Search results for: hospital waste

Authors: Joao A. Labrincha, Rui M. Novais, L. Senff, J. Carvalheiras

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The development of multifunctional materials to tackle the energy consumption and improve the hygrothermal performance of buildings is very relevant. This work reports the development of porous geopolymers or bi-layered composites, composed by a highly porous top-layer and a dense bottom-layer, showing high ability to reduce the temperature swings inside buildings and simultaneously buffer the humidity levels. The use of phase change materials (PCM) strongly reduces the indoor thermal fluctuation (up to 5 °C). The potential to modulate indoor humidity is demonstrated by the very high practical MBV (2.71 g/m2 Δ%HR). Since geopolymer matrixes are produced from wastes (biomass fly ash, red mud) the developed solutions contribute to sustainable and energy efficient and healthy building.

Keywords: waste-based geopolymers, thermal insulation, temperature regulation, moisture buffer

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Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

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Authors: Ahokas Mikko, Taskila Sanna, Varrio Kalle, Tanskanen Juha

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The present research aimed at the development of an energy efficient process for the concentration of starchy waste waters. The selected principle is mechanical vapor recompression evaporation (MVR) which leads to concentrated solid material and evaporated water phase. Evaporation removes water until a certain viscosity limit is reached. Materials with high viscosity cannot be concentrated using standard evaporators due to limitations of pumps and other constraints, such as wetting. Control of viscosity is thus essential for efficient evaporation. This applies especially to fluids in which due starch or other compounds the viscosity tends to increase via removal of water. In the present research, the effect of enzymes on evaporation of highly viscous starch industry waste waters was investigated. Wastewater samples were received from starch industry at pH of 4.8. Response surface methodology (RSM) was applied for the investigation of factor effects on the behaviour of concentrate during evaporation. The RSM was prepared using quadratic face-centered central composite design (CCF). The evaporation performance was evaluated by monitoring the viscosity of fluid during processing. Based on viscosity curves, the addition of glucoamylase reduced the viscosity during evaporation. This assumption was confirmed by CCF, suggesting that the use of starch decomposing glucoamylase allowed evaporation of the starchy wastewater to a relatively high total solid concentration without a detrimental increase in the viscosity. The results suggest that use of enzymes for reduction of viscosity during the evaporation allows more effective concentration of the wastewater and thereby recovery of potable water.

Keywords: viscous, wastewater, treatment, evaporation, concentration

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Authors: Hasan Taherkhani

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Increasingly accumulation of the solid waste materials has become a major environmental problem of communities. In addition to the protection of environment, the recycling and reusing of the waste materials are financially beneficial. Waste materials can be used in highway construction. This study aimed to investigate the applicability of recycled concrete, asphalt and steel slag powder, as a replacement of the primary mineral filler in asphalt concrete has been investigated. The primary natural siliceous aggregate filler, as control, has been replaced with the secondary recycled concrete, asphalt and steel slag powders, and some engineering properties of the mixtures have been evaluated. Marshal Stability, flow, indirect tensile strength, moisture damage, static creep and volumetric properties of the mixtures have been evaluated. The results show that, the Marshal Stability of the mixtures containing recycled powders is higher than that of the control mixture. The flow of the mixtures containing recycled steel slag is lower, and that of the mixtures containing recycled asphalt and cement concrete powder is found to be higher than that of the control mixture. It is also found that the resistance against moisture damage and permanent deformation of the mixture can be improved by replacing the natural filler with the recycled powders. The volumetric properties of the mixtures are not significantly influenced by replacing the natural filler with the recycled powders.

Keywords: filler, steel slag, recycled concrete, recycled asphalt concrete, tensile strength, moisture damage, creep

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Authors: Md. Abdul Karim, Syed Imran Ahmed, Pandora T. Hardtman

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Informed consent is one of the basic human and ethical rights for childbearing women. It plays a central role in promoting informed decision making between patients and service providers during the labor process. It gives mothers rights to accept or reject any examination and/or procedure, increases the respect and dignity of the mother during pregnancy, delivery and postpartum care. To assess the practices of this right during normal vaginal delivery and immediate postpartum care in tertiary level hospital setting in Bangladesh, a quantitative study with cross-sectional design was conducted in Dhaka Medical College & Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in Dhaka in November 2015. A prevalence-based sample size of 190 was calculated where prevalence, confidence interval and level of significance were at 9.7%, 98% and 5% respectively. The respondents were the mothers who gave normal vaginal childbirth within past 24 hours and received postpartum care there. They were selected through systematic random sampling technique and their face-to-face interview of 190 mothers was done using a structured questionnaire. Data were entered into the spreadsheet (MS Excel 2013 version) and descriptive analysis of findings was done. The result shows the complete absence of informed consent practices and mostly absence of consented care such as right to information, respect for choices of preferences for examination and/or procedure of childbearing women. Although 95% of the mothers were informed that they were being proceeded with normal vaginal delivery, their choice of preference was absent during the process. Only consent (not informed consent) was taken from 50%-72% mothers for examination (except breast examination ‘0%’) and 8%-83% for any procedures during postpartum care. Only one-ninth (11%) of the mothers could ask service providers regarding the services they received. No consent was taken from 3% of the mothers- neither in the labor process nor in postpartum care. This current practice doesn’t comply with the Respectful Maternity Care (RMC) Charter 2011. The issue is not even clarified in the current Standard Clinical Management Protocols of the country. So, improvement of the existing protocol and increased awareness are essential to address this right of child-bearing women and to practice it during normal vaginal delivery and postpartum care.

Keywords: informed consent, normal vaginal delivery, respectful maternity care, tertiary level hospital

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Authors: Dilek Ozlem Esen, Mesut Kaya

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The focus of this study is to analyse the results of heat recovery from exhaust gas which is produced by an internal combustion engine (ICE). To obtain a small amount of energy, an exhaust system which is suitable for recovery waste heat has been constructed. Totally 27 TEGs have been used to convert from the heat to electric energy. By producing a small amount of this energy by the help of thermoelectric generators can reduce engine loads thus decreasing pollutant emissions, fuel consumption, and CO2. This case study is conducted in an effort to better understand and improve the performance of thermoelectric heat recovery systems for automotive use. As a result of this study, 0,45 A averaged current rate, 13,02 V averaged voltage rate and 5,8 W averaged electrical energy have been produced in a five hours operation time.

