Search results for: Isak Andersen
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 15

Search results for: Isak Andersen

15 Safeguarding Product Quality through Pre-Qualification of Material Manufacturers: A Ship and Offshore Classification Society's Perspective

Authors: Sastry Y. Kandukuri, Isak Andersen

Abstract:

Despite recent advances in the manufacturing sector, quality issues remain a frequent occurrence, and can result in fatal accidents, equipment downtime, and loss of life. Adequate quality is of high importance in high-risk industries such as sea-going vessels and offshore installations in which third party quality assurance and product control play an important essential role in ensuring manufacturing quality of critical components. Classification societies play a vital role in mitigating risk in these industries by making sure that all the stakeholders i.e. manufacturers, builders, and end users are provided with adequate rules and standards that effectively ensures components produced at a high level of quality based on the area of application and risk of its failure. Quality issues have also been linked to the lack of competence or negligence of stakeholders in supply value chain. However, continued actions and regulatory reforms through modernization of rules and requirements has provided additional tools for purchasers and manufacturers to confront these issues. Included among these tools are updated ‘approval of manufacturer class programs’ aimed at developing and implementing a set of standardized manufacturing quality metrics for use by the manufacturer and verified by the classification society. The establishment and collection of manufacturing and testing requirements described in these programs could provide various stakeholders – from industry to vessel owners – with greater insight into the state of quality at a given manufacturing facility, and allow stakeholders to anticipate better and address quality issues while simultaneously reducing unnecessary failures that are costly to the industry. The publication introduces, explains and discusses critical manufacturing and testing requirements set in a leading class society’s approval of manufacturer regime and its rationale and some case studies.

Keywords: classification society, manufacturing, materials processing, materials testing, quality control

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14 Understanding Stock-Out of Pharmaceuticals in Timor-Leste: A Case Study in Identifying Factors Impacting on Pharmaceutical Quantification in Timor-Leste

Authors: Lourenco Camnahas, Eileen Willis, Greg Fisher, Jessie Gunson, Pascale Dettwiller, Charlene Thornton

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Stock-out of pharmaceuticals is a common issue at all level of health services in Timor-Leste, a small post-conflict country. This lead to the research questions: what are the current methods used to quantify pharmaceutical supplies; what factors contribute to the on-going pharmaceutical stock-out? The study examined factors that influence the pharmaceutical supply chain system. Methodology: Privett and Goncalvez dependency model has been adopted for the design of the qualitative interviews. The model examines pharmaceutical supply chain management at three management levels: management of individual pharmaceutical items, health facilities, and health systems. The interviews were conducted in order to collect information on inventory management, logistics management information system (LMIS) and the provision of pharmaceuticals. Andersen' behavioural model for healthcare utilization also informed the interview schedule, specifically factors linked to environment (healthcare system and external environment) and the population (enabling factors). Forty health professionals (bureaucrats, clinicians) and six senior officers from a United Nations Agency, a global multilateral agency and a local non-governmental organization were interviewed on their perceptions of factors (healthcare system/supply chain and wider environment) impacting on stock out. Additionally, policy documents for the entire healthcare system, along with population data were collected. Findings: An analysis using Pozzebon’s critical interpretation identified a range of difficulties within the system from poor coordination to failure to adhere to policy guidelines along with major difficulties with inventory management, quantification, forecasting, and budgetary constraints. Weak logistics management information system, lack of capacity in inventory management, monitoring and supervision are additional organizational factors that also contributed to the issue. There were various methods of quantification of pharmaceuticals applied in the government sector, and non-governmental organizations. Lack of reliable data is one of the major problems in the pharmaceutical provision. Global Fund has the best quantification methods fed by consumption data and malaria cases. There are other issues that worsen stock-out: political intervention, work ethic and basic infrastructure such as unreliable internet connectivity. Major issues impacting on pharmaceutical quantification have been identified. However, current data collection identified limitations within the Andersen model; specifically, a failure to take account of predictors in the healthcare system and the environment (culture/politics/social. The next step is to (a) compare models used by three non-governmental agencies with the government model; (b) to run the Andersen explanatory model for pharmaceutical expenditure for 2 to 5 drug items used by these three development partners in order to see how it correlates with the present model in terms of quantification and forecasting the needs; (c) to repeat objectives (a) and (b) using the government model; (d) to draw a conclusion about the strength.

