Search results for: allied ragas

Authors: Paul Rowley, Adam Thirkill, Nick Doylend, Philip Leicester, Becky Gough

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The dynamic performance of all energy generation technologies is impacted to varying degrees by the stochastic properties of the wider system within which the generation technology is located. This stochasticity can include the varying nature of ambient renewable energy resources such as wind or solar radiation, or unpredicted changes in energy demand which impact upon the operational behaviour of thermal generation technologies. An understanding of these stochastic impacts are especially important in contexts such as highly distributed (or embedded) generation, where an understanding of issues affecting the individual or aggregated performance of high numbers of relatively small generators is especially important, such as in ESCO projects. Probabilistic evaluation of monitored or simulated performance data is one technique which can provide an insight into the dynamic performance characteristics of generating systems, both in a prognostic sense (such as the prediction of future performance at the project’s design stage) as well as in a diagnostic sense (such as in the real-time analysis of underperforming systems). In this work, we describe the development, application and outcomes of a new approach to the acquisition of datasets suitable for use in the subsequent performance and impact analysis (including the use of Bayesian approaches) for a number of distributed generation technologies. The application of the approach is illustrated using a number of case studies involving domestic and small commercial scale photovoltaic, solar thermal and natural gas boiler installations, and the results as presented show that the methodology offers significant advantages in terms of plant efficiency prediction or diagnosis, along with allied environmental and social impacts such as greenhouse gas emission reduction or fuel affordability.

Keywords: renewable energy, dynamic performance simulation, Bayesian analysis, distributed generation

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Authors: Sriranjani Srinivasan

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To appreciate Indian art and architecture by studying it in India alone will only lead to partial understanding of the whole story and the variety of the statement has been amply proved by subsequent decades of patient research. The results of the work of the Archaeological Survey of India forms only one half of the picture, the other half emerges with the studies of the archaeology and art of the Far East that progressed almost simultaneously under the Archaeological Survey of the Dutch East Indies, the École française d'Extrême-Orient (EFEO), or French School of Asian Studies, and allied institutions. The conclusions arrived at have only rendered the assertion that India produced her ultimate master pieces only through foreign influences and in foreign lands (the South-Eastern peninsular and archipelagic regions) almost axiomatic. Angkor in Cambodia and Borobudur in Java, undoubtedly the two greatest architectural marvels of Indian genius, for in content and spirit these (and other monuments of varying magnitudes), are purely Indian, would well illustrate the statement mentioned earlier. Stimulated research followed the discoveries and among the many studies and publications of such pioneers like Coedes, Parmentier, Coomaraswamy and many others in Dutch, French and English made growing contributions to the subject. This paper will discuss in detail the impact of India on the architecture of South East Asia by detailed comparison of architectural styles, elements, and construction materials of a few specific architectural master pieces, in both India and South East Asian countries. It will also analyze the reasoning behind the influence of India on South East Asian countries in spite of them being exposed to the equally culturally rich and civilized kingdoms of China. The intention of this paper is to understand that, conquest by war is not always the only reason for architectural influences and impacts.

Keywords: architectural influence, Buddhist architecture, Indian architecture, Southeast Asian architecture

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Authors: Dike Ibegbulem

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This paper interrogates the chances of Nigeria achieving its target of making the list of the first 70 countries in World Bank’s Ease of Doing Business (EoDB) rankings by the year 2023. That is, in light of existing conflicts in policies relating to the door-to-door carriage of goods and multimodal transport operations (MTOs) in the country. Drawing on the famed Legal Origins theory plus data from World Bank; and using Singapore as a touchstone, the paper unveils how amongst the top-ranked Commonwealth jurisdictions, positive correlations have been recorded over the past years between certainty in their policies on MTOs on the one hand; and their Enforcing Contracts (EC) and Doing Business (DB) indices on the other. The paper postulates that to increase Nigeria’s chances of achieving her DB2023 objective, legislative and curial policies on MTOs and door-to-door carriage of goods have to be realigned in line with prevailing policies in highly-ranked Commonwealth jurisdictions of the Global North. Her appellate courts, in particular, will need some unshackling from English pedigrees which still delimit admiralty jurisdiction to port-to-port shipping, to the exclusion of door-to-door carriage of goods beyond navigable waters. The paper identifies continental and domestic instruments, plus judicial precedents, which provide bases for expanding admiralty jurisdiction to adjudication of claims derived from door-to-door or multimodal transport contracts and other allied maritime-plus contracts. It prescribes synergy between legislative and curial policies on MTOs and door-to-door carriage of goods as species of admiralty – an emerging trend in top-ranked Commonwealth jurisdictions of the Global North.

Keywords: admiralty jurisdiction, legal origins, world bank, ease of doing business, enforcing contracts, multimodal transport operation, door-to-door, carriage of goods by sea, combined transport shipping

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Authors: Ilona Copik

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The aim of this study is to analyze the representation of memories of the forced displacement of Poles and Germans from the eastern territories in 1945 as depicted by Polish and German feature films between the years 1945-1960. The aftermath of World War II and the Allied agreements concluded at Yalta and Potsdam (1945) resulted in changes in national borders in Central and Eastern Europe and the large-scale transfer of civilians. The westward migration became a symbol of the new post-war division of Europe, new spheres of influence separated by the Iron Curtain. For years it was a controversial topic in both Poland and Germany due to the geopolitical alignment (the socialist East and capitalist West of Europe), as well as the unfinished debate between the victims and perpetrators of the war. The research premise is to take a comparative view of the conflicted cultures of Polish and German memory, to reflect on the possibility of an international dialogue about the past recorded in film images, and to discover the potential of film as a narrative warning against totalitarian inclinations. Until now, films made between 1945 and 1960 in Poland and the German occupation zones have been analyzed mainly in the context of artistic strategies subordinated to ideology and historical politics. In this study, the intention is to take a critical approach leading to the recognition of how films work as collective memory media, how they reveal the mechanisms of memory/forgetting, and what settlement topoi and migration myths they contain. The main hypothesis is that feature films about forced displacement, in addition to the politics of history - separate in each country - reveal comparable transnational individual experiences: the chaos of migration, the trauma of losing one's home, the conflicts accompanying the familiar/foreign, the difficulty of cultural adaptation, the problem of lost identity, etc.

