Search results for: surgical safety checklist
3341 Evaluation of Minimization of Moment Ratio Method by Physical Modeling
Authors: Amin Eslami, Jafar Bolouri Bazaz
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Under active stress conditions, a rigid cantilever retaining wall tends to rotate about a pivot point located within the embedded depth of the wall. For purely granular and cohesive soils, a methodology was previously reported called minimization of moment ratio to determine the location of the pivot point of rotation. The usage of this new methodology is to estimate the rotational stability safety factor. Moreover, the degree of improvement required in a backfill to get a desired safety factor can be estimated by the concept of the shear strength demand. In this article, the accuracy of this method for another type of cantilever walls called Contiguous Bored Pile (CBP) retaining wall is evaluated by using physical modeling technique. Based on observations, the results of moment ratio minimization method are in good agreement with the results of the carried out physical modeling.Keywords: cantilever retaining wall, physical modeling, minimization of moment ratio method, pivot point
Procedia PDF Downloads 3313340 Real World Cancer Pain Incidence and Treatment in Daily Hospital
Authors: Alexandru Grigorescu, Alexandra Protesanu
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Background: Approximately 34-67 percent of cancer patients experience an episode of uncontrolled pain during the course of their disease, depending on the stage. The aim is to provide evidence-based data for pain prevalence, diagnosis and treatment recommendations on an integrative model of medical oncology and palliative care for patients with cancer diagnostic in a day hospital. Patients and method: Consultation registers and electronic records of 166 Patients (Pts) were studied from April 2022 to March 2023. Pts with pain syndrome were selected. The pain was objectified by the visual pain scale. To elucidate the causes of the pain, investigations were carried out: bone scintigraphy, CT scan, and PET-CT. The analgesic treatments were represented by weak and strong morphine, radiotherapy, and bisphosphonates. Result: During the mentioned period, 166 oncological patients (74 women and 92 men) were treated in the oncology day hospitalization service. There were 1,500 consultations, 40 of which were only for pain. The neoplastic locations were: gynecological, malignant melanoma, breast, gastric, bronchopulmonary, colorectal, liver, pancreatic, bladder, and kidney. 70 Pts presented pain syndrome. The causes of the pain were represented by bone metastases, compressive tumors, and post-surgical status. Drug treatment: Tramadol 47 Pts, of which 10 switched to a major opioid (Oxycodonum, Morphine sulfate), 20 Pts were treated with Oxycodonum as the first intention. In 5 patients ry to rotated morphine, 20 Pts received palliative radiotherapy, 10 Pts were treated with bisphosphonates. 2 Pts required neurosurgery consultation for an antalgic intervention. 5 Pts had important adverse reactions to morphine. All patients and their families were advised by a medical oncologist and psychologist for a lifestyle change. Conclusions: The prevalence of pain was similar to that described in the literature. In most cases, the pain could be managed in the day hospital. Weak and strong morphine represented the main pain therapy. Palliative radiotherapy was the second most effective therapy. Treatment with bisphosphonates was useful. Surgical interventions were rarely indicated. Discussions with patients and their families regarding the lifestyle change were important.Keywords: cancer pain, opioids, medical oncology, palliative care
Procedia PDF Downloads 653339 Domestic and Foreign Terrorism: Evaluation of the Breeding Ground
Authors: T. K. Hung
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Terrorism acts have occurred across both developed and developing states, with well-identified motivation and causes. For many years, terrorism eradication has become a major topic yet only passive actions were taken in response to acts. The linkage between the location of terrorism occurrence and breeding ground is not well-documented, resulting in the passive approach used in counter-terrorism nowadays. The evaluation investigates all post-9/11 terrorism affairs considering their state capacity, safety, ease of border access control, religion diversity, and technology access, to measure the level of breeding ground of the states. Those "weak" states with poor border access control, resources capacity and domestic safety are the best breeding ground for terrorists. Although many attacks were caused by religious motivation, religion diversity does not predict the breeding ground. States with censored technology access, particular computer-mediated communication, predict on the terrorism breeding ground, moderated by the level of breeding ground of neighboring states.Keywords: counter-terrorism, lethality, security, terrorism
Procedia PDF Downloads 3403338 Slope Stability Assessment of Himalayan Slope under Static and Seismic Conditions
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Stability of slope in Chamoli Distt. near River Alaknanda in Uttarakhand is essential to safeguard the infrastructure of the slope where a dam is proposed to be built near this slope. Every year the areas near the slope have been facing severe landslides (small or big) due to intensive precipitation inflicting substantial damages as per Geological Survey of India records. The stability analysis of the slope under static and pseudo static conditions are presented in this study by using FEM software PHASE2. As per the earthquake zonation map of India, the slope is found in zone V, and hence, pseudo static stability of slope has been performed considering pseudo static analysis. For analysing the slope Mohr-Coulomb shear strength criteria is adopted for soil material and self-drilling anchors are modelled as bolts with parameters like modulus of elasticity, diameter of anchors and peak pull-out resistance of the anchors with the soil present there. The slope is found to be unstable under pseudo static conditions with computed factor of safety= 0.93. Stability is provided to the slope by using Self Drilling Anchors (SDA) which gives factor of safety= 1.15 under pseudo static condition.Keywords: FEM, pseudo static, self-drilling anchors, slope stability
Procedia PDF Downloads 2473337 Fluid Prescribing Post Laparotomies
Authors: Gusa Hall, Barrie Keeler, Achal Khanna
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Introduction: NICE guidelines have highlighted the consequences of IV fluid mismanagement. The main aim of this study was to audit fluid prescribing post laparotomies to identify if fluids were prescribed in accordance to NICE guidelines. Methodology: Retrospective database search of eight specific laparotomy procedures (colectomy right and left, Hartmann’s procedure, small bowel resection, perforated ulcer, abdominal perineal resection, anterior resection, pan proctocolectomy, subtotal colectomy) highlighted 29 laparotomies between April 2019 and May 2019. Two of 29 patients had secondary procedures during the same admission, n=27 (patients). Database case notes were reviewed for date of procedure, length of admission, fluid prescribed and amount, nasal gastric tube output, daily bloods results for electrolytes sodium and potassium and operational losses. Results: n=27 based on 27 identified patients between April 2019 – May 2019, 93% (25/27) received IV fluids, only 19% (5/27) received the correct IV fluids in accordance to NICE guidelines, 93% (25/27) who received IV fluids had the correct electrolytes levels (sodium & potassium), 100% (27/27) patients received blood tests (U&E’s) for correct electrolytes levels. 0% (0/27) no documentation on operational losses. IV fluids matched nasogastric tube output in 100% (3/3) of the number of patients that had a nasogastric tube in situ. Conclusion: A PubMed database literature review on barriers to safer IV prescribing highlighted educational interventions focused on prescriber knowledge rather than how to execute the prescribing task. This audit suggests IV fluids post laparotomies are not being prescribed consistently in accordance to NICE guidelines. Surgical management plans should be clearer on IV fluids and electrolytes requirements for the following 24 hours after the plan has been initiated. In addition, further teaching and training around IV prescribing is needed together with frequent surgical audits on IV fluid prescribing post-surgery to evaluate improvements.Keywords: audit, IV Fluid prescribing, laparotomy, NICE guidelines
