Search results for: hospital waste management (HWM)

Authors: Balasooriya B. M. C. M., Sujeeva N., Thowfeek Z., Siddiqa Omo, Liyanagunawardana J. E., Jayawardana Saiu, Manathunga S. S., Katulanda G. W.

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Introduction and objectives: Adrenal venous sampling (AVS) is the gold standard to discriminate unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and only performed in a limited number of centers worldwide. To the best of our knowledge, Except for one study conducted in India, no other research studies on this area have been conducted in South Asia. This study aimed to evaluate the effectiveness of AVS in the management of primary aldosteronism. Methods: A total of 32 patients who underwent AVS at the National Hospital of Sri Lanka from April 2021 to April 2023 were enrolled. Demographic, clinical and laboratory data were obtained retrospectively. A procedure was considered successful when adequate cannulation of both adrenal veins was demonstrated. Cortisol gradient across the adrenal vein (AV) and the peripheral vein was used to establish the success of venous cannulation. Lateralization was determined by the aldosterone gradient between the two sides. Continuous and categorical variables were summarized with mean, SD, and proportions, respectively. The mean and standard deviation of the contralateral suppression index (CSI) were estimated with an intercept-only Bayesian inference model. Results: Of the 32 patients, the average age was 52.47 +26.14 and 19 (59.4%) were males. Both AVs were successfully cannulated in 12 (37.5%). Among them, lateralization was demonstrated in 11(91.7%), and one was diagnosed as a bilateral disease. There were no total failures. Right AV cannulation was unsuccessful in 18 (56.25%), of which lateralization was demonstrated in 9 (50%), and others were inconclusive. Left AV cannulation was unsuccessful only in 2 (6.25%); one was lateralized, and the other remained inconclusive. The estimated mean of the CSI was 0.33 (89% credible interval 0.11-0.86). Seven patients underwent unilateral adrenalectomy and demonstrated significant improvement in blood pressure during follow-up. Two patients await surgery. Others were treated medically. Conclusions: Despite failure due to procedural difficulties, AVS remained useful in the management of patients with PA. Moreover, the success of the procedure needs experienced hands and advanced equipment to achieve optimal outcomes in PA.

Keywords: adrenal venous sampling, lateralization, contralateral suppression index, primary aldosteronism

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Authors: Win Thandar Soe, Innocent Mpawenimana, Mathieu Di Fazio, Cécile Belleudy, Aung Ze Ya

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Intelligent electronic equipment and automation network is the brain of high-tech energy management systems in critical role of smart homes dominance. Smart home is a technology integration for greater comfort, autonomy, reduced cost, and energy saving as well. These services can be provided to home owners for managing their home appliances locally or remotely and consequently allow them to automate intelligently and responsibly their consumption by individual or collective control systems. In this study, three smart plugs are described and one of them tested on typical household appliances. This article proposes to collect the data from the wireless technology and to extract some smart data for energy management system. This smart data is to quantify for three kinds of load: intermittent load, phantom load and continuous load. Phantom load is a waste power that is one of unnoticed power of each appliance while connected or disconnected to the main. Intermittent load and continuous load take in to consideration the power and using time of home appliances. By analysing the classification of loads, this smart data will be provided to reduce the communication of wireless sensor network for energy management system.

Keywords: energy management, load profile, smart plug, wireless sensor network

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Authors: Kiurski S. Jelena, Ranogajec G. Jonjaua, Oros B. Ivana, Kecić S. Vesna

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The adsorption efficiency of fired clayey pellets of 5 and 8 mm diameter size for Cu(II) and Zn(II) ions removal from a waste printing developer was studied. In order to investigate the influence of contact time, adsorbent mass and pellet size on the adsorption efficiency the batch mode was carried out. Faster uptake of copper ions was obtained with the fired clay pellets of 5 mm diameter size within 30 minutes. The pellets of 8 mm diameter size showed the higher equilibrium time (60 to 75 minutes) for copper and zinc ions. The results pointed out that adsorption efficiency increases with the increase of adsorbent mass. The maximal efficiency is different for Cu(II) and Zn(II) ions due to the pellet size. Therefore, the fired clay pellets of 5 mm diameter size present an effective adsorbent for Cu(II) ions removal (adsorption efficiency is 63.6%), whereas the fired clay pellets of 8 mm diameter size are the best alternative for Zn(II) ions removal (adsorption efficiency is 92.8%) from a waste printing developer.

Keywords: adsorption efficiency, clayey pellet, metal ions, waste printing developer

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Authors: J. V. Thanikal, M. Torrijos, Philipe Sousbie, S. M. Rizwan, R. Senthil Kumar, Hatem Yezdi

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Co-digestion is one of the advantages of anaerobic digestion process because; several wastes having complimentary characteristics can be treated in a single process. The anaerobic co-digestion process, which can be defined as the simultaneous treatment of two –or more – organic biodegradable waste streams by anaerobic digestion offers great potential for the proper disposal of the organic fraction of solid waste coming from source or separate collection systems. The results of biogas production for sewage sludge, when used as a single substrate, were low (350ml/d), and also the biodegradation rate was slow. Sewage sludge as a co-substrate did not show much effect on biogas yield. The vegetable substrates (Potato, Carrot, Spinach) with a total charge of 27–36 g VS, with a HRT starting from 3 days and ending with 1 day, shown a considerable increase in biogas yield 3.5-5 l/d.

