Search results for: mobile field hospital

Authors: Siva Kumar Reddy, Anwesha Mukherjee, Abha Misra

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Excellent energy absorption capability in carbon nanotubes (CNT) is shown in their bulk structure that behaves like super compressible foam. Furthermore, a tunable mechanical behavior of CNT foam is achieved using several methods like changing the concentration of precursors, polymer impregnation, non covalent functionalization of CNT microstructure etc. Influence of magnetic field on compressive behavior of magnetic CNT demonstrated an enhanced peak stress and energy absorption capability, which does not require any surface and structural modification of the foam. This presentation discusses the mechanical behavior of micro porous CNT foam that is impregnated in magnetic field responsive fluid. Magnetic particles are dispersed in a nonmagnetic fluid so that alignment of both particles and CNT could play a crucial role in controlling the stiffness of the overall structure. It is revealed that the compressive behavior of CNT foam critically depends on the fluid viscosity as well as magnetic field intensity. Both peak Stress and energy absorption in CNT foam followed a power law behavior with the increase in the magnetic field intensity. However, in the absence of magnetic field, both peak stress and energy absorption capability of CNT foam presented a linear dependence on the fluid viscosity. Hence, this work demonstrates the role magnetic filed in controlling the mechanical behavior of the foams prepared at nanoscale.

Keywords: carbon nanotubes, magnetic field, energy absorption capability and viscosity

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Authors: Xiaodong Wen, Lijuan Liu, Xinfeng Sun

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A high power electrodeless plasma thruster is being developed at Lanzhou Institute of Physics. In this thruster, a rotating magnetic field (RMF) driven by two radio-frequency coils which dephased by 90 degrees are applied both for propellant ionization and plasma acceleration. In the ionization stage, a very high azimuthal current can be driven by RMF and then makes plasma forms a field reversed configuration, namely self-confined plasmoid. Profoundly understanding the transport characteristics of the plasmoid in the following acceleration stage is the key to improve the thruster performances. In this paper, a 3D MHD model is established and the influences of the RMF and an applied magnetic field on the self-confined plasmoid acceleration are investigated. The simulation results show that, by applying a RMF with strength and frequency of 250 G and 370 kHz, the plasmoid can be accelerated to an average velocity of 17 km/s at the exit of the thruster.

Keywords: electric space propulsion, field reversed configuration, rotating magnetic field, transport phenomena

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Authors: Launcelot McGrath

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The Coronavirus disease 2019 (COVID-19) has spread rapidly around the world, resulting in high mortality rates and very large numbers of people requiring medical treatment in ICU. Management of patient hospitalisation is a critical aspect to control this disease and reduce chaos in the healthcare systems. Remote monitoring provides a solution to protect vulnerable and elderly high-risk patients. Continuous remote monitoring of oxygen saturation, respiratory rate, heart rate, and temperature, etc., provides medical systems with up-to-the-minute information about their patients' statuses. Remote monitoring also limits the spread of infection by reducing hospital overcrowding. This paper examines the potential of remote monitoring for Covid-19 to assist in the rapid identification of patients at risk, facilitate the detection of patient deterioration, and enable early interventions.

Keywords: remote monitoring, patient care, oxygen saturation, Covid-19, hospital management

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Authors: Taha Zakaraia Abdel Wahid

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The behavior of the unsteady non-equilibrium distribution function for a dilute gas under the effect of non-linear thermal radiation field is presented. For the best of our knowledge this is done for the first time at all. The distinction and comparisons between the unsteady perturbed and the unsteady equilibrium velocity distribution functions are illustrated. The equilibrium time for the dilute gas is determined for the first time. The non-equilibrium thermodynamic properties of the system (gas+the heated plate) are investigated. The results are applied to the Argon gas, for various values of radiation field intensity. 3D-Graphics illustrating the calculated variables are drawn to predict their behavior. The results are discussed.

Keywords: dilute gas, radiation field, exact solutions, travelling wave method, unsteady BGK model, irreversible thermodynamics, unsteady non-equilibrium distribution functions

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Authors: Dana S. Smith, Angela Goins, Shahnaz Savani

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Using a mixed-methods approach, this study explored costs to student wellbeing generated by the social work field practicum requirement. The project was conducted by faculty at a medium-sized university in the United States. Social work educators and field practicum instructors participated in interviews. Students and former students completed surveys on the topic. The data analysis revealed emotional burdens as well as threats to student wellbeing in association with the fieldwork required for those in pursuit of a social work degree. The study includes recommendations for anti-oppressive approaches for academic programs and implications for further research.

Keywords: emotional wellbeing, field practicum, mixed-methods, social justice

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Authors: Dana S. Smith, Angela Goins, Shahnaz Savani

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Using a mixed-methods approach, this study explored costs to student wellbeing generated by the social work field practicum requirement. The project was conducted by faculty at a medium sized university in the United States. Social work educators and field practicum instructors participated in interviews. Students and former students completed surveys on the topic. The data analysis revealed emotional burdens as well as threats to student wellbeing in association with the fieldwork required for those in pursuit of a social work degree. The study includes recommendations of anti-oppressive approaches for academic programs and implications for further research.