Procedia PDF Downloads 1203336 Analysis of Truck Drivers’ Distraction on Crash Risk
Authors: Samuel Nderitu Muchiri, Tracy Wangechi Maina
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Truck drivers face a myriad of challenges in their profession. Enhancements in logistics effectiveness can be pivotal in propelling economic developments. The specific objective of the study was to assess the influence of driver distraction on crash risk. The study is significant as it elucidates best practices that truck drivers can embrace in an effort to enhance road safety. These include amalgamating behaviors that enable drivers to fruitfully execute multifaceted functions such as finding and following routes, evading collisions, monitoring speed, adhering to road regulations, and evaluating vehicle systems’ conditions. The analysis involved an empirical review of ten previous studies related to the research topic. The articles revealed that driver distraction plays a substantial role in road accidents and other crucial road security incidents across the globe. Africa depends immensely on the freight transport sector to facilitate supply chain operations. Several studies indicate that drivers who operate primarily on rural roads, such as those found in Sub-Saharan Africa, have an increased propensity to engage in distracted activities such as cell phone usage while driving. The findings also identified the need for digitalization in truck driving operations, including carrier management techniques such as fatigue management, artificial intelligence, and automating functions like cell phone usage controls. The recommendations can aid policymakers and commercial truck carriers in deepening their understanding of driver distraction and enforcing mitigations to foster road safety.Keywords: truck drivers, distraction, digitalization, crash risk, road safety
Procedia PDF Downloads 493335 Preliminary Short-Term Results of a Population of Patients Treated with Mitraclip Therapy: One Center Experience
Authors: Rossana Taravella, Gilberto M. Cellura, Giuseppe Cirrincione, Salvatore Asciutto, Marco Caruso, Massimo Benedetto, Renato Ciofalo, Giuliana Pace, Salvatore Novo
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Objectives: This retrospective analysis sought to evaluate 1-month outcomes and therapy effectiveness of a population of patients treated with MitraClip therapy. We describe in this article the preliminary results of primary effectiveness endpoint. Background: Percutaneous Mitral Repair is being developed to treat severe mitral regurgitation (MR), with increasing real-world cases of functional MR (FMR). In the EVEREST (Endovascular Valve Edge-to-Edge Repair Study)II trial, the percutaneous device showed superior safety but less reduction in MR at 1year. 4-year outcomes from EVEREST II trial showed no difference in the prevalence of moderate-severe and severe MR or mortality at 4years between surgical mitral repair and percutaneous approach. Methods: We analysed retrospectively collected data from one center experience in Italy enrolled from January 2011 to December 2016. The study included 62 patients [mean age 74±11years, 43 men (69%)] with MR of at least grade3+. Most of the patients had functional MR, were in New York Heart Association (NYHA) functional class III or IV, with a large portion (78%) of mild-to-moderate Tricuspid Regurgitation (TR). One or more clips were implanted in 67 procedures (62 patients). Results and Conclusions: Severity of MR was reduced in all successfully treated patients,54(90%) were discharged with MR≤2+ (primary effectiveness endpoint). Clinical 1-month follow-up data showed an improvement in NYHA functional class (42 patients (70%) in NYHA class I-II). 60 of 62 (97 %) successfully treated patients were free from death and mitral valve surgery at 1-month follow-up. MitraClip therapy reduces functional MR with acute MR reduction to <2+ in the great majority of patients, with a large freedom from death, surgery or recurrent MR in a great portion of patients.Keywords: MitraClip, mitral regurgitation, heart valves, catheter-based therapy
Procedia PDF Downloads 2953334 Mental Vulnerability and Coping Strategies as a Factor for Academic Success for Pupils with Special Education Needs
Authors: T. Dubayova
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Slovak, as well as foreign authors, believe that the influence of non-cognitive factors on a student's academic success or failure is unquestionable. The aim of this paper is to establish a link between the mental vulnerability and coping strategies used by 4th grade elementary school students in dealing with stressful situations and their academic performance, which was used as a simple quantitative indicator of academic success. The research sample consists of 320 students representing the standard population and 60 students with special education needs (SEN), who were assessed by the Strengths and Difficulties Questionnaire (SDQ) by their teachers and the Children’s Coping Strategies Checklist (CCSC-R1) filled in by themselves. Students with SEN recorded an extraordinarily high frequency of mental vulnerability (34.5 %) than students representing the standard population (7 %). The poorest academic performance of students with SEN was associated with the avoidance behavior displayed during stressful situations. Students of the standard population did not demonstrate this association. Students with SEN are more likely to display mental health problems than students of the standard population. This may be caused by the accumulation of and frequent exposure to situations that they perceive as stressful.Keywords: coping, mental vulnerability, pupil with special education needs, school performance, school success
Procedia PDF Downloads 3543333 Clinical Applications of Amide Proton Transfer Magnetic Resonance Imaging: Detection of Brain Tumor Proliferative Activity
Authors: Fumihiro Ima, Shinichi Watanabe, Shingo Maeda, Haruna Imai, Hiroki Niimi
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It is important to know growth rate of brain tumors before surgery because it influences treatment planning including not only surgical resection strategy but also adjuvant therapy after surgery. Amide proton transfer (APT) imaging is an emerging molecular magnetic resonance imaging (MRI) technique based on chemical exchange saturation transfer without administration of contrast medium. The underlying assumption in APT imaging of tumors is that there is a close relationship between the proliferative activity of the tumor and mobile protein synthesis. We aimed to evaluate the diagnostic performance of APT imaging of pre-and post-treatment brain tumors. Ten patients with brain tumor underwent conventional and APT-weighted sequences on a 3.0 Tesla MRI before clinical intervention. The maximum and the minimum APT-weighted signals (APTWmax and APTWmin) in each solid tumor region were obtained and compared before and after clinical intervention. All surgical specimens were examined for histopathological diagnosis. Eight of ten patients underwent adjuvant therapy after surgery. Histopathological diagnosis was glioma in 7 patients (WHO grade 2 in 2 patients, WHO grade 3 in 3 patients and WHO grade 4 in 2 patients), meningioma WHO grade1 in 2 patients and primary lymphoma of the brain in 1 patient. High-grade gliomas showed significantly higher APTW-signals than that in low-grade gliomas. APTWmax in one huge parasagittal meningioma infiltrating into the skull bone was higher than that in glioma WHO grade 4. On the other hand, APTWmax in another convexity meningioma was the same as that in glioma WHO grade 3. Diagnosis of primary lymphoma of the brain was possible with APT imaging before pathological confirmation. APTW-signals in residual tumors decreased dramatically within one year after adjuvant therapy in all patients. APT imaging demonstrated excellent diagnostic performance for the planning of surgery and adjuvant therapy of brain tumors.Keywords: amides, magnetic resonance imaging, brain tumors, cell proliferation
