Search results for: hospital safety

Authors: Shanza Akram, Samir Salah, Imran Saleem, Jassim Abdou, Ashraf Al Zaabi

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Estimated prevalence of asthma in UAE is around 10% (900,000 people). Patients with persistent symptoms despite using high dose ICS plus a second controller +/- Oral steroids are considered to have severe asthma. Omalizumab (Xolair) is an anti-IgE monoclonal antibody approved as add-on therapy for severe allergic asthma. The objective of our study was to obtain baseline characteristics of our local cohort, to determine the efficacy of omalizumab based on clinical outcomes pre and post 52 weeks of treatment and to assess safety and tolerability. Medical records of patients receiving omalizumab therapy for asthma at Zayed Military Hospital, Abu Dhabi were retrospectively reviewed. Patients fulfilling the criteria for severe allergic asthma as per GINA guidelines were included. Asthma control over 12 months pre and post omalizumab were analyzed by taking into account the number of exacerbations, hospitalizations, maintenance of medication dosages, the need for reliever therapy and PFT’s. 21 patients (5 females) with mean age 41 years were included. The mean duration of therapy was 22 months. 19 (91%) patients had Allergic Rhinitis/Sinusitis. Mean serum total IgE level was 648 IU/ml (65-1859). 11 (52%) patients were on oral maintenance steroids pre-treatment. 7 patients managed to stop steroids on treatment while 4 were able to decrease the dosage. Mean exacerbation rate decreased from 5 per year pre-treatment to 1.36 while on treatment. The number of hospitalizations decreased from a mean of 2 per year to 0.9 per year. Reliever inhaler usage decreased from mean of 40 to 15 puffs per week.2 patients discontinued therapy, 1 due to lack of benefit (2 doses) and 2nd due to severe persistent side effects. Patient compliance was poor in some cases. Treatment with omalizumab reduced the number of exacerbations, hospitalizations, maintenance and reliever medications, and is generally well tolerated. Our results show that there is room for improved documentation in terms of symptom recording and use of rescue medication at our institution. There is also need for better patient education and counseling in order to improve compliance.

Keywords: asthma, exacerbations, omalizumab, IgE

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Authors: Lele Zhang, Hui Leng Choo, Alexander Konyukhov, Shuguang Li

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China is currently the world's largest producer and distributor of electric bicycle (e-bike). The increasing number of e-bikes on the road is accompanied by rising injuries and even deaths of e-bike drivers. Therefore, there is a growing need to improve the safety structure of e-bikes. This 3D frictionless contact analysis is a preliminary, but necessary work for further structural design improvement of an e-bike. The contact analysis between e-bike and the ground was carried out as follows: firstly, the Penalty method was illustrated and derived from the simplest spring-mass system. This is one of the most common methods to satisfy the frictionless contact case; secondly, ANSYS static analysis was carried out to verify finite element (FE) models with contact pair (without friction) between e-bike and the ground; finally, ANSYS transient analysis was used to obtain the data of the penetration p(u) of e-bike with respect to the ground. Results obtained from the simulation are as estimated by comparing with that from theoretical method. In the future, protective shell will be designed following the stability criteria and added to the frame of e-bike. Simulation of side falling of the improved safety structure of e-bike will be confirmed with experimental data.

Keywords: frictionless contact, penalty method, e-bike, finite element

Procedia PDF Downloads 277

Authors: Asamaporn Puetpaiboon, Sunisa Chatmongkolchart, Nalinee Kovitwanawong, Osaree Akaraborworn

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Traumatic patients with massive bleeding require intensive resuscitation. The actual cost of anesthesia per case has never been clarified, so our study aimed to quantify the direct cost, and cost-to-charge ratio of anesthetic care in traumatic patients with intraoperative massive bleeding. This study was a prospective, observational, cost analysis study, conducted in Prince of Songkla University hospital, Thailand, with traumatic patients, of any mechanisms being recruited. Massive bleeding was defined as estimated blood loss of at least one blood volume in 24 hours, or a half of blood volume in 3 hours. The cost components were identified by the micro-costing method, and valued by the bottom-up approach. The direct cost was divided into 4 categories: the labor cost, the capital cost, the material cost and the cost of drugs. From September 2017 to August 2018, 10 patients with multiple injuries were included. Seven patients had motorcycle accidents, two patients fell from a height and another one was in a minibus accident. Two patients died on the operating table, and another two died within 48 hours. The median Sequential Organ Failure Assessment (SOFA) score was 8. The median intraoperative blood loss was 3,500 ml. The median direct cost, per case, was 250 United States Dollars (2017 exchange rate), and the cost-to-charge ratio was 0.53. In summary, the direct cost was nearly half of the hospital charge, for these traumatic patients with massive bleeding. However, our study did not analyze the indirect cost.

Keywords: cost, cost-to-charge ratio, micro-costing, trauma

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Authors: Abdullah Özbilgin, Oguzhan Kahraman, Mustafa Selçuk Alataş

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Plant breeders have made and will continue to make important contributions toward meeting the need for more and better feed and food. The use of new techniques to modify the genetic makeup of plants to improve their properties has led to a new generation of crops, grains and their by-products for feed. Plant breeders have made and will continue to make important contributions toward meeting the need for more and better feed and food. The use of new techniques to modify the genetic makeup of plants to improve their properties has led to a new generation of crops, grains and their by-products for feed. The land area devoted to the cultivation of genetically modified (GM) plants has increased in recent years: in 2012 such plants were grown on over 170 million hectares globally, in 28 different countries, and are at resent used by 17.3 million farmers worldwide. The majority of GM plants are used as feed material for food-producing farm animals. Despite the facts that GM plants have been used as feed for years and a number of feeding studies have proved their safety for animals, they still give rise to emotional public discussion.

