Search results for: airport emergency plan
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2817

Search results for: airport emergency plan

597 The Practice of Low Flow Anesthesia to Reduce Carbon Footprints Sustainability Project

Authors: Ahmed Eid, Amita Gupta

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Abstract: Background: Background Medical gases are estimated to contribute to 5% of the carbon footprints produced by hospitals, Desflurane has the largest impact, but all increase significantly when used with N2O admixture. Climate Change Act 2008, we must reduce our carbon emission by 80% of the 1990 baseline by 2050.NHS carbon emissions have reduced by 18.5% (2007-2017). The NHS Long Term Plan has outlined measures to achieve this objective, including a 2% reduction by transforming anaesthetic practices. FGF is an important variable that determines the utilization of inhalational agents and can be tightly controlled by the anaesthetist. Aims and Objectives Environmental safety, Identification of areas of high N20 and different anaesthetic agents used across the St Helier operating theatres and consider improvising on the current practice. Methods: Data was collected from St Helier operating theatres and retrieved daily from Care Station 650 anaesthetic machines. 60 cases were included in the sample. Collected data (average flow rate, amount and type of agent used, duration of surgery, type of surgery, duration, and the total amount of Air, O2 and N2O used. AAGBI impact anaesthesia calculator was used to identify the amount of CO2 produced and also the cost per hour for every pt. Communication via reminder emails to staff emphasized the significance of low-flow anaesthesia and departmental meeting presentations aimed at heightening awareness of LFA, Distribution of AAGBI calculator QR codes in all theatres enables the calculation of volatile anaesthetic consumption and CO2e post each case, facilitating informed environmental impact assessment. Results: A significant reduction in the flow rate use in the 2nd sample was observed, flow rate usage between 0-1L was 60% which means a great reduction of the consumption of volatile anaesthetics and also Co2e. By using LFA we can save money but most importantly we can make our lives much greener and save the planet.

Keywords: low flow anesthesia, sustainability project, N₂0, Co2e

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596 Promoting Effective Institutional Governance in Cameroon Higher Education: A Governance Equalizer Perspective

Authors: Jean Patrick Mve

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The increasing quest for efficiency, accountability, and transparency has led to the implementation of massive governance reforms among higher education systems worldwide. This is causing many changes in the governance of higher education institutions. Governments over the world are trying to adopt business-like organizational strategies to enhance the performance of higher education institutions. This study explores the changes that have taken place in the Cameroonian higher education sector. It also attempts to draw a picture of the likely future of higher education governance and the actions to be taken for the promotion of institutional effectiveness among higher education institutions. The “governance equalizer” is used as an analytical tool to this end. It covers the five dimensions of the New Public Management (NPM), namely: state regulation, stakeholder guidance, academic self-governance, managerial self-governance, and competition. Qualitative data are used, including semi-structured interviews with key informants at the organizational level and other academic stakeholders, documents and archival data from the university and from the ministry of higher education. It has been found that state regulation among higher education institutions in Cameroon is excessively high, causing the institutional autonomy to be very low, especially at the level of financial management, staffing and promotion, and other internal administrative affairs; at the level of stakeholder guidance there is a higher degree of stakeholders consideration in the academic and research activities among universities, though the government’s interest to keep its hands in most management activities is still high; academic self-governance is also very weak as the assignment of academics is done more on the basis of political considerations than competence; there is no real managerial self-governance among higher education institutions due to the lack of institutional capacity and insufficient autonomy at the level of decision making; there is a plan to promote competition among universities but a real competitive environment is not yet put into place. The study concludes that the government’s policy should make state control more relaxed and concentrate on steering and supervision. As well, real institutional autonomy, professional competence building for top management and stakeholder participation should be considered to guarantee competition and institutional effectiveness.

Keywords: Cameroon higher education, effective institutional governance, governance equalizer, institutional autonomy, institutional effectiveness

Procedia PDF Downloads 126
595 Evaluation of a Higher Diploma in Mental Health Nursing Using Qualitative and Quantitative Methods: Effects on Student Behavior, Attitude and Perception

Authors: T. Frawley, G. O'Kelly

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The UCD School of Nursing, Midwifery and Health Systems Higher Diploma in Mental Health (HDMH) nursing programme commenced in January 2017. Forty students successfully completed the programme. Programme evaluation was conducted from the outset. Research ethics approval was granted by the UCD Human Research Ethics Committee – Sciences in November 2016 (LS-E-16-163). Plan for Sustainability: Each iteration of the programme continues to be evaluated and adjusted accordingly. Aims: The ultimate purpose of the HDMH programme is to prepare registered nurses (registered children’s nurse (RCN), registered nurse in intellectual disability (RNID) and registered general nurse (RGN)) to function as effective registered psychiatric nurses in all settings which provide care and treatment for people experiencing mental health difficulties. Curriculum evaluation is essential to ensure that the programme achieves its purpose, that aims and expected outcomes are met and that required changes are highlighted for the programme’s continuing positive development. Methods: Both quantitative and qualitative methods were used in the evaluation. A series of questionnaires were used (the majority pre and post programme) to determine student perceptions of the programme, behaviour and attitudinal change from commencement to completion. These included the student assessment of learning gains (SALG); mental health knowledge schedule (MAKS); mental health clinician attitudes scale (MICA); reported and intended behaviour scale (RIBS); and community attitudes towards the mentally ill (CAMI). In addition, student and staff focus groups were conducted. Evaluation methods also incorporated module feedback. Outcome/Results: The evaluation highlighted a very positive response in relation to the achievement of programme outcomes and preparation for future work as registered psychiatric nursing. Some areas were highlighted for further development, which have been taken cognisance of in the 2019 iteration of the programme.

Keywords: learning gains, mental health, nursing, stigma

Procedia PDF Downloads 119
594 DPED Trainee Teachers' Views and Practice on Mathematics Lesson Study in Bangladesh

Authors: Mihir Halder

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The main aim and objective of the eighteen-month long Diploma in Primary Education (DPED) teacher education training course for in-service primary teachers in Bangladesh is to acquire professional knowledge as well as make them proficient in professional practice. The training, therefore, introduces a variety of theoretical and practical approaches as well as some professional development activities—lesson study being one of them. But, in the field of mathematics teaching, even after implementing the lesson study method, the desired practical teaching skills of the teachers have not been developed. In addition, elementary students also remain quite raw in mathematics. Although there have been various studies to solve the problem, the need for the teachers' views on mathematical ideas has not been taken into consideration. The researcher conducted the research to find out the cause of the discussed problem. In this case, two teams of nine DPED trainee teachers and two instructors conducted two lesson studies in two schools located in the city and town of Khulna Province, Bangladesh. The researcher observed group lesson planning by trainee teachers, followed by a trainee teacher teaching the planned lesson plan to an actual mathematics classroom, and finally, post-teaching reflective discussion in each lesson study. Two DPED instructors acted as mentors in the lesson study. DPED trainee teachers and instructors were asked about mathematical concepts and classroom practices through questionnaires as well as videotaped mathematics classroom teaching. For this study, the DPED mathematics course, curriculum, and assessment activities were analyzed. In addition, the mathematics lesson plans prepared by the trainee teachers for the lesson study and their pre-teaching and post-teaching reflective discussions were analyzed by some analysis categories and rubrics. As a result, it was found that the trainee teachers' views of mathematics are not mature, and therefore, their mathematics teaching practice is not appropriate. Therefore, in order to improve teachers' mathematics teaching, the researcher recommended including some action-oriented aspects in each phase of mathematics lesson study in DPED—for example, emphasizing mathematics concepts of the trainee teachers, preparing appropriate teaching materials, presenting lessons using the problem-solving method, using revised rubrics for assessing mathematics lesson study, etc.

