Search results for: emergency department admissions

Authors: Jiri Palecek, Radmila Hajkova, Alena Oulehlova, Hana Malachova

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The increase of emergency incidents and crisis situations requires proactive crisis management of authorities and for its solution. Application business continuity management systems help the crisis management authorities quickly and responsibly react to events and to plan more effectively and efficiently powers and resources. The main goal of this article is describing Military Continuity Management System (MCMS) based on the principles of Business Continuity Management System (BCMS) for dealing with floods in the territory of the selected municipalities. There are explained steps of loading, running and evaluating activities in the software application MCMS. Software MCMS provides complete control over the tasks, contribute a comprehensive and responsible approach solutions to solution floods in the municipality.

Keywords: business continuity management, floods plan, flood activity, level of flood activity

Procedia PDF Downloads 282

Authors: Sadaf Abbas, HimGauri Sabnis

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Introduction: Peripartum cardiomyopathy is a rare but potentially life-threatening condition that presents as heart failure during the last month of pregnancy or within five months postpartum. The incidence of postpartum cardiomyopathy ranges from 1 in 1300 to 1 in 15,000 pregnancies. Risk factors include multiparty, advanced maternal age, multiple pregnancies, pre-eclampsia, and chronic hypertension. Study: A 30-year-old Para3+0 presented to the Emergency Department of St’Marry Hospital, Isle of Wight, on the seventh day postpartum, with acute shortness of breath (SOB), chest pain, cough, and a temperature of 38 degrees. The risk factors were smoking and class II obesity (BMI of 40.62). The patient had mild pre-eclampsia in the last pregnancy and was on labetalol and aspirin during an antenatal period, which was stopped postnatally. There was also a history of pre-eclampsia and haemolysis, elevated liver enzymes, low platelets (HELLP syndrome) in previous pregnancies, which led to preterm delivery at 35 weeks in the second pregnancy, and the first baby was stillborn at 24 weeks. On assessment, there was a national early warning score (NEWS score) of 3, persistent tachycardia, and mild crepitation in the lungs. Initial investigations revealed an enlarged heart on chest X-ray, and a CT pulmonary angiogram indicated bilateral basal pulmonary congestion without pulmonary embolism, suggesting fluid overload. Laboratory results showed elevated CRP and normal troponin levels initially, which later increased, indicating myocardial involvement. Echocardiography revealed a severely dilated left ventricle with an ejection fraction (EF) of 31%, consistent with severely impaired systolic function. The cardiology team reviewed the patient and admitted to the Coronary Care Unit. As sign and symptoms were suggestive of fluid overload and congestive cardiac failure, management was done with diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), proton pump inhibitors, and supportive care. During admission, there was complications such as acute kidney injury, but then recovered well. Chest pain had resolved following the treatment. After being admitted for eight days, there was an improvement in the symptoms, and the patient was discharged home with a further plan of cardiac MRI and genetic testing due to a family history of sudden cardiac death. Regular appointment has been made with the Cardiology team to follow-up on the symptoms. Since discharge, the patient made a good recovery. A cardiac MRI was done, which showed severely impaired left ventricular function, ejection fraction (EF) of 38% with mild left ventricular dilatation, and no evidence of previous infarction. Overall appearance is of non-ischemic dilated cardiomyopathy. The main challenge at the time of admission was the non-availability of a cardiac radiology team, so the definitive diagnosis was delayed. The long-term implications include risk of recurrence, chronic heart failure, and, consequently, an effect on quality of life. Therefore, regular follow-up is critical in patient’s management. Conclusions: Peripartum cardiomyopathy is one of the cardiovascular diseases whose causes are still unknown yet and, in some cases, are uncontrolled. By raising awareness about the symptoms and management of this complication it will reduce morbidity and mortality rates and also the length of stay in the hospital.

Keywords: cardiomyopathy, cardiomegaly, pregnancy, puerperium

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Authors: Elizabeth Watson, Sara Vogt

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The transition from high school to college can be an exciting and confusing time for many students, especially college students with disabilities. In 1983, the University of Wisconsin-Whitewater created a Summer Transition Program (STP) for such students as part of a US Department of Education Demonstration Grant. This program offers incoming students the opportunity to take 2 college courses and live on campus for 4 weeks to help introduce and familiarize them with typical college expectations and support services. Over the past 30 years, 48% of the students have graduated, exceeding the national college graduation rate for students with disabilities. This mixed methods longitudinal study will discuss how this program has increased retention and graduation rates, and success in the co-curricular and living environments for students with disabilities.

Keywords: disability, transition, post-secondary education, retention

Procedia PDF Downloads 292

Authors: Elham Sharifineyestani, Mohammad Farshchin

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Tropical cyclones are one of the most expensive and deadliest natural disasters. They cause heavy rainfall and serious flash flooding that result in billions of dollars of damage and considerable mortality each year in the United States. Prediction of the frequency of tropical cyclone-induced rainfall events can be helpful in emergency planning and flood risk management. In this study, we have developed a machine-learning model to predict the exceedance frequencies of tropical cyclone-induced rainfall events in the United States. Model results show a satisfactory agreement with available observations. To examine the effectiveness of our approach, we also have compared the result of our predictions with the exceedance frequencies predicted using a physics-based rainfall model by Feldmann.

Keywords: flash flooding, tropical cyclones, frequencies, machine learning, risk management

Procedia PDF Downloads 247

Authors: Takashi Kaminagayoshi, Shigeyuki Haruyama

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To improve the manufacturing efficiency of biologics, such as antibody drugs, a quality engineering framework was designed. Within this framework, critical steps and parameters in the manufacturing process were studied. Identification of these critical steps and critical parameters allows a deeper understanding of manufacturing capabilities, and suggests to process development department process control standards based on actual manufacturing capabilities as part of a PDCA (plan-do-check-act) cycle. This cycle can be applied to each manufacturing process so that it can be standardized, reducing the time needed to establish each new process.

