Search results for: hospital waste management (HWM)

Authors: Amal Balila, Maria Vahdati

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Earth is a green building material with very low embodied energy and almost zero greenhouse gas emissions. However, it lacks strength and durability in its natural state. By responsibly sourcing stabilisers, it's possible to enhance its strength. This research draws inspiration from the robustness of termite mounds, where termites incorporate glycoproteins from their saliva during construction. Biomimicry explores the potential of these termite stabilisers in producing bio-inspired adobe bricks. The meat industry generates significant waste during slaughter, including blood, skin, bones, tendons, gastrointestinal contents, and internal organs. While abundant, many meat by-products raise concerns regarding human consumption, religious orders, cultural and ethical beliefs, and also heavily contribute to environmental pollution. Extracting and utilising proteins from this waste is vital for reducing pollution and increasing profitability. Exploring the untapped potential of meat industry waste, this research investigates how glycoproteins could revolutionize adobe brick construction. Bovine serum albumin (BSA) from cows' blood and mucin from porcine stomachs were the chosen glycoproteins used as stabilisers for adobe brick production. Despite their wide usage across various fields, they have very limited utilisation in food processing. Thus, both were identified as potential stabilisers for adobe brick production in this study. Two soil types were utilised to prepare adobe bricks for testing, comparing controlled unstabilised bricks with glycoprotein-stabilised ones. All bricks underwent testing for unconfined compressive strength and erosion resistance. The primary finding of this study is the efficacy of BSA, a glycoprotein derived from cows' blood and a by-product of the beef industry, as an earth construction stabiliser. Adding 0.5% by weight of BSA resulted in a 17% and 41% increase in the unconfined compressive strength for British and Sudanese adobe bricks, respectively. Further, adding 5% by weight of BSA led to a 202% and 97% increase in the unconfined compressive strength for British and Sudanese adobe bricks, respectively. Moreover, using 0.1%, 0.2%, and 0.5% by weight of BSA resulted in erosion rate reductions of 30%, 48%, and 70% for British adobe bricks, respectively, with a 97% reduction observed for Sudanese adobe bricks at 0.5% by weight of BSA. However, mucin from the porcine stomach did not significantly improve the unconfined compressive strength of adobe bricks. Nevertheless, employing 0.1% and 0.2% by weight of mucin resulted in erosion rate reductions of 28% and 55% for British adobe bricks, respectively. These findings underscore BSA's efficiency as an earth construction stabiliser for wall construction and mucin's efficacy for wall render, showcasing their potential for sustainable and durable building practices.

Keywords: biomimicry, earth construction, industrial waste management, sustainable building materials, termite mounds.

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Authors: M. Jafari Toosy, A. Zamani

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This article, considering the result of pandemics at the international level and all activities and projects performed virtually and the need for resource management and virtual teams in this period identifies the components of virtual management after searching the available resources. Exploration of virtual management in the pandemic era is explored in 10 international articles. The results of research with this method and according to the tasks and topics related to management knowledge and definition of virtual teams can be divided into topics such as planning, decision making, control, organization, leadership, attention to growth and capability, resources and facilities, Communication, creativity, innovation and security. In order to explain the nature of virtual management, a definition of virtual management was provided.

Keywords: management, virtual, virtual team management, pandemic, team

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Authors: S. Vadivukkarasi, K. Karthi, M. Karthick, C. Dinesh, S. Santhosh, A. Yogaraj

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The appointment system was designed to minimize patient’s idle time overlooking patients waiting time in hospitals. This is no longer valid in today’s consumer oriented society. Long waiting times for treatment in the outpatient department followed by short consultations has long been a complaint. Nowadays, customers use waiting time as a decisive factor in choosing a service provider. Queuing theory constitutes a very powerful tool because queuing models require relatively little data and are simple and fast to use. Because of this simplicity and speed, modelers can be used to quickly evaluate and compare various alternatives for providing service. The application of queuing models in the analysis of health care systems is increasingly accepted by health care decision makers. Timely access to care is a key component of high-quality health care. However, patient delays are prevalent throughout health care systems, resulting in dissatisfaction and adverse clinical consequences for patients as well as potentially higher costs and wasted capacity for providers. Arguably, the most critical delays for health care are the ones associated with health care emergencies. The allocation of resources can be divided into three general areas: bed management, staff management, and room facility management. Effective and efficient patient flow is indicated by high patient throughput, low patient waiting times, a short length of stay at the hospital and overtime, while simultaneously maintaining adequate staff utilization rates and low patient’s idle times.

Keywords: appointment system, patient scheduling, bed management, queueing calculation, system analysis

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Authors: Kholood A. Baron

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While radiologist numbers specialized in spine interventional procedures are limited in Kuwait, the number of patients demanding these procedures is increasing rapidly. Due to this high demand, the workload of radiologists is increasing, which might represent a radiation exposure concern. During these procedures, the doctor’s hands are in very close proximity to the main radiation beam/ if not within it. The aim of this study is to measure the radiation dose for radiologists during several interventional procedures for the spine. Methods: Two doctors carrying different workloads were included. (DR1) was performing procedures in the morning and afternoon shifts, while (DR2) was performing procedures in the morning shift only. Comparing the radiation exposures that the hand of each doctor is receiving will assess radiation safety and help to set up workload regulations for radiologists carrying a heavy schedule of such procedures. Entrance Skin Dose (ESD) was measured via TLD (ThermoLuminescent Dosimetry) placed at the right wrist of the radiologists. DR1 was covering the morning shift in one hospital (Mubarak Al-Kabeer Hospital) and the afternoon shift in another hospital (Dar Alshifa Hospital). The TLD chip was placed in his gloves during the 2 shifts for a whole week. Since DR2 was covering the morning shift only in Al Razi Hospital, he wore the TLD during the morning shift for a week. It is worth mentioning that DR1 was performing 4-5 spine procedures/day in the morning and the same number in the afternoon and DR2 was performing 5-7 procedures/day. This procedure was repeated for 4 consecutive weeks in order to calculate the ESD value that a hand receives in a month. Results: In general, radiation doses that the hand received in a week ranged from 0.12 to 1.12 mSv. The ESD values for DR1 for the four consecutive weeks were 1.12, 0.32, 0.83, 0.22 mSv, thus for a month (4 weeks), this equals 2.49 mSv and calculated to be 27.39 per year (11 months-since each radiologist have 45 days of leave in each year). For DR2, the weekly ESD values are 0.43, 0.74, 0.12, 0.61 mSv, and thus, for a month, this equals 1.9 mSv, and for a year, this equals 20.9 mSv /year. These values are below the standard level and way below the maximum limit of 500 mSv per year (set by ICRP = International Council of Radiation Protection). However, it is worth mentioning that DR1 was a senior consultant and hence needed less fluoro-time during each procedure. This is evident from the low ESD values of the second week (0.32) and the fourth week (0.22), even though he was performing nearly 10-12 procedures in a day /5 days a week. These values were lower or in the same range as those for DR2 (who was a junior consultant). This highlighted the importance of increasing the radiologist's skills and awareness of fluoroscopy time effect. In conclusion, the radiation dose that radiologists received during spine interventional radiology in our setting was below standard dose limits.

