Search results for: delays & cancellations

Authors: Fatemeh Rasooli, Behzad Simiari, Pooya Payandemehr, Amir Nejati, Maryam Bahreini, Atefeh Abdollahi

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Introduction: Pain is a complex physiological reaction to tissue injury. In the course of painful procedures such as nerve block, ice has been shown to be a feasible and inexpensive material to control pain. It delays nerve conduction, actives other senses and reduces inflammatory and painful responses. This study assessed the effect of ice in reducing pain caused by needling and infiltration during digital block. Patient satisfaction recorded as a secondary outcome. Methods: This study was designed as a non-blinded randomized clinical trial approved by Tehran University of Medical Sciences Ethical Committee. Informed consent was taken from all the participants who were then randomly divided into two groups. Digital block performed by standard approach in selected patients. Tubes of ice were prepared in gloves and were fragmented at a time of application for circling around the finger. Tubes were applied for 6 minutes before digital nerve block in the site of needling in the case group. Patients in the control group underwent digital nerve block with the conventional method without ice administration. Numeric Rating Scale (NRS) used for grading pain. 0 used for no pain and 10 for the worst pain that patient had experienced until now. Scores were analyzed by Wilcoxon Rank Sum test and compared in case and control groups. Results: 100 patients aged 16-50 years were enrolled. Mean NRS scores with and without ice were 1.5 mm (S.D ± 1.44) and 6.8 mm (S.D ± 1.40) for needling pain and for infiltration pain were 2.7mm ( S.D ±1.65) and 8.5mm ( S.D ± 1.47), respectively (p<0.001). Besides, patients’ satisfactions were significantly higher in the ice group (p<0.001). Conclusion: Application of ice for 6 minutes significantly reduced pain of needling and infiltration in digital nerve block; thus, it seems to be a feasible and inexpensive material which acts effectively to decrease pain and stress before the procedure.

Keywords: digital block, ice, needle, pain

Procedia PDF Downloads 207

Authors: Shu-Hui Jan, Hui-Ping Tserng, Shih-Ping Ho

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Construction project control attempts to obtain real-time as-built schedule information and to eliminate project delays by effectively enhancing dynamic schedule control and management. Suitable platforms for enhancing an as-built schedule visually during the construction phase are necessary and important for general contractors. As the application of building information modeling (BIM) becomes more common, schedule management integrated with the BIM approach becomes essential to enhance visual construction management implementation for the general contractor during the construction phase. To enhance visualization of the updated as-built schedule for the general contractor, this study presents a novel system called the Construction BIM-assisted Schedule Management (ConBIM-SM) system for general contractors in Taiwan. The primary purpose of this study is to develop a web ConBIM-SM system for the general contractor to enhance visual as-built schedule information sharing and efficiency in tracking construction as-built schedule. Finally, the ConBIM-SM system is applied to a case study of a commerce building project in Taiwan to verify its efficacy and demonstrate its effectiveness during the construction phase. The advantages of the ConBIM-SM system lie in improved project control and management efficiency for general contractors, and in providing BIM-assisted as-built schedule tracking and management, to access the most current as-built schedule information through a web browser. The case study results show that the ConBIM-SM system is an effective visual as-built schedule management platform integrated with the BIM approach for general contractors in a construction project.

Keywords: building information modeling (BIM), construction schedule management, as-built schedule management, BIM schedule updating mechanism

Procedia PDF Downloads 342

Authors: Bello Abdullahi, Kabir Bala, Yahaya M. Ibrahim, Ahmed D. Ibrahim

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Public sector tendering has traditionally been conducted using manual paper-based processes which are known to be inefficient, less transparent, and more prone to manipulations and errors. However, the advent of the Internet and its associated technologies has led to the development of numerous e-Tendering systems that addressed many of the problems associated with the manual paper-based tendering system. Currently, in Nigeria, the public tendering processes are largely conducted based on manual paper-based system that is bedevilled by a number of problems such as inordinate delays, inefficiencies, manipulation of the tender evaluation process, corruption, lack of transparency and competition, among other problems. These problems can be addressed through the adoption of existing web-based e-Tendering systems which are known to address most of these problems. However, these existing e-Tendering systems that have been developed are not based on the Nigerian legal procurement processes and as such their suitability for local application is very limited. This paper is part of a larger study that attempt to address this problem through the development of an e-Tendering system that is based on the requirements of the Nigerian public procuring entities. In this paper, the identified tendering processes commonly used by Nigerian public procuring entities in the selection of construction sources are presented. A multi-methods research approach was used to identify those tendering processes. Specifically, 19 existing business use cases used by Nigerian public procuring entities were identified and 61 system use cases were prescribed based on the identified business use cases. The use cases were used as the basis for the development of domain and software conceptual models. The models were successfully used to guide the development of an e-Tendering system called NPS-eTender. Ripple and Unified Process were adopted as the software development methodologies.

Keywords: e-tendering, e-procurement, requirement model, conceptual model, public sector tendering, public procurement

Procedia PDF Downloads 159

Authors: Aawag Mohsen Al-Awag, Wesam Salah Alaloul, M. S. Liew

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Industrialized building system (IBS) is a method of construction with concentrated practices consisting of techniques, products, and a set of linked elements which operate collectively to accomplish objectives. The Industrialised Building System (IBS) has been recognised as a viable method for improving overall construction performance in terms of quality, cost, safety and health, waste reduction, and productivity. The Malaysian construction industry is considered one of the contributors to the development of the country. The acceptance level of IBS is still below government expectations. Thus, the Malaysian government has been continuously encouraging the industry to use and implement IBS. Conventional systems have several drawbacks, including project delays, low economic efficiency, excess inventory, and poor product quality. When it comes to implementing IBS, construction companies still face several obstacles and problems, notably in terms of contractual and procurement concerns, which leads to the low adoption of IBS in Malaysia. There are barriers to the acceptance of IBS technology, focused on awareness of historical failure and risks connected to IBS practices to provide enhanced performance. Therefore, the transformation from the existing conventional building systems to the industrialized building systems (IBS) is needed more than ever. The flexibility of IBS in Malaysia’s construction industry is very low due to numerous shortcomings and obstacles. Due to its environmental, economic, and social benefits, IBS could play a significant role in the Malaysian construction industry in the future. This paper concentrates on the potential role of IBS in sustainable construction practices in Malaysia. It also highlights the awareness, barriers, advantages, and disadvantages of IBS in the construction sector. The study concludes with recommendations for Malaysian construction stakeholders to encourage and increase the utilization of industrialised building systems.

