthquake and 1987 Whitter Narrows Earthquake, respectively. In the absence of any site-specific response spectrum for the chosen sites in Mumbai, the generated spectrum at the surface may be utilized for the design of any superstructure at these locations.

Keywords: deepsoil, ground response analysis, multi point constraint, response spectrum

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Authors: Alldila Hendy, Agi Satria

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Background: A colostomy procedure is an important part in the management of surgical procedures in some diseases involving the gastrointestinal tract. So it is necessary to find the factors that influence the occurrence of complications. Methods: This is a retrospective cross-sectional analytic study in Cipto Mangunkusumo Hospital noting medical records of patients after the colostomy from January 2012 to December 2014 at the Division of Digestive Surgery. Results: In 136 cases of post-colostomy, 66 cases have complications, 14 is early-onset, and 52 is late-onset. 70 is without complications. Most complications are dermatitis, which is 31 (22.8%), cases of infection/abscess/fistula and intestinal obstruction are 13 (9.6%) and 5 patients (4.4%). A rare complication is colostomy retraction by 2 patients (1.5%), colostomy prolapse and necrosis/gangrene, which is only 3 patients (2.2%). A colostomy procedure in emergency surgery is riskier than elective surgery for complications after colostomy (p < 0.007, OR 2.85), Based on the operator who performs a colostomy procedure, the consultant had a lower risk of complications than fellow or resident (p < 0.0001). Based on the age factor, where the age of about 50 years has a risk of complications after colostomy (p < 0.018). Conclusion: The timing of operation (emergency or elective), age, and operator who perform a colostomy procedure have a significant relationship with an increased prevalence of complications after colostomy in RSCM.

Keywords: colostomy, complications, factors, procedure

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Authors: Mohammed Ali Hjaji, A.K. El-Senussi, Said H. Eshtewi

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The flexural dynamic response of symmetric laminated composite beams subjected to general transverse harmonic forces is investigated. The dynamic equations of motion and associated boundary conditions based on the first order shear deformation are derived through the use of Hamilton’s principle. The influences of shear deformation, rotary inertia, Poisson’s ratio and fibre orientation are incorporated in the present formulation. The resulting governing flexural equations for symmetric composite Timoshenko beams are exactly solved and the closed form solutions for steady state flexural response are then obtained for cantilever and simply supported boundary conditions. The applicability of the analytical closed-form solution is demonstrated via several examples with various transverse harmonic loads and symmetric cross-ply and angle-ply laminates. Results based on the present solution are assessed and validated against other well established finite element solutions and exact solutions available in the literature.

Keywords: analytical solution, flexural response, harmonic forces, symmetric laminated beams, steady state response

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Authors: Vasu Velagapudi, G. Suresh

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PTFE/HNTs nanocomposites are fabricated with 4%, 6%, and 8% by weight fraction, and the optimization study of wear parameters are performed using response surface methodology (RSM). The experiments are carried out on a pin on disc (POD) wear tester under different operating parameters planned according to Taguchi L27 orthogonal array. The input factors considered are wt% HNTs addition, sliding velocity, load, and distance with three levels for each factor. From ANOVA: The factors load, speed and distance and their interactions have a significant effect on COF. Also for SWR, composition factor and interaction of load and speed are observed to be significant ( < 0.05) Optimum input parameters corresponding to desirability 1 are found to be: COF (0.11) and SWR (17.5)×10⁻⁶ (mm3/N-m) at 6.34 wt% of composition, 5N of load, 2 km of distance and 1 m/sec of velocity.

Keywords: PTFE/HNT, nanocomposites, response surface methodology (RSM), specific wear rate

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Authors: Serges Mendomo Meye, Li Guowei, Shen Zhenzhong