Procedia PDF Downloads 1393332 Complex Decision Rules in Quality Assurance Processes for Quick Service Restaurant Industry: Human Factors Determining Acceptability
Authors: Brandon Takahashi, Marielle Hanley, Gerry Hanley
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The large-scale quick-service restaurant industry is a complex business to manage optimally. With over 40 suppliers providing different ingredients for food preparation and thousands of restaurants serving over 50 unique food offerings across a wide range of regions, the company must implement a quality assurance process. Businesses want to deliver quality food efficiently, reliably, and successfully at a low cost that the public wants to buy. They also want to make sure that their food offerings are never unsafe to eat or of poor quality. A good reputation (and profitable business) developed over the years can be gone in an instant if customers fall ill eating your food. Poor quality also results in food waste, and the cost of corrective actions is compounded by the reduction in revenue. Product compliance evaluation assesses if the supplier’s ingredients are within compliance with the specifications of several attributes (physical, chemical, organoleptic) that a company will test to ensure that a quality, safe to eat food is given to the consumer and will deliver the same eating experience in all parts of the country. The technical component of the evaluation includes the chemical and physical tests that produce numerical results that relate to shelf-life, food safety, and organoleptic qualities. The psychological component of the evaluation includes organoleptic, which is acting on or involving the use of the sense organs. The rubric for product compliance evaluation has four levels: (1) Ideal: Meeting or exceeding all technical (physical and chemical), organoleptic, & psychological specifications. (2) Deviation from ideal but no impact on quality: Not meeting or exceeding some technical and organoleptic/psychological specifications without impact on consumer quality and meeting all food safety requirements (3) Acceptable: Not meeting or exceeding some technical and organoleptic/psychological specifications resulting in reduction of consumer quality but not enough to lessen demand and meeting all food safety requirements (4) Unacceptable: Not meeting food safety requirements, independent of meeting technical and organoleptic specifications or meeting all food safety requirements but product quality results in consumer rejection of food offering. Sampling of products and consumer tastings within the distribution network is a second critical element of the quality assurance process and are the data sources for the statistical analyses. Each finding is not independently assessed with the rubric. For example, the chemical data will be used to back up/support any inferences on the sensory profiles of the ingredients. Certain flavor profiles may not be as apparent when mixed with other ingredients, which leads to weighing specifications differentially in the acceptability decision. Quality assurance processes are essential to achieve that balance of quality and profitability by making sure the food is safe and tastes good but identifying and remediating product quality issues before they hit the stores. Comprehensive quality assurance procedures implement human factors methodologies, and this report provides recommendations for systemic application of quality assurance processes for quick service restaurant services. This case study will review the complex decision rubric and evaluate processes to ensure the right balance of cost, quality, and safety is achieved.Keywords: decision making, food safety, organoleptics, product compliance, quality assurance
Procedia PDF Downloads 1883331 The Consequences of Cyberbullying and School Violence: Risk and Protective Factors
Authors: Ifigenia Stylianou
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As more than three-quarters of students going online daily via computers, tablets, and smartphones, the phenomenon of cyberbullying is growing rapidly. Knowing that victims of online bullying are often also victims of traditional bullying and that traditional bullying is considered as an extension of cyberbullying. In this study, we aim to identify (1) whether cyberbullying lead to more intense forms of school bullying, and (2) whether some biological and environmental factors mediate between this relation, and act protectively to bullying and inappropriate behaviour in school. To answer this questions, a sample of X students, aged X, were asked to complete eight questionnaires (Personal Experiences Checklist, Inventory of Peers Attachment, Questionnaire on Teacher Interaction, School Climate Survey for Bullying, Strengths and Difficulties Questionnaire, Youth Psychopathic Traits Inventory-Short Form, Barratt Impulsiveness Scale-11) in X time periods. Results can provide us important information to improve understanding the factors that are related to bullying. In addition, the results can assist in developing intervention programs to tangle the issue of bullying at schools. All data have been collected and are currently being processed for statistical analyses.Keywords: cyberbullying, bullying, school climate, psychopathy traits, attachment, mediation factors
Procedia PDF Downloads 2333330 Microbiological Properties and Mineral Contents of Honeys from Bordj Bou Arreridj Region (Algeria)
Authors: Diafat Abdelouahab, Ekhalfi A Hammoudia, Meribai Abdelmalek A, Bahloul Ahmedb
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The present study aimed to characterize 30 honey samples from the Bordj Bou Arreridj region (Algeria) regarding their floral origins, physicochemical parameters, mineral composition and microbial safety. Mean values obtained for physicochemical parameters were: pH 4.11, 17.17% moisture, 0.0061% ash, 370.57μS cm−1 electrical conductivity, 21.98 meq/kg free acidity, and 9.703 mg/kg HMF. The mineral content was determined by atomic absorption spectrometry. The mean values obtained were (mg/kg): Fe, 7.5714; Mg, 37.68; Na, 186,63; Zn, 3,86; Pb, 0,4869 × 10-3 ; Cd, 267 × 10-3. Aerobic mesophiles, fecal coliforms and sulphite-reducing clostridia were the microbial contaminants of interest studied. Microbiologically, the honey quality was considered good and all samples showed to be negative in respect to safety parameters. The results obtained for physicochemical characteristics of Bordj Bou Arreridj honey indicate a good quality level, adequate processing, good maturity and freshness.Keywords: pollen analysis, physicochemical analysis, mineral content, microbial contaminants
Procedia PDF Downloads 893329 Antimicrobial Activity of Fatty Acid Salts against Microbes for Food Safety
Authors: Aya Tanaka, Mariko Era, Manami Masuda, Yui Okuno, Takayoshi Kawahara, Takahide Kanyama, Hiroshi Morita