Keywords: emotional wellbeing, field practicum, mixed-methods, social justice

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Authors: C. Casini, V. Da Deppo, P. Zuppella, P. Chioetto, A. Slemer, F. Frassetto, M. Romoli, F. Landini, M. Pancrazzi, V. Andretta, E. Antonucci, A. Bemporad, M. Casti, Y. De Leo, M. Fabi, S. Fineschi, F. Frassati, C. Grimani, G. Jerse, P. Heinzel, K. Heerlein, A. Liberatore, E. Magli, G. Naletto, G. Nicolini, M.G. Pelizzo, P. Romano, C. Sasso, D. Spadaro, M. Stangalini, T. Straus, R. Susino, L. Teriaca, M. Uslenghi, A. Volpicelli

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Solar Orbiter, launched on February 9^th 2020, is an ESA/NASA mission conceived to study the Sun. The payload is composed of 10 instruments, among which there is the Metis coronagraph. A coronagraph aims at taking images of the solar corona: the occulter element simulates a total solar eclipse. This work presents some of the results obtained in the visible light band (580-640 nm) using a flat field panel source. The flat field panel gives a uniform illumination; consequently, it has been used during the on-ground calibration for several purposes: evaluating the response of each pixel of the detector (linearity); and characterizing the Field of View of the coronagraph. As a conclusion, a major result is the verification that the requirement for the Field of View (FoV) of Metis is fulfilled. Some investigations are in progress in order to verify that the performance measured on-ground did not change after launch.

Keywords: solar orbiter, Metis, coronagraph, flat field panel, calibration, on-ground, performance

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Authors: M. Kalbac, T. Verhagen, K. Drogowska, J. Vejpravova

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One- and two-dimensional carbon nano structures with sp2 hybridization of carbon atoms (single walled carbon nano tubes and graphene) are promising materials in future electronic and spintronics devices due to specific character of their electronic structure. In this paper, we present a comparative study of graphene and single-wall carbon nano tubes by Raman spectro-microscopy in strong magnetic field. This unique method allows to study changes in electronic band structure of the two types of carbon nano structures induced by a strong magnetic field.

Keywords: carbon nano structures, magnetic field, raman spectroscopy, spectro-microscopy

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Authors: Mingxin Li, Liya Ni

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Autonomous parking is a valuable feature applicable to many robotics applications such as tour guide robots, UV sanitizing robots, food delivery robots, and warehouse robots. With auto-parking, the robot will be able to park at the charging zone and charge itself without human intervention. As compared to self-driving vehicles, auto-parking is more challenging for a small-scale mobile robot only equipped with a front camera due to the camera view limited by the robot’s height and the narrow Field of View (FOV) of the inexpensive camera. In this research, auto-parking of a small-scale mobile robot with a front camera only was achieved in a four-step process: Firstly, transfer learning was performed on the AlexNet, a popular pre-trained convolutional neural network (CNN). It was trained with 150 pictures of empty parking slots and 150 pictures of occupied parking slots from the view angle of a small-scale robot. The dataset of images was divided into a group of 70% images for training and the remaining 30% images for validation. An average success rate of 95% was achieved. Secondly, the image of detected empty parking space was processed with edge detection followed by the computation of parametric representations of the boundary lines using the Hough Transform algorithm. Thirdly, the positions of the entrance point and center of available parking space were predicted based on the robot kinematic model as the robot was driving closer to the parking space because the boundary lines disappeared partially or completely from its camera view due to the height and FOV limitations. The robot used its wheel speeds to compute the positions of the parking space with respect to its changing local frame as it moved along, based on its kinematic model. Lastly, the predicted entrance point of the parking space was used as the reference for the motion control of the robot until it was replaced by the actual center when it became visible again by the robot. The linear and angular velocities of the robot chassis center were computed based on the error between the current chassis center and the reference point. Then the left and right wheel speeds were obtained using inverse kinematics and sent to the motor driver. The above-mentioned four subtasks were all successfully accomplished, with the transformed learning, image processing, and target prediction performed in MATLAB, while the motion control and image capture conducted on a self-built small scale differential drive mobile robot. The small-scale robot employs a Raspberry Pi board, a Pi camera, an L298N dual H-bridge motor driver, a USB power module, a power bank, four wheels, and a chassis. Future research includes three areas: the integration of all four subsystems into one hardware/software platform with the upgrade to an Nvidia Jetson Nano board that provides superior performance for deep learning and image processing; more testing and validation on the identification of available parking space and its boundary lines; improvement of performance after the hardware/software integration is completed.

Keywords: autonomous parking, convolutional neural network, image processing, kinematics-based prediction, transfer learning

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Authors: Dawid Sołoducha, Tomasz Borowski, Marian Kordas, Rafał Rakoczy

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The magnetic field in the past few years became an important part of many studies. Magnetic field (MF) may be used to affect the process in many ways; for example, it can be used as a factor to stabilize the system. We can use MF to steer the operation, to activate or inhibit the process, or even to affect the vital activity of microorganisms. Using various types of magnetic field generators is always connected with the delivery of some heat to the system. Heat transfer is a very important phenomenon; it can influence the process positively and negatively, so it’s necessary to measure heat stream transferred from the place of generation and prevent negative influence on the operation. The aim of the presented work was to apply various types of magnetic fields and to measure heat transfer phenomena. The results were obtained by continuous measurement at several measuring points with temperature probes. Results were compilated in the form of temperature profiles. The study investigated the undetermined heat transfer in a custom system equipped with a magnetic field generator. Experimental investigations are provided for the explanation of the influence of the various type of magnetic fields on the heat transfer process. The tested processes are described by means of the criteria which defined heat transfer intensification under the action of magnetic field.

