Search results for: delayed discharge

Authors: Usman Dahiru, Faisal Saleem, Kui Zhang, Adam Harvey

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Volatile organic compounds (VOCs) are atmospheric contaminants predominantly derived from petroleum spills, solvent usage, agricultural processes, automobile, and chemical processing industries, which can be detrimental to the environment and human health. Environmental problems such as the formation of photochemical smog, organic aerosols, and global warming are associated with VOC emissions. Research showed a clear relationship between VOC emissions and cancer. In recent years, stricter emission regulations, especially in industrialized countries, have been put in place around the world to restrict VOC emissions. Non-thermal plasmas (NTPs) are a promising technology for reducing VOC emissions by converting them into less toxic/environmentally friendly species. The dielectric barrier discharge (DBD) plasma is of interest due to its flexibility, moderate capital cost, and ease of operation under ambient conditions. In this study, a dielectric barrier discharge (DBD) reactor has been developed for the decomposition of cyclohexane (as a VOC model compound) using nitrogen, dry, and humidified air carrier gases. The effect of specific input energy (1.2-3.0 kJ/L), residence time (1.2-2.3 s) and concentration (220-520 ppm) were investigated. It was demonstrated that the removal efficiency of cyclohexane increased with increasing plasma power and residence time. The removal of cyclohexane decreased with increasing cyclohexane inlet concentration at fixed plasma power and residence time. The decomposition products included H₂, CO₂, H₂O, lower hydrocarbons (C₁-C₅) and solid residue. The highest removal efficiency (98.2%) was observed at specific input energy of 3.0 kJ/L and a residence time of 2.3 s in humidified air plasma. The effect of humidity was investigated to determine whether it could reduce the formation of solid residue in the DBD reactor. It was observed that the solid residue completely disappeared in humidified air plasma. Furthermore, the presence of OH radicals due to humidification not only increased the removal efficiency of cyclohexane but also improves product selectivity. This work demonstrates that cyclohexane can be converted to smaller molecules by a dielectric barrier discharge (DBD) non-thermal plasma reactor by varying plasma power (SIE), residence time, reactor configuration, and carrier gas.

Keywords: cyclohexane, dielectric barrier discharge reactor, non-thermal plasma, removal efficiency

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Authors: Prashant Neupane, Sumitra Kafle, Asmi Pandey, Laura Mitchell

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Pain following caesarean section can influence recovery, patient satisfaction, breast feeding success and mother-child bonding. Since the introduction of enhanced recovery protocols, mothers are often discharged 24 hours later. We identified concerns within our hospital with mothers tolerating poorly controlled pain in order to achieve earlier discharge and subsequently suffering significant pain at home with inadequate analgesia. Methods: We conducted a prospective audit of analgesic prescribing and post-operative pain scores after caesarean section. Mothers were seen on post-operative day one, their pain score recorded on a verbal analogue score from 0-10, and their prescription chart reviewed. A follow-up phone call was then made on post-operative day 3-7 to enquire about pain scores and analgesia use at home. Following this, a standardized proforma for prescribing after the caesarean section was introduced, including the addition of dihydrocodeine that patients can take home following discharge. There were educational update sessions for anesthetists and midwifes, and then a re-audit was conducted months later. Results: Data was collected from 50 women before and after the introduction of the change. Initial audit showed that there was considerable variation in prescribing, with four women prescribed no regular analgesia at all and inconsistency in the dose of oral morphine prescribed. Women were not given any form of analgesia to take home after discharge and were advised to take regular paracetamol and ibuprofen. However, 31/50 (62%) reported that they needed additional analgesia and eight women (16%) even sought prescription for additional analgesia from elsewhere. After the introduction of the change, prescribing was more consistent with all patients prescribed regular analgesia. 46/50 patients were given dihydrocodeine on discharge. Mean pain scores on post-operative day one improved from 5.16 to 3.9, and at home improved from 6.18 to 2.58. Use of dihydrocodeine at home significantly improved patients reporting of severe pain at home from 24% to zero. Discussion: Lack of strong analgesia out of the hospital and the increased demands on activity levels means that women are frequently in more pain at home after discharge. Introduction of a standardized prescription proforma, including the use of to-take-out dihydrocodeine, was successful in improving patient pain scores and the requirement for additional analgesia, both in hospital and at home.

Keywords: analgesia, caesarean section, post-operative pain, standardised

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Authors: Cheong Hyeon Oh, Dongho Nam, Byungsik Kim

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Due to the recent climate change, flood damage caused by local floods and typhoons has frequently occurred, the incidence rate and intensity of wildfires are greatly increased due to increased temperatures and changes in precipitation patterns. Wildfires cause primary damage, such as loss of forest resources, as well as secondary disasters, such as landslides, floods, and debris flow. In many countries around the world, damage and economic losses from secondary damage are occurring as well as the direct effects of forest fires. Therefore, in this study, the Rainfall-Runoff model(S-RAT) was used for the wildfire affected areas in Gangneung and Goseong, which occurred on April 2019, when the stability of vegetation and soil were destroyed by wildfires. Rainfall data from Typhoon Rusa were used in the S-RAT model, and flood discharge was calculated according to changes in land cover before and after wildfire damage. The results of the calculation showed that flood discharge increased significantly due to changes in land cover, as the increase in flood discharge increases the possibility of the occurrence of the debris flow and the extent of the damage, the debris flow height and range were calculated before and after forest fire using RAMMS. The analysis results showed that the height and extent of damage increased after wildfire, but the result value was underestimated due to the characteristics that using DEM and maximum flood discharge of the RAMMS model. This research was supported by a grant(2017-MOIS31-004) from Fundamental Technology Development Program for Extreme Disaster Response funded by Korean Ministry of Interior and Safety (MOIS). This paper work (or document) was financially supported by Ministry of the Interior and Safety as 'Human resoure development Project in Disaster management'.

