Search results for: patient safety incidents

Authors: H. Agbaria, A. Salman, M. Huleihel, G. Beck, D. H. Rich, S. Mordechai, J. Kapelushnik

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Viral and bacterial infections are responsible for variety of diseases. These infections have similar symptoms like fever, sneezing, inflammation, vomiting, diarrhea and fatigue. Thus, physicians may encounter difficulties in distinguishing between viral and bacterial infections based on these symptoms. Bacterial infections differ from viral infections in many other important respects regarding the response to various medications and the structure of the organisms. In many cases, it is difficult to know the origin of the infection. The physician orders a blood, urine test, or 'culture test' of tissue to diagnose the infection type when it is necessary. Using these methods, the time that elapses between the receipt of patient material and the presentation of the test results to the clinician is typically too long ( > 24 hours). This time is crucial in many cases for saving the life of the patient and for planning the right medical treatment. Thus, rapid identification of bacterial and viral infections in the lab is of great importance for effective treatment especially in cases of emergency. Blood was collected from 50 patients with confirmed viral infection and 50 with confirmed bacterial infection. White blood cells (WBCs) and plasma were isolated and deposited on a zinc selenide slide, dried and measured under a Fourier transform infrared (FTIR) microscope to obtain their infrared absorption spectra. The acquired spectra of WBCs and plasma were analyzed in order to differentiate between the two types of infections. In this study, the potential of FTIR microscopy in tandem with multivariate analysis was evaluated for the identification of the agent that causes the human infection. The method was used to identify the infectious agent type as either bacterial or viral, based on an analysis of the blood components [i.e., white blood cells (WBC) and plasma] using their infrared vibrational spectra. The time required for the analysis and evaluation after obtaining the blood sample was less than one hour. In the analysis, minute spectral differences in several bands of the FTIR spectra of WBCs were observed between groups of samples with viral and bacterial infections. By employing the techniques of feature extraction with linear discriminant analysis (LDA), a sensitivity of ~92 % and a specificity of ~86 % for an infection type diagnosis was achieved. The present preliminary study suggests that FTIR spectroscopy of WBCs is a potentially feasible and efficient tool for the diagnosis of the infection type.

Keywords: viral infection, bacterial infection, linear discriminant analysis, plasma, white blood cells, infrared spectroscopy

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Authors: Sophie Lemoussu, Jean-Charles Chaudemar, Robertus A. Vingerhoeds

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Many innovative projects exist in the field of aeronautics, each addressing specific areas so to reduce weight, increase autonomy, reduction of CO2, etc. In many cases, such innovative developments are being carried out by very small enterprises (VSE’s) or small and medium sized-enterprises (SME’s). A good example concerns airships that are being studied as a real alternative to passenger and cargo transportation. Today, no international regulations propose a precise and sufficiently detailed framework for the development and certification of airships. The absence of such a regulatory framework requires a very close contact with regulatory instances. However, VSE’s/SME’s do not always have sufficient resources and internal knowledge to handle this complexity and to discuss these issues. This poses an additional challenge for those VSE’s/SME’s, in particular those that have system integration responsibilities and that must provide all the necessary evidence to demonstrate their ability to design, produce, and operate airships with the expected level of safety and reliability. The main objective of this research is to provide a methodological framework enabling VSE’s/SME’s with limited resources to organize the development of airships while taking into account the constraints of safety, cost, time and performance. This paper proposes to provide a contribution to this problematic by proposing a Model-Based Systems Engineering approach. Through a comprehensive process modeling approach applied to the development processes, the regulatory constraints, existing best practices, etc., a good image can be obtained as to the process landscape that may influence the development of airships. To this effect, not only the necessary regulatory information is taken on board, also other international standards and norms on systems engineering and project management are being modeled and taken into account. In a next step, the model can be used for analysis of the specific situation for given developments, derive critical paths for the development, identify eventual conflicting aspects between the norms, standards, and regulatory expectations, or also identify those areas where not enough information is available. Once critical paths are known, optimization approaches can be used and decision support techniques can be applied so to better support VSE’s/SME’s in their innovative developments. This paper reports on the adopted modeling approach, the retained modeling languages, and how they all fit together.

Keywords: aeronautics, certification, process modeling, project management, regulation, SME, systems engineering, VSE

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Authors: Myunghoun Jang

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Most engineering colleges in South Korea have engineering design classes in order to develop and enhance a student's creativity and problem-solving ability. Many cases about engineering design class are shown in journals and magazines, but a case lasting many years is few. The engineering design class in the Department of Architectural Engineering, Jeju National University was open in 2009 and continues to this year. 3-5 teams in every year set up their problems found their solutions and produced good results. Three of the results obtained patents. The class also provides students with opportunities to improve communication skill because they have many discussions in solving their problems.

Keywords: engineering design, architectural engineering, team-based learning, construction safety

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Authors: Priya Kulkarni, Soumya Koppikar, Narendrakumar Wagh, Dhanshri Ingle, Onkar Lande, Abhay Harsulkar

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Cartilage is an extracellular matrix composed of aggrecan, which imparts it with a great tensile strength, stiffness and resilience. Disruption in cartilage metabolism leading to progressive degeneration is a characteristic feature of Osteoarthritis (OA). The process involves enzymatic depolymerisation of cartilage specific proteoglycan, releasing free glycosaminoglycan (GAG). This released GAG in synovial fluid (SF) of knee joint serves as a direct measure of cartilage loss, however, limited due to its invasive nature. Western Ontario and McMaster Universities Arthritis Index (WOMAC) is widely used for assessing pain, stiffness and physical-functions in OA patients. The scale is comprised of three subscales namely, pain, stiffness and physical-function, intends to measure patient’s perspective of disease severity as well as efficacy of prescribed treatment. Twenty SF samples obtained from OA patients were analysed for their GAG values in SF using DMMB based assay. LK 1.0 vernacular version was used to attain WOMAC scale. The results were evaluated using SAS University software (Edition 1.0) for statistical significance. All OA patients revealed higher GAG values compared to the control value of 78.4±30.1µg/ml (obtained from our non-OA patients). Average WOMAC calculated was 51.3 while pain, stiffness and function estimated were 9.7, 3.9 and 37.7, respectively. Interestingly, a strong statistical correlation was established between WOMAC function subscale and GAG (p = 0.0102). This subscale is based on day-to-day activities like stair-use, bending, walking, getting in/out of car, rising from bed. However, pain and stiffness subscale did not show correlation with any of the studied markers and endorsed the atypical inflammation in OA pathology. On one side, where knee pain showed poor correlation with GAG, it is often noted that radiography is insensitive to cartilage degenerative changes; thus OA remains undiagnosed for long. Moreover, active cartilage degradation phase remains elusive to both, patient and clinician. Through analysis of large number of OA patients we have established a close association of Kellgren-Lawrence grades and increased cartilage loss. A direct attempt to correlate WOMAC and radiographic progression of OA with various biomarkers has not been attempted so far. We found a good correlation in GAG levels in SF and the function subscale.

