Search results for: hospital design

Authors: Sıdıka Kaya, Gülay Sain Güven, Seda Karsavuran, Onur Toka

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This study is part of an ongoing research project supported by the Scientific and Technological Research Council of Turkey (TUBITAK) under Project Number 114K404, and participation to this conference was supported by Hacettepe University Scientific Research Coordination Unit under Project Number 10243. Evaluation of hospital readmissions is gaining importance in terms of quality and cost, and is becoming the target of national policies. In Turkey, the topic of hospital readmission is relatively new on agenda and very few studies have been conducted on this topic. The aim of this study was to determine 30-day readmission rates and risk factors for readmission. Whether readmission was planned, related to the prior admission and avoidable or not was also assessed. The study was designed as a ‘prospective cohort study.’ 472 patients hospitalized in internal medicine departments of a university hospital in Turkey between February 1, 2015 and April 30, 2015 were followed up. Analyses were conducted using IBM SPSS Statistics version 22.0 and SPSS Modeler 16.0. Average age of the patients was 56 and 56% of the patients were female. Among these patients 95 were readmitted. Overall readmission rate was calculated as 20% (95/472). However, only 31 readmissions were unplanned. Unplanned readmission rate was 6.5% (31/472). Out of 31 unplanned readmission, 24 was related to the prior admission. Only 6 related readmission was avoidable. To determine risk factors for readmission we constructed Chi-square automatic interaction detector (CHAID) decision tree algorithm. CHAID decision trees are nonparametric procedures that make no assumptions of the underlying data. This algorithm determines how independent variables best combine to predict a binary outcome based on ‘if-then’ logic by portioning each independent variable into mutually exclusive subsets based on homogeneity of the data. Independent variables we included in the analysis were: clinic of the department, occupied beds/total number of beds in the clinic at the time of discharge, age, gender, marital status, educational level, distance to residence (km), number of people living with the patient, any person to help his/her care at home after discharge (yes/no), regular source (physician) of care (yes/no), day of discharge, length of stay, ICU utilization (yes/no), total comorbidity score, means for each 3 dimensions of Readiness for Hospital Discharge Scale (patient’s personal status, patient’s knowledge, and patient’s coping ability) and number of daycare admissions within 30 days of discharge. In the analysis, we included all 95 readmitted patients (46.12%), but only 111 (53.88%) non-readmitted patients, although we had 377 non-readmitted patients, to balance data. The risk factors for readmission were found as total comorbidity score, gender, patient’s coping ability, and patient’s knowledge. The strongest identifying factor for readmission was comorbidity score. If patients’ comorbidity score was higher than 1, the risk for readmission increased. The results of this study needs to be validated by other data–sets with more patients. However, we believe that this study will guide further studies of readmission and CHAID is a useful tool for identifying risk factors for readmission.

Keywords: decision tree, hospital, internal medicine, readmission

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Authors: Zainul Huda, Mohammed Hani Ajani

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The design, manufacture, and operation of thin-walled pressure vessels must be based on maximum safe operating pressure and an adequate factor of safety (FoS). This research paper first reports experimental evaluation of longitudinal and hoops stresses based on working pressure as well as maximum pressure; and then includes a critical study of factor of safety (FoS) in the design of a glass fiber pressure vessel. Experimental work involved the use of measuring instruments and the readings from pressure gauges. Design calculations involved the computations of design stress and FoS; the latter was based on breaking strength of 55 MPa for the glass fiber (pressure-vessel material). The experimentally determined FoS value has been critically compared with the general FoS allowed in the design of glass fiber pressure vessels.

Keywords: thin-walled pressure vessel, hoop stress, longitudinal stress, factor of safety (FoS), fiberglass

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Authors: Zainul Huda, Mohammad Hani Ajani

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The design, manufacture, and operation of thin-walled pressure vessels must be based on maximum safe operating pressure and an adequate factor of safety (FoS). This research paper first reports experimental evaluation of longitudinal and hoops stresses based on working pressure as well as maximum pressure; and then includes a critical study of factor of safety (FoS) in the design of a glass fiber pressure vessel. Experimental work involved the use of measuring instruments and the readings from pressure gauges. Design calculations involved the computations of design stress and FoS; the latter was based on breaking strength of 55 MPa for the glass fiber (pressure-vessel material). The experimentally determined FoS value has been critically compared with the general FoS allowed in the design of glass fiber pressure vessels.

Keywords: thin-walled pressure vessel, hoop stress, longitudinal stress, factor of safety (FoS), fiberglass

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Authors: Rafia Rafique, Arifa Khadim

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This research investigates the moderating role of job satisfaction between organizational learning and work performance among nurses. Correlation research design was used. Non-probability purposive sampling technique was utilized to recruit a sample of 110 nurses from public hospitals situated in the city of Lahore. The construct of organizational learning was measured using subscale of Integrated Scale for Measuring Organizational Learning. Job satisfaction was measured with the help of Job Satisfaction Survey. Performance of employees (task performance, contextual performance and counterproductive work behavior) was assessed by Individual Work Performance Questionnaire. Job satisfaction negatively moderates the relationship between organizational learning and counterproductive work behavior. Education has a significant positive relationship with organizational learning. Age, current hospital experience, marital satisfaction and salary of the nurses have positive relationship while number of children has significant negative relationship with counterproductive work behavior. These outcomes can be insightful in understanding the dynamics involved in work performance. Based on the result of this study relevant solutions can be proposed to improve the work performance of nurses.

