Search results for: prosthetic socket relief areas

Authors: Linara Salikhova, Elmira Nizamova, Aleksandra Katasonova, Gleb Vitkov, Olga Sarapulova.

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While most European cities conduct research on heat-related risks, there is a research gap in the Caucasus region, particularly in Yerevan, Armenia. This study aims to test the method of establishing a correlation between urban heat islands (UHI) and urban greenery distribution for prioritization of heat-vulnerable areas for revegetation. Armenia has failed to consider measures to mitigate UHI in urban development strategies despite a 2.1°C increase in average annual temperature over the past 32 years. However, planting vegetation in the city is commonly used to deal with air pollution and can be effective in reducing UHI if it prioritizes heat-vulnerable areas. The research focuses on establishing such priorities while considering the distribution of urban greenery across the city. The lack of spatially explicit air temperature data necessitated the use of satellite images to achieve the following objectives: (1) identification of land surface temperatures (LST) and quantification of temperature variations across districts; (2) classification of massifs of land surface types using normalized difference vegetation index (NDVI); (3) correlation of land surface classes with LST. Examination of the heat-vulnerable city areas (in this study, the proportion of individuals aged 75 years and above) is based on demographic data (Census 2011). Based on satellite images (Sentinel-2) captured on June 5, 2021, NDVI calculations were conducted. The massifs of the land surface were divided into five surface classes. Due to capacity limitations, the average LST for each district was identified using one satellite image from Landsat-8 on August 15, 2021. In this research, local relief is not considered, as the study mainly focuses on the interconnection between temperatures and green massifs. The average temperature in the city is 3.8°C higher than in the surrounding non-urban areas. The temperature excess ranges from a low in Norq Marash to a high in Nubarashen. Norq Marash and Avan have the highest tree and grass coverage proportions, with 56.2% and 54.5%, respectively. In other districts, the balance of wastelands and buildings is three times higher than the grass and trees, ranging from 49.8% in Quanaqer-Zeytun to 76.6% in Nubarashen. Studies have shown that decreased tree and grass coverage within a district correlates with a higher temperature increase. The temperature excess is highest in Erebuni, Ajapnyak, and Nubarashen districts. These districts have less than 25% of their area covered with grass and trees. On the other hand, Avan and Norq Marash districts have a lower temperature difference, as more than 50% of their areas are covered with trees and grass. According to the findings, a significant proportion of the elderly population (35%) aged 75 years and above reside in the Erebuni, Ajapnyak, and Shengavit neighborhoods, which are more susceptible to heat stress with an LST higher than in other city districts. The findings suggest that the method of comparing the distribution of green massifs and LST can contribute to the prioritization of heat-vulnerable city areas for revegetation. The method can become a rationale for the formation of an urban greening program.

Keywords: heat-vulnerability, land surface temperature, urban greenery, urban heat island, vegetation

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Authors: Jhonnatan Eduardo Zamudio Palacios, Oscar Leonardo Mosquera Dussan, Daniel Guzman Perez, Daniel Alfonso Botero Rosas, Oscar Fabian Rubiano Espinosa, Jose Antonio Garcia Torres, Ivan Dario Chavarro, Ivan Ramiro Rodriguez Camacho, Jaime Orlando Rodriguez

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The training of cilsitas with some type of disability finds in the technological development an indispensable ally, generating every day advances to contribute to the quality of life allowing to maximize the capacities of the athletes. The performance of a cyclist depends on physiological and biomechanical factors, such as aerodynamic profile, bicycle measurements, connecting rod length, pedaling systems, type of competition, among others. This study particularly focuses on the description of the dynamic model of a transtibial prosthesis for Paralympic cyclists. To make the model, two points are chosen: in the radius centers of rotation of the plate and pinion of the track bicycle. The parametric scheme of the track bike represents a model of 6 degrees of freedom due to the displacement in X - Y of each of the reference points of the angles of the curve profile β, cant of the velodrome α and the angle of rotation of the connecting rod φ. The force exerted on the crank of the bicycle varies according to the angles of the curve profile β, the velodrome cant of α and the angle of rotation of the crank φ. The behavior is analyzed through the Matlab R2015a software. The average strength that a cyclist exerts on the cranks of a bicycle is 1,607.1 N, the Paralympic cyclist must perform a force on each crank about 803.6 N. Once the maximum force associated with the movement has been determined, it is continued to the dynamic modeling of the transtibial prosthesis that represents a model of 6 degrees of freedom with displacement in X - Y in relation to the angles of rotation of the hip π, knee γ and ankle λ. Subsequently, an analysis of the kinematic behavior of the prosthesis was carried out by means of SolidWorks 2017 and Matlab R2015a, which was used to model and analyze the variation of the hip angles π, knee γ and ankle of the λ prosthesis. The reaction forces generated in the prosthesis were performed on the ankle of the prosthesis, performing the summation of forces on the X and Y axes. The same analysis was then applied to the tibia of the prosthesis and the socket. The reaction force of the parts of the prosthesis varies according to the hip angles π, knee γ and ankle of the prosthesis λ. Therefore, it can be deduced that the maximum forces experienced by the ankle of the prosthesis is 933.6 N on the X axis and 2.160.5 N on the Y axis. Finally, it is calculated that the maximum forces experienced by the tibia and the socket of the transtibial prosthesis in high performance competitions is 3.266 N on the X axis and 1.357 N on the Y axis. In conclusion, it can be said that the performance of the cyclist depends on several physiological factors, linked to biomechanics of training. The influence of biomechanical factors such as aerodynamics, bicycle measurements, connecting rod length, or non-circular pedaling systems on the cyclist performance.

