Search results for: armed forces general hospital

Authors: Anmol Patel

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Cardiopulmonary resuscitation is medical intervention which should be considered for all inpatients; with a patient centred approach, open communication and accurate documentation of clinical decisions. National enquiries have shown that in a significant number of cases CPR was attempted when it was considered inappropriate. In these circumstances attempting to prevent a natural death and subjecting a patient to trauma at the end of life would deprive them of a dignified death. Anticipatory “do not attempt CPR (DNACPR)” decisions aim to prevent this for those considered appropriate. As a legal document, these forms are required to be completed accurately and thoroughly. The aim of this study was to evaluate the difference in quality of DNACPR forms completed using electronic versus paper formats. A retrospective review of DNACPR forms and related documentation was completed in two District General Hospitals in South-East England, one of which uses electronic forms, while the other uses paper red forms. 50 completed forms from each hospital were analysed to assess for legibility, and quality of completion of all subsections of the form, including communications with family, relatives and the Multidisciplinary team. The hospital using paper forms showed a 40-44% rate of completion of sections relating to communication with patients and family, compared to 70% with the hospital using electronic forms. Similar trends were observed with other sections of the form. Conclusion: This study suggests that the implementation of electronic DNACPR forms significantly improves clinical practice and promotes better open communication with patients, family and the MDT.

Keywords: DNACPR, resuscitation, DNAR, patient communication

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Authors: S. Boulenouar, M. Sefir, M. Benahmed

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All facilities need medication and other pharmaceuticals for their operation. Management and supply is therefore to provide the different services of the facility goods and services in required quantity and quality. The permanent availability of drugs in the facilities is very difficult because most face many difficulties at the inventory management and drug supplies. Therefore, it is necessary for each health facility to know the causes for the malfunction of its management system to cope with them. It is in this context that we have undertaken to conduct this study to know the causes which should be taken into consideration by the concerned authorities to carry out their mission, which is to provide quality health care for the population. In terms of financial resources, the budget for medicines represents a significant part of the budget of the pharmacy. Our study shows that the share of the hospital budget reserved for the drugs procurement represent on average 70% of the budget of the pharmacy. The results show a state of lack of anticancer drugs at Oran teaching hospital. The analysis of the management process allowed us to know the level that the problem of stock-outs of anti-cancer drugs is at. Suggestions were made to that effect to improve the availability for these products and to respond better to the needs of patients.

Keywords: anticancer drugs, health care facility, budget, hospital pharmacist, hospital service

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Authors: Hao-Su Liu, Jun-Qing Lei

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This study introduces the theory of modified particle swarm optimizer and its application in time-domain expressions for bridge self-excited aerodynamic forces. Based on the indicial function expression and the rational function expression in time-domain expression for bridge self-excited aerodynamic forces, the characteristics of the two methods, i.e. the modified particle swarm optimizer and conventional search method, are compared in flutter derivatives’ fitting process. Theoretical analysis and numerical results indicate that adopting whether the indicial function expression or the rational function expression, the fitting flutter derivatives obtained by modified particle swarm optimizer have better goodness of fit with ones obtained from experiment. As to the flutter derivatives which have higher nonlinearity, the self-excited aerodynamic forces, using the flutter derivatives obtained through modified particle swarm optimizer fitting process, are much closer to the ones simulated by the experimental. The modified particle swarm optimizer was used to recognize the parameters of time-domain expressions for flutter derivatives of an actual long-span highway-railway truss bridge with double decks at the wind attack angle of 0°, -3° and +3°. It was found that this method could solve the bounded problems of attenuation coefficient effectively in conventional search method, and had the ability of searching in unboundedly area. Accordingly, this study provides a method for engineering industry to frequently and efficiently obtain the time-domain expressions for bridge self-excited aerodynamic forces.

Keywords: time-domain expressions, bridge self-excited aerodynamic forces, modified particle swarm optimizer, long-span highway-railway truss bridge

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Authors: Abdulhamit Donder, Erhan Ilhan Konukseven

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Grinding operation is performed in order to obtain desired surfaces precisely in machining process. The needed relative motion between the cutting tool and the workpiece is generally created either by the movement of the cutting tool or by the movement of the workpiece or by the movement of both of them as in our case. For all these cases, the coherence level between the movements and the interaction forces is a key influential parameter for efficient grinding. Therefore, in this work, spectral coherence analysis has been performed to investigate the coherence level between grinding interaction forces and the movement of the workpiece on our robotic-grinding experimental setup in METU Mechatronics Laboratory.

Keywords: coherence analysis, correlation, FFT, grinding, hanning window, machining, Piezo actuator, reverse arrangements test, spectral analysis

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Authors: Prabha Rohatgi

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To obtain an efficient control over a huge amount of inventory of drugs in pharmacy department of any hospital, generally, the medicines are categorized on the basis of their cost ‘ABC’ (Always Better Control), first and then categorize on the basis of their criticality ‘VED’ (Vital, Essential, desirable) for prioritization. About one-third of the annual expenditure of a hospital is spent on medicines. To minimize the inventory investment, the hospital management may like to keep the medicines inventory low, as medicines are perishable items. The main aim of each and every hospital is to provide better services to the patients under certain limited resources. To achieve the satisfactory level of health care services to outdoor patients, a hospital has to keep eye on the wastage of medicines because expiry date of medicines causes a great loss of money though it was limited and allocated for a particular period of time. The objectives of this study are to identify the categories of medicines requiring incentive managerial control. In this paper, to minimize the total inventory cost and the cost associated with the wastage of money due to expiry of medicines, an inventory control model is used as an estimation tool and then nonlinear programming technique is used under limited budget and fixed number of orders to be placed in a limited time period. Numerical computations have been given and shown that by using scientific methods in hospital services, we can give more effective way of inventory management under limited resources and can provide better health care services. The secondary data has been collected from a hospital to give empirical evidence.

