Search results for: nuclear emergency
1795 Assessing Professionalism, Communication, and Collaboration among Emergency Physicians by Implementing a 360-Degree Evaluation
Authors: Ahmed Al Ansari, Khalid Al Khalifa
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Objective: Multisource feedback (MSF), also called the 360-Degree evaluation is an evaluation process by which questionnaires are distributed amongst medical peers and colleagues to assess physician performance from different sources other than the attending or the supervising physicians. The aim of this study was to design, implement, and evaluate a 360-Degree process in assessing emergency physicians trainee in the Kingdom of Bahrain. Method: The study was undertaken in Bahrain Defense Force Hospital which is a military teaching hospital in the Kingdom of Bahrain. Thirty emergency physicians (who represent the total population of the emergency physicians in our hospital) were assessed in this study. We developed an instrument modified from the Physician achievement review instrument PAR which was used to assess Physician in Alberta. We focused in our instrument to assess professionalism, communication skills and collaboration only. To achieve face and content validity, table of specification was constructed and a working group was involved in constructing the instrument. Expert opinion was considered as well. The instrument consisted of 39 items; were 15 items to assess professionalism, 13 items to assess communication skills, and 11 items to assess collaboration. Each emergency physicians was evaluated with 3 groups of raters, 4 Medical colleague emergency physicians, 4 medical colleague who are considered referral physicians from different departments, and 4 Coworkers from the emergency department. Independent administrative team was formed to carry on the responsibility of distributing the instruments and collecting them in closed envelopes. Each envelope was consisted of that instrument and a guide for the implementation of the MSF and the purpose of the study. Results: A total of 30 emergency physicians 16 males and 14 females who represent the total number of the emergency physicians in our hospital were assessed. The total collected forms is 269, were 105 surveys from coworkers working in emergency department, 93 surveys from medical colleague emergency physicians, and 116 surveys from referral physicians from different departments. The total mean response rates were 71.2%. The whole instrument was found to be suitable for factor analysis (KMO = 0.967; Bartlett test significant, p<0.00). Factor analysis showed that the data on the questionnaire decomposed into three factors which counted for 72.6% of the total variance: professionalism, collaboration, and communication. Reliability analysis indicated that the instrument full scale had high internal consistency (Cronbach’s α 0.98). The generalizability coefficients (Ep2) were 0.71 for the surveys. Conclusions: Based on the present results, the current instruments and procedures have high reliability, validity, and feasibility in assessing emergency physicians trainee in the emergency room.Keywords: MSF system, emergency, validity, generalizability
Procedia PDF Downloads 3571794 Aspects Regarding the Structural Behaviour of Autonomous Underwater Vehicle for Emergency Response
Authors: Lucian Stefanita Grigore, Damian Gorgoteanu, Cristian Molder, Amado Stefan, Daniel Constantin
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The purpose of this article is to present an analytical-numerical study on the structural behavior of a sunken autonomous underwater vehicle (AUV) for emergency intervention. The need for such a study was generated by the key objective of the ERL-Emergency project. The project aims to develop a system of collaborative robots for emergency response. The system consists of two robots: unmanned ground vehicles (UGV) on tracks and the second is an AUV. The system of collaborative robots, AUV and UGV, will be used to perform missions of monitoring, intervention, and rescue. The main mission of the AUV is to dive into the maritime space of an industrial port to detect possible leaks in a pipeline transporting petroleum products. Another mission is to close and open the valves with which the pipes are provided. Finally, you will need to be able to lift a manikin to the surface, which you can take to land. Numerical analysis was performed by the finite element method (FEM). The conditions for immersing the AUV at 100 m depth were simulated, and the calculations for different fluid flow rates were repeated. From a structural point of view, the stiffening areas and the enclosures in which the command-and-control elements and the accumulators are located have been especially analyzed. The conclusion of this research is that the AUV meets very well the established requirements.Keywords: analytical-numerical, emergency, FEM, robotics, underwater
Procedia PDF Downloads 1501793 Atmospheric Transport Modeling of Radio-Xenon Detections Possibly Related to the Announced Nuclear Test in North Korea on February 12, 2013
Authors: Kobi Kutsher
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On February 12th 2013, monitoring stations of the Preparatory Commission of the Comprehensive Nuclear Test-Ban Treaty Organization (CTBTO) detected a seismic event with explosion-like underground characteristics in the Democratic People’s Republic of Korea (DPRK). The location was found to be in the vicinity of the two previous announced nuclear tests in 2006 and 2009.The nuclear test was also announced by the government of the DPRK.After an underground nuclear explosion, radioactive fission products (mostly noble gases) can seep through layers of rock and sediment until they escape into the atmosphere. The fission products are dispersed in the atmosphere and may be detected thousands of kilometers downwind from the test site. Indeed, more than 7 weeks after the explosion, unusual detections of noble gases was reported at the radionuclide station in Takasaki, Japan. The radionuclide station is a part of the International Monitoring System, operated to verify the CTBT. This study provides an estimation of the possible source region and the total radioactivity of the release using Atmospheric Transport Modeling.Keywords: atmospheric transport modeling, CTBTO, nuclear tests, radioactive fission products
Procedia PDF Downloads 4251792 Research on Health Emergency Management Based on the Bibliometrics
Authors: Meng-Na Dai, Bao-Fang Wen, Gao-Pei Zhu, Chen-Xi Zhang, Jing Sun, Chang-Hai Tang, Zhi-Qiang Feng, Wen-Qiang Yin
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Based on the analysis of literature in the health emergency management in China with recent 10 years, this paper discusses the Chinese current research hotspots, development trends and shortcomings in this field, and provides references for scholars to conduct follow-up research. CNKI(China National Knowledge Infrastructure), Weipu, and Wanfang were the databases of this literature. The key words during the database search were health, emergency, and management with the time from 2009 to 2018. The duplicate, non-academic, and unrelated documents were excluded. 901 articles were included in the literature review database. The main indicators of abstraction were, the number of articles published every year, authors, institutions, periodicals, etc. There are some research findings through the analysis of the literature. Overall, the number of literature in the health emergency management in China has shown a fluctuating downward trend in recent 10 years. Specifically, there is a lack of close cooperation between authors, which has not constituted the core team among them yet. Meanwhile, in this field, the number of high-level periodicals and quality literature is scarce. In addition, there are a lot of research hotspots, such as emergency management system, mechanism research, capacity evaluation index system research, plans and capacity-building research, etc. In the future, we should increase the scientific research funding of the health emergency management, encourage collaborative innovation among authors in multi-disciplinary fields, and create high-quality and high-impact journals in this field. The states should encourage scholars in this field to carry out more academic cooperation and communication with the whole world and improve the research in breadth and depth. Generally speaking, the research in health emergency management in China is still insufficient and needs to be improved.Keywords: health emergency management, research situation, bibliometrics, literature
