Search results for: patient safety incidents

Authors: Ashley L. Freeman, Jessica D. Watkins

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TeleEmergency Medicine (TeleEM) is an innovative approach leveraging virtual technology to deliver specialized emergency medical care across diverse healthcare settings, including internal acute care and critical access hospitals, remote patient monitoring, and nurse triage escalation, in addition to external emergency departments, skilled nursing facilities, and community health centers. TeleEM represents a significant advancement in the delivery of emergency medical care, providing healthcare professionals the capability to deliver expertise that closely mirrors in-person emergency medicine, exceeding geographical boundaries. Through qualitative research, the extension of timely, high-quality care has proven to address the critical needs of patients in remote and underserved areas. TeleEM’s service design allows for the expansion of existing services and the establishment of new ones in diverse geographic locations. This ensures that healthcare institutions can readily scale and adapt services to evolving community requirements by leveraging on-demand (non-scheduled) telemedicine visits through the deployment of multiple video solutions. In terms of financial management, TeleEM currently employs billing suppression and subscription models to enhance accessibility for a wide range of healthcare facilities. Plans are in motion to transition to a billing system routing charges through a third-party vendor, further enhancing financial management flexibility. To address state licensure concerns, a patient location verification process has been integrated through legal counsel and compliance authorities' guidance. The TeleEM workflow is designed to terminate if the patient is not physically located within licensed regions at the time of the virtual connection, alleviating legal uncertainties. A distinctive and pivotal feature of TeleEM is the introduction of the TeleEmergency Medicine Care Team Assistant (TeleCTA) role. TeleCTAs collaborate closely with TeleEM Physicians, leading to enhanced service activation, streamlined coordination, and workflow and data efficiencies. In the last year, more than 800 TeleEM sessions have been conducted, of which 680 were initiated by internal acute care and critical access hospitals, as evidenced by quantitative research. Without this service, many of these cases would have necessitated patient transfers. Barriers to success were examined through thorough medical record review and data analysis, which identified inaccuracies in documentation leading to activation delays, limitations in billing capabilities, and data distortion, as well as the intricacies of managing varying workflows and device setups. TeleEM represents a transformative advancement in emergency medical care that nurtures collaboration and innovation. Not only has advanced the delivery of emergency medicine care virtual technology through focus group participation with key stakeholders, rigorous attention to legal and financial considerations, and the implementation of robust documentation tools and the TeleCTA role, but it’s also set the stage for overcoming geographic limitations. TeleEM assumes a notable position in the field of telemedicine by enhancing patient outcomes and expanding access to emergency medical care while mitigating licensure risks and ensuring compliant billing.

Keywords: emergency medicine, TeleEM, rural healthcare, telemedicine

Procedia PDF Downloads 88

Authors: Antònio Inês, Davide Silva, Filipa Carvalho, Luís Filipe-Riberiro, Fernando M. Nunes, Luís Abrunhosa, Fernanda Cosme

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The presence of mycotoxins in foodstuff is a matter of concern for food safety. Mycotoxins are toxic secondary metabolites produced by certain molds, being ochratoxin A (OTA) one of the most relevant. Wines can also be contaminated with these toxicants. Several authors have demonstrated the presence of mycotoxins in wine, especially ochratoxin A. Its chemical structure is a dihydro-isocoumarin connected at the 7-carboxy group to a molecule of L-β-phenylalanine via an amide bond. As these toxicants can never be completely removed from the food chain, many countries have defined levels in food in order to attend health concerns. OTA contamination of wines might be a risk to consumer health, thus requiring treatments to achieve acceptable standards for human consumption. The maximum acceptable level of OTA in wines is 2.0 μg/kg according to the Commission regulation No. 1881/2006. Therefore, the aim of this work was to reduce OTA to safer levels using different fining agents, as well as their impact on white wine physicochemical characteristics. To evaluate their efficiency, 11 commercial fining agents (mineral, synthetic, animal and vegetable proteins) were used to get new approaches on OTA removal from white wine. Trials (including a control without addition of a fining agent) were performed in white wine artificially supplemented with OTA (10 µg/L). OTA analyses were performed after wine fining. Wine was centrifuged at 4000 rpm for 10 min and 1 mL of the supernatant was collected and added of an equal volume of acetonitrile/methanol/acetic acid (78:20:2 v/v/v). Also, the solid fractions obtained after fining, were centrifuged (4000 rpm, 15 min), the resulting supernatant discarded, and the pellet extracted with 1 mL of the above solution and 1 mL of H2O. OTA analysis was performed by HPLC with fluorescence detection. The most effective fining agent in removing OTA (80%) from white wine was a commercial formulation that contains gelatin, bentonite and activated carbon. Removals between 10-30% were obtained with potassium caseinate, yeast cell walls and pea protein. With bentonites, carboxymethylcellulose, polyvinylpolypyrrolidone and chitosan no considerable OTA removal was verified. Following, the effectiveness of seven commercial activated carbons was also evaluated and compared with the commercial formulation that contains gelatin, bentonite and activated carbon. The different activated carbons were applied at the concentration recommended by the manufacturer in order to evaluate their efficiency in reducing OTA levels. Trial and OTA analysis were performed as explained previously. The results showed that in white wine all activated carbons except one reduced 100% of OTA. The commercial formulation that contains gelatin, bentonite and activated carbon reduced only 73% of OTA concentration. These results may provide useful information for winemakers, namely for the selection of the most appropriate oenological product for OTA removal, reducing wine toxicity and simultaneously enhancing food safety and wine quality.