Keywords: ABC-VED inventory classification, multi item inventory problem, nonlinear programming technique, optimization of EOQ

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Authors: Gary Young, David Zepeda, Gilbert Nyaga

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This study investigated whether vertical integration of hospitals and physicians is associated with better care for patients with cardiac conditions. A dramatic change in the U.S. hospital industry is the integration of hospital and physicians through hospital acquisition of physician practices. Yet, there is little evidence regarding whether this form of vertical integration leads to better operational performance of hospitals. The study was conducted as an observational investigation based on a pooled, cross-sectional database. The study sample comprised over hospitals in the State of California. The time frame for the study was 2010 to 2012. The key performance measure was hospitals’ degree of compliance with performance criteria set out by the federal government for managing patients with cardiac conditions. These criteria relate to the types of clinical tests and medications that hospitals should follow for cardiac patients but hospital compliance requires the cooperation of a hospital’s physicians. Data for this measure was obtained from a federal website that presents performance scores for U.S. hospitals. The key independent variable was the percentage of cardiologists that a hospital employs (versus cardiologists who are affiliated but not employed by the hospital). Data for this measure was obtained from the State of California which requires hospitals to report financial and operation data each year including numbers of employed physicians. Other characteristics of hospitals (e.g., information technology for cardiac care, volume of cardiac patients) were also evaluated as possible complements or substitutes for physician employment by hospitals. Additional sources of data included the American Hospital Association and the U.S. Census. Empirical models were estimated with generalized estimating equations (GEE). Findings suggest that physician employment is positively associated with better hospital performance for cardiac care. However, findings also suggest that information technology is a substitute for physician employment.

Keywords: physician employment, hospitals, verical integration, cardiac care

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Authors: Syed Sibtain Hussain Shah

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The Afghan Taliban returned to power corridors in Afghanistan in August 2021 after waging a twenty-year insurgency in the country. U.S.-led forces completed their withdrawal from Afghanistan on August 30, 2021, but the Taliban took control of the whole country till August 15, 2021. At the same time, some of the militant groups such as Tehrik-e-Taliban Pakistan (TTP) and Islamic State Khurasan (IS-K) reappeared in Pakistan’s borders and other areas and by increasing attacks on the armed forces of Pakistan and minorities communities. These groups once again created a crucial challenge to the internal security of the country. Since mid of 2021, many of the terrorist incidents in the countries specified in the areas of Pakistan bordering Afghanistan were committed by TTP and IS-K. The aim of this paper is to investigate the reappearance of TTP and IS-K in 2021 and 2022 as a crucial threat to the internal security of Pakistan. The author will particularly probe threats to the security of military personnel and their installations and threats to human security, including danger to religious minority communities in the different areas of the country, including border areas such as Waziristan, which was once a hub of TTP and other militant groups in the 2000s. The author will employ the relevant method and appropriate theories of security studies, such as religious extremism and terrorism, in this study. TTP, inspired by the Afghan Taliban, initially emerged in Pakistan in 2007 and this group has so far targeted various religious and ethnic communities and government installations in Pakistan. The group is not only against Pakistan’s government policies, but it also committed terrorist attacks on the communities of the other Muslim sects and as well as non-Muslim communities. Most of the prominent figures of this violent group disappeared or escaped to Afghanistan after military actions, such as the larger “Zarb-e-Azb” operation in Pakistan in 2015. IS-K, which established its branch of Khurasan covering Pakistan and Afghanistan in 2015, with its main formation in Iraq and Syria in 2015, by targeting religious minorities such as Shia Muslims, has so far created a vital security challenge for the security of the country.

Keywords: Pakistan, Afghanistan, Afghan Taliban, Pakistani Taliban, Islamic state Khorasan, security threat

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Authors: Ryan Adams

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Introduction: Major trauma is the leading cause of death in 15-45 year olds and a significant human, social and economic costs. Resuscitation is a stalwart of trauma management, especially in the pre-hospital environment and packed red blood cells (pRBC) are being increasingly used with the advent of permissive hypotension. The evidence in this area is lacking and further research is required to determine its efficacy. Aim: The aim of this retrospective, matched cohort study was to determine if major trauma patients, who received pre-hospital pRBC, have a difference in their initial emergency department cardiovascular status; when compared with injury-profile matched controls. Methods: The trauma databases of the Royal Brisbane and Women's Hospital, Royal Children's Hospital (Herston) and Queensland Ambulance Service were accessed and major trauma patient (ISS>12) data, who received pre-hospital pRBC, from January 2011 to August 2014 was collected. Patients were then matched against control patients that had not received pRBC, by their injury profile. The primary outcomes was cardiovascular status; defined as shock index and Revised Trauma Score. Results: Data for 25 patients who received pre-hospital pRBC was accessed and the injury profiles matched against suitable controls. On admittance to the emergency department, a statistically significant difference was seen in the blood group (Blood = 1.42 and Control = 0.97, p-value = 0.0449). However, the same was not seen with the RTS (Blood = 4.15 and Control 5.56, p-value = 0.291). Discussion: A worsening shock index and revised trauma score was associated with pre-hospital administration of pRBC. However, due to the small sample size, limited matching protocol and associated confounding factors it is difficult to draw any solid conclusions. Further studies, with larger patient numbers, are required to enable adequate conclusions to be drawn on the efficacy of pre-hospital packed red blood cell transfusion.