Keywords: crops, genetical modified plant(GM), plant, safety

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Authors: Mojtaba Valinejadshoubi, Ashutosh Bagchi, Osama Moselhi

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Structures such as buildings, bridges, dams, wind turbines etc. need to be maintained against various factors such as deterioration, excessive loads, environment, temperature, etc. Choosing an appropriate monitoring system is important for determining any critical damage to a structure and address that to avoid any adverse consequence. Structural Health Monitoring (SHM) has emerged as an effective technique to monitor the health of the structures. SHM refers to an ongoing structural performance assessment using different kinds of sensors attached to or embedded in the structures to evaluate their integrity and safety to help engineers decide on rehabilitation measures. Ability of SHM in identifying the location and severity of structural damages by considering any changes in characteristics of the structures such as their frequency, stiffness and mode shapes helps engineers to monitor the structures and take the most effective corrective actions to maintain their safety and extend their service life. The main objective of this study is to review the overall SHM process specifically determining the natural frequency of an instrumented simply-supported concrete beam using modal testing and finite element model updating.

Keywords: structural health monitoring, natural frequency, modal analysis, finite element model updating

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Authors: Do Thi Ha, Khanitta Nuntaboot

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Background: Competency of nurses is vital to safe nursing practice as well as essential component to drive quality of nursing services. There exists little up to date information concerning actual competency among Vietnamese nurses. Purposes: The purpose of this study is to identify the actual nursing competency among nurses in clinical settings in Vietnam. Methods: A qualitative study, ethnographic method, comprised of the participant-observation, in-depth interview, and focus group discussion with multidisciplinary groups of nurses employing in Cho Ray hospital, Vietnam, managers/administrators, nurse teachers, medical doctors, other health care providers, patients and family members which derived from purposeful sampling technique. Content analysis was used for data analysis. Results: Five essential themes of nursing competencies among nurses were identified include (1) knowledge, (2) skills, (3) attitude and value-based nursing practice, (4) legal and ethical competencies, and (5) transcultural competencies. Basic and advanced knowledge were identified as further two dimensions of knowledge. There were five sub themes identified as further dimensions of skills include technical skills, communication skills, organizing and management skills, teamwork and interrelationship, and critical thinking skills. Conclusions: The findings from this study provide valuable information and understanding of the actual competency among nurses in clinical settings in Vietnam. It is expected that this understanding would assist in developing a guide to nursing education and training, nursing practice and relevant policy regulation used for promoting nursing competency among nurses.

Keywords: ethnographic method, nursing competency, qualitative design, Vietnam

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Authors: Paria Soleimani, Arezoo Neshati

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Myocardial infarction is one of the leading causes of ‎death in the world. Some of these deaths occur even before the patient ‎reaches the hospital. Myocardial infarction occurs as a result of ‎impaired blood supply. Because the most of these deaths are due to ‎coronary artery disease, hence the awareness of the warning signs of a ‎heart attack is essential. Some heart attacks are sudden and intense, but ‎most of them start slowly, with mild pain or discomfort, then early ‎detection and successful treatment of these symptoms is vital to save ‎them. Therefore, importance and usefulness of a system designing to ‎assist physicians in the early diagnosis of the acute heart attacks is ‎obvious.‎ The purpose of this study is to determine how well a predictive ‎model would perform based on the only patient-reportable clinical ‎history factors, without using diagnostic tests or physical exams. This ‎type of the prediction model might have application outside of the ‎hospital setting to give accurate advice to patients to influence them to ‎seek care in appropriate situations. For this purpose, the data were ‎collected on 711 heart patients in Iran hospitals. 28 attributes of clinical ‎factors can be reported by patients; were studied. Three logistic ‎regression models were made on the basis of the 28 features to predict ‎the risk of heart attacks. The best logistic regression model in terms of ‎performance had a C-index of 0.955 and with an accuracy of 94.9%. ‎The variables, severe chest pain, back pain, cold sweats, shortness of ‎breath, nausea, and vomiting were selected as the main features.‎

Keywords: Coronary heart disease, Acute heart attacks, Prediction, Logistic ‎regression‎

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Authors: Elizaveta S. Prokofyeva, Svetlana V. Maltseva, Roman D. Zaitsev

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Rapidly evolving modern data analysis technologies in healthcare play a large role in understanding the operation of the system and its characteristics. Nowadays, one of the key tasks in urban healthcare is to optimize the resource allocation. Thus, the application of data analysis in medical institutions to solve optimization problems determines the significance of this study. The purpose of this research was to establish the dependence between the indicators of the effectiveness of the medical institution and its resources. Hospital discharges by diagnosis; hospital days of in-patients and in-patient average length of stay were selected as the performance indicators and the demand of the medical facility. The hospital beds by type of care, medical technology (magnetic resonance tomography, gamma cameras, angiographic complexes and lithotripters) and physicians characterized the resource provision of medical institutions for the developed models. The data source for the research was an open database of the statistical service Eurostat. The choice of the source is due to the fact that the databases contain complete and open information necessary for research tasks in the field of public health. In addition, the statistical database has a user-friendly interface that allows you to quickly build analytical reports. The study provides information on 28 European for the period from 2007 to 2016. For all countries included in the study, with the most accurate and complete data for the period under review, predictive models were developed based on historical panel data. An attempt to improve the quality and the interpretation of the models was made by cluster analysis of the investigated set of countries. The main idea was to assess the similarity of the joint behavior of the variables throughout the time period under consideration to identify groups of similar countries and to construct the separate regression models for them. Therefore, the original time series were used as the objects of clustering. The hierarchical agglomerate algorithm k-medoids was used. The sampled objects were used as the centers of the clusters obtained, since determining the centroid when working with time series involves additional difficulties. The number of clusters used the silhouette coefficient. After the cluster analysis it was possible to significantly improve the predictive power of the models: for example, in the one of the clusters, MAPE error was only 0,82%, which makes it possible to conclude that this forecast is highly reliable in the short term. The obtained predicted values of the developed models have a relatively low level of error and can be used to make decisions on the resource provision of the hospital by medical personnel. The research displays the strong dependencies between the demand for the medical services and the modern medical equipment variable, which highlights the importance of the technological component for the successful development of the medical facility. Currently, data analysis has a huge potential, which allows to significantly improving health services. Medical institutions that are the first to introduce these technologies will certainly have a competitive advantage.

