Search results for: seismic emergency

Authors: Kaviyarasan D., Satish Kumar S. R.

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India being vast in area and population with great scope of international business, roadways and railways network connection within the country is expected to have a big growth. There are numerous rail-cum-road bridges constructed across many major rivers in India and few are getting very old. So there is more possibility of repairing or coming up with such new bridges in India. Analysis and design of such bridges are practiced through conventional procedure and end up with heavy and uneconomical sections. Such heavy class steel bridges when subjected to high seismic shaking has more chance to fail by stability because the members are too much rigid and stocky rather than being flexible to dissipate the energy. This work is the collective study of the researches done in the truss bridge and steel concrete composite truss bridges presenting the method of analysis, tools for numerical and analytical modeling which evaluates its seismic behaviour and collapse mechanisms. To ascertain the inelastic and nonlinear behaviour of the structure, generally at research level static pushover analysis is adopted. Though the static pushover analysis is now extensively used for the framed steel and concrete buildings to study its lateral action behaviour, those findings by pushover analysis done for the buildings cannot directly be used for the bridges as such, because the bridges have completely a different performance requirement, behaviour and typology as compared to that of the buildings. Long span steel bridges are mostly the truss bridges. Truss bridges being formed by many members and connections, the failure of the system does not happen suddenly with single event or failure of one member. Failure usually initiates from one member and progresses gradually to the next member and so on when subjected to further loading. This kind of progressive collapse of the truss bridge structure is dependent on many factors, in which the live load distribution and span to length ratio are most significant. The ultimate collapse is anyhow by the buckling of the compression members only. For regular bridges, single step pushover analysis gives results closer to that of the non-linear dynamic analysis. But for a complicated bridge like heavy class steel bridge or the skewed bridges or complicated dynamic behaviour bridges, nonlinear analysis capturing the progressive yielding and collapse pattern is mandatory. With the knowledge of the postelastic behaviour of the bridge and advancements in the computational facility, the current level of analysis and design of bridges has moved to state of ascertaining the performance levels of the bridges based on the damage caused by seismic shaking. This is because the buildings performance levels deals much with the life safety and collapse prevention levels, whereas the bridges mostly deal with the extent damages and how quick it can be repaired with or without disturbing the traffic after a strong earthquake event. The paper would compile the wide spectrum of modeling to analysis of the steel concrete composite truss bridges in general.

Keywords: bridge engineering, performance based design of steel truss bridge, seismic design of composite bridge, steel-concrete composite bridge

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Authors: Alisher Agzamov, Hanan Al Harbi

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BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists. We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 220 +/- 80 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 150 +/- 55 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for patients with AML (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 20 % compared with the prerobot era, and there was an ICU cost savings of KD2.5 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, rp - 7 in icu management, cost and icu occupancy

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Authors: Esam Roshdy, Saleh AlRashdi, Turki Alharbi, Rawan Eskandarani, Zurina Cabilo

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Introduction/ background: Consultation in the Emergency Department constitute a major part of the work flow every day. Any delay in the consultation process have a major impact on the length of stay and patient disposition and thus affect the total waiting time of patients in the ED. King Fahad medical City in Riyadh City, Saudi Arabia is considered a major Tertiary hospital where there is high flow of patients of different categories visiting the ED. The importance of decreasing consultation time and decision for final disposition of patients was recognized and interpreted in this project to find ways to improve the patient flow in the department and thus the total patient disposition and outcome. Aim / Objectives: 1. To monitor the time of consultation for patients in the Emergency department and its impact on the length of stay of patients in the ED. 2. To detect and assess the problems that lead to long consultation times in the ED, and reach a targeted time of 2 hours for final disposition of patients, according to recognized international and our institutional consultation policy, to reach the final goal of decreasing total length of stay and thus improve the patient flow in the ED. Methods: Data was collected retrospectively for a 92 charts of consultations done in the ED over 2 month’s period. The data was analyzed to get the median of Total Consultation Time. A survey was conducted among all ED staff to determine the level of knowledge about the total consultation time and the compliance to the institutional policy target of 2 hours. A second Data sample of 168 chart was collected after awareness campaign and education of all ED staff about the importance of reaching the target consultation time and compliance to the institutional policy. Results: We have found that there is room for improvement in our overall consultation time. This was found to be more frequent with certain specialties. Our surveys have showed that many ED staff are not familiar or not compliant with our consultation policy which was not clear for everyone. Post-intervention data have showed that awareness of the importance to decrease the total consultation time and compliance alone to the targeted goal have had a huge impact on overall improvement and decreasing the time of final decision and disposition of the patient and the overall patient length of stay in the ED. Conclusion: Working on improving Consultation time in the Emergency Department is a major factor in improving overall length of stay and patient flow. This improvement helps in the overall patient disposition and satisfaction. Plan: As a continuation of our project we are planning to focus on the conflict of admission cases where more than one specialty is involved in the care of patients. We are planning to collect data on the time it takes to resolve and reach final disposition of those patients, and its impact on the length of stay and our department flow and the overall patient outcome and satisfaction.

Keywords: consultation time, impact, length of stay, in the ED

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Authors: Qassun S. Mohammed Shafiqu, Murtadha A. Abdulrasool

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The design of shallow foundations to withstand different dynamic loads has given considerable attention in recent years. Dynamic loads may be due to the earthquakes, pile driving, blasting, water waves, and machine vibrations. But, predicting the behavior of shallow foundations during earthquakes remains a difficult task for geotechnical engineers. A database for dynamic and static parameters for different soils in seismic active zones in Iraq is prepared which has been collected from geophysical and geotechnical investigation works. Then, analysis of a typical 3-D soil-raft foundation system under earthquake loading is carried out using the database. And a parametric study has been carried out taking into consideration the influence of some parameters on the dynamic behavior of the raft foundation, such as raft stiffness, damping ratio as well as the influence of the earthquake acceleration-time records. The results of the parametric study show that the settlement caused by the earthquake can be decreased by about 72% with increasing the thickness from 0.5 m to 1.5 m. But, it has been noticed that reduction in the maximum bending moment by about 82% was predicted by decreasing the raft thickness from 1.5 m to 0.5 m in all sites model. Also, it has been observed that the maximum lateral displacement, the maximum vertical settlement and the maximum bending moment for damping ratio 0% is about 14%, 20%, and 18% higher than that for damping ratio 7.5%, respectively for all sites model.

