Search results for: emergency and disaster response

Authors: Deborah Weidner, Melissa Morgera

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The model of care delivery in the Behavioral Health Network (BHN) is integrated across all five regions of Hartford Healthcare and thus spans the entirety of the state of Connecticut, with care provided in seven inpatient settings and over 30 ambulatory outpatient locations. While safety has been a core priority of the BHN in alignment with High Reliability practices, safety initiatives have historically been facilitated locally in each region or within each entity, with interventions implemented locally as opposed to throughout the network. To address this, the BHN introduced a network wide Safety Huddle during 2022. Launched in January, the BHN Safety Huddle brought together internal stakeholders, including medical and administrative leaders, along with executive institute leadership, quality, and risk management. By bringing leaders together and introducing a network-wide safety huddle into the way we work, the benefit has been an increase in awareness of safety events occurring in behavioral health areas as well as increased systemization of countermeasures to prevent future events. One significant discussion topic presented in huddles has pertained to environmental design and patient access to potentially dangerous items, addressing some of the most relevant factors resulting in harm to patients in inpatient and emergency settings for behavioral health patients. The safety huddle has improved visibility of potential environmental safety risks through the generation of over 15 safety alerts cascaded throughout the BHN and also spurred a rapid improvement project focused on standardization of patient belonging searches to reduce patient access to potentially dangerous items on inpatient units. Safety events pertaining to potentially dangerous items decreased by 31% as a result of standardized interventions implemented across the network and as a result of increased awareness. A second positive outcome originating from the BHN Safety Huddle was implementation of a recommendation to increase the emergency Narcan®(naloxone) supply on hand in ambulatory settings of the BHN after incidents involving accidental overdose resulted in higher doses of naloxone administration. By increasing the emergency supply of naloxone on hand in all ambulatory and residential settings, colleagues are better prepared to respond in an emergency situation should a patient experience an overdose while on site. Lastly, discussions in safety huddle spurred a new initiative within the BHN to improve responsiveness to assaultive incidents through a consultation service. This consult service, aligned with one of the network’s improvement priorities to reduce harm events related to assaultive incidents, was borne out of discussion in huddle in which it was identified that additional interventions may be needed in providing clinical care to patients who are experiencing multiple and/ or frequent safety events.

Keywords: quality, safety, behavioral health, risk management

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Authors: Sami Alanazi

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Teamwork practices have been recognized as a significant strategy to improve patient safety, quality of care, and staff and patient satisfaction in healthcare settings, particularly within the emergency department (ED). The EDs depend heavily on teams of interdisciplinary healthcare staff to carry out their operational goals and core business of providing care to the serious illness and injured. The ED is also recognized as a high-risk area in relation to service demand and the potential for human error. Few studies have considered the perceptions and experiences of the ED staff (physicians, nurses, allied health professionals, and administration staff) about the practice of teamwork, especially in Saudi Arabia (SA), and no studies have been conducted to explore the practices of teamwork in the EDs. Aim: To explore the practices of teamwork from the perspectives and experiences of staff (physicians, nurses, allied health professionals, and administration staff) when interacting with each other in the admission areas in the ED of a public hospital in the Northern Border region of SA. Method: A qualitative case study design was utilized, drawing on two methods for the data collection, comprising of semi-structured interviews (n=22) with physicians (6), nurses (10), allied health professionals (3), and administrative members (3) working in the ED of a hospital in the Northern Border region of SA. The second method is non-participant direct observation. All data were analyzed using thematic analysis. Findings: The main themes that emerged from the analysis were as follows: the meaningful of teamwork, reasons of teamwork, the ED environmental factors, the organizational factors, the value of communication, leadership, teamwork skills in the ED, team members' behaviors, multicultural teamwork, and patients and families behaviors theme. Discussion: Working in the ED environment played a major role in affecting work performance as well as team dynamics. However, Communication, time management, fast-paced performance, multitasking, motivation, leadership, and stress management were highlighted by the participants as fundamental skills that have a major impact on team members and patients in the ED. It was found that the behaviors of the team members impacted the team dynamics as well as ED health services. Behaviors such as disputes among team members, conflict, cooperation, uncooperative members, neglect, and emotions of the members. Besides that, the behaviors of the patients and their accompanies had a direct impact on the team and the quality of the services. In addition, the differences in the cultures have separated the team members and created undesirable gaps such the gender segregation, national origin discrimination, and similarity and different in interests. Conclusion: Effective teamwork, in the context of the emergency department, was recognized as an essential element to obtain the quality of care as well as improve staff satisfaction.