Keywords: radiation protection, interventional radiology dosimetry, ESD measurements, radiologist radiation exposure

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Authors: Abbas Ghahremani

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One of the most fundamental management issues in organizations and companies is the recruiting of efficient staff and compiling exact and perfect criteria for testing the applicants,which is guided and practiced by the manager of human resources of the organization. Obviously, each part of the organization seeks special features and abilities in the people apart from common features among all the staff in all units,which are called principal duties and abilities,and we will study them more. This article is trying to find out how we can identify the most efficient people among the applicants of employment by using proper methods of testing appropriate for the needs of different of employment by using proper methods of testing appropriate for the needs of different units of the organization and recruit efficient staff. Acceptable method for recruiting is to closely identify their characters from various aspects such as ability to communicate, flexibility, stress management, risk acceptance, tolerance, vision to future, familiarity with the art, amount of creativity and different thinking and by raising proper questions related with the above named features and presenting a questionnaire, evaluate them from various aspect in order to gain the proper result. According to the above explanations, it can be concluded which aspects of abilities and characteristics of a person must be evaluated in order to reduce any mistake in recruitment and approach an ideal result and ultimately gain an organized system according to the standards and avoid waste of energy for unprofessional personnel which is a marginal issue in the organizations.

Keywords: human resources management, staff recuiting, employment factors, efficient staff

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Authors: Ayeshmanthe Rathnayake, Ashutosh Hardikar

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Introduction: Lung cancer is the most common cause of cancer death in Australia, with more than 13000 cases per year. Until now, there has been a major deficiency of national comprehensive thoracic surgery data. The thoracic workload for surgeons as well as caseload per unit, is highly variable, with some centres performing less than 15 cases per annum, thus raising concerns about optimal care at low-volume sites. This is an attempt to review the outcomes of lung cancer surgery in Tasmania. Method: The objective of this study is to determine the surgical outcomes of lung cancer surgery at Royal Hobart Hospital (RHH) with the primary outcome of surgical mortality. Four hundred fifty-one cases were analysed retrospectively from 2010 to May 2022. Results: A total of 451 patients underwent thoracic surgery with a primary diagnosis of lung cancer. The primary outcome of 30-day mortality was <0.5%. The mean age was 65.3 years, with male predominance and a 4.2% prevalence of Indigenous Australians. The mean LOS was 7.5 days. The surgical approach was either VATS (50.3%) or Thoracotomy (49.7%), with a trend towards the former in recent years with an increase in the proportion of VATS from 18.2% to 51% (p<0.05) in complex resections since 2019. A corresponding reduction in conversion rate to open was observed (18% vs. 5.5%), and there were no deaths within this subgroup. Lung resections were divided into lobectomy (55.4%), wedge resection (36.8%), segmentectomy (2.9%) and pneumonectomy (4.9%). The RHH demonstrates good surgical outcomes for lung cancer and provides a sustainable service for Tasmania. Conclusion: This retrospective study reports the surgical outcomes of lung cancer surgery at the Royal Hobart Hospital, thereby providing insight into the surgical management of lung cancer in the state thus far. The state has been slow to catch up on the minimally invasive program, but the overall results have been comparable to most peers.

Keywords: lung cancer, thoracic surgery, lung resection, surgical outcomes

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Authors: Said Nurdin, Fatimah A. Misebah, Rosli M. Yunus, Mohd S. Mahmud, Ahmad Z. Sulaiman

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The discarded clam shell waste, fossil and edible oil as biolubricant feedstocks create environmental impacts and food chain dilemma, thus this work aims to circumvent these issues by using activated saltwater clam shell waste (SCSW) as solid catalyst for conversion of Jatropha curcas oil as non-edible sources to ester biolubricant. The characterization of solid catalyst was done by Differential Thermal Analysis-Thermo Gravimetric Analysis (DTA-TGA), X-Ray Fluorescence (XRF), X-Ray Diffraction (XRD), Brunauer-Emmett-Teller (BET), Field Emission Scanning Electron Microscopy (FESEM) and Fourier Transformed Infrared Spectroscopy (FTIR) analysis. The calcined catalyst was used in the transesterification of Jatropha oil to methyl ester as the first step, and the second stage was involved the reaction of Jatropha methyl ester (JME) with trimethylolpropane (TMP) based on the various process parameters. The formated biolubricant was analyzed using the capillary column (DB-5HT) equipped Gas Chromatography (GC). The conversion results of Jatropha oil to ester biolubricant can be found nearly 96.66%, and the maximum distribution composition mainly contains 72.3% of triester (TE).

Keywords: conversion, Jatropha curcas oil, ester biolubricant, solid catalyst

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Authors: Farha Ibrahim, Ely Zarina Samsudin, Ahmad Razali Ishak, Jeyanthini Sathasivam