Keywords: data analysis, demand modeling, healthcare, medical facilities

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Authors: Sumit Roy

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A clear understanding of pedestrian behaviour at road crossing at intersections is needed for providing necessary infrastructure and also for enhancing pedestrian safety at any intersection. Pedestrian road crossing behaviour is studied at Motijheel and Kakrail intersections where Motijheel intersection is a controlled roundabout, and Kakrail intersection is a signalized intersection. Around 60 people at each intersection were interviewed for a questionnaire survey and video recording at different time of a day was done for observation at each intersection. In case of Motijeel intersection, we got pedestrian road crossings were much higher than Kakrail intersection. It is because the number of workplaces here is higher than Kakrail. From questionnaire survey, it is found that 80% of pedestrians crosses at intersection to avail buses and their loading and unloading locations are at intersection, whereas at Kakrail intersection only 25% pedestrian crosses the road for buses as buses do not slow down here. At Motijheel intersection 25 to 40% of pedestrians choose to jump over the barricade for crossing instead of using overbridge for saving time and labour. On the other hand, the pedestrians using overbridge told that they use overbridge for safety. Moreover, pedestrian crosses at the same pace for both red and green interval with vehicle movement in the range of 12.5 to 14.5 km/h and gaps between vehicle were more than 4 m. Here pedestrian crossing speed varies from 3.5 to 7.2 km/h. In Kakrail intersection the road crossing situation can be classified into 4 categories. In case of red time, pedestrians do not wait to cross the road, and crossing speed varies from 3.5 to 7.2 km/h. When vehicle speed varies from 5.4 to 7.4 km/h, and gaps between vehicle vary from 1.5 to 2 m, most of the pedestrians initially choose to wait and try to cross the road in group with crossing speed 2.7 to 3.5 km/h. When vehicle speed varies from 10.8 to 18 km/h, and gaps between vehicles varies from 2 to 3 m most of the people waits and cross the road in group with crossing speed 3.5 to 5.4 km/h. When vehicle speed varies from 25.2 to 32.4 km/h and gaps between vehicles vary from 4 to 6 m most of the pedestrians choose to wait until red time. In Kakrail intersection 87% of people said that they cross the road with risk and 60% of pedestrians told that it is risky to get on and off the bus at this intersection. Planned location of loading and unloading area for buses can improve the pedestrian road crossing behaviour at intersections.

Keywords: crossing speed, pedestrian behaviour, road crossing, use of overbridge

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Authors: Hadj Brahim Mounia, Belhamel Farid, Souici Messoud

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In big cities, construction on sloping land (landslide) is becoming increasingly prevalent due to the unavailability of flat lands. This has created a major challenge for structural engineers with regard to structure design, due to the difficulties encountered during the implementation of projects, both for the structure and the soil. This paper analyses the effect of the number of floors of a building, founded on isolated footing on the stability of the slope using the computer code finite element PLAXIS 2D v. 8.2. The isolated footings of a building in this case were anchored in soil so that the levels of successive isolated footing realize a maximum slope of base of three for two heights, which connects the edges of the nearest footings, according to the Algerian building code DTR-BC 2.331: Shallow foundations. The results show that the embedment of the foundation into the soil reduces the value of the safety factor due to the change of the stress state of the soil by these foundations. The number of floors a building has also influences the safety factor. It has been noticed from this case of study that there is no risk of collapse of slopes for an inclination between 5° and 8°. In the case of slope inclination greater than 10° it has been noticed that the urbanization is prohibited.

Keywords: isolated footings, multi-storeys building, PLAXIS 2D, slope

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Authors: Samuel Kehinde Okunade, Daniel Sunday Tolorunshagba

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Globally women are classified to be part of the vulnerable group in any environment. In a conflict-ridden environment, women being vulnerable often suffer the consequences as it relates to security and access to basic social services such as medical care. This is the situation in border communities in Nigeria where cross-border crimes are on the rife, thus, putting women at a disadvantaged position and, eventually, victims of such inimical activities. Border communities in the Saki/Iseyin area of Oyo state are a case in point where the lives of inhabitants are daily threatened most, especially women. In light of the above, this article examined the security situation of the Saki/Iseyin area of Oyo State with a view to ascertaining its status in terms of safety of lives and property. This paper also explored the experiences of women in the border communities within the area as it relates to their safety, the safety of their children, access to good health facilities in their immediate environment, and above all, how they have been able to cope or manage the situation. The qualitative research model was adopted utilizing a phenomenological case study approach. A Focused Group Discussion was conducted with 10 pregnant women and 10 mothers in Okerete and Abugudu communities while a Key Informant Interview was conducted with the women leaders in both communities of the Saki/Iseyin border area of Oyo State. The findings of the study revealed the poor state of basic infrastructure. So bad to a point that inhabitants of these communities no longer see themselves as Nigerians because they have been neglected by the government for too long. The only solution is for the government to embark on developmental projects within these communities so that they can live a good life just as those in the cities do. More importantly, this will increase the loyalty of these communities to the Nigeria state by defending and resisting all forms of cross-border criminal activities that go on along the porous borders.

Keywords: security, women, Saki/Iseyin border area, cross-border criminalities, basic infrastructure

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Authors: Guillaume Craveur

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This study shows the opportunity to use numerical tools dedicated to Fire Safety Engineering for the Rolling Stock. Indeed, some lawful requirements can now be demonstrated by using numerical tools. The first part of this study presents the use of modelling evacuation tool to satisfy the criteria of evacuation time for the rolling stock. The buildingEXODUS software is used to model and simulate the evacuation of rolling stock. Firstly, in order to demonstrate the reliability of this tool to calculate the complete evacuation time, a comparative study was achieved between a real test and simulations done with buildingEXODUS. Multiple simulations are performed to capture the stochastic variations in egress times. Then, a new study is done to calculate the complete evacuation time of a train with the same geometry but with a different interior architecture. The second part of this study shows some applications of Computational Fluid Dynamics. This work presents the approach of a multi scales validation of numerical simulations of standardized tests with Fire Dynamics Simulations software developed by the National Institute of Standards and Technology (NIST). This work highlights in first the cone calorimeter test, described in the standard ISO 5660, in order to characterize the fire reaction of materials. The aim of this process is to readjust measurement results from the cone calorimeter test in order to create a data set usable at the seat scale. In the second step, the modelisation concerns the fire seat test described in the standard EN 45545-2. The data set obtained thanks to the validation of the cone calorimeter test was set up in the fire seat test. To conclude with the third step, after controlled the data obtained for the seat from the cone calorimeter test, a larger scale simulation with a real part of train is achieved.

