Search results for: emergency reconstruction

Authors: Kamel Abd Elaziz Mohamed

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Introduction: Drug related problems (DRPs) are of major concern, affecting patients of both sex. They impose considerable economic burden on the society and the health-care systems. Aim of the work: The aim of this work was to identify and categorize drug-related problems in adult intensive care unit. Patients and methods: The study was a prospective, observational study as eighty six patients were included. They were consecutively admitted to ICU through the emergency room or transferred from the general ward due to DRPs. Parameters included in the study as length of stay in ICU, need for cardiovascular support or mechanical ventilation, dialysis, as well as APACHE II score were recorded. Results: Drug related problems represent 3.6% of the total ICU admission. The median (range) of APACHE II score for 86 patients included in the study was 17 (10-23), and length of ICU stay was 2.4 (1.5-4.2) days. In 45 patients (52%), DRP was drug over dose (group 1), while other DRP was present in the other 41 patients (48%, group 11). Patients in group 1 were older (39 years versus 32 years in group 11), with significant impaired renal function. The need of inotropic drugs and mechanical ventilation as well as the length of stay (LOS) in ICU was significantly higher in group 1. There were no significant difference in GCS between both groups, however APACHE II score was significantly higher in group 1. Only four patients (4.6%) were admitted by suicidal attempt as well as three patients (3.4%) due to trauma drug-related admissions, all were in (group 1). Nineteen percent of the patients had drug related problem due to hypoglycaemic medication followed by tranquilizer (15%). Adverse drug effect followed by failure to receive medication were the most causes of drug problem in (group11).The total mortality rate was 4.6%, all of them were eventually non preventable. Conclusion: The critically ill patients admitted due to drug related problems represented a small proportion (3.6%) of admissions to the ICU. Hypoglycaemic medication was one of the most common causes of admission by drug related problems.

Keywords: drug related problems, ICU, cost, safety

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Authors: Amel M. A. Osman, Roy Mahony, Lisa Dann, McKenna S.

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Background: Computed Tomography (CT) is a significant source of radiation in the pediatric population. A new head injury (HI) pathway was introduced in 2021, which altered the previous process of HI being jointly admitted with general pediatrics and surgery to admit these patients under the Emergency Medicine Team. Admitted patients included those with positive CT findings not requiring immediate neurosurgical intervention and those who did not meet current criteria for urgent CT brain as per NICE guidelines but were still symptomatic for prolonged observations. This approach aims to decrease the number of CT scans performed. The main aim is to assess the variation in CT scanning rates since the change in the admitting process. A retrospective review of patients presenting to CHI PECU with HI over 6-month period (01/01/19-31/05/19) compared to a 6-month period post introduction of the new pathway (01/06/2022-31/12/2022). Data was collected from the electronic record databases, symphony, and PACS. Results: In 2019, there were 869 presentations of HI, among which 32 (3.68%) had CT scans performed. 2 (6.25%) of those scanned had positive findings. In 2022, there were 1122 HI presentations, with 47 (4.19%) CT scans performed and positive findings in 5 (10.6%) cases. 57 patients were admitted under the new pathway for observation, with 1 having a CT scan following admission. Conclusion: Quantitative lifetime radiation risks for children are not negligible. While there was no statistically significant reduction in CTs performed amongst HIs presenting to our department, a significant group met the criteria for admission under the PECU consultant for prolonged monitoring. There was also a greater proportion of abnormalities on CT scans performed in 2022, demonstrating improved patient selection for imaging. Further data analysis is ongoing to determine if those who were admitted would have previously been scanned under the old pathway.

Keywords: head injury, CT, admission, guidline

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Authors: Sahar Heidary, Ramin Ghasemi Shayan

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The recent coronavirus disease 2019 (COVID-19) occurrence has carried considerabletrials to the world health system, comprising the training of dental and maxillofacial radiology (DMFR). DMFR will keep avital role in healthcare throughout this disaster. Severe acute breathing disease coronavirus 2 (SARS-CoV-2), the virus producing the current coronavirus disease 2019 (COVID-19) pandemic, is not only extremely contagious but can make solemn consequences in susceptible persons comprising dental patients and dental health care personnel (DHCPs). Reactions to COVID-19 have been available by the Cores for Infection Switch and Inhibition and the American Dental Association, but a more detailed answer is necessary for the harmless preparation of oral and maxillofacial radiology. Our goal is to evaluation the existing information just how the illness threatens patients and DHCPs and how to define which patients are possible to be SARS-CoV-2 infected; study how the usage of private shielding utensils and contamination control measures based on recent top observes, and knowledge can decrease the danger of virus spread in radiologic trials; and scrutinize how intraoral radiography, with its actually superior danger of scattering the infection, might be changed by extraoralradiographic methods for definite diagnostic jobs. In the pandemic, teleradiology has been extensively recycled for diagnostic determinations of COVID-19 patients, for discussions with radiologists in crisis cases, or managing of distance among radiology clinics. Dentists can have the digital radiographic images of their emergency patients through online service area also by electronic message or messaging applications to view in their smart phones, laptops, or other electronic devices.

Keywords: radiology, dental, oral, COVID-19, infection

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Authors: Deddi Nordiawan

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Effective public policy creation required a strong budget system, both in terms of design and implementation. Performance-based Budget is an evolutionary approach with two substantial characteristics; first, the strong integration between budgeting and planning, and second, its existence as guidance so that all activities and expenditures refer to measurable performance targets. There are four processes in the government that should be followed in order to make the budget become performance-based. These four processes consist of the preparation of a vision according to the bold aspiration, the formulation of outcome, the determination of output based on the analysis of organizational resources, and the formulation of Value Creation Map that contains a series of programs and activities. This is consistent with the concept of logic model which revealed that the budget performance should be placed within a relational framework of resources, activities, outputs, outcomes and impacts. Through the issuance of Law 17/2003 regarding State Finance, local governments in Indonesia have to implement performance-based budget. Central Government then issued Government Regulation 58/2005 which contains the detail guidelines how to prepare local governments budget. After a decade, implementation of performance budgeting in local government is still not fully meet expectations, though the guidance is completed, socialization routinely performed, and trainings have also been carried out at all levels. Accordingly, this study views the practice of performance-based budget at local governments as a problematic situation. This condition must be approached with a system approach that allows the solutions from many point of views. Based on the fact that the infrastructure of budgeting has already settled, the study then considering the situation as complexity. Therefore, the intervention needs to be done in the area of human activity system. Using Soft Systems Methodology, this research will reconstruct the process of performance-based budget at local governments is area of human activity system. Through conceptual models, this study will invite all actors (central government, local government, and the parliament) for dialogue and formulate interventions in human activity systems that systematically desirable and culturally feasible. The result will direct central government in revise the guidance to local government budgeting process as well as a reference to build the capacity building strategy.