Keywords: biomechanics, dynamic model, paralympic cyclist, transtibial prosthesis

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Authors: María Dolores Caro, Eugenio M. Fedriani, Ángel F. Tenorio

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When lorries transport dangerous goods, there exist some legal stipulations in the European Union for assuring the security of the rest of road users as well as of those goods being transported. At this respect, lorry drivers cannot park in usual parking areas, because they must use parking areas with special conditions, including permanent supervision of security personnel. Moreover, drivers are compelled to satisfy additional regulations about resting and driving times, which involve in the practical possibility of reaching the suitable parking areas under these time parameters. The “European Agreement concerning the International Carriage of Dangerous Goods by Road” (ADR) is the basic regulation on transportation of dangerous goods imposed under the recommendations of the United Nations Economic Commission for Europe. Indeed, nowadays there are no enough parking areas adapted for dangerous goods and no complete study have suggested the best locations to build new areas or to adapt others already existing to provide the areas being necessary so that lorry drivers can follow all the regulations. The goal of this paper is to show how many additional parking areas should be built in the Iberian Peninsula to allow that lorry drivers may park in such areas under their restrictions in resting and driving time. To do so, we have modeled the problem via graph theory and we have applied a new efficient algorithm which determines an optimal solution for the problem of locating new parking areas to complement those already existing in the ADR for the Iberian Peninsula. The solution can be considered minimal since the number of additional parking areas returned by the algorithm is minimal in quantity. Obviously, graph theory is a natural way to model and solve the problem here proposed because we have considered as nodes: the already-existing parking areas, the loading-and-unloading locations and the bifurcations of roads; while each edge between two nodes represents the existence of a road between both nodes (the distance between nodes is the edge's weight). Except for bifurcations, all the nodes correspond to parking areas already existing and, hence, the problem corresponds to determining the additional nodes in the graph such that there are less up to 100 km between two nodes representing parking areas. (maximal distance allowed by the European regulations).

Keywords: dangerous goods, parking areas, Iberian peninsula, graph-based modeling

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Authors: Mary Abigail T. Ty, Mary Jocelyn Yu-Laygo, Jocelyn Z. Mariano

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This is a case of L.S.T., a 61 year old, G6P4 (3124) who presented with a one month history of intermittent, brownish, watery, non foul smelling vaginal discharge. There were no other accompanying symptoms. On rectovaginal examination, a palpable adnexal mass on the left was appreciated, with the lower border measuring 3 cm. The mass was non-tender, had irregular borders and solid areas. On transvaginal sonography, it revealed a left pelvic mass measuring 3 x 4 x 2 cm, with a Sassone score of 9. It had vascularization. The primary consideration was Ovarian Newgrowth, probably malignant in nature. CA-125 results were slightly elevated at 43.2 u/ml (NV: 0-35 u/ml). After intraoperative evaluation, the left fallopian tube was converted into a 9 x 4.5 x 3 cm bulbous cystic mass with solid areas. On cut section, the ampullary portion of the fallopian tube contained necrotic and friable looking tissues. Specimen was sent for frozen section and results revealed adenocarcinoma of the left fallopian tube. Patient subsequently underwent complete surgical staging with unremarkable post-operative course. The Surg Ico pathologic diagnosis was G6P4 (3124) Fallopian tube serous cystadenocarcinoma stage 1. The mean incidence of PFTC is 3.6 per million women yearly. This is associated with a generally low survival rate. The primary diagnosis is very difficult to establish because only 0–10% of patients suffering from PFTC are diagnosed pre-operatively. Symptoms play a very important role in the discovery of this disease, because there will be no presentation to the hospital without symptoms. The most common of which may be vaginal bleeding, abdominal pain, a palpable mass and ascites. A conglomerate of manifestations may be encountered, but not at all times. This is termed hydrops tubae profluens where there is presence of colicky pain with relief from intermittent passage of serosanguinous vaginal discharge. The significance of this report is to emphasize the rarity of the case and how the dilemma in the diagnosis is almost always present despite ancillary procedures.

Keywords: fallopian tube carcinoma, prognosis, rare, risk factors

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Authors: Carol Cameletti

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The goal of this study was to perform a pilot survey to assess pain frequency and intensity in an elderly population and to assess treatment options for chronic pain that include complementary and alternative medicines (CAM). Ten participants were recruited from an independent and supportive living housing facility in Northern Ontario and asked to complete two questionnaires: 1) a self-assessment on pain, and 2) the use of CAM for pain. Results from our study show that 80% of the participants experienced pains other than the regular everyday pains such as minor headaches, sprains or toothaches. Although participants stated that on average the highest level of pain they experienced within the past 24 hours had a score of 6.5 (0=no pain, 10=worst pain imaginable) the level of pain they experienced moderately interfered with their daily activities. Unfortunately, participants stated that they were only able to attain minimal levels of pain relief using treatments or medications causing some of the participants to seek alternative therapies or self-help practices. The most commonly used CAMs were vitamins/minerals, herbs and supplements, and self-help practices such as meditation, prayer, visualization and relaxation techniques. Although some of the participants stated that they had received complementary treatments directly from their physician, four of the nine participants said that they had not disclosed CAM use to their physician thereby indicating a need to open the lines of communication between healthcare providers and patients with regards to CAM use. It is our hope that the data generated from this study will serve as the platform for a pain management clinic that is client-centered, consumer-driven and truly integrative and tailored in order to meet the unique needs of older adults in Great Sudbury, Ontario.

Keywords: alternative, complementary, elderly, medicine

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Authors: Matthew Arnaouti, Michael Baird, Gabrielle Cahill, Tamara Worlton, Michelle Joseph

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Introduction: Over ten years after the 7.0 magnitude Earthquake struck the capital of Haiti, impacting over three million people and leading to the deaths of over two hundred thousand, the multinational humanitarian response remains the largest disaster relief effort to date. This study critically evaluates the multi-sector and multinational disaster response to the Earthquake, looking at how the lessons learned from this analysis can be applied to future disaster response efforts. We put particular emphasis on assessing the interaction between civilian and military sectors during this humanitarian relief effort, with the hopes of highlighting how concrete guidelines are essential to improve future responses. Methods: An extensive scoping review of the relevant literature was conducted - where library scientists conducted reproducible, verified systematic searches of multiple databases. Grey literature and hand searches were utilised to identify additional unclassified military documents, for inclusion in the study. More than 100 documents were included for data extraction and analysis. Key domains were identified, these included: Humanitarian and Military Response, Communication, Coordination, Resources, Needs Assessment and Pre-Existing Policy. Corresponding information and lessons-learned pertaining to these domains was then extracted - detailing the barriers and facilitators to an effective response. Results: Multiple themes were noted which stratified all identified domains - including the lack of adequate pre-existing policy, as well as extensive ambiguity of actors’ roles. This ambiguity was continually influenced by the complex role the United States military played in the disaster response. At a deeper level, the effects of neo-colonialism and concern about infringements on Haitian sovereignty played a substantial role at all levels: setting the pre-existing conditions and determining the redevelopment efforts that followed. Furthermore, external factors significantly impacted the response, particularly the loss of life within the political and security sectors. This was compounded by the destruction of important infrastructure systems - particularly electricity supplies and telecommunication networks, as well as air and seaport capabilities. Conclusions: This study stands as one of the first and most comprehensive evaluations, systematically analysing the civilian and military response - including their collaborative efforts. This study offers vital information for improving future combined responses and provides a significant opportunity for advancing knowledge in disaster relief efforts - which remains a more pressing issue than ever. The categories and domains formulated serve to highlight interdependent factors that should be applied in future disaster responses, with significant potential to aid the effective performance of humanitarian actors. Further studies will be grounded in these findings, particularly the need for greater inclusion of the Haitian perspective in the literature, through additional qualitative research studies.