Keywords: wildfire, debris flow, land cover, rainfall-runoff meodel S-RAT, RAMMS, height

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Authors: B. Rajesh Kamath, J. Sundara Rajan, M. K. Veeraiah, M. Z. Kurian

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Insulation performance of a gas insulated system is severely affected by particle contaminants. These metallic particles adversely affect the characteristics of insulating system. These particles can produce surface charges due to partial discharge activities. These particles which are free to move enhance the local electric fields. This paper deals with the influence of conducting particle placed in a co-axial duct on the discharge characteristics of gas mixtures. Co-axial duct placed in a high pressure chamber is used for the purpose. A gas pressure of 0.1, 0.2 and 0.3 MPa have been considered with a 10:90 SF₆ and N₂ gas mixtures. The 2D and 3D histograms of clean duct and duct with copper particle are discussed in this paper.

Keywords: coaxial duct, gas insulated system, gas mixtures, metallic particle, partial discharges, histograms

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Authors: Azazhu Wassie

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This study tried to evaluate the maximum design flood for appurtenance structure design using the given climatological and hydrological data analysis on the referenced study area. The maximum design flood is determined by using flood frequency analysis. Using this method, the peak discharge is 32,583.67 m3/s, but the data is transferred because the dam site is not on the gauged station. Then the peak discharge becomes 38,115 m3/s. The study was conducted in June 2023. This dam is built across a river to create a reservoir on its upstream side for impounding water. The water stored in the reservoir is used for various purposes, such as irrigation, hydropower, navigation, fishing, etc. The total average volume of annual runoff is estimated to be 115.1 billion m3. The total potential of the land for irrigation development can go beyond 3 million ha.

Keywords: dam design, flow duration curve, peak flood, rainfall, reservoir capacity, risk and reliability

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Authors: Junaid N. Chauhdary, Bernard A. Engel, Allah Bakhsh

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Solar powered tubewells can be a reliable and affordable source of supplying irrigation water compared with electric or diesel operated tubewells due to frequent load shedding and soaring energy prices. A study was conducted on a solar tubewell installed at the Water Management Research Center (WMRC), University of Agriculture, Faisalabad to investigate the viability of a solar powered tubewell in terms of discharge and benefit cost ratio. The tubewell discharge was 50 m3hr-1 with a total dynamic head of 30 m. The depth of bore was 31 m (14 m blind + 17 m screen) with a casing diameter of 15.2 cm (6 inches). A 3-stage submersible pump of 10.2 cm (4 inch) diameter was lowered in the casing to a depth of 22 m. The pump was powered from 21 solar panels of 200 W capacity each. The tubewell peak discharge was observed as 6 and 7 hr day-1 in winter and summer, respectively. The breakeven analysis of the solar tubewell showed that the payback period of the solar tubewell was 1.5 years of its 10 year usable life with an IRR (internal rate of return) of 69 %. The BCR (benefit cost ratio) of the solar tubewell at 2, 4, 6, and 8 percent discount rate were 3.75, 3.45, 3.19 and 2.96, respectively. The NPV (net present value) of the solar tubewell at 2, 4, 6, and 8 % discount rates were 1.89, 1.65, 1.45 and 1.27 million rupees, respectively. These results indicated that the solar powered tubewells are a viable option as well as environmentally friendly and can be adopted by the farmers due to their affordable payback period.

Keywords: benefit cost ratio, internal rate of return (IRR), net present value (NPV), solar tubewell

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Authors: Cheryl Forchuk, Sandra Fisman, Steve Cordes, Dan Catunto, Katherine Krakowski, Melissa Jeffrey, John D’Oria

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The discharge of youth aged 16-25 from hospital into homelessness is a prevalent issue despite research indicating social, safety, health and economic detriments on both the individual and community. Lack of stable housing for youth discharged into homelessness results in long-term consequences, including exacerbation of health problems and costly health care service use and hospital readmission. People experiencing homelessness are four times more likely to be readmitted within one month of discharge and hospitals must spend $2,559 more per client. Finding safe housing for these individuals is imperative to their recovery and transition back to the community. People discharged from hospital to homelessness experience challenges, including poor health outcomes and increased hospital readmissions. Youth are the fastest-growing subgroup of people experiencing homelessness in Canada. The needs of youth are unique and include supports related to education, employment opportunities, and age-related service barriers. This study aims to identify the needs of youth at risk of homelessness by evaluating the efficacy of the “Preventing Discharge to No Fixed Address – Youth” (NFA-Y) program, which aims to prevent youth from being discharged from hospital into homelessness. The program connects youth aged 16-25 who are inpatients at London Health Sciences Centre and St. Joseph’s Health Care London to housing and financial support. Supports are offered through collaboration with community partners: Youth Opportunities Unlimited, Canadian Mental Health Association Elgin Middlesex, City of London Coordinated Access, Ontario Works, and Salvation Army’s Housing Stability Bank. This study was reviewed and approved by Western University’s Research Ethics Board. A series of interviews are being conducted with approximately ninety-three youth participants at three time points: baseline (pre-discharge), six, and twelve months post-discharge. Focus groups with participants, health care providers, and community partners are being conducted at three-time points. In addition, administrative data from service providers will be collected and analyzed. Since homelessness has a detrimental effect on recovery, client and community safety, and healthcare expenditure, locating safe housing for psychiatric patients has had a positive impact on treatment, rehabilitation, and the system as a whole. If successful, the findings of this project will offer safe policy alternatives for the prevention of homelessness for at-risk youth, help set them up for success in their future years, and mitigate the rise of the homeless youth population in Canada.