Procedia PDF Downloads 1371791 Virtual Process Hazard Analysis (Pha) Of a Nuclear Power Plant (Npp) Using Failure Mode and Effects Analysis (Fmea) Technique
Authors: Lormaine Anne A. Branzuela, Elysa V. Largo, Monet Concepcion M. Detras, Neil C. Concibido
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The electricity demand is still increasing, and currently, the Philippine government is investigating the feasibility of operating the Bataan Nuclear Power Plant (BNPP) to address the country’s energy problem. However, the lack of process safety studies on BNPP focused on the effects of hazardous substances on the integrity of the structure, equipment, and other components, have made the plant operationalization questionable to the public. The three major nuclear power plant incidents – TMI-2, Chernobyl, and Fukushima – have made many people hesitant to include nuclear energy in the energy matrix. This study focused on the safety evaluation of possible operations of a nuclear power plant installed with a Pressurized Water Reactor (PWR), which is similar to BNPP. Failure Mode and Effects Analysis (FMEA) is one of the Process Hazard Analysis (PHA) techniques used for the identification of equipment failure modes and minimizing its consequences. Using the FMEA technique, this study was able to recognize 116 different failure modes in total. Upon computation and ranking of the risk priority number (RPN) and criticality rating (CR), it showed that failure of the reactor coolant pump due to earthquakes is the most critical failure mode. This hazard scenario could lead to a nuclear meltdown and radioactive release, as identified by the FMEA team. Safeguards and recommended risk reduction strategies to lower the RPN and CR were identified such that the effects are minimized, the likelihood of occurrence is reduced, and failure detection is improved.Keywords: PHA, FMEA, nuclear power plant, bataan nuclear power plant
Procedia PDF Downloads 1311790 Emergency Management of Poisoning Tracery Care Hospital in India
Authors: Rajiv Ratan Singh, Sachin Kumar Tripathi, Pradeep Kumar Yadav
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The timely evaluation, diagnosis, and treatment of people who have been exposed to toxic chemicals is a crucial component of emergency poison management in the medical field. The various substances that can poison include chemicals, medications, and naturally occurring poisons. The toxicology of the particular drug involved, as well as the symptoms and indicators of poisoning, must be thoroughly understood to handle poisoning emergencies effectively. One of the most important aspects of emergency poison management in medicine is the prompt examination, diagnosis, and treatment of persons who have been exposed to dangerous substances. To properly manage poisoning crises, one must have a good understanding of the toxicology of the particular medication concerned, as well as the signs and indicators of poisoning. Emergency management of poisoning includes not only prompt medical attention but also patient education, follow-up care, and monitoring for any long-term consequences. To achieve the greatest results for patients, the management of poisoning is a complicated and dynamic process that calls for collaboration between medical professionals, first responders, and toxicologists. All poisoned patients who present to the emergency room are assessed and diagnosed based on a collection of symptoms and a biochemical diagnosis, and they are then provided targeted, specialized treatment for the toxin identified. This article focuses on the loxodromic strategy as the primary method of treatment for poisoned patients. The authors of this article conclude that mortality and morbidity can be reduced if patients visit the emergency room promptly and receive targeted treatment.Keywords: antidotes, blood poisoning, emergency medicine, gastric lavage, medico-legal aspects, patient care
Procedia PDF Downloads 1011789 GIS-Based Automatic Flight Planning of Camera-Equipped UAVs for Fire Emergency Response
Authors: Mohammed Sulaiman, Hexu Liu, Mohamed Binalhaj, William W. Liou, Osama Abudayyeh
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Emerging technologies such as camera-equipped unmanned aerial vehicles (UAVs) are increasingly being applied in building fire rescue to provide real-time visualization and 3D reconstruction of the entire fireground. However, flight planning of camera-equipped UAVs is usually a manual process, which is not sufficient to fulfill the needs of emergency management. This research proposes a Geographic Information System (GIS)-based approach to automatic flight planning of camera-equipped UAVs for building fire emergency response. In this research, Haversine formula and lawn mowing patterns are employed to automate flight planning based on geometrical and spatial information from GIS. The resulting flight mission satisfies the requirements of 3D reconstruction purposes of the fireground, in consideration of flight execution safety and visibility of camera frames. The proposed approach is implemented within a GIS environment through an application programming interface. A case study is used to demonstrate the effectiveness of the proposed approach. The result shows that flight mission can be generated in a timely manner for application to fire emergency response.Keywords: GIS, camera-equipped UAVs, automatic flight planning, fire emergency response
Procedia PDF Downloads 1251788 Nuclear Safety and Security in France in the 1970s: A Turning Point for the Media
Authors: Jandot Aurélia
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In France, in the main media, the concern about nuclear safety and security has not really appeared before the beginning of the 1970s. The gradual changes in its perception are studied here through the arguments given in the main French news magazines, linked with several parameters. As this represents a considerable amount of copies and thus of information, are selected here the main articles as well as the main “mental images” aiming to persuade the readers and which have led the public awareness to evolve. Indeed, in the 1970s, in France, these evolutions were not made in one day. Indeed, over the period, many articles were still in favor of nuclear power plants and promoted the technological advances that were made in this field. They had to be taken into account. But, gradually, grew up arguments and mental images discrediting the perception of nuclear technology. Among these were the environmental impacts of this industry, as the question of pollution progressively appeared. So, between 1970 and 1979, the language has changed, as the perceptible objectives of the communication, allowing to discern the deepest intentions of the editorial staffs of the French news magazines. This is all these changes that are emphasized here, over a period when the safety and security concern linked to the nuclear technology, to there a field for specialists, has become progressively a social issue seemingly open to all.Keywords: environmental impacts, media discourse, nuclear security, public awareness
Procedia PDF Downloads 2831787 Impact of Air Pollution and Climate on the Incidence of Emergency Interventions in Slavonski Brod
Authors: Renata Josipovic, Ante Cvitkovic