Keywords: cartilage, Glycosaminoglycan, synovial fluid, western ontario and McMaster Universities Arthritis Index

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Authors: Sasidhar B., Bhaskar Rao N., Ramesh Babu D. R., Ravi Shankar M.

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Segmentation of lung pleura is a preprocessing step in Computer-Aided Diagnosis (CAD) which helps in reducing false positives in detection of lung cancer. The existing methods fail in extraction of lung regions with the nodules at the pleura of the lungs. In this paper, a new method is proposed which segments lung regions with nodules at the pleura of the lungs based on curvature analysis and morphological operators. The proposed algorithm is tested on 06 patient’s dataset which consists of 60 images of Lung Image Database Consortium (LIDC) and the results are found to be satisfactory with 98.3% average overlap measure (AΩ).

Keywords: curvature analysis, image segmentation, morphological operators, thresholding

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Authors: Nanditha Rajamani, Anirudhaa R. Rao, Divya Sriram

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One of the greatest difficulties in treating patients with pain is the highly subjective nature of pain sensation. The measurement of pain intensity is primarily dependent on the patient’s report, often with little physical evidence to provide objective corroboration. This is also complicated by the fact that there are only few and expensive existing technologies (Functional Magnetic Resonance Imaging-fMRI). The need is thus clear and urgent for a reliable, non-invasive, non-painful, objective, readily adoptable, and coefficient diagnostic platform that provides additional diagnostic information to supplement its current regime with more information to assist doctors in diagnosing these patients. Thus, our idea of developing a pain detector was conceived to take a step further the detection and diagnosis of chronic and acute pain.

Keywords: pain sensor, microwave radiometery, pain sensation, fMRI

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Authors: Wellemans Isabelle, Remmelink Myriam, Foucart Annick, Rusu Stefan, Compère Christophe

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Primary pulmonary meningioma (PPM) is a very rare tumor, and its occurrence has been reported only sporadically. Multiple PPMs are even more exceptional, and herein, we report, to the best of our knowledge, the fourth case, focusing on the clinicopathological features of the tumor. Moreover, the possible relationship between the use of progesterone–only contraceptives and the development of these neoplasms will be discussed. Case Report: We report a case of a 51-year-old female presenting three solid pulmonary nodules, with the following localizations: right upper lobe, middle lobe, and left lower lobe, described as incidental findings on computed tomography (CT) during a pre-bariatric surgery check-up. The patient revealed no drinking or smoking history. The physical exam was unremarkable except for the obesity. The lesions ranged in size between 6 and 24 mm and presented as solid nodules with lobulated contours. The largest lesion situated in the middle lobe had mild fluorodeoxyglucose (FDG) uptake on F-18 FDG positron emission tomography (PET)/CT, highly suggestive of primary lung neoplasm. For pathological assessment, video-assisted thoracoscopic middle lobectomy and wedge resection of the right upper nodule was performed. Histological examination revealed relatively well-circumscribed solid proliferation of bland meningothelial cells growing in whorls and lobular nests, presenting intranuclear pseudo-inclusions and psammoma bodies. No signs of anaplasia were observed. The meningothelial cells expressed diffusely Vimentin, focally Progesterone receptors and were negative for epithelial (cytokeratin (CK) AE1/AE3, CK7, CK20, Epithelial Membrane Antigen (EMA)), neuroendocrine markers (Synaptophysin, Chromogranin, CD56) and Estrogenic receptors. The proliferation labelling index Ki-67 was low (<5%). Metastatic meningioma was ruled out by brain and spine magnetic resonance imaging (MRI) scans. The third lesion localized in the left lower lobe was followed-up and resected three years later because of its slow but significant growth (14 mm to 16 mm), alongside two new infra centimetric lesions. Those three lesions showed a morphological and immunohistochemical profile similar to previously resected lesions. The patient was disease-free one year post-last surgery. Discussion: Although PPMs are mostly benign and slow-growing tumors with an excellent prognosis, they do not present specific radiological characteristics, and it is difficult to differentiate it from other lung tumors, histopathologic examination being essential. Aggressive behavior is associated with atypical or anaplastic features (WHO grades II–III) The etiology is still uncertain and different mechanisms have been proposed. A causal connection between sexual hormones and meningothelial proliferation has long been suspected and few studies examining progesterone only contraception and meningioma risk have all suggested an association. In line with this, our patient was treated with Levonorgestrel, a progesterone agonist, intra-uterine device (IUD). Conclusions: PPM, defined by the typical histological and immunohistochemical features of meningioma in the lungs and the absence of central nervous system lesions, is an extremely rare neoplasm, mainly solitary and associating, and indolent growth. Because of the unspecific radiologic findings, it should always be considered in the differential diagnosis of lung neoplasms. Regarding multiple PPM, only three cases are reported in the literature, and this is the first described in a woman treated by a progesterone-only IUD to the best of our knowledge.

Keywords: pulmonary meningioma, multiple meningioma, meningioma, pulmonary nodules

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Authors: Sara Ataei, Mohammad Bagher Oghazian, Mania Radfar

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We describe a patient with hypercalcemia associated with the injection of high doses vitamin D as supplement for a period of six months. A 76-year-old woman had been taking an intramuscular injection of vitamin D 300,000 IU every ten days for six months. She was hospitalized with symptoms of hypercalcemia: chronic constipation, unstable gait, a chronic generalized musculoskeletal pain and increased fatigue. On admission her 25 (OH) vitamin D and Calcium levels were 559 nmol/L and 13.85 mg/dL respectively, and Parathyroid Hormone (PTH) level was 7.1 pg/mL. Immediately she received diuresis therapy with saline and furosemide in conjunction with calcitonin and pamidronate. At discharge her serum calcium level was 11.5 mg/dL. To lower endogenous overproduction of calcitriol, prednisolone 20 mg/day for 10 days was administered at discharge time.