Keywords: inventory management, pharmaceutical forecasting and quantification, pharmaceutical stock-out, pharmaceutical supply chain management

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13 The Complete Modal Derivatives

Authors: Sebastian Andersen, Peter N. Poulsen

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The use of basis projection in the structural dynamic analysis is frequently applied. The purpose of the method is to improve the computational efficiency, while maintaining a high solution accuracy, by projection the governing equations onto a small set of carefully selected basis vectors. The present work considers basis projection in kinematic nonlinear systems with a focus on two widely used basis vectors; the system mode shapes and their modal derivatives. Particularly the latter basis vectors are given special attention since only approximate modal derivatives have been used until now. In the present work the complete modal derivatives, derived from perturbation methods, are presented and compared to the previously applied approximate modal derivatives. The correctness of the complete modal derivatives is illustrated by use of an example of a harmonically loaded kinematic nonlinear structure modeled by beam elements.

Keywords: basis projection, finite element method, kinematic nonlinearities, modal derivatives

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12 Role of Discrete Event Simulation in the Assessment and Selection of the Potential Reconfigurable Manufacturing Solutions

Authors: Mohsin Raza, Arne Bilberg, Thomas Ditlev Brunø, Ann-Louise Andersen, Filip SKärin

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Shifting from a dedicated or flexible manufacturing system to a reconfigurable manufacturing system (RMS) requires a significant amount of time, money, and effort. Therefore, it is vital to verify beforehand that the potential reconfigurable solution will be able to achieve the organizational objectives. Discrete event simulation offers the opportunity of assessing several reconfigurable alternatives against the set objectives. This study signifies the importance of using discrete-event simulation as a tool to verify several reconfiguration options. Two different industrial cases have been presented in the study to elaborate on the role of discrete event simulation in the implementation methodology of RMSs. The study concluded that discrete event simulation is one of the important tools to consider in the RMS implementation methodology.

Keywords: reconfigurable manufacturing system, discrete event simulation, Tecnomatix plant simulation, RMS

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11 Combined Optical Coherence Microscopy and Spectrally Resolved Multiphoton Microscopy

Authors: Bjorn-Ole Meyer, Dominik Marti, Peter E. Andersen

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A multimodal imaging system, combining spectrally resolved multiphoton microscopy (MPM) and optical coherence microscopy (OCM) is demonstrated. MPM and OCM are commonly integrated into multimodal imaging platforms to combine functional and morphological information. The MPM signals, such as two-photon fluorescence emission (TPFE) and signals created by second harmonic generation (SHG) are biomarkers which exhibit information on functional biological features such as the ratio of pyridine nucleotide (NAD(P)H) and flavin adenine dinucleotide (FAD) in the classification of cancerous tissue. While the spectrally resolved imaging allows for the study of biomarkers, using a spectrometer as a detector limits the imaging speed of the system significantly. To overcome those limitations, an OCM setup was added to the system, which allows for fast acquisition of structural information. Thus, after rapid imaging of larger specimens, navigation within the sample is possible. Subsequently, distinct features can be selected for further investigation using MPM. Additionally, by probing a different contrast, complementary information is obtained, and different biomarkers can be investigated. OCM images of tissue and cell samples are obtained, and distinctive features are evaluated using MPM to illustrate the benefits of the system.