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Objectives— Fungi and bacteria are present in a wide range of natural environments. They are breed in the foods such as vegetables and fruit, causing corruption and deterioration of these foods in some cases. Furthermore, some species of fungi and bacteria are known to cause food intoxication or allergic reactions in some individuals. To prevent fungal and bacterial contamination, various fungicides and bactericidal have been developed that inhibit fungal and bacterial growth. Fungicides and bactericides must show high antifungal and antibacterial activity, sustainable activity, and a high degree of safety. Therefore, we focused on the fatty acid salt which is the main component of soap. We focused on especially C10K and C12K. This study aimed to find the effectiveness of the fatty acid salt as antimicrobial agents for food safety. Materials and Methods— Cladosporium cladosporioides NBRC 30314, Penicillium pinophilum NBRC 6345, Aspergillus oryzae (Akita Konno store), Rhizopus oryzae NBRC 4716, Fusarium oxysporum NBRC 31631, Escherichia coli NBRC 3972, Bacillus subtilis NBRC 3335, Staphylococcus aureus NBRC 12732, Pseudomonas aenuginosa NBRC 13275 and Serratia marcescens NBRC 102204 were chosen as tested fungi and bacteria. Hartmannella vermiformis NBRC 50599 and Acanthamoeba castellanii NBRC 30010 were chosen as tested amoeba. Nine fatty acid salts including potassium caprate (C10K) and laurate (C12K) at 350 mM and pH 10.5 were used as antifungal activity. The spore suspension of each fungus (3.0×10⁴ spores/mL) or the bacterial suspension (3.0×10⁵ or 3.0×10⁶ or 3.0×10⁷ CFU/mL) was mixed with each of the fatty acid salts (final concentration of 175 mM). Samples were counted at 0, 10, 60, and 180 min by plating (100 µL) on potato dextrose agar or nutrient agar. Fungal and bacterial colonies were counted after incubation for 1 or 2 days at 30 °C. Results— C10K was antifungal activity of 4 log-unit incubated time for 10 min against fungi other than A. oryzae. C12K was antifungal activity of 4 log-unit incubated time for 10 min against fungi other than P. pinophilum and A. oryzae. C10K and C12K did not show high anti-yeast activity. C10K was antibacterial activity of 6 or 7 log-unit incubated time for 10 min against bacteria other than B. subtilis. C12K was antibacterial activity of 5 to 7 log-unit incubated time for 10 min against bacteria other than S. marcescens. C12K was anti-amoeba activity of 4 log-unit incubated time for 10 min against H. vermiformis. These results suggest C10K and C12K have potential in the field of food safety.Keywords: food safety, microbes, antimicrobial, fatty acid salts
Procedia PDF Downloads 4853328 Antiinflammatory and Wound Healing Activity of Sedum Essential Oils Growing in Kazakhstan
Authors: Dmitriy Yu. Korulkin, Raissa A. Muzychkina
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The last decade the growth of severe and disseminated forms of inflammatory diseases is observed in Kazakhstan, in particular, septic shock, which progresses on 3-15% of patients with infectious complications of postnatal period. In terms of the rate of occurrence septic shock takes third place after hemorrhagic and cardiovascular shock, in terms of lethality it takes first place. The structure of obstetric sepsis has significantly changed. Currently the first place is taken by postabortive sepsis (40%) that is connected with usage of imperfect methods of artificial termination of pregnancy in late periods (intraamnial injection of sodium chloride, glucose). The second place is taken by postnatal sepsis (32%); the last place is taken by septic complications of caesarean section (28%). In this connection, search for and assessment of effectiveness of new medicines for treatment of postoperative infectious complications, having biostimulating effect and speeding up regeneration processes, is very promising and topical. Essential oil was obtained by the method hydrodistillation air-dry aerial part of Sedum L. plants using Clevenger apparatus. Pilot batch of plant medicinal product based on Sedum essential oils was produced by Chimpharm JSC, Santo Member of Polpharma Group (Kazakhstan). During clinical test of the plant medicinal product based on Sedum L. essential oils 37 female patients at the age from 35 to 57 with clinical signs of complicated postoperative processes and 12 new mothers with clinical signs of inflammatory process on sutures on anterior abdominal wall after caesarean section and partial disruption of surgical suture line on perineum were examined. Medicine usage methods - surgical wound treatment 2 times a day, treatment with other medicines of local action was not performed. Before and after treatment general clinical test, determination of immune status, bacterioscopic test of wound fluid was performed to all women, medical history data was taken into account, wound cleansing and healing time, full granulations, side effects and complications, satisfaction with the used medicine was assessed. On female patients with inflammatory infiltration and partial disruption of surgical suture line anesthetic wound healing effect of plant medicinal product based on Sedum L. essential oils was observed as early as on the second day after beginning of using it, wound cleansing took place, as a rule, within the first row days. Hyperemia in the area of suture line also was not observed for 2-3-d day of usage of medicine, good constant course was observed. The absence of clinical effect on this group of patients was not registered. The represented data give evidence of that clinical effect was accompanied with normalization of changed laboratory findings. No allergic responses or side effects were observed during usage of the plant medicinal products based on Sedum L. essential oils.Keywords: antiinflammatory, bioactive substances, essential oils, isolation, sedum L., wound healing
Procedia PDF Downloads 2683327 Clinical Applications of Amide Proton Transfer Magnetic Resonance Imaging: Detection of Brain Tumor Proliferative Activity
Authors: Fumihiro Imai, Shinichi Watanabe, Shingo Maeda, Haruna Imai, Hiroki Niimi
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It is important to know the growth rate of brain tumors before surgery because it influences treatment planning, including not only surgical resection strategy but also adjuvant therapy after surgery. Amide proton transfer (APT) imaging is an emerging molecular magnetic resonance imaging (MRI) technique based on chemical exchange saturation transfer without the administration of a contrast medium. The underlying assumption in APT imaging of tumors is that there is a close relationship between the proliferative activity of the tumor and mobile protein synthesis. We aimed to evaluate the diagnostic performance of APT imaging of pre-and post-treatment brain tumors. Ten patients with brain tumor underwent conventional and APT-weighted sequences on a 3.0 Tesla MRI before clinical intervention. The maximum and the minimum APT-weighted signals (APTWmax and APTWmin) in each solid tumor region were obtained and compared before and after a clinical intervention. All surgical specimens were examined for histopathological diagnosis. Eight of ten patients underwent adjuvant therapy after surgery. Histopathological diagnosis was glioma in 7 patients (WHO grade 2 in 2 patients, WHO grade 3 in 3 patients, and WHO grade 4 in 2 patients), meningioma WHO grade 1 in 2 patients, and primary lymphoma of the brain in 1 patient. High-grade gliomas showed significantly higher APTW signals than that low-grade gliomas. APTWmax in one huge parasagittal meningioma infiltrating into the skull bone was higher than that in glioma WHO grade 4. On the other hand, APTWmax in another convexity meningioma was the same as that in glioma WHO grade 3. Diagnosis of primary lymphoma of the brain was possible with APT imaging before pathological confirmation. APTW signals in residual tumors decreased dramatically within one year after adjuvant therapy in all patients. APT imaging demonstrated excellent diagnostic performance for the planning of surgery and adjuvant therapy of brain tumors.Keywords: amides, magnetic resonance imaging, brain tumors, cell proliferation