Keywords: counterproductive work behavior, nurses, organizational learning, work performance

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Authors: Mohamed N. Al-Arifi, Hessa Othman Al-Husein, Mostafa Q. Al Shamiri, Ragab Said, Syed Wajid, Salmeen D. Babelghaith

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Polypharmacy was defined as a taking more than 4 medications per single patients (minor polypharmacy), patients who are taking more than 10 medications we considered as a major polypharmacy. This study was aimed to evaluate the prevalence of polypharmacy in elderly Saudi cardiac patient. A retrospective observational study was carried out at the department of CCU and cardiology unit of the King Fahad cardiac centre (KFCC) in King Khalid university hospital from May 2012 to October 2012. All Parameters was analyzed by using Statistical Packages for Social Science (SPSS) to conclude the result; tests of association were performed using the chi-square statistic. The mean age of patients was 70.1 ± 7.75 years, more than half 83 (51.6%) were males. The highest frequency of chronic diseases found were hypertension (91.0%) followed by, dyslipidemia (74.9%), and diabetes mellitus. Results showed that 82% had polypharmacy (>4 drugs) during the study period, and 47.9% had major polypharmacy. The incidence of inappropriate drug use was found to be higher with men than female (p = 0.984). In conclusion, this study revealed that high prevalence of polypharmacy and potentially inappropriate medications in elderly Saudi cardiac inpatients.

Keywords: cardiac inpatients, medications, polypharmacy, prevalence

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Authors: Muhammad Umar Hassan

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Renal cell carcinoma is a subset of kidney cancer that arises in the lining of DCT and is present in parenchymal tissue. Diagnosis is based on lab reports, including urinalysis, renal function tests (RFTs), and electrolyte balance, along with imaging techniques. Organ failure and other complications have been commonly observed in these cases. Over the years, the presentation of patients has varied, so carcinoma was classified on the basis of site, shape, and consistency for detailed analysis. Lifestyle patterns and occupational history were inquired about and recorded. Methods: Data from 100 patients presenting to the oncology and nephrology department of Mayo Hospital in the year 2015-2020 were included in this retrospective study on a random basis. The study was specifically focused on three risk factors. Smoking, occupational exposures, and Hakim medicine are taken by the patient for any cause. After procurement of data, follow-up contacts of these patients were established, resulting in a detailed analysis of lifestyle. Conclusion: The inference drawn is a direct causal link between smoking, industrial workplace exposure, and Hakim medicine with the development of Renal Cell Carcinoma. It was shown in the majority of the patients and hence confirmed our hypothesis.

Keywords: renal cell carcinoma, kidney cancer, clear cell carcinoma

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Authors: Siamak Jamshidi

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One of the major environmental problems in the southern coasts of the Caspian Sea is that the marine and coastal debris is being deposited and accumulated due to industrial, urban and tourism activities. Study, sampling and analysis on the type, size, amount and origin of human-made (anthropogenic) waste in the coastal areas of this sea can be very effective in implementing management, cultural and informative programs to reduce marine environmental pollutants. Investigation on marine litter distribution under impact of seawater dynamics was performed for the first time in this research. The rate of entry and distribution of marine and coastal pollutants and wastes, which are mainly of urban, tourist and hospital origin, has multiplied on the southern shore of the Caspian Sea in the last decade. According to the results, the two most important sources of hospital waste in the coastal areas are Tonekabon and Mahmoudabad. In this case, the effect of dynamic parameters of seawater such as flow (with speeds of up to about 1 m/s) and waves, as well as the flow of rivers leading to the shoreline are also influential factors in the distribution of marine litter in the region. Marine litters in the southern coastal region were transported from west to east by the shallow waters of the southern Caspian Sea. In other words, the marine debris density has been observed more in the eastern part.

Keywords: southern shelf, coastal oceanography, seawater flow, vertical structure, marine environment

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Authors: Muhammad Qamar Masood, Syed Abbas Raza, Umar Yousaf Raja, Imran Hassan, Bilal Afzal, Muhammad Aleem Zahir, Atika Shaheer