Keywords: thermoelectric, peltier, thermoelectric generator (TEG), exhaust, cogeneration

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Authors: Shamini Dhana, G. Subrahmanya VRK Rao

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The fashion industry is advancing towards a mindset of zero waste, personalization, creativity, and circularity. The trend of upcycling clothing and materials into personalized fashion is being demanded by the next generation. There is a need for a digital tool to accelerate the process towards mass customization. Dhana’s D/Sphere fashion technology platform uses digital tools to accelerate upcycling. In essence, advanced fashion garments can be designed and developed via reuse, repurposing, recreating activities, and using existing fabric and circulating materials. The D/Sphere platform has the following objectives: to provide (1) An opportunity to develop modern fashion using existing, finished materials and clothing without chemicals or water consumption; (2) The potential for an everyday customer and designer to use the medium of fashion for creative expression; (3) A solution to address the global textile waste generated by pre- and post-consumer fashion; (4) A solution to reduce carbon emissions, water, and energy consumption with the participation of all stakeholders; (5) An opportunity for brands, manufacturers, retailers to work towards zero-waste designs and as an alternative revenue stream. Other benefits of this alternative approach include sustainability metrics, trend prediction, facilitation of disassembly and remanufacture deep learning, and hyperheuristics for high accuracy. A design tool for mass personalization and customization utilizing existing circulating materials and deadstock, targeted to fashion stakeholders will lower environmental costs, increase revenues through up to date upcycled apparel, produce less textile waste during the cut-sew-stitch process, and provide a real design solution for the end customer to be part of circular fashion. The broader impact of this technology will result in a different mindset to circular fashion, increase the value of the product through multiple life cycles, find alternatives towards zero waste, and reduce the textile waste that ends up in landfills. This technology platform will be of interest to brands and companies that have the responsibility to reduce their environmental impact and contribution to climate change as it pertains to the fashion and apparel industry. Today, over 70% of the $3 trillion fashion and apparel industry ends up in landfills. To this extent, the industry needs such alternative techniques to both address global textile waste as well as provide an opportunity to include all stakeholders and drive circular fashion with new personalized products. This type of modern systems thinking is currently being explored around the world by the private sector, organizations, research institutions, and governments. This technological innovation using digital tools has the potential to revolutionize the way we look at communication, capabilities, and collaborative opportunities amongst stakeholders in the development of new personalized and customized products, as well as its positive impacts on society, our environment, and global climate change.

Keywords: circular fashion, deep learning, digital technology platform, personalization

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Authors: Mahsa Mafi

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Encapsulation of Micrococcus Luteus (M. Luteus) in polymeric composites has been employed for the bioremediation, sequestration of metals and for the biodegradation of chemical pollutants and toxic components in waste water. Polymer composites in the form of nonwovens of nanofibers, or core/shell particles can provide a bacterial friendly environment for transfer of nutrients and metabolisms, with the least leakage of bacteria. M. Luteus is encapsulated in a hydrophilic core of poly (vinyl alcohol), following by synthesis or coating of a proper shell as a support to maintain the chemical and mechanical strength. The biological activity of bacteria is confirmed by Live/Dead analysis and agar plate tests. SEM and TEM analysis were utilized for morphological studies of polymer composites. As a result of the successful encapsulation of the alive bacteria in polymers, longer storage time in their functional state were achieved.

Keywords: Polymer composites, Bacteria encapsulation, Bioremediation, Waste water treatment

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Authors: Cora Fernandez Dacosta, John A. Posada, Andrea Ramirez

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The biodegradable family of polymers polyhydroxyalkanoates are interesting substitutes for convectional fossil-based plastics. However, the manufacturing and environmental impacts associated with their production via intracellular bacterial fermentation are strongly dependent on the raw material used and on energy consumption during the extraction process, limiting their potential for commercialization. Industrial wastewater is studied in this paper as a promising alternative feedstock for waste valorization. Based on results from laboratory and pilot-scale experiments, a conceptual process design, techno-economic analysis and life cycle assessment are developed for the large-scale production of the most common type of polyhydroxyalkanoate, polyhydroxbutyrate. Intracellular polyhydroxybutyrate is obtained via fermentation of microbial community present in industrial wastewater and the downstream processing is based on chemical digestion with surfactant and hypochlorite. The economic potential and environmental performance results help identifying bottlenecks and best opportunities to scale-up the process prior to industrial implementation. The outcome of this research indicates that the fermentation of wastewater towards PHB presents advantages compared to traditional PHAs production from sugars because the null environmental burdens and financial costs of the raw material in the bioplastic production process. Nevertheless, process optimization is still required to compete with the petrochemicals counterparts.

Keywords: circular economy, life cycle assessment, polyhydroxyalkanoates, waste valorization

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Authors: Yiu K. C. Jacky, Tang S. K. Eric, W. Y. Tsang, C. Y. Li, C. K. Leung