Keywords: youth homelessness, no-fixed address, mental health, homelessness prevention, hospital discharge

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Authors: Mdoe Mwajuma Bakari, Mselle Lilian Teddy, Kibusi Stephen Mathew

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Background: Due to the increase of caesarean section (CS), many women are discharge early to their home. Women should be aware on how to take care of themselves at home after CS. Evidence shows non-uniform health education on home care after CS are provided to post CS mothers because of lack of standard home care guideline on home after CS; as existing guidelines explore only care of women in hospital setting, for health care workers. There is a need to develop post CS home care guide; exploring contents of home based care education after CS provided by nurse midwives will inform the development of the guide. Objective: To explore the content of health education provided by nurse midwives to post CS mother about home care after hospital discharge in Dodoma, Tanzania. Methodology: An exploratory qualitative study using in-depth interview was conducted in this study using triangulation of data collection method; where 14 nurse midwives working in maternity unit and 11 post CS mother attending their post-natal clinic were recruited. Content analysis was used to generate themes that describe health education information provided by nurse midwives to post CS mother about home care after hospital discharge. Results: The study found that, nutrition health education, maternal and newborn hygiene care of caesarean wound at home were the component of health education provided to post CS mothers by nurse midwives. Contradicting instruction were found to be provided to post CS mothers. Conclusion: This study reported non-uniform health education provided by the nurse midwives on home care after CS. Despite of the fact that nurse midwives recognizes the need to provide health education to the post CS mothers, there is a need to develop home care guideline as a reference for their education to ensure uniform package of education is provided to post CS mothers in order to improve recovery of post CS mothers from CS.

Keywords: caesarean section, home care, discharge education, homecare after caesarean section

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Authors: Malek Mahmoudi, Jonas Keruckas, Dmytro Volyniuk, Jurate Simokaitiene, Juozas V. Grazulevicius

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Host materials have been discovered as one of the most appealing methods for harvesting triplet states in organic materials for application in organic light-emitting diodes (OLEDs). The ideal host-guest system for emission in thermally delayed fluorescence OLEDs with 20% guest concentration for efficient energy transfer has been demonstrated in the present investigation. In this work, 3,3'-bis[9-(4-fluorophenyl) carbazole] (bFPC) has been used as the host, which induces balanced charge carrier transport for high-efficiency OLEDs.For providing a complete characterization of the synthesized compound, photophysical, photoelectrical, charge-transporting, and electrochemical properties of the compound have been examined. Excited-state lifetimes and singlet-triplet energy gaps were measured for characterization of photophysical properties, while thermogravimetric analysis, as well as differential scanning calorimetry measurements, were performed for probing of electrochemical and thermal properties of the compound. The electrochemical properties of this compound were investigated by cyclic voltammetry (CV) method, and ionization potential (IPCV) value of 5.68 eV was observed. UV–Vis absorption and photoluminescence spectrum of a solution of the compound in toluene (10-5 M) showed maxima at 302 and 405 nm, respectively. Photoelectron emission spectrometry was used for the characterization of charge-injection properties of the studied compound in solid. The ionization potential of this material was found to be 5.78 eV, and time-of-flight measurement was used for testing charge-transporting properties and hole mobility estimated using this technique in a vacuum-deposited layer reached 4×10-4 cm2 V-1s-1. Since the compound with high charge mobilities was tested as a host in an organic light-emitting diode. The device was fabricated by successive deposition onto a pre-cleaned indium tin oxide (ITO) coated glass substrate under a vacuum of 10-6 Torr and consisting of an indium-tin-oxide anode, hole injection and transporting layer(MoO3, NPB), emitting layer with bFPC as a host and 4CzIPN (2,4,5,6-tetra(9-carbazolyl)isophthalonitrile) which is a new highly efficient green thermally activated delayed fluorescence (TADF) material as an emitter, an electron transporting layer(TPBi) and lithium fluoride layer topped with aluminum layer as a cathode exhibited the highest maximum current efficiency and power efficiency of 33.9 cd/A and 23.5 lm/W, respectively and the electroluminescence spectrum showed only a peak at 512nm. Furthermore, the new bicarbazole-based compound was tested as a host in thermally activated delayed fluorescence organic light-emitting diodes are reaching luminance of 25300 cd m-2 and external quantum efficiency of 10.1%. Interestingly, the turn-on voltage was low enough (3.8 V), and such a device can be used for highly efficient light sources.

Keywords: thermally-activated delayed fluorescence, host material, ionization energy, charge mobility, electroluminescence

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Authors: Romisaa Ali

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This paper presents a comparison between twin-delayed Deep Deterministic Policy Gradient (TD3) and Soft Actor-Critic (SAC) reinforcement learning algorithms in the context of training robust navigation policies for Jackal robots. By leveraging an open-source framework and custom motion control environments, the study evaluates the performance, robustness, and transferability of the trained policies across a range of scenarios. The primary focus of the experiments is to assess the training process, the adaptability of the algorithms, and the robot’s ability to navigate in previously unseen environments. Moreover, the paper examines the influence of varying environmental complexities on the learning process and the generalization capabilities of the resulting policies. The results of this study aim to inform and guide the development of more efficient and practical reinforcement learning-based navigation policies for Jackal robots in real-world scenarios.