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Introduction: Indoor air quality (IAQ) has recently gained substantial traction as the airborne transmission of infectious respiratory disease has become an increasing public health concern. Public hospital outpatient department (OPD). IAQ warrants special consideration as it is the most visited department in which patients and staff are all directly impacted by poor IAQ. However, there is limited evidence on IAQ in these settings. Moreover, occupants’ behavior like occupant’s movement and operation of door, windows and appliances, have been shown to significantly affect IAQ, yet the influence of these determinants on IAQ in such settings have not been established. Objectives: This study aims to examine IAQ in Malaysian public hospitals OPD and assess its relationships with occupants’ behavior. Methodology: A multicenter cross-sectional study in which stratified random sampling of Johor public hospitals OPD (n=6) according to building age was conducted. IAQ measurements include indoor air temperature, relative humidity (RH), air velocity (AV), carbon dioxide (CO2), total bacterial count (TBC) and total fungal count (TFC). Occupants’ behaviors in Malaysian public hospital OPD are assessed using observation forms, and results were analyzed. Descriptive statistics were performed to characterize all study variables, whereas non-parametric Spearman Rank correlation analysis was used to assess the correlation between IAQ and occupants’ behavior. Results: After adjusting for potential cofounder, the study has suggested that occupants’ movement in new building, like seated quietly, is significantly correlated with AV in new building (r 0.642, p-value 0.010), CO2 in new (r 0.772, p-value <0.001) and old building (r -0.559, p-value 0.020), TBC in new (r 0.747, p-value 0.001) and old building (r -0.559, p-value 0.020), and TFC in new (r 0.777, p-value <0.001) and old building (r -0.485, p-value 0.049). In addition, standing relaxed movement is correlated with indoor air temperature (r 0.823, p-value <0.001) in new building, CO2 (r 0.559, p-value 0.020), TBC (r 0.559, p-value 0.020), and TFC (r -0.485, p-value 0.049) in old building, while walking is correlated with AV in new building (r -0.642, p-value 0.001), CO2 in new (r -0.772, p-value <0.001) and old building (r 0.559, p-value 0.020), TBC in new (r -0.747, p-value 0.001) and old building (r 0.559, p-value 0.020), and TFC in old building (r -0.485, p-value 0.049). The indoor air temperature is significantly correlated with number of doors kept opened (r 0.522, p-value 0.046), frequency of door adjustments (r 0.753, p-value 0.001), number of windows kept opened (r 0.522, p-value 0.046), number of air-conditioned (AC) switched on (r 0.698, p-value 0.004) and frequency of AC adjustment (r 0.753, p-value 0.001) in new hospital OPD building. AV is found to be significantly correlated with number of doors kept opened (r 0.642, p-value 0.01), frequency of door adjustments (r 0.553, p-value 0.032), number of windows kept opened (r 0.642, p-value 0.01), and frequency of AC adjustment, number of fans switched on, and frequency of fans adjustment(all with r 0.553, p-value 0.032) in new building. In old hospital OPD building, the number of doors kept opened is significantly correlated with CO₂, TBC (both r -0.559, p-value 0.020) and TFC (r -0.495, p-value 0.049), frequency of door adjustment is significantly correlated with CO₂, TBC (both r-0.559, p-value 0.020) and TFC (r -0.495, p-value 0.049), number of windows kept opened is significantly correlated with CO₂, TBC (both r 0.559, p-value 0.020) and TFC (r 0.495, p-value 0.049), frequency of window adjustment is significantly correlated with CO₂,TBC (both r -0.559, p-value 0.020) and TFC (r -0.495, p-value 0.049), number of AC switched on is significantly correlated with CO₂, TBC (both r -0.559, p-value 0.020) and TFC (r -0.495, p-value 0.049),, frequency of AC adjustment is significantly correlated with CO2 (r 0.559, p-value 0.020), TBC (0.559, p-value 0.020) and TFC (r -0.495, p-value 0.049), number of fans switched on is significantly correlated with CO2, TBC (both r 0.559, p-value 0.020) and TFC (r 0.495, p-value 0.049), and frequency of fans adjustment is significantly correlated with CO2, TBC (both r -0.559, p-value 0.020) and TFC (r -0.495, p-value 0.049). Conclusion: This study provided evidence on IAQ parameters in Malaysian public hospitals OPD and significant factors that may be effective targets of prospective intervention, thus enabling stakeholders to develop appropriate policies and programs to mitigate IAQ issues in Malaysian public hospitals OPD.

Keywords: outpatient department, iaq, occupants practice, public hospital

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Authors: Amel Asselah, Nadia Chabli, Imane Haddad

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The adsorption of methylene blue and congo red dyes in an aqueous solution, on a food waste adsorbent: potato peel, and on a commercial adsorbent: activated carbon powder, was investigated using batch experiments. The objective of this study is the valorization of potato peel by its application in the elimination of these dyes. A comparison of the adsorption efficiency with a commercial adsorbent was carried out. Characterization of the potato peel adsorbent was performed by scanning electron microscopy coupled to energy-dispersive X-ray spectroscopy, Fourier transforms infrared spectroscopy, X-ray diffraction, and X-ray fluorescence. Various parameters were analyzed, in particular: the adsorbent mass, the initial dye concentration, the contact time, the pH, and the temperature. The results reveal that it is about 98% for methylene blue-potato peel, 84% for congo red-potato peel, 84% for methylene blue-activated carbon, and 66% for congo red-activated carbon. The kinetic data were modeled by different equations and revealed that the adsorption of textile dyes on adsorbents follows the model pseudo-second-order, and the particular extra diffusion governs the adsorption mechanism. It has been found that the adsorption process could be described by the Langmuir isotherm.

Keywords: bioadsorbent, waste valorization, adsorptio, textile dyes

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Authors: Xuan Hua Huang, Shu Fen Wu, Yi Ting Huang, Pi Yueh Lee

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Background: In Taiwan, the Taiwan healthcare care Indicator Series regards the rate of hospital readmission as an important indicator of healthcare quality. Unplanned readmission not only effects patient’s condition but also increase healthcare utilization rate and healthcare costs. Purpose: The purpose of this study was explored the effects of adult unplanned readmission within 14 days of discharge at a regional teaching hospital in South Taiwan. Methods: The retrospectively review design was used. A total 495 participants of unplanned readmissions and 878 of non-readmissions within 14 days recruited from a regional teaching hospital in Southern Taiwan. The instruments used included the Charlson Comorbidity Index, and demographic characteristics, and disease-related variables. Statistical analyses were performed with SPSS version 22.0. The descriptive statistics were used (means, standard deviations, and percentage) and the inferential statistics were used T-test, Chi-square test and Logistic regression. Results: The unplanned readmissions within 14 days rate was 36%. The majorities were 268 males (54.1%), aged >65 were 318 (64.2%), and mean age was 68.8±14.65 years (23-98years). The mean score for the comorbidities was 3.77±2.73. The top three diagnosed of the readmission were digestive diseases (32.7%), respiratory diseases (15.2%), and genitourinary diseases (10.5%). There were significant relationships among the gender, age, marriage, comorbidity status, and discharge planning services (χ2: 3.816-16.474, p: 0.051~0.000). Logistic regression analysis showed that old age (OR = 1.012, 95% CI: 1.003, 1.021), had the multi-morbidity (OR = 0.712~4.040, 95% CI: 0.559~8.522), had been consult with discharge planning services (OR = 1.696, 95% CI: 1.105, 2.061) have a higher risk of readmission. Conclusions: This study finds that multi-morbidity was independent risk factor for unplanned readmissions at 14 days, recommended that the interventional treatment of the medical team be provided to provide integrated care for multi-morbidity to improve the patient's self-care ability and reduce the 14-day unplanned readmission rate.

Keywords: unplanned readmission, comorbidities, Charlson comorbidity index, logistic regression

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Authors: Jean C. G. Silva, Kaline N. Ferreira, Rennio F. Sena, Flavio L. H. Silva

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The Prosopis juliflora (called algaroba in Northeastern Region of Brazil) is a species of medium to large size that can reach 18 meters high, being typical of arid and semi-arid regions by to requirement less water to survive; this is a fundamental attribute from its adaptation. It's considered of multiple uses, because the trunk, the fruit, and the algaroba pods are utilized for several purposes, among them, the production of wood from lumber mill, charcoal, alcohol, animal and human consumption, being hence, a culture of economic and social value. The use of waste Prosopis juliflora can be carried out for like pyrolysis and gasification processes, in order to energy production in those regions where it is grown. Thus this study aims to characterize the residue of the algaroba pods and evaluate the kinetic parameters, activation energy (Ea) and pre-exponential factor (k0), the devolatilization process through the data obtained from TG/DTG curves with different levels of heating rates. At work was used the heating rates of 5 K.min-1, 10 K.min-1, 15 K.min-1, 20 K.min-1 and 30 K.min-1, in inert nitrogen atmosphere (99.997%) under a flow of 40 ml.min-1. The kinetic parameters were obtained using the methods of Friedman and Ozawa-Flynn-Wall.

