Search results for: hospital waste

Authors: Ryan Masoodi, Hossein Rostami

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Aluminum has been credited for the massive advancement of many industrial products, from aerospace and automotive to electronics and even household appliances. These developments have come with a cost, which is a toxic by-product. The rise of aluminum production has been accompanied by the rise of a waste material called Bauxite Residue or Red Mud. This toxic material has been proved to be harmful to the environment, yet, there is no proper way to dispose or recycle it. Herewith, a new experimental method to utilize this waste in the building material is proposed. A method to mix red mud, fly ash, and some other ingredients is explored to create a new construction material that can satisfy the minimum required strength for bricks. It concludes that it is possible to produce bricks with enough strength that is suitable for constriction in environments with low to moderate weather conditions.

Keywords: bauxite residue, brick, red mud, recycling

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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: Yanqing Yi, Maria Cristina Lavagnolo, Alessandro Manzardo

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Construction and demolition waste (C&DW) is a major challenge in the European Union, emphasizing the urgent need for appropriate waste management processes. Selecting these solutions is challenging, as it requires identifying efficient C&DW management techniques that balance acceptable practices, regulatory compliance, resource conservation, economic viability, and environmental concerns. Techniques for analyzing many kinds of criteria allow for the use of multi-criteria analysis in life cycle assessment (LCA). Although LCA is commonly used to analyze environmental effects, the economic factor has not been fully integrated into the LCA approach in C&DW management. The life cycle costing (LCC) approach was designed to assess economic performance in the C&DW management process. The choice of an effective multi-criteria decision-making (MCDM) technique is critical for the C&DW system. This study seeks to propose a model that employs MCDM by considering LCA and LCC results, thereby augmenting both environmental and economic sustainability. A widely used compensatory MCDM technique, TOPSIS, has been chosen to identify the most effective C&DW management scheme by comparing and ranking various scenarios. Four waste management alternatives were examined in the Lombardy region of Italy, namely, (i) landfill; (ii) recycling for concrete production and road construction, incineration with energy recovery; (iii) recycling for road construction; (iv) recycling for concrete production and road construction. We determine that, with the implementation of various scenarios, the most suitable scenario emerges to be recycled for concrete production and road construction, with a score of 0.711/1; recycling for road construction, with a final score of 0.291/1, ranks second; recycling for concrete production and road construction, incineration with energy recovery scores 0.002/1, ranks third; and landfill (scores: 0/1) is the worst choice, indicating it has the highest environmental impact. Finally, suggestions were developed to improve the system's environmental performance.

Keywords: life cycle assessment, life cycle costing, construction and demolition waste, multi-criteria decision making

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Authors: Sara Khan Mohammadi

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The world is facing a major challenge of feeding a growing population while ensuring the sustainability of food systems. The United Nations estimates that the global population will reach 9.7 billion by 2050, which means that food production needs to increase by 70% to meet the demand. However, this increase in food production should not come at the cost of environmental degradation, loss of biodiversity, and climate change. Therefore, there is a need for sustainable food systems that can provide healthy and nutritious food while minimizing their impact on the environment. Nutrition and Food Engineering: Nutrition and food engineering play a crucial role in promoting sustainable food system. Nutrition is concerned with the study of nutrients in foods, their absorption, metabolism, and their effects on health. Food engineering involves the application of engineering principles to design, develop, and optimize food processing operations. Together, nutrition and food engineering can help to create sustainable food systems by: 1. Developing Nutritious Foods: Nutritionists and food engineers can work together to develop foods that are rich in nutrients such as vitamins, minerals, fiber, and protein. These foods can be designed to meet the nutritional needs of different populations while minimizing waste. 2. Reducing Food Waste: Food waste is a major problem globally as it contributes to greenhouse gas emissions and wastes resources such as water and land. Nutritionists and food engineers can work together to develop technologies that reduce waste during processing, storage, transportation, and consumption. 3. Improving Food Safety: Unsafe foods can cause illnesses such as diarrhea, cholera, typhoid fever among others which are major public health concerns globally. Nutritionists and food engineers can work together to develop technologies that improve the safety of foods from farm to fork. 4. Enhancing Sustainability: Sustainable agriculture practices such as conservation agriculture can help reduce soil erosion while improving soil fertility. Nutritionists and food engineers can work together to develop technologies that promote sustainable agriculture practices.