Keywords: wine, ota removal, food safety, fining

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Authors: Ntokozo Dennis Ndwandwe

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The aim of the study was to explore the barriers facing the implementation of peace education as a strategy to combat violence in selected secondary schools in the Western Cape Province of South Africa. The problem that motivated this enquiry was the absence of stable peace and the increase of incidents of violence in schools. A qualitative approach was followed when conducting the study, and small samples of three case studies of secondary schools were used. Method used in collecting data consisted of semi-structured interviews; focus group interviews and observation. The participants consisted of the program manager for Quaker for Peace Centre (QPC), three principals, nine teachers, and fifteen learners. Data were analysed by transcribing, organising, marking by hand and coding that produced labels that allowed key points to be highlighted. Findings revealed that the effective implementation of peace education was being constrained by factors such as financial constraints, inadequate time allocated, lack of parental involvement, over work-loaded teachers, negative attitude and other societal influences. It is recommended that teachers should receive an ongoing training for peace education. Therefore, the government should prioritise and provide funds for peace education. In addition, parental involvement should be improved in order to enhance the implementation of peace education in selected secondary schools.

Keywords: barriers, implementation, conflict, peace, peace education, conflict resolution, violence

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Authors: Chiung-Hui Chen

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With advancements in science and technology, the concept of the Internet of Things (IoT) has gradually developed. The development of the intelligent environment adds intelligence to objects in the living space by using the IoT. In the smart environment, when multiple users share the living space, if different service requirements from different users arise, then the context-aware system will have conflicting situations for making decisions about providing services. Therefore, the purpose of establishing a communication and negotiation mechanism among objects in the intelligent environment is to resolve those service conflicts among users. This study proposes developing a decision-making methodology that uses “Event Agents” as its core. When the sensor system receives information, it evaluates a user’s current events and conditions; analyses object, location, time, and environmental information; calculates the priority of the object; and provides the user services based on the event. Moreover, when the event is not single but overlaps with another, conflicts arise. This study adopts the “Multiple Events Correlation Matrix” in order to calculate the degree values of incidents and support values for each object. The matrix uses these values as the basis for making inferences for system service, and to further determine appropriate services when there is a conflict.

Keywords: internet of things, intelligent object, event agents, negotiation mechanism, degree of similarity

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Authors: Jonathan D. Recchi

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Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

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Authors: J. M. Mayoral, M. Anaya

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The urban and economic development of cities demands the construction of water use and flood control infrastructure. Likewise, it is necessary to determine the safety level of the structures built with the current standards and if it is necessary to define the reinforcement actions. The foregoing is even more important in structures of great importance, such as dams, since they imply a greater risk for the population in case of failure or undesirable operating conditions (e.g., seepage, cracks, subsidence). This article presents a methodology for determining the seismic integrity of dams in urban areas. From direct measurements of the dynamic properties using geophysical exploration and ambient seismic noise measurements, the seismic integrity of the concrete-faced rockfill dam selected as a case of study is evaluated. To validate the results, two accelerometer stations were installed (e.g., free field and crest of the dam). Once the dynamic properties were determined, three-dimensional finite difference models were developed to evaluate the dam seismic performance for different intensities of movement, considering the site response and soil-structure interaction effects. The seismic environment was determined from the uniform hazard spectra for several return periods. Based on the results obtained, the safety level of the dam against different seismic actions was determined, and the effectiveness of ambient seismic noise measurements in dynamic characterization and subsequent evaluation of the seismic integrity of urban dams was evaluated.

Keywords: risk, seismic, soil-structure interaction, urban dams

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Authors: Özgür Öztürk, Cumhur Sipahi, Hande Yeşil

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Implant retained restorations commonly consist of a metal-framework veneered with ceramic or composite facings. The increasing and expanding use of indirect resin composites in dentistry is a result of innovations in materials and processing techniques. Of special interest to the implant restorative field is the possibility that composites present significantly lower peak vertical and transverse forces transmitted at the peri-implant level compared to metal-ceramic supra structures in implant-supported restorations. A 43-year-old male patient referred to the department of prosthodontics for an implant retained fixed prosthesis. The clinical and radiographic examination of the patient demonstrated the presence of an implant in the right mandibular first molar tooth region. A considerable amount of marginal bone loss around the implant was detected in radiographic examinations combined with a remarkable peri-implant soft tissue deficiency. To minimize the chewing loads transmitted to the implant-bone interface it was decided to fabricate an indirect composite resin veneered single metal crown over a screw-retained abutment. At the end of the treatment, the functional and aesthetic deficiencies were fully compensated. After a 6 months clinical and radiographic follow-up period the not any additional pathologic invasion was detected in the implant-bone interface and implant retained restoration did not reveal any vehement complication.

Keywords: dental implant, fixed partial dentures, indirect composite resin, peri-implant defects

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Authors: Khalil Boukfoussa

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It is important to provide students with food that contains complete nutrients to provide them with mental and physical energy during the school day. Especially since the time students spend in school is equivalent to 50% of their time during the day, which increases the importance of proper nutrition in schools and makes it an ideal way to inculcate the foundations of a healthy lifestyle and healthy eating habits. Proper nutrition is one of the most important things that affect the health and process of growth and development in children, in addition to being a key factor in supporting the ability to focus, supporting mental abilities and developing the student’s academic achievement. In addition to the importance of a healthy diet for the development and growth of the child's body, proper nutrition can significantly contribute to protecting the body from catching viruses and helping it to pass the winter safely. Effective food control systems in different countries are essential to protect the health and safety of domestic consumers. These systems are also crucial in enabling countries to ensure the safety and quality of food entering international trade and to ensure that imported food conforms to national requirements. The current global food trade environment places significant obligations on both importing and exporting countries to strengthen their food control systems and to apply and implement risk-based food control strategiesConsumers are becoming more interested in the way food is produced, processed and marketed, and are increasingly demanding that governments assume greater responsibility for consumer protection and food safety. In many countries, food control is weak because of the abundance of legislation, the multiplicity of jurisdictions and weaknesses in control, monitoring and enforcement. The following guidelines seek to advise national authorities on strategies to strengthen food control systems to protect public health, prevent fraud and fraud, avoid food contamination and help facilitate trade. These Guidelines will assist authorities in selecting the most appropriate food control system options in terms of legislation, infrastructure and enforcement mechanisms. The document clarifies the broad principles that govern food control systems and provides examples of the infrastructure and methods by which national systems can operate