Keywords: antibody drugs, biologics, manufacturing efficiency, PDCA cycle, quality engineering

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Authors: Aya Al Masri, Kamel Guerchouche, Youssef Laynaoui, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: Mobile C-arms move throughout operating rooms of the operating theater. Being designed to move between rooms, they are not equipped with relays to retrieve the exposition information and export it outside the room. Therefore, no light signaling is available outside the room to warn the X-ray emission for staff. Inadvertent exposition of staff outside the operating theater is a real problem for radiation protection. The French standard NFC 15-160 require that: (1) access to any room containing an X-ray emitting device must be controlled by a light signage so that it cannot be inadvertently crossed, and (2) setting up an emergency button to stop the X-ray emission. This study presents a system that we developed to meet these requirements and the results of its clinical test. Materials and methods: The system is composed of two communicating boxes: o The "DetectBox" is to be installed inside the operating theater. It identifies the various operation states of the C-arm by analyzing its power supply signal. The DetectBox communicates (in wireless mode) with the second box (AlertBox). o The "AlertBox" can operate in socket or battery mode and is to be installed outside the operating theater. It detects and reports the state of the C-arm by emitting a real time light signal. This latter can have three different colors: red when the C-arm is emitting X-rays, orange when it is powered on but does not emit X-rays, and green when it is powered off. The two boxes communicate on a radiofrequency link exclusively carried out in the ‘Industrial, Scientific and Medical (ISM)’ frequency bands and allows the coexistence of several on-site warning systems without communication conflicts (interference). Taking into account the complexity of performing electrical works in the operating theater (for reasons of hygiene and continuity of medical care), this system (having a size <10 cm²) works in complete safety without any intrusion in the mobile C-arm and does not require specific electrical installation work. The system is equipped with emergency button that stops X-ray emission. The system has been clinically tested. Results: The clinical test of the system shows that: it detects X-rays having both high and low energy (50 – 150 kVp), high and low photon flow (0.5 – 200 mA: even when emitted for a very short time (<1 ms)), Probability of false detection < 10-5, it operates under all acquisition modes (continuous, pulsed, fluoroscopy mode, image mode, subtraction and movie mode), it is compatible with all C-arm models and brands. We have also tested the communication between the two boxes (DetectBox and AlertBox) in several conditions: (1) Unleaded room, (2) leaded room, and (3) rooms with particular configuration (sas, great distances, concrete walls, 3 mm of lead). The result of these last tests was positive. Conclusion: This system is a reliable tool to alert the staff present outside the operating room for X-ray emission and insure their radiation protection.

Keywords: Clinical test, Inadvertent staff exposition, Light signage, Operating theater

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Authors: Aidan Ryan, Nahima Miah, Sahaj Kaur, Imogen Sutherland, Mohamed Saleh

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Pulmonary symptoms are a common presentation to the emergency department. Due to a lack of understanding of the underlying pathophysiology, chronic liver disease is not often considered a cause of dyspnea. We present three patients who were admitted with significant respiratory distress secondary to hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. The first is a 27-year-old male with a 6-month history of progressive dyspnea. The patient developed a severe type 1 respiratory failure with a PaO₂ of 6.3kPa and was escalated to critical care, where he was managed with non-invasive ventilation to maintain oxygen saturation. He had an agitated saline contrast echocardiogram, which showed the presence of a possible shunt. A CT angiogram revealed significant liver cirrhosis, portal hypertension, and large para esophageal varices. Ultrasound of the abdomen showed coarse liver echo patter and enlarged spleen. Along with these imaging findings, his biochemistry demonstrated impaired synthetic liver function with an elevated international normalized ratio (INR) of 1.4 and hypoalbuminaemia of 28g/L. The patient was then transferred to a tertiary center for further management. Further investigations confirmed a shunt of 56%, and liver biopsy confirmed cirrhosis suggestive of alpha-1-antitripsyin deficiency. The findings were consistent with a diagnosis of hepatopulmonary syndrome, and the patient is awaiting a liver transplant. The second patient is a 56-year-old male with a 12-month history of worsening dyspnoea, jaundice, confusion. His medical history included liver cirrhosis, portal hypertension, and grade 1 oesophageal varices secondary to significant alcohol excess. On admission, he developed a type 1 respiratory failure with PaO₂ of 6.8kPa requiring 10L of oxygen. CT pulmonary angiogram was negative for pulmonary embolism but showed evidence of chronic pulmonary hypertension, liver cirrhosis, and portal hypertension. An echocardiogram revealed a grossly dilated right heart with reduced function, pulmonary and tricuspid regurgitation, and pulmonary artery pressures estimated at 78mmHg. His biochemical markers showed impaired synthetic liver function with an INR of 3.2, albumin of 29g/L, along with raised bilirubin of 148mg/dL. During his long admission, he was managed with diuretics with little improvement. After three weeks, he was diagnosed with portopulmonary hypertension and was commenced on terlipressin. This resulted in successfully weaning off oxygen, and he was discharged home. The third patient is a 61-year-old male who presented to the local ambulatory care unit for therapeutic paracentesis on a background of decompensated liver cirrhosis. On presenting, he complained of a 2-day history of worsening dyspnoea and a productive cough. Chest x-ray showed a large pleural effusion, increasing in size over the previous eight months, and his abdomen was visibly distended with ascitic fluid. Unfortunately, the patient deteriorated, developing a larger effusion along with an increase in oxygen demand, and passed away. Without underlying cardiorespiratory disease, in the presence of a persistent pleural effusion with underlying decompensated cirrhosis, he was diagnosed with hepatic hydrothorax. While each presented with dyspnoea, the cause and underlying pathophysiology differ significantly from case to case. By describing these complications, we hope to improve awareness and aid prompt and accurate diagnosis, vital for improving outcomes.

