Search results for: indoor quality
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 9810

Search results for: indoor quality

7170 Design and Development of an Innovative MR Damper Based on Intelligent Active Suspension Control of a Malaysia's Model Vehicle

Authors: L. Wei Sheng, M. T. Noor Syazwanee, C. J. Carolyna, M. Amiruddin, M. Pauziah

Abstract:

This paper exhibits the alternatives towards active suspension systems revised based on the classical passive suspension system to improve comfort and handling performance. An active Magneto rheological (MR) suspension system is proposed as to explore the active based suspension system to enhance performance given its freedom to independently specify the characteristics of load carrying, handling, and ride quality. Malaysian quarter car with two degrees of freedom (2DOF) system is designed and constructed to simulate the actions of an active vehicle suspension system. The structure of a conventional twin-tube shock absorber is modified both internally and externally to comprehend with the active suspension system. The shock absorber peripheral structure is altered to enable the assembling and disassembling of the damper through a non-permanent joint whereby the stress analysis of the designed joint is simulated using Finite Element Analysis. Simulation on the internal part where an electrified copper coil of 24AWG is winded is done using Finite Element Method Magnetics to measure the magnetic flux density inside the MR damper. The primary purpose of this approach is to reduce the vibration transmitted from the effects of road surface irregularities while maintaining solid manoeuvrability. The aim of this research is to develop an intelligent control system of a consecutive damping automotive suspension system. The ride quality is improved by means of the reduction of the vertical body acceleration caused by the car body when it experiences disturbances from speed bump and random road roughness. Findings from this research are expected to enhance the quality of ride which in return can prevent the deteriorating effect of vibration on the vehicle condition as well as the passengers’ well-being.

Keywords: active suspension, FEA, magneto rheological damper, Malaysian quarter car model, vibration control

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7169 Scale Effects on the Wake Airflow of a Heavy Truck

Authors: Aude Pérard Lecomte, Georges Fokoua, Amine Mehel, Anne Tanière

Abstract:

Air quality in urban areas is deteriorated by pollution, mainly due to the constant increase of the traffic of different types of ground vehicles. In particular, particulate matter pollution with important concentrations in urban areas can cause serious health issues. Characterizing and understanding particle dynamics is therefore essential to establish recommendations to improve air quality in urban areas. To analyze the effects of turbulence on particulate pollutants dispersion, the first step is to focus on the single-phase flow structure and turbulence characteristics in the wake of a heavy truck model. To achieve this, Computational Fluid Dynamics (CFD) simulations were conducted with the aim of modeling the wake airflow of a full- and reduced-scale heavy truck. The Reynolds Average Navier-Stokes (RANS) approach with the Reynolds Stress Model (RSM)as the turbulence model closure was used. The simulations highlight the apparition of a large vortex coming from the under trailer. This vortex belongs to the recirculation region, located in the near-wake of the heavy truck. These vortical structures are expected to have a strong influence on particle dynamics that are emitted by the truck.

Keywords: CDF, heavy truck, recirculation region, reduced scale

Procedia PDF Downloads 202
7168 Patients' Quality of Life and Caregivers' Burden of Parkinson's Disease

Authors: Kingston Rajiah, Mari Kannan Maharajan, Si Jen Yeen, Sara Lew

Abstract:

Parkinson’s disease (PD) is a progressive neurodegenerative disorder with evolving layers of complexity. Both motor and non-motor symptoms of PD may affect patients’ quality of life (QoL). Life expectancy for an individual with Parkinson’s disease depends on the level of care the individual has access to, can have a direct impact on length of life. Therefore, improvement of the QoL is a significant part of therapeutic plans. Patients with PD, especially those who are in advanced stages, are in great need of assistance, mostly from their family members or caregivers in terms of medical, emotional, and social support. The role of a caregiver becomes increasingly important with the progression of PD, the severity of motor impairment and increasing age of the patient. The nature and symptoms associated with PD can place significant stresses on the caregivers’ burden. As the prevalence of PD is estimated to more than double by 2030, it is important to recognize and alleviate the burden experienced by caregivers. This study focused on the impact of the clinical features on the QoL of PD patients, and of their caregivers. This study included PD patients along with their caregivers and was undertaken at the Malaysian Parkinson's Disease Association from June 2016 to November 2016. Clinical features of PD patients were assessed using the Movement Disorder Society revised Unified Parkinson Disease Rating Scale (MDS-UPDRS); the Hoehn and Yahr Staging of Parkinson's Disease were used to assess the severity and Parkinson's disease activities of daily living scale were used to assess the disability of Parkinson’s disease patients. QoL of PD patients was measured using the Parkinson's Disease Questionnaire-39 (PDQ-39). The revised version of the Zarit Burden Interview assessed caregiver burden. At least one of the clinical features affected PD patients’ QoL, and at least one of the QoL domains affected the caregivers’ burden. Clinical features ‘Saliva and Drooling’, and ‘Dyskinesia’ explained 29% of variance in QoL of PD patients. The QoL domains ‘stigma’, along with ‘emotional wellbeing’ explained 48.6% of variance in caregivers’ burden. Clinical features such as saliva, drooling and dyskinesia affected the QoL of PD patients. The PD patients’ QoL domains such as ‘stigma’ and ‘emotional well-being’ influenced their caregivers’ burden.

Keywords: carers, quality of life, clinical features, Malaysia

Procedia PDF Downloads 231
7167 A Robust Visual Simultaneous Localization and Mapping for Indoor Dynamic Environment

Authors: Xiang Zhang, Daohong Yang, Ziyuan Wu, Lei Li, Wanting Zhou

Abstract:

Visual Simultaneous Localization and Mapping (VSLAM) uses cameras to collect information in unknown environments to realize simultaneous localization and environment map construction, which has a wide range of applications in autonomous driving, virtual reality and other related fields. At present, the related research achievements about VSLAM can maintain high accuracy in static environment. But in dynamic environment, due to the presence of moving objects in the scene, the movement of these objects will reduce the stability of VSLAM system, resulting in inaccurate localization and mapping, or even failure. In this paper, a robust VSLAM method was proposed to effectively deal with the problem in dynamic environment. We proposed a dynamic region removal scheme based on semantic segmentation neural networks and geometric constraints. Firstly, semantic extraction neural network is used to extract prior active motion region, prior static region and prior passive motion region in the environment. Then, the light weight frame tracking module initializes the transform pose between the previous frame and the current frame on the prior static region. A motion consistency detection module based on multi-view geometry and scene flow is used to divide the environment into static region and dynamic region. Thus, the dynamic object region was successfully eliminated. Finally, only the static region is used for tracking thread. Our research is based on the ORBSLAM3 system, which is one of the most effective VSLAM systems available. We evaluated our method on the TUM RGB-D benchmark and the results demonstrate that the proposed VSLAM method improves the accuracy of the original ORBSLAM3 by 70%˜98.5% under high dynamic environment.