Keywords: food, nutrision, school, safty

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Authors: Simone Rondelli, Damiano Rondelli, Bishesh Poudyal, Juan Jose Cabrera-Lazarini

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One of the main obstacles for Social Entrepreneurship is to find a business model that is financially sustainable. In other words, the captured value generates enough cash flow to ensure business continuity and reinvestment for growth. Providing Health Services in poor countries for the uninsured population affected by a high-cost chronical disease is not the exception for this challenge. As a prime example, cancer has become a high impact on a global disease not only because of the high morbidity but also of the financial impact on both the patient family and health services in underdeveloped countries. Therefore, it is relevant to find a Social Entrepreneurship Model that provides affordable treatment for this disease while maintaining healthy finances not only for the patient but also for the organization providing the treatment. Using the methodology of Constructive Research, this paper applied a Positive Theory and four business models of Social Entrepreneurship to a case of a Private Foundation model whose mission is to address the challenge previously described. It was found that the Foundation analyzed, in this case, is organized as an Embedded Business Model and complies with the four propositions of the Positive Theory considered. It is recommended for this Private Foundation to explore implementing the Integrated Business Model to ensure more robust sustainability in the long term. It evolves as a scalable model that can attract investors interested in contributing to expanding this initiative globally.

Keywords: affordable treatment, global healthcare, social entrepreneurship theory, sustainable business model

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Authors: Yonggu Jang, Jisong Ryu, Woosik Lee

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The study aims to address the limitations of existing underground facility exploration equipment in terms of exploration depth range, relative depth measurement, data processing time, and human-centered ground penetrating radar image interpretation. The study proposed the use of 3D absolute positioning technology to develop a precision underground facility exploration system. The aim of this study is to establish a precise exploration system for underground facilities based on 3D absolute positioning technology, which can accurately survey up to a depth of 5m and measure the 3D absolute location of precise underground facilities. The study developed software and hardware technologies to build the precision exploration system. The software technologies developed include absolute positioning technology, ground surface location synchronization technology of GPR exploration equipment, GPR exploration image AI interpretation technology, and integrated underground space map-based composite data processing technology. The hardware systems developed include a vehicle-type exploration system and a cart-type exploration system. The data was collected using the developed exploration system, which employs 3D absolute positioning technology. The GPR exploration images were analyzed using AI technology, and the three-dimensional location information of the explored precise underground facilities was compared to the integrated underground space map. The study successfully developed a precision underground facility exploration system based on 3D absolute positioning technology. The developed exploration system can accurately survey up to a depth of 5m and measure the 3D absolute location of precise underground facilities. The system comprises software technologies that build a 3D precise DEM, synchronize the GPR sensor's ground surface 3D location coordinates, automatically analyze and detect underground facility information in GPR exploration images and improve accuracy through comparative analysis of the three-dimensional location information, and hardware systems, including a vehicle-type exploration system and a cart-type exploration system. The study's findings and technological advancements are essential for underground safety management in Korea. The proposed precision exploration system significantly contributes to establishing precise location information of underground facility information, which is crucial for underground safety management and improves the accuracy and efficiency of exploration. The study addressed the limitations of existing equipment in exploring underground facilities, proposed 3D absolute positioning technology-based precision exploration system, developed software and hardware systems for the exploration system, and contributed to underground safety management by providing precise location information. The developed precision underground facility exploration system based on 3D absolute positioning technology has the potential to provide accurate and efficient exploration of underground facilities up to a depth of 5m. The system's technological advancements contribute to the establishment of precise location information of underground facility information, which is essential for underground safety management in Korea.

Keywords: 3D absolute positioning, AI interpretation of GPR exploration images, complex data processing, integrated underground space maps, precision exploration system for underground facilities

Procedia PDF Downloads 66

Authors: Altab Hossain, Shakerul Islam, Golamur R. Khan, Abu Zafar M. Salahuddin

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An effective identification of breakdowns is of premier importance for the safe and reliable operation of Nuclear Power Plants (NPP) and its associated facilities. A great number of monitoring and diagnosis methodologies are applied and used worldwide in areas such as industry, automobiles, hospitals, and power plant to detect and reduce human disasters. The potential consequences of several hazardous activities may harm the society using nuclear and its associated facilities. Hence, one of the most popular and effective methods to ensure safety and monitor the entire nuclear facility and imply risk-free operation without human interference during the hazardous situation is using a robot. Therefore, in this study, an advanced autonomous robot has been designed and developed that can monitor several parameters in the NPP to ensure the safety and do some risky job in case of nuclear disaster. The robot consisted of autonomous track following unit, data processing and transmitting unit can follow a straight line and take turn as the bank greater than 90 degrees. The developed robot can analyze various parameters such as temperature, altitude, radiation, obstacle, humidity, detecting fire, measuring distance, ultrasonic scan and taking the heat of any particular object. It has an ability to broadcast live stream and can record the document to its own server memory. There is a separate control unit constructed with a baseboard which processes the recorded data and a transmitter which transmits the processed data. To make the robot user-friendly, the code is developed such a way that a user can control any of robotic arm as per types of work. To control at any place and without the track, there is an advanced code has been developed to take manual overwrite. Through this process, administrator who has logged in permission to Dynamic Host Client Protocol (DHCP) can make the handover of the control of the robot. In this process, this robot is provided maximum nuclear security from being hacked. Not only NPP, this robot can be used to maximize the real-time monitoring system of any nuclear facility as well as nuclear material transportation and decomposition system.