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Background: Cardiovascular disease (CVD) is a major burden among people with type 2 diabetes (T2D) with 1 in 3 reported to have CVD. Therefore, understanding real-world clinical characteristics and prescribing patterns could help in better care. Objective: The CONVERGE (Cardiovascular Outcomes and Value in the Real world with GLP-1RAs) study characterized demographics and medication usage patterns in T2D intensified (add-on to metformin) overall population. The data were further divided into subgroups {dipeptidyl peptidase-4 inhibitors (DPP-4is), sulfonylureas (SUs), insulins, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is)}, according to the latest prescribed antidiabetic agent (ADA) in India/Pakistan/Thailand. Here, we report findings from Pakistan. Methods: A multi-center retrospective study utilized data from medical records between 13-Sep-2008 (post-market approval of GLP-1RAs) and 31-Dec-2017 in adults (≥18-year-old). The data for this study were collected from 05 centers / institutes located in major cities of Pakistan, including Karachi, Lahore, Islamabad, and Multan. These centers included National Hospital, Aga Khan University Hospital, Diabetes Endocrine Clinic Lahore, Shifa International Hospital, Mukhtar A Sheikh Hospital Multan. Data were collected at start of medical record and at 6 or 12-months prior to baseline based on variable type; analyzed descriptively. Results: Overall, 1,010 patients were eligible. At baseline, overall mean age (SD) was 51.6 (11.3) years, T2D duration was 2.4 (2.6) years, HbA1c was 8.3% (1.9) and 35% received ≥1CVD medications in the past 1-year (before baseline). Most frequently prescribed ADAs post-metformin were DPP-4is and SUs (~63%). Only 6.5% received GLP-1RAs and SGLT-2is were not available in Pakistan during the study period. Overall, it took a mean of 4.4 years and 5 years to initiate GLP-1RAs and SGLT-2is, respectively. In comparison to other subgroups, more patients from GLP-1RAs received ≥3 types of ADA (58%), ≥1 CVD medication (64%) and had higher body mass index (37kg/m2). Conclusions: Utilization of GLP-1RAs and SGLT-2is was low, took longer time to initiate and not before trying multiple ADAs. This may be due to lack of evidence for CV benefits for these agents during the study period. The planned phase 2 of the CONVERGE study can provide more insights into utilization and barriers to prescribe GLP-1RAs and SGLT-2is post 2018 in Pakistan.

Keywords: type 2 diabetes, GLP-1RA, treatment intensification, cardiovascular disease

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Authors: Ruth Green, Samantha Milton, Rinal Desai

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Background/Aims: Eye pain/swelling/redness is a common presentation to Barnet General Hospital (a district general hospital), pediatric emergency department, and is managed by both the pediatric and emergency teams. The management of each child differs dramatically depending on the healthcare professional who reviews them. There also appears to be confusion in diagnosis between periorbital cellulitis, pre-septal cellulitis, and orbital cellulitis. Pre septal cellulitis refers to an inflammation of the eyelids and soft tissue anterior to the orbital septum. In contrast, orbital cellulitis is a serious, rapidly progressive infection of soft tissues located posterior to the orbital septum. Pre-septal cellulitis is more prevalent and less serious than orbital cellulitis, although it may be part of a continuous spectrum if untreated. Pre-septal cellulitis should there be diagnosed and treated urgently to prevent spread to the septum. For the purpose of the audit, the term periorbital cellulitis has been used as an umbrella term for all spectrums of this infection. The audit aimed to look at, how as a whole, the department is diagnosing and managing orbital and pre-septal cellulitis. Gold Standard: Patients of the same age and diagnosis should be treated with the same medication, advice, and follow-up. Method: Data was collected retrospectively from pediatric patients ( < 18years) who attended the emergency department from June 2019 to February 2020 who had been coded as pre-septal cellulitis, periorbital cellulitis, orbital cellulitis, or eye pain/swelling/redness. Demographics, signs and symptoms, management, and follow-up were recorded for all patients with any of the diagnoses of pre-septal, periorbital, or orbital cellulitis. A Microsoft Excel spreadsheet was used to record the anonymised data. Results: There were vast discrepancies in the diagnosis, management, and follow-up of patients with periorbital cellulitis. Conclusion/Discussion: The audit concluded there is no uniform approach to managing periorbital cellulitis in Barnet General Hospital Paediatric Emergency Department. Healthcare professionals misdiagnosed conjunctivitis as periorbital cellulitis, and adequate steps did not appear to be documented on excluding red flag signs and symptoms of patients presenting. There was no consistency in follow-up, with some patients having timely phone reviews or clinical reviews for mild symptoms. Advice given by the staff was appropriate, and patients did return when symptoms got worse and were treated accordingly. Plan: Given the inconsistency, a gold standard care pathway or local easily accessible clinical guideline can be developed to help with the diagnosis and management of periorbital cellulitis. Along with this, a teaching session can be carried out for the staff of the pediatric team and emergency department to disseminate the teaching. Following the introduction of a guideline and teaching sessions, patients notes can be re-reviewed to check improvement in patient care.

Keywords: periorbital cellulitis, preseptal cellulitis, orbital cellulitis, erythematous eyelid

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Authors: Tolulope A. Olukunle

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Plastic waste management has emerged as one of the greatest challenges facing developing countries. This paper describes the design of various components of a plastic shredder. This machine is widely used in industries and recycling plants. The introduction of plastic shredder machine will promote reduction of post-consumer plastic waste accumulation and serves as a system for wealth creation and empowerment through conversion of waste into economically viable products. In this design research, a 10 kW electric motor with a rotational speed of 500 rpm was chosen to drive the shredder. A pulley size of 400 mm is mounted on the electric motor at a distance of 1000 mm away from the shredder pulley. The shredder rotational speed is 300 rpm.