Keywords: dynamic scene, dynamic visual SLAM, semantic segmentation, scene flow, VSLAM

Procedia PDF Downloads 94
7166 Time Series Analysis of Air Pollution in Suceava County ( Nord- East of Romania)

Authors: Lazurca Liliana Gina

Abstract:

Different time series analysis of yearly air pollution at Suceava County, Nord-East of Romania, has been performed in this study. The trends in the atmospheric concentrations of the main gaseous and particulate pollutants in urban, industrial and rural environments across Suceava County were estimated for the period of 2008-2014. The non-parametric Mann-Kendall test was used to determine the trends in the annual average concentrations of air pollutants (NO2, NO, NOx, SO2, CO, PM10, O3, C6H6). The slope was estimated using the non-parametric Sen’s method. Trend significance was assumed at the 5% significance level (p < 0.05) in the current study. During the 7 year period, trends in atmospheric concentrations may not have been monotonic, in some instances concentrations of species increased and subsequently decreased. The trend in Suceava County is to keep a low concentration of pollutants in ambient air respecting the limit values.All the results that we obtained show that Romania has taken a lot of regulatory measures to decrease the concentrations of air pollutants in the last decade, in Suceava County the air quality monitoring highlight for the most part of the analyzed pollutants decreasing trends. For the analyzed period we observed considerable improvements in background air in Suceava County.

Keywords: pollutant, trend, air quality monitoring, Mann-Kendall

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7165 The Development of Quality Standards for the Qualification of Community Interpreters in Germany: A Needs Assessment

Authors: Jessica Terese Mueller, Christoph Breitsprecher, Mike Oliver Mosko

Abstract:

Due to an unusually high number of asylum seekers entering Germany over the course of the past few years, the need for community interpreters has increased dramatically, in order to make the communication between asylum seekers and various actors in social and governmental agencies possible. In the field of social work in particular, there are community interpreters who possess a wide spectrum of qualifications spanning from state-certified professional interpreters with graduate degrees to lay or ad-hoc interpreters with little to no formal training. To the best of our knowledge, Germany has no official national quality standards for the training of community interpreters at present, which would serve to professionalise this field as well as to assure a certain degree of quality in the training programmes offered. Given the current demand for trained community interpreters, there is a growing number of training programmes geared toward qualifying community interpreters who work with asylum seekers in Germany. These training programmes range from short one-day workshops to graduate programmes with specialisations in Community Interpreting. As part of a larger project to develop quality standards for the qualification of community interpreters working with asylum seekers in the field of social work, a needs assessment was performed in the city-state of Hamburg and the state of North Rhine Westphalia in the form of focus groups and individual interviews with relevant actors in the field in order to determine the content and practical knowledge needed for community interpreters from the perspectives of those who work in and rely on this field. More specifically, social workers, volunteers, certified language and cultural mediators, paid and volunteer community interpreters and asylum seekers were invited to take part in focus groups in both locations, and asylum seekers, training providers, researchers, linguists and other national and international experts were individually interviewed. The responses collected in these focus groups and interviews have been analysed using Mayring’s concept of content analysis. In general, the responses indicate a high degree of overlap related to certain categories as well as some categories which seemed to be of particular importance to certain groups individually, while showing little to no relevance for other groups. For example, the topics of accuracy and transparency of the interpretations, as well as professionalism and ethical concerns were touched on in some form in most groups. Some group-specific topics which are the focus of experts were topics related to interpreting techniques and more concretely described theoretical and practical knowledge which should be covered in training programmes. Social workers and volunteers generally concentrated on issues regarding the role of the community interpreters and the importance of setting and clarifying professional boundaries. From the perspective of service receivers, asylum seekers tended to focus on the importance of having access to interpreters who are from their home region or country and who speak the same regiolect, dialect or variety as they do in order to prevent misunderstandings or misinterpretations which might negatively affect their asylum status. These results indicate a certain degree of consensus with trainings offered internationally for community interpreters.

Keywords: asylum seekers, community interpreting, needs assessment, quality standards, training

Procedia PDF Downloads 155
7164 The Effects of the Interaction between Prenatal Stress and Diet on Maternal Insulin Resistance and Inflammatory Profile

Authors: Karen L. Lindsay, Sonja Entringer, Claudia Buss, Pathik D. Wadhwa

Abstract:

