Search results for: flood risk perception
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 8018

Search results for: flood risk perception

6338 Seismic Activity in the Lake Kivu Basin: Implication for Seismic Risk Management

Authors: Didier Birimwiragi Namogo

Abstract:

The Kivu Lake Basin is located in the Western Branch of the East African Rift. In this basin is located a multitude of active faults, on which earthquakes occur regularly. The most recent earthquakes date from 2008, 2015, 2016, 2017 and 2019. The cities of Bukabu and Goma in DR Congo and Giseyi in Rwanda are the most impacted by this intense seismic activity in the region. The magnitude of the strongest earthquakes in the region is 6.1. The 2008 earthquake was particularly destructive, killing several people in DR Congo and Rwanda. This work aims to complete the distribution of seismicity in the region, deduce areas of weakness and establish a hazard map that can assist in seismic risk management. Using the local seismic network of the Goma Volcano Observatory, the earthquakes were relocated, and their focus mechanism was studied. The results show that most of these earthquakes occur on active faults described by Villeneuve in 1938. The alignment of the earthquakes shows a pace that follows directly the directions of the faults described by this author. The study of the focus mechanism of these earthquakes, also shows that these are in particular normal faults whose stresses show an extensive activity. Such study can be used for the establishment of seismic risk management tools.

Keywords: earthquakes, hazard map, faults, focus mechanism

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6337 Exploratory Analysis and Development of Sustainable Lean Six Sigma Methodologies Integration for Effective Operation and Risk Mitigation in Manufacturing Sectors

Authors: Chukwumeka Daniel Ezeliora

Abstract:

The Nigerian manufacturing sector plays a pivotal role in the country's economic growth and development. However, it faces numerous challenges, including operational inefficiencies and inherent risks that hinder its sustainable growth. This research aims to address these challenges by exploring the integration of Lean and Six Sigma methodologies into the manufacturing processes, ultimately enhancing operational effectiveness and risk mitigation. The core of this research involves the development of a sustainable Lean Six Sigma framework tailored to the specific needs and challenges of Nigeria's manufacturing environment. This framework aims to streamline processes, reduce waste, improve product quality, and enhance overall operational efficiency. It incorporates principles of sustainability to ensure that the proposed methodologies align with environmental and social responsibility goals. To validate the effectiveness of the integrated Lean Six Sigma approach, case studies and real-world applications within select manufacturing companies in Nigeria will be conducted. Data were collected to measure the impact of the integration on key performance indicators, such as production efficiency, defect reduction, and risk mitigation. The findings from this research provide valuable insights and practical recommendations for selected manufacturing companies in South East Nigeria. By adopting sustainable Lean Six Sigma methodologies, these organizations can optimize their operations, reduce operational risks, improve product quality, and enhance their competitiveness in the global market. In conclusion, this research aims to bridge the gap between theory and practice by developing a comprehensive framework for the integration of Lean and Six Sigma methodologies in Nigeria's manufacturing sector. This integration is envisioned to contribute significantly to the sector's sustainable growth, improved operational efficiency, and effective risk mitigation strategies, ultimately benefiting the Nigerian economy as a whole.

Keywords: lean six sigma, manufacturing, risk mitigation, sustainability, operational efficiency

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6336 Impact of Diabetes Mellitus Type 2 on Clinical In-Stent Restenosis in First Elective Percutaneous Coronary Intervention Patients

Authors: Leonard Simoni, Ilir Alimehmeti, Ervina Shirka, Endri Hasimi, Ndricim Kallashi, Verona Beka, Suerta Kabili, Artan Goda

Abstract:

Background: Diabetes Mellitus type 2, small vessel calibre, stented length of vessel, complex lesion morphology, and prior bypass surgery have resulted risk factors for In-Stent Restenosis (ISR). However, there are some contradictory results about body mass index (BMI) as a risk factor for ISR. Purpose: We want to identify clinical, lesional and procedural factors that can predict clinical ISR in our patients. Methods: Were enrolled 759 patients who underwent first-time elective PCI with Bare Metal Stents (BMS) from September 2011 to December 2013 in our Department of Cardiology and followed them for at least 1.5 years with a median of 862 days (2 years and 4 months). Only the patients re-admitted with ischemic heart disease underwent control coronary angiography but no routine angiographic control was performed. Patients were categorized in ISR and non-ISR groups and compared between them. Multivariate analysis - Binary Logistic Regression: Forward Conditional Method was used to identify independent predictive risk factors. P was considered statistically significant when <0.05. Results: ISR compared to non-ISR individuals had a significantly lower BMI (25.7±3.3 vs. 26.9±3.7, p=0.004), higher risk anatomy (LM + 3-vessel CAD) (23% vs. 14%, p=0.03), higher number of stents/person used (2.1±1.1 vs. 1.75±0.96, p=0.004), greater length of stents/person used (39.3±21.6 vs. 33.3±18.5, p=0.01), and a lower use of clopidogrel and ASA (together) (95% vs. 99%, p=0.012). They also had a higher, although not statistically significant, prevalence of Diabetes Mellitus (42% vs. 32%, p=0.072) and a greater number of treated vessels (1.36±0.5 vs. 1.26±0.5, p=0.08). In the multivariate analysis, Diabetes Mellitus type 2 and multiple stents used were independent predictors risk factors for In-Stent Restenosis, OR 1.66 [1.03-2.68], p=0.039, and OR 1.44 [1.16-1.78,] p=0.001, respectively. On the other side higher BMI and use of clopidogrel and ASA together resulted protective factors OR 0.88 [0.81-0.95], p=0.001 and OR 0.2 [0.06-0.72] p=0.013, respectively. Conclusion: Diabetes Mellitus and multiple stents are strong predictive risk factors, whereas the use of clopidogrel and ASA together are protective factors for clinical In-Stent Restenosis. Paradoxically High BMI is a protective factor for In-stent Restenosis, probably related to a larger diameter of vessels and consequently a larger diameter of stents implanted in these patients. Further studies are needed to clarify this finding.