Keywords: nuclear power plant, radiation, dynamic host client protocol, nuclear security

Procedia PDF Downloads 211

Authors: Maysoon Nasser Samhan, Somaya Alkiswani, Abdullah Alzibdeh

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Background: Routine lumbar MRIs for back pain may yield normal results despite persistent symptoms, which means the possibility of other causes for this pain, which was not shown on the routine images. Research suggests including coronal STIR imaging to detect additional pathologies like sacroiliitis. Objectives: This study aims to enhance diagnostic accuracy and aid in determining treatment processes for patients with persistent back pain who have normal routine lumbar MRI (T1 and T2 images) by incorporating coronal STIR into the examination. Methods: A prospectively conducted study involving 274 patients, 115 males and 159 females, with an age range of 6–92 years, reviewed their medical records and imaging data following a lumbar spine MRI. This study included patients with back pain and sciatica as their primary complaints, all of whom underwent lumbar spine MRIs at our hospital to identify potential pathologies. Using a GE Signa HD 1.5T MRI System, each patient received a standard MRI protocol that included T1 and T2 sagittal and axial sequences, as well as a coronal STIR sequence. We collected relevant MRI findings, including abnormalities and structural variations, from radiology reports. We classified these findings into tables and documented them as counts and percentages, using Fisher’s exact test to assess differences between categorical variables. We conducted a statistical analysis using Prism GraphPad software version 10.1.2. The study adhered to ethical guidelines, institutional review board approvals, and patient confidentiality regulations. Results: Exclusion of the coronal STIR sequence led to 83 subjects (30.29%) being classified as within normal limits on MRI examination. 36 patients without abnormalities on T1 and T2 sequences showed abnormalities on the coronal STIR sequence, with 26 cases attributed to spinal pathologies and 10 to non-spinal pathologies. In addition to that, Fisher's exact test demonstrated a significant association between sacroiliitis diagnosis and abnormalities identified solely through the coronal STIR sequence (P < 0.0001). Conclusion: Implementing coronal STIR imaging as part of routine lumbar MRI protocols has the potential to improve patient care by facilitating a more comprehensive evaluation and management of persistent back pain.

Keywords: magnetic resonance imaging, lumber MRI, radiology, neurology

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Authors: Sambit Supriya Dash

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Aerospace Industry has evolved over the last century and is growing by approaching towards, more fuel efficient, cheaper, simpler, convenient and safer ways of flight stages. In this paper, the accident records of aircrafts are studied and found about 71% of accidents caused on runways during Takeoff and Landing. By introducing the concept of interpreting electromagnetism, the cause of bounced touchdown and flare failure such as landing impact loads and instability could be eliminated. During Takeoff, the rate of fuel consumption is observed to be maximum. By applying concept of interpreting electromagnetism, a remarkable rate of fuel consumption is reduced, which can be used in case of emergency due to lack of fuel or in case of extended flight. A complete setup of the concept, its effects and characteristics are studied and provided with references of few popular aircrafts. By embedding series of strong and controlled electromagnets below the runway along and aside the centre line and fixed in the line of acting force through wing-fuselage aerodynamic centre. By the essence of its strength controllable nature, it can contribute to performance and fuel efficiency for aircraft. This ensures a perfect Takeoff with less fuel consumption followed by safe cruise stage, which in turn ensures a short and safe landing, eliminating the till known failures, due to bounced touchdowns and flare failure.

Keywords: efficiency, elctromagnetism, performance, reduced fuel consumption, safety

Procedia PDF Downloads 236

Authors: Júlia Alarcon Pinto, Carlos João Schaffhausser, Gustavo Alarcon Pinto

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Introduction: The deaf people in Brazil communicate through the Brazilian Sign Language (LIBRAS), which is restricted to this minority and people that received training. However, there is a lack of prepared professionals in the health system to deal with these patients. Therefore, effective communication, health education, quality of support and assistance are compromised. It is of utmost importance to develop measures that ensure the inclusion of deaf parents and children since there are frequent doubts about sphincter training and an absence of tools to promote effective communication between doctors and their patients. Objective: Use of an efficient, rapid and cheap communication method to promote social inclusion and patient education of deaf parents and children during pediatrics appointments. Results; The application demonstrates how to express phrases and symptoms within seconds and this allows patients to fully understand the information provided during the appointment and are capable to evaluate the signs of readiness, learn the correct approaches with the child, what are the adequate instruments, possible obstacles and the importance to execute medical orientations in order to achieve success in the process. Consequently, patients feel more satisfied, secured and embraced by professionals in the health system care. Conclusion: It is of utmost importance to use efficient and cheap methods that support patient care and education in order to promote health and social inclusion.

Keywords: application, deaf patients, social inclusion, sphincter training

Procedia PDF Downloads 124

Authors: Hao-Yuan Tseng, Chuan-Yang Chang, Ying-Hui Chen, Sheng-Che Chen, Chih-Han Chang

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Orthodontic tooth treatment has demonstrated a high success rate in clinical studies. It has been agreed upon that orthodontic tooth movement is based on the ability of surrounding bone and periodontal ligament (PDL) to react to a mechanical stimulus with remodeling processes. However, the mechanism of the tooth movement is still unclear. Recent studies focus on the simple principle compression-tension theory while rare studies directly measure tooth movement. Therefore, tracking tooth movement information during orthodontic treatment is very important in clinical practice. The aim of this study is to investigate the mechanism responses of the tooth movement during the orthodontic treatments. A stereovision system applied to track the tooth movement of the patient with the stamp brackets. The system was established by two cameras with their relative position calibrate. And the orthodontic force measured by 3D printing model with the six-axis load cell to determine the initial force application. The result shows that the stereovision system accuracy revealed the measurement presents a maximum error less than 2%. For the study on patient tracking, the incisor moved about 0.9 mm during 60 days tracking, and half of movement occurred in the first few hours. After removing the orthodontic force in 100 hours, the distance between before and after position incisor tooth decrease 0.5 mm consisted with the release of the phenomenon. Using the stereovision system can accurately locate the three-dimensional position of the teeth and superposition of 3D coordinate system for all the data to integrate the complex tooth movement.