Keywords: mathematics lesson study, knowledge of mathematics, knowledge of teaching mathematics, teachers' views

Procedia PDF Downloads 46
593 Tracheal Stenting to Relieve Respiratory Distress in Patient with Advanced Esophageal Malignancy and Its Anaesthetic Management

Authors: Aarti Agarwal, Ajmal Khan

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Background and Objective: Breathing difficulty is most distressing symptom for the patient and their caregivers providing palliative care to individuals with advanced malignancy. It needs to be tackled effectively and sometimes preemptively to provide relief from respiratory obstruction. Interventional procedures like tracheal stenting are becoming increasingly popular as a part of palliation for respiratory symptoms. We present a case of esophageal tumor earlier stented by Gastroenterologist to maintain esophageal patency, but the tumor outgrew to produce tracheal infiltration and thereby causing airway obstruction. Method and Result: 62-year-old man presented with unresectable Carcinoma oesophagus with inability to swallow. A metallic stent was placed by the gastroenterologist, to maintain esophageal patency and enable patient to swallow. Two months later, the patient returned to hospital in emergency with respiratory distress. CT neck and thorax revealed tumor infiltration through posterior tracheal wall. Lower extent of the tumor was till 1 cm above the carina. Airway stenting with Tracheo bronchial stent with Y configuration was planned under general anaesthesia with airway blocks. Superior Laryngeal Nerve Block, Glossopharyngeal block and Trans tracheal infiltration of local anaesthetics were performed. The patient was sedated with Fentanyl, Midazolam and propofol infusion but was breathing spontaneously. Once the rigid bronchoscope was placed inside trachea, breathing was supported with oxygen and sevoflurane. Initially, the trachea was cleared of tumor by coring. After creating space, tracheal stent was positioned and deployed. After stent placement patient was awakened, suctioned and nebulized. His respiratory stridor relieved instantaneously and was shifted to recovery. Conclusion: Airway blocks help in decreasing the incidence and severity of coughing during airway instrumentation thereby help in proper stent placement. They also reduce the requirement of general anaesthetics and hasten the post stenting recovery. Airway stent provided immediate relief to patient from symptoms of respiratory difficulty. Decision for early tracheal stenting may be taken for a select group of patients with high propensity for local spread, thereby avoiding respiratory complications and providing better quality of life in patients with inoperable malignancy.

Keywords: tracheal stent, respiratory difficulty, esophageal tumor, anaesthetic management

Procedia PDF Downloads 199
592 Industry Symbiosis and Waste Glass Upgrading: A Feasibility Study in Liverpool Towards Circular Economy

Authors: Han-Mei Chen, Rongxin Zhou, Taige Wang

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Glass is widely used in everyday life, from glass bottles for beverages to architectural glass for various forms of glazing. Although the mainstream of used glass is recycled in the UK, the single-use and then recycling procedure results in a lot of waste as it incorporates intact glass with smashing, re-melting, and remanufacturing. These processes bring massive energy consumption with a huge loss of high embodied energy and economic value, compared to re-use, which’s towards a ‘zero carbon’ target. As a tourism city, Liverpool has more glass bottle consumption than most less leisure-focused cities. It’s therefore vital for Liverpool to find an upgrading approach for the single-use glass bottles with low carbon output. This project aims to assess the feasibility of industrial symbiosis and upgrading the framework of glass and to investigate the ways of achieving them. It is significant to Liverpool’s future industrial strategy since it provides an opportunity to target economic recovery for post-COVID by industry symbiosis and up-grading waste management in Liverpool to respond to the climate emergency. In addition, it will influence the local government policy for glass bottle reuse and recycling in North West England and as a good practice to be further recommended to other areas of the UK. First, a critical literature review of glass waste strategies has been conducted in the UK and worldwide industrial symbiosis practices. Second, mapping, data collection, and analysis have shown the current life cycle chain and the strong links of glass reuse and upgrading potentials via site visits to 16 local waste recycling centres. The results of this research have demonstrated the understanding of the influence of key factors on the development of a circular industrial symbiosis business model for beverage glass bottles. The current waste management procedures of the glass bottle industry, its business model, supply chain, and material flow have been reviewed. The various potential opportunities for glass bottle up-valuing have been investigated towards an industrial symbiosis in Liverpool. Finally, an up-valuing business model has been developed for an industrial symbiosis framework of glass in Liverpool. For glass bottles, there are two possibilities 1) focus on upgrading processes towards re-use rather than single-use and recycling and 2) focus on ‘smart’ re-use and recycling, leading to optimised values in other sectors to create a wider industry symbiosis for a multi-level and circular economy.

Keywords: glass bottles, industry symbiosis, smart re-use, waste upgrading

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591 Spontaneous Rupture of Splenic Artery Pseudoaneurysm; A Rare Presentation of Acute Abdominal Pain in the Emergency Department: Case Report

Authors: Zainab Elazab, Azhar Aziz

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Background: Spontaneous Splenic artery pseudoaneurysm rupture is a rare condition which is potentially life threatening, if not detected and managed early. We report a case of abdominal pain with intraperitoneal free fluid, which turned out to be spontaneous rupture of a splenic artery pseudoaneurysm, and was treated with arterial embolization. Case presentation: A 28-year old, previously healthy male presented to the ED with a history of sudden onset upper abdominal pain and fainting attack. The patient denied any history of trauma or prior similar attacks. On examination, the patient had tachycardia and a low-normal BP (HR 110, BP 106/66) but his other vital signs were normal (Temp. 37.2, RR 18 and SpO2 100%). His abdomen was initially soft with mild tenderness in the upper region. Blood tests showed leukocytosis of 12.3 X109/L, Hb of 12.6 g/dl and lactic acid of 5.9 mmol/L. Ultrasound showed trace of free fluid in the perihepatic and perisplenic areas, and a splenic hypoechoic lesion. The patient remained stable; however, his abdomen became increasingly tender with guarding. We made a provisional diagnosis of a perforated viscus and the patient was started on IV fluids and IV antibiotics. An erect abdominal x-ray did not show any free air under the diaphragm so a CT abdomen was requested. Meanwhile, bedside ultrasound was repeated which showed increased amount of free fluid, suggesting intra-abdominal bleeding as the most probable etiology for the condition. His CT abdomen revealed a splenic injury with multiple lacerations, a focal intrasplenic enhancing area on venous phase scan (suggesting a pseudoaneurysm with associated splenic intraparenchymal, sub capsular and perisplenic hematomas). Free fluid in the subhepatic and intraperitoneal regions along the small bowel was also detected. Angiogram was done which confirmed a diagnosis of pseudoaneurysm of intrasplenic arterial branch, and angio-embolization was done to control the bleeding. The patient was later discharged in good condition with a surgery follow-up. Conclusion: Splenic artery pseudoaneurysm rupture is a rare cause of abdominal pain which should be considered in any case of abdominal pain with intraperitoneal bleeding. Early management is crucial as it carries a high mortality. Bedside ultrasound is a useful tool to help for early diagnosis of such cases.

Keywords: abdominal pain, pseudo aneurysm, rupture, splenic artery

Procedia PDF Downloads 291
590 The Covid Pandemic at a Level III Trauma Center: Challenges in the Management of the Spine Trauma.