Keywords: sustainable food, developing food, reducing food waste, food safety

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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: Serges Mendomo Meye, Li Guowei, Shen Zhenzhong, Gan Lei, Xu Liqun

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Due to the characteristics of high-heap and large-volume, the complex layers of waste and the high-water level of leachate, environmental pollution, and slope instability are easily produced. It is therefore of great significance to research the heterogeneous seepage field and stability of landfills. This paper focuses on the heterogeneous characteristics of the landfill piles and analyzes the seepage field and slope stability of the landfill using statistical and numerical analysis methods. The calculated results are compared with the field measurement and literature research data to verify the reliability of the model, which may provide the basis for the design, safe, and eco-friendly operation of the landfill. The main innovations are as follows: (1) The saturated-unsaturated seepage equation of heterogeneous soil is derived theoretically. The heterogeneous landfill is regarded as composed of infinite layers of homogeneous waste, and a method for establishing the heterogeneous seepage model is proposed. Then the formation law of the stagnant water level of heterogeneous landfills is studied. It is found that the maximum stagnant water level of landfills is higher when considering the heterogeneous seepage characteristics, which harms the stability of landfills. (2) Considering the heterogeneity weight and strength characteristics of waste, a method of establishing a heterogeneous stability model is proposed, and it is extended to the three-dimensional stability study. It is found that the distribution of heterogeneous characteristics has a great influence on the stability of landfill slope. During the operation and management of the landfill, the reservoir bank should also be considered while considering the capacity of the landfill.

Keywords: heterogeneous characteristics, leachate levels, saturated-unsaturated seepage, seepage field, slope stability

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Authors: M. Al-Saedi, A. Chegenizadeh, H. Nikraz

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Experimental investigations are conducted to assess a layered structure of glass (G) - rock (R) blends under the impact of repeated loading. Laboratory tests included sieve analyses, modified compaction test and repeated load triaxial test (RLTT) is conducted on different structures of stratified GR samples to reach the objectives of this study. Waste materials are such essential components in the climate system, and also commonly used in minimising the need for natural materials in many countries. Glass is one of the most widely used groups of waste materials which have been extensively using in road applications. Full range particle size and colours of glass are collected and mixed at different ratios with natural rock material trying to use the blends in pavement layers. Whole subsurface specimen sequentially consists of a single layer of R and a layer of G-R blend. 12G/88R and 45G/55R mix ratios are employed in this research, the thickness of G-R layer was changed, and the results were compared between the pure rock and the layered specimens. The relations between resilient module (Mr) and permanent deformation with sequence number are presented. During the earlier stages of RLTT, the results indicated that the 45G/55R specimen shows higher moduli than R specimen.

Keywords: Rock base course, Layered Structure, Glass, Resilient Modulus

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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: S. I. Usenko, V. N. Golubeva, I. A. Konopkina, I. V. Astakhova, O. V. Vakhnina, A. A. Korableva, A. A. Kalinina, K. B. Zhogova

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Gold can be determined in natural objects and manufactured articles of different origin. The up-to-date status of research and problems of high gold level determination in alloys and manufactured articles are described in detail in the literature. No less important is the task of this metal determination in minerals, process products and waste pieces. The latters, as objects of gold content chemical analysis, are most hard-to-study for two reasons: Because of high requirements to accuracy of analysis results and because of difference in chemical and phase composition. As a rule, such objects are characterized by compound, variable and very often unknown matrix composition that leads to unpredictable and uncontrolled effect on accuracy and other analytical characteristics of analysis technique. In this paper, the methods for the determination of gold are described, using flame atomic-absorption spectrophotometry and gravimetric analysis technique. The techniques are aimed at gold determination in a solution for gold etching (KJ+J2), in the technological mixture formed after cleaning stainless steel members of vacuum-deposit installation with concentrated nitric and hydrochloric acids as well as in gold-containing powder resulted from liquid wastes reprocessing. Optimal conditions for sample preparation and analysis of liquid and solid waste specimens of compound and variable matrix composition were chosen. The boundaries of relative resultant error were determined for the methods within the range of gold mass concentration from 0.1 to 30g/dm3 in the specimens of liquid wastes and mass fractions from 3 to 80% in the specimens of solid wastes.