Keywords: shallow foundation, seismic behavior, raft thickness, damping ratio

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Authors: Pauline Calleja, Brooke Alexander

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In 2010 the College of Emergency Nursing Australasia (CENA) undertook sole administration of the Trauma Nursing Program (TNP) across Australia. The original TNP was developed from recommendations by the Review of Trauma and Emergency Services-Victoria. While participant and faculty feedback about the program was positive, issues were identified that were common for industry training programs in Australia. These issues included didactic approaches, with many lectures and little interaction/activity for participants. Participants were not necessarily encouraged to undertake deep learning due to the teaching and learning principles underpinning the course, and thus participants described having to learn by rote, and only gain a surface understanding of principles that were not always applied to their working context. In Australia, a trauma or emergency nurse may work in variable contexts that impact on practice, especially where resources influence scope and capacity of hospitals to provide trauma care. In 2011, a program review was undertaken resulting in major changes to the curriculum, teaching, learning and assessment approaches. The aim was to improve learning including a greater emphasis on pre-program preparation for participants, the learning environment and clinically applicable contextualized outcomes participants experienced. Previously if participants wished to undertake assessment, they were given a take home examination. The assessment had poor uptake and return, and provided no rigor since assessment was not invigilated. A new assessment structure was enacted with an invigilated examination during course hours. These changes were implemented in early 2012 with great improvement in both faculty and participant satisfaction. This presentation reports on a comparison of participant evaluations collected from courses post implementation in 2012 and in 2015 to evaluate if positive changes were sustained. Methods: Descriptive statistics were applied in analyzing evaluations. Since all questions had more than 20% of cells with a count of <5, Fisher’s Exact Test was used to identify significance (p = <0.05) between groups. Results: A total of fourteen group evaluations were included in this analysis, seven CENA TNP groups from 2012 and seven from 2015 (randomly chosen). A total of 173 participant evaluations were collated (n = 81 from 2012 and 92 from 2015). All course evaluations were anonymous, and nine of the original 14 questions were applicable for this evaluation. All questions were rated by participants on a five-point Likert scale. While all items showed improvement from 2012 to 2015, significant improvement was noted in two items. These were in regard to the content being delivered in a way that met participant learning needs and satisfaction with the length and pace of the program. Evaluation of written comments supports these results. Discussion: The aim of redeveloping the CENA TNP was to improve learning and satisfaction for participants. These results demonstrate that initial improvements in 2012 were able to be maintained and in two essential areas significantly improved. Changes that increased participant engagement, support and contextualization of course materials were essential for CENA TNP evolution.

Keywords: emergency nursing education, industry training programs, teaching and learning, trauma education

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Authors: Swanand Patil, Pankaj Agarwal

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In past few decades, seismic performance objectives have shifted from earthquake resistance to earthquake resilience of the structures, especially for the lifeline buildings. Features such as negligible post-earthquake damage and replaceable damaged components, makes energy dissipating systems a valid choice for a seismically resilient building. In this study, various energy dissipation devices are applied on an eight-storey moment resisting RC building model. The energy dissipating devices include both hysteresis-based and viscous type of devices. The seismic response of the building is obtained for different positioning and mechanical properties of the devices. The investigation is carried forward to the deficiently ductile RC frame also. The performance assessment is done on the basis of drift ratio, mode shapes and displacement response of the model structures. Nonlinear dynamic analysis shows largely improved displacement response. The damping devices improve displacement response more efficiently in the deficient ductile frames than that in the perfectly moment resisting frames. This finding is important considering the number of deficient buildings in India and the world. The placement and mechanical properties of the dampers prove to be a crucial part in modelling, analyzing and designing of the structures with supplemental energy dissipation.

Keywords: earthquake resilient structures, lifeline buildings, retrofitting of structures, supplemental energy dissipation

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Authors: Ahmed T. Farid, Khaled Z. Soliman

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Due to limited areas and excessive cost of land for projects, backfilling process has become necessary. Also, backfilling will be done to overcome the un-leveling depths or raising levels of site construction, especially near the sea region. Therefore, backfilling soil materials used under the foundation of structures should be investigated regarding its effect on ground motion characteristics, especially at regions subjected to earthquakes. In this research, 60-meter thickness of sandy fill material was used above a fixed 240-meter of natural clayey soil underlying by rock formation to predict the modified ground motion characteristics effect at the foundation level. Comparison between the effect of using three different situations of fill material compaction on the recorded earthquake is studied, i.e. peak ground acceleration, time history, and spectra acceleration values. The three different densities of the compacted fill material used in the study were very loose, medium dense and very dense sand deposits, respectively. Shake computer program was used to perform this study. Strong earthquake records, with Peak Ground Acceleration (PGA) of 0.35 g, were used in the analysis. It was found that, higher compaction of fill material thickness has a significant effect on eliminating the earthquake ground motion properties at surface layer of fill material, near foundation level. It is recommended to consider the fill material characteristics in the design of foundations subjected to seismic motions. Future studies should be analyzed for different fill and natural soil deposits for different seismic conditions.