Keywords: body mass index, diabetes mellitus, in-stent restenosis, percutaneous coronary intervention

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6335 Making a Resilient Livable City: Explorations of Smart Management Mechanism for Aging Society’s Disaster Prevention

Authors: Wei-Kuang Liu, Ya-Hsu Chiang

Abstract:

In the coming of an aging society, the issues of living quality, health care, and social security for the elderly have been gradually taken seriously. In order to maintain favorable living condition, urban societies are also facing the challenge of disasters caused by extreme climate change. However, in the practice of disaster prevention, elderly people are always weak due to their physiological conditions. That is to say, in the planning of resilient urbanism, the aging society is relatively in need of more care. Thus, this research aims to map areas where have high-density elderly population and fragile environmental condition in Taiwan, and to understand the actual situation of disaster prevention management in these areas, so as to provide suggestions for the development of intellectual resilient urban management. The research takes the cities of Taoyuan and Taichung as examples for explorations. According to GIS mapping of areas with high aging index, high-density population and high flooding potential, the communities of Sihai and Fuyuan in Taoyuan and the communities of Taichang and Nanshih in Taichung are highlighted. In these communities, it can be found that there are more elderly population and less labor population with high-density living condition. In addition, they are located in the areas where they have experienced severe flooding in the recent past. Based on a series of interviews with community organizations, there is only one community out of the four using flood information mobile app and Line messages for the management of disaster prevention, and the others still rely on the traditional approaches that manage the works of disaster prevention by their community security patrol teams and community volunteers. The interview outcome shows that most elderly people are not interested in learning the use of intellectual devices. Therefore, this research suggests to keep doing the GIS mapping of areas with high aging index, high-density population and high flooding potential for grasping the high-risk communities and to help develop smart monitor and forecast systems for disaster prevention practice in these areas. Based on case-study explorations, the research also advises that it is important to develop easy-to-use bottom-up and two-way immediate communication mechanism for the management of aging society’s disaster prevention.

Keywords: aging society, disaster prevention, GIS, resilient, Taiwan

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6334 Development of Femoral Head Osteonecrosis Due to Corticosteroids Consumption; Probable Role of OCP: A Case Report

Authors: S. Alireza Mirghasemi, Shervin Rashidinia, Mohammad Saleh Sadeghi, Mohsen Talebizadeh, Narges Rahimi Gabaran, Seyed Shahin Eftekhari, Sara Shahmoradi

Abstract:

Avascular necrosis of femoral head is a pathologic condition that the main cause is decreased blood supply of femoral head. Among predisposing risk factors, chronic use of corticosteroids, alcoholism, smocking and hip traumas have more important role. Also we can mention OCP consumption as a risk factor among less common predisposing factors that lead to AVNF, in this study we introduce another cause of AVNF with a period of treatment with moderate dose of corticosteroids accompanied by OCP as a probable facilitating factor that leads to AVNF.

Keywords: AVN, corticosteroids consumption, femoral head osteonecrosis, OCP

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6333 South Korean Tourists' Expectation, Satisfaction and Loyalty Relationship

Authors: Tolga Gok, Kursad Sayin

Abstract:

The aim of this study is to investigate the relationship between expectation, satisfaction and loyalty of South Korean tourists visiting Turkey. In the research, a questionnaire was used as a data collecting tool. The questionnaires are filled by South Korean tourists coming to Turkey through package tours and individual. The survey was conducted in 2014 in Nevsehir (Cappadocia Region) and Istanbul. Tourist guides and agency staff have helped the implementation of surveys. The survey questions are composed of 4 parts, which are “demographic characteristics of tourists”, “travel behavior characteristics”, “perception of expectations on destination attributes” and “perception of destination loyalty”. 5-point Likert type scale including 28 destination attributes was used to measure the expectations of South Korean tourists coming to Turkey. Questions were directed to the tourists to measure the destination loyalty. The questions relating to destination loyalty are “Talking about Turkey to others”, “Recommendation Turkey to others” and “Tourists’ intentions to revisit Turkey”. The basic hypothesis of the research is that there is a statistically significant relationship among expectations, satisfactions and destination loyalty of South Korean tourists coming to Turkey. The results indicated that the expectation had a significant effect on overall satisfaction. In addition, it was seen that between overall satisfaction of tourists and destination loyalty had a significant relationship. Based on findings, some suggestions for tour operators and travel agencies were made.

Keywords: tourist expectation, tourist satisfaction, destination loyalty, destination attributes

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6332 Dysbiosis of the Intestinal Microbiome in Colorectal Cancer Patients at Hospital of Amizour, Bejaia, Algeria

Authors: Adjebli Ahmed, Messis Abdelaziz, Ayeche Riad, Tighilet Karim, Talbi Melissa, Smaili Yanis, Lehri Mokrane, Louardiane Mustapha

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Colorectal cancer is one of the most common types of cancer worldwide, and its incidence has been increasing in recent years. Data and fecal samples from colorectal cancer patients were collected at the Amizour Public Hospital's oncology department (Bejaia, Algeria). Microbiological and cohort study were conducted at the Biological Engineering of Cancers laboratory at the Faculty of Medicine of the University of Bejaia. All the data showed that patients aged between 50 and 70 years were the most affected by colorectal cancer, while the age categories of [30-40] and [40-50] were the least affected. Males were more likely to be at risk of contracting colorectal cancer than females. The most common types of colorectal cancer among the studied population were sigmoid cancer, rectal cancer, transverse colon cancer, and ascending colon cancer. The hereditary factor was found to be more dominant than other risk factors. Bacterial identification revealed the presence of certain pathogenic and opportunistic bacterial genera, such as E. coli, K. pneumoniae, Shigella sp, and Streptococcus group D. These results led us to conclude that dysbiosis of the intestinal microbiome is strongly present in colorectal cancer patients at the EPH of Amizour.

Keywords: microbiome, colorectal cancer, risk factors, bacterial identification

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6331 Older Adults' Perception of Successful Aging among Unrest Situation: A Case of the Three Southernmost Provinces of Thailand

Authors: Medina Adulyarat

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Like many other countries, Thailand is experiencing an increase in its proportion of older adults. However, the political, social, and religious climates of the various regions of Thailand are very diverse and the life experiences of older Thai citizens can vary greatly by region. For more than a decade, the southernmost provinces, namely Yala, Pattani and Narathiwat, have experienced social and political unrest, often characterized by violence in the form of bombings and shootings, which has impacted the older adults residing in these regions. While, Muslims are considered a minority in Thailand, the majority of individuals in southernmost regions are Muslims, causing these regions to be different in terms of culture and beliefs. Using a phenomenological approach, this study examines older adults’ perceptions of successful aging within the context of violent social and political unrest. This research aims to 1) understand how older adults living in these areas perceive successful aging in relation to Rowe and Kahn’s successful ageing model, and 2) describe the experiences of older adults living in areas of violent social and political unrest. Data were collected using in-depth interviews with eight older adults living in the unrest area, composing of four males and four females aged between 55-75. Content analysis was used to investigate older adults’ perception of successful aging. Older adults living their life amidst the violence did not view the situation as a threat to their life for they viewed that they are not the targets of the unrest situation. Additionally, participants identified their religious beliefs and a strong sense of community belonging as coping strategies employed to deal with social and political unrest. Thus, according to them, the violence did not affect their perception of successful aging. While the participants’ perceptions of successful aging were generally consistent with aspects identified in the successful aging model proposed by Rowe and Kahn, a theme of “financial stability” emerged. The results can be divided into four interrelated themes, which are; 1) engaging with others; 2) religiosity; 3) financial stability; and 4) health. Understanding the older persons’ view of successful aging in vulnerable situations should add more depth and enhance the conceptualization of the successful aging concept.