Keywords: microelectronics waste pieces, gold, sample preparation, atomic-absorption spectrophotometry, gravimetric analysis technique

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Authors: B. S. Al-Tulaian, M. J. Al-Shannag, A. M. Al-Hozaimy

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The development of new construction materials using recycled plastic is important to both the construction and the plastic recycling industries. Manufacturing of fibers from industrial or post-consumer plastic waste is an attractive approach with such benefits as concrete performance enhancement, and reduced needs for land filling. The main objective of this study is to investigate the effect of plastic fibers obtained locally from recycled waste on plastic shrinkage cracking of ordinary cement based mortar. Parameters investigated include: Fiber length ranging from 20 to 50 mm, and fiber volume fraction ranging from 0% to 1.5% by volume. The test results showed significant improvement in crack arresting mechanism and substantial reduction in the surface area of cracks for the mortar reinforced with recycled plastic fibers compared to plain mortar. Furthermore, test results indicated that there was a slight decrease in compressive strength of mortar reinforced with different lengths and contents of recycled fibers compared to plain mortar. This study suggests that adding more than 1% of RP fibers to mortar, can be used effectively for controlling plastic shrinkage cracking of cement based mortar, and thus results in waste reduction and resources conservation.

Keywords: mortar, plastic, shrinkage cracking, compressive strength, RF recycled fibers

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Authors: Ariana Kilic, Serena Arapyan

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Water pollution is a serious concern in all seas around the world and one major cause of it is dye textile wastes mixing with seawater. This common incident alters aquatic life, putting organisms’ lives in danger and deteriorating the water's nature. There is a significant need for a natural approach to reduce the amount of dye textile waste in seawater and ensure marine organisms' safety. Consequently, using marine algae is a viable solution since it can eliminate the excess waste by absorbing the dye. Also, marine algae are non-vascular that absorb water and nutrients, meaning that having them as absorbers is a natural process and no inorganic matters will be added to the seawater that could result in further pollution. To test the efficiency of this approach, the optical absorbance of the seawater samples was measured before and after the addition of marine algae by utilizing colorimetry. A colorimeter is used to find the concentration of a chemical compound in a solution by measuring the absorbance of the compound at a specific wavelength. Samples of seawater that have equal amounts of water were used and textile dye was added as the constant variables. The initial and final absorbances, the dependent variable, of the water were measured before and after the addition of marine algae, the independent variable, and observed. The lower the absorbance showed us that there is lower dye concentration and therefore, the marine algae had done its job by using and absorbing the dye. The same experiment was repeated with same amount of water but with different concentrations of dye in order to determine the maximum concentration of dye the marine algae can completely absorb. The diminished concentration of dye demonstrated that pollution caused by factories’ dye wastes could be prevented with the natural method of marine algae. The involvement of marine algae is an optimal strategy for having an organic solution to absorbing the dye wastes in seas and obstructing water pollution.

Keywords: water pollution, dye textile waste, marine algae, absorbance, colorimetry

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Authors: Shashi Arya, Nand L. Singh, Samiksha Singh, Pradeep K. Mishra, Siddh N. Upadhyay

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The enormous generation of E- waste and its recycling have greater environmental concern especially in developing countries like India. A major part of this waste comprises printed circuit boards (PCBs). Edge trims of PCBs have high copper content ranging between 25-60%. The extraction of various metals out of these PCBs is more or less a proven technology, wherein various hazardous chemicals are being used in the resource recovery, resulting into secondary pollution. The current trend of extracting of valuable metals is the utilization of microbial strains to eliminate the problem of a secondary pollutant. Keeping the above context in mind, this work aims at the enhanced recovery of copper from edge trims, through bioleaching using bacterial strain Acidithiobacillus ferrooxidans. The raw material such as motherboards, hard drives, floppy drives and DVD drives were obtained from the warehouse of the University. More than 90% copper could be extracted through bioleaching using Acidithiobacillus ferrooxidans. Inoculate concentration has merely insignificant effect over copper recovery above 20% inoculate concentration. Higher concentration of inoculation has the only initial advantage up to 2-4 days. The complete recovery has been obtained between 14- 24 days.