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Objectives : (1) To enhance the competence of nurses on using IPMOE for drug administration; (2) To ensure the transition on implementation of IPMOE in safer and smooth way hospital-wide. Methodology: (1) Well-structured Governance: To make provision for IPMOE implementation, multidisciplinary governance structure at Corporate and Local levels are well established. (2) Staff Engagement: A series of staff engagement events were conducted including Staff Forum, IPMOE Hospital Visit, Kick-off Ceremony and establishment of IPMOE Webpage for familiarizing the forthcoming implementation with frontline staff. (3) Well-organized training program: from Workshop to Workplace Two different IPMOE training programs were tailor-made which aimed at introducing the core features of administration module. Fifty-five identical training classes and six train-the-trainer workshops were organized at 2-3Q 2015. Lending Scheme on IPMOE hardware for hands-on practicing was launched and further extended the training from workshop to workplace. (4) Standard Guidelines and Workflow: the related workflow and guidelines are developed which facilitates users to acquire the competence towards IPMOE and fully familiarize with the standardized contingency plan. (5) Facilities and Equipment: The installations of IPMOE hardware were promptly arranged for rollout. Besides, IPMOE training venue was well-established for staff training. (6) Risk Management Strategy: UCH Medication Safety Forum is organized in December 2015 for sharing “Tricks & Tips” on IPMOE which further disseminate at webpage for arousal of medication safety. Hospital-wide annual audit on drug administration was planned to figure out the compliance and deliberate the rooms for improvement. Results: Through the comprehensive training plan, over 1,000 UCH nurses attended the training program with positive feedback. They agreed that their competence on using IPMOE was enhanced. By the end of November 2015, 28 wards (over 1,000 Inpatient-bed) involving departments of M&G, SUR, O&T and O&G have been successfully rolled out IPMOE in 5-month. A smooth and safe transition of implementation of IPMOE was achieved. Eventually, we all get prepared for embedding IPMOE into daily nursing and work altogether for medication safety at UCH.

Keywords: drug administration, inpatient medication order entry system, medication safety, nursing informatics

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Authors: Muhammed Ertugrul Celoglu, Beyza Furtana, Mehmet Yilmaz, Baha Vural Kok

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Biomass, which is considered to be one of the largest renewable energy sources in the world, has a potential to be utilized as a bitumen additive after it is processed by a wide variety of thermochemical methods. Furthermore, biomasses are renewable in short amounts of time, and they possess a hydrocarbon structure. These characteristics of biomass promote their usability as additives. One of the most common ways to create materials with significant economic values from biomasses is the processes of pyrolysis. Pyrolysis is defined as the process of an organic matter’s thermochemical degradation (carbonization) at a high temperature and in an anaerobic environment. The resultant liquid substance at the end of the pyrolysis is defined as bio-oil, whereas the resultant solid substance is defined as biochar. Olive pomace is the resultant mildly oily pulp with seeds after olive is pressed and its oil is extracted. It is a significant source of biomass as the waste of olive oil factories. Because olive pomace is waste material, it could create problems just as other waste unless there are appropriate and acceptable areas of utilization. The waste material, which is generated in large amounts, is generally used as fuel and fertilizer. Generally, additive materials are used in order to improve the properties of bituminous binders, and these are usually expensive materials, which are produced chemically. The aim of this study is to investigate the usability of biochars obtained after subjecting olive pomace and smashed olive seeds, which are considered as waste materials, to pyrolysis as additives in bitumen modification. In this way, various ways of use will be provided for waste material, providing both economic and environmental benefits. In this study, olive pomace and smashed olive seeds were used as sources of biomass. Initially, both materials were ground and processed through a No.50 sieve. Both of the sieved materials were subjected to pyrolysis (carbonization) at 400 ℃. Following the process of pyrolysis, bio-oil and biochar were obtained. The obtained biochars were added to B160/220 grade pure bitumen at 10% and 15% rates and modified bitumens were obtained by mixing them in high shear mixtures at 180 ℃ for 1 hour at 2000 rpm. Pure bitumen and four different types of bitumen obtained as a result of the modifications were tested with penetration, softening point, rotational viscometer, and dynamic shear rheometer, evaluating the effects of additives and the ratios of additives. According to the test results obtained, both biochar modifications at both ratios provided improvements in the performance of pure bitumen. In the comparison of the test results of the binders modified with the biochars of olive pomace and smashed olive seed, it was revealed that there was no notable difference in their performances.

Keywords: bituminous binders, biochar, biomass, olive pomace, pomace, pyrolysis

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Authors: Thi Lan Huong Nguyen, Motohei Kanayama, Takahiro Higashi, Van Chinh Le, Thu Ha Doan, Anh Daochu

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Waste from industrial sources, serves as sources of water for irrigating farms. The purpose of this study is to identify the impact of waste-water irrigation on the level of heavy metals in the soils. Soil samples were collected from the different locations from upstream to downstream of the Nhue River to evaluate heavy metal pollution. The results showed that the concentrations of all heavy metals in the soil samples in the farmland area were much higher than the background level in that area (1.2-2.6 mg/kg for Cd, 42-60 mg/kg for Cr, 22-62mg/kg for Cu, 30-86 mg/kg for Pb, 119-245 mg/kg for Zn, and 26-57 mg/kg for Ni), and exceeded the level of Vietnamese standard for agricultural soil for all heavy metals Cd, Cu, Pb, and Zn except soil samples at upstream and downstream of the Nhue River.

Keywords: heavy metal, soil, Nhue River, wastewater irrigation

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Authors: Z. Chen, C. S. Poon

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In Hong Kong, about 1,000 tonnes of sewage sludge were produced every day in 2014 representing a major fraction of the total solid municipal waste. Traditionally, sewage sludge is disposed of at landfills. This disposal method causes environmental issues and uses up precious space in landfills which are becoming saturated one by one. To tackle the disposal problem, Hong Kong government has just built a sewage sludge incinerator. Through incineration the volume of waste can be reduced up to 90% by converting sewage sludge into ash. Whilst sewage sludge ash (SSA) still needs to be disposed of at landfills, research has been conducted at the Hong Kong Polytechnic University on using SSA to substitute cement for the production of construction materials. Results demonstrated that SSA contained many open and isolated pores and thus can reduce the cement dilution effect resulting in only slight decrease in the flexural and compressive strengths of cement mortar. The incorporation of SSA in cement mortar can be up to 20% of the binder, without too much worry about adverse effect on strength development of mortar. There was some enhancement in strength using ground SSA in comparison to the original SSA. The original SSA shortened the relative initial setting time of cement paste but ground SSA caused slight delay in the setting of cement paste. The research also found that increasing the percentage of SSA lead to decreasing workability of cement mortar with the same water/binder ratio, and ground SSA was beneficial to workability although grinding increased the surface area of SSA. This paper summarizes the major findings of the research.