Keywords: acceleration, backfill, earthquake, soil, PGA

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Authors: Ghorbanali Mohammadi

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Background: Due to the widespread outbreak of the COVID-19 virus, a large number of people become infected with the disease every day and go to hospitals. The acute condition of this disease has caused the death of many people. Since all the stages of treatment for these people happen in the hospitals, nurses are at the forefront of the fight against this virus. This causes nurses to suffer from physical and mental health problems. Methods: Physical and mental problems in nurses were assessed using the Depression, Anxiety and Stress Scale (DASS-42) of Lovibond (1995) and the Nordic Questionnaire. Results: 90 nurses from emergency, intensive care, and coronary care units were examined, and a total of 180 questionnaires were collected and evaluated. It was found that 37.78%, 47.78%, and 21.11% of nurses have symptoms of depression, anxiety, and stress, respectively. 40% of the nurses had physical problems. In total, 65.17% of them were involved in one or more mental or physical illnesses. Conclusions: Of the three units surveyed, the nurses in intensive care, emergency room, and coronary care units worked more than ten hours a day. Examining the interaction of physical and mental health problems indicated that physical problems can aggravate mental problems.

Keywords: depression anxiety and stress scale of Lovibond, nordic questionnaire, mental health of nurses, physical health problems in nurses

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Authors: Mohamed A. Saleem

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Using mostly seismic data, this study intends to show some examples of igneous intrusions found in some areas of the Sirt Basin and explore the period of their emplacement as well as the interrelationships between these sills. The study area is located in the south of the Zallah Trough, south-west Sirt basin, Libya. It is precisely between the longitudes 18.35ᵒ E and 19.35ᵒ E, and the latitudes 27.8ᵒ N and 28.0ᵒ N. Based on a variety of criteria that are usually used as marks on the igneous intrusions, twelve igneous intrusions (Sills), have been detected and analysed using 3D seismic data. One or more of the following were used as identification criteria: the high amplitude reflectors paired with abrupt reflector terminations, vertical offsets, or what is described as a dike-like connection, the violation, the saucer form, and the roughness. Because of their laying between the hosting layers, the majority of these intrusions are classified as sills. Another distinguishing feature is the intersection geometry link between some of these sills. Every single sill has given a name just to distinguish the sills from each other such as S-1, S-2, and …S-12. To avoid the repetition of description, the common characteristics and some statistics of these sills are shown in summary tables, while the specific characters that are not common and have been noticed for each sill are shown individually. The sills, S-1, S-2, and S-3, are approximately parallel to one other, with the shape of these sills being governed by the syncline structure of their host layers. The faults that dominated the strata (pre-upper Cretaceous strata) have a significant impact on the sills; they caused their discontinuity, while the upper layers have a shape of anticlines. S-1 and S-10 are the group's deepest and highest sills, respectively, with S-1 seated near the basement's top and S-10 extending into the sequence of the upper cretaceous. The dramatic escalation of sill S-4 can be seen in N-S profiles. The majority of the interpreted sills are influenced and impacted by a large number of normal faults that strike in various directions and propagate vertically from the surface to the basement's top. This indicates that the sediment sequences were existed before the sill’s intrusion, were deposited, and that the younger faults occurred more recently. The pre-upper cretaceous unit is the current geological depth for the Sills S-1, S-2 … S-9, while Sills S-10, S-11, and S-12 are hosted by the Cretaceous unit. Over the sills S-1, S-2, and S-3, which are the deepest sills, the pre-upper cretaceous surface has a slightly forced folding, these forced folding is also noticed above the right and left tips of sill S-8 and S-6, respectively, while the absence of these marks on the above sequences of layers supports the idea that the aforementioned sills were emplaced during the early upper cretaceous period.

Keywords: Sirt Basin, Zallah Trough, igneous intrusions, seismic data

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Authors: Alisher Agzamov, Hanan Al Harbi

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BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists (1). We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study of 1501 oncology patients using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction, including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP, were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 210 +/- 40 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 140 +/- 35 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for oncology patients (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 29 % compared with the prerobot era, and there was an ICU cost savings of KD2.2 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, icu management and care, cost and icu occupancy

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Authors: Marco Furinghetti, Alberto Pavese, Michele Rinaldi

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Concave Surface Slider devices have been more and more used in real applications for seismic protection of both bridge and building structures. Several research activities have been carried out, in order to investigate the lateral response of such a typology of devices, and a reasonably high level of knowledge has been reached. If radial analysis is performed, the frictional force is always aligned with respect to the restoring force, whereas under bidirectional seismic events, a bi-axial interaction of the directions of motion occurs, due to the step-wise projection of the main frictional force, which is assumed to be aligned to the trajectory of the isolator. Nonetheless, if non-linear time history analyses have to be performed, standard codes provide precise rules for the definition of an averagely spectrum-compatible set of accelerograms in radial conditions, whereas for bidirectional motions different combinations of the single components spectra can be found. Moreover, nowadays software for the adjustment of natural accelerograms are available, which lead to a higher quality of spectrum-compatibility and to a smaller dispersion of results for radial motions. In this endeavor a simplified design procedure is defined, for building structures, base-isolated by means of Concave Surface Slider devices. Different case study structures have been analyzed. In a first stage, the capacity curve has been computed, by means of non-linear static analyses on the fixed-base structures: inelastic fiber elements have been adopted and different direction angles of lateral forces have been studied. Thanks to these results, a linear elastic Finite Element Model has been defined, characterized by the same global stiffness of the linear elastic branch of the non-linear capacity curve. Then, non-linear time history analyses have been performed on the base-isolated structures, by applying seven bidirectional seismic events. The spectrum-compatibility of bidirectional earthquakes has been studied, by considering different combinations of single components and adjusting single records: thanks to the proposed procedure, results have shown a small dispersion and a good agreement in comparison to the assumed design values.