Keywords: pre-hospital, packed red blood cells, severe trauma, emergency medicine

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Authors: Yusuke Katayama, Tetsuhisa Kitamura, Kosuke Kiyohara, Sumito Hayashida, Taku Iwami, Takashi Kawamura, Takeshi Shimazu

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Background: Recently, the number of ambulance dispatches has been increasing in Japan and it is, therefore, difficult to accept emergency patients to hospitals smoothly and appropriately because of the limited hospital capacity. To facilitate the request for patient transport by ambulances and hospital acceptance, the emergency information system using information technology has been built up and introduced in various communities. However, its effectiveness has not been insufficiently revealed in Japan. In 2013, we developed a smartphone application system that enables the emergency-medical-service (EMS) personnel to share information about on-scene ambulance and hospital situation. The aim of this study was to assess the introduction effect of this application for EMS system in Osaka City, Japan. Methods: This study was a retrospective study with population-based ambulance records of Osaka Municipal Fire Department. This study period was six years from January 1, 2010 to December 31, 2015. In this study, we enrolled emergency patients that on-scene EMS personnel conducted the hospital selection for them. The main endpoint was difficulty in hospital acceptance at the scene. The definition of difficulty in hospital acceptance at the scene was to make >=5 phone calls by EMS personnel at the scene to each hospital until a decision to transport was determined. The definition of the smartphone application group was emergency patients transported in the period of 2013-2015 after the introduction of this application, and we assessed the introduction effect of smartphone application with multivariable logistic regression model. Results: A total of 600,526 emergency patients for whom EMS personnel selected hospitals were eligible for our analysis. There were 300,131 smartphone application group (50.0%) in 2010-2012 and 300,395 non-smartphone application group (50.0%) in 2013-2015. The proportion of the difficulty in hospital acceptance was 14.2% (42,585/300,131) in the smartphone application group and 10.9% (32,819/300,395) in the non-smartphone application group, and the difficulty in hospital acceptance significantly decreased by the introduction of the smartphone application (adjusted odds ration; 0.730, 95% confidence interval; 0.718-0.741, P<0.001). Conclusions: Sharing information between ambulance and hospital by introducing smartphone application at the scene was associated with decreasing the difficulty in hospital acceptance. Our findings may be considerable useful for developing emergency medical information system with using IT in other areas of the world.

Keywords: difficulty in hospital acceptance, emergency medical service, infomation technology, smartphone application

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Authors: H. P. Kerry

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Drone technology has become a significant discourse in a nation’s national security, while this technology could constitute a danger to national security on the one hand, on the other hand, it is used in developed and developing countries for border security, and in some cases, for protection of security agents and migrants. In the case of Nigeria, drones are used by the military to monitor and tighten security around the borders. However, terrorist groups have devised a means to utilize the technology to their advantage. Therefore, the potential danger in the widespread proliferation of this technology has become a myriad of risks. The research on the effects of cross-border use of drones in Nigerian national security looks at the negative and positive consequences of using drone technology. The study employs the use of interviews and relevant documents to obtain data while the study applied the Just War theory to justify the reason why countries use force; it further buttresses the points with what the realist theory thinks about the use of force. In conclusion, the paper recommends that the Nigerian government through the National Assembly should pass a bill for the establishment of a law that will guide the use of armed and unarmed drones in Nigeria enforced by the Nigeria Civil Aviation Authority and the office of the National Security Adviser.

Keywords: armed drones, drones, cross-border, national security

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Authors: Justin Ntokamunda Kadima, Christian Ahadi Irenge, Patient Birindwa Mulashe, Félicien Mushagalusa Kasali, Patient Wimba

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Background: Bacterial strains carrying multidrug resistance traits are gaining ground worldwide, especially in countries with limited resources. This study aimed to evaluate the spreading of multidrug-resistant bacteria strains in Bukavu city hospitals in the Democratic Republic of Congo. Methods: We analyzed 758 antibiogram data recorded in files of patients consulted between January 2016 and December 2017 at three reference hospitals selected as sentinel sites, namely the Panzi General Reference Hospital (HGP), BIO -PHARM hospital (HBP), and Saint Luc Clinic (CSL). Results: Of 758 isolates tested, the laboratories identified 12 bacterial strains in 712 isolates, of which 223 (29.42%) presented MDR profile, including Escherichia coli (11.48%), Klebsiella pneumonia (6.07%), Enterobacter (5.8%), Staphylococcus aureus and coagulase-negative Staphylococci (1.58%), Proteus mirabilis (1.85%), Salmonella enterica (1.19%), Pseudomonas aeruginosa (0.53%), Streptococcus pneumonia (0.4%)), Citrobacter (0.13%), Neisseria gonorrhea (0.13%), Enterococcus faecalis (0.13%), and Morganella morganii (0.13%). Infected patients were significantly more adults (73.1% vs. 21.5%) compared to children and mainly women (63.7% vs. 30.9%; p = 0.001). Conclusion: The observed expansion requires that hospital therapeutic committees set up an effective clinical management system and define the right combinations of antibiotics.

