Search results for: emergency responders

Authors: Maatouk Mohamed, Nouira Mariem

Abstract:

Background and aims: Healthcare-associated infections (HAI) represent a major public health problem worldwide. They represent one of the most serious adverse events in health care. The objectives of our study were to estimate the prevalence of HAI at the Charles Nicolle Hospital (CNH) and to identify the main associated factors as well as to estimate the frequency of antibiotic use. Methods: It was a cross sectional study at the CNH with a unique passage per department (OctoberDecember 2018). All patients present at the wards for more than 48 hours were included. All patients from outpatient consultations, emergency and dialysis departments were not included. The site definitions of infections proposed by the Centers for Disease Control and Prevention (CDC) were used. Only clinically and/or microbiologically confirmed active HAIs were included. Results: A total of 318 patients were included with a mean age of 52 years and a sex ratio (Female/Male) of 1.05. A total of 41 patients had one or more active HAIs, corresponding to a prevalence of 13.1% (95% CI: 9.3%-16.9%). The most frequent sites infections were urinary tract infections and pneumonia. Multivariate analysis among adult patients (>=18 years) (n=261), revealed that infection on admission (p=0.01), alcoholism (p=0.01), high blood pressure (p=0.008), having at least one invasive device inserted (p=0.004), and history of recent surgery (p=0.03), increased significantly the risk of HAIs. More than 1 of 3 patients (35.4%) were under antibiotics on the day of the survey, of which more than half (57.4%) were under 2 or more types of antibiotics. Conclusion: The prevalence of HAIs and antibiotic prescriptions at the CNH were considerably high. An infection prevention and control committee, as well as the development of an Antibiotic stewardship program with continuous monitoring using repeated prevalence surveys must be implemented to limit the frequency of these infections effectively.

Keywords: tumors, oesophagectomy, esophagogastric junction, systematic review

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Authors: Ojetunde Ojewola, Mark Morgan, Sonja Wilhelm-Stanis

Abstract:

State parks and historic sites are vulnerable to extreme weather events which can affect visitor experiences, management priorities, and legislative requests for disaster relief funds. Recently, global attention has been focused on the perceptions of global warming and how the presence of extreme weather events might impact protected areas, both now and in the future. The effects of climate change are not equally distributed across the United States, leading to varied perceptions based on personal experience with extreme weather events. This study describes employee perceptions of vulnerability and resilience in Missouri State Parks & Historic Sites due to extreme weather events that occur across the state but grouped according to physiographic provinces. Using a four-point rating scale, perceptions of vulnerability and resilience were divided into high and low sub-groups, thus allowing researchers to construct a two by two typology of employee responses. Subsequently, this data was used to develop a three-point continuum of environmental concern (higher scores meant more concern). Employee scores were then compared against a statewide assessment which combined social, economic, infrastructural and environmental indicators of vulnerability and resilience. State park employees thought the system was less vulnerable and more resilient to climate change than data found in statewide assessment This result was also consistent in three out of five physiographic regions across Missouri. Implications suggest that Missouri state park should develop a climate change adaptation strategy for emergency preparedness.

Keywords: extreme weather events, resilience, state parks, vulnerability

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Authors: Enjia Zhang

Abstract:

During the prevention and control of the COVID-19 pandemic, all communities in China were gated and under strict management, which was highly effective in preventing the spread of the epidemic from spreading. Based on the TRIZ theory, this paper intends to propose green design strategies of community control in response to public health emergencies and to optimize community control facilities according to the principle of minimum transformation. Through the questionnaire method, this paper investigates and summarizes the situation and problems of community control during the COVID-19 pandemic. Based on these problems, the TRIZ theory is introduced to figure out the problems and associates them with prefabricated facilities. Afterward, the innovation points and solutions of prefabricated community control measures are proposed by using the contradiction matrix. This paper summarizes the current situation of community control under public health emergencies and concludes the problems such as simple forms of temporary roadblocks, sudden increase of community traffic pressure, and difficulties to access public spaces. The importance of entrance and exit control in community control is emphasized. Therefore, the community control measures are supposed to focus on traffic control, and the external access control measures, including motor vehicles, non-motor vehicles, residents and non-residents access control, and internal public space access control measures, including public space control shared with the society or adjacent communities, are proposed in order to make the community keep the open characteristics and have the flexibility to deal with sudden public health emergencies in the future.

Keywords: green design, community control, prefabricated structure, public health emergency

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Authors: Saveria Capecchi

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The aim of the quali-quantitative research conducted in the spring of 2021 (still in the midst of the Covid-19 emergency) was to analyze the relationship between the imaginary of 142 girls aged 10-12 from two Italian cities in the Emilia-Romagna region (the capital, Bologna, and Parma) and the influence that various socialization agents can have on it, with particular attention to social media. In order to investigate the relationship between imagination and media, two tools were used: first, the girls wrote an essay in class about their future lives, imagining waking up one morning as a thirty-year-old adults. Six types of "dreams" reflecting the values and lifestyles characteristic of contemporary Italian society emerged. Additionally, the girls completed a questionnaire on their leisure time and, in particular, media consumption aimed at identifying their favorite characters. The results provided insights into understanding the reference values and lifestyles that define their subculture (they belong to the so-called Generation Z). Another interesting aspect of this research is the possibility of comparing the results with those of a similar study on preadolescent imaginary conducted in 1995, involving 292 girls from Milan and Bologna, belonging to the Millennial generation. The narratives about the imagined adult life reflect some crucial changes undergone by Italian society in a quarter of a century: there are advancements towards gender equality, and the imagined family is increasingly detached from tradition. There is a more persistent dream of a life marked by beauty, wealth, and fame, while at the same time, there is a greater social commitment, from solidarity with marginalized people to environmentalism. Furthermore, the mentioned new digital and robotic professions will project us into the near future.