Procedia PDF Downloads 863326 An Explorative Research on the Electric and Electronic Officers Employment: Turkish Flagged Ship's Perspective
Authors: Mehmet Yahsi, Ozkan Ugurlu, Ercan Yuksekyildiz
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Assistant department among the electric and electronic officers on ships, has an important place for the maintenance of electric and electronic devices. From this perspective, ships must be employed with a sufficient number of assistant department. In this study, in order to research on the Turkish-flagged ships electric and electronic officers employment; Our national manning regulation compared with international regulations. The data used in this study were collected via visiting of the ships. 3000 gross tonnage and above engaged in international voyages 181 Turkish-flagged ship’s crew lists were compared with Minimum Safety Manning Certificates. According to the findings; employment rate, %54 electric and electronic officers. According to the results of the study; Turkish-flagged ships, although it is not obliged to electric and electronic officers, were employed on ships.Keywords: manning, electric officer, electronic officer, minimum safety manning certificate
Procedia PDF Downloads 4333325 Steady State Natural Convection in Vertical Heated Rectangular Channel between Two Vertical Parallel MTR-Type Fuel Plates
Authors: Djalal Hamed
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The aim of this paper is to perform an analytic solution of steady state natural convection in a narrow rectangular channel between two vertical parallel MTR-type fuel plates, imposed under a cosine shape heat flux to determine the margin of the nuclear core power at which the natural convection cooling mode can ensure a safe core cooling, where the cladding temperature should not be reach the specific safety limits (90 °C). For this purpose, a simple computer program is developed to determine the principal parameter related to the nuclear core safety such as the temperature distribution in the fuel plate and in the coolant (light water) as a function of the reactor power. Our results are validated throughout a comparison against the results of another published work, which is considered like a reference of this study.Keywords: buoyancy force, friction force, natural convection, thermal hydraulic analysis, vertical heated rectangular channel
Procedia PDF Downloads 3163324 Research on Development and Accuracy Improvement of an Explosion Proof Combustible Gas Leak Detector Using an IR Sensor
Authors: Gyoutae Park, Seungho Han, Byungduk Kim, Youngdo Jo, Yongsop Shim, Yeonjae Lee, Sangguk Ahn, Hiesik Kim, Jungil Park
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In this paper, we presented not only development technology of an explosion proof type and portable combustible gas leak detector but also algorithm to improve accuracy for measuring gas concentrations. The presented techniques are to apply the flame-proof enclosure and intrinsic safe explosion proof to an infrared gas leak detector at first in Korea and to improve accuracy using linearization recursion equation and Lagrange interpolation polynomial. Together, we tested sensor characteristics and calibrated suitable input gases and output voltages. Then, we advanced the performances of combustible gaseous detectors through reflecting demands of gas safety management fields. To check performances of two company's detectors, we achieved the measurement tests with eight standard gases made by Korea Gas Safety Corporation. We demonstrated our instruments better in detecting accuracy other than detectors through experimental results.Keywords: accuracy improvement, IR gas sensor, gas leak, detector
Procedia PDF Downloads 3913323 Influence of Deficient Materials on the Reliability of Reinforced Concrete Members
Authors: Sami W. Tabsh
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The strength of reinforced concrete depends on the member dimensions and material properties. The properties of concrete and steel materials are not constant but random variables. The variability of concrete strength is due to batching errors, variations in mixing, cement quality uncertainties, differences in the degree of compaction and disparity in curing. Similarly, the variability of steel strength is attributed to the manufacturing process, rolling conditions, characteristics of base material, uncertainties in chemical composition, and the microstructure-property relationships. To account for such uncertainties, codes of practice for reinforced concrete design impose resistance factors to ensure structural reliability over the useful life of the structure. In this investigation, the effects of reductions in concrete and reinforcing steel strengths from the nominal values, beyond those accounted for in the structural design codes, on the structural reliability are assessed. The considered limit states are flexure, shear and axial compression based on the ACI 318-11 structural concrete building code. Structural safety is measured in terms of a reliability index. Probabilistic resistance and load models are compiled from the available literature. The study showed that there is a wide variation in the reliability index for reinforced concrete members designed for flexure, shear or axial compression, especially when the live-to-dead load ratio is low. Furthermore, variations in concrete strength have minor effect on the reliability of beams in flexure, moderate effect on the reliability of beams in shear, and sever effect on the reliability of columns in axial compression. On the other hand, changes in steel yield strength have great effect on the reliability of beams in flexure, moderate effect on the reliability of beams in shear, and mild effect on the reliability of columns in axial compression. Based on the outcome, it can be concluded that the reliability of beams is sensitive to changes in the yield strength of the steel reinforcement, whereas the reliability of columns is sensitive to variations in the concrete strength. Since the embedded target reliability in structural design codes results in lower structural safety in beams than in columns, large reductions in material strengths compromise the structural safety of beams much more than they affect columns.Keywords: code, flexure, limit states, random variables, reinforced concrete, reliability, reliability index, shear, structural safety
Procedia PDF Downloads 4303322 Case Study of Human Factors and Ergonomics in the Design and Use of Harness-Embedded Costumes in the Entertainment Industry
Authors: Marielle Hanley, Brandon Takahashi, Gerry Hanley, Gabriella Hancock
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Safety harnesses and their protocols are very common within the construction industry, and the Occupational Safety and Health Administration has provided extensive guidelines with protocols being constantly updated to ensure the highest level of safety within construction sites. There is also extensive research on harnesses that are meant to keep people in place in moving vehicles, such as seatbelts. Though this research is comprehensive in these areas, the findings and recommendations are not generally applicable to other industry sectors where harnesses are used, such as the entertainment industry. The focus of this case study is on the design and use of harnesses used by theme park employees wearing elaborate costumes in parades and performances. The key factors of posture, kinesthetic factors, and harness engineering interact in significantly different ways when the user is performing repetitive choreography with 20 to 40 lbs. of apparatus connected to harnesses that need to be hidden from the audience’s view. Human factors and ergonomic analysis take into account the required performers’ behaviors, the physical and mental preparation and posture of the performer, the design of the harness-embedded