Keywords: optical coherence microscopy, multiphoton microscopy, multimodal imaging, two-photon fluorescence emission

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10 The Role of Questioning Techniques in a Literature Classroom

Authors: Barbara Magallona

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Given the observations between students who were active participants in a dialogue with their teacher and students who simply answered the teacher’s questions, the researcher will investigate the relationship between student-teacher dialogue in the classroom and the development of higher level thinking skills with an emphasis on the questioning techniques used by the teacher. The study posits the main question: What is the relationship between teachers’ questioning techniques and the development of students’ higher level thinking skills in a literature class (or in literature classes) in Xavier? The following are the study’s sub-questions: a) What types of questions do literature teachers at Xavier School ask? b) What types of responses do literature students at Xavier School give to teachers' questions? c) To what extent is the development of students' higher level thinking skills shown in teacher-student classroom dialogues in Xavier School's literature classroom? Since questioning techniques and student responses in the literature classroom form the core of this paper and in order to evaluate them, the study uses Andersen and Krathwohl’s revision of Harold Bloom’s Taxonomy of Educational Objectives. Teun van Dijk’s discourse-cognition-society triangle will be used as a theoretical framework to design and to guide the classroom interaction.

Keywords: discourse analysis, literature classroom, questioning techniques, secondary education

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9 Online Monitoring of Airborne Bioaerosols Released from a Composting, Green Waste Site

Authors: John Sodeau, David O'Connor, Shane Daly, Stig Hellebust

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This study is the first to employ the online WIBS (Waveband Integrated Biosensor Sensor) technique for the monitoring of bioaerosol emissions and non-fluorescing “dust” released from a composting/green waste site. The purpose of the research was to provide a “proof of principle” for using WIBS to monitor such a location continually over days and nights in order to construct comparative “bioaerosol site profiles”. Current impaction/culturing methods take many days to achieve results available by the WIBS technique in seconds.The real-time data obtained was then used to assess variations of the bioaerosol counts as a function of size, “shape”, site location, working activity levels, time of day, relative humidity, wind speeds and wind directions. Three short campaigns were undertaken, one classified as a “light” workload period, another as a “heavy” workload period and finally a weekend when the site was closed. One main bioaerosol size regime was found to predominate: 0.5 micron to 3 micron with morphologies ranging from elongated to elipsoidal/spherical. The real-time number-concentration data were consistent with an Andersen sampling protocol that was employed at the site. The number-concentrations of fluorescent particles as a proportion of total particles counted amounted, on average, to ~1% for the “light” workday period, ~7% for the “heavy” workday period and ~18% for the weekend. The bioaerosol release profiles at the weekend were considerably different from those monitored during the working weekdays.

Keywords: bioaerosols, composting, fluorescence, particle counting in real-time

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8 Is Audit Quality Implied by Accruals Quality Associated with Audit Fees and Auditor Tenure? Evidence from China

Authors: Hassan Y. Kikhia, Jin P. Zhang, Khaldoon G. Albiatr

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The Enron and Arthur Andersen scandal has raised concerns internationally about auditor independence and audit quality. Furthermore, the debate continues about the relationship between audit fees, auditor tenure and audit quality in spite of extensive empirical evidence examining audit failures and earnings management. Therefore, the purpose of current research is to determine the effect of audit fee and audit tenure both partially and simultaneously on the audit quality. Using a sample of Chinese firms, an environment where we believe it provides us with an opportunity to test whether the development of market and legal institutions affects the impact of audit fees and auditor tenure on audit quality. We employ the standard deviation of residuals from regressions relating current accruals to cash flows as proxy for audit quality. The paper documents statistically significant negative association between audit fees and audit quality. These findings are consistent with economic bonding being a determinant of auditor behavior rather than auditor reputational concerns. Further, the current paper shows a positive association between auditor tenure and audit quality in the earlier years of audit tenure. These results support the proposition that when the Learning Effect dominates the Bonding Effect in the earlier years of tenure, then audit quality is likely to be higher. Taken audit fees and audit tenure together, the results suggest that there is positive association between audit fees and audit quality in the earlier years of auditor tenure. Interestingly, the findings of our study have important implications for auditors, policymakers, multinational firms, and users of financial reports. As the rapid growth of China's economy gains global recognition, the Chinese stock market is capturing the attention of international investors. To a lesser extent, our paper also differs from the prior studies in methodology and findings in the investigation of audit quality.