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Earthquake is one of the main loads threatening dam safety. Once the dam is damaged, it will bring huge losses of life and property to the country and people. Therefore, it is very important to research the seismic safety of the dam. Due to the complex foundation conditions, high fortification intensity, and high scientific and technological content, it is necessary to adopt reasonable methods to evaluate the seismic safety performance of concrete arch dams built and under construction in strong earthquake areas. Structural seismic vulnerability analysis can predict the probability of structural failure at all levels under different intensity earthquakes, which can provide a scientific basis for reasonable seismic safety evaluation and decision-making. In this paper, the response surface method (RSM) is applied to the seismic vulnerability analysis of arch dams, which improves the efficiency of vulnerability analysis. Based on the central composite test design method, the material-seismic intensity samples are established. The response surface model (RSM) with arch crown displacement as performance index is obtained by finite element (FE) calculation of the samples, and then the accuracy of the response surface model (RSM) is verified. To obtain the seismic vulnerability curves, the seismic intensity measure ??(?1) is chosen to be 0.1~1.2g, with an interval of 0.1g and a total of 12 intensity levels. For each seismic intensity level, the arch crown displacement corresponding to 100 sets of different material samples can be calculated by algebraic operation of the response surface model (RSM), which avoids 1200 times of nonlinear dynamic calculation of arch dam; thus, the efficiency of vulnerability analysis is improved greatly.

Keywords: high concrete arch dam, performance index, response surface method, seismic vulnerability analysis, vector-valued intensity measure

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Authors: A. M. Khourshid, A. M. El-Kassas, I. Sabry

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The objective of this work was to investigate the mechanical properties in order to demonstrate the feasibility of friction stir welding for joining Al 6061 aluminium alloys. Welding was performed on pipe with different thickness (2, 3 and 4 mm), five rotational speeds (485, 710, 910, 1120 and 1400 rpm) and a traverse speed of 4mm/min. This work focuses on two methods which are artificial neural networks using software and Response Surface Methodology (RSM) to predict the tensile strength, the percentage of elongation and hardness of friction stir welded 6061 aluminium alloy. An Artificial Neural Network (ANN) model was developed for the analysis of the friction stir welding parameters of 6061 pipe. Tensile strength, the percentage of elongation and hardness of weld joints were predicted by taking the parameters tool rotation speed, material thickness and axial force as a function. A comparison was made between measured and predicted data. Response Surface Methodology (RSM) was also developed and the values obtained for the response tensile strength, the percentage of elongation and hardness are compared with measured values. The effect of FSW process parameters on mechanical properties of 6061 aluminium alloy has been analysed in detail.

Keywords: friction stir welding, aluminium alloy, response surface methodology, artificial neural network

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Authors: Langhit Kurar, Loren Charles

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Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.

Keywords: ankle, fracture, BOAST, radiology

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Authors: Sathyaseelan Subramaniam, Jacqueline Bober, Jennifer Chao, Shahriar Zehtabchi

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Background: Emergency physicians frequently evaluate skin and soft tissue infections in order to differentiate abscess from cellulitis. This helps determine which patients will benefit from incision and drainage. Our objective was to determine the operating characteristics of point-of-care ultrasound (POCUS) compared to clinical examination in identifying abscesses in emergency department (ED) patients with features of skin and soft tissue infections. Methods: We performed a comprehensive search in the following databases: Medline, Web of Science, EMBASE, CINAHL and Cochrane Library. Trials were included if they compared the operating characteristics of POCUS with clinical examination in identifying skin and soft tissue abscesses. Trials that included patients with oropharyngeal abscesses or that requiring abscess drainage in the operating room were excluded. The presence of an abscess was determined by pus drainage. No pus seen on incision or resolution of symptoms without pus drainage at follow up, determined the absence of an abscess. Quality of included trials was assessed using GRADE criteria. Operating characteristics of POCUS are reported as sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios and the respective 95% confidence intervals (CI). Summary measures were calculated by generating a hierarchical summary receiver operating characteristic model (HSROC). Results: Out of 3203 references identified, 5 observational studies with 615 patients in aggregate were included (2 adults and 3 pediatrics). We rated the quality of 3 trials as low and 2 as very low. The operating characteristics of POCUS and clinical examination in identifying soft tissue abscesses are presented in the table. The HSROC for POCUS revealed a sensitivity of 96% (95% CI = 89-98%), specificity of 79% (95% CI = 71-86), LR+ of 4.6 (95% CI = 3.2-6.8), and LR- of 0.06 (95% CI = 0.02-0.2). Conclusion: Existing evidence indicates that POCUS is useful in identifying abscesses in ED patients with skin or soft tissue infections.