Keywords: vitamin D, hypercalcemia, vitamin D toxicity, parathyroid hormone

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Authors: Zeynep Karacor, Rahime Hulya Ozturk

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In recent years, the rise of population density and the problem of aging population took attention to the health expenditures. In Turkey, some regulations and infrastructure changes in health sector have occurred. These changes are called Health Transformation Program. The productivity of health services, patient satisfaction, quality of services are tried to be improved with this program. Some radical changes are applied in Turkish economy in this context. The aim of this paper is to present the effects of Health Transformation Program on health expenditures. In the first part of the paper, some information’s about health system and applications in Turkey are discussed. In the second part, the aims of Health Transformation Program are explained. And in the third part the effects of Health Transformation Program on health expenditures are examined.

Keywords: health transformation program, Turkey, health services, health expenditures

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Authors: Yousef Alwashahi, Ahmed Almoqbali, Mayar Albahrani, Asma Alajmi

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We report a rare case of a 49-year-old Omani woman who is a known case of primary anti-phospholipid syndrome, glucose-6-phosphate dehydrogenase deficiency, and iron deficiency anaemia. During cannulation, she was found to develop bulla that progressed to ulcerations. With chronicity and recurrent abscess formation that usually increase after surgical intervention, a pathergy phenomenon was postulated. High suspicion of pyoderma gangrenosum was considered. Fortunately, the rapid progression of the disease was slowed down with corticosteroids, cyclosporin, and biological agents.

Keywords: anti-phospholipid syndrome, pyoderma gangrenosum, bullous pyoderma gangrenosum, pathergy, pathergy phenomenon

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Authors: D. K. Sreekantha, T. M. Girish, R. H. Fattepur

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In this article, we have given an overview of medical expert systems, which can be used for the developed of physicians in making decisions such as appropriate, prognostic, and therapeutic decisions which help to organize, store, and gives appropriate medical knowledge needed by physicians and practitioners during medical operations or further treatment. If they support the studies by using these systems, advanced tools in medicine will be developed in the future. New trends in the methodology of development of medical expert systems have also been discussed in this paper. So Authors would like to develop an innovative IT based solution to help doctors in rural areas to gain expertise in Medical Science for treating patients. This paper aims to survey the Soft Computing techniques in treating patient’s problems used throughout the world.

Keywords: expert system, fuzzy logic, knowledge base, soft computing, epilepsy

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Authors: Ken Munro

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Cruise ships are possibly the most complex collection of systems it is possible to find in one physical, moving location. Propulsion, navigation, power generation and more, combined with a hotel, restaurant, casino, theatre etc, with safety and fire control systems to boot. That complexity creates huge challenges with keeping OT and IT systems apart. Ships engines are often remotely managed, network segregation is often defeated through troubleshooting when at sea. This session will refer to multiple entertaining and informative tales of taking control of ships, including accessing a ships Azipods via a game simulator for passengers. Fortunately, genuine attacks against vessels are very rare, but the effects and impacts to world trade are becoming increasingly obvious.

Keywords: maritime security, cybersecurity, OT, IT, networks

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Authors: Aparajita Bhattacharya, Mousumi Dutta, Zakir Husain, Dionne Sequeira, Asima Mukhopadhyay

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Background: Tata Medical Centre (TMC), Kolkata is a major cancer referral centre in Eastern India and neighbouring countries providing state of the art facilities; however, it is a non-profit organisation with patients requiring to pay at subsidised rates. Although a system for social assessment and applying for governmental/ non-governmental (NGO) funds is in place, access is challenging. Amongst gynaecological cancers (GC), ovarian cancer (OC) is associated with the highest treatment cost; majority of which is required at the beginning when complex surgery is performed and funding arrangements cannot be made in time. We therefore appointed a dedicated Medical Social Worker (MSW) in 2016, supported by NGO for GC patients in order to assist patients/family members to access/avail these funds more readily and assist in economic evaluation for both direct and opportunity costs. Objectives: To reflect on our experience and challenges in collecting data on economic evaluation of cancer patients and compare success rates in achieving fund mobilization after introduction of MSW. Methods: A Retrospective survey. Patients with OC and their relatives were seen by the MSW during the initial outpatients department visit and followed though till discharge from the hospital and during follow-up visits. Assistance was provided in preparing the essential documents/paperwork/contacts for the funding agencies including both governmental (Chief-Minister/Prime-Minister/President) and NGO sources. In addition, a detailed questionnaire was filled up for economic assessment of direct/opportunity costs during the entire treatment and 12 months follow up period which forms a part of the study called HEPTROC (Health economic evaluation of primary treatment for ovarian cancer) developed in collaboration with economics departments of Universities. Results: In 2015, 102 patients were operated for OC; only 16 patients (15.68 %) had availed funding of a total sum of INR 1640000 through the hospital system for social assessment. Following challenges were faced by majority of the relatives: 1. Gathering important documents/proper contact details for governmental funding bodies and difficulty in following up the current status 3. Late arrival of funds. In contrast in 2016, 104 OC patients underwent surgery; the direct cost of treatment was significantly higher (median, INR 300000- 400000) compared to other GCs (n=274). 98/104 (94.23%) OC patients could be helped to apply for funds and 90/104(86.56%) patients received funding amounting to a total of INR 10897000. There has been a tenfold increase in funds mobilized in 2016 after the introduction of dedicated MSW in GC. So far, in 2017 (till June), 46/54(85.18%) OC patients applied for funds and 37/54(68.51%) patients have received funding. In a qualitative survey, all patients appreciated the role of the MSW who subsequently became the key worker for patient follow up and the chief portal for patient reported outcome monitoring. Data collection quality for the HEPTROC study was improved when questionnaires were administered by the MSW compared to researchers. Conclusion: Introduction of cancer specific MSW can expedite the availability of funds required for cancer patients and it can positively impact on patient satisfaction and outcome reporting. The economic assessment will influence fund allocation and decision for policymaking in ovarian cancer. Acknowledgement: Jivdaya Foundation Dallas, Texas.

