Search results for: hospital capacity planning

Authors: Elizelle Juanee Cilliers

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Recent planning thinking has laid the foundations for a general sense of best practice that aims to enhance the quality of life, suggesting an open and participatory process. It is accepted that integration of top-down and bottom-up approaches may lead to efficient action in environments and sustainable planning and development, although it is also accepted that such an integrated approach has various challenges of implementation. A flexible framework in which the strengths of both the top-down and bottom-up approaches were explored in this research, based on the EU Interreg VALUE Added project and five case studies where student education and student involvement played a crucial role within the participation process of the redesign of the urban environment. It was found that international student workshops were an effective tool to integrate bottom-up and top-down structures, as it acted as catalyst for communication, interaction, creative design, quick transformation from planning to implementation, building social cohesion, finding mutual ground between stakeholders and thus enhancing overall quality of life and quality of environments. It offered a good alternative to traditional participation modes and created a platform for an integrative planning approach. The role and importance of education and integration within the urban environment were emphasized.

Keywords: top-down, bottom-up, flexible, student involvement

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Authors: Javed Mohammed

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As urbanization process has been and will be happening in an unprecedented scale worldwide, strong requirements from academic research and practical fields for smart management and intelligent planning of cities are pressing to handle increasing demands of infrastructure and potential risks of inhabitants agglomeration in disaster management. Geo-spatial data and Geographic Information System (GIS) are essential components for building smart cities in a basic way that maps the physical world into virtual environment as a referencing framework. On higher level, GIS has been becoming very important in smart cities on different sectors. In the digital city era, digital maps and geospatial databases have long been integrated in workflows in land management, urban planning and transportation in government. People have anticipated GIS to be more powerful not only as an archival and data management tool but also as spatial models for supporting decision-making in intelligent cities. The purpose of this project is to offer observations and analysis based on a detailed discussion of Geographic Information Systems( GIS) driven Framework towards the development of Smart and Sustainable Cities through high penetration of Renewable Energy Technologies.

Keywords: digital maps, geo-spatial, geographic information system, smart cities, renewable energy, urban planning

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Authors: Parimalakrishnan Sundararjan, Madheswaran Murugan, Dhanya Dharman, Yatindra Kumar, Sudhir Singh Gangwar, Guru Prasad Mohanta

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Antibiotic resistance AR is a global issue, India started to redress the issues of antibiotic resistance late and it plans to have: active surveillance of microbial resistance and promote appropriate use of antibiotics. The present study attempted to achieve appropriate use of antibiotics through pharmacists’ intervention at practice point. In a quasi-experimental prospective cohort study, the cases with bacteremia from four hospitals were identified during 2015 and 2016 for intervention. The pharmacists centered intervention: active screening of each prescription and comparing with the selection of antibiotics with susceptibility of the bacteria. Wherever irrationality noticed, it was brought to the notice of the treating physician for making changes. There were two groups: intervention group and control group without intervention. The active screening and intervention in 915 patients has reduced therapeutic regimen time in patients with bacteremia. The intervention group showed the decreased duration of hospital stay 3.4 days from 5.1 days. Further, multivariate modeling of patients who were in control group showed that patients in the intervention group had a significant decrease in both duration of hospital stay and infection-related mortality. Unlike developed countries, pharmacists are not active partners in patient care in India. This unique attempt of pharmacist’ invention was planned in consultation with hospital authorities which proved beneficial in terms of reducing the duration of treatment, hospital stay, and infection-related mortality. This establishes the need for a collaborative decision making among the health workforce in patient care at least for promoting rational use of antibiotics, an attempt to combat resistance.

Keywords: antibiotics resistance, intervention, bacteremia, multivariate modeling

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Authors: Inayatullah Khan, Afzal Khan, Hamzullah Khan, Afzal Khan

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Objectives: The objective of this study was to compare different statistical variables for vaccinated and unvaccinated children in measles cases. Material and Methods: This cross sectional comparative study was conducted at Isolation ward, Department of Paediatrics, Lady Reading Hospital (LRH), Peshawar, from April 2012 to March 2013. A total of 566 admitted cases of measles were enrolled. Data regarding age, sex, address, vaccination status, measles contact, hospital stay and outcome was collected and recorded on a proforma. History of measles vaccination was ascertained either by checking the vaccination cards or on parental recall. Result: In 566 cases of measles, 211(39%) were vaccinated and 345 (61%) were unvaccinated. Three hundred and ten (54.80%) patients were males and 256 (45.20%) were females with a male to female ratio of 1.2:1.The age range was from 1 year to 14 years with mean age with SD of 3.2 +2 years. Majority (371, 65.5%) of the patients were 1-3 years old. Mean hospital stay was 3.08 days with a range of 1-10 days and a standard deviation of ± 1.15. History of measles contact was present in 393 (69.4%) cases. Fourty eight patients were expired with a mortality rate of 8.5%. Conclusion: Majority of the children in Khyber Pukhtunkhwa are unvaccinated and unprotected against measles. Among vaccinated children, 39% of children attracted measles which indicate measles vaccine failure. This figure is clearly higher than that accepted for measles vaccine (2-10%).