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Particulate matter belongs to pollutants that can lead to respiratory problems or premature death due to exposure (long-term, short-term) to these substances, all depending on the severity of the effects. The importance of the study is to determine whether the existing climatic conditions in the period from January 1st to August 31st, 2018 increased the number of emergency interventions in Slavonski Brod with regard to pollutants hydrogen sulfide and particles less than 10 µm (PM10) and less than 2.5 µm (PM2.5). Analytical data of the concentration of pollutants are collected from the Croatian Meteorological and Hydrological Service, which monitors the operation of two meteorological stations in Slavonski Brod, as well as climatic conditions. Statistics data of emergency interventions were collected from the Emergency Medicine Department of Slavonski Brod. All data were compared (air pollution, emergency interventions) according to climatic conditions (air humidity and air temperature) and statistically processed. Statistical significance, although weak positive correlation PM2.5 (correlation coefficient 0.147; p = 0.036), determined PM10 (correlation coefficient 0.122; p = 0.048), hydrogen sulfide (correlation coefficient 0.141; p = 0.035) with max. temperature (correlation coefficient 0.202; p = 0.002) with number of interventions. The association between mean air humidity was significant but negative (correlation coefficient - 0.172; p = 0.007). The values of the influence of air pressure are not determined. As the problem of air pollution is very complex, coordinated action at many levels is needed to reduce air pollution in Slavonski Brod and consequences that can affect human health.Keywords: emergency interventions, human health, hydrogen sulfide, particulate matter
Procedia PDF Downloads 1651786 Thermal Radiation and Noise Safety Assessment of an Offshore Platform Flare Stack as Sudden Emergency Relief Takes Place
Authors: Lai Xuejiang, Huang Li, Yang Yi
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To study the potential hazards of the sudden emergency relief of flare stack, the thermal radiation and noise calculation of flare stack is carried out by using Flaresim program 2.0. Thermal radiation and noise analysis should be considered as the sudden emergency relief takes place. According to the Flaresim software simulation results, the thermal radiation and noise meet the requirement.Keywords: flare stack, thermal radiation, safety assessment, noise
Procedia PDF Downloads 3551785 Outcomes of Using Guidelines for Caring and Referring ST Elevation Myocardial Infarction (STEMI) Patients at the Accident and Emergency Department of Songkhla Hospital, Thailand
Authors: Thanom Kaeniam
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ST-Elevation Myocardial Infarction (STEMI) is a state of sudden death of the heart muscle due to sudden blockage of the artery. STEMI patients are usually in critical condition and with a potential opportunity for sudden death. Therefore, management guidelines for safety in caring and referring STEMI patients are needed. The objective of this developmental research was to assess the effectiveness of using the guidelines for caring and referring STEMI patients at the Accident and Emergency Department of Songkhla Hospital. The subjects of the study were 22 nurses in the emergency room, and doctors on duty in the accident and emergency room selected using purposive sampling with inclusion criteria. The research instruments were the guidelines for caring and referring STEMI patients, and record forms for the effectiveness of using the guidelines for caring and referring STEMI patients (a general record form for STEMI patients, a record form for SK administering, a referring record form for PCI, and a record form for dead patient in the accident and emergency room and during referring). The instruments were tested for content validity by three experts, and the reliability was tested using Kuder-Richardson 20 (KR20). The descriptive statistic employed was the percentage. The outcomes of using the guidelines for caring and referring ST Elevation Myocardial Infarction (STEMI) Patients at the Accident and Emergency Department revealed that before using the guidelines in 2009, 2010, and 2011, there were 84, 73, and 138 STEMI patients receiving services at the accident and emergency room, of which, only 9, 32, and 48 patients were referred for PCI/SK medications, or 10.74; 43.84; and 34.78 percent, and the death rates were 10.71; 10.95; and 11.59 percent, respectively. However, after the use of the guidelines in 2012, 2013, and 2014, there were 97, 77, and 57 patients, of which, the increases to 77, 72, and 55 patients were referred for PCI /SK medications or 79.37; 93.51; and 96.49 percent, and the death rates were reduced to 10.30; 6.49; and 1.76 percent, respectively. The results of the study revealed that the use of the guidelines for caring and referring STEMI patients at the Accident and Emergency Department increased the effectiveness and quality of nursing, especially in terms of SK medication, caring and referring patients for PCI to reduce the death rate.Keywords: outcomes, guidelines for caring, referring, myocardial infarction, STEMI
Procedia PDF Downloads 3951784 Process Safety Evaluation of a Nuclear Power Plant through Virtual Process Hazard Analysis (PHA) using the What-If Technique
Authors: Lormaine Anne Branzuela, Elysa Largo, Julie Marisol Pagalilauan, Neil Concibido, Monet Concepcion Detras
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Energy is a necessity both for the people and the country. The demand for energy is continually increasing, but the supply is not doing the same. The reopening of the Bataan Nuclear Power Plant (BNPP) in the Philippines has been circulating in the media for the current time. The general public has been hesitant in accepting the inclusion of nuclear energy in the Philippine energy mix due to perceived unsafe conditions of the plant. This study evaluated the possible operations of a nuclear power plant, which is of the same type as the BNPP, considering the safety of the workers, the public, and the environment using a Process Hazard Analysis (PHA) method. What-If Technique was utilized to identify the hazards and consequences on the operations of the plant, together with the level of risk it entails. Through the brainstorming sessions of the PHA team, it was found that the most critical system on the plant is the primary system. Possible leakages on pipes and equipment due to weakened seals and welds and blockages on coolant path due to fouling were the most common scenarios identified, which further caused the most critical scenario – radioactive leak through sump contamination, nuclear meltdown, and equipment damage and explosion which could result to multiple injuries and fatalities, and environmental impacts.Keywords: process safety management, process hazard analysis, what-If technique, nuclear power plant
Procedia PDF Downloads 2221783 Development of Scenarios for Sustainable Next Generation Nuclear System
Authors: Muhammad Minhaj Khan, Jaemin Lee, Suhong Lee, Jinyoung Chung, Johoo Whang