Keywords: design, machine, plastic waste, recycling

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Authors: Yashved Serhun, Kim A. Timm

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Barclays Bank has identified the need for a head office building in Lusaka, Zambia, and construction of a 7200 m2 three-storey reinforced concrete office building with a structural steel roof is currently underway. A unique characteristic of the development is that the building footprint is positioned on dolomitic land. Dolomite rock has the tendency to react with and breakdown in the presence of slightly acidic water, including rainwater. This leads to a potential for subsidence and sinkhole formation. Subsidence and the formation of sinkholes beneath a building can be detrimental during both the construction and operational phases. This paper outlines engineering principles which were considered during the structural design of the raft foundation for the Barclays head office building. In addition, this paper includes multidisciplinary considerations and the impact of these on the structural engineering design of the raft foundation. By ensuring that the design of raft foundations on dolomitic land incorporates the requirements of all disciplines and relevant design codes during the design process, the risk associated with subsidence and sinkhole formation can be effectively mitigated during the operational phase of the building.

Keywords: dolomite, dolomitic land, raft foundation, structural engineering design

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Authors: Kazuhiro Tateda, Elisa Gonzalez, Shuhei Ito, Kirstin Heinrich, Kevin Sweetland, Pingping Zhang, Catia Ferreira, Michael Pride, Jennifer Moisi, Sharon Gray, Bennett Lee, Fred Angulo

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Clostridium difficile (C. difficile) is the most common cause of antibiotic-associated diarrhea and infectious diarrhea in healthcare settings. Japan has an aging population; the elderly are at increased risk of hospitalization, antibiotic use, and C. difficile infection (CDI). Little is known about the population-based incidence and disease burden of CDI in Japan although limited hospital-based studies have reported a lower incidence than the United States. To understand CDI disease burden in Japan, CLOUD (Clostridium difficile Infection Burden of Disease in Adults in Japan) was developed. CLOUD will derive population-based incidence estimates of the number of CDI cases per 100,000 population per year in Ota-ku (population 723,341), one of the districts in Tokyo, Japan. CLOUD will include approximately 14 of the 28 Ota-ku hospitals including Toho University Hospital, which is a 1,000 bed tertiary care teaching hospital. During the 12-month patient enrollment period, which is scheduled to begin in November 2018, Ota-ku residents > 50 years of age who are hospitalized at a participating hospital with diarrhea ( > 3 unformed stools (Bristol Stool Chart 5-7) in 24 hours) will be actively ascertained, consented, and enrolled by study surveillance staff. A stool specimen will be collected from enrolled patients and tested at a local reference laboratory (LSI Medience, Tokyo) using QUIK CHEK COMPLETE® (Abbott Laboratories). which simultaneously tests specimens for the presence of glutamate dehydrogenase (GDH) and C. difficile toxins A and B. A frozen stool specimen will also be sent to the Pfizer Laboratory (Pearl River, United States) for analysis using a two-step diagnostic testing algorithm that is based on detection of C. difficile strains/spores harboring toxin B gene by PCR followed by detection of free toxins (A and B) using a proprietary cell cytotoxicity neutralization assay (CCNA) developed by Pfizer. Positive specimens will be anaerobically cultured, and C. difficile isolates will be characterized by ribotyping and whole genomic sequencing. CDI patients enrolled in CLOUD will be contacted weekly for 90 days following diarrhea onset to describe clinical outcomes including recurrence, reinfection, and mortality, and patient reported economic, clinical and humanistic outcomes (e.g., health-related quality of life, worsening of comorbidities, and patient and caregiver work absenteeism). Studies will also be undertaken to fully characterize the catchment area to enable population-based estimates. The 12-month active ascertainment of CDI cases among hospitalized Ota-ku residents with diarrhea in CLOUD, and the characterization of the Ota-ku catchment area, including estimation of the proportion of all hospitalizations of Ota-ku residents that occur in the CLOUD-participating hospitals, will yield CDI population-based incidence estimates, which can be stratified by age groups, risk groups, and source (hospital-acquired or community-acquired). These incidence estimates will be extrapolated, following age standardization using national census data, to yield CDI disease burden estimates for Japan. CLOUD also serves as a model for studies in other countries that can use the CLOUD protocol to estimate CDI disease burden.