Keywords: gender equality, gender stereotypes, imaginary, preadolescents, social media

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Authors: Saimir Heta, Kastriot Haxhirexha, Virtut Velmishi, Nevila Alliu, Ilma Robo

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Background: Testicular rotation can occur at any age. The possibility to save the testicle is the fastest possible surgical intervention which is indicated by the presence of acute pain even at rest. The time element is more important to diagnose and proceed further with surgical intervention. Testicular damage is a consequence which mainly depends on the moment of onset of symptoms, at the time when the symptoms are diagnosed, the earliest action to be performed is surgical intervention. Sometimes medical tests are needed to confirm a diagnosis, or to help identify another cause for symptoms; for example, the urine test, that is used to check for infection, associated with the scrotal ultrasound test. Control of blood flow to the longitudinal supply vessels of the testicles is indicated. The sign that indicates testicular rotation is a reduction in blood flow. This is the element which is distinguished from ultrasound examination. Surgery may be needed to determine if the patient’s symptoms are caused by the rotation of the testis or any other condition. Discussion: As a surgical intervention of the emergency, the torsion of the test depends very much on the duration of the torsion, as the success in the life of the testicle depends on the fastest surgical intervention. From the previous clinic, it is noted that in any case presented to the pediatric patient diagnosed with testicular rotation, there is always a link with personal history that the patient refers to the presence of a previous episode of testicular trauma. Literature supports this fact very logically. Conclusions: Salvation without testicular atrophy depends closely on establishing the diagnosis of testicular rotation as soon as possible. Following the logic above, it can be said that the diagnosis for rotation should be performed as soon as possible, to avoid consequences that will not be favorable for the patient.

Keywords: acute scrotum, test torsion, newborns, clinical presentation

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Authors: Anjelika Kremer, Irina Nachimov, Dan Justo

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Background: C-reactive protein (CRP) serum levels are commonly measured in hospitalized patients. Elevated admission CRP serum levels and in-hospital mortality has been seldom studied in the general population of elderly patients admitted to the acute Geriatrics department. Methods: A retrospective cross-sectional study was conducted at a tertiary medical center. Included were all elderly patients (age 65 years or more) admitted to a single acute Geriatrics department from the emergency room between April 2014 and January 2015. CRP serum levels were measured routinely in all patients upon the first 24 hours of admission. A logistic regression analysis was used to study if admission CRP serum levels were associated with in-hospital mortality independent of age, gender, functional status, and co-morbidities. Results: Overall, 498 elderly patients were included in the analysis: 306 (61.4%) female patients and 192 (38.6%) male patients. The mean age was 84.8±7.0 years (median: 85 years; IQR: 80-90 years). The mean admission CRP serum levels was 43.2±67.1 mg/l (median: 13.1 mg/l; IQR: 2.8-51.7 mg/l). Overall, 33 (6.6%) elderly patients died during the hospitalization. A logistic regression analysis showed that in-hospital mortality was independently associated with history of stroke (p < 0.0001), heart failure (p < 0.0001), and admission CRP serum levels (p < 0.0001) – and to a lesser extent with age (p = 0.042), collagen vascular disease (p=0.011), and recent venous thromboembolism (p=0.037). Receiver operating characteristic (ROC) curve showed that admission CRP serum levels predict in-hospital mortality fairly with an area under the curve (AUC) of 0.694 (p < 0.0001). Cut-off value with maximal sensitivity and specificity was 19.7 mg/L. Conclusions: Admission CRP serum levels may be used to predict in-hospital mortality in the general population of elderly patients admitted to the acute Geriatrics department.

Keywords: c-reactive protein, elderly, mortality, prediction

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Authors: Rafiqul Tarefder, Mohiuddin Ahmad, Mohammad Hossain

Abstract:

While milling materials from old pavement surface can be an important component of cost effective maintenance operation, their use in maintenance projects are not uniform and well documented. This study documents the different maintenance practices followed by four transportation districts of New Mexico Department of Transportation (NMDOT) in an attempt to find whether millings are being used in maintenance projects by those districts. Based on existing literature, a questionnaire was developed related to six common maintenance practices. NMDOT district personal were interviewed face to face to discuss and get answers to that questionnaire. It revealed that NMDOT districts mainly use chip seal and patching. Other maintenance procedures such as sand seal, scrub seal, slurry seal, and thin overlay have limited use. Two out of four participating districts do not have any documents on chip sealing; rather they employ the experiences of the chip seal crew. All districts use polymer modified high float emulsion (HFE100P) for chip seal with an application rate ranging from 0.4 to 0.56 gallons per square yard. Chip application rate varies from 15 to 40 lb/ square yard. State wide, the thickness of chip seal varies from 3/8" to 1" and life varies from 3 to 10 years. NMDOT districts mainly use three type of patching: pothole, dig-out and blade patch. Pothole patches are used for small potholes and during emergency, dig-out patches are used for all type of potholes sometimes after pothole patching, and blade patch is used when a significant portion of the pavement is damaged. Pothole patches last as low as three days whereas, blade patch lasts as long as 3 years. It was observed that all participating districts use millings in maintenance projects.