Keywords: civilian and military collaboration, combined response, disaster, disaster response, earthquake, Haiti, humanitarian response

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Authors: Congrui Chen

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The European Court of Human Rights (hereinafter ECtHR) delivered its judgment of just satisfaction on the case of Cyprus v. Turkey, ordering a lump sum of 9,000,000 euros as the just compensation. It is the first time that the ECtHR applied the Article 41 of just compensation in an inter-state case, and it stands as the highest amount of just compensation awarded in the history of the ECtHR. The Cyprus v. Turkey case, which represents the most crucial contribution to European peace in the history of the court. This thesis uses the methodologies of textual research, comparison analysis, and case law study to go further on the following two questions specifically:(i) whether the just compensation is applicable in an inter-state case; (ii) whether such just compensation is of punitive nature. From the point of view of general international law, the essence of the case is the state's responsibility for the violation of individual rights. In other words, the state takes a similar diplomatic protection approach to seek relief. In the course of the development of international law today, especially with the development of international human rights law, States that have a duty to protect human rights should bear corresponding responsibilities for their violations of international human rights law. Under the specific system of the European Court of Human Rights, the just compensation for article 41 is one of the specific ways of assuming responsibility. At the regulatory level, the European Court of Human Rights makes it clear that the just satisfaction of article 41 of the Convention does not include punitive damages, as it relates to the issue of national sovereignty. Nevertheless, it is undeniable that the relief to the victim and the punishment to the responsible State are two closely integrated aspects of responsibility. In other words, compensatory compensation has inherent "punitive".

Keywords: European Court of Human Right, inter-state cases, just satisfaction, punitive damages

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Authors: Keden Montgomery, Kathie Ardzejewska, Alison Casey, Rosemarie Hogan

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Research was undertaken to explore the question “what is known about the experiences of regional, rural and remote Australian women undertaking a Bachelor of Nursing program delivered online?”. The findings will support future research aimed at improving the retention and completion rates of women studying nursing in regional, rural and remote areas.  There is a critical shortage of nurses working in regional, rural and remote (RRR) Australia. It is well supported that this shortage of nurses is most likely to be addressed by nursing students who are completing their studies in RRR areas. Despite this, students from RRR Australia remain an equity group and experience poorer outcomes than their metropolitan counterparts. Completion rates for RRR students who enrol in tertiary education courses are much less than students from metropolitan areas. In addition to this, RRR students are less likely than students from metropolitan areas to gain a tertiary level qualification at all, and even less likely to gain a Bachelor level degree which is required for Registered Nurses. Supporting students to remain in regional, rural and remote areas while they study reduces the need for students to relocate to metropolitan areas and to continue living and working in RRR areas after graduation. This research holds implications for workforce shortages internationally.

Keywords: nurse education, online education, regional, rural, remote, workforce

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Authors: Matthew Holland, Jason Everett, Martin Cox, Iain Suthers

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High spatial-resolution distribution of planktivorous reef fish can reveal behavioural adaptations to optimise the balance between feeding success and predator avoidance. We used a multi-beam echosounder to record bathymetry and the three-dimensional distribution of fish schools associated with natural and artificial reefs. We utilised generalised linear models to assess the distribution, orientation, and aggregation of fish schools relative to the structure, vertical relief, and currents. At artificial reefs, fish schooled more closely to the structure and demonstrated a preference for the windward side, particularly when exposed to strong currents. Similarly, at natural reefs fish demonstrated a preference for windward aspects of bathymetry, particularly when associated with high vertical relief. Our findings suggest that under conditions with stronger current velocity, fish can exercise their preference to remain close to structure for predator avoidance, while still receiving an adequate supply of zooplankton delivered by the current. Similarly, when current velocity is low, fish tend to disperse for better access to zooplankton. As artificial reefs are generally deployed with the goal of creating productivity rather than simply attracting fish from elsewhere, we advise that future artificial reefs be designed as semi-linear arrays perpendicular to the prevailing current, with multiple tall towers. This will facilitate the conversion of dispersed zooplankton into energy for higher trophic levels, enhancing reef productivity and fisheries.

Keywords: artificial reef, current, forage fish, multi-beam, planktivorous fish, reef fish, schooling

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Authors: Davie G. Dave, Prisca H. Mugabe, Tonderai Mutibvu

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Globally, HWCs are on the rise. Such is the case with urban areas in Zimbabwe, yet little has been documented about it. This study was done to provide insights into the occurrence of human-wildlife conflicts in urban areas. The study was carried out in Harare, Bindura, Masvingo, Beitbridge, and Chiredzi to determine the cause, nature, extent, and frequency of occurrence of HWC, to determine the key wildlife species involved in conflicts and management practices done to combat wildlife conflicts in these areas. Several sampling techniques encompassing multi-stage sampling, stratified random, purposive, and simple random sampling were employed for placing residential areas into three strata according to population density, selecting residential areas, and selecting actual participants. Data were collected through a semi-structured questionnaire and key informant interviews. The results revealed that property destruction and crop damage were the most prevalent conflicts. Of the 15 animals that were cited, snakes, baboons, and monkeys were associated with the most conflicts. The occurrence of HWCs was mainly attributed to the increase in both animal and human populations. To curtail these HWCs, the local people mainly used non-lethal methods, whilst lethal methods were used by authorities for some of the reported cases. The majority of the conflicts were seasonal and less severe. There were growing concerns by respondents on the issues of wildlife conflicts, especially in those areas that had primates, such as Warren Park in Harare and Limpopo View in Beitbridge. There are HWCs hotspots in urban areas, and to ameliorate this, suggestions are that there is a need for a multi-action approach that includes general awareness campaigns on HWCs and land use planning that involves the creation of green spaces to ease wildlife management.

