Search results for: respiratory failure

Authors: Fiona Jensen, Barb Goodwin, Nancy Kleiman, Rhonda Usunier

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Background: Clinical simulation is now a common component in many health profession curricula in preparation for clinical practice. In the Rady Faculty of Health Sciences (RFHS) college leads in simulation and interprofessional (IP) education, planned an eight hour simulated hospital day shift, where seventy students from six health professions across two campuses, learned with each other in a safe, realistic environment. Learning about interprofessional collaboration, an expected competency for many health professions upon graduation, was a primary focus of the simulation event. Method: Faculty representatives from the Colleges of Nursing, Medicine, Pharmacy and Rehabilitation Sciences (Physical Therapy, Occupation Therapy, Respiratory Therapy) and Pharmacy worked together to plan the IP event in a simulation facility in the College of Nursing. Each college provided a faculty mentor to guide the same profession students. Students were placed in interprofessional teams consisting of a nurse, physician, pharmacist, and then sharing respiratory, occupational, and physical therapists across the team depending on the needs of the patients. Eight patient scenarios were role played by health profession students, who had been provided with their patient’s story shortly before the event. Each team was guided by a facilitator. Results and Outcomes: On the morning of the event, all students gathered in a large group to meet mentors and facilitators and have a brief overview of the six competencies for effective collaboration and the session objectives. The students assuming their same profession roles were provided with their patient’s chart at the beginning of the shift, met with their team, and then completed professional specific assessments. Shortly into the shift, IP team rounds began, facilitated by the team facilitator. During the shift, each patient role-played a spontaneous health incident, which required collaboration between the IP team members for assessment and management. The afternoon concluded with team rounds, a collaborative management plan, and a facilitated de-brief. Conclusions: During the de-brief sessions, students responded to set questions related to the session learning objectives and expressed many positive learning moments. We believe that we have a sustainable simulation IP collaborative learning opportunity, which can be embedded into curricula, and has the capacity to grow to include more health profession faculties and students. Opportunities are being explored in the RFHS at the administrative level, to offer this event more frequently in the academic year to reach more students. In addition, a formally structured event evaluation tool would provide important feedback and inform the qualitative feedback to event organizers and the colleges about the significance of the simulation event to student learning.

Keywords: simulation, collaboration, teams, interprofessional

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Authors: Huidan Yu, Anurag Deb, Rou Chen, I-Wen Wang

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The use of left ventricle assist devices (LVADs) in patients with heart failure has been a proven and effective therapy for patients with severe end-stage heart failure. Due to the limited availability of suitable donor hearts, LVADs will probably become the alternative solution for patient with heart failure in the near future. While the LVAD is being continuously improved toward enhanced performance, increased device durability, reduced size, a better understanding of implantation management becomes critical in order to achieve better long-term blood supplies and less post-surgical complications such as thrombi generation. Important issues related to the LVAD implantation include the location of outflow grafting (OG), the angle of the OG, the combination between LVAD and native heart pumping, uniform or pulsatile flow at OG, etc. We have hypothesized that an optimal implantation of LVAD is patient specific. To test this hypothesis, we employ a novel in-house computational modeling technique, named InVascular, to conduct a systematic evaluation of cardiac output at aortic arch together with other pertinent hemodynamic quantities for each patient under various implantation scenarios aiming to get an optimal implantation strategy. InVacular is a powerful computational modeling technique that integrates unified mesoscale modeling for both image segmentation and fluid dynamics with the cutting-edge GPU parallel computing. It first segments the aortic artery from patient’s CT image, then seamlessly feeds extracted morphology, together with the velocity wave from Echo Ultrasound image of the same patient, to the computation model to quantify 4-D (time+space) velocity and pressure fields. Using one NVIDIA Tesla K40 GPU card, InVascular completes a computation from CT image to 4-D hemodynamics within 30 minutes. Thus it has the great potential to conduct massive numerical simulation and analysis. The systematic evaluation for one patient includes three OG anastomosis (ascending aorta, descending thoracic aorta, and subclavian artery), three combinations of LVAD and native heart pumping (1:1, 1:2, and 1:3), three angles of OG anastomosis (inclined upward, perpendicular, and inclined downward), and two LVAD inflow conditions (uniform and pulsatile). The optimal LVAD implantation is suggested through a comprehensive analysis of the cardiac output and related hemodynamics from the simulations over the fifty-four scenarios. To confirm the hypothesis, 5 random patient cases will be evaluated.

Keywords: graphic processing unit (GPU) parallel computing, left ventricle assist device (LVAD), lumped-parameter model, patient-specific computational hemodynamics

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Authors: S. P. Bansal, Mukesh Kumar Sharma, Ankit Prabhakar

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Luhri Hydroelectric Project Stage-I (210 MW) is a run of the river type development with a dam toe surface powerhouse (122m long, 50.50m wide, and 65.50m high) on the right bank of river Satluj in Himachal Pradesh, India. The project is located in the inner lesser Himalaya between Dhauladhar Range in the south and higher Himalaya in the north in the seismically active region. At the project, the location river is confined within narrow V-shaped valleys with little or no flat areas close to the river bed. Nearly 120m high cut slopes behind the powerhouse are proposed from the powerhouse foundation level of 795m to ± 915m to accommodate the surface powerhouse. The stability of 120m high cut slopes is a prime concern for the reason of risk involved. The slopes behind the powerhouse will be excavated in mainly in augen gneiss, fresh to weathered in nature, and biotite rich at places. The foliation joints are favorable and dipping inside the hill. Two valleys dipping steeper joints will be encountered on the slopes, which can cause instability during excavation. Geological exploration plays a vital role in designing and optimization of cut slopes. SWEDGE software has been used to analyze the geometry and stability of surface wedges in cut slopes. The slopes behind powerhouse have been analyzed in three zones for stability analysis by providing a break in the continuity of cut slopes, which shall provide quite substantial relief for slope stabilization measure. Pseudo static analysis has been carried out for the stabilization of wedges. The results indicate that many large wedges are forming, which have a factor of safety less than 1. The stability measures (support system, bench width, slopes) have been planned so that no wedge failure may occur in the future.