Keywords: Clostridium difficile, disease burden, epidemiology, study protocol

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Authors: D. Li

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Optical thin films are used in a wide variety of optical components and there are many software tools programmed for advancing multilayer thin film design. The available software packages for designing the thin film structure may not provide optimum designs. Normally, almost all current software programs obtain their final designs either from optimizing a starting guess or by technique, which may or may not involve a pseudorandom process, that give different answers every time, depending upon the initial conditions. With the increasing power of personal computers, functional methods in optimization and synthesis of optical multilayer systems have been developed such as DGL Optimization, Simulated Annealing, Genetic Algorithms, Needle Optimization, Inductive Optimization and Flip-Flop Optimization. Among these, DGL Optimization has proved its efficiency in optical thin film designs. The application of the DGL optimization technique to the design of optical coating is presented. A DGL optimization technique is provided, and its main features are discussed. Guidelines on the application of the DGL optimization technique to various types of design problems are given. The innovative global optimization strategies used in a software tool, OnlyFilm, to optimize multilayer thin film designs through different filter designs are outlined. OnlyFilm is a powerful, versatile, and user-friendly thin film software on the market, which combines optimization and synthesis design capabilities with powerful analytical tools for optical thin film designers. It is also the only thin film design software that offers a true global optimization function.

Keywords: optical coatings, optimization, design software, thin film design

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Authors: R. Sharma, J. K. Bhatnagar, Poonam, R. C. Sharma

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Metal–air batteries have been designed and developed as an essential source of electric power to propel automobiles, make electronic equipment functional, and use them as the source of power in remote areas and space. High energy and power density, lightweight, easy recharge capabilities, and low cost are essential features of these batteries. Both primary and rechargeable magnesium air batteries are highly promising. Our focus will be on the basics of electrode reaction kinetics of Mg–air cell in this paper. Design and development of Mg or Mg alloys as anode materials, design and composition of air cathode, and promising electrolytes for Mg–air batteries have been reviewed. A brief note on the possible and proposed improvements in design and functionality is also incorporated. This article may serve as the primary and premier document in the critical research area of Mg-air battery systems.

Keywords: air cathode, battery design, magnesium air battery, magnesium anode, rechargeable magnesium air battery

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Authors: Bilgen Özlük, Ülkü Baykal

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The study was conducted with the aim of determining the evaluations of nurses directed at the restructuring process carried out in the nursing services of a private hospital, and reveal how they have been affected by this process, in an integrated manner between a prospective approach and methods of quantitative and qualitative research, and as a comparative study, comparing the changes over a period of three years. The sample for the study is comprised of all of the nurses employed at a private hospital, and data has been collected from 17 nurses (a total of 30 interviews) for the qualitative part 377 nurses in 2013 and 429 nurses in 2014 for the quantitative part. As vehicles of data collection, the study used a form directed at identifying the changes in the organisational and management structure of the hospital, a nurses' interview form, a questionnaire identifying the personal and occupational characteristics of the nurses, the "Minnesota Job Satisfaction Scale", the "Organisational Citizenship Behaviour Scale" and the "Organisational Trust Scale". Qualitative data by researchers, quantitative data was analysed using number and percentage tests, a t-test, and ANOVA, progressive analysis Tukey and regression tests. While in the qualitative part of the study the nurses stated in the first year of the restructuring that they were satisfied with their relationship with top level management, the increases in salaries and changes in the working environment such as the increase in the number of staff, in later years, they stated that there had been a fall in their satisfaction levels due to reasons such as nursing services instead of nurse practitioners in a position they are not satisfied that the director, nursing services outside the nursing profession appointment of persons to positions of management and the lack of appropriate training and competence of these persons, increases in the burden of work, insufficient salaries and the lack of a difference in the salaries of senior and more junior staff. On the other hand, in the quantitative part, it was found that there was no difference in the levels of job satisfaction and organisational trust in any of the two years, that as the level of organisational trust increased the level of job satisfaction also increased, and that as the levels of job satisfaction and organisational trust a positive impact on organisational citizenship behaviour also increased.

Keywords: services, nursing management, re-structuring, job satisfaction, organisational citizenship behaviour, organisational trust

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Authors: Sasiwan Tassana-iem, Sumattana Glangkarn

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Diabetic nephropathy is a major complication in diabetic patients whom as the glomerular filtration rate falls. The affects their quality of life and results in loss of money for kidney replacement therapy costs. There is an existing intervention, but the prevalence remains high, thus this research aims to study lessons learned in implementing programs to delay diabetic nephropathy management in primary health care. Method: The target settings are, 24 sub-district health promoting hospital in Sakon Nakhon province. Participants included the health care professionals, head of the sub-district health promoting hospital and the person responsible for managing diabetic nephropathy in each hospital (n= 50). There are 400 patients with diabetes mellitus in an area. Data were collected using questionnaires, patient records data, interviews and focus groups and analyzed by statistics and content analysis. Result: Reflection of participants that the interventions to delay diabetic nephropathy management in each area, the Ministry of Public Health has a policy to screen and manage this disease. The implementing programs aimed to provide health education, innovative teaching media used in communication to educate. Patients and caregivers had misunderstanding about the actual causes and prevention of this disease and how to apply knowledge suitable for daily life. Conclusion: The obstacles to the success of the implementing programs to delay diabetic nephropathy management in primary health care were most importantly, the patient needs self-care and should be evaluated for health literacy. This is crucial to promote health literacy; to access and understand health information as well to decide their health-related choices based on health information which will promote and maintain a good health. This preliminary research confirms that situation of diabetic nephropathy still exists. The results of this study will lead to the development of delay in diabetic nephropathy implementation among patients in the province studied.