Keywords: forced displacement, Polish and German cinema, war victims, World War II

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Authors: Maiya Smith, Tyler Thorne

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Background: The Pacific faces multiple healthcare crises, including high rates of noncommunicable diseases, infectious disease outbreaks, and susceptibility to natural disasters. These issues are expected to worsen in the coming decades, increasing the burden on an already understaffed healthcare system. Telehealth is not new to the Pacific, but improvements in technology and accessibility have increased its utility and have already proven to reduce costs and increase access to care in remote areas. Telehealth includes distance learning; a form of education that can help alleviate many healthcare issues by providing continuing education to healthcare professionals and upskilling staff, while decreasing costs. This study examined distance learning programs at the Ministry of Health in the Pacific nation of Palau and identified key elements to their successful distance learning programs. Methods: Staff at the Belau National Hospital in Koror, Palau as well as private practitioners were interviewed to assess distance learning programs utilized. This included physicians, IT personnel, public health members, and department managers of allied health. In total, 36 people were interviewed. Standardized questions and surveys were conducted in person throughout the month of July 2019. Results: Two examples of successful distance learning programs were identified. Looking at the factors that made these programs successful, as well as consulting with staff who undertook other distance learning programs, four factors for success were determined: having a cohort, having a facilitator, dedicated study time off from work, and motivation. Discussion: In countries as geographically isolated as the Pacific, with poor access to specialists and resources, telehealth has the potential to radically change how healthcare is delivered. Palau shares similar resources and issues as other countries in the Pacific and the lessons learned from their successful programs can be adapted to help other Pacific nations develop their own distance learning programs.

Keywords: distance learning, Pacific, Palau, telehealth

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Authors: S. P. Rana

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Objectives: For the manufacture of a very thin strip or a strip with a high-quality finish, the stainless steel sheet that is called billet is re-rolled in re-rolling mill to make stainless steel sheet of 18 gauges. The rolls of re-rolling mill exert tremendous pressure over the sheet and there is likely chance of breaking of stainless steel strip from the sheet. The objective of the study was to minimise the number of accidents in steel re-rolling mills due to ejection of stainless steel strip and to minimize the pollution caused by the pickling process used in these units. Methods: Looking into the high rate of frequency and severity of accidents as well as pollution hazard in re-rolling and pickling mills, it becomes essential to make necessary arrangements for prevention of accidents in such type of industry. The author carried out survey/inspections of a large number of re-rolling and pickling mills and allied units. During the course of inspection, the working of these steel re-rolling and pickling mills was closely studied and monitored. A number of accidents involving re-rolling mills were investigated and subsequently remedial measures to prevent the occurrence of such accidents were suggested. Assessment of occupational safety and health system of these units was carried out and compliance level of the statutory requirements was checked. The workers were medically examined and monitored to ascertain their health conditions. Results: Proper use of safety gadgets by workers, machine guarding and regular training brought down the risk to an acceptable level and discharged effluent pollution was brought down to permissible limits. The fatal accidents have been reduced by 83%. Conclusions: Effective enforcement and implementation of the directions/suggestions given to the managements of such units brought down the no. of accidents to a rational level. The number of fatal accidents has reduced by 83% during the study period. The effective implementation of pollution control device curtailed the pollution level to an acceptable level.

Keywords: re-rolling mill, hazard, accident, health hazards

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Authors: Ayodeji Motunrayo Omoare

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Economically fish provides an important source of food and income for both men and women especially many households in the developing world and fishing has an important social and cultural position in river-rine communities. However, fish is highly susceptible to deterioration. Consequently, this study was carried out to correlate income generation of small-scale women fish processors in Abeokuta metropolis, Ogun State, Nigeria. Eighty small-scale women fish processors were randomly selected from five communities as the sample size for this study. Collected data were analyzed using both descriptive and inferential statistics. The results showed that the mean age of the respondents was 31.75 years with average household size of 4 people while 47.5% of the respondents had primary education. Most (86.3%) of the respondents were married and had spent more than 11 years in fish processing. The respondents were predominantly Yoruba tribe (91.2%). Majority (71.3%) of the respondents used traditional kiln for processing their fish while 23.7% of the respondents used hot vegetable oil to fry their fish. Also, the result revealed that respondents sourced capital from Personal Savings (48.8%), Cooperatives (27.5%), Friends and Family (17.5%) and Microfinance Banks (6.2%) for fish processing activities. The respondents generated an average income of ₦7,000.00 from roasted fish, ₦3,500.00 from dried fish, and ₦5,200.00 from fried fish daily. However, inadequate processing equipment (95.0%), non-availability of credit facility from microfinance banks (85.0%), poor electricity supply (77.5%), inadequate extension service support (70.0%), and fuel scarcity (68.7%) were major constraints to fish processing in the study area. Results of chi-square analysis showed that there was a significant relationship between personal characteristics (χ2 = 36.83, df = 9), processing methods (χ2 = 15.88, df = 3) and income generated at p < 0.05 level of significance. It can be concluded that significant relationship existed between processing methods and income generated. The study, therefore, recommends that modern processing equipment should be made available to the respondents at a subsidized price by the agro-allied companies.

Keywords: correlates, income, fish processors, women, small-scale

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Authors: Elissar Mansour, Emily Chen, Tracee Fernandez, Mariam Basheti, Christopher Gordon, Bandana Saini

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Sleep is an essential process for the maintenance of several neurobiological processes such as memory consolidation, mood, and metabolic processes. It is known that sleep patterns vary with age and is affected by multiple factors. While non-pharmacological strategies are generally considered first-line, sedatives are excessively used in the older population. This study aimed to explore the management of sleep in residential aged care facilities (RACFs) by nurse professionals and to identify the key factors that impact provision of optimal sleep health care. An inductive thematic qualitative research method was employed to analyse the data collected from semi-structured interviews with registered nurses working in RACF. Seventeen interviews were conducted, and the data yielded three themes: 1) the nurses’ observations and knowledge of sleep health, 2) the strategies employed in RACF for the management of sleep disturbances, 3) the organizational barriers to evidence-based sleep health management. Nurse participants reported the use of both non-pharmacological and pharmacological interventions. Sedatives were commonly prescribed due to their fast action and accessibility despite the guidelines indicating their use in later stages. Although benzodiazepines are known for their many side effects, such as drowsiness and oversedation, temazepam was the most commonly administered drug. Sleep in RACF was affected by several factors such as aging and comorbidities (e.g., dementia, pain, anxiety). However, the were also many modifiable factors that negatively impacted sleep management in RACF. These include staffing ratios, nursing duties, medication side effects, and lack of training and involvement of allied health professionals. This study highlighted the importance of involving a multidisciplinary team and the urge to develop guidelines and training programs for healthcare professionals to improve sleep health management in RACF.

Keywords: registered nurses, residential aged care facilities, sedative use, sleep

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Authors: Matheus Müller, Delma Vidal

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The present paper aims to expose two techniques of dewatering for sludge, analyzing its operations and dewatering processes, aiming at improving the conditions of disposal of residues with high liquid content. It describes the field tests performed on two geotextile systems, a closed geotextile tube and an open geotextile drying bed, both of which are submitted to two filling cycles. The sludge used in the filling cycles for the field trials is from the water treatment plant of the Technological Center of Aeronautics – CTA, in São José dos Campos, Brazil. Data about volume and height abatement due to the dewatering and consolidation were collected per time, until it was observed constancy. With the laboratory analysis of the sludge allied to the data collected in the field, it was possible to perform a critical comparative study between the observed and the scientific literature, in this way, this paper expresses the data obtained and compares them with the bibliography. The tests were carried out on three fronts: field tests, including the filling cycles of the systems with the sludge from CTA, taking measurements of filling time per cycle and maximum filling height per cycle, heights against the abatement by dewatering of the systems over time; tests carried out in the laboratory, including the characterization of the sludge and removal of material samples from the systems to ascertain the solids content within the systems per time and; comparing the data obtained in the field and laboratory tests with the scientific literature. Through the study, it was possible to perceive that the process of densification of the material inside a closed system, such as the geotextile tube, occurs faster than the observed in the drying bed system. This process of accelerated densification can be brought about by the pumping pressure of the sludge in its filling and by the confinement of the residue through the permeable geotextile membrane (allowing water to pass through), accelerating the process of densification and dewatering by its own weight after the filling with sludge.