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The Republic of Korea has been facing strong storage crisis from nuclear waste generation as At Reactor (AR) temporary storage sites are about to reach saturation. Since the country is densely populated with a rate of 491.78 persons per square kilometer, Construction of High-level waste repository will not be a feasible option. In order to tackle the storage waste generation problem which is increasing at a rate of 350 tHM/Yr. and 380 tHM/Yr. in case of 20 PWRs and 4 PHWRs respectively, the study strongly focuses on the advancement of current nuclear power plants to GEN-IV sustainable and ecological nuclear systems by burning TRUs (Pu, MAs). First, Calculations has made to estimate the generation of SNF including Pu and MA from PWR and PHWR NPPS by using the IAEA code Nuclear Fuel Cycle Simulation System (NFCSS) for the period of 2016, 2030 (including the saturation period of each site from 2024~2028), 2089 and 2109 as the number of NPPS will increase due to high import cost of non-nuclear energy sources. 2ndly, in order to produce environmentally sustainable nuclear energy systems, 4 scenarios to burnout the Plutonium and MAs are analyzed with the concentration on burning of MA only, MA and Pu together by utilizing SFR, LFR and KALIMER-600 burner reactor after recycling the spent oxide fuel from PWR through pyro processing technology developed by Korea Atomic Energy Research Institute (KAERI) which shows promising and sustainable future benefits by minimizing the HLW generation with regard to waste amount, decay heat, and activity. Finally, With the concentration on front and back end fuel cycles for open and closed fuel cycles of PWR and Pyro-SFR respectively, an overall assessment has been made which evaluates the quantitative as well as economical combativeness of SFR metallic fuel against PWR once through nuclear fuel cycle.Keywords: GEN IV nuclear fuel cycle, nuclear waste, waste sustainability, transmutation
Procedia PDF Downloads 3521782 Understanding ASPECTS of Stroke: Interrater Reliability between Emergency Medicine Physician and Radiologist in a Rural Setup
Authors: Vineel Inampudi, Arjun Prakash, Joseph Vinod
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Aims and Objectives: To evaluate the interrater reliability in grading ASPECTS score, between emergency medicine physician at first contact and radiologist among patients with acute ischemic stroke. Materials and Methods: We conducted a retrospective analysis of 86 acute ischemic stroke cases referred to the Department of Radiodiagnosis during November 2014 to January 2016. The imaging (plain CT scan) was performed using GE Bright Speed Elite 16 Slice CT Scanner. ASPECTS score was calculated separately by an emergency medicine physician and radiologist. Interrater reliability for total and dichotomized ASPECTS (≥ 6 and < 6) scores were assessed using statistical analysis (ICC and Cohen ĸ coefficients) on SPSS software (v17.0). Results: Interrater agreement for total and dichotomized ASPECTS was substantial (ICC 0.79 and Cohen ĸ 0.68) between the emergency physician and radiologist. Mean difference in ASPECTS between the two readers was only 0.15 with standard deviation of 1.58. No proportionality bias was detected. Bland Altman plot was constructed to demonstrate the distribution of ASPECT differences between the two readers. Conclusion: Substantial interrater agreement was noted in grading ASPECTS between emergency medicine physician at first contact and radiologist thereby confirming its robustness even in a rural setting.Keywords: ASPECTS, computed tomography, MCA territory, stroke
Procedia PDF Downloads 2361781 Non-Standard Forms of Reporting Domestic Violence: Analysis of the Phenomenon in the Perception of Operators of the Polish Emergency Number 112 and Polish Society
Authors: Joanna Kufel-Orlowska
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Domestic violence is a social threat to public safety and order. It poses a threat not only to the family members of the perpetrator but also disturbs the functioning of society and even the state. In a situation of danger, an individual either defends himself or/and calls for help by contacting an appropriate institution whose aim is to ensure civil security. Most often, such contact takes place through a telephone conversation, which is aimed at diagnosing the problem and prompt intervention. People in different situations and in different ways, despite the general reporting standards, try to inform about the need for help. The article aims to present the results of research on non-standard forms of reporting domestic violence in the opinion of the Polish society and operators of the Polish emergency number 112 (911). The research was conducted in the form of a survey technique on a sample of 160 operators (purposeful selection) and 300 people living in Poland (random selection). The research was conducted in the form of online surveys. The study found that in Poland: 1. emergency number operators often receive reports of domestic violence although they are not always able to diagnose whether the case is strictly about violence; 2. non-standard reports of domestic violence are received by about 30% of emergency number operators. Non-standard should be understood as reports of violence that deviate from the norm, are unusual, or are reported by a non-victim. 3. The most common forms of reporting violence not directly are: pretending to talk to a friend, calling a cab, making an appointment with a dentist/doctor, calling a store and helping with the selection of goods, asking about the bank's hotline, not speaking (in order for the emergency number operator to hear what is going on). 4. Emergency number operators in Poland are properly trained and are able to recognize the threatening situation of the reporting party and conduct the conversation in a safe manner for the reporting party. On the other hand, Polish people support the ability to report violence in a non-standard way and would do so themselves in the event of a threat to their own life, health, or property, thus expecting the emergency number operator to recognize a report and help us.Keywords: domestic violence, operator of the emergency number 112 (911), emergency call center, reporting domestic violence
Procedia PDF Downloads 1051780 Quality Standards for Emergency Response: A Methodological Framework
Authors: Jennifer E. Lynette
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This study describes the development process of a methodological framework for quality standards used to measure the efficiency and quality of response efforts of trained personnel at emergency events. This paper describes the techniques used to develop the initial framework and its potential application to professions under the broader field of emergency management. The example described in detail in this paper applies the framework specifically to fire response activities by firefighters. Within the quality standards framework, the fire response process is chronologically mapped. Individual variables within the sequence of events are identified. Through in-person data collection, questionnaires, interviews, and the expansion of the incident reporting system, this study identifies and categorizes previously unrecorded variables involved in the response phase of a fire. Following a data analysis of each variable using a quantitative or qualitative assessment, the variables are ranked pertaining to the magnitude of their impact to the event outcome. Among others, key indicators of quality performance in the analysis involve decision communication, resource utilization, response techniques, and response time. Through the application of this framework and subsequent utilization of quality standards indicators, there is potential to increase efficiency in the response phase of an emergency event; thereby saving additional lives, property, and resources.Keywords: emergency management, fire, quality standards, response
Procedia PDF Downloads 3181779 The Use of Regional Blocks Versus IV Opioid Analgesics for Acute Traumatic Pain Management in the Emergency Department
Authors: Lajeesh Jabbar, Shibu T. Varghese
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Being under pain is a very distressing factor that it prolongs the healing of any kind of trauma and add to the post traumatic stressful state. Alleviating the pain from acute traumatic conditions like fracture, degloving injury etc will help in faster recovery and also decrease the incidence of post traumatic stress disorder. Most of the emergency departments in INDIA are using IV opioid analgesics to relieve the patient from pain in cases of acute traumatic injuries. None of the Emergency Departments practice regional blocks in the country. In this study, we are comparing the efficacy of Regional Blocks in relieving the pain in lower limb fractures versus the use of IV analgesics for the same in the emergency department. The site of study is Malabar Institute Of Medical Sciences in Calicut in Kerala in India and is a place which receives approximately 10-20 traumatic fracture cases per day. The fracture sites used for the study purpose are femur fracture and phalangeal fractures.Keywords: regional blocks, IV analgesia, acute traumatic pain, femur fractures, phalanx fractures