Authors: Joana PaScoa Pinheiro, David Goncalves Ferreira, Filipe Ramos, Joaquim Soares Do Brito, Samuel Martins, Marco Sarmento

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Introduction: The SARS-CoV-2 (COVID-19) pandemic was identified in January 2020 in China, in the city of Wuhan. The increase in the number of cases over the following months was responsible for the restructuring of hospitals and departments in order to accommodate admissions related to COVID-19. Essential services, such as trauma, had to readapt to maintain their functionality and thus guarantee quick and safe access in case of an emergency. Objectives: This study describes the impact of COVID-19 on a Level III Trauma Center and particularly on the clinical management of hospitalized patients with spine injuries. Study Design & Methods: This is a retrospective cohort study whose results were obtained through the medical records of patients with spine injuries who underwent surgical intervention in the years 2019 and 2020 (period from March 1st to December 31st). A comparison between the two groups was made. In the study patients with injuries in the context of trauma were included who underwent surgery in the periods previously described. Patients hospitalized with a spine injury in a non-traumatic context and/or were not surgically treated were excluded. Results: In total, 137 patients underwent trauma spine surgery of which 71 in 2019 (51.8%) were without significant differences in intergroup comparisons. The most frequent injury mechanism in 2019 was motor vehicle crash (47.9%) compared to 2020 which was of a person falling from a height between 2-4 meters (37.9%). Cervical trauma was reported to be the most frequent spine injury in both years. There was a significant decrease in the need for intensive care in 2020, 51.4% vs 30.3%, p = .015 and the number of complications was also lower in 2020 (1.35% vs 0.98%), including the number of deaths, being the difference marginally significant. There were no significant differences regarding time for presentation to surgery or in the total days of hospitalization. Conclusions: The restructuring made in the trauma unit at a Level III Trauma Center in the context of the current COVID-19 pandemic was effective, with no significant differences between the years of 2019 vs 2020 when compared with the time for presentation to surgery or the number of days of hospitalization. It was also found that lockdown rules in 2020 were probably responsible for the decrease in the number of road traffic accidents, which justifies a significant decrease in the need for intensive care as well as in the number of complications in patients hospitalized in the context of spine trauma.

Keywords: trauma, spine, impact, covid-19

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589 Design Forms Urban Space

Authors: Amir Shouri, Fereshteh Tabe

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Thoughtful and sequential design strategies will shape the future of human being’s lifestyle. Design, as a product, either being for small furniture on sidewalk or a multi-story structure in urban scale, will be important in creating the sense of quality for citizens of a city. Technology besides economy has played a major role in improving design process and increasing awareness of clients about the character of their required design product. Architects along with other design professionals benefited from improvements in aesthetics and technology in building industry. Accordingly, the expectation platforms of people about the quality of habitable space have risen. However, the question is if the quality of architectural design product has increased with the same speed as technology and client’s expectations. Is it behind or a head of technological and economical improvements? This study will work on developing a model of planning for New York City, from the past to present to future. The role of thoughtful thinking at design stage regardless of where or when it is for; may result in a positive or negative aspect. However, considering design objectives based on the need of human being may help in developing a successful design plan. Technology, economy, culture and people’s support may be other parameters in designing a good product. ‘Design Forms Urban Space’ is going to be done in an analytical, qualitative and quantitative work frame, where it will study cases from all over the world and their achievements compared to New York City’s development. Technology, Organic Design, Materiality, Urban forms, city politics and sustainability will be discussed in different cases in international scale. From design professional’s interest in doing a high quality work for a particular answer to importance of being a follower, the ‘Zero-Carbon City’ in Persian Gulf to ‘Polluted City’ in China, from ‘Urban Scale Furniture’ in cities to ‘Seasonal installations’ of a Megacity, will all be studied with references and detailed look to analysis of each case in order to propose the most resourceful, practical and realistic solutions to questions on ‘A Good Design in a City’, ‘New City Planning and social activities’ and ‘New Strategic Architecture for better Cities’.

Keywords: design quality, urban scale, active city, city installations, architecture for better cities

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588 Fijian Women’s Role in Disaster Risk Management: Climate Change

Authors: Priyatma Singh, Manpreet Kaur

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Climate change is progressively being identified as a global crisis and this has immediate repercussions for Fiji Islands due to its geographical location being prone to natural disasters. In the Pacific, it is common to find significant differences between men and women, in terms of their roles and responsibilities. In the pursuit of prudent preparedness before disasters, Fijian women’s engagement is constrained due to socially constructed roles and expectation of women here in Fiji. This vulnerability is aggravated by viewing women as victims, rather than as key people who have vital information of their society, economy, and environment, as well as useful skills, which, when recognized and used, can be effective in disaster risk reduction. The focus of this study on disaster management is to outline ways in which Fijian women can be actively engaged in disaster risk management, articulating in decision-making, negating the perceived ideology of women’s constricted roles in Fiji and unveiling social constraints that limit women’s access to practical disaster management strategic plan. This paper outlines the importance of gender mainstreaming in disaster risk reduction and the ways of mainstreaming gender based on a literature review. It analyses theoretical study of academic literature as well as papers and reports produced by various national and international institutions and explores ways to better inform and engage women for climate change per ser disaster management in Fiji. The empowerment of women is believed to be a critical element in constructing disaster resilience as women are often considered to be the designers of community resilience at the local level. Gender mainstreaming as a way of bringing a gender perspective into climate related disasters can be applied to distinguish the varying needs and capacities of women, and integrate them into climate change adaptation strategies. This study will advocate women articulation in disaster risk management, thus giving equal standing to females in Fiji and also identify the gaps and inform national and local Disaster Risk Management authorities to implement processes that enhance gender equality and women’s empowerment towards a more equitable and effective disaster practice.

Keywords: disaster risk management, climate change, gender mainstreaming, women empowerment

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587 Refractory Cardiac Arrest: Do We Go beyond, Do We Increase the Organ Donation Pool or Both?

Authors: Ortega Ivan, De La Plaza Edurne

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Background: Spain and other European countries have implemented Uncontrolled Donation after Cardiac Death (uDCD) programs. After 15 years of experience in Spain, many things have changed. Recent evidence and technical breakthroughs achieved in resuscitation are relevant for uDCD programs and raise some ethical concerns related to these protocols. Aim: To rethink current uDCD programs in the light of recent evidence on available therapeutic procedures applicable to victims of out-of-hospital cardiac arrest (OHCA). To address the following question: What is the current standard of treatment owed to victims of OHCA before including them in an uDCD protocol? Materials and Methods: Review of the scientific and ethical literature related to both uDCD programs and innovative resuscitation techniques. Results: 1) The standard of treatment received and the chances of survival of victims of OHCA depend on whether they are classified as Non-Heart Beating Patients (NHBP) or Non-Heart-Beating-Donors (NHBD). 2) Recent studies suggest that NHBPs are likely to survive, with good quality of life, if one or more of the following interventions are performed while ongoing CPR -guided by suspected or known cause of OHCA- is maintained: a) direct access to a Cath Lab-H24 or/and to extra-corporeal life support (ECLS); b) transfer in induced hypothermia from the Emergency Medical Service (EMS) to the ICU; c) thrombolysis treatment; d) mobile extra-corporeal membrane oxygenation (mini ECMO) instituted as a bridge to ICU ECLS devices. 3) Victims of OHCA who cannot benefit from any of these therapies should be considered as NHBDs. Conclusion: Current uDCD protocols do not take into account recent improvements in resuscitation and need to be adapted. Operational criteria to distinguish NHBDs from NHBP should seek a balance between the technical imperative (to do whatever is possible), considerations about expected survival with quality of life, and distributive justice (costs/benefits). Uncontrolled DCD protocols can be performed in a way that does not hamper the legitimate interests of patients, potential organ donors, their families, the organ recipients, and the health professionals involved in these processes. Families of NHBDs’ should receive information which conforms to the ethical principles of respect of autonomy and transparency.