Keywords: activation energy, devolatilization, kinetic parameters, waste

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Authors: Bhupinder Kaur, P. P. Srivastav

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The fruit and vegetable industries are responsible for producing huge amount of waste, which is a problem to environmental safety and should be utilized efficiently. Mango (Mangifera indica L.) is an important commercially grown fruit and referred as the “King of fruits”. In 2015, India was the largest producer (18.506 MT) of mangoes and out of which 9.16 % lost during post-harvest handling. The mango kernel and peel represent approximately 17-22% and 7-22% of the overall mass of fruit respectively and discarded as waste. Hence, an attempt has been made with three mango cultivars (Langra, Dashehari, Fazli) to investigate the effect of cryogenic grinding on various characteristics of mango peel powder (MPP). The cryogenic grinding is an emerging technology which is used for retention of beneficial volatile and bioactive components. The feed rate was highest for Langra followed by Chausa. The samples have 2-4% fat along with significant amount of protein (4-6%) and crude fiber (9-13%). Mango peel is also a good source of minerals such as calcium, potassium, manganese, iron, copper, zinc, and magnesium. Interestingly, the significant amount of essential minerals like phosphorus and chlorine in all the varieties was found with the highest value in Langra (phosphorus 10.83% and chlorine 2.41%) which are not reported earlier. SEM analysis revealed the surface morphology and shape of the particles. Waste utilization is a promising measure from both an environmental and economic point of view. Chemical characterization of the samples indicated its potential to be used for the fortification of food products which in turn reduces hazards due to waste and improve functional quality of the foods.

Keywords: cryogenic grinding, morphological, mineral composition, SEM

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Authors: M. Crozet, D. Roudil, T. Branger, S. Boden, P. Peerani, B. Russell, M. Herranz, L. Aldave de la Heras

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The EURATOM work program project INSIDER (Improved Nuclear Site Characterization for Waste minimization in Decommissioning under Constrained Environment) was launched in June 2017. This 4-year project has 18 partners and aims at improving the management of contaminated materials arising from decommissioning and dismantling (D&D) operations by proposing an integrated methodology of characterization. This methodology is based on advanced statistical processing and modelling, coupled with adapted and innovative analytical and measurement methods, with respect to sustainability and economic objectives. In order to achieve these objectives, the approaches will be then applied to common case studies in the form of Inter-laboratory comparisons on matrix representative reference samples and benchmarking. Work Package 6 (WP6) ‘Performance analysis and overall uncertainty’ is in charge of the analysis of the benchmarking on real samples, the organisation of inter-laboratory comparison on synthetic certified reference materials and the establishment of overall uncertainty budget. Assessment of the outcome will be used for providing recommendations and guidance resulting in pre-standardization tests.

Keywords: decommissioning, sampling strategy, research and development, characterization, European project

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Authors: Narottam Puri, Gurvinder Kaur

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Background: The National Accreditation Board for Hospitals & Healthcare Providers (NABH) is India’s apex standard setting accrediting body in health care which evaluates and accredits healthcare organizations. NABH requires accredited organizations to become reaccredited every three years. It is often though that once the initial accreditation is complete, the foundation is set and reaccreditation is a much simpler process. Fortis Hospital, Shalimar Bagh, a part of the Fortis Healthcare group is a 262 bed, multi-specialty tertiary care hospital. The hospital was successfully accredited in the year 2012. On completion of its first cycle, the hospital underwent a reaccreditation assessment in the year 2015. This paper aims to gain a better understanding of the challenges that accredited hospitals face when preparing for a renewal of their accreditations. Methods: The study was conducted using a cross-sectional mixed methods approach; semi-structured interviews were conducted with senior leadership team and staff members including doctors and nurses. Documents collated by the QA team while preparing for the re-assessment like the data on quality indicators: the method of collection, analysis, trending, continual incremental improvements made over time, minutes of the meetings, amendments made to the existing policies and new policies drafted was reviewed to understand the challenges. Results: The senior leadership had a concern about the cost of accreditation and its impact on the quality of health care services considering the staff effort and time consumed it. The management was however in favor of continuing with the accreditation since it offered competitive advantage, strengthened community confidence besides better pay rates from the payors. The clinicians regarded it as an increased non-clinical workload. Doctors felt accountable within a professional framework, to themselves, the patient and family, their peers and to their profession; but not to accreditation bodies and raised concerns on how the quality indicators were measured. The departmental leaders had a positive perception of accreditation. They agreed that it ensured high standards of care and improved management of their functional areas. However, they were reluctant in sparing people for the QA activities due to staffing issues. With staff turnover, a lot of work was lost as sticky knowledge and had to be redone. Listing the continual quality improvement initiatives over the last 3 years was a challenge in itself. Conclusion: The success of any quality assurance reaccreditation program depends almost entirely on the commitment and interest of the administrators, nurses, paramedical staff, and clinicians. The leader of the Quality Movement is critical in propelling and building momentum. Leaders need to recognize skepticism and resistance and consider ways in which staff can become positively engaged. Involvement of all the functional owners is the start point towards building ownership and accountability for standards compliance. Creativity plays a very valuable role. Communication by Mail Series, WhatsApp groups, Quizzes, Events, and any and every form helps. Leaders must be able to generate interest and commitment without burdening clinical and administrative staff with an activity they neither understand nor believe in.

Keywords: NABH, reaccreditation, quality assurance, quality indicators

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Authors: Joseph Lillington, Tom Gout, Mike Harrison, Ian Farnan

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The vitrification of high-level nuclear waste within borosilicate glass and its incorporation within a multi-barrier repository deep underground is widely accepted as the preferred disposal method. However, for this to happen, any safety case will require validation that the initially localized radionuclides will not be considerably released into the near/far-field. Therefore, accurate mechanistic models are necessary to predict glass dissolution, and these should be robust to a variety of incorporated waste species and leaching test conditions, particularly given substantial variations across international waste-streams. Here, machine learning is used to predict glass material properties (viscosity, density) and glass leaching model parameters from large-scale industrial data. A variety of different machine learning algorithms have been compared to assess performance. Density was predicted solely from composition, whereas viscosity additionally considered temperature. To predict suitable glass leaching model parameters, a large simulated dataset was created by coupling MATLAB and the chemical reactive-transport code HYTEC, considering the state-of-the-art GRAAL model (glass reactivity in allowance of the alteration layer). The trained models were then subsequently applied to the large-scale industrial, experimental data to identify potentially appropriate model parameters. Results indicate that ensemble methods can accurately predict viscosity as a function of temperature and composition across all three industrial datasets. Glass density prediction shows reliable learning performance with predictions primarily being within the experimental uncertainty of the test data. Furthermore, machine learning can predict glass dissolution model parameters behavior, demonstrating potential value in GRAAL model development and in assessing suitable model parameters for large-scale industrial glass dissolution data.