Procedia PDF Downloads 4161778 Decommissioning of Nuclear Power Plants: The Current Position and Requirements
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Undoubtedly from construction's perspective, the use of explosives will remove a large facility such as a 40-storey building , that took almost 3 to 4 years for construction, in few minutes. Usually, the reconstruction or decommissioning, the last phase of life cycle of any facility, is considered to be the shortest. However, this is proved to be wrong in the case of nuclear power plant. Statistics says that in the last 30 years, the construction of a nuclear power plant took an average time of 6 years whereas it is estimated that decommissioning of such plants may take even a decade or more. This paper is all about the decommissioning phase of a nuclear power plant which needs to be given more attention and encouragement from the research institutes as well as the nuclear industry. Currently, there are 437 nuclear power reactors in operation and 70 reactors in construction. With around 139 nuclear facilities already been shut down and are in different decommissioning stages and approximately 347 nuclear reactors will be in decommissioning phase in the next 20 years (assuming the operation time of a reactor as 40 years), This fact raises the following two questions (1) How far is the nuclear and construction Industry ready to face the challenges of decommissioning project? (2) What is required for a safety and reliable decommissioning project delivery? The decommissioning of nuclear facilities across the global have severe time and budget overruns. Largely the decommissioning processes are being executed by the force of manual labour where the change in regulations is respectively observed. In term of research and development, some research projects and activities are being carried out in this area, but the requirement seems to be much more. The near future of decommissioning shall be better through a sustainable development strategy where all stakeholders agree to implement innovative technologies especially for dismantling and decontamination processes and to deliever a reliable and safety decommissioning. The scope of technology transfer from other industries shall be explored. For example, remotery operated robotic technologies used in automobile and production industry to reduce time and improve effecincy and saftey shall be tried here. However, the innovative technologies are highly requested but they are alone not enough, the implementation of creative and innovative management methodologies should be also investigated and applied. Lean Management with it main concept "elimination of waste within process", is a suitable example here. Thus, the cooperation between international organisations and related industries and the knowledge-sharing may serve as a key factor for the successful decommissioning projects.Keywords: decommissioning of nuclear facilities, innovative technology, innovative management, sustainable development
Procedia PDF Downloads 4711777 State of Emergency in Turkey (July 2016-July 2018): A Case of Utilization of Law as a Political Instrument
Authors: Neslihan Cetin
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In this study, we will aim to analyze how the period of the state of emergency in Turkey lead to gaps in law and the formation of areas in which there was a complete lack of supervision. The state of emergency that was proclaimed following the coup attempt of July 15, 2016, continued until July 18, 2018, that is to say, 2 years, without taking into account whether the initial circumstances persisted. As part of this work, we claim that the state of emergency provided the executive power with important tools for governing, which it took constant use. We can highlight how the concern for security at the center of the basic considerations of the people in a city was exploited as a foundation by the military power in Turkey to interfere in the political, legal, and social spheres. The constitutions of 1924, 1961, and 1982 entrusted the army with the role of protector of the integrity of the state. This became an instrument at the hands of the military to legitimize their interventions in the name of public security. Its interventions in the political field are indeed politically motivated. The constitution, the legislative, and regulatory systems are modified and monopolized by the military power that dominates the legislative, regulatory, and judicial power, leading to a state of exception. With the political convulsions over a decade, the government was able to usurp the instrument called the state of exception. In particular, the decree-laws of the state of emergency, which the executive makes frequent and generally abusive use, became instruments in the hands of the government to take measures that it wishes to escape from the rules and the pre-established control mechanisms. Thus the struggle against the political opposition becomes more unbalanced and destructive. To this must also be added the ineffectiveness of ex-post controls and domestic remedies. This research allows us to stress how a legal concept, such as ‘the state of emergency’ can be politically exploited to make it a legal weapon that continues to produce victims.Keywords: constitutional law, state of emergency, rule of law, instrumentalization of law
Procedia PDF Downloads 1421776 Distributed Leadership and Emergency Response: A Study on Seafarers
Authors: Delna Shroff
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Merchant shipping is an occupation with a high rate of fatal injuries caused by organizational accidents and maritime disasters. In most accident investigations, the leader’s actions are under scrutiny and point out the necessity to investigate the leader’s decisions in critical conditions. While several leadership studies have been carried out in the past, there is a tendency for most research to focus on holders of formal positions. The unit of analysis in most studies has been the ‘individual.’ A need is, therefore, felt to adopt a practice-based perspective of leadership, understand how leadership emerges to affect maritime safety. This paper explores the phenomenon of distributed leadership among seafarers more holistically. It further examines the role of one form of distributed leadership, that is, planfully aligned leadership in the emergency response of the team. A mixed design will be applied. In the first phase, the data gathered by way of semi-structured interviews will be used to explore the seafarer’s implicit understanding of leadership. The data will be used to develop a conceptual framework of distributed leadership, specific to the maritime context. This framework will be used to develop a simulation. Experimental design will be used to examine the relationship between planfully aligned leadership and emergency response of the team members during navigation. Findings show that planfully aligned leadership significantly and positively predicts the emergency response of team members. Planfully aligned leadership leads to a better emergency response of the team members as compared to authoritarian leadership. In the third qualitative phase, additional data will be gathered through semi-structured interviews to further validate the findings to gain a more complete understanding of distributed leadership and its relation to emergency response. Above are the predictive results; the study expects to be a cornerstone of safety leadership research and has important implications for leadership development and training within the maritime industry.Keywords: authoritarian leadership, distributed leadership, emergency response , planfully aligned leadership