Keywords: soft systems methodology, performance-based budgeting, Indonesia, public policy

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Authors: M. Haruna, O. O. Onafowokan, G. Holt, K. Anderson, R. G. Middleton

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Background: Requirements for satisfactory outcomes following total hip arthroplasty (THA) include restoration of femoral offset, version, and leg length. Various techniques have been described for restoring these biomechanical parameters, with leg length restoration being the most predominantly described. We describe a “quartered head technique” (QHT) which uses a stepwise series of femoral head osteotomies to identify and preserve the centre of rotation of the femoral head during THA in order to ensure reconstruction of leg length, offset and stem version, such that hip biomechanics are restored as near to normal as possible. This study aims to identify whether using the QHT during hip arthroplasty effectively restores leg length and femoral offset to within acceptable parameters. Methods: A retrospective review of 206 hips was carried out, leaving 124 hips in the final analysis. Power analysis indicated a minimum of 37 patients required. All operations were performed using an anterolateral approach by a single surgeon. All femoral implants were cemented, collarless, polished double taper CPT® stems (Zimmer, Swindon, UK). Both cemented, and uncemented acetabular components were used (Zimmer, Swindon, UK). Leg length, version, and offset were assessed intra-operatively and reproduced using the QHT. Post-operative leg length and femoral offset were determined and compared with the contralateral native hip, and the difference was then calculated. For the determination of leg length discrepancy (LLD), we used the method described by Williamson & Reckling, which has been shown to be reproducible with a measurement error of ±1mm. As a reference, the inferior margin of the acetabular teardrop and the most prominent point of the lesser trochanter were used. A discrepancy of less than 6mm LLD was chosen as acceptable. All peri-operative radiographs were assessed by two independent observers. Results: The mean absolute post-operative difference in leg length from the contralateral leg was +3.58mm. 84% of patients (104/124) had LLD within ±6mm of the contralateral limb. The mean absolute post-operative difference in offset from contralateral leg was +3.88mm (range -15 to +9mm, median 3mm). 90% of patients (112/124) were within ±6mm offset of the contralateral limb. There was no statistical difference noted between observer measurements. Conclusion: The QHT provides a simple, inexpensive yet effective method of maintaining femoral leg length and offset during total hip arthroplasty. Combining this technique with pre-operative templating or other techniques described may enable surgeons to reduce even further the discrepancies between pre-operative state and post-operative outcome.

Keywords: leg length discrepancy, technical tip, total hip arthroplasty, operative technique

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Authors: Maria Medrano, Cristina Cadenas-Sanchez, Maddi Oses, Lide Arenaza, Maria Amasene, Idoia Labayen

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The COVID-19 outbreak began in December 2019 in China and was rapidly expanded globally. Emergency measures, such as social distance or home confinement, were adopted by many country governments to prevent its transmission. In Spain, one of the most affected countries, the schools were closed, and one of the most severe mandatory home confinement was established for children from 14th March to 26th April 2020. The hypothesis of this study was that the measures adopted during the COVID-19 pandemic may have negatively affected physical activity and screen time of children. However, few studies have examined the effects of COVID-19 pandemic on lifestyle behaviours. Thus, the aim of the current work was to analyse the effects of the COVID-19 confinement on physical activity and screen time in Spanish children. For the current purpose, a total of 113 children and adolescents (12.0 ± 2.6 yr., 51.3% boys, 24.0% with overweight/obesity according to the World Obesity Federation) of the MUGI project were included in the analyses. Physical activity and screen time were longitudinally assessed by 'The Youth Activity Profile' questionnaire (YAP). Differences in physical activity and screen time before and during the confinement were assessed by dependent t-test. Before the confinement, 60% did not meet physical activity recommendations ( ≥ 60/min/day of moderate to vigorous physical activity), and 61% used screens ≥ 2 h/day. During the COVID-19 confinement, children decreased their physical activity levels (-91 ± 55 min/day, p < 0.001) and increased screen time ( ± 2.6 h/day, p < 0.001). The prevalence of children that worsened physical activity and screen time during the COVID-19 confinement were 95.2% and 69.8%, respectively. The current study evidence the negative effects of the COVID-19 confinement on physical activity and screen time in Spanish children. These findings should be taken into account to develop and implement future public health strategies for preserving children's lifestyle behaviours and health during and after the COVID-19 pandemic.

Keywords: COVID-19, lifestyle changes, paediatric, physical activity, screen time

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Authors: R. Unnikrishnan, K. Shankar

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In the case of high-speed fighter aircrafts, seat ejection is designed mainly for the safety of the pilot in case of an emergency. Strong windblast due to the high velocity of flight is one main difficulty in clearing the tail of the aircraft. Excessive G-forces generated, immobilizes the pilot from escape. In most of the cases, seats are ejected out of the aircrafts by explosives or by rocket motors attached to the bottom of the seat. Ejection forces are primarily in the vertical direction with the objective of attaining the maximum possible velocity in a specified period of time. The safe ejection parameters are studied to estimate the critical time of ejection for various geometries and velocities of flight. An equivalent analytical 2-dimensional biomechanical model of the human spine has been modelled consisting of vertebrae and intervertebral discs with a lumped mass approach. The 24 vertebrae, which consists of the cervical, thoracic and lumbar regions, in addition to the head mass and the pelvis has been designed as 26 rigid structures and the intervertebral discs are assumed as 25 flexible joint structures. The rigid structures are modelled as mass elements and the flexible joints as spring and damper elements. Here, the motions are restricted only in the mid-sagittal plane to form a 26 degree of freedom system. The equations of motions are derived for translational movement of the spinal column. An ejection force with a linearly increasing acceleration profile is applied as vertical base excitation on to the pelvis. The dynamic vibrational response of each vertebra in time-domain is estimated.