Keywords: cut slopes, geotechnical investigations, Himalayan geology, surface powerhouse, wedge failure

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Authors: Morgan Johansson, Joosef Leppanen, Mathias Flansbjer, Fabio Lozano, Josef Makdesi

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Concrete is commonly used for protective structures and how impact loading affects different types of concrete structures is an important issue. Often the knowledge gained from static loading is also used in the design of impulse loaded structures. A large plastic deformation capacity is essential to obtain a large energy absorption in an impulse loaded structure. However, the structural response of an impact loaded concrete beam may be very different compared to a statically loaded beam. Consequently, the plastic deformation capacity and failure modes of the concrete structure can be different when subjected to dynamic loads; and hence it is not sure that the observations obtained from static loading are also valid for dynamic loading. The aim of this paper is to investigate the residual plastic deformation capacity in reinforced concrete beams subjected to drop weight impact tests. A test-series consisting of 18 simply supported beams (0.1 x 0.1 x 1.18 m, ρs = 0.7%) with a span length of 1.0 m and subjected to a point load in the beam mid-point, was carried out. 2x6 beams were first subjected to drop weight impact tests, and thereafter statically tested until failure. The drop in weight had a mass of 10 kg and was dropped from 2.5 m or 5.0 m. During the impact tests, a high-speed camera was used with 5 000 fps and for the static tests, a camera was used with 0.5 fps. Digital image correlation (DIC) analyses were conducted and from these the velocities of the beam and the drop weight, as well as the deformations and crack propagation of the beam, were effectively measured. Additionally, for the static tests, the applied load and midspan deformation were measured. The load-deformation relations for the beams subjected to an impact load were compared with 6 reference beams that were subjected to static loading only. The crack pattern obtained were compared using DIC, and it was concluded that the resulting crack formation depended much on the test method used. For the static tests, only bending cracks occurred. For the impact loaded beams, though, distinctive diagonal shear cracks also formed below the zone of impact and less wide shear cracks were observed in the region half-way to the support. Furthermore, due to wave propagation effects, bending cracks developed in the upper part of the beam during initial loading. The results showed that the plastic deformation capacity increased for beams subjected to drop weight impact tests from a high drop height of 5.0 m. For beams subjected to an impact from a low drop height of 2.5 m, though, the plastic deformation capacity was in the same order of magnitude as for the statically loaded reference beams. The beams tested were designed to fail due to bending when subjected to a static load. However, for the impact tested beams, one beam exhibited a shear failure at a significantly reduced load level when it was tested statically; indicating that there might be a risk of reduced residual load capacity for impact loaded structures.

Keywords: digital image correlation (DIC), drop weight impact, experiments, plastic deformation capacity, reinforced concrete

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Authors: Mohammad H. Yarmohammadian, Fatemeh Rezaei

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Introduction: Improving patient safety in health systems is one of the main priorities in healthcare systems, so clinical risk management in organizations has become increasingly significant. Although several tools have been developed for clinical risk management, each has its own limitations. Aims: This study aims to develop a comprehensive tool that can complete the limitations of each risk assessment and management tools with the advantage of other tools. Methods: Procedure was determined in two main stages included development of an initial model during meetings with the professors and literature review, then implementation and verification of final model. Subjects and Methods: This study is a quantitative − qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment of the two parts of the fourth phase and seven phases of the research was conducted. Purposive and stratification sampling of various responsible teams for the selected process was conducted in the operating room. Final model verified in eight phases through application of activity breakdown structure, failure mode and effects analysis (FMEA), healthcare risk priority number (RPN), root cause analysis (RCA), FT, and Eindhoven Classification model (ECM) tools. This model has been conducted typically on patients admitted in a day-clinic ward of a public hospital for surgery in October 2012 to June. Statistical Analysis Used: Qualitative data analysis was done through content analysis and quantitative analysis done through checklist and edited RPN tables. Results: After verification the final model in eight-step, patient's admission process for surgery was developed by focus discussion group (FDG) members in five main phases. Then with adopted methodology of FMEA, 85 failure modes along with its causes, effects, and preventive capabilities was set in the tables. Developed tables to calculate RPN index contain three criteria for severity, two criteria for probability, and two criteria for preventability. Tree failure modes were above determined significant risk limitation (RPN > 250). After a 3-month period, patient's misidentification incidents were the most frequent reported events. Each RPN criterion of misidentification events compared and found that various RPN number for tree misidentification reported events could be determine against predicted score in previous phase. Identified root causes through fault tree categorized with ECM. Wrong side surgery event was selected by focus discussion group to purpose improvement action. The most important causes were lack of planning for number and priority of surgical procedures. After prioritization of the suggested interventions, computerized registration system in health information system (HIS) was adopted to prepare the action plan in the final phase. Conclusion: Complexity of health care industry requires risk managers to have a multifaceted vision. Therefore, applying only one of retrospective or prospective tools for risk management does not work and each organization must provide conditions for potential application of these methods in its organization. The results of this study showed that the integrated clinical risk management model can be used in hospitals as an efficient tool in order to improve clinical governance.

Keywords: failure modes and effective analysis, risk management, root cause analysis, model

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Authors: Houneïda Benbouzid, Houria Berrebbah, Mohammed-Réda Djebar

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The toxicological impacts of the increasing number of synthetic compounds present in the aquatic environment are assessed predominantly in laboratory studies where test organisms are exposed to a range of concentrations of single compounds. The bio-indicator Paramecium sp., characterized by a short life cycle, rapid multiplication and normal behavior that may be affected by the presence of pollutants. We therefore investigated the inhibitory effect of a newly synthesized acaricide: the chlorfenapyr tested at concentrations of 250, 300, and 350 µM on a pure culture of Paramecium sp. during 6 day. Paramecia treated with different concentrations of Chlorfenapyr illustrate strong inhibition of cell growth from the second day of treatment. Low levels of glutathione, increased glutathione S-transferase and the decrease in respiratory metabolism, recorded in the presence of different concentrations of Chlorfenapyr, involve the activation of detoxification system.

Keywords: Paramecium sp., chlorfenapyr, oxidative enzymes, detoxification

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Authors: Andres Bautista, Alicia Porras, Juan P. Casas, Maribel Silva

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The Colombian aeronautical industry has stimulated research in the mechanical behavior of materials under different loading conditions aircrafts are generally exposed during its operation. The Calima T-90 is the first military aircraft built in the country, used for primary flight training of Colombian Air Force Pilots, therefore, it may be exposed to adverse operating situations such as hard landings which cause impact loads on the aircraft that might produce the impact fatigue phenomenon. The Calima T-90 structure is mainly manufactured by composites materials generating assemblies and subassemblies of different components of it. The main method of bonding these components is by using adhesive joints. Each type of adhesive bond must be studied on its own since its performance depends on the conditions of the manufacturing process and operating characteristics. This study aims to characterize the typical adhesive joints of the aircraft under usual loads. To this purpose, the evaluation of the effect of adhesive thickness on the mechanical performance of the joint under quasi-static loading conditions, constant amplitude fatigue and cyclic impact fatigue using single lap-joint specimens will be performed. Additionally, using a double cantilever beam specimen, the influence of the thickness of the adhesive on the crack growth rate for mode I delamination failure, as a function of the critical energy release rate will be determined. Finally, an analysis of the fracture surface of the test specimens considering the mechanical interaction between the substrate (composite) and the adhesive, provide insights into the magnitude of the damage, the type of failure mechanism that occurs and its correlation with the way crack propagates under the proposed loading conditions.