Keywords: teamwork, barrier, facilitator, emergencydepartment

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Authors: Deepak K. Gupta, T. R. Ravindran

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Holographic Optical Tweezers (HOTs) in general use iterative algorithms such as weighted Gerchberg-Saxton (WGS) to generate multiple traps, which produce traps with 99% uniformity theoretically. But in experiments, it is the phase response of the spatial light modulator (SLM) which ultimately determines the efficiency, uniformity, and quality of the trap spots. In general, SLMs show a nonlinear phase response behavior, and they may even have asymmetric phase modulation depth before and after π. This affects the resolution with which the gray levels are addressed before and after π, leading to a degraded trap performance. We present a method to optimize the SLM for a linear phase response behavior along with a symmetric phase modulation depth around π. Further, we optimize the SLM for its varying phase response over different spatial regions by optimizing the brightness/contrast and gamma of the hologram in different subsections. We show the effect of the optimization on an array of trap spots resulting in improved efficiency and uniformity. We also calculate the spot sharpness metric and trap performance metric and show a tightly focused spot with reduced aberration. The trap performance is compared by calculating the trap stiffness of a trapped particle in a given trap spot before and after aberration correction. The trap stiffness is found to improve by 200% after the optimization.

Keywords: spatial light modulator, optical trapping, aberration, phase modulation

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Authors: Cabangile Ncengeni Ngwane, Gerald Mills

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Anthropogenic climate change is exacerbating natural hazards such as droughts, heat waves and sea-level rise. The associated risks are the greatest in places where socio-ecological systems are exposed to these changes and the populations and infrastructure are vulnerable. Identifying the communities at risk and enhancing local resilience are key issues in responding to the current and project climate changes. This paper explores the types of risks associated with multiple overlapping hazards in Durban, South Africa where the social, cultural and economic dimensions that contribute to exposure and vulnerability are compounded by its history of apartheid. As a result, climate change risks are highly concentrated in marginalized communities that have the least adaptive capacity. In this research, a Geographic Information System is to explore the spatial correspondence among geographic layers representing hazards, exposure and vulnerability across Durban. This quantitative analysis will allow authors to identify communities at high risk and focus our study on the nature of the current human-environment relationships that result in risk inequalities. This work will employ qualitative methods to critically examine policies (including educational practices and financial support systems) and on-the-ground actions that are designed to improve the adaptive capacity of these communities and meet UN Sustainable Development Goals. This work will contribute to a growing body of literature on disaster risk management, especially as it relates to developing economies where socio-economic inequalities are correlated with ethnicity and race.

Keywords: adaptive capacity, disaster risk reduction, exposure, resilience, South Africa

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Authors: Syarif Hidayat

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As millions of people with different backgrounds perform hajj every year in Saudi Arabia, it brings out several problems. Missing people is among many crucial problems need to be encountered. Some people might have had insufficient knowledge of using tracking system equipment. Other might become a victim of an accident, lose consciousness, or even died, prohibiting them to perform certain activity. For those reasons, people could not send proper SOS message. The major contribution of this paper is the application of the diverse alert method in pilgrims tracking system. It offers a simple yet robust solution to send SOS message by pilgrims during Hajj. Knowledge of context aware computing is assumed herein. This study presents four methods that could be utilized by pilgrims to send SOS. The first method is simple mobile application contains only a button. The second method is based on behavior analysis based off GPS location movement anomaly. The third method is by introducing pressing pattern to smartwatch physical button as a panic button. The fourth method is by identifying certain accelerometer pattern recognition as a sign of emergency situations. Presented method in this paper would be an important part of pilgrims tracking system. The discussion provided here includes easy to use design whilst maintaining tracking accuracy, privacy, and security of its users.

Keywords: context aware computing, emergency alert system, GPS, hajj pilgrim tracking, location-based services

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Authors: Ho-Jun Jo, Wook-Won Kim, Yong-Sung Kim, Jin-O Kim

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The application of ESS (Energy Storage Systems) in the future grids has been the solution of the microgrid. However, high investment costs necessitate accurate modeling and control strategy of ESS to justify its economic viability and further underutilization. Therefore, the reasonable control strategy for ESS which is subjected to generator and usage helps to curtail the cost of investment and operation costs. The rated frequency in power system is decreased when the load is increasing unexpectedly; hence the thermal power is operated at the capacity of only its 95% for the Governor Free (GF) to adjust the frequency as reserve (5%) in practice. The ESS can be utilized with governor at the same time for the frequency response due to characteristic of its fast response speed and moreover, the cost of ESS is declined rapidly to the reasonable price. This paper presents the ESS control strategy to extend usage of the ESS taken account into governor’s ramp rate and reduce the governor’s intervention as well. All results in this paper are simulated by MATLAB.

Keywords: micro grid, energy storage systems, ramp rate, control strategy

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Authors: Ben Abdallah Aicha

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In this work we show a H∞ synthesis method which enables us to calculate a feedback controller according to considerations of stability robustness and disturbance rejection translated on to the open loop response. However, it may happen that we have an additional specification on the closed loop response relating to tracking of the reference trajectory. The H∞ synthesis has the advantage of offering increased specifications in robustness stability. Implemented for a DC motor, it offers invaluable performance in speed control in both directions of rotation.

Keywords: H∞ synthesis, DC motor, robustness stability, performance conditions

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Authors: Mahmoudi Noureddine

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In this study the use of two variable refined plate theories of laminated composite plates to static response of laminated plates. The plate theory accounts for parabolic distribution of the transverse shear strains, and satisfies the zero traction boundary conditions on the surfaces of the plate without using shear correction factor. The validity of the present theory is demonstrated by comparison with solutions available in the literature and finite element method. The result is presented for the static response of simply supported rectangular plates under uniform sinusoidal mechanical loadings.