Keywords: biomechanical model, lumped mass, seat ejection, vibrational response

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Authors: Tali Capua, Karin Hermon, Miguel Glatstein, Oren Tavor, Ayelet Rimon

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Background: Electric bicycles (E-bikes) are one of a wide range of light electric vehicles that provide convenient local transportation and attractive recreational opportunities. Along with their growing use worldwide, the E-bike related injury rate increases. To the best of our knowledge, this study is the first to specifically compare E-bike with classic bicycle related injuries in children. Methods: Data of all pediatric ( < 16 years of age) bicycle related injuries presenting to an urban level I trauma center between 2014 and 2015 were collected and analyzed. The recorded data included age, gender, details of the accident, as well severity of injury, medical diagnosis, and the outcome. Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) were calculated for each patient. Data of E-bike related injuries and classic bicycle were then compared. Results: A total of 124 bicycle related injuries and 97 E-bike related injuries presented to the emergency department. Once pedestrians and bicycle passengers were removed, the groups of riders consisted of 111 bikers and 85 E-bikers. The mean age of bikers was 9.9 years (range 3-16 years) and of E-bikers was 13.7 years (range 7.5-16 years). Injuries to the head and the extremities were common in both groups. Compared to bikers, E-bikers had significantly more injuries to intra-abdominal organs (p = 0.04). Twenty patients (16%) with bicycle related injuries were admitted, and 13 (15%) patients with E-bike related injuries, of the latter group four underwent surgical intervention. ISS scores were low overall, but the injuries of higher severity (ISS > 9) were among the E-bikers. Conclusions: This study provides unique information which suggests that injuries in E-bikers tend to be more severe than in classic bikers. There is a need for regulation regarding the use of E-bikes to enhance the safety of both bikers and other road and pavement users.

Keywords: bicycle, electric bicycle, injury, pediatric, trauma

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Authors: Hala Obeid

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Among the cities that have been touched by hard events and have been experiencing this polemic of existence, one can quote Beirut. A city that defies and confronts itself for its own existence. Beirut materialized all the social complexity; it has also preserved the memory of a society that has been able to build and reflect a certain unique identity. In spite of its glory, Lebanon’s civil war has marked a turning point in Beirut’s history. It has caused many deaths and opposed religious communities. Once this civil war has ended, the reconstruction of the city center, however, saw the spatial exclusion of manual labor, small local commerce, and middle-class residences. The urban functions that characterized the pre-war center were removed, and the city’s spontaneous evolutions were replaced by a historical urban planning, which neglected the city’s memory and identity. The social and spatial fragmentation that has erupted since the war has led to a breakdown of spatial and social boundaries within the city. The aim of this study is to evaluate the impact of fragmentation and boundaries on the city of Beirut in spatial, social, religious and ethnic terms. The method used in this research is what we call the mixed method which is a combination between the quantitative method and the qualitative one. These two approaches, in this case, do not oppose but complement each other in order to study the city of Beirut physically and socially. The main purpose of the qualitative approach is to describe and analyze the social phenomenon of the fragmentation of the city; this method can be summarized by the field observation and study. While the quantitative approach is based on filling out questionnaires that leads to statistics analyzes. Together, these two approaches will mark the course of the research. As a result, Beirut is not only a divided city but is fragmented spatially into many fragments and socially into many groups. This fragmentation is creating immaterial boundaries between fragments and therefore between groups. These urban and social boundaries are specifically religious and ethnic limits. As a conclusion, one of the most important and discussed boundary in Beirut is a spatial and religious boundary called ‘the green line’ or the demarcation line, a true caesura within the city. It marks the opposition of two urban groups and the aggravated fragmentation between them. This line divided Beirut into two compartments: East Beirut (for Christians) and West Beirut (for Muslims). This green line has become an urban void that holds the past in suspension. Finally, to think of Beirut as an urban unit becomes an insoluble problem.

Keywords: Beirut, boundaries, fragmentation, identity

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Authors: Osama Zayed

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Aim of the work: The aim of this study is to assess the predictors of pelvic vascular injuries in patients with pelvic fractures from major blunt trauma. Methods: This study was conducted as a tool-assessment study. Forty six patients with pelvic fractures from major blunt trauma will be recruited to the study arriving to department of emergency, Suez Canal University Hospital. Data were collected from questionnaire including; personal data of the studied patients and full medical history, clinical examinations, outcome measures (The Physiological and Operative Severity Score for enumeration of Mortality and morbidity (POSSUM), laboratory and imaging studies. Patients underwent surgical interventions or further investigations based on the conventional standards for interventions. All patients were followed up during conservative, operative and post-operative periods in the hospital for interpretation the predictive scores of vascular injuries. Results: Significant predictors of vascular injuries according to computed tomography (CT) scan include age, male gender, lower Glasgow coma (GCS) scores, occurrence of hypotension, mortality rate, higher physical POSSUM scores, presence of ultrasound collection, type of management, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) POSSUM scores, presence of abdominal injuries, and poor outcome. Conclusions: There was higher frequency of males than females in the studied patients. There were high probability of morbidity and low probability of mortality among patients. Our study demonstrates that POSSUM score can be used as a predictor of vascular injury in pelvis fracture patients.

Keywords: predictors, pelvic vascular injuries, pelvic fractures, major blunt trauma, POSSUM

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Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah

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Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.

Keywords: ambulance offload, district general hospital, handover, quality improvement

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Authors: Amy Darwin, Claire Blacklock

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Background: Existing literature about delivering evidence-based mental health and psychosocial support (MHPSS) in emergency settings is limited. It is difficult to monitor and evaluate the approach to MHPSS in informal refugee camps such as ‘The Jungle’ in Calais, where there are multiple service providers and where the majority of providers are volunteers. AIM: To identify experiences of MHPSS delivery by service providers in an informal camp environment in Calais, France and describe MHPSS barriers and opportunities in this type of setting. Method: Qualitative semi-structured interviews were conducted with 13 individuals from different organisations offering MHPSS in Calais and analysed using conventional content analysis. Results: Unsafe, uncertain and unsanitary conditions in the camp meant MHPSS was difficult to implement, and such conditions contributed to the poor mental health of the residents. The majority of MHPSS was offered by volunteers who lacked resources and training, and there was no overall official camp leadership which meant care was poorly coordinated and monitored. Strong relationships existed between volunteers and camp residents, but volunteers felt frustrated that they could not deliver the kind of MHPSS that they felt residents required. Conclusion: While long-term volunteers had built supportive relationships with camp residents, lack of central coordination and leadership of MHPSS services and limited access to trained professionals made implementation of MHPSS problematic. Similarly, the camp lacked the necessary infrastructure to meet residents’ basic needs. Formal recognition of the camp, and clear central leadership were identified as necessary steps to improving MHPSS delivery.