Keywords: anaerobic digestion, co-digestion, vegetable substrate, sewage sludge

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Authors: Katalin Bándy

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The European emigration of highly educated immigrants draws attention to the problem of brain drain. Due to the Eastern European countries joining the EU and the opening of the Western European labour market the west-wards migration brisked up. By now another problem has been intensified correlated to migration: the migration of highly skilled workers related to brain waste tendencies. With some exceptions, educated immigrants from Eastern European countries are more likely to end up in unskilled jobs than residents. This paper is about to reveal the above-mentioned problems and this study is supported by the results of secondary pieces of research and the own survey made in the EU-15 among the Hungarian highly skilled (especially economics graduated) migrants, and it also examines the causes and in the focus there are the migrant motivations of the high-skilled young generation after the crisis.

Keywords: brain drain, brain waste, migration of highly-skilled, underemployment

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Authors: Jitender Sodhi, Shweta Talati, A. K. Gupta, Pankaj Arora

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Background:Equipment donation to hospitals in resource-limited settings can significantly benefit services in these settings albeit requires important ethical, practical and financial issues to be considered before accepting donations. Objective: To understand the decision making process leading to acceptance/ rejection/ deferment of equipment donation from the perspective of a public sector teaching tertiary care hospital. Design: Retrospective, record based study. Setting: 2000-bedded public sector teaching tertiary care hospital in North India. Methods: A total of 30 cases of equipment donation from March 2010-October 2013, were analysed for their decision process leading to acceptance/rejection/deferment.Each case was studied retrospectively and data pertaining to the agenda and decision taken was collected. Results: A total of 30 cases of equipment donation received from March 2010- October 2013 were screened, out of which 17 (56.6%) were for diagnostic purpose and 13 (43.3%) for therapeutic purpose. Out of 30 cases, 16 (53.3%) were accepted and 8 (26.6%) were rejected. The remaining 6 cases included 3 (10%) which required further clarification and other 3 (10%) which were out of the domain of committee. Conclusion: This study highlights the importance of equipment donation in resource limited settings and considerations involved while making decisions for acceptance/rejections/defermentof such donations.

Keywords: equipment donation, teaching hospital, decision-making, North India

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Authors: Mehrnoosh Askarizadeh

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To meet the challenges of the new global environment, companies have started paying great attention towards quality management as an integral part of their strategic business plans. The purpose of this article is to investigate the relationship between total quality management (TQM) and knowledge management (KM). Successful total quality management implementation throughout the organizations requires major changes in the main four aspects of knowledge management, namely: Creating, storage, sharing and application. Skill, knowledge and productivity are important factors in organization’s success and have important role. Therefore, TQM management system pays special attention to it. However, knowledge as the source is essential for organization’s survival. Our study points out how the quality management and knowledge management have been incorporated into each other for the development of the quality culture within the organization.

Keywords: knowledge management (KM), total quality management (TQM), organizational performance (OP), deming cycle

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Authors: Solomon Gebremariam, Mulugeta Naizigi, Aregawi Haileselassie

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Background: Knowledge of the pattern of bacterial isolates and their antimicrobial susceptibility is crucial for guiding empirical treatment and infection prevention and control measures. Objective: The aim of this study was to analyze the pattern of bacterial isolates and their susceptibility patterns from various specimens. Methods: Retrospectively, a total of 1067 microbiological culture results that were isolated, characterized, and identified by standard microbiological methods and whose antibiotic susceptibility was determined using CLSI guidelines between 2017 and 2019 were retrieved and analyzed. Data were entered and analyzed using the Stata release 10.1 statistical package. Result: The positivity rate of culture was 26.04% (419/1609). The most common bacteria isolated were S. aureus 23.8% (94), E. coli 15.1% (60), Klebsiella pneumonia 14.1% (56), Pseudomonas aeruginosa 8.5% (34), and CONS 7.3% (29). S. aureus and CONS showed a high (58.1% - 96.2%) rate of resistance to most antibiotics tested. They were less resistant to Vancomycin which is 18.6% (13/70) and 11.8% (2/17), respectively. Similarly, the resistance of E. coli, Klebsella pneumonia, and Pseudomonas aeruginosa was high (69.4% - 100%) to most antibiotics. They were less resistant to Ciprofloxacilin, which is 41.1% (23/56), 19.2% (10/52), and 16.1% (5/31), respectively. Conclusion: This study has shown that there is a high rate of antibiotic resistance among bacterial isolates in this hospital. A combination of Vancomycin and Ciprofloxacin should be considered in the choice of antibiotics for empirical treatment of suspected infections due to S. aureus, CONS, E. coli, Klebsiella pneumonia, Pseudomonas such as in infections within hospital setup.