Keywords: machine learning, predictive modelling, pattern recognition, radioactive waste glass

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Authors: Samantha Ramachandra, Avanthi Rupasinghe

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Demographic transition from lower to higher percentage of elderly population eventually coupled with epidemiological transition from communicable to non-communicable diseases (NCD). Higher percentage of NCD overload the health system as NCD survivors claims continuous health care. The demands are challenging to a resource constrained setting but reorganizing the system may find solutions. The study focused on the facilities available and their utilization at outpatient department (OPD) setting of the public hospitals of Sri Lanka for continuous medical care. This will help in identifying steps of reorganizing the system to provide better care with the maximum utilization of available facilities. The study was conducted as a situation analysis with secondary data at hospital planning units. Variable were identified according to the world health organization (WHO) recommendation on continuous health care for elders in “age-friendly primary health care toolkit”. Data were collected from secondary and tertiary care hospitals of Sri Lanka where most of the continuous care services are available. Out of 58 secondary and tertiary care hospitals, 16 were included in the study to represent each hospital categories. Average number of patient attending for episodic treatment at OPD and Clinical follow-up of chronic conditions shows vast disparity according to the category of the hospital ranging from 3750 – 800 per day at OPD and 1250 – 200 per clinic session. Average time spent per person at OPD session is low, range from 1.54 - 2.28 minutes, the time was increasing as the hospital category goes down. 93.7% hospitals had special arrangements for providing acute care on chronic conditions such as catheter, feeding tube and wound care. 25% hospitals had special clinics for elders, 81.2% hospitals had healthy lifestyle clinics (HLC), 75% hospitals had physical rehabilitation facilities and 68.8% hospitals had facilities for counselling. Elderly clinics and HLC were mostly available at lower grade hospitals where as rehabilitation and counselling facilities were mostly available at bigger hospitals. HLC are providing health education for both patients and their family members, refer patients for screening of complication but not provide medical examinations, investigations or treatments even though they operate in the hospital setting. Physical rehabilitation is basically offered for patients with rheumatological conditions but utilization of centers for injury rehabilitation and rehabilitation of survivors following major illness such as myocardial infarctions, stroke, cancer is not satisfactory (12.5%). Human Resource distribution within hospital shows vast disparity and there are 103 physiotherapists in the biggest hospital where only 36 physiotherapists available at the next level hospital. Counselling facilities also provided mainly for the patient with psychological conditions (100%) but they were not providing counselling for newly diagnosed patients with major illnesses (0%). According to results, most of the public-sector hospitals in Sri Lanka have basic facilities required in providing continuous care but the utilization of services need more focus. Hospital administration or the government need to have initial steps in proper utilization of them in improving continuous health care incorporating team approach of rehabilitation. The author wishes to acknowledge that this paper was made possible by the support and guidance given by the “Australia Awards Fellowships Program for Sri Lanka – 2017,” which was funded by the Department of Foreign Affairs and Trade, Australia, and co-hosted by Monash University, Australia and the Sri Lanka Institute of Development Administration.

Keywords: continuous care, outpatient department, non communicable diseases, rehabilitation

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Authors: V. E. Messerle, A. L. Mosse, O. A. Lavrichshev, A. N. Nikonchuk, A. B. Ustimenko

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One of the most serious environmental problems today is pollution by biomedical waste (BMW), which in most cases has undesirable properties such as toxicity, carcinogenicity, mutagenicity, fire. Sanitary and hygienic survey of typical solid BMW, made in Belarus, Kazakhstan, Russia and other countries shows that their risk to the environment is significantly higher than that of most chemical wastes. Utilization of toxic BMW requires use of the most universal methods to ensure disinfection and disposal of any of their components. Such technology is a plasma technology of BMW processing. To implement this technology a thermodynamic analysis of the plasma processing of BMW was fulfilled and plasma-box furnace was developed. The studies have been conducted on the example of the processing of bone. To perform thermodynamic calculations software package Terra was used. Calculations were carried out in the temperature range 300 - 3000 K and a pressure of 0.1 MPa. It is shown that the final products do not contain toxic substances. From the organic mass of BMW synthesis gas containing combustible components 77.4-84.6% was basically produced, and mineral part consists mainly of calcium oxide and contains no carbon. Degree of gasification of carbon reaches 100% by the temperature 1250 K. Specific power consumption for BMW processing increases with the temperature throughout its range and reaches 1 kWh/kg. To realize plasma processing of BMW experimental installation with DC plasma torch of 30 kW power was developed. The experiments allowed verifying the thermodynamic calculations. Wastes are packed in boxes weighing 5-7 kg. They are placed in the box furnace. Under the influence of air plasma flame average temperature in the box reaches 1800 OC, the organic part of the waste is gasified and inorganic part of the waste is melted. The resulting synthesis gas is continuously withdrawn from the unit through the cooling and cleaning system. Molten mineral part of the waste is removed from the furnace after it has been stopped. Experimental studies allowed determining operating modes of the plasma box furnace, the exhaust gases was analyzed, samples of condensed products were assembled and their chemical composition was determined. Gas at the outlet of the plasma box furnace has the following composition (vol.%): CO - 63.4, H2 - 6.2, N2 - 29.6, S - 0.8. The total concentration of synthesis gas (CO + H2) is 69.6%, which agrees well with the thermodynamic calculation. Experiments confirmed absence of the toxic substances in the final products.

Keywords: biomedical waste, box furnace, plasma torch, processing, synthesis gas

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Authors: K. W. Lee, C. M. Choi, H. C. Tsang, W. K. Fong, Y. K. Cheng, L. Y. Chan, C. K. Yuen, P. W. Lau, Y. L. To, K. C. Chow

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QR (Quick Response) Code is a matrix barcode. It enables users to open websites, photos and other information with mobile devices by just snapping the code. In usual Long Term Oxygen Therapy arrangement, piles of LTOT related information like leaflets from different oxygen service providers are given to patients to choose an appropriate plan according to their needs. If these printed materials are transformed into electronic format (QR Code), it would be more environmentally-friendly. More importantly, electronic materials including LTOT equipment operation and dyspnoea relieving techniques also empower patients in long-term disease management. The objective to this study is to investigate the effect of QR code in patient education on new LTOT users. This study was carried out in medical wards of North District Hospital. Adult patients and relatives who followed commands, were able to use smartphones with internet services and required LTOT arrangement on hospital discharge were recruited. In LTOT arrangement, apart from the usual LTOT education booklets which included patients’ personal information (e.g. oxygen titration and six-minute walk test results etc.), extra leaflets consisted of 1. QR codes of LTOT plans from different oxygen service providers, 2. Education materials of dyspnoea management and 3. Instructions on LTOT equipment operation were given. Upon completion of LTOT arrangement, a questionnaire about the use of QR code on patient education was filled in by patients or relatives. A total of 10 new LTOT users were recruited from November 2017 to January 2018. Initially, 70% of them did not know anything about the QR code, but all of them understood its operation after a simple demonstration. 70% of them agreed that it was convenient to use (20% strongly agree, 40% agree, 10% somewhat agree). 80% of them agreed that QR code could facilitate the retrieval of more LTOT related information (10% strongly agree, 70% agree) while 90% agreed that we should continue delivering QR code leaflets to new LTOT users in the future (30% strongly agree, 40% agree, 20% somewhat agree). It is proven that QR code is a convenient and environmentally-friendly tool to deliver information. It is also relatively easy to be introduced to new users. It has received welcoming feedbacks from current users.