Keywords: calais, mental health, refugees, the jungle, MHPSS

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Authors: A. Kherraf, M. Bouziane, A. Drighil, L. Azzouzi, R. Habbal

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Objective: Myxomas are rare heart tumors most commonly found in the left atrium. The purpose of this observation is to report a rare case of myxoma of the right atrium revealed by pulmonary embolism. Observation: A 34-year-old patient with no history presented to the emergency room with sudden onset dyspnea. Clinical examination showed arterial pressure at 110/70mmHg, tachycardia at 110bpm, and 90% oxygen saturation. The ECG enrolled in incomplete right bundle branch block. The radio-thorax was normal. Echocardiography revealed the presence of a large homogeneous intra-OD mass, contiguous to the inter-atrial septum, prolapsing through the tricuspid valve, and causing mild tricuspid insufficiency, with dilation of the right ventricle and retained systolic function with PAPs estimated at 45mmHg. A chest scan was performed, revealing the presence of right segmental pulmonary embolism. The patient was put under anticoagulant and underwent surgical resection of the mass; its pathological examination concluded to a myxoma. The post-operative consequences were simple, without recurrence of the mass after one year follow-up. Discussion: Myxomas represent 50% of heart tumors. Most often, they originate in the left atrium, and more rarely in the right atrium or the ventricles. Myxoma of the right atrium can be responsible for life-threatening pulmonary embolism. The most predictive factor for embolization remains the morphology of the myxomas; papillary or villous myxomas are the most friable. Surgery is the standard treatment, with regular postoperative follow-up to detect recurrence. Conclusion: Myxomas of the right atrium are a rare location for these tumors. Pulmonary embolism is the main complication and should routinely involve careful study of the right chambers on echocardiography.

Keywords: pulmonary embolism, myxoma, right atrium, heart tumors

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Authors: Matheus Madureira Matos, Alexandre Rodrigues Farias

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Magnetic Resonance Imaging (MRI) is a vital imaging technique used in both clinical and pre-clinical areas to obtain detailed anatomical and functional information. However, MRI scans can be expensive, time-consuming, and often require the use of anesthetics to keep animals still during the imaging process. Anesthetics are commonly administered to animals undergoing MRI scans to ensure they remain still during the imaging process. However, prolonged or repeated exposure to anesthetics can have adverse effects on animals, including physiological alterations and potential toxicity. Minimizing the duration and frequency of anesthesia is, therefore, crucial for the well-being of research animals. In recent years, various sampling trajectories have been investigated to reduce the number of MRI measurements leading to shorter scanning time and minimizing the duration of animal exposure to the effects of anesthetics. Compressed sensing (CS) and sampling trajectories, such as cartesian, spiral, and radial, have emerged as powerful tools to reduce MRI data while preserving diagnostic quality. This work aims to apply CS and cartesian, spiral, and radial sampling trajectories for the reconstruction of MRI of the abdomen of mice sub-sampled at levels below that defined by the Nyquist theorem. The methodology of this work consists of using a fully sampled reference MRI of a female model C57B1/6 mouse acquired experimentally in a 4.7 Tesla MRI scanner for small animals using Spin Echo pulse sequences. The image is down-sampled by cartesian, radial, and spiral sampling paths and then reconstructed by CS. The quality of the reconstructed images is objectively assessed by three quality assessment techniques RMSE (Root mean square error), PSNR (Peak to Signal Noise Ratio), and SSIM (Structural similarity index measure). The utilization of optimized sampling trajectories and CS technique has demonstrated the potential for a significant reduction of up to 70% of image data acquisition. This result translates into shorter scan times, minimizing the duration and frequency of anesthesia administration and reducing the potential risks associated with it.

Keywords: compressed sensing, magnetic resonance, sampling trajectories, small animals

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Authors: Samar Mousa, Rebecca Shirley

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Injuries to the hand account for 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. Functional impairments as a result of hand injuries often necessitate absence from employment, resulting in reduced productivity estimated to incur an additional £600m loss to the UK economy. Appropriate and early management is vital to preserve anatomy, prevent stiffness and allow function. The initial assessment and management of hand injuries are usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In our plastic surgery department at Stoke Mandeville hospital Buckinghamshire trust, we carried out an audit project to detect errors in hand splinting in the period between April 2022 and July 2022 and find out measures to support junior doctors, nurses and hand therapists in providing the best possible care for hand trauma patients. Our standards were The British Society for Surgery of the Hand (BSSH) standard of care in hand trauma, AO surgery reference and Stoke Mandeville hospital hand therapy mini protocol Feb 2022 During the period of 4 months, 5 cases were identified. Two cases of wrong splint choice, two cases of early removal of the splint and one tight splint that required change. In order to avoid those mistakes, a training program was given to junior doctors and nurses in collaboration with the hand therapy team regarding ways of splinting the hand in different injuries like fractures, tendons injuries, muscle injuries and ligamentous injuries. In addition to, a poster hung in the examination rooms and theatres to help junior doctors reach the correct decision.

Keywords: splinting, hand trauma, plastic surgery, tendon injury, hand fracrture

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Authors: Kodo Sektani, Apostolos Tsouvalas, Andrei Metrikine

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The reassessment of existing movable bridges in The Netherlands has created the need for acceptance/rejection criteria to assess whether the machineries are meet certain design demands. However, the existing design code defines a different limit state design, meant for new machineries which is based on a simple linear spring-mass model. Observations show that existing bridges do not confirm the model predictions. In fact, movable bridges are nonlinear systems consisting of mechanical components, such as, gears, electric motors and brakes. Next to that, each movable bridge is characterized by a unique set of parameters. However, in the existing code various variables that describe the physical characteristics of the bridge are neglected or replaced by partial factors. For instance, the damping ratio ζ, which is different for drawbridges compared to bascule bridges, is taken as a constant for all bridge types. In this paper, a model is developed that overcomes some of the limitations of existing modelling approaches to capture the dynamics of the powertrain of a class of bridge machineries First, a semidefinite dynamic model is proposed, which accounts for stiffness, damping, and some additional variables of the physical system, which are neglected by the code, such as nonlinear braking torques. The model gives an upper bound of the peak forces/torques occurring in the powertrain during emergency braking. Second, a discrete nonlinear dynamic model is discussed, with realistic motor torque characteristics during normal operation. This model succeeds to accurately predict the full time history of the occurred stress state of the opening and closing cycle for fatigue purposes.