Keywords: heat transfer, magnetic field, undetermined heat transfer, temperature profile

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Authors: Manasa Kalla, Narasimha Raju Chebrolu, Ashok Chatterjee

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We have studied the quantum transport properties of a single molecular transistor in the presence of an external magnetic field using the Keldysh Green function technique. We also used the Anderson-Holstein-Caldeira-Leggett Model to describe the single molecular transistor that consists of a molecular quantum dot (QD) coupled to two metallic leads and placed on a substrate that acts as a heat bath. The phonons are eliminated by the Lang-Firsov transformation and the effective Hamiltonian is used to study the effect of an external magnetic field on the spectral density function, Tunneling Current, Differential Conductance and Spin polarization. A peak in the spectral function corresponds to a possible excitation. In the presence of a magnetic field, the spin-up and spin-down states are degenerate and this degeneracy is lifted by the magnetic field leading to the splitting of the central peak of the spectral function. The tunneling current decreases with increasing magnetic field. We have observed that even the differential conductance peak in the zero magnetic field curve is split in the presence electron-phonon interaction. As the magnetic field is increased, each peak splits into two peaks. And each peak indicates the existence of an energy level. Thus the number of energy levels for transport in the bias window increases with the magnetic field. In the presence of the electron-phonon interaction, Differential Conductance in general gets reduced and decreases faster with the magnetic field. As magnetic field strength increases, the spin polarization of the current is increasing. Our results show that a strongly interacting QD coupled to metallic leads in the presence of external magnetic field parallel to the plane of QD acts as a spin filter at zero temperature.

Keywords: Anderson-Holstein model, Caldeira-Leggett model, spin-polarization, quantum dots

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Authors: Rasha Shoumar

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Background: Since the onset of the Syria crisis in 2011, Jordan has hosted many Syrian refugees, many of which are residing in urban and rural areas. Vulnerability of refugees has increased due to the COVID-19 pandemic, adding to their already existing challenge in access to medical services, rendering them vulnerable to the complications of untreated medical conditions and amplifying their risk for severe COVID-19 disease. To improve health outcomes and access to health care services in a COVID-19 context, IOM (The International Organization for Migration) provided health services including awareness raising, direct primary health care through mobile teams and referrals to secondary services were extended to the vulnerable populations of refugees. Method: 6 community health volunteers were trained and deployed to different governorates to provide COVID-19 and non-communicable disease awareness and collect data rated to non-communicable disease and access to medical health services. Primary health care services were extended to 7 governorates through a mobile medical team, providing medical management. The collected Data was reviewed and analyzed. Results: 2150 refugees in rural areas were reached out by community health volunteers, out of which 78 received their medications through the Ministry of Health, 121 received their medications through different non-governmental organizations, 665 patients couldn’t afford buying any medications, 1286 patients were occasionally buying their medications when they were able to afford it. 853 patients received medications and follow up through IOM mobile clinics, the most common conditions were hypertension, diabetes, hyperlipidemia, anemia, heart disease, thyroid disease, asthma, seizures, and psychiatric conditions. 709 of these patients had more than 3 of the comorbidities. Multiple cases were referred for secondary and tertiary lifesaving interventions. Conclusion: Non communicable diseases are highly prevalent among refugee population in Jordan, access to medical services have proven to be a challenge in rural areas especially during the COVID-19 era, many of the patients have multiple uncontrolled medical conditions placing them at risk for complications and risk for severe COVID-19 disease. Deployment of mobile clinics to rural areas plays an essential role in managing such medical conditions, thus improving the continuum of health care approach, physical and mental wellbeing of refugees and reducing the risk for severe COVID-19 disease among this group, taking us one step forward toward universal health access.

Keywords: COVID-19, refugees, mobile clinics, primary health care

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Authors: Chia-Jui Yu, Chien-Ju Chen, Jyun-Hao Liao, Chia-Ching Wu, Meng-Chyi Wu

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In this letter, we demonstrate high-performance AlGaN/GaN planar Schottky barrier diodes (SBDs) on the silicon substrate with field plate structure for increasing breakdown voltage V_B. A low turn-on resistance R_ON (3.55 mΩ-cm²), low reverse leakage current (< 0.1 µA) at -100 V, and high reverse breakdown voltage V_B (> 1.1 kV) SBD has been fabricated. A virgin SBD exhibited a breakdown voltage (measured at 1 mA/mm) of 615 V, and with the field plate technology device exhibited a breakdown voltage (measured at 1 mA/mm) of 1525 V (the anode–cathode distance was L_AC = 40 µm). Devices without the field plate design exhibit a Baliga’s figure of merit of V_B²/ R_ON = 60.2 MW/cm², whereas devices with the field plate design show a Baliga’s figure of merit of V_B²/ R_ON = 340.9 MW/cm² (the anode–cathode distance was L_AC = 20 µm).