Keywords: measles, vaccination, immunity, population

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Authors: Fernando Augusto Ullmann Tobe, Moacyr Amaral Domingues, Figueiredo, Stephany Rie Yamamoto Gushiken

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The purpose of this paper is to present the process of elaborating the layout of an assembly line of a welding industry using the principles of lean manufacturing as the main driver. The objective of this paper is relevant since the current layout of the assembly line causes non-productive times for operators, being related to the lean waste of unnecessary movements. The methodology used for the project development was Project-based Learning (PBL), which is an active way of learning focused on real problems. The process of selecting the methodology for layout planning was developed considering three criteria to evaluate the most relevant one for this paper's goal. As a result of this evaluation, Systematic Layout Planning was selected, and three steps were added to it – Value Stream Mapping for the current situation and after layout changed and the definition of lean tools and layout type. This inclusion was to consider lean manufacturing in the layout redesign of the industry. The layout change resulted in an increase in the value-adding time of operations carried out in the sector, reduction in movement times between previous and final assemblies, and in cost savings regarding the man-hour value of the employees, which can be invested in productive hours instead of movement times.

Keywords: assembly line, layout, lean manufacturing, systematic layout planning

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Authors: Ahmed M. Al-Mahbashi, Mosleh A. Al-Shamrani, Muawia Dafalla

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Mixtures of sand and clay are frequently used to serve for specific purposes in several engineering practices. In environmental engineering, liner layers and cover layers are common for controlling waste disposal facilities. These layers are exposed to moisture and temperature fluctuation specially when existing in unsaturated condition. The relationship between soil suction and water content for these materials is essential for understanding their unsaturated behavior and properties such as retention capacity and unsaturated follow (hydraulic conductivity). This study is aimed at investigating retention capacity for two sand-natural expansive clay mixtures (15% (C15) and 30% (C30) expansive clay) at two ambient temperatures within the range of 5 -50 °C. Soil water retention curves (SWRC) for these materials were determined at these two ambient temperatures using different salt solutions for a wide range of suction (up to 200MPa). The results indicate that retention capacity of C15 mixture underwent significant changes due to temperature variations. This effect tends to be less visible when the clay fraction is doubled (C30). In addition, the overall volume change is marginally affected by high temperature within the range considered in this study.

Keywords: soil water retention curve, sand-expansive clay liner, suction, temperature

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Authors: Lillian Musila, Valerie Oundo, Daniel Erwin, Willie Sang

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Staphylococcus aureus infections are a major cause of nosocomial infections in Kenya. Methicillin resistant S. aureus (MRSA) infections are a significant burden to public health and are associated with considerable morbidity and mortality. At a hospital in Western Kenya two clusters of MRSA cases emerged within short periods of time. In this study we explored whether these clusters represented a nosocomial outbreak by characterizing the isolates using phenotypic and molecular assays and examining epidemiological data to identify possible transmission patterns. Specimens from the site of infection of the subjects were collected, cultured and S. aureus isolates identified phenotypically and confirmed by APIStaph™. MRSA were identified by cefoxitin disk screening per CLSI guidelines. MRSA were further characterized based on their antibiotic susceptibility patterns and spa gene typing. Characteristics of cases with MRSA isolates were compared with those with MSSA isolated around the same time period. Two cases of MRSA infection were identified in the two week period between 21 April and 4 May 2015. A further 2 MRSA isolates were identified on the same day on 7 September 2015. The antibiotic resistance patterns of the two MRSA isolates in the 1st cluster of cases were different suggesting that these were distinct isolates. One isolate had spa type t2029 and the other had a novel spa type. The 2 isolates were obtained from urine and an open skin wound. In the 2nd cluster of MRSA isolates, the antibiotic susceptibility patterns were similar but isolates had different spa types: one was t037 and the other a novel spa type different from the novel MRSA spa type in the first cluster. Both cases in the second cluster were admitted into the hospital but one infection was community- and the other hospital-acquired. Only one of the four MRSA cases was classified as an HAI from an infection acquired post-operatively. When compared to other S. aureus strains isolated within the same time period from the same hospital only one spa type t2029 was found in both MRSA and non-MRSA strains. None of the cases infected with MRSA in the two clusters shared any common epidemiological characteristic such as age, sex or known risk factors for MRSA such as prolonged hospitalization or institutionalization. These data suggest that the observed MRSA clusters were multi strain clusters and not an outbreak of a single strain. There was no clear relationship between the isolates by spa type suggesting that no transmission was occurring within the hospital between these cluster cases but rather that the majority of the MRSA strains were circulating in the community. There was high diversity of spa types among the MRSA strains with none of the isolates sharing spa types. Identification of disease clusters in space and time is critical for immediate infection control action and patient management. Spa gene typing is a rapid way of confirming or ruling out MRSA outbreaks so that costly interventions are applied only when necessary.

Keywords: cluster, Kenya, MRSA, spa typing

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Authors: Feten Chihi, Gabriella Varga

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The world's most prevalent waste management strategy is landfills. However, it grew more difficult due to a lack of acceptable waste sites. In order to develop larger landfills and extend their lifespan, the purpose of this article is to expand the capacity of the construction by varying the slope's inclination and to examine its effect on the safety factor. The capacity change with tilt is mathematically determined. Using a new probabilistic calculation method that takes into account the heterogeneity of waste layers, the safety factor for various slope angles is examined. To assess the effect of slope variation on the overall safety of landfills, over a hundred computations were performed for each angle. It has been shown that capacity increases significantly with increasing inclination. Passing from 1:3 to 2:3 slope angles and from 1:3 to 1:2 slope angles, the volume of garbage that can be deposited increases by 40 percent and 25 percent, respectively, of the initial volume. The results of the safety factor indicate that slopes of 1:3 and 1:2 are safe when the standard method (homogenous waste) is used for computation. Using the new approaches, a slope with an inclination of 2:3 can be deemed safe, despite the fact that the calculation does not account for the safety-enhancing effect of daily cover layers. Based on the study reported in this paper, the malty layered nonhomogeneous calculating technique better characterizes the safety factor. As it more closely resembles the actual state of landfills, the employed technique allows for more flexibility in design parameters. This work represents a substantial advance in limiting both safe and economical landfills.