Keywords: cultural gerontology, minority population, successful aging, unrest situation

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6330 Analysis of Possible Draught Size of Container Vessels on the Lower Danube

Authors: Todor Bačkalić, Marinko Maslarić, Milosav Georgijević, Sanja Bojić

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Water transport could be the backbone of the future European combined transport system. The future transport policy in landlocked countries from the Danube Region has to be based on inland waterway transport (IWT). The development of the container transport on inland waterways depends directly on technical-exploitative characteristics of the network of inland waterways. Research of navigational abilities of inland waterways is the basic step in transport planning. The size of the vessel’s draught (T) is the limiting value in project tasks and it depends on the depth of the waterway. Navigation characteristics of rivers have to be determined as precise as possible, especially from the aspect of determination of the possible draught of vessels. This article outlines a rationale, why it is necessary to develop competence about infrastructure risk in water transport. Climate changes are evident and require special attention and global monitoring. Current risk assessment methods for Inland waterway transport just consider some dramatic events. We present a new method for the assessment of risk and vulnerability of inland waterway transport where river depth represents a crucial part. The analysis of water level changes in the lower Danube was done for two significant periods (1965-1979 and 1998-2012).

Keywords: container vessel, draught, probability, the Danube

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6329 Risk Mitigation of Data Causality Analysis Requirements AI Act

Authors: Raphaël Weuts, Mykyta Petik, Anton Vedder

Abstract:

Artificial Intelligence has the potential to create and already creates enormous value in healthcare. Prescriptive systems might be able to make the use of healthcare capacity more efficient. Such systems might entail interpretations that exclude the effect of confounders that brings risks with it. Those risks might be mitigated by regulation that prevents systems entailing such risks to come to market. One modality of regulation is that of legislation, and the European AI Act is an example of such a regulatory instrument that might mitigate these risks. To assess the risk mitigation potential of the AI Act for those risks, this research focusses on a case study of a hypothetical application of medical device software that entails the aforementioned risks. The AI Act refers to the harmonised norms for already existing legislation, here being the European medical device regulation. The issue at hand is a causal link between a confounder and the value the algorithm optimises for by proxy. The research identifies where the AI Act already looks at confounders (i.a. feedback loops in systems that continue to learn after being placed on the market). The research identifies where the current proposal by parliament leaves legal uncertainty on the necessity to check for confounders that do not influence the input of the system, when the system does not continue to learn after being placed on the market. The authors propose an amendment to article 15 of the AI Act that would require high-risk systems to be developed in such a way as to mitigate risks from those aforementioned confounders.

Keywords: AI Act, healthcare, confounders, risks

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6328 Vaccination against Hepatitis B in Tunisian Health Care Workers

Authors: Asma Ammar, Nabiha Bouafia , Asma BenCheikh, Mohamed Mahjoub, Olfa Ezzi, Wadiaa Bannour, Radhia Helali, Mansour Njah

Abstract:

Background: The objective of the present study was to identify factors associated with vaccination against Hepatitis B virus (HBV) among healthcare workers (HWs) in the University Hospital Center (UHC) Farhat Hached Sousse, Tunisia. Methods: We conducted a descriptive cross-sectional study all licensed physicians (n= 206) and a representative sample of paramedical staff (n= 372) exercising at UHC Hached Sousse (Tunisia) during two months (January and February 2014). Data were collected using a self-administered and pre-tested questionnaire, which composed by 21 questions. In order to determinate factors associated with vaccination against hepatitis B among HWs, this questionnaire was based on the Health Belief Model, one of the most classical behavior theories. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify the determinants of the use of vaccination against HBV. Results: The response rates were 79.8%. Fifty two percent believe that HBV is frequent in our healthcare units and 60.6% consider it a severe infection. The prevalence of HWs vaccination was 39%, 95% CI [34.49%; 43.5%]. In multivariate analysis, determinants of the use of vaccination against HBV among HWs were young age (p=10-4), male gender (p = 0. 006), high or very high importance accorded to health (p = 0.035), perception membership in a risk group for HBV infection (p = 0.038) and very favorable or favorable opinion about vaccination against HVB (p=10-4). Conclusion: The results of our study should be considered in any strategy for preventing VHB infection in HWs. In the mean time, coverage with standard vaccines should be improved also by supplying complete information on the risks of VHB infection and on the safety and efficacy of vaccination.

Keywords: Hepatitis B virus, healthcare workers, prevalence, vaccination

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6327 Analysing Responses of Intermediate and Expert Karate Athletes towards the Gyaku-Zuki Using Virtual Reality

Authors: Nicole Bandow, Peter Emmermacher, Oliver Wienert, Steffen Masik, Kerstin Witte

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Karate-kumite is a fast sport where a good perception and anticipation of movements is needed in order to respond appropriately. Perception and anticipation are therefore essential for an efficient and precise movement control and a limiting factor in karate kumite. Previous studies only used 2D video technologies combined with the occlusion technique to study anticipation in sports. These studies showed limitations in the usage of 2D video footage in regards to realism and the presentation of depth information. To overcome these issues a virtual 3D environment was developed to create a similar to real life environment. The aim of this study was to compare the differences in responses of intermediate and expert karate athletes towards temporally and spatially occluded virtual karate attacks from two attackers. Five male expert and five intermediate karate athletes responded physically to nine (3 temporal combined with 3 spatial) occluded attacks of the Gyaku-Zuki of each attacker in the 3D virtual environment. The responses were evaluated in regards to correct point of time and appropriate response technique. Significant differences between the expertises’ responses for the attackers were found. Experts respond more often correct to early information of attacks than novices.