Maternal nutrition and stress are independently recognized as among the most important factors that influence prenatal biology, with implications for fetal development and poor pregnancy outcomes. While there is substantial evidence from non-pregnancy human and animal studies that a complex, bi-directional relationship exists between nutrition and stress, to the author’s best knowledge, their interaction in the context of pregnancy has been significantly understudied. The aim of this study is to assess the interaction between maternal psychological stress and diet quality across pregnancy and its effects on biomarkers of prenatal insulin resistance and inflammation. This is a prospective longitudinal study of N=235 women carrying a healthy, singleton pregnancy, recruited from prenatal clinics of the University of California, Irvine Medical Center. Participants completed a 4-day ambulatory assessment in early, middle and late pregnancy, which included multiple daily electronic diary entries using Ecological Momentary Assessment (EMA) technology on a dedicated study smartphone. The EMA diaries gathered moment-level data on maternal perceived stress, negative mood, positive mood and quality of social interactions. The numerical scores for these variables were averaged across each study time-point and converted to Z-scores. A single composite variable for 'STRESS' was computed as follows: (Negative mood+Perceived stress)–(Positive mood+Social interaction quality). Dietary intakes were assessed by three 24-hour dietary recalls conducted within two weeks of each 4-day assessment. Daily nutrient and food group intakes were averaged across each study time-point. The Alternative Healthy Eating Index adapted for pregnancy (AHEI-P) was computed for early, middle and late pregnancy as a validated summary measure of diet quality. At the end of each 4-day ambulatory assessment, women provided a fasting blood sample, which was assayed for levels of glucose, insulin, Interleukin (IL)-6 and Tumor Necrosis Factor (TNF)-α. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was computed. Pearson’s correlation was used to explore the relationship between maternal STRESS and AHEI-P within and between each study time-point. Linear regression was employed to test the association of the stress-diet interaction (STRESS*AHEI-P) with the biological markers HOMA-IR, IL-6 and TNF-α at each study time-point, adjusting for key covariates (pre-pregnancy body mass index, maternal education level, race/ethnicity). Maternal STRESS and AHEI-P were significantly inversely correlated in early (r=-0.164, p=0.018) and mid-pregnancy (-0.160, p=0.019), and AHEI-P from earlier gestational time-points correlated with later STRESS (early AHEI-P x mid STRESS: r=-0.168, p=0.017; mid AHEI-P x late STRESS: r=-0.142, p=0.041). In regression models, the interaction term was not associated with HOMA-IR or IL-6 at any gestational time-point. The stress-diet interaction term was significantly associated with TNF-α according to the following patterns: early AHEI-P*early STRESS vs early TNF-α (p=0.005); early AHEI-P*early STRESS vs mid TNF-α (p=0.002); early AHEI-P*mid STRESS vs mid TNF-α (p=0.005); mid AHEI-P*mid STRESS vs mid TNF-α (p=0.070); mid AHEI-P*late STRESS vs late TNF-α (p=0.011). Poor diet quality is significantly related to higher psychosocial stress levels in pregnant women across gestation, which may promote inflammation via TNF-α. Future prenatal studies should consider the combined effects of maternal stress and diet when evaluating either one of these factors on pregnancy or infant outcomes.

Keywords: diet quality, inflammation, insulin resistance, nutrition, pregnancy, stress, tumor necrosis factor-alpha

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7163 Process Optimization and Microbial Quality of Provitamin A-Biofortified Amahewu, a Non-Alcoholic Maize Based Beverage

Authors: Temitope D. Awobusuyi, Eric O. Amonsou, Muthulisi Siwela, Oluwatosin A. Ijabadeniyi

Abstract:

Provitamin A-biofortified maize has been developed to alleviate Vitamin A deficiency; a major public health problem in developing countries. Amahewu, a non-alcoholic fermented maize based beverage is produced using white maize, which is deficient in Vitamin A. In this study, the suitable processing conditions for the production of amahewu using provitamin A-biofortified maize and the microbial quality of the processed products were evaluated. Provitamin A-biofortified amahewu was produced with reference to traditional processing method. Processing variables were Inoculum types (Malted provitamin A maize, Wheat bran, and lactobacillus mixed starter culture with either malted provitamin A or wheat bran) and concentration (0.5 %, 1 % and 2 %). A total of four provitamin A-biofortified amahewu products after fermentation were subjected to different storage conditions: 4ᴼC, 25ᴼC and 37ᴼC. pH and TTA were monitored throughout the storage period. Sample of provitamin A-biofortified amahewu were plated and observed every day for 5 days to assess the presence of Aerobic and Anaerobic spore formers, E.coli, Lactobacillus and Mould. The addition of starter culture substantially reduced the fermentation time (6 hour, pH 3.3) compared to those with no addition of starter culture (24 hour pH 3.5). It was observed that Lactobacillus were present from day 0 for all the storage temperatures. The presence of aerobic spore former and mould were observed on day 3. E.coli and Anaerobic spore formers were not present throughout the storage period. These microbial growth were minimal at 4ᴼC while 25ᴼC had higher counts of growth with 37ᴼC having the highest colony count. Throughout the storage period, pH of provitamin A-biofortified amahewu was stable. Provitamin A-biofortified amahewu stored under refrigerated condition (4ᴼC) had better storability compared to 25ᴼC and 37ᴼC. The production and microbial quality of provitamin A-biofortified amahewu might be important in combating Vitamin A Deficiency.

Keywords: biofortification, fermentation, maize, vitamin A deficiency

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7162 The Accuracy of Measures for Screening Adults for Spiritual Suffering in Health Care Settings: A Systematic Review

Authors: Sayna Bahraini, Wendy Gifford, Ian Graham, Liquaa Wazni, Suzettee Bremault-Phillips, Rebekah Hackbusch, Catrine Demers, Mary Egan

Abstract:

Objective: Guidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence on the accuracy of measures used to screen adults for spiritual suffering. Methods: A systematic review has been conducted. We searched five scientific databases to identify relevant articles. Two independent reviewers screened extracted data and assessed study methodological quality. Results: We identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the 2-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82-87%), and the revised Rush protocol has the highest specificity (81-90%). The methodological quality of all included studies was low. Significance of Results: While most of the identified spiritual screening measures are brief (comprise 1 to 12 number of items), few have sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.

Keywords: screening, suffering, spirituality, diagnostic test accuracy, systematic review

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7161 Risk Assessment and Haloacetic Acids Exposure in Drinking Water in Tunja, Colombia

Authors: Bibiana Matilde Bernal Gómez, Manuel Salvador Rodríguez Susa, Mildred Fernanda Lemus Perez

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In chlorinated drinking water, Haloacetic acids have been identified and are classified as disinfection byproducts originating from reaction between natural organic matter and/or bromide ions in water sources. These byproducts can be generated through a variety of chemical and pharmaceutical processes. The term ‘Total Haloacetic Acids’ (THAAs) is used to describe the cumulative concentration of dichloroacetic acid, trichloroacetic acid, monochloroacetic acid, monobromoacetic acid, and dibromoacetic acid in water samples, which are usually measured to evaluate water quality. Chronic presence of these acids in drinking water has a risk of cancer in humans. The detection of THAAs for the first time in 15 municipalities of Boyacá was accomplished in 2023. Aim is to describe the correlation between the levels of THAAs and digestive cancer in Tunja, a city in Colombia with higher rates of digestive cancer and to compare the risk across 15 towns, taking into account factors such as water quality. A research project was conducted with the aim of comparing water sources based on the geographical features of the town, describing the disinfection process in 15 municipalities, and exploring physical properties such as water temperature and pH level. The project also involved a study of contact time based on habits documented through a survey, and a comparison of socioeconomic factors and lifestyle, in order to assess the personal risk of exposure. Data on the levels of THAAs were obtained after characterizing the water quality in urban sectors in eight months of 2022. This, based on the protocol described in the Stage 2 DBP of the United States Environmental Protection Agency (USEPA) from 2006, which takes into account the size of the population being supplied. A cancer risk assessment was conducted to evaluate the likelihood of an individual developing cancer due to exposure to pollutants THAAs. The assessment considered exposure methods like oral ingestion, skin absorption, and inhalation. The chronic daily intake (CDI) for these exposure routes was calculated using specific equations. The lifetime cancer risk (LCR) was then determined by adding the cancer risks from the three exposure routes for each HAA. The risk assessment process involved four phases: exposure assessment, toxicity evaluation, data gathering and analysis, and risk definition and management. The results conclude that there is a cumulative higher risk of digestive cancer due to THAAs exposure in drinking water.