Keywords: Jackal robot environments, reinforcement learning, TD3, SAC, robust navigation, transferability, custom environment

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Authors: S. Haque, M. Kanapathy, E. Bollen, I. Younis, A. Mosahebi

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Background: Implant loss due to infection is the most devastating complication of implant-based breast reconstruction. The use of negative pressure wound therapy with instillation (NPWTi) for salvage of infected implant-based breast reconstructions has shown promising results to allow early reinsertion of a new implant as an alternative to current management of delayed reinsertion. This study compares the cost implication of NPWTi against current management of delayed reinsertion of infected breast implants. Methods: 20 cases of an infected breast implant treated with NPWTi (V.A.C. VERAFLO™ Therapy) followed by early re-insertion of a new implant were compared with 20 cases who had delayed reinsertion (non-NPWTi). Average cost per person was calculated using total operative expenses, cost of inpatient stay, cost of investigations, cost of antibiotics, and cost of outpatient visits. Results: Treatment with NPWTi allowed for earlier re-insertion of a new implant (NPWTi: 9.04 ± 2.92 days vs. non-NPWTi: 236.25 ± 123.89 days). The average cost per patient for NPWTi and non-NPWTi was £14,343.13 ± £2,786.70 and £8,920.31 ± £3,005.73 respectively. All patients treated with NPWTi had one admission and spent 11.9 ± 4.1days as an inpatient while non-NPWTi patients had 2.1 ± 0.3 admissions with total length of inpatient stay of 7.1 ± 5.8days. Patients treated with NPWTi had more surgeries (NPWTi: 3.35 ± 0.81 vs. non-NPWTi: 2.2 ± 0.41), however 3 non-NPWTi cases required flap reconstruction. Patients treated with NPWTi had fewer total outpatient visits (NPWTi: 12 ± 6 vs. non-NPWTi: 14.2 ± 6.3). Conclusion: Patients treated with NPWTi incurred higher average cost per patient, longer inpatient stay, and more procedures; however, had early re-insertion of new implants and fewer admissions and outpatient visits. A further study on patient-reported outcome is essential to compare cost against patient benefit.

Keywords: breast reconstruction, cost evaluation, infection, negative pressure wound therapy

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Authors: Anjali Vanpariya, Priyanka Marathey, Sakshum Khanna, Roma Patel, Indrajit Mukhopadhyay

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Silicon (Si) is a promising negative electrode material for lithium-ion batteries (LiBs) due to its low cost, non-toxicity, and a high theoretical capacity of 4200 mAhg⁻¹. The primary challenge of the application of Si-based LiBs is large volume expansion (~ 300%) during the charge-discharge process. Incorporation of graphene, carbon nanotubes (CNTs), morphological control, and nanoparticles was utilized as effective strategies to tackle volume expansion issues. However, molten salt methods can resolve the issue, but high-temperature requirement limits its application. For sustainable and practical approach, room temperature (RT) based methods are essentially required. Use of ionic liquids (ILs) for electrodeposition of Si nanostructures can possibly resolve the issue of temperature as well as greener media. In this work, electrodeposition of Si nanoparticles on gold substrate was successfully carried out in the presence of ILs media, 1-butyl-3-methylimidazolium-bis (trifluoromethyl sulfonyl) imide (BMImTf₂N) at room temperature. Cyclic voltammetry (CV) suggests the sequential reduction of Si⁴⁺ to Si²⁺ and then Si nanoparticles (SiNs). The structure and morphology of the electrodeposited SiNs were investigated by FE-SEM and observed interconnected Si nanoparticles of average particle size ⁓100-200 nm. XRD and XPS data confirm the deposition of Si on Au (111). The first discharge-charge capacity of Si anode material has been found to be 1857 and 422 mAhg⁻¹, respectively, at current density 7.8 Ag⁻¹. The irreversible capacity of the first discharge-charge process can be attributed to the solid electrolyte interface (SEI) formation via electrolyte decomposition, and trapped Li⁺ inserted into the inner pores of Si. Pulverization of SiNs results in the creation of a new active site, which facilitates the formation of new SEI in the subsequent cycles leading to fading in a specific capacity. After 20 cycles, charge-discharge profiles have been stabilized, and a reversible capacity of 150 mAhg⁻¹ is retained. Electrochemical impedance spectroscopy (EIS) data shows the decrease in Rct value from 94.7 to 47.6 kΩ after 50 cycles of charge-discharge, which demonstrates the improvements of the interfacial charge transfer kinetics. The decrease in the Warburg impedance after 50 cycles of charge-discharge measurements indicates facile diffusion in fragmented and smaller Si nanoparticles. In summary, Si nanoparticles deposited on gold substrate using ILs as media and characterized well with different analytical techniques. Synthesized material was successfully utilized for LiBs application, which is well supported by CV and EIS data.

Keywords: silicon nanoparticles, ionic liquid, electrodeposition, cyclic voltammetry, Li-ion battery

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Authors: K. K. Soundra Pandian, Bhupendra Gupta

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In the modern era, as the application data’s are massive and complex, it needs to be secured from the adversary attack. In this context, a non-recursive key based integrated spritz stream cipher with the circulant hash function using delayed feedback with carry shift register (d-FCSR) is proposed in this paper. The novelty of this proposed stream cipher algorithm is to engender the improved keystream using d-FCSR. The proposed algorithm is coded using Verilog HDL to produce dynamic binary key stream and implemented on commercially available FPGA device Virtex 5 xc5vlx110t-2ff1136. The implementation of stream cipher using d-FCSR on the FPGA device operates at a maximum frequency of 60.62 MHz. It achieved the data throughput of 492 Mbps and improved in terms of efficiency (throughput/area) compared to existing techniques. This paper also briefs the cryptanalysis of proposed circulant hash value based spritz stream cipher using d-FCSR is against the adversary attack on a hardware platform for the hardware based cryptography applications.