Keywords: multidrug resistance, bacteria, antibiogram, Bukavu

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Authors: Belkacem Chebil Sonia, Bensalem Wacef

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The majority of ball end milling models includes only the influence of cutting parameters (cutting speed, feed rate, depth of cut). Furthermore, this influence is studied in most of works on cutting force. Therefore, this study proposes an accurate ball end milling process modeling which includes also the influence of tool workpiece inclination. In addition, a characterization of residual stresses resulting of thermo mechanical loading in the workpiece was also presented. Moreover, the study of the influence of tool workpiece inclination and cutting parameters was made on residual stresses distribution. In order to achieve the predetermination of cutting forces and residual stresses during a milling operation, a thermo mechanical three-dimensional numerical model of ball end milling was developed. Furthermore, an experimental companion of ball end milling tests was realized on a 5-axis machining center to determine the cutting forces and characterize the residual stresses. The simulation results are compared with the experiment to validate the Finite Element Model and subsequently identify the optimum inclination angle and cutting parameters.

Keywords: ball end milling, cutting forces, cutting parameters, residual stress, tool-workpiece inclination

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Authors: Rizwan Iqbal

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Introduction: Re-TURBT has been recommended by international guidelines for patients with non-muscle invasive bladder cancer (NMIBC) who are deemed high-risk. Indications for re-TURBTs remain controversial and studies show mixed outcomes. It should be performed when the initial TURBT specimen lacks detrusor muscle, has tumor stage pT1 or G3/high-grade, or where resection is deemed incomplete. This ensures complete resection of tumors that have a high risk of recurrence as well as accurately identifying any tumors which have been upstaged. The aim of this audit was to evaluate the quality of re-TURBTs in a district general hospital. Method: Data were retrospectively collected from 31 patients who had re-TURBTs between April 2021 and September 2022. Data included baseline demographics, time from initial to re-TURBT, quality of operation note, presence of residual tumor, complications, and administration of chemotherapy within 24 hours of the initial TURBT. Data collection remains ongoing at the time of writing. Results: The mean age was 76 years old and 71.0% of patients were male. 32.3% of patients had their re-TURBT within six weeks and 32.3% had intravesical chemotherapy administered within 24 hours of the initial TURBT. 74.2% of initial TURBTs had detrusor muscle present in the specimen. 48.4% of patients had residual disease following re-TURBT. Just one patient had their pathology upstaged at re-TURBT. The use of the TURBT proforma on the operation note was variable, with 51.6% and 38.7% of surgeons using the proforma after the initial and re-TURBT. Conclusion: Re-TURBT improves bladder cancer staging and is necessary in patients who are deemed high-risk in order to identify any upstaging or recurrence of the disease.

Keywords: urology, bladder cancer, turbt, cancer

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Authors: Rocio Murad, Juan Carlos Rivillas, Nury Alejandra Rodriguez, Daniela Roldán

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In Colombia, around 5 million women have suffered forced displacement and all forms of gender-based violence, mostly adolescents and young women, single mothers, or widows with children affected by the war. After the signing of the peace agreements, the department of Antioquia has been one of the most affected by the armed conflict, from a territorial and gender perspective in the period. The objective of the research was to analyze the situation of sexual and reproductive rights in the department of Antioquia from a territorial and gender perspective in the period after the signing of the Peace Agreement. A mixed methodology was developed. The quantitative component conducted a cross-sectional descriptive study of barriers to access to contraceptive methods, safe abortion and gender-based violence based on microdata from the 2015 National Demographic and Health Survey. In the qualitative component, a case study was developed in Dabeiba, a municipality of Antioquia prioritized in order to deepen the experiences before, during and after the armed conflict in sexual and reproductive rights; using three research techniques: Focused observation, Semi-structured interviews, and Documentary review. The results showed that there is a gradient of greater vulnerability to greater effects of the conflict and that the subregion of Urabá Antioqueño, to which Dabeiba belongs, has the highest levels of vulnerability in relation to departmental data. In this subregion, the percentage of women with an unmet need for contraceptive methods (9%), women with unintended pregnancies (31%), of women between 15 and 19 years of age who are already mothers or are pregnant with their first child (32%) and the percentage of women victims of physical violence (42%) and sexual violence (13%) by their partners are significantly higher. Women, particularly rural and indigenous women, were doubly affected due to the existence of violence that is specifically directed at them or that has a greater impact on their life projects. There was evidence of insufficient, fragmented and disjointed social and institutional action in relation to women's rights and the existence of androcentric and patriarchal social imaginaries through which women and the feminine are undervalued. These results provide evidence of violations of sexual and reproductive rights in contexts of armed conflict and make it possible to identify mechanisms to guarantee the re-establishment of the rights of the victims, particularly women and girls. Among the mechanisms evidenced are: working for the elimination of gender stereotypes; supporting the formation and strengthening of women's social organizations; working for the concerted definition and articulated implementation of actions necessary to respond to sexual and reproductive health needs; and working for the recognition of reproductive violence as specific and different from sexual violence in the context of armed conflict. Also, it was evidenced that it is necessary to implement prevention, attention and reparation actions.