Keywords: economic evaluation, funding, medical social worker, ovarian cancer

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Authors: P. Pérez-Martín, G. Pedrós, P. Martínez-Jiménez, M. Varo-Martínez

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In recent decades, family habits related to children’s displacements to school have changed, increasing motorized travels against active modes. This entails a major negative impact on the urban environment, road safety in cities and the physical and psychological development of children. One of the more common actions used to reverse this trend is Walking School Bus (WSB), which consists of a predefined adult-scorted pedestrian route to school with several stops along the path where schoolchildren are collected. At Tirso de Molina School in Cordoba (Spain), a new ICT-based methodology to deploy WSB has been tested. A mobile app that allows the geoposition of the group, the notification of the arrival and real-time communication between the WSB participants have been presented to the families in order to organize and register the daily participation. After an initial survey to know the travel mode and the spatial distribution of the interested families, three WSB routes have been established and the families have been trained in the app usage. During nine weeks, 33 children have joined the WSB and their parents have accompanied the groups in turns. A high recurrence in the attendance has been registered. Through a final survey, participants have valued highly the tool and the methodology designed, emphasizing as most useful features of the mobile app: notifications system, chat and real-time monitoring. It has also been found that the tool has had a major impact on the degree of confidence of parents regarding the autonomous on foot displacement of their children to school. Moreover, 37,9% of the participant families have reported a total or partial modal shift from car to walking, and the benefits more reported are an increment of the parents available time and less problems in the travel to school daily organization. As a consequence, It has been proved the effectiveness of this user-centric innovative ICT-based methodology to reduce the levels of private car drop offs, minimize barriers of time constraints, volunteer recruitment, and parents’ safety concerns, while, at the same time, increase convenience and time savings for families. This pilot study can offer guidance for community coordinated actions and local authority interventions to support sustainable school travel outcomes.

Keywords: active travel, mobile app, sustainable mobility, urban transportation planning, walking school bus

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Authors: Shasta Bula

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This research provides the first case study of the Santa Ana riverbed homeless encampment. It contributes valuable information about the little-studied factors contributing to the formation and dismantling of transient homeless encampments. According to the author’s best knowledge, this is the discussion of three reoccurring characteristics of homeless camps: camps form a self-governing system, camps are viewed by the community as unsavory places, and the campers are viewed as being unable or unwilling to participate in normal society. Three theories are proposed as explanations for these characteristics: the social capital theory as a reason for homeless campers to develop a system of self-government, the aesthetics theory as rationale for camps being viewed as unsavory places, and the theory of vulnerable and inevitable inequality as a reason why campers are seen as being unable or unwilling to participate in normal society. Three hypotheses are introduced to assess these theories: The encampment was created because it provided inhabitants a sense of safety and autonomy. It was dismantled due to its highly visible location and lack of adherence to the Orange County consumption and leisure aesthetic. Most homeless people from this encampment relocated approximately thirty miles east to Riverside County to avoid harassment by police. An extensive review of interviews with camp inhabitants revealed that fifty-one percent resided in the camp because it gave them a sense of safety and autonomy. An examination of Anaheim city council meeting meetings showed that thirty-eight percent of complaints were related to aesthetic concerns. Analysis of population reports from the U.S. Department of Housing and Urban Development indicated that there was a notable increase in homelessness in Orange County the year after the camp was dismantled. These results reflect that the social capital theory is an applicable explanation for the homeless being drawn to set up camp as a collective. The aesthetics theory can be used to explain why a third of residents complained about the encampment. Camp residents did not move East to Riverside after the camp was dismantled. Further investigation into the enforcement of anti-camping ordinances needs to be conducted to evaluate if policing contributed to the vulnerability of the homeless.

Keywords: poverty, social relations, transformation of urban settlements, urban anthropology

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Authors: Saidi Abdelkrim, Hamouine Abdelmadjid, Abdellatif Megnounif

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The study of interaction between vehicles and bridge structures has become extremely important. Large deflections and vibration induced by heavy and high-speed vehicles affect significantly the safety and efficiency of bridge. The vibration of a bridge caused by passage of vehicles is one of the most imperative considerations in the design of a bridge as a common sort of transportation structure. A major goal of this study is to create a simplified model of a vehicle bridge system in MATLAB. The model will then be used to study the influence of parameters to vehicle-bridge vibrations.

Keywords: vehicle-bridge interaction, Newmark-β, MATLAB code

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Authors: E. Isaac, I. Jalo, Y. Alkali, A. Ajani, A. Rasaki, Y. Jibrin, K. Mustapha, A. Ayuba, S. Charanchi, H. Danlami

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Introduction: Hepatitis B infection continues to be a serious global health problem with about 2 billion people infected worldwide, many of these in sub-Saharan Africa. Nigeria is one of the countries with the highest incidence, with a prevalence of 10-15%. Methods: Records of Hepatitis B surface and envelope antigen test results in adults in Federal Teaching Hospital, Gombe between May 2000 and May 2015 were retrieved and analyzed. Findings: Adult out-patient consultations and in-patient admissions were 343,083 and 67,761 respectively, accounting for 87% of total. Hepatitis B surface antigenaemia was tested for in 23,888 adults and children. 88.9% (21240) were adults. Males constituted 56% (11902/21240) and females 44% (9211/21240). 5104 (24.0%) of tested individuals were 19-25years; 12,039 (56.7%) 26-45years; 21119 (9.0%) 46-55years; 2.8% (590/21240) and 766 (3.6%) >65years. Among adult males, 17% (2133/11902) was contributed by ages 19-25. 58% (7017/11902), 11.9% (1421/11902), 6.4% (765/11902) and 4.7% (563/11902) of males were 26-45 years old, 46-55 years old and 56-65 years and >65year old respectively. Adults aged 19-25years, 26-45 years, 46-55years, 56-65 and > 65years each constituted 32% (2966/9211); 54.4% (5009/9211); 7.4% (684/9211), 3.8% (350/9211) and 2.2% (201/9211) of females respectively. 16.2% (3431/21,240) demonstrated Hepatitis B surface antigenaemia. The sero-positivity rate was 16.9% (865//5104) between 19-25years, 21.2% (2559/12,039) among 26-45year old individuals. 17.9% (377/2111); 14.1% (83/590) and 7.3% (56/766) of 46-55year old, 56-65year old and >65year old individuals screened were seropositive. The highest sero-positivity rate was found in male young adults aged 19-25years 27.9% (398/1426) and lowest in elderly males 7.4% (28/377). HBe antigen testing rate among HbSAg seropositive individuals was 97.3% (3338/3431). Males constituted 59.7% (1992/3338) and females 40.3% (1345/3338). 25.3% (844/3338) were aged 19-25years; 61.1% (2039/3338) 26-45years; 10.2% (340/3338) 46-55years; 2.7% (90/3338) 56-65years and 0.7% >65years old. HB e antigenaemia was positive in 8.2% (275/3338) of those tested. 41% (113/275); 50.2% (138/275); 5.4% (15/275); 1.8% (5/275) and 1.1 (3/275) of HB e sero-positivity was among age groups 19-25, 26-45, 46-55, 56-65 and > 65year old individuals. Dual sero-positivity rate was highest 13% (113/844) in young adults 19-25years and lowest between 46-55years; 15/340 (4.4%). 4.2% (15/360); 13.5% (69/512); 6.7% (90/1348); 4.6% (10/214); 5% (2/40) and 6.7% (1/15) of males aged 19-25; 26-45; 46-55; 56-65; and >65years had HB e antigenaemia respectively. Among females - 27/293 (9.2%) aged 19-25; 26/500 (5.2%) 26-45; 2/84 (2.4%) 46-55; 1/12 (8.3%) 56-65 and 1/9(11.1%) >65years had dual antigenaemia. In women of childbearing age, 6.9% (53/793) had a dual carriage. Conclusion: Dual hepatitis B surface and envelope antigenaemia are highest in young adult males. This will have significant implications for the development of chronic liver disease and hepatocellular carcinoma.