Keywords: concave surface slider, spectrum-compatibility, bidirectional earthquake, base isolation

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Authors: Tarek M. Alguhane, Ayman H. Khalil, M. N. Fayed, Ayman M. Ismail

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The retrofitting of existing buildings to resist the seismic loads is very important to avoid losing lives or financial disasters. The aim at retrofitting processes is increasing total structure strength by increasing stiffness or ductility ratio. In addition, the response modification factors (R) have to satisfy the code requirements for suggested retrofitting types. In this study, two types of jackets are used, i.e. full reinforced concrete jackets and surrounding steel plate jackets. The study is carried out on an existing building in Madinah by performing static pushover analysis before and after retrofitting the columns. The selected model building represents nearly all-typical structure lacks structure built before 30 years ago in Madina City, KSA. The comparison of the results indicates a good enhancement of the structure respect to the applied seismic forces. Also, the response modification factor of the RC building is evaluated for the studied cases before and after retrofitting. The design of all vertical elements (columns) is given. The results show that the design of retrofitted columns satisfied the code's design stress requirements. However, for some retrofitting types, the ductility requirements represented by response modification factor do not satisfy KSA design code (SBC- 301).

Keywords: concrete jackets, steel jackets, RC buildings, pushover analysis, non-Linear analysis

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Authors: Michelangelo Liban, Debbie Liquete

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A case of a 93-year-old Filipina who experienced a sudden onset of left-sided hemichorea hemiballismus after falling from a standing height due to dizziness and then sought consult at the Emergency Room. She was not known to have diabetes mellitus nor experienced any symptoms of diabetes aside from its rare neurological manifestation of hemichorea-hemiballismus prior to this consult. On further workup, her baseline laboratory tests at the Emergency Room Department showed a CBG of 340mg/dL, an HbA1c of 15%, no ketones were detected in her urine but a hyperdensity with a Hounsfeld unit of 38 on CT, and hyperintensity on T1 weighted MRI on her right striatum with an incidental finding of a subdural hematoma measured as a 0.7cm hyperdensity on her right temporoparietal area with no midline shift. She was then treated with Clonazepam 2mg ¼ tab twice a day before bedtime and insulin 70/30 16 units in the morning and eight units in the evening, which provided good glycemic control maintained at 140-180 mg/dL, complete cessation of the left-sided hemichorea hemiballismus was also observed. The subdural hematoma was deemed non-surgical, and she refused admission into our institution; hence observation on an outpatient basis was done. This is a case of a rare neurological manifestation of diabetes mellitus but with good treatment response to anti-chorea medications combined with diabetes medications.

Keywords: hemichorea, hemiballismus, striatopathy, diabetes

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Authors: Tarek M. Alguhane, Ayman H. Khalil, M. N. Fayed, Ayman M. Ismail

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A 15-storey RC building, studied in this paper, is representative of modern building type constructed in Madina City in Saudi Arabia before 10 years ago. These buildings are almost consisting of reinforced concrete skeleton, i. e. columns, beams and flat slab as well as shear walls in the stairs and elevator areas arranged in the way to have a resistance system for lateral loads (wind–earthquake loads). In this study, the dynamic properties of the 15-storey RC building were identified using ambient motions recorded at several spatially-distributed locations within each building. After updating the mathematical models for this building with the experimental results, three dimensional pushover analysis (nonlinear static analysis) was carried out using SAP2000 software incorporating inelastic material properties for concrete, infill and steel. The effect of modeling the building with and without infill walls on the performance point as well as capacity and demand spectra due to EQ design spectrum function in Madina area has been investigated. The response modification factor (R) for the 15 storey RC building is evaluated from capacity and demand spectra (ATC-40). The purpose of this analysis is to evaluate the expected performance of structural systems by estimating, strength and deformation demands in design, and comparing these demands to available capacities at the performance levels of interest. The results are summarized and discussed.

Keywords: seismic assessment, pushover analysis, ambient vibration, modal update

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Authors: Farhood Rismanchian, Seong Hyeon Park, Young Hoon Lee

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During the recent years, demand for healthcare services has dramatically increased. As the demand for healthcare services increases, so does the necessity of constructing new healthcare buildings and redesigning and renovating existing ones. Increasing demands necessitate the use of optimization techniques to improve the overall service efficiency in healthcare settings. However, high complexity of care processes remains the major challenge to accomplish this goal. This study proposes a method based on process mining results to address the high complexity of care processes and to find the optimal layout of the various medical centers in an emergency department. ProM framework is used to discover clinical pathway patterns and relationship between activities. Sequence clustering plug-in is used to remove infrequent events and to derive the process model in the form of Markov chain. The process mining results served as an input for the next phase which consists of the development of the optimization model. Comparison of the current ED design with the one obtained from the proposed method indicated that a carefully designed layout can significantly decrease the distances that patients must travel.

Keywords: Mixed Integer programming, Facility layout problem, Process Mining, Healthcare Operation Management

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Authors: Tugce Duygu Koksal

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In recent years, given the fact that the acts of terrorism and the threat of the latter are taking place without any border and distinction, it has led the states to deal with the terrorism as a priority issue. More recently, as seen in different countries during state of emergency, the adoption of anti-terrorism measures motivated by the sole need of the prevention of terrorism targets directly the fundamental rights of individuals. Therefore, a contribution to the understanding of the value of the principle of legality is becoming more and more important nowadays. This paper aims to reflect the probable effects of the adoption of anti-terrorism measures regardless of the principle of legality, on the fundamental rights. In this respect, this paper will first discuss the margin of appreciation of the national authorities by countering terrorism, and then, the importance of the respect of the legality of the anti-terrorism measures will be examined in the light of actual examples. Indeed, one of the major findings of this study is the fact that the anti-terrorism laws and measures were taken in this framework must be subject to close scrutiny in democracies, which adopted the principle of the rule of law and respect human rights. Although the state's margin of appreciation in the field of counter-terrorism is broad, these measures which are based on the legitimate aim of a democracies’ legitimate right to protect itself against the activities of terrorist organizations should have the legal basis and be strictly required by the exigencies of the fight against terrorism. While combating terrorism, the legal basis shall only be achieved if the legal consequences of an individuals’ actions related to terrorism shall be clear and foreseeable by the individuals of a society. On the other hand, particularly during the state of emergency, the ambiguity of the law might be used to include a wide range of actions under acts of terrorism. This is becoming more dangerous where freedom of expression, freedom of the press, freedom of association and the right to information is in the substance of these actions. Disregarding the principle of legality is susceptible to create a chilling effect on the exercise of human rights, and therefore, the fight against terrorism can be transformed into a repressive regime on opponents. As a result, the efforts to counter terrorism of the national authorities irrespective of the principle of legality are susceptible to cause a transformation of the rule of law to a state of law which cannot be appreciated in a democratic society.