Keywords: uncontrolled donation after cardiac death resuscitation, refractory cardiac arrest, out of hospital cardiac, arrest ethics

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586 Correlation Study between Clinical and Radiological Findings in Knee Osteoarthritis

Authors: Nabil A. A. Mohamed, Alaa A. A. Balbaa, Khaled E. Ayad

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Osteoarthritis (OA) of the knee is the most common form of arthritis and leads to more activity limitations (e.g., disability in walking and stair climbing) than any other disease, especially in the elderly. Recently, impaired proprioceptive accuracy of the knee has been proposed as a local factor in the onset and progression of radiographic knee OA (ROA). Purpose: To compare the clinical and radiological findings in healthy with that of knee OA. Also, to determine if there is a correlation between the clinical and radiological findings in patients with knee OA. Subjects: Fifty one patients diagnosed as unilateral or bilateral knee OA with age ranged between 35-70 years, from both gender without any previous history of knee trauma or surgery, and twenty one normal subjects with age ranged from 35 - 68 years. METHODS: peak torque/body weight (PT/BW) was recorded from knee extensors at isokinetic isometric mode at angle of 45 degree. Also, the Absolute Angular Error was recorded at 45O and 30O to measure joint position sense (JPS). They made anteroposterior (AP) plain X-rays from standing semiflexed knee position and their average score of Timed Up and Go test(TUG) and WOMAC were recorded as a measure of knee pain, stiffness and function. Comparison between the mean values of different variables in the two groups was performed using unpaired student t test. The P value less or equal to 0.05 was considered significant. Results: There were significant differences between the studied variables between the experimental and control groups except the values of AAE at 30O. Also, there were no significant correlation between the clinical findings (pain, function, muscle strength and proprioception) and the severity of arthritic changes in X-rays. CONCLUSION: From the finding of the current study we can conclude that there were a significant difference between the both groups in all studied parameters (the WOMAC, functional level, quadriceps muscle strength and the joint proprioception). Also this study did not support the dependency on radiological findings in management of knee OA as the radiological features did not necessarily indicate the level of structural damage of patients with knee OA and we should consider the clinical features in our treatment plan.

Keywords: joint position sense, peak torque, proprioception, radiological knee osteoarthritis

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585 Application Case and Result Consideration About Basic and Working Design of Floating PV Generation System Installed in the Upstream of Dam

Authors: Jang-Hwan Yin, Hae-Jeong Jeong, Hyo-Geun Jeong

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K-water (Korea Water Resources Corporation) conducted basic and working design about floating PV generation system installed above water in the upstream of dam to develop clean energy using water with importance of green growth is magnified ecumenically. PV Generation System on the ground applied considerably until now raise environmental damage by using farmland and forest land, PV generation system on the building roof is already installed at almost the whole place of business and additional installation is almost impossible. Installation space of PV generation system is infinite and efficient national land use is possible because it is installed above water. Also, PV module's efficiency increase by natural water cooling method and no shade. So it is identified that annual power generation is more than PV generation system on the ground by operating performance data. Although it is difficult to design and construct by high cost, little application case, difficult installation of floater, mooring device, underwater cable, etc. However, it has been examined cost reduction plan such as structure weight lightening, floater optimal design, etc. This thesis described basic and working design result systematically about K-water's floating PV generation system development and suggested optimal design method of floating PV generation system. Main contents are photovoltaic array location select, substation location select related underwater cable, PV module and inverter design, transmission and substation equipment design, floater design related structure weight lightening, mooring system design related water level fluctuation, grid connecting technical review, remote control and monitor equipment design, etc. This thesis will contribute to optimal design and business extension of floating PV generation system, and it will be opportunity revitalize clean energy development using water.

Keywords: PV generation system, clean energy, green growth, solar energy

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584 The Interaction of Climate Change and Human Health in Italy

Authors: Vito Telesca, Giuseppina A. Giorgio, M. Ragosta

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The effects of extreme heat events are increasing in recent years. Humans are forced to adjust themselves to adverse climatic conditions. The impact of weather on human health has become public health significance, especially in light of climate change and rising frequency of devasting weather events (e.g., heat waves and floods). The interest of scientific community is widely known. In particular, the associations between temperature and mortality are well studied. Weather conditions are natural factors that affect the human organism. Recent works show that the temperature threshold at which an impact is seen varies by geographic area and season. These results suggest heat warning criteria should consider local thresholds to account for acclimation to local climatology as well as the seasonal timing of a forecasted heat wave. Therefore, it is very important the problem called ‘local warming’. This is preventable with adequate warning tools and effective emergency planning. Since climate change has the potential to increase the frequency of these types of events, improved heat warning systems are urgently needed. This would require a better knowledge of the full impact of extreme heat on morbidity and mortality. The majority of researchers who analyze the associations between human health and weather variables, investigate the effect of air temperature and bioclimatic indices. These indices combine air temperature, relative humidity, and wind speed and are very important to determine the human thermal comfort. Health impact studies of weather events showed that the prevention is an essential element to dramatically reduce the impact of heat waves. The summer Italian of 2012 was characterized with high average temperatures (con un +2.3°C in reference to the period 1971-2000), enough to be considered as the second hottest summer since 1800. Italy was the first among countries in Europe which adopted tools for to predict these phenomena with 72 hours in advance (Heat Health Watch Warning System - HHWWS). Furthermore, in Italy heat alert criteria relies on the different Indexes, for example Apparent temperature, Scharlau index, Thermohygrometric Index, etc. This study examines the importance of developing public health policies that protect the most vulnerable people (such as the elderly) to extreme temperatures, highlighting the factors that confer susceptibility.

Keywords: heat waves, Italy, local warming, temperature

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583 Identifying the Factors that Influence Water-Use Efficiency in Agriculture: Case Study in a Spanish Semi-Arid Region

Authors: Laura Piedra-Muñoz, Ángeles Godoy-Durán, Emilio Galdeano-Gómez, Juan C. Pérez-Mesa

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The current agricultural system in some arid and semi-arid areas is not sustainable in the long term. In southeast Spain, groundwater is the main water source and is overexploited, while alternatives like desalination are still limited. The Water Plan for the Mediterranean Basins 2015-2020 indicates a global deficit of 73.42 hm3 and an overexploitation of the aquifers of 205.58hm3. In order to solve this serious problem, two major actions can be taken: increasing available water, and/or improving the efficiency of its use. This study focuses on the latter. The main aim of this study is to present the major factors related to water usage efficiency in farming. It focuses on Almería province, southeast Spain, one of the most arid areas of the country, and in particular on family farms as the main direct managers of water use in this zone. Many of these farms are among the most water efficient in Spanish agriculture, but this efficiency is not generalized throughout the sector. This work conducts a comprehensive assessment of water performance in this area, using on-farm water-use, structural, socio-economic and environmental information. Two statistical techniques are used: descriptive analysis and cluster analysis. Thus, two groups are identified: the least and the most efficient farms regarding water usage. By analyzing both the common characteristics within each group and the differences between the groups with a one-way ANOVA analysis, several conclusions can be reached. The main differences between the two clusters center on the extent to which innovation and new technologies are used in irrigation. The most water efficient farms are characterized by more educated farmers, a greater degree of innovation, new irrigation technology, specialized production and awareness of water issues and environmental sustainability. The research shows that better practices and policies can have a substantial impact on achieving a more sustainable and efficient use of water. The findings of this study can be extended to farms in similar arid and semi-arid areas and contribute to foster appropriate policies to improve the efficiency of water usage in the agricultural sector.