Keywords: diabetic nephropathy, chronic kidney disease, primary health care, implementation

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Authors: Ming-Jyh Chen, Wen-Ming Huang, Yi-Chu Liu, Li-Hui Yang

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Introduction: Social responsibility is the key to sustainable organizational development. Under the ground Green Health Hospital Declaration signed by our superintendent, we have launched comprehensive energy conservation management in medical services, the community, and the staff’s life. To execute environment-friendly promotion with robust strategies, we build up a low-carbon medical system and community with smart green public construction promotion as well as intensifying energy conservation education and communication. Purpose/Methods: With the support of the board and the superintendent, we construct an energy management team, commencing with an environment-friendly system, management, education, and ISO 50001 energy management system; we have ameliorated energy performance and energy efficiency and continuing. Results: In the year 2021, we have achieved multiple goals. The energy management system efficiently controls diesel, natural gas, and electricity usage. About 5% of the consumption is saved when compared to the numbers from 2018 and 2021. Our company develops intelligent services and promotes various paperless electronic operations to provide people with a vibrant and environmentally friendly lifestyle. The goal is to save 68.6% on printing and photocopying by reducing 35.15 million sheets of paper yearly. We strengthen the concept of environmental protection classification among colleagues. In the past two years, the amount of resource recycling has reached more than 650 tons, and the resource recycling rate has reached 70%. The annual growth rate of waste recycling is about 28 metric tons. Conclusions: To build a green medical system with “high efficacy, high value, low carbon, low reliance,” energy stewardship, economic prosperity, and social responsibility are our principles when it comes to formulation of energy conservation management strategies, converting limited sources to efficient usage, developing clean energy, and continuing with sustainable energy.

Keywords: energy efficiency, environmental education, green hospital, sustainable development

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Authors: P. Tej, P. Kněž, M. Blank

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The paper presents design and production of thin-walled U-profile footbridge made of UHPFRC. The main structure of the bridge is one prefabricated shell structure made of UHPFRC with dispersed steel fibers without any conventional reinforcement. The span of the bridge structure is 10 m and the clear width of 1.5 m. The thickness of the UHPFRC shell structure oscillated in an interval of 30-45 mm. Several calculations were made during the bridge design and compared with the experiments. For the purpose of verifying the calculations, a segment of 1.5 m was first produced, followed by the whole footbridge for testing. After the load tests were done, the design was optimized to cast the final footbridge.

Keywords: footbridge, non-linear analysis, shell structure, UHPFRC, Ultra-High Performance Fibre Reinforced Concrete

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Authors: Tri Murti Tugiman, Awalyya Fasha

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This research aims to analyze the magnitude of the economic losses incurred as a result of a person suffering from a particular disease of the ten highest in the productive age diseases in Hospitals Inche Abdul Moeis Samarinda. This research was a descriptive survey research and a secondary data analysis. For the analysis of economic losses populations used are all in patients who suffer from the 10 highest diseases in the productive age in hospitals IA Moeis Samarinda in 2011. Sampling was performed by using a stratified random sampling with samples of 77 people. Research results indicate that the direct cost community incurred to obtain medical services in hospitals IA Moeis is IDR 74437520. The amount of indirect costs incurred during service in a community hospital is IDR 10562000. The amount lost due to sickness fee is IDR 5377800. The amount of economic lost people to obtain medical services in hospitals IA Moeis is IDR 90377320. The number of days of hospitalization was as much as 171 respondents throughout the day. This study suggests the economic loss could be prevented by changes in the lifestyle of the people who clean and healthy along with the following insurance.

Keywords: hospitalized, economic lost, productive age diseases, secondary data analysis

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Authors: Wei Chen Chang, Ming Yu Hsiao

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The commodity takes one kind of mark, the designer how to construction and interpretation the user how to use the process and effectively convey message in design education has always been an important issue. Cultural-creative design refers to signifying cultural heritage for product design. In terms of Peirce’s Semiotic Triangle: signifying elements-object-interpretant, signifying elements are the outcomes of design, the object is cultural heritage, and the interpretant is the positioning and description of product design. How to elaborate the positioning, design, and development of a product is a narrative issue of the interpretant, and how to shape the signifying elements of a product by modifying and adapting styles is a rhetoric matter. This study investigated the rhetoric of elements signifying products to develop a rhetoric model with cultural style. Figures of speech are a rhetoric method in narrative. By adapting figures of speech to the interpretant, this study developed the rhetoric context of cultural context by narrative means. In this two-phase study, phase I defines figures of speech and phase II analyzes existing cultural-creative products in terms of figures of speech to develop a rhetoric of style model. We expect it can reference for the future development of Cultural-creative design.