Keywords: human-wildlife conflicts, mitigation measures, residential areas, types of conflicts, urban areas

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Authors: Jyoti Singh, Ahmed Stifi, Sascha Gentes

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The process of construction significantly contributes to high level of risks, complexity and uncertainties leading to cost and time overrun, customer dissatisfaction etc. lean construction is important as it is a comprehensive system of tools and concepts focusing on moving closer to customer satisfaction by understanding the process, identifying the waste and eliminating it. The proposed work includes identification of knowledge areas from lean perspective, lean tools/concepts used in lean construction and establishing a relationship matrix between knowledge areas and lean tools/concepts, thus developing and building up a lean construction body of knowledge (LCBOK), i.e. a guide to lean construction, aiming to provide guidelines to manage individual projects and also helping construction industry to minimise waste and maximize value to the customer. In this study, we identified 8 knowledge areas and 62 lean tools/concepts from lean perspective and also one tool can help to manage two or more knowledge areas.

Keywords: knowledge areas, lean body matrix, lean construction, lean tools

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Authors: Lee Boudreau, Ash Kumar Khaitu, Laura A. S. MacDonald

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In April 2015, a magnitude 7.8 earthquake struck Nepal, killing, injuring, and displacing thousands of people. The earthquake also damaged water and sanitation service networks, leading to a high risk of diarrheal disease and the associated negative health impacts. In response to the disaster, the Environment and Public Health Organization (ENPHO), a Kathmandu-based non-governmental organization, worked with the Centre for Affordable Water and Sanitation Technology (CAWST), a Canadian education, training and consulting organization, to develop two training programs to educate volunteers on water, sanitation, and hygiene (WASH) needs. The first training program was intended for acute response, with the second focusing on longer term recovery. A key focus was to equip the volunteers with the knowledge and skills to formulate useful WASH advice in the unanticipated circumstances they would encounter when working in affected areas. Within the first two weeks of the disaster, a two-day acute response training was developed, which focused on enabling volunteers to educate those affected by the disaster about local WASH issues, their link to health, and their increased importance immediately following emergency situations. Between March and October 2015, a total of 19 training events took place, with over 470 volunteers trained. The trained volunteers distributed hygiene kits and liquid chlorine for household water treatment. They also facilitated health messaging and WASH awareness activities in affected communities. A three-day recovery phase training was also developed and has been delivered to volunteers in Nepal since October 2015. This training focused on WASH issues during the recovery and reconstruction phases. The interventions and recommendations in the recovery phase training focus on long-term WASH solutions, and so form a link between emergency relief strategies and long-term development goals. ENPHO has trained 226 volunteers during the recovery phase, with training ongoing as of April 2016. In the aftermath of the earthquake, ENPHO found that its existing pool of volunteers were more than willing to help those in their communities who were more in need. By training these and new volunteers, ENPHO was able to reach many more communities in the immediate aftermath of the disaster; together they reached 11 of the 14 earthquake-affected districts. The collaboration between ENPHO and CAWST in developing the training materials was a highly collaborative and iterative process, which enabled the training materials to be developed within a short response time. By training volunteers on basic WASH topics during both the immediate response and the recovery phase, ENPHO and CAWST have been able to link immediate emergency relief to long-term developmental goals. While the recovery phase training continues in Nepal, CAWST is planning to decontextualize the training used in both phases so that it can be applied to other emergency situations in the future. The training materials will become part of the open content materials available on CAWST’s WASH Resources website.

Keywords: water and sanitation, emergency response, education and training, building resilience

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Authors: Pascale Brasseur, Binu Gurung, Nicholas Halfpenny, James Eaton

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Development of minimally invasive treatments in recent years provides a potential alternative to invasive surgical interventions which are of limited value to patients with spinal metastases due to short life expectancy. A systematic review was conducted to explore the efficacy and safety of radiofrequency ablation (RFA), a minimally invasive treatment in patients with spinal metastases. EMBASE, Medline and CENTRAL were searched from database inception to March 2017 for randomised controlled trials (RCTs) and non-randomised studies. Conference proceedings for ASCO and ESMO published in 2015 and 2016 were also searched. Fourteen studies were included: three prospective interventional studies, four prospective case series and seven retrospective case series. No RCTs or studies comparing RFA with another treatment were identified. RFA was followed by cement augmentation in all patients in seven studies and some patients (40-96%) in the remaining seven studies. Efficacy was assessed as pain relief in 13/14 studies with the use of a numerical rating scale (NRS) or a visual analogue scale (VAS) at various time points. Ten of the 13 studies reported a significant decrease in pain outcome, post-RFA compared to baseline. NRS scores improved significantly at 1 week (5.9 to 3.5, p < 0.0001; 8 to 4.3, p < 0.02 and 8 to 3.9, p < 0.0001) and this improvement was maintained at 1 month post-RFA compared to baseline (5.9 to 2.6, p < 0.0001; 8 to 2.9, p < 0.0003; 8 to 2.9, p < 0.0001). Similarly, VAS scores decreased significantly at 1 week (7.5 to 2.7, p=0.00005; 7.51 to 1.73, p < 0.0001; 7.82 to 2.82, p < 0.001) and this pattern was maintained at 1 month post-RFA compared to baseline (7.51 to 2.25, p < 0.0001; 7.82 to 3.3; p < 0.001). A significant pain relief was achieved regardless of whether patients had cement augmentation in two studies assessing the impact of RFA with or without cement augmentation on VAS pain scores. In these two studies, a significant decrease in pain scores was reported for patients receiving RFA alone and RFA+cement at 1 week (4.3 to 1.7. p=0.0004 and 6.6 to 1.7, p=0.003 respectively) and 15-36 months (7.9 to 4, p=0.008 and 7.6 to 3.5, p=0.005 respectively) after therapy. Few minor complications were reported and these included neural damage, radicular pain, vertebroplasty leakage and lower limb pain/numbness. In conclusion, the efficacy and safety of RFA were consistently positive between prospective and retrospective studies with reductions in pain and few procedural complications. However, the lack of control groups in the identified studies indicates the possibility of selection bias inherent in single arm studies. Controlled trials exploring efficacy and safety of RFA in patients with spinal metastases are warranted to provide robust evidence. The identified studies provide an initial foundation for such future trials.