Keywords: cryptography, circulant function, field programmable gated array, hash value, spritz stream cipher

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Authors: Mohsen S. Sajadieha, Danyar Molavia

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In this paper, a truck scheduling problem is investigated at a two-touch cross-docking center with due dates for outbound trucks as a hard constraint. The objective is to minimize the total cost comprising penalty and delivery cost of delayed shipments. The sequence of unloading shipments is considered and is assumed that shipments are sent to shipping dock doors immediately after unloading and a First-In-First-Out (FIFO) policy is considered for loading the shipments. A mixed integer programming model is developed for the proposed model. Two meta-heuristic algorithms including genetic algorithm (GA) and variable neighborhood search (VNS) are developed to solve the problem in medium and large sized scales. The numerical results show that increase in due dates for outbound trucks has a crucial impact on the reduction of penalty costs of delayed shipments. In addition, by increase the due dates, the improvement in the objective function arises on average in comparison with the situation that the cross-dock is multi-touch and shipments are sent to shipping dock doors only after unloading the whole inbound truck.

Keywords: cross-docking, truck scheduling, fixed due date, door assignment

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Authors: Zhihong Luo, Guangbin Zhu, Lulu Guo, Zhujun Lyu, Kun Luo

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Cycling life has become the threshold for the prospective application of Li-O₂ batteries, and the protection of Li anode has recently regarded as the key factor to the performance. Herein, a simple low rate pre-activation (20 cycles at 0.5 Ag⁻¹ and a capacity of 200 mAh g⁻¹) was employed to effectively improve the performance and cyclability of Li-O₂ batteries. The charge/discharge cycles at 1 A g⁻¹ with a capacity of 1000 mAh g⁻¹ were maintained for up to 290 times versus 55 times for the cell without pre-activation. The ultimate battery capacity and high rate discharge property were also largely enhanced. Morphology, XRD and XPS analyses reveal that the performance improvement is in close association with the formation of the smooth and compact surface layer formed on the Li anode after low rate pre-activation, which apparently alleviated the corrosion of Li anode and the passivation of cathode during battery cycling, and the corresponding mechanism was also discussed.

Keywords: lithium oxygen battery, pre-activation, cyclability, capacity

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Authors: Asmae Tafraouti, Yasmina Layouni

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The fabrication of cylindrical Tungsten micro-tools with a high aspect ratio is a real challenge because of several constraints that come into during their manufacture. In this paper, we will describe the process used to fabricate these micro-tools. It consists of using electrochemical etching. We will also present the optimal protocol that makes it possible to fabricate micro-tools with a high aspect ratio in a reproducible way. Next, we will show the limit of the experimental parameters chosen to manufacture micro-tools from a wire with an initial diameter of Φ_0=250µm. The protocol used allows obtaining an average diameter of Φ=88µm ±1 µm over a length of L=3.5mm.

Keywords: drop-off effect, electrochemical etching, micro-electrical discharge machining, tungsten micro-tools

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Authors: Scott Ashby, Emily Granger, Mark Connellan

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Background: In-hospital management of Out-of-Hospital Cardiac Arrest (OHCA) is complex as the aetiologies are varied. Acute coronary angiography has been shown to improve outcomes for patients with coronary occlusion as the cause; however, these patients are difficult to identify. ECG results may help identify these patients, but the accuracy of this diagnostic test is under debate, and requires further investigation. Methods: Arrest and hospital management information was collated retrospectively for OHCA patients who presented to a single clinical site between 2009 and 2013. Angiography results were then collected and checked for significance with survival to discharge. The presence of a severe lesion (>70%) was then compared to categorised ECG findings, and the accuracy of the test was calculated. Results: 104 patients were included in this study, 44 survived to discharge, 52 died and 8 were transferred to other clinical sites. Angiography appears to significantly correlate with survival to discharge. ECG showed 54.8% sensitivity for detecting the presence of a severe lesion within the group that received angiography. A combined criterion including any ECG pathology showed 100% sensitivity and negative predictive value, however, a low specificity and positive predictive value. Conclusion: In the cohort investigated, ST elevation on ECG is not a sensitive enough screening test to be used to determine whether OHCA patients have coronary stenosis as the likely cause of their arrest, and more investigation into whether screening with a combined ECG criterion, or whether all patients should receive angiography routinely following OHCA is needed.

Keywords: out of hospital cardiac arrest, coronary angiography, resuscitation, emergency medicine

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Authors: Abdul Fatah, Naveenchandra Acharya, Vamshi Krishna, T. Shivaprasad, Ramesh Ramayya

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Background: Significant number of patients with bladder outlet obstruction due to BPH are on anti-platelets and anticoagulants. Prostate surgery in this group of patients either in the form of TURP or Open prostatectomy is associated with increased risk of bleeding complications requiring transfusions, packing of the prostatic fossa or ligation or embolization of internal iliac arteries. Withholding of antiplatelets and anticoagulants may be associated with cardiac and other complications. Efficacy of Thulium Laser in the above group of patients was evaluated in terms of peri-operative, postoperative and delayed bleeding complications as well as cardiac events in peri-operative and immediate postoperative period. Methods: 217 patients with a mean age of 68.8 years were enrolled between March 2009 and March 2013 (36 months), and treated for BPH with ThuLEP. Every patient was evaluated at base line according to: Digital Rectal Examination (DRE), prostate volume, Post-Voided volume (PVR), International Prostate Symptoms Score (I-PSS), PSA values, urine analysis and urine culture, uroflowmetry. The post operative complications in the form of drop in hemoglobin level, transfusion rates, post –operative cardiac events within a period of 30 days, delayed hematuria and events like deep vein thrombosis and pulmonary embolism were noted. Results: Our data showed a better post-operative outcome in terms of, postoperative bleeding requiring intervention 7 (3.2%), transfusion rate 4 (1.8%) and cardiac events within a period of 30 days 4(1.8%), delayed hematuria within 6 months 2(0.9 %) compared other series of prostatectomies. Conclusion: The thulium LASER prostatectomy is a safe and effective option for patients with cardiac comorbidties and those patients who are on antiplatelet agents and anticoagulants. The complication rate is less as compared to larger series reported with open and transurethral prostatectomies.