Keywords: cultural-creative design, cultural-creative products, figures of speech, Peirce’s semiotic triangle, rhetoric of style model

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Authors: Surasak Kangkhao, Chaturong Louhapensang

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This research investigates design and cultural heritage interpretations by residential architecture design in World Heritage cities: Kamphaeng Phet, Thailand reflect on the essence of design based on local identity. The research consisted of three thematic foci. First, the studies examined the contextual background that led to the genesis of the building. Second, the investigations concentrated on how its design was developed and implemented. Third, these modes of problematisation lent a basis to argue that a quality of placeness was not confined exclusively to traditional or vernacular structures but could be found from the unconventional aesthetics of Residential Architecture as well.

Keywords: expressions, local identity, residential architecture, practice, world heritage site

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Authors: M. M. El-Awad

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This paper deals with the introduction of thermal-design optimisation to engineering students by using Microsoft's Excel as a modelling platform. Thermal-design optimisation is an iterative process which involves the evaluation of many thermo-physical properties that vary with temperature and/or pressure. Therefore, suitable modelling software, such as Engineering Equation Solver (EES) or Interactive Thermodynamics (IT), is usually used for this purpose. However, such proprietary applications may not be available to many educational institutions in developing countries. This paper presents a simple thermal-design case that demonstrates how the principles of thermo-fluids and economics can be jointly applied so as to find an optimum solution to a thermal-design problem. The paper describes the solution steps and provides all the equations needed to solve the case with Microsoft Excel. The paper also highlights the advantage of using VBA (Visual Basic for Applications) for developing user-defined functions when repetitive or complex calculations are met. VBA makes Excel a powerful, yet affordable, the computational platform for introducing various engineering principles.

Keywords: engineering education, thermal design, Excel, VBA, user-defined functions

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Authors: Gaoyuan Wang, Tian Chen

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China’s emission peak and carbon neutrality strategies lead to the transformation of development patterns and call for new green urban design thinking. This paper begins by revealing the evolution of green urban design thinking during the periods of carbon enlightenment, carbon dependency, and carbon decoupling from the perspective of the energy transition. Combined with the current energy situation, national strengths, and technological trends, the emergence of green urban design towards carbon neutrality becomes inevitable. Based on the preliminary analysis of its connotation, the characteristics of the new type of green urban design are generalized as low-carbon orientation, carbon-related objects, carbon-reduction means, and carbon-control patterns. Its theory is briefly clarified in terms of the human-earth synergism, quality-energy interconnection, and form-flow interpromotion. Then, its mechanism is analyzed combined with the core tasks of carbon neutrality, and the scope of design issues is defined, including carbon flow mapping, carbon source regulation, carbon sink construction, and carbon emission management. Finally, a multi-scale spatial response system is proposed across the region, city, cluster, and neighborhood level. The discussion aims to provide support for the innovation of green urban design theories and methods in the context of peak neutrality.

Keywords: carbon neutrality, green urban design, energy transition, theoretical exploration

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Authors: Patrik Johansson, Selina Mardh

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The present study proposes a usability test method, Atmosphere, to assess the fitness of components and interaction patterns of design systems. The method covers the user’s perception of the components of the system, the efficiency of the logic of the interaction patterns, perceived ease of use as well as the user’s understanding of the intended outcome of interactions. These aspects are assessed by combining measures of first impression, visual affordance and expectancy. The method was applied to a design system developed for the design of an electronic health record system. The study was conducted involving 15 healthcare personnel. It could be concluded that the Atmosphere method provides tangible data that enable human-computer interaction practitioners to analyze and categorize components and patterns based on perceived usability, success rate of identifying interactive components and success rate of understanding components and interaction patterns intended outcome.

Keywords: atomic design, atmosphere methodology, design system, expectancy testing, first impression testing, usability testing, visual affordance testing

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Authors: Takuya Inoue

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Applying affordance theory to the field of communication research has been more significant. This paper suggests that the act of design, including language, is defined as encouraging or restricting affordance of an object or event and make it perceivable for users, rather merely conveying information. From this point of view, 5 types of oral expressions in Kyoto dialect, as well as 4 types of exterior design such as sekimori-ishi (a barrier-stone in a teahouse garden) which are specific to traditions in Kyoto, are examined. We found that exterior designs have no physical power in itself, they work as ‘signifier’ to highlight cultural frames which heavily depend on exclusive culture among city-dwellers in Kyoto. At the same time, the expressions are implicit, even sometimes sarcastic, which are also supported by cultural frames. In conclusion, the existence of traditional design is motivated in informative ‘ecological frame.’