Keywords: abscess, point-of-care ultrasound, pocus, skin and soft tissue infection

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Authors: Salem Alsanusi, Loubna Bentaher

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Response Surface Methods (RSM) provide statistically validated predictive models that can then be manipulated for finding optimal process configurations. Variation transmitted to responses from poorly controlled process factors can be accounted for by the mathematical technique of propagation of error (POE), which facilitates ‘finding the flats’ on the surfaces generated by RSM. The dual response approach to RSM captures the standard deviation of the output as well as the average. It accounts for unknown sources of variation. Dual response plus propagation of error (POE) provides a more useful model of overall response variation. In our case, we implemented this technique in predicting compressive strength of concrete of 28 days in age. Since 28 days is quite time consuming, while it is important to ensure the quality control process. This paper investigates the potential of using design of experiments (DOE-RSM) to predict the compressive strength of concrete at 28th day. Data used for this study was carried out from experiment schemes at university of Benghazi, civil engineering department. A total of 114 sets of data were implemented. ACI mix design method was utilized for the mix design. No admixtures were used, only the main concrete mix constituents such as cement, coarse-aggregate, fine aggregate and water were utilized in all mixes. Different mix proportions of the ingredients and different water cement ratio were used. The proposed mathematical models are capable of predicting the required concrete compressive strength of concrete from early ages.

Keywords: mix proportioning, response surface methodology, compressive strength, optimal design

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Authors: Samar Mousa, Rebecca Shirley

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Injuries to the hand account for 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. Functional impairments as a result of hand injuries often necessitate absence from employment, resulting in reduced productivity estimated to incur an additional £600m loss to the UK economy. Appropriate and early management is vital to preserve anatomy, prevent stiffness and allow function. The initial assessment and management of hand injuries are usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In our plastic surgery department at Stoke Mandeville hospital Buckinghamshire trust, we carried out an audit project to detect errors in hand splinting in the period between April 2022 and July 2022 and find out measures to support junior doctors, nurses and hand therapists in providing the best possible care for hand trauma patients. Our standards were The British Society for Surgery of the Hand (BSSH) standard of care in hand trauma, AO surgery reference and Stoke Mandeville hospital hand therapy mini protocol Feb 2022 During the period of 4 months, 5 cases were identified. Two cases of wrong splint choice, two cases of early removal of the splint and one tight splint that required change. In order to avoid those mistakes, a training program was given to junior doctors and nurses in collaboration with the hand therapy team regarding ways of splinting the hand in different injuries like fractures, tendons injuries, muscle injuries and ligamentous injuries. In addition to, a poster hung in the examination rooms and theatres to help junior doctors reach the correct decision.

Keywords: splinting, hand trauma, plastic surgery, tendon injury, hand fracrture

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Authors: Mary-Ellen Hooper, Anthony Paul O'Brien, Graeme Browne

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Background: It has been proposed that negative experiences in mental health nursing increase the risk of attrition for newly graduated nurses. The risk of nurse attrition is of particular concern with current nurse shortages worldwide continuing to rise. The purpose of this study was to identify and explore the qualitative experiences of new graduate nurses as they enter mental health services in their first year of clinical practice. Method: An ethnographic research design was utilized in order to explore the sub-cultural experiences of new graduate nurses. Which included 31 separate episodes of field observation (62 hours) and (n=24) semi-structured interviews. A total number of 26 new graduates and recently graduated nurses participated in this study – 14 new graduate nurses and 12 recently graduate nurses. Data collection was conducted across 6 separate Australian, NSW, mental health units from April until September 2017. Results: A major theme emerging from the research is the new graduate nurses experience of communication in their nursing role, particularly within the context of the multidisciplinary team, and the barriers to sharing information related to care. This presentation describes the thematic structure of the major theme 'communication' in the context of the everyday experience of the New Graduate mental health nurse's participation in their chosen nursing discipline. The participants described diminished communication as a negative experience affecting their envisioned notion of holistic care, which they had associated with the role of the mental health nurse. Conclusion: The relationship between nurses and members of the multidisciplinary team plays a key role in the communication of patient care, patient-centeredness and inter-professional collaboration, potentially affecting the role of the mental health nurse, satisfaction of new graduate nurses, and patient care.