Keywords: consolidation, dewatering, geotextile drying bed, geotextile tube

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Authors: Maisa Sales Gama Tobias, Humberto de Paiva Junior, Luciano Silva Brito, Rui António Rodrigues Ramos

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Waterway transport in the Amazon was the first means of access and occupation in the region. For the economic and social matter of high importance, still nowadays one of the main transport modes to several places in the region. To some places, still the only transport mode. With the advent of the pandemic, transport companies that already faced management challenges began to experience unprecedented structural changes and trends in trade and global supply chains. Thus, companies need operational reorganization to maintain the sustainability of the service under the penalty of loss of demand. Allied to this fact, it was observed that the demand presented behavior changes to adapt to this new moment. However, the lack of information about these changes makes it difficult to find solutions to maintain the quality of service. This work aimed to characterize the changes in the demand of waterway passengers through an empirical study with field research involving interviews with users and crew, on-board journeys, and visits to the waterway service company. The case study is the route Belém-Camara, on Marajó Island, in the state of Pará. This line is traditionally the only means of transport for this route, besides air transport on a much smaller scale. The collected data had a descriptive and analytical statistical treatment presented in this work. As the main result, the COVID-19 pandemic has caused significant changes, mainly in trip time and motives and, in the perception itself on service quality by part of the demand, with the increase of trip time and the feeling of insecurity. In conclusion, the service operator must review cost management and business survival strategies and tactics. The viability of the service and the social guarantee of transport proved to be threatened, putting at risk the service to the riverside populations.

Keywords: demand of waterway transport passengers, data analysis, COVID-19, amazonia

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Authors: K. R. Roopesh Bharatwaj, Avinash Maharana, Favour Tobi Aborisade, Roger Young

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Presently, there are few cases of complete automation of drones and its allied intelligence capabilities. In essence, the potential of the drone has not yet been fully utilized. This paper presents feasible methods to build an intelligent drone with smart capabilities such as self-driving, and obstacle avoidance. It does this through advanced Reinforcement Learning Techniques and performs object detection using latest advanced algorithms, which are capable of processing light weight models with fast training in real time instances. For the scope of this paper, after researching on the various algorithms and comparing them, we finally implemented the Deep-Q-Networks (DQN) algorithm in the AirSim Simulator. In future works, we plan to implement further advanced self-driving and object detection algorithms, we also plan to implement voice-based speech recognition for the entire drone operation which would provide an option of speech communication between users (People) and the drone in the time of unavoidable circumstances. Thus, making drones an interactive intelligent Robotic Voice Enabled Service Assistant. This proposed drone has a wide scope of usability and is applicable in scenarios such as Disaster management, Air Transport of essentials, Agriculture, Manufacturing, Monitoring people movements in public area, and Defense. Also discussed, is the entire drone communication based on the satellite broadband Internet technology for faster computation and seamless communication service for uninterrupted network during disasters and remote location operations. This paper will explain the feasible algorithms required to go about achieving this goal and is more of a reference paper for future researchers going down this path.

Keywords: convolution neural network, natural language processing, obstacle avoidance, satellite broadband technology, self-driving

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Authors: H. Singh, H. Bhowmick

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Now-a-days, particle based lubricants have been widely used to enhance the lubrication performance. Use of tailor made micro/nanofluids can reduce the friction losses and dissipate heat in a better way. Use of Carbon Nanotubes (CNTs) has gained interests because of its structure that can endure much better in a system mechanically or thermally in comparison to any other additive in oil. On the other hand, nanoclays have been characterized mechanically and tribologically for the use of clay/polymer composite, and they have been gaining huge interest. Hence it is interesting to be investigated the effect of nanoclays as additive in oil. Thermophysical characteristics of lubricant play a predominant role in defining the friction and wear characteristics of lubricated contacts. However, very limited studies have been carried out to correlate the thermophysical properties of nanolubricants with their lubricity characteristics. Besides, most of the lubricant formulations till dates are found to be optimized for steel/steel contacts. In the present study, Multiwall Carbon Nanotube (MWCNT) and nanoclay are used as particle additives in mineral oil to develop nanofluids of various concentrations. The prepared lubricants are tested for their rheological, thermal and lubricity characteristics under aluminium-steel contacts. From the thermophysical investigation, it is observed that nanoclay particles significantly improve the viscosity of lubricant with an insignificant improvement in thermal conductivity. On the other hand, MWCNT particles moderately increase the viscosity but significantly increase the thermal conductivity of the base oil. Frictional responses of the nanofluids are characterized using a Pin-on-Disc tribometer which reveal some interesting facts. The findings from this study will greatly aid in formulating the particle based lubricants for cutting fluid in metal forming industries as well as fully developed nanolubricants for aluminium and Aluminium Metal Matrix Composite (AMMC) tribocontact for the use in the automotive and their allied industries.

Keywords: MWCNT, Multiwall Carbon Nanotube, nanoclay, nanolubricant, rheology, thermal conductivity

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Authors: Pradip Kumar Das

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Phenomenal growth of population and industry exploits the environment in varied ways. Consequently, the greenhouse effect and other allied problems are threatening mankind the world over. Protection and up gradation of environment have, therefore, become the prime necessity all of mankind for the sustainable development of environment. People in humbler walks of life including the corporate citizens have become aware of the impacts of environmental pollution. Governments of various nations have entered the picture with laws and regulations to correct and cure the effects of present and past violations of environmental practices and to obstruct future violations of good environmental disciplines. In this perspective, environmental audit directs verification and validation to ensure that the various environmental laws are complied with and adequate care has been taken towards environmental protection and preservation. The discipline of environmental audit has experienced expressive development throughout the world. It examines the positive and negative effects of the activities of an enterprise on environment and provides an in-depth study of the company processes any growth in realizing long-term strategic goals. Environmental audit helps corporations assess its achievement, correct deficiencies and reduce risk to the health and improving safety. Environmental audit being a strong management tool should be administered by industry for its own self-assessment. Developed countries all over the globe have gone ahead in environment quantification; but unfortunately, there is a lack of awareness about pollution and environmental hazards among the common people in India. In the light of this situation, the conceptual analysis of this study is concerned with the rationale of environmental audit on the industry and the society as a whole and highlights the emerging dimensions in the auditing theory and practices. A modest attempt has been made to throw light on the recent development in environmental audit in developing nations like India and the problems associated with the implementation of environmental audit. The conceptual study also reflects that despite different obstacles, environmental audit is becoming an increasing aspect within the corporate sectors in India and lastly, conclusions along with suggestions have been offered to improve the current scenario.