Keywords: bending, composite, laminate, plates, fem

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Authors: Sejin Jung, Dongho Kang, Byungsik Kim

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Assessing the impact of climate change requires the use of a multi-model ensemble (MME) to quantify uncertainties between scenarios and produce downscaled outlines for simulation of climate under the influence of different factors, including topography. This study decreases climate change scenarios from the 13 global climate models (GCMs) to assess the impacts of future climate change. Unlike South Korea, North Korea lacks in studies using climate change scenarios of the CoupledModelIntercomparisonProject (CMIP5), and only recently did the country start the projection of extreme precipitation episodes. One of the main purposes of this study is to predict changes in the average climatic conditions of North Korea in the future. The result of comparing downscaled climate change scenarios with observation data for a reference period indicates high applicability of the Multi-Model Ensemble (MME). Furthermore, the study classifies climatic zones by applying the Köppen-Geiger climate classification system to the MME, which is validated for future precipitation and temperature. The result suggests that the continental climate (D) that covers the inland area for the reference climate is expected to shift into the temperate climate (C). The coefficient of variation (CVs) in the temperature ensemble is particularly low for the southern coast of the Korean peninsula, and accordingly, a high possibility of the shifting climatic zone of the coast is predicted. This research was supported by a grant (MOIS-DP-2015-05) of Disaster Prediction and Mitigation Technology Development Program funded by Ministry of Interior and Safety (MOIS, Korea).

Keywords: MME, North Korea, Koppen–Geiger, climatic zones, coefficient of variation, CV

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Authors: Kyugneun Lee, Ikjin Lee

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Parameter estimation with inverse problem often suffers from unfavorable conditions in the real world. Useless data and many input parameters make the problem complicated or insoluble. Data refinement and reformulation of the problem can solve that kind of difficulties. In this research, a method to solve the rank deficient inverse problem is suggested. A multi-physics system which has rank deficiency caused by response correlation is treated. Impeditive information is removed and the problem is reformulated to sequential estimations using Bayesian network (BN) and subset groups. At first, subset grouping of the responses is performed. Feature selection with singular value decomposition (SVD) is used for the grouping. Next, BN inference is used for sequential conditional estimation according to the group hierarchy. Directed acyclic graph (DAG) structure is organized to maximize the estimation ability. Variance ratio of response to noise is used to pairing the estimable parameters by each response.

Keywords: Bayesian network, feature selection, rank deficiency, statistical inverse analysis

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Authors: A. Nabhan, Mohamed R. El-Sharkawy, A. Rashed

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The main aim of this paper is to dedicate the belt drive system faults like cogs missing, misalignment and belt worm using vibration analysis technique. Experimentally, the belt drive test-rig is equipped to measure vibrations signals under different operating conditions. Finite element 3D model of belt drive system is created and vibration response analyzed using commercial finite element software ABAQUS/CAE.  Root mean square (RMS) and Crest Factor will serve as indicators of average amplitude of envelope analysis signals. The vibration signals pattern obtained from the simulation model and experimental data have the same characteristics. It can be concluded that each case of the RMS is more effective in detecting the defect for acceleration response. While Crest Factor parameter has a response with the displacement and velocity of vibration signals. Also it can be noticed that the model has difficulty in completing the solution when the misalignment angle is higher than 1 degree.

Keywords: simulation model, misalignment, cogs missing, vibration analysis

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Authors: Behrang Tavousi Tehrani, Mohammad-Zaman Kabir

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Shape memory alloys (SMA) are often implemented in smart structures as the active components. Their ability to recover large displacements has been used in many applications, including structural stability/response enhancement and active structural acoustic control. SMA wires or fibers can be embedded with composite cylinders to increase their critical buckling load, improve their load-deflection behavior, and reduce the radial deflections under various thermo-mechanical loadings. This paper presents a semi-analytical investigation on the non-linear load-deflection response of SMA-reinforced composite circular cylindrical shells. The cylinder shells are under uniform external pressure load. Based on first-order shear deformation shell theory (FSDT), the equilibrium equations of the structure are derived. One-dimensional simplified Brinson’s model is used for determining the SMA recovery force due to its simplicity and accuracy. Airy stress function and Galerkin technique are used to obtain non-linear load-deflection curves. The results are verified by comparing them with those in the literature. Several parametric studies are conducted in order to investigate the effect of SMA volume fraction, SMA pre-strain value, and SMA activation temperature on the response of the structure. It is shown that suitable usage of SMA wires results in a considerable enhancement in the load-deflection response of the shell due to the generation of the SMA tensile recovery force.