Keywords: chip seal, sand seal, scrub seal, slurry seal, overlay, patching, millings

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Authors: Hadas Sopher, Davide Schaumann, Yehuda E. Kalay

Abstract:

This paper addresses the shortcomings of architectural computation tools in representing human behavior in built environments, prior to construction and occupancy of those environments. Evaluating whether a design fits the needs of its future users is currently done solely post construction, or is based on the knowledge and intuition of the designer. This issue is of high importance when designing complex buildings such as hospitals, where the quality of treatment as well as patient and staff satisfaction are of major concern. Existing computational pre-occupancy human behavior evaluation methods are geared mainly to test ergonomic issues, such as wheelchair accessibility, emergency egress, etc. As such, they rely on Agent Based Modeling (ABM) techniques, which emphasize the individual user. Yet we know that most human activities are social, and involve a number of actors working together, which ABM methods cannot handle. Therefore, we present an event-based model that manages the interaction between multiple Actors, Spaces, and Activities, to describe dynamically how people use spaces. This approach requires expanding the computational representation of Actors beyond their physical description, to include psychological, social, cultural, and other parameters. The model presented in this paper includes cognitive abilities and rules that describe the response of actors to their physical and social surroundings, based on the actors’ internal status. The model has been applied in a simulation of hospital wards, and showed adaptability to a wide variety of situated behaviors and interactions.

Keywords: agent based modeling, architectural design evaluation, event modeling, human behavior simulation, spatial cognition

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Authors: Madikeri Rohit

Abstract:

As energy efficiency is the key concern in many aircraft manufacturing companies regenerative braking is a technique using which energy lost due to friction while braking can be regained. In the operation of an aircraft, significant energy is lost during deceleration or braking which occurs during its landing phase. This problem can be overcome using Regenerative Breaking System (RBS) in landing gear. The major problem faced is regarding the batteries and the overall efficiency gained in competence with the added weight. As the amount of energy required to store is huge we need batteries with high capacity for storage. Another obstacle by using high capacity batteries is the added weight which undermines the efficiency obtained using RBS. An approach to this problem is to either use the obtained energy immediately without storage or to store in other forms such as mechanical, pneumatic and hydraulic. Problem faced with mechanical systems is the weight of the flywheel needed to obtain required efficiency. Pneumatic and hydraulic systems are a better option at present. Using hydraulic systems for storing energy is efficient as it integrates into the overall hydraulic system present in the aircraft. Another obstacle is faced with the redundancy of this system. Conventional braking must be used along with RBS in order to provide redundancy. Major benefits obtained using RBS is with the help of the energy obtained during landing which can be used of engine less taxing. This reduces fuel consumption as well as noise and air pollution. Another added benefit of using RBS is to provide electrical supply to lighting systems, cabin pressurization system and can be used for emergency power supply in case of electric failure. This paper discusses about using RBS in landing gear, problems, prospects and new techniques being pursued to improve RBS.

Keywords: regenerative braking, types of energy conversion, landing gear, energy storage

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Authors: Fatma Koksal Çakirlar, Si̇nem Ozdemir, Selcan Akyol, Revazi̇ye Gulesen, Murat Gunaydin, Nevri̇ye Gonullu, Belkis Levent, Nuri̇ Kiraz

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Vibrio cholerae O1 and O139 are the causative agent of epidemic or pandemic cholera. V. cholerae O1 is generally accepted as a non-invasive enterotoxigenic organism causing gastroenteritis of various severities. Non-O1 V. cholerae can cause small outbreaks of diarrhea due to consumption of contaminated food and water. Particularly, the patients with achlorydria have a risk for vibrio infections. There are numerous case reports of bacteremia caused by vibrio in patients with predisposing conditions like cirrhosis, nephrotic syndrome, diabetes, hematologic malignancy, gastrectomy, and AIDS. We described in this study the first case of nontoxigenic, non-01/non-O139 V. cholerae isolated from the blood culture of a 77-year-old female patient with hipertension, diabetes, coronary artery disease, gout and about 9 years ago migrated breast cancer history. The patient with complaints of shortness of breath, fever and malaise admitted to our emergency clinic were evaluated. There was no diarrhea or abdominal symptoms in the patient. No growth in her urine culture, but blood culture (BACTEC 9120 system, Becton Dickinson, USA) was positive for non-01/non-O139 V. cholerae that was identified by conventional methods and Phoenix automated system (BD Diagnostic Systems, Sparks, MD). It does not secrete the cholera toxin. The agglutination test was negative with polyvalent O1 antisera and O139 antiserum. Empirically ceftriaxone was administered to the patient and she was discharged with improvement in general condition. In this study we report bacteremia by non-01/non-O139 V. cholerae that is rare in the worldwide and first in Turkey.

Keywords: bacteremia, blood culture, immunocompromised patient, Non-O1 vibrio cholerae

Procedia PDF Downloads 219

Authors: Nouira Mariem, Ennigrou Samir

Abstract:

Background and aims: Healthcare-associated infections (HAI) represent a major public health problem worldwide. They represent one of the most serious adverse events in health care. The objectives of our study were to estimate the prevalence of HAI at the Charles Nicolle Hospital (CNH) and to identify the main associated factors as well as to estimate the frequency of antibiotic use. Methods: It was a cross-sectional study at the CNH with a unique passage per department (October-December 2018). All patients present at the wards for more than 48 hours were included. All patients from outpatient consultations, emergency, and dialysis departments were not included. The site definitions of infections proposed by the Centers for Disease Control and Prevention (CDC) were used. Only clinically and/or microbiologically confirmed active HAIs were included. Results: A total of 318 patients were included, with a mean age of 52 years and a sex ratio (female/male) of 1.05. A total of 41 patients had one or more active HAIs, corresponding to a prevalence of 13.1% (95% CI: 9.3%-16.9%). The most frequent site infections were urinary tract infections and pneumonia. Multivariate analysis among adult patients (>=18 years) (n=261) revealed that infection on admission (p=0.01), alcoholism (p=0.01), high blood pressure (p=0.008), having at least one invasive device inserted (p=0.004), and history of recent surgery (p=0.03), increased the risk of HAIs significantly. More than 1 of 3 patients (35.4%) were under antibiotics on the day of the survey, of which more than half (57.4%) were under two or more types of antibiotics. Conclusion: The prevalence of HAIs and antibiotic prescriptions at the CNH were considerably high. An infection prevention and control committee, as well as the development of an antibiotic stewardship program with continuous monitoring using repeated prevalence surveys, must be implemented to limit the frequency of these infections effectively.

Keywords: prevalence, healthcare associated infection, antibiotic, Tunisia

Procedia PDF Downloads 82

Authors: Kamel Abd Elaziz Mohamed

Abstract:

Introduction: Drug related problems (DRPs) are of major concern, affecting patients of both sex. They impose considerable economic burden on the society and the health-care systems. Aim of the work: The aim of this work was to identify and categorize drug-related problems in adult intensive care unit. Patients and methods: The study was a prospective, observational study as eighty six patients were included. They were consecutively admitted to ICU through the emergency room or transferred from the general ward due to DRPs. Parameters included in the study as length of stay in ICU, need for cardiovascular support or mechanical ventilation, dialysis, as well as APACHE II score were recorded. Results: Drug related problems represent 3.6% of the total ICU admission. The median (range) of APACHE II score for 86 patients included in the study was 17 (10-23), and length of ICU stay was 2.4 (1.5-4.2) days. In 45 patients (52%), DRP was drug over dose (group 1), while other DRP was present in the other 41 patients (48%, group 11). Patients in group 1 were older (39 years versus 32 years in group 11), with significant impaired renal function. The need of inotropic drugs and mechanical ventilation as well as the length of stay (LOS) in ICU was significantly higher in group 1. There were no significant difference in GCS between both groups, however APACHE II score was significantly higher in group 1. Only four patients (4.6%) were admitted by suicidal attempt as well as three patients (3.4%) due to trauma drug-related admissions, all were in (group 1). Nineteen percent of the patients had drug related problem due to hypoglycaemic medication followed by tranquilizer (15%). Adverse drug effect followed by failure to receive medication were the most causes of drug problem in (group11).The total mortality rate was 4.6%, all of them were eventually non preventable. Conclusion: The critically ill patients admitted due to drug related problems represented a small proportion (3.6%) of admissions to the ICU. Hypoglycaemic medication was one of the most common causes of admission by drug related problems.

Keywords: drug related problems, ICU, cost, safety

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

Abstract:

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: Sahar Heidary, Ramin Ghasemi Shayan

Abstract:

The recent coronavirus disease 2019 (COVID-19) occurrence has carried considerabletrials to the world health system, comprising the training of dental and maxillofacial radiology (DMFR). DMFR will keep avital role in healthcare throughout this disaster. Severe acute breathing disease coronavirus 2 (SARS-CoV-2), the virus producing the current coronavirus disease 2019 (COVID-19) pandemic, is not only extremely contagious but can make solemn consequences in susceptible persons comprising dental patients and dental health care personnel (DHCPs). Reactions to COVID-19 have been available by the Cores for Infection Switch and Inhibition and the American Dental Association, but a more detailed answer is necessary for the harmless preparation of oral and maxillofacial radiology. Our goal is to evaluation the existing information just how the illness threatens patients and DHCPs and how to define which patients are possible to be SARS-CoV-2 infected; study how the usage of private shielding utensils and contamination control measures based on recent top observes, and knowledge can decrease the danger of virus spread in radiologic trials; and scrutinize how intraoral radiography, with its actually superior danger of scattering the infection, might be changed by extraoralradiographic methods for definite diagnostic jobs. In the pandemic, teleradiology has been extensively recycled for diagnostic determinations of COVID-19 patients, for discussions with radiologists in crisis cases, or managing of distance among radiology clinics. Dentists can have the digital radiographic images of their emergency patients through online service area also by electronic message or messaging applications to view in their smart phones, laptops, or other electronic devices.

Keywords: radiology, dental, oral, COVID-19, infection

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Authors: Maria Medrano, Cristina Cadenas-Sanchez, Maddi Oses, Lide Arenaza, Maria Amasene, Idoia Labayen

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The COVID-19 outbreak began in December 2019 in China and was rapidly expanded globally. Emergency measures, such as social distance or home confinement, were adopted by many country governments to prevent its transmission. In Spain, one of the most affected countries, the schools were closed, and one of the most severe mandatory home confinement was established for children from 14th March to 26th April 2020. The hypothesis of this study was that the measures adopted during the COVID-19 pandemic may have negatively affected physical activity and screen time of children. However, few studies have examined the effects of COVID-19 pandemic on lifestyle behaviours. Thus, the aim of the current work was to analyse the effects of the COVID-19 confinement on physical activity and screen time in Spanish children. For the current purpose, a total of 113 children and adolescents (12.0 ± 2.6 yr., 51.3% boys, 24.0% with overweight/obesity according to the World Obesity Federation) of the MUGI project were included in the analyses. Physical activity and screen time were longitudinally assessed by 'The Youth Activity Profile' questionnaire (YAP). Differences in physical activity and screen time before and during the confinement were assessed by dependent t-test. Before the confinement, 60% did not meet physical activity recommendations ( ≥ 60/min/day of moderate to vigorous physical activity), and 61% used screens ≥ 2 h/day. During the COVID-19 confinement, children decreased their physical activity levels (-91 ± 55 min/day, p < 0.001) and increased screen time ( ± 2.6 h/day, p < 0.001). The prevalence of children that worsened physical activity and screen time during the COVID-19 confinement were 95.2% and 69.8%, respectively. The current study evidence the negative effects of the COVID-19 confinement on physical activity and screen time in Spanish children. These findings should be taken into account to develop and implement future public health strategies for preserving children's lifestyle behaviours and health during and after the COVID-19 pandemic.