Keywords: pain relief, radiofrequency ablation, spinal metastases, systematic review

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Authors: Melissa Dorsey

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Moral distress and compassion fatigue plague nurses in the Cardiothoracic Intensive Care Unit (CTICU) and cause an unnecessary level of turnover. Dueling Burnout describes an initiative that was implemented in the CTICU to reduce the level of burnout the nurses endure by encouraging dual roles with collaborating departments. Purpose: Critical care nurses are plagued by burnout, moral distress, and compassion fatigue due to the intensity of care provided. The purpose of the dual role program was to decrease these issues by providing relief from the intensity of the critical care environment while maintaining full-time employment. Relevance/Significance: Burnout, moral distress, and compassion fatigue are leading causes of Cardiothoracic Critical Care (CTCU) turnover. A contributing factor to burnout is the workload related to serving as a preceptor for a constant influx of new nurses (RN). As a result of these factors, the CTICU averages 17% nursing turnover/year. The cost, unit disruption, and, most importantly, distress of the clinical nurses required an innovative approach to create an improved work environment and experience. Strategies/Implementation/Methods: In May 2018, a dual role pilot was initiated for nurses. The dual role constitutes .6 full-time equivalent hours (FTE) worked in CTICU in combination with .3 FTE worked in the Emergency Department (ED). ED nurses who expressed an interest in cross-training to CTICU were also offered the dual role opportunity. The initial hypothesis was that full-time employees would benefit from a change in clinical setting leading to increased engagement and job satisfaction. The dual role also presents an opportunity for professional development through the expansion of clinical skills in another specialty. Success of the pilot led to extending the dual role to areas beyond the ED. Evaluation/Outcomes/Results: The number of dual role clinical nurses has grown to 22. From the dual role cohort, only one has transferred out of CTICU. This is a 5% turnover rate for this group of nurses as compared to the average turnover rate of 17%. A role satisfaction survey conducted with the dual role cohort found that because of working in a dual role, 76.5% decreased their intent to leave, 100% decreased their level of burnout, and 100% reported an increase in overall job satisfaction. Nurses reported the ability to develop skills that are transferable between departments. Respondents emphasized the appreciation gained from working in multiple environments; the dual role served to transform their care. Conclusions/Implications: Dual role is an effective strategy to retain experienced nurses, decrease burnout and turnover, improve collaboration, and provide flexibility to meet staffing needs. The dual role offers RNs an expansion of skills, relief from high acuity and orientee demands, while improving job satisfaction.

Keywords: nursing retention, burnout, pandemic, strategic staffing, leadership

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Authors: Sugam Kale, Arif Uzair Bin Mohammed Roslan, Cindy Lee, Syed Beevee Mohammed Ismail

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Preemptive analgesia is an established concept in the modern practice of anaesthesia. To be most effective, it is best instituted earlier than the surgical stimulus and should last beyond the offset of surgically induced pain till healing is complete. Whereas the start of afferent pain blockade with regional anaesthesia is common, its effect often falls short to cover the entire period of pain impulses making their way to CNS in the post-operative period. We tried to use a combination of two regional anaesthetic techniques used sequentially to overcome this handicap. Madam S., a 56 year old lady, was scheduled for elective surgery for pancreatic cancer. She underwent laparotomy and distal pancreatectomy, splenectomy, bilateral salpingo oophorectomy, and sigmoid colectomy. Surgery was expected to be extensive, and it was presumed that the standard pain relief with PCA with opiates and oral analgesics would not be adequate. After counselling the patient pre-operative about the technique of regional anaesthesia techniques, including epidural catheterization and rectus sheath catheter placement, their benefits, and potential complications, informed consent was obtained. Epidural catheter was placed awake, and general anaesthesia was then induced. Epidural infusion of local anaesthetics was started prior to surgical incision and was continued till 60 hours into the postoperative period. Before skin closure, the surgeons inserted commercially available rectus sheath catheters bilaterally along the midline incision used for laparotomy. After 46 hours post-op, local anaesthetic infusion via these was started as bridging while the epidural infusion rate was tapered off. The epidural catheter was removed at 75 hours. Elastomeric pumps were used to provide local anaesthetic infusion with the ability to vary infusion rates. Acute pain service followed up the patient’s vital signs and effectiveness of pain relief twice daily or more frequently as required. Rectus sheath catheters were removed 137 hours post-op. The patient had good post-op analgesia with the minimal additional analgesic requirement. For the most part, the visual analog score (VAS) for pain remained at 1-3 on a scale of 1 to 10. Haemodynamics remained stable, and surgical recovery was as expected. Minimal opiate requirement after an extensive laparotomy also translates to the early return of intestinal motility. Our experience was encouraging, and we are hoping to extend this combination of two regional anaesthetic techniques to patients undergoing similar surgeries. Epidural analgesia is denser and offers excellent pain relief for both visceral and somatic pain in the first few days after surgery. As the pain intensity grows weaker, rectus sheath block and oral analgesics provide almost the same degree of pain relief after the epidural catheter is removed. We discovered that the background infusion of local anaesthetic down the rectus sheath catherter largely reduced the requirement for other classes of analgesics. We aim to study this further with a larger patient cohort and hope that it may become an established clinical practice that benefits patients everywhere.

Keywords: rectus sheath, epidural infusion, post operative analgesia, elastomeric

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Authors: L. Salvati, D. Smiraglia, S. Bajocco, M. Munafò

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This paper focuses on Land Use and Land Cover Changes (LULCC) occurred in the urban coastal regions of the Mediterranean basin in the last thirty years. LULCC were assessed diachronically (1975-2006) in two urban areas, Rome (Italy) and Athens (Greece), by using CORINE land cover maps. In strictly coastal territories a persistent growth of built-up areas at the expenses of both agricultural and forest land uses was found. On the contrary, a different pattern was observed in the surrounding inland areas, where a high conversion rate of the agricultural land uses to both urban and forest land uses was recorded. The impact of city growth on the complex pattern of coastal LULCC is finally discussed.