Keywords: anticipation, karate, occlusion, virtual reality

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6326 Screening for Internet Addiction among Medical Students in a Saudi Community

Authors: Nawaf A. Alqahtani, Ali M. Alqahtani, Khalid A. Alqahtani, Huda S. Abdullfattah, Ebtehal A. Alessa, Khalid S. Al Gelban, Ossama A. Mostafa

Abstract:

Background: The internet is an exciting medium that is becoming an essential part of everyday life. Although the internet is fully observed in Saudi Arabia, young people may be vulnerable to problematic internet use, possibly leading to addiction. Aim of study: To explore the magnitude of internet addiction (IA) among medical students associated risk factors and its impact on students' academic achievement. Subjects and Methods: A cross sectional study was conducted in 2014 on 571 medical students (293 males and 278 females) at the College of Medicine, King Khalid University, Abha, Saudi Arabia. Data Collection was done through using the Arabic version of the Compulsive Internet Use Scale and a checklist of demographic characteristics. Results: Age of participants ranged from 19 to 26 years (Mean+SD: 21.9+1.5 years). Internet access was available to 97.4% of students at home and to 80.2% of students at their mobile phones. The most frequently accessed websites by medical students were the social media (90.7%), scientific website (50.4%) and the news websites (31.3%). IA was mild in 47.8% of medical students while 5.8% had moderate IA. None of the students had severe IA. Prevalence of IA was significantly higher among female medical students (p=0.002), availability of internet at home (p=0.022), and availability of internet at the students' mobile phone (p=0.041). The mean General Point Average (GPA) was highest among students with mild IA (4.0+0.6), compared with 3.6+0.6 among those with moderate addiction, and 3.9+0.6 among those who did not show IA. Differences in mean GPA according to grade of IA were statistically significant ((P=0.001). Conclusions: Prevalence of IA is high among medical students in Saudi Arabia. Risk factors for IA include female gender, availability of internet at home or at the mobile phone. IA has a significant impact on students' GPA. Periodic screening of medical students for IA and raising their awareness toward the possible risk of IA are recommended.

Keywords: internet addiction, medical students, risk factors, Saudi Arabia

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6325 Social Health and Adaptation of Armenian Physicians

Authors: A. G. Margaryan

Abstract:

Ability of adaptation of the organism is considered as an important component of health in maintaining relative dynamic constancy of the hemostasis and functioning of all organs and systems. Among the various forms of adaptation (individual, species and mental), social adaptation of the organism has a particular role. The aim of this study was to evaluate the subjective perception of social factors, social welfare and the level of adaptability of Armenian physicians. The survey involved 2,167 physicians (592 men and 1,575 women). According to the survey, most physicians (75.1%) were married. It was found that 88.6% of respondents had harmonious family relationships, 7.6% of respondents – tense relationships, and 1.0% – marginal relationships. The results showed that the average monthly salary with all premium payments amounted to 88 263.6±5.0 drams, and 16.7% of physicians heavily relied on the material support of parents or other relatives. Low material welfare was also confirmed by the analysis of the living conditions. Analysis of the results showed that the degree of subjective perception of social factors of different specialties averaged 11.3±3.1 points, which corresponds to satisfactory results (a very good result – 4.0 points). The degree of social adaptation of physicians on average makes 4.13±1.9 points, which corresponds to poor results (allowable less than 3.0 points). The distribution of the results of social adaptation severity revealed that the majority of physicians (58.6%) showed low social adaptation, average social adaptation is observed in 22.4% of the physicians and high adaptation – in only 17.4% of physicians. In conclusions, the findings of this study suggest that the degree of social adaptation of currently practicing physicians is low.

Keywords: physician's health, social adaptation, social factor, social health

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6324 Diabetes Mellitus and Blood Glucose Variability Increases the 30-day Readmission Rate after Kidney Transplantation

Authors: Harini Chakkera

Abstract:

Background: Inpatient hyperglycemia is an established independent risk factor among several patient cohorts with hospital readmission. This has not been studied after kidney transplantation. Nearly one-third of patients who have undergone a kidney transplant reportedly experience 30-day readmission. Methods: Data on first-time solitary kidney transplantations were retrieved between September 2015 to December 2018. Information was linked to the electronic health record to determine a diagnosis of diabetes mellitus and extract glucometeric and insulin therapy data. Univariate logistic regression analysis and the XGBoost algorithm were used to predict 30-day readmission. We report the average performance of the models on the testing set on five bootstrapped partitions of the data to ensure statistical significance. Results: The cohort included 1036 patients who received kidney transplantation, and 224 (22%) experienced 30-day readmission. The machine learning algorithm was able to predict 30-day readmission with an average AUC of 77.3% (95% CI 75.30-79.3%). We observed statistically significant differences in the presence of pretransplant diabetes, inpatient-hyperglycemia, inpatient-hypoglycemia, and minimum and maximum glucose values among those with higher 30-day readmission rates. The XGBoost model identified the index admission length of stay, presence of hyper- and hypoglycemia and recipient and donor BMI values as the most predictive risk factors of 30-day readmission. Additionally, significant variations in the therapeutic management of blood glucose by providers were observed. Conclusions: Suboptimal glucose metrics during hospitalization after kidney transplantation is associated with an increased risk for 30-day hospital readmission. Optimizing the hospital blood glucose management, a modifiable factor, after kidney transplantation may reduce the risk of 30-day readmission.

Keywords: kidney, transplant, diabetes, insulin

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6323 Development of Trigger Tool to Identify Adverse Drug Events From Warfarin Administered to Patient Admitted in Medical Wards of Chumphae Hospital

Authors: Puntarikorn Rungrattanakasin

Abstract:

Objectives: To develop the trigger tool to warn about the risk of bleeding as an adverse event from warfarin drug usage during admission in Medical Wards of Chumphae Hospital. Methods: A retrospective study was performed by reviewing the medical records for the patients admitted between June 1st,2020- May 31st, 2021. ADEs were evaluated by Naranjo’s algorithm. The international normalized ratio (INR) and events of bleeding during admissions were collected. Statistical analyses, including Chi-square test and Reciever Operating Characteristic (ROC) curve for optimal INR threshold, were used for the study. Results: Among the 139 admissions, the INR range was found to vary between 0.86-14.91, there was a total of 15 bleeding events, out of which 9 were mild, and 6 were severe. The occurrence of bleeding started whenever the INR was greater than 2.5 and reached the statistical significance (p <0.05), which was in concordance with the ROC curve and yielded 100 % sensitivity and 60% specificity in the detection of a bleeding event. In this regard, the INR greater than 2.5 was considered to be an optimal threshold to alert promptly for bleeding tendency. Conclusions: The INR value of greater than 2.5 (>2.5) would be an appropriate trigger tool to warn of the risk of bleeding for patients taking warfarin in Chumphae Hospital.