Keywords: Dynamics of movable bridges, Bridge machinery, Powertrains, Torque measurements

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Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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Background and aims: While in Western countries, unilateral spinal anesthesia has been widely practiced for a long time, it remains little known in the local anesthesia community, and has not been the object of many studies. However, it is a simple, practical and effective technique. Our objective was to evaluate this practice in emergency anesthesia management in frail patients and to compare it with conventional spinal anesthesia. Methods: This is a prospective, observational, comparative study between hypobaric unilateral and conventional spinal anaesthesia for hip fracture surgery carried out in the operating room of the university military hospital of Staoueli. The work was spread over of 12-month period from 2019 to 2020. The parameters analyzed were hemodynamic variations, vasopressor use, block efficiency, postoperative adverse events, and postoperative morphine consumption. Results: -75 cases (mean age 72±14 years) -Group1= 41 patients (54.6%) divided into (ASA1=14.6% ASA2=60.98% ASA3=24.39%) single shoot spinal anaesthesia -Group2= 34 patients (45.3%) divided into (ASA1=2.9%, ASA2=26.4% ASA3=61.7%, ASA4=8.8%) unilateral hypobaric spinal anesthesia. -Hemodynamic variations were more severe in group 1 (51% hypotension) compared to 30% in group 2 RR=1.69 and odds ratio=2.4 -these variations were more marked in the ASA3 subgroup (group 1=70% hypotension versus group 2=30%) with an RR=2.33 and an odds ratio=5.44 -39% of group 1 required vasoactive drugs (15mg +/- 11) versus 32% of group 2 (8mg+/- 6.49) - no difference in the use of morphine in post-op. Conclusions: Within the limits of the population studied, this work demonstrates the clinical value of unilateral spinal anesthesia in ortho-trauma surgery in the frail patient.

Keywords: spinal anaesthesia, vasopressor, morphine, hypobaric unilateral spinal anesthesia, ropivacaine, hip surgery, eldery, hemodynamic

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Authors: Mukhtar Sarkin-Kebbi

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Insurgency, religious extremism and other related religious crises become hydra-headed in Nigeria, which caused destruction of human lives and properties worth of billions naira. As result, millions people were displaced and million children were out of school most of whom from Muslims community. The wrong teaching and misinterpretation of Islam by some Muslim community fuel the spread of extremist ideology hatred among Muslim sects, non-Muslims and emergency of extremist groups, like Boko Haram. A multi-religious country like Nigeria to realise its development in all human aspects, there must be unity and religious tolerance. Many agreed that changing the ideologies of insurgents and religious extremism will require intellectual role with vigorous campaign. Muslim scholars can play a vital role in promoting social reform and peaceful coexistence. This paper discusses the importance of unity among Muslim community and religious tolerance in light of the Qur’an and the Hadith. The paper also reviews the relationship between Muslims and non Muslims during the life time the Prophet (S.A.W.) in order to serve as exemplary model. Contemporary issues such as religious extremism, sectarians, intolerance and their consequences were examined. To minify religious intolerance and extremism,the paper identifies the roles to be played by Muslim scholars with references from Qur’an and Sunnah. The paper concludes that to realise overall human development and eternal salvation, Muslim should shun away from any religious crises and embrace unity and religious tolerance. Finally the paper recommends among others that only pious and learned scholars should be allowed to preach in any religious gathering, Muslim should exercise patience, tolerance in dealing with Muslims and non Muslims. Muslims should leave by example from the teaching of Qur’an and Sunnah of the Prophet (S.A.W.).

Keywords: Muslim scholars, peace building, religious extremism, religious tolerance

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Authors: Daniel Llanes, Alfredo Reyes, Sonia E. Ruiz, Federico Valenzuela Beltran

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Steel frames have been used in building construction for more than one hundred years. Beam-column may be connected to columns using either stiffened or unstiffened angles at the top and bottom beam flanges. Designers often assume that these assemblies acted as “pinned” connections for gravity loads and that the stiffened connections would act as “fixed” connections for lateral loads. Observation of damages sustained by buildings during the 1994 Northridge earthquake indicated that, contrary to the intended behavior, in many cases, brittle fractures initiated within the connections at very low levels of plastic demand, and in some cases, while the structures remained essentially elastic. Due to the damage presented in these buildings other type of alternative connections have been proposed. According to a research funded by the Federal Emergency Management Agency (FEMA), the screwed connections have better performance when they are subjected to cyclic loads, but at the same time, these connections have some degree of flexibility. Due to this situation, some researchers ventured into the study of semi-rigid connections. In the present study three steel buildings, constituted by regular frames are analyzed. Two types of connections are considered: pinned and semi-rigid connections. With the aim to estimate their structural capacity, a number of incremental dynamic analyzes are performed. 3D structural models are used for the analyses. The seismic ground motions were recorded on sites near Los Angeles, California, where the structures are supposed to be located. The vulnerability curves of the building are obtained in terms of maximum inter-story drifts. The vulnerability curves (which correspond to the models with two different types of connections) are compared, and its implications on its structural design and performance is discussed.

Keywords: steel frame Buildings, vulnerability curves, semi-rigid connections, pinned connections

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Authors: Marius Sebastian Secula, Mihaela Darie, Gabriela Carja

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Persistent organic pollutant discharged by various industries or urban regions into the aquatic ecosystems represent a serious threat to fauna and human health. The endocrine disrupting compounds are known to have toxic effects even at very low values of concentration. The anti-inflammatory agent Ibuprofen is an endocrine disrupting compound and is considered as model pollutant in the present study. The use of light energy to accomplish the latest requirements concerning wastewater discharge demands highly-performant and robust photo-catalysts. Many efforts have been paid to obtain efficient photo-responsive materials. Among the promising photo-catalysts, layered double hydroxides (LDHs) attracted significant consideration especially due to their composition flexibility, high surface area and tailored redox features. This work presents Fe(II) self-supported on ZnMeLDHs (Me =Al3+, Fe3+) as novel efficient photo-catalysts for Fenton-like catalysis. The co-precipitation method was used to prepare ZnAlLDH, ZnFeAlLDH and ZnCrLDH (Zn2+/Me3+ = 2 molar ratio). Fe(II) was self-supported on the LDHs matrices by using the reconstruction method, at two different values of weight concentration. X-ray diffraction (XRD), thermogravimetric analysis (TG/DTG), Fourier transform infrared (FTIR) and transmission electron microscopy (TEM) were used to investigate the structural, textural, and micromorphology of the catalysts. The Fe(II)/ZnMeLDHs nano-hybrids were tested for the degradation of a model pharmaceutical agent, the anti-inflammatory agent ibuprofen, by photocatalysis and photo-Fenton catalysis, respectively. The results point out that the embedment Fe(II) into ZnFeAlLDH and ZnCrLDH lead to a slight enhancement of ibuprofen degradation by light irradiation, whereas in case of ZnAlLDH, the degradation process is relatively low. A remarkable enhancement of ibuprofen degradation was found in the case of Fe(II)/ZnMeLDHs by photo-Fenton process. Acknowledgements: This work was supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNCS - UEFISCDI, project number PN-II-RU-TE-2014-4-0405.