Keywords: adhesive, composites, crack propagation, fatigue

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Authors: Keigo Nishitani, Kohei Mizuta Mizuta, Kazuyoshi Kurita, Yukinori Taniguchi

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To establish mass production process of Ti capsule which has Fe powder inside as magnetic hyperthermia implant, we assumed that Ti thin sheet can be drawn into a φ1.0 mm die hole through the medium of Fe Powder and becomes outer shell of capsule. This study discusses mechanism of powder assisted deep drawing process by both of numerical simulation and experiment. Ti thin sheet blank was placed on die, and was covered by Fe powder layer without pressurizing. Then upper punch was indented on the Fe powder layer, and the blank can be drawn into die cavity as pressurized powder particles were extruded into die cavity from behind of the drawn blank. Distinct Element Method (DEM) has been used to demonstrate the process. To identify bonding parameters on Fe particles which are cohesion, tensile bond stress and inter particle friction angle, axial and diametrical compression failure test of Fe powder compact was conducted. Several density ratios of powder compacts in range of 0.70 - 0.85 were investigated and relationship between mean stress and equivalent stress was calculated with consideration of critical state line which rules failure criterion in consolidation of Fe powder. Since variation of bonding parameters with density ratio has been experimentally identified, and good agreement has been recognized between several failure tests and its simulation, demonstration of powder assisted sheet forming by using DEM becomes applicable. Results of simulation indicated that indent/drawing length of Ti thin sheet is promoted by smaller Fe particle size, larger indent punch diameter, lower friction coefficient between die surface and Ti sheet and certain degrees of die inlet taper angle. In the deep drawing test, we have made die-set with φ2.4 mm punch and φ1.0 mm die bore diameter. Pure Ti sheet with 100 μm thickness, annealed at 650 deg. C has been tested. After indentation, indented/drawn capsule has been observed by microscope, and its length was measured to discuss the feasibility of this capsulation process. Longer drawing length exists on progressive loading pass comparing with the case of single stroke loading. It is expected that progressive loading has an advantage of which extrusion of powder particle into die cavity with Ti sheet is promoted since powder particle layer can be rebuilt while the punch is withdrawn from the layer in each loading steps. This capsulation phenomenon is qualitatively demonstrated by DEM simulation. Finally, we have fabricated Ti capsule which has Fe powder inside for magnetic hyperthermia cancer care treatment. It is concluded that suggested method is possible to use the manufacturing of Ti capsule implant for magnetic hyperthermia cancer care.

Keywords: metal powder compaction, metal forming, distinct element method, cancer care, magnetic hyperthermia

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Authors: Jaiden X. Schraut

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Medical Imaging Segmentation of Chest X-rays is used for the purpose of identification and differentiation of lung cancer, pneumonia, COVID-19, and similar respiratory diseases. Widespread application of computer-supported perception methods into the diagnostic pipeline has been demonstrated to increase prognostic accuracy and aid doctors in efficiently treating patients. Modern models attempt the task of segmentation and classification separately and improve diagnostic efficiency; however, to further enhance this process, this paper proposes a multi-output network that follows a U-Net architecture for image segmentation output and features an additional CNN module for auxiliary classification output. The proposed model achieves a final Jaccard Index of .9634 for image segmentation and a final accuracy of .9600 for classification on the COVID-19 radiography database.

Keywords: chest X-ray, deep learning, image segmentation, image classification

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Authors: S. Ajith Kumar, Vaisakh S. Rajan

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In external flows, vortex shedding behind the bluff bodies causes to experience unsteady loads on a large number of engineering structures, resulting in structural failure. Vortex shedding can even turn out to be disastrous like the Tacoma Bridge failure incident. We need to have control over vortex shedding to get rid of this untoward condition by reducing the unsteady forces acting on the bluff body. In circular cylinders, hydrophobic surface in an otherwise no-slip surface is found to be delaying separation and minimizes the effects of vortex shedding drastically. Flow over square cylinder stands different from this behavior as separation can takes place from either of the two corner separation points (front or rear). An attempt is made in this study to numerically elucidate the effect of hydrophobic surface in flow over a square cylinder. A 2D numerical simulation has been done to understand the effects of the slip surface on the flow past square cylinder. The details of the numerical algorithm will be presented at the time of the conference. A non-dimensional parameter, Knudsen number is defined to quantify the slip on the cylinder surface based on Maxwell’s equation. The slip surface condition of the wall affects the vorticity distribution around the cylinder and the flow separation. In the numerical analysis, we observed that the hydrophobic surface enhances the shedding frequency and damps down the amplitude of oscillations of the square cylinder. We also found that the slip has a negative effect on aerodynamic force coefficients such as the coefficient of lift (CL), coefficient of drag (CD) etc. and hence replacing the no slip surface by a hydrophobic surface can be treated as an effective drag reduction strategy and the introduction of hydrophobic surface could be utilized for reducing the vortex induced vibrations (VIV) and is found as an effective method in controlling VIV thereby controlling the structural failures.

Keywords: drag reduction, flow past square cylinder, flow control, hydrophobic surfaces, vortex shedding

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Authors: Farshid Marbouti, Jale Ulas, Julia Thompson

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The main sources of stress among college students are: changes in sleeping and eating habits, undertaking new responsibilities, and financial difficulties as the most common sources of stress, exams, meeting new people, career decisions, fear of failure, and pressure from parents, transition to university especially if it requires leaving home, working with people that they do not know, trouble with parents, and relationship with the opposite sex. The students use a variety of stress coping strategies, including talking to family and friends, leisure activities and exercising. The Yerkes–Dodson law indicates while a moderate amount of stress may be beneficial for performance, too high stress will result in weak performance. In other words, if students are too stressed, they are likely to have low academic performance. In a preliminary study conducted in 2017 with engineering students enrolled in three high failure rate classes, the majority of the students stated that they have high levels of stress mainly for academic, financial, or family-related reasons. As the second stage of the study, the main purpose of this research is to investigate the students’ level of stress, sources of stress, their relationship with student demographic background, students’ coping strategies, and academic performance. A device is being developed to gather data from students breathing patterns and measure their stress levels. In addition, all participants are asked to fill out a survey. The survey under development has the following categories: exam stressor, study-related stressors, financial pressures, transition to university, family-related stress, student response to stress, and stress management. After the data collection, Structural Equation Modeling (SEM) analysis will be conducted in order to identify the relationship among students’ level of stress, coping strategies, and academic performance.