Keywords: audit quality, accruals quality, audit fees, auditor tenure

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7 The Utilization of Healthcare by African Migrants: The Lived Experiences of Unaccompanied Adolescent Migrants in South Africa

Authors: Kwanele Shishane

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Numerous countries are faced with challenges such as disease, poverty and other social ills and inadequate government support to meet the needs of the entire population. In developing countries, the concept of child-headed households has become a ubiquitous phenomenon and lived experience. As such, migration of children is common in these countries. This study aims to explore the lived experiences of unaccompanied adolescent migrant, with regards to the utilization of health care in South Africa. The objectives of the study are to examine the lived experiences of health care utilization by unaccompanied adolescent migrants; examine the predisposing, enabling and need factors influencing utilization of health care among unaccompanied adolescent migrants; examine the social and cultural influences on health care utilization among unaccompanied adolescent migrants; and identify the health system barriers to utilization of health care by unaccompanied adolescent migrants. Andersen and Newman’s Model of Health Care Utilization (1995) which explains factors determining the utilization of healthcare will provide the theoretical framework for the empirical investigation of this study. The target population for this study is unaccompanied adolescent migrants, seeking to access services from migrant service organizations in four provinces in South Africa (Limpopo, KwaZulu-Natal, Free State, and Gauteng). Participants will be selected using a purposive sampling procedure. A qualitative research approach utilizing a descriptive phenomenological epistemology will be utilized in this study. Data will be collected through conducting in-depth interviews and focus group discussions with unaccompanied migrant adolescents, to explore their lived experiences related to access and utilization of health care, as an unaccompanied migrant in SA. The qualitative data will be analysed using Tech’s (1990) thematic analytical approach.

Keywords: health care utilisation, unaccompanied migrant youth, South Africa, lived experiences

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6 The Material-Process Perspective: Design and Engineering

Authors: Lars Andersen

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The development of design and engineering in large construction projects are characterized by an increased degree of flattening out of formal structures, extended use of parallel and integrated processes (‘Integrated Concurrent Engineering’) and an increased number of expert disciplines. The integration process is based on ongoing collaborations, dialogues, intercommunication and comments on each other’s work (iterations). This process based on reciprocal communication between actors and disciplines triggers value creation. However, communication between equals is not in itself sufficient to create effective decision making. The complexity of the process and time pressure contribute to an increased risk of a deficit of decisions and loss of process control. The paper refers to a study that aims at developing a resilient decision-making system that does not come in conflict with communication processes based on equality between the disciplines in the process. The study includes the construction of a hospital, following the phases design, engineering and physical building. The Research method is a combination of formative process research, process tracking and phenomenological analyses. The study tracked challenges and problems in the building process to the projection substrates (drawing and models) and further to the organization of the engineering and design phase. A comparative analysis of traditional and new ways of organizing the projecting made it possible to uncover an implicit material order or structure in the process. This uncovering implied a development of a material process perspective. According to this perspective the complexity of the process is rooted in material-functional differentiation. This differentiation presupposes a structuring material (the skeleton of the building) that coordinates the other types of material. Each expert discipline´s competence is related to one or a set of materials. The architect, consulting engineer construction etc. have their competencies related to structuring material, and inherent in this; coordination competence. When dialogues between the disciplines concerning the coordination between them do not result in agreement, the disciplines with responsibility for the structuring material decide the interface issues. Based on these premises, this paper develops a self-organized expert-driven interdisciplinary decision-making system.

Keywords: collaboration, complexity, design, engineering, materiality

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5 The Effects of Subjective and Objective Indicators of Inequality on Life Satisfaction in a Comparative Perspective Using a Multi-Level Analysis