Keywords: sexual and reproductive rights, Colombia, armed conflict, violence against women

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Authors: Antonio Lopez-Villegas, Daniel Catalan-Matamoros, Remedios Lopez-Liria

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Objectives: The purpose of this study was to analyze clinical data, health-related quality of life (HRQoL) and functional capacity of patients using a telemonitoring follow-up system (TM) compared to patients followed-up through standard outpatient visits (HM) 5 years after the implantation of a pacemaker. Methods: This is a controlled, non-randomised, nonblinded clinical trial, with data collection carried out at 5 years after the pacemakers implant. The study was developed at Hospital de Poniente (Almeria, Spain), between October 2012 and November 2013. The same clinical outcomes were analyzed in both follow-up groups. Health-Related Quality of Life and Functional Capacity was assessed through EuroQol-5D (EQ-5D) questionnaire and Duke Activity Status Index (DASI) respectively. Sociodemographic characteristics and clinical data were also analyzed. Results: 5 years after pacemaker implant, 55 of 82 initial patients finished the study. Users with pacemakers were assigned to either a conventional follow-up group at hospital (HM=34, 50 initials) or a telemonitoring system group (TM=21, 32 initials). No significant differences were found between both groups according to sociodemographic characteristics, clinical data, Health-Related Quality of Life and Functional Capacity according to medical record and EQ5D and DASI questionnaires. In addition, conventional follow-up visits to hospital were reduced in 44,84% (p < 0,001) in the telemonitoring group in relation to hospital monitoring group. Conclusion: Results obtained in this study suggest that the telemonitoring of users with pacemakers is an equivalent option to conventional follow-up at hospital, in terms of Health-Related Quality of Life and Functional Capacity. Furthermore, it allows for the early detection of cardiovascular and pacemakers-related problem events and significantly reduces the number of in-hospital visits. Trial registration: ClinicalTrials.gov NCT02234245. The PONIENTE study has been funded by the General Secretariat for Research, Development and Innovation, Regional Government of Andalusia (Spain), project reference number PI/0256/2017, under the research call 'Development and Innovation Projects in the Field of Biomedicine and Health Sciences', 2017.

Keywords: cardiovascular diseases, health-related quality of life, pacemakers follow-up, remote monitoring, telemedicine

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Authors: Routsukol Sunalai

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This research was to study the relationship between the organizational culture like bureaucratic system, and patronage system in government hospitals with hospital accreditation and its impact on the quality of service in the government hospital accredited. Qualitative research was applied in this study by in-depth interviews with samples containing 20 public welfare service providers, i.e. doctors, nurses and practical nurses and 20 service recipients in the units of study. It was found that the bureaucracy still existed and was evidenced by the structure of the line of command; work systems, clear cut duty divisions, procedures and plans, and the patronage system hindered the quality of service in the government hospitals under the process of development and accreditation. The administrators should encourage and support the creation of a learning process in the organization for self-improvement and work development.

Keywords: hospital in Dusit Area, organization culture, the quality of service, economics and financial engineering

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Authors: Colette Faucher

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In modern asymmetric conflicts, the Armed Forces generally have to intervene in countries where the internal peace is in danger. They must make the local population an ally in order to be able to deploy the necessary military actions with its support. For this purpose, psychological operations (PSYOPs) are used to shape people’s behaviors and emotions by the modification of their attitudes in acting on their perceptions. PSYOPs aim at elaborating and spreading a message that must be read, listened to and/or looked at, then understood by the info-targets in order to get from them the desired behavior. A message can generate in the info-targets, reasoned thoughts, spontaneous emotions or reflex behaviors, this effect partly depending on the means of conveyance used to spread this message. In this paper, we focus on psychological operations that generate emotions. We present a method based on the Intergroup Emotion Theory, that determines, from the characteristics of the conveyed message and of the people from the population directly reached by the means of conveyance (direct info-targets), the emotion likely to be triggered in them and we simulate the propagation of the effects of such a message on indirect info-targets that are connected to them through the social networks that structure the population.

Keywords: military psychological operations, social identity, social network, emotion propagation

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Authors: Lesley Clack, Rachel Ellison, Elizabeth Chambers

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A belief exists that there are huge gender and racial disparities among hospital CEO’s in the United States, and historically, male, Caucasian healthcare executives have made significantly larger salaries than females and other races. With a recent focus on reducing barriers and disparities in healthcare, it remains to be seen whether there have been changes in these disparities over time. The purpose of this study was to explore disparities among salaries of hospital executives in the United States. Analysis of salary data was conducted utilizing online hospital salary databases. Statistical analysis was conducted to examine the significance of the differences. Results indicated that there had been improvements in disparities among some ethnicities. Gender disparities remain the largest gap. The implications of this study are significant for the field of healthcare management as disparities can affect both social dynamics and organizational culture. Understanding where disparities lie is the first step towards bridging the gap and reducing barriers for cultural diversity within healthcare management.

Keywords: health care, disparities, management, executives

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Authors: Ayesha Asif, Muhammad Zeeshan

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The sensitivity of hospital-microenvironments for all types of pollutants, due to the presence of patients with immune deficiencies, makes them complex indoor spaces. Keeping in view, this study investigated indoor air quality (IAQ) of two most sensitive places, i.e., operation theater (OT) and intensive care unit (ICU), of a publically managed hospital. Taking CO₂ concentration as air quality indicator and temperature (T) and relative humidity (RH) as thermal comfort parameters, continuous monitoring of the three variables was carried out. Measurements were recorded at an interval of 1 min for weekdays and weekends, including occupational and non-occupational hours. Outdoor T and RH measurements were also used in the analysis. Results show significant variation (p < 0.05) in CO₂, T and RH values over the day during weekdays while no significant variation (p > 0.05) have been observed during weekends of both the monitored sites. Maximum observed values of CO₂ in OT and ICU were found to be 2430 and 624 ppm, T as 24.7ºC and 28.9ºC and RH as 29.6% and 32.2% respectively.