Keywords: landfill, municipal solid waste, slope inclination, capacity, safety factor

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Authors: Lilian Mbinya Muasa

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Climate change is inevitable and a global challenge with long term implications to the sustainable development of many countries today. The negative impacts of climate change are creating far reaching social, economic and environmental problems threatening lives and livelihoods of millions of people in the world. Developing countries especially sub-Saharan countries are more vulnerable to climate change due to their weak ecosystem, low adaptive capacity and high dependency on rain fed agriculture. Countries in Sub-Saharan Africa are more vulnerable to climate change impacts due to their weak adaptive capacity and over-reliance on rain fed agriculture. In Kenya, 78% of the rural communities are poor farmers who heavily rely on rain fed agriculture thus are directly affected by climate change impacts.Currently, many parts of Kenya are experiencing successive droughts which are contributing to persistently unstable and declining agricultural productivity especially in semi arid eastern Kenya. As a result, thousands of rural communities repeatedly experience food insecurity which plunge them to an ever over-reliance on relief food from the government and Non-Governmental Organization In addition, they have adopted poverty coping strategies to diversify their income, for instance, deforestation to burn charcoal, sand harvesting and overgrazing which instead contribute to environmental degradation.This research was conducted in Makueni County which is classified as one of the most food insecure counties in Kenya and experiencing acute environmental degradation. The study aimed at analyzing the adaptive capacity to climate change across farming households of Makueni County in Kenya by, 1) analyzing adaptive capacity to climate change and agricultural productivity across farming households, 2) identifying factors that contribute to differences in adaptive capacity across farming households, and 3) understanding the relationship between climate change, agricultural productivity and adaptive capacity. Analytical Hierarchy Process (AHP) was applied to determine adaptive capacity and Total Factor Productivity (TFP) to determine Agricultural productivity per household. Increase in frequency of prolonged droughts and scanty rainfall. Preliminary findings indicate a magnanimous decline in agricultural production in the last 10 years in Makueni County. In addition, there is an over reliance of households on indigenous knowledge which is no longer reliable because of the unpredictability nature of climate change impacts. These findings on adaptive capacity across farming households provide the first step of developing and implementing action-oriented climate change policies in Makueni County and Kenya.

Keywords: adaptive capacity, agricultural productivity, climate change, vulnerability

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Authors: Hind Bouami

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Handling life-critical systems complexity requires to be equipped with appropriate technology and the right human agents’ functions such as knowledge, experience, and competence in problem’s prevention and solving. Human agents are involved in the management and control of human-machine system’s performance. Documenting human agent’s situation awareness is crucial to support human-machine designers’ decision-making. Knowledge about risks, critical parameters and factors that can impact and threaten automation system’s performance should be collected using preventive and retrospective approaches. This paper aims to document operators’ situation awareness through the analysis of automated organizations’ feedback. The analysis of automated hospital pharmacies feedbacks helps to identify and control critical parameters influencing human machine interaction in order to enhance system’s performance and security. Our human machine system evaluation approach has been deployed in Macon hospital center’s pharmacy which is equipped with automated drug dispensing systems since 2015. Automation’s specifications are related to technical aspects, human-machine interaction, and human aspects. The evaluation of drug delivery automation performance in Macon hospital center has shown that the performance of the automated activity depends on the performance of the automated solution chosen, and also on the control of systemic factors. In fact, 80.95% of automation specification related to the chosen Sinteco’s automated solution is met. The performance of the chosen automated solution is involved in 28.38% of automation specifications performance in Macon hospital center. The remaining systemic parameters involved in automation specifications performance need to be controlled.

Keywords: life-critical systems, situation awareness, human-machine interaction, decision-making

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Authors: Waseim Ragab Azzam Ahmed Mohamed Nasr, Aalaa Ibrahim Khater

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Torsional loads from offshore wind turbines, waves, wind, earthquakes, ship collisions in the maritime environment, and electrical transmission towers might affect the pile foundations. Torsional loads can also be caused by the axial load from the sustaining structures. The paper introduces the finned pile, an alternative method of pile modification. The effects of torsional loads were investigated through a series of experimental tests aimed at improving the torsional capacity of a single pile in the sand (where sand was utilized in a state of medium density (Dr = 50%), with or without fins. In these tests, the fins' length, width, form, and number were varied to see how these attributes affected the maximum torsional capacity of the piles. We have noticed the torsion-rotation reaction. The findings demonstrated that the fins improve the maximum torsional capacity of the piles. It was demonstrated that a length of 0.6 times the embedded pile's length and a width equivalent to the pile's diameter constitute the optimal fin geometry. For the conventional pile and the finned pile, the maximum torsional capacities were determined to be 4.12 N.m. and 7.36 N.m., respectively. When subjected to torsional loads, the fins' presence enhanced the piles' maximum torsional capacity by almost 79%.