Keywords: cement replacement, construction material, sewage sludge ash, waste recycling

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Authors: Sakinul Islam, Nhol Kao, Sati Bhattacharya, Rahul Gupta

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Nanocrystalline cellulose (NCC) has been widely used for miscellaneous applications due to its superior properties over other nanomaterials. However, the major problems associated with the production of NCC are long reaction time, low production rate and inefficient process. The mass production of NCC within a short period of time is still a great challenge. The main objective of this study is to produce NCC from rice husk agro waste biomass from a high pressure delignification process (HPDP), followed by bleaching and hydrolysis processes. The HPDP has not been explored for NCC production from rice husk biomass (RHB) until now. In order to produce NCC, powder rice husk (PRH) was placed into a stainless steel reactor at 80 ˚C under 5 bars. Aqueous solution of NaOH (4M) was used for the dissolution of lignin and other amorphous impurities from PRH. After certain experimental times (1h, 3.5h and 6h), bleaching and hydrolysis were carried out on delignified samples. NaOCl (20%) and H2SO4 (4M) solutions were used for bleaching and hydrolysis processes, respectively. The NCC suspension from hydrolysis was sonicated and neutralized by buffer solution for various characterisations. Finally NCC suspension was dried and analyzed by FTIR, XRD, SEM, AFM and TEM. The chemical composition of NCC and PRH was estimated by TAPPI (Technical Association of Pulp and Paper Industry) standard methods to observe the product purity. It was found that, the 6h of the HPDP was more efficient to produce good quality NCC than that at 1h and 3.5h due to low separation of non-cellulosic components from RHB. The analyses indicated the crystallinity of NCC to be 71 %, particle size of 20-50 nm (diameter) and 100-200 nm in length.

Keywords: nanocrystalline cellulose, NCC, high pressure delignification, bleaching, hydrolysis, agro-waste biomass

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Authors: Shantha Kumari Muniyandi, Johan Sohaili, Siti Suhaila Mohamad

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The aim of this study was to investigate the suitability of reusing nonmetallic printed circuit boards (PCBs) waste in recycled HDPE (rHDPE) in terms of toxicity and mechanical properties. A series of X-ray Fluorescence Spectrometry (XRF) analysis tests have been conducted on raw nonmetallic PCBs waste to determine the chemical compositions. It can be seen that the nonmetallic PCBs approximately 72% of glass fiber reinforced epoxy resin materials such as SiO2, Al2O3, CaO, MgO, BaO, Na2O, and SrO, 9.4% of metallic materials such as CuO, SnO2, and Fe2O3, and 6.53% of Br. Total Threshold Limit Concentration (TTLC) and Toxicity Characteristic Leaching Procedure (TCLP) tests also have been done to study the toxicity characteristics of raw nonmetallic PCB powders, rHDPE/PCB and virgin HDPE for comparison purposes. For both of the testing, Cu was identified as the highest metal element contained in raw PCBs with the concentration of 905 mg/kg and 59.09 mg/L for TTLC and TCLP, respectively. However, once the nonmetallic PCB was filled in rHDPE composites, the concentrations of Cu were reduced to 134 mg/kg for TTLC and to 3 mg/L for TCLP testing. For mechanical properties testing, incorporation of 40 wt% nonmetallic PCB into rHDPE has increased the flexural modulus and flexural strength by 140% and 36%, respectively. While, Izod Impact strength decreased steadily with incorporation of 10 – 40 wt% nonmetallic PCBs.

Keywords: nonmetallic printed circuit board, recycled HDPE, composites, mechanical properties, total threshold limit concentration, toxicity characteristic leaching procedure

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Authors: Yoshitaka Ooya, Daishuke Furuya, Manabu Nemoto

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Some countries such as Canada and Australia have mandatory bicycle helmet laws for all citizens and age groups. As of 2008 Japan has also adopted a helmet law but it is restricted to people 13 years old and under. People over 13 years of age are not required to wear helmets in Japan. Currently, the rate that people 0-13 years old actually wear helmets is low. In 2013 a number of patients came to Saitama University Hospital International Medical Center for treatment due to bicycle-related trauma. The total number of patients was 89 (55 male and 34 female). The average age of the patients was 40.9 years old (eldest; 83 y/o, median; 40 y/o, youngest; 1 y/o with a standard deviation ± 2.8). 54 of these patients (61%) experienced head trauma as well as some experiencing multiple injuries associated with their accident. 13 patients were wearing helmets, 50 patients were not wearing helmets and it is unknown if the remaining 26 patients were wearing helmets. This information was acquired from the patient`s medical charts. Only one patient who was wearing a helmet had a severe head injury, and this patient also experienced other multiple injuries. 17 patients who were not wearing helmets had severe head injuries and out of the 17, two had multiple injuries. The mechanism for injury varied. 12 patients were injured in an accident with a vehicle, only one of which was wearing a helmet. This patient also had multiple injuries. Of the other 11 patients, two had multiple injuries. The remaining patient`s injuries were caused by other accidents (3; fell over while riding, 2; crashed into an inanimate object, 1; collided with a motorcycle). The ladder of which had a severe head injury. All of these patients had light energy accidents and were all over 13 years of age. In Japan it is not mandatory for people over the age of 13 years to wear a bicycle helmet. Research shows that light energy accidents were mostly present in people over the age of 13, to which the law does not require the wearing of helmets. It is important that all people in all age groups be required to wear helmets when operating a bicycle to reduce the rate of light energy severe head injuries.