Keywords: airy stress function, cylindrical shell, Galerkin technique, load-deflection curve, recovery stress, shape memory alloy

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Authors: S. Mishra, J. Monro, H. Edwards, J. Podd

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When a fruit such as kiwifruit is consumed its tissues are released from the physical /anatomical constraints existing in the fruit. During digestion they may expand several-fold to achieve a hydrated solids volume far greater than the original fruit, and occupy the available space in the gut, where they surround and interact with other food components. Within the cell wall dispersion, in vitro digestion of co-consumed carbohydrate, diffusion of digestion products, and mixing responsible for mass transfer of nutrients to the gut wall for absorption, were all retarded. All of the foregoing processes may be involved in the glycaemic response to carbohydrate foods consumed with kiwifruit, such as breakfast cereal. To examine their combined role in reducing the glycaemic response to wheat cereal consumed with kiwifruit we formulated diets containing equal amounts of breakfast cereal, with the addition of either kiwifruit, or sugars of the same composition and quantity as in kiwifruit. Therefore, the only difference between the diets was the presence of non-digestible fruit residues. The diet containing the entire disperse kiwifruit significantly reduced the glycaemic response amplitude and the area under the 0-120 min incremental blood glucose response curve (IAUC), compared with the equicarbohydrate diet containing the added kiwifruit sugars. It also slightly but significantly increased the 120-180 min IAUC by preventing a postprandial overcompensation, indicating improved homeostatic blood glucose control. In a subsequent study in which we used kiwifruit in a carbohydrate exchange format, in which the kiwifruit carbohydrate partially replaced breakfast cereal in equal carbohydrate meals, the blood glucose was further reduced without a loss of satiety, and with a reduction in insulin demand. The results show that kiwifruit may be a valuable component in low glycaemic impact diets.

Keywords: carbohydrate, digestion, glycaemic response, kiwifruit

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Authors: Kaddi Mohammed, A. Benatiallah, D. Benatiallah

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Data grid is a technology that has full emergence of new challenges, such as the heterogeneity and availability of various resources and geographically distributed, fast data access, minimizing latency and fault tolerance. Researchers interested in this technology address the problems of the various systems related to the industry such as task scheduling, load balancing and replication. The latter is an effective solution to achieve good performance in terms of data access and grid resources and better availability of data cost. In a system with duplication, a coherence protocol is used to impose some degree of synchronization between the various copies and impose some order on updates. In this project, we present an approach for placing replicas to minimize the cost of response of requests to read or write, and we implement our model in a simulation environment. The placement techniques are based on a cost model which depends on several factors, such as bandwidth, data size and storage nodes.

Keywords: response time, query, consistency, bandwidth, storage capacity, CERN

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Authors: M. D. Asemoloye, S. G. Jonathan, A. Rafiq, O. J. Olawuyi, D. O. Adejoye

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Calmodulin is one of the intracellular calcium proteins that regulates large spectrum of enzymes and cellular functions including metabolism of cyclic nucleotides and glycogen. The potentials of calmodulin gene in fungi necessitates their genetic response and their strong cassette of enzyme secretions for pesticide degradation. Therefore, this study was carried out to investigate the ‘Transcriptomic’ response of calmodulin encoding genes in Talaromyces fungi in response to 2, 2-dichlorovinyl dimethyl phosphate (DDVP or Dichlorvos) an organophosphate pesticide and γ-Hexachlorocyclohexane (Lindane) an organochlorine pesticide. Fungi strains isolated from rhizosphere from grasses rhizosphere in pesticide polluted sites were subjected to percentage incidence test. Two most frequent fungi were further characterized using ITS gene amplification (ITS1 and ITS4 combinations), they were thereafter subjected to In-vitro DDVP and lindane tolerance tests at different concentrations. They were also screened for presence and expression of calmodulin gene (caM) using RT-PCR technique. The two Talaromyces strains had the highest incidence of 50-72% in pesticide polluted site, they were both identified as Talaromyces astroroseus asemoG and Talaromyces purpurogenum asemoN submitted in NCBI gene-bank with accession numbers KY488464 and KY488468 respectively. T. astroroseus KY488464 tolerated DDVP (1.23±0.023 cm) and lindane (1.11±0.018 cm) at 25 % concentration while T. purpurogenum KY488468 tolerated DDVP (1.33±0.061 cm) and lindane (1.54±0.077 cm) at this concentration. Calmodulin gene was detected in both strains, but RT-PCR expression of caM gene revealed at 900-1000 bp showed an under-expression of caM in T. astrorosues KY488464 but overexpressed in T. purpurogenum KY488464. Thus, the calmodulin gene response of these fungal strains to both pesticides could be considered in monitoring the potentials of fungal strains to pesticide tolerance and bioremediation of pesticide in polluted soil.

Keywords: Calmodulin gene, pesticide, RT-PCR, talaromyces, tolerance

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Authors: F. Z. Mahi, H. Marinchio, C. Palermo, L. Varani

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We propose an analytical approach for the admittance response calculation of the high mobility InGaAs channel transistors. The development of the small-signal admittance takes into account the longitudinal and transverse electric fields through a pseudo two-dimensional approximation of the Poisson equation. The total currents and the potentials matrix relation between the gate and the drain terminals determine the frequency-dependent small-signal admittance response. The analytical results show that the admittance spectrum exhibits a series of resonant peaks corresponding to the excitation of plasma waves. The appearance of the resonance is discussed and analyzed as functions of the channel length and the temperature. The model can be used, on one hand, to control the appearance of plasma resonances, and on the other hand, can give significant information about the admittance phase frequency dependence.