Keywords: anti-terrorism measures, chilling effect, predictability, the principle of legality, state of emergency

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Authors: Harley Bray, Helen Pymar, Michelle Liu, Chau Pham, Tomislav Jelic, Fran Mulhall

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Background: Our study assesses the impact of the COVID-19 pandemic on early pregnancy assessment clinic (EPAC) referrals and the use of virtual consultation in Winnipeg, Manitoba. Our clinic expanded to accept referrals from all Winnipeg Emergency Department (ED)/Urgent Care (UC) sites beginning November 2019 to April 2020. By May 2020, the COVID-19 pandemic reached Manitoba and EPAC virtual care was expanded by performing hCG remotely and reviewing blood and ED/UC ultrasound results by phone. Methods: Emergency Department Information Systems (EDIS) and EPAC data reviewed ED/UC visits for pregnancy <20 weeks and vaginal bleeding 1-year pre-COVID (March 12, 2019, to March 11, 2020) and during COVID (March 12, 2020 (first case in Manitoba) to March 11, 2021). Results: There were fewer patient visits for vaginal bleeding or pregnancy of <20 weeks (4264 vs. 5180), diagnoses of threatened abortion (1895 vs. 2283), and ectopic pregnancy (78 vs. 97) during COVID compared with pre-COVID, respectively. ICD 10 codes were missing in 849 (20%) and 1183 (23%) of patients during COVID and pre-COVID, respectively. Wait times for all patient visits improved during COVID-19 compared to pre-COVID (5.1 ± 4.4 hours vs. 5.5 ± 3.8 hours), more patients received obstetrical ultrasounds, 761 (18%) vs. 787 (15%), and fewer patients returned within 30 days (1360 (32%) vs. 1848 (36%); p<0.01). EPAC saw 708 patients (218; 31% new ED/UC) during COVID-19 compared to 552 (37; 7% new ED/UC) pre-COVID. Fewer operative interventions for pregnancy loss (346 vs. 456) and retained products (236 vs. 272) were noted. Surgeries to treat ectopic pregnancy (106 vs 113) remained stable during the study time interval. Conclusion: Accurate identification of pregnancy complications was difficult, with over 20% missing ICD-10 diagnostic codes. There were fewer ED/UC visits and surgical management for threatened abortion during COVID-19, but ectopic pregnancy operative management remained unchanged.

Keywords: early pregnancy, ultrasound, COVID-19, obstetrics

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Authors: Kahlil Fredrick Cui, Marissa Pastor

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Earthquakes are complex phenomena, exhibiting complex correlations in space, time, and magnitude. Recently, the concept of complex networks has been used to shed light on the statistical and dynamical characteristics of regional seismicity. In this work, we study the relationships and interactions of seismic regions in Chile, Japan, and the Philippines through weighted and directed complex network analysis. Geographical areas are digitized into cells of fixed dimensions which in turn become the nodes of the network when an earthquake has occurred therein. Nodes are linked if a correlation exists between them as determined and measured by a correlation metric. The networks are found to be scale-free, exhibiting power-law behavior in the distributions of their different centrality measures: the in- and out-degree and the in- and out-strength. The evidence is also found of preferential interaction between seismically active regions through their degree-degree correlations suggesting that seismicity is dictated by the activity of a few active regions. The importance of a seismic region to the overall seismicity is measured using a generalized centrality metric taken to be an indicator of its activity or passivity. The spatial distribution of earthquake activity indicates the areas where strong earthquakes have occurred in the past while the passivity distribution points toward the likely locations an earthquake would occur whenever another one happens elsewhere. Finally, we propose a method that would project the location of the next possible earthquake using the generalized centralities coupled with correlations calculated between the latest earthquakes and a geographical point in the future.

Keywords: complex networks, correlations, earthquake, hazard assessment

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Authors: Kouassi Louis Kra

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The nearshore deep-water gravity flow deposits in the Northern steep slope of Dongying depression, Bohai Bay basin, have been acknowledged as important reservoirs in the rift lacustrine basin. These deep strata term as coarse clastic sediment, deposit at the root of the slope have complex depositional processes and involve wide diagenetic events which made high-quality reservoir prediction to be complex. Based on the integrated study of seismic interpretation, sedimentary analysis, petrography, cores samples, wireline logging data, 3D seismic and lithological data, the reservoir formation mechanism deciphered. The Geoframe software was used to analyze 3-D seismic data to interpret the stratigraphy and build a sequence stratigraphic framework. Thin section identification, point counts were performed to assess the reservoir characteristics. The software PetroMod 1D of Schlumberger was utilized for the simulation of burial history. CL and SEM analysis were performed to reveal diagenesis sequences. Backscattered electron (BSE) images were recorded for definition of the textural relationships between diagenetic phases. The result showed that the nearshore steep slope deposits mainly consist of conglomerate, gravel sandstone, pebbly sandstone and fine sandstone interbedded with mudstone. The reservoir is characterized by low-porosity and ultra-low permeability. The diagenesis reactions include compaction, precipitation of calcite, dolomite, kaolinite, quartz cement and dissolution of feldspars and rock fragment. The main types of reservoir space are primary intergranular pores, residual intergranular pores, intergranular dissolved pores, intergranular dissolved pores, and fractures. There are three obvious anomalous high-porosity zones in the reservoir. Overpressure and early hydrocarbon filling are the main reason for abnormal secondary pores development. Sedimentary facies control the formation of high-quality reservoir, oil and gas filling preserves secondary pores from late carbonate cementation.