Keywords: adult, Hepatitis B, Nigeria, dual carriage

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Authors: Ya-Chu May Tsai, Ibrahim Yacoub, Eoin Casey

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The Australian and New Zealand College of Anaesthetists (ANZCA) advises that smoking should not be permitted within 12 hours of surgery. There is little information in the medical literature regarding patients awareness of perioperative smoking cessation recommendations nor their appreciation of how smoking might negatively impact their perioperative course. The aim of the study is to assess the prevalence of current smokers presenting to Werribee Mercy Hospital (WMH) and to evaluate if pre-operative provision of both written and verbal pre-operative advice was, 1: Effective in improving patient awareness of the benefits of pre-operative smoking cessation, 2: Associated with an increase in the number of elective surgical patients who stop smoking at least 12 hours pre-operatively. Methods: The initial survey included all patients who presented to WMH for elective surgical procedures from 19 – 30 September 2016 using a standardized questionnaire focused on patients’ smoking history and their awareness of smoking cessation preoperatively. The intervention consisted of a standard pre-operative phone call to all patients advising them of the increased perioperative risks associated with smoking, and advised patients to cease 12 hours prior. In addition, written information on smoking cessation strategies were sent out in mail at least 1 week prior to planned procedure date to all patients. Questionnaire-based study after the intervention was conducted on day of elective procedure from 10 – 21 October 2016 inclusive. Primary outcomes measured were patient’s awareness of smoking cessation and proportion of smokers who quit >12 hours, considered a clinically meaning duration to reduce anaesthetics complications. Comparison of pre and post intervention results were made using SPSS 21.0. Results: In the pre-intervention group (n=156), 36 (22.4%) patients were current smokers, 46 were ex-smokers (29.5%) and 74 were non-smokers (48.1%). Of the smokers, 12 (33%) reported having been informed of smoking cessation prior to operation and 8 (22%) were aware of increased intra- and perioperative adverse events associated with smoking. In the post-intervention group n= 177, 38 (21.5%) patients were current smokers, 39 were ex-smokers (22.0%) and 100 were non-smokers (56.5%). Of the smokers, 32 (88.9%) reported having been informed of smoking cessation prior to operation and 35 (97.2%) reported being aware of increased intra- and perioperative adverse events associated with smoking. The median time since last smoke in the pre-intervention group was 5.5 hours (Q1-Q3 = 2-14) compared with 13 hours (Q1-Q3 = 5-24) in post intervention group. Amongst the smokers, smoking cessation at least 12 hours prior to surgery significantly increased from 27.8% pre-intervention to 52.6% post intervention (P=0.03). Conclusion: A standard preoperative phone call and written instruction on smoking cessation guidelines at time of waitlist placement increase preoperative smoking cessation rates by almost 2-fold.

Keywords: anaesthesia, audit, perioperative medicine, smoking cessation

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Authors: Kieren Wilson, Gulnaz Majeed

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NHS constitution gives rights to the patient with suspected cancer to be seen by a cancer specialist within 2 weeks of referral. Guys and St Thomas Hospital (GSTT) is one of the largest cancer centres in London. NICE guidelines have provided guidance for health professionals to refer patients appropriately to RAC. In GSTT suspected gynae cancer referrals are mostly by NHS e-Referral Service with some fax, emails as well as paper referrals. The objective of this study was to evaluate compliance with 2-week referral pathway with emphasis on one stop diagnostic service with supporting efficient pathways. A prospective evaluation over 3 months (1 Jan 2017 to 31 Mar 2017) was undertaken. There were 26 clinics, 761 patients were booked in the clinics with a DNA rate of 13% (n=101) hence 606 patients were seen. Majority of referrals were for post menopausal bleeding (PMB) 25% (n=194) followed by cervical, vaginal, vulval reasons 23% (n=179) (abnormal cytology excluded as patients directly referred to colposcopy unit in GSTT), ovarian 7% (n=54) and endometrial 5% (n=41). Women with new or previous established diagnosis of cancer were 24, cervical (n=17), vulva (n=6) and vagina (n=1). Multifocal preinvasive disease vulva (VIN), vagina (VAIN) and cervix (CIN) was confirmed in twenty-six patients 4% (high prevalence in HIV patients). Majority of cervical referrals: PCB (n=14), cervical erosion (n=7), polyps (n=9) and cervical cyst were benign. However, two women with PMB had cervical cancer. Only 2 out of 13 referrals with vaginal concerns had VAIN. One case with non-cervical glandular cytology was confirmed to have endometrial cancer. One stop service based on the diagnostic support of ultrasound, colposcopy and hysteroscopy was achieved in 54% (n=359). Patients were discharged to GP, benign gynaecology, endometriosis, combined vulval/dermatology clinic or gynae oncology. 33% (n=202) required a second visit, 12% (n=70) third visit, 3% (n=19) fourth visit, 1% (n=4) fifth visit and 1% (n=6) sixth visit. Main reasons for follow ups were the unavailability of diagnostic slots, patient choice, need for interpreters, the discussion following gynae MDM review for triage to benign gynae, delay in availability of diagnostic results like histology/MRI/CT. Recommendations following this study are multi disciplinary review of pathways with the availability of additional diagnostic procedure slots to aim for one stop service. Furthermore, establishment of virtual and telephone consultations to reduce follow ups.