Keywords: acidithiobacillus ferrooxidans, bioleaching, e-waste, printed circuit boards

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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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Authors: Adeiza Matthew, Oluwamishola Abubakar

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In conclusion, Fuelwood is a traditional and renewable source of energy that can have both positive and negative impacts. Adopting sustainable practices for its collection, transportation, and use and investing in renewable technologies can help mitigate the negative effects and provide a clean and reliable source of energy, improve living standards and support economic development. For example, solar energy can be used to generate electricity, heat homes and water, and can even be used for cooking. Wind energy can be used to generate electricity, and geothermal energy can be used for heating and cooling. Biogas can be produced from waste products such as animal manure, sewage, and organic kitchen waste and can be used for cooking and lighting.

Keywords: calorific, BTU, wood moisture content, density of wood

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Authors: Maneesha Pahlani, Najmin Sultana

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A hospital is one of the most suitable places for acquiring an infection because it harbors a high population of virulent strains of microorganisms that may be resistant to antibiotics, especially the prevalence of Methicillin-Resistant Staphylococcus Aureus (MRSA) infections. The hospital-acquired infection has become a global challenge. In developed countries, healthcare-associated infections occur in 5-15% of hospitalized clients, affecting 9-37% of those admitted to intensive care units (ICU). A non-experimental descriptive study was conducted among 50 nursing officers working in a selected hospital in Bangalore to assess the nursing officers’ level of knowledge regarding the prevention and management of MRSA infections and to associate the pre-test knowledge mean scores of nursing officers with selected socio-demographic variables. Data was collected using a structured questionnaire consisting of socio-demographic data and a structured questionnaire on knowledge regarding the prevention and management of MRSA infections. The data was analyzed in terms of frequencies and percentages for the analysis of demographic variables and computing chi-square to determine the association between knowledge means scores and selected demographic variables. The study findings revealed that the nursing officer had an overall good level of knowledge (63.05%) regarding the prevention and management of MRSA infections, and there is no significant association found between the level of knowledge mean scores for prevention and management of MRSA infection with the selected socio-demographic variables. However, the categorization of knowledge items showed that the nursing officer must thoroughly receive education on correct guidance and information regarding MRSA infection control policy, including measures and practices on hygiene precautions and information regarding antibiotic resistance for effective nursing care to patients with MRSA infections. The conclusions drawn from the study findings showed that it is necessary that the nursing officer thoroughly receive education on correct guidance and information regarding MRSA infection control policy, including measures and practices on hygiene precautions and information regarding antibiotic resistance to provide effective nursing care to patients with MRSA infection as they constantly care for the patient who can be at risk for multi-drug resistance organisms to reduce the risk of MRSA infection in hospital care settings as well community settings.

Keywords: MRSA, nursing officers, knowledge, preventive and management

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Authors: Sarra Bouhallel, Sara Legbedj, Rima Messaoud, Sofia Saffarbatti

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In the context of global waste management and sustainable resource utilization, millets emerge as a vital yet underutilized cereal resource. Despite their exceptional nutritional profile and resilience to harsh environmental conditions, their potential remains largely untapped. This study aims to contribute to the valorization of seven Algerian pearl millet landraces (Pennisetum glaucum (L.) R. Br) from the southern region by focusing on the characterization of their starches. Utilizing both conventional wet milling, incorporating sodium azide as a microbial growth inhibitor, and a novel green technology—Ultrasound-assisted isolation, we explore avenues for enhancing the functional properties of these starches. Analysis of key functional properties such as swelling power and water solubility index reveals significant enhancements, particularly during heat treatment near the gelatinization temperature [70 - 80 °C]. Furthermore, our investigation into the influence of pre-treatment methods on isolated starches highlights the potential of Ultrasound-assisted isolation in reducing absorbency and water solubility compared to conventional methods. Through rigorous data analysis using SPSS software (Version 23), we ascertain the efficiency of Ultrasound-assisted isolation, underscoring its promising role in the valorization of pearl millet waste. This research not only sheds light on the functional properties of pearl millet starch but also underscores the imperative of sustainable waste management in harnessing the full potential of underutilized cereal resources.