Keywords: Bohai Bay, Dongying Sag, deep strata, formation mechanism, high-quality reservoir

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Authors: Tassana Boontong, Vilaivan Thongcharoen, Orapan Thosingha, Suphamon Chansakul, Anorut Jenwitheesuk, Chanin Chakkrapopyodhin, Isara Phiwchai, Mattika Chaichan, Rungnapha Khiewchaum

Abstract:

According to Thailand health policy, subdistrict health promoting hospitals (SHPHs) serve as forefront facilities for inclusive health care service. Those services include health promotion, disease prevention, primary medical care and rehabilitation. However, SHPHs residing in some distant area, such as SHPHs residing on the islands, would deliver different services relevant to health needs of the local people and the tourists. This research aimed to study health care delivery services at SHPHs on the islands in Thailand. Data were collected using questionnaires. The result revealed that in Thailand, there are 58 SHPHs on the islands. During data collection process, the researchers were not allowed to collect data in 5 SHPHs in the southern part due to Covid-19 pandemic. The report is based on 53 SHPHs on the islands. Numbers of health care personnel were 201, 72.14 % were female, with the ages ranged from 22 to 60 years (mean = 35.56 years). About 53% were community health personnel, while 26.08% were professional nurses. In regard to work experiences, the range of year varied from less than 1 year to 30 years, with the mean of 8.36 years. The majority of their responsibilities focused on providing primary medical care (86.34%), caring of people with chronic illnesses (85.30%) and providing medical care procedures for patients with chronic illnesses at home (84.36%). Nurses were main health care personnel in performing primary medical care. Due to difficulty transportation from the islands to the mainland, nurses had to provide prompt emergency medical care while the patients arrived with emergency and critical illnesses such as severe head trauma, stroke or coronary artery disease. Although some medical procedures were complex and not covered by nursing and midwifery license, they decided to protect patients from life- threatening conditions and make them stable before transportation. In SHPHs, the workload exceeded manpower, health care personnel had to work overtime almost every day. In the famous tourist islands, health care personnel had to carry 3-4 folds of their workload during the holidays because of the large crowds of foreign and Thai tourists. It is recommended that SHPHs on the islands should scale up the level of services to cover advanced medical care. Health care personnel, in particular, professional nurses, should be equipped with emergency and critical care skills. The expected outcomes of the services should emphasize on rescuing patients with emergency and life-threatening illnesses and providing comprehensive care for people living on or visiting the islands.

Keywords: distant area, islands, sub district health promoting hospital, heath care services, Thailand

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Authors: Darma Putra Sitepu, Dewi Larasati, Yohanes Wolter Hendrik George

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Sepsis is a life-threatening medical emergency frequently observed in intensive care unit (ICU). Surviving Sepsis Campaign in 2018 has recommended the administration of early vasopressor in the first hour of sepsis or septic shock but has not yet included de-resuscitation protocol. De-resuscitation in acute management of septic shock is where patient received active removal of accumulated fluid. It has been proposed by some studies and ongoing clinical trials. Here we present a case with early vasopressor and de-resuscitation. Male, 27 years old presenting to the emergency room with shortness of breath, altered mental status, and widespread blisters on his body and lips started a few hours prior, after receiving non-steroidal anti-inflammatory drug through intravenous injection. Patient was hypotensive, tachycardic, and tachypneic at admission, diagnosed with Steven Johnson Syndrome with Septic Shock. Patient received fluid resuscitation, early vasopressor, and diuresis agent aimed to actively remove fluid after the initial phase of resuscitation. Patient was admitted to ICU and progressively recovering. At day-10, patient was stabilized and was transferred to general ward. Early vasopressor and de-resuscitation are beneficial for the patient.

Keywords: sepsis, shock, de-resuscitation, vasopressor, fluid, case report

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Authors: Nuhi Arslani, Aleks Brumec

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Adhesive small bowel obstruction (ASBO) accounts for 20% of emergency surgical procedures and intraabdominal adhesions account for 65% of such cases. In a 10-year post-operative period of abdominal surgery patients, around 35% of them will be readmitted because of ASBO. The first step in approaching ASBOs is using the Bologna guidelines, which include a thorough initial evaluation to diagnose or rule out an ASBO and then proceed with either further imaging studies or emergency surgery, which can be either open or laparoscopic. The contraindications for a laparoscopic approach include hemodynamic instability of the patient and infections in the peritoneum or port sites. Studies have shown that a laparoscopic approach to adhesiolysis is linked with a significantly smaller risk of readmissions and reoperations as well as with faster recovery time and fewer postoperative infections, but has a higher risk of bowel injuries, so a careful selection of patients is required. Although studies favor a laparoscopic approach, many countries still prefer a laparotomy, often because a laparoscopic approach requires surgeons to be highly skilled in the procedure. In the US and UK, between 50 and 60% of surgeons would approach an ASBO with laparoscopy, while in Italy, this number is around 15% and it is most likely similar in Slovenia. We believe that in the right cases and in the right patients, a laparoscopic approach can be equally feasible for treating ASBOs and is associated with fewer intraoperative and postoperative complications.

Keywords: adhesive small bowel obstruction, laparoscopy, adhesions, adhesiolysis

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Authors: Rafi Ullah, Shah Muhammad Emaduddin, Taha Jilani

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Vehicle Adhoc Networks (VANET) belongs to a special class of Mobile Adhoc Network (MANET) with high mobility. Network is created by road side vehicles equipped with communication devices like GPS and Wifi etc. Since the environment is highly dynamic due to difference in speed and high mobility of vehicles and weak stability of the network connection, it is a challenging task to design an efficient routing protocol for such an unstable environment. Our proposed algorithm uses heuristic for the calculation of optimal path for routing the packet efficiently in collaboration with several other parameters like geographical location, speed, priority, the distance among the vehicles, communication range, and networks congestion. We have incorporated probabilistic, heuristic and machine learning based approach inconsistency with the relay function of the memory buffer to keep the packet moving towards the destination. These parameters when used in collaboration provide us a very strong and admissible heuristics. We have mathematically proved that the proposed technique is efficient for the routing of packets, especially in a medical emergency situation. These networks can be used for medical emergency, security, entertainment and routing purposes.