Keywords: multifocal disease, post menopausal bleeding, preinvasive disease, rapid access clinic

Procedia PDF Downloads 185

Authors: Paul Holmes, Mike N. G.

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Foundation-year doctors face increased stress, pressure and uncertainty when starting new rotations throughout their first years of work. This research questionnaire resulted in an induction cheat sheet and induction video that enhanced the Junior doctor's understanding of how to work effectively within the plastic surgery department at NHS Tayside. The objectives and goals were to improve the transition between cohorts of junior doctors in ward 26 at Ninewells Hospital. Before this quality improvement project, the induction pack was 74 pages long and over eight years old. With the support of consultant Mike Ng a new up-to-date induction was created. This involved a questionnaire and cheat sheet being developed. The questionnaire covered clerking, venipuncture, ward pharmacy, theatres, admissions, specialties on the ward, the cardiac arrest trolley, clinical emergencies, discharges and escalation. This audit has three completed cycles between August 2022 and August 2023. The cheat sheet developed a concise two-page A4 document designed for doctors to be able to reference easily and understand the essentials. The document format is a table containing ward layout; specialty; location; physician associate, shift patterns; ward rounds; handover location and time; hours coverage; senior escalation; nights; daytime duties, meetings/MDTs/board meetings, important bleeps and codes; department guidelines; boarders; referrals and patient stream; pharmacy; absences; rota coordinator; annual leave; top tips. The induction video is a 10-minute in-depth explanation of all aspects of the ward. The video explores in more depth the contents of the cheat sheet. This alternative visual format familiarizes the junior doctor with all aspects of the ward. These were provided to all foundation year 1 and 2 doctors on ward 26 at Ninewells Hospital at NHS Tayside Scotland. This work has since been adopted by the General Surgery Department, which extends to six further wards and has improved the effective handing over of the junior doctor’s role between cohorts. There is potential to further expand the cheat sheet to other departments as the concise document takes around 30 minutes to complete by a doctor who is currently on that ward. The time spent filling out the form provides vital information to the incoming junior doctors, which has a significant possibility to improve patient care.

Keywords: induction, junior doctor, handover, plastic surgery

Procedia PDF Downloads 77

Authors: Nabila Farhin, Israt Jahan

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Despite the feminisation of the global health force, women mostly engage in nursing, midwifery and community health workers (HWs), and the posts like surgeons, doctors, and specialists are generally male-dominated. It is also prominent in Bangladesh, where female HWs witness systematic workplace inequalities, discrimination, and underpayment. The Covid-19 pandemic put unsurmountable pressure on HWs as they had to serve in high-risk workplaces as frontliners. The already disadvantaged female HWs shouldered the same burden, were overworked without adequate occupational health and safety measures (OSH) and risked their lives. Acknowledging their vulnerable workplace conditions, the World Health Organization (WHO) and International Labour Organization (ILO) circulated a few specialised guidelines amid the peril. Bangladesh tried to adhere to international guidelines while formulating pandemic management strategies. In reality, the already weak and understaffed health sector collapsed with the patient influx and many HWs got infected and died in the line of duty, exposing the high-risk nature of the work. Unfortunately, the gender-segregated data of infected HWs are absent. This qualitative research investigates whether the existing laws of Bangladesh are adequate in protecting female HWs as frontliners in high-risk workplaces during the Covid-19 pandemic. The paper first examines international labour laws safeguarding female frontline HWs. It also analyses the specialised Covid-19 pandemic guidelines protecting their interests. Finally, the research investigates the compliance of Bangladesh as per international legal guidance during the pandemic. In doing so, it explores the domestic laws, professional guidelines for HWs and pandemic response strategies. The paper critically examines the primary sources like international and national statutes, rules, regulations and guidelines. Secondary sources like authoritative journal articles, books and newspaper reports are contextually analysed in line with the objective of the paper. The definition of HW is ambiguous in the labour laws of Bangladesh. It leads to confusion regarding the extent of legal protection rendered to female HWs at private hospitals in high-risk situations. The labour laws are not applicable in Public hospitals, as the employees follow the public service rules. Unfortunately, the country has no specialised law to protect HWs in high-risk workplaces, and the professional guidelines for HWs also remain inadequate in this regard. Even though the pandemic management strategies highlight some protective measures in high-risk situations, they only deal with HWs who are pregnant or have underlying health issues. No specialised protective guidelines can be found for female HWs as frontliners. Therefore, the laws are insufficient and failed to render adequate legal protection to female frontline HWs during the pandemic. The country also lacks comprehensive health legislation and uniform institutional and professional guidelines, preventing them from accessing grievance mechanisms. Hence, the female HWs felt victimised while duty-bound to serve in high-risk workplaces without adequate safeguards. Bangladesh should clarify the definition of HWs and standardise the service rules for providing medical care in high-risk workplaces. The research also recommends adequate health legislation and specialised legal protection to safeguard female HWs in future emergencies.

Keywords: female health workers (HWs), high-risk workplaces, Covid-19 pandemic, Bangladesh

Procedia PDF Downloads 76

Authors: Lakshmi Chebolu

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'War’, the word itself, is so vibrant and handcuffs the entire society. Since the beginning of manhood, the world has been evident in constant struggles. However, along with the growth of communities, relations, on the one hand, and disputes, on the other hand, infinitely increased. When states cannot or will not settle their disputes or differences by means of peaceful agreements, weapons are suddenly made to speak. It does not mean states can engage in war whenever they desire. At an international level, there has been a vast development of the law of war in the 20th century. War, it may be internal or international, in all situations, belligerent actors should follow the principles of warfare. With the advent of technology, the shape of war has changed, and it violates fundamental principles without observing basic norms. Conversely, states' attitudes towards international relationships are also undermined to some extent as state parties are not prioritized the communal interest rather than political or individual interest. In spite of the persistent development of communities, still many people are innocent victims of modern wars. It costs a toll on many lives, liberties, and properties and remains a major obstacle to nations' development. Recent incidents in Afghan are a live example to World Nations. We know that the principles of international law cannot be implemented very strictly on perpetrators due to the lacuna in the international legal system. However, the rules of war are universal in nature. The Geneva Convention, 1949 which are the core element of IHL, has been ratified by all 196 States. In fact, very few international treaties received this much of big support from nations. State’s approach towards Modern International Law, places a heavy burden on States practice towards in implementation of law. Although United Nations Security Council possesses certain powers under ‘Pacific Settlement of Disputes’, (Chapter VI) of the United Nations Charter to prevent disputes in a peaceful manner, conversely, this practice has been overlooked for many years due to political interests, favor, etc. Despite international consensus on the prohibition of war and protection of fundamental freedoms and human dignity, still, often, law has been misused by states’. The recent tendencies trigger questions about states’ willingness towards the implementation of the law. In view of the existing practices of nations, this paper aims to elevate the legal obligations of the international community to save the succeeding generations from the scourge of modern war practices.