Keywords: AlGaN/GaN heterostructure, silicon substrate, Schottky barrier diode (SBD), high breakdown voltage, Baliga’s figure-of-merit, field plate

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Authors: Mohamed Hendawy Mousa, Warda Youssef Mohamed Morsy

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Background: Sepsis is a major cause of mortality and morbidity in trauma patients. Body mass index as an indicator of nutritional status was reported as a predictor of injury pattern and complications among critically ill injured patients. Aim: The aim of this study is to investigate the relationship between body mass index and the development of sepsis, systemic inflammatory response syndrome among adult trauma patients at emergency hospital - Cairo University. Research design: Descriptive correlational research design was utilized in the current study. Research questions: Q1. What is the body mass index profile of adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?, Q2. What is the frequency of systemic inflammatory response syndrome and sepsis among adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?, and Q3. What is the relationship between the development of sepsis, systemic inflammatory response syndrome and body mass index among adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?. Sample: A purposive sample of 52 adult male and female trauma patients with revised trauma score 10 to 12. Setting: The Emergency Hospital affiliated to Cairo University. Tools: Four tools were utilized to collect data pertinent to the study: Socio demographic and medical data tool, Systemic inflammatory response syndrome assessment tool, Revised Trauma Score tool, and Sequential organ failure assessment tool. Results: The current study revealed that, (61.5 %) of the studied subjects had normal body mass index, (25 %) were overweight, and (13.5 %) were underweight. 84.6% of the studied subjects had systemic inflammatory response syndrome and 92.3% were suffering from mild sepsis. No significant statistical relationship was found between body mass index and occurrence of Systemic inflammatory response syndrome (2= 2.89 & P = 0.23). However, Sequential organ failure assessment scores were affected significantly by body mass index was found mean of initial and last Sequential organ failure assessment score for underweight, normal and obese where t= 7.24 at p = 0.000, t= 16.49 at p = 0.000 and t= 9.80 at p = 0.000 respectively. Conclusion: Underweight trauma patients showed significantly higher rate of developing sepsis as compared to patients with normal body weight and obese. Recommendations: based on finding of this study the following are recommended: replication of the study on a larger probability sample from different geographical locations in Egypt; Carrying out of further studies in order to assess the other risk factors influencing trauma outcome and incidence of its complications; Establishment of standardized guidelines for managing underweight traumatized patients with sepsis.

Keywords: body mass index, sepsis, systemic inflammatory response syndrome, adult trauma

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Authors: Derwin K. C. Chan, Alfred S. Y. Lee

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The integrated model of self-determination theory and the theory of planned behaviour has been successfully applied to explain individuals’ adherence to health behaviours, including behavioural adherence toward rehabilitation. This study was a randomised controlled trial that examined the effectiveness of an mHealth intervention (i.e., mobile application) developed based on this integrated model in promoting treatment adherence of patients of anterior cruciate ligament rupture during their post-surgery home-based rehabilitation period. Subjects were 67 outpatients (aged between 18 and 60) who undertook anterior cruciate ligament (ACL) reconstruction surgery for less than 2 months for this study. Participants were randomly assigned either into the treatment group (who received the smartphone application; N = 32) and control group (who receive standard treatment only; N = 35), and completed psychological measures relating to the theories (e.g., motivations, social cognitive factors, and behavioural adherence) and clinical outcome measures (e.g., subjective knee function (IKDC), laxity (KT-1000), muscle strength (Biodex)) relating to ACL recovery at baseline, 2-month, and 4-month. Generalise estimating equation showed the interaction between group and time was significant on intention was only significant for intention (Wald x² = 5.23, p = .02), that of perceived behavioural control (Wald x² = 3.19, p = .07), behavioural adherence (Wald x² = 3.08, p = .08, and subjective knee evaluation (Wald x² = 2.97, p = .09) were marginally significant. Post-hoc between-subject analysis showed that control group had significant drop of perceived behavioural control (p < .01), subjective norm (p < .01) and intention (p < .01), behavioural adherence (p < .01) from baseline to 4-month, but such pattern was not observed in the treatment group. The treatment group had a significant decrease of behavioural adherence (p < .05) in the 2-month, but such a decrease was not observed in 4-month (p > .05). Although the subjective knee evaluation in both group significantly improved at 2-month and 4-month from the baseline (p < .05), and the improvements in the control group (mean improvement at 4-month = 40.18) were slightly stronger than the treatment group (mean improvement at 4-month = 34.52). In conclusion, the findings showed that the theory driven mobile application ameliorated the decline of treatment intention of home-based rehabilitation. Patients in the treatment group also reported better muscle strength than control group at 4-month follow-up. Overall, the mobile application has shown promises on tackling the problem of orthopaedics outpatients’ non-adherence to medical treatment.

Keywords: self-determination theory, theory of planned behaviour, mobile health, orthopaedic patients

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Authors: Bijay Kumar Sahoo

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An important feature of InₓGa₁-ₓN/GaN heterostructures is strong built-in polarization (BIP) electric field at the hetero-interface due to spontaneous (sp) and piezoelectric (pz) polarizations. The intensity of this electric field reaches several MV/cm. This field has profound impact on optical, electrical and thermal properties. In this work, the effect of BIP field on thermal conductivity of InₓGa₁-ₓN/GaN heterostructure has been investigated theoretically. The interaction between the elastic strain and built in electric field induces additional electric polarization. This additional polarization contributes to the elastic constant of InₓGa₁-ₓN alloy. This in turn modifies material parameters of InₓGa₁-ₓN. The BIP mechanism enhances elastic constant, phonon velocity and Debye temperature and their bowing constants in InₓGa₁-ₓN alloy. These enhanced thermal parameters increase phonon mean free path which boost thermal conduction process. The thermal conductivity (k) of InxGa1-xN alloy has been estimated for x=0, 0.1, 0.3 and 0.9. Computation finds that irrespective of In content, the room temperature k of InₓGa₁-ₓN/GaN heterostructure is enhanced by BIP mechanism. Our analysis shows that at a certain temperature both k with and without BIP show crossover. Below this temperature k with BIP field is lower than k without BIP; however, above this temperature k with BIP field is significantly contributed by BIP mechanism leading to k with BIP field become higher than k without BIP field. The crossover temperature is primary pyroelectric transition temperature. The pyroelectric transition temperature of InₓGa₁-ₓN alloy has been predicted for different x. This signature of pyroelectric nature suggests that thermal conductivity can reveal pyroelectricity in InₓGa₁-ₓN alloy. The composition dependent room temperature k for x=0.1 and 0.3 are in line with prior experimental studies. The result can be used to minimize the self-heating effect in InₓGa₁-ₓN/GaN heterostructures.