Keywords: environmental audit, environmental hazards, environmental laws, environmental protection, environmental preservation

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Authors: Aoife Prendergast

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The synergy between theory and practice can be considered elusive, the touchstone for the development of successful undergraduate programmes particularly in allied health professions such as social care. A 'pracademic' is a person who spans both the somewhat ethereal world of academia as a scholar and the pragmatic world of practice. This paper examines the concept of 'pracademia' in relation to the role of the social care practitioner and continuing professional development. It also assists in the understanding of the synergy between social care professionals and higher education. A consideration of the identity and position in terms of approach to regulation is explored as well as an acknowledgement of the strengths and opportunities for sharing power in hierarchical positions. The world of practice serves as the centre point of the academic compass for most professional programs. Just as schools of engineering and law are disciplined by the marketplace, which seeks well-trained students, so our social care programmes must perennially find ways to address the fast changing needs of practitioners, whether they be government, not-for-profit organizations, consulting firms or contractors. We may not expect such traditional academic disciplines as history, sociology, or political science to cater to the needs of external audiences or practitioners— indeed, these disciplines' insulation from public concerns and issues is considered a strength by some. This paper aims to explore the integration of academic teaching and research with the communities of practice in social care. This appears to be a fundamental aspiration of the social care profession. While building and integrating an important body of academic theory and concepts from a variety of disciplines, social care as a field has embraced a professional orientation by seeking to be relevant to practitioners at various levels. While teaching theory, social care programmes, and faculty are often acutely aware that their academic content and credibility, in part, rest on a deep connection with practitioners. While theory can be self-contained, the impact of our research and teaching arguably finds its most compelling and highest audience when it addresses the agenda items and concerns of practitioners.

Keywords: social care, pracademia, supervision, practice education

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Authors: Adeaga Ibiyemi Iyabo, Adeaga Oyetunde Adeoye

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Interestingly, mechanical drying methods has played a major role in the commercialization of agricultural and agricultural allied sectors. In the overall, drying enhances the favorable storability and preservation of agricultural produce which in turn promotes its producibility, marketability, salability, and profitability. Recent researches have shown that solar drying is easier, affordable, controllable, and of course, cleaner and purer than other means of drying methods. It is, therefore, needful to persistently appraise solar dryers with a view to improving on the existing advantages. In this paper, mathematical equations were formulated for solar dryer using mass conservation law, material balance law and least cost savings method. Computer codes were written in Visual Basic.Net. The developed computer software, which considered Ibadan, a strategic south-western geographical location in Nigeria, was used to investigate the relationship between variable orientation angle of flat plate collector on solar energy trapped, derived monthly heat load, available energy supplied by solar and fraction supplied by solar energy when 50000 Kg/Month of produce was dried over a year. At variable collector tilt angle of 10°.13°,15°,18°, 20°, the derived monthly heat load, available energy supplied by solar were 1211224.63MJ, 102121.34MJ, 0.111; 3299274.63MJ, 10121.34MJ, 0.132; 5999364.706MJ, 171222.859MJ, 0.286; 4211224.63MJ, 132121.34MJ, 0.121; 2200224.63MJ, 112121.34MJ, 0.104, respectively .These results showed that if optimum collector angle is not reached, those factors needed for efficient and cost reduction drying will be difficult to attain. Therefore, this software has revealed that off - optimum collector angle in commercial solar drying does not worth it, hence the importance of the software in decision making as to the optimum collector angle of orientation.

Keywords: energy, ibadan, heat - load, visual-basic.net

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Authors: Asif Khaliq, Sayeeda A. Sayed

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The drug information centers provide drug related information to the requesters that include physicians, pharmacist, nurses and other allied health care professionals. The International Pharmacist Federation (FIP) describes basic functions of a drug and poison information centers as drug evaluation, therapeutic counseling, pharmaceutical advice, research, pharmaco-vigilence and toxicology. Continuous advancement in the field of medicine has expanded the medical literature, which has increased demand of a drug and poison information center for the guidance, support and facilitation of physicians. The objective of the study is to determine the need of drug and poison information centers in public and private hospitals of Karachi, Pakistan. A cross sectional study was conducted during July 2013 to April 2014 using a self-administered, multi-itemed questionnaire. Non Probability Convenient sampling was used to select the study participants. A total of 307 physicians from public and private hospitals of Karachi participated in the study. The need for 24/7 Drug and poison information center was highlighted by 92 % of physicians and 67% physicians suggested opening a drug information center at the hospital. It was reported that 70% physicians take at least 15 minutes for searching the information about the drug while managing a case. Regarding the poisoning case management, 52% physicians complaint about the unavailability of medicines in hospitals; and mentioned the importance of medicines for safe and timely management of patients. Although 73% physicians attended continued medical education (CME) sessions, 92 % physicians insisted on the need of 24/7 Drug and poison information center. The scarcity of organized channel for obtaining the information about drug and poisons is one of the most crucial problems for healthcare workers in Pakistan. The drug and poison information center is an advisory body that assists health care professional and patients in provision of appropriate drug and hazardous substance information. Drug and poison information center is one of the integral needs for running an effective health care system. Provision of a 24 /7 drug information centers with specialized staff offer multiple benefits to the hospitals while reducing treatment delays, addressing awareness gaps of all stakeholders and ensuring provision of quality health care.

Keywords: drug and poison information centers, Pakistan, physicians, public and private hospitals

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Authors: V. Mani Rathnam, Giridhar Madras

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Fossil fuels are depleting rapidly as the demand for energy, and its allied chemicals are continuously increasing in the modern world. Therefore, sustainable renewable energy sources based on non-edible oils are being explored as a viable option as they do not compete with the food commodities. Oils such as castor oil are rich in fatty acids and thus can be used for the synthesis of biodiesel, bio-lubricants, and many other fine industrial chemicals. There are several processes available for the synthesis of different chemicals obtained from the castor oil. One such process is the transesterification of castor oil, which results in a mixture of fatty acid methyl esters. The main products in the above reaction are methyl ricinoleate and methyl 10-undecenoate. To separate these compounds, supercritical carbon dioxide (SCCO₂) was used as a green solvent. SCCO₂ was chosen as a solvent due to its easy availability, non-toxic, non-flammable, and low cost. In order to design any separation process, the preliminary requirement is the solubility or phase equilibrium data. Therefore, the solubility of a mixture of methyl ricinoleate with methyl 10-undecenoate in SCCO₂ was determined in the present study. The temperature and pressure range selected for the investigation were T = 313 K to 333 K and P = 10 MPa to 18 MPa. It was observed that the solubility (mol·mol⁻¹) of methyl 10-undecenoate varied from 2.44 x 10⁻³ to 8.42 x 10⁻³ whereas it varied from 0.203 x 10⁻³ to 6.28 x 10⁻³ for methyl ricinoleate within the chosen operating conditions. These solubilities followed a retrograde behavior (characterized by the decrease in the solubility values with the increase in temperature) throughout the range of investigated operating conditions. An association theory model, coupled with regular solution theory for activity coefficients, was developed in the present study. The deviation from the experimental data using this model can be quantified using the average absolute relative deviation (AARD). The AARD% for the present compounds is 4.69 and 8.08 for methyl 10-undecenoate and methyl ricinoleate, respectively in a mixture of methyl ricinoleate and methyl 10-undecenoate. The maximum solubility enhancement of 32% was observed for the methyl ricinoleate in a mixture of methyl ricinoleate and methyl 10-undecenoate. The highest selectivity of SCCO₂ was observed to be 12 for methyl 10-undecenoate in a mixture of methyl ricinoleate and methyl 10-undecenoate.