Keywords: small-signal admittance, Poisson equation, currents and potentials matrix, the drain and the gate terminals, analytical model

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Authors: Dandan Shen, Hui-zhu Wang, Xi Yu, LiLi Gui, Xiao Wei, Xiao-yan Jiang, Da-wei Wang, Min Hong

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Yu-ping-feng-san (YPFS) is a clinical medicine for asthma and other allergic diseases, but the mechanism of YPFS on relapse of allergy is unclear. Currently, people come to realize the epithelial cells(EC) play a key role in stimulating and regulating local immune response. The study of thymic stromal lymphopoietin（TSLP derived from EC provides an important evidence that the EC can regulate immune response to stimulate allergic response. In this study, we observed the effect of YPFS on TSLP in vivo and in vitro. We established a method by using bronchial epithelial cells (16HBE) for screening potential bioactive components by HPLC-MS in YPFS and then analyzed the components in serum containing YPFS by UPLC-MS. The results showed that YPFS could decrease TSLP protein level in OVA-sensitized mice and 16HBE cells. Five components combing with the 16HBE cells were both detected in the serum.

Keywords: TSLP, bronchial epithelial cells, cell-binding, drug-containing serum

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Authors: B.M. Balekwa, D.V.V. Kallon, D.J. Fourie

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Modal analysis is applied to establish the dynamic difference between vibration response of the rails supported on High Density Polyethylene (HDPE) and Hytrel/6358 rail pads. The experiment was conducted to obtain the results in the form of Frequency Response Functions (FRFs) in the vertical and lateral directions. Three antiresonance modes are seen in the vertical direction; one occurs at about 150 Hz when the rail resting on the Hytrel/6358 pad experiences a force mid-span. For the rail resting on this type of rail pad, no antiresonance occurs when the force is applied on the point of the rail that is resting on the pad and directly on top of a sleeper. The two antiresonance modes occur in a frequency range of 250 – 300 Hz in the vertical direction for the rail resting on HDPE pads. At resonance, the rail vibrates with a higher amplitude, but at antiresonance, the rail transmits vibration downwards to the sleepers. When the rail is at antiresonance, the stiffness of the rail pads play a vital role in terms of damping the vertical vibration to protect the sleepers. From the FRFs it is understood that the Hytrel/6358 rail pads perform better than the HDPE in terms of vertical response, given that at a lower frequency range of 0 – 300 Hz only one antiresonance mode was identified for vertical vibration of the rail supported on Hytrel/6358. This means the rail is at antiresonance only once within this frequency range and this is the only time when vibration is transmitted downwards.

Keywords: accelerance, FRF, rail corrugation, rail pad

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Authors: Luciano Roberto Fernandez-Sola, Cesar Augusto Arredondo-Velez, Miguel Angel Jaimes-Tellez

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This paper explores the modifications on peak acceleration, velocity and displacement profiles over the structure due to dynamic soil-structure interaction (DSSI). A shear beam model is used for the structure. Soil-foundation flexibility (inertial interaction) is considered by a set of springs and dashpots at the structure base. Kinematic interaction is considered using transfer functions. Impedance functions are computed using simplified expressions for rigid foundations. The research studies the influence of the slenderness ratio on the value of the peak floor response. It is shown that the modifications of peak floor responses are not the same for acceleration, velocity and displacement. This is opposite to the hypothesis used by methods included in several building codes. Results show that modifications produced by DSSI on different response quantities are not equal.

Keywords: peak floor intensities, dynamic soil-structure interaction, buildings with flexible base, kinematic and inertial interaction

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Authors: Elena Carcano, James Ball

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This work details the strategies adopted by the Italian Water Utilities during the distribution of water in emergency conditions which glide from earthquakes and droughts to floods and fires. Several water bureaus located over the national territory have been interviewed, and the collected information has been used in a database of potential interventions to be taken. The work discusses the actions adopted by water utilities. These are generally prioritized in order to minimize the social, temporal, and economic burden that the damaged and nearby areas need to support. Actions are defined relying on the Bayesian Network Approach, which constitutes the hard core of any decision support system. The Bayesian Networks give answers to interventions to real and most likely risky cases. The added value of this research consists in supplying the National Bureau, namely Protezione Civile, in charge of managing havoc and catastrophic situations with a univocal plot outline so as to be able to handle actions uniformly at the expense of different local laws or contradictory customs which squander any recovery conditions, proper technical service, and economic aids. The paper is organized as follows: in section 1, the introduction is stated; section 2 provides a brief discussion of BNNs (Bayesian Networks), section 3 introduces the adopted methodology; and in the last sections, results are presented, and conclusions are drawn.