Keywords: clean sand, finned piles, model tests, torsional load

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Authors: Mintesinot Teshome Mengsha

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Reinforced concrete structural walls are provided in structures to decrease horizontal displacements under seismic loads. The cyclic lateral load resistance capacity of a structural wall is controlled by two parameters, the strength and the ductility; it is better to have the shear strength somewhat greater than the compression to prevent shear failure, which is brittle, sudden and of serious consequence. Due to architectural and functional reasons, small openings are provided in this important structural part. The main objective of this study is to investigate the finite element of RC structural walls with small openings subjected to cyclic load using the finite element approach. The experimental results in terms of load capacity, failure mode, crack pattern, flexural strength, shear strength, and deformation capacity.

Keywords: ABAQUS, finite element method, small openings, reinforced concrete structural walls

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Authors: To Quyen Le, Oswald Devisch, Tu Anh Trinh, Els Hannes

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Urban centres worldwide are affected differently by flooding. In Vietnam this impact is increasingly negative caused by a process of rapid urbanisation. Traditional spatial planning and flood mitigation planning are not able to deal with this growing threat. This article therefore proposes to focus on increasing the participation of local communities in flood control and management. It explores, on the basis of a design studio exercise, how lay knowledge on flooding can be integrated within planning processes. The article presents a theoretical basis for the structured criterion for site selection for a flood resilient urban park from the perspective of science, then discloses the tacit and explicit knowledge of the flood-prone area and finally integrates this knowledge into the design strategies for flood resilient urban park design.

Keywords: analytic hierarchy process, AHP, design resilience, flood resilient urban park, knowledge integration

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Authors: Mehran Barani Shikhrobat, Roger Flanagan

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The construction planning and scheduling based on using the current tools and techniques is resulted deterministic in nature (Gantt chart, CPM) or applying a very little probability of completion (PERT) for each task. However, every project embodies assumptions and influences and should start with a complete set of clearly defined goals and constraints that remain constant throughout the duration of the project. Construction planners continue to apply the traditional methods and tools of “hard” project management that were developed for “ideal projects,” neglecting the potential influence of complexity on the design and construction process. The aim of this research is to investigate the emergence and growth of complexity in project planning and to provide a model to consider the influence of complexity on the total project duration at the post-contract award pre-construction stage of a project. The literature review showed that complexity originates from different sources of environment, technical, and workflow interactions. They can be divided into two categories of complexity factors, first, project tasks, and second, project organisation management. Project tasks may originate from performance, lack of resources, or environmental changes for a specific task. Complexity factors that relate to organisation and management refer to workflow and interdependence of different parts. The literature review highlighted the ineffectiveness of traditional tools and techniques in planning for complexity. However, this research focus on understanding the fundamental causes of the complexity of construction projects were investigated through a questionnaire with industry experts. The results were used to develop a model that considers the core complexity factors and their interactions. System dynamics were used to investigate the model to consider the influence of complexity on project planning. Feedback from experts revealed 20 major complexity factors that impact project planning. The factors are divided into five categories known as core complexity factors. To understand the weight of each factor in comparison, the Analytical Hierarchy Process (AHP) analysis method is used. The comparison showed that externalities are ranked as the biggest influence across the complexity factors. The research underlines that there are many internal and external factors that impact project activities and the project overall. This research shows the importance of considering the influence of complexity on the project master plan undertaken at the post-contract award pre-construction phase of a project.

Keywords: project planning, project complexity measurement, planning uncertainty management, project risk management, strategic project scheduling

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Authors: C. Salis, D. Zedda, M. F. Wilson

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The IDEA project was conceived for teachers who are interested in enhancing their capacity to effectively implement the use of specific technologies in their teaching practice. Participating teachers are coached and supported as they explore technologies applied to the educational context. They access tools such as the technological platform developed by our team. Among the platform functionalities, teachers access an instructional systems design (ISD) tool (learning designer) that was adapted to the needs of our project. The tool is accessible from computers or mobile devices and used in association with other technologies to create new, meaningful learning environments. The objective of an instructional systems design is to guarantee the quality and effectiveness of education and to enhance learning. This goal involves both teachers who want to become more efficient in transferring knowledge or skills and students as the final recipient of their teaching. The use of Blooms’s taxonomy enables teachers to classify the learning objectives into levels of complexity and specificity, thus making it possible to highlight the kind of knowledge teachers would like their students to reach. The fact that the instructional design features can be visualized through the IDEA platform is a guarantee for those who are looking for specific educational materials to be used in their lessons. Despite the benefits offered, a number of teachers are reluctant to use ISD because the preparatory work of having to thoroughly analyze the teaching/learning objectives, the planning of learning material, assessment activities, etc., is long and felt to be time-consuming. This drawback is minimized using a learning designer, as the tool facilitates to reuse of the didactic contents having a clear view of the processes of analysis, planning, and production of educational or testing materials uploaded on our platform. In this paper, we shall present the feedback of the teachers who used our tool in their didactic.