Authors: Atefeh Bagherianziarat, Dana Hamplova

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The inverse social gradient in life satisfaction (LS) is a well-established research finding. To estimate the influence of inequality on LS, most of the studies have explored the effect of the objective aspects of inequality or individuals’ socioeconomic status (SES). However, relatively fewer studies have confirmed recently the significant effect of the subjective aspect of inequality or subjective socioeconomic status (SSS) on life satisfaction over and above SES. In other words, it is confirmed by some studies that individuals’ perception of their unequal status in society or SSS can moderate the impact of their absolute unequal status on their life satisfaction. Nevertheless, this newly confirmed moderating link has not been affirmed to work likewise in societies with different levels of social inequality and also for people who believe in the value of equality, at different levels. In this study, we compared the moderative influence of subjective inequality on the link between objective inequality and life satisfaction. In particular, we focus on differences across welfare state regimes based on Esping-Andersen's theory. Also, we explored the moderative role of believing in the value of equality on the link between objective and subjective inequality on LS in the given societies. Since our studied variables were measured at both individual and country levels, we applied a multilevel analysis to the European Social Survey data (round 9). The results showed that people in deferent regimes reported statistically meaningful different levels of life satisfaction that is explained to different extends by their household income and their perception of their income inequality. The findings of the study supported the previous findings of the moderator influence of perceived inequality on the link between objective inequality and LS. However, this link is different in various welfare state regimes. The results of the multilevel modeling showed that country-level subjective equality is a positive predictor for individuals’ life satisfaction, while the GINI coefficient that was considered as the indicator of absolute inequality has a smaller effect on life satisfaction. Also, country-level subjective equality moderates the confirmed link between individuals’ income and their life satisfaction. It can be concluded that both individual and country-level subjective inequality slightly moderate the effect of individuals’ income on their life satisfaction.

Keywords: individual values, life satisfaction, multilevel analysis, objective inequality, subjective inequality, welfare regimes status

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4 Evidence-Based Practices in Education: A General Review of the Literature on Elementary Classroom Setting

Authors: Carolina S. Correia, Thalita V. Thomé, Andersen Boniolo, Dhayana I. Veiga

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Evidence-based practices (EBP) in education is a set of principles and practices used to raise educational policy, it involves the integration of professional expertise in education with the best empirical evidence in making decisions about how to deliver instruction. The purpose of this presentation is to describe and characterize studies about EBP in education in elementary classroom setting. Data here presented is part of an ongoing systematic review research. Articles were searched and selected from four academic databases: ProQuest, Scielo, Science Direct and Capes. The search terms were evidence-based practices or program effectiveness, and education or teaching or teaching practices or teaching methods. Articles were included according to the following criteria: The studies were explicitly described as evidence-based or discussed the most effective practices in education, they discussed teaching practices in classroom context in elementary school level. Document excerpts were extracted and recorded in Excel, organized by reference, descriptors, abstract, purpose, setting, participants, type of teaching practice, study design and main results. The total amount of articles selected were 1.185, 569 articles from Proquest Research Library; 216 from CAPES; 251 from ScienceDirect and 149 from Scielo Library. The potentially relevant references were 178, from which duplicates were removed. The final number of articles analyzed was 140. From 140 articles, are 47 theoretical studies and 93 empirical articles. The following research design methods were identified: longitudinal intervention study, cluster-randomized trial, meta-analysis and pretest-posttest studies. From 140 articles, 103 studies were about regular school teaching and 37 were on special education teaching practices. In several studies, used as teaching method: active learning, content acquisition podcast (CAP), precision teaching (PT), mediated reading practice, speech therapist programs and peer-assisted learning strategies (PALS). The countries of origin of the studies were United States of America, United Kingdom, Panama, Sweden, Scotland, South Korea, Argentina, Chile, New Zealand and Brunei. The present study in is an ongoing project, so some representative findings will be discussed, providing further acknowledgment on the best teaching practices in elementary classroom setting.