Keywords: cluster analysis, family farms, Spain, water-use efficiency

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582 Drawbacks of Second Generation Urban Re-Development in Addis Ababa

Authors: Ezana Haddis Weldeghebrael

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Addis Ababa City Administration is engaged in a massive facelift of the inner-city. The paper, therefore, aims to analyze the challenges of the current urban regeneration effort by paying special attention to Lideta and Basha Wolde Chilot projects. To this end, the paper has adopted a documentary research strategy to collect the data and Institutionalist perspective as well as the concept of urban regeneration to analyze the data. The sources were selected based on relevance and recency. Academic research outputs were used primarily. However, where much scholastic publications are not available institutional reports, newspaper articles, and expert presentations were used. The major findings of the research revealed that although the second generation of urban redevelopment projects have attempted to involve affected groups and succeeded in designing better neighborhoods, they are riddled with three major drawbacks. The first one is institutional constraints, i.e. absence of urban redevelopment strategy as well as housing policy, broad definition of ‘public purpose’, little regard for informal businesses, limitation on rights groups, negotiation power not devolved at sub-city level and no plan for groups that cannot afford to pay the down payment for low-cost apartments. The second one is planning limitation, i.e. absence of genuine affected group participation as well as consultative level of public engagement. The third one is implementation failure, i.e. no regard to maintaining social bond, non-participatory and ill-informed resettlement, interference from senior government officials, failure to protect the poor from speculators, corruption and disregard to heritage buildings. Based on the findings, the paper concluded that the current inner-city redevelopment has failed to be socially sustainable and calls for enactment of housing policy as well as redevelopment strategy, affected group participation, on-site resettlement, empowering the Sub-city to manage the project and allowing housing rights groups to advocate for the poor slum dwellers.

Keywords: participation, redevelopment, planning, implementation, consultation

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581 Enhancing Teaching of Engineering Mathematics

Authors: Tajinder Pal Singh

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Teaching of mathematics to engineering students is an open ended problem in education. The main goal of mathematics learning for engineering students is the ability of applying a wide range of mathematical techniques and skills in their engineering classes and later in their professional work. Most of the undergraduate engineering students and faculties feels that no efforts and attempts are made to demonstrate the applicability of various topics of mathematics that are taught thus making mathematics unavoidable for some engineering faculty and their students. The lack of understanding of concepts in engineering mathematics may hinder the understanding of other concepts or even subjects. However, for most undergraduate engineering students, mathematics is one of the most difficult courses in their field of study. Most of the engineering students never understood mathematics or they never liked it because it was too abstract for them and they could never relate to it. A right balance of application and concept based teaching can only fulfill the objectives of teaching mathematics to engineering students. It will surely improve and enhance their problem solving and creative thinking skills. In this paper, some practical (informal) ways of making mathematics-teaching application based for the engineering students is discussed. An attempt is made to understand the present state of teaching mathematics in engineering colleges. The weaknesses and strengths of the current teaching approach are elaborated. Some of the causes of unpopularity of mathematics subject are analyzed and a few pragmatic suggestions have been made. Faculty in mathematics courses should spend more time discussing the applications as well as the conceptual underpinnings rather than focus solely on strategies and techniques to solve problems. They should also introduce more ‘word’ problems as these problems are commonly encountered in engineering courses. Overspecialization in engineering education should not occur at the expense of (or by diluting) mathematics and basic sciences. The role of engineering education is to provide the fundamental (basic) knowledge and to teach the students simple methodology of self-learning and self-development. All these issues would be better addressed if mathematics and engineering faculty join hands together to plan and design the learning experiences for the students who take their classes. When faculties stop competing against each other and start competing against the situation, they will perform better. Without creating any administrative hassles these suggestions can be used by any young inexperienced faculty of mathematics to inspire engineering students to learn engineering mathematics effectively.

Keywords: application based learning, conceptual learning, engineering mathematics, word problem

Procedia PDF Downloads 213
580 Spontaneous Eruption of Impacted Teeth While Awaiting Surgical Intervention

Authors: Alison Ryan, Himani Chhabra, Mohammed Dungarwalla, Judith Jones

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Background: Impacted and ectopic teeth present in 1-2% of orthodontic patients and often require joint surgical and orthodontic management. The authors present two patients undergoing orthodontic treatment, where the impacted teeth, in a hopeless position, spontaneously erupted during the period of cessation of general anaesthetic lists during the COVID-19 pandemic. Patient information: A healthy 11-year-old boy was referred to the Department of Oral and Maxillofacial Surgery for the management of a mesioangular impacted LR7. The patient was seen by the joint oral surgery/orthodontic team, who planned for the removal of the LR7 under general anaesthetic. A healthy 13-year-old boy was referred to the same Department and team for surgical extraction of unerupted and buccally impacted UL3 and UR3 under general anaesthetic. Management and outcome: The majority of elective dental-alveolar work ceased as a result of the global pandemic. On resumption of activity, the first patient was reviewed in July 2021. The LR7 had spontaneously erupted in a favourable position, and following MDT review, a decision was made to forgo any further surgical intervention. The second patient was reviewed in July 2021. The UL3 had clinically erupted, and there was radiographic evidence of favourable movement of UR3. Due to the nature of the patient’s malocclusion, the decision was made to proceed with the extractions as previously planned. Key Learning Points: Severely impacted teeth do have a prospect of spontaneous eruption or alignment without clinical intervention, and current literature states the initial location, axial inclination, degree of root formation, and relation of the impacted tooth to adjacent teeth roots may influence spontaneous eruption. There is potential to introduce a period of observation to account for this possibility in the developing dentition, with the aim of reducing the unnecessary need for surgical intervention. This could help prevent episodes of general anaesthetic and allocate theatre space more appropriately.

Keywords: spontaneous eruption, impaction, observation, hopeless position, surgical, orthodontic, change in treatment plan

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579 An Observational Study Assessing the Baseline Communication Behaviors among Healthcare Professionals in an Inpatient Setting in Singapore

Authors: Pin Yu Chen, Puay Chuan Lee, Yu Jen Loo, Ju Xia Zhang, Deborah Teo, Jack Wei Chieh Tan, Biauw Chi Ong

Abstract:

Background: Synchronous communication, such as telephone calls, remains the standard communication method between nurses and other healthcare professionals in Singapore public hospitals despite advances in asynchronous technological platforms, such as instant messaging. Although miscommunication is one of the most common causes of lapses in patient care, there is a scarcity of research characterizing baseline inter-professional healthcare communications in a hospital setting due to logistic difficulties. Objective: This study aims to characterize the frequency and patterns of communication behaviours among healthcare professionals. Methods: The one-week observational study was conducted on Monday through Sunday at the nursing station of a cardiovascular medicine and cardiothoracic surgery inpatient ward at the National Heart Centre Singapore. Subjects were shadowed by two physicians for sixteen hours or consecutive morning and afternoon nursing shifts. Communications were logged and characterized by type, duration, caller, and recipient. Results: A total of 1,023 communication events involving the attempted use of the common telephones at the nursing station were logged over a period of one week, corresponding to a frequency of one event every 5.45 minutes (SD 6.98, range 0-56 minutes). Nurses initiated the highest proportion of outbound calls (38.7%) via the nursing station common phone. A total of 179 face-to-face communications (17.5%), 362 inbound calls (35.39%), 481 outbound calls (47.02%), and 1 emergency alert (0.10%) were captured. Average response time for task-oriented communications was 159 minutes (SD 387.6, range 86-231). Approximately 1 in 3 communications captured aimed to clarify patient-related information. The total duration of time spent on synchronous communication events over one week, calculated from total inbound and outbound calls, was estimated to be a total of 7 hours. Conclusion: The results of our study showed that there is a significant amount of time spent on inter-professional healthcare communications via synchronous channels. Integration of patient-related information and use of asynchronous communication channels may help to reduce the redundancy of communications and clarifications. Future studies should explore the use of asynchronous mobile platforms to address the inefficiencies observed in healthcare communications.