Keywords: modern wars, weapons, prohibition and suspension of war activities, states’ obligations

Procedia PDF Downloads 79

Authors: Bernard Ewuoso

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Introduction: Induction of labor (IOL) usually involves the patient moving between antenatal, labor, and postnatal wards. Delay in IOL has been defined as delay in the time it takes a woman to wait for induction after her cervix is assessed to be favorable. Opinions vary on the acceptable time the patient is allowed to wait for once the cervix is adjudged ripe for induction. What has been considered a benchmark is a delay of up to 12 hours. There is evidence that delay in IOL is associated with adverse outcomes. Aim: To determine the number of women experiencing delay in induction of labor and their outcomes. Method: This audit was retrospective and observational. It included women who had induction of labor in the month of October 2023 in two hospitals. Clinical data was collected from electronic medical records into an Excel sheet for analysis. Women had cervical ripening as inpatient or outpatient. The primary objective was to determine the number of women experiencing delay in induction of labor, while the secondary objective was to outcome these women. Result: 136 women had IOL. The least percentage of data retrieved for any parameter was 80%. The mean gestational age at IOL was 278.26 days. The mean waiting time was 905.34mins. Seventy-five women had their IOL at the Royal Infirmary of Edinburgh (RIE), fifty-seven at St. John’s Hospital (SJH), and three women were transferred from RIE to SJH. The preferred method of cervical ripening was balloon closely followed by prostaglandin. Twenty-seven women did not require cervical ripening and had their process started with amniotomy. Prostaglandin was the method of choice of cervical ripening at RIE, while balloon was preferred in SJH. Of the thirty-five women found to be suitable for outpatient cervical ripening, thirteen had outpatient ripening. There was a significant increase in the number of women undergoing outpatient cervical ripening at RIE from 10.5% in April 2022 to 42.9%. The preferred method for outpatient cervical ripening at the RIE was balloon, while it was prostaglandin for SJH. These were contradictory to the preferred method of inpatient cervical ripening at both centers. The average waiting time for IOL at RIE, 1166.92mins, is more than double that of SJH, 442.93mins, and far exceed 12hours, which is the proposed benchmark. The waiting time tends to be shorter with prostaglandin. Out of the women that had outpatient cervical ripening 63.6% had to wait for more than 12hrs before being induced while it was 36.1% for women that had inpatient cervical ripening. Overall, 38.5% women waited for more than 12 hours before having their induction. A lesser proportion of the women who waited for more than 12 hours had caesarean section, assisted vaginal delivery, and postpartum hemorrhage, whereas a greater proportion had spontaneous vaginal delivery and intrapartum or postpartum infection. Conclusion: A significant number of the women included in the study experienced delay in their induction process, and this was associated with an increased occurrence of intrapartum or postpartum infection. Outpatient cervical ripening contributed to delay.

Keywords: delay in induction of labor, inpatient, outpatient, intrapartum, postpartum, infection

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Authors: Retno Supriyanti, Teguh Budiono, Yogi Ramadhani, Haris B. Widodo, Arwita Mulyawati

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Cervical cancer is the leading cause of mortality in cancer-related diseases. In this diagnosis doctors usually perform several tests to determine the presence of cervical cancer in a patient. However, these checks require support equipment to get the results in more detail. One is by using ultrasonography. However, for the developing countries most of the existing ultrasonography has a low resolution. The goal of this research is to obtain abnormalities on low-resolution ultrasound images especially for cervical cancer case. In this paper, we emphasize our work to use Image Enhancement for pre-processing image quality improvement. The result shows that pre-processing stage is promising to support further analysis.

Keywords: cervical cancer, mortality, low-resolution, image enhancement.

Procedia PDF Downloads 634

Authors: Laurence Weinberg, Dominic Walpole, Dong-Kyu Lee, Michael D’Silva, Jian W. Chan, Lachlan F. Miles, Bradley Carp, Adam Wells, Tuck S. Ngun, Siven Seevanayagam, George Matalanis, Ziauddin Ansari, Rinaldo Bellomo, Michael Yii

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Background: There have been multiple recent advancements in the selection, optimization and management of cardiac surgical patients. However, there is limited data regarding the outcomes of nonagenarians undergoing cardiac surgery, despite this vulnerable cohort increasingly receiving these interventions. This study describes the patient characteristics, management and outcomes of a group of nonagenarians undergoing cardiac surgery in the context of contemporary peri-operative care. Methods: A retrospective observational study was conducted of patients 90 to 99 years of age (i.e., nonagenarians) who had undergone cardiac surgery requiring a classic median sternotomy (i.e., open-heart surgery). All operative indications were included. Patients who underwent minimally invasive surgery, transcatheter aortic valve implantation and thoracic aorta surgery were excluded. Data were collected from four hospitals in Victoria, Australia, over an 8-year period (January 2012 – December 2019). The primary objective was to assess six-month mortality in nonagenarians undergoing open-heart surgery and to evaluate the incidence and severity of postoperative complications using the Clavien-Dindo classification system. The secondary objective was to provide a detailed description of the characteristics and peri-operative management of this group. Results: A total of 12,358 adult patients underwent cardiac surgery at the study centers during the observation period, of whom 18 nonagenarians (0.15%) fulfilled the inclusion criteria. The median (IQR) [min-max] age was 91 years (90.0:91.8) [90-94] and 14 patients (78%) were men. Cardiovascular comorbidities, polypharmacy and frailty, were common. The median (IQR) predicted in-hospital mortality by EuroSCORE II was 6.1% (4.1-14.5). All patients were optimized preoperatively by a multidisciplinary team of surgeons, cardiologists, geriatricians and anesthetists. All index surgeries were performed on cardiopulmonary bypass. Isolated coronary artery bypass grafting (CABG) and CABG with aortic valve replacement were the most common surgeries being performed in four and five patients, respectively. Half the study group underwent surgery involving two or more major procedures (e.g. CABG and valve replacement). Surgery was undertaken emergently in 44% of patients. All patients except one experienced at least one postoperative complication. The most common complications were acute kidney injury (72%), new atrial fibrillation (44%) and delirium (39%). The highest Clavien-Dindo complication grade was IIIb occurring once each in three patients. Clavien-Dindo grade IIIa complications occurred in only one patient. The median (IQR) postoperative length of stay was 11.6 days (9.8:17.6). One patient was discharged home and all others to an inpatient rehabilitation facility. Three patients had an unplanned readmission within 30 days of discharge. All patients had follow-up to at least six months after surgery and mortality over this period was zero. The median (IQR) duration of follow-up was 11.3 months (6.0:26.4) and there were no cases of mortality observed within the available follow-up records. Conclusion: In this group of nonagenarians undergoing cardiac surgery, postoperative six-month mortality was zero. Complications were common but generally of low severity. These findings support carefully selected nonagenarian patients being offered cardiac surgery in the context of contemporary, multidisciplinary perioperative care. Further, studies are needed to assess longer-term mortality and functional and quality of life outcomes in this vulnerable surgical cohort.