Keywords: hierarchical process, strategic plan, water emergency conditions, water supply

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Authors: Jeonghyun Chang, Taegeun Lee, Heungsup Sung, Yoon-Seon Lee, Youn-Jung Kim, Mi-Na Kim

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Background: Safety device has been applied to improve safety and performance of blood culture practice. BD vacutainer® Safety-Lokᵀᴹ blood collection sets with pre-attached holder (Safety-Lok) (BD, USA) was evaluated in the emergency room (ER) of a tertiary care hospital. Methods: From April to June 2017, interns and nurses in ER were surveyed for blood culture practices with a questionnaire before and after 2 or 3 weeks of experience of Safety-Lok. All of them participated in exercise workshop for 1 hour combined with video education prior to the initial survey. The blood volume, positive and contamination rates of Safety-Lok-drawn (SD) blood cultures were compared to those of overall blood cultures. Results: Eighteen interns and 30 nurses were enrolled. As a result of the initial survey, interns had higher rates of needlestick incidence (27.8%), carriage of the blood-filled syringe with needle (88.9%) and lower rates of vacutainer use (38.9%) than nurses (13.3%, 53.3%, and 60.0%). Interns preferred to use safety devices (88.9%) rather than nurses (40.0%). The number of overall blood cultures and SD blood cultures was 9,053 and 555, respectively. While the overall blood volume of aerobic bottles was 2.6±2.1 mL, those of SD blood cultures were 5.0±3.0 mL in aerobic bottles and 6.0±3.0 mL in anaerobic bottles. Positive and contamination rates were 6.5% and 0.72% with SD blood cultures and 6.2% and 0.3% with overall blood cultures. Conclusions: The introduction of the safety device would encourage healthcare workers to collect adequate blood volume as well as lead to safer practices in the ER.

Keywords: blood culture, needlestick, safety device, volume

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Authors: Li Xu, Yang Hong, T. Zhao Wen

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Experimental results of many RC beam-column subassemblage indicate that slippage of longitudinal beam rebar within the joint and the shear deformation of joint core have significant influence on seismic behavior of the subassemblage. However, rigid joint assumption has been generally used in the seismic response analysis of RC frames, in which two kinds of inelastic deformation of joint have been ignored. Based on OpenSees platform, ‘Super Joint Element Model’ with more detailed inelastic mechanism is used to simulate the inelastic response of joints. Two finite element models of typical RC plane frame, namely considering or ignoring the inelastic deformation of joint respectively, were established and analyzed under seven strong earthquake waves. The simulated global and local inelastic deformations of the RC plane frame is shown and discussed. The analyses also confirm the security of the earthquake-resistant frame designed according to Chinese codes.

Keywords: frame structure, beam-column joint, longitudinal bar slippage, shear deformation, nonlinear analysis

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Authors: Mohammad Reza Zamani Kouhpanji

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Characterizing the fatigue and fracture properties of nanostructures is one of the most challenging tasks in nanoscience and nanotechnology due to lack of a MEMS/NEMS device for generating uniform cyclic loadings at high frequencies. Here, the dynamic response of a recently proposed MEMS/NEMS device under different inputs signals is completely investigated. This MEMS/NEMS device is designed and modeled based on the electromagnetic force induced between paired parallel wires carrying electrical currents, known as Ampere’s Force Law (AFL). Since this MEMS/NEMS device only uses two paired wires for actuation part and sensing part, it represents highly sensitive and linear response for nanostructures with any stiffness and shapes (single or arrays of nanowires, nanotubes, nanosheets or nanowalls). In addition to studying the maximum gains at different resonance frequencies of the MEMS/NEMS device, its dynamical responses are investigated for different inputs and nanostructure properties to demonstrate the capability, usability, and reliability of the device for wide range of nanostructures. This MEMS/NEMS device can be readily integrated into SEM/TEM instruments to provide real time study of the fatigue and fracture properties of nanostructures as well as their softening or hardening behaviors, and initiation and/or propagation of nanocracks in them.

Keywords: MEMS/NEMS devices, paired wire actuators and sensors, dynamical response, fatigue and fracture characterization, Ampere’s force law

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Authors: Maziyar Nouraee

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Electronic markets in recent decades contribute remarkably in business transactions. Many organizations consider traditional ways of trade non-economical and therefore they do trade only through electronic markets. There are different categorizations of electronic markets functions. In one classification, functions of electronic markets are categorized into classes as information, transactions, and value added. In the present paper, effects of the three classes on the two major elements of the supply chain management are measured. The two elements are decrease in the product unit cost and reduction in response time to the customer. The results of the current research show that among nine minor elements related to the three classes of electronic markets functions, six factors and three factors influence on reduction of the product unit cost and reduction of response time to the customer, respectively.

Keywords: electronic commerce, electronic market, B2B trade, supply chain management

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Authors: Olivier de Backer, Alexis Khelfi, Olivier Svensek, Axelle Nolmans, Dominique Desnoeck

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The SMC5-SMC6 complex helps replication and repair of DNA double-strand breaks. Nse1, Nse3 and Nse4 are non-SMC components of the complex in which Nse3 stimulates the E3 ubiquitin ligase activity of Nse1 and is required for recruiting the complex on DNA. In most eukaryotes, Nse3 is a single protein, but in eutherians (placental mammals), it belongs to a large family of proteins called MAGE (Melanoma antigen) that share a conserved domain of about 200 aa known as MHD (Mage homology domain). MAGE assembles specific RING and HECT ubiquitin ligases and determines new substrates for ubiquitination. The MHD is required for the interaction with the cognate E3 ligase. Some MAGEs (referred to as Type I) are exclusively expressed in germ cells of the testis but are often expressed ectopically in cancer cells as the result of epigenetic modifications. The 12 MAGE-A genes belong to this category. Serval MAGE-A proteins could promote tumorigenesis by targeting tumor suppressor proteins (including p53) for ubiquitination and degradation. We showed that depletion of MAGE-A proteins in melanoma cells results in impaired DNA damage response and increased double-strand breaks after exposure to camptothecin. Moreover, it was shown that other actors of the DNA Damage Response were impacted when cells were depleted of MAGEA proteins.