Keywords: COVID-19, lifestyle changes, paediatric, physical activity, screen time

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Authors: R. Unnikrishnan, K. Shankar

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In the case of high-speed fighter aircrafts, seat ejection is designed mainly for the safety of the pilot in case of an emergency. Strong windblast due to the high velocity of flight is one main difficulty in clearing the tail of the aircraft. Excessive G-forces generated, immobilizes the pilot from escape. In most of the cases, seats are ejected out of the aircrafts by explosives or by rocket motors attached to the bottom of the seat. Ejection forces are primarily in the vertical direction with the objective of attaining the maximum possible velocity in a specified period of time. The safe ejection parameters are studied to estimate the critical time of ejection for various geometries and velocities of flight. An equivalent analytical 2-dimensional biomechanical model of the human spine has been modelled consisting of vertebrae and intervertebral discs with a lumped mass approach. The 24 vertebrae, which consists of the cervical, thoracic and lumbar regions, in addition to the head mass and the pelvis has been designed as 26 rigid structures and the intervertebral discs are assumed as 25 flexible joint structures. The rigid structures are modelled as mass elements and the flexible joints as spring and damper elements. Here, the motions are restricted only in the mid-sagittal plane to form a 26 degree of freedom system. The equations of motions are derived for translational movement of the spinal column. An ejection force with a linearly increasing acceleration profile is applied as vertical base excitation on to the pelvis. The dynamic vibrational response of each vertebra in time-domain is estimated.

Keywords: biomechanical model, lumped mass, seat ejection, vibrational response

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Authors: Tali Capua, Karin Hermon, Miguel Glatstein, Oren Tavor, Ayelet Rimon

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Background: Electric bicycles (E-bikes) are one of a wide range of light electric vehicles that provide convenient local transportation and attractive recreational opportunities. Along with their growing use worldwide, the E-bike related injury rate increases. To the best of our knowledge, this study is the first to specifically compare E-bike with classic bicycle related injuries in children. Methods: Data of all pediatric ( < 16 years of age) bicycle related injuries presenting to an urban level I trauma center between 2014 and 2015 were collected and analyzed. The recorded data included age, gender, details of the accident, as well severity of injury, medical diagnosis, and the outcome. Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) were calculated for each patient. Data of E-bike related injuries and classic bicycle were then compared. Results: A total of 124 bicycle related injuries and 97 E-bike related injuries presented to the emergency department. Once pedestrians and bicycle passengers were removed, the groups of riders consisted of 111 bikers and 85 E-bikers. The mean age of bikers was 9.9 years (range 3-16 years) and of E-bikers was 13.7 years (range 7.5-16 years). Injuries to the head and the extremities were common in both groups. Compared to bikers, E-bikers had significantly more injuries to intra-abdominal organs (p = 0.04). Twenty patients (16%) with bicycle related injuries were admitted, and 13 (15%) patients with E-bike related injuries, of the latter group four underwent surgical intervention. ISS scores were low overall, but the injuries of higher severity (ISS > 9) were among the E-bikers. Conclusions: This study provides unique information which suggests that injuries in E-bikers tend to be more severe than in classic bikers. There is a need for regulation regarding the use of E-bikes to enhance the safety of both bikers and other road and pavement users.

Keywords: bicycle, electric bicycle, injury, pediatric, trauma

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Authors: Osama Zayed

Abstract:

Aim of the work: The aim of this study is to assess the predictors of pelvic vascular injuries in patients with pelvic fractures from major blunt trauma. Methods: This study was conducted as a tool-assessment study. Forty six patients with pelvic fractures from major blunt trauma will be recruited to the study arriving to department of emergency, Suez Canal University Hospital. Data were collected from questionnaire including; personal data of the studied patients and full medical history, clinical examinations, outcome measures (The Physiological and Operative Severity Score for enumeration of Mortality and morbidity (POSSUM), laboratory and imaging studies. Patients underwent surgical interventions or further investigations based on the conventional standards for interventions. All patients were followed up during conservative, operative and post-operative periods in the hospital for interpretation the predictive scores of vascular injuries. Results: Significant predictors of vascular injuries according to computed tomography (CT) scan include age, male gender, lower Glasgow coma (GCS) scores, occurrence of hypotension, mortality rate, higher physical POSSUM scores, presence of ultrasound collection, type of management, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) POSSUM scores, presence of abdominal injuries, and poor outcome. Conclusions: There was higher frequency of males than females in the studied patients. There were high probability of morbidity and low probability of mortality among patients. Our study demonstrates that POSSUM score can be used as a predictor of vascular injury in pelvis fracture patients.

Keywords: predictors, pelvic vascular injuries, pelvic fractures, major blunt trauma, POSSUM

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Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah

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Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.