Keywords: college student stress, coping strategies, academic performance, measuring stress

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Authors: Dih Ling Luh, Zhi Shih You, Szu Chieh Chen

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Social contact patterns among school-age children play an important role in the epidemiology of infectious disease. Since many of the greatest threats to human health are spread by direct person-to-person contact, understanding the spread of respiratory pathogens and patterns of human interactions are public health priorities. This study used social contact diaries to compare the number of contacts per day per participant across different flu/non-flu seasons and weekend/weekday. We also present contact properties such as sex, age, masking, setting, frequency, duration, and contact types among school-age children (grades 7–8). The sample size with pair-wise comparisons for the seasons (flu/non-flu) and stratification by location were 54 and 83, respectively. There was no difference in the number of contacts during the flu and non-flu seasons, with averages of 16.3 (S.D. = 12.9) and 14.6 (S.D. = 9.5) people, respectively. Weekdays were associated with 23% and 28% more contacts than weekend days during the non-flu and flu seasons, respectively (p < 0.001) (Wilcoxon signed-rank test).

Keywords: contact patterns, behavior, influenza, social mixing

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Authors: Nonde Lushinga, Jiang Xin, Danstan Chiponde, Lawrence P. Mutale

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In this paper, falling weight deflectometer (FWD) was used to determine the bonding condition of a newly constructed semi-rigid base pavement. Using Evercal back-calculation computer programme, it was possible to quickly and accurately determine the structural condition of the pavement system of FWD test data. The bonding condition of the pavement layers was determined from calculated shear stresses and strains (relative horizontal displacements) on the interface of pavement layers from BISAR 3.0 pavement computer programmes. Thus, by using non-linear layered elastic theory, a pavement structure is analysed in the same way as other civil engineering structures. From non-destructive FWD testing, the required bonding condition of pavement layers was quantified from soundly based principles of Goodman’s constitutive models shown in equation 2, thereby producing the shear reaction modulus (Ks) which gives an indication of bonding state of pavement layers. Furthermore, a Tack coat failure Ratio (TFR) which has long being used in the USA in pavement evaluation was also used in the study in order to give validity to the study. According to research [39], the interface between two asphalt layers is determined by use of Tack Coat failure Ratio (TFR) which is the ratio of the stiffness of top layer asphalt layers over the stiffness of the second asphalt layer (E1/E2) in a slipped pavement. TFR gives an indication of the strength of the tack coat which is the main determinants of interlayer slipping. The criteria is that if the interface was in the state full bond, TFR would be greater or equals to 1 and that if the TFR was 0, meant full slip. Results of the calculations showed that TFR value was 1.81 which re-affirmed the position that the pavement under study was in the state of full bond because the value was greater than 1. It was concluded that FWD can be used to determine bonding condition of existing and newly constructed pavements.

Keywords: falling weight deflectometer (FWD), backcaluclation, semi-rigid base pavement, shear reaction modulus

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Authors: Moroof, O. Oloruntola, Sunday Oladele, Daniel, O. Obasaju, Victor, O Ojekunle, Olateju, O. Bayewu, Ganiyu, O. Mosuro

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Integrated geophysical methods involving Vertical Electrical Sounding (VES) and 2D resistivity survey were deployed to gain an insight into the influence of the two varying rock types (mica-schist and granite gneiss) underlying the road alignment to the incessant highway failure along Ajaokuta-Anyigba, North-central Nigeria. The highway serves as a link-road for the single largest cement factory in Africa (Dangote Cement Factory) and two major ceramic industries to the capital (Abuja) via Lokoja. 2D Electrical Resistivity survey (Dipole-Dipole Array) and Vertical Electrical Sounding (VES) (Schlumberger array) were employed. Twenty-two (22) 2D profiles were occupied, twenty (20) conducted about 1 m away from the unstable section underlain by mica-schist with profile length each of approximately 100 m. Two (2) profiles were conducted about 1 m away from the stable section with a profile length of 100 m each due to barriers caused by the drainage system and outcropping granite gneiss at the flanks of the road. A spacing of 2 m was used for good image resolution of the near-surface. On each 2D profile, a range of 1-3 VES was conducted; thus, forty-eight (48) soundings were acquired. Partial curve matching and WinResist software were used to obtain the apparent and true resistivity values of the 1D survey, while DiprofWin software was used for processing the 2-D survey. Two exposed lithologic sections caused by abandoned river channels adjacent to two profiles as well as the knowledge of the geology of the area helped to constrain the VES and 2D processing and interpretation. Generally, the resistivity values obtained reflect the parent rock type, degree of weathering, moisture content and competency of the tested area. Resistivity values < 100; 100 – 950; 1000 – 2000 and > 2500 ohms-m were interpreted as clay, weathered layer, partly weathered layer and fresh basement respectively. The VES results and 2-D resistivity structures along the unstable segment showed similar lithologic characteristics and sequences dominated by clayey substratum for depths range of 0 – 42.2 m. The clayey substratum is a product of intensive weathering of the parent rock (mica-schist) and constitutes weak foundation soils, causing highway failure. This failure is further exacerbated by several heavy-duty trucks which ply the section round the clock due to proximity to two major ceramic industries in the state and lack of drainage system. The two profiles on the stable section show 2D structures that are remarkably different from those of the unstable section with very thin topsoils, higher resistivity weathered substratum (indicating the presence of coarse fragments from the parent rock) and shallow depth to the basement (1.0 – 7. 1 m). Also, the presence of drainage and lower volume of heavy-duty trucks are contributors to the pavement stability of this section of the highway. The resistivity surveys effectively delineated two contrasting soil profiles of the subbase/subgrade that reflect variation in the mineralogy of underlying parent rocks.