Keywords: indoor air quality, CO₂ concentration, hospital building, comfort assessment

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Authors: Mohar Kassim, Hardy Azmir, Rahmat Sholihin Mokhtar

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The purpose of this study is to build portable application software to determine the level of cardiovascular fitness for cadet students of the National Defence University of Malaysia (NDUM). Fitness in the context of this study refers to physical fitness, specifically the cardiovascular endurance level test battery in the form of a 2.4 km run test for UPNM cadet students. This run test will be conducted to measure, test, and evaluate the performance of UPNM cadet students. All the run test results can be recorded electronically inside the portable software and will later be able to show the level of cardiovascular fitness of every cadet student according to age and gender. This software can also calculate the body mass index (BMI). Normative survey method will be used in this study through the analysis of the 2.4 km run test results. The run test scores will be classified in interval and ratio scales. Based on the findings of this study, portable application software will produced. The software will be able to directly assist the Military Training Academy (ALK), Malaysian Armed Forces (ATM), and other relevant agencies in determining the level of cardiovascular fitness among their staff. The test can be done electronically and on portable mode. The next step to be taken is to have this application patented.

Keywords: development, software, application, portable, fitness norms, cardiovascular endurance

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Authors: Margaret Elaine J. Villamayor, Lobert A. Padua, Neil S. Bacaltos, Virgilio P. Bañez

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Significance: This study aimed to determine the prevalence of Hepatobiliary Tuberculosis (HBTB) with biliary obstruction and to compare the outcomes of ERCP versus PTBD in these patients. Methodology: This is a cross-sectional study involving patients from PGH who underwent biliary drainage from HBTB from January 2009 to June 2014. HBTB was defined as having evidence of TB (culture, smear, PCR, histology) or clinical diagnosis with the triad of jaundice, fever, and calcifications on imaging with other causes of jaundice excluded. The primary outcome was successful drainage and secondary outcomes were mean hospital stay and complications. Simple logistic regression was used to identify factors associated with success of drainage, z-test for two proportions to compare outcomes of ERCP versus PTBD and t-test to compare mean hospital stay post-procedure. Results: There were 441 patients who underwent ERCP and PTBD, 19 fulfilled the inclusion criteria. 11 underwent ERCP while 8 had PTBD. There were more successful cases in PTBD versus ERCP but this was not statistically significant (p-value 0.3615). Factors such as age, gender, location and nature of obstruction, vices, coexisting pulmonary or other extrapulmonary TB and presence of portal hypertension did not affect success rates in these patients. The PTBD group had longer mean hospital stay but this was not significant (p-value 0.1880). There were no complications reported in both groups. Conclusion: HBTB comprises 4.3% of the patients undergoing biliary drainage in PGH. Both ERCP and PTBD are equally safe and effective in the management of biliary obstruction from HBTB.

Keywords: cross-sectional, hepatobiliary tuberculosis, obstructive jaundice, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic biliary drainage

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Authors: Allyson Dale, Max Hlywa

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The Canadian public expects the highest moral standards from Canadian Armed Forces (CAF) members and Department of National Defence (DND) employees. The Chief, Professional Conduct and Culture (CPCC) stood up in April 2021 with the mission of ensuring that the defence culture and members’ conduct are aligned with the ethical principles and values that the organization aspires towards. The Defence Ethics Program (DEP), which stood up in 1997, is a values-based ethics program for individuals and organizations within the DND/CAF and now falls under CPCC. The DEP is divided into five key functional areas, including policy, communications, collaboration, training and education, and advice and guidance. The main focus of the DEP is to foster an ethical culture within defence so that members and organizations perform to the highest ethical standards. The measurement of organizational ethics is often complex and challenging. In order to monitor whether the DEP is achieving its intended outcomes, a performance measurement framework (PMF) was developed using the Director General Military Personnel Research and Analysis (DGMPRA) PMF development process. This evidence-based process is based on subject-matter expertise from the defence team. The goal of this presentation is to describe each stage of the DGMPRA PMF development process and to present and discuss the products of the DEP PMF (e.g., logic model). Specifically, first, a strategic framework was developed to provide a high-level overview of the strategic objectives, mission, and vision of the DEP. Next, Key Performance Questions were created based on the objectives in the strategic framework. A logic model detailing the activities, outputs (what is produced by the program activities), and intended outcomes of the program were developed to demonstrate how the program works. Finally, Key Performance Indicators were developed based on both the intended outcomes in the logic model and the Key Performance Questions in order to monitor program effectiveness. The Key Performance Indicators measure aspects of organizational ethics such as ethical conduct and decision-making, DEP collaborations, and knowledge and awareness of the Defence Ethics Code while leveraging ethics-related items from multiple DGMPRA surveys where appropriate.

Keywords: defence ethics, ethical culture, organizational performance, performance measurement framework

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Authors: Maria Luiza Fulga, Georgeta Truca, Mihaela Alexandru, Andriescu Mariana, Crin Marcean