Keywords: long-term oxygen therapy, physiotherapy, patient education, QR code

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Authors: Lebogang L. R. Mphahlele, Bruce B. Sithole

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Chicken meat is the highest consumed meat in south Africa, with a per capita consumption of >33 kg yearly. Hence, South Africa produces over 250 million kg of waste chicken feathers each year, the majority of which is landfilled or incinerated. The discarded feathers have caused environmental pollution and natural protein resource waste. Therefore, the valorisation of waste chicken feathers is measured as a more environmentally friendly and cost-effective treatment. Feather contains 91% protein, the main component being beta-keratin, a fibrous and insoluble structural protein extensively cross linked by disulfide bonds. Keratin is usually converted it into nanofibers via electrospinning for a variety of applications. keratin nanofiber composites have many potential biomedical applications for their attractive features, such as high surface-to-volume ratio and very high porosity. The application of nanofibers in the biomedical wound dressing requires antimicrobial properties for materials. One approach is incorporating inorganic nanoparticles, among which silver nanoparticles played an important alternative antibacterial agent and have been studied against many types of microbes. The objective of this study is to combine synthetic polymer, chicken feather keratin, and antibacterial nanoparticles to develop novel electrospun antibacterial nanofibrous composites for possible wound dressing application. Furthermore, this study will converting a two-dimensional electrospun nanofiber membrane to three-dimensional fiber networks that resemble the structure of the extracellular matrix (ECM)

Keywords: chicken feather keratin, nanofibers, nanoparticles, nanocomposites, wound dressing

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Authors: Osama Shakeel

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The objective of the paper is to study the clinic-pathological factors, survival analyses, recurrence rate, metastatic rate, risk factors and the management of cutaneous malignant melanoma at Shaukat Khanum Memorial Cancer Hospital and Research Center. Methodology: From 2014 to 2017, all patients with a diagnosis of cutaneous malignant melanoma (CMM) were included in the study. Demographic variables were collected. Short and long term oncological outcomes were recorded. All data were entered and analyzed in SPSS version 21. Results: A total of 28 patients were included in the study. Median age was 46.5 +/-15.9 years. There were 16 male and 12 female patients. The family history of melanoma was present in 7.1% (n=2) of the patients. All patients had a mean survival of 13.43+/- 9.09 months. Lower limb was the commonest site among all which constitutes 46.4%(n=13). On histopathological analyses, ulceration was seen in 53.6% (n=15) patients. Unclassified tumor type was present in 75%(n=21) of the patients followed by nodular 21.4% (n=6) and superficial spreading 3.5%(n=1). Clark level IV was the commonest presentation constituting 46.4%(n=13). Metastases were seen in 50%(n=14) of the patients. Local recurrence was observed in 60.7%(n=17). 64.3%(n=18) lived after one year of treatment. Conclusion: CMM is a fatal disease. Although its disease of fair skin individuals, however, the incidence of CMM is also rising in this part of the world. Management includes early diagnoses and prompt management. However, mortality associated with this disease is still not favorable.

Keywords: malignant cancer of skin, cutaneous malignant melanoma, skin cancer, survival analyses

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Authors: Yufeng Wu, Yifan Gu, Bin Li, Wei Wang

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Resource recycling process contains a subsystem with interactions of three dimensions including coupling allocation of primary and secondary resources, responsibility coordination of stakeholders in forward and reverse supply chains, and trans-boundary transfer of hidden resource and environmental responsibilities between regions. Overlap or lack of responsibilities is easy to appear at the intersection of the three management dimensions. It is urgent to make an overall design of the policy system for recycling resources. From theoretical perspective, this paper analyzes the unique external differences of resource and environment in various dimensions and explores the reason why the effects of trans-dimensional policies are strongly correlated. Taking the example of the copper resources contained in the waste electrical and electronic equipment, this paper constructs reduction effect accounting model of resources recycling and set four trans-dimensional policy scenarios including resources tax and environmental tax reform of the raw and secondary resources, application of extended producer responsibility system, promotion of clean development mechanism, and strict entry barriers of imported wastes. In these ways, the paper simulates the impact effect of resources recycling process on resource deduction and emission reduction of waste water and gas, and constructs trans-dimensional policy mix scenario through integrating dominant strategy. The results show that combined application of various dimensional policies can achieve incentive compatibility and the trans-dimensional policy mix scenario can reach a better effect. Compared with baseline scenario, this scenario will increase 91.06% copper resources reduction effect and improve emission reduction of waste water and gas by eight times from 2010 to 2030. This paper further analyzes the development orientation of policies in various dimension. In resource dimension, the combined application of compulsory, market and authentication methods should be promoted to improve the use ratio of secondary resources. In supply chain dimension, resource value, residual functional value and potential information value contained in waste products should be fully excavated to construct a circular business system. In regional dimension, it should give full play to the comparative advantages of manufacturing power to improve China’s voice in resource recycling in the world.

Keywords: resource recycling, trans-dimension, policy design, incentive compatibility, life cycle

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Authors: Farramae Francisco, Rhoda Mae Simora, Sharon Nunal

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Deproteination and demineralization efficiencies of shrimp waste using two Lactobacillus species treated with different carbohydrate sources for chitin production, its chemical conversion to chitosan and the quality of chitin and chitosan produced were determined. Using 5% glucose and 5% cassava starch as carbohydrate sources, pH slightly increased from the initial pH of 6.0 to 6.8 and 7.2, respectively after 24 h and maintained their pH at 6.7 to 7.3 throughout the treatment period. Demineralization (%) in 5 % glucose and 5 % cassava was highest during the first day of treatment which was 82% and 83%, respectively. Deproteination (%) was highest in 5% cassava starch on the 3rd day of treatment at 84.4%. The obtained chitin from 5% cassava and 5% glucose had a residual ash and protein below 1% and solubility of 59% and 44.3%, respectively. Chitosan produced from 5% cassava and 5% glucose had protein content below 0.05%; residual ash was 1.1% and 0.8%, respectively. Chitosan solubility and degree of deacetylation were 56% and 33% in 5% glucose and 48% and 29% in 5% cassava, respectively. The advantage this alternative technology offers over that of chemical extraction is large reduction in chemicals needed thus less effluent production and generation of a protein-rich liquor, although the demineralization process should be improved to achieve greater degree of deacetylation.