Keywords: educational benefits, educational quality, educational technology, ISD tool

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Authors: N. Khursheed, M. Fatima, S. Jamal, A. Raza, S. Rattani, Q. Ahsan, A. Rasheed, M. Jawed

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Introduction: Antibiotics are among the commonly prescribed medicines to treat bacterial infections. Their misuse intensifies resistance, and overuse incurs heavy losses to the healthcare system in terms of increased treatment costs and enhanced disease burden. Studies show that 40% of empirically used antibiotics are irrationally utilized. The objective of this study was to evaluate prescribing pattern of antibiotics at six public sector tertiary care hospitals across Pakistan. Methods: A multicenter cross-sectional point prevalence survey (PPS) was conducted in selected wards of six public sector tertiary care hospitals in Pakistan as part of the Clinical Engagement program by Fleming Fund Country Grant Pakistan in collaboration with Indus Hospital & Health Network (IHHN) from February to March 2021, these included Jinnah Postgraduate Medical Center and Dr. Ruth K. M. Pfau Civil Hospital from Karachi, Sheikh Zayed Hospital Lahore, Nishtar Medical University Hospital Multan, Medical Teaching Institute Hayatabad Medical Complex Peshawar, and Provincial Headquarters Hospital Gilgit. WHO PPS methodology was used for data collection (Hospital, ward, and patient level data was collected). Data was entered into the open-source Kobo Collect application and was analyzed using SPSS (version 22.0). Findings: Medical records of 837 in-patients were surveyed, of which the prevalence of antibiotics use was 78.5%. The most commonly prescribed antimicrobial was Ceftriaxone (21.7%) which is categorized in the Watch group of WHO AWaRe Classification, followed by Metronidazole (17.3%), Cefoperazone/Sulbactam (8.4%), Co-Amoxiclav (6.3%) and Piperacillin/Tazobactam (5.9%). The antibiotics were prescribed largely for surgical prophylaxis (36.7%), followed by community-acquired infections (24.7%). One antibiotic was prescribed to 46.7%, two to 39.9%, and three or more to 12.5 %. Two of six (30%) hospitals had functional drug and therapeutic committees, three (50%) had infection prevention and control committees, and one facility had an antibiotic formulary. Conclusion: Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasizes the importance of expanding the antimicrobial stewardship program. Mentoring clinical teams will help to rationalize antimicrobial use.

Keywords: antimicrobial resistance, antimicrobial stewardship, point prevalence survey, antibiotics

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Authors: Robert Pintaric, Joze Matela, Stefan Pintaric, Stanka Vadnjal

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Introduction: This work is aimed to represent the use of the OPTI-JET CS MD1 MR prototype for application of neutral electrolyzed oxidizing water (NEOW) in magnetic resonance rooms. Material and Methods: We produced and used OPTI-JET CS MD1 MR aerosolisator whereby was performed aerosolization. The presence of microorganisms before and after the aerosolisation was recorded with the help of cyclone air sampling. Colony formed units (CFU) was counted. Results: The number of microorganisms in magnetic resonance 3T room was low as expected. Nevertheless, a possible CFU reduction of 87% was recorded. Conclusions: The research has shown that the use of EOW for the air and hard surface disinfection can considerably reduce the presence of microorganisms and consequently the possibility of hospital infections. It has also demonstrated that the use of OPTI-JET CS MD1 MR is very good. With this research, we started new guidelines for aerosolization in magnetic resonance rooms. Future work: We predict that presented technique works very good but we must focus also on time capacity sensors, and new appropriate toxicological studies.

Keywords: biocide, electrolyzed oxidizing water (EOW), disinfection, microorganisms, OPTI-JET CS MD1MR

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Authors: S. I. Nwadioha, M. S. Odimayo, G. T. A. Jombo, E. O. P. Nwokedi

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Aims and Objectives: To determine the baseline CD4 positive T lymphocytes count of HIV/AIDS treatment naïve adults clients presenting for the first time treatment in Benue State University Teaching Hospital. Subjects and Methods: A total of 700 subjects age between 18 years to 70 years, were recruited for the study, comprising 600 HIV sero-positive patients and 100 healthy controls in Benue State University Teaching Hospital, Makurdi from 2013 to 2014. The CD4 counts of the subjects were evaluated using a Partec flow cytometer. Results: CD4 count of 200-299 cells/μl peaked with 25% (n=150/600)[control; 0%( n= 0/100)]. The study also showed that 44% (266/600) of HIV subjects had acquired immunodeficiency syndrome as defined by low CD4 counts below 200 cells/μl. Seventy-five per cent (n=451/600)of our patients would require to be placed on antiretroviral therapy with CD4 count of less than 350 cells/μl. At CD4 350 baseline criterion, age group 20-29 years had the highest demand 35%(160/451) for ARV followed by age groups 30-39 and 40-49 years with 28%(128/451) and 22%(98/451) respectively. Conclusion: There is a high prevalence of acquired immunodeficiency syndrome as defined by CD4 counts below 200 cells/μl, among the young active productive age group. The strict adopting of the ART WHO 2010 scale- up criteria doubles the number of the HIV clients that would qualify for ART with its attendant health benefits on the long run.