Keywords: trigger tool, warfarin, risk of bleeding, medical wards

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6322 Cyber Security and Risk Assessment of the e-Banking Services

Authors: Aisha F. Bushager

Abstract:

Today we are more exposed than ever to cyber threats and attacks at personal, community, organizational, national, and international levels. More aspects of our lives are operating on computer networks simply because we are living in the fifth domain, which is called the Cyberspace. One of the most sensitive areas that are vulnerable to cyber threats and attacks is the Electronic Banking (e-Banking) area, where the banking sector is providing online banking services to its clients. To be able to obtain the clients trust and encourage them to practice e-Banking, also, to maintain the services provided by the banks and ensure safety, cyber security and risks control should be given a high priority in the e-banking area. The aim of the study is to carry out risk assessment on the e-banking services and determine the cyber threats, cyber attacks, and vulnerabilities that are facing the e-banking area specifically in the Kingdom of Bahrain. To collect relevant data, structured interviews were taken place with e-banking experts in different banks. Then, collected data where used as in input to the risk management framework provided by the National Institute of Standards and Technology (NIST), which was the model used in the study to assess the risks associated with e-banking services. The findings of the study showed that the cyber threats are commonly human errors, technical software or hardware failure, and hackers, on the other hand, the most common attacks facing the e-banking sector were phishing, malware attacks, and denial-of-service. The risks associated with the e-banking services were around the moderate level, however, more controls and countermeasures must be applied to maintain the moderate level of risks. The results of the study will help banks discover their vulnerabilities and maintain their online services, in addition, it will enhance the cyber security and contribute to the management and control of risks that are facing the e-banking sector.

Keywords: cyber security, e-banking, risk assessment, threats identification

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6321 The Analysis of Urban Part-To-Whole Relationship in Terms of Residential Areas: Example of Konya

Authors: Gevher Sayar, Dicle Aydın

Abstract:

The need for shelter which is one of the essential requirement of humanity has emerged for different type of dwelling needs depend on upon different culture and location. Almost all dwellings as an element of the public improvements effect the physical appearance of the city. Dwelling zones create part of whole in terms of urban area use. Whereas in traditional texture merger of parcels create city blocks, in new settlement area city blocks become a part, so the property of each part differs. The perspective of this study is part-to-whole relationship of residential areas and diversified residential areas are illustrated. The purpose of this study is that dwelling applications which have constructed quickly as gated community in the last 20 years in new settlement area of Konya (Turkey) have compared traditional texture in terms of part-to-whole relationship. According to the perception of traditional neighborhood in Konya, the relationship of houses between street pattern and each other are suited for city culture and location. In contrast, new settlement areas cannot become integrated another part of city, they have become restricted areas, so new settlement areas have not integrated, they have separated. The perception of part forms whole has changed, roads provide the relationship of growing parts with one another and walls of gated communities has disjunctive feature. In this study, by using visual analysis photographs and technical drawings are used. Traditional texture and current dwelling have compared.

Keywords: dwelling, residential area, urban part, urban whole

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6320 Review of Concepts and Tools Applied to Assess Risks Associated with Food Imports

Authors: A. Falenski, A. Kaesbohrer, M. Filter

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Introduction: Risk assessments can be performed in various ways and in different degrees of complexity. In order to assess risks associated with imported foods additional information needs to be taken into account compared to a risk assessment on regional products. The present review is an overview on currently available best practise approaches and data sources used for food import risk assessments (IRAs). Methods: A literature review has been performed. PubMed was searched for articles about food IRAs published in the years 2004 to 2014 (English and German texts only, search string “(English [la] OR German [la]) (2004:2014 [dp]) import [ti] risk”). Titles and abstracts were screened for import risks in the context of IRAs. The finally selected publications were analysed according to a predefined questionnaire extracting the following information: risk assessment guidelines followed, modelling methods used, data and software applied, existence of an analysis of uncertainty and variability. IRAs cited in these publications were also included in the analysis. Results: The PubMed search resulted in 49 publications, 17 of which contained information about import risks and risk assessments. Within these 19 cross references were identified to be of interest for the present study. These included original articles, reviews and guidelines. At least one of the guidelines of the World Organisation for Animal Health (OIE) and the Codex Alimentarius Commission were referenced in any of the IRAs, either for import of animals or for imports concerning foods, respectively. Interestingly, also a combination of both was used to assess the risk associated with the import of live animals serving as the source of food. Methods ranged from full quantitative IRAs using probabilistic models and dose-response models to qualitative IRA in which decision trees or severity tables were set up using parameter estimations based on expert opinions. Calculations were done using @Risk, R or Excel. Most heterogeneous was the type of data used, ranging from general information on imported goods (food, live animals) to pathogen prevalence in the country of origin. These data were either publicly available in databases or lists (e.g., OIE WAHID and Handystatus II, FAOSTAT, Eurostat, TRACES), accessible on a national level (e.g., herd information) or only open to a small group of people (flight passenger import data at national airport customs office). In the IRAs, an uncertainty analysis has been mentioned in some cases, but calculations have been performed only in a few cases. Conclusion: The current state-of-the-art in the assessment of risks of imported foods is characterized by a great heterogeneity in relation to general methodology and data used. Often information is gathered on a case-by-case basis and reformatted by hand in order to perform the IRA. This analysis therefore illustrates the need for a flexible, modular framework supporting the connection of existing data sources with data analysis and modelling tools. Such an infrastructure could pave the way to IRA workflows applicable ad-hoc, e.g. in case of a crisis situation.

Keywords: import risk assessment, review, tools, food import

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6319 The Role of Cognitive Control and Social Camouflage Associated with Social Anxiety Autism Spectrum Conditions

Authors: Siqing Guan, Fumiyo Oshima, Eiji Shimizu, Nozomi Tomita, Toru Takahashi, Hiroaki Kumano