Keywords: dyspnea, hepatic hydrothorax, hepatopulmonary syndrome, portopulmonary syndrome

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Authors: Narges Solaymani

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medical training of patients. Nursing is a very important profession in the societies of the world. Although in the past, all caregivers of the sick and disabled were called nurses, nowadays, a nurse is a person who has a university education in this field. There are nurses in bachelor's, master's, and doctoral degrees in nursing. New courses have been launched in the master's degree based on duty-oriented nurses. A nurse cannot have an independent treatment center but is a member of the treatment team in established treatment centers such as hospitals, clinics, or offices. Nurses can establish counseling centers and provide nursing services at home. According to the standards, the number of nurses should be three times the number of doctors or twice the number of hospital beds, or there should be three nurses for every thousand people. Also, international standards show that in the internal and surgical department, every 4 to 6 patients should have a nurse.

Keywords: Nurse, Intensive Care, CPR, Bandage

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Authors: Obaidul Fattah Tanvir, Zinat Ara Afroze

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Community living adjacent to forests and Protected Areas, especially in South Asian countries, have a common practice in extracting resources for their living and livelihoods. This extraction of resources, because the way it is done, destroys the biophysical features of the area. Deforestation, wildlife poaching, illegal logging, unauthorized hill cutting etc. are some of the serious issues of concern for the sustainability of the natural resources that has a direct impact on environment and climate as a whole. To ensure community involvement in conservation initiatives of the state, community based forest management, commonly known as Comanagement, has been in practice in 6 South Asian countries. These are -India, Nepal, Sri Lanka, Pakistan, Bhutan and Bangladesh. Involving community in forestry management was initiated first in Bangladesh in 1979 and reached as an effective co-management approach through a several paradigm shifts. This idea of Comanagement has been institutionalized through a Government Order (GO) by the Ministry of Environment and Forests, Government of Bangladesh on November 23, 2009. This GO clearly defines the structure and functions of Co-management and its different bodies. Bangladesh Forest Department has been working in association with community to conserve and manage the Forests and Protected areas of Bangladesh following this legal document. Demographically young people constitute the largest segment of population in Bangladesh. This group, if properly sensitized, can produce valuable impacts on the conservation initiatives, both by community and government. This study traced the major factors that motivate community youths to work effectively with different tiers of comanagement organizations in conservation of forests and Protected Areas of Bangladesh. For the purpose of this study, 3 FGDs were conducted with 30 youths from the community living around the Protected Areas of Cox’s bazar, South East corner of Bangladesh, who are actively involved in Co-management organizations. KII were conducted with 5 key officials of Forest Department stationed at Cox’s Bazar. 2 FGDs were conducted with the representatives of 7 Co-management organizations working in Cox’s Bazar region and approaches of different community outreach activities conducted for forest conservation by 3 private organizations and Projects have been reviewed. Also secondary literatures were reviewed for the history and evolution of Co-management in Bangladesh and six South Asian countries. This study found that innovative community outreach activities that are financed by public and private sectors involving youths and community as a whole have played a pivotal role in conservation of forests and Protected Areas of the region. This approach can be replicated in other regions of Bangladesh as well as other countries of South Asia where Co-Management exists in practice.

Keywords: community, co-management, conservation, forests, protected areas, youth

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Authors: Andrea Giacomelli, Luciano Massetti, Elena Maggi, Antonio Raschi

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The presentation will report the activities managed during the Summer of 2017 by a team composed by staff from a University Department, a National Research Council Institute, and an outreach NGO, collecting measurements of night sky brightness and other information on artificial lighting, in order to characterize light pollution issues on portions of the Tuscan coast, in Central Italy. These activities combine measurements collected by the principal scientists, citizen science observations led by students, and outreach events targeting a broad audience. This campaign aggregates the efforts of three actors: the BuioMetria Partecipativa project, which started collecting light pollution data on a national scale in 2008 with an environmental engineering and free/open source GIS core team; the Institute of Biometeorology from the National Research Council, with ongoing studies on light and urban vegetation and a consolidated track record in environmental education and citizen science; the Department of Biology from the University of Pisa, which started experiments to assess the impact of light pollution in coastal environments in 2015. While the core of the activities concerns in situ data, the campaign will account also for remote sensing data, thus considering heterogeneous data sources. The aim of the campaign is twofold: (1) To test actions of citizen and student engagement in monitoring sky brightness (2) To collect night sky brightness data and test a protocol for applications to studies on the ecological impact of light pollution, with a special focus on marine coastal ecosystems. The collaboration of an interdisciplinary team in the study of artificial lighting issues is not a common case in Italy, and the possibility of undertaking the campaign in Tuscany has the added value of operating in one of the territories where it is possible to observe both sites with extremely high lighting levels, and areas with extremely low light pollution, especially in the Southern part of the region. Combining environmental monitoring and communication actions in the context of the campaign, this effort will contribute to the promotion of night skies with a good quality as an important asset for the sustainability of coastal ecosystems, as well as to increase citizen awareness through star gazing, night photography and actively participating in field campaign measurements.

Keywords: citizen science, light pollution, marine coastal biodiversity, environmental education

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Authors: Rade M. Ciric, Sasa Mandic

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Students of Higher Education Technical School of Professional Studies, in Novi Sad follow the subject Maintenance of electric power equipment at the Electrotechnical Department. This paper presents educational plan and program of the subject Maintenance of electric power equipment. The course deals with the problems of preventive and investing maintenance of transformer stations (TS), performing and maintenance of grounding of TS and pillars, as well as tracing and detection the location of the cables failure. There is a special elaborated subject concerning the safe work conditions for the electrician during network maintenance, as well as the basics of making and keeping technical documentation of the equipment.