Keywords: DNA damage response, melanoma, camptothecin, new role, MAGEA

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Authors: Falak Nawaz

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The Climate Change Vulnerability and Capacity Assessment carried out in the coastal regions of Thatta and Malir districts underscore the potential risks and challenges associated with climate change affecting water resources. This study was conducted by the author using participatory rural appraisal tools, with a greater focus on conducting focus group discussions, direct observations, key informant interviews, and other PRA tools. The assessment delves into the specific impacts of climate change along the coastal belt, concentrating on aspects such as rising sea levels, depletion of freshwater, alterations in precipitation patterns, fluctuations in water table levels, and the intrusion of saltwater into rivers. These factors have significant consequences for the availability and quality of water resources in coastal areas, manifesting in frequent migration and alterations in agriculture-based livelihood practices. Furthermore, the assessment assesses the adaptive capacity of communities and organizations in these coastal regions to effectively confront and alleviate the effects of climate change on water resources. It considers various measures, including infrastructure enhancements, water management practices, adjustments in agricultural approaches, and disaster preparedness, aiming to bolster adaptive capacity. The study's findings emphasize the necessity for prompt actions to address identified vulnerabilities and fortify the adaptive capacities of Sindh's coastal areas. This calls for comprehensive strategies and policies promoting sustainable water resource management, integrating climate change considerations, and providing essential resources and support to vulnerable communities.

Keywords: climate, climate change adaptation, disaster reselience, vulnerability, capacity, assessment

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Authors: Angelis P. Barlampas

Abstract:

PURPOSE: The purpose of this paper is to demonstrate the important role of taking an appropriate and detailed history, in order to reach the best possible diagnostic conclusion. MATERIAL: A patient presented to the emergency department due to the sudden onset of continuous abdominal pain, during the last hour and with the clinical symptoms of an acute abdomen. During the clinical examination, signs of peritoneal irritation and diffuse abdominal tenderness were found. The rest of the clinical and laboratory tests did not reveal anything important. From the reported medical history, nothing of note was found, except for the report of a large liver cyst, for which he was advised not to take any further action, except from regular ultrasound examination . METHOD: A computed tomography examination was performed after per os administration of gastrografin, which revealed a hyperdense ascitic effusion, similar in density to that of gastrografin within the intestinal tract. The presence of a large cyst of the left hepatic lobe was confirmed, contacting and pushing against the stomach. In the area of the contact between the liver cyst and the pylorus, there were extraluminal air bubbles and local opacity of the peritoneal fat, with a small hyperdense effusion. Result : The above, as well as the absence of a history of stomach ulcer or recent trauma, or other pathology, argue in favor of acute pyloric perforation, due to mural necrosis, in response to chronic external pressure from the pre-existing large liver cyst.

Keywords: perforation, stomach, large liver cyst, CT abdomen, acute abdominal pain, intraperitoneal leakage, constrast leakage

Procedia PDF Downloads 96

Authors: Amr Mansour, Boaz Granot, Amani Tatar, Assil Mahamid, Mohammad Haj Yahia, Fairoz Jayyusi, Eyal Behrbalk

Abstract:

INTRODUCTION: Distal radius fractures are common orthopedic injuries often treated in the fast-paced, high-stress environment of emergency departments (EDs). In such settings, patient satisfaction can be significantly influenced by the clarity of communication and the accessibility of information This study explores the impact of providing an informational pamphlet that outlines ED processes, treatment expectations, and follow-up instructions on patient satisfaction across key domains, including trust, communication, organization, responsiveness, and overall experience. We hypothesize that a structured informational pamphlet will enhance patient satisfaction by fostering better understanding and aligning patient expectations with the realities of the ED visit. METHODS: A total of 100 adult patients treated for distal radius fractures between January and August 2024 participated in this survey-based study. Patients were randomized into two equal groups: one group received an informational pamphlet detailing their condition and treatment, while the other did not. Satisfaction levels were assessed using a structured questionnaire addressing five domains. Fisher's exact test was used to compare satisfaction measures between the two groups, and multivariate logistic regression analysis was conducted to evaluate the association between receiving an information sheet and high satisfaction. The study was approved by the Institutional Review Board. RESULTS SECTION: Patients who received an informational pamphlet reported significantly higher satisfaction across all five domains (p < .001). In Trust and Understanding, 82% of info-sheet recipients felt “in good hands,” compared to 10% of non-recipients. For Communication, 86% rated doctor explanations as “very clear,” versus 16% among non-recipients. Logistic regression showed that receiving an informational pamphlet was a significant predictor of high satisfaction with Discharge Explanation—clarity on condition, treatment, and follow-up (OR = 17.65, 95% CI: 4.74 - 65.77, p < .001) and Reasonable Solution—feeling their primary concern was resolved (OR = 37.82, 95% CI: 8.75 - 163.42, p < .001). Other predictors, including fracture reduction, gender, and age, were not significant. DISCUSSION: This study highlights the substantial role that simple, cost-effective interventions like informational pamphlets can play in enhancing patient satisfaction in emergency care. By improving communication, fostering trust, and promoting a patient-centered approach, informational pamphlets offer a valuable tool for healthcare providers seeking to enhance the quality of care and patient experience in high-pressure emergency environments. However, the study's limitations, including its single-center design and reliance on self-reported satisfaction scores, may affect the generalizability of the results. Future research should consider a multi-center approach and explore long-term outcomes to further validate the efficacy of informational pamphlets in diverse ED settings. Ultimately, sustained improvement in patient satisfaction is a complex and dynamic issue necessitating a multifactorial approach, and other methods should also be explored to complement this strategy. SIGNIFICANCE/CLINICAL RELEVANCE: This study demonstrates that providing an informational pamphlet in the ED setting can significantly improve patient satisfaction across multiple domains, emphasizing its potential as a simple, cost-effective tool to enhance communication, trust, and overall patient experience during emergency care for distal radius fractures. Integrating such interventions into standard ED protocols may foster a more patient-centered approach, improving both patient outcomes and healthcare efficiency.