Keywords: construction industry, industrialized building system, barriers, advantages and disadvantages, construction, sustainability, Malaysia

Procedia PDF Downloads 67

Authors: Mohanad Moustafa, Julia Sieberer, Rhys Davies

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Background: Orbital compartment syndrome (OCS) is a sight-threatening Ophthalmologic emergency caused by rapidly increasing intraorbital pressure. It is usually caused by a retrobulbar hemorrhage as a result of trauma. If not treated in a timely manner, permanent vision loss can occur. Lateral canthotomy and cantholysis are minor procedures that can be performed bedside with equipment available in the emergency department. The aim of the procedure is to release the attachments between the suspensory ligaments of the eye and the bony orbital wall, leading to a decrease in intraorbital pressure and preventing irreversible loss of vision. As most Ophthalmologists across the UK provide non-resident on-call service, this may lead to a delay in the treatment of OCS and stresses the need for Emergency medical staff to be able to provide this sight-saving procedure independently. Aim: To survey current training, experience, and confidence levels among Emergency Medicine doctors in performing emergency lateral canthotomy and to establish whether these variables change the following teaching from experienced ophthalmologists. RESULTS: Most EM registrars had little to no experience in performing lateral canthotomy and cantholysis. The majority of them showed a significant increase in their confidence to perform the procedure following ophthalmic-led teaching. The survey also showed that the registrars felt such training should be added to/part of the EM curriculum. Conclusion: The involvement of Ophthalmologists in the teaching of EM doctors to recognise and treat OCS independently may prevent delays in treatment and reduce the risk of permanent sight loss. This project showed potential in improving patient care and will lead to a National Survey of EM doctors across the UK.

Keywords: lateral canthotomy, retrobulbar hemorrhage, Ophthalmology, orbital compartment syndrome, sight loss, blindness

Procedia PDF Downloads 73

Authors: Biswajit Pal, Amit Mallik, Anil K. Barik

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Current years have witnessed a phenomenal growth in the research on the rare earth-doped transparent host materials, the essential components in optoelectronics that meet up the increasing demand for fabrication of high quality optical devices especially in telecommunication system. The combination of low phonon energy (because of fluoride environment) and high chemical durability with superior mechanical stability (due to oxide environment) makes the oxyfluoride glass–ceramics the promising and useful materials in optoelectronics. The present work reports on the undoped and doped (1 mol% Pr2O3) glass ceramics of composition 16.52 Al2O3•1.5AlF3• 12.65LaF3•4.33Na2O•64.85 SiO2 (mol%), prepared by melting technique initially that follows annealation at 450 ºC for 1 h. The glass samples so obtained were heat treated at constant 600 ºC with a variation in heat treatment schedule (10- 80 h). TEM techniques were employed to structurally characterize the glass samples. Pr2O3 affects the phase separation in the glass and delays the onset of crystallization in the glass ceramic. The modified crystallization mechanism is established from the analysis of advanced STEM/EDXS results. The phase separated droplets after annealing turn into 10-20 nm of LaF3 nano crystals those upon scrutiny are found to be dotted with the doped Pr3+ ions within the crystals themselves. The EDXS results also suggest that the inner LaF3 crystal core is swallowed by an Al enriched layer that follows a Si enriched surrounding shell as the outer core. This greatly increases the viscosity in the periphery of the crystals that restricts further crystal growth to account for the formation of nano sized crystals.

Keywords: advanced STEM/EDXS, crystallization mechanism, nano crystals, pr3+ ion doped glass and glass ceramic, structural characterization

Procedia PDF Downloads 166

Authors: Sun-Young Jang, Sung-Ah Kim, Dongyoun Shin

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The Intelligent transportation system is essential to build smarter cities. Machine learning based transportation prediction could be highly promising approach by delivering invisible aspect visible. In this context, this research aims to make a prototype model that predicts transportation network by using big data and machine learning technology. In detail, among urban transportation systems this research chooses bus system.  The research problem that existing headway model cannot response dynamic transportation conditions. Thus, bus delay problem is often occurred. To overcome this problem, a prediction model is presented to fine patterns of bus delay by using a machine learning implementing the following data sets; traffics, weathers, and bus statues. This research presents a flexible headway model to predict bus delay and analyze the result. The prototyping model is composed by real-time data of buses. The data are gathered through public data portals and real time Application Program Interface (API) by the government. These data are fundamental resources to organize interval pattern models of bus operations as traffic environment factors (road speeds, station conditions, weathers, and bus information of operating in real-time). The prototyping model is designed by the machine learning tool (RapidMiner Studio) and conducted tests for bus delays prediction. This research presents experiments to increase prediction accuracy for bus headway by analyzing the urban big data. The big data analysis is important to predict the future and to find correlations by processing huge amount of data. Therefore, based on the analysis method, this research represents an effective use of the machine learning and urban big data to understand urban dynamics.

Keywords: big data, machine learning, smart city, social cost, transportation network

Procedia PDF Downloads 228

Authors: O. Delage, H. Bencherif, T. Portafaix, A. Bourdier

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The main purpose of time series analysis is to learn about the dynamics behind some time ordered measurement data. Two approaches are used in the literature to get a better knowledge of the dynamics contained in observation data sequences. The first of these approaches concerns time series decomposition, which is an important analysis step allowing patterns and behaviors to be extracted as components providing insight into the mechanisms producing the time series. As in many cases, time series are short, noisy, and non-stationary. To provide components which are physically meaningful, methods such as Empirical Mode Decomposition (EMD), Empirical Wavelet Transform (EWT) or, more recently, Empirical Adaptive Wavelet Decomposition (EAWD) have been proposed. The second approach is to reconstruct the dynamics underlying the time series as a trajectory in state space by mapping a time series into a set of Rᵐ lag vectors by using the method of delays (MOD). Takens has proved that the trajectory obtained with the MOD technic is equivalent to the trajectory representing the dynamics behind the original time series. This work introduces the singular spectrum decomposition (SSD), which is a new adaptive method for decomposing non-linear and non-stationary time series in narrow-banded components. This method takes its origin from singular spectrum analysis (SSA), a nonparametric spectral estimation method used for the analysis and prediction of time series. As the first step of SSD is to constitute a trajectory matrix by embedding a one-dimensional time series into a set of lagged vectors, SSD can also be seen as a reconstruction method like MOD. We will first give a brief overview of the existing decomposition methods (EMD-EWT-EAWD). The SSD method will then be described in detail and applied to experimental time series of observations resulting from total columns of ozone measurements. The results obtained will be compared with those provided by the previously mentioned decomposition methods. We will also compare the reconstruction qualities of the observed dynamics obtained from the SSD and MOD methods.