Procedia PDF Downloads 1751775 Study of Temperature Distribution in Coolant Channel of Nuclear Power with Fuel Cylinder Element Using Fluent Software
Authors: Elham Zamiri
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In this research, we have focused on numeral simulation of a fuel rod in order to examine distribution of heat temperature in components of fuel rod by Fluent software by providing steady state, single phase fluid flow, frequency heat flux in a fuel rod in nuclear reactor to numeral simulation. Results of examining different layers of a fuel rod consist of fuel layer, gap, pod, and fluid cooling flow, also examining thermal properties and fluids such as heat transition rate and pressure drop. The obtained results through analytical method and results of other sources have been compared and have appropriate correspondence. Results show that using heavy water as cooling fluid along with few layers of gas and pod have the ability of reducing the temperature from above 300 ◦C to 70 ◦C. This investigation is developable for any geometry and material used in the nuclear reactor.Keywords: nuclear fuel fission, numberal simulation, fuel rod, reactor, Fluent software
Procedia PDF Downloads 1661774 Factors Influencing Infection Prevention and Control Practices in the Emergency Department of Mbarara Regional Referral Hospital in Mbarara District- Uganda
Authors: Baluku Nathan
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Infection prevention and control (IPC) is a practical, evidence-based approach that prevents patients and emergency health workers from being harmed by avoidable infections as a result of antimicrobial resistance; all hospital infection control programs put together various practices which, when used appropriately, restrict the spread of infection. A breach in these control practices facilitates the transmission of infections from patients to health workers, other patients and attendants. It is, therefore, important for all EMTs and patients to adhere to them strictly. It is also imperative for administrators to ensure the implementation of the infection control program for their facilities. Purpose: The purpose of this study was to investigate the influencing factors of prevention practices against Infection exposure among emergency medical technicians (EMTs) in the emergency department at Mbarara hospital. Methodology: This was a descriptive cross-sectional study that employed a self-reported questionnaire that was filled out by 32 EMTs in the emergency department from 12th February to 3rd march 2022. The questionnaire consisted of items concerning the defensive environment and other Factors influencing Infection prevention and control practices in the accident and emergency department of Mbarara hospital. Results: From the findings, majority16(50%) always used protective gear when doing clinical work,14 (43.8%) didn’t use protective gear, citing they were only assisting those performing resuscitations, gumboots were the least used protective gear with only3(9.4%) usage. Regarding disposal techniques of specific products like blood and sharps, results showed 10 (31.3%) said blood is disposed of in red buckets, 5(15.6%) in yellow buckets and only5(15.6%) in black buckets and 12(37.5%) didn’t respond. However, 28(87.5%) said sharps were disposed of in a sharps container. The majority, 17(53.1%), were not aware of the infection control guidelines even though they were pinned on walls of the emergency rooms,15(46.9%) said they had never had quality assurance monitoring events,14(43.8%) said monitoring was continuous while15(46.9 %) said it was discrete. Conclusions: The infection control practices at the emergency department were inadequate in view of less than 100% of the EMTs observing the five principles of infection prevention, such as the use of personal protective equipment and proper waste disposal in appropriate color-coded bins. Dysfunctional infection prevention and control committees accompanied by inadequate supervision to ensure infection control remained a big challenge.Keywords: infection prevention, influencing factors, emergency medical technician (EMT), emergency unit
Procedia PDF Downloads 1131773 Factors Influencing Infection Prevention and Control Practices in the Emergency Department of Mbarara Regional Referral Hospital in Mbarara District-Uganda
Authors: Baluku Nathan
Abstract:
Infection prevention and control (IPC) is a practical, evidence-based approach that prevents patients and emergency health workers from being harmed by avoidable infections as a result of antimicrobial resistance; all hospital infection control programs put together various practices which, when used appropriately, restrict the spread of infection. A breach in these control practices facilitates the transmission of infections from patients to health workers, other patients, and attendants. It is, therefore important for all emergency medical technicians (EMTs) and patients to strictly adhere to them. It is also imperative for administrators to ensure the implementation of the infection control programme for their facilities. Purpose: The purpose of this study was to investigate the influencing factors of prevention practices against infection exposure among emergency medical technicians (EMTs) in the emergency department at Mbarara hospital. Methodology: This was a descriptive cross-sectional study that employed a self-reported questionnaire that was filled out by 32 EMTs in the emergency department from 12th February to 3rd march 2022. The questionnaire consisted of items concerning the defensive environment and other factors influencing infection prevention and control practices in the accident and emergency department of Mbarara hospital. Results: From the findings, the majority 16 (50%) always used protective gear when doing clinical work, 14 (43.8%) didn’t use protective gear, citing they were only assisting those performing resuscitations, gumboots were the least used protective gear with only3(9.4%) usage. About disposal techniques of specific products like blood and sharps, results showed 10 (31.3%) said blood is disposed of in red buckets, 5 (15.6%) in yellow buckets, and only 5(15.6%) in black buckets, and 12(37.5%) didn’t respond, however, 28(87.5%) said sharps were disposed of in a sharps container. The majority, 17 (53.1%), were not aware of the infection control guidelines even though they were pinned on walls of the emergency rooms, 15(46.9%) said they have never had quality assurance monitoring events, 14(43.8%) said monitoring was continuous while 15(46.9 %) said it was discrete. Conclusions: The infection control practices at the emergency department were inadequate in view of less than 100% of the EMTs observing the five principles of infection prevention, such as the use of personal protective equipment and proper waste disposal in appropriate color-coded bins. Dysfunctional infection prevention and control committees accompanied by inadequate supervision to ensure infection control remained a big challenge.Keywords: emergency medical technician, infection prevention, influencing factors, infection control
Procedia PDF Downloads 1081772 Forensic Nursing in the Emergency Department: The Overlooked Roles
Authors: E. Tugba Topcu