Keywords: built-in polarization, phonon relaxation time, thermal properties of InₓGa₁-ₓN /GaN heterostructure, self-heating

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Authors: Farzad Tofigh, Saeideh Najafi, Reza Heidari, Rashid Jamei

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In order to study the effects of magnetic field on the root system and growth of Phaseolus vulgaris, an experiment was conducted in 2012. The possible involvement of magnetic field (MF) pretreatment in physiological factors of Phaseolus vulgaris was investigated. Seeds were subjected to 10 days with 1.8 mT of magnetic field for 1h per day. MF pretreatment decreased the plant height, fresh and dry weight, length of root and length of shoot, Chlorophyll a, Chlorophyll b and carotenoid in 10 days old seedling. In addition, activity of enzymes such as Catalase and Guaiacol peroxidase was decreased due to MF exposure. Also, the total Protein and DPPH content of the treated by magnetic field was not significantly changed in compare to control groups, while the flavonoid, Phenol and prolin content of the treated of the treated by magnetic field was significantly changed in compare to control groups. Lateral branches of roots and secondary roots increased with MF. The results suggest that pretreatment of this MF plays important roles in changes in crop productivity. In all cases there was observed a slight stimulating effect of the factors examined. The growth dynamics were weakened. The plants were shorter. Moreover, the effect of a magnetic field on the crop of Phaseolus vulgaris and its structure was small.

Keywords: carotenoid, chlorophyll a, chlorophyll b, DPPH, enzymes, flavonoid, germination, growth, phenol, proline, protein, magnetic field

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Authors: Nkeiruka Queendarline Nwaizugbu

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The use of social media and mobile devices has become acceptable in virtually all areas of today’s world. Hence, this study is a survey that was carried out to find out if students and lecturers in public universities in Rivers State use social networking for educational purposes. The sample of the study comprised of 240 students and 99 lecturers from the University of Port Harcourt and the Rivers State University of science and Technology. The study had five research questions, two hypotheses and the instrument for data collection was a 4-point Likert-type rating scale questionnaire. The data was analysed using mean, standard deviation and z-test. The findings gotten from the analysed data shows that students participate in social networking using different types of web applications but they hardly use them for educational purposes. Some recommendations were also made.

Keywords: internet access, mobile learning, participation, social media, social networking, technology

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Authors: Amin Hamrahi

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Near Field Communication (NFC) is one of the latest wireless communication technologies. NFC enables electronic devices to communicate in short range using the radio waves. NFC offers safe yet simple communication between electronic devices. This technology provides the fastest way to communicate two device with in a fraction of second. With NFC technology, communication occurs when an NFC-compatible device is brought within a few centimeters of another NFC device. NFC is an open-platform technology that is being standardized in the NFC Forum. NFC is based on and extends on RFID. It operates on 13.56 MHz frequency.

Keywords: near field communication, NFC technology, wireless communication technologies, NFC-compatible device, NFC, communication

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Authors: Yuguang Gao, Mingtao Deng

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The integration of independently operating hospitals into a unified healthcare service system has become a strategic imperative in the pursuit of hospitals’ high-quality development. Central to the concept of group governance over such transformation, exemplified by a collaborative medical alliance, is the delineation of shared value, vision, and goals. Given the inherent disparity in capabilities among hospitals within the alliance, particularly in the treatment of different diseases characterized by Disease Related Groups (DRG) in terms of effectiveness, efficiency and resource utilization, this study aims to address the centralized decision-making of intra-hospital patient referral within the medical alliance to enhance the overall production and quality of service provided. We first introduce the notion of production utility, where a higher production utility for a hospital implies better performance in treating patients diagnosed with that specific DRG group of diseases. Then, a Discrete-Event Simulation (DES) framework is established for patient referral among hospitals, where patient flow modeling incorporates a queueing system with fixed capacities for each hospital. The simulation study begins with a two-member alliance. The pivotal strategy examined is a "whether-to-refer" decision triggered when the bed usage rate surpasses a predefined threshold for either hospital. Then, the decision encompasses referring patients to the other hospital based on DRG groups’ production utility differentials as well as bed availability. The objective is to maximize the total production utility of the alliance while minimizing patients’ average length of stay and turnover rate. Thus the parameter under scrutiny is the bed usage rate threshold, influencing the efficacy of the referral strategy. Extending the study to a three-member alliance, which could readily be generalized to multi-member alliances, we maintain the core setup while introducing an additional “which-to-refer" decision that involves referring patients with specific DRG groups to the member hospital according to their respective production utility rankings. The overarching goal remains consistent, for which the bed usage rate threshold is once again a focal point for analysis. For the two-member alliance scenario, our simulation results indicate that the optimal bed usage rate threshold hinges on the discrepancy in the number of beds between member hospitals, the distribution of DRG groups among incoming patients, and variations in production utilities across hospitals. Transitioning to the three-member alliance, we observe similar dependencies on these parameters. Additionally, it becomes evident that an imbalanced distribution of DRG diagnoses and further disparity in production utilities among member hospitals may lead to an increase in the turnover rate. In general, it was found that the intra-hospital referral mechanism enhances the overall production utility of the medical alliance compared to individual hospitals without partnership. Patients’ average length of stay is also reduced, showcasing the positive impact of the collaborative approach. However, the turnover rate exhibits variability based on parameter setups, particularly when patients are redirected within the alliance. In conclusion, the re-structuring of diagnostic disease groups within the medical alliance proves instrumental in improving overall healthcare service outcomes, providing a compelling rationale for the government's promotion of patient referrals within collaborative medical alliances.