Keywords: antimicrobial, resistance, bacteria, hospital

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Authors: Thomas Arink, Isam Janajreh

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The petroleum industry generates significant amounts of waste in the form of drill cuttings, contaminated soil and oily sludge. Drill cuttings are a product of the off-shore drilling rigs, containing wet soil and total petroleum hydrocarbons (TPH). Contaminated soil comes from different on-shore sites and also contains TPH. The oily sludge is mainly residue or tank bottom sludge from storage tanks. The two main treatment methods currently used are incineration and thermal desorption (TD). Thermal desorption is a method where the waste material is heated to 450ºC in an anaerobic environment to release volatiles, the condensed volatiles can be used as a liquid fuel. For the thermal desorption unit dry contaminated soil is mixed with moist drill cuttings to generate a suitable mixture. By thermo gravimetric analysis (TGA) of the TD feedstock it was found that less than 50% of the TPH are released, the discharged material is stored in landfill. This study proposes co-gasification of petroleum waste with waste tires as an alternative to thermal desorption. Co-gasification with a high-calorific material is necessary since the petroleum waste consists of more than 60 wt% ash (soil/sand), causing its calorific value to be too low for gasification. Since the gasification process occurs at 900ºC and higher, close to 100% of the TPH can be released, according to the TGA. This work consists of three parts: 1. a mathematical gasification model, 2. a reactive flow CFD model and 3. experimental work on a drop tube reactor. Extensive material characterization was done by means of proximate analysis (TGA), ultimate analysis (CHNOS flash analysis) and calorific value measurements (Bomb calorimeter) for the input parameters of the mathematical and CFD model. The mathematical model is a zero dimensional model based on Gibbs energy minimization together with Lagrange multiplier; it is used to find the product species composition (molar fractions of CO, H2, CH4 etc.) for different tire/petroleum feedstock mixtures and equivalence ratios. The results of the mathematical model act as a reference for the CFD model of the drop-tube reactor. With the CFD model the efficiency and product species composition can be predicted for different mixtures and particle sizes. Finally both models are verified by experiments on a drop tube reactor (1540 mm long, 66 mm inner diameter, 1400 K maximum temperature).

Keywords: computational fluid dynamics (CFD), drop tube reactor, gasification, Gibbs energy minimization, petroleum waste, waste tires

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Authors: Langhit Kurar, Loren Charles

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Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.

Keywords: ankle, fracture, BOAST, radiology

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Authors: Ahmeda Ali, Mary Codd, Susan Brundage

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Importance: This research focuses on devising and improving Health Service Executive (HSE) policy and legislation and therefore improving patient trauma care and outcomes in Ireland. Objectives: The study measures components of the Trauma System in the district hospital setting of the Cavan/Monaghan Hospital Group (CMHG), HSE, Ireland, and uses the collected data to identify the strengths and weaknesses of the CMHG Trauma System organisation, to include governance, injury data, prevention and quality improvement, scene care and facility-based care, and rehabilitation. The information will be made available to local policy makers to provide objective situational analysis to assist in future trauma service planning and service provision. Design, setting and participants: From 28 April to May 28, 2016 a cross-sectional survey using World Health Organisation (WHO) Trauma System Assessment Tool (TSAT) was conducted among healthcare professionals directly involved in the level III trauma system of CMHG. Main outcomes: Identification of the strengths and weaknesses of the Trauma System of CMHG. Results: The participants who reported inadequate funding for pre hospital (62.3%) and facility based trauma care at CMHG (52.5%) were high. Thirty four (55.7%) respondents reported that a national trauma registry (TARN) exists but electronic health records are still not used in trauma care. Twenty one respondents (34.4%) reported that there are system wide protocols for determining patient destination and adequate, comprehensive legislation governing the use of ambulances was enforced, however, there is a lack of a reliable advisory service. Over 40% of the respondents reported uncertainty of the injury prevention programmes available in Ireland; as well as the allocated government funding for injury and violence prevention. Conclusions: The results of this study contributed to a comprehensive assessment of the trauma system organisation. The major findings of the study identified three fundamental areas: the inadequate funding at CMHG, the QI techniques and corrective strategies used, and the unfamiliarity of existing prevention strategies. The findings direct the need for further research to guide future development of the trauma system at CMHG (and in Ireland as a whole) in order to maximise best practice and to improve functional and life outcomes.

Keywords: trauma, education, management, system

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Authors: Junyoung Kim, Shangwha Cha, Soomee Kang, Jake S. Byun

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This study shows the effect of parameter controls for livestock manure composting in waste recycling process for the development of a new design of a microorganism-oriented- composting system. Based on the preliminary studies, only the temperature control by changing mechanical mixing can reduce microorganisms’ biodegradability from 3 to 6 months to 15 days, saving the consumption of energy and manual labor. The final degree of fermentation in just 5 days of composting increased to ‘3’ comparing the compost standard level ‘4’ in Korea, others standards were all satisfied. This result shows that the controlling the optimum microorganism parameter using an ICT device connected to mixing condition can increase the effectiveness of fermentation system and reduce odor to nearly zero, and lead to upgrade the composting method than the conventional

Keywords: manure composting, odor removal, parameter control, waste recycling

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Authors: R. A. Abdel Rahman, A. E. Abdel Wahab, E. A. Goghneimy, H. F. Mohamed, E. M. Salama