Keywords: ambulance offload, district general hospital, handover, quality improvement

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Authors: Amy Darwin, Claire Blacklock

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Background: Existing literature about delivering evidence-based mental health and psychosocial support (MHPSS) in emergency settings is limited. It is difficult to monitor and evaluate the approach to MHPSS in informal refugee camps such as ‘The Jungle’ in Calais, where there are multiple service providers and where the majority of providers are volunteers. AIM: To identify experiences of MHPSS delivery by service providers in an informal camp environment in Calais, France and describe MHPSS barriers and opportunities in this type of setting. Method: Qualitative semi-structured interviews were conducted with 13 individuals from different organisations offering MHPSS in Calais and analysed using conventional content analysis. Results: Unsafe, uncertain and unsanitary conditions in the camp meant MHPSS was difficult to implement, and such conditions contributed to the poor mental health of the residents. The majority of MHPSS was offered by volunteers who lacked resources and training, and there was no overall official camp leadership which meant care was poorly coordinated and monitored. Strong relationships existed between volunteers and camp residents, but volunteers felt frustrated that they could not deliver the kind of MHPSS that they felt residents required. Conclusion: While long-term volunteers had built supportive relationships with camp residents, lack of central coordination and leadership of MHPSS services and limited access to trained professionals made implementation of MHPSS problematic. Similarly, the camp lacked the necessary infrastructure to meet residents’ basic needs. Formal recognition of the camp, and clear central leadership were identified as necessary steps to improving MHPSS delivery.

Keywords: calais, mental health, refugees, the jungle, MHPSS

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Authors: A. Kherraf, M. Bouziane, A. Drighil, L. Azzouzi, R. Habbal

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Objective: Myxomas are rare heart tumors most commonly found in the left atrium. The purpose of this observation is to report a rare case of myxoma of the right atrium revealed by pulmonary embolism. Observation: A 34-year-old patient with no history presented to the emergency room with sudden onset dyspnea. Clinical examination showed arterial pressure at 110/70mmHg, tachycardia at 110bpm, and 90% oxygen saturation. The ECG enrolled in incomplete right bundle branch block. The radio-thorax was normal. Echocardiography revealed the presence of a large homogeneous intra-OD mass, contiguous to the inter-atrial septum, prolapsing through the tricuspid valve, and causing mild tricuspid insufficiency, with dilation of the right ventricle and retained systolic function with PAPs estimated at 45mmHg. A chest scan was performed, revealing the presence of right segmental pulmonary embolism. The patient was put under anticoagulant and underwent surgical resection of the mass; its pathological examination concluded to a myxoma. The post-operative consequences were simple, without recurrence of the mass after one year follow-up. Discussion: Myxomas represent 50% of heart tumors. Most often, they originate in the left atrium, and more rarely in the right atrium or the ventricles. Myxoma of the right atrium can be responsible for life-threatening pulmonary embolism. The most predictive factor for embolization remains the morphology of the myxomas; papillary or villous myxomas are the most friable. Surgery is the standard treatment, with regular postoperative follow-up to detect recurrence. Conclusion: Myxomas of the right atrium are a rare location for these tumors. Pulmonary embolism is the main complication and should routinely involve careful study of the right chambers on echocardiography.

Keywords: pulmonary embolism, myxoma, right atrium, heart tumors

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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: Kodo Sektani, Apostolos Tsouvalas, Andrei Metrikine

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The reassessment of existing movable bridges in The Netherlands has created the need for acceptance/rejection criteria to assess whether the machineries are meet certain design demands. However, the existing design code defines a different limit state design, meant for new machineries which is based on a simple linear spring-mass model. Observations show that existing bridges do not confirm the model predictions. In fact, movable bridges are nonlinear systems consisting of mechanical components, such as, gears, electric motors and brakes. Next to that, each movable bridge is characterized by a unique set of parameters. However, in the existing code various variables that describe the physical characteristics of the bridge are neglected or replaced by partial factors. For instance, the damping ratio ζ, which is different for drawbridges compared to bascule bridges, is taken as a constant for all bridge types. In this paper, a model is developed that overcomes some of the limitations of existing modelling approaches to capture the dynamics of the powertrain of a class of bridge machineries First, a semidefinite dynamic model is proposed, which accounts for stiffness, damping, and some additional variables of the physical system, which are neglected by the code, such as nonlinear braking torques. The model gives an upper bound of the peak forces/torques occurring in the powertrain during emergency braking. Second, a discrete nonlinear dynamic model is discussed, with realistic motor torque characteristics during normal operation. This model succeeds to accurately predict the full time history of the occurred stress state of the opening and closing cycle for fatigue purposes.

Keywords: Dynamics of movable bridges, Bridge machinery, Powertrains, Torque measurements