Keywords: alternative carbon source, bioprocessing, lactic acid bacteria, waste utilization

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Authors: Mehmet Sener, Emre Kishali

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The establishment of republic brought radical changes related to the modernization of life in early republican Turkey considering the revolutions in socio-economical, cultural and political aspects. These changes also had many influences on the formation of city planning and architectural medium that the arrangements related with health facility production had an important place amongst them. While the health services were witnessing great transformations with all its sides, socio-cultural and architectural framework of these facilities necessitated the adaption of new conceptual approaches which led to the construction new hospital buildings by the republican state with a name ‘Sample Hospital’. In this period, the state constructed sample hospitals in some cities (Adana, Ankara, Erzurum, İstanbul, Konya, Sivas and Trabzon) for the aim of being a good example for further hospitals sheltering all the characteristics of a contemporary health complex for that day. In this study, these six hospitals will firstly be elucidated considering their historical evaluations and current situations. Then, being one of the most significant modern heritages of republican history, the ways to provide the interrelationship of these complexes with the rapidly evolving current world will be discussed by proposing solutions or approaches coming from the fields of city planning, architectural preservation, engineering and architectural history together with an awareness of the socio-economic conditions, health services and architectural medium of Turkey. These hospitals are complexes composed of building ensembles which have functional relationships with each other. So, some strategies will be proposed for the preservation, renovation, and refurbishment of these complexes with an awareness of the possibility of the conflict between conservation practices and today’s health facility standards. Accordingly, the addition or removal of some elements in the complex or the suggestion of some architectural changes for the modernization of these health facilities will be investigated considering the requirements of the contemporary architectural design of health facilities. Since these hospitals are highly complex structures and have vastly changing design and construction standards, they cannot be used without adopting necessary architectural and technological interventions. So, the adaptive re-use of these buildings instead of demolition or the preservation of their overall characteristics becomes inevitable for the sustaining of these health facility heritages in Turkey. In this context, a multidisciplinary analysis will be made in this study on ‘Sample Hospital’ concept and buildings existing in Turkish modern architectural history within the framework of the adaptive reuse of these health complexes.

Keywords: adaptive re-use, conservation, early republican Turkey, sample hospital

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Authors: Efil Yusrianto, Noraini Marsi, Noraniah Kassim, Izzati Abdul Manaf, Hafizuddin Hakim Shariff

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Today, municipal solid waste (MSW), noise pollution, and attack fire are three ongoing issues for inhabitants of urban including in Malaysia. To solve these issues, eco-friendly autoclaved aerated concrete (AAC) containing recycled ceramic and gypsum waste (CGW) as a partial replacement for sand with different ratios (0%, 5%, 10%, 15%, 20%, and 25% wt) has been prepared. The performance of samples, such as the physical, mechanical, sound absorption coefficient, and direct fire resistance, has been investigated. All samples showed normal color behavior, i.e., grey and free crack. The compressive strength was increased in the range of 6.10% to 29.88%. The maximum value of compressive strength was 2.13MPa for 15% wt of CGW. The positive effect of CGW on the compressive strength of AAC has also been confirmed by crystalline phase and microstructure analysis. The acoustic performances, such as sound absorption coefficients of samples at low frequencies (500Hz), are higher than the reference sample (RS). AAC-CGW samples are categorized as AAC material classes B and C. The fire resistance results showed the physical surface of the samples had a free crack and was not burned during the direct fire at 950ºC for 300s. The results showed that CGW succeeded in enhancing the performance of fresh AAC, such as compressive strength, crystalline phase, sound absorption coefficient, and fire resistance of samples.

Keywords: physical, mechanical, acoustic, direct fire resistance performance, autoclaved aerated concrete, recycled ceramic-gypsum waste

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Authors: Chaouki Ghenai

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Computational Fluid Dynamic analysis of co-combustion of coal/biomass waste fuel blends is presented in this study. The main objective of this study is to investigate the effects of biomass portions (0%, 10%, 20%, 30%: weight percent) blended with coal and oxygen concentrations (21% for air, 35%, 50%, 75% and 100 % for pure oxygen) on the combustion performance and emissions. The goal is to reduce the air emissions from power plants coal combustion. Sub-bituminous Nigerian coal with calorific value of 32.51 MJ/kg and sawdust (biomass) with calorific value of 16.68 MJ/kg is used in this study. Coal/Biomass fuel blends co-combustion is modeled using mixture fraction/pdf approach for non-premixed combustion and Discrete Phase Modeling (DPM) to predict the trajectories and the heat/mass transfer of the fuel blend particles. The results show the effects of oxygen concentrations and biomass portions in the coal/biomass fuel blends on the gas and particles temperatures, the flow field, the devolitization and burnout rates inside the combustor and the CO2 and NOX emissions at the exit from the combustor. The results obtained in the course of this study show the benefits of enriching combustion air with oxygen and blending biomass waste with coal for reducing the harmful emissions from coal power plants.

Keywords: co-combustion, coal, biomass, fuel blends, CFD, air emissions

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Authors: Firas Daghistani, Hossam Abuel Naga

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Waste tyres is a global problem that has a negative effect on the environment, where there are approximately one billion waste tyres discarded worldwide yearly. Waste tyres are discarded in stockpiles, where they provide harm to the environment in many ways. Finding applications to these materials can help in reducing this global problem. One of these applications is recycling these waste materials and using them in geotechnical engineering. Recycled waste tyre particulates can be mixed with sand to form a lightweight material with varying shear strength characteristics. Contradicting results were found in the literature on the inclusion of particulate rubber to sand, where some experiments found that the inclusion of particulate rubber can increase the shear strength of the mixture, while other experiments stated that the addition of particulate rubber decreases the shear strength of the mixture. This research further investigates the inclusion of particulate rubber to sand and whether it can increase or decrease the shear strength characteristics of the mixture. For the experiment, a series of direct shear tests were performed on a poorly graded sand with a mean particle size of 0.32 mm mixed with recycled poorly graded particulate rubber with a mean particle size of 0.51 mm. The shear tests were performedon four normal stresses 30, 55, 105, 200 kPa at a shear rate of 1 mm/minute. Different percentages ofparticulate rubber content were used in the mixture i.e., 10%, 20%, 30% and 50% of sand dry weight at three density states, namely loose, slight dense, and dense state. The size ratio of the mixture,which is the mean particle size of the particulate rubber divided by the mean particle size of the sand, was 1.59. The results identified multiple parameters that can influence the shear strength of the mixture. The parameters were: normal stress, particulate rubber content, mixture gradation, mixture size ratio, and the mixture’s density. The inclusion of particulate rubber tosand showed a decrease to the internal friction angle and an increase to the apparent cohesion. Overall, the inclusion of particulate rubber did not have a significant influenceon the shear strength of the mixture. For all the dense states at the low normal stresses 33 and 55 kPa, the inclusion of particulate rubber showed aslight increase in the shear strength where the peak was at 20% rubber content of the sand’s dry weight. On the other hand, at the high normal stresses 105, and 200 kPa, there was a slight decrease in the shear strength.