Keywords: clay, geophysical methods, pavement, resistivity

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Authors: Gokulan Vethanayakam, Daniel Aston

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Introduction: The ReSPECT process supports healthcare professionals when making patient-centered decisions in the event of an emergency. It has been widely adopted by the NHS in England and allows patients to express thoughts and wishes about treatments and outcomes that they consider acceptable. It includes (but is not limited to) cardiopulmonary resuscitation decisions. ReSPECT conversations should ideally occur prior to ICU admission and should be documented in the eight sections of the nationally-standardised ReSPECT form. This audit evaluated the use of ReSPECT on a busy cardiothoracic ICU in an NHS Trust where established policies advocating its use exist. Methods: This audit was a retrospective review of ReSPECT forms for a sample of high-risk patients admitted to ICU at the Royal Papworth Hospital between January 2021 and March 2022. Patients all received one of the following interventions: Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) for severe respiratory failure (retrieved via the national ECMO service); cardiac or pulmonary transplantation-related surgical procedures (including organ transplants and Ventricular Assist Device (VAD) implantation); or elective non-transplant cardiac surgery. The quality of documentation on ReSPECT forms was evaluated using national standards and a graded ranking tool devised by the authors which was used to assess narrative aspects of the forms. Quality was ranked as A (excellent) to D (poor). Results: Of 230 patients (74 VV-ECMO, 104 transplant, 52 elective non-transplant surgery), 43 (18.7%) had a ReSPECT form and only one (0.43%) patient had a ReSPECT form completed prior to ICU admission. Of the 43 forms completed, 38 (88.4%) were completed due to the commencement of End of Life (EoL) care. No non-transplant surgical patients included in the audit had a ReSPECT form. There was documentation of balance of care (section 4a), CPR status (section 4c), capacity assessment (section 5), and patient involvement in completing the form (section 6a) on all 43 forms. Of the 34 patients assessed as lacking capacity to make decisions, only 22 (64.7%) had reasons documented. Other sections were variably completed; 29 (67.4%) forms had relevant background information included to a good standard (section 2a). Clinical guidance for the patient (section 4b) was given in 25 (58.1%), of which 11 stated the rationale that underpinned it. Seven forms (16.3%) contained information in an inappropriate section. In a comparison of ReSPECT forms completed ahead of an EoL trigger with those completed when EoL care began, there was a higher number of entries in section 3 (considering patient’s values/fears) that were assessed at grades A-B in the former group (p = 0.014), suggesting higher quality. Similarly, forms from the transplant group contained higher quality information in section 3 than those from the VV-ECMO group (p = 0.0005). Conclusions: Utilisation of the ReSPECT process in high-risk patients is yet to be well-adopted in this trust. Teams who meet patients before hospital admission for transplant or high-risk surgery should be encouraged to engage with the ReSPECT process at this point in the patient's journey. VV-ECMO retrieval teams should consider ReSPECT conversations with patients’ relatives at the time of retrieval.

Keywords: audit, critical care, end of life, ICU, ReSPECT, resuscitation

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Authors: Lakhoua Najeh

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Aims of the work: The aim of this paper is to improve the reliability and the availability of a Packer production line of cigarettes based on two methods: The SADT method (Structured Analysis Design Technique) and the FMECA approach (Failure Mode Effects and Critically Analysis). The first method enables us to describe the functionality of the Packer production line of cigarettes and the second method enables us to establish an FMECA analysis. Methods: The methodology adopted in order to contribute to the improvement of the reliability and the availability of a Packer production line of cigarettes has been proposed in this paper, and it is based on the use of Structured Analysis Design Technique (SADT) and Failure mode, effects, and criticality analysis (FMECA) methods. This methodology consists of using a diagnosis of the existing of all of the equipment of a production line of a factory in order to determine the most critical machine. In fact, we use, on the one hand, a functional analysis based on the SADT method of the production line and on the other hand, a diagnosis and classification of mechanical and electrical failures of the line production by their criticality analysis based on the FMECA approach. Results: Based on the methodology adopted in this paper, the results are the creation and the launch of a preventive maintenance plan. They contain the different elements of a Packer production line of cigarettes; the list of the intervention preventive activities and their period of realization. Conclusion: The diagnosis of the existing state helped us to found that the machine of cigarettes used in the Packer production line of cigarettes is the most critical machine in the factory. Then this enables us in the one hand, to describe the functionality of the production line of cigarettes by SADT method and on the other hand, to study the FMECA machine in order to improve the availability and the performance of this machine.

Keywords: production system, diagnosis, SADT method, FMECA method

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Authors: Abdelmessih Malak Sadek Labib

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The Stability in harsh environments thanks to excellent electrical, mechanical and thermal properties is what ceramics are all about selected materials for many applications despite advent of new materials such as plastics and composites. However, ceramic materials have disadvantages, including brittleness. Fragility is often attributed to pottery strong covalent and ionic bonds in the ceramic body. There is still much to learn about brittle cracks in a attention to detail, hence the fragility of the ceramic and its catastrophic failure of a frequently studied topic, particularly in charging applications. One of the most commonly used ceramics for load-bearing applications such as veneers is porcelain. Porcelain is a type of traditional pottery. Traditional pottery consists mainly of three basic ingredients: clay, which gives plasticity; silica which maintains the shape and stability of the ceramic body over temperature high temperature; and feldspar affecting glazing. In traditional pottery, the inversion of quartz during cooling the process can create microcracks that act as a stress concentration centers. Consequently, subcritical crack growth is caused due to quartz inversion origins unpredictable catastrophic failure of the work of ceramic bodies when reloading. In the case of porcelain, however, this is what the mullite hypothesis says the strength of porcelain can be significantly increased with felt Interlocking of mullite needles in the ceramic body.in this way realistic assessment of the role of quartz and mullite Porcelain with a strength of is needed to grow stronger and smaller fragile porcelain. Currently,the lack of reports on Young's moduli in the literature leads to erroneous conclusions in this regard mechanical behavior of porcelain. Therefore, the current project uses the Young's modulus approach for the investigation the role of quartz and mullite on the mechanical strength of various porcelains, in addition to reducing particle size, flexural strength fractographic forces and techniques.