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The significance of nursing as a subject in the post-secondary healthcare curriculum is a major. We aimed to enable our students to assess the patient's risk, to establish prevention measures and to adapt to a specific learning context, in order to acquire the skills and abilities necessary for the nursing profession. In order to achieve these objectives, during the three years of study, teachers put an emphasis on acquiring communication skills, because in our country after the first cycle of hospital accreditation concluded in 2016, the National Authority for Quality of Health Management has introduced the criteria for the implementation and application of the nursing process according to the accreditation standards. According to these requirements, the nurse has to carry out the nursing assessment, based on communication as a distinct component, so that they can identify nursing diagnoses and implement the nursing plan. In this respect, we, the teachers, have refocused, by approaching various teaching strategies and preparing students for the real context of learning and applying what they learn. In the educational process, the tutors in the hospitals have an important role to play in acquiring professional skills. Students perform their activity in the hospital in accordance with the curriculum, in order to verify the practical applicability of the theoretical knowledge acquired in the school classes and also have the opportunity to acquire their skills in a real learning context. In clinical education, the student nurse learns in the middle of a guidance team which includes a practice tutor, who is a nurse that takes responsibility for the practical/clinical learning of the students in their field of activity. In achieving this objective, the tutor's abilities involve pedagogical knowledge, knowledge for the good of the individual and nursing theory, in order to be able to guide clinical practice in accordance with current requirements. The aim of this study is to find out the students’ confidence level in practice tutors in hospitals, the students’ degree of satisfaction in the pedagogical skills of the tutors and the practical applicability of the theoretical knowledge. In this study, we used as a method of investigation a student satisfaction questionnaire regarding the clinical practice in the hospital and the sample of the survey consisted of 100 students aged between 20 and 50 years, from the first, second and third year groups, with the General Nurse specialty (nurses responsible for general care), from 'Fundeni' Healthcare Post-Secondary School, Bucharest, Romania. Following the analysis of the data provided, we arrived the conclusion that the hospital tutor needs to improve his/her pedagogical skills, the knowledge of nursing diagnostics, and the implementation of the nursing plan, so that the applicability of the theoretical notions would be increased. Future plans include the pedagogical training of the medical staff, as well as updating the knowledge needed to implement the nursing process in order to meet current requirements.

Keywords: clinical training, nursing process, pedagogical skills, tutor

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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Introduction: To improve early detection and mortality rate of in-hospital cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditons and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90 mmHg, respiratory rate <8 or >28 breaths per minute, O2 saturation <90%, acute change in conscious state, acute chest pain or worry about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in in-hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in in-hospital cardiac arrest and overall hospital mortality rate, we conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed chi-square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010, 139 calls in 2011 and 245 calls in 2012. The number of ERT calls per 1000 admissions in year 2009-10 was 7.69; 5.61 in 2011 and 9.38 in 2013. The number of code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001 ). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, but we have not found difference in overall hospital mortality rate.

Keywords: cardiac arrest, outcome, in-hospital, ERT

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Authors: Bergun Meric Bingul, Cigdem Bulgan, Ozlem Tore, Mensure Aydin, Erdal Bal

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The aim of the study was to compare the effects of impact forces and some kinematic parameters with two different straight punch stance positions in boxing. 9 elite boxing athletes from the Turkish National Team (mean age± SD 19.33±2.11 years, mean height 174.22±3.79 cm, mean weight 66.0±6.62 kg) participated in this study as voluntarily. Boxing athletes performed one trial in straight punch technique for each two different stance positions (orthodox and southpaw stances) at sandbag. The trials were recorded at a frequency of 120Hz using eight synchronized high-speed cameras (Oqus 7+), which were placed, approximately at right- angles to one another. The three-dimensional motion analysis was performed with a Motion Capture System (Qualisys, Sweden). Data was transferred to Windows-based data acquisition software, which was QTM (Qualisys Track Manager). 11 segment models were used for determination of the kinematic variables (Calf, leg, punch, upperarm, lowerarm, trunk). Also, the sandbag was markered for calculation of the impact forces. Wand calibration method (with T stick) was used for field calibration. The mean velocity and acceleration of the punch; mean acceleration of the sandbag and angles of the trunk, shoulder, hip and knee were calculated. Stance differences’ data were compared with Wilcoxon test for using SPSS 20.0 program. According to the results, there were statistically significant differences found in trunk angle on the sagittal plane (yz) (p<0.05). There was a significant difference also found in sandbag acceleration and impact forces between stance positions (p < 0.05). Boxing athletes achieved more impact forces and accelerations in orthodox stance position. It is recommended that to use an orthodox stance instead of southpaw stance in straight punch technique especially for creating more impact forces.

Keywords: boxing, impact force, kinematics, straight punch, orthodox, southpaw

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Authors: V. S. S. Kumar, V. Ramya

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In the modern electronic warfare, the signal scenario is changing at a rapid pace with the introduction of Low Probability of Intercept (LPI) radars. In the modern battlefield, radar system faces serious threats from passive intercept receivers such as Electronic Attack (EA) and Anti-Radiation Missiles (ARMs). To perform necessary target detection and tracking and simultaneously hide themselves from enemy attack, radar systems should be LPI. These LPI radars use a variety of complex signal modulation schemes together with pulse compression with the aid of advancement in signal processing capabilities of the radar such that the radar performs target detection and tracking while simultaneously hiding enemy from attack such as EA etc., thus posing a major challenge to the ES/ELINT receivers. Today an increasing number of LPI radars are being introduced into the modern platforms and weapon systems so these LPI radars created a requirement for the armed forces to develop new techniques, strategies and equipment to counter them. This paper presents various modulation techniques used in generation of LPI signals and development of Time Frequency Algorithms to analyse those signals.

Keywords: anti-radiation missiles, cross terms, electronic attack, electronic intelligence, electronic warfare, intercept receiver, low probability of intercept

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Authors: Elaf N. Mahrous, Fares Al Mushref, Turkey Al Dossary

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An embedded particle finite element model has been developed to simulate the transient capillary forces acting on a moving contact line of spreading liquid drop on a smooth solid surface. Three common dissipative force models were tested numerically to account for the capillary effect at the solid-liquid interface. Among those models, Jiang’s model was found to be the most stable one. Our proposed numerical model was validated experimentally for a wide variety of surface wettability. A dimensionless relationship between the spreading rate and time was established, and the results showed good agreement with the experimental data.