Keywords: fire safety engineering, numerical tools, rolling stock, multi-scales validation

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Authors: Vivian W. L. Tsang, Karen Lockhart, Samuel Spiegel, Annalee Yassi

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Background: Workers in the informal economy often incur exposure to well-documented occupational health hazards. Insufficient attention has been afforded to rigorously evaluating intervention programs to reduce the risks, especially in artisanal and small-scale gold mining (ASGM). Objectives: This systematic review, conducted as part of the World Health Organization’s Global Plan of Action for Workers’ Health, sought to assess the state of knowledge on occupational health programs and interventions for the informal artisanal and small-scale gold mining (ASGM) sector, an occupation which directly employs at least 50 million people. Methods: We used a comprehensive search strategy for four well-known databases relevant to health outcomes: PubMed, Engineering Village, OVID Medline, and Web of Science, and employed the PRISMA framework for our analysis. Findings: Ten studies met the inclusion criteria of a primary study focused on assessing the impact of interventions addressing occupational health concerns in ASGM. There were no studies evaluating or even identifying comprehensive occupational health and safety programs for this sector, although target interventions addressing specific hazards exist. Major areas of intervention –education and introduction of mercury-reducing/eliminating technology were identified, and the challenges and limitations of each intervention taken into the assessment. Even for these, however, there was a lack of standardization for measuring outcome or impact, let alone long-term health outcomes for miners and mining communities. Conclusion: There is an urgent need for research on comprehensive occupational health programs addressing the array of hazards faced by artisanal and small-scale miners.

Keywords: informal economy, artisanal and small-scale gold mining, occupational health, health and safety, workplace safety

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Authors: Raheel Shakoor Siddiqui, Sanjay Narayana Murthy, Manikandar Srinivas Cheruvu, Kash Akhtar

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Major trauma is a dynamic public health epidemic that is continuously evolving. Major trauma care services rely on multi-disciplinary team input involving highly trained pre and in-hospital critical care teams. Pre-hospital critical care teams (PHCCTs), major trauma centres (MTCs), trauma units, and rehabilitation facilities all form an efficient and organised trauma system. England comprises 27 MTCs funded by the National Health Service (NHS). Major trauma care entails enhanced resuscitation protocols coupled with the expertise of dedicated trauma teams and rapid radiological imaging to improve trauma outcomes. Literature reports a change in the demographic of major trauma as elderly patients (silver trauma) with injuries sustained from a fall of 2 metres or less commonly present to services. Evidence of an increasing population age with multiple comorbidities necessitates treatment within the first hour of injury (golden hour) to improve trauma survival outcomes. Staffing and funding pressures within the NHS have subsequently led to a shortfall of available physician-led PHCCTs. Thus, there is a strong emphasis on targeted research and funding to appropriately deploy resources to deprived areas. This review article will discuss the current English trauma system whilst critically appraising present challenges, identifying insufficiencies, and recommending aims for an improved future trauma system in England.

Keywords: trauma, orthopaedics, major trauma, trauma system, trauma network

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Authors: Giulia Bonaldo, Alberto Vaccheri, Ottavio D'Annibali, Domenico Motola

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The Human Papilloma Virus (HPV) was shown to be the cause of different types of carcinomas, first of all of the cervical intraepithelial neoplasia. Since the early 80s to today, thanks first to the preventive screening campaigns (pap-test) and following to the introduction of HPV vaccines on the market; the number of new cases of cervical cancer has decreased significantly. The HPV vaccines currently approved are three: Cervarix® (HPV2 - virus type: 16 and 18), Gardasil® (HPV4 - 6, 11, 16, 18) and Gardasil 9® (HPV9 - 6, 11, 16, 18, 31, 33, 45, 52, 58), which all protect against the two high-risk HPVs (6, 11) that are mainly involved in cervical cancers. Despite the remarkable effectiveness of these vaccines has been demonstrated, in the recent years, there have been many complaints about their risk-benefit profile due to Adverse Events Following Immunization (AEFI). The purpose of this study is to provide a support about the ongoing discussion on the safety profile of HPV vaccines based on real life data deriving from spontaneous reports of suspected AEFIs collected in the Vaccine Adverse Events Reporting System (VAERS). VAERS is a freely-available national vaccine safety surveillance database of AEFI, co-administered by the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA). We collected all the reports between January 2007 to December 2017 related to the HPV vaccines with a brand name (HPV2, HPV4, HPV9) or without (HPVX). A disproportionality analysis using Reporting Odds Ratio (ROR) with 95% confidence interval and p value ≤ 0.05 was performed. Over the 10-year period, 54889 reports of AEFI related to HPV vaccines reported in VAERS, corresponding to 224863 vaccine-event pairs, were retrieved. The highest number of reports was related to Gardasil (n = 42244), followed by Gardasil 9 (7212) and Cervarix (3904). The brand name of the HPV vaccine was not reported in 1529 cases. The two events more frequently reported and statistically significant for each vaccine were: dizziness (n = 5053) ROR = 1.28 (CI95% 1.24 – 1.31) and syncope (4808) ROR = 1.21 (1.17 – 1.25) for Gardasil. For Gardasil 9, injection site pain (305) ROR = 1.40 (1.25 – 1.57) and injection site erythema (297) ROR = 1.88 (1.67 – 2.10) and for Cervarix, headache (672) ROR = 1.14 (1.06 – 1.23) and loss of consciousness (528) ROR = 1.71 (1.57 – 1.87). In total, we collected 406 reports of death and 2461 cases of permanent disability in the ten-year period. The events consisting of incorrect vaccine storage or incorrect administration were not considered. The AEFI analysis showed that the most frequently reported events are non-serious and listed in the corresponding SmPCs. In addition to these, potential safety signals arose regarding less frequent and severe AEFIs that would deserve further investigation. This already happened with the referral of the European Medicines Agency (EMA) for the adverse events POTS (Postural Orthostatic Tachycardia Syndrome) and CRPS (Complex Regional Pain Syndrome) associated with anti-papillomavirus vaccines.