Keywords: heuristics routing, intelligent routing, VANET, route optimization

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Authors: Chrysanthos Maraveas, Argiris Plesias, Garyfalia G. Triantafyllou, Konstantinos Petronikolos

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The current paper presents a structural assessment and proposals for retrofit of the National Youth Foundation Building, an existing reinforced concrete (RC) building in the city of Igoumenitsa, Greece. The building is scheduled to be renovated in order to create a Municipal Cultural Center. The bearing capacity and structural integrity have been investigated in relation to the provisions and requirements of the Greek Retrofitting Code (KAN.EPE.) and European Standards (Eurocodes). The capacity of the existing concrete structure that makes up the two central buildings in the complex (buildings II and IV) has been evaluated both in its present form and after including several proposed architectural interventions. The structural system consists of spatial frames of columns and beams that have been simulated using beam elements. Some RC elements of the buildings have been strengthened in the past by means of concrete jacketing and have had cracks sealed with epoxy injections. Static-nonlinear analysis (Pushover) has been used to assess the seismic performance of the two structures with regard to performance level B1 from KAN.EPE. Retrofitting scenarios are proposed for the two buildings, including type Λ steel bracings and placement of concrete shear walls in the transverse direction in order to achieve the design-specification deformation in each applicable situation, improve the seismic performance, and reduce the number of interventions required.

Keywords: earthquake resistance, pushover analysis, reinforced concrete, retrofit, strengthening

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Authors: Lokvendra S. Budania, Yogesh K Gaude, Vamsidhar Chamala

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Introduction: Congenitally corrected transposition of great arteries (CCTGA) is a complex congenital heart disease where there are both atrioventricular and ventriculoarterial discordances, usually accompanied by other cardiovascular malformations. Case Report: A 24-year-old primigravida known case of CCTGA at 37 weeks of gestation was referred to our hospital for safe delivery. Her electrocardiogram showed HR-40/pm, echocardiography showed Ejection Fraction of 65% and CCTGA. Temporary pacemaker was inserted by cardiologist in catheterization laboratory, before giving trial of labour in view of complete heart block. She was planned for normal delivery, but emergency Caesarean section was planned due to non-reassuring foetal Cardiotocography Pre-op vitals showed PR-50 bpm with temporary pacemaker, Blood pressure-110/70 mmHg, SpO2-99% on room air. Nil per oral was inadequate. Patency of two peripheral IV cannula checked and left radial arterial line secured. Epidural Anaesthesia was planned, and catheter was placed at L2-L3. Test dose was given, Anaesthesia was provided with 5ml + 5ml of 2% Lignocaine with 25 mcg Fentanyl and further 2.5Ml of 0.5% Bupivacaine was given to achieve a sensory level of T6. Cesarean section was performed and baby was delivered. Cautery was avoided during this procedure. IV Oxytocin (15U) was added to 500 mL of ringer’s lactate. Hypotension was treated with phenylephrine boluses. Patient was shifted to post-operative care unit and later to high dependency unit for monitoring. Post op vitals remained stable. Temporary pacemaker was removed after 24 hours of surgery. Her post-operative period was uneventful and discharged from hospital. Conclusion: Rare congenital cardiac disorders require detail knowledge of pathophysiology and associated comorbidities with the disease. Meticulously planned and carefully titrated neuraxial techniques will be beneficial for such cases.

Keywords: congenitally corrected transposition of great arteries, complete heart block, emergency LSCS, epidural anaesthesia

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Authors: Atif Zafar, Fan Haijun

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A sequence of different Reservoir Engineering methods and tools in reservoir characterization and field development are presented in this paper. The real data of Jin Gas Field of L-Basin of Pakistan is used. The basic concept behind this work is to enlighten the importance of well test analysis in a broader way (i.e. reservoir characterization and field development) unlike to just determine the permeability and skin parameters. Normally in the case of reservoir characterization we rely on well test analysis to some extent but for field development plan, the well test analysis has become a forgotten tool specifically for locations of new development wells. This paper describes the successful implementation of well test analysis in Jin Gas Field where the main uncertainties are identified during initial stage of field development when location of new development well was marked only on the basis of G&G (Geologic and Geophysical) data. The seismic interpretation could not encounter one of the boundary (fault, sub-seismic fault, heterogeneity) near the main and only producing well of Jin Gas Field whereas the results of the model from the well test analysis played a very crucial rule in order to propose the location of second well of the newly discovered field. The results from different methods of well test analysis of Jin Gas Field are also integrated with and supported by other tools of Reservoir Engineering i.e. Material Balance Method and Volumetric Method. In this way, a comprehensive way out and algorithm is obtained in order to integrate the well test analyses with Geological and Geophysical analyses for reservoir characterization and field development. On the strong basis of this working and algorithm, it was successfully evaluated that the proposed location of new development well was not justified and it must be somewhere else except South direction.

Keywords: field development plan, reservoir characterization, reservoir engineering, well test analysis

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Authors: Basanta Raj Adhikari

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Large and small scale earthquakes are frequent in the Nepal, Himalaya, and many co-seismic landslides are resulted out of it. Recently, Gorkha earthquake-2015 has triggered many co-seismic landslides destroying many lives and properties. People have displaced their original places due to having many cracks and unstable ground. Therefore, Nepal has been adopting a pronged development strategy to address the earthquake issues through reconstruction and rehabilitation policy, plans and budgets. Landslides are major threat for the mountain livelihood, and it is very important to investigate and mitigate to improve human wellbeing factoring in considerations of economic growth, environmental safety, and sustainable development. Community based landslide investigation was carried with the involvement of the local community in the Sindhupalchowk District of Central Nepal. Landslide training and field orientation were the major methodological approach of this study. Combination of indigenous and modern scientific knowledge has created unique working environment which enhanced the local capacity and trained people for replication. Local topography of the landslide was created with the help of Total Station and bill of quantity was derived based on it. River training works, plantation of trees and grasses, support structures, surface and sub-surface drainage management are the recommended mitigative measures. This is a very unique example of how academia and local community can work together for sustainable development by reducing disaster risk at the local level with very low-cost technology.