Keywords: time series analysis, adaptive time series decomposition, wavelet, phase space reconstruction, singular spectrum analysis

Procedia PDF Downloads 79

Authors: Dilshad Ali Mohammed, Ziyad Nayef Shamsulddin Aldoski, Millet Salim Mohammed

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The increase in levels of traffic congestion along urban signalized arterials needs efficient traffic management. The application of traffic signal coordination can improve the traffic operation and safety for a series of signalized intersection along the arterials. The objective of this study is to evaluate the benefits achievable through actuated traffic signal coordination and make a comparison in control delay against the same signalized intersection in case of being isolated. To accomplish this purpose, a series of eight signalized intersections located on two major arterials in Duhok City was chosen for conducting the study. Traffic data (traffic volumes, link and approach speeds, and passenger car equivalent) were collected at peak hours. Various methods had been used for collecting data such as video recording technique, moving vehicle method and manual methods. Geometric and signalization data were also collected for the purpose of the study. The coupling index had been calculated to check the coordination attainability, and then time space diagrams were constructed representing one-way coordination for the intersections on Barzani and Zakho Streets, and others represented two-way coordination for the intersections on Zakho Street with accepted progression bandwidth efficiency. The results of this study show great progression bandwidth of 54 seconds for east direction coordination and 17 seconds for west direction coordination on Barzani Street under suggested controlled speed of 60 kph agreeable with the present data. For Zakho Street, the progression bandwidth is 19 seconds for east direction coordination and 18 seconds for west direction coordination under suggested controlled speed of 40 kph. The results show that traffic signal coordination had led to high reduction in intersection control delays on both arterials.

Keywords: bandwidth, congestion, coordination, traffic, signals, streets

Procedia PDF Downloads 264

Authors: Victoria Bessonova, Robert Dorrell, Nina Dethlefs, Evdokia Tapoglou, Katharine York

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As the global pursuit of renewable energy intensifies, offshore wind farms have emerged as a promising solution to combat climate change. The global offshore wind installed capacity is projected to increase 56-fold by 2055. However, the impacts of climate change, particularly changes in wave climate, are not widely understood. Offshore wind installation and maintenance activities often require specific weather windows, characterized by calm seas and low wave heights, to ensure safe and efficient operations. However, climate change-induced alterations in wave characteristics can reduce the availability of suitable weather windows, leading to delays and disruptions in project timelines. it applied the operational limits of installation and maintenance vessels to past and future climate wave projections. This revealed changes in the annual and monthly accessibility of offshore wind farms at key global development locations. When accessibility is only defined by significant wave height, spatial patterns in the annual accessibility roughly follow changes in significant wave height, with increased availability where significant wave height is decreasing. This resulted in a 1-6% increase in Europe and North America and a similar decrease in South America, Australia and Asia. Monthly changes suggest unchanged or slightly decreased (1-2%) accessibility in summer months and increased (2-6%) in winter. Further assessment includes assessing the sensitivity of accessibility to operational limits defined by wave height combined with wave period and wave height combined with wind speed. Results of this assessment will be included in the presentation. These findings will help stakeholders inform climate change adaptations in installation and maintenance planning practices.

Keywords: climate change, offshore wind, offshore wind installation, operations and maintenance, wave climate, wind farm accessibility

Procedia PDF Downloads 48

Authors: Pepur Sandra, Bulog Ivana, Rimac Smiljanić Ana

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During the COVID-19 pandemic, stress and family financial fragility arose worldwide. Economic and health uncertainty created new pressure on the everyday life of families. The work from home, homeschooling, and care of other family members caused an increase in unpaid work and generated a new division of intrahousehold. As many times before, women have taken the higher burden. This paper analyzes family stress and finance during the COVID-19 pandemic. We propose that women's inclusion in paid and unpaid work and their financial literacy influence family finances. We build up our assumptions according to the two theories that explain intrahousehold family decision-making: traditional and barging models. The traditional model assumes that partners specialize in their roles in line with time availability. Consequently, partners less engaged in payable working activities will spend more time on domestic activities and vice versa. According to the bargaining model, each individual has their preferences, and the one with more household bargaining power, e.g., higher income, higher level of education, better employment, or higher financial knowledge, is likely to make family decisions and avoid unpaid work. Our results are based on an anonymous and voluntary survey of 869 valid responses from women older than 18 conducted in Croatia at the beginning of 2021. We found that families who experienced delays in settling current obligations before the pandemic were in a worse financial situation during the pandemic. However, all families reported problems settling current obligations during pandemic times regardless of their financial condition before the crisis. Women from families with financial issues reported higher levels of family and personal stress during the pandemic. Furthermore, we provide evidence that more women's unpaid work negatively affects the family's financial fragility during the pandemic. In addition, in families where women have better financial literacy and are more financially independent, families cope better with finance before and during pandemics.