Keywords: haloacetic acids, drinking water, water quality, cancer risk assessment

Procedia PDF Downloads 43
7160 Utilization of Chicken Skin Based Products as Fat Replacers for Improving the Nutritional Quality, Physico-Chemical Characteristics and Sensory Attributes of Beef Fresh Sausage

Authors: Hussein M. H. Mohamed, Hamdy M. B. Zaki

Abstract:

Fresh sausage is one of the cheapest and delicious meat products that are gaining popularity all over the world. It is considered as a practice of adding value to low-value meat cuts of high fat and connective tissue contents. One of the most important characteristics of fresh sausage is the distinctive marbling appearance between lean and fatty portions, which can be achieved by using animal fat. For achieving the marbling appearance of fresh sausage, a lager amount of fat needs to be used. The use of animal fat may represent a health concern due to its content of saturated fatty acids and trans-fats, which increase the risk of heart diseases. There is a need for reducing the fat content of fresh sausage to obtain a healthy product. However, fat is responsible for the texture, flavor, and juiciness of the product. Therefore, developing reduced-fat products is a challenging process. The main objectives of the current study were to incorporate chicken skin based products (chicken skin emulsion, gelatinized chicken skin, and gelatinized chicken skin emulsion) during the formulation of fresh sausage as fat replacers and to study the effect of these products on the nutritional quality, physicochemical properties, and sensory attributes of the processed product. Three fresh sausage formulae were prepared using chicken skin based fat replacers (chicken skin emulsion, gelatinized chicken skin, and gelatinized chicken skin emulsion) beside one formula prepared using mesenteric beef fat as a control. The proximate composition, fatty acid profiles, Physico-chemical characteristics, and sensory attributes of all formulas were assessed. The results revealed that the use of chicken skin based fat replacers resulted in significant (P < 0.05) reduction of fat contents from 17.67 % in beef mesenteric fat formulated sausage to 5.77, 8.05 and 8.46 in chicken skin emulsion, gelatinized chicken skin, and gelatinized chicken skin emulsion formulated sausages, respectively. Significant reduction in the saturated fatty acid contents and a significant increase in mono-unsaturated, poly-unsaturated, and omega-3 fatty acids have been observed in all formulae processed with chicken skin based fat replacers. Moreover, significant improvements in the physico-chemical characteristics and non-significant changes in the sensory attributes have been obtained. From the obtained results, it can be concluded that the chicken skin based products can be used safely to improve the nutritional quality and physico chemical properties of beef fresh sausages without changing the sensory attributes of the product. This study may encourage meat processors to utilize chicken skin based fat replacers for the production of high quality and healthy beef fresh sausages.

Keywords: chicken skin emulsion, fresh sausage, gelatinized chicken skin, gelatinized chicken skin emulsion

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7159 A Case Study of Assessment of Fire Affected Concrete Structure by NDT

Authors: Nikhil Gopalkrishnan, Praveen Bhaskaran, Aditya Bhargava, Gyandeep Bhumarkar

Abstract:

The present paper is an attempt to perform various Non-Destructive Tests on concrete structure as NDT is gaining a wide importance in the branch of civil engineering these days. Various tests that are performed under NDT not only enable us to determine the strength of concrete structure, but also provide us in-hand information regarding the durability, in-situ properties of the concrete structure. Keeping these points in our mind, we have focused our views on performing a case study to show the comparison between the NDT test results performed on a particular concrete structure and another structure at the same site which is subjected to a continuous fire of say 48-72 hours. The mix design and concrete grade of both the structures were same before the one was affected by fire. The variations in the compressive strength, concrete quality and in-situ properties of the two structures have been discussed in this paper. NDT tests namely Ultrasonic Pulse Velocity Test, Rebound Hammer Test, Core-Cutter Test was performed at both the sites. The main objective of this research is to analyze the variations in the strength and quality of the concrete structure which is subjected to a high temperature fire and the one which isn’t exposed to it.

Keywords: core-cutter test, non-destructive test, rebound hammer test, ultrasonic pulse velocity test

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7158 Clinicians’ Experiences with IT Systems in a UK District General Hospital: A Qualitative Analysis

Authors: Sunny Deo, Eve Barnes, Peter Arnold-Smith

Abstract:

Introduction: Healthcare technology is a rapidly expanding field in healthcare, with enthusiasts suggesting a revolution in the quality and efficiency of healthcare delivery based on the utilisation of better e-healthcare, including the move to paperless healthcare. The role and use of computers and programmes for healthcare have been increasing over the past 50 years. Despite this, there is no standardised method of assessing the quality of hardware and software utilised by frontline healthcare workers. Methods and subjects: Based on standard Patient Related Outcome Measures, a questionnaire was devised with the aim of providing quantitative and qualitative data on clinicians’ perspectives of their hospital’s Information Technology (IT). The survey was distributed via the Institution’s Intranet to all contracted doctors, and the survey's qualitative results were analysed. Qualitative opinions were grouped as positive, neutral, or negative and further sub-grouped into speed/usability, software/hardware, integration, IT staffing, clinical risk, and wellbeing. Analysis was undertaken on the basis of doctor seniority and by specialty. Results: There were 196 responses, with 51% from senior doctors (consultant grades) and the rest from junior grades, with the largest group of respondents 52% coming from medicine specialties. Differences in the proportion of principle and sub-groups were noted by seniority and specialty. Negative themes were by far the commonest stated opinion type, occurring in almost 2/3’s of responses (63%), while positive comments occurred less than 1 in 10 (8%). Conclusions: This survey confirms strongly negative attitudes to the current state of electronic documentation and IT in a large single-centre cohort of hospital-based frontline physicians after two decades of so-called progress to a paperless healthcare system. Greater use would provide further insights and potentially optimise the focus of development and delivery to improve the quality and effectiveness of IT for clinicians and their patients.