Keywords: land use changes, coastal region, Rome prefecture, Attica, southern Europe

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Authors: María Dolores Caro, Eugenio M. Fedriani, Ángel F. Tenorio

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The transportation of dangerous goods by lorries throughout Europe must be done by using the roads conforming the European Road Transport Network. In this network, there are several parking areas where lorry drivers can park to rest according to the regulations. According to the "European Agreement concerning the International Carriage of Dangerous Goods by Road", parking areas where lorries transporting dangerous goods can park to rest, must follow several security stipulations to keep safe the rest of road users. At this respect, these lorries must be parked in adapted areas with strict and permanent surveillance measures. Moreover, drivers must satisfy several restrictions about resting and driving time. Under these facts, one may expect that there exist enough parking areas for the transport of this type of goods in order to obey the regulations prescribed by the European Union and its member countries. However, the already-existing parking areas are not sufficient to cover all the stops required by drivers transporting dangerous goods. Our main goal is, starting from the already-existing parking areas and the loading-and-unloading location, to provide an optimal answer to the following question: how many additional parking areas must be built and where must they be located to assure that lorry drivers can transport dangerous goods following all the stipulations about security and safety for their stops? The sense of the word “optimal” is due to the fact that we give a global solution for the location of parking areas throughout the whole European Road Transport Network, adjusting the number of additional areas to be as lower as possible. To do so, we have modeled the problem using graph theory since we are working with a road network. As nodes, we have considered the locations of each already-existing parking area, each loading-and-unloading area each road bifurcation. Each road connecting two nodes is considered as an edge in the graph whose weight corresponds to the distance between both nodes in the edge. By applying a new efficient algorithm, we have found the additional nodes for the network representing the new parking areas adapted for dangerous goods, under the fact that the distance between two parking areas must be less than or equal to 400 km.

Keywords: trans-european transport network, dangerous goods, parking areas, graph-based modeling

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Authors: Chia-Hao Chang, Geng-Gui Wang, Jee-Cheng Wu

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The prediction of a landslide is a difficult task because it requires a detailed study of past activities using a complete range of investigative methods to determine the changing condition. In this research, first step, LiDAR 1-meter by 1-meter resolution of digital elevation model (DEM) was used to generate six environmental factors of landslide. Then, back-propagation neural networks (BPNN) was adopted to identify scarp, landslide areas and non-landslide areas. The BPNN uses 6 environmental factors in input layer and 1 output layer. Moreover, 6 landslide areas are used as training areas and 4 landslide areas as test areas in the BPNN. The hidden layer is set to be 1 and 2; the hidden layer neurons are set to be 4, 5, 6, 7 and 8; the learning rates are set to be 0.01, 0.1 and 0.5. When using 1 hidden layer with 7 neurons and the learning rate sets to be 0.5, the result of Network training root mean square error is 0.001388. Finally, evaluation of BPNN classification accuracy by the confusion matrix shows that the overall accuracy can reach 94.4%, and the Kappa value is 0.7464.

Keywords: digital elevation model, DEM, environmental factors, back-propagation neural network, BPNN, LiDAR

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Authors: Divya Pradip Roy, Md. Zahirul Alam Chowdhury

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Electromyography (EMG) sensors are generally used to record the electrical activity produced by skeletal muscles. The conventional EMG sensors available in the market are expensive. This research suggests a low cost EMG sensor design which can be built with simple devices within our reach. In this research, one instrumentation amplifier, two high pass filters, two low pass filters and an inverting amplifier is connected sequentially. The output from the circuit exhibits electrical potential generated by the muscle cells when they are neurologically activated. This electromyography signal is used to control prosthetic devices, identifying neuromuscular diseases and for various other purposes.

Keywords: EMG, high pass filter, instrumentation amplifier, inverting amplifier, low pass filter, neuromuscular

Procedia PDF Downloads 153

Authors: Konstantinos Tolidis

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The mountains are amongst the most fragile environments in the world. The world’s mountain areas cover 24% of the Earth’s land surface and are home to 12% of the global population. A further 14% of the global population is estimated to live in the vicinity of their surrounding areas. As urbanization continues to increase in the world, the mountains are also key centers for recreation and tourism; their attraction is often heightened by their remarkably high levels of biodiversity. Due to the fact that the features in mountain areas vary spatially (development degree, human geography, socio-economic reality, relations of dependency and interaction with other areas-regions), the spatial planning on these areas consists of a crucial process for preserving the natural, cultural and human environment and consists of one of the major processes of an integrated spatial policy. This research has been focused on the spatial decision problem of land use allocation optimization which is an ordinary planning problem on the mountain areas. It is a matter of fact that such decisions must be made not only on what to do, how much to do, but also on where to do, adding a whole extra class of decision variables to the problem when combined with the consideration of spatial optimization. The utility of optimization as a normative tool for spatial problem is widely recognized. However, it is very difficult for planners to quantify the weights of the objectives especially when these are related to mountain areas. Furthermore, the land use allocation optimization problems at mountain areas must be addressed not only by taking into account the general development objectives but also the spatial objectives (e.g. compactness, compatibility and accessibility, etc). Therefore, the main research’s objective was to approach the land use allocation problem by utilizing a hybrid meta-heuristic optimization technique tailored to the mountain areas’ spatial characteristics. The results indicates that the proposed methodological approach is very promising and useful for both generating land use alternatives for further consideration in land use allocation decision-making and supporting spatial management plans at mountain areas.

Keywords: multiobjective land use allocation, mountain areas, spatial planning, spatial decision making, meta-heuristic methods

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Authors: Mrudula Kudtarkar, Rajesh Mane

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Introduction: Cleft lip repair is one of the common surgeries performed in India and the usual method used for post-operative analgesia is perioperative opioids and NSAIDs. There has been an increase in use of regional techniques and Opioids are the common adjuvants but their efficacy and safety have not been studied extensively in children. Aim: A prospective, randomized, double-blind study was done to compare the efficacy, duration and safety of intraoral infraorbital nerve block on post-operative pain relief using bupivacaine alone or in combination with fentanyl or pethidine in paediatric cleft lip repair. Methodology: 45 children between the age group 5 – 60 months undergoing cleft lip surgery randomly allocated into 3 groups of 15 each received bilateral intraoral infraorbital nerve block with 0.75ml of solution. Group B received 0.25% bupivacaine; group P received 0.25% bupivacaine with 0.25mg/kg pethidine, group F received 0.25% bupivacaine with 0.25microgm/kg fentanyl. Sedation after recovery, post-operative pain intensity and duration of post-operative analgesia were assessed using Modified Hannallah Pain Score. Results: The mean duration of analgesia was 17.8 hrs in Group B, 23.53 hrs in Group F and 35.13 hrs in Group P. There was statistically significant difference between the means of the three groups- ANOVA (p < 0.05). Conclusion: Thus we conclude that addition of fentanyl or pethidine to bupivacaine for Bilateral Intraoral Infraorbital Nerve Block prolong the duration of analgesia with no complications and can be used safely in paediatric patients.