Keywords: isolation, solubility, starch, swelling, ultrasound

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Authors: Najmin Sultana, Maneesha Pahlani

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A hospital is one of the most suitable places for acquiring an infection because it harbors a high population of virulent strains of microorganisms that may be resistant to antibiotics, especially the prevalence of Methicillin-Resistant Staphylococcus Aureus (MRSA) infections. The hospital-acquired infection has become a global challenge. In developed countries, healthcare-associated infections occur in 5-15% of hospitalized clients, affecting 9-37% of those admitted to intensive care units (ICU). A non-experimental descriptive study was conducted among 50 nursing officers working in a selected hospital in bengaluru to assess the nursing officers’ level of knowledge regarding the prevention and management of MRSA infections and to associate the pre-test knowledge mean scores of nursing officers with selected socio-demographic variables. Data was collected using a structured questionnaire consisting of socio-demographic data and a structured questionnaire on knowledge regarding the prevention and management of MRSA infections. The data was analyzed in terms of frequencies and percentages for the analysis of demographic variables and computing chi-square to determine the association between knowledge means scores and selected demographic variables. The study findings revealed that the nursing officer had an overall good level of knowledge (63.05%) regarding the prevention and management of MRSA infections, and there is no significant association found between the level of knowledge mean scores for prevention and management of MRSA infection with the selected socio-demographic variables. However, the categorization of knowledge items showed that the nursing officer must thoroughly receive education on correct guidance and information regarding MRSA infection control policy, including measures and practices on hygiene precautions and information regarding antibiotic resistance for effective nursing care to patients with MRSA infections. The conclusions drawn from the study findings showed that it is necessary that the nursing officer thoroughly receive education on correct guidance and information regarding MRSA infection control policy, including measures and practices on hygiene precautions and information regarding antibiotic resistance to provide effective nursing care to patients with MRSA infection as they constantly care for the patient who can be at risk for multi-drug resistance organisms to reduce the risk of MRSA infection in hospital care settings as well community settings.

Keywords: MRSA, knowledge, nursing officers', prevention and management

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Authors: Stafford Stewart, Hui Yu, Rominder Suri

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This paper publishes the results of the first known study conducted in urban Philadelphia waterways that simultaneously utilized anthropogenic chemical and biological markers to identify suitable indicators of untreated human waste and fecal pollution. A total of 13 outfall samples, 30 surface water samples, and 2 groundwater samples were analyzed for fecal contamination and untreated human waste using a suite of 25 chemical markers and 5 bio-markers. Pearson rank correlation tests were conducted to establish associations between the abundances of bio-markers and the concentrations of chemical markers. Results show that 16S rRNA gene of human-associated Bacteroidales (BacH) was very strongly correlated (0.76 – 0.97, p < 0.05) with labile chemical markers acetaminophen, cotinine, estriol, and urobilin. Likewise, human-specific F- RNA coliphages (F-RNA-II) and labile chemical markers, urobilin, ibuprofen, cotinine and estriol, were significantly correlated (0.77 – 0.95, p < 0.05). Similarly, a strong positive correlation (0.67 – 0.91, p < 0.05) was evident between the abundances of bio-markers BacH and F-RNA-II, and the concentrations of the conservative markers, trimethoprim, meprobamate, diltiazem, triclocarban, metformin, sucralose, gemfibrozil, sulfamethoxazole, and carbamazepine. Human mitochondrial DNA (MitoH) correlated moderately with labile markers nicotine and salicylic acid as well as with conservative markers metformin and triclocarban (0.31 – 0.47, p<0.05). This study showed that by associating chemical and biological markers, a robust technique was developed for fingerprinting source-specific untreated waste and fecal contamination in source waters.