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Risk factors for social anxiety in autism spectrum conditions involve executive attention, emotion regulation, and thought regulation as processes of cognitive dysregulation. Social camouflaging behaviors as strategies used to mask and/or compensate for autism characteristics during social interactions in autism spectrum conditions have also been emphasized. However, the role of cognitive dysregulation and social camouflaging related to social anxiety in autism spectrum conditions has not been clarified. Whether these factors are specific to social anxiety in autism spectrum conditions or common to social anxiety independent of autism spectrum conditions needs to be clarified. Here, we explored risk factors specific to social anxiety in autism spectrum conditions and general risk factors for social anxiety independent of autism spectrum conditions. From the Japanese participants in early adulthood (age=18~39) of the online survey in Japan, those who exceeded the Japanese version Autism-Spectrum Quotient cutoff (33 points or more )were divided into the autism spectrum conditions group (ASC; N=255, mean age=32.08, SD age=5.16)and those who did not exceed the cutoff were divided into the non-autism spectrum conditions group (Non-ASC; N=255, mean age=31.70, SD age=5.09). Using the Japanese versions of the Social Phobia Scale, the Social Interaction Anxiety Scale, and the Short Fear of Negative Evaluation Scale, a composite score for social anxiety was calculated using a method of principal. We also measured emotional control difficulties using the Difficulties in Emotion Regulation Scale, executive attention using the Effortful Control Scale for Adults, rumination using the Rumination-Reflection Questionnaire, and worry using the Penn State Worry Questionnaire. This study was passed through the review of the Ethics Committee. No conflicts of interest. Multiple regression analysis with forced entry method was used to predict social anxiety in the ASC and non-ASC groups separately, based on executive attention, emotion dysregulation, worry, rumination, and social camouflage. In the ASC group, emotion dysregulation (β=.277, p<.001), worry (β=.162, p<.05), assimilation (β=.308, p<.001) and masking (β=.275, p<.001) were significant predictors of social anxiety (F (7,247) = 45.791, p <.001, R2=.565). In the non-ASC groups,emotion dysregulation (β=.171, p<.05), worry (β=.344,p <.001), assimilation (β=.366,p <.001) and executive attention (β=-.132,p <.05) were significant predictors of social anxiety (F (7,207) =47.333, p <.001, R2=.615).The findings suggest that masking was shown to be a risk factor for social anxiety specific to autism spectrum conditions, while emotion dysregulation, worry, and assimilation were shown to be common risk factors for social anxiety, regardless of autism spectrum conditions. In addition, executive attention is a risk factor for social anxiety without autism spectrum conditions.

Keywords: autism spectrum, cognitive control, social anxiety, social camouflaging

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6318 Analyzing the Impacts of Sustainable Tourism Development on Residents’ Well-Being Based on Stakeholder Perception: Evidence from a Coastal-Hinterland Region

Authors: Elham Falatoonitoosi, Vikki Schaffer, Don Kerr

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Over-development for tourism and its consequences on residents’ well-being turn into a critical issue in tourism destinations. Learning about undesirable impacts of tourism has led many people to seek more sustainable and responsible tourism. The main objective of this research is to understand how and to what extent sustainable tourism development enhances locals’ well-being regarding stakeholder perception. The research was conducted in a coastal-hinterland tourism region through two sequential phases. At the first phase, a unique set of 19 sustainable tourism indicators resulted from a triplex model was used to examine the sustainability effects on the main factors of residents’ well-being including equity and living condition, life satisfaction, health condition, and education quality. The triplex model including i) systematic literature search, ii) convergent interviewing, and iii) DEMATEL aimed to develop sustainability indicators, specify them for a particular destination, and identify the dominant sustainability issues acting as key predictors in sustainable development. At the second phase, a hierarchical multiple regression was used to examine the relationship between sustainable development and local residents’ well-being. A number of 167 participants from five different groups of stakeholders perceived the importance level of each sustainability indicators regarding well-being factors on 5-point Likert scale. Results from the first phase indicated that sustainability training, government support, tourism sociocultural effects, tourism revenue, and climate change are the top dominant sustainability issues in the regional sustainable development. Results from the second phase showed that sustainable development considerably improves the overall residents’ well-being and has positive relationships with all well-being factors except life satisfaction. It explains that it was difficult for stakeholders to recognize a link between sustainable development and their overall life satisfaction and happiness. Among well-being’s factors, health condition was influenced the most by sustainability indicators that indicate stakeholders believed sustainability development can promote public health, health sector performance, quality of drinking water, and sanitation. For the future research, it is highly recommended to analysis the effects of sustainable tourism development on the other features of a tourism destination’s well-being including residents sociocultural empowerment, local economic growth, and attractiveness of the destination.

Keywords: residents' well-being, stakeholder perception, sustainability indicators, sustainable tourism

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6317 The Influence of Environmental Attributes on Children's Pedestrian-Crash Risk in School Zones

Authors: Jeongwoo Lee

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Children are the most vulnerable travelers and they are at risk for pedestrian injury. Creating a safe route to school is important because walking to school is one of the main opportunities for promotion of needed physical exercise among children. This study examined how the built environmental attributes near an elementary school influence traffic accidents among school-aged children. The study used two complementary data sources including the locations of police-reported pedestrian crashes and the built environmental characteristics of school areas. The environmental attributes of road segments were collected through GIS measurements of local data and actual site audits using the inventory developed for measuring pedestrian-crash risk scores. The inventory data collected at 840 road segments near 32 elementary schools in the city of Ulsan. We observed all segments in a 300-meter-radius area from the entrance of an elementary school. Segments are street block faces. The inventory included 50 items, organized into four domains: accessibility (17items), pleasurability (11items), perceived safety from traffic (9items), and traffic and land-use measures (13items). Elementary schools were categorized into two groups based on the distribution of the pedestrian-crash hazard index scores. A high pedestrian-crash zone was defined as an school area within the eighth, ninth, and tenth deciles, while no pedestrian-crash zone was defined as a school zone with no pedestrian-crash accident among school-aged children between 2013 and 2016. No- and high pedestrian-crash zones were compared to determine whether different settings of the built environment near the school lead to a different rate of pedestrian-crash incidents. The results showed that a crash risk can be influenced by several environmental factors such as a shape of school-route, number of intersections, visibility and land-use in a street, and a type of sidewalk. The findings inform policy for creating safe routes to school to reduce the pedestrian-crash risk among children by focusing on school zones.

Keywords: active school travel, school zone, pedestrian crash, safety route to school

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6316 Governance and Public Policy: The Perception of Efficiency and Equility in Brazil and South Africa

Authors: Paulino V. Tavares, Ana L. Romao

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Public governance represents an articulated arrangement, dynamic and interactive, present in the exercise of authority aimed at strengthening the decision-making procedure in public administration with transparency, accountability, responsiveness and capable of to emerge control and social empowerment, to pursue and achieve the objectives efficiently and with the effectiveness desired by the collective, respecting laws and providing social, institutional and economic equility in society. With this, using a multidimensional approach with the application of three questionnaires to a universe of twenty Counselors of the Courts of Auditors (Brazil), twenty professionals of public administration (Brazil), twenty Government/Provincial Counselors (South Africa), and twenty South African professionals of public administration, the present work aims to capture what is the perception about the efficiency and equility of public policies in Brazil and South Africa. With this, up until now, 30 responses have been obtained, and the results indicate that, in Brazil, 65% affirm due to the inefficiency of public policies, 70% point out that they do not believe in the equility of these same policies. In South Africa, the results indicate that 45% believe in government efficiency, and, with regard to the equility of public policies, 65% do not believe. In Brazil, the research reveals at least three reasons for this result, that is, lack of planning, lack of clear objectives of public policies, and lack of information on the part of society, while in South Africa, so far, research has not identified a specific reason for this result.