Keywords: best practices, children, evidence-based education, elementary school, teaching methods

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3 Unionisation, Participation and Democracy: Forms of Convergence and Divergence between Union Membership and Civil and Political Activism in European Countries

Authors: Silvia Lucciarini, Antonio Corasaniti

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The issue of democracy in capitalist countries has once again become the focus of debate in recent years. A number of socio-economic and political tensions have triggered discussion of this topic from various perspectives and disciplines. Political developments, the rise of both right-wing parties and populism and the constant growth of inequalities in a context of welfare downsizing, have led scholars to question if European capitalist countries are really capable of creating and redistributing resources and look for elements that might make democratic capital in European countries more dense. The aim of the work is to shed light on the trajectories, intensity and convergence or divergence between political and associative participation, on one hand, and organization, on the other, as these constitute two of the main points of connection between the norms, values and actions that bind citizens to the state. Using the European Social Survey database, some studies have sought to analyse degrees of unionization by investigating the relationship between systems of industrial relations and vulnerable groups (in terms of value-oriented practices or political participation). This paper instead aims to investigate the relationship between union participation and civil/political participation, comparing union members and non-members and then distinguishing between employees and self-employed professionals to better understand participatory behaviors among different workers. The first component of the research will employ a multilinear logistic model to examine a sample of 10 countries selected according to a grid that combines the industrial relations models identified by Visser (2006) and the Welfare State systems identified by Esping-Andersen (1990). On the basis of this sample, we propose to compare the choices made by workers and their propensity to join trade unions, together with their level of social and political participation, from 2002 to 2016. In the second component, we aim to verify whether workers within the same system of industrial relations and welfare show a similar propensity to engage in civil participation through political bodies and associations, or if instead these tendencies take on more specific and varied forms. The results will allow us to see: (1) if political participation is higher among unionized workers than it is among the non-unionized. (2) what are the differences in unionisation and civil/political participation between self-employed, temporary and full-time employees and (3) whether the trajectories within industrial relations and welfare models display greater inclusiveness and participation, thereby confirming or disproving the patterns that have been documented among the different European countries.

Keywords: union membership, participation, democracy, industrial relations, welfare systems

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2 Using ANN in Emergency Reconstruction Projects Post Disaster

Authors: Rasha Waheeb, Bjorn Andersen, Rafa Shakir

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Purpose The purpose of this study is to avoid delays that occur in emergency reconstruction projects especially in post disaster circumstances whether if they were natural or manmade due to their particular national and humanitarian importance. We presented a theoretical and practical concepts for projects management in the field of construction industry that deal with a range of global and local trails. This study aimed to identify the factors of effective delay in construction projects in Iraq that affect the time and the specific quality cost, and find the best solutions to address delays and solve the problem by setting parameters to restore balance in this study. 30 projects were selected in different areas of construction were selected as a sample for this study. Design/methodology/approach This study discusses the reconstruction strategies and delay in time and cost caused by different delay factors in some selected projects in Iraq (Baghdad as a case study).A case study approach was adopted, with thirty construction projects selected from the Baghdad region, of different types and sizes. Project participants from the case projects provided data about the projects through a data collection instrument distributed through a survey. Mixed approach and methods were applied in this study. Mathematical data analysis was used to construct models to predict delay in time and cost of projects before they started. The artificial neural networks analysis was selected as a mathematical approach. These models were mainly to help decision makers in construction project to find solutions to these delays before they cause any inefficiency in the project being implemented and to strike the obstacles thoroughly to develop this industry in Iraq. This approach was practiced using the data collected through survey and questionnaire data collection as information form. Findings The most important delay factors identified leading to schedule overruns were contractor failure, redesigning of designs/plans and change orders, security issues, selection of low-price bids, weather factors, and owner failures. Some of these are quite in line with findings from similar studies in other countries/regions, but some are unique to the Iraqi project sample, such as security issues and low-price bid selection. Originality/value we selected ANN’s analysis first because ANN’s was rarely used in project management , and never been used in Iraq to finding solutions for problems in construction industry. Also, this methodology can be used in complicated problems when there is no interpretation or solution for a problem. In some cases statistical analysis was conducted and in some cases the problem is not following a linear equation or there was a weak correlation, thus we suggested using the ANN’s because it is used for nonlinear problems to find the relationship between input and output data and that was really supportive.

Keywords: construction projects, delay factors, emergency reconstruction, innovation ANN, post disasters, project management

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1 Factors Affecting Early Antibiotic Delivery in Open Tibial Shaft Fractures

Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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