Keywords: culture, mental health nursing, multidisciplinary team, new graduate nurse

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Authors: Gonzalez Carlos, Martinez Fransisco

Abstract:

The creation of a seismic prediction model that considers all the regional variations and perfectly adjusts its results to the response spectra is very complicated. To achieve statistically acceptable results, it is necessary to process a sufficiently robust data set, and even if high efficiencies are achieved, this model will only work properly in this region. However, when using it in other regions, differences are found due to different parameters that have not been calibrated to other regions, such as the site effect. The fact that impedance contrasts, as well as other factors belonging to the site, have a great influence on the local response is well known, which is why this work, using the residual method, is intended to establish a regional calibration of the corresponding parameters site effect for the Spain region in the global GMPM BSSA 14.

Keywords: GMPM, seismic prediction equations, residual method, response spectra, impedance contrast

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Authors: Nirmalasanti Pramesi

Abstract:

In 2004 the CLD KHI Team offered several new ideas in the field of Islamic family law, such as marriage, inheritance (waris), and waqf. The new idea is based on six main principles; pluralism, nationality, human rights, democracy, maslahah, and gender equality. However, the existence of this has actually caused various criticisms, appreciations, and controversies. For this reason, CLD-KHI, as the idea of reforming family law, especially in the field of marriage, really needs to be studied academically with a comprehensive method as an unfinished problem. The main issues examined in this study are what are the ideas for reforming the law of marriage that have been formulated by the CLD KHI team, as well as how to implement Maqasid Sharia in legal reform. The methodology used in this research is a qualitative method with a normative-empirical-sociological approach. The results of this research show every substance of the idea considers aspects of locality, nationality, and global ethics. The Maqasid approach used in most of the legal provisions is moderate (wasati). Meanwhile, in matters of wali niqah and inheritance, it is adjusted to the context of Indonesian society.

Keywords: Maqasid syari'ah, CLD KHI, marriage law reform, moderate

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Authors: Shepherd Manhokwe, Sheron Shoko, Cuthbert Zvidzai

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In the present study, the interactive effects of temperature and cultured bacteria on the performance of a biological treatment system of yeast processing wastewater were investigated. The main objective of this study was to investigate and optimize the operating parameters that reduce organic load and colour. Experiments were conducted based on a Central Composite Design (CCD) and analysed using Response Surface Methodology (RSM). Three dependent parameters were either directly measured or calculated as response. These parameters were total Chemical Oxygen Demand (COD) removal, colour reduction and total solids. COD removal efficiency of 26 % and decolourization efficiency of 44 % were recorded for the wastewater treatment. The optimized conditions for the biological treatment were found to be at 20 g/l cultured bacteria and 25 °C for COD reduction. For colour reduction optimum conditions were temperature of 30.35°C and bacterial formulation of 20g/l. Biological treatment of baker’s yeast processing effluent is a suitable process for the removal of organic load and colour from wastewater, especially when the operating parameters are optimized.

Keywords: COD reduction, optimisation, response surface methodology, yeast processing wastewater

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Authors: Yaping Zhao, Yimin Zhang

Abstract:

In the present paper, the stationary random vibration of a uniform cantilever beam is investigated. Two types of damping mechanism, i.e. the external and internal viscous dampings, are taken into account simultaneously. The excitation form is the support motion, and it is ideal white. Because two type of damping mechanism are considered concurrently, the product of the modal damping ratio and the natural frequency is not a constant anymore. As a result, the infinite definite integral encountered in the process of computing the mean square response is more complex than that in the existing literature. One signal progress of this work is to have calculated these definite integrals accurately. The precise solution of the mean square response is thus obtained in the infinite series form finally. Numerical examples are supplied and the numerical outcomes acquired confirm the validity of the theoretical analyses.

Keywords: random vibration, cantilever beam, mean square response, white noise

Procedia PDF Downloads 373

Authors: Brooke Sweeney, David White, Felix Amparano, Nick A. Clark, Amy R. Beck, Mathew Lindquist, Lora Edwards, Julie Vandal, Jennifer Lisondra, Katie Cox, Renee Arensberg, Allen Cummins, Jazmine Cedeno, Jason D. Fraser, Kelsey Dean, Helena H. Laroche, Cristina Fernandez