Keywords: thulium laser, prostatectomy, antiplatelet agents, bleeding

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Authors: Anh Vo Van Ha, Yun Zhao, Luat Cong Nguyen, Tan Khac Chu, Phung Hoang Nguyen, Minh Ngoc Pham, Colin W. Binns, Andy H. Lee

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This study aims to study longitudinal changes in blood pressure (BP) during the 1-year postpartum period and to evaluate the influence of parity, maternal age at delivery, prepregnancy BMI, gestational weight gain, gestational age at delivery and postpartum maternal weight. A prospective longitudinal cohort study of 883 singleton Vietnamese women was conducted in Hanoi, Haiphong, and Ho Chi Minh City, Vietnam during 2015-2017. Women diagnosed with gestational diabetes mellitus at 24-28 weeks of gestation, pre-eclampsia, and hypoglycemia was excluded from analysis. BP was repeatedly measured at discharge, 6 and 12 months postpartum using automatic blood pressure monitors. Linear mixed model with repeated measures was used to describe changes occurring during pregnancy to 1-year postpartum. Parity, self-reported prepregnancy BMI, gestational weight gain, maternal age and gestational age at delivery will be treated as time-invariant variables and measured maternal weight will be treated as a time-varying variable in models. Women with higher measured postpartum weight had higher mean systolic blood pressure (SBP), 0.20 mmHg, 95% CI [0.12, 0.28]. Similarly, women with higher measured postpartum weight had higher mean diastolic blood pressure (DBP), 0.15 mmHg, 95% CI [0.08, 0.23]. These differences were both statistically significant, P < 0.001. There were no differences in SBP and DBP depending on parity, maternal age at delivery, prepregnancy BMI, gestational weight gain and gestational age at delivery. Compared with discharge measurement, SBP was significantly higher in 6 months postpartum, 6.91 mmHg, 95% CI [6.22, 7.59], and 12 months postpartum, 6.39 mmHg, 95% CI [5.64, 7.15]. Similarly, DBP was also significantly higher in 6 and months postpartum than at discharge, 10.46 mmHg 95% CI [9.75, 11.17], and 11.33 mmHg 95% CI [10.54, 12.12]. In conclusion, BP measured repeatedly during the postpartum period (6 and 12 months postpartum) showed a statistically significant increase, compared with after discharge from the hospital. Maternal weight was a significant predictor of postpartum blood pressure over the 1-year postpartum period.

Keywords: blood pressure, maternal weight, postpartum, Vietnam

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Authors: Narupon Kunbootsri, J. Kraipoj, K. Phandech, P. Sirasaporn

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Physiotherapy is one of the treatments for frozen shoulder but there was no data about the treatment of physiotherapy. Moreover, it is question about onset of symptom before physiotherapy program and obtaining physical modalities and delayed start physiotherapy program lead to delayed improvement. Thus the aim of this study was to investigate physiotherapy program for frozen shoulder on pain score, onset of symptom and obtaining physical modalities. A retrospective study design was conducted. 182 medical records of patients with frozen shoulder were reviewed. These frozen shoulders were treated at physiotherapy unit, department of Rehabilitation last 3 years (January, 2014- December, 2016). The data consist of onset of symptom, pain score and obtaining physical modalities were recorded. There was a statistically significant improve in pain score, pretreatment score mean 7.24±1.52 and the last follow up pain score mean 3.88± 1.0 [mean difference 3.18 with 95%CI were [2.45- 3.92]. In addition, the onset of symptoms was 145 days before obtaining physiotherapy program. The physical modalities used frequently were hot pack 14.8% and ultrasound diathermy 13.7%. In conclusion, the retrospective study show physiotherapy program including, hot pack and ultrasound diathermy seem to be useful for frozen shoulder in term of pain score. But onset of symptom is too long to start physiotherapy programs.

Keywords: frozen shoulder, physiotherapy, pain score, onset of symptom, physical modality

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

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

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

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Authors: N. Matveev, A. Pervov

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Local utilities often face problems of local industrial wastes, storm water disposal due to existing strict regulations. For many local industries, the problem of wastewater treatment and discharge into surface reservoirs can’t be solved through the use of conventional biological treatment techniques. Current discharge standards require very strict removal of a number of impurities such as ammonia, nitrates, phosphate, etc. To reach this level of removal, expensive reagents and sorbents are used. The modern concept of rational water resources management requires the development of new efficient techniques that provide wastewater treatment and reuse. As RO membranes simultaneously reject all dissolved impurities such as BOD, TDS, ammonia, phosphates etc., they become very attractive for the direct treatment of wastewater without biological stage. To treat wastewater, specially designed membrane "open channel" modules are used that do not possess "dead areas" that cause fouling or require pretreatment. A solution to RO concentrate disposal problem is presented that consists of reducing of initial wastewater volume by 100 times. Concentrate is withdrawn from membrane unit as sludge moisture. The efficient use of membrane RO techniques is connected with a salt balance in water system. Thus, to provide high ecological efficiency of developed techniques, all components of water supply and wastewater discharge systems should be accounted for.