Keywords: adverse drug reactions, pharmacovigilance, safety, vaccines

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Authors: Zerihun Ketema Tadesse, Dabbu Suman Reddy

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Brain-Computer Interfaces (BCIs) give the possibility for disabled people to communicate and control devices. This work aims at developing steady-state visual evoked potential (SSVEP)-based BCI for patients with limb disabilities. In hospitals, devices like nurse emergency call devices, lights, and TV sets are what patients use most frequently, but these devices are operated manually or using the remote control. Thus, disabled patients are not able to operate these devices by themselves. Hence, SSVEP-based BCI system that can allow disabled patients to control nurse calling device and other devices is proposed in this work. Portable LED visual stimulator that flickers at specific frequencies of 7Hz, 8Hz, 9Hz and 10Hz were developed as part of this project. Disabled patients can stare at specific flickering LED of visual stimulator and Emotiv EPOC used to acquire EEG signal in a non-invasive way. The acquired EEG signal can be processed to generate various control signals depending upon the amplitude and duration of signal components. MATLAB software is used for signal processing and analysis and also for command generation. Arduino is used as a hardware interface device to receive and transmit command signals to the experimental setup. Therefore, this study is focused on the design and development of Steady-state visually evoked potential (SSVEP)-based BCI for limb disabled patients, which helps them to operate and control devices in the hospital room/wards.

Keywords: SSVEP-BCI, Limb Disabled Patients, LED Visual Stimulator, EEG signal, control devices, hospital room/wards

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Authors: Chalachew Kassaw, Henok Ababu, Bethelhem Sileshy, Lulu Abebe, Birhanie Mekuriaw

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Background: Psychological discomfort is a state of emotional distress caused by everyday stressors and obligations that are difficult to manage. Orthopedic trauma has a wide range of effects on survivors' physical health, as well as a variety of mental health concerns that impede recovery. Psychiatric and behavioral conditions are 3-5 times more common in people who have undergone physical trauma, and they are a predictor of poor outcomes. Despite the above facts, there is a shortage of research done on the subject. Therefore, this study aimed to determine the magnitude of psychological distress and associated factor among patients attending orthopedic treatment at Gedeo zone, South Ethiopia 2022. Methods: A cross-sectional study was undertaken at Dilla University Referral Hospital from October –November 2022. The data was collected via a face-to-face interview, and the Kessler psychological distress scale (K-10) was used to assess psychological distress. A total of 386 patients receiving outpatient and inpatient services at the orthopedic unit were chosen using a simple random selection technique. A Statistical Package for the Social Science version 21 (SPSS-21) was used to enter and evaluate the data. To find related factors, bivariate, and multivariate logistic regressions were used. Variables having a p-value of less than 0.05 were deemed statistically significant. Result: A total of 386 participants with a response rate of 94.8% were included in the study. Out of all respondents, 114 (31.4%) of the individuals have experienced psychological distress. Independent variables such as Females [Adjusted odds ratio (AOR)=5.8, 95%CI=(4.6-15.6)], Average monthly income of <3500 birrs [Adjusted odds ratio (AOR) =4.8, 95% CI=(2.4-9.8) ], Current history of substance use [Adjusted odds ratio (AOR) =2.6, 95% CI=(1.66-4.7)], Strong social support [Adjusted odds ratio (AOR)=0.4, 95% CI= 0.4(0.2-0.8)], and Poor sleep quality (PSQI score>5) [Adjusted odds ratio (AOR)=2.0, 95%CI= 2.0(1.2-2.8)] were significantly associated with psychological distress. Conclusion: The prevalence of psychological distress was high. Being female, having poor social support, and having a high PSQI score were significantly associated factors with psychological distress. It is good if clinicians emphasize orthopedic patients, especially females and those having poor social support and low sleep quality symptoms.

Keywords: psychological distress, orthopedic unit, Dilla University hospital, Dilla Town, Southern Ethiopia

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Authors: Mirjana Đ. Laban, Dragan N. Đurica, Nemanja M. Erceg

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Volunteer fire departments (VFD) in Serbia were established as civic associations in XIX Century. The founders and members of the first VFDs were prominent members of local communities. Today, those are volunteer organizations for preventing and extinguishing fires and rescuing people and property in various accidents. The paper presents the results of research about the number and resources of active VFDs done in Autonomous Province of Vojvodina, Serbia and about activities they perform today. The survey was done based on data provided by all registered VFDs in Vojvodina. Firefighters Association of Vojvodina includes 35 municipal firefighting associations, 230 volunteer fire departments with 5,300 active members in qualified fire units and more than 15,000 supporting members. Volunteer involvement is primarily an expression of high moral values and as such it has to be respected and stimulated. Better position of the volunteers would have a major impact on the formation of safety culture concept and general public awareness of fire safety and risk reduction, and therefore the security of the society as a whole. Volunteer fire departments make a significant contribution to educate young people and prevent catastrophic consequences of fires and natural disasters.

Keywords: education, prevention, rescue, volunteer fire departments

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Authors: Muhammad Waqas Baqai, Noman Shahzad, Rehman Alvi