Keywords: layered double hydroxide, heterogeneous Fenton, micropollutant, photocatalysis

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Authors: Christopher Holroyd

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With the various terrorist organizations and drug cartels that are currently active, there is a myriad of security concerns facing countries around the world. Organizations that focus their attacks on others through terror, such as what is seen with the Islamic State of Iraq and the Levant (ISIS), have no boundaries when it comes to doing what is needed to fulfill their desired intent. For countries such as Iraq, who have been trying to rebuild their country since the fall of the Saddam Hussein Regime, organizations such as Al-Qaeda and ISIS have been impeding the country’s efforts toward peace and stability. One method utilized by terrorist organizations around the world is human trafficking. This method is one that is seen around the world; modern slavery is still exploited by those who have no concern for human decency and morality, their only concern is to achieve their goals by any means. It is understandable that some people may not have even heard of 'modern slavery', or they just might not believe that it is even an issue in today’s world. Organizations such as ISIS are not the only ones in the world that seek to benefit from the immoral trading of humans. Various drug cartels in the world, such as those seen in Mexico and Central America, have recently begun to take part in the trade – moving humans from state to state, or country to country, to better fuel their overall operations. This now makes the possibility of human trafficking more real for those in the United States because of the proximity of the cartels to the southern border of the country. An issue that, at one time, might have only seen as a distant threat, is now close to home for those in the United States. Looking at these two examples is how we begin to understand why human trafficking is utilized by various organizations around the world. This trade of human beings and the violation of basic human rights is a plague that effects the entire world and not just those that are in a country other than your own. One of the security issues that stem from the trade includes the movement and recruitment of members of the organizations. With individuals being smuggled from one location to another in secrecy, this only puts those trying to combat this trade at a disadvantage. This creates concern over the accurate number of potential recruits, combatants, and other individuals who are working against the host nation, and for the mission of the cartel or terrorist organization they are a part of. An uphill battle is created, and the goals of peace and stability are now harder to reach. Aside from security aspects, it cannot be forgotten that those being traded and forced into slavery, are being done so against their will. Families are separated, children trained to be fighters or worse. This makes the goal of eradicating human trafficking even more dire and important.

Keywords: human trafficking, reconstruction, security, terrorism

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Authors: M. C. Teng, M. C. Ke, C. Y. Yang, S. S. Ke

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There are more than one thousand times a year of felt earthquakes in Taiwan. Because earthquakes are disaster threats to urban infrastructure, they often disrupt infrastructure services. For example, the highway system is very important to transportation infrastructure; however, it is vulnerable to earthquakes and typhoons in Taiwan. When a highway system is damaged by disaster, it will create a major impact on post-disaster communications and emergency relief and affect disaster relief works. In a study case on September 18th, 2022, the Taitung Chihshang earthquake, with a magnitude of 6.8 on the Richter scale with a depth of 7 km, caused one death; 171 people were injured and had a significant urban infrastructure impact. Hualien and Taitung areas have a large number of surface ruptures, road disruptions due to the collapses, over ten cases of bridges failure or closed, partial railroad section service shutdown, building collapses, and casualties. Taitung Chihshang earthquake, the peak ground acceleration is 585 gal (cm/s²), and the seismic intensity is Level 6 Upper(6+)in Chishang, Taitung County. After the earthquakes, we conducted on-site disaster investigation works in the disaster area; the disaster investigation works included a public and private building survey, a transportation facility survey, a total of ten damaged bridges, and one railroad station damaged were investigated in this investigation. The results showed that the affected locations were mainly concentrated along the Chihshang fault and the Yuli fault in the Huatung Longitudinal Valley. We recorded and described the impact and assessed its influence region in terms of its susceptibility to and the consequences of earthquake attacks. In addition, a lesson is learned from this study regarding the key issues after the Taitung Chihshang earthquake.

Keywords: earthquake, infrastructure, disaster investigation, lesson learned

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Authors: Yao Cheng, Weihua Zhang

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Although the measured vibration signal contains rich information on machine health conditions, the white noise interferences and the discrete harmonic coming from blade, shaft and mash make the fault diagnosis of rolling element bearings difficult. In order to overcome the interferences of useless signals, a new fault diagnosis method combining Complete Ensemble Empirical Mode Decomposition with adaptive noise (CEEMDAN) and Multipoint Optimal Minimum Entropy Deconvolution (MOMED) is proposed for the fault diagnosis of high-speed train bearings. Firstly, the CEEMDAN technique is applied to adaptively decompose the raw vibration signal into a series of finite intrinsic mode functions (IMFs) and a residue. Compared with Ensemble Empirical Mode Decomposition (EEMD), the CEEMDAN can provide an exact reconstruction of the original signal and a better spectral separation of the modes, which improves the accuracy of fault diagnosis. An effective sensitivity index based on the Pearson's correlation coefficients between IMFs and raw signal is adopted to select sensitive IMFs that contain bearing fault information. The composite signal of the sensitive IMFs is applied to further analysis of fault identification. Next, for propose of identifying the fault information precisely, the MOMED is utilized to enhance the periodic impulses in composite signal. As a non-iterative method, the MOMED has better deconvolution performance than the classical deconvolution methods such Minimum Entropy Deconvolution (MED) and Maximum Correlated Kurtosis Deconvolution (MCKD). Third, the envelope spectrum analysis is applied to detect the existence of bearing fault. The simulated bearing fault signals with white noise and discrete harmonic interferences are used to validate the effectiveness of the proposed method. Finally, the superiorities of the proposed method are further demonstrated by high-speed train bearing fault datasets measured from test rig. The analysis results indicate that the proposed method has strong practicability.