Keywords: community, earthquake, landslides, Nepal

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Authors: Satoko Yamasaki, Hiromi Kawasaki, Kotomi Yamashita, Susumu Fukita, Kei Sounai

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People are susceptible to rumors when the cause of their health problems is unknown or invisible. In order for individuals to be unaffected by rumors, they need basic knowledge and correct information. Community health nursing classes use cases where basic knowledge of radiation can be utilized on a regular basis, thereby teaching that basic knowledge is important in preventing anxiety caused by rumors. Nursing students need to learn that preventive activities are essential for public health nursing care. This is the same methodology used to reduce COVID-19 anxiety among individuals. This study verifies the learning effect concerning the basic knowledge of radiation necessary for case consultation by emergency distance learning. Sixty third-year nursing college students agreed to participate in this research. The knowledge tests conducted before and after classes were compared, with the chi-square test used for testing. There were five knowledge questions regarding distance lessons. This was considered to be 5% significant. The students’ reports which describe the results of responding to health consultations, were analyzed qualitatively and descriptively. In this case study, a person living in an area not affected by radiation was anxious about drinking water and, thus, consulted with a student. The contents of the lecture were selected the minimum amount of knowledge used for the answers of the consultant; specifically hot spots, internal exposure risk, food safety, characteristics of cesium-137, and precautions for counselors. Before taking the class, the most correctly answered question by students concerned daily behavior at risk of internal exposure (52.2%). The question with the fewest correct answers was the selection of places that are likely to be hot spots (3.4%). All responses increased significantly after taking the class (p < 0.001). The answers to the counselors, as written by the students, were 'Cesium is strongly bound to the soil, so it is difficult to transfer to water' and 'Water quality test results of tap water are posted on the city's website.' These were concrete answers obtained by using specialized knowledge. Even in emergency distance learning, the students gained basic knowledge regarding radiation and created a document to utilize said knowledge while assuming the situation concretely. It was thought that the flipped classroom method, even if conducted remotely, could maintain students' learning. It was thought that setting specific knowledge and scenes to be used would enhance the learning effect. By changing the case to concern that of the anxiety caused by infectious diseases, students may be able to effectively gain the basic knowledge to decrease the anxiety of residents due to infectious diseases.

Keywords: effect of class, emergency distance learning, nursing student, radiation

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Authors: Chao Xu

Abstract:

Selecting ground motion intensity measures reasonably is one of the very important issues to affect the input ground motions selecting and the reliability of vulnerability analysis results. In this paper, inelastic spectral displacement is used as an alternative intensity measure to characterize the ground motion damage potential. The inelastic spectral displacement is calculated based modal pushover analysis and inelastic spectral displacement based incremental dynamic analysis is developed. Probability seismic demand analysis of a six story and an eleven story RC frame are carried out through cloud analysis and advanced incremental dynamic analysis. The sufficiency and efficiency of inelastic spectral displacement are investigated by means of regression and residual analysis, and compared with elastic spectral displacement. Vulnerability curves are developed based on inelastic spectral displacement. The study shows that inelastic spectral displacement reflects the impact of different frequency components with periods larger than fundamental period on inelastic structural response. The damage potential of ground motion on structures with fundamental period prolonging caused by structural soften can be caught by inelastic spectral displacement. To be compared with elastic spectral displacement, inelastic spectral displacement is a more sufficient and efficient intensity measure, which reduces the uncertainty of vulnerability analysis and the impact of input ground motion selection on vulnerability analysis result.

Keywords: vulnerability, probability seismic demand analysis, ground motion intensity measure, sufficiency, efficiency, inelastic time history analysis

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Authors: Franco Primo Soffietti, Diego Fernando Turello, Federico Pinto

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Shear waves that propagate through the ground impose deformations that must be taken into account in the design and assessment of buried longitudinal structures such as tunnels, pipelines, and piles. Conventional engineering approaches for seismic evaluation often rely on a Euler-Bernoulli beam models supported by a Winkler foundation. This approach, however, falls short in capturing the distortions induced when the structure is subjected to shear waves. To overcome these limitations, in the present work an analytical solution is proposed considering a Timoshenko beam and including transverse and rotational springs. The present research proposes ground springs derived as closed-form analytical solutions of the equations of elasticity including the seismic wavelength. These proposed springs extend the applicability of previous plane-strain models. By considering variations in displacements along the longitudinal direction, the presented approach ensures the springs do not approach zero at low frequencies. This characteristic makes them suitable for assessing pseudo-static cases, which typically govern structural forces in kinematic interaction analyses. The results obtained, validated against existing literature and a 3D Finite Element model, reveal several key insights: i) the cutoff frequency significantly influences transverse and rotational springs; ii) neglecting displacement variations along the structure axis (i.e., assuming plane-strain deformation) results in unrealistically low transverse springs, particularly for wavelengths shorter than the structure length; iii) disregarding lateral displacement components in rotational springs and neglecting variations along the structure axis leads to inaccurately low spring values, misrepresenting interaction phenomena; iv) transverse springs exhibit a notable drop in resonance frequency, followed by increasing damping as frequency rises; v) rotational springs show minor frequency-dependent variations, with radiation damping occurring beyond resonance frequencies, starting from negative values. This comprehensive analysis sheds light on the complex behavior of embedded longitudinal structures when subjected to shear waves and provides valuable insights for the seismic assessment.

Keywords: shear waves, Timoshenko beams, Winkler springs, sol-structure interaction

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