Keywords: family financial fragility, stress, unpaid work, women's financial literacy

Procedia PDF Downloads 45

Authors: Sara Najiazarpour, Mahsa Najiazarpour

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There are many problems in contracting projects and their performance. At each project stage and due to different reasons, these problems affect cost, time and overall project quality. Hence, in order to increase the efficiency and performance in all levels of the chain and with supply chain management approach, there will be a coordination from the beginning of a project (contractor selection) to the end of project (handover of project). Contractor selection is the foremost part of construction projects which in this multi-criteria decision-making, the best contractor is determined by expert judgment, different variables and their priorities. In this paper for selecting the best contractor, numerous criteria were collected by asking from adept experts and then among them, 16 criteria with highest frequency were considered for questionnaire. This questionnaire was distributed between experts. Cronbach's alpha coefficient was obtained as 72%. Then based on Borda's function 12 important criteria was selected which was categorized in four main criteria and related sub-criteria as follow: Environmental factors and physical equipment: procurement and materials (supplier), company's machines, contractor’s proposed cost estimate - financial capacity: bank turnover and company's assets, the income of tax declaration in last year, Ability to compensate for losses or delays - past performance- records and technical expertise: experts and key personnel, the past technical backgrounds and experiences, employer satisfaction of previous contracts, the number of similar projects was done - standards: rank and field of expertise which company is qualified for and its validity, availability and number of permitted projects done. Then with PROMTHEE method, the criteria were normalized and monitored, finally the best alternative was selected. In this research, qualitative criteria of each company is became a quantitative criteria. Finally, information of some companies was evaluated and the best contractor was selected based on all criteria and their priorities.

Keywords: contractor evaluation and selection, project development, supply chain management, PROMTHEE method

Procedia PDF Downloads 40

Authors: D. Anderlini, G. Wallis

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Background: The number of people experiencing stroke is steadily increasing due to changes in diet and lifestyle, to longer life expectancy resulting in older population, to higher survival rates as a consequence of improvements during the acute phase. This study considers what risk factors might contribute to delayed entry to hospital for treatment. Methods: We analyzed data from 2472 patients admitted to the Stroke Unit of the Royal Brisbane Women's Hospital, Australia, between 2002 to 2011. Results: Previous studies have reported that factors which can contribute to delay include the patient’s age, the time of day, physical location, visit the GP instead of going to the emergency, means of transport, severity of symptoms and type of stroke. Contrary to findings of other studies, we found a strong correlation between side of lesion and delay in admission: patients with right hemisphere lesions had an average delay of 3.78 days, while patients with left hemisphere lesions had an average delay of 1.49 days. Damage to the right hemisphere generally ends in motor impairment in the non-dominant hand and no speech impediment. In contrast, left hemisphere lesions can result in deficit to; dominant hand function and aphasia which will be noticed even if their impact on performance is relatively minor. A finding which goes against many previous studies, is the fact that women get to the hospital much sooner than men, showing an average delay of 0.92 days in women vs. 3.36 days in men. Conclusion: Acute surgical-pharmacological therapies are most effective if applied immediately after stroke. Hence delays to admission can be crucial to the degree of recovery. The tendency of patients to overlook symptoms of right hemisphere lesion should be the target of information campaigns both for the general public and GPs. Why do men go to hospital so late? We don't know yet! Nevertheless an awareness plan specifically direct to male population should be on the agenda of Health Departments.

Keywords: gender, admission delay, stroke location, bioinformatics, biomedicine

Procedia PDF Downloads 200

Authors: Daniel F. Bohorquez, Luis M. Agudelo, Henry H. León

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Heart rate variability (HRV) is defined as the temporary variation between heartbeats or RR intervals (distance between R waves in an electrocardiographic signal). This distance is currently a recognized biomarker. With the analysis of the distance, it is possible to assess the sympathetic and parasympathetic nervous systems. These systems are responsible for the regulation of the cardiac muscle. The analysis allows health specialists and researchers to diagnose various pathologies based on this variation. For the acquisition and analysis of HRV taken from a cardiac electrical signal, electronic equipment and analysis software that work independently are currently used. This complicates and delays the process of interpretation and diagnosis. With this delay, the health condition of patients can be put at greater risk. This can lead to an untimely treatment. This document presents a single portable device capable of acquiring electrocardiographic signals and calculating a total of 19 HRV metrics. This reduces the time required, resulting in a timelier intervention. The device has an electrocardiographic signal acquisition card attached to a microcontroller capable of transmitting the cardiac signal wirelessly to a mobile device. In addition, a mobile application was designed to analyze the cardiac waveform. The device calculates the RR and different metrics. The application allows a user to visualize in real-time the cardiac signal and the 19 metrics. The information is exported to a cloud database for remote analysis. The study was performed under controlled conditions in the simulated hospital of the Universidad de la Sabana, Colombia. A total of 60 signals were acquired and analyzed. The device was compared against two reference systems. The results show a strong level of correlation (r > 0.95, p < 0.05) between the 19 metrics compared. Therefore, the use of the portable system evaluated in clinical scenarios controlled by medical specialists and researchers is recommended for the evaluation of the condition of the cardiac system.

Keywords: biological signal análisis, heart rate variability (HRV), HRV metrics, mobile app, portable device.

Procedia PDF Downloads 150

Authors: Nikhil A. Gavhane, Sachin Shah, Ishant S. Mahajan, Pawan D. Bahekar

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Introduction: Millions of people are affected with dengue fever every year, which drives up healthcare expenses in many low-income countries. Organ failure and other serious symptoms may result. Another worldwide public health problem is sickle cell anaemia, which is most prevalent in Africa, the Caribbean, and Europe. Dengue epidemics have reportedly occurred in locations with a high frequency of sickle cell disease, compounding the health problems in these areas. Aims and Objectives: This study examines dengue infection in sickle cell disease-afflicted pre-schoolers. Method:This Retrospective cohort study examined paediatric patients. Young people with sickle cell disease (SCD), dengue infection, and a control group without SCD or dengue were studied. Data on demographics, SCD consequences, medical treatments, and laboratory findings were gathered to analyse the influence of SCD on dengue severity and clinical outcomes, classified as severe or non-severe by the 2009 WHO classification. Using fever or admission symptoms, the research estimated acute illness duration. Result: Table 1 compares haemoglobin genotype-based dengue episode features in SS, SC, and controls. Table 2 shows that severe dengue cases are older, have longer admission delays, and have particular symptoms. Table 3's multivariate analysis indicates SS genotype's high connection with severe dengue, multiorgan failure, and acute pulmonary problems. Table 4 relates severe dengue to greater white blood cell counts, anaemia, liver enzymes, and reduced lactate dehydrogenase. Conclusion: This study is valuable but confined to hospitalised dengue patients with sickle cell illness. Small cohorts limit comparisons. Further study is needed since findings contradict predictions.