Keywords: orthodontic treatment, tooth movement, stereovision system, long-term tracking

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Authors: Mohammad Hossein Harirchian, Siavash Babaie, Nika keshtkaran, Sama Bitarafan

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Background: Fatigue is a common complaint of multiple sclerosis (MS) patients, adversely affecting their quality of life. There is a lot of evidence showing that Carnitine deficiency is linked to fatigue development and severity in some conditions. This study aimed to compare the levels of Free L-Carnitine (FLC) between MS patients and healthy people and evaluate its association with the severity of fatigue. Methods: This case-control study included 30 patients with relapsing-remitting MS (RRMS) in 2 sex-matched equal-number groups according to the presence or absence of fatigue and 30 sex-matched healthy people in the control group. In addition, between two patient groups, we compared Serum level of FLC between the patient and healthy group. Fatigue was scored using two valid questionnaires of fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS). In addition, association between Serum level of FLC and fatigue severity was evaluated in MS patients. Results: There was no significant difference in serum levels of FLC between MS patients and healthy people. The patients with fatigue had a significantly lower FLC (mg/dl) value than patients without fatigue (22.53 ± 15.84 vs. 75.36 ± 51.98, P < 0.001). The mean value of FSS and MFIS in patients with fatigue were 48.80±8.55 and 62.87 ± 13.63, respectively, which was nearly two-fold higher than group without fatigue (P < 0.001). There was a negative correlation between the serum level of FLC and fatigue severity scales (Spearman rank correlation= 0.76, P < 0.001). Conclusion: We showed healthy people and MS patients were not different in levels of FLC. In addition, patients with lower serum levels of FLC might experience more severe fatigue. Therefore, this could clarify that supplementation with L-Carnitine might be considered as a complementary treatment for MS-related fatigue.

Keywords: fatigue, multiple sclerosis, L-carnitine, modified fatigue impact scale

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Authors: Hadi Rouhi Belvirdi

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Reinforced concrete structures, in addition to bearing service loads and seismic effects, may also be subjected to impact loads resulting from unforeseen incidents. Understanding the behavior of these structures is crucial, as they serve to protect against such sudden loads and can significantly reduce damage and destruction. In examining the behavior of structures under such loading conditions, a total of eight specimens of single-layer reinforced concrete slabs were subjected to impact loading through the free fall of weights from specified heights. The weights and dimensions of the specimens were uniform, and the amount of reinforcement was consistent. By altering the slabs' overall shape and the reinforcement details, efforts were made to optimize the behavior of the slabs against impact loads. The results indicated that utilizing ductile features in the slabs increased their resistance to impact loading. However, the compressive strength of the reinforcement did not significantly enhance the flexural resistance. Assuming a constant amount of longitudinal steel, changes in the placement of tensile reinforcement led to a decrease in resistance. With a fixed amount of transverse steel, merely adjusting the angle of the transverse reinforcement could help control cracking and mitigate premature failures. An increase in compressive resistance beyond a certain limit resulted in local buckling of the compressive zone, subsequently decreasing the impact resistance.

Keywords: reinforced concrete slab, high-strength concrete, impact loading, impact resistance

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Authors: Stephanie Cheng, Benjamin Poh, Vivyan Tay, Sachin Mathur

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Aim: Diabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited. Methods: We conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analyzed. Results: During the study period, 1059 patients were admitted for STIs, of which 936 (88%) required surgical intervention. Diabetic patients were presented with a higher body-mass index (BMI) (28 vs 26), larger abscess size (24 vs 14 cm²) and a longer length of stay (LOS)(4.4 days vs 2.9 days). They also underwent a higher proportion of wide debridement as well as application of negative pressure wound therapy (NPWT) (42% vs 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs 4). There were no differences in re-admission rates within 30 days nor subsequent abscess formation in those followed for 6 months. Conclusion: The incidence of STIs among DM patients represents a significant disease burden; surgeons should consider intensive patient counseling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based on lifestyle modification and glucose control.

Keywords: general surgery, emergency general surgery, acute care surgery, soft tissue infections, diabetes mellitus

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Authors: Hassan M. Al-Ahmadi

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The fatality index (deaths/100 K population) due to road traffic accidents in the Kingdom of Saudi Arabia (KSA) is over 25, according to the World Health Organization Statistics (WHO) statistics, which is much higher than in the neighboring Arab regions. The KSA has implemented measures to mitigate traffic accidents by enforcing road safety regulations. As a result, there has been a slight decline in the frequency of road traffic accidents within the Kingdom. This study was based on the variations in the accidents for three provinces of KSA, i.e., Riyadh, Eastern Province (EP), & Qaseem, for 2016 and 2017 using ANOVA method. Data appropriateness for the ANOVA method was confirmed by the normality and the randomness of residuals. Additionally, the half-normal plot was used to identify the significant terms for the ANOVA analysis. The analysis revealed that the accidents in the EP were significantly higher than in the other two provinces during the analysis period. The monthly variation showed a spike in the accidents from month 7th to 9th month in the EP region and a slight drop in the accidents in the Qaseem and the Riyadh region during the same period, which was attributed to the increased leisure travels from the other regions to the EP. Furthermore, most of the accidents were found to occur in the age group of 18+ and 30+, and also the major reduction of accidents in 2017 as compared to 2016 was found to have occurred in the same group. These findings can be beneficial for developing strategies to further reduce the number of accidents.