Keywords: healthcare communication, healthcare management, nursing, qualitative observational study

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578 Best Practical Technique to Drain Recoverable Oil from Unconventional Deep Libyan Oil Reservoir

Authors: Tarek Duzan, Walid Esayed

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Fluid flow in porous media is attributed fundamentally to parameters that are controlled by depositional and post-depositional environments. After deposition, digenetic events can act negatively on the reservoir and reduce the effective porosity, thereby making the rock less permeable. Therefore, exploiting hydrocarbons from such resources requires partially altering the rock properties to improve the long-term production rate and enhance the recovery efficiency. In this study, we try to address, firstly, the phenomena of permeability reduction in tight sandstone reservoirs and illustrate the implemented procedures to investigate the problem roots; finally, benchmark the candidate solutions at the field scale and recommend the mitigation strategy for the field development plan. During the study, two investigations have been considered: subsurface analysis using ( PLT ) and Laboratory tests for four candidate wells of the interested reservoir. Based on the above investigations, it was obvious that the Production logging tool (PLT) has shown areas of contribution in the reservoir, which is considered very limited, considering the total reservoir thickness. Also, Alcohol treatment was the first choice to go with for the AA9 well. The well productivity has been relatively restored but not to its initial productivity. Furthermore, Alcohol treatment in the lab was effective and restored permeability in some plugs by 98%, but operationally, the challenge would be the ability to distribute enough alcohol in a wellbore to attain the sweep Efficiency obtained within a laboratory core plug. However, the Second solution, which is based on fracking wells, has shown excellent results, especially for those wells that suffered a high drop in oil production. It is suggested to frac and pack the wells that are already damaged in the Waha field to mitigate the damage and restore productivity back as much as possible. In addition, Critical fluid velocity and its effect on fine sand migration in the reservoir have to be well studied on core samples, and therefore, suitable pressure drawdown will be applied in the reservoir to limit fine sand migration.

Keywords: alcohol treatment, post-depositional environments, permeability, tight sandstone

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577 Social Medical Club: A Social Business Policy to Ensure Quality Health Services to the Underprivileged Areas of Underdeveloped Countries

Authors: Hasan Al Banna, Nazmus Sakib, Anjan Roy

Abstract:

From the perspective of the underdeveloped countries such as Bangladesh, health issue can readily be pointed out as the most demanding but the least promoted concern due to lack of initiatives from both government and NGOs. Furthermore an worldwide scenario is that most death and suffering from various pathogenic and non-pathogenic diseases occur due to delay diagnosis, and this happen for the lacking of regular health check-up facility or tradition. In this epistle, an innovative proposal on social business can be introduced to ensure the one-stop medical facility to the door-step of the rural society and create jobs for the educated rural youths to serve their own people. To illustrate the policy, this newly proposed organization will work as a health club which will offer a life-time membership to villagers within a very affordable fee of 250 BDT (2.63 Euro) per month. In this package the members will get the facility of tri-monthly full health check-up by specialist doctors, a health record book and computerized health database for each member and anytime medical consultancy for the members only. We will also organize free medical campaign and workshops on nutrition, sanitation, adulteration, pregnancy-care, child-health etc with the assistance of different sponsors. Among other services that will be provided on payment include emergency ambulance facility in low rents, quality diagnostic lab and 24-hour dispensary facility. Likewise, this policy will involve local educated people by recruiting them after providing intensive courses on nursing and other medical instrumental skills. Henceforth, the engagement of local youth will make the program more acceptable to the rural community. In the later part of this paper, a survey report on Daragram union of Manikganj district, Bangladesh, having population above 25000, will be presented to delineate the scenario how this policy can repay the initial capital expense of BDT 7 million (around 73381 Euro) within 5 years and how I can realistically earn handsome revenue from the first month of business. To recapitulate, this policy is very promising to enlighten the underprivileged community by providing health assurance, and alleviating unemployment besides the investor’s financial profit.

Keywords: create job for the rural people, handsome financial profit, quality health services, underprivileged areas of underdeveloped countries

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576 Community Involvement and Willingness To Pay for Municipal Solid Waste Management Activities in Rapid Urbanized Region: A Case Study of Mnadani and Madukani Wards-Dodoma Urban

Authors: Isabela Thomas Mkude

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This research was done to assess how the community is involved in waste management activities and their willingness to pay for services. Mnadani and Madukani are among the old wards in Dodoma urban. These two areas are similar and face numerous environmental problems, poor solid waste management practices being among them. People realize problems because they live with them daily but the study advice that the only way to stay off problems is to find appropriate measures. The findings recognized some problems that led to poor community involvement solid waste management the study areas. Lack of community education on how to deal with solid wastes, poor responsibility of ward leaders in issues concerning the environment and in active participation of communities in environmental meeting are among other major problems found during the research. The research also revealed that there is low willingness to pay for waste collection among communities and financial problems that make environmental committee inactive; that leading to a poor disposal and unavailable collection facilities in urban area. Although the municipal improves disposal activities by increasing amount of waste to be disposed off by 11% in three years, the amount of waste that collected is also increasing by 41% each day. It is advised that some corrective measures need to be put in place so that the communities are well involved in managing solid wastes as the best way to attain achievement in keeping the urban free from solid waste. Environmental education dissemination to the communities is needed so that they become responsible and dedicated citizen on the environment. There should be some incentives from government to the wards local government and CBOs so that they can practically implement solid waste management programs and to attract formation of more groups and motivate the present groups. Capacity building programs to the ward leaders need to be given priority so that leaders are well organized and able to plan, coordinate and cooperate with various governmental institutions, and NGOs responsible for development and environmental management.

Keywords: solid waste, waste management, public involvement, rapid urbanized region

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575 The Relationship between Creative Imagination and Curriculum

Authors: Faride Hashemiannejad, Shima Oloomi

Abstract:

Imagination is one of the important elements of creative thinking which as a skill needs attention by the educational system. Although most students learn reading, writing, and arithmetic skills well, they lack high level thinking skills like creative thinking. Therefore, in the information age and in the beginning of entry to knowledge-based society, the educational system needs to think over its goals and mission, and concentrate on creativity-based curriculum. From among curriculum elements-goals, content, method and evaluation “method” is a major domain whose reform can pave the way for fostering imagination and creativity. The purpose of this study was examining the relationship between creativity development and curriculum. Research questions were: (1) is there a relationship between the cognitive-emotional structure of the classroom and creativity development? (2) Is there a relationship between the environmental-social structure of the classroom and creativity development? (3) Is there a relationship between the thinking structure of the classroom and creativity development? (4) Is there a relationship between the physical structure of the classroom and creativity development? (5) Is there a relationship between the instructional structure of the classroom and creativity development? Method: This research is a applied research and the research method is Correlational research. Participants: The total number of participants in this study included 894 students from High school through 11th grade from seven schools of seven zones in Mashad city. Sampling Plan: Sampling was selected based on Random Multi State. Measurement: The dependent measure in this study was: (a) the Test of Creative Thinking, (b) The researcher-made questionnaire includes five fragments, cognitive, emotional structure, environmental social structure, thinking structure, physical structure, and instructional structure. The Results Show: There was significant relationship between the cognitive-emotional structure of the classroom and student’s creativity development (sig=0.139). There was significant relationship between the environmental-social structure of the classroom and student’s creativity development (sig=0.006). There was significant relationship between the thinking structure of the classroom and student’s creativity development (sig=0.004). There was not significant relationship between the physical structure of the classroom and student’s creativity development (sig=0.215). There was significant relationship between the instructional structure of the classroom and student’s creativity development (sig=0.003). These findings denote if students feel secure, calm and confident, they can experience creative learning. Also the quality of coping with students’ questions, imaginations and risks can influence on their creativity development.