Keywords: dengue, chills, headache, severe myalgia, vomiting, nausea, prostration

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Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

Procedia PDF Downloads 146

Authors: Kamila Weissova, Jitka Skrabalova, Katerina Skalova, Jana Koprivova, Zdenka Bendova

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Any Arctic visitor has to deal with extreme conditions, including constant light during the summer season or constant darkness during winter time. Light/dark cycle is the most powerful synchronizing signal for biological clock and the absence of daily dark period during the polar day can significantly alter the functional state of the internal clock. However, the inner clock can be synchronized by other zeitgebers such as physical activity, food intake or social interactions. Here, we investigated the effect of polar day on circadian clock of 10 researchers attending the polar base station in the Svalbard region during July. The data obtained on Svalbard were compared with the data obtained before the researchers left for the expedition (in the Czech Republic). To determine the state of circadian clock we used wrist actigraphy followed by sleep diaries, saliva, and buccal mucosa samples, both collected every 4 hours during 24h-interval to detect melatonin by radioimmunoassay and clock gene (PER1, BMAL1, NR1D1, DBP) mRNA levels by RT-qPCR. The clock gene expression was analyzed using cosinor analysis. From our results, it is apparent that the constant sunlight delayed melatonin onset and postponed the physical activity in the same order. Nevertheless, the clock gene expression displayed higher amplitude on Svalbard compared to the amplitude detected in the Czech Republic. These results have suggested that the common daily schedule at the Svalbard expedition can strengthen circadian rhythm in the environment that is lacking light/dark cycle. In conclusion, the constant sunlight delays melatonin onset, but it still maintains its rhythmic secretion. The effect of constant sunlight on circadian clock can be minimalized by common daily scheduled activity.

Keywords: actighraph, clock genes, human, melatonin, polar day

Procedia PDF Downloads 142

Authors: Claudia Huerta, Pepijn Doornenbal, Walaa Elsiddig

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Rising waves of nationalism around the world have led first-world migration receiving countries to exploit the ambiguity of international refugee law and establish asylum application processes that deter applications, allow for bureaucratic deniability, and violate human rights. This case study of Greek asylum application practices argues that the 'pre-application' asylum process in Greece violates the spirit of international law by making it incredibly difficult for potential asylum seekers to apply for asylum, in essence violating the human rights of thousands of asylum seekers. This study’s focus is on the Greek mainland’s asylum 'pre-application' process, which in 2016 began to require those wishing to apply for asylum to do so during extremely restricted hours via a basic Skype line. The average wait to simply begin the registration process to apply for asylum is 81 days, during which time applicants are forced to live illegally in Greece. This study’s methodology in analyzing the 'pre-application' process consists of hours of interviews with asylum seekers, NGOs, and the Asylum Service office on the ground in Athens, as well as an analysis of the Greek Asylum Service historical asylum registration statistics. This study presents three main findings: the delays associated with the Skype system in Greece are the result of system design, as proven by a statistical analysis of Greek asylum registrations, NGOs have been co-opted by the state to perform state functions during the process, and the government’s use of technology is both purposefully lazy and discriminatory. In conclusion, the study argues that such asylum practices are part of a pattern of first-world migration receiving countries policies’ which discourage asylum seekers from applying and fall short of the standards in international law.

Keywords: asylum, European Union, governance, Greece, irregular, migration, policy, refugee, Skype

Procedia PDF Downloads 104

Authors: B. McGovern, J. F. Luck, A. Gade, I. V. Lake, D. O’Connell, H. C. Cutcliffe, K. P. Shah, E. E. Ginalis, C. M. Lambert, N. Christian, J. R. Kait, A. W. Yu, C. P. Eckersley, C. R. Bass

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Mild traumatic brain injury (mTBI) in the form of post-concussive injuries and attention deficit / hyperactivity disorder (ADHD) share similar cognitive impairments, including impaired working memory and executive function. The memory-guided oculomotor task separates working memory and inhibitory components to provide further information on the nature of these deficits in each pathology. Eleven subjects with ADHD, fifteen control subjects, and ten subjects with recent concussive injury were matched on age, gender, and education (all high school-age males). Eye movements were recorded during memory-guided oculomotor tasks with varying delays using EyeLink 1000 (SR Research). The percentage of premature saccades and the latency of correct response are the analyzed measures for response inhibition and working memory, respectively. No significant differences were found in latencies between controls subjects and subjects with ADHD or post-concussive injuries, in accordance with previous studies. Subjects with ADHD and post-concussive injuries both demonstrated a trend of increased percentages of premature saccades compared to control subjects in the same oculomotor task. This trend reached statistical significance between the post-concussive and control groups (p < 0.05). These findings support the primary nature of the executive function deficits in response inhibition in ADHD and mTBI. The interpretation of results is limited by the small sample size and the exploratory nature of the study. Further investigation into oculomotor performance differences in mTBI and ADHD may help in differentiating these pathologies in consequent diagnoses and provide insight into the interaction of these deficits in mTBI.

Keywords: attention deficit / hyperactivity disorder (ADHD), concussion, diagnosis, oculomotor, pediatrics

Procedia PDF Downloads 276

Authors: Batool Ismaeel, Umair Farooq, Saad Mushtaq

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Construction projects in the oil industry can be very complex, having unknown outcomes and uncertainties that cannot be easily predicted. Each project has its unique risks generated by a number of factors which, if not controlled, will impact the successful completion of the project mainly in terms of schedule, cost, quality, and safety. This paper highlights the historic risks associated with projects in the south and east region of Kuwait Oil Company (KOC) collated from the company’s lessons learned database. Starting from Contract Award through to handover of the project to the Asset owner, the gaps in project execution in terms of managing risk will be brought to discussion and where a well-defined systematic approach in project risk management reflecting many claims, change of scope, exceeding budget, delays in engineering phase as well as in the procurement and fabrication of long lead items should be adopted. This study focuses on a proposed feasible approach in risk management for engineering, procurement and construction (EPC) level projects including the various stakeholders involved in executing the works from International to local contractors and vendors in KOC. The proposed approach covers the areas categorized into organizational, design, procurement, construction, pre-commissioning, commissioning and project management in which the risks are identified and require management and mitigation. With the effective deployment and implementation of the proposed risk management system and the consideration of it as a vital key in achieving the project’s target, the outcomes will be more predictable in the future, and the risk triggers will be managed and controlled. The correct resources can be allocated on a timely basis for the company for avoiding any unpredictable outcomes during the execution of the project. It is recommended in this paper to apply this risk management approach as an integral part of project management and investigate further in the future, the effectiveness of this proposed system for newly awarded projects and compare the same with those projects of similar budget/complexity that have not applied this approach to risk management.