Keywords: information technology, electronic patient records, digitisation, paperless healthcare

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7157 An Analysis of LoRa Networks for Rainforest Monitoring

Authors: Rafael Castilho Carvalho, Edjair de Souza Mota

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As the largest contributor to the biogeochemical functioning of the Earth system, the Amazon Rainforest has the greatest biodiversity on the planet, harboring about 15% of all the world's flora. Recognition and preservation are the focus of research that seeks to mitigate drastic changes, especially anthropic ones, which irreversibly affect this biome. Functional and low-cost monitoring alternatives to reduce these impacts are a priority, such as those using technologies such as Low Power Wide Area Networks (LPWAN). Promising, reliable, secure and with low energy consumption, LPWAN can connect thousands of IoT devices, and in particular, LoRa is considered one of the most successful solutions to facilitate forest monitoring applications. Despite this, the forest environment, in particular the Amazon Rainforest, is a challenge for these technologies, requiring work to identify and validate the use of technology in a real environment. To investigate the feasibility of deploying LPWAN in remote water quality monitoring of rivers in the Amazon Region, a LoRa-based test bed consisting of a Lora transmitter and a LoRa receiver was set up, both parts were implemented with Arduino and the LoRa chip SX1276. The experiment was carried out at the Federal University of Amazonas, which contains one of the largest urban forests in Brazil. There are several springs inside the forest, and the main goal is to collect water quality parameters and transmit the data through the forest in real time to the gateway at the uni. In all, there are nine water quality parameters of interest. Even with a high collection frequency, the amount of information that must be sent to the gateway is small. However, for this application, the battery of the transmitter device is a concern since, in the real application, the device must run without maintenance for long periods of time. With these constraints in mind, parameters such as Spreading Factor (SF) and Coding Rate (CR), different antenna heights, and distances were tuned to better the connectivity quality, measured with RSSI and loss rate. A handheld spectrum analyzer RF Explorer was used to get the RSSI values. Distances exceeding 200 m have soon proven difficult to establish communication due to the dense foliage and high humidity. The optimal combinations of SF-CR values were 8-5 and 9-5, showing the lowest packet loss rates, 5% and 17%, respectively, with a signal strength of approximately -120 dBm, these being the best settings for this study so far. The rains and climate changes imposed limitations on the equipment, and more tests are already being conducted. Subsequently, the range of the LoRa configuration must be extended using a mesh topology, especially because at least three different collection points in the same water body are required.

Keywords: IoT, LPWAN, LoRa, coverage, loss rate, forest

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7156 OnabotulinumtoxinA Injection for Glabellar Frown Lines as an Adjunctive Treatment for Depression

Authors: I. Witbooi, J. De Smidt, A. Oelofse

Abstract:

Negative emotions that are common in depression are coupled with the activation of the corrugator supercilli and procerus muscles in the glabellar region of the face. This research investigated the impact of OnabotulinumtoxinA (BOTOX) in the improvement of emotional states in depressed subjects by relaxing the mentioned muscles. The aim of the study was to investigate the effectiveness of BOTOX treatment for glabellar frown lines as an adjunctive therapy for Major Depressive Disorder (MDD) and to improve the quality of life and self-esteem of the subjects. It is hypothesized that BOTOX treatment for glabellar frown lines reduces depressive symptoms significantly and therefore augment conventional antidepressant medication. Forty-five (45) subjects diagnosed with MDD were assigned to a treatment (n = 15), placebo (n = 15), and control (n = 15) group. The treatment group received BOTOX injection, while the placebo group received saline injection into the Procerus and Corrugator supercilli muscles with follow-up visits every 3 weeks (weeks 3, 6 and 12 respectively). The control group received neither BOTOX nor saline injections and were only interviewed again on the 12th week. To evaluate the effect of BOTOX treatment in the glabellar region on depressive symptoms, the Montgomery-Asberg Depression Rating (MADRS) scale and the Beck Depression Inventory (BDI) were used. The Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) and Rosenberg Self-Esteem Scale (RSES) were used in the assessment of self-esteem and quality of life. Participants were followed up for a 12 week period. The expected primary outcome measure is the response to treatment, and it is defined as a ≥ 50% reduction in MADRS score from baseline. Other outcome measures include a clinically significant decrease in BDI scores and the increase in quality of life and self-esteem respectively. Initial results show a clear trend towards such differences. Results showed trends towards expected differences. Patients in the Botox group had a mean MADRS score of 14.0 at 3 weeks compared to 20.3 of the placebo group. This trend was still visible at 6 weeks with the Botox and placebo group scoring an average of 10 vs. 18 respectively. The mean difference in MDRS scores from baseline to 3 weeks were 9.3 and 2.0 for the Botox and placebo group respectively. Similarly, the BDI scores were lower in the Botox group (17.25) compared to the placebo group (19.43). The two self-esteem questionnaires showed expected results at this stage with the RSES 19.1 in the Botox group compared to 18.6 in the placebo group. Similarly, the Botox patients had a higher score for the Q-LES-Q-SF of 49.2 compared to 46.1 for the placebo group. Conclusions: Initial results clearly demonstrated that the use of Botox had positive effects on both scores of depressions and that of self-esteem when compared to a placebo group.

Keywords: adjunctive therapy, depression, glabellar area, OnabotulinumtoxinA

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7155 Use of the Gas Chromatography Method for Hydrocarbons' Quality Evaluation in the Offshore Fields of the Baltic Sea

Authors: Pavel Shcherban, Vlad Golovanov

Abstract:

Currently, there is an active geological exploration and development of the subsoil shelf of the Kaliningrad region. To carry out a comprehensive and accurate assessment of the volumes and degree of extraction of hydrocarbons from open deposits, it is necessary to establish not only a number of geological and lithological characteristics of the structures under study, but also to determine the oil quality, its viscosity, density, fractional composition as accurately as possible. In terms of considered works, gas chromatography is one of the most capacious methods that allow the rapid formation of a significant amount of initial data. The aspects of the application of the gas chromatography method for determining the chemical characteristics of the hydrocarbons of the Kaliningrad shelf fields are observed in the article, as well as the correlation-regression analysis of these parameters in comparison with the previously obtained chemical characteristics of hydrocarbon deposits located on the land of the region. In the process of research, a number of methods of mathematical statistics and computer processing of large data sets have been applied, which makes it possible to evaluate the identity of the deposits, to specify the amount of reserves and to make a number of assumptions about the genesis of the hydrocarbons under analysis.