Keywords: imagination, creativity, curriculum, bioinformatics, biomedicine

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574 Business Model Innovation and Firm Performance: Exploring Moderation Effects

Authors: Mohammad-Ali Latifi, Harry Bouwman

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Changes in the business environment accelerated dramatically over the last decades as a result of changes in technology, regulation, market, and competitors’ behavior. Firms need to change the way they do business in order to survive or maintain their growth. Innovating business model (BM) can create competitive advantages and enhance firm performance. However, many companies fail to achieve expected outcomes in practice, mostly due to irreversible fundamental changes in key components of the company’s BM. This leads to more ambiguity, uncertainty, and risks associated with business performance. However, the relationship among BM Innovation, moderating factors, and the firm’s overall performance is by and large ignored in the current literature. In this study, we identified twenty moderating factors from our comprehensive literature review. We categorized these factors based on two criteria regarding the extent to which: the moderating factors can be controlled and managed by firms, and they are generic or specific changes to the firms. This leads to four moderation groups. The first group is BM implementation, which includes management support, employees’ commitment, employees’ skills, communication, detailed plan. The second group is called BM practices, which consists of BM tooling, BM experimentation, the scope of change, speed of change, degree of novelty. The third group is Firm characteristics, including firm size, age, and ownership. The last group is called Industry characteristics, which considers the industry sector, competitive intensity, industry life cycle, environmental dynamism, high-tech vs. low-tech industry. Through collecting data from 508 European small and medium-sized enterprises (SMEs) and using the structural equation modeling technique, the developed moderation model was examined. Results revealed that all factors highlighted through these four groups moderate the relation between BMI and firm performance significantly. Particularly, factors related to BM-Implementation and BM-Practices are more manageable and would potentially improve firm overall performance. We believe that this result is more important for researchers and practitioners since the possibility of working on factors in Firm characteristics and Industry characteristics groups are limited, and the firm can hardly control and manage them to improve the performance of BMI efforts.

Keywords: business model innovation, firm performance, implementation, moderation

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573 Examining Fertility Desires and Reproductive Planning among Low-Income Black Fathers: A Mixed-Methods Approach

Authors: Adaobi Anakwe, Wilson Majee, Kari White, Rhonda BeLue

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Background: Black men in the U.S. have overall poorer health, are more likely to experience unintended pregnancies, and have pregnancies (with their partner) at younger ages than other racial/ethnic groups. These factors increase the likelihood that pregnancies among Black fathers will occur at suboptimal paternal health. Although several community-based programs exist to support low-income Black fathers’ involvement with their families, little is known about the sexual and reproductive health, and family planning needs of fathers enrolled in these programs. The objective of this study was to quantitatively examine the relationship between Black fathers’ fertility desires and pregnancy prevention strategies and qualitatively explore the nuances of this relationship. Methods: A concurrent mixed-methods approach was used to survey 36 and interview 13 Black fathers from low-income backgrounds, who were participating in a community-based fatherhood program in a Midwestern urban area. Fathers in this study were ≥18 years old with at least one child. Differences between groups were compared using Fisher’s Exact tests and thematic analyses to examine the relationship between participants' fertility desires and reproductive planning practices. Results: Participants had a median age of 33 years, and 72% were non-residential biological parents. About 40% of men desired pregnancy, and 69% reported they or their partner always used contraception. In bivariate analysis, participants’ fertility desires were not associated with pregnancy prevention (p=0.251). Although most interview participants desired pregnancies, several factors contributed to their ability to plan for a pregnancy. Men felt that using contraception to prevent pregnancies was dependent on navigating trust with a partner. Health before pregnancy and financial stability were also important. Overall, participants thought that using an adult mindset, in which they considered the consequences of unprotected sex, was key to family planning. Conclusion: Black fathers may not desire pregnancy and consider a variety of factors, but this does not always result in active pregnancy prevention/contraceptive use. Community-based organizations already working with Black fathers can be leveraged to increase reproductive health awareness and facilitate reproductive planning for fathers.

Keywords: reproductive planning, reproductive health, preconception health, Black fathers, fertility desires, pregnancy

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572 A Comparative Study to Evaluate Changes in Intraocular Pressure with Thiopentone Sodium and Etomidate in Patients Undergoing Surgery for Traumatic Brain Injury

Authors: Vasudha Govil, Prashant Kumar, Ishwar Singh, Kiranpreet Kaur

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Traumatic brain injury leads to elevated intracranial pressure. Intraocular pressure (IOP) may also be affected by intracranial pressure. Increased venous pressure in the cavernous sinus is transmitted to the episcleral veins, resulting in an increase in IOP. All drugs used in anesthesia induction can change IOP. Irritation of the gag reflex after usage of the endotracheal tube can also increase IOP; therefore, the administration of anesthetic drugs, which make the lowest change in IOP, is important, while cardiovascular depression must also be avoided. Thiopentone decreases IOP by 40%, whereas etomidate decreases IOP by 30-60% for up to 5 minutes. Hundred patients (age 18-55 years) who underwent emergency craniotomy for TBI are selected for the study. Patients are randomly assigned to two groups of 50 patients each accord¬ing to the drugs used for induction: group T was given thiopentone sodium (5mg kg-1) and group E was given etomi¬date (0.3mg kg-1). Preanaesthesia intraocular pressure (IOP) was measured using Schiotz tonometer. Induction of anesthesia was achieved with etomidate (0.3mg kg-1) or thiopentone (5mg kg-1) along with fentanyl (2 mcg kg-1). Intravenous rocuronium (0.9mg kg-1) was given to facilitate intubation. Intraocular pressure was measured after 1 minute of induction agent administration and 5 minutes after intubation. Maintainance of anesthesia was done with isoflurane in 50% nitrous oxide with fresh gas flow of 5 litres. At the end of the surgery, the residual neuromuscular block was reversed and the patient was shifted to ward/ICU. Patients in both groups were comparable in terms of demographic profile. There was no significant difference between the groups for the hemody¬namic and respiratory variables prior to thiopentone or etomidate administration. Intraocular pressure in thiopentone group in left eye and right eye before induction was 14.97±3.94 mmHg and 14.72±3.75 mmHg respectively and for etomidate group was 15.28±3.69 mmHg and 15.54±4.46 mmHg respectively. After induction IOP decreased significantly in both the eyes (p<0.001) in both the groups. After 5 min of intubation IOP was significantly less than the baseline in both the eyes but it was more than the IOP after induction with the drug. It was found that there was no statistically significant difference in IOP between the two groups at any point of time. Both the drugs caused a significant decrease in IOP after induction and after 5 minutes of endotracheal intubation. The mechanism of decrease in IOP by intravenous induction agents is debatable. Systemic hypotension after the induction of anaesthesia has been shown to cause a decrease in intra-ocular pressure. A decrease in the tone of the extra-ocular muscles can also result in a decrease in intra-ocular pressure. We observed that it is appropriate to use etomidate as an induction agent when elevation of intra-ocular pressure is undesirable owing to the cardiovascular stability it confers in the patients.