Keywords: reverse osmosis, stormwater treatment, open-channel module, wastewater reuse

Procedia PDF Downloads 315

Authors: Mamdouh Y. Saleh, Gaber El Enany, Medhat H. Elzahar, Mohamed Z. Elshikhipy, Rana Hamouda

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The heavy metals pollution in water, sediments and fish of Lake Manzala affected from the disposal of wastewater, industrial and agricultural drainage water into the lake on the environmental situation. A pilot plant with an industrial discharge flow of 135L/h was designed according to the activated sludge plant to simulate between the biological and chemical treatment with the addition of alum to the aeration tank with dosages of 100, 150, 200, and 250 mg/L. The industrial discharge had concentrations of Lead and BOD5 with an average range 1.22, 145mg/L, respectively. That means the average Pb was high up to 25 times than the allowed permissible concentration. The optimization of the chemical-biological process using 200mg/L alum dosage compared has improvement of Lead and BOD5 removal efficiency to 61.76% and 56%, respectively.

Keywords: industrial wastewater, activated sludge, BOD5, lead, alum salt

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Authors: Najeeb Hassan, Mahmudur Rahman

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Arial Khan River is one of the main south-eastward outlets of the River Padma. This river maintains a meander channel through its course and is erosional in nature. The specific objective of the research is to study and evaluate the hydrological characteristics in the form of assessing changes of cross-sections, discharge, water level and velocity profile in different stations and to create a hydrodynamic model of the Arial Khan River. Necessary data have been collected from Bangladesh Water Development Board (BWDB) and Center for Environment and Geographic Information Services (CEGIS). Satellite images have been observed from Google earth. In this study, hydrodynamic model of Arial Khan River has been developed using well known steady open channel flow code Hydrologic Engineering Centers and River Analysis System (HEC-RAS) using field surveyed geometric data. Cross-section properties at 22 locations of River Arial Khan for the years 2011, 2013 and 2015 were also analysed. 1-D HEC-RAS model has been developed using the cross sectional data of 2015 and appropriate boundary condition is being used to run the model. This Arial Khan River model is calibrated using the pick discharge of 2015. The applicable value of Mannings roughness coefficient (n) is adjusted through the process of calibration. The value of water level which ties with the observed data to an acceptable accuracy is taken as calibrated model. The 1-D HEC-RAS model then validated by using the pick discharges from 2009-2018. Variation in observed water level in the model and collected water level data is being compared to validate the model. It is observed that due to seasonal variation, discharge of the river changes rapidly and Mannings roughness coefficient (n) also changes due to the vegetation growth along the river banks. This river model may act as a tool to measure flood area in future. By considering the past pick flow discharge, it is strongly recommended to improve the carrying capacity of Arial Khan River to protect the surrounding areas from flash flood.

Keywords: BWDB, CEGIS, HEC-RAS

Procedia PDF Downloads 176

Authors: Po-Wen Chen, Jin-Yu Wu, Md. Manirul Ali, Yang Peng, Chen-Te Chang, Der-Jun Jan

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Dynamics of cathode spot has become a major part of vacuum arc discharge with its high academic interest and wide application potential. In this article, using a three-dimensional statistical model, we simulate the distribution of the ignition probability of a new cathode spot occurring in different magnetic pressure on old cathode spot surface and at different arcing time. This model for the ignition probability of a new cathode spot was proposed in two typical situations, one by the pure isotropic random walk in the absence of an external magnetic field, other by the retrograde motion in external magnetic field, in parallel with the cathode surface. We mainly focus on developed relationship between the ignition probability density distribution of a new cathode spot and the external magnetic field.

Keywords: cathode spot, vacuum arc discharge, transverse magnetic field, random walk

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Authors: Emil Ghiocel Ioanid, Viorica Frunză, Dorina Rusu, Ana Maria Vlad, Catalin Tanase, Simona Dunca

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The application of cold radio-frequency (RF) plasma in the conservation of cultural heritage became important in the last decades due to the positive results obtained in decontamination treatments. This paper presents an equipment especially designed for RF cold plasma application on paper documents, developed within a research project. The equipment allows the application of decontamination and cleaning treatments on any type of paper support, as well as the coating with a protective polymer. The equipment consists in a Pyrex vessel, inside which are placed two plane-parallel electrodes, capacitively coupled to a radio-frequency generator. The operating parameters of the equipment are: 1.2 MHz frequency, 50V/cm electric field intensity, current intensity in the discharge 100 mA, 40 W power in the discharge, the pressure varying from 5∙10-1 mbar to 5.5∙10-1 mbar, depending on the fragility of the material, operating in gaseous nitrogen. In order to optimize the equipment treatments in nitrogen plasma have been performed on samples infested with microorganisms, then the decontamination and the changes in surface properties (color, pH) were assessed. The analyses results presented in the table revealed only minor modifications of surface pH the colorimetric analysis showing a slight change to yellow. The equipment offers the possibility of performing decontamination, cleaning and protective coating of paper-based documents in successive stages, thus avoiding the recontamination with harmful biological agents.

Keywords: nitrogen plasma, cultural heritage, paper support, radio-frequency

Procedia PDF Downloads 519

Authors: Mohammadreza Nezamirad, Sepideh Amirahmadian, Nasim Sabetpour, Azadeh Yazdi, Amirmasoud Hamedi

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Cavitation inside diesel injector nozzle is investigated using Reynolds-Stress-Navier Stokes equations. Schnerr-Sauer cavitation model is used for modeling cavitation inside diesel injector nozzle. The carrying fluid utilized in the current study is diesel fuel. The flow is verified at the beginning by comparing with the previous experimental data, and it was found that K-Epsilon turbulent model could lead to a better accuracy comparing to K-Omega turbulent model. Moreover, the mass flow rate obtained numerically is compared with the experimental value, and the discrepancy was found to be less than 5 percent which shows the accuracy of the current results. Finally, a real-size four-hole nozzle is investigated, and the flow inside it is visualized based on velocity profile, discharge coefficient, and cavitation number. It was found that the mesh density could be reduced significantly by utilizing periodic boundary conditions. Velocity contour at the mid nozzle showed that the maximum value of velocity occurs at the end of the needle before entering the orifice area. Last but not least, at the same boundary conditions, when different needle heights were utilized, it was found that as needle height increases with an increase in cavitation number, discharge coefficient increases, while the mentioned increases are more tangible at smaller values of needle heights.