costume, and the environmental conditions during the performance (e.g., wind) that can determine the physical stresses placed on the harness and performer. The uniqueness and expense of elaborate costumes frequently result in one or two costumes created for production, and a variety of different performers need to fit into the same costume. Consequently, the harnesses should be adjustable if they are to minimize the physical and cognitive loads on the performer, but they are frequently more a “one-size fits all”. The complexity of human and technology interactions produces a range of detrimental outcomes, from muscle strains to nerve damage, mental and physical fatigue, and reduced motivation to perform at peak levels. Based on observations conducted over four years for this case study, a number of recommendations to institutionalize the human factors and ergonomic analyses can significantly improve the safety, reliability, and quality of performances with harness-embedded costumes in the entertainment industry. Human factors and ergonomic analyses can be integrated into the engineering design of the performance costumes with embedded harnesses, the conditioning and training of the performers using the costumes, the choreography of the performances within the staged setting and the maintenance of the harness-embedded costumes. By applying human factors and ergonomic methodologies in the entertainment industry, the industry management and support staff can significantly reduce the risks of injury, improve the longevity of unique performers, increase the longevity of the harness-embedded costumes, and produce the desired entertainment value for audiences.Keywords: ergonomics in entertainment industry, harness-embedded costumes, performer safety, injury prevention
Procedia PDF Downloads 903321 Management of Acute Appendicitis with Preference on Delayed Primary Suturing of Surgical Incision
Authors: N. A. D. P. Niwunhella, W. G. R. C. K. Sirisena
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Appendicitis is one of the most encountered abdominal emergencies worldwide. Proper clinical diagnosis and appendicectomy with minimal post operative complications are therefore priorities. Aim of this study was to ascertain the overall management of acute appendicitis in Sri Lanka in special preference to delayed primary suturing of the surgical site, comparing other local and international treatment outcomes. Data were collected prospectively from 155 patients who underwent appendicectomy following clinical and radiological diagnosis with ultrasonography. Histological assessment was done for all the specimens. All perforated appendices were managed with delayed primary closure. Patients were followed up for 28 days to assess complications. Mean age of patient presentation was 27 years; mean pre-operative waiting time following admission was 24 hours; average hospital stay was 72 hours; accuracy of clinical diagnosis of appendicitis as confirmed by histology was 87.1%; post operative wound infection rate was 8.3%, and among them 5% had perforated appendices; 4 patients had post operative complications managed without re-opening. There was no fistula formation or mortality reported. Current study was compared with previously published data: a comparison on management of acute appendicitis in Sri Lanka vs. United Kingdom (UK). The diagnosis of current study was equally accurate, but post operative complications were significantly reduced - (current study-9.6%, compared Sri Lankan study-16.4%; compared UK study-14.1%). During the recent years, there has been an exponential rise in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. Even though, the diagnostic accuracy without using CT, and treatment outcome of acute appendicitis in this study match other local studies as well as with data compared to UK. Therefore CT usage has not increased the diagnostic accuracy of acute appendicitis significantly. Especially, delayed primary closure may have reduced post operative wound infection rate for ruptured appendices, therefore suggest this approach for further evaluation as a safer and an effective practice in other hospitals worldwide as well.Keywords: acute appendicitis, computerised tomography, diagnostic accuracy, delayed primary closure
Procedia PDF Downloads 1663320 Iot-Based Interactive Patient Identification and Safety Management System
Authors: Jonghoon Chun, Insung Kim, Jonghyun Lim, Gun Ro
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We believe that it is possible to provide a solution to reduce patient safety accidents by displaying correct medical records and prescription information through interactive patient identification. Our system is based on the use of smart bands worn by patients and these bands communicate with the hybrid gateways which understand both BLE and Wifi communication protocols. Through the convergence of low-power Bluetooth (BLE) and hybrid gateway technology, which is one of short-range wireless communication technologies, we implement ‘Intelligent Patient Identification and Location Tracking System’ to prevent medical malfunction frequently occurring in medical institutions. Based on big data and IOT technology using MongoDB, smart band (BLE, NFC function) and hybrid gateway, we develop a system to enable two-way communication between medical staff and hospitalized patients as well as to store locational information of the patients in minutes. Based on the precise information provided using big data systems, such as location tracking and movement of in-hospital patients wearing smart bands, our findings include the fact that a patient-specific location tracking algorithm can more efficiently operate HIS (Hospital Information System) and other related systems. Through the system, we can always correctly identify patients using identification tags. In addition, the system automatically determines whether the patient is a scheduled for medical service by the system in use at the medical institution, and displays the appropriateness of the medical treatment and the medical information (medical record and prescription information) on the screen and voice. This work was supported in part by the Korea Technology and Information Promotion Agency for SMEs (TIPA) grant funded by the Korean Small and Medium Business Administration (No. S2410390).Keywords: BLE, hybrid gateway, patient identification, IoT, safety management, smart band
Procedia PDF Downloads 3113319 Comparison of Safety and Efficacy between Thulium Fibre Laser and Holmium YAG Laser for Retrograde Intrarenal Surgery
Authors: Sujeet Poudyal
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Introduction: After Holmium:yttrium-aluminum-garnet (Ho: YAG) laser has revolutionized the management of urolithiasis, the introduction of Thulium fibre laser (TFL) has already challenged Ho:YAG laser due to its multiple commendable properties. Nevertheless, there are only few studies comparing TFL and holmium laser in Retrograde Intrarenal Surgery(RIRS). Therefore, this study was carried out to compare the efficacy and safety of thulium fiber laser (TFL) and holmium laser in RIRS. Methods: This prospective comparative study, which included all patients undergoing laser lithotripsy (RIRS) for proximal ureteric calculus and nephrolithiasis from March 2022 to March 2023, consisted of 63 patients in Ho:YAG laser group and 65 patients in TFL group. Stone free rate, operative time, laser utilization time, energy used, and complications were analysed between the two groups. Results: Mean stone size was comparable in TFL (14.23±4.1 mm) and Ho:YAG (13.88±3.28 mm) group, p-0.48. Similarly, mean stone density in TFL (1269±262 HU) was comparable to Ho:YAG (1189±212 HU), p-0.48. There was significant difference in lasing time between TFL (12.69±7.41 mins) and Ho:YAG (20.44±14 mins), p-0.012). TFL group had operative time of 43.47± 16.8 mins which was shorter than Ho:YAG group (58±26.3 mins),p-0.005. Both TFL and Ho:YAG groups had comparable total energy used(11.4±6.2 vs 12±8 respectively, p-0.758). Stone free rate was 87%for TFL, whereas it was 79.5% for Ho:YAG, p-0.25). Two cases of sepsis and one ureteric stricture were encountered in TFL, whereas three cases suffered from sepsis apart from one ureteric stricture in Ho:YAG group, p-0.62). Conclusion: Thulium Fibre Laser has similar efficacy as Holmium: YAG Laser in terms of safety and stone free rate. However, due to better stone ablation rate in TFL, it can become the game changer in management of urolithiasis in the coming days.Keywords: retrograde intrarenal surgery, thulium fibre laser, holmium:yttrium-aluminum-garnet (ho:yag) laser, nephrolithiasis