Keywords: educational plan and program, electric power equipment, maintenance, technical documentation, safe work

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Authors: M. Linek, P. Nita

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In the previous airfield construction industry, pavements made of reinforced concrete have been used very rarely; however, the necessity to use this type of pavements in an emergency situations justifies the need reference to this issue. The paper concerns the problem of airfield pavement dimensioning made of reinforced concrete and the evaluation of selected dimensioning methods of reinforced concrete slabs intended for airfield pavements. Analysis of slabs dimensioning, according to classical method of limit states has been performed and it has been compared to results obtained in case of methods complying with Eurocode 2 guidelines. Basis of an analysis was a concrete slab of class C35/45 with reinforcement, located in tension zone. Steel bars of 16.0 mm have been used as slab reinforcement. According to comparative analysis of obtained results, conclusions were reached regarding application legitimacy of the discussed methods and their design advantages.

Keywords: rainforced concrete, cement concrete, airport pavements, dimensioning

Procedia PDF Downloads 255

Authors: K. Thamizhmaran, Akshaya Devi Arivazhagan, M. Anitha

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On the case of most important systematic issue that must need to be solved in means of implementing a data transmission algorithm on the source of Mobile adhoc networks (MANETs). That is, how to save mobile nodes energy on meeting the requirements of applications or users as the mobile nodes are with battery limited. On while satisfying the energy saving requirement, hence it is also necessary of need to achieve the quality of service. In case of emergency work, it is necessary to deliver the data on mean time. Achieving quality of service in MANETs is also important on while. In order to achieve this requirement, Hence, we further implement the Energy-Aware routing protocol for system of Mobile adhoc networks were it being proposed, that on which saves the energy as on every node by means of efficiently selecting the mode of energy efficient path in the routing process by means of Enhanced AODV routing protocol.

Keywords: Ad-Hoc networks, MANET, routing, AODV, EAODV

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Authors: Jezza Mae T. Francisco, Marianet R. Delos Santos, Crisjame C. Toribio

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This study aims to determine the reading preference for English enrichment and reading comprehension among primary students and the difference in the reading preference and comprehension for English enrichment among primary students. This study employed a Descriptive-Quantitative Correlational Research Design. This study yielded the following findings: (1) It reveals that primary students got fair on their reading comprehension, and (2) It shows that there is no significant relationship between the reading preference for English enrichment and reading comprehension of the students. It is safe to conclude that the students’ reading preference is growing evidently in various milieus. This can inform the English department curriculum planners to consider their students’ text preferences that interest them to maximize engagement within a dynamic interactive learning process.

Keywords: reading preferences, reading comprehension, primary student, English enrichment

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Authors: Luis Reynaldo Mota-Santiago, Angélica Lozano

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Determining appropriate measures to face earthquakesarea challenge for practitioners. In the literature, some analyses consider disaster scenarios, disregarding some important field characteristics. Sometimes, software that allows estimating the number of victims and infrastructure damages is used. Other times historical information of previous events is used, or the scenarios’informationis assumed to be available even if it isnot usual in practice. Humanitarian operations start immediately after an earthquake strikes, and the first hours in relief efforts are important; local efforts are critical to assess the situation and deliver relief supplies to the victims. A preparation action is prepositioning stockpiles, most of them at central warehouses placed away from damage-prone areas, which requires large size facilities and budget. Usually, decisions in the first 12 hours (standard relief time (SRT)) after the disaster are the location of temporary depots and the design of distribution paths. The motivation for this research was the delay in the reaction time of the early relief efforts generating the late arrival of aid to some areas after the Mexico City 7.1 magnitude earthquake in 2017. Hence, a preparation approach for planning the immediate response to earthquake disasters is proposed, intended for local governments, considering their capabilities for planning and for responding during the SRT, in order to reduce the start-up time of immediate response operations in urban areas. The first steps are the generation and analysis of disaster scenarios, which allow estimatethe relief demand before and in the early hours after an earthquake. The scenarios can be based on historical data and/or the seismic hazard analysis of an Atlas of Natural Hazards and Risk as a way to address the limited or null available information.The following steps include the decision processes for: a) locating local depots (places to prepositioning stockpiles)and aid-giving facilities at closer places as possible to risk areas; and b) designing the vehicle paths for aid distribution (from local depots to the aid-giving facilities), which can be used at the beginning of the response actions. This approach allows speeding up the delivery of aid in the early moments of the emergency, which could reduce the suffering of the victims allowing additional time to integrate a broader and more streamlined response (according to new information)from national and international organizations into these efforts. The proposed approachis applied to two case studies in Mexico City. These areas were affectedby the 2017’s earthquake, having limited aid response. The approach generates disaster scenarios in an easy way and plans a faster early response with a short quantity of stockpiles which can be managed in the early hours of the emergency by local governments. Considering long-term storage, the estimated quantities of stockpiles require a limited budget to maintain and a small storage space. These stockpiles are useful also to address a different kind of emergencies in the area.

Keywords: disaster logistics, early response, generation of disaster scenarios, preparation phase

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Authors: Grace Omowunmi Soyebi

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A computerized medical record system is a collection of medical information about a person that is stored on a computer. One principal problem of most hospitals in rural areas is using the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved, this may cause an unexpected to happen to the patient. This Data Mining application is to be designed using a Structured System Analysis and design method which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the Design and Implementation of a Computerized medical record system. This Computerized system will replace the file management system and help to quickly retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: programming, computing, data, innovation