Keywords: CD4 counts, HIV patients, young age group, Nigeria

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Authors: Muwaffaq Usman Adam, Isaac Quaye, Jim Anbazu, Yetimoni Kpeebi, Michael Osei-Assibey

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Urban informality, characterized by spontaneous and self-organized practices, plays a significant but often overlooked role in shaping the development of cities, particularly in the context of mixed-use and compact urban environments. This paper aims to explore the invisible planning processes inherent in informal practices and their influence on the urban form of Ghanaian cities. By examining the dynamic interplay between informality and formal planning, the study will discuss the ways in which informal actors shape and plan for mixed-use and compact development. Drawing on the synthesis of relevant secondary data, the research will begin by defining urban informality and identifying the factors that contribute to its prevalence in Ghanaian cities. It will delve into the concept of mixed-use and compact development, highlighting its benefits and importance in urban areas. Drawing on case studies, the paper will uncover the hidden planning processes that occur within informal settlements, showcasing their impact on the physical layout, land use, and spatial arrangements of Ghanaian cities. The study will also uncover the challenges and opportunities associated with informal planning. It examines the constraints faced by informal planners (actors) while also exploring the potential benefits and opportunities that emerge when informality is integrated into formal planning frameworks. By understanding the invisible planner, the research will offer valuable insights into how informal practices can contribute to sustainable and inclusive urban development. Based on the findings, the paper will present policy implications and recommendations. It highlights the need to bridge the policy gaps and calls for the recognition of informal planning practices within formal systems. Strategies are proposed to integrate informality into planning frameworks, fostering collaboration between formal and informal actors to achieve compact and mixed-use development in Ghanaian cities. This research underscores the importance of recognizing and leveraging the invisible planner in Ghanaian cities. By embracing informal planning practices, cities can achieve more sustainable, inclusive, and vibrant urban environments that meet the diverse needs of their residents. This research will also contribute to a deeper understanding of the complex dynamics between informality and planning, advocating for inclusive and collaborative approaches that harness the strengths of both formal and informal actors. The findings will likewise contribute to advancing our understanding of informality's role as an invisible yet influential planner, shedding light on its spatial planning implications on Ghanaian cities.

Keywords: informality, mixed-uses, compact development, land use, ghana

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Authors: Saeed Delara, Kendra MacKay

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Varying methodologies are considered for pile design for both Russian and Western approaches. Although both approaches rely on toe and side frictional resistances, different calculation methods are proposed to estimate pile capacity. The Western approach relies on compactness (internal friction angle) of soil for cohesionless soils and undrained shear strength for cohesive soils. The Russian approach relies on grain size for cohesionless soils and liquidity index for cohesive soils. Though most recommended methods in the Western approaches are relatively simple methods to predict pile settlement, the Russian approach provides a detailed method to estimate single pile and pile group settlement. Details to calculate pile axial capacity and settlement using the Russian and Western approaches are discussed and compared against field test results.

Keywords: pile capacity, pile settlement, Russian approach, western approach

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Authors: Sofia Hartati

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This research is aimed at describing training in early childhood education program empirically, describing teachers ability to plan lessons empirically, and acquiring empirical data as well as analyzing the influence of guided and independent training toward teachers competence in planning early childhood learning program. The method used is an experiment. It collected data with a population of 76 early childhood educators in Tunjung Teja Sub District area through random sampling technique and grouped into two namely 38 people in an experiment class and 38 people in a controlled class. The technique used for data collections is a test. The result of the research shows that there is a significant influence between training for guided educators toward Teachers Ability toward Planning Early Childhood Learning Program. Guided training has been proven to improve the ability to comprehend planning a learning program. The ability to comprehend planning a learning program owned by teachers of early childhood program comprises of 1) determining the characteristics and competence of students prior to learning; 2) formulating the objective of the learning; 3) selecting materials and its sequences; 4) selecting teaching methods; 5) determining the means or learning media; 6) selecting evaluation strategy as a part of teachers pedagogic competence. The result of this research describes a difference in the competence level of teachers who have joined guided training which is relatively higher than the teachers who joined the independent training. Guided training is one of an effective way to improve the knowledge and competence of early childhood educators.

Keywords: competence, planning, teachers, training

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Authors: А. I. Dovgyalo, S. O. Nekrasova, D. V. Sarmin, A. A. Shimanov, D. A. Uglanov

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Usually liquefied natural gas (LNG) gasification is performed due to atmospheric heat. In order to produce a liquefied gas a sufficient amount of energy is to be consumed (about 1 kW∙h for 1 kg of LNG). This study offers a number of solutions, allowing using a cold energy of LNG. In this paper it is evaluated the application turbines installed behind the evaporator in LNG complex due to its work additional energy can be obtained and then converted into electricity. At the LNG consumption of G=1000kg/h the expansion work capacity of about 10 kW can be reached. Herewith-open Rankine cycle is realized, where a low capacity cryo-pump (about 500W) performs its normal function, providing the cycle pressure. Additionally discussed an application of Stirling engine within the LNG complex also gives a possibility to realize cold energy. Considering the fact, that efficiency coefficient of Stirling engine reaches 50 %, LNG consumption of G=1000 kg/h may result in getting a capacity of about 142 kW of such a thermal machine. The capacity of the pump, required to compensate pressure losses when LNG passes through the hydraulic channel, will make 500 W. Apart from the above-mentioned converters, it can be proposed to use thermoelectric generating packages (TGP), which are widely used now. At present, the modern thermoelectric generator line provides availability of electric capacity with coefficient of efficiency up to 15%. In the proposed complex, it is suggested to install the thermoelectric generator on the evaporator surface is such a way, that the cold end is contacted with the evaporator’s surface, and the hot one – with the atmosphere. At the LNG consumption of G=1000 kgг/h and specified coefficient of efficiency the capacity of the heat flow Qh will make about 32 kW. The derivable net electric power will be P=4,2 kW, and the number of packages will amount to about 104 pieces. The carried out calculations demonstrate the research perceptiveness in this field of propulsion plant development, as well as allow realizing the energy saving potential with the use of liquefied natural gas and other cryogenics technologies.