Keywords: cleft lip, infraorbital block, NSAIDS, Opiods

Procedia PDF Downloads 219

Authors: Jerzy Bański

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The purpose of the paper is to describe the role of urban-rural partnership in social and economic development. The concept of urban-rural collaboration is relatively new and assumes the need to link large metropolitan areas with surrounding rural areas in a number of ways. It is strongly related to the existing concept of polycentric spatial development. At the European Union level, the first document to address the need for urban-rural partnerships was the European Spatial Development Perspective from 1999. The paper focuses on factors that generate social and economic success on examples of several metropolitan territories in Poland (Warsaw, Poznan, Wroclaw, Krakow). A survey focused on rural communes made it possible to assess key success factors (location, social and economic, technological and organizational) that could be later used to determine the right course of action in the area of urban-rural cooperation, with the desired outcome being effective metropolitan area development. The main challenges to urban-rural partnership are issues associated with spatial planning, infrastructure and public services. These are areas of the greatest conflict of interest, too. Any analysis of urban-rural cooperation in metropolitan areas really needs to focus on the unique nature of this type of relationship. This includes issues such as commuting to work in the urban core and vice versa, complementarity of technical infrastructure, and joint strategic planning. Other forms of cooperation should focus on the tourist and recreational aspects of areas surrounding the urban core.

Keywords: partnership, rural areas, urbanization, metropolitan areas, Poland

Procedia PDF Downloads 342

Authors: Abolghasem Yousefi-Babadi, Ali Bozorgi-Amiri, Aida Kazempour, Reza Tavakkoli-Moghaddam, Maryam Irani

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All over the world, natural disasters (e.g., earthquakes, floods, volcanoes and hurricanes) causes a lot of deaths. Earthquakes are introduced as catastrophic events, which is accident by unusual phenomena leading to much loss around the world. Such could be replaced by disasters or any other synonyms strongly demand great long-term help and relief, which can be hard to be managed. Supplies and facilities are very important challenges after any earthquake which should be prepared for the disaster regions to satisfy the people's demands who are suffering from earthquake. This paper proposed disaster response facility allocation problem for disaster relief operations as a mathematical programming model. Not only damaged people in the earthquake victims, need the consumable commodities (e.g., food and water), but also they need non-consumable commodities (e.g., clothes) to protect themselves. Therefore, it is concluded that paying attention to disaster points and people's demands are very necessary. To deal with this objective, both commodities including consumable and need non-consumable commodities are considered in the presented model. This paper presented the multi-objective multi-period mathematical programming model regarding the minimizing the average of the weighted response times and minimizing the total operational cost and penalty costs of unmet demand and unused commodities simultaneously. Furthermore, a Chebycheff multi-objective solution procedure as a powerful solution algorithm is applied to solve the proposed model. Finally, to illustrate the model applicability, a case study of the Tehran earthquake is studied, also to show model validation a sensitivity analysis is carried out.

Keywords: facility location, multi-objective model, disaster response, commodity

Procedia PDF Downloads 236

Authors: Chittana Phompila

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The current increased population pushes increasing demands for natural resources and living space. In Laos, urban areas have been expanding rapidly in recent years. The rapid urbanization can have negative impacts on landscapes, including forest and agriculture lands. The primary objective of this research were to map current urban areas in a large city in Savannakhet province, in Laos, 2) to compare changes in urbanization between 1990 and 2018, and 3) to estimate forest and agriculture areas lost due to expansions of urban areas during the last over twenty years within study area. Landsat 8 data was used and existing GIS data was collected including spatial data on rivers, lakes, roads, vegetated areas and other land use/land covers). GIS data was obtained from the government sectors. Object based classification (OBC) approach was applied in ECognition for image processing and analysis of urban area using. Historical data from other Landsat instruments (Landsat 5 and 7) were used to allow us comparing changes in urbanization in 1990, 2000, 2010 and 2018 in this study area. Only three main land cover classes were focused and classified, namely forest, agriculture and urban areas. Change detection approach was applied to illustrate changes in built-up areas in these periods. Our study shows that the overall accuracy of map was 95% assessed, kappa~ 0.8. It is found that that there is an ineffective control over forest and land-use conversions from forests and agriculture to urban areas in many main cities across the province. A large area of agriculture and forest has been decreased due to this conversion. Uncontrolled urban expansion and inappropriate land use planning can lead to creating a pressure in our resource utilisation. As consequence, it can lead to food insecurity and national economic downturn in a long term.

Keywords: urbanisation, forest cover, agriculture areas, Landsat 8 imagery

Procedia PDF Downloads 143

Authors: T. Garba, T. O. Quddus, Y. Y. Babanyara, M. A. Modibbo

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Desertification is define as the changing of productive land into a desert as the result of ruination of land by man-induced soil erosion, which forces famers in the affected areas to move migrate or encourage into reserved areas in search of a fertile land for their farming activities. This study therefore used remote sensing imageries to determine the level of changes in the vegetative areas. To achieve that Normalized Difference of the Vegetative Index (NDVI), classified imageries and image slicing derived from landsat TM 1986, land sat ETM 1999 and Nigeria sat 1 2007 were used to determine changes in vegetations. From the Classified imageries it was discovered that there a more natural vegetation in classified images of 1986 than that of 1999 and 2007. This finding is also future in the three NDVI imageries, it was discovered that there is increased in high positive pixel value from 0.04 in 1986 to 0.22 in 1999 and to 0.32 in 2007. The figures in the three histogram also indicted that there is increased in vegetative areas from 29.15 Km2 in 1986, to 60.58 Km2 in 1999 and then to 109 Km2 in 2007. The study recommends among other things that there is need to restore natural vegetation through discouraging of farming activities in and around the natural vegetation in the study area.