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Infectious diseases are a major cause of death worldwide. The treatment of infections continues to be problematic in modern time because of the severe side effects of some drugs and the growing resistance to antimicrobial agents. Hence, the search for newer, safer and more potent antimicrobials is a pressing need. Herbal medicines have received much attention as a source of new antibacterial drugs since they are considered time-tested and comparatively safe both for human use and the environment. In the present study, the antimicrobial activity of marjoram (Origanum majorana L.) essential oil on some gram positive and gram negative reference bacteria, as well as some hospital resistant microbes, was tested. Marjoram oil was extracted and the oil chemical constituents were identified using GC/MS analysis. Staphylococcus aureas ATCC 6923, Pseudomonus auregonosa ATCC 9027, Bacillus subtilis ATCC 6633, E. coli ATCC 8736 and two hospital resistant microbes isolates 16 and 21 were used. The two isolates were identified by biochemical tests and 16s rRNA as proteus spp. and Enterococcus facielus. The effect of different concentrations of essential oils on bacterial growth was tested using agar disk diffusion assay method to determine the minimum inhibitory concentrations and using micro dilution method to determine the minimum bactericidal concentrations. Marjoram oil was found to be effective against both reference and hospital resistance strains. Hospital strains were more resistant to marjoram oil than reference strains. P. auregonosa growth was completely inhibited at a low concentration of oil (4µl/ml). The other reference strains showed sensitivity to marjoram oil at concentrations ranged from 5 to 7µl/ml. The two hospital strains showed sensitivity at media containing 10 and 15µl/ml oil. The major components of oil were terpineol, cis-beta (23.5%), 1,6 – octadien –3-ol,3,7-dimethyl, 2 aminobenzoate (10.9%), alpha terpieol (8.6%) and linalool (6.3%). Scanning electron microscope (SEM) and transmission electron microscope (TEM) analysis were used to determine the difference between treated and untreated hospital strains. SEM results showed that treated cells were smaller in size than control cells. TEM data showed that cell lysis has occurred to treated cells. Treated cells have ruptured cell wall and appeared empty of cytoplasm compared to control cells which shown to be intact with normal volume of cytoplasm. The results indicated that marjoram oil has a positive antimicrobial effect on hospital resistance microbes. Natural crude extracts can be perfect resources for new antimicrobial drugs.

Keywords: antimicrobial activity, essential oil, hospital resistance microbes, marjoram

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Authors: Insaf Mehani, Bachir Bouchekima

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The fight against climate change and the replacement of fossil energies nearing exhaustion gradually emerge as major societal and economic challenges. It is possible to develop common dates of low commercial value, and put on the local and international market a new generation of products with high added values such as bio ethanol. Besides its use in chemical synthesis, bio ethanol can be blended with gasoline to produce a clean fuel while improving the octane.

Keywords: bio-energy, waste dates, bio ethanol, Algeria

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Authors: Anees K. Ahamed, Aakash Kumar R. G., Raj M. Mohan

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The main objective is to apply lean tools to identify and eliminate waste in and among the work stations so as to improve the process speed and quality. From the top seven wastes in the lean concept, we consider the movement of materials, defects, and inventory for the improvement since these cause the major impact on the performance measures. The layout was improved to reduce the movement of materials. It also quantifies the reduction in movement among the work stations. Value stream mapping has been used for identification of waste. Cause and effect diagram and 5W analysis are used to identify the reasons for defects and to provide the counter measures. Some cycle time reduction techniques also proposed to improve the productivity. Lean Audit check sheet was also used to identify the current position of the industry and to identify the gap to make the industry Lean.

Keywords: cause and effect diagram, cycle time reduction, defects, lean, waste reduction

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Authors: Malek Miladi, Miguel Vegara, Maria Perez-Infantes, Khaled Mohamed Ramadan, Antonio Ruiz-Canales, Damaris Nunez-Gomez

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Coffee is the second consumed commodity worldwide, yet it also generates colossal waste. Proper management of coffee waste is proposed by converting them into products with higher added value to achieve sustainability of the economic and ecological footprint and protect the environment. Based on this, a study looking at the recovery of coffee waste is becoming more relevant in recent decades. Spent coffee grounds (SCG's) resulted from brewing coffee represents the major waste produced among all coffee industry. The fact that SCGs has no economic value be abundant in nature and industry, do not compete with agriculture and especially its high oil content (between 7-15% from its total dry matter weight depending on the coffee varieties, Arabica or Robusta), encourages its use as a sustainable feedstock for bio-oil production. The bio-oil extraction is a crucial step towards biodiesel production by the transesterification process. However, conventional methods used for oil extraction are not recommended due to their high consumption of energy, time, and generation of toxic volatile organic solvents. Thus, finding a sustainable, economical, and efficient extraction technique is crucial to scale up the process and to ensure more environment-friendly production. Under this perspective, the aim of this work was the statistical study to know an efficient strategy for oil extraction by n-hexane using indirect sonication. The coffee waste mixed Arabica and Robusta, which was used in this work. The temperature effect, sonication time, and solvent-to-solid ratio on the oil yield were statistically investigated as dependent variables by Central Composite Rotatable Design (CCRD) 23. The results were analyzed using STATISTICA 7 StatSoft software. The CCRD showed the significance of all the variables tested (P < 0.05) on the process output. The validation of the model by analysis of variance (ANOVA) showed good adjustment for the results obtained for a 95% confidence interval, and also, the predicted values graph vs. experimental values confirmed the satisfactory correlation between the model results. Besides, the identification of the optimum experimental conditions was based on the study of the surface response graphs (2-D and 3-D) and the critical statistical values. Based on the CCDR results, 29 ºC, 56.6 min, and solvent-to-solid ratio 16 were the better experimental conditions defined statistically for coffee waste oil extraction using n-hexane as solvent. In these conditions, the oil yield was >9% in all cases. The results confirmed the efficiency of using an ultrasound bath in extracting oil as a more economical, green, and efficient way when compared to the Soxhlet method.