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The emergency services are usually the first places to encounter forensic cases. Hence, it is important to consider forensics from the perspective of the emergency services staff and the physiological and psychological consequences that may arise as a result of behaviour by itself or another person. Accurate and detailed documentation of the situation in which the patient first arrives at the emergency service and preservation of the forensic findings is pivotal for the subsequent forensic investigation. The first step in determining whether or not a forensic case exists is to perform a medical examination of the patient. For each individual suspected to be part of a forensic case, police officers should be informed at the same time as the medical examination is being conducted. Violent events are increasing every year and with an increase in the number of forensic cases, emergency service workers have increasing responsibility and consequently play a key role in protecting, collecting and arranging the forensic evidence. In addition, because the emergency service workers involved in forensic events typically have information about the accused and/or victim, as well as evidence related to the events and the cause of injuries, police officers often require their testimony. However, both nurses and other health care personnel do not typically have adequate expertise in forensic medicine. Emergency nurses should take an active role for determining that whether any patient admitted to the emergency services is a clinical forensic patient the emergency service with injury and requiring possible punishment and knowing of their roles and responsibilities in this area provides legal protection as well as the protection of the judicial affair. Particularly, in emergency services, where rapid patient turnover and high workload exists, patient registration and case reporting may not exist. In such instances, the witnesses, typically the nurses, are often consulted for information. Knowledge of forensic medical matters plays a vital role in achieving justice. According to the Criminal Procedure Law, Article 75, Paragraph 3, ‘an internal body examination or the taking of blood or other biological samples from the body can be performed only by a doctor or other health professional member’. In favour of this item, the clinic nurse and doctor are mainly responsible for evaluating forensic cases in emergency departments, performing the examination, collecting evidence, and storing and reporting data. The courts place considerable importance on determining whether a suspect is the victim or accused and, thus, in terms of illuminating events, it is crucial that any evidence is gathered carefully and appropriately. All the evidence related to the forensic case including the forensic report should be handed over to the police officers. In instances where forensic evidence cannot be collected and the only way to obtain the evidence is the hospital environment, health care personnel in emergency services need to have knowledge about the diagnosis of forensic evidence, the collection of evidence, hiding evidence and provision of the evidence delivery chain.Keywords: emergency department, emergency nursing, forensic cases, forensic nursing
Procedia PDF Downloads 2521771 Predicting Factors for Occurrence of Cardiac Arrest in Critical, Emergency and Urgency Patients in an Emergency Department
Authors: Angkrit Phitchayangkoon, Ar-Aishah Dadeh
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Background: A key aim of triage is to identify the patients with high risk of cardiac arrest because they require intensive monitoring, resuscitation facilities, and early intervention. We aimed to identify the predicting factors such as initial vital signs, serum pH, serum lactate level, initial capillary blood glucose, and Modified Early Warning Score (MEWS) which affect the occurrence of cardiac arrest in an emergency department (ED). Methods: We conducted a retrospective data review of ED patients in an emergency department (ED) from 1 August 2014 to 31 July 2016. Significant variables in univariate analysis were used to create a multivariate analysis. Differentiation of predicting factors between cardiac arrest patient and non-cardiac arrest patients for occurrence of cardiac arrest in an emergency department (ED) was the primary outcome. Results: The data of 527 non-trauma patients with Emergency Severity Index (ESI) 1-3 were collected. The factors found to have a significant association (P < 0.05) in the non-cardiac arrest group versus the cardiac arrest group at the ED were systolic BP (mean [IQR] 135 [114,158] vs 120 [90,140] mmHg), oxygen saturation (mean [IQR] 97 [89,98] vs 82.5 [78,95]%), GCS (mean [IQR] 15 [15,15] vs 11.5 [8.815]), normal sinus rhythm (mean 59.8 vs 30%), sinus tachycardia (mean 46.7 vs 21.7%), pH (mean [IQR] 7.4 [7.3,7.4] vs 7.2 [7,7.3]), serum lactate (mean [IQR] 2 [1.1,4.2] vs 7 [5,10.8]), and MEWS score (mean [IQR] 3 [2,5] vs 5 [3,6]). A multivariate analysis was then performed. After adjusting for multiple factors, ESI level 2 patients were more likely to have cardiac arrest in the ER compared with ESI 1 (odds ratio [OR], 1.66; P < 0.001). Furthermore, ESI 2 patients were more likely than ESI 1 patients to have cardiovascular disease (OR, 1.89; P = 0.01), heart rate < 55 (OR, 6.83; P = 0.18), SBP < 90 (OR, 3.41; P = 0.006), SpO2 < 94 (OR, 4.76; P = 0.012), sinus tachycardia (OR, 4.32; P = 0.002), lactate > 4 (OR, 10.66; P = < 0.001), and MEWS > 4 (OR, 4.86; P = 0.028). These factors remained predictive of cardiac arrest at the ED. Conclusion: The factors related to cardiac arrest in the ED are ESI 1 patients, ESI 2 patients, patients diagnosed with cardiovascular disease, SpO2 < 94, lactate > 4, and a MEWS > 4. These factors can be used as markers in the event of simultaneous arrival of many patients and can help as a pre-state for patients who have a tendency to develop cardiac arrest. The hemodynamic status and vital signs of these patients should be closely monitored. Early detection of potentially critical conditions to prevent critical medical intervention is mandatory.Keywords: cardiac arrest, predicting factor, emergency department, emergency patient
Procedia PDF Downloads 1591770 Confidence Levels among UK Emergency Medicine Doctors in Performing Emergency Lateral Canthotomy: Should it be a Key Skill in the ED
Authors: Mohanad Moustafa, Julia Sieberer, Rhys Davies
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Background: Orbital compartment syndrome (OCS) is a sight-threatening Ophthalmologic emergency caused by rapidly increasing intraorbital pressure. It is usually caused by a retrobulbar hemorrhage as a result of trauma. If not treated in a timely manner, permanent vision loss can occur. Lateral canthotomy and cantholysis are minor procedures that can be performed bedside with equipment available in the emergency department. The aim of the procedure is to release the attachments between the suspensory ligaments of the eye and the bony orbital wall, leading to a decrease in intraorbital pressure and preventing irreversible loss of vision. As most Ophthalmologists across the UK provide non-resident on-call service, this may lead to a delay in the treatment of OCS and stresses the need for Emergency medical staff to be able to provide this sight-saving procedure independently. Aim: To survey current training, experience, and confidence levels among Emergency Medicine doctors in performing emergency lateral canthotomy and to establish whether these variables change the following teaching from experienced ophthalmologists. RESULTS: Most EM registrars had little to no experience in performing lateral canthotomy and cantholysis. The majority of them showed a significant increase in their confidence to perform the procedure following ophthalmic-led teaching. The survey also showed that the registrars felt such training should be added to/part of the EM curriculum. Conclusion: The involvement of Ophthalmologists in the teaching of EM doctors to recognise and treat OCS independently may prevent delays in treatment and reduce the risk of permanent sight loss. This project showed potential in improving patient care and will lead to a National Survey of EM doctors across the UK.Keywords: lateral canthotomy, retrobulbar hemorrhage, Ophthalmology, orbital compartment syndrome, sight loss, blindness
Procedia PDF Downloads 981769 Barriers to Health Promotion Advice Delivered by Paramedics and Emergency Department Nurses – Promoted Study