Keywords: computer processing of large databases, correlation-regression analysis, hydrocarbon deposits, method of gas chromatography

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7154 The Models of Character Development Bali Police to Improve Quality of Moral Members in Bali Police Headquarters

Authors: Agus Masrukhin

Abstract:

This research aims to find and analyze the model of character building in the Police Headquarters in Bali with a case study of Muslim members in improving the quality of the morality of its members. The formation of patterns of thinking, behavior, mentality, and police officers noble character, later can be used as a solution to reduce the hedonistic nature of the challenges in the era of globalization. The benefit of this study is expected to be a positive recommendation to find a constructive character building models of police officers in the Republic of Indonesia, especially Bali Police. For the long term, the discovery of the character building models can be developed for the entire police force in Indonesia. The type of research that would apply in this study researchers mix the qualitative research methods based on the narrative between the subject and the concrete experience of field research and quantitative research methods with 92 respondents from the police regional police Bali. This research used a descriptive analysis and SWOT analysis then it is presented in the FGD (focus group discussion). The results of this research indicate that the variable modeling the leadership of the police and variable police offices culture have significant influence on the implementation of spiritual development.

Keywords: positive constructive, hedonistic, character models, morality

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7153 Comparison of Artificial Neural Networks and Statistical Classifiers in Olive Sorting Using Near-Infrared Spectroscopy

Authors: İsmail Kavdır, M. Burak Büyükcan, Ferhat Kurtulmuş

Abstract:

Table olive is a valuable product especially in Mediterranean countries. It is usually consumed after some fermentation process. Defects happened naturally or as a result of an impact while olives are still fresh may become more distinct after processing period. Defected olives are not desired both in table olive and olive oil industries as it will affect the final product quality and reduce market prices considerably. Therefore it is critical to sort table olives before processing or even after processing according to their quality and surface defects. However, doing manual sorting has many drawbacks such as high expenses, subjectivity, tediousness and inconsistency. Quality criterions for green olives were accepted as color and free of mechanical defects, wrinkling, surface blemishes and rotting. In this study, it was aimed to classify fresh table olives using different classifiers and NIR spectroscopy readings and also to compare the classifiers. For this purpose, green (Ayvalik variety) olives were classified based on their surface feature properties such as defect-free, with bruised defect and with fly defect using FT-NIR spectroscopy and classification algorithms such as artificial neural networks, ident and cluster. Bruker multi-purpose analyzer (MPA) FT-NIR spectrometer (Bruker Optik, GmbH, Ettlingen Germany) was used for spectral measurements. The spectrometer was equipped with InGaAs detectors (TE-InGaAs internal for reflectance and RT-InGaAs external for transmittance) and a 20-watt high intensity tungsten–halogen NIR light source. Reflectance measurements were performed with a fiber optic probe (type IN 261) which covered the wavelengths between 780–2500 nm, while transmittance measurements were performed between 800 and 1725 nm. Thirty-two scans were acquired for each reflectance spectrum in about 15.32 s while 128 scans were obtained for transmittance in about 62 s. Resolution was 8 cm⁻¹ for both spectral measurement modes. Instrument control was done using OPUS software (Bruker Optik, GmbH, Ettlingen Germany). Classification applications were performed using three classifiers; Backpropagation Neural Networks, ident and cluster classification algorithms. For these classification applications, Neural Network tool box in Matlab, ident and cluster modules in OPUS software were used. Classifications were performed considering different scenarios; two quality conditions at once (good vs bruised, good vs fly defect) and three quality conditions at once (good, bruised and fly defect). Two spectrometer readings were used in classification applications; reflectance and transmittance. Classification results obtained using artificial neural networks algorithm in discriminating good olives from bruised olives, from olives with fly defect and from the olive group including both bruised and fly defected olives with success rates respectively changing between 97 and 99%, 61 and 94% and between 58.67 and 92%. On the other hand, classification results obtained for discriminating good olives from bruised ones and also for discriminating good olives from fly defected olives using the ident method ranged between 75-97.5% and 32.5-57.5%, respectfully; results obtained for the same classification applications using the cluster method ranged between 52.5-97.5% and between 22.5-57.5%.

Keywords: artificial neural networks, statistical classifiers, NIR spectroscopy, reflectance, transmittance

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7152 Progress and Challenges of Smart Cities in India: An Exploratory Study

Authors: Sushil K. Sharma, Jeff Zhang, Saeed Tabar

Abstract:

Worldwide, several governments are utilizing the Internet of Things (IoT) and other information and communication technologies (ICTs) to create smart city infrastructures to improve both the quality of government services and citizen welfare. Over 700 cities from around the world have already started implementing their smart city projects. Smart City utilizes the network of connected things, or the Internet of Things (IoT), that interconnects devices and various components across city infrastructure, making them work together seamlessly to enhance the quality, performance, and interactivity of urban services, optimize resources, and reduce costs. Without developing smart cities, the accelerating growth of cities, and their disproportionate consumption of physical and social resources are unsustainable. In 2016, the Indian Government released a list of 100 cities with the intention of kick-starting the process of developing them into 'smart cities’ as part of the Smart Cities Mission. This study reports the progress and challenges of Smart City projects in India. The data were collected through the city/state government websites, media reports, and focus group discussions/interviews. The preliminary results indicate that smart city projects are not only behind in their implementation and scope but also lacks the sincerity for its implementation.

Keywords: smart city, smart government, Internet of Things, digital government

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7151 Artificial Intelligence as a Policy Response to Teaching and Learning Issues in Education in Ghana

Authors: Joshua Osondu

Abstract:

This research explores how Artificial Intelligence (AI) can be utilized as a policy response to address teaching and learning (TL) issues in education in Ghana. The dual (AI and human) instructor model is used as a theoretical framework to examine how AI can be employed to improve teaching and learning processes and to equip learners with the necessary skills in the emerging AI society. A qualitative research design was employed to assess the impact of AI on various TL issues, such as teacher workloads, a lack of qualified educators, low academic performance, unequal access to education and educational resources, a lack of participation in learning, and poor access and participation based on gender, place of origin, and disability. The study concludes that AI can be an effective policy response to TL issues in Ghana, as it has the potential to increase students’ participation in learning, increase access to quality education, reduce teacher workloads, and provide more personalized instruction. The findings of this study are significant for filling in the gaps in AI research in Ghana and other developing countries and for motivating the government and educational institutions to implement AI in TL, as this would ensure quality, access, and participation in education and help Ghana industrialize.