Keywords: association theory, liquid mixtures, solubilities, supercritical carbon dioxide

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Authors: Cláudia Alcoforado, Anabela Ribeiro

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This paper is part of an ongoing PhD thesis. It seeks to develop a model to identify the spatial failures of the public transportation supply. In the construction of the model, it also seeks to detect the social needs arising from the disadvantage in transport. The case study is carried out for the Brazilian city of Recife. Currently, Recife has a population density of 7,039.64 inhabitants per km². Unfortunately, only 46.9% of urban households on public roads have adequate urbanization. Allied to this reality, the trend of the occupation of the poorest population is that of the peripheries, a fact that has been consolidated in Brazil and Latin America, thus burdening the families' income, since the greater the distances covered for the basic activities and consequently also the transport costs. In this way, there have been great impacts caused by the supply of public transportation to locations with low demand or lack of urban infrastructure. The model under construction uses methods such as Currie’s Gap Assessment associated with the London’s Public Transport Access Level, and the Public Transport Accessibility Index developed by Saghapour. It is intended to present the stage of the thesis with the spatial/need gaps of the neighborhoods of Recife already detected. The benefits of the geographic information system are used in this paper. It should be noted that gaps are determined from the transport supply indices. In this case, considering the presence of walking catchment areas. Still in relation to the detection of gaps, the relevant demand index is also determined. This, in turn, is calculated through indicators that reflect social needs. With the use of the smaller Brazilian geographical unit, the census sector, the model with the inclusion of population density in the study areas should present more consolidated results. Based on the results achieved, an analysis of transportation disadvantage will be carried out as a factor of social exclusion in the study area. It is anticipated that the results obtained up to the present moment, already indicate a strong trend of public transportation in areas of higher income classes, leading to the understanding that the most disadvantaged population migrates to those neighborhoods in search of employment.

Keywords: gap assessment, public transport supply, social exclusion, spatial gaps

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Authors: B. Schofield, F. Gul, S. McClean, R. Hoskins, R. Terry, U. Rolfe, A. Gibson, S. Voss, J. Benger

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Aim: The aim of this study is to determine whether and how health promotion activities are undertaken by paramedics and emergency department nurses and investigate ways of overcoming potential barriers. Background: Paramedics and emergency department nurses are uniquely placed to reach millions of people and could use these contacts as positive opportunities to help people improve their health by identifying people with risk factors and provide information, brief interventions, and signposting to locally provided services. These interventions can be carried out when the opportunity arises, typically take no more than a few minutes, have a low financial cost and can be a highly efficient method of health promotion. Methodology: Three NHS Emergency Departments and four Ambulance Trusts in England were recruited to the study. A link to an online survey was distributed to paramedics and emergency department nurses at participating sites. Staff were invited to participate in virtual semi-structured interviews. Patients seen, treated, and discharged at the participating sites were invited to virtual semistructured interviews. Findings: A total of 331 survey responses were received, 21 virtual semi-structured staff interviews and 11 patient interviews were completed. Staff reported lack of time to prioritise, lack of knowledge, resources, and confidence as barriers. Receptiveness of patients guided their decision to undertake health promotion activities. They reported a desire to learn how to undertake health promotion conversations. Emergency department nurses felt more supported than paramedics by their organisations to undertake health promotion activities. Patients were not aware of health promotion activities and reported fear and lack of privacy as barriers. Conclusions: These results will guide the development of an intervention to support the provision of health promotion by staff in urgent and emergency care settings. The components of the intervention will be mapped to a framework which will consider the needs of staff working within these settings, patients they treat, and organisational issues and practices related to the implementation of such an intervention.

Keywords: emergency service, hospital, nursing, allied health personnel, emergency medical services, health promotion

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Authors: Hani Malik

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Background: Clinician burnout is a growing phenomenon in current health systems worldwide. Increasing emotional exhaustion, depersonalisation, and reduced personal accomplishment threaten the effective delivery of healthcare. This can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in clinicians. Objectives: To conduct a scoping review and identify high-quality studies on mindfulness practice in clinician burnout, synthesize themes that emerge from these studies, and discuss the implications of the results to healthcare leadership and innovation. Methodology: A focused scoping review was carried out to investigate the effects of mindfulness practice on clinician burnout. High-ranking journals were targeted to analyse high-quality studies and synthesize common themes in the literature. Studies conducted on current, practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Grey literature and studies conducted only on allied health personnel were excluded from this review. Analysis:31 studies were included in this scoping review. Mindfulness practice was found to decrease emotional exhaustion and depersonalisation while improving mood, responses to stress, and vigour. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged which include: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to clinician mindfulness practice. Conclusion: Mindfulness had widely been reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate clinician leader will play a crucial role in addressing gaps in current practice, prioritise staff mental health, and provide a supportive platform for innovation.

Keywords: mindfulness practice, clinician burnout, healthcare leadership, COVID-19

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Authors: Susan Scott, Dina Hanna, Bassel Zebian, Gary Ruiz, Sreena Das

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Although the number of cases of TB in England has fallen over the last 4 years, it remains an important public health burden with 1 in 20 cases dying annually. The vast majority of cases present in non-UK born individuals with social risk factors. We present a case of non-pulmonary TB presenting in a healthy child born in the UK to professional parents. We present a case of a healthy 10 year old boy who developed acute back pain during school PE. Over the next 5 months, he was seen by various health and allied professionals with worsening back pain and kyphosis. He became increasing unsteady and for the 10 days prior to admission to our hospital, he developed fevers. He was admitted to his local hospital for tonsillitis where he suffered two falls on account of his leg weakness. A spinal X-ray revealed a pathological fracture and gibbus formation. He was transferred to our unit for further management. On arrival, the patient had lower motor neurone signs of his left leg. He underwent spinal fixture, laminectomy and decompression. Microbiology samples taken intra-operatively confirmed Mycobacterium Tuberculosis. He had a positive Mantoux and T-spot and treatment were commenced. There was no evidence of immune compromise. The patient was born in the UK, had a BCG scar and his only travel history had been two years prior to presentation when he travelled to the Phillipines for a short holiday. The patient continues to have issues around neuropathic pain, mobility, pill burden and mild liver side effects from treatment. Discussion: There is a paucity of case reports on spinal TB in paediatrics and diagnosis is often difficult due to the non-specific symptomatology. Although prognosis on treatment is good, a delayed diagnosis can have devastating consequences. This case highlights the continued need for higher index of suspicion and diagnosis in a world with changing patterns of migration and increase global travel. Surgical intervention is limited to the most serious cases to minimise further neurological damage and improve prognosis. There remains the need for a multi-disciplinary approach to deal with challenges of treatment and rehabilitation.