Keywords: bearing, complete ensemble empirical mode decomposition with adaptive noise, fault diagnosis, multipoint optimal minimum entropy deconvolution

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Authors: Helen Huang, Francisco Javier Quesada Ocet, Blanca Quesada Oce, Javier Jimenez Bello, Victor Palanca Gil, Alba Cervero Rubio, Ana Paya Chaume, Alejandro Herreros-Pomares, Fernando Vidal-Vanaclocha, Rafael Paya Serrano, Aurelio Quesada Dorador, Monica Soliman

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Background: Cancer favors both the pro-inflammatory state and autonomic dysfunction, two important mechanisms in the genesis of AF. Atrial remodeling might be caused as a result of paraneoplastic conditions or the result of direct expression of neoplasia. Here, we hypothesize that cancer, through inflammatory mediators, may favor the appearance of AF and patients with the first episode of AF could have a higher risk of developing cancer. Method: Data was collected from patients who attended the emergency department of our hospital for the first episode of AF, diagnosed electrocardiographically, between 2010-2015 (n = 712). The minimum follow-up was 2 years, recording the appearance of cancer, total mortality, recurrences of AF and other events. Patients who developed cancer and those who did not during the 2 years after the onset of AF were compared, as well as with the incidence of cancer in Spain in 2012. Results: After 2 years, 35 patients (4.91%) were diagnosed with cancer, with an annual incidence of 2.45%. Hematological neoplasms were the most frequent (34.28%). The cancer group was older (76.68 +/-12.75 years vs 74.16 +/-12.71; p <0.05) and had fewer typical symptoms (palpitations) (33.38% vs 14.28% , p <0.05). The incidence of cancer in Spain during 2012 was 0.46%, much lower than our sample. When comparing the incidence by age, these differences were maintained both in those over 65 years of age and in those under 65 years of age (2.17% vs. 0.28%; 0.28% vs. 0.18% respectively). Discussion: Therefore, a high incidence of cancer in patients with the first episode of AF was observed (the annual incidence of 2.45% after the onset of AF is 6.1 times that of the general population). After the evaluation of patients with AF in their first detected episode, surveillance of the appearance of cancer should be considered in clinical practice.

Keywords: cancer, cardiovascular outcomes, atrial fibrillation, inflammation

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Authors: Hanjun Hu, Jinxiang Zhang

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With the decline of "growthism", China's urbanization process has shifted from the stage of spatial expansion to the stage of optimization of built-up spaces, and urban renewal has gradually become a new wave of China's urban movement in recent years. The ongoing urban renewal movement in China not only needs to generate new motivation for urban development but also solve the backlog of social problems caused by rapid urbanization, which provides an opportunity for the transformation of China's urban governance model. Unlike previous approaches that focused on physical space and functional renewal, such as urban reconstruction, redevelopment, and reuse, the key challenge of urban renewal in the post-growth era lies in coordinating the complex interest relationships between multiple stakeholders. The traditional theoretical frameworks that focus on the structural relations between social groups are insufficient to explain the behavior logic and mutual cooperation mechanism of various groups and individuals in the current urban renewal practices. Therefore, based on the long-term tracking of the urban renewal practices in the Old City of Nanjing (OCN), this paper introduces the "collective action" theory to deeply analyze changes in the urban renewal governance model in OCN and tries to summarize the governance strategies that promote the formation of collective action within recent practices from a micro-scale. The study found that the practice in OCN experienced three different stages "government-led", "growth coalition" and "asymmetric game". With the transformation of government governance concepts, the rise of residents' consciousness of rights, and the wider participation of social organizations in recent years, the urban renewal in OCN is entering a new stage of "collective renewal action". Through the establishment of the renewal organization model, incentive policies, and dynamic negotiation mechanism, urban renewal in OCN not only achieves a relative balance between individual interests and collective interests but also makes the willingness of residents the dominant factor in formulating urban renewal policies. However, the presentation of "collective renewal action" in OCN is still mainly based on typical cases. Although the government is no longer the dominant role, a large number of resident-led collective actions have not yet emerged, which puts forward new research needs for a sustainable governance policy innovation in this action.

Keywords: urban renewal, collective action theory, governance, cooperation mechanism, China

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Authors: Zhao Yu, Zhi-Nan Zhang

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More and more interactive devices are used in the transportation service system. Our mobile phones, on-board computers, and Head-Up Displays (HUDs) can all be used as the tools of the in-car service system. People can access smart systems with different terminals such as mobile phones, computers, pads and even their cars and watches. Different forms of terminals bring the different quality of interaction by the various human-computer Interaction modes. The new interactive devices require good ergonomics design at each stage of the whole design process. According to the theory of human factors and ergonomics, this paper compared three types of interactive devices by four driving tasks. Forty-eight drivers were chosen to experience these three interactive devices (mobile phones, on-board computers, and HUDs) by a simulate driving process. The subjects evaluated ergonomics performance and subjective workload after the process. And subjects were encouraged to support suggestions for improving the interactive device. The result shows that different interactive devices have different advantages in driving tasks, especially in non-driving tasks such as information and entertainment fields. Compared with mobile phones and onboard groups, the HUD groups had shorter response times in most tasks. The tasks of slow-up and the emergency braking are less accurate than the performance of a control group, which may because the haptic feedback of these two tasks is harder to distinguish than the visual information. Simulated driving is also helpful in improving the design of in-vehicle interactive devices. The paper summarizes the ergonomics characteristics of three in-vehicle interactive devices. And the research provides a reference for the future design of in-vehicle interactive devices through an ergonomic approach to ensure a good interaction relationship between the driver and the in-vehicle service system.

Keywords: human factors, industrial ergonomics, transportation system, usability, vehicle user interface

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Authors: Baluku Nathan

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Transferring critically ill patients from one health facility to another poses a major risk to the patient because of increased oxygen demands. transferring patients with critical COVID-19 from a rural health canter in a rural district to a national referral hospital over 350 km in 7 hours would require three size H oxygen cylinders for successful transfer. It was always difficult to arrange the three size cylinders in the ambulance as workspace was greatly compromised for the ambulance assistant. Purpose: The purpose of this study was to investigate the impact and effectiveness of transport ventilators on the transportation of the critically ill patients from rural health canters to national referral hospitals in Uganda. Methodology: This was a descriptive cross-sectional study conducted in sept 2022 among critical care nurses and ambulance assistants who had used both methods of transportation (ventilators and cylinders). A semi structured questionnaire was used to collect quantitative data after informed consent. Results: From the findings, distribution of transport ventilators to the regional referral hospitals by the Ministry of Health has gradually improved patient transfer as the team requires less than one size oxygen cylinder to successfully transfer a patient. We use two ambulance assistants (a critical care nurse and another nurse who has been trained on use of the ventilator) when transferring patients with critical COVID-19 as the teams have to interchange over the long distance. Conclusions: Transport ventilators are effective and efficient in transferring critically ill patients, therefore should be rolled out to lower levels coupled with user training to improve outcomes of patients transferred in ambulances in lower income countries.