Keywords: artificial intelligence, teacher, learner, students, policy response

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7150 Auto-Tuning of CNC Parameters According to the Machining Mode Selection

Authors: Jenq-Shyong Chen, Ben-Fong Yu

Abstract:

CNC(computer numerical control) machining centers have been widely used for machining different metal components for various industries. For a specific CNC machine, its everyday job is assigned to cut different products with quite different attributes such as material type, workpiece weight, geometry, tooling, and cutting conditions. Theoretically, the dynamic characteristics of the CNC machine should be properly tuned match each machining job in order to get the optimal machining performance. However, most of the CNC machines are set with only a standard set of CNC parameters. In this study, we have developed an auto-tuning system which can automatically change the CNC parameters and in hence change the machine dynamic characteristics according to the selection of machining modes which are set by the mixed combination of three machine performance indexes: the HO (high surface quality) index, HP (high precision) index and HS (high speed) index. The acceleration, jerk, corner error tolerance, oscillation and dynamic bandwidth of machine’s feed axes have been changed according to the selection of the machine performance indexes. The proposed auto-tuning system of the CNC parameters has been implemented on a PC-based CNC controller and a three-axis machining center. The measured experimental result have shown the promising of our proposed auto-tuning system.

Keywords: auto-tuning, CNC parameters, machining mode, high speed, high accuracy, high surface quality

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7149 Effects of Air Pollution on Dew Water: A Case Study of Ado-Ekiti, Nigeria

Authors: M. Sanmi Awopetu, Olugbenga Aribisala, Olabisi O. Ologuntoye, S. Olumuyi Akindele

Abstract:

Human existence vis-à-vis its environment is more and more getting a threatened sequel to air pollution occasioned majorly by human coupled with natural activities. Earth is getting warmer; ozone layer is getting depleted, acid rain is being experienced, all as a result of air pollution. This study seeks to investigate the effect of air pollution on dew water. Thirty-one (31) samples of dew water were collected in four locations in Ado- Ekiti, Ekiti State Nigeria. Analytical studies of the dew water samples were carried out to determine the pH, Total Dissolved Solids (TDS) and Electrical Conductivity (EC) in order to determine whether the dew water is polluted or not. There is no documented world standard for dew water quality. However, the standard for normal rain water which is pH between 5.0-5.6 and acid rain pH between 4.0-4.4 was adopted for this study. The pH of dew water samples collected and analyzed ranged between 5.5 and 7.9 in Olokun Ado-Ekiti while other samples fell in between this range. In Government Reserved Area (GRA), Ajilosun and EKSU school area, the pH ranged between 6.4 and 7.9 while EC fell in between 0.0 and 0.9 mS/cm which shows that the observed zones are polluted. Everyone has a role to play in order to reduce the pollutants being released into the atmosphere. There is a need to develop an international standard for dew water quality.

Keywords: dew, air pollution, total dissolved solids, electrical conductivity, Ado-Ekiti

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7148 Operation and Management System of New Ahmadi Hospital Facility

Authors: Abdulrahman H. Alrashidi

Abstract:

Kuwait Oil Company provides health care services through Ahmadi hospital for oil sector employee and their families. Due to increasing number of entitled patients in Ahmadi hospital, the company starts health insurance option in 2010. In addition, a new Ahmadi hospital decided to build to accumulate all entitled patients. Operation and management of new Ahmadi hospital investigated in this research. In order to maintain the high quality of medical services and satisfaction rate among oil sector community and reducing the operation cost. Six operation and management options evaluated in order to implement in new Ahmadi hospital. Qualitative Risk assessment method used to investigate proposed options for operation and management of new Ahmadi hospital. Evaluation criteria consist of quality of medical services, operation cost and satisfaction rate among oil sector community. Results show that using the same operation and management system in existing Ahmadi hospital with new Ahmadi hospital will bring cost higher. This approach brings risk to KOC. Results from risk assessment show that partially operated new Ahmadi hospital is the best opportunity to meet the objectives of KOC’s medical group.

Keywords: Kuwait Oil Company, new Ahmadi hospital, operation and management, risk assessment

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7147 The Role of Human Resource Flexibility and Agility in Achieving Sustainable Competitiveness

Authors: Agnieszka Leszczynska

Abstract:

Flexibility and agility constitute the most dominant features of modern human resource management systems. The former pertains to procedures, practices and competences of human resources, and the latter to the procedures and practices’ effectiveness in dealing with changing conditions in the surrounding environment. The purpose of the paper is to present the relations between the flexibility and agility of human resources and achieving sustainable competitiveness. Based upon hitherto research, we develop a conceptual model that links the constructs together. The conducted study is of theoretical and conceptual nature. Critical literature analysis and the synthesis method were applied. A premise was made that the three dimensions of HR (Human Resources) flexibility (employee skill flexibility, employee behaviour flexibility, and HR practice flexibility) and HR agility affect competitiveness, by increasing the flexibility, creativity of human resources, and improving quality performance, and exert an impact upon the quality of life of employees and social relations. In particular, the agility and flexibility of human resources contribute to the growth of adaptability and strategic orientation, which directly affects the organization's competitiveness. The research results will help to better understand the impact of flexibility and agility related to the HRM (Human Resources Management) system upon the implementation of the concept of sustainable development in the organization.