Keywords: PFEM-embedded, Eulerian-PFEM, surface tension, capillary forces, moving contact line, non-dimensional analysis

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Authors: Manar Aslan, Ayse Yildiz

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The study was conducted descriptively to assess their hospital institutionalization of upper and mid-level managers of 18 hospitals affiliated to Public Hospitals Association. In its simplest form institutionalization is whatever the subject matter, is dominated by the rules of articulated and determined behavior in all kinds of business, interaction, and communication. Hospital service is a type of service carried out chained together. It should not be forgotten that this kind of services is carried out without barrier, and who and what to do with definite lines, hospital management is a process, and this process can be achieved through institutionalization. With the establishment of the Public Hospitals Unions in Turkey, all the state hospitals in the provinces have been gathered under this roof. One of the goals is to establish control mechanisms to ensure that hospitals reach pre-determined financial, medical, and administrative standards. In this way, the preparations for the institutionalization of units and hospital enterprises will be completed. The data of the study were collected by institutionalization management attitude scale (cronbach alpha: 0.98) of composed of 5 sub-dimensions and 52 questions in 18 hospitals’ managers (N=310) in the largest province in Turkey. The results of the study revealed that the total score taken by managers at the institutionalization scale was 200.80, and this was close to the maximum score. In addition, it was determined that the difference between the mean score of the scale and its sub-dimensions with the gender, the hospitals, and the management position.

Keywords: institutionalization, hospital, manager, evaluation

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Authors: Mariana Calderón, Paola Montenegro, Diana Moreno

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Through this study, it was possible to identify the different levels and types of violence, both individual and collective, experienced by women, girls, and the sexually diverse population of Buenaventura translated from the different tensions and threats against ancestrality and accounting for a social and political context of violence related to race and geopolitical location. These threats are related to: the stigma and oblivion imposed on practices and knowledge; the imposition of the hegemonic culture; the imposition of external customs as a way of erasing ancestrality; the singling out and persecution of those who practice it; the violence that the health system has exercised against ancestral knowledge and practices, especially in the case of midwives; the persecution of the Catholic religion against this knowledge and practices; the difficulties in maintaining the practices in the displacement from rural to urban areas; the use and control of ancestral knowledge and practices by the armed actors; the rejection and stigma exercised by the public forces; and finally, the murder of the wise women at the hands of the armed actors. This research made it possible to understand the importance of using tools such as the violence meter to support processes of resistance to violence against women, girls, and sexually diverse people; however, it is essential that these tools be adapted to the specific contexts of the people. In the analysis of violence, it was possible to identify that these not only affect women, girls, and sexually diverse people individually but also have collective effects that threaten the territory and the ancestral culture to which they belong. Ancestrality has been the object of violence, but at the same time, it has been the place from which resistance has been organized. The identification of the violence suffered by women, girls, and sexually diverse people is also an opportunity to make visible the forms of resistance of women and communities in the face of this violence. This study examines how women, girls, and sexually diverse people in Buenaventura have been exposed to sexism and racism, which historically have been translated into specific forms of violence, in addition to the other forms of violence already identified by the traditional models of the violentometer. A qualitative approach was used in the study. The study included the participation of more than 40 people and two women's organizations from Buenaventura. The participants came from both urban and rural areas of the municipality of Buenaventura and were over 15 years of age. The participation of such a diverse group allowed for the exchange of knowledge and experiences, particularly between younger and older people. The instrument used for the exercise was previously defined with the leaders of the organizations and consisted of four moments that referred to i) ancestry, ii) threats to ancestry, iii) identification of resistance and iv) construction of the ancestral violentometer.

Keywords: violence against women, intersectionality, sexual and reproductive rights, black communities

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Authors: A. Fordham, A. Hudson

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Background: Studies have suggested 16-25% of normotensive trauma patients with no clinical signs of shock have abnormal lactate and BD readings evidencing shock; a phenomenon known as occult hypoperfusion (OH). In light of the scarce quantity of evidence currently documenting OH, this study aimed to identify the prevalence of OH in the pre-hospital setting and explore ways to improve its identification and management. Methods: A quantitative retrospective data analysis was carried out on 75 sets of patient records for trauma patients treated by Kent Surrey Sussex Air Ambulance Trust between November 2013 and October 2014. The KSS HEMS notes and subsequent ED notes were collected. Trends between patients’ SBP on the scene, whether or not they received PRBCs on the scene as well as lactate and BD readings in the ED were assessed. Patients’ KSS HEMS notes written by the HEMS crew were also reviewed and recorded. Results: -Suspected OH was identified in 7% of the patients who did not receive PRBCs in the pre-hospital phase. -SBP heavily influences the physicians’ decision of whether or not to transfuse PRBCs in the pre-hospital phase. Preliminary conclusions: OH is an under-studied and underestimated phenomenon. We suggest a prospective trial is carried out to evaluate whether detecting trauma patients’ tissue perfusion status in the pre-hospital phase using portable devices capable of measuring serum BD and/or lactate could aid more accurate detection and management of all haemorrhaging trauma patients, including patients with OH.

Keywords: occult hypoperfusion, PRBC transfusion, point of care testing, pre-hospital emergency medicine, trauma

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