Keywords: efficiency, equility, governance, public policy

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6315 Benefits of Monitoring Acid Sulfate Potential of Coffee Rock (Indurated Sand) across Entire Dredge Cycle in South East Queensland

Authors: S. Albert, R. Cossu, A. Grinham, C. Heatherington, C. Wilson

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Shipping trends suggest increasing vessel size and draught visiting Australian ports highlighting potential challenges to port infrastructure and requiring optimization of shipping channels to ensure safe passage for vessels. The Port of Brisbane in Queensland, Australia has an 80 km long access shipping channel which vessels must transit 15 km of relatively shallow coffee rock (generic class of indurated sands where sand grains are bound within an organic clay matrix) outcrops towards the northern passage in Moreton Bay. This represents a risk to shipping channel deepening and maintenance programs as the dredgeability of this material is more challenging due to its high cohesive strength compared with the surrounding marine sands and potential higher acid sulfate risk. In situ assessment of acid sulfate sediment for dredge spoil control is an important tool in mitigating ecological harm. The coffee rock in an anoxic undisturbed state does not pose any acid sulfate risk, however when disturbed via dredging it’s vital to ensure that any present iron sulfides are either insignificant or neutralized. To better understand the potential risk we examined the reduction potential of coffee rock across the entire dredge cycle in order to accurately portray the true outcome of disturbed acid sulfate sediment in dredging operations in Moreton Bay. In December 2014 a dredge trial was undertaken with a trailing suction hopper dredger. In situ samples were collected prior to dredging revealed acid sulfate potential above threshold guidelines which could lead to expensive dredge spoil management. However, potential acid sulfate risk was then monitored in the hopper and subsequent discharge, both showing a significant reduction in acid sulfate potential had occurred. Additionally, the acid neutralizing capacity significantly increased due to the inclusion of shell fragments (calcium carbonate) from the dredge target areas. This clearly demonstrates the importance of assessing potential acid sulfate risk across the entire dredging cycle and highlights the need to carefully evaluate sources of acidity.

Keywords: acid sulfate, coffee rock, indurated sand, dredging, maintenance dredging

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6314 Occupational Health Assessment in a Telco Account: A Workplace Integrated Safety and Health and Cornell Musculoskeletal Discomfort Questionnaire Analysis Among Diverse Employees at Alorica

Authors: Karl Bryant Buan, Owaida Macadadaya Jr., Mon Eleazar Nonato, Zeke Andrew Palabrica, Charistabelle Mae Santiago

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This study explored the occupational health risks faced by employees in the Business Process Outsourcing (BPO) industry, particularly in the Telco Account department of Alorica. The study used a stratified sampling method and a diagnostic tool called Workplace Integrated Safety and Health (WISH) Assessment to measure and evaluate the employees' perception of workplace health and safety. The results showed that more than 50% of call center workers reported feeling emotionally drained, sleep deprived, burnt out, and in need of anxiety or stress medication due to their work. Additionally, there was a significant difference in the perception of employee diversity, specifically in terms of leadership commitment, participation, policies, programs, and practices. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) results revealed that most employees complained of discomfort in their lower back, shoulder, upper back, neck, and hip. The researchers recommended an implementation plan for alternative work set-up, a satisfaction survey for employees, team-building activities or programs, and motivational approaches through benefits, incentives, and rewards.

Keywords: WISH assessment, CMDQ, ANOVA, diverse SOGIESC

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6313 Vine Copula Structure among Yield, Price and Weather Variables for Rating Crop Insurance Premium

Authors: Jiemiao Chen, Shuoxun Xu

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The main goal of our research is to apply the Vine copula measuring dependency between price, temperature, and precipitation indices to calculate a fair crop insurance premium. This research is focused on Worth, Iowa, United States, over the period from 2000 to 2020, where the farmers are dependent on precipitation and average temperature during the growth period of corn. Our proposed insurance considers both the natural risk and the price risk in agricultural production. We first estimate the distributions of crops using parametric methods based on Goodness of Fit tests, and then Vine Copula is applied to model dependence between yield price, crop yield, and weather indices. Once the vine structure and its parameters are determined based on AIC/BIC criteria and forecasting price and yield are obtained from the ARIMA model, we calculate this crop insurance premium using the simulation data generated from the vine copula by the Monte Carlo Simulation method. It is shown that, compared with traditional crop insurance, our proposed insurance is more fair and thus less costly for the farmers and government.

Keywords: vine copula, weather index, crop insurance premium, insurance risk management, Monte Carlo simulation

Procedia PDF Downloads 185
6312 Assessment of Knowledge, Attitude and Perception of Drug Resistance in Rural Communities of ADA District, Central Ethiopia

Authors: Argaw Amare, Abbuna Fuffa, Stringer Andy

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Improving public knowledge and changing their attitudes towards antibiotic use will be a crucial early strategy to contain Antibiotic resistance. The current study was undertaken from November 2015 to June 2016. A cross-sectional survey using a pretested questionnaire was conducted on 392 residents (330 male and 62 female) aged 18 and above. Participants were selected randomly. Data was analyzed using simple descriptive statistics; the Chi-square test was used to determine any significant difference. The majority of participants (81%) were farmers in their occupation. Most of the respondents (76%) were not able to define the difference between antimicrobials and antibiotics. Furthermore, (61%) of participants were not able to define what antibiotics and for what purpose they are used. Thirty-four percent of participants do not know the names of antibiotics they have used for their animals and for themselves. Nearly 68% have no knowledge about the disease they have been treated for. The majority of participants (73.5%) agree to complete their course of treatment even if they feel better. About 72.5% of participants disagree that antibiotics are safe and can be used to treat different diseases, without prescription. Most of the participants (95%) treat their animals after diagnosis; more than 80% of them agree to not purchase veterinary drugs from local traders. This study showed that the participants have poor knowledge and good attitude, with an average score of 41.3±16.1% and 79.6±16, respectively. Knowledge and attitude are significantly correlated (p<0.01). The participants in this study had a good attitude toward the rational use of antibiotics. Whereas they lack knowledge with regard to the kinds of antibiotics and the diseases they are prescribed for. Therefore, further educational interventions are necessary to improve their understanding of the antibiotics currently available and the major bacterial diseases they are prescribed.