Keywords: collaborative medical alliance, disease related group, patient referral, simulation

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Authors: Nabiha Bouafia, Asma Ben Cheikh, Asma Ammar, Olfa Ezzi, Mohamed Mahjoub, Khaoula Meddeb, Imed Chouchene, Hamadi Boussarsar, Mansour Njah

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Background: Hospital acquired infections (HAI) cause significant morbidity, mortality, length of stay and hospital costs, especially in the intensive care unit (ICU), because of the debilitated immune systems of their patients and exposure to invasive devices. The aims of this study were to determine the rate and the risk factors of HAI in an ICU of a university hospital in Tunisia. Materials/Methods: A prospective study was conducted in the 8-bed adult medical ICU of a University Hospital (Sousse Tunisia) during 14 months from September 15th, 2015 to November 15th, 2016. Patients admitted for more than 48h were included. Their surveillance was stopped after the discharge from ICU or death. HAIs were defined according to standard Centers for Disease Control and Prevention criteria. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: During the study, 192 patients had admitted for more than 48 hours. Their mean age was 59.3± 18.20 years and 57.1% were male. Acute respiratory failure was the main reason of admission (72%). The mean SAPS II score calculated at admission was 32.5 ± 14 (range: 6 - 78). The exposure to the mechanical ventilation (MV) and the central venous catheter were observed in 169 (88 %) and 144 (75 %) patients, respectively. Seventy-three patients (38.02%) developed 94 HAIs. The incidence density of HAIs was 41.53 per 1000 patient day. Mortality rate in patients with HAIs was 65.8 %( n= 48). Regarding the type of infection, Ventilator Associated Pneumoniae (VAP) and central venous catheter Associated Infections (CVC AI) were the most frequent with Incidence density: 14.88/1000 days of MV for VAP and 20.02/1000 CVC days for CVC AI. There were 5 Peripheral Venous Catheter Associated Infections, 2 urinary tract infections, and 21 other HAIs. Gram-negative bacteria were the most common germs identified in HAIs: Multidrug resistant Acinetobacter Baumanii (45%) and Klebsiella pneumoniae (10.96%) were the most frequently isolated. Univariate analysis showed that transfer from another hospital department (p= 0.001), intubation (p < 10-4), tracheostomy (p < 10-4), age (p=0.028), grade of acute respiratory failure (p=0.01), duration of sedation (p < 10-4), number of CVC (p < 10-4), length of mechanical ventilation (p < 10-4) and length of stay (p < 10-4), were associated to high risk of HAIS in ICU. Multivariate analysis reveals that independent risk factors for HAIs are: transfer from another hospital department: OR=13.44, IC 95% [3.9, 44.2], p < 10-4, duration of sedation: OR= 1.18, IC 95% [1.049, 1.325], p=0.006, high number of CVC: OR=2.78, IC 95% [1.73, 4.487], p < 10-4, and length of stay in ICU: OR= 1.14, IC 95% [1.066,1.22], p < 10-4. Conclusion: Prevention of nosocomial infections in ICUs is a priority of health care systems all around the world. Yet, their control requires an understanding of epidemiological data collected in these units.

Keywords: healthcare associated infections, incidence, intensive care unit, risk factors

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Authors: Kay-Anne Haykal, Issack Biyong

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The post-traumatic stress disorder (PTSD) rises from exposure to a traumatic event and appears by a persistent experience of this event. Several psychiatric co-morbidities are associated with PTSD and include mood disorders, anxiety disorders, and substance abuse. The main objective was to compare the criteria for PTSD according to the literature to those used to diagnose a patient in a francophone hospital and to check the correspondence of these two criteria. 700 medical charts of admitted patients on the medicine or psychiatric unit at the Montfort Hospital were identified with the following diagnoses: major depressive disorder, bipolar disorder, anxiety disorder, substance abuse, and PTSD for the period of time between April 2005 and March 2006. Multiple demographic criteria were assembled. Also, for every chart analyzed, the PTSD criteria, according to the Manual of Mental Disorders (DSM) IV were found, identified, and grouped according to pre-established codes. An analysis using the receiver operating characteristic (ROC) method was elaborated for the study of data. A sample of 57 women and 50 men was studied. Age was varying between 18 and 88 years with a median age of 48. According to the PTSD criteria in the DSM IV, 12 patients should have the diagnosis of PTSD in opposition to only two identified in the medical charts. The ROC method establishes that with the combination of data from PTSD and depression, the sensitivity varies between 0,127 and 0,282, and the specificity varies between 0,889 and 0,917. Otherwise, if we examine the PTSD data alone, the sensibility jumps to 0.50, and the specificity varies between 0,781 and 0,895. This study confirms the presence of an underdiagnosed and treated PTSD that causes severe perturbations for the affected individual.