Procedia PDF Downloads 753318 The Application of Nuclear Energy for Sustainable Agriculture and Food Security: A Review
Authors: Gholamreza Farrokhi, Behzad Sani
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The goals of sustainable agricultural are development, improved nutrition, and food security. Sustainable agriculture must be developed that will meet today’s needs for food and other products, as well as preserving the vital natural resource base that will allow future generations to meet their needs. Sustainable development requires international cooperation and the effective use of technology. Access to sustainable sources of food will remain a preeminent challenge in the decades to come. Based upon current practice and consumption, agricultural production will have to increase by about 70% by 2050 to meet demand. Nuclear techniques are used in developing countries to increase production sustainably by breeding improved crops, enhancing livestock reproduction and nutrition, as well as controlling animal and plant pests and diseases. Post-harvest losses can be reduced and safety increased with nuclear technology. Soil can be evaluated with nuclear techniques to conserve and improve soil productivity and water management.Keywords: food safety, food security, nuclear techniques, sustainable agriculture, sustainable future
Procedia PDF Downloads 3573317 Novel Use of a Quality Assurance Tool for Integrating Technology to HSE
Authors: Ragi Poyyara, V. Vivek, Ashish Khaparde
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The Product Development Process (PDP) in the technology group plays a very important role in the launch of any product. While a manufacturing process encourages the use of certain measures to reduce Health, Safety and Environmental (HSE) risks on the shop floor, the PDP concentrates on the use of Geometric Dimensioning and Tolerancing (GD&T) to develop a flawless design. Furthermore, PDP distributes and coordinates activities between different departments such as marketing, purchasing, and manufacturing. However, it is seldom realized that PDP makes a significant contribution to developing a product that reduces HSE risks by encouraging the Technology group to use effective GD&T. The GD&T is a precise communication tool that uses a set of symbols, rules, and definitions to mathematically define parts to be manufactured. It is a quality assurance method widely used in the oil and gas sector. Traditionally it is used to ensure the interchangeability of a part without affecting its form, fit, and function. Parts that do not meet these requirements are rejected during quality audits. This paper discusses how the Technology group integrates this quality assurance tool into the PDP and how the tool plays a major role in helping the HSE department in its goal towards eliminating HSE incidents. The PDP involves a thorough risk assessment and establishes a method to address those risks during the design stage. An illustration shows how GD&T helped reduce safety risks by ergonomically improving assembling operations. A brief discussion explains how tolerances provided on a part help prevent finger injury. This tool has equipped Technology to produce fixtures, which are used daily in operations as well as manufacturing. By applying GD&T to create good fits, HSE risks are mitigated for operating personnel. Both customers and service providers benefit from reduced safety risks.Keywords: HSE risks, product development process, geometric dimensioning and tolerances, mechanical engineering
Procedia PDF Downloads 2263316 Logo Design of Pajamas, OTOP Product of Sainoi Community, Sainoi District, Nonthaburi Province
Authors: Witthaya Mekhum, Napasri Suwanajote, Isara Sangprasert
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This research on logo design of pajamas, OTOP product of Sainoi community, Sainoi district, Nonthanuri Province is a participatory action research aiming to find the logo for pajamas, an OTOP product of Sainoi community. Sample of this research is 50 local residents from Sainoi community in Sainoi district, Nonthanuri Province. The questionnaire consisted of 4 main parts. Part 1: factors that influence the decisions of consumers; Part 2: characteristics of the materials used in the design; Part 3: attitude assessment and needs of consumers about logo designing to develop marketing channels; Part 4: suggestions. Interviews were conducted. For data analysis, checklist items were analyzed with frequency and percentage. Open-end items were analyzed by summarizing and using ratio scale and mean and standard deviation. The research results showed that the design, cutting and fabric affect the decision of the consumers. They want design to be decent and beautiful. Illustrations used in graphic design logos should be Lines. Fonts should be English letters and the color of the font should be the same color.Keywords: design, logo, OTOP product, pajamas
Procedia PDF Downloads 2703315 Development of a Core Set of Clinical Indicators to Measure Quality of Care for Thyroid Cancer: A Modified-Delphi Approach
Authors: Liane J. Ioannou, Jonathan Serpell, Cino Bendinelli, David Walters, Jenny Gough, Dean Lisewski, Win Meyer-Rochow, Julie Miller, Duncan Topliss, Bill Fleming, Stephen Farrell, Andrew Kiu, James Kollias, Mark Sywak, Adam Aniss, Linda Fenton, Danielle Ghusn, Simon Harper, Aleksandra Popadich, Kate Stringer, David Watters, Susannah Ahern
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BACKGROUND: There are significant variations in the management, treatment and outcomes of thyroid cancer, particularly in the role of: diagnostic investigation and pre-treatment scanning; optimal extent of surgery (total or hemi-thyroidectomy); use of active surveillance for small low-risk cancers; central lymph node dissections (therapeutic or prophylactic); outcomes following surgery (e.g. recurrent laryngeal nerve palsy, hypocalcaemia, hypoparathyroidism); post-surgical hormone, calcium and vitamin D therapy; and provision and dosage of radioactive iodine treatment. A proven strategy to reduce variations in the outcome and to improve survival is to measure and compare it using high-quality clinical registry data. Clinical registries provide the most effective means of collecting high-quality data and are a tool for quality improvement. Where they have been introduced at a state or national level, registries have become one of the most clinically valued tools for quality improvement. To benchmark clinical care, clinical quality registries require systematic measurement at predefined intervals and the capacity to report back information to participating clinical units. OBJECTIVE: The aim of this study was to develop a core set clinical indicators that enable measurement and reporting of quality of care for patients with thyroid cancer. We hypothesise that measuring clinical quality indicators, developed to identify differences in quality of care across sites, will reduce variation and improve patient outcomes and survival, thereby lessening costs and healthcare burden to the Australian community. METHOD: Preparatory work and scoping was conducted to identify existing high quality, clinical guidelines and best practice for thyroid cancer both nationally and internationally, as well as relevant