Keywords: distal radius fracture, quality care, patient satisfaction, emergency medicine, patient-centered care, communication

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Authors: Mars Burke, Alvin Gatto

Abstract:

Rotary-wing aircraft serve as indispensable components in the advancement of aviation, valued for their ability to operate in diverse and challenging environments without the need for conventional runways. This versatility makes them ideal for applications like environmental conservation, precision agriculture, emergency medical support, and rapid-response operations in rugged terrains. However, although highly maneuverable, rotary-wing platforms generally have lower aerodynamic efficiency than fixed-wing aircraft. This study takes the view of improving aerodynamic performance by examining a 1/7th scale rotor blade model with a NACA0012 airfoil using CROTOR software. The analysis focuses on optimal spanwise locations for separating morphing and fixed blade sections at 85%, 90%, and 95% of the blade radius (r/R) with up to +20 degrees of twist incorporated to the design.. Key performance metrics assessed include lift coefficient (CL), drag coefficient (CD), lift-to-drag ratio (CL / CD), Mach number, power, thrust coefficient, and Figure of Merit (FOM). Results indicate that the 0.90 r/R position is optimal for dividing the morphing and fixed sections, achieving a significant improvement of over 7% in both lift-to-drag ratio and FOM. These findings underscoring the substantial impact on overall performance of the rotor system and rotational aerodynamics that geometric modifications through the inclusion of a morphing capability can ultimately realise.

Keywords: rotary morphing, rotational aerodynamics, rotorcraft morphing, rotor blade, twist morphing

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Authors: Dalia El Hadi, Alaa Bou Ghannam, Hala Mostafa, Hana Mansour, Ibrahim Hashim, Soubhi Tahhan, Tharwat El Zahran

Abstract:

Introduction: Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. Some would require neuroimaging. Most commonly used are the CT and MRI of the Brain. They can be over-used when not indicated. Their yield remains dependent on multiple factors relating to the clinical scenario. Methods: A retrospective cross-sectional study was conducted by reviewing the electronic medical records of patients presenting to the Emergency Department (ED) with isolated neuro-ophthalmologic complaints. For each patient, data were collected on the clinical presentation, whether neuroimaging was performed (and which type), and the result of neuroimaging. Analysis of the performed neuroimaging was made, and its yield was determined. Results: A total of 211 patients were reviewed. The complaints or symptoms at presentation were: blurry vision, change in the visual field, transient vision loss, floaters, double vision, eye pain, eyelid droop, headache, dizziness and others such as nausea or vomiting. In the ED, a total of 126 neuroimaging procedures were performed. Ninety-four imagings (74.6%) were normal, while 32 (25.4%) had relevant abnormal findings. Only 2 symptoms were significant for abnormal imaging: blurry vision (p-value= 0.038) and visual field change (p-value= 0.014). While 4 physical exam findings had significant abnormal imaging: visual field defect (p-value= 0.016), abnormal pupil reactivity (p-value= 0.028), afferent pupillary defect (p-value= 0.018), and abnormal optic disc exam (p-value= 0.009). Conclusion: Risk indicators for abnormal neuroimaging in the setting of neuro-ophthalmological emergencies are blurred vision or changes in the visual field on history taking. While visual field irregularities, abnormal pupil reactivity with or without afferent pupillary defect, or abnormal optic discs, are risk factors related to physical testing. These findings, when present, should sway the ED physician towards neuroimaging but still individualizing each case is of utmost importance to prevent time-consuming, resource-draining, and sometimes unnecessary workup. In the end, it suggests a well-structured patient-centered algorithm to be followed by ED physicians.

Keywords: emergency department, neuro-ophthalmology, neuroimaging, risk indicators

Procedia PDF Downloads 179