Keywords: vegetative index, classified imageries, change detection, landsat, vegetation

Procedia PDF Downloads 334

Authors: S. Chuenchooklin, S. Taweepong, U. Pangnakorn

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This research was conducted in the Mae Sot Watershed whereas located in the Moei River Basin at the Upper Salween River Basin in Tak Province, Thailand. The Mae Sot Municipality is the largest urbanized in Tak Province and situated in the midstream of the Mae Sot Watershed. It usually faces flash flood problem after heavy rain due to poor flood management has been reported since economic rapidly bloom up in recently years. Its catchment can be classified as ungauged basin with lack of rainfall data and no any stream gaging station was reported. It was attached by most severely flood event in 2013 as the worst studied case for those all communities in this municipality. Moreover, other problems are also faced in this watershed such shortage water supply for domestic consumption and agriculture utilizations including deterioration of water quality and landslide as well. The research aimed to increase capability building and strengthening the participation of those local community leaders and related agencies to conduct better water management in urban area was started by mean of the data collection and illustration of appropriated application of some short period rainfall forecasting model as the aim for better flood relief plan and management through the hydrologic model system and river analysis system programs. The authors intended to apply the global rainfall data via the integrated data viewer (IDV) program from the Unidata with the aim for rainfall forecasting in short period of 7 - 10 days in advance during rainy season instead of real time record. The IDV product can be present in advance period of rainfall with time step of 3 - 6 hours was introduced to the communities. The result can be used to input to either the hydrologic modeling system model (HEC-HMS) or the soil water assessment tool model (SWAT) for synthesizing flood hydrographs and use for flood forecasting as well. The authors applied the river analysis system model (HEC-RAS) to present flood flow behaviors in the reach of the Mae Sot stream via the downtown of the Mae Sot City as flood extents as water surface level at every cross-sectional profiles of the stream. Both models of HMS and RAS were tested in 2013 with observed rainfall and inflow-outflow data from the Mae Sot Dam. The result of HMS showed fit to the observed data at dam and applied at upstream boundary discharge to RAS in order to simulate flood extents and tested in the field, and the result found satisfied. The result of IDV’s rainfall forecast data was compared to observed data and found fair. However, it is an appropriate tool to use in the ungauged catchment to use with flood hydrograph and river analysis models for future efficient flood relief plan and management.

Keywords: global rainfall, flood forecast, hydrologic modeling system, river analysis system

Procedia PDF Downloads 332

Authors: Michael Dole, Pierre Ninin, Denis Raffourt

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Most of the CERN’s facilities hosting particle accelerators are large, underground and radioactive areas. All fire detection systems installed in such areas, shall be carefully studied to cope with the particularities of this stringent environment. The detection equipment usually chosen by CERN to secure these underground facilities are based on air sampling technology. The electronic equipment is located in non-radioactive areas whereas air sampling networks are deployed in radioactive areas where fire detection is required. The air sampling technology provides very good detection performances and prevent the "radiation-to-electronic" effects. In addition, it reduces the exposure to radiations of maintenance workers and is permanently available during accelerator operation. In order to protect the Super Proton Synchrotron and its 7 km tunnels, a specific long distance aspirating smoke detector has been developed to detect smoke at up to 700 meters between electronic equipment and the last air sampling hole. This paper describes the architecture, performances and return of experience of the long distance fire detection system developed and installed to secure the CERN Super Proton Synchrotron tunnels.

Keywords: air sampling, fire detection, long distance, radioactive areas

Procedia PDF Downloads 134

Authors: Sepideh Jabbari Behnam, Elnaz Mohsenin

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Today, with the rapid growth of urbanization, urban issues are so problematic more than ever. These problems have various origins and they should be studied in different aspects. One of these problems is destroying the structure and identity of urban-rural textures around cities. This destruction appears due to an uncontrolled and unplanned growth of large cities inside and/or connecting suburban areas to the cities. These textures which were called urban-rural areas are faced with the dual identity of rural and urban tissues. It should be noted that, urban-rural areas have the potential for creating urban habitats with the rural nature. However; these areas, due to lack of planning and proper management have encountered serious problems. The main objective of this article is offering some solutions for the structural-physical problems of urban-rural areas with the using of morphological principles and studies. In this case, after morphological studies of one of urban-rural texture example, and also with the use of offered research literature, general solutions have been suggested to solve some of these textures' issues.

Keywords: morphology, typo- morphology, urban-rural, urban texture

Procedia PDF Downloads 479

Authors: Mohammad Zafar-ul Islam, Shaily Menon, Xingong Li, A. Townsend Peterson

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In addition to the mounting empirical data on direct implications of climate change for natural and human systems, evidence is increasing for other, indirect climate change phenomena such as sea-level rise. Rising sea levels and associated marine intrusion into terrestrial environments are predicted to be among the most serious eventual consequences of climate change. The many complex and interacting factors affecting sea levels create considerable uncertainty in sea-level rise projections: conservative estimates are on the order of 0.5-1.0 m globally, while other estimates are much higher, approaching 6 m. Marine intrusion associated with 1– 6 m sea-level rise will impact species and habitats in coastal ecosystems severely. Examining areas most vulnerable to such impacts may allow design of appropriate adaptation and mitigation strategies. We present an overview of potential effects of 1 and 6 m sea level rise for coastal conservation areas in the Indian Subcontinent. In particular, we examine the projected magnitude of areal losses in relevant biogeographic zones, ecoregions, protected areas (PAs), and Important Bird Areas (IBAs). In addition, we provide a more detailed and quantitative analysis of likely effects of marine intrusion on 22 coastal PAs and IBAs that provide critical habitat for birds in the form of breeding areas, migratory stopover sites, and overwintering habitats. Several coastal PAs and IBAs are predicted to experience higher than 50% losses to marine intrusion. We explore consequences of such inundation levels on species and habitat in these areas.

Keywords: sea-level change, coastal inundation, marine intrusion, biogeographic zones, ecoregions, protected areas, important bird areas, adaptation, mitigation

Procedia PDF Downloads 232

Authors: Ivana Barišić, Ivanka Netinger Grubeša, Ines Barjaktarić

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Road performance and traffic safety are highly influenced by improper water drainage system performance, particularly within intersection areas. So, the aim of the presented paper is the evaluation of pervious concrete made with two types and two aggregate fractions for potential utilization in intersection drainage areas. Although the studied pervious concrete mixtures achieved proper drainage but lower strength characteristics, this pervious concrete has a good potential for enhancing pavement drainage systems if it is embedded on limited intersection areas.

Keywords: drainage, intersection, pervious concrete, road

Procedia PDF Downloads 366