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Communication among health care givers is the essence of quality patient care and any compromise results in errors and inefficiency leading to cumbersome outcomes. The use of smartphone among health professionals has increased tremendously. Almost every health professional carries it and majority of them uses a third party communication software called whatsApp for work related communications. It gives instant access to the person responsible for any particular query and therefore helps in efficient and timely decision making. It is also an easy way of sharing medical documents, multimedia and provides platform for consensual decision making through group discussions. However clinical communication through whatsApp has some demerits too including reduction in verbal communication, worsening professional relations, unprofessional behavior, risk of confidentiality breach and threats from cyber-attacks. On the other hand the traditional pager device being used in many health care systems is a unidirectional communication that lacks the ability to convey any information other than the number to which the receiver has to respond. Our study focused on these two widely used modalities of communication among doctors of the largest tertiary care center of Pakistan i.e. The Aga Khan University Hospital. Our aim was to note which modality is considered better and has fewer threats to medical data. Approval from ethical review committee of the institute was taken prior to conduction of this study. We submitted an online survey form to all the interns and residents working at our institute and collected their response in a month’s time. 162 submissions were recorded and analyzed using descriptive statistics. Only 20% of them were comfortable with using pagers exclusively, 52% with whatsApp and 28% with both. 65% think that whatsApp is time-saving and quicker than pager. 54% of them considered whatsApp to be causing nuisance from work related notifications in their off-work hours. 60% think that they are more likely to miss information through pager system because of the unidirectional nature. Almost all (96%) of residents and interns found whatsApp to be useful in terms of saving information for future reference. For urgent issues, majority (70%) preferred pager over whatsApp and also pager was considered more valid in terms of hospital policies and legal issues. Among major advantages of whatsApp as listed by them were; easy mass communication, sharing of clinical pictures, universal access and no need of carrying additional device. However the major drawback of using whatsApp for clinical communication that everyone shared was threat to patients’ confidentiality as clinicians usually share pictures of wounds, clinical documents etc. Lastly we asked them if they think there is a need of a separate application for instant communication dedicated to clinical communication only and 90% responded positively. Therefore, we concluded that both modalities have their merits and demerits but the greatest drawback with whatsApp is the risk of breach in patients’ confidentiality and off-work disturbance. Hence, we recommend a more secure, institute-run application for all intra hospital communications where they can share documents, pictures etc. easily under a controlled environment.

Keywords: WhatsApp, pager, clinical communication, confidentiality

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Authors: Pranab Kumar Goswami, Elena Gurung

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Small and medium enterprises (SME) are considered as the driving force for the economic growth of a developing country like India. Most of the SMEs are located in residential/non-industrial areas to avoid legal obligations of occupational safety and health (OSH) provisions. This study was conducted in Delhiwith a view to analyze the accidents that occurredduringthe year 2019 & 2020. The objective of the study was to find out the accident prone SMEs in Delhi and major causes of such accidents. Methods: Survey and comprehensive data analysis methods, followed by applying simple statistical techniques, were used for this study. The accident reports for the study period collected from the labour department and police stations were analyzed for the study. The injured workers were interviewed to ascertain safety compliances, training and awareness programs, etc. The study was completed in March2021. Results: It was found that most of the accidents took place in SMEs located in residential/non- industrial areas in Delhi. The accident-prone machines were found to be power presses (42%) and injection moulding machines (37%). Predominantly unsafe machinery or unsafe working conditions and lack of training of worker were observed to be the major causes of accidents in such industries. Conclusions: It was concluded from the study that unsafe machinery/equipment and lack of proper training to the workers were two main reasons for increase in accidents.It was also concluded that the industries located in industrial areas were better placed in terms of workplace compliances. The managements who were running their operations from residential/non-industrial areaswere found to be less aware on health and safety issues. Lack of enforcement by government agencies in such areas has escalated this problem. Adequate training to workers, managing safe & healthy workplace, and sustained enforcement can reduce accidents in such industries.

Keywords: SME, accident prevention, cause of accident, unorganised

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Authors: Ganga K. V. Prakhya, V. Karthigeyan

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The paper describes the influences of the fluid and structure interaction in concrete structures that support large oil platforms in the North Sea. The dynamic interaction of the fluid both in 2D and 3D are demonstrated through a Computational Fluid Dynamics analysis in the event of explosion following a gas leak inside of the concrete column. The structural response characteristics of the column in water under dynamic conditions are quite complex involving axial, radial and circumferential modes. Fluid structure interaction (FSI) modelling showed that there are some frequencies of the column in water which are not found for a column in air. For example, it was demonstrated that one of the axial breathing modes can never be simulated without the use of FSI models. The occurrence of a shift in magnitude and time of pressure from explosion following gas leak along the height of the shaft not only excited the modes of vibration involving breathing (axial), bending and squashing (radial) modes but also magnified the forces in the column. FSI models revealed that dynamic effects resulted in dynamic amplification of loads. The results are summarized from a detailed study that was carried out by the first author for the Offshore Safety Division of Health & Safety Executive United Kingdom.

Keywords: concrete, explosion, fluid structure interaction, offshore structures

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Authors: Mira Filali, Amar Nechnech

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Most landslides in Algiers take place in Piacenzian marls of the Sahel (port in Arabic) and cause severe damage to properties and infrastructures. The aim of this paper is to describe the results of experimental as well as theoretical analysis of landslides. In order to understand the process which caused this slope instabilities, the results of geotechnical investigation carried out by the laboratory of construction (LNHC) laboratory in the area of Dounia park were analyzed, including particle size distribution, Atterberg limits, shear strength, odometer and pressuremeter tests. The study shows that the soils exhibited a high capacity to swelling according to index plasticity and clay content. Highs limit liquidity (LL) (53.45%) means that the soils are susceptible to landslides. The stability analysis carried out using finite element method, shows that the slope is stable (Fs > 1) in dry condition and in static state. Despite this results, the stable site could be described as only conditionally stable because slope failure can occur under combined effect of different factors. In fact the safety factor obtained by applying load when the phreatic surface is at ground, less than 1.5.

Keywords: index properties, landslides, safety factor, slope stability

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Authors: James Semmens, James Boyd, Anna Ferrante, Katrina Spilsbury, Sean Randall, Adrian Brown