Authors: B. Schofield, F. Gul, S. McClean, R. Hoskins, R. Terry, U. Rolfe, A. Gibson, S. Voss, J. Benger
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Aim: The aim of this study is to determine whether and how health promotion activities are undertaken by paramedics and emergency department nurses and investigate ways of overcoming potential barriers. Background: Paramedics and emergency department nurses are uniquely placed to reach millions of people and could use these contacts as positive opportunities to help people improve their health by identifying people with risk factors and provide information, brief interventions, and signposting to locally provided services. These interventions can be carried out when the opportunity arises, typically take no more than a few minutes, have a low financial cost and can be a highly efficient method of health promotion. Methodology: Three NHS Emergency Departments and four Ambulance Trusts in England were recruited to the study. A link to an online survey was distributed to paramedics and emergency department nurses at participating sites. Staff were invited to participate in virtual semi-structured interviews. Patients seen, treated, and discharged at the participating sites were invited to virtual semistructured interviews. Findings: A total of 331 survey responses were received, 21 virtual semi-structured staff interviews and 11 patient interviews were completed. Staff reported lack of time to prioritise, lack of knowledge, resources, and confidence as barriers. Receptiveness of patients guided their decision to undertake health promotion activities. They reported a desire to learn how to undertake health promotion conversations. Emergency department nurses felt more supported than paramedics by their organisations to undertake health promotion activities. Patients were not aware of health promotion activities and reported fear and lack of privacy as barriers. Conclusions: These results will guide the development of an intervention to support the provision of health promotion by staff in urgent and emergency care settings. The components of the intervention will be mapped to a framework which will consider the needs of staff working within these settings, patients they treat, and organisational issues and practices related to the implementation of such an intervention.Keywords: emergency service, hospital, nursing, allied health personnel, emergency medical services, health promotion
Procedia PDF Downloads 601768 Dose Evaluations with SNAP/RADTRAD for Loss of Coolant Accidents in a BWR6 Nuclear Power Plant
Authors: Kai Chun Yang, Shao-Wen Chen, Jong-Rong Wang, Chunkuan Shih, Jung-Hua Yang, Hsiung-Chih Chen, Wen-Sheng Hsu
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In this study, we build RADionuclide Transport, Removal And Dose Estimation/Symbolic Nuclear Analysis Package (SNAP/RADTRAD) model of Kuosheng Nuclear Power Plant which is based on the Final Safety Evaluation Report (FSAR) and other data of Kuosheng Nuclear Power Plant. It is used to estimate the radiation dose of the Exclusion Area Boundary (EAB), the Low Population Zone (LPZ), and the control room following ‘release from the containment’ case in Loss Of Coolant Accident (LOCA). The RADTRAD analysis result shows that the evaluation dose at EAB, LPZ, and the control room are close to the FSAR data, and all of the doses are lower than the regulatory limits. At last, we do a sensitivity analysis and observe that the evaluation doses increase as the intake rate of the control room increases.Keywords: RADTRAD, radionuclide transport, removal and dose estimation, snap, symbolic nuclear analysis package, boiling water reactor, NPP, kuosheng
Procedia PDF Downloads 3431767 Nuclear Characteristics of a Heterogeneous Thorium-Based Fuel Design Aimed at Increasing Fuel Cycle Length of a Typical PWR
Authors: Hendrik Bernard Van Der Walt, Frik Van Niekerk
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Heterogeneous thorium-based fuels have been proposed as an alternative for conventional reactor fuels and many studies have shown promising results. Fuel cycle characteristics still have to be explored in detail. This study investigates the use of a novel thorium-based fuel design aimed at increasing fuel cycle length of a typical PWR with an explicit focus on thorium- uranium content, neutron spectrum, flux considerations and neutron economy.As nuclear reactions are highly dependent on reactor flux and material matrix, analytical and numerical calculations have been completed to predict the behaviour of the proposed nuclear fuel. The proposed design utilizes various ratios of thorium oxide and uranium oxide pellets within fuel pins, divided into heterogeneous sections of specified length. This design renders multiple regions with unique characteristics. The goal of this study is to determine and optimally utilize these characteristics. Proliferation considerations result in the need for denaturing of heterogeneous regions, which renders more unique characteristics, these aspects were examined in this study. Finally, the use of fertile thorium to emulate a burnable poison for managing excess BOL reactivity has been investigated, as well as an option for flux shaping in a typical PWR.Keywords: nuclear fuel, nuclear characteristics, nuclear fuel cycle, thorium-based fuel, heterogeneous design
Procedia PDF Downloads 1351766 Sustainability through Resilience: How Emergency Responders Cope with Stressors
Authors: Sophie Kroeling, Agnetha Schuchardt
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Striving for sustainability brings a lot of challenges for different fields of interest, e. g. security or health concerns. In Germany, civil protection is predominantly carried out by emergency responders who perform essential tasks of civil protection. Based on theoretical concepts of different psychological stress theories this contribution focuses on the question, how the resilience of emergency responders can be improved. The goal is to identify resources and successful coping strategies that help to prevent and reduce negative outcomes during or after stressful events. The paper will present results from a qualitative analysis of semi-structured qualitative interviews with 20 emergency responders. These results provide insights into the complexity of coping processes (e. g. controlling the situation, downplaying perceived personal threats through humor) and show the diversity of stressors (like complexity of the disastrous situation, intrusive press and media, or lack of social support within the organization). Self-efficacy expectation was a very important resource for coping with stressful situations. The results served as a starting point for a quantitative survey (that was conducted in March 2017), the development of education and training tools for emergency responders and the improvement of critical incident stress management processes. First results from the quantitative study with more than 700 participants show that, e. g., the emergency responders use social coping within their private social network and also within their aid organization and that both are correlated to resilience. Moreover, missing information, bureaucratic problems and social conflicts within the organization are events that the majority of the participants considered very onerous. Further results from regression analysis will be presented. The proposed paper will combine findings from the qualitative study with the quantitative results, illustrating figures and correlations with respective statements from the interviews. At the end, suggestions for the improvement of the emergency responder’s resilience are given and it is discussed how this can make a contribution to strive for civil security and furthermore a sustainable development.Keywords: civil security, emergency responders, stress, resilience, resources
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