Keywords: etomidate, intraocular pressure, thiopentone, traumatic

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571 Single Mothers by Choice at Corona Time - The Perception of Social Support, Happiness and Work-Family Conflict and their Effect on State Anxiety

Authors: Orit Shamir Balderman, Shamir Michal

Abstract:

Israel often deals with crisis situations, but most have been characterized as security crises (e.g., war). This is the first time that the Israel has dealt with a health and social emergency as part of a global crisis. The crisis began in January 2020 with the emergence of the novel coronavirus (Covid-19), which was defined as a pandemic (World Health Organization, 2020) and arrived in Israel in early March 2020. This study examined how single mothers by choice (SMBC) experience state anxiety (SA), social support, work–family conflict (WFC), and happiness. This group has not been studied in the context of crises in general or a global crisis. Using a snowball sample, 386 SMBCanswered an online questionnaire. The findings show a negative relationship between income and level of state anxiety. State anxiety was also negatively associated with social support, level of happiness, and WFC. Finally, a stepwise regression analysis indicated that happiness explained 34% of the variance in SA. We also found that most of the women did not turn to formal support agencies such as social workers, other Government Ministries, or municipal welfare. A positive and strong correlations was also found between SA and WFC. The findings of the study reinforce the understanding that although these women made a conscious and informed decision regarding the choice of their family cell, their situation is more complex in the absence of a spouse support. Therefore, this study, as other future studies in the field of SMBC, may contribute to the improvement of their social status and the understanding that they are a unique group. Although SMBC are a growing sector of society in the past few years, there are still special needs and special attention that is needed from the formal and informal supports systems. A comparative study of these two groups and in different countries would shed light on SA among mothers in general, regardless of their relationship status and location.Researchers should expand this study by comparing mothers in relationships and exploring how SMBC coped in other countries. In summary, the findings of the study contribute knowledge on three levels: (a) knowledge about SMBC in general and during crisis situations; (b) examination of social support using tools assessing receipt of assistance and support, some of which were developed for the present study; and (c) insights regarding counseling, accompaniment, and guidance of welfare mechanisms.

Keywords: single mothers by choice, state anxiety, social support, happiness, work–family conflict

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570 Improving the Weekend Handover in General Surgery: A Quality Improvement Project

Authors: Michael Ward, Eliana Kalakouti, Andrew Alabi

Abstract:

Aim: The handover process is recognized as a vulnerable step in the patient care pathway where errors are likely to occur. As such, it is a major preventable cause of patient harm due to human factors of poor communication and systematic error. The aim of this study was to audit the general surgery department’s weekend handover process compared to the recommended criteria for safe handover as set out by the Royal College of Surgeons (RCS). Method: A retrospective audit of the General Surgery department’s Friday patient lists and patient medical notes used for weekend handover in a London-based District General Hospital (DGH). Medical notes were analyzed against RCS's suggested criteria for handover. A standardized paper weekend handover proforma was then developed in accordance with guidelines and circulated in the department. A post-intervention audit was then conducted using the same methods for cycle 1. For cycle 2, we introduced an electronic weekend handover tool along with Electronic Patient Records (EPR). After a one-month period, a second post-intervention audit was conducted. Results: Following cycle 1, the paper weekend handover proforma was only used in 23% of patient notes. However, when it was used, 100% of them had a plan for the weekend, diagnosis and location but only 40% documented potential discharge status and 40% ceiling of care status. Qualitative feedback was that it was time-consuming to fill out. Better results were achieved following cycle 2, with 100% of patient notes having the electronic proforma. Results improved with every patient having documented ceiling of care, discharge status and location. Only 55% of patients had a past surgical history; however, this was still an increase when compared to paper proforma (45%). When comparing electronic versus paper proforma, there was an increase in documentation in every domain of the handover outlined by RCS with an average relative increase of 1.72 times (p<0.05). Qualitative feedback was that the autofill function made it easy to use and simple to view. Conclusion: These results demonstrate that the implementation of an electronic autofill handover proforma significantly improved handover compliance with RCS guidelines, thereby improving the transmission of information from week-day to weekend teams.

Keywords: surgery, handover, proforma, electronic handover, weekend, general surgery

Procedia PDF Downloads 133
569 An Econometric Analysis of the Flat Tax Revolution

Authors: Wayne Tarrant, Ethan Petersen

Abstract:

The concept of a flat tax goes back to at least the Biblical tithe. A progressive income tax was first vociferously espoused in a small, but famous, pamphlet in 1848 (although England had an emergency progressive tax for war costs prior to this). Within a few years many countries had adopted the progressive structure. The flat tax was only reinstated in some small countries and British protectorates until Mart Laar was elected Prime Minister of Estonia in 1992. Since Estonia’s adoption of the flat tax in 1993, many other formerly Communist countries have likewise abandoned progressive income taxes. Economists had expectations of what would happen when a flat tax was enacted, but very little work has been done on actually measuring the effect. With a testbed of 21 countries in this region that currently have a flat tax, much comparison is possible. Several countries have retained progressive taxes, giving an opportunity for contrast. There are also the cases of Czech Republic and Slovakia, which have adopted and later abandoned the flat tax. Further, with over 20 years’ worth of economic history in some flat tax countries, we can begin to do some serious longitudinal study. In this paper we consider many economic variables to determine if there are statistically significant differences from before to after the adoption of a flat tax. We consider unemployment rates, tax receipts, GDP growth, Gini coefficients, and market data where the data are available. Comparisons are made through the use of event studies and time series methods. The results are mixed, but we draw statistically significant conclusions about some effects. We also look at the different implementations of the flat tax. In some countries there are equal income and corporate tax rates. In others the income tax has a lower rate, while in others the reverse is true. Each of these sends a clear message to individuals and corporations. The policy makers surely have a desired effect in mind. We group countries with similar policies, try to determine if the intended effect actually occurred, and then report the results. This is a work in progress, and we welcome the suggestion of variables to consider. Further, some of the data from before the fall of the Iron Curtain are suspect. Since there are new ruling regimes in these countries, the methods of computing different statistical measures has changed. Although we first look at the raw data as reported, we also attempt to account for these changes. We show which data seem to be fictional and suggest ways to infer the needed statistics from other data. These results are reported beside those on the reported data. Since there is debate about taxation structure, this paper can help inform policymakers of change the flat tax has caused in other countries. The work shows some strengths and weaknesses of a flat tax structure. Moreover, it provides beginnings of a scientific analysis of the flat tax in practice rather than having discussion based solely upon theory and conjecture.

Keywords: flat tax, financial markets, GDP, unemployment rate, Gini coefficient

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568 An Empirical Study of Performance Management System: Implementation of Performance Management Cycle to Achieve High-Performance Culture at Pertamina Company, Indonesia

Authors: Arif Budiman

Abstract:

Any organization or company that wishes to achieve vision, mission, and goals of the organization is required to implement a performance management system or known as the Performance Management System (PMS) in every part of the whole organization. PMS is a tool to help visualize the direction and work program of the organization to achieve the goal. The challenge is PMS should not stop merely as a visualization tool to achieve the vision and mission of the organization, but PMS should also be able to create a high-performance culture that is inherent in each individual of the organization. Establishment of a culture within an organization requires the support of top leaders and also requires a system or governance that encourages every individual in the organization to be involved in any work program of the organization. Keywords of creating a high-performance culture are the formation of communication pattern involving the whole individual, either vertically or horizontally, and performed consistently and persistently by all individuals in each line of the organization. PT Pertamina (Persero) as the state-owned national energy company holds a system to internalize the culture of high performance through a system called Performance Management System Cycle (PMS Cycle). This system has 7 stages of the cycle, those are: (1) defining vision, mission and strategic plan of the company, (2) defining key performance indicator of each line and the individual (‘expectation setting conversation’), (3) defining performance target and performance agreement, (4) monitoring performance on a monthly regular basis (‘pulse check’), (5) implementing performance dialogue between leaders and staffs periodically every 3 months (‘performance dialogue’), (6) defining rewards and consequences based on the achievement of the performance of each line and the individual, and (7) calculating the final performance value achieved by each line and individual from one period of the current year. Perform PMS is a continual communication running throughout the year, that is why any three performance discussion that should be performed, include expectation setting conversations, pulse check and performance dialogue. In addition, another significant point and necessary undertaken to complete the assessment of individual performance assessment is soft competencies through 360-degree assessment by leaders, staffs, and peers.

Keywords: 360-degree assessment, expectation setting conversation, performance management system cycle, performance dialogue, pulse check

Procedia PDF Downloads 418