Keywords: coffee waste, optimization, oil yield, statistical planning

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Authors: Soheil Heydari, Ailar Hajimohammadi, Nasser Khalili

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Polystyrene, being made from a monomer called styrene, is a rigid and easy-to mould polymer that is widely used for many applications, from foam packaging to disposable containers. Considering that the degradation of waste polystyrene takes up to 500 years, there is an urgent need for a sustainable application for waste polystyrene. This study evaluates the application of waste polystyrene as an asphalt modifier. The inclusion of waste plastics in asphalt is either practised by the dry process or the wet process. In the dry process, plastics are added straight into the asphalt mixture and in the wet process, they are mixed and digested into bitumen. In this article, polystyrene was used as an asphalt modifier in a dry process. However, the mixing process is precisely designed to make sure that the polymer is melted and modified in the binder. It was expected that, due to the rigidity of polystyrene, it will have positive effects on the permanent deformation of the asphalt mixture. Therefore, different mixtures were manufactured with different contents of polystyrene and Marshall specimens were manufactured, and dynamic creep tests were conducted to evaluate the permanent deformation of the modification. This is a commonly repeated loading test conducted at different stress levels and temperatures. Loading cycles are applied to the AC specimen until failure occurs; with the amount of deformation constantly recorded the cumulative, permanent strain is determined and reported as a function of the number of cycles. Also, to our best knowledge, hybrid mixes of polystyrene with crumb rubber and low-density polyethylene were made and compared with a polystyrene-modified mixture. The test results of this study showed that the hybrid mix of polystyrene and low-density polyethylene has the highest resistance against permanent deformation. However, the polystyrene-modified mixture outperformed the hybrid mix of polystyrene and crumb rubber, and both demonstrated way lower permanent deformation than the unmodified specimen.

Keywords: permanent deformation, waste plastics, polystyrene, hybrid plastics, hybrid mix, hybrid modification, dry process

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Authors: S. Ithai, A. Oloo

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The emergence of globalization has cultivated an international consensus that without economic development; it is very unlikely that a country may realize social or political development. It is equally important to note that the economic effect on social development automatically influence the country healthcare services as healthcare systems are improved and adopted. For decades and before 1980's, the colonial and the Governments of Kenya had pursued a goal to provide free healthcare services to its citizen with minimal success; but as population increased, this endeavor became almost a mirage. The challenge called for a change of strategy with introduction of cost sharing which also could not guarantee sustainability of healthcare services in the country due to increased number of poor people and poverty. An involvement of multisectral approach to provision of health individual, collaboration and adoption of all dimensions through globalization provides a ray of hope to not only economic, political and social development but also guaranteed equitable and reliable healthcare systems in Kenya and specifically referral healthcare services at KNH. With the advent of globalization, KNH has made positive strides that have guaranteed patients with reliable healthcare services. These include increased donor funding, collaboration levels, training and research as well as enhanced the hospital relations with international partners. During this period, the hospital has increased number of local doctors and nurses, enhanced transfer of skills, innovations and technologies which are driving forces to quality and efficient healthcare services. The period has also brought in challenges for the hospital which include increased competition, attraction of qualified nurses and doctors to international are some the issues that have made the hospital to spend more resources in research and development in order to stay afloat. This paper reveals the link between globalization and healthcare and its influence on institution policy choice. However, the process is not expected to take place automatically without institutional initiatives if KNH is to reap the benefits of globalization. KNH need to make use of the existing infrastructure, human resources and donor confidence, the opportunities that are indeed important in propelling KNH toward Vision 2030 and achieving the desired Millennium Development Goals (MDGs).

Keywords: globalization, Kenyatta National Hospital, native, healthcare

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Authors: Anita D. Adamu, Winston M. W. Shakantu

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Maintenance management is no longer a stand-alone activity. It has now assumed a strategic position in many organisations that have recognised its importance in achieving primary goals and a key aspect of effective management of facilities. This paper aims at providing an understanding of the role and function of strategic management in creating and sustaining an effective maintenance management system in an organisation. The background provides an articulated concept and principles of strategic management. The theoretical concepts paved way for a conceptual framework for which strategic management can be integrated into the maintenance management system of an organisation to improve effectiveness in the maintenance of facilities.

Keywords: facilities, maintenance management, organisations, strategic management

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Authors: Mohammed Abed, Rita Nemes

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In this study different amounts of waste cellular concrete powder (WCCP) as replacement of cement have been investigated as an attempt to produce green binder, which is useful for sustainable construction applications. From zero to up to 60% of WCCP by mass replacement amounts of cement has been conducted. Consistency, compressive strength, bending strength and the activity index of WCCP through seven to ninety days old specimens have been examined, where the optimum WCCP replacement was up to 30%, depending on which the activity index still increased to the end of test period (90 days) and this could be an evidence for its continuity to increase for longer age. Also up to 30% of WCCP increased the bending strength to be higher than the control one. The main point in the present study that there is a possibility of replacing cement by 30% of WCCP, however, it is preferable to be less than this amount.