Keywords: fatality index, emergency, road traffic accident, safety, leisure travels

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Authors: Pranjali Sharma, Swati Neogi

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Composite pressure vessels are low weight structures mainly used in a variety of applications such as automobiles, aeronautics and chemical engineering. Fiber reinforced polymer (FRP) composite materials offer the simplicity of design and use, high fuel storage capacity, rapid refueling capability, excellent shelf life, minimal infrastructure impact, high safety due to the inherent strength of the pressure vessel, and little to no development risk. Apart from these preliminary merits, the subsidized weight of composite vessels over metallic cylinders act as the biggest asset to the automotive industry, increasing the fuel efficiency. The result is a lightweight, flexible, non-explosive, and non-fragmenting pressure vessel that can be tailor-made to attune with specific applications. The winding pattern of the composite over-wrap is a primary focus while designing a pressure vessel. The critical stresses in the system depend on the thickness, angle and sequence of the composite layers. The composite over-wrap is wound over a plastic liner, whose geometry can be varied for the ease of winding. In the present study, we aim to optimize the FRP vessel geometry that provides an ease in winding and also aids in weight reduction for enhancing the vessel performance. Finite element analysis is used to study the effect of dome geometry, yielding a design with maximum value of burst pressure and least value of vessel weight. The stress and strain analysis of different dome ends along with the cylindrical portion is carried out in ANSYS 19.2. The failure is predicted using different failure theories like Tsai-Wu theory, Tsai-Hill theory and Maximum stress theory. Corresponding to a given winding sequence, the optimum dome geometry is determined for a fixed internal pressure to identify the theoretical value of burst pressure. Finally, this geometry is used to decrease the number of layers to reach the set value of safety in accordance with the available safety standards. This results in decrease in the weight of the composite over-wrap and manufacturing cost of the pressure vessel. An improvement in the overall weight performance of the pressure vessel gives higher fuel efficiency for its use in automobile applications.

Keywords: Compressed Gas Storage, Dome geometry, Theoretical Analysis, Type-4 Composite Pressure Vessel, Improvement in Vessel Weight Performance

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Authors: Nicole Brown

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This study considers the illness experience of fibromyalgia patients by using identity boxes. The results improve health care professionals' understanding of patient experiences. Additionally, the concept of the identity boxes may offer a practical solution for helping patients accept the diagnosis of fibromyalgia. Fibromyalgia research traditionally refers to pain experiences and relies on questionnaires, surveys, interviews and some narrative analysis. However, due to the variability in symptoms, symptom levels, and locations, these methods may not be best suited to provide an insight into the patient experience. On the other hand, lengthy interview processes are not easily accessible for sufferers of fibromyalgia. In addition to timelines and diary extracts, this study uses identity boxes as its main data collection method. Participants are asked to find items in response to specific questions and to arrange them in their box. The objects represent the patients' experiences holistically. Participants provide photographs of their identity box at each stage of the process and explain their chosen items. The photographs of the identity boxes and the patients' explanations of their objects and their boxes are subjected to interpretative phenomenological analysis. Despite the unique forms of the completed boxes, common experiences are described: the need for comfort, the role of spirituality and the impact of fibromyalgia on everyday life, that it plays a significant role but those patients are determined not to let it rule their lives. The work with the identity boxes has shown beneficial impact due to the reflective nature involved in the tasks. Further investigations will be needed to identify the long-term impact of identity work using such boxes.

Keywords: biographical disruption, fibromyalgia, illness experience, illness narrative

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Authors: Zeytu G. Asfaw, Serkalem K. Abrha, Demisew G. Degefu

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Background: HIV/AIDS remains a major public health problem in Ethiopia and heavily affecting people of productive and reproductive age. We aimed to compare the performance of Parametric Survival Analysis and Bayesian Survival Analysis using simulations and in a real dataset application focused on determining predictors of HIV patient survival. Methods: A Parametric Survival Models - Exponential, Weibull, Log-normal, Log-logistic, Gompertz and Generalized gamma distributions were considered. Simulation study was carried out with two different algorithms that were informative and noninformative priors. A retrospective cohort study was implemented for HIV infected patients under Highly Active Antiretroviral Therapy in Alamata General Hospital, North Ethiopia. Results: A total of 320 HIV patients were included in the study where 52.19% females and 47.81% males. According to Kaplan-Meier survival estimates for the two sex groups, females has shown better survival time in comparison with their male counterparts. The median survival time of HIV patients was 79 months. During the follow-up period 89 (27.81%) deaths and 231 (72.19%) censored individuals registered. The average baseline cluster of differentiation 4 (CD4) cells count for HIV/AIDS patients were 126.01 but after a three-year antiretroviral therapy follow-up the average cluster of differentiation 4 (CD4) cells counts were 305.74, which was quite encouraging. Age, functional status, tuberculosis screen, past opportunistic infection, baseline cluster of differentiation 4 (CD4) cells, World Health Organization clinical stage, sex, marital status, employment status, occupation type, baseline weight were found statistically significant factors for longer survival of HIV patients. The standard error of all covariate in Bayesian log-normal survival model is less than the classical one. Hence, Bayesian survival analysis showed better performance than classical parametric survival analysis, when subjective data analysis was performed by considering expert opinions and historical knowledge about the parameters. Conclusions: Thus, HIV/AIDS patient mortality rate could be reduced through timely antiretroviral therapy with special care on the potential factors. Moreover, Bayesian log-normal survival model was preferable than the classical log-normal survival model for determining predictors of HIV patients survival.