Keywords: cold energy, gasification, liquefied natural gas, electricity

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Authors: Somayeh Abedian, Pirhossein Kolivand, Hamid Reza Lornejad, Amin Karampour, Ebrahim Keshavarz Safari

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For emergency and relief service providers such as pre-hospital emergencies, quick arrival at the scene of an accident or any EMS mission is one of the most important requirements of effective service delivery. Response time (the interval between the time of the call and the time of arrival on scene) is a critical factor in determining the quality of pre-hospital Emergency Medical Services (EMS). This is especially important for heart attack, stroke, or accident patients. Location-based e-services can be broadly defined as any service that provides information pertinent to the current location of an active mobile handset or precise address of landline phone call at a specific time window, regardless of the underlying delivery technology used to convey the information. According to research, one of the effective methods of meeting this goal is determining the location of the caller via the cooperation of landline and mobile phone operators in the country. The follow-up of the Communications Regulatory Authority (CRA) organization has resulted in the receipt of two separate secured electronic web services. Thus, to ensure human privacy, a secure technical architecture was required for launching the services in the pre-hospital EMS information management system. In addition, to quicken medics’ arrival at the patient's bedside, rescue vehicles should make use of an intelligent transportation system to estimate road traffic using a GPS-based mobile navigation system independent of the Internet. This paper seeks to illustrate the architecture of the practical national model used by the Iranian EMS organization.

Keywords: response time, geographic location inquiry service (GLIS), location-based service (LBS), emergency medical services information system (EMSIS)

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Authors: Kenechi Kurtis Onochie

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This paper shows the use of filter paper technique in the measurement of matric suction of unsaturated expansive soil around the Haspolat region of Lefkosa, North Cyprus in other to establish the soil water characteristics curve (SWCC) or soil water retention curve (SWRC). The dry filter paper approach which is standardized by ASTM, 2003, D 5298-03 in which the filter paper is initially dry was adopted. The whatman No. 42 filter paper was used in the matric suction measurement. The maximum dry density of the soil was obtained as 2.66kg/cm³ and the optimum moisture content as 21%. The soil was discovered to have high air entry value of 1847.46KPa indicating finer particles and 25% hydraulic capacity using filter paper technique. The filter paper technique proved to be very useful for measuring the hydraulic capacity of unsaturated expansive soil.

Keywords: SWCC, matric suction, filter paper, expansive soil

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Authors: Rosalina Penaloza, Joanna Navarro, Pauline Jolly, Anna Junkins, Carlos Seas, Larissa Otero

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Background: Tuberculosis (TB) case detection in Peru relies on passive case finding. This strategy relies on the assumption that the community is aware that a persistent cough is a possible symptom of TB and that formal health care needs to be sought. Despite its importance, health knowledge specific to TB is underexplored in Peru. This study aimed to assess health literacy and level of TB knowledge among outpatients attending a referral hospital in Lima, Peru. The goal was to ascertain knowledge gaps in key areas relating to TB, to identify and prioritize subgroups for intervention, and to provide insight for policy and community interventions considering health literacy. Methods: An observational cross-sectional study was conducted using a survey to measure sociodemographic factors, tuberculosis knowledge, and health literacy. Bivariate and Multivariate logistic regression was performed to study the associations between variables and to account for potential confounders. The study was conducted at Hospital Cayetano Heredia in Lima, Peru from June – August 2017. Results: 272 participants were included in the analysis. 57.7% knew someone who had had TB before, 9% had had TB in the past. Two weeks a cough was correctly identified as a symptom that could be TB by 69.1%. High TB knowledge was found among 149 (54.8%) participants. High health literacy was found among 193 (71.0%) participants. Health literacy and TB knowledge were not significantly associated (OR 0.9 (95%CI 0.5-1.5)). After controlling for sex, age, district, education, health insurance, frequency of hospital visits and previous TB diagnosis: High TB knowledge was associated with knowing someone with TB (aOR 2.7 (95%CI 1.6-4.7)) and being a public transport driver, (aOR 0.2 (95%CI 0.05-0.9)). Not being poor was the single factor associated with high health literacy (aOR 3.8 (95%CI 1.6-8.9)). Conclusions: TB knowledge was fair, though 30% did not know the most important symptom of TB. Tailoring educational strategies to risk groups may enhance passive case detection especially amongst transport workers in Lima, Peru.

Keywords: health literacy, Peru, tuberculosis, tuberculosis knowledge

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Authors: Peter Burggräf, Moritz Krunke, Hanno Voet

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Due to shortening product and technology lifecycles, many companies use standardization approaches in product development and factory planning to reduce costs and time to market. Unlike large companies, where modular systems are already widely used, small and medium-sized companies often show a much lower degree of standardization due to lower scale effects and missing capacities for the development of these standards. To overcome these challenges, the development of industry sector specific standards in cooperations or by third parties is an interesting approach. This paper analyzes which branches that are mainly dominated by small or medium-sized companies might be especially interesting for the development of factory standards using the example of the German industry. For this, a key performance indicator based approach was developed that will be presented in detail with its specific results for the German industry structure.