Keywords: affordance theory, communication, cultural design, Japanese culture, Kyoto dialect, signifier

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Authors: Jyoti Agrawal

Abstract:

Introduction: Renal diseases in children and young adult can be difficult to diagnose early as it may present only with few symptoms, tends to have different course than adult and respond variously to different treatment. The pattern of renal disease in children is different from developing countries as compared to developed countries. Methods: This study was a hospital based prospective observational study carried from March, 2014 to February 2015 at BP Koirala institute of health sciences. Patients with renal disease, both inpatient and outpatient from birth to 14 years of age were enrolled in the study. The diagnosis of renal disease was be made on clinical and laboratory criteria. Results: Total of 120 patients were enrolled in our study which contributed to 3.74% % of total admission. The commonest feature of presentation was edema (75%), followed by fever (65%), hypertension (60%), decreased urine output (45%) and hematuria (25%). Most common diagnosis was acute glomerulonephritis (40%) followed by Nephrotic syndrome (25%) and urinary tract infection (25%). Renal biopsy was done for 10% of cases and most of them were steroid dependent nephrotic syndrome. 5% of our cases expired because of multiorgan dysfunction syndrome, sepsis and acute kidney injury. Conclusion: Renal disease contributes to a large part of hospital pediatric admission as well as mortality and morbidity to the children.

Keywords: glomerulonephritis, nephrotic syndrome, renal disease, urinary tract infection

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Authors: I. Iroka, L. Mgidlana, J. Willoughby, S. Dhlamini, P. Nxumalo, S. Sefadi, A. Mthembu, E. Gerber, E. Brits

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Introduction: Nephroblastoma is a common paediatric tumor with good survival rates when diagnosed and treated early. Method: This retrospective study aimed to describe the patients with nephroblastoma seen at Universitas Academic Hospital Complex between the years 2000 and 2020. Results: In the study period, there were 207 patients identified. The patient profile had slightly more male than female patients; the median age was under four years of age. The study found a median delay of one month between symptom onset and diagnosis; a common cause was a delay in seeking care. Patients diagnosed and treated more than a month after symptoms started had poorer survival rates. There was a higher rate of Stage IV disease compared to similar studies in South Africa. Good preoperative histology and no relapse had good survival rates.. Patients from Lesotho had longer delays and presented with more severe diseases than the South African cohort. Conclusion: Early identification and treatment lead to better outcomes. Health-seeking behaviour, misdiagnosis, and referral delays might contribute to the long delays. A targeted study for patients from Lesotho is recommended.

Keywords: nephroblastoma, South Africa, Lesotho, developing country

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Authors: Damian Gordon, Paul Doyle, Anna Becevel, Júlia Vilafranca Molero, Cinta Gascon, Arianna Vitiello, Tina Baloh

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It has long been recognized that the creation of any teaching content can be enhanced if the development process follows a pre-defined approach, which is often referred to as an instructional design methodology. These methodologies typically define a number of stages, or phases, that an educator should undertake to help ensure the quality of the final teaching content that is developed. In this paper, we present an instructional design methodology that is focused specifically on the introduction of blended resources into a heretofore bricks-and-mortar course. To achieve this, research was undertaken concerning a range of models of instructional design, as well as literature covering some of the key challenges and “pain points” of blending. Following this, our model, the BL-5D model, is presented, which incorporates some key questions at each stage of this five-stage methodology to guide the development process. Finally, a discussion of some of the key themes and issues that have been uncovered in this work is presented, as well as a template for a blended learning case study that emerged from this approach.

Keywords: blended learning, challenges of blended learning, design methodologies, instructional design

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Authors: Adam L. Yanagihara, Yong Seok Park

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The goal of this paper is to converge upon a design of a brake system that could be used for a roller coaster found at an amusement park. It was necessary to find what could be deemed as a “comfortable” deceleration so that passengers do not feel as if they are suddenly jerked and pressed against the restraining harnesses. A human factors engineering approach was taken in order to determine this deceleration. Using a previous study that tested the deceleration of transit vehicles, it was found that a -0.45 G deceleration would be used as a design requirement to build this system around. An adjustable linear eddy current brake using permanent magnets would be the ideal system to use in order to meet this design requirement. Anthropometric data were then used to determine a realistic weight and length of the roller coaster that the brake was being designed for. The weight and length data were then factored into magnetic brake force equations. These equations were used to determine how the brake system and the brake run layout would be designed. A final design for the brake was determined and it was found that a total of 12 brakes would be needed with a maximum braking distance of 53.6 m in order to stop a roller coaster travelling at its top speed and loaded to maximum capacity. This design is derived from theoretical calculations, but is within the realm of feasibility.

Keywords: eddy current brake, engineering design, design synthesis, human factors engineering

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Authors: Minsun Kim, Ki-Sun Choi, Hyun-Jee Lee, Young-Chan You

Abstract:

There is no reinforcement example for the renovation of the vertical and horizontal extension to existing building structures which is a shear wall type in apartment units in Korea. Among these existing structures, the structures which are shear wall type are rare overseas, while Korea has many shear wall apartment units. Recently, in Korea, a few researchers are trying to confirm the possibility of the vertical extension in existing building with shear walls. This study evaluates the possibility of the renovation by applying performance-based seismic design to existing buildings with shear walls in the analysis phase of the structure. In addition, force-based seismic design, used by general structural engineers in Korea, is carried out to compare the amount of reinforcement of walls, which is a main component of wall structure. As a result, we suggest that performance-based design obtains more economical advantages than force-based seismic design.

Keywords: design for extension, performance-based design, remodeling, shear wall frame, structural analysis

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