Keywords: post-traumatic stress disorder, co-morbidities, diagnosis, mental health disorders

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Authors: Mohammad Ahmad, Dayalan Kasilingam

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In this paper, a spectral domain implementation of the fast multipole method is presented. It is shown that the aggregation, translation, and disaggregation stages of the fast multipole method (FMM) can be performed using the spectral domain (SD) analysis. The spectral domain fast multipole method (SD-FMM) has the advantage of eliminating the near field/far field classification used in conventional FMM formulation. The study focuses on the application of SD-FMM to one-dimensional (1D) and two-dimensional (2D) electric field integral equation (EFIE). The case of perfectly conducting strip, circular and square cylinders are numerically analyzed and compared with the results from the standard method of moments (MoM).

Keywords: electric field integral equation, fast multipole method, method of moments, wave scattering, spectral domain

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Authors: Shashank Gahlaut, Chandrashekhar Sharan, J. P. Singh

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Increasing incidence of antibiotic-resistant bacteria is a big concern for the treatment of pathogenic diseases. The effect of treatment of patients with antibiotics often leads to the evolution of antibiotic resistance in the pathogens. The detection of antibiotic or antimicrobial resistant bacteria (microbes) is quite essential as it is becoming one of the big threats globally. Here we propose a novel technique to tackle this problem. We are taking a step forward to prevent the infections and diseases due to drug resistant microbes. This detection is based on some unique features of silver (a noble metal) nanorods (AgNRs) which are fabricated by a physical deposition method called thermal glancing angle deposition (GLAD). Silver nanorods are found to be highly sensitive and selective for hydrogen sulfide (H2S) gas. Color and water wetting (contact angle) of AgNRs are two parameters what are effected in the presence of this gas. H₂S is one of the major gaseous products evolved in the bacterial metabolic process. It is also known as gasotransmitter that transmits some biological singles in living systems. Nitric Oxide (NO) and Carbon mono oxide (CO) are two another members of this family. Orlowski (1895) observed the emission of H₂S by the bacteria for the first time. Most of the microorganism produce these gases. Here we are focusing on H₂S gas evolution to determine live/dead and antibiotic-resistant bacteria. AgNRs array has been used for the detection of H₂S from micro-organisms. A mobile app is also developed to make it easy, portable, user-friendly, and cost-effective.

Keywords: antibiotic resistance, hydrogen sulfide, live and dead bacteria, mobile app

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Authors: Sabiha Chouchane, Azzedine Hani, Jean-Paul Chopart, Alexandra Levesque

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The electrodeposition of Zn-Ni alloy is mostly studied for its high degree of corrosion and mechanical properties. In this work, the zinc–nickel alloy coatings elaborated from sulfate bath have been carried out under low and high applied magnetic field. The effect of alloy stuctural parameters upon corrosion behavior is studied. It has been found that the magnetically induced convection changes the phase composition, promoting the zinc phase in spite of the γ-Ni₅Zn₂₁. Low magnetic field acts also on the morphology of the deposits as a levelling agent and a refiner by lowering the deposit roughness Ra and the spot size. For alloy obtained with low magnetic field (up to 1T) superimposition, surface morphology modification has no significant influence on corrosion behavior whereas for low nickel content alloy, the modification of phase composition, induced by applied magnetic field, favours higher polarization resistance. When high magnetic field amplitude is involved (up to12T), the phase composition modifications are the same that for low applied B and the morphology is not largely modified. In this case, the hydrogen reduction current dramatically decreases that leads to a large shift of the corrosion potential. It is suggested that the surface reactivity of electrodeposited alloys depends on the magnetically induced convection that is efficient during the codeposition process.

Keywords: magnetic field, Zn-Ni alloy, corrosion, corrosive medium

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Authors: Bency Ann Massinello, Nancy Day, Janet Fellini

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Background: The use of an appropriate mode of communication among the multidisciplinary care team members regarding coordination of care is an extremely complicated yet important patient safety initiative. Effective communication among the team members(nursing staff, medical staff, respiratory therapists, rehabilitation therapists, patient-family services team…) become essential to develop a culture of trust and collaboration to deliver the highest quality care to patients are their families. The inpatient post-acute pediatrics, where children and their caregivers come for continuity of care, is no exceptions to the increasing use of text messages as a means to communication among clinicians. One such platform is the Vocera Communications (Vocera Smart Mobile App called Vocera Edge) allows the teams to use the application and share sensitive patient information through an encrypted platform using IOS company provided shared and assigned mobile devices. Objective: This paper discusses the quality initiative of implementing the transition from Vocera Smartbage to Vocera Edge Mobile App, technology advantage, use case expansion, and lessons learned about a secure alternative modality that allows sending and receiving secure text messages in a pediatric post-acute setting using an IOS device. This implementation process included all direct care staff, ancillary teams, and administrative teams on the clinical units. Methods: Our institution launched this transition from voice prompted hands-free Vocera Smartbage to Vocera Edge mobile based app for secure care team texting using a big bang approach during the first PDSA cycle. The pre and post implementation data was gathered using a qualitative survey of about 500 multidisciplinary team members to determine the ease of use of the application and its efficiency in care coordination. The technology was further expanded in its use by implementing clinical alerts and alarms notification using middleware integration with patient monitoring (Masimo) and life safety (Nurse call) systems. Additional use of the smart mobile iPhone use include pushing out apps like Lexicomp and Up to Date to have it readily available for users for evident-based practice in medication and disease management. Results: Successful implementation of the communication system in a shared and assigned model with all of the multidisciplinary teams in our pediatric post-acute setting. In just a 3-monthperiod post implementation, we noticed a 14% increase from 7,993 messages in 6 days in December 2020 to 9,116messages in March 2021. This confirmed that all clinical and non-clinical teams were using this mode of communication for coordinating the care for their patients. System generated data analytics used in addition to the pre and post implementation staff survey for process evaluation. Conclusion: A secure texting option using a mobile device is a safe and efficient mode for care team communication and collaboration using technology in real time. This allows for the settings like post-acute pediatric care areas to be in line with the widespread use of mobile apps and technology in our mainstream healthcare.