Keywords: anthropogenic markers, bacteroidales, fecal pollution, source waters, wastewater

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Authors: Aneta Nitsch-Osuch, Katarzyna Zycinska, Ewa Gyrczuk, Agnieszka Topczewska-Cabanek, Kazimierz Wardyn

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Introduction: Influenza is an important clinical and epidemiological problem and should be considered as a possible nosocomial infection. The aim of the study was to determine the influenza vaccine coverage rates among Polish nurses and to find out drivers and barriers for influenza vaccination among this group of health care workers (HCWs). Material and methods: The self- fulfilled survey with 26 questions about the knowledge, perception, and influenza coverage rates was distributed among 461 nurses. Results: Only 15% of nurses were vaccinated against influenza in the consecutive seasons. The majority (75%) of the regularly vaccinated nurses were ambulatory careworkers. The difference between the number of vaccinated hospitals and ambulatory care nurses was statistically significant (p < 0.05). The main motivating factors for an influenza vaccination were: a fear of the illness and its complications (97%) and a free of charge vaccine available at the workplace (87%). Ambulatory care nurses more often declared that they were vaccinated mainly to protect themselves while hospital care nurses more often declared the will to protect their patients, these differences in the perception and attitudes to an influenza vaccination among hospital and ambulatory care nurses were statistically significant (p < 0.05). The main barriers for an influenza vaccination among the nursing staff were: a lack of reimbursement of the vaccine (95%), a lack of insufficient knowledge about the effectiveness, and safety of the influenza vaccine (54%). The ambulatory care nurses more often found influenza vaccination as the ethical duty compared to hospital care nurses (p < 0.05). Conclusions: The influenza vaccine coverage rates among the Polish nurses are low and must be improved in the future. More educational activities dedicated to HCWs may result in the increased awareness of influenza vaccination benefits for both medical professionals and patients.

Keywords: influenza, vaccination, nurses, ambulatory careworkers

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Authors: Nicholas Agyepong, Paul Gyan

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Inappropriate prescribing of antibiotic is a common healthcare concern globally resulted in an increased risk of adverse reactions and the emergence of antimicrobial resistance. The wrong antibiotic prescribing habits may lead to ineffective and unsafe treatment, worsening of disease condition, and thus increase in health care costs. The study was to examine the antibiotic prescribing pattern and associated risk factors at Regional Hospital in the Bono region of Ghana. A retrospective cross-sectional study was conducted to describe the current prescribing practices at the Hospital from January 2014 to December, 2021. A systematic random sampling method was used to select the participants for the study. STATA version 16 software was used for data management and analysis. Descriptive statistics and logistic regression analysis were used to analyze the data. Statistical significance set at p<0.05. Antibiotic consumption was equivalent to 11 per 1000 inhabitants consuming 1 DDD per day. Most common prescribed antibiotic was amoxicillin/clavulanic acid (14.39%) followed by erythromycin (11.44%), and ciprofloxacin (11.36%). Antibiotics prescription have been steadily increased over the past eight years (2014: n=59,280 to 2021: n=190,320). Prescribers above the age of 35 were more likely to prescribe antibiotics than those between the ages of 20 and 25 (COR=21.00; 95% CI: 1.78 – 48.10; p=0.016). Prescribers with at least 6 years of experience were also significantly more likely to prescribe antibiotics than those with at most 5 years of experience (COR=14.17; 95% CI: 2.39 – 84.07; p=0.004). Thus, the establishment of an antibiotic stewardship program in the hospitals is imperative, and further studies need to be conducted in other facilities to establish the national antibiotic prescription guideline.

Keywords: antibiotic, antimicrobial resistance, prescription, prescribers

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Authors: Kulwinder Singh Mann

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The innovative features of information system, known as Radiology Information System (RIS), for electronic medical records has shown a good impact in the hospital. The objective is to help and make their work easier; such as for a physician to access the patient’s data and for a patient to check their bill transparently. The interoperability of RIS with the other intra-hospital information systems it interacts with, dealing with the compatibility and open architecture issues, are accomplished by two novel mechanisms. The first one is the particular message handling system that is applied for the exchange of information, according to the Health Level Seven (HL7) protocol’s specifications and serves the transfer of medical and administrative data among the RIS applications and data store unit. The second one implements the translation of information between the formats that HL7 and Digital Imaging and Communication in Medicine (DICOM) protocols specify, providing the communication between RIS and Picture and Archive Communication System (PACS) which is used for the increasing incorporation of modern medical imaging equipment.