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Authors: Susanne Shunnaq

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During the past decade, an increasing number of higher education institutions in Oman have sought accreditation in an attempt to assure the quality of their programs. Sultan Qaboos University (SQU), the only public university in the country, has also been seeking accreditation. Hence, the university administration has been encouraging departments to evaluate their programs for development purposes. The Department of English, where 100% of the students are learners of English as a foreign language, already produced a self-study report that outlined the strength and weaknesses of the current program. The department came to the realization that due to a changing local and regional job market, transferrable communication skills are high in demand among stakeholders in the public and private sectors. Failure to equip English literature students, for example, with excellent verbal communicative skills in English may have detrimental effects for undergraduate job-seekers who have to compete for jobs in employment sectors with a predominantly English-speaking workforce. Ongoing extensive discussions about restructuring the current literature program by means of partially replacing literature courses with skills courses, hoping to produce higher quality graduates who are equipped with effective communication skills for local and regional markets, have sparked the idea for this research. The researcher, who is an American Literature specialist at SQU, has set out to investigate to what extent senior American literature students have been able to apply transferable communication skills in an advanced literature course. The study also attempts to unearth performance inhibitors and causes for communication breakdown. The primary data source for the study were audio-recordings of 6 in-class peer-group discussions in an advanced contemporary American literature course during the academic year 2016/2017. The significance of this research lies in the rarity of studies focusing on verbal communication skills in Omani higher education literature classrooms at a time when English programs are in the process of being re-visited and revamped both for accreditation purposes and for meeting job-market demands. The results showed a considerable variation in Omani students' verbal communicative abilities and English proficiency levels. The study also raises crucial questions and provides important recommendations for administrators and teachers alike who are in the process of restructuring English programs in the region and in non-English speaking countries worldwide.

Keywords: job-market, literature, Oman, tertiary education, oral communication skills

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Authors: Christos E. Lampropoulos, Maria Konsta, Tamta Sirbilatze, Ifigenia Apostolou, Vicky Dradaki, Konstantina Panouria, Irini Dri, Christina Kordali, Vaggelis Lambas, Georgios Mavras

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Objectives: Full Mini Nutritional Assessment (MNA) questionnaire is one of the most useful tools in diagnosis of malnutrition in hospitalized patients, which is related to increased morbidity and mortality. The purpose of our study was to assess the nutritional status of elderly, hospitalized patients and examine the hypothesis that MNA may predict mortality and extension of hospitalization. Methods: One hundred fifty patients (78 men, 72 women, mean age 80±8.2) were included in this cross-sectional study. The following data were taken into account in analysis: anthropometric and laboratory data, physical activity (International Physical Activity Questionnaires, IPAQ), smoking status, dietary habits, cause and duration of current admission, medical history (co-morbidities, previous admissions). Primary endpoints were mortality (from admission until 6 months afterwards) and duration of admission. The latter was compared to national guidelines for closed consolidated medical expenses. Logistic regression and linear regression analysis were performed in order to identify independent predictors for mortality and extended hospitalization respectively. Results: According to MNA, nutrition was normal in 54/150 (36%) of patients, 46/150 (30.7%) of them were at risk of malnutrition and the rest 50/150 (33.3%) were malnourished. After performing multivariate logistic regression analysis we found that the odds of death decreased 20% per each unit increase of full MNA score (OR=0.8, 95% CI 0.74-0.89, p < 0.0001). Patients who admitted due to cancer were 23 times more likely to die, compared to those with infection (OR=23, 95% CI 3.8-141.6, p=0.001). Similarly, patients who admitted due to stroke were 7 times more likely to die (OR=7, 95% CI 1.4-34.5, p=0.02), while these with all other causes of admission were less likely (OR=0.2, 95% CI 0.06-0.8, p=0.03), compared to patients with infection. According to multivariate linear regression analysis, each increase of unit of full MNA, decreased the admission duration on average 0.3 days (b:-0.3, 95% CI -0.45 - -0.15, p < 0.0001). Patients admitted due to cancer had on average 6.8 days higher extension of hospitalization, compared to those admitted for infection (b:6.8, 95% CI 3.2-10.3, p < 0.0001). Conclusion: Mortality and extension of hospitalization is significantly increased in elderly, malnourished patients. Full MNA score is a useful diagnostic tool of malnutrition.

Keywords: duration of admission, malnutrition, mini nutritional assessment score, prognostic factors for mortality

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Authors: Zhengrong Wu, Haibo Yang

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In the context of escalating global climate change and environmental degradation, the complexity and frequency of natural disasters are continually increasing. Confronted with an abundance of information regarding natural disasters, traditional knowledge graph construction methods, which heavily rely on grammatical rules and prior knowledge, demonstrate suboptimal performance in processing complex, multi-source disaster information. This study, drawing upon past natural disaster reports, disaster-related literature in both English and Chinese, and data from various disaster monitoring stations, constructs question-answer templates based on large language models. Utilizing the P-Tune method, the ChatGLM2-6B model is fine-tuned, leading to the development of a disaster knowledge graph based on large language models. This serves as a knowledge database support for disaster emergency response.

Keywords: large language model, knowledge graph, disaster, deep learning

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Authors: Sahbi Farhani

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This study investigates the relationship between external debt and military spending in case of India over the period of 1970–2012. In doing so, we have applied the structural break unit root tests to examine stationarity properties of the variables. The Auto-Regressive Distributed Lag (ARDL) bounds testing approach is used to test whether cointegration exists in presence of structural breaks stemming in the series. Our results indicate the cointegration among external debt, military spending, debt servicing, and economic growth. Moreover, military spending and debt servicing add in external debt. Economic growth helps in lowering external debt. The Vector Error Correction Model (VECM) analysis and Granger causality test reveal that military spending and economic growth cause external debt. The feedback effect also exists between external debt and debt servicing in case of India.