Keywords: cellular concrete powder, waste cellular concrete powder (WCCP), supplementary cementatious material, SCM, activity index, mechanical properties

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Authors: Chibuzo Okoye Daniels, Gillian Glegg, Lynda Rodwell

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Marine debris from fishing nets to medical equipment to food packaging that play major roles in boosting the economy and protecting human health is now more than an environmental problem that can be solved by legislation, law enforcement and technical solutions. It has also been identified as a cultural problem that can only be addressed by identifying instruments that can be used to change human attitudes and behaviors. This may be through management approaches, education and involvement of all sectors/interests, including the public. To contribute to the sustainable development of coastal Nigeria, two case study areas (Ikoyi and Victoria Islands of Lagos State) were used to evaluate the socio-economic impacts of marine debris problem in coastal Nigeria. The following methods were used: (1) semi-structured interviews with key stakeholders and businesses on beaches, waterfronts and waterways within the study areas and (2) observational study of beaches, waterfronts and waterways within the study areas. The results of the study have shown that marine debris is a cultural and multi-sectoral problem that poses great threat not only to the environmental sustainability of the study areas but also to the wellbeing of its citizens and the economy of coastal Nigeria. Current solid waste and marine debris management practices are inefficient due to inadequate knowledge of how to tackle the problem. To ensure environmental sustainability in coastal Nigeria and avoid waste of scarce financial resources, adequate, appropriate and cost effective solutions to the marine debris problem need to be identified and effectively transferred for implementation in the study areas.

Keywords: sustainability, coastal Nigeria, study areas, aquaculture

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Authors: Prittesh Patel, Bhavika Patel, Ramar Krishnamurthy

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Present study was conducted to isolate lactic acid bacteria (LAB) from Oreochromis niloticus and Nemipterus japonicus fish gut. The LAB isolated were confirmed through 16s rRNA sequencing. It was observed that isolated Lactococcus spp. were able to tolerate NaCl and bile acid up to certain range. The isolated Lactococcus spp. were also able to survive in acidic and alkaline conditions. Further agro-industrial waste like peels of pineapple, orange, lemon, sugarcane, pomegranate; sweet lemon was analyzed for their polysaccharide contents and prebiotic properties. In the present study, orange peels, sweet lemon peels, and pineapple peels give maximum indigestible polysaccharide. To evaluate synbiotic effect combination of probiotic and prebiotic were analyzed under in vitro conditions. Isolates Lactococcus garvieae R3 and Lactococcus sp. R4 reported to have better fermentation efficiency with orange, sweet lemon and pineapple compare to lemon, sugarcane and pomegranate. The different agro-industrial waste evaluated in this research resulted in being a cheap and fermentable carbon source by LAB.

Keywords: agro-industrial waste, lactic acid bacteria, prebiotic, probiotic, synbiotic

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Authors: Md. Abdul Karim, Syed Imran Ahmed, Pandora T. Hardtman

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Informed consent is one of the basic human and ethical rights for childbearing women. It plays a central role in promoting informed decision making between patients and service providers during the labor process. It gives mothers rights to accept or reject any examination and/or procedure, increases the respect and dignity of the mother during pregnancy, delivery and postpartum care. To assess the practices of this right during normal vaginal delivery and immediate postpartum care in tertiary level hospital setting in Bangladesh, a quantitative study with cross-sectional design was conducted in Dhaka Medical College & Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in Dhaka in November 2015. A prevalence-based sample size of 190 was calculated where prevalence, confidence interval and level of significance were at 9.7%, 98% and 5% respectively. The respondents were the mothers who gave normal vaginal childbirth within past 24 hours and received postpartum care there. They were selected through systematic random sampling technique and their face-to-face interview of 190 mothers was done using a structured questionnaire. Data were entered into the spreadsheet (MS Excel 2013 version) and descriptive analysis of findings was done. The result shows the complete absence of informed consent practices and mostly absence of consented care such as right to information, respect for choices of preferences for examination and/or procedure of childbearing women. Although 95% of the mothers were informed that they were being proceeded with normal vaginal delivery, their choice of preference was absent during the process. Only consent (not informed consent) was taken from 50%-72% mothers for examination (except breast examination ‘0%’) and 8%-83% for any procedures during postpartum care. Only one-ninth (11%) of the mothers could ask service providers regarding the services they received. No consent was taken from 3% of the mothers- neither in the labor process nor in postpartum care. This current practice doesn’t comply with the Respectful Maternity Care (RMC) Charter 2011. The issue is not even clarified in the current Standard Clinical Management Protocols of the country. So, improvement of the existing protocol and increased awareness are essential to address this right of child-bearing women and to practice it during normal vaginal delivery and postpartum care.

Keywords: informed consent, normal vaginal delivery, respectful maternity care, tertiary level hospital

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Authors: Vidya Pratap, Seena Biju, Keshavdev A.

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In the educational town of Manipal (located in southern India) households dispose their wastes without segregation. Mixed wastes (organic, inorganic and hazardous items) are collected either by private collectors or by the local municipal body in trucks and taken to dump yards. These collectors select certain recyclables from the collected trash and sell them to scrap merchants to earn some extra money. Rag pickers play a major role in picking up card board boxes, glass bottles and milk sachets from dump yards and public areas and scrap iron from construction sites for recycling. In keeping with the Indian Prime Minister’s mission of Swachh Bharat (A Clean India), the local municipal administration is taking efforts to ensure segregation of domestic waste at source. With this in mind, each household in a residential area in Manipal was given two buckets – for wet and dry wastes (wet waste referred to organic waste while dry waste included recyclable and hazardous items). A study was conducted in this locality covering a cluster of 145 households to assess the residents’ knowledge of recyclable, organic and hazardous items commonly disposed by households. Another objective of this research was to evaluate the extent to which the residents actually dispose their wastes appropriately. Questionnaires were self-administered to a member of each household with the assistance of individuals speaking the local language whenever needed. Respondents’ knowledge of whether an item was organic, inorganic or hazardous was captured through a questionnaire containing a list of 50 common items. Their behaviour was captured by asking how they disposed these items. Results show that more than 70% of respondents are aware that banana and orange peels, potato skin, egg shells and dried leaves are organic; similarly, more than 70% of them consider newspapers, notebook and printed paper are recyclable. Less than 65% of respondents are aware that plastic bags and covers and plastic bottles are recyclable. However, the results of the respondents’ recycling behaviour is less impressive. Fewer than 35% of respondents recycle card board boxes, milk sachets and glass bottles. Unfortunately, since plastic items like plastic bags and covers and plastic bottles are not accepted by scrap merchants, they are not recycled. This study shows that the local municipal authorities must find ways to recycle plastic into products, alternate fuel etc.