Keywords: bicycle helmet, head trauma, hospital, traumatic situation

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Authors: Mebrahtu Haile

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Fuels obtained from renewable resources have garnered significant enthusiasm in recent decades due to concerns about fossil fuel depletion and climate change. This study aimed to investigate the potential of Prosopis juliflora pods mash for bio-ethanol production and its hydrolysis solid waste for solid fuel. Various parameters, such as acid concentration, hydrolysis times, fermentation times, fermentation temperature, and pH, were evaluated for their impact on bio-ethanol production using Saccharomyces cerevisiae yeast. The results showed that increasing acid concentration (up to 1 molar H₂SO₄) led to an increase in sugar content, reaching a maximum of 96.13%v/v. Optimal conditions for bio-ethanol production were found at 1 molar H₂SO₄ concentration (4.2%v/v), 48 hours fermentation time (5.1%v/v), 20 minutes hydrolysis time (5.57%v/v), 30°C fermentation temperature (5.57%v/v), and pH 5 (6.01%v/v), resulting in a maximum bio-ethanol yield of 6.01%v/v. The solid waste remaining after bio-ethanol production exhibited potential for use as a solid fuel, with a calorific value of 18.22 MJ/kg. These findings demonstrate the promising potential of Prosopis juliflora pods mash for bio-ethanol production and suggest a viable solution for addressing disposal challenges associated with solid waste, contributing to the exploration of renewable fuel sources in the face of fossil fuel depletion and climate change.

Keywords: prosopis juliflora, pods mash, invasive species, bio-ethanol, fermentation, Saccharomyces cerevisiae, solid fuel

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Authors: Luksanaporn Krungkraipetch

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Pterygium is a frequent ocular surface lesion that begins in the limbal conjunctiva within the palpebral fissure and spreads to the cornea. The lesion is more common in the nasal limbus than in the temporal, and it has a wing-like aspect. Indications for surgery, in decreasing order of significance, are growth over the corneal center, decreased vision due to corneal deformation, documented growth, sensations of discomfort, and esthetic concerns. The aim of this study is twofold: first, to determine the frequency of pterygium recurrence after surgery at the mentioned hospital, and second, to identify the factors that influence the recurrence of pterygium. The research design is a retrospective examination of 164 patient samples in an eastern Thai university hospital (Code 13766). Data analysis is descriptive statistics analysis, i.e., basic data details about pterygium surgery and the risk of recurrent pterygium, and for factor analysis, the inferential statistics chi-square and ANOVA are utilized. Twenty-four of the 164 patients who underwent surgery exhibited recurrent pterygium. Consequently, the incidence of recurrent pterygium after surgery was 14.6%. There were an equal number of men and women present. The participants' ages ranged from 41 to 60 years (62, 8 percent). According to the findings, the majority of patients were female (60.4%), over the age of 60 (51.2%), did not live near the beach (83.5%), did not have an underlying disease (92.1%), and 95.7% did not have any other eye problems. Gender (X² = 1.26, p = .289), age (X² = 5.86, p = .119), an address near the sea (X² = 3.30, p = .081)), underlying disease (X² = 0.54, p = .694), and eye disease (X² = 0.00, p = 1.00) had no effect on pterygium recurrence. Recurrences occurred in 79.1% of all surgical procedures and 11.6% of all patients using the bare sclera technique. The recurrence rate for conjunctival autografts was 20.9% for all procedures and 3.0% for all participants. Mitomycin-C and amniotic membrane transplant techniques had no recurrence following surgery. Comparing the surgeries done on people with recurrent pterygium did not show anything important (F = 1.13, p = 0.339). In conclusion, the prevalence of pterygium recurrence following pterygium, 14.6%, does not differ from earlier research. Underlying disease, other eye conditions, and surgical procedures such as pterygium recurrence are unaffected by pterygium surgery.

Keywords: pterygium, recurrence pterygium, pterygium surgery, excision pterygium

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Authors: H. Higashiyama, M. Sano, F. Nakanishi, M. Sugiyama, M. Kawanishi, S. Tsukuma

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The heat island phenomenon and extremely hot summer climate are becoming environmental problems in Japan. Cool pavements reduce the surface temperature compared to conventional asphalt pavements in the hot summer climate and improve the thermal environment in the urban area. The authors have studied cement–based grouting materials poured into voids in porous asphalt pavements to reduce the road surface temperature. For the cement–based grouting material, cement, ceramic waste powder, and natural zeolite were used. This cement–based grouting material developed reduced the road surface temperature by 20 °C or more in the hot summer season. Considering the urban landscape, this study investigates the effect of surface temperature reduction of colored cement–based grouting materials containing pigments poured into voids in porous asphalt pavements by measuring the surface temperature of asphalt pavements outdoors. The yellow color performed the same as the original cement–based grouting material containing no pigment and was thermally better performance than the other color. However, all the tested cement–based grouting materials performed well for reducing the surface temperature and for creating the urban landscape.

Keywords: ceramic waste powder, natural zeolite, road surface temperature, asphalt pavement, urban landscape

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Authors: Pierre Y. Matar, Louay S. El Hassanieh, Marleine F. Bayssary

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The demolished concrete is a major component of the construction and demolition (C&D) waste. The recycled aggregates obtained by crushing the demolished concrete can be used as a substitute of natural aggregates. Another major C&D waste is the flat glass. This glass can be also recycled and used as an aggregate substitute. The objective of this study is to determine the influence of the use of recycled concrete aggregates and recycled glass on the compressive strength and fire resistance of precast concrete masonry blocks. Tests are carried out on four series of blocks whose compositions include different percentages of recycled aggregates and recycled glass and one series of reference blocks whose composition consists of exclusively natural aggregates. The recycled coarse aggregates and recycled glass have 6.3/12.5 mm fraction and the natural aggregates have 0/6.3 mm fraction; no recycled fine aggregates are included in concrete mixes.