Keywords: external debt, military spending, ARDL approach, India

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Authors: Anthony S. Machi, Joseph Minardi

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We present a case report of left atrial myxoma diagnosed by bedside transesophageal (TEE) ultrasound. Left atrial myxoma is the most common benign cardiac tumor and can obstruct blood flow and cause valvular insufficiency. Common symptoms consist of dyspnea, pulmonary edema and other features of left heart failure in addition to thrombus release in the form of tumor fragments. The availability of bedside ultrasound equipment is essential for the quick diagnosis and treatment of various emergency conditions including cardiac neoplasms. A 48-year-old Caucasian female with a four-year history of an untreated renal mass and anemia presented to the ED with two months of sharp, intermittent, bilateral flank pain radiating into the abdomen. She also reported intermittent vomiting and constipation along with generalized body aches, night sweats, and 100-pound weight loss over last year. She had a CT in 2013 showing a 3 cm left renal mass and a second CT in April 2016 showing a 3.8 cm left renal mass along with a past medical history of diverticulosis, chronic bronchitis, dyspnea on exertion, uncontrolled hypertension, and hyperlipidemia. Her maternal family history is positive for breast cancer, hypertension, and Type II Diabetes. Her paternal family history is positive for stroke. She was a current everyday smoker with an 11 pack/year history. Alcohol and drug use were denied. Physical exam was notable for a Grade II/IV systolic murmur at the right upper sternal border, dyspnea on exertion without angina, and a tender left lower quadrant. Her vitals and labs were notable for a blood pressure of 144/96, heart rate of 96 beats per minute, pulse oximetry of 96%, hemoglobin of 7.6 g/dL, hypokalemia, hypochloremia, and multiple other abnormalities. Physicians ordered a CT to evaluate her flank pain which revealed a 7.2 x 8.9 x 10.5 cm mixed cystic/solid mass in the lower pole of the left kidney and a filling defect in the left atrium. Bedside TEE was ordered to follow up on the filling defect. TEE reported an ejection fraction of 60-65% and visualized a mobile 6 x 3 cm mass in the left atrium attached to the interatrial septum extending into the mitral valve. Cardiothoracic Surgery and Urology were consulted and confirmed a diagnosis of left atrial myxoma and clear cell renal cell carcinoma. The patient returned a week later due to worsening nausea and vomiting and underwent emergent nephrectomy, lymph node dissection, and colostomy due to a necrotic colon. Her condition declined over the next four months due to lung and brain metastases, infections, and other complications until she passed away.

Keywords: bedside ultrasound, echocardiography, emergency medicine, left atrial myxoma

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Authors: Tannia Vindel, Angel Matute, Erik Elvir, Kelvin Santos

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Currently in Honduras, is been incentivized the generation of energy using renewable fonts, such as: hydroelectricity, wind power, biomass and, more recently with the strongest growth, photovoltaic energy. In July 2015 were installed 455.2 MW of photovoltaic energy, increasing by 24% the installed capacity of the national interconnected system existing in 2014, according the National Energy Company (NEC), that made possible reduce the thermoelectric dependency of the system. Given the good results of those large-scale photovoltaic plants, arises the question: is it interesting for the distribution utility and for the consumers the integration of photovoltaic systems in micro-scale in the urban and rural areas? To answer that question has been researched the insertion of photovoltaic energy in the residential sector in Tegucigalpa and Comayagüela (Central District), Honduras to determine the technical and economic viability. Francisco Morazán department, according the National Statistics Institute (NSI), in 2001 had more than 180,000 houses with power service. Tegucigalpa, department and Honduras capital, and Comayagüela, both, have the highest population density in the region, with 1,300,000 habitants in 2014 (NSI). The residential sector in the south-central region of Honduras represents a high percentage being 49% of total consumption, according with NEC in 2014; where 90% of this sector consumes in a range of 0 to 300 kWh / month. All this, in addition to the high level of losses in the transmission and distribution systems, 31.3% in 2014, and the availability of an annual average solar radiation of 5.20 kWh/(m2∙day) according to the NASA, suggests the feasibility of the implementation of photovoltaic systems as a solution to give a level of independency to the households, and besides could be capable of injecting the non-used energy to the grid. The capability of exchange of energy with the grid could make the photovoltaic systems acquisition more affordable to the consumers, because of the compensation energy programs or other kinds of incentives that could be created. Technical viability of the photovoltaic systems insertion has been analyzed, considering the solar radiation monthly average to determine the monthly average of energy that would be generated with the technology accessible locally and the effects of the injection of the energy locally generated on the grid. In addition, the economic viability has been analyzed too, considering the photovoltaic systems high costs, costs of the utility, location and monthly energy consumption requirements of the families. It was found that the inclusion of photovoltaic systems in Tegucigalpa and Comayagüela could decrease in 6 MW the demand for the region if 100% of the households use photovoltaic systems, which acquisition may be more accessible with the help of government incentives and/or the application of energy exchange programs.

Keywords: grid connected, photovoltaic, residential, technical analysis

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Authors: Leonard Tiong, Sonit Singh, Kevin Ho Shon, Sarah Lewis

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Investigation into the use of artificial intelligence in radiology continues to develop at a rapid rate. During the coronavirus pandemic, the combination of an exponential increase in chest x-rays and unpredictable staff shortages resulted in a huge strain on the department's workload. There is a World Health Organisation estimate that two-thirds of the global population does not have access to diagnostic radiology. Therefore, there could be demand for a program that could detect acute changes in imaging compatible with infection to assist with screening. We generated a conventional neural network and tested its efficacy in recognizing changes compatible with coronavirus infection. Following ethics approval, a deidentified set of 77 normal and 77 abnormal chest x-rays in patients with confirmed coronavirus infection were used to generate an algorithm that could train, validate and then test itself. DICOM and PNG image formats were selected due to their lossless file format. The model was trained with 100 images (50 positive, 50 negative), validated against 28 samples (14 positive, 14 negative), and tested against 26 samples (13 positive, 13 negative). The initial training of the model involved training a conventional neural network in what constituted a normal study and changes on the x-rays compatible with coronavirus infection. The weightings were then modified, and the model was executed again. The training samples were in batch sizes of 8 and underwent 25 epochs of training. The results trended towards an 85.71% true positive/true negative detection rate and an area under the curve trending towards 0.95, indicating approximately 95% accuracy in detecting changes on chest X-rays compatible with coronavirus infection. Study limitations include access to only a small dataset and no specificity in the diagnosis. Following a discussion with our programmer, there are areas where modifications in the weighting of the algorithm can be made in order to improve the detection rates. Given the high detection rate of the program, and the potential ease of implementation, this would be effective in assisting staff that is not trained in radiology in detecting otherwise subtle changes that might not be appreciated on imaging. Limitations include the lack of a differential diagnosis and application of the appropriate clinical history, although this may be less of a problem in day-to-day clinical practice. It is nonetheless our belief that implementing this program and widening its scope to detecting multiple pathologies such as lung masses will greatly assist both the radiology department and our colleagues in increasing workflow and detection rate.