Keywords: nursing informatics, mobile secure texting, multidisciplinary communication, pediatrics post acute care

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Authors: A. Wahid Uddin

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Obstetric anal sphincter injury carries significant morbidity for a woman and affects the quality of life to the extent of permanent damage to anal sphincter musculature. The study was undertaken in a district general hospital by retrospectively reviewing random 63 case notes of patients diagnosed with a significant third or fourth-degree perineal tear admitted between the year of 2015 to 2018. The observations were collected by a pre-designed questionnaire. All variables were expressed as percentages. The major risk factors noted were nulliparity (37%), instrumental delivery (25%), and birth weight of more than 4 kg (14%). Forceps delivery with or without episiotomy was the major contributing factor (75%). In the majority of the cases (71%), no record of any perineal protection measures undertaken. The study concluded that recommended perineal protection measures should be adopted as a routine practise.

Keywords: forceps, obstetrics, perineal, sphincter

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Authors: Muhammad Waiz, Rana Maruf Tahir, Fatima Javaid

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Technology in the recent times is available for everyone in the world that no one is left behind. After getting technology into our daily routine, there is a need to study the different factors regarding online shopping. This study examines the impact of online reviews, mobile shopping and computer literacy on online purchasing intention. The sample size was 200 from which 167 complete questionnaires were collected from students and employees of twin cities. SPSS programming software was used to analyze the impact of different factors on purchasing intention. The results of this study showed that those websites which have good ratings and have online shopping application will attract more customers towards them whereas the results showed that the computer literacy has no impact on online purchasing intention. Findings may help for those who want to increase their sales or to start a new online business. Future research, limitations, and implications are discussed.

Keywords: computer literacy, mobile shopping, online purchase intention, online reviews, theory of planned behavior

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Authors: Desmond Wade, Alfredo Ormazabal

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Background: Ever since it commenced its registration process of pre-hospital practitioners in the year 2000 through the Irish Government Statute Instrument (SI 109 of 2000) process, the approach to education of its professionals has changed drastically. The progression from the traditional behaviouristic to the current constructivist approach has been based on experiences from other sectors and industries, nationally and internationally. Today, the delivery of a safe and efficient ambulance service heavily depends on its practitioners’ range of technical skills, academic knowledge, and overall competences. As these increase, so does the level of complexity of paramedics’ everyday practice. This has made it inevitable to consider the 'Human Factor' as a source of potential risk and made formative institutions like the National Ambulance Service College to include it in their curriculum. Methods: This paper used a mixed-method approach, where both, an online questionnaire and a set of semi-structured interviews were the source of primary data. An analysis of this data was carried out using qualitative and quantitative data analysis. Conclusions: The evidence presented leads to the conclusion that in the National Ambulance Service there is a considerable lack of education of Human Factors and the levels in understanding of how to manage Human Factors in practice vary across its spectrum. Paramedic Practitioners in Ireland seem to understand that the responsibility of patient care lies on the team, rather than on the most hierarchically senior practitioner present in the scene.

Keywords: human factors, ergonomics, stress, decision making, pre-hospital care, paramedic, education

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Authors: S. M. C. Kelly, M. Goulden

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Introduction: Chronic Pancreatitis is an increasing problem worldwide. Pain is the main symptom and the main reason for hospital readmission following diagnosis, despite the use of strong analgesics including opioids. Ketamine infusions reduce pain in complex regional pain syndrome and other neuropathic pain conditions. Our centre has trialed the use of ketamine infusions in patients with chronic pancreatitis. We have evaluated this service to assess whether ketamine reduces emergency department admissions and analgesia requirements. Methods: This study collected retrospective data from 2010 in all patients who received a ketamine infusion for chronic pain secondary to a diagnosis of chronic pancreatitis. The day-case ketamine infusions were initiated in theatre by an anaesthetist, with standard monitoring and the assistance of an anaesthetic practitioner. A bolus dose of 0.5milligrams/kilogram was given in theatre. The infusion of 0.5 milligrams/kilogram per hour was then administered over a 6 hour period in the theatre recovery area. A study proforma detailed the medical history, analgesic use and admissions to hospital. Patients received a telephone follow up consultation. Results: Over the last eight years, a total of 30 patients have received intravenous ketamine infusions, with a total of 92 ketamine infusions being administered. 53% of the patients were male with the average age of 47. A total of 27 patients participated with the telephone consultation. A third of patients reported a reduction in hospital admissions with pain following the ketamine infusion. Analgesia requirements were reduced by an average of 48.3% (range 0-100%) for an average duration of 69.6 days (range 0-180 days.) Discussion: This service evaluation illustrates that ketamine infusions can reduce analgesic requirements and the number of hospital admissions in patients with chronic pancreatitis. In the light of increasing pressures on Emergency departments and the increasing evidence of the dangers of long-term opioid use, this is clearly a useful finding. We are now performing a prospective study to assess the long-term effectiveness of ketamine infusions in reducing analgesia requirements and improving patient’s quality of life.

Keywords: acute-on-chronic pain, intravenous analgesia infusion, ketamine, pancreatitis

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