Keywords: compressive strength, precast concrete blocks, recycled aggregates, recycled glass

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Authors: Daniel Afolayan, Christina Olawepo, Francis Olowookanga, Nguhemen Tingir, Olawale Fadare, John Oko

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In Nigeria, traditional birth attendants (TBAs) can play an important role in the prevention of mother-to-child transmission of HIV. However, their role in improving access to antiretroviral therapy (ART) is unclear. Catholic Caritas Foundation of Nigeria (Caritas Nigeria) is an implementing agency supporting increased access to HIV testing and treatment services in Lagos state through health facilities including Mother Theresa Hospital. Despite intra-facility testing and community outreaches, ART uptake at Mother Theresa Hospital, Lagos was low with 6 individuals on antiretroviral drugs 3 months post-activation. This study explored improving access to ART through linkages with TBAs for ART uptake at the facility. Plan-Do-Study-Act model was used. The goal was to improve uptake of ART from 6 to 80 in 5 months (end of project year). Scanning revealed a network of 15 TBAs with potential as satellites for HIV testing. Caritas Nigeria linked the facility with 15 TBAs who were provided with HIV test kits and trained on HIV testing services for provider-initiated testing and outreaches. Weekly reports and referrals of positives were received, tracked and feedback given on testing yield. These TBAs serve individuals of various age and gender at their trado-medical centres. At the end of 5 months, HIV testing increased by 10,575 (78% from TBAs) and HIV positives obtained improved by 77 (44.2% from TBAs). 55 new individuals were enrolled and commenced on ART (61.8% from TBAs). There was a successful linkage of all clients with escort services due to incentives. Total uptake of ART was 61 (76.3% of target). Structured partnerships between TBAs and HIV care and treatment centers should be strengthened to improve access to ART.

Keywords: access improvement, antiretroviral therapy, traditional birth attendants, uptake

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Authors: Chernet Mulugeta, Girma Seyoum, Yeshineh Demrew, Kehabtimer Shiferaw

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Background: Obstetric fistula (OF) is a serious medical condition that includes an abnormal opening between the vagina and bladder (vesico-vaginal fistula) or the vagina and rectum (recto-vaginal fistula). It is usually caused by prolonged obstructed labour. Despite its serious health and psychosocial consequences, there is a paucity of evidence regarding the time it takes to heal from OF. Objective: The aim of this study was to assess the time to cure from obstetric fistula and its predictors among women admitted to Addis Ababa Hamlin Fistula Hospital, Addis Ababa, Ethiopia. Methodology: An institution-based retrospective cohort study was conducted from January 2015 to December 2020 among a randomly selected 434 women with OF in Addis Ababa Hamlin Fistula Hospital. Data was collected using a structured checklist adapted from a similar study. The open data kit (ODK) collected data was exported and analyzed by using STATA (14.2). Kaplan Meir was used to compare the recovery time from OF. To identify the predictors of OF, a Cox regression model was fitted, and an adjusted hazard ratio with a 95% confidence interval was used to estimate the strength of the associations. Results: The average time to recover from obstetric fistula was 3.95 (95% CI: 3.0-4.6) weeks. About ¾ of the women [72.8% (95% CI - 0.65-1.2)] were physically cured of obstetric fistula. Having secondary education and above [AHR=3.52; 95% CI (1.98, 6.25)] compared to no formal education, having a live birth [AHR=1.64; 95% CI (1.22, 2.21)], having an intact bladder [AHR=2.47; 95% CI (1.1, 5.54)] compared to totally destructed, and having a grade 1 fistula [AHR=1.98; 95% CI (1.19, 3.31)] compared to grade 3 were the significant predictors of shorter time to cure from an obstetric fistula. Conclusion and recommendation: Overall, the proportion of women with OF who were not being cured was unacceptably high. The time it takes for them to recover from the fistula was also extended. It connotes us to work on the identified predictors to improve the time to recovery from OF.

Keywords: time to recovery, obstetric fistula, predictors, Ethiopia

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Authors: Douglas Arthur, Oluwayemisi Ekor, Ernest Obese, Andrew Kissi Agyei, Elvis Ofori Ameyaw

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bjective: Pain negatively impacts every aspect of health, and patients with pain disorders create enormous demands on healthcare systems globally, costing economies up to $635 billion annually. The study was therefore conducted at the Cape Coast Teaching Hospital (CCTH), the only Tertiary Hospital in the Central Region of Ghana and was designed to assess pain disorders in patients between 18 and 90 years attending Urology Clinic. Methods: The study employed a descriptive cross-sectional design, and 149 subjects (16-24, 25-34, 35-44, 45-54, 55-64, 65-90 years) were conveniently selected. The McGill Pain Questionnaire (MPQ), a multidimensional instrument that assesses several aspects of pain by the use of words (descriptors) that the patient chooses to express his/her pain, was used as the primary instrument for data collection. A patient profile form (PPF) was also designed to document the demographics and history of patients. Results: The prevalence of pain disorders was higher among females compared to males. The univariate and multivariate analysis showed that females were more likely to experience pain while being married correlated with a lower likelihood of pain. Again, the 45-54 age group exhibited the highest prevalence of pain disorders. Results from the MPQ showed that half of the patients experienced pain on a daily basis, 15.91% had experienced pain for 3-6 months and 37% experienced pain for more than one year. Pain intensity was described by 25% of the subjects as excruciating for their worst pain experience, followed by 21% for the distressing experience. The most frequently reported area of pain was the abdominal region (22.72%). The co-administration of NSAIDs and opioid compounds was provided for 17.46% of the patients with chronic pain. Conclusion: The treatment interventions improved the pain and associated symptoms such as nausea, improved daily activities and ability to sleep. However, attention and resources should be devoted to 45-54 age group.

Keywords: pain, opioids, distressing, excruciating

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Authors: Mariem Meddeb Sidhom, Souhayel Hedfi, Rjaibia Houda, Mehdi Dridi, Mohamed Ali Yousfi, Sâadia Gargouri