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Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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Background and aims: While in Western countries, unilateral spinal anesthesia has been widely practiced for a long time, it remains little known in the local anesthesia community, and has not been the object of many studies. However, it is a simple, practical and effective technique. Our objective was to evaluate this practice in emergency anesthesia management in frail patients and to compare it with conventional spinal anesthesia. Methods: This is a prospective, observational, comparative study between hypobaric unilateral and conventional spinal anaesthesia for hip fracture surgery carried out in the operating room of the university military hospital of Staoueli. The work was spread over of 12-month period from 2019 to 2020. The parameters analyzed were hemodynamic variations, vasopressor use, block efficiency, postoperative adverse events, and postoperative morphine consumption. Results: -75 cases (mean age 72±14 years) -Group1= 41 patients (54.6%) divided into (ASA1=14.6% ASA2=60.98% ASA3=24.39%) single shoot spinal anaesthesia -Group2= 34 patients (45.3%) divided into (ASA1=2.9%, ASA2=26.4% ASA3=61.7%, ASA4=8.8%) unilateral hypobaric spinal anesthesia. -Hemodynamic variations were more severe in group 1 (51% hypotension) compared to 30% in group 2 RR=1.69 and odds ratio=2.4 -these variations were more marked in the ASA3 subgroup (group 1=70% hypotension versus group 2=30%) with an RR=2.33 and an odds ratio=5.44 -39% of group 1 required vasoactive drugs (15mg +/- 11) versus 32% of group 2 (8mg+/- 6.49) - no difference in the use of morphine in post-op. Conclusions: Within the limits of the population studied, this work demonstrates the clinical value of unilateral spinal anesthesia in ortho-trauma surgery in the frail patient.

Keywords: spinal anaesthesia, vasopressor, morphine, hypobaric unilateral spinal anesthesia, ropivacaine, hip surgery, eldery, hemodynamic

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Authors: Mukhtar Sarkin-Kebbi

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Insurgency, religious extremism and other related religious crises become hydra-headed in Nigeria, which caused destruction of human lives and properties worth of billions naira. As result, millions people were displaced and million children were out of school most of whom from Muslims community. The wrong teaching and misinterpretation of Islam by some Muslim community fuel the spread of extremist ideology hatred among Muslim sects, non-Muslims and emergency of extremist groups, like Boko Haram. A multi-religious country like Nigeria to realise its development in all human aspects, there must be unity and religious tolerance. Many agreed that changing the ideologies of insurgents and religious extremism will require intellectual role with vigorous campaign. Muslim scholars can play a vital role in promoting social reform and peaceful coexistence. This paper discusses the importance of unity among Muslim community and religious tolerance in light of the Qur’an and the Hadith. The paper also reviews the relationship between Muslims and non Muslims during the life time the Prophet (S.A.W.) in order to serve as exemplary model. Contemporary issues such as religious extremism, sectarians, intolerance and their consequences were examined. To minify religious intolerance and extremism,the paper identifies the roles to be played by Muslim scholars with references from Qur’an and Sunnah. The paper concludes that to realise overall human development and eternal salvation, Muslim should shun away from any religious crises and embrace unity and religious tolerance. Finally the paper recommends among others that only pious and learned scholars should be allowed to preach in any religious gathering, Muslim should exercise patience, tolerance in dealing with Muslims and non Muslims. Muslims should leave by example from the teaching of Qur’an and Sunnah of the Prophet (S.A.W.).

Keywords: Muslim scholars, peace building, religious extremism, religious tolerance

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Authors: Daniel Llanes, Alfredo Reyes, Sonia E. Ruiz, Federico Valenzuela Beltran

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Steel frames have been used in building construction for more than one hundred years. Beam-column may be connected to columns using either stiffened or unstiffened angles at the top and bottom beam flanges. Designers often assume that these assemblies acted as “pinned” connections for gravity loads and that the stiffened connections would act as “fixed” connections for lateral loads. Observation of damages sustained by buildings during the 1994 Northridge earthquake indicated that, contrary to the intended behavior, in many cases, brittle fractures initiated within the connections at very low levels of plastic demand, and in some cases, while the structures remained essentially elastic. Due to the damage presented in these buildings other type of alternative connections have been proposed. According to a research funded by the Federal Emergency Management Agency (FEMA), the screwed connections have better performance when they are subjected to cyclic loads, but at the same time, these connections have some degree of flexibility. Due to this situation, some researchers ventured into the study of semi-rigid connections. In the present study three steel buildings, constituted by regular frames are analyzed. Two types of connections are considered: pinned and semi-rigid connections. With the aim to estimate their structural capacity, a number of incremental dynamic analyzes are performed. 3D structural models are used for the analyses. The seismic ground motions were recorded on sites near Los Angeles, California, where the structures are supposed to be located. The vulnerability curves of the building are obtained in terms of maximum inter-story drifts. The vulnerability curves (which correspond to the models with two different types of connections) are compared, and its implications on its structural design and performance is discussed.

Keywords: steel frame Buildings, vulnerability curves, semi-rigid connections, pinned connections

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Authors: M. C. Teng, M. C. Ke, C. Y. Yang, S. S. Ke

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There are more than one thousand times a year of felt earthquakes in Taiwan. Because earthquakes are disaster threats to urban infrastructure, they often disrupt infrastructure services. For example, the highway system is very important to transportation infrastructure; however, it is vulnerable to earthquakes and typhoons in Taiwan. When a highway system is damaged by disaster, it will create a major impact on post-disaster communications and emergency relief and affect disaster relief works. In a study case on September 18th, 2022, the Taitung Chihshang earthquake, with a magnitude of 6.8 on the Richter scale with a depth of 7 km, caused one death; 171 people were injured and had a significant urban infrastructure impact. Hualien and Taitung areas have a large number of surface ruptures, road disruptions due to the collapses, over ten cases of bridges failure or closed, partial railroad section service shutdown, building collapses, and casualties. Taitung Chihshang earthquake, the peak ground acceleration is 585 gal (cm/s²), and the seismic intensity is Level 6 Upper(6+)in Chishang, Taitung County. After the earthquakes, we conducted on-site disaster investigation works in the disaster area; the disaster investigation works included a public and private building survey, a transportation facility survey, a total of ten damaged bridges, and one railroad station damaged were investigated in this investigation. The results showed that the affected locations were mainly concentrated along the Chihshang fault and the Yuli fault in the Huatung Longitudinal Valley. We recorded and described the impact and assessed its influence region in terms of its susceptibility to and the consequences of earthquake attacks. In addition, a lesson is learned from this study regarding the key issues after the Taitung Chihshang earthquake.