Keywords: behaviour, knowledge, plastic waste management, recyclables

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Authors: Mbonigaba Swale

Abstract:

Malaria is an infection or disease caused by parasites (Plasmodium Falciparum — causes severe Malaria, plasmodium Vivax, Plasmodium Ovale, and Plasmodium Malariae), transmitted by bites of infected anopheles (female) mosquitoes to humans. These vectors comprise of two types in Africa, particularly in Uganda, i.e. anopheles fenestus and Anopheles gambaie (‘example Anopheles arabiensis,,); feeds on man inside the house mainly at dusk, mid-night and dawn and rests indoors and makes them effective transmitters (vectors) of the disease. People in both urban and rural areas have consistently become prone to repetitive attacks of malaria, causing a lot of deaths and significantly increasing the poverty levels of the rural poor. Malaria is a national problem; it causes a lot of maternal pre-natal and antenatal disorders, anemia in pregnant mothers, low birth weights for the newly born, convulsions and epilepsy among the infants. Cumulatively, it kills about one million children every year in sub-Saharan Africa. It has been estimated to account for 25-35% of all outpatient visits, 20-45% of acute hospital admissions and 15-35% of hospital deaths. Uganda is the leading victim country, for which Rakai and Masaka districts are the most affected. So, it is not clear whether these abhorrent situations and episodes of recurrences and failure to cure from the disease are a result of poor diagnosis, prescription and dosing, treatment habits and compliance of the patients to the drugs or the ethical domain of the stake holders in relation to the main stream methodology of malaria management. The research is aimed at offering an alternative approach to manage and deal absolutely with problem by using a knowledge based software model of Artificial Intelligence (Al) that is capable of performing common-sense and cognitive reasoning so as to take decisions like the human brain would do to provide instantaneous expert solutions so as to avoid speculative simulation of the problem during differential diagnosis in the most accurate and literal inferential aspect. This system will assist physicians in many kinds of medical diagnosis, prescribing treatments and doses, and in monitoring patient responses, basing on the body weight and age group of the patient, it will be able to provide instantaneous and timely information options, alternative ways and approaches to influence decision making during case analysis. The computerized system approach, a new model in Uganda termed as “Software Aided Treatment” (SAT) will try to change the moral and ethical approach and influence conduct so as to improve the skills, experience and values (social and ethical) in the administration and management of the disease and drugs (combination therapy and generics) by both the patient and the health worker.

Keywords: knowledge based software, management, treatment, diagnosis

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Authors: Wameed Alghazali, Shawn Kenny, Paul J. Van Geel

Abstract:

Settlement of municipal solid waste (MSW) in landfills can be represented by mechanical settlement, which is instantaneous and time-dependent creep components, and biodegradation-induced settlement. Mechanical settlement is governed by the physical characteristics of MSW and the applied overburden pressure. Several research studies used oedometers and different size compression cells to evaluate the primary and mechanical creep compression indices/ratios. However, MSW is known for its heterogeneity, which means data obtained from laboratory testing are not necessary to be a good representation of the mechanical response observed in the field. Furthermore, most of the laboratory tests found in the literature were conducted on shredded samples of MSW to obtain specimens that are suitable for the testing setup. It is believed that shredding MSW samples changes the physical and mechanical properties of the waste. In this study, settlement field data was collected during the filling stage of Ste. Sophie landfill was used to estimate the primary and mechanical creep compression ratios. The field results from Ste. Sophie landfill indicated that both the primary and mechanical creep compression ratios of MSW are not constants but decrease with the increase in the applied vertical stress.

Keywords: mechanical creep compression ratio, municipal solid waste, primary compression ratio, stress level

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Authors: Sayan Munshi, Subrajit Banerjee, Indrani Chakraborty

Abstract:

Tourism is a prime sector in the economic development of many countries in particular the Indian sub-continent. Tourism is considered an integral pillar in the Make in India Program under the Government of India. The statistics of tourism in India had evolved from a past with the formation of History. The sector had shown dynamic changes in the statistics since 1980. With the evolving tourism along with destinations, this sector has been converted into the prime industry, as it not only impacts the destination but on the other hand supports the periphery of the destination. Tourism boost revenue and creates varied economic possibilities for the residents. Due to the influx of tourism in the cities, a load on the infrastructure and services can be observed, specifically in the Physical Infrastructure sectors. Due to the floating population in the designated tourism core of the Urban / Peri-Urban area, issues pertaining to Solid waste management and Transportation are highly observed. Thus, a need for capacity building arises for the infrastructure impacted by tourism, which may result in the upgradation of the lifestyle of the city and its permanent users. As tourism of a region has a dependency on the infrastructure, the paper here focuses on the relationship between tourism potential of a region and the infrastructural determinants of the city or region and hence to derive a structural equation supporting the relationship, further determine a coefficient and suggest the domain of in need of upgradation or retrofitting possibilities. The outcome of the paper is to suggest possible recommendations towards the formation of policies on an urban level to support the tourism potential of the region.