Keywords: RIS, PACS, HIS, HL7, DICOM, messaging service, interoperability, digital images

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Authors: B. A. Mir, Asim Malik

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Bottom ash is a by-product of the combustion process of coal in furnaces in the production of electricity in thermal power plants. In India, about 75% of total power is produced by using pulverized coal. The coal of India has a high ash content which leads to the generation of a huge quantity of bottom ash per year posing the dual problem of environmental pollution and difficulty in disposal. This calls for establishing strategies to use this industry by-product effectively and efficiently. However, its large-scale utilization is possible only in geotechnical applications, either alone or with soil. In the present investigation, bottom ash was collected from National Capital Power Station Dadri, Uttar Pradesh, India. Test samples of bottom ash admixed with 20% clayey soil were prepared and treated with different cement content by weight and subjected to various laboratory tests for assessing its suitability as an engineered construction material. This study has shown that use of 10% cement content is a viable chemical additive to enhance the mechanical properties of bottom ash, which can be used effectively as an engineered construction material in various geotechnical applications. More importantly, it offers an interesting potential for making use of an industrial waste to overcome challenges posed by bottom ash for a sustainable environment.

Keywords: bottom ash, environmental pollution, solid waste, sustainable environment, waste utilization

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Authors: E. P. Bhowmik, R. Singh

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Certain materials casually thrown away as by-product household waste, such as used tea leaves, used coffee remnants, eggshells, peanut husks, coconut coir, unwanted paper, and pencil shavings- have scope in the hidden properties that they offer as recyclable raw ingredients. This paper aims to explore and experiment with the sustainable potential of such disposed wastes, obtained from domestic and commercial backgrounds, that could otherwise contribute to the field of interior design if mass-collected and repurposed. Research has been conducted on available recorded methods of mass-collection, storage, and processing of such materials by certain brands, designers, and researchers, as well as the various application and angles possible with regards to re-usage. A questionnaire survey was carried out to understand the willingness of the demographics for efforts of the mass collection and their openness to such unconventional materials for interiors. An experiment was also conducted where the selected waste ingredients were used to create small samples that could be used as decorative panels. Comparisons were made for properties like color, smell, texture, relative durability, and weight- and accordingly, applications were suggested. The experiment, therefore, helped to propose to recycle of the common household as a potential surface finish for floors, walls, and ceilings, and even founding material for furniture and decor accessories such as pottery and lamp shades; for non-structural application in both residential and commercial interiors. Common by-product wastes often see their ends at landfills- laymen unaware of their sustainable possibilities dispose of them. However, processing these waste materials and repurposing them by incorporating them into interiors would serve as a sustainable alternative to ethical dilemmas in the construction of interior design/architecture elements.

Keywords: interior materials, mass-collection, sustainable, waste recycle

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Authors: Thampi Rawther, Jack Cecire, Andrew Sutherland

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Introduction: CT facilitates the diagnosis of potentially life-threatening injuries and facilitates early management. There is evidence that reduced CT acquisition time reduces mortality and length of hospital stay. Currently, there are variable recommendations for ideal timing. Indeed, the NHS standard contract for a major trauma service and STAG both recommend immediate access to CT within a maximum time of 60min and appropriate reporting within 60min of the scan. At Coffs Harbour Health Campus (CHHC), a CT radiographer is on site between 8am-11pm. Aim: To investigate the average time to CT at CHHC and assess for any significant relationship between time to CT and injury severity score (ISS) or time of triage. Method: All major trauma calls between Jan 2021-Oct 2021 were audited (N=87). Patients were excluded if they went from ED to the theatre. Time to CT is defined as the time between triage to the timestamp on the first CT image. Median and interquartile range was used as a measure of central tendency as the data was not normally distributed, and Chi-square test was used to determine association. Results: The median time to CT is 51.5min (IQR 40-74). We found no relationship between time to CT and ISS (P=0.18) and time of triage to time to CT (P=0.35). We compared this to other centres such as John Hunter Hospital and Gold Coast Hospital. We found that the median CT acquisition times were 76min (IQR 52-115) and 43min, respectively. Conclusion: This shows an avenue for improvement given 35% of CT’s were >30min. Furthermore, being proactive and aware of time to CT as an important factor to trauma management can be another avenue for improvement. Based on this, we will re-audit in 12-24months to assess if any improvement has been made.