Keywords: artificial intelligence, COVID, neural network, machine learning

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Authors: Lotfi Beji, Laredj Benchikh

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Underground tunnel face bolting and pipe umbrella reinforcement are one of the most challenging tasks in construction whether industrial or not, and infrastructures such as roads or pipelines. It is one of the first sectors of economic activity in the world. Through a variety of soil and rock, a cyclic Conventional Tunneling Method (CTM) remains the best one for projects with highly variable ground conditions or shapes. CTM is the only alternative for the renovation of existing tunnels and creating emergency exit. During the drilling process, a wide variety of non-desired vibrations may arise, and a method using a robot arm is proposed. The main kinds of drilling through vibration here is the bit-bouncing phenomenon (resonant axial vibration). Hence, assisting the task by a robot arm may play an important role on drilling performances and security. We propose to control the axial-vibration phenomenon along the drillstring at a practical resonant frequency, and embed a Resonant Sonic Drilling Head (RSDH) as a robot end effector for drilling. Many questionable industry drilling criteria and stability are discussed in this paper.

Keywords: drilling, resonant vibration, robot arm, control

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Authors: Ya-Ling Huang, Ming-Chun Tsai, Fan Hsu, Kai-Ru Hsieh

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This paper mainly discusses the research and practice process of a laboratory curriculum by leading students to perform field investigation into time-honoured shops that have existed for more than 50 years in the downtown area of Tainan, Taiwan, and then search again for design elements and completing the design. The participants are juniors from the Department of Visual Communication Design, Kun Shan University. The duration of research and practice is two months. Operators of these shops are invited to jointly appraise the final achievements. 9 works out of 27 are chosen for final exhibition and commercialization.

Keywords: culture creative industry, visual communication design, curriculum experimental, visual arts

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Authors: Keiko Tamura, Munenari Inoguchi, Michiyo Tsuji

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When disasters occur, in order to raise the speed of each decision making and response, it is common that delegation of authority is carried out. This tendency is particularly evident when the department or branch of the organization are separated by the physical distance from the main body; however, there are some issues to think about. If the department or branch is too dependent on the head office in the usual condition, they might feel lost in the disaster response operation when they are face to the situation. Avoiding this problem, an organization should decide how to delegate the authority and also who accept the responsibility for what before the disaster. This paper will discuss about the method which presents an approach for executing the delegation of authority process, implementing authorities, management by objectives, and preparedness plans and agreement. The paper will introduce the examples of efforts for the three research centers of Niigata University, Japan to arrange organizations capable of taking necessary actions for disaster response. Each center has a quality all its own. One is the center for carrying out the research in order to conserve the crested ibis (or Toki birds in Japanese), the endangered species. The another is the marine biological laboratory. The third one is very unique because of the old growth forests maintained as the experimental field. Those research centers are in the Sado Island, located off the coast of Niigata Prefecture, is Japan's second largest island after Okinawa and is known for possessing a rich history and culture. It takes 65 minutes jetfoil (high-speed ferry) ride to get to Sado Island from the mainland. The three centers are expected to be easily isolated at the time of a disaster. A sense of urgency encourages 3 centers in the process of organizational restructuring for enhancing resilience. The research team from the risk management headquarters offer those procedures; Step 1: Offer the hazard scenario based on the scientific evidence, Step 2: Design a risk management organization for disaster response function, Step 3: Conduct the participatory approach to make consensus about the overarching objectives, Step 4: Construct the unified operational action plan for 3 centers, Step 5: Simulate how to respond in each phase based on the understanding the various phases of the timeline of a disaster. Step 6: Document results to measure performance and facilitate corrective action. This paper shows the result of verifying the output and effects.

Keywords: delegation of authority, disaster response, risk management, unified command

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Authors: Adam Aboalkaz, Rana Shamoon, Duncan Meikle, James Lewis

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Background and aims: In orthopaedic theatres, radiological screening during operations is a commonly used and useful technique to visualise and guide the operating surgeon. Within any theatre using ionising radiation, it is imperative that the use of protective equipment and the wearing of a dosimeter at all times. 1. To assess compliance with use of protective equipment during orthopaedic procedures involving ionising radiation. 2. To assess the radiation risk knowledge of staff members regularly present in an orthopaedic theatre of a national major trauma centre, in accordance to the ionising radiation regulation (2000) guidelines. Method: We conducted an Observational study of 21 operations at the University Hospital of Wales, which is a major trauma centre, recording the compliance with use of protective equipment (lead aprons and thyroid shields) and dosimeters. The observations were performed sporadically over a two week period to ensure that all staff in monitored operating theatres were not aware of the ongoing study, as to avoid bias. A questionnaire testing the knowledge of trainees and staff within the orthopaedic department was given following completion of the initial phase of the study, with 19 responses. The questions were based on knowledge of ionising radiation exposure and monitoring. The questions also tested the general staff knowledge of what equipment should be worn and where to locate such equipment. Results: This study found that only 25% of staff members were wearing thyroid protectors when less than 1 meter from the radiation source and only 50% were wearing appropriate lead aprons whilst in this same vicinity. The study also showed that 0% of all staff members used a dosimeter whilst in an area of radiation exposure. From the distributed questionnaires, only 40% of staff understood where to stand whilst radiation was being used, and only 25% of staff knew where to find protective equipment. Conclusion: Overall our audit showed poor compliance with regards to the National and local policies, due to lack of awareness of the policy and lack of basic ionising radiation exposure knowledge. It was evident from the observational study and questionnaire that staff were not fully aware of what equipment should be worn, where to find such equipment and did not appreciate that the distance from the ionising radiation source altered its exposure effect. This lack of knowledge may affect the staff health and safety after long term exposure. Changes to clinical practice: From the outcome of this study, we managed to drastically increase awareness of ionising radiation within the orthopaedic department. A mandatory teaching session on the safety of ionising radiation has been incorporated into the orthopaedic induction week for all staff. The dosimeters have been moved to a visible location within the trauma operating theatre and all staff made aware of where to find protective equipment.