Keywords: factory planning, factory standards, industry sector specific standardization, production planning

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Authors: F. N. Bolu-Steve, T. A. Ajiboye

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A study was carried out on the awareness of counselling needs of psychiatric patients as perceived by medical personnel in the Federal Neuropsychiatric hospital, Aro, Abeokuta, Nigeria. The respondents comprised of medical personnel of the Neuropsychiatric hospital in Aro. Purposive sampling technique was used to select the respondents. The target population of the study consisted of all medical doctors treating the psychiatric patients. A total of 200 respondents participated in the study out of which 143 were males and 57 of them were females. With their years of experience as a medical doctors, 49.5% of them have worked between 1-5 years, 30.5% of the respondents have 6-10 years’ experience while those with 16 years and above experience are 7.0%. The major counselling need of psychiatric patients as expressed by medical doctors is the need to have information about the right balance diet. The data were analyzed using percentages, mean, frequency, Analysis of Variance (ANOVA) and t-test statistical tools. The instrument used for data collection was the structured questionnaire titled “Counselling Needs of Psychiatric Patients Questionnaire” (CNPPQ). This instrument was drafted by the researchers through the review of related literature. The reliability of the instrument was established using test-retest method. A reliability index of 0.74 was obtained. Three of the hypotheses were rejected while two of them were accepted at 0.05 alpha level of significance. Based on the findings of the study, it was recommended that broad based counselling services should be provided to psychiatric patients in order to assist them to develop positive self- image and to cope with their challenges.

Keywords: counselling, needs, psychiatric, medical personnel, patients

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Authors: A. GuhaRay, C. V. S. P. Kiranmayi, S. Rudraraju

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The present study considers the effect of variation of different geotechnical random variables in the design of stone column-foundation systems for assessing the bearing capacity and consolidation settlement of highly compressible soil. The soil and stone column properties, spacing, diameter and arrangement of stone columns are considered as the random variables. Probability of failure (P_f) is computed for a target degree of consolidation and a target safe load by Monte Carlo Simulation (MCS). The study shows that the variation in coefficient of radial consolidation (c_r) and cohesion of soil (c_s) are two most important factors influencing Pf. If the coefficient of variation (COV) of c_r exceeds 20%, P_f exceeds 0.001, which is unsafe following the guidelines of US Army Corps of Engineers. The bearing capacity also exceeds its safe value for COV of c_s > 30%. It is also observed that as the spacing between the stone column increases, the probability of reaching a target degree of consolidation decreases. Accordingly, design guidelines, considering both consolidation and bearing capacity of improved ground, are proposed for different spacing and diameter of stone columns and geotechnical random variables.

Keywords: bearing capacity, consolidation, geotechnical random variables, probability of failure, stone columns

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Authors: Priyanka Sharma, Manoj Jais, Poonam Gupta, Suraiya K. Ansari, Ravinder Kaur

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Introduction: As much as the Health Care is necessary for the population, so is the management of the Biomedical waste produced. Biomedical waste is a wide terminology used for the waste material produced during the diagnosis, treatment or immunization of human beings and animals, in research or in the production or testing of biological products. Biomedical waste management is a chain of processes from the point of generation of Biomedical waste to its final disposal in the correct and proper way, assigned for that particular type of waste. Any deviation from the said processes leads to improper disposal of Biomedical waste which itself is a major health hazard. Proper segregation of Biomedical waste is the key for Biomedical Waste management. Improper disposal of BMW can cause sharp injuries which may lead to HIV, Hepatitis-B virus, Hepatitis-C virus infections. Therefore, proper disposal of BMW is of upmost importance. Health care establishments segregate the Biomedical waste and dispose it as per the Biomedical waste management rules in India. Objectives: This study was done to observe the current trends of Biomedical waste generated in a tertiary care Hospital in Delhi. Methodology: Biomedical waste management rounds were conducted in the hospital wards. Relevant details were collected and analysed and sites with maximum Biomedical waste generation were identified. All the data was cross checked with the commons collection site. Results: The total amount of waste generated in the hospital during January 2014 till December 2014 was 6,39,547 kg, of which 70.5% was General (non-hazardous) waste and the rest 29.5% was BMW which consisted highly infectious waste (12.2%), disposable plastic waste (16.3%) and sharps (1%). The maximum quantity of Biomedical waste producing sites were Obstetrics and Gynaecology wards with a total Biomedical waste production of 45.8%, followed by Paediatrics, Surgery and Medicine wards with 21.2 %, 4.6% and 4.3% respectively. The maximum average Biomedical waste generated was by Obstetrics and Gynaecology ward with 0.7 kg/bed/day, followed by Paediatrics, Surgery and Medicine wards with 0.29, 0.28 and 0.18 kg/bed/day respectively. Conclusions: Hospitals should pay attention to the sites which produce a large amount of BMW to avoid improper segregation of Biomedical waste. Also, induction and refresher training Program of Biomedical waste management should be conducted to avoid improper management of Biomedical waste. Healthcare workers should be made aware of risks of poor Biomedical waste management.

Keywords: biomedical waste, biomedical waste management, hospital-tertiary care, New Delhi

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Authors: Sanjeev Singh

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Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-center prospective randomized and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross-clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant < 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

Keywords: inhaled nitric oxide, milrinone, pulmonary artery hypertension, total anomalous pulmonary venous connection

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