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‘Big data’ is a relatively new concept that describes data so large and complex that it exceeds the storage or computing capacity of most systems to perform timely and accurate analyses. Health services generate large amounts of data from a wide variety of sources such as administrative records, electronic health records, health insurance claims, and even smart phone health applications. Health data is viewed in Australia and internationally as highly sensitive. Strict ethical requirements must be met for the use of health data to support health research. These requirements differ markedly from those imposed on data use from industry or other government sectors and may have the impact of reducing the capacity of health data to be incorporated into the real time demands of the Big Data environment. This ‘big data revolution’ is increasingly supported by national governments, who have invested significant funds into initiatives designed to develop and capitalize on big data and methods for data integration using record linkage. The benefits to health following research using linked administrative data are recognised internationally and by the Australian Government through the National Collaborative Research Infrastructure Strategy Roadmap, which outlined a multi-million dollar investment strategy to develop national record linkage capabilities. This led to the establishment of the Population Health Research Network (PHRN) to coordinate and champion this initiative. The purpose of the PHRN was to establish record linkage units in all Australian states, to support the implementation of secure data delivery and remote access laboratories for researchers, and to develop the Centre for Data Linkage for the linkage of national and cross-jurisdictional data. The Centre for Data Linkage has been established within Curtin University in Western Australia; it provides essential record linkage infrastructure necessary for large-scale, cross-jurisdictional linkage of health related data in Australia and uses a best practice ‘separation principle’ to support data privacy and security. Privacy preserving record linkage technology is also being developed to link records without the use of names to overcome important legal and privacy constraint. This paper will present the findings of the first ‘Proof of Concept’ project selected to demonstrate the effectiveness of increased record linkage capacity in supporting nationally significant health research. This project explored how cross-jurisdictional linkage can inform the nature and extent of cross-border hospital use and hospital-related deaths. The technical challenges associated with national record linkage, and the extent of cross-border population movements, were explored as part of this pioneering research project. Access to person-level data linked across jurisdictions identified geographical hot spots of cross border hospital use and hospital-related deaths in Australia. This has implications for planning of health service delivery and for longitudinal follow-up studies, particularly those involving mobile populations.

Keywords: data integration, data linkage, health planning, health services research

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Authors: Ma Chaoyang

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With the acceleration of urbanization, old communities are facing renewal problems such as an aging material environment, declining living quality, and insufficient resilience. The once glorious old communities have become the most vulnerable areas in the city. Through a re-understanding of the ‘disaster chain’ and resilient communities, it is believed that considering the construction of resilient communities during community renewal is of great significance for promoting the sustainable development of communities. This article proposes renewal strategies for old communities based on the concept of preventing the occurrence of disaster chains. After analyzing the main demand characteristics of old communities, it proposes a reflection on improving community spatial safety resilience based on the ‘broken chain’ concept. In the four stages of ‘pre-disaster, mid-disaster, and post-disaster’, it elaborates that considering the occurrence of disaster chain in community renewal is the main content of research on spatial safety resilience construction and clarifies that community resilience is the idea and principle of responding with the process of disaster chain. The study focuses on the four dimensions of ‘pre-disaster, mid-disaster, and post-disaster’. This can provide ideas and references for resilience construction in community updates.

Keywords: community updates, disaster chain concept, community resilience, space environment

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Authors: Recep Kesli, Cengiz Demir, Onur Turkyilmaz, Hayriye Tokay

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Objective: Gram-negative rods are a large group of bacteria, and include many families, genera, and species. Most clinical isolates belong to the family Enterobacteriaceae. Resistance due to the production of extended-spectrum β-lactamases (ESBLs) is a difficulty in the handling of Enterobacteriaceae infections, but other mechanisms of resistance are also emerging, leading to multidrug resistance and threatening to create panresistant species. We aimed in this study to evaluate resistance rates of Gram-negative rods bacteria isolated from clinical specimens in Microbiology Laboratory, Afyon Kocatepe University, ANS Research and Practice Hospital, between October 2012 and September 2015. Methods: The Gram-negative rods strains were identified by conventional methods and VITEK 2 automated identification system (bio-Mérieux, Marcy l’etoile, France). Antibiotic resistance tests were performed by both the Kirby-Bauer disk-diffusion and automated Antimicrobial Susceptibility Testing (AST, bio-Mérieux, Marcy l’etoile, France) methods. Disk diffusion results were evaluated according to the standards of Clinical and Laboratory Standards Institute (CLSI). Results: Of the totally isolated 1.701 Enterobacteriaceae strains 1434 (84,3%) were Klebsiella pneumoniae, 171 (10%) were Enterobacter spp., 96 (5.6%) were Proteus spp., and 639 Nonfermenting gram negatives, 477 (74.6%) were identified as Pseudomonas aeruginosa, 135 (21.1%) were Acinetobacter baumannii and 27 (4.3%) were Stenotrophomonas maltophilia. The ESBL positivity rate of the totally studied Enterobacteriaceae group were 30.4%. Antibiotic resistance rates for Klebsiella pneumoniae were as follows: amikacin 30.4%, gentamicin 40.1%, ampicillin-sulbactam 64.5%, cefepime 56.7%, cefoxitin 35.3%, ceftazidime 66.8%, ciprofloxacin 65.2%, ertapenem 22.8%, imipenem 20.5%, meropenem 20.5 %, and trimethoprim-sulfamethoxazole 50.1%, and for 114 Enterobacter spp were detected as; amikacin 26.3%, gentamicin 31.5%, cefepime 26.3%, ceftazidime 61.4%, ciprofloxacin 8.7%, ertapenem 8.7%, imipenem 12.2%, meropenem 12.2%, and trimethoprim-sulfamethoxazole 19.2 %. Resistance rates for Proteus spp. were: 24,3% meropenem, 26.2% imipenem, 20.2% amikacin 10.5% cefepim, 33.3% ciprofloxacin and levofloxacine, 31.6% ceftazidime, 20% ceftriaxone, 15.2% gentamicin, 26.6% amoxicillin-clavulanate, and 26.2% trimethoprim-sulfamethoxale. Resistance rates of P. aeruginosa was found as follows: Amikacin 32%, gentamicin 42 %, imipenem 43%, merpenem 43%, ciprofloxacin 50%, levofloxacin 52%, cefepim 38%, ceftazidim 63%, piperacillin/tacobactam 85%, for Acinetobacter baumannii; Amikacin 53.3%, gentamicin 56.6 %, imipenem 83%, merpenem 86%, ciprofloxacin 100%, ceftazidim 100%, piperacillin/tacobactam 85 %, colisitn 0 %, and for S. malthophilia; levofloxacin 66.6 % and trimethoprim/sulfamethoxozole 0 %. Conclusions: This study showed that resistance in Gram-negative rods was a serious clinical problem in our hospital and suggested the need to perform typification of the isolated bacteria with susceptibility testing regularly in the routine laboratory procedures. This application guided to empirical antibiotic treatment choices truly, as a consequence of the reality that each hospital shows different resistance profiles.