Keywords: earthquake, infrastructure, disaster investigation, lesson learned

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Authors: Helen Huang, Francisco Javier Quesada Ocet, Blanca Quesada Oce, Javier Jimenez Bello, Victor Palanca Gil, Alba Cervero Rubio, Ana Paya Chaume, Alejandro Herreros-Pomares, Fernando Vidal-Vanaclocha, Rafael Paya Serrano, Aurelio Quesada Dorador, Monica Soliman

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Background: Cancer favors both the pro-inflammatory state and autonomic dysfunction, two important mechanisms in the genesis of AF. Atrial remodeling might be caused as a result of paraneoplastic conditions or the result of direct expression of neoplasia. Here, we hypothesize that cancer, through inflammatory mediators, may favor the appearance of AF and patients with the first episode of AF could have a higher risk of developing cancer. Method: Data was collected from patients who attended the emergency department of our hospital for the first episode of AF, diagnosed electrocardiographically, between 2010-2015 (n = 712). The minimum follow-up was 2 years, recording the appearance of cancer, total mortality, recurrences of AF and other events. Patients who developed cancer and those who did not during the 2 years after the onset of AF were compared, as well as with the incidence of cancer in Spain in 2012. Results: After 2 years, 35 patients (4.91%) were diagnosed with cancer, with an annual incidence of 2.45%. Hematological neoplasms were the most frequent (34.28%). The cancer group was older (76.68 +/-12.75 years vs 74.16 +/-12.71; p <0.05) and had fewer typical symptoms (palpitations) (33.38% vs 14.28% , p <0.05). The incidence of cancer in Spain during 2012 was 0.46%, much lower than our sample. When comparing the incidence by age, these differences were maintained both in those over 65 years of age and in those under 65 years of age (2.17% vs. 0.28%; 0.28% vs. 0.18% respectively). Discussion: Therefore, a high incidence of cancer in patients with the first episode of AF was observed (the annual incidence of 2.45% after the onset of AF is 6.1 times that of the general population). After the evaluation of patients with AF in their first detected episode, surveillance of the appearance of cancer should be considered in clinical practice.

Keywords: cancer, cardiovascular outcomes, atrial fibrillation, inflammation

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Authors: Zhao Yu, Zhi-Nan Zhang

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More and more interactive devices are used in the transportation service system. Our mobile phones, on-board computers, and Head-Up Displays (HUDs) can all be used as the tools of the in-car service system. People can access smart systems with different terminals such as mobile phones, computers, pads and even their cars and watches. Different forms of terminals bring the different quality of interaction by the various human-computer Interaction modes. The new interactive devices require good ergonomics design at each stage of the whole design process. According to the theory of human factors and ergonomics, this paper compared three types of interactive devices by four driving tasks. Forty-eight drivers were chosen to experience these three interactive devices (mobile phones, on-board computers, and HUDs) by a simulate driving process. The subjects evaluated ergonomics performance and subjective workload after the process. And subjects were encouraged to support suggestions for improving the interactive device. The result shows that different interactive devices have different advantages in driving tasks, especially in non-driving tasks such as information and entertainment fields. Compared with mobile phones and onboard groups, the HUD groups had shorter response times in most tasks. The tasks of slow-up and the emergency braking are less accurate than the performance of a control group, which may because the haptic feedback of these two tasks is harder to distinguish than the visual information. Simulated driving is also helpful in improving the design of in-vehicle interactive devices. The paper summarizes the ergonomics characteristics of three in-vehicle interactive devices. And the research provides a reference for the future design of in-vehicle interactive devices through an ergonomic approach to ensure a good interaction relationship between the driver and the in-vehicle service system.

Keywords: human factors, industrial ergonomics, transportation system, usability, vehicle user interface

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Authors: Baluku Nathan

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Transferring critically ill patients from one health facility to another poses a major risk to the patient because of increased oxygen demands. transferring patients with critical COVID-19 from a rural health canter in a rural district to a national referral hospital over 350 km in 7 hours would require three size H oxygen cylinders for successful transfer. It was always difficult to arrange the three size cylinders in the ambulance as workspace was greatly compromised for the ambulance assistant. Purpose: The purpose of this study was to investigate the impact and effectiveness of transport ventilators on the transportation of the critically ill patients from rural health canters to national referral hospitals in Uganda. Methodology: This was a descriptive cross-sectional study conducted in sept 2022 among critical care nurses and ambulance assistants who had used both methods of transportation (ventilators and cylinders). A semi structured questionnaire was used to collect quantitative data after informed consent. Results: From the findings, distribution of transport ventilators to the regional referral hospitals by the Ministry of Health has gradually improved patient transfer as the team requires less than one size oxygen cylinder to successfully transfer a patient. We use two ambulance assistants (a critical care nurse and another nurse who has been trained on use of the ventilator) when transferring patients with critical COVID-19 as the teams have to interchange over the long distance. Conclusions: Transport ventilators are effective and efficient in transferring critically ill patients, therefore should be rolled out to lower levels coupled with user training to improve outcomes of patients transferred in ambulances in lower income countries.

Keywords: emergency medical technician, critically ill, COVID-19, transport ventilator

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