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Considering the important increase in costs of caspofungin treatments and ahead the evolution of its indication, pharmacy department was prompted to realize a review of the adequacy of prescriptions in the medical intensive care units (ICU). A retrospective observational study was conducted in Tunis military hospital concerning ICU prescriptions of caspofungin from 2008 until 2013. A pharmacist had returned to the patient’s medical records to collect data and to the microbiology department for parasitological results. The adequacy of prescriptions was evaluated by a pharmacist and an infectiologist parasitologist, referring to predefined scale of criteria resuming the indications of the marketing authorization (MA) and grade AI-AII of the guidelines of the Infectious Diseases Society of America (IDSA). Sixty two ICU patients have been treated with caspofungin during the period of study; however, 8 files were lost. Thus, 54 patients were included in the study having received 55 prescriptions of caspofungin. Males were a majority with 64.8% of the population. Mean age was 51 years. Caspofungin was indicated in accordance with the IDSA recommendations in 43.6% of the cases. The most case of non respect to the guidelines was the indication of caspofungin as empirical treatment in non neutropenic patients. Caspofungin was utilized as a first line treatment in 9 cases where it was possible to give fluconazole first, as germs were fluconazole- sensitive. Caspofungin was indicated in 2 patients with good renal function and in which nor amphotericin B, liposomal ampho B neither itraconazole had been previously used, as indicates the MA. The posology of caspofungin was respected in all prescriptions with a loading dose of 70 mg in the first day and a maintenance dose of 50 mg daily. Seven patients had received a daily dose of 70 mg, the recommended dose for people weighing more than 80 Kg. Caspofungin prescriptions are far to be adequately done. There is a clear need of optimization in indicating this molecule and that must be done in collaboration between the pharmacy department, the ICUs and parasitology department.

Keywords: caspofungin, prescription, intensive care units, marketing authorization, Tunisian hospital cohort

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Authors: Floyd Misheck Mwanza, Paul Boniface Majura

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The paper looked at highways/ roadside waste generation, disposal and the consequent environmental impacts. The dramatic increase in vehicular and paved roads in the recent past in Zambia, has given rise to the indiscriminate disposal of litter that now poses a threat to health and the environment. Primary data was generated by carrying out oral interviews and field observations for holistic and in–depth assessment of the environment and the secondary data was obtained from desk review method, information on effects of roadside wastes on environment were obtained from relevant literatures. The interviews were semi structured and a purposive sampling method was adopted and analyzed descriptively. The results of the findings showed that population growth and unplanned road expansion has exceeded the expected limit in recent time with resultant poor system of roadside wastes disposal. Roadside wastes which contain both biodegradable and non-biodegradable roadside wastes are disposed at the shoulders of major highways in temporary dumpsites and are never collected by a road development agency (RDA). There is no organized highway to highway or street to street collection of the wastes in Zambia by the key organization the RDA. The study revealed that roadside disposal of roadside wastes has serious impacts on the environment. Some of these impacts include physical nuisance of the wastes to the environment, the waste dumps also serve as hideouts for rodents and snakes which are dangerous. Waste are blown around by wind making the environment filthy, most of the wastes are also been washed by overland flow during heavy downpour to block drainage channels and subsequently lead to flooding of the environment. Most of the non- biodegradable wastes contain toxic chemicals which have serious implications on the environmental sustainability and human health. The paper therefore recommends that Government/ RDA should come up with proper orientation and environmental laws should be put in place for the general public and also to provide necessary facilities and arrange for better methods of collection of wastes.

Keywords: biodegradable, disposal, environment, impacts

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Authors: Elida Gastelum-Martinez, Neith A. Pacheco-Lopez, Juan L. Morales-Landa

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Cashew agroindustry obtained from cashew apple crop (Anacardium occidentale L.) generates large amounts of unused waste in Campeche, Mexico. Despite having a high content of nutritional compounds such as ascorbic acid, carotenoids, fiber, carbohydrates, and minerals, it is not consumed due to its astringent sensation. The aim of this work was to develop a processing method for cashew apple waste in order to obtain a powder with reduced astringency able to be used as an additive in the food industry. The processing method consisted first in reducing astringency by inducing tannins from cashew apple peel to react and form precipitating complexes with a colloid rich in proline and histidine. Then cashew apples were processed to obtain a dry powder. Astringency reduction was determined by total phenolic content and evaluated by sensorial analysis in cashew-apple-powder based cookies. Total phenolic content in processed powders showed up to 72% lower concentration compared to control samples. The sensorial evaluation indicated that cookies baked using cashew apple powder with reduced astringency were 96.8% preferred. Sensorial characteristics like texture, color and taste were also well-accepted attributes. In conclusion, the method applied for astringency reduction is a viable tool to produce cashew apple powder with desirable sensorial properties to be used in the development of food products.

Keywords: astringency reduction, cashew apple waste, food industry, sensorial evaluation

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Authors: Angelica Corcoran, Fredrik Lind, Pavleta Knutsson, Henrik Thunman

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Solid waste volumes are at current predominately deposited on landfill. Furthermore, the impending climate change requires new solutions for a sustainable future energy mix. Currently, solid waste is globally utilized to small extent as fuel during combustion for heat and power production. Due to its variable composition and size, solid waste is considered difficult to combust and requires a technology with high fuel flexibility. One of the commercial technologies used for combustion of such difficult fuels is circulating fluidized beds (CFB). In a CFB boiler, fine particles of a solid material are used as 'bed material', which is accelerated by the incoming combustion air that causes the bed material to fluidize. The chosen bed material has conventionally been silica sand with the main purpose of being a heat carrier, as it transfers heat released by the combustion to the heat-transfer surfaces. However, the release of volatile compounds occurs rapidly in comparison with the lateral mixing in the combustion chamber. To ensure complete combustion a surplus of air is introduced, which decreases the total efficiency of the boiler. In recent years, the concept of partly or entirely replacing the silica sand with an oxygen carrier as bed material has been developed. By introducing an oxygen carrier to the combustion chamber, combustion can be spread out both temporally and spatially in the boiler. Specifically, the oxygen carrier can take up oxygen from the combustion air where it is in abundance and release it to combustible gases where oxygen is in deficit. The concept is referred to as oxygen carrier aided combustion (OCAC) where the natural ore ilmenite (FeTiO3) has been the oxygen carrier used. The authors have validated the oxygen buffering ability of ilmenite during combustion of biomass in Chalmers 12-MWth CFB boiler in previous publications. Furthermore, the concept has been demonstrated on full industrial scale during combustion of municipal solid waste (MSW) in E.ON’s 75 MWth CFB boiler. The experimental campaigns have showed increased mass transfer of oxygen inside the boiler when combustion both biomass and MSW. As a result, a higher degree of burnout is achieved inside the combustion chamber and the plant can be operated at a lower surplus of air. Moreover, the buffer of oxygen provided by the oxygen carrier makes the system less sensitive to disruptions in operation. In conclusion, combusting difficult fuels with OCAC results in higher operation stability and an increase in boiler efficiency.