Keywords: agility, human resource, sustainable competitiveness, sustainable development

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7146 Study of Effects of Hydro-Alcoholic Extract of Asparagus Root (Asparagus officinalis) Ontestes Spermyogenesis Index of Laboratory Mouse

Authors: Hamid Karimi, Naegar Mahdavi, Hossein Tayefi Nasrabadi

Abstract:

Spermatozoids production rate and its quality are more important factors in the diagnosis of infertility. Also, spematozids activity have a more important role in fertilization. Some medicinal plants as Asparagus(Asparagus officinalis) has many antioxidant component. Therefore, They can affect testes tissue to production more and high-quality spermatozoids. In this survey, Asparagus root extract is studied on spermatogenesis index in the laboratory mouse testes. Hydro-alcoholic extract of asparagus root is prepared and examined on four group of the mature male mouse. Blank group without extract, group 1,100ml/kg dose, group 2, 200 ml/kg dose and group 3, 300ml/kg dose. Then, mice are euthanized, and testes are removed. Testes are weighted, and paraffinized blocks are prepared. TDI(Tubular Differentiation Index) and SPI(Spermiation Index) are studied on histological sections by light microscope. This study results were showed that TDI and SPI in treatments groups with 200 and 300 ml/kg dose had significant enhancement (P<0.05). Consequently, Extract of Asparagus root can enhance spermatozoid production and, therefore, cause improve fertility in male laboratory mice.

Keywords: histology, spermatozoid, ASP [aragus, testes

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7145 Efficacy of Microbial Metabolites Obtained from Saccharomyces cerevisiae as Supplement for Quality Milk Production in Dairy Cows

Authors: Sajjad ur Rahman, Mariam Azam, Mukarram Bashir, Seemal Javaid, Aoun Muhammad, Muhammad Tahir, Jawad, Hannan Khan, Muhammad Zohaib

Abstract:

Partially fermented soya hulls and wheat bran through Saccharomyces cerevisiae (DL-22 S/N) substantiated as a natural source for quality milk production. Saccharomyces cerevisiae (DL-22 S/N) were grown under in-vivo conditions and processed through two-step fermentation with substrates. The extra pure metabolites (XPM) were dried and processed for maintaining 1mm mesh size particles for supplementation of pelleted feed. Two groups of a cow (Holstein Friesian) having 8 animals of similar age and lactation were given the experimental concentrates. Group A was fed daily with 12gm of XPM and 22% protein-pelleted feed, while Group B was provided with no metabolites in their feed. In thirty-nine days of trial, improvement in the overall health, body score, milk protein, milk fat, ash, and solid not fat (SNF), yield, and incidence rate of mastitis was observed. The collected data revealed an improvement in milk production of 2.02 liter/h/d. However, a reduction (3.75%) in the milk fats and an increase in the milk SNF was around 0.58%. The ash content ranged between 6.4-7.5%. The incidence of mastitis was reduced to less than 2%.

Keywords: microbial metabolites, Saccharomyces cerevisiae, milk production, fermentation, post-biotic metabolites, immunity

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7144 Factors Affecting the Success of Private Higher Education Businesses in Malaysia

Authors: Nasir Khalid

Abstract:

In Malaysia, higher education is big business. There are many companies that are willing if not already to invest heavily in higher education for students that aspire to pursue their degree in diploma, undergraduate as well as graduate studies. These companies sometimes even have a joint venture twinning program with other already established universities in and across Europe, Australia, the United States, and Canada. Some of these investments have been successful whereas others find themselves limited by the obstacle of receiving new students. Recently, the Malaysian Ministry of Higher Education has stopped issuing licenses to set up private institutions of higher education. This paper will thus examine the factors affecting the success of private higher education businesses in Malaysia. The samples will consist of thirty private institutions [N=30]. Among the factors that will be mentioned in the literature are academic programs, student quality and achievement, student employability, alumni satisfaction, student enrolment, institutional environment, lecturer-quality and effectiveness of supporting staff. A questionnaire was developed and analyzed using statistical analysis. The result of this study found that the top three factors affecting the success of private higher education businesses in Malaysia are student enrolment, institutional environment and the academic programs offered.

Keywords: higher education business, successful business factors, private institutions, business in Malaysia

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7143 Using Analytic Hierarchy Process as a Decision-Making Tool in Project Portfolio Management

Authors: Darius Danesh, Michael J. Ryan, Alireza Abbasi

Abstract:

Project Portfolio Management (PPM) is an essential component of an organisation’s strategic procedures, which requires attention of several factors to envisage a range of long-term outcomes to support strategic project portfolio decisions. To evaluate overall efficiency at the portfolio level, it is essential to identify the functionality of specific projects as well as to aggregate those findings in a mathematically meaningful manner that indicates the strategic significance of the associated projects at a number of levels of abstraction. PPM success is directly associated with the quality of decisions made and poor judgment increases portfolio costs. Hence, various Multi-Criteria Decision Making (MCDM) techniques have been designed and employed to support the decision-making functions. This paper reviews possible option to improve the decision-making outcomes in the organisational portfolio management processes using the Analytic Hierarchy Process (AHP) both from academic and practical perspectives and will examine the usability, certainty and quality of the technique. The results of the study will also provide insight into the technical risk associated with current decision-making model to underpin initiative tracking and strategic portfolio management.

Keywords: analytic hierarchy process, decision support systems, multi-criteria decision making, project portfolio management

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7142 Revolutionizing RNA Extraction: A Unified, Sustainable, and Rapid Protocol for High-Quality Isolation from Diverse Tissues

Authors: Ying Qi Chan, Chunyu Li, Xu Rou Yoyo Ma, Yaya Li, Saber Khederzadeh

Abstract:

In the ever-evolving landscape of genome extraction protocols, the existing methodologies grapple with issues ranging from sub-optimal yields and compromised quality to time-intensive procedures and reliance on hazardous reagents, often necessitating substantial tissue quantities. This predicament is particularly challenging for scientists in developing countries, where resources are limited. Our investigation presents a protocol for the efficient extraction of high-yield RNA from various tissues such as muscle, insect, and plant samples. Noteworthy for its advantages, our protocol stands out as the safest, swiftest (completed in just 38 minutes), most cost-effective (coming in at a mere US$0.017), and highly efficient method in comparison to existing protocols. Notably, our method avoids the use of hazardous or toxic chemicals such as chloroform and phenol and enzymatic agents like RNase and Proteinase K. Our RNA extraction protocol has demonstrated clear advantages over other methods, including commercial kits, in terms of yield. This nucleic acid extraction protocol is more environmentally and research-friendly, suitable for a range of tissues, even in tiny volumes, hence facilitating various genetic diagnosis and researches across the globe.

Keywords: RNA extraction, rapid protocol, universal method, diverse tissues

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7141 Applying the Global Trigger Tool in German Hospitals: A Retrospective Study in Surgery and Neurosurgery

Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser

Abstract:

Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.

Keywords: adverse events, global trigger tool, patient safety, record review

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