Keywords: cavitation, diesel fuel, CFD, real size nozzle, mass flow rate

Procedia PDF Downloads 142

Authors: T. Suleiman, C. Mchugh, H. Ranu

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Background; Asthma continues to be associated with poor patient outcomes, including mortality. An audit of the management of acute asthma admissions in our hospital in 2020 found poor compliance with National Asthma and COPD Audit Project (NACAP) standards which set out to improve inpatient asthma care. Clinical nurse specialists have been shown to improve patient care across a range of specialties. In September 2021, an asthma Nurse Specialist (ANS) was employed in our hospital. Aim; To re-audit management of acute asthma admissions using NACAP standards and assess for quality improvement post-employment of an ANS. Methodology; NACAP standards are wide-reaching; therefore, we focused on ‘specific elements of good practice’ in addition to the provision of inhaled corticosteroids (ICS) on discharge. Medical notes were retrospectively requested from the hospital coding department and selected as per NACAP inclusion criteria. Data collection and entry into the NACAP database were carried out. As this was a clinical audit, ethics approval was not required. Results; Cycle 1 (pre-ANS) and 2 (post-ANS) of the audit included 20 and 32 patients, respectively, with comparable baseline demographics. No patients had a discharge bundle completed on discharge in cycle 1 vs. 84% of cases in cycle 2. Regarding specific components of the bundle, 25% of patients in cycle 1 had their inhaler technique checked vs. 91% in cycle 2. Furthermore, 80% of patients had maintenance medications reviewed in cycle 1 vs. 97% in cycle 2. Medication adherence was addressed in 20% of cases in cycle 1 vs. 88% of cases in cycle 2. Personalized asthma action plans were not issued or reviewed in any cases in cycle 1 as compared with 84% of cases in cycle 2. Triggers were discussed in 30% of cases in cycle 1 vs. 88% of cases in cycle 2. Tobacco dependence was addressed in 44% of cases in cycle 1 vs. 100% of cases in cycle 2. No patients in cycle 1 had community follow-up requested within 2 days vs. 81% of the patients in cycle 2. Similarly, 20% of the patients in cycle 1 vs. 88% of the patients in cycle 2 had a 4-week asthma clinic follow-up requested. 75% of patients in cycle 1 were the recipient of ICS on discharge compared with 94% of patients in cycle 2. Conclusion; Our quality improvement project demonstrates the utility of an ANS in improving performance in the management of acute asthma admissions, evidenced here through concordance with NACAP standards. Asthma is a complex condition with biological, psychological, and sociological components; therefore, ANS is a suitable intervention to improve concordance with guidelines. ANS likely impacted performance directly, for example, by checking inhaler technique, and indirectly as a safety net ensuring doctors included ICS on discharge.

Keywords: asthma, nurse specialist, clinical audit, quality improvement

Procedia PDF Downloads 374

Authors: Miled Amel, Ben Maad Hatem, Askri Faouzi, Ben Nasrallah Sassi

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Metal hydride water pumping system uses hydrogen as working fluid to pump water for low head and high discharge. The principal operation of this pump is based on the desorption of hydrogen at high pressure and its absorption at low pressure by a metal hydride. This work is devoted to study a concept of the dynamic behavior of a metal hydride pump using unsteady model and LaNi5 as hydriding alloy. This study shows that with MHP, it is possible to pump 340l/kg-cycle of water in 15 000s using 1 Kg of LaNi5 at a desorption temperature of 360 K, a pumping head equal to 5 m and a desorption gear ratio equal to 33. This study reveals also that the error given by the steady model, using LaNi5 is about 2%.A dimensional mathematical model and the governing equations of the pump were presented to predict the coupled heat and mass transfer within the MHP. Then, a numerical simulation is carried out to present the time evolution of the specific water discharge and to test the effect of different parameters (desorption temperature, absorption temperature, desorption gear ratio) on the performance of the water pumping system (specific water discharge, pumping efficiency and pumping time). In addition, a comparison between results obtained with steady and unsteady model is performed with different hydride mass. Finally, a geometric configuration of the reactor is simulated to optimize the pumping time.

Keywords: dynamic behavior, LaNi5, performance of water pumping system, unsteady model

Procedia PDF Downloads 197

Authors: Yanhui Jia, Ning Guo, Juan Li, Yunkui Sun, Wei Yang, Tianping Zhang, Lin Ma, Wei Meng, Hai Geng

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The current statuses of lifetime test of LaB6 hollow cathode at the Lanzhou institute of physics (LIP), China, was described. 5A LaB6 hollow cathode was designed for LIPS-200 40mN Xenon ion thruster and it could be used for LHT-100 80 mN Hall thruster, too. Life test of the discharge and neutralizer modes of LHC-5 hollow cathode were stared in October 2011, and cumulative operation time reached 17,300 and 16,100 hours in April 2015, respectively. The life of cathode was designed more than 11,000 hours. Parameters of discharge and key structure dimensions were monitored in different stage of life test indicated that cathodes were health enough. The test will continue until the cathode cannot work or operation parameter is not in normally. The result of the endurance test of cathode demonstrated that the LaB6 hollow cathode is satisfied for the required of thruster in life and performance.

Keywords: LaB6, hollow cathode, thruster, lifetime test, electric propulsion

Procedia PDF Downloads 599