Keywords: antiretroviral therapy (ART), Bayesian analysis, HIV, log-normal, parametric survival models

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Authors: M. Abou-Amouna, A. Radwan, L. Al-kuwari, A. Hammuda, K. Al-Khalifa

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There is growing concern over increasing incidences of road accidents and consequent loss of human life in Qatar. In light to the future planned event in Qatar, World Cup 2022; Qatar should put into consideration the future deaths caused by road accidents, and past trends should be considered to give a reasonable picture of what may happen in the future. Qatar roads should be arranged and paved in a way that accommodate high capacity of the population in that time, since then there will be a huge number of visitors from the world. Qatar should also consider the risk issues of road accidents raised in that period, and plan to maintain high level to safety strategies. According to the increase in the number of road accidents in Qatar from 1995 until 2012, an analysis of elements affecting and causing road accidents will be effectively studied. This paper aims to identify and criticize the factors that have high effect on causing road accidents in the state of Qatar, and predict the total number of road accidents in Qatar 2022. Alternative methods are discussed and the most applicable ones according to the previous researches are selected for further studies. The methods that satisfy the existing case in Qatar were the multiple linear regression model (MLR) and artificial neutral network (ANN). Those methods are analyzed and their findings are compared. We conclude that by using MLR the number of accidents in 2022 will become 355,226 accidents, and by using ANN 216,264 accidents. We conclude that MLR gave better results than ANN because the artificial neutral network doesn’t fit data with large range varieties.

Keywords: road safety, prediction, accident, model, Qatar

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Authors: Raja Ezman Raja Shariff

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Acute kidney injury (AKI) is commonly seen in inpatients, and places a great cost on the NHS and patients. Timely and appropriate management is both nephron sparing and potentially life-saving. Ultrasound scanning (USS) is a well-recognised method for stratifying patients. Subsequently, the NICE AKI guidance has defined groups in whom scanning is recommended within 6 hours of request (pyonephrosis), within 24 hours (obstruction/cause unknown), and in whom routine scanning isn't recommended (cause for AKI identified). The audit looks into whether Stockport NHS Trust USS practice was in line with such recommendations. The audit evaluated 92 patients with AKI who had USS, between 01/01/14 to 30/04/14. Data collection was divided into 2 parts. Firstly, radiology request cards and the online imaging software (PACS) were evaluated. Then, the electronic case notes (ADVANTIS) was evaluated further. Based on request cards, 10% of requests were for pyonephrosis. Only 33% were scanned within 6hours and a further 33% within 24hours. 75% were requested for possible obstructions and unknown cause collectively. Of those due to possible obstruction, 71% of patients were scanned within 24 hours. Of those with unknown cause, 50% were scanned within 24 hours. 15% of requests had a cause declared and so potentially did not require scanning. Evaluation of the patients’ notes suggested further interesting findings. Firstly, potentially 39% of patients had a known cause for AKI, therefore, did not need USS. Subsequently, the cohort of unknown cause and possible obstruction was collectively reduced to 45%. Alarmingly the patient cohort with possible pyonephrosis went up to 16%, suggesting an under-recognition of this life-threatening condition. We plan to highlight these findings within our institution and make changes to encourage more appropriate requesting and timely scanning. Time will tell if we manage to save or increase our costs in this cost-conscious NHS. Patient benefits, though, seem to be guaranteed.

Keywords: AKI, ARF, kidney, renal

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Authors: Husni Mohd Radzi, Lilie Zahara Ramly, Sapora Sipon, Salhah Abdullah

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Malaysia have been experiencing series of huge floods all around the country for the past decades despide planned development done by local authorities. The floods incurred due to factors like natural climate change or man-made disaster. Floods have caused a lot of damages, destructions and losses in term of infrastructure, financial implications and physical health. However, other damaging aspect was not being given much attention are the psychological need of the flood victim. The traumatic impact from the natural disaster like floods may cause serious psychological and spiritual deterioration. Many flood relief shelters in the past did not provide counseling services for flood victims to consult, and as a result, it contributes to added stress among the flood victims, as the issue were not being addressed. Some studies indicates that flood victims did not look for counseling service being offered. A total of 257 flood victim was involved in this study. Main area of the study was Kg Bukit Changgang, Kg. Rancangan Tanah Belia, Kg. Labohan Dagang and Kg.Olak Lempit in Kuala Langat, Selangor. The flood victims have responded to the survey given and the data was analyze using SPSS for descriptive information and other measures. At least 13 victims were reported to have experienced moderate to severe level of stress and anxiety over the flood disaster incidents and a total of 88 respondents admitted to have at least thought and consider getting counseling service.

Keywords: perception, acceptance towards counseling, counseling service for flood victim, disaster

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Authors: Lakmali Anthony, Madeline Gillies

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Purpose: Long-term survivorship in colorectal cancer (CRC) is increasing as mortality decreases, leading to increased focus on patient-reported outcomes such as quality of life (QoL). CRC patients often have decreased QoL even after treatment is complete. This systematic review of the literature aims to identify psychosocial factors associated with decreased QoL in post-treatment CRC patients. Methodology: This systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search was conducted in MEDLINE, EMBASE, and PsychINFO using MeSH headings. The two authors screened studies for relevance and extracted data. Results: Seventeen studies were identified, including 6,272 total participants (mean = 392, 58% male) with a mean age of 60.6 years. The European Organisation for Research and Treatment of Cancer QLQ-C30 was the most common measure of QoL (n=14, 82.3%). Most studies (n=15, 88.2%) found that emotional distress correlated with poor global QoL. This was most commonly measured with the Hospital Anxiety & Depression Scale (n=11, 64.7%). Other psychosocial factors associated with QoL were lack of social support, body image, and financial difficulties. Clinicopathologic determinants included presence of stoma and metastasis. Conclusion: This systematic review provides a summary of the psychosocial determinants of poor QoL in post-treatment CRC patients, as well as the most commonly reported measures of these. An understanding of these potentially modifiable determinants of poor outcome is pivotal to the provision of quality, patient-centred care in surgical oncology.