Keywords: emergency medical technician, critically ill, COVID-19, transport ventilator

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Authors: Siamak Yaghoubi, Mohammad Reza Abootorabi, Hamid Kayalha

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Objective: The study was aimed to evaluate the applicability of the Cobra Perilaryngeal Airway (Cobra PLATM) for patients under general anesthesia and also compare result with the Laryngeal Mask Airway (LMA). Methods: Seventy three obese and overweight patients were included in the study. The patients were randomly assigned to either LMA or Cobra PLATM. Time required for intubation, successful intubation attempt, airway sealing pressure, the incidences of complications including blood staining, sore throat and dysphagia were assessed and noted. Results: Thirty six and thirty seven patients were allocated randomly to either LMA or Cobra PLATM, respectively. Most of the patients were male and were in Mallampati Class II airway in both groups. The first attempt and overall insertion success for the Cobra PLATM was significantly more frequent compared to the LMA (p<0.05). Tube insertion was more successful (Cobra PLATM, 94%; LMA™, 77%; P = 0.027) with the Cobra PLATM. The insertion times were similar with the Cobra PLATM and LMA™ (Cobra PLATM, 29.94±16.35s; LMA™, 27.00±7.88s). The airway sealing pressure in the Cobra PLATM (24.80±0.90 H2O) was significantly more than LMA™ (19.13 ±0.58 H2O, p<0.001). Sore throat was more frequent in the LMA™ groups that did not reach statistical significance (Fisher’s exact test, P = 0.33). Incidences of blood staining on airway tube were seen for both groups that was higher in the Cobra PLATM group (Fisher’s exact test, P = 0.02). Incidence of dysphagia was not different between the two groups. Conclusion: The CobraPLA™ was found to be safe and low complications, better airway sealing and high rate of the first insertion success for suing in obese and overweight patients. The study recommended using the CobraPLA™ as a rescue device in an emergency situation among obese and overweight patients.

Keywords: CobraPLA™, flexible laryngeal mask airway, obese patients, perilaryngeal airway

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Authors: Magdalena Smoktunowicz, Renata Wawrzyniak, Malgorzata Waleron, Krzysztof Waleron

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Pectobacterium spp. were previously classified into the Erwinia genus founded in 1917 to unite at that time all Gram-negative, fermentative, nonsporulating and peritrichous flagellated plant pathogenic bacteria. After work of Waldee (1945), on Approved Lists of Bacterial Names and bacteriology manuals in 1980, they were described either under the species named Erwinia or Pectobacterium. The Pectobacterium genus was formally described in 1998 of 265 Pectobacterium strains. Currently, there are 21 species of Pectobacterium bacteria, including Pectobacterium betavasculorum since 2003, which caused soft rot on sugar beet tubers. Based on the biochemical experiments carried out for this, it is known that these bacteria are gram-negative, catalase-positive, oxidase-negative, facultatively anaerobic, using gelatin and causing symptoms of soft rot on potato and sugar beet tubers. The mere fact of growing on sugar beet may indicate a metabolism characteristic only for this species. Metabolomics, broadly defined as the biology of the metabolic systems, which allows to make comprehensive measurements of metabolites. Metabolomics, in combination with genomics, are complementary tools for the identification of metabolites and their reactions, and thus for the reconstruction of metabolic networks. The aim of this study was to apply the GC-MS-based untargeted metabolomics to study the metabolism of P. betavasculorum in different growing conditions. The metabolomic profiles of biomass and biomass media were determined. For sample preparation the following protocol was used: extraction with 900 µl of methanol: chloroform: water mixture (10: 3: 1, v: v) were added to 900 µl of biomass from the bottom of the tube and up to 900 µl of nutrient medium from the bacterial biomass. After centrifugation (13,000 x g, 15 min, 4oC), 300µL of the obtained supernatants were concentrated by rotary vacuum and evaporated to dryness. Afterwards, two-step derivatization procedure was performed before GC-MS analyses. The obtained results were subjected to statistical calculations with the use of both uni- and multivariate tests. The obtained results were evaluated using KEGG database, to asses which metabolic pathways are activated and which genes are responsible for it, during the metabolism of given substrates contained in the growing environment. The observed metabolic changes, combined with biochemical and physiological tests, may enable pathway discovery, regulatory inference and understanding of the homeostatic abilities of P. betavasculorum.

Keywords: GC-MS chromatograpfy, metabolomics, metabolism, pectobacterium strains, pectobacterium betavasculorum

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Authors: Pornthip Seangsanga

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Sepsis or septic shock needs urgent care because it is a cause of the high mortality rate if patients do not receive timely treatment. Songkhla Hospital does not have a clear system or clinical practice guidelines for treatment of patients with severe sepsis or septic shock, which contributes to the said problem.To compare clinical outcomes based on the protocol after using the clinical guidelines between the Emergency Room, Intensive Care Unit, and the Ward. This quasi-experimental study was conducted on the population and 50 subjects who were diagnosed with severe sepsis or septic shock from December 2013 to May 2014. The data were collected using a nursing care and referring record form for patients with severe sepsis or septic shock at Songkhla Hospital. The record form had been tested for its validity by three experts, and the IOC was 1.The mortality rate in patients with severe sepsis or septic shock who were moved from the ER to the ICU was significantly lower than that of those patients moved from the Ward to the ICU within 48 hours. This was because patients with severe sepsis or septic shock who were moved from the ER to the ICU received more fluid within the first six hours according to the protocol which helped patients to have adequate tissue perfusion within the first six hours, and that helped improve blood flow to the kidneys, and the patients’ urine was found to be with a higher quantity of 0.5 cc/kg/hr, than those patients who were moved from the Ward to the ICU. This study shows that patients with severe sepsis or septic shock need to be treated immediately. Using the clinical practice guidelines along with timely diagnosis and treatment based on the sepsis bundle in giving sufficient and suitable amount of fluid to help improve blood circulation and blood pressure can clearly prevent or reduce severity of complications.

Keywords: clinical practice guidelines, caring, septic shock, sepsis bundle protocol

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