Keywords: cardiac surgery, mortality, nonagenarians, postoperative complications

Procedia PDF Downloads 115

Authors: Elmo Thiago Lins Cöuras Ford, Valentina Alessandra Carvalho do Vale, José Ubiragi de Lima Mendes

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In elapsing of the years it elaborates automobile it is developing automobiles more and more modern that, every year, the vehicles recently of the assembly lines, practically they push for the past produced models there is very little time. Those innovations didn't also pass unperceived in 0respect the safety of the vehicles. It is in this development apprenticeship the brakes systems equipped more and more with resources sophisticated. In that way, before of that context, this research tried to project a brake system for a vehicle off-road and to analyze your acting as the brakes efficiency: distances traveled and time, concluding with possible improvements in the system.

Keywords: brakes system, off-road, vehicle acting, automotive and mechanical engineering

Procedia PDF Downloads 481

Authors: A. Fathianpour, M. B. Jelodar, S. Wilkinson

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This paper outlines the approaches taken to assess multi-hazard assessments. There is currently confusion in assessing multi-hazard impacts, and so this study aims to determine which of the available options are the most useful. The paper uses an international literature search, and analysis of current multi-hazard assessments and a case study to illustrate the effectiveness of the chosen method. Findings from this study will help those wanting to assess multi-hazards to undertake a straightforward approach. The paper is significant as it helps to interpret the various approaches and concludes with the preferred method. Many people in the world live in hazardous environments and are susceptible to disasters. Unfortunately, when a disaster strikes it is often compounded by additional cascading hazards, thus people would confront more than one hazard simultaneously. Hazards include natural hazards (earthquakes, floods, etc.) or cascading human-made hazards (for example, Natural Hazard Triggering Technological disasters (Natech) such as fire, explosion, toxic release). Multi-hazards have a more destructive impact on urban areas than one hazard alone. In addition, climate change is creating links between different disasters such as causing landslide dams and debris flows leading to more destructive incidents. Much of the prevailing literature deals with only one hazard at a time. However, recently sophisticated multi-hazard assessments have started to appear. Given that multi-hazards occur, it is essential to take multi-hazard risk assessment under consideration. This paper aims to review the multi-hazard assessment methods through articles published to date and categorize the strengths and disadvantages of using these methods in risk assessment. Napier City is selected as a case study to demonstrate the necessity of using multi-hazard risk assessments. In order to assess multi-hazard risk assessments, first, the current multi-hazard risk assessment methods were described. Next, the drawbacks of these multi-hazard risk assessments were outlined. Finally, the improvements to current multi-hazard risk assessments to date were summarised. Generally, the main problem of multi-hazard risk assessment is to make a valid assumption of risk from the interactions of different hazards. Currently, risk assessment studies have started to assess multi-hazard situations, but drawbacks such as uncertainty and lack of data show the necessity for more precise risk assessment. It should be noted that ignoring or partial considering multi-hazards in risk assessment will lead to an overestimate or overlook in resilient and recovery action managements.

Keywords: cascading hazards, disaster assessment, mullti-hazards, risk assessment

Procedia PDF Downloads 109

Authors: Tiffany Wicks

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Queer patients can face issues with self-advocating due to the factors of implicit provider bias, lack of tools and resources to self-advocate, and lack of comfortability in self-advocating based on prior experiences. In this study, five participants who identify as queer discussed their interactions with their healthcare providers. This exploratory study revealed that there is a need for healthcare provider education to reduce implicit bias and judgments about queer patients. There is also an important need for peer advocates in order to further inform healthcare promotion and decision-making before and during provider visits in an effort for a better outcome. Through this exploration, queer patients voiced their experiences and concerns to inform a need for change in healthcare collaboration between providers and patients in the queer community.

Keywords: queer, LGBT, patient, self-advocacy, healthcare

Procedia PDF Downloads 82

Authors: J. R. Wang, S. W. Chen, Y. Chiang, W. S. Hsu, J. H. Yang, Y. S. Tseng, C. Shih

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In this research, the HABIT analysis methodology was established for Maanshan nuclear power plant (NPP). The Final Safety Analysis Report (FSAR), reports, and other data were used in this study. To evaluate the control room habitability under the CO₂ storage burst, the HABIT methodology was used to perform this analysis. The HABIT result was below the R.G. 1.78 failure criteria. This indicates that Maanshan NPP habitability can be maintained. Additionally, the sensitivity study of the parameters (wind speed, atmospheric stability classification, air temperature, and control room intake flow rate) was also performed in this research.

Keywords: PWR, HABIT, Habitability, Maanshan

Procedia PDF Downloads 441

Authors: Y. Chiang, W. Y. Li, J. R. Wang, S. W. Chen, W. S. Hsu, J. H. Yang, Y. S. Tseng, C. Shih

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In this research, the HABIT code was used to estimate the concentration under the CO₂ and H₂SO₄ storage burst conditions for Kuosheng nuclear power plant (NPP). The Final Safety Analysis Report (FSAR) and reports were used in this research. In addition, to evaluate the control room habitability for these cases, the HABIT analysis results were compared with the R.G. 1.78 failure criteria. The comparison results show that the HABIT results are below the criteria. Additionally, some sensitivity studies (stability classification, wind speed and control room intake rate) were performed in this study.

Keywords: BWR, HABIT, habitability, Kuosheng

Procedia PDF Downloads 486