Keywords: shear strength, direct shear, sand-rubber mixture, waste material, granular material

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Authors: Nourmalita Safitri Ningsih, Ridwan, Iqri Puspa Yunanda

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The aim of this study was to utilize the waste from slaughterhouses for chicken feed ingredients is probiotic. Livestock waste produced by livestock activities such as feces, urine, food remains, as well as water from livestock and cage cleaning. The process starts with the isolation of bacteria. Rumen fluid is taken at Slaughterhouse Giwangan, Yogyakarta. Isolation of Lactobacillus ruminus is done by using de Mann Rogosa Sharpe (MRS) medium. In the sample showed a rod-shaped bacteria are streaked onto an agar plates. After it was incubated at 37ºC for 48 hours, after which it is observed. The observation of these lactic acid bacteria it will show a clear zone at about the colony. These bacterial colonies are white, round, small, shiny on the agar plate mikroenkapsul In the manufacturing process carried out by the method of freeze dried using skim milk in addition capsulated material. Then the results of these capsulated bacteria are mixed with feed for livestock. The results from the mixing of capsulated bacteria in feed are to increase the quality of animal feed so as to provide a good effect on livestock. Scanning electron microscope testing we have done show the results of bacteria have been shrouded in skim milk. It can protect the bacteria so it is more durable in use. The observation of the bacteria showed a sheath on Lactobacillus sp. Preservation of bacteria in this way makes the bacteria more durable for use. As well as skim milk can protect bacteria that are resistant to the outside environment. Results of probiotics in chicken feed showed significant weight gain in chickens. Calculation Anova (P <0.005) shows the average chicken given probiotics her weight increased.

Keywords: chicken, probiotics, waste, Lactobacillus sp, bacteria

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Authors: Preethi Grace Theva Neethi Dhas

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A healthy human gut microbiome has commensal and symbiotic functions in digestion and is a decisive factor for human health. The soil microbiome is a crucial component in the ecosystem of soils and their health and resilience. Changes in soil microbiome are linked to human health. Ever since the industrial era, the human and the soil microbiome have been going through drastic changes. The soil microbiome has changed due to industrialization and extensive agricultural practices, whereas humans have less contact with soil and increased intake of highly processed foods, leading to changes in the human gut microbiome. Regenerating the soil becomes crucial in maintaining a healthy ecosystem. The nutrients, once obtained from the soil, need to be given back to the soil. Soil degradation needs to be addressed in effective ways, like adding organic nutrients back to the soil. Manure from animals and humans needs to be returned to the soil, which can complete the nutrient cycle in the soil. On the other hand, fecal sludge management (FSM) is a growing concern in many parts of the developing world. Hence, it becomes crucial to treat and reuse fecal sludge in a safe manner, i.e., low in risk to human health. Co-composting fecal sludge with organic wastes is a practice that allows the safe management of fecal sludge and the safe application of nutrients to the soil. This paper will discuss the possible impact of co-composting fecal sludge with coconut choir waste on the soil, water, and ecosystem at large. Impact parameters like nitrogen, phosphorus, and fecal coliforms will be analyzed. The overall impact of fecal sludge application on the soil will be researched and presented in this study.

Keywords: fecal sludge management, nutrient cycle, soil health, composting

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Authors: Wan Azuati Wan Omar, Selva Rani John Jasudass, Siti Rohaiza Md. Saad

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Introduction & objective: The objectives of this study were to assess patient’s knowledge of appropriate sublingual glyceryl trinitrate (GTN) use as well as to investigate how patients commonly store and carry their sublingual GTN tablets. Methodology: This was a cross-sectional survey, using a validated researcher-administered questionnaire. The study involved cardiac patients receiving sublingual GTN attending the outpatient and inpatient departments of Taiping Hospital, a non-academic public care hospital. The minimum calculated sample size was 92, but 100 patients were conveniently sampled. Respondents were interviewed on 3 areas, including demographic data, knowledge and use of sublingual GTN. Eight items were used to calculate each subject’s knowledge score and six items were used to calculate use score. Results: Of the 96 patients who consented to participate, majority (96.9%) were well aware of the indication of sublingual GTN. With regards to the mechanism of action of sublingual GTN, 73 (76%) patients did not know how the medication works. Majority of the patients (66.7%) knew about the proper storage of the tablet. In relation to the maximum number of sublingual GTN tablets that can be taken during each angina episode, 36.5% did not know that up to 3 tablets of sublingual GTN can be taken during each episode of angina. Fifty four (56.2%) patients were not aware that they need to replace sublingual GTN every 8 weeks after receiving the tablets. Majority (69.8%) of the patients demonstrated lack of knowledge with regards to the use of sublingual GTN as prevention of chest pain. Conclusion: Overall, patients’ knowledge regarding the self administration of sublingual GTN is still inadequate. The findings support the need for more frequent reinforcement of patient education, especially in the areas of preventive use, storage and drug stability.

Keywords: glyceryl trinitrate, knowledge, adherence, patient education

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Authors: Wudneh Asegedech Ayele

Abstract:

Background: Dietary diversity is strongly related with non-communicable disease (NCDs). Diet plays a key role as a risk factor for hypertension. Diets rich in fruits, vegetables, and low-fat dairy products that include whole grains, poultry, fish, and nuts, that contain only small amounts of red meat, sweets, and sugar-containing beverages, and that contain decreased amounts of total and saturated fat and cholesterol have been found to have a protective effect against hypertension. Methods: hospital based Cross-sectional study design was employed from June 1-June 25, 2021. Sampling technique was Systematic random sampling and data were collected using an interview method. Data were entered into Epi Data version 3.1 and exported to SPSS version 25 for processed and analysis respectively. Descriptive statistics were used to summarize data. Bivariate and multivariate logistic regression will employed to determine dietary diversity among hypertension patients. Results: Adequate dietary diversity score were 96 (24.68%). Most of them cereal, white roots and tubers, dark green leafy vegetables, Vitamin A rich fruits ,meat, egg and coffee or tea more intakes. Hypertensive patients who didn’t consume cereals four times less likely adequate dietary diversity than who consumed cereals [AOR= 4.083, 95%: CI (2.096 -7.352)]. Hypertensive patients who didn’t consume white roots and tubers 14 times less likely adequate dietary diversity than who consumed white roots and tubers [AOR= 13.733, 95% CI: (5.388-34.946)]. Conclusion and recommendation the study showed one of fourth part reported adequate dietary diversity score. Cereals, fruits, vegetables and milk and milk products were statistically associated with dietary diversity practice. Health education about dietary modifications and behavioral change to dietary diversity

Keywords: dietary diversity practice and associated facrors among hypertension patients at tirunesh beijing hospital, hypertension, dietary, diversity and tirunesh beijing hospital, associated facrors among hypertension patient, at tirunesh beijing hospita

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