Keywords: imaging, rural surgery, trauma surgery, improvement

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Authors: Taufik Hidayat, Yudha Nurhantari, Bambang U. D. Rianto

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Introduction: The examination of the Short Tandem Repeats (STR) locus on nuclear DNA is very useful in solving the paternity cases. The purpose of this study is to know the description of paternity cases and paternity index/probability of paternity analysis based on Indonesian allele frequency at Sardjito Hospital Yogyakarta. Method: This was an observational study with cross-sectional analytic method. Population and sample were all cases of disputed paternity from January 2011 to June 2015 that fulfill the inclusion and exclusion criteria and were examined at Forensic Medicine Unit of Sardjito Hospital, Medical Faculty of Gadjah Mada University. The paternity index was calculated with EasyDNA Program by Fung (2013). Analysis of the study was conducted by comparing the results through unpaired categorical test using Kolmogorov-Smirnov test. This study was designed with 95% confidence interval (CI) with α = 5% and significance level is p < 0,05. Results: From 42 disputed paternity cases we obtained trio paternity cases were 32 cases (76.2%) and duo without a mother was 10 cases (23.8%). The majority of the fathers' estimated ages were 21-30 years (33.3%) and the mother's age was 31-40 years (38.1%). The majority of the ages of children examined for paternity were under 12 months (47.6%). The majority of ethnic clients are Javanese. Conclusion of inclusion was 57.1%, and exclusion was 42.9%. The Kolmogorov-Smirnov test obtained p-value = 0.673. Conclusion: There is no significant difference between paternity index/probability of paternity based on Indonesian allele frequency between trio and duo of paternity.

Keywords: disputed paternity, paternity index, probability of paternity, short tandem

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Authors: Tess Howard, Lily Owens, Maneesha De Silva, Russell Hodgson

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Purpose: This study aims to evaluate the cost-effectiveness of laparoscopic common bile duct exploration (CBDE) compared to endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy for the emergency management of common bile duct (CBD) stones. Methodology: A retrospective case note review was conducted on consecutive patients undergoing emergency management of CBD stones using either CBDE, or ERCP and cholecystectomy at a single centre between January 2014-October 2014. Data on admission and procedural costs, length of hospital stay, postoperative complications and further stone related interventions were analysed. Results: A total of 350 patients were analysed. Among them, 299 patients underwent CBDE at the time of cholecystectomy, while the remaining 51 underwent ERCP either pre-, intra- or post cholecystectomy. CBDE was associated with lower overall costs compared to ERCP with an average hospital stay cost of $13,093 vs $22,930 respectively. This was largely attributed to shorter hospital stays (6.5 vs 10.3 days), decreased need for intensive care unit admission and fewer postoperative interventions within the CBDE group. Notably, single procedure laparoscopic cholecystectomy with CBDE demonstrated decreased operative costs compared to laparoscopic cholecystectomy combined with ERCP pre-/intra- or post-operatively ($3,747 vs. $4,641). Conclusion: Emergent CBDE is a cost-effective alternative to ERCP for managing CBD stones when combined with cholecystectomy. The upfront investment in equipment for CBDE and increased cholecystectomy procedural time is counterbalanced by reduced hospital stay, fewer procedures and subsequent cost savings. Economic considerations, in conjunction with clinical outcomes, should inform the selection of the optimal approach for CBD stone management in emergency settings.

Keywords: choledocolithiasis, management, cost-effectiveness, endoscopic retrograde cholangiopancreatography, ERCP, CBDE, common bile duct exploration

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Authors: Guo Yan

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Clothing recycling bin is a traditional way to collect textile waste in many areas. In the clothing recycling business, the transportation cost normally takes over 50% of total costs. This case gives a good way to reduce transportation cost by reverse logistics system. In this reverse logistics system, there are offline strategic alliance partners, such as transport firms, convenience stores, laundries, and post office which are integrated onto the mobile APP. Offline strategic alliance partners provide the service of textile waste collection, and transportation by their vacant vehicles return journey from convenience stores, laundries and post offices to sorting centers. The results of the case study provide the strategic alliance with a valuable and light - asset business model by using the logistics of offline memberships. The company in this case just focuses on textile waste sorting, reuse, recycling etc. The research method of this paper is a case study of a clothing recycling company in Chengdu by field research and interview; the analysis is based on the theory of the reverse logistics system.

Keywords: closed-loop recycles system, clothing recycling, end-of-life clothing, sharing economy, strategic alliance, reverse logistics.

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