Keywords: audit, ionising radiation, observational study, protection

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Authors: Ma. Cecilia D. Licuan

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The pandemic situation continues to affect the lives of many people, including children with disabilities and their families, globally, especially in developing countries like the Philippines. The operations of health programs, industries, and economic sectors, as well as academic training institutions, are still challenged in terms of operations and delivery of services. The academic community of the Physical Therapy program is not spared by this circumstance. The restriction posted by the quarantine policies nearly terminated the onsite delivery of training programs for the senior internship level, which challenged the academic institutions to implement flexible learning programs to ensure the continuity of the instructional and learning processes with full consideration of safety and compliance to health protocols. This study aimed to develop a benchmark model that can be used by tertiary-level health institutions in the implementation of the Pediatric Senior Clinical Internship Training Program using Telerehabilitation. It is a descriptive-qualitative paper that utilized documentary analysis and focused on explaining the design, development, and implementation processes used by De La Salle Medical and Health Sciences Institute – College of Rehabilitation Sciences (DLSMHSI-CRS) Physical Therapy Department in its Pediatric Cluster Senior Clinical Internship Training Program covering the pandemic years spanning from the academic year 2020- 2021 to present anchored on needs analysis based on documentary reviews. Results of the study yielded the determination of the Pediatric Telerehabilitation Model; declaration of developed training program outcomes and thrusts and content; explanation of the process integral to the training program’s pedagogy in implementation; and the evaluation procedures conducted for the program. Since the study did not involve human participants, ethical considerations on the use of documents for review were done upon the endorsement of the management of the DLSMHSI-CRS to conduct the study. This paper presents the big picture of how a tertiary-level health sciences institution in the Philippines embraced the senior clinical internship challenges through the operations of its telerehabilitation program. It specifically presents the design, development and implementation processes used by De La Salle Medical and Health Sciences Institute – College of Rehabilitation Sciences Physical Therapy Department in its Pediatric Cluster Senior Clinical Internship Training Program, which can serve as a benchmark model for other institutions as they continue to serve their stakeholders amidst the pandemic.

Keywords: pediatric physical therapy, telerehabilitation, clinical internship, pandemic

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Authors: Valentina Marutyan

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Healthcare data mining is a rapidly developing field at the intersection of technology and medicine that has the potential to change our understanding and approach to providing healthcare. Healthcare and data mining is the process of examining huge amounts of data to extract useful information that can be applied in order to improve patient care, treatment effectiveness, and overall healthcare delivery. This field looks for patterns, trends, and correlations in a variety of healthcare datasets, such as electronic health records (EHRs), medical imaging, patient demographics, and treatment histories. To accomplish this, it uses advanced analytical approaches. Predictive analysis using historical patient data is a major area of interest in healthcare data mining. This enables doctors to get involved early to prevent problems or improve results for patients. It also assists in early disease detection and customized treatment planning for every person. Doctors can customize a patient's care by looking at their medical history, genetic profile, current and previous therapies. In this way, treatments can be more effective and have fewer negative consequences. Moreover, helping patients, it improves the efficiency of hospitals. It helps them determine the number of beds or doctors they require in regard to the number of patients they expect. In this project are used models like logistic regression, random forests, and neural networks for predicting diseases and analyzing medical images. Patients were helped by algorithms such as k-means, and connections between treatments and patient responses were identified by association rule mining. Time series techniques helped in resource management by predicting patient admissions. These methods improved healthcare decision-making and personalized treatment. Also, healthcare data mining must deal with difficulties such as bad data quality, privacy challenges, managing large and complicated datasets, ensuring the reliability of models, managing biases, limited data sharing, and regulatory compliance. Finally, secret code of data mining in healthcare helps medical professionals and hospitals make better decisions, treat patients more efficiently, and work more efficiently. It ultimately comes down to using data to improve treatment, make better choices, and simplify hospital operations for all patients.

Keywords: data mining, healthcare, big data, large amounts of data

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Authors: Mohamed Jaditager, Julie Lovisa, Nagaratnam Sivakugan

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The Port of Townsville conducts regular annual maintenance dredging to maintain depths of its harbor basin and approach channels for the navigational safety of the vessels against the natural accumulation of marine sediments. In addition to the regular maintenance dredging, the port undertakes emergency dredging in cases where large quantities of sediments are mobilized and deposited in port waters by cyclone or major flood events. The maintenance dredging material derived from the port may be disposed at sea or on land in accordance with relevant state and commonwealth regulations. For the land disposal, the dredged mud slurry is hydraulically placed into containment ponds and left to undergo sedimentation and self-weight consolidation to form fill material for land reclamation. This paper provides an overview of the maintenance dredging at the Port of Townsville and emphasis on maintenance dredging requirements, sediment quality, bathymetry, dredging methods used, and dredged material disposal options.

Keywords: consolidation, dredged material, maintenance dredging, marine sediments, sedimentation

Procedia PDF Downloads 444