Keywords: AMR, knoweledge, attitude, perception

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6311 The Effectiveness of an Injury Prevention Workshop in Increasing Knowledge and Understanding in Grass-Root Youth Coaches

Authors: Mark De Ste Croix, Jonathan Hughes, Francisco Ayala, Michal Lehnert

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There are well-known challenges to implementing injury prevention training for youth players but no data are available on the knowledge and understanding of deliverers of such programmes at grass root level. To increase adoption and adherence to such programmes coach knowledge and understanding of injury risk and prevention is essential. Therefore, the purpose of this study was to examine grass-root coaches knowledge and understanding of injury risk and prevention in youth players. 68 grass root coaches (18 females and 50 males) who were attending a one-day injury prevention workshop completed a modified validated questionnaire exploring knowledge and understanding of injury risk and prevention in youth players. Only 59% of coaches agreed that youth players are at a high risk of suffering an injury. There were high levels of agreement that injuries can have negative impacts on team performance (75%) and can cause physical problems in later life (85%), however only around half of coaches felt that injuries affect youth players current quality of life (59%). There was strong agreement that it is possible to prevent injuries in youth players (84%), but coaches were generally unaware of programs to help prevent injuries (84%), and only 9% used some form of injury prevention program. Despite this, nearly all coaches felt that their coaching could benefit from a greater understanding of growth and maturation (91%), injury prevention programmes (91%) and specific exercises (93%) for youth athletes. 17% of coaches rated their knowledge of injury prevention as good/very good at the start of the workshop and this increased to 94% at the end of the workshop. 62% of coaches identified their attitude towards injury prevention as indifferent at the start of the workshop compared with only 1% at the end. Only 14% of coaches at the start of the workshop were confident to deliver an injury prevention session but 83% stated they were confident by the end of the workshop. Finally, 98% of coaches felt that the workshop provided them with the confidence and the knowledge to deliver an injury prevention session and 98% suggested that they would implement injury prevention into their coaching. These data suggest that there is a lack of understanding of grass root coaches that children are a high-risk group for injuries, and that such injuries impact on current quality of life. Despite understanding that injuries can be prevented most grass root coaches do not have the knowledge to implement injury prevention into their coaching and very few do. There is a common consensus amongst these coaches that a greater understanding of such programmes will enhance their coaching. The injury prevention workshop appears to have increased the knowledge and changed the attitude of coaches towards injury prevention. All coaches felt that the workshop provided them with the tools to adopt, implement and deliver injury prevention in their coaching. These data highlight that there is a clear need for education regarding injury risk and prevention to be embedded within the coach education pathway, especially at grass root level.

Keywords: coach education, injury prevention, knowledge, and understanding, youth

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6310 Learners' Perception of Digitalization of Medical Education in a Low Middle-Income Country – A Case Study of the Lecturio Platform

Authors: Naomi Nathan

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Introduction Digitalization of medical education can revolutionize how medical students learn and interact with the medical curriculum across contexts. With the increasing availability of the internet and mobile connectivity in LMICs, online medical education platforms and digital learning tools are becoming more widely available, providing new opportunities for learners to access high-quality medical education and training. However, the adoption and integration of digital technologies in medical education in LMICs is a complex process influenced by various factors, including learners' perceptions and attitudes toward digital learning. In Ethiopia, the adoption of digital platforms for medical education has been slow, with traditional face-to-face teaching methods still being the norm. However, as access to technology improves and more universities adopt digital platforms, it is crucial to understand how medical students perceive this shift. Methodology This study investigated medical students' perception of the digitalization of medical education in relation to their access to the Lecturio Digital Medical Education Platform through a capacity-building project. 740 medical students from over 20 medical universities participated in the study. The students were surveyed using a questionnaire that included their attitudes toward the digitalization of medical education, their frequency of use of the digital platform, and their perceived benefits and challenges. Results The study results showed that most medical students had a positive attitude toward digitalizing medical education. The most commonly cited benefit was the convenience and flexibility of accessing course material/curriculum online. Many students also reported that they found the platform more interactive and engaging, leading to a more meaningful learning experience. The study also identified several challenges medical students faced when using the platform. The most commonly reported challenge was the need for more reliable internet access, which made it difficult for students to access content consistently. Overall, the results of this study suggest that medical students in Ethiopia have a positive perception of the digitalization of medical education. Over 97% of students continuously expressed a need for access to the Lecturio platform throughout their studies. Conclusion Significant challenges still need to be addressed to fully realize the Lecturio digital platform's benefits. Universities, relevant ministries, and various stakeholders must work together to address these challenges to ensure that medical students fully participate in and benefit from digitalized medical education - sustainably and effectively.

Keywords: digital medical education, EdTech, LMICs, e-learning

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6309 Psychiatric Risk Assessment in the Emergency Department: The Impact of NEAT on the Management of Mental Health Patients

Authors: Euan Donley

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Emergency Departments (EDs) are heavily burdened as presentation rates continue to rise. To improve patient flow National Emergency Access Targets (NEAT) were introduced. NEAT implements timelines for ED presentations, such as discharging patients within four hours of arrival. Mental health patients use EDs more than the general population and are generally more complex in their presentations. The aim of this study is to examine the impact of NEAT on psychiatric risk assessment of mental health patients in the ED. Seventy-eight mental health clinicians from 7 Victoria, Australia, hospital EDs participated in a mixed method analysis via anonymous online survey. NEAT was considered helpful as mental health patients were seen quicker, were less likely to abscond, could improve teamwork amongst ED staff, and in some cases administrative processes were better streamlined. However, clinicians felt that NEAT was also responsible for less time with patients and relatives’, resulted in rushed assessments, placed undue pressure on mental health clinicians, was not conducive to training, and the emphasis on time was the wrong focus for patient treatment. The profile of a patient typically likely to be treated within NEAT timelines showed a perfect storm of luck and compliance. If a patient was sober, medically stable, referred early, did not require much collateral information and did not have distressed relatives, NEAT was more likely to be met. Organisationally participants reported no organisational change or training to meet NEAT. Poor mental health staffing, multiple ED presentations and a shortage of mental health beds also hamper meeting NEAT. Findings suggest participants were supportive of NEAT in principle, but a demanding workload and organisational barriers meant NEAT had an overall negative effect on psychiatric risk assessment of mental health patients in ED.

Keywords: assessment, emergency, risk, psychiatric

Procedia PDF Downloads 502