literature. A bi-national panel was invited to participate in a modified Delphi process. Panelists were asked to rate each proposed indicator on a Likert scale of 1–9 in a three-round iterative process. RESULTS: A total of 236 potential quality indicators were identified. One hundred and ninety-two indicators were removed to reflect the data capture by the Australian and New Zealand Thyroid Cancer Registry (ANZTCR) (from diagnosis to 90-days post-surgery). The remaining 44 indicators were presented to the panelists for voting. A further 21 indicators were later added by the panelists bringing the total potential quality indicators to 65. Of these, 21 were considered the most important and feasible indicators to measure quality of care in thyroid cancer, of which 12 were recommended for inclusion in the final set. The consensus indicator set spans the spectrum of care, including: preoperative; surgery; surgical complications; staging and post-surgical treatment planning; and post-surgical treatment. CONCLUSIONS: This study provides a core set of quality indicators to measure quality of care in thyroid cancer. This indicator set can be applied as a tool for internal quality improvement, comparative quality reporting, public reporting and research. Inclusion of these quality indicators into monitoring databases such as clinical quality registries will enable opportunities for benchmarking and feedback on best practice care to clinicians involved in the management of thyroid cancer.Keywords: clinical registry, Delphi survey, quality indicators, quality of care
Procedia PDF Downloads 1803314 An Improved Dynamic Window Approach with Environment Awareness for Local Obstacle Avoidance of Mobile Robots
Authors: Baoshan Wei, Shuai Han, Xing Zhang
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Local obstacle avoidance is critical for mobile robot navigation. It is a challenging task to ensure path optimality and safety in cluttered environments. We proposed an Environment Aware Dynamic Window Approach in this paper to cope with the issue. The method integrates environment characterization into Dynamic Window Approach (DWA). Two strategies are proposed in order to achieve the integration. The local goal strategy guides the robot to move through openings before approaching the final goal, which solves the local minima problem in DWA. The adaptive control strategy endows the robot to adjust its state according to the environment, which addresses path safety compared with DWA. Besides, the evaluation shows that the path generated from the proposed algorithm is safer and smoother compared with state-of-the-art algorithms.Keywords: adaptive control, dynamic window approach, environment aware, local obstacle avoidance, mobile robots
Procedia PDF Downloads 1593313 Study on the Effect of Pre-Operative Patient Education on Post-Operative Outcomes
Authors: Chaudhary Itisha, Shankar Manu
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Patient satisfaction represents a crucial aspect in the evaluation of health care services. Preoperative teaching provides the patient with pertinent information concerning the surgical process and the intended surgical procedure as well as anticipated patient behavior (anxiety, fear), expected sensation, and the probable outcomes. Although patient education is part of Accreditation protocols, it is not uniform at most places. The aim of this study was to try to assess the benefit of preoperative patient education on selected post-operative outcome parameters; mainly, post-operative pain scores, requirement of additional analgesia, return to activity of daily living and overall patient satisfaction, and try to standardize few education protocols. Dependent variables were measured before and after the treatment on a study population of 302 volunteers. Educational intervention was provided by the Investigator in the preoperative period to the study group through personal counseling. An information booklet contained detailed information was also provided. Statistical Analysis was done using Chi square test, Mann Whitney u test and Fischer Exact Test on a total of 302 subjects. P value <0.05 was considered as level of statistical significance and p<0.01 was considered as highly significant. This study suggested that patients who are given a structured, individualized and elaborate preoperative education and counseling have a better ability to cope up with postoperative pain in the immediate post-operative period. However, there was not much difference when the patients have had almost complete recovery. There was no difference in the requirement of additional analgesia among the two groups. There is a positive effect of preoperative counseling on expected return to the activities of daily living and normal work schedule. However, no effect was observed on the activities in the immediate post-operative period. There is no difference in the overall satisfaction score among the two groups of patients. Thus this study concludes that there is a positive benefit as suggested by the results for pre-operative patient education. Although the difference in various parameters studied might not be significant over a long term basis, they definitely point towards the benefits of preoperative patient education.Keywords: patient education, post-operative pain, postoperative outcomes, patient satisfaction
Procedia PDF Downloads 3393312 Management of First Trimester Miscarriage
Authors: Madeleine Cox
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Objective; analyse patient choices in management of first trimester miscarriage, rates of complications including repeat procedure. Design: all first trimester miscarriages from a tertiary institution on the Gold Coast in a 6 month time frame (July to December 2021) were reviewed, including choice of management, histopathology, any representations or admissions, and potential complications. Results: a total of 224 first trimester miscarriages were identified. Of these, 183 (81%) opted to have surgical management in the first instance. Of the remaining patients, 18 (8%) opted to have medical management, and 28 (12.5%) opted to have expectant management. In total, 33(15%) patients required a repeat treatment for retained products. 1 had medical management for a small volume PROC post suction curette. A significant number of these patients initially opted for medical management but then elected to have shorter follow up than usual and went on to have retained products noted. 5 women who had small volumes of RPOC post medical or surgical management had repeat suction curette, however, had very small volumes of products on scan and on curette and may have had a good result with repeated misoprostol administration. It is important to note that whilst a common procedure, suction curettes are not without risk. 2 women had significant blood loss of 1L and 1.5L. A third women had a uterine perforation, a rare but recognised complication, she went on to require a laparoscopy which identified a small serosal bowel injury which was closed by the colorectal team. Conclusion: Management of first trimester miscarriage should be guided by patient preference. It is important to be able to provide patients with their choice of management, however, it is also important to have a good understanding of the risks of each management choice, chances of repeated procedure, appropriate time frame for follow up. Women who choose to undertake medical or expectant management should be supported through this time, with appropriate time frame between taking misoprostol and repeat scan so that the true effects can be evaluated. Patients returning for scans within 2-3 days are more likely to be booked for further surgery, however, may reflect patients who did not have adequate counselling or simply changed their mind on their preferred management options.Keywords: miscarriage, gynaecology, obstetrics, first trimester
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