Keywords: materials, technical, ceramics, properties, thermal, stability, advantages

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Authors: Wei Zhao, Yuxuan Yao, Hao Chen

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In order to find out the mechanical properties and failure behavior of lithium-ion batteries, drop hammer impact experiments and finite element simulations are carried out on batteries with different packed angles. Firstly, a drop hammer impact experiment system, which is based on the DHR-1808 drop hammer and oscilloscope, is established, and then a drop test of individual batteries and packed angles of 180 ° and 120 ° are carried out. The image of battery deformation, force-time curve and voltage-time curve are recorded. Secondly, finite element models of individual batteries and two packed angles are established, and the results of the test and simulation are compared. Finally, the mechanical characteristics and failure behavior of lithium-ion battery modules with the packed arrangement of 6 * 6 and packing angles of 180 °, 120 °, 90 ° and 60 ° are analyzed under the same velocity with different battery packing angles, and the same impact energy with different impact velocity and different packing angles. The result shows that the individual battery is destroyed completely in the drop hammer impact test with an initial impact velocity of 3m/s and drop height of 459mm, and the voltage drops to close to 0V when the test ends. The voltage drops to 12V when packed angle of 180°, and 3.6V when packed angle of 120°. It is found that the trend of the force-time curve between simulation and experiment is generally consistent. The difference in maximum peak value is 3.9kN for a packing angle of 180° and 1.3kN for a packing angle of 120°. Under the same impact velocity and impact energy, the strain rate of the battery module with a packing angle of 180° is the lowest, and the maximum stress can reach 26.7MPa with no battery short-circuited. The research under our experiment and simulation shows that the lithium-ion battery module with a packing angle of 180 ° is the least likely to be damaged, which can sustain the maximum stress under the same impact load.

Keywords: battery module, finite element simulation, power battery, packing angle

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Authors: L. Gyansah, Yanfang Shen, Jiqiang Wang, Tianying Xiong

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SiCₚ/ pure Al composites with different SiC fractions (20 wt %, 30 wt %, and 40 wt %) were precisely cold sprayed, followed by hot axial-compression tests at deformation temperatures of 473 K to 673 K, leading to failure of specimens through routine crack propagation in their multiphase. The plastic deformation behaviour with respect to the SiCₚ contents and the deformation temperatures were studied at strain rate 1s-1.As-sprayed and post-failure specimens were analyzed by X-ray computed tomography (XCT), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). Quasi-static thermomechanical testing results revealed that compressive strength (UTS = 228 MPa and 30.4 %) was the highest in the composites that was thermomechanically compressed at 473 K compared to those of the as-sprayed, while the as-sprayed exhibited a compressive strength of 182.8 MPa related to the increment in SiC fraction. Strength—plasticity synergy was promoted by dynamic recrystallization (DRX) through strengthening and refinement of the grains. The DRX degree depends relevantly on retainment of the uniformly ultrafine SiCₚ particulates, the pinning effects of the interfaces promoted by the ultrafine grain structures (UFG), and the higher deformation temperature. Reconstructed X-ray computed tomography data revealed different crack propagation mechanisms. A single-plane shear crack with multi-laminates fracture morphology yields relatively through the as-sprayed and as-deformed at 473 K deposits, while a multiphase plane shear cracks preeminently existed in high temperature deformed deposits resulting in multiphase-interface delaminations. Three pertinent strengthening mechanisms, videlicet, SiCp dispersed strengthening, refined grain strengthening, and dislocation strengthening, existed in the gradient microstructure, and their detailed contributions to the thermomechanical properties were discussed.

Keywords: cold spraying, hot deformation, deformation temperature, thermomechancal properties, SiC/Al composite

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Authors: Ákos Cserny

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The unequivocal increase of the area of operation of the executive power can happen with the appearance of new areas to be influenced and its integration in the power, or at the expense of the scopes of other organs with public authority. The extension of the executive can only be accepted within the framework of the rule of law if parallel with this process we get constitutional guarantees that the exercise of power is kept within constitutional framework. Failure to do so, however, may result in the lack, deficit of democracy and democratic sense, and may cause an overwhelming dominance of the executive power. Therefore, the aim of this paper is to present executive power and responsibility in the context of different dimensions.

Keywords: confidence, constitution, executive power, liabiliy, parliamentarism

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Authors: Leilani Forby, Farid Pazhoohi, Alan Kingstone

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There is abundant research on the nature and content of mind wandering (MW) in neurotypical (NT) adults, however, there is little to no research in these areas on autistic individuals. The objective of the current study was to uncover any differences between low and high autistic trait individuals in their MW. In particular, we examined their attitudes toward, and the themes and temporal dimensions (past, present, future) of, their MW episodes. For our online study, we recruited 518 students (394 women and 124 men), between the ages of 18 and 51 years (M = 20.93, SD = 3.40) from the undergraduate Human Subject Pool at the University of British Columbia. Participants completed the Short Imaginal Processes Inventory (SIPI), which includes the three subscales Positive-Constructive Daydreaming (SIPI-PC), Guilt and Fear of Failure Daydreaming (SIPI-GFF), and Poor Attentional Control (SIPI-PAC). Participants also completed the Past (IPI-past) and Present (IPI-present) subscales of the Imaginal Processes Inventory (IPI), the Deliberate (MW-D) and Spontaneous (MW-S) Mind Wandering scales, the Short Form Perceived Stress Scale (PSS-4), and the 10-item Autism Quotient (AQ-10). Results showed that overall, participant AQ-10 scores were significantly correlated with MW-S, SIPI-GFF, and PSS-4 scores, such that as the number of autistic traits endorsed by participants increased, so did their reports of spontaneous mind wandering, guilt and fear of failure themed day dreaming, and stress levels. This same pattern held for female participants, however, AQ-10 scores were positively correlated with only PSS-4 scores for males. These results suggest that compared to males with autistic traits, MW in females with autistic traits is more similar to individuals with low autistic traits in terms of content and intentionality. Results are discussed in terms of clinical implications, their limitations, and suggested directions for future research.

Keywords: autism, deliberate, mind wandering, spontaneous, perceived stress

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Authors: Majid Dashtgerd, Eisa Moradi Afrapoli

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The “Yemen War” is one of the longest wars of the recent century, which was launched on 26 March 2015 after the Saudi Arabia-led alliance's military intervention in Yemen. The war began with the aim of fighting Yemen's Houthis and preventing Iranian influence in the region, and Saudi leaders expected a quick victory; However, the “Yemen War” lasted about seven years and is still going on (May 2022), and Saudi Arabia has not been able to achieve its strategic objectives. This study seeks to examine some of the most important reasons for Saudi Arabia's protracted war and failure in Yemen.