Keywords: tuberculosis, non-pulmonary TB, public health burden, diagnostic challenge

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Authors: Badru Hasan Segujja, Nassiwa Shamim

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This study “Territorial Influence of Religious Based Armed Conflicts in Africa” was in place to identify the influence of religious based armed conflicts, their parsistance and their impact on African societies. The study employed a qualitative research methodology, as data from respondents was descriptively recorded using random sampling technics. The study discovered that, the world is experiencing religious based armed violence where actors fight under the umbrella of freedom fighters where the African continent in particular has been at the pic of such armed violence almost since each countries independence to date. Because of this situation, the Continent is torn apart as families are traumatized by the memories of their dear ones who never survived in yesterdays’ faith based armed violence. The study disvovered that, some of these faith based armed conflicts are caused by factors ranging from undemocratic practices due to poor governance, poverty, Unemployment, religious extremism and radicalism which later turn into intractable violence. Religious armed groups such as, Holly Spirit Movement (HSM), Allied Democratic Forces (ADF) and Lords Resistance Army (LRA) in Uganda and now Eastern DRC and Central African Republic, ALSHABAB in East Africa, SELEKE and ANTI BALAKA in Central African Republic, BOKO HARAM in Nigeria, JANJAWEED in Sudan and Republic of Chad, Sudaneess Peoples Liberation Army (SPLA) in Southern Sudan, Alqaida Mission in Islamic Magreeb (AQIIM) in Mali coupled with acute racism of Hutu and Tutsi in Rwanda or Burundi and Xenophobic Nationalism in (South Africa). The study futher discovered that, the component of “freedom fighters” has strongly made these groups maintain the ground without fear of any repucation, which situation has resulted into children and women becoming disproportionally victims and the response of international communities to the violence is inadequate. The study concludes that, dialogue for peace is better than going for wars. The study recommends that, in order to restore peace on the African continent and elsewhere in the world, UN should recommend the teaching of peace values in schools, pre-conflict early warnings must be well attended, actors must refrain from using religious lebles, democracy, unemployment and poverty issues should as well be addressed to avoid unnessesary conflicts.

Keywords: influence, religious, armed, conflicts

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Authors: Elizabeth Grier, Meg Gemmill, Mary Martin, Leora Reiter, Herman Tang, Alexandra Donaldson, Isis Lunsky, Mia Wu

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Background: Individuals with Cerebral Palsy (CP) and/or IDD face numerous physical and mental health challenges, including difficulty accessing effective palliative care. The aim of this study is to assess the knowledge and comfort of healthcare providers in providing community-based palliative care for patients with Cerebral Palsy (CP) and severe to profound Intellectual and Developmental Disabilities (IDD). Methods: This study includes a mixed methods approach obtaining both quantitative and qualitative data. Quantitative data from palliative care practitioners was obtained through an online survey assessing comfort in symptom management, grief assessment, and goals of care discussion. This survey was distributed to physicians and allied health practitioners across Canada through the College of Family Physicians of Canada Member Interest Groups for Palliative Care and for IDD. Survey results guided the development of a semi-structured interview template, which was used to conduct a focus group on the same topic. Participants were four palliative care providers (3 physicians and one spiritual care practitioner). The focus group transcript is currently undergoing thematic analysis using NVivo 12 software. Results: 57 palliative care practitioners completed the survey. 87% of participants indicated they have provided palliative care services for persons with CP and/or IDD. Findings suggest practitioners are somewhat confident in identifying specific physical symptoms (dyspnea, pressure ulcers) but less confident in identifying physical/emotional pain, addressing grief, and prognosticating life expectancy in this population. 54% of responses indicated they had little/no training on palliating those with CP or IDD, and 45% somewhat or strongly disagree members of their profession can manage symptoms for this population. Focus group analysis is underway, and results will be available at the time of the poster presentation. Conclusion: Persons with CP and IDD are more likely to experience severe health inequities when accessing palliative care. Results of this study suggest further education is needed for palliative care professionals to address the barriers and challenges in providing palliative care to this patient population.

Keywords: palliative care, symptom management, health equity, community healthcare, intellectual and developmental disabilities

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Authors: Farah Amalina Mohamed Affandi, Redhwan Ahmad Al-Naggar, Seok Mui Wang, Thanikasalam Kathiresan

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Gestational choriocarcinoma is a condition in which there is an abnormal growth or a tumor inside the women’s uterus after conception. It is a type of gestational trophoblastic disease which is relatively rare and malignant. The current epidemiological data of this disease are inadequate. The purposes of this study are to examine the epidemiology of choriocarcinoma and their risk factors based on all available population-based and hospital-based data of the disease. In this study, we searched The MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases using the keywords ‘choriocarcinoma’, ‘gestational’, ‘gestational choriocarcinoma’ and ‘epidemiology’. We included only human studies published in English between 1995 and 2015 to ensure up to date evidence. Case studies, case reports, animal studies, letters to the editor, news, and review articles were excluded. Retrieved articles were screened in three phases. In the first phase, any articles that did not match the inclusion criteria based solely on titles were excluded. In the second phase, the abstracts of remaining articles were screened thoroughly; any articles that did not meet our inclusion criteria were excluded. In the final phase, full texts of the remaining articles were read and assessed to exclude articles that did not meet the inclusion criteria or any articles that fulfilled the exclusion criteria. Duplicates articles were also removed. Systematic reviews and meta-analysis were excluded. Extracted data were summarized in table and figures descriptively. The reference lists of included studies were thoroughly reviewed in search for other relevant studies. A total of ten studies met all the selection criteria. Nine were retrospective studies and one was cohort study. Total numbers of 4563 cases of choriocarcinoma were reviewed from several countries which are Korea, Japan, South Africa, USA, New Mexico, Finland, Turkey, China, Brazil and The Netherlands. Different studies included different range of age with their mean age of 28.5 to 30.0 years. All studies investigated on the disease’s incidence rate, only two studies examined on the risk factors or associations of the disease. Approximately 20% of the studies showed a reduction in the incidence of choriocarcinoma while the other 80% showed inconsistencies in rate. Associations of age, fertility age, occupations and socio-demographic with the status remains unclear. There is limited information on the epidemiological aspects of gestational choriocarcinoma. The observed results indicated there was a decrease in the incidence rate of gestational choriocarcinoma globally. These could be due to the reduction in the incidence of molar pregnancy and the efficacy of the treatment, mainly by chemotherapy.