Keywords: OCAC, ilmenite, combustion, CFB

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Authors: Hailemariam Getachew, John Sandi, Isata Dumbuya, Patricia Efe.Azikiwe, Evaline Nginge, Moses Mugisha, Eseoghene Dase, Foday Mandaray, Grace Moore

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Enhanced recovery after cesarean section (ERAC) is a standardized peri- operative care program that comprises the multidisciplinary team's collective efforts working in collaboration throughout the peri-operative period with the principal goal to improve quality of surgical care, decrease surgical related complications, and increasing patient satisfaction. Objective: The main objective of this project is to improve the implementation of enhanced recovery after cesarean section at Koidu Government hospital. Identified gap: Even though the hospital is providing comprehensive maternal and child care service, there are gaps in the implementation of ERAC. According to our survey, we found that there is low (13.3%) utilization of WHO surgical safety checklist, only limited (15.9%) patients get opioid free analgesia, pain was not recorded as a vital sign, there is no standardized checklist for hand over to and from Post Anesthesia care Unit(PACU). Furthermore, there is inconsistent evidence based post-operative care and there is no local consensus protocol and guideline as well. Implementation plan: we aimed at designing standardized protocol, checklist and guideline, provide training, build staff capacity, document pain as vital sign, perform regional analgesia, and provide evidence based post-operative care, monitoring and evaluation. Result: Data from 389 cesarean mothers showed that, Utilization of the WHO surgical safety check list found to be 95%, and pain assessment and documentation was done for all surgical patients. Oral feeding, ambulation and catheter removal was performed as per the ERAC standard for all patients. Postoperative complications drastically decreased from 13.6% to 8.1%. While, the rate of readmission was kept below 1%. Furthermore, the duration of hospital stay decreased from 4.64 days to 3.12 days. Conclusion The successful implementation of ERAC protocols demonstrates through this Quality Improvement Project that, the effectiveness of the protocols in improving recovery and patient outcome following cesarean section.

Keywords: cesarean delivery, enhanced recovery, quality improvement, patient outcome

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Authors: Jacqueline Michella Anak Nathen

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Subgrade soil is an essential component in the design of road structures as it provides lateral support to the pavement. One of the main reasons for the failure of the pavement is the settlement of the subgrade and the high susceptibility to moisture, which leads to a loss of strength of the subgrade. Construction over weak or soft subgrade affects the performance of the pavement and causes instability of the pavement. If the mechanical properties of the subgrade soils are lower than those required, the soil stabilisation method can be an option to improve the soil properties of the weak subgrade. Soil stabilisation is one of the most popular techniques for improving poor subgrade soils, resulting in a significant improvement in the subgrade soil’s tensile strength, shear strength, and bearing capacity. Soil stabilisation encompasses the various methods used to alter the properties of soil to improve its engineering properties. Soil stabilisation can be broadly divided into four types: thermal, electrical, mechanical, and chemical. The most common method of improving the physical and mechanical properties of soils is stabilisation using binders such as cement and lime. However, soil stabilisation with conventional methods using cement and lime has become uneconomical in recent years, so there is a need to look for an alternative, such as fiber. Although not a new technique, adding fiber is a very practical alternative to soil stabilisation. Various types of fibers, such as natural, synthetic, and waste fibers, have been used as stabilising agents to improve the strength and durability of subgrade soils. This review provides a comprehensive comparison of the effectiveness of natural, synthetic, and waste fibers in stabilising subgrade soils.

Keywords: subgrade, soil stabilisation, pavement, fiber, stabiliser

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Authors: Michael Adebayo, Saheed Lawal

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The Comprehensive Geriatric Assessment (CGA) is the multidimensional tool used to assess elderly, frail patients either on admission to hospital care or at a community level in primary care. It is a tool designed with the aim of using a holistic approach to managing patients. A Cochrane review of CGA use in 2011 found that the likelihood of being alive and living in their own home rises by 30% post-discharge. RCTs have also discovered 10–15% reductions in readmission rates and reductions in institutionalization, and resource use and costs. Past audit cycles at King’s College Hospital, Denmark Hill had shown inconsistent evidence of CGA completion inpatient discharge summaries (less than 50%). Junior Doctors in the Health and Ageing (HAU) wards have struggled to sustain the efforts of past audit cycles due to the quick turnover in staff (four-month placements for trainees). This 7th cycle created a multi-faceted approach to solving this problem amongst staff and creating lasting change. Methods: 1. We adopted multidisciplinary team involvement to support Doctors. MDT staff e.g. Nurses, Physiotherapists, Occupational Therapists and Dieticians, were actively encouraged to fill in the CGA document. 2. We added a CGA Document Pro-forma to “Sunrise EPR” (Trust computer system). These CGAs were to automatically be included the discharge summary. 3. Prior to assessing uptake, we used a spot audit questionnaire to assess staff awareness/knowledge of what a CGA was. 4. We designed and placed posters highlighting domains of CGA and MDT roles suited to each domain on geriatric “Health and Ageing Wards” (HAU) in the hospital. 5. We performed an audit of % discharge summaries which include CGA and MDT role input. 6. We nominated ward champions on each ward from each multidisciplinary specialty to monitor and encourage colleagues to actively complete CGAs. 7. We initiated further education of ward staff on CGA's importance by discussion at board rounds and weekly multidisciplinary meetings. Outcomes: 1. The majority of respondents to our spot audit were aware of what a CGA was, but fewer had used the EPR document to complete one. 2. We found that CGAs were not being commenced for nearly 50% of patients discharged on HAU wards and the Frailty Assessment Unit.

Keywords: comprehensive geriatric assessment, CGA, multidisciplinary team, quality of life, mortality

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