Keywords: Saudi Arabia, yemen war, houthis, Iran

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Authors: Esmeralda Hysenbelliu

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The aim of this paper is to present the QoE (Quality of Experience) IPTV SDN-based media streaming server enhanced architecture for configuring, controlling, management and provisioning the improved delivery of IPTV service application with low cost, low bandwidth, and high security. Furthermore, it is given a virtual QoE IPTV SDN-based topology to provide an improved IPTV service based on QoE Control and Management of multimedia services functionalities. Inside OpenFlow SDN Controller there are enabled in high flexibility and efficiency Service Load-Balancing Systems; based on the Loading-Balance module and based on GeoIP Service. This two Load-balancing system improve IPTV end-users Quality of Experience (QoE) with optimal management of resources greatly. Through the key functionalities of OpenFlow SDN controller, this approach produced several important features, opportunities for overcoming the critical QoE metrics for IPTV Service like achieving incredible Fast Zapping time (Channel Switching time) < 0.1 seconds. This approach enabled Easy and Powerful Transcoding system via FFMPEG encoder. It has the ability to customize streaming dimensions bitrates, latency management and maximum transfer rates ensuring delivering of IPTV streaming services (Audio and Video) in high flexibility, low bandwidth and required performance. This QoE IPTV SDN-based media streaming architecture unlike other architectures provides the possibility of Channel Exchanging between several IPTV service providers all over the word. This new functionality brings many benefits as increasing the number of TV channels received by end –users with low cost, decreasing stream failure time (Channel Failure time < 0.1 seconds) and improving the quality of streaming services.

Keywords: improved quality of experience (QoE), OpenFlow SDN controller, IPTV service application, softwarization

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Authors: Stefano Andrea Denes

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The use of dental implants to rehabilitate edentulous patients has become a well-established and effective treatment option; however, despite its high success rate, this treatment is not free of complications. The fracture of implant body is a rare cause of failure but when it does occur it can present technical challenges. In this article, we report the complete removal of a fractured osseointegrated implant using electrosurgery and ultrasonic instrumentation. The postoperative course was uneventful, no bleeding, infection, or hematoma formation was observed.

Keywords: dental implant, oral surgery, electrosurgery, piezosurgery

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Authors: S. Maniruzzaman, N. Ramanujam, Qazi Akhter Rasool, Swapan Kumar Biswas, P. Prasad, Chandrakanta Ojha

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Landslide is one of the major natural disasters in South Asian countries. Applying 2D Electrical Resistivity Tomographic Imaging estimation of geometry, thickness, and depth of failure zone of the landslide can be made. Landslide is a pertinent problem in Nilgris plateau next to Himalaya. Nilgris range consists of hard Archean metamorphic rocks. Intense weathering prevailed during the Pre-Cambrian time had deformed the rocks up to 45m depth. The landslides are dominant in the southern and eastern part of plateau of is comparatively smaller than the northern drainage basins, as it has low density of drainage; coarse texture permitted the more of infiltration of rainwater, whereas in the northern part of the plateau entombed with high density of drainage pattern and fine texture with less infiltration than run off, and low to the susceptible to landslide. To get comprehensive information about the landslide zone 2D Electrical Resistivity Tomographic imaging study with CRM 500 Resistivity meter are used in Coonoor– Mettupalyam sector of Nilgiris plateau. To calculate Factor of Safety the infinite slope model of Brunsden and Prior is used. Factor of Safety can be expressed (FS) as the ratio of resisting forces to disturbing forces. If FS < 1 disturbing forces are larger than resisting forces and failure may occur. The geotechnical parameters of soil samples are calculated on the basis upon the apparent resistivity values for litho units of measured from 2D ERT image of the landslide zone. Relationship between friction angles for various soil properties is established by simple regression analysis from apparent resistivity data. Increase of water content in slide zone reduces the effectiveness of the shearing resistance and increase the sliding movement. Time-lapse resistivity changes to slope failure is determined through geophysical Factor of Safety which depends on resistivity and site topography. This ERT technique infers soil property at variable depths in wider areas. This approach to retrieve the soil property and overcomes the limit of the point of information provided by rain gauges and porous probes. Monitoring of slope stability without altering soil structure through the ERT technique is non-invasive with low cost. In landslide prone area an automated Electrical Resistivity Tomographic Imaging system should be installed permanently with electrode networks to monitor the hydraulic precursors to monitor landslide movement.

Keywords: 2D ERT, landslide, safety factor, slope stability

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Authors: A. B. M. Rezaul Islam, Ernur Karadogan

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Shape memory alloys (SMAs) are known for their shape memory effect and pseudoelasticity behavior. Their thermomechanical behaviors are modeled by numerous researchers using microscopic thermodynamic and macroscopic phenomenological point of view. Tanaka, Liang-Rogers and Ivshin-Pence models are some of the most popular SMA macroscopic phenomenological constitutive models. They describe SMA behavior in terms of stress, strain and temperature. These models involve material parameters and they have associated uncertainty present in them. At different operating temperatures, the uncertainty propagates to the output when the material is subjected to loading followed by unloading. The propagation of uncertainty while utilizing these models in real-life application can result in performance discrepancies or failure at extreme conditions. To resolve this, we used probabilistic approach to perform the sensitivity and uncertainty analysis of Tanaka, Liang-Rogers, and Ivshin-Pence models. Sobol and extended Fourier Amplitude Sensitivity Testing (eFAST) methods have been used to perform the sensitivity analysis for simulated isothermal loading/unloading at various operating temperatures. As per the results, it is evident that the models vary due to the change in operating temperature and loading condition. The average and stress-dependent sensitivity indices present the most significant parameters at several temperatures. This work highlights the sensitivity and uncertainty analysis results and shows comparison of them at different temperatures and loading conditions for all these models. The analysis presented will aid in designing engineering applications by eliminating the probability of model failure due to the uncertainty in the input parameters. Thus, it is recommended to have a proper understanding of sensitive parameters and the uncertainty propagation at several operating temperatures and loading conditions as per Tanaka, Liang-Rogers, and Ivshin-Pence model.