Keywords: construction, project completion, risk management, uncertainties

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Authors: Smita Chaudhary

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Traffic in India are observed uncontrolled, and are characterized by chaotic (not follows the lane discipline) traffic situation. Bus Rapid Transit (BRT) has emerged as a viable option to enhance transportation capacity and provide increased levels of mobility and accessibility. At present in Ahmadabad there are as many intersections which face the congestion and delay at signalized intersection due to transit (BRT) lanes. Most of the intersection in spite of being signalized is operated manually due to the conflict between BRT buses and heterogeneous traffic. Though BRTS in Ahmadabad has an exclusive lane of its own but with this comes certain limitations which Ahmadabad is facing right now. At many intersections in Ahmadabad due to these conflicts, interference, and congestion both heterogeneous traffic as well as transit buses suffer traffic delays of remarkable 3-4 minutes at each intersection which has a become an issue of great concern. There is no provision of BRT bus priority due to which existing signals have their least role to play in managing the traffic that ultimately call for manual operation. There is an immense decrement in the daily ridership of BRTS because people are finding this transit mode no more time saving in their routine, there is an immense fall in ridership ultimately leading to increased number of private vehicles, idling of vehicles at intersection cause air and noise pollution. In order to bring back these commuters’ transit facilities need to be improvised. Classified volume count survey, travel time delay survey was conducted and revised signal design was done for whole study stretch having three intersections and one roundabout, later one intersection was simulated in order to see the effect of giving priority to BRT on side street queue length and travel time for heterogeneous traffic. This paper aims at suggesting the recommendations in signal cycle, introduction of intermittent priority for transit buses, simulation of intersection in study stretch with proposed signal cycle using VISSIM in order to make this transit amenity feasible and attracting for commuters in Ahmadabad.

Keywords: BRT, priority, Ridership, Signal, VISSIM

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Authors: Stavroula Stavropoulou-Tatla, Danyal Awal, Mohammad Ayaz Hossain

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The first wave of the COVID-19 pandemic saw several countries issue guidance postponing all non-urgent diagnostic evaluations and operations, leading to an estimated backlog of 28 million cases worldwide and over 4 million in the UK alone. In an attempt to regulate the resumption of elective surgical activity, the National Institute for Health and Care Excellence (NICE) introduced the ‘COVID-19 rapid guideline [NG179]’. This project aimed to increase healthcare staff knowledge of the aforementioned guideline to a targeted score of 100% in the disseminated questionnaire within 3 months at the Royal Free Hospital. A standardized online questionnaire was used to assess the knowledge of surgical and medical staff at baseline and following each 4-week-long Plan-Study-Do-Act (PDSA) cycle. During PDSA1, the A4 visual summary accompanying the guideline was visibly placed in all relevant clinical areas and the full guideline was distributed to the staff in charge together with a short briefing on the salient points. PDSA2 involved brief small-group teaching sessions. A total of 218 responses was collected. Mean percentage scores increased significantly from 51±19% at baseline to 81±16% after PDSA1 (t=10.32, p<0.0001) and further to 93±8% after PDSA2 (t=4.9, p<0.0001), with 54% of participants achieving a perfect score. In conclusion, the targeted distribution of guideline printouts and visual aids, combined with small-group teaching sessions, were simple and effective ways of educating healthcare staff about the new standards of elective surgical care at the time of COVID-19. This could facilitate the safe restoration of surgical activity, which is critical in order to mitigate the far-reaching consequences of surgical delays on an unprecedented scale during a time of great crisis and uncertainty.

Keywords: COVID-19, elective surgery, NICE guidelines, quality improvement

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Authors: Qianhui Li, Christoph H. Bruecker

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Atherosclerotic plaques are typically found where flow separation and variations of shear stress occur. Although helical flow patterns and flow separations have been recorded in the aorta, their relation has not been clearly clarified and especially in the condition of artificial heart valve prostheses. Therefore, an experimental study is performed to investigate the hemodynamic performance of different mechanical heart valves (MHVs), i.e. the SJM Regent bileaflet mechanical heart valve (BMHV) and the Lapeyre-Triflo FURTIVA trileaflet mechanical heart valve (TMHV), in a transparent model of the human aorta under a physiological pulsatile right-hand helical flow condition. A typical systolic flow profile is applied in the pulse-duplicator to generate a physiological pulsatile flow which thereafter flows past an axial turbine blade structure to imitate the right-hand helical flow induced in the left ventricle. High-speed particle image velocimetry (PIV) measurements are used to map the flow evolution. A circular open orifice nozzle inserted in the valve plane as the reference configuration initially replaces the valve under investigation to understand the hemodynamic effects of the entered helical flow structure on the flow evolution in the aortic arch. Flow field analysis of the open orifice nozzle configuration illuminates the helical flow effectively delays the flow separation at the inner radius wall of the aortic arch. The comparison of the flow evolution for different MHVs shows that the BMHV works like a flow straightener which re-configures the helical flow pattern into three parallel jets (two side-orifice jets and the central orifice jet) while the TMHV preserves the helical flow structure and therefore prevent the flow separation at the inner radius wall of the aortic arch. Therefore the TMHV is of better hemodynamic performance and reduces the pressure loss.