Keywords: urban planning, tourism planning, infrastructure, transportation, solid waste management

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Authors: I. Djefour, M. Saidi, I. Tlemsani, S. Toubal

Abstract:

Lignin is a molecule derived from wood and also generated as waste from the paper industry. With a view to its valorization and protection of the environment, we are interested in its use as a superplasticizer-type adjuvant in mortars and concretes to improve their mechanical strengths. The additives of the concrete have a very strong influence on the properties of the fresh and / or hardened concrete. This study examines the development and use of industrial waste and lignin extracted from a renewable natural source (wood) in cementitious materials. The use of these resources is known at present as a definite resurgence of interest in the development of building materials. Physicomechanical characteristics of mortars are determined by optimization quantity of the natural superplasticizer. The results show that the mechanical strengths of mortars based on natural adjuvant have improved by 20% (64 MPa) for a W/C ratio = 0.4, and the amount of natural adjuvant of dry extract needed is 40 times smaller than commercial adjuvant. This study has a scientific impact (improving the performance of the mortar with an increase in compactness and reduction of the quantity of water), ecological use of the lignin waste generated by the paper industry) and economic reduction of the cost price necessary to elaboration of self-compacting mortars and concretes).

Keywords: biopolymer (lignin), industrial waste, mechanical resistances, self compacting mortars (SCM)

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Authors: Floyd Misheck Mwanza, Paul Boniface Majura

Abstract:

The paper looked at highways/ roadside waste generation, disposal and the consequent environmental impacts. The dramatic increase in vehicular and paved roads in the recent past in Zambia, has given rise to the indiscriminate disposal of litter that now poses a threat to health and the environment. Primary data was generated by carrying out oral interviews and field observations for holistic and in–depth assessment of the environment and the secondary data was obtained from desk review method, information on effects of roadside wastes on environment were obtained from relevant literatures. The interviews were semi structured and a purposive sampling method was adopted and analyzed descriptively. The results of the findings showed that population growth and unplanned road expansion has exceeded the expected limit in recent time with resultant poor system of roadside wastes disposal. Roadside wastes which contain both biodegradable and non-biodegradable roadside wastes are disposed at the shoulders of major highways in temporary dumpsites and are never collected by a road development agency (RDA). There is no organized highway to highway or street to street collection of the wastes in Zambia by the key organization the RDA. The study revealed that roadside disposal of roadside wastes has serious impacts on the environment. Some of these impacts include physical nuisance of the wastes to the environment, the waste dumps also serve as hideouts for rodents and snakes which are dangerous. Waste are blown around by wind making the environment filthy, most of the wastes are also been washed by overland flow during heavy downpour to block drainage channels and subsequently lead to flooding of the environment. Most of the non- biodegradable wastes contain toxic chemicals which have serious implications on the environmental sustainability and human health. The paper therefore recommends that Government/ RDA should come up with proper orientation and environmental laws should be put in place for the general public and also to provide necessary facilities and arrange for better methods of collection of wastes.

Keywords: biodegradable, disposal, environment, impacts

Procedia PDF Downloads 323

Authors: J. Niyitegeka, G. Nshimirimana, A. Silverstein, J. Odhiambo, Y. Lin, T. Nkurunziza, R. Riviello, S. Rulisa, P. Banguti, H. Magge, M. Macharia, J. P. Dushime, R. Habimana, B. Hedt-Gauthier

Abstract:

In low-resource settings, women needing an emergency cesarean section experiences various delays in both reaching and receiving care that is often linked to poor neonatal outcomes. In this study, we quantified different measures of delays and assessed the association between these delays and neonatal outcomes at three rural district hospitals in Rwanda. This retrospective study included 441 neonates and their mothers who underwent emergency cesarean sections in 2015 at Butaro, Kirehe and Rwinkwavu District Hospitals. Four possible delays were measured: Time from start of labor to district hospital admission, travel time from a health center to the district hospital, time from admission to surgical incision, and time from the decision for the emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR < 7 or death) and favorable (APGAR ≥ 7). We assessed the relationship between each type of delay and neonatal outcomes using multivariate logistic regression. In our study, 38.7% (108 out of 279) of neonates’ mothers labored for 12 to 24 hours before hospital admission and 44.7% (159 of 356) of mothers were transferred from health centers that required 30 to 60 minutes of travel time to reach the district hospital. 48.1% (178 of 370) of caesarean sections started within five hours after admission and 85.2% (288 of 338) started more than thirty minutes after the decision for the emergency cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 minutes of travel time from the health center to the district hospital compared to health centers attached to the hospital (OR = 5.12, p = 0.02). Neonatal outcomes were also significantly different depending on decision to incision intervals; neonates with cesarean deliveries starting more than thirty minutes after decision had better outcomes than those started immediately (OR = 0.32, p = 0.04). Interventions that decrease barriers to access to maternal health care services can improve neonatal outcome after emergency cesarean section. Triaging could explain the inverse relationship between time from decision to incision and neonatal outcome; this must be studied more in the future.

Keywords: Africa, emergency obstetric care, rural health delivery, maternal and child health

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