Keywords: colorectal cancer, cancer surgery, quality of life, oncology, social determinants

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Authors: Evelyn Ilabaca, Ximena Valenzuela, Alejandra Torres, María José Galotto, Abel Guarda

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One of the biggest problems in food packaging industry, especially with the plastic materials, is the fact that these materials are usually obtained from non-renewable resources and also remain as waste after its use, causing environmental issues. This is an international concern and particular attention is given to reduction, reuse and recycling strategies for decreasing the waste from plastic packaging industry. In general, polyethylenes represent most plastic waste and recycling process of post-consumer polyethylene terephthalate (PCR-PET) has been studied. US Food and Drug Administration (FDA), European Food Safety Authority (EFSA) and Southern Common Market (MERCOSUR) have generated different legislative documents to control the use of PCR-PET in the production of plastic packaging intended direct food contact in order to ensure the capacity of recycling process to remove possible contaminants that can migrate into food. Consequently, it is necessary to demonstrate by challenge test that the recycling process is able to remove specific contaminants, obtaining a safe recycled plastic to human health. These documents establish that the concentration limit for substitute contaminants in PET is 220 ppb (ug/kg) and the specific migration limit is 10 ppb (ug/kg) for each contaminant, in addition to assure the sensorial characteristics of food are not affected. Moreover, under the Commission Regulation (EU) N°10/2011 on plastic materials and articles intended to come into contact with food, it is established that overall migration limit is 10 mg of substances per 1 dm2 of surface area of the plastic material. Thus, the aim of this work is to determine the safety of PCR-PET-containing food packaging materials in Chile by measuring their overall migration, and their comparison with the established limits at international level. This information will serve as a basis to provide a regulation to control and regulate the use of recycled plastic materials in the manufacture of plastic packaging intended to be in direct contact with food. The methodology used involves a procedure according to EN-1186:2002 with some modifications. The food simulants used were ethanol 10 % (v/v) and acetic acid 3 % (v/v) as aqueous food simulants, and ethanol 95 % (v/v) and isooctane as substitutes of fatty food simulants. In this study, preliminary results showed that Chilean food packaging plastics with different PCR-PET percentages agree with the European Legislation for food aqueous character.

Keywords: contaminants, polyethylene terephthalate, plastic food packaging, recycling

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Authors: Majid Samiee Zonoozian

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For such important constructions as jacket type platforms, scrupulous attention in analysis, design and calculation processes is needed. The reliability assessment method has been established into an extensively used method to behavior safety calculation of jacket platforms. In the present study, a methodology for the reliability calculation of an offshore jacket platform in contradiction of the extreme wave loading state is available. Therefore, sensitivity analyses are applied to acquire the nonlinear response of jacket-type platforms against extreme waves. The jacket structure is modeled by applying a nonlinear finite-element model with regards to the tubular members' behave. The probability of a member’s failure under extreme wave loading is figured by a finite-element reliability code. The FORM and SORM approaches are applied for the calculation of safety directories and reliability indexes have been detected. A case study for a fixed jacket-type structure positioned in the Persian Gulf is studied by means of the planned method. Furthermore, to define the failure standards, equations suggested by the 21st version of the API RP 2A-WSD for The jacket-type structures’ tubular members designing by applying the mixed axial bending and axial pressure. Consequently, the effect of wave Loades in the reliability index was considered.

Keywords: Jacket-Type structure, reliability, failure probability, tubular members

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Authors: Sareh Rajabi, Salwa Bheiry

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In general, Covid-19 created many financial and non-financial damages to the economy and community. Level and severity of covid-19 as pandemic case varies over the region and due to different types of the projects. Covid-19 virus emerged as one of the most imperative risk management factors word-wide recently. Therefore, as part of portfolio management assessment, it is essential to evaluate severity of such risk on the project and program in portfolio management level to avoid any risky portfolio. Covid-19 appeared very effectively in South America, part of Europe and Middle East. Such pandemic infection affected the whole universe, due to lock down, interruption in supply chain management, health and safety requirements, transportations and commercial impacts. Therefore, this research proposes Analytical Hierarchy Process (AHP) to analyze and assess such pandemic case like Covid-19 and its impacts on the construction projects. The AHP technique uses four sub-criteria: Health and safety, commercial risk, completion risk and contractual risk to evaluate the project and program. The result will provide the decision makers with information which project has higher or lower risk in case of Covid-19 and pandemic scenario. Therefore, the decision makers can have most feasible solution based on effective weighted criteria for project selection within their portfolio to match with the organization’s strategies.

Keywords: portfolio management, risk management, COVID-19, analytical hierarchy process technique

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Authors: Maryam Kamali Nezhad

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As part of the project to rehabilitate the main spillway ("main") of the Rapides-des-Îles development in 2019, it was noted that there is a difference between the water level of the intake gauge and the level measured at the main spillway. The Rapides-des-Îles Generating Station is a Hydro-Québec hydroelectric generating station and dam located on the Ottawa River in the Abitibi-Témiscamingue administrative region of Québec. This plant, with an installed capacity of 176 MW, was commissioned in 1966. During the start-up meeting held at the site in May 2019, it was noticed that the water level upstream of the main spillway was considerably higher than the water level at the powerhouse intake. Measurements showed that the level was 229.46 m, whereas the normal operating level (NOL) and the critical maximum level (CML) used in the design were 228.60 m and 229.51 m, respectively. Considering that the water level had almost reached the maximum critical level of the structure despite a flood with a recurrence period of about 100 years, the work was suspended while the project was being decided. This is the first time since the Rapides des îles project was commissioned that a significant difference in elevation between the water level at the powerhouse (intake) and the main spillway has been observed. Following this observation, the contractor's work was suspended. The objective of this study is to identify the reason(s) for this problem and find solutions. Then determine the new upstream levels at the main spillway at which the safety of the structure is ensured and then adjust the engineering of the main spillway in the rehabilitation project accordingly.

Keywords: spillway, rehabilitation, water level, powerhouse, normal operating level, critical maximum level, safety of the structure

Procedia PDF Downloads 77