Keywords: epidemiology, gestational choriocarcinoma, incidence, prevalence, risk factor

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Authors: Christine Lassen, Elizabeth Leonard, Matthew Oliver

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The management of trauma is often complex and outcomes dependent on clinical expertise, effective teamwork, and a supported trauma system. The implementation of a statewide trauma education program should be accessible to all clinicians who manage trauma, but this can be challenging due to diverse individual needs, trauma service needs and geography. The NSW Institute of Trauma and Injury Management (ITIM) is a government funded body, responsible for coordinating and supporting the NSW Trauma System. The aim of this presentation is to describe how education initiatives have been implemented across the state. Simulation: In 2006, ITIM developed a Trauma Team Training Course - aimed to educate clinicians on the technical and non-technical skills required to manage trauma. The course is now independently coordinated by trauma services across the state at major trauma centres as well as in regional and rural hospitals. ITIM is currently in the process of re-evaluating and updating the Trauma Team Training Course to allow for the development of new resources and simulation scenarios. Trauma Education Evenings: In 2013, ITIM supported major trauma services to develop trauma education evenings which allowed the provision of free education to staff within the area health service and local area. The success of these local events expanded to regional hospitals. A total of 75 trauma education evenings have been conducted within NSW, with over 10,000 attendees. Wed-Based Resources: Recently, ITIM commenced free live streaming of the trauma education evenings which have now had over 3000 live views. The Trauma App developed in 2015 provides trauma clinicians with a centralised portal for trauma information and works on smartphones and tablets that integrate with the ITIM website. This supports pre-hospital and bedside clinical decisions and allows for trauma care to be more standardised, evidence-based, timely, and appropriate. Online e-Learning modules have been developed to assist clinicians, reduce unwarranted clinical variation and provide up to date evidence based education. The modules incorporate clinically focused education content with summative and formative assessments. Conclusion: Since 2005, ITIM has helped to facilitate the development of trauma education programs for doctors, nurses, pre-hospital and allied health clinicians. ITIM has been actively involved in more than 100 specialized trauma education programs, seminars and clinical workshops - attended by over 12,000 staff. The provision of state-wide trauma education is a challenging task requiring collaboration amongst numerous agencies working towards a common goal – to provide easily accessible trauma education.

Keywords: education, simulation, team-training, trauma

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Authors: Muhammad Kashif Fida

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In the bank, teller’s job (cash officer) is highly important and critical as at one end it requires soft and brisk customer services and on the other side, handling cash with integrity. It is always challenging for recruiters to hire competent and trustworthy tellers. According to author’s knowledge, there is no comprehensive test available that may provide assistance in recruitment in Pakistan. So there is a dire need of a psychometric battery that could provide support in recruitment of potential candidates for the teller’ position. So, the aim of the present study was to construct ABL-Teller Aptitude Test (ABL-TApT). Three major phases have been designed by following American Psychological Association’s guidelines. The first phase was qualitative, indicators of the test have been explored by content analysis of the a) teller’s job descriptions (n=3), b) interview with senior tellers (n=6) and c) interview with HR personals (n=4). Content analysis of above yielded three border constructs; i). Personality, ii). Integrity/honesty, iii). Professional Work Aptitude. Identified indicators operationalized and statements (k=170) were generated using verbatim. It was then forwarded to the five experts for review of content validity. They finalized 156 items. In the second phase; ABL-TApT (k=156) administered on 323 participants through a computer application. The overall reliability of the test shows significant alpha coefficient (α=.81). Reliability of subscales have also significant alpha coefficients. Confirmatory Factor Analysis (CFA) performed to estimate the construct validity, confirms four main factors comprising of eight personality traits (Confidence, Organized, Compliance, Goal-oriented, Persistent, Forecasting, Patience, Caution), one Integrity/honesty factor, four factors of professional work aptitude (basic numerical ability and perceptual accuracy of letters, numbers and signature) and two factors for customer services (customer services, emotional maturity). Values of GFI, AGFI, NNFI, CFI, RFI and RMSEA are in recommended range depicting significant model fit. In third phase concurrent validity evidences have been pursued. Personality and integrity part of this scale has significant correlations with ‘conscientiousness’ factor of NEO-PI-R, reflecting strong concurrent validity. Customer services and emotional maturity have significant correlations with ‘Bar-On EQI’ showing another evidence of strong concurrent validity. It is concluded that ABL-TAPT is significantly reliable and valid battery of tests, will assist in objective recruitment of tellers and help recruiters in finding a more suitable human resource.

Keywords: concurrent validity, construct validity, content validity, reliability, teller aptitude test, objective recruitment

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Authors: Khair Al-Deen Bsisu, Osama Mahmoud Abuzeid

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Significant technological advances have been achieved in the design and building construction of steel and glass in the last two decades. The metal glass support frame has been replaced by further sophisticated technological solutions, for example, the point fixed glazing systems. The minimization of the visual mass has reached extensive possibilities through the evolution of technology in glass production and the better understanding of the structural potential of glass itself, the technological development of bolted fixings, the introduction of the glazing support attachments of the glass suspension systems and the use for structural stabilization of cables that reduce to a minimum the amount of metal used. The variability of solutions of tension structures, allied to the difficulties related to geometric and material non-linear behavior, usually overrules the use of analytical solutions, letting numerical analysis as the only general approach to the design and analysis of tension structures. With the characteristics of low stiffness, lightweight, and small damping, tension structures are obviously geometrically nonlinear. In fact, analysis of cable truss is not only one of the most difficult nonlinear analyses because the analysis path may have rigid-body modes, but also a time consuming procedure. Non-linear theory allowing for large deflections is used. The flexibility of supporting members was observed to influence the stresses in the pane considerably in some cases. No other class of architectural structural systems is as dependent upon the use of digital computers as are tensile structures. Besides complexity, the process of design and analysis of tension structures presents a series of specificities, which usually lead to the use of special purpose programs, instead of general purpose programs (GPPs), such as ANSYS. In a special purpose program, part of the design know how is embedded in program routines. It is very probable that this type of program will be the option of the final user, in design offices. GPPs offer a range of types of analyses and modeling options. Besides, traditional GPPs are constantly being tested by a large number of users, and are updated according to their actual demands. This work discusses the use of ANSYS for the analysis and design of tension structures, such as cable truss structures under wind and gravity loadings. A model to describe the glass panels working in coordination with the cable truss was proposed. Under the proposed model, a FEM model of the glass panels working in coordination with the cable truss was established.