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Background: National organizations call for standardized pre-surgical requirements and education to optimize postoperative outcomes. Since 2017 our surgery program has used defined protocols and educational curricula pre- and post-surgery. In response to patient outcomes, our educational content was refined to include quizzes to assess patient knowledge and surgical preparedness. We aim to optimize adolescent pre-bariatric surgery preparedness by improving overall aggregate pre-surgical assessment performance from 68% to 80% within 12 months. Methods: A multidisciplinary improvement team was developed within the weight management clinic (WMC) of our tertiary care, free-standing children’s hospital. A manual has been utilized since 2017, with limitations in consistent delivery and patient uptake of information. The curriculum has been improved to include quizzes administered during WMC visits prior to bariatric surgery. The initial outcome measure is the pre-surgical quiz score of adolescents preparing for bariatric surgery. Process measure was the number of questions answered correctly to test the questions. Baseline performance was determined by a patient assessment survey of pre-surgical preparedness at patient visits. Plan-Do-Study-Act cycles (PDSA) included: 1) creation and implementation of a refined curriculum, 2) development of 5 new quizzes based upon learning objectives, and 3) improving provider-lead teaching and quiz administration within clinic workflow. Run charts assessed impact over time. Results: A total of 346 quiz questions were administered to 34 adolescents. The outcome measure improved from a baseline mean of 68% to 86% following PDSA 2 cycles, and it was sustained. Conclusion/Implication: Patient/family comprehension of surgical preparedness improved with standardized education via team member-led teaching and assessment using quizzes during pre-surgical clinic visits. The next steps include launching redesigned teaching materials with modules correlated to quizzes and assessment of comprehension and outcomes post-surgically.

Keywords: bariatric surgery, adolescent, clinic, pre-bariatric training

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Authors: Zhaojun Wang, Zongdi Sun, Zhiyuan Liu

Abstract:

First of all, the carbon trading price and trading volume in Shanghai are transformed by Fourier transform, and the frequency response diagram is obtained. Then, the frequency response diagram is analyzed and the Blackman filter is designed. The Blackman filter is used to filter, and the carbon trading time domain and frequency response diagram are obtained. After wavelet analysis, the carbon trading data were processed; respectively, we got the average value for each 5 days, 10 days, 20 days, 30 days, and 60 days. Finally, the data are used as input of the Back Propagation Neural Network model for prediction.

Keywords: Shanghai carbon trading, carbon trading price, carbon trading volume, wavelet analysis, BP neural network model

Procedia PDF Downloads 372

Authors: Naza Djafarova, Tony Bates, Margaret Verkuyl, Leonora Zefi, Ozgur Turetken, Alex Ferworn, Mastrilli Paula, Daria Romaniuk, Kosha Bramesfeld, Anastasia Dimitriadou, Cheryl To

Abstract:

Designing serious games for education is a challenging and resource-intensive effort. If a well-designed process that balances pedagogical principles with game mechanics is in place, it can help to simplify the design process of serious games and increase efficiency. Multidisciplinary teams involved in designing serious games can benefit tremendously from such a process in their endeavours to develop and implement these games at undergraduate and graduate levels. This paper presentation will outline research results on identified gaps within existing processes and frameworks and present an adapted process that emerged from the research. The research methodology was based on a survey, semi-structured interviews and workshops for testing the adapted process for game design. Based on the findings, the authors propose a simple process for the pre-production stage of serious game design that may help guide multidisciplinary teams in their work. This process was used to facilitate team brainstorming, and is currently being tested to assess if multidisciplinary teams find value in using it in their process of designing serious games.

Keywords: serious game-design, multidisciplinary team, game design framework, learning games, multidisciplinary game design process

Procedia PDF Downloads 409

Authors: Aref Ghafouri, Mohammad javad Mollakazemi, Farhad Asadi

Abstract:

In this paper, model order reduction method is used for approximation in linear and nonlinearity aspects in some experimental data. This method can be used for obtaining offline reduced model for approximation of experimental data and can produce and follow the data and order of system and also it can match to experimental data in some frequency ratios. In this study, the method is compared in different experimental data and influence of choosing of order of the model reduction for obtaining the best and sufficient matching condition for following the data is investigated in format of imaginary and reality part of the frequency response curve and finally the effect and important parameter of number of order reduction in nonlinear experimental data is explained further.

Keywords: frequency response, order of model reduction, frequency matching condition, nonlinear experimental data

Procedia PDF Downloads 382