Keywords: flow separation, helical aortic flow, mechanical heart valve, particle image velocimetry

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Authors: Faeze omid, Morteza Banakar

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Background: The COVID-19 pandemic has had a significant impact on global health and healthcare systems, including oral health. The lockdown measures implemented in many countries have led to changes in oral health behaviors, access to dental care, and the delivery of dental services. However, the extent of these changes and their effects on oral health outcomes remains unclear. This systematic review aims to synthesize the available evidence on the state of oral health after the COVID-19 lockdown. Methods: We conducted a systematic search of electronic databases (PubMed, Embase, Scopus, and Web of Science) and grey literature sources for studies reporting on oral health outcomes after the COVID-19 lockdown. We included studies published in English between January 2020 and March 2023. Two reviewers independently screened the titles, abstracts, and full texts of potentially relevant articles and extracted data from included studies. We used a narrative synthesis approach to summarize the findings. Results: Our search identified 23 studies from 12 countries, including cross-sectional surveys, cohort studies, and case reports. The studies reported on changes in oral health behaviors, access to dental care, and the prevalence and severity of dental conditions after the COVID-19 lockdown. Overall, the evidence suggests that the lockdown measures had a negative impact on oral health outcomes, particularly among vulnerable populations. There were decreases in dental attendance, increases in dental anxiety and fear, and changes in oral hygiene practices. Furthermore, there were increases in the incidence and severity of dental conditions, such as dental caries and periodontal disease, and delays in the diagnosis and treatment of oral cancers. Conclusion: The COVID-19 pandemic and associated lockdown measures have had significant effects on oral health outcomes, with negative impacts on oral health behaviors, access to care, and the prevalence and severity of dental conditions. These findings highlight the need for continued monitoring and interventions to address the long-term effects of the pandemic on oral health.

Keywords: COVID-19, oral health, systematic review, dental public health

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Authors: Neda Safari, Jacob Petersen-Perlman

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There are more than two million dams in the United States, and a considerable portion of them are either non-operational or approaching the end of their designed lifespan. However, this emerging trend is new, and the majority of dam sites have not undergone thorough research and assessments after their removal to determine the overall effectiveness of restoration initiatives, particularly in the case of large-scale dams that may significantly impact their surrounding areas. A crucial factor to consider is the lack of specific regulations pertaining to dam removal at the federal level. Consequently, other environmental regulations that were not originally designed with dam removal considerations are used to execute these projects. This can result in delays or challenges for dam removal initiatives. The process of removing dams is usually the most important first step to restore the ecological and biological health of the river, but often there is a lack of measurable indicators to assess if it has achieved its intended objectives. In addition, the majority of studies on dam removal are only short-term and focus on a particular measure of response. Therefore, it is essential to conduct extensive and continuous monitoring to analyze the river's response throughout every aspect. Our study is divided into two sections. The first section of my research will analyze the establishment and utilization of dam removal laws and regulations in the Condit Dam removal process. We will highlight the areas where the frameworks for policy and dam removal projects remain in need of improvement in order to facilitate successful dam removals in the future. In this part, We will review the policies and plans that affected the decision-making process to remove the Condit dam while also looking at how they impacted the physical changes to the river after the dam was removed. In the second section, we will look at the effects of the dam removal over a decade later and attempt to determine how the river's physical response has been impacted by this modification. Our study aims to investigate the Condit dam removal process and its impact on the ecological response of the river. We anticipate identifying areas for improvement in policies pertaining to dam removal projects and exploring ways to enhance them to ensure improved project outcomes in the future.

Keywords: dam removal, ecolocgical change, water related regulation, water resources

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Authors: Khaled Hesham Hyari, Amjad Almani

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Construction projects in the public sector are commonly awarded through competitive bidding. In the last decade, the Construction projects environment in the Middle East went through many changes. These changes have been caused by different factors including the economic crisis, delays in monthly payments, international competition and reduced number of projects. These factors had a great impact on the bidding behaviors of contractors and their pricing strategies. This paper examines the competition characteristics in public construction projects through an analysis of bidding results of contractors in public construction projects over a period of 6 years (2006-2011) in Jordan. The analyzed projects include all categories of projects such as infrastructure, buildings, transportation and engineering services (design and supervision contracts). Data for the projects were obtained from the General Tender’s Directorate in Jordan and includes 462 projects. The analysis performed in this projects includes, studying the bid spread in all projects as it is an indication of the level of competition in the analyzed bids. The analysis studied the factors that affect bid spread such as number of bidders, Value of the project, Project category and years. It also studying the “Signal to Noise Ratio” in all projects as it is an indication of the accuracy of cost estimating performed by competing bidders and bidder´s evaluation of project risks. The analysis performed includes the relationship between signal to noise ratio and different parameters such as project category, number of bidders and changes over years. Moreover, the analysis includes determining the bidder´s aggressiveness in bidding as it is an indication of competition level in such projects. This was performed by determining the pack price which can be considered as the true value of the project and comparing it with the lowest bid submitted for each project to determine the level of aggressiveness in submitted bids. The analysis performed in this project should prove to be useful to owners in understanding bidding behaviors of contractors and pointing out areas that needs improvement in preparing bidding documents. Also the project should be useful to contractors in understanding the competitive bidding environment and should help them to improve their bidding strategies to maximize the success rate in obtaining contracts.

Keywords: construction projects, competitive bidding, public construction, competition

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Authors: Reema Tiwari, U. C. Kulshrestha

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As a key regulator of atmospheric oxidative capacity and secondary aerosol formations, the signatures of reactive nitrogen (Nr) emissions are becoming increasingly evident in the cascade of air pollution, acidification, and eutrophication of the ecosystem. However, their accurate estimates in N budget remains limited by the photochemical conversion processes where occurrence of differential atmospheric residence time of gaseous (NOₓ, HNO₃, NH₃) and particulate (NO₃⁻, NH₄⁺) Nr species becomes imperative to their spatio temporal evolution on a synoptic scale. The present study attempts to quantify such interactions under tropical conditions when low anticyclonic winds become favorable to the advections from west during winters. For this purpose, a diurnal sampling was conducted using low volume sampler assembly where ambient concentrations of Nr trace gases along with their ionic fractions in the aerosol samples were determined with UV-spectrophotometer and ion chromatography respectively. The results showed a spatial gradient of the gaseous precursors with a much pronounced inter site variability (p < 0.05) than their particulate fractions. Such observations were confirmed for their limited photochemical conversions where less than 1 ratios of day and night measurements (D/N) for the different Nr fractions suggested an influence of boundary layer dynamics at the background site. These phase conversion processes were further corroborated with the molar ratios of NOₓ/NOᵧ and NH₃/NHₓ where incomplete titrations of NOₓ and NH₃ emissions were observed irrespective of their diurnal phases along the sampling transect. Their calculations with equilibrium based approaches for an NH₃-HNO₃-NH₄NO₃ system, on the other hand, were characterized by delays in equilibrium attainment where plots of their below deliquescence Kₘ and Kₚ values with 1000/T confirmed the role of lower temperature ranges in NH₄NO₃ aerosol formation. These results would help us in not only resolving the changing atmospheric inputs of reduced (NH₃, NH₄⁺) and oxidized (NOₓ, HNO₃, NO₃⁻) Nr estimates but also in understanding the dependence of Nr mixing ratios on their local meteorological conditions.