Keywords: Glass Construction material, Facades, Finite Element, Pre-Tensioned Cable Truss

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Authors: C. A. Sharma, Birendra P. Singh

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Ichnofacies analysis is considered the best paleontological tool for interpreting ancient depositional environments. Nineteen (19) ichnogenera (namely: Bergaueria, Catenichnus, Cochlichnus, Cruziana, Diplichnites, Dimorphichnus, Diplocraterion, Gordia, Guanshanichnus, Lockeia, Merostomichnites, Monomorphichnus, Palaeophycus, Phycodes, Planolites, Psammichnites, Rusophycus, Skolithos and Treptichnus) are recocered from the Tal Group (Cambrian) of the Nigalidhar Syncline. The stratigraphic occurrences of these ichnogenera represent alternating proximal Cruziana and Skolithos ichnofacies along the contact of Sankholi and Koti-Dhaman formations of the Tal Group. Five ichnogenera namely Catenichnus, Guanshanichnus, Lockeia, Merostomichnites and Psammichnites are recorded for the first time from the Nigalidhar Syncline. Cruziana ichnofacies is found in the upper part of the Sankholi Formation to the lower part of the Koti Dhaman Formation in the NigaliDhar Syncline. The preservational characters here indicate a subtidal environmental condition with poorly sorted, unconsolidated substrate. Depositional condition ranging from moderate to high energy levels below the fair weather base but above the storm wave base under nearshore to foreshore setting in a wave dominated shallow water environment is also indicated. The proximal Cruziana-ichnofacies is interrupted by the Skolithos ichnofacies in the Tal Group of the Nigalidhar Syncline which indicate fluctuating high energy condition which was unfavorable for the opportunistic organism which were dominant during the proximal Cruziana ichnofacies. The excursion of Skolithos ichnofacies (as a pipe rock in the upper part of Sankholi Formation) into the proximal Cruziana ichnofacies in the Tal Group indicate that increased energy and allied parameters attributed to the high rate of sedimentation near the proximal part of the basin. The level bearing the Skolithos ichnofacies in the Nigalidhar Syncline at the juncture of Sankholi and Koti-Dhaman formations can be correlated to the level marked as unconformity in between the Deo-Ka-Tibba and the Dhaulagiri formations by the conglomeratic horizon in the Mussoorie Syncline, Lesser Himalaya, India. Thus, the Tal Group of the Nigalidhar syncline at this stratigraphic level represent slightly deeper water condition than the Mussoorie Syncline, where in the later the aerial exposure dominated which leads to the deposition of conglomeratic horizon and subsequent formation of unconformity. The overall ichnological and sedimentological dataset allow us to infer that the Cambrian successions of Nigalidhar Syncline were deposited in a wave-dominated proximal part of the basin under the foreshore to close to upper shoreface regimes of the shallow marine setting.

Keywords: Cambrian, Ichnofacies, Lesser Himalaya, Nigalidhar, Tal Group

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Authors: Ilyas Khan. Liliane Pintelon, Harry Martin, Michael Shömig

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The increasing costs of healthcare on one hand, and the rise in aging population and associated chronic disease, on the other hand, are putting increasing burden on the current health care system in many Western countries. For instance, chronic kidney disease (CKD) is a common disease and in Europe, the cost of renal replacement therapy (RRT) is very significant to the total health care cost. However, the recent advancement in healthcare technology, provide the opportunity to treat patients at home in their own comfort. It is evident that home healthcare offers numerous advantages apparently, low costs and high patients’ quality of life. Despite these advantages, the intake of home hemodialysis (HHD) therapy is still low in particular in Germany. Many factors are accounted for the low number of HHD intake. However, this paper is focusing on patients’ safety-related factors of current HHD practices in Germany. The aim of this paper is to analyze the current HHD practices in Germany and to identify risks related factors if any exist. A case study has been conducted in a dialysis center which consists of four dialysis centers in the south of Germany. In total, these dialysis centers have 350 chronic dialysis patients, of which, four patients are on HHD. The centers have 126 staff which includes six nephrologists and 120 other staff i.e. nurses and administration. The results of the study revealed several risk-related factors. Most importantly, these centers do not offer allied health services at the pre-dialysis stage, the HHD training did not have an established curriculum; however, they have just recently developed the first version. Only a soft copy of the machine manual is offered to patients. Surprisingly, the management was not aware of any standard available for home assessment and installation. The home assessment is done by a third party (i.e. the machines and equipment provider) and they may not consider the hygienic quality of the patient’s home. The type of machine provided to patients at home is similar to the one in the center. The model may not be suitable at home because of its size and complexity. Even though portable hemodialysis machines, which are specially designed for home use, are available in the market such as the NxStage series. Besides the type of machine, no assistance is offered for space management at home in particular for placing the machine. Moreover, the centers do not offer remote assistance to patients and their carer at home. However, telephonic assistance is available. Furthermore, no alternative is offered if a carer is not available. In addition, the centers are lacking medical staff including nephrologists and renal nurses.

Keywords: home hemodialysis, home hemodialysis practices, patients’ related risks in the current home hemodialysis practices, patient safety in home hemodialysis

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Authors: D. M. Lewis, L. Frisby, U. Stead

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Objective: Many patients are receiving invasive treatments in acute care or are dying in hospital without having had comprehensive goals of care conversations. Some of these treatments may not align with the patient’s wishes, may be futile, and may cause unnecessary suffering. While many staff may recognize the benefits of engaging patients and families in Serious Illness Conversations (a goal of care framework developed by Ariadne Labs in Boston), few staff feel confident and/or competent in having these conversations in acute care. Another barrier to having these conversations may be due to a lack of incorporation in the current workflow. An educational exercise, titled the Two Question Challenge, was initiated on four medical units across two Vancouver Coastal Health (VCH) hospitals in attempt to engage the entire interdisciplinary team in asking patients and families questions around goals of care and to improve the documentation of these expressed wishes and preferences. Methods: Four acute care units across two separate hospitals participated in the Two Question Challenge. On each unit, over the course of two eight-hour shifts, all members of the interdisciplinary team were asked to select at least two questions from a selection of nine goals of care questions. They were asked to pose these questions of a patient or family member throughout their shift and then asked to document their conversations in a centralized Advance Care Planning/Goals of Care discussion record in the patient’s chart. A visual representation of conversation outcomes was created to demonstrate to staff and patients the breadth of conversations that took place throughout the challenge. Staff and patients were interviewed about their experiences throughout the challenge. Two palliative approach leads remained present on the units throughout the challenge to support, guide, or role model these conversations. Results: Across four acute care medical units, 47 interdisciplinary staff participated in the Two Question Challenge, including nursing, allied health, and a physician. A total of 88 questions were asked of patients, or their families around goals of care and 50 newly documented goals of care conversations were charted. Two code statuses were changed as a result of the conversations. Patients voiced an appreciation for these conversations and staff were able to successfully incorporate these questions into their daily care. Conclusion: The Two Question Challenge proved to be an effective way of having teams explore the goals of care of patients and families in an acute care setting. Staff felt that they gained confidence and competence. Both staff and patients found these conversations to be meaningful and impactful and felt they were notably different from their usual interactions. Documentation of these conversations in a centralized location that is easily accessible to all care providers increased significantly. Application of the Two Question Challenge in non-medical units or other care settings, such as long-term care facilities or community health units, should be explored in the future.

Keywords: advance care planning, goals of care, interdisciplinary, palliative approach, serious illness conversations

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