Keywords: antibiotic resistance, gram negative rods, ESBL, VITEK 2

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Authors: Mauro Masili, Liliane Ventura

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It is still controversial in the literature the ultraviolet (UV) radiation effects on the ocular media, but the World Health Organization has established safe limits on the exposure of eyes to UV radiation based on reports in literature. Sunglasses play an important role in providing safety, and their lenses should provide adequate UV filters. Regarding UV protection for ocular media, the resistance-to-irradiance test for sunglasses under many national standards requires irradiating lenses for 50 uninterrupted hours with a 450 W solar simulator. This artificial aging test may provide a corresponding evaluation of exposure to the sun. Calculating the direct and diffuse solar irradiance at a vertical surface and the corresponding radiant exposure for the entire year, we compare the latter with the 50-hour radiant exposure of a 450 W xenon arc lamp from a solar simulator required by national standards. Our calculations indicate that this stress test is ineffective in its present form. We provide evidence of the need to re-evaluate the parameters of the tests to establish appropriate safe limits against UV radiation. This work is potentially significant for scientists and legislators in the field of sunglasses standards to improve the requirements of sunglasses quality and safety.

Keywords: ISO 12312-1, solar simulator, sunglasses standards, UV protection

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Authors: D. Bheenick, M. Young, M.Elmussareh, A.Ali

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Objective: Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the UK. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the UK. Patient and methods: Retrospective data of patients presenting acutely to the urology department was collected between 13th January to 22nd March 2020 (pre-lockdown period) and 23rd March to 31st May 2020 (lockdown period). The nature of referrals, types of admission encountered, and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown. Results: 1092 patients were included in the study. An overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age. Conclusion: The admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.

Keywords: COVID-19, lockdown, admissions, urology

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Authors: Shantanu Prakash, Suruchi Shukla, Amita Jain

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Introduction: The hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease. Injection drug use and individuals receiving blood and blood products are the primary modes of HCV transmission. Our study aims to establish the prevalent genotypes/ subtypes of HCV circulating in Uttar Pradesh, North India, as reported from a tertiary care hospital. Methods: It is a retrospective observational analysis of consecutive 404 HCV RNA positive cases referred to our hospital during September 2014 to April 2017. The study was approved by an institutional ethics committee. Written informed consent was taken from each participant. Clinical and demographic details of these patients were recorded using predesigned questionnaires. All the laboratory testing was carried on stored serum sample of enrolled cases. Genotyping of all 404 strains was done by Sanger’s sequencing of the core region. The phylogenetic analysis of 179 HCV strains with high -quality sequencing data was performed. Results: The distribution of prevalent genotypes/ subtypes as noted in the present study was; Genotype (GT)1a [n-101(25%)], GT1b [n-12(2.9%)], GT1c [1(0.25%)], GT3a [275(68.07%)], GT3b [9(2.2%)], GT3g [2(0.49%)], GT3i [3(0.74%)], and GT4a [1(0.24%)]. HCV genotypes GT2, GT5 and GT6 were not detected from our region. Sequence analysis showed high genotypic variability in HCV GT3. Phylogenetic analysis showed that HCV GT3 and GT1 circulating in our region were related to Indian strains reported earlier. Conclusions: HCV genotypes 3a and 1a are commonest circulating genotypes in Uttar Pradesh (UP), India.

Keywords: Hepatitis C virus, genetic variation, bioinformatics, genotype, HCV

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Authors: Rahil Sahragard, Mahmoud Hatami, Rostam Bahadori Khalili

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Diabetes is one of the most important health problems in the world and a chronic disease requiring continuous care and therefore, it is necessary for patients to undergo self-care and nutrition education. This study was conducted to evaluate the effect of nutrition education on the metabolic control of diabetic patients in Tehran in 2015. An experimental study was conducted on 100 patients who had previously been approved by a specialist physician for diabetes and at least one year after their onset. At first, patients without any knowledge of the educational program were selected as sample and from them a checklist containing demographic and specific information about diabetes was filled and were taken three fasting blood glucose and three times fasting blood glucose (5 p.m.) Then, the patients received face-to-face training in the same conditions for 2 weeks in a Mehregan hospital of Tehran, and received 3 months of training, while they were fully monitored and during this time, samples that had a cold or blood pressure-related disease or were admitted to the hospital were excluded from the study. After the end of the study, the checklist was filled again and 3 fasting blood glucose and 3 fasting blood glucose samples were taken, the results were statistically analyzed by MC Nemar's statistical test. The research findings were performed on 100 patients 41.7% male and 58.3% women, the range of age was between 22 and 60 years old, with a duration of diabetes ranging from 1 to 15 years. Abnormal fasting blood glucose from 95% to 48.3% (P <0.0001) and non-fasting blood glucose decreased from 91.6% to 71.2% (P <0.001). Research has shown that training on blood glucose control has been successful, therefore, it is recommended that more research is done in the field of education to help patients with diabetes more comfortable.

Keywords: nutrition education, diabetes, function, insulin, chronic, metabolic control

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Authors: Reihaneh Mahdavishahri

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This paper provides a brief introduction to emotionally focused therapy (EFT) and its culturally sensitive and informed application when working with immigrant couples. EFT's grounding in humanistic psychology prioritizes a non-pathologizing and empathic understanding of individuals' experiences, creating a safe space for couples to explore and create new experiences without imposing judgment or prescribing the couple "the right way of interacting" with one another. EFT's emphasis on attachment, bonding, emotions, and corrective emotional experiences makes it a fitting approach to work with multicultural couples, allowing for the corrective emotional experience to be shaped and informed by the couples' unique cultural background. This paper highlights the challenges faced by immigrant couples and explores how immigration adds a complex layer to each partner’s sense of self, their attachment bond, and their sense of safety and security within their relationships. Navigating a new culture, creating a shared sense of purpose, and re-establishing emotional bonds can be daunting for immigrant couples, often leading to a deep sense of disconnection and vulnerability. Reestablishing and fostering secure attachment between the partners in the safety of the therapeutic space can be a protective factor for these couples.

Keywords: attachment, culturally informed care, emotionally focused therapy, immigration

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