Keywords: diurnal ratios, gas-aerosol interactions, spatial gradient, thermodynamic equilibrium

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Authors: Salisu Gidado Dalibi, Sadiq Gumi Abubakar, JingChun Feng

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Nigeria’s population is about 190 million and is on the increase annually making it the seventh most populated nation in the world and first in Africa. This population growth comes with its prospects, needs, and challenges especially on the existing and future infrastructure. Infrastructure refers to structures, systems, and facilities serving the economy of a country, city, town, businesses, industries, etc. These include roads, railways lines, bridges, tunnels, ports, stadiums, dams and water projects, power generation plants and distribution grids, information, and communication technology (ICT), etc. The Nigerian government embarked on several infrastructural development projects (IDPs) to address the deficit as the present infrastructure cannot cater to the needs nor sustain the country. However, delivering such IDPs have not been smooth; comes with challenges from within and outside the project; frequent delays and abandonment. Thus, affecting all the stakeholders involved. Hence, the aim of this paper is to identify and assess the factors that are hindering the effective delivery of IDPs in Nigeria’s built environment with the view to offer more insight into such factors, and ways to address them. The methodology adopted in this study involves the use of secondary sources of data from several materials (official publications, journals, newspapers, internet, etc.) were reviewed within the IDPs field by laying more emphasis on Nigeria’s cases. The hindrance factors in this regard were identified which forms the backbone of the questionnaire. A pilot survey was used to test its suitability; after which it was randomly administered to various project professionals in Nigeria’s construction industry using a 5-point Likert scale format to ascertain the impact of these hindrances. Cronbach’s Alpha reliability test, mean item score computations, relative importance indices, T-test, Chi-Square statistics were used for data analyses. The results outline the impact of various internal, external and project related factors that are hindering IDPs within Nigeria’s built environment.

Keywords: built environment, development, factors, hindrances, infrastructure, Nigeria, project

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Authors: Asif Khaliq, Sayeeda A. Sayed

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The drug information centers provide drug related information to the requesters that include physicians, pharmacist, nurses and other allied health care professionals. The International Pharmacist Federation (FIP) describes basic functions of a drug and poison information centers as drug evaluation, therapeutic counseling, pharmaceutical advice, research, pharmaco-vigilence and toxicology. Continuous advancement in the field of medicine has expanded the medical literature, which has increased demand of a drug and poison information center for the guidance, support and facilitation of physicians. The objective of the study is to determine the need of drug and poison information centers in public and private hospitals of Karachi, Pakistan. A cross sectional study was conducted during July 2013 to April 2014 using a self-administered, multi-itemed questionnaire. Non Probability Convenient sampling was used to select the study participants. A total of 307 physicians from public and private hospitals of Karachi participated in the study. The need for 24/7 Drug and poison information center was highlighted by 92 % of physicians and 67% physicians suggested opening a drug information center at the hospital. It was reported that 70% physicians take at least 15 minutes for searching the information about the drug while managing a case. Regarding the poisoning case management, 52% physicians complaint about the unavailability of medicines in hospitals; and mentioned the importance of medicines for safe and timely management of patients. Although 73% physicians attended continued medical education (CME) sessions, 92 % physicians insisted on the need of 24/7 Drug and poison information center. The scarcity of organized channel for obtaining the information about drug and poisons is one of the most crucial problems for healthcare workers in Pakistan. The drug and poison information center is an advisory body that assists health care professional and patients in provision of appropriate drug and hazardous substance information. Drug and poison information center is one of the integral needs for running an effective health care system. Provision of a 24 /7 drug information centers with specialized staff offer multiple benefits to the hospitals while reducing treatment delays, addressing awareness gaps of all stakeholders and ensuring provision of quality health care.

Keywords: drug and poison information centers, Pakistan, physicians, public and private hospitals

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Authors: Subrata Sarkar

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The aerospace industry is experiencing a profound product development transformation driven by the powerful integration of digitalization and 3D printing technologies. This paper delves into the significant impact of this convergence on aerospace innovation, specifically focusing on developing jet pumps for fuel systems. This case study is a compelling example of the immense potential of these technologies. In response to the industry's increasing demand for lighter, more efficient, and customized components, the combined capabilities of digitalization and 3D printing are reshaping how we envision, design, and manufacture critical aircraft parts, offering a distinct paradigm in aerospace engineering. Consider the development of a jet pump for a fuel system, a task that presents unique and complex challenges. Despite its seemingly simple design, the jet pump's development is hindered by many demanding operating conditions. The qualification process for these pumps involves many analyses and tests, leading to substantial delays and increased costs in fuel system development. However, by harnessing the power of automated simulations and integrating legacy design, manufacturing, and test data through digitalization, we can optimize the jet pump's design and performance, thereby revolutionizing product development. Furthermore, 3D printing's ability to create intricate structures using various materials, from lightweight polymers to high-strength alloys, holds the promise of highly efficient and durable jet pumps. The combined impact of digitalization and 3D printing extends beyond design, as it also reduces material waste and advances sustainability goals, aligning with the industry's increasing commitment to environmental responsibility. In conclusion, the convergence of digitalization and 3D printing is not just a technological advancement but a gateway to a new era in aerospace product development, particularly in the design of jet pumps. This revolution promises to redefine how we create aerospace components, making them safer, more efficient, and environmentally responsible. As we stand at the forefront of this technological revolution, aerospace companies must embrace these technologies as a choice and a strategic imperative for those striving to lead in innovation and sustainability in the 21st century.

Keywords: jet pump, digitalization, 3D printing, aircraft fuel system.

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