Keywords: constitutive models, FAST sensitivity analysis, sensitivity analysis, sobol, shape memory alloy, uncertainty analysis

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Authors: Riaz A. Agha, Alexander J. Fowler, Seon-Young Lee, Buket Gundogan, Katharine Whitehurst, Harkiran K. Sagoo, Kyung Jin Lee Jeong, Douglas G. Altman, Dennis P. Orgill

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Introduction: Case Series are an important and common study type. Currently, no guideline exists for reporting case series and there is evidence of key data being missed from such reports. We propose to develop a reporting guideline for case series using a methodologically robust technique. The first step in this process is a systematic review of literature relevant to the reporting deficiencies of case series. Methods: A systematic review of methodological and reporting quality in surgical case series was performed. The electronic search strategy was developed by an information specialist and included MEDLINE, EMBASE, Cochrane Methods Register, Science Citation index and Conference Proceedings Citation index, from the start of indexing until 5th November 2014. Independent screening, eligibility assessments and data extraction was performed. Included articles were analyzed for five areas of deficiency: failure to use standardized definitions missing or selective data transparency or incomplete reporting whether alternate study designs were considered. Results: The database searching identified 2,205 records. Through the process of screening and eligibility assessments, 92 articles met inclusion criteria. Frequency of methodological and reporting issues identified was a failure to use standardized definitions (57%), missing or selective data (66%), transparency, or incomplete reporting (70%), whether alternate study designs were considered (11%) and other issues (52%). Conclusion: The methodological and reporting quality of surgical case series needs improvement. Our data shows that clear evidence-based guidelines for the conduct and reporting of a case series may be useful to those planning or conducting them.

Keywords: case series, reporting quality, surgery, systematic review

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Authors: Malkit Singh

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This paper presents an in-depth analysis of the problem of migration from Punjab to the West while analyzing the history and patterns of generations of migration of Punjabis to the West. A special emphasis is given to link the present socio-economic and political crisis with the historical pattern of Punjabis’ migration to the West from colonial India to Independent Bharat, along with the stories of the success and failures of Western aspirants’ youth from Punjab. The roots of the migration from Punjab to the West have been traced from the invasion of the British in Punjab, resulting in the socio-economic and political dismantling of the Punjabi society, which resulted in the migration of the Punjabis to the other colonies of the British Empire. The grim position at home despite of all the efforts and hard work by the majority of the Punjabis, particularly from the farmer community and the shining lifestyle of some families of the village or vicinity who have some relatives in the West have encouraged the large number of Punjabis to change their fortune by working in West. However, the Visa and Work Permit regime has closed the doors of the West for those who are unskilled, semi-skilled and not qualified for the visa and work permit norms, but their inspiration to change their fortune by working abroad at any cost has resulted into the development of big business fraud of immigration agent and firms in Punjab that resulted into the loss of the thousands lives, imprisonment in the foreign and selling of the properties of the Punjabis. The greed for the greener pastures in the West and, the plight of the deserted wives of NRIs and the illegal routes adopted by the Punjabi youth due to the non-availability of visas and work permits are dealt in a comprehensive method. The rise and fall of Punjab as a land of the breadbasket of Bharat and the marginalization of the farmers with middle and small holdings due to the capital-intensive techniques are linked with the forced migration of the Punjabis. The failure of the government to address and respond to the rampant corruption, agriculture failure and the resulting problems of law and order before and after the troubled period of militancy in Punjab and the resulting migration to the West are comprehensively covered. The new trend of the Student Visa and Study abroad, particularly in Canada, Australia, and New Zealand, despite of the availability of quality education at very low cost in India. The early success of some students in getting study visas from Australia, Canada, New Zealand etc. and getting permanent immigration to these countries have encouraged the majority of Punjabi youth to leave their motherland for better opportunities in the prosperous lands, that is, again, failed as these countries are flooded with the Punjabi students. Moreover, the total failure of the political leadership of Punjab to address the basic needs of society, like law and order and stop the drug menace issues in the post-militancy Punjab is also done to understand the problem.

Keywords: Punjab, migration, West, agriculture

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Authors: Majid Yazdandoust

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This study, tries to suggest a design method based on displacement using finite difference numerical modeling in reinforcing soil retaining wall with steel strip. In this case, dynamic loading characteristics such as duration, frequency, peak ground acceleration, geometrical characteristics of reinforced soil structure and type of the site are considered to correct the pseudo static method and finally introduce the pseudo static coefficient as a function of seismic performance level and peak ground acceleration. For this purpose, the influence of dynamic loading characteristics, reinforcement length, height of reinforced system and type of the site are investigated on seismic behavior of reinforcing soil retaining wall with steel strip. Numerical results illustrate that the seismic response of this type of wall is highly dependent to cumulative absolute velocity, maximum acceleration, and height and reinforcement length so that the reinforcement length can be introduced as the main factor in shape of failure. Considering the loading parameters, mechanically stabilized earth wall parameters and type of the site showed that the used method in this study leads to most efficient designs in comparison with other methods which are generally suggested in cods that are usually based on limit-equilibrium concept. The outputs show the over-estimation of equilibrium design methods in comparison with proposed displacement based methods here.

Keywords: pseudo static coefficient, seismic performance design, numerical modeling, steel strip reinforcement, retaining walls, cumulative absolute velocity, failure shape

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Authors: N. Nivedita, S. Durbha

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Critical Infrastructure (CI) consists of services and technological networks such as healthcare, transport, water supply, electricity supply, information technology etc. These systems are necessary for the well-being and to maintain effective functioning of society. Critical Infrastructures can be represented as nodes in a network where they are connected through a set of links depicting the logical relationship among them; these nodes are interdependent on each other and interact with each at other at various levels, such that the state of each infrastructure influences or is correlated to the state of another. Disruption in the service of one infrastructure nodes of the network during a disaster would lead to cascading and escalating disruptions across other infrastructures nodes in the network. The operation of Healthcare Infrastructure is one such Critical Infrastructure that depends upon a complex interdependent network of other Critical Infrastructure, and during disasters it is very vital for the Healthcare Infrastructure to be protected, accessible and prepared for a mass casualty. To reduce the consequences of a disaster on the Critical Infrastructure and to ensure a resilient Critical Health Infrastructure network, knowledge, understanding, modeling, and analyzing the inter-dependencies between the infrastructures is required. The paper would present inter-dependencies related to Healthcare Critical Infrastructure based on Hierarchical Coloured Petri Nets modeling approach, given a flood scenario as the disaster which would disrupt the infrastructure nodes. The model properties are being analyzed for the various state changes which occur when there is a disruption or damage to any of the Critical Infrastructure. The failure probabilities for the failure risk of interconnected systems are calculated by deriving a reachability graph, which is later mapped to a Markov chain. By analytically solving and analyzing the Markov chain, the overall vulnerability of the Healthcare CI HCPN model is demonstrated. The entire model would be integrated with Geographic information-based decision support system to visualize the dynamic behavior of the interdependency of the Healthcare and related CI network in a geographically based environment.

Keywords: critical infrastructure interdependency, hierarchical coloured petrinet, healthcare critical infrastructure, Petri Nets, Markov chain

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